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Biomedical subjects

J Elfström

Publications and source records attributed to J Elfström.

At least 37 records · Page 2Linked to original sources
PubMed1989

[Oral contraceptives and blood diseases are the most common causes of Budd-Chiari syndrome].

Two cases of young patients with the chronic form of Budd-Chiari syndrome are reported. The first concerns a 22-year-old woman with a 6-month history of hepatomegaly, who had used oral contraceptives almost continuously during the five years preceding diagnosis. In a thorough diagnostic work-up, thromboses were detected in all but one of the hepatic veins, and a possible non-occluding thrombosis in the retrohepatic portion of the inferior vena cava. In the blood and bone marrow, findings were compatible with polycythaemia rubra vera, and a high anti-cardiolipin antibody titre was found. The second case concerns a 25-year-old male smoker with normal bone marrow, who had thromboses in at least two of the hepatic veins, though the inferior vena cava was not occluded. In both cases a mesocaval shunt was interposed with synthetic grafts, and postoperatively the patients are doing well--at sixteen and five months, respectively. Both are maintained on anticoagulants, and even without diuretics there has been no recurrence of ascites. The woman takes a small dose of hydroxy-urea to control her hypercoagulability. To our knowledge, hers is the first case to be reported of Budd-Chiari syndrome with hypercoagulability due to the concomitant presence of oral contraceptives, polycythaemia rubra vera and anti-phospholipid antibodies.

Adult↗
PubMed1987

Muscle energy stores in relation to clinical findings and outcome in acute arterial ischaemia of the lower leg.

Forty-two patients (mean age 79 years) with acute ischaemia of one leg were evaluated in a prospective study. Forty-nine percent of the patients suffered from embolism, 29% from thrombosis while the etiology was uncertain in 22%. In 30 of the ischaemic legs and in 21 contralateral non-ischaemic legs the muscle energy metabolic status (ATP, ADP, AMP, ECP, PC, Cr and lactate) from the gastrocnemius muscle was measured and compared to values obtained from 24 healthy age-matched controls. There was a high degree of energy metabolic impairment in the ischaemic legs. Furthermore, the contralateral non-ischaemic legs were also energy depleted in comparison with those of the healthy controls. Legs with thrombosis were more energy-deprived than legs with embolism. Clinical evaluation of the degree of ischaemia and the level of occlusion correlated with energy metabolic parameters but the duration of ischaemia did not. The degree of metabolic impairment had no prognostic implication for the clinical outcome.

Adenine Nucleotides↗
PubMed1983

What causes the failures in surgically constructed arteriovenous fistulas?

A retrospective analysis was made of 191 uraemic patients whose first arteriovenous fistula was constructed in the period 1972-1978. Only direct-type lower forearm fistulas were considered. The aim was to identify and evaluate factors influencing fistula patency rate. Evaluation was done by simple and multiple regression analyses and by actuarial life table computation. Early failure of fistula occurred most frequently in patients with diabetes, peroperative blood pressure less than 110 mmHg, small-calibre veins and/or less than maximal uraemia. The early failure rate among patients with low peroperative blood pressure was 53%, and in the other patients 24%. Among patients with serum creatinine higher than 1 140 mumol/l the corresponding figure was 11%, while in those with lower values it was 35%. Long-term fistula patency was influenced by sex (with advantage to males), by diabetes or diabetic vasculopathy, and seemingly be a tendency to hypotension in some patients. Direct-type forearm fistula may well be utilized in patients with narrow veins. The operation should not be performed long before induction of haemodialysis. This is because some of the fistula's lifespan will be wasted if it is created too soon, and because the early failure rate is lower in patients with advanced uraemia. The analysis also reflects problems that can be anticipated, as diabetics constitute an increasing proportion of patients requiring vascular access.

Adolescent↗
PubMed1983

Adjuvant intravenous sympathetic block with guanethidine in construction of arteriovenous fistulas for blood access.

A prospective randomized investigation of regional intravenous sympathetic block with guanethidine (RGB) was made in patients undergoing surgical construction of arteriovenous fistula (AVF) for vascular access. The blockade was preoperatively performed on chronically uraemic patients without previous vascular access surgery. The studied data were preoperative forearm blood flow, intraoperative fistula blood flow and flow resistance, and patency rates of AVF. Serial occlusion plethysmography showed a 152% increase in mean forearm blood flow in the RGB group, with significant (p less than 0.001) difference from the controls. The fistula blood flow resistance was decreased (p less than 0.05). The early failure rate was 1/17 among the patients treated with RGB and 3/17 in an otherwise comparable control group. RGB may be useful for reducing early failure rates after construction of AVF, by facilitating blood flow through the fistula.

Adolescent↗
PubMed1982

Occurrence of lateral incompetent perforating veins of the calf. Usefulness of the posterior midline incision.

This investigation is an evaluation of the posterior approach for subfascial ligation of incompetent perforating veins (IPV) of the calf. The distribution of veins found incompetent at operation and the incidence of wound complications were studied. 39 patients with clinical multiple perforating vein insufficiency were operated on. At the end of the operation the crural fascia was sutured in half of them. The tissue pressure in the gastrocnemius muscle was measured in 13 patients postoperatively. 151 IPVs were found in the 39 legs operated on (3.8/ leg). 25% were found on the lateral side, and were inaccessible from a medial incision. Postoperative infection was noted in 3 patients and in a further 6 mostly minor skin necrosis with delayed healing occurred. The incidence of delayed healing was not influenced by fascia suture and the tissue pressure was normal in the 13 patients so examined. The posterior incision gives excellent access to both medial and lateral IPVs and makes possible resection of the short saphenous vein at the same time. This approach is useful when ulcers and stasis dermatitis are present on both medial and lateral sides or when there are medial IPVs and signs of incompetence of the short saphenous vein.

Adult↗
PubMed1982

Changes in human forearm blood flow after intravenous regional sympathetic blockade with guanethidine.

The effect of intravenous regional sympathetic blockade with guanethidine on total forearm blood flow and on muscle and skin blood flow in the forearm was studied in healthy humans, using venous occlusion plethysmography, 133Xe-clearance technique and skin temperature recordings. The total blood flow tripled in response to the blockade and the rise persisted for 2-3 days. The increase in blood flow was confined to the skin, with no demonstrable steal effect on muscle blood flow. The observations imply that this type of sympathetic blockade may be of therapeutic value in some vascular disorders of the hand, and as supportive treatment in vascular surgery on the extremities.

Adult↗
PubMed1981

The prognostic value of blood-flow measurements during construction of arteriovenous fistulae.

The most common route of access in haemodialysis is the conventional radio-cephalic fistula at the wrist. Some patients are better suited for a graft procedure, however. In order to select the most appropriate approach preoperative assessment of the veins is important. Certain observations made at operation may also be helpful. We have measured the vessel sizes and estimated blood flow before and after establishment of the fistula. 36 radio-cephalic fistulae were made in a series of patients not selected with regard to the condition of the veins, in order to find characteristics indicating a poor prognosis for the fistula. There were 8 early failures (22%), and another fistula ceased to function within 6 months. We found that a fistula flow of less than 40 ml/min immediately after construction was associated with a 70% risk of early failure, and no fistulae with such a flow rate survived 6 months. Neither vessel diameters nor preoperative blood flow in the radial artery influenced the risk of early failure.

Adult↗
PubMed1979

Healing of jejunal fistula using a silicone tube and patch.

In this case report is described a method of healing jejunal fistula by temporary use of a silicone tube and finally closing the defect in the intestinal wall by using a silicone patch. The patient was treated with parenteral nutrition during 7 months.

Humans↗
PubMed1978

Influence of bed rest on the pharmacokinetics of phenazone.

The pharmacokinetics of a single dose of phenazone was studied in six objects while ambulant and during bed rest for 3 days. Elimination of the drug was followed for 12 h after oral and intravenous administration. The elimination rate constant and total body clearance were significantly increased during bed rest as compared to the ambulant period, but the differences were small. The apparent volume of distribution decreased significantly. No consistent change due to bed rest was found in the rate of absorption or bioavailability of the oral dose.

Administration, Oral↗
PubMed1978

Metabolism of phenazone in man after hydrocortisone administration.

The influence of a high plasma concentration of hydrocortisone on the metabolism of phenazone in humans has been studied. Two series of experiments were carried out, Group A to demonstrate any enzyme-inducing effect of hydrocortisone, and Group B to study the immediate effect of hydrocortisone on the metabolism of phenazone. 9 subjects (Group A) received a total 250--400 mg hydrocortisone i.m. twice daily for three days and the 24-hour elimination of phenazone was studied before and afterwards. In a further 5 subjects (Group B) the elimination of phenazone was examined during administration of hydrocortisone of placebo. The elimination rate and the apparent volume of distribution of phenazone remained unchanged under both experimental conditions.

Adult↗
PubMed1978

The timing of cholecystectomy in patients with gallstone pancreatitis. A retrospective analysis of 89 patients.

A retrospective analysis has been made of 89 patients, who were treated for acute pancreatitis and later underwent cholecystectomy. The object was to elucidate whether cholecystectomy can be performed soon after recovery from the pancreatitis ('early operation') or must be postponed a few months ('elective operation'). While waiting for operation a quarter of the patients in the elective group had a recurrent attack of pancreatitis or acute cholecystitis. A further quarter of the patients had slight symptoms. The postoperative complications were few, their frequency being comparable in both groups. No damage resulted to the common bile duct, there was no postoperative bleeding and only one case of postoperative pancreatitis in the group of patients operated early. It is concluded that 'early operation' is to be preferred provided a firm diagnosis of gallstone disease has been made. However, the oral cholecystogram is unreliable during the first three weeks after the attack of pancreatitis. If an oral cholecystogram is performed during these weeks and shows nonvisualization of the gallbladder but no stones, a repeated examination must be performed.

Adult↗
PubMed1977

Plasma protein binding of phenytoin after cholecystectomy and neurosurgical operations.

The purpose of the present study was to investigate whether changes in the protein binding of phenytoin occur postoperatively. Fourteen patients were studied after cholecystectomy and six patients after operations for intracranial aneurysm or meningeoma. It was found that the fraction of phenytoin not bound to plasma proteins rose significantly after operation. The total concentration, on the other hand, decreased, so the concentration of free phenytoin did not change much. Possible explanations to the changes observed are discussed, as well as the clinical usefulness of determination of the protein binding of phenytoin.

Adolescent↗