bluuebunny/crossref_metadata_2025 huggingface dataset:
SEVENTY‐YEAR‐OLD PEOPLE IN GOTHENBURG A POPULATION STUDY IN AN INDUSTRIALIZED SWEDISH CITY
Authors: Svanborg A.
Published: August 2010

The prospective longitudinal population study of elderly individuals in Gothenburg started in 1971/72 with an investigation of a representative sample (about 3/10) of the 70‐year‐olds. This wide population study concerns the nature and manifestations of normal ageing processes, the incidence and prevalence of disease at higher ages and the occurrence and the nature of infirmity in old age. This paper is a general description of some of the social and medical observations obtained during the first study of the probands and concerns migration in the population, housing, dwelling conditions, mobility and transportations, social contacts, need of help, results of the general, othological, ophthalmological, psychiatric, psychological and odontological examinations as well as of certain laboratory analyses. The results showed that “underdiagnosis” was common in this age group, i.e. that previously unknown disease often was present. The results also indicate that “overdiagnosis” is rather common due to the fact that the border zone between normal ageing and disease is only a very vague presentiment in the higher age groups. More advanced handicaps were rather uncommon and only about 3 per cent of the 70‐year‐olds suffered from handicaps or diseases to such an extent that care within institutions was necessary. The 70‐year‐olds rather commonly are living under social conditions that from a medical point of view might be subjected to critizism. It should, however, also be emphasized that a majority of the 70‐year‐olds in Gothenburg were living a very comfortable life in rather good physical and mental condition.
INTAKE OF ENERGY AND NUTRIENTS AND MEAL HABITS IN 70‐YEAR‐OLD MALES AND FEMALES IN GOTHENBURG, SWEDEN A POPULATION STUDY
Authors: Steen B. , Isaksson B. , Svanborg A.
Published: August 2010

The objectives of this substudy within the population study “70‐year‐old people in Gothenburg, Sweden” were to survey the dietary habits of the probands including meal habits and intake of energy and nutrients. The subsample comprised 191 males and 199 females, of whom 182 males and 188 females took part in the complete dietary interview examination, comprising a 24‐hour recall interview and a dietary history interview. The examined subsample was considered representative of the 70‐year‐old population in Gothenborg. The dietary history method was found to be more valid than the 24‐hour recall method. On an average 1.8 hot meals and 0.9 meals of type beverages and sandwich with slices of meat, cheese etc. were consumed daily. The intakes of energy and nutrients were on average satisfactory but showed a fairly great variation. Examples of intakes calculated from the dietary history interview are (M±SD, males and females, respectively): Energy 9.8±2.4 MJ and 8.1±2.3 MJ, protein 74±18.7 g and 63±16.5 g, calcium 1033±414.0 mg and 927±368.0 mg and potassium 79±22.2 mmol and 68±25.1 mmol, respectively. Examples of significant associations between social data and data of the intake of energy and nutrients are that probands with an education higher than elementary school showed a higher proportion of energy intake from protein than other probands and that males living alone showed a lower iron intake than other males. A comparison between this study and cross‐sectional studies on e.g. middle‐aged women in Gothenburg showed that the energy intake and the body composition in females was of the same order of magnitude in these two groups. More definite conclusions concerning possible changes by age in intake of energy and nutrients presuppose, however, longitudinal studies. The present cross‐sectional data will be used as a basis for a prospective longitudinal geriatric/ gerontological study.
The Relationship between QT Interval and Ventricular Arrhythmias in Acute Myocardial Infarction
Authors: Ahnve Staffan , Lundman Torbjörn , Shoaleh‐var Mansour
Published: August 2010

ABSTRACT. Out of a total of 947 patients admitted to the CCU at Serafimerlasarettet during 2 years, all those with AMI and ventricular fibrillation (VF) or ventricular tachycardia (VT) during the CCU stay were selected. The QT interval could be measured in 15 patients with VF and 12 with VT before the event. The QT interval was also measured in two control groups; one consisted of 27 consecutively admitted patients with AMI without ventricular arrhythmias (VA), the other of 27 non‐AMI patients treated in the CCU. Most patients in the group with VA showed pathologically prolonged QT intervals and there were statistically significant differences between this group and the control groups regarding corrected mean QT intervals. If these findings are confirmed, QT measurements might be of value in the prediction of malignant VA in AMI.
Serum Lipoproteins in Massive Obesity
Authors: Rössner Stephan , Hallberg Dag
Published: August 2010

ABSTRACT. Serum lipoproteins in 31 grossly obese males and females were determined by preparative ultracentrifugation before and after jejunoileal shunt operation. The results were compared with data from a randomly selected group of healthy controls. Before surgery a type IV hyperlipoproteinaemia was found in 5/11 men, which reverted to normal after operation. The obese females had a lower VLDL TG concentration which did not fall after surgery. In 10/11 males and 19/20 females the HDL cholesterol concentration was below the median value for controls before surgery. The patients were followed up to 55 months after surgery and the lipoprotein pattern was repeatedly determined. The mean weight loss was about 30% at the time of the last lipoprotein analysis. The major finding was a marked reduction of LDL cholesterol, about 40%. The LDL TG concentration was not affected. The LDL composition thus changed: at all TG concentrations the LDL of the operated patients contained less cholesterol than LDL of controls. On agarose electrophoresis a β‐lipoprotein with increased mobility, referred to here as a “rapid β” lipoprotein, could be demonstrated in about 65% of the obese subjects before operation. After surgery this “rapid β” was seen in about 80% of the cases. No explanation for this lipoprotein abnormality can be offered as yet. A negative correlation between HDL cholesterol and VLDL TG has been described in several earlier studies. The values for our obese subjects were found below such a regression line of controls both before and after operation. A low HDL cholesterol concentration seems to constitute a risk factor for the development of atherosclerotic manifestations. Our data are in agreement with a hypothesis that the increased risks for atherosclerosis, seen in obese subjects, could be attributed in part to the low HDL cholesterol values seen in these subjects.
Prognostic Implications of Ventricular Arrhythmias Registered before Discharge and One Year after Acute Myocardial Infarction
Authors: Rehnqvist N. , Lundman T. , Sjögren A.
Published: August 2010

ABSTRACT. The prognostic weight of ventricular ectopic beats (VEBs) was evaluated in 160 patients discharged after a CCU‐treated acute myocardial infarction (AMI) and followed for two years. VEBs were registered prior to discharge by 6 hours of telemetry (3 hours during daytime including exercise and 3 hours at night) and again one year after the AMI. During the first year of follow‐up, 11 patients died suddenly and 20 suffered reinfarction. Sixteen (55%) of these had shown severe VEBs, i.e. multiform, paired, R‐on‐T, or ventricular tachycardia, as compared to 42 (29 %) of the remainder. During the second year of follow‐up, eight patients suffered reinfarction and five died suddenly. The occurrence of severe VEBs prior to discharge was not of prognostic value for the second year per se but continued to carry prognostic weight for the first plus the second year. One year after the AMI the VEB incidence in 122 survivors without reinfarction increased insignificantly from 71 to 78%. VEB severity increased in 43 % and decreased in 27 % and the shift towards severe forms is significant. Severe VEBs one year after the AMI carry a prognostic weight for the second follow‐up year, as 18% of patients with severe VEBs reinfarcted or died suddenly against 5% of those with no or uniform VEBs only. Patients who had severe VEBs both prior to discharge and one year later did especially badly.
Familial Lecithin: Cholesterol Acyltransferase Deficiency Complicated with Unconjugated Hyperbilirubinemia and Peripheral Neuropathy
Authors: Iwamoto Aikichi , Naito Chikayuki , Teramoto Tamio , Kato Hirokazu , Kako Makoto , Kariya Toshitsugu , Shimizu Teruo , Oka Hiroshi , Oda Toshitsugu
Published: August 2010

ABSTRACT. Three Japanese patients with lecithin: cholesterol acyltransferase (LCAT) deficiency, the offspring of a consanguineous marriage, are described. In addition to the Characteristic clinical and laboratory findings of the disease, our patients had hitherto unreported manifestations, namely unconjugated hyperbilirubinemia, peripheral neuropathy and marked hypocholesterolemia. Although the mechanism of the unconjugated hyperbilirubinemia is not clear, the rde of impaired hepatic bilirubin uridine‐diphosphate‐glucuronyl transferase activity combined with another unknown factor(s) was postulated. Non‐random assortment was observed between LCAT deficiency and haptoglobin types, as previously reported. The discovery of Japanese patients with LCAT deficiency indicates that the distribution of this hereditary metabolic disorder is not confined to the Western hemisphere.
Bartter's Syndrome without Hyperplasia of the Juxtaglomerular Apparatus, Treated with Indomethacin
Authors: Kornerup H. J. , Pedersen E. B. , Petersen V. Posborg
Published: August 2010

ABSTRACT. The present report describes a case of potassium‐wasting nephropathy with the physiological and endocrinological findings that are typical for Bartter's syndrome (BS). However, the renal juxtaglomerular apparatus shawed no hyperplasia at two renal biopsies two years apart. The short‐term (9 days) effect of indomethacin in combination with spironolactone was a suppression of hyperreninemia and hyperaldosteronism and an increase in vascular sensitivity to angiotensin II associated with potassium and sodium retention. Subsequently, on indomethacin alone, potassium balance was obtained on a lower level with persistent hypokalemia and persistent renal potassium leakage. Hypokalemia persisted during long‐term (9 months) treatment with indomethacin despite normalization of the activity of the renin‐aldosterone system. The results indicate that indomethacin as long‐term treatment may be ineffective in maintaining a normal potassium balance in BS.
Electrocardiographic Changes in Right Ventricular Infarction
Authors: Erhardt L. R. , Sjogren A.
Published: August 2010

ABSTRACT. ST segment elevations in leads CR4R or V4R indicating right ventricular (RV) involvement are sometimes seen in patients with acute inferior transmural infarction. Whether the RV lesion per se or the concomitant infarction of the posterior septum causes this ECG pattern is unknown. We describe a patient with anteroseptal transmural infarction who developed unusually marked ST segment elevations in lead V4R. At autopsy, extensive old fibrotic infarction was found, involving the anterior and lateral RV walls, as well 89 recent necrosis of the interventricular septum. These findings suggest that the ST segment elevation in V4R in patients with RV infarction may not be caused by the RV necrosis per se but rather by visualization of the posterior septum through the necrotic RV myocardium.
Cerebrospinal Fluid Lysozyme in Bacterial and Viral Meningitis
Authors: Klockars Matti , Reitamo Sakari , Weber Teddy , Kerttula Yrjö
Published: August 2010

ABSTRACT.The concentration of lysozyme (LZM) in cerebrospinal fluid was determined in 25 patients with bacterial meningitis, in 18 patients with viral meningitis and in 25 control patients who had other febrile illnesses. The concentration of LZM was less than 1.5 μg/ml in all control patients, and slightly to markedly raised in 10 patients with viral meningitis and in 11 out of 13 patients with untreated bacterial meningitis. The concentration of LZM was significantly different in the viral and bacterial meningitis paitents (p<0.001). Most raised concentrations of cerebrospinal fluid LZM persisted for at least one week after the start of antibiotic treatment. The concentrations of LZM correlated well with concentrations of lactic dehydrogenase. These results show that the determination of cerebrospinal fluid LZM is a useful tool in the differential diagnosis of menigitis, particularly when the prehospital treatment with antibiotics may be responsible for a diagnostically misleading negative bacterial culture of the cerebrospinal fluid and altered cerebrospinal fluid cytology.
Absorption and Elimination of D‐Propoxyphene, Acetyl Salicylic Acid, and Phenazone in a Combination Tablet (Doleron®): Comparison Between Young and Elderly Subjects
Authors: Melander A. , Bodin N.‐O. , Danielson K. , Gustafsson B. , Haglund G. , Westerlund D.
Published: August 2010

ABSTRACT. The single‐dose kinetics of D‐pro‐poxyphene, acetyl salicylic acid and phenazone, given in a combination tablet (Doleron®), were compared in young and elderly subjects. Serial blood samples were taken 0–48 hours after administration. The plasma concentrations of propoxyphene and of its major metabolite, norpropoxyphene, were assessed by mass fragmentography, those of phenazone by gas chromatography, and those of acetyl salicylic acid plus salicylic acid by spectrofluorometry. Neither for propoxyphene, norpropoxyphene, acetyl salicylic acid nor phenazone did the areas under the concentration curves or the elimination half‐lives differ between young and elderly subjects. These data do not provide pharmacokinetic support for a general reduction of the Doleron dosage in elderly subjects.
Lactoferrin in Human Neutrophilic Polymorphonuclear Leukocytes in Relation to Iron Metabolism
Authors: de Vet B. J. C. M. , ten Hoopen C. H.
Published: August 2010

ABSTRACT. Lactoferrin (LF), the iron‐binding protein of external secretions and neutrophilic polymorphonuclear leukocytes (PMN), was studied in 27 patients during granulocytosis caused by acute inflammation and in disorders without granulocytosis (iron deficiency anemia, iron overload and liver diseases). During granulocytosis the LF concentration of PMN was significantly lower than in controls (p <0.001). This difference proved to be related to the number of PMN. A relation between the LF concentration of PMN and iron metabolism could be demonstrated: loss of iron by blood donation is accompanied by a significant decrease in the LF concentration in PMN, whereas iron therapy in patients with iron deficiency anemia is accompanied by a significant increase in the LF concentration in PMN.
Neuropsychological Findings with Pseudoxanthoma Elasticum
Authors: Heaton R. K. , Vogt A. T. , Neldner K. H. , Reeve E. B.
Published: August 2010

ABSTRACT. It has been reported that the disease pseudoxanthoma elasticum (PXE) is associated with a high incidence of neurologic and psychiatric symptoms, which are possibly due to cerebrovascular ischemia. These reports are based mainly upon clinical observations made without reference to control group data. We have compared the results of 27 PXE patients with results of a control group on a battery of objective neuropsychological and personality tests. The PXE group showed only very mild deficits on extensive neuropsychological testing, a finding which argues against any marked involvement of cerebral vessels in these patients. Similarly, the personality test results did not reveal significant psychiatric disturbances which could be attributed to PXE. Possible reasons for the discrepancy with previous reports include the subjective data and much older PXE patients on which those reports are based. The need for systematic neuropsychological research with older PXE patients and control groups is suggested.
Cytomegalovirus Pneumonia after Treatment with Melphalan and Prednisone
Authors: von Eyben Finn , Olsen Tom Skyhøj
Published: August 2010

ABSTRACT. A patient with multiple myeloma had pancytopenia after treatment with melphalan and prednisone and died of an interstitial pneumonia. Post‐mortem examinations showed cytomegalic cells in the lungs. Lung tissue showed a high titer of cytomegalovirus. Only when other causes have been ruled out by microbiologic, serologic, and histologic examinations should melphalan be believed to cause respiratory illness.
Supraventricular Tachyarrhythmias in Acute Myocardial Infarction
Authors: Löfmark R. , Orinius E.
Published: August 2010

ABSTRACT. Onset of atrial tachycardia, flutter or fibrillation occurred in 11% of 274 consecutive patients with acute myocardial infarction (AMI). Atrial tachycardia started about 24 hours and atrial flutter/fibrillation about 72 hours after onset of AMI symptoms. Left heart failure, diagnosed as pulmonary rales or frank pulmonary edema, was not more common in these patients before onset of tachyarrhythmias than among the rest of the patients. On the other hand, a notching of the P wave in lead CR7 was significantly more common in the patients with atrial fibrillation (67%). In most of these cases the terminal P force in lead CR, was not negative as in so‐called left atrial enlargement. These findings suggest that atrial conduction disturbances might be a basis of atrial fibrillation in AMI.
Left ventricular function after myocardial infarction: Relation between systolic time intervals and quantitative ischaemic ECG changes
Authors: Godtfredsen John , Kryger Peter , Lublin Henrik
Published: August 2010

Twentyfour male patients with sustained myocardial infarction (MI) were studied with 12‐lead ECG and systolic time intervals (STI) 5 months after the acute episode. From the ECGs were calculated the summed voltages of the R wave (σR), the Q wave (σQ), and the ST segment deviation (σST). These ischaemic ECG variables were correlated with the STI parameters of left ventricular function: LVETI, PEP and PEP/LVET. Statistically significant regression equations relating the ECG changes to the STI variables were found in anterior MI, for σST in the entire series, but not in inferior MI. Thus a simple and rapid inspection of the resting 12‐lead ECG gives an indirect but reliable quantitative estimate of left ventricular function in patients with a sustained myocardial infarction.

Experimental studies have shown a relation between QRS changes in the ECG and the size of myocardial infarction (MI) (11, 21). As the extent of myocardial damage after MI determines the impairment of left ventricular (LV) function (14, 20, 25), a correlation between QRS changes and the LV performance would be expected. Linear correlation between the summed R wave voltages (σR) and the number of Q waves (Q index), and the angiographically determined LV ejection fraction has been reported in patients with chronic ischaemic heart disease (2, 4). This study looked for a quantitative correlation between the LV performance, as reflected by various systolic time intervals (STI), and ischaemic ECG changes (σR, σQ, and σST) in a group of patients with previous MI.
Accurate determination of serum ASAT isoenzymes
Authors: Konttinen Aarne , Ojala Kaarina
Published: August 2010

An improved electrophoretic modification for measuring aspartate aminotransferase (ASAT) isoenzymes is presented. This method fulfils the clinical requirements for sensitivity and allows the detection of 1 U/1 mitochondria ASAT activity at 25°C. The procedure is relatively simple, requiring about one hour for a series of 8 determinations. Mitochondrial ASAT activity was found in all patients suffering from acute myocardial infarction pathological activity was observed for several days longer than that of total serum ASAT enzyme. None of the 25 healthy people studied had mitochondrial ASAT in their serum.
The Influence of Propranolol on the Extrathyroidal Metabolism of 3,3‘,5’‐Triiodothyronine (Reverse T3)
Authors: Lumholtz I. B. , Busch‐Sørensen M. , Faber J. , Friis Th. , Kirkegaard C. , Siersbæk‐Nielsen K.
Published: August 2010

ABSTRACT The effect of propranolol 80 mg daily on the metabolism of 3,3′,5‐triiodothyronine (reverse T3, rT3), 3,3′,5‐triiodothyronine (T3) and thyroxine (T4) was studied by means of a non compartmental kinetic method in seven females with severe pretreatment hypothyroidism. The patients were maintained euthyroid on a constant L‐T4 replacement therapy. Serum rT3 levels increased significantly during propranolol (p < 0.02). This increase was explained by a decrease in metabolic clearance rate (MCR) (p < 0.02), since the conversion rate from T4 and the distribution volume of rT3 were unchanged. By contrast the decreased serum levels of T3 were due to a significant decreased conversion from T4 (p < 0.02) in spite of a decreased MCR. The results are compatible with the assumption of two different monodeiodinating enzymes, a 5‐deiodinase responsible for the deiodination of T4 to rT3 and a 5′‐deiodinase responsible for the deiodination of T4 to T3.
THE CROSS‐SECTIONAL ECHOCARDIOGRAM IN CLINICAL CARDIOLOGY: APPLICATIONS AND RELATIONSHIP TO THE M‐MODE TECHNIQUE.
Authors: WEYMAN A.E.
Published: August 2010

Until recently M‐mode echocardiography has been the standard in clinical practice. Although the M‐mode systems provide rapidly acquired, high resolution data concerning regional cardiac interface position and motion, the limited area encompassed by the narrow M‐mode beam and failure to provide spatial orientation may be a significant limitation in selected clinical areas.

Cross‐sectional echocardiography expands the area of the heart which is available for study and displays the acoustic images in a dynamic spatially oriented format allowing the moving cross‐sectional anatomy of the heart to be visualized. This variation in method of display provides more extensive information concerning valvular heart disease by permitting analysis of the morphology and motion patterns of the cardiac valves, direct visualization of valvular orifices, and appreciation of valvular movement in relationship to surrounding cardiac chambers. In patients with ischemic heart disease the cross‐sectional systems increase the area of the ventricle which is available for ultrasonic study by adding the cardiac apex and the medial and lateral walls of the ventricle to the recorded data. In addition the systems permit localized distortion in left ventricular shape and function to be evaluated. Finally, in congenital heart disease the cross‐sectional systems permit the orientation of the great vessels and cardiac chambers to be determined. In this report we have presented examples of the applications of cross‐sectional echocardiography in each of these areas in the hope that the reader can gain from these isolated examples an overall appreciation of the potential of this type of instrumentation and its relationship to be more conventional M‐mode display.
CROSS‐SECTIONAL ECHOCARDIOGRAPHIC ASSESSMENT OF AORTIC OBSTRUCTION
Authors: WEYMAN A.E.
Published: August 2010

Cross‐sectional echocardiographic features of aortic obstruction occurring at multiple levels of the left ventricular outflow tract are discribed. Specific pathologic entities considered include coarctation of the aorta, supravalvular, valvular, and discrete subvalvular aortic stenosis, as well as functional or idiopathic hypertrophic subaortic stenosis. At each of these levels the cross‐sectional method permits direct visualization of the obstructing lesion, it's morphologic characteristics, and extent. In addition the relationship of the area of obstruction to more normal surrounding areas of the outflow tract can be assessed. Studies at the supravalvular and valvular levels indicate the direct imaging of the stenotic area may permit estimation of severity.

At the subvalvular level the patterns of development of functional obstruction can be examined and the mechanisms of this type of obstruction further illucidated. Finally in addition to direct visualization of individual areas of obstruction it is possible to detect or exclude areas of concommittant obstruction at other levels of the outflow tract. Cross‐sectional echocardiography therefore represents a rapid, non‐invasive method for visualizing the location, extent, severity, and dynamic nature of lesions producing obstruction to left ventricular outflow.
TWO‐DIMENSIONAL ECHOCARDIOGRAPHY IN ATRIOVENTRICULAR CANAL MALFORMATION: A DIAGNOSTIC APPROACH
Authors: DRAULANS‐NOË H.A.Y. , VOOGD P.J. , LIGTVOET C.M. , RIDDER J. , WENINK A.C. G.
Published: August 2010

Two‐dimensional echocardiographic studies were performed in 20 children with various forms of atrio‐ventricular canal malformation. Both sagittal and transverse cross‐sections were evaluated. The most typical finding in all patients was the visualization of the cleft anterior mitral leaflet (AML) represented by a diastolic break of AML echoes in the sagittal cross‐section. ‐ In cases where the AML is attached to the interventricular septum, varying degrees of left ventricular outflow tract narrowing and elongation were observed.

In the transverse cross‐section mitral‐tricuspid alignment could be observed at the level of the aortic root. The ventricular septal defect in complete AVC was visualized as an echo‐free space between the common anterior leaflet and the interventricular septum.
Effect of Amiodarone in the Wolff‐Parkinson‐White Syndrome
Authors: Rasmussen Verner , Berning Jens
Published: August 2010

ABSTRACT. Six patients with Wolff‐Parkinson‐White (WPW) syndrome were given long‐term treatment with amiodarone. Symptomatic relief was obtained in all. Tolerance to the drug was good. Reversible corneal changes appeared after some weeks' treatment in five patients. No thyroid side‐effects were noticed. Prior to treatment, dual atrioventricular (AV) conduction was demonstrated on His bundle electrograms in all six patients. Recordings were made at varied heart rates, using atrial and ventricular pacing. Reciprocating tachycardia was readily provoked by properly timed extra stimuli in all patients. When amiodarone treatment had become clinically effective, a second comparative study was made in four patients after 26–85 days' treatment. Amiodarone reduced heart rate and second degree AV block appeared at a lower atrial pacing rate. It increased the refractory periods of right atrium, AV node, and the accessory pathway in proportion to the duration of treatment. Induction of tachycardia was effectively prevented by the drug. It appears that amiodarone in chronic treatment has a predictable and unique depressant action on cardiac conduction, supporting the opinion that this compound, despite side‐effects, has an important role to play in the treatment of refractory arrhythmias in patients with the WPW syndrome.
Recessive X‐Linked Hyperuricemia with Gout and Renal Damage, Normal Activity of Hypoxanthine Phosphoribosyltransferase and Resistance to Azaguanine
Authors: Westberg N. Gunnar , Rosén Elisabeth , Waldenström Johan
Published: August 2010

ABSTRACT. A family is reported where four males have developed hyperuricemia, renal damage and, except for the youngest person affected, gout at an early age. The disease appears to be inherited as an X‐linked recessive metabolic error. Clinically the patients have developed classical, tophaceous gout before the age of 25 and have suffered repeated attacks of renal colic. Renal tubular damage with decreased ability to concentrate and acidify urine was seen in a family member of only 16 years of age. Progressive renal failure seems to develop slowly. None in the family has shown neurologic symptoms, and two of the four affected men are apparently of at least average intelligence, two slightly below average. One female carrier has repeatedly passed uric acid stones. Studies of the red blood cell lysate have shown a normal activity of enzyme hypoxanthine phosphoribosyltransferase, and an increased level of adenine phosphoribosyltransferase. Skin fibroblasts from affected family members grew normally in the presence of 8‐azaguanine. Administration of azathioprine to the patients did not decrease their serum uric acid levels. This is the first family described with this type of disorder of the purine metabolism.
The Influence of Endogenous Cortisol on the Peripheral Conversion of Thyroxine in Patients with Acute Myocardial Infarction
Authors: Ljunggren Jan‐Gustaf , Falkenberg Claes , Savidge Geoffrey
Published: August 2010

ABSTRACT. A study was performed to elucidate whether endogenous cortisol, as previously suggested, could be responsible for the decreased T3 levels seen in euthyroid patients with acute myocardial infarction. Levels of these hormones as well as levels of T4 and reverse‐T3 were monitored in 31 consecutive patients admitted to the Coronary Care Unit with symptoms of precordial pain or with acute arrhythmias. Sixteen of the patients had proven myocardial infarction, the remaining 15 were used as a control group. The results demonstrated that a reduction of T3 levels was seen in the infarction group without evidence of a statistically significant difference between the daily mean cortisol levels. No significant difference could be observed in T4 or reverse‐T3 levels in the two groups or in T3 levels in the control group. It is concluded that the decrease in T3 levels is not a consequence of the increased levels of endogenous cortisol.
Mexiletine in Treatment of Ventricular Arrhythmias
Authors: Stavenow L. , Hanson A. , Johansson B. W.
Published: August 2010

ABSTRACT. Mexiletine, a new drug effective in the treatment of ventricular arrhythmias, was given to 20 patients for approximately 2 years. The study was designed to investigate the nature and prevalence of side‐effects during long‐term therapy, and the degree of correlation between such effects and the serum level of the drug. The methodology used to determine the serum level is described. Mexiletine was well tolerated and serious side‐effects were not seen. In particular, antinuclear factor was not detected during the treatment period. The serum level of mexiletine was easily maintained within the therapeutic range, and most side‐effects correlated closely with the drug level. Mexiletine appears to be an effective alternative to currently available antiarrhythmic agents.
Thrombotic Thrombocytopenic Purpura: Treatment with a Combination of Antiplatelet Drugs
Authors: Birgens Henrik , Ernst Peter , Hansen Mogens Sandbjerg
Published: August 2010

ABSTRACT. Thrombotic thrombocytopenic purpura (TTP) is a rare disease with a very high mortality. Different modalities of therapy have been tried, but often with no effect. Recently, interest has focused on drugs interfering with platelet function, though few patients have received antiplatelet drugs as the only therapy. We describe a patient with TTP, who recovered completely on a combination therapy with dextran, aspirin and dipyridamole.
Resolution of Renal Amyloidosis Secondary to Rheumatoid Arthritis
Authors: Falck Hans M. , Törnroth Tom , Skrifvars Bo , Wegelius Otto
Published: August 2010

ABSTRACT. A patient with seronegative rheumatoid arthritis developed a nephrotic syndrome. Histological examination of renal biopsy disclosed moderate amyloidosis. Ultrastructurally the glomerular amyloid deposits were seen to be located both within the mesangium and subepithelially in the peripheral capillaries. The patient was treated with prednisone and cyclophosphamide for two years. The nephrotic syndrome remitted and a follow‐up biopsy showed almost total disappearance of Congo red positive amyloid substance. Electron microscopy showed abundant finely granular material but only small amounts of fibrillar amyloid in the mesangial regions and intramembranous lucent areas containing few amyloid fibrils but no subepithelial deposits in the peripheral capillaries. We conclude that the mesangial amyloid substance was degraded to granular material and that the subepithelial amyloid deposits were resolved by mechanisms similar to those involved in the resolution of subepithelial immune complex deposits, i.e. through slow washing out and incorporation into the basement membrane.
The Diagnostic Challenge of Left Atrial Myxoma
Authors: Berning Jens , Egeblad Henrik , Lauridsen Poul , Wennevold Alf
Published: August 2010

ABSTRACT Left atrial myxomas are extremely difficult to diagnose since their variable manifestations mimic a host of clinical entities more commonly seen, e.g. mitral stenosis, endocarditis, rheumatic fever, cardiomyopathy or mesenchymosis. At the same time, early diagnosis followed by prompt surgical removal are mandatory to prevent mutilating or lethal complications of the tumor. Six cases of left atrial myxoma were diagnosed in our hospital during 2 1/2 years. We present the case histories, diagnostic procedures and surgical findings, consolidating the unique role of echocardiography in detecting left atrial myxomas. We propose the use of echocardiography as a screening examination for atrial myxomas in the following settings: suspected mitral obstructive disease, suspected endocarditis with negative blood cultures, peripheral embolism or thrombosis in young patients, unexplained cardiac failure and mesenchymosis with uncharacteristic presentation.
Arrhythmias in the Coronary Care Unit Recognized with the Aid of Automated ECG Monitoring
Authors: Hulting Johan
Published: August 2010

ABSTRACT Arrhythmia incidence in 339 patients with and 340 without proven acute myocardial infarction (AMI) has been compared with the aid of an automated arrhythmia monitoring system. Seventeen diagnoses of arrhythmia could be made with the system and resulted in alarms. All ECG write‐outs were analysed manually. The patients were further divided into subclasses of previous myocardial infarction, other previous or present heart diseases (HD), and no previous HD. Except for atrial fibrillation or flutter and bradycardia, all arrhythmias studied were significantly more common in patients with than without AMI. Arrhythmia incidences in AMI/non‐AMI patients regarding paired ventricular ectopic beats (VBs), tachycardia (heart rate >120/min), paroxysmal supraventricular tachycardia (SVT), and more than 5 VBs per min were 72/38, 55/34, 50/22 and 49/29%, respectively. Arrhythmia incidence in the various subclasses of AMI patients did not differ markedly. In the non‐AMI group, most ventricular arrhythmias were less common in patients without HD. The mortality in asystole, ventricular fibrillation and ventricular tachycardia (VT) did not differ between AMI and non‐AMI patients. Most other ventricular and supraventricular arrhythmias were associated with a poorer prognosis in AMI than in non‐AMI patients. No statistical difference in outcome was observed between AMI patients with and without VT. In AMI, paired VBs or SVT carried a good prognosis during stay in the Coronary Care Unit (CCU). The prognostic implications of several arrhythmias and, possibly, the indications for antiarrhythmic treatment in the CCU will be changed with improved monitoring methods.
Multiple Attacks of Jaundice Associated with Repeated Sulfonamide Treatment
Authors: Iwarson Sten , Lundin Per
Published: August 2010

ABSTRACT Four women who were treated with sulfonamides because of recurrent urinary tract infections experienced adverse liver reactions with jaundice during their third, fourth and fifth course of treatment, respectively. In spite of this, sulfonamide treatment was reinitiated some years later. Adverse liver reactions with jaundice recurred on all occasions. The clinical picture of the liver reactions was indistinguishable from that of viral hepatitis and a hepatitis‐like reaction was also seen histologically. Signs of fibrosis appeared histologically after a third attack of jaundice associated with sulfonamides in one patient, but otherwise no persisting abnormalities were noted.
Isochromosome 17 in a Patient with a Myeloproliferative Disorder Terminating in Eosinophilic Leukemia
Authors: Lönnqvist Berit , Gahrton Gösta , Eriksson Per , Friberg Kristina , Zech Lore
Published: August 2010

ABSTRACT A patient is described, who for more than two years had a myeloproliferative disorder which terminated in eosinophilic leukemia. Chromosome analysis revealed an isochromosome 17 in all metaphases of bone marrow cells. This abnormality has now been found in two out of six patients with eosinophilic leukemia investigated by banding techniques, and may therefore have etiologic importance. Chromosome analysis in the hypereosinophilic syndrome has practical value for differentiating malignant and non‐malignant disease.
Atrioventricular and Intraventricular Conduction in Familial Amyloidosis with Polyneuropathy
Authors: Olofsson B. O. , Andersson R. , Furberg B.
Published: August 2010

ABSTRACT. Atrioventricular and/or intraventricular conduction disturbances were found in 48 (67%) out of 71 patients with familial amyloidosis with polyneuropathy. Low voltage, often described in various forms of heart amyloidosis, was seen in one patient only. Myocardial infarction patterns, also often reported in heart amyloidosis, were not present in our patients. The prevalence of conduction disturbances increased with the duration of the disease. In 28 out of 47 patients from whom more than one ECG recording was available, a progression of conduction disturbances could be seen. Ten patients developed high‐degree conduction disturbances and required permanent pacemaker treatment.
Increased Urinary Protein Excretion after Intravenous Injection of Furosemide in Man
Authors: Ylitalo P. , Pasternack A. , Kallio S. , Vänttinen T. , Metsä‐Ketelä T.
Published: August 2010

ABSTRACT. The furosemide‐induced increase in protein excretion, and its relations to 1) the size of protein molecules as reflected by three enzymes, and 2) glomerular filtration rate (GFR), plasma renin activity (PRA) and prostaglandin (PG) E2 and F2α excretions were studied in 14 outpatients with normal renal function and 13 healthy males. Furosemide (120 mg) was given intravenously, and thereafter the protein excretion and the above parameters were monitored for 1–2 hours. In both groups, furosemide caused a transient increase in protein excretion. The excretion of the largest molecule, β‐glucuronidase, rose to 6.3‐fold, while those of N‐acetyl‐β‐D‐gluco‐saminidase and of the smallest molecule, α‐amylase, increased by 91 and 37%, respectively. GFR increased, too, but markedly less than the protein excretion. PGE2 and PGF2α excretions increased more than GFR and changed simultaneously with the excretion of proteins. Furosemide also caused a marked increase in PRA. This lasted, however, much longer than the rise in PG and protein excretion or GFR. The results suggest that the furosemide‐induced increase in protein excretion is 1) related to the molecular size of proteins, 2) partly due to the rise in GFR, 3) simultaneous with the change in PG excretion. Our findings also agree with the view that furosemide causes changes in glomerular permeability.
Comparative Single‐Dose Kinetics and Effects of Four Sulfonylureas in Healthy Volunteers
Authors: Sartor G. , Melander A. , Scherstén B. , Wåhlin‐Boll E.
Published: August 2010

ABSTRACT. The single‐dose kinetics and effects of tolbutamide (500 mg), chlorpropamide (250 mg), glibenclamide (5 mg) and glipizide (5 mg) were compared in 7 healthy male volunteers by measurements of serum concentrations of the drugs and of plasma insulin and blood glucose. The drugs were administered both on an empty stomach and together with a standardized breakfast. The concentrations of tolbutamide and chlorpropamide were measured by gas chromatography, those of glipizide with high‐pressure liquid chromatography, those of glibenclamide and insulin by radioimmunoassay and those of glucose by the hexokinase method. Glipizide and glibenclamide were more potent inducers of insulin release and blood glucose reduction than tolbutamide and chlorpropamide. As the concentrations of the former two drugs were in the range of nmol/1 and those of the latter two in the μmol/1 range, the findings support the notion that the intrinsic activity of the two second‐generation sulfonylureas is at least 1 000 times greater than that of the two first‐generation drugs. Glipizide seemed to be a more potent and more rapid insulin releaser than glibenclamide, but this may be secondary to biopharmaceutic differences between the two preparations. The bioavailability of glipizide was apparently greater than that of glibenclamide. Both glibenclamide (t½ = 1.8 h) and glipizide (t½=4.3 h) showed much shorter elimination half‐lives than tolbutamide (7 h) and chlorpropamide (34 h). It seems probable, however, that these half‐lives are not fully informative as to the duration of action of the drugs.
Early Insulin Response in Latent Gestational Diabetes
Authors: Blohmé G. , Karlsson K. , Waldenström J.
Published: August 2010

ABSTRACT. The intravenous glucose tolerance and glucose‐stimulated early insulin response (EIR) were studied in late pregnancy and post partum in a reference (R) group of 9 women and in 18 women with latent gestational diabetes (LD), defined as a k‐value of <0.66/h and a normal fasting blood glucose concentration. During pregnancy, the LD group showed a lower EIR than the R group. However, the response ranged between normal and non‐detectable. In the non‐pregnant state, the EIR was the same in the two groups. The inability to increase the EIR during pregnancy was most evident in women who even post partum had an abnormal glucose tolerance. In some women in the LD group, the EIR during pregnancy was even lower than in the non‐pregnant state. The magnitude of the response in the non‐pregnant state was not decisive of the capacity to increase the secretion during pregnancy. None of the women in the LD group developed manifest diabetes during pregnancy. They gave birth to children with normal birth weight, and no neonatal problems were registered except for one child with congenital heart malformation.
Effect of Different Kinds of Fibre on Postprandial Blood Glucose in Insulin‐Dependent Diabetics
Authors: Vaaler Stein , Hanssen Kristian F. , Aagenæs øystein
Published: August 2010

ABSTRACT. Dietary fibre may retard glucose absorption in normal and diabetic subjects. It is, however, unclear which type of fibre would be most suitable for this purpose. We therefore studied whether pectin differs from fibre from barley (85 %) and citrus (15%) (Dumovital®) in its effect on postprandial blood glucose responses. Eight insulin‐dependent diabetics fasted overnight and were then given a meal without their morning insulin. The basic meal, composed of 90 g white bread and 120 g jam (total carbohydrate 105 g), was given three times: alone, with 15 g pectin and with 15 g Dumovital fibre. Blood glucose was measured for three hours. The tests showed that pectin administration considerably inhibited the postprandial rise in blood glucose, while Dumovital showed no such effect. Barley/citrus fibre (a mixture of cellulose, hemicellulose, lignin and pectin) has not the same inhibiting effect on postprandial rise in blood glucose as pure pectin in insulin‐dependent diabetics. Thus, the specific type of fibre must be considered when prescribing dietary fibre to diabetics.
Emergency Treatment of Severe Hypertension Evaluated in a Randomized Study
Authors: Nielsen Poul Ebbe , Krogsgaard Arne , McNair Allan , Hilden Tage
Published: August 2010

ABSTRACT. Emergency treatment of acute, severe hypertension was monitored prospectively during a period of nine months in a Danish multicenter trial. A total of 101 patients with supine diastolic blood pressures (DBP), phase V, ≥135 mmHg in three measurements at 5 min intervals entered the study. The emergency treatment was divided into three periods. In period I, lasting for the first hour, the patient was placed in the supine position and no drug treatment was given. If DBP did not fall below 135 mmHg, the patient entered period II, during which furosemide, 80 mg i.v., was given and observation continued for another hour. Patients with pronounced hypertensive encephalopathy (n = 15) and left venticular heart failure (n =2) started directly at period II. Provided DBP thereafter was still 135 mmHg or higher, the patients were randomized in period III (2nd‐5th hour) to treatment with either chlorpromazine or dihydralazine in small refractory i.v. doses or diazoxide, 5 mg/kg b.wt. i.v., as a bolus injection. In period I, DBP fell below our “emergency limit” of 135 mmHg in 23 (27 %) of 84 patients whose mean arterial BP fell from 171 to 140 mmHg during the study. In period II, DBP fell below 135 mmHg in 23 (30%) of 78 patients and their mean arterial BP decreased from 174 to 135 mmHg during the study. In period III, 24 patients were treated with chlorpromazine, 16 with dihydralazine and 15 with diazoxide. In patients treated with chlorpromazine or dihydralazine, BP decreased gradually during the first hour, on average from 211/146 to 155/103 and from 219/147 to 162/89 mmHg, respectively. After diazoxide BP decreased abruptly in the first two minutes, on average from 211/144 to 166/100 mmHg. The complication rate was generally low and only a few patients were resistant to any of the treatments given. The study was not able to demonstrate that diazoxide is preferable to the other two drugs in emergency treatment.
Immunological and Hematological Abnormalities in Chronic Alcoholism
Authors: Björkholm Magnus
Published: August 2010

ABSTRACT. Thirty‐two chronic alcoholics were studied immunologically and hematologically on the first hospital day after a period of excessive alcohol consumption. No patient had any signs of severe liver disease. All patients were tested for delayed skin hypersensitivity to PPD and mumps antigens. Quantitation of immunoglobulins and routine hematological tests were also performed. Fifteen and 23 patients did not respond to PPD and mumps antigens, respectively, compared to about 10 and 40% of anergic controls. Anergic patients had lower haptoglobin levels than skin‐positive patients. Elevated IgM values were common. Thrombocytopenia was the most common (41%) hematological disturbance, while 19% of the patients were anemic.
Serum Myoglobin Compared with Creatine Kinase in Patients with Acute Myocardial Infarction
Authors: Nørregaard‐Hansen K. , Lindø K. E. , Ludvigsen C. Vind , Nørgaard‐Pedersen B.
Published: August 2010

ABSTRACT. In a retrospective study of 307 patients with suspected acute myocardial infarction (AMI) the diagnostic value of S‐myoglobin quantitation was compared with S‐creatine kinase (CK, EC 2.7.3.2). The results were compared with the final diagnoses, which were made according to the WHO criteria. A reference group of healthy blood donors and children hospitalized for removal of adenoids was investigated. Children (2–16 years) had significantly lower myoglobin levels (25±10 μg/l) than adults (19–65 years, 41±17 μg/l). In the children a positive correlation was found between age and S‐myoglobin concentration but not in adults. Women (34±17 μg/l) had lower S‐myoglobin concentration than men (47±15 μg/l). The difference in sensitivity for detection of AMI by S‐myoglobin or S‐CK analyses is not significant when the results from blood samples drawn on admission and on the following three mornings are compared, but myoglobin can be detected earlier in serum than CK after an AMI. If only the results from blood samples drawn on admission are compared, the S‐myoglobin analysis had a significantly higher sensitivity than the CK analysis. The S‐myoglobin analysis had a lower specificity than the CK analysis, and i.m. injections were found to be an important reason for false positive results. S‐myoglobin may be of value in the very early verification of AMI, but the frequent blood sampling and the low specificity are problematic. The simultaneous quantitation of S‐myoglobin and the heart specific CK isoenzyme fraction (MB) seems to be a good combination.
Pseudohypoparathyroidism
Authors: Frederiksen Peer Klose , Jacobsen Jørgen Georg
Published: August 2010

ABSTRACT. The diagnosis of pseudohypoparathyroidism is often not made until many years after the onset of symptoms and signs characteristic of the disease. A case history presented here illustrates this and stresses the importance of determining the calcium concentration in plasma in all patients with attacks of sensory and motor phenomena.