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Biomedical subjects

D Bergqvist

Publications and source records attributed to D Bergqvist.

At least 37 records · Page 2Linked to original sources
PubMed2004

Incidence of acute thrombo-embolic occlusion of the superior mesenteric artery--a population-based study.

OBJECTIVE: To determine the incidence of acute thrombo-embolic occlusion of the superior mesenteric artery (AOSMA) in a population-based study. MATERIAL: All clinical (n=23,446) and forensic (n=7569) autopsies performed in the city of Malmö between 1970 and 1982 (population 264,000-230,000 inhabitants). The autopsy rate was 87%. METHODS: Calculation of the incidence of AOSMA with intestinal gangrene in those autopsies coded for bowel ischaemia (997/23,446 clinical and 9/7569 forensic autopsies). The operative procedures performed in 1970, 1976 and 1982 were also analysed. RESULTS: Two forensic and 211 clinical autopsies demonstrated AOSMA with intestinal gangrene. Previous suspicion of intestinal ischaemia was noted in only 33%. Sixteen patients were operated. The cause-specific mortality was 6.0/1000 deaths. The incidence was 8.6/100,000 person years, increasing exponentially with age (p<0.001). Mortality was 93%. CONCLUSIONS: The incidence and mortality of AOSMA is higher than previously reported from clinical series. There is seldom any suspicion of the diagnosis prior to death.

Adult↗
PubMed2004

Recurrent varicose veins: incidence, risk factors and groin anatomy.

OBJECTIVES: To investigate the recurrence rate after sapheno-femoral junction (SFJ) ligation and great saphenous vein (GSV) stripping for varicose veins (VV), to evaluate risk factors for recurrence and to classify the anatomy of the recurrence in the groin. Design. Clinical follow-up study. METHODS: Eighty-nine consecutive patients with 100 operated legs were re-examined clinically and with duplex after 6-10 years. Fourteen groins were re-explored, 13 after varicography. The anatomy in the groin was classified according to the Edinburgh system. The original medical records were examined to check for risk factors which could lead to a recurrence. RESULTS: Fifty-seven legs had incompetent veins in the groin according to duplex. In 54 of them, it was possible to define whether the incompetent veins emanated from the former SFJ. Varicography and operative findings correlated well to duplex. The main difficulty was to distinguish neovascularization from residual branches. No significant risk factor for recurrence was found in the medical records. CONCLUSIONS: Recurrence of VV after SFJ ligation is common irrespective of perioperative difficulties or the surgeon's experience. The anatomy of recurrence in the groin is difficult to classify according to the Edinburgh system mainly because neovascularization is difficult to verify.

Adult↗
PubMed2004

Local haemodynamic changes during carotid endarterectomy--the influence on cerebral oxygenation.

OBJECTIVES: To characterize carotid bifurcation haemodynamics and cerebral oxygenation during clamping and at reperfusion after carotid endarterectomy (CEA). MATERIALS AND METHODS: Sixty-two patients with a symptomatic high-grade stenosis of the internal carotid artery (ICA), who underwent CEA under general anaesthesia, were studied prospectively. Measurements of stump-pressure, volume flow (transit time flowmetry) and changes in cerebral oxygenation (near-infrared spectroscopy (NIRS)) were performed. Selective shunting was based on stump pressure only. RESULTS: Stump pressure correlated with both ICA flow before clamping (r=0.45; p=0.03) and changes in cerebral oxygenation (rSO2) during clamping (r=0.61; p=0.002), the latter was reversed by shunt placement. ICA flow before clamping also correlated with changes in rSO2 during clamping (r=0.41; p=0.01). CONCLUSION: Measurements with transit time flowmetry and cerebral oximetry are technically easy and help to determine the need for selective shunting during CEA. High ICA flow before clamping in combination with a low stump pressure usually indicates the need for a shunt. Volume flow measurements may also be useful in the quality assessment of the CEA.

Aged↗
PubMed2004

Risk factors for complications after carotid endarterectomy--a population-based study.

OBJECTIVES: The overall benefit of carotid endarterectomy (CEA) is dependent on the outcome from the procedure. However, many reports are from selected centres and not population-based. The aim of this study was to assess the 30-day complication rate for a whole country and also to determine independent risk factors for serious complications. MATERIALS AND METHODS: One thousand five hundred and eighteen CEA were retrospectively reviewed, covering principally all the CEAs in Sweden, during a three year period. Indications for surgery were; minor stroke 34%, TIA 34%, amaurosis fugax 18%, asymptomatic 11% and others 3%. Data were collected from the Swedish Vascular Registry (Swedvasc). Combined cohort and case-control methodology was used. RESULTS: Registered complications were; 43 permanent strokes, 32 transient strokes (<30 days), 18 TIA/amaurosis fugax and 22 deaths (seven fatal stokes). In the cohort study, the 30-day permanent stroke and death rate were 4.3% (65/1518). Significant risk factors in multivariate analyses were the indication for surgery (minor stroke vs. other indications) (p=0.02, RR=1.38), diabetes (p=0.02, RR=1.41), cardiac disease (p<0.01, RR 1.43) and operation at a university hospital (p=0.02, RR=1.39). In the case-control study comparing the 65 cases of permanent stroke and/or death with 130 matched controls the only significant risk factor was contralateral occlusion (p<0.01, OR=5.27). One patient (1/130) with a permanent stroke was wrongly reported as a local neurological complication (facial paresis). CONCLUSION: This national audit demonstrated population-based data on complication rates after CEA well comparable with previous randomised trials. The validity of the Swedvasc data was confirmed. Combined cohort and case-control methodology was useful in analysing risk factors for serious perioperative complications.

Aged↗
PubMed2002

Renal hemodynamics during carbon dioxide pneumoperitoneum: an experimental study in pigs.

BACKGROUND: Laparoscopic living donor nephrectomy is increasingly being performed, although the effects of carbon dioxide pneumoperitoneum (CO2 PP) on renal function and hemodynamics and the levels of vasopressin are not well studied. METHODS: Renal blood flow, renal venous pressure, urine output, and vasopressin concentrations in renal venous blood were measured in pigs subjected to 12 mmHg of CO2 PP for 150 min. RESULTS: Renal blood flow was decreased at induction of PP and increased during the first 30 min after exsufflation. Renal venous pressure was increased during PP. There was indirect evidence of a decrease in urine output during PP. No changes in renal venous vasopressin concentrations were seen. CONCLUSION: A CO2 PP of 12 mmHg causes changes in renal hemodynamics and urine output. No changes in vasopressin levels were seen in this pig model, suggesting that other explanations for the observed changes must be sought.

Animals↗
PubMed2002

Revascularization of the superior mesenteric artery after acute thromboembolic occlusion.

BACKGROUND: The outcome and prognostic factors after revascularization of acute thromboembolic occlusion of the superior mesenteric artery (SMA) are poorly documented. METHODS: Sixty patients with acute thromboembolic occlusion of the SMA had revascularization procedures at 21 hospitals from 1987 to 1998. They were registered prospectively in the Swedish Vascular Registry. Patient files were analysed retrospectively. RESULTS: The median age of the patients was 76 years; 73 per cent suffered from cardiac disease and 23 per cent had previous vascular surgery. Onset of symptoms was classified as sudden (30 per cent), acute (33 per cent) or insidious (37 per cent). The occlusions were thought to be either embolic (67 per cent) or thrombotic (33 per cent). The diagnosis was suspected on first examination in 32 per cent of patients, a group whose median time to operation was shorter (P = 0.01). Fifty-eight patients had an exploratory laparotomy and subsequent revascularization, and two were treated with thrombolysis alone. Second-look laparotomy was performed in 41, and third look in eight patients; 19 required an additional bowel resection. The overall mortality rates were 43, 52, 60 and 67 per cent at 30 days, discharge, 1 and 5 years, respectively. No patient was dependent on intravenous nutrition after 1 year. Previous vascular surgery resulted in a higher institutional mortality rate (79 per cent; P = 0.02). Patients who had a sudden onset of symptoms outside hospital had a better outcome (mortality rate 27 per cent; P = 0.02). CONCLUSION: Many non-diagnostic radiological examinations were performed and a routine second-look is warranted. The results suggest that attempts at revascularization procedures for acute mesenteric ischaemia may improve the outcome.

Adult↗
PubMed2002

Duplex scan findings in patients with spontaneous cervical artery dissections.

AIM: to report duplex scan findings in patients with spontaneous internal carotid artery (ICA) or vertebral artery (VA) dissection. MATERIAL AND METHODS: the records of 24 patients (13 males and 11 females, median age 48 years [range 25-68 years]) with spontaneous extracranial ICA dissection (n=20) or VA dissection (n=4), identified between January 1995 and December 1999, were retrospectively analysed. RESULTS: four different abnormal flow patterns were observed in patients with ICA dissection: (a) absence of flow (15%), (b) staccato flow (50%), (c) reduced flow velocity (25%) and, (d) stenotic flow (10%). B-mode ultrasound showed a homogenous echolucent lesion in eight patients and a double lumen in two. Staccato flow along the entire ICA was observed in only four patients without verified dissection during the study period. In the four patients with VA dissection, duplex scanning demonstrated staccato flow in three and reversed low-amplitude pulsatile flow in one. CONCLUSION: duplex scanning is an important noninvasive diagnostic modality in patients with cervical artery dissection. Staccato flow along the extracranial ICA strongly indicates the presence of spontaneous ICA dissection.

Adult↗
PubMed2002

Areas of concern, quality of life and life satisfaction in patients with peripheral vascular disease.

OBJECTIVES: to explore the ways in which peripheral vascular disease subjectively affect patients and to relate these findings to validated measurements of quality of life (QOL) and life satisfaction. DESIGN: a cross-sectional study. SUBJECTS: eighty patients, with carotid artery stenosis (CAS), abdominal aortic aneurysm (AAA), intermittent claudication (IC) or critical limb ischaemia (CLI). METHODS: semi-structured interviews were used to explore the effect of the disease on the patients life situation. QOL was assessed by SF-36 and life satisfaction by LiSat-11. RESULTS: the SF36, LiSat-11 and our interview revealed two principal patterns: one for patients with CAS and AAA, and one for patients with IC and CLI. The interview revealed important areas affecting the vascular patient. Some of these areas: higher intellectual function, concern, sexual function, family concern and factors related to the operated areas were not covered by either the SF36 or the LiSat-11. CONCLUSIONS: for a full understanding of how peripheral vascular disease affects the individual, disease specific questions need to be added to generic QOL instruments and measurements of life satisfaction.

Adult↗
PubMed2002

Measuring the abdominal aorta with ultrasonography and computed tomography - difference and variability.

OBJECTIVES: The aim of this study was to estimate the agreement between ultrasonography (US) and computed tomography (CT) in the measurement of aortic diameter in subjects with and without abdominal aortic aneurysms (AAA). MATERIAL AND METHODS: Sixty-one subjects were investigated, 33 with a diameter >30mm and 28 with a diameter <30mm. Difference and variabily anteroposterior (AP) and transverse (TR) diameters were analysed. RESULTS: In non-aneurysmal aortas US gave larger AP: 2.8mm (95% CI 1.7-4.0) and TR: 3.8mm (2.3-5.3) diameter. In AAAs the mean diameter did not differ significantly. In non-aneurysmal aortas we expect 95% of differences to be <5.7mm in AP and <7.6mm in TR measurements. In aneurysmal aortas we expect 95% of differences to be <8.0mm in AP and <10.6mm in TR measurements. CONCLUSION: The difference and variability between US and CT varies depends on the diameter of the aorta and how it is measured. These differences have importance for clinical practice and for research.

Aged↗
PubMed2002

Endovascular approach to treating secondary arterioureteral fistula.

Two patients with the rare entity of arterio-ureteral fistula are presented. Both highlight the predisposing factors of radiation, major surgery in the region, history of vascular surgery and presence of double-J-stent. Both patients presented with the clinical sign of intermittent gross hematuria. Both patients were successfully treated by endovascular intervention using graft covered stent.

Aged↗
PubMed2001

Extended out-of-hospital low-molecular-weight heparin prophylaxis against deep venous thrombosis in patients after elective hip arthroplasty: a systematic review.

PURPOSE: Evidence-based medicine guidelines based on venographic end points recommend in-hospital prophylaxis with low-molecular-weight heparin (LMWH) in patients having elective hip surgery. Emerging data suggest that out-of-hospital use may offer additional protection; however, uncertainty remains about the risk-benefit ratio. To provide clinicians with a practical pathway for translating clinical research into practice, we systematically reviewed trials comparing extended out-of-hospital LMWH prophylaxis versus placebo. DATA SOURCES: Studies were identified by 1) searching PubMed, MEDLINE, and the Cochrane Library Database for reports published from January 1976 to May 2001; 2) reviewing references from retrieved articles; 3) scanning abstracts from conference proceedings; and 4) contacting pharmaceutical companies and investigators of the original reports. STUDY SELECTION: Randomized, controlled trials comparing extended out-of-hospital prophylaxis with LMWH versus placebo in patients having elective hip arthroplasty. DATA EXTRACTION: Two reviewers extracted data independently. Reviewers evaluated study quality by using a validated four-item instrument. DATA SYNTHESIS: Six of seven original articles met the defined inclusion criteria. The included studies were double-blind trials that used proper randomization procedures. Compared with placebo, extended out-of-hospital prophylaxis decreased the frequency of all episodes of deep venous thrombosis (placebo rate, 150 of 666 patients [22.5%]; relative risk, 0.41 [95% CI, 0.32 to 0.54; P < 0.001]), proximal venous thrombosis (placebo rate, 76 of 678 patients [11.2%]; relative risk, 0.31 [CI, 0.20 to 0.47; P < 0.001]), and symptomatic venous thromboembolism (placebo rate, 36 of 862 patients [4.2%]; relative risk, 0.36 [CI, 0.20 to 0.67; P = 0.001]). Major bleeding was rare, occurring in only one patient in the placebo group. CONCLUSIONS: Extended LMWH prophylaxis showed consistent effectiveness and safety in the trials (regardless of study variations in clinical practice and length of hospital stay) for venographic deep venous thrombosis and symptomatic venous thromboembolism. The aggregate findings support the need for extended out-of-hospital prophylaxis in patients undergoing hip arthroplasty surgery.

Aftercare↗
PubMed2001

[Research results should be freely accessible!-- Case reports demonstrate obstacles to contact with drug industry].

Recommendations on the use of medical technologies should be based on best available evidence. Publication bias due to delayed publication or non-publication of negative studies leads to inflated effect sizes in systematic reviews. We carried out a health technology assessment on prevention and treatment of venous thromboembolism, and in order to minimize publication bias asked the six pharmaceutical companies with antithrombotic drugs registered in Sweden to supply us with results from unpublished clinical trials. The answers were returned after 4 to 60 weeks, and with only one exception, after multiple reminders by telephone, fax and e-mail. No relevant unpublished studies were reported to us although we were made aware of two published studies that our literature search had not identified. One company did not mention a large negative unpublished clinical trial with their drug which has remained unpublished due to conflict between the company and the steering committee. We conclude that the companies did not contribute much and that the process was very time consuming with little result. As non-publication of trial results is unethical, we propose agreements between industry and researchers that all studies be prospectively registered and made publicly available.

Clinical Trials as Topic↗