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Biomedical subjects

D Bergqvist

Publications and source records attributed to D Bergqvist.

At least 397 records · Page 22Linked to original sources
PubMed1988

Deep vein thrombosis of the axillary-subclavian veins: epidemiologic data, effects of different types of treatment and late sequelae.

Upper extremity deep venous thrombosis (DVT) is uncommon. In the city of Malmö, Sweden (240,000 inhabitants), 296 cases undergoing phlebography due to a suspicion of upper extremity DVT, during 1971-1986 were analysed. 165 arm phlebograms did not reveal any thrombi (56%). In 11 cases (4%) external compression of the vein was found. Thrombi in the axillary or subclavian vein were found in 120 cases (40%) and were classified as primary in 73 cases and secondary in 47 cases. Only seven cases of effort thrombosis were found. Four cases had neurovascular symptoms mimicking thoracic outlet syndrome and underwent elective first rib resection. None of the patients with primary DVT had a fatal pulmonary embolism (FPE). One patient had clinical signs suspicious of pulmonary embolism (PE), however, scintigraphy of the lungs was negative. Of the cases with secondary thrombi three cases had fatal, and one case had contributory PE at autopsy. Additionally, one patient had a non-fatal PE verified scintigraphically. Post-thrombotic sequelae from the arm were in no case so severe that the patient had to change occupation. Patients with primary DVT had moderate complaints in three and mild in fifteen cases. Those with secondary arm thrombi experienced only moderate symptoms in two cases and mild sequelae in fourteen. There was no correlation between the type of treatment and late post-thrombotic symptoms. From this study it can be concluded that phlebography must be undertaken before treatment can be started in patients with a suspected arm DVT. Primary DVT seems to be a "benign" disease, and in general treatment with anticoagulants is sufficient.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1988

Risk factors in carotid artery surgery: an evaluation of 414 operations.

Four hundred and fourteen carotid reconstructions performed on 352 patients during the years 1971-82 were analysed retrospectively. Fifty-eight percent of the patients were operated on because of hemispheric transient ischaemic attacks (TIA). Twenty-eight percent had suffered a stroke before surgery. The overall combined mortality and morbidity was 7.7%. The procedure mortality was 2.9% with a slightly higher mortality i.e. 5.9% in the stroke group although not significantly higher than among non-stroke patients with a mortality of 1.4%. Patients of more than 70-years had a significantly higher operative mortality (11.1%) than the rest of the patients (1.7%). Non-fatal strokes occurred in 20 patients (4.8%). No correlation was found with the degree of stenosis of the contralateral artery.

Adult↗
PubMed1988

Interactive effects on renal function between renal ischemia and intravascular contrast media.

This review deals with some recent animal and clinical investigations that show that small amounts of intravascular contrast media (CM) that remain in the body at the time of surgery and are the residual from a preoperative roentgen examination may increase (potentiate) the renal injury resulting from temporary intraoperative renal artery occlusion. Such interaction (potentiation) may occur in each of the following clinical situations: (1) aortorenal reconstructive surgery after angiography; (2) kidney harvesting after cerebral angiography in cadaver donors; and (3) percutaneous dilatation of a stenotic renal artery that includes a sequence of CM injections and balloon inflations that occlude the renal artery. It is concluded that such a potentiation may be decreased by prolonging the time interval between CM injection and the subsequent temporary renal arterial occlusion because such a prolongation decreases the amount of CM that remains in the kidney at time of occlusion.

Animals↗
PubMed1988

Coarctation of the abdominal aorta in elderly patients. Case report and review of the literature.

Coarctation of the abdominal aorta as a congenital disease is infrequent, the diagnosis mostly being made at an early age because of renovascular hypertension. Patients who reach the age of 40 more often tend to have the problems located distally to the renal arteries. A 66-year-old female is described, who developed an aortic occlusion, renovascular hypertension and uremia. She was cured with a bifurcation graft and a patch angioplasty of a stenotic renal artery and nephrectomy of the contralateral kidney with an occluded artery without refilling. A literature survey is made of patients older than 40 years.

Aged↗
PubMed1988

Low specificity of the 125I-fibrinogen uptake test for the diagnosis of deep vein thrombosis in patients with erysipelas of the leg.

The 125I-fibrinogen test was evaluated as a diagnostic tool for deep vein thrombosis in patients with erysipelas. In the investigated group of 43 patients, several showed an increased uptake that could not be verified by subsequent phlebography. The false positive test may have been caused by the local inflammatory process. The 125I-fibrinogen test seems to be too unspecific to be used for diagnosing deep vein thrombosis in this patient group.

Adult↗
PubMed1988

Thromboembolic problems in colorectal cancer surgery.

The problem of thromboembolic complication in patients undergoing surgery for colorectal malignancies has been evaluated based on data from the literature and own experiences. One problem is the few studies dealing exclusively with this group of patients or presenting separate data on these patients. Deep vein thrombosis is somewhat more common than that seen after other types of abdominal surgery. No difference between patients operated on for colonic or rectal cancer have been found. The number of fatal or contributory pulmonary emboli is higher than the average number among other operated patients. Low dose heparin, low molecular weight heparin and mechanical methods, especially when combined with heparin or dextran, reduce the frequency of deep vein thrombosis. Fatal pulmonary embolism can effectively be prevented by low dose heparin with or without dihydroergotamine or by dextran.

Colorectal Neoplasms↗
PubMed1988

Frequency of thromboembolic complications in patients with acute pneumonia and pyelonephritis.

Infectious complications increase the risk of postoperative thromboembolism. In order to assess the risk of deep vein thrombosis (DVT) in acute infections not associated with surgery, 36 patients with acute pneumonia or pyelonephritis were evaluated regarding development of DVT with the 125I-fibrinogen uptake test with confirmative phlebography. 1/15 patients with pyelonephritis and 1/21 patients with pneumonia developed DVT. No fatal pulmonary embolism was seen. The frequency of DVT was thus 6%. This low figure may be due to early mobilization of the patients and does not motivate routine anticoagulant prophylaxis against thromboembolic complications in patients with acute infections.

Acute Disease↗
PubMed1988

Arachidonic acid cascade metabolites in porcine E. coli shock. Coagulation, fibrinolytic and hemodynamic response.

Cardiopulmonary hemodynamics and changes in various hemostatic factors (alpha 2M, alpha 2AP, AT III, prothrombin-proconvertin activity, fibrinogen concentration, ethanol gelation test and fibrinolytic activity on fibrin plates) were investigated in pigs during shock induced with live Escherichia coli. Anesthetized pigs were treated with indomethacin or with the combined cyclooxygenase/lipoxygenase inhibitor BW755C before the E. coli infusion or were left untreated as septic controls. Septic shock developed in all of these animals. Pretreatment attenuated the early deterioration of pulmonary circulation but did not modify the coagulation/fibrinolytic activation or the disturbed cardiopulmonary hemodynamics seen in the delayed phase of shock. The arachidonic acid cascade metabolites thus seems to mediate the early, but not the delayed cardiopulmonary reaction and to have minor importance for activation of coagulation and fibrinolysis in E. coli-shocked pigs.

Animals↗
PubMed1988

Surgery in patients with congenital antithrombin III deficiency.

A retrospective study is presented of 23 patients with congenital antithrombin (AT) III deficiency who underwent 57 operations of various types. Thromboprophylaxis was given in 28 operations. Dextran was used in most cases, sometimes in combination with specific AT III concentrate. No patient given AT III concentrate alone or in combination with other methods had signs of thromboembolism. Deep venous thrombosis followed four of the operations with prophylaxis (3 patients). After the 29 operations without prophylaxis there were three cases of deep venous thrombosis, one with clinical signs of pulmonary embolism and another with superficial thrombophlebitis. Despite its inherent drawbacks, this retrospective study indicated that AT III concentrate can effectively prevent postoperative thromboembolism. But as the selection criteria for thromboprophylaxis are difficult to evaluate, a prospective study should be of great value.

Adult↗
PubMed1988

Factors affecting the patency of infrainguinal bypass.

Two hundred forty-nine well-characterized difficult distal bypasses, entered into a multicenter dextran 40 trial, were reevaluated after 3 years. Seventy in situ (IS) vein grafts, 49 reversed saphenous (RS) vein grafts, 60 polytetrafluoroethylene (PTFE) grafts, and 70 umbilical vein (UV) grafts were used. Primary and secondary patency rates at 3 years were, respectively, 84% and 90% for IS, 66% and 73% for RS, 35% and 48% for PTFE, and 24% and 32% for UV. Subgroup analysis according to the site of distal anastomosis showed no significant differences in primary patency among these grafts at the above-knee level but significant differences between both vein grafts (IS and RV) and the others (PTFE and UV) below the knee (78% vs 31%, respectively). This difference increased at the tibial level (78% vs 10%) but there was also a significant difference between IS grafts (88%) and RS grafts (63%) at this level. Hazard functional analysis showed all grafts except IS grafts begin to fail at an increasing rate again by 24 months. Although overall results appeared to favor PTFE over UV, 62% of PTFE vs 16% of UV terminated at the above-knee level and the patency results of these two grafts were not significantly different at any level. The only other factor than graft type and distal anastomotic site that consistently correlated with late patency was tobacco use. Diabetic patients actually fared significantly better than nondiabetic patients, presumably because of the higher use of IS grafts and lower use of tobacco. The choice of graft overshadows all other factors affecting patency and its influence is magnified with more distal terminal anastomosis.

Anastomosis, Surgical↗
PubMed1988

Safety and efficacy of a low molecular weight heparin (Logiparin) versus dextran as prophylaxis against thrombosis after total hip replacement.

In order to study the plasma levels of factor XaI and IIaI activity an enzymatically depolymerized low molecular weight heparin (LMW-heparin; Logiparin) was given s.c. in a dose of 35 XaI mu/kg b.w. once daily for 7 days to 10 patients undergoing total hip replacement (THR) in a pilot study. The XaI activity was less than or equal to 0.24 XaI units/ml and the IIaI activity less than or equal to 0.043 IIaI mu/ml. No accumulation of the activities were seen. No phlebographically verified thrombi or any bleeding complications were registered. From this study it was concluded that the given dose of Logiparin was safe with regard to bleeding complications. Based on these data, an open, randomized controlled trial was started. In this main study the thromboprophylactic effect of the LMW-heparin (Logiparin) in a dose of 35 XaI mu/kg b.w. once daily was compared with that of dextran 70 in patients undergoing THR. 100 patients were randomized. The over-all thrombosis rate was 28% in patients treated with LMW-heparin and 39% in those given dextran, a non-significant difference. No bleeding complications, deaths or pulmonary embolism were recorded in either group. Peroperative blood loss and transfusion requirements were similar in the two groups. In conclusion, the investigated LMW-heparin (Logiparin) is safe and effective in preventing postoperative thromboembolism in patients undergoing total hip replacement, but the dosage can probably be optimized.

Adult↗
PubMed1988

Peripheral arterial embolectomy, risks and results.

Embolectomy of the extremities was performed on 221 patients (263 emboli) with median age 77 years. The upper extremity was affected in 21% of cases. No correlation was found between the time from onset of symptoms to embolectomy and the amputation rate. There were 81 deaths (37%) within a month of operation. The mortality rate was significantly higher (47%) among the patients who were already in hospital when embolism occurred and also when the embolism was associated with myocardial infarction (68%). Among patients given oral anticoagulants postoperatively the perioperative mortality was 5%, compared with 51% without such medication. Patient age, concomitant coronary artery disease and oral anticoagulant treatment were factors independently influencing morbidity during the first postoperative month. The 5-year survival rate was also significantly heightened by anticoagulant treatment (43 vs. 12%). Data concerning amputation rate, perioperative mortality and long-term survival in relation to oral anticoagulant treatment must be cautiously interpreted. Prospective trials are required to answer some of the questions.

Adult↗
PubMed1988

A comparison of the behaviour of autologous and homologous platelets in microporous polyurethane grafts. An experimental study in sheep.

In experimental studies in sheep the behaviour of autologous and homologous platelets in microporous polyurethane grafts was compared at a flow rate of 25 ml/min. The grafts were interposed to replace segments of resected carotid arteries. The deposition of 32P-labelled platelets on the graft wall was recorded, as were graft patency, thrombus weight and thrombus-free surface. Compared to autologous platelets, homologous platelets accumulated over longer periods of time and in greater numbers, leading to deposition of larger amounts of thrombus material and reduced patency.

Animals↗
PubMed1987

The influence of low molecular weight heparin in combination with dihydroergotamine on experimental thrombosis and haemostasis.

The influence of low molecular weight heparin in combination with dihydroergotamine (DHE) on thrombus formation and primary haemostasis was investigated in rabbit models. Conventional heparin in the dose of 60 units anti Xa activity/kg b. w. effectively prevented thrombus formation but the same dose of a low molecular weight fragment only gave a marginal decrease of the frequency of thrombosis. The thrombus weight was, however, significantly reduced. Doubling the dose of the heparin fragment totally abolished thrombus formation as did the combination of 60 units with DHE. With DHE it was also possible to diminish the low molecular weight heparin dose to 30 units with a good prophylactic effect. There was a small but significant increase of haemostatic plug formation time in all treatment groups except the one with low molecular weight heparin fragment 30 units anti Xa activity combined with DHE. Thus, by combining low molecular weight heparin in a low dose with DHE it is possible to prevent thrombus formation without influencing primary haemostasis in rabbits.

Animals↗