Biomedical subjects

M Appleyard

Publications and source records attributed to M Appleyard.

At least 19 recordsLinked to original sources

PubMed1992

Echocardiographic algorithms for admission and predischarge prediction of mortality in acute myocardial infarction.

To develop improved prognostic algorithms for routine bedside use in acute myocardial infarction (AMI), the prognostic value concerning 2- and 12-month mortality of an early (within 72 hours after AMI) resting echocardiogram was defined in 201 consecutive patients. The relation between (1) the clinical variables (age, sex, prior and repeat AMI, arrhythmias, cardiac arrest, early [less than 72 hours after AMI] and late heart failure, early and maximal in-hospital Killip class, and maximal creatine kinase-MB isoenzyme), (2) early myocardial performance by echocardiography, and (3) mortality was characterized by Kaplan-Meier survival curves and receiver-operating characteristic curves based on Cox regression model. Only age and clinical heart failure in terms of the maximal in-hospital Killip class had independent predictive value of death (p less than 0.05) when an early echocardiographic estimate of left ventricular ejection fraction (LVEF) was included in the multivariate statistical models. The following 2 optimized algorithms for admission and predischarge calculation of risk of mortality at 2 and 12 months were developed based on the Cox model, using combinations of age, maximal Killip class and early echocardiographic LVEF: mortality at 2 months = 1 - exp - [0.051 x exp [0.044 x (age -60) - (0.117 x (LVEF - 40)]]; and mortality at 1 year = 1 - exp - [0.101 x exp [0.408 x (maxKillip - 1) - (0.061 x (LVEF - 40)]]. Discriminative power for prediction of mortality of the predischarge algorithm in an independent population of 195 patients 5 days after AMI compared favorably with that obtained in the original population, confirming the validity of the proposed method of prognostication.

Adult↗

PubMed1992

[Early discharge after acute myocardial infarction. Cost-effectiveness of early echocardiographic risk evaluation].

A total of 195 consecutive patients with acute myocardial infarction were examined and risk classified (low or middle/high risk) on the fifth day by two physicians. These two physicians employed two different sets of criteria: conventional clinical examination compared with 2-D echocardiographic assessment of the wall motion of the left ventricle (wall motion index, WMI). Both physicians concluded their examination by determination of a theoretical time for discharge. By design this was on the 5th-7th days for low risk patients by echocardiography, while low risk patients by clinical criteria are normally discharged on the 7th to 8th days. The most sensitive method of identifying the low risk patients was achieved by combining the clinical examination with echocardiographic WMI determination. In this manner, a total of 104 (53%) low risk patients could be identified. A potential saving of 18% of the total duration of hospitalization could be calculated from the two theoretical times of discharge for the total population. All of the patients in this study could be assessed by echocardiography which provided valuable information and thus may be implemented in the routine treatment of acute myocardial infarction.

Adult↗

PubMed1992

[Relation between 1-year mortality after acute myocardial infarction and left ventricular ejection function estimated by echocardiography].

The pump function of the left ventricle was characterized by means of early echocardiographic determination of the motion of the ventricular walls (wall motion index, WMI) in a consecutive unselected series of 195 patients with acute myocardial infarction. The pump function, WMI, was related to one-year mortality after infarction. The patients were subdivided prospectively into three risk groups (low, middle and high) depending on WMI. One-year mortality in the three groups were 2%, 34% and 37%, respectively (p less than 0.0001). Patients with previous infarcts had significantly lower WMI and greater one-year mortality than patients with first infarct (p less than 0.001 and less than 0.05, respectively). Among patients with first infarct with inferior localization, significantly higher WMI and lower one-year mortality were found than with anterior localization (p less than 0.001 and = 0.15, respectively, (NS)). Women had significantly higher one-year mortality than men (30.2% compared with 16.9% (p less than 0.04)) although this was reflected by a corresponding difference in WMI. Regardless of sex, age, localization of the infarct and signs of residual ischaemia, patients who were allocated to the low risk group solely on the basis of WMI, had particularly good prognoses. Among patients with more extensive myocardial damage, WMI less than or equal to 1.3, other risk factors probably played a greater role.

Adult↗

PubMed1992

Sensitivity and specificity of echocardiographic identification of patients eligible for safe early discharge after acute myocardial infarction.

In a prospective clinical trial of 195 consecutive unselected patients with acute myocardial infarction (AMI), systematic blinded clinical and echocardiographic examinations were performed by two observers on day 5. The purpose was to define low-risk patients with regard to in-hospital and 2-month mortality and predict the potential costs (lost patient lives) and benefits (saved in-patient days) if as a routine procedure these low-risk patients were discharged earlier. By design, low-risk patients as defined by clinical criteria were allocated to discharge on days 7 to 10 and by echocardiographic criteria on days 5 to 7 after AMI. The sensitivity of the echocardiographic low-risk identification procedure was more than twofold higher than the sensitivity of clinical low-risk identification (49% vs 24%). Both procedures were safe with a specificity of 100% for cardiac mortality. Optimal identification of low-risk patients was provided by combining data from echocardiographic and clinical evaluations (sensitivity 59%). Results of the study suggest that a bedside echocardiographic approach to estimation of global left ventricular function is more sensitive and equally specific and therefore more efficient for risk stratification on post-AMI day 5 than clinical examination alone. Thus echocardiographic examination allows identification of a larger subset of patients with AMI (greater than 40% of the population alive on day 5) who can be discharged earlier and safely, with a potential saving of in-patient days of 436 days in 87 low-risk patients minus the cost of echocardiographic studies in 195 patients. However, the best prediction was obtained by combining clinical and echocardiographic examination.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗

PubMed1992

Actions of acetylcholinesterase in the guinea-pig cerebellar cortex in vitro.

Acetylcholinesterase is released in a calcium-dependent manner when afferents of the cerebellar cortex are stimulated. Since cholinergic transmission is probably insignificant in the cerebellar cortex, the esterase itself might serve as a transmitter or modulator. Therefore, the effect of acetylcholinesterase in the cerebellum was investigated in slices of guinea-pig cerebella during intracellular recording from Purkinje cell somata or dendrites. Addition of acetylcholinesterase (20 U/ml) to the superfusion medium did not change the membrane potential or the input resistance of the Purkinje cells. Thus, esterase does not act like a classical transmitter. The threshold for Na+ spikes generated by intracellular current injection was unaffected, but the threshold for Ca2+ spikes was increased. This increase was abolished by tetrodotoxin (1 microM). Furthermore, when Ca2+ currents were blocked by substituting Mn2+ for Ca2+ (2 mM) a decrease in a Na+ plateau potential was seen in the presence of esterase. The effect of acetylcholinesterase of Ca2+ spikes is therefore most likely due to a reduction of the non-inactivating Na+ current of the Purkinje cell membrane. When present this current contributes to activation of Ca2+ spikes in dendrites. Acetylcholinesterase also enhanced the response of Purkinje cells to the excitatory amino acids glutamate and aspartate thought to be transmitters in the cerebellar cortex. The responses became larger and faster in the presence of esterase. Responses to climbing fibre stimulation were also enhanced by acetylcholinesterase. The late part of this synaptic response was increased. The potentiation by esterase of responses of Purkinje cells to excitatory amino acids and to climbing fibre stimulation may be mediated through interference with transmitter uptake, because it was prevented by treatment with DL-2-amino-4-phosphonobutyric acid (0.5 mM) and di-hydrokainate (0.1 mM). None of the effects of esterase was due to hydrolysis of acetylcholine because irreversible inhibition of the catalytic site of the enzyme with soman did not prevent the actions. The observations were specific for acetylcholinesterase. Butyrylcholinesterase (20-40 U/ml) showed none of the effects. It is concluded that acetylcholinesterase in the cerebellar cortex seems to mediate a novel type of modulation by two separate mechanisms. Esterase reduces the tendency towards Ca2+ spike generation in Purkinje cells. Ca2+ spikes are followed by afterhyperpolarizations and in their absence firing of Na+ spikes at higher frequencies is possible. Secondly, there is an enhancement of the action of excitatory transmitters so that the extended operating range can be utilized.

Acetylcholinesterase↗

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↗

PubMed1992

Risk factor analysis for atrophic and exudative age-related macular degeneration. An epidemiological study of 1000 aged individuals.

The relationship between age-related macular degeneration and cardiovascular risk factors and certain life-style factors, collected in the Copenhagen City Heart Study (1981-83), was studied by multiple logistic regression analysis. The ophthalmological study sample comprised 1000 randomly selected persons aged 60 to 80 years. Separate analyses were made for the atrophic and the exudative forms of age-related macular degeneration. Among all the possible risk factors analysed, only three factors were significantly associated with macular degeneration. Age was associated with both atrophic and exudative macular degeneration (P less than 0.01). Among smokers who inhaled, the risk of atrophic maculopathy was 2.5 times higher than among non-smokers (P less than 0.01), whereas the use of hypnotics increased the risk of exudative maculopathy by 3.4 times (P less than 0.01).

Aged↗

PubMed1992

The cardiovascular, endocrine and renal response of tetraplegic and paraplegic subjects to dietary sodium restriction.

1. The effects of change from a high to low sodium diet upon renal sodium and water excretion and hormone responses were studied in patients with dissociated sympathetic control (DS, tetraplegic) and controls with sympathetic control largely intact (IS, paraplegic). 2. Total and fractional urinary sodium excretion fell in response to sodium restriction in both groups, but the fall in fractional sodium excretion was greater in the DS group compared with the IS group (DS, 1.34 +/- 0.12 to 0.42 +/- 0.05%; IS, 0.96 +/- 0.08 to 0.52 +/- 0.06%). 3. Supine mean arterial pressure fell during the low salt period in the DS group (80.2 +/- 2.7 to 74.4 +/- 2.3 mmHg) but was unaffected by salt restriction in the IS group (101 +/- 2.3 to 98.8 +/- 2.7 mmHg). In the DS group, creatinine clearance remained constant throughout the low salt period (103.7 +/- 7.9 to 98.3 +/- 9.7 ml min-1), but fell during salt restriction in the IS group (101.4 +/- 8.5 to 83.2 +/- 5 ml min-1). 4. Plasma renin activity was lower during salt loading in DS subjects but increased more rapidly and to higher levels in response to salt restriction (DS, 1021 +/- 142 to 4439 +/- 355; IS, 1765 +/- 269 to 3683 +/- 465 pg angiotensin I ml-1 h-1). Plasma atrial natriuretic peptide concentration was higher in the DS group during salt loading and salt restriction (DS, 37.6 +/- 5.6 to 22 +/- 3.8; IS, 20.2 +/- 2.3 to 11 +/- 1.6 pg ml-1).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

PubMed1992

Risk stratification after acute myocardial infarction by means of echocardiographic wall motion scoring and Killip classification.

In order to perform risk stratification, 195 consecutive, unselected patients with acute myocardial infarction (AMI) underwent independent echocardiographic and clinical evaluation of their left ventricular function by means of the wall motion index (WMI) and Killip classification 5 days after AMI. The patients were prospectively allocated to a low, medium or high risk class depending on WMI alone, and the 1-year mortality in these classes was 2, 34 and 37%, respectively (p < 0.0001). The 1-year mortality of the patients in Killip class I, II, or III and IV was 6, 26 and 48%, respectively (p < 0.00001). The number of patients allocated to the low risk group by means of WMI was 87, and the number of patients in Killip class I was 86. Since these groups were not identical, a total of 103 patients, i.e. 53% of the study population, could be identified as low risk patients regarding 1-year mortality 5 days after AMI, when WMI and Killip classification were used in combination. We conclude that the combination of echocardiographic and clinical evaluation of left ventricular function after AMI provides a strong and yet very simple procedure to identify low risk patients, which could be easily implemented in the routine work of coronary care units.

Adult↗

PubMed1992

Stroke incidence in Copenhagen, 1976-1988.

BACKGROUND AND PURPOSE: Temporal trends in stroke incidence in Denmark have not been previously reported. The Copenhagen City Heart Study is a prospective study based on a randomly selected sample of an urban population of, initially, 19,698 participants followed since 1976. Over a period of 12 years, we studied three important aspects of stroke incidence in 848 identified cases: temporal trends, dependence on age and sex, and comparison of responders and nonresponders. METHODS: The participants were invited to two health examinations at 5-year intervals. The participants who attended at least one of the two examinations are termed responders and those who attended none nonresponders. The cases of first-ever stroke were collected from responders, the National Patient Register, and the National Register of Deaths and were verified by study of hospital records and death certificates. RESULTS: For responders aged 35-64 years and greater than or equal to 65 years, there were no significant changes in the weighted rates in four consecutive 3-year periods. There was a tendency toward decreasing rates among younger women, but not in older women or men. The age- and sex-adjusted rates per 1,000 (based on the Danish population in 1982) in responders in the entire 12-year follow-up period were 1.61 in women, 2.67 in men, and 2.14 in both sexes combined. Stroke incidence rates increased exponentially with age in both sexes, with rates in men generally twice those in women, even in the greater than or equal to 75 years of age group. Age-adjusted rates were higher in nonresponders than in responders. For women, this ratio was 1.7; for men, 1.1. CONCLUSIONS: The stroke incidence in Copenhagen is relatively high and has shown no decreasing tendency over the period 1976-1988.

Adult↗

PubMed1992

Relationship of the type of tobacco and inhalation pattern to pulmonary and total mortality.

Data from The Copenhagen City Heart Study, a prospective population study, were analysed to investigate the influence of the type of tobacco and inhalation on pulmonary and total mortality. The study sample comprised 6,511 men and 7,703 women, selected randomly after age-stratification from the general population. There were 2,986 plain cigarette smokers, 3,222 filter cigarette smokers, 1,578 smokers of cheroots/cigars, 433 male pipe smokers and 773 subjects smoking more than one type of tobacco. From 1976 until the end of 1989, 2,765 subjects died. Lung cancer was considered as main death cause in 268. Chronic obstructive pulmonary disease (COPD) was considered as the main cause in 94 cases and main or contributory cause of death in 195 cases (COPD related mortality). Current smokers had a higher risk of total mortality compared to lifetime nonsmokers: the relative risks (RR) ranged between 1.2 for male pipe smokers and 2.4 for female plain cigarette smokers. With regard to lung cancer mortality, the RR ranged between 4.1 for male pipe smokers and 7.9 for female plain cigarette smokers. Even higher RR values were estimated for COPD related mortality. In both sexes, the RR for the investigated end-points were lower in cheroot/cigar smokers and in pipe smokers than in cigarette smokers, but these differences were markedly diminished after an adjustment for the inhalation habit. The present study substantiates the view that tobacco smoking increases pulmonary and total mortality. The small differences between the various types of tobacco are probably caused by different inhalation patterns.

Adult↗

PubMed1992

Prognostication in acute myocardial infarction by early echocardiographic estimation of left ventricular ejection fraction. Multivariate statistical comparison with a clinical prognostic index and its components.

The purpose of this study was to define the prognostic value concerning in-hospital, two-month, and one-year mortality of an early echocardiographic estimation of left ventricular ejection fraction, relative to traditional clinical variables and a clinical prognostic index, in an unselected series of 193 patients following acute myocardial infarction. Left ventricular ejection fraction was determined within 72 hours by echocardiographic wall motion analysis within the frame of a nine-segment model. Clinical variables (age, number of acute myocardial infarctions, reinfarction, heart failure, cardiac arrest, ventricular arrhythmias, asystole, supraventricular tachycardia, nodal rhythm) and a calculated, previously published index, based on these variables, were recorded on day five post infarction and predischarge. The Killip class was recorded at the time of echocardiography. All variables were compared by a multivariate approach (Cox regression model). The results showed that left ventricular ejection fraction was the strongest predictor of early and late mortality and increasingly so over the period of observation. Age and maximal Killip class had a modest additional prognostic value, whereas the composite clinical prognostic index had no predictive power when early left ventricular ejection fraction was included in the statistical model.

Adult↗

PubMed1991

[Various types of tobacco smoking and development of chronic obstructive pulmonary disease. Results from the Osterbro study].

On the basis of the Osterbro investigation (Copenhagen City Heart Study) which includes several thousand smokers and non-smokers, the authors have analysed the risk of developing chronic mucus hypersecretion and decrease in forced expiration volume in the first second of expiration (FEV1) in the course of a five-year period in the following groups: non-smokers, smokers of cigarettes without filters, smokers of filter cigarettes, smokers of cigarillos/cigars and pipe smokers. All of the types of tobacco investigated led to increased loss of pulmonary function and to increased risk of development of mucus hypersecretion as compared with non-smokers. The differences between the injurious effects of the types of tobacco were limited and were probably due to different inhalation habits in the various groups of smokers. It is concluded that there is no evidence that change from one type of tobacco (eg cigarettes) to another type (eg pipe or cigar tobacco) will reduce the risk of developing chronic obstructive pulmonary disease unless the change is accompanied by considerable reduction of the tobacco consumption.

Adult↗

PubMed1991

[Does smoking increase the degree of wrinkles on the face? The Osterbro study].

In order to illustrate whether there is a connection between smoking and the degree of wrinkles on the face, the authors investigated an age-stratified random sample of 4,485 women and 2,485 men aged 40-69 years. The degree of wrinkles lateral to the canthus of the right eye was described without the investigator being aware of the smoking habits of the individual concerned. For both sexes, the prevalence of deep wrinkles increased with increasing age and with decreasing household income but no significant association with body mass index was demonstrated. In men, a significant association was demonstrated between the cumulated cigarette consumption and the degree of deep wrinkles while this was not the case in women. No definite explanation of this difference between the sexes could be found but a difference in exposure to sunlight and use of face cream may be the reasons.

Adult↗

PubMed1991

Smoking and the risk of first acute myocardial infarction.

When analyzing risk factors for first acute myocardial infarction in the Copenhagen City Heart Study, a large prospective population study of 20,000 men and women, smoking was found to influence risk significantly in a dose-dependent manner, the risk increasing 2% to 3% for each gram of tobacco smoked daily. Risk was particularly associated with inhalation, the risk for inhalers being almost twice that of noninhalers. No difference in risk could be demonstrated between various types of tobacco (pipe, cigar/cheroots, or plain and filtered cigarettes). The risk seemed associated with current smoking only, inasmuch as the duration of the smoking habit was not important. Ex-smokers had the same risk as those who had never smoked regardless of duration of smoking and time elapsed since quitting. Relative excess risk was significantly higher in female smokers than in male smokers, and daily alcohol intake appeared to have some protective effect on the risk of first acute myocardial infarction among heavy smokers.

Adult↗

PubMed1991

Risk factors for acute myocardial infarction in Copenhagen, II: Smoking, alcohol intake, physical activity, obesity, oral contraception, diabetes, lipids, and blood pressure.

The Copenhagen City Heart Study is a prospective cardiovascular population study designed to evaluate incidence of, and risk factors for, cardiovascular disease. A random sample, comprising approximately 20,000 people, were invited to participate. Initial information about potential risk factors was collected during 1976-78 (attendance rate 74%); data about 389 new cases of first acute myocardial infarction (AMI) was obtained from a second survey in 1981-83, as well as from hospital and death registers up to 31 December 1983. The average observation period was 6.5 years. Cox's regression model was used for data analysis. Some 'basic' factors, namely age, sex, family history of AMI, early parental death, height, earlobe crease, length of school education, income and living alone or with a partner were dealt with in a previous paper and are among the potential risk factors for AMI included in the Copenhagen City Heart Study. In this analysis we also include life-style characteristics, some biological traits and disease conditions. An increased risk for first AMI among smokers was graded: the estimated relative risk (ERR) for heavy smokers consuming more than 29g tobacco per day was 2.8 relative to non-smokers. Alcohol intake of five or more drinks per day was associated with a decreased risk, an ERR of 0.6 relative to those who did not drink alcohol daily. Physical inactivity during work but not at leisure was associated with increased risk (ERR 1.4) as was body mass index where the risk was mediated mainly through blood pressure and plasma triglycerides. Oral contraception was not associated with an increased risk, whereas with diabetes the risk increased (the ERR for diabetes being 1.8). Plasma cholesterol above the level of approximately 7 mmol l-1 proportionally increased risk; the ERR in the 1.5% with the highest level was 3.7. A low triglyceride level was associated with low risk; the ERR in the fifth of the study population with the lowest level was 0.6. Elevated blood pressure also proportionally increased risk. Subjects on antihypertensive drug treatment had higher risk than non-treated subjects with similar blood pressure. The effect of socioeconomic factors described in the previous paper was not mediated through their influence on the risk factors included in the present analysis.

Adult↗

PubMed1991

Relative prognostic value of clinical heart failure and early echocardiographic parameters in acute myocardial infarction.

The relative prognostic value of clinical heart failure and early M-mode and 2-dimensional echocardiographic indexes of left ventricular performance was compared in a study of 205 consecutive patients with acute myocardial infarction (AMI). Statistical analysis showed that an early wall motion score was a stronger predictor of 1-year mortality than the occurrence of clinical heart failure early, late or at any time during the hospital course of AMI. The finding of clinical heart failure had an independent prognostic value of intermediate strength. M-mode echocardiographic parameters only had a weak independent prognostic value, possibly related to their content of information on left ventricular end-systolic dimension.

Adult↗

PubMed1991

Ventilatory function impairment and risk of cardiovascular death and of fatal or non-fatal myocardial infarction.

The relationship of ventilatory function to cardiovascular events was studied in 12,511 men and women, enrolled in 1976-1978 in a prospective population study. Until the end of 1983, 388 subjects died because of a cardiovascular disease, 133 died within 30 days of developing myocardial infarction (fatal myocardial infarction), while 238 had a non-fatal myocardial infarction. Cox proportional hazards models were employed for the analysis. In the models including tobacco smoking, cholesterol level, blood pressure, diabetes mellitus and body-mass index as covariates, forced expiratory volume in one second in percentage of predicted (FEV1% pred), forced vital capacity in percentage of predicted (FVC% pred), and the ratio between FEV1 and FVC (FEV1/FVC) were significantly related to the risk of cardiovascular death, e.g. compared with subjects with FEV1% pred or FVC% pred greater than or equal to 80 the risk of death from cardiovascular disease among subjects with FEV1% pred or FVC% pred less than 60 was approximately twice as high. There was a nonsignificant trend towards an increased risk of fatal myocardial infarction with reduction of FVC% pred, but in general the regression models did not show consistent relationship between lung function impairment and risk of myocardial infarction. In the regression models, which only included age and sex as covariates, reduced FVC% pred and FEV1% pred were significantly related to both cardiovascular mortality and to fatal myocardial infarction, but not to the non-fatal infarction, whereas the FEV1/FVC ratio was not related to fatal or to non-fatal myocardial infarction.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗