Biomedical subjects
Publications and source records attributed to P Bjerregaard.
Percutaneous balloon valvuloplasty of mitral stenosis was described in 1984. The subsequent results were promising and the method appears to be capable of replacing surgical valvotomy. Mitral balloon valvuloplasty in a patient with non-calcified rheumatic mitral stenosis is described here.
A 24-h Holter monitoring (HM) record was obtained on two occasions 8 years apart in 183 healthy subjects (120 male and 63 female), aged 40-85 years. The purpose of the study was to determine the minimal mean heart rate (HR-min) and longest pauses in heart rhythm, and to examine possible changes in these parameters over a longer period of time. (HR-min was calculated from a 1-min sample period.) HR-min was influenced by physical activity level and smoking habit, but was independent of age. Females had higher HR-min than males. In the male group mean HR-min was 54 beats min-1 and 53 beats min-1 on the two recordings (P greater than 0.05) (range 36-75 beats min-1 and 38-69 beats min-1). HR-min less than 40 beats min-1 was seen in 2.5% of the males. In the female group, the lowest recorded HR was 42 beats min-1 and mean HR-min on the two recordings was 58 beats min-1 and 56 beats min-1 (P less than 0.001). The paired HR-min observations were highly correlated. In all subjects, pauses greater than or equal to 1.75 s were registered in 6% and 6.5% on the two recordings. The occurrence of pauses was related to low HR-min. Above the age of 60 years sinus arrest was the type of pause most often seen.(ABSTRACT TRUNCATED AT 250 WORDS)
We report 12 patients with infiltrating muscular lipomas of the lower limbs all treated by wide resection. During follow-up averaging seven years, the tumour recurred in five patients. Our results and those reported by others suggest that, in order to avoid recurrence, this tumour, although benign, should be treated by total excision of the muscle or by compartmental resection. Hormonal imbalance was suspected in 9 of the patients but an oestrogen receptor analysis of the histological samples proved negative.
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The possible relation between Na-K-pump concentration and left ventricular (LV) function was studied in 24 patients with suspected idiopathic dilated cardiomyopathy. This was done by measurement of 3H-ouabain binding to biopsies obtained during left-sided heart catheterization. In all patients light microscopy of biopsies was compatilel with dilated cardiomyopathy. Nineteen patients had impaired LV function as defined by NYHA/WHO and a Na,K-pump concentration of 331 +/- 19 pmol/g wet weight, whereas 5 patients had normal LV function and a Na,K-pump concentration of 559 +/- 62 pmol/g wet weight (p less than 0.001). The correlation between Na,K-pump concentration and ejection fraction was highly significant n = 24, r = 0.81, p less than 0.001). There was no correlation between volume fraction of collagen tissue and Na,K-pump concentration in the biopsies (n = 24, r = -0.08, p less than 0.80), indicating that the decrease in Na,K-pump concentration with dilated cardiomyopathy is not the simple outcome of increased fibrosis in the myocardium. The results indicate that the decrease in Na,K-pump concentration may be of importance for myocardial dysfunction and suggest a simple biochemical assessment of dilated cardiomyopathy by measurement of 3H-ouabain binding.
To investigate whether the sodium-potassium pump or Na+,K+-ATPase concentration in muscles is related to the capacity for muscle performance, the 3H-ouabain binding site concentration or 3-O-methylflourescein phosphatase activity was determined in samples of heart ventricular muscles from trained rats, cardiomyopathic hamsters, and human subjects. These methods have earlier been shown to quantify the Na+,K+-ATPase concentration in muscle tissue with high accuracy. When rats were swim trained for six weeks the heart ventricular muscle Na+,K+-ATPase concentration was increased by 20% (p less than 0.02) and the heart to body weight ratio by 14% (p less than 0.005). The increase in Na+,K+-ATPase concentration was only slowly reversible. After three weeks of deconditioning an increase of 12% (p less than 0.05) was still observed. In comparison skeletal muscle Na+,K+-ATPase concentration was increased by up to 46% (p less than 0.001) and decreased by up to 30% (p less than 0.005) after training and immobilisation respectively. Cardiomyopathic hamsters showed a reduction of 33% (p less than 0.005) in the heart ventricular Na+,K+-ATPase concentration compared with normal hamsters. This decrease was associated with a heart to body weight increase of 19% (p less than 0.01) and congestive heart failure. In six patients with a mean ventricular ejection fraction of 68% the mean Na+,K+-ATPase concentration in endomyocardial biopsy specimens obtained by left heart catheterisation was 505(41) compared with 322(32) pmol.g-1 wet wt (p less than 0.001) in nine patients with a mean ejection fraction of 29%. Taken together the present data indicate a relation between the Na+,K+-ATPase concentration and the capacity for muscle performance.
Mortality 1968-83 from Ischaemic Heart Disease (IHD) and Cerebrovascular Disease (CD) was studied in native Greenlanders. Mortality from IHD was lower in Greenland than in Denmark for both males and females and especially low in Greenlandic settlements. IHD mortality decreased during the period. Mortality from CD was higher in Greenland than in Denmark with no certain time trend. Living conditions, of which a high intake of seafood may be a key factor, and/or a genetic predisposition seem to protect Greenlanders from IHD and to predispose them to CD.
A case of total dorsal luxation of the lunate, combined with an avulsion of the radial styloid is recorded. Radiographs did not reveal any other signs of carpal collapse. We suggest that a concurrent hyperflexion, ulnar deviation and pronation of the wrist joint may reasonably be regarded as the etiology of this lesion, which was treated by delayed, open reduction and partial intracarpal arthrodesis. Similar cases have not been reported.
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Twenty-four-hour heart rate control by verapamil given as conventional tablets t.d.s., or as a new slow release formulation once daily, has been compared in an open cross-over trial. Eight patients with chronic atrial fibrillation and one with chronic atrial flutter were studied outside hospital. Trough serum concentration of verapamil did not differ during the two dosage regimens (59 ng/ml - conventional formulation and 49.3 ng/ml - slow release tablet). The average serum concentration of digoxin in the patients was not changed. Compared to the control phase, both dosage regimens significantly and equally reduced individual and average heart rates throughout the entire 24-h period. A positive correlation between the serum concentration of verapamil and the relative increase in average R-R interval was demonstrated. It is concluded that dosage t.d.s. with conventional tablets of verapamil or once daily with the slow release formulation gave the same antiarrhythmic efficacy over 24 h, and was associated with equal trough serum concentrations of verapamil.
Amiodarone was administered to 53 patients with otherwise drug-refractory supraventricular tachycardias. Therapy was effective in 35 patients and partially effective in nine patients for a median duration of 35 months. The median maintenance dose was 200 mg/day in both groups, whereas the median serum amiodarone concentrations were 1.1 mg/l and 0.7 mg/l, respectively. Amiodarone was ineffective in nine patients despite higher dosage (median 400 mg/day) and insignificantly higher serum concentrations (median 2.0 mg/l). Neither the age of the patients, the duration or type of arrhythmia, the cardio-thoracic index, nor the type of underlying heart disease were predictive of the efficacy of amiodarone. Side-effects occurred in 28 patients, leading to withdrawal of therapy in 12 patients. Side-effects were not associated with higher serum amiodarone concentrations. Despite its efficacy, amiodarone should be reserved for otherwise drug-resistant supraventricular tachyarrhythmias.
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