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Biomedical subjects

E Wahlberg

Publications and source records attributed to E Wahlberg.

At least 19 recordsLinked to original sources
PubMed2002

A new automated toe blood pressure monitor for assessment of limb ischemia.

OBJECTIVE: toe blood pressure (TBP) is an important method to assess peripheral arterial disease especially in patients with diabetes, but remains difficult to measure. We have developed a simple portable device for TBP measurements. METHODS AND RESULTS: first, TBP was determined in 40 ischemic legs with both laser Doppler and photoplethysmography for perfusion monitoring, to assess if laser Doppler can be used for measurements. The median values recorded were identical, but slightly higher values were obtained with laser Doppler (p=0.03). Secondly, a computer based algorithm for automatic TBP readings with laser Doppler was compared to manual assessment in 28 legs of 20 patients. The median values differed 3mmHg (p=0.10). Finally the applicability of the new device was tested in eight legs of six patients by two nurses. CONCLUSION: laser Doppler is appropriate for perfusion monitoring during TBP measurements and automatic pressure readings seem accurate. The automatic portable device is simple to use and can probably determine TBP.

Adult↗
PubMed2001

Gender differences in vascular interventions for lower limb ischaemia.

OBJECTIVES: to investigate changes in intervention for lower limb ischaemia with regard to gender. MATERIAL AND METHOD: type of procedure, the age and gender of all patients (8687) undergoing interventions (12 295) for lower limb ischaemia in Stockholm 1970-1994, were obtained from the National Board of Health and Welfare. RESULTS: interventions rose from 18 per million inhabitants in 1970 to 786 in 1994. The proportion of women treated grew from 34% to 48%. The number of embolectomies decreased from 80 to 69 per million. Infrainguinal reconstructions increased most from 38 in 1980-1984 to 186 per million inhabitants in 1990-1994, with the proportion of women increasing from 33 to 43%. Mean age increased from 63 to 71 years. CONCLUSIONS: there was a marked increase in the number of procedures, the proportion of female patients and mean age.

Age Factors↗
PubMed2000

[Iatrogenic vascular injuries demand a lot from the surgeon. Better to prevent--errors and lack of knowledge can have serious consequences for the patient].

To investigate causes and consequences of iatrogenic vascular injuries requiring surgical repair, we retrospectively reviewed 18 cases during a ten year period between 1989 and 1999 at Karolinska sjukhuset. We hoped to identify specific injury patterns in these cases, which were found in all operating specialties. Inattention to vascular structures was the single most common cause of iatrogenic vascular injury. The second most common context was radical operations of cancers in which the tumor was adjacent to the vessel. A third cause was misunderstanding of the specific anatomy of the area. This study demonstrates that serious iatrogenic vascular injuries pose a great challenge for the surgeon. Representing a significantly increased risk for the patient, these serious incidents should be preventable through modifications in surgical technique.

Adult↗
PubMed2000

Continuous assessment of local metabolism by microdialysis in critical limb ischaemia.

OBJECTIVE: to investigate the feasibility of using microdialysate glucose, lactate and pyruvate concentrations for grading the severity of blood flow reduction in patients with critical limb ischaemia. PATIENTS AND METHODS: microdialysis catheters were inserted (two subcutaneously and one intramuscularly) in the symptomatic limb of ten patients. To further reduce limb perfusion, the lower leg was elevated during part of the experiment. RESULTS: elevation reduced ankle and toe blood pressure and transcutaneous oxygen tension. Microdialysate glucose concentration decreased at all three catheter sites, while lactate increased in the intramuscular catheter. Two patients interrupted the elevated position prematurely due to severe pain in the foot. They had among the highest lactate levels in the horizontal position and the most marked increases following provocation. Neither initial metabolite concentrations nor concentration changes during elevation were shown to correlate to conventional methods used to assess limb perfusion. CONCLUSIONS: in patients with critical limb ischaemia microdialysis can be used without complications. A significant decrease in glucose concentration may reflect lowered blood flow in the elevated position. Metabolic response, i.e. increase in lactate concentration during profoundly reduced limb perfusion was heterogeneous, indicating an overestimation of the presence of ischaemia in some patients using current diagnostic methods.

Arterial Occlusive Diseases↗
PubMed1999

[Intermittent claudication--a major cardiovascular risk factor. Proposed guidelines for investigation and treatment].

Intermittent claudication is a common disorder, the diagnosis of which can usually be made on the basis of careful history taking and physical examination. Treatment should be focused on abstinence from smoking, increased daily walking distance, risk-factor modification, and aspirin prophylaxis. Laboratory studies including duplex ultrasonography should be limited to cases where uncertainty exists or to the preoperative work-up for invasive intervention. Intermittent claudication patients merit special attention as a category at high risk of cardiovascular disease, and in whom risk factors such as hypertension, hyperlipidaemia and diabetes need to be identified and treated.

Cardiovascular Diseases↗
PubMed1999

Sexual function in women suffering from aortoiliac occlusive disease.

OBJECTIVE: To describe the sexual function in women suffering aortoiliac occlusive disease (AIOD) and in an age-matched reference group. PATIENTS AND METHODS: Thirty-six women suffering from AIOD were included. Twenty were investigated before vascular intervention (untreated) and 16 different women after treatment (treated). Eighteen age-matched women served as a reference group. The patients answered a questionnaire including sexual, social and medical questions and a gynaecological examination was performed. RESULTS: Untreated patients with AIOD have a significantly impaired physical well-being compared to the other groups (p < 0.001). A negative effect of the vascular disease and its treatment on sexual life was experienced by 69% of treated compared to 40% affected among untreated (p = 0.05). Vulval sensibility was impaired in 44% of treated, 11% of untreated and 22% of reference patients. Defective anal sphincter function was found in 33% of treated, 17% of untreated and 6% in the reference group. Those differences were not statistically significant. CONCLUSIONS: Symptomatic AIOD in women is associated with a significantly impaired physical and sexual well-being. Though limited by size and methodology, the results indicate the possibility of iatrogenic nerve damage.

Adult↗
PubMed1999

The toe pole test for evaluation of arterial insufficiency in diabetic patients.

OBJECTIVES: to evaluate if the pole test at the toe level can be used for assessment of arterial insufficiency in diabetic patients. METHODS: twenty-five legs in 23 diabetic patients suffering from leg ischaemia were examined prospectively. A laser Doppler probe was attached to the pulp of the first toe to monitor perfusion continuously before and after occluding the arterial inflow with a cuff and during elevation of the leg until perfusion disappeared (the pole test). At ankle level the examinations were made similarly but with an ankle cuff and a hand-held Doppler. RESULTS: in the 44% (11/25) of the legs where it was possible to compare cuff blood pressure at ankle level with the pole test, the cuff measurements were significantly higher (p <0.01). In 13 of the remaining 14, maximal elevation did not result in disappearance of the Doppler signal. At toe level where 76% (19/25) of the legs could be compared, there was no significant difference between the two methods. CONCLUSION: the pole test can be used at the toe level to evaluate arterial insufficiency in diabetes. When used in the toe, the pole test can assess pressures below 55-70 mmHg, while only pressures below 45 mmHg can be determined at the ankle level. Falsely elevated blood pressure in diabetics is probably of less importance in digital arteries than in ankle arteries, which makes cuff pressure at toe level a more acceptable approximation.

Aged↗
PubMed1997

Patients with diabetes and critical limb ischemia have a high peripheral vascular resistance.

Results of infrainguinal bypass surgery may be better in diabetic patients compared with nondiabetic patients. One important determinator of outcome in these operations is the peripheral vascular resistance (PR). The aim of the present prospective study is to evaluate whether there is a difference in PR in diabetic and nondiabetic patients with critical limb ischemia. The two patient groups (n = 11 for each) were matched for toe pressure, age, gender, and outflow vessel, PR was measured intraoperatively during infrainguinal bypass surgery by controlled infusions of autologous blood. The resistance was significantly higher in the diabetic group (p < 0.05), as compared to the nondiabetic group. Except for fibrinogen that tended to be higher in diabetics (p = 0.07), blood parameters, blood pressures and angiographic scoring of run-off were similar in both groups. This finding of higher PR in diabetic patients with critical limb ischemia compared with matched nondiabetic ischemic patients suggests that a low PR is not the reason for the positive results of infrainguinal bypass surgery in diabetic patients.

Aged↗
PubMed1997

Gene therapy and vascular disease: potential applications in vascular surgery.

Advances in molecular biology have generated methods that are used to enhance diagnosis and treatment of a variety of human diseases. More recently modification of gene expression in cells by gene transfer has been introduced as a new therapeutic modality. The targeting of vascular cells with this method is appealing not only for anatomical reasons, but also because endovascular techniques provide access to the vasculature and makes site-specific delivery possible. Over the past few years, gene transfer has been widely used to explore the pathophysiology of vascular diseases in experimental models and available data suggests that this method may eventually become a therapeutic alternative for vascular disorders such as restenosis, graft failure, and critical ischaemia. In the following we discuss the methodology of gene transfer, its tentative use in vascular diseases related to vascular surgery, and the problems associated with this new technology.

Animals↗
PubMed1996

Postocclusive reactive hyperemia estimating peripheral vascular resistance: a noninvasive method to predict outcome of infrainguinal vascular reconstructions?

OBJECTIVE: The peripheral vascular resistance is an important factor determining the outcome of infrainguinal revascularizations. When measured intraoperatively, it correlates to graft patency, but to select patients to surgery a preoperative, preferably noninvasive, method is necessary. The aim of the present study is to test if parameters recorded during postocclusive reactive hyperemia can be used for that purpose. EXPERIMENTAL DESIGN: This prospective study compares patients with occluded grafts within 30 days postoperatively to patients with patent grafts. SETTING: University Hospital. PATIENTS: Thirty patients with critical ischemia scheduled for infrainguinal bypass surgery. MEASURES: Correlations between intraoperatively measured peripheral resistance and preoperatively recorded parameters of postocclusive reactive hyperemia. The ability of the values to predict outcome. RESULTS: Peripheral resistance correlated significantly to two parameters during postocclusive reactive hyperemia recorded after thigh occlusion, flux reappearance time (r=0.47, p=0.01) and time to peak flux (r=0.41, p=0.03). Intraoperative peripheral resistance predicted graft occlusion at 30 days with a 90% accuracy, while parameters obtained during reactive hyperemia, only tended to predict adverse outcome. CONCLUSIONS: Several parameters during reactive hyperemia show weak correlation to intraoperatively measured peripheral resistance, but none was able to accurately predict graft failure. Further studies are needed to evaluate its capability for patient selection.

Aged↗
PubMed1995

Changes in postocclusive reactive hyperaemic values as measured with laser Doppler fluxmetry after infrainguinal arterial reconstructions.

OBJECTIVES: The aim of the present study was to evaluate microcirculartory changes of the postocclusive reactive hyperaemia test measured with Laser Doppler fluxmetry to detect results of arterial reconstructions. DESIGN: Prospective open study. SETTING: Vascular laboratory of a University Hospital. MATERIAL: Sixty patients with peripheral arterial occlusive disease who underwent infrainguinal reconstruction were examined the day before and 1-2 days after surgery. CHIEF OUTCOME MEASURES: The values were obtained during postocclusive reactive hyperaemia induced by release of a 3 min arterial occlusion with a cuff at ankle level with the laser Doppler probe placed dorsally on the first toe. The alterations after surgery in these hyperaemia parameters were compared to changes in ankle/brachial index and clinical improvement at 30 days postoperatively. MAIN RESULTS: Patients improved by surgery according to ankle/brachial index had significantly reduced time to peak (p < 0.001) and significantly increased resting flux value (p < 0.05) and peak flux value (p < 0.05). There was a significant correlation between the change after surgery in time to peak flux and increment of ankle/brachial index (r = 0.63, p < 0.001). CONCLUSIONS: Changes in reactive hyperaemia values as measured with laser Doppler fluxmetry, especially the time to peak flux, seem to detect circulatory changes caused by arterial reconstructions.

Aged↗
PubMed1995

PAS-Port: a new implantable vascular access device for arm placement: experiences from the first two years.

OBJECTIVE: To evaluate the performance of a new subcutaneous infusion port for placement in the arm. DESIGN: Retrospective study. SETTING: Karolinska Hospital, Stockholm, Sweden. SUBJECTS: 85 of 90 consecutive patients referred for implantation of a subcutaneous infusion port. Five records were missing. Implantation was successful in 81 cases (95%). INTERVENTIONS: Implantation of a PAS-Port (Kabi Pharmacia Deltec) subcutaneously on the forearm. Vascular access was obtained by cut-down. MAIN OUTCOME MEASURES: Success rate, complications and reliability in routine use. RESULTS: After a follow-up time of 1-24 months (median 5), 42 ports were still in use, 21 patients had died with functioning ports, two ports had been removed at the end of treatment, 11 had been removed because of complications and because they malfunctioned; and 3 patients were lost to follow-up. The overall infection rate was 0.08/100 catheter days. CONCLUSIONS: PAS-Port is a safe alternative to chest-placed port systems where there is a need for long term vascular access in adult patients.

Adolescent↗