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| 2. |
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| 3. |
- Heggebo, L. C., et al.
(författare)
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Investigating survival, quality of life and cognition in PROton versus photon therapy for IDH-mutated diffuse grade 2 and 3 GLIOmas (PRO-GLIO): a randomised controlled trial in Norway and Sweden
- 2023
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Ingår i: Bmj Open. - : BMJ. - 2044-6055. ; 13:3
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Tidskriftsartikel (refereegranskat)abstract
- IntroductionThe use of proton therapy increases globally despite a lack of randomised controlled trials demonstrating its efficacy and safety. Proton therapy enables sparing of non-neoplastic tissue from radiation. This is principally beneficial and holds promise of reduced long-term side effects. However, the sparing of seemingly non-cancerous tissue is not necessarily positive for isocitrate dehydrogenase (IDH)-mutated diffuse gliomas grade 2-3, which have a diffuse growth pattern. With their relatively good prognosis, yet incurable nature, therapy needs to be delicately balanced to achieve a maximal survival benefit combined with an optimised quality of life.Methods and analysisPRO-GLIO (PROton versus photon therapy in IDH-mutated diffuse grade 2 and 3 GLIOmas) is an open-label, multicentre, randomised phase III non-inferiority study. 224 patients aged 18-65 years with IDH-mutated diffuse gliomas grade 2-3 from Norway and Sweden will be randomised 1:1 to radiotherapy delivered with protons (experimental arm) or photons (standard arm). First intervention-free survival at 2 years is the primary endpoint. Key secondary endpoints are fatigue and cognitive impairment, both at 2 years. Additional secondary outcomes include several survival measures, health-related quality of life parameters and health economy endpoints.Ethics and disseminationTo implement proton therapy as part of standard of care for patients with IDH-mutated diffuse gliomas grade 2-3, it should be deemed safe. With its randomised controlled design testing proton versus photon therapy, PRO-GLIO will provide important information for this patient population concerning safety, cognition, fatigue and other quality of life parameters. As proton therapy is considerably more costly than its photon counterpart, cost-effectiveness will also be evaluated. PRO-GLIO is approved by ethical committees in Norway (Regional Committee for Medical & Health Research Ethics) and Sweden (The Swedish Ethical Review Authority) and patient inclusion has commenced. Trial results will be published in international peer-reviewed journals, relevant conferences, national and international meetings and expert forums.Trial registration numberClinicalTrials.gov Registry (NCT05190172).
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| 4. |
- Sachdev, P. S., et al.
(författare)
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STROKOG (stroke and cognition consortium): An international consortium to examine the epidemiology, diagnosis, and treatment of neurocognitive disorders in relation to cerebrovascular disease
- 2017
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Ingår i: Alzheimer's & Dementia. - : Wiley. - 1552-5260 .- 1552-5279. ; 7, s. 11-23
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Tidskriftsartikel (refereegranskat)abstract
- Introduction The Stroke and Cognition consortium (STROKOG) aims to facilitate a better understanding of the determinants of vascular contributions to cognitive disorders and help improve the diagnosis and treatment of vascular cognitive disorders (VCD). Methods Longitudinal studies with ≥75 participants who had suffered or were at risk of stroke or TIA and which evaluated cognitive function were invited to join STROKOG. The consortium will facilitate projects investigating rates and patterns of cognitive decline, risk factors for VCD, and biomarkers of vascular dementia. Results Currently, STROKOG includes 25 (21 published) studies, with 12,092 participants from five continents. The duration of follow-up ranges from 3months to 21years. Discussion Although data harmonization will be a key challenge, STROKOG is in a unique position to reuse and combine international cohort data and fully explore patient level characteristics and outcomes. STROKOG could potentially transform our understanding of VCD and have a worldwide impact on promoting better vascular cognitive outcomes. © 2016 The Authors
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| 5. |
- Andersson, Ulrika, et al.
(författare)
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Inactivation of aconitase and oxoglutarate dehydrogenase in skeletal muscle in vitro by superoxide anions and/or nitric oxide.
- 1998
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Ingår i: Biochemical and Biophysical Research Communications - BBRC. - : Elsevier BV. - 0006-291X .- 1090-2104. ; 249:2, s. 512-6
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Tidskriftsartikel (refereegranskat)abstract
- Strips of rat soleus muscle were incubated in media containing a superoxide generating system and/or the nitric oxide donor sodium nitroprusside (SNP) before the maximal catalytic activities of aconitase, citrate synthase, and oxoglutarate dehydrogenase were measured. The maximal activities of aconitase and oxoglutarate dehydrogenase were both decreased by 25-30% by superoxide anions; however, only the maximal activity of aconitase was decreased, by approximately 50%, by incubation of muscles with SNP. Furthermore, when both superoxide and NO were present in the medium, aconitase activity was decreased by 70%. The maximal activity of citrate synthase was not affected by any of the treatments. This is the first time that superoxide anions or NO has been shown to inactivate aconitase and oxoglutarate dehydrogenase in skeletal muscle. It is suggested that these effects may be responsible for some alterations in skeletal muscle metabolism, and these possibilities are discussed.
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| 6. |
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| 7. |
- Blomstrand, Eva, et al.
(författare)
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Changes in plasma concentrations of aromatic and branched-chain amino acids during sustained exercise in man and their possible role in fatigue.
- 1988
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Ingår i: Acta Physiologica Scandinavica. - : Wiley. - 0001-6772 .- 1365-201X. ; 133:1, s. 115-21
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Tidskriftsartikel (refereegranskat)abstract
- The plasma concentrations of branched-chain and aromatic amino acids have been measured in two different types of sustained dynamic exercise. Twenty-two subjects participated in the 1986 Stockholm Marathon and eight subjects took part in an army training programme of approximately 1.5-h duration. Both types of exercise caused a significant decrease in the plasma concentration of branched-chain amino acids, while there was no change in the concentration of total (free plus bound to albumin) tryptophan. The plasma concentration of free tryptophan, which was measured in the marathon runners, was found to increase 2.4-fold during the race. This increase is probably caused by a pronounced elevation in the concentration of plasma free fatty acids during exercise, since these are known to displace tryptophan from albumin. The observed increase in plasma free tryptophan concentration, together with the decrease in plasma concentration of branched-chain amino acids, gives rise to a marked increase in the plasma concentration ratio of free tryptophan/branched-chain amino acids. This should lead to an increase in the rate of transport of tryptophan across the blood-brain barrier and hence to an increase in the rate of synthesis of 5-hydroxytryptamine (5-HT) in the brain. An elevated concentration of 5-HT in specific areas of the brain may be responsible, at least in part, for the development of physical, and/or mental fatigue during prolonged exercise.
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| 9. |
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| 10. |
- Blomstrand, Eva, et al.
(författare)
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Influence of ingesting a solution of branched-chain amino acids on perceived exertion during exercise.
- 1997
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Ingår i: Acta Physiologica Scandinavica. - 0001-6772 .- 1365-201X. ; 159:1, s. 41-9
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Tidskriftsartikel (refereegranskat)abstract
- On two occasions, seven male endurance-trained cyclists performed exhaustive exercise on a cycle ergometer in the morning after they had performed a bout of exercise the preceding evening in an attempt to lower the muscle glycogen stores. The subjects exercised at a work rate corresponding to approximately 70% of their maximal oxygen uptake for 60 min, followed by another 20 min of maximal exercise. During exercise the subjects were given either a solution of branched-chain amino acids (BCAAs) or flavoured water (placebo). Every 10 min during exercise the subjects rated their perceived exertion and mental fatigue on two different Borg scales. During the 60 min exercise at a given work rate the subjects ratings of perceived exertion when they were given BCAAs were 7% lower, and their ratings of mental fatigue were 15% lower than when they were given placebo. In addition, the performance in the colour task of Stroops Colour Word Test performed after exercise was improved when BCAAs had been ingested during exercise, compared with the results from the placebo trial. There was no difference in the physical performance between the two trials measured as the amount of work done during the last 20 min of exercise when the subjects performed at their maximum. The plasma concentration ratio of free tryptophan/BCAAs, which increased by 45% during exercise and by 150% 5 min after exercise in the placebo trial, remained unchanged or even decreased when BCAAs were ingested.
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| 11. |
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| 12. |
- Blomstrand, Peter, et al.
(författare)
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Cardiovascular effects of dobutamine stress testing in women with suspected coronary artery disease
- 1996
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Ingår i: Heart. - : BMJ Publishing Group Ltd. - 1355-6037 .- 1468-201X. ; 75:5, s. 463-468
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Tidskriftsartikel (refereegranskat)abstract
- Objective. To investigate the central and peripheral haemodynamic response to dobutamine stress testing in women with suspected ischaemic heart disease and to seek an explanation for the hypotension phenomenon. Design. 18 women aged 54-73 years were investigated with Doppler echocardiography and venous occlusion plethysmography during intravenous infusion of dobutamine 5-10 d after an episode of unstable angina. Results. An average peak dose of 33 (SD 9.7) μg/kg/min was given. Heart rate and cardiac output increased by 49% and 59%, respectively (P < 0.001). Total and leg peripheral vascular resistance decreased by 44% and 26%, respectively (P < 0.001). Four patients developed hypotension (decrease in systolic blood pressure > 10 mm Hg), one of whom had a paradoxical bradycardia and two a low increase in cardiac output. Patients with hypotension had a more pronounced decrease in total peripheral vascular resistance but a similar change in leg peripheral vascular resistance compared with patients without hypotension. Conclusions. Dobutamine infusion leads to marked peripheral vasodilatation and an increase in cardiac output. Some patients experience hypotension during the test for reasons which include paradoxical vasovagal reactions and diminished capacity for adequate increase in cardiac output. There is also a disparity between the pattern of total and leg peripheral vascular resistance in patients with hypotension which might reflect a baroreceptor mediated compensatory increase in vasoconstrictor tone of muscle vessels not matched in other vascular territories.
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| 13. |
- Blomstrand, Peter, et al.
(författare)
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Exercise echocardiography : a methodological study comparing peak‐exercise and post‐exercise image information
- 1992
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Ingår i: Clinical Physiology. - : John Wiley & Sons. - 0144-5979 .- 1365-2281. ; 12:5, s. 553-565
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Tidskriftsartikel (refereegranskat)abstract
- It is unclear whether echocardiography at peak bicycle exercise adds information to registrations obtained recumbent immediately after the test and what factors influence image quality. Therefore, exercise echocardiography was performed consecutively and prospectively in 66 men, unselected with regard to echocardiography, one month after an episode of unstable coronary artery disease. Of 594 segments (9 × 66), 569 (96%) were adequately visualized recumbent at rest. The corresponding figures recumbent directly after exercise, seated before exercise, and seated at peak exercise were 544 (92%), 474 (80%), and 428 (72%), respectively. In the majority of our patients, acceptable images at peak exercise were obtained for the septal region, while for the anterior, lateral, and inferior segments the success rate varied from 50 to 70%. Recumbent after exercise, the success rate was acceptable for most segments, possibly with the exception of the apical and lateral segments. Fifty‐five patients developed new wall motion abnormalities or worsening of wall motion in connection with exercise. Echocardiography at peak exercise provided more information than afterwards in patients with images of good quality. However, in patients with inferior image quality, the registrations obtained recumbent after the test revealed wall motion abnormalities which were not obtained seated at peak exercise. Patients with worse image quality had significantly higher respiratory rate and weight, and rated a higher degree of dyspnoea at peak exercise than those with good quality. We conclude that in middle aged men with coronary artery disease, image acquisition at peak bicycle exercise and immediately after exercise are of complementary value.
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| 14. |
- Blomstrand, Peter, et al.
(författare)
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Exercise echocardiography and thallium 201 single-photon emission computed tomography in male patients after an episode of unstable coronary artery disease
- 1994
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Ingår i: American Journal of Cardiac Imaging. - 0887-7971. ; 8:4, s. 283-289
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Tidskriftsartikel (refereegranskat)abstract
- To compare modern, digital exercise echocardiography and thallium 201 single-photon emission computed tomography (SPECT) in patients with unstable coronary artery disease, 65 men unselected with regard to echocardiography were prospectively investigated 1 month after an episode of unstable angina or non-Q-wave myocardial infarction. Exercise echocardiography and 201Tl SPECT were performed on consecutive days in connection with a standard symptom-limited upright bicycle test and analyzed in a 9-segment model. Coronary angiography was performed in all but 1 patient and 60 patients had significant coronary lesions. Wall motion abnormalities were seen in 53 patients (81%) at rest and perfusion defects in 57 patients (88%) at the redistribution images. New or worsening of wall motion abnormalities were seen in 55 patients, either seated at peak exercise or recumbent after exercise, and 43 patients had reversible or partially reversible 201Tl scintigraphic defects (P = .02). The segmental agreement between wall motion abnormalities and scintigraphic defects was low (58%). The additional value of exercise echocardiography and 201Tl SPECT to exercise test was greatest in patients with one-vessel disease. Thus, 1 month after an episode of unstable coronary artery disease in men, there is a high incidence of significant coronary stenoses as well as signs of ischemia shown both by wall motion abnormalities during exercise echocardiography and by postexercise studies with 201Tl SPECT. Exercise echocardiography gives a higher diagnostic yield regarding occurrence of reversible ischemia.
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| 15. |
- Bojmar, Linda, et al.
(författare)
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Multi-parametric atlas of the pre-metastatic liver for prediction of metastatic outcome in early-stage pancreatic cancer
- 2024
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Ingår i: Nature Medicine. - : NATURE PORTFOLIO. - 1078-8956 .- 1546-170X.
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Tidskriftsartikel (refereegranskat)abstract
- Metastasis occurs frequently after resection of pancreatic cancer (PaC). In this study, we hypothesized that multi-parametric analysis of pre-metastatic liver biopsies would classify patients according to their metastatic risk, timing and organ site. Liver biopsies obtained during pancreatectomy from 49 patients with localized PaC and 19 control patients with non-cancerous pancreatic lesions were analyzed, combining metabolomic, tissue and single-cell transcriptomics and multiplex imaging approaches. Patients were followed prospectively (median 3 years) and classified into four recurrence groups; early (<6 months after resection) or late (>6 months after resection) liver metastasis (LiM); extrahepatic metastasis (EHM); and disease-free survivors (no evidence of disease (NED)). Overall, PaC livers exhibited signs of augmented inflammation compared to controls. Enrichment of neutrophil extracellular traps (NETs), Ki-67 upregulation and decreased liver creatine significantly distinguished those with future metastasis from NED. Patients with future LiM were characterized by scant T cell lobular infiltration, less steatosis and higher levels of citrullinated H3 compared to patients who developed EHM, who had overexpression of interferon target genes (MX1 and NR1D1) and an increase of CD11B(+) natural killer (NK) cells. Upregulation of sortilin-1 and prominent NETs, together with the lack of T cells and a reduction in CD11B(+) NK cells, differentiated patients with early-onset LiM from those with late-onset LiM. Liver profiles of NED closely resembled those of controls. Using the above parameters, a machine-learning-based model was developed that successfully predicted the metastatic outcome at the time of surgery with 78% accuracy. Therefore, multi-parametric profiling of liver biopsies at the time of PaC diagnosis may determine metastatic risk and organotropism and guide clinical stratification for optimal treatment selection.<br />
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| 16. |
- Esbjörnsson, M, et al.
(författare)
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Sprint exercise enhances skeletal muscle p70S6k phosphorylation and more so in women than in men.
- 2012
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Ingår i: Acta Physiologica. - : Wiley. - 1748-1708 .- 1748-1716. ; 205:3, s. 411-22
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Tidskriftsartikel (refereegranskat)abstract
- AIM: Sprint exercise is characterized by repeated sessions of brief intermittent exercise at a high relative workload. However, little is known about the effect on mTOR pathway, an important link in the regulation of muscle protein synthesis. An earlier training study showed a greater increase in muscle fibre cross-sectional area in women than men. Therefore, we tested the hypothesis that the activation of mTOR signalling is more pronounced in women than in men. Healthy men (n=9) and women (n=8) performed three bouts of 30-s sprint exercise with 20-min rest in between.METHODS: Multiple blood samples were collected over time, and muscle biopsy specimens were obtained at rest and 140 min after the last sprint.RESULTS: Serum insulin increased by sprint exercise and more so in women than in men [gender (g) × time (t)]: P=0.04. In skeletal muscle, phosphorylation of Akt increased by 50% (t, P=0.001) and mTOR by 120% (t, P=0.002) independent of gender. The elevation in p70S6k phosphorylation was larger in women (g × t, P=0.03) and averaged 230% (P=0.006) as compared to 60% in men (P=0.04). Phosphorylation rpS6 increased by 660% over time independent of gender (t, P=0.003). Increase in the phosphorylation of p70S6k was directly related to increase in serum insulin (r=0.68, P=0.004).CONCLUSION: It is concluded that repeated 30-s all-out bouts of sprint exercise separated by 20 min of rest increases Akt/mTOR signalling in skeletal muscle. Secondly, signalling downstream of mTOR was stronger in women than in men after sprint exercise indicated by the increased phosphorylation of p70S6k.
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| 17. |
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| 18. |
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| 19. |
- Hassmén, Peter, et al.
(författare)
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Branched-chain amino acid supplementation during 30-km competitive run : mood and cognitive performance.
- 1994
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Ingår i: Nutrition. - 0899-9007 .- 1873-1244. ; 10:5, s. 405-10
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Tidskriftsartikel (refereegranskat)abstract
- It has been suggested that an elevated concentration of the neurotransmitter serotonin (5-hydroxytryptamine, 5-HT) in specific areas of the brain may contribute to the development of central/mental fatigue during and after sustained exercise. Supplementation with branched-chain amino acids (BCAAs) should prevent the exercise-induced increase in the plasma concentration ratio of free tryptophan to other large neutral amino acids (including BCAAs) and thereby prevent an elevation in the level of 5-HT in the brain. In this study, subjects were given either a mixture of BCAAs in a carbohydrate solution or a placebo drink that contained only carbohydrates during a 30-km cross-country race. Several tasks to measure cognitive performance were performed before and after the race. When subjects were supplied with BCAAs, their performance in the different parts of the color-word test (words, colors and color words) was improved by an average of 3-7% (p < 0.05) after exercise, whereas there was no difference in performance before and after exercise in the subjects who were given the placebo. Furthermore, the experimental group, supplied with BCAAs, maintained their performance in the shape-rotation and figure-identification tasks, whereas an impairment in performance in these tests by 25% (p < 0.05) and 15% (p < 0.05), respectively, was found in the subjects who received the placebo. Thus, BCAA supplementation seemed to have an effect on the more complex tasks, whereas no effect could be detected on the less demanding tasks. However, an intake of BCAAs during exercise modified only slightly the exercise-induced changes in mood.
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| 20. |
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| 21. |
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| 22. |
- Nybo, L, et al.
(författare)
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A spurious correlation - Reply
- 2004
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Ingår i: JOURNAL OF APPLIED PHYSIOLOGY. - 8750-7587. ; 97:2, s. 793-793
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)
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| 23. |
- Rosendahl, Lene, et al.
(författare)
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Late gadolinium uptake demonstrated with magnetic resonance in patients where automated PERFIT analysis of myocardial SPECT suggests irreversible perfusion defect
- 2008
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Ingår i: BMC Medical Imaging. - : BioMed Central. - 1471-2342. ; 8
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Myocardial perfusion single photon emission computed tomography (MPS) is frequently used as the reference method for the determination of myocardial infarct size. PERFIT(R) is a software utilizing a three-dimensional gender specific, averaged heart model for the automatic evaluation of myocardial perfusion. The purpose of this study was to compare the perfusion defect size on MPS, assessed with PERFIT, with the hyperenhanced volume assessed by late gadolinium enhancement magnetic resonance imaging (LGE) and to relate their effect on the wall motion score index (WMSI) assessed with cine magnetic resonance imaging (cine-MRI) and echocardiography (echo).METHODS: LGE was performed in 40 patients where clinical MPS showed an irreversible uptake reduction suggesting a myocardial scar. Infarct volume, extent and major coronary supply were compared between MPS and LGE as well as the relationship between infarct size from both methods and WMSI.RESULTS: MPS showed a slightly larger infarct volume than LGE (MPS 29.6 +/- 23.2 ml, LGE 22.1 +/- 16.9 ml, p = 0.01), while no significant difference was found in infarct extent (MPS 11.7 +/- 9.4%, LGE 13.0 +/- 9.6%). The correlation coefficients between methods in respect to infarct size and infarct extent were 0.71 and 0.63 respectively. WMSI determined with cine-MRI correlated moderately with infarct volume and infarct extent (cine-MRI vs MPS volume r = 0.71, extent r = 0.71, cine-MRI vs LGE volume r = 0.62, extent r = 0.60). Similar results were achieved when wall motion was determined with echo. Both MPS and LGE showed the same major coronary supply to the infarct area in a majority of patients, Kappa = 0.84.CONCLUSION: MPS and LGE agree moderately in the determination of infarct size in both absolute and relative terms, although infarct volume is slightly larger with MPS. The correlation between WMSI and infarct size is moderate.
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| 24. |
- Rosendahl, Lene, 1963-, et al.
(författare)
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Longitudinal peak strain detects a smaller risk area than visual assessment of wall motion in acute myocardial infarction
- 2010
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Ingår i: Cardiovascular Ultrasound. - : BioMed Central (BMC). - 1476-7120. ; 8:1
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Tidskriftsartikel (refereegranskat)abstract
- Background. Opening of an occluded infarct related artery reduces infarct size and improves survival in acute ST-elevation myocardial infarction (STEMI). In this study we performed tissue Doppler analysis (peak strain, displacement, mitral annular movement (MAM)) and compared with visual assessment for the study of the correlation of measurements of global, regional and segmental function with final infarct size and transmurality. In addition, myocardial risk area was determined and a prediction sought for the development of infarct transmurality 50%.Methods. Twenty six patients with STEMI submitted for primary percutaneous coronary intervention (PCI) were examined with echocardiography on the catheterization table. Four to eight weeks later repeat echocardiography was performed for reassessment of function and magnetic resonance imaging for the determination of final infarct size and transmurality.Results. On a global level, wall motion score index (WMSI), ejection fraction (EF), strain, and displacement all showed significant differences (p ≤ 0.001, p ≤ 0.001, p ≤ 0.001 and p = 0.03) between the two study visits, but MAM did not (p = 0.17). On all levels (global, regional and segmental) and both pre- and post PCI, WMSI showed a higher correlation with scar transmurality compared to strain. We found that both strain and WMSI predicted the development of scar transmurality 50%, but strain added no significant information to that obtained with WMSI in a logistic regression analysis.Conclusions. In patients with acute STEMI, WMSI, EF, strain, and displacement showed significant changes between the pre- and post PCI exam. In a ROC-analysis, strain had 64% sensitivity at 80% specificity and WMSI around 90% sensitivity at 80% specificity for the detection of scar with transmurality 50% at follow-up.
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| 25. |
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| 26. |
- Zachrisson, Helene, et al.
(författare)
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Changes in middle cerebral artery blood flow after carotid endarterectomy as monitored by transcranial Doppler.
- 2002
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Ingår i: Journal of Vascular Surgery. - 0741-5214 .- 1097-6809. ; 36:2, s. 285-90
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: By using transcranial Doppler (TCD) it is possible to measure blood flow velocities within the circle of Willis. In this study, TCD was performed before and after carotid endarterectomy (CEA) with the aim to describe cerebral hemodynamics after normalization of the carotid artery blood flow.METHODS: Thirty CEA patients were consecutively entered into the TCD study, whereas 15 patients were referred for postoperative TCD for various clinical reasons. All 45 patients were investigated by using TCD: first preoperatively, then during the first few days after CEA before discharge from the hospital, and finally 3 to 12 months later. In addition, all patients underwent duplex investigation of the internal carotid artery the day before surgery and 3 months postoperatively. For the analysis, the patients were divided into two groups, one with (S-group), suspected postoperative neurologic complications/symptoms and another one without (C-group). Six patients were assigned to the S-group and 37 to the C-group, the latter including two patients who underwent bilateral CEAs.RESULTS: In the whole study group,a significant postoperative increase in systolic flow velocity was recorded bilaterally in the middle cerebral artery (MCA) as measured some days after surgery. The patients in the S-group showed high blood flow velocities mainly in the MCA on the ipsilateral side. A contralateral flow velocity increase did not occur in patients with very severe contralateral stenosis or occlusion (n = 9) if the late follow-up investigation was chosen as a reference value. Twenty patients in the C-group formed a subgroup with high blood pressure and/or headache postoperatively (CB-group) The other 19 patients were referred to as the CA-group. The CB- and S-groups showed more pronounced vessel disease in internal carotid artery on the contralateral side combined with lower collateral capacity in the circle of Willis compared to the CA-group. In the S-group the mean +/- standard deviation peak systolic velocity in ipsilateral MCA increased from a preoperative value of 0.71 +/- 0.22 m/sec to 2.23 +/- 0.72 m/sec (P <.005). In the CB-group, we observed a bilateral MCA blood flow velocity increase from 0.72 +/- 0.18 to 1.35 +/- 0.56 m/sec (P <.0001) on the ipsilateral side and from 0.82 +/- 0.37 to 1.28 +/- 0.66 m/sec (P < 0.001) on the contralateral side. In the CA-group, we observed minor bilateral blood flow velocity increases in the MCA, from 0.79 +/- 0.25 m/sec to 1.03 +/- 0.33 m/sec on the ipsilateral (P <.001) and from 0.70 +/- 0.17 m/sec to 0.93 +/- 0.26 m/sec on the contralateral side (P <.005). At the follow-up 3 to 12 months after surgery, the MCA flow velocities had returned to normal.CONCLUSIONS: Soon after surgery, blood flow velocity increases often bilaterally in the MCA. However a contralateral flow velocity increase did not occur in patients with very severe contralateral stenosis or occlusion if the late follow-up investigation was chosen as a reference value. The clinical significance of bilateral flow velocity increases is uncertain, but very high blood flow velocities might be a signal for cerebrovascular hyperperfusion. In those patients, increased postoperative surveillance is recommended.
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