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Biomedical subjects

D Bergqvist

Publications and source records attributed to D Bergqvist.

At least 199 records · Page 11Linked to original sources
PubMed1995

Intraplaque haemorrhage at carotid artery surgery--a predictor of cardiovascular mortality.

OBJECTIVE: To ascertain whether carotid intraplaque haemorrhage (IH) in patients undergoing carotid artery surgery is a predictor of increased cardiac mortality over a 5.5 year follow-up. DESIGN AND SUBJECTS: Carotid artery plaques were obtained at surgery from 47 consecutive patients (41 men, six women), median age 67 (range 48-81) years, with symptoms of carotid transient ischaemic attacks (TIAs) or carotid territory minor stroke. As determined at preoperative angiography, the degree of stenosis was 50-99%. Specimens were classified histologically as manifesting severe atherosclerosis, fibrous plaque, IH, or residual IH debris. SETTING: Medical Angiology and Vascular Surgery Units, Malmö General Hospital. INTERVENTION: Carotid endarterectomy. MAIN OUTCOME MEASURE: Correlation between mortality and IH. RESULTS: At follow-up after 5.5 years, mortality was 28% (13/47) overall, 92% (12/13) in the IH subgroup [of stroke (n = 1) or myocardial infarction (n = 11)], but only 3% (1/34), of pancreatic cancer, in the non-IH subgroup (P = 0.0001). Mortality was also significantly higher in the severe atherosclerosis than in the fibrous plaque subgroup, 39% (12/31) vs. 6% (1/16) (P = 0.044), but not significantly increased in any other subgroup (fibrous plaque, residual IH, TIA, minor stroke, or acetylsalicylic acid or anticoagulant treatment). No correlation existed between IH or death and haemoglobin value or platelet count. CONCLUSIONS: Evidence of recent IH seen at carotid artery surgery may be a marker of cardiovascular mortality. As IH was also found in a post-mortem control subgroup, the difference may be due to abnormality in blood components (e.g., coagulation factors) or impaired vessel-wall healing capacity (e.g. endothelial dysfunction).

Aged↗
PubMed1995

Influence of haemorrhage and blood transfusion on haemostasis. An experimental study in rabbits.

The influence of haemorrhage and blood transfusion on primary haemostasis, coagulation and fibrinolysis was investigated in rabbits. Acute loss of 20% of the blood volume gave a significantly shortened coagulation time (Lee-White method) but no detectable change in fibrinolysis (euglobulin clot lysis time) and primary haemostasis (primary haemostatic plug formation time in transected arterioles in rabbit mesenteric microcirculation). Acute loss of 20% of blood volume followed by blood transfusion resulted in a prolonged coagulation time and also in a prolonged primary haemostatic plug formation time, but no change in fibrinolysis. It could be concluded that the haemorrhage did not affect the platelet-dependent primary haemostasis but resulted in a shortened coagulation time. Blood transfusion seemed to affect adversely both the primary haemostasis and the shortened coagulation time induced by haemorrhage.

Animals↗
PubMed1995

Comparative analysis of patency, limb salvage and survival in diabetic and non-diabetic patients undergoing infrainguinal bypass surgery.

In 92 diabetic and 175 non-diabetic patients undergoing 336 femoropopliteal or femorodistal bypass procedures, 1- and 3-year cumulative life-table patency, limb salvage, and survival rates were comparatively analysed. The peroperative mortality rate was significantly higher in diabetic patients (5% compared to 1.4%, p < 0.001). The cumulative graft patency rates were 61% at 12 months and 46% at 36 months in diabetic patients compared to 64 and 52% in non-diabetic patients. Significantly better patency rates were observed in limbs with good runoff compared to limbs with poor runoff in both groups. The limb salvage rates at 3 years were 70% in diabetic patients and 62% in non-diabetic patients. The survival rate at 3 years was significantly lower in diabetic patients, 62% compared to 86% in non-diabetic patients. Diabetic patients with poor runoff demonstrated a significantly lower survival rate after 36 months compared to diabetic patients with good runoff (48% and 74%, respectively). The results of this study demonstrate that the early and intermediate patency and limb salvage rates are similar in diabetic and non-diabetic patients. On the other hand the survival rate in diabetic patients, especially in those with poor distal runoff, is significantly lower than non-diabetic patients.

Aged↗
PubMed1995

Platelet count, antiplatelet therapy and pulmonary embolism--a prospective study in patients with hip surgery.

Pulmonary embolism (PE) is a serious complication following hip surgery. Trials of antiplatelet thromboprophylaxis indicated a substantial reduction in PE rate, and we prospectively studied the effect of a combination of low-dose heparin and two different antiplatelets. Furthermore, our experience in previous studies suggested that platelet count (PC) levels could be useful to reliably suspect PE at a very early stage, and we prospectively tried to confirm our previous findings. Ours is a prospective study in 459 consecutive patients operated on because of hip fracture (265) or elective hip replacement (194), aimed to determine: 1) whether the benefits of antiplatelets plus heparin on PE outweigh the risks; 2) to assess the clinical usefulness of PC monitoring in these patients, so as to confirm whether PE could be recognized early. It was a prospective, randomized, double-blind study. All patients received unfractioned heparin (7500 IU sc twice daily, starting 2 h before operation). In addition, they received aspirin (200 mg thrice daily, with meals), Triflusal (300 mg thrice daily, with meals), or placebo. Real time B-mode ultrasonography (US) was performed on all patients on the 8-9th day after surgery. Venography was performed in patients with normal US, if clinical symptoms suggested venous thrombosis. Twelve out of the 459 patients (2.6%) had to discontinue prophylaxis, because of major bleeding (6 patients), or gastric intolerance (6 patients). There were no significant differences between groups in either deep vein thrombosis (26 patients (18%) with aspirin, 18 (12%) with Triflusal, 26 (17%) with placebo), or PE development (7 patients (5%) with aspirin, 3 (2%) with Triflusal, 8 (5%) taking placebo).(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1995

Long-term follow-up of autologous vein grafts. 40 years after reconstruction for cystic adventitial disease.

Long term follow-up (38-41 years postoperatively) has been undertaken in three patients who were initially operated on with autologous reversed vein grafts due to cystic adventitial disease of the popliteal artery. The patients were evaluated clinically as well as with colour coded ultrasonography and phase-locked echo-tracking ultrasonography. One vein graft was occluded, the others were patent, without dilatation and with a compliance similar to that in the femoral artery. Autologous vein grafts below the groin are very durable.

Adult↗
PubMed1995

Inhibition of heparin-resistant microarterial thrombosis by recombinant hirudin: a specific thrombin inhibitor.

The effects of heparin boluses comparable with those commonly used during angioplasty procedures were compared with equal gravimetric doses of recombinant desulfatohirudin (CGP 39393) in a rabbit model of microarterial thrombosis. Seven-millimeter segments of the central arteries of the ears were isolated between microvascular clamps and subjected to arteriotomy and deep vessel wall trauma. Arteriotomies were closed with continuous 10-0 sutures. Five minutes before vascular reperfusion (opening of vascular clamps), boluses of heparin (1.00 mg/kg), hirudin (1.00 mg/kg), hirudin (0.25 mg/kg), or vehicle (saline) were administered to groups of 10 rabbits in a blind, random fashion. Neither agent prolonged arteriotomy bleeding times relative to vehicle. All active agents significantly increased patency rates versus vehicle at 30 minutes after reperfusion, though reduced vessel patency was noted in a substantial portion of vessels in the groups receiving 0.25 mg hirudin or 1.00 mg/kg heparin. Patency rates at 120 minutes were only improved by the 1.00 mg/kg hirudin dose, and in accord, thrombus weights were significantly reduced only by the 1.00 mg/kg dose of hirudin. In contrast, the anticoagulant response (measured as the activated partial thromboplastin time and anti-IIa and anti-Xa activities) was considerably more pronounced and of longer duration after administration of heparin and hirudin. This is consistent with the hypothesis that the inactivation of clot-bound thrombin that is produced by specific thrombin inhibition (hirudin) but not by cofactor-mediated thrombin inhibition (heparin) is of pivotal importance in achieving a profound and sustained antithrombotic effect following vascular trauma. While heparin boluses seem to be of doubtful value, hirudin seems a promising strategy in context with angioplasty procedures.

Animals↗
PubMed1995

Hydrotherapy of patients with intermittent claudication: a novel approach to improve systolic ankle pressure and reduce symptoms.

OBJECTIVE: To study the effects of alternating cold and hot water therapy on walking ability and systolic blood pressure in claudicants. EXPERIMENTAL DESIGN: A prospective case study with repeated measurements before and 1, 4 and 12 months after treatment. The systolic blood pressure levels were measured with an occlusion cuff for brachial and ankle and with a strain gauge for the first toe. STUDY POPULATION: Twenty consecutively included patients, 11 women and 9 men; mean age 73.9 yrs, with intermittent claudication according to clinical examination and ankle-arm systolic blood pressure (AAI) below 0.90. INTERVENTION: Alternate hot and cold hydrotherapy of the legs were given at ten 25-minute treatments during a three-week period. The outcome measures were maximal walking ability (MW), walking ability before pain (PW) and systolic blood pressures of toe, ankle, arm and AAI. RESULTS: Fourteen patients (70%) reported reduced pain after treatment and their PW increased from 134 +/- 29 m to 415 +/- 119 m 12 months later (p < 0.05) and the MW in the total group increased form 348 +/- 75 m to 523 +/- 103 m. Systolic blood pressure increased in right ankle and toe one month after treatment in the total group. Among those who reported improved walking ability one year after treatment, systolic blood pressure in both right and left ankles and toes increased; e.g. right toe increasing from 72 +/- 7 to 86 +/- 2 (p < 0.001). Improvements of systolic blood pressure in left and right leg and changes of walking ability were correlated, in the order of 0.60 to 0.81, p < 0.05. CONCLUSIONS: Showering the legs of claudicants improved walking ability and blood pressures which sustained up to 1-year later. This therapy might be an additional alternative to conservative treatment of intermittent claudication.

Aged↗
PubMed1994

Prevention of experimental venous thrombosis in rabbits with low molecular weight heparin, dextran and their combinations, administered before or during induction of venous endothelial trauma.

An in vivo experimental venous thrombosis model based on endothelial damage and flow reduction was used to investigate the effect of low molecular weight heparin (LMWH) alone and in combination with dextran and the effect of surgical and endothelial trauma on thrombus formation, formation of occlusive thrombi and thrombus weights. Five groups with 15 rabbits in each were studied. Two groups received dalteparin (50 anti-Xa IU/kg i.v.) before surgical trauma or after, during the endothelial trauma and two groups received dalteparin (50 anti-Xa IU/kg i.v.) with dextran 70 (1 g/kg i.v.) before surgical trauma or after, during the endothelial trauma. Compared to a control group (saline) all treatment regimes reduced significantly the frequency of thrombosis and occlusive thrombi as well as thrombus weights. No significant difference was observed between the identical treatment groups when the substances were introduced before respective after surgical trauma. It is concluded, from the present study that thromboprophylaxis with LMWH in this particular in vivo model, given before or after surgical trauma is equally effective. Dextran has a certain augmenting thromboprophylactic effect when added to LMWH in this model.

Animals↗
PubMed1994

Deep venous thrombosis and occult malignancy: an epidemiological study.

OBJECTIVE: To determine the risk of subsequent cancer in patients with deep venous thrombosis confirmed by venography. DESIGN: Follow up of all patients who had venography for suspected deep venous thrombosis during 1984-88. Patients were traced through a cancer registry up to 1 January 1991. SUBJECTS: 4399 patients who had phlebography in one hospital. SETTING: General hospital in Malmö, Sweden, serving a population of 230,000. MAIN OUTCOME MEASURE: Number of cancers recorded. RESULTS: 4399 patients had venography for suspected deep venous thrombosis; 604 were known to have a malignancy at the time of venography and were excluded from further analysis. 1383 had deep venous thrombosis, 150 of whom subsequently developed cancer. 182 of the 2412 patients without thrombosis developed cancer. During the first six months after venography 66 patients with thrombosis developed malignancy compared with 37 patients without thrombosis (P < 0.0001). 38 of the cancers in the deep venous thrombosis group were detected by history, physical examination, and laboratory tests. Three patients had postoperative or post-traumatic deep venous thromboses. Only two of the remaining patients would have benefited from early detection by extensive screening. After six months the incidence of cancer was identical in patients with and without thrombosis. CONCLUSION: Deep venous thrombosis is associated with a significantly higher frequency of malignancy during the first six months after diagnosis. Malignancies can be found with simple clinical and diagnostic methods and extensive screening is not required.

Adult↗
PubMed1994

Venous and non-venous leg ulcers: clinical history and appearance in a population study.

In a defined Swedish population of 270,800, all patients with current chronic leg ulcers (827) were identified and a random sample of 382 studied in detail. Ulcers of primarily venous cause comprised 54 per cent of the total, giving a point prevalence of 0.16 per cent (95 per cent confidence interval 0.15-0.18 per cent). Half of all patients experienced their first ulcer episode before the age of 65 years, a greater proportion (61 per cent, P < 0.0001) in the subgroup with venous ulcers. The median duration of ulcer diathesis was significantly longer in patients with venous than in those with non-venous lesions (13.4 versus 2.5 years, P < 0.001). About half the patients with venous and non-venous ulcers had had their current lesion for longer than 1 year. Venous ulcers were more often recurrent than those of non-venous type (72 versus 45 per cent of patients, P < 0.0001). Patients with venous ulcers had a significantly higher body mass index (P < 0.001). The number of dressing changes performed per week was 1100 per 100,000 population. The predictive value of 'classical' clinical indicators of venous ulcer did not exceed 0.76. To increase the accuracy of diagnosis of venous ulcer, clinical examination should be combined with non-invasive 'objective' haemodynamic assessment of the venous circulation.

Adolescent↗
PubMed1994

Long-term results of arterial reconstruction of the upper extremity.

Arterial reconstructive surgery for upper limb ischaemia of non-traumatic non-embolic origin is uncommon in comparison to that of the lower extremities and long-term follow-ups are rare. Forty-eight patients (27 females, 21 males) with a median age of 58 years (range 22-88) were retrospectively analysed for risk factors, survival and patency rates. Seventy-three per cent were smokers, 42% had hypertension and 33% had had previous vascular interventions. Diabetes was only seen in 4% of the cases. Effort fatigue was the dominant cause for surgery followed by micro-embolism and rest pain or gangrene. The left side was more frequently affected with 30 procedures compared to 18 on the right. Bypass with either Dacron, ePTFE or autologous vein was the most frequent procedure in 56% of the cases followed by thrombendarterectomy (23%) and subclavio-carotid transposition (11%). Arm-arm index rose from 0.63 (SD 0.28) preoperatively to 1.02 (SD 0.12) after 1 month and at the end of follow-up (median 75 months) it was 0.96 (SD 0.15). Cumulative survival rates were at 1 month 98%, 1 year 91%, 5 years 81% and at 10 years 73%. Cumulative primary patency rates at the same intervals were 96, 96, 88 and 80%, respectively. Thus the survival rate and patency rate are favourable in comparison with arterial surgical procedures of the lower extremity.

Adult↗