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Biomedical subjects

R von Essen

Publications and source records attributed to R von Essen.

At least 19 recordsLinked to original sources
PubMed1992

[Congenital heart defects also in adulthood?].

Congenital heart diseases that escape detection are a rarity in adulthood (less than 1%). The number of patients with such abnormalities operated on during childhood or adolescence is, in contrast, on the increase. The most common heart abnormalities diagnosed for the first time in adulthood are atrial septal and ventricular septal defects, but anomalies of the left ventricular outflow tract or coarctation of the aorta is sometimes also detected only in adulthood on the occasion of an investigation of hypertension. In addition to the findings at auscultation, clinical pictures, ECG and chest X-ray, echocardiography is becoming ever decisive for the diagnostic work-up. Further, the extent of the haemodynamic changes can now be determined non-invasively, and may thus tip the balance when deciding for and against an operation.

Adult↗
PubMed1992

Improved thrombolysis in acute myocardial infarction with front-loaded administration of alteplase: results of the rt-PA-APSAC patency study (TAPS)

Thrombolysis with recombinant tissue-type plasminogen activator (rt-PA) and anisoylated plasminogen streptokinase activator (APSAC) in myocardial infarction has been proved to reduce mortality. A new front-loaded infusion regimen of 100 mg of rt-PA with an initial bolus dose of 15 mg followed by an infusion of 50 mg over 30 min and 35 mg over 60 min has been reported to yield higher patency rates than those achieved with standard regimens of thrombolytic treatment. The effects of this front-loaded administration of rt-PA versus those obtained with APSAC on early patency and reocclusion of infarct-related coronary arteries were investigated in a randomized multicenter trial in 421 patients with acute myocardial infarction. Coronary angiography 90 min after the start of treatment revealed a patent infarct-related artery (Thrombolysis in Myocardial Infarction [TIMI] grade 2 or 3) in 84.4% of 199 patients given rt-PA versus 70.3% of 202 patients given APSAC (p = 0.0007). Early reocclusion within 24 to 48 h was documented in 10.3% of 174 patients given rt-PA versus 2.5% of 163 patients given APSAC. Late reocclusion within 21 days was observed in 2.6% of 152 patients given rt-PA versus 6.3% of 159 patients given APSAC. There were 5 in-hospital deaths (2.4%) in the rt-PA group and 17 deaths (8.1%) in the APSAC group (p = 0.0095). The reinfarction rate was 3.8% and 4.8%, respectively. Peak serum creatine kinase and left ventricular ejection fraction at follow-up angiography were essentially identical in both treatment groups. There were more bleeding complications after APSAC (45% vs. 31%, p = 0.0019).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1992

Acquired bisalbuminemia in staphylococcal endocarditis treated with dicloxacillin.

An albumin fraction with increased anodal mobility was observed on cellulose acetate electrophoresis, isoelectric focusing, and immunoelectrophoresis of serum obtained 1 month after a 68-year-old male patient had been treated with dicloxacillin for Staphylococcus epidermidis endocarditis. The patient also suffered from rheumatoid arthritis demanding hospital treatment. Normal albumin results from several earlier runs were thus available, and follow-up showed reversion to normal albumin mobility. Treating albumin with dicloxacillin in vitro produced a corresponding mobility increase.

Aged↗
PubMed1991

[Effect of molsidomine infusion on thrombocyte function in acute myocardial infarct].

In 10 patients with acute myocardial infarction i.v. molsidomine was given over 48 h and a number of platelet functions was evaluated before and 3, 24, and 48 h after therapy. There was a significant prolongation of template bleeding time from 290 s to 400 s. The amplitude of spontaneous and induced platelet aggregation remained unchanged. In four of the 10 patients initially high plasma concentrations of beta-TG and PF4, and high serum concentrations of TxB2, decreased, indicating an effect of molsidomine in states of hyperreactive platelets.

Aged↗
PubMed1990

Salmonella lipopolysaccharide in synovial cells from patients with reactive arthritis.

Synovial cells from nine patients with reactive arthritis following Salmonella enteritidis or Salmonella typhimurium infection were examined for salmonella antigens. Extensive bacterial cultures of the synovial fluid were negative. Eight synovial-fluid cell samples stained positively on immunofluorescence with rabbit antisera against heat-killed S enteritidis or S typhimurium or with monoclonal antibodies specific for the causative salmonella lipopolysaccharide (LPS). Synovial tissue from the ninth patient stained positively in the avidin-biotin-peroxidase complex method with the monoclonal antibody. Control samples (synovial-fluid cells from thirteen patients with other rheumatic diseases and synovial tissue from two) were negative. Synovial cells from eight patients and five controls were studied by western blotting with the same monoclonal antibodies. Four of the eight patients but no controls had blots indicating salmonella LPS in the synovial cells. The presence of bacterial LPS in the joint is a common and pathogenetically important feature of reactive arthritis.

Acute Disease↗
PubMed1990

Occurrence of two germline-related rheumatoid factor idiotypes in rheumatoid arthritis and in non-rheumatoid seropositive individuals.

Human rheumatoid factor (RF) paraproteins express two distinct light chain cross-reactive idiotypes defined by the monoclonal antibodies 17.109 and 6B6.6. These germline gene-related cross-reactive idiotypes are both carried on VK3 light chains and are each present on about one-third of IgM RF paraproteins. We assessed the degree to which these idiotypes are represented in polyclonal RFs. We used rheumatoid arthritis (RA) and non-RA RF-positive sera selected from a large cross-sectional population study (the Mini-Finland Health Survey), and sera from a community-based follow-up study of recent-onset RA patients from Heinola, Finland. In the Mini-Finland Health Survey, elevated levels of the 17.109 RF idiotype were seen in sera of 13% of the RA and 19% of the non-RA group; 6B6.6 RF was seen in 26% of the RA and 28% of the non-RA group. In sera of the Heinola follow-up study, 17.109 RF was seen in 12% initially, but in only 3% at 8 years. Similarly, 6B6.6 RF was detected in 25% initially, but in only 7% at 8 years. Ten sera positive for RF prior to the onset of clinical RA were identified from individuals of a second large population study from Finland (North Karelia project); two of these sera exhibited the 6B6.6 idiotype; none exhibited the 17.109 idiotype. The data are consistent with the concept that these germline gene-related cross-reactive RF idiotypes occur frequently in the polyclonal RF of non-RA as well as RA sera, and that in RA the idiotypes may sometimes be reduced or lost as a consequence of somatic diversification of the RF through somatic mutation, usage of new germline genes, or both.

Arthritis, Rheumatoid↗
PubMed1990

Waterborne Campylobacter jejuni epidemic in a Finnish hospital for rheumatic diseases.

A waterborne Campylobacter jejuni outbreak in the Rheumatism Foundation Hospital in Heinola, Finland, in November-December 1986 is described. 32 patients and 62 members of the staff developed gastrointestinal symptoms. C. jejuni heat-stable serotype 45 was isolated from the faeces of 32 enteritis patients and from none of the controls. No other enteropathogens were found. Positive serological responses to C. jejuni acid extract antigen were detected by enzyme immunoassay in 34% of the symptomatic hospital patients, in 40% of the symptomatic staff members, and in 10% of the controls. The clinical course of the illness was mostly mild and self-limited. No striking progress in the arthritis symptoms of the patients was found after the outbreak. The hospital has its own water supply. C. jejuni of the same serotype as the epidemic strain was isolated from the water of the pipeline system. After a careful examination some aged components of the waterworks were found to be responsible for leaks that resulted in the contamination of the water.

Adult↗
PubMed1990

Intraarticular osmic acid in postinfectious arthritis persisting after treated bacterial arthritis.

We describe 4 patients successfully treated with intraarticular osmic acid for post-infectious arthritis persisting after apparent eradication of bacteria from the infected joint. In addition the bactericidal effect of osmic acid in vitro is demonstrated. We conclude that treatment with osmic acid carries no risk of iatrogenic infection; on the contrary, an antibacterial effect seems likely.

Adult↗
PubMed1990

[ECG in acute myocardial infarct. Continuous registration in thrombolytic therapy].

For 35 patients with acute myocardial infarction undergoing thrombolytic therapy (31 patients with streptokinase and 4 with rt-PA), the treatment effect was assessed angiographically and correlated with ECG changes. These ECG changes were found by continuous registration of eight "strategically" located precordial leads in patients with anterior myocardial infarction, and five precordial leads plus three limb leads in those with posterior myocardial infarction. In 31 patients (group A), successful reperfusion could be verified by angiography, while in 4 patients the infarct-related vessel remained closed. In 3 further cases (group B), recanalization could be achieved only by additional mechanical intervention. The average duration of ECG surveillance was 87 min in group A and 85 min in group B. A significant change of R-amplitudes during this period of time could not be observed. ST-60-value of group A (total of ST-elevations and depressions 60 msec after S of all surveillance electrodes, divided by number of electrodes) was reduced under thrombolysis from 0.377 mV (SD +/- 0.270) to 0.133 mV (SD +/- 0.118) (p less than 0.004). This means a reduction of 64%, while the corresponding values in group B did not change (0.535 mV, respectively 0.546 mV) before and after therapy. When only the electrode with the highest ST-60-value was checked before therapy ("sensitive lead"), reduction in group A was as high as 71%. Except for two patients, all other 29 patients with successful reperfusion either precordially or in the limb leads showed a reduction of ST-segment abnormalities (ST 60) of more than 50% during surveillance time. This could not be observed in any of the unsuccessfully treated patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1990

Antibodies to synthetic peptides from Epstein-Barr nuclear antigen-1 in sera of patients with early rheumatoid arthritis and in preillness sera.

We studied IgG antibody levels to synthetic peptides (p62, E11 and E3) from Epstein-Barr nuclear antigen-1 (EBNA-1) protein sequence in sera of patients with rheumatoid arthritis (RA), in pre-RA and in rheumatoid factor (RF) positive non-RA sera from Finland. Anti-E11 and anti-E3 antibody levels were significantly elevated in RA sera, compared with both RF negative and RF positive nonrheumatoid controls. The concentrations of anti-E11 and anti-E3 antibodies in the preillness sera were lower than those in RA sera. Eight-year followup samples of patients with RA had slightly decreased levels of anti-E3 and anti-E11 antibodies compared with samples taken within 6 months of the disease onset. Anti-p62 antibody levels did not differ significantly between any of the groups studied. Thus, elevated levels of antibodies to 2 of the glycine containing EBNA-1 peptides were associated with clinical RA.

Adult↗
PubMed1989

Evolution of left ventricular function after intracoronary thrombolysis for acute myocardial infarction.

The temporal evolution of left ventricular (LV) function after intracoronary streptokinase therapy for acute myocardial infarction (AMI) was assessed from the data of 264 patients who had complete occlusion of either the left anterior descending or the right coronary artery before treatment. Angiography was performed immediately, and at 3 days and 6 months after AMI in 91%, 71% and 47% of the study group, respectively. Wall motion was measured by the centerline method. In patients with sustained reperfusion, the ejection fraction decreased at 3 days (delta = -2.0 +/- 9.9%, n = 134, p = 0.02) and recovered later (from 54 +/- 12% acutely to 57 +/- 12% at 6 months, n = 82, p less than 0.05). These changes in global function were associated with a marked regression in hyperkinesis in the noninfarcted wall by 3 days, and delayed recovery of wall motion in the infarct region (delta = 0.2 +/- 0.9 at 3 days, p = 0.055; 1.0 +/- 1.2 at 6 months, p less than 0.001). Patients without reperfusion or with reocclusion had a more severe decrease in ejection fraction at 3 days, and little or no subsequent functional recovery. The length of the hypokinetic segment increased significantly by 3 days but subsequently diminished to slightly less than the acute value. It is concluded that full recovery of ischemically impaired myocardium takes greater than 3 days, but compensatory hyperkinesis regresses earlier so that global LV function deteriorates by the third day. Variability or deterioration of LV function early after AMI need not be due to infarct extension; it can reflect regression of hyperkinesis in the noninfarcted region.

Angiography↗
PubMed1989

Yersinia antigens in synovial-fluid cells from patients with reactive arthritis.

We examined synovial-fluid cells from 15 patients with reactive arthritis after yersinia infection for the presence of yersinia antigens. Extensive bacterial cultures of the synovial fluid were negative. All the samples were studied by immunofluorescence with use of a rabbit antiserum to Yersinia enterocolitica O:3 and a monoclonal antibody to Y. enterocolitica O:3 lipopolysaccharide. Synovial-fluid cells from 41 patients with other rheumatic diseases served as controls. Synovial-fluid cells from 10 patients with reactive arthritis after yersinia infection stained positively on immunofluorescence; rabbit antiserum and the monoclonal antibody yielded similar results. In most patients the percentage of positive cells ranged from 1 to 10 percent, but in one patient nearly all the cells in the sample stained strongly. Most of the positively stained cells were polymorphonuclear leukocytes, but yersinia antigens were also found in mononuclear phagocytes. All the control samples were negative. Synovial-fluid cell deposits from nine patients were also studied by Western blotting with use of the same antibodies. The results were positive in six of the nine cell deposits from patients with reactive arthritis and in none of the 10 cell deposits from control patients with rheumatoid arthritis. We conclude that in patients with reactive arthritis after yersinia infection, microbial antigens can be found in synovial-fluid cells from the affected joints.

Adult↗
PubMed1989

Bacterial infection following intra-articular injection. A brief review.

The literature on 443 cases of postinjection bacterial arthritis is reviewed. The utter rarity of the condition may have been overemphasized in the past. Haematogenous infection of the puncture track may be more important than the transfer of skin bacteria into the joint.

Arthritis, Infectious↗