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Biomedical subjects

U Nyman

Publications and source records attributed to U Nyman.

At least 37 records · Page 2Linked to original sources
PubMed1999

Validity of pulmonary cine arteriography for the diagnosis of pulmonary embolism.

The aim of this study was to assess the interobserver variations in diagnosis of pulmonary embolism (PE) with cine technique and to compare the diagnostic accuracy of pulmonary arteriograms to final-outcome diagnosis. One hundred and seventy patients with clinical suspicion of acute PE were examined with ECG, laboratory tests, chest X-ray, pulmonary scintigraphy and selective pulmonary cine arteriography. The follow-up time was 6 months. Fifty-one arteriograms were interpreted as positive for PE. Two pulmonary emboli were missed when compared with the diagnosis as stated by the final-outcome committee. No arteriograms were considered as not of diagnostic quality. Mean interobserver agreement in lobar vessels was 100%, in segmental vessels 93% and in subsegmental vessels 63%. The mean interobserver agreement was 89%. Pulmonary cine arteriography produces high diagnostic accuracy and few inconclusive results in patients with suspected PE.

Angiography↗
PubMed1999

An ethnopharmacological survey for potential angiotensin converting enzyme inhibitors from Indian medicinal plants.

Plants used in different traditional systems of Indian medicine and some relatives/substitutes have been investigated for their angiotensin converting enzyme (ACE) inhibitory activity. They were selected on the basis of their usage as cardiotonics, diuretics and other uses related to the symptoms of hypertension. Out of the 73 species investigated, 22 showed more than 50% ACE inhibitory activity.

Angiotensin-Converting Enzyme Inhibitors↗
PubMed1999

Distal migration of stent-grafts after endovascular repair of abdominal aortic aneurysms.

PURPOSE: To analyze patients after endovascular repair of abdominal aortic aneurysm (AAA) with respect to distal migration of stent-grafts and its underlying causes. MATERIALS AND METHODS: Sixty-five patients underwent endovascular repair between January 1994 and February 1997. There were seven women and 58 men, with a mean age of 71 years (range, 51-84 years). Three patients died in the perioperative period (one of myocardial infarction and two of multiorgan failure) and two patients died within 4 months of the procedure of non-procedure-related causes. In addition, two patients were followed at another hospital. The remaining 58 patients were followed up with spiral computed tomography scans at 1, 3, and 6 months, and biannually thereafter. Angiography was performed at 1 month and 1 year after the procedure and additionally when deemed clinically necessary. Mean follow-up was 29 months (range, 1-49). Migration more than 5 mm was considered significant. RESULTS: Twenty-six patients (45%) showed distal migration of stent-grafts during follow-up. Mean follow-up time at detection of migration was 13 months (range, 1-36 months). Thirteen cases of migration were ascribed to dilatation of the proximal aneurysmal neck during follow-up. Ten cases of migration were ascribed to causes other than neck dilatation or poor patient selection. In three cases, no obvious cause for the migration was found. The migration was complete in eight cases, leading to late conversion to open surgical repair. On two of these occasions, complete migration lead to aneurysm rupture. In addition, four patients received additional stent-grafts as proximal extensions. CONCLUSIONS: Distal migration of stent-grafts after endovascular AAA repair occurred frequently in this series. Dilatation of the proximal aneurysmal neck is a major cause of distal migration of stent-grafts. Improved proximal fixation is needed to secure long-term durability.

Aged↗
PubMed1999

Percutaneous placement of stents in chronic iliac and aortic occlusive disease.

OBJECTIVES: to evaluate the long-term results of stenting in iliac and aortic occlusive disease and identify factors predicting clinical outcome. DESIGN: retrospective study. MATERIALS AND METHODS: 82 patients (87 limbs) with stenoses (n =63) and occlusions (n =24) in the aortoiliac segment were treated with stents. 81 lesions involved the iliac arteries, 3 the infrarenal aorta and 3 the aortic bifurcation. Primary stenting was performed in 57 limbs (complex stenotic lesions and occlusions). Stents were placed following failed PTA in 30 limbs. Median follow-up was 13.2 months (1-66 months). RESULTS: technical success was 99% and clinical success 89%. Cumulative primary and secondary patency of stented iliac atherosclerotic lesions at 1 and 3 years was 75 and 61%, and 83 and 75% respectively. The factors predicting outcome of primary patency identified in Cox multivariate analysis were ankle-brachial index (ABI) prior stenting (p =0.03) and length of the lesion (p =0. 007). Major non-fatal complications occurred in 7.4% of the patients and there were no deaths attributed to the treatment. The 30-day mortality was 3.7%. CONCLUSION: stenting of complex aortoiliac stenoses and chronic occlusions is a safe and effective treatment modality. Long lesions and lower pre-procedure ABIs were found to negatively influence outcome.

Adult↗
PubMed1999

Abdominal aortic aneurysm morphology in candidates for endovascular repair evaluated with spiral computed tomography and digital subtraction angiography.

PURPOSE: To analyze the morphology of abdominal aortic aneurysms (AAAs) and to study the usefulness of spiral computed tomography (CT) versus digital subtraction angiography (DSA) in the evaluation of patients for endovascular repair. METHODS: Of 133 AAA patients (120 men, mean age 67 years, range 52 to 84) evaluated preoperatively with CT imaging, 77 endograft candidates (68 men) were also assessed with intra-arterial DSA. Arterial parameters were measured on axial CT scans and angiographic films for comparison. RESULTS: Mean maximum AAA diameter was 58 +/- 11 mm (range 39 to 95). Aneurysmal neck diameter was consistently smaller on DSA than on CT (20.7 +/- 3.6 mm versus 23.0 +/ 3.5 mm, p < 0.0001). The distance from the most distal renal artery to the aortic bifurcation was longer on angiography than on CT (mean difference 10.0 mm, p < 0.0001). There was a positive correlation between the maximum AAA diameter and the AAA length (r = 0.49, p < 0.0001) and an inverse relationship between the neck length and the neck diameter (r = -0.36, p < 0.0001). No correlation was found between the maximum AAA diameter and maximum iliac diameter, angulation, or length. CONCLUSIONS: AAA anatomy varies widely and independently of the aneurysm size. Therefore, the maximum size of the aneurysm is a poor predictor of whether or not an aneurysm is suitable for endovascular repair. The discrepancy between angiographic and axial CT measurements suggests that neither alone is sufficient as a preoperative imaging technique when evaluating a patient for an endovascular graft procedure.

Aged↗
PubMed1998

[Chronic mesenteric ischemia. Endovascular treatment is as effective as open surgery].

Chronic mesenteric ischaemia is a rare but serious condition, which if untreated may cause death secondary to starvation or bowel infarction. As the symptoms are sometimes unspecific, its diagnosis may be delayed or missed. Although open surgical revascularisation has been the traditional treatment, a review of published reports suggests it to be associated with operative mortality rates of 6-9 per cent, and major morbidity rates of 22-26 per cent. Reports by others, and our own experience, suggest that endovascular treatment of mesenteric atherosclerotic obstructions with PTA (percutaneous transluminal angioplasty) and stenting may yield patency rates differing little from those associated with surgery, but significantly lower mortality (1.6%) and morbidity (5.6%).

Angioplasty, Balloon↗
PubMed1998

Ethnomedical information and in vitro screening for angiotensin-converting enzyme inhibition of plants utilized as traditional medicines in Gujarat, Rajasthan and Kerala (India).

Plants utilized as traditional medicines in India have been investigated for their ability to inhibit the angiotensin converting enzyme (ACE). In total, 75 species belonging to 42 families have been investigated and new ethnomedical information has been obtained for 41 species. Four species were found to possess a high ACE inhibiting ability and were low in their tannin content.

Angiotensin-Converting Enzyme Inhibitors↗
PubMed1998

Aggressive treatment of acute limb ischemia due to thrombosed popliteal aneurysms.

OBJECTIVE: The absence of infra-popliteal runoff in patients with acute limb ischemia and thrombosed popliteal aneurysms carries a high risk of amputation. A combined treatment method involving thrombolysis and surgery is reported. MATERIAL AND METHODS: Information regarding six patients was reviewed. Ankle brachial indices and degree of ischemia were recorded. All patients underwent digital subtraction angiography. In five patients thrombus dissolution was achieved using a combination of mechanical and pharmacologic therapy. One patient was judged incapable of withstanding any delay in reperfusion and was treated with isolated limb perfusion using a thrombolytic agent. All patients underwent surgical revascularization. Follow-up (1-3 years) consisted of duplex examinations at 6 months and yearly thereafter. RESULTS: Five patients had no measurable ankle brachial index (ABI), while one patient had an ABI of 0.4. Initial angiography noted all patients to have no runoff in continuity to the pedal arch. Following thrombolytic therapy, an adequate bypass vessel was noted in all cases, with reconstitution of the plantar arch in five patients. Distal revascularizations included one peroneal, and five below knee popliteal arterial bypasses. Fasciotomies were performed in four of the six patients. There were no amputations. One patient developed a persistent foot drop. Two patients developed bypass grafts occlusions; one of which required therapy. CONCLUSION: The pre-operative use of thrombolytic therapy is a safe and effective method to achieve limb salvage in this patient population. Patients must be capable of withstanding an additional period of ischemia allowing for reconstitution of distal runoff. Isolated limb perfusion is of use when a delay to reperfusion cannot be tolerated.

Acute Disease↗
PubMed1998

Persistent collateral perfusion of abdominal aortic aneurysm after endovascular repair does not lead to progressive change in aneurysm diameter.

PURPOSE: To differentiate between the phenomenon of collateral perfusion from a side branch versus graft-related endoleaks after endovascular repair of abdominal aortic aneurysms (AAA), with respect to aneurysm size and prognosis. METHODS: We successfully treated 64 AAA patients with endovascular grafting. We followed all the patients postoperatively with spiral computed tomography at one, three, six and 12 months, and biannually thereafter. We measured aneurysm diameters preoperatively and postoperatively. We calculated preoperatively the relation of maximum aortic diameter (D) to the thrombus-free lumen diameter (L) expressed as an L/D ratio. Median follow-up was 15 months. RESULTS: Sixteen patients had collateral perfusion during follow-up. We successfully treated two patients with embolization. One patient showed resolution of collateral perfusion after we stopped warfarin treatment. Two patients died of unrelated causes during follow-up. One patient was converted to surgical treatment, and two patients showed spontaneous resolution of their collateral perfusion. The group of patients with perfusion showed no statistically significant change of their aortic diameter on follow-up. The group of patients without perfusion showed a median decrease in aortic diameter of 8mm (p < 0.0001) at 18 months postoperatively. The group of patients with perfusion had significantly less thrombus in their aneurysm sac preoperatively than the group without perfusion, as expressed by the L/D ratio (mean L/D 0,61 versus 0,78, respectively; p=0.0021.) CONCLUSION: There was no significant increase in aortic diameter on an average 18 months postoperatively despite persistent collateral perfusion. This may indicate a halted disease progression in the short term. Embolization of collateral vessels is associated with risk of paraplegia. We recommend a conservative approach with close observation if aneurysm diameter is stable.

Adult↗
PubMed1998

Angiotensin converting enzyme (ACE) inhibitors from Jasminum azoricum and Jasminum grandiflorum.

Bioactivity-guided fractionation of extracts of the aerial parts of Jasminum azoricum var. travancorense, using an in vitro ACE inhibition assay, led to isolation of three oligomeric, iridoid-type compounds, which were named sambacein I-III. Their structures are based on spectroscopic and chemical evidence. Similarly, fractionation of extracts of aerial parts of J. grandiflorum resulted in the isolation of the previously reported ACE inhibitor, oleacein. The IC50 values of purified ACE inhibitors were 26-36 microM. Moreover, 2-(3,4-dihydroxyphenyl)-ethanol, isoquercitrin and ursolic acid were isolated from J. grandiflorum. Sambaceins and oleacein are formed from genuine iridoid glucosides during processing of the plant material. NMR spectroscopy was used to measure the level of the ACE inhibitors in the traditional medicines prepared in Kerala from these Jasminum species.

Angiotensin-Converting Enzyme Inhibitors↗
PubMed1998

Late aortic arch perforation by graft-anchoring stent: complication of endovascular thoracic aneurysm exclusion.

PURPOSE: To describe a fatal case of late aortic perforation by an endograft-anchoring stent. METHODS AND RESULTS: A 69-year-old woman presented 2 years after thoracoabdominal aneurysm repair with a 9-cm dilatation of the descending thoracic aorta proximal to the conventional aortic graft. A 38-mm Dacron graft with multiple Gianturco Z-stents sutured inside was placed transluminally across the aortic arch such that part of the uncovered portion of the proximal stent was partially across the left subclavian orifice. Four months later, the patient died from massive hemorrhage. Autopsy showed that the uncovered portion of the proximal stent had perforated the aortic arch. CONCLUSIONS: This case stresses the need for low-profile stent-grafts and smaller, more flexible introducer systems. Anchoring stents must be flexible, less traumatic, and strong enough to create a watertight seal even in tortuous vessels. To avoid aortic arch damage by thoracic stent-grafts, the proximal stent should be fully covered by the fabric.

Aged↗
PubMed1997

Antimicrobial screening of selected medicinal plants from India.

From the Indian traditional medicines 78 plants were selected on the basis of their use in the treatment of infectious diseases. Different concentrations of 80% ethanol extracts were tested, using the agar dilution method, against four bacteria: Bacillus subtilis, Staphylococcus aureus, Escherichia coli and Pseudomonas aeruginosa and, using the agar-well diffusion method, against two fungi: Candida albicans and Aspergillus niger. In the lowest tested concentration of 1.6 mg/ml, 10% of the plant extracts were active; 44% in a concentration of 6.25 mg/ml and 90% of the plant extracts were active against at least two bacteria in a concentration of 25 mg/ml. Only 13% of the plant extracts were active against at least one fungus in a concentration of 50 mg/ml.

Bacteria↗
PubMed1997

New anti-HIV-1, antimalarial, and antifungal compounds from Terminalia bellerica.

A bioactivity-guided fractionation of an extract of Terminalia bellerica fruit rind led to the isolation of two new lignans named termilignan (1) and thannilignan (2), together with 7-hydroxy-3',4'-(methylenedioxy)flavan (3) and anolignan B (4). All four compounds possessed demonstrable anti-HIV-1, antimalarial, and antifungal activity in vitro.

Anti-HIV Agents↗
PubMed1997

Amelioration of collagen II-induced arthritis in rats by the type IV phosphodiesterase inhibitor Rolipram.

The effect of Rolipram, a selective inhibitor of the cyclic AMP specific phosphodiesterase (PDE IV) was evaluated in the rat collagen type II (RCII)-induced arthritis model in the DA rat. Rolipram was given either shortly before expected onset of disease (days 10-14) or shortly after the onset of clinically evident arthritis (days 15-19 after immunization). Administration at days 10-14 delayed the onset of arthritis for approximately 5 days, but the severity of arthritis was thereafter comparable to that seen in a non-treated control group. Rolipram treatment of animals with manifest arthritis inhibited further arthritis development and also tended to diminish its severity at a phase of disease where non-treated control animals showed a rapidly progressing disease development. Serum levels of antibodies to RCII were in all experiments similar between Rolipram-treated and control animals. An in situ hybridization method for determining cytokine mRNA synthesis in regional lymph nodes, after administration of Rolipram (at days 2-7), demonstrated a strong inhibitory effect on tumour necrosis factor-alpha (TNF-alpha) and interferon-gamma (IFN-gamma) mRNA expression, whereas no effects were seen on IL-2 mRNA synthesis after in vivo challenge with native RCII emulsified in Freund's incomplete adjuvant. The results thus demonstrate strong preventive as well as therapeutic effects of Rolipram in a model for arthritis that is very similar to human rheumatoid arthritis with respect to cytokine regulation, and suggest that Rolipram has its major effects in the effector stage of the arthritogenic immune response.

Animals↗
PubMed1997

Immunization with alum-collagen II complex suppresses the development of collagen-induced arthritis in rats by deviating the immune response.

Collagen-induced arthritis (CIA) is an experimental rat model sharing a number of features with human rheumatoid arthritis (RA). The model is associated with a proinflammatory (TH1) type of immune response and treatments with cytokines associated with TH2 immune responses are beneficial. Since agents with TH1-inducing properties, such as Freund's incomplete adjuvant (FIA), are necessary for disease induction, it is of interest to investigate whether an adjuvant with TH2-inducing properties affects CIA in a different way than does FIA. The authors studied arthritis development in DA rats after immunization with the TH2 stimulatory adjuvant alum adsorbed to rat collagen type II (CII) or collagen II fragments. Such treatments suppressed disease development both prophylactically and therapeutically. This beneficial effect of alum-CII immunization was associated with an increase in the IgG1 anti-CII antibody response as compared to untreated rats or rats pretreated with alum alone. Treatment with alum without the addition of collagen did not have any clinical effect. In addition, alum-CII treated rats had a significantly higher expression of IL-4 mRNA than untreated rats in the lymph nodes, 7 days after CIA induction. The authors suggest that alum-CII induces a TH2 immune response against rat CII which counteracts the development of CIA.

Alum Compounds↗
PubMed1997

Abdominal aortic aneurysms: experience with the Ivancev-Malmö endovascular system for aortomonoiliac stent-grafts.

PURPOSE: To describe a component-based aortomonoiliac stent-graft system and the first clinical results achieved with this device in endovascular abdominal aortic aneurysm (AAA) repair. METHODS: From November 1993 to October 1996, 45 patients aged 60 to 86 years underwent endoluminal exclusion of true AAAs (median diameter 60 mm) involving the common iliac arteries (median diameter 16 mm right and 15 mm left) using unilimb stent-grafts deployed with the Iancev-Malmö system. RESULTS: Six immediate conversions occurred in the beginning of the series due to endografts that were too short. Complications, including 2 inadvertent renal artery occlusions, 7 kinked grafts, 6 iliac artery dissections, and 3 perioccluder leaks, were prominent features in the first 15 patients. Five patients died in the postoperative period, four of whom were nonsurgical candidates. There were five significant stent-graft migrations: one 3 weeks after surgery due to mechanical injury of the proximal stent and four after 1 year owing to continuous dilation of a wide proximal neck, stent-graft placement in a conical, thrombus-lined proximal neck, and two instances of proximal extension separation from the main graft. Translumbar aneurysm perfusion required embolization in 3 patients. CONCLUSIONS: Despite early complications associated with a learning curve, exclusion of large AAAs using unilimb stent-grafts is feasible. Strict inclusion criteria are necessary in order to improve mortality among nonsurgical candidates and minimize the risk for late migration.

Aged↗