Biomedical subjects

J Engdahl

Publications and source records attributed to J Engdahl.

4 recordsLinked to original sources

PubMed1998

Occurrence, characteristics, and outcome of patients hospitalized with a diagnosis of acute myocardial infarction who do not fulfill traditional criteria.

BACKGROUND: The diagnosis of acute myocardial infarction (AMI) is traditionally based on clinical history, elevation of serum enzyme activity, and typical changes in the electrocardiogram (ECG); however, not all patients who develop AMI fulfill these criteria on discharge from hospital. HYPOTHESIS: The aim of the study was to evaluate (1) the frequency with which the traditional criteria for AMI are not fulfilled among patients diagnosed with AMI on discharge, and (2) whether patients with and without these criteria differ in terms of characteristics, treatment, and outcome. METHODS: All patients aged < 75 years and hospitalized in the municipality of Göteborg with a discharge diagnosis of AMI were included. Fulfillment criteria for AMI were two of the following three points: (1) chest pain, (2) increase in cardiac enzymes, and (3) development of Q waves. RESULTS: In all, 1,188 admitted patients, 27% of whom were women, were included in the analysis. Of these, 193 (16%) did not fulfill the traditional criteria for AMI. These patients had an in-hospital mortality rate of 48%; of these, 59% died a sudden death, and of those who were autopsied (62%), 96% showed signs of a fresh AMI. The most common symptom on admission to hospital in patients who did not fulfill the traditional criteria was chest pain (34%), followed by dyspnea (27%) and fatigue (14%). Of those who died suddenly, fewer than half had been admitted to the coronary care unit. CONCLUSION: Patients diagnosed with AMI who do not fulfill the traditional diagnosis criteria have high mortality. On admission to hospital, the initial suspicion of AMI is often vague. Measures for earlier detection of life-threatening coronary artery disease among these patients are warranted.

Adult↗

PubMed1992

Effect of training on insulin secretion from single pancreatic beta cells.

The objective of this study was to determine whether insulin secretion from single pancreatic beta cells is reduced by endurance training. Male Sprague Dawley rats either trained (T, N = 9) for 11 wk on a rodent treadmill, remained sedentary, and were fed ad libitum (S, N = 8) or remained sedentary and were food restricted (pair fed, PF, N = 8) so that final body weights were similar to T. After training, T had significantly higher red gastrocnemius muscle citrate synthase activity compared with S and PF. In vivo insulin secretion was lower in T (4.6 +/- 1.4 ng.ml-1, mean +/- SEM of 70' + 90' concentrations during a hyperglycemic glucose clamp) when compared with S, 8.1 +/- 1.6 and PF, 9.7 +/- 1.7 ng.ml-1. In vitro insulin secretion from single beta cells was measured using the cell blot assay (Kendall and Hymer, Endocrinology, 121:2260-2262, 1987) and T, had lower secretion 2.6 +/- 1.4 pg.cell-1 when compared (P less than 0.05) with S, 6.7 +/- 0.6, but not lower than PF, 4.1 +/- 1.7 pg.cell-1. These data suggest that some of the training-induced reduction in insulin secretory response to glucose may be attributable to changes within the beta cell itself.

Adaptation, Physiological↗

PubMedDate not supplied

There is a difference in characteristics and outcome between women and men who suffer out of hospital cardiac arrest.

OBJECTIVE: To evaluate whether there is a difference in characteristics and outcome in relation to gender among patients who suffer out of hospital cardiac arrest. DESIGN: Observational study. SETTING: The community of Göteborg. PATIENTS: All patients in the community of Göteborg who suffered out of hospital cardiac arrest between 1980 and 1996, and in whom cardiopulmonary resuscitation (CPR) was initiated. MAIN OUTCOME MEASURES: Factors at resuscitation and the proportion of patients being hospitalized and discharged from hospital. P values were corrected for age. RESULTS: The women were older than the men (median of 73 vs. 69 years; P < 0.0001), they received bystander-CPR less frequently (11 vs. 15%; P = 0.003), they were found in ongoing ventricular fibrillation less frequently (28 vs. 44%; P < 0.0001), and their arrests were judged to be of cardiac origin less frequently. In a multivariate analysis considering age, gender, arrest being due to a cardiac etiology, initial arrhythmia and by-stander initiated CPR, female gender appeared as an independent predictor for patients being brought to hospital alive (odds ratio 1.37; P = 0.001) but not for patients being discharged from hospital. CONCLUSION: Among patients who suffer out of hospital cardiac arrest with attempted CPR women differ from men being older, receive bystander CPR less frequently, have a cardiac etiology less frequently and are found in ventricular fibrillation less frequently. Finally female gender is associated with an increased chance of arriving at hospital alive.

Adolescent↗

PubMedDate not supplied

Quantitative evaluation of a comprehensive motion, resolution, and attenuation correction program: initial experience.

BACKGROUND: Tomographic myocardial imaging is widely used in the diagnosis and evaluation of patients with coronary artery disease. However, its specificity remains suboptimal because of attenuation, resolution, and motion artifacts. The purpose of this study was to optimize and assess the value of attenuation, blur, and motion correction of myocardial single photon emission computed tomographic data. METHODS AND RESULTS: Forty-seven studies were selected for analysis to provide 3 patient groups. Group A consisted of 18 patients with a low likelihood of coronary artery disease who were used to construct a quantitative normal database and assess changes in the normal bull's-eye produced by filtering and by attenuation correction. Group B consisted of 13 patients with a high probability of normal results, and group C consisted of 16 patients with coronary artery disease defined on angiography. The effects of attenuation correction, especially in conjunction with RESTORE (a depth-dependent deblurring filter), have been quantitated. Analysis indicates a trend to improved sensitivity and specificity for detecting individual vessel disease in this retrospective study. The motion correction program was successfully applied to 93% of patients but detected significant motion requiring correction in only 11 (24%) patients. CONCLUSION: This preliminary retrospective study indicates a potential for improved myocardial single photon emission computed tomography imaging with the use of attenuation and motion correction together with a restorative deblurring filter. Confirmation by a multicenter study and larger patient numbers remain necessary to assess fully the prospective value of the technique.

Adult↗