bluuebunny/crossref_metadata_2025 huggingface dataset:
Smoking Habits in the Glostrup Population of Men and Women, Born in 1914
Authors: Schroll Marianne
Published: August 2010

ABSTRACT. Of a total population of 514 men and 461 women, born in 1914, from seven municipalities in Copenhagen County, 87 % were examined in 1964 and 1974. Smoking habits (inhalation, kind of tobacco, amount, duration of smoking and changes over a decade) have been described in this age‐specific, general population. The health implications were examined. Tobacco consumption was in this population the most important risk factor for overall mortality, cardiovascular manifestations, peripheral arterial disease, decline in pulmonary function and symptoms of ulcer. The results are consistent with other prospective epidemiological studies. The relative risk of death, of fatal and nonfatal cardiovascular manifestations, and of decline in pulmonary function increased gradually with the amount of tobacco smoked. Inhalation roughly doubled the risk. The excess risk for pipe/cheroot smokers was less than that for cigarette smokers. Ex‐smokers reduced their risk about 50%. The risk associated with smoking was independent of other factors. The excess risk attributable to smoking was as great in women as in men, but the community problem of smoking‐related diseases was most pronounced in men, among whom smoking habits are more widespread and morbidity is higher. The results from the 1914 population study suggest that almost one third of all deaths and heart attacks in middle‐aged Danes might be avoided, if all 50‐year‐olds would have given up smoking.
Tissue Zinc at Autopsy— Relation to Medication with Diuretics
Authors: Wester P. O.
Published: August 2010

ABSTRACT. Diuretic treatment has been shown to cause a substantial increase in the urinary output of zinc. However, the serum zinc levels remain normal or even raised. In the present study, tissue zinc was studied in liver, kidney and skeletal muscle tissue from 147 consecutive autopsies. In 90 of the cases heart muscle and aortic tissue were also studied. The zinc values were correlated to previous treatment with diuretics. A lower liver zinc level was observed in the group of patients who had been on diuretic treatment for more than 6 months compared to the group without treatment, the difference being highly significant. The skeletal muscle zinc was also low in the patients who had been on diuretic treatment. With regard to the metabolic functions of zinc, the tissue depletion of this element after diuretic treatment may be of clinical importance.
Psychological and Social Problems Encountered in Active Treatment of Chronic Uraemia
Authors: Hirvas Juhani , Enckel Mikael , Kuhlbäck Börje , Pasternack Amos
Published: August 2010

ABSTRACT. Sixteen kidney donors were interviewed by a psychiatrist and given the Rorschach test before and one year after operation. We used our previous study as a basis in predicting the expectable level of psychic traumatization that the donation process would provoke. In 10 of the donors the prediction proved to be correct. A trend towards a better predictability was observed in cases of successful transplantation. An unsuccessful operation is always followed by psychological complications, reducing the possibilities of an accurate prediction and necessitating psychotherapeutic help. The present procedures are clinically simple and require relatively little time.
Urinary Excretion of Inorganic Sulfate, Ester Sulfate, Total Sulfur and Taurine in Cancer Patients
Authors: Baldetorp L. , Mårtensson J.
Published: August 2010

ABSTRACT. The urinary excretion of inorganic sulfate, ester sulfate, taurine and total sulfur has been estimated in 18 patients with malignancy, and compared with those of an age‐matched reference group. The absolute amount of inorganic sulfate was significantly lower in the cancer group, whereas an increased ester sulfate excretion was observed. Reduced excretion of total sulfate (inorganic plus ester sulfate) and increased excretion of “neutral sulfur” (total sulfur minus total sulfate) in the cancer group was calculated from these data. If these values were recalculated with respect to creatinine, no significant differences were found for inorganic and total sulfate between the two patient groups, whereas ester sulfate and the “neutral sulfur” fractions were still increased. The enlarged “neutral sulfur” could to a large extent be explained by an increased excretion of taurine. The mechanism behind these findings is discussed.
Blood Glucose Control and Lipolysis in Diabetes Mellitus
Authors: Arner P. , Engfeldt P. , östman J.
Published: August 2010

ABSTRACT. The relationship between the blood glucose level and the rate of lipolysis was investigated in 19 maturity onset diabetics (MOD) and 9 juvenile onset diabetics (JOD). Subcutaneous adipose tissue was incubated with and without isoprenaline or nor‐adrenaline. Before antidiabetic treatment the blood glucose concentration was positively correlated with basal and catecholamine‐induced rates of lipolysis in MOD (R =0.41–0.60) and in JOD (r=0.51–0.71). The reduction in blood glucose concentration during antidiabetic treatment was positively correlated with the reduction in the rate of lipolysis in MOD (r=0.50–0.64) and in JOD (r=0.75–0.90). Fat cell size and blood glucose level were not correlated either in untreated or treated diabetics. In diabetes mellitus, blood glucose homeostasis and rate of lipolysis in adipose tissue seem to be associated. The relationship is most apparent in JOD.
Pseudotumor Cerebri in Pseudohypoparathyroidism
Authors: Asplund Johan
Published: August 2010

ABSTRACT. A case of hypocalcemia with elevated serum PTH but normal renal response of cAMP and phosphate to PTH infusion is reported. The patient also had papilledema since many years probably due to long‐lasting hypocalcemia.
Comparison of Energy and Nutrient Intakes in Women with High and Low Blood Pressure Levels
Authors: Thulin T. , Abdulla M. , Dencker I. , Jägerstad M. , Melander A. , Nordén å. , Scherstén B. , åkesson B.
Published: August 2010

ABSTRACT. The present study found no link between the intake of energy and various nutrients, on the one hand, and high or low blood pressure (BP) in women, on the other. Sixty women not on treatment for hypertension were selected from a defined population and examined, applying the duplicate portion technique, with respect to the relationships between BP and the intake of energy and nutrients. They were selected from above the 95th percentile for BP (group A) and from below the 30th (group B). The two groups were age‐matched. The food sampling comprised six days, divided into three periods of two consecutive days within a period of four weeks. Twenty‐four‐hour urine specimens were collected in each period and on two other occasions. The mean values for intake of energy, fat, protein, carbohydrates, minerals and electrolytes did not differ between the two groups despite the large differences in BP and obesity. The mean values for urinary excretion of minerals, electrolytes and nitrogen (calculated as crude protein) did not differ between the groups. The present findings for the effect of salt on BP do not justify restriction of the salt intake as a means for decreasing BP in the population.
Studies on Hemopoietic Dysplasia (the Preleukemic Syndrome)
Authors: Lidbeck Jan
Published: August 2010

ABSTRACT. The clinical course of 42 patients with hemopoietic dysplasia diagnosed during 1974–77 has been studied. The clinical, laboratory and morphological findings at presentation were investigated for prognostic significance. At the time of completion of the study (Aug. 1979), 38% had developed acute leukemia (median survival after diagnosis 5 months) and 45 % had died of complications (bleeding and infections) due to severe cytopenia (median survival 6 months). An overall malignant course was observed in patients with low platelet count (<80 times 109/l), bleedings and a severe myeloid maturation defect in the bone marrow (≥30% myeloblasts and promyelo‐cytes). Increased serum vitamin B12 and presence of myeloblasts, promyelocytes and abnormal 'mono‐cytoid' cells in the peripheral blood indicated a leu‐kemic termination.
Sinus Node Dysfunction in Acute Myocardial Infarction
Authors: Simonsen E. , Nielsen B. Lyager , Nielsen J. Stræde
Published: August 2010

ABSTRACT. In a retrospective study of patients admitted for acute myocardial infarction (AMI) during six years, sinus node dysfunction (SND) was detected in 29 (1.04%). Twelve had persistent sinus bradycar‐dia, 11 sinotrial block or sinus arrest and six brady‐tachy syndrome. Symptoms occurred in 17 patients, 12 of whom required temporary pacing for periods up to three weeks. A permanent cardiac pacemaker was implanted in three patients with brady‐tachy syndrome. Three patients died during the primary admission and six during the observation period. Follow‐up after a mean observation period of 34 months showed continuous signs of SND in 11 out of 19 patients. The arrhythmia caused symptoms in five patients, two of whom had a cardiac pacemaker and two received medical treatment. It is concluded that SND appearing during an AMI persists in a high number of these patients.
Borderline Hypertension
Authors: Julius Stevo , Hansson Lennart , Andrén Lennart , Gudbrandsson Thorkell , Sivertsson Ramon , Svensson Anders
Published: August 2010

ABSTRACT.Borderline hypertension was the topic of one of the “Hypertension seminars” arranged by the Hypertension Section at the östra Hospital, Göteborg, Sweden. On that occasion Professor Stevo Julius, Ann Arbor, Michigan, USA, was an invited guest. During the seminar, various aspects of borderline hypertension were discussed, e.g. the natural history, hemodynamics and management of this condition. The present review is based on these discussions.
A Comparative Study of Cardioselective β‐Blockade and Diazepam in Patients with Acute Myocardial Infarction and Tachycardia
Authors: Johansson Bengt W.
Published: August 2010

ABSTRACT. Eighty‐seven patients with an acute myocardial infarction and a pulse rate of ≥80/min on admission were randomly allotted to one group given cardioselective β‐blockade, a second group given diazepam, and a third group given placebo. The three groups were comparable in age, sex distribution, previous history of ischemic heart disease, initial pulse rate, blood pressure, pain index, enzyme values, and degree of ST elevation. The acute mortality (within 10 days) did not differ between the groups. The drug treatment elicited no reduction of infarct size, as judged from enzyme levels, degree of reduction of ST elevation, or physical exercise capacity. The reasons for this negative result are discussed. One possibility is that in routine clinical practice the therapeutic intervention starts too late after onset of symptoms. A beneficial effect on mortality among the patients whose treatment started early after onset of symptoms supports this conclusion.
Peripheral Blood Flow in Chronic Ergotism
Authors: Leinonen Hannu
Published: August 2010

ABSTRACT. Muscle blood flow (MBF) was determined in 11 patients on chronic overdoses of ergotamine tartrate and in 12 controls, using the local 133xenon clearance method. The difference in MBFs between the groups was insignificant, 59.7±21.4 and 61.6±10.8 ml/100 g/min, respectively. Six patients taking ergotamine in doses exceeding 0.25 mg/kg/week showed a significant (p<0.01) reduction of MBF (45.2±10.7 ml/100 g/min). This reduction could be measured before the manifestation of symptoms or signs of circulatory insufficiency.
Reversible Bone Marrow Granulomas—Adverse Effect of Oxyphenbutazone Therapy
Authors: Andersson Dan E. H. , Langworth Sven , Newman Harry C. , Öst Åke
Published: August 2010

ABSTRACT. A 48‐year‐old woman treated with oxyphenbutazone developed fever, gastrointestinal disturbances, mucocutaneous reactions, leukopenia, eosinophilia and thrombocytopenia. Bone marrow biopsy showed granulomatous lesions. Following withdrawal of the drug, all signs and symptoms subsided and the blood changes and the bone marrow biopsy normalized. The granulomatous reaction in the bone marrow is considered to be a hypersensitivity manifestation of oxyphenbutazone.
Interaction of Clonidine and β‐Blockers
Authors: Lilja M. , Jounela A. J. , Juustila H. , Mattila M. J.
Published: August 2010

ABSTRACT. On the hypothesis that non‐selective β‐blockers can antagonize or reverse the antihypertensive effect of clonidine (C), 12 hypertensive outpatients were treated with C alone and in combination with propranolol (P), atenolol (A) and prazosin (Pz). C alone (0.11 or 0.22 mg b.i.d.) or in combination with P (80 mg b. i. d.) did not provide nor mo tension. Changing P to A (50 mg b. i. d.) reduced supine systolic and diastolic pressures, which now were significantly lower (p<0.01) than during C alone. Changing A to P again resulted in elevated pressures. Pz (1 mg t. i. d.) added to the C+P regimen lowered supine blood pressures to the levels otherwise recorded during C+A. C dose‐dependently contracted rabbit aortic spiral in vitro, reaching about 50% of maximum responses to noradrenaline. Pz abolished this response. P (0.1–10 μg/ml) but not A somewhat enhanced responses to high doses of C. Sotalol rather antagonized C contractions. We conclude that A but not P enhances the antihypertensive action of C. No hypertensive interaction was observed.
Does Aortocoronary Saphenous Vein Bypass Surgery Change the Native Coronary Arteries?
Authors: Nitter‐Hauge S. , Levorstad K.
Published: August 2010

ABSTRACT. Progression of disease in the native coronary circulation was studied in 60 patients before and after aortocoronary saphenous vein bypass surgery. The mean interval between the first angiographic study and operation was 2.0 months and the mean interval from operation to second catheterization was 15.3 months. The results from a second arteriographic study after an interval of 12.3 months on 25 comparable patients, with no surgery in between, served as a control material for frequency and severity of the “natural” progression of the disease. Only vessels which were not occluded at the first examination were included in the re‐study. In the 60 operated patients, 106 arteries were grafted and 74 ungrafted. Total graft patency at the time of re‐study was 66%. Progression was found in segments proximal to the anastomosis in 42% of arteries with patent graft, and in 47% of arteries with occluded graft, whereas in segments distal to the site of anastomosis progression was found in 5% of the arteries with patent graft and in 55% of arteries with occluded graft. Progression of the disease was found in 11% of ungrafted arteries. In the control group, progression of the disease was found in 24%. The study thus shows that after aortocoronary bypass surgery, progression in segments proximal to the anastomosis is significantly higher than in nongrafted arteries. The progression was independent of patency or occlusion of the graf to the vessel. Progression in the segments distal to the anastomosis was not significantly different from the frequency of progression seen in nongrafted arteries if the graft was patent, but was much higher if the graft was occluded.
Failure of Chlorothiazide to Improve Urinary Concentrating Capacity in Lithium‐Treated Patients
Authors: Wahlin Anders , Rapp Walter , Jonsson Elsa H.
Published: August 2010

ABSTRACT. Seven patients on long‐term lithium treatment were given chlorothiazide for three days. The urinary concentrating capacity did not change during the study, but serum potassium decreased significantly. Thus, chlorothiazide does not seem to produce an effect on a moderately decreased concentrating capacity during long‐term lithium treatment.
Serum Ferritin and Bone Marrow Iron in Non‐Dialysis, Peritoneal Dialysis and Hemodialysis Patients with Chronic Renal Failure
Authors: Milman Nils , Christensen Thomas Elo , Pedersen Nils Strandberg , Visfeldt Jakob
Published: August 2010

ABSTRACT.Serum ferritin was measured by immunoradiometric assay, and stainable bone marrow iron was assessed semiquantitatively in 38 patients (19 ♂, 19 ♀) with chronic renal failure (7 non‐dialysed uremic patients, 14 patients on regular peritoneal dialysis and 17 patients on regular hemodialysis). Serum ferritin was also measured in 60 healthy subjects (30 ♂, 30 ♀). There was a good correlation (p<0.001) between serum ferritin and marrow iron in the total group of uremic patients. Patients without stainable marrow iron (n=19) had a geometric mean serum ferritin of 51 ng/ml (range 6–136), mean serum ferritin in patients with “normal” marrow iron (n=14) was 326 ng/ml (range 112–1120) and in patients with slightly increased marrow iron (n=5) 634 ng/ml (range 480–960). Male patients had higher mean serum ferritin (244 ng/ml) and higher marrow iron score than female patients (76 mg/ml) (p<0.01). All patients had higher mean serum ferritin (141 ng/ml, range 6–1120) than the healthy subjects (46 ng/ml, range 5–285) (p<0.001). Patients with serum ferritin levels of <112 ng/ml had no stainable marrow iron, while those with ferritin levels of >136 ng/ml had adequate marrow iron stores. The serum ferritin concentration appears to be a reliable indicator of stainable marrow iron content in uremic subjects. Regular monitoring of serum ferritin may be a guide to appropriate iron supplementation and reduces the need for repeated marrow punctures in the assessment of iron status in chronic renal failure.
Clinical Trial of Prednimustine, Leo‐1031 (NSC‐134087), in Patients with Non‐Hodgkin Lymphomata and Chronic Lymphocytic Leukaemia Previously Treated with Steroids and Alkylating Agents
Authors: Pedersen‐Bjergaard J. , Hansen M. Mørk , Geisler C. H. , Nissen N. I.
Published: August 2010

ABSTRACT. Prednimustine, a chlorambucil ester of prednisolone, was administered to 16 patients with non‐Hodgkin lymphomata (NHL) and 14 patients with chronic lymphocytic leukaemia (CLL), all previously treated with steroids and alkylating agents. Response was obtained in 8 patients with NHL and 11 patients with CLL. Two NHL patients had long‐lasting complete remissions. Median duration of response for lymphomata was 12 weeks, for CLL more than 15 weeks. Delayed reversible and rather pronounced myelosuppression was the major side‐effect observed in median 6 weeks from the start of Prednimustine with a median duration of 4 weeks.
Hazards of Therapy for Excessive Hypertension in Acute Stroke
Authors: Britton Mona , de Faire Ulf , Helmers Claes
Published: August 2010

ABSTRACT. Six cases with acute onset of neurological symptoms and extremely high blood pressure (BP) are reviewed. Hypertensive crisis or stroke were the main differential diagnoses. According to what is advocated for both situations, prompt antihypertensive therapy was instituted. Although recommended doses of hydralazine, reserpine or furosemide were given, the systolic BPs fell to less than 100 mmHg. Intracerebral hemorrhage or infarction was subsequently established in all patients and only one survived. Convincing evidence for a beneficial effect of BP reduction in acute stroke is lacking. Our data indicate excessive response to therapy in some patients. Also, moderate lowering of BP might reduce cerebral blood flow in these patients, often chronically hypertensive and with raised intracranial pressure. Extreme caution with antihypertensive therapy seems therefore warranted if the diagnosis of hypertensive crisis is not certain and a stroke is suspected.
The Effect of Quinidine on Digoxin Kinetics in Cardiac Patients
Authors: Pedersen Knud Erik , Hastrup Jens , Hvidt Steffen
Published: August 2010

ABSTRACT. The pharmacokinetics of digoxin was studied in 11 subjects before and during quinidine treatment. Renal clearances of digoxin and creatinine were calculated from plasma concentrations and urinary excretions of digoxin and creatinine in subjects on long‐term digoxin treatment. The investigations were repeated in the same subjects during administration of quinidine. Renal clearance of digoxin decreased, while plasma concentration of digoxin and renal excretion of digoxin increased in the presence of quinidine, indicating substantial changes of digoxin kinetics, induced by quinidine. The reduction in renal clearance of digoxin may be due to a specific inhibition of tubular secretion of digoxin. The considerable rise of the plasma digoxin level and the increased excretion of digoxin support the assumption of a major extrarenal mechanism of interaction.
Spontaneous Pneumothorax as First Symptom in Bronchial Carcinoma
Authors: Lundgren R. , Sternberg N.
Published: August 2010

ABSTRACT. Pneumothorax is a rare manifestation of lung cancer. It has been reported to date in a total of about 25 patients. We describe two patients with spontaneous pneumothorax as the first sign of a bronchial carcinoma.
Sucrose and Sorbitol as Sweeteners in the Diet of Insulin‐Dependent Diabetics
Authors: Vaaler S. , Hanssen K. F. , Aagenæs Ø.
Published: August 2010

ABSTRACT. Blood glucose levels following breakfast meals containing sorbitol or sucrose as sweeteners were investigated. Nine insulin‐treated diabetics received two test meals after an overnight fast. The meals were composed of 90 g white bread, 9 g butter and 100 g stawberry jam which on one occasion contained 18 g sorbitol as sweetener and on another 18 g sucrose. Blood glucose was measured for three hours following the meal. The test meal sweetened with sucrose showed a slightly faster postprandial rise in blood glucose than the sorbitol‐sweetened meal, but this difference is not statistically significant at any point of the curves. Taking into consideration that sorbitol has a sweetening effect of only 60% of that of sucrose, we conclude that neither sucrose nor sorbitol are acceptable sweeteners for insulin‐dependent diabetics.
The Natural History of Stroke in Diabetic Patients
Authors: Asplund Kjell , Hägg Erik , Helmers Claes , Lithner Folke , Strand Tage , Wester Per‐Olov
Published: August 2010

ABSTRACT. A five‐year follow‐up of 53 diabetic patients admitted for their first stroke in 1972–73 has been performed. They were compared with two groups of 53 non‐diabetic patients each with cerebrovascular disease (CVD), one randomly selected and one matched with the diabetics for age, sex and diagnosis of CVD at discharge. All patients could be traced at follow‐up. The mean age at the time of first stroke was 66.5 years in male and 73.2 years in female diabetics. Manifest diabetes was diagnosed in 19% during hospitalization for stroke; of the remainder, 74% had had diabetes since less than ten years. In 85% of the diabetics there were no signs of severe angiopathy affecting eyes, kidneys or lower extremities. The majority of diabetic as well as non‐diabetic CVD patients had a history of hypertension and/or heart disease. Few were overweight. Case fatality rate was significantly higher in diabetics than in non‐diabetics throughout the follow‐up (p<0.01 for diabetics vs. matched non‐diabetics, p<0.001 for diabetics vs. randomly selected non‐diabetics). The presence of heart disorder predicted mortality in the diabetic subjects. Surprisingly, hypertension diagnosed before stroke involved a more favourable long‐term prognosis in all three groups (p<0.05). The major causes of death in diabetic CVD patients were cardiac disorders (50%) and stroke (47%). Previous investigations have identified diabetes as a risk factor for stroke. This study shows that diabetes also adversely affects the short‐term as well as the long‐term outcome in stroke.
Evaluation of Tests for Gilbert's Syndrome
Authors: Olsson Rolf , Lindstedt Göran
Published: August 2010

ABSTRACT. The effect of caloric restriction (400 kcal for 24 hours) on serum total and unconjugated bilirubin was studied in 30 subjects with Gilbert's syndrome and in 22 patients with different liver diseases. The method could not completely differentiate between Gilbert's syndrome and liver disease, but an increase in unconjugated bilirubin of 15 μmol/l or more supports the former diagnosis. This limit gave a 100% specificity and a sensitivity for males of about 90% and for females of about 40%. I.v. nicotinic acid caused similar rises of unconjugated bilirubin as reduced caloric intake in eight subjects with Gilbert's syndrome, but most of the subjects preferred the latter test. Results from erythrocyte porphyrin determination in seven subjects with Gilbert's syndrome gave some support to the presence of dyserythropoiesis.
Correlation between Prognostic Factors and Blood Variables in Osteosarcoma
Authors: Broström Lars‐Åke , Ingimarsson Snorri , Strander Hans , Eklund Gunnar
Published: August 2010

ABSTRACT. Prognostic factors and the blood chemistry were analyzed prior to treatment in 33 consecutive patients with primary osteosarcoma. The only variables of blood chemistry with values outside the normal range were alkaline phosphatase and ESR, which were increased. There was a correlation between certain prognostic factors and between some of these and a number of the blood variables. The degree of malignancy tended to be lower in the female than in the male patients. Distally located tumors tended to be smaller and were assessed with a less marked effect on the blood variables than those located proximally.
Hemoperfusion with Amberlite Resin in the Treatment of Self‐Poisoning
Authors: Heath Andrew , Delin Krister , Edén Elisabeth , Mårtensson Eric , Selander Dag , Wickström Ingemar , Ahlmén Jarl
Published: August 2010

ABSTRACT. Ten patients with various intoxications were treated with resin hemoperfusion. Three of four patients with grade IV coma due to tricyclic antidepressant (TCA) poisoning could be extubated during or on termination of hemoperfusion. Clearance values of 135–185 and 190–200 ml/min were obtained for amitriptyline and nortriptyline, respectively. One patient with severe chloral hydrate poisoning could be extubated after less than one hour's hemoperfusion. A clearance of 140 ml/min was obtained in a uremic patient with AV block II due to digitoxin intoxication. Four patients with mushroom poisoning were treated with combined hemoperfusion‐hemodialysis. A transient fall in platelet count was seen in all patients. Resin hemoperfusion is of definite value in selected, severe cases of self‐poisoning with psychotropic drugs such as TCA and possibly in cases of mushroom poisoning where the prognosis with hemodialysis and supportive therapy is doubtful.
Methenamine‐Hippurate and Bacteriuria in the Geriatric Patient with a Catheter
Authors: Wibell L. , Scheynius A. , Norrman K.
Published: August 2010

ABSTRACT. Oral treatment with methenamine‐hippurate (MH) in patients with an indwelling catheter has been found to reduce the need of frequent catheter exchange and the number of symptomatic infections. Bacteriuria, however, persists during MH treatment. The hypothesis that the therapeutic effect is due to a reduction in the number of bacteria, or a change in the pattern of strains was tested in a crossover study (2times6 weeks). MH treatment, 1 g twice daily, was compared to control periods in 52 patients. The majority of quantitative and qualitative bacterial cultures at 2‐week intervals yielded 2–4 strains. Of the bacterial isolates, 50% were found on 4–6 occasions out of 6 possible. MH treatment had no significant influence on the pattern of various strains. A 30% decrease in the mean total bacterial count during MH treatment did not reach statistical significance (p≅0.07). It is suggested that prevention of catheter complications during MH treatment may be due to a physiochemical action on salt formation rather than a direct antibacterial effect.
Metabolic Control of Diabetes Mellitus during Routine Management at an Out‐Patient Department
Authors: Karlander Sven‐Gunnar , Ålinder Inger , Hellström Kjell
Published: August 2010

ABSTRACT. The current study comprised 376 living and 140 deceased diabetic patients. A majority of the patients had received oral hypoglycemic agents (tablets) or insulin, while a modified diet alone had been prescribed for a minority. The mean age of the tablet‐treated patients (67 and 73 years for those now alive and deceased, respectively) was in general 6–10 years higher than that of insulin‐treated patients. The mean morning blood glucose level ranged between 8.3 and 10.5 mmol/l. A considerable number of the tablet‐treated patients were overweight and hyper‐triglyceridemic. About one third of the patients in both groups were considered to be in a fairly good state of metabolic control, arbitrarily defined as a urinary glucose excretion of less than 110 mmol/24 h, a relative body weight of less than 115% and a serum triglyceride level below 2.0 mmol/l. Cardiovascular disease was the cause of death in 60–70% of the patients. Patients with clinical evidence of atherosclerosis did not differ from age‐matched pairmates without signs of macroangiopathy with regard to hyperglycemia and hyperglucosuria. However, the prevalences of hypertriglyceridemia, hypertension and overweight tended to be higher in the former. It is concluded that factors of importance for development of atherosclerosis in a non‐diabetic population should be considered in the treatment of diabetes mellitus.
Ullrich‐Noonan Syndrome
Authors: Johansson Bengt W. , Mandahl Nils
Published: August 2010

ABSTRACT. A case of Ullrich‐Noonan syndrome with pulmonary stenosis, epicanthus, ptosis, small stature, curved tibia, positive sex chromatin, and a diploid chromosome number is presented. A detailed chromosomal banding analysis with the G‐staining, C‐staining and Ag‐I‐staining techniques revealed no significant anomalies. The literature is reviewed and the criteria for diagnosing Ullrich‐Noonan syndrome are presented.
A New Mechanism for the Regulation of Platelet Functional State
Authors: Markosyan R. A.
Published: August 2010

ABSTRACT. A study has been performed on the effects of alternating pressure on the functional state of circulating platelets. Platelet aggregation, changes in platelet shape and the time of shape recovery after deformation have been measured, as well as plasma adenine nucleotide concentrations. A pressure impulse of 60–80 Torr applied for 1 min causes a 50°% decrease in the extent of platelet aggregation, but if 110–120 Torr is applied, the amplitude of platelet aggregation is increased by 50°%. With pressure impulses increasing to 350 Torr, the peak of aggregation process was recorded, with subsequent inhibition as the alternating pressure grew further. The possible physiological significance of these findings is discussed.
Patterns of Repair in the Arterial Wall and their Possible Relationship to Growth Characteristics of Smooth Muscle and Endothelium
Authors: Björkerud Sören
Published: August 2010

ABSTRACT. The concept of a multi‐factorial mechanism for the development of atherosclerosis has been increasingly established during the last decade. It has also been increasingly apparent that the arterial wall, the target tissue for the disease, is a very dynamic and complex structure. A consequence of these facts is that an analysis of the atherogenic mechanism must largely depend upon the use of experimental model systems where this complexity can be offset by the possibility of defining and controlling the different atherogenic factors.
Factors Modulating the Interaction of LDL with an Arterial Lipoprotein Complexing Proteoglycan: The Effect of HDL
Authors: Camejo German , Cortez Maria M. , López Flor , Starosta Rebeca , Mosquera Beatriz , Socorro Lilian
Published: August 2010

ABSTRACT. The presence of a lipoprotein complexing proteoglycan (LCP) in extracts of human arterial intima/media that forms specific complexes with low density lipoproteins (LDL) has suggested that it may play a role in the interaction of LDL with the arterial wall and the atherogenic process. The formation of insoluble LDL‐LCP complexes by incubation of serum with arterial extracts appears directly related to the concentration of LDL and inversely to the content of high density lipoproteins (HDL), indicating that HDL may inhibit the interaction between LDL and LCP. This inhibition is clearly visible by addition of HDL to LCP containing extracts before their incubation with LDL. This effect is also shown by apoHDL but not by lipoprotein‐free plasma. It is suggested that the HDL/LDL ratio of the plasma crossing the endothelial barrier may be an important modulator of the net accumulation of LDL in the intima/media and of its contribution to atherogenesis.
CORRELATION STUDIES BETWEEN EMPLOYABILITY, LEFT VENTRICULAR HEMODYNAMICS AND EXERCISE ECG BEFORE AND AFTER AORTOCORONARY BYPASS SURGERY
Authors: Nitter‐Hauge S.
Published: August 2010

The occupational status of a group of 70 male patients, 30 to 65 years of age, operated with aortocoronary bypass surgery, were studied and related to left ventricular function, number of patent grafts, and exercise ECG using a bicycle ergometer, in connection with a re‐study on an average of 14 months after operation. The patients consisted of two series of males: one series (n = 39) consisted of subjects unable to work (<> group), the other series (n = 31), consisted of subjects actually working up to the time of examination (<> group). The <> group had a higher percentage of men in manual occupations (77 vs 48 %), and most of them had been temporarily or permanently disabled before operation (87 vs 55 %) compared with the <> group. There was no correlation between employability. on the one hand and objective means of left ventricular function as left ventricular end‐diastolic pressure before and after angiography and ejection fraction, and number of patent grafts per patient on the other. The <> group had in general increased their tolerance for exercise, and had a higher exercise capacity than the <> group. In the former series, all but 3 patients had a normal exercise tolerance. The increase in exercise tolerant in the <> group was more modest, and only 1/3 of the patients had a normal exercise capacity. Exhaustion and angina pectoris were the two principally different causes of limiting exercise, in this respect there was no difference between the two groups.
COARCTATION OF THE AORTA. FOLLOw‐UP OF 218 PATIENTS OPERATED ON AFTER 13 YEARS OF AGE
Authors: Forfang Kolbjørn , Rostad Hans , Sørland Svein
Published: August 2010

Twohundred and eighteen patients aged 13 years or more at operation for coarctation of the aorta were selected for a long‐term postoperative follow‐up study. The mean age at operation was 25,3 years, range 13 to 62 years, and the mean follow‐up period was 13 years, range 2 to 28 years.

The surgical mortality rate was 1,4%, all 3 patients being in their fourth decade. There were 35 late deaths (16,3%), 26 having cardio‐vascular disease as the causation; 3 patients developed a dissecting aneurysm of the ascending aorta, and 11 died suddenly of unknown cause. Persisting hypertension was found in approximately one third of the patients. A highly significant correlation was demonstrated between the systolic blood pressures before and after surgery. Aortic valve disease occurred in 31 patients (14,2%).

Coarctation of the aorta should be operated on in childhood, and a close postoperative long‐term follow‐up in all patients is recommended.
ATRIAL SEPTAL DEFECTS OF SECUNDUM TYPE IN PATIENTS LESS THAN 40 YEARS OF AGE. A FOLLOw‐UP STUDY
Authors: Rostad Hans , Sørland Svein J.
Published: August 2010

The series comprised 479 consecutive patients from all parts of Norway operated on in the period 1955–1976. Only 8% were less than 7 years at surgery. Dominating preoperative symptoms were dyspnea and increased fatique. The follow‐up period ranged from 2 to 21 years, mean 10,28 years. There were 4 early deaths (within 30 days after surgery), and at follow‐up further 5 patients had died. Excluding a man who died in a traffic accident the total mortality is 1,7%. Of the 470 surviving patients 81,7% were improved, 17% were unchanged and 1,3% had deteriorated. In patients with symptoms dyspnea and palpitations were common complaints. Different types of arrhythmia were found in 31 patients. One third were paroxysmal tachy‐arrhythmias, and 9 patients had atrial fibrillation. Only 3 of the 31 patients had some type of preoperative arrhythmia, and 26 were more than 20 years of age at surgery. Seven patients were reoperated because of a residual left to right shunt, 5 of them were initially operated in hypothermia and inflow occlusion. During the follow‐up period 10 patients had late cardiovascular disorders.
CLASSIFICATION OF CARDIOACTIVE DRUGS IN VIVO BY USING PROGRAMMED ELECTRICAL STIMULATION IN COMBINATION wITH MONOPHASIC ACTION POTENTIAL RECORDINGS AT DIFFERENT PACING RATES
Authors: Landmark Knud , Amlie Jan P. , Refsum Helge
Published: August 2010

The effect of antiarrhythmic drugs on myocardial refractoriness may be due to changes either in Vmaxof phase 0 or the phase of repolarization of the AP or both. By using programmed electrical stimulation in combination with MAP recordings at different pacing rates in the intact dog heart, it was possible to classify and to a certain extent to elucidate the mode of action of various cardioactive drugs in vivo.

Vaughan williams (68, 69) has proposed that antiarrhythmic drugs possess one or more of four main classes of action. The first class of action (quinidine may be regarded as the prototype) is a direct membrane effect which restricts the fast sodium current (the fast component) and thereby Vmaxof the AP in the absence of significant changes in MDP (30, 32, 67, 73). The second class causes β‐adrenergic receptor blockade, the third class increases the AP duration (amiodarone may be regarded as a prototype (62)) and the fourth class modifies the inward calcium current during the excitation period (6, 20, 21, 33). Classification of antiarrhytmic drugs have been based primarily on their effects on AP duration and amplitude, Vmax, membrane responsiveness (the relationship between MDP and Vmax), conduction and refractoriness in vitro and in vivo (56).

The duration of the AP has been regarded as a valuable determination of the refractory period (28, 72) and it has been shown that the ERP of isolated dog Purkinje fibres ends when the repolarization has restored the transmembrane AP to a value of ‐55 to ‐65 mV (28). However, the correlation between the process of repolarization and the reactivation of the sodium carrying system is not always constant, and the effects of certain antiarrhythmic agents have been attributed partly to a change in this relationship (67). Thus, drugs with first class action shift the values relating Vmax(ordinate) to MDP (abcisse) to the right, indicating that fewer sodium carriers are available at all membrane potentials (61, 73).

In assessing the mode of action of cardioactive drugs on the myoardium, it is therefore necessary to combine different experimental techniques and procedures. The present work was carried out to study the effects of different drugs on the refractoriness of the right ventricle of the dog heart and to see if any changes were correlated to alterations in the duration of the MAP. For this purpose we used programmed electrical stimulation in combination with MAP recordings at different pacing rates.
PHARMACOLOGICAL EFFECTS ON CORONARY HAEMODYNAMICS: A COMPARATIVE STUDY BETWEEN ATENOLOL, VERAPAMIL, NIFEDIPINE AND CARBOCROMEN
Authors: Simonsen Svein
Published: August 2010

Effects on coronary haemodynamics were investigated in patients with ischaemic heart disease. Investigations were performed at rest and during a cardiac stress test provoked by atrial pacing to submaximal heart rates. The effects of 4 drugs used in the treatment of angina pectoris were studied.

The continuous infusion thermodilution method was used to measure left ventricular venous drainage.

CVF was significantly increased by atrial pacing, both in the GCV and in the CS.

Atenolol reduced CVF and MVO2 at rest, but had no effect during atrial pacing. The decrement in flow and oxygen consumption effected by the drug could be attributed solely to a reduction in heart rate and therefore in left ventricular work. No direct effect on CAR could be identified.

Both injection (verapamil) and sublingual (nifedipine) application of calcium antagonists gave a weak coronary vasodilatory effect at rest, but not during cardiac stress. No oxygen saving effect could be demonstrated as both MVO2 and MVO2 per unit left ventricular work was totally unaffected by the drugs. Neither was there any effect on the major general haemody‐namic determinants of oxygen demand.

Carbocromen was found to be a potent coronary vasodilator both at rest and during atrial pacing. This did not result in any change in MVO2 as there was a parallel decrease in coronary arteriovenous oxygen difference. Investigations performed during angina pectoris demonstrated metabolic evidence of increased ischaemia after carbocromen which may be due to to a <> effect.

The present study demonstrated that interventions may influence left ventricular oxygen consumtion in a favourable way. On the other hand no effects, or even untoward effects, are exerted by substances which are in use today in patients with coronary heart disease.
Arterial Hypertension in 70 – 80 year old men and women.
Authors: Agner Erik , Mørck Henning I.
Published: August 2010

Abstract: In a longitudinal study of an unselected population of men and women standardized arterial blood pressure was measured at 70 and again at 80. At 70 the prevalence of arterial hypertension (≤ 160/95 mmHg) was 46% in men and 45% in women. At 80 it was only 19% and 30%. This decrease was partly owed to an increased ten year mortality in hypertensive 70 year old women. However, also a significant individual decrease was seen in the participants examined twice, – a decrease that did not seem connected to the increased use of antihypertensive medicine and was not connected to the presence of arteriosclerotic symptoms, but showed a connection to pathological ECG‐changes at 80.
Circulatory Effects of Stress in Essential Hypertension
Authors: Andrén Lennart , Hansson Lennart , Section Hypertension
Published: August 2010

Abstract: Hemodynamics and plasma catecholamines were studied during mental arithmetics and cold pressor test in thirteen patients with essential hypertension. Blood pressure was significantly increased by both forms of “stress”. Cold pressor test caused a significant increase in total peripheral resistance, while mental arithmetics increased heart rate and cardiac output significantly. Thus, different forms of “stress” can increase blood pressure by totally different hemodynamic mechanisms.

Acute cardioselective and non‐selective beta‐receptor blockade did not affect the hemodynamic reaction pattern during cold pressor test. The increase in heart rate and cardiac output during mental arithmetics was blocked by non‐selective but not with cardioselective beta‐blockade. Both beta‐blockers were, however, inefficient in preventing the blood pressure elevation induced by mental arithmetics. Plasma noradrenalin was significantly increased during mental arithmetics after both cardioselective and non‐selective beta‐blockade compared to placebo. During cold pressor test there was a significant increase in noradrenalin only after non‐selective beta‐blockade. Adrenalin in plasma was significantly incre sed only during mental arithmetics after cardioselective beta‐blockade.

The pathogenesis of essential hypertension is complex and still not fully understood. Both hereditary (1) and environmental factors such as salt intake (2) and stress (3,4,5) are probably of importance as risk factors for essential hypertension.

Animal studies have shown that different forms of stress can produce permanent hypertension due to structural changes in the resistance vessels (6). Against this background we decided to investigate acute hemodynamic effects of two well‐defined types of “stress”, e.g. mental arithmetics and cold pressor test in patients with essential hypertension and to study if the hemodynamic reactions could be modified by cardioselective and non‐selective beta‐receptor blockade. Catecholamines in plasma were studied before, during and after “stress”.
PRESSURE NATRIURESIS IN HYPERTENSION.
Authors: Omvik Per
Published: August 2010

Pressure natriuresis, defined as the relationship between sodium excretion and mean arterial pressure (MAP), was assessed during graded reduction of arterial pressure with nitroprusside in 16 essential hypertensives (EH). In all patients, sodium excretion fell linearly with reductions in arterial pressure (r > 0.68; p < 0.05). The per cent change of sodium excretion from control per mmHg change in MAP (δUNa V/δMAP) was less in patients with resting MAP above 120 mmHg than in those with lower blood pressure (1.4 ± 0.1 versus 3.0 ± 0.3; p < 0.001), but the pressure at which urine flow extrapolated to zero (75 ± 3 mmHg) was not significantly different in the two groups.

The slope of the relationship between sodium excretion and arterial pressure was significantly correlated with resting MAP (r = −0.67; p < 0.05) and with plasma volume (r = 0.61; p < 0.05). Furthermore, the ratio δUNa V/ δMAP also rose in concert with body fluid volumes when a salt load of 8 g of sodium chloride was added to the regular diet. Thus, the sensitivity of pressure natriuresis was determined by level of resting arterial pressure and body fluid volumes. These experiments suggest that two mechanisms might be activated in EH to avoid dangerous sodium and volume depletion: 1) attenuation of pressure natriuresis at higher levels of arterial pressure, and 2) blunting of pressure natriuresis by volume contraction. By this hypothesis, the lower slope of pressure natriuresis is secondary to hypertension rather than its cause.
Potassium Supplementation in the Treatment of Ventricular Arrhythmias
Authors: Rowland Edward , Krikler Dennis M.
Published: August 2010

Potassium has a fundamental role in the regulation of the action potential in both myocardial and specialized cardiac cells. The frequency and diversity of ventricular arrhythmia associated with hypokalemia suggests that potassium also plays a crucial part in the genesis of many cardiac arrhythmias. In addition, the presence of potassium in adequate amounts is required for the effective action of many antiarrhythmic agents.

While more information on the mechanism of ventricular arrhythmias in the human is required, as well as observing local biochemical status in the myocardium, it would appear that maintaining the serum potassium towards the upper limit of the normal range offers a logical adjunct to the drug treatment of ventricular arrhythmias.
Relation between Potassium, Magnesium and Cardiac Arrhythmias
Authors: Dyckner Thomas , Wester Per Ola
Published: August 2010

Magnesium may influence the incidence of cardiac arrhythmias by

a direct effect

an effect on potassium metabolism

an effect as a calcium blocking agent.

In the event of a magnesium deficiency the cell cannot attract potassium against the transmembrane concentration gradient. The reason may be that a magnesium deficiency interferes with the function of membrane ATPase, and thus the pumping of sodium out from the cell and potassium into the cell is impaired. The interference from a magnesium deficiency on the equilibrium of potassium between the intra‐ and extracellular spaces may result in changes in the resting membrane potential, changes in potassium conductance across the cell membrane as well as disturbances in the repolarization phase.
CHEST PAIN ‐ PROPHET OF DOOM OR NAGGING NEUROSIS?
Authors: Levene Donald L.
Published: August 2010

ABSTRACT. A six month survey of 588 patients presenting with chest pain to our emergency room revealed some 85 different diagnoses. The most common ages were the sixties and there were more men than women. Myocardial infarction and reflux esophagitis were more common in men, esophageal spasm equally prevalent in both sexes and psychiatric disorders more common in women. Site, radiation, duration and description were helpful in presumptive diagnosis with a few surprises. The problem was common (3.7% of 15.716 visits to the Emergency Room) and frequently perplexing. Wrong diagnoses abound! An overview of the problem is presented including neural mechanisms in pain perception. Chest pain due to intrathoracic structures, the chest wall, nerve roots and extrathoracic structures are considered.