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Biomedical subjects

K G Ljungström

Publications and source records attributed to K G Ljungström.

At least 19 recordsLinked to original sources
PubMed2000

[Results of vascular surgery in the very old. Costs are comparable to those of younger patients].

An increasing number of very old patients are treated in hospitals but there are few Swedish studies of the results of the treatment. In this study the results and costs of vascular surgery in octogenarians were compared to those of younger patients. All Swedish patients treated in 1996 (10,185 procedures) were analyzed; one fifth were over 80 years of age. During the past ten years the number of procedures had increased 2.6 times in the old age group. The technical result, measured as patency rate one year after bypass surgery, was comparable in the two groups--73 per cent versus 81 per cent--but the mortality was higher in the older age group both in direct connection with the procedure and a year thereafter. The cost per procedure was not higher in the old age group.

Aged↗
PubMed1997

The incidence of clinical postoperative thrombosis after gastric surgery for obesity during 16 years.

BACKGROUND: Suggested risk factors for postoperative thrombosis such as high fatty acid levels, hypercholesterolemia and diabetes are common in obese patients. METHODS: In a retrospective study, the case records of 328 patients operated for obesity by gastric procedure from September 1977 until December 1993 were analyzed: 253 women and 75 men with a mean age of 38 years and a mean body mass index (BMI) of 44 kg/m2. The operation time, use of epidural anesthesia, and the occurrence of risk factors; fatty acid levels, hypercholesterolemia and diabetes were recorded. Symptomatic thromboses were verified by phlebography or phlethysmography and pulmonary embolism with ventilation/perfusion scintigraphy or autopsy. RESULTS: The mean operating time was 128 minutes, 77% had epidural anesthesia and the mean hospital stay was 12.3 days. The long hospital stay was due to the fact that most patients took part in different scientific studies perioperatively. The incidence of thromboembolism was 2.4%. Four patients had pulmonary embolism, in one of them this was fatal. Three patients had deep leg vein thrombosis and one patient had arm thrombosis secondary to a central venous catheter. None of these patients had high fatty acids, diabetes or high cholesterol. Of the patients, 298 were given dextran-70 (Macrodex, Pharmacia) as prophylaxis, seven were given heparin and 23 were given no prophylaxis. In the patient group without diagnosed thrombosis, 31% had high fatty acid levels, 2% had high cholesterol levels and 9% had diabetes. CONCLUSIONS: Obese patients seem to have a moderate risk of developing postoperative thrombosis when an effective prophylaxis is used. High free fatty acids, hypercholesterolemia and diabetes are not obvious extra risk factors in obese patients. Thromboprophylaxis should be given to all operated obesity patients regardless of age. The surgeons must be aware and investigate promptly any symptoms suggestive of thromboembolism.

Adult↗
PubMed1996

Thromboprophylaxis with a low molecular weight heparin (tinzaparin) in emergency abdominal surgery. A double-blind multicenter trial.

In this prospective randomized double-blind study the thromboprophylactic effect of postoperative low molecular weight heparin (tinzaparin) was compared with placebo in 80 patients undergoing emergency abdominal surgery. The fibrinogen uptake test was used but because of withdrawal of the labelled fibrinogen from the market the calculated number of patients was not reached. However, this is one of the few studies in emergency abdominal surgery we thought it important to report. The frequency of deep vein thrombosis was reduced with prophylaxis from 22% (95% conf. intervall 11-38%) to 8% (2-21%), a risk reduction of 65%, which is however not significant. Together with data from the few previously published studies it can be concluded that patients undergoing emergency abdominal surgery seem to benefit from prophylaxis, which should be instituted either before operation or at latest 24 hours after. The exact prophylactic relation between pre- and post-operative start would, however, require a separate, randomized study.

Abdomen↗
PubMed1996

Risk factors for major thromboembolism and bleeding tendency after elective general surgical operations. The Fragmin Multicentre Study Group.

OBJECTIVE: To elucidate those factors that contribute to the risk of major postoperative thromboembolism and perioperative bleeding tendency. DESIGN: Retrospective multiple logistic regression analysis. SETTING: 7 Scandinavian hospitals (6 Swedish and 1 Norwegian). SUBJECTS: 2070 patients undergoing elective major abdominal surgery. INTERVENTIONS: Patients were randomised to receive 2500 or 5000 XaI units of low molecular weight heparin daily. MAIN OUTCOME MEASURES: Major thromboembolism (proximal deep vein thrombosis confirmed by phlebography or necropsy, or pulmonary embolism confirmed by scintigraphy or necropsy, or both). Bleeding tendency (bleeding complications which were not explained by local haemorrhagic lesions or by coexisting disease). RESULTS: Previous thromboembolism, leg fracture or arthroplasty, present leg ulcer or malignant disease, operating time longer than 150 minutes, preoperative transfusion of 2 or more units, and preoperative hospital stay of 6 days or more (but not age, body weight, or varicose veins) were independent predictors for major postoperative thromboembolism. The risk was significantly increased with an increasing number of such risk factors. The risk of developing a diffuse bleeding complication was dependent on the dose of low molecular weight heparin, particularly in patients without risk factors. CONCLUSIONS: The use of a narrow definition of thromboembolism lead to a pattern of risk factors which was partly different from that found in previous studies, which were usually based on diagnosis with the 125I-fibrinogen uptake test.

Abdomen↗
PubMed1995

Clinical relevance of the fibrinogen uptake test in patients undergoing elective general abdominal surgery--relation to major thromboembolism and mortality. Fragmin Multicentre Study Group.

Postoperative thromboembolic complications were evaluated in 2578 patients undergoing elective abdominal surgery, all receiving prophylaxis with low molecular weight heparin. A positive fibrinogen uptake test (FUT) developed in 217 patients (8.4%), while 37 patients (1.4%) had major thromboembolism (TE, defined as proximal deep vein thrombosis and/or pulmonary embolism, verified with phlebography, pulmonary scintigraphy or autopsy). In only 14% a positive FUT was associated with a major TE event. In 19% of the patients with major TE the FUT was negative. In multiple logistic regression the independent predictors for major TE were partially different from those for positive FUT. Thirty day mortality was 3.0%. There were significant associations between both positive FUT and major TE on one hand and mortality on the other (relative risks 2.4 and 5.8, respectively). FUT is not a good predictor of major TE. Both positive FUT and major TE indicate a significant risk of postoperative death.

Abdomen↗
PubMed1993

Monofilament versus multifilament absorbable sutures for abdominal closure.

This study compares monofilament continuous absorbable sutures with multifilament interrupted absorbable sutures for abdominal closure. Before closure of an abdominal incision, 988 patients were randomized to receive either a monofilament polyglyconate (Maxon) or a multifilament polyglactin 910 (Vicryl) suture. At 1 year after operation, 684 patients (69 per cent) were examined for the presence of incisional hernia, sinus and other wound-healing problems; 179 (18 per cent) had died and 125 (13 per cent) did not attend for follow-up. Incisional hernia occurred in 8 per cent of patients receiving monofilament continuous sutures compared with 6 per cent of those having multifilament interrupted closure (P not significant). Wound dehiscence occurred in 1 per cent of both groups. The mean time for suturing was 7.1 min for monofilament continuous and 8.7 min for multifilament interrupted sutures (P < 0.001). It is concluded that closure of an abdominal incision can be effected by a monofilament continuous absorbable suture more quickly than by multifilament interrupted absorbable sutures without an increased risk of wound dehiscence or incisional hernia.

Abdominal Muscles↗
PubMed1993

Hapten inhibition of dextran anaphylaxis. Nine years of post-marketing surveillance of dextran 1.

All spontaneous reports to the manufacturer and to WHO's database INTDIS regarding adverse reactions to clinical dextran after preinjection of dextran 1 and to dextran 1 alone 1983-1991 were collected. During 1983-1991 a total of 4.8 million doses of Promit were sold in fourteen countries. The incidence of severe DIAR (grades III-V) to clinical dextran after the prophylactic use of hapten inhibition was approximately one case per 200,000 doses of dextran 1. In Sweden, where reporting of severe adverse drug reactions is mandatory, the incidence was one case per 70,000. This indicates a 35-fold reduction in the incidence of severe DIAR compared with the use of clinical dextran without dextran 1. Only two fatal reactions were reported; the incidence was therefore one case per 2.4 million doses, indicating a 77-fold reduction. Both these occurred in patients with extremely high titers of DRA. Side effects to dextran 1, mostly mild, were reported in one case per 100,000 doses. These side effects were not antibody mediated. It is concluded that the introduction of hapten inhibition with dextran 1 has greatly reduced the risk for serious side effects to dextran, making dextran one of the safest colloids in use.

Anaphylaxis↗
PubMed1993

Renal effects of high dose desmopressin and dextran. A study in normal subjects and in patients undergoing total hip replacement.

Dextran 70 and the haemostatically active vasopressin analogue desmopressin were administered to four healthy volunteers and to 12 patients undergoing total hip replacement. In volunteers the antidiuretic effect of a single i.v. dose of desmopressin (0.3 microgram/kg bodyweight) caused a mean net urine deficit, compared with controls, of 890 ml/24 h. Both drugs increased estimated blood volume, but only the combination caused an increase still persisting after 24 h (+530 ml). Desmopressin-treated surgical patients had the same urine volumes as controls, without the use of more diuretics or more i.v. fluid administration. Creatinine clearance was significantly increased postoperatively in patients on desmopressin, compared with controls. Thus the long-lasting antidiuretic effect of desmopressin seen in healthy volunteers was absent in surgical patients, possibly because there was a compensatory increase in glomerular filtration rate (creatinine clearance).

Adult↗
PubMed1993

Thromboprophylaxis in emergency surgery.

Except for hip fracture surgery, emergency surgery has been only exceptionally studied concerning thromboprophylaxis. There are, however, several reasons to believe the frequency to be fairly high and that the patient group would be in need of prophylaxis. This paper discusses various emergency situations and also gives the design for an ongoing controlled study on the effect of postoperative start of thromboprophylaxis with low molecular weight heparin in emergency abdominal surgery.

Abdomen↗
PubMed1993

Safety of dextran in relation to other colloids--ten years experience with hapten inhibition.

OBJECTIVE: The effects of hapten inhibition with dextran 1 (molecular weight: 1,000 D, Promit), which is in use since 1982 for the prevention of severe dextran-induced anaphylactic reactions (DIAR) caused by immune complexes, were studied. DESIGN: Spontaneous reports to the manufacturer and to the WHO database INTDIS regarding adverse reactions to clinical dextran after preinjection of dextran 1 and to dextran 1 alone were collected from 1983 to 1992. During this period a total of 5.1 million doses of dextran 1 were sold in 15 countries. INTERVENTIONS: Analysis of pre- and post-reaction titers of dextran-reactive antibodies (DRA) was made in most Scandinavian reports. RESULTS: The incidence of severe DIAR (grades III-V) to clinical dextran after the prophylactic use of hapten inhibition was approximately 1/200,000 patients receiving dextran 1. In Sweden, where reporting of severe adverse drug reactions is mandatory, the incidence was approximately 1/70,000, indicating a 35-fold reduction. Only 2 fatal reactions were reported, an incidence of 1/2.5 million doses, indicating a 90-fold reduction. Both these occurred in patients with extremely high titers of DRA. Side effects to dextran 1, mostly mild, were reported in approximately 1 case per 100,000 doses. These side effects were not antibody mediated. CONCLUSIONS: The above findings, together with other recent safety profile data, suggest that dextran with hapten inhibition has possibly become the safest plasma substitute in current clinical practice.

Adverse Drug Reaction Reporting Systems↗