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R Jelnes

Publications and source records attributed to R Jelnes.

At least 19 recordsLinked to original sources
PubMed1992

[Arteriosclerosis of the lower extremities--patients' contacts with alternative therapists].

During the period July 1987-April 1988, ninety-one patients with arterial insufficiency in the lower limbs were referred to the Department of Thoracic and Vascular Surgery at Aalborg Hospital. The mean delay between contact with the general practitioner and the vascular surgeon was nine months. Twenty-nine of the patients contacted alternative therapists before referral to the vascular surgeon. Twenty-five of these patients had suffered from intermittent claudication for at least two years and the total cost of treatment was 76,013 Danish crowns (900 Danish crowns or approximately pounds 75 per patient).

Adult↗
PubMed1992

[Intermittent claudication].

Intermittent claudication is a symptom triggered from the musculature during walking. The pathogenesis of the pain is unknown. All patients with peripheral vascular disease must abstain from smoking, perform physical exercise and dietary advice is sometime needed. Reconstructive vascular surgery or percutaneous transluminal angioplasty (PTA) are indicated when the occupational pattern and, in some instances, the recreational activities, are threatened. The results of these treatments are good. For various reasons a number of patients, however, cannot be offered these treatments. These patients must be informed of the importance of physical exercise and discontinuation of smoking. Some of these patients can be offered supplementary medical treatment (e.g. pentoxifylline).

Diagnosis, Differential↗
PubMed1992

[EDTA treatment of arteriosclerosis. Bias or manipulation?].

A 62-year-old man suffering intermittent claudication had 20 infusions of EDTA in a double blind, placebo controlled trial. No effect on symptoms or systolic ankle/brachial blood pressure index was found. Following the trial, he received 30 further infusions of EDTA in a private clinic. The systolic ankle/brachial index was unchanged throughout the total period as measured in Hillerød Central Hospital. However, the private clinic found a significant increase in the index following EDTA treatment. The reason for this discrepancy could be poor technique in the clinic or it could be due to bias or manipulation. The discrepancy explains the difference between the positive results claimed by the private EDTA clinics and the results of the double blind placebo controlled Danish trial.

Arteriosclerosis↗
PubMed1992

EDTA treatment of intermittent claudication--a double-blind, placebo-controlled study.

A double-blind, randomized multicentre study was undertaken to evaluate the possible effect of chelation treatment with ethylenediamine-tetraacetic acid (EDTA) in patients with severe intermittent claudication. A total of 153 patients received 20 intravenous infusions of either 3 g Na2EDTA or placebo during a period of 5-9 weeks. Vitamin, mineral and trace element supplements were administered orally. The changes observed in the pain-free and maximal walking distances, measured on a treadmill, were similar in the two groups. During the 3-month (n = 149) and 6-month (n = 123) follow-up period, no long-term therapeutic effect of EDTA could be demonstrated. The ankle-brachial blood pressure index remained unchanged throughout the study period. This study failed to demonstrate any effect of EDTA chelation treatment in intermittent claudication.

Aged↗
PubMed1991

Arteriographic findings in EDTA chelation therapy on peripheral arteriosclerosis.

In a randomized, double-blind, controlled study, 153 patients with claudication were each given either 20 infusions of Na2EDTA or 20 infusions of saline. Walking distances and ankle/brachial indices were measured before, during, and after treatment. In 30 patients, angiograms and transcutaneous oxygen tensions were obtained before, during, and after treatment. The patients' subjective evaluations of the effect of treatment were also recorded. It is concluded that EDTA chelation therapy has no effect in patients with intermittent claudication in the legs caused by arteriosclerosis.

Adult↗
PubMed1990

Development of gangrene during sleep.

A method for continuous measurement of subcutaneous adipose tissue blood flow in the forefoot over 24 h (SBF) is described. The method is based on the radioisotope wash-out principle using 133-Xenon (133Xe). A portable semiconductor detector is placed just above a local depot of 37-74 kBq 133Xe in 0.1 ml isotonic saline, injected into the subcutaneous adipose tissue in the forefoot. The detector is connected to a memory unit allowing for storage of data. Because of the short distance, the recorded elimination rate constant must be corrected for combined convection and diffusion of the radioactive indicator. Characteristic 24-h blood flow patterns were unveiled in patients with normal peripheral circulation and in patients having ischaemic nocturnal rest pain. In normal subjects, SBF doubled from day to night. This is ascribed to the local veno-arteriolar sympathetic axon reflex, which induces vasoconstriction when the transmural pressure of the veins exceeds approximately 25 mmHg. In patients having ischaemic rest pains SBF was reduced by 37% on the average from day to night. This was caused by nocturnal hypotension, which is reflected proportionally in the foot. As the resistance vessels most probably are fully dilatated in feet with rest pain, the blood pressure drop during sleep causes the perfusion pressure and, therefore, blood flow to drop below a certain critical limit. There was a pronounced correlation between the reduction systemic mean arterial blood pressure and SBF. The patients complaining of intermittent claudication, but no rest pains, demonstrated a variety of changes in SBF compatible with the continuous spectrum of peripheral arteriosclerotic disease. The reduced blood flow during sleep in patients having ischaemic rest pains give rise to the concept of the development of gangrene during sleep.

Adipose Tissue↗
PubMed1989

[Anterior gastropexy using the Boerma method in gastroesophageal reflux].

The results obtained in 38 patients with gastro-oesophageal reflux who had been submitted to operation by Boerema's method are presented. Twenty-nine (76%) became entirely symptomfree and eight (21%) experienced reduction of symptoms. Postoperative oesophageal stenosis was demonstrated in five patients.

Adolescent↗
PubMed1989

[Social aspects of reconstructive vascular surgery in patients under 60 years of age].

The effect of initial elective arterial reconstructive surgery was evaluated in relation to employment and social status. Ninety patients with intermittent claudication were followed for a period of 3.5 years. The male to female ratio was 1:12. At the time of operation, all the patients were under the age of 60 years and potentially professionally active. The indication for operation in fifty-nine patients was intermittent claudication. For thirty-one patients, the indication for operation was ischaemic rest pain, gangrene or ulcer. Fifty-six patients (74%) returned to active employment following vascular reconstructive surgery. It is concluded that reconstructive vascular surgery is of great importance for rehabilitation and in the success of resumption of active employment.

Adult↗
PubMed1989

Conservative drug treatment in patients with moderately severe chronic occlusive peripheral arterial disease. Scandinavian Study Group.

A double-blind, parallel group, multicenter clinical trial of pentoxifylline compared with placebo enrolled 150 patients with moderately severe chronic occlusive arterial disease (COAD) at three centers in Scandinavia. The study consisted of a 4-6 week single-blind, placebo-controlled run-in phase, during which the stabilization of the initial claudication distance of all patients was assessed before randomization to a 6-month double-blind observation period. The diagnosis of COAD was established by clinical findings, conventional angiography, and noninvasive peripheral Doppler pressure assessment at rest and after exercise. The results of the overall intention-to-treat analysis of the study population show statistically significant superiority of pentoxifylline over placebo for all absolute claudication distance summary and end point measures. By using two clinically relevant parameters, which are a resting ankle/arm pressure ratio 0.8 or less and a duration of COAD for greater than 1 year, a target population could be defined in whom trial results became highly significant. For nontarget patients with mild COAD, we conclude that basic therapeutic measures should include the treatment of risk factors and the initiation of physical training. For target patients, however, a multifactorial therapeutic approach, including the use of pentoxifylline, is justified.

Aged↗
PubMed1988

Microvascular circulatory changes in the lower extremities after reconstructive vascular surgery for intermittent claudication.

We have studied the circulatory changes in the lower extremities after reconstructive vascular surgery in ten patients with intermittent claudication. The following examinations were carried out 3 days before, 3 days, and 28 days after the operation: measurement of ankle systolic blood pressure, calf plethysmography, resting calf muscle blood flow and resting subcutaneous foot blood flow. The vasoconstrictor response (veno-arteriolar reflex) was also assessed. On the night before the operation and on the 28th night after aorto-bifemoral bypass surgery, subcutaneous adipose tissue blood flow in the forefoot was measured during sleep. The ankle systolic blood pressure and the ankle index rose significantly. The former increased from 57 +/- 16.4 mmHg to 93 +/- 24.0 mmHg (mean +/- S.E.M.) and was still elevated on the 28th postoperative day. The total limb blood flow, the muscle blood flow and the blood flow in the subcutaneous tissue of the forefoot during daytime were unchanged. In contrast, the blood flow in the forefoot during sleep increased significantly from 3.5 +/- 1.63 ml x (min x 100 g)-1 to 5.2 +/- 2.14 ml x (min x 100 g)-1 (mean +/- S.E.M.) on the 28th night. The vasoconstrictor response was potentiated, and increased from 27% before the operation to 45% on the third postoperative day. This change was maintained 28 days postoperatively. In conclusion the increase in arterial blood pressure was only reflected in the vasoconstrictor response which had returned to normal by the third postoperative day and nocturnal blood flow in the subcutaneous adipose tissue which did likewise.

Aged↗
PubMed1988

The cause of ischaemic nocturnal rest pain.

Adipose tissue blood flow in the forefoot was measured simultaneously with mean systemic arterial blood pressure over 24 hours in 8 patients (15 feet) with different degrees of arterial insufficiency. Mean systemic arterial pressure decreased by 19 +/- 9% during sleep, irrespective of symptomatology. In two limbs, with a normal peripheral circulation, blood flow decreased by 8 +/- 7%. In five limbs with arterial insufficiency, but no rest pain, blood flow decreased by 16 +/- 8% and in eight limbs with ischaemic nocturnal rest pain blood flow was reduced by 32 +/- 12% during sleep. It is concluded that nocturnal hypotension is a major factor in the production of nocturnal ischaemic rest pain.

Aged↗
PubMed1988

The regulation of subcutaneous adipose tissue blood flow in the ischaemic forefoot during 24 hours. Studies using the 133-xenon wash-out technique continuously over 24 hours.

A method for continuous measurement of subcutaneous adipose tissue blood flow in the forefoot during 24 hours (SBF) is described. The method is based on the radioisotope wash-out principle using 133-Xenon. A portable semiconductor detector is placed just above a local depot of 1-2 microCi 133-Xenon in 0.1 ml isotonic saline injected into the subcutaneous adipose tissue in the forefoot. The detector is connected to a memory unit allowing for storage of data. Due to the short distance, the recorded elimination rate constant must be corrected for combined convection and diffusion of the radioactive indicator. Characteristic 24-hour blood flow patterns were unveiled in patients with normal peripheral circulation and in patients having ischaemic nocturnal rest pain. In normals SBF doubled from day to night. This is ascribed to the local veno-arteriolar sympathetic axon reflex, which induces arteriolar vasoconstriction when the transmural pressure of the veins exceeds approximately 25 mmHg. In patients having ischaemic rest pains SBF was reduced by 37% on the average from day to night. This was caused by nocturnal hypotension, which is reflected proportionally in the foot. As the resistance vessels most probably are fully dilatated in feet with rest pain, the blood pressure drop during sleep causes the perfusion pressure and thus blood flow to come below a certain critical limit. There was a pronounced correlation between the reduction of systemic mean arterial blood pressure and SBF. The patients complaining of intermittent claudication, but no rest pains showed a variety of changes in SBF compatible with the continuous spectrum of the peripheral arteriosclerotic disease. After reconstructive vascular surgery, the 24-hour blood flow pattern normalized although the ankle/arm systolic blood pressure index did not come within normal range. SBF during day-time activities decreased by up to 50% postoperatively. This is caused by the reappearance of the local, sympathetic, veno-arteriolar vasoconstrictor response. During sleep SBF increased by 71%. The term postreconstructive hyperaemia seems improper, at least in a long-term context, normalization of preoperative ischaemia is a more correct notation. The coefficient of variation of nocturnal SBF was calculated to 10%. The method thus seems apt as a monitor in medical therapy for occlusive arterial disease. Changes of lambda has, however, to be considered in each study.

Adipose Tissue↗
PubMed1987

[Pneumothorax].

Explore the source record for details and available documents.

Denmark↗
PubMed1987

Tissue/blood partition coefficients for xenon in various adipose tissue depots in man.

Tissue/blood partition coefficients (lambda) for xenon were calculated for subcutaneous adipose tissue from the abdominal wall and the thigh, and for the perirenal adipose tissue after chemical analysis of the tissues for lipid, water and protein content. The lambda in the perirenal tissue was found to correlate linearly to the relative body weight (RBW) in per cent with the regression equation lambda = 0.045 . RBW + 0.99. The subcutaneous lambda on the abdomen correlated linearly to the local skinfold thickness (SFT) with the equation lambda = 0.22 SFT + 2.99. Similarly lambda on the thigh correlated to SFT with the equation lambda = 0.20 . SFT + 4.63. It is concluded that the previously accepted lambda value of 10 is generally too high in perirenal as well as in subcutaneous tissue. Thus, by application of the present regression equations, it is possible to obtain more exact estimates of the adipose tissue blood flow measured with the 133Xe wash-out method.

Adipose Tissue↗
PubMed1987

A pitfall in the measurement of arterial blood pressure in the ischaemic limb during elevation.

In order to evaluate if elevation of the ischaemic limb above heart level is an alternative to the conventionally applied method with external counterpressure for estimation of skin perfusion pressure, femoral and popliteal artery pressures were measured directly in eight patients with occlusion of the superficial femoral artery. The measurements were done in the horizontal position and during elevation of the calf above heart level. During elevation relative blood flow, measured by arterio-venous oxygen saturation differences, decreased compared with the horizontal position. In contrast the popliteal arterial pressure decreased only by 20% of the value expected from the degree of elevation of the calf above the level of the heart. Thus, it could be calculated that calf vascular resistance increased two- to three-fold on average during elevation. Four patients were reexamined with the venous pressure kept at 10 mmHg during elevation. In these patients, the increase in vascular resistance was significantly less compared with the situation in which venous pressure was 0 mmHg during elevation. The arterial pressure still did not decrease. It is concluded that perfusion pressure in the ischaemic lower extremity cannot be determined non-invasively by elevation of the extremity, probably due to collapse of segments of the vascular bed increasing the vascular resistance considerably.

Arteriosclerosis↗