bluuebunny/crossref_metadata_2025 huggingface dataset:
Creatine Phosphokinase Following Cardioversion
Authors: Forssell G. , Nordlander R. , Nyquist O. , Orinius E. , Styrelius I.
Published: August 2010

Abstract. Serial estimations of total serum creatine phosphokinase (CPK) have been performed before and during 18–51 hours after cardioversion of supraventricular tachyarrhythmias in 12 patients without acute myocardial infarction (AMI). The maximal CPK rise was 78 mU/ml (110%) and the CPK did not exceed the upper normal limit (130 mU/ml) in more than two patients (149 respectively 156 mU/ml). The CPK rise we have observed in a series of AMI patients varied between 101 (133%) and 2260 mU/ml (3780%), mean 900 mU/ml (1184%). Therefore, cardioversion performed as described seldom seems to interfere with diagnosing AMI by serial estimations of serum CPK during the next 24 hours.
Effect of Alprenolol and Hydralazine on Plasma Renin Concentration in Patients with Arterial Hypertension
Authors: Pedersen E. B. , Kornerup H. J.
Published: August 2010

Abstract. The effect of alprenolol alone and in combination with hydralazine on plasma renin concentration has been studied in 25 patients with arterial hypertension. Alprenolol caused a significant fall in plasma renin concentration and in BP but the two falls were not inter correlated. Addition of hydralazine to the treatment regimen produced a further reduction of BP. Changes in plasma renin concentration varied greatly during combination therapy. A modest, non‐significant increase in plasma renin concentration was measured compared with the level after treatment with alprenolol. It is concluded that mechanisms other than suppression of plasma renin concentration are important for the reduction of BP during β‐adrenergic blockade and that the plasma renin concentration probably has no clinical significance with regard to forecasting the antihypertensive effect of alprenolol. Even though a significant correlation was found between the fall in plasma renin concentration and the fall in diastolic BP during combination therapy, it is uncertain whether changes in the renin‐angiotensin system are of primary importance for BP regulation during this therapy.
Sudden Death in Rheumatoid Arthritis with Atlanto‐axial Dislocation
Authors: Mikulowski Pawel , Wollheim Frank A. , Rotmil Paul , Olsen Ingeborg
Published: August 2010

Abstract. A post mortem material of 11 consecutive cases of severe atlanto‐axial dislocation (a.a.d.) with cord compression is reported. The total number of deaths from rheumatoid arthritis (RA) during the period of 5 years was 104, and all were autopsied. Neurological symptoms correlated poorly to fatal a.a.d. Hemiplegia was found in three cases, one of which, however, was caused by thrombosis cerebri. Spastic signs were transiently recorded in two patients and dysphagia in a further two. Five patients had a history of recent vomiting. A.a.d. was the sole or main cause of death in 8 cases and contributory in 2. Sudden death occurred in 7 of the cases. Only 2 cases had obtained a correct diagnosis intra vitam. The CNS findings at autopsy consisted of cord compression (11/11 cases), cord malacia (2/11) and cerebral oedema (3/11). One case had polyarteritis and renal amyloidosis and one pulmonary carcinoma with metastatic spread. Signs of active inflammation in the axial joints were present in 4 cases. This study, based on systematic post mortem examinations, revealed an unexpectedly high and not previously reported incidence of fatal medulla compression in RA patients with a.a.d. (10%).
Routine Exercise ECG Three Weeks after Acute Myocardial Infarction
Authors: Ibsen Hans , Kjøller Erik , Styperek Janus , Pedersen Asger
Published: August 2010

Abstract. In the third week after acute myocardial infarction, mean 18 days, exercise tests have been performed in 209 patients prior to discharge from the Coronary Care Unit. The exercise was done on a bicycle ergometer with electrically controlled braking, starting at the load 300 kpm/min (equal to 50 W), increasing with 300 kpm/min every 6th min, aiming at a maximal symptom‐limited performance. ECG, in 3 extremity leads and 3 precordial leads, and heart rate (HR) were continuously recorded, and blood pressure (BP) was measured every minute. The most common cause for discontinuing exercise was fatigue (in 58%). Anginal pain or dyspnoea was the cause in 23.8%. Only in 9.1% was the exercise interrupted by the investigator because of rhythm disturbances or pronounced ST‐T changes. Maximal work varied from 1 min exercise at 300 kpm/min to 6 min at 900 kpm/min (150 W); 18% of all patients were able to work for 6 min at 600 kpm/min (100 W). HR increased on an average from 80 beats/min at rest to 129 beats/min at maximal work load. Systolic blood pressure (SBP) increased on an average from 126 to 170 mmHg. The maximal values reached during exercise were HR 170/min, and SBP 270 mmHg. The product HR × SBP increased a little more than two‐fold on an average. ST‐T changes indicating myocardial ischaemia during exercise were observed in 70%. During exercise ventricular ectopic beats occurred in 42 %. All rhythm disturbances provoked by exercise disappeared spontaneously shortly after work. Persistent ECG changes, reinfarction or other serious complications were not observed in connection with the exercise test. It is concluded that an exercise test under controlled circumstances is safe in patients of all ages in the third week after myocardial infarction. It is an objective measure of physical work capacity and describes the reaction to physical activity. It gives a basis for advising return to normal life and is of great psychological importance to the patient.
Diagnosis of Ventricular Septal Defect in Acute Myocardial Infarction without Cardiac Catheterization
Authors: Gustafson A. , Nordenfelt I. , White T.
Published: August 2010

Abstract. Five patients with acute myocardial infarction and a systolic murmur suggestive of ventricular septal rupture or mitral regurgitation have been examined by external vascular isotope dilution curves over the chest after i.v. injection of 125I‐hippuran. In three patients these isotope dilution curves showed signs of left‐to‐right shunting of blood, and subsequent autopsy demonstrated the presence of ventricular septal defect. In two patients there was no sign of left‐to‐right shunting, and these patients recovered.
Uriglox® and Quantitative Urine Microscopy in Diagnosis of Urinary Tract Infection
Authors: Hällström K. A. , Hällström K. O. , Grönroos P. , Ruosteenoja R.
Published: August 2010

Abstract. The aim of this study was to find an alternative to the sole use of abundant cultural findings as a basis for the diagnosis of urinary tract infection (UTI). For this purpose, the results obtained from the bacteriological culture of daytime urine specimens from 154 students by the dip slide method were checked against the findings from the quantitative culture, microscopy and Uriglox® testing of the first morning urines voided later at home. As a diagnostic criterion, the finding of 105 or more bacteria/ml urine in two successive cultures had an error of 19%. For the simultaneous occurrence in the morning urine of abundant bacteria (≥ 105/ml) and a subnormal glucose concentration (as revealed by the Uriglox test), this error was 1.5%. Only the latter combination showed, therefore, the presence of UTI at the confidence level of ≥ 95%, or was “clinically significant”. The specificity indices for the Uriglox test and the quantitative culture were 0.99 and 0.97, respectively. Microscopy of the morning urine showed 103 or more bacteria/ml in all the subjects with infection but the number of leucocytes was normal in a fifth of them. The specificity indices for microscopic counts of 103 or more organisms/ml and 10 or more leucocytes/mm3 were 0.74 and 0.94, respectively. For higher counts, i.e. 105 or more bacteria/ml and 50 or more leucocytes/mm3, the specificity index of positive microscopy was 1.0. This specificity level was, however, attained at the expense of the sensitivity, which for 105 or more organisms/ml was 0.67 and for 50 or more leucocytes/mm3 0.53. It is concluded that abundant bacterial contamination of specimens often decisively complicates the diagnostic use of urine culture, and therefore the combined use of quantitative culture, microscopy and the Uriglox test is recommended as the principal tool for the diagnosis of UTI in ordinary hospital and ambulatory health services.
Waldenström's Disease with an IgA Paraprotein
Authors: Hijmans W.
Published: August 2010

Abstract. A patient is described, in whom the diagnosis of Waldenström's disease was made on the basis of clinical and morphological findings, but whose M‐component belonged to the IgA class of immunoglobulins.
Survival after Portacaval Shunt: Who and how?
Authors: Amman R. , Olsson R. , Scherstén T.
Published: August 2010

ABSTRACT In a series of 74 portacaval‐shunted patients no statistically significant differences in long‐term survival or in incidence of postoperative encephalopathy have been observed between electively and emergency operated patients, between patients with slight and moderate impairment of liver function (groups A and B according to Child) or between patients with alcoholic and non‐alcoholic cirrhosis. Patients older than 60 years had a higher risk of postoperative encephalopathy and a borderline significantly lower survival rate six months after the operation. Among the patients with more than six months' survival, about 50% returned to work.
Haematologic Adaptation in Patients with Chronic Bronchitis and Pulmonary Insufficiency
Authors: Skouby Arne P.
Published: August 2010

ABSTRACTThe relationship between respiratory insufficiency, expressed by gas tensions in blood and bone marrow, and haematologic adaptation has been studied in 82 men with chronic bronchitis and persistent breathlessness for at least one year. For the group as a whole and for various subgroups, a linear correlation was demonstrated between arterial hypoxia and Hb concentration, haematocrit, blood volume, Hb mass and erythrocyte volume, respectively. The increase in Hb concentration compensated for the fall in arterial oxygen saturation. Only for one subgroup, with a pH difference between arterial and venous blood ≥ 0.08, was no correlation found between the degree of hypoxia and Hb concentration. The haematologic parameters correlated significantly better with arterial oxygen tensions than with oxygen tensions in the bone marrow. There was no indication that decreased oxygen supply to the bone marrow led to the increased erythrocyte and Hb production in patients with arterial hypoxia caused by chronic bronchitis.
Peripheral Circulation, Particularly Heat Regulation Reactions, in Patients with Amyloidosis and Polyneuropathy
Authors: Andersson Rune , Bjerle Per
Published: August 2010

ABSTRACT As patients with amyloidosis and polyneuropathy often have signs and symptoms of circulatory disturbances in the extremities, especially the legs, we have examined such patients and controls with oscillometry and digital pulse plethysmography in order to estimate the occurrence of any arterial circulatory insufficiency. No signs of significant obliterative arterial changes were found. Skin temperature was also determined in fingers and toes during body‐cooling and at subsequent indirect heating. At low environmental temperature the skin temperature was higher in patients than in controls. In a few patients there was almost no decrease in skin temperature, despite a long period of cooling and a low rectal temperature. Indirect heating elicited a marked increase in the skin temperature of the toes and fingers of the controls. In most patients this reaction was completely absent in the toes and absent or reduced in the fingers. These deviations can be explained by nerve damage caused by amyloid deposition in the nerves. Amyloid deposits in the walls of small blood vessels may be an additional factor. Maximum blood flow in the anterior tibial muscle after combined ischemia and exercise, investigated with radioactive xenon, was reduced in half of the patients.
Prognostic Value of Mitotic Studies in Myeloid Leukaemias
Authors: Sjögren U.
Published: August 2010

ABSTRACT Seven patients with various forms of myeloid leukaemia have been studied by repeated sternal punctures during the course of illness. None of the patients received cytostatics before or during the study. The mitotic indices declined with time and there was a significant relation between the slopes of the mitotic curves and survival time. Repeated mitotic counts seem to serve as a diagnostic and prognostic tool in myeloid leukaemias.
Clinical Features in Poisonings by Tricyclic Antidepressants with Special Reference to the ECG
Authors: Thorstrand Curt
Published: August 2010

ABSTRACT Clinical variables, and especially thenrelation to the ECG, have been studied in 153 cases of poisonings by tricyclic antidepressants (TCA). The mean age of the patients was 34 years. Amitriptyline poisoning accounted for 112 (73%) of the cases and the mean dose ingested was about 1000 mg. Coma was present in 87 patients (57%) and on admission 40 (26%) had a systolic blood pressure (BP) below 100 mmHg. The systolic BP on admission was significantly lower (p < 0.001) and the hart rate (HR) higher (p < 0.001) than when the patients left the ward. Apart from an increased HR (≥ 90 beats/min), which was present in 73% of the cases, the most characteristic ECG change was a QRS prolongation (≥ 0.11 sec), this being found in 42% of the cases. About the same proportion displayed a QT prolongation and 28% had a prolonged PQ time. The mean of the QRS times was 0.11 sec. Unlike the QT time, the QRS time was not correlated to HR. Statistical analysis of the material with regard to clinical variables (dose of TCA, BP, coma duration, etc.) showed that the QRS time was closely related to the severity of poisoning. Five patients (3%) died, all of whom already on admission demonstrated advanced ECG changes with arrhythmias and a mean QRS time of 0.19 sec. Excluding dibenzepine poisonings (4 cases, all fatal), the mortality rate was 0.7%. The importance of high initial preparedness for cardiac complications is pointed out, as is the value of the QRS time as a guide to the severity of poisoning.
The Effect of Antilipolytic Agents on Cyclic AMP, Free Fatty Acid and Total Catecholamine Concentrations in Plasma
Authors: Strange R. C. , Rowe M. J. , Mjøs O. D. , Oliver M. F.
Published: August 2010

ABSTRACT Plasma concentrations of adenosine 3′:5′ cyclic monophosphate (cyclic AMP) and free fatty acids have been measured in 15 patients with acute myocardial infarction and in 6 dogs given infusions of isoprenaline. Plasma total catecholamines were also estimated in the patients. Inhibition of adipose tissue lipolysis with a nicotinic acid analogue did not decrease plasma cyclic AMP concentrations, either in the patients or when elevated in the dogs, thus suggesting that this tissue is not a major source of the nucleotide in plasma.
Effects of Metoprolol in Angina Pectoris
Authors: Keyriläinen Olavi , Uusitalo Arto
Published: August 2010

ABSTRACT Eighteen patients with angina pectoris, who had previously participated in a cross‐over study with 20 mg metoprolol t.i.d. and placebo, have been included in this study. During an introductory six‐month open tolerability study, all patients were treated with 50 mg metoprolol t.i.d. and during a subsequent cross‐over study, the efficacy of this dose was compared with that of placebo under double‐blind conditions. An exercise test was performed at the end of each cross‐over period. Metoprolol, in a dose of 50 mg t.i.d., gave a significant improvement compared with placebo in respect of the number of anginal attacks, nitroglycerin consumption and daily subjective assessment of the patients' anginal symptoms. Metoprolol also gave a significant increase in exercise capacity, both until the appearance of 1 mm ST segment depression and until the end of exercise. Heart rate and blood pressure were reduced both at rest and during exercise. No severe unwanted effects were observed during this study ranging over eight months, and none of the patients had any signs or symptoms of cardiac failure or pulmonary dysfunction on any occasion. Unwanted effects reported were mild to moderate, and the frequency was the same as during placebo treatment. No abnormal laboratory findings were observed and the relative heart volume was not significantly changed. Administration of 50 mg metoprolol t.i.d. seems to be of greater benefit than 20 mg metoprolol t.i.d., previously investigated in these patients.
Diabetes Mellitus and Acute Myocardial Infarction
Authors: Kvetny Jan
Published: August 2010

ABSTRACT. A series of 597 consecutive patients with acute myocardial infarction (AMI) have been screened for diabetes mellitus (DM). Six per cent of the series had DM, which is exactly the frequency of DM in an age‐matched population. This finding corresponds with results of other investigators, indicating that treated diabetics do not have an increased risk of AMI. Diabetics suffering from AMI do not have an increased mortality, nor do patients treated with oral antidiabetics have a higher mortality than those treated with insulin.
Metabolism of Mono‐ and Diacylglycerols in Subcutaneous Adipose Tissue of Obese and Normal‐weight Subjects
Authors: Arner Peter , Liljeqvist Lars , Östman Jan
Published: August 2010

ABSTRACT. Tissue monoacylglycerols (MG), diacylglycerols (DG), free fatty acids (FFA), and cyclic AMP (cAMP) and release of FFA and glycerol have been studied in vitro in subcutaneous adipose tissue of 6 obese and 7 normal‐weight subjects. The tissue was incubated without or with 6times10‐5 mol/1 of isoprenaline (ISNA). The DG level and the fat cell volume were strongly interrelated (r=+0.95, p<0.001). The concentration of DG was increased (p<0.05) in obesity. The changes in DG and MG were significantly interrelated (r=+0.65, p<0.05) during basal incubation. ISNA increased the DG concentration in a way that was correlated (r= +0.81, p<0.001) with the ISNA‐induced glycerol release. This indicates that 1) the basal metabolic activities of MG and DG lipase are similar and 2) DG lipase is an important rate limiting factor in lipolysis. Without ISNA, tissue FFA and the release of FFA and glycerol were significantly increased in the obese patients. As a mean, MG and DG did not accumulate in the basal state in the two patient groups. The findings indicate that basal lipolysis was increased in obesity. This was probably due to increased basal metabolic activity of triacylglycerol lipase, since the basal cAMP levels were similar in the two patient groups. In the presence of ISNA, the production of FFA and the glycerol release were similar in both patient groups, as was the increase in tissue DG. Also the ISNA‐induced maximal level of cAMP was similar in the two groups. With ISNA, a small increment of MG was observed in adipose tissue of the normal‐weight subjects. Taking all metabolites into account, the rate of lipolysis as well as the activation of triacylglycerol lipase via cAMP in the presence of ISNA appeared to be unaltered in obesity. Separate experiments with I‐‐14C‐ glycerol provided further evidence for the existence of a MG pathway for the esterification of FFA.
Serum Triglycerides and Fatty Acid Incorporation into Human Adipose Tissue (FIAT)
Authors: Walldius Göran
Published: August 2010

ABSTRACT. Fatty acid incorporation into adipose tissue (FIAT), the metabolic process assimilating plasma triglyceride fatty acids liberated by lipoprotein lipase, was recently found to be lower in hyper‐than in normotriglyceridaemia. In the present report, the relation of FIAT to glucose tolerance and adipose tissue morphology and fatty acid composition has been studied in a population of men with normo‐ and hypertriglyceridaemia, using needle biopsy specimens. In addition, the associations between plasma triglyceride concentration and these factors as well as FIAT were examined by statistical methods. FIAT and GLIAT (glucose incorporation into adipose tissue) activities per cell were positively correlated with fat cell diameter but not with fat cell number. FIAT activities per cell and per unit surface area were lower in hyper‐ than in normo‐triglyceridaemic subjects. The k‐value of the i.v. glucose tolerance test and glycerol release from adipose tissue did not correlate with FIAT or GLIAT activities. The proportion of stearic acid in adipose tissue was negatively correlated with the serum triglyceride level and with fat cell diameter, but positively correlated with FIAT. Linolenic acid in adipose tissue correlated positively with the k‐value. The negative correlation between serum triglycerides and FIAT remained when the other variables which were significantly correlated with FIAT or the serum triglycerides were entered in partial correlation analysis. These results suggest that although low FIAT activity is related in part to other characteristics, it occurs in hypertriglyceridaemia independent of glucose tolerance or various characteristics in fat. With serum triglyceride concentration as dependent variable, stepwise regression analysis was performed, entering all other variables as independent ones. The highest multiple k‐value was 0.76 (p<0.001) and it was obtained with three adipose tissue parameters: FIAT (or GLIAT), content of linolenic acid and of stearic acid. The other parameters did not give rise to any further improvement in the prediction of the serum triglyceride concentration which is better than 50% (R2=0.57).
Nephrotic Syndrome due to Subacute Glomerulonephritis—Association with Hydrocarbon Exposure?
Authors: von Schéele Christian , Althoff Peter , Kempi Viktor , Schelin Ulf
Published: August 2010

ABSTRACT. A 59‐year‐old man developed a nephrotic syndrome 40 days after hydrocarbon exposure of 3 days' duration. Renal biopsy gave evidence of a subacute proliferative glomerulonephritis. A lasting remission was obtained with immunosuppressive therapy. The case history is discussed in the light of recent studies indicating a causal relationship between hydrocarbon exposure and glomerulonephritis. The reversible nature of the disease in the present case is discussed in relation to the disease in experimental animals induced by a single administration of heterologous antigen.
A Case Report Including EM and DNA Repair Investigations in a Dermatosis Associated with Multiple Skin Cancers: Epidermodysplasia Verruciformis
Authors: Hammar Hans , Hammar Lena , Lambert Bo , Ringborg Ulrik
Published: August 2010

ABSTRACT. This report describes the clinical, histological and electron microscopic observations in a 51‐year‐old male with epidermodysplasia verruciformis (EV). Cells with early signs of malignant transformation were found closely connected with virus infected epidermal regions. Skin cancers appeared initially on sun‐exposed areas, such as the face and ear lobes. The UV‐induced DNA repair synthesis was therefore studied, utilizing peripheral leukocytes. The patient had 40% lower UV‐induced DNA repair synthesis than the mean of nine healthy subjects of the same age. These results suggest that a decrease in UV‐induced DNA repair synthesis in combination with a possibly oncogenic viral infection may enhance the disposition for somatic mutations and malignant transformation in patients with EV.
Systolic Time Intervals in Cardiac Tamponade
Authors: Brubakk Oddbjørn , Kalager Tore , Følling Magne , Solberg Claus Ola , Overå Olav
Published: August 2010

ABSTRACT. Systolic time intervals (STI) have been measured in three patients with cardiac tamponade. The left ventricular ejection time (LVET), the pre‐ejection period (PEP) and the ratio PEP/LVET deviated significantly from the normal values. All three parameters improved immediately after pericardiocentesis and aspiration. The total electromechanical systole changed to only a minor degree. Measurement of STI may be a valuable tool in the diagnosis and treatment of cardiac tamponade.
The Intercorrelation of Serum Cholsterol, Cigarette Smoking and Body Weight
Authors: Hjerman Ingvar , Helgeland Anders , Lund‐Larsen Ingar Holme Per G. , Leren Paul
Published: August 2010

ABSTRACT. A screening for coronary risk factors in 18000 Oslo men yielded 16525 “healthy” men, aged 20–49. The intercorrelation of serum cholesterol, body weight and cigarette smoking was found to be more pronounced than described in other studies. Increasing daily exposure to cigarette smoke in the order: never‐smoker, ex‐smoker, non‐inhaling smoker, inhaling smoker and present non‐filter smoker, was parallelled by increasing cholesterol levels, but not by increasing body weight. Daily cigarette‐smokers had lower body weight and higher serum cholesterol values than never‐cigarette‐smokers, with the exception of the 20+ cigarette‐smokers who had higher serum cholesterol values and body weight than the never‐cigarette‐smokers. As regards ex‐cigarette‐smokers, both body weight and serum cholesterol tended to increase with the number of cigarettes smoked before quitting. Possible explanations of these findings are discussed.
Thyroid Autonomy (Plummer's Disease) with Contralateral Malignancy—Mere Coincidence?
Authors: Wiener Jan D. , Frensdorf Ernst L.
Published: August 2010

ABSTRACT. A patient with an autonomously functioning nodule in the left lobe and a papillary carcinoma in the right lobe of the thyroid gland is described. Some evidence suggests the association to be more than coincidental.
Permanent Pacemaker Treatment at Gentofte Hospital
Authors: BERNING JENS , LARSEN BJØRN
Published: August 2010

ABSTRACT. Results of a follow‐up study of 125 patients treated with permanent pacemakers at Gentofte Hospital during the years 1962–1973 are presented. Complications with endocardial electrodes are reported and longevity curves of pacemaker units are given.

The series shows a high frequency of electrode displacement in the first three months and battery exhaustion from the 18th to the 42nd month.

The appearence of complications correlates with the frequences of check‐up intervals.

In order to predict pacing failure due to battery exhaustion, there would seem to be some merit in carrying out an oscilloscopic display of the pulse artifact in addition to the usual measurement of pulse frequency.

The aim of this retrospective report is, by analysing a pacemaker series for sudden electrode failures and battery longevity, to comment on the value of check‐up procedures in an outpatient pacemaker clinic.
Aetiology of Febrile Mucocutaneous Syndromes with Special Reference to the Provocative Role of Infections and Drugs
Authors: Ström Justus
Published: August 2010

ABSTRACT The survey covers 266 patients with febrile mucocutaneous syndromes. A brief account of the highly varied clinical picture is given. The syndromes constitute an allergic reaction which in most drug‐provoked cases appeared as a late immunological reaction of serum disease type; for the rest sensitization had probably often taken place. An allergic disposition could be traced in 34% of the cases. Infections and drugs were the causative factor in 235 cases (88.3%). Infections accounted for 25.2%, drugs for 36.1% and both together for 27.1%. An account is given of the provocative bacterial and viral infections and of the role of drugs in cases with and without infection. Among the remaining 31 cases an infection and/or drug may have been the provocative agent in 16 (6%) whereas 15 (5.6%) may have been due to alimentary and other factors.
Studies on Hereditary Spherocytosis in Iceland
Authors: Jensson ólafur , Jónasson Jóhann L. , Magnússon Sigmundur
Published: August 2010

ABSTRACT Thirty members with typical hereditary spherocytosis (HS) and over 90 apparently unaffected members belonging to 12 families have been studied. Splenectomy has been performed on 22 HS patients. Of nine HS individuals, who had not undergone surgical treatment in 1957, four suffered from temporary severe anaemia, presumably due to aplastic crisis associated with influenza. One of them died, a male 18 years of age. Pedigree studies on one of the families indicate that the HS gene or genes have been transmitted through six generations over the past 200 years. Marked deficiency in the number of affected compared with the apparently unaffected members in the HS families is present. The most striking example of uneven genetic ratio is a sibship of 15 members investigated haematologically, with one suffering from typical HS. Much reduced penetration of the HS gene or the presence of the so‐called “mild form” is upheld as the main explanation for the unevenness in the genetic ratio. However, families are also present in which abortions and death at an early age indicated that selection against the affected could also disturb the genetic ratio in HS families.
Regulation of Plasma Aldosterone in Anephric and Non‐nephrectomized Patients during Hemodialysis Treatment
Authors: ølgaard K. , Madsen S.
Published: August 2010

ABSTRACT The relationships between plasma aldosterone and changes in plasma potassium, plasma cortisol, plasma sodium, blood volume and body weight have been studied in 6 anephric and 11 non‐nephrectomized patients on regular hemodialysis. In all patients, the plasma aldosterone concentration decreased during dialysis. In the anephric patients, a significant correlation (p<0.001) was demonstrated between the fall in plasma aldosterone and the fall in plasma potassium (total body potassium depletion). Measurements between consecutive hemodialyses, furthermore, showed a significant correlation (p<0.001) in anephric patients between total body potassium repletion (increasing plasma potassium) and the rise in plasma aldosterone. In contrast, the potassium and aldosterone changes did not correlate in the non‐nephrectomized group. During dialysis, a decrease was found in all parameters, but no correlation was demonstrable in either group between the changes in plasma aldosterone and the fall in plasma cortisol, sodium, blood volume and body weight. The data in the anephric patients emphasize the important role of potassium in the regulation of aldosterone secretion.
The Effect of 1‐α‐hydroxycholecalciferol on the Renal Handling of Phosphate in Parathyroidectomized Man
Authors: Madsen S. , Ølgaard K. , Thaysen J. Hess
Published: August 2010

ABSTRACT In a previous investigation by our group it was suggested that the stimulating effect of 1‐α‐hydroxycholecalciferol (1‐α‐OH‐D3) on the tubular reabsorption of phosphate is mediated via the parallel suppression of the parathyroid hormone (PTH). A direct effect of 1‐α‐OH‐D3 on the renal tubule could however not be completely excluded. Therefore, the effect of 1‐α‐OH‐D3 was studied in 5 totally parathyroidectomized patients, in whom concomitant suppression of PTH would not occur. TmP/GFR, i.e. the ratio between the maximal tubular reabsorption of phosphate (TmP) and the glomerular filtration rate (GFR), was used as an indicator of the renal handling of phosphate. Estimation of TmP/GFR was performed 1) when the patients were vitamin D depleted and hypocalcemic, and 2) after 14–27 days of treatment with 1‐α‐OH‐D3 to obtain stable normocalcemia. In patients with absent parathyroid function, no effect of 1‐α‐OH‐D3 on TmP/GFR could be demonstrated. It is therefore concluded that 1‐α‐OH‐D3 exhibits no antiphosphaturic effect in the absence of PTH and that the previously demonstrated antiphosphaturic effect of 1‐α‐OH‐D3 in man is mediated via a concomitant suppression of PTH.
The Clinical Value of Serum Triiodothyronine, Thyroxine and Thyrotropin Estimations during Medical Antithyroid Treatment
Authors: Rogowski P. , Friis Th. , Kirkegaard C. , Siersbæk‐Nielsen K.
Published: August 2010

ABSTRACT The relation between clinical status and serial determinations of serum T3, serum T4 and serum TSH has been evaluated in the early phase of medical antithyroid treatment in 12 unselected hyperthyroid patients, and in 19 patients who later during treatment accidentally developed low serum T4 values. Determination of both serum T3 and serum T4 was found necessary to avoid undertreatment. Two patients with signs of hypothyroidism in the early phase developed low serum T4, while serum T3 and serum TSH remained normal. In all of the 19 patients selected with low serum T4, serum T3 was normal. Serum TSH was elevated in 5 patients without hypothyroid symptoms, while 2 developed hypothyroid symptoms in spite of normal serum TSH values. Our results suggest that serum T4 is a more sensitive parameter than both serum TSH and serum T3 in avoiding overtreatment during medical antithyroid treatment.
Combination Chemotherapy of an APUDoma
Authors: Hansen Mogens , Hansen Heine H. , Hansen O. Paaske , Hainau Bo
Published: August 2010

ABSTRACT Investigations are presented on the occurrence of tumour products during combination chemotherapy of a 49‐year‐old female with an APUDoma metastatic to the liver. Calcitonin was demonstrated in high concentration in the tumour tissue. Serum calcitonin, serum histaminase and 5‐HIAA in a 24‐hour urine sample increased immediately after the administration of cytotoxic agents, falling subsequently below the pretreatment level. These findings indicate a therapeutic effect with lysis of tumour cells. Continuous determination of the three tumour substances showed an increase in these products before clinical suspicion of progression. Electron microscopic examination during the initial course disclosed the tumour to be an APUDoma. Autopsy failed to disclose a primary site outside the liver. Further autopsy findings were an adenoma of the thyroid and a chromofobe adenoma of the pituitary, thus assigning the patient to type I multiple endocrine neoplasia.
Metabolism of Very Low Density Lipoprotein of Sf 100–400 in Type V Hyperlipoproteinaemia
Authors: Ballantyne Fiona C. , Ballantyne David , Olsson Anders G. , Rössner Stephan , Carlson Lars A.
Published: August 2010

ABSTRACT The metabolism of the apolipoproteins of very low density lipoprotein (VLDL) was studied in three subjects with primary type V hyperlipoproteinaemia (HLP) after injection of autologous 125I‐labelled VLDL of Sf 100–400. The fractional disappearance rate of total radioactivity was stable during the two‐week period of study. Transfer of apolipoprotein C (apo‐C) from VLDL to high density lipoprotein (HDL) occurred both in vivo and in vitro upon mixing the labelled VLDL preparation with serum and significant amounts of 125I‐labelled apoli‐poprotein B (apo‐B) and apo‐C were recovered in the chylomicron fraction (Sf >400) in both situations. The time‐courses of the disappearance of specific activity from VLDL (Sf 20–400) and its appearance in low density lipoprotein (LDL) are consistent with apo‐B in VLDL (VLDL‐B) being the precursor of that in LDL. In comparison to studies in which the whole VLDL class (Sf 20–400) was labelled, the rate of synthesis of VLDL‐B was slightly decreased and the fractional rates of catabolism (FCRs) of apo‐B in VLDL and in the whole spectrum of VLDL+chylomicrons were markedly depressed. In turn, the rate of formation of LDL was low, and its FCR was probably slightly decreased. The findings are consistent with the belief that in these three subjects the type V HLP is to a great extent due to impaired rates of formation and breakdown of apo‐B in VLDL. They do not exclude the possibility that the disorder is also caused by an increased rate of formation of chylomicrons.
Free Fatty Acids in Plasma and Platelets Following Low and High‐Dose Heparin during Alimentary Hyperlipaemia
Authors: Nordøy Arne , Vik‐Mo Harald , Mjøs Ole D. , Johnsen Roar
Published: August 2010

ABSTRACT A high caloric meal composed of mainly saturated or unsaturated fatty acids was given to 10 healthy male subjects. Three hours later, during the period of alimentary hyperlipaemia with high plasma triglyceride levels, they were given 5000 U heparin s.c. or 15000 U heparin i.v. During the subsequent three hours, plasma and platelet triglycerides, plasma and platelet FFA and platelet number were registered. A marked increase in plasma FFA was observed on both occasions, most pronounced initially after the high‐dose heparin. The concentrations were still markedly increased after both dosages three hours after administration. The platelet FFA also showed a moderate but significant increase at the end of the experiment. Both plasma and platelet FFA reflected the fatty acid composition of the dietary fatty acids. After high‐dose heparin, a positive correlation was established between the plasma TG level at the time of heparin administration and the subsequent increase in plasma FFA. A transient drop in the number of circulating platelets was registered after high‐dose heparin. In 6 patients with thromboembolic disorders treated with a continuous i.v. heparin infusion, no marked changes were observed in plasma TG or plasma FFA after an ordinary breakfast. The possible harmful effects of high levels of FFA are discussed. It is suggested that the actual plasma TG level should be estimated by inspection of plasma before heparin treatment is initiated.
The Adrenocortical Response to Angiotensin II Infusion in Anephric and Non‐Nephrectomized Patients on Regular Hemodialysis
Authors: Ølgaard K. , Madsen S. , Hammer M.
Published: August 2010

ABSTRACT In the present study 8 anephric and 4 non‐nephrectomized patients were stimulated with angiotensin II (A‐II). In 5 of the anephric patients, an increased plasma aldosterone concentration (PAC) in response to ACTH stimulation had previously been demonstrated. After A‐II stimulation, all 8 anephric patients responded with a significant rise in PAC although the increase was less pronounced than in 4 non‐nephrectomized patients. In both groups of patients the increase in PAC was correlated to the increase in diastolic and systolic BP and to the A–II dose. Furthermore, in the non‐nephrectomized patients, the plasma renin activity showed a significant decline, which was inversely correlated to the increase in PAC. When all 12 patients, regardless of the difference in remaining renin–angiotensin system, were considered as one population, the variable basal levels of PAC correlated significantly to the increase in PAC during A–II and ACTH stimulation. It is concluded that the adrenals of anephric man respond to A–II with an increase in PAC and that the reason for a lower response appears to be the lack of the renin–angiotensin system.
Recording of Drug Prescriptions in the County of Jämtland, Sweden
Authors: Boethius G.
Published: August 2010

ABSTRACT The pattern of drug usage as obtained from a continuous recording of prescriptions in the county of Jämtland, Sweden, is described. Of 16600 persons monitored, about 60% purchase prescription drugs every year. Considering all drugs, 55 % of the patients make 4 purchases or less and 21% 10 purchases or more (mean 6.2 for men, 7.1 for women). A small portion (4%) of the patients accounts for 20% of the total prescriptions and 21% of the total costs. The six largest pharmacologic groups of drugs, antimicrobials (prescribed to 21% of the population), analgesics (19%), psychotropics (18%), drugs used in respiratory diseases (15%), cardiovascular (14%) and gastrointestinal drugs (13%), constitute 67% of total purchases and 73% of total costs. Evidence for the representative nature of the recorded data is presented. Women dominate in all age groups except the youngest and in all main groups of drugs. Although exposition to drugs generally increases markedly with age, prescriptions of antiallergic and ear, nose and throat drugs decrease with increasing age. As the indication for the prescription is not recorded, the relationship between prescription and incidence of disease is clear only for drugs used for a single indication, e.g. antidiabetics. With the exception of drugs such as antidiabetics, cardiac glycosides and antihypertensives, there is a marked fall in prescribing during the summer. Every year 50% of the patients receive prescriptions from one physician only, while 1% obtain drugs from 7 or more doctors. Physicians outside the county hospital (30% of total) issue 74% of the total prescriptions. The total number of prescribed drug specialities has been little affected by the recommendations from the Drug Committee of the county but the number of recommended drugs which were prescribed by many physicians increased from 1972 to 1975. In the case of serious adverse drug reactions, the data will provide information on the number of patients exposed to the drug, the duration of exposure and the number of physicians who prescribe the drug. At the time of its withdrawal from the market, practolol had been prescribed to 112 of the monitored individuals, who could have been reached for follow‐up if necessary. Seven of the 33 physicians prescribing the drug issued their first prescription after the manufacturer's preliminary warning about side‐effects.
Bone Changes during Prednisone Treatment
Authors: Deding Aage , Tougaard Lars , Jensen Mogens Krogh , Rødbro Paul
Published: August 2010

ABSTRACT To evaluate changes in bone composition during treatment with corticosteroids, the bone mineral content (BMC, measured by photon absorptiometry) and the degree of bone mineralization (measured as the bone phosphorus/hydroxyproline ratio) were determined in 18 patients during prednisone treatment for haematological and connective tissue diseases. The prednisone dose ranged from 12 to 51 mg/day (mean 27). The BMC decreased significantly (mean 2.5%) during the studied 12 weeks of treatment, but the change did not correlate significantly to the prednisone dose. The degree of bone mineralization remained unchanged, indicating equal losses of mineral and of collagen in bone during prednisone treatment. The changes correspond to a rapidly developing osteoporotic state.
Acute Hepatitis: A Prognostic Study with Observation Time up to 37 Years
Authors: Dietrichson O. , Zoffmann H. , Christoffersen P. , Hilden M. , Juhl E. , Thomsen Å. Chr.
Published: August 2010

ABSTRACT Re‐evaluation of 890 consecutive liver biopsies from 1939–59 gave the diagnosis of acute hepatitis in 147 patients. A follow‐up study of these patients was performed 15–37 years after the diagnostic biopsy, based on repeated liver biopsies, biochemical liver tests, autopsy reports and death certificates. Two patients died from acute liver failure, and development of cirrhosis was documented or strongly suspected in 22 patients (15%). A comparison between these 24 patients with a malignant course of hepatitis and 86 patients with a well documented uncomplicated disease, revealed a significantly larger number of women, a higher age, and more cases with piece‐meal necrosis, confluent necrosis and marked portal inflammation in the intitial liver biopsy in the group with the poor prognosis.
Serum Inorganic Phosphate in Middle‐Aged Men
Authors: Lindgärde Folke , Trell Erik
Published: August 2010

ABSTRACT Serum inorganic phosphate was determined in 752 men born in 1926. An inverse correlation was found between serum inorganic phosphate levels and body weight. Other parameters of possible relevance to this finding, such as serum calcium, serum albumin, serum γ‐glutamyltransferase, and the occurrence of upper gastrointestinal disorders were analysed, and no correlations to the phosphate level were detected.
Glucose Tolerance and Insulin Release in Hypertensive Patients Treated with the Cardioselective β‐Receptor Blocking Agent Metoprolol
Authors: Ekberg Göran , Hansson Bengt‐Göran
Published: August 2010

ABSTRACT Blood glucose and plasma insulin levels were studied under fasting conditions and following an i. v. and an oral glucose load, respectively, in nine males with moderate hypertension before treatment, after one month on placebo and after three months on the cardioselective β‐receptor blocking agent metoprolol. The studies were performed under metabolic ward conditions. The reproducibility of blood glucose and plasma insulin values following an i. v. glucose load was very good. Medication with metoprolol caused no changes in the fasting levels of blood glucose or plasma insulin, nor in the blood glucose response following a glucose load given i. v. or orally. The initial and total integrated insulin response to the i. v. administration of glucose was similar before and during metroprolol. Following oral glucose both the total integrated blood glucose response and the insulin response were unaffected by treatment with metoprolol.
Bone Marrow Kinetic Studies on Three Patients with Myelomatosis
Authors: Mellstedt H. , Killander D. , Pettersson D.
Published: August 2010

ABSTRACT The proliferative activity has been studied in lymphocyte and plasma cell populations of purified bone marrow from three myeloma patients. In one of them, proliferation was also recorded in blood lymphocytes. Immunofluorescence studies, using idiotypic antisera against the M‐component, were performed to identify lymphocytes and plasma cells belonging to the malignant cell clone. Pulse incubations with 3H‐thymidine (3H‐TdR) were made in vitro. Autoradiographic analyses revealed a higher overall 3H‐TdR labelling index in the myeloma cell populations than in normal control cell populations. A few labelled plasma cells were observed in the myeloma cases (2.5–5%) but the major fraction (11.5–14 %) and intensity of labelled cells were found among the lymphoid cells. This indicates that the proliferation of malignant cells in myeloma occurs not only within the plasma cell but also in the lymphoid cell population. The results provide additional support for the assumption that B‐lymphocytes are part of the malignant cell clone in myelomatosis and most likely precursors to the myeloma plasma cells.
Paroxysmal Ventricular Fibrillation in Children
Authors: Wennevold Alf , Sandøe Erik
Published: August 2010

ABSTRACT A long‐term follow‐up report is given on three children with stress‐induced bursts of ventricular activity, occasionally proceeding to ventricular fibrillation causing syncope. All patients were treated with a β‐blocking agent as prophylaxis for 12, 10 and 6 years, respectively. Case 1 has no signs of organic heart disease. She has been followed from the age of 8 years and had her last syncope in 1974. She was last seen in Nov. 1976, doing well at the age of 20. Case 2 started having syncopes after an attack of measles at the age of 8 years, at which time she probably acquired some damage to her myocardium. She had persistent bradycardia but no other signs of heart disease. She had an uneventful pregnancy and delivery in 1973 and gave birth to a normal child. She died suddenly in 1974, at the age of 22, four years after her last syncopal attack. Case 3 had cardiomyopathy with increasing heart size and exertional dyspnoea and marked ischaemic ECG changes during exercise. He was followed from the age of 7 years. He died suddenly in 1974 at the age of 16, four years after his last syncope.
Digitalis Therapy in a 70‐Year‐Old Population
Authors: Landahl S. , Lindblad B. , Roupe S. , Steen B. , Svanborg A.
Published: August 2010

ABSTRACT In the population study “70‐year‐old people in Gothenburg” 14% of the probands were found to be undergoing treatment with digitalis, 6% with digoxin, 6% with digitoxin and 2% with other glycosides. A comparison between results of the interview method and those of S‐digoxin analyses indicates that the interview method was acceptable. As far as can be judged from S‐digoxin analyses, only about 60% of the treated patients were on a dosage considered to be effective and free from obvious risks of side‐effects. Out of the 130 70‐year‐olds who were on digitalis treatment, 37% had obvious symptoms of heart disease requiring such treatment, 34% lacked symptoms of arrhythmia and/or congestive failure but had heart volumes larger than those used as reference values in younger age groups, and 29% had no symptoms indicating digitalis treatment. At least 13% of the population had indications for digitalis therapy and about 75% of those apparently needing digitalis were on such treatment. Thus both over‐ and underdiagnosis of heart disease requiring digitalis therapy were common in this age group.