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C Olin

Publications and source records attributed to C Olin.

At least 19 recordsLinked to original sources
PubMed2003

Unspecific elevation of plasma troponin-T and CK-MB after coronary surgery.

OBJECTIVE: Biochemical markers of myocardial injury are frequently elevated after cardiac surgery. It is generally accepted that release unrelated to permanent myocardial damage explains a proportion of these elevations. However, little is known about the magnitude and temporal characteristics of this diagnostic noise. One way to address this issue would be to study a group without permanent myocardial injury. DESIGN: The unique release kinetics of troponin-T (permanent myocardial injury causes a sustained release of structurally bound troponin) were used to identify patients with no or minimal permanent myocardial injury. Blood was sampled from patients undergoing coronary artery bypass grafting (CABG) with cardiopulmonary bypass (CPB) before surgery, 3 and 8 h after unclamping the aorta, and each morning until postoperative day 4, for analysis of enzymes and troponin-T. From 302 consecutive patients a subgroup was identified that fulfilled the following criteria: (a) normalized troponin-T levels < or = postoperative day 4; (b) no ECG changes indicating myocardial injury. RESULTS: Seventy-seven patients fulfilled the criteria above and in this subgroup troponin-T (2.08 +/- 1.42 microg/l; range 0.35-8.99 microg/l) peaked at the 3 h recording and creatine kinase monobasic (CK-MB) (28.6 +/- 11.3 microg/l; range 11.9-86.0 microg/l) peaked at the 8 h recording after unclamping the aorta. CONCLUSION: Substantial early elevations of plasma CK-MB and troponin-T occurred in patients with no or minimal permanent myocardial injury after CABG. Unspecific release was most pronounced during the timeframe that is usually studied to evaluate myocardial protective strategies or to compare revascularization procedures.

Aged↗
PubMed2003

Are overground or treadmill runners more likely to sustain tibial stress fracture?

BACKGROUND: Repetitive high bone strain and/or strain rates, such as those that occur during running, contribute to stress fractures as well as promoting maintenance of or increase in bone mass. Kinematic differences are known to exist between overground and treadmill running and these may be reflected in different bone strains and strain rates during the two running techniques. AIM: To measure in vivo strains and strain rates in human tibia during treadmill and overground running and determine if there are significant differences in strain and strain rate levels between the two running techniques. METHODS: A strain gauged bone staple was mounted percutaneously along the axial direction in the mid diaphysis of the medial tibia in three subjects, and in vivo tibial strains were measured during treadmill and overground running at 11 km/h. RESULTS: Axial compression strains (p<0.0001), tension strains (p<0.001), compression strain rates (p<0.0001), and tension strain rates (p<0.0001) were 48-285% higher during overground running than during treadmill running. CONCLUSIONS: On the basis of lower in vivo strains and strain rates, treadmill runners are at lower risk of developing tibial stress fractures, but less likely to achieve tibial bone strengthening, than overground runners.

Adult↗
PubMed2002

Early identification of permanent myocardial damage after coronary surgery is aided by repeated measurements of CK-MB.

OBJECTIVE: ECG diagnosis of myocardial infarction after cardiac surgery is associated with major pitfalls and enzyme diagnosis is interfered by unspecific elevation unrelated to permanent myocardial injury. Sustained release of troponin-T is a marker of permanent myocardial injury if renal function is maintained. However, early identification of perioperative myocardial infarction is desirable and therefore the usefulness of creatine kinase monobasic (CK-MB) kinetics to detect myocardial injury early after coronary surgery was investigated. DESIGN: Two hundred and eighty-six patients undergoing coronary surgery were studied with respect to release of enzymes and troponin-T preoperatively and postoperatively 3 and 8 h after unclamping the aorta, and every morning postoperative days 1-4. RESULTS: CK-MB peak was found at 3 h (n = 145), 8 h (n = 103) and 16-20 h after unclamping (n = 38). Depending on when the CK-MB peak was recorded different demographic and perioperative characteristics were found. A sustained release of troponin-T was characteristic for the group with the CK-MB peak at 16-20 h after unclamping. CONCLUSION: If CK-MB is measured only once it may be advisable to do it on the first postoperative morning as these measurements provided the best discrimination between patients with and without sustained elevation of troponin-T. However, repeated sampling provides additional information that aids in the early identification of permanent myocardial injury particularly in patients with borderline elevations of CK-MB.

Aged↗
PubMed2001

Heart rescue in acute left main coronary artery occlusion with CABG using initial retrograde perfusion.

Acute occlusion of the left main coronary artery (LMCA) is a rare and almost invariably fatal condition. Here, we report on heart salvage in two such cases with CABG aided by emergent retrograde reperfusion as the initial operative step. Both cases were extremely unusual. The first patient had twice survived LMCA occlusion; the second also had right coronary artery occlusion. We will also review the literature on acute LMCA occlusion and coronary venous retroperfusion.

Acute Disease↗
PubMed2000

Perioperative myocardial infarction in cardiac surgery--risk factors and consequences. A case control study.

OBJECTIVE: The aim of the study was to analyze risk factors and clinical outcome in patients sustaining perioperative myocardial infarction (PMI) after cardiac surgery. DESIGN: A retrospective, case control study was conducted, in which 42 patients fulfilling both Q-wave criteria and enzyme criteria for PMI, or autopsy diagnosis, from a cohort of 1147 operated on during the same time period were compared with matched controls. A follow-up by telephone interview was conducted, on average 24 months after the operation. RESULTS: Unstable angina, peripheral vascular disease, short stature and low body weight were more prevalent in the PMI group. Intraoperative remarks of poor quality coronary vessels and incomplete revascularization were more frequent in the PMI group; 30-day mortality was 24% in the PMI group vs 0% in the control group (p < 0.01). The postoperative course was more complicated and protracted in the PMI group. At follow-up, the control group managed significantly better with regard to freedom from angina and the need for nitroglycerine. However, 24 of the 30 survivors in the PMI group reported an improved quality of life after surgery. CONCLUSIONS: We found that PMI was mainly associated with coronary surgery and that unstable angina was the most important preoperative risk factor for PMI. Poorer conditions for revascularization may explain some of the infarcts and could also contribute to the impaired long-term outcome in the PMI group.

Aged↗
PubMed1998

Are electrocardiographic Q-wave criteria reliable for diagnosis of perioperative myocardial infarction after coronary surgery?

OBJECTIVE: A major assumption in cardiovascular medicine is that Q-waves on the electrocardiogram indicate major myocardial tissue damage. The appearance of a new Q-wave has therefore been considered the most reliable criterion for diagnosis of perioperative myocardial infarction (PMI) in cardiac surgery. In a study, originally intended to evaluate troponin-T as a marker of PMI, analysis of our data aroused the need to address the reliability of Q-wave criteria for diagnosis of PMI. METHODS: In 302 consecutive patients undergoing coronary surgery, Q-wave and other electrocardiogram (ECG) criteria were compared with biochemical markers of myocardial injury and the postoperative course. All ECGs were analysed by a cardiologist blinded to the biochemical analyses and the clinical course. RESULTS: The incidence of positive Q-wave criteria was 8.1%. Combined biochemical (CK-MB > or = 70 microg/l) and Q-wave criteria were found in 1.0%. Patients with new Q-waves did not have CK-MB or troponin-T levels significantly different from those without Q-waves. More than 25% of the Q-waves were associated with plasma troponin-T below the reference level (< 0.2 microg/l) on the fourth postoperative day. Q-wave criteria alone did not influence the postoperative course. In contrast, biochemical markers correlated with clinical outcome. CONCLUSIONS: The majority of Q-waves appearing after coronary surgery were not associated with major myocardial tissue damage, and according to troponin-T one-fourth of the Q-waves were not associated with myocardial necrosis. Furthermore, the appearance of Q-waves had little influence on short term clinical outcome. Therefore, the use of Q-wave criteria as the gold standard for diagnosis of PMI may have to be questioned.

Aged↗
PubMed1997

Late outcome and quality of life after complicated heart operations.

BACKGROUND: Patients with severe postoperative complications consume a great deal of the economic resources for intensive care. Our knowledge of the late outcome and quality of life of these patients is scarce. METHODS: One thousand five hundred twenty-two patients undergoing cardiac operations during 1991 and 1992 were studied, and the 100 patients who needed the most expensive treatment were identified. The patients were retrospectively risk scored (Higgins score), and the clinical outcome was studied. The surviving patients were followed up for 2 years after the operation. Their quality of life and remaining symptoms were assessed. RESULTS: No significant age difference between groups was observed. There were significantly more women, emergency cases, high-risk patients, and postoperative complications in the studied group. Mortality rate during the first postoperative year was significantly higher in the studied group. Later the difference in mortality rate between the groups decreased. At the 2-year follow-up all the 72 surviving patients in the study group had returned home with less physical and psychological symptoms related to their heart disease. CONCLUSIONS: The cost of treating severe complications in the intensive care unit is high. However, the results of the present study indicate that even a very complicated postoperative course is not incompatible with a successful outcome in the long run.

Age Factors↗
PubMed1997

Primary idiopathic chylopericardium--a case report and review of the literature.

Primary idiopathic chylopericardium is a rare entity with obscure etiology. In recent years, a few reports have been published where the lymphatic leak and fistula were identified by combined lymphangiography and computed tomography or intraoperative thoracic ductogram. Here we report a case occurring in a previously healthy 51 year old woman, to our knowledge the first case described in Scandinavia. She presented with cough and dyspnea of about 1 year duration. Chest X-ray demonstrated enlargement of the cardiac silhouette. Echocardiography revealed pericardial effusion and at puncture pericardiocentecis 760 ml of chylous fluid was evacuated. There was no history of trauma, infection or neoplasm. She underwent extensive investigations but no apparent cause of the chylous effusion could be determined. Conservative treatment with pericardial drainage and low fat (medium chain triglyceride) diet failed. The patient was cured by surgical ligature of the thoracic duct and partial pericardectomy through a left anterolateral thoracotomy. At 12 months post operation she was doing well and echocardiography did not reveal any signs of recurrence. A brief review of the literature is presented.

Echocardiography↗
PubMed1997

Phenotypic alterations in circulating monocytes induced by open heart surgery using heparinized and nonheparinized cardiopulmonary bypass systems.

In this study of 31 patients with coronary bypass surgery, we used flow cytometry to compare heparin-coated and noncoated cardiopulmonary bypass systems on leukocyte activation. We found significant differences between the groups during bypass, with activation of the complement system, measured as elevated levels of C3a desArg, upregulation of granulocyte beta2 integrin (CD11b), and a loss of circulating monocytes when noncoated systems were used. In both groups an early increase in the monocyte cell surface CD62L expression was obvious while the percentage of human leukocyte antigen (HLA)-DR positive monocytes did not alter. The morning after the operation, leukocytosis was present, together with a highly significant reduction in the monocyte expression of CD11b and HLA-DR, indicating the recruitment to the peripheral blood of cells with altered phenotypes. This alteration in phenotype on potent inflammatory cells may be one part of the impaired function of the immunological system reported after major surgery.

Adult↗
PubMed1997

Mini-sternotomy for aortic valve surgery.

In the recent years more and more efforts have been made widely to introduce new techniques in the minimally invasive cardiac surgery. At our Department and the Linköping University Hospital, Cardiothoracic Surgery Department, from August 1996 to January 1997, aortic valve surgery was performed in 23 adult patients (9 female, 14 male), age 28-86 years (mean age 62.5 years). Twenty-two patients had aortic valve replacement, among these, in 3 cases concomitant aortic annulus dilatation was made and in one case reduction-plasty of the dilated ascending aorta. In another one case resection of a sub-aortic membrane was performed. The operations and postoperative period were free of complications in all patients. Following an average 36 hours intensive care all patients were discharged after an average of 11.2 day hospital stay. The authors introduce the new surgical technique and present its advantages and disadvantages. Mini-sternotomy has less detrimental structural and functional effects on the thorax. Moreover, due to its minimal surgical trauma, this less invasive technique reduces patient morbidity, hospital stay and cost of care. Since mini-sternotomy is a safe and advantageous technique, the authors recommend applying this new technique in most of aortic valve operations.

Adult↗