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Abstract
Two contrast media, iodixanol (Visipaque, Nycomed) 270 mg I/ml and iohexol (Omnipaque, Nycomed) 300 mg I/ml, were compared in femoral arteriography, in 147 patients. Both contrast media were diagnostically effective for use in femoral arteriography, without any significant difference. Pain was reported in connection with injection of iohexol by 36% of the patients, after injection of iodixanol none reported pain. Seventy-two percent of the patients in the iodixanol group reported a sensation of warmth in connection with contrast injection versus 90% in the iohexol group. The average intensity of the warmth was greater with iohexol than with iodixanol. Fourteen percent of patients in the iodixanol group and 1% in the iohexol group reported one or more subjective adverse events.
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Affiliation(s)
- Ö. Thorstensen
- Departments of Radiology, Huddinge Hospital, Karolinska Institute, Stockholm, University Hospital, Lund, and Södersjukhuset, Stockholm, and the Department of Surgery, University Hospital, Lund and Nycomed Imaging AS, Oslo, Norway
| | - U. Albrechtsson
- Departments of Radiology, Huddinge Hospital, Karolinska Institute, Stockholm, University Hospital, Lund, and Södersjukhuset, Stockholm, and the Department of Surgery, University Hospital, Lund and Nycomed Imaging AS, Oslo, Norway
| | - B. Calissendorff
- Departments of Radiology, Huddinge Hospital, Karolinska Institute, Stockholm, University Hospital, Lund, and Södersjukhuset, Stockholm, and the Department of Surgery, University Hospital, Lund and Nycomed Imaging AS, Oslo, Norway
| | - H. Lárusdóttir
- Departments of Radiology, Huddinge Hospital, Karolinska Institute, Stockholm, University Hospital, Lund, and Södersjukhuset, Stockholm, and the Department of Surgery, University Hospital, Lund and Nycomed Imaging AS, Oslo, Norway
| | - L. Norgren
- Departments of Radiology, Huddinge Hospital, Karolinska Institute, Stockholm, University Hospital, Lund, and Södersjukhuset, Stockholm, and the Department of Surgery, University Hospital, Lund and Nycomed Imaging AS, Oslo, Norway
| | - M. Tengvaw
- Departments of Radiology, Huddinge Hospital, Karolinska Institute, Stockholm, University Hospital, Lund, and Södersjukhuset, Stockholm, and the Department of Surgery, University Hospital, Lund and Nycomed Imaging AS, Oslo, Norway
| | - B. Bolstad
- Departments of Radiology, Huddinge Hospital, Karolinska Institute, Stockholm, University Hospital, Lund, and Södersjukhuset, Stockholm, and the Department of Surgery, University Hospital, Lund and Nycomed Imaging AS, Oslo, Norway
| | - P. Aspelin
- Departments of Radiology, Huddinge Hospital, Karolinska Institute, Stockholm, University Hospital, Lund, and Södersjukhuset, Stockholm, and the Department of Surgery, University Hospital, Lund and Nycomed Imaging AS, Oslo, Norway
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Kehler M, Albrechtsson U, Arnadóttir E, Ebbesen A, Hochbergs P, Lundin A, Lyttkens K, Kheddache K, Månsson LG, Angelhed JE. Digital Luminescence Radiography Using a Chest Phantom. Acta Radiol 2016. [DOI: 10.1177/028418519203300207] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Ninety-eight digital radiographs of a chest phantom with simulated tumors in the mediastinum and left lung and a pneumothorax-simulation in the right hemithorax were compared with the corresponding examinations saved on optical disk and viewed on a 1 000-line monitor. The examinations were reviewed by 7 radiologists with different experience, and receiver operating characteristic (ROC) curves were constructed. There was no significant difference between the hard-copy and the monitor results. A significant interobserver difference was seen only with the low attenuating 6 mm “tumor” and then only between the observer with the highest and the one with the lowest scores.
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Kehler M, Albrechtsson U, Andrésdóttir A, Brådvik I, Hochbergs P, Lárusdóttir H, Lundin A. Digital Luminescence Radiography in Interstitial Lung Disease. Acta Radiol 2016. [DOI: 10.1177/028418519103200106] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The subtle changes often found in interstitial lung disease can be difficult to evaluate at conventional radiography. In order to define the information obtained with digital radiography, it is particularly important to find out to what extent interstitial lung disease can be observed with this technique. Ninety-one patients, 56 with interstitial lung disease and 35 with normal lungs, were examined both with a digital system and with conventional film-screen technique. The examinations were reviewed independently by 4 radiologists with different experience and receiver operating characteristics (ROC) curves were constructed. The 2 systems were equal in diagnostic performance with no statistic difference between the conventional radiographs, the 2 digital images reviewed together or the 2 digital images reviewed separately. There was a significant difference between the 2 observers with the highest and the one with the lowest score only in the review of digital unsharp mask images, but otherwise no differences statistically. A lower number of false negatives and a higher number of false positives were seen with the digital unsharp mask image, producing a higher sensitivity and lower specificity.
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Kehler M, Albrechtsson U, Andersson B, Lárusdóttir H, Lundin A, Pettersson H. Assessment of Digital Chest Radiography Using Stimulable Phosphor. Acta Radiol 2016. [DOI: 10.1177/028418518903000603] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In this pilot study, conventional and digital radiography of the chest was compared in 170 patients. Two digitized radiographs, one frequency modified and one simulating the conventional film-screen combination, and the conventional films were reviewed independently by 5 radiologists with different experience. In spite of the smaller size and lower spatial resolution of the digitized compared with the conventional radiograph, only slight differences were revealed in the observation of different pulmonary and mediastinal changes. Digitized radiography is therefore considered suitable for chest examinations.
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Kehler M, Albrechtsson U, Alwmark A, Lárusdottír H, Ribbe E, Svahn G, Thörne J. Intra-Operative Digital Angiography as a Control of the in Situ Saphenous Vein By-Pass Grafts. Acta Radiol 2016. [DOI: 10.1177/028418518802900606] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Forty-two patients undergoing in situ saphenous vein by-pass grafting procedures, in two patients bilaterally, were examined intra-operatively with digital subtraction angiography. In 19 (43%) of the examinations the graft and the anastomoses appeared adequate. In 8 cases (18%) significant abnormalities were found, including stenoses (11 %), deficient anastomoses (5%) and graft kinking (2%). Remaining arteriovenous fistulas were found in 17 patients (39%). In most cases immediate correction was possible avoiding later re-operation. At follow up 11 of the 44 grafts were occluded, 10 of these during the first five months and of these five during the first week.
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Kehler M, Albrechtsson U, Andrésdóttir A, Lárusdóttir H, Lundin A. Accuracy of Digital Radiography Using Stimulable Phosphor for Diagnosis of Pneumothorax. Acta Radiol 2016. [DOI: 10.1177/028418519003100109] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
To evaluate the efficacy of digitized radiography in diagnosing pneumothorax 78 patients were examined with both the conventional film-screen technique and digital radiography. Of these 78 examinations 40 were normal and in 38 a pneumothorax was found. Four observers with different experience reviewed the films. In an ROC analysis no significant differences were found between the two systems. Between the observers, however, there were slight differences, one of them showing significantly lower specificity.
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7
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Abstract
In 26 patients iodixanol, a new nonionic dimer, isotonic to blood in all concentrations, was used as contrast medium in aortofemoral angiography. Half of the patients received contrast medium in a concentration of 270 mg I/ml and the other half 320 mg I/ml. The aim of the trial was to evaluate the safety and tolerability of iodixanol and the radiographic efficacy of the two concentrations. The degree of discomfort, adverse events, changes in serum chemistry parameters, and diagnostic information were assessed. There were no changes or trends of clinical importance in serum chemistry parameters. The side effects were mild and consisted mostly of some sensation of warmth of short duration. No other adverse events were seen. The overall radiographic efficacy did not show any significant difference between the two concentrations. This indicates that iodixanol is safe and well tolerated when used in adult femoral angiography.
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Affiliation(s)
- U. Albrechtsson
- Departments of Diagnostic Radiology and Surgery, University Hospital, Lund, Sweden, and Nycomed AS, Oslo, Norway
| | - H. Lárusdóttir
- Departments of Diagnostic Radiology and Surgery, University Hospital, Lund, Sweden, and Nycomed AS, Oslo, Norway
| | - L. Norgren
- Departments of Diagnostic Radiology and Surgery, University Hospital, Lund, Sweden, and Nycomed AS, Oslo, Norway
| | - B. Lundby
- Departments of Diagnostic Radiology and Surgery, University Hospital, Lund, Sweden, and Nycomed AS, Oslo, Norway
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Cronberg CN, Sjöberg S, Albrechtsson U, Leander P, Lindh M, Norgren L, Danielsson P, Sonesson B, Larsson EM. Peripheral arterial disease. Contrast-enhanced 3D MR angiography of the lower leg and foot compared with conventional angiography. Acta Radiol 2016. [DOI: 10.1258/rsmacta.44.1.59] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Purpose: To determine whether contrast-enhanced 3D MR angiography (CE MRA) could replace digital subtraction angiography (DSA) for the evaluation of atherosclerotic peripheral vascular disease of the lower leg and foot. Material and Methods: Thirty-five patients with symptoms of atherosclerotic disease of the leg were examined prospectively with CE MRA of the foot and the lower legs as well as with DSA from the aorta to the pedal arches. The MRA technique was focused on optimal imaging of the arteries of the foot. Results: The agreement between CE MRA and DSA for grading of stenosis was moderate to good (weighted κ-values 0.48–0.80). The sensitivity of CE MRA for detection of significant stenosis (≥ 50%) was 92% and the specificity was 64% with DSA as gold standard. Conclusion: CE MRA is a fairly accurate method for the demonstration of atherosclerotic disease below the knee including the pedal arches. It can replace DSA for the assessment of distal arteries in patients with impaired renal function. However, image quality and resolution still needs to be improved before CE MRA can become the method of choice in all patients.
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Affiliation(s)
- C. N. Cronberg
- Center for Medical Imaging and Physiology, University Hospital, Lund, Sweden
| | - S. Sjöberg
- Department of Diagnostic Radiology, University Hospital, Lund, Sweden
| | - U. Albrechtsson
- Center for Medical Imaging and Physiology, University Hospital, Lund, Sweden
| | - P. Leander
- Department of Diagnostic Radiology, University Hospital, Lund, Sweden
| | - M. Lindh
- Department of Diagnostic Radiology, University Hospital, Lund, Sweden
| | - L. Norgren
- Department of Vascular Surgery Malmö/Lund, University Hospital, Malmö, Sweden
| | - P. Danielsson
- Department of Vascular Surgery Malmö/Lund, University Hospital, Malmö, Sweden
| | - B. Sonesson
- Department of Vascular Surgery Malmö/Lund, University Hospital, Malmö, Sweden
| | - E.-M. Larsson
- Center for Medical Imaging and Physiology, University Hospital, Lund, Sweden
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Abstract
The natural history of an aortic dissection is either endothelialization of the false lumen forming a so-called double-barrelled aorta, or thrombosis of the sack leading to fibrosis and scarring. Complete healing of an aortic dissection is extremely rare, and has to our knowledge only been reported once in vivo. Here we report a second case of spontaneous resolution of an aortic dissection, disclosed by contrast medium enhanced computed tomography.
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Thorvinger B, Lundin A, Albrechtsson U. Increased Rate of Left Predominance Associated with Adult Valvular Aortic Stenosis. Acta Radiol 2016. [DOI: 10.1177/028418519003100304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The anatomy of the coronary arteries was outlined angiographically in 2 190 adult patients in order to determine the proportion of left predominance. Of 253 patients with valvular aortic stenosis 14.3 per cent were found to have left predominance, while the frequency of left predominance in the rest of the patients (1 937) was 8.5 per cent. Furthermore, this rate increases with the severity (gradient > 50 mmHg) of the aortic stenosis in the absence of aortic valve incompetence. These findings support the current concept of a relationship between adult aortic stenosis and congenital valvular malformation.
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Kehler M, Albrechtsson U, Andrésdóttir A, Hochbergs P, Lárusdóttir H, Lundin A, Lönntoft M. Efficacy of Inverted Digital Luminescence Radiography in Evaluating Chest Neoplasms. Acta Radiol 2016. [DOI: 10.1177/028418519103200602] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Inverted (positive) digital chest radiographs of patients with lung tumors were compared with commonly used (negative) digital images, consisting of one simulated normal and one contrast enhanced image. The first part of the material consisted of 80 patients of whom 40 had tumors and 40 were normal. Five radiologists with different experience reviewed the examinations. From their answers, ROC curves were constructed. The second part of the material consisted of 100 chest phantom examinations with a simulated tumor in the mediastinum (45 examinations) and/or the left lung (46 examinations). In 31 exposures there was no abnormality. These were reviewed by 3 observers and performed as an ROC study as well. There was no statistical difference between the different types of images or between the observers in the 2 studies.
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Abstract
Twenty-five patients with clinical relapse after previous successful angioplasty of iliac or femoro-popliteal arteries were evaluated with repeat angiography. The angiographic patency was 80% despite the clinical symptoms. The discrepancy between the angiographic appearance and the clinical findings was explained by the progress of the general arteriosclerotic vascular disease. Such progression is more important regarding late prognosis than the result of the angioplasty per se.
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13
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Ohlsén H, Albrechtsson U, Billström Å, Calissendorff B, Gustavsson S, Jensen R, Johnsson K, Nyberg P, Strindberg L. Comparison of Iopromide versus Iohexol in Aortobifemoral Arteriography. Acta Radiol 2016. [DOI: 10.1177/028418519103200208] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
A double-blind randomized, clinical trial was conducted in 9 hospitals comparing the use of non-ionic contrast media (CM) iopromide 300 (Ultravist) and iohexol 300 (Omnipaque) during peripheral arteriography in a total of 446 patients. After premedication with morphine-scopolamine each patient was given two consecutive injections of 50 ml CM at a rate of 12 ml/s above the aortic bifurcation. Both CM were well tolerated. There were no differences between the two substances as far as general tolerance, pulse rate, blood pressure, sensation of heat or pain after CM injection were concerned.
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Olsson CG, Albrechtsson U. A modified 125I-fibrinogen technique in suspected deep vein thrombosis. A comparison with plethysmography and phlebography. Acta Med Scand 2009; 207:461-7. [PMID: 7424565 DOI: 10.1111/j.0954-6820.1980.tb09755.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
The diagnostic efficiencies of a modified 125I-fibrinogen uptake test (FUT), venous strain gauge plethysmography, and the routine report on phlebography were compared in 301 consecutive patients with suspected deep vein thrombosis (DVT) in the leg. A keen, independent review of the phlebography films was used as the reference method. The FUT detected 62% of all thrombi after one hour, 71% after one day, and 98% after two days. False positive results were, however, found after two days in 52% of all patients without DVT. Plethysmography revealed 63% of the thrombi and was falsely positive in 23% of patients without DVT. The routine examination of phlebography films revealed only 86% of the thrombi seen at the final independent review. The routine report was falsely positive in 6% of patients without thrombi. Consequently, the modified FUT is a useful screening test; at one hour it was equally sensitive to DVT as plethysmography and after two days it excluded DVT with a significantly better sensitivity than the routine report on phlebography. Drawbacks of FUT are the delay of the diagnosis in some patients and the low specificity. In patients with a pathological FUT, further investigation is often required. Plethysmography is not recommended as a screening test, since it lacks both sensitivity and specificity.
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Gustavsson CG, Gustafson A, Albrechtsson U, Lárusdóttir H, Ståhl E, Olin C. Diagnosis and management of acute aortic dissection, clinical and radiological follow-up. Acta Med Scand 2009; 223:247-53. [PMID: 3354351 DOI: 10.1111/j.0954-6820.1988.tb15794.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
A clinical series of acute aortic dissections is presented. Twenty cases were of type A and 10 of type B. Acute severe chest pain was common, in type A also blood pressure difference between the arms and aortic regurgitation. The diagnosis was established by echocardiography, computerized tomography and/or aortography. Antihypertensive therapy was instituted immediately after diagnosis and was in type A cases followed by acute surgery unless definite contraindications existed. Of 14 surgically treated type A patients 13 survived the operation. On follow-up 1.5-3.5 years later, 12 patients were still alive and doing well, but the false channel remained open in all cases where it had not been resected totally. Only one of six conservatively treated type A patients survived. Type B dissections were operated on only if conservative therapy failed. Four of five conservatively and two of five surgically treated type B patients survived.
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Affiliation(s)
- C G Gustavsson
- Department of Cardiology, University Hospital, Lund, Sweden
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Engellau L, Albrechtsson U, Norgren L, Larsson EM. Long-term results after endovascular repair of abdominal aortic aneurysms with the Stentor and Vanguard stent-graft. Acta Radiol 2004; 45:275-83. [PMID: 15239422 DOI: 10.1080/02841850410004535] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
PURPOSE To present a single institution experience of long-term results after endovascular repair of abdominal aortic aneurysms (AAA) with the Stentor and Vanguard stent-grafts. MATERIAL AND METHODS Twenty-three patients (20 men, 3 women; mean age 68 years, range 53-81 years) were included in this prospective study. A first generation nitinol stent-graft (Stentor) was used in 12 patients and a second generation (Vanguard) in 11 patients. Follow-up was performed with magnetic resonance imaging (MRI) with contrast-enhanced MR angiography (CE MRA) at 1, 6, and 12 months, and thereafter annually (median follow-up 3 years; range 8 months to 8 years). A conventional radiograph of the abdomen was also performed. Before secondary intervention the findings on MRI with CE MRA were confirmed with spiral computed tomography (CT) and/or angiography (DSA). RESULTS Only one patient (4%) had no complication. Endoleak was found in 15 patients (65%), graft migration in 8 (35%), and graft deformation in 18 (78%). Secondary endovascular repair was required in 7 patients (30%) and 7 (30%) were converted to open repair. CONCLUSION Complications with the Stentor and Vanguard stent-grafts were common. Long-term follow-up of endovascularly repaired AAA is mandatory.
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Affiliation(s)
- L Engellau
- Department of Radiology, Lund University Hospital, Malmö University Hospital, Sweden
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Engellau L, Albrechtsson U, Dahlström N, Norgren L, Persson A, Larsson EM. Measurements before endovascular repair of abdominal aortic aneurysms. MR imaging with MRA vs. angiography and CT. Acta Radiol 2003. [PMID: 12694105 DOI: 10.1034/j.1600-0455.2003.00029.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
PURPOSE 1) To compare measurements obtained with MR imaging (MRI)/contrast-enhanced MR angiography (CE MRA) with measurements obtained with angiography (DSA) and CT, for stent-graft sizing of abdominal aortic aneurysms (AAA). 2) To compare MRA measurements obtained with the two post processing techniques MIP (maximum intensity projection) and VRT (3D volume rendering technique). MATERIAL AND METHODS The prospective study included 20 consecutive patients with AAA identified by DSA and CT as suitable for endovascular repair. For the study, MRI/CE MRA was performed. Five measurement variables for stent-graft sizing were chosen. Comparisons were made between MRI/CE MRA, DSA and CT, and between observers. Comparisons were also made between MIP and VRT. RESULTS Significantly shorter lengths were obtained with MRA-MIP than with DSA. Three out of six diameter measurements were significantly smaller on MRI/CE MRA than on DSA and CT. No significant differences were found between the observers. One diameter measurement was significantly smaller on MIP than on VRT, while the other measurements showed no significant differences. CONCLUSION The length measurements obtained with MRA-MIP were probably more correct than those with DSA. For more reliable diameter measurements with CE MRA, improvements of the technique, including VRT reconstructions and a standardized determination of the vessel boundaries, are needed.
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Affiliation(s)
- L Engellau
- Department of Radiology, Lund University Hospital, Lund, Sweden.
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Engellau L, Albrechtsson U, Höjgård S, Norgren L, Larsson EM. Costs in follow-up of endovascularly repaired abdominal aortic aneurysms. Magnetic resonance imaging with MR angiography versus EUROSTAR protocols. INT ANGIOL 2003; 22:36-42. [PMID: 12771854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Abstract
AIM Endovascular repair of abdominal aortic aneurysms (AAA) necessitates a long-term follow-up. These patients are often old and renal insufficiency is not unusual. Cost-effectiveness needs to be addressed in evaluating methods of follow-up. The aim of this study was to compare costs of 5 years follow-up with magnetic resonance imaging with contrast enhanced three-dimensional magnetic resonance angiography (MRI/MRA) with follow-up using CT with DSA, or CTA. We also assessed the impact of contrast media induced (CMI) nephropathy on follow-up costs. METHODS We have implemented Swedish costs of CT with DSA, and CTA on the reported follow-up examinations from the EUROSTAR progress report 2000. The costs of follow-up with CT with DSA, or CTA were compared to a follow-up protocol with MRI/MRA. A cost analysis including a risk analysis of CMI nephropathy was made between MRI/MRA and CT with DSA, or CTA. RESULTS Excluding the risk of CMI nephropathy, the 5 years follow-up cost in Euro ( ) with MRI/MRA ( 5715) is substantially higher than CT with DSA ( 3 095) or CTA ( 3573). The cost analysis favours MRI/MRA if the risk of CMI nephropathy from CT with DSA, or CTA is more than 5%. CONCLUSION MRI/MRA can be cost-effective for follow-up of endovascularly repaired AAA depending on the risk of CMI nephropathy for CT with DSA, and CTA. MRI/MRA should be the method of choice for patients with pre-existing renal insufficiency.
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Affiliation(s)
- L Engellau
- Department of Radiology, Lund University Hospital, Lund, Sweden.
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19
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Engellau L, Albrechtsson U, Dahlström N, Norgren L, Persson A, Larsson EM. Measurements before endovascular repair of abdominal aortic aneurysms. MR imaging with MRA vs. angiography and CT. Acta Radiol 2003; 44:177-84. [PMID: 12694105 DOI: 10.1080/j.1600-0455.2003.00029.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/20/2023]
Abstract
PURPOSE 1) To compare measurements obtained with MR imaging (MRI)/contrast-enhanced MR angiography (CE MRA) with measurements obtained with angiography (DSA) and CT, for stent-graft sizing of abdominal aortic aneurysms (AAA). 2) To compare MRA measurements obtained with the two post processing techniques MIP (maximum intensity projection) and VRT (3D volume rendering technique). MATERIAL AND METHODS The prospective study included 20 consecutive patients with AAA identified by DSA and CT as suitable for endovascular repair. For the study, MRI/CE MRA was performed. Five measurement variables for stent-graft sizing were chosen. Comparisons were made between MRI/CE MRA, DSA and CT, and between observers. Comparisons were also made between MIP and VRT. RESULTS Significantly shorter lengths were obtained with MRA-MIP than with DSA. Three out of six diameter measurements were significantly smaller on MRI/CE MRA than on DSA and CT. No significant differences were found between the observers. One diameter measurement was significantly smaller on MIP than on VRT, while the other measurements showed no significant differences. CONCLUSION The length measurements obtained with MRA-MIP were probably more correct than those with DSA. For more reliable diameter measurements with CE MRA, improvements of the technique, including VRT reconstructions and a standardized determination of the vessel boundaries, are needed.
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Affiliation(s)
- L Engellau
- Department of Radiology, Lund University Hospital, Lund, Sweden.
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Cronberg CN, Sjoberg S, Albrechtsson U, Leander P, Lindh M, Norgren L, Danielsson P, Sonesson B, Larsson EM. Peripheral Arterial Disease. Contrast-Enhanced 3D Mr Angiography of the Lower Leg and Foot Compared with Conventional Angiography. Acta Radiol 2003. [DOI: 10.1034/j.1600-0455.2003.00007.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Cronberg CN, Sjöberg S, Albrechtsson U, Leander P, Lindh M, Norgren L, Danielsson P, Sonesson B, Larsson EM. Peripheral arterial disease. Contrast-enhanced 3D MR angiography of the lower leg and foot compared with conventional angiography. Acta Radiol 2003; 44:59-66. [PMID: 12631001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
PURPOSE To determine whether contrast-enhanced 3D MR angiography (CE MRA) could replace digital subtraction angiography (DSA) for the evaluation of atherosclerotic peripheral vascular disease of the lower leg and foot. MATERIAL AND METHODS Thirty-five patients with symptoms of atherosclerotic disease of the leg were examined prospectively with CE MRA of the foot and the lower legs as well as with DSA from the aorta to the pedal arches. The MRA technique was focused on optimal imaging of the arteries of the foot. RESULTS The agreement between CE MRA and DSA for grading of stenosis was moderate to good (weighted kappa-values 0.48-0.80). The sensitivity of CE MRA for detection of significant stenosis (> or = 50%) was 92% and the specificity was 64% with DSA as gold standard. CONCLUSION CE MRA is a fairly accurate method for the demonstration of atherosclerotic disease below the knee including the pedal arches. It can replace DSA for the assessment of distal arteries in patients with impaired renal function. However, image quality and resolution still needs to be improved before CE MRA can become the method of choice in all patients.
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Affiliation(s)
- C N Cronberg
- Center for Medical Imaging and Physiology, University Hospital, Lund, Sweden
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Danielsson G, Albrechtsson U, Norgren L, Danielsson P, Ribbe E, Thörne J, Zdanowski Z. Percutaneous Transluminal Angioplasty of Crural Arteries: Diabetes and other Factors Influencing Outcome. Eur J Vasc Endovasc Surg 2001; 21:432-6. [PMID: 11352519 DOI: 10.1053/ejvs.2001.1351] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE to evaluate the efficacy of percutaneous transluminal angioplasty (PTA) of the crural arteries. PATIENTS AND METHODS a retrospective review of patients treated with PTA of at least one crural artery during an 8-year period (1990--1997). RESULTS one hundred and fifty-five legs in 140 consecutive patients (mean age 74 years, range 38--91 years) were treated. In 76% a more proximal lesion was also treated. After 1 year, results were significantly better in non-diabetics (improvement rate of 66% vs 32%p <0.05). The outcome for patients with a combination of diabetes, heart disease and renal disease was significantly worse compared to all other patients with an improvement rate of only 9% after 1 year. Patients alive and not amputated at 1 year were significantly more common (p <0.05) among non-diabetics (90%), compared to diabetics (66%). The 1-year mortality for the whole group was 15%, significantly higher for diabetic patients (p =0.04). CONCLUSION PTA of crural arteries produces reasonably good results in non-diabetic patients. Diabetic patients were doing worse than non-diabetics after a year, though 1-month results were not significantly different. Patients with diabetes, heart disease and renal disease make a high-risk group that has a significantly worse outcome.
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Affiliation(s)
- G Danielsson
- Section of Vascular Surgery, Department of Surgery, Lund University Hospital, Lund, Sweden
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Danielsson P, Schatz P, Swartbol P, Truedsson L, Danielsson G, Zdanowski Z, Albrechtsson U, Norgren L. Response of inflammatory markers to balloon angioplasty in peripheral arterial occlusive disease. Eur J Vasc Endovasc Surg 2000; 20:550-5. [PMID: 11136591 DOI: 10.1053/ejvs.2000.1244] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVES To study the inflammatory response to balloon angioplasty (PTA). DESIGN Prospective study. MATERIALS Blood samples were drawn for cytokine analysis from 10 patients undergoing PTA before, after 60 min and 6 h after the balloon inflation. Adhesion molecules were analysed in 14 patients undergoing PTA and in seven patients undergoing angiography only. Arterial samples were taken in eight patients, before PTA, immediately after and 15 min later. Venous samples were taken in six patients and in the group undergoing angiography only. The sampling was before, 60, 90 and 120 min after the procedure. As controls served 15 patients with no signs of peripheral arterial disease. METHODS Cytokines (IL-6, TNF-alpha) were analysed using ELISA. Adhesion molecule expression on WBC was measured by flow cytometry. RESULTS A significant increase of IL-6 in the sample taken 6 h after the last balloon inflation was seen in five patients. TNF-alpha was raised only in one patient. The group of patients with peripheral arterial occlusive disease (PAOD) expressed pre-interventionally a higher level of adhesion molecules on WBC compared to the controls. The expression of adhesion molecules (CD11b/CD18) was significantly decreased after PTA. CONCLUSION Only a very limited cytokine response is caused by PTA reflecting the small surgical trauma. PTA results in a downregulation of detectable CD11b/CD18 expression on WBC in the circulation, which may reflect removal of activated cells through adhesion and extravasation.
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Engellau L, Olsrud J, Brockstedt S, Albrechtsson U, Norgren L, Ståhlberg F, Larsson EM. MR evaluation ex vivo and in vivo of a covered stent-graft for abdominal aortic aneurysms: ferromagnetism, heating, artifacts, and velocity mapping. J Magn Reson Imaging 2000; 12:112-21. [PMID: 10931571 DOI: 10.1002/1522-2586(200007)12:1<112::aid-jmri13>3.0.co;2-g] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Magnetic resonance imaging (MRI) safety was evaluated at 1.5 T in a covered nickel titanium stent-graft (Vanguard) used for endovascular treatment of abdominal aortic aneurysms (AAAs). Imaging artifacts were assessed on MRI with contrast-enhanced (CE) three-dimensional (3D) MR angiography (MRA) and spiral computed tomography (CT) in 10 patients as well as ex vivo. Velocity mapping was performed in the suprarenal aorta and femoral arteries in 14 patients before and after stent-graft placement. For comparison it was also performed in six healthy volunteers. No ferromagnetism or heating was detected. Metal artifacts caused minimal image distortion on MRI/MRA. The artifacts disturbed image evaluation on CT at the graft bifurcation and graft limb junction. No significant differences in mean flow were found in patients before and after stent-graft placement. Our study indicates that MRI at 1.5 T may be performed safely in patients with the (Vanguard) stent-graft. MRI/MRA provides diagnostic image information. Velocity mapping is not included in our routine protocol.
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Affiliation(s)
- L Engellau
- Department of Radiology, University Hospital Lund, Sweden.
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Pettersson H, Albrechtsson U, Arheden H, Holtås S, Jarlman O, Jonson B, Jonsson K, Laurin S, Lundstedt C, Stridbeck H. [Very rapid development of functional image diagnostics]. Lakartidningen 1999; 96:5501-6. [PMID: 10643245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Affiliation(s)
- H Pettersson
- Sektionen för lung- och kärlradiologi, Universitetssjukhuset i Lund
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Zdanowski Z, Albrechtsson U, Lundin A, Jonung T, Ribbe E, Thörne J, Norgren L. Percutaneous transluminal angioplasty with or without stenting for femoropopliteal occlusions? A randomized controlled study. INT ANGIOL 1999; 18:251-5. [PMID: 10811511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
BACKGROUND To investigate the-one year outcome of PTA and stenting and PTA alone for femoropopliteal occlusions. DESIGN Randomized prospective study METHODS 32 patients with femoropopliteal occlusions were randomized into two treatment groups: PTA and Strecker-stent (n=15) and PTA alone (n=17). The median age of the patients was 71 years. All patients had chronic limb ischaemia, 66% had tissue loss, 19% had rest pain and 15% had disabling claudication. The median ABPI was 0.45. The occlusion was confined to the superficial femoral artery in 30 cases and to the popliteal artery in 2 cases. The median length of the occlusions was 7.3 cm. Aspirin (ASA), 160 mg daily, was administrated postoperatively but no anticoagulation was used. The follow-up included: clinical examination, measurement of ABPI and control angiography at 12 months or earlier when necessary (20 patients). RESULTS There was no mortality or limb loss as a consequence of the treatment. There were six (16%) immediate major complications in five patients. In the PTA group, one patient had a myocardial infarction and three patients needed arteriography due to bleeding. In the stent group, one patient required arteriography and embolectomy. The one-year mortality was 6% and there were no amputations. Four patients (two in each group) were operated on with a femorodistal bypass. The rate of clinical improvement was 71% after PTA and stent and 60% after PTA alone (p=0.17). An increased ABPI (>0.10) was shown in 50% of the stent group and 61% in the PTA group (p=0.17). Angiographic re-occlusions were seen in 33% and 75% in the stent and PTA groups respectively (p=0.17), while the rate of restenosis was significantly higher in the stent group (50% vs 25%) (p=0.033). CONCLUSIONS Stenting following PTA for femoropopliteal occlusions does not significantly improve neither the clinical state nor the clinical/angiographic patency. The results do not justify any routine placement of stent following PTA in the successfully recanalized femoropopliteal arteries. The low rate of acceptance of a follow-up angiography indicates that this kind of study should preferably use duplex scanning instead of angiography for follow-up.
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Affiliation(s)
- Z Zdanowski
- Department of Surgery, Lund University, Sweden
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Norgren L, Toksvig-Larsen S, Magyar G, Lindstrand A, Albrechtsson U. Prevention of deep vein thrombosis in knee arthroplasty. Preliminary results from a randomized controlled study of low molecular weight heparin vs foot pump compression. INT ANGIOL 1998; 17:93-6. [PMID: 9754896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND We evaluated in a randomized controlled study the possibility to use foot pump mechanical compression compared to routine LMWH as prophylaxis against deep vein thrombosis during knee arthroplasty. METHODS Forty patients were included in this preliminary report. Eleven patients withdrew, usually during the early phase of the study. RESULTS Among the 29 patients completing a venography, 27% in the compression group and none in the LMWH group had a DVT. This difference was statistically significant (p<0.05). One further patient in the compression group died from pulmonary embolism 17 days postoperatively. CONCLUSIONS With the present study protocol, mechanical foot pump compression failed to be as efficient as LMWH prophylaxis.
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Affiliation(s)
- L Norgren
- Department of Orthopedic Surgery, Lund University, Sweden
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Engellau L, Larsson EM, Albrechtsson U, Jonung T, Ribbe E, Thörne J, Zdanowski Z, Norgren L. Magnetic resonance imaging and MR angiography of endoluminally treated abdominal aortic aneurysms. Eur J Vasc Endovasc Surg 1998; 15:212-9. [PMID: 9587333 DOI: 10.1016/s1078-5884(98)80178-0] [Citation(s) in RCA: 70] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVES To evaluate magnetic resonance imaging (MRI) with gadolinium-based contrast medium-enhanced MR angiography (MRA) for the follow-up of endoluminally treated abdominal aortic aneurysms. DESIGN MRI/MRA, angiography and computed tomography (CT) were performed 1 month after endoluminal stent-graft placement. MRI/MRA was repeated at 6 and 12 months and angiography and CT were added to confirm unexpected findings. MATERIALS Fifteen male patients with endoluminally treated abdominal aortic aneurysms. METHODS MRI with MRA, spiral CT with transverse images and angiography were performed. RESULTS MRI/MRA demonstrated changes of stent-graft morphology, aortic neck- and aneurysmal diameter, stent-graft blood flow, stent-graft leakage, blood flow in lumbar arteries, intra-aneurysmal thrombus, periaortic inflammation and vertebral body infarction. For most of these features MRI/MRA provided more information than angiography and/or CT. MRI was the only method demonstrating thrombus reorganisation and vertebral body infarction. CONCLUSIONS MRI with MRA provides the relevant information needed for follow-up of endoluminally treated abdominal aortic aneurysms (AAA). This may be the method of choice because of its use of contrast media with very low nephrotoxicity, lack of ionising radiation and non-invasiveness.
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Affiliation(s)
- L Engellau
- Dept. of Radiology, University Hospital, Lund, Sweden
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Norgren L, Danielsson G, Jonung T, Ribbe E, Thörne J, Zdanowski Z, Albrechtsson U, Engellau L, Larsson EM. [Endovascular technique in aortic aneurysm. A promising alternative to open surgery]. Lakartidningen 1998; 95:508-12. [PMID: 9494353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The article consists in a presentation of endovascular surgery for abdominal aortic aneurysm repair in 23 cases. Two cases required conversion to open surgery, but the procedure could be completed in the remaining 21 cases, with a current duration of follow-up of up to 30 months. There was early leakage in one case, and late leakage in five cases. Late conversion has been necessary in three instances, and supplementary endovascular measures have been required in a further two instances. All complications have occurred in those cases operated during the first half of the study period. Modification of the endoprosthesis used and increasing skill have reduced both operation time and the complication rate. Intensive care is no longer required, and the median duration of hospitalisation is three days. Follow-up with magnetic resonance imaging has yielded new and important information.
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Lindén CJ, Mercke C, Albrechtsson U, Johansson L, Ewers SB. Effect of hemithorax irradiation alone or combined with doxorubicin and cyclophosphamide in 47 pleural mesotheliomas: a nonrandomized phase II study. Eur Respir J 1996; 9:2565-72. [PMID: 8980970 DOI: 10.1183/09031936.96.09122565] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
In order to assess the value of radiotherapy in the treatment of pleural mesotheliomas, we studied tumour response and survival after hemithorax irradiation alone (RT), or radiotherapy combined with doxorubicin and cyclophosphamide chemotherapy (RTCT). Forty seven patients with pleural mesotheliomas received irradiation of the diseased hemithorax at 8 MV (megavolt) photons to a total dose of 40 Gy, administered in 20 daily fractions of 2 Gy for 5 days a week. One month after RT, patients aged < or = 70 yrs with a good performance status were offered supplementary chemotherapy (CT) with doxorubicin 30 mg.m-2 body surface on Day 1 and Day 8, combined with cyclophosphamide 600 mg.m-2 on Day 1, in cycles of 21 days. Tumour response was evaluated by computed axial tomography (CAT) before and 1 month after RT and/or CT. Only 3 of the 47 (95% confidence interval (95% CI)-0.6-13%) irradiated tumours responded with a partial response (PR). In 31 patients treated with RT alone, one PR was observed; whereas, in the combined treatment group, 2 out of 16 responded with PR to RT. CT with doxorubicin and cyclophosphamide induced only 2 out of 16 PRs (95% CI -3.4-28.4%), and the combined treatment consisting of RT followed by CT induced 2 out of 16 PRs. The median survival following the initiation of RT was 7 months in all patients (n = 47), 6 months in the RT group (n = 31), and 13 months in the combined RTCT group (n = 16). Chest pain, performance status and body weight were not favourably affected by the radiotherapy. We conclude that hemithorax irradiation of pleural mesotheliomas with a moderately high dose is not useful, since it produces no improvement in chest pain, few objective tumour responses and no prolongation of survival.
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Affiliation(s)
- C J Lindén
- Dept. of Lung Medicine, University Hospital, Lund, Sweden
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Swartbol P, Albrechtsson U, Pärsson H, Norgren L. Dilatation of aorto-bifemoral knitted Dacron grafts after a mean implantation of 5 years. INT ANGIOL 1996; 15:236-9. [PMID: 8971582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To evaluate the dilatation-rate of a reverse locknitted Dracon graft. EXPERIMENTAL DESIGN Comparative study, a follow-up after 5 years. SETTING Department of Surgery, University Hospital. PATIENTS During 1987 to 1990, 105 patients underwent elective aorto-bifemoral bypass surgery for aorto-iliac occlusive disease. Nineteen patients received a reverse locknitted Dacron graft. During follow-up in 1993 ten patients were available for evaluation of graft-diameter. For comparison 14 patients who received a wrap knitted Dacron graft (12 collagen impregnated and two uncoated) operated during the same time period were randomly chosen. INTERVENTION CT-scan evaluation. RESULTS A significantly lower increase (a mean aortic body dilatation of 6.8%) of the graft-size was found for this reverse locknitted Dacron (p < 0.001) compared to two wrap knitted Dacron grafts (collagen impregnated and uncoated knitted Dacron) (31.0% and 37.8% respectively). At the femoral level mean dilatation rates of respectively, 2.5%; 23.8% and 31.7% were found. Mural thrombus was observed in three grafts. No false aneurysms, graft degradation or graft occlusions were observed. CONCLUSION It was concluded that reverse locknitted Dacron dilates to a minimum, however, further studies are needed to evaluate the relation of graft-composition/structure and dilatation.
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Affiliation(s)
- P Swartbol
- Department of Surgery, Lund University, Sweden
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Swartbol P, Norgren L, Albrechtsson U, Cwikiel W, Jahr J, Jonung T, Pärsson H, Ribbe E, Thörne J, Truedsson L, Zdanowski Z. Biological responses differ considerably between endovascular and conventional aortic aneurysm surgery. Eur J Vasc Endovasc Surg 1996; 12:18-25. [PMID: 8696891 DOI: 10.1016/s1078-5884(96)80270-x] [Citation(s) in RCA: 65] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
OBJECTIVES To determine the inflammatory responses in endovascular abdominal aortic aneurysm (AAA) repair and their relation to clinical findings. DESIGN Prospective non-randomised study. SETTING University Hospital, Department of Surgery. PATIENTS AND METHODS Seven patients treated with an endoluminal procedure (AAA-E) and seven patients undergoing conventional surgery (AAA-C) were included. Inflammatory parameters were assessed by measurements of the cytokines interleukin (IL)-1 beta, IL-6, IL-8 and Tumour Necrosis Factor-alpha (TNF-alpha); analyses of complement proteins C1q, C4, C3, C5a and Terminal Complement Complexes (TCC); haematologic parameters and determination of C-reactive protein (CRP). RESULTS In six of seven patients in the AAA-E group blood pressure decreases were recorded during introduction of the device. IL-6 and CRP levels were found to be significantly higher in AAA-C patients compared to the AAA-E group. On the other hand, high TNF-alpha levels were recorded in the AAA-E group. Less consumption of the complement proteins C1q, C4 and C3 was observed in AAA-E compared to AAA-C patients. Increased C5a levels were recorded in the AAA-C group, whereas only slight fluctuations were noticed in the AAA-E group. TCC levels were unchanged in both groups. CONCLUSION Endovascular aortic aneurysm repair induced a significant inflammatory response, mainly involving TNF-alpha and differing from the findings during open AAA repair. These inflammatory responses were probably related to blood pressure decreases during the procedures. On the other hand, conventional repair induced responses related to the more extensive surgical trauma and reperfusion injury.
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Affiliation(s)
- P Swartbol
- Department of Surgery, Lund University, Sweden
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Affiliation(s)
- L Norgren
- Department of Surgery, University Hospital, Lund, Sweden
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Thorstensen O, Albrechtsson U, Calissendorff B, Lárusdóttir H, Norgren L, Tengvar M, Bolstad B, Aspelin P. Iodixanol in femoral arteriography. A randomized, double-blind, phase III, parallel study with iodixanol 270 mg I/ml and iohexol 300 mg I/ml. Acta Radiol 1994; 35:629-31. [PMID: 7946690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Two contrast media, iodixanol (Visipaque, Nycomed) 270 mg I/ml and iohexol (Omnipaque, Nycomed) 300 mg I/ml, were compared in femoral arteriography, in 147 patients. Both contrast media were diagnostically effective for use in femoral arteriography, without any significant difference. Pain was reported in connection with injection of iohexol by 36% of the patients, after injection of iodixanol none reported pain. Seventy-two percent of the patients in the iodixanol group reported a sensation of warmth in connection with contrast injection versus 90% in the iohexol group. The average intensity of the warmth was greater with iohexol than with iodixanol. Fourteen percent of patients in the iodixanol group and 1% in the iohexol group reported one or more subjective adverse events.
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Affiliation(s)
- O Thorstensen
- Department of Radiology, Huddinge Hospital, Karolinska Institute, Stockholm
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Thorstensen O, Albrechtsson U, Calissendorff B, Larusdottir H, Norgren L, Tengvar M, Bolstad B, Aspelin P. Iodixanol in Femoral Arteriography. Acta Radiol 1994. [DOI: 10.3109/02841859409173335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Thorstensen Ö, Albrechtsson U, Calissendorff B, Lárusdóttir H, Norgren L, Tengvar M, Bolstad B, Aspelin P. Iodixanol in Femoral Arteriography. Acta Radiol 1994. [DOI: 10.1080/02841859409173335] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Albrechtsson U, Lárusdóttir H, Norgren L, Lundby B. Iodixanol--a new nonionic dimer--in aortofemoral angiography. Acta Radiol 1992; 33:611-3. [PMID: 1449891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
In 26 patients iodixanol, a new nonionic dimer, isotonic to blood in all concentrations, was used as contrast medium in aortofemoral angiography. Half of the patients received contrast medium in a concentration of 270 mg I/ml and the other half 320 mg I/ml. The aim of the trial was to evaluate the safety and tolerability of iodixanol and the radiographic efficacy of the two concentrations. The degree of discomfort, adverse events, changes in serum chemistry parameters, and diagnostic information were assessed. There were no changes or trends of clinical importance in serum chemistry parameters. The side effects were mild and consisted mostly of some sensation of warmth of short duration. No other adverse events were seen. The overall radiographic efficacy did not show any significant difference between the two concentrations. This indicates that iodixanol is safe and well tolerated when used in adult femoral angiography.
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Affiliation(s)
- U Albrechtsson
- Department of Diagnostic Radiology, University Hospital, Lund, Sweden
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Nilsson L, Albrechtsson U, Jonung T, Ribbe E, Thorvinger B, Thörne J, Astedt B, Norgren L. Surgical treatment versus thrombolysis in acute arterial occlusion: a randomised controlled study. Eur J Vasc Surg 1992; 6:189-93. [PMID: 1572460 DOI: 10.1016/s0950-821x(05)80239-7] [Citation(s) in RCA: 58] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Thrombolytic treatment has been tried in various forms for acute limb ischaemia with varying degrees of success but is also often accompanied by bleeding problems. The present investigation compares the effect of surgical thrombectomy (TE) and thrombolysis (TL) using recombinant tissue plasminogen activator (rt-PA). Twenty patients with a need for intervention owing to ischaemia lasting more than 24 h but less than 14 days were included. Patients randomised to TE were operated under epidural anaesthesia and patients in the TL group received 30 mg rt-PA during a 3 h period through a catheter placed into the thrombus and advanced as lysis was achieved. Thrombectomy resulted in an immediate restitution of blood flow in six out of nine cases, in three cases a bypass procedure was performed, and one of these failed with a resultant amputation. Thrombolysis gave a good primary result in six cases which lasted in four of them. Three had a subsequent percutaneous transluminal angioplasty. Partial lysis was seen in two cases and a further two failed. Five went to surgery with three bypass and two fogarty procedures being necessary. There was no hospital mortality and there were no bleeding complications due to the rt-PA treatment in this series. In 19 out of 20 patients the circulation was re-established. Appropriate handling of acute ischaemic conditions implies the use of both thrombolysis and appropriate surgical procedures, including distal bypass grafts.
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Affiliation(s)
- L Nilsson
- Department of Surgery, Lund University, Sweden
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Kehler M, Albrechtsson U, Arnadóttir E, Ebbesen A, Hochbergs P, Lundin A, Lyttkens K, Kheddache K, Månsson LG, Angelhed JE. Digital luminescence radiography using a chest phantom. Comparison between radiographs displayed on monitor and hard-copy. Acta Radiol 1992; 33:117-22. [PMID: 1562402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Ninety-eight digital radiographs of a chest phantom with simulated tumors in the mediastinum and left lung and a pneumothorax-simulation in the right hemithorax were compared with the corresponding examinations saved on optical disk and viewed on a 1,000-line monitor. The examinations were reviewed by 7 radiologists with different experience, and receiver operating characteristic (ROC) curves were constructed. There was no significant difference between the hard-copy and the monitor results. A significant interobserver difference was seen only with the low attenuating 6 mm "tumor" and then only between the observer with the highest and the one with the lowest scores.
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Affiliation(s)
- M Kehler
- Department of Diagnostic Radiology, University Hospital, Lund, Sweden
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41
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Kehler M, Albrechtsson U, Arnadottir E, Ebbesen A, Hochbergs P, Lundin A, Lyttkens K, Kheddache K, Månsson LG, Angelhed JE. Digital Luminescence Radiography using a Chest Phantom. Acta Radiol 1992. [DOI: 10.3109/02841859209173143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Kehler M, Albrechtsson U, Arnadóttir E, Ebbesen A, Hochbergs P, Lundin A, Lyttkens K, Kheddache K, Månsson LG, Angelhed JE. Digital Luminescence Radiography using a Chest Phantom. Acta Radiol 1992. [DOI: 10.1080/02841859209173143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Albrechtsson U, Lärusdóttir H, Norgren L, Lundby B. Iodixanol — a New Nonionic Dimer — in Aortofemoral Angiography. Acta Radiol 1992. [DOI: 10.1080/02841859209173224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Thorvinger B, Norgren L, Albrechtsson U. Patency after iliac and femoro-popliteal angioplasty. Difference between angiographic and clinical results. Acta Radiol 1992; 33:29-30. [PMID: 1531020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Twenty-five patients with clinical relapse after previous successful angioplasty of iliac or femoro-popliteal arteries were evaluated with repeat angiography. The angiographic patency was 80% despite the clinical symptoms. The discrepancy between the angiographic appearance and the clinical findings was explained by the progress of the general arteriosclerotic vascular disease. Such progression is more important regarding late prognosis than the result of the angioplasty per se.
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Affiliation(s)
- B Thorvinger
- Department of Diagnostic Radiology, University Hospital, Lund, Sweden
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46
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Gustavsson CG, Albrechtsson U, Forslind K, Ståhl E, White T. A case of right coronary artery occlusion, caused by blunt chest trauma and treated with acute coronary artery bypass surgery. Eur Heart J 1992; 13:133-6. [PMID: 1577020 DOI: 10.1093/oxfordjournals.eurheartj.a060033] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
A 37-year-old man sustained occlusion of the right coronary artery after a bicycle accident with blunt chest trauma over the left scapula. Acute coronary angiography was performed because of chest pain and ST-segment elevation. Despite surgically successful acute revascularization the patient developed a transmural inferior wall infarction. Coronary artery occlusion after blunt chest trauma is rare, especially occlusion of the right coronary artery. When it occurs, the impact is usually frontal (car accidents), and not dorsal as in this case. Coronary artery bypass surgery has been reported in a few cases but to the best of our knowledge this is the first report of bypass surgery at the stage of acute transmural ischaemia.
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Affiliation(s)
- C G Gustavsson
- Department of Cardiology, University Hospital, Lund, Sweden
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48
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Kehler M, Albrechtsson U, Andrésdóttir A, Hochbergs P, Lárusdóttir H, Lundin A, Lönntoft M. Efficacy of inverted digital luminescence radiography in evaluating chest neoplasms. Acta Radiol 1991; 32:442-8. [PMID: 1742124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Inverted (positive) digital chest radiographs of patients with lung tumors were compared with commonly used (negative) digital images, consisting of one simulated normal and one contrast enhanced image. The first part of the material consisted of 80 patients of whom 40 had tumors and 40 were normal. Five radiologists with different experience reviewed the examinations. From their answers, ROC curves were constructed. The second part of the material consisted of 100 chest phantom examinations with a simulated tumor in the mediastinum (45 examinations) and/or the left lung (46 examinations). In 31 exposures there was no abnormality. These were reviewed by 3 observers and performed as an ROC study as well. There was no statistical difference between the different types of images or between the observers in the 2 studies.
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Affiliation(s)
- M Kehler
- Department of Diagnostic Radiology, University Hospital, Lund, Sweden
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49
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Brådvik I, Wollmer P, Blom-Bülow B, Albrechtsson U, Jonson B. Lung mechanics and gas exchange in steroid treated pulmonary sarcoidosis. A seven year follow-up. Sarcoidosis 1991; 8:105-14. [PMID: 1669974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Fifteen patients with pulmonary sarcoidosis, representing the functionally most severely affected quartile of referred patients, were prescribed steroids during one year. During this period and after 7 years on average, measurements were made of lung volumes, the static elastic pressure/volume (PstL/V) curve and lung resistance (RL). Lung mechanics and arterial blood gases were studied at exercise. Within months static compliance (CstL) and the arterial partial pressure of oxygen improved along with radiography. A modest positive trend continued throughout the follow-up. The vital capacity followed CstL changes closer than did the total lung capacity, which remained low. Though CstL improved, transpulmonary pressure at maximal inspiration increased and the upper part of the PstL/V curve became flatter. RL remained moderately increased. The course of the physiologic findings may be explained by fairly stable parenchymal and peribronchial fibrosis after cessation of active inflammation, and by regress of reflex inhibition of inspiration. Thus most subjects showed modest improvement during and after treatment. The initial study of lung function provided important prognostic information. The study does not allow conclusive evidence with respect to long term benefit of treatment, but encourages continued use of steroids under the guidance of function tests.
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Affiliation(s)
- I Brådvik
- Department of Lung Medicine, University Hospital, Lund, Sweden
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50
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Norgren L, Albrechtsson U, Bergqvist D, Fagrell B, Lörelius LE. [Intervention radiology increases the therapeutic possibilities in peripheral vascular diseases]. Lakartidningen 1991; 88:1705-7. [PMID: 1828287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- L Norgren
- Kirurgiska kliniken, Lasarettet i Lund
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