The Scandinavian Propaten(®) trial - 1-year patency of PTFE vascular prostheses with heparin-bonded luminal surfaces compared to ordinary pure PTFE vascular prostheses - a randomised clinical controlled multi-centre trial.

OBJECTIVE: To compare 1-year potencies' of heparin-bonded PTFE [(Hb-PTFE) (Propaten(®))] grafts with those of ordinary polytetraflouroethylene (PTFE) grafts in a blinded, randomised, clinically controlled, multi-centre study. MATERIALS AND METHODS: Eleven Scandinavian centres enrolled 569 patients with chronic functional or critical lower limb ischaemia who were scheduled to undergo femoro-femoral bypass or femoro-poplitaeal bypass. The patients were randomised 1:1 stratified by centre. Patency was assessed by duplex ultrasound scanning. A total of 546 patients (96%) completed the study with adequate follow-up. RESULTS: Perioperative bleeding was, on average, 370 ml with PTFE grafts and 399 ml with Heparin-bonded PTFE grafts (p = 0.32). Overall, primary patency after 1 year was 86.4% for Hb-PTFE grafts and 79.9% for PTFE grafts (OR = 0.627, 95% CI: 0.398; 0.989, p = 0.043). Secondary patency was 88% in Hb-PTFE grafts and 81% in PTFE grafts (OR = 0.569 (0.353; 0.917, p = 0.020)). Subgroup analyses revealed that significant reduction in risk (50%) was observed when Hb-PTFE was used for femoro-poplitaeal bypass (OR = 0.515 (0.281; 0.944, p = 0.030)), and a significant reduction in risk (50%) was observed with Hb-PTFE in cases with critical ischaemia (OR = 0.490 (0.249; 0.962, p = 0.036)). CONCLUSION: The Hb-PTFE graft significantly reduced the overall risk of primary graft failure by 37%. Risk reduction was 50% in femoro-poplitaeal bypass cases and in cases with critical ischaemia.

Secondary medical prevention among Danish patients hospitalised with either peripheral arterial disease or myocardial infarction.

OBJECTIVE: We compared the use of secondary prevention among patients with a first-time hospitalisation for peripheral arterial disease (PAD) of the lower limb with that among patients with a first-time hospitalisation for myocardial infarction (MI). DESIGN AND MATERIALS: Population-based follow-up study between 1997 and 2003 using registry data from the counties of Northern Jutland, Aarhus and Viborg, Denmark. RESULTS: Between 1997 and 2003, within 180 days after hospital discharge, 26% of patients with lower limb PAD (n=3,424) used antiplatelet drugs, 10% statins, 22% ACE-inhibitors/AT-II receptor antagonists and 13% betablockers compared with 55%, 46%, 42% and 78% respectively among patients with MI (n=11,927). Patients with PAD were substantially less likely than patients with MI to use antiplatelet drugs [adjusted relative risk (RR)=0.39 (95% confidence interval (CI): 0.36-0.41)], statins [adjusted RR=0.21 (95% CI: 0.19-0.23)], ACE-inhibitors/AT-II receptor antagonists [adjusted RR=0.43 (95% CI: 0.40-0.47)] and beta-blockers [adjusted RR=0.10 (95% CI: 0.09-0.11). Between 1997 and 2003 secondary prevention increased considerably in both patient groups, but the disparity in treatment persisted. CONCLUSIONS: Efforts to further increase secondary prevention among patients with PAD are needed urgently.

Effect of an ibuprofen-releasing foam dressing on wound pain: a real-life RCT.

OBJECTIVE: To compare an ibuprofen-releasing foam dressing (Biatain Ibu, ColoplastA/S) with local best practice in the treatment of painful exuding wounds. METHOD: In this large-scale randomised comparative study, 853 patients were randomised to either ibuprofen-releasing foam (test) dressing (n=467) or local best practice (n=386). Primary endpoint was wound pain relief from day 1-7, assessed by the patients twice daily using a five-point verbal rating scale. Secondary endpoints were reduction in pain intensity from day 0-7 (assessed using an 11-point numeric box scale), quality of life (assessed using the WHO-5 well-being index and effect on health-related activities of daily living) and the incidence of adverse events. RESULTS: After seven days significantly more patients in the experimental group experienced relief from temporary and persistent pain and a reduction in pain intensity,when compared with patients in the local best practice group (p<0.0001). They also experienced a greater improvement in quality of life. The number of adverse events in both groups was low. CONCLUSION: The test dressing provided an appropriate wound healing environment, relieved temporary and persistent wound pain, and decreased pain intensity. It was also associated with an improvement in quality of life.

[Infusion cavernosography and erectile dysfunction]. / Infusionskavernosografi og erektiv dysfunktion.

Infusion cavernosography with the object of quantitating the rate of venous drainage from the penis and localization of possible abnormities in drainage was employed as a routine investigation in examination of erectile dysfunction in 46 patients. "Infusion to obtain erection" (IOE) and "infusion to maintain erection" (IME) were determined. In five patients, IOE was found to be greater than 180 ml/minute which was considered to be diagnostic of venous leakage. Infusion cavernosography could be assessed in 31 patients. Filling of the glans with the radio-opaque medium was found before rigidity was obtained in 27 whereas, in 19 filling of the glans occurred after rigidity was obtained. No localizing fistulae were demonstrated. It is concluded that routine employment of infusion cavernosography in investigation of impotence is unnecessary. Filling of the glans with the radio-opaque medium in infusion cavernosography does not appear to be a sign of a cavernoso-spongious fistula but rather a physiological phenomenon.

Pharmacologically induced prolonged erections produced by papaverine. Follow-up of injection therapy.

Over a 27 months period papaverine induced erections were routinely used in the treatment of erectile dysfunction (ED). A total of 53 patients, 29 with neurogenic, 20 with arteriogenic, one with a combined arteriogenic/neurogenic ED and 4 with ED of uncertain etiology, in total used 1149 injections, of which 1069 (93%) produced erections with a rigidity sufficient for vaginal penetration. Fifteen patients discontinued treatment during the observation period. Nine patients experienced sustained erections on 16 occasions; all cases were managed by aspiration of blood and/or injection of adrenergic drugs. Penile indurations occurred in three cases, one of which resolved spontaneously. Papaverine induced erections was found to be an effective and well tolerated tool in the treatment of erectile dysfunction.

Vesico-ureteral reflux. II. The longterm outcome of kidney function in non-surgical treatment.

Seventy one patients were included in a prospective study of non-surgical treatment of vesico-ureteral reflux (VUR). We found 111 refluxing ureters, with 20 grade 1, 4 grade 2, 41 grade 3, 5 grade 4 and 1 grade 5. There was no correlation between presenting symptoms and degree of VUR or nephropathy, or between renal function in terms of glomerular filtration rate. During followup the patients were treated with long-term low-dose antibiotic prophylaxis and voiding disorders were corrected pharmacologically or by micturitional training. With a median follow up time of 6 years (3-10) 63% of the patients had cessation or down grading of VUR, irrespective of initial VUR degree. There was no correlation between cessation rate and urodynamic parameters, GFR, history of enuresis or previous urinary infections. The study supports a non-surgical attitude towards VUR patients irrespective of VUR degree, with prophylaxis of urinary infections and possibly correction of voiding disorders.

Vesico-ureteral reflux. I. Renal function and morphology in relation to anamnestic and urodynamic parameters.

Hundred and one children aged 12 years or less were consecutively referred with non-neurogenic vesico-ureteral reflux. None of the patients were previously operated for reflux. Based on the degree of reflux and the degree of nephropathy judged from urograms or renoscintigrams the patients were assigned an index defined as the sum status of both nephro-ureteric units. We found no correlation between VUR index, nephropathy index and GFR on one side, and bladder function parameters (spontaneous voiding, cystometry, bladder activity during sleep) on the other. Further, no correlation was found to history concerning urinary tract infections or enuresis the year before admittance. Possible reasons for the lack of correlation are discussed.

Neurological sequelae after cryoanalgesia for thoracotomy pain relief.

Twenty-two patients treated with cryoanalgesia of the intercostal nerves in connection with thoracic surgery were re-examined with special attention to possible late neurological sequelae. Half of the patients had some degree of hypoaesthesia in the scar or the adjacent skin segment, but apart from one patient (a known morphine addict) none of the patients had any neurological complaints.

Propensity of Streptococcus pneumoniae for the aorta. Report of 3 cases.

Streptococcus pneumoniae was the unsuspected cause of a ruptured aortic aneurysm in 3 patients, as confirmed by culture of specimens obtained during surgery. A 60-y-old woman had a recently diagnosed saccular aortic aneurysm and presented with symptoms indicating a vascular catastrophe. A 66-y-old man and a 69-y-old woman were both admitted with pyrexia and abdominal pain and proper diagnosis was delayed for 4 and 15 d, respectively. All 3 patients were treated with graft insertion and antibiotic therapy for 3 months and recovered fully.

Effect of nitrendipine on renal function and on hormonal parameters after intravascular iopromide.

PURPOSE: To evaluate the effect of the low-molecular nonionic radiographic contrast agent iopromide (Ultravist) on renal function, vasoactive peptides (angiotensin II, aldosterone, arginine vasopressin, and atrial natriuretic factor (ANF)), and blood pressure, and to evaluate the influence of the calcium antagonist nitrendipine on these parameters. The findings were evaluated in a prospective double-blind and placebo-controlled randomized study. MATERIAL AND METHODS: Twenty-six patients undergoing routine aortofemoral arteriography for peripheral atherosclerotic disease were treated with nitrendipine tablets (10 mg) or placebo twice daily for a week. Angiography was performed on the fifth day of medication. Efficacy variables were determined on the day before and 2 days after arteriography. The glomerular filtration rate and renal plasma flow were measured by the constant infusion technique. Renal tubular function was estimated from the clearance of lithium. Hormones were measured by radioimmunoassays. RESULTS: Arteriography with iopromide did not change renal function. No differences between the nitrendipine and placebo groups were found in renal hemodynamics, tubular sodium handling, or blood pressure. Nitrendipine changed ANF (26.1%) compared to placebo (1.5%), whereas the other hormones were not affected. CONCLUSION: The use of iopromide for angiography did not affect renal function in normotensive patients with peripheral atherosclerotic disease. Short-term treatment with nitrendipine may lower the plasma levels of ANF but it had no effect on renal function or blood pressure. Treatment with calcium antagonists prior to arteriography with iopromide is not indicated in these patients.

Influence of a single dose of indomethacin on some biochemical changes and postoperative intestinal paralysis following minor surgery. A prospective randomized double-blind study.

The influence of a single dose of indomethacin on the surgical stress response was investigated in a double-blind study including 43 patients scheduled for elective operation of inguinal hernia. Indomethacin or placebo was administered rectally 1 h before the start of operation. All patients had a standardized general anaesthetic. Blood samples for leucocyte count, sedimentation rate, iron and haemoglobin, and measurements of body temperature were taken preoperatively and on the day after surgery. Blood samples for glucose were taken preoperatively, and 4, 8 and 24 h after skin incision. In both groups a significant increase in leucocyte count and sedimentation rate as well as a decrease in serum iron were found, but there was no difference between the groups. Plasma glucose increased from 4 to 8 h after skin incision in the indomethacin group, but not in the placebo group. The postoperative need for methadon, the time needed to regain normal intestinal function and the hospital stay were the same in the two groups, and body temperature showed no change. These findings indicate that a single dose of indomethacin given preoperatively increased plasma glucose but had no effect on the other parameters studied.