bluuebunny/crossref_metadata_2025 huggingface dataset:
Unique Antigenic Determinants (Idiotypes) Used as Markers in a Patient with Macroglobulinemia and Urticaria
Authors: Olsen E. , Førre Ø. , Lea T. , Langeland T.
Published: August 2010

ABSTRACT. An antiserum was raised against a monoclonal IgMκ macroglobulin isolated from serum of a patient with recurrent urticaria. The antiserum was made idiotype‐specific through adequate absorptions. The anti‐idiotype antiserum reacted only with the immunizing protein and its Fab fragments and not with other monoclonal proteins of IgM and IgA class or pooled IgG as assayed in an enzyme‐linked immunosorbent assay. IgM antibodies with the same idiotype as the monoclonal IgM protein were detected in the dermal/epidermal junction area of diseased skin. The similar idiotypic determinants could also be demonstrated on membrane‐bound molecules of peripheral blood B and T lymphocytes using the immunofluorescence methods.
Influence of Coronary Bypass Surgery on Oesophageal Function and Symptomatology
Authors: Areskog Magnus , Tibbling Lita , Wranne Bengt
Published: August 2010

ABSTRACT. The incidence of oesophageal dysfunction (OD) is higher in patients with coronary heart disease (CHD) than in a population sample. The hypothesis was raised that this finding is the result of a cardio‐oesophageal reflex in which afferent pain impulses from the heart trigger dysfunction in the oesophagus. Twenty‐three patients with CHD were examined before and 14±5 (S.D.) months after coronary bypass surgery. Total relief of angina pectoris was attained in 6 patients and improvement in 16. One patient deteriorated. The incidence of OD was 52% before operation and 65% at the follow‐up investigation (no significant difference). Symptoms related to the oesophagus, other than chest pain, were as frequent before as after operation. The findings do not support the contention that OD in patients with CHD is caused by a cardio‐oesophageal reflex.
A Modified 125I‐Fibrinogen Technique in Suspected Deep Vein Thrombosis
Authors: Olsson Carl‐Gustav , Albrechtsson Ulf
Published: August 2010

ABSTRACT. The diagnostic efficiencies of a modified 125I‐fibrinogen uptake test (FUT), venous strain gauge plethysmography, and the routine report on phlebography were compared in 301 consecutive patients with suspected deep vein thrombosis (DVT) in the leg. A keen, independent review of the phlebography films was used as the reference method. The FUT detected 62% of all thrombi after one hour, 71% after one day, and 98% after two days. False positive results were, however, found after two days in 52% of all patients without DVT. Plethysmography revealed 63% of the thrombi and was falsely positive in 23% of patients without DVT. The routine examination of phlebography films revealed only 86% of the thrombi seen at the final independent review. The routine report was falsely positive in 6% of patients without thrombi. Consequently, the modified FUT is a useful screening test; at one hour it was equally sensitive to DVT as plethysmography and after two days it excluded DVT with a significantly better sensitivity than the routine report on phlebography. Drawbacks of FUT are the delay of the diagnosis in some patients and the low specificity. In patients with a pathological FUT, further investigation is often required. Plethysmography is not recommended as a screening test, since it lacks both sensitivity and specificity.
Knowledge of Diabetes Mellitus, Diets and Nutrition in Diabetic Patients
Authors: Karlander Sven‐Gunnar , Ålinder Inger , Hellström Kjell
Published: August 2010

ABSTRACT. A multiple choice questionnaire was used to test the level of knowledge about diabetes mellitus and diet‐nutrition in diabetic patients (n=317), non‐diabetic patients (n=70), nursing personnel (n=53) and third‐year medical students (n=43). The results concerning diabetes were better than those for diet‐nutrition. A score of ≥ 80% in diet‐nutrition was considered necessary for proper management of the diet at home. This level was reached by 84% of the students, 26% of the nursing personnel, 29% of the insulin‐treated diabetics (n=178), 9% of the tablet‐treated diabetics (n=124) and 4% of the non‐diabetic patients. It was concluded that the piecemeal instruction system used to teach the diabetic patients is inefficient and should be replaced by a formal educational program integrated into the patient care system. The level of knowledge among nursing personnel needs to be improved.
Severe Angina Pectoris and β‐Blocker‐Induced Bradycardia Treated with an Artificial Pacemaker
Authors: Otterstad Jan Erik , Strøm Odd
Published: August 2010

ABSTRACT. A 54‐year‐old man, who was treated with propranolol for severe angina pectoris, developed severe symptomatic bradycardia during this treatment. Coronary angiography revealed severe coronary artery stenosis, but a bypass operation was judged to be technically impossible. When propranolol was withdrawn, the effort angina deteriorated and anginal pains even developed at rest. A favourable symptomatic effect was obtained with a combined regimen of propranolol and a permanent demand pacemaker. Nitroglycerin consumption was reduced from about 20 to less than 3 tablets a day. His condition remained stable during the observation period of 44 months. The symptomatic effect of a β‐blocking agent combined with a permanent pacemaker is considered to be due to the reduced inotropic and chronotropic effect of propranolol during exercise as well as the elimination of a bradycardia‐induced angina at rest. Placebo effect to a certain extent cannot be excluded.
Platelet Taurine in Patients with Arterial Hypertension, Myocardial Failure or Infarction
Authors: Paasonen M. K. , Penttilä O. , Himberg J. J. , Solatunturi E.
Published: August 2010

ABSTRACT. The content of taurine in the hypertrophied left ventricle is increased in congestive heart failure and in spontaneously hypertensive (SH) rats. In SH rats the taurine content of and taurine uptake by the platelets are also increased. The present results indicate that, as in the heart, the taurine content may also increase in the platelets of those patients with congestive heart failure. The taurine content and uptake are not increased in the platelets of hypertensive patients as they are in the platelets of SH rats. It is likely that in acute myocardial infarction, a considerable amount of taurine is released from the heart into the plasma. However, there is no simultaneous increase in the platelet taurine content.

From this work one can only conclude that platelets may reflect taurine changes in the heart in some pathological states, e.g. congestive heart failure.
Platelets, Intravascular Coagulation and Fibrinolysis in Hyperlipidaemias: Relationship to Thrombo‐Embolic Complications
Authors: Carvalho Angelina C. A. , Lees Robert S.
Published: August 2010

ABSTRACT. Platelet function, intra‐vascular coagulation (IVC) and fibrinolysis were studied in 85 patients with Type II hyperlipo‐proteinaemia, 36 with Type IV hypertriglyce‐ridaemia and 36 normal subjects. The effects of clofibrate and nicotinic acid therapy on their plasma lipid concentrations, platelet behaviour, IVC and fibrinolysis were also evaluated. Untreated Type II patients had platelet hyperreactivity to aggregating agents and increased nucleotide release. Their platelet phospholipid content was quantitatively and qualitatively altered. The mechanism of platelet hyperreactivity appears to be related to their ability to convert AA to cyclic endoperoxides and thromboxanes. Although both groups of common hyperlipidaemias had accelerated activation of the blood coagulation systems, the Type II patients had worse blood alterations than the Type IV patients did. Furthermore, our data also suggests that in hypercholesterolaemia platelets appear to mediate these blood changes. Clofibrate treatment in Type II patients improved the platelet reactivity, reversed IVC and stimulated fibrinolysis without altering their plasma lipid levels. In contrast, in Type IV patients, clofibrate therapy significantly lowered plasma triglycerides but did not alter the blood coagulation changes nor did it stimulate fibrinolysis. Thrombo‐embolic complications were common in both groups of hyperlipida etnias but more so in Type II patients. A correlation therefore appears to exist between laboratory evidence of platelet reactivity and IVC and increased incidence of thromboembolic complications.

Taken together, these observations suggest that anti‐platelet drugs may be useful in the prevention of thrombo‐embolic complications in Type II patients. In contrast, in hypertriglyceridaemia, impairment of the fibrinolytic system is the likely mechanism by which these thrombotic events occur. Unfortunately, simple preventive treatments to stimulate fibrinolysis are not yet available.
ARTERIAL BLOOD PRESSURE AND ELECTRODERMAL ACTIVITY IN HYPERTENSIVE AND NORMOTENSIVE SUBJECTS DURING INNER‐ AND OUTER‐DIRECTED ATTENTION
Authors: Fredrikson Mats , Dimberg Ulf , Frisk‐Holmberg Marianne
Published: August 2010

Arterial blood pressure (BP), skin conductance level (SCL) and spontaneous fluctuations in skin conductance (SFs) were monitored in 14 subjects with essential hypertension (HT), and 14 matched normotensive (NT) controls during a letter identification task (L) and mental arithmetic (MA). During both tasks, the groups displayed different reponse patterns such that SFs and BP tended to be negatively correlated in the HT group but were positively correlated in the NT group. No correlation between BT and SCL was obtained in any group during either task. SFs and SCL were positively correlated in the NT group during both tasks whereas no correlation was found in the HT group. The results are consistent with the hypothesis that an increased BP is associated with the rejection of the environment.
The Heart Cell: Some Metabolic Aspects of Cardiac Arrhythmias
Authors: Nayler Winifred G.
Published: August 2010

The maintenance of normal electrical activity in the myocardium is an ATP‐dependent process. Consequently failure to maintain the tissue reserves of ATP above a critical level, as occurs during ischaemia and post ischaemic reperfusion, results in the development of ionic imbalance. The ions involved include Na+, K+, Mg2+. Under conditions of low flow ischaemia an accumulation of K+ in the T‐tubules may account for the genesis of some of the arrhythmias that occur during the ischaemic episode. Electrical uncoupling, another late event in an ischaemic episode, is probably due to an intracellular accumulation of Ca+.

The contribution of an altered pattern of electrolyte distribution to the genesis of arrhythmias during myocardial ischaemia is discussed, with reference to the mechanisms whereby these ionic imbalances can be minimized or prevented.
The Effect of Diuretics on Lymphocyte Magnesium and Potassium
Authors: Ryan Michael P. , Ryan Michael F. , Counihan Timothy B.
Published: August 2010

Lymphocytes have advantages over other tissues, such as erythrocytes and muscle, for assessing intracellular magnesium and potassium. During experimental magnesium deficiency in rats, the magnitude of the magnesium loss from lymphocytes was similar to that of cardiac and skeletal muscle. During experimental potassium deficiency, cardiac muscle retained potassium more effectively than skeletal muscle. The magnitude of the potassium loss from lymphocytes was of similar magnitude to that of cardiac muscle.

Chronic congestive heart failure patients being treated with the loop‐blocking diuretic, furosemide, were found to have significantly reduced lymphocyte magnesium (p < 0.05) and potassium (p < 0.01) compared to values obtained in 20 control subjects. The effects of acute administration of the potassium‐sparing diuretic, amiloride, were investigated in 10 congestive heart failure patients. Each patient was studied over a 6‐day period comprising a 3‐day control period involving furosemide administration, followed immediately by a 3‐day test period when amiloride (10 mg twice daily) was added to the therapeutic regimen. Amiloride reduced urinary potassium and magnesium, and increased both plasma and lymphocyte potassium and magnesium. Under these conditions, amiloride exerted magnesium‐sparing actions in addition to its well‐established potassium‐sparing actions. The magnesium‐sparing actions may be beneficial in that many experimental studies have shown that magnesium is required for maintenance and restoration of cell potassium.
THE ‘BORDER ZONE’ AND MYOCARDIAL PROTECTION: a time for reassessment?
Authors: Hearse D.J. , Yellon D. M.
Published: August 2010

The rather static concept of a potentially salvageable ‘border zone’ of intermediate injury surrounding an area of regional ischemia would no longer seem tenable. This model, which has formed the basis for many approaches to therapeutic infarct size reduction, fails to take adequate account of a number of important factors including the dynamic nature of the ischemic process, the anatomy of the coronary microcirculation and the practical realities of tissue salvage. There is considerable evidence, from a number of species, that spatially identifiable border zones of intermediate injury do not exist, at least in the lateral plane. The apparent absence of a zone of target tissue does not necessitate the abandonment of concepts of myocardial protection but may require a major reappraisal.
METHODOLOGICAL ASPECTS IN THE DESIGN OF SECONDARY PREVENTION TRIALS
Authors: Wilhelmsson Claes , Vedin Anders , Wedel Hans
Published: August 2010

The aim of a secondary preventive trial is to produce results that may serve as a basis for therapeutic recommendations to other patients.

The natural history of a disease studied including the mortality and reinfarction rate must be known and taken into consideration. The patients should be recruited without selection. By comparing the placebo mortality with expected levels the representativeness of patients can be assessed.

One type of treatment can be expected to give different results in different groups of patients with the same disease, thus, prognostic prospective stratification may increase the value of comparisons and conclusions. The registration of end‐points should preferably be done by a separate independent organisation. Carefully classified specific mortality may be used as a major end‐point in addition to total mortality. Similarly, different modes of deaths, e.g. sudden death, may be used if reliable definitions are used.

Confounding factors are often difficult to isolate and identify and may have profound effects on the interpretation of a study. In all studies it is mandatory that the patient characteristics on entry do not differ between the different treatment groups. Concomitant treatment should be administered according to standardized criteria. The drop‐out rate should be kept at a minimum. The possibility of generalization decreases with increasing drop‐out rate.

If the follow‐up time becomes too long it is likely that at some time the relative benefit becomes less. Since the proportion of non‐cardiovascular deaths increases with follow‐up time and age it may be critical to decide on the relevant follow‐up time.
Community Screening for Glucose Intolerance in Middle‐Aged Icelandic Men
Authors: Sigurdsson Gunnar , Gottskàlksson Gizur , Thorsteinsson Thorsteinn , Davidsson David , Olafsson Olafur , Samuelsson Sigurdur , Sigfusson Nikulas
Published: August 2010

ABSTRACT. A number of 2203 middle‐aged Icelandic men (aged 34–61 years) participated in a health survey in Reykjavik in 1967‐68. Blood glucose in the fasting state and during an oral glucose tolerance test (OGTT) showed a unimodal distribution with a slight skewness towards higher values. A positive age gradient was established, which showed an increment of about 7 mg/dl per decade in capillary blood sugar values at 1 ½ hours after a 50 g oral glucose load. The age gradient was mostly independent of age‐related changes in body weight. A 7 ½‐year follow‐up of the eligible participants (response rate >80%) showed an overall 1% incidence of metabolic deterioration to “overt diabetes” during this period. Those with positive screening tests (50 g OGTT) at baseline were at greater risk of developing diabetes, but the incidence of deterioration in this group was low, about 1% per year. The progression to diabetes was significantly related to body weight at baseline, suggesting that weight reduction might be beneficial in individuals showing impaired glucose tolerance at medical examination. This study, however, lends support to recent reports showing that mildly impaired glucose tolerance cannot be equated with early diabetes.
Studies on Kidney Function in Subjects Exposed to Organic Solvents
Authors: Askergren Alf
Published: August 2010

ABSTRACT. The excretion of erythrocytes and leucocytes in the urine from 101 men professionally exposed to styrene or toluene or to a combination of xylene and toluene was compared with the cell excretion in the urine from 39 non‐exposed controls. The men exposed to organic solvents excreted significantly more cells than the controls. The findings are in agreement with the present discussion regarding the role of organic solvents in glomerular disease.
Convulsions and Possible Spasm of the Lower Oesophageal Sphincter in a Fatal Case of Propranolol Intoxication
Authors: Laake Knut , Kittang Eirik , Refstad Sverre O. , Holm Hans A.
Published: August 2010

ABSTRACT. A fatal case of propranolol intoxication is described. The patient had ingested 3–5 g of the drug and probably no other drugs. Gastric lavage could not be performed due to some kind of obstruction in the distal part of the oesophagus. At autopsy, the oesophagus was normal, and a spasm due to β‐blockade is suggested. Epileptiform seizures resistant to treatment with diazepam and barbiturates were frequent and probably not solely caused by cerebral ischaemia.
Plasma Cortisol Concentrations after Oral Substitution of Cortisone in the Fasting and Non‐Fasting State
Authors: Aanderud Sylvi , Myking Ole Langeland
Published: August 2010

ABSTRACT. Nine corticosteroid‐substituted patients received oral cortisone acetate in the fasting state and together with a breakfast meal. Plasma cortisol concentrations were determined before, after 30 min, and at 1‐hour intervals until 6 hours after drug ingestion. There were great interindividual variations in the time to peak values (tmax), the peak concentrations (Cmax), and the areas under the time‐concentration curves (AUC0–6 h). The AUC and Cmax values were significantly increased when cortisone tablets were ingested with food compared to the values obtained in the fasting state (p <0.01 and p <0.05 respectively), whereas tmax values were not significantly different. The differences were minor and probably without clinical implications.
Circadian Plasma Citrate Rhythms in Juvenile Diabetics
Authors: Thomassen A. , Nielsen T. Toftegaard , Bagger J. P. , Charles P. , Løvgreen N. A. , Sørensen N. Schwartz
Published: August 2010

ABSTRACT. Postabsorptive plasma concentrations of citrate, glucose, lactate, free fatty acids (FFA), ketone bodies and free insulin were measured once weekly for 5 weeks in 18 male juvenile diabetics. The circadian rhythms of the same substances were followed in 12 male diabetics. In 8 of them, daily rhythms were measured twice, before and after plasma glucose was lowered by increasing insulin doses. In the postabsorptive state, the mean plasma citrate concentration of the diabetics, 117 μmol/1 (range 65–160), did not differ from that of non‐diabetics despite two‐ to threefold higher levels of plasma glucose, FFA and ketone bodies in diabetics. Daily plasma citrate profile in diabetics showed peak concentrations in the morning and late afternoon. Citrate level throughout the day fell after increased insulin administration, whereas the diurnal pattern remained unchanged. Both the week‐to‐week coefficient of variation (mean 10%) and the diurnal coefficient of variation (mean 17%) of plasma citrate were below those of any other substances measured (p<0.001). Postabsorptive citrate concentration correlated negatively to the diurnal variation of plasma glucose whether diabetic control was apparently good or poor. The results support the idea that plasma citrate level reflects intracellular citrate regulation of glucose utilization. In spite of an interindividual range of 100%, individual citrate level was remarkably constant. Postabsorptive plasma citrate concentration is proposed as a control marker of lability of circulating glucose in insulin‐treated diabetics.
Hypertension in the Elderly
Authors: Amery Antoon , Hansson Lennart , Andrén Lennart , Gudbrandsson Thorkell , Sivertsson Ramon , Svensson Anders
Published: August 2010

ABSTRACT.A review on the effects of ageing on cardiovascular function, with special reference to high blood pressure (BP), is given in this seminar. In most western populations the diastolic and especially the systolic BP increases with age in both sexes and this has been observed both in cross‐sectional and longitudinal studies. Over the age of 60 the diastolic BP decreases. Of the different risk factors for cardiovascular diseases, only BP has been shown consistently to be an independent risk indicator in subjects 70 years or older. Hypotensive drugs used in the treatment of middle‐aged hypertensive patients can also reduce the BP in elderly hypertensive patients but are likely to produce more adverse reactions such as electrolyte disturbances and glucose intolerance by thiazides, depression by reserpine, orthostatic hypotension by methyldopa and excessive bradycardia by β‐blockers. A prolongation of life expectancy in hypertensive patients 60 years or older by hypotensive drug therapy has not been shown conclusively in controlled trials.
Pre‐ and Postoperative Studies in 72 Hypertensive Patients with Renal Artery Stenosis, with Special Reference to Renin Activity and Aldosterone
Authors: Hansson B.‐G. , Bergentz S.‐E. , Dymling J.‐F. , Hedeland H. , Hökfelt B.
Published: August 2010

ABSTRACT. Seventy‐two patients, aged 6–69 years, were operated on because of presumed renovascular hypertension and subjected to follow‐up studies for 4–60 months (mean 28). Unilateral renal artery stenosis was present in 47 patients. Surgery was followed by normalization of blood pressure (BP) in 28 and improvement in 7, whereas 12 showed no response. Sixteen were below the age of 40 and only one failed to respond to surgery. Peripheral venous plasma renin activity (PRA) was increased in 32 and urinary aldosterone elevated in 22 of 35 patients responding favourably to surgery. Renal vein PRA was higher from the kidney with the stenotic renal artery as compared to the contralateral side in all patients responding to surgery. Preoperative peripheral PRA difference was also found in 7 of 12 patients not responding to surgery. Preoperative peripheral PRA was increased in 26 of the patients becoming nor‐motensive after surgery. In 20 of these patients normalization of BP was associated with a fall in peripheral PRA. Twenty‐five patients had bilateral renal artery stenosis. Four of them had severe hypertension, renal insufficiency and generalized atherosclerosis. They died in immediate connection with operation. Unilateral operation, performed in 11 of the remaining 21 patients, was followed by normalization of BP in 3 and no response in 8. Bilateral reconstructive surgery, performed in 10 patients, resulted in normotension in 2 and improvement in 7. Our studies indicate that determination of peripheral PRA and/or urinary aldosterone can serve as a useful prognostic indicator after surgery in hypertensive patients with renal artery stenosis.
Associated Conduction Disturbances in Patients with Symptomatic Sinus Node Disease
Authors: Vallin Hans , Edhag Olof
Published: August 2010

ABSTRACT. Electrophysiological investigations were performed in 30 patients with symptomatic sinus node disease (SND) to assess the extent and distribution of associated functional disturbances in the conduction system. The tests were performed before and after inhibition of autonomous tone with propranolol, 0.1 mg/kg, and atropine, 0.02 mg/kg. Surface ECG had shown bundle branch blocks (BBB) in 5 patients and fascicular blocks in 2. AV block I had been recorded in 4 patients, while none had shown high‐degree AV block. Malfunction was most often detected in the AV junction, 17 patients showing a prolonged conduction time or an abnormal effective AV node refractory period. Intraventricular conduction delay was present in 7 patients, with a prolonged HV interval in 3 and a complete permanent BBB in the others. Rate‐dependent BBBs were demonstrated in a further 4 patients. Long cardiac arrests following interruption of atrial pacing, suggesting impaired automaticity also of subsidiary escape pacemakers, were seen in 11 patients. Only 6 patients, 20%, showed no signs of associated malfunction of the conduction system. Thus, detailed electrophysiological assessment demonstrated associated conduction abnormalities in the majority of these SND patients. The results agree with histopathological studies and show that sinus node malfunction is often the clinically apparent manifestation of a widespread degenerative process in the cardiac conduction system.
QT Prolongation and Ventricular Fibrillation in Acute Myocardial Infarction
Authors: Forssell Gunilla , Orinius Erik
Published: August 2010

ABSTRACT. Fourteen acute myocardial infarction (AMI) patients with early ventricular fibrillation (VF) were compared to 27 control patients without VF with regard to the corrected QT interval (QT) and the QRS duration. Patients with complete bundle branch block (BBB) had been excluded. The QT tended to be longer in the VF group than in the controls, but the difference, 13 msec, disappeared after exclusion of a further 5 VF patients and one control with QRS duration >0.10 sec of other configurations than complete BBB. In the long QT syndrome of various types, VF is characteristically preceded by diastolic waves (DW) with larger amplitudes than the preceding T waves. None of the 5 AMI patients with an evaluable recording of the onset of VF, showed DWs preceding the arrhythmia. The results of this study do not support the opinion that VF is associated with a prolonged QT interval in AMI in the same way as in the long QT syndrome. The longer QT interval in patients with VF seems to be mainly secondary to the longer QRS duration.
Pernicious Anemia as a Risk Factor in Gastric Cancer
Authors: Eriksson Sten , Clase Li , Moquist‐Olsson Ingrid
Published: August 2010

ABSTRACT. We have analyzed the prevalence of pernicious anemia (PA) in all patients with autopsy‐verified gastric carcinoma (GC) registered during 1958‐76 in a Swedish city, with one Department of Pathology serving approximately 240000 inhabitants and with a high autopsy frequency. The prevalence was compared to that in a reference group of 917 sex‐and age‐matched individuals without GC. PA was found in 19 persons, 2.1%, (7 males and 12 females) in the GC group and in 13 persons, 1.4%, (5 males and 8 females) in the reference group. This difference is not significant (p<0.15). After exclusion of individuals with PA known for less than 5 years before death, the corresponding figures were 16 in the GC group against 8 in the control group. This difference is significant (p<0.05). Regarding individuals with a diagnosis of PA for >10 or >15 years, the prevalence was twice as high in the GC as in the reference group. The differences were again insignificant (p<0.10). PA as a risk factor for the development of GC has been overestimated, probably due to inadequate reference groups. Only 2% of all GCs are associated with PA. Large‐scale preventive search for GC in PA patients is thus unjustified.
Does Verapamil Influence Glucose‐Induced Insulin Release in Man?
Authors: Röjdmark S. , Andersson D. E. H. , Hed R. , Nordlund A. , Sundblad L. , Wiechel K.‐L.
Published: August 2010

ABSTRACT. The effect of verapamil on the tolerance for oral glucose and on the pancreatic release of insulin was investigated in 6 normoglycemic patients admitted to hospital because of abdominal diseases. Each patient was studied twice. On one occasion, 100 g glucose was ingested during simultaneous i.v. infusion of verapamil, on the other, glucose was given during i.v. infusion of saline. Blood samples for insulin and glucose measurements were collected simultaneously via a portal and an antecubital vein catheter. It was found that the blood glucose and serum insulin responses to oral glucose were unaffected by verapamil both in the portal and in the peripheral venous blood. These findings imply that the pancreatic release of insulin, the tolerance for oral glucose, and the intestinal absorption of glucose remain unaffected by i.v. verapamil in normoglycemic individuals.
Oxypurine Release in Cardiac Disease
Authors: Buhl L. , Vilhelmsen K. N. , Nielsen J. Rokkedal
Published: August 2010

ABSTRACT. The excretion of hypoxanthine‐xanthine and uric acid in urine and the concentrations in peripheral venous blood were determined in nine patients with cardiac arrest due to acute myocardial infarction (AMI), in ten control patients with AMI without cardiac arrest and in nine with angina pectoris. The patients with cardiac arrest showed a 6‐fold increase in urinary excretion of hypoxanthinexanthine 0–2 hours after cardiac arrest. No difference was observed in the uric acid excretion or the hypoxanthine‐xanthine and uric acid concentrations in peripheral venous blood. The urinary excretion of hypoxanthine‐xanthine increases considerably in connection with reversible cardiac arrest, indicating general tissue hypoxia. No relationship could be found between the duration of cardiac arrest and the increased hypoxanthine‐xanthine excretion in the urine.
A 69‐Year‐Old Man with Chronic Obstructive Pulmonary Disease, Pancreatic Insufficiency and Elevated Sweat Electrolytes
Authors: Evensen S. A.
Published: August 2010

ABSTRACT. A 69‐year‐old man with chronic obstructive lung disease and steatorrhea presented with diffuse peribronchial thickenings in both lungs, pancreatic insufficiency and elevated sweat electrolytes. The findings are best compatible with cystic fibrosis. Cystic fibrosis should be considered in the differential diagnosis of unexplained chronic obstructive pulmonary disease even in the elderly, particularly if combined with evidence of maldigestion or recurrent pancreatitis.
Characteristic Changes in the Concentrations of Some Peptide Hormones, in Particular Those Regulating Serum Calcium, in Acute Pancreatitis and Myocardial Infarction
Authors: de Boer A. C. , Mulder H. , Fischer H. R. A. , Schopman W. , Hackeng W. H. L. , Silberbusch J.
Published: August 2010

ABSTRACT. In order to further investigate hormonal changes and possible metabolic consequences in acute pancreatitis, 10 cases with a mild form of the disease were studied. The influence of tissue injury per se on the hormones in question was assessed from comparisons with the hormone levels in the course of myocardial infarction (MI) in 9 cases. Insulin and glucose showed no consistent changes. Glucagon was suppressed on admission, 22±10 pgml‐1 compared with the ultimate concentration, 40 ±20 pg * ml‐1 (p > 0.05), and with the initial value in MI, 74±32 pg * ml‐1 (p > 0.01). Serum calcitonin (CT) was strongly elevated initially, 348±313 pg‐ml‐1, compared with the ultimate level, 24±7 pg mg‐1 (p > 0.001), and with the normal initial level in MI, 43±44 pg * ml‐1 (p > 0.01). Serum CT elevations were time‐related to a slight reduction in corrected serum Ca, which might reflect a biological expression of this substance. In pancreatitis, parathyroid hormone (PTH) remained normal and unchanged throughout the study, whereas patients with MI had an increased level of this hormone on admission, 0.19±0.08 μgEq * 1‐1, compared with the ultimate concentration, 0.09±0.03 μgEq r‐1 (p > 0.02) and with the initial concentration in pancreatitis, 0.11 ±0.06 μgEq 1‐1 (p > 0.05). Supranormal PTH levels were found in more than half of the infarction patients on days 0 and 1.
Time and Intensity of First Pollen Contacts and Risk of Subsequent Pollen Allergies
Authors: Björkstén Fred , Suoniemi Ilpo
Published: August 2010

ABSTRACT. We find that the risks of immediate hypersensitivity to grass and mug wort pollens, as measured by a skin test, are positively correlated with the intensity of the first pollen season encountered in infancy. However, only indirect measures of the intensity of the pollen seasons (weather factors and vegetative growth of grasses) were available for the regression analysis performed. The risks were also dependent on the month of birth, maximal risk for both grass nad mugwort pollen sensitivity being associated with birth in April‐May. The results support an earlier suggestion that pollen contacts during the first 6 months of life increase the risk of pollen allergy for 20 years or more. We estimate that the elimination of early pollen contacts could have reduced the prevalence of immediate hypersensitivity to grass and mugwort pollens by approximately 20 % each in the age group 0–19 years.
The Effect of Pindolol and Isosorbide Dinitrate and Their Combination on Exercise Tolerance and ECG Changes in Angina Pectoris
Authors: Storstein Liv
Published: August 2010

ABSTRACT. The effect of placebo, isosorbide dinitrate (ISDN) (5 mg orally), pindolol (1.0 mg i.v.) and the combination of ISDN and pindolol was tested in 12 patients with stable, exercise‐induced angina pectoris and normal resting ECG. A graded submaximal exercise test was performed on a bicycle ergometer 30 min after medication. All patients had ST depression during and shortly after exercise. ISDN and pindolol increased exercise tolerance to a similar degree but through different mechanisms. Pindolol decreased heart rate and markedly reduced ST depression in the ECG, while ISDN had no effect on ECG changes. The combination of ISDN and pindolol was superior to either drug alone in increasing exercise tolerance in angina pectoris.
Propranolol in the Treatment of Thyrotoxicosis
Authors: Kvetny J. , Frederikesen P. K. , Jacobsen J. G. , Haas V. , Feldt‐Rasmussen U. , Date J.
Published: August 2010

ABSTRACT.Twenty‐five patients with newly diagnosed thyrotoxicosis participated in a double‐blind study of the added effect of propranolol during tiamazol treatment. During the trial, the effect of treatment was ascertained by estimation at regular intervals of the clinical score (Crooks‐Wayne index), free thyroxine index, serum triiodothyronine, serum reverse triiodothyronine, serum thyroglobulin and serum thyroglobulin antibodies. Both groups became euthyroid within two weeks. No statistically significant difference in the values for the clinical score or for any of the laboratory parameters measured was found between propranolol‐ and the placebo‐treated patients. It is concluded that propranolol has no beneficial effect on tiamazol‐treated hyper‐thyroid patients.
Myocardial Infarction in Young Subjects
Authors: Cullhed I. , Waern U.
Published: August 2010

ABSTRACT. The occurrence of myocardial infarction (MI) in subjedts younger than 35 years of age is the subject of this work. The aims were to evaluate the validity of the diagnosis and to study the long‐term prognosis for these patients. Through the central data register of all hospital discharges in the Uppsala hospital region (approximately 1.25 mill. inhabitans) 30 patient histories were obtained. They were carefully evaluated and all survivors were invited to an examination at the Department of Cardiology. The follow‐up period from the initial hospital stay was up to 11 years. The hospital mortality among 14 subjects with MI and coronary atheromatosis was 29%, increasing to 43 % in the follow‐up period. Six of the seven investigated survivors in this group were symptom‐free and full‐time employed. Hyperlipoproteinemia, smoking and heredity for ischemic heart disease seemed to be the most important risk factors among the 14 subjects in this group. Further studies are necessary to evaluate the validity of diagnoses obtained from central data registers. In ten patients the initial diagnosis had been incorrect.
Effect of Cortisol on the Proliferation and Protein Synthesis of Human Aortic Smooth Muscle Cells in Culture
Authors: Järveläinen Hannu , Halme Tapio , Rönnemaa Tapani
Published: August 2010

ABSTRACT. The synthesis of collagen (measured as the formation of non–dialyzable hydroxyproline) and other proteins, and the activity of lysyl oxidase, the enzyme responsible for the formation of cross–links in elastin and collagen, were measured in cultured human aortic smooth muscle cells in the presence of various Cortisol concentrations. In addition, the effect of Cortisol on the proliferation of the cells was also studied. At concentrations of 10–6M and greater, Cortisol retarded cell growth markedly, as judged by decreased incorporation of 3H–thymidine by the cells and decreased DNA content of the cultures. At the same concentrations, Cortisol increased the synthesis of collagen and other proteins. The magnitude of the increase was similar for collagen and other proteins. The activity of lysyl oxidase was also increased in the presence of 10–6and 10–5M Cortisol, but to a lesser extent than the synthesis of collagen.

Other studies using cultured cells have shown that Cortisol decreases the synthesis of hyaluronic acid but not of sulphated glycosaminoglycans by smooth muscle cells and does not injure endothelial cells. Considering these findings in the light of the present results, it is suggested that Cortisol induces changes in the metabolism of connective tissue macromolecules of smooth muscle cells that can be regarded as atherogenic. However, some other important biological changes associated with atherogenesis (smooth muscle cell proliferation and endothelial injury) do not occur in vascular cells exposed to Cortisol.
Type A in the Mini–Finland Health Survey
Authors: Hanses Orvokki , Reunanen Antti , Maatela Jouni , Impivaara Olli , Aromaa Arpo
Published: August 2010

ABSTRACT. The prevalence of coronary–prone behaviour, Type A, was investigated in a representative sample of all Finnish adults comprising 1941 men and 2168 women aged 30–64 years. The behaviour pattern was assessed by the Jenkins Activity Survey. The mean of the Type A scores was –5.7 for men and –5.8 for women. Among men, 28.2%, and among women 26.8% had scores greater than or equal to 0. Type A was positively associated with the level of education. The prevalence of Type A in Finnish men and women seems to be lower than that found in most other surveys.
Stress, Catecholamines and Beta–Blockade
Authors: Bonelli J.
Published: August 2010

ABSTRACT. In order to investigate the effects of beta–blockade on haemodynamic response to stress, 2 groups of volunteers received either propranolol or mepindolol sulphate under basal conditions and under the stress of mental arithmetic. In control conditions, increases occurred in heart rate (HR), cardiac output (CO) and systolic and diastolic blood pressure in response to calculation stress. Stress–induced increases in HR and CO were significantly reduced by propranolol. Systolic blood pressure during calculation stress under propranolol was slightly less than in control conditions. However, diastolic blood pressure under stress was higher with propranolol than in the control study. Mepindolol sulphate also reduced HR and CO under calculation stress but it produced no significant change in diastolic pressure.

A significant increase in plasma adrenaline occurred under stress. The level was not altered by propranolol but was reduced to less than 50% of the untreated stress value by mepindolol.

Since beta–blocking agents suppress an increase in heart rate in stressful situations but either fail to prevent or even potentiate increased diastolic pressure, their use in patients without hypertension should be reserved for those showing pathological stress reactions. They do not appear to be indicated for the management of stressful situations in general.
Metabolic effects of prenalterol in healthy volunteers
Authors: Klein G. , Wirtzfeld A. , Schmidt G. , Zilker Th.
Published: August 2010

The aim of our study was to ascertain the β–adrenoceptor selectivity of prenalterol in healthy volunteers by determining haemodynamic and metabolic parameters over a wide dose range. As we have shown in a previous publication, by using these parameters in healthy humans it is possible to determine the receptor selectivity of a β–adrenoceptor active substance [l].

This paper only deals with the metabolic variables glucose, lactate, free fatty acids (FFA) and serum–insulin.
Haemodynamic effects of prenalterol in patients with severe congestive heart failure – NYHA lll–IV
Authors: Erbel R. , Meyer J. , Schweizer P. , Lambertz H. , Voelker W. , Effert S.
Published: August 2010

In 12 patients with severe congestive heart failure due to ischaemic heart disease (n=6) and due to congestive cardiomyopathy (n=6) the haemodynamic effects of a new β1–agonist, prenalterol, were studied. Left ventricular (LV) function was studied before and 20 min after infusion of 12 mg prenalterol. Heart rate was kept constant by atrial pacing at a rate of 100 min−1 unless intrinsic heart rate exceeded it.

As a sign of positive inotropic support, prenalterol enhanced peak rate of LV pressure development (dP/dt) from 1160+100 mm Hg/s to 1590 ± 190 mm Hg/s (p > 0.005). In the mean LV end–diastolic and end–systolic volume determined by cineventriculography and two–dimensional echocardiography decreased. LV stroke work index measured with both methods increased with 4 ml/m2 and 5 ml/m2, respectively (p > 0.02). LV ejection fraction was improved by 6% and 8% (p > 0.005). Increase of peak fall of left ventricular pressure (dP/dt) (1050+60 mm Hg/s to 1270+100 mm Hg/s, p > 0.005) and shortening of time constant (T) of pressure fall from 64.5 ± 5.0 ms to 44.5 ± 6.0 ms (p > 0.005) demonstrated the improved LV relaxation. Analysis of LV volume and myocardial compliance revealed decrease of left ventricular stiffness. Thus, LV filling pressure was reduced from 22.1 ± 4 mm Hg to 14 ± 3.5 mm Hg (p > 0.001). Pressure volume analysis showed a significant increase of LV power and work, as well as a slight decrease of wall stress.

Our study could demonstrate, even in patients with severe heart failure, a sustained positive inotropic effect of prenalterol leading to an improved left ventricular contractility, relaxation and compliance. LV power and work was enhanced. The increase of oxygen demand seemed to be counterbalanced by an improved perfusion of particularly subendocardial layers indicated by an increased transmyocardial pressure gradient.
1,25(OH)2D3 and Renal Function
Authors: Jensen G. F. , Christiansen C. , Transbøl I.
Published: August 2010

ABSTRACT. A controlled study of the effect of 1,25(OH)2D3 was performed in 58 normal 70‐year‐old Danish women. After 6 months' observation of the spontaneous course the participants were randomized to treatment with either 1,25(OH)2D3 (0.5 μg daily) or placebo. Both groups received 500 mg calcium daily. Seven out of 20 participants treated with 1,25(OH)2D3 developed slight hypercalcaemia which disappeared after dose adjustment. One participant in the placebo group developed slight hypercalcaemia. A highly significant increase in serum creatinine was observed in the 1,25(OH)2D3 group when compared with the initial value and with the change in the placebo group. Serum creatinine remained elevated throughout the study despite normalization of serum calcium. It is concluded that 1,25(OH)2D3 treatment in normal, elderly women has a negative effect on the renal function as estimated from serum creatinine.
Intravenous Fat Tolerance Test with Intralipid® in Chronic Renal Failure
Authors: Norbeck H. E. , Rössne S.
Published: August 2010

ABSTRACT. The intravenous fat tolerance test with Intralipid® has been used to evaluate the triglyceride (TG) removal capacity in 34 male patients with varying degree of chronic renal failure (CRF). The investigations were repeated in 10 patients after 2–3 years when the renal function had deteriorated further. The fractional removal rate of Intralipid® (k2) was low compared to controls, regardless of degree of renal function, etiology of renal disease or treatment with antihypertensive drugs. The k2 value did not change in patients investigated twice, although there was a considerable decrease in renal function. Both in patients and controls there was a strong negative correlation between k2 and the very low density lipoprotein (VLDL) TG concentration. However, at the same k2 value, the VLDL TG concentration was higher in patients than in controls. These data suggest that the hypertriglyceridemia commonly seen in patients with CRF is caused both by an increased VLDL production and a decreased VLDL removal from the circulation. Furthermore, these changes in TG metabolism are induced early in the course of renal insufficiency.
An Unusual Case of Myeloma
Authors: Nelis G. F.
Published: August 2010

ABSTRACT.The present report concerns a patient with “non‐secretory” IgD‐kappa myeloma with two separate clones of myeloma cells: one secreting IgD‐kappa and one producing but not secreting kappa light chains. The second clone is thought to be derived from the first by de‐differentiation. Before the diagnosis of myeloma was made, the patient was considered to have a solitary plasmocytoma.
In Vitro Colony Studies in 87 Patients with Acute Nonlymphoblastic Leukemia
Authors: Hörnsten P. , Gahrton G. , Sundman B. , Wahren B.
Published: August 2010

ABSTRACT. Colony‐forming cells (CFU‐C) in peripheral blood and bone marrow and colony‐stimulating activity (CSA) in mononuclear peripheral white blood cells were studied at diagnosis in 87 patients with acute nonlymphoblastic leukemia (ANLL). Absence of CFU‐C in peripheral blood was more frequent in patients who did not enter remission than in those who did, and survival was significantly shorter in CFU‐C‐negative than in CFU‐C‐positive patients. No correlation was found between CFU‐C in the bone marrow and frequency of remission or survival time. Absence of CSA was significantly more frequent in patients who did not enter remission than in those who did. Only 4 of 28 patients who lacked CSA entered remission. Survival was significantly longer in CSA‐positive than in CSA‐negative patients. Thus, CSA synthesis in peripheral mononuclear blood cells appears to be a valuable prognostic factor in ANLL.
Genetics of Autoantibodies in Relation to Disease
Authors: Aho Kimmo , Sistonen Pertti , Takala Jorma , Sievers Kai
Published: August 2010

ABSTRACT. Familial occurrence of three types of autoantibodies, viz. rheumatoid factors, antinuclear antibodies and thyroid autoantibodies, was investigated in two population series: twins from the Finnish Twin Registry representing the adult twin population living in an urban area (76 monozygotic and 82 dizygotic same‐sex twin pairs) and siblings from a middle‐aged rural population subject to an ongoing epidemiological study (311 sibling groups comprising 801 subjects and 584 married couples). The observations were compatible with the concept of two components in the above autoantibody system. The major component is determined predominantly by environmental factors and is manifested with increasing age. The autoantibodies belonging to the minor, familial component occur in somewhat higher titers, exhibit certain specificity features of their own (RF reacting with rabbit gamma globulin), and are associated with “autoimmune” diseases.