Biomedical subjects

R Takolander

Publications and source records attributed to R Takolander.

80 records · Page 5Linked to original sources

PubMedDate not supplied

Fatal thrombo-embolic complications at aorto-femoral angiography.

Fatal complications due to angiographic procedures are rare. An awareness of these complications is, however, mandatory in order to be able to prevent them. This report concerns three fatal cases with a deleterious complication of distal macro- and microembolization in connection with the angiographic procedure. In all cases the local circulation was surgically restored. The microcirculation was 'out of reach' and all three patients succumbed with profound tissue ischemia.

Aged↗

PubMedDate not supplied

Acute renal failure in rats. Interaction between a contrast medium and renal arterial occlusion.

Acute renal failure is a serious complication of reconstructive aortoiliac surgery. The question was raised whether its etiology includes interaction between preoperative angiographic contrast medium and intra-operative clamping of the renal arteries. Renal arteries of 180 rats were bilaterally clamped 10 to 120 min and serum urea was determined from 3 h to 7 days later. In 35 rats 40 min clamping alone produced an increase in urea reaching a maximum 1 day later (median increase 70%). In 3 groups of 12 rats intravenous injection of the contrast medium metrizoate alone in doses 1, 2 and 3 g I/kg body-weight produced no significant increase in urea. Intravenous injection of the same doses to 3 groups of 10 rats each followed 1 h later by renal arterial occlusion for 40 min produced median urea increases one day later of 110, 130 and 170 per cent, respectively, in the 3 groups. The increase was higher than that produced by contrast medium alone (p less than 0.01) or by renal artery clamping alone (p less than 0.05) indicating a potentiation of transient renal failure by the combination of contrast medium and renal arterial clamping.

Acute Kidney Injury↗

PubMedDate not supplied

Acute renal failure in rats. Interaction between contrast media and temporary renal arterial occlusion.

It was demonstrated in rats that renal injury which follows transient renal hypoxia is potentiated by the contrast media metrizoate, ioxaglate, iopamidol and iohexol. Intravenous injection of 1 g I/kg of all four media alone to 82 rats caused no significant increase in serum urea 1, 3 and 7 days later. The percentage increase of serum urea is given in median values and interquartile range (in parentheses). Bilateral renal arterial occlusion alone for 40 minutes in 42 rats increased serum urea one day later by 40 per cent (20-130). Intravenous injection of the media followed in one hour by bilateral renal arterial occlusion for 40 minutes in 104 rats caused serum urea to increase one day later by 130 per cent (70-350) after metrizoate, by 220 per cent (50-380) after ioxaglate, by 290 per cent (60-420) after iopamidol and by 160 per cent (50-330) after iohexol. There were no significant differences between the potentiating effects of the various media on ischemic renal failure.

Acute Kidney Injury↗

PubMedDate not supplied

Lower limb oedema after arterial reconstructive surgery. Influence of preoperative ischaemia, type of reconstruction and postoperative outcome.

To investigate the early limb oedema after various types of arterial reconstructions 180 patients operated on due to occlusive or aneurysmatic arterial disease were followed by daily circumference measurements of the lower leg. For volume calculations circumference measurements were shown to be well correlated to water displacement volumetry. Femoro-popliteal bypass resulted regularly in a pronounced oedema, significantly more than in any of the other groups. Aortofemoral reconstruction did not lead to significant leg oedema, but all other reconstructions resulted in a volume increase in the symptomatic leg. Following distal reconstruction, patients with popliteal aneurysm and no ischaemia developed the same maximal volume increase as patients with severe ischaemia. Regarding all patients as one group the volume increase was not significantly correlated to the preoperative ankle blood pressure or ankle brachial pressure index. Only after various proximal reconstructions, with a limited postoperative oedema, there was a correlation between the degree of preoperative ischaemia and postoperative volume increase. A successful reconstruction was not necessary for the development of postoperative oedema. A failed distal reconstruction was followed by a significant oedema, although less pronounced than after a successful. Exploration of the vessels without reconstruction also led to a postoperative oedema. The findings indicate that the pathogenesis of postreconstructive oedema is multifactorial. The type of reconstruction is the most important predictive factor and degree of preoperative ischaemia and success of operation are contributing factors.

Aneurysm↗

PubMedDate not supplied

Does cerebral angiography of cadaveric kidney donors interfere with graft function?

Cerebral angiography is used to diagnose brain death of cadaver kidney donors. Clinical and animal data suggest that angiographic contrast media may potentiate the noxious effect of renal ischemia. In order to find out if cerebral angiography of cadaveric kidney donors prior to nephrectomy interferes with function or survival of the renal grafts, two groups of cadaveric donors were compared. One group had been exposed to contrast medium from cerebral angiography in median 18 hours before nephrectomy and the other had not. There was no difference in graft survival and function between the two groups. In a previous investigation angiography was performed two hours before explantation and in that investigation there was a shorter graft survival in the angiography group than in a control group. A delay of 12 hours is suggested between cerebral angiography and explanation, to decrease the combined harmful effects of contrast media and ischemia on renal grafts.

Adolescent↗

PubMedDate not supplied

Abdominal aortic dilatation in patients operated on for carotid artery stenosis.

The prevalence of abdominal aortic dilatation among 201 men and 86 women who underwent carotid endarterectomy in 1971-1982 was studied from the date of operation to the end of 1984. Of the 109 patients who died during this time, 96 were autopsied, and 13 (13.5%) of them had aneurysm of the abdominal aorta. Ultrasonographic screening of the abdominal aorta was performed on 154 survivors, and showed dilatation in 17 (11%), 12/100 men and 5/54 women. The prevalence of hypertension, intermittent claudication, diabetes mellitus and coronary insufficiency at the time of endarterectomy did not differ between the patients with or without aortic aneurysm or dilatation. Patients who have undergone endarterectomy of the internal carotid artery constitute a group with high prevalence of abdominal aortic dilatation.

Aged↗

PubMedDate not supplied

Ulceration of the carotid bifurcation. A preliminary report on a diagnostic problem.

The prevalence of ulceration in the carotid bifurcation, as judged from high-resolution 2-D ultrasound scanning and angiography, was compared with the findings at carotid endarterectomy in patients with TIA or stroke. The surgeons registered ulceration in 26 of the 29 treated carotid arteries. Angiography and ultrasonography identified ulceration in 9 and 19, respectively, of the same arteries, indicating that high-resolution 2-D ultrasound scanning is superior to angiography in the diagnosis of carotid ulceration. All arteries with tight stenosis (diameter reduction greater than or equal to 75%), but only two of four with less than 30% stenosis were ulcerated.

Carotid Artery Diseases↗

PubMedDate not supplied

Unilateral reconstruction of the iliac artery. A comparative evaluation.

Unilateral reconstruction of the iliac artery because of obliterating atherosclerotic disease was performed on 122 patients (group A) in the period 1971 through 1979. A bifurcation dacron bypass was used for iliac artery reconstruction in 52 patients (group B) during the same period. Of the group A patients, 24% required eventual contralateral iliac reconstruction, and in 16% redoing of the ipsilateral operation became necessary. In group B the need for redoing was 25%. The 30-day mortality was 1.6% in group A and 7.8% in group B. The patency rates were similar up to 5 years postoperatively. The authors conclude that there is a place for unilateral iliac artery reconstruction, especially in high-risk cases or for patients with short life expectation who require relief of the vascular obstruction but for whom bilateral operation is not immediately mandatory.

Adult↗