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Biomedical subjects

T Jogestrand

Publications and source records attributed to T Jogestrand.

At least 37 records · Page 2Linked to original sources
PubMed1996

Femoral vein blood flow during transurethral resection of the prostate.

OBJECTIVE: To determine whether bladder distension affects venous haemodynamics during transurethral resection of the prostate (TURP) such that irrigating fluid is more easily absorbed. PATIENTS AND METHODS: The right common femoral vein was examined using an ultrasound Doppler blood-flow scanner in 10 patients (mean age 73 years, range 63-80) undergoing TURP. Measurements of blood flow were performed before, during and after the bladder was filled with irrigating solution. Fluid absorption was measured by the ethanol method. RESULTS: Measurements before, half-way through and immediately after the resection all showed that the luminal diameter and the cross-sectional area of the femoral vein increased significantly when the bladder was filled with irrigating fluid. Furthermore, a decrease in the normal variation of blood flow with breathing often occurred when the bladder was filled, indicating that proximal venous obstruction was the cause of the increase in vessel diameter. However, there was no apparent association between these changes and the absorption of irrigating fluid. CONCLUSIONS: Filling the bladder with irrigating fluid with the patient in the lithotomy position during TURP was followed by signs of iliac venous obstruction but this did not correlate with the absorption of irrigating fluid.

Aged↗
PubMed1996

Chronic cluster headache: provocation with carbon dioxide breathing and nitroglycerin.

Nine patients with chronic cluster headache were studied as to end-tidal PCO2, heart rate, blood pressure, common carotid artery blood flow, vascular resistance, and intensity and duration of pain before, during, and after breathing 6% CO2 in air for 6 minutes and before and after administration of 1 mg nitroglycerin sublingually. End-tidal PCO2 was low at rest without provocation indicating that chronic cluster headache patients hyperventilate. Carbon dioxide provocation induced an increase in common carotid artery blood flow. This provocation, previously shown to induce pain in episodic cluster headache patients, did not result in unilateral pain in chronic cluster headache patients. Nitroglycerin did not provoke any pain in 4 of 5 chronic cluster headache patients in contrast to the effects in episodic cluster headache patients in a cluster period. In one chronic cluster headache patient, a short-lasting attack of moderate pain intensity was provoked. The results agree with the hypothesis that chronic cluster headache patients have changed vascular reactivity due to permanent sympathicoplegia unilaterally in the middle fossa in contrast to episodic cluster headache patients who it has been suggested have a nonpermanent sympathicoplegia unilaterally in the same region.

Administration, Inhalation↗
PubMed1996

Carotid artery blood flow and middle cerebral artery blood flow velocity during physical exercise.

Factors controlling cerebral blood flow (CBF) during exercise are complex and incompletely known. Different techniques have shown partly contradictory results of changes in regional and global cerebral perfusion during dynamic exercise in healthy subjects. To elucidate the global CBF response to supine stepwise increasing physical exercise, we measured blood flow in the left common carotid artery (QCCA) and the left internal carotid artery (QICA) simultaneously with the blood flow velocity in the ipsilateral middle cerebral artery (VMCA) using duplex ultrasonography and transcranial Doppler ultrasonography. During moderate exercise intensity (60-67% of maximal capacity), the VMCA increased 14% (P < 0.001), the QICA 17% (P < 0.01), and the QCCA 33% (P < 0.001) compared with baseline values. High physical exercise intensity (80-90% of maximal capacity) tended to reduce VMCA and QICA compared with moderate exercise, in contrast to a continued increase in QCCA. The results indicate an increased global CBF during exercise. This increase was reduced during hard exercise due to a decrease of the arterial PCO2 secondary to hyperventilation.

Adult↗
PubMed1996

Knee arthroscopy and venous blood flow in the lower leg.

We conducted a series of duplex ultrasound examinations to evaluate the venous blood flow in the lower leg during arthroscopic knee surgery. All knees were placed in loosely fitted leg-holder, without a tourniquet. The flow velocity in and the diameter and area of one of the posterior tibial veins and the great saphenous vein were measured just above the ankle at 0, 100, and 180 mmHg of intraarticular pressure (IAP). All recordings were done with the lower leg dependent and the thigh both supported and unsupported by the leg-holder. The diameter and cross-sectional area of the veins were not influenced by the IAP or by the position of the thigh in the leg-holder. There was, however, a significant increase in the venous blood flow velocity in the great saphenous vein each time the thigh was placed in the leg-holder. A simultaneous decrease in the flow velocity was seen in the posterior tibial vein and this was statistically significant at 180 mmHg IAP. Our findings indicate an additive effect of external compression of the thigh by a leg-holder and an increased IAP, which causes a redistribution of the venous flow in the lower leg from the deep system to the superficial one.

Adult↗
PubMed1996

Increased prevalence of atherosclerotic wall changes in patients with hyperlipidaemia after renal transplantation.

OBJECTIVES: The initial aim of this study was to evaluate the possibility of influencing atherosclerosis in hyperlipidaemic renal transplant patients by lowering blood lipids with gemfibrozil treatment. DESIGN: Although this double-blind, randomized trial was stopped after 6 months owing to the suspicion of drug interference, we report here on the results of baseline ultrasonographic examinations. SETTING: The outpatient clinic at the Department of Transplantation Surgery, Huddinge University Hospital, Huddinge, Sweden. SUBJECTS AND METHODS: The carotid arteries were examined in 16 out of the 19 kidney transplant patients included in the study using an ultrasonographic duplex scanner. MAIN OUTCOME MEASURES: Plaque occurrence and the common carotid intima-media thickness of the renal transplant recipients were compared to the same parameters in a normotensive control group of approximately the same age from a previous study. RESULTS: An increased prevalence of plaque (75% of the patients having plaque on one or both sides) was seen in the hyperlipidaemic renal transplant patients in comparison with the control group (16%; P < 0.001). The common carotid intima-media complex was thicker (P < 0.05), and the lumen diameter and the calculated cross-sectional intima-media area were greater (P < 0.01-0.001) in the transplant recipients. CONCLUSIONS: Markedly increased atherosclerotic wall changes are seen in the carotid arteries of patients with hyperlipidaemia after renal transplantation.

Adult↗
PubMed1995

The "ad hoc" estimation of outflow does not predict patency of infrainguinal reconstructions.

OBJECTIVES: This prospective study was performed to evaluate the clinical implication of the adhoc estimation (also called SVS score) of outflow on patency of infrainguinal in situ femoropopliteal or -distal bypasses. METHODS: The bypasses were followed with Duplex scanning at 1, 3, 6, and 12 months after surgery. Fifty-three bypasses were recruited for the study, 20 of which were performed in 17 diabetics. In 47% the adhoc scoring was < or = 4.5 and in 53% it was between 5 and 10 (1 corresponds to an excellent outflow and 10 to a blind segment). RESULTS: Within the first 30 days eight occlusions occurred, all of which were surgically corrected. The adhoc score for these bypasses was 4.2 vs. 4.9 (NS) for those who did not occlude. During follow-up, revisions were performed in 21 cases (40%) with 30 interventions. At the end of 1 year, 68% of the bypasses were patent (80% among diabetics and 64% among non-diabetics, NS). Patency at 1 year was not influenced by the adhoc classification. CONCLUSION: The estimation of outflow from angiography seems to be of no value in predicting graft patency in infrainguinal grafting.

Adult↗
PubMed1995

Effects of increasing the intracranial blood volume in cluster headache patients and controls.

Eleven patients with episodic cluster headache in period, five patients out of period and six controls were studied concerning the effects of an increase of the intracranial blood volume by tilting. Common carotid artery (CCA) blood flow was similar in all three groups at baseline and during tilting. CCA diameters were similar at baseline and increased during tilting in all three groups, indicating that tilting caused an increase in the extra- and intracranial blood volume. Unilateral pain or sympathetic dysfunction did not appear during tilting in the patients out of period or in the controls. In four of eight studied patients with cluster headache in period, unilateral miosis and ptosis appeared during tilting. Two of these four patients developed intense unilateral pain, while the other two did not report any pain. Four other patients developed slight unilateral pain but no sympathetic dysfunction during tilting.

Adult↗
PubMed1995

Provocation of unilateral pain in cluster headache patients by breathing CO2.

Ten patients with cluster headache in an active period and 6 controls were studied as to heart rate, blood pressure, blood flow in the common carotid arteries (CCA), end-tidal PCO2 and pain before, during and after 6 minutes of breathing 6% CO2 in air. Heart rate increased significantly during CO2 breathing in controls but not in patients. The cluster headache patients had significantly lower baseline end-tidal PCO2 than controls. CCA blood flow increased significantly during CO2 breathing in both groups. Vascular resistance decreased during CO2 provocation and increased above baseline levels 5 minutes after provocation in both groups and related to the end-tidal PCO2. Six of eight cluster headache patients, who had an increase of blood flow at provocation, reported slight to moderate unilateral pain in relation to the CO2 provocation in contrast to controls. One patient treated with 6 mg sumatriptan 2.5 hours before the provocation had an end-tidal PCO2 within the range of the controls, and did not get an increase of CCA blood flow or pain at provocation. Six of the cluster headache patients were restudied when out of the active period. There was still no heart rate increase during CO2 breathing and end-tidal PCO2 was still lower than in the controls. Unilateral headache was not provoked.

Administration, Inhalation↗
PubMed1995

Carotid intima-media thickness and plaque in borderline hypertension.

BACKGROUND AND PURPOSE: In this study, we investigated intima-media thickness and plaque occurrence in the carotid arteries of men with borderline hypertension compared with that in normotensive control subjects and investigated the relations of these variables to atherosclerotic risk factors. METHODS: Using B-mode ultrasonography, we compared carotid artery intima-media thickness and plaque occurrence in men with borderline hypertension (diastolic blood pressure of 85 to 94 mm Hg, n = 73) with that in age-matched normotensive control subjects (diastolic blood pressure of 80 mm Hg, n = 72). We evaluated the relationships of intima-media thickness and plaque occurrence to atherosclerotic risk factors such as age, smoking, lipoprotein levels, and fasting insulin levels. RESULTS: The borderline hypertensive group exhibited a slight increase in overall intima-media thickness (0.73 versus 0.69 mm, P = .07), which was most evident in the right carotid artery (0.72 versus 0.67 mm, P < .05). There were more borderline hypertensive subjects with plaque (26% versus 16%, NS), again more evident on the right side (18% versus 6%, P < .05). Age and high-density lipoprotein cholesterol were consistently related to intima-media thickness (t = 1.94 to 3.24 and t = -2.25 to -2.69, respectively, P < .05), whereas age was the only significant determinant for plaque/nonplaque (F = 6.4, P < .05). In addition, there was a significant difference in intima-media thickness between the right and left carotids, irrespective of group (F = 4.43, P < .05). CONCLUSIONS: Our results indicate that vascular structural changes occur even in borderline hypertension, although this seems more related to general atherosclerotic risk factors than to blood pressure alone. Additionally, a possible difference in the development of atherosclerotic lesions of the left and right carotid arteries is suggested, emphasizing the importance of measuring and reporting values from both sides when studying carotid intima-media thickness and plaque occurrence.

Adult↗
PubMed1995

Peripheral artery disease in patients with coronary artery disease.

The prevalence of peripheral vascular disease in patients with coronary artery disease has been investigated in many different ways and depends on the diagnostic methods and the definition of the atherosclerotic manifestations in the different vascular beds. In this study we used the non-invasive methods digital volume pulse plethysmography and ankle and toe blood pressure measurements to identify arterial abnormalities in the lower limbs in 58 patients (49 males and 9 females; age 37-72 years) examined with coronary angiography. The prevalence of peripheral artery disease was 22%, in agreement with the results of most previous investigations. There was a tendency towards increasing prevalence of peripheral artery disease with more advanced coronary artery disease: 14% of the patients with no or minimal coronary atheromotous lesions, 18% of the patients with moderate coronary atheromotous lesions and 32% of the patients with marked coronary atheromotous disease. For this reason a non-invasive investigation of the peripheral arterial circulation should be included early in the clinical consideration of patients with chest pain or similar symptoms suggesting coronary heart disease. Toe pressure measurement appears to be the most appropriate technique being rather simple in management and also in evaluation of results.

Arteriosclerosis↗
PubMed1994

The effect of erythropoietin treatment on arteriovenous haemodialysis fistula/graft: a prospective study with colour flow Doppler ultrasonography.

To determine the effect of erythropoietin (EPO) on patency the haemodynamics and morphology in haemodialysis fistula/graft were prospectively assessed using ultrasonographic two-dimensional imaging and colour flow Doppler together with pulsed Doppler, prior to and during partial correction of anaemia with EPO. Nineteen radiocephalic fistula and 11 loop grafts in 30 patients on routine maintenance haemodialysis were investigated prior to EPO treatment. A significant stenosis defined as a localised 100% increase in flow velocity was found in the arterial inflow in seven (23%) patients, in the loop graft in seven (64% of loop grafts) patients, and in the venous segments in 23 (77%) patients. Fourteen patients were rescanned after more than 200 days of EPO therapy. There was a significant increase in haemoglobin (84 +/- 14 g/l to 104 +/- 18 g/l) and haematocrit (24 +/- 4 to 31 +/- 5%) during this time. One arterial, four loop grafts and two venous stenoses appeared or increased in severity, and one venous return flow segment had occluded. Blood flow according to ultrasonography was unchanged. Of the 16 patients lost to follow-up, three underwent surgical intervention (clinical failure rate 0.20 access/year). EPO therapy may contribute to minor changes in access haemodynamics but does not seem to be detrimental to patency.

Adult↗
PubMed1994

Effect of physical activity on the day-to-day variation in serum digoxin concentration.

Physical exercise has been found to increase digoxin binding in working skeletal muscle along with a concomitant decrease in serum digoxin concentration. In a recent study on healthy volunteers, moderate physical activity during maintenance digoxin treatment was shown to decrease the renal excretion of digoxin secondary to this redistribution of the drug, thereby affecting the body content of digoxin. In the present study the influence of changes in everyday physical activities, carried out during a 10-h period after ingestion of the daily maintenance digoxin dose, on the steady-state serum digoxin concentration (24 h after the last dose) was studied in 10 digoxin-treated outpatients (61-81 years of age). Compared to normal daily activity, complete bed rest for 10 h after ingestion of the maintenance dose did not affect the steady-state serum digoxin concentration. The lack of such an influence may be explained either by a low degree of everyday physical activity in the investigated patients or to a compensatory increase in the renal excretion of digoxin during the night preceding the serum digoxin measurement. Thus, standardization of physical activity 1-2 h before blood sampling is adequate when analysing the serum digoxin concentration in elderly outpatients.

Administration, Oral↗
PubMed1994

Progressive decline in renal function induces a gradual decrease in total hemoglobin and exercise capacity.

We examined 58 patients (38 men, 20 women; mean age: 45 +/- 12 years; body mass index: 24 +/- 4 kg/m2) with a glomerular filtration rate (GFR) ranging from 3 to 32 ml/min, in order to determine the effects of a progressive decline in renal function on total hemoglobin (THb) and exercise capacity. The THb ranged from 185 to 759 g and the hemoglobin concentration ranged from 66 to 151 g/l. Maximal exercise capacity ranged from 50 to 260 W (40-143% of the expected norm). Nearly all the patients interrupted their exercise tests due to general fatigue, leg tiredness or a combination of these factors. There was a significant partial correlation between THb and GFR after sex and age had been accounted for (r = 0.39; p < 0.005). Maximal exercise capacity and THb showed a significant partial correlation after sex, age and GFR had been accounted for (r = 0.27; p < 0.05). Maximal exercise capacity showed a significant partial correlation with GFR after sex, age and THb had been accounted for (r = 0.30; P < 0.05). In conclusion, there is a gradual decline in THb and maximal exercise capacity as uremia progresses. Anemia appears to be a contributory cause responsible for the decrease in maximal exercise capacity along with other factors pertinent to uremia per se.

Adult↗
PubMed1993

The minimum number of cardiac cycles necessary for calculation of renal blood flow velocity indices in pregnant and non-pregnant women.

In this study Doppler ultrasound was used to measure the blood flow velocity in the main and segmental renal arteries in 16 healthy non-pregnant women. There were no differences in blood flow indices between the right and left kidneys as well as between the main and segmental arteries. The variability of the indices in the main and segmental renal arteries in healthy non-pregnant and in the segmental renal artery in normal pregnant women (32-37 weeks of gestation) was investigated. The within-patient error standard deviations of ten cycles and two, and three to nine averaged cycles were compared. In non-pregnant women, values for the error standard deviation comparable with those obtained from ten cycles for the systolic/diastolic ratio and pulsatility index from both main and segmental arteries were obtained by averaging from five to six consecutive cycles, while the error standard deviation for the resistance index stabilized when averaging only two to four cycles. In pregnant women, the error standard deviations for both the systolic/diastolic ratio and pulsatility index reached quite stable values after three cycle had been averaged as did the error standard deviation for the resistance index. We speculate that this difference between non-pregnant and pregnant women is due to more favorable conditions for renal visualization and consequently higher quality Doppler signals during pregnancy. A knowledge about the number of cardiac cycles required for an accurate calculation of renal blood flow velocity indices may prevent time-consuming calculations and inaccurate conclusions.

Journal Article↗
PubMed1993

Blood flow through irradiated rabbit submandibular glands measured with fluorescein angiography.

Microvascular injury has been regarded as a contributing factor in irradiation damage of biologic tissues, including morphologic changes and increased permeability of the vascular network. The late irradiation effect on the capillary circulation of salivary glands was studied with dynamic fluorescein angiography. In 31 rabbits one side of the head was exposed to a single radiation dose of 15 Gy. At 4 and 10 months thereafter no significant difference was detectable in the microcirculation between the unshielded and shielded glands.

Aging↗