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Biomedical subjects

M Brekke

Publications and source records attributed to M Brekke.

At least 37 records · Page 2Linked to original sources
PubMed1999

[Angioplasty in heart arrest].

Early onset of cardiopulmonary resuscitation (CPR) and defibrillation are the most important factors for improving outcome after cardiac arrest. Many patients do not receive thrombolytic therapy after prolonged CPR, as there is a fear of serious bleeding complications. Ten patients with cardiac arrest and acute myocardial infarction were treated with primary angioplasty after prolonged CPR. Angioplasty was successful in nine of the patients, and left ventricular function was well preserved after six weeks. Primary angioplasty is highly effective and safe in establishing reperfusion in selected patients with acute myocardial infarction and cardiac arrest.

Adult↗
PubMed1999

Disease activity and severity in patients with rheumatoid arthritis: relations to socioeconomic inequality.

The aim of this study was to investigate possible differences in measures on disease process, joint damage, health status and self-efficacy between patients with rheumatoid arthritis (RA) living in an affluent and in a less affluent area in the same city. We analyzed data collected on patients enrolled in a community-based register of patients with RA in Oslo, Norway. 246 patients were examined by questionnaire in 1994 and 133 patients were examined clinically in 1997. Measures on disease process, joint damage, health status and self-efficacy were compared between patients from two residential areas. There was no significant difference regarding joint counts, patients' or investigator's evaluation of disease severity, blood test results and number of joint replacements. Significant differences were observed for disability and for various dimensions of health measured by the arthritis impact measurement scales and the short form-36: patients in the less affluent area reported poorer health status. Patients in this area also showed significantly lower scores on the arthritis self-efficacy scale. Patients with RA in two socioeconomically different areas in Oslo thus were found to be equal regarding disease process and joint damage measures. However, in the measures reflecting physical and psychosocial health status, patients in the less affluent area seemed to be more seriously ill. They also showed less confidence in their ability to influence the disease. Even in a welfare society with universal access to health care the impact of a well-defined chronic disease seems to be closely linked to the patient's socioeconomic situation.

Adolescent↗
PubMed1999

N-3 fatty acids do not prevent restenosis after coronary angioplasty: results from the CART study. Coronary Angioplasty Restenosis Trial.

OBJECTIVES: The aim of the study was to investigate whether omega-3 fatty acids (n-3 FA) reduce the occurrence of restenosis after percutaneous transluminal coronary angioplasty. BACKGROUND: Meta-analyses have shown significant reduction of restenosis after coronary angioplasty upon supplementation with n-3 FA. METHODS: In a prospective, placebo-controlled, double-blind study, 500 patients were randomly allocated to treatment with n-3 FA (Omacor, Pronova AS, Oslo, Norway) 5.1 g/day or corn oil (placebo) starting at least two weeks prior to elective coronary angioplasty. The treatment was continued until restenosis evaluation by quantitative coronary angiography after six months. Stenosis was defined as a minimal luminal diameter (MLD) < 40% of the reference diameter. Successful coronary angioplasty was defined as > or = 20% acute gain in MLD and a residual stenosis < 50%. Restenosis was defined as > or = 20% late loss of diameter and stenosis > 50% or an increase in stenosis of > or = 0.7 mm. Three-hundred ninety-two patients fulfilled the criteria for initial stenosis and successful coronary angioplasty, and, except four patients who died, none were lost for follow-up. RESULTS: Restenosis occurred in 108/266 (40.6%) of the treated stenoses in the Omacor group and in 93/263 (35.4%) in the placebo group (odds ratio [OR] 1.25, 95% confidence interval [CI] [0.87-1.80] p = 0.21). In the Omacor group one or more restenoses occurred in 90/196 (45.9%) patients as compared with 86/192 (44.8%) in the placebo group (OR 1.05, 95% CI [0.69-1.59] p = 0.82). CONCLUSIONS: Supplementation with 5.1 g n-3 FA/day for six months, initiated at least two weeks prior to coronary angioplasty did not reduce the incidence of restenosis.

Aged↗
PubMed1999

Periprosthetic leak and rupture after endovascular repair of abdominal aortic aneurysm: the significance of device design for long-term results.

We present a case of abdominal aortic aneurysm treated with an endovascular bifurcated aortic graft in which a periprosthetic leak caused by a tear in the polyester prosthesis appeared between 9 and 12 months after surgery. The tear appeared adjacent to a suture breakage that caused separation of two struts of the nitinol wire framework in the body of the stent graft. The leak was sealed with insertion of a new endovascular tube graft into the body of the bifurcation. Eight months later, the patient had a nonfatal rupture of the abdominal aortic aneurysm because detachment of the second limb from the bifurcation caused a new major periprosthetic leak. According to the manufacturer of this device, suture breakage with separation of metal components is commonly seen, but perforation of the polyester prosthesis caused by movement of the metal stent against the fabric has not been reported. It is likely that this occurred in our patient. Detachment of the second limb from the bifurcated stent, causing a rupture, has been described before. Increasing angulation and tortuosity of the stent graft, as a result of either remodeling of the sac or elongation of the stent, and reduced compliance to angulation after the stent-in-stent procedure might have contributed to the detachment in this case.

Aged↗
PubMed1999

Endovascular treatment of abdominal aortic aneurysms in Norway: the first 100 patients.

OBJECTIVES: to present the first 100 consecutive endograft implantations for abdominal aortic aneurysms (AAAs) in Norway. DESIGN: retrospective study of 100 consecutive graft implantations, performed at five University Hospitals during 1995 to 1997. MATERIAL: one hundred patients with a median age of 70 years were included. In all patients the Vanguard modular system (Boston Scientific Corp.) was used. Ninety-four of the 100 patients were treated under regional anaesthesia. A completion angiography was done to evaluate the position of the graft and whether endoleaks were present. RESULTS: two patients died within 30 days, one due to cardiac insufficiency and another due to haemorrhage during the procedure. There were four early conversions to open repair. At discharge eight patients had an endoleak, while retrograde flow into the aneurysmal sac was observed in four patients. During the follow-up period one conversion to open repair became necessary due to graft migration. Four late leaks were all repaired successfully using endovascular techniques. Five cases of retrograde filling were detected and embolisation with coils was performed in two cases, while three were observed. Seven graft-limb occlusions occurred during the follow-up period and four of these required treatment. CONCLUSIONS: endovascular AAA repair should be regarded as an experimental treatment, although the short term results are promising. Close follow-up of patients with CT scans or arteriography is necessary.

Aged↗
PubMed1998

[Angioplasty in acute myocardial infarction].

20 patients with acute myocardial infarction and a medical history of less than six hours were treated with immediate percutaneous transluminal coronary angioplasty. The median time from start of symptoms until establishment of reperfusion of the infarct related artery was 190 minutes, and the time from admission to insertion of the balloon was 52 minutes. Angioplasty was successful in all patients, with no serious complications. All patients experienced pain relief immediately after angioplasty. No patients died or had further infarctions. None needed hospitalization during the first three months of follow up. Eight patients had an exercise test between five and seven days after angioplasty and the other 12 at their six-week check up; there were no signs of ischemia or anginal pain. Measurement of global ejection fraction one week and six weeks after treatment showed median normal values and no significant changes (58% versus 57%). Myocardial perfusion imaging was carried out in eight patients both before hospital discharge and six weeks later. Normalization and improvement was seen in six patients using this method, whereas the perfusion was found unaltered in two patients. Hibernation or stunning, or both are suggested as possible explanations for this. We found the method highly effective and safe in selected patients.

Adult↗
PubMed1998

[Antithrombotic treatment in percutaneous transluminal coronary angioplasty].

Percutaneous transluminal coronary angioplasty is the most commonly used method for coronary revascularization in Norway. More than 3,500 procedures were performed in 1997. The presence of atherosclerotic endothelium is a strong stimulus to increased haemostasis. During balloon angioplasty, activation of the coagulation system is further increased by the trauma caused to the vessel wall. Major complications associated with coronary angioplasty include vessel occlusion, myocardial infarction, and periprocedural death. Most early complications occur as a result of the formation of a thrombus at the angioplasty site. Effective antithrombotic treatment is essential to reduce the risk of thromboembolic complications during and after percutaneous transluminal coronary angioplasty with or without stent implantation. All patients should be treated in advance with acetylsalicylic acid. Heparin must be given during the procedure. After stent implantation the patient should be treated with a combination of the two antiplatelet agents acetylsalicylic acid and ticlopidine. This article presents the current practice for using antithrombotic medication in percutaneous transluminal coronary angioplasty.

Angioplasty, Balloon, Coronary↗
PubMed1998

[Differences in morbidity between the Eastern central city district and the suburban Western district of Oslo].

Oslo, the capital of Norway, has a population of 500,000. Living conditions vary considerably within the city, and the mortality rate in the most deprived area is almost three times as high as in the most affluent one. We wanted to explore how morbidity varies within Oslo. We used four town-wide disease registers to study the prevalence of the four diseases in the most deprived and the most affluent part of the city. We found that tuberculosis occurs more frequently in the poor area, while type 1 diabetes mellitus in children occurs more frequently in the most affluent area. For multiple sclerosis and rheumatoid arthritis we could not find any differences between the areas.

Adult↗
PubMed1998

Myocardial damage during percutaneous transluminal coronary angioplasty as evidenced by troponin T measurements.

AIM: The present study was undertaken to assess the effect of balloon inflation during percutaneous transluminal coronary angioplasty on markers of myocardial damage. METHODS AND RESULTS: Seventy-five patients undergoing elective percutaneous transluminal coronary angioplasty were evaluated with serum creatine kinase MB and cardiospecific troponin T before and 1 and 4 days after the procedure. On day 1, 28% of the patients had increased cardiospecific troponin T values and 18% had increased creatine kinase MB values. On day 4, 24% had increased cardiospecific troponin T values, whereas all creatine kinase MB values were normal. A high degree of correlation between creatine kinase MB and cardiospecific troponin T on day 1, as well as between both markers on day 1 and cardiospecific troponin T on day 4 were found. The increased levels of cardiospecific troponin T on day 4 was significantly correlated with the total balloon inflation time (P < 0.001). CONCLUSION: We conclude that irreversible myocardial damage, as evidenced by increased cardiospecific troponin T values on day 4, occurs in an appreciable number of patients during percutaneous transluminal coronary angioplasty, and that this damage is strongly correlated with the total balloon inflation time.

Adult↗
PubMed1998

Markers of myocardial injury in blood following PTCA: a comparison of CKMB, cardiospecific troponin T and troponin I.

In 74 patients undergoing elective PTCA, CKMB, cTnT, cTnI-Access (cTnI-Acc) and cTnI-Abbott (cTnI-Abb) were measured in serum before and days 1 and 4 after the procedure. Two of the patients had pronounced biochemical evidence of AMI. In addition, a minor to moderate increase in CKMB, cTnT, cTnI-Acc and cTnI-Abb were found on day 1 in 13, 22, 18 and 25 patients, respectively. Excluding the two with AMI, cTnT was also increased on day 4 in 16 patients and cTnI-Abb in 15 patients, whereas CKMB and cTnI-Acc levels were essentially normal in all. Thus, an unexpected discrepancy between the two methods for cTnI was revealed on day 4. In these 16 patients, there was no statistically significant relationship between the level of cTnT on day 4 and the levels of CKMB or cTnI-Acc on day 1. This is in contrast to a significant correlation to cTnT and cTnI-Abb on day 1. Based on these results, it is speculated that the marker levels on day 1 are due to reversible as well as irreversible damage, whereas cTnT and cTnI-Abb on day 4 more selectively reflect the degree of myocardial necrosis. cTnT and TnI-Abb on day 4 are therefore proposed as valuable markers for further study of the clinical implications of myocardial damage following PTCA and related interventions.

Angioplasty, Balloon, Coronary↗