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- Herbst, Andreas, et al.
(författare)
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Infections and antibiotic prophylaxis in reconstructive vascular surgery
- 1989
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Ingår i: European Journal of Vascular Surgery. - 0950-821X. ; 3:4, s. 303-307
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Tidskriftsartikel (refereegranskat)abstract
- In 98 patients undergoing elective vascular surgery, specimens for bacterial cultures were obtained from urine, ischaemic ulcers, incisional wounds and the implanted grafts. Wound and graft infections were registered and compared with the results of these cultures and suspected risk factors in an attempt to find the source of infections. Antibiotic prophylaxis with cefuroxime was given for 24 h beginning at the start of surgery. Patients with ischaemic ulcers also received "spread prophylaxis", directed against isolated bacteria, for ten days. Three cases of graft infection and twelve cases of wound infection occurred. Positive postoperative cultures from wounds did not correlate with pre- or peroperative cultures. Peroperative cultures revealed small numbers of staphylococcus epidermidis in eleven patients, and none of them developed graft infection. Ischaemic ulcers, diabetes or re-do procedures were not accompanied by a significantly increased frequency of wound or graft infection, although each of three patients with graft infection had one of these risk factors. Bacteria, sensitive to cefuroxime, were found in one graft infection, six wound infections, and in two patients with urosepsis, whereas cefuroxime resistant organisms were isolated from one graft infection and three infected wounds. One of the three graft infections was probably caused by bacteria originating from the patient's ischaemic ulcer. In the other two patients the source of bacteria could not be determined. Cefuroxime seems to be an adequate alternative for prophylaxis of vascular graft infection, but in some patients with bacteriuria or indwelling catheters, a one day regimen may be too short.
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- Lundberg, Johan, et al.
(författare)
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Direct evidence of active sympathetic vasodilatation in the skin of the human foot
- 1989
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Ingår i: Journal of Physiology. - 1469-7793. ; 417, s. 437-446
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Tidskriftsartikel (refereegranskat)abstract
- 1. During operative aorto-femoral vascular reconstructions on sixteen patients, the sympathetic chain was stimulated electrically between the L2 and L4 ganglia while blood flow was monitored by laser doppler flowmeters from the skin on the sole of the foot and the ankle and by an electromagnetic flowmeter from the deep femoral artery. Epidural anaesthesia to at least the T6 level was used which excluded reflex effects. 2. Stimulation (10 Hz) at 1-12 mA current strengths for 30 s evoked both reductions and increases of blood flow in glabrous and hairy skin. Initial short-lasting flow increases (durations 9-19 s) followed by sustained decreases were common: sometimes there were sustained flow increases at low and decreases at high current strengths. 3. In the deep femoral artery (supplying predominantly muscle) only flow reductions were evoked. 4. The results provide evidence for sympathetically mediated vasodilatation in the skin of the human foot whereas leg muscles may be supplied by vasoconstrictor nerves only.
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| 5. |
- Ribbe, Else, et al.
(författare)
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Platelet aggregation on peritoneal tube grafts and double velour grafts in the inferior vena cava of the pig
- 1988
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Ingår i: British Journal of Surgery. - : Oxford University Press (OUP). - 1365-2168 .- 0007-1323. ; 75:1, s. 81-85
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Tidskriftsartikel (refereegranskat)abstract
- In 14 pigs the infrarenal vena cava was replaced with a peritoneal tube graft or a collagen-coated double velour graft. With 111In-labelled platelets dynamic in vivo imaging of platelet aggregation over the graft was carried out using a scintillation camera. After removal, the grafts were examined by autoradiography for an evaluation of the platelet aggregation pattern. Measurements of activity in different regions of the grafts were also performed. The results indicated low activity uptakes both in vivo and in vitro. The dynamic study did not show any uniform increase of activity content 1-3 h postoperatively, in any of the groups. During the period 2-3 h postoperatively no increasing activity accumulation was found. Hemashield Microvel grafts had an uptake of 0.19 per cent of the total activity while the corresponding figure for peritoneal tube grafts was 0.17 per cent. The activity distribution on different parts of the grafts indicated lower accumulation on the Hemashield graft surfaces than in the anastomoses, while the accumulation was higher on the graft surface of peritoneal tube grafts. The autoradiographical findings supported this indication. In conclusion, low platelet aggregation was found with both dynamic in vivo imaging and in vitro activity measurements on both peritoneal tube grafts and collagen-coated double velour grafts.
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