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Biomedical subjects

Jan Jesper Andreasen

Publications and source records attributed to Jan Jesper Andreasen.

8 recordsLinked to original sources
PubMed2006

Manual pressure distension of the human saphenous vein changes its biomechanical properties-implication for coronary artery bypass grafting.

Patency rates of saphenous vein grafts following coronary artery bypass grafting (CABG) depend on multiple factors. Information regarding the impact of biomechanical properties of vein grafts on patency rates is not available. The objective of the present study was to evaluate whether uncontrolled manual pressure distension during routine preparation of the saphenous vein in CABG-induced changes in the biomechanical properties of the vein. The morphometric and stress-strain properties were studied in isolated segments of the saphenous vein from 12 patients undergoing elective CABG. Six segments were manually distended without pressure control and six were not distended. The mechanical test was performed as a ramp inflation using syringe pump. The vein dimensions were obtained from digitised images at different pressures as well as at the no-load and zero-stress states. The circumferences, the wall and lumen area, the wall thickness, and the outer diameter as function of the applied pressure were largest in the segments with uncontrolled manual distension compared to those without distension (P<0.05). The opening angle and the absolute value of the residual strains were lower (P<0.01) and the circumferential stress-strain curve shifted to the left, indicating the wall became stiffer with uncontrolled manual distension compared to those without distension (P<0.05). In conclusion, manual pressure distension changed the morphometric and biomechanical properties of the saphenous vein. The perspective is that studies on biomechanical properties on the saphenous vein may guide surgeons how to handle graft material without causing major changes of the biomechanical properties during harvesting and preparation.

Aged↗
PubMed2006

[Constrictive pericarditis caused by carbergoline].

A 72-year-old male with paralysis agitans presented with symptoms and findings of constrictive pericarditis (CP). One year prior, he had a minor lateral MI. The patient had been treated with cabergoline for four years. At pericardiectomy, a thickened pericardium of 1-1,5 cm encased the right side of the heart. The pericardium was normal in the infarction area. Dopamine agonists pergolide and cabergoline for treatment of Parkinson s disease have been associated with development of CP. The absence of pericardial thickening in the infarction area suggests cabergoline as a probable cause.

Aged↗
PubMed2006

Coronary artery bypass grafting within the first year after treatment of large acute myocardial infarctions with angioplasty or fibrinolysis.

OBJECTIVES: To calculate the incidence and analyse and outcome after coronary artery bypass grafting (CABG) within the first year after randomisation of 1,572 patients with acute myocardial infarctions with ST-segment elevation (STEMI) to either percutaneous coronary intervention (PCI) or fibrinolysis. DESIGN: The study includes 131 patients: 108 male and 23 female with a mean age 62 years. RESULTS: The total 30-day mortality after CABG was 4.6% (7.5% in the PCI group and 2.6% in the fibrinolysis group). The 30-day mortality was 9.8% after CABG within the first 30-days and 1.3% after CABG within 31-365 days. The patients who were operated early had a reduced EF to 43% as compared to 50% in patients who were not operated or patients having CABG after 30-days (p=0.002). CONCLUSION: CABG was performed within the first year after STEMI in 10% of patients randomised to fibrinolysis and in 6.7% of patients randomised to PCI. Patients having CABG within the first 30-days after treatment of STEMI had an increased mortality of 9.8%.

Angioplasty, Balloon, Coronary↗
PubMed2006

Effect of selective serotonin reuptake inhibitors on requirement for allogeneic red blood cell transfusion following coronary artery bypass surgery.

BACKGROUND: Selective serotonin reuptake inhibitors (SSRIs) inhibit platelet function, and use of these drugs has been associated with bleeding events. The objective of this study was to examine whether the requirement for red blood cell transfusion was increased following preoperative use of SSRIs among patients undergoing coronary artery bypass grafting (CABG). METHODS: A population-based cohort study of transfusion requirements (red blood cells, fresh frozen plasma, and/or platelets) was conducted among patients undergoing CABG at either Aalborg or Skejby Hospitals between 1 January 1998 and 31 December 2003. All prescriptions for antidepressants, including SSRIs, filled before the date of admission for CABG were identified using prescription databases. Patients were categorized according to use of antidepressants (never users, current users [<90 days before admission for CABG], and former users). Antidepressants were classified according to their action on serotonin and norepinephrine reuptake mechanisms. Relative risk (RR) for transfusion were adjusted for: age; sex; preoperative use of platelet inhibitors (low-dose aspirin [acetylsalicylic acid], clopidogrel, and dipyridamole), NSAIDs and oral anticoagulants; place of surgery; extracorporeal circulation; concomitant valve surgery; and Charlson comorbidity index score. RESULTS: There were 124 (3.5%) current users of SSRIs among 3454 patients. Adjusted RRs for transfusion among current users of SSRIs, users of nonselective serotonin reuptake inhibitor antidepressants, and users of other antidepressants were 1.1 (95% CI 0.9, 1.3), 0.9 (95% CI 0.6, 1.3), and 1.0 (95% CI 0.7, 1.5), respectively, when compared with never users of any type of antidepressant. The adjusted RR among former SSRI users was 1.0 (95% CI 0.7, 1.4). Risk of re-exploration for bleeding and mortality within 30 days did not differ according to the examined drug-exposure categories. CONCLUSION: Preoperative use of SSRIs was not associated with any substantially increased requirement for allogeneic red blood cell transfusion among patients undergoing CABG. The main strengths of this study are its relatively large size, the use of prospectively collected data obtained from population-based databases with complete follow-up, and the ability to examine specific types of antidepressants. The limitations include a lack of detailed clinical data regarding other factors that may influence transfusion requirements.

Adult↗
PubMed2004

Coronary artery bypass grafting within 30 days after treatment of acute myocardial infarctions with angioplasty or fibrinolysis - a surgical substudy of DANAMI-2.

OBJECTIVE: To calculate the incidence and analyse the indications and outcome after surgical revascularization within the first 30 days after randomization of 1572 patients with acute myocardial infarction (MI) associated with ST-segment elevation (STEMI). DESIGN: Data regarding the patients undergoing heart surgery within the first 30 days after randomization were collected. RESULTS: Three patients (0.2%) with acute STEMI and randomized to percutaneous coronary intervention (PCI) underwent emergent coronary artery bypass grafting (CABG). A total of 50 patients (3.2%), 30 in the PCI group and 20 in the fibrinolysis group were revascularized by surgery within the first 30 days after randomization. The most frequent indication for surgery in both groups was unstable angina pectoris, followed by left main stenosis. The incidence of postoperative complications was higher compared with the outcome after elective CABG. CONCLUSIONS: The incidence of emergency CABG in this study was low (0.2%) after treatment of acute MI with either PCI or fibrinolysis. The overall incidence within 30 days was 3.2%, however, the mortality is increased with a 30-day mortality of 10% in this high-risk patient group.

Acute Disease↗
PubMed2002

[Postoperative wound infection. Indicator of clinical quality?].

INTRODUCTION: The aim of the study was to gain experience with continuous electronic registration of data regarding surgical postoperative wound infection after heart surgery. MATERIAL AND METHODS: Every patient undergoing cardiac surgery from February 1999 to May 1999 was entered in a prospective study and followed up for 30 days. Information on the type of operation, development of postoperative wound infection, risk factors for wound infection, and a risk stratification was sent electronically to a central database. RESULTS: All 180 operations were registered in the database, and risk variables were registered for all patients except one (99.4%). A spot test comprising 32% of the operations showed a diagnostic specificity of 78% with respect to correct diagnosis of wound infection. Only 4/7 (57%) of the infections were registered in the database. All deep wound infections were registered during the study period. DISCUSSION: The study showed that risk stratification of data in relation to postoperative wound infection after heart surgery can be registered continuously in a central database. Registration of all postoperative wound infections requires several resources and may be incomplete. However, the high quality of registration of deep wound infection and risk stratification indicates that registration of deep wound infection could be an indicator of clinical quality.

Cardiac Surgical Procedures↗
PubMed2002

Postoperative wound infection: indicator of clinical quality?

INTRODUCTION: This study aims to gain experience with continuous electronic registration of data regarding postoperative wound infection following heart surgery. METHODOLOGY: Every patient undergoing cardiac surgery from February 1999 to May 1999 was included in a prospective study and followed for 30 days. Data regarding type of operation, development of postoperative wound infection, risk factors for wound infection and a risk stratification were submitted electronically to a central database. RESULTS: All 180 operations were registered in the database, and risk variables were registered for all patients but one (99.4%). A spot test comprising 32% of 131 operations registered at the time of the spot test, showed a predictive value of a correctly applied diagnosis of wound infection at 78%. Only 4/7 (57%) of infections in the spot test were registered in the database. All deep wound infections were registered during the study period. CONCLUSION: Data, including risk stratification, in relation to postoperative wound infection following heart surgery can be registered continuously in a central database. Registration of all wound infections, however, requires several resources and may be incomplete. The present registration's good level of cover concerning deep wound infection and risk variables indicates, that deep wound infection may provide a meaningful indicator of clinical quality, although good risk variables still need to be developed.

Cardiac Surgical Procedures↗