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Biomedical subjects

Carl-Erik Slagsvold

Publications and source records attributed to Carl-Erik Slagsvold.

4 recordsLinked to original sources

[Venous leg ulcers].

Patients with venous leg ulcers usually have extensive symptoms both related to their venous insufficiency and to the wound itself, often combined with a reduced quality of life. Prevalence of venous leg ulcers varies from 0.1 to 1.0%. Treatment costs are high and may amount to 1.5% of a nation's total spending on health care. Venous hypertension is the common denominator for all patients with venous leg ulcers. Isolated superficial as well as deep or combined venous insufficiency with or without insufficient perforators may cause ulceration. In the microcirculation, inflammation is involved, but the exact mechanisms behind the ulcer formation remain unresolved. During the examination, a presence of superficial venous insufficiency accessible for superficial resection must be established. In addition to a clinical examination, venous pressure measurements/plethysmography and colour duplex scanning is recommended in order to locate and evaluate the significance of the venous insufficiency. The key element in the treatment of venous ulcers is to reduce oedema and venous hypertension by adequate compression and elevation. If primary superficial venous insufficiency is established, venous resection is recommended. This may improve healing and reduce recurrences. In selected patients, deep venous reconstruction is an alternative approach.

Bandages↗

[Arterial ischemic ulcers].

Arterial ischaemic ulcers develop because of inadequate perfusion leading to local ischaemia in the skin and underlying tissue. The most common cause is peripheral arterial disease, giving rise to symptoms like intermittent claudication, rest pain and gangrene, in addition to local ulceration. Diabetes mellitus increases the risk of ulcer formation; admittedly mainly neuropathic ulcers with a low component of peripheral arterial disease. Yet a combination of neuropathy and ischaemia is common ("neuro-ischaemic ulcer"). A thorough patient history and clinical examination can help discriminate arterial ulcers from venous, pressure, traumatic and vasculitis ulcers. Reduction of ankle systolic pressure and calculated ankle/brachial index, sometimes additional other non-invasive laboratory tests, confirm peripheral arterial disease. The primary treatment of arterial ischaemic ulcer is to increase blood supply to the affected area, primarily by endovascular treatment or open arterial reconstruction. Endovascular treatment (balloon angioplasty) is the method of choice because of graft infection risk in patients with open ulcers. Most arterial ischaemic ulcers will progress to healing if the blood supply is reestablished.

Angioplasty, Balloon↗

[Catheter-directed thrombolysis of iliofemoral venous thrombosis].

BACKGROUND: Although a success rate of 80% has been reported in patients with iliofemoral venous thrombosis treated with catheter-based thrombolysis, the possible long-term benefit of this treatment is not known. MATERIAL AND METHOD: 28 consecutive patients referred for catheter-based thrombolysis of iliofemoral venous thrombosis were treated with infusion of alteplase into the thrombus for two to five days. Following thrombolysis, warfarin was given for at least one year. All patients were examined every six months with colour duplex scanning and air pletysmography. RESULTS: 100% thrombolysis was achieved in eight patients, 75-99% in ten, 50-74% in nine and < 50% in one patient. Angioplasty (four) or stent implantation (four) was successful in eight out of twelve patients with stenosis of the left common iliac vein. Early recurrence of thrombosis (< 7 days) occurred in three patients, pulmonary embolism in one, and bleeding at the insertion site in six. After a mean follow-up of 2.5 years, 17 patients were free of symptoms, seven had a mild degree and four a moderate degree of postthrombotic syndrome. Eighteen patients had normal venous physiology, nine deep venous reflux, and three functional obstruction of deep veins. Postthrombotic syndrome was associated with deep venous reflux and/or functional obstruction of the iliofemoral segment. INTERPRETATION: Catheter-based thrombolysis is a safe and effective treatment of proximal deep venous thrombosis and might reduce the occurrence of postthrombotic syndrome compared to treatment with anticoagulation alone.

Adolescent↗

[Increased cortisol levels, frostbite and effects on the muscles and skeleton during extreme polar conditions].

BACKGROUND: We wanted to record physiological changes, injuries and illnesses during a long sledge expedition in North Canada. MATERIAL AND METHODS: The expedition consisted of four men aged 41 to 50, and 16 polar dogs. Measurements of cortisol in saliva were performed before, during and after the expedition. Frostbites and other injuries were registered continuously. Body weight and muscle, fat and bone mass were measured by dual X-ray absorptiometry scanning, and strength and endurance of shoulders, knees and back were tested. The group encountered extreme frost (-30 to -42 degrees C day temperature), wind, unexpected amounts of pack ice, and poorly motivated dogs. RESULTS AND INTERPRETATION: The participants showed increased free cortisol levels during their stay on the ice, probably because of increased mental stress. Three got first degree and two second-degree frostbites, but the affected areas were normal on vascular examination five months later. All members increased their muscle mass, but muscle strength and endurance remained unchanged.

Absorptiometry, Photon↗