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Biomedical subjects

R Sivertsson

Publications and source records attributed to R Sivertsson.

At least 19 recordsLinked to original sources
PubMed2001

A colour Doppler ultrasound study of venous reflux in patients with chronic leg ulcers.

OBJECTIVES: to evaluate the distribution of superficial and deep venous reflux in patients with chronic leg ulcers. MATERIALS: retrospective study of 186 patients with chronic leg ulcers (212 lower limbs). RESULTS: in 127 legs without arterial disease and a history of deep venous thrombosis (DVT), 62 (49%) had superficial, 45 (35%) had superficial and deep, and 14 (11%) had isolated deep venous reflux. In legs with a previous DVT, isolated deep venous reflux was more common (21/55, 38%) but superficial reflux, often in combination with deep reflux, still predominated (56%). CONCLUSIONS: a large part of the venous insufficiency causing venous leg ulcers is superficial and suitable for varicose vein surgery. In patients with chronic leg ulcers most reflux affects the superficial system and is potentially suitable for surgical correction.

Adult↗
PubMed1996

Girls prone to urinary infections followed into adulthood. Indices of renal disease.

This study describes blood pressure and renal function, as well as indices of renal disease, in females with and without renal scarring followed from their first urinary tract infection (UTI) in childhood. Of the 111 patients with a median follow-up time of 15 years, 54 had renal scarring (reflux nephropathy) on urography, which was severe in 19 and moderate in 35. The glomerular filtration rate was lower in patients with severe renal scarring and correlated with renal area on urography. However, the filtration rate was decreased below the lower reference limit in only 7 patients, with a lowest value of 70 ml/min per 1.73 m2. The diastolic blood pressure was higher in women with severe scarring. Hypertension of at least 140/90 mmHg was diagnosed in 3 of 54 (5.5%) females with renal scarring, 2 before and 1 at the follow-up examination. The excretion of albumin in urine was low and not correlated to filtration rate. Tubular enzymes in urine were similar in all groups. Thus the renal function was well preserved and the incidence of hypertension low. Within this range of renal function, the level of albumin in urine did not predict the degree of renal scarring.

Acetylglucosaminidase↗
PubMed1996

Gender-related differences in gastric emptying rate of solid meals.

Controversy exists about the occurrence of a gender-related difference in gastric emptying in humans. In this paper, a strictly standardized scintigraphic method, in which pancakes were labeled with technetium-99m-macroaggregated albumin, was used to follow gastric emptying in 16 male and 14 female healthy young subjects. The resulting mean gastric emptying curves described biphasic patterns. There was a similar lag period (30.6 +/- 4.2 vs 33.6 +/- 3.8 min; means +/- SEM) but a faster linear gastric emptying rate (32.9 +/- 1.4 vs 22.0 +/- 1.3%/hr), a shorter half-emptying time (111.2 +/- 8.6 vs 158.2 +/- 6.4 min) and lower residual radioactivity after 2 hr (43.0 +/- 3.5 vs 62.8 +/- 1.7%) in the male subgroup as compared with the female subgroup. The differences were highly statistically significant. As a result, separate reference values are recommended for young male and fertile female subjects.

Adult↗
PubMed1996

Is colour Doppler ultrasound a sensitive screening method in diagnosing deep vein thrombosis after hip surgery?

Patients under going orthopedic surgery are at high risk of developing deep vein thrombosis. One hundred and thirty-eight consecutive patients undergoing total hip replacement or hip fracture surgery were included in this study. They were surveilled with colour Doppler ultrasound (CDU) and bilateral ascending contrast phlebography. The prevalence of proximal and distal DVT in this study was 5.8% and 20.3% respectively. CDU has a satisfactory sensitivity in patients with symptomatic deep vein thrombosis, especially in the proximal region. These results could not be confirmed in the present study of asymptomatic patients. The sensitivity was 62.5% (95% confidence interval: C.I. 24-91%) and the specificity 99.6% (C.I. 98-100%) for proximal DVT; 53.6% (C.I. 34-73%) and 98% (C.I. 96-99%) respectively for distal thrombi. the overall sensitivity was 58.1% (C.I. 39-75%) and the specificity 98% (C.I. 96-99%). The positive predictive value was 83.3% (C.I. 36-99%) and 75% (C.I. 51-91%) for proximal and distal DVT respectively. The negative predictive value was 98.9% (C.I. 98-100%) and 94.9% (C.I. 92-98%) for proximal and distal DVT respectively. The results of this study showed that even with a highly specialised and experienced investigator the sensitivity of CDU was too low to make it suitable for screening purposes in a high risk surgical population.

Anticoagulants↗
PubMed1995

Colour Doppler ultrasound in diagnosing venous insufficiency. A comparison to descending phlebography.

OBJECTIVE: To evaluate the technique of ultrasound colour Doppler in diagnosing venous valvular incompetence in the lower leg. DESIGN: Prospective clinical study. SETTING: Department of clinical physiology. MATERIALS: 44 patients (56 legs) referred with a clinical diagnosis of deep venous insufficiency. CHIEF OUTCOME MEASURES: Colour Doppler and descending phlebography. MAIN RESULTS: Using phlebography as a "gold standard" the accuracy of the colour Doppler technique varied between 93% and 55% for the different veins. For the superficial and deep femoral veins, the popliteal vein and the long and short saphenous veins the accuracy was between 90% and 70%. The lowest correlation was found for the deep calf veins (55-66% accuracy). CONCLUSIONS: Colour Doppler was found to be a suitable technique for non-invasive investigation of patients with suspected venous insufficiency. Since the colour Doppler technique is non-invasive it is well suited for follow-up studies. Descending phlebography should be reserved as an adjunct technique in patients scheduled for valve reconstructive surgery.

Adolescent↗
PubMed1995

Body weight and fat cell size in young men with mild blood pressure elevation.

The aim of the study was to assess the relationship between body fat distribution and blood pressure. Forty-four men, aged 19-22 years, with mild blood pressure elevation (MBPE) and 29 normotensive controls (NC) were investigated. Body fat distribution was assessed by calculating fat cell size in biopsy samples of adipose tissue from different subcutaneous depots. The subjects in MBPE group were heavier than those in NC group (79.7 +/- 2.7 and 71.5 +/- 1.6 kg, p < 0.05). Total body fat was also significantly higher in the MBPE group (12.5 +/- 1.6 and 8.1 +/- 1.3 kg, p < 0.05) but not the lean body cell mass (36.8 +/- 1.1 and 34.7 +/- 0.9 kg, n.s.). Fat cell size (microgram/cell) in the lower abdominal area were significantly bigger in MBPE than in NC (respectively 40.9 +/- 4.4 and 28.0 +/- 3.1, p < 0.05). The same differences applied for fat cell size in the upper abdominal (respectively 43.1 +/- 3.0 and 26.8 +/- 3.0, p < 0.001) and averaged abdominal areas (respectively 40.1 +/- 3.4 and 26.8 +/- 2.8; p < 0.05). Fat cell size in gluteal, femoral and averaged gluteofemoral areas did not differ between MBPE and NC. Therefore, the abdominal/gluteofemoral ratio was significantly higher in MBPE than in NC (respectively 1.1 +/- 0.1 and 0.7 +/- 0.1; p < 0.005).(ABSTRACT TRUNCATED AT 250 WORDS)

Adipocytes↗
PubMed1991

Tc-labelled pancake for studies of gastric emptying of solids.

To achieve a stable isotope marker of solid food, different variants of isotope-labelled Swedish pancake were tested. The marker stability was investigated by a new method assumed to test both the affinity of the isotope complex to the test meal and the mechanical stability. The test procedure included use of a gamma camera and human gastric juice. Pancakes labelled with either pertechnetate, 99TcmO4 (Tc-pert), or 99Tcm-macroalbumin aggregates (Tc-MAA) were compared. The results showed a significant difference (P less than 0.01), with 91.4 +/- 2.1% (mean +/- 1 S.D.) of activity remaining in the Tc-MAA pancake (n = 5) and only 81.1 +/- 5.8% in the Tc-pert pancake (n = 6) after 3 h. Pancakes labelled with Tc-MAA were also compared with chicken liver labelled in vivo with 99Tcm-sulphur colloid (Tc-SC). The results revealed significantly better marker stability (P less than 0.05) of pancakes compared to chicken liver, with 83.0 +/- 9.1% remaining in the Tc-MAA pancake (n = 8) and 74.9 +/- 6.7% in the Tc-SC chicken liver (n = 8) after 180 min.

Food↗
PubMed1991

Body weight is more important than family history of hypertension for left ventricular function.

Left ventricular function was studied in young men with a positive family history of hypertension for two generations (n = 15). The findings were compared with three control groups: one age-, sex-, and weight-matched group with a negative family history of hypertension (n = 14); one normotensive control group unselected as regards family history of hypertension (n = 27); and one group also unselected regarding family history of hypertension but selected with blood pressure criteria to have mild blood pressure elevation (n = 59). The group with a positive family history of hypertension, in comparison with the normotensive control group, was heavier, had higher blood pressure, increased left ventricular wall thickness, increased left ventricular mass, and signs of changes in diastolic and systolic left ventricular function. There were no differences in these variables between the group with a positive family history and the other two control groups. Data clearly indicated that subjects with a positive family history of hypertension, as well as subjects with mild blood pressure elevation, were heavier than the normotensive control group. It is not possible to judge, with available data, if the changes in left ventricular morphology and function in the two groups with a different family history of hypertension and in the group with mild blood pressure elevation occurred as a physiological response to the increase in afterload or if the neurohormonal and metabolic disturbances leading to the condition of slight overweight also affected left ventricular function.

Body Mass Index↗
PubMed1991

Swedish Isradipine Study in Hypertension: evaluation of quality of life, safety, and efficacy. SWISH Group.

This was a double-blind multicenter study to compare the efficacy, tolerability and effects on the quality of life with isradipine and atenolol in the treatment of essential hypertension. Of 588 patients entering the 6-week placebo run-in period, 549 were eligible for randomization to receive either isradipine or atenolol for 8 weeks. If, at the end of this period, diastolic blood pressure (DBP) remained greater than 90 mm Hg, then both agents were given in combination for a further 10 weeks. Tolerability and quality of life were assessed repeatedly during the placebo and active-treatment phases. A subgroup of 30 patients were followed by 24-h ambulatory blood pressure monitoring, and their results are now being analyzed. In another subgroup of 26 patients, maximum exercise capacity, as determined by ergometer bicycle-testing, was measured once during placebo and twice during active treatment. At the end of the 24-week study period, both isradipine and atenolol as monotherapy had produced significant decreases in blood pressure. There were no significant differences overall between the compounds in quality-of-life and side-effect profiles, although there was a relative absence of ankle edema and headache with isradipine. Furthermore, patients receiving isradipine had no change in performance on exercise testing whereas patients on atenolol had a significant decrease (p less than 0.01).

Antihypertensive Agents↗
PubMed1989

Does hyperkinetic circulation constitute a pre-hypertensive stage? A 5-year follow-up of haemodynamics in young men with mild blood pressure elevation.

In a previous haemodynamic examination, 44 young men (18-22 years) with blood pressure elevation above the 98th percentile, mean arterial blood pressure (MAP) greater than or equal to 95 +/- 6 mm Hg, showed an increased cardiac index (dye-dilution) and an enhanced resistance at maximal vasodilation of the hand (venous occlusion plethysmography during hyperaemia). This latter finding suggested arteriolar wall hypertrophy. However, the subgroup with the highest cardiac index (greater than or equal to 3.86 1 min-1 x m2) (n = 18) displayed normal vascular resistance at maximal dilation in comparison with the normotensive control group (n = 29). Consequently, functional signs of arteriolar hypertrophy were restricted to individuals with normal or low cardiac index. At the re-investigation 5 years later, a significant reduction in blood pressure was observed in the normotensive control group (MAP: from 88 +/- 7 to 85 +/- 7 mm Hg, P less than 0.05). There was no change in individuals with initially elevated blood pressure. Furthermore, cardiac index fell significantly with time in this latter group. Thus, the blood pressure elevation in the hypertensive group, previously mainly dependent on high blood flow was, 5 years later, more related to an increased total peripheral resistance, (delta total peripheral resistance = 8%). However, no definite evidence indicating development of hypertrophy of the resistance vessels of the hand was observed during the follow-up period. Since the hyperkinetic subgroup did not display a concomitant fall in blood pressure with cardiac output, our results do not support the theory that the hyperkinetic form of borderline hypertension is a temporary phenomenon, explained by the inclusion of anxious individuals afraid of the experimental situation. Hyperkinetic hypertension may be the initial phase of sustained hypertension in a subgroup of the future hypertensive population.

Adult↗
PubMed1987

Structural adaptation of the cardiovascular system in hypertension. Hemodynamic consequences of vascular wall hypertrophy.

The existence of a structural adaptation of the cardiovascular system in hypertension has been known for many years, in fact already since the time of Bright. This paper is concerned with the hemodynamic consequences of the wall thickening of the small arteries and the arterioles. Studies are reported which illustrate the hemodynamic effects of the vascular changes in man, the limited reversibility of these changes and the early occurrence of the wall changes in the course of human hypertension. The pathophysiological role of the structural vascular changes in human hypertension is discussed.

Antihypertensive Agents↗
PubMed1987

Acute and long-term hemodynamic effects of carvedilol, a combined beta-adrenoceptor blocking and precapillary vasodilating agent, in hypertensive patients.

The purpose of these studies was to investigate the hemodynamic effects of carvedilol, a compound with combined properties of nonselective beta-adrenoceptor blockade and precapillary vasodilatation. The acute effects were studied with invasive technique (dye dilution) in 10 patients taking 25 mg orally and noninvasively (forearm plethysmography) in 10 patients taking 25 mg and in 10 patients taking 50 mg orally, all with essential hypertension. Significant reductions of systolic and diastolic blood pressure (p less than 0.05-0.001) were observed in all groups. Total peripheral resistance (TPR) did not change acutely whereas resistance in the forearm was reduced by 16% (p less than 0.05; invasive group). When a comparison with propranolol (80 mg x 2) was made in a randomized double-blind placebo controlled trial in 30 patients, carvedilol acutely reduced blood pressure significantly by 13/6 mg Hg (25 mg) and 17/10 mm Hg (50 mg) in contrast to propranolol. Resistance in the forearm fell significantly with 50 mg carvedilol, whereas propranolol caused a significant rise. After 4 weeks, both compounds had reduced blood pressure significantly. Blood flow was still reduced with propranolol in contrast to the findings with carvedilol. In conclusion, the summary of these studies shows that carvedilol given orally has a useful antihypertensive effect both acutely and during prolonged treatment, and it has an attractive hemodynamic profile, in agreement with the hemodynamic findings in essential hypertension.

Adrenergic beta-Antagonists↗
PubMed1986

An evaluation of automated indirect blood pressure measurement during pregnancy.

An automatic microcomputer-assisted instrument (Dinamap) for indirect determination of blood pressure was evaluated in 10 healthy women in the last trimester of pregnancy. Blood pressure determined intra-arterially was significantly (p less than 0.001) higher than indirect blood pressure determined with the Dinamap instrument or by manual sphygmomanometry. However, there was no significant difference in the mean change in blood pressure determined by the three techniques under investigation. A close correlation was recorded between systolic and diastolic blood pressure determined intra-arterially and with the Dinamap instrument (r = 0.92, r = 0.90), and between blood pressure determined intra-arterially and indirectly by auscultation (r = 0.93, r = 0.81). There was no significant difference in the reproducability of individual blood pressure values determined intra-arterially (systolic, 2.4 mmHg, diastolic, 3.7 mmHg) or by the Dinamap instrument (systolic, 2.8 mmHg, diastolic, 3.4 mmHg) or by auscultation (systolic, 5.0 mmHg, diastolic, 4.9 mm Hg). The Dinamap instrument proved reliable for the measurement of changes in blood pressure during late pregnancy. The technique eliminates the problem of inter-observer error which otherwise becomes evident when checking blood pressure antenatally.

Adult↗
PubMed1985

Hemodynamic effects of combined beta-adrenoceptor blockade and precapillary vasodilatation in hypertension.

Carvedilol (BM14190) is a new compound with combined properties of nonselective beta-adrenoceptor blockade, devoid of ISA, and precapillary vasodilatation. Its acute hemodynamic effects were studied with invasive technique (dye-dilution using Cardio-Green) in 10 patients taking 25 mg orally and noninvasive (fore-arm plethysmography) in 10 patients taking 25 mg and in 10 patients taking 50 mg orally, all with essential hypertension. Significant reductions of systolic and diastolic blood pressures (p less than 0.05 - 0.001) were observed in all groups. TPR did not change acutely whereas resistance in the fore-arm was reduced by 16% (p less than 0.05). When a comparison with propranolol (80 mgx2) was made in a randomized, double-blind placebo controlled trial comprising 30 patients with essential hypertension, carvedilol acutely reduced blood pressure significantly 13/6 mm Hg (25 mg) and 17/10 mm Hg (50 mg) in contrast to propranolol. Resistance in the fore-arm (plethysmography) fell significantly with carvedilol 50 mg whereas propranolol caused a significant rise. After 4 weeks both compounds had reduced blood pressure significantly and to the same extent. Blood flow was still reduced with propranolol in contrast to the findings with carvedilol. We conclude that carvedilol given orally has a useful antihypertensive effect both acutely and during prolonged treatment. It has an attractive hemodynamic profile.

Adrenergic beta-Antagonists↗
PubMed1985

Maternal haemodynamic changes during caesarean section: a comparison of epidural and general anaesthesia.

Haemodynamic measurements were performed on 20 healthy women before and during elective caesarean section under epidural (10 women) or general anaesthesia (10 women). The influence of the two anaesthetic techniques on the haemodynamic changes associated with operative delivery was compared. The following haemodynamic variables were studied: cardiac output (CO), stroke volume (SV) determined non-invasively with impedance cardiography, heart rate (HR), systolic (SBP) and diastolic blood pressure (DBP), pulse pressure, mean arterial pressure (MAP) and total peripheral vascular resistance (TPR). During epidural anaesthesia, SV was largely unchanged before delivery but increased (P less than 0.05) following delivery. However, CO increased (P less than 0.05) prior to delivery due to an increase (P less than 0.01) in HR. A further increase (P less than 0.05) in CO was recorded following delivery. SBP, DBP, MAP and TPR decreased (P less than 0.01) during epidural anaesthesia. In the patients undergoing general anaesthesia, SV decreased (P less than 0.05) prior to delivery. However, CO remained largely unchanged due to an increase (P less than 0.01) in HR. Following delivery, CO (P less than 0.05) and SV (P less than 0.01) increased whereas HR decreased (P less than 0.01). SBP, DBP and MAP increased (P less than 0.01) prior to delivery, returning to the same level as prior to induction of anaesthesia following delivery. TPR was largely unchanged prior to delivery but decreased (P less than 0.01) following delivery.

Anesthesia, Epidural↗
PubMed1984

Haemodynamic effects of carvedilol, a new beta-adrenoceptor blocker and precapillary vasodilator in essential hypertension.

Carvedilol (BM 14190) is a new antihypertensive compound which combines beta-adrenoceptor blocking and precapillary vasodilating properties but is devoid of intrinsic sympathomimetic activity. The acute and long-term effects on blood pressure and regional haemodynamics (forearm plethysmography) were studied with carvedilol 25 mg b.i.d. or 50 mg b.i.d. Comparisons were made with propranolol 80 mg b.i.d. in a randomized double-blind placebo controlled trial comprised of 30 patients with essential hypertension. After a four-week placebo period active therapy was given for four weeks. Carvedilol administered acutely reduced blood pressure at both doses, delta 13/6 mmHg (P less than 0.001/P less than 0.01) and 17/10 mmHg (P less than 0.001/P less than 0.01). Resistance in the forearm fell significantly with the higher dose. This was in contrast to propranolol which only reduced heart rate acutely, and as expected caused a rise in forearm resistance. After four weeks both compounds had reduced blood pressure significantly and to the same extent. Blood flow was still significantly reduced with propranolol in contrast to the findings with carvedilol. We conclude that carvedilol given orally has a useful antihypertensive effect both acutely and during prolonged treatment. It is well tolerated and its haemodynamic profile is attractive.

Adrenergic beta-Antagonists↗