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Biomedical subjects

I Krakau

Publications and source records attributed to I Krakau.

At least 55 records · Page 3Linked to original sources
PubMed1995

Psychosocial and behavioral factors associated with serum lipids in university students.

The impact of psychosocial and behavioral factors on serum lipids was examined in 46 male and 47 female students with a mean age of 23 years. Subjects were recruited from the University of Stockholm and the study was performed with the Student Health Care Organization in order to have a basis for intervention programs. Significant associations between serum lipids and parental education, regularity of breakfast habits, nourishing eating, social support, depressive feelings and quality of life are found. However, there is no consistent pattern for these associations in men and women. Thus, some associations are significant for men and some for women. Women with parents having higher levels of education had lower values of cholesterol, triglycerides and apo B, and higher values of apo A-1 (representing the 'good' cholesterol) than women whose parents were not highly educated. When controlling the associations for confounding factors such as age, body mass index, physical activity, coffee, alcohol, smoking habits, nourishing eating and quality of life, the associations were strongly confirmed. No similar associations were found in men. Men who reported low social support or social integration and a low perceived quality of life showed a tendency to higher levels of lipids compared to those who reported high integration and quality of life. Regularity of dietary habits was found to be associated to serum lipids in men, the greater the regularity, the lower the lipid levels. The strongest association was found for regularity of breakfast habits. This association was also strongly significant in the regression analysis after controlling for the described confounding factors.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1995

Cost-utility analysis of group living in dementia care.

A cost-utility analysis (CUA) was applied to group living for dementia patients. A Markov-model of an expected life-length of 8 years was used. Forty-six patients in group living were compared to 39 patients living at home by inclusion and 23 institutionalized patients. When the cost per gained quality-adjusted life-year (QALY) was calculated, the group living alternative was the most favorable for the patients, giving a cost per paired QALY of US dollars < 0. In the extensive sensitivity analysis the main result was consistent but methodological problems were indicated.

Aged↗
PubMed1995

[Successful high frequency current catheter ablation of an accessory conduction pathway in the "neck region" of a coronary sinus aneurysm. A case report].

In this case report the electrophysiological findings in a 24 year old female patient are demonstrated. For about 12 years she suffered from recurrent atrioventricular reentrant tachycardia with a rate of 230 beats per minute. Electrophysiological study resulted in diagnosis of a posteroseptal accessory pathway. Ablation was attempted primarily from a left ventricular access, but the pathway could not be reached from this position. After contrasting the coronary sinus a large coronary sinus aneurysm could be diagnosed. The accessory pathway was located in the "neck"-region of the aneurysm. By application of radiofrequency current in this location the bypass tract could be ablated. This case report shows that accessory pathways in coronary sinus aneurysms can be ablated without complications in this location.

Adult↗
PubMed1995

[Ventricular bigeminy with fixed with fixed coupling at rest and during exercise as the cause of recurrent dizziness and syncope--successful anti-arrhythmic therapy by high frequency current catheter ablation of a right ventricular arrhythmogenic focus. A case report].

In a 52-year-old patient with beginning dilatative cardiomyopathy dizziness and syncopes could be observed due to a ventricular bigeminy at rest and under exercise conditions. The patient also showed a marked reduction of exercise capacity and was handicapped in his profession as electrician and unable to work for more than 10 months. Antiarrhythmic drug therapy including the subsequent use of all available antiarrhythmic agents failed in suppressing this arrhythmia. In an electrophysiological study the arrhythmogenic focus could be localized in the right ventricular outflow tract. Application of radiofrequency current resulted in instantaneous termination of the extrasystoly; this result could be documented in repeat Holter monitorings over 12 weeks to present. This case report shows that radiofrequency catheter ablation can in special cases be applied for therapy of extrasystolic phenomena when clinical symptoms necessitate treatment and antiarrhythmic drug therapy fails.

Cardiac Complexes, Premature↗
PubMed1995

Cardiogenic shock in acute myocardial infarction. Improving survival rates by primary coronary angioplasty.

This study reports on 16 patients suffering from cardiogenic shock in the setting of acute myocardial infarction (11 men, five women; average age: 52.5 +/- 14 years) treated by means of primary coronary angioplasty: These 16 patients were part of a total population of 261 patients suffering from acute myocardial infarction at the time of admittance to the Wuppertal Heart Center, who were consecutively treated during the period from 1/90 to 6/94 by primary coronary angioplasty without having received any prior thrombolytic therapy. For all patients, primary re-opening of the vessel infarcted was successful. The period of time between onset of pain until re-opening of the vessel averaged 176 +/- 49 min. Eleven patients suffered from multi-vessel coronary artery disease. Prior to re-opening, systolic blood pressures averaged 66 +/- 10 mm Hg; average biplan left ventricular ejection fraction, 40 +/- 12%; left ventricular end-diastolic pressures (LVEDP), 26 +/- 7 mm Hg. In 63% of the cases evaluated, it proved possible to document collaterals to the infarcted vessel. Thirteen patients survived acute coronary occlusion. Two patients died due to protracted myocardial pumping failure, despite re-opened arteries that effectively re-established coronary flows. Showing symptoms of re-occlusion, one patient developed electromechanical decoupling. Thirteen patients were discharged from the hospital for normal life or subsequent treatment. Overall, this corresponds to an in-hospital survival rate of 81%. During follow-up examinations performed over 14 +/- 8 months (range 3 to 30 months), all of the patients are alive. Mean left ventricular ejection fraction increased to 56% +/- 17%; mean left ventricular end-diastolic pressure dropped to 14 mm Hg +/- 5 mm Hg. In the infarct-related artery there was no recurrence of stenoses exceeding 50%. By now, one of the patients has received elective aorto-coronary bypass grafting; for another one, multi-vessel PTCA of non-infarcted arteries is being employed; 77% of the patients state that they are satisfied with the quality of their lives. These results demonstrate that rapid revascularization using coronary angioplasty in cardiogenic shock following acute myocardial infarction substantially improves the prognosis for survival and favorably influences long-term outcome. Thus, primary PTCA is the method of choice for treating cardiogenic shock; any patient-and particularly those resistant to lyse therapy-should immediately receive this treatment.

Adult↗
PubMed1995

Primary mechanical recanalization of occluded coronary arteries without prior thrombolytic therapy in patients with acute myocardial infarction. A single-center study reporting acute results and complications.

This study reports on 261 consecutive patients admitted to the Wuppertal Heart Center with acute myocardial infarction (186 men, 75 women; average age: 58.2 +/- 11.6 years) and then treated by primary coronary artery angioplasty. Sixteen patients with cardiogenic shock were included, as well as 42 patients aged > or = 70 years, 51 patients with contraindications for thrombolysis, and 13 patients with prior coronary bypass surgery. All patients were treated between 12/89 to 6/94 and had not received prior thrombolytic therapy. The period of time between onset of pain and revascularization of the infarct-related vessel averaged 224 +/- 205 min. Half of the patients had multi-vessel disease, and about 31% had had a prior myocardial infarction. 100 patients suffered from an anterior wall infarction, 109 patients from an inferior wall infarction, 50 patients from a posterolateral infarction, and in two cases the infarct localization could not be determined from the ECG. Mean biplane left ventricular ejection fraction averaged 56 +/- 13%, left ventricular end-diastolic pressure 20 +/- 7 mm Hg. In about 50% of the patients collaterals to the infarct-related coronary artery could be documented. With the first contrast injection into the infarct-related vessel TIMI flow 0/I was demonstrated in 94.9%, TIMI flow II in 5.7% and TIMI flow III in 0.4%. Reopening of the infarct-related coronary artery with establishment of TIMI-flow III was primarily successful in 91.9%. Average time for coronary angiography and angioplasty in the cathlab was 69 +/- 28 min. In 29 patients an autoperfusion balloon catheter was used to treat manifest or threatening reocclusion. Thirty-day-mortality in the total study group was 3.4%. In patients aged > or = 70 years mortality raised to 14.3%; in patients in cardiogenic shock mortality increased to 18.7%, in patients with inferior wall infarction up to 5.5%, and in cases with multi-vessel disease up to 5.0%. The in-hospital and 30-day course were complicated by major peripheral bleeding in seven patients (2.7%) requiring blood transfusions and surgical femoral vascular repair, and in another two patients with a false aneurysm which was treated by surgical means. No hemorrhagic stroke occurred, but three ischemic strokes with complete restitutio ad integrum within the 30-day-observation period were registered. As major cardiac complication early re-occlusion of the initially reopened infarct-related coronary artery was diagnosed in 10 patients; 11 patients developed a re-infarction within the first 30-days, in three cases leading to a fatal outcome.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗
PubMed1994

[Emergency intracoronary stent implantation: complications and experiences with 124 patients].

From January 1990 to February 1993, 88 patients (group 1) received an emergency stent implantation with threatening vascular occlusion within the framework of an elective PTCA or a second emergency PTCA after up to 5 days following a primary successful PTCA. In addition, 36 patients (group 2) received an intracoronary stent during emergency PTCA of instable angina pectoris or acute myocardial infarction. The attempted stent implantation was not successful in 6 other patients. All patients were anticoagulated with heparin, aspirin (100 to 500 mg), and phenprocoumon. Since October 1991, 3 x 75 mg dipyridamole was given and heparinization was stopped after measuring the anticoagulation factor II (prothrombin time < 40%). Main complications within the first 2 to 3 weeks were acute and subacute stent thrombosis (21.8%) and complications of the puncture site (bleeding 19.3%, a. spurium/av-fistula 1.6%). The risk of acute stent thrombosis was significantly higher in patients of group 2 (instable angina pectoris despite of drug therapy or acute myocardial infarction) compared with group 1 (42.4 versus 14.8%). Implantation of multiple stents to stabilize extended dissections had a lower occlusion rate (6.3%). Acute myocardial infarctions were registered in group 1 in 25% (11.4% following implantation, 13.6% following stent occlusion, CK 153 to 3380 U/I, average 826 U/I) and in 58.3% of the high risk patients in group 2 (50% just before or following implantation, 36.1% infarctions or re-infarctions caused by stent occlusion, CK 152 to 1950 U/I, average 657 U/I). The risk of infarction could be limited to approximately 58% of the patients of group 2.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

Diet and exercise are equally effective in reducing risk for cardiovascular disease. Results of a randomized controlled study in men with slightly to moderately raised cardiovascular risk factors.

To study the impact of diet and exercise and the combination thereof on cardiovascular risk factors, 157 healthy men aged 35-60 years (mean +/- S.D.; 46.2 +/- 5.0) with slightly to moderately raised cardiovascular risk factors, were randomized to 4 groups, diet (D, n = 40), exercise (E, n = 39), diet plus exercise (DE, n = 39), and no active intervention (controls (C, n = 39)), and investigated at baseline and after 6 months. BMI was significantly reduced in Groups E and DE (mean difference and 95% confidence intervals (CI), -0.3 (-0.5, -0.01) and -0.6 (-0.9, -0.3) kg/m2, respectively). Waist circumference was reduced in all 3 intervention groups (D, E, and DE), -1.3 (-2.5, -0.1), -2.2 (-3.2, -1.3) and -3.0 (-3.9, -2.0) cm, but not in the control group. Blood pressure (BP) was reduced in all 3 intervention groups, systolic BP 4-7 mmHg and diastolic BP 2-6 mmHg. Serum cholesterol was reduced in Group DE, -0.45 (-0.77, -0.13) mmol/l. VLDL-cholesterol was reduced in Groups E and DE, -0.14 (-0.26, -0.03) and -0.09 (-0.18, -0.01) mmol/l, whereas LDL-cholesterol was reduced in Groups D and DE -0.30 (-0.54, -0.06) and -0.35 (-0.64, -0.05) mmol/l. In contrast, neither HDL-cholesterol nor serum triglycerides were influenced by the interventions. According to the coronary risk profile derived from the Framingham study, all 3 intervention groups (D, E, and DE) significantly reduced their estimated 10-year risk (-13, -12, and -14%, respectively). We conclude that even with rather moderate changes in diet and exercise, several important cardiovascular risk factors can be affected and that diet and exercise were about equally effective in reducing cardiovascular risk.

Adult↗
PubMed1993

Prevention of cardiovascular disease within the primary health care system--feasibility of a prevention programme within the Sollentuna primary health care catchment area.

OBJECTIVE: To integrate prevention of cardiovascular disease within the primary health care. DESIGN: A prevention programme which combines population and individual high-risk strategy. SETTING: The Primary Health Care in Sollentuna, Stockholm, Sweden. MAIN OUTCOME MEASURE: Characteristics of, and risk factor prevalence among, persons registered in the prevention programme. RESULTS: During the first year more than 2000 persons, representing every tenth visitor and 6% of the population aged 15-60 years, were registered in the prevention programme. 90% were < or = 60 years and 62% were women. A large proportion (70%) had risk factors that required advice, treatment, and follow up. 24% of the men and 27% of the women were smokers, 68% and 62% respectively, had serum cholesterol > or = 5.2 mmol/l, and 33% and 22% had a diastolic blood pressure > or = 90 mmHg. CONCLUSION: The present study implies that it is possible to integrate a large scale prevention programme in the existing primary health care organization. The prevalence of risk factors in those who enter the prevention programme is high, which places great demands for treatment and follow up.

Adolescent↗