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Biomedical subjects

E Einarsson

Publications and source records attributed to E Einarsson.

At least 19 recordsLinked to original sources
PubMed2001

Apolipoprotein A-I-derived amyloid in atherosclerosis. Its association with plasma levels of apolipoprotein A-I and cholesterol.

Wild-type apolipoprotein A-I (apo A-I)-derived amyloid commonly occurs in atherosclerotic plaques. To clarify apo A-I amyloid formation, plasma levels of apo A-I and cholesterol were related to the presence of amyloid in atherosclerotic plaques in 15 patients with peripheral atherosclerosis, subjected to arterial reconstruction. Plasma levels of apo A-I and high-density lipoprotein (HDL) cholesterol were slightly higher in patients with apo A-I-derived amyloid than in those without, but the difference was not significant. Levels of low-density lipoprotein cholesterol and total cholesterol were significantly higher in the group with amyloid. High concentrations of apo A-I in the arterial intima are probably of greater importance to amyloid formation than high plasma levels of the protein. During atherosclerosis, the acute phase reactant serum amyloid A may displace apo A-I from HDL, leading to increased concentration of lipid-free apo A-I in the intima and conformational changes of apo A-I, which make it more fibrillogenic. Some forms of amyloid fibrils have been shown to be cytotoxic. Apo A-I-derived amyloid is possibly a pathogenically important factor in atherosclerosis.

Aged↗
PubMed1994

Vascular surgical audit during a 5-year period. Steering committee on behalf of the Swedish Vascular Registry (Swedvasc).

UNLABELLED: The objective was to explore possible time trends in the indications for peripheral vascular surgery in Sweden. DESIGN: Analysis of data from the Swedvasc vascular registry 1987-1991. SETTING: Routine vascular surgery in university, county and district hospitals within the Swedish public hospital system. The registry is independent of local administration, run by the surgeons themselves and financed by national authorities. MATERIALS: 4950 procedures registered in the 17 original centres 1987-91 and 1892 procedures registered in 16 new centres 1991. CHIEF OUTCOME MEASURES: Distribution of indications, mortality within 30 days and clinical outcome at one year. MAIN RESULTS: During the first 5 years of the registry (1987 to 1991) the proportion of procedures performed for acute ischaemia significantly decreased from 20% to 14.3%. Simultaneously procedures for critical leg ischaemia significantly increased from 24.8 to 30.3%. Changes in the proportions treated for aortic aneurysms, carotid artery stenosis, claudication, vascular access or other indications were less striking or nonsignificant. The 30-day mortality decreased in patients operated on for acute ischaemia but did not change in other groups. The proportion of elective/emergency operation for aortic aneurysm changed from 1.2 to 2.0 leading to a minimal decrease in overall aneurysm mortality. The proportion of patients treated for claudication who were alive and improved at one year changed from 77.2% to 72.9% which was not statistically significant, while the proportion of patients treated for critical ischaemia who were alive with an intact leg after one year increased from 65.2% to 80.2% which was a significant improvement. CONCLUSIONS: Decision making among vascular surgeons in Sweden appears to have improved as proportionally fewer patients are operated on for acute ischaemia, more for critical ischaemia with possibly an improved outcome.

Humans↗
PubMed1993

The functional long-term value of different types of treatment for saphenous vein incompetence.

OBJECTIVE: To compare the long-term value of different forms of treatment for primary varicose veins with saphenous vein insufficiency. EXPERIMENTAL DESIGN: A prospective, partially randomized study with 5-year follow-up. SETTING: Ambulatory day-case care. PATIENTS AND INTERVENTIONS: The study includes 211 patients (214 lower limbs), who received compression sclerotherapy (CST; n = 78), radical operation (OP; n = 74) or CST combined with high tie under local anesthesia (HT + CST; n = 63). MEASURES: The patient's subjective opinion, objective finding by the surgeon and functional (foot-volumetric) assessment were obtained just after treatment and 6 months, 1, 3 and 5 years later. RESULTS: Subjectively the result started to deteriorate in both the CST and HT + CST groups after one year. The patient satisfaction was greatest in the OP group throughout the study period. Objectively the CST group cure rate fell markedly after 6 months and at 5 year follow-up the failure rate reached 51%, while the OP group still had a high rate of cured (60%) and improved (35%) patients. The HT + CST treatment seemed to hold well for three years followed by increasing failure rate with only 16% objectively cured after 5 years. The foot-volumetric parameters expelled volume (= calf pump function) and refilling flow ratio (= venous reflux) increased 51-79% respectively decreased 8-29% post-treatment in all groups. After 5 years these parameters had returned to pre-treatment levels in the CST and HT + CST groups, while the OP group was still significantly improved. CONCLUSIONS: Radical surgery is superior to compression sclerotherapy alone or in combination with high tie in the treatment of varicose veins with saphenous vein incompetence. The foot-volumetric assessment correlated well with and supported objective findings as a whole but could not replace the clinical examination of each individual patient.

Adult↗
PubMed1991

The effect of unilateral ovariectomy on intraluminal pressure in the porcine oviductal isthmus.

Intraluminal pressure variations in the isthmus of the porcine oviduct were studied under anaesthesia in 4 previously unilaterally ovariectomized gilts during either prooestrus, day 1, day 2, or day 3 of the oestrous cycle. The objective was to see if the removal of one ovary would have any effect on the activity of the ipsilateral oviduct. Blood collected from the jugular vein and both utero-ovarian veins were analysed for concentrations of oestradiol-17 beta and progesterone. Although a clear difference was seen between ovarian steroid concentrations in the blood plasma collected from the utero-ovarian veins of the same animal, the isthmic activity was similar in both oviducts.

Animals↗
PubMed1990

Long-term results of venous thrombectomy combined with a temporary arterio-venous fistula.

Forty-one patients with acute iliofemoral venous thrombosis were randomised to conventional anticoagulation or acute thrombectomy combined with a temporary arterio-venous fistula (AVF) and anti-coagulation. Follow-up after 5 years in 22 medical and 19 surgical patients revealed slightly more asymptomatic patients (37 vs. 18%) and less frequent severe post-thrombotic sequelae (16 vs. 27%) in the surgical group (N.S.). The iliac vein was more frequently (P less than 0.05) normal following thrombectomy (71 vs. 30%) as demonstrated by radionuclide angiography, but occlusion plethysmography showed an outflow capacity (61 vs. 45 ml/min/100 ml) that was not significantly better. There was no obvious difference in muscle pump function (EVrel) and reflux (Q/EVrel) assessed by foot volumetry. Still, the ambulatory venous pressure was significantly (P less than 0.05) lower in the surgical group. There was a tendency towards better results following thrombectomy in patients with fresh thrombosis and a successful initial procedure. Although the numbers of observations in many cases were too small to provide statistical evidence of benefit with venous thrombectomy + AVF, this procedure seems to improve the long-term outcome following acute iliofemoral venous thrombosis. Since the difference in outcome is not very striking, anticoagulation treatment is still an acceptable alternative.

Acute Disease↗
PubMed1987

Ketanserin in intermittent claudication: effect on walking distance, blood pressure, and cardiovascular complications.

In a 7-center Scandinavian double-blind placebo-controlled study of 179 patients with intermittent claudication, the effect of the serotonin antagonist ketanserin was evaluated on walking distance, brachial and ankle blood pressure, and symptoms. For all centers together, pain-free walking distance was significantly increased after 6 months with both ketanserin (+65%; 71 patients) and placebo (+42%; 78 patients), with no significant difference. However, there was large variability among centers. Classification of "responders" (doubling of walking distance) and patients who deteriorated (decrease of walking distance or dropout for inefficacy) showed significantly more patients responding and significantly fewer patients deteriorating with ketanserin than with placebo. Systemic blood pressure was significantly decreased by ketanserin in hypertensive, but not normotensive, patients, while ankle pressure was unaffected. The incidence and nature of side effects were equal with ketanserin and placebo, but there were more side effects causing dropout in the ketanserin group. An unexpected and possibly important observation was the occurrence of six serious cardiovascular events (myocardial infarction, cerebrovascular complications, and development of rest pain) in the placebo group but none in ketanserin-treated patients. Moreover, there were four additional similar complications in the placebo run-in period. Ketanserin appears to be beneficial in a subgroup of patients with intermittent claudication. A fortuitous finding of this study is that ketanserin might possess a protective effect against thrombovascular complications in patients with intermittent claudication.

Adult↗
PubMed1986

Follow-up evaluation of venous morphologic factors and function after thrombectomy and temporary arteriovenous fistula in thrombosis of iliofemoral vein.

Fifty-seven patients (58 post-thrombotic legs) treated with venous thrombectomy and temporary arteriovenous fistula for thrombosis of the iliofemoral vein were evaluated in a follow-up study regarding clinical, morphologic and functional aspects nine to ten months after thrombectomy. There were 33 men and 24 women, between 15 and 84 years of age (a mean of 51 years). The results of clinical examination revealed that 75 per cent of the patients had a good and 20 per cent a fair result of the treatment. No ulcers of the leg or venous claudication had developed. Venography (53 legs) demonstrated 61 per cent patency rate of the iliofemoral segment, although post-thrombotic changes were noted in 23 per cent. Venous femoral pressure measurement was normal in 82 per cent of 28 legs examined despite some proximal stenosis or occlusion. A good venous emptying with plethysmography was achieved in 29 per cent and foot volumetry showed normal peripheral venous function in 29 per cent. The results of this follow-up study, however short, reveal that venous patency can be restored to a high extent with good clinical result. Functionally, these patients may be at high risk for having sequelae develop later.

Adolescent↗
PubMed1985

Iliac vein obstruction associated with acute iliofemoral venous thrombosis. Results of early reconstruction using polytetrafluoroethylene grafts.

The results of iliac vein reconstruction performed early after secondary iliofemoral venous thrombosis were retrospectively evaluated. The review comprised seven patients who underwent acute thrombectomy combined with cross-femoral (4 cases) or iliocaval (3 cases) bypass procedures using polytetrafluoroethylene (PTFE) grafts. The clinical course, graft patency and venous physiology were studied. Five patients had a satisfactory clinical course, but one patient died of postoperative complications and another underwent leg amputation after 20 months. Contrast and radionuclide phlebograms showed that only two grafts were still patent after two years, but only one of these was still patent five years postoperatively. Clinical symptoms and physiologic parameters correlated poorly with graft patency, demonstrating the necessity of phlebography in evaluating patency rates after venous surgery. Our study indicates that early venous reconstruction using PTFE grafts does not result in satisfactory long-term patency rates. Further development of graft materials suitable for the venous system is required.

Acute Disease↗
PubMed1984

Thrombectomy with temporary arteriovenous fistula: the treatment of choice in acute iliofemoral venous thrombosis.

The treatment of choice in acute iliofemoral venous thrombosis is still controversial. This prospective randomized study compares the results of conventional anticoagulation of 32 patients with the results obtained in 31 patients undergoing acute thrombectomy combined with a temporary arteriovenous fistula and anticoagulation. Early complications were few in both treatment groups, and significant pulmonary embolism developed in only one conservatively treated patient. At 6-month follow-up in all surviving patients, leg swelling, varicose veins, and venous claudication were more frequent after conservative treatment. Only 7% (2 of 27) of these patients were completely free from postthrombotic symptoms compared with 42% (10 of 24) of the operated patients (p less than 0.005). Contrast phlebography demonstrated an excellent venous outflow through the iliofemoral segment in 35% (9 of 26) of the conservatively treated and in 76% (16 of 21) of the operated patients (p less than 0.025). Open femoropopliteal veins with competent valves were recorded in 26% (7 of 27) in the conservative group and in 52% (12 of 23) in the thrombectomy group (p less than 0.05). Thus thrombectomy combined with arteriovenous fistula decreases early symptoms and preserves venous outflow and valvular function better than conservative treatment. This procedure is therefore recommended for young patients with acute iliofemoral thrombosis to avoid development of incapacitating postthrombotic sequelae.

Acute Disease↗
PubMed1984

Scanning electron microscopy and evans blue staining for assessing endothelial trauma and reconstitution after venous thrombectomy.

Thrombectomy and a temporary arteriovenous fistula as treatment for deep venous thrombosis has been shown to cause a severe endothelial trauma in an experimental dog study. In vivo staining with Evans blue has been compared to scanning electron microscopy findings to assess the extent of the trauma and the time necessary for endothelial reconstitution. A good correlation between these techniques was found. After the initial almost complete denudation of the veins, new endothelium grew out from small branch openings and valve pockets within four weeks except in the proximity of the arteriovenous fistula where endothelialization was still incomplete after four months.

Animals↗
PubMed1981

Streptokinase treatment of deep venous thrombosis and the postthrombotic syndrome. Follow-up evaluation of venous function.

The conditions of 35 patients with deep venous thrombosis treated with streptokinase were reevaluated after a mean of 29 months with clinical examination, venous plethysmography, foot volumetry, phlebography (28 patients) and femoral vein pressure measurement (24 patients). At follow-up, 25 patients (71%) had symptoms and 22 (63%) had signs of venous insufficiency. Plethysmography was abnormal in 29 patients (83%) and foot volumetry in 25 (72%). Only two (6%) of the patients had normal plethysmography and foot volumetry and were free from symptoms and signs. No leg ulcer or severe postthrombotic syndrome was found. Phlebography showed that no patient had a normal deep venous system. Six of earlier thrombotic iliac veins (38%) and femoral veins 14 (48%), respectively, remained occluded. Increased femoral venous pressure, more pronounced during and after exercise, was found when iliac vein was diseased. Our results emphasize the importance of functional evaluation of the patient with a postthrombotic leg.

Adult↗
PubMed1981

Complications secondary to thrombectomy with the Fogarty balloon catheter.

Thrombectomy performed with the Fogarty balloon catheter may, in a small percentage of cases, give rise to complications. In four cases reviewed, this procedure was associated with aneurysms or arteriovenous fistulae. Careful catheter manipulation and a judicious use of fluoroscopy or angiography during the procedure can reduce the number of such complications.

Aged↗