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Biomedical subjects

B Eklöf

Publications and source records attributed to B Eklöf.

At least 37 records · Page 2Linked to original sources
PubMed1984

Popliteal artery injury in Kuwait.

While there is an abundant literature on popliteal artery injury secondary to penetrating trauma, few reports deal with popliteal artery injury caused by severe blunt trauma with or without fracture. Eight cases of popliteal artery injury are described. Seven of the patients had sustained blunt trauma, usually resulting also in damage to bone and soft tissues. The popliteal vein was involved in five of the injuries. The time lag between causal trauma and vascular repair averaged 25 hours. Delay was due mainly to failure to consult the vascular surgeon at an early stage. Leg amputation was necessary in two cases. Two patients died. The importance of early recognition of the vascular injury and appropriate surgical measures was illustrated in this small series of patients from a developing Middle Eastern country. Adequate fasciotomy, venous repair, use of intraoperative Doppler and repeated postoperative débridement are discussed in connection with management.

Adult↗
PubMed1984

Intramuscular pressure, blood flow, and skeletal muscle metabolism in patients with venous claudication.

Nine patients with chronic iliac vein obstruction and venous claudication were investigated. Intramuscular pressure was measured in the anterior tibial and the deep posterior compartments in both legs at rest and during exercise. The pressures were significantly higher in the leg with iliac vein obstruction (39 +/- 10 mm Hg) than in the contralateral leg (26 +/- 12 mm Hg) at rest as well as during exercise (60 +/- 16 mm Hg and 41 +/- 15 mm Hg, respectively) in the deep posterior compartment. Similar changes were observed in the anterior tibial compartment. Muscle water content was higher (P less than 0.01) in the obstructed leg and contributes to the explanation for the high intramuscular pressure in this leg. Muscle blood flow, adenosine triphosphate, phosphocreatine, and lactate were determined in the gastrocnemius muscles at rest and at exercise. Muscle blood flow, measured with the 133xenon clearance technique, was lower in the obstructed leg (17.5 ml/min, 100 gm) than in the control leg (28.1 ml/min, 100 gm) during exercise. Lactate increased more (P less than 0.05) in the obstructed leg. It is suggested that pain in venous claudication is caused by the high intramuscular pressure, and therefore fasciotomy may be useful in the treatment of this disorder.

Adenosine Triphosphate↗
PubMed1984

Scanning electron microscopy and evans blue staining for assessing endothelial trauma and reconstitution after venous thrombectomy.

Thrombectomy and a temporary arteriovenous fistula as treatment for deep venous thrombosis has been shown to cause a severe endothelial trauma in an experimental dog study. In vivo staining with Evans blue has been compared to scanning electron microscopy findings to assess the extent of the trauma and the time necessary for endothelial reconstitution. A good correlation between these techniques was found. After the initial almost complete denudation of the veins, new endothelium grew out from small branch openings and valve pockets within four weeks except in the proximity of the arteriovenous fistula where endothelialization was still incomplete after four months.

Animals↗
PubMed1983

Intramuscular pressure after revascularization of the popliteal artery in severe ischaemia.

Swelling is known to occur after peripheral revascularization. In this study of 14 patients undergoing revascularization of the popliteal artery for severe ischaemia, leg swelling and intramuscular pressure were recorded before and after operation. Calf circumference increased with a maximum swelling of 3.9 +/- 1.1 cm on postoperative day 6. There was a gradual increase in intramuscular pressure from 9 +/- 2 mmHg on the day before operation in the anterior tibial compartment to a maximum pressure on postoperative days 6-7 of 26 +/- 4 mmHg. Similar intramuscular pressure changes were seen in the superficial posterior compartment. These high intramuscular pressures may lead to a compartment syndrome and perhaps graft failure, which was actually observed in one case. Deep-vein thrombosis in the postoperative course may contribute to the high intramuscular pressures. Phlebography revealed a deep-vein thrombosis in 2 patients. In conclusion popliteal revascularization causes leg swelling and increased intramuscular pressure which may lead to a compartment syndrome and graft failure. Therefore follow-up of intramuscular pressure in patients with marked swelling after distal revascularization procedures and early fasciotomy may be considered on wide indications.

Aged↗
PubMed1983

Analysis of vasospasm in hand arteries by in vitro pharmacology, hand angiography and finger plethysmography.

1. The distribution of sympathetic nerves in hand arteries and veins from 18 normal subjects was studied by microscopy according to the Falck-Hillarp histofluorescence method for the cellular visualization of cathecholamines and by quantitative analysis of noradrenaline with a radioenzymatic method. Segments of hand arteries and veins were tested in vitro for the vasomotor effect of sympathomimetic agonists. 2. Fluorescence microscopy revealed a plexus of noradrenaline-containing nerve fibres surrounding both arteries and veins. The concentration of noradrenaline in the walls were 4.5-4.7 ng/mg protein. The relative agonist potency was characteristic for alpha-receptors. Phentolamine produced parallel shift of the dose-response curves both for arteries and veins. 3. Finger plethysmography with local cold provocation down to 10 degrees C was performed in the patients with traumatic vasospastic disease before and after inhibition of the sympathetic nervous system by body warming and orally administered alcohol. Four patients had undisturbed circulation, as revealed by the ratio between the systolic blood pressure in the arm and in the finger in conjunction with cold provocation tests. 13 patients had vasospasm of varying degrees, and 3 patients suffered from organic stenosis. 4. Hand angiography was performed before and after local cold provocation. The patients with organic stenosis did not show vasodilatation after 4-6 mg phentolamine injection. Patients with true vasospasm responded, in addition, with efficient vasodilatation 15 min after reserpine injection, which also abolished the cold-induced vasospasm.

Angiography↗
PubMed1983

Intramuscular pressure in the lower leg in deep vein thrombosis and phlegmasia cerulae dolens.

The influence of deep vein thrombosis on intramuscular pressure was evaluated in 22 patients by means of the wick technique. Intramuscular pressure was measured in the anterior tibial and the deep posterior compartments in both legs before and during treatment. The intramuscular pressure was significantly (p less than 0.001) higher in the thrombosed leg than in the contralateral leg (0-16 mmHg). The increase in intramuscular pressure was related to the extension of the thrombus. Iliofemoral thrombosis caused a significantly (p less than 0.001) higher pressure (17-28 mmHg) than calf thrombosis (16-23 mmHg). A compartment syndrome was found to be a part of the entity phlegmasia cerulea dolens (rest pressure 47-56 mmHg). In the treatment of phlegmasia cerulea dolens, fasciotomy is suggested additional to other therapeutic procedures.

Adult↗
PubMed1983

Physiologic and therapeutic aspects in congenital vein valve aplasia of the lower limb.

Ten patients with congenital vein valve aplasia verified at contrast phlebography were evaluated clinically and by physiologic examinations. All had orthostatic edema and varicose veins, but leg ulcers and other "postphlebitic" sequelae were infrequent. Foot volumetry and measurement of ambulatory foot vein pressures revealed a severe deep venous incompetence with a defective muscle pump function and considerable reflux. Eight limbs were operated on with conventional varicose vein surgery and physiologically re-examined six to 26 weeks after the operation. All had an improved ambulatory pressure reduction (p less than 0.001). Foot volumetry revealed better muscle pump function (p less than 0.01), while the reflux flow was unchanged. Surgery of the incompetent superficial venous system is therefore recommended in cases with deep venous insufficiency due to congenital vein valve aplasia.

Adolescent↗
PubMed1983

Temporary incomplete ischemia of the legs induced by aortic clamping in man. Metabolic and hemodynamic effects of temporary extracorporeal by-pass.

The effects on central hemodynamics and skeletal muscle metabolism during surgery for abdominal aortic aneurysm were compared in 6 patients given a preoperative adrenergic block (group B) and in 6 patients who additionally had a temporary brachio-femoro-femoral by-pass during the aortic clamping (group B + S). The cardiac output, heart rate, arterial and pulmonary artery pressures and the cardiac filling pressure were studied. Biopsy specimens from the lateral vastus muscle and blood samples from the radial artery and the iliac vein were taken before aortic clamping and also before and 30 minutes, 4 and 16 hours after the aortic declamping. Intramuscular temperature and pH were measured. The glycogen, glucose, lactate, pyruvate, ATP, ADP, AMP, phosphocreatine (PCr) and creatine (Cr) contents of the muscle and the lactate and pyruvate concentration in iliac venous and radial arterial blood were determined, using enzymatic fluorometric techniques. In group B, aortic clamping induced severe temporary incomplete ischemia with a 300% increase in lactate/pyruvate (L/P) ratio and a fall in intramuscular pH (pHm). The adenylate energy charge (EC) decreased, but the creatine (PCr + CR) and the adenylate (ATP + ADP + AMP) pool remained unchanged. After aortic declamping, the L/P ratio, EC and pHm regained their preclamping values, but the pools of energy phosphate compounds were reduced, indicating dysfunction or damage of the muscle cells. In group B + S there were no major muscle metabolic changes during clamping or after declamping of the aorta. In group B the systemic vascular resistance (SVR), mean arterial blood pressure (MAP) and left ventricular stroke work (LVSW) increased during the occlusion. On release of the clamp, cardiac output rose, possibly due to the sudden reduction of SVR. A temporary marked fall of MAP occurred. In group B + S, no increase of SVR, MAP or LVSW was observed during aortic clamping. After the declamping, only a minor MAP drop was observed. In both groups, a brief rise in pulmonary vascular resistance after the aortic declamping suggested transient pulmonary microembolism. If a high-risk patient is to undergo reconstructive surgery of the abdominal aorta and/or technical difficulties can be expected to necessitate prolonged cross-clamping during the operation, a temporary extracorporeal by-pass may be a favorable adjuvant, improving cardiac performance and preventing derangement of muscle metabolism.

Adrenergic beta-Antagonists↗
PubMed1983

The chronic compartment syndrome and response to diuretic treatment.

In five middle-aged men with calf pain during jogging or fast walking, chronic compartment syndrome of the calf or anterior tibial muscles was revealed by circulatory studies which included measurement of compartment tissue pressure. After two to three weeks of diuretic medication the men were re-examined. Initially elevated compartment tissue pressures at rest and after exercise were significantly decreased following diuretic treatment. The study indicates that calf pain similar to that of arterial insufficiency may be caused by compartment syndrome even in elderly persons and may be relieved with diuretic medication.

Adult↗
PubMed1983

Intramuscular pressure, muscle blood flow, and skeletal muscle metabolism in chronic anterior tibial compartment syndrome.

One hundred eight patients with lower leg pain of unknown cause underwent intramuscular pressure measurements by the wick technique. Fifteen patients (14%) were found to have a chronic anterior tibial compartment syndrome. In these patients the intramuscular pressure was significantly increased at rest and during and after exercise as compared with normal subjects. The pressure increase after exercise was long-lasting (40 minutes). Biopsies of the anterior tibial muscles showed increased water content, which may explain the elevated pressures. Muscle blood flow during exercise as measured by the xenon-133 clearance technique was decreased, and muscle lactate concentration was increased in the anterior tibial muscles. Fasciotomy relieved pain and normalized intramuscular pressure, muscle blood flow, and skeletal muscle metabolism.

Adolescent↗
PubMed1983

Intramuscular pressure, venous function and muscle blood flow in patients with lymphedema of the leg.

Intramuscular pressure, muscle blood flow and venous emptying was studied in seven patients with unilateral lymphedema of the leg. Intramuscular pressure was measured with the wick technique. Muscle blood flow was assessed by means of the 133Xenon clearance technique. Venous emptying was studied with strain gauge technique. Intramuscular pressure in the anterior tibial compartment of the edematous leg was 30 +/- 14 mmHg at rest, rising to 49 +/- 16 mmHg during exercise (p less than 0.05). In the healthy leg the pressure rose from 16 +/- 8 mmHg at rest to 28 +/- 6 mmHg during exercise (p less than 0.05). In the deep posterior compartment similar pressure values were obtained. Muscle blood flow during exercise was significantly higher (p less than 0.05) in the healthy leg, 32.4 +/- 6.8 ml X min-1 X (100 g)-1 than in the edematous leg, 29.9 +/- 4.8 ml X min-1 X (100 g)-1. Venous emptying was significantly lower (p less than 0.05) in the diseased leg, 44.7 +/- 18.7 ml X min-1 X (100 g)-1 than in the healthy leg, 61.4 +/- 18,9 ml X min-1 X (100 g)-1. Thus, lymphatic obstruction of the leg causes edema which leads to an increased intramuscular pressure and a decreased muscle blood flow and venous emptying.

Aged↗
PubMed1982

Human skeletal muscle metabolism and morphology after temporary incomplete ischaemia.

Incomplete ischaemia was caused by clamping the aorta during reconstructive vascular surgery. After restoration of the blood flow extensive metabolic and morphological changes in the muscle tissue were observed. The adenylate (ATP + ADP + AMP) and the creatine (PCr + Cr) pools declined 30-40% and the energy charge of the adenine nucleotides dropped significantly. The metabolic pool changes were closely related to the changes in the lactate/pyruvate ratios. Morphological signs of membrane disturbances, such as fibre oedema and swelling of mitochondria, were seen in many muscle fibres 30 min after declamping. 5 days postoperatively, a number of mitochondrial abnormalities were observed and fibre regeneration was seen in places. The relative number of Type 2 fibres and the width of the capillary lumen were both related to the decrease of the metabolic parameters. Thus, the metabolic state and the fine structure of the incompletely ischaemic muscle were closely related to each other. The amount of Type 2 fibres seemed to be of special importance for the patho-physiological events in intermittently ischaemic muscle fibres.

Adenosine Diphosphate↗
PubMed1982

Reference values for intramuscular pressure in the lower leg in man.

Intramuscular pressures in the anterior tibial and superficial posterior compartments of the lower leg were measured by the wick catheter technique in 34 healthy individuals (17 males and 17 females, mean age 42 years). The pressures were measured at rest, during and after exercise and during venous and arterial occlusion. The pressure was 1.1 (range 0.3-3.0) kPa in the anterior tibial and 0.5 (range 0.0-2.0) kPa in the superficial posterior compartment at rest. During exercise the intramuscular pressures rose to 3.5 (range 1.0-8.0) kPa and 0.9 (range 0.1-2.8) kPa respectively. The anterior tibial compartment pressures were lower in females than in males at exercise and lower in older than in younger persons at rest. After exercise the pressures were back to the pre-exercise levels within 5 min. Venous occlusion caused an increase in the pressure which was more marked in the anterior tibial compartment than in the superficial posterior compartment. Arterial occlusion did not cause any dramatic changes in intramuscular pressures, but there was a slight elevation during the period of reactive hyperaemia.

Adult↗
PubMed1981

Streptokinase treatment of deep venous thrombosis and the postthrombotic syndrome. Follow-up evaluation of venous function.

The conditions of 35 patients with deep venous thrombosis treated with streptokinase were reevaluated after a mean of 29 months with clinical examination, venous plethysmography, foot volumetry, phlebography (28 patients) and femoral vein pressure measurement (24 patients). At follow-up, 25 patients (71%) had symptoms and 22 (63%) had signs of venous insufficiency. Plethysmography was abnormal in 29 patients (83%) and foot volumetry in 25 (72%). Only two (6%) of the patients had normal plethysmography and foot volumetry and were free from symptoms and signs. No leg ulcer or severe postthrombotic syndrome was found. Phlebography showed that no patient had a normal deep venous system. Six of earlier thrombotic iliac veins (38%) and femoral veins 14 (48%), respectively, remained occluded. Increased femoral venous pressure, more pronounced during and after exercise, was found when iliac vein was diseased. Our results emphasize the importance of functional evaluation of the patient with a postthrombotic leg.

Adult↗
PubMed1981

Femoral vein pressure measurements for evaluation of venous function in patients with postthrombotic iliac veins.

Fifty patients with postthrombotic disease were examined by phlebography and by bilateral femoral vein pressure measurements. The degree of obstruction to venous flow was best evaluated by measuring the pressure elevation and pressure difference after exercise and the time required for these parameters to return to pre-exercise levels; pressures during rest and exercise were less conclusive indicators of obstruction. Good correspondence was found between femoral vein pressure and the severity of postthrombotic symptoms, while phleboraphy provided largely morphologic, rather than functional, information. We, therefore, consider it important to determine femoral vein pressure during and after exercise to evaluate the significance of postthrombotic iliac vein disease.

Adult↗
PubMed1981

Prevention of synthetic arterial graft infections by improved hygienic routine and dicloxacillin administration.

30/60 patients electively reconstructed with synthetic arterial grafts were randomly treated with dicloxacillin per- and postoperatively for 6 days. Wound infections occurred in 10 of the non-treated patients. 1 of whom had a graft infection. In the dicloxacillin group no wound infection was recorded. Overgrowth with bacteria resistant to isoxazolylpenicillin was not noticed during treatment. No late infections occurred. In comparison with previous results, improved hygienic routines before, during and after operation reduced the incidence of postoperative graft infections from 15 to 3%. As postoperative infections after synthetic arterial graft implantation are serious complications, per- and postoperative antibiotic treatment seems justified as a complement to a rigorous hygienic routine.

Adult↗