bluuebunny/crossref_metadata_2025 huggingface dataset:
Effects of Previous Intake of Glucose on Postprandial Hyperglycemia in Type 2 Diabetics
Authors: GRILL V. , ADAMSON U. , VIKLUND M.
Published: August 2010

ABSTRACT Previous glucose improves subsequent glucose tolerance (the Staub‐Traugott effect) in normal man. We have investigated whether a small amount of glucose (5 g) given perorally 30 min before breakfast would improve postprandial hyperglycemia in type 2 diabetics (19 patients). Blood glucose was increased 30 min after glucose ingestion (from 7.6±0.4 to 8.7±0.4 mmol/1, p<0.001). Total glucose areas measured between the time of glucose ingestion and 180 min after breakfast were similar during test and control conditions (breakfast alone). Apparent differences between individuals with regard to the effects of previous glucose on hyperglycemia were further analyzed. Differences could not be explained by interexperimental variation since they persisted on repeated testing (3 patients). Differences were not correlated with age, sex, duration of diabetes, obesity, fasting blood glucose or the insulin responses evoked in the experiments. We conclude that a small amount of glucose before breakfast fails to ameliorate postprandial hyperglycemia in overt type 2 diabetics except in individual patients in whom, in turn, the effect is not directly related to insulin secretion.
Liver Affection in Iron Overload Studied with Serum Ferritin and Serum Aminotransferases
Authors: OLSSON K. SIGVARD , RITTER BERND , LUNDIN PER M.
Published: August 2010

ABSTRACT Liver dysfunction as measured by S‐ALAT activity was present in 72% of patients over 40 years of age with HLA‐related iron overload, mainly detected by laboratory screening. Liver dysfunction was correlated to the amount of iron stored (r=0.54, p<0.001). When iron was removed by phlebotomy, liver function returned to normal. S‐ALAT activity was closely correlated to serum ferritin concentration (r=0.73, p<0.001). Even a mild iron excess can affect hepatocytes and result in increased levels of ferritin and aminotransferases in serum. Patients with “transaminitis” should be investigated for iron overload.
Prevention of Recurrent Life‐threatening Ventricular Arrhythmias by Temporary Cardiac Pacing
Authors: PEKARSKY V. , GIMRIKH E. , KARPOV R. , POPOV S. , CHEKHOV A. , SAVENKOV G. , PEKARSKAYA M.
Published: August 2010

ABSTRACT Overdrive pacing has been applied in 26 patients to prevent frequent recurrent ventricular fibrillation (VF) and ventricular tachycardia (VT) occurring in the setting of ventricular extrasystole of 2–5 degrees graded by Lown. These patients had 3–47 recurrent attacks of VF and VT (11.4±2.4) which were not prevented with antiarrhythmic agents. Overdrive pacing was continued for 2–236 hours (21.3±3.7) and appeared to be effective in 23 (88.4%) of the 26 patients including those with prolonged QT intervals. Atrial pacing was more effective than ventricular overdriving and required stimulation at a slower rate. Antiarrhythmic therapy and overdrive pacing in combination were more effective than both used independently. Suppression of ventricular extrasystole and prevention of life‐threatening arrhythmias were achieved by increasing the heart rate by 23.2±4.5 beats/min.
Prediction of the Course of Graves' Disease after Medical Antithyroid Treatment
Authors: ESHØJ O. , KVETNY J. , MOGENSEN E. F. , BECH K. , BLIDDAL H.
Published: August 2010

ABSTRACT The course of thyrotoxicosis in 33 patients with Graves' disease was evaluated clinically and biochemically (free thyroxine index, serum triiodothyronine, thyroid stimulating antibodies, (TSAb), thyroid stimulating hormone binding inhibiting immunoglobulins (TBII)). Relapse of the disease was found to be correlated to anamnestic information of thyrotoxicosis among first degree relatives (predictive value 90%) and to concomitantly raised levels of TSAb and TBII at the start of treatment (predictive value 71%). Mean duration of treatment of patients with long‐lasting remission was 16.8 months. When comparing various information used to predict relapse of Graves' disease, anamnestic information of familial predisposition to thyrotoxicosis carries the highest predictive value.
Facial Skin Temperature in Chlorpropamide Alcohol Flush
Authors: JERNTORP PETER
Published: August 2010

ABSTRACT Objective methods to study the chlorpropamide alcohol flush (CPAF) have been inadequate. Determination of blood acetaldehyde has proved to be a promising method, but the analysis is difficult and time‐consuming. To measure the facial skin temperature is more handy. The results of these measurements can be presented as δT (skin temperature increase), %T (per cent of maximum possible temperature rise) or δMTCI (malar thermal circulation index) after calculations. The baseline skin temperature is accounted for in %T and δMTCI. Blood acetaldehyde determinations and placebo‐alcohol tests can be used to separate the CPAF reaction from alcohol flushing. Single dose CPAF tests including facial skin temperature measurements were performed in 133 type 2 (non‐insulin dependent) diabetics. Facial flush was observed in 42.9%. The specificity and sensitivity of all three skin temperature methods were high: 88.2, 85.5, 96.1%, and 89.5, 86.0, 86.0%, respectively. Skin temperature measurement, whether expressed as δT, %T or δMTCI, provides a method to study CPAF with high accuracy.
Factors Associated with Changes in Serum Cholesterol during a Community‐based Hypertension Programme
Authors: TUOMILEHTO JAAKKO , SALONEN JUKKA T. , NISSINEN AULIKKI
Published: August 2010

ABSTRACT A cohort of 1 019 male and 1 232 female hypertensives, aged 25–59 years, based on a random population sample, was followed for five years during a community‐based cardiovascular prevention programme. A small mean reduction in serum cholesterol level was found. The observed changes in casual serum cholesterol values were partly due to the regression to the mean. The reductions were most marked in elderly people and in those with high baseline serum cholesterol values. The partial regressions of the cholesterol change were computed in subgroups by age, sex and baseline serum cholesterol level. Changes in weight in men and in age in women were the strongest independent predictors of the change in serum cholesterol. Changes in dietary fat intake were also associated with the change in serum cholesterol. Only a small part of the total variation in the change in serum cholesterol was explained by the regression models. The results indicate that reduction of the serum cholesterol level among hypertensive persons, especially men, was caused by changes in their dietary habits.
The Relationship between QTc Changes and Nutrition during Weight Loss after Gastroplasty
Authors: RASMUSSEN LARS HERLUF , ANDERSEN TEIS
Published: August 2010

ABSTRACT Electrocardiograms, serum electrolytes, plasma concentrations of pre‐albumin and retinol‐binding globulin, and dietary intakes were analyzed in 22 women during weight loss after gastroplasty surgery for morbid obesity. QT interval corrected for heart rate (QTc) was prolonged (>0.44 sec) in 32% (95% confidence limits 14–55%) on one or more occasions. No clinical or electrocardiographic complications were seen. Occurrence of QTc prolongation was significantly (p<0.05) associated with protein intake below recommendation and with low plasma pre‐albumin concentrations. QTc prolongation was not associated with mineral intake and occurred in spite of normal serum levels of calcium (uncorrected and albumin‐corrected), magnesium, potassium and sodium. Because QTc prolongation may precede fatal arrhythmias, adequate protein intake is mandatory during weight reduction.
Acute Cardiovascular Effects of Intravenous Cimetidine
Authors: TÖTTERMAN KARL , KUPARI MARKKU , PAAKKARI ILARI , NIEMINEN MARKKU S.
Published: August 2010

ABSTRACT To assess the acute cardiovascular effects of cimetidine—a widely used histamine‐H(2)‐receptor antagonist—cuff arterial blood pressure, M‐mode echocardiogram of the left ventricle and systolic time intervals were recorded in 10 healthy volunteers before and after 200 mg of cimetidine or isotonic saline given intravenously in a double‐blind crossover manner. Neither echocardiograms nor systolic time intervals revealed any significant effects of cimetidine on the left ventricular performance. However, cimetidine decreased slightly the systolic arterial pressure. The maximal effect of cimetidine (7±1 mmHg, mean ± SEM) differed significantly from that of saline (3±1 mmHg, p<0.02). When compared with the pre‐injection level, the calculated total peripheral resistance decreased significantly after cimetidine (p<0.01), whereas saline induced no such change. We conclude that a bolus injection of cimetidine does not impair cardiac performance but may induce transient hypotension due to reduction of the total peripheral resistance. This reduction can explain the hypotensive effect of i.v. cimetidine reported in acutely ill patients.
Glucose Intolerance in Middle‐aged Subjects—a Cause of Hypertension?
Authors: CEDERHOLM JAN , WIBELL LARS
Published: August 2010

ABSTRACT At a health survey of 819 middle‐aged, 47–54‐year‐old, males and females in a Swedish urban area with a participation rate of 70%, the prevalence of glucose intolerance (GI) was 6.2%, 51 subjects (7.0% of females and 5.3% of males), as the result of two subsequent 75 g oral glucose tolerance tests according to the WHO criteria. In comparison with normoglycemic subjects from the same health survey, with both fasting and 2‐hour glucose values <5.0 mmol·I‐1, the GI group was characterized by higher mean relative body mass index, higher mean blood pressure and rate of hypertension, higher rate of low‐degree physical activity during leisure and had more often a family history of diabetes in first‐degree relatives. Smoking was less prevalent in GI subjects. Hypertension was more frequent in obese (relative body mass index (BMI) 120–150%) GI subjects than NGT subjects. Finally, comparison of all GI subjects with all normoglycemic subjects of the survey, with use of analysis of covariance, showed that mean systolic and diastolic blood pressures were higher in GI subjects, independently of age, BMI and also smoking.
Plasma Total Prekallikrein/Kallikrein Activity in Rheumatoid Arthritis with and without Amyloidosis
Authors: TEPPO ANNA‐MAIJA , PAKKANEN RAIMO , MAURY C.P. J.
Published: August 2010

ABSTRACT Following exposure to kaolin, plasma samples were assayed for total prekallikrein/kallikrein activity in 19 patients with rheumatoid arthritis (RA), 39 patients with RA complicated by amyloidosis, 13 patients with nonamyloid nephropathy and 54 healthy subjects. Increased total kallikrein activity was found in RA patients with amyloidosis and in patients with nonamyloid nephropathy. The concentrations of the plasma kallikrein inhibitors Cl‐inactivator and α2‐macroglobulin were normal in RA patients without amyloidosis, whereas they were increased in patients with amyloidosis as well as in patients with nonamyloid nephropathy. The results suggest that the increased activity of plasma kaolinstimulated kallikrein in RA patients with amyloidosis is due to the nephropathy per se and probably reflects increased levels of prekallikrein.
The Prognosis for Patients Referred with Suspected Acute Myocardial Infarction
Authors: ENGBY BIRGER , STRUNGE POUL , OLSEN JØRN
Published: August 2010

ABSTRACT. Engby B, Strunge P, Olsen J. (Department of Internal Medicine, Horsens Hospital, Horsens, Denmark.) The prognosis for patients referred with suspected acute myocardial infarction.

A follow‐up investigation of the prognosis of 381 patients admitted with suspected acute myocardial infarction (AMI) has been carried out in respect of later AMI or death. During hospitalization the patients were divided into groups with particular attention to patients with no demonstrable myocardial infarction but with ischaemic heart disease (non‐AMI) and patients with confirmed AMI. All patients were subjected to follow‐up for 43 months (range 37–54). The mortality from cardiovascular causes after four years was 26.2% of 130 non‐AMI patients and 25.8% of AMI patients. The majority of new infarctions were found in the AMI patients, but with even increase in both groups, 50% occurring within the first 12 months. The groups were studied with regard to earlier manifestations of ischaemic heart disease and heart failure during hospitalization, without any difference being observed. Due to the poor prognosis the question is raised whether non‐AMI patients as a group should be offered prophylactic therapy.
The Significance of ST and T Changes for the Development of Coronary Events in Patients with Acute Coronary Chest Pain, Treated in a Coronary Care Unit without Verified Acute Myocardial Infarction
Authors: LINDBERG KJELL , NYQUIST OLOF , EDHAG OLOF
Published: August 2010

ABSTRACT. Lindberg K, Nyquist O, Edhag O. (Cardiac Division of the Department of Internal Medicine, Karolinska Institute, Huddinge University Hospital, Huddinge, Sweden.) The significance of ST and T changes for the development of coronary events in patients with acute coronary chest pain, treated in a coronary care unit without verified acute myocardial infarction.

The one‐year prognosis for patients with a confirmed diagnosis of acute myocardial infarction (AMI) was compared with that of non‐AMI patients treated in the coronary care unit (CCU). The one‐year incidence of coronary events (CE) after discharge from CCU was 37% in the 51 AMI patients and 20% in the 81 non‐AMI patients. The one‐year mortality rates were 27 and 4%, respectively. Among the non‐AMI patients, well known risk factors such as hypertension, previous AMI, congestive heart failure, smoking, diabetes and hyperlipaemia were not more common in those who developed a CE. ST segment depression and T wave inversion, each of at least 0.1 mV, in three or more ECG leads were selective criteria for a high‐risk group with respect to CE. Preventive measures should be considered in this group of patients without verified AMI.
Post‐Myocardial Infarction Exercise Testing: Clinical Significance of a Left Ventricular Function Index and Ventricular Arrhythmias
Authors: SAUNAMÄKI K. I. , ANDERSEN J. D.
Published: August 2010

ABSTRACT. A predischarge exercise test was performed in a prospective series of 187 patients, less than 70 years old, with acute myocardial infarction. A survival analysis confirmed previous retrospective findings of a significantly increased long‐term mortality in patients with a low increase in the pressure‐rate‐product (PRP) and/or with major exercise‐induced arrhythmias. ST segment depression was without prognostic significance. By a graduated, quantitative re‐evaluation of the significance of exercise‐induced ventricular arrhythmias, an appropriate, significantly discriminating cutoff point for the frequency of solitary ventricular premature beats (VPBs) was found at two or more VPBs/min. Repetitive VPBs had an equal significance. The probability of 4.5‐year survival in patients with these arrhythmias and a low increase in PRP was 0.49 vs. 0.85 in patients with less frequent arrhythmias and with a high increase in PRP (p < 10‐6).
Effects of Hypoxia and Ischaemia on Coronary Vascular Resistance, A‐V Node Conduction and S‐A Node Excitation
Authors: Berne R.M. , Belardinelli L.
Published: August 2010

ABSTRACT. Hypoxia and ischaemia produce relaxation of the vascular smooth muscle of the resistance vessels in the myocardium. A low pH may contribute to the arteriolar dilatation but cannot account for the major response. In all likelihood the reduced pO2 acts indirectly by release of a vasodilator mediator rather than by a direct effect on the vascular muscle. Potassium release may account for a transient component of the vasodilation, but it appears that a major factor is the release of adenosine from the ischaemic tissue. Adenosine also appears to be responsible for slowing of the sinus rate and impaired A‐V conduction in myocardial ischaemia. These observations are of clinical significance because hypoxia‐induced A‐V block, such as may occur in inferior myocardial infarction, can be abolished by an adenosine antagonist such as aminophylline. In contrast, adenosine is also useful in the treatment of some cardiac arrhythmias. Supraventricular tachycardia, in which the A‐V node is involved in the re‐entrant pathway, is readily abolished in humans by the intravenous administration of small doses of adenosine.
Does β‐Blockade Provoke Intermittent Claudication?
Authors: LEPÄNTALO MAURI , AROMAA ARPO , KLAUKKA TIMO , LUKKARI ERJA
Published: August 2010

ABSTRACT. Intermittent claudication has been claimed to be a side‐effect of β‐adrenoceptor blocking drugs. The confounding effect of coronary heart disease has not been controlled in earlier studies. In this case‐control study, the cases were selected from a hospital material of patients with verified intermittent claudication and the controls from a nationwide health survey. The pool of potential cases and controls consisted of persons who had been treated with antihypertensives, but did not have coronary heart disease. The controls and cases were matched for age, sex, place of residence and time of examination. Comparison of current or previous use of β‐blocking drugs among our 55 case‐control pairs revealed no association between intermittent claudication and β‐blockade. β‐Blockade is not a risk factor for intermittent claudication.
Systemic Manifestations and Enzyme Studies in Sarcoidosis with Neurologic Involvement
Authors: OKSANEN V. , GRÖNHAGEN‐RISKA C. , FYHRQUIST F. , SOMER H.
Published: August 2010

ABSTRACT. The dissemination and activity of systemic disease was evaluated retrospectively in 50 patients with neurosarcoidosis, 24 of whom presented with neurologic symptoms. During follow‐up, five patients never developed detectable systemic disease. In 26 patients, sarcoidosis had previously been diagnosed, but in 11 (42%) of them the neurologic symptoms were initially not connected with this disease. During follow‐up, extraneural features were those of sarcoidosis in general. However, 23 patients (46%) had normal chest X‐ray on admission to neurologic examinations. Fourteen (35%) of 40 examined patients had ocular changes, 13 (33%) of 39 hypercalciuria and 13 (26%) of 50 skin manifestations. Serum angiotensin converting enzyme (ACE) was elevated in only 31 % of the patients. Measurable amounts of ACE were recorded in the cerebrospinal fluid from 13 of 17 examined patients. During follow‐up the activity of neurosarcoidosis seemed to be linked to the course of systemic disease in general.
Correction of Respiratory Acidosis and Transient Hypomagnesemia
Authors: KRISTIANSEN VIGGO B. , LARSEN JOHN , NIELSEN THYGE L. , STORM TOMMY L.
Published: August 2010

ABSTRACT.Four elderly patients with established chronic obstructive airways disease were admitted with a days' to weeks' history of increasing dyspnea. Acute respiratory acidosis was diagnosed and mechanical ventilation instituted. A few hours after initiation of treatment, arterial pH was normal in all patients, but serum magnesium concentrations decreased over the next 1–3 days. Thereafter, a spontaneous normalization was seen. It is suggested that the transient hypomagnesemia is due to correction of the acidosis per se.
Prevalence and Incidence of Moderate and Severe Chronic Renal Failure in South‐western Finland, 1973–76
Authors: PASTERNACK A. , KASANEN A. , SOURANDER L. , KAARSALO E.
Published: August 2010

ABSTRACT. In an area of south‐western Finland with 195 000 inhabitants and a highly centralized health care system, all subjects with elevated serum creatinine (≥230 μmol/1) were registered on the basis of data collected from all hospitals and clinical laboratories of the region. The prevalence of chronic renal failure (S‐creatinine ≥230 μmol/1) was 67 per 100 000 inhabitants and that of severe chronic renal failure (S‐creatinine ≥500 μmol/1) 12.3/105. The annual incidence of chronic renal failure (S‐creatinine ≥230 μmol/1) was 31.7 per 100 000 inhabitants and that of severe chronic renal failure (S‐creatinine ≥500 μmol/1) 11.9/105. Age‐specific prevalences and incidences rose progressively with age and were very high in the aged population. Chronic interstitial nephritis, in a broad sense, was the most common cause of chronic renal failure, and it was related to analgesic abuse in about half of the cases. Eleven of 68 subjects entering the study with a serum creatinine ≥500 μmol/1 had no previous knowledge of their chronic renal disease.
Evidence for the Presence in Human Plasma of Lecithin: Cholesterol Acyltransferase Activity (β‐LCAT) Specifically Esterifying Free Cholesterol of Combined Pre‐β‐ andβ‐Lipoproteins:Studies of Fish Eye Disease Patients and Control Subjects
Authors: CARLSON LARS A. , HOLMQUIST LEIF
Published: August 2010

ABSTRACT.The present study was undertaken to test our hypothesis that two different lecithin: cholesterol acyltransferase (LCAT) activities exist in normal human plasma, one denotedα‐LCAT esterifying the free cholesterol of high density lipoproteins (HDL) and the other denotedβ‐LCAT acting on the free cholesterol of very low (VLDL) and low (LDL) density lipoproteins. Plasmas depleted of HDL were obtained by means of preparative ultracentrifugation. Incubation at 37°C of these plasma fractions from control subjects and patients with fish eye disease resulted in esterification of the remaining free cholesterol of combined VLDL and LDL (pre‐β‐ andβ‐lipoproteins) in the HDL depleted plasmas. The shapes of the cholesterol esterification rate curves were similar for whole and HDL depleted plasmas from both control subjects and fish eye disease patients. In crosswise mixed incubation experiments with isolated combined VLD and LDL and total lipoprotein depleted plasma from a control subject and a patient with fish eye disease, respectively, esterification of free cholesterol occurred. Incubation of isolated total lipoproteins in plasma from a patient with LCAT deficiency mixed with total lipoprotein depleted plasma from a fish eye disease patient as a source of LCAT caused cholesterol esterification but did not result in normalization of the LCAT deficiency HDL particles, while the amount of normal‐sized LDL particles increased. The present results support the hypothesis thatβ‐LCAT exists in normal human plasma.
Diabetes Mellitus and Intermittent Claudication: Relation between Peripheral Vascular Complications and Location of the Occlusive Atherosclerosis in the Legs
Authors: JONASON TOMMY , RINGQVIST IVAR
Published: August 2010

ABSTRACT. Forty‐seven diabetic patients with intermittent claudication without rest pain or gangrene at the initial examination were followed up over a six‐year period. They were compared with 224 non‐diabetic patients with intermittent claudication. The cumulative proportions of patients with gangrene were 31 % in the diabetic group and 5% in the control group (p < 0.001). The corresponding figures for rest pain and/or gangrene were 40 and 18%, respectively (p < 0.001). The frequency of aorto‐iliac and multiple stenoses was higher among diabetic patients who developed peripheral vascular complications (rest pain, gangrene) than in the control group. The frequency of multiple stenoses was also higher in the former subgroup than in diabetics without such complications. In conclusion, the degree of involvement of the large vessels in occlusive arterial disease influences the risk of development of peripheral vascular complications in diabetic patients with intermittent claudication.
Effect of Somatostatin in Necrolytic Migratory Erythema of Glucagonoma
Authors: ELSBORG LARS , GLENTHØJ ANDERS
Published: August 2010

ABSTRACT. A 63‐year‐old woman with necrolytic migratory erythema associated with a glucagonoma in the pancreas is described. The diagnosis was suggested on the basis of a characteristic lesion in skin biopsy. Infusion of somatostatin (25 μg/h) for 48 hours was followed by a rapid and almost complete healing of the skin eruptions. Serum glucagon was depressed during infusion. No significant changes in plasma glucose were detected. As the patient experienced a cramp‐like sensation after cessation of somatostatin infusion, a tail‐off period in the infusion program is advocated. The pathogenesis of necrolytic erythema in glucagonoma is discussed.
The First Human Case of Domestic Q Fever in Sweden
Authors: KINDMARK C.‐O. , NYSTRÖM‐ROSANDER C. , FRIMAN G. , PEACOCK M. , VENE S.
Published: August 2010

ABSTRACT. A case of Q fever in a 56‐year‐old man is reported. The patient had visited Mallorca six months prior to the present disease. Except for that he had not been outside Sweden for several years, thus being the first known case of Q fever acquired in this country.
Converting Enzyme Inhibition in Mild and Moderate Essential Hypertension: I. Acute Effects on Blood Pressure, the Renin‐Angiotensin System and Blood Bradykinin after a Single Dose of Captopril
Authors: RASMUSSEN STEN , LETH ARNE , IBSEN HANS , NIELSEN META DAMKJÆR , NIELSEN FINN , GIESE JØRN
Published: August 2010

ABSTRACT. The acute effects of 25 mg captopril on blood pressure, heart rate, components of the renin‐angiotensin system and blood concentration of bradykinin were followed in a single‐blind placebo study of untreated (group A, n = 15) and thiazide‐treated (group B, n = 13) patients with mild or moderate essential hypertension. A drug‐related fall in blood pressure was seen in both groups. The blood pressure reduction was more marked in group B than in group A. Heart rate remained unchanged. Plasma concentrations of angiotensin II decreased significantly with concurrent increases in plasma concentrations of renin and angiotensin I, indicating the in vivo inhibition of converting enzyme. Blood concentrations of bradykinin showed no systemic changes. The magnitude of blood pressure reduction was correlated both with the pretreatment levels and the concurrent decreases in plasma angiotensin II. Inhibition of angiotensin II formation can explain a large part of the acute hypotensive pharmacological action of captopril. Other vasoactive systems may be involved. The kallikrein‐kinin system does not appear to participate as indicated by the unchanged concentrations of kinin in blood.
High‐dose Prenalterol inβ‐Blockade Intoxication
Authors: LINDVALL K. , PERSONNE M. , SJÖGREN A.
Published: August 2010

ABSTRACT.This study presents a case ofβ‐blocker intoxication due to massive overdose of metoprolol (7.5 g). Prenalterol in a dose of 420 mg was given as antidote, in combination with epinephrine in intermittent doses. Resuscitation was performed during 4 hours because of mechanical asystole. The patient regained health in 24 hours after further repeated doses of 30 mg prenalterol. Prenalterol is valuable in the management of toxic doses ofβ‐blocking drugs, and a titration to extremely high doses of prenalterol might be necessary.
The Gemfibrozil Study*
Authors: Manninen Vesa
Published: August 2010

ABSTRACT.In clinical studies in dyslipidaemic patients gemfibrozil has produced falls in LDL and VLDL of 10—20% and 30—50%, respectively, but a rise in HDL of 15—25%. Gemfibrozil also produces increases in both Apo AI and AII, and in kininogen and prekallikrein. Side‐effects are not a major problem. The Helsinki Heart Study has compared the effects of gemfibrozil with those of placebo in a group of 4080 dyslipidaemic Finnish men aged 40—55. The results are not yet available but there is reason to believe that the probable level of coronary risk reduction will be at least as great as that reported by the Lipid Research Clinics Study Coronary Primary Prevention Trial (LRC‐CPPT).
Thyroid Function Tests in Elderly Finnish Men
Authors: NISSINEN AULIKKI , KIVELÄ SIRKKA‐LIISA , PEKKANEN JUHA , PITKÄNEN LAHJA , PUNSAR SVEN , KAARSALO ESKO , PUSKA PEKKA
Published: August 2010

ABSTRACT Serum total thyroxine (T4), triiodothyronine (T3) and thyrotrophin (TSH) levels were determined among 65‐84‐year‐old Finnish men living either in eastern Finland (n=309) or in southwestern Finland (n=389). The mean value for serum total T4 was 112.2±23.0 nmol/1 in eastern Finland and 111.3±21.9 nmol/l in southwestern Finland. The mean value for serum T3 was 1.76±0.30 nmol/1 in eastern Finland and 1.75±0.46 nmol/1 in southwestern Finland. Serum TSH values showed the mean for men from eastern Finland to be 3.25±2.29 mU/1 and the mean for men from southwestern Finland to be 3.11±1.83 mU/1. No differences were found in the means of the thyroid function tests between the two areas. Serum T4 levels were not related to age. Serum T3 values fell with age. In both areas, serum TSH levels were highest among men 70‐74 years of age.
Effects of Dietary Supplementation with n‐6 and n‐3 Long‐chain Polyunsaturated Fatty Acids on Serum Lipoproteins and Platelet Function in Hypertriglyceridaemic Patients
Authors: BOBERG MERIKE , VESSBY BENGT , SELINUS INGEMAR
Published: August 2010

ABSTRACT Twenty‐seven patients with hypertriglyceridaemia were given dietary supplementation either with evening primrose oil rich in gammalinolenic acid (GLA, 18: 3 n‐6) (n=13) or a marine oil concentrate containing n‐3 fatty acids (n=14) in a double‐blind cross‐over design during 8+8 weeks with olive oil as placebo. During GLA supplementation, increases in GLA and dihomogammalinolenic acid (20: 3 n‐6) were found in plasma lipid esters and platelet phospholipids, whereas platelet function and serum lipoproteins were unaffected. During supplementation with n‐3 fatty acids there was a significant decrease in triglycerides in all lipoprotein fractions with a slight increase in high density lipoprotein and low density lipoprotein cholesterol. A marked increase in the long‐chain n‐3 fatty acids was found both in plasma and platelets, mainly at the expense of the n‐6 fatty acids. No pronounced effects on platelet reactivity could be demonstrated. Our results confirm a triglyceride‐lowering effect of n‐3 fatty acids, whereas no such effect of GLA could be demonstrated.
The Effect of Sodium Depletion and Potassium Supplementation on Vasopressin, Renin and Catecholamines in Hypertensive Men
Authors: OS INGRID , KJELDSEN SVERRE ERIK , WESTHEIM ARNE , JACKSON MARY BETH , ÅKESSON INGVAR , FREDERICHSEN PER , EIDE IVAR , LEREN PAUL
Published: August 2010

ABSTRACT Seventeen 50‐year‐old hypertensive men (157±4/110±2 mmHg, mean ± SE) were given low sodium diet for one week, which was supplemented with potassium the following week. The urinary Na+/K+ excretion ratio changed from 2:1 to 1:5 and 1:12, respectively, during dietary intervention. Arterial plasma vasopressin decreased by 3.4±1.7 ng/l (0.05>p<0.10) and urinary excretion of vasopressin was reduced by nearly 50% (p<0.001) during sodium depletion, while plasma noradrenaline increased by 38% (p<0.001) and plasma dopamine showed an increase by 58% (p<0.001). Plasma renin concentration increased four‐fold during sodium depletion (p<0.001). With combined salt depletion and potassium supplementation, arterial plasma vasopressin decreased by 9.5±4.0 ng/l (p<0.05) compared to control. Urinary excretion of vasopressin together with plasma noradrenaline and dopamine were unchanged during the second week. The reduction of blood pressure was most marked during the first week (143±3/103±2 mmHg, p<0.05), but continued to fall also during the second week. Thus, during sodium restriction in middle‐aged hypertensive men, blood pressure reduction occurs concomitantly with inhibited vasopressin release, despite enhanced renin and catecholamine release. Potassium supplementation during sodium restriction induces only minor changes in these variables.
Peripheral Arterial Disease—Natural Outcome
Authors: LASSILA RIITTA , LEPÄNTALO MAURI , LINDFORS OLOF
Published: August 2010

ABSTRACT Three hundred and twelve patients with peripheral arterial disease were followed up for 8 3/4 years or more (maximum 11 3/4 years) to assess the natural history of the disease and factors determining its outcome. Of the 312 patients, 188 (69%) died during the follow‐up, 68% of the deaths having cardiovascular causes. The 10‐year relative cumulative survival rate was 0.61 for males and 0.48 for females. The role of smoking as a risk factor could not be analysed without bias. In addition to known risk factors diabetes mellitus, cerebrovascular disease and coronary heart disease, the degree of peripheral arterial disease itself also proved to be a risk factor among men. The expected life lost for men with intermittent claudication was 20%, but 44.3% for men with advanced lower limb ischaemia (p<0.01). This difference could not be explained by the well‐known association of advanced ischaemia and diabetes mellitus. The present results therefore suggest that the state of advanced ischaemia indicates larger involvement of the whole of the arterial tree and predicts fatal cardiovascular events among these patients.
Serum Amyloid A Protein in Acute Myocardial Infarction
Authors: MARHAUG G. , HÅRKLAU L. , OLSEN B. , HUSBY G. , HUSEBEKK A. , WANG H.
Published: August 2010

ABSTRACT Tissue injury including myocardial infarction leads to a variety of changes in plasma proteins commonly referred to as “the acute phase response”. In this report the concentrations of serum amyloid A protein (SAA) were measured serially in 6 patients with myocardial infarction and 4 with angina. SAA was found to be increased in all patients with infarction, but in no patients with angina. Significantly increased SAA levels were detected 12 hours after the peak level of creatine kinase, and the concentrations of SAA seemed to correlate to the amount of damaged tissue. The SAA‐response was both faster and more extensive than the response of C‐reactive protein (CRP), but the correlation between SAA and CRP was very good.
Platelet Number and Volume during Myocardial Infarction in Relation to Infarct Size
Authors: GLUD TORBEN , SCHMIDT ERIK BERG , KRISTENSEN STEEN DALBY , ARNFRED TERKEL
Published: August 2010

ABSTRACT Platelet number and mean platelet volume (MPV) were measured in 100 patients with acute chest pain, 41 with acute myocardial infarction (AMI), 33 with angina pectoris (AP) and 26 with non‐coronary event (NCE), and compared with 21 controls. We found no significant difference in platelet count on admission in the patient groups, but it was lower compared with controls. There were no significant differences in MPV between the patient groups nor between patients and controls. Thirty patients with AMI were followed for 10 days and showed an initial 12% fall in platelet count followed by a 36% increase. Initially there was an increase in MPV (2%) followed by a fall (8%). The fall in platelet count and increase in MPV correlated with infarct size (maximum activity of lactate dehydrogenase (LDH)) and might reflect consumption of platelets. The precise role of platelets in the process of infarction is still unknown.
Plasma Concentrations of Complement Split Product C3d and Immune Complexes after Procainamide Induced Production of Antinuclear Antibodies
Authors: BRANDSLUND I. , IBSEN H. H. W. , KLITGAARD N. A. , SVEHAG S.‐E. , SIMONSEN E. , DIEDERICHSEN H.
Published: August 2010

ABSTRACT Seventeen patients treated with procainamide for cardiac ventricular arrhythmias were followed for up to 40 weeks. Immunological data as a clue to developing the systemic lupus erythematosus (SLE)‐like syndrome was emphasized. Ten patients developed antinuclear antibodies (IgG or IgM), but no increase in the plasma concentration of the complement split product C3d or immune complexes, measured by two different methods, was demonstrated. This finding is in contrast to the high levels of both C3d and immune complexes in SLE. The discrepancy may be caused by a lack of immune complex mediated complement activation by the procainamide induced antibodies, or may be due to a difference in severity of disease. The acetylator phenotype of the patients was determined but due to the low frequency of fast acetylators no comparison of the immunological response of the two phenotypes could be done.
Epidemiology of Diabetes Mellitus in Sweden
Authors: ÖSTMAN J. , ARNQVIST H. , BLOHMÉ G. , LITHNER F. , LITTORIN B. , NYSTRÖM L. , SANDSTRÖM A. , SCHERSTÉN B. , WALL S. , WIBELL L.
Published: August 2010

ABSTRACTAll newly diagnosed cases of diabetes mellitus aged 15–34 years in Sweden, where the population in this age interval is about 2.3 million, were registered on standardized forms. During 1983, the first year of the study, there were 311 males and 161 females, excluding 280 with gestational diabetes. The annual incidence of diabetes was 26.2 per 100000 in males and 14.2 in females. The respective figures for type I were 18.5 and 10.1, and for type II 5.7 and 2.9. The incidence of type I diabetes was similar for the four age groups (15–19, 20–24, 25–29, 30–34 years), while for type II it was highest in the oldest group. Types I and II, but not the sexes, differed as regards the cumulative distribution curves of the maximum blood glucose concentration during the first two weeks after diagnosis. The present incidence of diabetes in Sweden is higher, particularly in males than the rates for similar age groups in Oslo (1925–64) and Denmark (1970–77).
An Evaluation of Ultrafiltration as Treatment of Therapy‐resistant Cardiac Edema
Authors: FAUCHALD PER , FORFANG KOLBJØRN , AMLIE JAN
Published: August 2010

ABSTRACT. In six patients with therapy‐resistant cardiac edema, ultrafiltration on two consecutive days removed on an average 7750 ml fluid and reduced body weight by 7.3 kg. A difference between the mean ultrafiltration rate (17.4 ml/min) and the calculated plasma refilling rate (12.7 ml/min) led to a reduction in plasma volume during treatment together with an increase in plasma colloid osmotic pressure. Systemic blood pressure, heart rate and cardiac output were unchanged during ultrafiltration while systemic vascular resistance increased and pulmonary capillary wedge pressure and right atrial pressure decreased significantly. No complications were recorded during or after treatment. Ultrafiltration is a safe method of fluid removal in patients with therapy‐resistant cardiac edema and can be used as preparation for cardiac catheterization or surgery.
Long‐Term Survival in Acute Leukemia
Authors: EVENSEN STEIN A. , STAVEM PER
Published: August 2010

ABSTRACT. An intermittent combination chemotherapy program was initiated in 1971–79 in 172 patients, aged 15–59 years, with acute leukemia (131 myelogenous (AML) and 41 lymphoblastic (ALL)). Sixteen patients with AML and 6 with ALL have survived for more than 5 years. These long‐term survivors represent 24% of AML and 18% of ALL patients who obtained complete remission. Twelve patients (10 AML and 2 ALL) are in continuous first remission 5.5–13.5 years after diagnosis. Occasional late relapses up to 9 years after diagnosis make it impossible to declare any individual patient cured.
Cardiac Amyloidosis
Authors: LEINONEN HANNU , POHJOLA‐SINTONEN SINIKKA
Published: August 2010

ABSTRACT. Two male patients with primary cardiac amyloidosis are described. Patient 1 presented with typical effort angina pectoris with no ischemic electrocardiographic changes and a normal coronary angiogram. At necropsy, a severe diffuse, intravascular amyloid deposition was observed in the intramural coronary arteries. In patient 2 the presenting symptom was congestive heart failure with echocardiographic evidence of asymmetric septal hypertrophy and pericardial effusion. Technetium‐99m pyrophosphate scintigraphy showed diffuse myocardial uptake, and the diagnosis of cardiac amyloidosis was confirmed in the postmortem examination. The diagnostic and therapeutic problems associated with cardiac amyloidosis are discussed in the light of these case reports.
The Skaraborg Hypertension Project
Authors: RÅSTAM LENNART , BERGLUND GÖRAN , ISACSSON SVEN‐OLOF , RYDÉN LARS
Published: August 2010

ABSTRACT. The prevalence of hypertension in the age group 40–69 in the County of Skaraborg, Sweden (265 000 inhabitants) was estimated using diagnostic criteria commonly accepted in Sweden in recent years. The prevalence was higher than expected (16%) and most of the patients (80%) were previously identified and undergoing treatment. The quantitative aspect of hypertension was even more impressive in the ages above 69 years. Eighteen per cent of the men and 33 % of the women aged 75 years were on antihypertensive medication. An unexpectedly large proportion of the population had a borderline pressure requiring further follow‐up (16%). It is concluded that quantitative aspects must be taken into consideration when planning hypertension care and deciding diagnostic criteria.
Body Composition, Intraerythrocyte Sodium Content, Volume Regulation and Blood Pressure during Moderate Sodium Restriction in Hypertensive Men
Authors: FAGERBERG BJÖRN , ISAKSSON BJÖRN , HERLITZ HANS , ANDERSSON OVE K.
Published: August 2010

ABSTRACT. Eleven moderately obese middle‐aged male outpatients with untreated mild hypertension reduced their sodium intake by about 120 mmol per day during 4–6 weeks. Diastolic blood pressure was then significantly reduced in comparison with a matched control group. The reduction of urinary sodium excretion was significantly correlated to the change in mean arterial pressure. Mean body mass showed a small significant decrease, although there were no significant changes in total body water or body fat as determined from measurements of 40K and tritiated water. Nor did mean extracellular water or plasma volume (Evan's blue) show any significant change. The decrease in urinary sodium excretion was associated with increases in plasma renin activity and urinary aldosterone excretion, while a sympathetic nervous natriuretic index (urinary dopamine to noradrenaline excretion ratio) decreased. The low sodium diet period was followed by a period of energy reduction as well as sodium restriction for 15 weeks. Mean body mass was then reduced by about 8 kg. The systolic but not the diastolic blood pressure showed a significant decrease. The intraerythrocyte content of water, sodium and potassium did not change significantly during any of the diet periods. We conclude that moderate sodium restriction lowered the blood pressure and affected the renin‐aldosterone and sympathetic nervous system to retain sodium which might explain the constancy of the plasma volume.
Self‐poisoning with Theophylline
Authors: RYGNESTAD TARJEI , WALSTAD ROLF A. , DAHL KETIL
Published: August 2010

ABSTRACT. A heavy smoking male patient with moderate to severe theophylline poisoning is presented. Repeated doses of oral charcoal were given in addition to usual supportive treatment. During this treatment the elimination half‐life of the drug (T ½) was 2 hours. The toxic symptoms disappeared rapidly when the serum concentration was reduced to the therapeutic concentration range. T ½. was approximately 24 hours in the same patient in a steady state study without oral charcoal treatment. Repeated doses of oral charcoal seem to increase theophylline elimination and should be administered in moderate to severe theophylline poisoning in addition to the usual supportive treatment and correction of metabolic disturbances.
Diagnostic Potential of Urinary Enzymes and β2‐Microglobulin in Acute Urinary Tract Infection
Authors: SANDBERG T. , BERGMARK J. , HULTBERG B. , JAGENBURG R. , TROLLFORS B.
Published: August 2010

ABSTRACT. Urinary excretions of β2‐microglobulin (β2M), N‐acetyl‐β‐D‐glucosaminidase (NAG), alanine aminopeptidase, β‐glucuronidase, acid and neutral α‐glucosidase as indicators of proximal tubular dysfunction were measured in patients with acute upper and lower urinary tract infection (UTI) and fever of non‐renal origin. The sensitivity of β2M was 67% and of NAG 49% as assessed in more than 100 episodes of acute pyelonephritis. Combined use of β2M and NAG increased the sensitivity to 75%. The degree of β2‐microglobulinuria and enzymuria was comparable in patients with acute pyelonephritis and fever due to non‐renal infections. The excretion of β2M and the various enzymes was too variable and unpredictable in individual cases to be useful as diagnostic indicator. In localizing an acute UTI, tests for proximal tubular dysfunction seem to be of no more clinical value than properly measured body temperature.
Thermogenesis with Relation to Exercise and Exercise‐training
Authors: LEBLANC JACQUES
Published: August 2010

ABSTRACT. Exercise‐training at environmental temperatures outside the thermal neutral zone, causes thermoregulatory adaptive reactions. In the heat, sweat efficiency is enhanced thus reducing the incidence of hyperthermia while in the cold discomfort and danger of frostbite are minimized by an improved cutaneous circulation specially in the extremities. Over long periods of time exercise does not affect thermogenesis except when refeeding. It is suggested that the reduced postprandial heat production reported in exercise‐trained subjects is related to changes in nutrient metabolism which in turn could be related to insulin and norepinephrine modified actions.
Physical Activity, Other Life‐style Patterns, Cardiovascular Disease and Longevity
Authors: PAFFENBARGER RALPH S. , HYDE ROBERT T. , HSIEH CHUNG‐CHENG , WING ALVIN L.
Published: August 2010

ABSTRACT.Longitudinal study of 16936 Harvard alumni, followed for life‐style experiences as related to cardiovascular disease (CVD) and longevity, identified 572 first coronary heart disease (CHD) attacks, 1962–1972, and 1413 all‐cause deaths, 1962–1978. Men expending 8.4+ MJ (2000+ kcal) per week in walking, stair‐climbing, and sports play were at 39% lower risk of developing CHD than less active classmates. Attributable risk estimates suggested: there might have been 16% fewer CVD deaths in the alumni population if every man had exercised 8.4+ MJ per week; 25% fewer from total cigarette abstinence; 9% fewer from abolition of hypertension; 6% fewer with less obesity; and 11 % fewer CVD deaths in the absence of parental CHD. Discounting the influence of blood pressure status, cigarette habit, net weight gain since college, and parental history of early death, the more active alumni (39 % of the population) are estimated to have lived on average one and one‐quarter years longer than less active men.