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Biomedical subjects

B Fagrell

Publications and source records attributed to B Fagrell.

At least 19 recordsLinked to original sources
PubMed1999

Transcutaneous oxygen tension and toe blood pressure as predictors for outcome of diabetic foot ulcers.

OBJECTIVE: The present study was undertaken to compare the predictive values of transcutaneous oxygen tension (TcPO2) and toe blood pressure (TBP) measurements for ulcer healing in patients with diabetes and chronic foot ulcers. RESEARCH DESIGN AND METHODS: Investigated prospectively were 50 diabetic patients (37 men) with chronic foot ulcers. The age was 61 +/- 12 (mean +/- SD), and the diabetes duration was 26 +/- 14 years. TBP (mmHg) was measured in dig I and TcPO2 (mmHg) at the dorsum of the foot. Ulcer healing was continuously evaluated by measuring the ulcer area every 4-6 weeks. After a follow-up time of 12 months, the patients were divided into three groups according to clinical outcome: healed with intact skin, improved ulcer healing, or impaired ulcer healing. RESULTS: Of the 13 patients who deteriorated, 11 had TcPO2 < 25 mmHg, while 34 of the 37 patients who improved had TcPO2 > or = 25 mmHg. The sensitivity and specificity for TcPO2 were 85 and 92%, respectively, when a cutoff level of 25 mmHg was used for determination of outcome of ulcer healing (healing or nonhealing). The corresponding values for TBP at 30 mmHg were 15 and 97%. Measurement of TcPO2 provided a higher positive predictive value (79%) than TBP (67%). CONCLUSIONS: The results indicate that TcPO2 is a better predictor for ulcer healing than TBP in diabetic patients with chronic foot ulcers, and that the probability of ulcer healing is low when TcPO2 is < 25 mmHg.

Blood Pressure↗
PubMed1998

Pronounced skin capillary ischemia in the feet of diabetic patients with bad metabolic control.

Skin capillary circulation is impaired during postocclusive reactive hyperaemia (PRH) in toes of diabetic patients independent of diabetes duration and macrocirculation. The aim of this study was to examine its relation to metabolic control. The skin microcirculation was investigated in 20 patients with insulin-dependent diabetes mellitus: 10 patients with bad [HbA1c > 7.5 (8.7 +/- 0.8) %], and 10 patients with good metabolic control [HbA1c < 7.5 (6.3 +/- 1.0) %]. The diabetes duration was similar in both groups (16 +/- 9 and 16 +/- 6 years, respectively). None had macroangiopathy. Thirteen healthy subjects served as controls. The capillary blood cell velocity (CBV) in the nailfold of the great toe was investigated by videophotometric capillaroscopy, and the total skin microcirculation by laser Doppler fluxmetry (LDF). CBV and LDF were studied during rest and after 1-min arterial occlusion. The vibration perception thresholds (VPT) of the feet were higher (p < 0.05) in the patients with bad (34 +/- 12 V), as compared to patients with good metabolic control (18 +/- 10 V) and to healthy subjects (13 +/- 3 V). Peak CBV during PRH was reduced in both patient groups (p < 0.01), and lowest in the patients with bad metabolic control (p < 0.05). Time to peak CBV was prolonged (p < 0.01) in the patients with bad, while normal in the patients with good metabolic control. LDF was similar in all groups. An inverse correlation was found between HbA1c and peak CBV during PRH (r = 0.60; p = 0.008), while positive correlations were found to time to peak CBV (r = 0.62; p = 0.004) and VPT (r = 0.60; p = 0.01). No associations were seen between VPT and the microcirculatory variables. The results indicate that the metabolic control is of importance for the nutritive capillary circulation and the peripheral nerve function in the diabetic foot.

Adult↗
PubMed1997

Microcirculation: its significance in clinical and molecular medicine.

Microcirculation represents the smallest functional unit of the cardiovascular system, where the interaction between blood and tissue creates the environment necessary for cell function. Analysis of physiology and pathophysiology of this system gives a unique perspective to the disease process, and provides the link between clinical and molecular medicine. The present status and future directions of this medical and scientific frontier were assessed and projected by experts in the field at a meeting in Italy in 1995, and the conclusions are presented in this article.

Blood Gas Monitoring, Transcutaneous↗
PubMed1996

Altered properties of the fibrin gel structure in patients with IDDM.

High plasma fibrinogen levels are associated with vascular complications in the general population. Fibrin, the structural element in a clot, is derived from fibrinogen by activation of thrombin. An abnormal fibrin gel structure has been demonstrated in patients with myocardial infarction and in diabetic patients during poor metabolic control. In the present study the properties of fibrin gel structure were investigated in 20 patients with insulin-dependent diabetes mellitus (IDDM): 10 patients without (age: 30 +/- 8; diabetes duration: 7 +/- 6 years), and 10 patients (age: 44 +/- 7; diabetes duration: 27 +/- 9 years) with microangiopathy. Fifteen healthy subjects served as controls (age: 40 +/- 8 years). The glycosylated haemoglobin level (HbA1c) was elevated (p < 0.001) in the patients: 6.5 +/- 1.5% in diabetic patients without, and 7.1 +/- 1.0% in diabetic patients with microangiopathy. C-reactive protein and plasma fibrinogen were similar as compared to healthy control subjects. The properties of the fibrin gel structure; i.e. the permeability coefficient (Ks) and the fibre mass length ratio (mu) formed in recalcified plasma on addition of thrombin were investigated. Ks was decreased in the diabetic patients, with (6.5 +/- 2.0 cm2; p < 0.01) and without microangiopathy (6.5 +/- 2.7 cm2; p < 0.05), as compared to healthy subjects (10.0 +/- 3.4 cm2), while mu was not significantly (p = 0.14) altered. The results indicate a lower fibrin gel porosity in patients with IDDM, despite normal plasma fibrinogen and irrespective of microangiopathy. The abnormal fibrin gel structure may be due to an increased glycosylation of the fibrin (-ogen) molecule caused by long-term hyperglycaemia and may be of importance for the development of angiopathy in diabetic patients.

Adult↗
PubMed1995

Skin capillary circulation severely impaired in toes of patients with IDDM, with and without late diabetic complications.

We have recently shown that the skin microcirculation of toes is significantly impaired in patients with diabetes and peripheral vascular disease, and this may be one major reason why these patients are highly susceptible to developing skin ulcers. The aim of the present study was to investigate whether the skin microcirculation is impaired also in diabetic patients free from macroangiopathy. One foot in each of 20 patients with insulin-dependent diabetes was investigated: 10 patients with and 10 patients without late complications. All patients had normal arterial circulation of their lower extremities. Two groups of age- and sex-matched healthy subjects served as controls. The capillary blood cell velocity in the nailfold of the great toe was investigated by computerised videophotometric capillaroscopy, and the total microcirculation within the same area evaluated by laser Doppler fluxmetry. The capillary blood cell velocity and the total skin microcirculation were studied during rest, and during postocclusive reactive hyperaemia. The total microcirculation was similar in patients and control subjects, whereas the capillary circulation was markedly reduced (p < 0.01) in the patients. The ratio between the capillary and total microcirculation was significantly decreased (p < 0.05-0.01) in the patients as compared to the control subjects, indicating a local maldistribution of blood in the skin microcirculation of the diabetic patients. The results of the present study show that in spite of a normal total skin microcirculation in the toes of insulin-dependent diabetic patients, both with and without late complications, the nutritional capillary circulation is severely impaired.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1995

Changes in postocclusive reactive hyperaemic values as measured with laser Doppler fluxmetry after infrainguinal arterial reconstructions.

OBJECTIVES: The aim of the present study was to evaluate microcirculartory changes of the postocclusive reactive hyperaemia test measured with Laser Doppler fluxmetry to detect results of arterial reconstructions. DESIGN: Prospective open study. SETTING: Vascular laboratory of a University Hospital. MATERIAL: Sixty patients with peripheral arterial occlusive disease who underwent infrainguinal reconstruction were examined the day before and 1-2 days after surgery. CHIEF OUTCOME MEASURES: The values were obtained during postocclusive reactive hyperaemia induced by release of a 3 min arterial occlusion with a cuff at ankle level with the laser Doppler probe placed dorsally on the first toe. The alterations after surgery in these hyperaemia parameters were compared to changes in ankle/brachial index and clinical improvement at 30 days postoperatively. MAIN RESULTS: Patients improved by surgery according to ankle/brachial index had significantly reduced time to peak (p < 0.001) and significantly increased resting flux value (p < 0.05) and peak flux value (p < 0.05). There was a significant correlation between the change after surgery in time to peak flux and increment of ankle/brachial index (r = 0.63, p < 0.001). CONCLUSIONS: Changes in reactive hyperaemia values as measured with laser Doppler fluxmetry, especially the time to peak flux, seem to detect circulatory changes caused by arterial reconstructions.

Aged↗
PubMed1995

Skin capillary circulation is more impaired in the toes of diabetic than non-diabetic patients with peripheral vascular disease.

The aim of the present study was to investigate if diabetes negatively influences the skin microvascular reactivity in the toes of patients with peripheral vascular disease (PVD). Twenty healthy subjects, 20 diabetic, and 20 non-diabetic patients with PVD participated. One foot in each subject was investigated. The patient groups were matched for age, sex, and toe pressure. The capillary blood cell velocity in the nailfold of the great toe was investigated by videophotometric capillaroscopy, and the total skin microcirculation within the same area by laser Doppler fluxmetry. Capillary blood cell velocity and laser Doppler flux were studied during rest, and following a 1 min arterial occlusion at the toe base. The skin microvascular reactivity was impaired in both diabetic and non-diabetic patients. In the diabetic patients the disturbances were mainly seen in the capillaries, and the capillary blood flow was severely reduced during reactive hyperaemia (p < 0.01). In contrast, the total skin microcirculation was normal, indicating that sufficient blood reaches the area, but does not come out into the capillaries. The ratio between capillary blood cell velocity and laser Doppler flux, representing the distribution of blood between nutritional and non-nutritional blood compartments, was reduced in the diabetic patients (p < 0.05). These findings may contribute to the higher risk for development of chronic foot ulcers in diabetic patients with PVD.

Aged↗
PubMed1995

Advances in microcirculation network evaluation: an update.

Many methods are available today for clinical evaluation of the blood supply to an extremity or part of an extremity, some of which are excellent for determining the presence and severity of arterial and venous disorders. These methods, however, do not give any information on the microvascular status of the diseased areas. This is particularly true for the skin circulation, which has a rather complex vascular network with nutritional and thermoregulatory vessels, arteriovenous shunts, etc. The most useful method for clinical evaluation of the skin capillary circulation is vital capillary microscopy. The skin capillaries in an area with a reduced microcirculation change in structure, and it is possible to evaluate the viability of the skin by microscopic studies of these capillary changes. Both morphology and blood flow can be investigated. By using different intravital fluorescent dyes, e.g. sodium fluorescein and indocyanine green, the microvascular dynamics, flow distribution and microvascular permeability can also be studied. The total skin microcirculation can be evaluated by Laser Doppler fluxmetry, which measures primarily the blood flow in the thermoregulatory vascular bed, i.e. the subpapillary arterial and venous plexa. It is easy to use in clinical practice, but interpretation of the results can sometimes be difficult. Measuring transcutaneous oxygen tension has for many years been used in clinical routine to evaluate the viability of skin in patients with vascular disorders. It has recently been shown that inhalation of oxygen may induce vasoconstriction in healthy subjects and in patients with moderate arterial insufficiency, but an increase of the skin microcirculation in areas of severe ischaemia. By using different combinations of the above mentioned microcirculatory techniques, valuable information can be gained regarding pathophysiological phenomena of the microcirculation in many diseases, e.g. vascular disorders, collagenosis. Raynaud's phenomenon, diabetes and hypertension. Using techniques for both macro- and microcirculation is also of great importance for evaluating the effect of therapeutic procedures in several of these disorders.

Arterial Occlusive Diseases↗
PubMed1995

Vital microscopy and the pathophysiology of deep venous insufficiency.

Insufficiency of the deep venous system of the leg may cause severe disturbances of the skin microcirculation. The pressure in the deep venous system increases markedly during walking when the venous valves are destroyed. This pressure increase is transmitted out through the ankle perforators into the superficial veins of the skin, causing a marked pressure increase in the skin microcirculation, interfering with the normal nutritional circulation. In patients with only superficial venous incompetence, the number of capillaries is unchanged, and the configuration mostly normal. When the capillary pressure is markedly increased, blood components are pressed out through the capillary wall and deposited between the wall and the skin cells. By ordinary capillary microscopy this can be seen as light areas around the capillaries. The capillaries themselves become very enlarged and tortuous, and the number is decreased. One of the most striking findings is the appearance of a < > formation around the nutritional skin capillaries. This halo is caused by a specific microedema which can be demonstrated by microscopic techniques. The edema fluid seems to contain high concentrations of fibrin, other proteins and neutral polysaccharides. The development of the halo formation is most probably due not only to incompetence of the venous but also of the lymphatic system of the affected leg. The normal pathway of nutrients from the capillaries out to the skin cells will be blocked by the oedema, and skin ulcers develop. The good effectiveness of compression bandaging in venous leg ulcers can be explained by a marked reduction of the edema, facilitating the transport of nutrients from the capillaries to the skin cells.

Capillaries↗