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Biomedical subjects

E Stranden

Publications and source records attributed to E Stranden.

At least 19 recordsLinked to original sources
PubMed2006

The Oslo balloon angioplasty versus conservative treatment study (OBACT)--the 2-years results of a single centre, prospective, randomised study in patients with intermittent claudication.

OBJECTIVES: To compare the effect of optimal medical treatment only (OMT) with OMT combined with percutaneous transluminal angioplasty (OMT+PTA) in patients with intermittent claudication (IC). DESIGN: A single centre prospective, randomised study. Quality of life (QoL) was the primary outcome measure. Secondary measures were ankle-brachial-index (ABI), treadmill walking distances and mortality. METHODS: From a total of 434 patients considered for inclusion into the trial, only 56 patients with disabling IC fulfilled the inclusion criteria. The patients were randomised into treatment groups consisting of 28 patients each and followed for 2 years. ABI and treadmill walking distances were measured in addition to the visual analogue scale (VAS) for pain evaluation, and QoL assessment using the Short Form (SF-36 and Claudication Scale (CLAU-S). RESULTS: The demographic data in the 2 groups were almost identical. After 2 years of follow-up the ABI, the treadmill walking distances and the VAS were significant improved in the group treated with OMT+PTA, compared to the group treated with OMT only (p<0.01 for all). Furthermore, some variables from the QoL assessment also showed a significant improvement in favour of the OMT+PTA group (p<0.05 for all). CONCLUSION: The advantage of conducting a single centre study and adhering to very strict inclusion criteria was illustrated by the homogenous demographic data of the two groups. This partly outweighed the disadvantage of having included a relatively small number of patients. Early intervention with PTA in addition to OMT seems to have a generally more positive effect compared to OMT only, on haemodynamic, functional as well as QoL aspects during the first 2 years in patients with IC.

Aged↗
PubMed2006

Doses to nuclear technicians in a dedicated PET/CT centre utilising 18F fluorodeoxyglucose (FDG).

The first dedicated PET/CT centre in Norway was established at the Norwegian Radiumhospital in Oslo in 2005. Knowing that the introductions of PET-isotopes in nuclear medicine give increased occupational radiation dose to the technicians, a study was carried out in order to map the doses to staff members during different working operations and to see if any dose reducing measures were needed. The results of the study are in good agreement with other studies, and a technician dose of 20-25 nSv per injected MBq of 18F seems to be representative for such centres. For an average injected activity of 350 MBq per patient, the dose limit is reached after handling around 3000 patients annually. For an annual number of less than 500 patients at the centre and rotation of the staff, an annual individual dose for the technicians would realistically be less than 2-3 mSv. Even a major increase in the number of patients will not result in individual doses near the ICRP dose limit.

Allied Health Personnel↗
PubMed2006

Blood pressure in patients with intermittent claudication increases continuously during walking.

OBJECTIVES: The purpose of this study was to compare the circulatory responses to walking in patients with peripheral atherosclerotic disease (PAD) and healthy controls. METHODS: The participants were eleven patients with diagnosed PAD, and a control group of six healthy age-matched adults. Blood pressure, heart rate (HR), and acral skin perfusion were recorded continuously before, during and after a walking exercise on a treadmill. RESULTS: The patients walked to maximum claudication distance (MCD) on a treadmill, median walking distance 103 (34-223) metres [median (range)], at 3.3 (1.0-4.5) km/h. There was a steep increase in HR and mean arterial pressure (MAP) while the patients were walking. At claudication the median rise in MAP was 46.6 (10.3-61.3) mmHg, systolic blood pressure (SP) increased by 84.9 (31.4-124.9) mmHg, and diastolic blood pressure (DP) by 21.7 (-2.1-31.7) mmHg. HR increased by 34.9 (12.9-48.1) beats/min. The control group walked for 5 minutes at 3.2 (3.0-3.3) km/h. In the control group the blood pressure initially increased moderately but stabilised thereafter. Median rise in MAP during walking was 8.5 (5.6-14.6) mmHg, SP increased by 30.9 (6.6-41.5) mmHg, and DP was reduced by -1.4 (-5.4-1.5) mmHg. HR increased by 27.1 (18.8-34.9) beats/min. We found no significant differences in acral skin perfusion during walking exercise between the patients and control group. CONCLUSIONS: In patients with PAD, blood pressure increased continuously and significantly when walking to MCD (dynamic exercise). The level of increase in blood pressure was similar to that caused in response to isometric exercise.

Aged↗
PubMed2006

External venous valve plasty (EVVP) in patients with primary chronic venous insufficiency (PCVI).

OBJECTIVES: To evaluate the patency of EVVP and its effect in symptom relief, ulcer healing and ulcer-free period in patients with PCVI. METHODS: Between 1993 and 2004, 1800 patients with CVI were evaluated and seventeen with PCVI were selected for EVVP. They were all investigated with ambulatory venous pressure measurement (AVP), colour duplex ultrasound (CDU), ascending venography and descending video venography. The CEAP classification was used to group the patients. Six patients were C4, four C5 and seven C6. All had deep reflux and high levels of AVP. RESULTS: All procedures were technically successful. The ulcer healing rate was 4/7 (57%) within 3 months. All C4 patients experienced symptom improvement postoperatively and had a median recurrence free period of 72 (range 60-122) months. The C5 group had an median ulcer free period of 61 months (12-72) and the C6 of median 48 (12-72) months. Single valve plasties (4) reached a median competence period of 48 months (12-72), 12 multiple valve plasties at the same level show a median 78 months (63-122) and 10 multilevel repairs median 54 months (12-96). Multiple valve plasties at the same level (multi-station plasties) performed on the C4 group seemed to yield the longest durability with a median of 103 months (84-122). CONCLUSION: EVVP with an ulcer healing rate of 57% and satisfactory symptom improvement seems to be an alternative of surgical treatment for selected patients with PCVI. The durability of this technique seems to be related to clinical severity and the multiplicity of repairs.

Adult↗
PubMed2006

Markers of vascular inflammation are associated with the extent of atherosclerosis assessed as angiographic score and treadmill walking distances in patients with peripheral arterial occlusive disease.

The importance of inflammation in atherosclerosis is well established in cardiovascular disease. However, limited data exist on the relationship between vascular inflammation and the severity of peripheral arterial occlusive disease (PAD). We investigated the relationship between biochemical markers of vascular inflammation and the diagnostic measures of PAD: ankle-brachial pressure index (ABI), maximum treadmill walking distance and angiographic score. In 127 patients (mean age 66 years; 64% males) with angiographically verified PAD, fasting blood samples were drawn for determination of selected soluble cell adhesion molecules, cytokines and chemokines. Tumor necrosis factor-alpha (TNFalpha), interleukin-6 (IL-6), monocyte chemoattractant protein-1 (MCP-1) and CD40 ligand (CD40L) were all significantly correlated with the angiographic score (p < 0.05 for all). After adjustment for relevant co-variates, MCP-1 and CD40L remained statistically significant (p < 0.01 for both). IL-6 was, independent of other risk factors, inversely correlated with the maximum treadmill walking distance (p < 0.01). Our cross-sectional study in PAD patients showed that the vascular inflammatory markers MCP-1, CD40L and IL-6 were significantly associated with the extent of atherosclerosis, assessed by angiographic score and maximum treadmill walking distance. These findings indicate that vascular inflammation is implicated in PAD, which might be of importance in future diagnosis and treatment of the disease.

Aged↗
PubMed2005

Gadolinium-enhanced magnetic resonance angiography, colour duplex and digital subtraction angiography of the lower limb arteries from the aorta to the tibio-peroneal trunk in patients with intermittent claudication.

OBJECTIVES: To evaluate the sensitivity, specificity, positive and negative predictive value of contrast-enhanced (gadolinium) magnetic resonance imaging (CE-MRA) and colour duplex ultrasound (CDU) of lower limb arteries. DESIGN: Prospective, single centre study. MATERIAL AND METHODS: A consecutive series of 58 patients with intermittent claudication (IC) were examined with CE-MRA and CDU from the infrarenal aorta to the tibio-peroneal trunk with digital subtraction angiography (DSA) as reference. The arterial tree was divided into 15 segments, pooled into three regions; suprainguinal, thigh and knee. Sensitivity, specificity, positive and negative predictive values for significant obstructions were calculated. Cohen Kappa statistics was used to establish agreement between the three methods. RESULTS: The sensitivity (specificity in parentheses) for significant obstructions in the suprainguinal region were 96% (94%) for CE-MRA and 91% (96%) for CDU, in the thigh region 92% (95%) for CE-MRA and 76% (99%) for CDU, and in the knee region 93% (96%) for CE-MRA and 33% (98%) for CDU. CDU failed to visualize 10% of suprainguinal, 2% of thigh and 13% of knee-region arterial segments. CONCLUSIONS: Both CE-MRA and CDU are good alternatives to DSA in the suprainguinal- and thigh-region. In the knee region only CE-MRA can be relied upon as an alternative to DSA. Imaging by CDU is not suited to situations were evaluation of runoff vessels is important.

Aged↗
PubMed2005

Effects of mechanical irritation on the autonomic part of the median nerve.

The diagnosis of median nerve compression is generally based upon a prolonged nerve conduction velocity although this frequently is preceded by clinical symptoms for years. The present study was designed to identify indicators for early decompression of the median nerve in patients exhibiting symptoms compatible with carpal tunnel syndrome (CTS). Microvascular perfusion in finger tip skin and skin temperature were studied during dorsiflexion of the hand prior to and following a manual exercise test in control subjects and in patients with clinical symptoms and signs of CTS. Evaluation of the microcirculation was performed using photoplethysmography (PPG) and laser Doppler fluxmetry (LDF). Fingertip skin temperature was measured by thermography and was significantly reduced in patients after exercise (P < 0.001), whereas no significant change occurred in control subjects. During increasing degrees of dorsiflexion (0-75 degrees ) and after manual exercise, fingertip skin perfusion remained unchanged in both patients and control subjects. In conclusion, patients with low-grade CTS experience skin temperature reduction, presumably caused by increased sweating as opposed to a generally suspected vasoconstriction. These autonomic median nerve dysfunctions provide the physiological basis for the use of thermography in confirming low-grade CTS.

Adolescent↗
PubMed2001

The concentration of protein-compounds in interstitial tissue of patients with chronic critical limb ischaemia and oedema.

BACKGROUND: Many of chronic critical limb ischaemia (CLI) patients have distal leg and foot oedema. Previous electronmicroscopic studies have shown that chronic severe ischaemia may cause hypoxic damage of the capillary endothelium, including morphological changes i.e. multiplicated/thickened basal lamina, and formation of interendothelial gaps. To assess the functional consequences of these morphologic derangements, where proteins can leak through, we investigated the composition of the interstitial fluid in oedematous ischaemic limbs. PATIENTS AND METHODS: Nine female and 3 male patients with a mean age of 79 +/- 7.9 years were included. All had unilateral CLI and peripheral pitting oedema. Leg and foot volume was measured with water displacement volumetry. Blister suction technique was used to collect subcutaneous interstitial fluid. The concentration of albumin, transferrin, immunoglobulin G and alpha 2-macroglobulin in plasma and blister fluid was measured by immunoturbidimetry. Nine patients, 8 women and 1 man with a mean age of 83 +/- 5.5 years with a proximal femur fracture served as an age-matched control group. RESULTS: The mean concentration of albumin in blister fluid was significantly lower in the patients, whereas the mean concentration of alpha 2-macroglobulin in blister fluid did not differ between patients and controls. Mean ratio between concentrations in blister and serum of albumin, transferrin and immunoglobulin G in the limbs with CLI and oedema were significantly lower than respective values in the control group. However, there was no significant difference in the ratio of alpha 2-macroglobulin between these groups. CONCLUSION: A higher transcapillary concentration gradient for proteins in CLI limbs signifies an increase in the net osmotic pressure gradient across the capillary wall, which may be a potential oedema limiting factor.

Aged↗
PubMed2000

Alterations in capillary permeability in the lower limb of patients with chronic critical limb ischaemia and oedema.

BACKGROUND: Oedema formation in lower limbs of patients with chronic critical limb ischaemia (CLI) is a common clinical feature. The rate of fluid filtration through the capillary wall depends on the capillary permeability, i.e. capillary filtration coefficient (CFC). In order to elucidate the pathogenesis of this ischaemic oedema, CFC was measured in the limbs with CLI and oedema and was compared with CFC measurements both in the contralateral sides and in the lower limbs of a control group. PATIENTS AND METHODS: Eleven women and 4 men, with a mean age of 75 +/- 8.8 years, with unilateral CLI and leg and foot oedema were included. Leg and foot volume was measured with water displacement volumetry (WDV). CFC was measured in both limbs by strain-gauge plethysmography using a double-stranded mercury in silicone strain gauge around the middle portion of the foot. As a control group, 8 patients, 5 women and 3 men, with a mean age of 77 +/- 7.6 years with a proximal femur fracture were included and the CFC in this group was measured in the foot of the non-fractured limb. RESULTS: Mean CFC in the limbs with CLI and oedema was 0.0036 +/- 0.001 ml/min.100 ml.mmHg, significantly greater than both the contralateral limbs (0.0019 +/- 0.0003 ml/min.100 ml.mmHg, p < 0.01) and mean CFC in the control limbs (0.0017 +/- 0.0002 ml/min.100 ml.mmHg, p < 0.003). There was a mean volume difference of 13 +/- 9% between limbs with CLI and contralateral sides measured by WDV. There was no significant correlation between total leg-foot volume and CFC (p > 0.05). CONCLUSION: CFC in the ischaemic limb was twice as great as both the contralateral side and the limbs of the control group. It is therefore concluded that an increased CFC is probably one of the important factors in the development of this ischaemic oedema.

Aged↗
PubMed2000

Transcapillary forces and the development of oedema in the lower limb of patients with chronic critical limb ischaemia (CLI).

OBJECTIVE: factors regulating transcapillary fluid transport were investigated to elucidate the causes of oedema in CLI. MATERIAL: sixteen patients, 6 men and 10 women (mean age of 79+/-10.3 years) with unilateral CLI and peripheral pitting oedema. METHODS: measurements were performed in both limbs. Interstitial fluid was collected by applying blister suction cups on the dorsolateral part of the foot and colloid osmotic pressure of this fluid (COP if) was measured in a colloid oncometer. Plasma colloid osmotic pressure (COP pl) was obtained from venous blood. Interstitial fluid pressure (P if) was measured by wick-in-needle technique. RESULTS: mean COP if in the limbs with CLI was 2.3 S.D. 0.5 mmHg, significantly lower than in the limbs without CLI (3.1 S.D. 0.7 mmHg, p<0.0001). Mean COP pl was 21.1 S.D. 1.8 mmHg, which was lower than in healthy controls. Mean plasma albumin concentration was 30 S.D. 6 g/l which was lower than the reference values. Mean P if in the limbs with CLI was 0.7 S.D. 1.6 mmHg, significantly higher than in the limbs without CLI (-1.4 S.D. 1.4 mmHg, p<0.0001). The calculated mean reabsorption pressure (P r) in the limbs with CLI was 19.6 S.D. 1.7 mmHg, significantly higher than in the contralateral limbs (16.7 S.D. 2.1 mmHg, p<0.001). CONCLUSION: a low plasma albumin concentration in patients with CLI agrees with the reduction in COP pl but cannot explain the oedema formation, since it is unilateral. The high P r may cause a high transcapillary filtration pressure, resulting in a relatively great net filtration and subsequent oedema formation.

Aged↗
PubMed2000

Vascular and stromal features in the skin of the lower limb in patients with chronic critical limb ischaemia (CLI) and oedema.

OBJECTIVE: peripheral oedema is often observed in limbs affected by chronic critical limb ischaemia (CLI) and is mainly subcutaneous in distribution. Previous work has shown that capillary filtration coefficient (CFC) in limbs with CLI and oedema was twice as great as that in the contralateral limb. These changes might be due to morphological changes. Transmission electron microscopy (TEM) was used to examine the morphological features of the capillary walls and surrounding stromal tissues in the skin of these limbs. MATERIAL AND METHODS: eight patients with unilateral CLI and peripheral pitting oedema (four men, four women, a mean age of 81+/-6.9 years) was studied. Skin biopsies were taken from the pulp of the first toe, interdigital space between the first and second digits and dorsal part of forefoot just prior to amputation. RESULTS: stromal oedema and dilated capillaries were most prominent in the distal part of the foot. Some of the capillaries were filled with blood cells and some were empty. The endothelium of the dilated vessels was elongated and distended. In some patients a number of capillaries were collapsed with degenerate endothelial cells. <<< >>>, i.e. large openings, were found between the elongated oedematous endothelial cells. The basal lamina was thickened in all patients. Stromal haemorrhage and degeneration were seen in approximately 50% of patients. CONCLUSION: CLI causes ultrastructural changes in the capillary endothelium and surrounding stroma. The presence of large gaps between endothelial cells as well as an increased capillary pressure may enhance transcapillary transudation, and are most likely the causative factors in the formation of the ischaemic oedema. The stromal haemorrhage as well as degeneration probably signifies a terminal stage of CLI.

Aged↗
PubMed2000

Patterns of skin flowmotion in the lower limbs of patients with chronic critical limb ischaemia (CLI) and oedema.

OBJECTIVE: To study flowmotion (FM) in lower limbs with critical limb ischaemia (CLI) and oedema and to elucidate FM patterns when skin viability is threatened. MATERIAL AND METHODS: Fourteen patients with unilateral CLI and oedema and two control groups were included - one consisting of 10 healthy participants and the other nine patients with unilateral CLI without oedema. Laser Doppler was used to evaluate the foot skin microcirculation simultaneously at four different areas, with the limbs in supine and dependent position. FM was expressed using fast Fourier transformation (FFT) as low frequency (LF) and high frequency (HF) waves and their respective FFT-powers. RESULTS: All patients with CLI, both with and without oedema, showed HF waves in both diseased and contralateral limbs. These were absent in healthy controls. There were no regional differences in frequency in the critically ischaemic feet (with and without oedema) and between ischaemic and their contralateral feet. Changing the position of ischaemic limbs from supine to dependency had no significant effect on the frequency, while a significant increase of the median FFT-powers of LF and HF waves at the pulp of the first toe was observed. This manoeuvre resulted in decrease of the median FFT-powers of LF in healthy controls. CONCLUSIONS: HF waves are associated with CLI. Ischaemia also appears to influence the FFT-power of each frequency domain. Ischaemic oedema does not seem to affect the pattern of FM in the foot of patients with CLI.

Aged↗
PubMed2000

Dynamic leg volume changes when sitting in a locked and free floating tilt office chair.

It is well established that prolonged sitting may lead to swelling of the lower extremities. However, activation of the vein pump system by repeated walking breaks or dynamic tiltable foot-rests have been shown to reduce foot and leg oedema. Some office chairs incorporate tilt mechanisms facilitating movements of the body from the feet up. The present study was undertaken to establish whether a beneficial effect on the transcapillary fluid balance of the legs by enabling such mechanisms could be documented. An office chair where the tilt mechanism could be locked or open was used for the study. The seat position and seat activity level was recorded by a transducer system developed for the study. Calf volume and calf muscle pump activity was detected by mercury strain gauge plethysmography. In the locked position there was a steady increase in volume of mean = 1.2% (range = 0.8-1.8%) for all participants in the 30-min study period. On the other hand, for all participants there was a decrease in calf volume (mean = 0.7%, range = 0.1-1.2%, p = 0.008) when the tilt mechanism was open (30-min period), irrespective of what study period came first. The study showed that upward seat deflection was not associated with concomitant venous obstruction, since such obstruction was detected in less than 2% of the time period with more than 50% of maximal upward deflection. A locked seat mechanism does not prevent activation of the vein pump mechanism, but the study indicates that office chairs that permit variation in seat angle per se stimulate movements of the leg. This, in turn, activates vein pumps and counteracts local oedema formation in seated working postures.

Adult↗
PubMed2000

The role of the veno-arteriolar reflex (VAR) in the pathogenesis of peripheral oedema in patients with chronic critical limb ischaemia (CLI).

BACKGROUND AND AIMS: Relatively many patients with chronic critical limb ischaemia (CLI) have oedema in the afflicted limb. Previous studies in these patients indicate derangement in the Starling forces governing transcapillary fluid balance. An impaired veno-arteriolar reflex (VAR) may cause an increase in capillary pressure and hence increased filtration pressure resulting in oedema. The aim of the present study was to investigate VAR in patients with CLI to come to a better understanding of the pathogenesis of ischaemic oedema. MATERIAL AND METHODS: Sixteen patients (mean age of 78+/-9.4 years) with unilateral CLI and oedema were included. There were two control groups of similar age, one consisted of 8 patients with unilateral CLI but without oedema and the other of 9 healthy subjects. Laser Doppler fluxmeters were used to evaluate the foot skin microcirculation, with the limbs in supine as well as in the dependent position, simultaneously in 4 different areas: the pulp of the first toe (Sitel), at the level of the second metatarsal body (Site 2), at the anterolateral part of ankle (Site 3) and the pulp of the first toe of the contralateral limb (Site 4) as reference. Laser Doppler flux (LDF) values (expressed in perfusion unit, PU) were recorded with the foot dependent (PUd), in the horizontal position (PUh), and the orthostatic response (OR) was calculated at all measuring sites as PUd/PUh. RESULTS: In none of the measured sites there was a significant difference in OR between the limbs with CLI and oedema and the limbs with CLI but without oedema. The median OR of CLI limbs at site 1 [2.5 (0.61-8.96)] was greater than at sites 2 [0.99 (0.46-2.38), p < 0.01] and 3 [0.95 (0.68-10.31), p < 0.04] respectively, while the differences in OR between site 2 and 3 were not significant. The median OR in the limbs of healthy controls at sites 1, 2 and 3 were 0.58 (0.37-1.43), 0.54 (0.28-1.33) and 0.51 (0.34-0.91), respectively. There were no significant differences in OR between sites 1, 2 and 3 of the control group. The OR of CLI at site 1, 2 and 3 were significantly greater than the corresponding sites in the healthy subjects (p < 0.001, p < 0.008, p < 0.001). CONCLUSIONS: The VAR is disturbed in limbs with CLI, both in the ones with and without oedema. There were regional differences in the OR in these ischaemic feet but there were no differences in OR between those with and without oedema. Thus, disturbances in VAR may play a role in the development of ischaemic oedema, but is probably not the only causative factor.

Aged↗
PubMed1999

The distribution of oedema in the lower limb of patients with chronic critical limb ischaemia: a study with computed tomography.

BACKGROUND: A substantial number of patients with chronic critical limb ischaemia (CLI) have considerable oedema at the distal leg and foot of non deep venous thrombosis origin. The primary aim of the present study was to quantify the distribution of oedema in the different tissues of the leg and foot by applying computed tomography and planimetry. The interstitial fluid hydrostatic pressure (Pif) in the subcutaneous tissue was measured to evaluate the effect of oedema on local tissue pressure. PATIENTS AND METHODS: Six men and 12 women with unilateral CLI and peripheral pitting oedema were included. Cross sectional areas (CSA) of subcutaneous tissue, muscle and bone were measured by computer tomography combined with planimetry to assess the distribution of oedema within the soft tissues. Pif was measured by "wick-in-needle" technique. RESULTS: The median total CSA of soft tissue, subcutaneous and muscle tissues at the foot level were respectively 17%, 34% and 9% greater in the limbs with CLI compared to the contralateral limb (p < 0.001). At ankle level these differences were 13%, 30% and 4%, respectively (p < 0.001). At the level of the calf these differences were not significant. Mean Pif in the limbs with CLI was 0.3 mmHg, significantly higher than in limbs without CLI (-1.8 mmHg), (p < 0.003). CONCLUSION: The study verified oedema of considerable magnitude at the ankle and foot. The great part of the oedema was located within the subcutaneous tissue, which was associated with a relatively moderate, but significant increase in Pif confirming the high compliance of the subcutaneous tissue. The combination of the excessive fluid and increased Pif in the interstitial tissue might aggravate the microcirculation. The aetiology of oedema formation is probably multifactorial.

Aged↗
PubMed1999

Oedema in the lower limb of patients with chronic critical limb ischaemia (CLI).

OBJECTIVE: approximately 70% of patients with chronic critical limb ischaemia (CLI) show clinical signs of oedema in the distal leg and foot. The primary aim of the present investigation was to quantify this oedema. In addition we investigated whether oedema formation could be due to deep venous thrombosis (DVT). METHODS: fifteen patients with unilateral CLI and oedema were studied, four males and 11 females, with a mean age of 77+/-10.3 years. Water displacement volumetry (WDV) was used to measure limb volume. Colour duplex ultrasound (CDU) and venous occlusion plethysmography (VOP) were applied to exclude functionally significant DVT. Blood chemistry was analysed to screen for some causative factors of generalised oedema formation. RESULTS: the mean volume of the limbs with CLI was 9% greater than the contralateral limbs (1279+/-325 ml vs. 1179+/-298 ml). None of the patients had functionally significant DVT. The mean plasma albumin concentration was reduced at 28.5+/-6.6 g/l. CONCLUSION: a significantly reduced plasma albumin concentration cannot be regarded as a causative factor, since the oedema is unilateral. The aetiology of oedema formation is probably multifactorial, and further investigations are under progress to elucidate relevant pathogenetic factors.

Aged↗
PubMed1998

How critical is chronic critical leg ischaemia?

"Critical" according to the Oxford dictionary means: a "turning point" where an acute change for better or worse may be anticipated. Thus, the meaning of the word "critical" complies with its use in relation to ischaemia. We don't really know, prospectively, what will happen to the critically ischaemic limb, whether it will improve or worsen. The answer to the question "How critical is critical leg ischaemia (CLI)?" must be: "We don't know!" The addition of ankle systolic pressure as an objective haemodynamic measurement has not made the definition of the Second European Consensus Group significantly better than the original Fontaine classification, grade III and IV. For clinical practice the Fontaine classification will be sufficient. For scientific purposes macro- and microcirculatory assessments and information about the patient's risk profile should be added.

Chronic Disease↗