bluuebunny/crossref_metadata_2025 huggingface dataset:
Hypertriglyceridemia—Acute Pancreatitis—Ischemic Heart Disease
Authors: LITHELL HANS , VESSBY BENGT , WALLDIUS GÖRAN , CARLSON LARS A.
Published: August 2010

ABSTRACT Hyperlipoproteinemia type V, with serum triglyceride concentrations of about 20 mmol/1, was detected in a pair of monozygotic, 40‐year‐old twin brothers. One of them had had recurrent attacks of pancreatitis, the other not. The endocrine and exocrine pancreatic functions were apparently normal, supporting that the pancreatitis was secondary to the hypertriglyceridemia. After successful lipid‐lowering therapy the attacks of abdominal pain disappeared and remained absent during a 13‐year follow‐up period. The other twin died of ischemic heart disease nine years after the discovery of his lipid abnormality. The reduction of his lipid levels had been much less successful. His average “atherogenic index” (the ratio of cholesterol in low density to that in high density lipoproteins) was normal but increased to a very high value if cholesterol in very low density lipoproteins was also included together with the low density ones in the numerator. Lipoprotein particles modified in composition may have contributed to an increased uptake through a scavenger pathway and promoted atherosclerosis.
Increased Plasma Levels of Atrial Natriuretic Peptide (ANP) in Patients with Paroxysmal Supraventricular Tachyarrhythmias
Authors: NILSSON GÖRAN , PETTERSSON ANDERS , HEDNER JAN , HEDNER THOMAS
Published: August 2010

ABSTRACT. Nilsson G, Pettersson A, Hedner J, Hedner T (Department of Internal Medicine, Central Hospital, Halmstad and Department of Clinical Pharmacology, Sahlgrenska University Hospital, Göteborg, Sweden). Increased plasma levels of atrial natriuretic peptide (ANP) in patients with paroxysmal supraventricular tachyarrhythmias. Acta MedScand 1987; 221:15–21.

Atrial natriuretic peptide (ANP) is a cardiac hormone originating from atrial cardiocytes. It seems to be involved in the regulatory control of circulating volume and vascular tone. Plasma immunoreactive atrial natriuretic peptide (IrANP) was investigated in 22 patients with paroxysmal supraventricular tachyarrhythmia (16 with atrial fibrillation, 4 with atrial flutter, one with a Wolf‐Parkinson‐White syndrome (WPW) and one with atrial tachycardia). During the aute attack, IrANP was significantly increased (125.3± 11.4 pmol/1) compared to samples obtained during convalescence (55.9±4.7 pmol/1). Heart rate (HR) was 144±4.3 beats/min during the arrhythmia and 75±2.6 during convalescence. The reduction of IrANP in plasma from the acute attack of tachycardia to follow‐up was significantly related to the reduction of HR (p<0.05). Irrespective of type of paroxysmal supraventricular tachyarrhythmia, 50% of the patients experienced polyuria during the attack. This symptom was more frequent in younger patients with a shorter duration of tachycardia. Polyuria patients had a higher HR during the attack of supraventricular tachycardia. Even though polyuria was not alwavs found in the patients with the highest IrANP values, the symptom was associated with significantly higher concentrations of Ir ANP in plasma compared to the non‐polyuria group. We conclude that Ir ANP is increased in plasma during acute attacks of paroxysmal supraventricular tachycardia. Furthermore, the polyuria frequently associated with this condition may partly be due to excess release of ANP from cardiac myocytes.
Angina Pectoris, Intermittent Claudication and Congestive Heart Failure in Middle‐aged Male Hypertensives
Authors: SAMUELSSON OLA , WILHELMSEN LARS , PENNERT KJELL , BERGLUND GÖRAN
Published: August 2010

ABSTRACT.Samuelsson O, Wilhelmsen L, Pennert K, Berglund G (Section of Preventive Cardiology, Department of Internal Medicine I, Sahlgrenska and Östra Hospitals, University of Göteborg, Göteborg, Sweden). Angina pectoris, intermittent claudication and congestive heart failure in middle‐aged male hypertensives. Acta Med Scand 1987; 221:23–32.

A group of middle‐aged male hypertensives, derived from a random sample of a Swedish urban population, has been treated and followed for 10 years. The development of angina pectoris, intermittent claudication and congestive heart failure have been analysed. The initial prevalence and the average yearly incidence of angina pectoris was 3.9% and 1.3% p.a., of intermittent claudication 1.7% and 0.6% p.a. and of heart failure 1.0% and 0.8% p.a. ECG signs indicating subclinical heart disease (major Q wave, STdepression, T wave inversion) were risk factors for development of angina pectoris and congestive heart failure. Heart enlargement on chest X‐ray was also a risk factor for development of congestive heart failure, as were a high serum creatinine, body mass index, serum uric acid and proteinuria. Smoking was found to be a strong and independent risk factor for any one of these cardiovascular disorders. After 10 years about one fourth of all patients, still attending the clinic, had at least one cardiovascular complication. Hence, the risk of developing cardiovascular disorders is substantial and seems to be potentiated by the same risk factors known to operate in the general population.
The Clinical Picture of the Painful Diabetic Shoulder—Natural History, Social Consequences and Analysis of Concomitant Hand Syndrome
Authors: MORÉN‐HYBBINETTE INGALILL , MORITZ ULRICH , SCHERSTÉN BENGT
Published: August 2010

ABSTRACT.Morén‐Hybbinette I, Moritz U, Scherstén B (Department of Physical Medicine, University Hospital, Lund and Department of Community Health Sciences, University of Lund, Dalby, Sweden). The clinical picture of the painful diabetic shoulder—natural history, social consequences and analysis of concomitant hand syndrome. Acta Med Scand 1987; 221:73–82.

Sixty diabetic patients with shoulder pain were followed in order to trace the natural history of the disease. The triad of painful shoulder, hand syndrome and restricted hip joint mobility was strongly correlated to the duration of diabetes and retinopathy. Painful shoulder with restricted mobility (58%) and tendinitis (28%) predominated. Hand syndrome was found in 62% and restricted hip joint mobility in 42%. Ninety percent of painful shoulders with restricted mobility had difficulties in the activities of daily living in the acute phase. There was functional limitation of shoulder mobility in 17% of painful shoulders with restricted mobility at the end of the study. The duration of diabetes and the duration of shoulder symptoms were correlated. In 25%, working capacity was affected by the painful shoulder. A serious risk of developing shoulder symptoms persisting for more than 2 years was associated with insulin treatment, diabetes lasting more than 10 years, proliferative retinopathy and painful shoulder with restricted mobility.
Localized Primary Amyloidosis of the Stomach Presenting with Gastric Hemorrhage
Authors: BJÖRNSSON SIGURDUR , JÓHANNSSON JÓHANN HEIDAR , SIGURJÓNSSON FROSTI
Published: August 2010

ABSTRACT. Bjdrnsson S, Jóhannsson JH, Sigurjónsson F (Departments of Internal Medicine and Surgery, Reykjavik City Hospital, and Department of Pathology, University of Iceland, Reykjavik, Iceland). Localized primary amyloidosis of the stomach presenting with gastric hemorrhage. Acta Med Scand 1987; 221:115–9.

We report a patient with localized, primary gastric amyloidosis, who presented with recurrent hematemesis, a rare presentation for an unusual disease. The patient was initially thought to have stomach cancer because of the X‐ray and gastroscopic appearance of the gastric mucosa, but was eventually found to have primary amyloidosis confined to the stomach and regional lymph nodes. The amyloid was found to be of immunoglobulin origin, AL amyloid. Other reports of localized gastric amyloidosis are reviewed and compared with the present case. Most of the patients were clinically suspected of gastric carcinoma, and only one had hematemesis. We propose that amyloidosis should be considered in the differential diagnosis of hematemesis and gastric tumors.
Significant Relationship between Renin Suppression and Atrial Natriuretic Peptide (α‐hANP) during Volume Loading in Hypertensive Men
Authors: ANDERSSON OVE K. , PERSSON BENGT , WYSOCKI MARIAN , BERGLUND GÖRAN , TOWLE ANDREW C. , AURELL MATTIAS , HEDNER JAN , HEDNER THOMAS
Published: August 2010

ABSTRACT. We have studied eight men with moderate hypertension to determine the atrial natriuretic peptide (α‐hANP) response to acute volume expansion. Rapid infusion of 1000 ml 0.9% saline (10–20 min) caused an increase in central venous pressure (4.7±1.6 cmH2O) while blood pressure and pulse pressure (arterial baroreceptor load) did not change. Stroke volume and heart rate were not affected by the volume load but plasma renin activity (PRA) was significantly suppressed (from 0.83±0.14 to 0.68±0.34 μg AI I/ml‐h; p<0.01). A significant hemodilution was also observed. Renal sodium excretion was significantly increased. Arterial α‐hANP increased significantly from 21.1 ±6.1 to 30.5±4.0 pmol/1 (p<0.02) during volume expansion. There was a significant correlation between corrected plasma volume increase (urine volume subtracted from the infused volume) and α‐hANP plasma elevation (r=0.78; p<0.05). There was also a significant negative correlation between changes α‐hANP and PRA (r=‐0.78, p<0.05). We conclude that only moderate voume loading in human hypertensives is a mechanism for increase in plasma α‐hANP levels. The significant negative correlation between changes in α‐hANP and PRA suggests that α‐hANP may be the humoral factor at least partly responsible for suppression of renin in hypertensive man. Since increased fluid volume also affects sympathetic renal efferents as well as vasopressin secretion, our observed relationship between volume load and renin may well be related also to such mechanisms.
Drug Treatment in 70–82‐year‐old Persons
Authors: LANDAHL STEN
Published: August 2010

ABSTRACT. The drug consumption has been studied in two 70‐year‐old cohorts within the frames of the longitudinal population study “70‐year‐old people in Göteborg, Sweden”. The first cohort has been followed for 12 years and the second, which was born 5 years later, for 5 years. In the first cohort the proportion of men and women on drug treatment increased from 61 and 77% at age 70 to 90 and 97% at age 82. The average number of drugs among those on treatment increased from 3.1 (men) and 3.4 (women) to 3.9 and 5.4, respectively. The most common drugs at age 70 were anxiolytics (20 and 29%), diuretics (IS and 29%), analgesics (12 and 20%), and digitalis (13 and 14%) and at 82 years of age analgesics (39 and 56%), anxiolytics (27 and 49%), diuretics (26 and 42%), and laxatives (19 and 28%). The second examined cohort used more drugs mainly at age 75 than the first cohort. The longitudinal follow‐up of the first cohort indicated an overmortality mainly among men on drug treatment at ages 70 and 75. The patients' knowledge of the indications for the treatment was often weak and at age 82, 25% of the patients were unaware of the indications for one or more of the drugs.
Subacute Rupture of the Free Left Ventricular Wall Following Acute Myocardial Infarction
Authors: BRODIN LARS‐ÅKE , MOOR ELISABETH , ORINIUS ERIK , SEMB BJARNE , SZAMOSI ALFRED
Published: August 2010

ABSTRACT. In previously published cases of subacute or sealed postinfarction rupture of the free left ventricular wall, the patients presented a clinical picture of sudden shock and tamponade. Our patient, a 64‐year‐old man, suffered renewed chest pain on the fourth postinfarction day and went into cardiogenic shock, which was pharmacologically reversible. There were no bed‐side signs of tamponade and the ECG showed the pattern of acute pericarditis, both features in contrast to previously reported cases in the literature. Echocardiography demonstrated localized fluid in the pericardial sac and a puncture revealed non‐coagulating blood. The patient was successfully operated on. At surgery a small rupture sealed by blood clots was demonstrated in the infarcted inferior wall of the left ventricle.
Painful Autoimmune Thyroiditis Occurring on Amiodarone Therapy
Authors: Gudbjörnsson Björn , Kristinsson Árm , Geirsson Gunnlaugur , Hreidarsson ÁstrÁdur B.
Published: August 2010

ABSTRACT. A 51‐year‐old housewife, who had been on treatment with amiodarone for ten months, developed a painful enlargement of the thyroid gland. Thyroid antibody titers were highly elevated and a fine needle aspirate of the gland showed infiltration of lymphocytes and plasma ce?ls. Initially the patient was hyperthyroid, later she developed hypothyroidism which required thyroid substitution. The possibility of amiodarone provoking autoimmune thyroiditis is discussed.
Amiodarone for Refractory Supraventricular Tachycardias
Authors: EMMERTSEN K. , BJERREGAARD P. , ANDREASEN F.
Published: August 2010

ABSTRACT. Emmertsen K, Bjerregaard P, Andreasen F (Department of Cardiology, Aarhus Kommunehospital and Institute of Pharmacology, University of Aarhus, Aarhus, Denmark). Amiodarone for refractory supraventricular tachycardias. Acta Med Scand 1987; 221:435–9.

Amiodarone was administered to 53 patients with otherwise drug‐refractory supraventricular tachycardias. Therapy was effective in 35 patients and partially effective in nine patients for a median duration of 35 months. The median maintenance dose was 200 mg/day in both groups, whereas the median serum amiodarone concentrations were 1.1 mg/l and 0.7 mg/l, respectively. Amiodarone was ineffective in nine patients despite higher dosage (median 400 mg/day) and insignificantly higher serum concentrations (median 2.0 mg/l). Neither the age of the patients, the duration or type of arrhythmia, the cardio‐thoracic index, nor the type of underlying heart disease were predictive of the efficacy of amiodarone. Side‐effects occurred in 28 patients, leading to withdrawal of therapy in 12 patients. Side‐effects were not associated with higher serum amiodarone concentrations. Despite its efficacy, amiodarone should be reserved for otherwise drug‐resistant supraventricular tachyarrhythmias.
Changes in Plasma Atrial Natriuretic Peptide during Exercise in Healthy Volunteers
Authors: THAMSBORG GORM , STORM TOMMY , KELLER NIELS , SYKULSKI ROMAN , LARSEN JOHN
Published: August 2010

ABSTRACT.Thamsborg G, Storm T, Keller N, Sykulski R, Larsen J (Departments of Clinical Chemistry and Internal Medicine, Sundby Hospital, Copenhagen, and Department of Cardiology, Hvidovre Hospital, Hvidovre, Denmark). Changes in plasma atrial natriuretic peptide during exercise in healthy volunteers. Acta Med Scand 1987; 221:441–4.

Graded exercise was performed in three healthy volunteers. Plasma levels of immunoreactive atrial natriuretic peptide (iANP) were determined at different workloads. Unchanged or slightly decreased plasma levels of iANP were observed during light exercise, whereas at medium to high workloads a considerable increase in plasma levels of iANP was found. Factors responsible for the increase in plasma levels of iANP might include elevated right atrial pressure and increased plasma levels of epinephrine and norepinephrine.
Spontaneous Regression of Budd‐Chiari Syndrome (Hepatic Venous Occlusion) in a Young Female
Authors: HULTCRANTZ ROLF , ANGELIN BO , EINARSSON KURT , FRIMAN LEIF
Published: August 2010

ABSTRACT. Hultcrantz R, Angelin B, Einarsson K, Friman L (Departments of Internal Medicine and Roentgenology, Serafimer Hospital, and Department of Internal Medicine, Huddinge University Hospital, Karolinska Institute, Stockholm, Sweden). Spontaneous regression of Budd‐Chiari syndrome (hepatic venous occlusion) in a young female. Acta Med Scand 1987; 221:503–7.

A case of occlusion of the hepatic veins in an 18‐year‐old girl is presented. The onset was sudden with massive ascites and markedly impaired general condition. The diagnosis was based on liver biopsy and angiograms of the caval and hepatic veins as well as of the celiac artery. No predisposing factors could be found. The patient was treated conservatively with laparo‐centesis and diuretics. Clear improvement was seen after two weeks, and after four weeks she had no ascites and could be discharged. All liver function tests were then normalized. After three months, all diuretics could be withdrawn, and in the following 11 years she has remained completely recovered. The case illustrates that also widespread thrombi of the hepatic veins may sometimes rapidly dissolve spontaneously, with apparent total reconstitution of hepatic function. This case is unusual since previously reported cases have had high mortality rates and, in surviving cases, operative procedures or large doses of diuretics have been required to control the ascites.
Ibuprofen‐induced Meningitis in a Male with Systemic Lupus Erythematosus
Authors: JENSEN SØREN , GLUD TORBEN K. , BACHER THEIS , ERSGAARD HANS
Published: August 2010

ABSTRACT. Jensen S, Glud TK, Bacher T, Ersgaard H (Departments of Endocrinology, Clinical Immunology and Anaesthetics, Aalborg Hospital, Aalborg, Denmark). Ibuprofen‐induced meningitis in a male with systemic lupus erythematosus. Acta Med Scand 1987; 221:509–11.

A 36‐year‐old male with systemic lupus erythematosus developed aseptic meningitis after in‐gestion of ibuprofen. He was unconscious, had a universal rash, high fever and a pathological CSF. Being severely ill he was treated with high doses of corticosteroids and plasmapheresis and recovered within a week.

Ibuprofen, a non‐steroidal anti‐inflammatory drug of the propionic acid group, is frequently used in patients with connective tissue disorders. Within the past eight years a few reports have been published on aseptic meningitis following ingestion of ibuprofen in patients with systemic lupus erythematosus (SLE) (1–5) and mixed connective tissue disease (6–8). All of these patients were women. We report a serious case of aseptic meningitis in a male subject with SLE.
Determinants of Long‐term Mortality after Stroke
Authors: VIITANEN M. , ERIKSSON S. , ASPLUND K. , WESTER P. O. , WINBLAD B.
Published: August 2010

ABSTRACT.Viitanen M, Eriksson S, Asplund K, Wester PO, Winblad B (Departments of Internal Medicine and Geriatric Medicine, University of Umeå, Umeå, Sweden). Determinants of long‐term mortality after stroke.

Risk factors of death for a population of 409 patients with well‐defined cerebrovascular disease (patients with subarachnoidal hemorrhage excluded) admitted to the Stroke Unit were studied with the aid of the life table technique, log rank test, and multivariate analysis with BMDP's program for regression on the survival curves with Cox's proportional hazard model. The estimated proportion of survivors was 77% after three months, 69% after one year, and 32% after five years. Patients with intracerebral hemorrhage and embolic cerebral infarction had the worst outcome. Impaired consciousness on admission was the most important risk factor of death followed by high age, previous cardiac failure, diabetes mellitus and male sex.
Increase in Hepatic Lipase Activity after Testosterone Substitution in Men with Hypogonadism of Pituitary Origin
Authors: VALDEMARSSON STIG , HEDNER PAVO , NILSSON‐EHLE PETER
Published: August 2010

ABSTRACT. Valdemarsson S, Hedner P, Nilsson‐Ehle P (Departments of Internal Medicine and Clinical Chemistry, University Hospital, Lund, Sweden). Increase in hepatic lipase activity after testosterone substitution in men with hypogonadism of pituitary origin.

Ten men with hypogonadism of pituitary origin were studied before and during testosterone substitution therapy with regard to effects on the activities of hepatic lipase (HL) and lipoprotein lipase (LPL) in postheparin plasma, and on plasma lipoprotein concentrations. The mean (±SEM) testosterone level increased from 1.8±0.5 to 16.3±2.4 nmol/l). The mean activity of HL rose from 327.1 ±35.2 to 432.8±57.2 mU/ml (p<0.02), while the activity of LPL did not change significantly, 71.0+9.1 mU/ml before and 62.2±3.8 mU/ml after treatment. No significant alterations in lipoprotein concentrations were recorded. These results indicate that a normal testosterone level is of importance for maintaining the activity of HL in men, thereby contributing to the sex difference previously recorded for HL activity.
Use of Computerized Databases to Survey Drug Utilization in Relation to Diagnoses
Authors: STROM BRIAN L. , MORSE M. LEE
Published: August 2010

Many studies of drug utilization have suffered from the absence of information on the indications for therapy. A few data sets on drug utilization are available which include indication information. In addition, a number of computerized collections of medical billing data now exist in North America which can be used for such studies. These include data from the Kaiser Permanente Medical Plan; the Group Health Cooperative of Puget Sound; the Commission on Professional and Hospital Activities' Professional Activity Study; the U.S. state of Rhode Island; the Saskatchewan Health Plan in Canada; and Medicaid, the state run but federally financed health insurance plan for economically or medically needy individuals in the United States. These databases have a number of general advantages and disadvantages, which are reviewed. In addition, the differences among these databases are also explored. Finally, examples are presented demonstrating how these databases can be used for: 1) descriptive research on drug utilization, 2) evaluating the appropriateness of drug utilization, and 3) interventions designed to improve the appropriateness of prescribing.
The Associations between Obesity, Adipose Tissue Distribution and Disease
Authors: BJÖRNTORP PER
Published: August 2010

ABSTRACT Recent research has shown the marked differences in association with disease between obesity localized to the abdominal respectively to the gluteal‐femoral regions. In this review systematic analyses were performed of the associations between obesity (body mass index, BMI) or abdominal obesity (increased waist‐over‐hip circumference ratio, WHR) on the one hand, and a number of disease end points, and their risk factors, as well as other factors on the other, WHR was associated with cardiovascular disease, premature death, stroke, non‐insulin‐dependent diabetes mellitus and female carcinomas. In contrast, BMI tended to be negatively correlated to cardiovascular disease, premature death, and stroke, but positively to diabetes. The established risk factors for these end points were found to correlate to WHR, while this was often not the case with BMI. BMI was positively correlated only to insulin, triglycerides and blood pressure. Together with diabetes mellitus, this seems to constitute a metabolic group of conditions which are thus associated with BMI. Androgens (in women), and perhaps Cortisol, seem to be positively, and progesterone negatively correlated to WHR. The WHR was also positively associated with sick leave, several psychological maladjustments, psychosomatic and psychiatric disease. Attempts were made to interpret these findings. In a first alternative an elevation of FFA concentration, produced from abdominal adipose tissue, was considered to be the trigger factor for the pathologic aberrations associated with abdominal distribution of body fat. When obesity is added, the metabolic aberrations may be exaggerated. In a second alternative adrenal cortex hyperactivity was tested as the cause. When combined with the FFA hypothesis, this might explain many but not all of the findings. It seems possible to produce an almost identical syndrome in primates by defined experimental stress. Women with high WHR were found to have a number of symptoms of poor coping to stress. It was therefore suggested that part of the background to this syndrome might be a hypothalamic arousal syndrome developing with stress. It was concluded that obesity and abdominal distribution of adipose tissue constitute two separate entities with different pathogenesis, clinical consequences and probably treatment.
Steroid Hormones and Distribution of Adipose Tissue
Authors: REBUFFÉ‐SCRIVE MARIELLE
Published: August 2010

ABSTRACT Several descriptive studies, performed in women before and after menopause, in young and older men and in women with Cushing's disease, have suggested that steroid hormones have a role in the regulation of regional fat metabolism. Femoral lipoprotein lipase (LPL) activity seems to be increased by progesterone, while it might be inhibited by testosterone. Estradiol and testosterone might be lipolytic in the abdominal region. Long‐term exposure to corticosteroid might increase femoral LPL activity and decrease abdominal lipolysis. These conclusions, however, are only tentative. Corticosteroid hormones bind to the cytosolic fraction of human adipose tissue, while no binding was observed with estradiol or progesterone. The relationship between steroid hormone receptors and biological effects is unknown. Further work should be performed to investigate the mechanisms by which steroid hormones might influence human adipose tissue metabolism and distribution.
Sequence and Regulation of Two Growth‐hormone‐contn Sex‐specific Isozymes of Cytochrome P‐450 in Rat Liver, P‐45015βand P‐45016α
Authors: ZAPHIROPOULOS PETER G. , MODE AGNETA , STRÖM ANDERS , HUSMAN BOLETTE , ANDERSSON GÖRAN , GUSTAFSSON JAN‐ÅKE
Published: August 2010

ABSTRACTFull length cDNA clones for the sexually differentiated rat liver cytochrome P‐450 isozymes 15β and 16α have been isolated and sequenced. The deduced amino acid sequence of P‐45015βis 66% homologous to that of P‐45016α. Furthermore, either of these two cytochromes has a homology of about 50 % with the major phenobarbital inducible form, cytochrome P‐450b, while the homology with the major carcinogen inducible form, cytochrome P‐450c, is less than 30%. Also, the homology of these two sex‐dependent cytochromes with the developmentally regulated cytochrome P‐450 isozymes and PB‐1 is about 70%. Therefore, it is concluded that P‐450 isozymes 15β, 16α, f, and PB‐1 represent a subfamily within the phenobarbital related cytochrome P‐450 gene family. Growth hormone is known to be a major determinant for expression of P‐45015βand P‐45016αand the time course of this induction was studied at the pretranslational level. Continuous infusion of GH to hypophysectomized male rats caused an induction of P‐45015βmRNA after 6 days of treatment while intermittent injections had no effect during that time course. The opposite was found to be the case for P‐45016α, mRNA where no effect was observed following continuous administration of GH, whereas intermittent injections caused an induction after 2 days of treatment.
Relationship of Anthropometric Measurements of Body Fat Distribution to Metabolic Profile in Premenopausal Women
Authors: PEIRIS ALAN N. , HENNES MAGDA I. , EVANS DAVID J. , WILSON CHARLES R. , LEE MARTHA B. , KISSEBAH AHMED H.
Published: August 2010

ABSTRACT Regional fat distribution has emerged as an independent predictor of metabolic aberrations including glucose intolerance, hyperinsulinemia, insulin resistance, hyperlipidemia and hypertension. We investigated the comparative efficacy of various body fat distribution indices in predicting these aberrations. The relationship of circumferential ratios, skinfold measurements, and computerized tomography (CT)‐derived indices of intra‐ and extra‐abdominal fat distribution to the metabolic variables and blood pressure was examined in a cohort of healthy premenopausal women. All indices denoting preponderance of fat in the central, upper body or abdominal region were predictive of the metabolic profile. The subscapular skinfold, subscapular‐triceps ratio, waist‐hip ratio (WHR), and the CT derived intra‐abdominal fat area (CT‐IFA) were closely related to alterations in glucose and insulin concentrations independent of age and obesity. The WHR and CT‐IFA were better predictors of plasma triglyceride levels and blood pressure profile and thus the overall aberrations than skinfold measurements. Despite a high degree of intercorrelation between the anthropometric indices measured, only the relationship of WHR to CT‐IFA remained significant after adjusting for the effects of age and degree of adiposity, suggesting that WHR indexes not only the relative distribution of truncal to gluteofemoral subcutaneous fat but also the abundance of intra‐abdominal or visceral fat depots. The greater reproducibility of CT‐IFA and WHR also suggests that these measurements are the most useful in predicting the regional obesity‐associated metabolic abnormalities with their morbidity and mortality risks.
α‐Lecithin: Cholesterol Acyltransferase Deficiency
Authors: HOLMQUIST LEIF , CARLSON LARS A.
Published: August 2010

ABSTRACT. The phospholipase A2 and acyltransferase activities characteristic of human plasma lecithin: cholesterol acyltransferase have been evaluated in incubation mixtures of lipoprotein depleted plasma of fish eye disease patients and autologous HDL or homologous normal HDL3. Both enzyme activities were strongly reduced as compared to those of normal controls. These findings further support the claim that fish eye disease plasma has a specific lack of high density lipoprotein lecithin: cholesterol acyltransferase (α‐LCAT deficiency), although the cholesterol esterification of combined VLDL and LDL in such plasma proceeds at a normal rate.
Predictive Value of Prodromal Symptoms in Myocardial Infarction
Authors: KLÆBOE GUNNAR , OTTERSTAD JAN ERIK , WINSNES TORD , ESPELAND NIELS
Published: August 2010

ABSTRACT. Prodromal symptoms within four weeks prior to an acute event leading to coronary care unit admission have been studied in 276 consecutive patients interviewed within 24 hours after arrival at hospital. Coronary heart disease (CHD) was diagnosed in 237 patients, 140 of whom did develop acute myocardial infarction (AMI) (Group I) and 97 who did not (Group 2). Of the remainder, 15 had miscellaneous heart diseases (Group 3) and 24 no heart disease (Group 4). Unstable angina pectoris was equally frequent among CHD patients with and without development of AMI and was related to a higher hospital mortality in AMI patients. Less specific symptoms occurred with equal frequency in the four groups. Patients who developed AMI were not possible to identify by prodromal symptoms.
Experiences of Duplex Ultrasonography of Carotid Arteries Performed by Clinicians—correlation to Angiography
Authors: STAVENOW LARS , BJERRE PONTUS , LINDGÄRDE FOLKE
Published: August 2010

ABSTRACT.One hundred and eleven carotid vessels in 56 patients were analysed by high‐resolution duplex ultrasound. Vessels were graded as normal, 25,50 or 75% stenotic and 100% occluded and the results were compared with similarly graded biplanar angiograms. There was absolute agreement in 68.5% of the vessels, agreement within one grade of severity of disease in 27.0%, while poor correlation was obtained in 4.5%. The results of ultrasound and angiography were also related to the surgical specimens obtained after thrombendarterectomy of 23 vessels in 20 patients. Good agreement was obtained between the three methods in 20/23 vessels. In one case ultrasound was better than angiography, in another case the reverse was true and in a third case both methods overdiagnosed a plaque. It is concluded that duplex ultrasound will work in the hands of a clinician and is a reliable non‐invasive screening method for carotid artery disease leading to a more optimal selection of candidates for angiography.
Effect of Guar Gum on the Arterial Blood Pressure
Authors: KROTKIEWSKI MARCIN
Published: August 2010

ABSTRACT. Forty moderately overweight men with high waist/hip girth ratio and mild hypertension participated in a trial with gel‐forming fiber—guar gum. After two weeks of familiarization and controlled food intake, ensuring weight stability, the participants received 7 g of guar three times daily during two weeks. Patients were then followed during a 5‐week wash‐out period. There were no changes in body weight and body composition but total cholesterol decreased during gum treatment. Blood pressure measured at standing, supine and sitting positions decreased after two weeks of guar treatment by 9.8% systolic and 9% diastolic and did not revert to pre‐treatment values until after three weeks of the wash‐out period. There was also a decrease in both systolic (8 %) and diastolic (7%) blood pressures during exercise on the ergometer bicycle at 50 and 100 W (4.6 and 4.7% respectively) submaximal work load. It is concluded that mar gum exerts a lowering effect on the blood pressure in moderately obese men even in the absence of any change in body weight. If confirmed in further long‐term studies, guar may be a valuable alternative to pharmacological preparations in the treatment of mild hypertension.
Prognosis and Clinical Follow‐Up of Patients Resuscitated from Out‐of‐Hospital Cardiac Arrest
Authors: JAKOBSSON J. , NYQUIST O. , REHNQVIST N. , NORDLANDER R. , ÅSTRÖM H. , VALLIN H. , LILJEFORS I.
Published: August 2010

ABSTRACT A new organization has been formed in which ambulance personnel have been trained to recognize ventricular tachycardia and ventricular fibrillation (VF) and to defibrillate. Cardiac arrest (CA) occurred in 307 patients and 140 were defibrillated. Twenty‐eight patients were resuscitated and admitted for further hospital care. A previous history of ischaemic heart disease was found in 24 patients. Twenty‐two of the patients admitted were found to have VF, two asystole and four other rhythms. All 11 survivors regained circulation at the site of the CA. At the time of admission all but one of the patients were unconscious and one longtime survivor remained unconscious until the 5th day following admission. Seventeen patients died while still in hospital. In 16 cases a diagnosis of acute myocardial infarction was established, a further six had VF without evidence of acute myocardial infarction and six had other diagnoses. Ten out of the 11 survivors were still alive six months after discharge. Only one case of recurrent VF was seen during a median follow‐up period of 16 months. Prolonged coma, especially in combination with convulsions, was associated with a poor prognosis, while early return of circulation was significantly more common among survivors. Ongoing medication with β‐blockers, a high QRS rate on admission and VF without proof of any acute myocardial infarction were also found to be more common in survivors.
Appropriate Replacement Dose of Thyroxine in Primary Hypothyroidism
Authors: FREY H. , JOHANNESEN Ø. , KAPELRUD H. , SAND T.
Published: August 2010

ABSTRACT An ultrasensitive thyrotropin (TSH) assay was used to determine how many of 65 patients with primary hypothyroidism on thyroxine (T4) replacement therapy had suppressed serum TSH. In 13 patients (20%) TSH levels ≤0.1 mlU/l were found, indicating an overdose of thyroxine. After correction of the dose, 48 patients had normal TSH values. Their mean dose of thyroxine was 119 μg/24 hours, and the appropriate replacement dose tended to decline with advancing age. The serum level of thyroid hormones during replacement therapy with thyroxine very imperfectly reflected serum TSH values. It is concluded that overdose of thyroxine is common when suppressed serum TSH is used as an end point. Biochemical follow‐up of replacement therapy with thyroxine in primary hypothyroidism therefore requires the use of an ultrasensitive TSH assay in order to detect such suppression. Serum levels of thyroxine or triiodothyronine (T3) during thyroxine therapy are poor indicators of pituitary TSH secretion and are therefore not useful as parameters of adequate thyroxine dosage.
Alcoholic Intemperance, Coronary Heart Disease and Mortality in Middle‐aged Swedish Men
Authors: ROSENGREN ANNIKA , WILHELMSEN LARS , PENNERT KJELL , BERGLUND GÖRAN , ELMFELDT DAG
Published: August 2010

ABSTRACTHigh alcohol consumption is one of the major risk indicators for premature death in middle‐aged men. An indicator of alcohol abuse—registration with the social authorities for alcoholic problems—was used to evaluate the role of alcohol in relation to general and cause‐specific mortality in a general population sample. Altogether 1116 men (11%) out of a total population of 10004 men were registered for alcoholic problems. Total mortality during 11.8 years' follow‐up was 10.4% among the non‐registered men, compared to 20.5% among men with occasional convictions for drunkenness and 29.6% among heavy abusers. Fatal cancer as a whole was not independently associated with alcohol abuse, but oropharyngeal and oesophageal cancers together were seven times more common in the alcohol‐registered groups. Total coronary heart disease (CHD) was significantly and independently associated with alcohol abuse, but nearly all the excess CHD mortality among the alcohol‐registered men could be attributed to sudden coronary death. Cases with definite recent myocardial infarction were not more common in the alcoholic population. A combined effect of coronary arteriosclerosis and heart muscle damage secondary to alcohol abuse is suggested. Other causes of death strongly associated with registration for alcohol abuse include pulmonary embolism, pneumonia and peptic ulcer, as well as death from liver cirrhosis and alcoholism. Of the excess mortality among alcohol‐registered subjects, 20.1% could be attributed to CHD, 18.1% to violent death, 13.6% to alcoholism without another diagnosis and 11.1% to liver cirrhosis.
Increased Activity of Serum γ‐Glutamyltransferase in Myotonic Dystrophy
Authors: RÖNNEMAA TAPANI , ALARANTA HANNU , VIIKARI JORMA , TILVIS REIJO , FALCK BJÖRN
Published: August 2010

ABSTRACT The activity of serum γ‐glutamyltransferase (γ‐GT) and its determinants were studied in 17 patients with myotonic dystrophy. The γ‐GT activity was elevated in 11 patients and its mean value was five‐fold higher than in healthy controls. The increase in γ‐GT could not be explained by factors generally known to result in a misleading elevation of γ‐GT. Most patients with elevated γ‐GT also had one or more other pathological laboratory tests related to hepatic function but none had a clinically significant liver disease. Serum γ‐GT activity was not related to the disability caused by dystrophy or to the level of serum creatine kinase suggesting that the elevation of serum γ‐GT is not an indication of a general cell membrane dysfunction. It is concluded that the increase in serum γ‐GT activity in patients with myotonic dystrophy is due to a real but mild liver involvement, which should be taken into account in the examination of these patients who often complain of gastrointestinal symptoms.
Chronic 5‐HT2‐Receptor Blockade by Ritanserin Does Not Reduce Blood Pressure in Patients with Essential Hypertension
Authors: HEDNER THOMAS , PETTERSSON ANDERS , PERSSON BENGT
Published: August 2010

ABSTRACTThe selective 5‐HT2‐receptor‐blocking agent ritanserin is an analogue of the antihypertensive agent ketanserin. By evaluating the antihypertensive effects of ritanserin the aim of this investigation was to indirectly elucidate the mechanism of action of ketanserin. Thirteen patients with essential hypertension were treated with placebo and ritanserin, 10 mg bid., in a double‐blind, cross‐over design (4‐week periods). At the end of the treatment periods blood pressure as well as plasma concentrations of ritanserin were evaluated for 24 hours. Despite high steady state and peak plasma concentrations of ritanserin the compound did not lower the blood pressure compared with placebo. Since chronic selective 5‐HT2‐receptor blockade by means of ritanserin did not lower the blood pressure, it is concluded that the 5‐HT2blocking properties of ketanserin cannot alone be responsible for the antihypertensive effects of ketanserin.
Low Risk of Coronary Heart Disease in Female Type II Diabetic Subjects with Diabetic Relatives
Authors: JERNTORP PETER
Published: August 2010

ABSTRACT Possible risk factors for cardiovascular disease were studied in 52 type II diabetic subjects, 19 with and 33 without a history of coronary heart disease (CHD). None of the recognized risk factors, such as hypertension, hyperlipidaemia, smoking and blood glucose imbalance, could be related to CHD. However, all female patients with CHD were lacking a family history of diabetes, while seven of nine female diabetic subjects without a history of CHD had diabetes in the family (p<0.02). This was confirmed in a second study of 150 type II diabetic subjects; CHD was more common among female patients without compared to those with diabetes in the family; 9/38 and 1/28, respectively (p<0.03). Diabetes increases the risk of CHD, and it does so for women more than it does for men. The finding of a possible low CHD risk in female diabetic subjects with diabetes in the family supports the hypothesis of genetic factors being important for the pathogenesis of cardiovascular disease in diabetes mellitus.
Incidence of Deep Vein Thrombosis in Bedridden Non‐surgical Patients
Authors: KIERKEGAARD ASBJöRN , NORGREN LARS , OLSSON CARL‐GUSTAV , CASTENFORS JAN , PERSSON GUNNAR , PERSSON STIG
Published: August 2010

ABSTRACT. In order to detect deep vein thrombosis (DVT), 101 patients with acute medical or infectious disorders were examined with the 125I‐fibrinogen uptake test. All patients were bedridden on admission and were scanned daily from the second to the eighth day. Thirteen patients developed a positive fibrinogen uptake test. Thus, if a positive test is interpreted as DVT, the incidence of DVT was 13% in our bedridden patients. Of the patients admitted because of heart disease or pneumonia 20% had DVT, but only 4% of those admitted with other diagnoses. Other clinical “risk factors” studied, could not identify patients who developed DVT.
Snoring and Systemic Hypertension—an Epidemiological Study
Authors: GISLASON THORARINN , åBERG HANS , TAUBE ADAM
Published: August 2010

ABSTRACT. The prevalence of snoring, overweight and systemic hypertension was estimated in a random sample of 4064 Swedish men, aged 30–69 years. Of the responders, 15.5% complained of habitual snoring and 29.6% of occasional snoring. Although there was an age‐related increase in the prevalence of snoring up to 60 years, habitual snoring was found to be mainly related to body mass index (BMI) (p<0.0001) but not to age. Altogether 299 men (9.3%) reported hypertension, 21.5% of whom were habitual snorers, compared with 14.9% of the non‐hypertensives (p<0.01). The hypertensives were also more often overweight. Logistic multiple regression analyses showed that among subjects 40–49 years old there was an average increase in the predicted prevalence of hypertension from 6.5% among non‐snorers to 10.5% of habitual snorers in the same weight group. For the whole study population, however, the increase was mainly dependent on age and BMI. Thus, the importance of habitual snoring for the prevalence of hypertension differs in various age groups.
Reversibility of alcohol‐related brain damage: Clinical and experimental observations
Authors: Carlen Peter L , Wilkinson D Adrian
Published: August 2010

Chronic alcoholics who maintain abstinence often demonstrate remarkable improvement of neurological and mental dysfunction. This paper presents an overview of the clinical and laboratory work of our group. Reversible clinical manifestations include psychometric scores, ataxia, tremor, Parkinsonism, dyskinesia, cerebral atrophy, EEG parameters, and a CSF acidosis. Electrophysiological investigations showed that in the in vitro hippocampus of rats fed ethanol for several months there was evidence for diminished long‐term potentiation, impaired neuronal inhibitory mechanisms (diminished inhibitory postsynaptic potentials and post‐spike after hyperpolarisations), decreased neuronal specific membrane capacitance and increased specific membrane resistance. Golgi stains sho wed attenuation of hippocampal CA1neuronal dendrites in rats fed ethanol for five months, which reverted to control size in rats permitted two months of alcohol withdrawal.
Brain lesions in alcoholics: Neuropathological observations
Authors: Torvik Ansgar
Published: August 2010

Examination of the autopsy material from a city hospital in Oslo gave the following results:

The brain weight of male alcoholics was significantly lower than that of age‐matched controls in all 10‐year age groups from 40 to 69 years. The mean weight reduction was 31 g.

Combined morphometric and histologic studies demonstrated atrophy of the anterior vermis in 42 per cent of all male alcoholics under 70 years of age. In cases over 70 years, 33 per cent of the non‐alcoholic controls showed atrophy of the anterior vermis. This is assumed to be a consequence of physiologic ageing. The prevalence of alcoholic cerebellar atrophy could therefore not be determined in this age group.

Wernicke's encephalopathy was found in 12.5 per cent of all alcoholics and in 0.8 per cent of all autopsies. One third of the Wernicke cases had acute and subacute lesions while two thirds were chronic. Most of the acute lesions were widespread and severe. The chronic lesions were more restricted but showed great variations in extent and severity within the affected areas. There were corresponding variations in the severity of the clinical symptoms.
Experimental models for studying the effects of ethanol on the myocardium
Authors: Regan Timothy J , Morvai Veronika
Published: August 2010

The ability to induce alcoholic cardiomyopathy has been tested in a variety of animal species. Myocardial alterations consistent with subclinical heart disease have been produced in many of these studies through a direct effect of ethanol or its metabolites upon the heart or a neurohumoral mechanism. In the rat most studies have, however, failed to finding diminished contractility in the basal state. In long‐term animals the acute left ventricular responses to isoproterenol and calcium as well as pacing were reduced. Long‐term studies in mongrel dogs fed 36 per cent of calories as ethanol produced an early decrease in left ventricular diastolic compliance related to interstitial collagen accumulation. Diminished contractility developed by four years. In addition to the morphologic evidence of distorted sarcoplasmic reticulum, in vitro experiments suggest important acute effects. Each mole of ethanol is bound tightly to each mole of protein comprising the Ca‐ATPase pump, which is inhibited. Impaired uptake and binding of calcium by the sarcoplasmic reticulum has been observed in chronic alcohol models at one to two day intervals following the last exposure to ethanol. In addition, the flux of calcium ion does not appear normal in terms of access to contractile protein, where the calcium regulated inhibition of the troponin interaction with myosin is impaired. Experimental studies in a canine model of alcoholism revealed that the ventricular fibrillation threshold was moderately reduced in the basal state after 18 months and was diminished further after acute exposure.
Monitoring of Major Cardiovascular Diseases in Moscow, USSR
Authors: VARLAMOVA T. , ZHUKOVSKI G. , CHAZOVA L. , BRITOV A.
Published: August 2010

ABSTRACT. Since 1984, suspected events of myocardial infarction and cerebral stroke have been registered and validated for residents of both sexes aged 25–64 in three Moscow administrative districts. The results of the myocardial infarction and stroke registers for 1985 are presented. In men, age‐standardized attack rates per 100,000 population in the three districts were 310–400 for myocardial infarction, and 100–180 for stroke; the mortality due to myocardial infarction was 136–179, and the mortality due to stroke was 30–53. In women these rates were 70–90, 60–100, 24–35 and 24–32, respectively.