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Biomedical subjects

O Kjellgren

Publications and source records attributed to O Kjellgren.

At least 19 recordsLinked to original sources
PubMed1997

Infrapopliteal transcatheter interventions for limb salvage in diabetic patients: importance of aggressive interventional approach and role of transcutaneous oximetry.

OBJECTIVES: This study sought to determine whether infrapopliteal transcatheter interventions can salvage ischemic limbs in diabetic patients referred for below the knee amputation at our institution. BACKGROUND: The value of transcatheter interventions in diabetic crural arteries is controversial. Tissue oxygen partial pressure (TCO2) levels < 40 mm Hg predict poor wound healing. METHODS: Percutaneous interventions were performed in 29 consecutive diabetic patients in need of limb salvage. Technical success was defined as < 20% residual vessel stenosis. Clinical success was defined as the avoidance of amputation and achievement of wound healing. At hospital discharge, patients were treated with Coumadin and aspirin. Ankle-brachial index (ABI) and TCO2 measurements were obtained before and after the intervention. RESULTS: After 12-month follow-up, six patients had presistent wounds, whereas 23 experienced wound healing. Forty of the 50 infrapopliteal arteries successfully dilated were occluded, with a mean (+/-SD) lesion length of 18.0 +/- 3.5 cm. After the procedure, TCO2 improved from 27.82 +/- 9.97 mm Hg (95% confidence interval [CI] 23.95 to 31.69) to 54.5 +/- 14.73 mm Hg (95% CI 48.79 to 60.21, p < 0.0001), whereas the ABI did not (p > 0.2). TCO2 predicted procedural and clinical success (p < 0.0182). CONCLUSIONS: Infrapopliteal transcatheter interventions in diabetic patients may salvage the majority of limbs doomed to amputation. Although TCO2 measurements are valuable in predicting wound healing and success after interventions, ABI measurements are not.

Angiography↗
PubMed1996

Rotational atherectomy with a new device: initial clinical experience.

The Bard Atherectomy Catheter is a new rotational atherectomy device that consists of a flexible, hollow, thin-walled cutting catheter that, while rotated at 1,500 revolutions per minute, is advanced across the lesion over a special spiral guidewire system. We report the initial clinical experience with this device in 20 peripheral lesions in ten patients. The majority of patients were treated for limb salvage. All lesions were successfully intervened on by atherectomy followed by adjunctive balloon angioplasty. A reduction to less than 50% stenosis was achieved in 13 of the 20 lesions (65%) after atherectomy but in all 20 lesions (100%) after adjunctive angioplasty for all lesions and stenting for dissections in two. Baseline minimal lesion lumen diameter was 0.8 +/- 0.7 mm with a reference vessel diameter of 4.2 +/- 1.7 mm (75 +/- 21% stenosis). The lumen improved to 2.0 +/- 0.8 mm (45 +/- 19% stenosis) (P < 0.001) following atherectomy and to 3.9 +/- 1.9 mm (13 +/- 16% stenosis) (P < 0.001) after adjunctive angioplasty. The average weight of removed atheroma was 45 +/- 58 mg. All ten patients had initial improvement in symptoms. At 6 months follow-up there was persistent improvement in eight patients and two subjects had undergone amputations. Our early clinical experience with this low profile, flexible atherectomy device, that enables extraction of a large amount of atheroma, suggests that it will become a valuable addition to current atherectomy technologies in small- and medium-sized vessels. The value of this device in coronary vessels is under investigation.

Angioplasty, Balloon↗
PubMed1996

Comparison of angioscopy, intravascular ultrasound imaging and quantitative coronary angiography in predicting clinical outcome after coronary intervention in high risk patients.

OBJECTIVES: The purpose of this study was to identify qualitative or quantitative variables present on angioscopy, intravascular ultrasound imaging or quantitative coronary arteriography that were associated with adverse clinical outcome after coronary intervention in high risk patients. BACKGROUND: Patients with acute coronary syndromes and complex lesion morphology on angiography are at increased risk for acute complications after coronary angioplasty. Newer devices that primarily remove atheroma have not improved outcome over that of balloon angioplasty. Intravascular imaging can accurately identify intraluminal and intramural histopathologic features not adequately visualized during coronary arteriography and may provide mechanistic insight into the pathogenesis of abrupt closure and restenosis. METHODS: Sixty high risk patients with unstable coronary syndromes and complex lesions on angiography underwent angioscopy (n = 40) and intravascular ultrasound imaging (n = 46) during interventional procedures. In 26 patients, both angioscopy and intravascular ultrasound were performed in the same lesion. All patients underwent off-line quantitative coronary arteriography. Coronary interventions included balloon (n = 21) and excimer laser (n = 4) angioplasty, directional (n = 19) and rotational (n = 6) atherectomy and stent implantation (n = 11). Patients were followed up for 1 year for objective evidence for recurrent ischemia. RESULTS: Patients whose clinical presentation included rest angina or acute myocardial infarction or who received thrombolytic therapy within 24 h of procedure were significantly more likely to experience recurrent ischemia after intervention. Plaque rupture or thrombus on preprocedure angioscopy or angioscopic thrombus after intervention were also significantly associated with adverse outcome. Qualitative or quantitative variables on angiography, intravascular ultrasound or off-line quantitative arteriography were not associated with recurrent ischemia on univariate analysis. Multivariate predictors of recurrent ischemia were plaque rupture on preprocedure angioscopy (p < 0.05, odds ratio [OR] 10.15) and angioscopic thrombus after intervention (p < 0.05, OR 7.26). CONCLUSIONS: Angioscopic plaque rupture and thrombus were independently associated with adverse outcome in patients with complex lesions after interventional procedures. These features were not identified by either angiography or intravascular ultrasound.

Angioplasty, Balloon, Coronary↗
PubMed1995

Diffuse vasospasm following stenting of a free gastroepiploic artery graft: resolution with balloon angioplasty and intensive medical therapy.

Vasospasm following balloon angioplasty of gastroepiploic artery bypass grafts can be prevented or reversed with vasodilators. In our patient, stent deployment for ostial stenosis of a free gastroepiploic artery graft was accompanied by severe, diffuse spasm and a change in graft configuration that required both intensive medical therapy and balloon angioplasty for resolution.

Angioplasty, Balloon, Coronary↗
PubMed1995

Successful treatment of chronic total peripheral occlusions that failed conventional techniques using the stiff backend of the Glidewire.

The vast majority of failures of transcatheter interventions in patients with peripheral vascular disease are due to inability to cross the lesion with a guidewire. Although the use of the Glidewire has clearly improved the success rate, failures with especially chronic total occlusions still occur. We describe a new technique using the very stiff backend of the Glidewire, which we have found very successful, when conventional techniques fall in crossing highly resistant lesions.

Aged↗
PubMed1995

Coronary artery flow monitoring following coronary interventions.

Coronary guidewires with ultrasound transducer tips are commercially available and are appropriately sized for use in coronary interventions. These guidewires permit monitoring of coronary flow before, during and after the interventions. The measured flow signal contains valuable information regarding the quality and the stability of the final result. After completion of the procedure, monitoring the trend in average velocity over several minutes can reveal subtle alterations in flow that may presage abrupt closure. Abnormal or unstable flow patterns also may help predict lesions that might develop recurrences in the weeks and months after successful procedures.

Angioplasty, Balloon, Coronary↗
PubMed1995

Aggressive interventional treatment of acute myocardial infarction. Lessons from the animal laboratory applied to the catheterization suite.

Myocardial necrosis progresses with the duration of coronary occlusion in the early stages of acute myocardial infarction. Prompt recanalization of the infarct-related artery resulting in effective and sustained reperfusion of jeopardized myocardium is the goal of modern therapy. Clinical thrombolysis trials have demonstrated a significant survival advantage for treated patients, but only a modest recovery of global or regional systolic left ventricular function. Accelerated regimens of administering currently available thrombolytic agents are associated with early coronary patency rates approaching 85%, although effective coronary perfusion is restored in only slightly better than one half of patients treated. Primary angioplasty without antecedent thrombolytic therapy has resulted in high patency rates with superior coronary flow when performed in some experienced centers. Treatment of cardiogenic shock requires immediate mechanical or surgical intervention to reestablish coronary perfusion often following placement of a circulatory assistance device. Future trends toward very early initiation of thrombolytic therapy, improvements in adjunctive therapy and advances in the noninvasive detection of recanalization should permit selective use of aggressive interventional therapy for failed thrombolysis in a minority of patients with acute myocardial infarction.

Angioplasty, Balloon, Coronary↗
PubMed1995

The development of gynecological radiotherapy/oncology in Sweden.

The development of gynecological radiotherapy and oncology during this century has changed the methods of a diagnosis and treatment of cancer and given better results. From the beginning the gynecologist could only palpate and inspect. Later on roentgen examination was introduced and later still microscopic diagnosis, more advanced diagnostic methods, e.g. endoscopy, ultrasound, isotope examination, advanced microscopic diagnosis and computerized tomography. In parallel with the development in diagnosis, treatment has developed. To start with surgery was the only method available. Later on intracavitary radiation, low energy radiation, endocrine therapy, chemotherapy and high energy treatment became available along with some experimental therapies. Today we have a broad range of therapeutic tools to use. In the future we might use profylaxis more than we do today to prevent cancer and when cancer is already there we might enhance the immune defence or introduce specific immunotherapy with clonal antibodies, specially made for the actual tumour, and consequently surgery, radiotherapy and chemotherapy will be often less used. It is, of course, impossible in a short paper to review fully the development of gynecological radiotherapy/oncology in Sweden. The following is a short review based on my personal selection of some important and interesting developments in the field of gynecological radiotherapy/oncology, especially treatment of cancer of the cervix uteri (1).

Female↗
PubMed1994

Prolonged intracoronary infusion of streptokinase: an alternative pharmacologic approach to extensive thrombus in native coronary artery.

Several reports suggest that pretreatment of intracoronary thrombus with fibrinolytic agents may reduce the risk for complications during subsequent balloon angioplasty. We report a case, for the first time, of successful lysis of an extensive thrombus in a native coronary artery by administering a prolonged intracoronary infusion of streptokinase to facilitate subsequent angioplasty and discuss the management strategy when intracoronary thrombus is encountered.

Aged↗
PubMed1994

The role of parasympathetic modulation of the reentrant arrhythmic substrate in the genesis of sustained ventricular tachycardia.

The influence of parasympathetic activity on the reentrant arrhythmic substrate in the genesis of sustained ventricular tachycardia remains unclear. To assess this influence, we studied the heart rate variability in 59 patients referred for invasive electrophysiological testing. In addition, the presence of late potentials and high grade ventricular ectopy, and the left ventricular ejection fraction was determined. The 28 patients with inducible sustained ventricular tachycardia were found to have lower heart rate variability by time- and frequency-domain measurements over 24 hours when compared to the 31 subjects who were noninducible. PNN50 was 4% in the inducible patients, whereas it was 9% in the subjects who were noninducible (P = 0.03). Similarly, HFP24H was 9 and 14 msec, respectively (P = 0.02). MAXHFP1H also differed (20 vs 27 msec [P = 0.04]) but not MINHFP1H (5 vs 6 msec). There was no association between heart rate variability and late potentials, degree of ventricular ectopy, or left ventricular ejection fraction. Thus, vagal tone does not appear to correlate with the presence of late potentials, ventricular ectopy, or left ventricular dysfunction. Low mean as well as maximal vagal tone, in contrast to minimal vagal tone, predicts inducibility of sustained ventricular tachycardia. Our data suggest that the inability to modulate parasympathetic tone appears to be an important determinant in the genesis of reentrant sustained ventricular tachycardia.

Action Potentials↗
PubMed1993

Current usefulness of the signal-averaged electrocardiogram.

Signal-averaged electrocardiography is a relatively simple, noninvasive technique by which valuable information can be gained to help in the management of patients with cardiovascular disease. The presence of late potentials on the SAECG is a good marker for the presence of an arrhythmogenic substrate that is believed to be the source of ventricular tachycardia in patients with coronary artery disease. The value of the detection of late potentials has been studied best after myocardial infarction, when the absence of late potentials makes the occurrence of an arrhythmic event very unlikely. The positive predictive value for an arrhythmic event to occur in the presence of late potentials is low, however, comparable to the predictive value of decreased left ventricular function, complex ventricular ectopy, or abnormal autonomic tone. This appears to have its explanation in the complex pathophysiology behind the occurrence of arrhythmic events. Improved accuracy for the SAECG is achieved when the result of the test is interpreted with consideration of the presence or absence of other predictive markers. A thorough understanding of the signal-averaged electrocardiogram makes optimal clinical use of the information gained from this easily acquired test possible.

Arrhythmias, Cardiac↗
PubMed1993

Identification of patients with high risk of arrhythmic mortality. Role of ambulatory monitoring, signal-averaged ECG, and heart rate variability.

This article discusses the roles of 24-hour ambulatory Holter monitoring, left ventricular function, the signal-averaged electrocardiogram (ECG), and heart rate variability for identification of high risk patients following myocardial infarction. Because these noninvasive tests have low positive predictive value, a combination of noninvasive tests is recommended for risk stratification.

Algorithms↗
PubMed1990

Relationship between CA 125 and progesterone production in women with ovarian carcinoma.

CA 125 and steroid production is compared in a group of 48 women with ovarian epithelial carcinoma. The histologic types were I C (n = 20), II C (n = 5), III C (n = 11), or V (n = 12). The number of patients in Stage I was six; Stage II, 11; Stage III, 16; and Stage IV, 15. All patients were naturally or surgically postmenopausal. Blood samples were taken at the first admission to the hospital and 14 cases with large tumors were followed with monthly sampling during chemotherapy, and in 13 cases until a recurrence of the tumor. CA 125 and steroid production were analyzed using radioimmunoassay. The results show a high correlation between initial CA 125 and especially progesterone plasma concentration. Both decreases during chemotherapy parallel the shrinkage of the tumor and increase 1 to 4 months before recurrence. Progesterone and CA 125 together predicted all recurrences but none of the factors alone. The prognostic value for 5-year survival was somewhat higher for progesterone than CA 125. CA 125 correlated highly with sex hormone binding globulin (SHBG) and negatively with albumin. The correlation may be due to the intercorrelation with tumor burden.

Adult↗
PubMed1990

Human chorionic gonadotropin, follicle-stimulating hormone, and luteinizing hormone in patients with epithelial ovarian carcinoma.

Plasma levels of human chorionic gonadotropin (hCG), follicle-stimulating hormone (FSH), and luteinizing hormone (LH) were studied in patients with epithelial ovarian carcinoma prior to and during chemotherapy. Blood samples were drawn for radioimmunoassay at monthly intervals. Plasma concentrations were compared to those of three different control groups: healthy post-menopausal women (PM), fertile women in the follicular phase of the menstrual cycle (FPh), and postmenopausal women with nongynecologic disseminated malignant disease (DMD). The hCG level was elevated in women with great tumor burden, such as large tumor volume, FIGO stage IV, and histologic type V. LH and FSH levels showed the reverse pattern. hCG concentration decreased during chemotherapy, whereas LH increased. Initial plasma concentrations were not found to have prognostic importance. We discuss the possibility that hCG is produced by the tumor, which stimulates steroid hormone production by the stroma, which, in turn, exerts negative feedback on FSH production by the pituitary.

Adult↗
PubMed1990

Prognosis of endometrial carcinoma stage I in two Swedish regions. A study with special regard to the effects of intracavitary irradiation with high dose-rate afterloading technique or with low dose-rate radium.

A high dose-rate afterloading technique (60Co) was compared with a low dose-rate packing method (226Ra) in the treatment of endometrial carcinoma stage I. In all, 1,021 patients treated during the period 1977-1986 at two Swedish gynecologic oncology centers were analyzed regarding treatment set-up, histopathologic outcome in the operative specimens, recurrence rates, survival rates and radiation side effects. Complete tumor eradication in the operative specimen was achieved in 80% after radium therapy and in 60% after irradiation by the high dose-rate technique. The overall recurrence rate was 15.7% in the radium packing series and 11.5% after cobalt afterloading treatment. The risk of pelvic recurrences increased by 2.1-2.6 if hysterectomy was replaced by dilatation and curettage. The two radiation techniques seemed to be comparable with regard to the risk of both pelvic recurrences and distant metastases. The 5-year crude survival rates were 85% in the afterloading series and 82% in the radium series. The corrected survival rates were similar (90%) for the two techniques. Age, tumor grade and uterine size were significant prognostic factors with regard to the probability of death due to cancer. Early radiation reactions had quite similar rates in the two series, whereas late radiation reactions were more frequent in the high dose-rate afterloading group in the 10-12 Gy dose fraction range, but not in the 5-8 Gy range. The radium packing method seemed to give a higher frequency of tumor-free operative specimens in this study, but with regard to recurrence rates and survival probabilities the techniques were comparable. Since the different proportion of surgery in the two series and the histopathologic evaluation might have influenced the rate of local tumor eradication in the operative specimens and the risk of pelvic recurrences the results must be assessed with great caution and only a crude comparison of the two treatment techniques could be made.

Adult↗
PubMed1989

Significance of initial plasma steroid concentrations in the prognosis of 'nonendocrine' malignant ovarian tumors.

The prognostic value of progesterone (P), androstenedione (A), Estradiol, Testosterone, 20 alpha-hydroxy-progesterone, sex hormone binding globulin, and albumin (Alb) was investigated in 51 women with ovarian carcinoma. All patients had observation periods greater than 5 years. The plasma concentrations of P, A, and Alb and the P/Alb and A/Alb ratios showed a significant correlation with the observation time of the patients. P, P/Alb, Alb, and A/Alb separately or in combination showed the highest prognostic specificity and sensitivity. The patients with a plasma concentration above an optimal limit or above mean + 2 SD of a control group of 20 postmenopausal women were grouped together. The groups with P/Alb, A, A/Alb, and Alb above the limit showed an equal survival rate as patients in FIGO stage IV. Patients with a high A/Alb ratio and a high testosterone concentration showed an even poorer prognosis than FIGO stage IV patients. Among the patients in stage IV the A/Alb ratio and sex hormone binding globulin gave additional prognostic information on the stage. The steroid concentration is not only related to tumor volume, as shown earlier, but also reflects the prognosis of the disease.

Adult↗
PubMed1989

Results of primary radiation treatment of endometrial carcinoma. 20 years' experience of an unselected material from the north of Sweden.

An unselected material of endometrial carcinoma from the northern part of Sweden, treated during the years 1963-1982 is presented. The material comprises 1,114 patients treated almost uniformly. With few exceptions the patients received primary irradiation, usually with radium packing according to a modified Heyman method. Operable patients underwent total hysterectomy and bilateral salpingo-oophorectomy six weeks after the radiation treatment. Patients with contraindications to surgery had a curettage three months after radiation treatment and if cancer was still present surgery was considered. The 5-year survival rate in stage 1 treated with irradiation and surgery was 91%, and after correction for intercurrent death 93%. The 5-year survival rate in stage I as a whole was 82% and corrected for intercurrent death 90%. The survival rate in the whole material was 76% and after correction for intercurrent death 84%.

Female↗