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Biomedical subjects

J von Knorring

Publications and source records attributed to J von Knorring.

At least 19 recordsLinked to original sources
PubMed1998

Poor reproducibility of exercise test in assessment of claudication.

To assess reproducibility of the exercise test in intermittent claudication, a prospective, comparative, randomized study was undertaken. Ten patients with stable intermittent claudication of ischaemic origin were exercised on a flat surface (0-Ex), with 12% steady inclination (12-Ex) and with progressively increasing inclination (p-Ex) in a random order during three different sessions. The ankle-brachial index (ABI) at rest and after exercise (rABI, exABI), initial and maximum walking distance (IWD, MWD) and metabolic equivalent (MET) were obtained as the main outcome measures. The results were analysed using intraindividual coefficients of variation (CVs) and standard deviations (SDs). The ABI values of the worst extremity were used in evaluation of results. Reproducibility of the exercise ABI appeared to be good, especially during progressively increasing exercise, the mean CV being 9 +/- 5%. The best mean CV was observed during p-Ex (16% +/- 14%) for maximum walking distance. The mean CV for initial walking distances ranged from 30% to 54%. Treadmill exercise testing to measure walking distances is highly inaccurate and the value of exercise on the flat treadmill should be questioned. Graded exercise appeared to be the most reproducible in this respect. The ABI after exercise, however, was a reliable single parameter when assessing arterial insufficiency causing decreased walking capacity.

Aged↗
PubMed1996

Long-term results of percutaneous transluminal angioplasty in renovascular hypertension.

PURPOSE: The long-term effect of percutaneous transluminal renal angioplasty (PTRA) was assessed in 50 patients with renovascular hypertension. MATERIAL AND METHODS: Thirty-eight of the patients had atherosclerotic disease and 12 patients fibromuscular dysplasia (FMD). Dilatation with a balloon catheter were performed at 6 to 8 atm for 15 to 30 s. RESULTS: PTRA was technically successful in 46 (92%) patients. Three of the failures underwent surgical revascularization. There was no mortality connected with PTRA. Minor complications occurred in 6 (12%) patients, and surgical intervention was required in 1. In 4 patients with restenosis, repeated PTRA was performed in 2, and surgery in the other 2 patients. Bilateral disease occurred in 12 patients, and 3 had sequential bilateral PTRA. In 9 patients with atherosclerotic ostial stenosis, PTRA was technically successful in 8 (89%). Thirty-eight patients were re-examined with a mean follow-up of 4 years. At follow-up, 5 (45%) of the patients with FMD were classified as cured, 6 (55%) as improved, and none as failed. In the 27 patients with atherosclerotic disease, 23 (85%) had long-term benefit, 3 (11%) were cured, 20 (74%) were improved, and 4 (15%) were failures. In the 8 patients with ostial atherosclerotic lesions and successful PTRA, there was a 75% long-term benefit. Two patients died during follow-up, both from myocardial infarction. CONCLUSION: The result suggest that PTRA is effective in long-term management of renovascular hypertension, not only in patients with fibromuscular stenosis, but also in patients with atherosclerotic disease, even when ostial lesions are present.

Adult↗
PubMed1995

Predicting of postoperative cardiac events using ambulatory ECG monitoring prior to abdominal aortic surgery.

OBJECTIVES: The purpose of this study was to estimate the value of preoperative electrocardiographic (ECG) monitoring in predicting postoperative cardiac events in patients undergoing abdominal aortic surgery. DESIGN: A prospective open study. SETTING: University Hospital. MATERIALS: One hundred consecutive patients were studied before aortic or aortofemoral surgery by ambulatory ECG monitoring for 24 hours. CHIEF OUTCOME MEASURES: An ischaemic episode by ECG criteria was defined as a > or = 1 mm horizontal or downsloping ST segment depression measured 60 msec after the J point and persisting for at least 40 sec. MAIN RESULTS: Twenty-four patients had preoperative ambulatory ischaemia. Twenty patients had postoperative cardiac events including three with fatal myocardial infarction, one with a nonfatal infarction, eight with unstable angina, three with pulmonary oedema and five with atrial fibrillation. Sixteen out of 24 (67%) patients with ambulatory ischaemia had postoperative cardiac events (p < 0.01). Only four events occurred among 76 patients without ischaemia (p < 0.005). The sensitivity of ambulatory ischaemia predicting cardiac events was 80% with a specificity of 90%, the predictive value of ischaemia was 67% and the predictive value of a negative result was 95%. CONCLUSIONS: Preoperative ECG monitoring for myocardial ischaemia could non-invasively identify patients at high risk for postoperative cardiac morbidity and mortality after vascular surgery.

Aged↗
PubMed1992

Cardiac arrhythmias and myocardial ischemia after thoracotomy for lung cancer.

The records of 598 patients undergoing a thoracic surgical procedure for lung cancer from 1975 through 1989 were reviewed for occurrence of cardiac arrhythmias and myocardial ischemic events. Atrial tachycardias occurred in 16% (94/598); atrial fibrillation was preponderant (87%), followed by supraventricular tachycardia and atrial flutter. Patients with recurrent episodes of dysrhythmias had a significantly higher mortality rate than those without episodes or with a single episode only (17% versus 2.4%; p less than 0.01). Transient ischemic electrocardiographic changes were documented in 23 patients (3.8%) and myocardial infarction in 7 (1.2%). An abnormal preoperative exercise test result and intraoperative hypotension were strongly associated with both dysrhythmia and ischemia (p less than 0.01). Pneumonectomy, ischemic changes on the electrocardiogram, and cardiac enlargement were also associated with arrhythmias (p less than 0.01). A weaker association (p less than 0.05) was found between postoperative arrhythmias and old myocardial infarction (greater than 6 months), arterial hypertension, and heart failure. Pulmonary function had no predictive value in this respect. A history of angina or old myocardial infarction was predictive of transient postoperative myocardial ischemia but not myocardial infarction. Despite improved anesthetic and monitoring techniques and more frequent use of the intensive care unit postoperatively in the last decade, the incidence of arrhythmias after thoracotomy has not decreased. More effective prevention is needed, particularly for patients with defined preoperative and perioperative risk factors.

Aged↗
PubMed1992

Giant cell arteritis and polymyalgia rheumatica in a region of Finland: an epidemiologic, clinical and pathologic study, 1984-1988.

The occurrence of giant cell arteritis (GCA) (considering temporal arteritis and polymyalgia rheumatica as its manifestations) was investigated in Western Nyland, Finland. Between 1984 and 1988 54 patients were diagnosed in a population of about 44,500. Fourteen patients (26%) had biopsy proven arteritis at the initial evaluation, and 2 patients became biopsy positive during followup. The retrospectively determined annual incidence of GCA in a 44 month period was 22.5/10(5) in the whole population, and 69.8/10(5) in residents aged 50 years or older. The corresponding figures of a prospective 16 month study were 30.4/10(5) and 94.4/10(5). The incidence rates of the prospective study are higher than those reported in comparable studies. Polymyalgia rheumatica, occurring alone or combined with cranial symptoms, was the most frequent manifestation of GCA, being present in 87% of patients.

Aged↗
PubMed1991

Effect of verapamil on right ventricular pressure and atrial tachyarrhythmia after thoracotomy.

We have studied the effect of verapamil on the incidence of ECG changes and right ventricular pressures (RVP) in 25 male patients (aged 62 (SD 9) yr) undergoing thoracotomy in a placebo-controlled double-blind trial. Verapamil 0.01 mg kg-1 h-1 (n = 12) or saline (n = 13) i.v. was started after surgery and continued on the first day after operation with oral verapamil 80 mg or placebo, 8-hourly. Haemodynamic data were collected before operation and on three days after operation with the patients breathing air and then 60% oxygen (FIO2 0.60) for 10 min. Atrial tachyarrhythmia (AT) (4/13) and new ischaemic ECG changes (3/13) occurred only in the control group (P less than 0.05). With an FI02 of 0.21, systolic RVP increased by 54% on the first two days after operation in the control group and by 13% in the verapamil group (P less than 0.02). With an FIO2 of 0.60 for 10 min, systolic RVP decreased more in the control than in the verapamil group (P less than 0.01). In the control group, an increase in end-diastolic RVP (P less than 0.001) and central venous pressure (P less than 0.05) on the first day after operation was predictive of AT occurring on the second day.

Administration, Oral↗
PubMed1990

Development of acute myelocytic leukemia in patients with Crohn's disease.

In our hospital within one year two patients with Crohn's disease were seen who developed an acute myelocytic leukemia. A review of the literature reveals eight previously reported patients with both Crohn's disease and leukemia. Six of the reported 10 patients have had acute myelocytic leukemia and, interestingly, three of them, including our two patients, have shown monocytic differentiation (FAB type M4). It has been suggested that the relative risk of leukemia, especially acute myelocytic leukemia, is increased in patients suffering from ulcerative colitis. More data of patients with Crohn's disease and acute leukemia are needed to evaluate the possible association between these diseases.

Crohn Disease↗
PubMed1989

Long-term prognosis of surgical treatment of renovascular hypertension.

During the period 1974-1986, 71 patients were operated on for renovascular hypertension. Forty-eight patients had atherosclerotic disease and 23 patients had fibromuscular dysplasia. There was no operative mortality. Fourteen patients died during the follow-up, 12 of them from cardiovascular causes. The 57 surviving patients were reexamined with a mean follow-up of 7 years. The relative cumulative 5- and 10-year survival rates in all patients were 79% and 55%, respectively. At follow-up, seven (19%) of the atherosclerotic patients were classified as cured, 22 (59%) as improved and eight (22%) as failures. In the patients with fibromuscular dysplasia, 12 (60%) were normotensive without medication, and six (30%) were improved. The relative 5-year survival rates in these aetiological groups were 73% and 90%, respectively. Only complete cure of hypertension by surgery predicted a good outcome, whereas very similar survival curves were found in the improved and failed groups. This could be due to a higher incidence of target organ changes before surgery in the latter groups. A positive blood pressure response to long-term converting-enzyme inhibition correlated well with the response to surgery. Renal venous renin studies correctly predicted long-term outcome of surgery in 78% of the patients studied, but require careful preparation of the patients and interpretation of results.

Adult↗
PubMed1989

Vitamin D status and concentrations of serum vitamin D metabolites and osteocalcin in elderly patients with femoral neck fracture: a follow-up study.

Vitamin D status and the serum osteocalcin concentration in patients with femoral neck fractures were studied as follows. Thirty-seven elderly patients (P) with fracture of the femoral neck were studied, whereas 24 age-matched persons (C) seen at the out-patient department for non-orthopaedic reasons served as controls. The dietary intake of vitamin D, estimated using a vitamin D score based on food items known to be the main sources of vitamin D, was significantly lower in the patients than in the controls. There was no difference in the serum 25-hydroxy-vitamin D (25-OH-D) (P: 22.3 +/- 7.5 nmol/l; C: 27.5 +/- 13.5) or the serum 1,25-dihydroxy-vitamin D3 concentration (P: 86 +/- 43 pmol/l; 31) C: 85 +/- 31) between the groups. The 25-OH-D concentration was, however, low as compared to reference values, suggesting vitamin D deficiency in both groups. There was no difference in the serum osteocalcin concentration between the groups (P: 3.1 +/- 1.7 micrograms/l; C: 3.4 +/- 1.5). One year later the serum osteocalcin concentrations (5.9 +/- 2.2 micrograms/l, n = 11) was significantly higher (P less than 0.005) in the patients than at the time of the fracture (3.2 +/- 2.2 micrograms/l), indicating an active bone turnover in the patients still present 1 year after the fracture.

Aged↗
PubMed1987

Late results and prognosis after carotid artery surgery.

Carotid reconstruction was performed on 75 patients (84 operations) mainly because of transient ischemic attacks (TIA) and/or amaurosis fugax (67%) or TIA with incomplete recovery (20%). The operative mortality was 2.4%. The incidence of permanent postoperative neurologic deficit was 6.0%. The postoperative observation time was 1 year to 13 years 5 months (mean 66 months). At follow-up 87% of the survivors were symptom-free. Three new strokes, one of them not related to the operated side, occurred follow-up, and 26 more patients died. The relative cumulative 5-year survival was 87.3%. Of the total 28 deaths, 16 were due to myocardial infarction. Mortality was significantly heightened and cumulative 5-year survival reduced when preoperative ECG had indicated coronary heart disease. The high incidence of deaths from myocardial disease during long-term follow-up was directly related to preoperative presence of coronary heart disease.

Adult↗
PubMed1986

Prediction of perioperative cardiac complications by electrocardiographic monitoring during treadmill exercise testing before peripheral vascular surgery.

ECG monitoring during treadmill exercise testing was performed in a prospective series of 105 consecutive patients with intermittent claudication scheduled for peripheral vascular surgery. ECG monitoring during the exercise test was useful in predicting perioperative cardiac complications. In 55 patients with evidence of coronary artery disease by history and ECG obtained at rest, a strong association (p less than 0.001) between an ischemic response to exercise testing and the occurrence of perioperative cardiac events was observed. ECG monitoring during the exercise test also revealed previously unsuspected ischemia or arrhythmias in six of the remaining 50 patients and predicted perioperative cardiac problems in four of these six. An ischemic response to low-level treadmill exercise testing probably indicates advanced coronary artery disease and offers valuable predictive information when a revascularization procedure is considered for the relief of intermittent claudication.

Arteriosclerosis↗
PubMed1984

Walking capacity of patients with intermittent claudication during chronic antihypertensive treatment with metoprolol and methyldopa.

In a placebo-controlled double-blind crossover trial, the effect of a 3-week course of treatment with metoprolol (100-200 mg daily) and methyldopa (500-1000 mg daily) on walking capacity on a treadmill with increasing work load was studied in 14 hypertensive patients with intermittent claudication. The walking capacity was not affected by the antihypertensive treatment.

Adult↗
PubMed1983

The effect of withdrawal of beta-adrenergic blockade on intermittent claudication.

Twenty-eight patients with intermittent claudication were studied before and one month after withdrawal of treatment with beta-adrenergic blocking drugs for hypertension, coronary heart disease or both. Heart rate, blood pressure, ankle/arm systolic blood pressure ratio and ankle pulse volume recording (PVR) at rest and after treadmill exercise were recorded, as well as walking distance, time of recovery from subjective symptoms, restitution time of pressure ratio and PVR. A control group of 14 patients, whose beta-adrenergic blocking drugs were not withdrawn, was also included. The result can be summarized as showing that withdrawal of beta-blockade was not demonstrably advantageous in patients with intermittent claudication. Significant improvement was observed only during the first month of the trial, a change which was independent of withdrawal of beta-blockade. The relief of subjective symptoms after exercise occurred significantly faster after withdrawal of nonselective beta-blockade. Otherwise, there was no difference between nonselective and cardioselective beta-adrenergic blocking drugs.

Adrenergic beta-Antagonists↗
PubMed1983

Five-year results of proximal gastric vagotomy.

Between February 1972 and December 1976 100 proximal gastric vagotomies (PGV) were performed on duodenal ulcer patients after failure of conservative treatment. The diagnosis was verified by preoperative barium meal and endoscopy and by peroperative examination. There was no operative mortality. Mean duration of postoperative hospital stay was 9.6 days. The percentual distribution in Visick-grading at the 1-year follow-up was 90% in class I + II, and 10% in class III + IV. The corresponding figures at the 5-year follow-up were 82% and 18%. The mean postoperative basal acid output did not change from one to five years. The reduction in pentagastrin stimulated acid output was unchanged at the 1- and 5-year follow-up. Neither did the mean acid output after insulin stimulation change between one and five years postoperatively. The mean concentration of serum gastrin was raised at one year but decreased to normal at the 5-year follow-up. Ten patients (10%) had ulcer recurrence during follow-up. Seven of these were successfully treated by gastric resection and three by antacids and cimetidine.

Adult↗
PubMed1982

Serum levels of 25-hydroxyvitamin D, 24,25-dihydroxyvitamin D and parathyroid hormone in patients with femoral neck fracture in southern Finland.

Serum concentrations of 25-hydroxyvitamin D (25-OHD), 24,25-dihydroxyvitamin D [24,25(OH)2D] and immunoreactive parathyroid hormone (PTH) were determined in elderly patients with fracture of the femoral neck and in age-matched controls during summer, winter and early spring in southern Finland. The expected seasonal variation in 25-OHD values was observed in both patients and controls, though the patient group had significantly lower values during winter (P less than 0.02) and spring (P less than 0.01). The 24,25(OH)2D:25-OHD ratio remained constant in both patients and controls throughout the study. A significant negative correlation between PTH and 25-OHD values was found in the patient group. Thus, vitamin D deficiency may contribute to the high incidence of femoral neck fractures in elderly people, and the increased PTH activity, observed in many patients with these fractures, is secondary to vitamin D deficiency.

24,25-Dihydroxyvitamin D 3↗