Siv Bornmyr

Deep vein thrombosis after renal transplantation: a prospective analysis of frequency and risk factors

In a prospective study the frequency of deep vein thrombosis during the first 3 weeks after kidney transplantation has been evaluated using the combination of thermography and strain-gauge plethysmography for objective diagnosis. 83 consecutive patients were included, 33 with juvenile diabetes mellitus. The overall frequency of thrombosis was 24.1%, diabetes mellitus being a significant risk factor. No other risk factors were found. The transplant did not influence the venous outflow from the corresponding leg. Plasminogen activator activity in the iliac vein wall at transplantation did not differ between patients with and without thrombosis.

Postoperative deep venous thrombosis after renal transplantation: effects of cyclosporine

In this prospective study the frequency of deep venous thrombosis during the first three weeks after renal transplantation was determined using a combination of strain gauge plethysmography and thermography for objective diagnosis. Ninety-seven consecutive patients were studied, 30 patients having juvenile diabetes mellitus. As immunosuppression cyclosporine and low-dose steroids were used. The series was compared with a similar group of 83 patients, 33 having juvenile diabetes mellitus treated with azathioprine and high-dose steroids as immunosuppression, in which the diagnosis of deep venous thrombosis was made with an identical technique. The overall frequency of thrombosis was 9.3% in the cyclosporine-treated group, which is a significant reduction in comparison with the azathioprine group (24.1%). It is concluded that the combination of cyclosporine and low-dose steroids does not increase the frequency of deep venous thrombosis in comparison with azathioprine and high-dose steroids in renal transplanted patients.

EFFECTS OF TRANSCUTANEOUS NERVE STIMULATION ON THE MICROCIRCULATION IN CHRONIC LEG ULCERS

The purpose of this study was to find out to what extent transcutaneous electrical nerve stimulation (TENS) affects the blood flow in and around chronic lower leg ulcers, as measured with a new technique, laser Doppler imaging (LDI). Fifteen patients, mean age 73 years (range 38-85) with chronic leg ulcers of various causes participated in the study. The duration of the ulcers ranged from 3 months to 16 years. Low-frequency (2 Hz; 10-45 mA) TENS was given for 60 minutes. The changes in blood flow were measured every 5 minutes by LDI. After 60 minutes, mean blood flow had increased in the ulcer by 35%, and in the intact skin surrounding the ulcer by 15%. Even 15 minutes after the TENS had finished there was still a mean blood flow increase of 29% in the ulcer and 9% in the skin. The present results show that TENS has a stimulating effect on local blood circulation in and around chronic ulcers.The purpose of this study was to find out to what extent transcutaneous electrical nerve stimulation (TENS) affects the blood flow in and around chronic lower leg ulcers, as measured with a new technique, laser Doppler imaging (LDI). Fifteen patients, mean age 73 years (range 38-85) with chronic leg ulcers of various causes participated in the study. The duration of the ulcers ranged from 3 months to 16 years. Low-frequency (2 Hz; 10-45 mA) TENS was given for 60 minutes. The changes in blood flow were measured every 5 minutes by LDI. After 60 minutes, mean blood flow had increased in the ulcer by 35%, and in the intact skin surrounding the ulcer by 15%. Even 15 minutes after the TENS had finished there was still a mean blood flow increase of 29% in the ulcer and 9% in the skin. The present results show that TENS has a stimulating effect on local blood circulation in and around chronic ulcers.

Cutaneous vasomotor responses in young type I diabetic patients.

Abnormal skin temperature reactions have been reported in type I diabetic patients. Whether this is due to a primary vascular disturbance or autonomic neuropathy is unclear. The aim of this study was to clarify this issue by evaluating cutaneous circulatory reactions before and after provocation. Seventeen type I diabetic patients and 17 age-matched controls were studied by recording blood flow (laser Doppler technique) on the dorsum of the hand (before, during, and after arterial occlusion), blood flow and skin temperatures on the dorsum of the foot and on the toe (before and after cooling followed by indirect body heating) and autonomic nerve function (heart rate reaction to deep breathing and to tilting). The results showed that before [4.6 +/- 0.5 perfusion units (PU) versus 6.1 +/- 0.7 PU; p = 0.0356] and after arterial occlusion (17.5 +/- 1.6 PU versus 25.3 +/- 1.7 PU; p = 0.0024), hand skin blood flow was significantly lower in patients than in controls. On the dorsum of the foot, skin temperatures was significantly lower in patients than in controls before cooling (29.2 degrees C +/- 0.3 degrees C versus 30.5 degrees C +/- 0.4 degrees C; p = 0.0107) whereas toe temperature and toe blood flow were similar before and after cooling in patients and controls. After body heating, however, toe temperature (after 30 min: 25.2 degrees C +/- 1.4 degrees C versus 30.9 degrees C +/- 1.2 degrees C; p = 0.0022) and toe blood flow (after 30 min: 10.9 +/- 2.5 degrees C versus 22.9 +/- 4.9 PU; p = 0.0313) were significantly lower in patients than in controls, especially in patients with parasympathetic neuropathy (i.e., patients with abnormal heart rate reactions to deep breathing). In conclusion, type I diabetic patients demonstrated a vascular disturbance in their skin that seemed to be exaggerated by parasympathetic neuropathy.

Wound healing after total elbow replacement in rheumatoid arthritis Wound complications in 50 cases and laser-Doppler imaging of skin microcirculation

Wound healing complications, predisposing to deep infection, are common following prosthetic surgery of the elbow. 50 capitellocondylar elbow prostheses were inserted, using a lateral approach, in 42 patients with rheumatoid arthritis. The first 5 elbows were immobilized postoperatively for 5 days and the following 45 elbows for 12 days, because of delayed wound healing in 2 of the first 5 elbows. No wound healing complications were recorded in elbows immobilized for 12 days and elbow motion was not compromised. 5 elbows were investigated with laser-Doppler imaging (LDI) technique, both pre- and postoperatively. Postoperative LDI values were considerably higher than preoperative ones, indicating no impairment of local skin microcirculation. The authors conclude that the lateral approach is safe to use in prosthetic surgery on the elbow. Early mobilization can delay wound healing, but this can be prevented by 2 weeks of postoperative immobilization.

Skin Perfusion Pressure Assessed by Measuring the External Pressure Required To Stop Blood Cell Flux

Laser Doppler flowmetry (LDF) was used to determine the point at which blood flow cessation is achieved under circumferentially applied external counter pressure at the ankle level. In 13 individuals with a normal ankle index, the flow of cessation external pressure (FCEP) was, on average, 28 mmHg lower than the systolic ankle pressure (range: 7-62). In 19 patients with an ankle index below 1.0, FCEP correlated with the ankle pressure (rs=0.76) and even more closely with the ankle index (rs = 0.82) . In patients with a more pronounced degree of arterial occlusive disease, FCEP can be equal to or even higher than the ankle pressure. This may be due to a release of sympathetic vasoconstrictor tone and possibly to the presence of a collateral circulation supplying the skin. Individual LDF values from the skin at rest do not reflect the degree of peripheral circulatory insufficiency.