bluuebunny/crossref_metadata_2025 huggingface dataset:
INCIDENCE AND PRESENTATION OF MYOCARDIAL INFARCTION IN NORTH KARELIA, FINLAND
Authors: Puska Pekka , Mustaniemi Harri
Published: August 2010

AbstractA myocardial infarction (MI) register was started on May 1, 1972 in the county of North Karelia in Eastern Finland as a part of the North Karelia project. Information about all cases with a suspected acute MI among the North Karelian population are collected by the register. The principles of the register follow the recommendations of the WHO expert working group. Altogether 713 cases were registered between May 1, and Dec. 31, 1972. The distribution of them into diagnostic categories was: “definite” 57%, “possible” 30%, “no acute MI” 8% and “insufficient information” 5%. Patients with no acute MI have been excluded in the results. About 47% of the male patients below 65 years had a history of previous MI. Most of the patients in the group had been heavy cigarette smokers, eating mainly butter as the fat in their diet. Overweight was rare among the male patients but not among the females. During the years preceding the attack, most of the patients had visited a physician and a pathological ECG had been recorded. The average time delay before hospital treatment was internationally relatively short. The 4‐week fatality rate among patients below 65 years was 37% for males and 35% for females. These rates were slightly lower than those in the register material in Helsinki. The annual incidence rate per thousand for the age group 30–64 in North Karelia was 13.8 among males and 2.6 among females. The incidence rate increased continuously with age among males, among females it increased markedly only after the age of 60. The risk ratio between North Karelia and Helsinki for the age standardized incidence rates of males in the age group 30–64 was 1.38, and for respective mortality rates 1.21. Within North Karelia the highest incidence rate for males aged 30–64 was recorded in the rural area of Ilomantsi‐Tuupovaara in the East.
LIVER IMPAIRMENT DURING CHRONIC HEMODIALYSIS AND AFTER RENAL TRANSPLANTATION
Authors: Nielsen Victor , Clausen Ebba , Ranek Leo
Published: August 2010

Abstract Liver impairment has been evaluated in a consecutive series of 79 patients with chronic renal failure of whom 23 were treated with hemodialysis alone and 37 with hemodialysis and renal transplantation alone. In half of the chronic hemodialysis patients and half of the patients receiving a renal allograft elevation of serum alanine aminotransferases was observed for a shorter or longer period during the study. In half of these cases from both groups the clinical course, laboratory data and liver histology were consistent with virus hepatitis and four patients died from fulminant hepatic failure. In the other half of the patients with elevated transaminases, this was either asymptomatic and unexplained or due to other causes such as septicaemia or urinary leakage. Liver biopsy showed unspecific changes. Renal transplantation was not performed in patients suffering from virus hepatitis, but 12 of the 37 patients who received a renal allograft had elevated aminotransferases at the time of transplantation. In seven of them a marked increase in aminotransferase was observed postoperatively, but none developed clinical sign of liver disease. It is concluded that elevated aminotransferase activity per se is no contraindication to surgical procedures, including renal transplantation, in these patients. However a liver biopsy should be performed to detect a possible liver disease.
INVOLUTION OF POLYCYSTIC KIDNEYS DURING ACTIVE TREATMENT OF TERMINAL UREMIA
Authors: Thaysen Jørn Hess , Christensen Erik , Alarcon‐Zurita Antonio , Movild Børge
Published: August 2010

Abstract Following institution of chronic dialysis and/or renal transplantation for terminal uremia, four consecutive patients observed for 15–48 months with their polycystic kidneys in situ invariably showed a rapid relief of symptoms (pain, hematuria) followed by a gradual, but steady, involution of the kidneys. The mechanism and the practical clinical implications are discussed.
ACETYLATOR PHENOTYPE AND THE ANTIHYPERTENSIVE RESPONSE TO HYDRALAZINE
Authors: Jounela A. J. , Pasanen M. , Mattila M. J.
Published: August 2010

Abstract Twenty‐three out‐patients with mild or moderate essential hypertension have been treated with a combination of hydralazine (37.5–150 mg daily) and oxprenolol (60 mg daily). Before treatment the patients were phenotyped for polymorphic acetylation by means of the sulphamethazine test: 12 proved to be slow and 11 rapid acetylators. A significant correlation was found between daily doses of hydralazine and the plasma hydralazine levels, separately in slow (r =0.480) and in rapid (r =0.580) acetylators. The antihypertensive response to hydralazine correlated well to plasma hydralazine levels. The mean fall of BP in slow acetylators was 33/23 mmHg in supine and 20/18 mmHg in standing position. The corresponding values in rapid acetylators were 22/15 and 21/15 mmHg. The average daily doses of hydralazine needed for these responses were 1.3 mg/kg in slow and 1.6 mg/kg in rapid acetylators. To reduce the systolic BP by 20 mmHg, 1.0 mg/kg of hydralazine was needed in slow acetylators; rapid acetylators needed a significantly higher dose of 1.4 mg/kg. During a follow‐up of 1 year there have been virtually no side‐effects. The results tally with the previous finding of Zacest and Koch‐Weser, who demonstrated a similar correlation during the triple‐drug regimen. It seems as if hypertensive patients can be succesfully treated with hydralazine and β‐blocking drugs without knowledge of the patient's acetylator phenotype. However, acetylator status is a determinant of tissue levels and long‐term toxicity of hydralazine, and patients should be phenotyped because β‐blockers may mask the warning side‐effects.
SELECTIVE CORONARY ARTERIOGRAPHY
Authors: Hoel Björn , Eie Harald , Semb Gudmund , Sivertssen Egil
Published: August 2010

Abstract A series of 414 selective coronary arteriographies in 322 patients has been done at Ullevål Hospital from May 1971 to Jan. 1974. Judkins' technique was used in all cases. The indications for arteriography, the diagnoses as regards the coronary arteries, the therapeutic consequences, and the complications of selective coronary arteriography are described.
CARDIAC ARRHYTHMIAS, ELECTROLYTES, AND DIGOXIN CONCENTRATION IN PLASMA AND URINE IN PATIENTS TREATED WITH DIGOXIN
Authors: Bertler Åke , Monti Mario , Ohlin Per , Redfors Arne
Published: August 2010

AbstractCardiac arrhythmias, digoxin concentration in plasma and urine, digoxin and creatinine clearances, electrolytes in plasma and in erythrocytes, and subjective symptoms have been carefully studied for 5 consecutive days in 19 patients with definite or suspected digitalis intoxication. The digoxin treatment was discontinued during the observation period. Eleven controls without any signs of toxicity were similarly followed on unchanged maintenance dosage. All patients were independently classified as toxic or non‐toxic from the follow‐up of extended ECG recordings and subjective symptoms. In 9 definitely toxic patients a plasma digoxin concentration of 3.1 ± 0.7 ng/ml was found, as compared to 1.4 ± 0.5 ng/ml for the 11 controls. In the suspect toxic group 1.5–3.9 ng/ml was found. The high digoxin level in the toxic group corresponds to a low digoxin clearance. In the toxic patients cardiac arrhythmias were related in most cases to a plasma digoxin level above 2.5 ng/ml and usually disappeared when the concentration had decreased below this. Suspect toxic patients, classified as probably non‐toxic, and controls had with two exceptions plasma digoxin levels below 2 ng/ml. It is suggested that digitalis toxicity should be considered at a plasma digoxin concentration above 2 ng/ml. It must be stressed that this limit is not absolute and is affected by, among other things, a disturbance of intra‐ and extracellular electrolytes.
TOTAL DISAPPEARANCE OF A FATAL PULMONARY EMBOLUS DURING STREPTOKINASE THERAPY OF AN ILIOFEMORAL THROMBOSIS
Authors: Eklund Jan , Johansson Evald , Paul Christer
Published: August 2010

Abstract During streptokinase treatment of an iliofemoral thrombosis, a formerly healthy man developed clinical signs of major pulmonary embolism. In spite of all attempts at resuscitation, the patient died after 1.5 hours. The autopsy showed no signs of remaining thrombus or emboli. The probable explanation is that the thrombus had partially been lysed and that the remaining parts formed an embolus large enough to cause considerable haemodynamic changes which could not be influenced. Lysis continued pre‐ and postmortally and was complete at the time of autopsy.
PLASMA RENIN ACTIVITY, BLOOD PRESSURE AND SODIUM EXCRETION DURING TREATMENT WITH CLONIDINE
Authors: Fyhrquist F. , Kurppa K. , Huuskonen M.
Published: August 2010

Abstract Clonidine, 225 μg a day, has been given orally for 3 months to 15 patients with essential hypertension. Mean BP was reduced from 159/107 to 143/87 mmHg. The antihypertensive effect of the drug was dissociated from changes in plasma renin activity (PRA) during clonidine treatment. PRA levels decreased initially in 6 patients with the highest PRA values before treatment, but then increased again. In 6 patients with lower pretreatment PRA levels, PRA rose continuously. Opposite patterns of 24‐hour urinary sodium excretion were observed in these arbitrary subgroups. The antihypertensive effect of clonidine in essential hypertension appears to be independent of changes in PRA.
SUBCUTANEOUS ADMINISTRATION OF SODIUM L‐THYROXINE TO PATIENTS WITH HYPOTHYROIDISM
Authors: Ljunggren J. G. , Persson B.
Published: August 2010

Abstract Two patients with primary hypothyroidism are described in whom an euthyroid condition could not be achieved by oral administration of 1‐thyroxine, 1‐triiodothyronine or desiccated thyroid. Daily subcutaneous injections of 1‐thyroxine normalized the thyroxine and triiodothyronine levels in the blood and the patients became euthyroid.
A POSTMYOCARDIAL INFARCTION CLINIC IN GÖTEBORG, SWEDEN
Authors: Elmfeldt Dag , Wilhelmsen Lars , Tibblin Gösta , Vedin J. Anders , Wilhelmsson Claes‐E. , Bengtsson Calle
Published: August 2010

Abstract The registration of all myocardial infarctions (MI) in the city of Göteborg started on Jan. 1st 1968, when a special clinic was set up for ambulatory posthospital care of infarction patients. In 1970 this clinic was expanded to cover all patients below 67 years of age with MI in the city of Göteborg, the aim being to standardize and unify patient care and therapeutic regimens, to provide opportunities for the study of patient characteristics, natural history, risk factors and effects of preventive measures. Results from such studies have been published, but so far no unified description of this special out‐patient unit, nor of any similar unit elsewhere. Patient recruitment, considerations concerning personnel, patient education procedures and return visit routines are covered, together with investigative methods and criteria for the treatment of complications, symptoms and risk factors. The cumulative drop‐out rate up to and including 2 years' follow‐up was only 3%. A brief bibliography of studies originating at the Postmyocardial Infarction Clinic is included.
THE OPHTHALMOSCOPIC AND FLUORESCEIN ANGIOGRAPHIC PICTURE OF DIABETIC RETINOPATHY
Authors: Larsen Hans‐Walther
Published: August 2010

Abstract. The ophthalmoscopic and fluorescein angiographic findings in diabetic retinopathy are reviewed. It is pointed out that the fundus lesions seen in diabetic retinopathy are characteristic, but not specific for diabetes.

It is still not settled which role alterations in the microcirculation, alterations in the tissue metabolism, hypoxia or defects in the oxygen delivery system may play as provoking factors in the development of the diabetic retinopathy.

Future investigations should concentrate on early diabetes and must include studies on the retinal blood‐flow, electroretinographic and histopathologic changes.
DYNAMIC CHANGES IN THE MICROCIRCULATION OF DIABETICS AS RELATED TO DIABETIC MICROANGIOPATHY
Authors: Kohner Eva M.
Published: August 2010

Abstract. Reversible abnormalities of many vascular beds have been observed in early diabetes, before irreversible structural changes of diabetic microangiopathy became apparent.

In the bulbar conjenctiva and in the kidney the changes are associated with vascular dysfunction and may be due to autonomic neuropathy. The role of autoregulation in these vascular beds is not clear.

In the limb muscles and in the retina the functional abnormality in early diabetes and in those with only mild retionopathy is increased blood flow. This increase in blood flow is probably the result of autoregulatory adaptation to hypoxia induced by 2,3 diphosphoglycerate deficiency. Lactic acid accumulation may also contribute.

Breakdown of the autoregulation in the retina results in the development of diabetic retinopathy. The late stages of retinopathy, new vessel formation, are an attempt at revascularisation of areas of capillary non‐perfusion.
THE PROBLEM OF TISSUE OXYGENATION IN DIABETES MELLITUS
Authors: Ditzel Jørn
Published: August 2010

Abstract. Evidence for a causative relationship between prolonged tissue hypoxia and diabetic retinopathy and glomerulosclerosis are presented. Based on the assumption that one of the most fundamental requirements for optimal cellular metabolism is a constant cellular oxygen tension, the “three‐in‐one concept” for the development of diabetic microangiopathy is formulated. The term “three‐in‐one” is employed because this concept partly or completely includes “the glycoprotein‐”, “the hypoxia‐”, and “the growth hormone hypothesis”. Diabetics show evidence of variability in the tissue oxygen availability/demand ratio which is compensated by three self‐regulating factors: 1) an increase in local flow, 2) an increase in red cell 2,3‐DPG leading to a shift to the right of the oxyhaemoglobin dissociation curve, and 3) an increase in the oxygen‐binding capacity or the haemoglobin concentration. The level of plasma inorganic phosphate (Pi) is of importance in maintaining high 2,3‐DPG levels. However, since Pi fluctuates depending upon changes in the control of diabetes, the regulatory mechanism of the 2,3‐DPG modulated unloading of oxygen from the erythrocytes often becomes insufficient, and therefore in poorly regulated diabetics with less than optimal 2,3‐DPG levels, the main load of compensation against tissue hypoxia is placed on an adjustment in the microcirculation of the organ involved. However, in order for the microvascular dilatation to occur, the cells must experience a hypoxic stimulus. The summation of the infinite number of discrete and occasionally pronounced hypoxic injuries to the tissue cells in association with the adverse effect of local vasodilatation with increased plasma permeation through the vessel walls might over the years lead to diabetic microangiopathy.

Based on this theory the high level of Pi in diabetes becomes of particular significance. Our experience with a high phosphate diabetes diet in the treatment of diabetics is presented. This dietary regimen leads to a significant increase in the oxygen release capacity of the erythrocytes, suggesting an improvement in tissue oxygenation, and may therefore become of value in the prophylaxis of diabetic microangiopathy.
Studies of the Mode of Action of Erucic Acid on Heart Metabolism
Authors: HEIJKENSKJÖLD LOLO , ERNSTER LARS
Published: August 2010

The effects of erucic acid on the oxidative metabolism of rat‐heart mitochondria have been investigated using intact animals, perfused beating heart, isolated mitochondria and mitochondrial extracts. Feeding rats with a diet containing erucic acid was found to lead to a diminished ability of the isolated heart mitochondria to oxidize various substrates, in accordance with previous reports (Houtsmuller et al., Biochim. Biophys. Acta 218 (1970) 564). This effect was most pronounced with palmitylcarnitine as substrate, in which case the rate of oxidation was decreased by more than 50 % at such a low erucic acid content in the diet as 1.4 % given over 2–4 weeks. Oxidation of palmitylcarnitine was also found to be inhibited when erucylcarnitine was added to isolated heart mitochondria from control animals, in agreement with earlier observations (Christophersen and Bremer, FEES Lett. 23 (1972) 230; Biochim. Biophys. Acta 280 (1972) 506). The inhibition was accompanied by a decrease in the rate and extent of reduction of mitochondrial flavoprotein. Experiments with perfused beating rat‐heart likewise revealed an inhibition of flavoprotein reduction, as well as nicotinamide nucleotide reduction, when erucate was added to the perfusing medium of the beating heart respiring with oleate ‐ but not with octanoate ‐ as substrate. These data together with those earlier published in the literature indicate that erucic acid may interfere with the enzyme system involved in the mitochondrial oxidation of long‐chain fatty acids, probably at the level of acyl‐CoA dehydrogenase. Kinetic data supporting this conclusion, obtained with extracts of rat‐heart mitochondria containing the acyl‐CoA dehydrogenase and electron‐transferring flavoprotein system, are presented. The possible implications of these results for the known effect of dietary erucic acid in causing an accumulation of fat in the heart are discussed.
Treatment of Hypertension in a Swedish Community—the Problem of Borderline Hypertension
Authors: WILHELMSEN LARS
Published: August 2010

Summary. In a multifactor primary preventive trial currently in progress in Gothenburg, one‐third of men born between 1915–1922 and 1924–1925 were examined. The remaining two‐thirds acted as controls. Coronary heart disease (CHD) and stroke account for a considerable part of fatal and non‐fatal serious events in this population. In the intervention group the mortality was considerably higher among the non‐participants than among the participants.

Hypertension is the main risk factor for stroke and is important in addition to hypercholesterolemia and smoking in CHD.

The experiences concerning hypertension in the present population samale have been that:

Between 10% and iO% of men aged 47–55 years need treatment for high blood pressure.

At least 50% of these men do not know that they have hypertension and only 15% were on adequate treatment at the screening examination.

With the provision of information and use of calling system the drop‐out rate during the first year of follow‐up was only 1–2%.

Adverse drug reactions have not been a serious problem.

A major problem is the difficulty in controlling BP during the whole day including stressful events.

Another problem is to find simple additional tests which can reveal the prognosis in “borderline hypertension”.
Auscultatory Measurement of Blood Pressure Performed by the Doctor on Duty
Authors: Nielsen Poul Ebbe , Oxenbøll Birgitte , Astvad Kenneth , Gyntelberg Finn
Published: August 2010

Abstract. A review is presented of the measurements of blood pressure on admission of 600 patients to the wards in a department of general medicine. Three doctors each examined 200 patients, distributed over two periods with an interval of one year. Large differences were found between the doctors as regards the distribution of the BPs, particularly the diastolic pressures. On the other hand, no differences were observed in the distributions during the two periods as far as the individual doctors were concerned. Great preference was shown for zero as the terminal digit and also for certain BP values. It is concluded that the observer introduces a considerable subjective factor in measuring the BP by auscultation. Correct performance of this simple procedure requires meticulous instruction.
Progression of Coronary Artery Disease in Patients with Stable Angina Pectoris
Authors: Nitter‐Hauge Sigurd , Sangvik Kjell , Bjönness Jens
Published: August 2010

Abstract. Left ventriculography and selective coronary angiography with determination of resting left ventricular end‐diastolic pressures and ejection fraction have been carried out twice on 25 patients with stable angina pectoris. The interval between the two angiographic studies varied between 7 and 16 months (mean 12.3). Progression of obstruction amounting to occlusion was found in 4 of 73 arteries studied (5%). No new lesions occurred. Resting end‐diastolic pressures before and after ventriculography did not change during the observation period. Values for ejection fraction were also unchanged, but there was a tendency for them to decrease in patients in whom this parameter had been abnormal at the first catheterization.
Long‐term Treatment with Methenamine Hippurate in Recurrent Urinary Tract Infection
Authors: Nilsson Stig
Published: August 2010

Abstract. Twenty‐four patients with a history of recurrent urinary tract infection and in whom residual urine was considered to be a factor of importance for chronicity, have been treated for an average of 16 months with 1 g methenamine hippurate morning and evening. No patient had urinary calculus at the commencement of treatment and neither did any patient have an indwelling catheter. In patients without urinary tract infection or in whom abacteriuria was achieved with methenamine hippurate, the number of reinfections was reduced by approximately two thirds compared to periods prior to treatment. No patient was completely free from infection throughout the whole treatment period. However, in no case did bacteria with extensive resistance appear. When urinary tract infection was treated with methenamine hippurate, abacteriuria was achieved in only 6 of 14 patients. It would therefore seem that this agent is only of limited value for treatment of established infection. In the event of manifest infection it would appear appropriate to treat the infection primarily with antibiotics and to use methenamine hippurate for prophylaxis when abacteriuria has been achieved. No patient developed urinary calculus during treatment with methenamine hippurate and no deterioration of renal function or haematological change was observed.
The Degree of Bone Mineralization in Chronic Renal Failure Estimated from Phosphorus/Hydroxyproline Ratio in Bone Biopsies
Authors: Schaadt Ole , Tougaard Lars
Published: August 2010

Abstract. The degree of bone mineralization is the proportion between the contents of mineral and collagen in bone. As phosphorus (P) and hydroxyproline (Hypro) constitute a constant fraction of bone mineral and collagen, respectively, the P/Hypro ratio in bone tissue provides an estimate of the degree of mineralization. The P/Hypro ratio has been studied in bone biopsies from 42 patients with severe chronic renal failure. A few of them had a subnormal P/Hypro ratio and these patients corresponded to the diagnosis of classical osteomalacia or probably hyperparathyroidism. However, the mean bone P/Hypro ratio was significantly higher than normal, indicating a general tendency towards a higher degree of bone mineralization in patients with chronic renal failure.
Treatment of Whipple's Disease with Sulphamethoxazole‐Trimethoprim
Authors: Elsborg L. , Gravgaard E. , Jacobsen N. O.
Published: August 2010

Abstract. A patient with Whipple's disease responding rapidly to sulphamethoxazole‐trimethoprim is described. In spite of initial folate deficiency, the drug was well tolerated for one year. It is proposed that a sulphonamide combined with trimethoprim should be the drug of first choice in the treatment of Whipple's disease. Repeated jejunal biopsy is suggested as the best way to record the effectiveness of treatment.
Heme Catabolism during Short‐term Treatment with Phenobarbital, Diazepam and Oxazepam
Authors: Mercke C. , Cavallin‐Ståhl E. , Lundh B.
Published: August 2010

Abstract.Carbon monoxide production (VCO) total body heme (TBH) and serum bilirubin (SB) have been determined in healthy young men before and after 100 mg phenobarbital (10 subjects), 15 mg diazepam (7 subjects) and 75 mg oxazepam (7 subjects), respectively, daily for seven days. None of the drugs had any significant effect on VCO. SB and TBH were also unaffected. Baseline VCO (mean ±1 S.E.M.) was 12.6±0.6 μmol/mmol TBH and day. The postdrug VCO was 15.1 ± 1.8, 14.1 ± 1.4 and 14.7 ± 1.5 after phenobarbital, diazepam and oxazepam, respectively. The corresponding values for SB were 5.4±0.8, 6.0±1.5 and 6.2±1.0 μg/ml, compared to a baseline value of 6.6±0.8 μg/ml. However, when the pooled postdrug data were compared with the pooled baseline values, mean VCO showed a probably significant increase (from 12.6±0.6 to 14.7±1.0 μmol/mmol TBH and day (p<0.05). It is concluded that although phenobarbital is known to increase the hepatic heme turnover, this effect is not measurable in terms of total heme turnover, no more than 20% of which comes from the liver.
Plasma Aldosterone in Anephric and Non‐nephrectomized Dialysis Patients in Relation to Changes in Plasma Potassium without Change in Total Potassium Balance
Authors: Ølgaard Klaus
Published: August 2010

Abstract. Plasma aldosterone concentration has been measured in 13 patients on regular hemodialysis, 7 anephric and 6 non‐nephrectomized, following infusion of insulin—glucose. In all patients the plasma potassium fell about 16% within the first 60 min after the infusion, increasing again to about preinfusion levels within 180 min. All anephric patients showed a very low preinfusion value for plasma aldosterone (mean 33.3 pg/ml plasma), which increased significantly (p<0.01) after the infusion of insulin—glucose, to about 180% of the initial values, simultaneously with the fall in plasma potassium concentration. A significant inverse correlation (p<0.01) was found between changes in plasma aldosterone and potassium. The preinfusion plasma aldosterone values were significantly higher (p<0.01) in the non‐nephrectomized than in the anephric group—but of a wide range (26–700 pg/ml plasma). In this group the mean plasma aldosterone concentration showed a significant fall simultaneously with the fall in plasma potassium concentration, but with great variations between patients. There was a significant positive correlation (p<0.005) between the changes in plasma aldosterone and potassium. These studies indicate an extremely sensitive regulation of plasma aldosterone secretion in anephric patients, in all probability positively correlated to changes in intracellular adrenal potassium concentration.
Antazoline‐induced Immune Hemolytic Anemia, Hemoglobinuria, and Acute Renal Failure
Authors: Bengtsson Ulla , Ahlstedt Staffan , Aurell Mattias , Kaijser Bertil
Published: August 2010

Abstract. A case of repeated antazoline‐induced immune hemolytic anemia, thrombocytopenia, hemoglobinuria, and acute renal failure is reported. The first episode of renal failure occurred after an i.v. pyelography causing an anaphylactic shock, and the two later episodes were preceded by allergic reaction to drugs. Antazoline was given among other remedies, but this drug was the only one used for treatment on every occasion. The clinical picture and the immunological tests, including an antazoline‐dependent Coombs' test, indicate that the blood disorders might have been caused by a type 2 allergic reaction and the renal lesion by a type 3 reaction, at least on the second and third occasions.
The First Two Cases of Coccidioidomycosis in Finland
Authors: Alanko Kari , Kahanpää Asko , Pätiälä Jorma
Published: August 2010

Abstract. Endemic areas of coccidioidomycosis are described. The mycology of Coccidioides immitis is reviewed, with special reference to the risk of laboratory infection. A classification of coccidioidomycosis is listed and two cases from Finland are presented. The first patient had typical X‐ray and clinical findings, including a positive coccidioidin test. The second case, occurring soon after a visit to Arizona, was confirmed by positive fungal cultures from the sputum and from a resected specimen. Because the latter patient became pregnant and the risk of dissemination was considered great, legal abortion was performed. The resection of the pulmonary cavitation with infiltration around it took place under coverage of pre‐ and postoperative amphotericin B medication. Complete recovery was obtained. The indications for thoracic surgery are briefly listed. Diagnostic and mycologic aspects of this rare and exotic disease are discussed. Among other things, the importance of a good medical history in finding the contact with infective environment or material is stressed.
A Study of Graves' Disease in Iceland
Authors: Thjodleifsson Bjarni
Published: August 2010

Abstract. The incidence of Graves' disease and its response to treatment have been studied in Iceland, where the main environmental factor possibly affecting Graves' disease is a high iodine intake. The incidence was found to be similar or lower to that reported for Europe. The response to treatment with drugs and radioiodine does not differ from that found in other countries but recurrent hyperthyroidism after subtotal thyroidectomy is more common in Iceland.
Selected Psychosocial Variables in the Delay of Reaching the Coronary Care Unit
Authors: Theorell T. , Erhardt L. R. , Lind E. , Sjögren A. , Säwe U.
Published: August 2010

Abstract. Sixty‐one first admissions to a coronary care unit have been analysed regarding “delay period” from onset of chest pain to admission to the CCU in relation to psychosocial information, collected from the closest relative. On the whole, psychosocial variables seemed to play a modest role in the determination of the delay period. However, one “type A behavior” variable, inability to relax during leisure time, was related to a shorter delay period. Young subjects tended to have a relatively short delay.
Deaths and Non‐fatal Reinfarctions during Two Years' Follow‐up after Myocardial Infarction
Authors: Vedin Anders , Wilhelmsson Claes , Elmfeldt Dag , Säve‐Söderbergh Johan , Tibblin Gösta , Wilhelmsen Lars
Published: August 2010

Abstract.Since 1968 special units for registering and following up all myocardial infarction patients have been in operation in Göteborg. The present paper reports on the deaths and non‐fatal reinfarctions among 440 men and women below 67 years of age followed for two years after hospitalization for myocardial infarction. Of the 359 men, 299 had their first infarction and 60 a recurrent infarction. During two years 13% of men with a first infarction, and 37% of men with a recurrent infarction died. Deaths were significantly more common during the first than during the second year. There was no significant difference in mortality between men and women. The incidence of non‐fatal reinfarctions was of similar magnitude and showed similar time relationships. Two thirds of the deaths were sudden (within 24 hours after onset of new symptoms) and half of the deaths occurred outside hospital. The autopsy rate was 92%. Two thirds of the deaths were caused by a fresh morphological infarct. In one fourth of the deaths where no cause was found at autopsy, death was ascribed to malignant arrhythmias. Heart weights were higher among patients dying after recurrent infarction at entry to the study. No distinctive pattern was found when autopsy findings were correlated to the interval between the onset of symptoms and death. Deaths due to fresh infarction and without an identifiable cause were more common among those who died within 24 hours of onset of symptoms compared to those dying after longer intervals.
Seventy‐year‐old People in Gothenburg A Population Study in an Industrialized Swedish City
Authors: Rinder L. , Roupe S. , Steen B. , Svanborg A.
Published: August 2010

Abstract. The objectives of this cross‐sectional population study of 70‐year‐old people in Gothenburg, Sweden, were to make a survey of the social and medical conditions of the population, to obtain basic data for planning the care of the elderly, to contribute to the knowledge of normal ageing processes and of normal criteria within the age group, and to offer the subjects a thorough medical examination. A representative systematic sample comprised 1148 propositi (521 males and 627 females). The study comprised a homecall part regarding basic personal data, dwelling conditions, economy, social and physical communications, previous migration, educational level, previous and any present professions, need for care, consumption of health care and drugs. Observations and measurements were done of illumination at the habitual site of reading, and a simple test of visual acuity was performed. Later on, examinations at the Out‐patient Department of the Geriatric Hospital were performed, comprising in all probands general medical and ophthalmological examination, blood and urine sampling, ECG and X‐ray of heart, lungs, and breasts and on subsamples, psychological, psychiatric, dental, somatometric, and audiometric examination. Furthermore, a dietary interview and a body composition examination were performed on subsamples. This first presentation deals with the design and procedure of the study, analysis of observer variation and a comparison between responders (85%) and non‐responders (15%). The general design of the study, the sampling procedure, and general methods of data collection were found to be adequate. The responders were found to be representative for the population as a whole in most respects studied. The results of this study to be reported in subsequent papers will in general allow conclusions regarding the population of 70‐year‐olds in Gothenburg.
Artificial Hyperventilation during 21 Years in Three Cases of Complete Respiratory Paralysis
Authors: Christensen M. Stig , Kristensen H. Sund , Hansen E. Lyders
Published: August 2010

Abstract. Three patients with paralytic poliomyelitis have been ventilated via tracheostomy with uncuffed silver cannula for 21 years, with high tidal volumes of atmospheric air (8.3, 7.2, and 5.4 ml/kg b.wt.), at a frequency of 20, passive expiration, and without periodic hyperinflation. No pulmonary complications were seen during the whole of this period. The total compliance was significantly decreased. The pulmonary physiological shunt relative to the total pulmonary blood flow (Qs/Qt) was slightly increased. PaO2 was nevertheless normal, probably due to a high alveolar PO2 caused by the hyperventilation. The physiological dead space relative to the tidal volume (VD/VT) was within the normal range, but VD was high in one case. Two of the patients disclosed an extremely low CO2 production and a PaCO2 averaging 12 mmHg, with small fluctuations during a 24‐hour study. This profound respiratory alkalosis was only partly compensated in the arterial blood (pH: 7.54 and 7.50), suggesting a new state of acid‐base equilibrium. The cerebrospinal fluid lactate was significantly increased to about 4 mmol/l, but the patients revealed no signs of impaired cerebral function. A reduction of the degree of hypocapnia by the use of a mechanical dead space is recommended.
Skeletal Status in Patients with Rheumatoid Arthritis
Authors: Christiansen Claus , Rødbro Paul
Published: August 2010

Abstract. The total body calcium – estimated from the bone mineral content in the distal part of the forearm, measured by means of photon absorptiometry — has been determined in 15 patients with rheumatoid arthritis. None of the patients were treated with steroids and all were relatively mobile. The results indicate that osteoporosis is uncommon in such patients.
A Controlled Clinical Trial of Treatment with ALG in Established Rejection of Renal Allografts
Authors: Birkeland S. A.
Published: August 2010

Abstract. A controlled clinical investigation of the effect of equine anti‐human‐lymphocyte globulin (ALG) on established rejection after transplantation has been carried out in a group of 31 patients. Compared with a control group, the treated group showed a significantly positive effect of ALG in the form of a faster reversal of rejection episodes (p < 0.05). Leucocytes, lymphocytes, erythrocytes, thrombocytes and immunoglobulins were unaffected by the treatment, but there were signs of a complement‐consuming process and an influence on blast transformation tests. No rise in antibody titre against equine globulin was seen.
Diagnosis of Cardiac Amyloidosis by Myocardial Biopsy
Authors: Hedner Pavo , Rausing Alf , Steen Karin , Torp Alf
Published: August 2010

Abstract. A case of cardiac amyloidosis with severe heart failure is presented. The diagnosis was confirmed by myocardial biopsy. The microscopical and ultrastructural changes in this biopsy are described in detail.
Systolic Time Intervals in Acute Myocardial Infarction
Authors: Brubakk Oddbjørn , Overskeid Kåre
Published: August 2010

ABSTRACT Systolic time intervals (STI) have been measured in 50 individuals without heart disease. Electromechanical systole (QS2), left ventricular ejection time (LVET) and preejection period (PEP), but not PEP/LVET, were correlated to heart rate (HR). Regression equations were made and used when correcting STI for HR in two groups of patients: a) 51 patients with acute myocardial infarction (AMI) b) 22 patients with chest pains, but no AMI. STI was measured on the first 4 days, on the 7th day, on the day of discharge and at a control about 60 days later. In the AMI group there was a reduction in left ventricular performance from the 1st to the 4th day, and the difference in shortening of LVET was significant (p < 0.001), while PEP and PEP/LVET increased from the 1st to the 3rd day (p < 0.001). Between the AMI and the control groups there were significant differences (p < 0.001) in LVET and PEP/LVET on the 3rd, 4th and 7th day, and in PEP on the 3rd and 4th day. STI was not found to separate clinical groups with heart failure of different severity. The survivors had a lover (p < 0.05) PEP/LVET on the 1st day than those who died. The various localization of the infarction made no difference in STI. LVET was found to be strongly correlated (p <0.001) to the hydroxybutyric dehydrogenase values.
Hemodynamic and Electrocardiographic Effects of Disopyramide in Patients with Ventricular Arrhythmia
Authors: Hulting Johan , Rosenhamer Gunnar
Published: August 2010

ABSTRACTAntiarrhythmic and hemodynamic effects of i.v. disopyramide phosphate (1.7 mg/kg b.wt. over 2 min) have been studied in nine patients, several in various degrees of cardiac decompensation, with sinus rhythm and persistent ventricular ectopic beats (VEBs). In one case with primary cardiomyopathy, with > 30 VEBs/min, disopyramide (DE) abolished the arrhythmia for 30 min, but precipitated brief dyspnoea. Other side‐effects were tolerable and mainly attributable to anticholinergic effects of the drug. DE either abolished or significantly reduced the arrhythmia in all cases. For 30 min, only one patient showed VEBs, and in three patients no VEBs were seen for three hours. Changes in cardiac output and pulmonary artery (PAP) and central aortic pressures were measured in eight patients. Negative inotropic effects were indicated in seven by an increased diastolic PAP/stroke volume ratio and in seven by a decreased central aortic (dp/dt)max. Patients with high control values for diastolic PAP showed marked reductions in cardiac output, stroke volume and stroke work. In predicting myocardial depressant effects of DE, the control values for diastolic PAP seemed to be superior to central venous pressure, cardiac index and systolic time intervals. Mean arterial pressure measured 5 and 10 min after drug administration showed no significant change, indicating that vasoconstrictor reflexes were well preserved, and a pressure level significantly above the control value was reached from the 20th min. It is concluded that DE is potent in suppressing VEBs but exerts negative inotropic effects that may be of clinical importance. The optimal antiarrhythmic dose is probably lower than that used in the present study.
Evaluation of a Computer‐based System for Detecting Ventricular Arrhythmias
Authors: Hulting Johan , Nygårds Mats‐Erik
Published: August 2010

ABSTRACT A digital system for real‐time arrhythmia monitoring in the coronary care unit has been designed. The system is based on an algorithm for discrimination between normal complexes and ventricular ectopic beats (VBs). A beat is classified as normal if the absolute difference from a running average of the patient's normal QRS is below an adaptive threshold. To prevent artifacts and beats of non‐ventricular origin from being falsely interpreted as VBs, each abnormal beat is correlated with a typical VB waveform, incorporated into the program. A VB is recognized only when the correlation coefficient exceeds 0.8. In a performance study, ECGs from 15 patients were recorded on magnetic tape and replayed to the computer. Independent evaluation by two physicians showed a total of 1306 VBs, 94 % correctly classified by the computer. In the group labelled “suspected VBs” the detection rate was lower (average 69%). Out of the whole number of complexes (53 260), 0.45 % were falsely interpreted as VBs by the computer. Artifacts giving rise to false VBs are included in this figure. The causes of false positive and false negative VBs were thoroughly investigated and on the basis of these results, possible improvements in the system are discussed.
Beta1‐blocker (Practolol) and Exercise in Patients with Chronic Obstructive Lung Disease
Authors: Schaanning Jan , Vilsvik Jan Sverre
Published: August 2010

ABSTRACT Ventilatory and circulatory data from 20 patients suffering from chronic obstructive lung disease have been obtained before, during and after exercise at 600 kpm/min for 5 min on a bicycle ergometer. The patients had been given intravenously practolol, 15 mg, or saline alternatively, using a double‐blind cross‐over technique. A slight postexercise reduction of FEV1 (8%) was noted after practolol medication as compared to placebo, with an accompanying decrease in PaCO2; PaO2 did not differ substantially. No wheezing or inappropriate dyspnea attributable to the medication was noted in any of the patients. The well known β1‐blocking effects on the circulation were confirmed, with maintained Q and reduced HR, together with a lowered systemic BP during and after exercise. There was a significant positive relationship between the postexercise reduction of FEV, and the concomitant fall in HR. It is concluded that practolol in doses with near maximal circulatory effects had a slight, but clinically insignificant effect on the ventilatory parameters.
The Effect of Metoprolol —a New Selective Adrenergic β1‐receptor Blocking Agent—in Mild Hypertension
Authors: Bengtsson C.
Published: August 2010

ABSTRACTMetoprolol, a new selective adrenergic β1‐receptor blocking drug, has been compared to placebo in a series of 24 women who previously had taken alprenolol and propranolol during a cross‐over study. Blood pressure (BP) and heart rate (HR) were significantly reduced during metoprolol treatment compared to placebo. The occurrence of side‐effects was similar during treatment with metoprolol and placebo. After the cross‐over study the patients continued on metoprolol for more than two years, except for short periods on placebo or propranolol. During this follow‐up period BP remained at a similar level when the metoprolol dose was unchanged. Dose reduction (from SO or 100 mg t.i.d. to 50 or 100 mg b.i.d.) caused no, or only a very slight, increase in BP. No side‐effects were reported during long‐term treatment.
Enzymes and Long‐term Survival after First Myocardial Infarction
Authors: Thygesen K. , Nielsen B. Lyager , de Nielsen J. Stræ
Published: August 2010

ABSTRACT The study covers 342 patients still alive one month after the acute attack of their first myocardial infarction. Daily determinations of creatinine phosphokinase (CPK), lactic dehydrogenase (LDH) and glutamic oxaloacetic transaminase (SGOT) in serum were carried out during hospitalization, so that a maximum enzyme value could be obtained for each enzyme and patient. A follow‐up examination was performed after an observation time ranging from 12 to 38 months. Having calculated the mean (x) of the maximum enzyme values, a parallel relationship was found between the maximum CPK, LDH and SGOT values and the long‐term prognosis in myocardial infarction, inasmuch as patients with maximum enzyme values above or equal to the mean had a significantly higher 2‐year mortality than patients with values below x̄. In order to detect any slight difference between the three enzymes with reference to the long‐term prognosis, the material was divided into four groups: one with peak values less than x̄‐x̄/2 (lowest), one with values from x̄‐x̄/2 to x̄ exclusive (next lowest), one with values from x̄ to x̄+x̄/2 exclusive (next highest) and a group with peak elevations greater than or equal to x̄+x̄/2 (highest). A tendency to increasing mortality from the next lowest to the highest maximum enzyme values was found. On the other hand, patients with the lowest peak values had a tendency to higher mortality than patients in the next lowest group. This characteristic was observed with regard to both CPK and LDH and to some extent to SGOT.
Streptokinase Treatment of Deep Venous Thrombosis of the Lower Extremity
Authors: Johansson Evald , Ericson Kaj , Zetterquist Staffan
Published: August 2010

ABSTRACT The investigation comprises 19 patients with acute deep vein thrombosis of the leg treated with streptokinase. The acute clinical symptoms rapidly subsided in 15 patients. Phlebography, performed immediately after treatment, revealed complete thrombus regression in 7 cases, restoration of venous flow but remnants of thrombi in 4 and no effect in 7. One woman was not evaluated radiologically due to pregnancy. The phlebographic restoration seemed to be correlated to the duration of the thrombotic symptoms. Follow‐up examinations 6–50 months after the thrombotic incident demonstrated normal phlebograms in 8 patients, all of whom were also free from post‐thrombotic symptoms. Venous occlusion plethysmography confirmed that these patients had a normal venous outflow capacity and valvular function in the relevant limbs. By contrast, the remaining 11 patients, with more or less extensive remnants of thrombi at the follow‐up phlebography, were found to have plethysmographic signs of venous obstruction and sometimes also valvular insufficiency. The results indicate that thrombolytic treatment is able to give a complete and lasting anatomical and functional restitution of the deep veins after an acute thrombosis in the leg, provided that treatment is induced early enough.
Thromboembolic Complications, Heparin Treatment and Increase in Coagulation Factors in Cushing's Syndrome
Authors: Sjöberg H. E. , Blombäck Margareta , Granberg P. O.
Published: August 2010

ABSTRACT Seven of 19 consecutive patients with Cushing's syndrome demonstrated thromboembolic manifestations before or after adrenalectomy. These were successfully treated with heparin. The mean values of coagulation factors VIII (AHF) and V as well as prothrombin were increased. There was a positive correlation between the increase in factor VIII content and the severity of disease. The possibility that these changes in blood coagulation activity reflect an increased coagulability state in Cushing's syndrome is discussed.
Bacteriological and Clinical Evaluation of Different Dialysate Delivery Systems
Authors: Dawids Steen Gamwell , Vejlsgaard René
Published: August 2010

ABSTRACT In the period 1964–74 four different dialysate delivery systems have been used in our department. 1) Central mixing of dialysate using tap water and a dialysate delivery line with “dead ends” resulting in stagnant dialysate. 2) Central mixing of dialysate with cold distilled water, otherwise equal to system 1. 3) Local mixing of dialysate with cold distilled water, delivered through a line with “dead ends” resulting in stagnant water. 4) Local mixing of dialysate with distilled water, cooled to 25°C just prior to use, reduced “dead ends” and monitored constant overflow to drain through the water supply line. The bacterial contamination of the four systems was examined and related to the clinical occurrence of pyrogenic and other reactions. An improvement was noted with the change from central to local mixing of dialysate (system 3) but complete sterility and virtual freedom from clinical reactions were first obtained in system 4. It is concluded that the use of sterile or near sterile dialysate is recommendable.