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ABSTRACT: To evaluate the long-term prognosis amongst patients with a very small or unconfirmed acute myocardial infarction (AMI) in relation to clinical history, metabolic screening and signs of myocardial ischaemia at exercise test.
Patients with a very small or unconfirmed AMI, aged < 76 years, were selected and given a clinical evaluation, metabolic screening and checked for ischaemia at an exercise test 4 weeks after admittance. The 10-year mortality was related to age, sex, clinical history, body weight, serum (S) cholesterol, S-triglycerides, S-gammaglutamyltranspeptidase (GT), S-glucose and various indices of myocardial ischaemia at exercise test.
In all, 714 patients participated in the evaluation. The median age was 63 years and 33% were women. The overall 10-year mortality was 33%. In univariate analysis, the following factors appeared as risk indicators for death: age (P < 0.0001), a history of previous AMI (P < 0.0001), angina pectoris (P < 0.001), diabetes mellitus (P < 0.0001), congestive heart failure (P < 0.0001), smoking (P = 0.030), S-triglycerides (P < 0.0001), S-gamma GT (P < 0. 0001) and S-glucose (P < 0.0001). In multivariate analysis, the following remained as independent risk indicators for death: age (P < 0.0001), S-gamma GT (P < 0.0001), previous AMI (P < 0.0001), smoking (P < 0.0001) and S-glucose (P = 0.010).
Amongst patients with a very small or a unconfirmed AMI, factors reflecting their clinical history, including age, a history of AMI and current smoking, as well as factors reflecting their metabolic status, including S-gamma GT and S-glucose, were important predictors for the long-term outcome.
Journal of Internal Medicine 04/2000; 247(4):449-56. · 5.48 Impact Factor
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ABSTRACT: We describe a 19-year-old woman developing acute left ventricular heart failure during her first exacerbation of multiple sclerosis. Histopathologic examination of myocardial tissue showed extensive myocytolysis. A left ventricular assist device was implanted. Three months later the cardiac function was restored and the left ventricular assist device was explanted. After 1 year the patient still remains well and her cardiac function is normal.
The Annals of Thoracic Surgery 03/2000; 69(2):628-30. · 3.74 Impact Factor
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ABSTRACT: All of the presently used methods for in-vivo determination of body composition have inherent methodological errors and depend on various assumptions. We have therefore compared several different methods used to measure body fat in adult GH deficiency during GH treatment.
Comparison of body composition data from a two-phase trial with an initial placebo-controlled, double-blind 6-month period, followed by open treatment with GH until all patients had received GH for 12 months.
Twenty-five patients with known GH deficiency entered the study. Baseline examinations were complete in 23 patients, and 22 patients (16 males, 6 females) completed all examinations after treatment.
Body fat calculated from total body potassium (TBK) by whole-body 40K counting, total body water (TBW) by tritium dilution, total body nitrogen (TBN) by neutron activation, and bioelectric impedance (BIA) measurements were compared to body fat determinations by dual-energy X-ray absorptiometry (DEXA) in two-compartment and multicompartment body composition models.
At baseline, DEXA fat mass agreed well at group level with measurements based on TBW or TBK alone, in a four-compartment model based on TBK and TBW, and a multicompartment model based on bone mineral (by DEXA), TBN and TBW. Body fat by BIA agreed less well. After 12 months of GH treatment, body fat decreased by all methods used. This decrease was smaller by DEXA than by the other methods. The four-compartment model based on TBK and TBW, and TBW alone, showed the best agreement with changes in DEXA fat.
All methods showed a decrease of body fat with GH treatment, but variation between methods was considerable.
Clinical Endocrinology 05/1996; 44(4):395-402. · 3.17 Impact Factor
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ABSTRACT: This study aims at describing the in-hospital prognosis of patients admitted with suspected acute myocardial infarction, focusing on the possibility of emergency room prediction of the risk for death and severe complications. From 7157 consecutive patients with chest pain or other symptoms suggestive of acute myocardial infarction in the emergency room, 4690 were hospitalized. Of these, 246 (5%) died in hospital, with a mortality rate among the 921 patients who developed myocardial infarction of 14%, and among those without infarction of 3%. From the clinical history, examination and electrocardiogram in the emergency room, independent predictors of death and death or any severe complication were determined by logistic regression analysis. These included age, initial degree of suspicion of infarction, electrocardiographic pattern, history of diabetes mellitus, history of congestive heart failure and on admission arrhythmias, loss of consciousness, acute congestive heart failure, or unspecific symptoms. From these analyses the probability of death or death or any severe complication can be calculated. Thus, 18% of patients hospitalized due to suspected acute myocardial infarction suffered a severe complication or died in hospital. From a statistical model it is possible to predict the in-hospital prognosis of every such patient.
European Heart Journal 12/1994; 15(11):1558-65. · 10.48 Impact Factor
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ABSTRACT: Sixty moderately obese women (mean BMI = 33, mean age = 43), randomized to a lactovegetarian or regular 1300-kcal weight-reducing diet were followed at 3, 8 and 24 months. Weight follow-up was 92%, while 47% complied with the program throughout with no differences between the two diets with respect to compliance rate, weight loss or behavioral test results. Over 24 months compliers lost a mean 3.9 kg compared to a gain of 1.8 kg in the non-compliers. Short-term improvements in mental well-being measured by the Mood Adjective Check List deteriorated after 2 years to lower levels than at entry. Self-assessed motivation to diet was inversely related to mental well-being at two years. Positive long-term changes of functional status (Sickness Impact Profile) were found. Though subjective prediction of success measured after 3 weeks on diet predicted short-term and maximum weight loss, it did not predict ultimate outcome. More difficulties in resisting emotional and social eating cues (high disinhibition score on the Three-Factor Eating Questionnaire) before and during the diet predicted weight gain. The more initial health-related dysfunction (SIP) the greater the weight regain. Psychological characteristics at baseline did not predict compliance or overall weight loss. The magnitude of weight loss after 24 months was related to amount and duration of maximum weight loss.
Appetite 09/1994; 23(1):15-26. · 2.59 Impact Factor
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ABSTRACT: An elevated waist to hip ratio (WHR) has been found to be a predictor for several prevalent diseases. To examine the potential role of alcohol in the elevation of WHR, established alcoholic men without severe liver damage who were in adequate nutritional condition were compared with organized teetotalers matched for age, height, and body weight; the groups had similar total body fat content and lean body mass. Computed tomographic (CT) measurements at thigh and trunk levels showed a significant increase in the visceral adipose tissue (AT) areas and a slight decrease of muscle areas in the gluteal and femoral regions of the alcoholics. The alcoholic men had 48% of their AT areas of trunk scans localized retroperitoneally and intraperitoneally compared with 38% for the teetotalers (P < .01). The difference seemed to be more marked for retroperitoneal than for intraperitoneal AT (97 v 60 cm2, P < .01). The elevated visceral AT areas seemed to be independent of smoking. It was concluded that the increased WHR of alcoholics may include not only changes in AT, but also in muscle tissue distribution.
Metabolism 06/1993; 42(5):569-73. · 2.66 Impact Factor
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ABSTRACT: The prognosis during 1 year of follow-up in 715 patients admitted to one single hospital due to suspected acute myocardial infarction (AMI) with a history of unstable angina pectoris immediately preceding hospitalization is described. AMI developed in 192 patients (27%) during the first three days and in 255 patients (38%) during the first year. The mortality during hospitalization was 7% (50 patients) and during 1 year 19% (130 patients). Of the nonsurvivors, 54% died of AMI, 28% of congestive heart failure, and 20% of cardiogenic shock. Based on simple clinical parameters on admission to the emergency room, risk indicators for death during the following year could be identified as follows, in the order of significance: high age (p < 0.001), ST-segment depression on admission (p < 0.001), and a history of diabetes mellitus (p < 0.05). At admission to the emergency room, risk indicators for development of AMI during the following year were as follows: initial degree of suspicion of AMI (p < 0.001), electrocardiographic signs of acute ischemia on admission (p < 0.001), ST-segment elevation on admission (p < 0.01), age (p < 0.05), and lack of a previous history of chronic stable angina pectoris (p < 0.05). We conclude that, among patients admitted to hospital due to suspected AMI with a history of unstable angina pectoris immediately preceding hospitalization, 38% developed a confirmed infarction and 19% died during the following year.
Clinical Cardiology 05/1993; 16(5):397-402. · 2.15 Impact Factor
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ABSTRACT: SOS (Swedish obese subjects) is an on-going intervention trial designed to determine whether the mortality and morbidity rates among obese individuals who lose weight by surgical means (gastric banding, vertical banded gastroplasty and gastric by-pass) differ from the rates associated with conventional treatment. For this purpose, the study is recruiting a sample of obese men and women who constitute a registry of potential subjects from which the participants are drawn. Eligibility criteria for participation in the registry were: age at application 37-57 years and BMI greater than or equal to 34 kg/m2 for men and greater than or equal to 38 kg/m2 for women. Before receiving a health examination, all patients complete extensive questionnaires on current and past health status, utilization of medical care and medications, socio-economic status, psychological profiles, dietary habits, physical activity, weight history, and familial disposition to obesity. Each surgical case is matched to its optimal control in the registry, to ensure that the two groups do not differ systematically with respect to any of 18 matching variables that may affect prognosis. The first 1006 subjects included in the registry have been studied with respect to morbidity and compared with on-going population studies of men and women in Göteborg, Sweden. The relative risks of prevalent disease and symptoms associated with obesity in 50-year-old males and females respectively were 4.3 and 4.7 (dyspnoea), 14.7 and 11.8 (angina), 6.3 (myocardial infarction, males only), 2.1 and 4.5 (hypertension), 5.2 and 6.6 (diabetes), 4.6 and 26.1 (claudication) and 1.7 and 1.8 (gall bladder disease). Correspondingly, obese males and females display elevations of systolic and diastolic blood pressure, fasting glucose, insulin, triglyceride, and uric acid levels. However, total cholesterol was not increased in obese males and was in fact significantly lower in obese compared with reference women. HDL-cholesterol was lower in obese than reference men (data were not available in reference women). The rate of taking sick pensions was over twice as high in SOS obese patients than in population controls. Finally, comparison of measurements with self-reported prevalence estimates revealed a considerable amount of previously undiagnosed hypertension and diabetes in the obese subjects. These data suggest that the excess health risks associated with obesity may not be fully appreciated.
International Journal of Obesity 07/1992; 16(6):465-79. · 4.69 Impact Factor
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ABSTRACT: The characteristics and the prognosis in 921 consecutive patients with acute myocardial infarction (AMI) admitted to one single hospital are described and related to whether they were treated in the coronary care unit or not. Patients treated in the coronary care unit (n = 779) had a 1-year mortality rate of 26% as compared with 41% for patients treated in general wards (n = 115; p < 0.001) and 74% for patients treated in the intensive care unit (n = 27; p < 0.001). Patients treated outside the coronary care unit had a different risk factor pattern including a higher age and a higher prevalence of a previous cardiovascular disease. Independent clinical risk indicators for death among patients in the coronary care unit were in order of significance, high age (p < 0.001), arrhythmia on admission (p < 0.01), acute congestive heart failure on admission (p < 0.01) and a history of diabetes mellitus (p < 0.05). In patients treated in general wards, the only risk indicator for death was a history of congestive heart failure.
Cardiology 02/1992; 81(2-3):134-44. · 1.71 Impact Factor
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ABSTRACT: During a 21-month period, the prognosis in all patients admitted to a hospital ward from the emergency room with suspected acute myocardial infarction (AMI) was prospectively recorded and related to the time between onset of symptoms and arrival in hospital. They were classified as early arrivers (less than or equal to 2 h), intermediate arrivers (2-8 h) and late arrivers (greater than 8 h). Among patients developing a confirmed AMI (n = 909) the 1-year mortality rate was 26.0% in early arrivers, 28.1% in intermediate arrivers and 32.6% in late arrivers. The corresponding figures for patients in whom AMI was ruled out (n = 2,035) were 15.2, 15.1 and 17.6%, respectively. In AMI patients, various morbidity aspects during hospitalization and 1 year of follow-up appeared mainly independent of delay time, whereas among those in whom AMI was ruled out congestive heart failure during hospitalization was most common in early arrivers. We conclude that patients with suspected AMI who do not arrive early in hospital have a high 1-year mortality rate regardless of whether they develop AMI or not. Whether their prognosis can be improved by shortening of delay time remains to be clarified.
Cardiology 02/1991; 78(2):131-7. · 1.71 Impact Factor
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ABSTRACT: Ethyl esters of fatty acids (EEFA) have been found to be formed during ethanol metabolism. Human adipose tissue contains high concentrations of free fatty acids, the substrate for EEFA synthesis, and might therefore be a tissue with great potential for EEFA formation. In order to explore their potential usefulness as markers of alcohol abuse, the EEFA concentration and the activity of EEFA-synthesizing enzyme were therefore determined in adipose tissue from men belonging to the following categories: teetotalers, social drinkers, alcoholics under treatment, or established alcoholics found to have died as a result of alcohol intoxication. In order to estimate the half-life of EEFA and the synthase activity induction, the alcoholics were examined after different time periods of abstinence from alcohol. Comparisons were also made with several established markers of alcohol abuse. EEFA were not found in teetotalers, and were found in low concentrations in some of the social drinkers. EEFA were found in several alcoholics, and the forensic cases had high concentrations. EEFA-synthesizing enzyme activity was found in all subjects, increasing from teetotalers to social drinkers, and being 2-fold higher in alcoholics and 5-fold higher in dead alcoholics. The induction of the enzyme after abstinence appeared to have a half-life of the order of several weeks. Correlations were found between EEFA synthase activity and previously established markers of alcohol abuse known to remain for a long time period after abstinence, such as mean erythrocyte corpuscular volume. This preliminary study suggests the possibility that EEFA synthase induction in adipose tissue might have a longer half-life than previously used markers of alcohol abuse. It is therefore suggested that the induction of EEFA synthase might be a potentially useful new marker for alcohol abuse because of its apparent proportionality to alcohol intake over a prolonged time period, its presumed specificity, and long-term elevation after alcohol abstinence. This potential marker should be analysed further.
Journal of Internal Medicine 01/1991; 228(6):557-62. · 5.48 Impact Factor
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Lakartidningen 01/1990; 86(50):4438-43.
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ABSTRACT: The oxygen consumption of human adipose tissue (AT) was determined in 53 adults, lean and obese, and in nine lean boys. The oxygen consumption was positively related to fat cell weight and negatively to age and degree of obesity. Men and women did not differ with respect to oxygen consumption of AT. The positive relationship between oxygen consumption per cell and fat cell size was also demonstrated in size-separated cells from the same donors. Expressed per cell the oxygen consumption was higher in fat cells from obese than in cells from lean subjects, but expressed per gram of tissue the opposite result was found. The oxygen consumption of the total AT organ was higher in obese than in lean subjects. The energy expenditure of AT constituted approximately 4% of the estimated 24-h energy expenditure in both groups. It is concluded that obese subjects do not maintain their obesity because of a reduced energy expenditure of the total AT (or of the total body). After a partial weight reduction in five subjects, the energy metabolism tended to change in direction toward the conditions seen in lean subjects. However, it is still an open question whether the observed energy metabolic aberrations of obese human AT are only secondary to the obese state or partly primary and thus of etiological importance.
The American journal of physiology 05/1989; 256(4 Pt 1):E467-74.
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ABSTRACT: Fifty-one morbidly obese women were randomized and operated upon with either gastroplasty or gastric bypass. The patients were studied preoperatively and 12 months after surgery. The weight loss was significantly larger after gastric bypass. Fat cell weight was determined from subcutaneous fat biopsies of the epigastric, hypogastric, femoral and gluteal regions. Intra-abdominal biopsies were also taken during the operation. Fat cell weight decreased significantly in all subcutaneous regions. Fat cell number, derived from calculated body fat and measured mean subcutaneous fat cell weight, decreased significantly in both treatment groups.
International Journal of Obesity 02/1988; 12(3):191-7. · 4.69 Impact Factor
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ABSTRACT: A new polarographic system for measurement of oxygen consumption in vitro has been constructed to minimize different types of errors. The system was built of polyamide-6, Monax glass, stainless steel, and rubber to diminish oxygen leakage and gas capacitance properties. With these materials the system was gas-tight. Nevertheless, the incubation chambers had oxygen capacitance properties that had to be corrected for mathematically. Thus, in order to obtain more exact absolute values of the respiratory rate, the apparent respiratory slopes were continuously corrected for delta pO2. Furthermore, the initial slope observed in the absence of biological material was also taken into account. Using these variables, the apparent slope (mm Hg/min) could be adjusted by subtracting the following correction factor: correction factor = 0.00306 X delta pO2 + 0.198 X (initial slope). This correction gave a high degree of linearity and an overall error on the order of 10%. Without the described correction for the oxygen capacitance, the true respiratory rate may be underestimated by up to 50%.
The Journal of Lipid Research 10/1986; 27(9):996-1005. · 5.56 Impact Factor
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J. Internal Med. 228 (1990) 557-562.
