Cardiac function associated with previous, current and repeated depression and anxiety symptoms in a healthy population: the HUNT study.

OBJECTIVE: Symptoms of anxiety and depression often co-exist with cardiovascular disease (CVD), yet little is known about the association with left ventricular (LV) subclinical dysfunction. We aimed to study the cross-sectional associations of previous, current and repeated depression or anxiety symptoms, with sensitive indices of LV systolic and diastolic function, based on tissue Doppler (TD) and speckle tracking (ST) imaging methods. METHODS: A random selection of 1296 individuals free from known CVD, hypertension and diabetes were examined with echocardiography at baseline of the third Nord-Trøndelag Health Study, (HUNT3, 2006-2008). The primary outcomes were LV diastolic function (e') and LV systolic function (longitudinal global strain). The primary exposures were self-report on the Hospital Anxiety and Depression Scale (HADS). Associations between outcomes and baseline exposures were available for 1034 (80%), and with previous and repeated exposures for 700 participants who also participated in HUNT2 (1995-1997). RESULTS: Previous and repeated depression symptoms, but not current depression, were linearly associated with a reduction in e'. The average sum of two repeated HADS-D scores 10 years apart had the strongest effect on e' (-8.3%; 95% CI -13.9% to -2.7%) per 5 units. We observed a sex difference between depression symptoms and longitudinal global strain (p for interaction 0.019), where women had a marginal negative effect. Anxiety symptoms, neither previous, current nor repeated were associated with subclinical LV dysfunction. CONCLUSIONS: In a healthy sample, confirmed free of CVD, past and repeated depression symptoms were associated with subclinical LV dysfunction. Thus, depression symptoms might represent a modifiable risk factor for future CVD.

Heart rate and suicide: findings from two cohorts of 533 000 Taiwanese and 75 000 Norwegian adults.

OBJECTIVE: To investigate the association of resting heart rate with suicide in two large cohorts. METHOD: The MJ cohort (Taiwan) included 532 932 adults from a health check-up programme (1994-2008). The HUNT cohort (Norway) included 74 977 adults in the Nord-Trøndelag County study (1984-1986), followed up to 2004. In both cohorts heart rate was measured at baseline, and suicide was ascertained through linkage to cause-of-death registers. Risk of suicide was estimated using Cox proportional hazards models. RESULTS: There were 569 and 188 suicides (average follow-up period of 8.1 and 16.9 years) in the MJ and HUNT cohorts respectively. Sex- and age-adjusted hazard ratio for every 10 beat increase in heart rate per minute was 1.08 (95% Confidence Interval 1.00-1.16) and 1.24 (1.12-1.38) in the MJ and HUNT cohorts, respectively. In the MJ cohort this association was confined to individuals with a history of heart diseases vs. those without such a history (P for interaction = 0.008). In the HUNT cohort the association did not differ by history of heart diseases and was robust to adjustment for health-related life style, medication use, and symptoms of anxiety and depression. CONCLUSION: Elevated resting heart rate may be a marker of increased suicide risk.

A U-shaped relationship between systolic blood pressure and panic symptoms: the HUNT study.

BACKGROUND: Previous studies on the relationship between blood pressure (BP) and psychological morbidity are conflicting. To resolve this confusing picture we examined the hypothesis that there is a non-linear relationship between panic and systolic BP (SBP) and explored the association of generalized anxiety symptoms with SBP. Method We used data from the population-based Nord-Trøndelag health study (HUNT) in which all 92 936 individuals aged ≥20 years residing in one Norwegian county were invited to participate. Panic was assessed using one item from the anxiety subscale of the Hospital Anxiety and Depression Scale (HADS) and generalized anxiety with the remaining six items of this subscale. SBP was the mean of two measurements by an automatic device. RESULTS: A total of 64 871 respondents had SBP recorded (70%). Both unadjusted (n=61 408) and adjusted analyses provided evidence for a non-linear relationship between panic and SBP, represented by a U-shaped curve with a minimum prevalence of panic at around 140 mmHg. The relationship was strengthened after adjustment for confounders, with the quadratic term significantly associated with panic (p=0.03). Generalized anxiety symptoms were associated only with low SBP. CONCLUSIONS: The U-shaped relationship between SBP and panic provides a unifying explanation for the separate strands of published literature in this area. The results support the hypothesis that high BP and panic disorder could share brainstem autonomic and serotonergic abnormalities. By contrast, generalized anxiety symptoms were more common only at lower BPs, suggesting that any biological link between panic and high BP does not extend to generalized anxiety.

The associations of high levels of C-reactive protein with depression and myocardial infarction in 9258 women and men from the HUNT population study.

BACKGROUND: Elevated levels of circulating C-reactive protein (CRP) have been associated with coronary heart disease and, in some studies, depression. Most studies have been of populations selected by age and/or gender. We investigate these associations with depression, myocardial infarction (MI), or both, in a large general population sample. METHOD: A cross-sectional population study of 9258 women and men aged ≥ 20 years. The study included clinical examination, self-report of MI and depression and factors known to confound their associations. The Hospital Anxiety and Depression Scale was used to assess severity of depressive symptoms. Elevated high sensitive-CRP was defined as values >2.2 mg/l. RESULTS: The association of elevated CRP with depression was attenuated towards the null [from odds ratio (OR) 1.28, p=0.001 to OR 1.08, p=0.388] following extensive adjustment, while associations with MI (adjusted OR 1.42, p=0.032) and co-morbid MI and depression (adjusted OR 2.66, p=0.003) persisted. Confounders associated with elevated CRP levels were smoking (OR 1.66; p<0.001), chronic physical illness (OR 1.34, p<0.001), BMI ≥ 30 (OR 1.13, p<0.001), employment (OR 0.70, p<0.001) and high coffee consumption (OR 0.83, p=0.017). Interaction tests indicated a lower effect of old age (OR 0.54, p<0.001) and smoking (OR 0.63, p<0.001) on elevated CRP levels in women compared with men. CONCLUSIONS: CRP levels were raised in those with MI and co-morbid MI and depression; the positive association with depression was explained by confounding factors. We found new evidence that might help understand gender-specific patterns. Future studies should explore the neurobiological mechanisms underpinning these interrelations and their relevance for treatment of these conditions.

[Intraoperative ultrasonography in laparoscopic cholecystectomy]. / Intraoperativ ultralyd ved laparoskopisk kolecystektomi.

BACKGROUND: Laparoscopic ultrasonography has been increasingly used over the last several years as a new imaging modality. This study assessed the effectiveness of laparoscopic ultrasonography in detecting main biliary duct stones during laparoscopic cholecystectomy. MATERIAL AND METHODS: During the eight-year period 1991-98, 441 patients treated by laparoscopic cholecystectomy were at the same time included in laparoscopic ultrasonography. After port placement and dissection of the gallbladder, laparoscopic ultrasonography of the extrahepatic common bile duct was performed in the longitudinal plane. RESULTS: Laparoscopic ultrasonography failed to recognise the intrapancreatic part of the common bile duct in 64 cases (14%). The time used for sonography was approximately eight minutes. In this study, common bile duct stones were found in 29 cases (7%). One false negative result was recognised. INTERPRETATION: Laparoscopic ultrasonography is a safe, repeatable, noninvasive and cost-effective procedure, but a considerable learning curve is necessary in order to optimise its efficacy. Once learned, however, the method can be used as a primary screening procedure for bile duct calculi.

Laparoscopic ultrasound (LUS) in gastrointestinal surgery.

Intraoperative ultrasonography during abdominal surgery became widespread by availability of high-frequency, high-resolution transducers. It's usefulness has particularly been proven in biliar and gastrointestinal surgery. Our objective was to examine the method in laparoscopic cholecystectomy and in laparoscopic staging of malignancies of the upper gastrointestinal tract as well. Lapaoscopic ultrasound (LUS) examination was performed in 567 patients operated on because of biliary stones and in 12 patients with carcinoma in the upper part of the gastrointestinal tract. In accordance to the known criteria endoscopic retrograde cholangiopancreatography (ERCP) was performed in 89 patients, and additionally, ERCP was performed in 58 patients because of dilated common bile duct. Choledochal stones were demonstrated in 72 of the 147 patients. Laparoscopic ultrasonography demonstrated preoperatively undetected bile duct stones in 18 of these patients (12%). In 294 other patients without any criteria of bile duct stones, laparoscopic ultrasonography demonstrated bile duct stones in 11 patients (4%). Laparoscopic ultrasonography in 12 patients with proximal gastrointestinal malignancies demonstrated inoperability in all of the patients. Laparotomy could thereby be avoided. LUS examination is an ideal operative tool as it is safe, reproducible and requires no special patient preparation or positioning. The method of imaging is therefore justified for patients undergoing laparoscopic surgery because of biliary stones and gastrointestinal surgery.

[Radiologic intervention in the biliary tract performed at a central hospital]. / Radiologisk intervensjon i galleveiene utført ved et sentralsykehus.

During the ten-year period 1987-96, 131 diagnostic percutaneous transhepatic cholangiographies (PTC) were performed in 103 patients due to obstructive jaundice. 54 cases of percutaneous transhepatic bile drainage (endoprosthesis) (PTBD) and 53 of percutaneous transhepatic external drainage (PTED) were also performed. In 89 patients (86%) the obstructive jaundice was caused by malignant disease. Puncture was done under fluoroscopic or ultrasonographic control. An 8 Fr. plastic endoprosthesis of 15 cm length was used for internal bile drainage, and a 7.6 Fr. 60 cm long catheter was used for external drainage. For combined external/internal drainage an 8.4 Fr. catheter of 60 cm length was used. 24 patients (23%) developed complications. Eight of these complications were serious, and three patients (2.5%) died as a result of the procedure. Three patients developed duodenal perforations. 11 out of 51 patients (20%) treated with endoprosthesis died within 30 days. Mean functioning time for endoprostheses was 128 days. Progress in radiologic intervention technique has changed the treatment of obstructive jaundice. In our view, endoscopic bile drainage should be the treatment of choice. Percutaneous transhepatic bile drainage is an alternative in cases where endoscopic therapy fails.

Evaluation of enoxaparin given before and after operation to prevent venous thromboembolism during digestive surgery: play-the-winner designed study.

A total of 316 patients were included in a play-the-winner (PTW) designed study comparing the safety of enoxaparin started preoperatively versus postoperatively as prophylaxis against venous thromboembolism for digestive surgery. In a PTW-designed study the treatment of any next patient depends on the outcome of the previous patient. If successful, the next patient receives the same treatment, if not, the comparative regimen is given. Excessive bleeding according to specified criteria, severe adverse reactions, clinically detected deep venous thrombosis (DVT), or pulmonary embolism (PE) were criteria for classification as "loser." The PTW design allocates most patients to the superior treatment. The main variable in PTW studies is the number of consecutive patients receiving the same treatment. In this study 163 patients were allocated to postoperatively started and 153 to preoperatively started prophylaxis with enoxaparin. The frequency of "winners" was found to be 82.8% and 78.4% in the post- and preoperatively treated groups, respectively. No significant differences were found between the groups with regard to frequency of "winners" or the number of consecutive patients before change of treatment. The percentile of survival distribution did not detect superiority of any group. Prophylaxis against postoperative venous thromboembolism for digestive surgery using enoxaparin can safely be started preoperatively.

[Herniography. A 3-year material from a central hospital]. / Herniografi. Et treårsmateriale fra et sentralsykehus.

Herniography is the roentgenographic demonstration of hernias in the pelvic region by positive contrast peritoneography. The main indication for herniography is obscure groin pain and the suspicion of a hernia not visible at clinical examination. In a review of the last 75 patients from 1991-93, 30 hernias and 18 other findings were demonstrated. 13 patients have been operated till now, and their results are presented. Only 5.6% of Norwegian hospitals perform ten or more herniographies a year. We find herniography to be a reliable and safe diagnostic method that should receive more attention.