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Biomedical subjects

C Torp-Pedersen

Publications and source records attributed to C Torp-Pedersen.

At least 91 records · Page 5Linked to original sources
PubMed1994

Is digoxin an independent risk factor for long-term mortality after acute myocardial infarction?

The safety of treatment with digoxin in patients with acute myocardial infarction (MI) was investigated in 584 hospital survivors of MI. All patients were examined by radionuclide ventriculography, with determination of left ventricular ejection fraction (LVEF), close to the time of discharge. Clinical data were collected on admission. All patients were followed up with regard to death (median 6.2 years, range 3.9-7.8 years). Patients treated with digoxin (N = 172 (29%) were older (median 66 vs 59 years; (P < 0.001), had a higher incidence of diabetes (13% vs 7%; P = 0.025), and a lower LVEF (0.33 vs 0.49; P < 0.001). As expected, clinical heart failure was more frequent among them (84% vs 14%; P < 0.001), than in patients not receiving digoxin. The 1- and 5-year mortality of patients treated with digoxin was 38% and 74% compared to 8% and 26% in patients not receiving digoxin (P < 0.001). The increased risk associated with digoxin therapy remained statistically significant when patients were stratified according to the presence or absence of heart failure or atrial fibrillation/flutter during hospitalization, or to LVEF above or below 0.45 at discharge. In a proportional hazard model including age, LVEF, diabetes mellitus, heart failure, atrial fibrillation or flutter, ventricular fibrillation, gender, dose of furosemide at discharge and calcium antagonists and digoxin treatment as covariates, digoxin was independently associated with an increased risk of death (relative risk 1.8 (95% confidence limit 1.2-2.5)). We conclude that administration of digoxin may be harmful in hospital survivors of MI.

Aged↗
PubMed1994

Myocardial infarction 1979-1988 in Denmark: secular trends in age-related incidence, in-hospital mortality and complications.

All admissions to a coronary care unit (CCU) in Copenhagen County were prospectively registered over a 10-year period, from 1979 to 1988, i.e. after the introduction of CCUs but before the era of intervention with thrombolytic or prophylactic medical treatment. The catchment area remained nearly constant throughout the study period; all patients with MI were admitted to the CCU regardless of age and concomitant diseases, and treatment and discharge policy of the department was unchanged. A total of 4176 MI admissions were registered. During the study period, the age-specific incidence of MI decreased in males above 50 years of age, but was virtually unchanged in females, increasing the proportion of women in the MI population from 26 to 33%. In-hospital and 30-day mortality was unchanged. The occurrence of atrial fibrillation during the admission increased significantly (from 11 to 18%), while the incidence of ventricular fibrillation, heart failure and pulmonary oedema was unchanged.

Adult↗
PubMed1994

Hip and distal arm fracture rates in peri- and postmenopausal insulin-treated diabetic females.

OBJECTIVES: Hip and distal arm fractures are associated with osteoporosis in the postmenopausal female. In diabetic patients, bone mass has been found to be reduced leading to the hypothesis that diabetes is a risk factor for osteoporosis. Whether this has any clinical implication has only been sparsely elucidated. DESIGN: A cross-sectional case-control study. SETTING: All insulin-treated diabetic females above the age of 40 years who regularly visited the Steno Memorial Hospital out-patient clinic in 1989. Peri-and postmenopausal females from the general population living in a similar suburban region of Copenhagen admitted to Glostrup University Hospital because of a hip or Colles' fracture between 1 January 1989 and 31 October 1990. SUBJECTS: The study comprised 748 insulin-treated diabetic females. Thirty hip fractures and 82 Colles' fractures were reported after the age of 40 years. Out of 26,564 females from the general population, 622 were admitted to Glostrup hospital because of a hip or Colles' fracture. METHODS/INTERVENTION: Answers based on questionnaires sent to all diabetic females, and the use of hospital files and hospital registers. RESULTS: In diabetic females aged 40-49 years, Colles' fracture rate was 2/1000 years and hip fracture rate 0.43/1000 years. Fracture rate increased with age and, amongst 80-89-year-old diabetic females, the frequency of both fracture rates was 31/1000 years. These rates were slightly lower than the rates in the general female population. The relative risk of Colles' fracture in diabetic females aged 40-49 years was 0.3 +/- 0.2 (95% confidence limits) and that of hip fracture 1.0 +/- 1.1. In diabetic females aged 80-89 years, the risk of Colles' fracture and hip fracture were 1.3 +/- 1.1 and 1.0 +/- 0.9. Fracture rate was not associated with the development of diabetic complications, long-term metabolic control, or age at diagnosis. CONCLUSION: Our results suggest that diabetic osteopenia does not have any clinical impact on fracture risk.

Adult↗
PubMed1992

Reduced infarct size in nonreperfused myocardial infarction by combined infusion of isosorbide dinitrate and streptokinase.

The value of thrombolytic therapy in myocardial infarction is well established, while any beneficial effect of adjunct therapy is more uncertain. In a double-blind, randomized, parallel-group study the effect of combined intravenous infusions of streptokinase and isosorbide dinitrate (ISDN) on enzyme-estimated infarct size was investigated. One hundred consecutive patients with strong clinical and electrocardiographic suspicion of myocardial infarction, admitted to the coronary care unit within 8 hours after the onset of symptoms, were given a streptokinase infusion of 1.5 million units for 1 hour and a titrated dose of ISDN or placebo for 48 hours. From isoenzyme B of creatine kinase (CK-B) values measured every 4 hours, the infarct size was calculated and the possible presence of reperfusion was evaluated. The infarct size in patients receiving ISDN infusion was reduced (p = 0.04, one-sided test) compared with placebo. By subdividing the patients according to whether or not reperfusion had occurred, the infarct size appeared to be similar following ISDN and placebo in patients with reperfusion (419 versus 369 U/L), whereas the infarct size in patients not reperfused was markedly reduced after treatment with ISDN (223 versus 1320 U/L, p = 0.003). In conclusion, the present study demonstrates that the infarct size may be reduced by other means than reperfusion and it supports the use of combined infusion of thrombolytic agents and nitrates in patients with suspected myocardial infarction.

Adult↗
PubMed1992

Prognosis of ventricular fibrillation in hospital.

In a retrospective study of 520 patients with in-hospital ventricular fibrillation 421 (81%) had acute myocardial infarction (MI), 66 (13%) had ischaemic heart disease (IHD) without MI, 33 (6%) had no signs of IHD. The in-hospital mortality of these three groups was 51%, 52%, and 27%, respectively (P = 0.01). Logistic regression analysis demonstrated that heart failure and cardiogenic shock were significant risk factors for in-hospital death among patients with IHD. Among discharged patients 1 and 5 years survival was 78% and 51% for patients with MI, 63% and 25% for patients with IHD, 67% and 54% for patients without IHD. A proportional hazard model demonstrated old age, heart failure and cardiogenic shock as risk factors for long-term prognosis, while MI was associated with a reduced relative risk ratio = 0.58 of long-term mortality among patients with IHD. In conclusion, patients with known IHD suffering in-hospital VF without AMI have a very poor short- and long-term prognosis. These patients need extensive cardiac examination.

Aged↗
PubMed1991

[Prognosis in early and late ventricular fibrillation after acute myocardial infarction].

Of 413 patients with in-hospital ventricular fibrillation complicating acute myocardial infarction 281 had early (less than 48 hours post infarction) ventricular fibrillation and 132 had late ventricular fibrillation. In-hospital and longterm prognoses were not influenced by time of ventricular fibrillation, but advanced age and signs of reduced left ventricular function were found to be independent significant risk factors for short and longterm prognoses.

Adult↗
PubMed1991

Sudden cardiac arrest outside the hospital--value of defibrillators in ambulances.

In a region with a population of 250,000 people, all emergency calls for cardiac arrest were prospectively registered during a period of 6 years. Timing of events were carefully registered as were treatment and the participation of 3 ambulances equipped with defibrillators. When time until initial treatment of cardiac arrest was below 5 min, 12% could be resuscitated and discharged alive. This figure decreased to 2% in the period between 5 and 10 min and was zero to above 10 min. Similarly, a reasonable 12% of patients experiencing ventricular fibrillation at a public place could be resuscitated and discharged alive whereas only 5% of ventricular fibrillation occurring at the patients home could be successfully resuscitated. Asystolia was rarely treated successfully. Faster treatment improved results much and 63% of patients having ventricular fibrillation in the emergency room left hospital alive. Results of cardioversion in ambulances did not depend on time from initiation of cardiac arrest, but all patients receiving cardioversion later than 10 min died without regaining consciousness. The results were compared with other more effective programs. The study region apparently had much fewer cardiac arrest than a similar region in Seattle, U.S.A. In those cases where treatment could be initiated within 5 min, results were comparable.

Ambulances↗
PubMed1990

Prognosis of late versus early ventricular fibrillation in acute myocardial infarction.

To determine the prognosis of late ventricular fibrillation (VF) after acute myocardial infarction (AMI), the length of the monitoring period after AMI was extended. All patients in this series were continuously monitored in a coronary care unit to ensure observation of all VF within 18 days of AMI. From 1977 to 1985, 4,269 patients were admitted with AMI and 413 (9.6%) had in-hospital VF. Of these 281 (6.8%) had early VF (less than 48 hours after AMI) and 132 (3.2%) had late VF (greater than or equal to 48 hours after AMI). In-hospital mortality was 50 and 54% for early and late VF, respectively (p = 0.31). Kaplan-Meier survival analysis showed better survival after discharge for patients with early versus late VF (p = 0.009) but this difference was fully explained by the presence of heart failure. Survival analysis showed the same prognosis after 1, 3 and 5 years for early and late VF, when VF was not associated with heart failure. When VF was associated with heart failure (secondary VF) early VF had a greater mortality than late VF after 2 and 5 years. Logistic regression analysis showed that heart failure (relative risk 1.9 [1.1 to 3.1]) and cardiogenic shock (relative risk 3.9 [1.8 to 8.5]) were significant risk factors for in-hospital death. Late VF compared to early VF had no prognostic implication (relative risk 1.0 [0.6 to 1.6]). For patients discharged from the hospital, risk factors were heart failure (1.8 [1.1 to 2.8]) and previous AMI (1.6 [1.3 to 2.1]).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1990

Relation between dose of bendrofluazide, antihypertensive effect, and adverse biochemical effects.

OBJECTIVE: To determine the relevant dose of bendrofluazide for treating mild to moderate hypertension. DESIGN: Double blind parallel group trial of patients who were given placebo for six weeks and then randomly allocated to various doses of bendrofluazide (1.25, 2.5, 5, or 10 mg daily) or placebo for 12 weeks. SETTING: General practices in Zealand, Denmark. PATIENTS: 257 Patients with newly diagnosed or previously treated hypertension, aged 25-70, who had a mean diastolic blood pressure of 100-120 mm Hg after receiving placebo for six weeks. MAIN OUTCOME MEASURES: Reduction in diastolic blood pressure and changes in biochemical variables (potassium, urate, glucose, fructosamine, total cholesterol, apolipoprotein A I, apolipoprotein B, and triglyceride concentrations). RESULTS: All doses of bendrofluazide significantly reduced diastolic blood pressure to the same degree (10-11 mm Hg). Clear relations between dose and effect were shown for potassium, urate, glucose, total cholesterol, and apolipoprotein B concentrations. The 1.25 mg dose increased only urate concentrations, whereas the 10 mg dose affected all the above biochemical variables. CONCLUSION: The relevant range of doses of bendrofluazide to treat mild to moderate hypertension is 1.25-2.5 mg a day. Higher doses caused more pronounced adverse biochemical effects including adverse lipid effects. Previous trials with bendrofluazide have used too high doses.

Adult↗
PubMed1990

Feasibility of intracardiac injection of drugs during cardiac arrest.

In a cardiological department (Coronary Care Unit) routine treatment of asystole and electromechanical dissociation has comprised intracardiac injection (ICI) of drugs, usually given by trained nurses, using the parasternal approach into the right ventricle, followed by continued external cardiac massage. A 7-year experience is presented with 543 consecutive ICIs to 247 patients. Cardiac action was restored in half of the patients (125/247); 7.7% (19/247) were discharged alive. Autopsy was done in 80% of fatal cases (182/228). A left-sided pneumothorax was demonstrated in 9 of the 80 patients surviving ICI for greater than 1 h, a minor haemopericardium in three, but serious consequences in none. Lesions of the coronary artery or of the myocardium attributable to the ICI were never seen. Asystole in some patients was converted into ventricular fibrillation or ventricular tachycardia which in six patients proved intractable, but other serious cardiac arrhythmias having a possible connection with the ICI were not observed. It is concluded that during a cardiac standstill, drug treatment by ICI with good technique carries a low risk, quite acceptable in these circumstances, and from a theoretical point of view can be expected to have advantages over administration of the drug into a peripheral vein.

Bicarbonates↗
PubMed1989

The time factor in resuscitation initiated by ambulance drivers.

This study is concerned with the value of basic CPR (manual ventilation and closed chest cardiac massage) initiated within 5 min in delaying brain damage after cardiac arrest in adult patients at ambient temperature. In 88 cases of cardiac arrest, basic CPR was initiated within 5 min of collapse by trained ambulance personnel. Basic CPR was continued during transport to the hospital in ambulances not equipped with defibrillators. Advanced CPR was instituted in all patients upon hospital arrival. All 11 patients eventually discharged from the hospital without apparent brain damage arrived at the hospital within 10 min of cardiac arrest. A significant number of patients arriving later could be resuscitated acutely but later died unconscious or were discharged with severe brain damage. We conclude that basic CPR, including bystander CPR initiated within 5 min of cardiac arrest is likely to be of long-term value only if definitive advanced life support can be provided within 10 min after the patient's collapse.

Ambulances↗
PubMed1987

Central venous pressure--a physiological stimulus for secretion of atrial natriuretic peptide in humans?

A sensitive radio-immunoassay (RIA) for the measurement of human alpha-atrial natriuretic peptide (ANP) in extracted plasma was developed and used in a study of the possible effect of posture on the concentration of ANP in plasma. The least detectable quantity was less than 2 pg per tube equivalent to 5 pg ml-1 plasma. In the middle sensitivity range (approximately 50 pg per tube), the within-assay and between-assay coefficients of variation were 4.0 and 2.8%, respectively. The recovery of ANP added to plasma prior to extraction was 95-101%. High pressure liquid chromatography (HPLC) of plasma extracts revealed that endogenous ANP was eluted in the same fractions as synthetic ANP. In order to investigate the effect of posture on the concentration of ANP in plasma six healthy volunteers were exposed to five positions in the following sequence: supine, standing, sitting, supine and 10 degrees head-down tilt on a tilt-table. The concentration of ANP was lower in the standing and sitting position than in the supine and head-down tilted position. In another study six healthy volunteers were subjected to passive tilting on a tilt-table in order to evaluate the effect of tilting on blood pressure (BP), heart rate, central venous pressure (CVP) and the concentration of ANP in plasma. It was found that a fall in CVP was accompanied by a significant decrease in the concentration of ANP and that a rise in CVP was accompanied by a rapid increase in the concentration of ANP in plasma. The results are in agreement with the hypothesis that CVP is a physiological stimulus for the secretion of ANP.

Atrial Natriuretic Factor↗
PubMed1986

Effects of synthetic human atrial natriuretic peptide (hANP) in conscious dogs.

The effects of synthetic human atrial natriuretic peptide (hANP) on arterial blood pressure, heart rate, and renal functions were evaluated in conscious trained dogs in moderate sustained water diuresis. Synthetic hANP was given i.v. over 3 min at doses of 0.27-2.16 micrograms kg-1 body wt. It did not cause significant changes in blood pressure or heart rate. The rate of sodium excretion increased 20-fold following 2.16 micrograms kg-1 and 2.5-fold after 0.54 micrograms kg-1. Natriuresis was immediate and vanished after 10 min, regardless of dose. The concomitant increase in diuresis was less than 50%, but significant for a longer period of time. Increases in potassium excretion were significant, but small, that is, by a factor of 1.5-2.8. All natriuretic doses of hANP increased PAH clearance (at constant blood pressure), but some did so without measurably affecting creatinine clearance.

Animals↗