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Biomedical subjects

J Holm

Publications and source records attributed to J Holm.

334 records · Page 19Linked to original sources
PubMedDate not supplied

Ankle-brachial index (ABI) and leg blood flow following epidural anaesthesia.

The influence of the severity of occlusive arterial disease, as evaluated from the ankle-brachial index (ABI) values, on blood flow and the distribution of blood flow within the lower limb following epidural block to the level of Th 4 to 6 was studied in 48 patients (ABI values ranging from 0.45-1.62). Leg (LBF) and foot (FBF) blood flows were measured with plethysmography and skin blood flow (SBF) was evaluated from laser-Doppler flowmetry and temperature recordings. The resting control LBF, FBF and SBF values were similar for all patients. Following the epidural block mean arterial blood pressure (MAP) decreased by about 20 mmHg. LBF, FBF and SBF all increased. There were significant correlations between the ABI values and the changes following the epidural block in LBF and FBF but not between ABI and SBF changes as evaluated from laser-Doppler flowmetry.

Aged↗
PubMedDate not supplied

Acute limb ischemia due to arterial embolism or thrombosis: influence of limb ischemia versus pre-existing cardiac disease on postoperative mortality rate.

Fatal outcome is common after arterial thromboembolectomy. Initial conservative treatment has been suggested to reduce the mortality rate, but the indications for such treatment are poorly defined. This analysis of 201 patients with acute arterial embolism or thrombosis demonstrates that advanced age, recent myocardial infarction, and proximal occlusions are associated with a high mortality rate after arterial thromboembolectomy. Operations performed 13-24 hours after the onset of ischemia, arteriosclerosis in the occluded artery and poor distal backbleeding after completion of thromboembolectomy were also associated with an increased mortality rate, whereas surprisingly the presence of pre-existing cardiac disease, recent myocardial infarction excluded, was not. The present findings suggest that the prognosis quoad vitam after arterial thromboembolectomy is influenced by limb ischemia itself and possibly also by the revascularization procedure. It is suggested that the severity of limb ischemia and an assessment of cardiac function should determine the initial treatment: conservative treatment, or early attempts at revascularization.

Acute Disease↗
PubMedDate not supplied

Effects of intravenous injection of diatrizoate, iohexol or ioxilan on renal size, urine profiles and blood profiles in the rabbit.

Diatrizoate, iohexol or ioxilan were injected intravenously in 18 rabbits. The contrast medium passage through the kidneys was recorded on digital subtraction images for the first 50 s followed by 100 mm exposures up to 15 min after injection. The renal area was measured planimetrically. Urine profiles (glucose, phosphate, LDH, GGT, NAG), blood profiles (potassium, urea) and the relative clearance of albumin and sodium were followed for 5 days and compared with a control group injected with saline. All kidneys were examined by light and immunofluorescence microscopy. All three contrast media produced excellent arteriograms and urograms. The three different contrast media caused a rapid increase of the kidney area within the first minute, reaching an average maximum of 10 to 12 per cent after 5 min, followed by a gradual decline. Contrary to expectations the increase in renal area was similar for all three contrast media, so hyperosmolality is no likely explanation of this phenomenon. None of the contrast agents caused significant changes in any of the profile components with one exception: the GGT excretion was significantly elevated during the first 24 h after diatrizoate administration as compared with the effect of saline. Light and immunofluorescence microscopy revealed no differences.

Animals↗
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Arterial thromboembolectomy--should anticoagulants be administered?

Perioperative administration of heparin with subsequent coumarin therapy is often recommended in surgery for acute limb ischemia. This retrospective study compares the results of arterial thromboembolectomy with and without concomitant use of anticoagulants. Good results were more common in adequately anticoagulated patients, but the hospital death rate did not differ. Further analysis, however, showed that the better results in the anticoagulated patient group could have been influenced by selection factors. The cumulative recurrence rate of thromboembolism was not significantly reduced in patients on long-term anticoagulation treatment. A review of 15 recently published series of acute limb ischemia showed similar results from centers in which anticoagulants were administered after arterial thromboembolectomy and in centers where postoperative anticoagulant therapy was not used. Definite evidence of a beneficial effect of anticoagulants given before and after arterial thromboembolectomy thus is concluded to be lacking, and a prospective randomized trial is required.

Aged↗
PubMedDate not supplied

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↗
PubMedDate not supplied

Ileofemoral venous thrombectomy.

Twentyeight patients with ileofemoral venous thrombosis were treated surgically. Five of the patients had moderate degree of venous congestion, 18 patients had phlegmasia alba dolens and five patients had phlegmasia coerulea dolens. The mean age was 54 years, range 15-80 years, and 15 were men and 13 were women. In all cases the thrombosis was verified by phlebography. Thrombectomy was performed with a Fogarty venous thrombectomy catheter. Peroperative phlebography was used in most cases to guarantee complete extraction of thrombotic material. No operative pulmonary embolism or mortality was encountered. Postoperative continuous heparin infusion in the thrombectomized segment was used for the first week followed by dicumarol treatment. The patients were followed from 6 months to 4 years postoperatively. In two patients thrombectomy was not possible to perform. One of these patients developed a pronounced postthrombotic syndrome, the other developed venous congestion of more moderate degree. Excellent long-term time results were obtained in 82% of the patients and satisfactory in 14%. Thrombectomy is an efficient treatment of ileofemoral venous thrombosis.

Adolescent↗
PubMedDate not supplied

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↗
PubMedDate not supplied

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↗