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P Lindqvist

Publications and source records attributed to P Lindqvist.

At least 19 recordsLinked to original sources
PubMed2006

Pulsed tissue Doppler and strain imaging discloses early signs of infiltrative cardiac disease: a study on patients with familial amyloidotic polyneuropathy.

BACKGROUND: Familial amyloidotic polyneuropathy (FAP) is a hereditary systemic amyloidosis with cardiac involvement. As early identification of the cardiac involvement is of major clinical interest we performed this study to test the hypothesis that tissue Doppler imaging (TDI) and strain imaging (SI) might disclose cardiac involvement in patients with early stages of FAP. METHODS: Twenty-two patients with FAP and 36 healthy controls were studied. Standard M-mode and Doppler echocardiography were performed. TDI and SI were used to assess the regional longitudinal left ventricular (LV) lateral and septal and right ventricular (RV) wall functions. All time intervals were corrected for heart rate by dividing with R-R interval and presented as percentage. RESULTS: We found that patients in comparison with controls had increased LV and RV wall thickness and by using TDI a prolonged isovolumic relaxation time (IVRt) at the septal segment (15.0+/-7.0 vs 10.7+/-4.1%, p<0.05) and prolonged isovolumic contraction time (IVCt) at LV lateral (12.8+/-4.3 vs 10.1+/-3.3%, p<0.05), septal (12.5+/-3.5 vs 8.9+/-1.9%, p<0.001) and RV free wall segments (12.0+/-3.6 vs 8.3+/-2.1%, p<0.001). Strain was reduced at LV lateral basal segment (-4.6+/-14.0 vs -20.2+9.1, p<0.001), RV free wall mid segment (-16.2+/-12.8 vs -29.4+/-15.2) as well as both septal segments (-4.1+/-11.7 vs -16.2+/-9.0%, p<0.001, -8.8+/-11.5 vs -19.4+/-8.4%, p<0.001 for septal basal and mid-segment). Even in the absence of septal hypertrophy the septal strain was reduced and the regional IVCt was prolonged. CONCLUSIONS: This is the first clinical study using TDI and strain in patients with FAP showing functional abnormalities before any morphological echocardiographic abnormalities were present. Both the left and right heart functions are involved and the disease should therefore be regarded as biventricular.

Adult↗
PubMed2005

Pulmonary venous flow reversal and its relationship to atrial mechanical function in normal subjects--Umeå General Population Heart Study.

AIMS: Although pulmonary venous flow reversal (Ar) is useful in the evaluation of left ventricular (LV) diastolic function, it is often difficult to study with transthoracic echocardiography (TTE). We determined the relationship between Ar and left atrial (LA) mechanical function and sought to define surrogate measurements for Ar. METHODS AND RESULTS: A total of 130 healthy subjects, mean age 54.3+/-18.3 years, 62 women, were studied and classified into three groups: [young (Y), 25-44 years; n=44], [middle-age (M), 45-64 years; n=43] and [elderly (E), > or =65 years; n=43]. Pulmonary venous flow and LV inflow studies were performed by TTE and LV basal free-wall motion was studied by Doppler tissue imaging (DTI). All images were acquired with a superimposed electrocardiogram. RR interval was similar in all groups while LA dimension and PR interval were increased in Group E vs. Y (P<0.001). LA contraction (A(m)) on DTI, transmitral A-wave (A) and Ar were simultaneous and started 84ms after onset of P wave and this interval increased with age (P=0.02). Similarly, the time intervals from the same landmark to peak A(m), A, and Ar were prolonged with age (all, P<0.001). Despite this prolongation, peak A(m) coincided with peak Ar in every age group (r=0.97, P<0.001) and Ar acceleration and deceleration times were consistently equal. CONCLUSION: The timing of A(m) obtained by DTI can be used to accurately estimate corresponding measurements of Ar recorded by TTE in subjects without cardiac disease.

Adult↗
PubMed2003

Molecular dynamics simulations of lipid bilayers: major artifacts due to truncating electrostatic interactions.

We study the influence of truncating the electrostatic interactions in a fully hydrated pure dipalmitoylphosphatidylcholine (DPPC) bilayer through 20 ns molecular dynamics simulations. The computations in which the electrostatic interactions were truncated are compared to similar simulations using the particle-mesh Ewald (PME) technique. All examined truncation distances (1.8-2.5 nm) lead to major effects on the bilayer properties, such as enhanced order of acyl chains together with decreased areas per lipid. The results obtained using PME, on the other hand, are consistent with experiments. These artifacts are interpreted in terms of radial distribution functions g(r) of molecules and molecular groups in the bilayer plane. Pronounced maxima or minima in g(r) appear exactly at the cutoff distance indicating that the truncation gives rise to artificial ordering between the polar phosphatidyl and choline groups of the DPPC molecules. In systems described using PME, such artificial ordering is not present.

1,2-Dipalmitoylphosphatidylcholine↗
PubMed2003

Right ventricular outflow-tract fractional shortening: an applicable measure of right ventricular systolic function.

AIMS: Assessment of right ventricular function is important. However, this is not easy to achieve due to the complex anatomy and geometry of the right ventricle, making the evaluation of its function limited. Therefore, a simple reliable and easy method is needed. This study was performed (1) to evaluate the use of right ventricular outflow tract fractional shortening obtained by M-mode echocardiography as a measure of right ventricular systolic function and (2) to determine the relationship between this parameter and other established measurements of right ventricular function such as long axis excursion. METHODS AND RESULTS: Ninety-two consecutive patients referred for echocardiographic assessment of left and right ventricular function, age mean+/-SD was 68+/-14 years, were investigated. Twenty healthy controls, age 46+/-12 years were also studied. M-mode echocardiography was used to measure right ventricular outflow tract fractional shortening and right ventricular long axis excursion. Doppler echocardiography was used for the estimation of right ventricular-right atrial pressure drop and pulmonary artery acceleration time. Right ventricular outflow tract fractional shortening (P<0.0001), right ventricular long axis excursion (P<0.0001) and pulmonary acceleration time (P<0.0001) were reduced in patients compared to controls. Right ventricular outflow tract fractional shortening correlated with long axis excursion (r=0.66 P<0.0001), pulmonary artery acceleration time (r=0.80 P<0.0001) and right ventricular-right atrial pressure drop (r=-0.53 P<0.0001). Right ventricular long axis excursion correlated with right ventricular-right atrial pressure drop though to a lesser significance (r=-0.27 P <0.001). Furthermore, right ventricular outflow tract fractional shortening was reduced in patients with pulmonary hypertension compared to patients without, this difference was not observed in the right ventricular systolic long axis excursion. CONCLUSION: Right ventricular outflow tract fractional shortening provides a simple and non-invasive measure of right ventricular systolic function. In combination with long axis excursion and Doppler velocities they should provide comprehensive assessment of right ventricular function.

Adult↗
PubMed2002

Suicide classification--clues and their use. a study of 122 cases of suicide and undetermined manner of death.

In order to identify clues to forensic pathologist's classification of suicide, the forensic files of 100 consecutive cases of suicide, and 22 cases of undetermined manner of death, were analysed. Some specific causes of death, suicidal communication and other circumstantial evidence suggesting suicidal intent explained all but three classifications. Problematic cases concerned death by poisoning and by submersion, alcohol-dependent persons and subjects with positive blood alcohol concentration at autopsy. Guidelines to support the police investigation as well as the medico-legal examination can probably reduce the number of undetermined cases in cases of possible suicide.

Adolescent↗
PubMed2002

Tissue Doppler analysis of age-dependency in diastolic ventricular behaviour and filling: a cross-sectional study of healthy hearts (the Umeå General Population Heart Study).

BACKGROUND: Much in the diagnosis of diastolic ventricular dysfunction is dependent upon the filling pattern, and most patients diagnosed with diastolic heart failure are elderly. Data from healthy asymptomatic individuals across a range of ages are rare. We sought to find an age-related variation in normal diastolic physiology, specifically the filling pattern and segmental myocardial longitudinal velocities. METHODS AND RESULTS: To assess the effect of normal ageing on left ventricular longitudinal function, we studied myocardial shortening and lengthening velocities using the tissue Doppler technique in 60 healthy subjects who were randomly selected from the Umeå (Sweden) General Population Register, which represents a wide range of ages (23-88 years). Myocardial velocities were documented at four left ventricular sites (anterior, left, posterior and septal) and at three levels (basal, mid-cavity and apical). Transmitral, transtricuspid and pulmonary venous flow velocities were recorded using pulsed-wave Doppler. While systolic myocardial velocities were conserved across ages, there was a marked decrease in early diastolic velocities with age (from 16 cm. s(-1)at 30 years to 9 cm. s(-1)at 80 years at the basal segment) and a corresponding significant increase in late diastolic velocities (from 10 to 16 cm. s(-1)). Although these findings were most marked at the basal level, they were also clearly manifested at the apical level. Myocardial lengthening velocities were related to transmitral flow velocities, showing a correlation of 0.64 (P<0.0001) in early diastole and 0.68 (P<0.0001) in late diastole. Finally, diastolic pulmonary venous flow velocity was found to correlate with early diastolic myocardial velocities (at the basal level, r=0.53, P<0.0001). CONCLUSIONS: Normal ageing causes a decrease in early diastolic and a substantial increase in late diastolic myocardial lengthening velocities. These changes explain the known trends in the transmitral flow pattern with age. In contrast, systolic myocardial velocities do not change significantly with age. These findings should be considered when evaluating diastolic function, especially in the elderly.

Adult↗
PubMed2000

Teenage suicides in northern Sweden: an interview study of investigating police officers.

OBJECTIVE: To disclose recurrent, dynamic, and static factors in teenage suicide involving the suicidee, his/her family, and the community; and to investigate the feasibility of using police as informants for suicide studies. SUBJECTS: All deaths categorised as suicide 1993 through 1995 among teenagers in Northern Sweden (n=15). METHOD: Semiqualitative interviews with police officers, and, when applicable, general practitioners. Police reports, necropsy protocols, medical records, and conscription data were also analysed. RESULTS: Most suicides occurred in rural and depopulated areas. In contrast to males, females often had a history of overt psychiatric problems with suicide attempts. At least two thirds of the suicides were planned. CONCLUSION: Cultural and sociopolitical aspects are important in teenage suicide as well as gender differences. Police officers can provide essential information. Identifying teenagers at risk remains difficult, however, due to low baseline rates.

Adolescent↗
PubMed2000

Evidence-based rehabilitation in forensic psychiatry.

BACKGROUND: The extent to which forensic psychiatric rehabilitation alters an individual's level of risk is unclear. AIMS: To highlight some essential features of a forensic psychiatric rehabilitation system, and to discuss risk assessment in this context to create a conceptual framework for risk research and practice. METHOD: The applicability of risk assessment instruments to forensic psychiatric rehabilitation was examined. Core processes and elements considered essential in this type of rehabilitative work were reviewed. RESULTS: Current risk research has limited application to rehabilitation. Future research aimed at analysing forensic psychiatric rehabilitation will be hampered by the complexity of the treatment systems and the number of methodological issues relevant to this type of research. CONCLUSIONS: Novel research approaches are suggested to analyse further the risk factors and processes important in forensic psychiatric rehabilitation.

Evidence-Based Medicine↗
PubMed1999

Thrombotic risk during pregnancy: a population study.

OBJECTIVE: To determine the incidence of pregnancy-related venous thromboembolic events and the relationship to selected risk factors such as maternal age, parity, smoking, preeclampsia, or cesarean delivery. METHODS: All Swedish women reported as having pregnancy-related venous thromboembolic events during 1990-1993 (608 of 479,422 deliveries) were compared with all thrombosis-free Swedish pregnant women during 1993 (114,940). RESULTS: The incidence of pregnancy-related venous thromboembolic events was 13 per 10,000 deliveries. Cesarean delivery was associated with a fivefold increased risk of venous thromboembolic events. Advanced age was not a significant risk factor itself, but was associated with an age-related increase in frequency of cesareans. Women with preeclampsia were at a threefold higher risk postpartum, but at no increased risk before delivery. There was a tobacco consumption-dependent increase in the risk of thrombosis among smokers. CONCLUSION: The incidence of pregnancy-related thrombosis was 13 per 10,000 and provided new insights to important risk factors such as age, cesarean delivery, smoking, and preeclampsia.

Adolescent↗
PubMed1999

Epidermal growth factor in maternal urine--a predictor of intrauterine growth restriction?

Epidermal growth factor (EGF), an angiogenic and mitogenic peptide, is known to be essential for normal fetal development in mice. Hypothetically, low maternal urine EGF levels might be associated with intrauterine growth restriction (IUGR) or pre-eclampsia (PE). We carried out a prospective study of 1009 consecutive women whose urine was sampled in early pregnancy (at a median of 13 weeks of gestation) between January and November 1993. Thirty women gave birth to IUGR babies and 24 developed PE. The study was designed as a nested case-control study with two matched controls for each case. EGF and human chorionic gonadotrophin (HCG) levels were measured and expressed in ng EGF/mg creatinine and IU HCG/mg creatinine. Logistic regression analysis was made with EGF or HCG levels as explanatory variables. Urinary EGF levels were significantly lower in the IUGR subgroup than in their controls, but no such difference was found between the PE subgroup and their controls. In the series as a whole, smokers were found to have lower EGF and HCG levels than non-smokers. In addition, correlation was found to exist between EGF and HCG levels (Spearman's rho 0.35; P<0.001). We conclude that a relative deficiency of EGF in early pregnancy might be one of the pathophysiological mechanisms of IUGR. However, the EGF level was an insufficiently discriminative variable to be of use for screening purposes.

Adult↗
PubMed1999

A phenomenological study of fibromyalgia. Patient perspectives.

OBJECTIVE: To describe the way in which the fibromyalgia patients understand the meaning of their illness. DESIGN: Qualitative, empirical phenomenological psychological method. SETTING: A collaborative transdisciplinary interview study of patients' described experiences of living with fibromyalgia. No therapeutic relationships existed between patients and researchers. SUBJECTS: Eighteen patients with fibromyalgia were interviewed. Ten of the 18 taped interviews were transcribed and analysed. MAIN OUTCOME MEASURES: Patients' narratives, described experiences of living with fibromyalgia. RESULTS: The patients were intensively involved in efforts to get their self-images as ill persons confirmed. Their experience was that the disease started dramatically, with a variety of capriciously appearing symptoms of unknown cause that gave rise to the suffering. The fibromyalgia patients seemed to develop strategies to cope with a precarious self-image and find ways to manage the thought of what the future would bring. CONCLUSION: The meaning structures revealed in the patients' ways of describing their experiences of living with fibromyalgia seemed to be partially constituted by their efforts to stand forth as afflicted with a disease, which could be a way to help them to manage the demands that they placed upon themselves.

Adaptation, Psychological↗
PubMed1998

A phenomenological analysis of doctor-patient interaction: a case study.

The fact that the biomedical model has been very successful in practice does not preclude that some health issues can be understood by way of other health care perspectives. Acquiring skills in meeting patients requires theories that structure other fields of knowledge than the biomedical sciences. An old man, who experiences himself as deeply misunderstood by the medical profession, is interviewed, his personal life-story is gone into and his case records and other available data are analysed. A phenomenological method is used, i.e. disciplined and rigorous reflection upon available data, remaining close to the particular pieces of the patient's narrative as they stand forth in their contextual relationships. The study shows that the doctors involved did not relate to the patient but to a biomedical image of him. His efforts to make himself understood were converted into instrumentally manageable disorders. Finally, dialogue medicine is briefly introduced as a model for counselling patients, especially when they need assistance to abandon the notion that they have been afflicted with a disease, a perception that might serve the purpose of keeping a threatening self-image out of consciousness.

Aged↗
PubMed1998

Uterine and umbilical artery velocimetry in pre-eclampsia.

BACKGROUND: The aim of the present study was to evaluate whether Doppler velocimetry of the placental circulation can predict adverse outcome of pregnancies complicated by pre-eclampsia and whether there is a correlation between maternal blood pressure, proteinuria and placental vascular resistance. MATERIAL AND METHODS: One hundred and eight pregnant women with pre-eclampsia were followed and examined by Doppler velocimetry of the uterine arteries. The presence of a notch and the mean pulsatility index (PI) in the two arteries were recorded. The velocity waveforms in umbilical arteries were also evaluated. The Doppler velocimetry results were related to the perinatal outcome, maternal blood pressure and proteinuria. RESULTS: Abnormal arterial blood velocity waveforms on both sides of the placenta were significantly correlated with a shorter gestational age at delivery, lower birthweight, increased cesarean section rate and more frequent admissions to the neonatal intensive care unit. Bilateral rather than unilateral uterine artery notches were predictive of poor perinatal outcome. The combination of umbilical and uterine artery waveform results was the best predictor of adverse outcome. The uterine artery velocimetry was, however, not related to maternal blood pressure or the degree of proteinuria. CONCLUSIONS: Abnormal velocity waveforms in the uterine and umbilical arteries have clinical significance in pregnancies complicated by pre-eclampsia and predict adverse outcome of pregnancy, especially the fetal growth restriction and need for operative interventions during labor and delivery.

Adult↗
PubMed1998

Doctors' attitudes to fibromyalgia: a phenomenological study.

Besides specific technical skills, successful encounters with patients require an understanding of the many ways in which patients may express themselves. This qualitative study reports on the clinical experiences of doctors when meeting patients with fibromyalgia (FM). Ten strategically chosen rheumatologists and 10 GPs in central Sweden were interviewed. The interviews were taped, transcribed and analysed in accordance with the empirical, phenomenological, psychological method. The analyses indicate that doctors try to comply with the wishes and demands of patients, and at the same time avoid perceptions of personal frustration. They are inclined to be objective and to act instrumentally, apparently in order to keep in touch with what gave biomedical meaning to an otherwise incomprehensible phenomenon. The meaning structures revealed by doctors' descriptions of FM and of relating to FM patients were characterized mainly by the way in which the doctors were (i) managing their clinical uncertainty, (ii) adhering to the biomedical paradigm, (iii) prioritizing diagnostics, (iv) establishing an instrumental relationship, and (v) avoiding recognizing FM as a possible biomedical anomaly.

Adult↗
PubMed1998

Frequency of anal sphincter rupture at delivery in Sweden and Finland--result of difference in manual help to the baby's head.

BACKGROUND: Anal sphincter rupture is a serious complication of vaginal delivery and almost half the affected women have persistent defecatory symptoms despite adequate primary repair. During the past decade, the incidence of anal sphincter ruptures has been increasing in Sweden and is currently estimated to occur in 2.5% of vaginal deliveries. The aim of the study was to report the frequency of anal sphincter ruptures in two university hospitals in two Scandinavian countries, Malmö in Sweden and Turku in Finland, and analyze the potential determinants. METHODS: Retrospective analysis of a population of 30,933 deliveries (26,541 vaginal) during the years 1990 to 1994. RESULTS: The incidence of anal sphincter ruptures in Malmö, Sweden was 2.69%, and in Turku, Finland 0.36%. There were no significant population differences for the known risk factors (fetal weight, nulliparity or fetal head circumference). However, there is a difference in manual support given to the perineum and to the baby's head when crowning through the vaginal introitus between Malmö and Turku. The proportion of operative vaginal deliveries and abnormal presentations was significantly higher in Turku reflected in the lower Apgar score at 5 minutes and longer duration of second phase of labor. When high risk deliveries (operative vaginal delivery, abnormal presentation and newborns over 4,000 g) were excluded, the risk for anal sphincter ruptures was estimated to be 13 times higher in Malmö than in Turku. CONCLUSIONS: The difference in the incidence of anal sphincter rupture between Malmö, Sweden and Turku, Finland may be due to the difference in manual control of the baby's head when crowning.

Anal Canal↗