Biomedical subjects
Publications and source records attributed to P Ortenwall.
Although some techniques have been described for securing chest tubes, many complications are still reported. A simple method is described for securing chest tubes and closure of the wound, resulting in good fixation of the tube and an airtight closure of the chest wall with a cosmetically satisfactory result.
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OBJECTIVE: To document the occurrence, causes, severity and consequences of accidental injuries over a time period May 1989-May 1992. DESIGN: Prospective study. SETTING: County of Alingsås, Sweden. SUBJECTS: 33,000 inhabitants. MAIN OUTCOME MEASURES: Incidence, age, sex, activity preceding accident, mechanism of trauma, type of injury and injury severity score (ISS). RESULTS: The yearly incidence was 14.7% (n = 4,867), and a third of them occurred within the home. The largest percentage (36%) happened during spare time activities, followed by sports (18%), and on the road (11%). Only 34 (0.7%) were severe injuries (ISS > 12). Most injuries (67%) occurred in people below the age of 40. The risk of getting injured was the same for elderly (> 75) as for young people, and 9% of all those who were injured were admitted to hospital. CONCLUSIONS: Injuries were a common reason for seeking medical attention, but only 1 in 10 needed admission to hospital. Most injuries occurred at home during spare time activities. Serious injuries were rare.
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UNLABELLED: Local fibrinolytic changes in atherosclerotic arteries have been suggested to influence plaque growth and promote mural thrombosis on ruptured or ulcerated plaques. Increased levels of plasminogen activator inhibitor (PAI-1) have been found in atherosclerotic arteries. In this study tissue plasminogen activator (t-PA), urokinase-type plasminogen activator (u-PA) and PAI-1 were localized in arterial biopsies of healthy and atherosclerotic vessels by immunohistochemistry. The expression of fibrinolytic regulators was related to the distribution of endothelial cells (EC) and macrophages. RESULTS: t-PA was expressed in vasa vasorum. PAI-1 was positive in endothelial cells, in the media and in the adventitia. Increased expression of t-PA, u-PA and PAI-1 was found in atherosclerotic vessels. t-PA, u-PA, PAI-1 and macrophages were co-localized in plaques. These results support the concept that macrophages can be important in the local regulation of fibrinolysis in atherosclerotic vessels.
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OBJECTIVES: This study was designed to test the hypothesis that spinal cord stimulation (SCS) improves limb salvage in patients with inoperable severe leg ischaemia. DESIGN: Prospective randomised controlled study with 18 months follow-up. SETTING: Vascular surgical units in two university hospitals. MATERIALS: Atherosclerotic (n = 41) and diabetic (n = 10) patients having chronic leg ischaemia with rest pain and/or ischaemic ulcerations due to technically inoperable arterial occlusions. CHIEF OUTCOME MEASURES: Limb salvage and amount of tissue loss within 18 months, pain relief. MAIN RESULTS: Twenty-five patients were randomized to SCS and 26 to analgesic (control) treatment. Macrocirculatory parameters were not different in the two groups during follow-up. Long-term pain relief was observed only in the SCS group. At 18 months, limb salvage rates in the SCS and control groups were 62% and 45% (N.S.). Tissue loss was less (p = 0.05) in the SCS group. A subgroup analysis of patients without arterial hypertension showed a significantly lower amputation rate in the SCS vs the control group. CONCLUSIONS: SCS provided long-term pain relief but limb salvage at 18 months was not significantly improved by SCS in this rather small study. The results suggest that SCS may reduce amputation levels in patients with severe inoperable leg ischaemia and be most effective in patients without arterial hypertension.
The incidence and mortality rate of ruptured aortic aneurysm in a defined and stable Swedish population was determined for the period 1952-1988. The annual rupture rate of abdominal aneurysm rose significantly from 0.9 per 100,000 inhabitants in the 1950s to 6.9 in the 1980s. After standardization for age, the mortality rate increased between 1960 and 1988 by 2.4 per cent annually (95 per cent confidence interval 1.2-3.6 per cent, P = 0.0004). Comparable figures from the UK during the 1980s have been reported to be two to three times higher. The mortality rate of ruptured thoracic aneurysm in the Swedish population did not increase when adjusted for age. In the 1980s the overall mortality rate of ruptured abdominal aneurysm was 85 per cent. Death occurred outside surgical clinics in 52 per cent of cases; 37 per cent of the total number of patients with ruptured aneurysm reached the operating table but only 30 per cent underwent aortic reconstruction. Patients treated by vascular surgeons had lower blood loss and transfusion needs, shorter aortic clamp time and operation time, and lower mortality rate than patients treated by non-specialized general surgeons. Specialized vascular surgeons also completed the reconstruction, and used straight grafts, in a higher proportion of cases than general surgeons.
The Kensey dynamic angioplasty catheter is an instrument for mechanical intravascular atherectomy using a rotating cam to recanalize occluded arteries. Twelve dynamic angioplasties were performed in 11 patients. The procedure was followed by an additional balloon dilatation in all cases. A technical success, i.e., a restored lumen, was recorded in 7 patients but only 4 had a functional improvement. No distal embolization or other serious complication occurred. This preliminary report shows that the therapeutic potential with this technique must be further investigated.
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This article describes the formation of oxygen radicals and their biological effects, especially in relation to lung injury. Various recent experimental data are reviewed. The relationships between hydrostatic effects and permeability effects in producing injury and edema are stressed. Means of prevention and problems related to extrapolation to clinical situations are focused.
In the present communication venoscopy using a flexible choledochoscope is advocated after thrombectomy of the iliac veins. In 10 patients operated upon for occlusive thrombi in the pelvic veins, venoscopy was used to assess the status of the vein. The procedure was conveniently performed using a regular flexible choledochoscope. Venoscopy gave detailed information of the veins and lead to altered therapy in seven of the 10 patients. Venoscopy is recommended for intra-operative control during surgical thrombectomy and the use of a choledochoscope can simplify this procedure.
Vascular prostheses in humans do not endothelialize spontaneously. In the present study we explored the feasibility of seeding autologous endothelial cells into prostheses implanted in patients undergoing reconstruction of the infrarenal aorta. In 22 patients one limb of an aortic Dacron bifurcation prosthesis was seeded with autologous endothelial cells harvested from the distal portion of the saphenous vein. The other limb was sham-seeded with culture medium only. The effect of seeding was studied by use of indium 111 radiolabeled platelets and external gamma camera scanning at 1, 4, and 12 months after surgery. No complications ascribable to the seeding procedure were seen. During the first year after surgery a gradual decrease in platelet accumulation occurred over the whole vascular prosthesis. At all time points studied the seeded graft limbs exhibited significantly less deposition of radiolabeled platelets than did control limbs. The observed difference in platelet accumulation on autologous endothelial seeding-treated graft segments merits further investigation of this technique in humans.
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A new incision for retroperitoneal approach to the abdominal aorta is described. The incision extends from alongside the rectus abdominis muscle across the costal arch over the 7-8th intercostal space. In the upper part only the skin and muscles are divided, allowing wide opening of the incision. The approach is muscle-sparing, since fibers of the transverse abdominal muscle are incised only in the upper part. It permits a good approach even for high aortic reconstruction.
The concept of autologous endothelial cell seeding has proved successful in animal models with respect to decrease of graft thrombogenicity and increase in patency. In the present study, application of this method in humans was explored. In 23 patients, random halves of expanded polytetrafluoroethylene grafts, used for lower limb arterial reconstructions, were seeded with endothelial cells at a seeding density of 3500 cells/cm2. These cells were derived from the saphenous vein by enzymatic harvesting. The other half was sham seeded with culture medium. Graft thrombogenicity was estimated by measuring platelet deposition on graft surface 1 and 6 months after surgery, with indium 111-labeled platelets and external gamma-camera imaging. Seeded graft segments accumulated significantly (p less than 0.03) fewer platelets at all imaging times. It is concluded that seeding of expanded polytetrafluoroethylene vascular grafts in humans reduces graft surface thrombogenicity. The clinical implications of this remain to be demonstrated.