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Biomedical subjects

B Westman

Publications and source records attributed to B Westman.

9 recordsLinked to original sources
PubMed1999

Cytokine and fibrinogen response in patients undergoing open abdominal aortic aneurysm surgery.

OBJECTIVES: To assess whether open abdominal aortic aneurysm (AAA) surgery influences cytokines and fibrinogen. METHODS: Twenty-three consecutive patients operated on for AAA were compared to 11 operated controls and 20 age-matched controls. Cubital blood was sampled pre-, intra- and postoperatively and femoral blood also sampled intraoperatively. RESULTS: Preoperatively, interleukin (Il)-6 was elevated in AAA patients. During aortic clamping, Il-6, Il-10 and monocyte chemoattractant protein-1 (MCP-1) increased significantly (p < 0.001, p < 0.01 and p < 0.05 respectively) while soluble interleukin-2 receptor (sIl-2R) and fibrinogen decreased significantly (p < 0.001 for both). After aortic declamping, Il-6, Il-10 and MCP-1 had further significant increases compared with levels during aortic clamping while sIl-2R had a further non-significant and fibrinogen a significant decrease (p < 0.05 in cubital and p < 0.001 in femoral blood). One week postoperatively Il-6, Il-10 and MCP-1 had all decreased but were still significantly elevated compared with baseline values while sIl-2R and fibrinogen showed an increase in comparison with baseline (p < 0.001 for both). Intraoperative levels of Il-6 and Il-10 showed a significant co-variation with the magnitude of operative trauma. CONCLUSIONS: These data indicate that open AAA surgery induces a profound inflammatory and coagulative response which persists at one week postoperatively.

Aged↗
PubMed1999

Ischaemia and reperfusion during open abdominal aortic aneurysm surgery induce extensive thrombin generation and activity.

OBJECTIVES: does open surgery for abdominal aortic aneurysm (AAA) influence coagulation? METHODS: in 23 patients operated on for AAA, cubital blood was sampled pre-, intra- and postoperatively. Femoral blood was also sampled intraoperatively. RESULTS: preoperatively, prothrombin fragment 1+2 (F1+2), thrombin-antithrombin complex (TAT) and soluble fibrin (SF) were elevated in AAA patients. During aortic clamping all parameters increased significantly in cubital blood (p<0.01) as well as in femoral blood (p<0.001) and after aortic declamping F1+2 and TAT increased further. F1+2, TAT and SF were significantly higher in femoral than cubital blood. Postoperatively F1+2 and TAT returned to preoperative values, while SF still had a significantly higher level than preoperatively (p<0.001). Blood loss showed co-variation with F1+2 increase in femoral blood after aortic declamping (p<0.05). CONCLUSIONS: these data indicate that the coagulation system was strongly activated by the occurrence of an AAA. During AAA surgery a further extensive activation was seen. The activity was still high, but on decline, one week postoperatively. Ischaemia and reperfusion of the lower part of the body were the major stimuli for thrombin generation and activity.

Adult↗
PubMed1996

Decrease in muscle glutamine, ribosomes, and the nitrogen losses are similar after laparoscopic compared with open cholecystectomy during the immediate postoperative period.

BACKGROUND: The purpose of the study was to compare the postoperative muscle amino acid pattern, the ribosome concentration and size distribution, and postoperative nitrogen balance in patients who underwent either laparoscopic or open cholecystectomy. METHODS: Patients who underwent cholecystectomy by means of either laparoscopy (n=8;LAP) or laparotomy (n=8;OPEN) were studied. The concentrations of amino acids, ribosomes, and polyribosomes, reflecting protein synthesis, were determined in skeletal muscle tissue before operation and on postoperative day 2. The cumulated nitrogen balance was determined. RESULTS. Decreases in muscle glutamine (26.7% +/- 8.4% in the LAP group and 30.3% and +/- 4.5% in the OPEN group) and in polyribosomes (28.7% +/- 6.5% in the LAP group and 23.6% +/- 8.5% in the OPEN group) were observed without differences between the groups (mean +/- SEM). The nitrogen losses were similar in both groups (15.2 +/-1.6 gm in the LAP group and 15.5 +/- 1.2 gm in the OPEN group). CONCLUSION: A stress++ response with effects on amino acid and protein metabolism in muscle in present also after laparoscopic cholecystectomy. On postoperative day 2 this response is of similar magnitude after both the laparoscopic and the open procedures.

Adult↗
PubMed1993

Avoiding blow-out of the aortic stump by reinforcement with fibrin glue. A report of two cases.

Generally vascular surgeons agree that the most rational way to treat a patient with an infected aortic graft or aortoenteric fistula is excision of the graft, closure of the aortic stump and construction of an axillobifemoral bypass. Due to the feared complication of blow-out of the aortic stump, other solutions have been proposed, such as in-situ reconstruction with homologous saphenous veins or even with a synthetic graft, provided the perigraft fluid is non-purulent. Since this alternative is not always feasible, various methods to reinforce the closure of the aortic stump have been proposed. The present report describes two cases, where fibrin glue (Tisseel) was successfully used to reinforce the suture row of the aortic stump.

Aged↗
PubMed1987

Hyaluronic acid in bronchoalveolar lavage in rats exposed to quartz.

Hyaluronic acid, a connective tissue component, in bronchoalveolar lavage fluid (BAL) is correlated with decreased lung volumes in sarcoidosis. To investigate whether hyaluronic acid could be a marker of fibrosis in another interstitial lung disease, silicosis, the level of the substance in BAL fluid from rats exposed to crystalline silica (n = 3), amorphous silica (n = 3), and in one sham injected rat was measured. There was an increase in the total number of alveolar cells recovered in the rats exposed to crystalline silica and also a pronounced increase in the proportions of neutrophils and lymphocytes. In addition, the concentration of hyaluronic acid was high in this group of rats, and electron microscopic investigation of the lungs showed fibrosis. Thus hyaluronate in BAL fluid in rats exposed to crystalline silica seems to be a possible marker of fibrotic changes.

Animals↗
PubMedDate not supplied

The use of below-knee percutaneous transluminal angioplasty in arterial occlusive disease causing chronic critical limb ischemia.

PURPOSE: To determine the efficacy, safety and long-term results of crural artery percutaneous transluminal angioplasty (PTA) in limbs with chronic critical limb ischemia (CLI). METHODS: Patients undergoing crural artery PTA due to CLI were followed at regular clinic visits with ankle brachial pressure index (ABPI) measurements. PTA of the crural arteries was attempted either alone (n = 39) or in combination with PTA of the superficial and/or popliteal artery (n = 55) in 86 limbs (82 patients and 94 procedures) presenting with CLI. The ages of patients ranged from 37 to 94 years (mean 72 years). The indications for PTA were rest pain in 10 and ulcer/gangrene in 84 limbs. RESULTS: A technically successful PTA with at least one crural level was achieved in 88% of cases (n = 83). Cumulative primary clinical success rates at 6, 12, 24, and 36 months were 55%, 51%, 36%, and 36%, respectively. Cumulative secondary clinical success and limb salvage rates at 36 months were 44% and 72%, respectively. CONCLUSION: PTA of the crural arteries might be considered the primary choice of treatment in patients with CLI and distal lesions with localized stenosis or segmental short occlusions.

Adult↗
PubMedDate not supplied

Pain relief by wound infiltration with bupivacaine or high-dose ropivacaine after inguinal hernia repair.

BACKGROUND AND OBJECTIVES: Wound infiltration with bupivacaine is often used for pain relief after inguinal hernia surgery. We hypothesized that the lower systemic toxicity of another long-acting local anesthetic of similar potency (ropivacaine) would make it possible to increase the dose to above that recommended for bupivacaine and thereby achieve more effective pain control. METHODS: Elective unilateral open hernia repair was performed on 144 patients at 4 hospitals. Surgery was performed under general anesthesia and, in a double-blind manner, the operating field was infiltrated with 40 mL ropivacaine 7.5 mg/mL (in = 73) or bupivacaine 2.5 mg/mL (n = 71 ) for postoperative pain relief. Pain at rest, on mobilization, and on coughing was assessed repeatedly during 24 hours using a visual analog scale. The patients' ability to walk and the need for supplementary analgesics were also recorded. RESULTS: No statistically significant differences were found between the two groups with respect to pain scores, which the patients reported to be less than 15% (median) of the worst pain imaginable in all examinations performed at rest, or in the consumption of supplementary analgesics. Those who received ropivacaine could walk with no or only minor problems at an earlier stage than the bupivacaine patients (P < .03). Both treatments were well tolerated. CONCLUSIONS: Wound infiltration with long-acting local anesthetics resulted in low pain scores after hernia surgery. Bupivacaine 100 mg was as effective as ropivacaine 300 mg.

Adult↗