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Biomedical subjects

G Sigurdsson

Publications and source records attributed to G Sigurdsson.

At least 19 recordsLinked to original sources
PubMed2005

Relationship between C-reactive protein and arterial stiffness in an asymptomatic population.

Plasma concentration of high sensitive C-reactive protein (hsCRP) is used as a marker for inflammatory states and is directly correlated with the risk for coronary heart disease. Evidence concerning the role of inflammation in atheroma formation has been derived from several models of atherosclerosis. Inflammation should exert its adverse vascular effects by structural changes in the artery wall and consequently alterations in arterial elasticity, which could be detected already in asymptomatic early vascular disease. We hypothesized that CRP is related to large artery elasticity, but not to small artery elasticity in early vascular disease. Therefore, we examined the association between arterial stiffness of large and small arteries and inflammation in an asymptomatic population referred for primary prevention cardiovascular screening. Studies were performed in 391 subjects (age 21-82 years; 254 men, 137 women) who underwent screening at the Cardiovascular Disease Prevention Center. Large artery (C1) and small artery (C2) elasticity indices were obtained by the CVProfiler 2000 (HDI, Eagan, MN, USA). After overnight fasting, venous samples were taken for measurement of hsCRP, lipids, glucose. There was a significant inverse correlation between hsCRP (0.29 +/- 0.40 mg/dl) and C1 (16.7 +/- 5.8 ml/mmHg), r = -0.133, P = 0.01; there was no significant correlation between hsCRP and C2 (6.6 +/- 3.2 ml/mmHg). C2, but not hsCRP, was inversely correlated with age, abnormal lipids and glucose, whereas C1, but not hsCRP, was inversely correlated with age and systolic blood pressure (SBP). In multiple regression analysis, the relationship between hsCRP and C1 was not affected by age, body mass index, SBP, serum glucose or lipids. In conclusion, these findings support the hypothesis that hsCRP, a marker for acute and low-grade inflammation, is associated with large artery but not with small artery elasticity in asymptomatic individuals undergoing primary prevention cardiovascular screening.

Adult↗
PubMed2005

Physical activity in the post-pubertal period is associated with maintenance of pre-pubertal high bone density-- a 5-year follow-up.

OBJECTIVE: To evaluate the association between physical activity (PA) and skeletal growth in girls during adolescence. DESIGN: A 5-year, observational, population-based study (Reykjavik, Iceland). SUBJECTS: Seventy-eight Caucasian girls, mean age 13.4+/-1.0 (mean+/-SD) years at baseline. METHODS: Bone mineral density (BMD, g/cm2) and bone width (cm) were measured in the forearm by single-photon absorptiometry at baseline and with dual-energy X-ray absorptiometry after 3 and 5 years, when lumbar spine, femoral neck (FN) and total body were also evaluated. Half of the physically active girls were compared with the other half of less active girls. RESULTS: BMD in physically active girls was higher in the forearm at both baseline (P=0.001) and after 5 years (P=0.04) in comparison with less active girls. BMD was higher for the total body (P=0.0001), spine L2-L4 (P=0.02) and FN (P=0.002) in the active girls at age 18. The accrual of forearm BMD and bone width from age 13 to 18 was no different when comparing the two groups. CONCLUSIONS: Pre-pubertal PA is associated with high BMD at age 13 and continued PA is associated with maintenance of high BMD until age 18.

Absorptiometry, Photon↗
PubMed2002

Fifteen percent of myocardial infarctions and coronary revascularizations explained by family history unrelated to conventional risk factors. The Reykjavik Cohort Study.

Aims To examine the relationship between history of myocardial infarction in first-degree relatives and the risk of developing coronary heart disease (myocardial infarction or coronary revascularization). Methods and Results A total of 9328 males and 10062 females, randomly selected residents of the Reykjavik area, aged 33-81 years, were examined in the period from 1967 to 1996 in a prospective cohort study. Cardiovascular risk assessment was based on characteristics at baseline. Information on history of myocardial infarction in first-degree relatives was obtained from a health questionnaire. Mean follow-up was 18 and 19 years for men and women, respectively. During follow-up 2700 men and 1070 women developed coronary heart disease. Compared with subjects without a family history, the hazard ratio of coronary heart disease was 1.75 (95% confidence interval, CI, 1.59-1.92) for men and 1.83 (95% CI, 1.60-2.11) for women, with one or more first-degree relatives with myocardial infarction. The risk factor profile was significantly worse in individuals with a positive family history. After allowance for these risk factors, the hazard ratio was still highly significant, 1.66 (CI, 1.51-1.82) and 1.64 (CI, 1.43-1.89) for men and women, respectively. Family history of myocardial infarction was attributed to 15.1% of all cases of coronary heart disease in men and 16.6% in women, independent of other known risk factors. Conclusion Family history of myocardial infarction increases the risk of developing coronary heart disease in both men and women and is largely independent of other classic risk factors. Approximately 15% of all myocardial infarctions can be attributed to familial factors that have not been measured in the study or remain to be elucidated.

Adult↗
PubMed2001

Successful management of a B-type cardiac allograft into an O-type man with 3(1/2)-year clinical follow-up.

BACKGROUND: In May 1997, a 19-year-old male patient of histo-blood group type O suffering from congenital end-stage heart failure accidentally received a cardiac allograft of type B and is still alive in fair condition. METHODS: In addition to conventional immunosuppressive therapy, plasma exchange (PEX), extracorporeal immunoabsorption (EIA), intravenous immunoglobulins (IVIG), and C1 inhibitor were used. RESULTS: Such treatment successfully reduced both IgM and IgG anti-B levels and complement hyperactivity and allowed to reach the state of accommodation without obvious signs of rejection. The patient has been surviving for 42 months; retransplantation with an O-type heart remained unnecessary. CONCLUSION: Humoral rejection has been avoided in this patient, with PEX, EIA, IVIG, and C1 inhibitor substantially contributing to this success. With future availability of such combined therapies, preferably before transplantation, vascular rejection events caused by preformed antibodies and complement (ABO mismatch or anti-HLA) could be prevented or treated.

ABO Blood-Group System↗
PubMed2001

The -629C>A polymorphism in the CETP gene does not explain the association of TaqIB polymorphism with risk and age of myocardial infarction in Icelandic men.

The aim of this study was to examine whether the well-established effect of the common TaqIB polymorphism in intron 1 of the gene for cholesterol ester transfer protein (CETP) on high density lipoprotein cholesterol (HDL-C) concentration and increased risk of myocardial infarction (MI), could be explained by the recently identified -629C>A functional polymorphism in the promoter. Non-fatal MI cases (388 male) and a control group of 794 healthy men were recruited from the 30 year long prospective Reykjavik Study. In the healthy men the frequency of the TaqIB B2 allele was 0.47 (95% CI: 0.44-0.50) and there was a strong allelic association with the -629A allele (D=-0.21, P<0.0001), which had a frequency of 0.52 (95% CI: 0.49-0.56). B2B2 homozygotes displayed 15% higher HDL-C levels than subjects homozygous for the B1 allele (P<0.0001). Homozygotes for the -629A allele displayed 14% higher HDL-C concentrations than subjects homozygous for the -629C allele (P<0.0001). The frequencies of the alleles associated with lower HDL-C were significantly higher in cases compared with controls, 0.59 versus 0.53 (TaqIB B1) and 0.52 versus 0.48 (-629 C) respectively (P<0.05 for both). There was a significantly higher risk for MI in B1B1 homozygotes (OR=1.44, 95% CI: 1.10-1.87, P<0.01), compared to the other genotypes combined. This was not observed for the CC homozygotes (OR=1.16, 95% CI: 0.87-1.54). In addition, homozygotes for the TaqI B2 allele experienced a first MI 2 years later than men with other genotypes, 59 versus 61 years (P<0.05). This effect was not seen for the promoter polymorphism. These results strongly confirm the role of the CETP gene and the TaqIB variant as a risk factor for MI and suggest that another functional polymorphism is yet to be discovered in the CETP gene, that will explain the effect on MI associated with TaqIB observed in this study.

Aged↗
PubMed2001

Liquorice-induced rise in blood pressure: a linear dose-response relationship.

To clarify the dose-response and the time-response relationship between liquorice consumption and rise in blood pressure and explore the inter-individual variance this intervention study was designed and executed in research laboratories at University hospitals in Iceland and Sweden. Healthy, Caucasian volunteers who also served as a control for himself/herself consumed liquorice in various doses, 50-200 g/day, for 2-4 weeks, corresponding to a daily intake of 75-540 mg glycyrrhetinic acid, the active substance in liquorice. Blood pressure was measured before, during and after liquorice consumption. Systolic blood pressure increased by 3.1-14.4 mm Hg (P < 0.05 for all), demonstrating a dose-response but not a time-response relationship. The individual response to liquorice followed the normal distribution. Since liquorice raised the blood pressure with a linear dose-response relationship, even doses as low as 50 g of liquorice (75 mg glycyrrhetinic acid) consumed daily for 2 weeks can cause a significant rise in blood pressure. The finding of a maximal effect of liquorice after only 2 weeks has important implications for all doctors dealing with hypertension. There does not seem to be a special group of responders since the degree of individual response to liquorice consumption followed the normal distribution curve.

Adult↗
PubMed2001

Increased bone mineral density in a population-based group of 70-year-old women on thiazide diuretics, independent of parathyroid hormone levels.

BACKGROUND: Several studies have shown greater bone mineral density (BMD) in people receiving thiazide diuretics compared with controls. Most researchers have related this association to the hypocalciuric effect of thiazides with subsequent rise in serum calcium and fall in parathyroid hormone (PTH) levels. Recent experimental evidence suggests, however, a direct effect of thiazides on osteoblast-like cells. OBJECTIVE: To test the hypothesis that the association of thiazides and raised BMD is independent of PTH levels in humans. SUBJECTS: A population-based group of 248 70-year-old Icelandic women, 51 receiving thiazide diuretics, 39 receiving other antihypertensive therapy and the rest acting as controls. MAIN OUTCOME MEASURES: The independent contribution of thiazide usage and PTH to BMD in a multivariate analysis. RESULTS: The mean BMD was 9.6% greater in the lumbar spine (P < 0.01) and 5.4% greater in the whole skeleton (P < 0.01) amongst thiazide users than in controls, reduced to 7.6% (P < 0.02) and 4.5% (P < 0.01), respectively, when corrected for fat mass which was 5.8 kg greater in the thiazide group. In a multivariate analysis, corrected for body weight and body composition, serum calcium and ln-PTH, thiazides remained a significant independent predictor of BMD in the total skeleton and lumbar spine, but not in the total hip or femoral neck. Thiazides explained about 3% of the variability in whole body and lumbar spine BMD. CONCLUSIONS: Thiazides augment or preserve BMD independent of PTH, implying other mechanisms.

Aged↗
PubMed2001

Adrenocorticotrophic hormone exerts marked lipid-lowering effects in simvastatin-treated patients.

OBJECTIVE: Recently, it was reported that treatment with adrenocorticotrophic hormone (ACTH) has a strong lipid-lowering effect in healthy individuals. The mechanism behind this has not been established. The aim of the present investigation was to study the effect of ACTH on the plasma lipoprotein pattern in patients treated with a 3-hydroxy-3-methylglutaryl-coenzyme A reductase inhibitor. DESIGN: The ACTH treatment was given to 10 patients who were on long-term treatment with simvastatin 40 mg daily. ACTHI-24 was administered at the dose of 1 mg daily for four consecutive days. Blood samples for analyses of lipids, lipoproteins and apolipoproteins were collected before and after treatment. Second baseline was obtained 2 weeks after the end of treatment. RESULTS: The serum concentrations of cholesterol, triglycerides, low density lipoprotein (LDL) cholesterol, apolipoprotein B and lipoprotein(a) fell significantly by 16, 23, 23, 10 and 38%, respectively. The serum apolipoprotein E concentration increased significantly by 39%; the fraction that was not associated with apolipoprotein B increased by 47% whereas the fraction that was did not change significantly. There were no changes in the serum concentrations of high density lipoprotein (HDL) cholesterol and apolipoprotein AI. At the second baseline, the lipid variables had generally returned to previous levels. CONCLUSIONS: In patients on long-term simvastatin treatment, ACTH had marked lowering effects on the lipoproteins that contain apolipoprotein B. Moreover, the serum apolipoprotein E concentration increased significantly in response to ACTH treatment.

Adrenocorticotropic Hormone↗
PubMed2001

Ketoconazole and pulmonary failure after esophagectomy: a prospective clinical trial.

Thromboxane is a key mediator in pulmonary injury after esophageal resection. In this prospective trial we studied the clinical course and development of pulmonary alterations in patients undergoing esophagectomy and prophylactic treatment with a thromboxane synthase inhibitor. Thirty-eight consecutive patients undergoing esophageal resection were treated pre- and perioperatively with 3 x 200 mg ketoconazole. The clinical course was studied and pulmonary function was assessed according to the Murray score. A historical group of 118 patients undergoing esophagectomy for benign and malignant esophageal diseases served as controls. Patients in both groups were similar in terms of age, sex, and preoperative pulmonary function, as well as in the anesthetic and surgical procedures performed. However, in the ketoconazole group, more patients were at risk of pulmonary failure by receiving neoadjuvant radiochemotherapy (22/38) or undergoing thoracotomies (33/38) than control subjects (14/118 and 80/118, P < 0.05). Two out of 38 ketoconazole-treated patients developed acute lung injury after esophagectomy, as did 20/118 control patients (P < 0.05). This prospective non-randomized clinical study (in patients subjected to esophagectomy) provides further evidence that prophylactic thromboxane synthase inhibition by ketoconazole reduces the incidence of acute lung injury in patients at risk.

Aged↗
PubMed2000

The association between parathyroid hormone, vitamin D and bone mineral density in 70-year-old Icelandic women.

Parathyroid hormone (PTH) may be an important determinant of cortical bone remodeling in the elderly. Vitamin D status is one of the determining factors in this relationship. The aim of this study was to quantify the relationship between serum PTH, vitamin D and bone mineral density (BMD) in elderly women in Reykjavik (64 degrees N), where daily intake of cod liver oil is common and mean calcium intake is high. In PTH correlated inversely with 25(OH)D (r = -0.26, p<0.0 1). In multivariate analysis PTH correlated inversely with whole body BMD (mostly cortical bone) (R2 = 2.2%, p = 0.04) but not with the lumbar spine BMD, reflecting more cancellous bone. No association was found between 25(OH)D levels and BMD at any site in univariate or multivariate analysis. Osteocalcin, a measure of bone turnover, was negatively associated with BMD and this association remained significant when corrected for PTH levels. In summary, in this fairly vitamin D replete population with high calcium intake, PTH was negatively associated with total body BMD. We infer that suppression of PTH may reduce cortical bone loss, but other factors are likely to contribute to age-related bone remodeling and osteoporosis.

Absorptiometry, Photon↗
PubMed2000

Effects of sleep deprivation on neural circulatory control.

Effects of sleep deprivation on neural cardiovascular control may have important clinical implications. We tested the hypothesis that sleep deprivation increases heart rate, blood pressure, and sympathetic activity and potentiates their responses to stressful stimuli. We studied 8 healthy subjects (aged 40+/-5 years, 6 men and 2 women). Blood pressure, heart rate, forearm vascular resistance, and muscle sympathetic nerve activity were measured at rest and during 4 stressors (sustained handgrip, maximal forearm ischemia, mental stress, and cold pressor test). Measurements were obtained twice, once after normal sleep and once after a night of sleep deprivation. All measurements were obtained in a blinded, randomized manner. In comparison with normal sleep, sleep deprivation resulted in an increase in blood pressure (normal sleep versus sleep deprivation=82+/-8 versus 86+/-7 mm Hg, mean+/-SEM, P=0.012) and a decrease in muscle sympathetic nerve activity (normal sleep versus sleep deprivation=28+/-6 versus 22+/-6 bursts/min, P=0.017). Heart rate, forearm vascular resistance, and plasma catecholamines were not significantly changed by sleep deprivation, nor did sleep deprivation affect autonomic and hemodynamic responses to stressful stimuli. Sleep deprivation results in increased resting blood pressure, decreased muscle sympathetic nerve activity, and no change in heart rate. Thus, the pressor response to sleep deprivation is not mediated by muscle sympathetic vasoconstriction or tachycardia.

Adult↗
PubMed1999

Lean mass and physical activity as predictors of bone mineral density in 16-20-year old women.

OBJECTIVE: The aim of the study was to quantify the inter-relationship between bone mineral density and physical activity, muscle strength, and body mass composition in a group of healthy 16-20-year-old women. DESIGN: A cross-sectional study. SETTING: Reykjavik area. SUBJECTS: Two-hundred and fifty-four Icelandic Caucasian women aged 16, 18 and 20 years, randomly selected from the registry of Reykjavik. MAIN OUTCOME MEASURES: Bone mineral content (BMC) and density (BMD) in lumbar spine, hip, distal forearm and total skeleton and lean mass and fat mass were measured with dual energy X-ray absorptiometry (DEXA) and compared with grip strength measured with a dynamometer and physical activity as assessed by a questionnaire. RESULTS: The lean mass had the strongest correlation with BMC and BMD, stronger than weight, height and fat mass, both in univariate analysis (r = 0.41-0.77; P<0.001) and in linear regression analysis. The total skeletal BMD was logarithmically higher by hours of exercise per week (P<0.001)). About 30% of variability in total skeletal BMD in this age group can be predicted by lean mass and physical exercise. CONCLUSIONS: Modifiable factors, such as exercise and adequate muscle seem to be significant predictors of the attainment of peak bone mass in women.

Absorptiometry, Photon↗
PubMed1998

Serum 25-hydroxyvitamin D levels and bone mineral density in 16-20 years-old girls: lack of association.

OBJECTIVE: Hypovitaminosis D has been shown to be associated with low bone mineral density in middle-aged and elderly women. The aim of this study was to evaluate whether such an association might exist in adolescent and young adult girls, approaching peak bone mass. DESIGN: Cross-sectional study carried out in late winter. SETTING: Reykjavik area at latitude 64 degrees N. SUBJECTS: Two-hundred and fifty-nine Icelandic Caucasian girls, aged 16, 18 and 20 years, randomly selected from the registry of Reykjavik. MAIN OUTCOME MEASURES: Bone mineral density in lumbar spine, hip, distal forearm and total skeleton was measured with dual-energy X-ray absorptiometry (DEXA) and compared with 25-hydroxyvitamin D levels [25 (OH)D] in serum, measured by radioimmunoassay. Calcium and vitamin-D intake were also assessed by a questionnaire. RESULTS: 18.5% of the girls were below 25 nmol L-1 in serum 25 (OH)D which has been recognized as the lower normal limit for adults. No significant association was found between 25 (OH)D levels and bone mineral density. CONCLUSIONS: Normal calcium and phosphate concentrations in plasma and normal bone mineral density are maintained in adolescent and young adult girls at lower 25 (OH)D levels than published 'normal' levels for middle-aged and elderly.

Absorptiometry, Photon↗
PubMed1998

Coronary heart disease mortality amongst non-insulin-dependent diabetic subjects in Iceland: the independent effect of diabetes. The Reykjavik Study 17-year follow up.

OBJECTIVES: The main aim of this study was to estimate the independent risk for coronary heart disease (CHD) death associated with non-insulin dependent (Type 2) diabetes (NIDDM) and effect on life expectancy. DESIGN AND SETTING: The Reykjavik Study is a prospective cardiovascular population study which started in 1967. A randomized selection procedure identified individuals for invitation to participate, based on their year and date of birth. Participants were examined in the years 1967-91 in one research clinic in Reykjavik. SUBJECTS AND METHODS: The population in this survey were Icelandic Caucasian males and females, born 1907-35 and therefore 34-79 years old when their examination was performed. Altogether 9139 males and 9773 females attended, and of those 267 males and 210 female were NIDDM as defined by a questionnaire or an oral glucose tolerance test. Other factors measured in the study included systolic and diastolic blood pressure, fasting total cholesterol, triglycerides, uric acid, smoking habits, height, and weight. The causes of death were determined by a review of all death certificates. Results. The relative risk of death from CHD (95% confidence limits), independently associated with NIDDM, was 2.0 (1.5-2.6) for males and 2.4 (1.6-3.6) for females. The relative risk of death from all causes was 1.9 (1.6-2.3) and 1.7 (1.3-2.1), respectively, for male and female diabetic patients. CONCLUSIONS: Non-insulin dependent diabetes mellitus carried twice the risk of CHD death in both sexes, independently of other risk factors. The diagnosis of NIDDM at the age 55 years reduced an individual's life expectancy by about five years, mostly because of increased CHD death rate.

Adult↗
PubMed1998

Simvastatin compared to fluvastatin in the reduction of serum lipids and apolipoproteins in patients with ischaemic heart disease and moderate hypercholesterolaemia.

OBJECTIVE: Inhibitors of HMG-CoA reductase are widely used for the treatment of hypercholesterolaemia and have recently been shown in the Scandinavian Simvastatin Survival Study (4S), to reduce coronary mortality as well as total mortality in CH D patients. Although a couple of studies have already established the efficacy ratio between simvastatin and fluvastatin, one of the newest members of this class, we considered it to be important to verify the comparative efficacy in patients with coronary artery disease in the same type of patients that were included in 4S particularly since the previous studies include rather few patients with CHD, 17-28% only. METHODS AND RESULTS: Three Scandinavian lipid clinics participated in this randomized double-blind study and enrolled a total of 113 hypercholesterolaemic patients with a profile similar to the 4S patients, i.e. either a history of typical angina pectoris lasting at least three months or a myocardial infarction at least six months before the study and with moderate hypercholesterolaemia, total serum cholesterol between 5.5 and 8.0 mmol/l. After a diet run-in period lasting at least 8 weeks, followed by a two week placebo period, patients received treatment with active drug for a 16 week period, with measurement of lipids using the same technique and laboratory as was used in 4S. Patients were randomly assigned to simvastatin 20 mg or fluvastatin 20 mg. If after 6 weeks of double-blind treatment, the 4S total cholesterol target of < or = 5.2 mmol/l total serum cholesterol had not been reached, the dose was doubled at the next visit, i.e. at week 10 based upon blinded titration information from the central lipid laboratory like in the 4S study. A final assessment of serum lipids and lipoproteins was made at week 16. The mean percent reductions in LDL-cholesterol from baseline were 37% and 40% in the simvastatin group compared to 19% and 26% in the fluvastatin group, at weeks 10 and 16, respectively (p < 0.001). In the simvastatin group 18 percent of the patients needed an increase in the dose to 40 mg compared to 63 percent in the fluvastatin group (p < 0.001). At the 20 mg dosage, simvastatin produced a lowering of LDL-cholesterol approximately twice that of fluvastatin 20 mg and resulted in 82% of patients achieving the cholesterol target levels as defined in the 4S study, compared to 19% for fluvastatin. All other recorded lipid variables showed differences which favoured simvastatin over fluvastatin at comparable doses including serum triglyceride reductions where serum triglycerides at week 6 were borderline significantly different between the two groups. Patient tolerability of the two drugs was similar. CONCLUSION: At the recommended doses in patient with angina or a prior MI and mild to moderate hypercholesterolaemia simvastatin is considerably more effective than fluvastatin in lowering serum total cholesterol, LDL-cholesterol as well as other serum lipid risk factors. At an average titrated dose of 32 mg less than 50% of the fluvastatin patients reached the 4S cholesterol target of < 5.2 mmol/l compared to 89% of the simvastatin patients at an average dose of 23 mg daily and only 13% of the fluvastatin patients achieved an LDL-cholesterol reduction of at least 40% compared to 63% of the simvastatin patients.

Analysis of Variance↗
PubMed1997

[Acute type B aortic dissection: prognosis after initial conservative treatment and predictive factors for a complicated course].

OBJECTIVE: Today there is still debate concerning the optimal mode of treatment for type B dissection of the aorta. Controversies are mainly due to discordant results regarding survival following medical or surgical treatment. We assessed the early and long-term outcome of acute dissection of the descending aorta after initial conservative treatment. METHODS: Between 1980 and 1995, 225 patients were hospitalized in the medical or surgical department of our institution with the diagnosis of acute type B aortic dissection. 38 patients (16.8%) underwent replacement of the descending aorta within the first week after hospital admission. Primary indications for immediate surgery were rupturing aneurysm in 15 patients, extensive dilatation of the descending aorta in 13, distal malperfusion in 8, and pseudocoarctation syndrome with uncontrollable hypertension in 2. All other patients (n = 187) underwent primary conservative treatment in the intensive care unit, which included appropriate antihypertensive medication. RESULTS: Hospital mortality during and after initial conservative treatment was 17.6% (33/187 patients). Main causes of death were rupture in 14 patients, intestinal malperfusion in 13 and cardiac failure in 3, whereas in 3 patients the cause of death could not be determined. Nine additional patients had to be referred for early surgery during the initial hospitalization because of contained rupture (n = 4), rapidly increasing size of the aorta (n = 2) and suspected intestinal ischemia (n = 3). Hospital mortality after early surgery was 21% (8/38 patients) for the overall time period. After hospital discharge from the initial acute dissection, surgery for chronic dissection was performed in 47 patients, mainly because of expanding descending aortic aneurysm. Hospital mortality was 8% in these patients (4/47). Actuarial survival rates after primary conservative therapy were 76 +/- 5% and 50 +/- 7% after 5 and 8 years respectively. CONCLUSION: Currently, surgery for acute type B dissection is limited to patients with rupturing disease, distal malperfusion or uncontrollable hypertension and pains. Despite aggressive antihypertensive treatment, hospital mortality after primary conservative treatment is still high and a substantial proportion of patients requires surgery during initial hospitalization. Although conservative treatment is recommended in most uncomplicated type B aortic dissections, early surgery should be considered in the following situations: younger patients with 5 cm diameter of the aorta at initial evaluation, as well as those with Marfan syndrome, patients with limited false aneurysm or retrograde dissection into the aortic arch, and those with poor medical compliance or uncontrollable proximal hypertension. Radiographic follow-up for an indefinite period may allow detection of potential late complications and proper planning of elective operations when indicated.

Acute Disease↗
PubMed1997

Prevalence and incidence of NIDDM in Iceland: evidence for stable incidence among males and females 1967-1991--the Reykjavik Study.

This is the first large survey carried out in Iceland to estimate the prevalence and incidence of known and unknown non-insulin-dependent (Type 2) diabetes (NIDDM) among males and females, aged 34-79. The population in this survey was 9128 males and 9759 females born between 1907 and 1935 and examined in the prospective Reykjavik Study 1967-1991. Participants were invited from one to five times during the 24 years. The overall age-standardized prevalence (95% confidence limits) was 2.9% (2.5 to 3.3) for males and 2.1% (1.8 to 2.5) for females, aged 30-79, according to the European standard population. The overall annual age-standardized incidence rate per 100,000 was 377 (303 to 457) for males and 266 (212 to 320) for females, aged 35-74, standardized to the European population. Our study indicates that the prevalence of NIDDM is relatively low compared to other Nordic and western countries, and has not been increasing over the past 20 years. Furthermore, the incidence of NIDDM has not been changing during the past 20 years of follow-up among Icelandic males and females aged 34-79.

Administration, Oral↗