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Biomedical subjects

L Frost

Publications and source records attributed to L Frost.

At least 55 records · Page 3Linked to original sources
PubMed1995

Hemodynamic predictors of atrial fibrillation or flutter after coronary artery bypass grafting.

The cumulated incidence of atrial fibrillation or flutter after coronary artery bypass grafting is 30%. The causes of these arrhythmias have not yet been sufficiently identified. We therefore undertook the present study to analyze the possible association of hemodynamic function during the various phases of coronary artery bypass grafting and the later development of atrial fibrillation/flutter. Hemodynamic function was measured with a pulmonary artery catheter in 120 consecutive patients undergoing elective coronary artery bypass surgery. Thirty-five (29%) of the patients developed atrial fibrillation/flutter. Logistic regression analysis identified independent predictors of atrial fibrillation/flutter. After induction of general anesthesia, the relative risk (95% confidence interval) of older age was 1.09/year (1.03-1.16), and the reduction in relative risk by an increase in left ventricular stroke work was 0.96/gm (0.93-0.99). After weaning from the extracorporeal circulation the independent significant predictors were age, relative risk 1.07/year (1.01-1.13), and increased central venous pressure, relative risk 1.12/mm Hg (1.00-1.26). At the time of admission to the intensive care unit, the relative risk of age was 1.10/year (1.03-1.18), and the relative risk of an increased central venous pressure was 1.26/mm Hg (1.06-1.49). However, the best prediction model (prediction after induction of general anesthesia) only provided a median predicted probability of atrial fibrillation/flutter of 0.37 for the patients who had atrial fibrillation/flutter, and a median predicted probability of atrial fibrillation/flutter of 0.20 for the patients without these arrhythmias. We identified possible hemodynamic predictors of atrial fibrillation/flutter after coronary bypass surgery, but the use of a risk stratification for development of atrial fibrillation/flutter based on hemodynamic function cannot be recommended.

Age Factors↗
PubMed1995

Sterility of the uterine cavity.

In a prospective open study the sterility of the uterine cavity was evaluated in 99 women admitted for hysterectomy. The indications for hysterectomy were in most cases persistent irregular vaginal bleeding and fibromyomas of the uterus. Samples for both aerobic and anaerobic bacteria, Chlamydia trachomatis, yeasts and viruses were taken preoperatively from the apex of the vagina and cervical os. Immediately after hysterectomy the uterus was opened under sterile conditions and samples obtained from the isthmus and fundus of the uterine cavity for microbiological examination. Wet smears were taken from the same sites. Nearly a quarter of all the patients harbored one or more microorganisms in the uterus, mostly Gardnerella vaginalis, Enterobacter and Streptococcus agalactiae. We found that in a significant number of cases, the uterine cavity is colonized with potentially pathogenic organisms which may play a causative role in endometritis. The results indicate that inflammation of the uterine cavity should be evaluated by hysteroscopic examination before hysterectomy is undertaken in patients with persistent irregular vaginal bleeding.

Adult↗
PubMed1995

Decontamination of dental equipment. A validation of three devices designed for cleaning, disinfecting, and lubricating of dental high-speed turbines and handpieces.

This study deals with the decontamination of dental turbines and handpieces (DTH) aiming at eliminating the cross-infection risk in dental practice. Three types of equipment designed for cleaning/lubricating DTH were validated. The effect of the three devices was determined for four different types of DTH, which were artificially contaminated with Streptococcus salivarius ATCC 13419 in a controlled manner. Sampling was carried out by collecting one ml water flushed through the DTH connected to a dental unit. The study resulted in a model for testing the decontamination potential of a cleaning/lubrication device for DTH. One of the devices could not reduce the contamination, while two others were able to reduce the bioburden with at least 3.9 logarithmic steps. However none of the devices tested could constantly eliminate the contamination, for which reason an additional heat treatment of the DTH is recommended.

Alcohols↗
PubMed1995

The signal-averaged ECG becomes late potential-positive at low noise levels in healthy subjects.

Late potentials are detected at various noise levels in clinical studies. The aim of this study was to quantify the effect of residual noise level on the signal-averaged ECG. Thirty minutes of raw ECG (lead -X, +X, -Y, +Y, -Z, and +Z) from 10 healthy volunteers were digitized and stored on optical discs. Each ECG was analysed by four signal averaging procedures to noise level 0.1, 0.2, 0.3, and 0.4 microV, respectively. At each noise level, time domain analysis of the filtered vector (40-250 Hz) included determination of the QRS duration (QRS), late potential duration (LPD, duration of terminal signals below 40 microV), and root-mean-square voltage of the terminal 40 ms of the filtered QRS (RMS40). On average, the measured signal-averaged QRS duration was prolonged by 7.0 ms (range 0.9-12.5 ms) per 0.1 microV reduction in noise level. Late potential duration increased by 5.9 ms (range 0.2-10.0 ms) per 0.1 microV reduction in noise level, and RMS40 was reduced by 9.1 microV (range 0.5-20.2 microV) per 0.1 microV reduction in noise level. At noise level 0.4 microV, 0.3 microV, 0.2 microV, and 0.1 microV the number of late potential-positive subjects were 1, 2, 4, and 6, respectively. Late potential parameters are significantly dependent on noise level after signal averaging. Using conventional criteria for late potentials, healthy subjects become false-positive at low noise levels. Establishment of standards for noise level is recommended.

Adult↗
PubMed1994

[Late ventricular potentials after myocardial infarction].

Late potentials in the QRS complex can be detected with signal-averaged electrocardiography and are associated with delayed and disorganized ventricular activation. This article reviews the technique, describes the pathophysiological basis of late potentials, and assesses the prognostic value of late potentials for subsequent development of ventricular tachyarrhythmias and sudden cardiac death in postmyocardial infarction patients.

Age Factors↗
PubMed1994

Quantification of the mononuclear phagocyte response to Wallerian degeneration of the optic nerve.

We investigated the numbers, origin and phenotype of mononuclear phagocytes (macrophages/microglia) responding to Wallerian degeneration of the mouse optic nerve in order to compare it with the response to Wallerian degeneration in the PNS, already described. We found macrophage/microglial numbers elevated nearly four fold in the distal segments of crushed optic nerves and their projection areas in the contralateral superior colliculus 1 week after unilateral optic nerve crush. This relative increase in mononuclear phagocyte numbers compared well with the four-to-five-fold increases reported in the distal segments of transected saphenous or sciatic nerves. Moreover, maximum numbers are reached at 3, 5 and 7 days in the saphenous, sciatic and optic nerves respectively, suggesting that the very slow clearance of axonal debris and myelin in CNS undergoing Wallerian degeneration is not simply due to a slow or small mononuclear phagocyte response. The apparent delay in the response in the CNS occurs because the mononuclear phagocytes respond to the Wallerian degeneration of axons, which is slightly slower in the CNS than the PNS, rather than to events associated with the crush itself, such as the abolition of normal electrical activity in the distal segment. This was demonstrated by the protracted time course of the mononuclear phagocyte response in the distal segment following optic nerve crush in mice carrying the Wlds mutation which dramatically slows the rate at which the axons undergo Wallerian degeneration. By [3H]-Thymidine labelling or by blocking microglial proliferation by X-irradiation of the head prior to optic nerve crush, we showed that the majority of macrophages/microglia initiating the response to Wallerian degeneration were of local, CNS origin but these cells rapidly (from 3 days post crush) upregulate endocytic and phagocytic functional markers although they do not resemble rounded myelin-phagocytosing macrophages observed in degenerating peripheral nerves. We speculate that the poor clearance of myelin in CNS fibre tracts undergoing Wallerian degeneration compared to the PNS, in the face of a mononuclear phagocyte response which is similar in relative magnitude and time course, is because Schwann cells in degenerating peripheral nerves promptly modify their myelin sheaths such that they can be recognized and phagocytosed by macrophages, whilst in the CNS oligodendrocytes do not.

Analysis of Variance↗
PubMed1994

Serum propeptides of type I and III procollagens in renal transplant recipients. A comparison of cyclosporine and azathioprine treatment.

Chronic cyclosporine nephrotoxicity is characterized morphologically by cortical interstitial fibrosis. The most important collagens involved in renal fibrosis are collagen types I and III. In order to estimate the synthesis of type III and type I collagens, we analyzed serum levels of the amino-terminal propeptide of type III procollagen (PIIINP) and the carboxy-terminal propeptide of type I procollagen (PICP) in 11 renal transplant recipients receiving cyclosporine (group CY) and a comparable group of 16 renal transplant recipients treated with azathioprine (group AZ). In addition, 27 healthy subjects and 15 patients with chronic renal disease and reduced renal function (group CRD) were examined. The cyclosporine-treated patients had serum PIIINP and PICP similar to the azathioprine-treated patients. Both groups of renal transplant recipients had significantly increased serum PIIINP compared to healthy controls (2p < 0.01) and serum PIIINP levels similar to group CRD in which serum PIIINP was also elevated compared to healthy controls (2p < 0.01). Mean serum PIIINP levels were: group CY 0.81 U/l (n = 11); group AZ 0.98 U/l (n = 16); controls 0.62 U/l (n = 27); and group CRD 1.06 U/l (n = 15). The renal graft recipients--both cyclosporine- and azathioprine-treated patients--had significantly increased PICP serum levels compared to healthy controls, but the patients with chronic renal disease had serum PICP levels which did not differ from that of healthy controls. Mean serum PICP levels were: group CY174 micrograms/l; group AZ151 micrograms/l; controls 106 micrograms/l; and group CRD119 micrograms/l.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1993

[The 24-hour heart rate variability. An important predictor of sudden death after myocardial infarction].

The activity of the cardiac autonomic nervous system can be estimated by measurement of beat to beat variations in heart rate-heart rate variability (HRV). In survivors after myocardial infarction, reduced 24-hour HRV, is an independent predictor of mortality/sudden cardiac death. The attenuated HRV is presumed to indicate reduced vagal function and concomitant high sympathetic activity. In experimental studies, this combination reduces the threshold for inducing malignant tachyarrhythmias, and is very probably a clinically important factor for the evolution of ventricular arrhythmias. Measurement of HRV in ordinary 24-hour ECG recordings can, together with other non-invasive measurements, stratify arrhythmic risk in survivors of myocardial infarction.

Arrhythmias, Cardiac↗
PubMed1993

Skeletal muscle magnesium content during cyclosporin and azathioprine treatment in renal transplant recipients.

Cyclosporin treatment is often accompanied by hypomagnesaemia and renal magnesium wasting, but it is unknown whether cyclosporin induces tissue magnesium depletion. Magnesium status is best evaluated by measurement of skeletal muscle magnesium content. The purpose of the present study was to evaluate whether skeletal muscle magnesium content was reduced during cyclosporin treatment. In two groups of renal transplant recipients treated with either cyclosporin and prednisolone (group Cy, n = 13) or azathioprine and prednisolone (group Az, n = 17) skeletal muscle content of magnesium, serum magnesium, and urinary excretion of magnesium were determined, and the relationships between skeletal muscle magnesium content, serum magnesium and urinary magnesium were analysed. Skeletal muscle magnesium content did not differ significantly between groups; 7.93 mumol/g wet weight (median) in group Cy versus 8.38 mumol/g wet weight in group Az. Serum magnesium was significantly (P < 0.01) lower in group Cy (0.71 mmol/l) than in group Az (0.82 mmol/l). The urinary excretion of magnesium did not differ between the groups. Skeletal muscle magnesium did not correlate with either serum magnesium or urinary magnesium excretion in group Cy or group Az. Thus the present study indicates that cyclosporin-treated patients are not magnesium depleted, and serum magnesium in these patients does not reflect the skeletal muscle content of magnesium.

Adolescent↗
PubMed1993

Short and long term outcome in a consecutive series of 419 patients with acute dialysis-requiring renal failure.

UNLABELLED: This analysis was done in a consecutive series of 419 patients with potentially reversible acute renal failure (ARF) requiring dialysis treated during the 12 year period January 1977 to December 1988. The aims were to describe the relationship between morbidity, mortality, and the year of admission, to evaluate the effects of various follow-up periods and stratification on main prognostic factors, and to report long term survival. RESULTS: 1) There was a significantly higher (p < 0.001) number of organ failures/patient in the last 6 year period compared with the first 6 year period. 2) Early (day 90) mortality was 46% and did not change significantly during the 12 year period. 3) Etiology, age of the patient, and the severity and the progression of the underlying disease were the most important factors determining outcome. 4) Time of censorship and stratification of the patients influenced prediction models. 5) Estimated 5 year survival rate was 52% (95% confidence limits 44-60%) in patients with a medical etiology, and 28% (95% confidence limits 20-36%) in patients with a surgical etiology. CONCLUSIONS: 1) Prognosis did not change significantly during the 12 year study period, and was almost solely dependent on the severity and progression of the underlying disease process. 2) Changed censoring time and stratification were important tools for enhancing the yield of information from the study. 3) The time(s) and method(s) of risk scoring, stratification(s) of patients, the time(s) of censorship on vital status, and the method for statistical analysis have to be identical if results of treatment for ARF from different centers should be compared.

Acute Kidney Injury↗
PubMed1992

[Angiotensin I converting inhibitors in connection with anesthesia and surgery].

The renin angiotensin system is activated during anaesthesia and operation, and the degree to which this activation takes place depends on the hydration and circulation of the patient. The anaesthetic agent used is also important for the activation. Treatment with ACE-inhibitors blunts or abolishes the sympathetic response to anaesthesia/operation. ACEI treatment reduces the need for other hypotensive agents in controlled hypotensive anaesthesia. Some studies suggest that ACEI-treatment should be continued peroperatively on account of its stabilising effect on the circulation to avoid sudden fluctuations in blood pressure and organ perfusion. On the other hand measurements of the cerebral blood flow under anaesthesia in patients treated with ACEI have shown low values in a few patients and this led the authors to recommend discontinuation before anaesthesia. We conclude that controlled clinical trials to evaluate the haemodynamic and neurohumoral consequences of the interaction between ACEI and anaesthetics are required.

Anesthetics↗
PubMed1992

Enalapril and exercise-induced hyperkalemia. A study of patients randomized to double-blind treatment with enalapril or placebo after acute myocardial infarction.

During exercise a marked increase in plasma potassium in healthy subjects has repeatedly been demonstrated. In patients on treatment with angiotensin-converting enzyme inhibitors this may be further augmented. Therefore, the aim of present study was to evaluate the effect of enalapril on exercise-induced hyperkalemia. This was done in patients with acute myocardial infarction randomized to double-blind treatment with enalapril 10-20 mg per day (n = 7) or placebo (n = 6) within 24 h of onset of chest pain, and the results were compared with data from healthy control subjects (n = 11). Baseline plasma potassium did not differ between the three groups; i.e. 4.2, 4.0, and 4.1 mmol/l, respectively. An incremental, symptom-limited, bicycle exercise test was done one month after the myocardial infarction, and blood samples were taken for determination of plasma potassium. The exercise-induced increase in plasma potassium was not higher in the enalapril group as compared to the placebo and control groups, and there was no difference between the enalapril and placebo group, the specific values being 0.6 vs. 0.6 and 0.7 mmol/l, respectively. No difference was observed in the slope (dK/dt) between the 3 groups. In conclusion, enalapril at a dosage of 10-20 mg per day does not provoke any augmentation of the increase in plasma potassium during exercise.

Adult↗
PubMed1992

Atrial fibrillation and flutter after coronary artery bypass surgery: epidemiology, risk factors and preventive trials.

Atrial fibrillation and atrial flutter are common arrhythmias after coronary artery bypass grafting. Although the consequences of the arrhythmia are generally not life-threatening, it constitutes a major clinical problem often requiring conversion to sinus rhythm. Atrial fibrillation or flutter can result in hypotension, heart failure, pneumonia, and stroke. This article reviews the literature on epidemiology, electrophysiology, risk factors, and preventive trials. The major conclusions are: (1) In patients undergoing coronary artery bypass surgery, the incidence of postoperative atrial fibrillation or flutter is 20-30%, the peak incidence being on the second or third postoperative day. (2) The strongest independent preoperative predictor for atrial fibrillation or flutter is the patients' age. (3) Intra-atrial conduction delay recorded pre and peroperatively may predict development of atrial fibrillation. (4) Peroperative inducibility of atrial fibrillation by pacing the right atrium may identify patients at risk for postoperative atrial fibrillation. (5) Development of postoperative atrial fibrillation or flutter has not been associated with peroperative or postoperative events. (6) The specificity and sensitivity of age and other possible relevant factors for prediction of atrial fibrillation or flutter after coronary artery bypass grafting is low. (7) No effective prophylactic regimen has yet been established.

Adrenergic beta-Antagonists↗
PubMed1992

Nonpharmacologic treatment of supraventricular and ventricular tachyarrhythmias. A review of 249 consecutive patients.

Incapacitating or life-threatening tachyarrhythmias were treated nonpharmacologically in 249 patients from 1982 to 1991. Among 92 patients surgically treated for supraventricular tachycardia the cure rate was 93% and the complication rate 12%. Radiofrequency catheter ablation gave an equal cure rate in 51 patients, but with no major complications or mortality. Direct-current catheter ablation of the His bundle was successful in 96% of 27 patients with drug-refractory atrial fibrillation or other supraventricular tachyarrhythmias. Among 64 patients undergoing surgery for ventricular tachycardia/ventricular fibrillation, the perioperative mortality was 9%, estimated 5-year survival 69% and estimated 5-year freedom from the preoperative arrhythmias 72%. Of 18 patients treated with implantable cardioverter defibrillator, three (18%) died of heart failure during follow-up. Nonpharmacologic treatment of tachyarrhythmias is concluded to be effective and often definitively curative. The safety-risk ratio is improving as new treatment modalities are developed.

Adolescent↗