Biomedical subjects

O Munck

Publications and source records attributed to O Munck.

At least 37 records · Page 2Linked to original sources

PubMed1989

Prospective evaluation of chronic cardiotoxicity due to high-dose epirubicin or combination chemotherapy with cyclophosphamide, methotrexate, and 5-fluorouracil.

In a prospective study the left ventricular ejection fraction (LVEF), right ventricular ejection fraction (RVEF), systolic blood pressure, ECG, and heart rate were recorded at rest and during submaximal work to compare the cardiotoxic effect of epirubicin with a combination chemotherapy without known cardiotoxicity. A total of 14 females with advanced breast cancer were treated with epirubicin at a median cumulative dose of 827 mg/m2 (range, 550-1244). These patients had previously received cyclophosphamide, methotrexate, and 5-fluorouracil (CMF) or cyclophosphamide alone as adjuvant treatment, or CMF for advanced disease. The control group consisted of 11 females with advanced breast cancer given CMF only. The systolic blood pressure at rest as well as during submaximal work was significantly lower (P less than 0.05) after treatment in the epirubicin group than in the CMF controls. With regard to LVEF, the median value of 54% at rest was significantly lower after treatment in the epirubicin group than in the controls (59%). There was a significant fall in LVEF at rest and during exercise in the epirubicin group, whereas no such changes were found in the CMF controls after treatment. The RVEF was unaffected. In the epirubicin-treated group one patient developed fatal congestive heart failure, and in the remaining 13 patients treatment was discontinued due to progression of the cancer and not to cardiotoxicity. Thus, the cardiotoxicity of epirubicin changed the clinical outcome in only 1 of 14 patients with advanced breast cancer.

Adult↗

PubMed1989

The value of the left ventricular ejection fraction in the treatment of angina pectoris following acute myocardial infarction: a randomized double blind study.

Radionuclide determination of left ventricular ejection fraction was performed at hospital discharge and one month later in 60 patients who had suffered acute myocardial infarction. At the first determination, the patients were randomized into two groups. In the first group, the cardiologist who cared for the patients was provided with the result of the determination of the ejection fraction whereas, in the second group, the result was withheld. At a 'blinded' evaluation two months after hospital discharge, 7 of those patients (24%) from the group where the cardiologist knew the ejection fraction and 11 of the patients (38%) in whom this result was withheld complained of angina pectoris on exertion (ns). The medication of the patients did not differ in the two groups. No significant difference was found in the values of the ejection fraction in patients with and without angina pectoris. In this controlled study, we were not able to document a clinical effect by routinely determinating left ventricular ejection fraction in patients with acute myocardial infarction in the treatment of angina pectoris.

Adrenergic beta-Antagonists↗

PubMed1989

First passage radionuclide cardiography for determination of cardiac output: evaluation of an improved method.

A noninvasive method for determination of cardiac output by aid of first passage radionuclide cardiography is presented. As opposed to most other scintigraphic methods, a forward blood flow is measured, even in patients with valvar incompetence. In addition, the technique allows measurement of cardiac output in the presence of cardiac arrhythmias. No geometrical assumptions, corrections for radiation attenuation, loss of tracer, or empirical correction factors due to extracardiac radioactivity are required. We have evaluated the method in 19 patients with various heart diseases by comparison of the radionuclide cardiac outputs with those derived from the thermodilution technique performed simultaneously. Eight patients had valvar incompetence and 2 had cardiac arrhythmias. The mean radionuclide and thermodilution cardiac output values were 5.03 l/min (SD 1.21) and 5.18 l/min (SD 1.09), respectively. The 95% confidence interval for the bias was -0.40 to 0.10 l/min, and correlation analysis demonstrated an excellent correlation between results obtained with the two methods, r = 0.91 (P less than 0.001). This study shows that the improved gamma camera method represents a valid noninvasive technique for determination of cardiac output.

Adult↗

PubMed1989

Reproducibility in the analysis of multigated radionuclide studies of left ventricular ejection fraction.

The authors determined the reproducibility (the standard deviation [SD]) in the analysis of multigated radionuclide studies of left ventricular ejection fraction (LVEF). Radionuclide studies from a consecutive series of 38 patients suspected of ischemic heart disease were analyzed independently by four nuclear medicine physiologists and four laboratory technicians. Each study was analyzed three times by each of the observers. Based on the analyses of the eight observers, the SD could be estimated by the use of a variance component model for LVEF determinations calculated as the average of the analyses of an arbitrary number of observers making an arbitrary number of analyses. This study presents the SDs for LVEF determinations based on the analyses of one to five observers making one to five analyses each. The SD of a LVEF determination decreased from 3.96% to 2.98% when an observer increased his number of analyses from one to five. A more pronounced decrease in the SD from 3.96% to 1.77% was obtained when the LVEF determinations were based on the average of a single analysis made by one to five observers. However, when dealing with the difference between LVEF determinations from two studies, the highest reproducibility was obtained if the LVEF determinations at both studies were based on the analyses made by the same observer. No significant difference was found in the reproducibility of analyses made by nuclear medicine physicians and laboratory technicians. Our study revealed that to increase the reproducibility of LVEF determinations, special efforts should be made to standardize the outlining of the end-systolic region interest.

Adult↗

PubMed1989

Elemental diet: a therapeutic approach in chronic inflammatory bowel disease.

The therapeutic effect of an elemental diet (Pepti 2000) and blended normal diet (placebo) was investigated in 43 out-patients with chronic inflammatory bowel disease (IBD); 24 with ulcerative colitis (UC) and 19 with Crohn's disease (CD), in a mild to moderate state of disease activity. A pilot study on healthy volunteers was executed to investigate palatability of the two diets. The patients were randomized in a double-blind study to the two diet regimes for 14 d. A simultaneous determination of laboratory data including plasma C3c split product and urinary excretion of 51Cr-EDTA was carried out together with a careful registration of the clinical symptoms and signs. No significant effect on the stage of clinical activity was seen in CD. A significant effect on clinical activity was obtained in both UC groups. The clinical improvement was primarily due to a decrease in number of bowel movements both in the elemental diet group and in the group of patients on the blended normal diet. The gross appearance of rectal mucosa did not improve during the study period in the Pepti 2000 or in the placebo group. The concentration of complement split products in plasma remained unchanged. 51Cr-EDTA excretion, as an expression of a leaky bowel mucosa, also remained unchanged. It was concluded that an effect on inflammation could not be demonstrated even if both diets seem to have a beneficial effect on the stage of clinical activity, especially diarrhoea, in patients with UC.

Adult↗

PubMed1989

Long-term prognosis and quality of life after reversible cerebral ischemic attacks.

The long-term prognosis and quality of life of 201 patients admitted to hospital with reversible ischemic attacks (RIA) were estimated in a prospective study. The median follow-up time was 58 months. Further RIAs were reported by 91 patients (45%) and 48 (24%) suffered a stroke. The risk of stroke was markedly higher in the first 6 months after RIA, after which the annual stroke rate was rather constant with an average of 4.8%, about 8 times higher than expected. The average annual mortality rate for the RIA patients was 5.9%, which is significantly higher than expected. Cardiovascular deaths accounted for more than half of all deaths, stroke for one fourth. Life-table analysis of subgroups disclosed a much more favorable prognosis for women under 60 years. High systolic blood pressure, diabetes, and previous myocardial infarction were identified as risk factors. The occurrence of RIA had significantly influenced the quality of life and occupational status for the majority of the patients, even for those who did not suffer a subsequent stroke. Decreased working capacity, general asthenia and fatigue and impaired memory were the most common complaints. We conclude that RIA may be a more serious vascular event than generally believed. Apart from carrying a substantial risk of stroke and death, even a single RIA can cause permanent psychological dysfunction influencing the quality of life.

Actuarial Analysis↗

PubMed1989

Central haemodynamic changes after a meal.

Eight healthy people (seven men and one woman, aged 19 to 31 years) were studied by radionuclide cardiography when supine before and 30 minutes after a standard meal (6300 kJ). Control investigations were performed on a different day within a week of the standard meal. There was a median increase in cardiac output of 62% that was attributable to a 17% increase in heart rate and a 41% increase in stroke volume. Blood pressure and concentrations of plasma catecholamines did not change. The median end diastolic and end systolic volumes of the left ventricle increased by 41% so that the left ventricular ejection fraction was unchanged. There were no significant changes during the control experiments. In healthy people a meal caused an appreciable increase in stroke volume and dilatation of the left ventricle. The activity of the sympathetic nervous system, as measured by plasma catecholamines, did not change much, and changes in blood volume alone did not seem to explain the haemodynamic response to the meal.

Adult↗

PubMed1989

The effects of cimetidine on creatinine excretion, glomerular filtration rate and tubular function in renal transplant recipients.

The renal clearance of endogenous creatinine (CCr), sodium (CNa) and lithium (CLi) was determined before and after a single intravenous bolus of cimetidine in nine renal transplant recipients. The glomerular filtration rate (GFR) was measured with 125I-iothalamate clearance (CTh). The initial CCr of 65 ml/min (median) was reduced to a nadir of 46 ml/min (p less than 0.01) during the first 2 h after infusion of cimetidine. GFR remained unchanged, and thus the fractional clearance of creatinine (CCr/CTh) was reduced from 1.43 (median) to 1.03 (p less than 0.01). CNa and the fractional excretion of sodium decreased throughout the study (p less than 0.05); CLi was unchanged. In conclusion cimetidine, when measured during 1-h clearance periods, interferes with tubular creatinine secretion in the denervated kidney of transplant recipients without affecting the glomerular filtration rate or proximal tubular flow. This suggests that on-going cimetidine treatment must be taken into account when graft function is evaluated by the CCr alone.

Absorption↗

PubMed1989

Experience with 7,604 bone scintigraphies at time of operation for breast cancer 1977-1987.

From 1977 to 1987, 7,604 out of a total of 20,483 Danish breast cancer patients had a bone scintigraphy in order to exclude or localise osseous metastases. The scintigrams were performed and interpreted at 14 local hospitals. In 1979, standardised guidelines for interpretation were agreed upon. Until 1983, the scintigrams were described centrally, based on the local reports. From 1979, the frequency of positive bone scintigrams suggesting bone metastases stabilised at about 5% of the patients compared with 12 and 20% in 1977-78. The local take-over of description did not change the frequency. The frequency was also stable from 1979 when evaluated in age groups. With increasing age the frequency of positive scintigrams increased. The frequency of positive scintigrams was significantly lower in patients entering a protocol than in those not entering a protocol. The conclusion is that on a nation-wide basis it is possible to establish a stable, uniform interpretation of bone scintigrams after a two-year introduction period.

Adult↗

PubMed1988

Hemodynamic effects of alcohol at rest and during upright exercise in coronary artery disease.

The hemodynamic effects of acute alcohol intoxication were studied at rest and during upright exercise in 28 patients with coronary artery disease by right-sided heart catheterization and radionuclide cardiography. The mean arterial blood pressure at rest was reduced by 5% and the left ventricular ejection fraction at rest decreased 2% because of end-systolic dilation during intoxication (serum ethanol 21 mmol/liter). No changes were observed in heart rate, stroke volume, pulmonary artery pressure, pulmonary artery wedge pressure or total peripheral resistance. No significant changes occurred in plasma catecholamines, and no changes occurred in any variable during mild exercise corresponding to a 30 to 40% heart rate increase. Thus, alcohol ingested in moderate doses causes slight impairment of left ventricular emptying and a reduction in the arterial blood pressure at rest in patients with coronary artery disease. A mild exercise load can be tolerated during alcohol intoxication without hemodynamic changes.

Aged↗

PubMed1988

Combined first pass and equilibrium radionuclide cardiographic determination of stroke volume for quantitation of valvular regurgitation.

A new noninvasive procedure for quantitation of cardiac valve regurgitation was evaluated using a combination of first pass and gated equilibrium radionuclide cardiography in 38 subjects with and without cardiac valve disease. Left-sided cardiac catheterization was performed to determine the severity of mitral incompetence and aortic regurgitation semiquantitatively. In healthy subjects and in patients without valve disease, stroke volumes were nearly identical with the two methods and the correlation was high (r = 0.98 [p less than 0.001]). The mean regurgitation fraction was 13% in patients with mild mitral incompetence and 2+ aortic regurgitation, 37% in patients with moderate mitral incompetence and 3+ aortic regurgitation and 57% in patients with severe mitral incompetence and 4+ aortic regurgitation. These findings suggest that combined first pass and gated equilibrium radionuclide cardiography, being insensitive to intracardiac shunts and right-sided valve disorders, constitutes a valid noninvasive technique for quantitation of left-sided cardiac valve regurgitation.

Adult↗

PubMed1988

Changes in glomerular filtration rate, lithium clearance and plasma protein clearances in the early phase after unilateral nephrectomy in living healthy renal transplant donors.

1. Glomerular and tubular function was studied before and 2 months after unilateral nephrectomy in 14 healthy kidney donors by measurement of the clearances of 51Cr-labelled ethylenediaminetetra-acetate, lithium, beta 2-microglobulin, albumin and immunoglobulin G. 2. The glomerular filtration rate (GFR) of the kidney that remained in the donor rose from 45 +/- 10 (mean +/- SD) to 59 +/- 10 ml/min (P less than 0.01) 5 days after contralateral nephrectomy and remained at this level through the observation period. 3. The lithium clearance (CLi) of the remaining kidney rose from 11.6 +/- 3.7 to 20.5 +/- 8.2 ml/min (P less than 0.01) and remained significantly elevated throughout the observation period. 4. Absolute proximal fluid reabsorption rate (APR), which was estimated as GFR minus CLi, was unchanged 5 days after contralateral nephrectomy, but then rose gradually to reach significantly elevated levels after 4 weeks. 5. Fractional proximal reabsorption (FPR; APR/GFR) fell from 0.75 +/- 0.06 to 0.66 +/- 0.11 (P less than 0.01) but subsequently rose to levels not significantly decreased from normal. 6. Twenty-four hour fractional clearances of beta 2-microglobulin, albumin and immunoglobulin G rose markedly on the day of nephrectomy, peaked at 2-3 days and subsequently fell to moderately elevated levels. 7. Both the CLi and the plasma protein clearance studies demonstrate that the early response of the remaining kidney to contralateral nephrectomy in man is an increase in GFR, an unchanged APR and a fall in FPR. The proximal tubules thus initially handle the increased filtrate load by passing it on to more distal nephron segments.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1988

Sensitivity of 131I-hippuran diuresis renography and pressure flow study (Whitaker test) in upper urinary tract obstruction.

Diuresis renography and pressure flow studies were performed in 14 patients with unilateral hydronephrosis. Based upon the results of intravenous pyelography, typical symptomatology, and the outcome of surgical treatment, all patients were found to have upper urinary tract obstruction. It was therefore possible to calculate the sensitivity of the two tests. Obstruction was found at the pressure flow studies in 7 of 14 patients (50%), while an obstructive pattern was found at diuresis renography in 12 of 13 patients (92%). Due to a very low glomerular filtration rate, diuresis renography was equivocal in 1 case. Based upon these results, diuresis renography seems to be superior to pressure flow studies in cases with upper urinary tract obstruction.

Adult↗

PubMed1988

The influence of body posture on lithium clearance.

To establish appropriate standard circumstances for lithium clearance measurements, a study was undertaken in 12 healthy volunteers. In each subject, the glomerular filtration rate (GFR), as estimated by [51Cr]EDTA plasma clearance, and the renal clearances of lithium, sodium and potassium were measured four times at 1-week intervals: two in the supine and one in the sitting position, and one when the subject was walking around. Glomerular filtration rate was not influenced by posture changes. On the contrary, lithium clearance, which in the supine position was 30 +/- 9 ml/min (1 SD), tended to fall in the sitting position, and fell significantly to 26 +/- 5 ml/min (p less than 0.025) in walking subjects. Absolute proximal tubular reabsorption rate of fluid correspondingly rose from 83 +/- 16 to 92 +/- 15 ml/min (p less than 0.005) and sodium clearance fell from 1.52 +/- 0.81 to 1.00 +/- 0.52 ml/min (p less than 0.05) in walking subjects. Absolute distal reabsorption of sodium decreased during walking from 4052 +/- 1219 to 3449 +/- 658 mumol/min (p less than 0.025), while fractional distal reabsorption of sodium was unchanged. Our results show a rise in proximal tubular reabsorption during moderate physical activity. Hence, when renal tubular function is studied with the lithium clearance method, standardization of posture and physical activity is important. In such studies physical activity such as walking should particularly be avoided.

Adolescent↗

PubMed1988

Reliability of scintigraphic diagnosis of liver metastases.

Three experienced specialists in nuclear medicine independently read 52 liver scans for the presence or absence of metastases. The accuracy of the assessments was, for each of the observers and for the observers' agreed-upon assessments, determined against findings at laparotomy or autopsy. Overall accuracy, predictive values of a positive and negative test result, sensitivity, and specificity were 0.71-0.79, 0.80-0.90, 0.63-0.72, 0.63-0.77, and 0.77-0.91. The accuracy was not higher for the agreed-upon assessment than for each of the observers' assessments. The interobserver variation was calculated as overall agreement between pairs of observers and ranged from 0.85 to 0.94. After adjustment of overall agreement for chance agreement, kappa values from 0.70 to 0.88 were obtained. In the determination of intraobserver variation overall agreement rates and kappa values ranged from 0.90 to 0.94 and 0.84 to 0.88. The scintigraphic diagnosis of hepatic metastases is reliable but, to increase the reliability further, it should be examined whether observer error reflects error in the primary detection of findings in the scans or error in the overall interpretation.

Adult↗

PubMed1988

The value of pre-scheduled bone scintigraphies in breast cancer.

During the first 10 years of Danish Breast Cancer Cooperative Group (DBCG), the subcommittee on bone scintigraphy has focused on the value of bone scintigraphy at the time of operation in all patients and then yearly in those considered to be primarily operable (stage I and II). Out of 1175 patients examined at time of operation, bone metastases could be verified by x-ray or histology in only 16, of whom the majority had bone pain and/or spread to other organs. Similarly, around 2.5% per year for the first 3 postoperative years and about 1% per year during the next 4 postoperative years had bone metastases verified by x-ray or histology within 12 months after the latest scheduled bone scintigraphy. It is concluded that bone scintigraphy is of no value in primarily operable patients with breast cancer, and that the examination should be reserved for patients with symptoms and/or signs of bone metastases and for patients with relapse.

Bone Neoplasms↗

PubMed1988

Diuresis renography in patients with reduced renal function.

Diuresis renography was performed twice at an interval of one week in 13 uraemic patients without hydronephrosis. In five of the patients, the 51Cr-EDTA clearance was below 10 ml/min x 1.73 m2 for the individual kidney, in eight of the patients between 10 and 25. During the renographies, respectively, 0.5 and 7.5 mg/kg of frusemide was given I.V. at 20 min. Compared with the data from eight normal control patients, the effect of frusemide on the renography curve was very poor and varied much in both groups. Our results suggest that diuresis renography gives no conclusive information about the upper urinary tract in kidneys with a 51Cr-EDTA clearance below 25 ml/min x 1.73 m2, even when the dose of frusemide is increased to 7.5 mg/kg.

Diuresis↗

PubMed1988

Thallium-201 myocardial scintigraphy during dipyridamole-induced coronary hyperaemia. First experiences with a new regional washout programme.

Eight patients with severe peripheral vascular atherosclerosis scheduled for abdominal aortic surgery were investigated to detect coexisting coronary artery disease. None of the patients had a history of angina pectoris or previous myocardial infarction. Preoperative computerised thallium-201 dipyridamole myocardial scintigraphy was abnormal in all patients, showing either myocardial scar tissue and/or ischaemia with redistribution and/or low washout. In all but one patient, the serum level of creatin kinase was elevated during the first postoperative days. In two patients, the serum concentrations of aspartate aminotransferase and lactate dehydrogenase were elevated. None of the patients showed clinical or electrocardiographical signs of acute myocardial infarction. Thallium-201 dipyridamole myocardial imaging is a new noninvasive method for detection of ischaemic heart disease in patients with severe peripheral atherosclerosis who are unable to perform a bicycle exercise test. The new programme for determination of regional washout appeared to be very precise and may be especially applicable in the case of low washout values.

Aged↗