bluuebunny/crossref_metadata_2025 huggingface dataset:
Cardiovascular Effects of Extreme Physical Training
Authors: HOLLMANN W. , ROST R. , DE MEIRLEIR K. , LIESEN H. , HECK H. , MADER A.
Published: August 2010

ABSTRACT. After a short historical remark the development of athlete's heart in childhood is described. Within 2 years significant differences were observed between endurance‐trained (swimming) and untrained girls and boys determined by X‐ray and echocar‐diographical examinations. The limits of the physiological size in relation to body weight were not exceeded within 10 years of longitudinal studies. A second point deals with athlete's heart from physiological and clinical viewpoints. The largest healthy heart ever found in our examinations of athletes had a size of 1 700 ml. Sixteen years after stopping the active career it was reduced to 950 ml without a pathological finding. Questionable and pathological cases are described. A third chapter covers the blood supply of internal organs during exercise combined with air or oxygen breathing. In this connection liver, kidneys, heart, lungs, and brain have been investigated. The reduced blood supply of the liver and kidneys during intense exercise on the cycle ergometer was not influenced significantly by inspiration of oxygen. A significant blood volume increase of the lungs was noticed during incremental rates of work. Exercise augmented also blood flow of the brain in relation to the work rate (at 100 W a 27% increase in grey matter flow of the right hemisphere). A fourth chapter deals with new hormonal and neurohormonal aspects related to the cardiovascular system. Beta‐endorphines remained unchanged at work rates below the anaerobic threshold but increased significantly during maximal rate of work. The opiate antagonist naloxone abolished the rise in body temperature seen during ergometer exercise. The serotonin antagonist ketanserin lowered the blood pressure and the arterial lactic acid level during an incremental exercise test, similar to the results with the dopamine agonist pergolide. The hormon cardiodilantin is produced in the atrial appendages, and it is a potent substance in the regulation of the cardiovascular system. The adaptive reaction of the sympathetic nerve fibres in the myocard revealed different directions: activation, degeneration, and regeneration. These findings correlated highly significantly with the total amount of catecholamines in the heart muscle.
Mechanical Properties of Young and Elderly Human Muscle
Authors: DAVIES C. T. M. , THOMAS D. O. , WHITE M. J.
Published: August 2010

ABSTRACT. The electrically evoked isometric properties of the triceps surae have been studied in young (22 yr) and elderly (69 yr) men and women. The results show that the triceps surae of elderly subjects had an increased time to peak tension (TPT) of the twitch, a lower specific tension (force/cross section area), and showed a greater relative force loss when subjected to a standard “fatigue” test procedure than young triceps surae. The respective figures for TPT, specific tension, and fatigue index (FI) were 147 ± 15 ms (♂), 143 ± 8 ms (♀), 19.5 N/cm2 and 0.52 ± 0.16 (♂), 0.37 ± 0.09 (♀) in the elderly, compared with 118 ± 14 ms (♂), 132 ± 11 ms (♀), 32.9 N/cm2 and 0.67 ± 0.11 (♂), 0.62 ± 0.09 (♀) in their younger counterparts. The peak rates of rise (δP50. δP200) and relaxation (δP50, δPR200) of tetani at 50 Hz and 200 Hz were slower (p < 0.05) in the elderly group. The δP50 and δP200 were inversely associated (r = – 0.76 and –0.50 respectively) with TPT, and the half relaxation time (½RT) of the maximal twitch was related to δP50 (r = – 0.53). The decrease of tetanus relaxation rate during the 2 min fatigue test (δPR) was greater in the elderly than the young and was positively associated (r = 0.74) with FI. It is concluded that elderly muscle is weaker, more slowly contracting and fatiguable than that of the young. However, it is suggested that the reduced specific tension and enhanced fatiguability of the elderly may in part be due respectively to the inadequacies of our estimates of the effective cross‐sectional area CSA) of contractile tissue in the lower leg and the influence of blood flow which may be compromised during a 2 min test.
Physical Activity and Muscle Training in the Elderly
Authors: GRIMBY GUNNAR
Published: August 2010

ABSTRACT. Most elderly people have some kind of regular daily activity, usually closely connected to their daily habits. A six‐graded scale for classification of physical activity is presented. Persons with a low physical activity also usually perceive their physical strain as rather light or moderate. There is a reduction with age in muscle volume, muscle strength, and aerobic capacity which are rather parallel. From a muscular point of view there are only moderate qualitative changes up to the ages around 70; at higher ages there will be a tendency to more marked changes in muscle structure. The maximal aerobic power as well as muscle strength can be increased by physical training also in the elderly. At least up to the ages around 70 there will be an adaptation in muscle structure and enzymatic capacity. In very well‐trained 70–year‐old men high levels of oxidative enzymes are found together with high maximal aerobic power capacity. A positive attitude should be taken towards physical exercise for prevention and rehabilitation also in the elderly.
PLATELET VOLUME, PLATELET RELEASE REACTION AND PLATELET RESPONSE TO INFUSED ADRENALINE ARE INCREASED IN ESSENTIAL HYPERTENSION
Authors: LANDE KNUT , OS INGRID , KJELDSEN SVERRE ERIK , WESTHEIM ARNE , AAKESSON INGVAR , HJERMANN INGVAR , EIDE IVAR , GJESDAL KNUT
Published: August 2010

ABSTRACT. Hypertensive men aged 42 (n = 35) were compared to normotensive men of similar age (n=44). Platelet numbers were similar in the two groups, but hypertensive men had larger venous platelets than the normotensive (7.46 versus 7.12 femtoliter, p=0.01). Plasma concentration of β‐thromboglobulin (BTG), a marker of platelet release reaction, was increased in arterial blood in hypertension (40 versus 21 μg/1, p=0.02). The normotensive subjects had markedly higher BTG concentration in venous compared to arterial blood (p<0.01), but this arterio‐venous difference was not present in the hypertensive group. Twelve normotensive subjects received infused saline, which did not induce changes in platelet variables. Adrenaline was infused to 13 hypertensive and 12 normotensive subjects, with dose gradually increasing to 0.04 μg/kg/min. Platelet count, increased in both groups, but significantly more in the hypertensive group. Platelet volume and BTG both increased markedly in the hypertensive group, but not in the normotensive men. Thus, young men with hypertension have increased platelet activity and increased sensitivity to exogenous adrenaline.
INTRACELLULAR ELECTROLYTES IN CARDIAC FAILURE
Authors: Wester Per Olov , Dyckner Thomas
Published: August 2010

Abstract In congestive heart failure (CHF) there are several compensatory mechanisms operating which may influence electrolyte metabolism. The activation of the renin‐angiotensin‐aldosteron system causes retention of sodium (Na) and losses of potassium (K) and magnesium (Mg). The secondary hyperaldosteronism may give rise to high intracellular Na and low intracellular K through a direct permeability effect on the cell membrane. The Mg deficiency may lead to a further increase of intracellular Na and decrease of intricellular K since Mg is a necessary ion for the function of the Na‐K pump.

In 297 patients with diuretic treated CHF we found that 42% had hypokalemia, 37% hypomagnesemia and 12% hyponatremia. We also found that 57% had excess muscle Na, 52% had depletion of muscle K and 43% had low muscle Mg. We have also shown that the low muscle K cannot be corrected by K supplementation when there is a concomitant Mg deficiency and that Mg infusions may change the disturbed relation between extra‐ and intracellular electrolytes towards normal.
Pulmonary Veno‐occlusive Disease
Authors: LEINONEN HANNU , POHJOLA‐SINTONEN SINIKKA , KROGERUS LEENA
Published: August 2010

ABSTRACT A 50‐year‐old female patient with a long history of Raynaud's phenomenon and rapidly deteriorating right‐sided cardiac failure is presented. Pulmonary veno‐occlusive disease was diagnosed from typical clinical and hemodynamic findings using a Swan‐Ganz balloon catheter. The diagnosis was definitely confirmed at necropsy. There was no clinical, laboratory, or histologic evidence of a connective tissue disease.
Plasma Potassium and Phosphate Concentrations—Influence by Adrenaline Infusion, β‐blockade and Physical Exercise
Authors: LJUNGHALL SVERKER , JOBORN HENRIK , RASTAD JONAS , ÅKERSTRÖM GÖRAN
Published: August 2010

ABSTRACT. Ljunghall S, Joborn H, Rastad J, Åkerström G (Departments of Internal Medicine, and Surgery, University Hospital, Uppsala, Sweden). Plasma potassium and phosphate concentrations—influence by adrenaline infusion, β‐blockade and physical exercise. Acta Med Scand 1987; 221:83–93.

Infusion of adrenaline into healthy male subjects reduced the plasma concentrations of both potassium and phosphate to a similar extent, in a dose‐dependent manner, an effect which was prevented by the administration of propranolol. Ergometer bicycling until exhaustion, which caused marked accumulation of lactic acid in the blood and reduction of pH, induced great elevations of both plasma potassium and phosphate with close relationships between the raised plasma concentrations and the reduction in pH, also during β‐blockade. However, longer‐term aerobic exercise, without acidosis, also caused some rise of the potassium and phosphate concentrations. During recovery from anaerobic, but not from aerobic, exercise there was a rapid decrease of the plasma potassium levels while the phosphate values normalized gradually together with pH. From measurements of the ion concentrations both in the femoral effluent of one leg, which carried out maximal isokinetic work, and in the opposite antecubital vein it could be calculated that there was for potassium, but not for phosphate, a post‐exercise uptake both in the exercised muscle and in the entire organism, indicating the participation of systemic factors.
Hemodynamic Effects of Loud Noise before and after Central Sympathetic Nervous Stimulation
Authors: EGGERTSEN ROBERT , SVENSSON ANDERS , MAGNUSSON MARIE , ANDRÉN LENNART
Published: August 2010

ABSTRACT. The hemodynamic effects of loud noise after central α2‐adrenoceptor stimulation were studied in 13 patients with mild (WHO 1) essential hypertension. The patients were randomized (double‐blind) to treatment with either placebo or guanfacine 1–2 mg for four weeks and then crossed over and treated for another four weeks. All patients were exposed to a loud broad‐band noise (105 dBA for 30 min) and all were studied both on placebo and guanfacine. Guanfacine significantly reduced the resting blood pressure from 141/92 to 134/ 88 mmHg (p<0.01) as well as heart rate at rest from 63 to 58 beats/min (p<0.05). Noise stimulation caused a significant increase in blood pressure and resistance in the placebo‐treated group, while cardiac output decreased significantly. Pretreatment for one month with the central α2‐adrenoceptor stimulating agent guanfacine did not block the noise‐induced pressor response nor the increase in peripheral resistance. A significant decrease in stroke volume was observed and cardiac output also tended to decrease in this group. It could be concluded that loud noise is a potent pressor stimulus which causes vasoconstriction and that the blood pressure response during noise could not be blocked by the centrally acting an‐tihypertensive agent guanfacine. Since noise causes vasoconstriction it also induces an increased tone in the small arteries and, if the noise stimulus is sufficiently strong and repeated for a long time, it might cause structural changes in the resistance vessels and permanent arterial hypertension in humans.
Endogenous Overnight Creatinine Clearance, Serum β2‐Microglobulin and Serum Water during the Menstrual Cycle
Authors: PAABY PER , MØLLER‐PETERSEN JENS , LARSEN CARSTEN E. , RAFFN KJELD
Published: August 2010

ABSTRACT. Endogenous overnight (22.00–08.00 hours) creatinine clearance and serum concentrations of β2‐microglobulin and water were measured three times a week during 11 ovulatory menstrual cycles. In some of the women creatinine clearance changed more than 100% within a week from values below reference range to high normal levels. In all the women the creatinine clearance was higher during the luteal than during the follicular phase and correlated with the production of ovarian hormones. The urinary excretion rate of creatinine was highest during the luteal phase. Urinary volume, serum creatinine and serum water were not significantly influenced by the menstrual phases. An unexplained finding was a parallel change in the individual creatinine clearance and serum β2‐microglobulin during the luteal, but not during the follicular phase. Our results suggest that ovarian hormones influence creatinine clearance during the menstrual cycle. One must therefore accept even considerable short‐time variations in creatinine clearance in fertile women. It remains to be settled if these changes reflect true alterations in glomerular filtration rate or mainly changes in the urinary (tubular) excretion rate of creatinine.
A Syndrome with Painful Lipomas, Familial Dysarthria, Abnormal Eye‐movements and Clumsiness
Authors: JUHLIN LENNART , STRAND ANDERS , JOHNSEN BIRGITTA
Published: August 2010

ABSTRACT. A syndrome of dysarthria, clumsiness and abnormal ocular movements are described in a man and his 3 children. His father, who died when our patient was born, also had the same speech abnormality. Our patient also had multiple painful lipomas suggesting a probable diagnosis of adipositas dolorosa Dercum. Although he looked muscular he complained of muscular weakness and fatigue. Oral treatment with a local anesthetic, mexiletin, inhibited the pain in the lipomas. Analysis of the speech disorder in our patient and his children revealed disturbances in the coordination of jaws, larynx and tongue with a poor control of pitch and volume and impaired intelligibility. The poor fine coordination of hands, clumsiness when walking, dysarthria and disturbance of eye‐movements could be due to a familial malformation in the pons or cerebellum. Computer tomography and X‐ray of head were normal but the grooves on the surface of the cerebellum were more marked than usual.
Autonomic and Peripheral Nerve Function in Early Diabetic Neuropathy
Authors: SUNDKVIST GÖRAN , LILJA BO , ROSÉN INGMAR , AGARDH CARL‐DAVID
Published: August 2010

ABSTRACT. Sundkvist G, Lilja B, Rosén I, Agardh C‐D (Departments of Internal Medicine and Clinical Physiology, Malmö General Hospital, and Departments of Clinical Neurophysiology and Internal Medicine, University Hospital, University of Lund, Lund, Sweden). Autonomic and peripheral nerve function in early diabetic neuropathy. Possible influence of a novel aldose reductase inhibitor on autonomic function. Acta Med Scand 1987; 221:445–53.

Autonomic and peripheral nerve functions as well as the possible short‐term effect of a novel aldose reductase inhibitor (ARI) on neuropathy were evaluated in 30 male type I diabetics (age 25–44 years, mean 34; duration of diabetes 10–20 years, mean 34) with neurographic signs of peripheral neuropathy (PN). Autonomic neuropathy (AN) was established by the heart rate reactions to deep breathing (E/I ratio = vagal function) and to tilt (acceleration index = sympathetic and vagal functions; the brake index = vagal function). Twenty‐nine patients, 13 with AN, completed the study. Among neurographic variables, only sural nerve function tests correlated with autonomic functions. Patients with AN showed significantly lower mean sensory action potential amplitudes (SAPA) sural, indicating axonal losses, than patients without AN (3.58±0.79 μV vs. 7.34±1.12 μV; p<0.01). PN as measured by neurography did not improve during ARI treatment. On the other hand, vagal function (brake indices) improved (p<0.05) during ARI in AN patients.
Familial Dysalbuminemic Hyperthyroxinemia
Authors: JENSEN IVAN W. , FABER JENS
Published: August 2010

ABSTRACT. Jensen IW, Faber J (Department of Endocrinology, Aalborg Hospital North, Aalborg, and Departments of Internal Medicine and Clinical Chemistry, Frederiksberg Hospital, Copenhagen, Denmark). Familial dysalbuminemic hyperthyroxinemia. Acta Med Scand 1987; 221:469–73.

A family with familial dysalbuminemic hyperthyroxinemia is described. The syndrome is inherited as an autosomal dominant trait and is characterized by marked elevation of serum thyroxine, due to increased binding of thyroxine to albumin, whereas serum triiodothyronine is normal. Serum free thyroxine is normal when measured with ultrafiltration or equilibrium dialysis, but artefactually high when measured with an analogue assay. The importance of the condition, which is harmless, lies in the misinterpretation of values with subsequent erroneous treatment of thyrotoxicosis. By using an ultrasensitive TSH method it is possible to discriminate between euthyroid and hyperthyroid patients and thereby to avoid incorrect diagnosis in subjects with euthyroid hyperthyroxinemia.
Effect of Regulatory Withdrawal of Drugs and Prescription Recommendations on the Pattern of Self‐poisonings in Oslo
Authors: EKEBERG ØIVIND , JACOBSEN DAG , FLAATEN BORGAR , MACK ASBJØRN
Published: August 2010

ABSTRACT. Ekeberg Ø, Jacobsen D, Flaaten B, Mack A (Medical Department 7 and Division of Clinical Pharmacology and Toxicology, Central Laboratory, Ullevaal Hospital, Oslo, Norway). Effect of regulatory withdrawal of drugs and prescription recommendations on the pattern of self‐poisonings in Oslo. Acta Med Scand 1987; 221:483–7.

A two‐year prospective study of 1350 admissions for self‐poisoning, covering the Oslo area was undertaken to identify the sources of the toxic agents. After the first year of the study, four barbiturates were withdrawn from the Norwegian market and recommendations were made by the Health Authorities to promote more restrictive attitudes when prescribing psychoactive drugs. The patterns of self‐poisonings in the two periods were compared. The withdrawal of four barbiturates resulted in a 55% decrease in the rate of barbiturate poisonings in general (p<0.001). No increase could be detected in the rate of self‐poisoning with benzodiazepines and other hypnotics, but the incidence of self‐poisonings with antidepres‐sants (p<0.01) and neuroleptics (p<0.01) was found to have increased significantly. The regulations and recommendations resulted in a significant decrease in drugs obtained from doctors randomly consulted (p<0.01), and a significant increase in drugs prescribed by psychiatrists (p<0.01). Drugs obtained from non‐medical sources increased from 28% in the first period to 33.2% in the second. The total number of admissions and toxic agents taken remained unaltered. Thus, regulatory measures can influence the pattern of self‐poisoning but do not seem to influence the tendency to abuse drugs or to take an overdose.
Clodronate Treatment in Patients with Malignancy‐associated Hypercalcemia
Authors: RASTAD JONAS , BENSON LARS , JOHANSSON HENRY , KNUUTILA MARKKU , PETTERSSON BO , WALLFELT CHRIS , ÅKERSTRÖM GÖRAN , LJUNGHALL SVERKER
Published: August 2010

ABSTRACT. Rastad J, Benson L, Johansson H, Knuutila M, Pettersson B, Wallfelt C, Åkerström G, Ljunghall S (Departments of Surgery and Internal Medicine, University Hospital, Uppsala, Sweden). Clodronate treatment in patients with malignancy‐associated hypercalcemia. Acta Med Scand 1987; 221:489–94.

The possibility of reducing symptomatic hypercalcemia and of maintaining total serum calcium concentrations <2.8 mmol/1 with clodronate (dichloromethylene bisphosphonate) was evaluated in 28 patients with various types of malignant tumors. Four episodes of hypercal‐cemic crisis with mean serum calcium concentrations of 4.43 mmol/1 were controlled within 4–6 days of intravenous clodronate (4 mg/kg BW/day). This was accompanied by a moderate increase in serum creatinine values which, however, returned to pretreatment levels after therapy withdrawal in all but one case. Oral clodronate successfully reduced a mean serum calcium concentration of 3.16 mmol/1 in 22 out of 25 patients after 3–12 days (800–3 200 mg/ day). After reversal of the hypercalcemias oral clodronate controlled the serum calcium concentration for up to 42 weeks in six out of 15 patients After discontinuation of initial therapy five of seven recurrent hypercalcemias were successfully treated with oral or intravenous clodronate. Hypocalcemia and subjective side‐effects were uncommon. It is concluded that clodronate is a valuable clinical tool in the management of patients with malignancy‐associated hypercalcemia.
Fasting, Postprandial and Postprandial plus Glucagon‐stimulated Plasma C‐peptide Levels in Non‐insulin‐dependent Diabetics and in Control Subjects
Authors: SARLUND H. , LAAKSO M. , PYÖRÄLÄ K. , PENTTILÄ I.
Published: August 2010

ABSTRACT. Sarlund H, Laakso M, PyÖrÄlÄ K, PenttilÄ I (Departments of Internal Medicine and Clinical Chemistry, Kuopio University Central Hospital, Kuopio, Finland). Fasting, postprandial and postprandial plus glucagon‐stimulated plasma C‐peptide levels in non‐insulin‐dependent diabetics and in control subjects.

We have studied fasting, postprandial and postprandial plus glucagon‐stimulated plasma C‐peptide levels in 149 non‐insulin‐dependent diabetics treated either with diet or oral drugs and in 101 non‐diabetic control subjects. Diet‐treated diabetics showed the highest fasting, postprandial and post‐glucagon C‐peptide levels in both sexes. In men, diabetics treated with oral drugs showed lower postprandial and glucagon‐stimulated C‐peptide levels than control subjects, while in women C‐peptide levels in this group of diabetics were similar to those in control subjects. The distribution of individual plasma C‐peptide levels was wide in non‐insulin‐dependent diabetics and control subjects and there was considerable overlapping in plasma C‐peptide distribution for diabetics and control subjects. Fasting and post‐glucagon plasma C‐peptide levels in diabetics showed an inverse association to plasma glucose levels and a positive association to degree of obesity, but no association with the known duration of diabetes.
A Crossover Comparison of Continuous Insulin Infusion and Conventional Injection Treatment of Type I Diabetes
Authors: HELVE E. , KOIVISTO V. A. , LEHTONEN A. , PELKONEN R. , HUTTUNEN J. K. , NIKKILÄ E. A.
Published: August 2010

ABSTRACT. Helve E, Koivisto VA, Lehtonen A, Pelkonen R, Huttunen JK, NikkilÄ EA (Third Department of Medicine, University of Helsinki, and National Public Health Institute, Helsinki, Finland). A crossover comparison of continuous insulin infusion and conventional injection treatment of type I diabetes.

We evaluated the feasibility and effectiveness of continuous subcutaneous insulin infusion therapy (CSII) as compared to conventional injection treatment (CIT) in an ordinary diabetic clinic in a one‐year randomized crossover study of 65 type I diabetic patients. Home blood glucose levels were lower during CSII (8.6±0.2 mmol/1, mean ± SEM) than during CIT (9.1±0.3 mmol/1, p<0.05). During the first six months, HbA1 fell on CSII therapy (from 10.6±0.4 to 9.7±0.3%, p<0.001), whereas no change occurred during CIT. After the crossover, HbA1 decreased again on CSII (p<0.05), but rose in patients shifted from CSII to CIT (p<0.05). The fall in glycosylated haemoglobin during CSII correlated with the initial HbA1 level (r=0.54, p<0.001). Ketoacidosis was more common during CSII (16 vs. 2 verified episodes). Hypoglycaemia occurred infrequently, without difference between CSII and CIT. Fifty‐six per cent of the patients preferred CSII after the study. In conclusion, while CSII slightly improves the metabolic control, the improvement in the unselected study population is less than previously reported among highly selected patients.
Hydroxocobalamin for Initial and Long‐term Therapy for Vitamin B12 Deficiency
Authors: SKOUBY ARNE P.
Published: August 2010

ABSTRACT. Skouby AP (Medical Department II, Municipal Hospital, Copenhagen, Denmark). Hydroxocobalamin for initial and long‐term therapy for vitamin B12 deficiency.

Seventeen patients were treated for vitamin B12 deficiency with i.m. injection of 1 mg hydroxocobalamin every three months as maintenance therapy for eight to 20 years after an initial depot treatment of one or two series of five i.m. injections on alternate days. In three of four patients given two depot series ≤3 months apart, and with no antibody to transcobalamin II (TC II) detected previously, abnormally high values of serum cobalamins were measured at the end of injection intervals after seven to 12 years. No increase in unsaturated B12 binding capacity (UB12BC) was found in contrast to findings in patients given identical therapy, in whom an early increase above the normal level occurred associated with antibody to TC II. One depot series followed by i.m. injection of 1 mg hydroxocobalamin every third month secured values within the normal range for serum cobalamin, UB12BC and total B12 binding capacity (TB12BC).
Progressive Pulmonary Fibrosis Complicating Cyclophosphamide Therapy
Authors: STENTOFT JESPER
Published: August 2010

ABSTRACT. Stentoft J (Department of Internal Medicine and Haematology, Aalborg Hospital, Aalborg, Denmark). Progressive pulmonary fibrosis complicating cyclophosphamide therapy.

A 26‐year‐old woman with extra‐pulmonary Wegener's granulomatosis was treated with cyclophosphamide for 3.25 years, cumulated dose of 91 g. Six months before cessation of therapy discrete radiological signs of apical fibrosis appeared. The changes were progressive regardless of discontinuation of cyclophosphamide and led to severe restrictive ventilatory defect.
Approaches to Assessing the Rationality of Drug Usage in a Developed Country
Authors: BOËTHIUS G.
Published: August 2010

The prerequisites for analyses of the medical, social and economic consequences of drug usage are in part available in Sweden. Hard data, though, are still fragmentary. Examples are given where various data sources and methods have been applied. It is suggested that feedback of drug utilization data should increase to create a more questioning attitude among pre‐scribers. The concept of medical audit has to be better explained including the fact that individual‐based registers are necessary tools in trying to assess the rationality of drug treatment. In the future such analyses should focus on everyday treatment of common disease entities such as hypertension, diabetes, dyspepsia and asthma. Long term medical and economical consequences of optimized pharmacological versus non‐pharmacological treatment should be studied.
Methods to Assess Health Economic Aspects on Drug Utilization
Authors: BRENNER G.
Published: August 2010

The increasing rate of drug consumption is influenced by different trends which are partly counter‐rotating. The increasing rate of price is statistically to separate from effects influenced by structural shifts in the drug spectrum. The analysis based on a randomized sample (0.1%) of all prescriptions in the Federal Republic of Germany in 1984 give the following: Total expenditure +7.4%; sold packages ‐1.6%; average value per prescription +9.2%; price +2.8%; shift in the structure of consumption +6.0%. The shift in drug consumption influenced by changes in demand or prescription habits were more intensive than price effects in 1984.
Hazard of Obesity‐the Norwegian Experience
Authors: WAALER HANS T.
Published: August 2010

ABSTRACT Ten years' follow‐up of mortality of 1.7 million persons aged 15 years or more with measured body weight and height demonstrates a consistent correlation between body mass index and mortality. The risk function is an asymmetrical U‐function. This shape makes the determination of an optimum very uncertain. The two tails in the distribution of the body mass index show marked differences as to the causes of death: the lower tail is characterized by tuberculosis, lung cancer, obstructive lung diseases, and the upper tail by cerebrovascular and cardiovascular diseases, diabetes and (for males) colon cancer.
Phosphate Binding by a Myeloma Protein
Authors: PETERSSON TOM , HORTLING LARS , TEPPO ANNA MAIJA , TÖTTERMAN KARL JOHAN , FYHRQUIST FREJ
Published: August 2010

ABSTRACT. A patient with IgG kappa myeloma had markedly elevated serum phosphate concentrations but no clinical features of hyperphosphataemia. The hyperphosphataemia was due to a high phosphate per protein unit than normal IgG.
Vasospastic Angina Assessed by Hyperventilation‐Thallium‐201 Myocardial Scintigraphy
Authors: FALSTIE‐JENSEN N. , ENGBY B. , RASMUSSEN K. , BAGGER J. P. , THUESEN L. , TÅGEHØJ‐JENSEN E.
Published: August 2010

ABSTRACT The response to prolonged hyperventilation (HVT) was evaluated by electrocardiography (HVT‐ECG) and thallium‐201 myocardial scintigraphy (HVT‐TI‐Sc) in 40 patients suspected of vasospastic angina. Both tests showed ischaemic changes in 16 patients and no changes in 20 patients. Two patients had abnormal HVT‐ECG and normal HVT‐TI‐Sc, and the reverse combination was found in two patients. Prolonged HVT was performed in 14 patients during coronary angiography (CAG). Nine developed transient total or subtotal occlusion in one of the major coronary arteries, all of whom had ischaemic HVT‐ECG and eight had abnormal HVT‐TI‐Sc. In the five patients without spasm at CAG four had normal HVT‐ECG and all five normal HVT‐TI‐Sc. Our data suggest that HVT‐ECG and HVT‐TI‐Sc have essentially the same sensitivity and specificity in detecting vasospastic angina.
Syndrome of Inappropriate Antidiuresis in Small‐Cell Lung Cancer
Authors: SØRENSEN JENS BENN , KRISTJANSEN PAUL E. G. , ØSTERLIND KELL , HAMMER MOGENS , HANSEN MOGENS
Published: August 2010

ABSTRACT Patients with small‐cell lung cancer and hyponatremia were examined for the syndrome of inappropriate antidiuresis (SIAD). A comparison was made between the definition based on hyponatremia, serum hypoosmolality and urine hyperosmolality (classic SIAD, 12 patients) and a definition based on measurement of plasma ADH concentration by radioimmunoassay (RIA‐SIAD, nine patients) and patients without SIAD (eight patients). A standard water load test was performed as a reference before initiation of cytostatic treatment. All tests were repeated if remission of the malignant disease occurred. RIA‐SIAD patients were a subgroup of classic SIAD patients, with more pronounced homeostatic abnormalities. Biochemical abnormalities were reduced after tumor regression but a completely normal renal water handling was achieved in only few patients, even when complete remission of the tumor was achieved, presumably due to the persistence of subclinical disease. However, an effect of other yet unknown factors might be of influence.
Treatment with One‐alpha‐hydroxycholecalciferol in Middle‐aged Men with Impaired Glucose Tolerance—A Prospective Randomized Double‐blind Study
Authors: LJUNGHALL S. , LIND L. , LITHELL H. , SKARFORS E. , SELINUS I. , SØRENSEN O. H. , WIDE L.
Published: August 2010

ABSTRACT Experimental evidence suggests a specific role for the active metabolite of vitamin D (1,25(OH)2D3) in insulin secretion. In order to evaluate the possible clinical significance, 65 middle‐aged men with impaired glucose tolerance, and normal serum levels of vitamin D metabolites, were enrolled in a three‐month study where they were given either 0.75 μg alpha‐calcidol (1α(OH)D3) daily or placebo. Indices of glucose and lipid metabolism were evaluated before and after treatment. There were no significant changes during the trial neither for fasting blood glucose, hemoglobin A1C or for the intravenous glucose tolerance between the treatment and the placebo groups, nor were there any consistent changes in insulin values during the glucose tolerance test. Subjects treated with alpha‐calcidol displayed a significant reduction in body weight with an average of 1.1. kg, while those receiving placebo lost no weight. Treatment did not affect the serum lipoprotein values. Thus, a modest dose of active vitamin D, which did not cause elevation of serum calcium, did not provide general improvement of glucose tolerance or of insulin secretion when given to patients with impaired glucose tolerance, but without vitamin D deficiency, over a three‐month period.
Acute Myocardial Infarction in Diabetic Patients
Authors: MøLSTAD PER , NUSTAD MIMMI
Published: August 2010

ABSTRACT. All patients hospitalized during a 3‐year period with an acute myocardial infarction were followed for the occurrence of reinfarction or death. The patients with diabetes mellitus (n=95) were compared with the non‐diabetic population (n=545). The diabetics had a higher mortality rate (relative death rate of 1.44 vs. 0.93, p<0.01) and a higher frequency of reinfarctions (18.9 vs. 10.8%, p=0.04) than the non‐diabetic population. A larger proportion of the diabetics had suffered a previous infarction, but the excess mortality was also present in those without a previous infarction. Established risk factors for death after myocardial infarction, such as age, infarct size, infarct localization and heart size, could not account for the difference in mortality. It is suggested that the increased mortality among the diabetics may be due to an increase in the rate of progression of the atherosclerotic heart disease.
Cardiovascular Risk Factors in Type I (Insulin‐dependent) Diabetic Patients with and without Proteinuria
Authors: VALDORF‐HANSEN FLEMMING , JENSEN TONNY , BORCH‐JOHNSEN KNUT , DECKERT TORSTEN
Published: August 2010

ABSTRACT.In diabetes mellitus cardiovascular mortality among patients with increased urinary albumin excretion seems to be higher than in patients with normal urinary albumin excretion. Therefore we investigated blood pressure, total cholesterol, fibrinogen and in vivo platelet adhesion in 61 patients with type I (insulin‐dependent) diabetes, 39 without complications, such as retinopathy or proteinuria and 22 with proteinuria and slightly elevated serum creatinine. The two groups had similar age, sex, diabetes duration and glucose control. Blood pressure, total cholesterol, fibrinogen and in vivo platelet adhesion were all significantly elevated in patients with proteinuria (p<0.01), whereas these parameters were normal in the uncomplicated diabetic patients, independent of diabetes duration. The mortality of cardiovascular disease during 20 years' follow‐up was significantly higher among patients with proteinuria compared with patients without proteinuria (p<0.001), indicating that these risk factors contribute to the increased cardiovascular mortality in patients with clinical nephropathy.
The Carry‐over Effect on the Bowel Habit in Elderly Long‐term Patients of Long‐term Bulk‐forming Products Containing Stimulant Laxative
Authors: KINNUNEN OSMO , SALOKANNEL JUHANI
Published: August 2010

ABSTRACT. This study was undertaken to investigate the possible carry‐over effect on elderly long‐term patients of bulk‐forming products containing stimulant type laxatives. Thirty 48 patients received magnesium hydroxide daily for a mean period of 10 months prior to the study, and 23 patients received bulk laxatives containing cassiae senna daily for a mean period of 13 months prior to the study. The pre‐study laxatives were randomly changed either to magnesium hydroxide or to bulk laxatives. In the patient group receiving a bulk‐forming product containing stimulant type laxative long‐term prior to the study, the need for additional stimulant laxatives during the pure bulk laxative (3.0 vs. 3.8/4 weeks, NS) or magnesium hydroxide treatment (2.6 vs. 2.7/4 weeks, NS) was not more frequent and the frequency of defaecation was not lower than in the patients (during bulk laxative 11.2 vs. 9.3/4 weeks, NS and during magnesium hydroxide 12.0 vs. 13.714 weeks, NS) who received long‐term magnesium hydroxide treatment prior to the study. Thus, our data indicated no carry‐over effect after the use of bulk‐forming laxatives containing senna for 13 months in elderly long‐term patients.
Nutrition and alcoholic encephalopathies
Authors: ThomsonBSC Allan D , Jeyasingham Marina D , Pratt Oliver E , Shaw George K
Published: August 2010

An assessment has been made of metabolic factors possibly causing or contributing to the brain damage associated with chronic alcoholism, especially thiamin lack or disturbance of amino acid metabolism. Abnormalities in the thiamin‐dependent enzyme, transketolase, provide evidence of a high incidence of thiamin deficiency as well as of disturbed thiamin metabolism in chronic alcoholics, which are likely to be caused by reduced vitamin intake as well as impaired absorption. A grossly disturbed pattern of amino acids in the blood of patients undergoing treatment for alcohol withdrawal syndromes is likely to be caused by loss of hepatic function and may well aggravate brain damage caused by B group vitamin deficiency. A hypothesis is proposed of how chronic thiamin lack can lead to brain damage.
Comparison of the attack rates of acute myocardial infarction in two Belgian towns
Authors: BERGHMANS L. , DE BACKER G. , KORNITZER M. , DRAMAIX M. , LAGASSE R. , PAYEN R. , KITTEL F. , VAN DER STICHELEN C. , DERESE A. , HEYERICK J.P.
Published: August 2010

ABSTRACT. Comparison of the attack rates for acute myocardial infarction in two Belgian towns AMI attack rates in two Belgian towns

Belgium is divided in two main regions: Flanders in the North with a Dutch‐speaking population, and Wallonia in the South with a French‐speaking community. From 1982 onwards, a register of acute myocardial infarction has been in operation in Ghent, a Flemish town, and in Charleroi in Wallonia, following the procedures of the MONICA (Multinational Monitoring of Trends and Determinants in Cardiovascular Diseases) study.

Annual attack rates of myocardial infarction are presented for a 5‐year period. During this period, the annual attack rates for men are 10–20 % higher in Charleroi than in Ghent. In women, the ratio between the two cities is less clear. The results of this community registers confirms the regional differences observed previously in Belgium using other epidemiological techniques.
Risk factors in the population of the GDR‐MONICA Study (1983/84)
Authors: HEINEMANN L. , HEINE H. , ASSMANN A. , SCHÄDLICH H. , BARTH W. , THIEL C. , MARTIN I. , EISENBLÄTTER D. , BRAUN H. , JOHNSEN D. , CASPER W.
Published: August 2010

ABSTRACT. The GDR‐MONICA project comprises 25 administratively defined areas with a population of nearly two million people aged 25–64. Data from the first random sample survey are reported here.

The survey gathered information regarding risk factors, dietary behaviour, physical activity and psychosocial factors from 11,281 persons aged 25–64. The average risk factor levels were high in the population: The mean casual blood pressure was 140/88 mmHg and 138/86 mmHg for men and women respectively. In both sexes the mean total cholesterol level exceeded 6.1 mmol/L, and the mean body mass index (BMI) was just over 26.0. The study population consumed, on average, excessive amounts of energy, fat, alcohol, and sodium, and too few carbohydrates. Preliminary conclusions regarding unfavourable trends in risk factor levels have been drawn by comparing the present data with other recent reliable epidemiological studies.
Dietary survey of the FINMONICA project in 1982
Authors: PIETINEN P. , UUSITALO U. , VARTIAINEN E. , TUOMILEHTO J.
Published: August 2010

ABSTRACT. A dietary survey concerning 1348 persons aged 25–64 was carried out in connection with the first FINMONICA risk factor survey in the three monitoring areas, North Karelia and Kuopio in the east, and Turku—Loimaa in the south‐west in 1982. Three‐day food records were used in the dietary assessment. The fat content of the diet in men was 38–39 % of energy in all areas, whereas in women it was about 36 % in the east compared to 38 % in the south‐west. The ratio of polyunsaturated to saturated fat of the diet was lower in the east than in the southwest in both sexes (0.25 vs. 0.31). This seemed to be the result of higher milk and butter consumption in the east. The regional differences in the quality of dietary fats seemed to be the result of both different occupational structures and different dietary habits within each occupational group, especially among women.
Comparison between Different Methods of Detecting Patients with Excessive Consumption of Alcohol
Authors: PERSSON JESPER , MAGNUSSON PER‐HENRIK
Published: August 2010

ABSTRACT A study of excessive alcohol consumption was carried out on 2114 adult somatic outpatients. All patients were evaluated by the following methods: Blood‐chemical tests (serum gamma‐glutamyltransferase (S‐GT), serum aspartate aminotransferase (S‐ASAT) and ethanol), patient's and doctor's questionnaires, and analysis of data from psychiatric records, social welfare registers and alcohol ambulatory services. Records from psychiatric clinics detected 48% of the patients. Forty per cent of the alcohol patients had S‐GT levels > 0.9 μkat/l. S‐ASAT and blood ethanol levels were of little informative value. The doctors recognized excessive consumption in 25% of the patients. Only 16% of the alcohol patients reported excessive consumption (> 280 g of ethanol/week). The combination of S‐GT and questionnaires to patients and doctors detected 63% of the alcohol patients. Both in epidemiological studies and in clinical practice it seems appropriate to use combinations of different methods to detect patients with underlying alcohol problems.
Studies of Insulin Resistance Following Hypoglycemia in Insulin‐dependent Diabetes Mellitus
Authors: KOLLIND MAGNUS , ADAMSON ULF , LINS PER‐ERIC
Published: August 2010

ABSTRACT Insulin resistance was assessed after a hypoglycemia induced by insulin (1.5 mU×kg‐1 ×min‐1) between 7 and 8 a.m. in 10 well‐insulinized patients with insulin‐dependent diabetes mellitus (IDDM). Blood glucose levels during a somatostatin (100 μg×h‐1)‐insulin (0.4 mU×kg‐1×min‐1)‐glucose (4.5 mg×kg‐1)‐infusion test (SIGIT) performed between 11 a.m. and 3 p.m. served as an indicator of total body insulin resistance. Plasma epinephrine, growth hormone, and Cortisol increased in response to hypoglycemia, while blunted responses of glucagon were simultaneously registered. At the start of the subsequent SIGIT, blood glucose and plasma‐free insulin concentrations were similar to those obtained in the control study without preceding hypoglycemia, and at this point all counter‐regulatory hormones had returned to basal. During the SIGIT close to identical levels of plasma‐free insulin and counter‐regulatory hormones were registered, despite which a significant hyperglycemia was seen 2 hours after the start of the SIGIT when preceded by hypoglycemia. In a separate study, the SIGIT was shown to have a good reproducibility in IDDM patients. We conclude that hypoglycemia evokes a state of insulin resistance for several hours, as demonstrated by elevated blood glucose levels during a somatostatin‐insulin‐glucose‐infusion test.
Thromboxane A2 and Prostacyclin Release in Bleeding Time Blood during Primary Haemostasis in Healthy Individuals
Authors: THORNGREN MARGARETA , VINGE ELLEN
Published: August 2010

ABSTRACT It is generally believed that prostacyclin (PGI2) generation is greatly stimulated when blood vessels are injured, even by minor trauma, such as venepuncture. The Simplate technique for measuring skin bleeding time was adapted to quantify by radioimmunoassay PGI2 and thromboxane A2 (TXA2) in the emerging blood, as the stable degradation products 6‐keto‐prostaglandin F1α (6‐keto‐PGF1α) and thromboxane B2 (TXB2), both of which were measured in venous plasma as well as in serum (clotted at 37°C for 1 h). During bleeding, when platelets aggregate to occlude the injured vessels, the median TXB2 level in the emerging bleeding time blood was 1.7 ng/ml. The median TXB2 level in plasma was < 1 ng/ml and in serum 275 ng/ml. The levels of immunoreactive 6‐keto‐PGF1α were always below determination limit in bleeding time blood (0.2 ng/ml) and in plasma (0.1 ng/ml), whereas in serum the levels ranged between 0.26 and 0.47 ng/ml. The fact that enhanced PGI2 production in primary haemostasis in skin incisions could not be demonstrated calls for further investigations of possible PGI2 production with more sensitive assays or in injured large vessels.
Effects on Mortality during Five Years after Early Intervention with Metoprolol in Suspected Acute Myocardial Infarction
Authors: HERLITZ JOHAN , HJALMARSON ÅKE , SWEDBERG KARL , RYDÉN LARS , WAAGSTEIN FINN
Published: August 2010

ABSTRACT This study reports the mortality over a 5‐year‐period determined a double‐blind trial, which evaluated the effect of early intervention with metoprolol in suspected acute myocardial infarction. In all, there were 1 395 randomized patients, 698 and 697 of whom were allocated to metoprolol 200 mg daily and placebo treatments, respectively, for the first 3 months. Thereafter, the two groups were treated in a similar fashion implying β‐blockade to a majority. Within the first 3 months, mortality in the metoprolol group was 5.7% versus 8.9% of the placebo group (p = 0.02). This difference persisted after 2 years (metoprolol 13.2%; placebo 17.2%; p = 0.04). Over a 5‐year‐period, 24.2% of the patients who originally were allocated to metoprolol had died as compared to 25.7% of those originally allocated to placebo (p > 0.2). Among patients in whom treatment started early (≤ 8 hours after onset of pain = the median delay time), enzyme activities in the metoprolol group was lower (p = 0.03) than in the placebo group. Mortality during the first 2 years among these patients treated early was lower in the metoprolol (11.8%) than in the placebo group (17.3%; p = 0.04). Corresponding figures after 5 years were 22.0% and 25.3%, respectively (p > 0.2). Among patients in whom treatment started later than 8 hours onset of pain, there was neither any difference in enzyme activity nor in mortality after 2 and 5 years. It can be concluded that early treatment with metoprolol in suspected acute myocardial infarction reduced mortality during the first 3 months compared with placebo. The difference persisted after 2 years. However, 5 years after randomization, no significant difference in mortality was observed between the two treatment groups.
Non‐invasive Recognition of Arrhythmogenic Right Ventricular Dysplasia
Authors: BRANDT JOHAN , HOFVENDAHL STEFAN , LJUNGDAHL LARS , DAHLSTRÖM JAN A. , OHLIN PER
Published: August 2010

ABSTRACT Arrhythmogenic right ventricular dysplasia causes ventricular arrhythmias and sometimes heart failure. The condition is easily overlooked, but once suspected, it may be diagnosed non‐invasively. This is illustrated by the case reported. The clinical features of this syndrome are discussed, with special emphasis on the non‐invasive findings.
Turner's Syndrome Associated with Chronic Inflammatory Bowel Disease. A Case Report and Review of the Literature
Authors: KNUDTZON JØRGEN , SVANE SIVERT
Published: August 2010

A 26‐year‐old woman with Turner's syndrome (45,X/46,X,i(Xq)) and Crohn's disease is reported. The inflammatory bowel disease was aggressive with development of intestinal fistulas. Total proctocolectomy was performed, and the patient recovered remarkably well postoperatively. The association of Turner's syndrome and inflammatory bowel disease is reviewed, with special reference to karyotype, severity, mortality and treatment.
Sudden Death Caused by Heart Block in a Patient with Multiple Myeloma and Cardiac Amyloidosis
Authors: SKADBERG BRITT T. , BRUSERUD ØYSTEIN , KARWINSKI WITOLD , OHM OLE‐JØRGEN
Published: August 2010

A patient with multiple myeloma and amyloidosis was admitted to hospital following successful cardiopulmonary resuscitation at home. No disturbances in heart rhythm were seen during the first 48 hours of continuous telemetric ECG recording. The patient died from ventricular asystole due to complete atrioventricular block, while he was on a 24‐hour Holter monitoring the fifth night in hospital. Patients with known cardiac amyloidosis and syncope should undergo long‐term ECG recordings, preferably by telemetry. Repeated registrations may be necessary to discover disturbances in heart rhythm.