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Biomedical subjects

B Almgren

Publications and source records attributed to B Almgren.

At least 37 records · Page 2Linked to original sources
PubMed1990

Prevention of myocardial infarction and stroke in patients with intermittent claudication; effects of ticlopidine. Results from STIMS, the Swedish Ticlopidine Multicentre Study.

The Swedish Ticlopidine Multicentre Study (STIMS) was a double-blind placebo-controlled trial designed to determine whether ticlopidine, a platelet antiaggregatory agent, reduces the incidence of myocardial infarction, stroke and transitory ischaemic attacks in patients with intermittent claudication. A total of 687 patients was monitored for a minimum of 5 years or until an end-point was reached. The number of end points (99 vs. 89), analysed according to the intention-to-treat principle, was 11.4% lower in the ticlopidine group (P = 0.24). The mortality rate was 29.1% lower in the ticlopidine group (64 vs. 89, P = 0.015); this observation could be accounted for by a reduced mortality from ischaemic heart disease. On-treatment analysis showed there to be significantly fewer end points in the ticlopidine group (47 vs. 76, P = 0.017). Diarrhoea was the most common side-effect. Reversible leucopenia or thrombocytopenia was reported in seven patients on ticlopidine. It is concluded that the high morbidity and mortality from cardio- and cerebrovascular disease in patients with intermittent claudication can be reduced by long-term treatment with ticlopidine.

Aged↗
PubMed1990

Valvular incompetence in superficial, deep and perforator veins of limbs with varicose veins.

Venous valvular incompetence was investigated with Doppler technique in 296 limbs with untreated primary varicose veins. Partial or complete insufficiency of the long saphenous vein was found in 95%. Six patterns of incompetence of this vein could be distinguished. Insufficiency of the short saphenous vein was present in 15% of the limbs and perforator incompetence in 45%. Femoral and/or popliteal vein reflux was found in 20% of the limbs. In eight limbs (2.7%) with verified primary deep venous insufficiency there was a moderate or severe degree of femoral and popliteal venous reflux. Skin changes secondary to the venous disease were present in 18% of the limbs, mainly those with incompetence of perforator and long saphenous veins. Doppler investigation of varicose limbs give valuable information and can be recommended as a standard pre-treatment test.

Adolescent↗
PubMed1990

Phlebographic evaluation of nonthrombotic deep venous incompetence: new anatomic and functional aspects.

The anatomy, valvular function, and reflux patterns in the deep veins of the lower extremities were studied by ascending and descending phlebography in 126 limbs with nonthrombotic deep venous incompetence. The most common patterns were isolated reflux in the superficial femoral vein (51%), and combined reflux in the superficial femoral and the deep femoral veins (44%). Isolated deep femoral vein reflux occurred in 5%. As the degree of reflux in this vein varied considerably, a grading system for classification of deep femoral vein reflux was proposed. Depending on variations in the deep femoral vein anatomy, four different patterns could be distinguished. This study demonstrated that contrast filling of the deep femoral vein during ascending phlebography may indicate the presence of reflux in this vein. Complete visualization of the deep femoral vein is a new diagnostic sign that strongly correlates (p less than 0.001) with reflux in the deep femoral vein. The mean number of valves in the superficial femoral vein was reduced with increasing degree of reflux compared with a reference group consisting of 41 extremities without reflux. The diameter of the popliteal vein was significantly increased in the presence of pathologic reflux, which may indicate that vein wall dilation is a major cause of primary nonthrombotic deep venous incompetence.

Female↗
PubMed1990

Angiographic criteria for prediction of early graft failure of secondary infrainguinal bypass surgery.

Complete intraoperative postreconstruction angiograms were obtained during 93 reoperations after failed femoropopliteal and femorodistal bypass grafts to evaluate the predictive value of a new method of angiographic runoff assessment. Good runoff was defined as patency of two or three lower leg arteries to the foot, or one patent vessel continuous with an intact anterior or posterior foot arch in femoropopliteal and proximal femorodistal bypasses, and integrity of both arches in low femorodistal bypasses. All other outflow patterns were considered poor. The cumulative 1-year patency rate was 61% with a 79% limb salvage rate after reoperations performed in limbs with good runoff. In reoperations with poor runoff, the patency rate was only 5% with a 22% limb salvage rate. In reoperations with good runoff, and 85% patency rate of vein grafts compared to 43% of prosthetic grafts clearly demonstrated the importance of graft material on early outcome. The improved prediction of early outcome with this new method of angiographic runoff evaluation might allow more rational management of patients with failed infrainguinal grafts.

Adult↗
PubMed1989

Arterial lesions of the foot vessels in diabetic and non-diabetic patients undergoing lower limb revascularisation.

This study was undertaken to compare the atherosclerotic involvement of the foot arteries in diabetic and non-diabetic patients with leg ischaemia. Ninety-four non-diabetic and 57 diabetic patients were investigated with intraoperative postreconstruction serial angiography during femoro-popliteal and femoro-distal bypass surgery. The foot vessels were evaluated with regard to the anterior and posterior foot arches which were classified as intact, deficient or occluded. Integrity of the pedal circulation was defined as patency of both the anterior and posterior foot arches. Severe involvement of the foot arches was rarely seen in limbs with 3- or 2-lower leg vessel run-off to the foot. The posterior foot arch was more often spared than the anterior foot arch, especially in the non-diabetic group (P less than 0.001). The integrity of the pedal circulation was similar in diabetic and non-diabetic patients (intact in about 20%). Patients with claudication showed a significantly lower occlusion rate of leg and foot arteries than patients with rest pain or gangrene. The results of this study showed that the foot vessels were similarly affected in diabetics and non-diabetics undergoing lower limb revascularization. The same aggressive diagnostic and therapeutic approach should be applied for limb salvage in both groups.

Aged↗
PubMed1989

Primary deep venous incompetence in limbs with varicose veins.

Deep venous valvular incompetence (DVI) of primary, non-thrombotic origin has received little interest compared with secondary, postthrombotic DVI. In this study both limbs of 308 patients with untreated or surgically treated varicose veins in at least one limb were examined with Doppler ultrasound for signs of deep vein reflux. Ascending venography was used to exclude limbs with secondary DVI and descending venography to assess valve function. Doppler examination disclosed reflux in 3.5% of the "normal" limbs but in none of the limbs without recurrent varicose veins. A high incidence of primary DVI was found in limbs with untreated varicose veins (20.6%, p less than 0.001) and in those with recurrent or residual varicose veins (42.9%, p less than 0.001), compared with that in "normal" limbs. Popliteal vein reflux was observed in 14% and 37% in these two groups and a combination of femoral and popliteal reflux in 4% and 16%. Reflux of grade 2 or more at descending venography was noted in 43 of 78 limbs with Doppler evidence of reflux. Primary DVI is a common condition in patients with varicose veins. Further studies are needed to determine its clinical significance.

Adolescent↗
PubMed1989

Postoperative predictive value of a new method of intraoperative angiographic assessment of runoff in femoropopliteal bypass grafting.

In 96 consecutive patients undergoing primary femoropopliteal bypass grafting, the runoff was evaluated with a new grading system, based on findings at intraoperative postreconstruction serial angiography. This concept, which takes foot vessel involvement into account in patients with only one patent crural artery, is a modification of the traditional method of runoff assessment. Good runoff was defined as patency of two or three lower leg arteries to the foot or one patent, vessel continuous with intact anterior or posterior foot arch. In limbs with no patent vessel or one patent vessel with deficient or occluded foot arches, the runoff was classified as poor. The cumulative primary patency rates at 12 months in groups with good and poor runoff were 81% and 37%, respectively. The predictive value of the new method was superior to that of other comparable methods (traditional method, Society for Vascular Surgery and International Society for Cardiovascular Surgery criteria, and modified Society for Vascular Surgery and International Society for Cardiovascular Surgery criteria). This improved prediction can be ascribed to the optimal angiographic technique for visualizing distal vessels, selective evaluation of foot vessel runoff with a new concept, and the criteria used to define good and poor runoff.

Adult↗
PubMed1989

Angiographic runoff patterns in patients undergoing lower limb revascularization.

Intraoperative postreconstruction serial angiography was performed in 194 patients undergoing lower-limb revascularization (206 limbs), in order to analyze the atherosclerotic involvement of the lower leg and foot arteries. Occlusion of two or three leg vessels was found in 71% of the diabetic patients, and in 52% of the non-diabetics. The peroneal artery was less frequently affected than the other leg arteries. Severe involvement of the foot arteries was commonly observed in patients with only one or no patent leg vessel. The posterior foot arch was less commonly affected than the anterior. Complete visualization of the lower leg and foot arteries is suggested to be important for adequate evaluation of the distal vascular runoff. Pedal runoff may have prognostic significance in femoropopliteal as well as femorodistal bypass surgery.

Adult↗
PubMed1988

Surgical reconstruction of incompetent deep vein valves.

Conventional treatment of deep venous insufficiency results in a rather high failure rate. The introduction of methods for surgical repair of incompetent deep vein valves has implied new possibilities for active treatment and has added increased knowledge to venous pathophysiology. This study summarizes our clinical experience with surgical reconstruction of deep vein valves during a nine-year period.

Adult↗
PubMed1986

Influence of the profunda femoris vein on venous hemodynamics of the limb. Experience from thirty-one deep vein valve reconstructions.

Venous valve reconstruction in 31 limbs (28 patients) with chronic deep venous insufficiency is analyzed. The indications for operation were primary or secondary deep valvular incompetence with severe reflux and venous hypertension. Valvuloplasty was performed on a proximal valve of the superficial femoral vein (SFV) in 17 limbs and on a common femoral vein valve in two limbs; transplantation of a valve-bearing segment of the axillary vein was made to the common femoral vein in two limbs, to the SFV in seven limbs, and to the popliteal vein in three limbs. The results of valvuloplasty were satisfactory, with six failures observed during a follow-up period extending to 84 months (mean, 44 months). Eight of 12 valve transplant reconstructions failed within 2 years. Patency and competence of the reconstruction were obtained in 27 limbs at the 6-month postoperative control period. The effects on venous pressure were analyzed regarding the presence or absence of reflux into the profunda femoral vein (PFV) with preoperative retrograde phlebography. The results showed significant reduction of the ambulatory venous pressure (p less than 0.05) and increase in venous recovery time (p less than 0.01) in limbs with PFV competence. In limbs in which the PFV was incompetent the pressure values remained unchanged. These findings suggest that the functional state of the PFV is of great importance to the venous hemodynamics of the limb. This study also indicates that the principle of one-level repair in the SFV seems appropriate in limbs with a competent PFV.

Adult↗
PubMed1986

Pharmacokinetics of dicloxacillin in serum and aortic wall during aneurysmal surgery.

Twenty-one patients undergoing elective surgery for abdominal aortic aneurysm were randomly assigned to receive 2 grams of dicloxacillin as an intravenous infusion either at the induction of anaesthesia, 3 hours or approximately 6 hours before surgery. Samples from serum and aortic tissue were simultaneously obtained so that antibiotic levels could be compared as a function of time. High concentrations of dicloxacillin in serum and aortic tissue were present already shortly after infusion and active levels were maintained in aortic tissue for approximately six hours. The kinetics of dicloxacillin was similar in serum and aortic tissue. These results support the need for antibiotic administration shortly before surgery to ensure adequate tissue levels of antibiotics.

Aged↗