[DANAMI. A Danish study of invasive versus conservative treatment of patients with post-infarction ischemia who had received thrombolytic therapy]. / DANAMI. En dansk undersøgelse af invasiv versus medicinsk behandling af trombolysebehandlede patienter med postinfarkt iskaemi.

INTRODUCTION: To compare an invasive strategy employing percutaneous transluminal coronary angioplasty (PTCA) or coronary artery by-pass grafting (CABG) with a medical strategy in patients who had received thrombolytic treatment for first acute myocardial infarction (AMI), and with signs of inducible ischaemia. METHODS: In a prospective study 1008 patients were randomized, 503 to invasive treatment, of whom 266 (52.9%) had PTCA, and 147 (29.2%) CABG, 505 to conservative treatment, of whom eight (1.6%) were revascularized within two months. RESULTS: After a median follow-up of 2.4 years the mortality in the invasive group was 3.6% vs. 4.4% (p = 0.45) in the conservative group, re-infarction incidence was 5.6% vs. 10.5% (p = 0.0038) and percentage of admissions with unstable angina was 17.9% vs. 29.5% (p < 0.00001). DISCUSSION: We conclude that post-infarct patients with inducible ischaemia should be referred to coronary angiography and revascularised accordingly.

[A 20-year follow-up of Danish coronary artery bypass patients]. / Tyve års opfølgning af danske koronararteriebypass-patienter.

This study describes the influence of complete revascularization on the long term survival of patients following coronary artery bypass surgery. The patient population consists of 100 consecutive patients discharged from our department after undergoing a coronary bypass operation between November 1973 and July 1978. Patients who survived less than 30 days postoperatively are excluded from the study. The patient population consists of 87 males and 13 females. Mean age was 52.2 years at time of surgery. The rate of revascularization was estimated by coronary angiography, performed between one and 34 months postoperatively, in contrast to other similar studies found in the literature, where such estimation was performed peroperatively. Twenty-five of 86 patients were completely revascularized at postoperative angiographic estimation. Long term survival for the patient population and for the group of completely revascularized patients were compared to the expected survival of the Danish background population (comparable age and sex). Long term survival for the patient population as a whole was similar to that found in similar studies. There was an expected increased mortality compared to the Danish background population.

[Bacterial endocarditis at a county hospital department, 1983-1992. Prognosis in relation to bacteriology, disease localization and treatment]. / Bakteriel endokardit på en landsdelsafdeling, 1983-1992. Prognose i relation til bakteriologi, sygdomslokalisation og behandling.

The case records of 69 patients with a diagnosis of bacterial endocarditis were reviewed. Forty-nine patients had native valve endocarditis (NVE) and 20 patients had prosthetic valve endocarditis (PVE). Among patients with NVE left-sided endocarditis was treated surgically more often than right-sided endocarditis. Involvement of the aortic valve was the most important indicator of death and acute/subacute surgical intervention. The mortality was 29%. No patient with right-sided endocarditis died. The infective agent did not seem to influence outcome or frequency of surgical intervention. Among patients with PVE the most frequently isolated organism was coagulasenegative staphylococci. Surgical intervention occurred most frequently in those with infection with coagulase-negative staphylococci or culture negative endocarditis. The mortality was 25%, identical for early and late cases. The patients who died were all infected with staphylococci. The localization did not seem to influence treatment or outcome. In spite of advances in surgical and medical treatment bacterial endocarditis is still a life-threatening disease with a high mortality.

[201-thallium myocardial scintigraphy before and after percutaneous transluminal coronary angioplasty]. / 201thallium myokardieskintigrafi før og efter perkutan transluminal koronar angioplastik.

We describe our experience from the first 30 patients treated with percutaneous transluminal coronary angioplasty (PTCA) in the Cardiologic Department P, Gentofte Hospital. The main purpose was to evaluate the value of thallium scintigraphy performed before and three months after PTCA. After PTCA, 23 (77%) had no angina and 22 (73%) had normal exercise-ECG. On the basis of the scintigraphies before PTCA, the patients were divided into two groups: In group 1, five had normal scintigraphy and 14 reversible perfusion defects only. In group 2, all 11 patients had both persistent and reversible defects. In patients without persistent defects, significantly more were free from angina. No difference was observed between group 1 and 2 in percentage stenosis of the vessel or in reduction of the diameter. Significant reduction in the extent of reversible perfusion defects after PTCA was observed in both groups and also in the extent of persistent defects in group 2. In about 1/3 of the patients, the changes in percentage stenosis after PTCA and in the perfusion as judged by the scintigraphies differed. Therefore, as the two methods supplement each other, the main conclusions are: 1) Evaluation of the revascularization procedure is more reliable if a scintigraphy is obtained both before and after PTCA than if only coronary arteriography is performed. 2) Scintigraphy alone suffices for the three-month follow-up examination, partly because it gives better information about the myocardial perfusion than does the arteriography, partly because scintigraphy is a noninvasive procedure.

Omnipaque and Urografin in left ventriculography and coronary arteriography. A randomised, double blind study.

In order to compare tolerability and radiographic properties of Omnipaque (iohexol) 350 mg I/ml and Urografin (sodium meglumine diatrizoate) 76% (370 mg I/ml) in left ventriculography and coronary arteriography, a randomised, double-blind parallel study was conducted. ECG, heart rate, blood pressure, cardiac output, oxygen saturation, CK-MB, adverse reactions and opacification were recorded. Twenty-five patients received Omnipaque and 24 Urografin and all patients were included in the final material. Omnipaque was found to have less influence on haemodynamics than Urografin. Few adverse reactions were encountered in the entire study, but fewer after injections of Omnipaque than after Urografin. Equally good opacification was demonstrated for both media. Omnipaque was found well suited for cardioangiography and superior to standard ionic media.

Immediate and long-term results in aortic valve replacement.

In a 12-year period, 127 patients with isolated aortic valve disease underwent valve replacement surgery. Long-term results are presented in regard to patients with operation between 1967 and 1974 and immediate results in the later cases. The main conclusions from the study are that the type of myocardial protection is important for the perioperative mortality rate. This rate was 18% in patients operated on in normothermia and 6% in those with chemical cardioplegia. No significant correlation was found between preoperative NYHA grouping and mortality or complication rate, and the long-term result was independent of the type of valvular prosthesis.

Localization of the c-ab1 oncogene adjacent to a translocation break point in chronic myelocytic leukaemia.

The human c-ab1 oncogene maps within the region (q34-qter) of chromosome 9 which is translocated to chromosome 22, the Philadelphia (Ph') chromosome, in chronic myelocytic leukaemia (CML). The position of the Ph' chromosomal break point is shown to be variable and, in one CML patient, has been localized immediately 5' of, or within, the c-ab1 oncogene. A DNA restriction fragment corresponding to this site has been molecularly cloned and shown to represent a chimaeric fragment of DNA from chromosomes 9 and 22.

Fasting serum cholesterol and triglycerides in a ten-year prospective study in old age.

In a ten-year prospective study of a population of men and women aged exactly 70 at entry and otherwise selected only according to geography, the predictive values of serum cholesterol and serum triglycerides were evaluated concerning total mortality and cardiovascular disease (CVD) and cancer manifestations in the eighth decade. Both high and low cholesterol values at 70 were associated with excess total mortality in men, the former showing excess CVD mortality, the latter excess cancer mortality. In men, high values of triglycerides at 70 were associated with increased CVD mortality as well as CVD development. In women, high values of triglycerides at 70 were associated with excess hospitalization for cerebrovascular incidence alone.

Epidemiological observations of old age.

Disease prevention in the higher age bracket is a rather new discipline. A necessary prerequisite for any prophylactic interference is a thorough knowledge about prevalence of and incidence change in health condition in various ages and in cohorts followed for a period of time. In the Glostrup Population Studies cohorts aged 50 and 70 years were followed for 10 years. Furthermore, two birth cohorts 14 years apart were investigated at the age of 50 years. From these and other surveys findings included: (a) conservation of muscle strength keeps glucose consumption and insulin production at a normal level even in old age: (b) abstinence from smoking conveys a minimum of respiratory distress and reduction of respiratory parameters by age: (c) food consumption is high in fat (43% of energy) and saturated fat (S/P 3:1) both at ages 40 and 60, with no sex difference. A secular trend pointing toward a change in eating and drinking habits is, however, indicated from the fact that 50-year-old men and women present lower serum cholesterol and higher fasting serum triglyceride levels than do people at the same age deriving from a birth cohort 14 years earlier.

Spontaneous and/or training-induced haemodynamic changes after myocardial infarction.

Maximal oxygen uptake (VO2max) determinations and haemodynamic studies at rest and during two submaximal exercise levels (60 and 85% of the maximal) were performed in 30 male patients under 60 yr of age, 2, 5 and 8 mth after an uncomplicated myocardial infarction. Fourteen patients participated in a physical training programme during the first 3 mth of the study, while 16 patients attended the training during the second 3-mth period. An increase in VO2max occurred at 5 mth in both groups, 16 and 11%, respectively. Corresponding to this improvement cardiac index (CI) at the same relative submaximal work load increased similarly in the two groups. During the second period of the study only slight increments in VO2max and no salient alterations of the haemodynamics were recorded within or between the two groups. The linear relationship between oxygen uptake and CI was not affected throughout the study. As the work load was augmented from 60 to 85% of the maximal during the exercise test, the stroke volume index did not tend to fall. Our data suggest that allowing all patients to resume work in the very early rehabilitation period after an uncomplicated myocardial infarction, the improvement in physical work capacity and cardiac function is not significantly affected by a training programme of low intensity and short weekly duration.