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J S Lindholt

Publications and source records attributed to J S Lindholt.

At least 19 recordsLinked to original sources
PubMed2006

Relatively high pulmonary and cardiovascular mortality rates in screening-detected aneurysmal patients without previous hospital admissions.

BACKGROUND: Men with abdominal aortic aneurysm (AAA) who are not hospitalised for pulmonary and cardiovascular diseases may have higher mortality due to such disorders. MATERIAL AND METHODS: Previous discharge diagnoses and causes of death were collected for 4,816 men aged 64-73 years attending mass screening for AAA. Of these, 191 (4%) had an AAA. Overall, cardiovascular- and pulmonary-disease-specific mortality was compared for men with and without AAA stratified for earlier pulmonary or cardiovascular hospitalisations by Cox's proportional hazards regression while adjusting for age. Absolute risk differences after five years were calculated by life table analysis. RESULTS: The median observation time was 63 months. 362 men died from cardiovascular causes other than AAA, and 144 died from pulmonary causes. The cardiovascular mortality was significantly higher in aneurysm patients without previous related hospitalisation (HR=4.35, 95% CI: 2.73-6.94, P<0.001) with an absolute mortality difference after 5 years of 16.3% (95% CI: 10.2-22.5%). Pulmonary-cause mortality was higher among men with AAA both with and without previous hospitalisation for pulmonary causes (HR=3.05; 95% CI: 1.19-7.83, P=0.020, and HR=3.29; 95% CI: 1.78-6.08, P<0.001, respectively). CONCLUSIONS: Men with AAA who had not been hospitalised for cardiovascular diseases have more than four times higher cardiovascular mortality. Studies of cohorts being offered relevant prophylaxis may clarify the potential benefits of general preventive actions.

Aged↗
PubMed2006

Preliminary ten year results from a randomised single centre mass screening trial for abdominal aortic aneurysm.

BACKGROUND: At present, several regions and countries are considering screening for abdominal aortic aneurysm (AAA). However, The Chichester Aneurysms Screening Trial has reported poor long term benefit of screening for AAA. We therefore supplement previously published data with a preliminary analysis of the ten-year mortality from AAA, based upon population-based data until 2002 (7 years) and incomplete hospital-based information on deaths until 2005 (10 years). METHODS AND MATERIAL: In 1994 we started a randomised screening trial of 12,639 64-73 year-old males; 6,306 were controls, and 6,333 were invited to an abdominal ultrasound scan at their district hospital. Information on all deaths until 15.3.2005 was obtained from the Office of Civil Registration. Information on AAA related deaths was obtained from the national registry of Causes of Deaths from 1.4.1994 to 31.12.2001, and supplemented with AAA deaths known to the Danish National Patient Registry until 15.3.2005. Operations were obtained from the Danish National Vascular Registry from 1.4.1994 to 15.3.2005. Death certificates and medical records were reviewed by two independent assessors. The analyses were based on "intention to treat" from the date of randomisation. RESULTS: The attendance rate was 76.6% and 191 (4.0%) had an AAA. The median observation time was 9.58 years. In the invited group 13 subjects were acutely operated on compared to 40 in the control group (Risk ratio: 0.32 (95% C.I. 0.17-0.60, P<0.001)), and 14 died due to AAA compared to 51 in the control group (Hazard ratio: 0.27 (95% C.I.: 0.15-0.49, P<0.001). CONCLUSION: Over ten years, screening reduced mortality from AAA by 73%, and the frequency of emergency operations by 68%.

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PubMed2006

Cost-effectiveness analysis of screening for abdominal aortic aneurysms based on five year results from a randomised hospital based mass screening trial.

BACKGROUND: The aim of this study was to estimate the cost effectiveness of screening for abdominal aortic aneurysm (AAA). MATERIAL AND METHODS: All 12,639 men born in the years 1921-1933 (aged 64-73) living in Viborg County, Denmark, were randomly allocated either to receive an invitation to abdominal ultrasound scanning for AAA or to be controls. Costs for screening and surveillance were assessed prospectively. Diagnosis Related Group (DRG) costs from 1999 were used concerning admissions with uncomplicated and complicated operations. Admissions for AAA surgery were retrospectively classified according to complications in patient records. RESULTS: Mean follow-up time was 52 months. 76.6% of invited men attended screening, and 191 (4.0%) had an AAA. As previously reported, the cumulative 5-year AAA-specific mortality in the invited group was significantly reduced by 67% compared to the control group (P = 0.003). The costs were estimated to be Euro 11.23 per scan. The costs per life-year saved were Euro 9057 (Euro 5872-20,063) after 5 years, and were expected to decrease to Euro 2708 (Euro 1758-6031) after 10 years and to Euro 1825 (Euro 1185-4063) after 15 years. CONCLUSION: Screening of 64-73 years old males in Denmark seems cost effective.

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PubMed2006

Chronic inflammation, immune response, and infection in abdominal aortic aneurysms.

Abdominal aortic aneurysms (AAA) are associated with atherosclerosis, transmural degenerative processes, neovascularization, decrease in content of vascular smooth muscle cells, and a chronic infiltration, mainly located in the outer aortic wall. The chronic infiltration consists mainly of macrophages, lymphocytes, and plasma cells. The dominant cells are Th2 restricted CD3+ lymphocytes expressing interleukine 4, 5, 8, and 10, and tumor necrosis factor-alpha for regulation of the local immune response. They also produce interferon-gamma and CD40 ligand to stimulate surrounding cells to produce matrix metalloproteases and cysteine proteases for aortic matrix remodeling. The lymphocyte activation may be mediated by microorganisms as well as autoantigens generated from vascular structural proteins, perhaps through molecular mimicry. As in autoimmune diseases, the risk of AAA is increased by certain genotypes concerning human leucocyte antigen class II. These types are also associated with increased aneurysmal inflammation indicating a genetic susceptibility to aortic inflammation. Chlamydia pneumoniae is often detected in AAA but the validity of the methods can be questioned, and two small antibiotic trials have been disappointing. However, serum antibodies against C. pneumoniae have been associated with AAA growth and cross-react with AAA wall proteins. Thus, immune responses mediated by microorganisms and autoantigens may play a pivotal role in AAA pathogenesis.

Aortic Aneurysm, Abdominal↗
PubMed2003

Systemic levels of cotinine and elastase, but not pulmonary function, are associated with the progression of small abdominal aortic aneurysms.

OBJECTIVE: to study whether smoking and impaired pulmonary function are associated with the expansion of abdominal aortic aneurysms (AAA). METHODS AND MATERIAL: seventy-nine men with small (3-5 cm), screen-detected AAA underwent a simple 5-step smoking history, measurement of the forced first second expiratory volume (FEV1), venepuncture and annual ultrasound scan for mean follow-up period of 3.5 years. RESULTS: all but one patient had a significantly reduced FEV1 (p<0.05, Mann-Whitney). The FEV1/expected FEV1 ratio (rFEV1) was not related to AAA expansion but was negatively correlated with P-elastase-alpha1-antitrypsin-complexes (P-Elastase). P-Elastase was positively correlated with smoking and S-cotinine. Smoking, S-cotinine, and P-elastase were positively correlated with the mean annual AAA expansion rate but not rFEV1. CONCLUSION: in general, patients with AAA have impaired pulmonary function. A simple five step smoking classification is as predictive of AAA-expansion as S-cotinine. Smoking may cause elastase secretion leading to pulmonary and aortic elastin degradation but the lack of association between AAA-expansion and rFEV1 suggest that other mechanisms are important.

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PubMed2003

Radiocontrast induced nephropathy.

In spite of improvements in chemical structure, contrast media assisted X-ray examination is still the third leading cause of hospital-acquired acute renal failure. An increase >50% or >88 micro mol/L in S-creatinine is a clinically important acute renal failure. The peak in S-creatinine occurs within 2-5 days after exposure. The frequency of oliguria, transient or permanent haemodialysis is unknown. The cause is a hypoxic tubular injury due to vasoconstriction with release of free oxygen radicals. Major risk factors are prior renal insufficiency and diabetes mellitus. Minor risk factors are congestive heart disease, dehydration, hypotension, hypoxia, amount of contrast, ionic and high osmolar contrast, repeated examinations at short intervals, abdominal examination, and perhaps age, smoking, hypercholesterolaemia, and use of Non-Steroidal Anti inflammatory Drug. Prevention seems possible by omission or reduction of contrast, ameliorating predisposing factors, saline hydration 24h before and after exposure, and 600 mg acetylcysteine orally twice daily 24h before and after exposure. A three-day treatment with 20mg nitrendipine daily, starting 1 day before examination may also be preventive. The present research is unfortunately characterised by small numbers, lack of clinical important renal failure, and lack of long term results. The latter may be important after new data indicate that radiation may trigger a chronic oxidative process through a similar pathway.

Acute Kidney Injury↗
PubMed2003

Relationships between activators and inhibitors of plasminogen, and the progression of small abdominal aortic aneurysms.

OBJECTIVE: plasmin is a common activator of the known proteolytic systems involved in the aneurysmal degradation, and is reported to be associated with the expansion of abdominal aortic aneurysms (AAA). The aim of this study was to study the activating pathways of plasminogen as predictors of the progression of AAA. MATERIALS AND METHODS: one hundred and twelve of 122 male patients with a small AAA (def.: +3cm) were interviewed, examined, had blood samples taken at diagnosis, and scanned annually for 1-5 years (mean 3.5 years), and referred for surgery if the AAA exceeded 5cm in diameter.A random sample of 70 of the 112 cases had plasma levels of urokinase-like-plasminogen activator (uPA), tissue-type-plasminogen activator (tPA), plasminogen-activator-inhibitor-1 (PAI-1), macrophage inhibiting factor (MIF), tumour-growth-factor-beta1 (TGF-beta1), homocysteine, and serum levels of IgA-antibodies against Chlamydia pneumoniae (IgA-CP) and Cotinine (a nicotine metabolite) measured. Spearmans correlation analysis was used for statistics. RESULTS: the annual expansion rate correlated positively with tPA, IgA-CP and S-Cotinine; r =0.37 (p=0.002), 0.29 (p=0.006) and 0.24 (p=0.038), while PAI1, uPA, TGF-beta1, homocysteine, and MIF did not. S-Cotinine did also correlate positively with tPA, r=0.24 (p=0.049). CONCLUSION: the aortic matrix degradation in AAA may be partly caused by an activation of plasminogen by tPA, but apparently not by uPA, which usually dominates matrix degradation. Smoking seems to be a factor for this pathway, while the pathways of IgA-CP and MIF, a new marker of aneurysmal progression, seem different. The latter observations suggest that other proteolytic pathways are involved in the aortic wall degradation in AAA.

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PubMed2002

Hospital costs and benefits of screening for abdominal aortic aneurysms. Results from a randomised population screening trial.

OBJECTIVES: to analyse the hospital costs and benefits of screening older males for abdominal aortic aneurysm (AAA). MATERIALS AND METHODS: in 1994 a hospital-based screening trial of 12 658 65-73-year-old males was started. AAA >5 cm were referred for surgery. The remaining AAA were offered annual scans. Those with aortic ectasia were rescreened at 5 yearly intervals. AAA-operations and hospital AAA-related deaths were researched. The costs of screening, surveillance, and treatment were also registered. RESULTS: the attendance rate was 76%; of whom 191 (4.0%) had AAA. Mean observation time was 5.13 years. Sixty in the screened and 41 in the control group were operated (p=0.06), of which 7 and 27 respectively were operated as an emergency (p<0.001), and 6 and 19 respectively died due to AAA (p=0.009). The costs per scan were 83.50 DKK, 81 400 DKK per emergency operation (71 485 DKK after screening), and 117 000 DKK per emergency operation. The cost per prevented hospital death was 67 855 DKK, equivalent to approximately life year saved approx. 7540 DKK (GBP1=12 DKK). CONCLUSION: screening appears to reduce hospital AAA mortality and to be cost-effective.

Aged↗
PubMed2002

Immunoblotting analysis of abdominal aortic aneurysms using antibodies against Chlamydia pneumoniae recombinant MOMP.

OBJECTIVES: antibodies against Chlamydia pneumoniae have been associated with atherosclerosis and with expansion of abdominal aortic aneurysms (AAA). C. pneumoniae has been demonstrated in coronary arteries, AAA and the carotid arteries by use of polymerase chain reactions (PCR), immunohistochemical procedures and electron microscopy. However, the correlation between demonstrating C. pneumoniae DNA or antigen in tissue from plaque material or aneurysms and the antibody titres in serum is controversial. The specificity of immunohistochemical procedures is unknown. The aim of this study was to assess the possibility of potential non-specific findings for methods based on immunostaining. MATERIALS AND METHODS: twenty patients undergoing infrarenal AAA repair were studied. Full AAA thickness tissue was collected from the anterior wall of the aneurysm. Analysis was performed using polyacrylamide gelelectrophoresis, immunoblotting and mass spectrometric protein identification. RESULTS: C. pneumoniae antigen was not demonstrated in any of the AAA samples, whereas a major cross-reacting protein was present in all AAA samples. The protein was identified as the human haemoglobin beta chain. CONCLUSION: we were not able to find C. pneumoniae antigens reacting with an anti C. pneumoniae major outer membrane protein (MOMP). Direct detection of C. pneumoniae by immunohistostaining procedures should be interpreted with caution due to potential crossreaction with non chlamydial proteins.

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PubMed2001

[Screening of first-degree relatives of patients with abdominal aortic aneurysm].

Whereas the lethality of elective resection of abdominal aortic aneurysms (AAA) is 3-6%, that for ruptured cases is 75-95%. Unfortunately AAA seldom cause symptoms before rupture. As ultrasonographic screening is quick, inexpensive, and reliable, this has been suggested. First-degree relatives are reported to have a 2-4 times increased risk of AAA. Substantial benefits would be gained by population screening of 65-year-old men, particularly in the case of male first-degree relatives. Female first-degree relatives seem to have a risk similar to that of the male population, but the data are uncertain. Ruptured AAA rarely occur before the age of 60. Familial AAA do not expand faster nor are they associated with unusual locations, but they may occur earlier in life. Screening causes psychological side effects, and it could therefore be offered to male first-degree relatives from the age of 60, and be confined to ultrasonographic scanning of the infrarenal abdominal aorta at five-year intervals.

Adult↗
PubMed2001

[Catheter-guided thrombolysis in peripheral arterial occlusion].

By catheter-directed, regional, intravascular thrombolysis a thrombus-dissolving enzyme is applied through a catheter placed at/in the occlusion. Non-fibrin-specific (streptokinase or urokinase) and fibrin-specific agents (tissue plasminogen activators) are available. The large randomised trials (TOPAS and STILE) have serious selection bias, which makes generalisation difficult. Other studies have incomparable data and thus meta-analysis is impossible. Consequently, a recent consensus document cannot recommend an agent or principle of infusion. Thrombolysis of late, but transitory (< 14 days), occlusions seems beneficial but long-term results are lacking and recurrences are common. Exclusion of preoperative thrombolysis in late and longer lasting occlusions (> 14 days) is debatable, because of a potential thrombolysis-caused improved run-off. Individual case selection is still needed, because thrombolysis is a promising, although experimental, treatment.

Arterial Occlusive Diseases↗
PubMed2001

[What are the direct costs of an abdominal aortic aneurysm repair in a Danish hospital?].

INTRODUCTION: The aim of the study was to estimate the direct cost of an abdominal aortic aneurysm (AAA) repair and to validate it against the national Diagnostic Related Group (DRG) costs. MATERIAL: Over a three-year period, between January 1996 and December 1998, a total of 100 men were selected at random from a series of 197 patients treated with open surgery for (AAA) at the Department of Vascular Surgery, Viborg Hospital. RESULTS: The total cost of an AAA operation without complications was estimated to be 70,000 DKK, compared to the DRG price of 79,000 DKK. Complications were significantly more frequent after emergency repair (odds ratio = 4.3 (95% CI; 1.9-10.1)). A statistically significant difference was seen in the cost of AAA repair between elective and emergency operations with rupture (p < 0.05), mainly because of the longer stay in hospital. DISCUSSION: The estimated cost is sufficiently reliable to be used in analysis of cost-effectiveness.

Aortic Aneurysm, Abdominal↗
PubMed2001

[Optimal interval screening and observation of abdominal aortic aneurysms].

INTRODUCTION: Screening and observation of abdominal aortic aneurysms (AAA) produce psychological stress. Consequently, safe and optimal intervals of rescreening and observation must be developed. METHOD: In a randomised, mass screening trial of 6,339 men aged, 65-73 years from 1994 to 1998, 76% attended, and 191 (4%) had AAA > or = 3 cm. Twenty-four (0.5%) had AAA above 5 cm in diameter and were referred for surgery, while the rest were offered annual control. Later, all 348 (7.5%) men who, 3 to 5 years before, had had an ectatic aorta (an infrarenal aortic diameter of 25-29 mm or a distal/renal aortic diameter ratio of > 1.2) were offered rescreening, together with a control group of 380 men. RESULTS: None of the controls had developed AAA. Of those who initially had an aortic diameter of 25-29 mm aorta, 28.5% had developed AAA (size range 30-48 mm), whereas only 3.5% with a ratio > 1.2 developed AAA (size range 30-34 mm). During the fourth year of surveillance some AAA initially sized below 3.5 cm expanded to above 5 cm, whereas this occurred in some sized 3.5-3.9 cm during the second year and in most above 4 cm did during the first year of observation. CONCLUSION: Rescreening for AAA can be restricted to initially ectatic aortas sized 25-29 mm at five-year intervals. Observation of small AAA can be restricted to 1-4 year intervals.

Aged↗
PubMed2001

Randomized double-blind controlled trial of roxithromycin for prevention of abdominal aortic aneurysm expansion.

BACKGROUND: Macrolide treatment has been reported to lower the risk of recurrent ischaemic heart disease. The influence of macrolides on the expansion rate of abdominal aortic aneurysms (AAAs) remains unknown. The aim was to investigate the effect of roxithromycin on the expansion rate of small AAAs. METHODS: A total of 92 subjects with a small AAA were recruited from two populations. One population consisted of 6339 men aged 65-73 years who were offered a hospital-based mass screening programme for AAA. From this population 66 subjects were recruited. The remaining 26 men were recruited from among 49 subjects diagnosed at interval screening for an initial aortic diameter between 25 and 29 mm. Subjects were randomized to receive either oral roxithromycin 300 mg once daily for 28 days or matching placebo, and followed for a mean of 1.5 years. RESULTS: During the first year the mean annual expansion rate of AAAs was reduced by 44 [corrected] per cent in the intervention group (1.56 mm per year), compared with 2.80 mm per year following placebo (P = 0.02). During the second year the difference was only 5 per cent [corrected]. Multiple linear regression analysis showed that roxithromycin treatment and initial AAA size were significantly related to AAA expansion when adjusted for smoking, diastolic blood pressure and immunoglobulin A level of 20 or more [corrected]. Logistic regression analysis confirmed a significant difference in expansion rates above 2 mm annually between the intervention and placebo groups: odds ratio = 0.09 (95 per cent confidence interval 0.01-0.83) [corrected]. CONCLUSION: In comparison to placebo, roxithromycin 300 mg daily for 4 weeks reduced the expansion rate of AAAs.

Administration, Oral↗
PubMed2001

Cystatin C deficiency is associated with the progression of small abdominal aortic aneurysms.

BACKGROUND: The cysteine protease inhibitor cystatin C may play a role in the development and progression of abdominal aortic aneurysms (AAAs). METHODS: From a mass screening trial of men aged 65-73 years, 151 small AAAs were followed for a mean of 2.9 years. Of these patients, 142 had serum samples taken to determine the levels of cystatin C, creatinine and C-reactive protein (CRP). RESULTS: Serum cystatin C concentration correlated negatively with AAA size (r = - 0.22 (95 per cent confidence interval (c.i.) - 0.59 to - 0.02)) and annual expansion rate (r = - 0.24 (95 per cent c.i. - 0.75 to - 0.05)), persisting after adjustment for renal function, smoking, diastolic blood pressure, CRP, age and AAA size. Creatinine clearance and CRP did not correlate with size or expansion rate. Thirty-one AAAs had expanded to over 50 mm, when operation was recommended. The serum level of cystatin C was a significant predictor of this occurrence, with a sensitivity and specificity of 61 and 57 per cent respectively. However, initial AAA size had the optimal sensitivity and specificity (both 81 per cent) in this regard. CONCLUSION: Deficiency of cystatin C was associated with increased aneurysm size and expansion rate, possibly due to lack of inhibition of cysteine proteases.

Aged↗
PubMed2001

Smoking, but not lipids, lipoprotein(a) and antibodies against oxidised LDL, is correlated to the expansion of abdominal aortic aneurysms.

OBJECTIVES: to study the role of smoking, lipids, lipoprotein (a), and autoantibodies against oxidised low density lipoprotein (Ab-oxLDL) in the expansion of small abdominal aortic aneurysms (AAA). To study the role of Ab-oxLDL and lp(a) in the progression of lower limb atherosclerosis. METHODS AND MATERIALS: one hundred and thirty-eight male patients with AAA were interviewed, examined, and their serum lipids and S-Ab-oxLDL determined. Of these, 117 were followed annually with ultrasound and underwent control scans and blood pressure measurements for a mean of 2.5 (range 1-5) years. RESULTS: initial AAA size, smoking and level of triglycerides were positively correlated to increased aneurysmal expansion, while beta-blocker medication was associated with decreased expansion. Besides initial AAA size, only smoking had persisting significance after adjustment of the other significant variables. Initial ankle brachial pressure index (ABI) and Lp(A) but not ab-oxLDL were significantly correlated to ABI change. CONCLUSION: smoking cessation may inhibit aneurysmal expansion. Lipids seem to play a minor role in the progression of AAA.

Aged↗