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Biomedical subjects

A Aberg

Publications and source records attributed to A Aberg.

At least 73 records · Page 4Linked to original sources
PubMed1985

Recurrent myocardial infarction. 1. Natural history of fatal and non-fatal events.

1306 men below 68 years of age who survived a first myocardial infarction (MI) during 1968-1977 were followed up between 2 and 12 years after discharge from hospital. The mean follow-up time was 6.5 years. The patients were unselected and paid regular visits to a Post-MI Clinic where treatment was standardized. The diagnosis of a non-fatal reinfarction was based on conventional clinical criteria, and the diagnosis of a fatal reinfarction on autopsy findings of a recent myocardial injury and/or a fresh coronary thrombus. The autopsy rate was high and the follow-up of endpoints was complete. The total cumulative rate of endpoint free patients was 64% at 5 years and 50% at 10 years follow-up. The total mortality rate was 19% at 5 years and 33% at 10 years follow-up. The total cumulative rate of a first reinfarction was 28% at 5 years and 37% at 10 years follow-up (80% non-fatal and 20% fatal). 63 patients suffered more than one reinfarction. The mortality rate was strongly associated with age. In contrast the rate of non-fatal reinfarctions was independent of age.

Adult↗
PubMed1985

Recurrent myocardial infarction. 2. Possibilities of prediction.

1306 men less than 68 years of age who survived a first myocardial infarction (MI) during 1968-1977 were followed up between 2 and 12 years. The mean follow-up time was 6.5 years. The patients were unselected and paid regular visits to a Post-MI Clinic where treatment was standardized. The autopsy rate was high and the follow-up of endpoints was complete. The diagnosis of a non-fatal reinfarction was based on conventional clinical criteria, and the diagnosis of a fatal reinfarction on autopsy findings of a recent myocardial injury and/or a fresh coronary thrombus. The patients were randomly assigned to two halves. One was used only for derivation of the predictive models, and the other only for validation. Common clinical variables judged to be prognostically important were selected. Among variables available at discharge from hospital a history of hypertension, angina pectoris or diabetes before the MI and the maximal serum ASAT during the MI were independently related to reinfarctions during the follow-up. A predictive index was formed and validated. The rate of reinfarction among risk quartiles in the validation sample increased from 24 to 38% (P = 0.003). The aetiologic fraction (the percent of reinfarctions predicted by the index) was 24%. Among variables from the follow-up only cessation of smoking after the MI had independent predictive power. A new predictive index including this variable was formed and validated. The reinfarction rate in the risk quartiles increased from 15 to 39% (P less than 0.001). The aetiologic fraction was 44%. When only reinfarctions occurring before the median follow-up time of 21 months were considered, the aetiologic fraction was 62%.

Adult↗
PubMed1985

Long-term prognosis after myocardial infarction in men with diabetes.

Men (1306) who survived a first myocardial infarction (MI) were studied. The mean follow-up time was 6.5 yr, and at the end of the follow-up period survival status was known for all patients. By the time of the MI the prevalence of diabetes was 5.6%. Patients with and without diabetes were compared. There were no differences in the estimated primary or secondary risk. The cumulative survival rate 1, 2, and 5 yr after the MI was 82, 78, and 58% among the diabetic subjects compared with 94, 92, and 82% among the nondiabetic subjects (P less than 0.001). The difference remained even after allowance for age and estimated secondary risk in a multivariate regression analysis. There were no differences in mortality rates among patients with type I diabetes compared with type II diabetes, nor among patients treated with diet alone, sulfonylurea, or insulin, but the numbers were small. The cumulative rate of reinfarctions after 1, 2, and 5 yr was 18, 28, and 46% in diabetic subjects and 12, 17, and 27% in nondiabetic subjects (P = 0.004). A history of diabetes was an independent secondary risk factor among male survivors of a first MI with respect to deaths and reinfarctions.

Adult↗
PubMed1984

Prognostic importance of cholesterol levels after myocardial infarction.

The aim of this study was to analyze the relationship between serum cholesterol level and all causes mortality in men who sustained a first myocardial infarction. The cholesterol distribution 3 months after the infarction was established. Ten annual cohorts (n = 1,204) were followed for a maximum period of 11 years. Secondary risk factors were comparable among the groups of the serum cholesterol distribution quintiles according to a multiple logistic prognostic function based on left heart failure, atrial fibrillation, breathlessness on infarction, maximum S-ASAT, relative heart size, and a history of hypertension. When all ages were analyzed together, the total mortality was higher in the upper cholesterol quintiles (P = 0.02). This association was confirmed when analyzed with Coxian adjustments for age, change in smoking habits after infarction, and the previously mentioned prognostic function. When broken down by age (less than or equal to 49, 50-59, greater than or equal to 60) and period of follow-up (3-24 and 25-84 months), the association between mortality and cholesterol quintiles was confined to patients under 50 years during the late follow-up period (P = 0.01), whereas there was no association for the other age groups.

Adult↗
PubMed1984

Sex differences in preinfarction characteristics and longterm survival among patients with myocardial infarction.

The prevalence of primary risk factors, previous medical history, and physical activity were assessed among 262 women and 1259 men who suffered a first nonfatal myocardial infarction between 1968 and 1977 in Göteborg, Sweden. The probability of suffering a myocardial infarction based on the conventional factors cholesterol level, systolic blood pressure and smoking habits was estimated in both sexes by means of a multiple risk function. Comparisons between sexes were made with age alone and age and estimated primary risk as confounders. Survival rate and reinfarction rate were calculated for a 5-year period of follow-up. Women with infarctions had higher serum cholesterol levels (p less than 0.001) and higher blood pressure values (p less than 0.001) but were less often smokers than men (p less than 0.001). The female patients also reported chest pain and dyspnea on exertion, and low physical activity both at work and during leisure time significantly more often than men; these differences remained after controlling for estimated primary risk. An overrepresentation of hypertension and diabetes prior to myocardial infarction was found among women below 45 years of age compared with men. A high frequency of women in this age group was also on sick leave or disability pension at onset of myocardial infarction, suggesting that mainly women with several risk factors including socioeconomic factors suffer an infarction at this age. No similar and consistent differences were found between women and men of older ages. The cumulative 5-year survival rate was 80% in women and 81% in men. Below age 45 the survival rate was lower among women than men (p less than 0.01). No sex difference was found in the recurrence rate of nonfatal reinfarctions. This indicates that once women have suffered a myocardial infarction they are exposed to at least as high a risk as men.

Adult↗
PubMed1984

Declining trend in mortality after myocardial infarction.

All patients under 60 years of age who were discharged from hospital after a first myocardial infarction between 1968 and 1977 in Göteborg were followed for a minimum of 24 months. The patients were unselected, and treatment was standardised. The patients were divided into five two yearly cohorts, and the prognostic comparability and mortality of these cohorts were assessed. There was a reduction in the two year mortality rate after discharge during the 10 year period. Small baseline differences between the cohorts were controlled by multivariate methods, and a subsequent analysis showed that there was a declining trend in mortality between 1968 and 1977. A higher tendency among smokers to give up smoking and a lower prevalence of angina pectoris could explain only part of the reduction in mortality. A small number of patients underwent a coronary bypass operation; the slight increase in the number of operations during the period cannot, however, account for the reduced mortality. Most of the patients in the later cohorts were treated with beta blockers, and this is the most likely explanation for the majority of the decline in mortality.

Adult↗
PubMed1984

Risk grouping of 113 patients with hypertensive disorders during pregnancy, with respect to serum urate, proteinuria and time of onset of hypertension.

In order to describe the outcome of a one-year material of hypertensive pregnancies, a retrospective analysis was made of the patients with respect to time of onset of hypertension, absence/presence of significant proteinuria, and maximum recorded serum urate values less or greater than 350 mumol/l. The material comprised 113 hypertensive patients, 3.7% of 3036 deliveries in 1980. Of these only 87 could be classified as intended. Twenty-two patients lacked information on serum urate values, and the remaining 4 did not fulfil the inclusion criteria. As the type of antihypertensive treatment was almost exclusively restricted to beta 1-selective betablockers, alone or in combination with hydralazine, the type of treatment given was analysed with respect to the classification system applied. From this retrospective study it is evident that most hypertensive patients tend to be older than the average pregnant woman and that they also tend to represent problems arising during recurrent pregnancies. Patients with additive risk factors such as proteinuria and high serum urate values tend to need more vigorous antihypertensive treatment and in that sense seem to be more difficult to treat. In our material, patients with an early rise in high blood pressure and high serum urate values accounted for the entire perinatal mortality of the hypertensive pregnancies. The values of serum urate monitoring and the future detection and monitoring of hypertensive pregnant patients is discussed.

Adult↗
PubMed1984

Hypertension in pregnancy and the infant. A controlled follow-up study.

A one-year population comprising 119 infants of 113 mothers with hypertension in pregnancy has been studied regarding fetal and neonatal mortality and morbidity. The overall incidence of hypertension in pregnancy was 3.7%, but was higher in preterm deliveries (from 16.6% in gestational weeks 25-29 to 8.6% in gestational weeks 34-36). Fetal loss with intra-uterine death was related to hypertension in pregnancy in 23%. Auxological parameters in 16 SGA infants of hypertensive parturients showed growth recovery in all infants as regards head circumference and in all but 2 as regards body weight and body length. A controlled follow-up study was performed in 104 infants of hypertensive mothers and 104 control infants of similar gestational age and birthweight but without pregnancy complications. There was a significantly higher rate of cesarean section, of low Apgar score at 1 minute, and SGA infants and neonatal morbidity requiring admittance to the neonatal intensive care unit. At 2 years of age the rate of neurodevelopmental handicaps was similar in the study population and in control infants. Stillborn infants all belonged to the group of mothers with hypertension starting before the 21st gestational week and with an increased serum urate level. Three of 4 infants with a handicap at 2 years also belonged to this group of mothers. With modern peri-and neonatal intensive care and appropriate fetal assessment, delivery after 26-28 weeks of gestation seems to be associated with a slightly increased neonatal morbidity but no increase in long-term handicaps at 2 years of age.

Albuminuria↗
PubMed1983

Cessation of smoking after myocardial infarction. Effects on mortality after 10 years.

Ten annual cohorts of men suffering from their first myocardial infarction have been followed up to a maximum period of 10.5 years. One thousand and twenty-three male patients of 1306 were smokers. Three months after the infarction 55% had stopped smoking and 45% continued smoking. These two groups were then compared and followed with regard to non-fatal reinfarctions and deaths. Preinfarction characteristics were shown to be similar for the two groups. The prognostic comparability of the two groups was tested using two multiple logistic models. Those who stopped smoking had a slightly higher predicted two year mortality after the infarction. In different age groups it is shown with life table technique that those who stopped smoking had a considerably higher survival rate and lower cumulative frequency of reinfarction. The present study shows a reversion of the expected prognosis after myocardial infarction caused by changing the smoking habit.

Adult↗
PubMed1982

Comparison of once and twice daily sotalol in exercise-induced angina pectoris.

The efficacy of chronic oral treatment with a total daily dose of 320 mg sotalol, given as a single or as two divided doses, was compared with placebo in a double-blind cross-over study of 12 patients with angina pectoris. Sotalol given once or twice daily significantly reduced heart rate and systolic and diastolic blood pressures at rest. The exercise heart rates were significantly decreased in both treatment groups. After sotalol 320 mg once daily, there was a greater reduction in the maximum exercise heart rate 2 h after taking the last tablet than after sotalol 160 mg b.i.d. The systolic blood pressure at the highest comparable work-load was significantly and equally reduced by sotalol both once and twice daily. Total work (watts X minutes in both sotalol treatment groups was significantly increased compared to placebo. There was no difference between the two sotalol dosage regimens. The peak plasma levels were higher after the once daily treatment, but the trough levels were similar for both regimens. No serious side effects were observed.

Adult↗
PubMed1982

Prevention of prematurity in twin pregnancy by orally administered terbutaline.

The intention of this study was to evaluate whether perorally administrated terbutaline given prophylactically could reduce prematurity in twin pregnancy. In a double-blind study, 50 women with twin pregnancies were given either placebo (25) or terbutaline (25). Six in the terbutaline group and 15 in the placebo group went into preterm labor which required intravenous infusion of terbutaline. The difference is statistically significant (p = 0.010). The total number of days in hospital due to preterm labor was 115 in the terbutaline group and 256 in the placebo group. There is a slight difference in prematurity (delivery week less than 37th week) - the placebo group gave birth somewhat earlier - but this difference is not statistically significant. When evaluating this, it has to be considered that 15 of the 25 in the placebo group received parenteral treatment with terbutaline because of preterm labor. Birth weights of the twins in relation to gestational age seemed to be the same in the two groups.

Administration, Oral↗
PubMed1981

Controlled cross-over study of a 5-HT uptake inhibiting and an NA uptake inhibiting antidepressant.

A double-blind comparison of zimelidine, a potent and fairly selective 5-hydroxytryptamine (5-HT) uptake inhibitor, and desipramine, a noradrenaline (NA) uptake inhibitor, was carried out in hospitalized patients with endogenous depression. The patients were randomized into parallel groups receiving either zimelidine 100 mg b.i.d. or desipramine 75 mg b.i.d. Forty patients completed the study, twenty in each treatment group. Patients who did not respond adequately to one drug after 4 weeks were treated with the other drug (cross-over design) after a washout period. For evaluation of the therapeutic efficacy Hamilton Rating Scale for Depression, Comprehensive Psychopathological Rating Scale for Depression, Beck's Inventory and Global Rating Scales were used. All ratings indicated greater effectiveness for zimelidine as compared with desipramine, although the differences were not generally statistically significant. Only "somatic anxiety" on the Hamilton scale was significantly (P less than 0.05) in favour of zimelidine. Although both zimelidine and desipramine were well tolerated, the zimelidine patients reported significantly less severe anticholinergic adverse reactions. Of five patients who did not improve on zimelidine, three were then given desipramine but only one recovered completely. Of 10 patients who were switched over to zimelidine, 6 recovered completely and one moderately. Zimelidine produced strong inhibition of the uptake of 5-HT in platelets and a decrease in blood 5-HT after 2 weeks or longer treatment. The uptake of 5-HT in rat hypothalamic synaptosomes was reduced by about 50% and that of NA about 20% when incubated in the patients' plasma. All these effects seem to be mainly due to norzimelidine. Desipramine produced strong inhibition of the uptake of NA in hypothalamic synaptosomes but weak effect on the 5-HT uptake. Urinary MHPG tended to decrease during desipramine treatment but was not affected or tended to increase during zimelidine treatment.

Antidepressive Agents↗
PubMed1980

Diagnostic ultrasound in threatened abortion and suspected ectopic pregnancy.

200 women threatened with abortion during the first 16 weeks of pregnancy were examined with diagnostic ultrasound to determine whether there were signs of intrauterine life. Of the 90 who showed positive signs, 8 aborted spontaneously later, the other 82 continued their pregnancy. The ultrasound investigation revealed no signs of intrauterine life in 110 patients. Of these, spontaneous abortion or later evacuation because of missed abortion 101 (histopathological examination showed degenerated villi in 98), not pregnant 4, mola hydatidosa 3, extrauterine pregnancies 2. An ultrasound examination was performed to ascertain whether 136 women with suspected ectopic pregnancy had intrauterine pregnancies. 61 of them had an intrauterine gestational sac, confirmed at clinical follow-up. One of the 61 was operated on with laparoscopy because of pain; no abnormalities were found. In 36 of the other 75, laparoscopy was performed. Ectopic pregnancy 21, ovarian or parovarian cyst 11, adhesions 2, salpingitis 1, and normal 1. Diagnostic ultrasound is excellent for accurate prognosis in threatened abortion. Unnecessary operations avoided; hospitalization in suspected ectopic pregnancies reduced.

Abortion, Threatened↗
PubMed1979

Preliminary clinical test of zimelidine (H 102/09), a new 5-HT uptake inhibitor.

Zimelidine, a bicyclic compound, which in animal experiments causes specific inhibition of the uptake of 5-HT, was tried on 15 patients with depression of endogenous type. It produced considerable and highly significant 5-HT uptake inhibition in rat brain slices incubated in blood plasma from the patient under treatment, but no inhibition of NA uptake. Depressive symptoms were effectively relieved or entirely abolished in about two thirds of the patients. Only four patients did not react to the drug, and three of these were probably in need of NA uptake inhibitors, which on other occasions had worked well on their depressions. These three patients showed an extreme degree or retardation. During zimelidine treatment they were not just unaffected but showed signs of excitation, impatience and desperate feelings. These preliminary findings strongly indicate the true existence of depressive cases in need of an NA uptake inhibitor, but completely resistant to a specific 5-HT uptake inhibitor. The final dose of zimelidine was 75 mg b.i.d. This dose, although sufficient in most cases, was obviously somewhat low for a few of our patients. The concentration in blood plasma of zimelidine should probably reach a minimum level of 250 nmol/l and norzimelidine 500 nmol/l, and to achieve this a general dosage of 100 mg b.i.d. is recommended.

Adult↗