Biomedical subjects
Publications and source records attributed to H Weibull.
Acute necrotizing pancreatitis is a rare complication of various types of surgery, with a few cases reported after aortic operations. Following renovascular surgery, severe acute pancreatitis developed in three (0.9%) of 332 patients, and was fatal in one case. Various etiologic possibilities are discussed.
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This review deals with some recent animal and clinical investigations that show that small amounts of intravascular contrast media (CM) that remain in the body at the time of surgery and are the residual from a preoperative roentgen examination may increase (potentiate) the renal injury resulting from temporary intraoperative renal artery occlusion. Such interaction (potentiation) may occur in each of the following clinical situations: (1) aortorenal reconstructive surgery after angiography; (2) kidney harvesting after cerebral angiography in cadaver donors; and (3) percutaneous dilatation of a stenotic renal artery that includes a sequence of CM injections and balloon inflations that occlude the renal artery. It is concluded that such a potentiation may be decreased by prolonging the time interval between CM injection and the subsequent temporary renal arterial occlusion because such a prolongation decreases the amount of CM that remains in the kidney at time of occlusion.
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During a five-year-period percutaneous transluminal renal angioplasty (PTRA) was attempted in 90 renal arteries with 109 stenoses and 3 occlusions in 78 patients. Complications were systematically recorded and classified as major, minor and radiological-technical. Twenty-one major complications (20.8%) including one fatality occurred as well as 17 minor, (16.8%) and 37 radiological-technical (36.6%) problems. The last group showed no clinical symptoms. The frequency of complications in our series is high compared with that in a survey of ten papers reviewing results in 675 patients. The most marked discrepancy was our high frequency of septic problems. Radiological changes are not usually reported in other series, probably because they are regarded as methodological but we considered these as potentially dangerous and important to report as they can lead to clinically relevant complications. Because of the problems reported here PTRA should only be performed in centres where complications can be properly dealt with.
During a 5-year period percutaneous transluminal angioplasty (PTA) was attempted in 134 iliac, femoral, and popliteal arteries in 127 patients. Complications were systematically registered and classified as major, minor, and radiologic. Seventeen major complications (12.7%), including three deaths, occurred, as well as five minor (3.7%) and 13 radiologic complications (9.7%). The last group showed no clinical symptoms. The frequency of complications in our series is high compared with that found in a survey of 13 studies with 2043 patients. The most marked discrepancy was our high frequency of septic symptoms. A mortality rate of 2.2% was also higher in our series, but we have consequently registered the 30-day mortality rate to make comparisons with surgical series relevant. Radiologic alterations are usually not reported in other series probably because they are regarded as a part of the method, but we consider these alterations as potentially dangerous and important to report because they can result in clinically relevant complications. Because of the complications PTA should only be performed in centers in which complications can be optimally treated.
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Three patients developed reversible renal insufficiency after successfully performed PTA at the same time as their hypertension was beneficially influenced. The main cause of this complication probably is toxic effects of contrast medium in combination with the temporary occlusion of the renal artery during the PTA of kidneys with previously damaged parenchymal and impaired perfusion. During the phase of renal insufficiency contrast medium retention in the renal cortex was noted at computed tomography.
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Abnormalities of renal perfusion can be recognised more readily by sequential CT than by a plain CT scan or after "static" enhancement with contrast medium. Haemodynamically significant stenoses of the renal arteries and total, or partial, infarct can be diagnosed in this way. Intrarenal and capsular collaterals can be recognised by slow contrast accumulation in the infarcted area, or by the development of contrast in the sub-capsular portion of the cortex. Renal cortical necrosis is very well demonstrated by the absence of cortical perfusion; this is seen, for instance, in the DIC syndrome or during rejection after renal transplant.
A growing empirical literature has investigated attitudes towards discounting of health benefits with regard to social choices of life-saving and health-improving measures and individuals' time preferences for the management of their own health. In this study, the authors elicited the time preferences of vascular surgeons in the context of management of small abdominal aortic aneurysms, for which the choice between early elective surgery and watchful waiting is not straightforward. They interviewed 25 of a random sample of 30 Swedish vascular surgeons. Considerable variation in the time preferences was found in the choices between watchful waiting and surgical intervention among the otherwise very homogeneous group of surgeons. The discount rates derived ranged from 5.3% to 19.4%. The median discount rate (10.4%) is similar to those usually reported for social choices concerning life-saving measures. The surgeons who were employed in university hospitals had higher discount rates than did their colleagues in county and district hospitals.