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Biomedical subjects

David Bergqvist

Publications and source records attributed to David Bergqvist.

At least 37 records · Page 2Linked to original sources
PubMed2006

Low frequency of phlebographic deep vein thrombosis after laparoscopic cholecystectomy--a pilot study.

To investigate the rate of deep vein thrombosis (DVT) after laparoscopic surgery, 50 patients underwent bilateral phlebography 7-11 days after laparoscopic cholecystectomy (LC). All received thromboembolism prophylaxis, either low molecular weight heparin (LMWH) or dextran. Three patients were converted to open cholecystectomy. D-dimer was investigated preoperatively, on day 1 and on the day of phlebography. One asymptomatic DVT was found. One phlebogram was incomplete. Seven phlebograms were not optimal but of sufficient quality to rule out DVT. The frequency of DVT was thus 1 of 49 or 2.0% (95% confidence interval, 0-6.0%). No anticoagulants were prescribed after discharge. No patient developed late thromboembolic complications. D-dimer values increased significantly at day 1 and were further increased at the time of phlebography. The frequency of phlebographical DVTs thus seems to be low despite prophylaxis of questionable efficacy. The D-dimer values, however, suggest that the effects of LC on coagulation/fibrinolysis have a duration of longer than 1 week.

Adult↗
PubMed2006

Effective thromboprophytaxis administered close to the time of major orthopedic surgery: a review.

As major orthopedic surgery poses a high risk for venous thromboembolic disease, use of thromboprophylaxis has become routine in this setting. Unfortunately, there is still no consensus regarding optimal time to initiate thromboprophylaxis. Results from several studies indicate the importance of timing to the efficacy and safety of thromboprophylaxis. As thrombogenesis is thought to begin perioperatively, "just-in-time" thromboprophylaxis has been proposed-antithrombotic therapy with low-molecular-weight heparins initiated soon before or soon after surgery. Results from our large clinical trial show the efficacy and safety of a modified dalteparin regimen administered close to the time of total hip arthroplasty.

Dose-Response Relationship, Drug↗
PubMed2005

Prevalence and risk of pulmonary embolism in patients with intracardiac thrombosis: a population-based study of 23 796 consecutive autopsies.

AIMS: While right intracardiac thrombosis (IT) is a potential cause of pulmonary embolism (PE) similar to that of stroke in left-sided IT, its prevalence and prognostic significance has not been studied in the general population. The aim of this study was to assess the age- and gender-specific prevalence of IT and its relation to PE in a population-based autopsy cohort. METHODS AND RESULTS: Between 1970 and 1982, 23 796 autopsies, representing 84% of all in-hospital deaths in the Malmö city population, were performed, using a standardized procedure. The relationship between IT and PE was evaluated by cohort analyses and nested case-control studies. IT was present in 1706 (7.2%) patients, 727 and 747 of whom had right and left atrial IT, respectively. PE prevalence in patients with isolated left IT, isolated right IT, and combined IT was 28.5, 35.6, and 48.9%, with RR (95% CI) of 1.5 (1.3-1.8), 2.0 (1.6-2.5), and 3.5 (2.7-4.7), respectively, compared with age- and gender-matched controls. Patients dying from ischaemic heart disease had a 3.2 (2.7-3.6) times higher risk of right IT, which was associated with 43% PE prevalence. Of all patients with PE at autopsy, right IT was found in 354 (6.5%), and the only detected source of PE in 220 (4.0%). CONCLUSION: Right cardiac thrombosis, though difficult to assess clinically, is as common as left cardiac thrombosis and is associated with an increased risk of PE. The diagnosis should be considered in all cases of PE, especially in patients with atrial fibrillation or myocardial infarction and in the absence of confirmed deep vein thrombosis.

Adolescent↗
PubMed2005

Mesenteric venous thrombosis with transmural intestinal infarction: a population-based study.

OBJECTIVE: To determine the cause-specific mortality from and incidence of transmural intestinal infarction caused by mesenteric venous thrombosis (MVT) in a population-based study and to evaluate the findings at autopsy by evaluating autopsies and surgical procedures. METHODS: All clinical (n = 23,446) and forensic (n = 7569) autopsies performed in the city of Malmö between 1970 and 1982 (population 264,000 to 230,000) were evaluated. The autopsy rate was 87%. The surgical procedures were performed in 1970, 1976, and 1982. Autopsy protocols coded for intestinal ischemia or mesenteric vessel occlusion, or both, were identified in a database. In all, 997 of 23,446 clinical and 9 of 7,569 forensic autopsy protocols were analyzed. A 3-year sample of the surgical procedures, comprising 21.3% (11,985 of 56,251) of all operations performed during the entire study period, was chosen to capture trends of diagnostic and surgical activity. In a nested case-control study within the clinical autopsy cohort, four MVT-free controls, matched for gender, age at death, and year of death were identified for each fatal MVT case to evaluate the clinical autopsy findings. RESULTS: Four forensic and 23 clinical autopsies demonstrated MVT with intestinal infarction. Seven patients were operated on, of whom six survived. The cause-specific mortality ratio was 0.9:1000 autopsies. The incidence was 1.8/100,000 person years. At autopsy, portal vein thrombosis and systemic venous thromboembolism occurred in 2 of 3 and 1 of 2 of the cases, respectively. Obesity was an independent risk factor for fatal MVT (P =.021). CONCLUSIONS: The estimated incidence of MVT with transmural intestinal infarction was 1.8/100,000 person years. Portal vein thrombosis, systemic venous thromboembolism and obesity were associated with fatal MVT.

Adult↗
PubMed2005

Risk factors associated with abdominal aortic aneurysm: a population-based study with historical and current data.

OBJECTIVES: To define risk factors associated with the development of abdominal aortic aneurysm (AAA) in a population-based case-control study. MATERIAL AND METHODS: Thirty-five patients found to have AAA at screening were compared with 140 age- and sex-matched controls. Three distinct comparisons were made. Current risk factors in both cohorts were compared. Because data were also available for both cohorts from a study conducted 12 years previously, a historical comparison was made between risk factors identified at the time of this initial evaluation. A longitudinal comparison was made between historical and current risk factors. RESULTS: Elevated low-density-lipoprotein cholesterol, total cholesterol, and triglyceride levels 12 years before AAA screening were associated with current AAA with an odds ratio (OR) of 2.3 (95% confidence interval [CI], 1.2 to 4.4); OR, 1.9 (95% CI, 1.3 to 2.8); and OR, 1.9 (95% CI,1.2 to 3.1)/mmol/L, respectively. Current variables assessed at AAA screening that were associated with AAA were: A history of atherosclerotic disease, OR, 3.8 (95% CI, 1.7 to 8.5); having a first-degree relative with AAA, OR, 4.4 (95% CI, 1.5 to 13.0); current smoking, OR, 5.2 (95% CI, 1.6 to 16.8); high-density-lipoprotein cholesterol level, OR, 0.1 (95% CI, 0.02 to 0.7)/mmol/L; and high-sensitivity C-reactive protein (hsCRP) level, OR, 1.1 (95% CI, 1.01 to 1.2)/mg/L. Hypertension and diabetes were not associated with AAA. A significant increase of hsCRP over time (12 years) was observed in AAA patients ( P = .039) but not among controls. The variables of a history of atherosclerosis, smoking, and family history of AAA appear to interact synergistically to increase the prevalence of AAA ( P < .001). CONCLUSION: Among traditional risk factors for atherosclerosis, some were associated with AAA and others were not, indicating complex and partly different causes. Inflammation and heredity appear to be important factors in the development of AAA.

Age Factors↗
PubMed2005

Cost-effectiveness of different screening strategies for abdominal aortic aneurysm.

OBJECTIVE: The primary objective of this study was to develop a simulation model to assess the cost-effectiveness of different screening strategies for abdominal aortic aneurysms (AAAs) in men. METHODS: A systematic review of the literature was conducted for different screening strategies in terms of age (60, 65, or 70 years) and risk profiles (all men or specific high-risk groups) of the screened population, and rescreening after 5 or 10 years. These data were analyzed in a Markov simulation cohort model. RESULTS: The cost per life year gained for different screening strategies ranged from US 8,309 dollars to US 14,084 dollars and was estimated at US 10,474 dollars when 65-year-old men were screened once. Screening 60-year-old men was equally cost-effective, with the advantage of more life years gained. We demonstrated a trade-off between high prevalence of AAA and lower life expectancy, eliminating the expected benefits of screening high-risk groups such as smokers (US 10,695 dollars) or cardiovascular patients (US 10,392 dollars). Assuming general population utility resulted in a cost per quality-adjusted life year (QALY) gained of US 13,900 dollars, whereas a hypothetical 5% reduction in utility among men with a screening-detected AAA raised the cost per QALY gained to US 75,100 dollars. CONCLUSION: This Markov model, which was based on a systematic review of the literature, supplied information on the estimated cost-effectiveness of different screening strategies. Screening men for AAA may be cost-effective in the long-term. Different screening strategies and quality-of-life effects related to screening for AAA need to be evaluated in future clinical studies.

Age Factors↗
PubMed2005

Changes in superficial and perforating vein reflux after varicose vein surgery.

OBJECTIVES: This prospective duplex study was conducted to study the effect of current surgical treatment for primary varicose veins on the development of venous insufficiency < or = 2 years after varicose vein surgery. METHODS: The patients were part of a randomized controlled study where surgery for primary varicose veins was planned from a clinical examination alone or with the addition of preoperative duplex scanning. Postoperative duplex scanning was done at 2 months and 2 years. RESULTS: Operations were done on 293 patients (343 legs), 74% of whom were women. The mean age was 47 years. In 126 legs, duplex scanning was done preoperatively, at 2 months and 2 years, and at 2 months and 2 years in 251 legs. Preoperative perforating vein incompetence (PVI) was present in 64 of 126 legs. Perforator ligation was not done on 42 of these; at 2 months, 23 of these legs (55%) had no PVI, and at 2 years, 25 legs (60%) had no PVI. Sixty-one legs had no PVI preoperatively, 5 (8%) had PVI at 2 months, and 11 (18%) had PVI at 2 years. In the group of 251 legs, reversal of PVI between 2 months and 2 years was found in 28 (41%) of 68 and was more common than new PVI, which occurred in 41 (22%) of 183 (P = .003). After 2 years, the number of legs without venous incompetence in which perforator surgery was not performed was 11 (26%) of 42 legs with preoperative PVI and 18 (30%) of 61 legs without preoperative PVI, (P = .713). After 2 years, new vessel formation was more common in the surgically obliterated saphenopopliteal junction (SPJ), 4 (40%) of 10, than in the saphenofemoral junction (SFJ), 17 (11%) of 151(P = .027), and new incompetence in a previously normal junction was more common in the SFJ, 11 (18%) of 63, than in the SPJ, 3 (1%) of 226 (P < .001). Reflux in the great saphenous vein (GSV) below the knee was abolished after stripping above the knee in 17 (34%) of 50 legs at 2 months and in 22 legs (44%) after 2 years. CONCLUSIONS: Varicose vein surgery induces changes in the remaining venous segments of the legs that continue for several months. In most patients, perforators and the GSV below the knee can be ignored at the primary surgery. A substantial number of recurrences in the SFJ and SPJ are unavoidable with present surgical knowledge because they stem from new vessel formation and progression of disease.

Female↗
PubMed2005

Low-molecular-weight heparin for the prevention of postoperative venous thromboembolism after abdominal surgery: a review.

PURPOSE OF REVIEW: To analyze the effect of low-molecular-weight heparin in abdominal surgery, which carries a significant risk of thrombosis, a risk further increased by cancer. RECENT FINDINGS: Searches in EMBASE and PubMed between 1980 and 2004 were conducted to identify studies of thromboprophylaxis in abdominal surgery patients. Sixteen comparative studies were identified. They showed that low-molecular-weight heparin is as effective as unfractionated heparin in reducing venous thromboembolism and, at appropriate doses, can reduce bleeding complications. In very-high-risk cancer patients, a higher dose of low-molecular-weight heparin may offer increased efficacy without increasing the risk of bleeding. Extending the standard 7-10-day low-molecular-weight heparin prophylaxis period may benefit certain high-risk patient groups. SUMMARY: Patients undergoing abdominal surgery should be stratified according to thromboembolism risk and given prophylaxis accordingly. Low-molecular-weight heparin is a recommended alternative to unfractionated heparin in moderate- or high-risk patients. In patients with cancer, high doses of low-molecular-weight heparin may offer increased efficacy without increased bleeding, and an extended 4-week period of prophylaxis could be beneficial.

Anticoagulants↗
PubMed2005

Renal effects of CO2 and iodinated contrast media in patients undergoing renovascular intervention: a prospective, randomized study.

PURPOSE: CO2 gas has been proposed for use instead of iodinated contrast media in angiographic examinations in patients at risk of developing renal failure from contrast media. The influence of intraarterial injection of CO2 with small added amounts of ioxaglate (200 mgI/mL) or ioxaglate alone on renal function in patients with suspected renal artery stenosis was studied in a prospective, randomized study. MATERIALS AND METHODS: One hundred twenty-three patients underwent renovascular intervention (n = 83) and/or renal angiography (n = 40) for suspected renal artery stenosis. Patients with a serum creatinine concentration less than 200 micromol/L (n = 82) were randomized prospectively to receive CO2 with small added amounts of ioxaglate (n = 37) or only ioxaglate (n = 45). Patients with serum creatinine levels greater than 200 micromol/L (n = 41) were not randomized and initially received CO2. Serum creatinine concentrations were measured within 1 day before and 1 day, 2 days, and 2-3 weeks after the procedure. RESULTS: The amount of injected CO2 did not relate to an increase in serum creatinine level. In the randomized groups, and also when the whole patient sample was considered, the amount of injected iodine was significantly correlated (P = .011) with an increase in serum creatinine level and a decrease in estimated creatinine clearance after 2 days. Among the randomized patients, one in the CO2 group and three in the ioxaglate group had a more than 25% increase in serum creatinine level within the first 2 days after the intervention. CONCLUSION: The risk of impairment of renal function is lower after injection of CO2 with small amounts of added ioxaglate compared with injection of a larger amount of ioxaglate alone. The larger the amount of administered iodinated contrast medium, the greater the risk of development of renal failure.

Acute Kidney Injury↗
PubMed2005

The effects of carbon dioxide versus ioxaglate in the rat kidney.

PURPOSE: The renal medulla seems to be particularly vulnerable to vascular injection of iodinated contrast media, particularly in patients with preexisting renal dysfunction. The gas carbon dioxide is frequently used as an alternative to iodinated contrast medium in these patients. In this study, the renal effects of CO(2) are investigated and compared with those of the iodinated contrast medium ioxaglate. MATERIALS AND METHODS: Cortical and outer medullary blood flow (measured by laser Doppler flowmetry) and oxygen tension (Po(2); measured by oxygen microelectrodes) were recorded in anesthetized Sprague-Dawley rats given an intraarterial injection of ioxaglate (320 mgI/kg body weight), a volume-matched dose of CO(2), or Ringer solution. RESULTS: Injection of CO(2) induced a pronounced and transient decrease in cortical blood flow and Po(2) (approximately -45%), whereas outer medullary blood flow and Po(2) were transiently increased (+21% and +29%, respectively). In contrast, injection of ioxaglate did not influence cortical blood flow and caused outer medullary blood flow to decrease by 17%. Ioxaglate injection also resulted in a decrease in cortical and outer medullary Po(2) (-15% and -33%, respectively). Ringer solution affected none of the recorded parameters. CONCLUSIONS: Although injection of CO(2) markedly affected regional renal blood flow and Po(2), there were qualitatively different effects in the cortex and outer medulla compared with those seen after injection of ioxaglate. The pronounced decrease in medullary blood flow and Po(2) observed after injection of ioxaglate was absent in the animals injected with CO(2). This might suggest beneficial effects of the use of CO(2) instead of iodinated contrast media in patients with increased risk of developing renal failure.

Animals↗
PubMed2005

Clinical implications for the management of acute thromboembolic occlusion of the superior mesenteric artery: autopsy findings in 213 patients.

OBJECTIVE: To study findings at autopsy in patients with fatal acute thromboembolic occlusion of the superior mesenteric artery (SMA). SUMMARY BACKGROUND DATA: Acute occlusion of the SMA is difficult to diagnose and mortality remains high. In Malmo, Sweden, the autopsy rate between 1970 and 1982 was 87%, creating possibilities for a population-based study. METHODS: Among 23,496 clinical autopsies and 7569 forensic autopsies, 213 cases with acute thromboembolic occlusion of the SMA and intestinal infarction were identified. RESULTS: A clinical suspicion of intestinal infarction was documented in 32% of the patients, only 35% being in the care of surgeons. The embolus/thrombus ratio was 1.4 to 1. Thrombotic occlusions were located more proximally than embolic occlusions (P < 0.001), intestinal infarction was more extensive (P = 0.025) and thrombotic occlusions were associated with old brain infarction (P = 0.048), aortic wall thrombosis (P = 0.080), and disseminated cancer (P = 0.079). Patients with embolic occlusions (n = 122) had a higher frequency of acute myocardial infarction (AMI) than patients with thrombotic occlusions (P = 0.049). The embolic source was identified in 80%. In 115 (94%), synchronous embolism and/or source of embolus were present. There were findings of remaining cardiac thrombi in 58 (48%) and synchronous emboli affected 273 other arterial segments in 83 (68%). CONCLUSIONS: Early recognition and revascularization would have been a prerequisite for survival in at least half of the patients, since the jejunum, ileum, and colon were affected by infarction. A minority of all patients were under surgical care. AMI, cardiac thrombi, and synchronous emboli were common findings among patients with embolic occlusions.

Acute Disease↗
PubMed2004

Oral imatinib mesylate (STI571/gleevec) improves the efficacy of local intravascular vascular endothelial growth factor-C gene transfer in reducing neointimal growth in hypercholesterolemic rabbits.

BACKGROUND: Platelet-derived growth factor (PDGF) antagonists have demonstrated beneficial effects on neointima formation, but in studies using PDGF inhibitors and extended follow-up, the lesions reoccur. These findings implicate a need to combine targeting of PDGF with other strategies. Stimulation of reendothelialization by treatment with endothelial cell mitogens of the vascular endothelial growth factor (VEGF) family counteracts restenosis, but there are also concerns regarding the durability of the effect with this approach. METHODS AND RESULTS: To explore whether a combined use of PDGF antagonist and stimulation of reendothelialization confers better results than each therapy alone, we combined systemic administration of imatinib mesylate (STI571/Gleevec, 10 mg/kg(-1) per d(-1)), a tyrosine kinase inhibitor with activity against PDGF receptors, with local intravascular adenovirus-mediated VEGF-C gene transfer (1.15x10(10) pfu) in cholesterol-fed, balloon-injured rabbits. Throughout the course of the STI571 therapy, the circulating concentrations were able to suppress PDGF receptor phosphorylation. At 3 weeks, the treatment with STI571 led to a transient decrease in intralesion macrophages and to an increase in intimal smooth muscle cell apoptosis. VEGF-C application reduced neointima formation and accelerated reendothelialization. However, none of the therapies alone reduced intimal thickening at a 6-week time point, whereas the combined treatment led to a persistent reduction (55% versus control) in lesion size at this time point. CONCLUSIONS: Our study provides one of the first successful examples of gene therapy combined with a pharmacological treatment to modulate 2 distinct ligand-receptor signaling systems and suggests combination of local VEGF-C gene therapy with systemic inhibition of PDGF signaling as a novel principle to prevent intimal hyperplasia after vascular manipulations.

Adenoviridae↗
PubMed2004

Low quality of life prior to screening for abdominal aortic aneurysm: a possible risk factor for negative mental effects.

The objective of this study was to evaluate the effect on quality of life (QOL) of screening for abdominal aortic aneurysm (AAA) in a population-based AAA screening program. Twenty-four patients with screening-detected AAA and 45 controls with normal aortic diameter were studied in a prospective, controlled, population-based study. Prior to and 12 months after the ultrasonography examination, all participants completed Short-Form 36 and at 12 months, 10 AAA-specific questions were added. Comparisons were made between the two groups (AAA patients and controls), within each group, and between the groups and norms for the general Swedish population in the same age interval. Our results showed that screening for AAA results in impairment of QOL among those who have the disease and who suffered a low QOL prior to screening. Among those who had an age-adjusted normal QOL prior to screening and who were found to have the disease, and among those who were found to have normal aortas, no negative effect on QOL was observed. Thus, low QOL before screening is a possible risk factor for negative mental effects of diagnosing an AAA by screening.

Activities of Daily Living↗
PubMed2004

Activation of fibrinolysis and coagulation in non-occlusive intestinal ischaemia in a pig model.

The present study was carried out to explore the dynamics of the fibrinolytic and coagulation systems during non-occlusive intestinal ischaemia in a porcine model. Nineteen pigs underwent laparotomy. The inferior mesenteric artery and the collateral vessels to the rectum were ligated. The superior mesenteric artery (SMA) was isolated at its origin from the aorta, and constriction and flowmeter devices were applied. The blood flow of the SMA was reduced to cause ischaemia in the distal colon within the pHi interval 6.9-7.1. Fibrinogen, soluble fibrin, D-dimer, tissue plasminogen activator/plasminogen activator inhibitor-1 (tPA/PAI-1) complex and albumin were measured. Corrections for pig D-dimer and albumin were performed. Fibrinogen decreased significantly after laparotomy (P < 0.0001) and further after constriction of the SMA (P < 0.05), whereas soluble fibrin increased significantly (P < 0.005) after constriction of the SMA. The tPA/PAI-1 complex increased significantly after laparotomy (P < 0.05) and, after constriction of the SMA, the values first tended to decrease (P = 0.06) and then to increase (P = 0.056). The need to calibrate assays of human plasma proteins when applying them to experimental pig models was demonstrated. After constriction of the SMA, there was a rapidly reversed peak in the coagulation marker soluble fibrin and a strong tendency of alteration of the fibrinolytic marker tPA/PAI-1 complex.

Animals↗
PubMed2004

Bleeding profiles of anticoagulants, including the novel oral direct thrombin inhibitor ximelagatran: definitions, incidence and management.

Ximelagatran is a novel oral direct thrombin inhibitor (oral DTI) that is currently in advanced clinical development for the prevention and treatment of thromboembolic events in a wide range of patient populations and indications. The clinical development of novel anticoagulant therapies requires that treatments be assessed according to both their clinical benefit (reduction of risk of thromboembolic events) and safety profile (primarily bleeding). Definition and assessment of bleeding severity is thus an important factor in clinical trial design. Lack of consistency in bleeding definitions used in different clinical trial programmes makes comparison of bleeding event data difficult. Standard bleeding definitions would be required to make fair comparisons between clinical trials possible. The definitions of bleeding events used in clinical trials of ximelagatran are broadly consistent with those used in many other major trials. Results of phase II and III trials comparing ximelagatran with currently available anticoagulant therapies demonstrate that ximelagatran can be used with fixed dosing with no coagulation monitoring, dose titration, or dose adjustment, without compromising efficacy or safety. The incidences of major bleeding events in clinical trials of ximelagatran have been low and similar to those with other anticoagulant drugs. Adequate treatment in case of emergency situations such as serious bleeding should include cessation of treatment and maintenance of adequate diuresis.

Administration, Oral↗