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Biomedical subjects

R Takolander

Publications and source records attributed to R Takolander.

At least 37 records · Page 2Linked to original sources
PubMed1990

Carotid artery surgery. Local versus general anaesthesia as related to sympathetic activity and cardiovascular effects.

Arterial plasma catecholamines, blood pressure and heart rate were determined in 75 patients before, during and after carotid endarterectomy. Local anaesthesia given as a cervical block with skin infiltration containing 200 micrograms adrenaline was used in 28 patients (LA-group), general anaesthesia (nitrous oxide, fentanyl, isoflurane) with skin infiltration containing 200 micrograms adrenaline in 32 patients (GAs-group) and general anaesthesia without skin infiltration in 15 patients (GAo-group). In the LA-Group plasma noradrenaline (P-NA) levels were significantly higher during anaesthesia and surgery, with an increase from preanaesthesia levels (P less than 0.05). P-NA decreased from a preanaesthesia level in the GAo-group (P less than 0.01) but remained unaltered in the GAs-group. P-NA values in the GAo-group were lower than those of the GAs-group (P less than 0.001) following anaesthesia and surgery. Plasma adrenaline (P-A) increased in the LA- and the GAs-group and decreased in the GAo-group (P less than 0.001) following anaesthesia and surgery. In the LA-group P-A was similar before the skin incision and clamping but higher after declamping as compared to the GAs-group. Before the skin incision and thereafter P-A was lower in the GAo-group as compared to the other groups. There was a positive correlation between plasma catecholamines, on the one hand, and mean blood pressure and heart rate on the other. Two patients in the LA-, eight in the GAs- and seven in the GAo-group showed a hypotensive blood pressure reaction (SBP less than 100 mmHg; LA vs. GAo, P less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Anesthesia, General↗
PubMed1990

Pressure measurements as predictors for peroperative neurologic deficits in carotid surgery.

Forty-eight carotid endarterectomies were performed using local anaesthesia. The need for an intra-operative shunt was estimated from the development of neurological symptoms during a test clamping period of 1 min. Two patients developed symptoms during test clamping but four others developed symptoms after 11 to 20 min of clamping. The internal carotid back pressure was 30 to 40 mmHg in all these cases and significantly lower than among patients not developing symptoms. A better prediction of the need for a shunt was developed from a combination of the stump index (SI = internal carotid artery stump pressure/systemic pressure x 100) and the carotid index (CI = carotid pressure before clamping/systemic pressure x 100). The combination of SI less than 30 and CI greater than 85 predicted in a highly significant way the need for a shunt during operation. With this method a group of patients with a higher risk of postoperative stroke may also be detected.

Anesthesia, Local↗
PubMed1990

A stable prostacyclin analogue (iloprost) in the treatment of ischaemic ulcers of the lower limb. A Scandinavian-Polish placebo controlled, randomised multicenter study.

The clinical efficacy of the prostacyclin analogue iloprost was studied during a 2 week treatment and 6 month follow-up period in 103 patients with ischaemic ulcers who were randomised to receive active treatment or placebo. Responders were defined as those patients who achieved healing of at least one third of the ulcer area during the study period. The overall responder rate was 41.3%, compared with 25% for the control group (P = 0.086). Side effects including flushing and headache, were common. The study population had a mortality of 23% during the 6 month period, the amputation rate was 43.5% for iloprost and 50% for placebo treated patients. In this severely diseased population of patients a treatment period limited to 2 weeks did not sufficiently improve ulcer healing.

Adult↗
PubMed1990

Outcome in vascular surgery.

In this review of outcome after vascular surgery the results after surgery for abdominal aortic aneurysm (AAA), carotid endarterectomy (CEA) and reconstructions for ischemia of the lower limbs are discussed and compared with the natural course of the disease. Deaths due to rupture of AAA is an increasing problem even though elective surgery because of AAA has increased, the appropriateness of CEA, which is a seemingly logical operation, has been widely discussed, and operations because of ischemia in the lower limbs constitute some 50% of the work of the vascular surgeon.

Aorta, Abdominal↗
PubMed1990

Lower-limb oedema after thromboembolectomy for acute arterial occlusion.

To establish the degree of oedema after thromboembolectomy ad modum Fogarty, leg volume changes were recorded daily in 56 patients. Significant increase was found in the volume of the ipsilateral leg, maximally 12.9 +/- 12% after c. 1 week. The swelling was significantly greater if the popliteal artery had been explored than if it had not. The volume increase was weakly correlated to the duration of ischaemia, but this could be explained by higher incidence of below-knee incisions in patients with longer preoperative ischaemia. Compartment syndrome occurred in one case. The outcome of the operation correlated to leg volume changes on postoperative day 1, but not significantly to the maximal volume increase. It is suggested that the early volume changes represent increased microvascular permeability, and that to this relatively modest oedema is in some cases later added more severe swelling due to impairment of the lymphatic outflow.

Arterial Occlusive Diseases↗
PubMed1989

Pharyngeal function after carotid endarterectomy.

Neurologic deficiencies, with special reference to pharyngeal function, were studied prospectively in 12 patients before and after they underwent carotid endarterectomy. Pharyngeal function was monitored with cineradiography. Five patients developed pharyngeal dysfunction: defective closure of the laryngeal vestibule, epiglottic dysmotility, and pharyngeal constrictor paresis 1 week postoperatively. In 2 patients this dysfunction remained, while in 3 it had resolved 4 weeks after the operation. Pharyngeal dysfunction was more common in patients with preoperative minor stroke and a temporary perioperative carotid shunt and in patients with a long operation time. The registered transient pharyngeal dysfunction may be due to manipulation of the cervical structures including the vagus nerve and the pharynx or due to cerebrovascular damage during the operation. Our findings support careful monitoring of postoperative oral finding in patients at risk.

Adult↗
PubMed1989

Lipid peroxidation and activity of antioxidant enzymes in muscle of the lower leg before and after arterial reconstruction.

Reperfusion syndrome and lipid peroxidation due to toxic effects of free oxygen radicals might be one pathophysiological cause of the oedema that develops during the first week after a femoro-popliteal reconstruction. This paper reports the activity of the protecting antioxidant enzymes superoxide dismutase (SOD), glutathione peroxidase and catalase in gastrocnemic muscle before and after reperfusion of chronically ischaemic legs with comparison to activities in non-ischaemic muscle. Furthermore the susceptibility to lipid peroxidation in the muscle was measured as thiobarbituric acid reactive material (TBAR). The activities of CuZn SOD, Mn SOD and glutathione peroxidase were equal in normally perfused and chronically ischaemic muscle and there was no difference after reperfusion. Muscle catalase activity was low compared to activity of red blood cells and could not be reliably estimated. There was no difference in iron-stimulated lipid peroxidation of ischaemic and non-ischaemic muscle but in reliably estimated. There was no difference in iron-stimulated lipid peroxidation of ischaemic and non-ischaemic muscle but in muscle biopsied 10 min after reperfusion there was a significant increase in production of TBAR indicating an increased susceptibility for lipid peroxidation at this time. The finding is compatible with the occurrence of an oxidant insult on the muscle at reperfusion. Ischaemia--or reperfusion--induced reductions in activity of antioxidant enzymes are however not related to this reaction.

Arteriosclerosis↗
PubMed1989

Evaluation of ulceration in the extracranial carotid artery with ultrasonography: a comparison with arteriography.

The accuracy of duplex-scanning and angiography in detecting ulceration in the carotid arteries was evaluated. Sixty-nine patients underwent duplex-scanning and carotid arteriography, and the findings were blindly compared to the operative specimens. Duplex-scanning had a significantly higher sensitivity (90 vs 48%, P less than 0.001) and accuracy (88 vs 59%, P less than 0.001) than angiography. There was no difference in specificity (84 vs 89%, P = 0.28). Comparison was also made between conventional arch angiography and selective carotid angiography in detecting ulceration. There was no significant difference between the methods (sensitivity 47 vs 50%, specificity 82 vs 100%). Finally, interobserver variability in detecting ulceration with duplex-scanning was evaluated in double-blind evaluation of the duplex-scans. The interobserver agreement was 84%. Duplex-scanning seems to be superior to angiography in detecting ulcerations in the extracranial carotid artery.

Adult↗
PubMed1989

Local versus general anaesthesia in carotid surgery. A prospective, randomised study.

A randomised, prospective study was performed to compare local (LA) and general anaesthesia (GA) in carotid surgery with special emphasis on complications and the need for intra-operative shunting. Fifty-six patients were randomised to LA and 55 to GA. Eight patients in the LA group required a GA for various reasons. During the same period 14 patients were not randomised. Seven perioperative neurological deficits occurred (5.6%), four in the LA group, two in the GA group, and one in the non-randomised group (NS). Selective shunting was used, in the Ga group according to stump pressure or in cases with a previous stroke and in the LA group according to the appearance of neurological symptoms. In the GA group 25 patients were shunted and in the LA group five patients (P less than 0.001) needed a shunt. If strict pressure criteria for shunting had been used in the LA patients, ten would have been shunted and three of the patients who developed symptoms during clamping would not have been shunted. During surgery the highest recorded systolic pressure was significantly higher in the LA group (210 mmHg versus 173 mmHg, P less than 0.001). LA for carotid endarterectomy is comparable with general anaesthesia regarding peroperative complications but produces significantly higher blood pressures than general anaesthesia. On the other hand it allows the possibility of neurologic monitoring of the patient and leads to significantly less use of an intra-operative shunt.

Adult↗
PubMed1989

Solitary aneurysms of the iliac arterial system: an estimate of their frequency of occurrence.

Solitary iliac artery aneurysms are rare, and most reports have been presented as case reports. By combining autopsy records and operating records, a total of 13 cases were found: during a 15-year period (1971 to 1985), 42,010 of the inhabitants of Malmö died (population 230,000) and 35,265 (including 9014 forensic autopsies) underwent autopsy (84%). Solitary iliac artery aneurysms were found in seven (0.03%) of the 26,251 patients who underwent autopsy at the hospital; six of those had been asymptomatic and one was ruptured. Among the 9014 persons who underwent forensic medical autopsy, there were two with ruptured solitary iliac artery aneurysms. Four patients had clinically detected solitary iliac artery aneurysms, three of which were ruptured. All patients underwent surgery, and two of the three patients with ruptured solitary iliac artery aneurysms left the hospital well. The rupture rate of iliac aneurysm among those found at autopsy was one of seven (14%) and among those clinically detected three of four.

Adult↗
PubMed1988

Long-term results after carotid artery surgery.

This study presents the results from a follow-up after 414 carotid reconstructions performed on 352 patients during the years 1971-82. At the end of the follow-up period 267 patients were alive (75.8%) and 253 patients remained asymptomatic. The median follow-up time was 35 months (6 months-12 years). Patients with coronary artery disease (CAD) had a significantly lower survival than patients without signs of CAD. Coronary artery disease was significantly more frequent among patients with bilateral carotid lesions compared to patients with unilateral lesions. The actuarial stroke frequency, operative morbidity included, on the operated side was 2.5%/year. However, from 6 months postoperatively up to 8 years the stroke frequency was 1%/year. In the stroke frequencies all neurological deficits of more than 24 h duration are accounted for. Although there was a trend toward higher stroke rates among older patients there were no significant differences between age groups. Assuming a 10% stroke frequency during the first year after a TIA and a 6% annual stroke rate thereafter our results would cross even such a natural course curve at 18 months.

Actuarial Analysis↗
PubMed1988

Risk factors in carotid artery surgery: an evaluation of 414 operations.

Four hundred and fourteen carotid reconstructions performed on 352 patients during the years 1971-82 were analysed retrospectively. Fifty-eight percent of the patients were operated on because of hemispheric transient ischaemic attacks (TIA). Twenty-eight percent had suffered a stroke before surgery. The overall combined mortality and morbidity was 7.7%. The procedure mortality was 2.9% with a slightly higher mortality i.e. 5.9% in the stroke group although not significantly higher than among non-stroke patients with a mortality of 1.4%. Patients of more than 70-years had a significantly higher operative mortality (11.1%) than the rest of the patients (1.7%). Non-fatal strokes occurred in 20 patients (4.8%). No correlation was found with the degree of stenosis of the contralateral artery.

Adult↗
PubMed1988

Interactive effects on renal function between renal ischemia and intravascular contrast media.

This review deals with some recent animal and clinical investigations that show that small amounts of intravascular contrast media (CM) that remain in the body at the time of surgery and are the residual from a preoperative roentgen examination may increase (potentiate) the renal injury resulting from temporary intraoperative renal artery occlusion. Such interaction (potentiation) may occur in each of the following clinical situations: (1) aortorenal reconstructive surgery after angiography; (2) kidney harvesting after cerebral angiography in cadaver donors; and (3) percutaneous dilatation of a stenotic renal artery that includes a sequence of CM injections and balloon inflations that occlude the renal artery. It is concluded that such a potentiation may be decreased by prolonging the time interval between CM injection and the subsequent temporary renal arterial occlusion because such a prolongation decreases the amount of CM that remains in the kidney at time of occlusion.

Animals↗
PubMed1988

Coarctation of the abdominal aorta in elderly patients. Case report and review of the literature.

Coarctation of the abdominal aorta as a congenital disease is infrequent, the diagnosis mostly being made at an early age because of renovascular hypertension. Patients who reach the age of 40 more often tend to have the problems located distally to the renal arteries. A 66-year-old female is described, who developed an aortic occlusion, renovascular hypertension and uremia. She was cured with a bifurcation graft and a patch angioplasty of a stenotic renal artery and nephrectomy of the contralateral kidney with an occluded artery without refilling. A literature survey is made of patients older than 40 years.

Aged↗
PubMed1988

Peripheral arterial embolectomy, risks and results.

Embolectomy of the extremities was performed on 221 patients (263 emboli) with median age 77 years. The upper extremity was affected in 21% of cases. No correlation was found between the time from onset of symptoms to embolectomy and the amputation rate. There were 81 deaths (37%) within a month of operation. The mortality rate was significantly higher (47%) among the patients who were already in hospital when embolism occurred and also when the embolism was associated with myocardial infarction (68%). Among patients given oral anticoagulants postoperatively the perioperative mortality was 5%, compared with 51% without such medication. Patient age, concomitant coronary artery disease and oral anticoagulant treatment were factors independently influencing morbidity during the first postoperative month. The 5-year survival rate was also significantly heightened by anticoagulant treatment (43 vs. 12%). Data concerning amputation rate, perioperative mortality and long-term survival in relation to oral anticoagulant treatment must be cautiously interpreted. Prospective trials are required to answer some of the questions.

Adult↗