bluuebunny/crossref_metadata_2025 huggingface dataset:
The Influence of Uremia on Pharmacokinetics and Protein Binding of Prednisolone
Authors: Bergrem Harald
Published: August 2010

ABSTRACT The pharmacokinetics and protein binding of prednisolone have been compared in 6 uremic patients and 6 healthy controls after intravenous injection of 20 mg prednisolone. The uremic patients had a 53% longer elimination half‐time (p<0.01) and a 34% larger area under the time‐concentration curve (AUC) (p<0.05) of total prednisolone than the controls. The total body clearance of total prednisolone was 26% lower and of free prednisolone 40% lower in the uremic patients than in the controls (p<0.01). The volume of distribution at steady state was 17% larger in the patients than in the controls, but the difference was not statistically significant. The protein binding of prednisolone was decreased in the patients, the proportion of free prednisolone being 26% higher than in the controls (p<0.05). The amount of free prednisolone, expressed as the AUC of free prednisolone, was 67% larger in the patients than in the controls (p<0.01). These results indicate that uremic patients taking prednisolone may be more prone to develop glucocorticoid side‐effects because of higher concentration of free, biologically active prednisolone, secondary to a reduced rate of elimination and a decreased serum protein binding of prednisolone.
The Diagnostic Value of Determination of Intraerythrocytic Sodium and Potassium Concentrations versus Plasma Digoxin Concentration in Digoxin Intoxication
Authors: Pedersen K. E. , Koldkjær O. , Berndtz N. H. , Hvidt S. , Kjær K. , Midtskov C. , Sanchez G.
Published: August 2010

ABSTRACT Plasma digoxin measurements have proved unserviceable as a means of differentiating between toxic and non‐toxic patients. In order to assess the value of a biological effect of digoxin in this discrimination, intraerythrocytic sodium and potassium concentrations were determined in 55 chronically digitalized patients of whom 10 were digoxin‐intoxicated according to ECG criteria. Digitoxicity was associated with elevated intraerythrocytic sodium concentration (mean ± SEM 19.3±1.2 versus 11.3±0.3 mmol/1, p<0.001) and reduced intraerythrocytic potassium concentration (94.6±2.3 versus 100.0±0.6 mmol/1, p<0.001) compared to non‐toxic patients. Mean (± SEM) plasma digoxin concentrations in the two groups were 3.14±0.41 and 1.57±0.09 nmol/1, respectively (p<0.001). When diagnosing toxicity in chronically digitalized patients, plasma digoxin and intraerythrocytic sodium determinations showed sensitivities of 60 and 100%, respectively. The predictive values of a positive test were 75% for plasma digoxin and 83% for intraerythrocytic sodium.
Complaints of Cold Extremities among Patients on Antihypertensive Treatment
Authors: Feleke E. , Lyngstam O. , Råstam L. , Rydén L.
Published: August 2010

ABSTRACT A total of 758 consecutive patients attending three hypertension clinics answered a questionnaire designed to assess the prevalence and severity of complaints of cold extremities among patients on various antihypertensive drugs. Forty‐four per cent claimed to have had complaints of cold extremities and about 50% of these had had symptoms already prior to antihypertensive treatment. Among the newly symptomatic patients the prevalence of symptoms was 18% of those on diuretics and 40% of those on β‐blockers (p<0.01). No significant association was found between the prevalence of symptoms and age, sex, use of vibrating tools, smoking or history of various conditions associated with atherosclerosis. No significant difference was found in the prevalence of symptoms among patients on propranolol, alprenolol, pindolol, atenolol and metoprolol. It is concluded that cold hands and feet are common among hypertensive patients and may be aggravated by treatment with not only β‐blockers but also diuretics.
Evaluation of a New Semiquantitative Test Strip for Urine Glucose Determination
Authors: Almér Lars‐Olof
Published: August 2010

ABSTRACT. Diabur‐Test 5000 is a new semiquantitative test strip for the determination of urine glucose concentrations up to 5%. The results are comparable to those obtained with the Clinitest method, although Diabur‐Test 5000 has the advantage of being sensitive also for low glucose concentrations. Diabur‐Test 5000 is easier to use than the Clinitest method. It is well accepted by patients for self control, and might also be used for routine clinical work.
Insulin Pumps and Insulin Quality—Requirements and Problems
Authors: Brange Jens , Havelund Svend
Published: August 2010

ABSTRACT. In developing insulin solution suitable for delivery devices the chemical and biological stability, as well as the physical stability, must be taken into consideration. Addition of certain mono‐ and disaccharides increases the physical stability of neutral insulin solutions, but concurrently the chemical and biological stability decrease to an unacceptable degree. Addition of Ca‐ions in low concentrations offers a physiologically acceptable method for stabilizing neutral insulin solutions against heat precipitation without affecting the quality, including the chemical and biological stability.
Practical Experiences with Insulin Infusion Pumps
Authors: C. Pickup John
Published: August 2010

ABSTRACT. The future role of continuous subcutaneous insulin infusion as a routine treatment for insulin‐dependent diabetics rests on clinical considerations such as patient reactions to the system, the possibilities and consequences of pump malfunction and the effect of pump‐induced strict metabolic control on diabetic complications. These issues are discussed in the light of recent evidence.
Long‐Term 1,25‐Dihydroxycholecalciferol Treatment in Renal Failure
Authors: HORTLING LARS , FYHRQUIST FREJ , BONSDORFF MARTIN V. , HOLMBERG PETER , EDGREN JOHAN , KOCK BORIS , TELLA MATTI , EKLUND BJÖRN , HOLMSTRÖM TEDDY
Published: August 2010

ABSTRACT. 1,25‐Dihydroxycholecalciferol (1,25‐DHCC) was administered to four patients on maintenance hemodialysis and to four patients with renal failure not requiring hemodialysis. Secondary hyperparathyroidism was found in both groups of patients. Before initiation of 1,25‐DHCC treatment both groups had serum 1,25‐DHCC levels below the normal range (33.1 +15.3 pg/ml). During the treatment period, serum 1,25‐DHCC concentrations were normalized. Parathormone concentration in serum decreased in both groups during the observation period. Serum calcium concentration was normalized in patients with renal failure and within the upper normal range in patients on maintenance hemodialysis. Bone biopsy and densitometry of the radius showed a trend towards normalization of bone during the treatment period, while X‐ray studies showed no clear effect of 1,25‐DHCC treatment. This study shows that changes in bone mineralizatoin can be reversed by normalization of 1,25‐DHCC.
Autoantibodies and Immunoglobulins in Alcoholic Steatosis and Cirrhosis
Authors: GLUUD C. , TAGE‐JENSEN U.
Published: August 2010

ABSTRACT. Antinuclear antibodies were significantly more prevalent (p<0.01) in 143 patients with alcoholic cirrhosis than in 64 patients with alcoholic steatosis and in 94 controls. Smooth muscle antibodies were significantly more prevalent (p<0.05) in patients with alcoholic steatosis and cirrhosis than in controls. The prevalence of antimitochondrial antibodies and IgG liver membrane antibodies did not differ significantly between the three groups. Immunoglobulin G, A, and M concentrations were only occasionally increased in patients with steatosis. Patients with cirrhosis had significantly increased (p<0.005) concentrations of immunoglobulins G, A, and M when compared to patients with steatosis. These results indicate that the degree of liver damage has more effect than chronic alcoholism on the humoral immune system. Whether this influence is direct or indirect remains to be established.
Programmed Atrial Pacing for Orthostatic Hypotension
Authors: KRISTINSSON ARNI
Published: August 2010

ABSTRACT. Programmable atrial inhibited pacemakers were implanted in two patients with orthostatic hypotension due to autonomic failure. They were paced at 95 beats/min during the day and programmed themselves to 55 beats at night. This treatment resulted in virtual disappearance of orthostatic symptoms during a two‐year follow‐up. Haemodynamic studies showed a mean increase in erect systolic blood pressure from 47 mmHg pre‐implantation to 85 mmHg at nine months post‐implant during pacing. Cardiac output averaged 3.0 1/min without pacing and 3.8 1/min with pacing at two investigations. Rapid heart rate and high supine blood pressure at night were avoided by programming the pacemaker.
Orthostatic Response before and after Nitroglycerin in Metoprolol‐ and Verapamil‐Treated Angina Pectoris
Authors: HYLDSTRUP LARS , MOGENSEN NIKOLAJ B. , NIELSEN POUL EBBE
Published: August 2010

ABSTRACT. The Orthostatic changes in heart rate (HR) and blood pressure (BP) were recorded in ten patients with stable angina pectoris before and after simultaneous sublingual nitroglycerin administration. All patients were examined three times: without other medication, during chronic metoprolol treatment, and during chronic verapamil treatment. Under control conditions, only minor changes were found in systolic BP following vertical tilting, while diastolic BP increased by approximately 10%. Nitroglycerin augmented these changes to some extent, while neither metoprolol nor verapamil caused significant changes. The Orthostatic HR increase was considerably augmented by nitroglycerin. Verapamil treatment did not influence this response, while metoprolol caused significant reductions. These findings seem to explain why some few patients have observed severe Orthostatic symptoms while taking nitroglycerin during treatment with β‐adrenergic blocking agents.
Spontaneous Erythroid Colony Formation in Erythrocytosis
Authors: PARTANEN SEIJA
Published: August 2010

ABSTRACT.Erythroid colony formation from the bone marrow and blood of 30 patients with erythrocytosis has been studied. Seventeen patients formed spontaneous erythroid colonies. They included patients with polycythaemia vera (PV) and 4 patients who did not quite fulfil the Polycythemia Vera Study Group criteria for PV, but had suggestive evidence of a myeloproliferative disorder. Thirteen patients did not form spontaneous colonies. They included patients with secondary polycythaemia, patients with normal total red cell volume and patients with absolute pure erythrocytosis of unknown origin. All patients with PV, and none with secondary polycythaemias, had spontaneous erythroid colony formation. Three of 4 untreated and 2 of 9 treated PV patients had increased number of CFU‐E colonies in bone marrow. From these results it can be concluded that erythroid progenitor cell culture is a useful differential diagnostic method in erythrocytosis patients who cannot be classified clinically under PV or secondary polycythaemias.
A New Case of Familial LCAT Deficiency
Authors: VERGANI CARLO , CATAPANO ALBERICO L. , ROMA PAOLA , GIUDICI GINO
Published: August 2010

ABSTRACT. Twenty‐eight patients with familial lecithin:cholesterol acyltransferase deficiency have been reported to date. We report a new Italian case who presents the clinical and biochemical characteristics of the disease. Typical disc‐shaped high density lipoproteins (d= 1.063‐1.21 g/ml) were detected by electron microscopy. An abnormal distribution of apolipoproteins in the different lipoprotein fractions was found by sodium dodecyl sulphate polyacrylamide electrophoresis.
Liver Damage in Nurses Handling Cytostatic Agents
Authors: SOTANIEMI EERO A. , SUTINEN SEPPO , ARRANTO ARNO J. , SUTINEN SIRKKA , SOTANIEMI KYÖSTI A. , LEHTOLA JUHANI , PELKONEN R. OLAVI
Published: August 2010

ABSTRACT. Three consecutive head nurses developed liver injury after years of handling cytostatic drugs. They had neurological symptoms associated with elevated serum alanine amino‐transferase (ALAT) and alkaline phosphatase (ALP) levels. Liver histology showed portal hepatitis with piecemeal necrosis in one of them, the others had hepatic fibrosis and fat accumulation. The subjects' livers were metabolically active as reflected by adaptive and toxic changes in cellular ultrastructure. After withdrawal of the drugs, serum ALAT and ALP values fluctuated between normal and 2–3 times elevated. Follow‐up biopsies demonstrated an increase in collagen fibres and a decrease in microsomal enzyme activity, as reflected by arylhydrocarbon hydroxylase activity in vitro. The findings suggest that handling of cytostatic drugs may insidiously damage the liver, which, with time, seems to lead to irreversible fibrosis.
Induced Tolerance in Hemophilia Patients with Antibodies against IX:C
Authors: HEDNER U. , NILSSON I. M.
Published: August 2010

ABSTRACT. Two patients with severe hemophilia B complicated with antibodies against factor IX have been treated 13 and 10 times, respectively, with high doses of factor IX concentrate in combination with cyclophosphamide over a period of 10 years. During this treatment a lowering of the anamnestic response was observed over the years. Both patients have now been treated with factor IX and hydrocortisone but no cyclophosphamide in order to find out if real tolerance was induced. One patient received such treatment three times and the other once. Their inhibitor titer following these treatment episodes never ecxeeded 0.3 U/ml (˜0.9 BU/ml) and 0.9 U/ml (˜2.7 BU/ml) which is of the same order of magnitude as following the combined treatment (factor IX, hydrocortisone and cyclophosphamide). It is therefore suggested that these patients have been converted from high responders (10–100‐fold increase in the inhibitor titer on the original treatment with factor IX and hydrocortisone) into low repsonders showing a very reasonable inhibitor increase after treatment with factor IX and hydrocortisone but no cyclophosphamide.
Blood Glucose and Diabetes Mellitus in Subjects Aged 85 Years or More
Authors: HAAVISTO M. , MATTILA K. , RAJALA S.
Published: August 2010

ABSTRACT.Blood and urine glucose values and the prevalence of diabetes mellitus were determined in the course of a health survey covering inhabitants of Tampere, Finland, aged 85 or over. Out of the total cohort, 561 (83%) subjects, of whom 82% were women, were examined. A high blood glucose level (≥7.0 mmol/l) was recorded in 10% of the males and 7% of the females. The prevalence of diabetes mellitus in the series was 17%. Five per cent of the total series were on drug treatment for their diabetes; 5 % of the diabetics were on insulin therapy and 25% took oral antidiabetic drugs, while 70% were either on diet or had no treatment. Diabetes seems to be common among the very aged, but it is generally mild and easy to treat.
Massive Metoprolol Poisoning Treated with Prenalterol
Authors: WALLIN CARL‐JOHAN , HULTING JOHAN
Published: August 2010

ABSTRACT.A case of massive metoprolol poisoning (50 g) is described. Clinical signs included coma, seizures, hypoventilation, immeasurable blood pressure, nodal bradycardia, and metabolic acidosis. Treatment comprised intubation, assisted ventilation, gastric lavage, atropin, bicarbonate, glucagon and repeated doses of prenalterol (a total of 160 mg over 15 hours). Prenalterol dosage was simple and could be guided by blood pressure response. Pacemaker treatment was not required. Ethanol concentration was 50 mmol/l (2.4 %c) on admission. Plasma metoprolol was 68 nmol/l (18000 ng/ml) 2 hours after admission. The patient was awake after 15 hours.
Echocardiographic Features in Familial Amyloidosis with Polyneuropathy
Authors: BACKMAN C. , OLOFSSON B. O.
Published: August 2010

ABSTRACT Twenty‐two patients with the Swedish variant of familial amyloidosis with polyneuropathy were studied by M‐mode and two‐dimensional echocardiography. These patients had few symptoms consistent with cardiac disease but, nevertheless, echocardiograms of only two of them, both with a short history of the disease, were considered normal in all aspects. The most common abnormality was increased thickness of the interventricular septum found in 20 (91 %) of the patients. This septal hypertrophy was asymmetric in 12 (55 %) of them. Two‐dimensional echocardiography revealed a characteristic hyperrefractile appearance of the myocardium in 15 (68%) of the patients. Thus, echocardiography showed a characteristic pattern in these patients. This study also indicates that cardiac amyloidosis can be diagnosed in the preclinical, asymptomatic state by M‐mode and two‐dimensional echocardiography.
Musculo‐skeletal Symptoms in Early Sarcoidosis
Authors: UDDENFELDT P. , BJELLE A. , OLSSON T. , STJERNBERG N. , THUNELL M.
Published: August 2010

ABSTRACT Musculo‐skeletal symptoms were screened in 24 consecutive patients with newly diagnosed sarcoidosis and followed up two years later. Ten patients had joint involvement. Symptoms were most frequently found in ankle joints, followed by hand and knee joints. Arthritis was found in seven (29%) patients, two of whom suffered from monoarthritis of foot and wrist joint, respectively. Three patients had tenosynovitis. Muscle symptoms such as myalgia were present in six patients. Open biopsy of the gastrocnemius muscle showed epithelioid cell granulomatosis in nine of 20 patients. Only three of these nine patients had symptoms of myalgia, although not in the biopsied muscle. At follow‐up, musculo‐skeletal symptoms were found in only three patients, all of whom initially had Löfgren's syndrome.
Left Ventricular Function after Long‐Term Treatment with Ventricular Inhibited Compared to Atrial Triggered Ventricular Pacing
Authors: PEHRSSON S. KENNETH , ÅSTRÖM HANS
Published: August 2010

ABSTRACT The long‐term effect of ventricular inhibited (VVI) and atrial triggered ventricular (VAT) pacing on cardiac performance was determined by cardiac catheterization at rest and during exercise in 9 patients with high‐degree AV block. Cardiac output (Q) increased at rest by 22% during VAT vs. VVI (5.5 vs. 4.5 l/min, p<0.01). An increased stroke volume constituted the difference (75 vs. 63 ml, p<0.05). Mean working capacity increased by 12% in the supine position with VAT vs. VVI (p<0.05). During exercise Q increased by 40% with VAT vs. VVI (10.2 vs. 7.3 l/min, p<0.01) due to an increase in heart rate. Most pressures were largely unchanged. Stroke work and atrial rate decreased during VAT vs. VVI, which may indicate a lower sympathetic activity with VAT vs. VVI. The study demonstrated that hemodynamic advantages of VAT are still obtainable after several years of VVI pacing.
Left Ventricular Volumes with Ventricular Inhibited and Atrial Triggered Ventricular Pacing
Authors: PEHRSSON S. KENNETH , ÅSTRÖM HANS , BONE DIANNA
Published: August 2010

ABSTRACT Left ventricular (LV) volumes were assessed with equilibrium radionuclide angiocardiography at rest and during exercise in nine patients with high‐degree AV block treated with ventricular inhibited pacing (VVI), which was subsequently changed to atrial triggered ventricular pacing (VAT). The ventricular rates were similar at rest but higher on exercise during treatment with VAT (102 bpm) than with VVI (71 bpm). The LV end‐diastolic volume tended to be larger with VAT than with VVI pacing, both at rest (185 vs. 145 ml) and during exercise (220 vs. 162 ml). The LV end‐systolic volume also tended to be larger at rest (110 vs. 81 ml) and during exercise (149 vs. 83 ml). The LV ejection fractions were similar at rest but on exercise they decreased to significantly lower levels with VAT (0.35), while remaining unchanged with VVI (0.47). One mechanism for this difference could be an enhanced contractile state in VVI pacing compared with VAT pacing.
Influence of Heart Rate and Atrioventricular Synchronization on Maximal Work Tolerance in Patients Treated with Artificial Pacemakers
Authors: PEHRSSON S. KENNETH
Published: August 2010

ABSTRACT In 14 patients with symptomatic high‐degree AV block, studies were carried out of the effect on physical working capacity when an atrial triggered mode of cardiac pacing (VAT) was substituted for ventricular inhibited pacing (VVI). The tests were designed to elucidate the quantitative relationship between the effect of rate increase and AV synchronization by comparing VVI pacing matched to the same rate as VAT. The work load was increased by 10 W/min. The physical working capacity increased by 25 % with VAT as compared with VVI (p<0.001). The improvement was entirely attributed to heart rate increase, and not to AV synchronization.
Atrial Fibrillation—a Review of Course and Prognosis
Authors: PETERSEN PALLE , GODTFREDSEN JOHN
Published: August 2010

Abstract Four recent major studies concerning the prognosis in atrial fibrillation (AF) are reviewed. The one‐year mortality ranged from 16.0 to 0.2%, highest in elderly, hospitalized patients with chronic AF and lowest in young individuals with paroxysmal AF without other heart disease. The recognized clinical impression that the prognosis in AF is determined by age, type of AF and clinical status is thus confirmed. In three studies, however, the prognosis in lone atrial fibrillation seemed to be poorer than previously thought. The overall rate of thromboembolic complications in AF was about 25% in several studies. The effectiveness of coumarin drugs in the prophylaxis of these complications is not proved, and the time has come to subject them to more careful clinical investigation.
Serum Alkaline Phosphatase During Hormone Treatment in Early Postmenopausal Women
Authors: CHRISTIANSEN CLAUS , RØDBRO PAUL , TJELLESEN LONE
Published: August 2010

Abstract We propose a new model for use in establishing optimal treatment of postmenopausal osteoporosis. When hydroxyproline is taken as an estimate of bone resorption and alkaline phosphatase (ALP) of bone formation, the model indicates that the difference between hydroxyproline and ALP is reflected in the negative calcium balance, and thus the decline in bone mineral content (BMC). Since BMC increases during oestrogen treatment in postmenopausal women, in whom ALP declines gradually, it is postulated that this only happens because of a rapid decline in hydroxyproline. This decline together with BMC, must be dose‐related since changes in ALP are uncorrelated to the oestrogen dose. This model fits the generally accepted opinion that the effect of oestrogen on bone loss in postmenopausal osteoporosis is limited, declines with age, and is dose‐related. The model indicates that oestrogen treatment should be introduced early after the menopause in order to obtain the optimum prophylactic effect.
Leg Muscle Circulation by 133Xenon Clearance as a Predictor of Cardiovascular Disease in an Aged Population
Authors: AGNER ERIK
Published: August 2010

Abstract In a 10‐year cardiovascular survey of an unselected population aged 70 at entry. 133Xenon clearance was carried out in the anterior tibial muscle in both legs after maximal exercise during ischaemia in 211 men and 166 women. The maximal blood flow and the delay time (Ti) until this was achieved were measured. Using multivariate Cox's regression analyses with mortality from cardiovascular diseases (CVD) and CVD events in the eighth decade as end‐points, and maximal blood flow, Ti, distal pulse abnormality and intermittent claudication as possible predictors, high Ti was found to be an independent predictor of both end‐points in both sexes. In further multivariate Cox's regression analyses including other possible CVD risk markers, high Ti was of individual predictive value for excess total mortality, excess CVD mortality and excess CVD events in both sexes. It is concluded that high Ti by 133Xenon clearance at the age of 70 is a powerful predictor of future CVD events.
A Long‐term Follow‐up of Patients with Essential Hypertension Treated with Captopril
Authors: ÖHMAN PETER , AURELL MATTIAS , ASPLUND JOHAN , CONRADSSON TORBJÖRN , DELIN KRISTER , FORSLUND TERJE , FYHRQUIST FREJ , FRITHZ GÖRAN , HERLITZ HANS , KARLBERG BENGT , NILSSON OVE , RYDÉN LARS , WETTRE STAFFAN
Published: August 2010

Abstract Seventy‐four patients from four short‐term studies of captopril in mild‐moderate essential hypertension continued in a cooperative long‐term efficacy and tolerance program. The duration of observation is 2–>4 years, the total treatment time being 2434 months. No development of resistance to therapy was observed. The total daily dose of captopril has been gradually decreased and in 20 patients changed from t.i.d. to b.i.d. regime. The drug has been well tolerated and only few and mild side‐effects have been observed after the initial titration period. The drop‐outs (n=19) were mostly due to non‐medical causes (n=14). Except for one case of proteinuria, no laboratory abnormalities were detected and there were no signs of long‐term toxicity.
Permanent Pacemaker Treatment in Older Age Groups
Authors: BREIVIK KJELL , OHM OLE‐JÖRGEN
Published: August 2010

Abstract Of 693 patients on permanent pacemaker treatment between 1962 and 1981, 282 (40.7%) were above the age of 75. Of this number, 142 patients were 75–79 years, 95 80–84 years and 45 85–93 (mean 87) years old at the time of the first pacemaker implantation. The patients were followed for 13–154 months (mean 37.1) with special attention being paid to morbidity and mortality after the implantation. Complications occurred in 65 (23%) of the elderly patients, with no significant difference between the three age groups. Excessive threshold rise with stimulation failure (6%) and infections or skin erosions (4.9%) were the most frequent complications. Mortality increased in all age groups during the first 6–12 months compared with the age‐ and sex‐matched Norwegian population. Five‐year survival rates were 56, 32 and 25% respectively. We conclude that cardiac pacemaker treatment in the elderly is a safe symptom‐relieving therapeutic procedure and that the prognosis for these patients is similar to that for their fellow senior citizens after the first year of treatment
Charcoal Hemoperfusion for Treatment of Serious Carbamazepine poisoning
Authors: NILSSON CHRISTER , STERNER GUNNAR , IDVALL JAN
Published: August 2010

Abstract A case of severe carbamazepine intoxication (total dose 80 g) is reported. Because of deep coma and cardiovascular symptoms, intensive care and hemoperfusion were employed. The carbamazepine hemoperfusion clearance rate was 80–90 ml/min, but due to a probable ongoing absorption from the gut the effect of hemoperfusion was limited. Long hemoperfusion periods are recommended due to the pharmacokinetic pattern of carbamazepine
Iron Metabolism and “Sports Anemia”
Authors: MAGNUSSON BENGT , HALLBERG LEIF , ROSSANDER LENA , SWOLIN BIRGITTA
Published: August 2010

Abstract Several reports have suggested that iron deficiency might explain “sports anemia” especially in long distance runners. The present study was made to further study the iron metabolism in runners as the proposed cause of “sports anemia” is abstruse considering the good iron nutrition in these athletes. Based on a screening of 43 elite male runners, using bone marrow hemosiderin, serum ferritin and transferrin saturation, two groups of subjects were selected for a very extensive study on iron metabolism. In group 1 (n=5) iron depletion was suggested in at least one of the screening studies. In group 2 (n=7) at least one test strongly indicated good iron repletion. This experimental design was chosen to obtain two groups with similar body composition and exercise load but different iron metabolism. The studies comprised determinations of red cell and plasma volumes, plasma iron turnover and red cell incorporation of radioiron, red cell indices, plasma iron and transferrin, red cell protoporphyrin, serum ferritin, serum haptoglobin, urinary iron losses, iron absorption, bone marrow hemosiderin, dietary intake of energy and nutrients and a Desferal test. Pooling the results together it was obvious that none of the subjects were truly iron‐deficient. A few occasional findings suggesting low iron stores cannot be satisfactorily explained and indicate that further studies are needed
Platelet Function in Blood Sampled through Heart Catheters
Authors: THAULOW ERIK
Published: August 2010

AbstractPlatelet function was studied in blood sampled from the caval vein of 56 patients through various heart catheters. Reduced platelet retention was the most consistent finding while aggregation was not influenced by the sampling procedure. Polyurethane (Cordis and Positrol) catheters affected platelets less than catheters of woven dacron (Sones and Zucker). Sones catheters increased plasma β‐thromboglobulin levels slightly, and some platelets were trapped in the Zucker catheters. Much the same reduction in retention was induced by heparinized as by other catheters. Platelet retention values had a poorer reproducibility than the other platelet function parameters in samples collected at intervals of 45 min, while an acceptable correlation existed between parallel samples. The influence on platelets of blood sampled via polyurethane catheters was very moderate, and should allow the detection of alterations in platelet functions that occur in the circulation.
Effects of Timolol on Platelets in Coronary Sinus Blood and on Myocardial Ischemia during Pacing‐induced Angina
Authors: THAULOW ERIK , DALE JON
Published: August 2010

AbstractThe effect of timolol on blood platelet function was studied in coronary sinus and caval vein blood at rest and during pacing‐induced angina in 20 patients with coronary heart disease. During pacing‐induced angina, lactate measurements confirmed that coronary sinus blood was sampled from ischemic regions in 13 men. The ischemia did not influence platelet function. In blood from non‐ischemic myocardium, platelet activation was found during pacing: the ADP‐induced aggregation, platelet retention and plasma β‐thromboglobulin levels increased moderately but significantly. Timolol administration prevented this platelet activation, possibly by inhibiting catecholamine release from the myocardium, and reduced the ischemic response during pacing as judged from lactate measurements and ST depressions. It is concluded that timolol reduced platelet activation induced in non‐ischemic regions of the heart during tachycardia stress as well as myocardial ischemia.
The Effects of a Highly Purified Hyaluronidase Preparation on Experimental Myocardial Infarction in the Rat
Authors: NILSSON J.‐E. , SJÖGREN C. , SÄWE U.
Published: August 2010

Abstract Several substances have been claimed to be effective in reducing the area of necrosis in acute myocardial infarction. The effects of a highly purified hyaluronidase preparation (Hyalas®) on experimental myocardial infarction in the rat have been evaluated in this study. In the first series, one group of rats was treated with hyaluronidase 1 500–2 000 IU/kg injected intravenously 2, 4, 18, 24, 28 and 42 hours after induction of infarction by coronary artery occlusion. Another group was treated with NaCl solution. The infarction size was evaluated by serum lactate dehydrogenase and weight of infarcted myocardium. In a second series, the substances were administered immediately after the occlusion. In this experiment, the infarction size was estimated by planimetry. The percentage of salvaged myocardium in the hyaluronidase‐treated groups was within the range of 20%. It seems reasonable to suggest that the use of highly purified hyaluronidase may be of clinical value for reduction of the myocardial infarction size.
The Effect of Acute and Chronic Exercise on Thyroid Hormones in Obesity
Authors: KROTKIEWSKI M. , SJÖSTRÖM L. , SULLIVAN L. , LUNDBERG P.‐A. , LINDSTEDT G. , WETTERQVIST H. , BJÖRNTORP P.
Published: August 2010

Abstract Thyroid hormones were measured before, during and after acute exercise (60 min) or physical training (3 months) in obese women. Thyroid stimulating hormone concentration increased during acute work and decreased immediately after. No changes were seen during the two following days. An increase was seen after ten days as well as after three months of physical training. Thyroxine concentrations showed no changes. 3,5,3′‐Triiodothyronine decreased slightly immediately after acute exercise, and after three months of physical training, 3,3′,5′‐triiodothyronine (reverse triiodothyronine) increased slowly during and after acute exercise. A negative correlation was found between changes in fasting insulin and thyroxine and a positive correlation between changes in blood pressure and triiodothyronine after training. Lack of agreement in previous reports is probably due to methodological differences such as methods more or less susceptible to fatty acid interference, and thyroid hormones changing differently during acute work and before and after physical training. The duration of the study may also be of importance, even 3 months possibly being too short for attaining equilibrium in thyroid homeostasis.
A Comparison of 100 mg Atenolol and 100 mg Metoprolol Once a Day at Rest and during Exercise in Hypertensives
Authors: NILSSON OVE R. , ATTERHÖG JAN‐HENRIK , CASTENFORS JAN , JORFELT LENNART , KARLBERG BENGT E. , THULIN THOMAS , TOLAGEN KERSTIN , WETTRE STAFFAN , ÖHMAN K. PETER
Published: August 2010

Abstract The effects of once daily dosage of the two cardioselective β‐adrenoceptor blocking agents, atenolol and metoprolol, were studied in 26 patients with primary hypertension. The study was a randomized double‐blind cross‐over trial with placebo run‐in and wash‐out. Assessment of effect was performed about 1 and 25 hours after dosing. At rest, both atenolol and metoprolol lowered the blood pressure (BP) and heart rate (HR) compared to placebo. Atenolol induced a more effective BP reduction than metoprolol, especially 25 hours after drug intake. During exercise 1 hour after dosing both drugs reduced BP and HR to a similar extent, whereas 25 hours after dosing atenolol gave a more efficient BP and HR reduction than metoprolol. Our data show that both 100 mg atenolol and 100 mg metoprolol are effective antihypertensive β‐blockers at rest and during exercise, 1 hour after intake. Metoprolol was less effective than atenolol 25 hours after dosing probably due to its shorter plasma half‐life, thus implying a twice daily regimen for metoprolol in standard preparation.
Overdosage of Piroxicam
Authors: MOSVOLD JACOB , MELLEM HARALD , STAVE ROLV , OSNES MAGNE , LAUFEN HEINRICH
Published: August 2010

Abstract A 54‐year‐old woman took an overdose of 1 800 mg piroxicam. She complained of nausea and abdominal pain. Endoscopy revealed multiple superficial ulcerations in the pyloric antrum and the first part of duodenum. There were no symptoms or signs from other organ system and recovery was uneventful. The highest serum concentration was 241.6 mg/1, which is about 30 times the usual therapeutic level of 5–10 mg/1.
Prevalence of Mitral Valve Prolapse in Younger Patients with Cerebral Ischaemic Attacks
Authors: Egeblad Henrik , Sørensen Per Soelberg
Published: August 2010

Abstract The association between cerebral ischaemic attacks (CIA) and mitral valve prolapse (MVP) was investigated in a blinded study of 30 consecutive patients with cerebrovascular disease and 30 control patients matched by age, sex, and immediately apparent neurological signs. All patients were below the age of 40 years. Phonocardiography, motion‐mode and two‐dimensional echocardiography were performed at rest and during various manoeuvres. MVP demonstrated by all three diagnostic modalities was classified as definite and prolapse in at least one but not in all three tests was designated as ambiguous. Regarding the frequency of definite MVP, no statistically significant difference was demonstrated between patients with CIA (3%) and controls (0%). Ambiguous MVP was rather common in patients with cerebrovascular disease (13%) but equally frequent in control patients (20%). It is concluded that MVP does not appear particularly common in Northern Europe in younger patients with cerebral ischaemic events.
Microsomal Esterification of Retinol in Human Liver
Authors: Rasmussen Magnhild , Helgerud Per , Petersen Lizette Balle , Norum Kaare R.
Published: August 2010

Abstract Recent work has shown that esterification of retinol in microsomes from rat liver, mammary gland and small intestine and from human small intestine is catalyzed by an acyl CoA: retinol acyl transferase (ARAT). The current study demonstrates ARAT activity in human liver microsomes. At optimal incubation conditions the rate of retinyl ester formation due to ARAT (0.37+0.31 nmole ester formed mg microsomal protein‐1. minute‐1, mean+SD, n=6) suggests that the enzyme is of physiological importance.
Paroxysmal Dysarthria and Raynaud's Phenomenon in the Tongue
Authors: NIELSEN HENRIK VAGN , KRISTENSEN JOHANNES KJELDSTRUP , KLEMP PER , STABERG BENT , THOMSEN KRISTIAN
Published: August 2010

Abstract Three patients suffering from systemic scleroderma and Raynaud's phenomenon in the digits as well as the tongue are reported. Following exposure to cold, a vasospasm was observed in the digits and the tongue accompanied by severe dysarthria. These striking oral symptoms had been overlooked for years in the medical ward. It is recommended to question all patients with Raynaud's phenomenon about visceral manifestations during the digital attacks.
Screening for Postoperative Pulmonary Embolism on the Basis of Clinical Symptomatology, Routine Electrocardiography and Plain Chest Radiography
Authors: RISSANEN VILJO , SUOMALAINEN OLAVI , KARJALAINEN PAAVO , KETTUNEN KAUKO , KÄRKKÄINEN AULIS , LÄNSIMIES ESKO , WILJASALO MAURI
Published: August 2010

ABSTRACT The incidence of pulmonary embolism (PE) and the usefulness of various screening methods for its detection were studied in 108 patients undergoing elective hip surgery. Twenty patients had PE as shown by perfusion‐ventilation lung scintigraphy. Six of them had symptoms of embolism. Clinical symptoms of PE, highly suggestive electrocardiographic (ECG) signs and signs in chest radiographs showed high specificity but low sensitivity with regard to PE. If the non‐specific ECG signs and the symptoms and signs of deep vein thrombosis in the calves had also been taken into account, it would have been possible to identify 95% of the patients with PE. The use of all these screening tests revealed a suspicion of PE in two thirds of the patients. The simplest way to screen for postoperative PE seems to be to use a combination of the symptoms and signs of both PE and deep vein thrombosis, and to identify any tachycardia. This method gave a sensitivity of 85%.
Relationship between the Enzymatically Estimated Infarct Size and Clinical Findings in Acute Myocardial Infarction
Authors: HERLITZ J. , WALDENSTRÖM J. , HJALMARSON Å.
Published: August 2010

ABSTRACT In 580 patients with a definite myocardial infarction (MI) and no previous MI, the enzymatically estimated infarct size was related to the clinical course including various complications. In all patients, heat‐stable lactate dehydrogenase activity (EC 1.1.1.27, LD) was analyzed every 12 hours for 48–108 hours and in a subgroup (n=170) creatine kinase activity (EC 2.7.3.2, CK) and creatine kinase subunit B (CK B) were analyzed every 6 hours for 48 hours. The highest recorded enzyme activity was used as a rough estimate of infarct size. A positive correlation was found between serum enzyme activity and most of the clinical variables studied, such as incidence of congestive heart failure, treatment with furosemide, incidence of hypotension, cardiogenic shock, pericarditis, post myocardial infarction syndrome, AV block III, and the duration of hospitalization. We conclude that the enzymatically estimated infarct size determined by heat‐stable LD, CK and CK B closely reflects the severity of the infarction.
Changes in Heart Size during Long‐Term Timolol Treatment after Myocardial Infarction
Authors: GUNDERSEN TORSTEIN , TRÆTTEBERG KJELL , RØNNEVIK PER , VON BRANDIS CORDT , BARSTAD STÅLE , ABRAHAMSEN ARNE M.
Published: August 2010

ABSTRACTThe effect of long‐term timolol treatment on heart size after myocardial infarction was evaluated by X‐ray in a double‐blind study including 241 patients (placebo 126, timolol 115). The follow‐up period was 12 months. The timolol‐treated patients showed a small but significant increase in heart size from baseline in contrast to a decrease in the placebo group. These differences may be caused by timolol‐induced bradycardia and a compensatory increase in end‐diastolic volume. The timolol‐related incrase in heart size was observed only in patients with normal and borderline heart size. In patients with cardiomegaly, the incrase in heart size was similar in both groups. After re‐infarction, heart size increased in the placebo group and remained unchanged in the timolol group.
Dose‐dependent Subcutaneous Absorption of Porcine, Bovine and Human NPH Insulins
Authors: HILDEBRANDT PER , BIRCH KJELD , SESTOFT LEIF , VØLUND AAGE
Published: August 2010

ABSTRACTThe absorption of125I‐labelled porcine, bovine and human neutral protamine Hagedorn (NPH) insulins was compared in 40 diabetic patients after subcutaneous injections in the thighs using doses of 6 and 24 IU (40 IU/ml). Furthermore, the absorption of porcine NPH insulin was compared with bovine NPH insulin and porcine lente type insulin in the same dose (6 IU). All these intermediately acting insulins showed similar absorption rates when administered in the same dose. However, an increase in the injected dose from 6 to 24 IU resulted in a decrease of approximately 30% in the absorption rate of all NPH insulins.
Aplastic Anaemia in a Case of Hepatitis B with a High Titer of Hepatitis B Antigen
Authors: KINDMARK C.‐O. , SJÖLIN J. , NORDLINDER H. , NYSTRÖM‐ROSANDER C. , SIMONSSON B. , SUNDSTRÖM C. , MAGNIUS L.
Published: August 2010

ABSTRACT A high titer of hepatitis B antigen (HBsAg) was found in a patient with acute hepatitis B infection complicated by bone marrow aplasia. A possible antimitotic effect of HBsAg as an aetiological factor of the aplasia in this patient is discussed.
Treatment of Digital Vasospastic Disease with the Calcium‐Entry Blocker Nifedipine
Authors: NILSSON HANS , JONASSON TOMMY , RINGQVIST IVAR
Published: August 2010

ABSTRACT Eight patients with vasospastic disease of the digital arteries were treated with the calcium‐entry blocker nifedipine (capsules), 10 mg t.i.d. and 20 mg t.i.d. The degree of cold‐induced digital vasospasm after local cooling of the finger to 15 and 10°C, measured by strain‐gauge technique, was significantly decreased by nifedipine. The degree of reduction was dose‐dependent. All patients improved symtomatically. The side‐effects of the drug were minor but became more prominent when the dose was increased. We conclude that nifedipine is a useful agent in the treatment of digital vasospastic disease.
Influence of Dialysis on Prednisolone Kinetics
Authors: BJÖRCK S. , AHLMÉN J. , MELLSTRAND T. , STELIN G.
Published: August 2010

ABSTRACT Six patients with end‐stage renal disease were given prednisolone, 0.7–1.0 mg/kg/b.wt. parenterally. Prednisolone kinetics were investigated during dialysis, in 3 patients on hemodialysis and in 3 on continuous peritoneal dialysis, and also on days without dialysis. Mean plasma half‐life was 250 min in five patients and 690 min in one patient who also suffered from intermittent porphyria. No change was found in prednisolone kinetics when the dialysis‐free period was compared to the dialysis periods.
Visual Disturbances and Occipital Brain Infarct Following Acute, Transient Hypotension in Hypertensive Patients
Authors: STRANDGAARD SVEND , ANDERSEN GERT STEEN , AHLGREEN PREBEN , NIELSEN POUL EBBE
Published: August 2010

ABSTRACT In four hypertensive patients, acute lowering of blood pressure by therapeutic or diagnostic procedures caused visual disturbances ranging from transient visual hallucinations to severe, long‐lasting visual impairment. These symptoms were associated with occipital lobe cerebral infarcts that tended to occur in the border zones between the major cerebral arteries. The infarcts may be seen as the combined result of a “watershed” effect during acute hypotension and the presence of structural hypertensive vascular adaptation. When a hypertensive patient complains of visual disturbances during acute blood pressure lowering, the pressure should be allowed to settle at a level somewhat above normal.
Leucopenia Associated with β‐Lactam Antibiotic Therapy
Authors: KAAJA RISTO , VALTONEN VILLE V.
Published: August 2010

ABSTRACT Two cases of penicillin‐induced and one case of cephalosporin‐induced leucopenia are described. This unusual compliation of widely used β‐lactam antibiotics can occur when these antibiotics are administered parenterally in high doses for prolonged periods (14 days or more). The close monitoring of the white cell count is important when treating patients with high doses of β‐lactam antibiotics for prolonged periods. We would like to emphasize that when penicillin‐ or cephalosporin‐induced leucopenia is suspected, continuation with another β‐lactam antibiotic may be dangerous.
CAPTOPRIL OR ATENOLOL IN ESSENTIAL HYPERTENSION
Authors: Andrén Lennart , Svensson Anders , Hansson Lennart
Published: August 2010

ABSTRACT. Twenty‐five patients with essential hypertension were randomly assigned to treatment with either captopril or atenolol. There were 15 males and 10 females and their mean age was 53 years, range 32 – 66 years. Systolic and diastolic blood pressures were significantly reduced by atenolol 50 – 100 mg once daily. Captopril 25 – 50 mg 3 times daily caused a significant decrease in supine diastolic but not in systolic blood pressure. After the addition of hydrochlorothiazide (25 – 50 mg) to those who did not become normotensive (supine diastolic blood pressure less than 95 mm Hg) on captopril or atenolol alone, blood pressure was further reduced. Captopril combined with hydrochlorothiazide significantly reduced both supine and standing blood pressure by 31/17 mm Hg (p < 0.01) and 33/18 mm Hg (p < 0.001) respectively. Atenolol combined with hydrochlorothiazide caused a significant decrease of both recumbent and standing blood pressure by 21/10 mm Hg (p < 0.01) and 23/13 mm Hg (p < 0.05 systolic, p < 0.001 diastolic). The reduction of systolic blood pressure was significantly better with the captopril/hydrochlorothiazide combination, while there was no difference between the groups as regards diastolic blood pressure reduction. Thus, hydrochlorothiazide potentiates the blood pressure lowering effect of captopril more than of atenolol. This could be due to a synergistic interaction between captopril and hydrochlorothiazide.
The Influence of Calcium Antagonists on Plasma Digoxin Concentration
Authors: Pedersen Knud Erik
Published: August 2010

Several investigators have independently discovered that the calcium antagonist, verapamil, causes a 60–80% increase in plasma digoxin. Pharmacokinetic studies indicate, that the elevated plasma digoxin level is due to verapamil‐induced inhibition of both renal and extrarenal digoxin clearance. No significant changes in single‐dose digoxin pharmacokinetics were observed during nifedipine coadministration.

To elucidate the clinical relevance of this interaction, we investigated the influence of verapamil on digoxin‐induced inotropism as assessed from systolic time intervals. In single‐dose trials, the verapamil‐induced elevation of plasma digoxin was associated with a more sustained reduction in left ventricular ejection time as compared to control. Correspondingly, the concentration‐response relationship of digoxin inotropism was unaffected by verapamil.

In‐vitro studies showed that verapamil had no influence on the number of digitalis receptors on human lymphocytes. In accordance, verapamil enhanced the digoxin‐induced elevation of intracellular sodium concentration possibly reflecting an increased receptor effect.

The plasma digoxin elevation resulting from verapamil coadministration seems cardioactive with regard to both inotropism and toxic effects.