59 results on '"Dag Sørlie"'
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2. 2020/48 Norwegian parental benefits provisions disadvantaging men found outside the scope of Equal Treatment Directive (NO)
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Dag Sørlie Lund and Jonas Thorsdalen Wik
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Scope (project management) ,Political science ,Law ,language ,Norwegian ,Directive ,language.human_language - Published
- 2020
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3. Special Issue on the Legal Remedies and Implications from the Fosen-Linjen Case ∙ The Fosen-Linjen Saga – A Norwegian Perspective
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Dag Sørlie Lund
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Political science ,Law ,Perspective (graphical) ,language ,Norwegian ,General Economics, Econometrics and Finance ,language.human_language - Published
- 2019
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4. Direct angiography demonstrates equal 8-12 years patency rates of radial artery and saphenous vein grafts
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Terje K. Steigen, Amjid Iqbal, Rolf Busund, Dag Sørlie, Jan Mannsverk, Øystein Dahl-Eriksen, Kristian Bartnes, Truls Myrmel, Stig Eggen Hermansen, Ramez Bahar, Per Erling Dahl, and Thor Trovik
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medicine.medical_specialty ,Time Factors ,Vein graft ,030204 cardiovascular system & hematology ,03 medical and health sciences ,Coronary artery bypass surgery ,0302 clinical medicine ,Predictive Value of Tests ,medicine.artery ,Graft selection ,Medicine ,Humans ,Saphenous Vein ,030212 general & internal medicine ,Radial artery ,Coronary Artery Bypass ,Vascular Patency ,Graft patency ,medicine.diagnostic_test ,business.industry ,Norway ,Angiography ,Graft Occlusion, Vascular ,VDP::Medisinske Fag: 700::Basale medisinske, odontologiske og veterinærmedisinske fag: 710 ,VDP::Medical disciplines: 700::Basic medical, dental and veterinary science disciplines: 710 ,Surgery ,surgical procedures, operative ,Treatment Outcome ,Radial Artery ,Cardiology and Cardiovascular Medicine ,business - Abstract
This is an Accepted Manuscript of an article published by Taylor & Francis in Scandinavian Cardiovascular Journal on 30. june 2020, available online: https://doi.org/10.1080/14017431.2020.1784454. Objectives: The benefits of coronary artery bypass surgery depend on lasting graft patency. To aid rational graft selection, the relative long-term merits of radial artery and saphenous vein grafts need to be determined by a gold standard method and with minimal clinically driven selection bias. Methods: The patency rates of various conduits were determined by direct angiography in 76 patients from a cohort of 119 undergoing coronary artery bypass grafting 7.6–12.1 (mean 8.9) years before. Results: 14 out of 76 radial artery and 10 out of 61 saphenous vein grafts were occluded (rates 0.18 and 0.16, respectively). Conclusion: The high long-term patency rate of saphenous vein grafts does not support a preferential use of the radial artery as a coronary artery bypass conduit.
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- 2020
5. 2020/48 Norwegian parental benefits provisions disadvantaging men found outside the scope of Equal Treatment Directive (NO)
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Wik, Jonas Thorsdalen, primary and Lund, Dag Sørlie, additional
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- 2020
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6. Arterial grafts do not counteract target vessel occlusion
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Kristian Bartnes, Ramez Bahar, Rolf Busund, Truls Myrmel, Øystein Dahl-Eriksen, Stig Eggen Hermansen, and Dag Sørlie
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Adult ,Male ,Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Internal thoracic artery ,Coronary Angiography ,Coronary artery bypass surgery ,medicine.artery ,Internal medicine ,Occlusion ,medicine ,Humans ,Saphenous Vein ,Coronary Artery Bypass ,Mammary Arteries ,Radial artery ,Vascular Patency ,Coronary atherosclerosis ,Aged ,Chi-Square Distribution ,business.industry ,Graft Occlusion, Vascular ,General Medicine ,Middle Aged ,Coronary Vessels ,Surgery ,Coronary arteries ,medicine.anatomical_structure ,Coronary occlusion ,Right coronary artery ,Radial Artery ,Cardiology ,Female ,Cardiology and Cardiovascular Medicine ,business - Abstract
OBJECTIVES: Grafted, non-occluded coronary arteries might contribute substantially to the myocardial blood supply and serve as a basis for vascular collateralization which preserves the myocardium in the event of graft occlusion. Early studies indicated that grafting with saphenous vein, but not internal mammary arteries, accelerates coronary atherosclerosis. This has not been extensively studied for the radial artery, which like the internal mammary artery (IMA) is largely resistant to atherosclerosis. A differential effect of various grafts might facilitate identification of disease-modifying principles. Our surgical cohort represented an opportunity to analyse new native coronary occlusions by comparison with preoperative angiograms. METHODS: One hundred and two patients underwent angiography 1.3–3.9 years after coronary artery bypass surgery, primarily in order to compare the patency of radial artery, IMA and saphenous vein grafts. RESULTS: Out of 290 stenotic, grafted vessels, 67 (23%) occluded during follow-up. Native occlusion occurred in 47% of the patients and correlated with serum-cholesterol. In a per target analysis, independent predictors of postoperative native occlusion were the right coronary artery territory, patent corresponding graft, the corresponding graft being an IMA and end-to-side anastomosis. CONCLUSIONS: Target vessel occlusion is similar with radial artery and saphenous vein grafts and proceeds rapidly even in the current era of secondary prophylaxis against atherosclerosis. Competitive graft flow appears to promote occlusion. Contrary to previous studies, we do not find vein grafts to be inferior to IMA grafts with respect to preservation of native vessel patency.
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- 2013
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7. Radial artery graft patency relates to gender, diabetes mellitus and angiotensin inhibition
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Per Erling Dahl, Øystein Dahl-Eriksen, Truls Myrmel, Thor Trovik, Rolf Busund, Stig Eggen Hermansen, Amjid Iqbal, Terje K. Steigen, Kristian Bartnes, Dag Sørlie, and Jan Mannsverk
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Adult ,Male ,medicine.medical_specialty ,Time Factors ,Angiotensin-Converting Enzyme Inhibitors ,Coronary Artery Disease ,Coronary Angiography ,Risk Assessment ,Diabetes Complications ,Coronary artery disease ,Sex Factors ,Risk Factors ,Diabetes mellitus ,Internal medicine ,medicine.artery ,Occlusion ,Odds Ratio ,medicine ,Humans ,Saphenous Vein ,Prospective Studies ,Coronary Artery Bypass ,Radial artery ,Vein ,Prospective cohort study ,Vascular Patency ,Aged ,Chi-Square Distribution ,Norway ,business.industry ,Graft Occlusion, Vascular ,Odds ratio ,Middle Aged ,medicine.disease ,Surgery ,Logistic Models ,Treatment Outcome ,medicine.anatomical_structure ,Radial Artery ,Cardiology ,Female ,Cardiology and Cardiovascular Medicine ,business ,Angiotensin II Type 1 Receptor Blockers ,Artery - Abstract
The radial artery is resistant to atherosclerotic degeneration and therefore appears more attractive for coronary artery bypass grafting than the saphenous vein. However, the patency of radial artery grafts varies widely among studies. Therefore, before deciding whether to adopt this as the conduit of choice second to internal mammary artery grafts, we have prospectively monitored our first cohort of patients with radial-to-coronary bypasses.Angiographic and clinical outcome parameters were registered for the 119 patients receiving radial artery grafts at our institution during April 4, 2001 to October 7, 2003.Reangiography of 102 patients (86%) showed that after two to three years, 79% of the radial artery and 87% of the saphenous vein grafts remained patent. Radial artery harvesting was well tolerated. Patency of radial artery grafts was correlated to diabetes mellitus (detrimental), gender (women had higher occlusion rates), and use of angiotensin inhibiting medication (beneficial).The pre-study assumption that radial artery grafts would out-perform those of saphenous vein at mid-term is not borne out. The propensity of radial artery graft failure in diabetics and the higher patency associated with angiotensin inhibition might both relate to endothelial modulation of the muscular tone of the graft.
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- 2010
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8. Adenosine protects against hypoxic injury at hypothermia in guinea pig papillary muscles
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Øyvind Jakobsen, Dag Sørlie, Kirsti Ytrehus, and Tor Steensrud
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Male ,Adenosine ,Indoles ,Time Factors ,Potassium Compounds ,Guinea Pigs ,Action Potentials ,In Vitro Techniques ,Pharmacology ,Adenosine receptor antagonist ,Potassium Channels, Calcium-Activated ,Adenosine A1 receptor ,chemistry.chemical_compound ,Hypothermia, Induced ,Potassium Channel Blockers ,medicine ,Animals ,Paxilline ,Cardioprotection ,Dose-Response Relationship, Drug ,business.industry ,Receptors, Purinergic P1 ,Papillary Muscles ,Hypothermia ,Hypoxia (medical) ,Myocardial Contraction ,Adenosine receptor ,Cell Hypoxia ,chemistry ,Anesthesia ,Mitochondrial Membranes ,Heart Arrest, Induced ,Female ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business ,medicine.drug - Abstract
To investigate the protective effects of adenosine against hypoxic injury at hypothermia; both magnitude and mechanisms.Receptor versus non-receptor dependent mechanisms in cardioprotection by adenosine were examined in guinea pig papillary muscles exposed to glucose free hypoxia at 24 degrees C. Contractile force amplitude (CFA) and action potential duration (APD) during increasing concentrations of adenosine at 37 degrees C, 30 degrees C and 24 degrees C normoxia were also examined.CFA was significantly improved after adenosine treatment during hypothermic hypoxia compared to control (80.7+/-17.4% vs 40.5+/-10.7%, p0.001). Adenosine receptor antagonist SPT did not antagonize (64.6+/-21.1%), and adenosine receptor agonists (APNEA+NECA) could not mimic the cardioprotection (53.8+/-9.3%). MitoK(Ca) blocker paxilline antagonized the cardioprotection (40.0+/-7.7%). During normoxic conditions hypothermia-induced increase in CFA was significantly decreased by adenosine (0.12-12 mM) whereas the increase in action potential duration was potentiated.Adenosine (1.2 mM) had marked cardioprotective effect in hypothermic substrate free hypoxia. Possible mechanisms are non-receptor dependent and related to mitoK(Ca) channels. The cardiodepressive effect at hypothermia may contribute to cardioplegia.
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- 2010
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9. Adenosine instead of supranormal potassium in cardioplegic solution preserves endothelium-derived hyperpolarization factor-dependent vasodilation☆
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Sveinung Ekse, Dag Sørlie, Lars M. Ytrebø, Thor Allan Stenberg, Øyvind Jakobsen, and Ole Kristian Losvik
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Male ,Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Adenosine ,Endothelium ,Hyperkalemia ,Vasodilator Agents ,Hemodynamics ,Myocardial Reperfusion Injury ,Vasodilation ,Biological Factors ,Random Allocation ,Coronary circulation ,Coronary Circulation ,Internal medicine ,medicine ,Animals ,Cardioplegic Solutions ,Cardioprotection ,Cardiopulmonary Bypass ,business.industry ,General Medicine ,Treatment Outcome ,medicine.anatomical_structure ,Anesthesia ,Heart Arrest, Induced ,Potassium ,Cardiology ,Female ,Surgery ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business ,medicine.drug ,Blood vessel - Abstract
Objective: We have recently shown that adenosine instead of supranormal potassium in cold crystalloid cardioplegia improves cardioprotection. Studies indicate that hyperkalemia has unfavorable effects on vascular endothelial function. Three pathways have been identified as major vasodilatory pathways: thenitricoxide(NO)pathway,thecyclooxygenase (COX)pathway, andtheendothelium-derivedhyperpolarization(EDHF) pathway, where the EDHF pathway, in particular, seems susceptible to hyperkalemia. We hypothesized that adenosine cardioplegia improves postcardioplegic endothelial function. Methods: Sixteen pigs were randomized to receive either cold (6 8C) hyperkalemic cardioplegia (n =8 ) or cardioplegia where hyperkalemia was substituted with 1.2 mM adenosine (n = 8). After 1 h of cold ischemic arrest, coronary blood flow was monitored for the following 2 h. The LAD artery was then explanted, and cylindrical rings were mounted for isometric tension recordings in organ chambers. Vessels were preconstricted with U46610 (Thromboxane A2 analog) and then bradykinin-mediated relaxation was investigated. To differentiate between the vasodilatory pathways the relaxation was assessed in the absence and presence of inhibitors of the COX (indomethacin), NO (L-NAME + carboxy-PTIO), and EDHF (apamin + charybdotoxin) pathways. Results: In vivo: The adenosine group had, as distinct from the hyperkalemic group, a significantly increased coronary blood flow index 1 h after cross-clamp release (from (ml/min/100 g, mean SD) 50.9 13.9 to 72.8 21.9, p = 0.010). The difference was, however, not statistically significant between groups. In vitro: Maximal relaxation without blockers was 27.4 10.1% of maximal tension in the adenosine group and 22.2 7.5% in the hyperkalemic group. To investigate EDHFdependent vasodilation the vessel rings were simultaneously treated with indomethacin, L-NAME, and carboxy-PTIO. Maximal relaxation in the hyperkalemic group was then reduced to 47.4 17.4% of maximal tension, which was a significant reduction compared to the adenosine group with a maximal relaxation of 20.6 8.7% (p = 0.028). Conclusion: Adenosine instead of supranormal potassium in cold crystalloid cardioplegia increases postcardioplegic myocardial blood flow and preserves EDHF-dependent vasodilation. # 2007 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved.
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- 2008
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10. Coronary artery disease cannot be reliably evaluated by 16-slice multidetector spiral computed tomography
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Truls Myrmel, Thor Trovik, Trude Sildnes, Kristian Bartnes, Øystein Dahl-Eriksen, Dag Sørlie, Amjid Iqbal, Rica Mortensen, Terje K. Steigen, and Jan Mannsverk
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medicine.medical_specialty ,Bypass grafting ,Coronary Angiography ,Sensitivity and Specificity ,Coronary artery disease ,Predictive Value of Tests ,Occlusion ,medicine ,Humans ,cardiovascular diseases ,Coronary Artery Bypass ,Vascular Patency ,Selective angiography ,medicine.diagnostic_test ,business.industry ,Coronary Stenosis ,Reproducibility of Results ,medicine.disease ,Spiral computed tomography ,Stenosis ,Treatment Outcome ,medicine.anatomical_structure ,Radial Artery ,Angiography ,cardiovascular system ,Feasibility Studies ,Radiology ,Cardiology and Cardiovascular Medicine ,business ,Tomography, Spiral Computed ,Artery - Abstract
Angiography by selective catheterization is the standard method for coronary artery imaging but carries a risk of rare, but serious complications. We investigated whether 16-slice multidetector spiral computed tomography (MDCT) could substitute for selective angiography for evaluation of coronary artery disease in surgically revascularized patients.In a setting closely resembling routine clinical practice, 45 patients who had been operated with coronary artery bypass grafting 508-1135 (mean 811) days before were examined with MDCT and conventional selective angiography on the same day. The interpreters were blinded to the results of the parallel imaging modality.Significant pathology (stenosis/=50% or occlusion) in the larger coronary artery segments was detected by MDCT with a sensitivity of 70-98% (mean 87%) and a specificity of 0-37% (mean 21%). MDCT failed to identify three of ten left main stem stenoses.Sixteen-slice MDCT cannot routinely replace selective angiography for evaluation of coronary artery disease.
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- 2007
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11. Transfusion vs. alternative treatment modalities in acute bleeding: a systematic review
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Hans Erik Heier, Knut Hjelmeland, Lise Lund Håheim, Wilhelm Bugge, Eldar Søreide, and Dag Sørlie
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medicine.medical_specialty ,Resuscitation ,Antifibrinolytic ,medicine.drug_class ,Anemia ,Plasma Substitutes ,Hemorrhage ,Hypoxemia ,Hemoglobins ,Blood Component Transfusion ,Hypovolemia ,Humans ,Medicine ,Blood Transfusion ,Intensive care medicine ,business.industry ,General Medicine ,medicine.disease ,Combined Modality Therapy ,Anesthesiology and Pain Medicine ,Systematic review ,Hemostasis ,Acute Disease ,Fluid Therapy ,medicine.symptom ,Erythrocyte Transfusion ,business - Abstract
Background and methods: The practice of transfusion varies a great deal between countries and hospitals. Therefore, a systematic literature review was performed to evaluate the evidence underlying practice of transfusion and alternative treatment modalities in acute bleeding. After a stepwise evaluation, 79 out of 2438 abstracts were approved as the evidence base. Results: Albumin for volume therapy is not better than artificial colloids or crystalloids and may be detrimental in trauma patients. No outcome difference has been proved between artificial colloids and crystalloids. Use of hypertonic solutions remains controversial, as do the concepts of delayed and hypotensive resuscitation. Healthy individuals tolerate acute, normovolaemic anaemia at 5 g haemoglobin/dl, but pre-operative haemoglobin < 6 g/dl gives increased mortality from surgical interventions. Keeping haemoglobin higher than 8–9 g/dl has not been associated with any positive effect on mortality or morbidity, even in patients with cardiovascular disease. The changes induced in erythrocytes by storage may be clinically insignificant. No alternative to erythrocyte transfusion was established. Evidence underlying the practice of thrombocyte and plasma transfusion is scarce. Available evidence on recombinant coagulation factor VIIa is insufficient to define its future role in acute bleedings. Antifibrinolytic drugs in general seem to reduce the need for transfusion. Conclusions: Intravenous volume replacement and transfusion policies seem largely based on local tradition and expert opinions. As a result of the difficulties in performing controlled studies in patients with acute bleeding and the large number of patients needed to prove effects, other scientific evidence should be sought to better define best practice in this important field.
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- 2006
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12. Coronary bypass graft patency cannot be determined by multidetector spiral computed tomography
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Rica Mortensen, Thor Trovik, Truls Myrmel, Jan Mannsverk, Dag Sørlie, Kristian Bartnes, Trude Sildnes, Amjid Iqbal, Øystein Dahl-Eriksen, and Terje K. Steigen
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medicine.medical_specialty ,Graft patency ,medicine.diagnostic_test ,business.industry ,Angiography ,Medicine ,Radiology ,Cardiology and Cardiovascular Medicine ,business ,Reference standards ,Spiral computed tomography - Abstract
Objectives. Angiography by selective catheterization is the reference standard for coronary bypass graft patency assessment but carries a risk of serious complications. We have investigated whether...
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- 2006
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13. Replacing potassium with nicorandil in cold St. Thomas' Hospital cardioplegia improves preservation of energetics and function in pig hearts
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Dag Nordhaug, Tor Steensrud, Kjell Vidar Husnes, Dag Sørlie, and Ebrahim Aghajani
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Pulmonary and Respiratory Medicine ,Potassium Channels ,Swine ,medicine.medical_treatment ,Sodium Chloride ,Potassium Chloride ,Contractility ,Calcium Chloride ,Procaine ,Oxygen Consumption ,medicine ,Animals ,Magnesium ,Nicorandil ,Cardioplegic Solutions ,Saline ,Cardioprotection ,business.industry ,Myocardium ,Hemodynamics ,Myocardial Contraction ,Cold Temperature ,Bicarbonates ,Preload ,Anesthesia ,Circulatory system ,Heart Arrest, Induced ,Potassium ,cardiovascular system ,Surgery ,Potassium channel opener ,Energy Metabolism ,Cardiology and Cardiovascular Medicine ,business ,medicine.drug - Abstract
Background To determine whether the adenosine triphosphate-sensitive potassium channel opener nicorandil, instead of potassium in cold crystalloid cardioplegia, may enhance cardioprotection, crystalloid cardioplegia with nicorandil, magnesium, and procaine was compared with standard crystalloid cardioplegia in terms of left ventricular performance and efficiency. Methods Sixteen pigs were randomly assigned to receive cold hyperkalemic crystalloid cardioplegia (n = 8) or nicorandil in cold saline (n = 8). Cold (4°C) cardioplegic solutions were given antegradely and intermittently, with a cross-clamp time of 60 minutes. The preload recruitable stroke work relationship (PRSW), pressure-volume area (PVA), and myocardial oxygen consumption (MVO 2 ) were calculated at baseline and at one and two hours following cross-clamp release, using combined pressure-volume conductance catheters, coronary flow probes, and O 2 -content differences. Results The left ventricular contractility expressed in PRSW was reduced to 58% (standard deviation [SD]: 20) of baseline in the crystalloid group and to 89% (SD: 20) in the nicorandil group two hours after cross-clamp release ( p = 0.044). The slope of the MVO 2 -PVA relationship increased in the crystalloid group from 1.59 (SD: 0.22) before cardioplegia to 2.55 (SD: 0.73) afterwards, significantly more than in the nicorandil group, where the slope changed from 1.69 (SD: 0.30) to 1.95 (SD: 0.47) ( p = 0.027). Conclusions Nicorandil in a crystalloid cardioplegic solution was easily employed and contractility was significantly better than after standard hyperkalemic cardioplegia. The smaller shift of the slope in the MVO 2 -PVA relationship in the nicorandil group shows improved efficiency in oxygen to mechanical transfer compared with the crystalloid group.
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- 2004
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14. Both Glucose-Insulin-Potassium and Glutamine in Warm Blood Cardioplegia Increase the Rates of Myocardial Glucose and Free Fatty Acid Oxidation
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Christian Korvald, Øivind Irtun, Terje S. Larsen, Odd Petter Elvenes, and Dag Sørlie
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Blood Glucose ,Male ,medicine.medical_specialty ,Time Factors ,Swine ,Glutamine ,Potassium ,medicine.medical_treatment ,Hemodynamics ,chemistry.chemical_element ,Sensitivity and Specificity ,Random Allocation ,Reference Values ,Internal medicine ,medicine ,Animals ,Insulin ,Beta oxidation ,chemistry.chemical_classification ,biology ,business.industry ,Myocardium ,Fatty acid ,Metabolism ,biology.organism_classification ,Surgery ,Disease Models, Animal ,Glucose ,Endocrinology ,chemistry ,Tasa ,Heart Arrest, Induced ,Linear Models ,Female ,Energy Metabolism ,Cardiology and Cardiovascular Medicine ,business ,Body Temperature Regulation - Abstract
We wanted to assess the effect of glucose-insulin-potassium (GIK) and glutamine on the oxidative metabolism during and after prolonged warm continuous blood cardioplegia (WB).WB was given to 21 pigs divided into three equally sized groups: WB (control), WB and GIK, or WB and glutamine. Oxidation rates of radiolabeled glucose (14C) and free fatty acid (FFA) (3H) were assessed before, during, and at 30 and 60 min after 3 h of cardiac arrest with WB.During standstill the substrate oxidation dropped markedly (60%), glucose oxidation was highest in the WB + GIK group (p0.05) and FFA oxidation highest in the WB + glutamine group (NS). During recovery the GIK group had an elevated glucose oxidation (47 and 40% vs WB at 30 and 60 min recovery, respectively -p0.05). Following 30 min recovery the addition of GIK suppressed FFA oxidation some 60%. Glutamine increased the oxidation of both glucose (30%) and FFA (150%) following 60 min recovery (p0.05). During the whole recovery phase the relative FFA oxidation was significantly lowered in the GIK group. There were no differences between the groups regarding arterial levels or uptake of substrates, except for a higher myocardial oxygen consumption (MVO2) during cardioplegia in the glutamine group. All the hearts performed similarly.Addition of GIK or glutamine to the well-perfused and oxygenated heart during WB led to a postcardioplegic increase in oxidative metabolism and MVO2. GIK resulted in a significant metabolic shift from FFA to glucose.
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- 2002
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15. Myocardial metabolism and efficiency after warm continuous blood cardioplegia
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Øivind Irtun, Truls Myrmel, Odd Petter Elvenes, Lars M. Ytrebø, Terje S. Larsen, Christian Korvald, and Dag Sørlie
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Blood Glucose ,Male ,Pulmonary and Respiratory Medicine ,Mean arterial pressure ,Cardiac output ,Swine ,Myocardial Reperfusion Injury ,Fatty Acids, Nonesterified ,Ventricular Function, Left ,Contractility ,Oxygen Consumption ,Animals ,Medicine ,Blood cardioplegia ,chemistry.chemical_classification ,business.industry ,Myocardial metabolism ,Myocardium ,Hemodynamics ,Fatty acid ,Blood flow ,Metabolism ,Perfusion ,chemistry ,Anesthesia ,Heart Arrest, Induced ,Female ,Surgery ,Energy Metabolism ,Cardiology and Cardiovascular Medicine ,business ,Body Temperature Regulation - Abstract
Warm continuous blood cardioplegia (WCBCP) has been recommended during prolonged cardiac arrest to minimize functional deterioration. Myocardial metabolism and efficiency after this cardioplegic modality are not well described.Substrate oxidation, blood flow, and myocardial function were measured before, during, and after 3 hours of WCBCP in 7 pigs.Free fatty acid and glucose oxidation decreased by 60% +/- 3.8% and 94% +/- 1.2%, respectively, during cardioplegia (both p0.05) and increased to 62% +/- 28% and 122% +/- 62% of baseline during the early recovery phase (p0.05 for glucose). One hour after WCBCP oxidation rates were similar to baseline. The transient postcardioplegic increase in substrate oxidation was associated with a 43% +/- 23% elevation of oxygen consumption (MVO2) compared with baseline and a 62% +/- 18% increase in myocardial blood flow. Cardiac output and mean arterial pressure did not change significantly after WCBCP, although myocardial function (stroke work, left ventricular end-systolic pressure, end-diastolic pressure, contractility, and efficiency) was depressed (p0.05). End-diastolic pressure and contractility improved from early to late phase of recovery, whereas the other indicators of ventricular function remained depressed.Myocardial substrate oxidation was preserved after 3 hours of WCBCP, although ventricular function was moderately impaired. Thus, WCBCP with a seemingly normal substrate and oxygen supply was associated with a reduced cardiac efficiency.
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- 2000
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16. Predictors of satisfaction with surgical treatment
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Tore Sørlie, Dag Sørlie, Rolf Busund, and Harold Sexton
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medicine.medical_specialty ,Pediatrics ,Medical staff ,business.industry ,Health Policy ,Public Health, Environmental and Occupational Health ,Retrospective cohort study ,General Medicine ,After discharge ,University hospital ,Treatment satisfaction ,Emergency medicine ,medicine ,Prospective cohort study ,business ,Surgical treatment ,Psychosocial - Abstract
Objective. To investigate prospectively which medical, psychosocial or treatment-related factors predicted treatment satisfaction and to evaluate the adequacy of a preceding retrospective study which had examined the same factors. Furthermore, to examine the predictors and the stability of the major determinants of patient treatment satisfaction. Design. Assessments made before admission, at discharge and 2 and 4 months after discharge were used to predict both the level and the rate of change in satisfaction with different aspects of treatment. Setting. Three surgical departments at a University Hospital. Study participants. Four-hundred and eighty-two patients electively admitted for several surgical conditions. Results. The central treatment-related measures were the same in the retrospective and prospective studies: global satisfaction with treatment (GS), perceived quality of contact with the nursing (QCN) and medical staff (QCM) and provision of adequate treatment information (INF). More of the variance in GS was explained in the prospective study (48.7% versus 36.3%). GS was most influenced by treatment-related factors with QCN as the strongest predictor in both studies. Only a small portion of the variance in QCN and QCM could be accounted for by the characteristics of the patients. INF was predicted by characteristics of the patients, their illness and life situation and by treatment-related factors. QCN was the strongest predictor of INF. The relationships with the nursing and medical personnel appear to be the major determinants of both patient treatment satisfaction and patients' reception of adequate information about their condition and its treatment.
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- 2000
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17. Normotherm Continuous Blood Cardioplegia for 4 Hours in an in Vivo Pig Model
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Knut Hansen, Ulf Larsen, Jan P. Solbø, Terje S. Larsen, Øivind Irtun, Terje Broks, and Dag Sørlie
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Mean arterial pressure ,Swine ,Hemodynamics ,Blood Pressure ,Models, Biological ,Extracorporeal ,Constriction ,law.invention ,law ,Cardiopulmonary bypass ,Animals ,Medicine ,Creatine Kinase ,Heart metabolism ,L-Lactate Dehydrogenase ,biology ,business.industry ,Coronary Vessels ,Blood pressure ,Anesthesia ,Heart Arrest, Induced ,biology.protein ,Creatine kinase ,Cardiology and Cardiovascular Medicine ,business - Abstract
Warm, continuous blood cardioplegia should theoretically maintain cardiac arrest for hours without ischaemic or hypothermic injury. In the absence of in vivo studies of myocardial metabolism and ultrastructural and/or functional preservation during and after more than 2 hours of cardiac arrest and after weaning from bypass, we devised a porcine model with a closed extracorporeal circuit for the heart alone. Normothermic blood cardioplegia was administered antegrade and recirculated for 2 or 4 hours, each in seven pigs. After aortic declamping all were successfully weaned from bypass and reperfused for 1 hour. Thereafter we found no significant intergroup difference in haemodynamic characteristics (average fall in mean arterial pressure 31.7 +/- 3.2% and 26.9 +/- 2.6%) or blood analyses. After 5 and 60 minutes of cardiac arrest there was minimal lactate production (5.7 +/- 10.7 and 0.5 +/- 10.5 nmol/l, respectively), whereas in the remainder of the arrest period there was lactate uptake, indicating aerobic heart metabolism. Our setup avoids systemic hyperkalaemia, gives good cardiac protection with no deterioration between 2 and 4 hours and is well suited for studies on the quiescent, blood-perfused oxygenated heart.
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- 1996
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18. Survival in Thoracic or Thoracoabdominal Aortic Aneurysm:Comparison between patients with or without surgical treatment
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Per Erling Dahl, Mons Lie, Truls Myrmel, Siv Robertsen, Dag Sørlie, and Sven M. Almdahl
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Adult ,Male ,medicine.medical_specialty ,Aortic Rupture ,Comorbidity ,Thoracic aortic aneurysm ,Brain Ischemia ,Aortic aneurysm ,Aneurysm ,Cause of Death ,medicine.artery ,medicine ,Humans ,cardiovascular diseases ,Surgical treatment ,Aged ,Aged, 80 and over ,Aorta ,Aortic Aneurysm, Thoracic ,Norway ,Vascular disease ,business.industry ,Age Factors ,Aortic arch aneurysm ,Middle Aged ,medicine.disease ,Aortic Aneurysm ,Surgery ,Survival Rate ,Elective Surgical Procedures ,Concomitant ,cardiovascular system ,Female ,Emergencies ,Cardiology and Cardiovascular Medicine ,business ,Aortic Aneurysm, Abdominal ,Follow-Up Studies - Abstract
The surgical mortality among 22 patients treated for thoracic or thoracoabdominal aneurysm was compared with the mortality in 47 patients managed without surgery. Surgical mortality (30 days) was low (1/13) in ascending aortic aneurysm, but higher (3/8) in aneurysm of the descending or thoracoabdominal aorta (including both acute and elective operations). Of the 20 non-surgically managed patients in the latter group, 15 died after a mean of 1.1 year. The only patient operated on for aortic arch aneurysm died of cerebral ischaemia 2 days postoperatively. Most of the 19 non-operated patients with aneurysm of the arch or total aorta (mean age 76 years) were never considered for surgical treatment. The analysis supports aggressive management of patients with aneurysm of the ascending, descending or thoracoabdominal aorta. Many of our patients with aneurysm of the arch or involving most of the aorta were old and had other, concomitant diseases, and in such cases an aggressive treatment strategy does not seem justified.
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- 1995
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19. Thromboplastin Activities and Monocytes in the Coronary Circulation of Reperfused Human Myocardium: No Effect of Preoperative Treatment with n-3 Fatty Acids
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J. Vaage, Dag Sørlie, Sven M. Almdahl, Dennis W. T. Nilsen, and Bjarne Østerud
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Male ,medicine.medical_specialty ,Monocytes ,Angina Pectoris ,Thromboplastin ,Coronary circulation ,chemistry.chemical_compound ,Double-Blind Method ,Coronary Circulation ,Internal medicine ,Fatty Acids, Omega-3 ,Preoperative Care ,medicine ,Humans ,Platelet ,Coronary Artery Bypass ,Mean platelet volume ,Coronary sinus ,Aged ,Blood Volume ,Triglyceride ,Platelet Count ,business.industry ,Monocyte ,Middle Aged ,Eicosapentaenoic acid ,Blood Cell Count ,medicine.anatomical_structure ,chemistry ,Cardiology ,Female ,Corn Oil ,Cardiology and Cardiovascular Medicine ,business - Abstract
In a double-blind study 18 patients were randomized to receive a daily dietary supplement of concentrated ethyl ester compound of n-3 fatty acids or placebo (corn oil) for at least 6 weeks before coronary bypass surgery. Three-fold increase of serum eicosapentaenoic acid and 20% reduction of triglyceride levels were found preoperatively in the n-3 group, while the two groups were similar as regards monocyte and platelet counts, mean platelet volume and monocyte activation as expressed by thromboplastin activities. For determination of transcardiac gradients, coronary sinus and aortic blood were sampled preoperatively 5, 10 and 30 minutes after release of the aortic cross-clamp. In both patient groups the monocyte count was lower in coronary sinus than in aortic blood at 5 and 10 minutes, but the differences were not significant. The platelet counts showed no significant change. In vitro stimulation of monocytes, however, evoked significantly (p0.05) less thromboplastin activity in coronary sinus blood than in aortic blood at all three sampling times, without significant intergroup difference. The monocytes most sensitive to activation presumably were trapped in the reperfused myocardium, and this sequestration was not hindered by pretreatment with n-3 fatty acids.
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- 1993
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20. A new protective solution for hypothermic storage of free vein grafts in cardiovascular surgery
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J. H. Brox, K. Bertheussen, L. Jørgensen, A. Småbrekke, Dag Sørlie, Steinar Solberg, Larsen T, and Bjarne Østerud
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medicine.medical_specialty ,Endothelium ,Swine ,Potassium ,Clinical Biochemistry ,chemistry.chemical_element ,Vein graft ,Veins ,chemistry.chemical_compound ,medicine ,Animals ,Humans ,Incubation ,Cells, Cultured ,HEPES ,business.industry ,General Medicine ,Poloxamer ,Surgery ,Cold Temperature ,Solutions ,Endothelial stem cell ,medicine.anatomical_structure ,chemistry ,Endothelium, Vascular ,Tissue Preservation ,Mannitol ,business ,medicine.drug - Abstract
In order to reduce the operative injury of the endothelium in free reversed vein grafts, cultured human endothelial cells were used to test the optimal concentration of the constituents of a flushing solution for improved protection of the endothelium. The following solution proved to be the most suitable when tested at 20 degrees C; mannitol 160 mmol l-1, glucose 15 mmol l-1, NaCl 30 mmol l-1, KHCO3 5 mmol l-1, K2SO4 10 mmol l-1, KH2PO4 4 mmol l-1, MgSO4 20 mmol l-1, CaCl2 1.5 mmol l-1, potassium citrate 1.0 mmol l-1, Pluronic F-68 20 mg l-1, HEPES 4 mmol l-1, HEPES-Na 6 mmol l-1, pH 7.25, osmolality 325 mosmol kg-1 H2O. When endothelial cell injury was measured by a 51Cr-release assay, the new solution protected human endothelial cells in culture during hypothermic incubation better than isotonic NaCl, St Thomas' cardioplegic solution or Krebs-Henseleit's buffer. Transmission and scanning electron microscopy showed that the endothelium of human saphenous vein grafts was well preserved following 6 h of incubation at 20 degrees C with the new solution. As determined by morphometry using scanning electron microscopy, the endothelium of free porcine vein grafts was better preserved after incubation for 2 h at 20 degrees C with the new solution than with either isotonic NaCl (p = 0.02) or diluted, heparinized blood (p = 0.02) as the incubation medium, all cases observed following 2 h of subsequent arterial flow. The present study indicates that the endothelium of free vein grafts can be well protected against hypothermia when the flushing and irrigation fluid has a composition favouring endothelial protection. It appears likely that such treatment of vein grafts will reduce the frequency of vein graft narrowing and occlusion, post-operatively.
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- 1992
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21. Leucocytes and cardiopulmonary bypass: in vitro production of oxygen free radicals and trapping in the reperfused myocardium
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J. Vaage, Dag Sørlie, Ole D. Mjøs, A.G. Semb, and M. Lie
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medicine.medical_specialty ,Radical ,030204 cardiovascular system & hematology ,law.invention ,03 medical and health sciences ,Coronary circulation ,Coronary artery bypass surgery ,0302 clinical medicine ,law ,Internal medicine ,Cardiopulmonary bypass ,Medicine ,Radiology, Nuclear Medicine and imaging ,Coronary sinus ,Advanced and Specialized Nursing ,business.industry ,General Medicine ,In vitro ,medicine.anatomical_structure ,030228 respiratory system ,Anesthesia ,Cardiology ,Arterial blood ,Cardiology and Cardiovascular Medicine ,business ,Safety Research ,Ex vivo - Abstract
The production of oxygen free radicals (OFR) by leucocytes was evaluated ex vivo by chemiluminescence (CL) before, during and after routine coronary artery bypass surgery (group A, n=11). The possibility of leucocyte trapping in the coronary circulation during the early reperfusion period was also investigated (group B, n=9). In group A, arterial blood samples were taken immediately before the start of surgery during anaesthesia, five minutes before and five and 30 minutes after the start of cardiopulmonary bypass (CPB), five minutes before and five and 30 minutes after the start of reperfusion of the heart, and then four and 24 hours after the end of CPB. In group B, arterial and coronary sinus blood samples were simultaneously drawn five and 30 minutes after the release of the aortic crossclamp. All blood samples were corrected for haemodilution. In group A, both CL and the level of circulating leucocytes declined during CPB. The lowest value of CL was measured 30 minutes after the start of CPB (69± 2% of baseline values) (mean±SEM). The lowest level of leucocytes was found after 30 minutes of CPB: 2.6±0.4 (109/l) vs 4.2±0.5 before surgery. Twenty-four hours after CPB, CL was increased to 170±49% and a leucocytosis was present (12.2±1.1). In group B, after five minutes of reperfusion the number of circulating leucocytes in arterial blood was 3.8±0.9 x 109/l as compared to 2.2±0.5 x 109/l in the coronary sinus (p
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- 1990
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22. Ultrastructural Changes in Rat Hearts Following Cold Cardioplegic Ischemia of Differing Duration and Differing Modes of Reperfusion
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Sigurd Lindal, Leif Jørgensen, Irene Lund, Bjørn Straume, Dag Sørlie, and Sigurd Gunnes
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Male ,medicine.medical_specialty ,Pathology ,Endothelium ,Ischemia ,Myocardial Reperfusion Injury ,Internal medicine ,Animals ,Humans ,Medicine ,Cardioplegic Solutions ,Cardiopulmonary Bypass ,business.industry ,Myocardium ,Rats, Inbred Strains ,Hypothermia ,medicine.disease ,Rats ,Microscopy, Electron ,medicine.anatomical_structure ,Interstitial edema ,Temperature and pressure ,Ventricle ,Electron micrographs ,Heart Arrest, Induced ,Ultrastructure ,Cardiology ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business - Abstract
Morphologic consequences of prolonged global hypothermic (15 degrees C), cardioplegic ischemia and two reperfusion techniques were studied in Langendorff-perfused rat hearts. A 'gentle' reperfusion technique, with gradual rise in perfusate temperature and pressure to physiologic levels over 30 min, was used for 12 hearts following 2-hour or 3 1/2-hour (6 in each group) ischemia. Abrupt reperfusion, with perfusate at 37 degrees C and 70 mmHg, was performed on 13 hearts (6 ischemic for 2 hours and 7 for 3 1/2 hours). Six nonischemic, perfused hearts served as controls. Randomly selected specimens from the left ventricle after 45-60 min reperfusion were prepared for transmission electron microscopy. Volume fractions of myocardial structural components were calculated from stereologic point-counting on the electron micrographs. Two-way analysis of variance revealed that interstitial edema developed with increasing ischemic time and was not influenced by reperfusion technique. The degree of endothelial damage was independent of ischemic time, but was lessened by 'gentle' reperfusion. Both mitochondrial injury and myocyte edema were less when perfusate temperature and pressure were slowly raised after 3 1/2-hour ischemia.
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- 1990
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23. Effects of Initial Reperfusion Temperature and Pressure After Prolonged Cardioplegic Ischemic Arrest: A Metabolic and Functional Study in Rat Hearts
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Dag Sørlie, Sigurd Gunnes, and Kirsti Ytrehus
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Male ,medicine.medical_specialty ,Time Factors ,Phosphocreatine ,Ischemia ,Myocardial Reperfusion ,Myocardial Reperfusion Injury ,Creatine ,chemistry.chemical_compound ,Adenosine Triphosphate ,Coronary Circulation ,Internal medicine ,Pressure ,Animals ,Medicine ,Coronary flow ,business.industry ,Myocardium ,Temperature ,Rats, Inbred Strains ,Phosphate ,medicine.disease ,Rats ,Temperature and pressure ,chemistry ,Heart Arrest, Induced ,Cardiology ,Ventricular pressure ,Cardiology and Cardiovascular Medicine ,business ,Perfusion ,Adenosine triphosphate - Abstract
The effects of temperature and pressure during early cardiac reperfusion after 3.5 hours of hypothermic, cardioplegic ischemia were investigated in isolated Langendorff-perfused rat hearts. The hearts were randomized in two groups and subjected to different techniques of reperfusion. The group I hearts were exposed to rapidly rising perfusion pressure and temperature, and in group II slowly rising pressure and temperature were employed. After 60 min of reperfusion, left ventricular developed pressure, coronary flow and tissue content of high-energy phosphates were evaluated. Left ventricular pressure and coronary flow were significantly better preserved in group II. Recovery of adenosine triphosphate and creatine phosphate was significantly lower in group I (5.27 +/- 0.38 and 8.72 +/- 0.62 mumol x g dry weight-1) than in group II (9.31 +/- 0.41 and 14.97 +/- 0.62). The study thus demonstrated that functional recovery, restoration of coronary flow and normalization of high-energy phosphate stores after long periods of hypothermic cardioplegic ischemia can be considerably influenced by the employed reperfusion technique.
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- 1990
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24. Clinical testing of nicorandil supplemented normokalemic cardioplegic solution
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Dag Sørlie, Tor Steensrud, Petter C Endresen, and Stig Müller
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Pulmonary and Respiratory Medicine ,Cardioprotection ,Aorta ,Troponin T ,business.industry ,Potassium ,Hemodynamics ,chemistry.chemical_element ,chemistry.chemical_compound ,Myoglobin ,chemistry ,Anesthesia ,medicine.artery ,cardiovascular system ,Medicine ,Surgery ,Cardiology and Cardiovascular Medicine ,Early release ,business ,Nicorandil ,medicine.drug - Abstract
Does nicorandil instead of supranormal potassium safely provide cardioplegia and cardioprotection in humans? Fifty patients eligible for coronary artery surgery were randomly divided into two groups; one group received standard St Thomas' Hospital solution (STHS) and the other group got a crystalloid solution in which supranormal potassium was replaced with 0.2 mmol/l nicorandil. We measured time to arrest, rhythm abnormalities, pre- and postoperative troponin-T, CK-MB and myoglobin release as well as hemodynamic parameters. Time to arrest was significantly shorter in the STHS group (41.0+/-16.8 s) than in the nicorandil group (120.9+/-78.8 s, P
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- 2007
25. Adenosine instead of supranormal potassium in cardioplegic solution improves cardioprotection
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Tor Steensrud, Erling Aarsæther, Øyvind Jakobsen, Stig Müller, and Dag Sørlie
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Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Mean arterial pressure ,Adenosine ,Hyperkalemia ,Swine ,Diastole ,Hemodynamics ,Myocardial Reperfusion Injury ,Random Allocation ,Reperfusion therapy ,Internal medicine ,medicine ,Animals ,Systole ,Cardioplegic Solutions ,Coronary sinus ,business.industry ,General Medicine ,Myocardial Contraction ,Anesthesia ,Cardiology ,Heart Arrest, Induced ,Potassium ,Surgery ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business ,medicine.drug - Abstract
Objective: To determine whether adenosine instead of supranormal potassium in cold crystalloid cardioplegia gives satisfactory cardiac arrest and improved cardioprotection. Cold crystalloid cardioplegia with adenosine, procaine and magnesium (A) was compared with standard cold crystalloid hyperkalemic cardioplegia (K). Methods: Sixteen pigs were randomized to receive either cold K (n =8 ) or A (n = 8), where hyperkalemia was substituted with 1.2 mM adenosine. The cold (6 8C) cardioplegia was given intermittently and antegradely, with an aortic cross-clamp time of 1 h. Hemodynamic data was continuously measured and pressure—volume conductance catheters were used to determine global left ventricular systolic and diastolic function. Coronary flow and O2 content differences allowed determination of left ventricular energetics. Bloodsamples,andleft ventricularmicrodialysis were usedto measureparameters of ischemia. Measurements were doneat1 and 2 h after cross-clamp release.Results: Mean arterial pressure was reduced with 55 mmHg (standard deviation, SD: 19) in the K group versus 30 mmHg (SD:14) inthe A group2 h aftercross-clamprelease (p = 0.030).Left ventricular contractility expressedas slope ofthe preloadrecruitablestroke work index (Mw) was reduced to 53% (SD: 14) in the K group versus 78% (SD: 23) in the A group 2 h after cross-clamp release (p = 0.046). Reduction of maximum of first derivate of pressure with respect to time (dP/dtmax) was 804 mmHg/s (SD: 189) in the K group versus 538 mmHg/s (SD: 184) in the A group ( p= 0.033). The slope of the myocardial oxygen consumption—pressure volume area was at 2 h reperfusion increased from 1.37 (SD: 0.64)to2.86(SD:1.27)intheKgroup,whereasnoshiftwasdetectedintheAgroup(p = 0.019).CardiactroponinTmeasuredinthecoronarysinus 1 h after cross-clamprelease was 1.25 mg/l (SD: 0.64) inthe K group versus 0.73 mg/l(SD: 0.31) in the A group (p = 0.046).Conclusion:Adenosine instead of supranormal potassium in cold crystalloid cardioplegia gives satisfactory cardiac arrest, improves post cardioplegic left ventricular systolic function and efficiency, and attenuates myocardial cell damage. # 2007 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved.
- Published
- 2006
26. Video information combined with individualized information sessions: Effects upon emotional well-being following coronary artery bypass surgery--A randomized trial
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Rolf Busund, Hal Sexton, Tore Sørlie, Dag Sørlie, and Joseph Sexton
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Male ,medicine.medical_specialty ,Health Status ,MEDLINE ,Anxiety ,Patient Care Planning ,law.invention ,Hospitals, University ,Coronary artery bypass surgery ,Randomized controlled trial ,Patient Education as Topic ,law ,Intervention (counseling) ,Surveys and Questionnaires ,Health care ,Outcome Assessment, Health Care ,Preoperative Care ,Medicine ,Humans ,Single-Blind Method ,Coronary Artery Bypass ,Psychiatric Status Rating Scales ,business.industry ,Depression ,Norway ,Videotape Recording ,General Medicine ,Middle Aged ,Mental health ,Emotional well-being ,Mental Health ,Multivariate Analysis ,Physical therapy ,Female ,medicine.symptom ,business ,Factor Analysis, Statistical ,Attitude to Health ,Follow-Up Studies - Abstract
Objective: To test the efficacy of an information intervention upon emotional recovery following coronary artery bypass surgery. Methods: Randomized trial. Video information was combined with individualized information sessions carried out by nurses at admission and at discharge from the hospital. The video was shown pre-operatively and again during the session at admission. Patients were helped to express their questions and worries and congruent information and support was provided. Control group patients received standardized information and no video. Recordings were made at baseline, discharge from hospital and during a 2 years follow-up period. Results: One hundred and nine patients were randomized to the intervention or the control groups. A MANOVA was used to test of the variance of the outcome variables at each time point. At discharge intervention patients reported less anxiety ( p = 0.046) and better subjective health ( p = 0.005). They reported better subjective health during the whole follow-up period (0.040 p 0.000), less anxiety up to 1 year (0.042 p 0.004), and less depression from 6 months to 2 years following discharge (0.023 p 0.004). Conclusion: The effects of the intervention probably relate to the combined use of the video and patient centered information sessions. Practice implications: The intervention can easily be implemented in clinical practice and nurses strongly identified with its principles. # 2006 Elsevier Ireland Ltd. All rights reserved.
- Published
- 2006
27. Contractile recovery of heart muscle after hypothermic hypoxia is improved by nicorandil via mitochondrial K(ATP) channels
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Øyvind Jakobsen, Dag Sørlie, Tor Steensrud, and Kirsti Ytrehus
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Pulmonary and Respiratory Medicine ,Cardiotonic Agents ,Potassium Channels ,Vasodilator Agents ,Guinea Pigs ,Action Potentials ,Mitochondrion ,Pharmacology ,Mitochondria, Heart ,Tissue Culture Techniques ,Hypothermia, Induced ,Medicine ,Animals ,Nicorandil ,Hypoxia ,Papillary muscle ,Heart metabolism ,Cardioprotection ,Dose-Response Relationship, Drug ,business.industry ,Temperature ,Heart ,General Medicine ,Hypothermia ,Myocardial Contraction ,Potassium channel ,medicine.anatomical_structure ,Anesthesia ,cardiovascular system ,Heart Arrest, Induced ,Surgery ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business ,medicine.drug ,Muscle contraction - Abstract
Background The ATP-sensitive potassium channel (K(ATP)) opener nicorandil used instead of potassium in hypothermic cardioplegia significantly improves preservation of cardiac function and energetics in the in situ heart preparation. The present study, therefore, examines the effect of nicorandil at different temperatures and the role of sarcolemmal and mitochondrial K(ATP) channels under ex vivo conditions using contractile force (CF) and action potential duration (APD) as end points. Methods Guinea-pig papillary muscles at 37, 27, or 22 degrees C (1Hz) were exposed to nicorandil 0.2-1.1 mM. The contributions of K(ATP) channel subtypes in cardioprotection were examined using mitochondrial (mito) (0.1 mM) or non-selective (1.0 mM) concentrations of nicorandil, mito K(ATP) blocker 5-hydroxyl decanoate (5HD, 300 microM) or sarcolemmal (sarc) K(ATP) blocker HMR1098 (30 microM) before and during 140 min of hypothermic (22 degrees C) glucose-free hypoxia. Results Nicorandil >0.5 mM shortened the APD, and this was abolished by hypothermia and HMR1098 but not by 5HD. Nicorandil in both tested concentrations preserved contractile force after hypoxia-reoxygenation significantly better than control (73.7+/-4.4% and 75.8+/-3.9% vs 40.6+/-2.6%, n=6 in each group). Protection was blocked by 5HD but not by HMR1098. 5HD and HMR1098 alone did not change recovery of contractile force compared to control. Conclusion Shortening of APD and activation of sarc K(ATP) by nicorandil were not related to myocardial protection. Thus, the mito K(ATP) seems to play a significant role in cardioprotection compared to the sarc K(ATP) also when substrate depletion and hypoxia are combined with hypothermia.
- Published
- 2005
28. [Patient satisfaction after hospitalisation for surgery]
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Tore, Sørlie, Rolf, Busund, Harold C, Sexton, and Dag, Sørlie
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Adult ,Male ,Physician-Patient Relations ,Length of Stay ,Patient Discharge ,Patient Admission ,Patient Education as Topic ,Elective Surgical Procedures ,Patient Satisfaction ,Humans ,Female ,Nurse-Patient Relations ,Surgery Department, Hospital ,Quality of Health Care - Abstract
What illness-related, psychosocial or treatment-related factors predict treatment satisfaction following hospitalisation for surgery?482 patients electively admitted to three different surgical departments at a university hospital. Assessments were made before admission, at discharge and two and four months after discharge.The central treatment-related measures were global treatment satisfaction, perceived quality of contact with nurses and doctors, and the information received. Out of 49% explained variance in global treatment satisfaction, one half was explained by the quality of contact with nurses. Only a small portion of the variance in quality of contact with nurses and doctors could be accounted for by the characteristics of the patients. Much of the unexplained variance must relate to characteristics and skills of the medical staff. Treatment information was predicted by characteristics of the patients, their illness and situation in life, and by treatment-related factors. Quality of contact with the nurses was the strongest predictor of satisfaction with the information received.The experienced quality of contact with nurses appears to be the major determinant of both global treatment satisfaction and satisfaction with the information received. Among other predictors, the quality of contact with doctors is also important. The relationship between patients and caregivers can probably be better utilised to improve treatment satisfaction.
- Published
- 2005
29. [A programme for boosting medical research in North Norway, 1992-2001]
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Dag, Sørlie, Torben, Wisborg, Lennart, Wählby, Arne, Wilskow, Tom Eirik, Mollnes, Jann, Gamnes, and Egil, Arnesen
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Biomedical Research ,Quality Assurance, Health Care ,Norway ,Research Support as Topic ,Humans ,Clinical Competence ,Personnel Selection ,Research Personnel - Abstract
Goals for the programme were recruitment of specialists and lowering turnover among them, generating new knowledge, quality assurance and professional development. Close to NOK 25 million were spent on this research programme in regional non-university hospitals over the 1992-2001 period.78 projects were funded, 77 responded to our questionnaire.36 (47%) of respondents claim to have completed their projects, 5 (7%) have not, whereas 36 (47%) have ongoing projects. 70% of the projects have led to publications, 39% as part of doctoral theses, 61% have been done locally and 43 % also had other funding. In relation to the aims of the programme, those responding were very positive and 75 out of 77 suggested that a low-threshold, supportive programme of this type should be continued.We conclude that the programme has had positive effects beyond the generation of new knowledge.
- Published
- 2005
30. Superior myocardial protection with nicorandil cardioplegia
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Odd Petter Elvenes, Dag Sørlie, Tor Steensrud, D. Nordhaug, and Christian Korvald
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Pulmonary and Respiratory Medicine ,Male ,medicine.medical_specialty ,Hyperkalemia ,Potassium Compounds ,Swine ,Ischemia ,Diastole ,Ventricular Function, Left ,law.invention ,Random Allocation ,Oxygen Consumption ,law ,Suidae ,Hypothermia, Induced ,Internal medicine ,Coronary Circulation ,medicine ,Cardiopulmonary bypass ,Animals ,Nicorandil ,Cardioplegic Solutions ,Cardiopulmonary Bypass ,biology ,business.industry ,General Medicine ,medicine.disease ,biology.organism_classification ,Coronary Vessels ,Myocardial Contraction ,Preload ,medicine.anatomical_structure ,Blood ,Ventricle ,Anesthesia ,cardiovascular system ,Cardiology ,Heart Arrest, Induced ,Surgery ,Female ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business ,medicine.drug - Abstract
Objective: The ATP-sensitive potassium channel (KATP) activator nicorandil used as cardioplegic agent may protect the left ventricle during cardiac arrest. Nicorandil in cold blood was compared with standard hyperkalemic blood and crystalloid cardioplegia. Methods: Twenty-one pigs were randomly assigned to three groups: (1) cold hyperkalemic crystalloid (n ¼ 7); (2) cold hyperkalemic blood (n ¼ 7); and (3) nicorandil as cardioplegia in cold blood (n ¼ 7). Left ventricular mechanical performance, pressure-volume area (PVA) and myocardial oxygen consumption (MVO2) were measured before and at 1 and at 2 h after 60 min of cold global ischemia on cardiopulmonary bypass using intraventricular pressure-volume conductance catheters, coronary flow probes and O2-content difference. Results: The slope (Mw) of the stroke work end-diastolic volume relationship, the preload recriutable stroke work relationship, was unchanged after ischemia in the nicorandil group, but was reduced to averaged 62.5% (standard deviation 14) of baseline values in both hyperkalemic perfusions (P , 0:05). The slope of the MVO2-PVA relationship was unchanged after nicorandil cardioplegia while the slope after hyperkalemic blood and crystalloid cardioplegia increased with 33% (P , 0:02) and 52% (P , 0:02) of baseline values, respectively. Conclusions: Nicorandil as sole cardioplegic agent in cold blood given intermittently preserves left ventricular contractility and myocardial energetics significantly better than traditional forms of cardioplegia after cardiac arrest. q 2003 Elsevier Science B.V. All rights reserved.
- Published
- 2003
31. Warm retrograde blood cardioplegia saves more ischemic myocardium but may cause a functional impairment compared to cold crystalloid
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Reidar Myklebust, Dag Sørlie, Odd Petter Elvenes, and Christian Korvald
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Pulmonary and Respiratory Medicine ,Cardiac output ,medicine.medical_specialty ,Mean arterial pressure ,Potassium Compounds ,Swine ,Ischemia ,Myocardial Ischemia ,Hemodynamics ,law.invention ,Coronary circulation ,Necrosis ,law ,Internal medicine ,Coronary Circulation ,medicine ,Cardiopulmonary bypass ,Animals ,Cardioplegic Solutions ,Coronary sinus ,Cardiopulmonary Bypass ,Troponin T ,business.industry ,Myocardium ,Temperature ,General Medicine ,medicine.disease ,medicine.anatomical_structure ,Blood ,Anesthesia ,Cardiology ,Heart Arrest, Induced ,Surgery ,Cardiology and Cardiovascular Medicine ,business - Abstract
Objectives: Ongoing ischemia, or even ischemia in progress, is regularly encountered in today’s patients amenable to cardiac surgery. We set out to assess the effect of ‘active resuscitation’ during cardioplegia with warm continuous retrograde blood cardioplegia (WB) in a protocol simulating a clinical situation. Methods: After 60 min with a regional ischemic injury to the left ventricle, 21 pigs were randomized to receive no treatment (control), cold retrograde intermittent crystalloid cardioplegia (CC) or WB. All animals were put on cardiopulmonary bypass. After 1 h of cardioplegia and 1 h of reperfusion the perfused left ventricle was colored with methylene blue. After excision of the hearts a standard planimetri technique was used to determine the area at risk and amount of necrosis (triphenyltetrazolium). Heart rate, mean arterial pressure (MAP), cardiac output and myocardial blood flow were recorded as well as myocardial oxygen consumption, plasma levels of free fatty acids, glucose, lactate and Troponin T from the coronary sinus. Results: The area at risk of the left ventricle was 13.6 ^ 1.2%. We found 71 ^ 2, 61 ^ 3 and 30 ^ 2% necrosis of the area at risk in the controls, CC and WB, respectively (P , 0:001, CC versus control and P , 0:0001, WB against CC and control). Troponin T release was highest in the CC group in the reperfusion period. Glucose levels increased significantly after ischemia in the controls and WB. In accordance with the amount of saved myocardium in the WB group which also had a normal coronary sinus lactate level as opposed to the fourfold increase in the CC group after ischemia. After standstill cardiac output and MAP were significantly lower than baseline values in the WB group only ðP , 0:05Þ. Conclusions: CC did reduce the size of the infarction by about 10% compared to control animals, whereas WB reduced the infarction by more than 50% of that seen after CC. Both modalities are, however, associated with a functional reduction during the first 60 min of reperfusion, WB being the worst. q 2002 Elsevier Science B.V. All rights reserved.
- Published
- 2002
32. [Long-term results with the left internal mammary artery as coronary bypass]
- Author
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Kristian, Bartnes, Barthold, Vonen, Arne Johannes, Tofte, Pål, Gunnes, Per, Lunde, Truls, Myrmel, Dag, Sørlie, and Mons, Lie
- Subjects
Adult ,Male ,Coronary Stenosis ,Coronary Disease ,Middle Aged ,Coronary Angiography ,Cohort Studies ,Treatment Outcome ,Myocardial Revascularization ,Humans ,Female ,Coronary Artery Bypass ,Mammary Arteries ,Aged ,Follow-Up Studies - Abstract
From 1986 we have routinely used the left internal mammary artery instead of autologous vein as bypass to the left anterior descending coronary artery.A cohort of 52 patients has been followed up for up to 12 years. Six years postoperatively, 40 patients were evaluated by clinical examination, exercise testing and serum lipid assessment. Of these, 38 underwent angiography of the native coronary arteries and of all grafts, which represented 47 left internal mammary artery, 90 saphenous vein, and 3 right internal mammary artery bypasses. Information regarding angina recurrence and the need for repeated revascularisation was obtained from hospital records. Twelve-year mortality data were provided by public registers.Fifty patients were discharged alive. Two serious complications, of which one was fatal, were directly related to the use of the left internal mammary artery. After six years, all the re-examined patients had improved their exercise tolerance; 25 (63%) were angina-free. 44 (94%) left internal mammary artery and 67 (74%) saphenous vein bypasses were patent. Tobacco consumption was considerably reduced over the first six years postoperatively while mean triglyceride and cholesterol levels remained moderately elevated. After 12 years, 18 patients were deceased, half of them from coronary heart disease.Our results are in accordance with large, international studies.
- Published
- 2002
33. Postinfarction Rupture of Left Ventricular Free Wall Repaired With a Glued-on Pericardial Patch
- Author
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Sven M. Almdahl, Dag Sørlie, Ragnar Hotvedt, and Ulf Larsen
- Subjects
medicine.medical_specialty ,Pericardial patch ,business.industry ,medicine.medical_treatment ,Ventricular Free Wall Rupture ,Tissue glue ,Free wall ,Surgery ,medicine.anatomical_structure ,Emergency surgery ,Ventricle ,Pericardiocentesis ,Internal medicine ,Shock (circulatory) ,medicine ,Cardiology ,cardiovascular diseases ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business - Abstract
In a 68-year-old man admitted in deep shock, prompt echocardiographic diagnosis of post-infarction left ventricular free wall rupture was followed by probably life-saving pericardiocentesis. At emergency surgery a 2 cm linear tear in the antero-lateral wall of the left ventricle was successfully repaired with a glued-on pericardial patch, without infarctectomy or placement of sutures in the infarcted area.
- Published
- 1993
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34. Cardiac dysfunction and inefficiency after substrate-enriched warm blood cardioplegia
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Truls Myrmel, Dag Sørlie, Christian Korvald, and Odd Petter Elvenes
- Subjects
Pulmonary and Respiratory Medicine ,Swine ,medicine.medical_treatment ,Glutamine ,Diastole ,Ventricular Function, Left ,law.invention ,Oxygen Consumption ,law ,Suidae ,Cardiopulmonary bypass ,medicine ,Animals ,Insulin ,Cardioplegic Solutions ,Cardiopulmonary Bypass ,biology ,business.industry ,Myocardium ,Hemodynamics ,Temperature ,General Medicine ,biology.organism_classification ,Myocardial Contraction ,Preload ,Blood ,Glucose ,Anesthesia ,Heart Arrest, Induced ,Potassium ,Surgery ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business ,Energy Metabolism ,Perfusion ,Muscle contraction - Abstract
Objective: The study assessed the outcome after prolonged warm continuous antegrade blood cardioplegia (WCBC) with substrate enrichment, in terms of mechanical performance and mechanoenergetic efficiency. Methods: WCBC was given for 3 h to three groups of pigs on cardiopulmonary bypass; WCBC alone (na 7), WCBC 1 glucose and insulin (1GIK, na 7) and WCBC 1 l-glutamine (1GLN, na 7). Cardiac systolic and diastolic function, pressure‐volume area (PVA) and myocardial oxygen consumption (MVO2) were assessed before, and twice after WCBC using pressure-conductance catheter, coronary flow-probes and O2-content difference. Results: In the WCBC, 1GIK and 1GLN groups respectively, the following parameters decreased after WCBC compared to baseline: left ventricular developed pressure by 26, 19 and 25% (P , 0:001); dP/dtmax by 36, 37 and 34% (P , 0:001); preload recruitable stroke work by 35, 41 and 28% (P , 0:001); mechanoenergetic efficiency (PVA/MVO2) by 44, 41 and 22% (P , 0:001). End-diastolic stiffness increased early after WCBC in the WCBC and 1GLN groups, while it was unchanged in the 1GIK group (Pa 0:032). Conclusion: Despite continuous aerobic conditions and additional substrates, post-WCBC cardiac contractile function and mechanoenergetic efficiency was severely depressed. The results demonstrate the hazards of sustained normothermic hyperkalemic perfusion. q 2001 Elsevier Science B.V. All rights reserved.
- Published
- 2001
35. Endothelial injury and trapping of blood cells in human myocardium following coronary bypass surgery
- Author
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Jarle Vaage, Leif Jørgensen, Dag Sørlie, Bjørn Straume, Randi Olsen, and Sigurd Lindal
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Adult ,Male ,medicine.medical_specialty ,Time Factors ,Endothelium ,Myocardial Reperfusion Injury ,Microcirculation ,Internal medicine ,medicine ,Humans ,Platelet ,Derivation ,Heart Atria ,Coronary Artery Bypass ,Aged ,Analysis of Variance ,business.industry ,Middle Aged ,medicine.disease ,Coronary Vessels ,Extravasation ,Pathophysiology ,Blood Cell Count ,medicine.anatomical_structure ,Bypass surgery ,Anesthesia ,Data Interpretation, Statistical ,Cardiology ,Female ,Endothelium, Vascular ,Cardiology and Cardiovascular Medicine ,business ,Reperfusion injury - Abstract
To investigate the focal myocytic and microvascular injury that develops during the first hour of reperfusion after hypothermic cardioplegic cardiac arrest, and to compare the influence of gentle versus more abrupt reperfusion, serial atrial biopsies were obtained from 14 patients undergoing uneventful coronary bypass surgery. The biopsies were taken before cardioplegia, at the start of reperfusion, and after 20 and 60 min of reperfusion. Transmission electron micrographs of biopsies examined by stereological techniques revealed endothelial injury. Following 20 min reperfusion there was accumulation of both red blood cells (p = 0.03) and polymorphonuclear leucocytes (p = 0.0004) were found. There was also intravascular accumulation of platelets (p = 0.008) and extravasation of red blood cells (p = 0.02), which increased throughout the observation period. If reperfusion was started with a gradual rise in temperature and pressure, the numbers of platelets in the microvessels were lower than following ordinary, abrupt reperfusion (p = 0.06). It is concluded that reperfusion injury is associated with microcirculatory disturbances with trapping of blood cells, changes which may be favourably modified by a gentle reperfusion technique.
- Published
- 1999
36. Oxygen-wasting effect of inotropy in the 'virtual work model'
- Author
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Truls Myrmel, Odd Petter Elvenes, Dag Sørlie, Lars M. Ytrebø, and Christian Korvald
- Subjects
Inotrope ,Male ,medicine.medical_specialty ,Cardiotonic Agents ,Physiology ,Swine ,Dopamine ,chemistry.chemical_element ,Stimulation ,Oxygen ,Ventricular Function, Left ,Oxygen Consumption ,Physiology (medical) ,Internal medicine ,Heart rate ,medicine ,Animals ,Chemistry ,Myocardium ,Hemodynamics ,Models, Cardiovascular ,Myocardial Contraction ,Endocrinology ,Volume (thermodynamics) ,Circulatory system ,Catecholamine ,Female ,Cardiology and Cardiovascular Medicine ,Energy Metabolism ,medicine.drug - Abstract
In the “virtual work model,” left ventricular total mechanical energy (TME) is linearly related to myocardial oxygen consumption (MV˙o2). This relationship (MV˙o2-TME) is supposedly independent of inotropic stimulation, vascular loading, and heart rate variations. We reexamined the effect of inotropic stimulation (dopamine) on the metabolic to mechanical energy transfer in nine open-chest anesthetized pigs. Left ventricular mechanical energy was calculated using TME (mean ejection pressure × end-diastolic volume + stroke work), TMEW(end-diastolic volume reduced by unstressed ventricular volume), and the pressure-volume area (PVA). A highly linear relationship between MV˙o2and mechanical energy was found for all three indexes during control and dopamine runs ( r = 0.87–0.99). The slopes were unaltered by dopamine. y-Axis intercepts were (control vs. dopamine) as follows (in J ⋅ beat−1⋅ 100 mg−1; means ± SD): TME, 0.36 ± 0.12 vs. 0.61 ± 0.30 ( P< 0.02); TMEW, 0.43 ± 0.16 vs. 0.72 ± 0.32 ( P < 0.02); and PVA, 0.34 ± 0.13 vs. 0.60 ± 0.30 ( P < 0.02). We conclude that the virtual work model is dependent on inotropic stimulation and that new insight into myocardial chemomechanical coupling is not added by this concept.
- Published
- 1999
37. Unilateral adrenal haemorrhage following systemic thrombolysis
- Author
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Tor Steensrud, Dag Sørlie, and Lil-Sofie Ording Müller
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Male ,Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,medicine.medical_treatment ,Adrenal Gland Diseases ,Myocardial Infarction ,Hemorrhage ,Ruptured Aortic Aneurysm ,Preoperative care ,medicine ,Humans ,Thrombolytic Therapy ,Myocardial infarction ,Ligation ,Aortic dissection ,business.industry ,Adrenal gland ,Adrenalectomy ,Thrombolysis ,Middle Aged ,medicine.disease ,Treatment Outcome ,medicine.anatomical_structure ,Clinical diagnosis ,cardiovascular system ,Surgery ,Radiology ,Tomography, X-Ray Computed ,Cardiology and Cardiovascular Medicine ,Adrenal Hemorrhage ,business ,Vascular Surgical Procedures - Abstract
We report a case of unilateral adrenal bleeding, worsened or initiated by systemic thrombolytic therapy given for a suspected myocardial infarction. Initial clinical diagnosis was ruptured aortic aneurysm or aortic dissection. A preoperative contrast-enhanced computer tomography (CT) scan showed a possible bleeding from the left adrenal gland. An emergency left subcostal retroperitoneal approach revealed a ruptured and bleeding adrenal gland and its arteries were ligated.
- Published
- 2008
- Full Text
- View/download PDF
38. High cardioplegic perfusion pressure entails reduced myocardial recovery
- Author
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Dag Sørlie and Øivind Irtun
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Pulmonary and Respiratory Medicine ,Swine ,Hydrostatic pressure ,Diastole ,Hemodynamics ,Myocardial Reperfusion ,Myocardial Reperfusion Injury ,Sodium Chloride ,law.invention ,Potassium Chloride ,Calcium Chloride ,Adenosine Triphosphate ,Dry weight ,law ,medicine.artery ,Cardiopulmonary bypass ,Hydrostatic Pressure ,Medicine ,Animals ,Magnesium ,Energy charge ,Cardioplegic Solutions ,Aorta ,Cardiopulmonary Bypass ,business.industry ,General Medicine ,Bicarbonates ,Anesthesia ,Heart Arrest, Induced ,Surgery ,Cardiology and Cardiovascular Medicine ,business ,Perfusion - Abstract
Objecti6e: The cardioplegic solution is often given at high flow and pressure following aortic clamping to ensure rapid diastolic arrest. With standard setup in clinical practice, it is easy to exceed 200 mmHg in the aortic root. To investigate whether cardioplegic solution delivery pressure has an influence on myocardial protection, intermittent infusions of crystalloid cardioplegia were given at two different pressures using an in vivo pig model. Methods: Fourteen pigs (48‐57 kg) were put on cardiopulmonary bypass, aorta-clamped (2 h) and 500 ml St. Thomas’ cardioplegia (4°C) was delivered antegradely at either 75 mmHg (group 1, n7) or 175 mmHg (group 2, n7) pressure via a 9-F aortic root cardioplegic needle. Every 20 min, 100 ml cardioplegia were delivered at either one of the two pressures. After 2 h, the aorta was unclamped and the hearts reperfused. Attempts were made to wean the pigs from bypass following 20 min reperfusion or, if they were failing, after 40 min. If failing once again, the pigs were reperfused for the last 20 min on the heart‐lung machine. Results: Hearts in group 1 (n 7) needed significantly longer time to stop after aortic clamping (3899 s) than did group 2 hearts (n 7) (219 5s ) ( P0.043). In group 1, all pigs were weaned from bypass, whereas in group 2 only 2 out of 7 pigs were able to sustain circulation without cardiopulmonary bypass (P0.01), and then with lower hemodynamic performances. At the end of cardiac arrest, group 1 had significantly higher adenosine triphosphate (19.4191.1 mmol:g dry weight and 15.059 1.8 mmol:g dry weight, respectively) (P 0.05) and significantly lesser fall in energy charge than group 2 (0.0290.01 and 0.059 0.02, respectively) (P 0.05). Also at the end of reperfusion, group 1 had significantly higher adenosine triphosphate (16.5491.4 mmol:g dry weight and 12.539 0.95 mmol:g dry weight, respectively) (P0.016) than group 2. Conclusions: Despite a swifter diastolic cardiac arrest, the high cardioplegic solution delivery pressure caused significantly poorer postischemic recovery than a moderate pressure with the same amount of cardioplegic solution. © 1997 Elsevier Science B.V.
- Published
- 1997
39. Myocardial substrate oxidation during warm continuous blood cardioplegia
- Author
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Thomas V. Andreasen, Øivind Irtun, Terje S. Larsen, Dag Sørlie, and Terje K. Steigen
- Subjects
Pulmonary and Respiratory Medicine ,Male ,medicine.medical_specialty ,Swine ,Oleic Acids ,Hematocrit ,Fatty Acids, Nonesterified ,law.invention ,Hemoglobins ,Insulin resistance ,Adenosine Triphosphate ,Oxygen Consumption ,law ,Internal medicine ,medicine ,Cardiopulmonary bypass ,Animals ,Blood cardioplegia ,Lactic Acid ,Coronary sinus ,chemistry.chemical_classification ,medicine.diagnostic_test ,business.industry ,Myocardium ,Temperature ,Fatty acid ,Substrate (chemistry) ,medicine.disease ,Surgery ,Blood ,Glucose ,chemistry ,Plasma concentration ,Cardiology ,Heart Arrest, Induced ,Lactates ,Female ,Cardiology and Cardiovascular Medicine ,business ,Energy Metabolism ,Oxidation-Reduction ,Oleic Acid - Abstract
Although long-chain fatty acids are a major energy substrate utilized by the myocardium, changes in the substrate balance toward a predominating fatty acid utilization could jeopardize the myocardium during cardiac operative procedures.In the present study myocardial substrate utilization was examined during warm continuous blood cardioplegia (4 hours, 37 degrees C), using pigs undergoing cardiopulmonary bypass. Hearts were perfused antegradely in a closed extracorporeal circuit in which cardioplegic donor blood (hematocrit, 22%) containing 14C-glucose and 3H-oleate was delivered to the heart. Arterial and coronary sinus blood samples were taken at intervals for determination of plasma concentrations of energy substrates, as well as glucose and oleate oxidation rates (14CO2 and 3HOH production).The concentration of fatty acids in the cardioplegic perfusate did not change significantly during the cardiac arrest period. The mean concentration of glucose showed a 30% decline (not significant), whereas the lactate concentration increased from a starting value of 3.12 +/- 0.27 to 6.31 +/- 0.72 mmol/L at the end (mean +/- standard error of the mean; n = 8; p0.05). Only fatty acid levels showed a significant (positive) arterial-coronary sinus difference. Myocardial oxidation of oleate varied between 302 +/- 71 and 650 +/- 66 nmol.min-1.heart-1, whereas the range of variation for glucose oxidation was 144 +/- 64 to 355 +/- 107 nmol.min-1.heart-1. However, the changes in fatty acid levels and glucose oxidation rates during the cardiac arrest period were not statistically significant. We calculated that overall glucose oxidation accounted for less than 5% of the total aerobic energy production.The present results demonstrate overreliance on fatty acids as a source of energy during warm continuous blood cardioplegia, consistent with a condition of myocardial insulin resistance.
- Published
- 1996
40. Brystsmerter kan være så mangt
- Author
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Dag Sørlie
- Subjects
medicine.medical_specialty ,business.industry ,Physical therapy ,Medicine ,General Medicine ,medicine.symptom ,business ,Chest pain - Published
- 2012
- Full Text
- View/download PDF
41. Amelioration of reperfusion injury following hypothermic, ischemic cardioplegia in isolated, infarcted rat hearts
- Author
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Kirsti Ytrehus, Sigurd Gunnes, Sigurd Lindal, Jørgensen L, Dag Sørlie, and Straume Bk
- Subjects
Pulmonary and Respiratory Medicine ,Male ,medicine.medical_specialty ,Myocardial Infarction ,Myocardial Reperfusion ,Myocardial Reperfusion Injury ,Left coronary artery ,Hypothermia, Induced ,Internal medicine ,medicine.artery ,medicine ,Myocyte ,Animals ,Myocardial infarction ,business.industry ,Myocardium ,Rats, Inbred Strains ,General Medicine ,medicine.disease ,Rats ,Interstitial edema ,Temperature and pressure ,Electron micrographs ,Cardiology ,Heart Arrest, Induced ,Surgery ,Cardiology and Cardiovascular Medicine ,business ,Reperfusion injury ,Perfusion - Abstract
The left coronary artery was ligated and myocardial infarction developed in 28 rats. Three weeks later, the hearts were excised and mounted in an apparatus for perfusion of non-working isolated hearts (Langendorff). Hypothermic (15 degrees C), ischemic cardioplegia was induced for either 2 or 3 1/2 h followed by reperfusion for 45 min. Half of the hearts were reperfused with an initially gradual rise in temperature and pressure of the perfusion fluid, whereas the other half was reperfused directly with the perfusate at 37 degrees C and 100 cm H2O pressure. The hearts were examined by transmission electron microscopy and randomized for stereological analysis based on point counting on electron micrographs. Cardioplegia of 2 h duration was tolerated better than cardioplegia for 3 1/2 h (interstitial edema; P = 0.03, fraction of altered mitochondria; P = 0.001). Particularly in the hearts undergoing the longest cardioplegia, myocardial injury was less severe following a gentle reperfusion as compared with those exposed to the clinically common abrupt technique (fraction of mitochondria in the myocyte; P = 0.03, fraction of altered mitochondria; P = 0.008). In the interstitium, the luminal area of capillaries was significantly increased and the endothelial swelling less pronounced in the groups undergoing the gentle reperfusion technique, (luminal/endothelial fraction; P = 0.01). The study shows that previously infarcted hearts are susceptible to ischemic damage even after 2 h of regular hypothermic, ischemic cardioplegia and that a gentle reperfusion technique significantly ameliorates reperfusion injury.
- Published
- 1990
42. Coronary trapping of a complement activation product (C3a des-Arg) during myocardial reperfusion in open-heart surgery
- Author
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J. Vaage, Ole D. Mjøs, A.G. Semb, Dag Sørlie, and Mons Lie
- Subjects
Male ,medicine.medical_specialty ,Infarction ,Myocardial Reperfusion ,Myocardial Reperfusion Injury ,law.invention ,Coronary circulation ,law ,Internal medicine ,medicine ,Cardiopulmonary bypass ,Humans ,Complement Activation ,Coronary sinus ,Cardiopulmonary Bypass ,business.industry ,Myocardium ,Extracorporeal circulation ,Hypothermia ,Middle Aged ,medicine.disease ,Surgery ,medicine.anatomical_structure ,Anesthesia ,Cardiology ,Complement C3a ,Heart Arrest, Induced ,Arterial blood ,Female ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business ,Artery - Abstract
Accumulation of complement factors has been found to occur in the myocardium after infarction. We studied the possibility that the complement activation product C3a des-Arg is trapped within the coronary circulation during reperfusion of the ischemic myocardium. In 11 patients undergoing routine coronary artery bypass grafting, arterial blood was sampled before, during and after cardiopulmonary bypass. Blood was drawn from the coronary sinus concomitantly with arterial blood sampling 5 and 30 min after release of the aortic cross-clamp (n = 10). From a preoperative value of 92 +/- 13 ng/ml, C3a des-Arg rose during CPB to a maximum of 1816 +/- 393 at the end of CPB. Following reperfusion for 5 min, C3a des-Arg was 1284 +/- 232 ng/ml in arterial and 1106 +/- 100 in coronary sinus blood, a significant difference (p less than 0.05). The amount of C3a des-Arg trapped in the heart at 5-min reperfusion showed positive correlation with its arterial concentration (p less than 0.05). No significant difference was found after 30 min of reperfusion. Complement activation products trapped in the heart in the early reperfusion period may play a pathogenetic role in myocardial ischemia-reperfusion injury.
- Published
- 1990
43. Reply to Chambers
- Author
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Christian Korvald, Odd Petter Elvenes, Tor Steensrud, Dag Sørlie, and Dag Nordhaug
- Subjects
Pulmonary and Respiratory Medicine ,business.industry ,Medicine ,Surgery ,General Medicine ,Cardiology and Cardiovascular Medicine ,business ,Classics - Published
- 2003
- Full Text
- View/download PDF
44. Multiply Beta-lactam Resistant Enterobacter cloacae Infections Linked to the Environmental Flora in a Unit for Cardiothoracic and Vascular Surgery
- Author
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Ragnar Hotvedt, Kjell Olafsen, Dag Sørlie, Robert George, Sven M. Almdahl, Bjørg Marit Andersen, and Anette Gilfillian
- Subjects
Adult ,Male ,Microbiology (medical) ,Serotype ,Operating Rooms ,medicine.medical_specialty ,Enterobacter ,Hospital Departments ,beta-Lactams ,Gastroenterology ,Beta-lactam ,chemistry.chemical_compound ,Enterobacteriaceae ,Sepsis ,Resistant strain ,Internal medicine ,medicine ,Postoperative infection ,Humans ,Surgical Wound Infection ,Cardiac Surgical Procedures ,Serotyping ,Aged ,Cross Infection ,General Immunology and Microbiology ,biology ,business.industry ,Enterobacteriaceae Infections ,Drug Resistance, Microbial ,General Medicine ,Middle Aged ,Vascular surgery ,biology.organism_classification ,medicine.disease ,Mediastinitis ,Anti-Bacterial Agents ,Surgery ,Infectious Diseases ,chemistry ,Sputum ,Female ,medicine.symptom ,business ,Surgery Department, Hospital ,Vascular Surgical Procedures ,Enterobacter cloacae - Abstract
During the period March 1987-May 1988, postoperative infection or colonization with Enterobacter cloacae occurred in 9/379 (2.4%) patients who underwent cardiovascular surgery. Five of the patients were infected with multiply beta-lactam resistant E. cloacae, of whom 4 had been infected with an identical, resistant strain during intervals of months. This strain was also found in the environmental flora of the cardiovascular operating suite and in a sink reservoir in the surgery department. All 4 patients with the identical resistant strain had serious complications during the postoperative period with symptoms of septicaemia in 3, multiorgan failure and shock in 2, and mediastinitis in 3. The single resistant strain of a different serotype was also associated with severe postoperative complications. The 4 sensitive strains were all different serotypes. None caused septicaemia, one was associated with mediastinitis, another with an uncomplicated sternum infection, and 2 were from sputum. In the 3 latter patients with sensitive strains and few postoperative complications, cephalosporins had not been used during the pre- or postoperative period.
- Published
- 1989
- Full Text
- View/download PDF
45. Wilms tumor with extension to the right atrium
- Author
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Svein Kolmannskog, Dag Sørlie, P J Moe, and Emmanuel Besigye
- Subjects
Male ,Cancer Research ,medicine.medical_specialty ,Wilms Tumor ,Inferior vena cava ,law.invention ,Heart Neoplasms ,law ,medicine ,Cardiopulmonary bypass ,Humans ,Neoplasm Invasiveness ,Heart Atria ,Child ,Postoperative chemotherapy ,business.industry ,Wilms' tumor ,medicine.disease ,Kidney Neoplasms ,Surgery ,medicine.anatomical_structure ,Oncology ,medicine.vein ,Pediatrics, Perinatology and Child Health ,cardiovascular system ,Right atrium ,Radiology ,Renal vein ,business ,Cardiac symptoms - Abstract
A seven-year-old boy had cardiac symptoms for five months before the diagnosis of Wilms tumor was made. The tumor extended into the inferior vena cava through the renal vein and protruded into the right atrium. All demonstrable tumor masses could be removed at a one-step surgical procedure without using cardiopulmonary bypass. Intensive postoperative chemotherapy has been given, and 15 months after surgery he was without signs of relapse.
- Published
- 1979
- Full Text
- View/download PDF
46. Determination of lower leg blood flow in man by thermodilution
- Author
-
Kjell Myhre and Dag Sørlie
- Subjects
Adult ,Male ,Supine position ,Physical Exertion ,Thermodilution ,Clinical Biochemistry ,Femoral vein ,Lower limb ,Dogs ,Ischemia ,Popliteal vein ,Animals ,Humans ,Medicine ,Electromagnetic flow ,Leg ,business.industry ,General Medicine ,Blood flow ,Femoral Vein ,Sitting Positions ,Catheter ,Regional Blood Flow ,Anesthesia ,business ,Nuclear medicine - Abstract
A thermodilution method for measuring distal femoral vein flow in man is presented. The catheter is introduced percutaneously in central direction into the popliteal vein. Tests for accuracy in vitro (r = 0.999, range of true flow 63–2600 ml/min) and in dog experiments (r = 0.994, range of electromagnetic flow measurements 110–780 ml/min) are presented and discussed in relation to the anatomical (dissections on corpses) and functional conditions in the popliteal/distal femoral vein of man. A group of normal persons [7] and of patients suffering from ischaemic lower limb disease [17] were studied at rest and during exercise on an ergometer in supine and sitting positions. In all but two, reliable measurements were obtained. In the normals, a mean resting flow of 114 ml/min (range 82–140 ml/min) was found. The individual coefficient of correlation between load and flow measurements in the normals varied from 0.80 to 0.94 during stepwise increasing load exercise. No serious complications occurred. The method...
- Published
- 1977
- Full Text
- View/download PDF
47. Improved energy preservation following gentle reperfusion after hypothermic, ischemic cardioplegia in infarcted rat hearts
- Author
-
Dag Sørlie, Mjøs Od, Sigurd Gunnes, Kirsti Ytrehus, and Helgesen Kg
- Subjects
Male ,Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Phosphocreatine ,Myocardial Infarction ,Ischemia ,Myocardial Reperfusion ,Myocardial Reperfusion Injury ,Energy preservation ,Adenosine Triphosphate ,Left coronary artery ,Hypothermia, Induced ,Internal medicine ,medicine.artery ,Pressure ,medicine ,Animals ,cardiovascular diseases ,Myocardial energetics ,business.industry ,Myocardium ,Temperature ,Rats, Inbred Strains ,General Medicine ,medicine.disease ,Rats ,Temperature and pressure ,Anesthesia ,Heart Arrest, Induced ,Cardiology ,Surgery ,Energy Metabolism ,Cardiology and Cardiovascular Medicine ,business - Abstract
The influence of temperature and pressure during early reperfusion after 2 h of hypothermic, cardioplegic ischemia was investigated. Adenosine triphosphate (ATP) and creatine-phosphate (CP) were measured after 45-min reperfusion. The experiments were carried out in normal and previously infarcted rat hearts (the left coronary artery having been ligated 3 weeks earlier). Four groups, each containing six hearts, were studied. Group 1 consisted of normal hearts reperfused with an abrupt rise in temperature and pressure, group 2 of normal hearts exposed to slowly rising temperature and pressure, and group 3 and 4 of previously infarcted hearts. Reperfusion procedures in groups 3 and 4 were the same as in group 1 and 2, respectively. The study showed that previously infarcted hearts have a lowered tolerance to ischemia and that the reperfusion technique may influence the preservation of myocardial energetics, although this influence was not statistically significant in normal hearts following only 2 h of ischemia. The gently reperfused infarcted hearts had energy stores equal to the normal hearts after 2 h of ischemia and 45 min of reperfusion, whereas the infarcted hearts reperfused in a rougher mode had significantly lowered values (P less than 0.05 for ATP and P less than 0.01 for CP).
- Published
- 1987
- Full Text
- View/download PDF
48. Doxycycline in the treatment of perforated appendicitis
- Author
-
Dag Sørlie and Karl Erik Giercksky
- Subjects
Doxycycline ,Perforated Appendicitis ,medicine.medical_specialty ,business.industry ,Incidence (epidemiology) ,Ampicillin ,medicine ,General Medicine ,business ,medicine.drug ,Surgery - Abstract
The effect of doxycycline and ampicillin on the incidence of septic complications after surgery for perforated appendicitis was studied in 84 patients. The doxycycline group had a 20% incidence of ...
- Published
- 1975
- Full Text
- View/download PDF
49. Lower leg blood flow in intermittent claudication
- Author
-
Dag Sørlie and Kjell Myhre
- Subjects
Adult ,Male ,medicine.medical_specialty ,Physical Exertion ,Posture ,Clinical Biochemistry ,Ischemia ,Work Capacity Evaluation ,Sitting ,Internal medicine ,medicine ,Humans ,In patient ,Aged ,Leg ,business.industry ,General Medicine ,Arteriosclerosis ,Blood flow ,Intermittent Claudication ,Middle Aged ,medicine.disease ,Intermittent claudication ,Surgery ,Cardiology ,Thermodilution technique ,medicine.symptom ,Maximal exercise ,business - Abstract
Lower leg blood flow was measured at rest and both during and after graduated bicycle exercise in five healthy men and in seventeen patients suffering from various degrees of obliterating arteriosclerosis of the lower limbs. A thermodilution technique was used for flow determinations. The subject exercised in the sitting position and the work load was increased stepwise from a starting load of 100 kpm/min (100 kpm/min load increment every second minute until exhaustion). Three flow phases were depicted during and after the exercise: the aerobic phase, the phase of relative ischaemia and a postexercise phase. During exercise, lower leg blood flow increased approximately twenty times in healthy subjects, while in the arteriosclerotic subjects there was a two-fold to ten-fold increase in flow. In patients with serious distal and proximal stenoses a proximal steal phenomenon was demonstrated during submaximal and maximal exercise. A close correlation was found between maximum individual work load capacity and maximum lower leg blood flow (r = 0.71, P less than 0.001). In the patient group lower leg blood flow at a certain work load was 45% (P less than 0.001) higher in the sitting than in the supine position.
- Published
- 1978
- Full Text
- View/download PDF
50. Metabolic effects of low and high doses of insulin during beta-receptor blockade in dogs
- Author
-
O Reikerås, Ole Danbolt Mjøs, Pål Gunnes, Rolf Jorde, Dag Sørlie, and Rolf Ekroth
- Subjects
Male ,medicine.medical_specialty ,Physiology ,medicine.medical_treatment ,Hemodynamics ,Blood Pressure ,Propranolol ,Fatty Acids, Nonesterified ,Biology ,Carbohydrate metabolism ,Glucagon ,Hemoglobins ,Dogs ,Heart Rate ,Coronary Circulation ,Internal medicine ,Receptors, Adrenergic, beta ,medicine ,Animals ,Insulin ,Cardiac Output ,Dose-Response Relationship, Drug ,Myocardium ,Heart ,General Medicine ,Metabolism ,Hydrogen-Ion Concentration ,Blockade ,Oxygen ,Dose–response relationship ,Glucose ,Endocrinology ,Hematocrit ,Female ,medicine.drug - Abstract
Metabolic effects of low and high doses of insulin during beta-receptor blockade were studied in eight dogs. Beta-receptor blockade was induced by 0.5 mg/kg propranolol which caused depression of heart performance. This was accompanied by a significant reduction in myocardial blood-flow and oxygen consumption. There was also a significant reduction in arterial concentrations and myocardial uptake of free fatty acids, while arterial concentrations and myocardial uptake of glucose and lactate were not significantly changed. Fifteen minutes after beta receptor blockade, an intravenous (i.v.) bolus injection of 0.5 IU/kg, of insulin, free of glucagon and calcium, was given followed by a continuous infusion of 0.5 IU/kg/h. Glucose and potassium were given to maintain constant levels of these factors. After 30 min another bolus dose of 300 IU insulin was injected. Thirty minutes after a low dose of insulin, a significant increase in heart performance was recorded at unaltered myocardial oxygen consumption. Arterial concentrations of free fatty acids were significantly reduced while levels of glucose and lactate were unchanged. Myocardial uptake of glucose increased significantly while uptake of lactate and free fatty acids was unchanged. After a high dose of insulin there was a considerable improvement in heart performance. Myocardial blood-flow and oxygen consumption were not changed, nor were there alterations in arterial concentrations and myocardial uptake of glucose, lactate and free fatty acids. It is concluded that, during beta-receptor blockade high doses of insulin improve the mechanical performance of the heart through mechanisms that are independent of insulin's effects on substrate metabolism.
- Published
- 1985
- Full Text
- View/download PDF
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