Glucose tolerance and fractional extraction of glucose and insulin in patients with peripheral arterial insufficiency. Effect of arterial reconstructive surgery.
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Adult↗
Biomedical subjects
J Hammarsten
Publications and source records attributed to J Hammarsten.
Enzyme activities in skeletal muscles from patients with peripheral arterial insufficiency.
The enzyme pattern in gastrocnemius muscle tissue was studied in 39 patients with peripheral arterial insufficiency. Phosphofructokinase and glucose-6-phosphate-dehydrogenase were significantly increased in the skeletal muscles from these patients. The most pronounced changes were found in 3-OH-acyl-CoA-dehydrogenase, citrate synthase, and in cytochrome-c-oxidase. These enzyme activities were increased by 60, 40 and 25 per cent respectively. In patients with claudication as the only symptom, the metabolic capacity was generally increased in skeletal muscles affected by the low blood flow. With increasing severity of arterial insufficiency, all enzyme activities decreased and glycolytic enzymes were affected first. 3-OH-acyl-CoA-dehydrogenase, citrate synthase and cytochrome-c-oxidase activities were still comparatively high in patients with gangrenous foot ulcers, indicating some maintenance of the muscle viability even in situations with very low blood flow.
Adult↗
Bile flow and biliary lipid secretion following release of biliary obstruction in man.
In order to elucidate the relationship between bile acid secretion and the secretion of lecithin and cholesterol in the postcholestatic condition, five patients were studied after release of complete biliary obstruction. Ten patients operated on for uncomplicated gallstone disease served as controls. The secretion of bile acids, which constituted only newly synthesized acids, increased in the postcholestatic period 2.5-22 times. In spite of that the secretion rate of bile acids was low (less than or equal to 7.5 mumol x min-1). The pattern of the relationships between bile acid secretion and bile flow and bile acid secretion and lecithin and cholesterol secretion was the same in the postcholestatic patients as in the controls. However, the bile flow showed a higher bile acid dependency in the postcholestatic condition, and the bile-acid-independent flow varied considerably in these patients as compared with controls. Linear relations between the secretion rate of bile acids and lecithin and cholesterol secretion rates were found. Extrapolation to zero bile secretion revealed Y-intercepts, which were not statistically significantly different from origo. Calculations of bile acid - lecithin and bile acid - cholesterol relations in the controls at correspondingly low bile acid secretion rates (less than or equal to 5 mumol x min-1) gave results similar to those in the study group. The bile was supersaturated with cholesterol in all the postcholestatic patients similar to the condition in the controls at correspondingly low bile acid secretion rates. It is concluded that the bile acids are determinative for the biliary secretion of cholesterol and lecithin even at very low bile acid secretion rates. This conclusion was valid in patients with presumably normal liver function as well as in the early phase after release of severe cholestasis.
Aged↗
Infections in vascular surgery.
The frequency of postoperative wound infections after 304 vascular surgical procedures was studied. Mean age of the patients was 67 years and the male-female ratio was 5:1. Seventyfive per cent of the operations were of elective type. Wound infections occurred in 12% and was in the majority of cases caused by staphylococcus aureus. Wound infection caused prolongation of hospital stay from 11.9 to 31.3 days. A higher frequency of postoperative wound infections was found in diabetics, in patients with manifest gangrene, in patients with long preoperative hospital stay and after operations with inadequate hemostasis. Infections are potentially dangerous and in this series they caused loss of limb and life in one patient and loss of limb in one.
Adult↗
Positive and negative effects of anticoagulant treatment during and after arterial embolectomy.
Eighty-four consecutive patients subjected to arterial embolectomy were studied. Cardiac arrythmia was found in 64% of the cases. The incidence of upper limb embolus was 15%, and lower limb 85%. Our total results are in agreement with most reports--the limb salvage rate of survivors was 84%, and the amputation rate was 16%. The primary mortality, 18%, is a rather low figure considering the high mean age (72 years) of the material. The prognosis after embolectomy was dependent on time from onset of symptoms and on the age of the patient. In the group of patients treated with anticoagulants the primary mortality was 7%, and in the untreated group 26%. The results of this investigation of patients treated with arterial embolectomy indicate: Adequate anticoagulant treatment during the per- and postoperative period decreased the primary mortality significantly, possibly as a result of fewer thromboembolic complications. The anticoagulant treatment was associated with a higher frequency of local complications as postoperative hemorrhage and reocclusions, which increased the frequency of reoperations and amputations. These drawbacks of anticoagulant treatment could possibly be counteracted by proper measures during the operation.
Adolescent↗
Peripheral arterial insufficiency. Experiences from 229 operated limbs.
The results of arterial reconstructions in 229 limbs in 177 patients were studied. Intermittent claudication resistant to physical training was indication for surgery in 82 cases and threatening gangrene in 147 cases. In the claudication group the long-term result was good in 77%, the reocclusion frequency was 21%, and the amputation rate was 2%. No operative mortality was encountered. In the gangrene group the long-term result was good in 40%, the reocclusion freuqency was 25%, the amputation rate was 24%, and theoperative mortality was 11%. Limb salvage rate was 65%. The results indicated that preoperative physical training did not jeopardice the operative results, but in most cases made surgical treatment unnecessary. In cases with threatening or beginning gangrene an aggressive attitude towards vascular reconstruction resulted in a substantial limb salvage.
Adult↗