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Biomedical subjects

G Forssell

Publications and source records attributed to G Forssell.

13 recordsLinked to original sources
PubMed1990

Unnecessary deaths from valvular aortic stenosis.

The annual mortality from aortic valvular stenosis was calculated among potential candidates for surgical replacement of the aortic valve. From the Swedish Central Register of Causes of Death, 70 patients below the age of 80 years who had died from aortic stenosis during a 1-year period in the County of Stockholm (population 1.5 million), were identified. A retrospective analysis of their medical records showed that 37 individuals were suitable candidates for surgery. The presence of aortic stenosis had been verified at autopsy in 31 (84%) patients. The remaining six patients (16%) had their aortic stenosis diagnosis established by a thorough non-invasive investigation performed before death. Although typical signs and symptoms of aortic stenosis were recorded in all 37 patients, only six (16%) of them had been considered by their physicians to be suitable candidates for surgery prior to death. The deceased patients were compared with a group of 68 patients who had undergone aortic valve replacement for aortic stenosis during the same period. There were no significant differences between the two groups with regard to symptoms and clinical findings, except for a higher incidence of syncope in the operated group. It is concluded that, of 105 (68 surgically treated and 37 deceased) eligible patients with aortic stenosis, 37 individuals did not receive surgical care in time. The reason for this was probably insufficient knowledge of the curability of the disease.

Aged↗
PubMed1989

Coronary endarterectomy--angiographic and clinical results.

Of 75 patients who underwent coronary endarterectomy, 16% had left main stem stenosis, 4% one-vessel, 27% two-vessel and 53% three-vessel disease. On average 2.9 grafts per patient were inserted, in conjunction with 82 manual endarterectomies (38 right coronary, 35 left anterior descending, 9 circumflex branches). In 68/75 cases (91%) the endarterectomy was not preplanned and in 39 cases (52%) greater than or equal to 3 cm of the atherosclerotic core was removed. All four early deaths (5%) followed endarterectomy of LAD. Acute perioperative myocardial infarction was confirmed in 19% and probable in further 8%. At angiography 1-139 (median 25) months postoperatively, all three internal mammary artery grafts and 19/34 saphenous vein grafts (56%) to endarterectomized vessels were patent, though in 4 of the 19, the coronary artery was occluded distal to the anastomosis. In addition 17/18 conventional internal mammary artery (94%) and 48/59 conventional saphenous vein grafts (81%) were patent. The vein graft patency rate was not significantly influenced by postoperative anticoagulant therapy, but was significantly increased among patients with relief of angina: 44% reported freedom from angina and 92% at least some relief after a median of 3 years. The 5-year and 10-year survival rates were 85% and 68%. Despite the increased risk, endarterectomy can be recommended for severely diseased major coronary arteries.

Angina Pectoris↗
PubMed1988

Strut-fracture of a Björk-Shiley tilting disc valve diagnosed by echocardiography--a case report.

A 40-year-old man with Björk-Shiley valves implanted in the aortic and mitral positions nine months previously presented with central chest pain. Shortly after admission he developed clinical features consistent with left ventricular failure. Fracture of the mitral prosthesis was diagnosed by echocardiography. At emergency operation the outlet strut of the mitral valve was found to be fractured and the disc was in the left ventricle. The patient survived valve re-placement and is in good health four years later.

Acute Disease↗
PubMed1986

Effort dyspnea after coronary artery bypass grafting.

Two series of consecutive patients with disabling effort angina were studied prospectively. From the first series, 94 survivors were followed up 9 months after coronary artery bypass grafting. Thirty-five patients (37%) reported that they still suffered from effort angina. Another 26 patients (28%) also used to stop when walking uphill/upstairs but because of dyspnea and 2 (2%) because of leg fatigue. A symptom-limited exercise test performed in 24 of the 26 with dyspnea revealed effort angina in 2 patients and high-degree dyspnea (mean grade 6.6 of 10) in 22. The exercise capacity was less than normal in 16 of these 22 patients. The number of peripheral anastomoses did not differ between the 26 dyspnea patients and the 31 free from effort restriction, nor did the incidence of perioperative infarctions or treatment with diuretics and beta-blocking drugs at follow-up. The second series of 95 survivors confirmed the high prevalence of disabling dyspnea after coronary artery bypass grafting (24%) and showed that it was not predictable. We conclude that physical fitness is restored in less than half the patients undergoing coronary artery bypass grafting.

Angina Pectoris↗
PubMed1979

Intraaortic balloon pumping in the treatment of cardiogenic shock complicating acute myocardial infarction.

A 5.1% incidence of cardiogenic shock was found in consecutive series of 680 patients with acute myocardial infarction (AMI) during a five-year period. The hospital mortality was 94%. Shock was treated according to a stepwise policy including assisted circulation with intraaortic balloon pumping (IABP). During the five-year period, only five patients, 14% of the shock patients, had shock for more than three hours (the minimal time for attempting medical therapy and preparing for assisted circulation), were below 75 years of age and without terminal diseases. Together with ten AMI patients in shock referred from or treated in other hospitals, altogether 15 patients were given IABP during 1--318 hours (mean 58). Shock was reversed in 12 (80%) of these patients and five (33%) could be weaned off IABP and discharged from the CCU. However, only two patients (13%) were long-term survivors.

Acute Disease↗
PubMed1975

Diazepam in cardioversion.

Diazepam has been used to an increasing extent in cardioversion, since avoiding general anaesthesia simplifier the procedure. The present study concerns the effect of diazepam on BP and blood gases in 13 cases of cardioversion. A moderate fall of both systolic and diastolic BP occurred. The arterial pO2 and pCO2 did not change significantly.

Aged↗
PubMed1975

Creatine phosphokinase after submaximal physical exercise in untrained individuals.

Serial estimations of total serum creatine phosphokinase (CPK) have been performed before and during 18-49 hours after submaximal physical exercise in 17 untrained individuals, mean age 50 years. The maximal CPK increase after exercise was 32 mU/ml (73%). The serum CPK did not exceed the upper normal limit (130 mU/ml) except in one individual (150 mU/ml). The maximal CPK increase in patients with acute myocardial infarction (AMI) varied between 101 mU/ml (133%) and 2 260mU/ml(3 790%), mean 900 mU/ml (1 184%). As the maximal CPK elevation in AMI occurs within the same period, it seems that heavy physical work of short duration just before the onset of symptoms will very seldom impair the diagnosis of AMI with the CPK technique used.

Adult↗
PubMed1975

Creatine phosphokinase following cardioversion.

Serial estimations of total serum creatine phosphokinase (CPK) have been performed before and during 18-51 hours after cardioversion of supraventricular tachyarrhythmias in 12 patients without acute myocardial infarction (AMI). The maximal CPK rise was 78 mU/ml (110%) and the CPK did not exceed the upper normal limit (130 mU/ml) in more than two patients (149 respectively 156 mU/ml). The CPK rise we have observed in a series of AMI patients varied between 101 (133%) and 2 260 mU/ml (3 780%), mean 900 mU/ml (1 184%). Therefore, cardioversion performed as described seldom seems to interfere with diagnosing AMI by serial estimations of serum CPK during the next 24 hours.

Aged↗