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Biomedical subjects

B Eklof

Publications and source records attributed to B Eklof.

At least 37 records · Page 2Linked to original sources
PubMed1995

Deep venous valve reconstruction.

The place of deep venous valve reconstruction in the surgical management of the patient with chronic venous insufficiency has become clearer with collected experience over the past 25 years. The reasons to perform surgery in chronic venous disease and the specific rationale for deep venous repair are contrasted with the management of the same patient by medical means. A new classification of chronic venous disease has been developed and provides the basis for a more objective understanding of specific entities in the entire field of chronic venous symptoms. The requirements for diagnosis before reconstructive surgery are stringent and a diagnostic algorithm is discussed in the selection of candidates for deep venous reconstruction. The multiple surgical techniques for deep venous reconstruction include internal intravenous direct valve repair and extravenous tightening of the vein wall around the valve cusp. The results of valve repair for primary valve incompetence are discussed in terms of long-term clinical results, long-term imaging results and long-term physiologic results as reflected by venous pressure examinations. It is becoming increasingly clear with the passage of time and the sharpening of our diagnostic skills that reflux is the dominant cause of chronic venous insufficiency. The ability of surgical procedures to decrease reflux in a diseased extremity can be used to restore patients to their normal way of life free of pain, swelling and ulceration and, in the ideal case, free of the need for elastic support.

Chronic Disease↗
PubMed1995

Breakdown of adenine nucleotides, formation of oxygen free radicals, and early markers of cellular injury in endotoxic shock.

OBJECTIVE: To study the influence of shock on muscle and plasma adenine nucleotide and creatine pools and their metabolites, and to identify early markers of cellular injury in shock. SETTING: Surgical research laboratory, Kuwait and UAE. DESIGN: Experimental study. MATERIAL: 19 New Zealand rabbits. INTERVENTIONS: 15 rabbits were injected with Escherichia coli endotoxin, and an additional 4 rabbits acted as controls. MAIN OUTCOME MEASURES: Blood and muscle energy metabolites, platelet count, arterial blood gas tensions, and arterial pressure were followed until the animals died. RESULTS: Five minutes after injection of endotoxin muscle ATP, creatine phosphate, and total adenine purine concentration decreased. This decrease was later reversed, but again decline to a critical level in the terminal phase. Loss of the muscle creatine pool indicated cellular damage after 3 hours. Plasma hypoxanthine, creatine, and lactate concentrations increased continuously throughout the study. CONCLUSION: Hypoxanthine formation is a possible source of oxygen free radicals in shock. The rise of hypoxanthine, creatine, and lactate concentrations in plasma during septic shock may reflect early high energy nucleotide failure, membrane injury, and anaerobic metabolism, respectively.

Adenine↗
PubMed1994

Prospective study of duplex scanning for venous reflux: comparison of Valsalva and pneumatic cuff techniques in the reverse Trendelenburg and standing positions.

PURPOSE: To achieve uniform testing of venous reflux between institutions, comparable methods of testing by duplex scanning are desired. This study directly examines differences of testing by two techniques, Valsalva and rapid cuff deflation, performed in two positions: 15-degree reverse Trendelenburg (RT-15) and standing. METHODS: Duplex examination of 22 extremities in 19 patients with moderate to severe, class 2 and 3 chronic venous insufficiency symptoms were compared with duplex scanning of 21 limbs in 11 normal, healthy volunteers. Duration of retrograde flow and peak velocity were measured in 247 venous segments. All extremities were studied in four ways: RT-15 Valsalva, standing Valsalva, RT-15 cuff, and standing cuff. Reflux was defined as duration of retrograde flow or reflux time greater than 0.5 seconds. Six venous segments were examined: common femoral, superficial femoral, deep femoral, and greater saphenous in the upper thigh, popliteal, and posterior tibial (at the ankle). RESULTS: The results of testing the Valsalva technique and the cuff in both the RT-15 and standing non-weight bearing positions indicate that the Valsalva method is best performed in the RT-15 position as opposed to standing, whereas the cuff technique is more effective in the standing position. In symptomatic limbs, the RT-15 Valsalva method showed similar proportion of reflux in the upper thigh when compared with the standing cuff method: common femoral (90% vs 67%), superficial femoral (81% vs 71%), greater saphenous (88% vs 59%), and deep femoral veins (30% vs 15%). In the popliteal vein the standing cuff test showed similar proportion of reflux (77%) as compared with the RT-15 Valsalva test (68%); however, a case-by-case analysis identified a large amount of variability between techniques, and inconsistencies could not be used to identify one technique as better than the other. Examination of the posterior tibial veins by all methods produced inconsistencies and a low yield of reflux in symptomatic limbs. In the common femoral vein, RT-15 Valsalva testing produced reflux times of up to 1.5 seconds in normal limbs, and represented "physiologic reflux." There was no recognizable effect of iliac vein valves on testing distal venous segments by Valsalva maneuver. CONCLUSIONS: Reflux in the upper thigh veins--common femoral, superficial femoral, deep femoral, and greater saphenous-is similarly demonstrated in both normal and symptomatic states by cuff deflation and RT-15 Valsalva techniques. In the popliteal vein, discrepancies between these two techniques are identified in patients with chronic venous insufficiency, and tibial vein reflux is not well demonstrated by either technique. Further investigation is needed to determine ideal techniques for identifying popliteal and tibial vein reflux.

Adult↗
PubMed1991

Iliofemoral venous thrombectomy followed by percutaneous closure of the temporary arteriovenous fistula.

Iliofemoral venous thrombosis treated by anticoagulants alone almost invariably results in postthrombotic sequelae with deep venous reflux alone or combined with an outflow obstruction. This study evaluates the result of iliofemoral venous thrombectomy with temporary proximal arteriovenous fistula (AVF) performed on 48 consecutive patients. In 10 patients the thrombus extended in the inferior vena cava, and the thrombectomy was combined with inferior vena cava interruption. The AVF closed spontaneously in 8 of 48 patients (patency rate, 84%). An attempt to close the AVF by placing a detachable balloon percutaneously under radiographic control was made 6 to 12 weeks later (success rate, 87%; complications, rare). A preclosure arteriovenography of the femoro-iliaco-caval segment revealed 34 of 38 segments open (patency rate, 89%). Four patients had severe stenosis of the iliac segment, and a transvenous percutaneous dilatation was successfully performed in three of the four patients, keeping the fistula. At AVF closure 4 weeks later the arteriovenography showed sustained dilatation in only two patients. Thirty-seven patients were followed for 3 to 48 months (median, 24 months) and 30 of 37 patients (81%) who had no symptoms were not using compression stockings. Doppler investigation revealed patent and competent femoral and popliteal veins and normal photoplethysmography in 56% of the patients. Four iliac veins were occluded (patency rate, 88%). No recurrence of fistula had occurred. Venous iliofemoral thrombectomy seems to better preserve valve function. The percutaneous balloon closure of the AVF has decreased the complication rate, facilitated venographic evaluation of the result, and made possible the performance of percutaneous interventions under the protection of the AVF.

Adolescent↗
PubMed1990

Adenosine, inosine, and hypoxanthine/xanthine measured in tissue and plasma by a luminescence method.

This simple method for sequentially quantifying hypoxanthine (HYP), inosine (INO), and adenosine (ADN) concentrations exploits the H2O2 peroxidase-catalyzed chemiluminescence of luminol. Though applied here only to tissue and plasma, this method can be adapted to analyze other body fluids. HYP in human plasma was stable for 30 min in 10 mmol/L EDTA reagent, whereas ADN was slowly converted to INO. Analytical recovery of HYP and INO added to plasma was 102% each; that of ADN was 95%. The within-run mean CVs for determinations of HYP, INO, and ADN at 1 mumol/L were 3.46%, 2.65%, and 3.01%; at 10 mumol/L they were 2.16%, 1.88%, and 1.63%, respectively. Corresponding between-run CVs were 5.34%, 4.09%, and 4.17%; and 3.43%, 2.40%, and 2.88%, respectively. Bilirubin at a concentration greater than 50 mumol/L interferes, but this interference is eliminated by bilirubin oxidase. Results for both tissue and plasma are compared with previously published results based on different analytical methods.

Adenosine↗
PubMed1986

Dynamic lymph flow imaging in lymphedema. Normal and abnormal patterns.

Dynamic imaging of lymphatic flow was performed in 23 patients complaining of lymphedema of the lower extremities. All were injected intradermally with 1 mCi of Tc-99m human serum albumin (HSA) in the medial web on the dorsum of both feet. Image acquisition for the lower pelvis and both thighs was started within 5 minutes. An extra-large field-of-view gamma camera (General Electric 500A) with a low-energy, all-purpose collimator interfaced to a General Electric Star computer was used. Images were acquired in dynamic-byte mode, 128 X 128 matrix size, every one minute up to 40 minutes. Delayed images for the same region and for both legs were taken at 90 minutes. Time-activity curves from equal regions of interest over the inguinal regions on both sides were generated. Three patterns were recognized. Normal flow (12 patients) with symmetric or slightly increased or decreased flow on one side than the other and characterized by early appearance of medial bands, inguinal and pelvic lymph nodes in the early and the delayed images. Time-activity curves showed a stepladder rise in pulses every 3 to 4 minutes. Enhanced pattern (six patients), characterized by fast flow of lymph through the dilated lymphatics, and occasionally by subcutaneous pooling and increase in the number and size of inguinal and pelvic lymph nodes on the affected side.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1985

Takayasu's disease in Arabs.

Four cases of Takayasu's disease in female Arabs are reported. All patients had classical features of the disease. Typing for HLA phenotype showed that all patients had HLA A2, A9, BW35 and DR7 antigens, suggesting an immunogenetic basis for the disease. As far as we know, this is the first report of Takayasu's disease in this ethnic group.

Adult↗
PubMed1985

Lymphscintigraphy in peripheral lymphedema using technetium-labelled human serum albumin: normal and abnormal patterns.

Lymphscintigraphy using Tc-99m human serum albumin (HSA) was examined in 23 patients with peripheral leg lymphedema. Each was injected intradermally with one mCi in the medial web space bilaterally. Images of the lower pelvis and both thighs were obtained within five minutes after injection using an extralarge field view camera GE 500A with low energy all purpose collimator interfaced with G.E. Star computer. These images were acquired in dynamic byte mode, 128 X 128 matrix size, every minute for 40 minutes. Delayed images for this region and of both legs were also taken at 90 minutes and time activity curves from comparable regions of interest over the inguinal area bilaterally were generated. Three patterns emerged: 1--normal lymph flow (12 patients) characterized by symmetrical or nearly symmetrical early appearance of lymphatics (medial bands) with visualization of inguinal and pelvic lymph nodes in both early and delayed images. Time activity curves showed step ladder rise, in "pulses" every three to four minutes. 2--enhanced lymph flow pattern (6 patients) was characterized by rapid movement of radiolabelled albumin through dilated lymphatics, occasionally with subcutaneous pooling, and both larger and more numerous inguinal and pelvic nodes on the lymphedematous side. 3--obstructed lymph flow (5 patients) was characterized by subcutaneous pooling, absent lymphatics, (medial bands) and flat, time activity curve on the lymphedematous side (only background activity) and absent inguinal and pelvic nodes. On delayed images, where lymphatic obstruction was incomplete there was delayed appearance of inguinal pelvic nodes which were fewer and smaller compared to the nonedematous side.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1978

The surgical treatment of chronic intestinal ischemia.

The mortality in acute intestinal ischemia is high, and 50% of such patients have previous attacks of abdominal angina due to chronic intestinal ischemia. Vascular reconstruction is remarkably successful in relieving the symptoms of chronic intesintal ischemia and for this reason angiographic examination is recommended in all patients in whom chronic intestinal ischemia is suspected. If the diagnosis is established by arteriography with appropriate supporting evidence, vascular reconstruction should be performed.

Adult↗
PubMedDate not supplied

The late results after axillo-femoral bypass grafts in patients with leg ischaemia.

The late results--up to six years--after axillo-femoral bypass reconstruction are reported for 85 patients with leg ischaemia who were regarded as poor-risk patients for aortic bypass surgery, or who had aortic graft infection. Velour-Dacron grafts and expanded polytetrafluoroethylene (PTFE, Gore-Tex)--grafts have been used. The cumulative patency rate (life table) six years after graft implantation was 64% (PTFE-grafts) and 58% (Velour-Dacron grafts). The corresponding cumulative limb salvage rate six years after graft implantation was 88% when PTFE grafts were used and 77% when Velour-Dacron grafts were used. Our results demonstrate that axillo-femoral reconstruction is a useful procedure with a good patency rate 6 years after implantation. This procedure should be considered when dealing with poor risk patients with severe leg ischaemia.

Aged↗
PubMedDate not supplied

Embolic brain infarction: a rare complication of thoracic outlet syndrome. A report of two cases.

The thoracic outlet syndrome is known to cause brachial neuropathy. Pressure on the subclavian artery causing post-stenotic dilatation with intraluminal thrombosis is not a common complication. This may lead to antegrade embolisation and ischemic changes in the upper limb. In right sided thoracic outlet syndrome the thrombus may extend retrogradely. From this an embolus may detach to the right hemisphere of the brain resulting in left sided hemiplegia. This is a rare but serious complication from a neglected, relatively benign, curable condition. This report describes two cases of a right sided thoracic outlet syndrome due to cervical rib compression with retrograde embolisation.

Adult↗