bluuebunny/crossref_metadata_2025 huggingface dataset:
Experimental Studies of Psychophysiological Factors in Sudden Cardiac Death
Authors: Verrier Richard L. , Lown Bernard
Published: August 2010

ABSTRACT. Earlier research in the field of sudden cardiac death is reviewed. Such studies were largely oriented towards the provocation of myocardial injury and asystole in normal animals. However, such investigations constitute an inadequate model to describe the clinical appearance of sudden death, where underlying coronary disease is often present and the precipitating event is usually ventricular fibrillation rather than asystole.

This report describes a series of studies designed to investigate the processes underlying cardiac vulnerability and the influence upon it of various psychological stresses. It is concluded that the primary mediator of ventricular vulnerability is the sympathetic nervous system. The efferent vagus appears to exert some protective influence against arrhythmias due to adrenergic stimulation. An appropriate clinical strategy for the treatment of malignant arrhythmias would therefore involve attempts to decrease cardiac sympathetic drive whilst at the same time enhancing vagal tone. Treatments are described which aim to bring this situation about by the use of clonidine, morphine sulphate, 1–tryptophan and tyrosine. The use of neurochemical agents in this context appears promising.
Socio–Economic Status as a Coronary Risk Factor: the Oslo Study
Authors: Holme I. , Helgeland A. , Hjermann I. , Leren P.
Published: August 2010

ABSTRACT. The association between socioeconomic status, measured by a combination of income and education, and CHD mortality has been studied in a cohort of 40–49 year old Oslo men.

Socio–economic status was significantly associated with CHD mortality. However, the lowest CHD mortality was found in social status Group III (middle class) and this could not be explained by the risk factor gradients seen among those studied.

Although the number of fatalities is small (68 CHD deaths during 4.5 years) socio–economic status seems to be independently associated with coronary risk after adjusting for serum cholesterol, systolic blood pressure and cigarette smoking.
Bio–Behavioural Perspectives on Coronary Heart Disease, Hypertension and Sudden Cardiac Death
Authors: Eliot Robert S. , Buell James C. , Dembroski Theodore M.
Published: August 2010

ABSTRACT. A series of research developments is described which together consider the problem of the relationships between behavioural, physiological and pathophysiological processes. Arguments are advanced for the measurement of challenge–induced changes in haemodynamic responses for use in the understanding, prediction and control of coronary heart disease (CHD), hypertension and sudden cardiac death. A methodology is presented as a possible tool for accomplishing this latter goal and preliminary data are reported in support of the feasibility of these methods. Finally, basic pathophysiological mechanisms in cardiovascular disorders are examined in relation to potentially damaging haemodynamic activity.
Single–dose pharmacokinetics of labetalol in healthy young men
Authors: Nyberg Gunnar , Hansson Roy , Tietz F.
Published: August 2010

ABSTRACT. Single doses of labetalol (200 mg i.v. over 5 min, 200 and 400 mg orally) were given to five helthy men on three different occasions. Plasma levels were followed for up to 25 h and blood pressure for 5 h.

The elimination half–life was 1.6 to 8.5 h for the first 8 h. The oral bioavailability ranged from 4 to 23%. All doses induced a significant fall in systolic blood pressure at 2 h, the peak effect occurring at 30–120 (mean 63–72) min. After intravenous administration the peak supine blood–pressure fall was significant for both systolic and diastolic blood pressure and occurred 16 min after administration.
Short–term influence of a post–synaptic α–adrenoceptor blocking drug (prazosin) on carbohydrate metabolism
Authors: Waern A. Urban , Berne Christian , Wibell Lars , Lithell Hans
Published: August 2010

ABSTRACT.Since sympathetic nervous activity is intimately involved in the regulation of hormonal and metabolic responses, it may be assumed that antihypertensive drugs acting on adrenergic receptors will interfere with metabolic control mechanisms.

We have therefore evaluated the effect of the selective α1–adrenoceptor blocker prazosin on intravenous glucose tolerance and insulin response in a group of 6 healthy subjects. Ninety minutes after a single oral dose of 2 mg prazosin we observed a significant (p < 0.05) fall in K–value (mean decrease from 1.7 to 1.0), which was accompanied by a blunting of the early insulin response. The acute effects of prazosin closely resemble those observed after 6–8 weeks of treatment with therapeutic doses of prazosin in hypertensive women. It is postulated that the effect of prazosin is mediated by an increase in circulating catecholamines acting on the pancreatic β–cell α2–adrenoceptors, which are responsible for the wellknown inhibitory action af α–adrenergic agents upon the release of insulin.
Haemodynamic effects of β–receptor blockade during acute administration and chronic treatment
Authors: Jensen Henrik AErenlund
Published: August 2010

ABSTRACT. In early essential hypertension, an increase in cardiac output (CO) is seen in about twothirds of the patients. In established essential hypertension, CO is usually normal or subnormal, while total peripheral resistance (TPR) is increased.

Treatment with β–adrenergic blocking agents accentuates these haemodynamic changes; in particular CO is further decreased. Comparison of the effects of β–blockers with and without β1–selectivity and instrinsic activity reveals slight differences in the haemodynamic responses. Although none of the β–blockers normalizes the haemodynamics, satisfactory blood–pressure reduction may be achieved at rest and during exercise with minimal side effects.
Peripheral vasodilatation in the treatment of hypertension. Prazosin compared with hydralazine in patients not responding to β–receptor blockade
Authors: Malmberg Lars , Fagerberg Sven–Erik , Frithz Göran
Published: August 2010

Prazosin was compared with hydralazine in 39 patients (mean age 49 years), who were already on β–blockade for arterial hypertension. They all had a resting DBP > 100 mm Hg on propranolol 80 mg b i d. They were randomly allocated to prazosin or hydralazine treatment. Blood pressure was measured after 4, 8 and 12 weeks. We noted a significant fall in blood pressure in both groups, in most cases to normotensive levels. Side–effects and other variables of interest are discussed. Together with β–blockade, i e propranolol, both prazosin and hydralazine give good blood–pressure control and no important differences could be found.
Inotropic, chronotropic and dromotropic effects of prenalterol, a new cardiostimulant drug
Authors: Moore E. N. , Aberg G. , Spear J. F. , Hodess A. B. , Herrmann I. , Adler G.
Published: August 2010

Prenalterol (H 133/22) is an adrenergic β–receptor stimulator which unlike isoproterenol is both orally active and has a long duration of action. The inotropic, chronotropic and dromotropic effects of prenalterol were investigated in pentobarbital anaesthetized dogs. Prenalterol was found to increase left ventricular maximum dP/dt in a dose–dependent manner up to a dose level of 50 μg/kg. Additional doses resulted in only small further increases in cardiac contractility. Electrophysiological studies were done to compare the effects of prenalterol and isoproterenol on sinus node and ventricular pacemaker function. Complete AV block was produced by electrocauterization of the His bundle. Prenalterol accelerated both ventricular and sinus node pacemakers at doses up to 50 μg/kg. The increase in ventricular rate was greater than the increase in sinus rate following supramaximal inotropic doses of prenalterol, yet no ventricular extrasystoles were ever observed. Similar acceleration of the ventricular and sinus node pacemakers were observed by infusion of isoproterenol. Prenalterol and isoproterenol accelerated AV nodal conduction and ventricular conduction but had little effect upon His–Purkinje conduction. Sinus node reset time was abbreviated as was the functional and effective refractory periods of the atrium and AV nodes.
Pharmacokinetics of prenalterol in healthy subjects and patients with congestive heart failure
Authors: Rönn O.
Published: August 2010

1. Prenalterol is rapidly and completely absorbed after oral administration with peak concentrations reached after 30 minutes.

2. Prenalterol is rapidly distributed to extravascular tissues after intravenous administration.

3. The extent of bioavailability after administration of prenalterol as a solution is about 25% of an intravenous dose. After administration of 20 mg prenalterol in a controlled release preparation the bioavailability is increased to about 45%.

4. The half–life of the elimination phase is close to 2 hours.

5. 60% of an intravenous dose and 15% of an oral dose is eliminated unchanged by renal excretion. The rest is mainly excreted as the sulphate ester of prenalterol.

This presentation deals with the pharmacokinetic properties of prenalterol. The results have been obtained mainly from studies in healthy subjects after acute administration of the drug both intravenously and orally, but some preliminary data on the pharmacokinetics of prenalterol In patients with cardiac failure will also be presented.

The studies were performed in six healthy male volunteers 22 to 25 years of age and with a mean weight of 78 kg. The subjects were in good health as judged from clinical and laboratory examinatlons. Prenalterol was administered on occasions separated by at least three days and was given in a randomised order. The subjects arrived at the laboratory after having fasted overnight. A standardised meal was given 3 and 6 hours after drug administration.

Prenalterol was administered as prenalterol hydrochloride, a salt freely soluble In water. A single dose of 2.5 mg prenalterol was infused intravenously over 5 min. Oral prenalterol was given as a solution together with 100 ml of water in doses of 2.5, 5.0 and 10.0 mg. Three of the subjects received the intravenous dose and the oral dose of 2.5 mg as tritiated compound.
Circulatory response to prenalterol in normal subjects and in patients with primary congestive cardiomyopathy
Authors: Guazzi M. D. , Qing Lü Guo , Olivari M. T. , Fiorentini C. , Loaldi A. , Bartorelli A. , Moruzzi P. , Polese A.
Published: August 2010

Experimental pharmacology indicates that prenalterol is a selective β1–adrenoceptor activator. In 5 normal individuals, 15 minutes after the drug (infused at a dose of 15 μg/kg over 5 min) the following circulatory changes were seen:

a) increase of cardiac index (+31%), heart rate, stroke Index, systolic aortic pressure, left and right ventricular mean rate of ejection and mean rate of the pressure rise in either ventricle during the pre–ejection phase;

b) reduction of systemic vascular resistance (–18%), appearance, built–up and disappearance times in the left ventricular dye dilution curves. Pulmonary systolic, diastolic and wedge pressures and vascular resistance did not vary consistently. The circulatory effects persisted almost unchanged 30 minutes after the infusion.

In a group of 5 patients with heart failure due to primary congestive cardiomyopathy, refractory to conventional therapy, the haemodynamic response to prenalterol (infused at a dose of 30 μg/kg over 5 min) was qualitatively similar to that of normal subjects in 3 cases. In 2 other patients cardiac performance deteriorated. The reasons for this paradoxical effect were not identified.

These preliminary results suggest that prenalterol is a potent selective inotropic agent in man, that may assist in the therapeutic management of refractory heart failure due to congestive cardiomyopathy. However, careful haemodynamic monitoring is advisable for its use in this dysfunction until broader clinical experience can be accumulated.
Dose–dependent haemodynamic response to prenalterol in patients with congestive heart failure
Authors: Leinberger H. , Mäurer W. , Haueisen H. , Schuler G. , Kübler W.
Published: August 2010

The effect of three doses of prenalterol, 12.5, 25 and 50 μg, on cardiac index (CI), pulmonary artery pressure (PAP), heart rate (HR), and stroke volume index (SVI) was investigated in 18 patients with congestive heart failure (CHP). Twelve patients received only prenalterol, while 6 patients received prenalterol 1 hour after an oral dose of hydralazine and isosorbid dinitrate. In 7 out of 12 patients a dose–dependent increase in HR was observed. The response of HR was inversely correlated to resting catecholamine levels; patients with high resting catecholamines – these are patients with severe CHP – did not show any increase2 in HR. CI increased in 8 out of 12 patients (average l.l/min m2) and SVI in 5 out of 12 patients. This inconsistent response was not dependent on left ventricular ejection fraction or plasma catecholamines at rest. Pretreatment with vasodilators did not improve the haemodynamic response to prenalterol. Pour out of 17 patients demonstrated an increase in severity of arrhythmias suggestive of arrhythmogenic properties of prenalterol.
Hypercalcemic and Calcium‐Antagonistic Effects on Insulin Release and Oral Glucose Tolerance in Man
Authors: Andersson D. E. H. , Röjdmark S. , Hed R. , Sundblad L.
Published: August 2010

ABSTRACT.The present investigation was carried out in order to study the acute effects of hypercalcemia on the carbohydrate metabolism in healthy subjects and in patients with non insulin‐dependent diabetes mellitus (NIDDM). The combined effect of hypercalcemia and a calcium‐antagonistic agent (verapamil) was also studied in healthy subjects, in patients with NIDDM, and in patients with chronic hypercalcemia, e.g. primary hyperparathyroidism (PHPT). Calcium, infused intravenously to fasting diabetic patients, induced a significant decline in the blood glucose concentration. This was not the case in healthy individuals. When glucose was administered orally during exogenous hypercalcemia, glucose tolerance decreased significantly in the diabetic as well as in the healthy individuals. Verapamil, however, abolished this hypercalcemic effect, and even improved the tolerance for oral glucose when administered intravenously together with calcium in the patients with NIDDM. No such effect of verapamil was seen in the healthy subjects or in the patients with PHPT. Insulin activity was left unaffected by hypercalcemia and/or verapamil in all experimental situations. These findings thus imply that hypercalcemia decreases the tolerance for oral glucose in normoglycemic subjects, and further deteriorates the glucose tolerance in patients with an already impaired carbohydrate metabolism. Verapamil, on the other hand, appears to counteract this effect of hypercalcemia in diabetic patients. Since insulin remains unaffected by calcium and verapamil in the above mentioned situations, it is reasonable to assume that the calcium‐ and verapamil‐induced effects on the glucose tolerance are due to glucose‐regulatory factors other than insulin.
Diagnosis of Deep Venous Thrombosis by Phlebography and99Tcm‐Plasmin
Authors: Edenbrandt Carl‐Magnus , Nilsson Jan , Ohlin Per
Published: August 2010

ABSTRACT.One hundred and thirty‐four patients admitted to the medical emergency ward due to suspect deep venous thrombosis (DVT) were examined. The uptake of intravenously injected porcine99Tcm‐plasmin was estimated in both legs. Thereafter, phlebography was performed using a high osmolar contrast medium. All phlebographies were evaluated independently. All patients with negative phlebography were examined clinically after 3–5 days. The plasmin test and phlebography were repeated when called for. The sensitivity of the plasmin test was 100% and the specificity 51% when compared to phlebography. The extension of the DVT as demonstrated by the plasmin test was similar to that determined by phlebography. Post‐phlebographic thrombosis was very rare. It is concluded that99Tcm‐plasmin test is a rapid method, convenient to the patient and well suitable as a screening test. The results indicate that a negative plasmin test excludes DVT while a positive test necessitates additional examination by phlebography.
Clinical Characteristics of 18‐Year‐Old Men with Elevated Blood Pressure
Authors: Theorell T. , Svensson J. , Löw H. , Nerell G.
Published: August 2010

ABSTRACT. Twenty “hypertensive” 18‐year‐old men (systolic BP ± 146 and/or diastolic BP ±90 mmHg) from the screening examinations of a military draught bureau were compared with 17 normotensive (systolic BP 124–131) and 12 hypotensive (systolic BP 100–106) subjects. The hypertensive subjects were on average taller, showed more often ECG evidence of sympathoadrenomedullary overactivity, tended to excrete more adrenaline in the urine during a standardized psychological stress test, had higher serum levels of sodium and potassium and reported more frequently family prevalence of hypertension than the normotensives and hypotensives. Non‐participating subjects without verified hypertension had higher mean relative weight than any of the study groups. Only one hypertensive subject showed dilated pulmonary vessels on chest X‐ray and borderline evidence of mild left ventricular hypertrophy. None of the hypertensive subjects showed evidence of decreased glomerular filtration rate or endocrine disorder. The subjects in both comparison groups showed frequently ECG evidence of parasympathetic activity. The hypotensive group had a lower average relative body weight than the other groups.
The Effect on Blood Pressure, ECG and Heart Rate of Psychological Stress, Static and Dynamic Muscle Work
Authors: Ohlsson O. , Henningsen N. C.
Published: August 2010

ABSTRACT. A total of 195 relatives of patients from families with essential hypertension in at least two generations have been examined in regard to blood pressure (BP) and heart rate (HR) during muscle work and psychological stress. They were compared to controls without heredity for hypertension. The differences in BP and HR at rest between the groups were maintained throughout all tests, but during heavy dynamic muscle work systolic BP rose less in relatives than in controls. When relatives and controls were divided into subgroups, we found that BP was more related to age in relatives than in controls, both at rest and during the provocation tests. The differences in BP between the groups could thus depend on a genetic factor with greater penetration with increasing age.
Melphalan‐Related Leukemia in Multiple Myeloma
Authors: Wahlin Anders , Roos Göran , Rudolphi Olle , Holm Jan
Published: August 2010

ABSTRACT. Five patients with multiple myeloma ending in acute leukemia are described. The preleukemic phase was characterized by anemia, leukopenia and/or thrombocytopenia. The incidence of acute leukemia in myeloma was calculated to be 6%. Melphalan therapy for more than two years increased the incidence to 14%. All patients who developed leukemia had received a total melphalan dose of at least 1100 mg.
Urine Microscopy as Screening Method for Bacteriuria
Authors: Holm Stig , Wahlin Anders , Wahlqvist Lennart , Wedrén Hans , Lundgren Barbro
Published: August 2010

ABSTRACT. Fresh urine samples from 90 ambulatory patients with urological disorders were examined for leucocytes by counting the number of WBC/mm3 and per high power field (HPF) in sediment. Bacteria could be cultured in 20 samples, 18 of which contained >8 WBC/mm3. Two (3%) of the 63 samples with ±8 WBC/mm3 contained bacteria. Bacteriuria was found in two (3%) of 65 samples containing 0–1 WBC/HPF. Microscopic examination of the sediment might be used for the screening of patients with a high frequency and urgency of micturition for bacteriuria. A normal number of urinary leucocytes (±8/mm3) indicates that no bacteria will be found in culture. Leucocyturia indicates a high probability of bacteriuria.
Antinuclear and Antinative DNA Antibodies during Captopril Treatment
Authors: Kallenberg C. G. M. , Hoorntje S. J. , Smit A. J. , Weening J. J. , Donker A. J. M. , Hoedemaeker Ph. H. , The T. H.
Published: August 2010

ABSTRACT. Antinuclear antibodies (ANA) developed in 13 out of 78 patients treated with captopril for a mean period of 11 months. In another 11 patients, who were ANA‐positive before captopril therapy, no increase in ANA titer was observed during treatment. Neither the development nor the presence of ANA before captopril treatment were associated with (drug‐induced) lupus erythematosus or increased incidence of clinical side‐effects, although development of ANA was accompanied by a serum‐sickness‐like syndrome in one patient. The ANA were mainly of the IgM class, did not fix complement and were transiently present. In three patients, antinative DNA antibodies, exclusively of IgM class and not complement‐fixing, were transiently present without clinical signs of systemic lupus erythematosus, although recurrence of these antibodies was associated with slight proteinuria in one of them.
Bone Scintigraphy in the Diagnosis of Skeletal Involvement and Metastatic Calcification in Multiple Myeloma
Authors: Nilsson‐Ehle Herman , Holmdahl Carl , Suurküla Madis , Westin Jan
Published: August 2010

ABSTRACT. The contribution of bone scintigraphy to the diagnosis of skeletal involvement in multiple myeloma was evaluated in a consecutive, unselected series of 25 previously untreated patients. Definite scintigraphic abnormalities were found in 11 patients (localized in 4, generalized in 7) (44%). In the majority of patients the clinical value of the information gained from scintigraphy was roughly equal to that found by radiography. However, 2 patients with normal and 2 with questionable bone scans had X‐ray evidence of skeletal involvement, and the extent of bone destruction in 4 cases was seriously underestimated in the bone scans. Small osteolytic lesions were as a rule not detected by scintigraphy. On the other hand, in 8 patients the bone scan added information of involvement of ribs, pelvis and vertebrae, not clearly visualized by X‐ray. In 2 patients, both with IgA myeloma, hypercalcemia and uremia, a massive extraskeletal uptake of the bone‐seeking isotope was observed. Autopsy verified in one case the presence of a disseminated metastatic calcification.
The Prognosis for Patients Admitted to a Coronary Care Unit due to Suspected Acute Myocardial Infarction with and without Confirmed Diagnosis
Authors: Madsen Jan Kyst , Hansen Jørgen Fischer
Published: August 2010

ABSTRACT. In a retrospective study the incidence of AMI and death after discharge from CCU have been recorded in 67 patients with and 93 without a diagnosis of AMI confirmed in the CCU. No statistically significant differences were found between the two groups in mortality rate during the first 3 years, 18.3% (non‐AMI) and 22.4% (AMI), or in cardiac events, sudden death and AMI, 19.3% (non‐AMI) and 24.9% (AMI), during the first 2 years after discharge. Non‐AMI patients with either previous AMI, angina pectoris or ST‐T abnormalities in the ECG accounted for the major part of cardiac events in this group. The mortality rates in the two groups, compared to a normal population matched for sex and age, were in the AMI group in the 1st year 13.4 and 2.6% (p<0.01), in the 2nd year 3.4 and 2.8% (p>0.05), in the 3rd year 7.1 and 2.9% (p>0.05) and in the non‐AMI group in the 1st year 11.8 and 1.8% (p<0.01), in the 2nd year 3.7 and 2.0% (p>0.05), in the 3rd year 3.8 and 2.1% (p>0.05). It is concluded that the prognosis after discharge from the CCU is as unfavourable for patients without as for patients with AMI. The mortality is highest during the first 6–12 months after discharge.
Neutrophil and Lymphocyte Function in Patients with Diabetes Mellitus
Authors: Valerius N. H. , Eff C. , Hansen N. E. , Karle H. , Nerup J. , Søeberg B. , Sørensen S. F.
Published: August 2010

ABSTRACT. Neutrophil granulocyte chemotaxis and intraneutrophilic and plasma levels of lysozyme as well as the number of T and B lymphocytes and lymphocyte transformation in vitro on stimulation with mitogens and microbial antigens were studied in four groups of patients with diabetes mellitus (DM). Twelve patients with insulin‐dependent diabetes mellitus (IDDM) and ketoacidosis and 4 patients with non‐insulin‐dependent diabetes mellitus were studied at the time of diagnosis and before and after start of treatment. Ten patients with IDDM of less than 10 years' duration which had been difficult to regulate well and 10 patients with IDDM well regulated for more than 20 years were studied at their regular outpatient visits. Apart from a slight increase in plasma lysozyme in group 1 from the first to the second examination, we found no differences between diabetics and healthy control persons. It is concluded that if patients with DM are more susceptible to infections, it is probably caused by elements of neutrophil or lymphocyte function not examined in this study or by factors unrelated to immunity.
Myotonic Dystrophy and Selenium
Authors: örndahl Gustav , Rindby Anders , Selin Eva
Published: August 2010

ABSTRACT. The correlation between selenium concentration in blood serum and the severity of the disease was investigated in 22 patients with myotonic dystrophy. Their serum concentrations of selenium and some other trace elements were compared with those of a control grup. It was found that the selenium concentration decreased in parallel with progression of the illness.
A Bartter‐like Syndrome after Jejunoileal Bypass for Obesity
Authors: Julkunen Risto , Haapalahti Jouko , Torstila Ilkka , Miettinen Tatu A.
Published: August 2010

ABSTRACT. A case of an adult woman with a Bartter‐like syndrome after jejunoileal bypass for obesity is described. Diarrhoea, hypokalaemia, high plasma renin activity, hyperaldosteronism, alkalosis, increased urinary prostaglandin E and hyperplasia of the juxtaglomerular apparatus with low or normal blood pressure were the major features. After corrective surgery the values turned only transiently towards normal, despite permanent disappearance of the diarrhoea. Spironolactone, amiloride or propranolol had no real effect on clinical symptoms or biochemical aberrations. Indomethacin, a prostaglandin synthetase inhibitor, normalized most of the aberrations, but—inexplicably—not the prosta‐glandinuria.
Timolol Eyedrop‐Induced Severe Bronchospasm
Authors: Laursen Søren østergaard , Bjerrum Pernille
Published: August 2010

ABSTRACT. A patient with glaucoma simplex and chronic pulmonary obstruction was treated with the non‐selective β‐adrenergic blocking agent timolol in ophthalmic solution of 0.25% for 1 1/2 years, when he had daily asthma attacks. In a provocation test, forced expiratory volume in the first second was reduced by 56% and bradycardia was induced after application of two drops of timolol eyedrops 0.25%. The severe systemic side‐effects of timolol, when used as eyedrops, are related to the liver bypass and perhaps to the fast absorption from the cornea. It is suggested that when timolol ophthalmic solution is given for the first time to glaucoma patients with chronic obstructive pulmonary disease, they should be observed for one hour with special reference to difficulty in breathing.
Studies on Methanol Poisoning
Authors: Jacobsen Dag , Jansen Helge , Wiik‐Larsen Else , Bredesen Jan Erik , Halvorsen Stein
Published: August 2010

ABSTRACT.Eleven patients concomitantly poisoned with methanol are described. Their whole blood methanol concentration ranged from 137.2 mmol/l (4.39 g/1) to 7.4 mmol/l (0.24 g/1). The clinical course in most patients was mild, which was attributed to the concomitant and subsequent ethanol ingestion and rapid transport to dialysing units. One patient suffered permanent visual impairment of one eye while the others recovered completely. Symptoms of poisoning were most clearly correlated to the degree of metabolic acidosis. All patients were hemodialysed. In two patients the average dialysator clearance of methanol was 157 and 176 ml/min at blood flows of 200 and 215 ml/min, respectively. In the same patients the average dialysator clearance of ethanol was 149 and 164 ml/min. Assuming a volume of distribution of methanol of 0.7 l/kg, the dialysator represented about 89 and 95%, respectively, of the total body clearance of methanol during ethanol therapy. Ethanol in concentrations even lower than usually recommended may be useful as the only treatment of patients with blood methanol concentrations up to 15 mmol/l (0.5 g/l), provided there is no acidosis or visual impairment.
Serum β‐Hexosaminidase in Diabetes Mellitus with Reference to the Type of Treatment
Authors: Agardh Carl‐David , Hultberg Björn , Thorén Sven
Published: August 2010

ABSTRACT. A significantly increased serum level of β‐hexosaminidase was found in an unselected group of 85 diabetics. When the patients were divided into three groups according to type of treatment, increased enzyme levels were found only in patients treated with oral hypoglycemic agents or diet while insulin‐treated patients had normal serum levels of β‐hexosaminidase. There was a positive correlation between β‐hexosaminidase and blood glucose concentration for the entire patient series. When grouped according to treatment, a positive correlation was found only in the insulin‐treated group despite its normal serum activity of β‐hexosaminidase. Serum β‐hexosaminidase of patients with retinopathy did not differ from the mean value of their group. It is concluded that the activity of β‐hexosaminidase in diabetics can produce different results depending on the type of patients under study.
Platelet Factor 4 Plasma Levels at Rest and after Exercise in Patients with Recent Myocardial Infarction
Authors: Ek I. , Falkenberg C. , Bygdeman S. , Thunell S.
Published: August 2010

ABSTRACT. Plasma levels of platelet factor 4 (PF 4) were determined in 30 patients with recent acute myocardial infarction. Comparisons were made with the levels in 26 age‐matched controls. In another 15 patients, also with recent myocardial infarction, PF 4 plasma levels were determined before and immediately after a standardized exercise stress test. At rest, none of the patients had elevated PF 4 levels. Only one patient demonstrated an increase after exercise. These findings are in conflict with some recent reports. The importance of age‐matched controls, the hazard of in vitro platelet activation and the possible effect of β‐blocking and calcium‐antagonistic drugs on PF 4 plasma levels is discussed below.
Prediction of Left Main Coronary Artery Stenosis by Exercise Electrocardiography
Authors: Forssell Gunilla , Jonasson Rune , Landou Christian , Orinius Erik
Published: August 2010

ABSTRACT. The possibilities of predicting left main coronary artery stenosis (LMCAS) by the T wave pattern in exercise ECG were studied in a consecutive series of patients with stable angina pectoris and were compared to the predictive ability of ST criteria. After exclusion of patients with interfering diagnoses and digitalis treatment, 146 patients remained; 16 of them had LMCAS. Appearance or increase of a biphasic or negative T wave in leads V2–6 2 min after exercise detected 63% of the LMCAS, and the predictive value of a positive test was 36%. The sensitivity of the ST criteria was only 38% and the predictive value 26%. The observer concordance was 98% for the T wave and 84% for the ST criteria. These T wave criteria are at least as sensitive and predictive as the ST criteria and easier to apply.
Antihypertensive Effects at Rest and during Exercise of a Calcium Blocker, Nifedipine, alone and in Combination with Metoprolol
Authors: Ekelund L.‐G. , Ekelund C. , Rössner S.
Published: August 2010

ABSTRACT.The effects of metoprolol and/or nifedipine on blood pressure were studied in 12 hypertensive males at rest and during standardized exercise on an ergometer bicycle. Metoprolol (100 mg ×2) and nifedipine (10 mg ×3) gave similar blood pressure reductions both at rest and during exercise. When the drugs were combined, the antihypertensive effect was potentiated. The PQ interval was not affected during any treatment period. No adverse reactions to the combined treatment were noted. The combination of a calcium blocker with vasodilating properties with a β‐blocker, which reduces cardiac output, thus seems a logical and promising therapeutic approach in the treatment of hypertension.
Hemodynamic and Angiocardiographic Observations in Familial Amyloidosis with Polyneuropathy
Authors: Olofsson B. O. , Bjerle P. , Osterman G.
Published: August 2010

ABSTRACT. Eleven patients with familial amyloidosis with polyneuropathy were studied by heart catheterization; eight of them also by right and left ventriculography and selective coronary angiography. Signs of congestive heart failure, often reported as typical of cardiac amyloidosis, were found in only one patient. The systolic function was relatively unimpaired, but in several patients hemodynamic data suggested restrictive cardiomyopathy. Six patients showed signs of right or left ventricular outflow tract obstruction. Thus, no uniform hemodynamic pattern could be identified, but the changes found indicate impaired diastolic function.
Coupling between Dietary Changes, Reduced Body Weight, Muscle Fibre Size and Improved Glucose Tolerance in Middle‐Aged Men with Impaired Glucose Tolerance
Authors: Lindgärde F. , Eriksson K.‐F. , Lithell H. , Saltin B.
Published: August 2010

ABSTRACT. Fourteen middle‐aged med with impaired glucose tolerance were studied prior to and 6 months after exchange of simple carbohydrates for complex carbohydrates rich in fibers and saturated for polyunsaturated fats in their diet when exchangeable. Body weight was reduced by 6.4 kg (p<0.001). Physical work capacity was unchanged. Fasting blood glucose and insulin were lowered (p<0.001) at 6 months and so were the values during an OGTT at 120 min. Both serum triglyceride and cholesterol concentrations were reduced (p<0.01) by the changed diet, the most marked reduction being found in the VLDL fraction. HDL levels increased by 21% (p<0.01). Enzyme activities in gastrocnemius muscle specimens were subnormal and uninfluenced by changed dietary habits. The number of capillaries per fiber was normal throughout, but as muscle fiber size was reduced in relation to the decreased body weight, the number of capillaries/mm2 increased during the dieting period. It is suggested that the observed improvement in insulin sensitivity and glucose tolerance after a dietary period with weight reduction is related to and partly explained by shorter diffusing distances in weight‐bearing muscles.
Effects of Bed Rest and Prazosin in Congestive Heart Failure
Authors: Thaulow Erik , Ihlen Halfdan , Kjekshus John , Forfang Kolbjörn , Storstein Ole
Published: August 2010

ABSTRACT. Twelve patients with congestive heart failure were monitored with invasive and noninvasive techniques to evaluate the effect of vasodilator treatment. During the 18 hours of strict bed rest before administration of prazosin, the hemodynamics improved substantially while only small and transient hemodynamic changes were observed after introduction of prazosin. At 6 weeks' control the effect of vasodilator treatment with prazosin, 3 mg × 4, was lost. The beneficial results often credited to vasodilators in studies on congestive heart failure might in part be due to the concomitant bed rest introduced during the monitoring of the patients.
Renal Function in Familial Amyloidosis with Polyneuropathy
Authors: Steen Lars , Wahlin Anders , Bjerle Per , Holm Sonja
Published: August 2010

ABSTRACT. The renal function is assumed to be normal in most patients with familial amyloidosis with polyneuropathy (FAP) type 1. In the present study of 24 patients with FAP type 1, estimation of the urinary concentrating capacity and ***31Cr‐EDTA clearance demonstrated that the glomerular clearance and the concentrating capacity were impaired in most patients. The concentrating capacity was significantly correlated with the clearance values. Urine electrophoresis indicated a glomerular cause for the proteinuria. It is suggested that the renal dysfunction should be attributed to deposition of amyloid substance in the glomeruli.
Prevalence of Retinopathy and Proteinuria in Type 1 Diabetics in Iceland
Authors: Danielsen R. , Jónasson F. , Helgason T.
Published: August 2010

ABSTRACT. The prevalence of retinopathy and proteinuria was assessed in 212 and 230 type 1 diabetics in Iceland respectively. They represent 78% and 84% of all such patients identified in the country. Retinopathy was present in 33.5%, background lesions only in 27.4% and more severe retinopathy in 6.1%. After 5–9 years of diabetes (mean 6.9) the prevalence of retinopathy was 18.8%, including 2.1% proliferative, and rose to 76.7% after 20 years or more of diabetes (mean 26.7), including 16.2% in the proliferative stage. Blindness was found in 2.4% of the patients. Diabetics diagnosed at the age of 0–19 years had a lower prevalence of retinopathy during their first 20 years of diabetes than those diagnosed later in life (p<0.05). Proteinuria was present in 14%, intermittent in 10% and continuous in 4%. After 10 years or more of diabetes (mean 19.3) the prevalence of intermittent and continuous proteinuria was 13.0% and 8.3%, respectively.
Urinary Excretion of Prostaglandin F2α and 6‐Keto‐Prostaglandin F1αa during Volume Expansion in Patients with Glomerulonephritis
Authors: Linné Tommy , Oliw Ernst , Aperia Anita
Published: August 2010

ABSTRACT. Thirteen patients with active IgA glomerulonephritis (IgA GN), ten patients with a history of Henoch‐Schönlein glomerulonephritis (HS GN) and nine healthy controls were studied during hydropenia (HP) and 3% volume expansion (VE) with isotonic saline. Clearance of inulin and para‐aminohippurate, urinary excretion of Na, immunoreactive prostaglandin F2α (PGF2α) and 6‐keto‐prostaglandin F1α (6‐keto‐PGF1α) were determined. The patients with a history of HS GN had normal blood pressure and renal function. As in the controls, the urinary excretion of PGF2α decreased and the excretion of 6‐keto‐PGF1α increased during VE. In the patients with IgA GN the glomerular filtration rate (GFR) was normal, markedly reduced and supernormal. Five patients had hypertension and an increased N A excretion in relation to the GFR during VE. As a group, the patients with IgA GN increased their urinary excretion of 6‐keto‐PGF1α during VE, while the excretion of PGF2α did not change. In relation to the GFR, the urinary excretion of PGF2α, and 6‐keto‐PGF1α was markedly increased in two patients with low GFR, which implies that these substances play a role in advanced renal disease. VE had little effect on PG excretion in these patients. In the hypertensive patients the urinary excretion of PGF2α and 6‐keto‐PGF1α was the same as in those with normal blood pressure. PGs are therefore not likely to mediate the increased natriuretic response to VE in hypertension.
Involution of Polycystic Kidneys during Replacement Therapy of Terminal Renal Failure
Authors: Thaysen Jørn Hess , Thomsen Henrik S.
Published: August 2010

ABSTRACT. Total kidney volume, i.e. the combined volume of both kidneys (TKV), was determined by computerized tomography (CT scanning) during replacement therapy of terminal renal failure in 12 patients with adult polycystic kidney disease. Mean TKV was 2090 (872–3437) cm3 in six of 11 patients with both kidneys in situ, treated for 44 (28–59) months, and 1184 (308–2761) cm3 in five, treated for 97 (75–130) months. The difference is not statistically significant (0.1>p>0.05). Two patients, treated for 89 and 130 months, had a TKV of 308 and 408 cm3, respectively, i.e. almost equal to the normal (303 cm3 (SD 29)). Six patients, five with both kidneys in situ and one unilaterally nephrectomized, were examined with two CT scans at an interval of 31 (17–46) months and all showed a significant decrease in TKV, averaging 0.77 (0.49–1.09)% per month of treatment. It is concluded that polycystic kidneys undergo involution during replacement therapy, but the gradual shrinkage may be difficult to verify by single volumetric measurements in patients treated for varying periods due to the large interindividual variation in TKV in adult polycystic kidney disease.
Effects of Long‐Term Bromocriptine Treatment on Catecholamine Excretion and on Circulatory Adaptation to Orthostasis and to Exercise in Patients with Hyperprolactinemia
Authors: Werner S. , Brismar K. , Freyschuss U.
Published: August 2010

ABSTRACT. Sympatho‐adrenally regulated mechanisms of the circulatory system have been studied in seven patients with hyperprolactinemia in order to evaluate the effects of long‐term (1–3 months) treatment with bromocriptine. Before treatment catecholamine excretion was within the normal range. Blood volume was low and there was a marked heart rate reaction to orthostasis. ECG showed no abnormalities. Blood pressure and ECG reaction during exercise were normal. The blood pressure heart rate response to handgrip was less marked than in healthy young men. During bromocriptine treatment, serum prolactin levels normalized in all but one patient. Total catecholamine excretion was lowered. Body weight diminished. Resting heart rate and blood pressure fell significantly. Blood volume per kg body weight remained unchanged as did the orthostatic heart rate increase. The circulatory response to handgrip was less marked than before therapy. It seems that long‐term bromocriptine therapy provokes a cardiovascular pattern reflecting an inhibition of sympatho‐adrenal activity.
Clinical Studies on Phosphate Handling in Hypercalcaemia
Authors: Wikström B. , Ljunghall S. , Wide L. , Åkerstrom G.
Published: August 2010

ABSTRACT. Phosphate indices (serum phosphate, tubular reabsorption of phosphate, renal threshold phosphate concentration (TmP/GFR) and index of phosphate excretion) were studied in 88 hypercalcaemic subjects: 64 with primary hyperparathyroidism (HPT) and 24 with hypercalcaemia from other causes, predominantly malignant disease. HPT patients as a group could easily be separated from normal subjects (n = 16) and patients with functional hypoparathyroidism (n =7) by use of the phosphate variables but these indices were of little discriminating value for the differential diagnosis between HPT and hypercalcaemia from other causes. There was no difference in the urinary cyclic adenosine monophosphate (cAMP) excretion between the two hypercalcaemic patient groups, but HPT patients had clearly elevated serum parathyroid hormone (PTH) levels compared with normal PTH concentrations in patients with other causes of hypercalcaemia. A positive correlation between cAMP and serum calcium and an inverse relationship between cAMP and TmP/GFR were found in patients with hypercalcaemic malignant disease. These findings suggest the existence of a humoral factor with PTH‐like effects in malignant disease. Since PTH levels were low, the physiological actions were apparently not mediated by circulating PTH. No difference in the values for phosphate variables, PTH, cAMP or serum calcium was found between renal stone‐forming and stone‐free patients with HPT.
Effects of Sulfonylurea on the Secretion and Disposition of Insulin and C‐peptide
Authors: Almér Lars‐Olof , Johansson Elisabet , Melander Arne , Wåhlin‐Boll Elisabeth
Published: August 2010

ABSTRACT. In an attempt to examine the influence of sulfonylurea on the secretion, disposition and effect of insulin, 9 diabetic patients were studied during three one‐month medications with (a) chlorpropamide (t½>24 h) once daily, (b) glipizide (t½ 2–4 h) once daily, and (c) glipizide in divided dosage. The food intake of each patient was identical during each examination period. Blood concentrations of C‐peptide, insulin, glucose, and drugs were determined before and after breakfast and lunch on the 4th day of each examination period. As expected, once‐daily administration of glipizide led to higher after‐breakfast concentrations of the drug than when the dose was divided. However, the C‐peptide changes following breakfast were similar both during these two treatments and also during chlorpropamide, indicating that the amounts of insulin released from the pancreas were equivalent. In spite of this, glipizide once daily yielded 60–70% more insulin in systemic blood following breakfast than did the two other treatments. Reasonably, this signifies that the hepatic extraction of insulin was reduced during once‐daily glipizide, allowing more insulin to reach systemic circulation. In addition, this was found to promote a more effective utilization of glucose following breakfast. Following lunch, the C‐peptide release, the plasma insulin increase and the blood glucose reduction were greater when glipizide was given in divided dosage than when once‐daily glipizide or chlorpropamide was employed. This occurred even though the after‐lunch concentration of glipizide in systemic blood was lower rather than higher during divided than during once‐daily administration. This supports the notion that the effect of orally administered sulfonylurea is determined not only by its concentration in systemic blood but also by its gastroenterohepatic appearance. Glipizide may offer greater therapeutic flexibility than chlorpropamide, but further studies are required to define the optimum choice and use of sulfonylureas.
Hemoglobin A1 in Community Care
Authors: Ahrén B. , Bitzén P.‐O. , Scherstén B.
Published: August 2010

ABSTRACT. In order to investigate the potential usefulness of knowing the blood concentrations of HbA1 in primary care, HbA1 was measured in diabetic subjects attending a primary care centre. The values were compared with concentration of HbA1 in a reference group on non‐diabetics. The reference group had a mean value in HbA1 of 7.6±0.1% with a tendency to increased values with advancing age. The diabetic subjects had a mean value in HbA1 of 10.8±0.2%. Diabetics under good control had lower values (10.2±0.2%), than patients under poor control (12.0±0.2%) (p<0.001). There was a correlation (r=0.50, p<0.001) between HbA1 and fasting blood glucose levels. It is concluded that determination of HbA1 can be an aid in the control of diabetics in primary care. However, the method requires good technical management, and the results are most reliable when the same person analyses all samples. The objective in diabetic therapy in this respect should no doubt be to depress the concentrations of HbA1 towards normal values.
Twelve Years of Coronary Bypass Surgery in Helsinki
Authors: Frick M. H. , Harjola P‐T. , Valle M. , Järvinen A. , Hekali P.
Published: August 2010

ABSTRACT. During the 12‐year period from 1970 to 1981 662 patients have had an elective coronary bypass operation at our institution with a hospital mortality of 1,9%. Selected randomized subsets of the series have been subjected to detailed postoperative studies to elucidate the effects on morbidity, employment, and mortality, in particular. Other studied variables include graft patency, progression of coronary atherosclerosis, and left ventricular function.

Exercise tolerance is markedly improved especially in patients with complete revascularization (+98%, p < 0.001) in contrast to unchanged data in medically managed patients. This improvement persists for at least 2 years and has an impact on employment. Sixty per cent of the surgical patients were at work 2 years after operation in contrast to 26% of the similar medically managed patients (p < 0.05). Annual mortality during a follow‐up of 5 years has been 0.9% in surgical patients compared with 4% in randomized medical patients (p < 0.05).

Unsettled topics include the surgical management of patients with unstable angina pectoris and patients with modest or no symptoms but a multivessel coronary artery disease. Further problems are the possible surgical management of high risk patients at discharge after myocardial infarction and the final position of non‐surgical coronary artery manipulations.