PubMed Health⌕ Search

Biomedical subjects

B Kalin

Publications and source records attributed to B Kalin.

At least 19 recordsLinked to original sources
PubMed2003

Quality assurance with regard to outcome and use of medical resources for patients hospitalized with acute chest pain: a comparison between a city university hospital and a county hospital.

This study aimed to test the hypothesis that there is a difference in mortality between patients hospitalized with acute chest pain in a university hospital and those hospitalized in a county hospital, and to describe differences in characteristics and use of medical resources in these two settings. All patients hospitalized at Sahlgrenska University Hospital in Göteborg (with a catchment population of 706 inhabitants/km(2)) and Uddevalla County Hospital (with a catchment population of 34 inhabitants/km(2)) with symptoms of acute chest pain during a registration period of 6 months were included in the study. A total of 1592 patients in the city hospital and 822 in the county hospital fulfilled the given criteria for inclusion. Patients in the urban area differed from those in the rural area in that they had a lower prevalence of previous angina pectoris and hypertension and a higher prevalence of previous cancer, previous percutaneous transluminal coronary angioplasty (PTCA) and coronary artery bypass grafting (CABG) and current smoking. On admission to hospital, patients in the urban area less frequently showed clinical signs of congestive heart failure and acute ischaemia on the electrocardiogram (ECG) but more frequently had a pathological ECG without signs of ischaemia and more frequently had a heart rate >100 beats/min. The use of medical resources differed between the two hospitals. Revascularization was more frequent in the city hospital and the use of -blockers in the county hospital. The overall 30 day mortality was 4.7% in the urban area and 4.3% in the rural area (P=0.74). When correcting for differences at baseline, the risk ratio for death in the county hospital versus the city hospital was 0.84 (95% confidence interval 0.51-1.40, P=0.53). In conclusion, among patients hospitalized with acute chest pain in a city university and a county hospital the mortality during the subsequent 30 days did not differ. However, there were differences in terms of the use of medical resources and in previous history, chronic medication prior to hospital admission and status on admission between the two cohorts.

Acute Disease↗
PubMed2000

Growth of thrombus may be a better predictor of rupture than diameter in patients with abdominal aortic aneurysms.

OBJECTIVES: to investigate the relationships between diameter, surface and thrombus area in abdominal aortic aneurysms (AAAs) <5 cm. METHODS AND MATERIAL: sixty-seven patients with AAA underwent at least 2 CT examinations. At the point of maximal diameter, surface area and thrombus area were calculated and related to rupture, or impending rupture, during follow-up. RESULTS: the mean increase in measured diameter, surface area and thrombus area were 3.4 mm, 1.9 cm(2)and 1.7 cm(2)per year respectively. Patients with AAA >4 cm and whose thrombus area increased >1.5 cm(2)/year were more likely to rupture (6/24 vs 1/23). CONCLUSIONS: a rapid increase of thrombus area may be a better predictor of AAA rupture than increase in maximal diameter.

Aged↗
PubMed2000

Patients admitted to the emergency department with acute chest pain--is there a difference between patients in an urban and a rural area?

The aim of this study was to compare the characteristics and outcome for patients coming to the emergency department with acute chest pain in a city university hospital, representing an urban area, and a county hospital, representing a rural area. This was a retrospective survey of all chest pain patients at Sahlgrenska University Hospital, Göteborg, covering an area with 706 inhabitants/km2, and at Uddevalla County Hospital, Uddevalla, covering an area with 34 inhabitants/km2, over a period of 6 months. In all 2,297 patients were registered at Sahlgrenska University Hospital and 1062 at Uddevalla Hospital (per 100,000 inhabitants and year 1,502 and 1,342 patients, respectively). The patients in the urban area were more frequently sent home from the emergency department than in the rural area (30% versus 23%; p < 0.0001). Patients in the urban area had a lower prevalence of previous cardiovascular diseases. An obvious acute myocardial infarction (AMI) or a strong suspicion of AMI at initial evaluation was less frequent in the urban area whereas no suspicion of AMI was twice as common (46% versus 24%; p < 0.0001). Furthermore, there was a difference in the use of medications; various cardiovascular drugs were more frequently used in the rural area. Despite these differences at baseline the 30-day mortality was similar (3.5% in the urban area and 3.6% in the rural area; NS), as well as the 2-year mortality (14.0% and 12.7%, respectively; NS). It is concluded that the number of patients admitted to the emergency department with acute chest pain/100,000 was slightly higher in the urban than in the rural area. Patients in the urban area differed from those in the rural area having a lower prevalence of previous cardiovascular diseases, a lower initial suspicion of AMI, they were less frequently hospitalized and less frequently prescribed various cardiovascular drugs. Mortality did not differ between the two cohorts.

Adolescent↗
PubMed2000

Endovascular treatment of atherosclerotic lower limb lesions using a PTFE-collared stent-graft.

PURPOSE: To assess the feasibility of a polytetrafluoroethylene-collared (PTFE) endoluminal graft in the treatment of lower limb atherosclerosis. METHODS: We designed an endograft using a 3-mm-diameter balloon-expandable PTFE graft with terminal Palmaz stents placed on the outside of the graft, folding the PTFE back over the stents to form a collar at each end. Under protocol, this device was implanted in 8 symptomatic patients with lower limb ischemia. The lesions, ranging from 4 to 20 cm long, were located in the superficial femoral artery (n = 5), femoropopliteal segment (n = 1), and common (n = 1) and external (n = 1) iliac arteries. The device required a 14-F introducer system. RESULTS: Graft lengths varied from 4 to 35 cm. Implantation was successful in all cases, but procedural complications occurred in 4 patients (2 access site hematomas, 1 leading to endograft occlusion; 1 arterial injury, and 1 distal thromboembolism). At a mean 14-month follow-up, 5 endografts were patent (2 after reintervention for restenosis or thrombosis). The common iliac endograft and 2 superficial femoral artery devices occluded after 3, 2, and 12 months, respectively. CONCLUSIONS: Although this endoluminal graft system is technically feasible and showed encouraging intermediate-term patency in a small pilot study, the early and late complications identified several shortcomings of this design, which needs refinement.

Aged↗
PubMed1994

Venous shunting as a complication to penile revascularization--a case report.

As a serious complication to arterial penile revascularisation arterio-venous shunting was observed in a 60 years old male. The patient suffered bilateral obstruction of his pudendal arteries. Following revascularization using the left inferior epigastric artery he obtained good pulsation in the penis but no return of sexual function. Instead his general condition deteriorated. A follow-up angiogram revealed shunting of the contrast from the epigastric artery, via the penis, to the venous system. Venous ligation was carried out. The patient's general condition returned to normal status and he can now obtain rigid erections. Reconstructive arterial surgery for erectile dysfunction should never be carried out unless venous leak has been ruled out as a complicating factor.

Follow-Up Studies↗
PubMed1993

Low dose cyclophosphamide, alpha-interferon and continuous infusions of interleukin-2 in advanced renal cell carcinoma.

Pretreatment with a low dose of cyclophosphamide (CY) has been claimed to inhibit suppressor functions and augment various immune functions. A combination of a low dose of CY, alpha-interferon (IFN-alpha) and continuous infusion of interleukin-2 (IL-2) was used to treat patients with advanced renal cell cancer (RCC) (stage IV). Sixteen patients received four cycles consisting of CY (500 mg m-2) three days prior to daily i.m. injections of alpha-IFN (3 x 10(6) U), and continuous infusion of 18 x 10(6) IU rIL-2 for five days. The cycle interval was three weeks. Two patients had partial response (13%) (26+ and 12+ months), two had a minor response (9+ and 4 months), and three patients achieved stable disease (19+, 14+ and 8+ months). No patients required intensive care. Side effects were mainly fever, malaise, capillary leak syndrome and diarrhoea. Non-responders showed significantly higher eosinophil and platelet counts compared to responders. Serum concentration of IL-2 was significantly higher in responders. 5/11 patients had abnormally low values of serum thyroxine after therapy. Two patients needed thyroid hormone substitution. The difference between the initial and the lowest thyroxine values correlated significantly to survival (p < 0.03). The addition of CY to rIL-2 and IFN-alpha in the present protocol did not contribute to an increased major response rate.

Adolescent↗
PubMed1993

Can pharmacological intervention improve the visualization of the reticuloendothelial system using 99mTc-labeled albumin nanocolloid to that achievable with 111In-labeled granulocytes? Experimental studies in mice.

The use of 99mTc-colloids for bone marrow scintigraphy is limited by a high liver uptake, which hampers the evaluation of surrounding skeletal structures. In an experimental mouse system, different measures to increase the bone marrow activity in relation to the liver activity have been tested. A slightly positive, but significant, outcome was achieved by three different measures, namely fasting, pretreatment with a calcium-blocking pharmaceutical (Nimodipine) and pretreatment with large amounts of a gelatine colloid. It is concluded that the possibilities of dramatically improving the bone marrow uptake of a colloid compared to the liver are limited and not comparable to that achievable using radiolabeled granulocytes.

Animals↗
PubMed1993

A better target-to-background activity ratio using a large-sized colloid compared to a nano-sized colloid for scintigraphy of the peripheral bone marrow. A study in mice and humans.

Small-sized radiocolloids with a diameter less than 100 nm (nanocolloids), reduce the confounding liver and spleen uptake compared to large-sized colloids at bone marrow scintigraphy. Consequently, nanocolloids are today generally used for this purpose. Such colloids, though, seem to produce considerable background activity, especially from the large vessels and the urinary tract. This has been studied in mice and humans using a nanocolloid and a large-sized colloid, both composed of human albumin. In mice, the findings confirm a lower relative and absolute uptake of the nanocolloid in the liver and spleen compared to the large-sized colloid, whereas the bone marrow activity relative to the activity of kidneys, heart, lungs, intestines and peripheral blood is higher for the large-sized colloid than for the nanocolloid. The latter was confirmed in humans who were examined by single photon emission computed tomography corrected for attenuation and scattering of photons. It is concluded that a large-sized colloid should be used for spot examination of a specific marrow region outside the liver and spleen, while a nanocolloid must be used when examining structures close to the liver and spleen as well as for depiction of the entire bone marrow.

Animals↗
PubMed1993

A method to improve the quality of bone marrow scintigraphy by scatter radiation correction with the use of two opposing views.

Bone marrow scintigraphy using radiocolloids labelled with 99Tcm allows imaging of the active marrow with moderate effort. However, most of the administered colloid is trapped in the liver and spleen giving rise to a considerable amount of scattered photons, which cause considerable problems when evaluating the adjacent bone marrow. There are scatter correction methods developed for single photon emission computed tomography. The application of such a technique to bone marrow scintigraphy in the liver region using two opposing views is described. Phantom measurement and patients studies show that substantially improved visualization of the bone marrow close to the liver is possible using this technique for scatter correction.

Bone Marrow↗
PubMed1993

Gastric intestinal metaplasia eleven years after randomized selective proximal vagotomy for peptic ulcer.

The presence of intestinal metaplasia (IM) 11 years after selective proximal vagotomy (SPV), selective proximal vagotomy with pyloroplasty (SPV + PP) and selective vagotomy with pyloroplasty (SV + PP) was investigated in 38 consecutive patients. IM was significantly more frequent in SPV than in SV + PP, SPV + PP or in unoperated controls of matching ages. IM occurred more frequently both at an older age (> or = 60 years) in SPV and in a larger number of gastric areas than in the other group of patients. Reports in the literature indicate that vagotomy may increase the risk of gastric carcinoma and that IM may antedate malignant transformation. It would thus appear that patients previously operated with SPV (without pyloroplasty) having IM, should be the group of patients to be enrolled in endoscopical surveillance programs for detection of possible cancer development.

Adult↗
PubMed1993

Improving bone marrow scintigraphy. A clinical and experimental study.

Today bone marrow scintigraphy is performed by imaging either the reticuloendothelial system by means of colloids or the hematopoietic marrow with granulocytes. When visualizing the marrow with radiolabeled colloids most of the administered activity will be taken up by the liver and spleen. To use granulocytes for bone marrow imaging is a comparatively expensive and complicated method. The aim of this study was to investigate the possibilities to shift the uptake of some of the injected activity from the liver-spleen and/or background to the bone marrow. Four small-sized colloids were evaluated in patients routinely referred for single photon emission computed tomography of the liver/spleen. After correction for attenuation and scattering of photons quantitative assessment of the activity in different organs was performed. Of the four colloids Nanocoll turned out to be the most favorable, thus this colloid was decided to be evaluated further. To assess the possibilities to improve the relative bone marrow uptake of Nanocoll, it was separated by gel filtration and different sized subfractions were injected into mice. None of the subfractions exhibited a more favorable bone marrow/liver-spleen ratio than the unseparated colloid. As blood clearance of a colloid is dependent on perfusion different measures were evaluated in mice aiming at either an increase in the blood flow to the bone marrow or a decrease in the liver-spleen perfusion. Nine different pharmaceuticals were tested. None improved the bone marrow uptake in relation to the liver enough to justify administration to humans. Fasting increased, however, the relative bone marrow uptake by approximately 15%. To evaluate the soft tissue background activity for colloids of different size a nanosized colloid (Nanocoll) and a larger colloid (Albu-Res) were investigated in an experimental mouse system and in humans. The latter were examined by quantitative single photon emission computed tomography as described above. The bone marrow activity relative to the soft tissue background activity was higher for the larger colloid in both mice and humans. By quantitative single photon emission computed tomography of the liver, spleen, bone marrow, and background the distribution of in vitro labeled autologous granulocytes and a colloid (Nanocoll) were assessed in patients. The activity of the bone marrow relative to the liver was significantly higher for granulocytes. The influence of scattered radiation is considerable in the vicinity of the liver. A technique for scatter correction with two opposing views was applied in a phantom and a human study. Both showed a considerable improvement of the visibility of the bone marrow close to the liver.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗
PubMed1991

Effect of size fractionation on the distribution of an albumin colloid in the reticuloendothelial system of the mouse.

To study if by varying the particle size of a 99mTc albumin colloid preparation its relative bone marrow accumulation could be increased, it was separated by gel filtration and different fractions were injected into mice. Particles around and smaller than the peak size of the colloid, 31 nm, exhibited a higher bone marrow/liver-spleen uptake ratio than larger particles but the uptake ratio was similar to that of the unseparated colloid. An antimony sulphide colloid showed a similar particle size distribution, but the corresponding uptake ratio was half of the albumin colloid. This indicates that characteristics other than size determine the distribution of a colloid in the reticuloendothelial system.

Animals↗
PubMed1991

Quantitative evaluation of four 99Tcm colloids for bone marrow scintigraphy using single photon emission computed tomography.

Colloids used for bone marrow scintigraphy are also taken up in the liver and spleen. The liver activity in particular hampers interpretation of the study. In this study, four small-sized commercial colloids labelled with 99Tcm were compared for bone marrow uptake relative to the liver, spleen and background activity. Three human albumin colloids (Microlite, E.I. du Pont de Nemours & Co; Solco Nanocoll, Solco Nuclear; TCK-9, International CIS) and one antimony sulphide colloid (TechneScan Sb2S3, Mallinckrodt Diagnostics) were compared. The study was performed in patients routinely referred for liver/spleen scintigraphy who had a normal result. Each examination was carried out using single photon emission computed tomography. After correction for attenuation and scattering of photons, the activity of the bone marrow of the lumbar spine was related to the liver, spleen and background activity. The bone marrow/liver activity quotient of Solco Nanocoll and TCK-9 was almost twice the value for Microlite and TechneScan Sb2S3. The bone marrow/spleen quotient was almost four times higher and the bone marrow/background quotient almost twice as high for Solco Nanocoll as for the other three colloids, between which there were no significant differences.

Antimony↗
PubMed1990

Comparison of In-111 granulocytes and Tc-99m albumin colloid for bone marrow scintigraphy by the use of quantitative SPECT imaging.

A comparison of In-111 oxinate labeled autologous granulocytes and Tc-99m albumin colloid for bone marrow scintigraphy is reported. The aim of this report was to determine if the intense uptake in the liver and spleen with nano-sized colloids, which hampers the evaluation of the skeletal parts surrounding the liver, is reduced by the use of radiolabeled granulocytes. This study is based on a retrospective analysis of 19 abdominal tomographic examinations with In-111 granulocytes performed to detect septic foci. After correction for attenuation and scattering of photons was performed, the uptake in the bone marrow of the lumbar spine was seen to be related to the liver, spleen, and tissue background activity. The results in this study were compared with corresponding data from 20 normal liver/spleen tomographic examinations performed with Tc-99m nanocolloid, which is routinely used for bone marrow scintigraphy. The bone marrow/liver activity ratio for granulocytes varied, but it exceeded the corresponding mean ratio for colloid in all examinations. The mean values for granulocyte uptake 3 and 20 hours after injection was, respectively, about 6 and almost 10 times higher than were those for colloid. The activity ratios between bone marrow and spleen as well as between bone marrow and tissue background was not improved and or may even have been reduced by the use of granulocytes. It is suggested that granulocytes labeled in vitro by Tc-99m hexamethylpropylene amineoxime (HMPAO) or in vivo by monoclonal antigranulocyte antibodies may provide techniques for improved bone marrow imaging.

Adult↗
PubMed1989

Kinematics of the ankle/foot complex: plantarflexion and dorsiflexion.

In an in vivo investigation of eight healthy volunteers, three dimensional ankle/foot kinematics were analyzed by roentgen stereophotogrammetry in 10 degrees steps of motion from 30 degrees of plantar flexion to 30 degrees of dorsiflexion of the foot. The study included all of the joints between the tibia and the first metatarsal, as well as the talocalcaneal joint, and was performed under full body load. Although the talocrural joint was found to account for most of the rotation around the transverse axis occurring from 30 degrees of plantar flexion to 30 degrees of dorsiflexion, there was a substantial contribution from the joints of the arch. This was seen particularly in the input arc from 30 degrees of plantar flexion to the neutral position, where the dorsiflexion motion of these joints amounted to 10% to 41% of the total transverse axis rotation.

Adult↗
PubMed1982

Effect of percutaneous transhepatic drainage upon liver function and postoperative mortality.

The results of the use of percutaneous transhepatic drainage in 109 patients between 1968 and 1980 were analyzed. The serum concentration of bilirubin decreased during the three week drainage period but not to normal values and more slowly than would be expected from normal hepatic bilirubin elimination, in site of adequate drained bile volumes. This decrease was most pronounced during the first week of drainage and in patients with high predrainage bilirubin levels. During refeeding of bile into the intestine, hepatic bilirubin excretion seemed to increase, possibly as a result of higher bile acid excretion. Of the 109 percutaneous transhepatic drainage patients, 58 underwent surgical treatment. Their postoperative mortality was compared with that of a control group of 65 patients, who were operated upon immediately after simple diagnostic percutaneous transhepatic cholangiography. It was not possible to demonstrate any significant difference in the postoperative mortality between these two groups. When the complications and, in addition, even mortality of the percutaneous transhepatic drainage procedure are taken into account, it seems doubtful that percutaneous transhepatic external drainage will benefit patients undergoing operation. This procedure may still be of great value in patients in whom only palliation is demanded.

Adult↗
PubMedDate not supplied

The role of coagulation and inflammation after angioplasty in patients with peripheral arterial disease.

PURPOSE: Restenosis remains a frequent complication after angioplasty in peripheral arterial disease. Inflammation plays a critical role in the vascular response to injury. Effective medical treatment to improve patency after angioplasty is still elusive. The aims of this prospective clinical study were to investigate changes in blood coagulation and inflammatory markers after angioplasty and their significance for restenosis. METHODS: Thirty-four patients with peripheral arterial disease underwent angioplasty of the iliac and superficial femoral arteries. Ten patients undergoing diagnostic angiography were included in the study as controls. Plasma levels of tissue factor, prothrombin fragment 1 + 2, D-dimer, P-selectin, C-reactive protein (CRP), and fibrinogen were analyzed before and after angioplasty. Patients were followed up with angiography after 6 months to assess restenosis. RESULTS: CRP was elevated the day after angioplasty (6.6 mg/l, p = 0.0001) and tended to peak after 1 week (11 mg/l, p = 0.09). There was a significant increase of D-dimer and P-selectin 1-4 hr after angioplasty (0.4 mg/l, p = 0.001 and 68 ng/ml, p = 0.05, respectively). None of the biochemical markers was a statistically significant predictor of restenosis. CONCLUSION: We have observed a much more prolonged inflammatory response than previously noted, but only minor changes in coagulation activity after angioplasty. The biochemical markers, before and after angioplasty, were not related to restenosis. Further studies are needed to delineate the molecular mechanisms behind these observations and their involvement in thrombosis and restenosis. If these pathways are further defined, improved treatment strategies, including antithrombotic treatments and statins, could be tailored to modulate postprocedural inflammation.

Aged↗