bluuebunny/crossref_metadata_2025 huggingface dataset:
BLOOD PRESSURE AND RESPONSE TO “STRESS” IN 11–16 YEAR OLD CHILDREN
Authors: Svensson Anders , Hansson Lennart
Published: August 2010

ABSTRACT. Blood pressure at rest and cardiovascular response to “stress” were studied in 27 girls and 33 boys 11–16 years old. One group (HT, n = 23) had hypertensive mothers with a previous hypertensive pregnancy, another group (NT, n = 20) had normotensive mothers with a previous hypertensive pregnancy and the control group (C, n = 17) had normotensive mothers with normotensive pregnancies. Resting blood pressure was 124/71 mmHg (HT), 117/67 mmHg (NT) and 112/65 mmHg in the 3 groups. Systolic pressure was significantly different in all 3 groups (p < 0.05 ‐ p <0.001).

Responses to noise stimulation (100 dBA) were identical in all groups with increases in diastolic and mean arterial blood pressure and cardiac output. During a video game session increases in blood pressure and heart rate were equal in the groups but during physical exercise a slight decrease in diastolic blood pressure was seen in the NT and C groups only.

Differences in blood pressure in children with varying maternal history of hypertension do not seem to reflect alterations in the cardiovascular response pattern to “stress”.
ANGIOTENSIN II NATRIURESIS AND ANTINATRIURESIS: ROLE OF RENAL ARTERY PRESSURE, RENAL HEMODYNAMICS, AND TUBULAR REABSORPTION.
Authors: Olsen Margrethe E. , Hall John E. , Montani Jean‐Pierre , Guyton Arthur C.
Published: August 2010

ABSTRACT. The aim of this study was to determine the role of changes in renal artery pressure (RAP), renal hemodynamics, and tubular reabsorption in mediating the natriuretic and antinatriuretic actions of angiotensin II (AII). In anesthetized dogs, endogenous AII formation was blocked with SQ‐14225 and AII was infused i.v. at rates of 5–1215 ng/kg/min while RAP was either servo‐controlled at the normal level or permitted to increase. When RAP was servo‐controlled to prevent a rise i RAP, AII infusion at all rates from 5–1215 ng/kg/min decreased urinary sodium excretion (UNa V) and fractional sodium excretion (FENa), while increasing fractional reabsorption of lithium (FRLi), an index of proximal tubule fractional sodium reabsorption and distal fractional sodium reabsorption (FRDNa): When RAP was permitted to increase, AII infusion rates up to 45 ng/kg/min decreased UNa V, and FENa, while increasing FRLi and FRDNa However, at 135 ng/ Kg/min and above UNa V, and FENa, increasing while FRLi and FRDNa decreased when RAP was allowed to rise, even though RBF and FF were not substantially different from the values observed when RAP was servo‐controlled. Filtered sodium load was slightly higher when RAP was permitted to increase during AII infusion, compared to the dogs in which RAP was servocontrolled, although the differences were not statistically significant. Thus, even very large doses of AII cause antinatriuresis when RAP was prevented from increasing. The natriuretic effect of high dose of AII is caused by increased RAP which decreases fractional sodium reabsorption in proximal and distal tubules and causes slight increases in sodium delivery to the tubules.
Evidence of Myocardial Ischaemia in Patients with Chest Pain Syndromes and Normal Coronary Angiograms
Authors: Virtanen K. S.
Published: August 2010

ABSTRACT. Patients with chest pain syndromes and normal coronary angiograms were studied with a new set of methods that included thermodilution coronary sinus blood flow and coronary dye dilution curves with special computer analysis, oxygen and lactate determinations, thallium scannings, atrial pacing and dipyridamole tests.

The following observations and conclusions were made:

Patients with cardiac hypertrophy have a reduced circulating coronary blood volume in relation to the left ventricular mass; this may play a role in patients' vulnerability to ischaemia.

During pacing‐induced angina a significant imbalance between oxygen supply and demand can be demonstrated in patients with »syndrome X».

Dipyridamole‐induced chest pain as a result of myocardial ischaemia seems to occur in patients with normal coronary arteries.

Marked ischaemia evidenced by a regional intensity reduction of 25% or more in thallium scans results in a significant increase in coronary volume. This is obviously due to mobilization of reserve vasculature as a response to ischaemia. A reduction in the ratio of myocardial oxygen supply to demand was demonstrated even in connection with milder defects, the regional intensity reduction being as low as 12.5%.
The Fatty Acid Composition of 12 North‐European Fish Species
Authors: PUUSTINEN TAPIO , PUNNONEN KARI , UOTILA PEKKA
Published: August 2010

ABSTRACT. Cardiovascular diseases among Greenland Eskimos are rare because their diet is rich in fatty fish and marine mammals. The beneficial effect of the fish diet appears to be mediated, at least in part, by the high amount of eicosapentaenoic acid in fish. We investigated the total lipid amount and fatty acid composition of 12 commonly eaten North‐European fish species. Most of the detected fatty acids were unsaturated, and the content of eicosapentaenoic acid varied usually between 6 and 16%. The amount of total lipid varied between 3.5 and 216 mg/g wet tissue. The total amount of lipid in different fish species seems to be more important than the respective fatty acid composition when considering which fish should be especially beneficial in the diet. Herring, salmon, Baltic herring, turbot and trout seem to contain most abundantly eicosapentaenoic acid.
Demonstration of Circulating Immune Complexes by the Indirect Leucocyte Phagocytosis Test in Chronic Inflammatory Bowel Disease: Relation to Results of a Standard Complement Consumption Assay
Authors: ELMGREEN J. , WIIK A. , NIELSEN H. , NIELSEN O. H.
Published: August 2010

ABSTRACT. Circulating immune complexes were studied in untreated Crohn's disease (CD) and ulcerative colitis (UC) by leucocyte phagocytosis. Neutrophils from normal donors took up large immunoglobulin‐containing inclusions from 14 of 15 CD sera, 3 of 15 UC sera (p < 0.002) and from none of 15 reference sera from healthy volunteers (p < 0.002). In contrast, inclusions could not be demonstrated on direct microscopic investigation. Our study confirms the presence of circulating immune complexes in Crohn's disease. Predominance of IgG‐containing complexes in this condition is consistent with a mucosal origin. Discrepant results obtained by direct examination and by incubation of sera from patients with normal test neutrophils suggest a defective immune complex phagocytosis in CD. In consistency with this possibility, control experiments revealed a markedly decreased complex uptake by neutrophils of CD patients in vitro.
Carbamazepine Therapy in Restless Legs: Discrimination between Responders and Non‐responders
Authors: LARSEN S. , TELSTAD W. , Sørensen Ø. , THOM E. , STENSRUD P. , NYBERG‐HANSEN R.
Published: August 2010

ABSTRACT. One hundred and seventy‐four patients suffering from restless legs were included in a double‐blind trial. Eighty‐four patients were treated with carbamazepine (CBZ) and 90 with placebo. Discrimination analysis was carried out in order to characterize the patients who did not benefit from the treatment. Patients treated with CBZ were divided into responders and non‐responders. A discriminant function classified 15 out of 19 actual non‐responders as non‐responders and 60 out of 65 actual responders as responders. By using the “leaving‐one‐out” technique, 14 of the non‐responders and 57 of the responders were still correctly classified. The probability of erroneously classifying a patient increased from about 10 to 15% by this correction. The discriminant function classified approximately 80% of the patients in the placebo group as responders to CBZ.
Plasma Exchange in the Treatment of Heterozygous Familial Hypercholesterolaemia
Authors: VAN DE WIEL A. , KRUISWIJK T. , DE GRUIJTER A. J. , HART H. CH. , IMHOF J. W.
Published: August 2010

ABSTRACT. Five patients with heterozygous familial hypercholesterolaemia, whose response to diet and medication was inadequate, received additional treatment with plasma exchange (PE). Two and a half to three liters of plasma were replaced by a 5 % albumin solution once every 3 weeks. Treatment with diet and cholestyramine was continued. This resulted in a reduction of serum total cholesterol (Tot‐c) by 21.8–52.2% compared to pretreatment values. Normocholesterolaemia was not achieved. Since the mean Tot‐c curve after PE exceeded the upper limit of the normal range approximately 10 days after exchange, the PE frequency was increased to once every 10 days. Tot‐c was reduced by 42.6–57.5% and normocholesterolaemia was achieved in most cases. We conclude that normocholesterolaemia can be achieved by treatment which includes PE in all patients with heterozygous familial hypercholesterolaemia and inadequate response to the usual therapy. Individual adjustment of the PE frequency, based on the mean Tot‐c curve after PE, is advised.
Prevalence of Coronary Artery Disease in Patients with Valvular Heart Disease
Authors: OLOFSSON BERT‐OVE , BJERLE PER , ÅBERG TORKEL , OSTERMAN GÖRAN , JACOBSSON KARL‐ANDERS
Published: August 2010

ABSTRACT. To evaluate the usefulness of preoperative coronary angiography in patients undergoing preoperative investigation because of valvular heart disease, we performed coronary angiography in a consecutive series of 329 patients. The prevalence of significant coronary artery disease was 32%. Asymptomatic coronary artery disease was present in 13%. Angina pectoris proved to be a poor predictor of coronary artery disease in aortic valve disease. In mitral valve disease, however, the specificity was high. A cost‐benefit calculation was carried out in order to assess what advantage routine coronary angiography might have. According to this, coronary angiography should be performed in all patients suffering from valvular heart disease with angina pectoris, whereas it can be omitted in younger patients without angina. A cut‐off point of 60 years seems appropriate for aortic valve disease and 65 years for mitral valve disease.
Hydrochlorothiazide and Potassium Chloride in Comparison with Hydrochlorothiazide and Amiloride in the Treatment of Mild Hypertension
Authors: ANDERSEN BOGI , SNORRASON SNORRI PALL , RAGNARSSON JOHANN , HARDARSON THORDUR
Published: August 2010

ABSTRACT. A randomized, double‐blind, cross‐over study comparing 50 mg hydrochlorothiazide plus 5 mg amiloride (HCTZ/A) with 50 mg hydrochlorothiazide plus 26 mmol potassium chloride (HCTZ/K) was conducted in 18 patients with mild essential hypertension (diastolic pressure 90–105 mmHg). The sequence of treatment was: placebo for 2 weeks, one active drug for 3 weeks, placebo for 2 weeks, the other active drug for 3 weeks. The two agents were significantly and equally efficacious in lowering the systolic and diastolic blood pressure. Baseline vs. treatment mean serum potassium levels were 3.82 vs. 3.78 mmol/1 for HCTZ/A and 3.82 vs. 3.70 mmol/1 for HCTZ/K. The decrease in serum potassium level from baseline was significant for both agents but not significantly different when the two treatment forms were compared. Both treatment forms elevated fasting serum cholesterol and glucose. Serum triglycerides and uric acid rose significantly with HCTZ/K. Amiloride may affect the tubular handling of uric acid causing increased uric acid excretion, thus counteracting thiazide‐induced hyperuricemia. During 3 weeks' extension of the main study, 5 patients received HCTZ/A in double the original dose (100 mg/10 mg) and 6 patients received HCTZ/K in double the orginal dose (100 mg/52 mmol). No further blood pressure reduction was observed on treatment with these doses. The mean serum potassium levels did not decrease further on doubling the HCTZ/A dose, while a significant fall was observed for HCTZ/K (3.60 vs. 3.42 mmol/1) (p < 0.05, single tailed t‐test). Both drug combinations were well tolerated and side‐effects were not significantly different from those during placebo administration. This study demonstrates that 50 mg hydrochlorothiazide plus 26 mmol potassium chloride are as effective as 50 mg hydrochlorothiazide plus 5 mg amiloride, both in reducing blood pressure and preventing hypokalemia in the treatment of essential hypertension. A small extension study indicates that amiloride might be more effective than potassium chloride in preventing hypokalemia when high doses (100 mg/day) of hydrochlorothiazide are administered.
Development of atherosclerotic plaques
Authors: Ylä‐Herttuala Seppo
Published: August 2010

ABSTRACT. Atherosclerosis is a multifactorial disease. A unified model for the lesion development reveals many connections between the response‐to‐injury hypothesis and the lipid hypothesis. Various cellular uptake mechanisms for native and modified lipoproteins are discussed with respect to foam cell formation and lesion development. The role of arterial smooth muscle cells in atherogenesis is emphasized. Preliminary results of biochemical analyses from the coronary arteries of accidentally died Finnish children and adults reveal that 1) the accumulation of plasma‐derived cholesteryl esters in young children began early in childhood, long before the vessels became macroscopically affected and 2) changes in arterial glycosaminoglycans correlated significantly with the accumulation of cholesteryl esters.
Pituitary‐Thyroid Function and Thyrotropin, Prolactin and Growth Hormone Responses to TRH in Patients with Chronic Alcoholism
Authors: AGNER TOVE , HAGEN CLAUS , ANDERSEN BENT NYBOE , HEGEDÜS LASZLO
Published: August 2010

ABSTRACT Basal plasma concentrations of thyroxine (T4), 3,3′,5‐triiodothyronine (T3), free T4 index (TF4I), free T3 index (FT3I) reverse T3, 3,3′,5‐triiodothyronine (rT3), resin T3 uptake (TR3U), thyroxine‐binding globulin (TBG), thyrotropin (TSH), prolactin (PRL) and growth hormone (GH) as well as thyrotropin releasing hormone (TRH) stimulated TSH, PRL and GH were investigated in 31 consecutive male patients (mean age 41 years) with chronic alcoholism. According to the histology of their liver biopsies the patients were divided into three groups: patients with normal livers, steatosis and cirrhosis. The control group consisted of 30 healthy males. The patients had abstained from alcohol for at least one week when studied, and they were on a nutritionally adequate diet. All had consumed a daily minimum of 52 g ethanol for at least 5 years. None of the patients had severe or decompensated liver disease. The patients had significantly reduced T3 and rT3 plasma levels compared to normals. Patients with cirrhosis of the liver had increased TBG and normal RT3U levels, while those without cirrhosis had increased RT3U and normal TBG levels. Plasma concentrations of basal as well as TRH‐stimulated TSH and PRL were unchanged in alcoholic patients, whereas basal as well as stimulated GH levels were increased in cirrhotic alcoholics. It is concluded that alcohol per se influences T3 levels, but not the part of the hypothalamic‐pituitary axis studied, and that the binding proteins are mostly determined by the degree of liver disease.
Circadian Characteristics of Urinary Melatonin from Clinically Healthy Young Women at Different Civilization Disease Risks
Authors: WETTERBERG LENNART , HALBERG FRANZ , HALBERG ERNA , HAUS ERHARD , KAWASAKI TERUKAZU , UENO MICHIO , UEZONO KEIKO , CORNELISSEN GERMAINE , MATSUOKA MIDORI , OMAE TERUO
Published: August 2010

ABSTRACT Rhythm characteristics in the about‐daily (circadian) and about‐yearly (circannual) frequency ranges were assessed for urinary melatonin. Clinically healthy women in Minnesota, USA, and Kyushu, Japan, were sampled around the clock once in 1‐4 seasons. Possible differences that could reflect the large difference in breast cancer incidence in these two geographic locations were investigated. Each subject's risk of developing breast cancer, cardiovascular diseases resulting from an elevated blood pressure, and emotional conditions was numerically evaluated according to epidemiologic questionnaires. A prominent circadian rhythm characterizes urinary melatonin in both populations, peaking in the middle of the night. The American women exhibit a larger circadian rhythm‐adjusted mean (mesor) than do the Japanese women. A circannual rhythm is also apparent in the North American women, but not in the Japanese women. The circadian mesor of urinary melatonin correlates negatively with the risk score of emotional depression and positively with that of developing cardiovascular diseases.
Congestive Heart Failure and Ejection Fraction in Acute Myocardial Infarction
Authors: MANGSCHAU ARILD , ROLLAG ARNFINN , JONSBU JØRGEN , KARLSEN RAGNAR LUND
Published: August 2010

ABSTRACT Left ventricular ejection fraction (EF) was determined by means of radionuclide ventriculography (RNV) in 477 patients 8‐12 days after an acute myocardial infarction (AMI). EF was correlated to infarct size and clinical and radiological parameters of congestive heart failure (CHF). The 138 patients (29%) who had signs of CHF had a mean (±SD) EF of 35 ±14% and a relative heart volume of 597 ±112 ml/m1 compared to 51 ±14% and 487±88 ml/m2 among those without CHF. The 52 patients who also had radiological signs of CHF had a mean EF of 27±12% versus 35±14% among those with clinical signs and symptoms of CHF. Presence of CHF was positively correlated to the size of AMI and to the reduction of EF. CHF was seen with increasing frequency from 16% in small to 46% in large first infarctions. Patients with reinfarctions showed the same correlation between these parameters, however, with subsequently more depressed EF values and more frequent presence of CHF due to previous myocardial damage. CHF was seldom (8%) observed in patients with EF>50%. In contrast, 67% of the patients with EF<35% had CHF. Thus patients with an EF<35% represent a high risk group with regard to development of CHF and should be followed closely. It is suggested that radionuclide measurement of EF adds important clinical information in patients with diagnostic uncertainty of CHF.
Exercise Stress Testing in Angina Patients with Positive Response to Hyperventilation Testing: Influence of the Coronary Artery Tone
Authors: RASMUSSEN KLAUS , ENGBY BIRGER , BAGGER JENS PEDER , HENNINGSEN PER
Published: August 2010

ABSTRACTWe studied the exercise stress test and the coronary artery tone in two groups of angina patients with comparable coronary atherosclerosis. Group I (20 males and 5 females, mean age 53.5 years) with a positive, and group 11 (22 males and 3 females, mean age 52.5 years) with a negative response to the hyperventilation test (HVT). A positive exercise stress test (ST depression ≥1 mm) was found in 24 patients in group 1 vs. 15 in group II (p<0.01), despite a lower maximal rate pressure product (198±11.2 vs. 236±10.1,p<0.05) and maximal work load (110 W±7.1 vs. 136±7.4 W,p<0.02) in group I. A high coronary artery tone (dilatation (DIL %) of the coronary arteries after nitroglycerin ≥ 10%) was found in 18 patients in group I and in 4 in group II (p<0.01). DIL % was 22.6±3.8 vs. 5.8±1.4 in groups I and II, respectively (p<0.005). DIL% was significantly related to persistence of ST depression after exercise (r=0.36,p<0.05), and 21 of 22 patients with high tone had a positive exercise stress test vs. 18 of 28 with low tone (p<0.05). These findings suggest that the coronary artery tone influences the response to exercise in some patients with angina. Since the patients in group I were identified by HVT, our results underline the clinical relevance of this test.
Changes in Peripheral Blood Pressures after Five Years of Follow‐up in Non‐operated Patients with Intermittent Claudication
Authors: JONASON TOMMY , RINGQVIST IVAR
Published: August 2010

ABSTRACT Changes in the segmental blood pressures (BP) in the legs after five years of follow‐up and factors related to the changes were studied in 93 non‐operated non‐diabetic patients with intermittent claudication. Independent variables affecting the ankle/arm BP index (ABI) in the more affected leg were the initial ABI, smoking, duration of claudication and location of the stenoses (whether single or multiple). ABI was stable in non‐smokers but decreased in smokers. It also decreased in patients with multiple stenoses at the initial examination but not in those with single stenoses. The correlation between subjective changes in claudication and changes in the ankle BP was poor. In the less affected leg, ABI decreased both in smokers and non‐smokers but stenoses in legs without signs of stenoses initially developed to a greater extent in smokers than in non‐smokers. Smoking is an important risk factor for progression of the occlusive atherosclerotic disease in intermittent claudication. Patients with multiple stenoses seem to have a more progressive occlusive disease.
Peripheral Arterial Disease and Its Relationship to Cardiovascular Risk Factors and Coronary Heart Disease in Newly Diagnosed Non‐insulin‐dependent Diabetics
Authors: SIITONEN ONNI , UUSITUPA MATTI , PYÖRÄLÄ KALEVI , VOUTILAINEN ERKKI , LÄNSIMIES ESKO
Published: August 2010

ABSTRACT The prevalence of peripheral arterial disease and its relationship to cardiovascular risk factors was investigated in 133 patients aged 45–64 years with newly diagnosed non‐insulin‐dependent diabetes and in 144 randomly selected non‐diabetic subjects of the same age. History of intermittent claudication, absent foot pulses, decreased ankle‐arm blood pressure ratio (<0.9) and radiologically detectable arterial calcifications of the lower limbs were used as indicators of the presence of peripheral arterial disease. Peripheral arterial disease tended to be somewhat more common in men with newly diagnosed non‐insulin‐dependent diabetes than in non‐diabetic men, whereas no difference was found in prevalence of peripheral arterial disease between diabetic and non‐diabetic women. The association of various indicators of peripheral arterial disease with cardiovascular risk factors and coronary heart disease was low or absent.
Pheochromocytoma in Sweden 1958–1981
Authors: STENSTRÖM GUNNAR , SVÅRDSUDD KURT
Published: August 2010

ABSTRACT An epidemiological study of 439 cases (184 males, 255 females) of pheochromocytoma (paraganglioma) diagnosed in Sweden from 1958‐81 is presented. From the mid 1960's an average of 22 cases have been diagnosed each year. In 255 cases, the pheochromocytoma was diagnosed by clinical examination and/or surgery. In 184 cases (40%), the diagnosis was achieved by autopsy and out of which 60 (14% of all cases) were reported as incidental findings. Ninety‐five pheochromocytomas (22%) were located outside the adrenals. The average (±SD) age at diagnosis for the total study population was 55.8 ± 17.7 years. Clinically diagnosed tumour cases were significantly younger (48.5±16.3 years) compared to cases diagnosed at autopsy (65.8±14.0). Pheochromocytomas were more common among women than among men. The age specific incidence rate increased continuously for both sexes from the youngest to the oldest age groups. The average incidence of pheochromocytoma in the 24 counties of Sweden was 2.1 cases per million inhabitants per year, range 0.9–5.3. A North to South gradient was noted with a higher incidence in the Southern parts of the country. Whether this is due to a real geographical variation of incidence, to a larger number of unreported cases in the Northern parts, or to presence of families with Sipple's syndrome in the South is unclear.
Increase in Muscular Strength Following Surgery for Primary Hyperparathyroidism
Authors: WERSÄLL‐ROBERTSON EVA , HAMBERGER BERTIL , EHRÉN HENRIK , ERIKSSON EJNAR , GRANBERG PER‐OLA
Published: August 2010

ABSTRACT The muscle strength of the quadriceps muscle was measured in a computerized modified Cybex II muscle dynamometer. The method used is easy and has an error of >5%. A marked increase in muscular strength was found after successful surgery for primary hyperparathyroidism (PHPT) with normalization of serum calcium levels. The results support the opinion that all patients with PHPT, with or without muscle weakness, should be recommended an operation if no serious contra‐indications exist.
Ulceration and Necrosis of the Tongue Due to Giant Cell Arteritis
Authors: CHRISTENSEN LENE
Published: August 2010

ABSTRACT A case is reported of giant cell arteritis in a 74‐year‐old woman, complicated by ulceration and necrosis of the tongue. During steroid treatment recovery was observed.
Malignant Hypercalcemia—a Hospital Survey
Authors: BLOMQVIST CARL P.
Published: August 2010

ABSTRACT A hypercalcemia frequency of 1.5% was found in patients with malignant disease attending a large oncological center. Eighty per cent of hypercalcemias were of obvious malignant etiology. Hypercalcemia was most frequent in multiple myeloma, renal carcinoma, squa‐mocellular carcinomas of different sites and breast cancer. Most patients had advanced metastasized disease. In 80% of those with solid tumors malignant hypercalcemia was associated with bone metastases. Serum calcium could almost invariably be reduced by treatment, and active treatment was associated with a more favorable prognosis. One year actuarial survival of patients with malignant hypercalcemia was 31%.
Glucose Tolerance in Patients Undergoing Continuous Ambulatory Peritoneal Dialysis
Authors: LINDHOLM BENGT , KARLANDER SVEN‐GUNNAR
Published: August 2010

ABSTRACT The effects of continuous ambulatory peritoneal dialysis (CAPD) on glucose tolerance and serum immunoreactive insulin and glucagon responses to oral glucose over the first year of therapy were studied in 13 uremic patients. Oral glucose tolerance tests were performed before treatment started, and again after 3 and 12 months on CAPD. Before CAPD, the patients showed decreased glucose tolerance. However, neither fasting blood glucose and serum insulin and glucagon levels nor the insulin and glucagon levels during the tests were significantly different from results obtained in 13 healthy controls. During CAPD, the mean intraperitoneal supply of glucose from the dialysates varied between 121 and 245 g/day and did not change during the study period. Glucose tolerance and hormone responses to glucose did not change during the study period. No patient developed manifest diabetes mellitus. We conclude that glucose intolerance in uremia persists during CAPD, but despite the continuous peritoneal absorption of 100–200 g of glucose during CAPD, the treatment had no effect on glucose tolerance and insulin secretory response.
Acute Meningitis and Cerebellar Dysfunction Complicating High‐dose Cytosine Arabinoside Therapy
Authors: THORDARSON HRAFNKELL , TALSTAD INGEBRIGT
Published: August 2010

ABSTRACT A patient with acute lymphocytic leukemia (ALL) who was treated with high‐dose cytosine arabinoside (Ara‐C) 3 g/m2 twice daily, developed reversible acute aseptic meningitis and signs of cerebellar dysfunction after a total dose of 24 g Ara‐C. To our knowledge this is the first case report of meningitis complicating intravenous high‐dose Ara‐C therapy.
Left Ventricular Function in Aortic Valve Endocarditis
Authors: VIK‐MO HARALD
Published: August 2010

ABSTRACT. The value of M‐mode echocardiography in assessment of left ventricular (LV) function in patients with aortic regurgitation due to aortic valve endocarditis (AVE) was studied in 12 consecutive patients and compared with the findings in 30 patients with chronic aortic regurgitation (CAR). Patients with AVE had markedly increased LV end‐diastolic and end‐systolic diameters, whereas fractional shortening was normal. A linear correlation was found between the LV ejection fractions calculated by echocardiography and angiography, but echocardiography markedly overestimated the ejection fractions. There was a close linear correlation between the prematurity of mitral valve closure (MVC) and LV end‐diastolic pressure. Patients with CAR had lower end‐diastolic pressure, similarly increased LV internal diameters and none had premature MVC. Thus, M‐mode echocardiography can identify patients with premature MVC and high LV filling pressure. However, echocardiographic LV function indices based on measurement of internal dimensions overestimate the LV function and these data should be interpreted with caution.
Plasma Lipoproteins and Fatty Acid Composition during a Moderate Eicosapentaenoic Acid Diet
Authors: THORNGREN MARGARETA , NILSSON ELISABETH , GUSTAFSON ANDERS
Published: August 2010

ABSTRACT. The effect of a diet rich in marine fatty acids, especially eicosapentaenoic acid, on plasma lipids (total plasma cholesterol, HDL cholesterol, total triglycerides and apolipoproteins A and B) and fatty acid composition in plasma phosphatidylcholine (PC) was studied in 10 healthy men. They were maintained for 11 weeks on their normal diet which was partly replaced by 150–200 g of fatty fish per day. In the same individuals this diet had previously caused a delay in primary haemostasis and a decrease in platelet aggregability similar to that caused by acetylsalicylic acid, a known inhibitor of thromboxane A2 formation. Apart from its effect on haemostasis, the fish diet substantially reduced serum triglycerides (by 43%, p < 0.01) but caused no changes in total plasma or HDL cholesterol or apolipoproteins A and B. After three weeks on the diet the proportion of plasma PC ω‐3 polyunsaturated fatty acids increased (C20: 5 and C22: 6) and ω‐6 fatty acids decreased (C18: 2 and C20:3). The relative plasma PC content of arachidonic acid was unaffected throughout. These alterations in plasma PC fatty acid composition were principally in accordance with those seen in platelet membrane PC. There was a linear correlation between the content of ω‐3 and of ω‐6 fatty acids in plasma PC with that of platelet PC as well as in predominate individual fatty acids of the two series. Six weeks after the volunteers had resumed their usual diet, total triglycerides and the fatty acid composition of plasma PC had returned to the original state.
Serum Thyroid‐stimulating Hormone in Cerebrovascular Disease
Authors: HÄGG ERIK , ASPLUND KJELL , ERIKSSON STURE , LITHNER FOLKE , STRAND TAGE , WESTER PER OLOV
Published: August 2010

ABSTRACT. A thyrotropin‐releasing hormone (TRH) test with serum thyroid‐stimulating hormone (TSH) assays was performed in 22 euthyroid stroke patients without thyroid disease and the results were compared with those in 17 age‐matched euthyroid controls. Basal and maximum TSH levels after TRH injeciton were significantly lower in the stroke group without elevation of basal serum thyroid hormone levels. There was a tendency towards an inverse relationship betweeen TSH levels and the degree of pareses of the extremities. The test was repeated in 7 stroke patients 3–4 months after the onset of stroke with essentially the same results. The abnormal TSH parameters in stroke patients seem to be the result of the brain lesion per se.
The Effects of Acebutolol and Metoprolol on Walking Distances and Distal Blood Pressure in Hypertensive Patients with Intermittent Claudication
Authors: SVENDSEN T. L. , JELNES R. , TØNNESEN K. H.
Published: August 2010

ABSTRACT. The effects of acebutolol (with intrinsic sympathomimetic activity (ISA)) and metoprolol (without ISA) on arm blood pressure, ankle systolic blood pressure, claudication distances (CD) and maximal walking distances (MWD) were compared in patients with essential hypertension and intermittent claudication. Fourteen patients participated in a long‐term, open, randomized cross‐over study. After randomization the patients received either acebutolol, 200 mg b.i.d., or metoprolol, 100 mg b.i.d. After eight weeks the drugs were shifted and after another eight weeks they were withdrawn. Arm and ankle blood pressure, CD and MWD were determined before randomization and after 4, 8, 12 and 16 weeks, and again 4–6 weeks after withdrawal of the drugs. The arm blood pressure was reduced by 20/13 mmHg after acebutolol and by 22/21 mmHg after metoprolol. In spite of a significant decrease in arm blood pressure there were no significant changes in ankle blood pressure, CD or MWD after the two drugs. After withdrawal of the drugs and after the arm blood pressure had returned to the control value no significant changes were seen in CD, MWD or ankle blood pressure. It is concluded that β‐blockers have no deleterious effect on CD, MWD or ankle blood pressure in patients with hypertension and intermittent claudication. No effect of ISA was demonstrated.
Insulin Secretion in Alcoholics in a Withdrawal State
Authors: ADNER NILS , NYGREN ARNE
Published: August 2010

ABSTRACT. Insulin secretion was studied after stimulation with oral glucose and intravenous glucagon in 23 chronic alcoholics in a withdrawal state. Each subject was studied twice at one week's interval between the examinations. The insulin and C‐peptide responses to glucagon were lower in the early withdrawal state. Moreover, the insulin and C‐peptide increments were, when related to the magnitude of the glycemic stimulus, lower in the early than in the late withdrawal state. The fasting values of blood glucose, insulin and C‐peptide and the blood glucose and C‐peptide levels after oral glucose were higher in the early withdrawal state. These findings indicate that glucose metabolism in alcoholics in a withdrawal state can be disturbed by impaired insulin secretion and insulin resistance.
Biochemical Markers of Bone Turnover in Rheumatoid Arthritis
Authors: ALS O. S. , RIIS B. J. , GOTFREDSEN A. , CHRISTIANSEN C. , DEFTOS L. J.
Published: August 2010

ABSTRACT. Bone turnover was determined in 125 patients with rheumatoid arthritis (RA). Bone Gla protein (BGP) and alkaline phosphatase (AP) were used as markers of bone formation. Fasting urinary calcium relative to creatinine (FU Ca/Cr) and fasting urinary hydroxyproline relative to creatinine (FU Hpr/Cr) were used as markers of bone resorption. These variables were compared to the values of two groups of normal controls in order to elucidate the pathophysiology of the osteopenia occurring in patients with RA. When the patients were divided into groups according to treatment (gold salts, penicillamine, or glucocorticoids), serum AP was highly significantly increased in all three groups, whereas serum BGP was below the normal mean. FU Ca/Cr and FU Hpr/Cr were moderately decreased in the groups treated with gold salts or penicillamine, but increased in the glucocorticoid‐treated group. When divided according to sex and menopausal state and glucocorticoid treatment versus non‐glucocorticoid treatment, there was a balance between bone formation and bone resorption parameters in all groups, except glucocorticoid‐treated men and premenopausal women who had increased values of bone resorption parameters.
Role of Surgery in Infective Endocarditis
Authors: ANDERSSON PER , DUBIEL WIESLAW , ENGHOFF EBBA , FRIMAN GÖRAN , HÄGG ANDERS , NYSTRÖM SVEN‐OLOF , ÅBERG TORKEL
Published: August 2010

ABSTRACT. One‐hundred‐and‐thirteen patients with endocarditis and valvular insufficiency were studied retrospectively with special regard to indications for operation and the optimum time for cardiac valve surgery. Thirty patients (group I) had acute, 63 (group II) subacute and 20 (group III) prosthetic valve endocarditis. Group I: Eleven patients underwent surgery in the acute stage, 8 while bacteremic; 5 of the latter died perioperatively. Of the 19 patients treated medically, 16 died. Group II: All patients underwent operation in a bacteria‐free state. The mortality was 5%. Group III: Eight patients had early (<60 days postoperatively) and 12 late endocarditis. Total mortality was 40% (71 % early and 25% late mortality). Ten patients underwent reoperation, with a mortality of 20%, compared with 60% in the medically treated group. The results support the indication for early operation in acute endocarditis with progressive cardiac failure and renal failure and prosthetic valve endocarditis, even during bacteremia.
Prognostic Influence of Early Diagnostic Splenectomy in Hodgkin's Disease
Authors: ASKERGREN J. , BJÖRKHOLM M. , HOLM G. , JOHANSSON B. , MELLSTEDT H.
Published: August 2010

ABSTRACT. The influence of early laparotomy with splenectomy on prognosis in patients with Hodgkin's disease who were regarded as having uncertain prognostic indices (all patients except those with lymphocytic predominance and nodular sclerosis stages IA and IIA with right‐sided presentation, stage IV disease, splenomegaly or age >65 years) was evaluated in a randomized trial initiated in Jan. 1973. The patients were treated with total nodal irradiation (excluding the splenic and hepatic areas) and 33 of 69 patients were randomized to laparotomy with splenectomy. No significant difference in relapse‐free or overall survival was found between the two groups after a median observation time of 85 months. Progressive or recurrent disease was as common in splenectomized as in non‐splenectomized patients. Splenectomized patients with splenic tumour involvement fared worse than those without. It is concluded that diagnostic laparotomy with splenectomy is of no benefit in this clinical setting.
Expansion of Extracellular Volume in Early Polycystic Kidney Disease
Authors: DANIELSEN H. , PEDERSEN E. B. , NIELSEN A. H. , HERLEVSEN P. , KORNERUP H. J. , POSBORG V.
Published: August 2010

ABSTRACT. Blood volume (BV), extracellular volume (ECV), blood pressure (BP), creatinine clearance (CCr), plasma levels of angiotensin II (AII), aldosterone (Aldo) and arginine vasopressin (AVP), and serum osmolality (Sosm) were determined in 18 patients with adult polycystic kidney disease, 8 normotensive (group I), 10 hypertensive (group II), and in 11 control subjects (group III). ECV but not BV was increased in group I compared with group III, whereas BV and ECV did not differ significantly between groups II and III. In group II, Aldo and AVP were increased and AII tended to be increased, while in group I the hormone levels did not differ significantly from those in group III. Sosm did not differ significantly between the groups. In the combined patient group, CCr correlated positively with BV and ECV and negatively with BP. In the patients, AII and AVP were positively correlated with BP but not with CCr. The results suggest that both the renin‐angiotensin system and AVP might be involved in the BP elevation, whereas expansion of ECV can be found without an increase in BP.
Osteoporosis and Physical Activity
Authors: SMITH EVERETT L. , RAAB DIANE M.
Published: August 2010

ABSTRACT. Bone involution poses serious health risks for aging women. Bone mass is subject to both local (mechanical) and systemic (hormonal) homeostatic control mechanisms. The local forces acting on bone are due to gravity and muscular contraction. There are several theories concerning the mechanisms of local control. When bent, bone functions as a piezoelectric crystal with calcium accumulation on the negatively charged concave surface. Microfractures that occur in response to stress greater than normal levels stimulate osteoclastic activity to remove the damaged structure. Studies of astronauts and immobilized subjects have consistently found bone atrophy. The degree of bone loss is related to the difference in levels of stress normally applied and those at bedrest in the site studied. Correspondingly, athletes have greater bone mass than the sedentary population, with the greatest hypertrophy found in the areas most stressed. Exercise intervention also promotes bone hypertrophy. Both middle‐aged and elderly women increase bone mass or reduce the rate of loss in response to physical activity intervention programs.
HEMODYNAMIC EFFECTS AT REST AND DURING EXERCISE OF LONG‐TERM SODIUM RESTRICTION IN MILD ESSENTIAL HYPERTENSION.
Authors: Omvik Per , Lund‐Johansen Per
Published: August 2010

ABSTRACT. During moderate sodium restriction for 9 months in 19 men (33 years) with previously untreated mild essential hypertension (EH) sodium excretion fell from 209 to 139 mmol/24 h. Concomitantly intraarterial pressure at rest sitting fell from 145/93 to 138/88 mmHg (5%) and during 100 W exercise from 168/90 to 162/86 mmHg (4%). The fall in BP was due to reduction in cardiac output (5–11% at rest and during exercise) while peripheral vascular resistance was raised (4–10%). Thus, moderate sodium restriction was not very efficient treatment in our patients with mild EH. The main hemodynamic disturbance of established EH ‐ an increase in vascular resistance ‐ was not normalized after 9 months of low salt diet.
NERVOUS SYSTEM CONTROL MECHANISMS IN HEART FAILURE
Authors: Cohn Jay N.
Published: August 2010

Abstract Alterations in the peripheral circulation by influencing aortic impedance and venous capacitance have a remarkable effect on cardiac performance in patients with left ventricular dysfunction.

Systemic vasoconstriction in heart failure is influenced by activation of the sympathetic nervous system (increased plasma norepinephrine), the renin‐angiotensin system (increased PRA) and the antidiuretic hormone system (increased arginine vasopressin). The level of plasma norepinephrine is related weakly to the severity of resting left ventricular dysfunction and strongly to the subsequent risk of mortality. Attenuation of reflex responsiveness to low pressure mechanoreceptors (orthostatic tilt) and to carotid and aortic baroreceptors (nitroprusside infusion) occurs in heart failure and the degree of abnormality also may be related to mortality.

Vasodilation with consequent improvement in left ventricular function may be accomplished by non‐specific dilators (nitroprusside, nitrates, hydralazine, nitrendipine) or by specific interference with neurohumoral mechanisms (sympathetic blockade, converting enzyme blockade, AVP blockade). Plasma norepinephrine may be reduced by central or presynaptic mechanisms (guanabenz, bromocriptine, captopril). The hemodynamic effect of this anti‐sympathetic effect appears to be related to the relative influence on cardiac vs. peripheral sympathetic tone and/or concomitant effects of the drugs. Long‐term trials are needed to determine whether chronic inhibition of the sympathetic nervous system will have a salutary effect on the hemodynamics, symptomatology and prognosis of cardiac failure.
EFFECTS OF ACE INHIBITION ON RENAL REGULATION OF SALT AND WATER
Authors: Grönhagen‐Riska Carola
Published: August 2010

Abstract CHF may activate the RAS by various mechanisms. Acute CHF is associated with high PRA, whereas chronic, stable disease is combined with normal values. The response to ACEI is affected by blood pressure, degree of activation of the RAS, salt balance and degree of possible renal failure. It may also be affected by concomitant diuretic or, e.g., digoxin therapy. ACEI improves RPF, GFR may remain normal or may increase, if it was previously impaired due to reduced RPF. Severe hypotension in combination with decreased autoregulatory capacity may decrease GFR. Generally, renal excretion of sodium and water increase These changes in renal handling of salt and water are primarily caused by decreased All. They are also augmented by inhibited sympathetic tone and thirst and decreased release of ADH and aldosterone Increased synthesis of vasodilating and natriuretic PGs is probably also of some importance.

Dilutional hyponatremia may be corrected by combined ACE inhibitor and furosemide treatment. Water and sodium excretion increase and sodium is redistributed from the intracellular space. Low serum sodium values increase and azotemia may be corrected, if ACE inhibitor doses are carefully titrated to avoid severe hypotension. These effects are ascribed mainly to a decrease of AII, thirst and ADH release The effect of furosemide is improved since increased amounts of salt are delivered to the loop of Henle and access of furosemide to its she of action is facilitated by increased RPF. ACEI does not cause any obvious negative effects on renal handling of salt and water. However, during extreme salt and water depletion, the patient's ability to increase sodium reabsorption and retain water is impaired. Consequently, ACE inhibitors should be interrupted, or administered with care in such situations.
Vasospastic Angina: Control of Disease Activity and Efficacy of Drug Treatment Using the Prolonged Hyperventilation Test
Authors: NIELSEN HENRIK , MORTENSEN SVEND AAGE , SANDOE ERIK
Published: August 2010

ABSTRACT Sixteen consecutive patients with vasospastic angina underwent a control provocation test in the coronary care unit or the cardiac catheterization laboratory in order to evaluate the disease activity and the efficacy of long‐term calcium antagonist treatment. In patients without angina at rest, the prolonged hyperventilation test was negative in 10/10 patients on calcium antagonist treatment (group A+B) and in 4/5 patients without medication (group C). The test was positive in 1/1 patient with angina at rest without medication (group D). However, the test provoked vasospastic angina in 1/5 patients who were asymptomatic without medication. In both the latter patients the prolonged hyperventilation test became negative after the restart of calcium antagonist treatment. During a mean follow‐up period of 18 months (range 16–19) after the control hyperventilation test, no relapse of angina at rest, arrhythmias, syncopes, deaths or myocardial infarctions were registered. Thus, a negative test is compatible with low disease activity and/or efficacy of calcium antagonist treatment. Further, the test may reveal a subclinical tendency to coronary artery spasm.
The Incidence and Prognosis of Cerebrovascular Disease in Hospital Patients in Helsinki, Finland, in the Decade 1970–1980
Authors: TILVIS REIJO , AUTIO LAURI , MÄHOUNEN YRJÖ , MÄNTYLÄ JUKKA , HEINONEN MARTTI , BROMMELS MATS
Published: August 2010

ABSTRACT Over 21000 hospital episodes due to cerbrovascular disease (CVD, ICD‐8 nos. 430–438) were registered in the Helsinki hospitals in 1970–1980. Of those 17629 were identified as new cases. The age‐adjusted incidence of haemorrhagic and thrombotic stroke (430–433) declined during the period 1970–1975 from 221 to 139 cases/100000 inhabitants, whereafter no further decrease was observed. The decline in incidence was significant in both sexes. Analysis by diagnosis group showed that the decrease was confined to the incidence of haemorrhagic stroke (430–432), whereas the incidence of thromboembolic stroke (433, 434) and transient ischaemic attacks (435) remained virtually unchanged. Survival was mainly determined by patient age and type of CVD. Intracerebral haemorrhage and occlusion of precerebral arteries exhibited the poorest short‐term prognosis. About half of the patients hospitalised due to cerebral thrombosis and embolism survived over One year. Long‐term prognosis of the major CVD groups was very poor with only 10% of the patients alive after eight years. Transient cerebral ischaemia and subarachnoid haemorrhage had a clearly better prognosis, the survival rates after eight years being 45 and 30%, respectively.
Is Exercise‐induced Blood Pressure Rise Predictive of Nephropathy in Insulin‐dependent Diabetes?
Authors: TORFFVIT O. , PERSSON G.
Published: August 2010

ABSTRACTA follow‐up study was performed in 48 male diabetics and 17 age‐matched male controls, who in 1963 and 1971 participated in an exercise study to evaluate if the results could predict later development of diabetic nephropathy. The inclusion criteria were: Type I (insulin‐dependent) diabetes with age below 40, onset of diabetes before age of 30, duration of diabetes more than 7 years and no proteinuria at the time for the first study. The diabetics demonstrated higher systolic blood pressure (BP) at work but as good physical condition as the controls. Thirteen developed nephropathy after 23 years (range 15–36) of diabetes duration. It was found that exercise‐induced, abnormally raised systolic BP was not associated with later development of diabetic nephropathy.