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| 3. |
- Gardtman, M, et al.
(author)
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Effects of intravenous metoprolol before hospital admission on chest pain in susptected acute myocardial infarction
- 1999
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In: American Heart Journal. - : Mosby, Inc.. - 0002-8703 .- 1097-6744. ; 137:5, s. 821-829
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Journal article (peer-reviewed)abstract
- BACKGROUND: The aim of this study was to describe the effect of intravenous metoprolol on the intensity of chest pain before hospital admission in patients with suspected acute myocardial infarction AMI). METHODS AND RESULTS: Two hundred sixty-two patients with acute chest pain and suspected AMI were randomly assigned before hospital admission to either 5 mg morphine plus metoprolol 5 mg x 3 intravenously or 5 mg morphine plus intravenous placebo. Chest pain was evaluated on a 10-grade scale before and for 60 minutes after intravenous injection. One hundred thirty-four patients were randomly assigned to metoprolol and 128 to placebo. Among all patients randomized to metoprolol, the mean chest pain score was reduced by 3.0 +/- 1.9 arbitrary units AU) from before to after intravenous injection compared with 2.6 +/- 2.1 AU for placebo not significant). Among patients with an initially confirmed or strong suspicion of AMI, the corresponding figures were 3.1 +/- 1.8 AU for metoprolol and 2.2 +/- 1.6 AU for placebo P =.02). Among patients with only a vague or moderate suspicion of AMI, there was no difference. The treatment was well tolerated. CONCLUSIONS: When all patients were included in the analyses, there was no significant difference with regard to reduction of chest pain in the patients randomly assigned to metoprolol compared with placebo. A retrospective subgroup analysis indicated a beneficial effect of metoprolol among patients with an initially strong suspicion of or confirmed AMI. Further investigations are warranted to confirm this finding.
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| 4. |
- Herlitz, Johan, et al.
(author)
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Similar risk reduction of death of extended-release metoprolol once daily and immediate release metoprolol twice daily during 5 years after myocardial infarction
- 1999
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In: Cardiovascular Drugs and Therapy. - : Springer New York LLC. - 0920-3206 .- 1573-7241. ; 13:2, s. 127-135
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Journal article (peer-reviewed)abstract
- The pooled results from five placebo-controlled postinfarction studies with metoprolol have shown a significant reduction in total mortality. All five studies used immediate-release metoprolol twice daily. An extended-release formulation of metoprolol for once-daily use has since been developed. The aim of the present study was to compare the two different forms of metoprolol with regard to the risk reduction of death for 5 years postinfarction and to analyze whether treatment with the beta-blocker metoprolol is associated with a reduced mortality after the introduction of modern therapies such as thrombolysis, aspirin, and ACE inhibitors. All patients discharged after an acute myocardial infarction (AMI) from Sahlgrenska University Hospital (SU) during 1986-1987 (n = 740, Period I) and during 1990-1991 (n = 1446, Period II) from both SU and Ostra Hospital, Göteborg, Sweden, were included in the study. During Period I, 56% were prescribed immediate-release metoprolol compared with 61% prescribed extended-release metoprolol during Period II. Immediate-release metoprolol was not available for outpatient use during Period II. In a multivariate analysis, all variables significantly associated with either increased or decreased postinfarction mortality during Periods I and II (univariate analysis of patient characteristics, medical history, complications during the AMI medication at discharge) studied were with Cox's proportional hazards model. Treatment with immediate-release metoprolol was significantly associated with reduced mortality over 5 years during Period I (relative risk reduction for total mortality, -34%, P = 0.003; 95% CI for RR, 0.51-0.87), and treatment with extended-release metoprolol was significantly associated with reduced mortality during Period II (-34%, P < 0.0001; 95% CI for RR, 0.53-0.82). Thrombolysis and the use of aspirin and ACE inhibitors were more frequently used during Period II. The results showed that postinfarction treatment with extended-release metoprolol given once daily was associated with a similar risk reduction of death over 5 years as immediate-release metoprolol given twice daily. The data, furthermore, indicate that the beta-blocker metoprolol is associated with a reduced risk of death after the introduction of modern therapy such as thrombolysis, aspirin, and ACE inhibitors.
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| 9. |
- Berggård, T, et al.
(author)
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Alpha1-microglobulin chromophores are located to three lysine residues semiburied in the lipocalin pocket and associated with a novel lipophilic compound
- 1999
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In: Protein Science. - : Wiley. - 0961-8368. ; 8:12, s. 20-2611
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Journal article (peer-reviewed)abstract
- Alpha1-microglobulin (alpha1m) is an electrophoretically heterogeneous plasma protein. It belongs to the lipocalin superfamily, a group of proteins with a three-dimensional (3D) structure that forms an internal hydrophobic ligand-binding pocket. Alpha1m carries a covalently linked unidentified chromophore that gives the protein a characteristic brown color and extremely heterogeneous optical properties. Twenty-one different colored tryptic peptides corresponding to residues 88-94, 118-121, and 122-134 of human alpha1m were purified. In these peptides, the side chains of Lys92, Lys118, and Lys130 carried size heterogeneous, covalently attached, unidentified chromophores with molecular masses between 122 and 282 atomic mass units (amu). In addition, a previously unknown uncolored lipophilic 282 amu compound was found strongly, but noncovalently associated with the colored peptides. Uncolored tryptic peptides containing the same Lys residues were also purified. These peptides did not carry any additional mass (i.e., chromophore) suggesting that only a fraction of the Lys92, Lys118, and Lys130 are modified. The results can explain the size, charge, and optical heterogeneity of alpha1m. A 3D model of alpha1m, based on the structure of rat epididymal retinoic acid-binding protein (ERABP), suggests that Lys92, Lys118, and Lys130 are semiburied near the entrance of the lipocalin pocket. This was supported by the fluorescence spectra of alpha1m under native and denatured conditions, which indicated that the chromophores are buried, or semiburied, in the interior of the protein. In human plasma, approximately 50% of alpha1m is complex bound to IgA. Only the free alpha1m carried colored groups, whereas alpha1m linked to IgA was uncolored.
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| 13. |
- Grane, P, et al.
(author)
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Evaluation of the post-operative lumbar spine with MR imaging. The role of contrast enhancement and thickening in nerve roots
- 1997
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In: Acta radiologica (Stockholm, Sweden : 1987). - : SAGE Publications. - 0284-1851 .- 1600-0455. ; 38:6, s. 1035-1042
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Journal article (peer-reviewed)abstract
- Purpose: Two new signs of lumbar nerve-root affection have been reported in recent years on the basis of MR examinations, namely: thickening in nerve roots; and contrast enhancement in nerve roots. the aim of this study was to assess contrast enhancement in nerve roots in a standardised way, and to evaluate the clinical significance of contrast enhancement and of nerve-root thickening in the symptomatic post-operative lumbar spine Material and Methods: A total of 121 patients (who had previously been operated on for lumbar disc herniation) underwent 152 MR examinations, mainly on a 1.5 T system. Focal nerve-root enhancement was identified by visual assessment. Intradural enhancement was also quantified by pixel measurements that compared the affected nerve roots before and after contrast administration. Non-affected nerve roots were used as reference Results: Enhanced nerve roots in the dural sac increased at least 40–50% in signal intensity after contrast administration compared to pre-contrast images and also compared to non-affected nerve roots. Intradural nerve-root enhancement was seen in 10% of the patients and focal enhancement in the root sleeve was seen in a further 26%. Nerve-root thickening was seen in 30%. Good correlation with clinical symptoms was found in 59% of the patients with intradural enhancement, in 84% with focal enhancement, and in 86% with nerve-root thickening. the combination of thickening and enhancement in the nerve root correlated with symptoms in 86% of the patients Conclusion: Nerve-root enhancement (whether focal or intradural) and thickening in the nerve root are significant MR findings in the post-operative lumbar spine. in combination with disc herniation or nerve-root displacement, these two signs may strengthen the indication for repeat surgery. However, root enhancement within 6 months of previous surgery may be a normal post-operative finding
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| 14. |
- Gustafsson, G, et al.
(author)
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The electric field and wave experiment for the Cluster mission
- 1997
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In: Space Science Reviews. - 0038-6308 .- 1572-9672. ; 79, s. 137-156
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Journal article (peer-reviewed)abstract
- The electric-field and wave experiment (EFW) on Cluster is designed to measure the electric-field and density fluctuations with sampling rates up to 36 000 samples s(-1). Langmuir probe sweeps can also be made to determine the electron density and temperature. The instrument has several important capabilities. These include (1) measurements of quasi-static electric fields of amplitudes lip to 700 mV m(-1) with high amplitude and time resolution, (2) measurements over short periods of time of up to five simualtaneous waveforms (two electric signals and three magnetic signals from the seach coil magnetometer sensors) of a bandwidth of 4 kHz with high time resolution, (3) measurements of density fluctuations in four points with high time resolution. Among the more interesting scientific objectives of the experiment are studies of nonlinear wave phenomena that result in acceleration of plasma as well as large- and small-scale interferometric measurements. By using four spacecraft for large-scale differential measurements and several Langmuir probes on one spacecraft for small-scale interferometry, it will be possible to study motion and shape of plasma structures on a wide range of spatial and temporal scales. This paper describes the primary scientific objectives of the EFW experiment and the technical capabilities of the instrument.
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| 15. |
- Gustafsson, G, et al.
(author)
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The electric field and wave experiment for the Cluster mission
- 1997
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In: SPACE SCIENCE REVIEWS. - : KLUWER ACADEMIC PUBL. - 0038-6308. ; 79:1-2, s. 137-156
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Journal article (peer-reviewed)abstract
- The electric-field and wave experiment (EFW) on Cluster is designed to measure the electric-field and density fluctuations with sampling rates up to 36 000 samples s(-1). Langmuir probe sweeps can also be made to determine the electron density and tempera
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| 17. |
- Herlitz, Johan, et al.
(author)
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Long-term prognosis in men and women coming to the emergency demartment with chest pain or other symptoms suggestive of acute myocardial infarction
- 1997
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In: European journal of emergency medicine. - : Lippincott Williams & Wilkins, Ltd.. - 0969-9546 .- 1473-5695. ; 4:4, s. 196-203
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Journal article (peer-reviewed)abstract
- The aim of this study was to describe mortality, mode of death and risk indicators for death during 5 years of follow-up among men and women coming to the emergency department with chest pain or other symptoms raising suspicion of acute myocardial infarction (AMI). During the 21 months of the study, all patients who came to the medical emergency department of one single hospital with chest pain or other symptoms suggestive of AMI were prospectively followed for 5 years. A total of 5362 patients came on 7157 occasions; men accounted for 55% of the admissions. The 5-year mortality rate was 25.6% for men compared with 25.7% for women. The women were older and had a higher prevalence of known congestive heart failure and hypertension, whereas the prevalence of previous myocardial infarction was higher in men. When correcting for dissimilarities in age and clinical history, male gender appeared as an independent predictor of death. In terms of mode of death men differed from women: more frequently dying at home, more frequently dying in association with ventricular fibrillation and less frequently dying in association with congestive heart failure. However, these differences were to some extent explained by differences in age. Independent risk indicators for death during 5 years of follow-up differed in men and women. It was concluded that in a consecutive series of patients with chest pain or other symptoms suggesting AMI in the emergency department, male gender was an independent risk indicator for death during a 5-year follow-up. This might be explained by a higher occurrence of coronary artery disease in men than in women in this patient population.
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| 18. |
- Herlitz, Johan, et al.
(author)
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Predictors and mode of death over 5 years amongst patients admitted to the emergency department with acute chest pain or other symptoms raising suspicion of acute myocardial infarction
- 1997
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In: Journal of Internal Medicine. - : Wiley-Blackwell Publishing Ltd.. - 0954-6820 .- 1365-2796. ; 243:1, s. 41-48
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Journal article (peer-reviewed)abstract
- AIM: To describe the mortality and mode of death over 5 years, and factors associated with death amongst patients with acute chest pain. PATIENTS: All patients who came to the emergency department at Sahlgrenska Hospital in Göteborg with acute chest pain or other symptoms raising suspicion of acute myocardial infarction (AMI) during a 21-month period. RESULTS: In all, 5241 patients were evaluated, of whom 1345 (26%) died during the 5 years of follow-up. The following factors were independent predictors male sex (P < 0.001); symptoms of acute congestive heart failure (P < 0.001) or unspecific symptoms on admission (P < 0.05); smoking (P < 0.001); a history of either congestive heart failure (P < 0.001), diabetes mellitus (P < 0.001), previous myocardial infarction (P < 0.001) or hypertension (P < 0.05); initial degree of suspicion of AMI (P < 0.001) and presence of pathological electrocardiogram (P < 0.001) on admission to hospital. Amongst patients who died, 66% died a cardiac death and 35% died in association with a myocardial infarction. CONCLUSION: Amongst patients admitted to the emergency department due to chest pain or other symptoms raising suspicion of AMI, several predictors based on clinical history and clinical presentation can be defined, which are strongly related to the long-term prognosis.
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| 19. |
- Herlitz, Johan, et al.
(author)
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Predictors of death and mode of death among patients with acute chest pain in various age groups
- 1997
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In: Cardiology in the Elderly. - : Lippincott Williams & Wilkins. - 1058-3661. ; 8:11-12, s. 719-726
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Journal article (peer-reviewed)abstract
- AIM: To describe predictors of death and mode of death among consecutive patients in various age groups admitted to the emergency department with acute chest pain. METHODS: All such patients admitted to Sahlgrenska University Hospital in Göteborg, Sweden, between February 1986 and November 1987 were prospectively registered. These patients were divided into three age groups: i.e. those aged less than 50 years; those aged 50-75 years; and those aged more than 75 years. RESULTS: In all, 5016 patients participated in the evaluation, of whom 24% died during 5 years of follow-up. One factor was independently associated with death in all three age groups: a normal electrocardiogram in the emergency department (better prognosis). Whereas a history of hypertension or smoking were associated with a worse prognosis in the two lower age groups (age < or = 75 years), a history of diabetes mellitus or congestive heart failure and male sex were associated with a worse prognosis in the two higher age groups (age > or = 50 years). CONCLUSION: Among patients with acute chest pain various risk indicators for death during long-term follow up can be defined in various age groups. However, a normal electrocardiogram on admission to hospital was an independent predictor of a low death rate in all age groups.
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| 20. |
- Herlitz, Johan, et al.
(author)
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Predictors of death and mode of death during long term follow-up among patients with nonconfirmed acute myocardial infarction.
- 1999
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In: Clinical Cardiology. - : John Wiley & Sons, Inc.. - 0160-9289 .- 1932-8737. ; 22:3, s. 179-183
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Journal article (peer-reviewed)abstract
- BACKGROUND: Among patients hospitalized with a suspected acute coronary syndrome, a minority will eventually develop a confirmed acute myocardial infarction (AMI). In the remaining patients, coronary artery disease is the underlying cause in a large proportion. HYPOTHESIS: The aim of the study was to determine risk indicators for death and the mode of death during 5 years of follow-up among patients hospitalized and surviving hospitalization, who presented with initially suspected AMI, but in whom infarction was not confirmed. METHODS: Consecutive patients who fulfilled the above criteria and were discharged from Sahlgrenska Hospital alive during 1986 and 1987 were followed for 5 years. RESULTS: In all, 1,227 patients, of whom 396 (34%) died during the 5 years of follow-up, fulfilled the criteria. The following factors appeared to be independent risk indicators for death: age (p < 0.001); male gender (p < 0.001); a history of either current smoking (p < 0.001), congestive heart failure (p < 0.01), or myocardial infarction (p < 0.05); congestive heart failure during hospital stay (p < 0.01); and prescription of digitalis at discharge (p < 0.05). Among patients who died, only 63% were judged to have been dying a cardiac death. CONCLUSION: Among patients hospitalized with suspected acute coronary syndrome and discharged from hospital without a confirmed AMI, one third had died during the 5 years of follow-up. Risk indicators for death were related to age, male gender, history of current smoking, congestive heart failure or previous AMI, congestive heart failure in hospital, and digitalis medication at discharge.
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| 21. |
- Herlitz, Johan, et al.
(author)
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Predictors of death during 5 years after hospital discharge among patients with a suspected acute coronary syndrome with particular emphasis on whether an infarction was developed
- 1998
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In: International Journal of Cardiology. - : Elsevier Ireland Ltd. - 0167-5273 .- 1874-1754. ; 66:1, s. 73-80
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Journal article (peer-reviewed)abstract
- Aim: To describe predictors of death after hospital discharge during 5 years of follow-up in a consecutive series of patients surviving hospitalization for symptoms and signs of a confirmed or suspected acute coronary syndrome. Patients and methods: All patients who between February 15, 1986 and November 9, 1987, were hospitalized at Sahlgrenska University Hospital in Göteborg, Sweden, and fulfilled the above given criteria. Results: In all, 1948 patients were included of whom 731 (38%) had a confirmed acute myocardial infarction (AMI). Independent risk indicators for death were: age (P=0.0001); male sex (P=0.005); a history of previous AMI (P=0.0001), diabetes mellitus (P=0.003) and smoking (P=0.0001); development of AMI during first 3 days in hospital (P=0.0001); in-hospital signs of congestive heart failure (P=0.0001); prescription of digitalis (P=0.001) and diuretics (P=0.02) at hospital discharge. A history of smoking interacted significantly (P=0.02) with the relationship between development of AMI and prognosis. Thus, the difference between patients who did and who did not develop an AMI was more pronounced among non-smokers than smokers. Other factors which interacted significantly with this relationship were a history of angina pectoris, and development of ventricular fibrillation and hypotension while in hospital. Conclusion: Among hospital survivors of a confirmed or suspected acute coronary syndrome predictors of death during 5 years were: age, male sex, history of AMI, diabetes mellitus and smoking, development of AMI and congestive heart failure while in hospital and prescription of digitalis and diuretics at hospital discharge. A history of smoking and angina pectoris as well as development of hypotension and ventricular fibrillation while in hospital interacted significantly with the relationship between development of AMI and prognosis.
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| 22. |
- Herlitz, Johan, et al.
(author)
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Prognosis during five years of follow up among patients admitted to the emergency department with acute chest pain in relation to a history of hypertension
- 1998
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In: Blood Pressure. - : Informa Healthcare. - 0803-7051 .- 1651-1999. ; 7:2, s. 81-88
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Journal article (peer-reviewed)abstract
- AIM: To describe the mortality, mode and place of death and risk indicators of death during 5 years of follow-up among patients admitted to the emergency department (ED) with acute chest pain or other symptoms raising a suspicion of acute myocardial infarction (AMI) in relation to a history of hypertension. METHODS: All the patients admitted to the ED at Sahlgrenska University Hospital during a period of 21 months with acute chest pain or other symptoms raising a suspicion of AMI were followed up prospectively for 5 years. RESULTS: Of 5,355 patients fulfilling the inclusion criteria, 22% had a history of hypertension. Hypertensive patients differed from non-hypertensive patients in that there were more females, they were older and had a higher prevalence of previous cardiovascular disease. Patients with a history of hypertension had a 5-year mortality rate of 37.4% as compared with 22.2% among non-hypertensive patients (p < 0.001). The difference in mortality appeared to be more marked among patients without a history of cardiovascular disease. A history of hypertension was an independent predictor of death. Risk indicators of death appeared to be relatively similar among patients with and without a history of hypertension. Of the patients who died, those with a history of hypertension were more frequently judged to have suffered a cardiac death and died more frequently in association with an AMI. CONCLUSION: Among patients admitted to the ED with acute chest pain and with a history of hypertension, 37% died during the following 5 years. A history of hypertension was an independent predictor of death.
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| 23. |
- Herlitz, Johan, et al.
(author)
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Rate and mode of death during five years of follow-up among patients with acute chest pain with and without a history of diabetes mellitus
- 1998
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In: Diabetic Medicine. - : Wiley-Blackwell Publishing Ltd.. - 0742-3071 .- 1464-5491. ; 15:4, s. 308-314
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Journal article (peer-reviewed)abstract
- In order to determine the effect of diabetes on the mortality rate and mode of death during 5 years of follow-up among patients who came to the emergency department with acute chest pain or other symptoms suggestive of acute myocardial infarction (AMI), all patients thus presenting to one single hospital during a period of 21 months were followed for 5 years. In total 5230 patients were included, of whom 402 (8%) had a history of diabetes. Patients with diabetes differed from those without by being older, having a higher prevalence of previously diagnosed cardiovascular diseases, having less symptoms of chest pain and more symptoms of acute severe heart failure, and more electrocardiographic (ECG) abnormalities on admission. Diabetic patients had a 5-year mortality of 53.5% as compared with 23.3% among non-diabetic patients (p < 0.001; adjusted risk ratio 1.60; 95% confidence limits 1.35-1.90). Among diabetic patients the following appeared as independent predictors of death: age (p < 0.001), ST-segment elevation on admission (P < 0.001), a history of myocardial infarction (p < 0.05), and a non-pathological ECG on admission (p < 0.001). We conclude that among diabetic patients admitted to the emergency department with acute chest pain or other symptoms suggestive of AMI more than 50% are dead 5 years later. Future research should focus on interventions in order to reduce their mortality.
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| 24. |
- Herlitz, Johan, et al.
(author)
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Rhythm changes during resuscitation from ventricular fibrillation in relation to delay until defibrillation, number of shocks delivered and survival
- 1997
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In: Resuscitation. - : Elsevier Ireland Ltd. - 0300-9572 .- 1873-1570. ; 34:1, s. 17-22
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Journal article (peer-reviewed)abstract
- AIM: To describe rhythm changes during the initial phase of resuscitation from ventricular fibrillation in relation to the interval between collapse and defibrillation, to survival and to bystander-initiated cardiopulmonary resuscitation (CPR). PATIENTS: All patients who suffered out-of-hospital cardiac arrest between 1980 and 1992, who were reached by the emergency medical service system (EMS), in whom resuscitation attempts were initiated and who were found in ventricular fibrillation. RESULTS: In all, 1216 patients were included in the study. Among patients who converted to a pulse-generating rhythm after the first defibrillation (n = 119) were 56% discharged from hospital as compared with 6% among patients who converted to asystole. The corresponding figures after the third defibrillation were 49% and 2%, respectively, and after the fifth defibrillation 28% and 7%, respectively. Among patients in whom the first defibrillation took place less than 5 min after collapse, 28% directly converted to a pulse-generating rhythm as compared with 3% when the first defibrillation took place 12 min or more after collapse. CONCLUSION: Among patients who suffer out-of-hospital cardiac arrest and are found in ventricular fibrillation, there is a strong relationship between survival and initial rhythm changes after defibrillation. These rhythm changes are directly related to the interval between collapse and the first defibrillation.
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