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Biomedical subjects

I Krakau

Publications and source records attributed to I Krakau.

At least 37 records · Page 2Linked to original sources
PubMed1998

[Differential indication for coronary stent implantation. Comparative study of acute cardial and vascular complications in relation to the indication].

BACKGROUND AND OBJECTIVE: Coronary stents are used nowadays not only for the reduction of restenosis and for treating acute vessel occlusions after PTCA but also after acute myocardial infarction. This study was undertaken to determine whether widening the indications has affected the incidence of acute complications and to compare acute cardiac and vascular complications. PATIENTS AND METHODS: The data on 197 consecutive patients (155 men, 42 women; mean age 62 +/- 9 [37-85] years) with coronary stents were analysed retrospectively, divided into 5 groups depending on the indications for the stent implantation: 1) acute or threatened vessel occlusion after elective PTCA ("bail-out"); 2) acute myocardial infarction (AMI); 3) unstable angina with threatened vessel occlusion; 4) suboptimal primary results (angiographically assessed) after PTCA; 5) elective stent implantation to prevent restenosis. Acute or subacute stent thrombosis, side-branch occlusion, intra- and transmural infarction, death and emergency aortocoronary bypass operation were classified as acute cardiac complications. Haemorrhage in the inguinal region requiring blood transfusion, false aneurysm and operative vascular reconstruction were classified as vascular complications. RESULTS: An intended stent implantation was impossible in 18 patients (primary success rate 91%). Independent of indication an acute or chronic stent stenosis occurred in three (1.6%) and seven (3.9%) patients, respectively. Side-branch occlusion was observed in 12 patients (6.7%), transmural infarction in nine (5.6%). No emergency bypass operation had to be performed. Comparing the different indication groups there was a significantly increased rate of "non-Q" infarctions in patients with unstable angina pectoris (P < 0.014). Among acute vascular complications (10 [5%] inguinal haemorrhages requiring transfusion and 5 [2.5%] operative vascular reconstructions), false aneurysm was significantly more common in patients with AMI (P < 0.014). Comparing emergency and elective stent implantations, side-branch occlusions were significantly more common in the former (12% vs. 0%; P < 0.08), as were also "non-Q" infarcts (10% vs. 0%; P < 0.002). CONCLUSION: Coronary stent implantation for these indications, including AMI, can be taken as firmly established. Stent thrombosis was not significantly increased after "bail out". Implantation in an acute ischaemic episode led to a significantly higher incidence of side-branch occlusion and "non-Q" infarction.

Acute Disease↗
PubMed1998

Type A behavior intervention in primary health care reduces hostility and time pressure: a study in Sweden.

This study evaluates the effects of an intervention on hostility and time pressure in primary health care patients. A total of 47 men and women were studied, of whom 22 participated in an intervention program and 25 were controls. The intervention group changed global Type A behavior, hostility and time pressure significantly more than the control group and this change was stable up to 2 years following the study. Men altered their behavior significantly more than women.

Adult↗
PubMed1998

Patient charges--a hindrance to financially and psychosocially disadvantage groups seeking care.

This study examines the extent to which people forego seeking primary health care due to the cost and to investigate the associated demographic, physical, psychological and social factors. In 1995, questionnaires were sent to a random sample of the population in two healthcare regions in the Stockholm area in Sweden covering a total of about 400,000 inhabitants. Among the sample of 8200 people over the age of 17 yr, 69% replied to the questionnaire. About 22% stated that on one or more occasions during the past year they had foregone seeking care due to the cost. About 30% stated that they had foregone or hesitated seeking medical help due to the cost during the past year. This applied to women to a greater extent than men. Not seeking medical care was strongly correlated to a self-assessment of personal finances. Among those who described their financial situation as poor, more than half stated that, on at least one occasion, they had foregone seeking medical care due to the cost. As a consequence, weaker groups in society such as the unemployed, students, foreign nationals and single mothers were overrepresented in this group. Those who had foregone care perceive their health as worse and they had a greater degree of general pains and a higher occurrence of chronic disease/disability compared to those who had not foregone care. Between 1970 and 1995, patient charges for consulting a general practitioner within Stockholm County have increased more than three times faster than the consumer price index. The results suggest that the rapidly increasing patient charges particularly affect the weaker social groups and thus pose a threat to the aim of Swedish healthcare legislation--that good care should be available to everyone on equal terms.

Adolescent↗
PubMed1998

Is there a connection between car accidents, near accidents, and type A drivers?

The authors examined Type A behavior pattern, which has been investigated primarily as a risk factor for coronary heart disease, as a risk factor for car accidents and near accidents. Type A behavior pattern, which is characterized by excessive impatience, competitiveness, hostility, and time pressure, was assessed by means of the Videotaped Structured Interview. One hundred thirty-five Swedish car drivers (66 men and 69 women) were studied: 78 Type A and 58 Type B (that is, not having, Type A behavior). Time pressure was significantly associated with near accidents when age, sex, annual mileage, and urban driving were controlled in a multivariate model.

Accidents, Traffic↗
PubMed1998

Aspects of diagnosis of acute otitis media.

BACKGROUND: Acute otitis media is a common disease, particularly among children. The importance of a correct diagnosis is crucial, especially as unjustified prescription of antibiotics has become a major problem in clinical praxis. OBJECTIVES: Our aim was to evaluate the predictive value of different otological findings in diagnostics and treatment of acute otitis media among GPs and ear specialists and to investigate if the diagnosis could be improved by the use of an ear microscope instead of an otoscope. Furthermore, we aimed to test the value of following an algorithm, METHODS: Thirty-one patients with otalgia at the Emergency Department at the Karolinska Hospital in Stockholm were examined by both a GP and an ear specialist. The GP used an otoscope, whereas the ear specialist first used an otoscope and then an ear microscope. The doctors registered their findings and their proposal for treatment in questionnaires. The ability among participating ear specialists to give a correct diagnosis was confirmed by the use of 12 video-taped selected cases of aural diseases. An algorithm for diagnostics, based on medical facts, was formulated and tested. RESULTS: In general, the concordance between ear specialists and GPs was satisfactory with regard to establishing the diagnosis acute otitis media. The diagnostics were not improved by use of an ear microscope. The algorithm identified most patients with acute otitis media. Conclusion. The results indicate that the following of a simple algorithm may simplify the CONCLUSION: and lead to a correct diagnosis of acute otitis media.

Acute Disease↗
PubMed1997

[Treatment of myocardial infarction by primary PTCA within 12 to 24 hours after onset of pain].

BACKGROUND AND OBJECTIVE: The time elapsed until effective infarct vessel perfusion has been identified as an essential determinant of survival after acute myocardial infarction (MI). Significant mortality rate reduction has not been demonstrated for patients who received thrombolytic treatment more than 12 to 24 hours after MI. For this reason such patients have so far largely been denied reperfusion treatment and have thus been excluded from any potential benefit of an reopened infarct vessel. It was the aim of this study to assess the applicability and safety of achieving reperfusion by percutaneous transluminal coronary angioplasty (PTCA) without prior thrombolysis (primary PTCA) within 12 (> 12) to 24 (< or = 24) hours after onset of pain, taking into account early and late results in selected consecutive patients. PATIENTS AND METHODS: The data were analysed retrospectively of 35 patients (29 men, 6 women; mean age 60 [49-78] years) who had been admitted and treated by primary PTCA for MI more than 12-24 hours after onset of pain, with persisting ECG changes and (or) continuing chest pain. Reperfusion rates, acute haemodynamic parameters, acute cardiac and noncardiac complications, 30-day mortality rate, 3-month angiographic results and late mortality rate were obtained after an average of 23 (4-36) months. RESULTS: Complete infarct vessel reperfusion was achieved in 30 patients (85.7%), the infarct vessel remaining occluded in five. The early measurement of mean left ventricular ejection fraction was 53% (8-76%). A small, conservatively managed pericardial effusion occurred in one patient due to coronary artery penetration. Three patients who were in cardiogenic shock on admission died (8.6% 30-day mortality rate). Nine cases of restenosis and two of re-occlusion of the infarct vessel were documented in 24 patients who were investigated invasively 3 months after the primary PTCA. One patient had sustained a nonfatal MI. During the follow-up period one patient died of a noncardiac cause. INTERPRETATION: In this selected group of patients who received treatment more than 12 to 24 hours after MI primary PTCA achieved a high rate of reperfusion, while early and late complications were rare. Using individualized criteria of patient selection, primary PTCA can accomplish recanalization. The question of prognostic advantage can only be answered by results in a larger and randomized cohort of patients.

Aged↗
PubMed1997

Concentrations of copper, zinc and selenium in brain and kidney of second trimester fetuses and infants.

The concentrations of copper (Cu), zinc (Zn) and selenium (Se) in the brain and kidneys of second trimester fetuses (abortion cases) and infants (deceased before three months of age) were determined. Concentrations of Cu in brain, 0.31-1.6 mg/kg wet weight, increased with age, and were, on the average, three times higher in the brains of infants than of fetuses. In kidneys, Cu concentrations ranged between 0.34 and 2.9 mg/kg, and increased with age after birth. Concentrations of Zn in the brain decreased significantly with age in the fetuses, from about 7 mg/kg at post-conceptional week 12 to less than 5 mg/kg at week 20, but increased again postnatally. In kidneys, Zn concentrations (12-37 mg/kg) increased in parallel with the increase in tissue density. Concentrations of Se in brain, 0.072-0.14 mg/kg, decreased with age in the fetuses, but increased with age postnatally. Kidney Se concentrations (0.16-0.55 mg/kg) did not change significantly with age during the fetal period, but increased about 2.5 times during the postnatal period. There was a significant association between the concentrations (on molar basis) of Zn and Cu in kidneys, but not in brain. There was no correlation between the concentrations of Cu, Zn or Se and those of mercury, cadmium and lead, previously determined in the same samples, with the exception of mercury and Se in kidneys.

Brain↗
PubMed1997

Detection of myocardial viability using stress echocardiography.

Asynergic myocardial regions in patients with coronary artery disease can be viable. They may have the ability to improve their function after restoring coronary blood flow. Asynergic but viable myocardial regions have a positive inotropic reserve which can be stimulated by catecholamines. Because echocardiography is an established method for evaluating regional left ventricular function, it has the potential to detect the inotropic response of asynergic myocardial regions. In the clinical setting, prediction of left ventricular functional improvement after revascularization is particularly important. Dobutamine stress echocardiography is the most frequently used stress echocardiographic test for detection of myocardial viability. Dobutamine is infused at low rates of 2.5 to 20 micrograms.kg-1.min-1 to detect myocardial viability. This paper reports on the sensitivity and specificity of the method for the detection of viability and its usefulness for prediction of left ventricular functional improvement after revascularization.

Adult↗
PubMed1997

Dobutamine stress echocardiography.

Dobutamine is a synthetic catecholamine with predominant beta-stimulation. Its half-life is approximately 2 min. The positive chronotropic and inotropic effects of dobutamine induce myocardial ischaemia if significant coronary artery obstruction is present. Regional ischaemia produces regional wall motion abnormalities which can be detected by echocardiography. Most dobutamine stress protocols start at an infusion rate of 5 micrograms.kg-1.min-1 and increase to a peak dose of 40 or 50 micrograms.kg-1.min-1; to further increase heart rate, a bolus injection of 0.25-1.0 mg atropine is added. Test endpoints are the detection of new wall motion abnormalities, the occurrence of severe complications or achievement of the target heart rate. Viable myocardial regions have a positive inotropic reserve, which can be stimulated by dobutamine and detected by echocardiography. Indications for the use of dobutamine stress echocardiography are to prove stress-inducible myocardial ischaemia and to detect myocardial viability. The test should only be performed for the detection of stress-induced myocardial ischaemia if patients are unable to undergo exercise echocardiography, or if patients fail to reach their required test level in exercise echocardiography.

Adrenergic beta-Antagonists↗
PubMed1997

Psychometric properties of a brief self-report Type A questionnaire for use in primary health care.

OBJECTIVE: To develop a short and easily used self-report measure of Type A behaviour (Simplified Type A Questionnaire = STAQ) and to examine its capacity to predict Type A behaviour as assessed by more time-consuming measures. DESIGN: A Videotaped Structured Interview (VSI) and a self-report measure, previously validated in Sweden, were used as comparison instruments to the STAQ. SETTING: Primary health care. PATIENTS: 206 (81 men and 125 women) aged 17-75 years attending a health centre during one year. MAIN OUTCOME MEASURES: The reliability, measured by Cronbach's alpha and split-half correlation. The specificity and sensitivity of the STAQ. The correlaiton between the STAQ and the two other diagnostic measures. RESULTS: The reliability of the STAQ was 0.70 and 0.75, respectively. The specificity was 83% and the sensitivity 75%. The correlation between the STAQ and the VSI was 0.45. The correlation between the STAQ and the previously validated self-report was 0.61. CONCLUSIONS: The STAQ has good psychometric properties and, in comparison with other diagnostic measurement instruments in medical service, it has an acceptable discrimination capacity.

Adolescent↗
PubMed1996

[Percutaneous transluminal coronary angioplasty (PTCA) as primary therapy in acute myocardial infarct].

BASIC PROBLEM AND OBJECTIVE: Percutaneous transluminal coronary angioplasty (PTCA) is being increasingly considered as an alternative to thrombolytic treatment of acute myocardial infarction. Studies performed so far, some on selected groups of patients, have produced high initial results of success. This prospective study was undertaken to determined primary success, complications and recurrence after primary PTCA in acute myocardial infarction (AMI). PATIENTS AND METHODS: Primary treatment in the form of immediate PTCA of the infarct vessel was undertaken in 111 patients (84 men, 27 women; mean age 58.6 +/- 10.3 years) with AMI. PTCA was judged successful if the infarct vessel had been reopened to perfusion grade 3 and restenosis was < 50%. No thrombolytic treatment was given, but heparin infusions were given during and for 24-48 hours after the procedure. 13 patients (11.7%) were in cardiogenic shock or required cardiopulmonary resuscitation for infarct-related arrhythmias. RESULTS: The primary success rate of PTCA for the whole group was 91% (101 of 111 patients), but only 77% (ten of 13) among patients in cardiogenic shock and (or) after resuscitation. Acute re-occlusion (0-6 days after PTCA) occurred in seven patients. Eight patients (7.2%) died during the hospital phase (0-4 weeks), seven of whom had been in shock or required resuscitation (death rate 54%). The overall complication rate of the intervention was 6.3%. No emergency aortocoronary bypass was necessary. Repeat coronary angiography was performed in 71 of the 101 successfully treated patients 6 or 12 weeks after the PTCA. Re-occlusion was demonstrated in four (5.6%), a restenosis of more than 50% in 25% of patients. Mean left ventricular ejection fraction, obtained by planimetry from the levocardiogram was 58.6 +/- 9.3%. CONCLUSION: PTCA, performed immediately after acute myocardial infarction is an effective therapeutic measure with a high primary success rate.

Aged↗
PubMed1996

Concentrations of mercury, cadmium and lead in brain and kidney of second trimester fetuses and infants.

The concentrations of mercury (Hg), cadmium (Cd) and lead (Pb) in brain (cerebrum) and kidney during fetal (second trimester terminations or abortions, n = 20) and postnatal (infants deceased before three months of age, n = 15) development have been studied. Information on possible sources of exposure was obtained from the mothers of the fetuses, but not from those of the infants. The median concentration of Hg in the brain was 4 micrograms/ kg wet weight in both fetuses and infants (total range < or = 2-23 micrograms/kg). The concentrations of Hg in the kidneys were significantly higher than in brain, median of Hg 6 micrograms/kg (range < or = 5-34 micrograms/kg) in fetuses and 10 micrograms/kg (< or = 7-37) in infants. There was a tendency of increasing concentration of Hg in the fetal kidney, but not in the brain, with increasing number of amalgam fillings in the mothers. The concentration of Cd in the brain was less than 1 microgram/kg in most cases, both in fetuses and infants. The concentration of Cd in the kidneys was significantly higher, with a median of about 2 micrograms/kg (1-8 micrograms/kg) in both groups. There was no detectable association between tissue Cd concentrations and the smoking habits of the mothers. The concentration of Pb in brain was below 10 micrograms/kg in most cases. In the kidneys, the concentrations of Pb were significantly higher, with a median of 12 micrograms/kg in the fetuses (range < or = 6-20 micrograms/kg) and 15 micrograms/kg (< or = 9-36 micrograms/kg) in the infants. In general, the concentrations of Cd and Pb were lower than in previously reported studies.

Brain Chemistry↗
PubMed1996

Screening for cutaneous malignant melanoma: a feasibility study.

OBJECTIVES: To study two different procedures for inviting subjects to screening for malignant melanoma, and to study the role of specially trained nurses as primary examiners. METHODS: The study was carried out in Stockholm county and comprised 5000 randomly selected men and women aged 40 to 60, of whom 2,500 were invited with a personal invitation letter and with a set time of appointment and 2,500 were sent a questionnaire and instructions for self examination of the skin. To test the nurses' competence, a survey was made, comparing the judgments of skin examination between nurses and doctors. RESULTS: 1654 (66%) of those invited for a skin examination took part. 1507 (60%) replied in the questionnaire group, of whom 1024 (41%) requested and attended a subsequent skin examination. Of the subjects attending from both groups, the nurses judged 9% v 11% as having skin lesions suggesting malignant melanoma, whereas the two doctors referred 4% v 3% of the subjects for surgical biopsy. Two malignant melanomas were detected, both of them in the questionnaire group. In the study of nurses' screening competence, both nurses and doctors equally judged one case out of 19 as having a lesion suspicious for malignant melanoma. CONCLUSIONS: When the questionnaire method was used the results were achieved with one third fewer skin examinations, but it is difficult to conclude whether one of the procedures is better than the other. The results also indicate that nurses can be trained to be the primary examiners in a melanoma screening programme.

Adult↗
PubMed1995

Quality of life is not negatively affected by diet and exercise intervention in healthy men with cardiovascular risk factors.

Health-related quality of life was assessed in a diet and exercise intervention study among 157 healthy men aged 35-60 years (mean +/- s.d.; 46.2 +/- 5.0) with moderately raised cardiovascular risk factors. The men were randomized to four groups, diet (D, n = 40), exercise (E, n = 39), diet plus exercise (DE, n = 39), and no active intervention (controls (C) n = 39). Quality of life was measured with two self-administered questionnaires; Subjective Symptoms Assessment Profile and Minor Symptom Evaluation Profile, at baseline and after 1.5, 3 and 6 months. Cardiovascular risk factors were investigated at baseline and after 6 months. As a result of changes in dietary habits and physical exercise in the three intervention groups, several important cardiovascular risk factors were significantly reduced. The quality of life/well-being did not differ between the four groups and did not change significantly in any of the groups during the study. There was, however, a tendency towards fewer gastrointestinal symptoms in group D and fewer cardiac symptoms in group DE. We conclude that advice on lifestyle changes in the form of diet and exercise reduce risk factors in middle-aged men without negative effects on their quality of life.

Adult↗