bluuebunny/crossref_metadata_2025 huggingface dataset:
Antacids in the Treatment of Duodenal Ulcer
Authors: LUBLIN HENRIK , AMIRI SHOKOUH , JENSEN HANS‐ERIC
Published: August 2010

ABSTRACT Fifty patients with endoscopically proven pyloric‐prepyloric ulcers (PU/PPU) and 50 with duodenal ulcers (DU) completed a six‐week double‐blind clinical trial initially comprising 124 patients. The antacid‐treated patients received 10 ml of an antacid suspension seven times a day (buffering 367.5 mmol acid). Healing rate after three weeks of treatment was 74% in the antacid and 42% in the placebo group (p<0.01). After six weeks the corresponding figures were 96 and 68% (p<0.001). Regarding the PU/PPU and DU subgroups we found significant differences compared to placebo in the PU/PPU group only. Antacids caused a significantly faster and more perceptible pain relief than placebo. We found no significant correlation between ulcer healing and smoking habits. Regression analyses showed that, besides antacids, ulcer size and peak acid output influenced the healing rate significantly.
Genetic and Environmental Determinants for Lipoprotein Concentrations in Blood
Authors: ISELIUS LENNART , CARLSON LARS A. , MORTON NEWTON E. , EFENDIĆ SUAD , LINDSTEN JAN , LUFT ROLF
Published: August 2010

ABSTRACT Path and segregation analyses have been performed on cholesterol and triglyceride contents of serum as well as on very low, low and high density lipoproteins in 78 Swedish nuclear families. The effect of environmental variables like alcohol and smoking on the concentrations of the different lipoproteins has been studied. Genetic heritability was 0.16‐0.68 for the cholesterol fractions and 0‐0.56 for the triglyceride fractions. No major gene was evident for any of the variables studied.
Does Post‐exercise ST Depression Reflect Local Ischemia or Some Global Effect in the Left Ventricle?
Authors: CARLENS PER , FORSSELL GUNILLA , JONASSON RUNE , LANDOU CHRISTIAN , ORINIUS ERIK
Published: August 2010

ABSTRACT As exercise‐induced ST depressions are most frequent and marked in lead V5 independent of which single coronary artery is obstructed, some other mechanisms of ST depressions than local ischemia should be searched for. Left ventricular hemodynamics during exercise was studied in two groups of patients with severe effort angina, 19 with and 12 without ST depression after exercise (STAE). During supine exercise until angina, stroke index became significantly lower (37 vs. 52 ml/m2) and left ventricular end‐diastolic pressure (LVEDP) significantly higher (40 vs. 30 mmHg) in the STAE group. The best discriminator was the early diastolic pressure (LVeDP) (22 vs. 11 mmHg), which is interpreted as a sign of a more ischemic ventricle in the STAE group. The sum of STAE in all leads is correlated to LVeDP but not to LVEDP during exercise. The link between the significant ischemia in various locations and STAE appearing most frequently and markedly in V5 seems to be some global mechanism as the occurrence of STAE and the height of the R wave were positively correlated in the various leads. As STAE in coronary heart disease shows similar configuration and distribution as in aortic valvular stenosis and digoxin medication of healthy subjects, a possible link could be the compensatory increase in contractility in non‐ischemic parts of the ventricle.
Pericardiocentesis in Patients with and without Incipient Cardiac Tamponade Due to Pericardial Effusion
Authors: KELBÆK HENNING , SKAGEN KNUD , GODTFREDSEN JOHN
Published: August 2010

ABSTRACT Fourteen patients with pericardial effusion of various origins underwent pericardiocentesis on 16 occasions. Incipient cardiac tamponade was present on 19 occasions in 12 patients. Pericardiocentesis was carried out bedside under sterile conditions by a trained cardiologist. In case of impaired central circulation, drainage was sufficient to stabilize the clinical condition haemodynamically, and no adverse events occurred during pericardiocentesis. Fenestration of the parietal pericardium was necessary in 5 patients because of rapid regeneration of the fluid and in one patient due to pyopericardium with cardiac constriction. Pericardiocentesis is recommended in incipient cardiac tamponade. In the hands of experienced cardiologists the drainage procedure can be carried out safely without sophisticated equipment.
Left Ventricular Function in Newly Diagnosed Non‐insulin‐dependent (Type 2) Diabetics Evaluated by Systolic Time Intervals and Echocardiography
Authors: UUSITUPA M. , SIITONEN O. , PYÖRÅLÅ K. , LÅNSIMIES E.
Published: August 2010

ABSTRACT Systolic time intervals (STI) and echocardiography were recorded in 133 (70 men, 63 women) newly diagnosed non‐insulin‐dependent diabetics aged 45–64 years and in 144 (62 men, 82 women) non‐diabetic control subjects of the same age. Both male and female diabetics had significantly increased pre‐ejection period/left ventricular ejection time ratio (PEP/LVET) in STI as compared with the respective non‐diabetic control subjects. Male diabetics showed a reduced ejection fraction (EF) in echocardiography, but no significant difference was found in this respect between female diabetics and controls. A significant negative correlation was found between 2‐hour postglucose serum insulin level and EF in male and female diabetics. After adjusting for the effect of age, coronary heart disease, hypertension, obesity and haemoglobin concentration, male diabetics still had a higher PEP/LVET ratio and a lower EF than male controls. In women, no significant differences were found between diabetics and controls in the PEP/LVET ratio or EF adjusted for the above factors. The results of this study are compatible with the view that impaired left ventricular function may be an early phenomenon in the clinical course of non‐insulin‐dependent diabetes.
Four‐year Incidence of Myocardial Infarction and Sudden Coronary Death in Twelve Finnish Population Cohorts
Authors: SUHONEN OLLI , REUNANEN ANTTI , AROMAA ARPO , KNEKT PAUL , PYÖRÄLÄ KALEVI
Published: August 2010

ABSTRACT. Suhonen O, Reunanen A, Aromaa A, Knekt P, PyÖrÄlÄ K. (Research Institute for Social Security, Social Insurance Institution, Helsinki, Finland.) Four‐year incidence of myocardial infarction and sudden coronary death in twelve Finnish population cohorts.

The incidence of myocardial infarction (MI) and sudden coronary death in four years was studied in 6510 men and 5800 women, aged 30–59 years, derived from 12 Finnish population cohorts constituting the invited population to a prospective study. The incidence of all fatal coronary events in four years was 13.0/1000 in men and 1.8/1000 in women. The incidence of sudden coronary death was 7.8/1000 in men and 0.7/1000 in women. The incidence of non‐fatal MI was 22.2/1000 in men and 7.3/1000 in women. Coronary mortality was significantly higher in non‐participants in the initial survey than in participants. The incidence of MI was highest in men from eastern Finland (North Karelia), intermediate in men from central and western Finland and lowest in men from southwestern Finland. There were no significant regional differences in the incidence of MI in women. The incidence of MI in this study was in good agreement with that recorded in the myocardial community registers.
Paradoxical Esterification of Plasma Cholesterol in Fish Eye Disease
Authors: CARLSON LARS A. , HOLMQUIST LEIF
Published: August 2010

ABSTRACT. Carlson LA, Holmquist L. (King Gustaf V Research Institute and Department of Internal Medicine, Karolinska Hospital and Karolinska Institute, Stockholm, Sweden.) Paradoxical esterification of plasma cholesterol in fish eye disease.

The activity of lecithin: cholesterol acyl transferase (LCAT), the enzyme which catalyses the esterification of human plasma cholesterol, has been measured by two independent methods in plasma from the two known living Swedish patients with fish eye disease. The enzyme activity was in both cases about 15% of that of normal plasma. Paradoxically, however, the percentage of plasma cholesterol which was esterified was almost normal in both patients. In addition, a normal spectrum of the fatty acids of the cholesteryl esters was present indicating a normal cholesterol esterification pathway in vivo. Incubation experiments in vitro of plasma from the two patients also yielded normal cholesterol esterification rates when measured by two different methods. These paradoxical results for cholesterol esterification are discussed on the basis of the present biochemical knowledge of fish eye disease and LCAT deficiency.
Anti‐acetylcholine Receptor Antibodies in Primary Biliary Cirrhosis
Authors: SUNDEWAL ANN‐CHARLOTT , LEFVERT ANN KARI , OLSSON ROLF
Published: August 2010

ABSTRACT. Sundewall A‐C, Lefvert AK, Olsson R. (Department of Clinical Chemistry, Huddinge University Hospital, Huddinge, and Department of Medicine II, Sahlgrenska University Hospital, Gothenburg, Sweden.) Anti‐acetylcholine receptor antibodies in primary biliary cirrhosis.

Low concentrations of acetylcholine receptor antibodies were found in 16 out of 17 patients with primary biliary cirrhosis. Seven patients were treated or had been treated with penicillamine. Ten untreated patients had antibody levels corresponding to those found in the treated group. Our data support the presence of receptor antibodies of both IgG and IgM class.
Regional Differences in the Idiopathic Hemochromatosis Gene Frequency in Sweden
Authors: LINDMARK BERTIL , ERIKSSON STEN
Published: August 2010

ABSTRACT. Screening for idiopathic hemochromatosis (IH) in 941 men, 55 years of age, did not reveal any individual with both biochemical abnormalities and liver iron content compatible with homozygosity for the IH gene. In a large autopsy series of 8834 males representative of southern Sweden, we found classical hemochromatosis in 0.1 %. The results are in contrast with the high frequency of homozygous IH found in the county of Jämtland in central Sweden. We suggest that the difference in gene frequency is a result of enrichment of the recessive IH gene in the Jämtland population by the mechanisms of sampling and drift. We conclude that population screening for early IH in southern Sweden is not worthwhile.
Coronary Circulation in the Presence of Vascular Disease
Authors: Laird J.D. , Spaan J.A.E.
Published: August 2010

ABSTRACT. This paper discusses three specific aspects of coronary circulation as they relate to the patient with coronary artery disease. Firstly, the normal autoregulatory and metabolic control of the coronary circulation is considered in the light of current understanding of the relevant processes. Secondly, the implications of microcirculatory heterogeneities are discussed. Thirdly, the implications of the current debate on the impact of cardiac contraction for our understanding of the perfusion of the myocardium in compromised circumstances are analysed in an attempt to provide the clinician with a tool for assessing current therapy.
Thallium Tomography in the Detection of Myocardial Perfusion Defects
Authors: Bone D. , Holmgren A. , Svane B.
Published: August 2010

ABSTRACT.Tomographic 201‐TI scintigrams (SPECT) were compared with conventional planar images (PLAN) in 100 consecutive patients with ischaemic heart disease (IHD). Agreement was obtained in 78/100 and disagreement in 7/100. In 15 patients the results were equivocal. The sensitivity of PLAN and SPECT was studied in 35 patients with IHD and angina pectoris who were also examined with coronary angiography. SPECT had a sensitivity of 88 per cent compared with 84 per cent for PLAN. SPECT was better in matching perfusion defects to coronary stenoses in this small patient group.
Effect of Lipid Lowering Diet on Low Density Lipoprotein Receptor Activity in Freshly Isolated Peripheral Blood Mononuclear Cells
Authors: LEREN TROND P. , HJERMANN INGVAR , MAARTMANN‐MOE KJELL , BECKMANN SISSEL LYBERG , LEREN PAUL , BERG KÅRE
Published: August 2010

ABSTRACT. The effect of lipid lowering diet on low density lipoprotein (LDL) receptor activity has been studied in freshly isolated peripheral blood mononuclear cells (PBMCs) from 16 hypercholesterolemic male subjects during a three weeks' dietary intervention trial. The participants were randomized to an intervention group or to a control group. The subjects in the intervention group had a non‐significantly larger increase in LDL receptor activity, determined as degradation of 125I‐LDL at 37°C, than the control group (49.7 ± 18.1 and 35.4 ± 21.2 ng/mg, respectively). Irrespective of assignment to the intervention group or control group, the eight subjects with the largest reduction in total serum cholesterol had significantly larger absolute and percentage increases in LDL receptor activity than the eight subjects with the smallest reduction in total serum cholesterol (p < 0.05). Thus, it appears that the cholesterol reduction that can be achieved in humans by dietary intervention results in a small increase in LDL receptor activity in freshly isolated PBMCs.
The Sodium Intake Modifies the Renin‐Aldosterone and Blood Pressure Changes Associated with Moderately Low Energy Diets
Authors: FAGERBERG BJÖRN , ANDERSSON OVE K. , LINDSTEDT GÖRAN , WALDENSTRÖM JOHAN , AURELL MATTIAS
Published: August 2010

ABSTRACT. Thirty middle‐aged, moderately obese men with untreated mild hypertension were allocated to two groups of 15 men each. Both groups were placed on energy‐reduced diets (5.1 MJ/day) for 9–11 weeks which resulted in similar losses of body mass (8.5 kg). In group I the low energy diet was supplemented with sodium chloride leading to no change in urinary sodium excretion. During dieting there were significant reductions of plasma renin activity (PRA) and urinary excretion of noradrenaline and aldosterone. Heart rate but not mean arterial pressure (MAP) decreased significantly. Then followed a period of sodium restriction which resulted in a significant decrease in MAP and an increase in aldosterone excretion. In group II there was a reduction of sodium intake by about 80 mmol as judged from determinations of urinary sodium excretion. In this group the energy restriction was not accompanied by any changes in PRA or urinary excretion of aldosterone, whereas urinary noradrenaline excretion, heart rate and MAP decreased significantly. Urinary adrenaline excretion remained unchanged. It is concluded that the hypotensive response to moderate energy and sodium reduction cannot be explained by changes in the renin‐aldosterone system.
Immunological Studies in a Patient with the Glucagonoma Syndrome
Authors: DOHLSTEN MIKAEL , HALLBERG TORGNY
Published: August 2010

ABSTRACT. The glucagonoma syndrome is a rare clinical entity characterized by a glucagon‐producing tumor of the pancreas, necrolytic migratory erythema, weight loss and usually decreased glucose tolerance. Lately there has been increasing interest in the interaction of peptide hormones and the immune system, implicating a regulatory role of the peptide hormones on immune activation and function. We present a patient with metastasizing glucagonoma and highly elevated plasma levels of glucagon and pancreatic polypeptide. Normal numbers of peripheral blood lymphocytes with normal proportions of the T and B populations were seen. Within the T lymphocyte population the percentage of T4+ cells (helper phenotype) was increased with a concomitant decrease in T8+ cells (suppressor/cytotoxic phenotype), resulting in an abnormally high T4/T8 ratio of 6.7 (mean reference value 1.8). Functional tests demonstrated a normal tuberculin reaction and adequate lymphocyte responses in vitro to polyclonal activators. Furthermore we noticed a urine electrophoretic pattern consistent with a proximal tubular kidney defect. It is concluded that studying the immune system in patients with endocrine active pancreatic tumors may give clues on the influence of pancreatic peptide hormones on immune function and regulation.
Metabolic and Blood Pressure Monitoring in Diabetic Renal Failure
Authors: BERGLUND JONAS , LINS LARS‐ERIC , LINS PER‐ERIC
Published: August 2010

ABSTRACT. In a prospective study of eight patients with type I diabetic renal failure, metabolic and blood pressure monitoring was evaluated during progression to end‐stage renal disease (ESRD). The mean observation time was 37 months. The mean glomerular filtration rate (GFR) fell significantly (from 33 to 16 ml/min) implying a mean deterioration rate of 0.57 ml/min/month. This rate showed significant correlation with mean arterial blood pressure at out‐patient observations, but not with blood glucose monitored as 24‐hour profile or with glycosylated hemoglobin. Patients with growth hormone values within the upper limit of the normal range showed faster decline of GFR than patients with low values. The study demonstrated that advanced diabetic renal failure may progress slowly to ESRD. The blood pressure pattern, but not blood glucose values, influenced significantly the deterioration rate of glomerular function.
Fatal Pulmonary Embolism in Hospitalized Non‐surgical Patients
Authors: GÅRDLUND BENGT
Published: August 2010

ABSTRACT. A retrospective study of autopsy‐verified fatal pulmonary embolism at a department of infectious diseases was carried out, covering a four‐year period (1980–83). During that time 8646 patients were hospitalized at the department and 221 patients died. In addition, 103 patients died within 30 days of discharge from the department. Pulmonary embolism was found at autopsy in 38 cases (autopsy rate 78%). In 16 of these patients, acute pulmonary embolism was a major contributing cause of death, otherwise the prognosis would have been favourable. All 16 patients were over 55 years old and all but one were over 65 years old. The incidence of hospital‐acquired clinically relevant autopsy‐verified fatal pulmonary embolism in these age groups was 0.4 and 0.5%, respectively. In patients with respiratory tract infections, the incidence was 0.7 and 0.8% in the respective age groups.
Variation of Body Weight with Age, Sex and Height: An Index for Classification of Obesity
Authors: LUNDH BJÖRN
Published: August 2010

ABSTRACT. The body weight of 472 randomly selected inhabitants of a city population was studied in relation to age, sex and height. Weight tables were constructed from multiple regression equations. The reliability of the weights obtained and the concepts of average weight and obesity are discussed. Comparisons with earlier weight standards are made and commented upon. Over‐ and underweight can be expressed as % of expected weight (WE), i.e. (Wo‐WE)/WE × 100, where WO = observed weight. WE are calculated from the formulas WE = 6 + 0.78 × (height (cm) — 100) + 0.17 × age for men and WE = 7 + 0.71 × (height (cm) — 100) + 0.17 × age for women. These formulas are the basis for the weight tables and are derived from a subsample, obtained by excluding obese subjects from the total sample.
Serum Concentration of Cystatin C, Factor D and β2‐Microglobulin as a Measure of Glomerular Filtration Rate
Authors: GRUBB A. , SIMONSEN O. , STURFELT G. , TRUEDSSON L. , THYSELL H.
Published: August 2010

ABSTRACT. Serum concentrations of creatinine and of the three low molecular weight (LMW) proteins cystatin C, factor D of the complement system and β2‐microglobulin were measured in 135 consecutive patients, whose glomerular filtration rates (GFR) were determined by Cr‐EDTA. In the total patient series, the reciprocals of S‐creatinine and S‐cystatin C were numerically and, in males, significantly more closely correlated to GFR than the reciprocals of S‐factor D. The reciprocals of β2‐microglobulin showed a weaker correlation to GFR than those of the other three substances. The calculated glomerular elimination rates of creatinine, cystatin C and factor D were normally distributed, in contrast to those of β2‐microglobulin. According to data presented so far, cystatin C seems to be the LMW protein of first choice when GFR is to be estimated by measuring the plasma concentration of a LMW protein.
Acid Instillation Increases Gastric Luminal Prostaglandin E2 Output in Man
Authors: ALY ANDREAS , GRÉEN KRISTER , JOHANSSON CATJA
Published: August 2010

ABSTRACT. The capacity of the gastroduodenal mucosa to maintain integrity when exposed to acid and pepsin may require formation of endogenous prostaglandins (PG). The gastric mucosa is capable of PG biosynthesis, and PGE2 is present in the gastric contents of man. The purpose of this study was to examine if acidification of the human stomach affects the output of PGE2. Gastric perfusion was made with 150 mM HC1 in seven healthy subjects pretreated with a histamine‐2‐receptor blocker (ranitidine). Gastric luminal PGE2 was measured by gas chromatography‐mass spectrometry. Basal output of PGE2 was 1.42 ± 0.24 pmol/min (mean+SEM), which increased to 5.37 ± 0.91 pmol/min (p < 0.02) during acid perfusion. Gastric acidification did not cause mucosal damage as judged by luminal DNA. We conclude that PGE2 is synthesized in the gastric mucosa even during nearly complete inhibition of parietal cell secretion. Luminal acid, a likely physiological stimulator of mucosal defense, induces a fivefold increase in PGE2 output from the intact mucosa.
Randomised Controlled Trial of the Treatment of Hyperlipidaemia on Progression of Atherosclerosis
Authors: Lewis Barry
Published: August 2010

ABSTRACT. Two types of end‐point measurement are presently available in clinical trials of the effect of treatment of hyperlipidaemia on cardiovascular disease; these are the incidence of clinical events and the arteriographic assessment of progression or regression of atherosclerosis. These approaches are briefly reviewed. In the present trial, 25 hyperlipidaemic men with symptomatic femoral atherosclerosis underwent biplanar femoral arteriography at baseline. They were then randomised into treatment and usual‐care groups; treatment was individualized, comprising a lipid‐lowering diet with cholestyramine, nicotinic acid or clofibrate as appropriate for the lipoprotein disorder. Mean cholesterol and triglyceride levels were 19% and 37% lower in the treatment group. Arteriography was repeated after a mean period of 19 months. With attention to blinding of observers, changes in arteriograms were quantitated using computerised image analysis and visual methods, and expressed both by patient and by arterial segment. All end‐points were in conformity and showed a lower rate of progression of arterial disease in the treatment group, and a higher frequency of segmental regression in treated patients. In this small trial of patients with functionally‐significant atherosclerosis, effective treatment of hyperlipidaemia favourably affected the course of the arterial disease.
Interpretation of Trends in Coronary Heart Disease Mortality
Authors: Marmot M. G.
Published: August 2010

ABSTRACT. Coronary heart disease (CHD) mortality has decreased markedly in the U.S.A., Finland, Australia and other countries. Although the data are lacking, a decline in incidence is likely. Possible reasons include increased dietary consumption of essential fatty acids and decreased consumption of saturated fat and cholesterol, reduction in smoking, increased control of high blood pressure and increase in exercise. Not all countries fit this schema. Sweden has an increased CHD mortality which is not easily explained. Japan has had a continued decline in CHD mortality despite apparent increases in dietary fat. In the U.K., a decrease in CHD mortality began late, but there are encouraging signs both of changes in life style and of decreased mortality.
Prevention of Reinfarction and Sudden Death
Authors: Julian D.G.
Published: August 2010

ABSTRACT. There are many potential approaches to the prevention of reinfarction and sudden death, but the proof of benefit as yet is confined to the use of beta‐adrenoceptor blocking drugs and coronary artery bypass surgery. In selected cases, aspirin, anticoagulants and antiarrhythmics drugs may prevent one or other of these complications, but other categories of drugs, including the calcium antagonists, seem at present unsuccessful. Greatest hope for the future lies in the development of strategies that limit infarct size.
Reversibility of Cerebral Symptoms in Severe Hypertension in Relation to Acute Antihypertensive Therapy
Authors: KROGSGAARD ARNE R. , McNAIR ALLAN , HILDEN TAGE , NIELSEN POUL EBBE
Published: August 2010

ABSTRACT Cerebral symptoms were registered in a multicenter study including 64 patients with severe hypertension, diastolic blood pressure (DBP) ≥135 mmHg, and more or less pronounced hypertensive encephalopathy. The symptoms were: headache (70%), dizziness (35%), consciousness disturbances (28%), nausea (27%), paresis (23%), blurred vision (22%), para‐esthesia (21%) and vomiting (14%). None had convulsions or coma. Initial treatment was furosemide i.v., and if DBP was ≥125 mmHg after one hour, patients were randomized to treatment with either i.v. diazoxide (bolus injections of 75‐150 mg) or i.m. dihydralazine (bolus injections of 6‐12.5 mg). A gradual fall in blood pressure (BP) was obtained in all three groups. Along with BP reduction a substantial regression of neurological symptoms was registered. After 5 hours only minor cerebral symptoms were present without significant difference between diazoxide and dihydralazine. None developed cerebral complications. The study failed to show a significant correlation between BP reduction and regression of neurological symptoms graded semiquantitatively. Reduction of BP by titration using small repeated bolus injections is recommended, but oral treatment should be considered in the patients who are able to ingest peroral medication in spite of neurological symptoms
Excessive Hypercalcaemia and Mixed Connective Tissue Disease
Authors: CHRISTENSEN PER DAHL , STARKLINT HENRIK , TVEDE MICHAEL , DIEPERINK HANS
Published: August 2010

ABSTRACT A 23‐year‐old female with extreme hypercalcaemia was treated with calcitonin, mitramycin and parathyroidectomy and normocalcaemia was achieved after 4 weeks. Nevertheless, the patient later died of cutaneous necrosis, impaired circulation and multiple organ failure. Serum immunoreactive parathyroid hormone was in the normal range and parathyroid tissue normal. Mixed connective tissue disease was diagnosed on the basis of high titers of antibody to extractable nuclear antigen, moderately elevated levels of antibody to nuclear antigen and only marginal elevation of anti‐double standed DNA. The role of Cl. difficile toxin in the blood and an acinic cell tumour is unclear.
Thyroid Function after Surgical Treatment of Nontoxic Goitre: A Randomized Study of Postoperative Thyroxine Administration
Authors: GEERDSEN JAN PICO , FRØLUND LARS
Published: August 2010

ABSTRACT Following thyroid resection for nontoxic goitre, 29 euthyroid patients were randomly allocated to no medication or to 0.2 mg levothyroxine daily (17 and 12 patients). The two groups were comparable in age, sex, extent of surgery and thyroid pathology. The patients were free from other endocrine disorders and had no other medication. Serum TSH, T4 and T3 were measured and T3‐resin test performed preoperatively and 14 days and 3, 6, 12 and 18 months postoperatively. All values were within normal range. Only at the 3‐month follow‐up could statistically significant intergroup differences be observed, with T4 higher in the thyroxine‐treated and TSH higher in the untreated group, but the outset values were thereafter regained. The T3 values in both groups were slightly reduced immediately after the operation. There was no recurrence of goitre in the 18‐month observation period, and none of the findings suggested that routine thyroxine treatment is of value after resection of nontoxic goitre “in Denmark”.
Venous Thromboembolism after Cerebral Infarction and the Prophylactic Effect of Dextran 40
Authors: MELLBRING GÖRAN , STRAND TAGE , ERIKSSON STURE
Published: August 2010

ABSTRACT In a prospective study of the incidence of deep vein thrombosis (DVT) after stroke, and the prophylactic effect of dextran, 50 patients, admitted with a diagnosis of cerebral infarction with paresis of the lower extremity within the first 48 hours, were randomly allocated to treatment or non‐treatment groups. The treatment group received 500 ml of dextran 40 on admission and on days 1 and 2, and 250 ml on days 4 and 6. Venesection was performed on admission and if necessary on day 1. The control group received no dextran or venesection. DVT was diagnosed with the 125I‐fibrinogen test during the first ten days. The incidence of DVT was 54% in the treatment group and 50% in the control group. There were no statistically significant differences between the groups regarding number of DVTs needing treatment, number of positive scanning points or number of days for scan to become positive. Lethal pulmonary emboli occurred in one treated and in three control patients, respectively. Age and progress of neurologic symptoms predisposed for the development of DVT. The high incidence of DVT in stroke patients indicates the need for prophylactic routines.
The Natural History of Sexual Dysfunction in Diabetic Women
Authors: JENSEN SØREN BUUS
Published: August 2010

ABSTRACT. The natural history of sexual dysfunction in diabetic women was evaluated in a 6‐year prospective study. Fifty type I, insulin‐treated diabetic women, aged 26–45 years, were assessed and re‐evaluated 6 years later. Measures included psychological, physiological and social parameters. The frequency of sexual dysfunction was similar in 1977 and 1983. Diabetic women did not differ in sexual function from their healthy controls. None of the physiologic measures studied were predictive of sexual function. Six out of 14 women who were sexually dysfunctional in 1977 recovered normal function, some of them in spite of objective evidence of neuropathy. None of the women had been on psychotherapy for their sexual problem. The most important factor in the spontaneous remission rate seemed to be improvement in the overall marital and social situation. The women's acceptance of illness, as judged by the interviewer, and data from the questionnaires concerning psychological distress, were strong predictors of sexual function. Sexual dysfunction in diabetic women is thus an index of psychological adjustment to chronic illness. Family and marital counseling should be routinely offered as part of the medical care of the diabetic patient.
Metacarpal Bone Measurements in Renal Transplant Recipients, in Corticosteroid‐treated Patients with Polymyalgia Rheumatica and in Patients with Primary Hyperparathyroidism
Authors: ANDRESEN J. , NIELSEN H. E. , ALBERTSEN K.
Published: August 2010

ABSTRACT. Quantitative radiological measurements on the second left metacarpal bone were carried out in 23 patients with primary hyperparathyroidism, 22 corticosteroid‐treated patients with polymyalgia rheumatica and 40 renal transplant recipients treated with prednisone and azathioprine. Women with primary hyperparathyroidism and corticosteroid‐treated women showed significantly decreased mean values of metacarpal bone compared to normal controls, probably due to a higher bone resorption than formation at the endosteal surface. Bone loss was more pronounced in corticosteroid‐treated women than in women with primary hyperparathyroidism, partly due to age difference. In renal transplant recipients, bone loss took place during the initial period after renal transplantation, probably due to increased endosteal bone resorption. During this period a periosteal new bone formation look place in female renal transplant recipients. The quantitative radiological measurements make it possible to determine whether bone loss is due to a higher ratio of bone resorption than of bone formation at the periosteal and/or endosteal surface.
Effect of Sunlight Exposure on Circulating 1,25‐Dihydroxyvitamin D in Hemodialyzed Patients and of Exogenous Parathyroid Hormone in Anephric Patients
Authors: SØRENSEN OLE H. , LUND BJARNE , THODE JØRGEN D. , STORM TOMMY L. , LUND BIRGER , BRAHM MARIANNE , FRIEDBERG MICHAEL , HOLMEGAARD STIG N.
Published: August 2010

ABSTRACT. Sunshine exposure increased the serum concentration of 25‐hydroxyvitamin D (25‐OHD) in 9 hemodialyzed patients. Mean 1,25‐dihydroxyvitamin D (1,25‐(OH)2D) was unchanged, but in two patients with low initial 25‐OHD values this increase was accompanied by a rise in circulating l,25‐(OH)2D, although not to normal levels. One hemodialyzed patient developed liver insufficiency with a resultant reduction of serum 25‐OHD concentration accompanied by a decrease in serum 1,25‐(OH)2D concentration. The results indicate that the circulating levels of 1,25‐(OH)2D in patients with end‐stage renal failure are to some extent regulated by the serum 25‐OHD concentrations. Injection of parathyroid hormone (PTH) induced minor increases in serum concentrations of 1,25‐(OH)2D in patients with end‐stage renal failure and even in anephric patients, suggesting the existence of an extrarenal PTH‐sensitive 1‐α‐hydroxylase. However, the enzyme was stimulated by supra‐physiological concentrations of PTH, and therefore not necessarily of importance in the normal regulation of calcium metabolism.
Nonantral Gastric Carcinoid Tumours Associated with Hypergastrinaemia
Authors: WILANDER ERIK , NORDGREN HANS , ÖBERG KJELL
Published: August 2010

ABSTRACT. Nonantral gastric carcinoid tumours in association with pronounced hypergastrinaemia are reported in 6 patients. It is suggested that the hypergastrinaemia, as a result of lack of a negative acid feedback inhibition in an achlorhydric stomach, promoted the tumour development, possibly initiated by action of carcinogenic nitrosamines, in the gastric juice.
Cardiac Amyloidosis Mimicking Hypertrophic Cardiomyopathy
Authors: HEMMINGSON LARS OLOF , ERIKSSON PETER
Published: August 2010

ABSTRACT. Amyloid infiltration of the heart may frequently masquerade as other cardiac disorders. The extended use of echocardiography may contribute to an erroneuous diagnosis of hypertrophic cardiomyopathy, as both conditions show several features in common. This was the case with the patient reported below. A low QRS amplitude, an increased right ventricular wall thickness, thickened cardiac valves, and a pericardial effusion may, however, indicate amyloid infiltration. The diagnosis of systemic amyloidosis of immunocytic origin was subsequently established in our patient. A definitive diagnosis of amyloid heart disease requires endomyocardial biopsy, but it is suggested that typical noninvasive findings together with demonstration of amyloid in an organ other than the heart is sufficient for a reliable diagnosis. In addition, systemic manifestations may contribute to a correct diagnosis in generalized amyloidosis. Our patient had features consistent with the rare muscle pseudohypertrophy syndrome, which is associated with immunocytic amyloidosis.
Tuberculosis in a Developed Country
Authors: LANGE P. , MORTENSEN J. , VISKUM K.
Published: August 2010

ABSTRACT. All 515 patients notified for tuberculosis for the first time in 1972, 1977 and 1982 in Copenhagen have been studied. Changes during the period and differences between Danes and immigrants were looked for. The percentage of immigrants increased during the period. The immigrants had a different age distribution, higher frequency of extrapulmonary tuberculosis with a distribution different from that of Danes, fewer complicating diseases and they drank less alcohol. No significant changes in the patient population took place in the decade studied, except for a decreasing number of Danes with tuberculosis, a decreasing number of abacillary patients and an increase in the percentage of extrapulmonary tuberculosis. At follow‐up in 1983, none of the immigrants, but 147 of 407 Danes had died, mainly from complicating diseases. Life expectancy for the Danes, who survived the initial phase, was not significantly different from that for the population at large. None of the patients were bacillary at the time of the follow‐up.
The Cardiovascular Risks of Physical Activity
Authors: VUORI ILKKA
Published: August 2010

ABSTRACT. The incidence of sudden death, serious arrhythmias, and myocardial infarction in connection with both recreational and rehabilitative physical activity is small. However, the incidence of e.g. sudden death is several times higher in exercise than at other times. This relative risk is highest in middle‐aged men, and higher in strenuous than in nonstrenuous exercise. In the vast majority of the cases the underlying cause is advanced coronary heart disease, which in large proportion of the cases has been asymptomatic and has allowed regular strenuous training. Attempts to prevent the complications by special large scale screening programs would be ineffective and individual councelling limited by lack of resources. These measures should, however, be used in selected groups and individuals. Another approach is to inform the exercisers and their families at large by systematic, well‐planned and repeated messages of the risks of physical activity, of the symptoms and findings indicating this risk, of the individual and environmental factors increasing the risk, and of the necessary measures to be taken to minimize the risk. Even if all available measures at present were used, the cardiovascular complications of physical activity could not be totally prevented. Fortunately, preliminary evidence suggests that at population level the cardiovascular hazards of physical activity are outweighed by its cardiovascular benefits.
EXPERIENCE WITH PERCUTANEOUS TRANSLUMINAL RENAL ANGIOPLASTY IN RENOVASCULAR HYPERTENSION
Authors: Pedersen E. B. , Madsen B. , Danielsen H. , Jespersen B.
Published: August 2010

ABSTRACT. Percutaneous transluminal renal angioplasty (PTRA) was attempted in 17 patients with a diastolic blood pressure greater than or equal to 95 mmHg in spite of treatment with two or three antihypertensive drugs in combination and unilateral or bilateral renal artery stenosis with a reduction of vessel diameter to less than 25%. PTRA resulted in a dilatation of the stenosis in 12 patients. After an observation period of at least 6 months 2 patients were cured, 7 improved and 3 unchanged. Renal vein renin ratio (RVRR) was determined in the last 9 of these patients but was unknown when PTRA was done. RVRR was higher than 1.5 in 5 patients of whom one was cured and 4 improved and less than 1.5 in 4 of whom one was improved and 3 unchanged. No persistent complications were observed after PTRA. It can be concluded that PTRA is an effective antihypertensive treatment in several patients with renovascular hypertension, and a RVRR greater than 1.5 suggests a favourable outcome with regard to blood pressure regulation.
POTASSIUM‐SPARING DIURETICS
Authors: Dyckner Thomas , Wester Per‐Olov
Published: August 2010

AbstractThe hemodynamic and the endocrine disturbances in congestive heart failure (CHF) impose major changes in electrolyte balance with a retention of sodium and concomitant losses of potassium and magnesium from the body. These changes are of great importance for the development of cardiac dysrhythmias, a diminished glucose tolerance and for the well‐being of the patient.

The use of conventional diuretics imposes further burdens on the already deranged electrolyte balance. On long‐term therapy with conventional diuretics in CHF we observed that approximately 50% of the 297 patients studied had potassium and magnesium deficiencies and an increased sodium content as judged by skeletal muscle biopsies. The magnesium deficiency is especially dangerous since it prevents the cells from keeping their high intracellular potassium concentration unchanged. Potassium substitution is without effect in a magnesium deficiency since magnesium is necessary for the transportation of potassium over the cell membrane against the concentration gradient. In case of magnesium depletion, potassium substitution may even have negative effects on the body potassium content. The reason for this is probably the increase of p‐potassium concentration induced by the substitution, leading to an increase of aldosterone secretion. An increase of p‐potassium levels by 0.2–0.4 mmol/1 may thus result in a 50–100% rise in p‐aldosterone concentration. These changes promote further urinary losses of potassium and magnesium.

Several studies have demonstrated the positive effects of the potassium‐sparing diuretics amiloride, spironolactone and triamterene on p‐potassium concentration, but also on the body potassium content. There are theoretical indications that these diuretics may also save magnesium. This would mean a further protection against the electrolyte disturbances induced by the combination of CHF and conventional diuretic therapy.

In three different studies we have confirmed the potassium‐sparing properties of amiloride, spironolactone and triamterene Furthermore, these diuretics had the ability to restitute the magnesium balance that had been deranged prior to the investigation by CHF and conventional diuretic therapy.

On using these potassium‐ and magnesium‐sparing diuretics–amiloride, spironolactone and triamterene–sizeable increases of p‐aldosterone levels have been observed, probably induced by the raised p‐potassium concentration and by volume changes induced by the additional diuresis. Prior investigations on the body potassium content have been performed on a short‐term basis. It has been speculated that the duration of the effects of amiloride and triamterene on the body content of potassium would not be lasting in the long‐term prospect in the face of a persistently raised p‐aldosterone level. In the above three investigations, however, we observed that all three agents were capable of even restituting the skeletal muscle content of both potassium and magnesium on a long‐term basis (6 months).
α‐GLUCOSIDASE INHIBITION IN OBESITY
Authors: William‐Olsson Tom
Published: August 2010

Acarbose is an alpha‐glucosidase inhibitor which reversibly and competitively inhibits the digestion of oligo‐ and disaccharides at the brush border of the small intestine. This study evaluates the preventive and therapeutic properties of acarbose in the treatment of obesity.

Dose‐response experiments were performed during repeated sucrose loads in man in order to investigate the effects of acarbose on plasma insulin and blood glucose levels. After titration of efficient doses, a long‐term tolerance test of acarbose was undertaken in a small pilot study. Finally, the relapse preventing effect of acarbose was tested during double‐blind cross‐over conditions in 24 weight reduced obese women.

In growing Sprague‐Dawley rats, the effects of acarbose on body weight, lipid depots and adipose tissue cellularity were tested during pair‐feeding and ad libitum conditions. Such effects were also studied in adult ad libitum‐fed rats.

Blood glucose, plasma insulin, body fat, depot lipids as well as fat cell weight and number were determined with established techniques.

During a sucrose load, acarbose reduced insulin in a dose‐dependent fashion. Glucose was also reduced, but not dose‐dependently and only to a moderate extent. During a 200 g sucrose load, 400 mg of acarbose did not necessarily result in a maximal reduction of the insulin response while the glucose response was maximally inhibited after 100 mg.

Acarbose reduced the relapse rate after weight reduction. No serious side effects were observed. Flatulence and meteorism occurred frequently. In growing rats, acarbose retarded the development of body weight and of lipid depots not only during pair‐feeding conditions but also in ad libitum‐fed animals eating considerably more than their controls. The spontaneous food consumption was increased by acarbose also in adult rats but in these animals neither body weight nor lipid depots were significantly reduced by acarbose.

It is concluded that acarbose induces a carbohydrate malabsorption. Insulin levels are reduced not only via a decreased glycemic stimulus but also by interference with other insulin releasing mechanism(s). Acarbose is the first drug ever tested with long‐term relapse reducing effects after weight reduction. Animal experiments suggest that acarbose may be of value in the prevention of obesity, particularly since the drug retards lipid accumulation also during ad libitum‐feeding.
Hypoalphalipoproteinemia Resembling Fish Eye Disease
Authors: FROHLICH JIRI , HOAG GORDON , McLEOD ROGER , HAYDEN MICHAEL , GODIN DAVID V. , WADSWORTH LUOIS D. , CRITCHLEY J. DOUGLAS , PRITCHARD P. HAYDN
Published: August 2010

ABSTRACT A 16‐year‐old boy presented with bilateral arcus cornealis and markedly decreased plasma high density lipoprotein cholesterol. The plasma lipoprotein abnormalities, as well as decreased mass and activity of lecithin: cholesterol acyltransferase (LCAT), were similar to those described in patients with fish eye disease. Increased number of target cells and decreased osmotic fragility of the proband's erythrocytes were noted. The proband's father and one of his brothers showed intermediate plasma lipoprotein and LCAT alterations. The father's erythrocytes also showed abnormal osmotic fragility. The mother of the propositus had normal plasma lipoproteins and erythrocyte osmotic fragility, but her LCAT activity was also low. Many of these features suggest a disorder similar to fish eye disease which is clinically and biochemically distinct from other hypoalphalipoproteinemias.
Plasma Exchange in a Patient with Heterozygous Familial Hypercholesterolaemia Resistant to Drug Therapy
Authors: ERIKSSON MATS , LANTZ BO , BERGLUND LARS , ANGELIN BO
Published: August 2010

ABSTRACT A 40‐year‐old male with heterozygous familial hypercholesterolaemia was resistant to combined drug treatment with cholestyramine and nicotinic acid in adequate doses. He had angina pectoris and evidence of three vessel disease in the coronary angiogram. Repeated plasma exchange at intervals of 1–3 weeks simultaneously with combined drug treatment decreased the plasma cholesterol levels by nearly 40%. There were also signs of regression of xanthomata and some improvement of his angina pectoris. No progression of atherosclerosis was seen angiographically after two years treatment. Plasma exchange may be a therapeutic alternative in drug‐resistant familial hypercholesterolaemia.
Sorbitol as a Sweetener in the Diet of Insulin‐dependent Diabetes
Authors: VAALER STEIN , BJØRNEKLETT ARVID , JELLING INGRID , SKREDE GRETE , HANSSEN KRISTIAN F. , FAUSA OLAV , AAGENjES ØYSTEIN
Published: August 2010

ABSTRACT. We compared sorbitol given alone and as part of a mixed meal to nine insulin‐dependent diabetics (IDD's) during continuous subcutaneous insulin infusion (CSII). Blood glucose, sorbitol and breath hydrogen+methane were measured following six test meals: Pure glucose, sorbitol and lactulose, a mixed meal alone, and sweetened with sorbitol and sucrose. Blood glucose increase was very small after lactulose and sorbitol, significantly larger after glucose. A considerable increase in breath hydrogen+methane appeared after sorbitol and lactulose, but not after glucose. No differences in blood glucose responses were found after the mixed meal alone or sweetened with sorbitol and sucrose. A sustained low level increase in breath hydrogen+methane occurred after all solid meals. Sorbitol was not detected in serum after any meal. Conclusion: Sorbitol ingested by IDD's during CSII in watery solution is not absorbed in the small intestine and causes osmotic diarrhoea. Ingested in a composite meal it does not affect blood glucose and does not cause osmotic diarrhoea.
Electrocardiographic Changes in Spontaneous Left Pneumothorax
Authors: KELLER NIELS , SZAFF MARTA , SYKULSKI ROMAN
Published: August 2010

ABSTRACT. Keller N, Szaff M, Sykulski R (Department of Internal Medicine, Sundby Hospital, Copenhagen, Denmark). Electrocardiographic changes in spontaneous left pneumothorax. Acta Med Scand 1987; 221:499–501.

A 25‐year‐old man was admitted with severe chest pain and an electrocardiogram suggestive of anterior myocardial infarction. Echocardiogram was normal, but chest X‐ray showed left‐sided pneumothorax. The electrocardiogram showed increasing R‐wave amplitude in the days after correction of pneumothorax. Taken in the supine position the electrocardiogram can be misleading in case of pneumothorax or mediastinal emphysema, but the electrocardiogram should be normal if taken in the erect position.