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- Florén, Claes-Henrik, et al.
(författare)
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Bone mineral density in patients with Crohn's disease during long-term treatment with azathioprine
- 1998
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Ingår i: Journal of Internal Medicine. - 1365-2796. ; 243:2, s. 123-126
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: To ascertain whether patients with Crohn's disease treated with azathioprine maintained bone mineral mass better than patients treated with steroids alone. DESIGN: Retrospective study. SETTING: University Hospital of Malmo, Sweden. SUBJECTS: A total of 59 patients with ileocolonic, ileocaecal or colonic Crohn's disease. METHODS: Bone mass was assessed by dual photon X-ray absorptiometry at the level of L2-L4. RESULTS: Patients treated with a high lifetime dose of steroids (> 5 g prednisolone) had significantly (P = 0.011) lower Z-score of L2-L4 (-0.87 +/- 1.11; 11 SD) than steroid-treated patients, who had received a low dose of prednisolone (< 5 g) (0.08 +/- 1.16 SD). Azathioprine did not negatively influence the steroid effect on bone mineral density. CONCLUSIONS: Azathioprine does not seem to affect bone mineral density by itself. However, by being steroid-saving, it seems to conserve bone mineral mass in patients with Crohn's disease.
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| 3. |
- Jönsson, Peter, et al.
(författare)
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Chest wall sarcoma: outcome in 22 patients after resection requiring thoracic cage reconstruction.
- 1998
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Ingår i: Sarcoma. - : Hindawi Limited. - 1357-714X .- 1369-1643. ; 2:3-4, s. 143-147
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Tidskriftsartikel (refereegranskat)abstract
- Purpose. To evaluate the outcome after resection of malignant chest wall sarcoma, requiring reconstruction of the chest wall.Subjects. Twenty-two patients, 15 with primary tumours, were operated on in our institution between 1983 and 1996. Four patients underwent surgery after a previous intralesional or marginal excision and three patients because of a local recurrence.Methods. The tumour was resected 'en bloc', including skin, muscle and thoracic skeleton. When necessary, adjacent organs invaded by the tumour, such as lung, pericardium and diaphragm, were also removed to obtain a wide margin. Reconstruction of the chest wall was performed with Marlex mesh (n=9), methylmethacrylate cement (n=2) or a Marlex methylmethacrylate 'sandwich' (n=11).Results. The median tumour size was 9.5 (2-20) cm. The most common type of tumour was chondrosarcoma (12 cases). No patient died in hospital. Five patients required reoperation because of complications, two patients because of loosening of the acrylate prosthesis, two because of necrosis of soft tissue coverage and one was reoperated because of bleeding. Four patients died of generalized tumour disease between 5 and 77 months after surgery and one patient died of a local recurrence 32 months after the primary operation. Seventeen patients are alive, with a median follow-up of 36 (4-162) months. Microscopic radicality (negative margin) was achieved in 17 patients but 5 of these had local recurrences. Two of five patients with positive margins had a local recurrence of the tumour. Of the seven patients with local recurrences, two also developed metastases.Discussion. Large chest wall sarcomas can be successfully resected and the chest wall reconstructed with low morbidity and mortality.
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- Astermark, Jan, et al.
(författare)
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Low recurrence rate after deep calf-vein thrombosis with 6 weeks of oral anticoagulation
- 1998
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Ingår i: Journal of Internal Medicine. - : Wiley. - 1365-2796 .- 0954-6820. ; 244:1, s. 79-82
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: To evaluate the recurrence rate after deep calf-vein thrombosis treated with 6 weeks of oral anticoagulation. DESIGN AND SUBJECTS: A 2 year follow-up of 126 consecutive patients admitted to the Department of Internal Medicine with venographically verified deep calf-vein thrombosis. RESULTS: One hundred and twenty-six patients were treated with warfarin for 6 weeks, 18 of them having had a previous episode of venous thrombosis (DVT). Eleven patients (8.7%) suffered a recurrent thromboembolic episode within 2 years, four of which were within the first 3 months. Eight of those without a history of DVT had a recurrence (7.4%). Three of these were activated protein C (APC)-resistant, one was protein C-deficient and one had malignant melanoma. Eight patients (6.3%) reported minor haemorrhagic complications, but no major bleeding was seen. CONCLUSION: Our data support the use of a 6 week regimen of secondary oral prophylaxis after a first episode of deep calf-vein thrombosis in patients without a permanent risk factor. Whether individuals with inherited thrombophilia require prolonged treatment remains to be evaluated.
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| 7. |
- Karlsson, C, et al.
(författare)
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Endothelium-derived prostanoids reduce 5-hydroxytryptamine-induced contraction in the human uterine artery
- 1998
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Ingår i: Human Reproduction. - 0268-1161. ; 13:7, s. 1947-1951
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Tidskriftsartikel (refereegranskat)abstract
- The contribution of endothelium-linked mechanisms to the contraction induced by 5-hydroxytryptamine (5-HT) was investigated in the isolated human uterine artery. 5-HT contracted the uterine artery concentration-dependently. Removal of the endothelium or treatment with the cyclooxygenase inhibitor indomethacin potentiated the contractile response to 5-HT. The nitric oxide synthase inhibitor L-N(G)-monomethyl-arginine (L-NMMA) did not influence the contraction induced by 5-HT. Indomethacin did not affect the response to 5-HT in endothelium-denuded vessels. The 5-HT1 receptor agonist 5-carboxyamidotryptamine (5-CT) did not relax precontracted arteries. Removal of the endothelium did not change the response to 5-HT in the presence of the 5-HT(1B/D) receptor antagonist GR127935 and the 5-HT1A and 5-HT1B receptor antagonist -pindolol. The 5-HT1B receptor antagonist SB224289 did not affect the contraction induced by 5-HT. The results indicate that the 5-HT-induced contraction in the human uterine artery is accompanied by the release of an endothelium-derived relaxing factor (EDRF). This EDRF seems to be a prostanoid, probably prostacyclin (PGI2). The endothelium-linked mechanism seems to be mediated via a 5-HT1 receptor, but it is not possible to further classify the receptor subtype by the information obtained in this study.
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| 8. |
- Malina, Martin, et al.
(författare)
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Endovascular AAA exclusion: will stents with hooks and barbs prevent stent-graft migration?
- 1998
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Ingår i: Journal of Endovascular Surgery. - 1074-6218. ; 5:4, s. 310-317
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: To investigate if stents with hooks and barbs will improve stent-graft fixation in the abdominal aorta. METHODS: Sixteen- to 24-mm-diameter Dacron grafts were deployed inside cadaveric aortas. The grafts were anchored by stents as in endovascular abdominal aortic aneurysm repair. One hundred thirty-seven stent-graft deployments were carried out with modified self-expanding Z-stents with (A) no hooks and barbs (n = 75), (B) 4 5-mm-long hooks and barbs (n = 39), (C) 8 10-mm-long, strengthened hooks and barbs (n = 19), or (D) hooks only (n = 4). Increasing longitudinal traction was applied to determine the displacement force needed to extract the stent-grafts. The radial force of the stents was measured and correlated to the displacement force. RESULTS: The median (interquartile range) displacement force needed to extract grafts anchored by stent A was 2.5 N (2.0 to 3.4), stent B 7.8 N (7.4 to 10.8), and stent C 22.5 N (17.1 to 27.9), p < 0.001. Both hooks and barbs added anchoring strength. During traction, the weaker barbs were distorted or caused intimal tears. The stronger barbs engaged the entire aortic wall. The radial force of the stents had no impact on fixation, while aortic calcification and graft oversizing had marginal effects. CONCLUSIONS: Stent barbs and hooks increased the fixation of stent-grafts tenfold, while the radial force of stents had no impact. These data may prove important in future endograft development to prevent stent-graft migration after aneurysm exclusion.
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| 9. |
- Malina, Martin, et al.
(författare)
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Late aortic arch perforation by graft-anchoring stent: complication of endovascular thoracic aneurysm exclusion
- 1998
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Ingår i: Journal of Endovascular Surgery. - 1074-6218. ; 5:3, s. 274-277
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: To describe a fatal case of late aortic perforation by an endograft-anchoring stent. METHODS AND RESULTS: A 69-year-old woman presented 2 years after thoracoabdominal aneurysm repair with a 9-cm dilatation of the descending thoracic aorta proximal to the conventional aortic graft. A 38-mm Dacron graft with multiple Gianturco Z-stents sutured inside was placed transluminally across the aortic arch such that part of the uncovered portion of the proximal stent was partially across the left subclavian orifice. Four months later, the patient died from massive hemorrhage. Autopsy showed that the uncovered portion of the proximal stent had perforated the aortic arch. CONCLUSIONS: This case stresses the need for low-profile stent-grafts and smaller, more flexible introducer systems. Anchoring stents must be flexible, less traumatic, and strong enough to create a watertight seal even in tortuous vessels. To avoid aortic arch damage by thoracic stent-grafts, the proximal stent should be fully covered by the fabric.
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| 10. |
- Sonesson, Björn, et al.
(författare)
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Dilatation of the infrarenal aneurysm neck after endovascular exclusion of abdominal aortic aneurysm
- 1998
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Ingår i: Journal of Endovascular Surgery. - 1074-6218. ; 5:3, s. 195-200
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: To determine the fate of the infrarenal aneurysm neck and suprarenal aorta after endovascular exclusion of abdominal aortic aneurysms (AAAs). METHODS: Thirty-four patients underwent endovascular AAA repair between January 1994 and December 1995 using custom-made stent-grafts constructed from polyester graft material and modified self-expanding Gianturco Z-stents sutured to the graft orifices. Thirty-one patients were available for follow-up. Pre- and postimplantation diameters were measured using spiral computed tomography in the infrarenal aneurysm neck and the suprarenal aorta at the level of the superior mesenteric artery (SMA). RESULTS: The mean follow-up time was 25 months. There was a significant increase of the diameter of the infrarenal aneurysm neck (+ 1.65 mm, p = 0.002), but not in the aorta at the level of the SMA (+0.52 mm, p = 0.100). There was no difference in the change in diameter in the infrarenal neck in the group with a stent adjacent to the level of measurement (n = 20) compared with the group without an adjacent stent (n = 11, p = 0.790). There was no correlation between preimplantation size of the infrarenal neck and its diameter change (r = 0.14, p = 0.488). There was no correlation (r = 0.10, p = 0.603) or association (chi-square test, p = 0.211) between aortic diameter change at the level of the SMA and the infrarenal neck. CONCLUSIONS: This investigation shows a significant dilatation of the infrarenal aneurysm neck, but not in the suprarenal aorta, after endovascular AAA repair with this device. The clinical significance of these findings is unclear. Whether such a dilatation in the infrarenal aneurysm neck may affect the long-term attachment of stent-grafts remains to be shown in the future.
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