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Biomedical subjects

H C Engell

Publications and source records attributed to H C Engell.

At least 37 records · Page 2Linked to original sources
PubMed1984

Postoperative complications in abdominal vascular surgery.

Two hundred patients who consecutively underwent abdominal vascular surgery were retrospectively studied with regard to early (less than 30 days) postoperative complications. The mortality was 4% after elective surgery and 30% after emergency surgery, which was chiefly for aortic aneurysm. The main causes of death were cardiac and renal diseases. Postoperative morbidity was mainly of cardiopulmonary or renal origin. Quantitatively, however (length of hospital stay), the foremost complications were local--haematoma, lymph fistula and necrosis in the incisions, especially in the groins. Against this background, the importance of scrupulous technique in vascular surgery is stressed.

Abdomen↗
PubMed1983

Delayed distal blood pressure rise after partial arterial reconstruction for combined aorto-iliac and superficial femoral artery occlusive disease.

The blood pressure in the ankle and great toe was measured with cuff and strain-gauge technique in 39 patients after insertion of aorto-femoral bifurcation graft. In 40 limbs with patent superficial femoral artery (complete reconstruction) the distal blood pressure remained unchanged from the tenth postoperative day to follow-up after 12 to 26 months. In 30 limbs with occluded superficial femoral artery (partial reconstruction) the ankle/arm pressure index rose from 0.54 to 0.61 between the tenth day and late follow-up. The blood pressure in the great toe had increased by 8 mmHg on the tenth postoperative day and by additionally 17 mmHg during the next 12 to 26 months. The delayed pressure rise after partial arterial reconstruction presumably reflected development of collateral vessels from the deep femoral artery system. The clinical significance of the findings is discussed.

Adult↗
PubMed1982

Local regulation of blood flow and the occurrence of edema after arterial reconstruction of the lower limbs.

The relation between edema after arterial reconstruction of the lower limbs and various potential etiologic factors, including disturbances in local blood flow regulating mechanisms, was investigated in 22 patients with occlusive arterial disease. The occurrence of edema was unrelated to the severity of symptoms as well as to the perioperative changes in distal arterial blood pressure. Postreconstructive edema developed independently of postreconstructive hyperemia and of disturbances in the local vasoconstrictor response to increased venous pressure. The decisive factor for development of edema was the extensive dissection in the thigh and in the popliteal region required for femoropopliteal bypass surgery. Edema developed after nine of nine femoropopliteal bypass operations, and only after one of 12 reconstructions in the aorto-iliac or in the profound femoral segments (p = 0.001). It is concluded that the postreconstructive edema is a lymphedema due to surgical trauma, rather than the result of microvascular derangement.

Adult↗
PubMed1982

Changes after arterial reconstruction in the forefoot local vasoconstrictor response to increased venous transmural pressure.

Local blood flow regulation on the forefoot was studied by the 133Xe wash-out technique in twenty-seven patients before and after arterial reconstruction for occlusive arterial disease. In thirteen limbs with severe symptoms the local vasoconstrictor response to increased venous pressure was absent preoperatively, as blood flow in the foot increased in median by 47% when the foot was lowered 40 cm below the heart. Three months postoperatively the vasoconstrictor response had returned as blood flow decreased 28% during lowering. Fourteen limbs with milder symptoms had a vasoconstrictor response before operation. In nine limbs of this group treated with aortoiliac reconstruction the vasoconstrictor response was absent at the early postoperative examination, but the response returned till the late examination. It is concluded that the local vasoconstrictor response is normalized after arterial reconstruction. Disturbances may, however, occur in the postoperative period, possibly due to operative stress.

Adult↗
PubMed1982

Intellectual function in patients with transient ischaemic attacks (TIA) or minor stroke. Long-term improvement after carotid endarterectomy.

Psychological testing was performed in 25 patients (mean age 56 years) with transient ischaemic attacks and/or minor strokes and with angiographically verified internal carotid artery stenosis. The effects of carotid endarterectomy on intellectual functions were evaluated postoperatively at 2 weeks and 8 months respectively. Preoperatively the mean test values were below the normal level for all tests indicating a general intellectual impairment for the group as a whole. This may reflect multi-infarct dementia in statu nascendi. At the early postoperative test session some test results were statistically significantly worse than the preoperative. 8 months postoperatively the mean values for all tests had improved as compared with the preoperative values. This improvement reached a statistically significant level in 6 tests. When the side of operation was considered a pattern emerged: in the 12 patients with left-sided endarterectomies improvement was significant for tests mainly related to left-hemisphere function (Word Pairs Test, Story Recall, Trail Making B, Similarities) and in the 13 patients with right-sided endarterectomies significant improvement occurred in the functions mainly related to the right hemisphere (Visual Gestalts, Block Design, Digit Span backwards). This relationship between side of operation and improvement in lateralized functions cannot be explained by retest effects. It is concluded that TIA's and minor strokes per se may impair intellectual function, and that reversal of deterioration and even improved mental state may follow carotid endarterectomy.

Adult↗
PubMed1982

Episodic secretion of vasopressin in man.

The plasma arginine vasopressin concentration (pAVP) was measured in blood samples obtained from an internal jugular vein of 8 patients who underwent surgery for a carotid artery stenosis. Ten blood samples were taken with 1 min interval during the operation. Arterial pAVP was measured in 10 simultaneous samples from a radial artery and the brain venoarterial difference of pAVP was calculated. The venoarterial difference was 0-3 pg/ml in 7 of the patients, while it increased to 35 pg/ml upon baroreceptor stimulation in one patient. A pulsatile pattern was found in the veno-arterial difference of pAVP both at low and higher peripheral pAVP levels. This appeared to reflect a discontinuous release of AVP from the neurohypophysis. The described method results in a more accurate picture of ongoing secretory activity than can be obtained by measurements of peripheral pAVP alone. The general usefulness of the method, however, is restricted by the need of a multitude of samples and the difficult approach to the internal jugular vein.

Adult↗
PubMed1981

Pre-operative exercise testing in patients suspected of arteriosclerotic heart disease: methods, risks and reproducibility.

In order to estimate the value of haemodynamic parameters in assessing impaired left ventricular function the reproducibility of haemodynamic measurements were investigated at rest and during supine exercise on a bicycle ergometer in fifty-one patients suspected of arteriosclerotic heart disease by means of a Swan-Ganz pulmonary artery thermodilution catheter and a radial artery catheter. Furthermore the minimal significant (P less than 0.05) change from rest to exercise was determined. In conclusion we found that haemodynamic measurements during exercise testing estimate left ventricular function in a safe and reproducible manner. A rise in pulmonary capillary wedge pressure (PCWP) of only 0.9 kPa during exercise was significant, whereas changes in stroke volume index (SVI) were considered significant only when exceeding 9 ml/m2.

Adult↗
PubMed1981

Prophylactic digitalization preoperatively of patients with arteriosclerotic heart disease.

This study was undertaken to investigate the hemodynamic effect of prophylactic digitalization before major surgical procedures. Sixteen patients, all admitted for an elective vascular operation for arteriosclerotic disease and all with impaired left ventricular function, were investigated. In half of the patients, digitalis was given before the operation, the other half of the patients served as the control study. The measured parameters were pulmonary artery mean pressure, pulmonary capillary wedge pressure, central venous pressure, mean arterial blood pressure, heart rate, cardiac output, blood volume and arterial, as well as venous, oxygen content. Preoperatively, before digitalization, no significant differences were noted between the two groups at rest and during exercise. Before anesthesia and postoperatively, those given digitalis had improved cardiac function. Those in both groups, however, had a normal hemodynamic response to the surgical trauma. In this study, a definite answer is not provided concerning the usefulness of prophylactic digitalization but an increase in the ability of the digitalized heart to withstand the imposition of a pressure load postoperatively is suggested.

Aged↗
PubMed1980

Acute postoperative digitalization of patients with arteriosclerotic heart disease after major surgery. A randomized haemodynamic study and proposal for therapy.

Twenty patients with impaired left ventricular function during exercise, who underwent major vascular surgery for arteriosclerotic disease, were randomly digitalized in the immediate postoperative period. All patients had a smooth postoperative course. Haemodynamic measurements showed improved left ventricular function in those who received digitalis, since 60 min after full digitalization the digitalized patients had a highly significant decrease in pulmonary capillary wedge pressure (PCWP) with unchanged stroke volume index (SVI) and left ventricular stroke work index (LVSWI). The same improvement in cardiac function was present the next morning. The present study provides haemodynamic data in support of clinical studies showing a beneficial effect of prophylactic digitalization in surgical patients with clinical signs of arteriosclerotic heart disease, though not in overt failure.

Aged↗
PubMed1980

Digitalis induced haemodynamic changes in patients with vascular disease during a preoperative exercise test.

Haemodynamic studies at rest and during exercise before and after digitalization were carried out in 11 patients with vascular disease. Haemodynamic parameters at rest were within normal limits except for one patient, who had a cardiac index (CI) below 2.51/min/m2. During exercise 7 of the patients showed impaired left ventricular function. In the resting patients digitalization produced a significant decrease in pulmonary capillary wedge pressure (PCWP) and an increase of approximately 15% in left ventricular stroke work index (LVSWI) and total oxygen consumption. Myocardial oxygen consumption seemed unchanged as no significant changes were found in the product of mean arterial blood pressure and heart rate. After digitalization 6 of 7 patients with impaired left ventricular function showed improved haemodynamic response to exercise while the 4 patients with normal left ventricular function had an unchanged haemodynamic response.

Aged↗
PubMed1980

Diagnostic correctness of distal blood pressure measurements in patients with arterial insufficiency.

The value of distal blood pressure measurement by strain gauge technique in arterial insufficiency was analysed by means of the so-called direct method for evaluation of diagnostic tests, and by the calculation of the diagnostic specificity (predictive value of a positive test), the diagnostic sensitivity (predictive value of a negative test), and the diagnostic correctness (the proportion of patients correctly classified by the test). A blood pressure gradient greater than or equal to 20 mmHg from arm to ankle had a high diagnostic correctness as a screening procedure for arterial insufficiency among forty out-patients. Likewise, in sixty-seven patients admitted for arterial reconstruction a toe blood pressure < 30 mmHg had a high diagnostic correctness in deciding whether constant pain was in fact ischaemic rest pain. In contrast, distal blood pressure measurement was of no value as an indicator of the walking distance of claudicants or in locating the arterial obliterations. It is proposed, that similar evaluations are performed on other tests for arterial insufficiency.

Adult↗
PubMed1980

Carotid endarterectomy in patients with cerebral transient ischemic attacks.

Eighty-seven consecutive patients with cerebral transient ischemic attacks (TIA) subjected to 98 surgical operations for stenosis of the internal carotid artery were followed for a period of 3.5 years in average. In the immediate postoperative period one patient died and two other patients had a severe neurological deficit. These complications occurred in patients where medical risk factors were present preoperatively. During the follow-up period six patients had a stroke. This figure is about 1/3 og the estimated expected number in an untreated patient group of the same size. Three strokes occurred from the hemisphere ipsilateral to the operated internal carotid artery and three from the contralateral hemisphere. Although estimation of expected number of strokes is associated with many uncertainties the present results suggest that carotid endarterectomy in patients with TIA and carotid artery stenosis reduced the frequency of strokes.

Adult↗
PubMed1978

Hemodynamic observation in relation to extensive surgical treatment of patients with increased operative risk.

In 25 patients, considered high surgical risks according to clinical criteria, systemic and pulmonary hemodynamic parameters were monitored using a flow-directed pulmonary arterial thermodilution catheter before, during and after major vascular surgery. During and after the operation, hemodynamic complications were observed in 13 patients. The following conditions were dealt with: hypovolemia, increased systemic vascular resistance, and left ventricular failure in hypervolemia and in normovolemia. Tachy-arrhythmias seen in six of the patients were associated with left ventricular failure, hypovolemia or normal hemodynamics. Operation for renovascular hypertension and thoracolaparotomy carried the highest risk. Two of the patients died from primarily surgical complications.

Adult↗
PubMed1978

Preoperative hemodynamic evaluation of patients submitted for major surgery.

Prior to major vascular surgery, hemodynamic studies were carried out in 63 patients by means of a flow-directed pulmonary artery balloon catheter. The results were correlated to electrocardiographic and roentgenologic findings, as well as to pertinent clinical information. Of 15 patients with either atrial fibrillation or both left ventricular hypertrophy and an increased cardiace volume, six had pulmonary pressures elevated above normal values; none of 14 patients with only one of the two signs (left ventricular hypertrophy or increased cardiac volume) had elevated pulmonary pressures. Also, the 34 patients with normal roentgenologic and electrocardiographic findings had normal hemodynamics, irrespective of a history of previous AMI, present angina or dyspnea on exertion. It is concluded that hemodynamic studies by means of a balloon-tipped catheter floating in the pulmonary artery are indicated before major surgery in patients with either atrial fibrillation or both electrocardiographic and roentgenologic signs of left ventricular hypertrophy. In such patients pulmonary pressures should be monitored during and after surgical operation.

Adult↗
PubMed1978

Postoperative haemodynamics in patients with and without cardiac disease.

The cardiovascular reaction to primarily major vascular surgery was examined in 39 patients without cardiac disease and in 11 patients with cardiac disease. In the immediate postoperative period (24 h), patients without cardiac disease showed significant increases in heart rate and cardiac index and a decreased blood volume. The central pressures were increased during the first postoperative hour. Systemic blood pressure and vascular resistance remained unchanged, or decreased slightly. Postoperative haemodynamics in patients with cardiac disease followed the same trends as in normal patients; there were, however, no significant changes in cardiac index or central pressures, and in general the cardiovascular reaction to operation was less conspicuous than in the group of normal patients. The preoperative haemodynamic differences between the two groups were diminished in the immediate postoperative period because therapy could be guided by measuring central pressures.

Adult↗