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Biomedical subjects

M B Jorgensen

Publications and source records attributed to M B Jorgensen.

At least 19 recordsLinked to original sources
PubMed1999

Primary angioplasty for acute myocardial infarction resulting from the simultaneous occlusion of two major coronary arteries.

Primary angioplasty for acute myocardial infarction is frequently performed. Not uncommonly, more than one occluded artery may be present. Usually only one is an acute event, the others being chronic occlusions. We encountered a patient who presented with two simultaneous occlusions; both were successfully recanalized. We discuss some observations that assisted us in devising our treatment strategy.

Angioplasty, Balloon, Coronary↗
PubMed1997

Long-term clinical follow-up after directional coronary atherectomy.

Although several studies have been done to assess the safety, efficacy, and angiographic restenosis rates of directional coronary atherectomy (DCA), there have been no studies to document the need for repeat revascularization of the target vessel based purely on recurrence of symptoms. To answer this question, clinical and angiographic data were obtained for 187 consecutive patients undergoing this procedure on a native coronary artery utilizing a lesion specific approach in a referral hospital. Most of the patients had anginal symptoms that were not well controlled with medical therapy. The decision to perform DCA was based on the lesion characteristics (i.e., eccentric, ulcerated, or irregular discrete lesions in a large epicardial vessel). The procedure was successful in 96% of patients. In-hospital major complications were seen in 6 patients (3%) including acute myocardial infarction in 3 (1.5%) and emergency coronary artery bypass surgery in the other 3 (1.5%). There were no deaths. Among 141 consecutive successful patients on whom the procedure was performed between January 1992 and June 1994, 128 (91%) were contacted. At 6 months, revascularization was required in 20 patients for recurrent anginal symptoms, and there were no deaths or myocardial infarctions. The clinical restenosis rate, therefore, was 15.6%. At long-term follow-up (25 +/- 9 months), revascularization was performed in 3 more patients. One patient had a myocardial infarction and 3 patients died of noncardiac causes. Among those without clinical restenosis, 83% patients were asymptomatic and the rest had infrequent chest pains effectively managed with medications. The patients in the study group were using an average of 1.2 cardiac medications. Quality of life improved in 74% of the patients. Thus, in this study utilizing a lesion specific approach, the success rate for DCA was comparable to the published trials and in-hospital complications were few. The long-term clinical outcome was favorable with a low rate of clinical restenosis requiring repeat revascularization.

Adult↗
PubMed1995

Nonselective angiography of the internal mammary artery: a fast, reliable, and safe technique.

Selective cannulation of the mammary artery can be time consuming and carries a risk of arterial injury. The nonselective technique described here is faster, safer, and as reliable as the standard selective technique. A consecutive series of patients with previous coronary artery bypass graft surgery (CABG) were randomized to undergo either selective or nonselective mammary artery angiography. Selective angiography was performed using the standard selective technique. Nonselective angiography was performed by placing a standard catheter in the subclavian artery and hand injecting 10 ml of contrast while inflating a blood pressure cuff 10 mm above the systolic pressure in the ipsilateral arm. Fifty-six patients were studied, 30 patients selectively, and 26 patients nonselectively. The time to visualize adequately both native and grafted mammary arteries in the selective group was 4.83 + 5.00 min and in the nonselective group 1.76 + 1.16 minutes (P = 0.006). A nonselective technique for visualizing the mammary artery is significantly faster and as reliable as the standard selective technique.

Angiography↗
PubMed1995

Spontaneous regression of restenosis: an angiographic study.

OBJECTIVES: This study was designed to examine the possibility that spontaneous regression in stenosis severity occurs over time in patients with restenosis after percutaneous transluminal coronary angioplasty. BACKGROUND: The underlying mechanisms of restenosis are intimal hyperplasia and smooth muscle cell proliferation in response to vascular injury. We hypothesized that the initial hyperplastic response is followed by dynamic remodeling and eventual spontaneous regression, leading to stabilization or a reduction in stenosis severity. METHODS: A total of 136 patients participated in a trial to evaluate the efficacy of fish oil versus placebo in preventing restenosis after angioplasty. One hundred thirteen patients completed this study with angiographic follow-up, of whom 56 had restenosis. Of these, 19 were asymptomatic and did not undergo repeat revascularization; 15 consented in a separate study to undergo repeat angiography, which was performed 6 to 25 months later to assess the possibility of regression. RESULTS: There was a significant mean (+/- SD) decrease in lesion severity from 66.9 +/- 8.7% to 47.5 +/- 9.0% (p < 0.0001) and a significant mean increase in minimal lumen diameter from 0.91 +/- 0.31 mm to 1.44 +/- 0.35 mm (p < 0.0001). No patient showed progression of stenosis, but regression of restenosis, defined as a decrease in minimal lumen diameter > or = 0.2 mm, was noted in 12 of the patients. CONCLUSIONS: Although all 15 study patients were asymptomatic, similar changes may occur in symptomatic patients. A trial of medical therapy may be appropriate in asymptomatic or mildly symptomatic patients before further interventions. This strategy would avoid unnecessary invasive procedures, prevent a "restenosis cycle" and result in significant cost savings.

Aged↗
PubMed1994

Spontaneous coronary dissection: a cluster of cases with this rare finding.

Spontaneous coronary dissection is a rare entity. It has been reported to be usually fatal, with greater than an 80% mortality rate. From April 1990 through March 1993, 10 patients had spontaneous coronary dissection. This is a significant increase in the incidence of this diagnosis, with only one prior case at this institution in 1983 (p < 0.001). All of the patients survived. Of the 10 patients, eight were women, and seven of those were premenopausal. Only one was post partum. Acute myocardial infarction was the presenting condition in nine patients. Three patients had spontaneous dissections involving two arteries. Only one patient had associated atherosclerotic coronary artery disease. Surgery was required for continued symptoms in three patients, with difficulty grafting the dissected artery in two. Nine patients have no symptoms, and one has class II angina. With aggressive medical therapy the prognosis of patients with spontaneous coronary dissection may not be as dismal as previously reported.

Adult↗
PubMed1994

Do fish oils prevent restenosis after coronary angioplasty?

BACKGROUND: The omega-3 polyunsaturated fatty acids derived from fish oils have been shown to modulate many factors believed to affect the pathogenesis of atherosclerosis. Because certain features of restenosis following angioplasty mimic some of the early changes of atherogenesis, some researchers have suggested that fish oil might prevent restenosis following angioplasty. We report the effects of omega-3 fatty acids on the rate of restenosis following percutaneous intraluminal coronary angioplasty (PTCA). METHODS AND RESULTS: From August 1989 through September 1992, 551 patients were randomized to start receiving a daily dietary supplement of ten 1.0-g capsules containing 80.6% ethyl esters of omega-3 fatty acids providing 4.1 g eicosapentaenoic acid (EPA) and 2.8 g docosahexaenoic acid (DHA) for 6 months or an equal amount of an ethyl ester of corn oil. Four hundred seventy subjects who were well matched for risk factors completed successful angioplasty of one or multiple lesions in native coronary vessels and constituted the study cohort, of whom 447 were evaluable at 6 months after PTCA. The criteria for restenosis were that the quantitative coronary angiography at 6 months show a > 30% increase in narrowing at the stenosis site or loss of at least half of the gain achieved at the time of PTCA and final restenosis with < 50% luminal diameter remaining. In 93% of the patients, the end point was determined by angiography and in all except 1% of these by quantitative coronary angiography. Compliance with the fish oil supplement was good as judged by incorporation of EPA and DHA in plasma and red blood cell phospholipids. The restenosis rate among analyzable patients was 46% for corn oil and 52% for fish oil (P = .37). The addition of 200 mg alpha-tocopherol for all subjects during the study had no effect on restenosis rates. CONCLUSIONS: This was the largest of such trials to date, and a supplement of 8 g/d of omega-3 fatty acids failed to prevent the usual high rate of restenosis after PTCA. No adverse effects were attributable to this large daily supplement of omega-3 fatty acids.

Adult↗
PubMed1992

Diagnosis and treatment of granulomatous mastitis.

Granulomatous mastitis is a benign inflammatory breast disease of unknown etiology. Although it is rare, it frequently presents in a manner similar to that of breast carcinoma. Surgical resection of the affected tissue has often been the method of treatment, but many patients have experienced recurrences. Corticosteroids have also been used, but the initiation of this therapy is often limited by concerns related to the presence of an infectious etiology. Presented here are two cases that demonstrate the efficacy of corticosteroids in this condition after appropriate evaluation is performed.

Adult↗
PubMed1991

Post- and presynaptic lesions in the CA1 region of hippocampus: effect on [3H]forskolin and [3H]phorboldibutyrate ester binding.

The effect of transient cerebral ischemia and intraventricular injection of kainic acid on adenylate cyclase and protein kinase C as labeled by [3H]forskolin ([3H]FOR) and [3H]phorboldibutyrate ester ([3H]PDBU) in several rat brain microregions was investigated in a quantitative autoradiographic study. Four days after transient four vessel occlusion a 80% loss of [3H]FOR and a 35% loss of [3H]PDBU binding could be measured in the CA1 stratum radiatum of operated Wistar rats as compared to control rats. Four days after intraventricular injection of kainic acid only a marginal loss of [3H]FOR and a 30% increase of [3H]PDBU binding was seen in the CA1 stratum radiatum while in the CA3 stratum lucidum and radiatum respectively a 30% loss of [3H]FOR and no significant change in [3H]PDBU binding was observed. As transient cerebral ischemia and intraventricular kainic acid injection are depleting the hippocampal CA1 region of CA1 pyramidal cells and axons of CA3 pyramidal cells respectively in rat brain, these findings strongly suggest that both adenylate cyclase and protein kinase C are localized in CA1 pyramidal cells of rat hippocampus.

Adenylyl Cyclases↗
PubMed1988

Evidence for pre- and postsynaptic localization of adenosine A1 receptors in the CA1 region of rat hippocampus: a quantitative autoradiographic study.

The cellular localization of adenosine A1 receptors in the CA1 region of the rat hippocampus was investigated using radioligand binding and lesioning methods in a quantitative autoradiographic study. Kainic acid injection reduced [3H]cyclohexyladenosine binding in the CA3 region by 40% and in the CA1 region by 30%. Transient cerebral ischemia reduced [3H]cyclohexyladenosine binding in the CA1 region by 50%, while no change was measured in the CA3 region. These findings suggest that adenosine A1 receptors are located presynaptically on axon terminals of CA3 pyramidal cells and postsynaptically on the dendrites of CA1 pyramidal cells in the CA1 region of rat hippocampus.

Adenosine↗
PubMed1982

Bone resorption in otospongiosis.

"Considerable interest has been raised in recent years concerning the basic mechanisms involved in bone destruction and rebuilding in the otospongiotic focus. Under general bone resorption the osteoclasts play a decisive role, but in otospongiotic tissue electron-microscopic and cytochemical studies have shown that osteoclasts alone are not responsible for the bone resorption. Mononuclear histiocytes found in the marrow spaces and in the surrounding bone of an otospongiotic focus together with osteocytes take active part in the resorption. Cytochemical studies of acid phosphatase activity have shown that hydrolases in the lysosomes are expelled into the surrounding tissue, resulting in its resorption.

Acid Phosphatase↗