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Biomedical subjects

P E Nilsson

Publications and source records attributed to P E Nilsson.

At least 19 recordsLinked to original sources
PubMed2001

Transrectal catheter drainage of deep abdominal and pelvic abscesses using combined ultrasonography and fluoroscopy.

OBJECTIVE: To describe our experience with transrectal drainage of deep abdominal or pelvic abscesses guided by ultrasonography and fluoroscopy. DESIGN: Open study. SETTING: Teaching hospital, Sweden. SUBJECTS: Eight seriously ill patients with deep abdominal or pelvic abscesses. INTERVENTION: Ultrasonographic and fluoroscopic transrectal drainage. MAIN OUTCOME MEASURES: Clinical follow-up. RESULTS: Eight patients (2 septic, 2 with high fever, and 2 with moderate fever) were effectively and safely drained without general anaesthesia. Their condition improved considerably within hours after drainage. Three patients had recurrent abscesses as a result of the underlying disease. The drainage overcame the sepsis in two patients and allowed a later elective operation. CONCLUSIONS: Transrectal ultrasonographic and fluoroscopic drainage is an effective and safe method for treatment of deep abdominal or pelvic abscesses in seriously ill patients.

Abdominal Abscess↗
PubMed2001

On difficulties in diagnosing deep vein thrombosis in daily clinical work and research practice.

This article enlightens the diagnostic difficulties when performing and interpreting a phlebography or color Doppler ultrasonography (CDU), which may have serious consequences in the daily clinical and laboratory work. In laboratory research as well as in clinical trials the most fundamental principle is to obtain a correct diagnosis. Less than 50% of patients with deep venous thrombosis (DVT) manifest the classical symptoms and signs of DVT and consequently the diagnosis is based upon methods such as phlebography or CDU. Some veins are especially hard to display, i.e. the veins of the planta pedis, the deep muscle veins of the calf and thigh and the deep internal iliac vein. Thus, the ideal diagnostic method must display the whole venous system from the planta pedis to the caval vein. A false negative examination puts the patient at risk of pulmonary embolism, which may present with a sudden onset and fatal outcome. A venous dysfunction as well as recurrent DVT will also be a continuous risk factor. A false positive interpretation may result in unnecessary anticoagulation treatment and bleeding complications. The combination of phlebography and CDU together with the strict use of a scoring method will increase the possibility of a proper diagnosis focusing on the diagnostically difficult areas of the venous system.

Clinical Laboratory Techniques↗
PubMed2001

Complexes between activated protein C and protein C inhibitor measured with a new method: comparison of performance with other markers of hypercoagulability in the diagnosis of deep vein thrombosis.

A first clinical evaluation has been made of the performance of a newly devised immunofluorometric assay for measuring plasma concentrations of activated protein C (APC) in complex with protein C inhibitor (PCI). The method was compared with testing for other markers of hypercoagulability in a case-control study comprising 123 patients with clinical suspicion of deep vein thrombosis (DVT). The diagnosis was confirmed by ascending phlebography, and the thrombotic burden estimated with a newly developed scoring system. Receiver operating characteristics (ROC) curves calculated to demonstrate the discriminatory capacity of the methods, showed the area under the curves (AUCs) to be similar for the APC-PCI and D-dimer methods. However, in contrast to the D-dimer method, the APC-PCI method measures a well-defined analyte, a prerequisite for reliable comparisons of future clinical studies. The APC-PCI method appears to be particularly useful as a marker for detection of recently developed proximal thrombi.

Activated Protein C Resistance↗
PubMed2000

Symptomatic and asymptomatic deep vein thrombosis after total hip replacement. Differences in phlebographic pattern, described by a scoring of the thrombotic burden.

The aim was to describe the phlebographic pattern of asymptomatic and symptomatic deep vein thrombosis (DVT) after total hip replacement by the use of a scoring system in 102 consecutive patients (54 asymptomatic, 48 symptomatic). The DVTs were scored from 1 to 3, and registered in a scoring system dividing the deep veins into 12 separate segments. The asymptomatic patients had a significantly lower total mean DVT score of 3.7 compared to 9.1 in the symptomatic group of patients. The mean ratio of the DVT scores in the deep muscle veins in conjunction with the superficial femoral vein in relation to the total mean score was significantly higher in the asymptomatic patients (74.9%) compared to the symptomatic group (62.4%). A direct sign of DVT, displayed as a filling defect, was seen on the phlebogram in 116 of the 119 legs, and concomitant nonfilling in other vein segments was noted in 6% of the asymptomatic patients, while in the symptomatic group this was the case to a significantly higher level, namely, 46%. A subgroup of asymptomatic patients operated unilaterally, with bilateral DVT had a significantly higher total mean DVT score on the operated side (4. 6) compared to the unoperated side (3.4). The total mean DVT score increased with time after surgery in the group of symptomatic patients. A low total mean DVT score with a predominance of DVT in, or in the connection to, the deep muscle veins is displayed among the asymptomatic patients. This is significantly different from the symptomatic patients who have more extensive DVTs, especially when diagnosed several weeks postoperatively, and frequently with edema and occlusive DVT.

Adult↗
PubMed2000

Scoring of extensive deep leg vein thrombosis displayed as wide-spread non-filling of contrast on phlebography. A comparison with colour doppler ultrasonography.

PURPOSE: To evaluate whether wide-spread non-filling of contrast in vein segments, displayed on phlebography, is interpreted as deep venous thrombosis (DVT) on colour Doppler ultrasonography (CDU) and if the same score value is obtained. MATERIAL AND METHODS: Twenty consecutive patients were analysed by both phlebography and CDU with a scoring system. RESULTS: One hundred and fifty-one venous segments were initially analysed, but 19 (12.6%) were excluded because their entire extent could not be interpreted by CDU. The total score was 366 (mean 18.3) according to the phlebograms and 298 (mean 14.9) when interpreted by CDU, p=0.0001. The difference was due mainly to the scoring of the anterior tibial vein found to be open on CDU in most cases, and then the thrombotic burden percentage was 84% and 75%, respectively. In 19 of the 20 patients (95%) a DVT was confirmed by CDU. The great saphenous vein, the femoropopliteal vein, and the deep femoral vein, formed the main collateral circulation. CONCLUSION: Wide-spread non-filling of vein segments is due to an extensive DVT in the vast majority of cases. Scoring is possible by both phlebography and CDU and the difference in the results of the scoring is generally of minor importance.

Adult↗
PubMed2000

Isolated nonfilling of contrast in deep leg vein segments seen on phlebography, and a comparison with color Doppler ultrasound, to assess the incidence of deep leg vein thrombosis.

Nonfilling of contrast in deep veins on phlebography is claimed to be an indirect sign of deep vein thrombosis (DVT) by some authors but rejected by others. The aim of this study was to prospectively assess, with color Doppler ultrasound (CDU), the occurrence and distribution of DVT in isolated, nonfilling, deep vein segments seen on a phlebogram. One hundred consecutive patients with clinical signs of acute DVT, in whom phlebography displayed nonfilling of the posterior tibial veins and/or the deep calf muscle veins, were examined with CDU on the same occasion. Ultrasound confirmed a DVT in 31 (31%) patients; in another 38 (38%) patients other pathology, without concomitantly detected DVT, such as edema, bleedings, ligament and muscle ruptures, Baker cysts, or superficial thrombophlebitis were found instead; and in the remaining 31 (31%) patients no pathology that could explain the nonfilling was identified. Isolated, nonfilling of the posterior tibial and/or deep muscle veins of the calf found by phlebography may be an indirect sign of DVT but is equally commonly caused by other pathological conditions or arises without any detectable explanation. When the thrombotic burden is to be scored, and to facilitate the establishment of the correct diagnosis, additional CDU is recommended when isolated nonfilling is present.

Adult↗
PubMed2000

Location and extent of deep vein thrombosis in patients with and without FV:R 506Q mutation.

Resistance to activated protein C due to FV:R 506Q mutation is the most common known genetic risk factor for deep leg vein thrombosis (DVT). The aim of this prospective study was to describe and compare the location and extent of DVT, reflected by a scoring system, in a group of patients with and without FV:R 506Q mutation. Of 247 consecutively included patients undergoing phlebography 105 had a DVT, 36 (35%) in the FV:R 506Q mutation group and 69 (65%) in the non-FV:R 506Q mutation group. Compared to the non-FV:R 506Q mutation group there was a significant increase in the incidence of DVT in the FV:R 506Q mutation group (p = 0.041, OR = 1.79 [1.02-3.15]), a significantly lower mean DVT score of the iliofemoral vein segments (p = 0.0081) and a significantly lower incidence of DVT in the iliofemoral vein segments (p = 0.007, OR = 10.6 [1.3-83.3]), 1/36 (2.8%) compared to 16/69 (23.2%). As controls 288 blood donors were included, with and without FV:R 506Q mutation and with no history of DVT in order to evaluate risk factors of DVT. The odds ratio of an iliofemoral DVT was 0.5 ([0.06-3.90), p = 0.50]) when FV:R 506Q mutation was present, compared to the control group, and at locations below the iliofemoral segments 5.28 ([3.01-9.28], p = less than 0.0001). Our findings provide the basis of a detailed phlebographic description and for the first time, to our best knowledge, shows a specific phlebographic pattern that may be linked to an inherited hypercoagulable state.

Activated Protein C Resistance↗
PubMed1999

A new scoring system for the detailed description of the distribution and thrombotic burden in deep leg vein thrombosis.

The scoring system most commonly used to date to describe the thrombotic burden of deep vein thrombosis (DVT) excludes several deep vein segments and is thereby of limited use in research. The aim of this prospective, comparative study was to develop a new scoring and distribution system that would include all major deep veins of the leg and pelvis. In total, 247 consecutive patients were included, of whom 105 had a positive phlebography. The positive phlebographies were registered in the new system and the result was compared with that obtained by the Marder system. In 72% (76/105) of the patients the DVT distribution was not completely described and the thrombotic burden was significantly underestimated by the Marder system. Of these, 12% (13/105) were not scored at all, thus representing false-negative investigations. It was possible to score all DVTs and important vein segments of these patients with the new system. The scoring system previously used excludes several deep vein segments. A description of the important vein segments, where DVT is shown to originate and propagate, is mandatory in a scoring system designed for the purpose of research of DVT and later detected deep vein insufficiency. The new system meets this demand.

Adult↗
PubMed1997

Typical sonographic appearance of duodenal diverticulum.

During routine transabdominal ultrasonography of the hepatobiliary tract an occasional persistent bright linear or concave echo was detected that disrupted the normal images we routinely obtained of the pancreatic head. We began to suspect this echo to be the sonographic representation of a duodenal diverticulum. To confirm our suspicions we performed a prospective study. Over a 20 month period, 30 consecutive patients with a sonographically suspected duodenal diverticulum were followed up with either an upper gastrointestinal series, gastroscopy, or, depending on the patient's clinical symptoms, endoscopic retrograde cholangiopancreaticography. One patient was examined with simultaneous fluoroscopy and ultrasonography. The results of these examinations were then compared to the respective ultrasonograms by a qualified radiologist and sonographer. The suspected duodenal diverticulum, detected primarily with ultrasonography, was confirmed with follow-up examinations in all 30 patients. The persistent echo detected sonographically had the same anatomic position as the diverticulum seen during fluoroscopy. We concluded that duodenal diverticulum located near the pancreatic head has a rather typical sonographic appearance.

Diverticulum↗
PubMed1997

The post-discharge prophylactic management of the orthopedic patient with low-molecular-weight heparin: enoxaparin.

This prospective, double-blind trial was performed to determine whether 4 weeks' prophylaxis with enoxaparin after total hip replacement (THR) is more effective in protecting against deep vein thrombosis (DVT) than prophylaxis during hospitalization. Two hundred sixty-two patients undergoing THR were given enoxaparin 40 mg once daily during hospitalization (9 +/- 2 days) before being randomized at discharge to continue enoxaparin (N = 131) or receive placebo (N = 131) for a total of 1 month (30 +/- 4 days). According to intention-to-treat analysis, 43 DVT and 2 pulmonary emboli (PE) occurred in the placebo group (34.4%) versus 21 DVT and no PE in the enoxaparin group (P < 0.001). The reduction in proximal DVT was also significant (21.4 vs 6.1%; P < 0.001). No major bleeding complications developed. Prophylaxis with enoxaparin for one month significantly reduces venous thromboembolic disease in patients undergoing THR compared to conventional prophylaxis during hospitalization.

Adult↗
PubMed1987

Effect of four non-ionic contrast media on red blood cells in vitro. I. Morphology.

The influence of four non-ionic contrast media on red blood cell morphology was analyzed. The newly synthesized monomeric iopentol and the dimeric iodixanol were compared with the monomeric iopamidol and iohexol in both hypertonic and isotonic solutions at constant hematocrit of 10%. All contrast media solutions induced morphologic changes of the red blood cells and with differences between the different solutions. In isotonic solutions and with increasing concentration of contrast medium, echinocytes were produced in increasing frequency. In isotonic solution and with a high concentration of contrast medium, iopamidol, iopentol and iohexol produced 50% echinocytes and 50% stomatocytes while iodixanol produced 90-100% stomatocytes. In original solution the hypertonic iopamidol, iopentol and iohexol solutions induced desiccocyte deformation, while the nearly isotonic iodixanol still produced stomatocytes. In all the 90% volume ratio solutions (contrast medium/blood) rouleaux formation was inhibited regardless of type of red blood cell.

Contrast Media↗
PubMed1987

Effect of four non-ionic contrast media on red blood cells in vitro. II. Aggregation.

The newly synthesized non-ionic monomeric iopentol and dimeric iodixanol were compared with the non-ionic monomers iopamidol and iohexol in both original hypertonic and isotonic solutions at a constant hematocrit of 35%. All contrast media at all volume ratios (contrast medium/blood) decreased red blood cell aggregation with no difference between the various contrast media. The degree of disaggregation of red blood cells increased with increasing concentration of contrast medium in solution. At the lowest volume ratio (2%) red blood cell aggregation was near that of normal blood. At the volume ratio 50% the disaggregatory effects following both isotonic and hypertonic solutions were pronounced. At a high molar concentration both the isotonic iodixanol and the hypertonic solutions of iohexol, iopentol and iopamidol induced an almost total inhibition of red blood cell aggregation. This indicates that the concentration of contrast medium (chemotoxic effect) for non-ionic contrast media is more important for the disaggregatory effect than the osmolality.

Contrast Media↗
PubMed1987

Effect of four non-ionic contrast media on red blood cells in vitro. III. Deformability.

The influence of four non-ionic contrast media and one ionic contrast medium was analyzed on red blood cell deformability in vitro. The newly synthesized non-ionic monomeric iopentol and dimeric iodixanol were compared with the currently used non-ionic monomers iopamidol and iohexol and the ionic monomeric diatrizoate at a constant hematocrit of 8%. The effect on red blood cell deformability was analyzed in 50% volume ratio solutions of both original hypertonic and isotonic contrast media solutions. The samples were studied in a red blood cell filtrometer through new Mynipore microsieves using an improved procedure of data processing. Diatrizoate induced significantly more red blood cell rigidification compared with all non-ionic contrast media solutions and normal blood. There was no difference between the investigated non-ionic contrast media, nor between the non-ionic contrast media and normal blood without additive.

Contrast Media↗
PubMed1986

Ultrasound guided percutaneous drainage of pericardial fluid with an indwelling catheter.

The technique of ultrasonographic guided percutaneous drainage of pericardial fluid, applied in three patients, is reported. The primary disease was synovial sarcoma, rheumatoid arthritis and prostatic carcinoma, respectively. Although three slightly different techniques and catheters were used all patients were sufficiently drained and the clinical symptoms promptly relieved. The catheters were left for drainage 3 months, 5 days and 14 days respectively. There were no major complications. One patient complained of transient palpitations. Percutaneous ultrasound-guided catheter drainage seems to be a safe method in patients with pericardial fluid where an indwelling catheter is considered.

Adult↗
PubMed1986

Herniography: comparison of morbidity and image quality after use of high and low osmolality contrast media.

The morbidity and image quality after administration of three different contrast media were compared in 229 patients referred for herniography. Sixty patients received metrizoate 150 mg I/ml, 92 received metrizoate 200 mg I/ml, and 77 patients, ioxaglate 200 mg I/ml. Patient discomfort was single-blindedly assessed based on an arbitrary verbal rating scale. The number of patients with pain increased with the osmolality of the contrast media. Metrizoate 200 induced pain in 57% of the patients, metrizoate caused pain in 39%, and ioxaglate 200 in 18%. Hernia patients who received metrizoate 200 had pain significantly more often (72%) than patients without hernia (45%). Seven patients, predominantly young men, had a vasovagal reaction associated with the administration of contrast media. The image quality was sufficient after all injections of 200 mg I/ml. The results indicate that low osmolality contrast media with an iodine concentration of about 200 mg I/ml are well suited for herniography.

Adult↗
PubMed1984

Effect of ioxaglate on the liver and pancreas following selective visceral angiography in man.

Selective visceral angiography was performed with the ionic, monoacidic, dimeric contrast medium ioxaglate (280 and 320 mg I/ml). Twenty patients with and without disease of the liver and/or pancreas were prospectively and consecutively studied. Changes in the serum activities of ALAT, ASAT, GT, AP, and pancreatic isoamylase and changes in the level of serum bilirubin, prothrombin index and haematocrit were evaluated sequentially before and after angiography. The total volume of contrast medium ranged from 100 to 340 ml per patient and the median dosage was 3.5 ml per kg body weight. There was no statistically significant elevation within the entire group of patients in the measured parameters after angiography when compared with pre-angiographic values. No clinically important toxic effect on the liver or pancreas induced by the contrast medium was found.

Abdomen↗
PubMed1984

Tolerance and biochemical effects from intravenous injection of ioxaglate in healthy volunteers.

The influence of intravenous injection of ioxaglate (Hexabrix, 320 mg I/ml) on various biochemical, coagulation and fibrinolytic parameters, fractionated plasma proteins, precordial ECG and blood pressure was prospectively and sequentially studied in 9 healthy volunteers. One ml/kg body weight of the contrast medium was injected within one minute into an antecubital vein. Small, but statistically significant, changes in some of the biochemical parameters were found during the observation period, 2 to 4 days. All values of the biochemical parameters were, however, within the normal reference range for each parameter. No significant alterations were seen in the coagulation parameters. Increased fibrinolysis was recorded in some subjects both before and after the injection. No fibrinolytic degradation products were found indicating that the fibrinolysis was nominal. No significant changes were observed in the fractionated plasma proteins. The heart rate decreased significantly 15 seconds after commencing the injection. No significant changes in blood pressure were recorded. Two participants became nauseated and one of them vomited during the injection. Apart from this, no adverse effects were noted. No clinically significant changes following the injections were found.

Adult↗