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Biomedical subjects

J Kuikka

Publications and source records attributed to J Kuikka.

At least 55 records · Page 3Linked to original sources
PubMed1991

Cardiotoxicity of epirubicin and doxorubicin: a double-blind randomized study.

24 patients with non-Hodgkin lymphoma were randomized into two multidrug regimens including either epirubicin (N = 12) or doxorubicin (N = 12) to establish the cardiotoxicity of each treatment modality. At cumulative doses of 400-500 mg/m2 left ventricular ejection fraction (LVEF) at rest determined by radionuclide angiocardiography decreased significantly more in the doxorubicin (-15 +/- 11%) than in the epirubicin group (0 +/- 13%, p less than 0.005). During epirubicin therapy no clinically significant cardiotoxicity developed, but a decrease larger than 10% in LVEF was seen in 4 of 12 patients at a mean cumulative level of 450 mg/m2. During doxorubicin therapy 1 patient developed a heart failure at a cumulative level of 200 mg/m2 and, altogether, in 7 patients LVEF decreased more than 10%. The monitoring of cardiac toxicity is imperative in patients treated with doxorubicin and is advisable if the patient is expected to receive epirubicin at more than 450 mg/m2.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1991

Effect of hemodilution on maximal oxygen consumption, blood lactate response to exercise and cerebral blood flow in subjects with a high-affinity hemoglobin.

10 subjects with Hb Linköping (beta 36 Pro greater than Thr), a high-affinity hemoglobin variant, with a P50 of 2.2 kPa (16.5 mm Hg) were investigated before and 3-4 days after normovolemic hemodilution. Blood hemoglobin concentration decreased from 176 +/- 13 (SD) to 146 +/- 15 g l-1 and the red cell volume from 2.77 +/- 0.83 to 2.23 +/- 0.67 l. Maximal oxygen consumption decreased slightly by 2.7 +/- 3.8 ml min-1 kg-1 and maximal exercise power by 11 +/- 23 W; these changes were, however, not statistically significant. Maximal heart rate was unchanged (-1.1 +/- 6.4 beats min-1) while submaximal heart rate was consistently increased on comparable loads after hemodilution compared to before. The exercise ECG was normal both before and after hemodilution. Capillary lactate levels at exercise were always higher after hemodilution than before. Cerebral blood flow was normal both before and after hemodilution in all subjects but one who had a high flow. The grey matter blood flow increased slightly but significantly by 8.6 +/- 10.3 ml min-1 100 g-1 from before to after hemodilution. The results indicate that subjects with Hb Linköping have only limited benefit from their increased blood hemoglobin concentration.

Adult↗
PubMed1989

Effect of early metoprolol injection followed by oral dosage on CK-MB release, and myocardial function in suspected acute myocardial infarction. A double-blind controlled study.

The effect of metoprolol on indices of infarct size and left ventricular function was compared with that of placebo in a double-blind randomized trial in patients with definite or suspected acute myocardial infarction. Intravenous metoprolol (15 mg) or placebo was given within 24 h of the onset of symptoms, and oral treatment (200 mg daily) was continued for 15 days. Thirty-five patients received metoprolol and 34 patients placebo. The mean (+/- SD) of maximal creatinine phosphokinase (CK)-MB activities was 142 +/- 110 IU/l in the placebo group and 74 +/- 72 IU/l in the metoprolol group (p less than 0.001). The ECG QRS score at discharge from hospital was 5.22 +/- 4.47 and 4.61 +/- 3.06 (NS), respectively. Global left ventricular ejection fraction at rest was 44 +/- 14 and 51 +/- 15% (p = 0.054), respectively, and no change occurred in either group from rest to peak exercise. Ventricular fibrillation occurred in 1 placebo patient during the first day in hospital and in 1 metoprolol patient on the 14th day. Holter monitoring revealed no significant difference in the occurrence of ventricular arrhythmias during the first 24 h. Smaller enzyme release and higher ejection fraction suggest myocardial protection by early metoprolol treatment in acute myocardial infarction.

Clinical Trials as Topic↗
PubMed1989

Reversed left internal mammary artery graft for coronary bypass. Evaluation of function with digital subtraction angiography and radionuclide imaging.

Reversed left internal mammary artery grafting with retrograde flow to the left anterior descending coronary branch was used in five of 500 consecutive bypass operations. The indications were significant stenosis in the left subclavian artery (3 patients) or the proximal left internal mammary artery (1) and proximal damage to the left internal mammary artery during dissection from the thoracic wall (1). The postoperative clinical course was smooth in all five patients, with no evidence of myocardial ischemia. In follow-up averaging 14 months four patients were asymptomatic. The reversed internal mammary artery graft was visualized with digital subtraction angiography in four cases. Radionuclide imaging during exercise confirmed graft patency in all but the symptomatic patient, who was found to have an area of reversible ischemia anteriorly in the left ventricle.

Adult↗
PubMed1988

Improvement of left ventricular function after starting insulin treatment in patients with non-insulin-dependent diabetes.

Left ventricular function was evaluated noninvasively before and three months after starting insulin treatment in nine patients (mean age 61.8 years, range 51-68 years) with non-insulin dependent diabetes showing an impaired insulin secretion capacity. After starting insulin treatment, fasting blood glucose decreased from 12.9 +/- 0.5 mmol/l (mean +/- SEM) to 9.8 +/- 1.2 mmol/l (p = 0.03), but the decrease of glycosylated haemoglobin Alc was not significant (9.0 +/- 0.4% vs. 8.3 +/- 0.6%). On systolic time intervals, PEP/LVET ratio improved from 0.44 +/- 0.03 to 0.37 +/- 0.02 (p = 0.03). On M-mode echocardiography, E-F slope became steeper (89 +/- 6 mm/sec vs. 103 +/- 8 mm/sec; p = 0.01) but no significant changes were observed in other variables reflecting diastolic or systolic function. On equilibrium radionuclide angiocardiography, the left ventricular ejection fraction at rest was similar before and after starting insulin treatment (48.6 +/- 3.2% vs. 49.2 +/- 2.8%) but during peak exercise the left ventricular ejection fraction improved significantly (51.0 +/- 5.3% vs. 59.9 +/- 4.7%; p = 0.02). The change of PEP/LVET ratio correlated significantly with the changes of blood glucose and glycosylated haemoglobin Alc levels, but the correlation between these metabolic variables and the change of left ventricular ejection fraction during exercise did not reach statistical significance. In conclusion, the left ventricular function improved concomitantly with improved metabolic control after starting insulin treatment in middle-aged patients with non-insulin-dependent diabetes having an impairment in insulin secretion capacity. This finding suggests that metabolic factors are involved in the left ventricular dysfunction observed in diabetes.

Blood Glucose↗
PubMed1987

First-pass radionuclide ventriculography in conscious dogs.

Trained, chronically instrumented, conscious dogs were used to study the function of the left ventricle by first-pass radionuclide ventriculography (RNV). Six dogs were trained prior to a sterile left thoracotomy, where a left atrial catheter was implanted. After recovery of four days RNV was carried out by injecting a bolus of technetium-99m-DTPA via the catheter to the left atrium. The data was collected for 12 s to a computer by frame rate of 20 frames/s from left lateral view of the dog. The experiments were performed both in four-leg standing and in 60 degrees head-up tilted positions. The measurements were done with two injection volumes (0.25 and 1.0 ml/kg) to study the effect of volume on the results. The body position had effect on left ventricular end-diastolic and stroke volumes, whereas ejection fraction remained unchanged. In comparison of the two injection volumes a minor difference was found in left atrial emptying, while the differences in left ventricular function were non-significant. In spite of training and careful standardization of experimental procedures, relatively high individual variation between animals was found in most parameters studied. The first-pass RNV method proved to be promising for measuring the left ventricular function in conscious dogs. Although the left atrium has reflectory tachycardic potential to distension, the volumes used for RNV did not affect the results. The left ventricular adaptation to head-up tilting in conscious dogs seems to consist mainly of decrease in left ventricular volume without significant effect on ejection fraction.

Animals↗
PubMed1986

Volumetric measurements in endotoxic shock using single photon emission tomography (SPET).

In 25 sheep organ volumes were determined using single photon emission tomography (SPET) prior to and during early endotoxic shock. The tracer used was in vitro 99Tcm-labelled red blood cells. The comparisons between the SPET volumes with the different lower threshold (LT) settings and the 'true' weighed organ volumes were done. The correlation coefficient of -0.87 was found between the LT and the 'true' liver volume and same for the spleen was -0.87. The LT-volume correction curves were used to determine the correct SPET volumes. Thus the accuracy of the liver volume lies within +/- 8%, the splenic volume within +/- 13% and that for the kidney volume +/- 19%. A highly significant decrease of the splenic volume was found 1 h after the induction of endotoxic shock, from 178 +/- 55 ml (mean +/- S.D.) to 101 +/- 25 ml. The kidney volume also decreased from 102 +/- 28 to 78 +/- 19 ml (p less than 0.05), whereas the liver volume remained nearly unchanged (796 +/- 219 versus 761 +/- 165 ml). The SPET study allows measurement of the organ volumes in vivo and the results are reliable when compared to the 'true' volumes. However, the proper LT-settings for organ contour are volume dependent and must be taken into account.

Animals↗
PubMed1986

Multiple tracer dilution estimates of D- and 2-deoxy-D-glucose uptake by the heart.

Permeability-surface area products of the capillary wall, PSc, and the myocyte sarcolemma, PSpc, for D-glucose and 2-deoxy-D-glucose were estimated via the multiple indicator-dilution technique in isolated blood-perfused dog and Tyrode-perfused rabbit hearts. Aortic bolus injections contained 131I-albumin (intravascular reference), two of three glucoses: L-glucose (an extracellular reference solute), D-glucose, and 2-deoxy-D-glucose. Outflow dilution curves were sampled for 1-2.5 min without recirculation. The long duration sampling allowed accurate evaluation of PSpc by fitting the dilution curves with a multiregional axially distributed capillary-interstitial fluid-cell model accounting for the heterogeneity of regional flows (measured using microspheres and total heart sectioning). With average blood flow of 1.3 ml . g-1 . min-1, in the dog hearts the PSc for D-glucose was 0.72 +/- 0.17 ml . g-1 . min-1 (mean +/- SD; n = 11), and PSpc was 0.57 +/- 0.15 ml . g-1 . min-1. In the rabbit hearts with perfusate flow of 2.0 ml . g-1 . min-1 (n = 6), PSc was 1.2 +/- 0.1 and PSpc was 0.4 +/- 0.1 ml . g-1 . min-1. PSc for 2-deoxy-D-glucose was about 4% higher than for D-glucose and L-glucose in both preparations. Relative to L-glucose, there was no measurable transendothelial transport of either dextroglucose, indicating that transcapillary transport was by passive diffusion, presumably via the clefts between cells. The technique allows repeated measurements of D-glucose uptake at intervals of a few minutes; it may therefore be used to assess changes in transport rates occurring over intervals of several minutes.

Animals↗
PubMed1986

A radionuclide model for studying changes in the regional blood volumes during early endotoxic shock: an experimental model.

Septic shock constitutes a great threat to patients undergoing major abdominal surgery and also to trauma patients. The current state of knowledge on pathophysiological mechanisms in septic shock is not fully known. The aim of this study was to develop an experimental model that resembled the clinical situation and allowed the exploration of central and peripheral vascular mechanisms in endotoxic shock. Seven anesthetized sheep (weighing 30-45 kg) were provoked to lethal endotoxic shock by intravenous injection of 3 mg/kg bodyweight Escherichia coli endotoxin. The arterial pressure was monitored. Serial radionuclide images of the chest and abdomen were recorded after injecting technetium-99m-labeled RBC's. The volumetric (blood) alterations of liver, spleen, kidney, heart, and lungs, as well as peripheral muscle were measured. Prior to injection of endotoxin base-line data were obtained. Two to 4 minutes after injection, spleen volume decreased by -36% (mean) followed by a slow restoration; the left ventricular volume and kidneys increased by a maximum of 10-15%, while the liver volume increased by 38% of initial volume.

Animals↗
PubMed1986

Enalapril in chronic heart failure, a double-blind placebo-controlled study.

The efficacy of enalapril, a new angiotensin-converting enzyme inhibitor, was investigated in a double-blind placebo-controlled study in 24 patients with chronic heart failure. The patients belonging to NYHA functional class II-IV and treated with digoxin and diuretics were randomized to enalapril (12 patients) or placebo (12 patients) treatment for a 12-week period. Assessments were carried out at baseline and at 4 and 12 weeks during the treatment period. Complete data could be obtained on 10 patients receiving enalapril and on 11 patients receiving placebo. NYHA functional class improved by at least one class in 6 of 10 patients in the enalapril group, but only in 1 of 11 patients in the placebo group (chi 2 = 6.54; p less than 0.05). Duration of bicycle ergometer exercise increased significantly in the enalapril group from 8.8 +/- 3.4 to 11.3 +/- 4.2 (4 weeks) and to 11.2 +/- 3.6 min (12 weeks; p less than 0.05 for both), whereas it remained unchanged in the placebo group. Left ventricular ejection fraction by radionuclide ventriculography in the enalapril group increased significantly (baseline: 33.5 +/- 19.9%, 4 weeks: 40.0 +/- 20.0% (p less than 0.001), 12 weeks: 39.6 +/- 20.1% (p less than 0.01], whereas in the placebo group it did not change significantly from the baseline of 48.8 +/- 16.7%. The results indicate that enalapril induces a sustained relief of symptoms and improves exercise capacity in patients with heart failure. This subjective improvement appears to be accompanied by an increase in ejection fraction.

Adult↗
PubMed1986

Assessment of cardiopulmonary alterations in endotoxic shock.

Using radionuclide first-pass technique, seven sheep were studied prior to and during endotoxic shock. In vitro labeled 99mTC red blood cells were used to measure right and left ventricular ejection fractions (RVEF and LVEF) and cardiopulmonary transit time (CPTT) prior to and at 1, 4, 30, and 60 minutes after the intravenous injection of endotoxin Escherichia coli, 3 mg/kg bodyweight. The LVEF decreased slightly from 51 to 42% but became normal four minutes later, while the RVEF remained decreased from 49 to 26% for 60 minutes. The CPTT was prolonged from 13 to 26 cardiac beats. The decrease in RVEF was well correlated with the prolongation of the CPTT.

Animals↗
PubMed1983

Cerebral blood flow in polycythaemia vera.

Haematological variables, cerebral blood flow (CBF) and cardiac index were investigated in 14 patients with polycythaemia vera undergoing venesections. The most important determinant of the CBF was the age of the patients (r = 0.52, p less than 0.05). CBF improved after venesection in the patients in whom the blood volume removed by venesections was over 1000 ml (from 28 to 34 ml/100 g/min; p less than 0.005) and in elderly patients with very low initial CBF (less than or equal to 25 ml/100 g/min) at the haematocrit levels higher than 0.45 (p less than 0.02). Venesections did not change cardiac index. It is suggested that the importance of the haematocrit level as a regulator of CBF increases with age.

Aged↗
PubMed1982

Non-invasive evaluation of anthracycline-induced cardiotoxicity in man.

Measurements of radionuclide first-pass left ventricular ejection fraction (LVEFrn) were carried out in 37 patients receiving doxorubicin and/or daunorubicin treatment for their malignant disease. The validity of the systolic time intervals (STI) and echocardiography (ECHO) in the detection of left ventricular dysfunction was evaluated using LVEFrn as reference method. LVEFrn showed a significant decrease in left ventricular function with cumulative anthracycline doses inpatients with and without previous clinical evidence of cardiovascular disease. A multiple regression analysis showed that the impairment in LVEFrn was significantly correlated with the cumulative anthracycline dose, patient's age and previous cardiovascular disease. In five patients (one without previous cardiac disease, one with coronary artery disease, three with hypertension) the drug had to be withdrawn due to signs or symptoms of cardiac dysfunction. The sensitivity and the specificity of STI and ECHO in the detection of left ventricular dysfunction remained rather low as compared with the results by LVEFrn.

Adolescent↗
PubMed1981

Serial measurements of quantitative EEG and cerebral blood flow and circulation time after brain infarction.

The quantitative EEG (QEEG), regional cerebral blood flow (rCBF) and circulation time of 17 patients were examined semisimultaneously thrice during the first 3 months after a cerebral supratentorial infarction. The EEG was quantified according to normalized slope descriptor technique in nine patients and by means of a combined period and amplitude analysis in eight patients. Intravenously injected isotopes 133Xenon and 99TcmO4 were used for blood flow and circulation time measurements. The QEEG-values improved during the whole follow-up period. Cerebral blood flow stayed low for all 3 months and did not alter during this period, while initially prolonged circulation time to some extent improved within 2 weeks remaining, however, prolonged even thereafter. A tendency for a positive correlation between QEEG and rCBF values in the infarcted hemisphere could be seen.

Adult↗
PubMed1981

Elimination of extracranial blood flow during dynamic cerebral perfusion studies using diffusible and non-diffusible radioisotope.

The extracranial blood flow seriously complicates the interpretation of dynamic cerebral studies. To eliminate this, we used a blood pressure cuff placed around the head in 50 patients with no evidence of cerebrovascular disease. The pressure in the headband was increased to 30 mmHg above the patient's systolic pressure, and the first 60 sec static scintigram was taken exactly 3 min after the injection of 99mTc-pertechnetate. A second 60 sec static scintigram was taken without pressure in the headband at 6 min after injection. After correction for diffusion of tracer into extravascular compartments we could still show 13% reduction in counting rates over the hemispheric regions and 30% over the convexity regions during application of the pressure headband. With the Xenon method, the application of the headband appears to have insignificant influence on the results of cerebral perfusion. We thus recommend that a headband should be used for dynamic 99mTc-isotope cerebral circulation studies.

Cerebrovascular Circulation↗