bluuebunny/crossref_metadata_2025 huggingface dataset:
Alcohol‐related Death and Associated Risk Factors in Urban Middle‐aged Males
Authors: PETERSSON BO , TRELL ERIK , HOOD BERTIL , KRISTENSSON HANS
Published: August 2010

ABSTRACT Alcohol‐related disorders belong to the spectrum of major non‐infectious diseases in Western societies which can be prevented by means that have not yet been fully implemented. Total consecutive mortality in a population of 10 353 middle‐age males invited to take a part in a preventive medical population program in Malmö was followed up for 3.5–8.5 years (mean 4.5) after the time of invitation and analysed in relation to participation or non‐participation and forensic or in‐hospital autopsy. Entry characteristics in the 7935 males who attended the screening were compared in order to evaluate risk factor patterns for the major categories of premature death during the follow‐up period. Even in the males participating in the screening, alcohol‐related deaths (ARD) constituted a major mortality category, comprising 55 of 218 cases, whereas cancer comprised 61 and coronary heart disease (CHD) 50 of the premature deaths in this group. Both in the ARD and CHD categories of male premature mortality, significant and distinctly differential risk factor patterns were found; in CHD for smoking, cholesterol, serum triglycerides and systolic blood pressure, and in ARD for γ‐glutamyltransferase, questionnaire alcoholism screening test and, inversely, serum cholesterol and serum creatinine. In both groups of diseases, these risk factors could be combined into highly predictive multiple logistic risk factor functions. The discriminative power of this instrument was even higher in ARD than in CHD deaths. In consequence, these factors may be applied both as indicators of the ARD risk and as signals and instrument for directed preventive measures in analogy with previously well established and tested methods for the regulation of blood pressure, serum lipids, etc. in the conquest of the cardiovascular diseases.
Impaired Left Ventricular Filling in Young Female Diabetics
Authors: AIRAKSINEN J. , IKÄHEIMO M. , KAILA J. , LINNALUOTO M. , TAKKUNEN J.
Published: August 2010

ABSTRACT To assess left ventricular (LV) function in diabetes mellitus, M‐mode echocardiograms were recorded in 36 insulin‐treated diabetic women, mean age 25±6 (SD) years, and 13 healthy women of the same age. Echocardiographic tracings of the septum and LV posterior wall were digitized and continuous plots were made of LV dimension and its rate of change. The pattern of LV filling was abnormal in 19 diabetics, when the mean value ±2 SD in the healthy women was taken as the normal range of the indices. The most common abnormality was a prolonged rapid filling period. The LV systolic function was normal in all diabetics. Diabetics with severe microvascular complications had thicker LV walls (p<0.05) and smaller LV end‐diastolic diameters and stroke volumes (p<0.01) than the healthy women. The electrocardiographic voltage was lower in the diabetic group (p<0.05). These studies suggest that minor abnormalities in LV function reflecting stiffness of the myocardium are common in young female diabetics, a patient group with a relatively low prevalence of coronary artery disease.
Increased Peripheral Catecholamine Release in Patients with Long‐Standing, Untreated Essential Hypertension
Authors: E.Kjeldsen Sverre , Flaaten Borgar , Eide Ivar , Helgeland Anders , Leren Paul
Published: August 2010

ABSTRACT. Both arterial and venous plasma adrenaline and noradrenaline concentrations were elevated in 20 middle‐aged men with long‐standing, untreated essential hypertension compared to 19 normotensive control men (p<0.01). The mean a‐v (arterial‐venous) difference of adrenaline and v‐a difference of noradrenaline were increased in the hypertensive (p<0.05) consistent with raised adrenal adrenaline release and release of noradrenaline from the peripheral vascular beds of the forearm.
CHANGES IN INTRAERYTHROCYTE CONTENT AND TRANSMEMBRANE FLUXES OF SODIUM DURING SALT LOADING IN SUBJECTS WITH AND WITHOUT FAMILY HISTORY OF HYPERTENSION
Authors: Herlitz Hans , Gudmundsson Ottar , Jonsson Olof , Nauclér Jacob , Berglund Göran
Published: August 2010

ABSTRACT. We studied 17 young normotensive men with family history of hypertension (H) in two generations (father and grandfather) and 17 age matched control subjects (C) with respect to intraerythrocyte sodium (IeNa), sodium influx, and rate of sodium efflux. The investigation was done during ordinary salt intake and after four week's salt load.

H had a significantly higher IeNa (9.5 ± 0.4 mmol/l) compared to C (8.2 ± 0.3 mmol/l), p < 0.01. After salt loading H decreased significantly to 8.1 ± 0.3 mmol/l while C did not change significantly (7.6 ± 0.3 mmol/l). There was no significant difference between H and C in Na influx either on normal or on high salt intake. The rate constant for Na efflux was significantly lower on normal salt intake in H (0.0038 ± 0.0003 vs 0.0050 ± 0.0004 min, p < 0.05). High salt intake increased the efflux rate constant significantly in H (0.0048 ± 0.0003 min‐1, p < 0.05), while control subjects showed no difference (0.0053 ± 0.0004 min‐1) compared to pre‐salt conditions.

Our results suggest that young men with heredity for hypertension have a higher intraerythrocyte Na‐content secondary to a lower rate of Na efflux. The Na influx did not differ between the two groups probably indicating an unchanged permeability for sodium in subjects with a family history of hypertension.
A HIGH MOLECULAR WEIGHT FORM OF ANGIOTENSIN I IS GENERATED IN RAT SERUM INCUBATED WITH SYNTHETIC AND NATIVE ANGIOTENSIN I
Authors: Lauritzen Edgar , Rubin Inger
Published: August 2010

Summary A high molecular weight form of angiotensin I, ‘big angiotensin I’ with m.w. 25000 was generated in rat serum incubated with angiotensin I (m.w. 1296). Angiotensin I and ‘big angiotensin I’ were separated by sodium dode‐cyl sulphate polyacrylamide gelelectrophoresis (SDS‐P3GE) and extracted from the gels. Only sera with high concentrations of angiotensin I (2000–4300 ng per ml) incubated at neutral pH at 24 C for several hours, contained ‘big angiotensin I1.’ Big angiotensin ‘I was stable in sera’, where angiotensin I was rapidly degraded. The proportion of ‘big angiotensin I’ to angiotensin I in sera, where angiotensin I was stable, was approx. 5%. In addition to ‘big angiotensin I’, which was generated during the incubations, a serum protein with m.w. 60000 was extracted from the SDS‐PAGE. This protein had angiotensin I‐like activity in the radioiimunoassay, and it was isolated from the unincubated sera in concentrations at the detection limit of the radioimmunoassay.
On the Mechanism of Action of Calcium Antagonists
Authors: Andersson K.‐E. , Högestätt E.D.
Published: August 2010

A short review is given of possible mechanisms of action of the organic “calcium antagonists”. Calcium antagonists comprise a chemically heterogenous group of drugs, and the term may be used to denote agents that inhibit Ca2+‐dependent processes or regulatory mechanisms without acting at other sites. Such drugs may be subdivided into those that decrease the availability of Ca2+ to the myoplasm, and those that decrease the cellular effects of Ca2+ without lowering the intracellular Ca2+ concentration. Accordingly, calcium channel blockers, such as verapamil, nifedipine, and diltiazem, form a subgroup of calcium availability inhibitors, as they block influx of extracellular calcium through ion selective channels in the membrane both in cardiac and smooth muscle. However, it cannot be excluded that some of these drugs, particularly in smooth muscle, may have additional sites of action, which must be taken into consideration when they are used as investigational tools.
Influence of Verapamil on Glucose Tolerance
Authors: Röjdmark Sven , Andersson Dan E.H.
Published: August 2010

Verapamil has previously been found to inhibit insulin release from pancreatic β‐cells in laboratory animals. In our department, however, both oral pretreatment with verapamil for one week and a 3‐hour iv infusion of the drug improved the tolerance to oral glucose in type II diabetics without affecting insulin release. It failed, however, to potentiate the hypoglyemic effect of oral glibenclamide therapy in patients with type II diabetes. Since iv infusion of verapamil left the portal vein glucose response to glucose ingestion unaffected in normoglycaemic patients (being portal vein catheterised for diagnostic purposes), it seems unlikely that the hypoglyceamic effect of verapamil could have been due to reduced glucose absorption from the gut. More likely is that verapamil, in the diabetic patients, influenced metabolic processes inside the hepatocytes that are of importance for glucose homeostasis.

In‐vitro experiments have shown that calcium affects factors of importance for the glucose metabolism. Accordingly, calcium triggers the stimulus‐secretion coupling process which leads to insulin release from the pancreatic β‐cells (1). Calcium also tightens cell membranes, thereby decreasing their permeability to various substances, including glucose (2). Finally, calcium mediates cellular responses to glucagon stimulation (3,4) and thus affects the hepatic glucose output. Calcium apparently influences glucose metabolism by several pathways and different overall effects on the blood glucose concentration may be forthcoming depending on which of these pathways is the dominating one.

In view of these well‐documented in‐vitro effects of calcium on some of the metabolic processes which determine the glucose tolerance, it is surprising to find that relatively few clinical studies have been carried out to investigate whether calcium antagonists influence glucose tolerance in man. Although a few such studies, dealing with the effect of nifedipine (5,6) and verapamil (7,8,9,10) on human glucose tolerance have been performed recently, the result obtained in these investigations have been highly conflicting. Our intention has therefore been to elucidate how oral and iv administration of verapamil affects glucose tolerance not only in normoglycaemic subjects, but also in patients with untreated, and sulfonylurea‐treated type II diabetes.
Verapamil or Propranolol in the Treatment of Stable Angina Pectoris of Effort
Authors: Sigurd Bjarne , Fischer Jørgen
Published: August 2010

In a double blind cross‐over study the effect of verapamil (Isoptin) 360 mg/d and propranolol 180 mg/d was evaluated in patients with stable angina of effort. The results of verapamil and propranolol treatment were compared to a single blind placebo period of 2 weeks.

Both verapamil and propranolol caused a significant reduction in nitroglycerin consumption, days with angina pectoris and in severe angina attacks as compared to placebo. A 50% reduction in angina pectoris attacks and/or nitroglycerin consumption compared to placebo was demonstrated in thirteen of eighteen patients during verapamil treatment (P < 0.01) and in seven of seventeen patients during propranolol treatment (P > 0.05). Of sixteen patients completing both treatment periods, ten were improved both on verapamil and propranolol, three on verapamil only, one on propranolol only, one was unchanged and one deteriorated on verapamil and propranolol. During exercise, maximum exercise capacity was increased during verapamil as compared to placebo (P < 0.01) and propranolol (P < 0.02). Maximum exercise capacity was not increased after propranolol as compared to placebo.

These findings, that verapamil is at least as effective as propranolol in the treatment of angina of effort, are in accordance with other reported series.
Verapamil and Propranolol: A Comparison of Two Antihypertensive Agents
Authors: Leonetti G. , Pasotti C. , Ferrari G.P. , Zanchetti A.
Published: August 2010

Verapamil, a calcium antagonist, was compared with propranolol, a widely used beta‐adrenoreceptor blocker, in hypertensive patients with respect to its antihypertensive efficacy and incidence and severity of adverse effects.

Both drugs caused similar blood pressure reductions without interfering with pulse pressure. The hypotensive effect of verapamil was not accompanied by any effect on heart rate, while after propranolol there was a significant bradycardia. ST‐segment and T wave abnormalities at rest and after exercise were partially or completely reverted by both drugs.

The incidence and severity of adverse effects was very low and no patient was withdrawn from the study because of complaints due to the active drugs.

Verapamil can be compared as antihypertensive drug to the beta‐blocker propranolol and this may justify, together with the absence of negative effects on lipids, blood sugar, serum electrolytes and renal function, its use as an antihypertensive drug of first choice.
Measurement of Drug Utilization in Sweden: Methodological and Clinical Implications
Authors: Bergman Ulf , Sjöqvist Folke
Published: August 2010

ABSTRACT. The available sources of information on drug utilization in the Swedish population at large are reviewed. They comprise whole‐sale statistics, drug deliveries to hospitals and prescription data. Drug consumption is preferably expressed in defined daily doses (DDD) per capita, where DDD is the average recommended dose on the major indication of the drug. Under ideal circumstances–drugs used continuously on one indication–the number of DDDs per population ought to agree with morbidity data. This turned out to be the case with antidiabetic drugs. The pitfalls with this unit of measurement include major discrepancies between recommended and prescribed doses, and the use of the drug on vastly different indications (such as neurosis and psychosis in the case of neuroleptics). Nevertheless, the DDD methodology may serve as a therapeutic audit in attempts to follow and influence therapeutic habits of health personnel in hospitals and primary health care. Wholesale data combined with individual‐based prescription data are particularly useful in this regard.
The Epidemiological Evaluation of Drugs
Authors: Shapiro Samuel
Published: August 2010

ABSTRACT. Depending on the research problem, the epidemiological evaluation of drugs must be based on a combination of research strategies that include experimental methods (controlled trials), and non‐experimental methods. Among the latter are correlational studies; spontaneous reporting systems and published case reports; cohort studies; and case‐control studies. The spread of computer technology may, by record linkage, facilitate cohort or case‐control studies. Comprehensive drug surveillance must be based on the combined use of each research strategy, as appropriate.
Case‐control Studies in the Assessment of Drug Safety
Authors: Vessey Martin P.
Published: August 2010

ABSTRACT. In a case‐control study, the basic approach is to identify a group of subjects newly presenting with the illness of interest and to discover how many of them were exposed to the suspected cause. The frequency of exposure in these cases is then compared with that in a series of control subjects free from the illness under investigation. Many of the epidemiological studies of drug‐induced illness now appearing in the literature are of the case‐control type, principally because such studies are usually easy to set up, are reasonably cheap, and can often be completed in a short space of time. This paper considers the main areas of methodological importance in carrying out a case‐control study of the effects of drugs–i.e. selection of cases, selection of controls, identification of exposure to drugs under study, influence of confounding factors, analysis of the data and interpretation of the results. It is noted that accurate, up to date and accessible registers of disease events and drug exposures relating to identifiable individuals are of great assistance in the conduct of case‐control studies.
Patterns in Drug Utilization–National and International Aspects: Psychoactive Drugs 1966–80
Authors: King David J. , Griffiths Kathryn
Published: August 2010

ABSTRACT. Although the press claimed there were dramatic increases in the use of tranquillizers in Northern Ireland after the outbreak of civil unrest in 1969, our data, based on the computerised pricing system for drugs prescribed in the province, showed average annual increases of about 20% from 1966 to 1969, and 10% from 1970 to 1975, thereafter tranquillizer prescribing levels reached a plateau and declined between 1979 and 1980. Total psychotropic drug use also reached a peak in 1975, when about 12.5% of the adult population were estimated to have been receiving such a drug, and declined in the following 5 years. Benzodiazepines accounted for three‐quarters of all psychotropic drugs and 98% of tranquillizers prescribed in 1980. Benzodiazepine tranquillizer prescribing has consistently been 20–30% higher than the rest of the United Kingdom, in contrast to hypnotic and antidepressant prescribing which has been consistently lower. The rate of increase in benzodiazepine tranquillizer prescribing over the decade from 1966 was greater than in other European countries, overtaking the level in Norway in 1972 and has since remained third to Iceland and Denmark. Some possible demographic and socioeconomic determinants of these trends are discussed. The prescribing of benzodiazepine hypnotics was almost entirely explained by these variables.
Is Hemoglobin Concentration a Predictor for the Outcome of Distal Gangrenous Lesions in Diabetics?
Authors: WETTER LARS , LITHNER FOLKE , HALLMANS GÖRAN
Published: August 2010

ABSTRACT. The predictive value of some routine laboratory tests given on admission was evaluated in a retrospective study to determine whether any given value could predict the outcome of distal gangrenous lesions and amputations in diabetic and nondiabetic patients. There was no difference in preoperative hemoglobin concentration between successful and unsuccessful amputations in 45 diabetic and 59 nondiabetic patients. In another group of 191 diabetic patients with distal gangrenous lesions, the lesions healed after nonsurgical treatment in 112 patients, 54 patients were submitted to amputation and 25 patients died before the lesions healed. Patients submitted to amputation had lower hemoglobin levels and higher erythrocyte sedimentation rates and white blood counts than patients in whom the lesions healed, whilst there were no differences between these two groups concerning blood glucose concentration or body temperature.
Foot Angiography in Diabetic Patients with Gangrene
Authors: HIETALA SVEN‐OLA , LITHNER FOLKE
Published: August 2010

ABSTRACT. The most unpleasant side effect of peripheral angiography is an intense pain and a burning sensation following the injection of the contrast material. It was recently shown (1) that the use of a non‐ionic and less hypertonic contrast medium (metrizamide) in femoral angiography was associated with less pain when compared to an ionic medium (metrizoate). We thought it therefore advisable to perform foot angiography with such a non‐ionic contrast medium (Amipaque, Nyegaard & Co, Oslo, Norway) in 9 diabetic patients with soft tissue and skeletal lesions of the foot. The angiographic examination was considered valuable for planning of therapy and predicting the prognosis. The results of the examinations are illustrated and discussed with regard to visualization of the digital arteries, subjective reactions to the angiographic examination and relationship of the vascular findings to soft tissue and skeletal lesions. It is stated that foot angiography performed with a non‐ionic contrast medium is painless and allows contrast filling of the most peripheral digital arterial branches. On the basis of the angiographic findings the gangrenous lesions were categorized as ischemic or non‐ischemic.
Plasminogen Content in Diabetic Wounds
Authors: WIMAN BJÖRN , LITHNER FOLKE
Published: August 2010

ABSTRACT. Plasminogen concentrations in secretions from distal wounds of 10 diabetic and 5 non‐diabetic patients were determined spectrophotometrically. The plasminogen content in the secretions from the wounds was very low, only about 2% of the plasminogen content in plasma. There was no significant difference between diabetic and non‐diabetic wounds concerning plasminogen content.
Amputations in Diabetic Patients in Gotland and Umeå Counties 1971–1980
Authors: LINDEGÅRD PER , JONSSON BERNT , LITHNER FOLKE
Published: August 2010

ABSTRACT. In two counties of Sweden, Gotland and Umeå, lower leg or thigh amputations were performed during 1971–1980 in 111 and 71 diabetic patients, respectively. These figures correspond to 20.5 and 6.5 per 100000 inhabitants and year, respectively. The corresponding incidence for Umeå city and the rural area surrounding Umeå was 3.1 and 13.8/100000 inhabitants and year, respectively. The lower frequency of amputations in Umeå was probably the consequence of a restricted period of systematic search for early signs of gangrene, as a part of a research program, but other factors could also be of importance and these are discussed. The death rate of the patients was high in both series, after 2 years only about one third of the patients were still alive.
Serum Immunoglobulin Sedimentation Patterns and Circulating Immune Complexes in IgA Glomerulonephritis and Schönlein‐Henoch Nephritis
Authors: DANIELSEN H. , ERIKSEN E. F. , JOHANSEN A. , SØLLING J.
Published: August 2010

ABSTRACT Sera from 8 patients with IgA glomerulonephritis and from 6 patients with Schönlein‐Henoch nephritis were investigated by the Clq‐binding assay (Clq‐BA) test and by sucrose gradient centrifugation followed by sensitive solid phase radioimmunoassay determinations of IgA, IgG and IgM in each fraction obtained. Abnormal sedimentation profiles were found in sera from 3 of 8 patients with IgA nephritis and in 3 of 6 patients with Schönlein‐Henoch nephritis. The abnormal fraction consisted of low molecular weight IgA in 2 patients, IgG in 1 patient and IgM in 4 patients. The absolute level of polymeric IgA was increased in 3 of 8 patients with IgA nephritis, but the relative distribution was normal. An abnormal sedimentation pattern of immunoglobulins was correlated to a positive Clq‐BA test (p<0.001).
Thyroid Blocking Antibodies in Thyroiditis
Authors: KARLSSON F. ANDERS , DAHLBERG PER ANDERS , RITZÉN E. MARTIN
Published: August 2010

ABSTRACT Serum from a woman with a history of Hashimoto's thyroiditis, who had given birth to two children with congenital hypothyroidism, contained potent TSH blocking activity. Immunoglobulin preparation from this serum abolished completely TSH‐stimulated cAMP production in human thyroid membranes. The blocking activity was associated with the IgG fraction absorbed to and eluted from a Protein A column. The stimulation of adenylate cyclase by a preparation of thyroid‐stimulating antibodies from a patient with Graves' disease was also inhibited by the antibodies. In contrast, no effect was observed upon fluoride‐stimulated cAMP production. The data indicate that the antibody activity was directed against the TSH receptor. Immunoglobulin preparations from 22 other patients with Hashimoto's thyroiditis and 16 patients with subacute thyroiditis were examined for the existence of TSH receptor blocking antibodies. A blocking activity was found in two of the 22 Hashimoto patients. No such activity was found in the patients with subacute thyroiditis. It appears that thyroid blocking antibodies sometimes contribute to hypothyroidism associated with Hashimoto's thyroiditis.
Endemic Goitre in the Darfur Region (Sudan)
Authors: ELTOM M. , HOFVANDER Y. , TORELM I. , FELLSTRÖM B.
Published: August 2010

ABSTRACT In the Darfur region of Sudan, 85.5% of 4134 subjects examined, mainly school children, had goitre and in 23.9% the goitre was large (stage II or III). The prevalence of goitre was high in prepubertal children of both sexes and in adult females. There was a higher frequency of large goitre in the rural than in the urban areas (40.9 nad 11.4%, respectively). In Port Sudan on the Red Sea Coast the goitre rate was 13.5% among 7697 schoolchildren, but here visible goitre was extremely rare. Of the subjects from Darfur, 54.5% excreted less than 50 μg of iodine/g creatinine, while all except one subject in Port Sudan excreted mote than that. the median urinary excretion of iodine was 45.6μg/g in subjects from Darfur and 171.2 in those from Port Sudan, the mean value being significantly lower in the former than in the latter (p<0.001). The iodine content of all water samples was very low, nad the contents of calcium nad fluoride were not high. Ohter goitrogenic facotrs cound not be excluded. However, iodine dificiency is the major cause of goitre in the Darfur region nad a prophylactic programme is urgently needed.
Effect of Sulfonylurea on Glucose, Insulin and C‐peptide Responses to a Meal Stimulus in a Patient with Type 2 Diabetes and Liver Disease
Authors: AHRÉN BO , SCHERSTÉN BENGT
Published: August 2010

ABSTRACT The influence of two sulfonylureas on blood glucose and plasma immunoreactive insulin (IRI) and C‐peptide responses to a standardized meal was investigated in a patient with type 2 diabetes and a liver disease with enhanced peripheral levels of liver enzymes. The very high fasting values of plasma IRI and C‐peptide were further elevated by the meal. This response to the meal was markedly enhanced by both sulfonylureas, glipizide and glibenclamide. The blood glucose increment after the meal was diminished by sulfonyl‐ureas. Sulfonylureas thus seem to have beneficial effects in this diabetic patient, who had a liver disease and markedly elevated basal levels of plasma IRI and C‐peptide concentrations.
An Evaluation of Ultrafiltration as Treatment of Diuretic‐resistant Oedema in Nephrotic Syndrome
Authors: FAUCHALD P. , NODDELAND H. , NORSETH J.
Published: August 2010

ABSTRACT Plasma volume, plasma colloid osmotic pressure, creatinine clearance and sodium excretion were measured before and after ultrafiltration treatment in six patients with diureticresistant nephrotic syndrome. The mean total ultrafiltrate volume in two sessions on two successive days was 7 460 ml, the mean ultrafiltration rate was 22.0 ml/min and the calculated plasma refilling rate was 19.9 ml/min. Plasma volume and creatinine clearance were unchanged and sodium excretion was reduced after treatment. A short‐lasting drop in blood pressure was seen in 3 of the 12 treatment sessions. No other complications were noted. Ultrafiltration is a safe and useful alternative in the treatment of the few patients with massive oedema due to nephrotic syndrome not responding to conventional therapy.
On the Mechanism of Action of Theophylline and Caffeine
Authors: FREDHOLM BERTIL B.
Published: August 2010

ABSTRACTImportant developments in our understanding of the mechanism of action of methylxan‐thines have taken place in the last 10 years. A brief overview of these developments is provided below and the author concludes that the common view that theophylline (and caffeine) acts by raising the levels of cyclic AMP is generally untenable. Instead, many of the actions of the methylxanthines can be explained on the basis of their being antagonists of endogenous adenosine. However the mechanism behind the antiasthmatic effects of xanthines still remains unknown and further research is necessary.
Ten Years of Infective Endocarditis: A Clinicopathologic Study
Authors: GOSSIUS GEORG , GUNNES PÅL , RASMUSSEN KNUT
Published: August 2010

ABSTRACT The records of 46 patients with infective endocarditis diagnosed either clinically or postmortem were analyzed. Twenty‐six patients were over 60 years of age. S. aureus was the predominant organism, almost exclusively found in patients with acute endocarditis. Thirty‐six patients had pre‐existing heart disease, the most common being non‐rheumatic valvular calcification and congenital defects. Two thirds of the patients, especially those with aortic valve regurgitation, developed new or progressive heart failure. A correct clinical diagnosis was established in only 30 patients. Twenty‐three patients died, the mortality being 71% in acute and 32% in subacute disease. Only one of eight patients with prosthetic valve infection died. Four patients required urgent valve replacement. Early surgical intervention should be considered in patients with uncontrolled heart failure.
Effects of Secretin on Parathyroid Hormone and Calcium in Normal Subjects, Patients with Hyperparathyroidism and Patients with Gastrinoma
Authors: BENSON LARS , LUNDQVIST GUDMAR , WIDE LEIF , ÅKERSTRÖM GÖRAN , ÖBERG KJELL , LJUNGHALL SVERKER
Published: August 2010

ABSTRACT In vitro studies have demonstrated that secretin can stimulate the release of parathyroid hormone (PTH), but reports concerning its effects on PTH and calcium in vivo are contradictory. To examine this question further, a bolus injection of secretin (75 IU) was given to 12 normal subjects and 10 patients with primary hyperparathyroidism (HPT). Six of the patients had multiple endocrine neoplasia and five had endocrine pancreatic tumours (EPT). Three normocalcaemic patients with EPT were also included in the study. The mean serum gastrin level rose significantly (from 19 to 40 pmol/1, p<0.01) within 15 min of secretin injection in the normal subjects. HPT patients without EPT had a somewhat higher mean basal level of gastrin (39 pmol/1, p<0.05 compared with controls), but it did not increase significantly after the secretin bolus. In six EPT patients the gastrin concentrations rose by more than 300 pmol/1. Although secretin had a biological capacity to release gastrin, it had no discernible effects on either serum PTH or serum calcium in any of the groups studied. Nor were any changes in PTH or calcium observed when secretin was given as a continuous infusion (3 IU/kg/h) over 90 min. Thus, our data do not support the concept that secretin, in vivo, is a secretagogue of PTH.
The Acquired Immunodeficiency Syndrome (AIDS) in Denmark
Authors: GERSTOFT J. , NIELSEN J. O. , DICKMEISS E. , RØNNE T. , PLATZ P. , MATHIESEN L.
Published: August 2010

ABSTRACT Twenty Danish patients with the acquired immunodeficiency syndrome (AIDS) had been diagnosed by January 1984, 14 of them after 1982. Eighteen patients were male homosexuals, 8 of whom had visited the USA after 1979, 2 were heterosexual males with a history of sexual contacts in Central Africa, suggesting a transmission of AIDS from woman to man. AIDS has not been observed in drug abusers, hemophiliacs or transfused non‐risk persons in Denmark. The clinical picture varied according to the presence of Kaposi sarcoma or the type of opportunistic infections, but was in general similar to that reported from the USA. Investigation of T‐lymphocyte subsets revealed that the AIDS patients differed from controls and healthy homosexual men by having either a very low number of helper cells or a low helper/suppressor cell ratio. Functional immunological studies revealed a decreased natural killer cell activity and decreased blast transformation by mitogens. The survival two years after diagnosis was 16%.
Yersinia Enterocolitica Infection Complicated by Severe Thrombocytopenia Resistant to High‐dose Intravenous Immunoglobulin
Authors: GLUD TORBEN K. , LAURSEN BENEDICTE
Published: August 2010

ABSTRACT A young female patient developed severe thrombocytopenia 10 days after an infection with Yersinia enterocolitica, serotype 3. She was treated with high‐dose intravenous immunoglobulin without effect, and later corticosteroids also failed to induce remission. After 10 days of profuse bleeding the platelet count rose slowly to normal. Her tissue type was HLA‐B27. To our knowledge, thrombocytopenia complicating Yersinia infection has not been reported before.
Hypokalemia, Arrhythmias and Early Prognosis in Acute Myocardial Infarction
Authors: NORDREHAUG JAN ERIK
Published: August 2010

ABSTRACTSerum potassium concentration was estimated on admission to hospital in 289 women and 785 men with acute myocardial infarction. The proportion of women in potassium subgroups was inversely related to serum potassium concentration, increasing from 8% at serum potassium ≥5.2 mmol/1 to 58% at ≤3 mmol/1. The frequency of diuretic therapy was also higher in women (35%) than in men (23%). The mortality rate was high at 3 months in patients with one or more arrhythmias (atrioventricular block grade 2, complete heart block, bundle branch block, atrial fibrillation, premature ventricular contractions, ventricular tachycardia) detected by conventional methods during the first 48 hours after admission. Hypokalemia (serum potassium ≤3.5 mmol/1) did not significantly predict increased occurrence of any of these arrhythmias. Small inhomogeneities of arrhythmias between the potassium groups may have been caused by digitalis therapy prior to admission. Hypokalemia on admission did not predict altered prognosis during the first 3 months.
Juvenile Diabetes Mellitus—a Risk Factor for Postoperative Venous Thromboembolism?
Authors: BERGQVIST DAVID , ARNADOTTIR MARGARET , BERGENTZ SVEN‐ERIK , BORNMYR SIV , HUSBERG BO , LINDHOLM TORE , KONRAD PETER
Published: August 2010

ABSTRACT In a retrospective analysis of 125 patients and a prospective evaluation of 83 patients with terminal uremia undergoing kidney transplantation, juvenile diabetes mellitus was found to be a significant risk factor for the development of postoperative thromboembolism. We found a high frequency of objectively verified thromboembolism despite the relatively young age of the patients. Besides diabetes, no other clinical risk factor differed between patients with and without thrombosis.
Does Fever or Myalgia Indicate Reduced Physical Performance Capacity in Viral Infections?
Authors: FRIMAN GÖRAN , WRIGHT JAMES E. , ILBÅCK NILS G. , BEISEL WILLIAM R. , WHITE JOHN D. , SHARP DAN S. , STEPHEN EDWARD L. , DANIELS WILLIAM L. , VOGEL JAMES A.
Published: August 2010

ABSTRACT To study prospectively the effects of a brief febrile viral infection on parameters of muscle and circulatory function, seven volunteers were inoculated with sandfly fever virus and two control subjects with sterile saline. During but not after fever, decreased isometric and dynamic strength and endurance were recorded in various muscles. Impairment could not be explained by altered activities of relevant muscle enzymes in serum or muscle tissue or by altered muscle ultrastructure, but correlated with the severity of perceived symptoms, including myalgia, as rated by each subject. Compared to baseline, cardiac stroke volume was lower during and after fever. During fever, an increased heart rate maintained cardiac output at pre‐inoculation values, whereas cardiac output fell in early convalescence. This decrease in cardiac output correlated significantly with the severity of fever. Thus, in brief viral infections a transient impairment of muscle performance capacity is correlated to subjective symptoms such as myalgia, rather than to fever, whereas a decreased cardiac output following such infections seems to be associated with the fever reaction.
Glucose Tolerance and Physical Activity in a Health Survey of Middle‐aged Subjects
Authors: CEDERHOLM JAN , WIBELL LARS
Published: August 2010

ABSTRACT Glucose tolerance and reported physical leisure time activity were studied in middle‐aged, 47–54 years old, subjects in a health survey. The mean 2‐hour blood glucose value after 75 g oral glucose tolerance tests was higher (p<0.001) in 682 subjects with a lower degree of leisure time activity than in 125 subjects who were regularly active at least 2–3 hours per week. The mean 2‐hour glucose values in the inactive and active groups, respectively, were 4.61 and 4.09 mmol·1‐1 after adjustment for the influence of age, body mass index, smoking and physical job activity by analysis of covariance. The difference between adjusted mean 2‐hour glucose values was also significant (p<0.001) in the subgroups of 280 low leisure time activity males (4.53 mmol·1‐1) and 91 active males (3.93 mmol·1‐1). Thus, a relation between physical leisure time inactivity and raised post load blood glucose values seems to exist in the general population.
Coronary Thromboembolism with Fatal Outcome Following Coronary Angiography
Authors: MOGENSEN L. , SZAMOSI A. , TÖRNELL G.
Published: August 2010

ABSTRACT A case of fatal thromboembolic occlusion of the left coronary artery at selective coronary arteriography is described. The course of events and the findings at autopsy suggest that thrombotic material was deposited on one intravascular catheter and transferred to a second catheter inserted over the same guide wire. Contrast injection through the second catheter into the left coronary ostium resulted in immediate and fatal occlusion of the two major branches of the left coronary artery.
Coronary Artery Thrombosis Developing during Angiography
Authors: FORSSELL GUNILLA , JOHNSSON HANS , LASKA JACK
Published: August 2010

ABSTRACT A case of coronary thrombosis developing during coronary arteriography is described. In spite of obstruction of a main coronary artery, only a small myocardial infarction developed. Increased coagulability probably contributed to the thrombus formation.
Triglycerides—Main Lipid Risk Factor for Cardiovascular Disease in Women?
Authors: LAPIDUS LEIF , BENGTSSON CALLE , LINDQUIST OLOF , SIGURDSSON JOHANN A. , RYBO ELISABETH
Published: August 2010

ABSTRACT. Lapidus L, Bengtsson C, Lindquist O, Sigurdsson JA, Rybo E. (Departments of Medicine II and Clinical Chemistry, Sahlgrenska Hospital, Gothenburg University, Gothenburg, Sweden, and Health Centre, HafnarfjÖrdur, Iceland.) Triglycerides—main lipid risk factor for cardiovascular disease in women?

A 12‐year longitudinal population study of 1462 women, aged 38–60, was carried out in Gothenburg, Sweden in 1968‐69. Women with high initial serum triglyceride values had a higher 12‐year incidence of myocardial infarction, stroke and total mortality than the others. The findings for serum triglycerides persisted for myocardial infarction, stroke and total mortality after adjustment for other possible risk factors for ischaemic heart disease such as age, systolic blood pressure, smoking, indices of obesity and serum cholesterol, while serum cholesterol did not predict any end‐points studied when taking other risk factors including serum triglycerides into account.
Urinary Excretion of Kallikrein before and after Operation for Aldosterone‐producing Adenoma
Authors: HESSE BIRGER , RASMUSSEN STEN , LUND JENS OTTO , CHRISTENSEN POVL , NIELSEN META DAMKJÆR
Published: August 2010

ABSTRACT. Hesse B, Rasmussen S, Lund JO, Christensen P, Damkjær Nielsen M. (Department of Clinical Physiology, Glostrup Hospital, and Institute for Experimental Medicine, Copenhagen, Denmark.) Urinary excretion of kallikrein before and after operation for aldosterone‐producing adenoma.

Urinary kallikrein excretion (UKal), determined by the esterase method, was measured in 10 normotensive volunteers, 10 patients with essential hypertension and in 7 patients with primary aldosteronism before and after operative removal of the adenoma. UKal values were low in 5 of the patients with essential hypertension. Preoperative UKal values in the patients with aldosteronism did not differ significantly from those of the normal subjects, but decreased in all after operation in parallel with changes in urinary excretion of tetrahydroaldosterone and plasma aldosterone concentration. The study supports the assumption of an association between the renal kallikrein‐kinin system and the mineralo‐corticoid state in man.
Abnormal Renal Sodium Excretion in the Nephrotic Syndrome after Furosemide: Relation to Glomerular Filtration Rate
Authors: DANIELSEN H. , PEDERSEN E. B. , MADSEN M. , JENSEN T.
Published: August 2010

ABSTRACT. Danielsen H, Pedersen EB, Madsen M, Jensen T. (Department of Internal Medicine C, Aarhus Kommunehospital, and University of Aarhus, Aarhus, Denmark.) Abnormal renal sodium excretion in the nephrotic syndrome after furosemide: relation to glomerular filtratoni rate.

The effect of 40 mg furosemide intravenously on sodium excretion, the renin‐aldosterone system and arginine vasopressin (AVP) was studied in 14 patients with the nephrotic syndrome and in 13 control subjects. Creatinine clearance (Ccr) was reduced in all patients but four. Before furosemide, AVP, but not angiotensin II (AII) or aldosterone (Aldo), was increased in the nephrotic patients. After fursoemide, sodium excretion (NaE) increased less and changes in AVP, AII and Aldo were blunted in the patients. Ccr and NaE were positively correlated in the nephrotic syndrome. The reduced sodium response after furosemide in the nephrotic syndrome seems to be closely correlated to a reduced glomerular filtration rate but not to an increased activity of the renin‐angiotensin‐aldosterone system. The reduced response of AVP, AII and Aldo after furosemide is consistent with a lower degree of volume depletion in nephrotic patients.
Alternatives to Optimal Administration of Tablets
Authors: HASSELBALCH H. , JØRGENSEN F. , WAMBERG T. , HEY H.
Published: August 2010

ABSTRACT. Hasselbalch H, JØrgensen F, Wamberg T, Hey H. (Department of Radiology, Glostrup Hospital, the Dispensary, Royal Veterinary and Agricultural University, Departments of Medicine B and Radiology, Frederiksberg Hospital, Copenhagen, and Department of Clinical Physiology, County Hospital, HillerØd, Denmark.) Alternatives to optimal administration of tablets.

This controlled investigation of 27 volunteers compared the effect of cold and lukewarm tap water and carbonated water on the passage through the esophagus of a large circular tablet containing barium sulphate and of the same size and specific gravity as an acetylsali‐cylic acid tablet (Kodimagnylss®). The influence of yoghurt on the passage of the same tablet was also examined. The investigation emphasized the importance of taking tablets together with 100 ml of liquid. A comparison of the transit times for tablets taken together with 100 ml of cold carbonated water and 100 ml of lukewarm tap water showed a significantly better passage when the tablets were taken with cold carbonated water (p=0.01). A similar advantage of carbonated liquids was seen when tablets were taken with 25 ml of lukewarm tap water as compared with 25 ml of cold carbonated water (p=0.01). Administration of a tablet in a tablespoon of yoghurt is a good alternative, even though the bioavailability of certain preparations may be reduced.
The Duration of Oral Anticoagulation after Deep Vein Thrombosis
Authors: SCHULMAN S. , LOCKNER D. , JUHLIN‐DANNFELT A.
Published: August 2010

ABSTRACT. Schulman S, Lockner D, Juhlin‐Dannfelt A. (Thrombosis Unit, Department of Internal Medicine, and Laboratory of Clinical Physiology, Huddinge University Hospital, Huddinge, Sweden.) The duration of oral anticougulation after deep vein thrombosis.

Eighty patients with deep vein thrombosis (DVT) were randomized between our routine duration of oral anticoagulation and 50% reduction thereof, in order to evaluate whether shorter therapy could be given without increased risks. The study was stratified, so that 20 patients with the 1st episode of DVT caused by a temporary risk factor were treated for 1.5 or 3 months, 40 patients with the 1st episode of DVT caused by a permanent risk factor for 3 or 6 months, and 20 patients with the 2nd episode of DVT for 6 or 12 months. When warfarin therapy was discontinued, the patients were followed by means of venous occlusion plethysmography every 3 months for 1 year, and clinically for 15–27 months in the different subgroups. Thromboembolic complications were registered and verified by venography and perfusion lung scan. We could not detect any difference between the groups. The rate of rethrombosis and embolism during 12 and 24 months after cessation of anticoagulant therapy was 8 and 10%, respectively, among the patients with reduced duration of treatment and 8 and 14%, respectively, among those with regular duration. One fatal, warfarin‐induced hemorrhage occurred. It is important to reduce unnecessary extension of oral anticoagulation after DVT in order to minimize the negative side‐effects without increasing the recurrence rate. More extensive trials should be performed to confirm our results and define the optimal duration of treatment.
One‐Month versus Six‐Month Therapy with Oral Anticoagulants after Symptomatic Deep Vein Thrombosis
Authors: HOLMGREN KAJ , ANDERSSON GUNNAR , FAGRELL BENGT , JOHNSSON HANS , LJUNGBERG BENGT , NILSSON ERLING , WILHELMSSON SÖREN , ZETTERQUIST STAFFAN
Published: August 2010

ABSTRACT. The length of time for which deep vein thrombosis (DVT) should be treated with oral anticoagulants (OA) is controversial. In this study, 135 patients with symptomatic first period DVT (83 % with proximal DVT) were randomly allocated to OA for one or six months. The diagnosis of initial and recurrent DVT was confirmed by phlebography or plethysmography and thermography, or by a combination of all these methods. Pulmonary emboli were confirmed by lung scans or at autopsy. The patients were followed for at least one year. One patient had to discontinue OA prematurely because of haemorrhage. Seventeen patients left the project for other reasons, ten during and seven after therapy; in one of these DVT recurred. The recurrence rate during the first year was high (17% symptomatic recurrences) irrespective of whether OA had been given for one or six months.
Renal Effects of Acute Exposure to Toluene
Authors: NIELSEN HANS KRÆMMER , KRUSELL LARS , BÆLUM JESPER , LUNDQVIST GUNNAR , OMLAND ØYVIND , VÆTH MICHAEL , HUSTED STEEN E. , MOGENSEN CARL ERIK , GEDAY ERLING
Published: August 2010

ABSTRACT. Urinary excretion rates of β2‐microglobulin and albumin were measured in 43 male printing trade workers and 43 age‐matched male controls before and during exposure to toluene, 382 mg/m3, for 61/2 hours in a climate chamber. There were no significant changes in renal excretion rates of albumin and β2‐microglobulin during toluene exposure indicating that no causal relationship exists between moderate exposure to organic solvents and renal injury.
Clostridium Perfringens Septicemia and Acute Leukemia
Authors: GRÜTZMEIER SVEN
Published: August 2010

ABSTRACT. Three cases of fatal clostridial septicemia in patients with acute leukemia are described. Predisposing factors and treatment are discussed. Clostridium septicemia should always be suspected when a patient with neutropenia suddenly develops diffuse abdominal pain, fever, and tachycardia over 120/min. The importance of early treatment with penicillin or another adequate antibiotic is discussed.
Tricuspid Insufficiency Caused by Nonpenetrating Chest Trauma
Authors: ESKILSSON JAN
Published: August 2010

ABSTRACT. Two cases of traumatic tricuspid insufficiency are presented. Both patients followed a benign clinical course although an associated injury to the intraventricular septum was found in one. A flail anterior tricuspid leaflet was seen on two‐dimensional echocardiography in both patients and the diagnosis was confirmed by Doppler cardiography.
HYPERTENSION IN PREGNANCY
Authors: Svensson Anders , Andersch Bjöm , Hansson Lennart
Published: August 2010

ABSTRACT. In the years 1969 — 1973, 0.3% of 17000 unselected non‐diabetic pregnancies were complicated by severe pre‐eclampsia, 0.6% by mild pre‐eclampsia and 0.6% by hypertension in pregnancy. Records from affiliated maternity centers and the hospital were studied for these 261 women and for 260 women with matched normotensive pregnancies.

The women with pre‐eclampsia/hypertension in pregnancy had higher blood pressure than the control group very early in pregnancy. The hypertensive women were more often primiparous and they had a slightly higher body weight. The patients with severe pre‐eclampsia were older than the other women (30.4 vs 25.4 years for controls, p < 0.001). Immigrants were not more commonly found in the hypertensive groups, but unmarried mothers were more often seen in the mild preeclampsia and pregnancy hypertension groups, 19.1% and 20.6% respectively compared to 7.7% in the control group (p <0.01). A family history of hypertension was frequently reported in all groups.

The most striking characteristic of women with pre‐eclampsia/hypertension in pregnancy was their elevated blood pressure before or very early in pregnancy.