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Biomedical subjects

J Swedenborg

Publications and source records attributed to J Swedenborg.

At least 19 recordsLinked to original sources
PubMed2006

Influence of perioperative blood glucose levels on outcome after infrainguinal bypass surgery in patients with diabetes.

BACKGROUND: High glucose levels are associated with increased morbidity and mortality after coronary surgery and in intensive care. The influence of perioperative hyperglycaemia on the outcome after infrainguinal bypass surgery among diabetic patients is largely unknown. The aim was to determine whether high perioperative glucose levels were associated with increased morbidity after infrainguinal bypass surgery. METHODS: Ninety-one consecutive diabetic patients undergoing primary infrainguinal bypass surgery were identified from a prospective vascular registry. Risk factors, indication for surgery, operative details and outcome data were extracted from the medical records. Exposure to perioperative hyperglycaemia was measured using the area under the curve (AUC) method; the AUC was calculated using all blood glucose readings during the first 48 h after surgery. RESULTS: Multivariable analysis showed that the AUC for glucose (odds ratio (OR) 13.35, first versus fourth quartile), renal insufficiency (OR 4.77) and infected foot ulcer (OR 3.38) was significantly associated with poor outcome (death, major amputation or graft occlusion at 90 days). Similarly, the AUC for glucose (OR 14.45, first versus fourth quartile), female sex (OR 3.49) and tissue loss as indication (OR 3.30) was associated with surgical wound complications at 30 days. CONCLUSION: Poor perioperative glycaemic control was associated with an unfavourable outcome after infrainguinal bypass surgery in diabetic patients.

Aged↗
PubMed2004

Outcome after abdominal aortic aneurysm repair. Difference between men and women.

OBJECTIVES: To evaluate short- and long-term outcome after open repair for ruptured and non-ruptured abdominal aortic aneurysm (AAA) with special emphasis on the difference between men and women. DESIGN: Single center retrospective study. Time and cause of death were determined from hospital charts, the National Bureau of Statistics and the Department for National Health and Welfare. Materials. Eight hundred and forty-six patients were followed-up, 597 were operated on for non-ruptured and 249 for ruptured aneurysms. METHODS: Case fatality was analyzed by multiple logistic regression considering year of surgery, age at surgery, and gender as covariates. The mortality rate for patients surviving 60 days after surgery was compared with the mortality in the general population by calculating the standardised mortality ratio (SMR). Mortality was also stratified according to gender and type of surgery. RESULTS: The SMR for patients surviving 60 days after surgery was significantly increased. SMR was significantly higher for women than for men. There was no statistically significant difference in SMR between patients operated for rupture compared to those operated for non-ruptured aneurysms. CONCLUSIONS: Women with AAA have a poorer outcome than women in the general population. This finding may relate to the large number of risk factors present in this patient sub-group.

Adult↗
PubMed2003

The use of recombinant activated factor VII to control bleeding during repair of a suprarenal abdominal aortic aneurysm.

Recombinant activated factor VII (rFVIIa) was first used to control bleeding in haemophilia patients. More recently, it has been used to prevent severe bleeding in patients without pre-existing coagulopathy. We report a case where rFVIIa was used to successfully control postoperative bleeding in a patient undergoing suprarenal abdominal aortic aneurysm (AAA) repair.

Aortic Aneurysm, Abdominal↗
PubMed2001

In vitro endothelialization of bioprosthetic heart valves provides a cell monolayer with proliferative capacities and resistance to pulsatile flow.

OBJECTIVES: Degeneration of bioprosthetic heart valves has been suggested to be at least partly an immunogenic reaction toward the xenogeneic tissue. An autologous endothelial lining has been proposed to overcome this problem. We examined in vitro endothelialization of such tissue and retention of endothelial cells after exposure to flow resembling the in vivo situation. METHODS: Cultured human saphenous vein endothelial cells were used to in vitro endothelialize photo-oxidized bioprosthetic heart valves. The endothelialized valves were mounted in a specially designed flow device, creating a pulsatile flow through the valve. Maintenance of a confluent cell layer and deposition of basement membrane markers were determined with immunohistochemical labeling. RESULTS: Labeling of the main components of the basement membrane, laminin and collagen type IV, was verified within 6 hours after in vitro endothelialization. Under static conditions, 4-mm wide denudations were completely re-endothelialized in 4 days, which was similar to the growth rate on gelatin-coated cell culture plastic, which served as a control material. After exposure of endothelialized valves to pulsatile flows for 24 hours (80 beats/min, 3.4 L/min), there were minimal cell losses from the bioprostheses. The cell layer adapted to the pulsatile flow, as verified by rearrangement of morphology and intracellular stress fibers. CONCLUSIONS: This study shows the feasibility of in vitro endothelialization of photo-oxidized bioprosthetic heart valves. The cells are able to withstand a pulsatile flow in vitro, to develop basement membrane-like structures, and to re-endothelialize denuded areas. This technology may be used to enhance the performance of bioprosthetic heart valve prostheses.

Basement Membrane↗
PubMed2000

[Vascular surgery after the year of 2000--challenges for the future].

Vascular surgery is in a dynamic phase of rapid development. Particularly endovascular procedures have revolutionized the care of vascular patients. Around 35-40% of all interventions in Sweden are endovascular. In all aspects of vascular surgery (arterial, venous, endovascular, biomaterials) there is a great need for more basic knowledge. The organization of vascular units must be centered around the vascular patient. Specialists need to collaborate in the care of each patient. It is proposed that the care of vascular patients should be organized in Vascular Departments.

Biocompatible Materials↗
PubMed2000

Continuous assessment of local metabolism by microdialysis in critical limb ischaemia.

OBJECTIVE: to investigate the feasibility of using microdialysate glucose, lactate and pyruvate concentrations for grading the severity of blood flow reduction in patients with critical limb ischaemia. PATIENTS AND METHODS: microdialysis catheters were inserted (two subcutaneously and one intramuscularly) in the symptomatic limb of ten patients. To further reduce limb perfusion, the lower leg was elevated during part of the experiment. RESULTS: elevation reduced ankle and toe blood pressure and transcutaneous oxygen tension. Microdialysate glucose concentration decreased at all three catheter sites, while lactate increased in the intramuscular catheter. Two patients interrupted the elevated position prematurely due to severe pain in the foot. They had among the highest lactate levels in the horizontal position and the most marked increases following provocation. Neither initial metabolite concentrations nor concentration changes during elevation were shown to correlate to conventional methods used to assess limb perfusion. CONCLUSIONS: in patients with critical limb ischaemia microdialysis can be used without complications. A significant decrease in glucose concentration may reflect lowered blood flow in the elevated position. Metabolic response, i.e. increase in lactate concentration during profoundly reduced limb perfusion was heterogeneous, indicating an overestimation of the presence of ischaemia in some patients using current diagnostic methods.

Arterial Occlusive Diseases↗
PubMed2000

Expression of cyclo-oxygenase-2 in human atherosclerotic carotid arteries.

OBJECTIVES: the preventive effect of acetylsalicylic acid in cardiovascular disease may be due to inhibition of platelet aggregation mediated by COX-1, but may in addition be due to anti-inflammatory effects by inhibition of COX-2. The objective of this study was to analyse the expression of COX-1 and COX-2 in atherosclerotic and healthy vascular walls. DESIGN: the expression COX-1 and COX-2 was analysed in biopsies from human atherosclerotic carotid arteries and from healthy mammary arteries and saphenous veins. MATERIALS: vascular biopsies were obtained from patients undergoing carotid endarterectomy or coronary bypass surgery. METHODS: RT-PCR was used for mRNA analysis and for localization of proteins we used immunohistochemistry. RESULTS: COX-2 was found in atherosclerotic plaques: in macrophages, in some smooth muscle cells and in endothelial cells of small vessels in the lesions. In non-atherosclerotic blood vessels, COX-2 was detected in the endothelium of the vasa vasorum in the adventitia. COX-1 was found in the endothelium in healthy and in atherosclerotic vessels. CONCLUSIONS: the expression of COX-2 by inflammatory and vascular cells in atherosclerotic arteries suggests that products of this enzyme may be important in the pathogenesis of atherosclerosis.

Arteriosclerosis↗
PubMed2000

Growth of thrombus may be a better predictor of rupture than diameter in patients with abdominal aortic aneurysms.

OBJECTIVES: to investigate the relationships between diameter, surface and thrombus area in abdominal aortic aneurysms (AAAs) <5 cm. METHODS AND MATERIAL: sixty-seven patients with AAA underwent at least 2 CT examinations. At the point of maximal diameter, surface area and thrombus area were calculated and related to rupture, or impending rupture, during follow-up. RESULTS: the mean increase in measured diameter, surface area and thrombus area were 3.4 mm, 1.9 cm(2)and 1.7 cm(2)per year respectively. Patients with AAA >4 cm and whose thrombus area increased >1.5 cm(2)/year were more likely to rupture (6/24 vs 1/23). CONCLUSIONS: a rapid increase of thrombus area may be a better predictor of AAA rupture than increase in maximal diameter.

Aged↗
PubMed2000

Fucoidan inhibits smooth muscle cell proliferation and reduces mitogen-activated protein kinase activity.

OBJECTIVES AND DESIGN: fucoidan has previously been shown to inhibit the proliferation of arterial smooth muscle cells both in animal models and in vitro. However, the mechanisms behind the anti-proliferative effects of this polysulfated polysaccharide are not known in detail. Here, the inhibitory effect of fucoidan on rat aortic smooth muscle cell proliferation was examined and compared with the effects of heparin after stimulation with fetal calf serum, platelet-derived growth factor BB, basic fibroblast growth factor, heparin-binding epidermal growth factor, and angiotensin II. MATERIALS AND METHODS: the cultures were analysed with respect to cell proliferation and DNA synthesis by cell counting and measurement of(3)H-thymidine incorporation. Phosphorylation of mitogen-activated protein kinase and nuclear translocation of phosphorylated mitogen-activated protein kinase were studied by immunoblotting and immunocytochemistry. RESULTS: fucoidan was shown to be a more potent inhibitor of smooth muscle cell proliferation than heparin. Fucoidan also reduced growth factor-induced activation of mitogen-activated protein kinase and prevented nuclear translocation of phosphorylated mitogen-activated protein kinase. CONCLUSION: fucoidan is a more potent anti-proliferative polysulphated polysaccharide than heparin and may mediate its effects through inhibition of the mitogen-activated protein kinase pathway in a similar manner as heparin.

Angiotensin II↗
PubMed2000

Endovascular treatment of atherosclerotic lower limb lesions using a PTFE-collared stent-graft.

PURPOSE: To assess the feasibility of a polytetrafluoroethylene-collared (PTFE) endoluminal graft in the treatment of lower limb atherosclerosis. METHODS: We designed an endograft using a 3-mm-diameter balloon-expandable PTFE graft with terminal Palmaz stents placed on the outside of the graft, folding the PTFE back over the stents to form a collar at each end. Under protocol, this device was implanted in 8 symptomatic patients with lower limb ischemia. The lesions, ranging from 4 to 20 cm long, were located in the superficial femoral artery (n = 5), femoropopliteal segment (n = 1), and common (n = 1) and external (n = 1) iliac arteries. The device required a 14-F introducer system. RESULTS: Graft lengths varied from 4 to 35 cm. Implantation was successful in all cases, but procedural complications occurred in 4 patients (2 access site hematomas, 1 leading to endograft occlusion; 1 arterial injury, and 1 distal thromboembolism). At a mean 14-month follow-up, 5 endografts were patent (2 after reintervention for restenosis or thrombosis). The common iliac endograft and 2 superficial femoral artery devices occluded after 3, 2, and 12 months, respectively. CONCLUSIONS: Although this endoluminal graft system is technically feasible and showed encouraging intermediate-term patency in a small pilot study, the early and late complications identified several shortcomings of this design, which needs refinement.

Aged↗
PubMed1999

[Clinical assessment of critical ischemia is always to be done prior to amputation].

Patients with critical limb ischemia (rest pain and/or ulcer/gangrene, together with low ankle pressure) are at risk of amputation, and should therefore undergo arterial reconstruction if that is at all technically possible. Thorough clinical investigation will usually distinguish patients in need of further evaluation by a vascular surgeon. No amputation should be undertaken without such evaluation. Diabetic patients belong to a special category, in that neuropathy makes it difficult to evaluate pain, and ankle pressure is often falsely high due to medial arterios sclerosis.

Amputation, Surgical↗
PubMed1999

Cytokine expression in advanced human atherosclerotic plaques: dominance of pro-inflammatory (Th1) and macrophage-stimulating cytokines.

The atherosclerotic lesion contains large numbers of macrophages and T lymphocytes. This suggests that a cellular immune response may take place in the lesion, and oxidized lipoproteins, heat shock proteins, and micro-organisms have been implied as candidate antigens. However, the effector mechanisms elicited by this response have been largely unclear. We have therefore analyzed endarterectomy specimens by immunohistochemistry and reverse transcription-PCR to detect immune cytokines produced by immunocompetent cells of the advanced human plaque. The pro-inflammatory T cell cytokines, interleukin-2 and interferon-7, were found in a large proportion of plaques (IL-2 in 50% and interferon-gamma in 30% of plaques by immunohistochemistry and mRNA for both cytokines in 70% of plaques by PCR). In contrast, interleukin-4 and interleukin-5 were rarely observed (both cytokines in 10% of plaques by immunohistochemistry, mRNA for interleukin-4 in 10% and for interleukin-5 in 40% by PCR). This demonstrates the presence of a predominantly pro-inflammatory, Th1-type T cell response in atherosclerosis. This conclusion was further supported by the expression of the pro-inflammatory cytokine, interleukin-1 by plaque macrophages and endothelial cells. In addition, the chemokine interleukin-8 and the macrophage differentiation-stimulating cytokine, granulocyte-monocyte colony stimulating factor, were observed in plaque tissues, suggesting that the micro-environment promotes monocyte recruitment and macrophage differentiation. Occasional eosinophils and B cells were, however observed, which is compatible with a microheterogeneity within the lesion. Finally, the anti-inflammatory and fibrogenic cytokines, transforming growth factor-beta1-3 and its carrier protein, latent TGF-beta binding protein, were found in large amounts in all plaques. Together, these results show that a pro-inflammatory, Thl type cellular immune response takes place in the atherosclerotic plaque. The balance between pro-inflammatory and anti-inflammatory cytokines may be decisive for the progression of the lesion.

Arteriosclerosis↗
PubMed1999

Complications in carotid endarterectomy are predicted by qualifying symptoms and preoperative CT findings.

OBJECTIVES: To relate the 30-day perioperative rate of stroke or death in carotid endarterectomy (CEA) to preoperative qualifying symptoms and to the presence of cerebral infarction (CI) demonstrated on computed tomography (CT). DESIGN: Retrospective clinical study. MATERIAL AND METHODS: Two hundred and seventy-two consecutive CEAs for symptomatic stenosis in 262 patients were analysed. RESULTS: The total complication rate was 5.9%. Patients with retinal symptoms (n = 81) had no complications, TIA patients (n = 76) had 6.6% (p < 0.001). Patients qualifying with minor stroke (n = 113) had complications in 9.7% (N.S. compared to TIA patients). Patients qualifying with cortical symptoms had a significantly higher complication rate compared to those with retinal (8.4% vs. 0%, p = 0.004). The presence of a preoperative CT-verified infarction resulted in a higher risk for stroke or death (9.8% vs 2.8%, p = 0.008). Within the subgroup presenting with minor stroke, the presence of CI resulted in stroke or death in 13.9%. In patients without CI the corresponding figure was 2.4% (p = 0.017). CONCLUSION: The qualifying symptoms and the presence of CI visualized by CT influence the complication rate in CEA. When evaluating risk and comparing outcome, these parameters should be included in reporting standards.

Adult↗
PubMed1999

The toe pole test for evaluation of arterial insufficiency in diabetic patients.

OBJECTIVES: to evaluate if the pole test at the toe level can be used for assessment of arterial insufficiency in diabetic patients. METHODS: twenty-five legs in 23 diabetic patients suffering from leg ischaemia were examined prospectively. A laser Doppler probe was attached to the pulp of the first toe to monitor perfusion continuously before and after occluding the arterial inflow with a cuff and during elevation of the leg until perfusion disappeared (the pole test). At ankle level the examinations were made similarly but with an ankle cuff and a hand-held Doppler. RESULTS: in the 44% (11/25) of the legs where it was possible to compare cuff blood pressure at ankle level with the pole test, the cuff measurements were significantly higher (p <0.01). In 13 of the remaining 14, maximal elevation did not result in disappearance of the Doppler signal. At toe level where 76% (19/25) of the legs could be compared, there was no significant difference between the two methods. CONCLUSION: the pole test can be used at the toe level to evaluate arterial insufficiency in diabetes. When used in the toe, the pole test can assess pressures below 55-70 mmHg, while only pressures below 45 mmHg can be determined at the ankle level. Falsely elevated blood pressure in diabetics is probably of less importance in digital arteries than in ankle arteries, which makes cuff pressure at toe level a more acceptable approximation.

Aged↗
PubMed1998

[Significant regional differences in the frequency of vascular surgery].

The six health care regions of Sweden were compared with regard to the frequency of vascular surgery for three diagnoses: chronic lower extremity ischaemia, abdominal aorta aneurysm, and carotid stenosis. In 1995, the frequency of intervention for chronic lower extremity ischaemia varied from 26/100,000 of the population in northern Sweden to 68/100,000 in the southern region, the variation being greater for critical limb ischaemia than for intermittent claudication. In the country as a whole, the frequency of abdominal aorta aneurysm surgery increased five-fold from 1987-89 to 1993-95. During 1995, regional figures varied from 4.7 to 8.4 per 100,000 for elective procedures, and from 3.8 to 5.5 per 100,000 for emergency procedures. Overall surgical mortality varied regionally, and emergency surgery mortality differed between regional and county hospitals. Carotid surgery manifested the greatest regional difference in frequency, which was 7-fold greater in the southern than in the northern region, while its overall mean frequency was 6/100,000.

Aortic Aneurysm, Abdominal↗
PubMed1998

Carotid atherosclerosis in patients operated for lower extremity ischemia before the age of 50: a case control study.

The purpose of this study was to investigate the presence of, and to identify factors associated with carotid atherosclerosis in patients, previously operated on for lower extremity ischemia before the age of 50. Forty-eight patients were compared to sex- and age-matched controls. All subjects were examined with duplex ultrasonography of the neck arteries and analysis of serum lipoproteins. History including smoking habits, family history of cardiovascular disease, and medication was also obtained. The patients were examined clinically and their preoperative angiograms were reevaluated. Thirty-one patients (64%) and 13 controls (23%) had a carotid lesion (p < 0.0001). Patients with suprainguinal or multilevel disease had a higher proportion of carotid lesions than those with only infrainguinal disease in whom the proportion was similar to the controls. A multiple regression analysis among the patients revealed that age, level of lower extremity arterial disease, presence of family history, and the ratio apolipoproteinB/apolipoproteinA discriminated significantly between those with and without carotid disease. It is concluded that a high proportion of patients operated on for lower extremity suprainguinal arterial occlusive disease at an early age have carotid lesions at follow-up, while patients operated on due to isolated infrainguinal disease have a prevalence similar to controls.

Arteriosclerosis↗