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Träfflista för sökning "L4X0:0345 0082 ;srt2:(1990-1994)"

Sökning: L4X0:0345 0082 > (1990-1994)

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41.
  • Johansson, Birgitta (författare)
  • Effects of neutrophil activation and differentiation on membrane receptor mobility
  • 1994
  • Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
    • The human neutrophils comprise the first line of defence against invading microorganisms. Activation of membrane receptors for bacterial nformyl peptides, exemplified by formylmethionyl-leucyl phenylalanine (fMLF), and complement cleavage products are instrumental for neutrophil chemotaxis, phagocytosis and activation of the NADPH oxidase, generating reactive oxygen metabolites. The aim of this work was to elucidate the role of lateral mobility of membrane components for neutrophil function. Lateral mobility was measured by fluorescence recovery after photobleaching (FRAP). The results show that: i) neutrophil differentiation is accompanied by a more restricted mobility of membrane components, ii) oxidative metabolites produced by neutrophils in response to activation of protein kinase C increase the overall mobility of membrane components, iii) activation induces lateral redistribution and immobilisation of the neutrophil receptor for fMLF, and iv) internalisation of receptors is not only governed by classical signalling motifs in the receptor tail but also by receptor lateral diffusion; a fast diffusing receptor is internalised more rapidly. The effect can be shown for transfected complement receptor I (CRI) constructs, and may be exemplified in the neutrophil where activation of the fMLF receptor induces increased CRI diffusion. Finally, v) regulation of the lateral mobility of the membrane b-cytochrome appears to play a role in the activation of the neutrophil NADPH oxidase. In conclusion, the results imply that membrane domain formation and regulation of the lateral mobility of membrane components are important for neutrophil function.
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42.
  • Johnson, Anders (författare)
  • Breathe without pain : Clinical and experimental studies in patients and volunteers with special reference to ventilatory regilation
  • 1992
  • Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
    • The major aims were, first, to study the advantages and disadvantages of intrathecal analgesia with bupivacaine and morphine with special reference to ventilation and pain relief and, second, to develop a method for studies of the ventilatory response to carbon dioxide and hypoxaemia in volunteers and in patients with varying degrees of ventilation-perfusion ratios.341 elderly patients undergoing major hip surgery perfonned under intrathecal analgesia or general anaesthesia and 31 young and healthy volunteers participated in this work. There were fewer complications and a shorter postoperative hospital stay in patients undergoing surgery under intrathecal analgesia with 0.3 mg morphine added to 20-22.5 mg bupivacaine without glucose compared to the general anaesthesia group as evaluated with the aid of case records. Postoperative pain after intrathecal morphine was evaluated by systemic morphine consumption and a visual analogue scale and was found to be of good quality for at least 40 h in the majority of the patients. Postoperative naloxone infusion rate was lowered stepwise between patient groups receiving intrathecal morphine. The dose 1 pg/kglh IV for 12 h and 0.25 pg/kg/h IV for the next 12 h had no influence on pain relief obtained by the intrathecal morphine.A non-rebreathing cireuit was designed and evaluated in volunteers and patients. The apparatus had no influence on ventilation of air over time, the results could be reproduced and the method was found to be suitable and safe for patients with varying ventilation-perfusion ratios. The ventilatory response to C02 was measured after 1.5 times the time taken to reach a new steady-state in FIITC02 after stimulation with 6% C02. The ventilatory response to hypoxaemia was measured when S02 had declined from normal values to 85%. The responses were evaluated before operation and 8 and 24 h after intrathecal injection in three patient groups: intrathecal analgesia with bupivacaine, with bupivacaine-morphine and with bupivacaine-morphine plus an IV infusion of naloxone. Intrathecal morphine had, on the whole, no effect on the ventilatorytesponses. However, additional systemic morphine or sedatives attenuated the responses. Naloxone infusion was judged to counteract ventilatory depression. The response to hypoxaemia was poor or absent in 1/3 of the elderly before operation,In conclusion, intrathecal analgesia with a mixture of bupivacaine and morphine offers excellent operative conditions in major hip surgery and a favourable postoperative course without pain for the elderly patient. Postoperative care of these elderly patients for at least 24 h is recommended and experienced personnel should continuously evaluate patients' status for detection of signs of ventilatory depression. The staff should have the knowledge and the facilities to treat ventilatory depression. Naloxone infusion can well be used as prophylaxis against ventilatory depression. Oxygen therapy is also recommended in these elderly patients both during and after operation until normal or near normal oxygenation, without oxygen therapy, is proven present.
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43.
  • Jonsson, Brynjolfur (författare)
  • Destructive reumatoid arthritis : Epidemiological, economic, and rheumasurgical aspects
  • 1991
  • Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
    • This study comprising 8 separate papers is concerned with the prevalence of rheumatic disease and different aspects of destructive rheumatoid arthritis in the population. In an epidemiologically representative population subjective joint disease was found in 30% in ages 45 years and over. All those people were clinically examined and diagnosis established. Joint disease becomes commoner with increasing age and causes considerable disability. Destructive rheumatoid arthritis, ARA criteria 5-8, i.e. classical and definite RA, was found in 0.65% of the population. This patient group with joint destructions is the most interesting from rheumasurgical view. A clinical evaluating system, total locomotion score, comprising of a subjective and an objective part, was developed for numerical multifactorial assessment of patients with destructive RA. It is based on WHO's recommandations for disease integration (1980). This system was tested and was found to have good interobserver reliability and showed good correlation between patient's subjective and objective status. All 82 RA patients found in the epidemiological population were evaluated by total locomotion score and for hand function with Sollerman's hand function test and current status emerged. The destructive RA manifestations of the locomotor system, including the hand, were increasing with age, longer disease duration, and were more pronounced in women than men. In this patient group further reconstructive operations were needed in 55% of cases and this care was closely correlated with low total locomotion score. Reconstructive joint and hand surgery was found to prevent deterioration of the disease. The costs of RA were correlated to effects of the disease destructions; patients in working-age had highest indirect costs and elderly patient medical and social costs. Total costs of the disease were better correlated to the status of lower extremities than upper. Elbow replacement in RA reliefs pain well and improves function of arm and hand. Total hip and knee replacement in RA improves status regardless age, sex, and low preoperative total locomotion score. Besides better quality of life, reduced indirect costs and reduced costs of home help are achieved.
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44.
  • Kalman, Sigga, 1952- (författare)
  • Studies on the halothane-diethyl-ether azeotrope
  • 1994
  • Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
    • Requirements for a safe standard for anaesthesia under primitiveconditions differ from those under peaceful circumstances. It is important not to blunt the reflexes that guard vital functions. Safety requirements concerning breathing, circulation, and drug interaction must be sharpened because professional surveillance of the patient may be restricted. The halothane-diethyl-ether azeotrope (HE azeotrope) has properties that could make it suitable for anaesthesia under adverse circumstances. We have re-evaluated the HE azeotrope with special reference to safety in studies on 102 patients and 19 pigs.The vaporizers were calibrated to guarantee their performance. Guidelines for the use of Auotec® Mark Ill and Servo® vaporizer for halothane combined with the HE azeotrope are set out. Minimum alveolar concentration (MAC) for the HE azeotrope has not previously been published. The MAC for the HE azeotrope was determined in man (0.71 vol.%± 0.03, ± SEM) and pig (0.99 vol.%± 0.07) to allow comparison with other inhalation anaesthetics. The safety ratio defined as the ratio between fatal alveolar concentration and minimum alveolar concentration was found to be 3.1 in pig, which is about twice as high as previously reported data for halothane anaesthesia alone.Ventilation during surgical anaesthesia (1.1-1.2 MAC), both when resting and during challenge with raised inspiratory levels of carbon dioxide and decreased inspiratory concentration of oxygen, was measured. Ventilation was maintained during resting. Response to hypercarbia was preserved, in contrast to what was seen under isoflurane anaesthesia. Response to hypoxia was abolished.The central circulation was well preserved under normovolaemia in pigs during HE azeotrope anaesthesia. Haemorrhage. with a loss of30% of the blood volume was well tolerated, no matter whether the pig had received HE azeotrope or isoflurane. Isoflurane is considered in the literature to be an anaesthetic well tolerated by pigs.Most inhalation anaesthetics potentiate neuromuscular blockade, which is an important and sometimes dangerous component of anaesthesia. We therefore thought it important to investigate whether interaction takes place between vecuronium induced neuromuscular blockade and the HE azeotrope. Potentiation similar to that occurring during halothane anaesthesia was found.Early postoperative liver function was studied by tests of cellular metabolic capacity, cell integrity, cholestasis, and synthesizing capacity. No major impact on hepatic function after HE azeotrope anaesthesia was seen.Thus, the halothane-diethyl-ether azeotrope has properties that could make it interesting as an alternative anaesthetic drug under difficult circumstances.
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45.
  • Karlsson, Jan-Erik (författare)
  • Unstable coronary artery disease : non-invasive indicators of severity of coronary lesions and the effects of thrombolysis
  • 1994
  • Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
    • Non-invasive indicators of severity of coronary lesions and the effects of thrombolysis were evaluated in 205 men, 38 to 70 years of age with unstable coronary aticty disease (CAD)- i.e. unstable angina or non-Q wave myocardial infarction - admitted to the coronary care units in nine hospitals. The patients were randomised to double-blind and placebo-controlled treatment with an intravenous infusion of recombinant tissue-type plasminogen activator (tt-PA) in addition to aspirin, heparin and betablockade. A symptom-limited exercise test was performed before discharge in 190 patients and a second exercise test, combined with thallium-201 SPECT, was performed after one month in 170 patients. Coronary angiography was performed in 199 patients after one month when also exercise echocardiography and 48 hours ambulatory ST-recording were performed in 65 and 95 patients respectively. The non-invasive tests were compared to each other and to coronary angiography in order to elucidate the best method to identify patients with severe coronary lesions -defined as three vessel disease, left main stenosis or proximal left anterior descending artery stenosis as part of two vessel disease.Thrombolytic treatment with rt-PA did not reduce the incidence of death, myocardial infarction or urgent revascularisation early or during one year follow-up. Myocardial ischemia, defined as death, myocardial infarction, revascularisation because of refractory angina or signs of ischemia at an exercise test, was reduced by treatment with rt-PA both at discharge, 53%compared to 70% (p=0.02), and after one month, 61% compared to 80% (p=0.005) respectively. No severe side-effects of rt-PA occurred.Stepwise multiple regression analysis showed that ST -depression and low maximal work load were the most important exercise variables for identification of severe coronary lesions. Using a combination of these parameters, the sensitivity and specificity for identification of severe coronary lesions were respectively 77% and 70%. More sophisticated methods of evaluating the ECG reaction during exercise were not diagnostically superior to the simple identification of ST-depression of > 0.1 m V.In patients with ST -depression at ambulatory monitoring, 79% demonstrated lhe same finding at the exercise test. A "high risk exercise test response" defined as either ST-depression in:?. 3 leads or ST -depression in 1 - 2 leads with a maximal work load below the 60th percentile or a maximal work load below the 30th percentile regardless of the ECG reaction during exercise, occurred in 82%, while ST -depression at ambulatory monitoring was observed only in 41% of the patients with severe coronary lesions (pA combination of thallium-201 SPECT and ECG at exercise testing identified 82% of the patients with severe coronary lesions with a specificity of 63%. Furthermore, thallium-201 SPECT identified more patients with isolated proximal left anterior descending artery stenosis than the exercise test alone.Wall motion abnormalities at exercise echocardiography were seen in 53 patients (81 %) at rest and perfusion defects at thallium-201 SPECT in 57 patients (88%) in the rest images. New or worsening of wall motion abnormalities were seen in 55 patients (180 segments) either seated at peak exercise or recumbent after exercise whereas 43 patients (105 segments) had reversible or partially reversible thallium-201 SPECT scintigraphic defects (p=0.02). The segmental agreement between wall motion abnormalities and scintigraphic defects was low (58%). Theadditional value of exercise echocardiography to the exercise test was greatest in patients with one vessel disease.Based on the present and other studies, thrombolysis can not be recommended as a routine therapy in unstable CAD. An early exercise test is safe and contributes to the identification of patients with severe coronary lesions who might benefit from revascularisation. Thallium-201SPECT and exercise echocardiography one month after an episode of unstable CAD have additional value to an ordinary exercise test for the identification or exclusion of severe coronary lesions, while ST -recording has no additional value.
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46.
  • Karlsson, Mats G. (författare)
  • T lymphocytes in allergic rhinitis
  • 1994
  • Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
    • The role of the T lymphocyte and T cell associated events in the allergic reaction were investigated in the nasal mucosa and in the peripheral blood. Patients with seasonal allergic rhinitis (birch pollen) and healthy controls were subjected to an allergen provocation study during non-pollen season. The subjects were also studied during the natural pollen season.T helper cells have recently been subdivided into two majorsubpopulations according to their cytokine synthesis upon activation. Naive T cells synthesis e.g. IL-2 whilst memory T cells produces e.g. IL-4 and IL-5. These cytokines have been associated to lgE synthesis and eosinophilia, respectively.In peripheral blood, patients with allergic rhinitis have an increased T cell activation even when not exposed to allergen. During the allergen provocation study a further increase in peripheral blood T cell activation occurred. During natural pollen season there is, among allergic patients only, a T helper cell population shifting from naive to memory T cell phenotype in the peripheral blood.A computerized image analysis method was evaluated concerning standardisation of image acquiring and processing as well as sample size. This method was highly reproducible and was used to assess T cell subpopulation stained by immunohistochemistry in nasal biopsies.T memory cell predominates within the nasal mucosa of allergic patients as well as healthy controls. Early during the allergic reaction there is a local T cell activation. Later during the allergic reaction there is an increase of the T cell and the CD45R0+ memory phenotype, in allergic subjects only. Furthermore, allergic patients have an increased expression of the endothelial adhesion molecule VCAM-1 during the allergic reaction.During the allergic reaction, allergic patients have an increased local synthesis of IL-4 and IL-5 as determined by RT-PCR. This may constitute the basis for the increased endothelial VCAM-1 expression and the concomitant homing of memory T helper cells to the nasal mucosa from  the peripheral blood.Topical steroid treatment inhibits local IL-4 synthesis, endothelial VCAM-1 expression and the accumulation ofCD45R0+ memory cells.
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47.
  • Kjellberg, Svante, 1946- (författare)
  • Zinc and human sperm chromatin
  • 1993
  • Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
    • X-rny microanalysis, Sephadex® chromatography of seminal plasma and exposure of spermatozoa to sodium dodecyl sulphate (SDS), were methods used to study the zinc content of sperm chromatin, the nature of the zinc binding ligands present in seminal plasma and the stability of the sperm chromatin in whole semen samples from fertile and infertile men. Split ejaculates were used to study the same variables in different fractions of the same ejaculate.To obtain "pure" samples of prostatic fluid ejaculates were collected from four men with agenesis of the Wolffian ducts.Spermatozoa were obtained from the vas deferens and the ejaculates from each of four men operated on with vasectomy to study how contact between the sperm and seminal plasma might influence the eventual content of zinc in the sperm chromatin.The relative content of zinc in sperm chromatin was extremely low in the vasal spermatozoa as compared to the content of zinc in the chromatin of the ejaculated spermatozoa. This indicates that sperm may take up zinc from the seminal plasma. Another role for zinc in seminal fluid could be to prevent loss of zinc from the spenn chromatin of ejaculated spermatozoa.The proportion of sperm heads which remained stable after exposure to SDS was found to be related to the relative content of zinc in the sperm chromatin. The content of zinc in spermatozoa from fertile men corresponded to one zinc atom per protamine molecule in the chromatin.The relative content of zinc in the sperm chromatin had no simple relation to the zinc concentration in the seminal plasma. It was, however, found that men with a relative low content of zinc in the sperm chromatin had a disturbed sequence of ejaculation. They ejaculate the majority ofspennatozoa in an ejaculate fraction with a high admixture of seminal vesicular fluid. These fractions had a low zinc/fructose molar ratio i e a low ratio between prostatic derived zinc and vesicular derived fructose. Furthermore in these fractions seminal plasma zinc was to a high degree OOund to high molecular weight ligands (Zn~LnMw).The low molecular weight zinc binding ligand (Zn-LLMW) was shown to be of prostatic origin and identical to citrate.Sperm samples derived from fertile semen donors (n=5) a had a' higher proportion of sperm heads remaining stable after exposure to SDS, as well as a higher content of zinc in the sperm chromatin as compared to samples from group of men with "unexplained" infertility (n=lO). A larger sample of men investigated because of infertility (n=ll5) was also studied. Onequarter of these men had an impaired sperm chromatin stability with less than 80 per cent stable spermatozoa. The proportion zinc bound to the ligand Zn-LIIMW varied between 2~67 per cent. It is concluded that the liquefied seminal plasma, despite a high zinc concentration, could act as a zinc~ chelating medium that could deprive spermatozoa of zinc. It was, however, not possible to predict the individual fecundity in this group of infertile men by measuring the proportion of sperm heads, which remained stable after exposure to SDS or the proportion of zinc in the seminal fluid which was bound to Zn~L'IMW. The first split~ejaculate fraction should probably be studied instead of the whole mixed ejaculate to evaluate whether spermatozoa that tentatively enter the cervical mucus have an appropriate zinc~dependent stabilisation of their chromatin.
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48.
  • Kniola, Barbara (författare)
  • Methods in electron microscopic quantitative immunocytochemistry using adenohypophysis as a model
  • 1994
  • Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
    • Quantitative ultrastructural immunocytochemistry (QUIC) is based on the assessment of immunogold labeling over the surface of ultrathin resin-embedded sections. The density of specific labeling, expressed as the number of gold particles/mm2 of a specific area can only be used as an approximative estimation of antigen concentration in the object.The reliability of QUIC depends on the quality of the methods used to prepare the samples; therefore, to make QUIC reliable, the entire preparative protocol! has to be evaluated, step by step. Secretory granules in cells of the pituitary gland have been chosen as a model system. They constitute targets that are sensitive enough for analyses of exogenous factors, such as fixation, dehydration, embedding and immunostaining. Morphological parameters, such as diameter, area, roundness and gray values could be measured by computerized image analysis and the results related to the experimental factors.Certain combinations of processing for EM were found to give the highest immunolabeling. A further criteria was, however, added-reproducibility of immunostaining among series of ultrathin sections. The most consistent labeling densities were found after cryofixation followed by physical dehydration and embedding in epoxy resin. One of the explanations could be that the greater resin surface relief of the latter provides a larger accessible area for the attachment of immunogold reactants. The advantages of certain techniques, such as EM in STEM mode and X-ray microanalysis were demonstrated and facilitated the evaluation of techniques in QUIC.
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49.
  • Kullman, Eric, 1952- (författare)
  • Trends and current clinical aspects of complicated gallstone disease - with special reference to endoscopic treatment
  • 1993
  • Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
    • Time trends regarding incidence, management, and outcome of acute (AC) and elective cholecystectomy (EC), as well as symptomatic (cholangitis, pancreatitis, jaundice) and asymptomatic (detected accidentally during cholecystectomy) common bile duct (CBD) stones were studied during the time period 1970-1986 in a welldefined Swedish population. From period I (1970-1978) to period II (1979-1986) there was a four-fold increase in the ratio of AC (period I: mean 10/100,000/year, period II: mean 30/100,000/year) to EC (period 1: mean 190/100,000/year, period II: mean 120/100,000/year). For both AC and EC the fraction of patients older than 70 years increased significantly with time. For AC, the female to male ratio decreased significantly from 2.6 to 1.0. The duration of history and frequency of previous hospital stay for gallstone disease decreased significantly for both groups. The postoperative morbidity did not change, whereas the postoperative mortality after AC decreased significantly. Postoperative mortality was significantly higher after AC than EC in both periods. Complications occurred less frequently among patients with a short history of gallstone symptoms than among those with a long history.During the same time periods, there was a significant increase in the incidence of symptomatic CBD stones (8 - 20 cases/100,000 inhabitants/year), and a slight decrease in the incidence of asymptomatic CBD stones (12- 10 cases/lOO cholecystectomies/year). The fraction of patients older than 70 years increased from 31% to 60% for patients with symptomatic CBD stones and from 17% to 27% for patients with asymptomatic CBD stones. In period 11 endoscopic sphincterotomy (EST) accounted for 81 % of all primary procedures performed in patients with symptomatic CBD stones. Type of treatment disregarded, the frequency of clinically overt retained CBD stones increased from 7 % to 22 %. Overall, the frequency of general complications decreased significantly,mainly due to a decrease in the group with symptomatic CBD stones. The frequency of procedure related complications also decreased in the symptomatic group, whereas it increased in the asymptomatic group. Theoverall mortality rate decreased significantly. The total time of stay in hospital decreased by 48 % for patients with symptomatic CBD stones and 23 %for those with asymptomatic stones.EST for retained or recurrent CBD stones after cholecystectomy was performed in 128 patients with an overall success rate of 92 %. Late bile duct complications (recurrent stones and/or stenosis) occurred in seven patients at a median time of 20 months after EST and were best treated with repeat EST. To minimize short-term complications, efforts to extract all stones and confirmation of CBD clearance is mandatory at the initialprocedure. EST is safe and efficient as the first procedure of choice in patients with retained and recurrent CBD stones.EST was performed in 148 patients with CBD stones and the gallbladder left in situ with an overall success rate of 88 %. The median observation time in 118 patients discharged with the gallbladder in situ was 42 months. Complications necessitating acute surgery arose from the remaining gallbladder in seven patients (6 %) at a median of 14 months after EST. Another six patients (5 %) underwent elective cholecystectomy at a median of 21 months after EST. A stone bearing gallbladder left in situ after EST does not appear to be an additional risk factor for future complications compared to the natural history in patients with verified cholelithiasis. Leaving the gallbladder in situ after EST is justified in elderly and frail patients. Surgery should be restricted to patients in whom symptoms develop.The occurrence of bacteremia in association with diagnostic or therapeutic ERCP were studied in 180 patients undergoing 194 examinations, and it occurred in 15 % and 27 %, respectively. There was no correlation between the occurrence of bacteremia and the duration of the procedure. The frequency of complications in patients with bacteremia did not diffef from that in patients without bacteremia, whether the procedure was diagnostic or therapeutic. Routine antibiotic prophylaxis is not indicated in patients undergoing diagnostic or therapeutic ERCP.Extracorporeal shock wave lithotripsy (ESWL) was performed in 28 patients with problematic CBD stones and 9 patients with intrahepatic duct (IHD) stones. The overall fraction of successfully treated patients was 89 %, with no major complications or mortality. It is concluded that ESWL is a safe and efficient treatment modality for CBD and IHD stones after failed endoscopic treatment. It further extends the number of patients with bile duct stones who can be treated by non-surgical means.
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50.
  • Larsson, Hans (författare)
  • Myocardial ischemia : As a risk indicator after an episode of unstable angina or non-Q-wave myocardial infarction
  • 1991
  • Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
    • The diagnostic and prognostic value of different noninvasive tests were evaluated in men below 70 years of age admitted to the coronary care unit (CCU) with unstable coronary artery disease (CAD) i.e unstableangina or non-Q-wave myocardial infarction (Ml). A symptom limited exercise test (ET) was performed before discharge in 740 patients. In subgroups 24 hour ST-recordings were performed in the CCU (n=75),before discharge (n=198) and ambulatory after one month (n=109). A second ET combined with SPECT Tl201 myocardial perfusion imaging was done after one month in 197 patients. Myocardial ischemia was defined as ST-depression > 0.1 m V or according to a model developed for interpretation of SPECTT1201 scintieraphy. All patients were followed one year. Patients with myocardial ischemia at the predischargc ET (51 %) had a significantly higher rate of death or MI (18 %) compared to those without (9 %) regardless of simultaneous pain or not. STrccordingin the acute phase or before discharge showed less often myocardial ischemia (23-18 %) than ambulatory during ordinary daily life (33 %). In the same group of patients myocardial ischemia was more often elicited by a predischarge ET (52%). The majority of patients with ST-depression at ST-recordings also showed myocardial ischemia at the predischarge ET. Myocardial ischemia at the ST-rccording beforedischarge identified a small group (18 %) of patients with a more severe prognosis- 23% rvn or death after 3 months compared to 7 % in the patients without this observation. In a logistic regression analysis ST-depression at the predischarge ST-recording was the only significant predictor of MI or death during the first three months while myocardial ischemia at the predischarge ET became the only significant indicator of long term outcome. In a comparison between the predischarge and the one month ET 83 % of patients showed the same response regarding occurrence of ST -depression. The rate of MI or death during the first month were more common in patients with (8.3 %) than without (3.7 %) myocardial ischemia at the predischarge ET and so was the occurrence of future symptoms of severe angina. Regarding the following 11 months, myocardial ischemia at the predischarge or the one month ET had the same prognostic importance for MI, death or severe angina. SPECT Tl 201 imaging at ET improved the separation between high and low risk patients. If both SPECT Tl 201 imaging and the ECG response showed signs of ischemia (37 %) the risk of future cardiac events was markedly elevated- 17 % MI or death compared to 7 % in patients without this finding. Thus, risk stratification of men after an episode of unstable coronary artery disease can be performed already before discharge. Patients with continuing myocardial ischemia despite treatment should be considered for rcvascularisation whether or not the ischemia is associated with pain.
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