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Biomedical subjects

B Lindahl

Publications and source records attributed to B Lindahl.

At least 55 records · Page 3Linked to original sources
PubMed1999

Improved fibrinolysis by intense lifestyle intervention. A randomized trial in subjects with impaired glucose tolerance.

OBJECTIVE: To assess the effects of lifestyle intervention on cardiovascular risk factors in general and especially on fibrinolysis. DESIGN: Randomized clinical study. SUBJECTS: A total of 186 subjects with impaired glucose tolerance and obesity. INTERVENTIONS: The intervention programme included a low-fat, high-fibre diet and regular physical exercise. Half of the participants (n = 93) took part in a one-month learning and training session using different behavioural modification techniques and conducted in a full-board wellness centre (intense intervention group). The other half (n = 93) was randomized a one-hour counselling session with a specially trained nurse (usual care group). Follow-up was carried out after 12 months. MAIN OUTCOME MEASURES: Body weight, oxygen consumption, plasminogen activator inhibitor type 1 (PAI-1) activity, tissue plasminogen activator (tPA) antigen, fibrinogen and fasting plasma insulin measured at the start of the programme and at follow-up after 1 year. RESULTS: The intense intervention group had a mean weight decline by 1 year of 5.4 kg compared to 0.5 kg in the usual care group. Oxygen consumption in the intense group increased 10% vs. a 1% decline in the usual care group. In the intense group, PAI-1 activity decreased 31% (-10.1 U mL(-1)), which was significantly more than in the usual care group (12%; -3.0 U mL(-1)). The corresponding reductions in tPA antigen were 14% (-1.65 microg L(-1)) and 6% (-0.69 microg L(-1)). CONCLUSIONS: The present randomized study shows that an intense lifestyle programme has sustained beneficial effects on fibrinolysis.

Adult↗
PubMed1999

Reduction of myocardial damage by prolonged treatment with subcutaneous low molecular weight heparin in unstable coronary artery disease. FRISC study group. Fragmin during Instability in Coronary Artery Disease.

AIMS: Several studies have proved heparin useful in treating patients with unstable coronary artery disease. The present study investigates whether Selvester QRS scoring for estimation of myocardial infarct size increases the incidence of detection of acute myocardial infarction during follow-up in a trial of patients with unstable angina/non-Q wave myocardial infarction treated with low molecular weight heparin or placebo. Finally it will be discussed how the QRS score, used for end-point identification, impacts on the power calculation in clinical trials. METHODS AND RESULTS: Electrocardiographic data on 1276 patients (644 in the placebo group, 632 in the low molecular weight heparin treatment group) were available. All ECGs were scored according to the Selvester QRS scoring method. At 40 days, more patients in the placebo than in the heparin group had achieved a threshold level of QRS score (25.9% vs 21.1%, P=0.05). Myocardial infarction, diagnosed as per the classic Q wave criteria, occurred in 3.7% of patients in the placebo group and in 0.9% in the low molecular weight heparin group at 6 days (P=0.002). At 40 days, the rates were 8.2% (placebo) and 5.7% (low molecular weight heparin, P=0.2). By combining the classic criteria with the Selvester method the myocardial infarction end-point rate in both groups was almost doubled (8.2% to 14.4% in the placebo group and 5.7% to 11.1% in the low molecular weight heparin group, P=0.07). The 216 patients with non-evaluable electrocardiograms did not differ from the 1276 patients as regards baseline characteristics; however, they had a significantly poorer prognosis, with a death/myocardial infarction rate of 20% at 40 days, compared with 8% among the patients with evaluable electrocardiograms (P<0.00001). CONCLUSION: Long-term subcutaneous treatment with low molecular weight heparin decreases the number of subsequent myocardial infarctions - determined both conventionally and by an increase in QRS score - in patients with unstable coronary artery disease. Silent myocardial infarctions detected by QRS score, as well as clinical myocardial infarctions, could be used as end-points in clinical trials of ischaemic heart disease and thus lower the population needed for obtaining statistical power.

Aged↗
PubMed1999

Screening for impaired glucose tolerance. Results from a population-based study in 21,057 individuals.

OBJECTIVE: To study the distribution of fasting plasma glucose and impaired glucose tolerance (IGT) in a large general population and explore their possible implications for large-scale screening. The study focuses especially on the relation to age, obesity, and heredity background of diabetes. RESEARCH DESIGN AND METHODS: A total of 21,057 men and women aged 30-60 years were used for this cross-sectional study. Individuals with known diabetes and individuals with a fasting plasma glucose > or = 7 mmol/l were excluded. A physical examination, including blood sampling and an oral glucose tolerance test, was conducted. RESULTS: The relative risk for IGT increased more than fourfold among obese subjects compared with normal-weight subjects, yet only 25% of IGT subjects were obese. Similarly, IGT subjects more frequently reported having first-degree relatives with diabetes than did subjects with normal glucose tolerance. Nonetheless, > 70% of IGT subjects reported no heredity background of diabetes. Subjects with IGT showed higher mean values of BMI, blood pressure, and triglycerides. Only 13% of the men and 19% of the women having impaired fasting glucose (IFG) fulfilled the criteria of IGT. CONCLUSIONS: The present study shows that a high-risk screening strategy for IGT targeted solely toward subjects with obesity and/or heredity background of diabetes will fail to detect the majority of subjects with IGT in the general population. The new concept of IFG may not replace the concept of IGT as a risk marker for worsening to diabetes.

Adult↗
PubMed1999

Therapeutic implications of the use of cardiac markers in acute coronary syndromes.

Patients admitted with suspicion of an acute coronary syndrome still constitute a diagnostic, prognostic and therapeutic challenge. In the vast majority of these patients the diagnosis is dependent on the results of measurements of cardiac markers. The troponins have a higher diagnostic sensitivity and specificity for detection of myocardial damage than previous markers and have also been proved to be valuable for early risk stratification. There is emerging evidence that these new cardiac markers might be used for selection of treatment in various forms of acute coronary syndromes.

Acute Disease↗
PubMed1998

[Biochemical markers enable early diagnosis of myocardial damage].

Diagnosis of myocardial damage based on early measurement of biochemical markers is becoming an increasingly important guide in the management and treatment of suspected coronary artery disease. The new, more sensitive and/or specific markers myoglobin, CK-MB (creatine kinase and its cardiospecific isoenzyme), and the troponins T and I, are reviewed in the article, new rapid analytical tests are discussed, and modified sampling routines proposed. The combination of a marker with high early sensitivity and a marker with a broad time window and high specificity, together with modified sampling routines and analysis of whole blood can yield a reliable diagnosis within minutes or (3-6) hours of the patient's presentation. Moreover, together with other non-invasive methods, use of the markers of myocardial injury enables rapid and reliable risk analysis.

Angina, Unstable↗
PubMed1998

[Uniform diagnosis of myocardial infarction. Rapid development at Swedish hospitals].

Criteria for the diagnosis of myocardial infarction vary not only from one cardiac intensive care unit (CICU) to another, but also from one study to another. Even the appropriate juncture for ECG, the type of biochemical markers used and blood sampling times vary. Thus, epidemiological studies comparing results over time or between various regions or hospitals tend to be misleading. Reported results are difficult to interpret and to apply to one's own CICU. In order to survey myocardial infarction diagnosis in Sweden and planned future changes, in February-March 1997 a questionnaire was sent to all 82 CICUs in the country. Of the 74 (90%) responders, 72% (53/74) reported formalized printed criteria for myocardial diagnosis to be available at the unit. Eight different biochemical markers of myocardial injury were in use; CK-MB (creatine kinase and its cardio-specific isoenzyme) was the most common, being used at 64% (47/74) of the units; CK and CK-B were used at 32%, and troponin T or I at 53%. Myoglobulin has not been very widely used. If planned changes are carried out, 86% of the units will soon be using CK-MB, and 79% troponin T och I. Cut-off levels of biochemical markers of myocardial infarction varied. Of the 47 units where CK-MB was used, the cut-off level was 10 micrograms/L at 10 (28%) of the units, 15 micrograms/L at 31 (66%) units, and a higher level in a smaller group of units. Cut-off levels for CK-B manifested a similar lack of uniformity. The greatest difference was manifested by troponin levels; of the 28 units using quantitative tests and that cited their cut-off levels, three (11%) used 0.10 microgram/L, 12 (43%) used 0.20 microgram/L, and the remaining 13 (46%) used 0.50 microgram/L. The use of ischaemia monitoring in conjunction with diagnosis and prognosis of myocardial infarction has increased, 72% of the units reporting that they used some form of monitoring, and a further 13% that they planned to introduce it in the near future. Thus, the questionnaire study showed marked differences in myocardial infarction diagnosis to exist in Sweden, although a manifest trend toward increasing uniformity was also seen, and the outlook for the standardisation of diagnostic criteria is good.

Biomarkers↗
PubMed1998

Intense nonpharmacological intervention in subjects with multiple cardiovascular risk factors: decreased fasting insulin levels but only a minor effect on plasma plasminogen activator inhibitor activity.

Increased plasma levels of insulin and the fibrinolytic inhibitor, plasminogen activator inhibitor type 1 (PAI-1), are two new cardiovascular risk factors. The extent to which these two risk factors can be affected by nonpharmacological intervention modalities has not been convincingly proven in subjects at high risk for cardiovascular disease. This study assesses the effects on fasting plasma insulin and plasma PAI-1 activity of an intervention program including a low-fat, high-fiber diet and regular daily physical exercise. The intervention was implemented by a 1-month learning and training session in a full-boarding wellness center and included a follow-up evaluation after 12 months. The study was conducted on 108 subjects (31 men and 77 women) referred for multiple risk factor treatment. After 1 month of intense intervention, the physical condition improved significantly, and this effect was maintained during the year. The body mass index (BMI), fasting plasma insulin, and plasma lipids were significantly decreased. In women, PAI-1 activity was significantly reduced. At follow-up study in both sexes, the BMI and fasting insulin were still significantly decreased. In women, PAI-1 activity reverted to the preintervention level. In subjects with multiple risk factors, ie, the insulin resistance syndrome, the plasma insulin level can be reduced by an intense nonpharmacological program. Also, at least in women, plasma PAI-1 activity can be modestly modified. However, the magnitude of the decrease in PAI-1 activity was probably too small to reverse the hypofibrinolytic state characteristic of these subjects.

Adolescent↗
PubMed1998

The role of advocacy in critical care nursing: a caring response to another.

With the aim of clarifying critical care nursing, six critical care nurses, working in a Swedish intensive care unit (ICU) were each asked to narrate a care situation with which they had been satisfied or dissatisfied. The stories were tape-recorded and analysed using a phenomenological-hermeneutic approach inspired by the philosophy of Ricoeur. The themes uncovered in the analysis describe the nurse's role of advocacy as: to build a caring relationship, to carry out a commitment, to empower, to make room for and interconnect, to be a risk-taker, to be a moral agent and to create a trusting atmosphere conducive to recovery. The meaning of the role of advocacy lies in a moral and existential response to another human being, an expression of caring. Advocacy rests on the patient-nurse relationship and occurs as an outspoken demand of another human being whose autonomy is threatened. The results are discussed from the ethical perspectives of Lögstrup, Watson's concept of care, and existential advocacy as expressed by Gadow.

Attitude of Health Personnel↗
PubMed1998

Ischaemia monitoring with on-line vectorcardiography during dobutamine stress echocardiography in patients after an episode of unstable coronary artery disease.

OBJECTIVES: This study investigated the ability of on-line vectorcardiography (VCG) to detect myocardial ischaemia as assessed by dobutamine stress echocardiography after an episode of unstable coronary artery disease. DESIGN: Dobutamine stress test (incrementally infused doses of 5, 10, 20, 30 and 40 microg kg(-1) per minute) was performed during simultaneous VCG monitoring. QRS vector difference (QRS-VD), ST vector magnitude (ST-VM), ST change vector magnitude (STC-VM) and T change vector magnitude (TC-VM) were monitored. A new wall motion abnormality or worsening of abnormal wall motion was regarded as indicating a positive dobutamine stress test. SUBJECTS: Fifty-five patients with unstable angina pectoris and 16 patients with an acute non-Q-wave myocardial infarction were studied 5-8 days after admission. RESULTS: A positive dobutamine stress test was observed in 37 patients (52%). The sensitivity, specificity and total accuracy of identifying patients with a positive dobutamine stress test by VCG were: 38%, 91% and 63% for QRS-VD; 59%, 88% and 73% for ST-VM; 84%, 79% and 82% for STC-VM; and 86%, 23% and 56% for TC-VM. Patients with a positive dobutamine stress test showed higher maximum VCG values than patients with a negative dobutamine stress test (QRS-VD, P < 0.01; ST-VM, P < 0.001; STC-VM, P < 0.001). The maximum VCG values were related to the number of segments showing new or worsening wall motion abnormality (QRS-VD: r=0.41, P < 0.001; ST-VM: r=0.44, P < 0.001; STC-VM: r=0.57, P < 0.001). CONCLUSION: STC-VM and ST-VM seem to be the best VCG variables for detection of myocardial ischaemia as assessed by dobutamine stress echocardiography.

Aged↗
PubMed1998

Increased fibrinogen levels are associated with persistent Chlamydia pneumoniae infection in unstable coronary artery disease.

AIM: Increased levels of acute phase proteins, e.g., fibrinogen, are related to a poor outcome in unstable coronary artery disease, but the cause of inflammation is unknown. We therefore investigated the prevalence of persistent Chlamydia pneumoniae infection, and its relationship to inflammation in this condition. METHODS AND RESULTS: In 256 patients participating in the FRISC trial, evaluating the effects of dalteparin (a low molecular weight heparin) in unstable angina or non-Q wave myocardial infarction, Chlamydia pneumoniae IgA antibody titres and levels of fibrinogen, C-reactive protein and troponin T were determined at inclusion. Increased C. pneumoniae IgA antibody titres were significantly more common in the patients (36%) than in a reference population of similar age (19%); P < 0.001. Raised titres were associated with male gender, increasing age, smoking, and elevated concentrations of fibrinogen, C-reactive protein and troponin T. The association between persistent C. pneumoniae infection and increased fibrinogen levels was independent of other risk factors evaluated in multivariate analysis (P = 0.009). CONCLUSION: Persistent C. pneumoniae infection is common in unstable coronary artery disease. The independent association between increased C. pneumoniae IgA antibody titres and fibrinogen levels indicates that chronic infection could be of importance for disease activity.

Angina, Unstable↗
PubMed1998

The FRISC experience with troponin T. Use as decision tool and comparison with other prognostic markers.

Early prognostic evaluation is essential for the application of appropriate treatment and further management in the heterogeneous population with unstable coronary artery disease. Among the variety of prognostic indicators that have been suggested, biochemical markers of myocardial damage, especially the troponins, have gained increasing interest. The FRISC troponin T (TnT) substudy has validated and provided additional insights into the use of biochemical markers for prognostic evaluation. Nine hundred and seventy-eight patients were enrolled and followed for 5 months. An increase in the rate of cardiac death or myocardial infarction was seen during follow-up, with increasing levels of TnT. The TnT level separated low and high risk patients better than the conventional division of unstable angina and myocardial infarction. In the comparison with other early available risk indicators TnT was an independent risk indicator and gave additive prognostic information to both inclusion ECG and the result of a predischarge exercise test. TnT was superior to CK-MB for risk stratification, while TnT and troponin I showed comparable results. In patients with elevated TnT, treatment with dalteparin significantly decreased the risk for death or myocardial infarction compared to placebo, while there was no benefit from dalteparin in patients without Tn-T elevation. Based on the experiences of the FRISC study and the literature we suggest that the use of troponins should be included in the diagnostic and prognostic evaluation of patients with suspicion of unstable coronary artery disease.

Aged↗
PubMed1997

Prognostic influence of increased fibrinogen and C-reactive protein levels in unstable coronary artery disease. FRISC Study Group. Fragmin during Instability in Coronary Artery Disease.

BACKGROUND: The prognostic influences of fibrinogen and C-reactive protein levels and their relations to myocardial damage in unstable coronary artery syndromes have not been well described. METHODS AND RESULTS: Fibrinogen and C-reactive protein were determined at inclusion and related to outcome after 5 months in 965 patients with unstable angina or non-Q-wave myocardial infarction randomized to 5 weeks with low-molecular-weight heparin or placebo. The probabilities of death were 1.6%, 4.6%, and 6.9% (P=.005) and the probabilities of death and/or myocardial infarction were 9.3%, 14.2%, and 19.1% (P=.002), respectively, in patients stratified by tertiles of fibrinogen (< 3.38, 3.38 to 3.99, and > or = 4.0 g/L). The probabilities of death were 2.2%, 3.6%, and 7.5% (P=.003) after stratification of patient data by tertiles of C-reactive protein level (< 2, 2 to 10, and > 10 mg/L). In logistic multiple regression analysis, increased fibrinogen levels were independently associated with the incidence of death and/or myocardial infarction (P=.013), and elevated C-reactive protein level was associated with the incidence of death (P=.012). The increased relative risk of subsequent death or myocardial infarction in individuals with an elevated fibrinogen level was consistent in most subgroups evaluated; although significantly so only in patients with signs of myocardial damage. CONCLUSIONS: Increased levels of both fibrinogen and C-reactive protein are associated with a worse outcome in patients with unstable coronary artery disease. The increased risk associated with elevated fibrinogen levels is independent of, and additive to, the prognostic influence of myocardial damage.

Aged↗
PubMed1997

Amyloid-specific heparan sulfate from human liver and spleen.

Heparan sulfate proteoglycans are consistently accumulated in tissues afflicted by amyloidosis and have been implicated in the mechanism of amyloid deposition. To study this relationship, heparan sulfate was isolated from liver and spleen of patients with AA amyloidosis and from normal organs and subjected to structural analysis. The polysaccharides were deaminated with nitrous acid, and the products were reduced with NaB3H4 to yield labeled oligosaccharides. Disaccharides obtained by selective deamination of intact or N-deacetylated polysaccharides were separated and quantified by anion-exchange high performance liquid chromatography and thus defined the composition of N-sulfated block regions or the entire heparan sulfate chains, respectively. The heparan sulfate samples derived from liver or spleen with AA-type amyloidosis were all similar in composition, regardless of tissue source, but differed from either control material. These findings suggest that secondary amyloidosis is associated with the deposition in the affected tissues of a heparan sulfate with a specifically modified structure.

Adult↗
PubMed1997

Noninvasive risk stratification in unstable coronary artery disease: exercise test and biochemical markers. FRISC Study Group.

Early risk assessment is essential for the application of appropriate treatment and further management in patients with unstable coronary artery disease, i.e., unstable angina or non-Q-wave myocardial infarction. In this article, the use of exercise testing and biochemical markers for identification of high- and low-risk patients is discussed, with special reference to experiences from the FRISC (Fragmin During Instability in Coronary Artery Disease) trial. It is concluded that a symptom-limited predischarge exercise test (provided all relevant information obtained is considered) and determination of troponin T are inexpensive, widely applicable, and useful methods for early risk stratification in both men and women after an episode of unstable coronary artery disease.

Biomarkers↗
PubMed1997

Troponin T identifies patients with unstable coronary artery disease who benefit from long-term antithrombotic protection. Fragmin in Unstable Coronary Artery Disease (FRISC) Study Group.

OBJECTIVES: We sought to evaluate whether troponin T might be used for identification of patients with unstable coronary artery disease in whom treatment with low molecular weight heparin is beneficial. BACKGROUND: Early identification of subgroups with differences in response to a certain treatment is important to optimize the utilization of different therapeutic approaches. METHODS: Nine-hundred seventy-one patients with unstable coronary artery disease who participated in a trial of the low molecular weight heparin dalteparin (Fragmin) and who provided blood samples were classified into subgroups according to troponin T level. In the short-term phase all patients received subcutaneous dalteparin/placebo twice daily for 6 days. During the long-term phase they continued with daltparin/placebo once daily for another 5 weeks. RESULTS: In the short-term phase, dalteparin reduced the incidence of death or myocardial infarction from 2.4% to 0% (p = 0.12) and from 6.0% to 2.5% (p < 0.05) in 327 and 644 patients with troponin T levels < 0.1 and > or = 0.1 micrograms/liter, respectively. During long-term treatment there was an increasing difference between the placebo and dalteparin group in those with troponin T levels > or = 0.1 microgram/liter, in whom the incidences at 40 days were 14.2% and 7.4%, respectively (p < 0.01). In contrast, no beneficial effect of the long-term treatment could be demonstrated in those with troponin T levels < 0.1 microgram/liter (4.7% vs. 5.7%). CONCLUSIONS: Elevation of troponin T identifies a subgroup of patients in whom prolonged antithrombotic treatment (e.g., with dalteparin) is beneficial.

Aged↗
PubMed1997

Serum levels of parathyroid hormone are related to the mortality and severity of illness in patients in the emergency department.

Hypocalcaemia is a common finding in intensive care patients. In addition, raised levels of parathyroid hormone (PTH) have been described. The explanation and clinical importance of these findings are yet to be revealed. To investigate the occurrence of hypocalcaemia and elevated PTH levels and their relationship to morality and the severity of disease, serum levels of PTH, ionized calcium (Ca2+) and the cytokines interleukin 6 (IL-6) and tumour necrosis factor alpha (TNF-alpha) were measured on arrival in the emergency department in a broad spectrum of 140 acutely ill patients patients suffering from common diseases such as stroke, acute abdominal disorders, obstructive lung diseases, heart failure, acute myocardial infarction, angina pectoris, trauma and infectious diseases. A score (APACHE II) was calculated to assess the severity of disease. Elevated PTH levels (> 55 pg ml-1) were seen in 16% of the patients, being most frequent in patients with myocardial infarction (28%) and congestive heart failure (42%). The levels were significantly correlated with the APACHE II score (r = 0.48, P < 0.0001) and with the length of stay in hospital (r = 0.26, P < 0.002). PTH was also significantly (P < 0.03) elevated in non-survivors compared with survivors and was found to be a stronger predictor of mortality (P < 0.01) than the APACHE II score (P < 0.02) in Cox's proportional hazard analysis. No close relationships were found between the cytokine levels and the indices of calcium metabolism. In conclusion, a rise in serum levels of PTH was common and related to the severity of disease and mortality in a mixed emergency department population.

APACHE↗