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Biomedical subjects

L Perbeck

Publications and source records attributed to L Perbeck.

At least 37 records · Page 2Linked to original sources
PubMed1993

Changes in skin blood flow in ischaemic limbs after vascular reconstruction measured by fluorescein flowmetry and laser Doppler flowmetry.

It is not known to what extent the skin blood flow increases after vascular reconstruction in ischaemic limbs. Thus, a study was undertaken to measure skin blood flow, using the two techniques laser Doppler flowmetry and fluorescein flowmetry, before and after vascular reconstruction. The skin temperature was measured also. The plantar circulation was assessed in 14 patients (9 non-diabetics and 5 diabetics; mean age 65 years; range 47-80), with the patient in the supine position, 1-2 days before and 8-10 days after surgery. After vascular reconstruction the skin blood flow increased by 240% (P < 0.01) when measured by fluorescein flowmetry and by 148% (P < 0.01) when measured by laser Doppler flowmetry, and the skin temperature rose by 3.2 degrees C (P < 0.01). In the contralateral non-operated limb there was no significant change in skin blood flow as measured by the two methods. The results imply that after vascular reconstruction in ischaemic limbs the skin blood flow increases both in the superficial layer as determined by fluorescein flowmetry (which measures the blood flow down to 0.6 mm) and in deeper layers as determined by laser Doppler flowmetry (which measures flux down to 6 mm).

Adult↗
PubMed1992

The effect of weight-bearing pressure on the plantar circulation in diabetes mellitus.

Patients with diabetic neuropathy are prone to ulceration on the sole of the foot, especially in areas with high weight-bearing pressure. The relationship between weight-bearing pressure and nutritive skin circulation in the plantar region was studied. Gait analysis was performed with the EMED Gait Analysis System and the skin circulation was measured by fluorescein flowmetry in ten neuropathic diabetic patients and in eight healthy controls. The critical plantar foot pressure above which nutritional blood flow in the skin was arrested was 3 N cm-2 or more in both diabetic and control subjects. Below 3 N cm-2 the blood flow was independent of weight-bearing pressure both in diabetic and control subjects (correlation coefficient r = -0.01 and -0.19, respectively). Thus, our results indicate that the nutritional blood flow in the plantar region is not decreased in patients with diabetic neuropathy.

Adult↗
PubMed1992

The circulation in the nipple-areola complex following subcutaneous mastectomy in breast cancer.

To evaluate the decrease in circulation in the nipple-areola complex after subcutaneous mastectomy and immediate implantation of a submuscular prosthesis, the blood flow was studied by both fluorescein flowmetry and laser Doppler flowmetry in 24 patients with invasive breast cancer. In 14 patients a lazy-S-shaped horizontal lateral incision was used, and 10 underwent a subcutaneous reduction mammaplasty. After subcutaneous mastectomy with a lazy-S incision there was no significant decrease in blood flow in the nipple-areola complex compared with that in the untreated contralateral breast. In the breasts in which reduction mammaplasty had been done, the blood flow was reduced by 74% as measured by fluorescein (p less than 0.01), and 70% by laser Doppler flowmetry (p less than 0.05), compared with the contralateral breast. Five patients had partial or complete epidermal, and one patient had total dermal, necrosis of the complex, but there was no deep necrosis. No fluorescence was seen within the areas in which necrosis later developed in any of these six cases. The laser Doppler signal in the corresponding areas, however, was not reduced. The results show that the circulation in the nipple-areola complex is reduced more after subcutaneous reduction mammaplasty than after subcutaneous mastectomy with a lazy-S incision.

Adult↗
PubMed1992

Hyperparathyroidism associated with treatment of manic-depressive disorders by lithium.

OBJECTIVE: To clarify the association between treatment of affective psychiatric disorders with lithium, and the development of secondary hyperparathyroidism. DESIGN: Retrospective review of medical records, 1973-89. SUBJECTS: 17 patients with affective psychiatric disorders who were treated with lithium (n = 6) or with tricyclic antidepressant, or neuroleptic, drugs (n = 11) all of whom were operated on for hyperparathyroidism. MAIN OUTCOME MEASURE: Duration of lithium therapy and parathyroid histology. RESULTS: Parathyroid hyperplasia was present in 5 patients who had taken lithium during a median period of 13 years. A parathyroid adenoma was found in one patient treated with lithium for three years. Ten of the 11 patients who had been treated with tricyclic antidepressant, or neuroleptic drugs had a parathyroid adenoma and the remaining one had an adenoma as an underlying cause of hyperparathyroidism. CONCLUSION: Hyperparathyroidism in patients who have undergone long term treatment with lithium is associated with parathyroid hyperplasia. This indicates that lithium may exert a chronic stimulus that results in secondary hyperparathyroidism.

Adenoma↗
PubMed1991

Routine examination of the vocal cords before and after thyroid and parathyroid surgery.

A prospective study of the value of routine examination of the vocal cords in 239 patients before and after thyroid or parathyroid surgery is presented. From the patient's history and voice the surgeon assessed before and after operation whether vocal cord examination was necessary or not. The surgeon's judgement was compared with the phoniatrician's report. All except one of the documented recurrent laryngeal nerve palsies were suspected by the surgeon. No additional important clinical information was gained by the laryngologist's examinations. Routine vocal cord examination in connection with thyroid and parathyroid surgery is probably not necessary.

Adolescent↗
PubMed1991

Skin circulation in the nipple after reduction mammaplasty with a bipedicle vertical dermal flap.

Necrosis of the nipple after a reduction mammaplasty with transposition of the nipple is a serious complication. A study was undertaken to measure the skin circulation in the nipple before, during and after this operation. In 16 patients undergoing reduction mammaplasty according to the method of McKissock, the skin circulation was measured in both breasts by laser Doppler flowmetry (LDF) and fluorescein flowmetry (FF). LDF showed that the skin circulation increased after de-epithelialization to 245.7 +/- 39.3% of the preoperative blood flow (100%) (mean +/- SEM, p less than 0.01). When 40 ml of 0.25% adrenaline was injected into the incision lines, the corresponding increase in blood flow was 153.4 +/- 15.6% (p less than 0.01). After the medical and lateral glandular resections the blood flow in the nipple of the vertical dermal pedicle was 125.6 +/- 21.2% of the preoperative blood flow and when adrenaline was given the corresponding value was 79.3 +/- 6.5%. After the skin had been sutured, the blood flow was 128.4 +/- 25.9% of the preoperative value and in the breast in which adrenaline was injected it was 177 +/- 96.9%. One to four days postoperatively the blood flow was 123.1 +/- 19.9% of the preoperative value and in the breast that received adrenaline 130 +/- 24%. At FF homogeneous fluorescence was observed in the nipple postoperatively in all patients but one; in this patient avascular necrosis later developed. Our results thus show that the circulation in the nipple after reduction mammaplasty by the McKissock method is adequate.

Adult↗
PubMed1990

Vascular changes in the chest wall after unilateral resection of the intercostal nerves in the growing rabbit.

In young, growing white New Zealand rabbits the third, fourth, and fifth intercostal nerves were resected anteriorly on the right side. Six months later the animals developed structural left convex scoliosis, with a Cobb angle ranging from 15 to 31 degrees. The vascular structure changes of the anterior chest wall were evaluated by measuring surface temperature and fluorescein intensity of the pectoral muscles, and the capillary density of the pectoral and intercostal muscle and periosteal parts of the ribs after angiography. In five normal control rabbits there was neither scoliotic deformity nor significant differences in the examined vascular variables between the right and left sides. In the animals undergoing resection, the temperature of the pectoral muscle on the side of the denervation--the right side--was significantly increased (p less than 0.05), but the difference was not correlated to the degree of scoliosis. The fluorescence index was significantly greater (p less than 0.05) on the right than on the left side, this difference being fairly strongly correlated to the degree of scoliosis. The capillary densities of the costal periosteum and the intercostal and the pectoral muscle were significantly greater (p less than 0.05) on the right than on the left side, and the difference was positively correlated to the degree of scoliosis. The volume density of the periosteum of the ribs was likewise significantly greater on the right. These results demonstrate that unilateral resection of the intercostal nerves significantly increases the vascularity of the structures on the denervated side of the thorax.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1990

Studies of human gastric mucosa after application of 0.42% fluoride gel.

Dental prophylaxis with APF gels (1.23%) may cause gastric distress as a side-effect. This gastric irritation is probably due to a direct toxic effect of fluoride (F), swallowed in conjunction with the treatment, on the gastric mucosa. The aim of the present study was to investigate whether--and to what extent--a dental treatment with 3 g of a 0.42%-F gel could affect the gastric mucosa due to inadvertent swallowing of the gel. Ten subjects underwent a control gastroscopy, and two weeks later, a second gastroscopy was performed two h after a F gel treatment. During the gastroscopy, the mucosa was examined and the injuries graded according to an arbitrary scale. Four biopsies of the antral and corpus regions of the stomach were taken and evaluated histologically. The mean (+/- SD) amount of F retained after the application was 5.1 +/- 2.1 mg, i.e., 40% of the applied amount of F. Petechiae and erosions were found in the mucosa in seven of the ten patients. The histopathological evaluation revealed changes in nine of ten patients, with the surface epithelium as the most affected component of the mucosa. The present study clearly shows that a treatment with a F gel of rather low F concentration may result in injuries to the gastric mucosa. The importance of current recommended guidelines so that the amount of F swallowed during a gel application can be minimized is emphasized. From a toxicological standpoint, the use of a low-F gel instead of a 1.23%-F gel in small children is recommended for avoidance of adverse gastric effects.

Binomial Distribution↗
PubMed1990

Correlation between fluorescein flowmetry and laser Doppler flowmetry. A study in the intestine (ileoanal pouch) in man.

A study was undertaken to compare two new methods of capillary blood flow measurement, namely fluorescein flowmetry (FF) and laser Doppler flowmetry (LDF). The blood flow was measured in a pelvic pouch during its construction and in the completed ileoanal anastomosis in 12 patients. There was a high correlation between the two methods (correlation coefficient, 0.78) (p less than 0.01) when the blood flow was measured in the pelvic pouch. The correlation coefficient between the two methods for the difference between the blood flow in the pelvic pouch at the site of the planned anastomosis when the pouch resided in the abdomen and that in the completed ileoanal anastomosis was r = 0.99 (n = 12, p less than 0.001); the reduction amounted to 25% as measured by FF and 27% as measured by LDF (n = 12, p less than 0.01). All ileoanal anastomoses healed perfectly, the lowest FF and LDF values being 0.004 density units/sec and 0.3 V, respectively. The results indicate that either method can be considered for measuring capillary blood flow.

Adenomatous Polyposis Coli↗
PubMed1989

Intrathoracic microvascular circulation in haemorrhagically shocked rats. Studies by fluorescence techniques.

The microvascular circulation in the heart, lung and thymus was studied by fluorometry in 32 haemorrhagically shocked rats. Exsanguination to a blood pressure of 35 mmHg for 180 min did not result in any reduction of this circulation in the heart or lung, but in the thymus it was reduced by 52%. Retransfusion of shed blood caused no change in cardiac microcirculation, whereas the microcirculation in the thymus was increased by 59%. In the lungs a heterogeneous fluorescence pattern was observed after retransfusion, with large dark areas alternating with normal fluorescent ones and even some small intensively fluorescent areas. After retransfusion, maldistribution of blood flow seems to be a phenomenon of haemorrhagic shock in the lungs.

Animals↗
PubMed1988

Skin circulation in the nipple after reduction mammaplasty by upper and lower glandular resections.

Avascular necrosis of the nipple is a serious complication of reduction mammaplasty with nipple transposition. A study was undertaken to measure the skin circulation in the nipple before, during and after this operation. In 14 patients undergoing a reduction mammaplasty according to the method of Strömbeck, the skin circulation was measured in 25 breasts with laser doppler flowmetry (LDF) and fluorescein flowmetry (FF). LDF showed that the skin circulation increased after de-epithelialization to 204.4 +/- 31.0% of the preoperative value (100%) (mean +/- SEM, p less than 0.01). After the upper and lower glandular resection the circulation was reduced to 90.7 +/- 12.3% of the preoperative value. The division of the lateral pedicle did not affect the circulation. After the skin had been sutured, the circulation was 71.5 +/- 9.1% of the preoperative value (p less than 0.01). One to four days postoperatively the circulation was 100.3 +/- 13.2% of the preoperative value. At FF uniform fluorescence was observed in the nipple postoperatively in all patients but two, in whom avascular necrosis later developed. Our results thus show that the circulation in the nipple after reduction mammaplasty by the Strömbeck method is adequate and that it is safe to divide the lateral dermal pedicle.

Adult↗
PubMed1987

The transcapillary exchange of sodium fluorescein in ischaemic limbs measured by fluorescein flowmetry.

The transcapillary exchange of sodium fluorescein in the skin of 36 extremities (19 patients) with arterial occlusive disease was measured using two different ways of analysing the tissue fluorescence, fluorescein flowmetry (FF) and dynamic fluorescein angiography (FA). 7 mg sodium fluorescein/kg body weight was given intravenously. With FF, the transcapillary exchange of sodium fluorescein is expressed in arbitrary units as a fluorescence index. With FA, the time interval from the bolus injection to the first appearance of the fluorescence in the tissue is measured. There was an inverse correlation between pain and fluorescence index. All eight extremities with a fluorescence index of 0.001 density units/s or lower needed amputation, whereas all extremities with higher indices were viable. All extremities requiring amputation had an appearance time of 150 s or more, which contrasted with those remaining viable, having an appearance time of 120 s or less. The results indicate that FF as well as FA are appropriate methods to measure a 'nutritive' transport of solutes in the skin. Theoretically, however, if quantitative values for blood flow are required, we recommend FF, this method being more adequate, since it is influenced both by the fraction of cardiac output distributed to the tissue and by cardiac output itself. If, however, only a prognosis of a limb's viability is needed, FA is sufficient, being easier to perform, only requiring the measurement of the appearance time.

Adult↗
PubMed1987

Endoscopic fluorescein flowmetry in the evaluation of gastric and duodenal mucosal blood flow.

Fluorescein flowmetry (FF) implies the measurement of a relative capillary blood flow, expressed as an index--that is, the ratio between the maximum fluorescence, obtained during the first circulatory passage of sodium fluorescein (Na-F), and the rise time, defined as the time interval between 10% and 90% of the maximum fluorescence. The aim of this study was to develop FF to be used during endoscopy for the evaluation of ventricular and duodenal mucosal blood flow. FF was applied during gastroduodenoscopy in 38 patients with normal mucosa, as verified by histopathologic examination. The blood flow index did not differ significantly for the mucosa of the fundus, corpus, and antrum. However, when compared with the duodenal mucosa, the blood flow index of the ventricular mucosa was almost twice as high (P less than 0.01). This, in turn, was due to a significantly higher maximum fluorescence in the ventricular mucosa (P less than 0.01), indicating a denser capillary network than in the duodenal mucosa. Since FF is a reliable method, easy to perform and without complications, it is suitable whenever mucosal blood flow warrants measurement during endoscopy.

Adult↗
PubMed1986

The effect of palliative biliodigestive operations for unresectable pancreatic cancer.

During a 12 year period 38 patients underwent various palliative biliodigestive procedures for unresectable pancreatic carcinoma. Jaundice, upper abdominal pain and weight loss was present in 82%, 53% and 40% of the patients respectively. Serum bilirubin was elevated in 95% of patients, on average almost 9 times the upper limit of normal. Alcaline phosphatase was elevated in 97% of patients, on average almost 5 times the upper normal limit. Fourteen patients died without leaving hospital, 10 within one month, for an inhospital mortality of 36.8%. For the remaining 24 patients mean survival was slightly more than 7 months. Only 4 patients survived for more than one year. Palliation thus was short but reasonably good as judged by decrease in serum bilirubin and alcaline phosphatase levels.

Aged↗