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- Herlitz, Johan, et al.
(författare)
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Ambulance despatchers´ estimation of intensity of pain and presence of associated symptoms in relation to outcome among patients who call for an ambulance because of acute chest pain
- 1995
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Ingår i: European Heart Journal. - : Oxford University Press. - 0195-668X .- 1522-9645. ; 16:12, s. 1789-1794
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: A large number of patients who call for an ambulance because of acute chest pain have an acute ischaemic event, but some do not. AIM. To relate the ambulance despatcher's estimated severity of pain and presence of associated symptoms, in patients who call for an ambulance because of acute chest pain, to whether they develop acute myocardial infarction (AMI) and to the risk of early death. PATIENTS: All those with acute chest pain who contacted the despatch centre in Göteborg over a 2-month period. RESULTS: In all, 503 patients fulfilled the inclusion criteria. Patients judged as having severe chest pain (68%) developed AMI during the first 3 days in hospital on 26% of occasions as compared with 13% among patients judged as having only vague chest pain (P = 0.0004). The difference was less marked among the elderly and women. The presence of any of the following associated symptoms, dyspnoea, nausea, vertigo, cold sweat or syncope, tended to be associated with a higher infarction rate (24%) than if none of these symptoms was present (17%, P = 0.06). Mortality during the pre-hospital and the hospital phase was not associated with the estimated severity of pain or the presence of associated symptoms. CONCLUSIONS: The despatcher's estimation of the severity of pain and the presence of associated symptoms appears to be associated with the development of AMI but not with early mortality.
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| 2. |
- Herlitz, Johan, et al.
(författare)
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Improvement in Quality of Life during 5 years after coronary artery bypass grafting
- 1998
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Ingår i: Coronary Artery Disease. - : Lippincott Williams & Wilkins. - 0954-6928 .- 1473-5830. ; 9:8, s. 519-526
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To describe the changes in various aspects of quality of life (QOL) from before coronary artery bypass grafting (CABG) to 5 years after the procedure. PATIENTS AND METHODS: Patients who underwent CABG in the western region of Sweden in 1988-1991 were approached with questionnaires evaluating their QOL prior to and 3 months and 1, 2, and 5 years after the operation. Three different instruments were used: the Nottingham Health Profile, the Psychological General Well-Being Index, and the Physical Activity Score. RESULTS: In all 2121 patients underwent CABG, of whom 310 died during 5 years of follow-up. With all three instruments QOL had improved 5 years after CABG compared with prior to the operation. However, all three instruments revealed a slight but significant deterioration in estimated QOL between 2 and 5 years after CABG. CONCLUSIONS: QOL 5 years after CABG is better than that prior to the operation, but between 2 and 5 years after the operation a slight deterioration in QOL is observed.
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| 3. |
- Herlitz, Johan, et al.
(författare)
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Predictors of death during 5 years after coronary artery bypass grafting
- 1998
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Ingår i: International Journal of Cardiology. - : Elsevier Ireland Ltd. - 0167-5273 .- 1874-1754. ; 64:1, s. 15-23
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Tidskriftsartikel (refereegranskat)abstract
- Aim: To describe predictors of death during five years of follow-up after coronary artery bypass grafting (CABG). Methods: All patients who underwent CABG during a period of three years in Western Sweden were included in the analysis and were prospectively followed for five years. Mortality was related to preoperative and peroperative factors as well as findings at physical examination and medication 4–7 days after the operation. Results: In all 2121 patients underwent CABG without simultaneous valve surgery during the study period. The overall five-year mortality was 14.6%. The following appeared as independent predictors of death during five years but >30 days after CABG: Current smoking (relative risk ratio 2.43 [95% Ci 1.64–3.61]) degree of impairment of left ventricular function (1.51 [1.23–1.86]), a history of congestive heart failure (1.91 [1.35–2.70]), age (1.04 [1.02–1.06]) arrhythmia 4–7 days after CABG (1.89 [1.26–2.83]), intermittent claudication (1.73 [1.19–2.52]), a history of diabetes (1.71 [1.16–2.51]), time in respirator (1.43 [1.13–1.81]), a history of cerebrovascular disease (1.72 [1.13–2.64]), treatment with digitalis at day 4–7 (1.48 [1.07–2.05]), enzyme release (1.49 [1.03–2.16]). Conclusion: Among patients who underwent CABG 11 independent predictors for mortality were found including smoking habits at CABG, history of cardiovascular diseases, left ventricular dysfunction, age, post operative complications and medication after CABG.
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| 4. |
- Herlitz, Johan, et al.
(författare)
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The feeling of loneliness prior to coronary artery bypass grafting might be a predictor of short and long term postoperative mortality
- 1998
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Ingår i: European Journal of Vascular and Endovascular Surgery. - : Elsevier Ltd. - 1078-5884 .- 1532-2165. ; 16:2, s. 120-125
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: To evaluate the effect of different aspects of quality of life (QL) upon mortality during short-and long-term follow-up after coronary artery bypass grafting (CABG). DESIGN: Prospective evaluation. MATERIALS: Consecutive patients from western Sweden who during 3 years underwent CABG. METHODS: They answered a questionnaire at the time of coronary angiography prior to CABG. Quality of life was measured with questions from the Nottingham Health Profile (NHP) part I. RESULTS: In all, 1290 patients were included in the analyses. When accounting for various preoperative factors known to be independently associated with morality the NHP question "I feel lonely" was found to be associated with mortality, both at 30 days (RR 2.61; 95% CI 1.15-5.95; p = 0.02) and at 5 years (RR 1.78; 95% CI 1.17-2.71; p = 0.007) after the operation. Thirteen per cent reported they felt lonely. At 5 years was, in addition, the statement "I have difficulty climbing stairs" also independently associated with mortality (RR 1.50; 95% CI 1.02-2.22; p = 0.04). CONCLUSION: Among the 38 statements in NHP as a judgment of QL prior to CABG, one of them, "I feel lonely" was independently associated with survival both at 30 days and 5 years after CABG.
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| 5. |
- Malm, J, et al.
(författare)
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Cognitive impairment in young adults with infratentorial infarcts.
- 1998
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Ingår i: Neurology. - 0028-3878 .- 1526-632X. ; 51:2, s. 433-40
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To describe cognitive functions and functional outcome in young patients with isolated infratentorial infarcts.BACKGROUND: Contemporary knowledge implies a cerebellar contribution to cognitive behavior. Neuropsychological examination of patients with selective cerebellar lesions provides an opportunity to document the existence and nature of clinically relevant cognitive manifestations from lesions of the cerebellum.METHODS: Prospective case series. The patients were assessed acutely and at 4 and 12 months after onset. Twenty-four patients from a consecutive series of 105 patients aged 18 to 44 years with cerebral infarction had a brain stem or cerebellar infarction. Fourteen age-matched controls were used for neuropsychological comparisons. Evaluation included MRI, angiography, and transesophageal echocardiography. Disability and neurologic dysfunction were assessed by the modified Rankin scale, NIH stroke scale, and maximal working capacity. A comprehensive neuropsychological battery was performed at baseline in 20 of the 24 patients.RESULTS: Eighteen patients had a cerebellar infarct. Two patients had lateral medullary infarcts, and two isolated pontine infarcts. Twenty-two patients had a favorable outcome according to the modified Rankin scale (grade 0-2) and the NIH scale. In contrast, 12 patients were granted full or partial sick leave at the 4 months follow-up, and 10 patients at 12 months. Patients generally performed worse than controls in various aspects of cognitive function, especially in tasks concerning working memory, the temporary storage of complex information, and cognitive flexibility. Measures of verbal IQ (r = -0.74) and performance IQ (r = -0.78) were related to the size of the infarct. The block design task performance in the early poststroke period predicted maximal working capacity at 12 months.CONCLUSIONS: Cerebellar damage impairs central aspects of attention and visuospatial skills. In contrast, intelligence and episodic memory remain unchanged. When the lesion involves large portions of the cerebellar hemispheres, changes concerning broad areas of intelligence may occur. The prognosis is favorable for neurologic dysfunction, but cognitive deficits may prevent return to work.
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| 6. |
- Wallin, Gunnar B, 1936, et al.
(författare)
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Two neural mechanisms for respiration-induced cutaneous vasodilatation in humans?
- 1998
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Ingår i: The Journal of physiology. - : Wiley. - 0022-3751. ; 513 ( Pt 2), s. 559-69
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Tidskriftsartikel (refereegranskat)abstract
- 1. In humans, a deep breath is known to induce cutaneous vasoconstriction in the warm state, and vasodilatation in the cold state. To investigate whether vasodilatation in the cold state is related to reduction of sympathetic vasoconstrictor nerve traffic, we studied the effect of a deep breath on vascular resistance in a skin area on the dorsum of the hand, in which release of noradrenaline from sympathetic nerves was blocked by iontophoretic pretreatment with bretylium tosylate. Simultaneous measurements were made in two control areas. In eight healthy subjects, data were obtained from deep breaths taken before bretylium in the warm state, after general cooling to a finger skin temperature below 25 C and after rewarming to above 32 C. 2. In the warm state before bretylium pretreatment, the deep breath evoked short-lasting vasoconstrictions at all sites. In the cold state there was no change of vascular resistance in the bretylium-pretreated area, whereas in the control areas an initial tendency towards vasoconstriction was followed by a significant transient vasodilatation. After rewarming, transient vasoconstrictions reappeared at the control sites, whereas only a transient vasodilatation occurred at the bretylium-pretreated site. 3. In six healthy subjects we also monitored the effects of a deep breath on skin sympathetic nerve activity (recorded by microneurography in the peroneal nerve), and skin vascular resistance within the innervation zone of the impaled nerve fascicle in the foot. Data from thirty deep breaths per subject were averaged. 4. In the cold state, the deep breath induced a strong increase in neural discharge, followed by a transient reduction of nerve traffic lasting approximately 15 s and associated with a subsequent reduction of vascular resistance. 5. We conclude that the deep breath-induced vasodilatation in the cold state is due to reduction of sympathetic vasoconstrictor nerve traffic. The vasodilatation after bretylium treatment in the warm state raises the possibility that a deep breath induces two simultaneous neural reactions, a vasoconstrictor and an active vasodilator component, the latter being weaker and normally masked by the strong vasoconstrictor component.
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