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Biomedical subjects

B Fagrell

Publications and source records attributed to B Fagrell.

At least 55 records · Page 3Linked to original sources
PubMed1991

Postocclusive reactive hyperemia and thermal response in the skin microcirculation of subjects with spinal cord injury.

The response of skin blood cell flux (SBF) to locally applied pressure was evaluated by laser Doppler fluxmetry over the sacrum and the gluteus maximus muscle in twenty patients with spinal cord injuries (SCI)-ten with tetraplegia, ten with paraplegia-and ten healthy subjects. The SCI patients were further divided into two subgroups, one with sensation and the other without sensation over the sacrum area. The SBF over the sacrum, without applied pressure, showed somewhat higher values among the patients. The ten paraplegic patients (p less than 0.05) and the subgroup of patients without sensation over the sacrum (p less than 0.05) showed the highest values. Occlusion of the SBF was reached at a lower external skin pressure over the sacrum than over the gluteus maximus muscle in the group with spinal cord injuries (p less than 0.01). During the postocclusive reactive hyperemia we found a much shorter time to peak SBF over the gluteus muscle for the patients compared to the healthy subjects (p less than 0.01). In the subgroup of patients without sensation over the sacrum a prolonged time to peak SBF was found (p less than 0.01) over the sacrum compared to patients with sensation and to healthy subjects. The increase of the SBF during postocclusive hyperemia response was lower over both the sacrum and the gluteus maximus muscle areas in the patients with spinal cord injuries (p less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1990

Does combined kidney and pancreas transplantation reverse functional diabetic microangiopathy?

Using videophotometric capillaroscopy and laser Doppler fluxmetry, we have investigated skin microvascular reactivity in the fingers of 14 diabetic patients with severe, late complications 20 months after combined kidney and pancreas transplantation. The results were compared with those obtained in 20 diabetic patients awaiting pancreas transplantation and in 19 healthy subjects. The capillary blood cell velocity at rest (P less than 0.01) and during postocclusive reactive hyperemia (P less than 0.05) was significantly lower in both patient groups than in the healthy controls. However, the time to peak capillary blood cell velocity during hyperemia was normal in the post-transplantation group (NS) but significantly prolonged in the pretransplantation group (P less than 0.01). The ability to decrease flow during venous stasis-the so called venoarte-riolar reflex--was strongly impaired in the pretransplantation group (P less than 0.001) but less so in the post-transplantation group (P less than 0.05) as compared to healthy controls. It may be concluded that diabetic patients, after combined kidney and pancreas transplantation, show a tendency towards better microvascular reactivity than those awaiting transplantation.

Adult↗
PubMed1990

Reactivity of the microcirculation in port wine stain hemangiomas evaluated by laser Doppler fluxmetry.

Twelve patients with port wine stains (both untreated and treated with argon laser) had their microcirculation monitored by laser Doppler flux at rest and after arterial occlusion lasting one minute. The blood cell flux was measured in normal, untreated and treated skin areas. The resting flux was significantly higher in untreated port wine stains than in the normal skin. The reactive hyperemia response was significantly impaired in the untreated skin, although a 60% increase in blood cell flux was achieved by the short arterial occlusion. In most of the recorded parameters the treated areas showed a less pathological reaction than the untreated ones. We conclude that peroperative vasodilation can be induced in port wine stains, and this may be used to improve the outcome of argon laser treatment.

Adult↗
PubMed1990

Discrepancies between total and nutritional skin microcirculation in patients with peripheral arterial occlusive disease (PAOD).

Clinical observations indicate that a discrepancy may exist between the total and nutritional skin microcirculation in extremities of patients with peripheral arterial occlusive disease (PAOD), which suggests a local maldistribution of blood flow. The present study was performed to investigate how the skin blood flow is locally distributed in the toes of patients with PAOD. The total skin microcirculation was evaluated by laser Doppler fluxmetry (LDF), and the blood flow in the nutritional skin capillaries by dynamic capillaroscopy. This combination was simultaneously used to study the nailfold microcirculation in the big toe of 12 legs of 8 patients with various degrees of PAOD, using 10 legs of 8 healthy subjects as control. Capillary blood cell velocity (CBV) was evaluated by a new computerized videophotometric technique (CapiFlow). It was found that the nutritional blood flow, as evaluated by CBV, was similar in both groups (0.2 vs. 0.25 mm/s, NS), whereas the total blood flow, as evaluated by LDF, was significantly (p less than 0.05) increased in toes of patients with PAOD (11.7 AU) in comparison to normal subjects (2.0 AU). The postocclusive reactive hyperemia was impaired for both CBV (6% vs. 70%, p less than 0.05) and LDF (14% vs. 50%, p less than 0.01) in the PAOD group. The prevalence of flow motion (30% vs. 80%) was significantly (p less than 0.05) lower in patients as compared to controls. It is concluded that the resting blood flow in the skin microcirculation is increased but maldistributed in patients with PAOD. The reactivity of the microcirculation is also impaired in the affected region.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1990

The influence of reactive hyperemia and leg dependency on skin microcirculation in patients with peripheral arterial occlusive disease (PAOD), with and without diabetes.

The increase in venous pressure during leg dependency causes a vasoconstriction of the distal vascular bed in healthy subjects, which is due to the so-called veno-arteriolar reflex. The aim of the present study was to investigate if this reflex is disturbed in patients with severe peripheral arterial occlusive disease (PAOD), with and without diabetes. The total skin microcirculation during rest and postocclusive reactive hyperemia (PRH) after a three minute arterial occlusion at the ankle was studied by laser Doppler (LD) fluxmetry. The LD probe was attached to the dorsal region of the foot in 10 legs of healthy control subjects, patients with PAOD, and patients with PAOD and diabetes respectively. No vasoconstriction was seen in the PAOD group when the leg was moved from the supine to the dependent position. The PRH response was also significantly (p less than 0.05-0.01) impaired compared to the controls in both positions. The diabetic PAOD patients had an almost normal reactivity in spite of an equally reduced arterial circulation as the non-diabetic patients. The results show that patients with PAOD have a significantly disturbed reactivity of the skin microcirculation in the ischemic foot, while the reactivity in diabetic PAOD patients is almost normal.

Aged↗
PubMed1990

Mechanisms for edema formation in normal pregnancy and preeclampsia evaluated by skin capillary dynamics.

Disturbances of vasomotor activity and veno-arteriolar reflex mechanism probably promote cutaneous edema formation. Videophotometric capillaroscopy was used to measure nailfold skin capillary blood cell velocity (CBV) and its response to increased transmural pressure induced by venous occlusion in healthy subjects, normal pregnancies and patients with preeclampsia. Vasomotion, assessed by rhythmic variation of CBV, was also recorded. Both frequency (3-10 cycles/minute) and amplitude (0.01-0.23 mm/s) of CBV fluctuations were similar in all groups investigated. In healthy controls basal CBV was positively correlated with the amplitude of individual velocity fluctuations (r = 0.89). CBV response to venous occlusion was significantly reduced (p less than 0.05) in preeclampsia compared to normal pregnancies and non-pregnant controls. This finding indicates impaired veno-arteriolar reflex which may contribute to the edema formation seen in preeclampsia. It is suggested that vasomotor activity may serve as a physiological modulator of vascular resistance and hence CBV.

Adolescent↗
PubMed1989

Bilateral involvement and the effect of sympathetic blockade on skin microcirculation in the sympathetic dystrophies.

In a recent study we found skin capillary blood cell velocity (CBV) at rest, laser Doppler flux (LDF), and its response to lowering of the hand to be reduced in the dystrophic hand of patients suffering from sympathetic dystrophies. This study confirms these previous findings. Four of the 12 patients investigated felt intermittent pain in the "healthy" hand. Basal CBV, LDF, and reaction during dependency were not impaired in the asymptomatic hand compared with controls. However, during cooling of the contralateral hand CBV and LDF decreased significantly (median 44 and 37.5%) in the control group but neither in the affected nor in the asymptomatic hand among patients. Sympathetic blockade significantly increased both CBV and LDF in the dystrophic hand (median 58 and 20%), but no obvious beneficial symptomatic effect was noted. The lack of response to contralateral cooling in both hands indicates a disturbance of a central nervous mechanism in patients with unilateral sympathetic dystrophies.

Adult↗
PubMed1989

Changes of activated partial thromboplastin time during constant intravenous and fixed intermittent subcutaneous administration of heparin.

Marked circadian variations in the activated partial thromboplastin time (APTt) during continuous heparin infusions for thromboembolic episodes have been reported in a French study. The aim of the present study was to test if these variations could be reproduced in a Swedish population. The frequency spectrum variations in APTt values were analysed with the Prony and the statistical Pearson product momentum correlation coefficient methods. In seven patients with pulmonary embolism, APTt was checked every fourth hour during 48 h of continuous, constant heparin treatment. In only one patient was a distinct circadian variation of APTt values seen. In six patients with venous leg thromboses, treated with s.c. heparin, marked variations in APTt were noticed over periods of 12 h. These variations paralleled the regular s.c. injections of heparin every twelfth hour. The results of the present study could not confirm the marked circadian variations in APTt reported in an earlier French study during continuous heparin infusions, except in one patient.

Adult↗
PubMed1989

Local skin pressure and its effects on skin microcirculation as evaluated by laser-Doppler fluxmetry.

The effect of prolonged local pressure on the skin microcirculation was investigated in the regions of the sacrum and gluteus maximus muscle to determine the aetiology of pressure sores. Thirty normal subjects (15 female, 15 male) were investigated. The subjects were divided into three age groups: group 1, less than or equal to 35 years; group 2, 36-64 years; and group 3, greater than or equal to 65 years. Local pressure was applied with a specially designed instrument according to the sequence 0----110----0----110----0----mmHg. Skin blood cell flux (SBF) was measured with a laser-Doppler technique and the local skin temperature measured with a thermistor. No significant differences were seen in SBF due to sex or age. However, differences between the two areas studied were observed. SBF was maximal over the sacrum at 12-50 mmHg (1.6-6.7 kPa) applied pressure. With further pressure increases, the SBF signal decreased successively, reaching minimum level at 110 mmHg (14.6 kPa), where it was approximately 43% below the initial value. The SBF in the gluteus region showed a more stable pattern, with a maximum SBF at 13-60 mmHg (1.7-8.0 kPa). At both locations, an increased SBF at zero pressure was seen when the pressure was decreased from 110 to 0 mmHg. The skin temperature (n = 7) increased by 2.7 degrees C (range 1.9-3.5 degrees C) over the gluteus and by 1.3 degrees C (range 0.8-2.5 degrees C) over the sacrum. This increase was more rapid over the gluteus region. Concomitantly a temperature-dependent increase of SBF could be seen. It is concluded that a cause for the greater frequency of pressure sores over the sacrum than over the gluteus region is the comparatively poorer regulation of microvascular flow in this area.

Adult↗
PubMed1989

Skin capillary blood cell velocity in preeclampsia. The effect of plasma expansion.

Blood viscosity and peripheral vascular resistance have been reported to be increased in preeclampsia, indicating the possibility of an impaired capillary circulation. Nailfold skin capillary blood cell velocity (CBV) was measured by videophotometric capillaroscopy in 14 healthy pregnant women and 12 preeclamptic patients. No significant difference was found between basal CBV in the preeclamptic group (median 0.58 mm/s) and the healthy controls (0.52 mm/s). Following infusion of dextran 70 in preeclamptic patients CBV at rest increased to 154% of pre-infusion values (p less than 0.05). The time to peak CBV during post-occlusive reactive hyperemia was almost equal in the two groups and did not change in the preeclamptic group after dextran 70 administration. The enhanced dermal microcirculation following infusion of dextran 70 may be explained by hemodynamic and hemorheological effects, which presumably would be of greater importance if also present in the placental nutritive circulation.

Adult↗
PubMed1989

Delayed arterial thrombosis following an apparently trivial low-voltage electric injury.

Vascular damage is a frequent and serious complication following high voltage injuries (greater than 1000 V), but does not seem to have been described with low-voltage current. We report an unusual case with delayed thromboses in the hand arteries of a young, healthy 24 yo man, after a 220 V electric shock. Two weeks after the accident he developed a successively increasing hand ischemia with Raynaud phenomenon, and finally fingertip necroses. Angiography revealed multiple small vessel occlusion. Although systemic fibrinolysis with streptokinase was not initiated until eight weeks after the accident, a partial restitution of the markedly reduced macro- and microcirculation in the fingers was possible. The blood pressure of the ischemic fingers increased from 0 to 40 mmHg, with total relief of symptoms. Concomitantly, a marked improvement of the skin microcirculation could be objectively demonstrated by laser Doppler fluxmetry and dynamic capillaroscopy. Three conclusions can be made 1) low-voltage electric shock can initiate late vascular thromboses, 2) thrombolysis can be effective also weeks after the thromboses have been established, and 3) the improvement of the nutritional circulation in the ischemic areas can be nicely and objectively documented by the two methods described.

Adult↗
PubMed1988

One-year sequential follow-up of venous emptying rate and leg temperature profiles after acute deep vein thrombosis.

In order to study the natural course of venous flow and temperature reaction in the legs after symptomatic first episode of deep vein thrombosis (DVT), 65 patients (57 with proximal DVT) without further thromboembolic complications during the observation period were followed for 1 year by repeated plethysmography (PG) and thermography (TG). Regarding the non-invasive parameters substantial individual variations was observed during the observation period. After 1 year pathologic PG and TG were still demonstrated in 39% (I mu (95%) = /0.43 +/- 0.05/) and 65% (I mu (95%) = /1.18 +/- 0.11/), respectively, of the patients after proximal DVT. Only a minority of the patients were normalized permanently in both PG and TG during the first year. The high frequency of remaining venous obstruction and especially, persistent thermoactivity is notable and may be of clinical importance.

Adult↗
PubMed1988

Skin microvascular circulation in the sympathetic dystrophies evaluated by videophotometric capillaroscopy and laser Doppler fluxmetry.

Finger-skin microcirculation and its reactions to sympathetic stimuli were investigated in 12 patients with sympathetic dystrophies, secondary to trauma or other diseases. Nailfold-skin capillary blood cell velocity (CBV) was measured by videophotometric capillaroscopy. Laser Doppler fluxmetry was used to provide an index of skin circulation in vessels in addition to the superficial capillaries. Both CBV and laser Doppler flux (LDF) values were significantly lower in the patients, compared with the healthy controls (P less than 0.05), despite the fact that skin temperature was the same in both groups. During cooling of the contralateral hand, CBV and LDF decreased markedly (22-60%) in the control group but not in the patients (0-13%). The decrease in skin perfusion normally seen upon lowering of the hand was also impaired in the patient group (7%) compared with controls (42%) (P less than 0.05). These impaired vasomotor reflex responses are consistent with sympathetic dysfunction and may well explain some of the typical features of the syndrome, e.g. limb oedema.

Aged↗
PubMed1988

Capillary blood cell velocity in full-term infants as determined in skin by videophotometric microscopy.

In order to study the neonatal microcirculation, the capillary hemodynamics in skin was investigated in 43 full-term infants 2-7 days after birth. The nailfold capillaries of the thumb were visualized by means of television microscopy and the capillary blood cell velocity (CBV) was videophotometrically quantified in 107 microvessels. The skin temperature, mean arterial blood pressure, and heel puncture hematocrit were measured simultaneously to evaluate any relation with the CBV. The mean CBV in all infants was 0.38 +/- 0.21 mm/s, with a range of 0.04 to 1.2 mm/s in individual capillaries. There was no correlation between CBV and skin temperature (27-33 degrees C), mean arterial blood pressure (44-68 mm Hg), or postnatal age. However, a significant correlation was found between the log CBV and the skin prick hematocrit (r = -0.64, p less than 0.001). It is concluded that the mean CBV during the 1st wk of life is not significantly different from the capillary velocity reported in adults. Normal variations in skin temperature and mean arterial blood pressure, as well as age differences 2-7 days after birth, do not significantly influence the neonatal skin capillary blood flow. However, the hematocrit is of major importance for skin capillary perfusion in the newborn infant.

Blood Flow Velocity↗