| 1. |
- Acosta, Stefan, et al.
(författare)
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Diagnostic pitfalls at admission in patients with acute superior mesenteric artery occlusion
- 2012
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Ingår i: Journal of Emergency Medicine. - : Elsevier. - 0736-4679 .- 1090-1280. ; 42:6, s. 635-641
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Acute superior mesenteric artery (SMA) occlusion leads to acute intestinal ischemia and is associated with high mortality. Early diagnosis is often missed, and confounding factors leading to diagnostic delays need to be highlighted.OBJECTIVES: To identify potential diagnostic laboratory pitfalls at admission in patients with acute SMA occlusion.METHODS: Fifty-five patients with acute SMA occlusion were identified from the in-hospital register during a 4-year period, 2005-2009.RESULTS: The median age was 76 years; 78% were women. The occlusion was embolic in 53% and thrombotic in 47% of patients. At admission, troponin I was above the clinical decision level (> 0.06 μg/L) for acute ischemic myocardial injury in 9/19 (47%) patients with embolic occlusion. Elevated pancreas amylase and normal plasma lactate were found in 12/45 and 13/27, respectively. A troponin I (TnI) above the clinical decision level was associated with a high frequency of referrals from the general surgeon to a specialist in internal medicine (p = 0.011) or a cardiologist (p = 0.024). The diagnosis was established after computed tomography angiography in 98% of the patients. The overall in-hospital mortality rate was 33%. Attempting intestinal revascularization (n = 43; p < 0.001), with a 95% frequency rate of completion control of the vascular procedure, was associated with a higher survival rate, whereas referral to the cardiologist was associated with a higher mortality rate (p = 0.018).CONCLUSION: Elevated TnI was common in acute SMA occlusion, and referral to the cardiologist was found to be associated with adverse outcome. Elevated pancreas amylase and normal plasma lactate values are also potential pitfalls at admission in patients with acute SMA occlusion.
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| 2. |
- Bergqvist, David, et al.
(författare)
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Inga dödsfall/slaganfall efter kirurgi vid asymtomatisk karotisstenos : femårsresultat redovisat i riksstäckande register
- 2006
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Ingår i: Läkartidningen. - 0023-7205 .- 1652-7518. ; 103:5, s. 301-302
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Tidskriftsartikel (refereegranskat)abstract
- In the Swedish vascular registry 7473 carotid endarterectomies are registered, in 10% the indication being a symptomatic stenosis. There are great variations in indication for carotid endarterectomy within Sweden. During the last five years the combined postoperative mortality and/or postoperative permanent stroke has varied between 3% in 1999 and 1.5% in 2003. During the same period not a single patient operated on for a symptomatic carotid stenosis experienced these complications.
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| 3. |
- Block, Tomas, et al.
(författare)
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Altered mRNA-expression due to acute mesenteric ischaemia in a porcine model
- 2011
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Ingår i: European Journal of Vascular and Endovascular Surgery. - : Elsevier BV. - 1078-5884 .- 1532-2165. ; 41:2, s. 281-287
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: mRNA changes in the small intestine in response to acute mesenteric ischaemia (AMI) could offer novel diagnostic possibilities, but have not been described. The aim was to characterize the mRNA response to experimental AMI. Materials and methods: Twelve pigs underwent catheterization of the superior mesenteric artery with injection of polivinylalcohol embolization particles or sodium chloride. Laparotomy and intestinal tissue sampling was performed. Microarray analysis was performed using the GeneChip® whole porcine genome array. Results: Seven down-regulated cellular pathways were associated with protein, lipid and carbohydrate metabolism. Seventeen up-regulated pathways were associated with inflammatory and immunological activity, regulation of extracellular matrix and decreased cellular proliferation. Thrombospondin(THS), Monocyte Chemoattractant Protein 1(MCP-1) and Gap Junction Alpha 1(GJA-1) were consistently up-regulated in all embolized pigs. Genes encoding earlier proposed biomarkers for AMI were up-regulated, such as lactate dehydrogenase and creatine kinase, or down-regulated, such as intestinal fatty acid binding protein and glutathione S-transferase. Conclusion: This study describes the intestinal tissue response on a gene expression level to AMI. THS, MCP-1 and GJA-1 were consistently up-regulated by ischemia, whereas earlier proposed biomarkers for AMI were not. Gene expression may not be directly linked to the use of the corresponding proteins as potential clinical biomarkers.
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| 4. |
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| 5. |
- Koraen-Smith, Linn, et al.
(författare)
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Urgent carotid surgery and stenting may be safe after systemic thrombolysis for stroke
- 2014
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Ingår i: Stroke. - : Lippincott Williams & Wilkins. - 0039-2499 .- 1524-4628. ; 45:3, s. 776-780
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND AND PURPOSE: Early carotid surgery or stenting after thrombolytic treatment for stroke has become more common during recent years. It is unclear whether this carries an increased risk of postoperative complications and death. The aim of this nationwide population-based study was, therefore, to investigate the safety of urgently performed carotid procedures in patients treated with thrombolysis for stroke.METHODS: Using the national Vascular and Stroke registries, we identified 3998 patients who had undergone carotid endarterectomy or carotid artery stenting for symptomatic carotid stenosis between May 2008 and December 2012. Among these, 2% (79 of 3998) had undergone previous thrombolysis for stroke. We conducted a retrospective review of registry data and individual case records with regard to postoperative complications, including surgical-site bleeding, stroke, and death. The outcome was compared with the results for the remaining patient cohort (3919 of 3998) undergoing carotid surgery and stenting during the study period.RESULTS: The median time between thrombolysis and the carotid procedure was 10 days. Seventy-one patients underwent carotid endarterectomy, and 6 patients underwent carotid artery stenting. The 30-day death and stroke rate for the thrombolysis cohort was 2.5% (2 of 79), and for the whole cohort, it was 3.8% (139 of 3626; P=0.55). The postoperative bleeding rates requiring reoperation were not significantly different between the groups (3.8% [3 of 79] in the thrombolysis group versus 3.3% [119 of 3626] in the whole cohort; P=0.79). There was no correlation between time from lysis to surgery or stenting and complications at 30 days postoperatively.CONCLUSIONS: Urgent carotid endarterectomy or carotid artery stenting after thrombolysis for stroke may be safe without increased risk of serious complications.
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| 6. |
- Sörelius, Karl, et al.
(författare)
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Endovascular treatment of mycotic aortic aneurysms: a European multicenter study.
- 2014
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Ingår i: Circulation. - : Lippincott Williams & Wilkins. - 1524-4539 .- 0009-7322. ; 130:24, s. 2136-42
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Tidskriftsartikel (refereegranskat)abstract
- Mycotic aortic aneurysm (MAA) is a rare and life-threatening disease. The aim of this European multicenter collaboration was to study the durability of endovascular aortic repair (EVAR) of MAA, by assessing late infection-related complications and long-term survival.
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| 7. |
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| 8. |
- Wågsäter, Dick, Professor, et al.
(författare)
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Circulating microRNA in patients with popliteal and multiple artery aneurysms
- 2021
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Ingår i: JVS-vascular science. - : Elsevier. - 2666-3503. ; 2, s. 129-135
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Tidskriftsartikel (refereegranskat)abstract
- Background: Patients with popliteal artery aneurysm (PA) often have multiple aneurysms, such as bilateral disease or a concomitant abdominal aortic aneurysm (AAA). microRNAs (miRs) are regulators of biological processes and have been investigated as biomarkers for AAA. The aim of this study was to explore if the presence of multiple aneurysms and/or location correlated with miR levels in blood.Methods: Using quantitative polymerase chain reaction, 23 miRs were analyzed in plasma from 183 patients with PA.Results: Fifteen of the miRs were associated with the number and/or location of aneurysms (1.3- to 2.1-fold changes). Levels of miR-93 (1.4-fold) and miR-215 (1.6- to 1.9-fold) were changed in all compared groups. MiR-24 and miR-23a were altered in those with AAA (1.4- and 1.5-fold, respectively) or bilateral PA (1.5- and 1.4-fold, respectively), compared with in those without. MiR-145 were significantly altered (1.7-fold) in those with isolated PA and AAA, whereas miR-326 were altered in those with bilateral (2.3-fold) and isolated PA (1.9-fold).Conclusions: Different miRs seem to be important or to be markers for different subgroups of patients with PA. The identified miRs target vascular smooth muscle cell proliferation and vascular inflammation. Further studies are needed to increase the understanding of the pathogenesis of aneurysmal disease.
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