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Biomedical subjects

B Wranne

Publications and source records attributed to B Wranne.

At least 109 records · Page 6Linked to original sources
PubMed1981

The acid perfusion test as differential diagnostic aid in patients with chest pain.

A short review of the literature of the acid perfusion test is first given. Data from 67 patients with chest pain investigates with an acid perfusion test during ECG-surveillance in close connection to an exercise test are then presented. Arrhythmias or ST-T changes on ECG were not induced by the acid infusion. Six patients had a "positive related" acid perfusion test which in this context means that they recognized the chest discomfort elicited by the acid infusion as that which had brought them to the exercise test. The acid perfusion test in close connection to an exercise test is in selected patients a safe and useful technique for establishing whether or not the symptoms have an oesophageal component.

Diagnosis, Differential↗
PubMed1981

Bronchial obstruction after oesophageal acid perfusion in asthmatics.

Fifteen patients with the combination of bronchial asthma and symptoms of gastro-esophageal reflux reproduced at endo-oesophageal acid perfusion (group 1) were investigated to detect bronchial obstruction, reflexly elicited from the distal oesophagus. Five patients with bronchial asthma but without symptoms of gastro-oesophageal reflux (group 2) and five patients with symptoms of gastro-oesophageal reflux but without respiratory symptoms (group 3) served as controls. The vital capacity (VC), the slope of the alveolar plateau (delta N2) and the closing volume (CV) were measured with the single breath nitrogen test before and after acid perfusion of the oesophagus, and again after antacid and glucose perfusion of the oesophagus. In group 1 a significant decrease of VC by 0.21 (P less than 0.001) and a significant increase of delta N2 by 0.9% (P less than 0.05) was seen while no change in CV was found. There was no change after acid perfusion in groups 2 or 3. After glucose and antacid the VC increased significantly in group 1 while no significant change was seen in delta N2 or CV. These findings were taken as indirect evidence of bronchial obstruction induced by the acid infusion. Since the changes were provoked in the sitting position and only in asthmatics with a positive acid perfusion test and since no patient complained of acid taste in the mouth it is unlikely that the bronchial obstruction was due to aspiration. A neural oesophago-bronchial reflex mechanism is suggested.

Adult↗
PubMed1981

Effects of oestrogens, orchidectomy and cyproterone acetate on salt and water metabolism in carcinoma of the prostate.

Salt and water metabolism was investigated during treatment with oestrogens and with cyproterone acetate and after orchidectomy in 46 patients. An increase in plasma volume was noted during oestrogen treatment and a slight transitory rise in plasma volume was also seen after orchidectomy. During cyproterone acetate therapy there was a reduction of body weight and a transitory increase in 24-hour urine volume and urinary sodium excretion. The increase in plasma volume during oestrogen treatment might tax the circulatory capacity. Cyproterone acetate treatment does not change the salt-water balance or the plasma volume in such a way that the risk of congestive heart failure could be increased.

Aged↗
PubMed1981

[Effects of cyproterone acetate on cardiovascular risk factors in patients with carcinoma of the prostate (author's transl)].

15 patients with advanced carcinoma of the prostate were studied in a prospective trial during treatment with 200 mg cyproterone acetate daily by mouth. Changes in variables (salt-water balance, antithrombin III, fibrinolytic activity, plasma lipoproteins) known to influence the risk of cardiovascular complications were recorded during the initial two months. Blood and plasma volume were unchanged, whereas the 24 h urine volume and the urinary sodium excretion were transitory increased. The body weight was decreased. The antithrombin III concentration and the fibrinolytic activity were increased. The lipoprotein fractions HDL and LDL and the HDL/LDL quotient decreased. The recorded changes of cardiovascular risk factors indicate that the risk of water retention and thereby congestive heart failure is not increased during cyproterone acetate treatment. The risk for thrombembolic disease is rather decreased. The small changes in lipoprotein fractions can hardly affect the incidence of cardiovascular disease in elderly men with prostatic carcinoma.

Aged↗
PubMed1981

Non-infarction coronary care unit patients. A three-year follow-up with special reference to oesophageal dysfunction and ischaemic heart disease as origin of chest pain.

Among 55 consecutive coronary care unit (CCU) patients with chest pain of unknown origin at discharge from hospital, signs of oesophageal dysfunction (OD) were found in 58% and signs of ischaemic heart disease (IHD) in 35% within 2-6 months. At a three-year follow-up, signs of OD were found in 62% and signs of IHD in 28%. Forty-six patients (84%) had experienced a pain similar to that which caused the CCU admission (i.e. the CCU chest pain). OD was regarded as the cause of the CCU chest pain in seven patients (13%) and as a possible cause in another nine (16%). IHD was regarded as the cause of the CCU chest pain in 17 patients (31%), four of whom had died from acute myocardial infarction during the follow-up period. All ten patients who developed coronary events, such as myocardial infarction or progressive angina pectoris, during the follow-up period had an ischaemic ECG reaction at exercise test 2-6 months after discharge from the CCU. IHD was found to be the predominant disease in terms of severity of symptoms and prognosis and was also recorded as the most common single cause of the CCU chest pain. Since OD was common and even caused severe chest pain in some patients, oesophageal origin should be considered in the differential diagnosis of chest pain in non-infarction CCU patients.

Aged↗
PubMed1981

Oesophageal function in asthmatics.

The frequency of different kinds of oesophageal dysfunction (OD) namely hiatal hernia at manometry, dysmotility, hypotension of the lower oesophageal sphincter (LES) and positive acid perfusion test was investigated in 97 patients with bronchial asthma seen at a hospital clinic. Thirty-six patients had signs of hiatal hernia, 37 of dysmotility, 26 of LES hypotension and 23 had a positive acid perfusion test. Four per cent of all the asthma patients fulfilled four criteria for OD and 10%, 28% and 25% fulfilled three, two and one criteria respectively. The incidence of OD was significantly higher in patients with Exogenous (95%) than in patients with endogenous asthma (58%, P less than 0.01). The history of asthma in patients with OD was of significantly longer duration (mean 16.9 years) than that of the OD itself (mean 6.5 years, P less than 0.01). Productive cough and frequent wheezing were more common in patients with OD (46%) than in patients without (19%, P less than 0.01). Spirometric lung volumes did not differ between asthmatics with OD and those without. Asthmatics with OD seem therefore to suffer more from respiratory symptoms than asthmatics without OD.

Adult↗
PubMed1981

Effect of conservative treatment of oesophageal dysfunction on bronchial asthma.

Sixty-two patients with both bronchial asthma and oesophageal dysfunction (OD) were randomized into an OD treatment group and a control group. Patients in the treatment group were given advice and medication for their OD. No changes were made in their existing asthma therapy. Patients in the control group were told that there was a suspicion of OD which should be rechecked in 2 months. After 2 months the patients of the treatment group reported alleviation of their oesophageal and bronchial symptoms significantly more frequently than patients of the control group. Fewer signs of OD were found after treatment than before. Lung function tests did not differ between the group treated for 2 months and the control group but there was a significant reduction in consumption of beta-adrenergic stimulating drugs in the treatment group compared with the control group. In conclusion, treatment of OD improves not only oesophageal symptoms but also respiratory symptoms in asthmatic patients. OD should therefore be looked for in patients with bronchial asthma and treated whenever found.

Adult↗
PubMed1980

Influence of coronary bypass surgery on oesophageal function and symptomatology.

The incidence of oesophageal dysfunction (OD) is higher in patients with coronary heart disease (CHD) than in a population sample. The hypothesis was raised that this finding is the result of a cardio-oesophageal reflex in which afferent pain impulses from the heart trigger dysfunction in the oesophagus. Twenty-three patients with CHD were examined before and 14+/-5(S.D.) months after coronary bypass surgery. Total relief of angina pectoris was attained in 6 patients and improvement in 16. One patient deteriorated. The incidence of OD was 52% before operation and 65% at the follow-up investigation (no significant difference). Symptoms related to the oesophagus, other than chest pain, were as frequent before as after operation. The findings do not support the contention that OD in patients with CHD is caused by a cardio-oesophageal reflex.

Angina Pectoris↗
PubMed1980

Hemodynamic effects of extreme positive pressure breathing using a two-pressure flying suit.

The central hemodynamics during extreme positve pressure breathing (PPB) with 4.0-9.3 kPa breathing pressures using a two-pressure flying suit was studied with the thermodilution technique. Pressures measured simultaneously in right atrium, pulmonary artery, and systemic circulation increased in proportion to, but somewhat less than, the breathing pressures. A decreased transmural right atrial and pulmonary arterial pressure was found during PPB to be most pronounced during simultaneous counterpressure to the thorax. Stroke volume (SV) as well as cardiac output (CO) decreased successively during PPB, mostly during PPB with more than 4 kPa. Simultaneous counterpressure to the thorax added further hemodynamic effects. During recovery after PPB, a marked compensatory increase in SV and CO was registered. An increased systemic blood pressure and heart frequency was found at all levels of PPB, suggesting that PPB may be of value to increase G tolerance.

Adult↗
PubMed1979

Oesophageal dysfunction in non-infarction coronary care unit patients.

Oesophageal dysfunction (OD) is a common finding in patients discharged from a coronary care unit without definite diagnosis. Of 55 patients investigated with oesophageal manometry, acid perfusion test and exercise ECG, 32 had signs of OD and 19 signs of ischaemic heart disease (IHD). Symptoms such as heart burn, acid regurgitations, feeling of a lump in the throat, surfeitness after meals, chest pain at night, and relief of chest pain when lying with the head raised were significantly more common in patients with OD than in patients with normal oesophageal function. Chest pain was significantly more often provoked by effort, emotions or cold and more often relieved by nitroglycerine in patients with signs of IHD than in those without. These pain-provoking factors were, however, also common in patients with OD. A careful case history with specific inquiry directed at not only cardiac but also oesophageal symptoms is important in the differential diagnosis of chest pain.

Adult↗
PubMed1979

Oesophageal symptoms and manometry in valvular heart disease.

A possible relationship between heart disease, oesophageal dysfunction (OD) and symptomatology was studied in 47 patients with valvular heart disease. They were investigated with oesophageal manometry and oesophageal acid perfusion test. OD was found in 32 percent of the patients. A local pressure increase in the middle part of the oesophagus, probably an effect of cardiac enlargement and compression of the oesophagus, was found at manometry in 38 percent. The incidence of OD and of oesophageal symptoms was the same in patients with and without oesophageal compression. We did not find any indications that valvular disease in itself provokes OD, nor that symptoms of chest pain and cough in patients with valvular heart disease are due to OD.

Adult↗
PubMed1978

Oesophageal function and coronary angiogram in patients with disabling chest pain.

Sixty-four patients with a history of disabling chest pain belonging to groups III or IV classified according to the NYHA criteria were examined with oesophageal function tests, coronary angiography and bicycle ergometry and also answered a symptom questionnaire. At the exercise test, 52 had effort angina; 45 (89%) of them had a pthological coronary angiogram and 22 (42%) had signs of oesophageal dysfunction (OD). OD as the single possible etiological factor for typical effort angina therefore seemed unlikely. Chest pain was absent or atypical at the exercise test in 12 patients, 11 (92%) of whom had signs of OD. This incidence is significantly higher (p less than 0.01) than that found in the patients with effort-related chest pain. Five (42%) of the 12 patients with atypical chest pain at the exercise test had a pathological coronary angiogram, an incidence which is significantly lower (p less than 0.001) than that found in the group with effort-related chest pain. In patients with a history of disabling chest pain but with atypical chest pain in connection with the exercise test, OD was more frequent than coronary disease and therefore more likely to have caused the symptoms.

Adult↗
PubMed1978

Platypnoea after pneumonectomy caused by a combination of intracardiac right-to-left shunt and hypovolaemia. Relief of symptoms on restitution of blood volume.

A patient developed platypnoea about a month after pneumonectomy. The symptoms proved to be due to a combination of an atrial right-to-left shunt and hypovolaemia. Blood volume substitution did not change the direction of the shunt, but the symptoms were relieved. The physiological background to this may be a less pronounced venous desaturation and thereby a less marked influence of the shunt on the arterial oxygen saturation.

Aged↗
PubMed1977

Oesophageal acid perfusion test as a complement to work test in patients with chest pain.

Out of 121 patients referred to a work test on account of chest pain, 67 with a case history typical for oesophageal dysfunction have been further investigated with an acid perfusion test during continuous ECG monitoring. Neither arrhythmias nor ST-T changes were induced by the procedure. Of the 67 patients, 6 had a "positive related" acid perfusion test, 23 a "positive unrelated" and the remainder a negative test. Five of the 14 patients with pathological effort ECG belonged to the group with a positive acid perfusion test. The acid perfusion test, as a safe routine in close connection with the effort ECG in selected patients, is a useful technique for establishing whether or not the patient's symptoms have an oesophageal component.

Adult↗
PubMed1977

Influence of temperature on hemoglobin-ligand interaction in whole blood.

Temperature-dependent change in hemoglobin-oxygen affinity was measured as a function of hemoglobin-oxygen saturation. In addition, the CO2 Bohr factor and fixed acid Bohr factor were measured as a function of saturation of temperatures of 23, 30, 37, and 44 degrees C. Measurements were made on normal blood and blood with reduced 2,3-diphosphoglycerate (DPG). The influence of temperature is greatest at low saturation and is enhanced slightly by DPG depletion. The CO2 Bohr factor is increased at high temperatures; this is primarily due to increased carbamino formation with rising temperature, especially at lower oxygen saturation. The effect of DPG on oxygen affinity is reduced at a high temperature and elevated at low temperature. These diverse effects of temperature on hemoglobin-ligand interaction require consideration in assessing oxygen delivery when temperature is increased or decreased.

Carbon Dioxide↗
PubMed1976

Oesophageal dysfunction in male patients with angina-like pain.

Twenty-eight male patients referred to work ECG due to chest pain, all with a positive oesophageal symptom questionnaire believed to detect oesophageal dysfunction (OD), have been subjected to a graded work test and an oesophageal manometry test and answered a questionnaire believed to detect effort angina. Ischaemic heart disease (IHD) was defined as earlier infarction on ECG at rest or a pathological effort ECG. OD was defined as a positive acid perfusion test, hernia or a clear dysmotility in combination with a lower sphincter incompetence. Twenty patients had a positive effort angina questionnaire. Among these, OD was more common (n = 13) than IHD (n = 8). Five of the 20 patients had signs of both IHD and OD. Eight patients had a negative effort angina questionnaire; OD was found in 7 and IHD in 1 of these patients. It is concluded that in cases with angina-like chest pain OD should be considered.

Adult↗
PubMed1975

Central and peripheral circulation immediately after pulmonary surgery as related to sympathodrenal activity.

Catecholamine output and circulation were observed in connection with pulmonary surgery in one group of ten patients who were anaesthetized with halothane-N20-02-d-tubocurarine and who breathed spontaneously after operation. In another group of four patients who received a modified neurolept anaesthesia with phenoperidine-N2O-O2-d-tubocurarine and who were mechanically ventilated also after operation, catecholamine output and temperature were observed. In both patient groups, catecholamine output was normal during iperation. Adrenaline output increased by 400% the first postoperative hours, while noradrenaline output remained normal. Thereafter, noradrenaline output increased, while adrenaline output started to decrease. A subnormal body temperature was seen at the end of the operation. In two patients from the neurolept group, adrenaline output and temperature were recorded hour by hour; maximal adrenaline output concided with maximal temperature rise. In the patients from the halothane group, the pstoperative change in foot, calf and forearm blood flow correlated well with the change in catecholamine output. The central circulatory response to the symptahoadrenal stimulation was, however, found to be less pronounced than is ordinarily seen.

Adult↗