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Biomedical subjects

T Haghfelt

Publications and source records attributed to T Haghfelt.

At least 55 records · Page 3Linked to original sources
PubMed1994

Detection of a single base deletion in codon 424 of the low density lipoprotein receptor gene in a Danish family with familial hypercholesterolemia.

We performed a screening of exon 9 of the low density lipoprotein receptor (LDLR) gene in 14 Danish families with familial hypercholesterolemia (FH) using the denaturing gradient gel electrophoresis (DGGE) technique. In one of the probands from these families an abnormal band pattern in the gradient gel was detected. Subsequent DGGE analysis of the family of this index patient revealed that the DGGE pattern cosegregated with the disease in this family. Sequencing of the exon showed a deletion of a C in codon 424 of the LDLR gene resulting in a frame shift with the introduction of a stop codon 5 codons further downstream. The mutation is referred to as FH-Odense. The predicted truncated receptor protein consists of the 428 amino terminal amino acids. Consequently, the cytosolic and membrane spanning parts of the mature LDL receptor, which normally secure the receptor in the plasma membrane, are missing. The FH-Odense mutation results in severe premature coronary atherosclerosis as shown by the clinical expression in 5 generations of the affected family.

Adolescent↗
PubMed1994

Thrombolysis in acute myocardial infarction. The implementation of thrombolytic therapy in a coronary care unit in 1992.

In order to describe the execution of thrombolytic therapy in acute myocardial infarction (AMI) in a coronary care unit, case records of 427 admissions in 1992 due to definite or possible AMI were reviewed: 32% received thrombolytic therapy while 68% did not because of contraindications, delayed admission, advanced age or nondiagnostic ECG changes. Among cases otherwise eligible for thrombolytic therapy according to the instructions of the department, 32% did not receive thrombolytic treatment solely because of nondiagnostic ECG changes. There is an obvious need for implementation of improved early diagnostic tools in the decision-making of thrombolysis as for instance newer, sensitive biochemical markers and continuous vectocardiography.

Adult↗
PubMed1993

[Optimal treatment of chronic heart failure--with particular emphasis on angiotensin-converting enzyme (ACE) inhibitors].

The article reviews recent discoveries about the pathophysiology of chronic heart failure, especially where new insights have led to new treatment strategies, with particular emphasis on the use of angiotensin converting enzyme inhibitors. Indications for referral of patients with chronic heart failure to hospital for further investigation or treatment are also given. It is concluded that ACE-inhibitors represent a new era in the treatment of chronic heart failure in patients with isolated or for the main part systolic left ventricle dysfunction, and that ACE-inhibitor treatment must be regarded as a first line drug in this condition, along with diuretics and perhaps digoxin. Patients in NYHA class IIIb-IV should be referred to a specialist or hospital with regard to supplemental cardiological investigations and initiation of ACE-inhibitor treatment, if such treatment has not already ben started. Patients with slight to moderate heart failure (NYHA class II-IIIa) should be referred as well, unless it is known that the cause of heart failure is an ischaemic heart condition that does not require operation. In the latter case, after the relevant investigations have been conducted, ACE-inhibitor treatment can usually be started in a general practice setting, bearing the usual safety regulations and contraindications in mind.

Adult↗
PubMed1993

[Treatment of primary hypercholesterolemia with pravastatin. A placebo-controlled trial].

We present the results of a multicentre, placebo-controlled, randomized double-blind comparison of the treatment of primary hypercholesterolaemia with pravastatin (Pravachol), an HMG-CoA-reductase inhibitor. The study was conducted in both general practice and hospital settings. Two hundred and eighty-six patients who despite oral and written dietary instructions and advice on healthy living had elevated total serum cholesterol levels of between six and eight mmol/l were randomized to treatment with either parvastatin (Pravachol) or placebo. The study showed a significant reduction in both total serum cholesterol (of 16%) and serum LDL-cholesterol among those treated with pravastatin (Pravachol), as well as a small increase tin serum HDL-cholesterol of six percent. Advice on diet and healthy living resulted in a reduction of serum cholesterol of only 1.5%. There were no important differences between those treated from the hospital and those treated in general practice. The incidence of side-effects was low and comparable to placebo levels, and only two percent of the pravastatin (Pravachol) treated patients had to have the treatment stopped. All side-effects were reversible. No side-effects relating to the central nervous system were registered, and no elevations of serum creatinine phosphokinase were observed amongst the pravastatin treated patients, presumably because of the drug's selective inhibitory effect on cholesterol synthesis in the liver.

Adult↗
PubMed1993

[Neurohormonal activity in heart insufficiency].

The maintenance of cardiac pumping ability in the presence of a primary disturbance of myocardial contractility and/or an excessive haemodynamic strain on the heart is dependent on several compensatory mechanisms. Particular attention has formerly been paid to the importance of the Frank-Starling mechanism and cardiac hypertrophy and dilatation in maintaining a blood supply sufficient to cover the metabolic needs of various tissues in heart failure. In recent years, however, it has been found that certain neurohormonal systems (the sympathetic nervous system, the renin-angiotensin-aldosterone system, atrial natriuretic peptide and several locally acting vaso-active substances) undergo considerable changes according to the degree of heart failure. These compensatory mechanisms support the circulation wholly or partially in acute heart failure, however sustained neurohormonal activation may be harmful in chronic heart failure, where several neurohormonal factors may be activated to ill-effect. The most significant neurohormonal systems and their importance in heart failure are reviewed on the basis of the available literature.

Atrial Natriuretic Factor↗
PubMed1993

Neurohormonal systems during progression of heart failure: a review.

In the presence of a primary disorder in myocardial contractility and/or extraordinary hemodynamic pressure on the heart, ventricular performance depends on several compensating mechanisms. In the past, studies were mostly focused on the importance of the Frank-Starling mechanism and the hypertrophy and dilation of the heart in maintaining a circulation sufficient for metabolic intake during heart failure. Recently, however, the existence of neurohormonal systems has been demonstrated (the sympathetic nervous system, the renin-angiotensin system, atrial natriuretic peptide and several locally produced vasoactive substances), which change considerably according to the severity of the heart failure. While these compensatory mechanisms support the circulation in patients with acute heart failure, in whole or in part, neurohormonal activation over an extended period of time might be harmful to patients with chronic congestive heart failure since several neurohormonal factors might be inappropriately activated. This article will review the key neurohormonal systems and their importance in heart failure on the basis of the current literature.

Atrial Natriuretic Factor↗
PubMed1992

Lack of indication of myocardial cell damage after myocardial ischaemia in patients with severe stable angina.

To evaluate myocardial cell damage in relation to spontaneous and exercise-induced ischaemia, release of myoglobin, creatine kinase (CK) and its isoenzyme MB (CK-MB) into the serum was estimated in 10 patients with severe stable angina. All patients had a positive exercise test, significant stenosis of one or more of the main coronary arteries and more than five ischaemic attacks per week. ST-segment monitoring was performed for 36 h. During the last 24 h of that period (period A) serial blood samples were analysed for myoglobin, CK and CK-MB using sensitive assays. Three days later (period B) the patients performed an exercise test at 0815 h, with ST-segment monitoring and blood sampling carried out as described for period A. During period A, 47 ischaemic episodes (100% silent) with a total duration of 599 min were noted in four patients. Forty-seven ischaemic episodes (94% silent) with a total duration of 804 min, were observed in seven patients during period B. Release of myoglobin, CK, and CK-MB did not increase in relation either to spontaneous or exercise-induced ischaemia. Thus even frequent and prolonged episodes of transient myocardial ischaemia (symptomatic or asymptomatic) in patients with severe stable angina pectoris does not seem to cause irreversible myocardial damage.

Adult↗
PubMed1992

Drug related admissions to medical wards: a population based survey.

1. In total 1999 consecutive admissions to six medical wards were subjected to a prospective high-intensity drug event monitoring scheme to assess the extent and pattern of admissions caused by adverse drug reactions (ADRs) or dose related therapeutic failures (TF), in a population-based design. The wards were sub-specialised in general medicine, geriatrics, endocrinology, cardiology, respiratory medicine and gastroenterology. 2. Considering definite, probable and possible drug events, the prevalence of drug related hospital admissions was 11.4% of which 8.4% were caused by ADRs and 3.0% by TFs. There were large inter-department differences. 3. The six classes of drugs most frequently involved in admissions caused by ADRs were anti-rheumatics and analgesics (27%), cardiovascular drugs (23%), psychotropic drugs (14%), anti-diabetics (12%), antibiotics (7%), and corticosteroids (5%). Noncompliance accounted for 66% of the TFs with diuretics and anti-asthmatics most frequently involved. 4. The pattern of drugs involved in ADRs was compared with the regional drug sales statistics. Drugs with a particularly high rate of ADR related admissions per unit dispensed were nitrofurantoin and insulin (617 and 182 admissions per 1,000,000 defined daily doses), while low rates were seen for diuretics and benzodiazepines (10 and 7 admissions per 1,000,000 defined daily doses). Confidence intervals were wide. 5. Patients who had their therapy prescribed by a hospital doctor had a slightly higher prevalence of drug events than those who were treated by a general practitioner (12.6% vs 11.8%). The reverse applied for drug events assessed as avoidable (3.3% vs 4.6%). Although these differences were not statistically significant, it may suggest general practitioners as the appropriate target for interventive measures.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1991

Evaluation of intensified prehospital treatment in out-of-hospital cardiac arrest: survival and cerebral prognosis. The Odense ambulance study.

During a period of 3 years three different types of emergency medical service (EMS) systems were evaluated in a city with about 238,000 inhabitants/population density of 570/km2. Included were 393 out-of-hospital cardiac arrest patients in whom prehospital cardiopulmonary resuscitation was provided by personnel on basic, intermediate, or advanced care training. When ordinary ambulances (basic EMS) were used, 8 (5%) patients were discharged alive. When ambulances with specially trained paramedics (intermediate EMS) were used, 2 (1%) patients were discharged. Finally medically staffed ambulances with doctors collaborating (advanced EMS) were used, and 11 (13%) patients were discharged. The intermediate EMS system was used in another area with 45,000 inhabitants/population density of 340/km2, and in this area 20 (18%) patients were discharged. Among the survivors a psychological assessment in form of a test for dementia was assessed in long-term survivors (n = 30) together with 28 patients surviving acute myocardial infarction and 11 control persons. The results of the investigation demonstrate that the more intensive the prehospital treatment of out-of-hospital cardiac arrest, the more patients survive and the more patients survive with good cerebral function. However, the ambulances with specially trained paramedics were only effective in the area with 340 inhabitants/km2.

Brain Ischemia↗
PubMed1990

[Prehospital treatment. The Odense ambulance project. A prospective study].

No legislation exists about ambulance services in Denmark. The present Danish prehospital treatment is undertaken by Falcks Redningskorps A/S and the municipal fire services. During a period of 12 months (1.2.1988-31.1.1989) a prospective investigation was carried out in Odense concerning the effect of medical support to the ambulance service, partly in the form of a medically staffed ambulance, partly in the form of an arrangement in which an independent doctor's car (rendez-vous arrangement) was sent together with the nearest ambulance. In addition, the heart ambulance model as recommended by the Danish National Board of Health was also tested. Experience from abroad and recent Danish trial arrangements demonstrate the positive effect of extended professional prehospital treatment. The authors consider, therefore, that an ambulance law is required as this would ensure better and more uniform prehospital treatment in Denmark. Planning of the future prehospital treatment of acute and injured patients including the extent of the training, equipment and treatment must be established on the basis of a healtheconomical assessment of the Danish arrangements.

Ambulances↗
PubMed1990

[Ambulance services for patients with acute cardiac conditions in Denmark--current state].

In 1985, the Danish Board of Health published a review of the therapeutic value of heart ambulances. A report is presented here concerning the extent to which prehospital treatment of cardiac arrest recommended by the Board of Health has been intensified after publication of the review. The prehospital treatment of cardiac arrest has been intensified in four counties and in the municipalities of Copenhagen and Frederiksberg whereas it has not been altered in the remaining ten counties. Recent Danish investigations have demonstrated better prognosis both as regards survival and as regards recovery when intensified prehospital treatment of cardiac arrest is employed. Hence legislation steps should be taken to improve pre-hospital treatment of cardiac arrest.

Ambulances↗
PubMed1990

[First aid in cases of out-of-hospital heart arrest].

In connection with participation of doctors in the emergency ambulance service in Odense, the number of cases of observed cardiac arrest outside hospital was registered during a period of six months. The object was to assess how often primary treatment for cardiac arrest was instituted by passers-by before arrival of the ambulance. Seventy-four cases of observed cardiac arrest occurred. In 11 of these (15%) primary resuscitation was attempted outside hospital. In only three (4%) cases the primary resuscitation was undertaken by lay persons. Treatment of cardiac arrest before arrival of the ambulance increases survival. It is therefore essential to increase the number of courses in the treatment of cardiac arrest for lay persons, if mortality is to be reduced.

Denmark↗