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Biomedical subjects

S Aune

Publications and source records attributed to S Aune.

At least 37 records · Page 2Linked to original sources
PubMed2000

Above-knee prosthetic femoropopliteal bypass for intermittent claudication. Results of the initial and secondary procedures.

OBJECTIVES: [corrected] to report the results of primary and secondary prosthetic above-knee femoropopliteal bypass for intermittent claudication. DESIGN: a retrospective study in a University hospital. PATIENTS: one hundred and twelve operations performed in 103 patients (26 women) between January 1990 and June 1997. METHODS: a comparison of primary assisted patency was made between Dacron and PTFE, between men and women and between operations performed early and late in the study period. Patency of secondary procedures was also studied. RESULTS: there were no operative deaths. The 5-year survival rate was 81% and equal to that of a demographically matched population. The primary assisted graft patency was 58% after two years. Women had a significantly better graft patency than men (79% vs. 49%). The type of graft and the date of the operation did not influence the outcome. Forty of the 55 occluded grafts were subjected to a redo procedure with a 1-year patency of 29%. CONCLUSIONS: the results after prosthetic above-knee femoropopliteal bypass procedures are disappointing, and a controversy persists as to whether this operation should be performed for intermittent claudication. The results of secondary procedures are even worse, and perhaps should only be considered in patients suffering critical ischaemia.

Adult↗
PubMed1999

Association between the number of vascular operation on the lower limbs and long term survival.

OBJECTIVE: To investigate to what extent the need for more than one vascular operation for chronic lower limb ischaemia was associated with relative long term survival. DESIGN: Retrospective observational study. SETTING: University hospital, Norway. SUBJECTS: 1574 patients (29% women) operated on for chronic lower limb arterial insufficiency. Of these 447 needed at least one further operation for progressive limb ischaemia. MAIN OUTCOME MEASURES: Long term survival estimated by the Kaplan-Meier method. The expected survival was calculated from mortality tables issued by the Norwegian Central Bureau of Statistics. RESULTS: The 10-year survival rate was 46% for the patients operated on once and 24% for the patients who had two or more operations. The expected survival rates were 57% and 52%, respectively. Both categories of patients had significantly shorter long term survival than a demographically-matched population. The long term survival of patients operated on twice or more was significantly less than that of those who needed only one operation. CONCLUSION: There is an association between the need for more than one vascular operation and long-term survival. Atherosclerotic disease among these patients seems to be more aggressive.

Adult↗
PubMed1998

Operative mortality and long-term survival of patients operated on for acute lower limb ischaemia.

OBJECTIVES: To investigate the operative mortality and long-term survival of patients with lower limb embolism or acute thrombosis. DESIGN: A retrospective survival analysis. MATERIALS: Eighty patients with acute thrombosis treated by bypass and 192 patients with embolism treated by embolectomy during the years from 1985 to 1996 were studied. METHODS: The observed survival rates were calculated with the product limit method. The expected survival rates were estimated from death-rate tables. The standard mortality rate was compared over a 5-year follow-up. RESULTS: The patients treated for embolism had an operative mortality of 17% and a 5-year survival rate of 17%, which was significantly lower than the expected rate of 62%. Those treated for acute thrombosis had an operative mortality of 14% and a 5-year survival rate of 44%. This was significantly higher than for the embolism group, but significantly lower than the expected rate of 74%. Both groups had a standard mortality rate of 2.2 at 5 years. CONCLUSION: Patients with acute ischaemia have a poor short-term and long-term prognosis. The patients treated for embolism are older and they have a shorter life expectancy than those treated for acute thrombosis. The standard mortality rate of the two groups appears similar.

Aged↗
PubMed1998

Surveillance of above-knee prosthetic femoropopliteal bypass.

OBJECTIVES: To evaluate a surveillance programme based on colour duplex ultrasound scanning of above-knee prosthetic femoropopliteal bypass. DESIGN: A retrospective clinical study. MATERIALS: One hundred and eighteen above-knee prosthetic femoropopliteal bypass procedures performed from 1993 to 1996. METHODS: Scans were done at 1, 3, 6 and 12 months, and annually thereafter. Significant graft-related stenotic lesions were defined as 50% diameter reduction or more located at the inflow or outflow arteries, or associated with the graft. Identified lesions were treated by angioplasty or surgical repair. RESULTS: The primary and secondary patency rates at 2 years were 55% and 71%, respectively. Stenotic lesions were documented on 45 of 463 scans (9.7%). Twenty-nine grafts (25%) were treated and only six of these grafts (21%) occluded. This was significantly superior to the occlusion rate of 41% for the whole series. CONCLUSIONS: It appears that one-quarter of above-knee prosthetic femoropopliteal bypasses develop graft-related stenoses. The favourable prognosis of these grafts after treatment for stenotic lesions justifies a surveillance programme. However, most graft occlusions seem to occur in grafts where no stenotic lesion has been previously detected.

Adult↗
PubMed1997

[Surgical treatment of obesity. Is gastric wrapping an alternative?].

To remedy the disabling side effects of gastric banding, a group of eleven patients were re-operated with gastric wrapping. Encouraging results led us to perform primary gastric wrapping straight away in fourteen additional patients. There were few serious complications. A comparison of the performance of the two groups is based on observations four years later. In the first group, a mean body-mass-index (BMI) of 41 +/- 4 SD was noted before banding, 32 +/- 8 SD at conversion to wrap and 31 +/- 9 SD at control. The mean BMI in the second group was reduced from 40 +/- 5 SD to 32 +/- 6 SD after primary gastric wrapping. Radiographic control showed a shortening of the wraps in both groups, with pouch formation in half of the cases, uncorrelated to weight loss. It appears that gastric wrapping can be a useful revisional procedure in patients who do not tolerate gastric banding. Primary gastric wrapping produces results comparable to those of gastric banding. Modifications in our version of gastric wrapping are discussed with reference to the original method and other surgical approaches.

Adult↗
PubMed1997

[Indications for carotid surgery].

The indications for carotid endarterectomy are discussed on the basis of studies of the literature. The most important multicentre studies that have led to these indications are reported and commented on. The recommended strategy with regard to complicating factors such as an occluded contralateral carotid artery, tandem lesions or planned heart surgery is to follow the ordinary indications for surgery. Patients with stroke-in-evolution may benefit from surgery but are difficult to identify. Crescendo transitory ischemic attack should be treated with anticoagulation and immediate operation. Operating on a recurrent carotid stenosis is rarely indicated, and patients needing intervention are perhaps best treated with endovascular techniques.

Carotid Arteries↗
PubMed1997

Early morbidity and patterns of survival after carotid endarterectomy.

OBJECTIVE: Assessment of operative morbidity and survival patterns after carotid endarterectomy. DESIGN: Retrospective clinical study. SETTING: University hospital, Norway. SUBJECTS: One hundred and ninety-four carotid endarterectomies done in 165 patients over a 16 year period. MAIN OUTCOME MEASURES: Long term survival was investigated using the product limit method. Expected survival of a demographically matched population was calculated from death-rate tables. Relative was defined as the ratio of the observed: expected survival. RESULTS: The combined stroke rate and mortality after 30 days was 5.1%. The estimated weight year survival rate of 73% did not differ from the expected. Relative survival seemed unaffected by the age at the time of the operation, hypertension or bilateral disease. Ischaemic heart disease was present in 69 patients (42%). This group had a mortality rate that was 2.4 times that expected during the first five years after operation. CONCLUSIONS: The overall long term survival of patients undergoing carotid endarterectomy seems to be similar to that of the general population. The patients with symptomatic ischaemic heart disease have a significantly lower long term survival than the expected.

Adult↗
PubMed1996

The influence of age on long-term survival pattern of patients operated on for lower limb ischaemia.

OBJECTIVE: To study the long-term survival patterns of patients subjected to surgery for lower limb ischaemia. DESIGN: A retrospective clinical study. SETTING: University Hospital. MATERIALS: A series of 1411 patients older than 50 years operated on for all stages of lower limb ischaemia. CHIEF OUTCOME MEASURES: Observed and expected long-term survival rates were calculated. Relative survival, defined as the ratio of the observed to the expected survival rates, was studied for age influence. MAIN RESULTS: The observed 10 year survival rate of 26% was significantly lower than the expected of 49%. Although women were 8 years older than men at the time of the operation they had similar long-term survival and relative survival. An inverse proportionality was found between the patient's age at the time of the operation and relative survival. The young patients experienced a 10 year mortality rate three to four times the expected, while the older had a mortality that was elevated 25-50% from the expected. CONCLUSIONS: Patients operated on for lower limb ischaemia experience a significantly lower long-term survival than that of a demographically matched population. This relative survival is significantly influenced by the patient's age at the time of the operation.

Age Factors↗
PubMed1995

The influence of age on operative mortality and long-term relative survival following emergency abdominal aortic aneurysm operations.

OBJECTIVE: To study operative mortality and long-term survival following emergency operations for abdominal aortic aneurysm. DESIGN: Retrospective survey in a university hospital. MATERIALS: Two hundred and twenty-seven patients with median age 72 years, (17% women). METHODS: Founded on data from the Norwegian Registrar's Office, operative mortality and long-term survival was estimated using the life-table method. Expected survival for demographically matched subgroups was calculated from death rate tables issued by the Norwegian Central Bureau of Statistics. RESULTS: Operative mortality was 41% for the 175 patients with ruptured aneurysms and 17% for the 52 with imminent rupture. The 6-year survival rate was 61% for all the successfully operated patients, and not different from that of a demographically matched population. For the patients of 72 years or older the 6-year survival rate was 53%. This was equal to that of an age and sex matched population. The younger patients had an observed 6-year survival rate of 64%, which was significantly lower than the expected of 84%. The standard mortality rate for this group was 2.25. No statistically significant difference in long-term survival was detected between the two age groups. CONCLUSIONS: Age at the time of the operation for a symptomatic abdominal aortic aneurysm does not seem to influence long-term survival. Consequently, younger patients experience a higher relative mortality compared to the older.

Adult↗
PubMed1995

Operative mortality and long-term relative survival of patients operated on for asymptomatic abdominal aortic aneurysm.

OBJECTIVE: Assessment of mortality and long-term relative survival following repair of asymptomatic abdominal aortic aneurysms. DESIGN: Retrospective review. SETTING: University Hospital. MATERIALS: Three hundred and twenty seven patients with a median age of 68 years and male to female proportion of 10:1. CHIEF OUTCOME MEASURES: Operative mortality and long-term mortality obtained from Norwegian Registrar's Office. Demographically matched expected survival calculated from death rate tables published by the Norwegian Central Bureau of Statistics. MAIN RESULTS: The overall operative mortality was 5.2%. Ten-year survival rate for all the patients was 38% compared to the expected of 52%. The standard mortality rate was 1.30, indicating a 30% higher mortality compared to a demographically matched population. Older patients and patients with known cardiac disease had significantly increased operative mortality. These patients also had the lowest long-term survival. Patients with cardiac disease suffered a postoperative mortality more than two times expected. CONCLUSIONS: Further studies are needed to define subgroups unsuitable for elective surgery.

Age Factors↗
PubMed1994

Relative mortality of patients operated for femoropopliteal occlusive disease.

The postoperative survival of 410 patients operated for femoropopliteal occlusive disease was evaluated retrospectively. Claudicants and patients operated for critical ischaemia were separated by age and their relative mortality compared. The relative mortality risk based on standard mortality rate calculations was estimated by relating observed survival to age and sex adjusted expected survival rates. The statistical differences in observed mortality from the expected was assessed using the Mantel-Haenszel test, and a proportional-hazard test, based on a multiplicative model, was employed to compare differences in relative mortality risk. The five-year observed and expected survival for all patients was 59 and 78% respectively, indicating a doubled risk of mortality. No conspicuous differences were found between males and females. Patients operated on for intermittent claudication were significantly younger and lived significantly longer than those with critical ischaemia. There was, however, no difference in relative mortality risk for the two groups. Claudicants younger than 70 years lived longer than the older patients, but there was no difference in relative death risk for the two groups. Patients operated on for critical ischaemia showed similar mortality for younger and older patients but the younger patients had a three to four times higher relative risk of mortality compared to the older.

Age Factors↗
PubMed1993

[Femoropopliteal reconstruction for obliterative arteriosclerosis. A 6-year surgical material].

The results of 144 femoropopliteal bypass procedures performed during the six-year period from 1986 to 1991 have been examined. Mean age at operation was 70.7 years. Three- and five-year cumulative survival was 69% and 60% respectively. Diabetes mellitus and critical ischaemia significantly reduced postoperative survival. 60% of the grafts were patent after three years. A distal anastomosis situated above-knee level significantly improved graft patency. Three-year cumulative limb salvage was 78%. Limb salvage rate was highest for claudicants with an above-knee distal anastomosis. The results support use of prosthetic grafts in above-knee femoropopliteal revascularisation.

Aged↗
PubMed1993

Occurrence of hypotension during streptokinase infusion in suspected acute myocardial infarction, and its relation to prognosis and metoprolol therapy.

In all patients who received streptokinase infusion for strongly suspected acute myocardial infarction in 1 hospital during 1989 to 1990, the occurrence of hypotension during infusion is described and related to prognosis. In 54% of patients, the beta blocker metoprolol was simultaneously administered intravenously. The median systolic blood pressure (BP) before infusion was 135 mm Hg, and the median value for the lowest systolic BP recorded during infusion was 100 mm Hg (p < 0.001). A positive correlation between systolic BP before streptokinase and the lowest systolic BP during infusion was found (r = 0.53; p < 0.001). Among patients administered streptokinase and metoprolol, 23% had systolic BP < 90 mm Hg, and 12% had < 80 mm Hg at any time during infusion; corresponding values for patients administered streptokinase only were 47 and 30%, respectively. Patients with the lowest systolic BP < 80 mm Hg during infusion had a mortality during the first 2 weeks of 22 vs 11% for those with between 80 and 100 mm Hg, and 8% for those with > 100 mm Hg (p < 0.001). However, in a multivariate analysis the systolic BP before infusion rather than the lowest systolic BP during infusion was independently associated with death. It is concluded that although patients with low systolic BP during streptokinase infusion have a high mortality, the level of systolic BP before infusion is more strongly associated with the outcome. Simultaneous use of intravenous beta blockade does not increase the occurrence of hypotension during streptokinase infusion.

Adult↗
PubMed1993

Delay time between onset of myocardial infarction and start of thrombolysis in relation to prognosis.

In 292 patients with suspected acute myocardial infarction given thrombolytic agents, we describe the delay time between the onset of pain and the start of thrombolysis and relate the observations to the prognosis. In 3%, treatment was started 1 h or less and in 22% 2 h or less after onset of symptoms. The median delay time between onset of symptoms and arrival in hospital was 1 h 38 min, and the median delay time between the arrival in hospital and start of thrombolysis was 1 h 25 min. A very strong association between delay time to thrombolysis and mortality during 2 weeks and 1 year of follow-up was observed.

Aged↗
PubMed1989

[Hiatal hernia and reflux esophagitis].

Between 1985 and 1987, 25 patients had abdominal operations for hiatal hernia and/or gastroesophageal reflux disease. Eight of them had complicated reflux esophagitis. One patient had a Belsey Mark IV repair, the others had a Nissen fundoplication. There was no mortality. After a median follow-up of 16 months (range 3-38) six patients had symptoms of "gas-bloat". The esophagitis was healed in ten patients. 22 patients were completely or fairly satisfied with the results of the surgery. Two patients were not satisfied. Both had complicated reflux esophagitis before they were operated on. Patients with esophagitis should be evaluated for surgery before stricture or Barrett's ulcer develop.

Adult↗
PubMed1986

Effects of protease inhibitor pretreatment on hemodynamic performances and survival rate in experimental, acute pancreatitis.

Acute pancreatitis was induced in pigs by manual retrograde injection of Na-Taurocholate into the pancreatic duct. Using chromogenic peptide substrate assays, increased plasma kallikrein activity (KK), paralleled by a reduction in functional plasma kallikrein inhibition values (KKI) were found in the peritoneal exudate in untreated animals. Several of the untreated animals experienced an increased trypsin activity (TRY) in the same exudate. Five out of eight animals died during a 6 hour observation period. Pretreatment with either Cl-INH or aprotinin given intravenously, resulted in a significantly increase in KKI capacity paralleled by unchanged KK and TRY activities in the peritoneal exudate. Furthermore, inhibitor pretreatment significantly improved hemodynamic performances (AP and CO) and the survival rate. The study underlines the pathophysiological importance of trypsin and the plasma kallikrein-kinin system during acute, severe pancreatitis.

Acute Disease↗
PubMed1986

Effects on peritoneal proteolysis and hemodynamics of prophylactic and therapeutic infusions of high doses of aprotinin in experimental acute pancreatitis.

Acute pancreatitis was induced in pigs by retrograde injection of Na-taurocholate into the pancreatic duct. Chromogenic peptide substrate assays showed increased trypsin (TRY) and plasma kallikrein activity (KK), parallel with a reduction of plasma prekallikrein (PKK) and functional kallikrein inhibition (KKI) values, in the peritoneal exudate in untreated animals. Intravenous high-dose pretreatment or therapy with aprotinin starting 3 h after the induction of acute pancreatitis resulted in significantly increased KKI capacity and unchanged KK and TRY activities in the peritoneal exudate. In test animals receiving aprotinin intravenously a significantly increased survival rate and improved cardiac output and arterial blood pressure were found during the 6-h observation period. All animals treated with aprotinin survived the observation period, whereas 63% of the untreated animals died. The study emphasizes the pathophysiological importance of the plasma kallikrein-kinin system in acute pancreatitis.

Acute Disease↗