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Biomedical subjects

D Bergqvist

Publications and source records attributed to D Bergqvist.

At least 325 records · Page 18Linked to original sources
PubMed1991

A population based screening of abdominal aortic aneurysms (AAA).

The prevalence of abdominal aortic aneurysm (AAA) in a defined population of elderly men and its correlation to some risk factors were studied in the population cohort "men born in 1914 from Malmö". A total of 499 were invited to attend and 375 (75%) did so. The aorta could be visualised with ultrasound in 364 patients, 39 (10.7%) of whom had aneurysmal changes. The presence of an AAA was related to the findings at a general health examination undertaken 5 years previously. Tobacco and alcohol consumption, impaired lung function and a history of angina pectoris were related to the presence of an AAA. No relationship was found between an AAA and hypertension, hyperlipidaemia or hyperglycaemia. A decreased tissue elasticity as a common denominator for the lung function impairment and development of AAA is discussed.

Aged↗
PubMed1991

Abdominal aortic aneurysm with perianeurysmal fibrosis: experience from 11 Swedish vascular centers.

Case records of 2026 patients operated on because of abdominal aortic aneurysms from 11 Swedish Vascular Centers were reviewed and revealed 98 cases (4.8%) of inflammatory abdominal aortic aneurysm. Also included in this case-control study was an analysis of a randomized group of 82 patients from the same centers who had noninflammatory abdominal aortic aneurysms. Four inflammatory aneurysms were ruptured, compared with 16 in the noninflammatory group (p less than 0.01). A higher proportion of patients with inflammatory abdominal aortic aneurysms had symptoms that led to radiographic investigations. The median erythrocyte sedimentation rate was 39 mm versus 19 mm (26% of patients with inflammatory abdominal aortic aneurysms had erythrocyte sedimentation rates greater than 50 mm; p less than 0.001), and the serum creatinine level was increased in 27 and 8 patients (p less than 0.01) in the inflammatory and noninflammatory groups, respectively. Preoperative investigations revealed ureteral obstruction in 19 patients with inflammatory abdominal aortic aneurysms, of whom 12 had preoperative nephrostomy or ureteral catheter placement. At operation, 20 additional patients exhibited fibrosis around one or both ureters. Although ureterolysis was performed in 19 patients, preoperative and postoperative creatinine levels did not differ between these patients and the conservatively treated ones. Duration of surgery (215 vs 218 minutes), intraoperative blood loss (2085 vs 2400 ml) and complications did not differ significantly between the groups. Overall operative (30-day) mortality was equal (11% vs 12%) but was increased for patients undergoing elective surgery for inflammatory abdominal aortic aneurysms (9% vs 0%; p = 0.03).(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1991

No transplacental passage of standard heparin or an enzymatically depolymerized low molecular weight heparin.

In 21 women who had an abortion by hysterotomy between the 15th and 23rd week of pregnancy, the possibility that unfragmented heparin or low molecular weight heparin (LMWH) passed the placental barrier to the foetus was studied. Laboratory analyses included amidolytic assays of factor Xa inhibitory activity (XaI), antithrombin III (ATIII) and a direct measurement of heparin-like substances in plasma with a competitive binding assay. The ATIII concentration in foetal plasma was about 20% of that in normal human plasma and varied considerably between individuals (2-27%). The XaI activity did not differ between the two treated groups, but the mean XaI activity of the combined groups differed from zero (P less than 0.05). If the XaI activity was corrected for the ATIII concentration, the heparin activities no longer differed significantly from zero. As the concentration of heparin-like substances were above the detection limit (0.35 microgram/ml) in 6/16 analysable samples of foetal plasma, a further 15 women who had not received any heparin were included as controls. In 12/14 analysable foetal plasmas heparin-like substances in concentrations above 0.35 micrograms/ml could be detected. Determination of heparin activity in foetal plasma is thus difficult due to the influence of endogenous ATIII on heparin assays. In conclusion, this study did not demonstrate any evidence for the passage of heparin or LMWH across the placental barrier. No differences were detected whether unfragmented heparin or LMWH had been given to the mothers. Our results also indicate the presence of an endogenous glycosaminoglycan in foetal plasma.

Adolescent↗
PubMed1991

The influence of surgical trauma on factor XaI and IIaI activity and heparin concentration after a single dose of low-molecular-weight heparin.

To study the influence of surgical trauma on the XaI and IIaI activity after injection of a low-molecular-weight heparin (LMWH) 24 patients undergoing elective cholecystectomy received one subcutaneous injection of the LMWH Fragmin. Each group of eight patients received either 2,500 or 5,000 XaI U 2 h before operation or 5,000 XaI U 10 h before surgery. For comparison an additional eight patients received 5,000 IU unfragmented heparin (UH) before operation. Laboratory analyses included amidolytically measured XaI- and IIaI-activities and direct measurements of heparin. Dose-dependent increase in the XaI- and IIaI-activity with maximal levels about 3-4 h after injection was seen. Patients given the LMWH 2 h before operation had lower levels of XaI-activity 2 h after injection than those receiving it 10 h before surgery, despite the same dose given. This correlated with the heparin concentrations, where the highest concentration was measured in patients given the LMWH 10 h before surgery. In conclusion, the surgical trauma of a cholecystectomy does not seem to have any major influence on the XaI- or IIaI-activity after administration of the studied LMWH. Alterations of the absorption and/or elimination rates cannot, however, be ruled out, but are related to factors other than the operative trauma per se, such as effects of premedication or circadian rhythmic variations.

Adult↗
PubMed1991

Chronic leg ulcers: an underestimated problem in primary health care among elderly patients.

STUDY OBJECTIVE: The aim was to establish leg ulcer point prevalence, basal patient characteristics, and level of caretaking. DESIGN: The study was a postal cross sectional survey. The validity was ensured by examining a randomly selected sample of reported patients. Responding health care officials were asked to report all patients with an open wound below knee (including foot ulcer) which did not heal or was supposed to heal within a six week period after onset of ulceration. Response rate was 92%. SETTING: Inpatient and outpatient care in hospitals, community health care, and private nursing homes within Skaraborg county, with a population of 270,800. PARTICIPANTS: 827 individual patients were found with active leg ulcers, 526 women and 301 men. MEASUREMENTS AND MAIN RESULTS: Age adjusted sex ratio of ulcer patients was 1:1.4 (M:F). The median age was 78 years for women and 76 for men; 700 patients (85%) were older than 64 years. The point prevalence for active leg ulcers was 3.0/1000 total population. District nurses provided care for 680 patients (82%), 106 (13%) were in hospital care, and 41 (5%) were managed by outpatient departments. CONCLUSIONS: There has been an underestimation of the leg ulcer problem among elderly patients, especially men. With an expected increasing number of elderly people it is important that this problem is recognised and measures taken to improve the primary care of these patients.

Adolescent↗
PubMed1991

Lower-limb vasospasm and renal failure during postoperative thromboprophylaxis. Case report.

In a 73-year-old woman with trimalleolar fracture, secondary acute ischemia of the limb and renal failure developed in association with heparin-dihydroergotamine thromboprophylaxis. Earlier cases of thromboprophylaxis-related angiospasm are briefly reviewed. The condition is infrequent, but trauma of extremities and shock are risk factors. Renal failure is rare.

Acute Kidney Injury↗
PubMed1991

Accessory nerve injury after carotid endarterectomy. Case report.

Although cranial nerve injuries associated with carotid endarterectomy are well known, involvement of the accessory nerve is extremely rare. A case of partly reversible accessory nerve injury is described. Hitherto published cases are analyzed and possible pathogenetic mechanisms discussed.

Accessory Nerve Injuries↗
PubMed1991

Pulmonary embolism and mortality in patients with fractured hips--a prospective consecutive series.

To find out the causes of death with particular reference to venous thromboembolism all patients being operated on for hip fractures who were taking part in a trial of two methods of prophylaxis against thromboembolism were consecutively and prospectively registered. A total of 806 patients were included, 66 of whom died within three months (8%). The necropsy rate was 64%. The patients who died were significantly older than those who did not. Pulmonary emboli were diagnosed in 17 of the 42 necropsies: 3 fatal, 5 contributory, and 9 incidental. The patients with fatal and contributory emboli died a median of 31 days postoperatively. In the 24 patients who did not have necropsies the clinical cause of deaths were cardiac insufficiency (n = 11), pneumonia (n = 8), pulmonary embolism (n = 2), and myocardial infarction, cerebral infarction, and pancreatic cancer (n = 1 each). The incidence of fatal pulmonary embolism therefore varies between a minimum of 0.37% and a theoretical maximum of 3.3%. In conclusion, fatal pulmonary embolism after operations for fractured hips is low where routine thromboprophylaxis is used. Most patients who develop large pulmonary emboli are old but live independently. To study causes of death a high necropsy rate is essential.

Adult↗
PubMed1991

Thromboprophylaxis in patients with hip fractures: a prospective, randomized, comparative study between Org 10172 and dextran 70.

A prospective, randomized, assessor-blind trial has been undertaken to compare the thromboprophylactic effect and safety of the heparinoid Org 10172 (a mixture of low molecular-weight sulfated glycosaminoglycuronides) and dextran 70 in patients operated on for hip fracture. Prestudy biostatistical calculations led to the need for 260 patients. Three hundred eight patients were randomized and 19 were excluded after randomization, the majority because of postponed surgery. Analyses were made on the 289 patients on an intention-to-treat basis, as well as on the 247 patients given correct prophylaxis. Diagnosis of deep vein thrombosis was based on bilateral ascending phlebography on postoperative days 10 through 12. The frequency of deep vein thrombosis on an intention-to-treat basis was 10% in the Org 10172 group and 30% in the dextran 70 group and, on the basis of correct prophylaxis, 12% and 31%, respectively, both differences being significant (p less than 0.001). Two-month mortality rates were equal in the groups. Three fatal pulmonary emboli were seen in the dextran group. Significantly more patients in the dextran group received postoperative transfusions; no other differences in various hemorrhagic parameters were seen. Thus it can be concluded that Org 10172 has a significantly better thromboprophylactic effect than does dextran in patients with hip fractures without significant side effects.

Aged↗
PubMed1991

Leg ulcer etiology--a cross sectional population study.

Three hundred eighty-two patients with active leg ulcers were clinically examined after random selection out of a population of 827 patients identified within a previous cross-sectional population survey. Bidirectional Doppler ultrasonography was used for objective assessment of arterial and venous circulation. The purpose was to register causative factors and the etiologic spectrum. Venous insufficiency was present in 332 (72%) of 463 legs with active ulceration; deep insufficiency occurred in 176 (38%), and purely superficial insufficiency was present in 156 (34%). Ankle/brachial index was 0.9 or less in 185 (40%) of ulcerated legs. Venous insufficiency was the dominating causative factor in 250 legs (54%), of which 60% was the result of deep venous insufficiency. Arterial insufficiency was judged to be the possible dominating factor in 12%, and 6% showed clearly ischemic ulcers. Mixed ulcers with combined arterial and venous insufficiency were found to be common as were patients with diabetes and arterial impairment. In 10% of the legs a multifactorial origin was present, and in 10% no venous or arterial impairment was detectable. Thus after classification of causes 40% of all ulcerated legs showed potentially surgically curable circulatory disturbances. It is necessary to objectively assess all patients with chronic leg ulcers to be able to detect patients with potentially surgically curable disease.

Adolescent↗
PubMed1991

Acute lower limb ischemia: failure of anticoagulant treatment to improve one-month results of arterial thromboembolectomy. A prospective randomized multi-center study.

The value of short-term anticoagulant treatment in improving the early outcome in patients operated on for acute lower-limb ischemia has been debated and so far unproven. In this prospective randomized multi-center study, 188 such patients were randomized on admission, either to preoperative and postoperative anticoagulant medication (AC group, n = 94) or no anticoagulant treatment during the first month after surgery (O group, n = 94). Background factors were evenly distributed in the two groups, and 89% of the cases were considered as embolic. Analysis on an intention-to-treat basis showed no differences in outcome after 30 days. Good results, survivors who had amputation, and patients who died in the two groups are given respectively: AC group, 61%, 9%, 30%; O group, 65%, 11%, 24%. The results were similar in the two treatment groups also if only patients with a cardiac source of embolism were analyzed. Local bleeding complications were more common in the AC group (17% vs 2%, p less than 0.01). It is concluded that preoperative and early postoperative anticoagulant medication should not be routinely administered since such treatment is unlikely to improve the short-term results of lower-limb arterial thromboembolectomy while bleeding complications increase. The possible value of late (beyond 1 month) long-term anticoagulant treatment remains to be studied.

Amputation, Surgical↗
PubMed1990

The use of fibrinogen uptake test in screening for deep vein thrombosis in patients with hip fracture.

255 hip fracture patients were studied by 125I-fibrinogen uptake test and bilateral phlebography. We found the sensitivity of fibrinogen scanning to be 44% for the non-operated limb and 50% for the calves. The predictive value of a negative result was found to be 92% and 93% respectively. We conclude that the use of fibrinogen uptake test as single diagnosticum is not valid and can only be recommended in combination with phlebography when studying patient where the frequency of DVT is expected to be low.

Fibrinogen↗
PubMed1990

[Management of visceral aneurysm].

In the article we discuss our experience in dealing with visceral aneurysms at Malmö General Hospital during the period, 1971-85. Of the total of 25 patients diagnosed, eight had ruptured aneurysms, six underwent elective surgery, and 11 underwent no surgical intervention. Of the aneurysms found, nine were of the splenic artery, five of the superior mesenteric artery and its branches, three of the pancreaticoduodenal artery, two of the celiac artery, and one of the gastroduodenal artery. There was no mortality either among patients undergoing surgery, or from complications among those treated conservatively without surgery.

Aged↗
PubMed1990

Effects of plasma on PGI2 release from prolonged perfused canine veins.

Prostacyclin release from endothelial cells in culture appears increased by the presence of plasma, but occurrence of a similar phenomenon in intact vessels has not been established. In the present investigation release of 6-keto-PGF1 alpha, the stable breakdown product of prostacyclin, was quantitated from canine veins perfused ex vivo for 15 minute periods, using three different perfusates: 1) Hank's balanced salt solution (HBSS), 2) 20% platelet poor plasma (PPP) derived from heparinized blood, in HBSS, and 3) 20% PPP in HBSS with added arachidonic acid (AA). No differences in initial 6-keto-PGF1 alpha release existed among the three perfusates. However, PPP and PPP + AA solutions were associated with lesser declines in release, than occurred with HBSS alone, these differences being statistically significant after 60 min of perfusion (p less than 0.05). When PPP derived from heparinized and citrated blood rather than from only heparinized blood was used, there was a significantly lower release of prostacyclin (p less than 0.05). The latter may be due to citrate binding of calcium. These data indicate that autologous plasma does not alter initial prostacyclin release from freshly harvested canine veins, but that it weakens the decline in release usually following prolonged periods of perfusion.

Animals↗