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Biomedical subjects

S Rosfors

Publications and source records attributed to S Rosfors.

At least 19 recordsLinked to original sources
PubMed2006

High sensitivity with color duplex sonography in thrombosis screening after ankle fracture surgery.

BACKGROUND: Phlebography is regarded as the reference standard for diagnosing asymptomatic deep vein thrombosis (DVT) in studies of thromboprophylaxis. However, technical advances with noninvasive color duplex sonography (CDS) have made this procedure an interesting alternative. OBJECTIVES: The objective of the present prospective study was to compare the sensitivity and specificity of CDS with those of phlebography. PATIENTS: The first 180 consecutive patients included in a larger randomized trial for prolonged thromboprophylaxis were subject to unilateral CDS and to phlebography after ankle fracture surgery. The patients were examined 6 weeks after surgery, all examinations being evaluated blindly. After patient drop outs and exclusions, 144 patients were left for analysis. RESULTS: Phlebography and CDS examinations were inconclusive or were not completed for 19% of these patients (28/144). DVT was diagnosed by phlebography in 21% (24/116) of the remaining patients. Most of the thrombi were isolated calf DVTs (18/24). In contrast, DVT was diagnosed by CDS in 31% of these patients (36/116): only one case diagnosed by phlebography was missed by CDS. The specificity of CDS is thus 86% and its sensitivity is 96%. The positive predictive value is 64%, and the negative predictive value is 99%. CONCLUSIONS: CDS is a safe method for detecting asymptomatic distal DVT. It has a high sensitivity and high negative predictive value, which means that the method is highly reliable to rule out DVT. Our results indicate that CDS could be considered as an alternative method for DVT screening.

Adolescent↗
PubMed2005

Circulating markers of inflammation are related to carotid artery atherosclerosis.

AIM: The role of inflammation in atherothrombotic disorders is becoming increasingly recognized. The present study prospectively investigates relationships between inflammatory markers and hemostatic variables, and non-invasive measures of carotid artery atherosclerosis. METHODS: Markers of hemostasis (sP-selectin and fibrinogen), cytokines (IL-6, IL-8, TNF-a and MCP-1), inflammatory variables (hsCRP, SAA and calprotectin) and cell adhesion molecules (ICAM-1 and VCAM-1) as well as ultrasonography of the carotid arteries were assessed in 111 consecutive outpatients with manifest or suspected coronary artery disease (CAD). RESULTS: Thirty-eight patients with manifest cardiovascular disease had higher IL-6 (P < 0.01) but not hsCRP levels. Higher levels of IL-6, calprotectin and VCAM-1 (all P < 0.05) were found in 35 patients with carotid plaques. In the whole study population (n = 109) an increased common carotid artery lumen diameter (LD) and cross sectional intima-media area (CIMA) was related to higher IL-6, IL-8 and MCP-1 levels (all P < 0.05), and increased LD also to higher hsCRP, calprotectin (both P < 0.05), sP-selectin and fibrinogen levels (both P < 0.01). Both LD and CIMA were related to VCAM-1 (both P < 0.01), but not to ICAM-1 levels. The intima-media thickness of the carotid artery was only positively related to MCP-1 levels (P < 0.05). Only the relation between IL-6 and LD remained significant after adjustment for age, gender, body mass index, smoking status or present lipid-lowering treatment. CONCLUSIONS: Several biomarkers of inflammation are related to ultrasonographic measures of carotid artery atherosclerosis in patients with moderate to high prevalence of CAD. IL-6 seems to be an independent and useful biomarker of atherosclerosis in this group of patients.

Adult↗
PubMed2001

A 16-year haemodynamic follow-up of women with pregnancy-related medically treated iliofemoral deep venous thrombosis.

OBJECTIVES: to evaluate clinical and functional long-term outcomes following pregnancy-related medically treated iliofemoral deep venous thrombosis (DVT). DESIGN: retrospective follow-up of patients identified through a registry search. MATERIAL AND METHODS: twenty-five women underwent clinical examination, colour duplex ultrasound and computerised strain-gauge plethysmography on two occasions a mean of nine and 16 years after DVT. RESULTS: 40% of the patients were completely asymptomatic and 52% had no clinical signs of venous disease after a mean follow-up of 16 years. The clinical signs were in general mild, and none of the 25 patients had skin changes or ulcers. Deep venous reflux was found in 36% of the patients; the same percentage at nine- and 16-years follow-up, and 24% had normal ultrasonographic appearance of all deep veins. None of the patients had plethysmographic evidence of outflow obstruction. There was a significant relationship between measures of venous reflux and the presence of leg swelling, but there was no clear relation between functional abnormalities and the extent of the initial DVT. CONCLUSION: even after 16 years there are relatively mild symptoms and signs of venous disease in women with medically treated pregnancy-related iliofemoral DVT. Our results do not support earlier stated opinions that these patients represent a particular risk group for developing post-thrombotic syndrome.

Adult↗
PubMed2000

[Varices and venous insufficiency--therapeutic philosophy prior the 2000's].

Varicose veins represent everything from a cosmetic problem to a risk of venous leg ulcers. Predicting the risk of complications has been difficult, not least due to less than satisfactory diagnostic procedures. Recent investigations have pointed out some important new concepts: Superficial venous incompetence may give rise to an ulcer, and such an ulcer may be prevented by varicose vein surgery. Recanalization and stenting may be useful in treating chronic iliac and caval venous occlusions; however, long-term outcome is yet to be established. Venous diameter can be reduced, thus effecting valve competence. To what extent this result is long-lasting is not known. Neither has the method been attempted on deep veins. Clinical diagnosis is never sufficient in cases of suspected chronic venous incompetence. The minimum requirement is the use of a hand-held Doppler. Frequently, a more detailed ultrasonographic analysis is required, and for a global assessment of venous function, plethysmographic techniques are useful. Primary health care may contribute effectively to the care of venous leg ulcers.

Humans↗
PubMed2000

Carotid atherosclerosis in relation to symptoms from the territory supplied by the carotid artery.

OBJECTIVES: To investigate the relationship between intima-media thickness in the common carotid artery, plaque morphology in the carotid bifurcation and symptoms of cerebral embolism. Design prospective study of consecutive patients referred for carotid duplex examination. METHODS: One hundred and eighty-eight patients were classified by one of two neurologists into four categories (symptomatic, asymptomatic, undefined, uncertain). Carotid atherosclerosis was measured by means of high-resolution ultrasound technique. Carotid plaques were classified based on visual evaluation of plaque echogenicity. RESULTS: Intima-media thickness (IMT) was correlated to presence of plaques, age and gender, but not to symptoms referable to the carotid circulation. Carotid plaques were more common in symptomatic than in asymptomatic vessels (p<0.05). There was no difference in plaque occurrence between the ipsi- and contralateral sides in the symptomatic patients, neither in frequency of echolucent plaques between the sides or between symptomatic and asymptomatic patients. Echogenic plaques were more common and generally smaller than echolucent plaques. CONCLUSIONS: IMT correlates with presence of plaques, but not with symptoms from the territory supplied by the carotid artery. Echolucent plaques in the carotid bifurcation are not more frequently symptomatic than echogenic plaques are, in patients with low-to-moderate degree of carotid stenosis.

Adult↗
PubMed1999

Effects of exercise on Doppler-derived pressure difference, valve resistance, and effective orifice area in different aortic valve prostheses of similar size.

The effects of increased transvalvular volume flow on Doppler-derived measurements were compared in similarly sized, normally functioning, mechanical prostheses, stented and stentless porcine bioprostheses, and homografts. Homograft and stentless valves showed the largest effective orifice area and the lowest pressure differences and valve resistance at rest and during exercise-induced increase in flow rates.

Aged↗
PubMed1999

Temporal variability of exercise Doppler echocardiography in patients with nonstented aortic bioprostheses.

Temporal variability and reproducibility of Doppler-derived variables obtained during supine symptom-limited exercise was investigated in 26 patients who were in clinically and hemodynamically stable condition with normally functioning nonstented aortic bioprostheses (stentless porcine, n = 13; cryopreserved homografts, n = 13). All patients had normal systolic left ventricular function and underwent 2 similar exercise tests within 12 months (mean time interval 7.2 +/- 1.9 months). The coefficient of variation was 8% to 9% for primary Doppler-derived variables (ie, velocities and velocity time integrals) at rest and during exercise. The coefficient of variation for calculated maximal pressure difference was 16% at rest and 15% at peak exercise. Measurement variability assessed from repeated measurements from the same videotaped recording was approximately 2%. High reproducibility was shown for most variables with intraclass correlation coefficients of 0.85 or more. We conclude that Doppler echocardiography can be used in patients with nonstented aortic bioprostheses with the same high reproducibility during exercise as at rest. The results provide clinically useful information regarding temporal variability for Doppler-derived variables.

Aged↗
PubMed1998

Pulmonary function following adjuvant chemotherapy and radiotherapy for breast cancer and the issue of three-dimensional treatment planning.

BACKGROUND AND PURPOSE: The frequency and grade of pulmonary complications following adjuvant radiotherapy for breast cancer are still debated. This study focuses on loss of pulmonary function. MATERIALS AND METHODS: We have measured the reduction of pulmonary function 5 months following radiotherapy in 144 node-positive stage II breast cancer patients by using pulmonary function tests. RESULTS: No deterioration of pulmonary function was detected among the patients who were treated with local radiotherapy. On the contrary, there was a mean increase in diffusion capacity by 7% (P = 0.004) following radiotherapy, which most likely was explained by the adjuvant chemotherapy administered prior to the baseline pulmonary function tests. Patients undergoing loco-regional radiotherapy showed a mean reduction in diffusion capacity by 5% (P < 0.001) and in vital capacity by 3% (P = 0.001). The subset of patients (9%) who were diagnosed with severe pulmonary complications needing cortisone treatment had significantly larger mean paired differences in vital capacity (-0.446 L, -15% (equivalent to 15 years of normal ageing or the loss of 3/4 of a lung lobe)) compared to the patients who were asymptomatic (-0.084 L) (P < 0.05). When the effects of potential confounding factors and different radiotherapy techniques were tested on the reduction of pulmonary function by stepwise multiple regression analysis, a significant correlation was found only to locoregional radiotherapy including the lower internal mammary lymph nodes. CONCLUSIONS: We conclude that a clinically important reduction of pulmonary function is seen in the subset of patients who are diagnosed with severe pulmonary complication following loco-regional radiotherapy for breast cancer. The results of this study warrant further studies based on individual lung dose volume histograms.

Adult↗
PubMed1998

Hemodynamic performance of cryopreserved aortic homograft valves during midterm follow-up.

OBJECTIVES: The aim of this prospective study of adult patients operated with a cryopreserved aortic homograft was to use serial echocardiographic data to evaluate the postoperative hemodynamic performance of these valves. BACKGROUND: Only limited data on hemodynamic performance of aortic homografts at rest and during exercise are available. Controversy also exists regarding incidence and progression of aortic regurgitation (AR). METHODS: Fifty-nine patients aged 39-86 years who received an aortic homograft (median size 21 mm) implanted with subcoronary technique were studied with serial Doppler-echocardiography (D-E). In 31 of these patients, D-E also was performed during supine exercise. RESULTS: Overall survival was 100% during a median follow-up of 28 months (range 4-54). During follow-up AR grade II or more was detected in 25% of the patients with an increasing time-related risk of developing AR. Maximum and mean pressure differences at 7 months follow-up calculated with the short form of the Bernoulli equation were 11.4 (4.6) and 5.5 (2.1) mm Hg, respectively. During supine exercise that increased cardiac output 72%, maximum pressure difference increased from 11.9 (5.2) to 18.5 (9.5) mm Hg. CONCLUSIONS: The aortic homograft valve shows low pressure differences at rest and during exercise, but AR grade I or II is often seen during follow-up. As AR progresses with time we stress the importance of echocardiographic follow-up of patients with aortic homografts.

Adult↗
PubMed1998

Relationship between intima-media thickness in the common carotid artery and atherosclerosis in the carotid bifurcation.

BACKGROUND AND PURPOSE: An increase in intima-media thickness (IMT) in the common carotid artery (CCA) is commonly used as a marker of atherosclerosis. The purpose of this study was to investigate the relationship between IMT in the CCA and atherosclerosis in the carotid bifurcation. METHODS: 182 consecutive patients (mean age, 67 years) referred for carotid duplex scanning were included. We measured IMT and classified plaques by means of a high-resolution ultrasound technique. RESULTS: IMT was correlated to age, male gender, ischemic heart disease, and presence of plaques or stenoses in any of the carotid bifurcations. In men, IMT was larger on the left than on the right side. Plaques were seen in 163 carotid bifurcations, in 45 of these with > 50% stenosis. On the left side but not on the right, there was a correlation between IMT in the CCA and presence of plaques or stenoses in the carotid bifurcation. Echogenic plaques were more common than echolucent, but the latter caused significantly more stenoses. No relationship was found between plaque echogenicity and IMT. CONCLUSIONS: IMT of the CCA is correlated to the degree of atherosclerosis in the carotid bifurcations in general and on the left side also to the presence of plaques or stenoses in the left carotid bifurcation. Our results support earlier observations suggesting faster development of carotid atherosclerosis on the left than on the right side. Echogenic plaques were more common and generally smaller than echolucent plaques, but there was no correlation between plaque echogenicity and IMT.

Adult↗
PubMed1997

In vitro endothelialisation of arteriovenous loop grafts for haemodialysis.

OBJECTIVES: To evaluate the feasibility in a pilot study of in vitro endothelialisation of PTFE grafts used as interposition arteriovenous fistulas in uraemic patients. METHODS: Autologous saphenous vein endothelial cells were harvested and cultured on PTFE grafts in seven patients undergoing maintenance haemodialysis. The patients had several previous failures of vascular access sites. The patients were followed with duplex ultrasound, clinical examination and in one case an explanted graft was examined. RESULTS: At the end of follow-up four of the seven patients had patent grafts. One patient occluded the graft immediately postoperatively and another after 3.5 months. The former patient received a second endothelialised graft. In two further patients revision of the outflow was performed. In two patients a functioning graft was excised, in one case because of bleeding of a venous aneurysm and in one case because of suspected infection. The former which was excised 5 weeks postoperatively revealed that 85% of the surface was covered by endothelial cells. CONCLUSIONS: This pilot study shows that in vitro endothelialisation of PTFE grafts used for haemodialysis is possible in uraemic patients. In this highly problematic patient group the results are promising with endothelial cell coverage after 5 weeks of implantation.

Aged↗
PubMed1997

A methodological study of arterial wall function using ultrasound technique.

We aimed to establish reference values for three important properties of the arterial wall using a conventional ultrasound scanner. We measured: (1) intima-media thickness (IMT) of the carotid arteries with the internal trace function of the ultrasound system; (2) wall stiffness by pulsatile diameter changes in the right common carotid artery assessed by M-mode; and (3) endothelial function expressed as flow-mediated dilatation (FMD) of the brachial artery. IMT and wall stiffness measurements and reproducibility were compared with those obtained by external analysing systems. All variables were obtained in healthy subjects (n = 20), 29-53 years old. IMT increased with age (P < 0.01). There was no difference in IMT between men and women. The inter-operator variability for measuring IMT was 6-9%. The same order of reproducibility was obtained with an external PC-based analysing system. Regarding wall stiffness, no correlation was found with age, nor any difference between men and women. A low intra-operator variability (CV < 10%) was found for measurements of wall stiffness with both M-mode and an external wall tracking system. FMD of the brachial artery diminished with age (P < 0.01). There was a relation between FMD and brachial artery size (P < 0.01) and, therefore, as men have larger arterial diameters (P < 0.01), smaller FMD in men. We conclude that it is possible to characterize arterial wall function non-invasively in an adequately reproducible manner using a conventional ultrasound system in healthy middle-aged men and women.

Adult↗
PubMed1997

A prospective follow-up study of acute deep venous thrombosis using colour duplex ultrasound, phlebography and venous occlusion plethysmography.

OBJECTIVE: To study the extent of deep venous thrombosis (DVT) and thrombus regression over time and to compare the results obtained with different diagnostic techniques. EXPERIMENTAL DESIGN: A prospective follow-up study with repeated examinations during a 6-month period. SETTING: Patients studied at clinical vascular laboratories. PATIENTS: Forty patients hospitalised for acute DVT. Thirty-six of these completed the follow-up period. MEASURES: The diagnosis of DVT was confirmed with phlebographic and/or ultrasonographic techniques. The patient were then re-examined with colour duplex ultrasound and venous occlusion plethysmography after one week, 3 months and 6 months and with phlebography after 1 week and 6 months. The extent of DVT and number of occluded segments were determined with phlebographic and ultrasonographic techniques. Venous occlusion plethysmography was used to evaluate the functional degree of outflow obstruction. RESULTS: Colour duplex scanning at 3 months' and 6 months' follow-up showed that 55% and 74% of initially occlusive thrombi, respectively, were recanalized, with thrombus resolution occurring faster and more completely in those initially limited to popliteal and/or calf level. Discrepancies between phlebography and duplex scanning were found in 6% (26/441) of venous segments investigated by both methods, primarily concerning flow in the veins below the knee. CONCLUSIONS: In comparison with phlebography, colour duplex scanning is an accurate method for evaluation and follow-up of patients with DVT. The non-invasive nature of colour duplex scanning makes this method extremely suitable for repeated studies and thus a potentially very valuable tool for both clinical and research studies of circulatory changes involved in acute and chronic DVT.

Adult↗
PubMed1996

The long-term outcome of proximal vein thrombosis during pregnancy is not improved by the addition of surgical thrombectomy to anticoagulant treatment.

OBJECTIVES: To compare the long-term outcome for pregnant/puerperal women with iliofemoral venous thrombosis treated either with thrombectomy and additional anticoagulants or with anticoagulants alone. DESIGN: Retrospective study of two treatment methods. MATERIALS: Thirty women with iliofemoral venous thrombosis during pregnancy or puerperium were treated with thrombectomy and additional anticoagulants. Twenty-five women, with the same condition, treated with anticoagulants only were obtained from a registry. The mean follow-up time for both groups was 9 years. The patients of the two groups were well matched, had the same risk factor score and were comparable except for duration of symptoms before treatment. METHODS: The follow-up comprised history and clinical examination, colour Duplex ultrasound and venous strain-gauge plethysmography. RESULTS: Patency of iliac veins, symptoms of chronic venous disease, venous emptying and venous reflux did not differ between the groups. A significant reduction of outflow was found in 20% of the surgically treated patients and 16% of the controls. Impaired muscle pump function was seen in less than half of the patients in both groups. CONCLUSIONS: Surgical thrombectomy does not offer any advantage over anticoagulation treatment alone in the long-term outcome for patients with iliofemoral venous thrombosis during pregnancy or puerperium.

Adolescent↗
PubMed1994

Transcutaneous oxygen pressure measurements in patients with intermittent claudication.

Transcutaneous oxygen pressure (TcPO2) measurements were performed on 10 male patients with moderate-to-severe intermittent claudication. The TcPO2 electrode was attached to the dorsum of the foot. TcPO2 response to a standardized treadmill exercise test was evaluated, as was the reproducibility of TcPO2 measurements at rest and during exercise. Reproducibility was assessed using a similar exercise test within 2-5 days. Treadmill exercise induced a marked decrease in TcPO2 in all patients, from 9.3 +/- 0.9 to 2.8 +/- 2.0 kPa. Maximal walking distance was 280 +/- 127 m at the first treadmill test and 272 +/- 113 m at the second. Blood lactate and heart rates at rest and at end of exercise were also unchanged. TcPO2 at rest was highly reproducible, but considerable variation was found for measurements during and after exercise. This variation was most obvious for measurements during exercise and no direct or reproducible relation was found between ischaemic calf pain and TcPO2 values. Post-exercise measurements were slightly more reproducible and somewhat easier to assess. In contrast to standard TcPO2 measurements, total exercise-induced ischaemia expressed as area under the post-exercise TcPO2 curve was highly reproducible. In summary, our results with TcPO2 measurements in patients with intermittent claudication showed a marked exercise-induced decrease in all patients. However, the variation in TcPO2 values when the test was repeated after 2-5 days under stable clinical and circulatory conditions limits its application as a quantitative measure of lower-limb ischaemia. Thus, measurements of area under the TcPO2 curve might be preferred for this purpose.

Aged↗