bluuebunny/crossref_metadata_2025 huggingface dataset:
Risk Factors for Ischaemic Heart Disease in Men and Women:Results of the 19‐Year Follow‐up of the Stockholm Prospective Study
Authors: CARLSON LARS A. , BÖTTIGER LARS ERIK
Published: August 2010

ABSTRACT.In this 19‐year follow‐up of the Stockholm Prospective Study (SPS), 321 male and 55 female deaths from myocardial infarction (MI) had occurred. Fasting levels of plasma triglycerides acted as an independent risk factor for this cause of death in both sexes, which was the primary question asked when the SPS was designed. Other independent risk factors for MI were for men and women age, systolic blood pressure, smoking and for men only, plasma cholesterol, haemoglobin and erythrocyte sedimentation rate.
Vasospastic Ischaemia Induced by the Hyperventilation Test in Patients with a Negative Response to Ergometrine
Authors: RASMUSSEN KLAUS , BAGGER JENS PEDER
Published: August 2010

ABSTRACT.We present the case histories of two patients with angina pectoris who developed coronary artery spasm in response to provocation with prolonged hyperventilation (verified by ST segment elevation in both and coronary angiography in one) despite a negative ECG response to intravenous injection of 0.4 mg ergometrine. This new observation, which is in conflict with recent publications stating that ergot provocation is more sensitive than hyperventilation, suggests that in some patients diagnostic provocation with hyperventilation may be an alternative to the widely used ergot provocation.
Antihypertensive, Haemodynamic and Metabolic Effects of Nifedipine Slow‐Release Tablets in Elderly Patients
Authors: LANDMARK KNUD , DALE JON
Published: August 2010

ABSTRACT. In a double‐blind, cross‐over study for 8 weeks, including 10 non‐hospitalized elderly hypertensives (average age 73.2 years), WHO stage I—II, the antihypertensive effect of nifedipine slow‐release tablets, 20 mg twice daily, was compared with placebo. Nifedipine reduced supine and standing blood pressure values significantly, and no signs of orthostatic hypotension were noted. An initial increment in heart rate was found after 1 week with a subsequent fall towards control values after 8 weeks of nifedipine administration. Heart rate pressure product in the supine position was reduced, and this reduction became statistically significant at the 8th week. Cardiac output measured non‐invasively in 8 patients after 6–8 weeks' nifedipine therapy, using an Irex echocardiograph, was on an average 34% higher than in the placebo period (p < 0.05). Serum electrolytes, cholesterol, HDL cholesterol, blood glucose and renal function were not affected by the drug. Side‐effects were few and mild. It is concluded that nifedipine is a potent antihypertensive agent which may represent an attractive first choice alternative in the treatment of elderly hypertensive patients.
Identifying Severe Aortic Valvular Stenosis by Bedside Examination
Authors: FORSSELL GUNILLA , JONASSON RUNE , ORINIUS ERIK
Published: August 2010

ABSTRACT. Sixty‐seven consecutive symptomatic patients with aortic valvular stenosis (AS) and no or slight aortic incompetence were prospectively examined bedside by a senior cardiologist before an invasive pre‐operative investigation. A history of effort syncope had the highest predictive value (pos), 100%, for a significant degree of AS (defined as a calculated valve area ≤0.9 cm2 or a peak systolic pressure difference across the valve of 5≥40 mmHg). The absence of effort syncope had a predictive value (neg) of 40%. The corresponding figures for peak intensity of the murmur in mid‐systole were 93 and 82%, respectively. For the combination of effort syncope and/or mid‐systolic peak intensity of the murmur (borderline findings included) the predictive values were 90% (pos) and 94% (neg), respectively. No other combination of symptoms and physical finding was more discriminating. This combination of criteria for prediction of a significant stenosis was prospectively applied to the next 39 AS patients. The criteria were fulfilled by 29 patients and all were found to have a significant AS as were four of the 10 patients not fulfilling the criteria. These four falsely negative patients had a valve area/peak pressure difference of 0.5, 0.8, 0.8 cm2 and 43 mmHg. The inter‐observer variation was studied in a third series by two senior cardiologists independently examining 22 AS patients. They were concordant in all with regard to a history of effort syncope and in all but one (0.6 cm2) with regard to the timing of the peak murmur. Bedside examination of an AS patient by an experienced cardiologist has a good predictivity for severity, and the inter‐observer variation is low. Non‐invasive laboratory investigations have only a supplementary role. However, as many patients have effort angina, a pre‐operative invasive procedure including coronary arteriography is often unavoidable.
Staging of Idiopathic Myelofibrosis: Significance of Haemoglobin Value and Reticulocyte Count
Authors: GUSTAVSSON PETER , HOLM JAN , WAHLIN ANDERS , NORBERG BO
Published: August 2010

ABSTRACT. A retrospective analysis of 18 patients with idiopathic myelofibrosis (IMF) suggested that IMF is adequately staged by combining haemoglobin value and reticulocyte count. Four stages were recognized. All deaths occurred in late stage. The stages appeared to reflect a sequential course of the disease. The present staging system adequately identified patients at high risk. However, the rate of disease progress varied greatly. It is therefore suggested that the rate of disease progress should also be considered when an individual patient is evaluated.
Rapid Effect of Prednisolone on Serum 1,25‐Dihydroxycholecalciferol Levels in Hypercalcemic Sarcoidosis
Authors: NORDAL KNUT P. , DAHL EILIF , HALSE JOHAN , AKSNES LAGE , AARSKOG DAGFINN
Published: August 2010

ABSTRACT. We have studied a hypercalcemic patient with sarcoidosis and advanced renal failure. Bone biopsy and urinary cAMP excretion indicated suppression of parathyroid function. 1,25(OH)2D levels were moderately elevated and dropped to low normal levels during prednisolone treatment. Discontinuation of prednisolone treatment caused deterioration of renal function and hypercalcemia, 1,25(OH)2D serum levels being within the normal range. Our data demonstrate the rapid speed at which prednisolone causes a drop in serum 1,25(OH)2D level. Since hypercalcemia was observed both during periods of hypercalciuria and normal serum 1,25(OH)2D levels, increased sensitivity to active vitamin D seems likely. There was no significant correlation between 25(OH)D, 24,25(OH)2D or 25,26(OH)2D. Furthermore there was no correlation between any of these three metabolites and either 1,25(OH)2D or serum calcium.
PACEMAKER INFECTIONS
Authors: Bluhm Gösta
Published: August 2010

Infection is a major complication of pacemaker treatment. Antibiotic prophylaxis has been used in association with pacemaker surgery with conflicting results, and conclusive prospective trials are lacking. This investigation indicated that systemic antibiotic prophylaxis was of benefit when infections occured frequently. The effect of local antibiotic prophylaxis was comparable with that of systemic prophylaxis at generator replacements. No serious adverse effects of the prophylaxis were noted. However, with modern surgical methods and hygienic principles, antibiotic prophylaxis did not seem to be necessary at implantation of new cardiac pacemakers.

Once infection had developed it was difficult to eradicate and serious complications sometimes occured. Most infections commenced in the pacemaker pocket. A few cases were cured by antibiotic treatment alone but, particularly if the infection spread along the electrode, surgery was strongly needed and in the presence of endocarditis and/or septicemia all foreign material should be removed if possible.

The most common causal microorganisms of pacemaker infections were Staphylococcus aureus and Staphylococcus epidermidis. Routinely performed pre‐, per‐ and postoperative cultures were of no prognostic value. Persistent use of antibiotics could select for methicillin‐resistant coagulase‐negative staphylococci, therefore bacteriological monitoring of wound infections was considered important.

The dosage schedules used for cloxacillin and flucloxacillin gave satisfactory serum concentrations peroperatively. Local treatment with cloxacillin in the pacemaker pocket peroperatively gave adequate concentrations in tissue fluid from the pocket 24 h after the operation, as did systemic administration of flucloxacillin. The pharmacokinetics of flucloxacillin in these elderly patients differed in some respects from that found in healthy volunteers. Plasma elimination half‐life was almost twice as long. Despite the high degree of plasma protein binding, flucloxacillin appeared to pass rapidly and efficiently to extravascular compartments, such as a pacemaker pocket.
The Role of Glucagon, Catecholamines and Cortisol in Counterregulation of Insulin‐induced Hypoglycemia in Normal Man
Authors: LINS PER‐ERIC , ADAMSON ULF , CLAUSEN NINA , HAMBERGER BERTIL , EFENDIĆ SUAD
Published: August 2010

ABSTRACT To study the response of glucose counterregulation to insulin‐induced hypoglycemia, six normals were given a 4‐hour infusion of insulin (2.4 U/h) ± somatostatin (50 μg/h). Supplementary glucagon (1.5 or 3.0 ng/kg/min) was given in additional experiments. In a separate study, glucagon was supplemented for 4 hours as a constant rate infusion (3.25 ng/kg/min) or at rates stepwise increasing from 1.5 to 5.0 ng/kg/min. Insulin decreased blood glucose by 1.5 mmol/1 and simultaneous suppression of glucagon resulted in a more pronounced hypoglycemia enhancing the adrenaline and Cortisol responses. The hyperglycemic effect of glucagon substitution (3 ng/kg/min) faded out after about 2 hours, whereafter exaggerated adrenaline and Cortisol responses to hypoglycemia were seen. A comparison between the effects of steady state hyperglucagonemia and gradually appearing hyperglucagonemia on the counterregulation of hypoglycemia revealed no significant differencies in glucose, adrenaline and Cortisol responses to insulin. It is concluded that the glycemic effect of glucagon is transient in the hypoglycemic state. When the hepatic responsiveness to this hormone is decreased during hypoglycemia, adrenaline becomes the essential protective factor.
The Significance of the Enterohepatic Circulation on the Metabolism of Digoxin in Patients with the Ability of Intestinal Conversion of the Drug
Authors: NØRREGAARD‐HANSEN K. , KLITGAARD N. A. , PEDERSEN K. E.
Published: August 2010

ABSTRACT A cardiac patient had to be given a very high dosage of digoxin to attain therapeutic plasma level. The increased dosage requirement could partly be explained by reduced bioavailability due to intestinal conversion of digoxin. Consequently, the kinetics of the drug was examined before and after erythromycin treatment. Before treatment the determination of the area under the concentration versus time curve (AUC) following a single dose of digoxin given orally or intravenously demonstrated a substantial reduction in the absolute bioavailability. Erythromycin administration during 20 days caused a dramatic rise in AUC when the single oral dose was repeated, exceeding the two AUC obtained prior to initiation of the antibiotic therapy, and the steady state plasma digoxin level was 2–3–fold increased. The fact that the AUC obtained for a single oral dose of digoxin after erythromycin treatment exceeded that obtained when given intravenously before erythromycin indicated the presence of an entrohepatic circulation of digoxin. This may contribute substantially to the elimination of digoxin in patients with the capability of intestinal conversion of digoxin.
Detection of Nocturnal Hypoglycemia in Insulin‐treated Diabetics by a Skin Temperature ‐ Skin Conductance Meter
Authors: JOHANSEN K. , ELLEGAARD S. , WEX S.
Published: August 2010

ABSTRACT The efficacy and credibility of a skin temperature ‐ skin conductance meter (Teledyne Sleep Sentry) for detecting hypoglycemia was studied during night‐time in 22 adult insulin‐treated diabetics. Capillary blood glucose concentration was measured 99 times (when the alarm sounded, in case of hypoglycemic symptoms, and at 3 a.m.). Hypoglycemia was defined as a capillary blood glucose concentration of ≤3 mmol/l. Blood glucose was measured 61 times in connection with sounding of the alarm and 38 times without the alarm sounding. At 3 a.m. the Sleep Sentry sounded the alarm 22 times, of which hypoglycemia was present 6 times giving a diagnostical specificity or diagnostical true positive rate of 0.27 (95 % confidence limits 0.11–0.50). In 35 of 38 cases of no alarm the blood glucose was >3 mmol/l, giving a diagnostical sensitivity of 0.92 (95 % confidence limits 0.79–0.98). The Sleep Sentry sounded the alarm in 6 of 9 cases of hypoglycemia, giving a nosological sensitivity of 0.67 (95 % confidence limits 0.30–0.93). The Sleep Sentry did not sound the alarm in 35 of 51 cases of non‐hypoglycemia, giving a nosological specificity of 0.69 (95 % confidence limits 0.54–0.81). In other words, the Sleep Sentry detects about 2/3 of blood glucose values ≤3 mmol/l, but in addition it sounds a false alarm in 2/3 of the cases.
Heat Stroke in Endurance Exercise
Authors: AARSETH H. P. , EIDE I. , SKEIE B. , THAULOW E.
Published: August 2010

ABSTRACT Six athletes were examined immediately after collapsing from heat stroke during exercise, and then followed for several weeks. At the time of collapse most of the patients were sweating profusely, their rectal temperatures being more than 42°C. All recovered within a few hours. The renal function was not disturbed more than expected during heavy exercise, serum levels of liver enzymes were, however, increased for several weeks. Electrolyte homeostasis was undisturbed but for a transient hypercalcemia that can not be fully explained. The marked increments in plasma levels of catecholamines, vasopressin and renin were as expected after heavy exercise. We conclude that as heat stroke presents as a continuum of clinical pictures, biochemical evidence of liver cell injury is a sensitive and important parameter for the diagnosis.
Acupuncture in Severe, Stable Angina Pectoris: a Randomized Trial
Authors: BALLEGAARD SOEREN , JENSEN GORM , PEDERSEN FLEMMING , NISSEN VIBEKE H.
Published: August 2010

ABSTRACT Twenty‐six patients with stable angina pectoris, resistant to medical treatment, were randomized to either active or sham acupuncture in a single‐blind design. Sham acupuncture was defined as the insertion of needles in a point within the same spinal segments as the active acupuncture, but outside the Chinese meridian system. The effect was evaluated from anginal attack rate, nitroglycerin consumption and exercise tests. Compared to patients receiving sham acupuncture the patients receiving active acupuncture increased cardiac work capacity significantly, expressed as dPRP (difference in pressure‐rate‐product between rest and maximum exercise) and maximal PRP during exercise (p<0.001). None of the other variables showed any significant difference between the two groups. Concerning exercise tolerance the median difference was 138 Wmin (95% confidence limits ‐12.5 to 325 Wmin), concerning anginal attack rate the median difference was 29.5% (95% confidence limits 55% to ‐11%) and with regard to nitroglycerin consumption the median difference was 5% (95% confidence limits +67% to ‐44%). No significant effect of sham treatment was observed, no adverse effect was observed. We suggest that acupuncture may improve cardiac work capacity in patients with angina pectoris, refractory to medical treatment.
Prevalence of Hyperglycaemia and Undiagnosed Diabetes Mellitus in Patients with Acute Myocardial Infarction
Authors: MADSEN JAN KYST , HAUNSØE STIG , HELQUIST STEFFEN , HOMMEL EVA , MALTHE INGER , PEDERSEN NIELS THORSGAARD , SENGELØV HENRIK , RØNNOW‐JESSEN DORTE , TELMER STEEN , PARVING HANS‐HENRIK
Published: August 2010

ABSTRACT The prevalence of hyperglycaemia and undiagnosed diabetes mellitus was assessed in 214 consecutive patients admitted to the coronary care units with acute myocardial infarction (AMI). On admission, 16 patients (7.5%) had known diabetes, and 19 patients, not previously known to be diabetic, had blood glucose concentrations of ≥9 mmol/1. Fifteen patients survived for 2 months at which time a 75 g oral glucose tolerance test showed diabetes in 9 (60%) and impaired glucose tolerance in 4 (27%). Ten of these 13 patients (77%) with abnormal glucose tolerance had elevated glycosylated haemoglobin (HbA1c) on admission, indicating pre‐existing glucose intolerance or diabetes. The prevalence of undiagnosed diabetes was 4.5% (9/198). However, we may have overlooked undiagnosed diabetes in a small number of patients on admission, since only a random blood glucose <8 mmol/1 rules out diabetes, WHO criteria. Elevated blood glucose in patients with AMI is more likely to reflect a stationary pre‐existing abnormal glucose tolerance than a temporary stress‐induced phenomenon.
Long‐term Survival in Giant Cell Arteritis Including Temporal Arteritis and Polymyalgia Rheumatica
Authors: ANDERSSON RUNE , MALMVALL BO‐ERIC , BENGTSSON BENGT‐ÅKE
Published: August 2010

ABSTRACT Ninety patients with giant cell arteritis (GCA) were followed for 9–16 years after diagnosis. Corticosteroids were given to all but one patient. Forty‐two patients died during the observation period (27 women and 15 men). The survival was compared with that in the general population and found not to be reduced among the GCA patients. In fact, we found a lower mortality than expected after five years from diagnosis (p<0.05). We did not see any increase in deaths due to vascular or malignant diseases in our patients.
Long‐term Corticosteroid Treatment in Giant Cell Arteritis
Authors: ANDERSSON RUNE , MALMVALL BO‐ERIC , BENGTSSON BENGT‐ÅKE
Published: August 2010

ABSTRACT Ninety patients with giant cell arteritis were followed up 9–16 years (median 11.3 years) after diagnosis. The mean duration of corticosteroid therapy was 5.8 years (range 0–12.8 years). Together, the patients had received corticosteroids for 492 patient‐years. Five years after diagnosis, 43% of the patients were on corticosteroid therapy. After 9 years, 15 of 60 surviving patients (25%) were still being treated with 1.25–10 mg of prednisolone daily (median dose 5 mg). The relapse rate was about 50%, regardless of the time after diagnosis, when an attempt to withdraw the treatment was made. Forty‐six per cent of the relapses occurred within one month and 96% within one year of the end of treatment. Most of the flare‐ups occurred during the first year of therapy and in 55% of the patients on a prednisolone dosage of 5 mg or less. We did not find any increase in morbidity in our patients compared to the general population. Nor did we see any significant complications which we could attribute to the steroid treatment.
Urinary Tract and Renal Findings in Acute Yersinia Infections
Authors: KORPELA M. , MUSTONEN J. , PASTERNACK A. , LEINIKKI P.
Published: August 2010

ABSTRACT We studied 71 patients with acute Yersinia infection for the occurrence of pathologic urinary and renal findings. Transient proteinuria and/or microhematuria was found in 17 patients (24%) and slightly elevated serum creatinine in seven patients (10%). Renal biopsy was done in two patients and revealed mild mesangial glomerulonephritis in both cases. One of these patients had IgA glomerulonephritis and Reiter's syndrome. Pyuria occurred in 16 patients (23%) and was frequently associated with Reiter's syndrome. Seventy‐three patients with acute intrinsic renal failure were studied for the occurrence of acute Yersinia infection by determining Yersinia antibodies by ELISA. One out of 13 patients with acute glomerulonephritis but none of 60 patients with acute tubulointerstitial renal disease had acute Yersinia infection. Acute Yersinia infection seems to be rarely an etiologic factor in acute intrinsic renal failure. Our results indicate that transient proteinuria, microhematuria, pyuria or impaired renal function are frequent findings in patients with acute Yersinia infections. However, glomerulonephritis seems to be a rather infrequent and mild complication of acute Yersinia infection.
Acrodermatitis Chronica Atrophicans Herxheimer Can Often Mimic a Peripheral Vascular Disorder
Authors: FAGRELL BENGT , STIERNSTEDT GÖRAN , ÖSTERGREN JAN
Published: August 2010

ABSTRACT During the past few years five patients have been referred to the angiology section at Danderyd Hospital under the diagnosis of chronic venous insufficiency but who were instead suffering from acrodermatitis chronica atrophicans (ACA). The typical case of ACA starts with a limited inflammatory lesion, which is gradually replaced by atrophy and the skin shows a bluish, red discoloration. Late changes may be subluxation of joints in hands or feet and periosteal thickening. Capillary microscopy often reveals a clear picture of atrophy and a prominent, dilated subpapillary venular plexus. If localized to the leg the blood flow of the foot and lower leg may be increased, skin temperature elevated and venous capacity and return augmented. All these variables can consequently mimic venous insufficiency of the leg. ACA is caused by a Borrelia infection and serological testing will always show a significantly elevated titer to Borrelia. The disease is most often easily cured by 2–3 g of penicillin daily for two to three weeks.
The Many Faces of Goodpasture's Syndrome
Authors: NILSSEN DAG E. , TALSEHT TORE , BRODWALL ERLING K.
Published: August 2010

ABSTRACT Four cases of antiglomerular basement membrane (antiGBM) antibody mediated disease with unusual features are presented. Lung involvement was absent in one patient whereas the other 3 had Goodpasture's syndrome. Recognition of the nature of the disease was delayed in all cases, due to occurrence during pregnancy in one case and due to the indolent course of the renal injury in the other 3 cases. The therapeutic approach to these variant forms of antiGBM antibody mediated disease is discussed.
Converting Enzyme Inhibition in Mild and Moderate Essential Hypertension. II
Authors: RASMUSSEN STEN , LETH ARNE , IBSEN HANS , NIELSEN META DAMKJÆR , NIELSEN FINN , GIESE JØRN
Published: August 2010

ABSTRACT. In 24 patients with mild/moderate essential hypertension, we studied the effects of captopril with/without hydrochlorothiazide (Htz) on blood pressure, the renin‐angiotensin system, blood bradykinin concentration (BBK), plasma volume, exchangeable sodium and glomerular filtration. Daily captopril doses of 75 and 150 mg were equally effective in reducing the blood pressure. Addition of Htz caused further blood pressure reductions. Nineteen patients attained a diastolic blood pressure ≤90 mmHg. Angiotensin converting enzyme inhibition with captopril led to a fall in plasma concentrations of angiotensin II (PAII) and renin substrate, and an increase in plasma concentrations of renin and angiotensin I. Patients starting with Htz had a higher PAII and subsequently a larger fall in blood pressure on captopril than untreated patients. BBK remained unchanged, indicating that the hypotensive action of captopril does not involve an accumulation of circulating kinin. Body fluid volumes and renal function were not affected by the various treatment regimens.
The Relationship of Blood Pressure to Blood Glucose and Physical Leisure Time Activity
Authors: CEDERHOLM JAN , WIBELL LARS
Published: August 2010

ABSTRACT. Hypertension was detected in 56 of 436 women and 34 of 371 men in an urban population sample of 47–54‐year‐old individuals. The prevalence of glucose intolerance according to WHO criteria was 22.2% in the hypertensive group and 4.3% among the normotensives, with mean 2‐hour blood glucose values of 5.8 and 4.4 mmol 1‐1, respectively. The difference in mean 2‐hour blood glucose was independent of body mass index, physical activity during leisure time or at work, age and smoking in covariance analysis. Subjects with high physical leisure time activity (n = 125) had a lower mean blood pressure and a lower prevalence of hypertension, 4.8%, than those with low activity (n = 682), 12.3%. The increase in diastolic blood pressure in the latter group and the male subgroup appeared to be independent of body mass index, physical job activity, age and smoking. Multiple regression analyses with blood pressure as dependent variable and six metabolic and clinical characteristics as predictors identified 2‐hour blood glucose and body mass index as the most important predictors. Physical leisure time activity was associated with diastolic blood pressure, however only when 2‐hour blood glucose was not included as predictor. Thus, physical activity may exert an influence on the blood pressure level mainly through changes in glucose tolerance and/or body weight, although alternative mechanisms cannot be excluded.
Distribution of High Density Lipoprotein Cholesterol According to Relative Body Weight, Cigarette Smoking and Leisure Time Physical Activity
Authors: FØRDE OLAV H. , THELLE DAG S. , ARNESEN EGIL , MJØS OLE D.
Published: August 2010

ABSTRACT. The relationship between HDL cholesterol and relative body weight, cigarette smoking and leisure time physical activity were examined in 7 338 healthy men and 6 768 healthy women aged 20–53 years, living in Finnmark County, Northern Norway. The independent effects of the three factors were examined by an analysis of covariance. In both sexes a strong and almost linear negative association was observed between relative body weight and HDL cholesterol. HDL cholesterol was lower in smokers than in non‐smokers, the difference being more pronounced in females than in males. A weak but significant positive association was observed between leisure time physical activity and HDL cholesterol in both sexes.
Xamoterol, a New Selective β‐1‐Adrenoceptor Partial Agonist, in the Treatment of Postural Hypotension
Authors: MEHLSEN J. , TRAP‐JENSEN J.
Published: August 2010

ABSTRACT. Three patients severely disabled from postural hypotension were treated with xamoterol, a selective β‐1‐adrenoceptor antagonist with a high degree of partial agonist activity. Oral treatment (200 mg b.i.d.) was chosen on the basis of the effects of acute intravenous administration of xamoterol and pindolol, a non‐selective β‐adrenoceptor antagonist with partial agonist activity. In these patients pindolol had a predominantly antagonist effect, whereas xamoterol had a predominantly agonist effect after intravenous administration. Oral treatment was carried out with placebo control in a single‐blind fashion. The patients reported gradual improvement during the first days of treatment. After 1 month of oral treatment, heart rate had increased by 15 beats/min, systolic blood pressure from 131 to 170 mmHg, diastolic blood pressure from 77 to 91 mmHg and mean blood pressure by 22 mmHg (mean values, supine). During the placebo period (2 weeks) heart rate decreased to pretreatment levels and mean blood pressure was reduced by only 14 mmHg. The patients reported substantial improvement in their condition during active medication. Xamoterol seems to be a useful alternative in the treatment of postural hypotension.
Hepatotoxicity of Amiodarone
Authors: RUMESSEN JÜRI JOHANNES
Published: August 2010

ABSTRACT.Amiodarone has proved very effective in the treatment of otherwise resistant cardiac tachyarrhythmias. The use of amiodarone has, however, been limited due to its serious side‐effects. A patient with cholestatic hepatitis due to amiodarone treatment is presented below and a review of the hepatotoxicity of amiodarone is given. It is concluded that solid evidence exists of hepatic injury due to amiodarone treatment, including steatosis, alterations resembling alcoholic hepatitis, cholestatic hepatitis and micronodular cirrhosis of the liver. Patients receiving amiodarone should be regularly screened with respect to hepatic enzyme levels. Therapy should be discontinued on the suspicion of cholestatic injury or hepatomegaly.
The Skaraborg Hypertension Project
Authors: RÅSTAM LENNART , BERGLUND GÖRAN , ISACSSON SVEN‐OLOF , RYDÉN LARS
Published: August 2010

ABSTRACT.The feasibility of a nurse‐based care program for hypertension has been evaluated. The program was established in one half of the County of Skaraborg, the other half being selected as control area. Record forms from the diagnostic work‐up and annual check‐ups of all 3 240 patients registered during five years were reviewed. Compliance with diagnostic procedures and treatment was excellent. At the end of the five‐year trial period, 7% of the population studied (40–69 years old) were registered at special outpatient hypertension clinics. Random samples were drawn of patients treated at these clinics and patients taken care of in the control area. These patients were interviewed concerning their general opinion about the care, their opinion about nurses as the main deliverers of care, the continuity of care and needs for information. The comparisons favoured care at the hypertension clinics. It is concluded that the program was feasible and preferred to conventional care by the consumers.
Reduction of the Pyrexial Response to Acute Myocardial Infarction by β‐Adrenoceptor Blockade
Authors: RISØE CECILIE , KIRKEBY OLE J.
Published: August 2010

ABSTRACT. We have studied the effect of β‐adrenoceptor blockade on the pyrexial response to acute myocardial infarction (AMI). Temperatures of 22 patients treated with timolol, 20 mg daily, in the acute phase of AMI were compared to temperatures of 22 patients not receiving timolol treatment. Fever response after AMI was significantly reduced in the timolol‐treated patients, maximal and mean temperature in the febrile period being lower and the febrile period being shorter. Reduction of fever in AMI may be of importance as a higher body temperature increases the risk of developing heart failure and arrhythmias. The study lends support to the use of β‐adrenoceptor blockade in AMI. It also substantiates a possible role of β‐adrenergic receptors in the regulation of body temperature during fever.
Lack of Association between Hemochromatosis and α‐Antitrypsin Deficiency
Authors: ERIKSSON STEN , LINDMARK BERTIL , OLSSON SIGVARD
Published: August 2010

ABSTRACT. α1‐Antitrypsin (AAT) deficiency of phenotype PiZ and idiopathic hemochromatosis (IH) predispose to the development of cirrhosis and liver cell carcinoma. Several reports have suggested an association between these two inborn errors. To elucidate this question we used a monoclonal antibody against the PiZ gentic variant of AAT to analyze and compare the PiZ gene frequency in an area (county of Jämtland in Central Sweden) with a high, and another area (the city of Malmö in Southern Sweden) with a low IH prevalence. The PiZ gene frequencies did not differ between the areas. We also analyzed sera from 27 unrelated adult males with hemochromatosis diagnosed in the high IH area for the presence of the PiZ gene product but none was a carrier of the PiZ allele. These findings strongly refute any association between. AAT deficiency and IH.
Muscle Water and Electrolytes in Patients Undergoing Continuous Ambulatory Peritoneal Dialysis
Authors: LINDHOLM BENGT , ALVESTRAND ANDERS , HULTMAN ERIC , STRÖM JONAS BERG
Published: August 2010

ABSTRACT. Muscle water and electrolytes were determined in percutaneous muscle biopsy material from m. quadriceps femoris in 33 uremic patients undergoing continuous ambulatory peritoneal dialysis (CAPD) for 1–38 months, and in 34 normal subjects. The patients showed increased muscle contents of water, sodium, and chloride relative to fat‐free solids (FFS); both intra‐ and extracellular water contents were increased. The total water content was inversely correlated with the duration of CAPD. The muscle potassium content was increased, both relative to FFS and to magnesium, whereas the intracellular potassium concentration was normal. Despite hypermagnesemia, the muscle content of magnesium was normal and the intracellular concentration was even slightly decreased due to the increase in intracellular water. We conclude that muscle water and electrolyte status is abnormal in CAPD patients, but the alterations appear to be less marked than in uremic patients undergoing other forms of therapy.
Long‐term Sequelae of Calf Vein Thrombosis Treated with Heparin or Low‐dose Streptokinase
Authors: SCHULMAN SAM , GRANQVTST STAFF AN , JUHLIN‐DANNFELT ANDERS , LOCKNER DIETER
Published: August 2010

ABSTRACT. A prospective randomized study was performed to investigate the long‐term sequelae of calf vein thrombosis (CVT) and correlate them to the success of the initial treatment. Thirty‐six patients with symptomatic CVT, verified by venography, were treated with heparin or low‐dose streptokinase (SK) combined with low‐dose heparin. Venography was repeated after 1 week, and long‐term follow‐up was performed clinically and with foot volumetry after an average of 5 years. Since the low‐dose SK regimen led to serious hemorrhagic side‐effects in a parallel study, the present investigation was discontinued prematurely. The thrombolysis achieved was greater with SK but, since the initial thrombi were somewhat larger in this group, no significant difference in the average size of the thrombi after therapy could be displayed between the groups. The long‐term sequelae and results of foot volumetry were also equal. Signs or symptoms of venous insufficiency were found in 37%, and foot volumetry showed deep venous insufficiency in 26% of the cases. There was a correlation between the hemodynamic change, as assessed by foot volumetry, and the venographic severity. This relation was stronger for the size of the thrombus after treatment than for the initial size. Thus, it seems important to limit the extent of a CVT in order to minimize the long‐term sequelae, but administration of SK is not justified due to side‐effects.
Antihypertensive and Biochemical Effects of Different Doses of Hydrochlorothiazide Alone or in Combination with Triamterene
Authors: KOHVAKKA ANTTI , SALO HANNU , GORDIN ARIEL , EISALO ANTTI
Published: August 2010

ABSTRACT.The antihypertensive and biochemical effects of 25 mg hydrochlorothiazide alone or 50 mg hydrochlorothiazide alone or in combination with triamterene (either 37.5 or 75 mg) once daily were studied in 26 patients with essential hypertension. After a 5‐week run‐in period the patients were randomized to receive active therapy in a cross‐over manner. Each treatment period lasted 3 months. All drugs significantly (p< 0.01) lowered both systolic and diastolic blood pressure. There were no differences in blood pressure between the medication periods. Serum potassium concentration was slightly lower during all medication periods than during the run‐in period. This change was statistically significant (p< 0.01) only on 50 mg hydrochlorothiazide daily. There were no significant changes in serum magnesium during any of the periods compared to the run‐in period. The lowest values were recorded on 50 mg hydrochlorothiazide alone and the highest on 50 mg hydrochlorothiazide plus 75 mg triamterene daily. A slight increase in serum urate was recorded in all medication periods compared to the run‐in period. No significant changes were observed in serum total cholesterol, HDL cholesterol or triglycerides between any of the periods. It can be concluded that 25 mg of hydrochlorothiazide is as effective in lowering blood pressure as higher doses of the diuretic. Higher doses of thiazides will in some patients cause adverse metabolic reactions of which the fall in serum potassium and magnesium is effectively hindered by triamterene.
Indices of Mineral Metabolism in Relation to Blood Pressure in a Sample of a Healthy Population
Authors: HVARFNER A. , LJUNGHALL S. , MÖRLIN C. , WIDE L. , BERGSTRÖM R.
Published: August 2010

Indices of mineral metabolism in blood and urine were analysed in relation to blood pressure in 97 healthy subjects aged 16–82 years. In a multivariate analysis, after allowing for the effects of sex, body mass index (BMI) and age, there was an inverse relationship between plasma level of ionized calcium and mean blood pressure (MBP) (β=‐50.0 mmHg/mmol/l P‐ionized calcium, p= 0.0005). In univariate analyses MBP also showed statistically significant inverse relationships with plasma ionized calcium, serum phosphate and renal threshold concentration of phosphate; positive relationships to MBP were found for fasting urinary excretion of calcium and cyclic adenosine monophosphate. However, when examined multivariately, only the relation between MBP and plasma ionized calcium persisted. This study supports previous findings of an inverse relationship between blood pressure and serum ionized calcium and extends the observations to the physiological range. It is further evident from this study that BMI and age should be taken into account in analyses of the relationship between blood pressure and mineral metabolism.
Local Disodium Cromoglycate Is Ineffective in Ulcerative Proctosigmoiditis
Authors: HOVDENAK NILS , HALVORSEN LARS , NORDGÅRD KÅRE , SCHJØNSBY HENNING , SIGSTAD HELGE
Published: August 2010

ABSTRACT. Conflicting results have emerged from studies using oral and rectal disodium cromoglycate (DSCG) in inflammatory bowel disease. In the present double‐blind study, 43 patients with active ulcerative proctosigmoiditis received either placebo (n=22) or 600 mg DSCG (n= 21) rectally as enemas for eight weeks. Assessment was made from clinical investigations, endoscopy, laboratory tests, biopsies, and diary cards. No statistically significant differences in bowel frequency, rectal bleeding, general well‐being, abdominal pain, and severity and extent of the disease were found between the groups during the study. There was no significant change in the histologic parameters. No side‐effect was encountered. It is concluded that DSCG did not improve symptoms or inflammatory changes in ulcerative proctosigmoiditis.
Antipyretic Effect of Indomethacin in Malignant Lymphoma
Authors: ENGERVALL P. , BJÖRKHOLM M. , GRIMFORS G. , HOLM G.
Published: August 2010

ABSTRACT. Fifteen patients with lymphoid malignancies and tumour‐related fever (>38.0°C) were given 50 mg indomethacin (IM) orally. This resulted in a reduction of body temperature in all cases (mean±SD 3.4±2.0°C). In one patient with untreated Hodgkin's disease, temperature fell from 40.6° to 30.6°C within 12 hours without any cardiovascular or respiratory distress. The lytic effect of IM on fever was more pronounced and more rapid in the 15 patients with lymphoma than in a group of 10 patients with acute myocardial infarction. IM therapy has a clear value in relieving tumour‐associated fever in patients with malignant lymphoma. There may be a qualitative difference between the IM response of tumour‐related fever and fever related to non‐malignant diseases.
The Painful Diabetic Shoulder
Authors: MORÉN‐HYBBINETTE INGALILL , MORITZ ULRICH , SCHERSTÉN BENGT
Published: August 2010

ABSTRACT. Different types of shoulder affection were studied in 62 diabetic patients with shoulder pain. Three groups of shoulder joint disorder were found: painful shoulder with restricted mobility (62%), tendinitis without mobility restriction (27%), and a small group with mixed diagnoses. Sixty per cent had hand symptoms and 38% had restricted mobility of their hip joints. High frequencies of retinopathy and neuropathy were found. Affection of the shoulder joint was seen with almost the same frequency in insulin‐dependent as in non‐insulin‐dependent patients, but after a shorter duration of diabetes in the latter. A group of patients with the triad shoulder pain, hand symptoms and restricted mobility of the hip joints had a significantly higher frequency of proliferative retinopathy than patients with shoulder pain only. The long duration of diabetes, the high frequency of insulin treatment and classical late complications indicate that diabetic patients with painful shoulder and restricted mobility are suffering from clinically advanced diabetes mellitus.
Bone Marrow Transplantation in Three Patients with Multiple Myeloma
Authors: GAHRTON GÖSTA , RINGDÉN OLLE , LÖNNQVIST BERIT , LINDQUIST RAGNHILD , LJUNGMAN PER
Published: August 2010

ABSTRACT. Three patients with multiple myeloma received bone marrow grafts from HLA‐identical sibling donors. One of the patients, with IgA kappa myeloma, refractory to alkeran‐prednisone therapy, is well and still without sign of disease 26 months post transplantation. A second patient with Bence‐Jones kappa myeloma is well, and sceletal pain and Bence‐Jones proteinuria has disappeared 2 months after transplantation. A third patient with IgG‐lambda myeloma died of effusive pericarditis shortly after transplantation. Bone marrow transplantation may be indicated in a selective group of patients with multiple myeloma.
Exercise Training and Hypertension
Authors: HAGBERG JAMES M. , SEALS DOUGLAS R.
Published: August 2010

ABSTRACT. Hypertension is a major health dilemma in the world today because of its high rate of incidence. Exercise training is usually mentioned as a useful nonpharmacological therapy for essential hypertension. Seventeen studies have assessed the effect of exercise training in individuals with essential hypertension. The majority of the results indicate that both systolic and diastolic blood pressure may be lowered by approximately 10 mmHg with training, however, this conclusion must be interpreted in light of numerous design deficiencies, methodological shortcomings, and the limited populations studied in these investigations. Some studies appear to indicate that mild to moderate intensity training may be as useful in lowering blood pressure as higher intensity training. Very little data is available to indicate if cardiac output and/or total peripheral resistance are reduced to bring about the reduction in blood pressure. Clearly more studies are required to evaluate the belief that exercise training is beneficial in essentia] hypertension and to determine the responsible mechanisms.
Muscle Fatigue and Pain
Authors: EDWARDS RICHARD H. T.
Published: August 2010

ABSTRACT. Muscle fatigue and pain are together common symptoms which can be analysed physiologically. For many patients attending a medical clinic the problem for the doctor is to decide whether the problem is “in the mind” or “in the muscle”. A history of the symptoms occurring at rest without any exercise is a hint of psychological origin. Exercise fatigue or pain should ideally be reproduced by an appropriate provoking exercise test. Needle biopsy with histochemistry is cost‐effective as a means of reaching a diagnosis while blood determinations of erythrocyte sedimentation rate and plasma creatine kinase and lactate are more specific but less sensitive indicators of a msucle cause. Fatigue is analysed by force and action potential measurements with electrically stimulated contractions. Pain worse after exercise can be related to muscle damage. A programme of therapeutic exercise may be tried as a further means of assessment of these symptoms.
VALUE OF THE CLONIDINE SUPPRESSION TEST IN THE DIAGNOSIS OF PHEOCHROMOCYTOMA
Authors: Karlberg Bengt E. , Hedman Lisbeth
Published: August 2010

ABSTRACT. The clinical value of a clonidine suppression test was assessed in three different groups: I. 14 normotensive, healthy people: II. 34 patients with “neurogenic” hypertension: III. 10 patients with pheochromocytoma confirmed at operation. After clonidine (300 mg by mouth) blood pressure (BP) and circulating plasma catecholamines (CA) were reduced in groups I and II. The maximum fall in mean BP was 25/9 mmHg in group I and 43/24 mmHg in group II; the corresponding fall in patients with pheochromocytoma was 19/0 mmHg. The mean concentrations of ciruculating noradrenaline (NA) were significantly reduced in groups I and II, maximum suppression occurring 2–3 h after giving clonidine. In group I the mean reductions in NA were from 1.3 (SEM 0.2) to 0.6 (0.06) nmol/l (p <0.01), and in group II from 2.6 (0.3) to 0.7 (0.05 nmol/l (p< 0.2); plasma concentrations of A were very low (<0.01 nmol/l) in both groups, and remained unchanged throughout the test.

In contrast, in the 10 patients with pheochromocytoma the mean basal plasma CA concentrations exceeded our upper reference limit NA 7.7 (2.2 and A 4.0 (1.7 nmol/l), and remained high or even rose during the test. Four patients in this group with only marginally elevated basal plasma CA showed the same pattern of response during clonidine administration. After successful removal of the catecholamine‐secreting tumour all patients achieved a normal BP. The plasma CA was suppressed into the normal range when the clonidine test was repeated 1–2 weeks postoperatively. No serious adverse effects were observed. We conclude that the clonidine suppression test is a safe and useful procedure in the diagnosis of pheochromocytoma, especially when basal levels of CA are normal or only marginally elevated.

Part of this matter was presented at the First International Congress of Endocrine Surgery, Paris, September 1–6, 1985.
HORMONAL RESPONSES TO TREATMENT OF HIGH BLOOD PRESSURE WITH LOW‐SALT DIET ALONE AND COMBINED WITH ADDED POTASSIUM
Authors: OS INGRID , KJELDSEN SVERRE ERIK , WESTHEIM ARNE , JACKSON MARY BETH , AAKESSON INGVAR , FREDERICHSEN PER , LEREN PAUL , EIDE IVAR
Published: August 2010

ABSTRACT. One week strict sodium depletion in essential hypertensive men (n=17) decreased blood pressure and body weight. Plasma renin concentration increased four‐fold (p<0.001), plasma noradrenaline with 38% (p<0.001), plasma dopamine with 58% while plasma adrenaline remained unchanged. The urinary excretion of vasopressin was reduced with 50% (p<0.00l). Extra potassium induced only small changes when already sodium depleted. Thus, vasopressin was the only pressor hormone which varied directly with sodium intake, blood pressure and body weight during sodium depletion.
THIAZIDES AND LOOP‐DIURETICS THERAPEUTIC ASPECTS
Authors: Beermann Björn
Published: August 2010

AbstractThiazides and compounds with similar models of action exert their most important renal effects on the cortical‐diluting segment of the nephron, most likely from the peritubular side, In contrast, the most important site of action of loop‐diuretics is the luminal side of the ascending part of the diluting segment. The different sites of action explain the clinically proven efficacious combination of thiazides and loop‐diuretics in severe cardiac failure.

Most thiazides and loop‐diuretics are eliminated via renal tubular secretion, which leads to decreased renal clearance in patients with chronic heart failure (CHF) as their renal blood flow is decreased even if glomural filtration rate (GFR) is maintained. A rational approach to enhance the effects of loop‐diuretics is to combine them with drugs that increase renal blood flow, thereby increasing the rate of delivery of the drug to its site of action.

Dilutional hyponatremia is an important complication of treatment with diuretics. An efficacious treatment of that condition seems to be a combination of loop‐diuretics and ACE‐inhibitors.

Thiazides decrease the urinary excretion of calcium, while loop‐diuretics have the opposite effect. The possibility of loop‐diuretic induced osteopenia cannot be ruled out, which should be considered when choosing between thiazides and loop‐diuretics for the treatment of mild to moderate CHF.