Biomedical subjects

L Jivegård

Publications and source records attributed to L Jivegård.

57 records · Page 4Linked to original sources

PubMed1984

Treatment of acute massive gastroduodenal haemorrhage with cimetidine in elderly patients.

Ninety-two patients over the age of 60 with acute upper GI-haemorrhage were included in a prospective randomized doubleblind three-centre study of the effect of a five day treatment with cimetidine. Twenty patients had to be excluded because of different reasons. The remaining 72 patients bled from either erosive gastritis, gastric ulcer or duodenal ulcer. Thirty-two patients received cimetidine and 39 placebo. There was no difference in the number of transfusions, rebleedings or operative interventions. Mortality was 1/33 (3%) in the cimetidine group compared to 5/39 (13%) in the placebo group (NS). In the gastric ulcer group there was no mortality among 10 cimetidine patients compared to a mortality of 4 of 12 (33%) patients receiving placebo (p less than 0.05). It is concluded with caution that cimetidine might be effective in haemorrhage from gastric ulcer in patients 60 years and older. For convincing conclusions a larger study of patients with bleeding ulcers is desirable.

Acute Disease↗

PubMedDate not supplied

Acute limb ischemia due to arterial embolism or thrombosis: influence of limb ischemia versus pre-existing cardiac disease on postoperative mortality rate.

Fatal outcome is common after arterial thromboembolectomy. Initial conservative treatment has been suggested to reduce the mortality rate, but the indications for such treatment are poorly defined. This analysis of 201 patients with acute arterial embolism or thrombosis demonstrates that advanced age, recent myocardial infarction, and proximal occlusions are associated with a high mortality rate after arterial thromboembolectomy. Operations performed 13-24 hours after the onset of ischemia, arteriosclerosis in the occluded artery and poor distal backbleeding after completion of thromboembolectomy were also associated with an increased mortality rate, whereas surprisingly the presence of pre-existing cardiac disease, recent myocardial infarction excluded, was not. The present findings suggest that the prognosis quoad vitam after arterial thromboembolectomy is influenced by limb ischemia itself and possibly also by the revascularization procedure. It is suggested that the severity of limb ischemia and an assessment of cardiac function should determine the initial treatment: conservative treatment, or early attempts at revascularization.

Acute Disease↗

PubMedDate not supplied

Arterial thromboembolectomy--should anticoagulants be administered?

Perioperative administration of heparin with subsequent coumarin therapy is often recommended in surgery for acute limb ischemia. This retrospective study compares the results of arterial thromboembolectomy with and without concomitant use of anticoagulants. Good results were more common in adequately anticoagulated patients, but the hospital death rate did not differ. Further analysis, however, showed that the better results in the anticoagulated patient group could have been influenced by selection factors. The cumulative recurrence rate of thromboembolism was not significantly reduced in patients on long-term anticoagulation treatment. A review of 15 recently published series of acute limb ischemia showed similar results from centers in which anticoagulants were administered after arterial thromboembolectomy and in centers where postoperative anticoagulant therapy was not used. Definite evidence of a beneficial effect of anticoagulants given before and after arterial thromboembolectomy thus is concluded to be lacking, and a prospective randomized trial is required.

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