| 1. |
- Berglund, Jan, et al.
(författare)
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Rapid increase in volume of the remnant after hemithyroidectomy does not correlate with serum concentration of thyroid stimulating hormone
- 1998
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Ingår i: European Journal of Surgery. - : Oxford University Press (OUP). - 1102-4151 .- 1741-9271. ; 164:4, s. 257-262
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To study the effect of postoperative thyroxine on the volume of the thyroid remnant after lobectomy for benign nontoxic goitre. DESIGN: Prospective, randomised study. SETTING: University hospital, Sweden. SUBJECTS: 50 consecutive patients who underwent lobectomy for benign non-toxic goitre. INTERVENTIONS: Patients were randomised postoperatively to take thyroxine 0.1 mg or placebo daily. MAIN OUTCOME MEASURES: The median volume of the remaining thyroid lobe measured by ultrasound. Serum concentrations of thyroxine, triiodothyronine (T3) and thyroid stimulating hormone (TSH) were measured preoperatively and 1, 3, 6, 12 months postoperatively. RESULTS: The median volume of the remaining lobe had increased significantly compared with preoperatively by 1 month postoperatively by 30% in the thyroxine group and 25% in the placebo group (p < 0.01). The difference between the groups was not significant. After the first month the volume did not change significantly. In the thyroxine group, the TSH concentration was unchanged and the thyroxine concentration increased significantly throughout the study. In the placebo group there was a significant increase in TSH concentration and a significant decrease in that of thyroxine at all follow-up examinations. CONCLUSIONS: There is a significant increase in the volume of the remaining thyroid 1 month after lobectomy that persisted throughout the first year. Thyroxine given in a dose that kept the serum TSH concentration at the same level as preoperatively did not seem to influence volume changes; consequently we consider that these are caused by factors other than TSH.
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| 2. |
- 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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| 3. |
- 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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| 4. |
- 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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| 5. |
- 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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| 6. |
- Kölby, Lars, 1963, et al.
(författare)
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Somatostatin receptor subtypes, octreotide scintigraphy, and clinical response to octreotide treatment in patients with neuroendocrine tumors.
- 1998
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Ingår i: World journal of surgery. - 0364-2313. ; 22:7, s. 679-83
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Tidskriftsartikel (refereegranskat)abstract
- Several types of neuroendocrine tumor express high numbers of somatostatin receptors (sstr). We have compared the expression of sstr subtypes with the outcome of octreotide scintigraphy in patients with carcinoids and medullary thyroid carcinoma (MTC) in comparison with Hürthle cell tumors. The effect of sstr activation (octreotide treatment) on tumor markers was also studied in patients with disseminated carcinoid tumors. Six patients with carcinoid tumors (four midgut and two foregut), and three patients with thyroid tumors (one MTC, one Hürthle cell carcinoma, and one Hürthle cell adenoma) were studied. Octreotide scintigraphy visualized tumor sites in all nine patients. Macroscopic tumor was verified at these sites at subsequent surgical exploration. Using Northern blotting and subtype-specific riboprobes, sstr could be detected in all tumors examined. All five sstr subtypes were detected in most of the carcinoid tumors. All six carcinoids expressed sstr2. This was in contrast to the findings for the thyroid tumors analyzed, which also expressed several sstr subtypes but in some cases lacked expression of sstr2. This was also the case for normal thyroid tissue. Clinically, octreotide treatment of the patients with midgut carcinoid tumors resulted in palliation of hormonal symptoms accompanied by a significant reduction of urinary 5-HIAA levels (28-71%). These results indicate that carcinoid tumors frequently express all five sstr subtypes. The thyroid tumors also expressed multiple sstr but could lack expression of sstr2. Nevertheless, these tumors were visualized by octreotide scintigraphy, indicating that sstr2 expression is not a prerequisite for tumor imaging.
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| 7. |
- Boegård, Torsten
(författare)
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Radiography and bone scintigraphy in osteoarthritis of the knee: comparison with MR imaging
- 1998
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The aim was to compare radiography of the tibiofemoral joint (TFJ) and the patellofemoral joint (PFJ), as well as bone scinigraphy with MR imaging in middle-aged individuals with chronic knee pain in the format of a prospective study of knee osteoarthritis. Individuals aged 35-54 years with chronic knee pain were identified. The prevalence of chronic knee pain was 15% (279/2000). Within this group of people, both knees in 61 randomly chosen persons, were examined with plain weight-bearing radiograms of the TFJ, standing axial radiograms of the PFJ and bone scintigraphy. One knee (the most painful at inclusion in the study) in each person was examined with MR imaging on a 1.0 T imager. Assessment of the minimal joint space (MJS) width in the PA view of the TFJ in weight-bearing examinations should be performed with equal weight on both legs and in semiflexion. MJS of 3 mm in the TFJ and MJS of 5 mm in the PFJ are limits in diagnosing joint-space narrowing (JSN) in the TFJ and the PFJ, respectively. There is a high prevalence of meniscal abnormalities within the narrowed compartments of the TFJ in comparison with those that were narrowed. With the presence of marginal osteophytes in the TFJ there is a high prevalence of MR-detected cartilage defects in the same joint whether JSN (MJS < 3 mm) is present or not. No such relationship, independent of MJS, was found between marginal osteophytes and cartilage defects in the PFJ. The agreement between increased bone uptake and MR-detected subchondral lesion was good. The agreement between increased bone uptake and MR-detected osteophytes or cartilage defects was in general poor. With the increased knowledge about interpreting weight-bearing PA radiograms of the TFJ and axial radiograms of the PFJ, these examinations will even in the future be valuable when evaluating knee pain. Further studies have to be done to evaluate if MR imaging has the same ability as bone scintigraphy to predict the progression of the OA process.
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| 8. |
- Bornmyr, Siv
(författare)
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Laser Doppler Flowmetry and Imaging: Methodological Studies
- 1998
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Laser Doppler flowmetry (LDF) and laser Doppler imaging (LDI) are modern methods for non-invasive and continuous assessment of skin blood flow. The techniques are based on the phenomenon that monochromatic light transilluminating a perfused tissue is spectrally broadened owing to scattering by moving blood cells. In this study, methodological aspects of the two methods are presented. LDF was used in healthy subjects and in patients with peripheral arterial occlusive disease to determine the skin perfusion pressure by measuring the flow cessation external pressure (FCEP). With a normal ankle index, FCEP is lower than the ankle pressure and with a decreased ankle index, FCEP correlates with the ankle pressure. LDF and LDI were used in healthy subjects to investigate the mechanisms of skin blood flow regulation particularly related to the sympathetic nervous system, and to elucidate the interrelation between skin temperature and skin blood flow. We found that LDF and LDI can be used to monitor sympathetic vasoconstriction. The interrelation between skin temperature and skin blood flow as measured with the laser Doppler techniques is ambiguous. LDI was used to examine the pathophysiological background to cold intolerance experienced by patients with traumatic division of the ulnar artery. Although ligation of the ulnar artery causes reduced finger skin blood flow, cold intolerance cannot be attributed solely to alterations in blood flow. A clinical test based on LDI was developed for routine assessment of the sympathetic vasoconstrictor response (VAC). Healthy subjects as well as patients with sympathectomy due to hand hyperhidrosis underwent the test procedure. A VAC nomogram was constructed in relation to which the patients with sympathectomy showed a clearly attenuated response. Finally, LDI was combined with digital photography to facilitate the interpretation of blood flow profiles in relation to clinical signs, and the device proved to be of clinical value.
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| 9. |
- Hochbergs, Peter
(författare)
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Magnetic Resonance Imaging in Legg-Calvé-Perthes Disease
- 1998
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The aims of this study were: to compare the cartilaginous outline of the femoral head obtained on arthrograms with those on MR images and to correlate it to the bony head outlines on conventional radiograps; to study early, postoperative cartilaginous and bony remodeling of the femoral head, after proximal femoral varus derotation extension osteotomy, with MR imaging and conventional radiography; to describe signal abnormalities on MR images in the femoral epiphysis, their location, extent and restitution over time; to evaluate the degree and persistence of synovitis in the hip joint by MR imaging; to analyze the metaphyseal histology and to correlate it to the signal intensity on the MR images in the corresponding biopsy region. Results and conclusions: MR imaging and arthrography define the shape of the femoral head cartilage equally well. The bony head outlines on conventional radiographs do not adequately reflect the cartilaginous outlines of the femoral head obtained by MR imaging. There is an early, postoperative, continuous, spherical remodeling following proximal femoral varus derotation extension osteotomy. The cartilaginous remodeling as seen in MR images appears earlier than the bony remodeling seen on conventional radiographs. In the coronal plane on MR images, the pathological signal is lowest in the central portion of the necrotic epiphysis. In addition, hips with advanced disease show signal changes in the peripheral regions. Repair processes start from the periphery, slowly progressing towards the center of the necrotic epiphyseal region. Signal changes persist in the period 3-6 years after diagnosis. All diseased hips have synovitis initially. The degree of synovitis on MR images in the inferomedial aspect of the hip joint correlates to the extent of the epiphyseal necrosis seen in conventional radiography or MR imaging. Synovitis is most intense initially in the disease, slowly decreasing, but persisting for several years, in some hips for more than 5 years after diagnosis. There is no correlation between the uniform histological patterns of consistent morphologic changes of the metaphysis and MR imaging with a low-field unit.
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| 10. |
- Sandgren, Thomas, et al.
(författare)
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Factors predicting the diameter of the popliteal artery in healthy humans
- 1998
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Ingår i: Journal of Vascular Surgery. - 1097-6809. ; 28:2, s. 284-289
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: To determine the relevance of popliteal dilatations, knowledge of the normal popliteal artery diameter is essential. This study investigates the diameter of the popliteal artery in healthy males and females. METHODS: We measured the diameter of the popliteal artery in 121 healthy volunteers (59 males and 62 females), ages 8 to 81, with echo-tracking B-mode ultrasonography. We analyzed the influence of age, sex, height, weight, body surface area (BSA) and systolic blood pressure with a multiple regression model. RESULTS: The popliteal artery increased steadily in diameter throughout life. From 25 years on, the diameter was larger in males than in females. If corrected for BSA, this difference decreased from 17% to 7%. This study found a correlation between popliteal artery diameter and BSA (r=0.47 and r=0.61, respectively, p < 0.0001). Age, followed by BSA, was the most influencing factor on popliteal diameter in both males and females (r=0.62 and r=0.66, respectively, p < 0.0001). We used age and BSA in creating a model for prediction of popliteal artery diameter. CONCLUSIONS: The diameter of the popliteal artery increases with age, initially during growth, but also in adults. This is related to age, body size and sex, with males having larger arteries than females. It is now possible to predict the normal popliteal arterial diameter, and nomograms are presented for use in the study of aneurysmal arterial disease.
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