Effects of spinal cord stimulation in angina pectoris induced by pacing and possible mechanisms of action.

Abstract:

OBJECTIVE:To investigate the effects of spinal cord stimulation on myocardial ischaemia, coronary blood flow, and myocardial oxygen consumption in angina pectoris induced by atrial pacing. DESIGN:The heart was paced to angina during a control phase and treatment with spinal cord stimulation. Blood samples were drawn from a peripheral artery and the coronary sinus. SETTING:Multidisciplinary pain centre, department of medicine, Ostra Hospital, and Wallenberg Research Laboratory, Sahlgrenska Hospital, Gothenburg, Sweden. SUBJECTS:Twenty patients with intractable angina pectoris, all with a spinal cord stimulator implanted before the study. RESULTS:Spinal cord stimulation increased patients' tolerance to pacing (p < 0.001). At the pacing rate comparable to that producing angina during the control recording, myocardial lactate production during control session turned into extraction (p = 0.003) and, on the electrocardiogram, ST segment depression decreased, time to ST depression increased, and time to recovery from ST depression decreased (p = 0.01; p < 0.05, and p < 0.05, respectively). Spinal cord stimulation also reduced coronary sinus blood flow (p = 0.01) and myocardial oxygen consumption (p = 0.02). At the maximum pacing rate during treatment, all patients experienced anginal pain. Myocardial lactate extraction reverted to production (p < 0.01) and the magnitude and duration of ST segment depression increased to the same values as during control pacing, indicating that myocardial ischaemia during treatment with spinal cord stimulation gives rise to anginal pain. CONCLUSIONS:Spinal cord stimulation has an anti-anginal and anti-ischaemic effect in severe coronary artery disease. These effects seem to be secondary to a decrease in myocardial oxygen consumption. Furthermore, myocardial ischemia during treatment gives rise to anginal pain. Thus, spinal cord stimulation does not deprive the patient of a warning signal.

journal_name

BMJ

authors

Mannheimer C,Eliasson T,Andersson B,Bergh CH,Augustinsson LE,Emanuelsson H,Waagstein F

doi

10.1136/bmj.307.6902.477

subject

Has Abstract

pub_date

1993-08-21 00:00:00

pages

477-80

issue

6902

eissn

0959-8138

issn

1756-1833

journal_volume

307

pub_type

杂志文章
  • Doctors' experience with handheld computers in clinical practice: qualitative study.

    abstract:OBJECTIVE:To examine doctors' perspectives about their experiences with handheld computers in clinical practice. DESIGN:Qualitative study of eight focus groups consisting of doctors with diverse training and practice patterns. SETTING:Six practice settings across the United States and two additional focus group sessi...

    journal_title:BMJ (Clinical research ed.)

    pub_type: 杂志文章,多中心研究

    doi:10.1136/bmj.328.7449.1162

    authors: McAlearney AS,Schweikhart SB,Medow MA

    更新日期:2004-05-15 00:00:00

  • Factors affecting early unplanned readmission of elderly patients to hospital.

    abstract::A random sample of 133 elderly patients who had an unplanned readmission to a district general hospital within 28 days of discharge from hospital was studied and compared with a matched control sample of patients who were not readmitted. The total group was drawn from all specialties in the hospital, and by interviewi...

    journal_title:BMJ (Clinical research ed.)

    pub_type: 杂志文章

    doi:10.1136/bmj.297.6651.784

    authors: Williams EI,Fitton F

    更新日期:1988-09-24 00:00:00

  • Should fertile people have access to in vitro fertilisation?

    abstract::Some existing laws and some proposed legislation regulating the practice of in vitro fertilization (IVF) limit its availability to infertile couples. Dawson and Singer question whether it is reasonable to so restrict access to IVF, and examine some of the medical and social circumstances in which IVF and the related ...

    journal_title:BMJ (Clinical research ed.)

    pub_type: 杂志文章

    doi:10.1136/bmj.300.6718.167

    authors: Dawson K,Singer P

    更新日期:1990-01-20 00:00:00

  • Prospective study of post-traumatic stress disorder in children involved in road traffic accidents.

    abstract:OBJECTIVE:To determine the prevalence of severe psychological trauma --that is, post-traumatic stress disorder--in children involved in everyday road traffic accidents. DESIGN:12 month prospective study. SETTING:Accident and emergency department, Royal United Hospital, Bath. SUBJECTS:119 children aged 5-18 years inv...

    journal_title:BMJ (Clinical research ed.)

    pub_type: 杂志文章

    doi:10.1136/bmj.317.7173.1619

    authors: Stallard P,Velleman R,Baldwin S

    更新日期:1998-12-12 00:00:00

  • Effect of perioperative beta blockade in patients with diabetes undergoing major non-cardiac surgery: randomised placebo controlled, blinded multicentre trial.

    abstract:OBJECTIVES:To evaluate the long term effects of perioperative beta blockade on mortality and cardiac morbidity in patients with diabetes undergoing major non-cardiac surgery. DESIGN:Randomised placebo controlled and blinded multicentre trial. Analyses were by intention to treat. SETTING:University anaesthesia and sur...

    journal_title:BMJ (Clinical research ed.)

    pub_type: 杂志文章,多中心研究,随机对照试验

    doi:10.1136/bmj.332.7556.1482

    authors: Juul AB,Wetterslev J,Gluud C,Kofoed-Enevoldsen A,Jensen G,Callesen T,Nørgaard P,Fruergaard K,Bestle M,Vedelsdal R,Miran A,Jacobsen J,Roed J,Mortensen MB,Jørgensen L,Jørgensen J,Rovsing ML,Petersen PL,Pott F,Haas M,

    更新日期:2006-06-24 00:00:00

  • The impact of removing financial incentives from clinical quality indicators: longitudinal analysis of four Kaiser Permanente indicators.

    abstract:OBJECTIVE:To evaluate the effect of financial incentives on four clinical quality indicators common to pay for performance plans in the United Kingdom and at Kaiser Permanente in California. DESIGN:Longitudinal analysis. SETTING:35 medical facilities of Kaiser Permanente Northern California, 1997-2007. PARTICIPANTS:...

    journal_title:BMJ (Clinical research ed.)

    pub_type: 杂志文章,多中心研究

    doi:10.1136/bmj.c1898

    authors: Lester H,Schmittdiel J,Selby J,Fireman B,Campbell S,Lee J,Whippy A,Madvig P

    更新日期:2010-05-11 00:00:00

  • Disease management.

    abstract::The disease management approach to patient care seeks to coordinate resources across the healthcare delivery system. The growing interest in evidence based medicine and outcomes, and a commitment to integrated care across the primary, secondary, and community care sectors, all contribute to making disease management a...

    journal_title:BMJ (Clinical research ed.)

    pub_type: 杂志文章

    doi:10.1136/bmj.315.7099.50

    authors: Hunter DJ,Fairfield G

    更新日期:1997-07-05 00:00:00

  • Empirical evidence of bias in treatment effect estimates in controlled trials with different interventions and outcomes: meta-epidemiological study.

    abstract:OBJECTIVE:To examine whether the association of inadequate or unclear allocation concealment and lack of blinding with biased estimates of intervention effects varies with the nature of the intervention or outcome. DESIGN:Combined analysis of data from three meta-epidemiological studies based on collections of meta-an...

    journal_title:BMJ (Clinical research ed.)

    pub_type: 杂志文章

    doi:10.1136/bmj.39465.451748.AD

    authors: Wood L,Egger M,Gluud LL,Schulz KF,Jüni P,Altman DG,Gluud C,Martin RM,Wood AJ,Sterne JA

    更新日期:2008-03-15 00:00:00

  • Childhood energy intake and adult mortality from cancer: the Boyd Orr Cohort Study.

    abstract:OBJECTIVE:To examine the relation between energy intake in childhood and adult mortality from cancer. STUDY DESIGN:Cohort study. SETTING:16 rural and urban centres in England and Scotland. SUBJECTS:3834 people who took part in Lord Boyd Orr's Carnegie survey of family diet and health in prewar Britain between 1937 a...

    journal_title:BMJ (Clinical research ed.)

    pub_type: 杂志文章

    doi:10.1136/bmj.316.7130.499

    authors: Frankel S,Gunnell DJ,Peters TJ,Maynard M,Davey Smith G

    更新日期:1998-02-14 00:00:00

  • Selective chromosome analysis in couples with two or more miscarriages: case-control study.

    abstract:OBJECTIVE:To identify additional factors, such as maternal age or factors related to previous reproductive outcome or family history, and the corresponding probability of carrying a chromosome abnormality in couples with two or more miscarriages. DESIGN:Nested case-control study. SETTING:Six centres for clinical gene...

    journal_title:BMJ (Clinical research ed.)

    pub_type: 杂志文章,多中心研究

    doi:10.1136/bmj.38498.669595.8F

    authors: Franssen MT,Korevaar JC,Leschot NJ,Bossuyt PM,Knegt AC,Gerssen-Schoorl KB,Wouters CH,Hansson KB,Hochstenbach R,Madan K,van der Veen F,Goddijn M

    更新日期:2005-07-16 00:00:00

  • Bone density and risk of hip fracture in men and women: cross sectional analysis.

    abstract:OBJECTIVE:To determine the relative contribution of decline in bone density to the increase in risk of hip fracture with age in men and women. DESIGN:Incidence data of hip fracture from the general population were combined with the bone density distribution in a sample from the same population and with a risk estimate...

    journal_title:BMJ (Clinical research ed.)

    pub_type: 杂志文章

    doi:10.1136/bmj.315.7102.221

    authors: De Laet CE,van Hout BA,Burger H,Hofman A,Pols HA

    更新日期:1997-07-26 00:00:00

  • Patterns of physical activity among 11 to 16 year old British children.

    abstract:OBJECTIVE:To examine the patterns of physical activity among British schoolchildren aged 11 to 16 and to assess whether the children experience the intensity and duration of physical activity that are believed to stress the cardiopulmonary system appropriately. DESIGN:Cross sectional study of a sample of children draw...

    journal_title:BMJ (Clinical research ed.)

    pub_type: 杂志文章

    doi:10.1136/bmj.301.6745.203

    authors: Armstrong N,Balding J,Gentle P,Kirby B

    更新日期:1990-07-28 00:00:00

  • Randomised crossover trial of transdermal fentanyl and sustained release oral morphine for treating chronic non-cancer pain.

    abstract:OBJECTIVES:To compare patients' preference for transdermal fentanyl or sustained release oral morphine, their level of pain control, and their quality of life after treatment. DESIGN:Randomised, multicentre, international, open label, crossover trial. SETTING:35 centres in Belgium, Canada, Denmark, Finland, the Unite...

    journal_title:BMJ (Clinical research ed.)

    pub_type: 临床试验,杂志文章,多中心研究,随机对照试验

    doi:10.1136/bmj.322.7295.1154

    authors: Allan L,Hays H,Jensen NH,de Waroux BL,Bolt M,Donald R,Kalso E

    更新日期:2001-05-12 00:00:00

  • Influence of environmental factors on mental health within prisons: focus group study.

    abstract:OBJECTIVE:To increase understanding of how the prison environment influences the mental health of prisoners and prison staff. DESIGN:Qualitative study with focus groups. SETTING:A local prison in southern England. PARTICIPANTS:Prisoners and prison staff. RESULTS:Prisoners reported that long periods of isolation wit...

    journal_title:BMJ (Clinical research ed.)

    pub_type: 杂志文章

    doi:10.1136/bmj.327.7413.480

    authors: Nurse J,Woodcock P,Ormsby J

    更新日期:2003-08-30 00:00:00

  • Paracetamol plus ibuprofen for the treatment of fever in children (PITCH): randomised controlled trial.

    abstract:OBJECTIVE:To investigate whether paracetamol (acetaminophen) plus ibuprofen are superior to either drug alone for increasing time without fever and the relief of fever associated discomfort in febrile children managed at home. DESIGN:Individually randomised, blinded, three arm trial. SETTING:Primary care and househol...

    journal_title:BMJ (Clinical research ed.)

    pub_type: 杂志文章,多中心研究,随机对照试验

    doi:10.1136/bmj.a1302

    authors: Hay AD,Costelloe C,Redmond NM,Montgomery AA,Fletcher M,Hollinghurst S,Peters TJ

    更新日期:2008-09-02 00:00:00

  • Risk factors for HIV infection in people attending clinics for sexually transmitted diseases in India.

    abstract:OBJECTIVE:To investigate the risk factors for HIV infection in patients attending clinics for sexually transmitted diseases in India. DESIGN:Descriptive study of HIV serology, risk behaviour, and findings on physical examination. SUBJECTS:2800 patients presenting to outpatient clinics between 13 May 1993 and 15 July ...

    journal_title:BMJ (Clinical research ed.)

    pub_type: 杂志文章

    doi:10.1136/bmj.311.7000.283

    authors: Rodrigues JJ,Mehendale SM,Shepherd ME,Divekar AD,Gangakhedkar RR,Quinn TC,Paranjape RS,Risbud AR,Brookmeyer RS,Gadkari DA

    更新日期:1995-07-29 00:00:00

  • Randomised trial of heroin maintenance programme for addicts who fail in conventional drug treatments.

    abstract:OBJECTIVE:To evaluate an experimental heroin maintenance programme. DESIGN:Randomised trial. SETTING:Outpatient clinic in Geneva, Switzerland. SUBJECTS:Heroin addicts recruited from the community who were socially marginalised and in poor health and had failed in at least two previous drug treatments. INTERVENTION:...

    journal_title:BMJ (Clinical research ed.)

    pub_type: 临床试验,杂志文章,随机对照试验

    doi:10.1136/bmj.317.7150.13

    authors: Perneger TV,Giner F,del Rio M,Mino A

    更新日期:1998-07-04 00:00:00

  • Probiotics for treatment of acute diarrhoea in children: randomised clinical trial of five different preparations.

    abstract:OBJECTIVE:To compare the efficacy of five probiotic preparations recommended to parents in the treatment of acute diarrhoea in children. Design Randomised controlled clinical trial in collaboration with family paediatricians over 12 months. SETTING:Primary care. PARTICIPANTS:Children aged 3-36 months visiting a famil...

    journal_title:BMJ (Clinical research ed.)

    pub_type: 杂志文章,随机对照试验

    doi:10.1136/bmj.39272.581736.55

    authors: Canani RB,Cirillo P,Terrin G,Cesarano L,Spagnuolo MI,De Vincenzo A,Albano F,Passariello A,De Marco G,Manguso F,Guarino A

    更新日期:2007-08-18 00:00:00

  • Does the decline in child injury mortality vary by social class? A comparison of class specific mortality in 1981 and 1991.

    abstract:OBJECTIVE:To examine whether the decline in child injury death rates between 1981 and 1991 varied by social class. DESIGN:Comparison of class specific child injury death rates for 1979, 1980, 1982, and 1983, with those for the four years 1989-92. SETTING:England and Wales. SUBJECTS:Children aged 0-15 years. MAIN OU...

    journal_title:BMJ (Clinical research ed.)

    pub_type: 杂志文章

    doi:10.1136/bmj.313.7060.784

    authors: Roberts I,Power C

    更新日期:1996-09-28 00:00:00

  • Cohort study of hepatotoxicity associated with nimesulide and other non-steroidal anti-inflammatory drugs.

    abstract:OBJECTIVE:To estimate the risk of acute hepatotoxicity associated with nimesulide compared with other non-steroidal anti-inflammatory drugs. DESIGN:Retrospective cohort and nested case-control study. SETTING:Umbria region, Italy. PARTICIPANTS:400 000 current, recent, and past users (almost 2 million prescriptions) o...

    journal_title:BMJ (Clinical research ed.)

    pub_type: 杂志文章

    doi:10.1136/bmj.327.7405.18

    authors: Traversa G,Bianchi C,Da Cas R,Abraha I,Menniti-Ippolito F,Venegoni M

    更新日期:2003-07-05 00:00:00

  • Rates for obstetric intervention among private and public patients in Australia: population based descriptive study.

    abstract:OBJECTIVE:To compare the risk profile of women receiving public and private obstetric care and to compare the rates of obstetric intervention among women at low risk in these groups. DESIGN:Population based descriptive study. SETTING:New South Wales, Australia. SUBJECTS:All 171,157 women having a live baby during 19...

    journal_title:BMJ (Clinical research ed.)

    pub_type: 杂志文章

    doi:10.1136/bmj.321.7254.137

    authors: Roberts CL,Tracy S,Peat B

    更新日期:2000-07-15 00:00:00

  • Prophylaxis and follow-up after possible exposure to HIV, hepatitis B virus, and hepatitis C virus outside hospital: evaluation of policy 2000-3.

    abstract:PROBLEM:Prophylactic treatment and follow-up after exposure to HIV, hepatitis B, and hepatitis C outside hospital needs to be improved. BACKGROUND AND SETTING:Until January 2000, people in Amsterdam could report exposure outside hospital to either a hospital or the municipal health service. If they reported to the mun...

    journal_title:BMJ (Clinical research ed.)

    pub_type: 杂志文章

    doi:10.1136/bmj.330.7495.825

    authors: Sonder GJ,Regez RM,Brinkman K,Prins JM,Mulder JW,Spaargaren J,Coutinho RA,van den Hoek A

    更新日期:2005-04-09 00:00:00

  • Primary care--opportunities and threats. The changing meaning of the GP contract.

    abstract::The meaning of the GP contract has changed since the last major upheaval in the mid-1960s. The government has always dealt with general practitioners as independent contractors, but the way in which it treated them in 1990 was entirely different from the way in which they were treated in 1966. In 1966, the profession'...

    journal_title:BMJ (Clinical research ed.)

    pub_type: 杂志文章

    doi:10.1136/bmj.314.7084.895

    authors: Lewis J

    更新日期:1997-03-22 00:00:00

  • Hospital admission for acute pancreatitis in an English population, 1963-98: database study of incidence and mortality.

    abstract:OBJECTIVES:To investigate trends in the incidence of acute pancreatitis resulting in admission to hospital, and mortality after admission, from 1963 to 1998. DESIGN:Analysis of hospital inpatient statistics for acute pancreatitis, linked to data from death certificates. SETTING:Southern England. SUBJECTS:5312 people...

    journal_title:BMJ (Clinical research ed.)

    pub_type: 杂志文章

    doi:10.1136/bmj.328.7454.1466

    authors: Goldacre MJ,Roberts SE

    更新日期:2004-06-19 00:00:00

  • Mortality associated with moderate intakes of wine, beer, or spirits.

    abstract:OBJECTIVE:To examine the association between intake of different types of alcoholic drinks and mortality. DESIGN:Prospective population study with baseline assessment of alcohol intake, smoking habit, income, education, and body mass index, and 10-12 years' follow up of mortality. SETTING:Copenhagen city heart study,...

    journal_title:BMJ (Clinical research ed.)

    pub_type: 杂志文章

    doi:10.1136/bmj.310.6988.1165

    authors: Grønbaek M,Deis A,Sørensen TI,Becker U,Schnohr P,Jensen G

    更新日期:1995-05-06 00:00:00

  • Size at birth, maternal nutritional status in pregnancy, and blood pressure at age 17: population based analysis.

    abstract:OBJECTIVE:To assess the effect of size at birth, maternal nutrition, and body mass index on blood pressure in late adolescence. DESIGN:Population based analysis of birth weight corrected for gestational age, mother's weight before pregnancy and weight gain in pregnancy, obtained from the Jerusalem perinatal study, and...

    journal_title:BMJ (Clinical research ed.)

    pub_type: 杂志文章

    doi:10.1136/bmj.315.7106.449

    authors: Laor A,Stevenson DK,Shemer J,Gale R,Seidman DS

    更新日期:1997-08-23 00:00:00

  • Cost effectiveness of strategies to combat road traffic injuries in sub-Saharan Africa and South East Asia: mathematical modelling study.

    abstract:OBJECTIVE:To identify and estimate the population costs and effects of a selected set of enforcement strategies for reducing the burden of road traffic injuries in developing countries. DESIGN:Cost effectiveness analysis based on an epidemiological model. SETTING:Two epidemiologically defined World Health Organizatio...

    journal_title:BMJ (Clinical research ed.)

    pub_type: 杂志文章

    doi:10.1136/bmj.e612

    authors: Chisholm D,Naci H,Hyder AA,Tran NT,Peden M

    更新日期:2012-03-02 00:00:00

  • Work of a rehabilitation medicine service.

    abstract::The results of the work of the Edinburgh Rehabilitation Medicine Service in one year were evaluated. Over 1400 new patients were seen, of whom 525 were in hospital at the time. Patients most often referred were those who had had cardiovascular accidents, back pain, lower limb amputations, and head injuries and those c...

    journal_title:BMJ (Clinical research ed.)

    pub_type: 杂志文章

    doi:10.1136/bmj.297.6648.601

    authors: Roy CW,Arthurs Y,Hunter J,Parker S,McLaren A

    更新日期:1988-09-03 00:00:00

  • Cancer risk among users of oral contraceptives: cohort data from the Royal College of General Practitioner's oral contraception study.

    abstract:OBJECTIVE:To examine the absolute risks or benefits on cancer associated with oral contraception, using incident data. DESIGN:Inception cohort study. SETTING:Royal College of General Practitioners' oral contraception study. PARTICIPANTS:Directly standardised data from the Royal College of General Practitioners' oral...

    journal_title:BMJ (Clinical research ed.)

    pub_type: 杂志文章,多中心研究

    doi:10.1136/bmj.39289.649410.55

    authors: Hannaford PC,Selvaraj S,Elliott AM,Angus V,Iversen L,Lee AJ

    更新日期:2007-09-29 00:00:00

  • Amblyopia treatment outcomes after screening before or at age 3 years: follow up from randomised trial.

    abstract:OBJECTIVE:To assess the effectiveness of early treatment for amblyopia in children. DESIGN:Follow up of outcomes of treatment for amblyopia in a randomised controlled trial comparing intensive orthoptic screening at 8, 12, 18, 25, 31, and 37 months (intensive group) with orthoptic screening at 37 months only (control ...

    journal_title:BMJ (Clinical research ed.)

    pub_type: 临床试验,杂志文章,随机对照试验

    doi:10.1136/bmj.324.7353.1549

    authors: Williams C,Northstone K,Harrad RA,Sparrow JM,Harvey I,ALSPAC Study Team.

    更新日期:2002-06-29 00:00:00