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Biomedical subjects

R Takolander

Publications and source records attributed to R Takolander.

At least 55 records · Page 3Linked to original sources
PubMed1987

Analysis of complications after percutaneous transluminal angioplasty of renal artery stenoses.

During a five-year-period percutaneous transluminal renal angioplasty (PTRA) was attempted in 90 renal arteries with 109 stenoses and 3 occlusions in 78 patients. Complications were systematically recorded and classified as major, minor and radiological-technical. Twenty-one major complications (20.8%) including one fatality occurred as well as 17 minor, (16.8%) and 37 radiological-technical (36.6%) problems. The last group showed no clinical symptoms. The frequency of complications in our series is high compared with that in a survey of ten papers reviewing results in 675 patients. The most marked discrepancy was our high frequency of septic problems. Radiological changes are not usually reported in other series, probably because they are regarded as methodological but we considered these as potentially dangerous and important to report as they can lead to clinically relevant complications. Because of the problems reported here PTRA should only be performed in centres where complications can be properly dealt with.

Acute Kidney Injury↗
PubMed1987

Management of early neurologic deficits after carotid thrombendarterectomy.

A neurologic deficit appearing during the early postoperative period after an interval following an otherwise successful carotid endarterectomy may be caused by thrombotic material formed in the carotid bifurcation. Our experience of immediate reoperation on eight such cases during a period of 2 years is reported in this paper. Thrombotic occlusion was found at reoperation in seven cases and a non-occluding thrombus in one case. Four of the patients were fully restored immediately after reoperation. In two cases good recovery but with some persisting symptoms was seen. One patient became hemiparetic with moderate restitution and one suffered a dense hemiplegia. We recommend an aggressive approach with immediate reoperation in these cases.

Aged↗
PubMed1987

Terbutaline and budesonide as inhibitors of postischaemic permeability increase.

A temporary ischaemia with total circulatory arrest of the hamster cheek pouch was obtained by clamping the neck of the everted cheek pouch. The macromolecular permeability increase in postcapillary venules was quantified as the leakage of fluorescein-labelled dextran using intravital microscopy and a fluorometer simultaneously. At reperfusion after 30 min ischaemia, there was a significant and reversible permeability increase. This response could be totally prevented by topical administration of either terbutaline, a selective beta 2-receptor agonist, or budesonide, a glucocorticoid, but it was not significantly impeded by the antihistamine mepyramine. The study shows that, in conformity with the situation in inflammation, the postischaemic permeability increase at reperfusion after ischaemia can be blocked by either beta 2-stimulation or glucocorticoids. Furthermore, it indicates that histamine, a common inflammatory mediator, is not responsible for the postischaemic permeability increase.

Animals↗
PubMed1987

Complications after percutaneous transluminal angioplasty in the iliac, femoral, and popliteal arteries.

During a 5-year period percutaneous transluminal angioplasty (PTA) was attempted in 134 iliac, femoral, and popliteal arteries in 127 patients. Complications were systematically registered and classified as major, minor, and radiologic. Seventeen major complications (12.7%), including three deaths, occurred, as well as five minor (3.7%) and 13 radiologic complications (9.7%). The last group showed no clinical symptoms. The frequency of complications in our series is high compared with that found in a survey of 13 studies with 2043 patients. The most marked discrepancy was our high frequency of septic symptoms. A mortality rate of 2.2% was also higher in our series, but we have consequently registered the 30-day mortality rate to make comparisons with surgical series relevant. Radiologic alterations are usually not reported in other series probably because they are regarded as a part of the method, but we consider these alterations as potentially dangerous and important to report because they can result in clinically relevant complications. Because of the complications PTA should only be performed in centers in which complications can be optimally treated.

Adult↗
PubMed1987

Treatment of arterial lesions after radiation therapy.

Of 1,724 patients who underwent peripheral vascular operation, 12 (0.7 per cent) underwent radiation therapy of the areas including the relevant arteries one and one-half to 28 years (a mean of 15 years) previously; one patient had carcinoma of the breast, three had tumors of the neck and eight patients had malignant gynecologic disease. One patient with an occluded carotid artery was not actively treated, two underwent percutaneous transluminal angioplasty and the remaining patients underwent different types of vascular reconstructions. These patients frequently have other radiation lesions as well with involvement of the skin, bladder or intestine, which may make them problematic from a surgical point of view. Extra-anatomic reconstructions or percutaneous transluminal angioplasty can be recommended. One patient died of malignant disease three years after arterial operation. Otherwise, the results of follow-up study for these patients did not differ from other patients who underwent arterial reconstruction.

Aged↗
PubMed1986

Small bowel necrosis after aorto-iliac reconstruction.

Small bowel ischaemia causing necrosis is a rare complication after aorto-iliac reconstructive surgery. During a 14-year-period we have seen 6 cases out of 1343 reconstructions, making a frequency of 0.4 per cent. Diagnosis was difficult, causing a delay until re-exploration. Thrombocytopenia was a constant finding, and should raise suspicion. Pathogenesis was multifactorial. In two of our cases diagnosis was made at autopsy and in four at operation. Two patients survived extensive bowel resection but had a long stormy postoperative course.

Adult↗
PubMed1986

Spectral analysis with digital presentation of C-W Doppler signals in the evaluation of carotid stenosis.

Using a continuous-wave ultrasound Doppler system with spectral analysis (FFT) and digital processing and presentation, the Doppler shift characteristics of the carotid arteries were studied in 40 healthy subjects (20 men and 20 women; average age 69 years). The reference values, thus obtained, were applied to the analysis of sonograms from 46 carotid arteries, which were also studied angiographically. Stenoses which reduced the diameter of the internal carotid artery by more than 30% could be identified with a sensitivity of 97% and a specificity of 100%. The results extend previous experience that spectral analysis improves the usefulness of the ultrasound Doppler system in the evaluation of carotid artery disease. The addition of digital processing and presentation of the Doppler shift characteristics increases the diagnostic precision and provides a permanent record. The importance of well-trained sonographers and adequate reference values is emphasized.

Aged↗
PubMed1986

Doppler spectral analysis of the internal carotid before and after endarterectomy.

In 37 randomly selected patients, stenosis of the internal carotid artery was evaluated with Doppler spectral analysis before and 6-10 weeks after endarterectomy. Postoperatively 20 of the vessels were entirely within the normal variation range and four, though not normal, showed significantly lower blood flow velocity, indicating wider vascular lumen. In ten cases there were no significant postoperative change, and in three significant worsening of the Doppler shift was seen without clinical implications. The method is useful for evaluating the endarterectomized carotid noninvasively without use of contrast medium, and when bilateral operation is contemplated the analysis is most valuable for ruling out occlusion in the artery first operated on.

Aged↗
PubMed1985

The hamster cheek pouch--an experimental model to study postischemic macromolecular permeability.

In order to study permeability changes after local ischemia the cheek pouch of the hamster was everted for intravital microscopy. Macromolecular permeability was quantified as leakage of fluoroscein labelled dextran (Mw 70,000). Temporary ischemia with total circulatory arrest of the whole cheek pouch was obtained by a cuff mounted around the everted cheek pouch where it leaves the mouth of the hamster. At reperfusion after repeated ischemic periods of 5 min no leaks were seen. A prolongation of the ischemic period to 30 min resulted in a temporary increase in the number of postcapillary venular leaks. When the occlusion was repeated the response was significantly smaller. An occlusion period of 60 min gave no further increase in macromolecular permeability. Locally applied histamine was used to test the reactivity of the cheek pouch. It was concluded that the model is suited for studies of permeability increase after local ischemia.

Animals↗
PubMed1985

Late mortality and morbidity after arterial reconstruction: the influence of arteriosclerosis in popliteal artery trifurcation.

Mortality and the incidence of myocardial infarction and cerebrovascular lesion have been retrospectively analyzed in patients who have survived 30 days after lower limb vascular reconstruction. These events have been related to the extent of arteriosclerotic lesions in the trifurcation of the popliteal artery (trifurcational disease, TFD) in 368 patients treated consecutively. One hundred fifty-five patients underwent aortoiliac reconstruction, 229 had femorodistal bypass, and 16 underwent both procedures. The median follow-up period was 4.4 years. The mortality rate in male and female patients was increased compared with the expected mortality. This increase was found both in patients with and without TFD. In patients having TFD the mortality was 2.0 times higher than in patients who did not have TFD (p less than 0.001). The difference in the mortality rate persisted after correction for the influence of age, sex, and diabetes mellitus. The higher mortality rate in patients who had TFD was most marked early in the postoperative period and was mainly caused by myocardial infarction. The incidence of myocardial infarction and cerebrovascular events was significantly increased in patients who had TFD compared with those who did not, particularly in the early postoperative period.

Adult↗
PubMed1985

Cranial nerve injuries associated with carotid endarterectomy. A prospective study.

To determine the incidence and nature of cranial nerve damage in connection with carotid artery surgery, 139 patients were studied before and after 162 operations. Nerve damage was detected in association with 19.8% of the operations. The hypoglossal nerve was most commonly affected. The injuries were of benign character and usually resolved within 4 to 6 weeks. Apart from damage to the great auricular nerve, all lesions resolved within 5 months. The incidence of nerve disturbance was greater than that found in a retrospective study from the same hospital. Gentleness of technique is important in carotid artery surgery, in order to avoid nerve damage.

Carotid Arteries↗