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Biomedical subjects

L I Andersen

Publications and source records attributed to L I Andersen.

At least 19 recordsLinked to original sources
PubMed2000

[DANAMI. A Danish study of invasive versus conservative treatment of patients with post-infarction ischemia who had received thrombolytic therapy].

INTRODUCTION: To compare an invasive strategy employing percutaneous transluminal coronary angioplasty (PTCA) or coronary artery by-pass grafting (CABG) with a medical strategy in patients who had received thrombolytic treatment for first acute myocardial infarction (AMI), and with signs of inducible ischaemia. METHODS: In a prospective study 1008 patients were randomized, 503 to invasive treatment, of whom 266 (52.9%) had PTCA, and 147 (29.2%) CABG, 505 to conservative treatment, of whom eight (1.6%) were revascularized within two months. RESULTS: After a median follow-up of 2.4 years the mortality in the invasive group was 3.6% vs. 4.4% (p = 0.45) in the conservative group, re-infarction incidence was 5.6% vs. 10.5% (p = 0.0038) and percentage of admissions with unstable angina was 17.9% vs. 29.5% (p < 0.00001). DISCUSSION: We conclude that post-infarct patients with inducible ischaemia should be referred to coronary angiography and revascularised accordingly.

Adult↗
PubMed2000

Emergency coronary artery bypass surgery after failed percutaneous transluminal coronary angioplasty.

Coronary complications caused by percutaneous transluminal coronary angioplasty (PTCA) may necessitate emergency coronary artery bypass grafting (CABG). In 1994-1998, 132 patients (1.5% of the patients registered in the Danish PTCA registry) underwent CABG within 24 h because of angioplasty complications. We reviewed the files of 86 patients who had emergency operations within 6 h and found that 35% suffered from 1-vessel disease. Fifty-eight percent were taken directly to the operating room from the cardiovascular laboratory, and 13% were given preoperative cardiovascular resuscitation. The vessels most frequently injured were the right coronary artery and the left anterior descending branch (LAD). The patients received a mean of 2.4 coronary bypasses each. Forty-three percent of the patients with lesions of the left main coronary artery and/or the LAD received a vein graft to the LAD. A perioperative Q-wave myocardial infarction developed in 51% of the patients. The in-hospital mortality rate was 12%. These results are inferior to those obtained after elective surgery. Local cardiothoracic backup is vital when PTCA is performed in an unselected patient group.

Adult↗
PubMed1999

Expanding the use of total mitral valve preservation in combination with implantation of the CarboMedics heart valve prosthesis.

BACKGROUND: Preservation of the mitral valve and subvalvular apparatus was introduced into the clinic in the early sixties, but for two decades the standard technique for mitral valve replacement included excision of both leaflets and their attached chordae tendineae. Lately, increased emphasis has again been placed on retention of the mitral subvalvular apparatus during valve replacement because of its role on left ventricular function. METHODS: We have preserved the valvular and subvalvular mitral apparatus, when possible, in connection with mitral valve replacement during the last seven years and the present investigation (partly prospective and partly retrospective) was done with the aim of making up the results of our mitral preservation technique. In the period between January 1990 and December 1995, 30% of the patients who underwent mitral valve replacement had complete retention of all mitral tissue. In 1996, the percentage had increased to 50, and during the first seven months of 1997, 70% of the patients had complete retention of all mitral tissue. Since January 1997, we have exclusively used the CarboMedics mitral heart valve prosthesis. A total of 56 patients were identified to have had a CarboMedics heart valve prosthesis implanted. There were 33 men and 23 women with a mean age of 63 years, range 23-77 years. Coronary bypass was a concomitant procedure in 22 patients. In seven patients, both the mitral and aortic valves were replaced. A severely altered valve with thickened and or calcified leaflets, stenotic leaflets, or shortened, retracted and thickened chordae tendineae were not a contraindication for the procedure. Calcified plaques were removed. Adhesion between anterior and posterior leaflets was treated with sharp dissection. Valve and subvalvular tissue were preserved. The leaflets were reefed within the valve-sutures and compressed between the sewing ring and the native annulus when implanting the valve prosthesis. Chordal tension on the ventricle was thereby maintained and the chordae pulled away from the valve effluent. Echocardiography with measurement of ejection-fraction was performed preoperatively during the postoperative course in case of cardiac problems and on a routine basis 1 month after surgery and at various intervals when the patient was seen in the outpatient clinic. Left ventricular outflow tract gradients were measured during the postoperative course in case of cardiac problems and routinely 1 month postsurgically. RESULTS: Five patients died in the postoperative period and one patient had transient neurological symptoms. In none of the patients was death or transient neurological symptoms a consequence of the retention of mitral leaflets with subvalvular apparatus. The remaining 51 patients were all alive at follow-up. Postoperative echocardiography demonstrated a preserved left ventricular function and a left ventricular outflow tract without obstruction. CONCLUSIONS: We find that the described technique in combination with implantation of a CarboMedics heart valve prosthesis is very useful even in patients with a severely altered valve, when preserving the mitral leaflets with subvalvular apparatus during valve replacement. The technique is without procedure related complications and preserves left ventricular function without obstructing the left ventricular outflow tract.

Adult↗
PubMed1998

CABG shortly after AMI treated with thrombolysis: an analysis of the surgical group and a comparison with PTCA in the DANAMI study. Danish multicenter randomized study of invasive versus conservative treatment in patients with inducible ischemia after thrombolysis in acute myocardial infarction.

OBJECTIVE: To present surgical results of the DANAMI study comparing conservative and invasive treatment of postinfarction myocardial ischaemia and to compare these with percutaneous transluminal angioplasty (PTCA) which was the alternative invasive treatment in that study. METHODS: A group of 413 patients with verified acute myocardial infarction treated with thrombolysis within 12 h of the onset of symptoms, who demonstrated postinfarction myocardial ischaemia were treated with coronary artery bypass grafting (CABG) or PTCA. Patients with left main lesions, three-vessel disease, two-vessel disease with more than three stenoses and patients with occlusions of a non-infarct related vessel had primary CABG. Patients with 1- and 2-vessel disease with not more than a total of three stenoses had PTCA. In case of failed PTCA patients had secondary CABG. The median distance from AMI to CABG was 45 days. PTCA was performed at a mean of 39 days after the infarction. RESULTS: A total of 147 patients had CABG and 266 had PTCA. The operative mortality for CABG was 1.4%. No PTCA patients died in relation to the procedure, 0.8% developed acute myocardial infarction as a consequence of the procedure, 1.5% had acute CABG and 3.5% elective CABG due to failed PTCA. In spite of more severe coronary artery disease among the CABG patients there was no difference in survival at 2.4 years. The CABG group had significantly fewer episodes of unstable angina, 10.2% versus 25.6% (P = 0.0002). No CABG patients had re-do revascularisation at 2.4 years follow-up versus 15.4% of the PTCA patients. At 3 years 80% of the CABG patients were free of angina compared to the 61% of the PTCA group (P < 0.0001). CONCLUSION: Low morbidity and mortality justifies the deferred elective revascularisation in patients with postinfarction myocardial ischaemia even in patients with silent ischaemia. There is no difference in survival at 2.4 years between CABG and PTCA but CABG offers more lasting results concerning incidence of stable and unstable angina than PTCA, which, however, is a valuable alternative in patients with less severe coronary artery disease.

Adult↗
PubMed1997

Danish multicenter randomized study of invasive versus conservative treatment in patients with inducible ischemia after thrombolysis in acute myocardial infarction (DANAMI). DANish trial in Acute Myocardial Infarction.

BACKGROUND: The aim of the DANish trial in Acute Myocardial Infarction (DANAMI) study was to compare an invasive strategy of percutaneous transluminal coronary angioplasty (PTCA) or coronary artery bypass grafting (CABG) with a conservative strategy in patients with inducible myocardial ischemia who received thrombolytic treatment for a first acute myocardial infarction (AMI). METHODS AND RESULTS: Of the 503 patients randomized to an invasive strategy, PTCA was performed in 266 (52.9%) and CABG in 147 (29.2%) from 2 to 10 weeks after the AMI. Of the 505 patients in the conservative treatment group, only 8 (1.6%) had been revascularized 2 months after the AMI. The patients were followed up from 1 to 4.5 years. The primary end points were mortality, reinfarction, and admission with unstable angina. At 2.4 years' follow-up (median), mortality was 3.6% in the invasive treatment group and 4.4% in the conservative treatment group (not significant). Invasive treatment was associated with a lower incidence of AMI (5.6% versus 10.5%; P=.0038) and a lower incidence of admission for unstable angina (17.9% versus 29.5%; P<.00001). The percentages of patients with a primary end point were 15.4% and 29.5% at 1 year, 23.5% and 36.6% at 2 years, and 31.7% versus 44.0% at 4 years (P=<.00001) in the invasive and conservative treatment groups, respectively. At 12 months, stable angina pectoris was present in 21% of patients in the invasive treatment group and 43% in the conservative treatment group. CONCLUSIONS: Invasive treatment in post-AMI patients with inducible ischemia results in a reduction in the incidence of reinfarction, fewer admissions due to unstable angina, and lower prevalence of stable angina. We conclude that patients with inducible ischemia before discharge who have received treatment with thrombolytic drugs for their first AMI should be referred to coronary arteriography and revascularized accordingly.

Adult↗
PubMed1997

Mitral valve replacement with total preservation of native valve and subvalvular apparatus.

BACKGROUND AND AIMS OF THE STUDY: Preservation of the mitral valve and subvalvular apparatus was introduced clinically in the early 1960s, but for two decades the technique for mitral valve replacement included excision of both leaflets and their attached chordae tendineae. Lately, emphasis has been replaced on retaining the mitral subvalvular apparatus during valve replacement because of its role in left ventricular function. Hence, during the past six years, when performing mitral valve replacement we have, when possible, preserved the valvular and sub-valvular mitral apparatus. METHODS: Between January 1990 and November 1996, complete retention of all mitral tissue in connection with mitral valve replacement was performed in 58 patients (23 women and 35 men). Mean age was 63 years (range: 23 years to 77 years). Coronary bypass was a concomitant procedure in 19 patients; both the mitral and aortic valve was replaced in four cases. Calcified and/or stenotic valves were not a contraindication for the procedure; calcified plaques were removed. Adhesion between anterior and posterior leaflets was treated with sharp dissection. Valve and subvalvular tissue were preserved. The leaflets were reefed within the valve-sutures and compressed between the sewing ring and the native annulus when implanting the valve prosthesis. Chordal tension on the ventricle is thus maintained and the chordae pulled away from the valve effluent. RESULTS: Six patients died in the postoperative period and three had transient neurological symptoms. In no patient was death or transient neurological symptoms a consequence of the retention of mitral leaflets with subvalvular apparatus. CONCLUSIONS: We find the described technique to be useful not only in valve insufficiency but also in valve stenosis when preserving the mitral leaflets with sub-valvular apparatus during valve replacement. The technique is without procedure-related complications and prevents obstruction of left ventricular outflow tract.

Adult↗
PubMed1996

[Rational transfusion therapy. A study of transfusion practice and possibilities of optimization in elective coronary bypass surgery].

The objective of the study was to evaluate the effect of intervention on physicians' transfusion behavior in elective coronary artery bypass grafting (CABG). We analyzed transfusion data on 176 patients who underwent primary elective CABG during two periods, either before (phase one, n = 102) or after (phase two, n = 74) intervention. The intervention was based on cooperation with the involved department of cardiac surgery, interviews of the surgeons and anaesthesiologists ordering blood, and concurrent audit of transfusion practice using a blood order form. The proportion af patients receiving allogenic transfusions decreased from 90% in phase one to 58% in phase two and the total use of blood components was reduced from an average of 6.3 units/patient to 2.7 units/patient, p < 0.01. Indications for transfusion documented in the medical record increased from 19% in phase one to 63% in phase two. It is concluded that intervention on physicians' transfusion behavior can improve the transfusion therapy in patients who undergo elective CABG.

Adult↗
PubMed1996

[Digoxin poisoning treated with Digibind].

A case of digoxin intoxication and hyperkalaemia causing cardiac arrest in a 63-year-old female who had undergone cardiac surgery is presented. Symptomatic treatment was given. However, as the patient continued to be unstable we introduced digoxin Fab-antibody in the treatment. The patient changed her heart rhythm from atrioventricular conduction block to atrial fibrillation within a few minutes and recovered later on. The pharmacology and the indications for treatment with digoxin Fab-antibody fragments are discussed.

Accidents↗
PubMed1995

[Screening for prehypoxemia with oximetry--a study of two methods].

The aim of the present study was to evaluate the validity of pulse oximetry screening for prehypoxaemia, to assess the agreement between pulse- and haem-oximetry and to elucidate any influence of peripheral temperature on pulse oximeter measurements. A consecutive prospective study was undertaken in 91 cardiac surgery patients still in treatment with controlled mechanical ventilation in the early postoperative period. We examined arterial oxygen tension (paO2), arterial oxygen saturation (SaO2) and pulse oximeter saturation (SpO2) from 657 arterial blood samples. The sensitivity of the pulse oximeter was 0.83, the specificity 0.73, and the diagnostic specificity was 0.10, at the chosen level of screening. The pulse oximeter showed a tendency to underestimate the oxygen saturation by 0.85%. The agreement between pulse- and haem-oxymetry was found to be good. The authors conclude that the pulse oximeter is acceptable for respiratory screening in postoperative cardiac surgery. The low specificity and the low diagnostic specificity results in frequent false alarms. Low peripheral temperature (down to 25%) do not influence the validity of either methods.

Evaluation Studies as Topic↗
PubMed1992

Prevalence of esophageal Candida colonization in a Danish population: special reference to esophageal symptoms, benign esophageal disorders, and pulmonary disease.

A population sample selected at random after stratification for the presence of pulmonary disease was screened for benign esophageal disease; 175 subjects agreed to participate in the invasive investigation, 86 without pulmonary disease and 89 with chronic obstructive pulmonary disease (COPD). Of these, 169 underwent endoscopy of the upper gastrointestinal tract, 164 had mucosal brushings for the presence of Candida albicans in the esophagus, 169 had esophageal pressure measurements, and 113 had 12-h pH measurements. One hundred fourteen subjects with benign esophageal disease were found. The prevalence of C. albicans in the esophagus (greater than or equal to 50 colonies) in subjects with and without COPD was 12.3% and 25.1%, respectively. C. albicans occurred equally in subjects with and without esophageal symptoms. There was no relation between the presence of C. albicans and benign esophageal disease and no significant clinical correlation between esophageal plaques and colony counts of C. albicans.

Adult↗
PubMed1991

[Surgical treatment of lung cancer in Denmark in 1982-1986. Special attention to the surgical procedure and mortality].

UNLABELLED: The operative activity and hospital mortality for lung cancer in Denmark, were investigated for the five year period from 1982 to 1986. Of the 2,898 operations performed 38.3% were pneumonectomies, 34.2% lobectomies, 6.0% lesser resections (segmental or wedge) and 21.5% were exploratory thoracotomies. The total hospital mortality was 7.2% (208 patients). Following pneumonectomy, the hospital mortality was 11.2%, after lobectomy 3.5% (p less than 0.001). Lesser resections carried a 2.3% mortality, not statistically different from lobectomy. Exploratory thoracotomy was connected with a mortality of 7.2%. In patients under the age of 60 years the mortality was 4.7% and in patients at the age of 60 to 69 years 7.9% (p less than 0.01). Patients over 70 years carried a mortality of 9.7%, not statistically different from patients from 60 to 69 years. The hospital mortality was significantly higher in the nonspecialized departments. IN CONCLUSION: Lung cancer is still increasing. Compared to the past the resectability rate is decreasing and hospital mortality is almost unchanged. To improve the results of efforts to increase the proportion of curable patients have to go hand in hand with efforts to reduce the numbers of exploratory thoracotomies and pneumonectomies as well as the number of operative and postoperative complications. Further centralization must be considered, in order to obtain better selectionscriteries and optimal treatment modalities per- and postoperatively.

Adult↗
PubMed1991

Risk factors for benign oesophageal disease in a random population sample.

The association of sex, age, relative weight, smoking and drinking habits, chronic obstructive pulmonary disease (COPD) and economic and marital status, with benign oesophageal disease (BOD) was investigated by means of a point-prevalence study of BOD in a Danish population. A total of 346 individuals, representing subjects who gave positive responses to the discriminating questions pertaining to BOD and risk factors in a previously described questionnaire, as well as control subjects, were invited to participate in a clinical examination. Invasive investigation was accepted by 175 subjects, 114 of whom were diagnosed as having BOD. A statistically significant relationship between BOD and COPD was demonstrated by univariate analysis, and later confirmed by multivariate analysis (P less than 0.01). Odds ratios suggested a non-significant association between BOD and smoking at least 20 g tobacco a day and consuming greater than or equal to 50 alcoholic drinks per week. Obesity, sex, age, marital and economic status were not risk factors for BOD.

Adult↗
PubMed1991

Twelve hour overnight oesophageal pH monitoring in patients with reflux symptoms.

Results of continuous 12 hour overnight pH monitoring (duration of pH less than 4) were reviewed in 112 patients with heartburn or regurgitation, or both, and in 56 normal subjects. Patients had more reflux than normal subjects. Medically controlled patients (n = 51) had less acid reflux than patients who subsequently underwent reflux surgery (n = 61), but there was a considerable overlap between those two groups. Surgery was followed by a reduction in acid reflux to a value similar to that in normal subjects. Patients in whom surgery was deemed to have failed had more reflux after the operation than those in whom it was successful, but no difference could be found in the preoperative reflux values of these two subgroups. Monitoring pH is not of value in selecting candidates for surgery since the results are not a good predictor of outcome, but it is useful in the objective evaluation of surgical results.

Esophagus↗
PubMed1990

[Surgical treatment of cancer of the cardia and the esophagus].

During the period 1977 to 1989, 379 patients with cancer cardiac and cancer esophagi were admitted. The ages ranged from 18-88 years with an average of 65 years. The treatment concept was basically unchanged during the study period. Resection as described by Ivor Lewis was employed as palliative or curative treatment when resection was considered possible. Intubation of the esophagus was employed when no other treatment was considered possible. Resection was employed in 251 patients, eight of these emergencies on account of perforation or haemorrhage. Bypass operations were employed in five patients, intubations in 63 and no surgical treatment was undertaken in 60 patients. The all over operative mortality for resections was 11.2% and for elective operations 9.9%. The operative mortality increased with the TNM stage of the tumour and was 3.2% for stages I + II, 8.2% for stage III and 24.4% for stage IV. The complication ration was 42%. 15% of the patients submitted to resection required reoperation. Anastomotic leaks were encountered in 18 patients and nine of these died. Pulmonary complications were the most frequent and resulted in ten early postoperative deaths. The mortality connected with intubations was 15%. The over all five-year survival rate after resections was 10.4%. In stages I + II this was 42% and 8% in stage III. None of the patients in stage IV survived for two years. The longest survival after intubation was less than one year.

Adolescent↗
PubMed1990

[Delayed diagnosis of bronchial foreign body].

An open safety pin was found in the middle lobe bronchus in a 3-year old girl with pneumonia. The point was directed downwards, and the pin could be removed during bronchoscopy. The lock was found to be partly corroded following months in the bronchial tree. The safety pin had thus most probably been closed when aspirated, and had thereafter remained silent until its spontaneous opening.

Bronchial Diseases↗
PubMed1989

[The Angelchik prosthesis in the treatment of gastroesophageal reflux].

Eighteen patients were treated for severe symptomatic gastroesophageal reflux with insertion of an Angelchik prosthesis. Three months after the operation all were free of symptoms. Postoperative 12-hour intra-esophageal pH monitoring showed significant reduction in acid reflux. Basal gastroesophageal sphincter pressure did not change significantly. After three years, one of the patients had symptomatic relapse. We conclude that the Angelchik prosthesis is effective in the treatment of symptomatic gastro-esophageal reflux, and that it is an alternative to conventional surgical procedures.

Adult↗