ISSN:0954-6820    

DOI:10.1046/j.1365-2796.1996.456792000.x

出版商:Blackwell Science Ltd    

年代:1996

数据来源: WILEY

摘要:

During recent years, the exploration of different aspects of atrial fibrillation (AF) has become increasingly interesting. Thus, knowledge about basic underlying mechanisms, consequences and different modes of treatment has rapidly expanded. At a meeting in Lund, Sweden, in 1993, scientists within different fields of AF research gathered for the exchange of information. This paper is a short summary of some topics discussed at the Lund meeting and some suggestions as to how further research in this field may help to improve our understanding of this arrhythmia and the treatment of patients suffering from it.Underlying pathoelectrophysiological mechanisms in AF have been explored in experimental models in animals and by direct recordings of different atrial myocardial electrophysiological variables both in the catheter laboratory and during open heart surgery in man. Some findings illustrate possible generalized atrial myocardial mechanisms, whilst other findings clearly indicate the possibility of localized pathoelectrophysiological mechanisms. The generally accepted hypothesis that AF is perpetuated by multiple re‐entry mechanisms is, thus, both verified and modified by recent studies.In addition to subjective symptoms and well identified thromboembolic consequences, accumulating evidence tells us that AF may precipitate a myocardial dysfunction which may be misinterpreted as an underlying factor initiating the arrhythmia.Today's treatment of AF includes several newer antiarrhythmic drugs, different ablation techniques, the application of different electrical devices as well as different surgical methods. New, improved and simplified methods are expected.Atrial fibrillation is the single most important supraventricular arrhythmia needing substantial further exploration of mechanisms, consequences and treatment. The Lund symposium contributed to this process by defining the state of knowledge in 1993 and outlining the need for the years to com

ISSN:0954-6820    

DOI:10.1046/j.1365-2796.1996.357688000.x

出版商:Blackwell Science Ltd    

年代:1996

数据来源: WILEY

ISSN:0954-6820    

DOI:10.1046/j.1365-2796.1996.331661000.x

出版商:Blackwell Science Ltd    

年代:1996

数据来源: WILEY

摘要:

Objectives.Changes in the electrical activity of the heart reflecting the infarct process can be recorded by continuous vector‐ECG, a method which is now clinically available for cardiac supervision. Shifts of the ST‐segment and QRS‐vector reflect ischaemia and necrosis of the myocardium. Continuous vector‐ECG changes were evaluated against myocardial scintigraphy in 18 patients with acute myocardial infarction treated with streptokinase in order to study the impact of improved myocardial perfusion.Design.Myocardial perfusion was analysed with99Tcm‐Sestamibi (Cardiolite, DuPont Scandinavia AB, Kista, Sweden) single photon emission computerized tomography (SPECT). Registrations were performed before and after thrombolysis in order to estimate the amount of myocardium with impaired perfusion initially (threatened myocardium) and the degree of perfusion improvement in this myocardial area. X, Y, Z vectors were registered continuously by Frank leads (Ortivus Medical, Täby, Sweden). QRS‐vector difference, and the time to plateau phase and the ST‐vector magnitude were used as a measurement of ischaemia and size of the myocardial infarction.Results.In seven out of 11 patients treated within 3 h of onset of symptoms, an improvement in myocardial perfusion in the initially hypoperfused areas was achieved in contrast to none of the seven patients treated>3 h after onset of pain (P<0.05). In the whole patient material, there was a negative correlation between the time to plateau level for the QRS‐vector and the improvement in myocardial perfusion (r=‐0.53, P<0.05). Among patients treated within 3 h, there was a negative correlation between the plateau level for the QRS‐vector magnitude compared to the improvement in myocardial perfusion (r=‐0.61, P<0.05) and a negative correlation between the plateau level and the myocardial perfusion level after therapy (r=‐0.69, P<0.05). In these patients, there were also negative correlations between the maximal ST‐vector magnitude and the myocardial perfusion both before and after thrombolysis (r=‐0.81, P<0.05 andr=‐61, P<0.05, respectively).Conclusion.Patients with marked improvement in myocardial perfusion indicating successful thrombolysis reach their plateau levels of the QRS‐change faster and have lower total QRS‐vector differences than patients without successful thrombolysis as reflected by myocardial scintigraphy. Patients with a high ST‐vector magnitude have low perfusion levels both before and after therapy indicating a pronounced ischaemic damage of the myocardium. Thus, VCG‐changes reflect impairment in myocardial perfus

ISSN:0954-6820    

DOI:10.1046/j.1365-2796.1996.412754000.x

出版商:Blackwell Science Ltd    

年代:1996

数据来源: WILEY

摘要:

Objectives.Comparison of 60° mydriatic retinal photography, in screening for diabetic retinopathy, with diabetes clinic doctors, formal ophthalmological assessment, and with one or two 45° fields.Design.Consecutive subjects screened by clinicians and photography, and selected eyes evaluated by an ophthalmologist. Randomized photographs assessed through one or two 45° fields (by masking the slides), and at 60°.Setting.The first 663 patients attending for routine clinic visits and screened for retinopathy.Main outcome measures.The relative diagnostic sensitivity of screening methods, the utility of screening one eye only, and the costs of photographic screening.Results.Compared to an ophthalmologist’s assessment, retinal photography had a sensitivity of 93% and a specificity of 89% for any retinopathy, and 100 and 75%, respectively, for severe retinopathy. Photography detected 28% more retinopathy (16% severe) than the clinicians. Compared to a 60° field, one 45° field missed 31%, and 2×45° fields 11% of retinopathy. Of 57 patients with retinopathy meeting referral criteria, 31 pairs of eyes had substantially discordant scores. The cost of diagnosis in a patient requiring referral to ophthalmologist was about US$37.00.Conclusions.60° retinal photography compares well with an ophthalmologists screening, and is better than clinical and one to two 45° field assessments. Both retinae should be screened. This method is cost‐effective

ISSN:0954-6820    

DOI:10.1046/j.1365-2796.1996.413755000.x

出版商:Blackwell Science Ltd    

年代:1996

数据来源: WILEY

摘要:

Objectives.To study the relationships between plasma renin activity and metabolic cardiovascular risk factors in patients with essential hypertension.Subjects and design.Patients with uncomplicated essential hypertension (n=36) with a diastolic blood pressure of 95–115 mmHg were studied. Assessment of plasma renin activity (PRA) related to urinary sodium excretion was used to define subgroups with high (n=12), medium (n=16) and low renin profiles (n=8).Main outcome measures.Fasting plasma lipid levels were determined. Glucose, insulin and C‐peptide responses to standard oral glucose tolerance test (OGTT) were measured.Results.Patients with high PRA had higher levels of plasma cholesterol (6.13±0.81 versus 4.67±0.7 mmol L‐1,P<0.05) and triglycerides (2.14±0.18 versus 0.98±0.13 mmol L‐1,P<0.05), than the low PRA group. HDL‐cholesterol levels were lower in the high renin group than in the low renin group (1.05±0.04 versus 1.26±0.09 mmol L‐1,P<0.05). Insulin and C‐peptide sums were higher in high PRA group (33.8±1.2 versus 25.1±0.9 and 2.6±0.3 versus 1.9±0.4 ng L‐1,P<0.05), than in the low PRA group.Conclusions.Essential hypertensive patients with a high renin profile display more pronounced dyslipidaemia and higher levels of plasma insulin than patients with a low renin profile. This may be one explanation for higher incidence of cardiovascular disease previously r

ISSN:0954-6820    

DOI:10.1046/j.1365-2796.1996.414756000.x

出版商:Blackwell Science Ltd    

年代:1996

数据来源: WILEY

摘要:

Objective and design.To compare the total and age‐specific incidence of thyrotoxicosis, as well as the incidence of the individual types of thyrotoxicosis [i.e. thyrotoxicosis of Graves' type (GD), toxic nodular goitre (TNG) and solitary toxic adenoma (STA)] in Malmö during the years 1988–1990 to those of a previous study in 1970–1974.Setting.The town of Malmö in southern Sweden.Subjects.All patients from the Malmö population treated for thyrotoxicosis (GD, TNG and STA) for the first time during the 3‐year period 1988–1990 were included.Results.Overall, 299 (263 females and 36 males) new cases of thyrotoxicosis were diagnosed in 1988–1990, corresponding to a mean annual incidence of thyrotoxicosis of 43.0 per 100000 inhabitants. The incidence of GD was 22.3, of TNG 16.0 and of STA 4.8 per 100000 per year. Comparing age‐ and sex‐standardized incidences to the results in 1970–1974, there was a significant increase (P<0.001) in the mean annual incidence of thyrotoxicosis in the total material as well as in TNG. In addition, there was an increase in GD in females younger than 50 years (P<0.01), whereas in TNG/STA, an increase was seen in females of 50 years or older (P<0.001). The incidence figures in males were not significantly changed. There was a higher proportion of smokers in females with GD compared to females with TNG (P<0.001) and STA (P<0.05).Conclusions.The total incidence of thyrotoxicosis, as well as the incidence of GD in females younger than 50 years and the incidence of TNG/STA in females of 50 years or older, has increased in Malmö during the period from 1970 to 1990. The increase was probably caused by several factors such as more sensitive diagnostic tools and GD changes in smoking habits, but additional unknown factors might

ISSN:0954-6820    

DOI:10.1046/j.1365-2796.1996.415757000.x

出版商:Blackwell Science Ltd    

年代:1996

数据来源: WILEY

摘要:

Objectives.To study the frequency of islet cell (ICA) and glutamic acid decarboxylase (GAD‐Ab) antibodies in patients with hyperthyroidism of different types at diagnosis before treatment and in the euthyroid state following treatment.Setting.Department of Endocrinology, Malmö University Hospital, Malmö, Sweden.Subjects and design.Blood samples were collected at diagnosis from 129 hyperthyroid patients, and about 6 months later, from 78 of the patients (euthyroid state). Ninety‐two patients had Graves' disease (69 females and 23 males, median age 49 years, range 17–85 years), and 37 patients had toxic nodular goitre/solitary toxic adenoma (34 females and three males, median age 69 years, range 24–86 years).Interventions.Most patients were treated by radioactive iodine following the first blood sample.Main outcome measures.ICA and GAD‐Ab in serum.Results.At diagnosis of Graves' disease, ICA were detected in two out of 92 (2.2%) patients, two out of 85 (2.4%) without diabetes mellitus and in the euthyroid state in one patient. None of the patients with toxic nodular goitre/solitary toxic adenoma had detectable ICA. At diagnosis of Graves' disease, GAD65‐Ab as well as GAD67‐Ab were detected in 11 out of 85 (13%) patients without diabetes. As many as six out of 11 GAD67‐Ab‐positive patients were GAD65‐Ab negative. In the euthyroid state, GAD65‐Ab were found in six out of 51 (12%) and GAD67‐Ab in eight out of 51 (16%) of the non‐diabetic Graves' disease patients. The frequencies of GAD65‐Ab and GAD67‐Ab in toxic nodular goitre/solitary toxic adenoma, diabetes excluded, were 3 and 0%, respectively, in the hyperthyroid state.Conclusion. The frequency of ICA in patients with hyperthyroidism is not increased as compared to the background population. GAD‐Ab seems to be associated with Graves' disease and not with hyperthyroidism. The presence of GAD67‐Ab in GAD65‐Ab negative sera from patients with Graves' disease indicates autoreacti

ISSN:0954-6820    

DOI:10.1046/j.1365-2796.1996.417758000.x

出版商:Blackwell Science Ltd    

年代:1996

数据来源: WILEY

摘要:

Objectives.To assess patients' perception of the therapeutic outcome after coronary artery bypass surgery, and to find predictors for increased well‐being.Design.Self‐administered questionnaires (Family APGAR and GHQ‐30) were completed on admission and at the follow‐up after 12 months, together with functional classification according to the NYHA index.Setting.Ullevål University Hospital, Oslo, Norway, 1990–1992.Subjects.Two hundred and thirteen patients with stable angina admitted for elective coronary artery bypass surgery.Intervention.Elective coronary artery bypass surgery.Main outcome measures.Improved physical and psychosocial functioning after one year.Results.One hundred and ninety‐seven (92%) patients improved their NYHA class, while it remained stable or declined in 16 (8%) patients. Significantly fewer patients with mental distress were found at the follow‐up than at the baseline examination (49 patients [23%] versus 80 patients [38%], respectively,P<0.0001). One hundred and forty‐six patients (69%) reported enhanced psychosocial well‐being, while it was reduced (n=60) or unchanged (n=7) in 67 patients (31%). Predictors for improved psychosocial well‐being following coronary artery bypass surgery were mental distress before surgery (odds ratio 2.8) and being a male patient (odds ratio 2.8).Conclusions.The majority of the patients reported significant improvement in their physical and psychosocial functioning one year after coronary artery bypass surgery. Mental distress and male sex were significant predictors of enhanced well‐being. Questionnaires on psychosocial well‐being such as the GHQ‐30 may, in addition to health status measurements, offer additional useful information when coronary artery by

ISSN:0954-6820    

DOI:10.1046/j.1365-2796.1996.425768000.x

出版商:Blackwell Science Ltd    

年代:1996

数据来源: WILEY

摘要:

The case history of a 68‐year‐old woman with progressive dysphagia caused by extrinsic compression of the oesophagus by an aberrant right subclavian artery or arteria lusoria is presented. Previous history mentioned a Riedel's thyroiditis, idiopathic retroperitoneal fibrosis and an aortic sclerosis. The authors want to report the case because it is an example of an association between lusoria dysphagia and retroperitoneal fibrosis, the connective tissue disease responsible for Riedel's thyroiditis, and perhaps, aortic sclerosis. This is the first report of this particular associat

ISSN:0954-6820    

DOI:10.1046/j.1365-2796.1996.379746000.x

出版商:Blackwell Science Ltd    

年代:1996

数据来源: WILEY