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Biomedical subjects

M Hanssen

Publications and source records attributed to M Hanssen.

At least 37 records · Page 2Linked to original sources
PubMed2001

Prevalence of psychotic disorder and community level of psychotic symptoms: an urban-rural comparison.

BACKGROUND: Urban and rural populations have different rates of psychotic illness. If psychosis exists as a continuous phenotype in nature, urban-rural population differences in the rate of psychotic disorder should be accompanied by similar differences in the rate of abnormal mental states characterized by psychotic or psychosislike symptoms. METHODS: A random sample of 7076 individuals aged 18 to 64 years were interviewed by trained lay interviewers with the Composite International Diagnostic Interview. Approximately half of those with evidence of psychosis according to the Composite International Diagnostic Interview were additionally interviewed by clinicians. We investigated associations between a 5-level urbanicity rating and (1) any DSM-III-R diagnosis of psychotic disorder (sample prevalence, 1.5%), (2) any rating of hallucinations and/or delusions (sample prevalence, 4.2%), and (3) any rating of psychotic or psychosislike symptoms (sample prevalence, 17.5%). RESULTS: Level of urbanicity was associated not only with DSM-III-R psychotic disorder (adjusted odds ratio [OR] over 5 levels, 1.47; 95% confidence interval [CI], 1.25-1.72), but also, independently, with any rating of delusion and/or hallucination (adjusted OR, 1.28; 95% CI, 1.17-1.40; clinician-assessed psychotic symptoms only: OR, 1.30; 95% CI, 1.03-1.64) and any rating of psychosislike symptom (adjusted OR, 1.18; 95% CI, 1.13-1.24). Psychotic symptoms were strongly and independently associated with psychotic disorder, regardless of the level of urbanization. CONCLUSIONS: Community level of psychotic and psychosislike symptoms may be inextricably linked to the prevalence of psychotic disorder. The prevalence of abnormal mental states that facilitate development to overt psychotic illness increases progressively with level of urbanization.

Adolescent↗
PubMed2000

Strauss (1969) revisited: a psychosis continuum in the general population?

Although dichotomously defined for clinical purposes, psychosis may exist as a continuous phenotype in nature. A random sample of 7076 men and women aged 18-64years were interviewed by trained lay interviewers with the Composite International Diagnostic Interview (CIDI). Those with evidence of psychosis according to the CIDI were additionally interviewed by psychiatrists. For the 17 CIDI core psychosis items, we compared a psychiatrist's rating of hallucinations and/or delusions (Clinical Psychosis; sample prevalence 4.2%) with three other possible positive CIDI ratings of the same items: (i) symptom present, but not clinically relevant (NCR Symptom; sample prevalence 12.9%); (ii) symptom present, but the result of drugs or somatic disorder (Secondary Symptom; sample prevalence 0.6%); (iii) symptom appears present, but there is a plausible explanation (Plausible Symptom; sample prevalence 4.0%). Of the 1237 individuals with any type of positive psychosis rating (sample prevalence 17.5%), only 26 (2.1%) had a DSM-III-R diagnosis of non-affective psychosis. All the different types of psychosis ratings were strongly associated with the presence of psychiatrist-rated Clinical Psychosis (NCR Symptom: OR=3.4; 95% CI: 2.9-3.9; Secondary Symptom: OR=4.5; 95% CI: 2.7-7.7; Plausible Symptom: OR=5.8; 95% CI: 4.7-7.1). Associations with lower age, single marital status, urban dwelling, lower level of education, lower quality of life, depressive symptoms and blunting of affect did not differ qualitatively as a function of type of rating of the psychotic symptom, were similar in individuals with and without any CIDI lifetime diagnosis, and closely resembled those previously reported for schizophrenia. Presence of any rating of hallucinations was strongly associated with any rating of delusions (OR=6.7; 95% CI: 5.6-8.1), regardless of presence of any CIDI lifetime diagnosis. The observation by Strauss (1969. Hallucinations and delusions as points on continua function. Arch. Gen. Psychiatry 21, 581-586) that dichotomously diagnosed psychotic symptoms in clinical samples are, in fact, part of a continuum of experiences, may also apply to the general population. The boundaries of the psychosis phenotype may extend beyond the clinical concept of schizophrenia.

Adolescent↗
PubMed1999

[Rupture of a branch of the pulmonary artery during Swan-Ganz catheterization. Treatment by coil embolization].

Rupture of the pulmonary artery or of one of its branches during a Swan-Ganz catheterisation is a rare complication which remains lethal in about 50% of cases. The risk factors and mechanisms of this complication have been previously described. There are two means of treatment: intensive care and specific medical or surgical treatment. In this case, the rupture of the pulmonary artery occurred during Swan-Ganz catheterisation and was treated by coil embolisation. This simple and rapid technique seems to be very promising.

Aged↗
PubMed1997

Comparison of saruplase and alteplase in acute myocardial infarction. SESAM Study Group. The Study in Europe with Saruplase and Alteplase in Myocardial Infarction.

Four hundred seventy-three patients with acute myocardial infarction (AMI) were treated with either saruplase (80 mg/hour, n = 236) or alteplase (100 mg every 3 hours, n = 237). Comedication included heparin and acetylsalicylic acid. Angiography was performed at 45 and 60 minutes after the start of thrombolytic therapy. When flow was insufficient, angiography was repeated at 90 minutes. Coronary angioplasty was then performed if Thrombolysis In Myocardial Infarction (TIMI) trial 0 to 1 flow was seen. Control angiography was at 24 to 40 hours. Baseline characteristics were similar. Angiography showed comparable and remarkably high early patency rates (TIMI 2 or 3 flow) in both treatment groups: at 45 minutes, 74.6% versus 68.9% (p = 0.22); and at 60 minutes 79.9% versus 75.3% (p = 0.26). Patency rates at 90 minutes before additional interventions were also comparable (79.9% and 81.4%). Angiographic reocclusion rates were not significantly different: 1.2% versus 2.4% (p = 0.68). After rescue angioplasty, angiographic reocclusion rates of 22.0% and 15.0% were observed. Safety data were similar for both groups. Thus, (1) early patency rates were high for saruplase and alteplase treatment, (2) reocclusion rates for both drugs were remarkably low, and (3) complication rates were similar. Thus, saruplase seems to be as safe and effective as alteplase.

Aged↗
PubMed1996

[Emergency angioplasty for total thrombosis of the left main coronary artery. Apropos of a case].

Complete thrombosis of the left main coronary artery is a rare angiographic finding and usually gives rise to cardiogenic shock during unstable angina or myocardial infarction. The prognosis of this condition is very dependent on the collateral coronary circulation and the myocardial protection seems to depend on the rapidity of revascularisation. Two therapeutic approaches may be envisaged; emergency coronary bypass grafting or percutaneous angioplasty, the natural history being particularly disastrous. The authors report the case of a 42-year-old patient with complete occlusion of the left main stem responsible for unstable angina and acute pulmonary oedema. The outcome with angioplasty in the acute phase associated with surgical revascularisation four days later, was good.

Angina, Unstable↗
PubMed1995

A study of biochemical markers of reperfusion early after thrombolysis for acute myocardial infarction. The PERM Study Group. Prospective Evaluation of Reperfusion Markers.

BACKGROUND: In acute myocardial infarction (AMI), early noninvasive identification of patients with occluded infarct-related arteries (IRAs) after thrombolysis has important prognostic and therapeutic implications. The aims of this study were to evaluate biochemical methods for the early diagnosis of patency after thrombolysis prospectively and to establish the optimal diagnostic criteria retrospectively. METHODS AND RESULTS: In 97 patients with AMI treated with thrombolytic agents < or = 6 hours after the onset of symptoms, myoglobin, troponin T, creatine kinase, the MB isoenzyme and MM isoforms of creatine kinase were measured just before thrombolysis began and 90 minutes later. IRA patency was assessed by means of 90-minute coronary angiography. For each marker, compared with the expected sensitivity and specificity based on published thresholds for the diagnosis of patency, the observed values were consistently lower but were markedly improved in a subset of patients treated > 3 hours after the onset of symptoms. With receiver-operator characteristic curve analysis of the slopes of increase and relative increases in each marker over 90 minutes, the best diagnostic performance was achieved by use of the relative increase in myoglobin, troponin T, and MM3/MM1 creatine kinase isoforms in patients treated > 3 hours after onset (areas under the curve of 0.84, 0.83, and 0.85, respectively). CONCLUSIONS: Effective early noninvasive diagnosis of patency after thrombolysis is possible in patients treated > 3 hours after symptom onset by use of criteria derived from the relative increase over 90 minutes in plasma markers, particularly myoglobin, troponin T, and MM3/MM1 creatine kinase isoforms. The diagnostic performance of the relative increase in myoglobin appears to be less susceptible to small changes in the diagnostic threshold value.

Biomarkers↗
PubMed1994

[Differences in the mechanisms of damage to Kupffer cells and liver endothelial cells during preservation in UW solution].

AIM OF THE STUDY: The predominant injury during cold preservation of the liver appears to affect the non-parenchymal cells. Therefore we studied the contribution of hypoxia and the effect of the University of Wisconsin (UW) solution on the injury to cultured liver endothelial and Kupffer cells. METHODS: Cultured endothelial cells and Kupffer cells of the rat liver were incubated in Krebs-Henseleit buffer at 37 degrees C and in both, Krebs-Henseleit buffer and UW solution, at 4 degrees C. Hypoxic conditions were simulated by the addition of cyanide (1 mM), to some of the cultures glucose (10 mM) was added. Cell injury was assessed by the uptake of the vital dye trypan blue and by the release of cytosolic lactate dehydrogenase. RESULTS: Kupffer cells as well as endothelial cells exhibited a high hypoxia tolerance in Krebs-Henseleit buffer at both 37 degrees C and 4 degrees C. A large difference between both cell types, however, was seen during cold incubation in UW solution: whereas only 35 +/- 10% of Kupffer cells lost viability during 24 hrs under aerobic control conditions, the loss of viability of liver endothelial cells was already 83 +/- 12% under the same conditions. The addition of KCN increased the Kupffer cell injury to 75 +/- 8% but strongly decreased the endothelial cell injury to 3 +/- 2%. The addition of glucose to the cyanide-containing UW solution decreased the injury to Kupffer cells but increased the injury to endothelial cells. CONCLUSION: During cold incubation in UW solution cultured liver endothelial cells are affected by an energy-dependent injury. This type of injury is not detectable in Kupffer cells.

Adenosine↗
PubMed1993

Injury to cultured liver endothelial cells during cold preservation: energy-dependent versus energy-deficiency injury.

Previously, we demonstrated an energy-dependent injury to cultured liver endothelial cells during cold incubation in University of Wisconsin (UW) solution. Here, the effects of Histidine-Tryptophan-Ketoglutarate (HTK) and Euro-Collins (EC) solutions on these cells were studied. In HTK solution, 83% +/- 4% of the cells had lost viability after 9 h of incubation at 4 degrees C. The addition of cyanide (1 mM) to simulate hypoxic conditions protected the cells to the extent that only 9% +/- 1% of the cells lost viability over the same period; the addition of glucose (10 mM) led to increased cell injury. ATP levels were highest in the incubations with the most rapid loss of viability. In Krebs-Henseleit buffer and EC solution, in contrast, cell injury increased upon addition of cyanide; the addition of glucose to Krebs-Henseleit buffer decreased injury. We conclude that the injury to cultured liver endothelial cells during cold incubation in HTK solution is energy-dependent, as it is in UW solution, whereas cells behave differently in EC solution and Krebs-Henseleit buffer.

Adenosine Triphosphate↗
PubMed1993

Energy-dependent injury to cultured sinusoidal endothelial cells of the rat liver in UW solution.

The critical injury to liver during cold preservation is believed to occur to the sinusoidal endothelium. In this study the viability of cultured sinusoidal endothelial cells from rat liver was assessed during storage in University of Wisconsin solution at 4 degrees C. The vast majority of cells (83 +/- 12%) died within 24 hr of storage. Addition of KCN (1 mM) to the solution to simulate hypoxia markedly increased survival: only 3 +/- 2% of cells had lost viability after 24 hr in the presence of cyanide. Further experiments showed that other inhibitors of mitochondrial ATP formation (antimycin A 1 microM, rotenone 1 microM, oligomycin 10 microM, carbonyl cyanide m-chlorophenylhydrazone 1 microM) were protective as well, whereas glucose (10 mM) greatly diminished the protective effect of cyanide (loss of viability 38 +/- 7% after 24 hr). ATP measurements confirmed the correlation between the energy state of the cells and cell death: ATP levels after 6 hr of incubation were 19.9 +/- 4.0 nmol/10(6) cells in UW solution, 13.7 +/- 2.9 nmol/10(6) cells in UW + glucose, 6.9 +/- 1.9 nmol/10(6) cells in UW + KCN + glucose and 1.9 +/- 1.5 nmol/10(6) cells in UW + KCN. In contrast to the protective effect observed in UW solution, addition of KCN to Krebs-Henseleit buffer led to increased endothelial cell damage upon cold storage. We therefore conclude that in UW solution damage to the sinusoidal endothelium is energy-dependent.

Adenosine↗
PubMed1993

[Evolution of the ST segment in myocardial reperfusion].

Intracoronary thrombolysis showed the chronological order of clinical electric and biological changes following the reestablishment of coronary flow. These changes make up the reperfusion syndrome; ST segment changes are part of this syndrome. They occur in practically all cases at the moment of reperfusion. The ST elevation may regress more or less rapidly or, on the contrary, increase transiently to a greater or lesser degree. When associated with other criteria of reperfusion-enzyme changes, arrhythmias, ST changes contribute to the indirect diagnosis of reestablishment of coronary flow. Rapid decrease in ST segment elevation is usually associated with a good myocardial outcome. The prognostic significance of transient increases in ST elevation--so called "reperfusion ischaemia"--is not fully understood, in particular its relationship to myocardial reperfusion injury. The myocardial prognosis after reperfusion may be the "biological" sum of cellular lesions due to ischaemia and reperfusion.

Arrhythmias, Cardiac↗
PubMed1992

[Acute myocardial infarction: recent physiopathological data. 1: acute coronary occlusion].

Acute myocardial infarction is the result of sudden coronary occlusion in the absence of a collateral circulation. There main factors are required for this to occur: an acute parietal lesion on a stenosis of variable, sometimes minor, importance; local coronary vasoconstriction and a platelet and fibrin thrombus. Parietal fissuration is the commonest "trigger" of coronary spasm and the thrombotic cascade. All factors of coronary occlusion are potentially reversible--vasodilation--platelet anti-aggregation--physiological fibrinolysis--remodeling and cicatrisation of the plaque, thereby explaining cases of spontaneous regression of occlusion (10% at 1 hour; 20% at 6 hours; 30% at 24 hours; 50 to 70% at 1 year). The pathogenesis of myocardial infarction with angiographically normal coronary arteries may be reviewed and attributed to acute parietal fissuration at a non-significant or angiographically undetectable plaque resulting in occlusive thrombosis. In this case, the role of other pathogenic factors is also discussed (diabetes, oral contraception, haemostatic abnormalities, platelet disorders...).

Coronary Angiography↗
PubMed1992

[Acute myocardial infarction: recent physiopathological data. 2: Left ventricular function].

Myocardial infarction is an anatomical and therefore functional amputation of some of the myocardial tissues. Moments after acute coronary occlusion, a cascade of metabolic, mechanical and electrical ischaemia related events is observed. Contraction stops and regional left ventricular akinesis (then dyskinesis) occurs in the zone at risk of irreversible myocardial damage. This is partially compensated by hyperkinetic motion of non-ischaemic myocardium. The degree of alteration of the global ejection fraction is the resultant of these akinetic and hyperkinetic wall motions. It is lower in cases of anterior myocardial infarction, of occlusion of the proximal segment of the left anterior descending artery and of multivessel disease. Its eventual outcome depends on coronary blood flow. If the artery responsible is recanalized early, the global ejection fraction stabilises or improves. When this does not happen, the global ejection fraction decreases. The end-diastolic volume, an indicator of left ventricular remodeling, increases in relation to the size of the infarct and to the persistence of coronary artery occlusion. The delay before the appearance of the first irreversible lesions, the rate of their propagation within the myocardial wall and the presence of reperfusion lesions are poorly understood factors in the clinical setting and influence the efficacy of methods of myocardial protection.

Coronary Disease↗
PubMed1992

[Myocardial reperfusion syndrome].

Myocardial reperfusion is associated with a number of clinical, electrocardiographic (arrhythmias, conduction defects, ST segment changes), haemodynamic and biological events. The commonest arrhythmias are ventricular extra-systoles, rapid ventricular tachycardias, and accelerated idio-ventricular rhythms. Reperfusion bradycardias are less common. When the arrhythmia is related to ischaemia it usually regresses when perfusion is restored. Reperfusion of the inferior wall of the left ventricle is often associated with sinus bradycardia and hypotension. The ST segment changes may evolve in two different ways: progressive regression or accentuation of ST elevation. When the responsible artery is recanalized, there is an immediate rise in plasma enzyme and myoglobin concentrations. The peak CPK concentration is usually observed after the 12th hours. The diagnostic value of the reperfusion syndrome lies in the interpretation of rapid ventricular tachycardias, accelerated idio-ventricular rhythms, ST segment changes and immediate rise in plasma CPK levels. The clinical risks of the reperfusion syndrome are low, practically never rhythmic and only exceptionally haemodynamic.

Arrhythmias, Cardiac↗
PubMed1991

Invasive reperfusion study. II. Multicentre European randomized trial of anistreplase vs streptokinase in acute myocardial infarction.

IRS II (Invasive reperfusion study II) was a multicentre randomized trial comparing the efficacy of a 2-5-min 30 U anistreplase intravenous injection with a 1,500,000 U 60-min streptokinase (SK) intravenous infusion in acute myocardial infarction. 116 patients were randomized within 6 h of onset of symptoms. Early coronary patency was assessable in 107 patients by coronary angiogram performed 102 min after thrombolytic treatment (range: 30-297 min) in the anistreplase group and 93 min (range: 22-330 min) in the SK group. The early coronary patency rate was significantly higher in the anistreplase group than in the SK group: respectively, 70% (38/54) and 51% (27/53), P less than 0.05). Fifty patients had assessable coronary angiograms at 90 min and 24 h. The 24-h patency rate was 92.3% (24/26) in the anistreplase group vs 87.5% (21/24) in the SK group. No early reocclusion occurred in the anistreplase group vs 15.4% (2/13) in the SK group (NS). Fibrinogen fell to 13.2 +/- 19.8% on anistreplase vs 9.4 +/- 10.3% on SK (NS). Bleeding complications occurred in 12% (7/58) of treated patients in the anistreplase group vs 20.7% (13/58) in the SK group (NS). Two cerebrovascular accidents occurred after thrombolytic treatment with anistreplase (3.4%) vs one after SK (1.7%) (NS). Thus, anistreplase is more effective than intravenous SK and easier to administer.

Adult↗
PubMed1991

[Rotacs: a device used in coronary and peripheral arterial recanalization].

The authors report their preliminary results with the Rotacs system in the reopening of chronic coronary artery occlusion by low-speed rotational angioplasty. This system improves the percentage of coronary recanalisation in cases where it is impossible to pass the guide wire alone. It seems to be an effective, low-cost complementary tool for the treatment of this type of lesion.

Angioplasty, Balloon↗
PubMed1990

[Transluminal balloon coronary angioplasty. Indications and results].

Thirteen years after its introduction transluminal balloon catheter angioplasty is a widely used technique. Owing to major technological advances and to the experience acquired by surgical teams, the primary success rate now reaches 90 p. 100. Hospital mortality has fallen down to 1 p. 100 and the need for emergency aorto-coronary bypass has been reduced to 4 p. 100 of the cases. However, despite repeated attempts at pharmacological or mechanical prevention, the restenosis rate remains around 30 p. 100. Coronary angioplasty is part of a wider strategy of myocardial reperfusion. Its indications are roughly the same as those of surgery. In patients with one-vessel coronary disease angioplasty is the first choice treatment, except for unprotected restenosis of the common trunk or very proximal lesions of the anterior interventricular artery. In multiple vessel disease the more complex the anatomical situation the more pronounced the left ventricular dysfunction and the greater the need for surgery. The acute phase of myocardial infarction is a legitimate indication for angioplasty, notably when thrombolytic agents are contraindicated or have failed when given intravenously, or in case of recurrence after an initially successful thrombolysis.

Angioplasty, Balloon, Coronary↗