34 research outputs found
Percutaneous coronary intervention in Europe 1992-2003
peer reviewedAims: The purpose of this registry is to collect data on trends in interventional cardiology within Europe.
Special interest focuses on relative increases and ratios in newer revascularization approaches and its distribution
in different regions in Europe. We report the data of the year 2003 and give an overview of the
development of coronary interventions since 1992, when the first data collection was performed.
Methods and results: Questionnaires were distributed yearly to delegates of all national societies of cardiology
represented in the European Society of Cardiology to collect the case numbers of all local institutions
and operators. The overall numbers of coronary angiographies increased from 1992 to 2003 from 684,000
to 1,993,000 (from 1,250 to 3,500 per million inhabitants). The respective numbers for percutaneous
coronary interventions (PCI-coronary angioplasty) and coronary stenting procedures increased from
184,000 to 733,000 (from 335 to 1,300) and from 3,000 to 610,000 (from 5 to 1,100), respectively.
Germany has been the most active country for the past years with 653,000 angiographies (7,800),
222,000 angioplasties (2,500), and 180,000 stenting procedures (2,200) in 2003. The indication has shifted
towards acute coronary syndromes, as demonstrated by raising rates of interventions for acute myocardial
infarction over the last decade. The procedures are more readily performed and safer, as shown by
increasing rate of “ad hoc” PCI and decreasing need for emergency coronary artery bypass surgery
(CABG). In 2003, use of drug-eluting stents had further increased. However, an enormous variability is
reported with the highest rate in Portugal (55%).
Conclusion: Interventional cardiology in Europe is still expanding, mainly but not exclusively due to rapid
growth in the eastern European countries. A number of new coronary revascularization procedures introduced
over the years have all but disappeared. Only stenting has experienced an exponential growth. The
same can be forecast for drug-eluting stenting
Pollen profile from Schonen, Sweden
Two new Standard pollen diagrams from the raised bog Ageröds mosse in central Scania are presented and discussed. They have been made giving extensive consideration to the NAP and spores also. The new diagrams comprise in the main only the Post-glacial and can easily be compared with the earlier published Standard diagram from the bog (T. NILSSON 1935). The development of the Post-glacial Vegetation in the surroundings is also discussed and compared with the conditions in the southernmost part of the province (Bjärsjöholmssjön, T. Nilsson 1961).
One of the new diagrams has been prepared in connection with the study of a core brought up by means of a special borer in order to bring about C14 datings. The core was almost ömlong and had a diameter of 6 cm. It was divided into pieces of 2—6 cm, which were preserved. After the preparation of the pollen diagram, suitable samples were selected for C14 dating. In all 33 samples, comprising the whole Post-glacial inclusive of the youngest part of the Late-glacial, were C14-dated.
With the aid of the C14 dates the growth conditions of the bog are discussed. After very slow Sedimentation of predominantly minerogenous deposits in the last part of the Late-glacial, and still slow Sedimentation of gyttjas in the oldest part of the Post-glacial, the rate of growth (primarily of the gyttja) distinctly increased in the first part of the Late Boreal. A temporary retardation of the growth of the sphagnum peat at the end of the Sub-boreal is probably entirely local. The average rate of growth of the really highly humified parts of the old sphagnum peat amounts to 42 mm per Century, that of the slightly humified young sphagnum peat 81 mm per Century or somewhat more.
Based on the C14-determinations, the pollen zone boundaries have been given the following approximate dates: boundary Late-glacial/Post-glacial (DR/PB) 8300 B.C., boundary Pre-boreal/Boreal (PB/BO) 7900 B.C., boundary Early Boreal/Late Boreal (BO 1/2) 6800 B.C., boundary Boreal/Atlantic (BO/AT) 6200 B.C., boundary Early Atlantic/Late Atlantic (AT 1/2) 4600 B.C. (?), boundary Atlantic/Sub-boreal (AT/SB) 3300 B.C., boundary Early Sub-boreal/Late Sub-boreal (SB 1/2) 1700—1800 B.C., boundary Sub-boreal/Sub-atlantic (SB/ SA) 300 B.C., boundary Early Sub-atlantic/Late Sub-atlantic (SA 1/2) 650 A.D
Pulmonary embolism : Validation of diagnostic imaging methods in the clinical setting
Pulmonary embolism (PE) is an elusive diagnosis and none of the existing
imaging modalities have a 100% diagnostic specificity or sensitivity.
Pulmonary arteriography (PA) is the most specific test although the
improvement of computed tomography technique has made this a commonly
used method. Lung scintigraphy often gives ambiguous results. Fibrin
split products (D-dimer) are released into the blood in PE were elevated
levels can be measured. However, D-dimer levels are elevated in venous
thromboembolic (VTE) disease as well as in a number of other conditions.
The aims of this thesis were to evaluate different radiological methods
including pulmonary arteriography, lung scintigraphy and spiral computed
tomography for the diagnosis of acute pulmonary embolism and to study if
a clinical probability protocol or a simple blood test such as D- dimer
could improve the diagnostic accuracy.
Study I investigated the complication rate of PA in 707 patients. The
overall complication rate was 1.6%, which is lower than previously
reported.
Study II assessed the interobserver variations in PA in 170 patients and
compared the consensus results to a final outcome diagnosis. The mean
interobserver agreement was 89%, higher for central vessel emboli, lower
for peripheral locations.
Study III investigated if the use of a combination of a clinical and
scintigraphic protocol in relation to the final outcome could improve the
diagnosis in patients with clinical suspicion of acute PE. A low combined
probability yielded a negative predictive value (NPV) of 98%. The
positive predictive value (PPV) was 100% if the combined probability was
high.
Study IV compared the diagnostic accuracy of contrast medium enhanced
spiral computed tomography of the pulmonary arteries (s-CTPA) and a latex
agglutination D-dimer assay in patients with suspected acute PE by using
PA and clinical follow up as reference method. sCTPA had 95% NPV and 94%
PPV. If a cut off level of 0.25 mg/L was used the corresponding figures
for D-dimer were 92% and 63%.
Study V investigated if 441 patients with a negative s-CTPA and without
DVT symptoms, venous studies or anticoagulant treatment had a new episode
of PE during three months follow up. Only 0.9% of the patients had proven
PE during the follow up period.
To conclude, the results of our studies show that PA is a safe method
with good interobserver agreement and low complication rate. By applying
a model of combined clinical and scintigraphic probabilities for PE, the
diagnosis is ruled in when the combined probability is high, and ruled
out when the combined probability is low. However, nearly half of the
patients will still have an uncertain diagnosis if lung scintigraphy is
used as diagnostic method.
A low cut-off level of D-dimer can be used as a screening test to rule
out PE, but can not confirm the diagnosis. s-CTPA has a high diagnostic
accuracy when compared to PA. The overall results indicate that a
negative s-CTPA result safely can rule out the existence of clinically
significant, acute PE
The Pleistocene : geology and life in the quaternary Ice Age /
Bibliography: p. 540-620.Includes index