Search PubMed⌕ Search

Biomedical subjects

D Bergqvist

Publications and source records attributed to D Bergqvist.

At least 109 records · Page 6Linked to original sources
PubMed1999

Diabetes mellitus as a risk factor for early outcome after carotid endarterectomy--a population-based study.

BACKGROUND AND PURPOSE: to determine if diabetes mellitus is a risk factor for outcome after carotid endarterectomy (CEA). METHODS: the outcome and complications of all vascular procedures performed in Sweden are registered prospectively in the Swedish Vascular Registry (Swedvasc) and form the basis of this report. During the 10-year period 1987-96 2622 CEAs were analysed for notified complications. RESULTS: of the 2622 CEAs, 341 (13%) were performed on diabetics and 2281 (87%) on non-diabetics. Patients with diabetes presented at a younger age (67.1+/-8.3 years vs. 68.2+/-8.3 years p =0.028), were more likely to have a history of hypertension (61.9% vs. 50% p =0.001) and were less often smokers (34.9% vs. 43.2% p =0.001). Diabetics presented more often with minor stroke (41.3% vs. 30.8% p =0.002) and non-diabetics more often with amaurosis fugax (18.9% vs. 14.4% p =0.04). Diabetics had a higher 30-day mortality (3.2% vs. 1. 4% p =0.02). The 30-day neurologic and cardiac morbidity did not differ. The 1-year mortality was 7.9% in diabetics and 4.4% in non-diabetics (p =0.008). Non-diabetics operated on in 1992-96 compared to those operated on in 1987-91 had a significantly lower combined permanent stroke and death rate (3.7% vs. 5.7% p =0.05), a difference not found in diabetics (6.3% for 1987-92 and 6.8% for 1992-96; N.S). CONCLUSIONS: diabetics had both a higher 30-day and 1-year mortality after CEA compared to non-diabetics, mainly because of cardiac complications. However, postoperative neurologic morbidity did not differ.

Aged↗
PubMed1999

Complications after carotid endarterectomy are related to surgical errors in less than one-fifth of cases. Swedvasc--The Swedish Vascular Registry and The Quality Committee for Carotid Artery Surgery.

OBJECTIVES: to study possible relations between indications, contraindications and surgical technique and stroke and/or death within 30 days of carotid endarterectomy (CEA). DESIGN: analysis of hospital records for patients identified in a national vascular registry. METHOD: during 1995-1996, 1518 patients were reported to the Swedish Vascular Registry - Swedvasc. Among these the sixty-five with a stroke and/or death within 30 days were selected for study. Complete surgical records were reviewed by three approved reviewers using predetermined criteria for indications and possible errors. RESULTS: an error of surgical technique or postoperative management was found in eleven patients (17%). In six cases (9%) the indication was inappropriate or there was an obvious contraindication. The indication was questionable in fourteen (21.5%). Half of the patients (52.5%) had surgery for an appropriate indication, and no contraindication or error in surgical technique or management was identified. CONCLUSION: more than half the complications of CEA represent the "method cost", i.e. the indication, risk and surgical technique were correct. However, the stroke and/or death rate might be reduced if all operations conformed to agreed criteria.

Aged↗
PubMed1999

Surgical repair of type B aortic dissection complicated by early postoperative lung vein and artery thrombosis.

A 24-year old man with Marfan syndrome previously operated for abdominal aortic aneurysm and type A dissection sustained a type B dissection. He underwent graft replacement of the descending and upper abdominal aorta, complicated by infarction of the left upper lobe and lobectomy was carried out. The postoperative course was uneventful. The mechanism for this rare complication is discussed.

Adult↗
PubMed1999

A new scoring system for the detailed description of the distribution and thrombotic burden in deep leg vein thrombosis.

The scoring system most commonly used to date to describe the thrombotic burden of deep vein thrombosis (DVT) excludes several deep vein segments and is thereby of limited use in research. The aim of this prospective, comparative study was to develop a new scoring and distribution system that would include all major deep veins of the leg and pelvis. In total, 247 consecutive patients were included, of whom 105 had a positive phlebography. The positive phlebographies were registered in the new system and the result was compared with that obtained by the Marder system. In 72% (76/105) of the patients the DVT distribution was not completely described and the thrombotic burden was significantly underestimated by the Marder system. Of these, 12% (13/105) were not scored at all, thus representing false-negative investigations. It was possible to score all DVTs and important vein segments of these patients with the new system. The scoring system previously used excludes several deep vein segments. A description of the important vein segments, where DVT is shown to originate and propagate, is mandatory in a scoring system designed for the purpose of research of DVT and later detected deep vein insufficiency. The new system meets this demand.

Adult↗
PubMed1998

[Significant regional differences in the frequency of vascular surgery].

The six health care regions of Sweden were compared with regard to the frequency of vascular surgery for three diagnoses: chronic lower extremity ischaemia, abdominal aorta aneurysm, and carotid stenosis. In 1995, the frequency of intervention for chronic lower extremity ischaemia varied from 26/100,000 of the population in northern Sweden to 68/100,000 in the southern region, the variation being greater for critical limb ischaemia than for intermittent claudication. In the country as a whole, the frequency of abdominal aorta aneurysm surgery increased five-fold from 1987-89 to 1993-95. During 1995, regional figures varied from 4.7 to 8.4 per 100,000 for elective procedures, and from 3.8 to 5.5 per 100,000 for emergency procedures. Overall surgical mortality varied regionally, and emergency surgery mortality differed between regional and county hospitals. Carotid surgery manifested the greatest regional difference in frequency, which was 7-fold greater in the southern than in the northern region, while its overall mean frequency was 6/100,000.

Aortic Aneurysm, Abdominal↗
PubMed1998

[Vascular surgery is steadily increasing in Sweden].

Analysis of the development of arterial surgery between 1980 and 1995, on the basis of questionnaire response and data from the Swedish vascular registry (Swedvasc), showed the annual incidence of elective procedures to have increased from 2,284 to 7,425, and that of emergency procedures from 1,619 to 1,951, the overall annual incidence of operations being 1,068 per million of the population in 1995. There are manifest regional differences in the country as a whole, and the period studied was characterized by relative redistribution of operations from regional to county hospitals. Detailed scrutiny of carotid artery surgery again showed manifest regional differences to exist, but at few hospitals were more than 50 operations performed annually. There was good agreement between Swedvasc data and official operation statistics.

Elective Surgical Procedures↗
PubMed1998

Isovolemic hemodilution and skeletal muscle function during ischemia and reperfusion.

Hemodilution has previously been shown to improve microcirculation in skeletal muscle after ischemia. We have studied the effects of isovolemic hemodilution with dextran on the function of anterior tibial muscle in the rabbit. Hemodiluted (hematocrit 28%) and nonhemodiluted animals were compared. Hemodilution led to an immediate increase in femoral blood flow. Flow normalized within 1-2 h, possibly due to flow redistribution. Hemodilution increased muscle force by 10%, which can reflect alterations in blood chemical composition or an improved microcirculation. Unilateral hindlimb ischemia induced by arterial occlusion inhibited muscle force to less than 15% in 150 min. Force and blood flow recovered almost completely after ischemia. After longer ischemia (170-300 min) when force was <5%, muscles did not recover. Hemodilution did not alter the muscle force or the extent or rate of force recovery after ischemia, which shows that the increased blood flow and improved microcirculation are not directly associated with changes in the sensitivity of muscle function to ischemia.

Animals↗
PubMed1998

The effect of dobutamine on distal colon ischaemia in the pig.

OBJECTIVE: To test the hypotheses that dobutamine increases intestinal blood flow, it reduces mucosal acidosis and it prevents mucosal injury in an experimental porcine model of distal colonic ischaemia. And the hypothesis that mannitol prevents reperfusion injury. DESIGN: Randomised animal experiment. SETTING: University Hospital, Department of Experimental Research. MATERIALS: Twenty-four pigs. INTERVENTIONS: Twenty-one pigs were subjected to 7 h of controlled non-occlusive intestinal ischaemia of the distal colon, consisting of an occlusion of the inferior mesenteric artery (IMA) and a constriction of the superior mesenteric artery (SMA). At 3.5 h six pigs were treated with dobutamine, six with mannitol (0.18 g/kgBW), six with dobutamine and mannitol and three served as controls. Three non-ischaemic pigs were treated with dobutamine. MEASUREMENTS AND RESULTS: All animals were haemodynamically stable throughout the experiment. There was no difference in any variable between the animals treated with mannitol and those not treated. The ischaemic dobutamine-treated animals increased their cardiac output (CO) by 14% compared to baseline and by 59% compared to controls. The median final dosage of dobutamine was 13.2 micrograms/kg per min (range 8.6-25.8). The blood flow in the restricted SMA, the intramucosal pH of the colonic mucosa (pHi) and the degree of histological mucosal injury were identical in animals treated with dobutamine and controls. The pH gap (pHa-pHi) correlated well (r = 0.97) with the PCO2 gap (aPCO2-intestinal PCO2). The non-ischaemic animals treated with dobutamine increased CO by 37% and blood flow of the SMA by 16%. CONCLUSIONS: Dobutamine increased CO but did not ameliorate or deteriorate colonic ischaemia in this experimental model. The PCO2 gap correlated well with the pH gap.

Adrenergic beta-Agonists↗
PubMed1998

Effects of heparin, desmopressin, and isovolemic hemodilution with dextran on thrombus formation in synthetic vessel grafts inserted into the vena cava of the rabbit.

The objective of this study was to investigate the effects of isovolemic hemodilution with dextran-70 on thrombus formation and blood flow in synthetic venous vessel grafts. Polytetrafluoroethylene grafts (length, 11 mm; inner diameter, 3 mm) were inserted into the vena cava of rabbits. Six groups were studied: (1) the control group; (2) animals that underwent isovolemic hemodilution with dextran-70 to a hematocrit of about 30%; (3) animals that underwent isovolemic dextran hemodilution combined with a bolus injection of heparin; (4) animals that underwent heparin treatment only; (5) animals that underwent isovolemic dextran hemodilution combined with infusion of desmopressin; and (6) animals that underwent an identical treatment to group 3 but with a 2-week, instead of a 2-day, follow-up. Vena cava blood flow was measured before and after hemodilution and graft insertion and at the termination of the experiments at 2 days (groups 1 to 5) and 2 weeks (group 6) after surgery. Graft patency and thrombus mass weight were evaluated. In the control group, most of the vessels occluded within 2 days. Hemodilution with dextran improved blood flow and reduced thrombus mass weight significantly. Desmopressin, which increases factor VIII, did not influence the effects of hemodilution with dextran, which suggests that the effects of dextran are not mediated by a reduction in the level of this coagulation factor. A single bolus dose of heparin did not reduce thrombus formation in the grafts but did potentiate the effects of isovolemic hemodilution on thrombus mass and graft blood flow. We conclude that isovolemic dextran hemodilution combined with a single bolus of heparin had beneficial long-lasting effects. The grafts in groups 3 and 6 were all patent.

Animals↗
PubMed1998

Helicobacter pylori and the relation to other risk factors in patients with acute bleeding peptic ulcer.

BACKGROUND: The influence of ulcer risk factors is well known in chronic peptic ulcer disease. In this study the risk factors were investigated in patients with peptic ulcer complicated by an acute bleeding episode. METHOD: In 106 consecutive patients with acute bleeding peptic ulcer, age, previous history of ulcer disease, presence of dyspeptic symptoms, smoking habits, consumption of nonsteroidal anti-inflammatory drugs (NSAIDs), and haemoglobin concentration at admission were recorded. Helicobacter pylori infection was detected by means of two serologic tests in samples obtained at admission for the acute bleeding episode. RESULTS: Three-quarters of both gastric ulcer and duodenal ulcer patients were shown to have H. pylori antibodies. NSAID use and smoking habits were similar in patients with and without H. pylori antibodies. CONCLUSIONS: The results indicate that H. pylori infection, NSAID use, and smoking habits act as largely independent risk factors in patients with acute bleeding peptic ulcer.

Acute Disease↗