bluuebunny/crossref_metadata_2025 huggingface dataset:
Dietary factors and hypertension
Authors: Huttunen Jussi K. , Pietinen Pirjo , Nissinen Aulikki , Puska Pekka
Published: August 2010

ABSTRACT. There is increasing evidence that nutritional factors are critical in the pathogenesis of essential hypertension typical for acculturated societies. These factors include sodium, potassium, calcium, alcohol, and type and level of fat in the diet. More research is needed, however, before the role of various nutrients in the prevention and treatment of hypertension will be ascertained.
Influence of Treatment of »Mild» Hypertension on Coronary Heart Disease
Authors: Stamler Rose
Published: August 2010

ABSTRACT. High blood pressure (HBP) in the range 90—104 DBP (»mild») has been shown to carry a sizeable excess risk of coronary death, at least in countries with atherogenic diets. Effective treatment to control HBP should result in lowering CHD risk.

Early trials comparing drug treatment vs placebo in such hypertensives were generally too small or too limited to demonstrate this, although overall trends favored treatment. The U.S. Hypertension Detection and Follow‐up Program (HDFP), a population based trial with 10,940 patients, did demonstrate large reductions in CHD mortality and in nonfatal CHD, as measured by a variety of indices. A subsequent large trial, the Multiple Risk Factor Trial (MRFIT), found benefit in reducing CHD deaths for most hypertensives, but for the subgroup with resting ECG abnormalities, CHD deaths were greater in the Special Intervention than in the Usual Care group. The overall findings of the several studies indicate benefit of effective antihypertensive treatment in reducing CHD mortality and morbidity for most hypertensives with DBP 90—104. However, need to highlight a number of other aspects of anti‐hypertensive treatment is indicated: use of lowest drug level possible to achieve BP normalization; need to control all major CHD risk factors in hypertensives; need to utilize nutritional means to further both these aims; need to monitor and counteract unwanted metabolic effects of antihypertensive drug therapy.
Intracoronary Streptokinase in Acute Myocardial Infarction A review
Authors: Hugenholtz P.G. , Simoons M.L. , Serruys P.W. , van den Brand M.
Published: August 2010

ABSTRACT. The attempt to salvage myocardium threatened by ischemia during temporary or permanent occlusion of one or more of the nutrient arteries, is based on the observation that the major determinant of survival is the extent to which myocardium has been lost through infarction. Modern clinical cardiology has therefore looked at various approaches which might limit unnecessary loss of potentially viable myocardium. These are attempts to reduce the oxygen consumption through pharmacological means, attempts at restoring the blood supply and oxygen delivery at an early stage by manipulations on the coronary arteries and interventions aimed at »protecting» cardiac cells threatened by ischemia or reperfusion. Endpoints considered to be proof of improved left ventricular function will be wall motion and ejection fraction measurements as well as reduction in death rate and other serious cardiovascular complications.
Transluminal Coronary Angioplasty — State of the Art 1984
Authors: Meier Bernhard , Rutishauser Wilhelm
Published: August 2010

ABSTRACT. Since its introduction in 1977 by Grüntzig, percutaneous transluminal coronary angioplasty (PTCA) has been increasingly applied to the treatment of coronary artery disease manifested by symptomatic ischemia. Initially only recommended for proximal short stenoses of one major coronary artery, the indication for PTCA has gradually been enlarged. Today even distally situated coronary stenoses in more than one vessel can be dilated successfully by using a steerable system. In experienced hands, an immediate improvement can be achieved in about 90% of the patients. In the realm of cost and morbidity PTCA offers obvious advantages over bypass surgery. However, indications for PTCA are more restricted than those for bypass surgery, specially in multi‐vessel disease where the application of PTCA is still controversial. Moreover, long‐term results are less favourable after PTCA since 25—30% of the patients show a recurrence within 6 to 12 months.

Although PTCA will not replace coronary bypass surgery, it is already established as an alternative and complementary method for coronary revascularization.
Reduction of Nonfatal Reinfarctions in Patients with a History of Hypertension by Chronic Postinfarction Treatment with Metoprolol
Authors: OLSSON GUNNAR , REHNQVIST NINA
Published: August 2010

ABSTRACT The Stockholm Metoprolol Trial is a prospective double‐blind placebo‐controlled postmyocardial infarction study of 301 patients treated with metoprolol, 100 mg b.i.d., or matching placebo for three years. From this study we have retrospectively evaluated the outcome in patients with a history of treatment for hypertension prior to the index infarction. There were 41 such patients in the placebo group and 35 in the metoprolol group. Blood pressures during follow‐up were nearly identical in the two groups. During the three years 11 patients died in the placebo group and 7 in the metoprolol group. Corresponding figures for nonfatal events such as reinfarction, coronary artery bypass surgery, cerebrovascular events and lower limb amputation were 12 vs. 1 (p<0.005), 3 vs. 0, 4 vs. 0 and 1 vs. 0, respectively. The numbers of patients with fatal and nonfatal events were 24 vs. 8 (p<0.01). In a retrospective subgroup analysis the results must always be interpreted with caution. The present results may, however, imply that postinfarction treatment with metoprolol reduces nonfatal atherosclerotic complications, especially nonfatal reinfarctions, in patients with a history of hypertension.
Serum Lipids and Lipoproteins during Continuous Ambulatory Peritoneal Dialysis
Authors: LINDHOLM BENGT , NORBECK HANS ERIK
Published: August 2010

ABSTRACT The effects of continouos ambulatory peritoneal dialysis (CAPD) on serum lipids and lipoproteins over the initial year of therapy were studied in 23 uremic patients. Lipoprotein abnormalities typical for the uremic dyslipoproteinemia were present at the start of CAPD. During the first months of CAPD these abnormalities were accentuated. The concentrations of very low density lipoprotein (VLDL)‐cholesterol (CHOL), low density lipoprotein (LDL)‐CHOL, serum CHOL and serum triglycerides (TG) increased significantly. However, after one year of CAPD only the VLDL‐CHOL and serum CHOL levels remained significantly higher than the baseline values. VLDL‐TG, VLDL‐CHOL and serum TG, and the changes of these variables over the study period, correlated with the amount of glucose in the dialysates. We conclude that the continuous peritoneal absorption of glucose (100‐200 g/24 h) during CAPD contributes to potentially atherogenic changes in serum lipids and lipoproteins. However, some of the changes are transitory, indicating an adaptation to the peritoneal glucose load.
A Hospital Survey of Hypocalcemia in Patients with Malignant Disease
Authors: BLOMQVIST CARL P.
Published: August 2010

ABSTRACT Hypocalcemia was found in 122 (1.6%) of the patients attending a large oncological center. In 10% of the cases, hypocalcemia was caused by hypoparathyroidism and/or uremia, in 12% it was related to a major infection. Osteoblastic metastases were responsible in 4% of the cases and in 74% hypocalcemia accompanied an impairment of the general condition due to the malignancy or its treatment, usually in the terminal stage of the disease. The most common cause of hypocalcemia in this group of patients seemed to be hypoproteinemia. Correction of serum calcium for variations in serum albumin concentration, however, indicated that a small proportion had a decreased ionized calcium value as well, the mechanism of which remained obscure. The hypocalcemia was usually relatively mild, especially after correction for albumin variations. Tetanic symptoms were not seen. Hypocalcemia thus seems to be a fairly common complication of malignant disease, the clinical relevance of which, however, appears to be relatively small in most cases.
A Controlled Randomized Study on the Effect of Long‐term Physical Exercise on the Metabolic Control in Type 2 Diabetic Patients
Authors: RÖNNEMAA TAPANI , MATTILA KARI , LEHTONEN AAPO , KALLIO VEIKKO
Published: August 2010

ABSTRACT The effects of 4 months' physical exercise on the metabolic control in non‐insulin‐dependent diabetes were studied in 25 patients divided randomly into exercise (n=13) and control (n=12) groups. In the exercise group glycosylated hemoglobin A1 fell from 9.6–8.6% (p<0.01) and the 2 hour plasma glucose in oral glucose tolerance test decreased from 19.7–16.5 mmol/l (p<0.01). The mean fall in fasting plasma glucose from 11.8–10.5 mmol/l was not statistically significant. The responses of plasma insulin and C‐peptide to oral glucose increased significantly during the exercise period. However, patients with initially poorest metabolic control were not able to improve their physical fitness and did not show significant improvement in metabolic control. In the control group no changes occurred in any parameter of glucose metabolism. The results suggest that physical exercise is beneficial for the glycemic control in patients with mild and moderate non‐insulin‐dependent diabetes. Increased insulin response is at least one main mechanism of the action of exercise.
Serum Concentrations of 25‐Hydroxyvitamin D and Vitamin D‐binding Protein in Elderly People
Authors: TOSS G. , SÖRBO B.
Published: August 2010

ABSTRACT Serum concentrations of 25‐hydroxyvitamin D (25‐OH‐D) and vitamin D‐binding protein (DBP) were measured in institutionalized and non‐institutionalized elderly people. The institutionalized subjects were found to have low serum 25‐OH‐D in confirmation of other studies, but their serum DBP levels were similar to those found in non‐institutionalized elderly subjects. Serum DBP concentrations were slightly higher in elderly females than in males, while no age dependence was found for DBP. Elderly people with protein‐energy malnutrition who lived in their own homes had slightly reduced serum DBP and 25‐OH‐D levels. Elderly subjects with infections or other diseases causing acute inflammation, as indicated by an elevated serum haptoglobin and C‐reactive protein, had normal levels of DBP.
Ketoconazole is Effective against the Chronic Mucocutaneous Candidosis of Autoimmune Polyendocrinopathy‐Candidosis‐Ectodermal Dystrophy (APECED)
Authors: AHONEN PEKKA , MYLLÄRNIEMI SINIKKA , KAHANPÄÄ ASKO , PERHEENTUPA JAAKKO
Published: August 2010

ABSTRACT Ketoconazole was administered as a single daily oral dose of 200 mg to 12 patients with chronic mucocutaneous candidosis (CMC) of autoimmune polyendocrinopathy‐candidosis‐ectodermal dystrophy (APECED). The study was double‐blind and placebo‐controlled, with 4‐month therapy periods and crossover, and transfer to open‐label ketoconazole therapy in cases of failure. During the double‐blind trial, all six initially ketoconazole‐treated patients showed a clear clinical and mycological improvement. In contrast there was no change or worsening in the initially placebo‐treated group (p=0.001). Oral candidosis cleared up in all patients, but more rapidly (<2 weeks) in those aged <25 years than in older patients (4–10 weeks; p=0.001). Similarly, nail candidosis improved more rapidly in the younger group. All patients had a recurrence of the candidosis during 36–48 months of post‐therapy follow‐up. The recurrences likewise responded to ketoconazole. In one patient serum transaminase activities were transiently and marginally elevated during 2–6 weeks of therapy.
On the Influence of Vitamin K‐rich Vegetables and Wine on the Effectiveness of Warfarin Treatment
Authors: KARLSON B. , LEIJD B. , HELLSTRÖM K.
Published: August 2010

ABSTRACT Thrombotest (TT) values were studied in patients fed an ordinary diet and on continuous and well controlled warfarin therapy because of deep venous thrombosis or pulmonary embolism. The aim was to characterize the effect of single and multiple administrations (daily during one week) of vitamin K1 (Konakion®), vitamin K‐rich vegetables such as spinach and broccoli, and table wine. Single administration of 250 μg vitamin K1, 250 g spinach, 250 g broccoli and 37.5 cl wine did not result in TT‐values outside the therapeutic range. However, when Konakion®, broccoli and spinach were given daily during one week the TT‐values tended to rise above the therapeutic limit, requiring dose adjustment. On the basis of this study it appears that excessive intake of vitamin K‐rich food and a moderate intake of alcohol on one occasion may be permitted during anticoagulant therapy.
Waldenström's Macroglobulinemia in Monozygotic Twins
Authors: FINE J. M. , MULLER J. Y. , ROCHU D. , MARNEUX M. , GORIN N. C. , FINE A. , LAMBIN P.
Published: August 2010

ABSTRACTThis paper reports a unique familial occurrence of Waldenström's macroglobulinemia (WM) in monozygotic twins. The determination of twin monozygosity has been performed by electrophoretic and immunological typing of genetic systems (erythrocyte blood groups, leucocyte antigens and serum protein polymorphism). The two monoclonal IgM differ one from the other by their light chain type and their idiotypic determinants. Although a genetic predisposition to WM exists in these twins, the gene recombination leading to idiotypic specificity and light chain assortment occurs independently of the monoclonal malignant involvement.
HLA Antigens in a Family with Behçet's Syndrome
Authors: FALLINGBORG JAN , CHRISTENSEN LISBET AMBROSIUS , GRUNNET NIELS
Published: August 2010

ABSTRACT A family is described in which 3 of 12 members suffered from Behçet's syndrome. Four members, including the three patients with Behçet's syndrome suffered from recurrent aphthous stomatitis. These four family members possessed the HLA‐haplotype HLA A2, B15, Cw3, DR4. However, one relative had inherited the same HLA‐haplotype without showing any symptoms of the disease. Genetic influence from the actual HLA‐haplotype may interact in manifestation of the syndrome.
A Study of the Association between the Prolongation of the QT Interval in the Resting ECG and Myocardial Infarction
Authors: ROBERTS PATRICIA M. , FODOR J. GEORGE , TIBBLIN GÖSTA , WILHELMSEN LARS
Published: August 2010

ABSTRACT The relationship between the incidence of myocardial infarction in the 10 year follow‐up period and the length of the QT interval and its two components (the time elapsing between the Q wave and the beginning of the T wave, and the duration of the T wave) was investigated in a study of the records of a group of men drawn from a random sample of all 55‐year‐old men living in Göteborg, Sweden. A significant association was found between the incidence of myocardial infarction and the first component but not with the second component or the QT interval itself. The two components were found to be independent and thus to have the potential to act as confounding factors if the QT interval is examined alone. Further, our results suggest that correcting the QT interval for heart rate needs careful reassessment.
Differential Hemodynamic Effects of β‐Adrenoceptor Blockers, Ca Antagonists and Combined α‐β‐Receptor Blockade in Ischemic Heart Disease
Authors: KOCH G.
Published: August 2010

ABSTRACT. The hemodynamic responses to 3 different therapeutical regimens: β‐adrenoceptor blockade, calcium inflow inhibition and combined α‐β‐blockade were evaluated in 3 matched randomized groups of patients with ischemic heart disease and typical exercise‐induced angina. The groups consisted of 22, 16 and 15 men, mean age 55–59 years. They were studied at rest and during ischemia‐inducing exercise, before and after single oral doses of 100 mg metoprolol, 10 mg nifedipine and 200 mg labetalol. Pressures in the brachial artery and the pulmonary circulation were recorded by means of percutaneously introduced catheters. Cardiac output was determined according to the Fick principle. Metoprolol reduced mean arterial pressures, heart rate and cardiac output. Systemic vascular resistance and left ventricular filling pressure increased. Nifedipine resulted under all conditions in a distinct reduction of systemic vascular resistance and arterial pressures and a slight increase in heart rate and cardiac output. Left ventricular filling pressure was significantly lowered, the more the higher the initial level. The effect of labetalol was similar to that of nifedipine; however, cardiac output was unchanged and heart rate was slightly reduced. Left ventricular filling pressure was significantly lower. It is apparent that suppression of adrenergic stimulation by β‐receptor blockade alone may have adverse hemodynamic effects in ischemic heart disease and prompt further functional deterioration. Conversely, both calcium and combined α‐β‐receptor blockade tend to improve left ventricular function by lowering both left ventricular preload and total systemic vascular resistance. The results strongly suggest that in patients in whom β‐receptor blockers appear indicated, their adverse hemodynamic effects can be offset by concomitant α1‐receptor blockade or vasodilation without losing symptomatic efficacy. Combined α‐β‐receptor blockade has the advantage over calcium antagonists alone to prevent any increase in adrenergic activity and related hyperkinetic response.
Constant Glomerular Filtration Rate in Diabetic Nephropathy
Authors: NYBERG GUDRUN , BLOHMÉ GÖRAN , NORDÉN GUNNELA
Published: August 2010

ABSTRACT. Twenty‐one patients with diabetes of type I and diabetic nephropathy with reduced glomerular filtration rate (GFR) were followed prospectively with regard to GFR, proteinuria, blood pressure and glucosylated haemoglobin (HbA1). All patients were on antihypertensive treatment. The mean rate of decline in GFR was only 0.38 ml/month = 4.6 ml/year. In one third of the patients, GFR remained constant at a reduced level for at least 24 months. Mean plasma clearance of 51Cr‐EDTA in this group was 48.3±14.6 ml/min/1.73 m2 body surface at entry and 48.0±13.6 at the time of evaluation. The patients with constant GFR had significantly less proteinuria and lower systolic as well as mean arterial pressure during the study than patients with falling GFR. They also had significantly lower mean HbA1 and fewer very high HbA1 values than patients who deteriorated. The data thus indicate that a combination of good metabolic control and effective blood pressure control may strongly delay the progression of renal insufficiency in diabetic nephropathy. They also show that low degree of proteinuria is a marker of good prognosis.
Serological Evidence for the Role of Bacterial Infections in the Pathogenesis of Thyroid Diseases
Authors: VALTONEN V. V. , RUUTU P. , VARIS K. , RANKI M. , MALKAMÄKI M. , MÄKELÄ P. H.
Published: August 2010

ABSTRACT. Subacute thyroiditis is generally believed to be of viral origin, and infection is also suspected of playing a role as a triggering factor in the pathogenesis of autoimmune thyroid diseases. We have measured a broad spectrum of bacterial and viral antibodies in paired sera of 32 patients with thyroid disease of recent onset. The data indicate a preceding infection in 14 (44%) of the patients, enterobacterial in 5, streptococcal in 4 and staphylococcal in 2. A viral infection was suggested in 6 patients, in each case caused by different agents; 3 of them also showed evidence of a bacterial infection. Patients with positive microbial serology were found in all diagnostic groups, including subacute thyroiditis, Graves' disease and Hashimoto's disease. These results suggest an association between a preceding bacterial infection and the development of thyroid disease in some patients.
The Familial Magnesium‐losing Kidney
Authors: HEDEMANN LARS , STRUNGE POUL , MUNCK VIGGO
Published: August 2010

ABSTRACT.Magnesium deficiency is often secondary to existing disease. Over a period of 20 years, 17 cases of primary magnesium‐losing kidney have been reported. This report describes two additional cases, and a comparison with previous cases is made. The familial magnesiumlosing kidney appears to be caused by a congenital tubular defect in the reabsorption of magnesium. Its manifestations may be various but the diagnosis is established by the presence of Hypomagnesemia with an unappropriately high urinary magnesium excretion in patients with no other renal disorder.
Evaluation of Platelet Reactivity in Diabetes Mellitus
Authors: KUTTI JACK , WADENVIK HANS , HENESTAM BIRGITTA , STENSTRÖM GUNNAR
Published: August 2010

ABSTRACT. Seventeen patients with insulin‐dependent diabetes mellitus, all below the age of 45 years, were studied. Five of them had retinopathy but no other micro‐ or macrovascular diabetic complications. None of them had any other concurrent disorder or were on any medication but insulin. The results were compared to those of 17 healthy volunteers of comparable age. There was no difference between the two groups in venous platelet counts, serum production of thromboxane B2 (TXB2), ADP‐induced platelet aggregation or bleeding times. As compared to the controls, the diabetics had significantly elevated blood glucose and glycosylated hemoglobin values. The mean plasma values of β‐thromboglobulin, platelet factor 4 and TXB2 were significantly lower in the patients than in the controls. Thus, our results do not lend support to the current concept that platelet reactivity is enhanced in diabetes mellitus.
A Case of Esophageal Spasms in Amyloidosis
Authors: FUNCH‐JENSEN P. , FOGED E. , RAVNSBÆK J. , SØGAARD H.
Published: August 2010

ABSTRACT. Impairment of esophageal peristalsis in amyloidosis is well known. A patient in whom esophageal spasms and orocricopharyngeal dyscoordination accompanied myeloma‐associated amyloidosis is presented below. The different possible mechanisms producing these abnormalities are discussed.
The Skaraborg Hypertension Project
Authors: RÅSTAM LENNART , BERGLUND GÖRAN , ISACSSON SVEN‐OLOF , RYDÉN LARS
Published: August 2010

ABSTRACT. Aiming at a better control of hypertension, a medical care program including nurse‐run outpatient hypertension clinics was implemented in one half of the County of Skaraborg (265 000 inhabitants), the other half forming a control area. The program was evaluated during a 5‐year trial. Among patients registered and followed up for a minimum of one year (n = 2806), systolic and diastolic blood pressure decreased significantly, regardless of the patients' status of treatment prior to admission to the clinics. A baseline and a terminal population study revealed an increasing effectiveness in the treatment of hypertension in the study area. A consistent difference (mean 8/5 mmHg) was found in average blood pressure between patients treated at the hypertension clinics and patients treated in regular care. It is concluded that the medical care program increased the effectiveness of care and that this was due to the program organization.
Streptokinase Therapy in the Routine Management of Deep Venous Thrombosis in the Lower Extremities
Authors: OTT PETER , ELDRUP EBBE , OXHOLM PETER , VESTERGÅRD AAGE , KNUDSEN JENS BJERRE
Published: August 2010

ABSTRACT. One hundred and eight patients with phlebographically verified deep venous thrombosis were treated with streptokinase. Total or partial thrombolysis was phlebographically demonstrated in 60 patients (55.6%). Three patients died during treatment, all from pulmonary embolism. Six patients developed clinical signs suggestive of pulmonary embolism. In 16 patients (14.8%), major bleeding complicated the treatment. One patient had anaphylactic shock, while various allergic reactions were recorded in 22. Streptokinase therapy in the routine management of deep venous thrombosis carries an acceptable efficacy and safety similar to what has been achieved under research conditions.
Monocyte Chemotactic Properties in Hereditary Hemochromatosis
Authors: BJÖRN‐RASMUSSEN E. , NIELSEN H. , HAGEMAN J. , VAN DEN DUNGEN P.
Published: August 2010

ABSTRACT. Several observations indicate that the innate metabolic defect in hereditary hemochromatosis (HH) leads to a defective function of the monocyte‐macrophage system. The present study was performed to investigate the possibility that a defect in migration of cells of the monocyte‐macrophage system can explain the abnormal location of the submucosal macrophages in HH. Monocytes isolated from 14 patients with HH were investigated with regard to chemotactic responsiveness (MCR). Two different methods were used at two different laboratories. Casein and zymosan‐activated serum were used as attractants. No difference in MCR was found between the control group and the group of HH patients. The conclusion can therefore be drawn that the abnormal location of the macrophages of the gut wall in HH cannot be explained by an inborn abnormality of the function of receptors responsible for the chemotactic activity of the monocyte‐macrophage system. It is, however, still possible that local factors responsible for the macrophage migration (gut hormones?) may have defective activity in HH patients.
Wilson's Disease in Two Siblings—One with Fatal Outcome
Authors: SAGEN ERLING , LANGE OVE , WESTGAARD GUNNAR , BLAND JONATHAN , ROMSLO INGE
Published: August 2010

ABSTRACT. The clinical and biochemical findings in two siblings with Wilson's disease are described. One of them, an 11‐year‐old girl, developed acute liver failure terminating in death within a few weeks. Prior to her terminal illness she had been in good health without symptoms suggestive of Wilson's disease. Copper contents of urine, liver, kidney and brain were 20–100 times above the upper normal limits. The liver showed extensive micronodular cirrhosis with nonbile pigment deposits. Her 15‐year‐old brother had abnormal liver function tests with urinary copper excretion 20 times above the upper normal limit. Treatment with penicillamine was started. Following a short period of deterioration his condition has steadily improved.
Effects of Postprandial Plasma and Chylomicrons on Endothelial Cells
Authors: AVIRAM MICHAEL , BROX JAN , NORDØY ARNE
Published: August 2010

ABSTRACT. The acute effects of fatty meals (900 kcal) rich in saturated (cream) or n‐3 polyunsaturated (cod liver oil, CLO) fatty acids on human umbilical vein endothelial cells (ECM) and platelet behavior were studied. The ECM were incubated for 24 hours at 37°C with either plasma or chylomicrons (CM) obtained 3 hours after the meals. The ability of the ECM to inhibit platelet aggregation (PIA) and the release of prostaglandin I2 measured as 6‐ketoprostaglandin F1α (6‐keto‐PGF1α) were measured after 24 hours of incubation, after stimulation and after freezing and thawing. Similar studies were done with CM from a patient with type V hyperlipoproteinemia. The release of 6‐keto‐PGF1α was increased by postprandial plasma and by CM obtained after both meals. Plasma collected after CLO, but not after cream, increased PIA, whereas CM derived from all sources studied stimulated the PIA of ECM. No consistent correlation could be established between the release of 6‐keto‐PGF1α and PIA. Increased platelet aggregation in platelet‐rich plasma was always observed during postprandial hyperlipidemia.
Abnormal Vasopressin and Aldosterone Response to Furosemide in Essential Hypertension
Authors: PEDERSEN E. B. , DANIELSEN H. , MADSEN M. , SØRENSEN S. S. , THOMSEN O. Ø.
Published: August 2010

ABSTRACT. Plasma concentrations of arginine vasopressin (AVP), angiotensin II (AII), aldosterone (Aldo), urinary output (V), osmolar clearance (Cosm), free water clearance (CH2O), fractional excretions of sodium (FENa) and potassium (FEK), urinary sodium excretion rate (U‐Na) and serum potassium (S‐K) were determined in 9 patients with essential hypertension (group I) and 13 normotensive healthy control subjects (group II) before and three times during the first 4 hours after an intravenous injection of 40 mg of furosemide. AVP, AII, Aldo, V, Cosm, FENa, FEK and U‐Na increased in both groups. However, the elevation in AVP was significantly more pronounced and the rate of increase in Aldo was significantly slower in group I than in group II. There were no significant differences in AII, V, Cosm, CH2O. FENa, FEK and U‐Na between the groups. S‐K was significantly reduced only in group I. AVP and AII were not significantly correlated to each other or to blood pressure. It is suggested that the responsiveness of the renal tubules to AVP is reduced in essential hypertension and that the larger increase in AVP might be a compensatory phenomenon. The slower increase in Aldo in essential hypertension could be attributed to the reduction in S‐K.
Deficiency of Hepatic Lipase Activity in Post‐heparin Plasma in Familial Hyper‐α‐Triglyceridemia
Authors: CARLSON LARS A. , HOLMQUIST LEIF , NILSSON‐EHLE PETER
Published: August 2010

ABSTRACT. Hyper‐α‐triglyceridemia is a rare dyslipoproteinemia characterized by a pronounced increase in the concentration of triglycerides in the plasma high density lipoprotein (HDL) fraction. One case with this condition, an apparently healthy 61‐year‐old man, has been studied. Additional lipoprotein abnormalities were present, such as abnormally cholesterol‐rich very low density lipoproteins (VLDL) with retarded electrophoretic mobility (β‐VLDL) and triglyceride enrichment of low density lipoproteins‐(LDL). The patient's plasma concentration of apolipoproteins A‐I, A‐II and B were normal and those of C‐I, C‐II, C‐III and E were elevated. No abnormal forms of the soluble apolipoproteins of VLDL and high density lipoproteins (HDL) were found after analysis by isoelectric focusing. Lecithin: cholesterol acyltransferase activities, plasma cholesterol esterification rates and lipid transfer protein activities were normal. Post‐heparin plasma activity of hepatic lipase was virtually absent and that of lipoprotein lipase was reduced by 50%. In plasma of this patient, HDL was almost exclusively present as large triglyceride‐rich particles corresponding in size to particles of the HDL2 density fraction. The only brother of the patient also had hyper‐α‐triglyceridemia together with the other lipoprotein abnormalities described for the index case and deficiency of postheparin plasma activity of hepatic lipase. The findings presented below support the hypothesis that one primary function of hepatic lipase is associated with degradation of plasma HDL2. Deficiency of this enzyme activity thus causes accumulation of HDL2 in plasma leading to hyper‐α‐triglyceridemia. The results further suggest that the abnormal chemical and electrophoretic properties of VLDL and LDL in plasma from the patient, reminiscent of type III hyperlipoproteinemia, are secondary to the lack of the action of hepatic lipase on the HDL particles.
Physiological Adaptation to Physical Conditioning
Authors: SALTIN BENGT
Published: August 2010

ABSTRACT. Three classical problems in the field of man's adaptive response to exercise are reviewed. A case is made for the pump capacity of the heart limiting maximal oxygen uptake in man. This conclusion is based on findings that the capacity of skeletal muscle of man markedly surpasses that of the heart supplying it with a flow and thereby oxygen. It is suggested that only one third of the muscle mass of man can fully tax the capacity of the heart and consume the oxygen delivered by the heart. If a larger muscle mass is intensely engaged in the exercise, vasoconstriction must occur in the arterioles of the exercising limbs to avoid a reduction in blood pressure Evidence is presented that a decrease in heart rate at submaximal exercise‐observed after a period of physical conditioning, is caused by an altered autonomic chronotropic activity to heart, which most likely is due to a less potent feed back reflex from exercising muscles. The enlarged stroke volume is secondary to a larger diastolic filling, which via a Frank‐Starling mechanism results in an elevation in the stroke volume. Last, it is argued that the altered metabolic response to exercise after physical conditioning, i.e. the larger lipid oxidation and reduced lactate production, results from local regulatory mechanisms rather than from changes in supply of oxygen, substrates, or hormones. Further, the muscle metabolic response to exercise is thought to play a major role in modulating systemic cardiovascular regulation in exercise.
Hemodynamic Adaptations to Stress with Advancing Age
Authors: LAKATTA EDWARD G.
Published: August 2010

ABSTRACT. With advancing adult aging an increase in vascular stiffness, an increase in systolic, pulse and mean arterial pressure, modest left ventricular hypertrophy, and a moderate decline in early diastolic filling rate have uniformly been observed. In some individuals these changes are not associated with enhanced systemic resistance if arterial pressure remains within the normotensive range. End‐systolic volume, stroke volume, ejection fraction, velocity of ejection, and cardiac output are preserved in these elderly subjects. In other individuals both aortic impedance and peripheral vascular resistance are increased with age and modest declines in resting stroke volume and cardiac output have been observed. During maximal exercise a diminished heart rate and a diminished reduction of end‐systolic volume occur in elderly subjects. In some, an enhanced end‐diastolic volume prevents a reduction in or enhances stroke volume (Starling mechanism); this adaptation bears a striking resemblance to that observed during exercise when the beta‐adrenergic system is pharmacologically inhibited. In other elderly subjects, stroke volume during exercise does not increase to the extent that it does in younger subjects. Even in these subjects in whom peak cardiac output during exercise declines, however, it is not entirely clear that the central circulation limits peak oxygen consumption (VO2). The non‐uniformity of results of studies that have investigated the effect of aging on cardiac function and vascular resistance suggests that variables that impact on cardiovascular function other than aging per se, i.e. life style variables, e.g. nutrition, smoking, physical conditioning status, or the prevalence of occult coronary disease, differed among the various subjects studied.
Population Strategies to Enhance Physical Activity: The Minnesota Heart Health Program
Authors: CROW RICHARD , BLACKBURN HENRY , JACOBS DAVID , HANNAN PETER , PIRIE PHYLLIS , MITTELMARK MAURICE , MURRAY DAVID , LUEPKER RUSSELL
Published: August 2010

ABSTRACT. A population‐wide, community‐based program in cardiovascular disease prevention, the Minnesota Heart Health Program (MHHP), has been designed to promote more frequent and vigorous physical activity in North American communities, along with improved eating and smoking patterns. The physical activity component of this broad‐based education strategy is based on the facilitation which physical activity provides to lowering of other risk characteristics for heart disease and its enhancement of other healthy behaviors and on the potential for prevention of elevated risk in the first place. The rationale for a population strategy to complement medical approaches to prevention is that exercise patterns are largely socially learned and culturally determined. The MHHP Physical Activity Program is implemented through three major education strategies: direct education, community organization, and mass communications. Early results from this 10year project indicate that it is feasible to enter U. S. communities and to involve their leadership actively in MHHP activities of health promotion. Moreover, attitudes, knowledge, awareness, participation, and behaviors related to exercise and eating patterns appear to be changed by the program. Nevertheless, there are problems in the design, implementation, analysis and interpretation of population changes in physical activity and other health behaviors in community demonstration programs. These issues, along with their solutions, should provide useful information for medical science and for the public health about population strategies of disease prevention and health promotion.
Influence of Muscle Power on Aerobic Performance and the Effects of Training
Authors: JONES NORMAN L. , McCARTNEY NEIL
Published: August 2010

ABSTRACT. This paper reviews briefly the authors' experience with a short (30 s) maximal isokinetic cycling test in which peak and average power, the decline in power during the test (fatigue index, FI), and the total work accomplished are measured by a computer assisted technique. In an untrained population, the power variables and total work were linearly related to height and lean thigh volume and decline with age; the FI was less in subjects who took part in regular leisure activity. A close linear relationship was found between the total work in 30 s and maximal oxygen intake (VO2 max). The method was applied to studies of the effects of endurance exercise in sedentary young and old men and in patients with coronary artery disease. In the young and old men training increased VO2 max by 28% and 38% respectively, with no change in isokinetic power measurements in the young, but increases of 12% in total work in 30 s in the old. In cardiac patients, reductions in initial VO2 max were greater than in the isokinetic test variables. Control subjects showed reductions in maximal 30 s performance after the study period (12 wk) with no change in VO2 max. Exercised subjects increased VO2 max by 18.5% with variable changes in 30 s performance. There is a close link between maximal short‐term muscle capacity and VO2 max in healthy subjects. VO2 max may be increased by training, but this may or may not be accompanied by increases in maximal short‐term capacity, presumably depending on the mechanisms that are limiting in any given case.
Preventive Use of Exercise Rehabilitation after Myocardial Infarction
Authors: OLDRIDGE N. B. , JONES N. L.
Published: August 2010

ABSTRACT.Randomized controlled clinical trials of exercise after myocardial infarction, although difficult to compare, have not shown a reduction in mortality or morbidity. However, physiological and psychological improvements occur that enable patients to improve their quality of life. The effectiveness of exercise programmes is impaired by poor patient compliance. Some characteristics of poor compilers may be identified, but it is safer to assume all participants are potential non‐compliers, and to apply compliance‐improving strategies within exercise programmes. The authors' experience has indicated that a number of strategies may be followed at little cost. These include a spouse support programme, a written agreement to participate, self‐control techniques including self‐monitored exercise testing, and group discussion periods.
Physical Activity and Prostanoids
Authors: RAURAMAA RAINER
Published: August 2010

ABSTRACT. Physical activity plays an important role in the prevention of ischaemic heart disease. However, data on the mediating mechanisms are only partly established, and concentrated mainly on plasma lipoproteins. Prostanoids, especially prostacyclin and thromboxane, through their effects on vascular endothelium, platelet function, and interaction with lipoproteins, are postulated to be centrally involved in the pathogenesis of atherosclerosis. The reported acute effects of physical activity on prostanoids and platelet function are contradictory and may be considered both beneficial and unfavourable. On the other hand, although even less is reported on the response to regular exercise, data appear more favourable in relation to atherosclerosis. Currently, data on physical activity and prostanoids, including both acute and chronic effects, are limited and necessitate additional, systematic studies on dose‐response relationships.
Experimental Studies on the Influences of Physical Activity on Ligaments, Tendons and Joints: A Brief Review
Authors: TIPTON CHARLES M. , VAILAS ARTHUR C. , MATTHES RONALD D.
Published: August 2010

ABSTRACT. The clinical practices of the future depend upon the experimental findings of today. Because of the uniqueness of connective tissue, animal experimentation will be essential for advances in this field. During the last decade, the improvements in technology and the increased interest of basic scientists and research clinicans on the effects of physical activity has markedly enhanced the amount of information available to practicing physicians. Studies spanning the appearances of structure to the changes in the crosslinks of collagen, clearly demonstrate that limb immobilization (inactivity) is deleterious to all structures involved whether evaluated anatomically, physiologically, or biomechanically. Furthermore, when surgical repair is included, there are stages when the deleterious processes become accelerated with or without immobilization. Hence, clinical immobilization must be utilized in a prudent and careful manner. There is sufficent experimental evidence for clinicians to utilize motion and mechanical stimuli as a means to improve the structure and function of tendons, ligaments, and joints. However, the unresolved issues are the mode, time of initiation, or the intensity of application. Even when used with repair, recovery of normal structures and function is protracted. The primary or secondary mechanisms associated with these effects of physical activity are unknown and virtually uninvestigated at the present time.
ANTIHYPERTENSIVE AND HORMONAL EFFECTS OF LISINOPRIL, A NEW ANGIOTENSIN CONVERTING ENZYME (ACE) INHIBITOR IN PATIENTS WITH RENOVASCULAR HYPERTENSION.
Authors: Karlberg Bengt E , Rosenqvist Ulf
Published: August 2010

ABSTRACT. The antihypertensive and hormonal effects of a new ACE‐inhibitor, lisinopril (MK‐521), was studied in 11 patients with renal arterial stenosis (bilateral in 1). Oral doses exceeding 5 mg a day significantly reduced blood pressure (BP), the maximum fall occurring 6 h after taking the drug. At higher doses (20–80 mg/day) sustained antihypertensive effects persisted for 24 h. Lisinopril was equally effective in lowering supine and standing BP. When the drug was given stepwisely in increasing doses, (5, 10, 20, 40, and in 5 cases 80 mg/day) the BP was successivly normalized in 10 of 11 patients (supine BP < 90 mmHg). 3 patients with low renin hypertension (LRH) responded less well to monotherapy on long‐term treatment with lisinopril than the others. A significant increase in heart rate was observed, initially and after 1 month of treatment.

After 5 days treatment with increasing doses the plasma concentrations of angiotensin II (All) and aldosterone (Aldo) fell significantly to very low concentrations. However, on long term treatment (3 months) suppression of All and Aldo did not always take place. A concomitant decrease in 24 h urinary aldosterone excretion occurred.

No changes in renal function or other biochemical tests except for a slight increase in S‐K were observed. There were no adverse side‐effects. We conclude that lisinopril is an effective and safe medication for renovascular hypertension.
Competitive Inhibitor Binding Assay (CIBA) of ACE Inhibitors
Authors: GRÖNHAGEN‐RISKA C. , TIKKANEN I. , FYHRQUIST F.
Published: August 2010

ABSTRACT. We describe a new principle for measuring concentrations of pharmacologically active captopril or other angiotensin‐converting enzyme (ACE) inhibitors in blood. Serum is incubated with 125‐I‐labeled ACE inhibitor (substance 351A, a lisinopril analogue, Merck Sharp & Dohme) in a nonequilibrated system, in which label and ACE inhibitor compete for binding to added serum ACE. Free label is separated by adsorption to coated charcoal. Concentration of captopril or other ACE inhibitor is calculated from a standard curve.

Results in healthy volunteers showed rapid absorption of captopril with maximal concentration of active drug within 1 h, and fast disappearance within 2.5 h. Stability of captopril was improved by immediate 1:100 dilution of blood samples with assay buffer. In spite of this precaution, analysis should be performed within two days to avoid loss of active drug due to polymerization and protein binding. Samples of other tested ACE inhibitors can be frozen and later analyzed at convenience. The new principle is simple, sensitive, and specific.
EFFECT OF EXERCISE TRAINING IN PATIENTS WITH ESSENTIAL HYPERTENSION
Authors: WESTHEIM ARNE , SIMONSEN KJERSTI , SCHAMAUN OLE , QVIGSTAD ELLEN K. , STAFF PEER , TEISBERG PER
Published: August 2010

ABSTRACT. After 12 weeks of regular exercise training in 34 patients with moderate essential hypertension, supine systolic blood pressure at rest decrease from 152+2 (means+SEM) to 149+2 mmHg (p<0.05), and diastolic blood pressure from 106+1 to 102+1 mmHg (p<0.001). At corresponding submaximal exercise levels, diastolic blood pressure also decreased significantly from 110+2 to 98+3 mmHg (p<0.001), but no significant reduction in systolic blood pressure was observed. Heart rate at the same submaximal work load was significantly reduced (p<0.0). This data shows that exercise training might have blood pressure lowering effect in patients with moderate essential hypertension, and might in some patients be an alternative to pharma‐cological treatment.
ADRENERGIC MECHANISMS IN CONGESTIVE HEART FAILURE
Authors: Anderson K.‐E.
Published: August 2010

AbstractThe normal control of cardiovascular function exerted by the sympathetic nervous system is disturbed in congestive heart failure. The failing pump function of the heart evokes an increase in sympathetic activity which may be reflected in increased levels of plasma noradrenaline. However, these levels are generally below the concentrations needed to activate the adrenergic effector systems, indicating that the cardiovascular consequences of the intreased sympathetic activity is not mediated by circulating noradrenaline In the failing human heart there is a decrease in β‐adrenoceptor density which is related to decreasing ventricular function. This finding suggests that the myocardium is exposed to high concentrations of noradrenaline, inducing downregulation of the receptor number, despite the fact that in the failing heart the noradrenaline stores are reduced. In heart failure the plasma noradrenaline concentration was found to be directly related to mortality and was suggested to provide a better guide to prognosis than other commonly measured indexes of cardiac performance.
ANTIDIURETIC HORMONE AND ATRIAL NATRIURETIC PEPTIDE IN CONGESTIVE HEART FAILURE
Authors: Fyhrquist F. , Tikkanen I.
Published: August 2010

Abstract Plasma concentrations of antidiuretic hormone (ADH) were measured in 8 patients with congestive heart failure (CHF) of NYHA functional class III–IV, before and during treatment with captopril, 6.25–25.0 mg t.i.d., added to their drug regimen. Before captopril treatment, plasma ADH was high, 2.5 times the upper limit of normal reference values. During treatment with captopril, plasma ADH levels were normalized, and remained so throughout the study, for at least 6 months. Plasma levels of angiotensin II were also reduced to a normal level. Reduction of plasma ADH during captopril treatment in CHF may partly depend on reduced angiotensin II formation, and may be beneficial by improving water balance.

Atrial natriuretic peptide (ANP), was measured by radioimmunoassay in 17 patients with CHF. The highest levels were measured in the most severe CHF cases, and intermediate high values on NYHA functional class I–II patients. Plasma ANP concentrations in control patients (n=18) without cardiac diseases ranged between 0 and 30 pg/ml. In two patients with paroxysmal supraventricular tachycardia, associated with transient polyuria, high plasma ANP concentrations were noticed during tachycardic episodes. Thus, ANP appears to be a circulating hormone in humans, and is released into the blood in clinical conditions associated with raised preload and atrial wall stretch.