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Biomedical subjects

H Akesson

Publications and source records attributed to H Akesson.

11 recordsLinked to original sources
PubMed1999

External support valvuloplasty in the treatment of chronic deep vein incompetence of the legs.

BACKGROUND: To evaluate the benefit from external support valvuloplasty in chronic deep vein incompetence of the legs. METHODS DESIGN: prospective study. PATIENTS: twenty patients 7 primary and 13 secondary (post-thrombotic), with severely symptomatic deep vein incompetence (DVI) of the legs. Preoperative duplex sonography, videophlebography with ambulatory venous pressure measurement. Surgical treatment with external support valvuloplasty with Venocuff (Vaso Products Inc., Sommer-ville, NJ, USA). Postoperative clinical follow-up, duplex and pressure measurements. RESULTS: In primary DVI, symptoms disappeared in all 7 patients, and in secondary DVI in 7 of 13 patients. All reconstructions were competent in primary DVI and in 10 out of 13 in secondary DVI. The follow-up period averaged 19 (6-32) months in primary DVI and 18 (5-31) months in secondary DVI patients. CONCLUSIONS: In severely symptomatic deep vein incompetence of the legs external support valvuloplasty is effective, especially in primary DVI. In secondary DVI the competence of the reconstructions was 78% and the symptoms disappeared in 52%. This means that external valvuloplasty is indicated even in post-thrombotic patients.

Adult↗
PubMed1996

Venous strain-gauge plethysmography--reference values.

OBJECTIVE: To establish sex and age related reference values for venous strain-gauge plethysmography. DESIGN: Strain-gauge plethysmography measurements in healthy volunteers. SETTING: Examinations performed in a University Hospital (Malmö) and a County Hospital (Kalmar). PARTICIPANTS: Healthy volunteers, without history or signs of venous insufficiency. Twenty-seven men, 31 women, age range 15-74 years. MAIN OUTCOME MEASURE: Refilled volume (RV;ml/100 ml tissue), half refilling time (T50;sec), and refilling time to 90% of RV (T90;sec). RESULTS: RV; lower limit 0.6 ml/100 ml tissue. T50; lower limit 3.3 sec T90; lower limit age dependent and calculated from the ekvation: In (T90) = 3.864-0.0111 age-0.337, where in is the natural logarithm. Methodological error: RV (15%), T50 (28%), T90 (23%). CONCLUSIONS: Strain-gauge plethysmography can be used to evaluate venous insufficiency and could be especially useful in follow-up studies after therapy. Normal age and sex related reference values are needed. In this study reference values are established. Preferably RV and T90 should be used.

Adolescent↗
PubMed1995

Leg ulcers: report on a multidisciplinary approach.

In a Swedish survey, leg ulcer disease has been found to have a prevalence of around 1%. The multifactorial etiology requires a multidisciplinary approach. Forty-three patients with leg ulcers have been examined clinically and by pathophysiological and roentgenological investigations. Proper conservative treatment was instituted in 25 of the patients, and the remaining were treated by venous surgery, arterial surgery and skin transplantation. The previously used therapy only achieved healing in 23% of these patients, but after multidisciplinary assessment and treatment the healing rate was improved to 83%. The ulcer-free period of the whole group was 62% during a follow-up of 24 (3-36) months. The healing of venous ulcers can be improved by a multidisciplinary assessment by a vascular surgeon and a dermatologist.

Adult↗
PubMed1990

Venous function assessed during a 5 year period after acute ilio-femoral venous thrombosis treated with anticoagulation.

To determine the chronological changes of venous physiology following major thromboses, 20 patients were repeatedly examined for over 5 years after an acute ilio-femoral thrombosis which was treated with conventional anticoagulation. Radionuclide angiography showed that 70% of the patients had obstructive lesions of the iliac vein with only minor changes occurring from 6 months to 5 years. In spite of this, the plethysmographic maximum venous outflow increased from 31 to 45 ml/min/100 ml (P less than 0.001). The foot volumetric reflux did not change with time and about half of the patients had abnormal values. Venous reflux assessed by the refill time of foot vein pressure, deteriorated with time (P less than 0.05), and at 5 years all but one patient had a refill time less than 20 s. The muscle pump function, examined by foot volumetry, was abnormally low in about half of the patients throughout the study. The ambulatory foot vein pressure was constantly pathological (greater than 60 mmHg) in half of the patients and only two of 18 patients had normal values (less than 45 mmHg) at 5 years. Five patients with thromboses involving only the proximal veins had better physiological results than 15 patients with thromboses that extended to the peripheral veins. Three patients who developed venous claudication had iliac vein obstruction and an impaired venous outflow and three patients who developed venous ulcers had venous reflux and severe venous hypertension. Although venous outflow continuously improves following ilio-femoral thromboses, valvular competence and muscle pump function are constantly pathological, creating severe venous hypertension with a risk of post-thrombotic sequelae.

Anticoagulants↗
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↗
PubMed1979

Neonatal non-ketotic hyperglycinemia: a clinical, biochemical and neuropathological study including electronmicroscopic findings.

In a family of four children, three died within 8 days after birth. The fourth child survived after a critical first week with the same symptoms as the siblings. He was at the age of four found to have non-ketotic hyperglycinemia. The histories and neuropathology of the other children were then reexamined. It seems highly probable that all siblings suffered from non-ketotic hyperglycinemia. This report points to the clinical, biochemical and neuropathological diagnostic problems in this disease and also adds new information on the ultrastructural changes, not hitherto visualized.

Amino Acid Metabolism, Inborn Errors↗
PubMedDate not supplied

Excision of lipodermatosclerotic tissue: an effective treatment for non-healing venous ulcers.

In longstanding venous ulcers, the development of lipodermatosclerosis of the skin surrounding the ulcer is common. According to our clinical experience lipodermatosclerosis impairs the opportunities for the ulcer to heal. In this combined retrospective and prospective study the lipodermatosclerotic skin area was excised in 7 non-healing venous ulcers and then covered with split skin graft. All 7 legs had previously been treated with superficial venous surgery. Laser Doppler scanning of the ulcer area was performed pre- and postoperatively. Five of the 7 ulcers healed within 4 months and 1 healed within 9 months. Laser Doppler scanning showed increased blood flow in the lipodermatosclerotic skin area, which was decreased after the operation. This study indicates that excision of the lipodermatosclerotic skin area followed by split skin grafting can accomplish healing in non-healing venous leg ulcers that have failed to respond to previous superficial venous surgery.

Adipose Tissue↗
PubMedDate not supplied

Radionuclide angiography in the evaluation of iliofemoral venous patency.

Radionuclide angiography (RNA), was compared to contrast phlebography (CP) for evaluation of iliofemoral venous patency. Twenty-three patients that six months earlier had been treated for iliofemoral venous thrombosis were investigated. The reproducibility of RNA was good as the interindividual and intraindividual variation was 80-85% and 90-95% respectively. The sensitivity of RNA was 91% in the iliac and 65% in the femoral segment. The specificity was 78% in the iliac and 74% in the femoral segment. The advantages as compared to CP are: easy performance, easy to repeat, no adverse reactions and visualization of the whole venous system. The disadvantages are: e.g. difficulties in interpretation in bilateral disease or abnormal anatomy. RNA is recommended as a screening method for suspected iliac venous obstruction and for follow-up of venous patency after iliofemoral venous thrombosis.

Adolescent↗