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Biomedical subjects

H Persson

Publications and source records attributed to H Persson.

At least 19 recordsLinked to original sources
PubMed2006

No apparent effect of surgery for temporal lobe epilepsy on heart rate variability.

BACKGROUND: Impaired cardiac autonomic function may contribute to the risk of sudden unexpected death in epilepsy (SUDEP). Clinical observations indicate that successful epilepsy surgery is associated with a reduced risk of SUDEP. However, in a previous study we found impaired cardiac control pre-surgically in patients with poor outcome of surgery, indicating an a priori lower risk in responders to epilepsy surgery. We have now examined the effect of surgery on cardiac autonomic control in the same patients. METHODS: We used 24 h EKG recordings to assess heart rate variability (HRV) by spectral analysis in 21 consecutive patients after temporal lobe epilepsy surgery. The HRV was compared with healthy controls, with pre-surgical HRV in the same patients, and analyzed in relation to seizure control 1 year after surgery. RESULTS: The patients with poor outcome after surgery had significantly lower SD of RR-intervals, total power, very low frequency power and low frequency power than matched healthy controls. The patients with favorable outcome did not differ from the controls, and the postoperative HRV was not different from HRV before surgery in any of the patient groups. CONCLUSION: We could not demonstrate any effect on HRV of temporal lobe epilepsy surgery in these patients. The observed lower HRV in the poor outcome group was present already before epilepsy surgery as previously reported. Although our results need confirmation in a larger study, the observations suggest that the increased risk of SUDEP in patients failing epilepsy surgery may be due to a common factor predisposing to surgical failure, impaired HRV as well as to an increased risk of SUDEP.

Autonomic Nervous System↗
PubMed2005

Preoperative heart rate variability in relation to surgery outcome in refractory epilepsy.

BACKGROUND: Epilepsy patients may have an impaired autonomic cardiac control, which has been associated with an increased incidence of sudden unexpected death among people with epilepsy (SUDEP). The risk of SUDEP is particularly high among epilepsy surgery candidates with refractory epilepsy. This risk seems to be reduced after successful surgery but whether this is an effect of surgery or reflects pre-existing differences between good and poor responders is under debate. METHODS: We used spectral analysis to analyze prospectively heart rate variability (HRV) preoperatively in 21 consecutive patients with temporal lobe epilepsy who were planned for epilepsy surgery. The presurgical HRV based on ambulatory 24 hours EKG recordings was analyzed in relation to seizure control at 1 year after surgery. RESULTS: Patients had significantly lower SD of RR-intervals, total power, very low frequency power and low frequency power than matched healthy controls. Patients with good outcome of surgery (Engel class I; n = 11) did not differ from their controls while those with poor outcome (Engel class II-IV; n = 10) had significantly lower power in all domains than those with a favorable outcome. CONCLUSIONS: Measurements of heart rate variability preoperatively indicate that patients with a poor outcome of surgery have a more pronounced impairment of sympathetic as well as parasympathetic cardiac control than those with good outcome. Reduced heart rate variability may be associated with an increased risk of sudden unexpected death among people with epilepsy (SUDEP). Good surgery candidates may a priori have a lower risk of SUDEP.

Arrhythmias, Cardiac↗
PubMed2005

Predicting readmissions and cardiovascular events in heart failure patients.

AIMS: To analyse measures of clinical data, functional capacity, left ventricular function and neurohormonal activation for the ability to predict mortality and morbidity in patients after a hospitalisation for heart failure. METHODS: In a prospective study, patients 60 years or above with systolic heart failure NYHA II-IV were followed for at least 18 months. At study start, a physical examination, echocardiography, blood samples and measurements of quality of life (QoL) by Nottingham Health Profile were obtained. Data on mortality and readmission rates were collected. RESULTS: 208 patients, 58% men, with a mean age of 76 years, and an ejection fraction of 0.34 were included and followed for a mean of 1,122 days. In all, 74 (36%) patients died and 171 (82%) were readmitted. By univariate analysis, readmissions were predicted by poor QoL (169 +/- 118 vs. 83 +/- 100, p < 0.001), age, creatinine, haemoglobin (p < 0.01 all) and diabetes (p < 0.1). By multivariate analyses, QoL at study start was the only independent predictor of readmissions (chi(2) = 25.2, p < 0. 001). Mortality was univariately associated with QoL (183 +/- 117 vs. 142 +/- 115, p < 0.05) and in multivariate analyses to traditional variables: age, male gender, systolic function, BNP and serum creatinine (chi(2) = 48.9, p < 0.001). CONCLUSIONS: Measurements representing different aspects of the heart failure syndrome can easily be obtained to stratify long-term risks of mortality and morbidity in hospitalised heart failure patients. Poor QoL was a univariate predictor for mortality and a strong multivariate predictor for the important outcome of readmission, pointing to the need for a simple assessment of QoL.

Aged↗
PubMed2005

Acute barium nitrate intoxication treated by hemodialysis.

A 22-year-old male was admitted to hospital with diarrhea and vomiting, cardiac arrhythmias, severe hypokalemia and gradual onset of muscular weakness. A potassium infusion was started, but for several hours serum potassium remained low. Evidence of toxic ingestion was initially lacking. When it became clear -- after a considerable delay -- that the patient had ingested barium nitrate, hemodialysis was started. This resulted in rapid clinical improvement with correction of hypokalemia and restored muscular function. Intoxication with barium causes hypokalemia, arrhythmias, muscular weakness and paralysis, often requiring respiratory support. This patient presented with symptoms typical of severe barium intoxication, non-responsive to potassium supplementation. There are few published reports on the use of hemodialysis in barium poisoning. This case confirms the possible benefit of hemodialysis in severe cases, where potassium supplementation alone is insufficient.

Adult↗
PubMed2004

Effect of carvedilol on diastolic function in patients with diastolic heart failure and preserved systolic function. Results of the Swedish Doppler-echocardiographic study (SWEDIC).

AIM: The purpose of this study was to investigate the effects of carvedilol on diastolic function (DF) in heart failure patients with preserved left ventricular (LV) systolic function and abnormal DF. PATIENTS AND METHODS: We randomised 113 patients with diastolic heart failure (DHF) (symptomatic, with normal systolic LV function and abnormal DF) into a double blind multi-centre study. The patients received either carvedilol or matching placebo in addition to conventional treatment. After uptitration, treatment was continued for 6 months. Two-dimensional and Doppler echocardiography were used for quantification of LV function at baseline and at follow-up. Four different DF variables were evaluated by Doppler echocardiography: mitral flow E:A ratio, deceleration time (DT), isovolumic relaxation time (IVRT) and the ratio of systolic/diastolic pulmonary venous flow velocity (pv-S/D). Primary endpoint was change in the integrated quantitative assessment of all four variables during the study. RESULTS: Ninety-seven patients completed the study. A mitral flow pattern reflecting a relaxation abnormality was recorded in 95 patients. There was no effect on the primary endpoint, although a trend towards a better effect in carvedilol treated patients was noticed in patients with heart rates above 71 beats per minute. At the end of the study, there was a statistically significant improvement in E:A ratio in patients treated with carvedilol (0.72 to 0.83) vs. placebo (0.71 to 0.76), P<0.05. CONCLUSIONS: Treatment with carvedilol resulted in a significant improvement in E:A ratio in patients with heart failure due to a LV relaxation abnormality. E:A ratio was found to be the most useful variable to identify diastolic dysfunction in this patient population. This effect was observed particularly in patients with higher heart rates at baseline.

Adrenergic beta-Antagonists↗
PubMed2004

Limited long term effects of a management programme for heart failure.

OBJECTIVE: To evaluate the effects of a nurse based outpatient management programme for elderly patients discharged with heart failure from a university hospital. DESIGN: Patients with heart failure (New York Heart Association class II-IV) and left ventricular systolic dysfunction aged 60 years or more were randomly assigned to follow up within the management programme or to conventional follow up, usually in primary care. Of the 208 participants, 58% were men, mean age was 75 years, and mean ejection fraction 34%. All patients were scheduled for three observational study visits at six month intervals. The primary end point was quality of life (QoL) and secondary end points were hospitalisation and mortality. RESULTS: More patients achieved target doses of angiotensin converting enzyme (ACE) inhibitors in the intervention group than in the control group (82% v 69%, 88% v 69%, and 88% v 74% of recommended target doses at 6, 12, and 18 months of follow up, respectively, p < 0.05 for all). Patients with initial low QoL had a poor prognosis. After a mean 1122 days of follow up, 82% of all patients had been readmitted. There were on average 4.7 readmissions per patient and 66% were due to non-cardiac diagnoses. There were no differences in QoL or health care consumption between the two study groups during follow up. CONCLUSION: A nurse based management programme is more effective than follow up in primary care in optimising medication for elderly patients with heart failure. However, such a programme does not seem to have a favourable influence on QoL or readmission rate during long term follow up.

Aged↗
PubMed2002

Ventilatory variables are strong prognostic markers in elderly patients with heart failure.

OBJECTIVE: To evaluate the safety and prognostic capacity of cardiopulmonary exercise testing in patients > or = 60 years old who are hospitalised with heart failure caused by left ventricular dysfunction. DESIGN: Prospective study. SETTING: University hospital. PATIENTS: Study participants were 67 patients (66% men) with clinical heart failure stabilised on medical treatment. The study is a part of a nursing intervention study. Mean (SD) age was 74 (6) years, New York Heart Association functional class II-III, and ejection fraction 0.36 (0.11). INTERVENTIONS: Cardiopulmonary exercise testing and echocardiography. MAIN OUTCOME MEASURES: Peak oxygen consumption (VO2), peak ventilatory equivalents for carbon dioxide (VE/VCO2) and oxygen (VE/VO2), left ventricular volumes, and mortality. RESULTS: Mean (SD) peak VO2 was 11.7 (3.7) ml/kg/min, peak VE/VCO2 43 (9), and peak VE/VO2 46 (11). During 12-59 months of follow up, 14 patients died. In univariate analyses peak VO2, VE/VO2, and VE/VCO2 were all strongly related (p < 0.01) to mortality. In a multivariate Cox regression analysis, peak VE/VCO2 was the strongest predictor of mortality (p < 0.001), followed by left ventricular end systolic volume (p < 0.001). A cut off of peak VE/VCO2 at > or = 45 gave a univariate hazard ratio of 6.7 for death during follow up. No adverse events occurred during the exercise test. CONCLUSION: These findings extend results found in selected middle aged patients to elderly patients with heart failure and show that ventilatory parameters from a cardiopulmonary exercise test, such as peak VO2, VE/O2, and VE/VCO2 are powerful predictors of mortality.

Aged↗
PubMed2001

Epidemiology of heart failure in Sweden--a national survey.

BACKGROUND: In Sweden heart failure is the most frequent discharge diagnosis within internal medicine. The prevalence of heart failure seems to be increasing, mainly due to an ageing population, but also because of improved survival in patients with cardiovascular diseases. AIM: To describe the epidemiology of heart failure in Sweden from a perspective based on demographic and health care data. METHODS: The national registers in Sweden provide detailed information on health care consumption in relation to different diagnoses. Pharmaceutical sales are also registered. There are national epidemiological reports, reports on health care utilization and on health economics concerning heart failure patients. RESULTS: There has been structural changes in the Swedish health care system due to financial restraints in the health care budget. Aiming at reducing hospital costs, the total amount of hospital beds has been cut down markedly during the last decade. The number of heart failure patients and the number of hospital stays have increased during the same period. Hospital stays have become shorter. The number of patients and hospital stays more than double when heart failure as both primary and secondary discharge diagnoses are included. CONCLUSION: The available national registers provide a good opportunity to study epidemiology of heart failure in Sweden. The number of hospital beds has decreased markedly within the last decade due to changes in the Swedish health care system. Nevertheless, there has been an increase in the number of patients discharged with heart failure from the hospitals, suggesting an increase in prevalence.

Ambulatory Care Facilities↗
PubMed2001

Envenoming by European vipers antivenom treatment--influence on morbidity.

The incidence of venomous viper bites in Europe is difficult to assess. Mortality after bites by European vipers is nowadays low, but morbidity is by no means negligible. Serious and life-threatening reactions occur, especially in small children and elderly people. The critically ill can nowadays be managed with symptomatic and supportive care in an astonishing way, but antivenom treatment may reduce the extent of such treatment and also reduced the overall risk for the patient. In particular, the only way to prevent extensive swelling and related complications is to give antivenom. The aim of this study was to test efficacy and safety of ovine Fab (a new specific ovine Fab fragments against various snake venoms) as an alternative to equine F(ab)2 antibodies in patients presenting with moderate and severe envenoming.

Aged↗
PubMed2000

Immunostaining of ganglioside GD1b, GD3 and GM1 in rat cerebellum: cellular layer and cell type specific associations.

We have studied the cellular distribution of gangliosides GD1b, GD3 and GM1 in rat cerebellum by immunostaining, using monoclonal antibodies and confocal microscopy. Antibodies against astroglial, neuronal and synaptic vesicle associated molecules were used for colocalization analyses. In the gray matter, the anti-GD1b antibody stained thin strands in the molecular layer (ML), interpreted as Bergman glia fibers based on colocalized staining with anti-glial fibrillary acidic protein (GFAP). The neuropil in the granule (GL) and Purkinje (PL) cell layers was also anti-GD1b positive. The anti-GD3 antibody stained the ML, the neuropil in the GL and PL and also the granule and Purkinje cell bodies, appearing intracytoplasmically and vesicle associated. Anti-GD1b and anti-GD3 staining in the GL glomeruli were colocalized with anti-synaptophysin staining. The anti-GM1 antibody stained cell bodies in the ML but they could not be characterized in colocalization experiments. The GL and PL were not stained with the anti-GM1 antibody. In the white matter, different staining patterns were seen for the gangliosides, the anti-GM1 staining being the most intense. This study shows cellular layer and cell type specific associations of the investigated gangliosides and localization of GD1b and GD3 at synaptic sites, warranting further studies on their role in synaptic mechanisms.

Animals↗
PubMed2000

Doppler tissue imaging in congestive heart failure patients due to diastolic or systolic dysfunction: a comparison with Doppler echocardiography and the atrio-ventricular plane displacement technique.

BACKGROUND: Doppler tissue imaging (DTI) is an echocardiographic technique by which regional contractility, relaxation properties and time intervals are obtained easily. DTI has been reported to be relatively pre-load independent and could, in comparison with the commonly used mitral pulse wave Doppler (MPWD) method, be of clinical interest for identification of patients with diastolic dysfunction. The atrio-ventricular plane displacement (AVPD) method is an established technique to assess left ventricular systolic function. AIMS: To determine the pulsed Doppler DTI-pattern in patients with heart failure and to examine whether it has a similar capacity as MPWD and AVPD to diagnose diastolic dysfunction. METHODS: We studied 15 controls without congestive heart failure (CHF), 15 patients with diastolic (EF>45%+CHF) and 15 patients with systolic (EF<35%+CHF) left ventricular dysfunction and CHF. RESULTS: The DTI maximal velocities during systole (s), early filling wave (e) and atrial filling wave (a), decrease with reduced left ventricular ejection fraction, r=0.75, r=0.56 and r=0.66 (P<0.001) and regional isovolumetric contraction and intraventricular relaxation time measured by DTI are prolonged, r=0.59 and r=0.73, respectively (P<0.001). The 15 patients with diastolic heart failure were identified by MPWD or DTI but only 11 by AVPD with 8, 10 and 9 false-positive, respectively (P<0.01, P<0.05 and NS). CONCLUSIONS: Regional DTI show a consistent pattern in patients with left ventricular dysfunction and heart failure. Regional DTI has similar accuracy as MPWD in identifying diastolic heart failure patients and is superior to the AVPD technique. DTI may be a useful diagnostic tool in diastolic heart failure patients.

Aged↗
PubMed1999

Exposure of cryptic epitopes on transthyretin only in amyloid and in amyloidogenic mutants.

The structural requirements for generation of amyloid from the plasma protein transthyretin (TTR) are not known, although it is assumed that TTR is partly misfolded in amyloid. In a search for structural determinants important for amyloid formation, we generated a TTR mutant with high potential to form amyloid. We demonstrated that the mutant represents an intermediate in a series of conformational changes leading to amyloid. Two monoclonal antibodies were generated against this mutant; each displayed affinity to ex vivo TTR and TTR mutants with amyloidogenic folding but not to wild-type TTR or mutants exhibiting the wild-type fold. Two cryptic epitopes were mapped to a domain of TTR, where most mutations associated with amyloidosis occur and which we propose is displaced at the initial phase of amyloid formation, opening up new surfaces necessary for autoaggregation of TTR monomers. The results provide direct biochemical evidence for structural changes in an amyloidogenic intermediate of TTR.

Amino Acid Sequence↗
PubMed1999

Diagnostic tests, treatment and follow-up in heart failure patients--is there a gender bias in the coherence to guidelines?

AIMS: To relate clinical data in a consecutive cohort of patients admitted with heart failure in Sweden to demographic data and the use of diagnostic tests, medical treatment, care process and mortality. METHODS AND RESULTS: Retrospective investigation of all charts concerning patients discharged with primary diagnosis of heart failure in two Swedish hospitals during the second half of 1995 was undertaken. Records from 187 men and 192 women were analyzed, median age was 78 years. During hospital stay 75% of the patients, regardless of gender, were examined with chest radiography. Echocardiography was performed in 59% of all patients, more often in men than in women (68% vs. 55%, P<0.011). The proportion of patients receiving ACE-inhibitors was higher if echocardiography had been performed, in both men (38% vs. 72%, P<0.001) and women (38% vs. 55%, P<0.033). Mean hospital stay was 6.4 days. After discharge 57% of the patients were referred to the general practitioners (GP), 21% to the hospital outpatient clinic. Young age (P<0.001), male gender (P<0.01) and treatment with beta-blocking agents (P<0.035) were independently related to referral to hospital outpatient clinic. Within the group referred to the GPs, 62% of the patients had a follow-up visit within 3 months after discharge while 49% had visited the hospital outpatient clinic. The 1-year mortality rate was high, 30%. CONCLUSION: Patients admitted with heart failure in Sweden are old and carry a poor prognosis. In spite of the poor prognosis, only approximately half of the patients are followed-up within 3 months after discharge. There is, in contrast to practice guidelines, an underuse of diagnostic tests of left ventricular function and medical treatment is often suboptimal. These unsatisfactory findings were more pronounced in women.

Adult↗
PubMed1999

Tissue reactions to polyethylene implants with different surface topography.

This study investigates the importance of implant surface topography on soft tissue response. The tissue response in the rat abdominal wall to discs of low density polyethylene with smooth to coarse surfaces was evaluated after one, six or 12 weeks. Capsule thickness and immunohistochemical quantification of monocytes-macrophages were used as measures. The macrophage specific antibody ED1 was used for identification of newly recruited macrophages and the ED2 antibody for the mature tissue macrophages. The smoother surfaces gave a thicker capsule than the rougher surfaces, and at one week also larger total numbers of cells and ED1 positive macrophages at interface. The capsule thickness increased over time for the smooth and intermediate surface topographies. In contrast, the cell numbers generally decreased over time. In conclusion, a coarse surface elicited lesser tissue reaction compared with a smooth surface.

Journal Article↗