[Norwegian physicians in war?].
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Humans↗
Biomedical subjects
M Rostrup
Publications and source records attributed to M Rostrup.
[Angioplasty in acute myocardial infarction].
20 patients with acute myocardial infarction and a medical history of less than six hours were treated with immediate percutaneous transluminal coronary angioplasty. The median time from start of symptoms until establishment of reperfusion of the infarct related artery was 190 minutes, and the time from admission to insertion of the balloon was 52 minutes. Angioplasty was successful in all patients, with no serious complications. All patients experienced pain relief immediately after angioplasty. No patients died or had further infarctions. None needed hospitalization during the first three months of follow up. Eight patients had an exercise test between five and seven days after angioplasty and the other 12 at their six-week check up; there were no signs of ischemia or anginal pain. Measurement of global ejection fraction one week and six weeks after treatment showed median normal values and no significant changes (58% versus 57%). Myocardial perfusion imaging was carried out in eight patients both before hospital discharge and six weeks later. Normalization and improvement was seen in six patients using this method, whereas the perfusion was found unaltered in two patients. Hibernation or stunning, or both are suggested as possible explanations for this. We found the method highly effective and safe in selected patients.
Adult↗
[HIV epidemic--treatment only for the richest. Interview by Kari Anne Aase].
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Cost of Illness↗
Catecholamines, hypoxia and high altitude.
Hypoxia is a potent activator of the sympathetic nervous system by stimulating arterial chemoreceptors. However, out of 15 laboratory studies on the effects of acute and prolonged hypoxia on catecholamines, 14 failed to show any changes in plasma or urinary noradrenaline and only four studies showed significant increases in plasma or urinary adrenaline. By contrast, six out of eight studies on MSNA showed increased sympathetic nerve activity to the leg. An increased clearance of plasma catecholamines during hypoxia may be a possible explanation. Furthermore, many of the studies had limitations in a number of subjects and catecholamine assays used. Emotional aspects of the study protocols, which could contribute to the increase in adrenaline, was only assessed by sham runs in one chamber study. However, 13 out of 14 reviewed field studies on subjects staying for more than 1 week at high altitude, reported increased plasma or urinary excretion of noradrenaline which may be compatible with increased sympathetic activity. Adrenaline changed to a lesser degree. Out of seven studies on more short-term (4 h to 3 days) exposure to high altitude, only one demonstrated significantly increased plasma noradrenaline. In this study, however, several subjects had been exposed to high altitude less than 1 week before the experiment. In a new study on 12 climbers reported in this paper, a temporary reduction in plasma catecholamines was found 2 days after arrival at 4200 m. There was a steady increase towards normal levels after 1 week. Plasma vasopressin (AVP) increased suggesting a compensatory mechanism. Both plasma noradrenaline and adrenaline were positively correlated with oxygen saturation in these subjects. Thus, in previously unacclimatized subjects, short-term exposure to high altitude does not increase plasma catecholamines, rather plasma levels decreased. In addition to increased clearance, there is some evidence of reduced synthesis of catecholamines during short-term hypoxia. The oxygen sensitivity of tyrosine hydroxylase (TH) activity, may be one possible mechanism.
Acclimatization↗
Arterial and venous plasma catecholamines during submaximal steady-state exercise.
Arterial and venous plasma catecholamine responses to 15 min of cycling at 60% of maximal oxygen uptake were examined 11 times during exercise and recovery in nine young men. Intra-arterial blood pressure, heart rate and oxygen uptake were recorded continuously. All variables increased significantly during the initial 4 min, after which oxygen uptake, diastolic blood pressure and arterial plasma adrenaline showed no further increase. Heart rate and plasma noradrenaline, however, continued to increase, although significantly more slowly, and were closely correlated (r = 0.81, 95% CI 0.71-0.87), as were systolic blood pressure and heart rate (r = 0.78, 95% CI 0.71-0.87). Venous plasma adrenaline showed a steady increase during the whole exercise period and thus a different response pattern from arterial plasma adrenaline. In conclusion, arterial plasma catecholamines respond to steady-state exercise by a two-phase pattern paralleling the changes in arterial blood pressure and heart rate. Venous sampling does not reveal this association.
Adult↗
Plasma catecholamines and haemodynamic changes during pneumoperitoneum.
BACKGROUND: Insufflation of CO2 into the abdomen is used during all kinds of laparoscopic operations. The procedure elicits haemodynamic and hormonal responses. The reports on sympathetic responses to laparoscopic surgery have been conflicting. However, few studies have assessed sympathetic and haemodynamic responses to CO2 insufflation per se, eliminating possible effects of intubation, skin incision, surgical manipulation and positioning of the body. No studies have measured both venous and arterial plasma catecholamines, the latter being a more sensitive indicator of sympathetic activity. In the present study, we hypothesised an increased sympathetic activity during pneumoperitoneum and an association between haemodynamic and sympathetic responses. METHODS: Plasma adrenaline and noradrenaline from the radial artery and superior vena cava were measured immediately before and 10 min after abdominal insufflation of CO2 in 11 subjects. Haemodynamics were monitored invasively. RESULTS: During pneumoperitoneum arterial plasma noradrenaline increased from 155 (106, 209) pg/ml (median, lowest and highest quartile) to 283 (188, 378) pg/ml (P = 0.003), while there were no changes in arterial plasma adrenaline. The calculated arterial-superior vena cava difference in plasma noradrenaline did not change, indicating no increased sympathetic activity in the drainage area of the superior vena cava. Heart rate and cardiac index were unchanged, while total peripheral resistance and mean arterial blood pressure increased (P = 0.002). The changes in arterial plasma noradrenaline were closely related to the changes in total peripheral resistance (r = 0.69, P = 0.01). CONCLUSIONS: Plasma noradrenaline increases during pneumoperitoneum and is associated with changes in total peripheral resistance. Plasma adrenaline is unchanged and there is no evidence of increased sympathetic outflow to the drainage area of the superior vena cava. Thus, the increase in plasma noradrenaline may be due to more local activation of the sympathetic nervous system, probably somewhere from the drainage area of the inferior vena cava.
Adult↗
Relationship between insulin sensitivity and maximal forearm blood flow in young men.
Insulin resistance is a part of the metabolic cardiovascular syndrome. We aimed to test the hemodynamic hypothesis of insulin resistance, which suggests that a decreased skeletal muscle blood supply with subsequent reduced nutritional flow causes insulin resistance in skeletal muscle. We assessed determinants of peripheral blood flow such as maximal forearm blood flow (MFBF), minimal forearm vascular resistance (MFVR), and whole blood viscosity (WBV) in 27 young men with borderline elevation of blood pressure. Insulin sensitivity measured as glucose disposal rate (GDR) correlated with MFBF (r=0.55, P=0.003), MFVR (r=-0.58, P=0. 002), and WBV (r=-0.39, P=0.046 at shear rate 201 s-1). There was no correlation between GDR and myocardial thickness or left ventricular mass. In a stepwise multiple regression analysis, MFVR and WBV explained 54% of the variation in GDR. The relative increase in mean arterial blood pressure during a mental stress test, as a marker of reactivity or an alert reaction, was correlated with MFVR (r=0.56, P=0.002) and inversely with GDR (r=-0.45, P=0.018) and MFBF (r=-0.49, P=0.01) but not with cardiac dimensions. In a stepwise multiple regression analysis, 48% of the increase in blood pressure during a mental stress test was explained by MFVR and WBV. Fasting insulin correlated with MFVR (r=0.41, P=0.036) and GDR (r=-0.62, P=0.001). These data show a positive association between the appearance of peripheral structural vascular changes as quantified through a hemodynamic technique and insulin resistance in young men with borderline elevation of blood pressure. The cause-effect relationship of this finding needs further evaluations.
Adult↗
[Splenic atrophy and fatal pneumococcal infection in inflammatory bowel disease].
Fatal pneumococcal disease occurred in a young woman with ulcerative colitis that had been quiescent for ten years. Howell-Jolly bodies were present in the peripheral blood smear. Severe atrophy of the spleen (weight 7 g) was discovered at autopsy. The evidence that hyposplenism is associated with inflammatory bowel disease is reviewed and it is suggested that these patients should undergo ultrasound examination and examination of blood smear for detection of functional hyposplenism. We conclude that pneumococcal vaccination should be considered for all patients with inflammatory bowel disease.
Adult↗
[Acute high altitude sickness--medical experiences from Mount Everest during the spring season 1996].
In April-May 1996 a Norwegian expedition climbed Mount Everest from the Tibetan side, Eight out of the ten members reached the summit. The expedition did not experience any serious incidents but took part in the rescue and treatment of climbers from other expeditions. Eleven cases are reported. Four of these were fatal. Cerebral oedema and frostbite were the most common problems in addition to hypothermia and exhaustion. The author also discusses acute mountain sickness, including clinical features, treatment and prophylaxis.
Acute Disease↗
Halofantrine-associated ventricular fibrillation in a young woman with no predisposing QTc prolongation.
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Adult↗
Calcium antagonist treatment and cardiovascular responses to a cold pressor test at high altitude.
OBJECTIVE: We assessed the effects of the calcium antagonist felodipine on blood pressure, heart rate, oxygen saturation and cardiovascular responses to a cold pressor test at an altitude of 5200 m. Sixteen healthy climbers participated. A double-blind, placebo-controlled, randomized, crossover design was used. Placebo or felodipine were taken for 2 days and the treatment was changed after 3 days washout. RESULTS: During felodipine treatment there were no significant changes in blood pressure (125/89 vs 127/86 mmHg), heart rate (82 vs 81 beats.min-1) or oxygen saturation (86% vs 86%). Moreover, there were no changes in the cardiovascular responses to the cold pressor test. CONCLUSION: Felodipine is well tolerated at high altitude. It does not induce hypotension in normotensive men and does not affect cardiovascular reactivity to cold stress.
Adult↗
Blood platelet responses to laboratory stress in young men. The effect of awareness of high blood pressure.
Healthy 19-year old males from the 95th percentile of mean arterial screening blood pressure were randomized to prolonged mental stress by receiving a letter informing of a high screening blood pressure (n = 13), or a neutral letter (n = 13). Blood platelet function in vivo was assessed by measurements of plasma concentrations of the platelet-specific protein beta-thromboglobulin, platelet counts, and mean platelet volumes before and during two laboratory stress tests (hand cold pressor test and arithmetic challenge). The cold pressor test caused a significant increase in beta-thromboglobulin concentrations in both groups, and significantly more in the uniformed group. Platelet count increased significantly in both groups during mental arithmetic with significantly higher counts in the uninformed group. Overall plasma beta-thromboglobulin responses were significantly larger in the uninformed group. This study demonstrates that laboratory stress is associated with blood platelet activation and that awareness of high blood pressure attenuates the platelet responses to such stress tests.
Adult↗
[Chances to survive an avalanche--new data].
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Asphyxia↗
Insulin sensitivity, sympathetic activity, and cardiovascular reactivity in young men.
The present study was undertaken to examine the relationships between insulin sensitivity, blood pressure (BP), and cardiovascular reactivity, and to assess sympathetic nervous system influence. Insulin sensitivity (GDR/I; euglycemic glucose clamp technique) was related to BP and heart rate (HR) in different situations in 40 healthy young men: in the laboratory, during a mental arithmetic stress test, and during baseline conditions at home. GDR/I correlated with supine diastolic BP in the laboratory and with maximum diastolic BP during mental stress (r = -0.46, P = .003; r = -0.62, P = .0001, respectively), but not so strongly with diastolic BP measured at home (r = -0.29, P = .09). Diastolic BP during stress and body mass index were the only independent explanatory variables of GDR/I in multiple regression analysis (multiple R = 0.71, R2 = 0.50, P < .0001). GDR/I and systolic BP were not significantly correlated at any time. GDR/I correlated negatively with HR in the laboratory and with maximum HR during mental stress, but not with HR at home. Maximum plasma epinephrine during stress correlated with stress BP and HR (r = 0.53, P = .001; r = 0.70, P < .0001, respectively) and negatively with GDR/I (r = -0.36, P < .05). In the present study, GDR/I is related to diastolic but not to systolic BP, and more closely correlated to diastolic BP and HR measured during mental stress than to diastolic BP and HR during baseline conditions at home.(ABSTRACT TRUNCATED AT 250 WORDS)
Adolescent↗
Left ventricular mass and cardiovascular reactivity in young men.
The relation between left ventricular wall thickness and mass, arterial plasma catecholamines, and blood pressure at rest and during a mental arithmetic challenge and a cold pressor test was examined in 69 healthy men 19 years of age. The subjects were recruited from the 1st (n = 21), 50th (n = 26), and 99th (n = 22) percentiles in mean blood pressure. All underwent echocardiography to determine mean wall thickness and left ventricular mass. Continuous intra-arterial blood pressure, electrocardiogram, and arterial sampling of plasma catecholamines were performed after 30 minutes of supine rest, during a 5-minute mental arithmetic challenge, and during a 1-minute cold pressor test. Stepwise multiple-regression analyses considering mean wall thickness and left ventricular mass as the dependent variables were applied. Intra-arterial systolic blood pressure (r = .54, P < .0001) and arterial plasma epinephrine (r = .31, P = .009) after 30 minutes of supine rest were the only independent explanatory variables of mean wall thickness (multiple R2 = .33, P < .0001). Blood pressure at screening and during mental stress and cold pressor tests were not independent explanatory variables. The present study suggests that resting arterial blood pressure and plasma epinephrine may be of importance for development of left ventricular hypertrophy.
Adult↗
[White coat hypertension and blood pressure measurement at home].
"White-coat" hypertension, i.e. high readings in the clinic but normal readings at home, has been demonstrated in 21-58% of hypertensive subjects without end-organ injury. The condition can be diagnosed by means of home blood pressure monitoring, which should therefore be used as a supplement to monitoring by the physician. Owing to the low blood pressure readings at home, these patients should not be treated with drugs. In the event of anti-hypertensive treatment, home blood pressure monitoring is useful in helping to decide the minimum required dose, thus reducing risk of side effects, and in monitoring the response to therapy. White coat hypertension is associated with overweight, lipid abnormalities and high fasting insulin. Owing to the high risk of developing sustained hypertension, the patients' blood pressure must be measured regularly both at the clinic and at home.
Adult↗
[Avalanche accidents].
Most avalanche victims die from asphyxia (68%) followed by trauma (13%). Hypothermia is a less common cause of death. Asphyxia may be caused by obstructed airways owing to aspiration of snow, an immobile thorax due to compression by the surrounding snow or lack of diffusion of oxygen through the mass of snow. Clearing airways and quick mobilization of the thorax are of utmost importance in the initial treatment. Cardiopulmonary resuscitation may be required. Unconscious victims without vital signs should be treated in the same way as victims with severe hypothermia.
Asphyxia↗
Cardiovascular reactivity, coronary risk factors, and sympathetic activity in young men.
We have previously demonstrated that awareness of high blood pressure may increase blood pressure, plasma catecholamine levels, and stress responses. In the present study, three groups of 19-year-old men, all unaware of their blood pressure status, were selected from the first (group-1, 62 +/- 2 mm Hg, [mean +/- SEM], n = 15), 50th (group-50, 90 +/- 4 mm Hg, n = 15), and 99th (group-99, 123 +/- 5 mm Hg, n = 14) percentiles in causal mean blood pressure at a screening. They were studied (blinded examiners) with intra-arterial blood pressure recordings and multiple measurements of arterial plasma epinephrine and norepinephrine during a mental arithmetic challenge and cold pressor test. Despite high mean blood pressure at the screening, group-99 did not differ from group-50 either in intra-arterial mean blood pressure after 30 minutes of supine rest (89 +/- 3 versus 86 +/- 2 mm Hg) or in serum lipids and resting plasma epinephrine and norepinephrine. However, in group-99 resting plasma epinephrine showed a positive hyperbolic relation to resting diastolic blood pressure (r = .73, P = .004) and a negative hyperbolic relation to the ratio of high-density lipoprotein cholesterol to total cholesterol (r = -.75, P = .002). None of these correlations were present in the two other groups. Furthermore, the three groups differed in heart rate responses (P < .0005) and systolic (P < .0005) and diastolic (P < .05) blood pressure responses to mental arithmetic challenge, group-99 being hyperreactive compared with the other two groups.(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗