bluuebunny/crossref_metadata_2025 huggingface dataset:
Response to Busulphan Treatment of Paroxysmal Nocturnal Hemoglobinuria and Myelofibrosis in One and the Same Patient
Authors: Almquist Anders , Holm Jan , Wahlin Anders
Published: August 2010

ABSTRACT. Paroxysmal nocturnal hemoglobinuria (PNH) occurs occasionally in association with other blood disorders. This fact has led to the suspicion, that a mutation on the stem cell level may produce a dual defect of hematopoiesis, the PNH defect as well as other disturbances in blood formation. A patient with PNH and myelofibrosis appearing simultaneously is presented. Treatment with busulphan resulted in reduction of the hemolysis and improvement of the patient's condition. To our knowledge, this experience has not been described previously.
M‐Mode Echocardiographic Mapping in Differentiation of Normal from Dysfunctioning left Ventricular Myocardium
Authors: Lindvall Kaj
Published: August 2010

ABSTRACT. Seventeen severely ill patients with acute myocardial infarction (AMI) (12 men and 5 women; mean age 65) and 37 healthy persons with similar age and sex distribution were investigated. Regional left ventricular wall motion was studied in terms of mean wall velocity, in 16 segments, 8 basal and 8 apical, by M‐mode echocardiographic (Echo) mapping from 6 probe positions. Adequate Echo registrations were obtained from 88 % of the total of 864 segments. The best classification (88.5%) of normal and infarcted segments was obtained with a ‐30 % deviation of mean systolic wall velocity (Vmean) values from the mean values of the control segments (CS). Non‐infarcted segments (NIS) in the AMI group had significantly lower Vmean values than the CS (p> 0.001). Subendocardially (SIS) and transmurally (TIS) infarcted segments could be clearly separated from both CS and NIS (p > 0.001). Per cent deviation of Vmean from the mean value of the control segments (PD‐V) for SIS varied considerably overlapping CS, NIS and ITS. With a PD‐V between 0 and ‐30% the probability of NIS is 94%, SIS 6% and TIS less than 1%. A PD‐V more than ‐66% was rarely seen among NIS (2 %) but was the normal finding in TIS (94%).
Malignant Mesenchymoma of the Heart Presenting as Mitral Stenosis
Authors: Frandsen N. E. , Andersen G. , Nielsen J. Rokkedal
Published: August 2010

ABSTRACT. Malignant mesenchymoma of the left atrium obstructing the mitral orifice was revealed at autopsy in a 39‐year‐old woman with a history indicating mitral stenosis. Minor tumour nodules were found in the walls of the right and left ventricle together with a few distant metastases. Clinical findings in primary cardiac tumours and the rarity of primary malignant mesenchymoma of the heart are discussed.
Metoprolol and Atenolol Administered Once Daily in Primary Hypertension
Authors: Lyngstam Olle , Rydén Lars
Published: August 2010

ABSTRACT.To compare the antihypertensive effect of two β‐blocking agents, metoprolol (Seloken®) and atenolol (Tenormin®), a double‐blind study was performed in 55 patients. Following a six‐week placebo period the patients, who all had mild to moderate essential hypertension (WHO I‐II), were randomly allocated to treatment with either metoprolol (n=28) or atenolol (n=27). During a six‐week period they received 100 mg of either drug once daily. For patients who at the end of that period did not reach a diastolic blood pressure (BP) of <95 mmHg the daily dose was increased to 200 mg. Patients who responded (diastolic BP<95 mmHg) continued on the initial dosage regimen. When comparing the two groups with regard to the reduction of BP, there was no difference either 24 hours after the last dose or 5–9 hours after drug administration. The decrease in supine systolic/diastolic BP was 18/16 mmHg on metoprolol and 20/16 on atenolol. The decrease in heart rate was comparable in the two groups. Eight patients in the metoprolol and 7 in the atenolol group had their dose increased to 200 mg at the end of the first six‐week period. This means that the number of patients not responding to 100 mg daily was comparable in the two groups. We did not observe any differences in side‐effects of the two drugs. The results dearly suggest that atenolol and metoprolol are equipotent following once daily administration in patients with mild to moderate hypertension.
Antihypertensive Effect of Atenolol (100 mg Once a Day) and Methyldopa (250 mg Thrice a Day)
Authors: Kristensen Bent Ø. , Brøns Morten , Christensen Cramer K. , Geday Erling , Jacobsen Finn K. , Jensen Søren N. , Linde Niels C.
Published: August 2010

ABSTRACT. In a double‐blind cross‐over multicentre study lasting for 16 weeks, the antihypertensive effect of atenolol (100 mg once a day) was compared with that of methyldopa (250 mg thrice a day) in 48 patients with mild to moderately severe hypertension. At the end of the trial, atenolol was superior to methyldopa in achieving clinically relevant BP levels, <150/95 mmHg (p > 0.001), and in respect to patients' drug preference (p > 0.04). The BP levels after the first 2 weeks of treatment with either drug were identical but, in contrast to methyldopa, atenolol caused further significant reduction in BP during the following 4 weeks. This finding implies that one should hesitate to start additional therapy until after at least six weeks of atenolol treatment, whereas no further reduction in BP can be expected after the first 2 weeks of treatment with methyldopa. Two patients had to be withdrawn from the study during treatment with atenolol, as they developed severe bradycardia and dyspnoea, respectively. Other side‐effects were few and of minor clinical importance.
Runner's Anemia and Iron Deficiency
Authors: Hunding Axel , Jordal Robert , Paulev Poul‐Erik
Published: August 2010

ABSTRACT. Systemic iron deficiency was found in 63 (56 %) of 113 joggers and competition runners (33 women and 80 men). Thirteen women and ten men had latent anemia. A majority of the women were fertile with iron loss from menstruation; the men were runners training long distances. The average transferrin iron‐binding capacity was 80 μmol/l serum in the women and 77 (iron‐binding groups) in the men. The haptoglobin and iron concentrations in serum were remarkably low (most often below 10 and 20 μ mol/l, respectively). Three of the longdistance runners ran 25 km daily. They returned with so much free hemoglobin in their plasma that an accompanying iron loss (integrated over months), if not balanced by diet, would lead to iron deficiency and anemia. Oral iron therapy (200 mg ferrous sulphate per day) normalized the hemoglobin concentration and improved the transferrin saturation fraction in 61 persons. The competition runners reported personal records.
The Clinical Significance of Macrocytosis
Authors: Breedveld Ferdinand C. , Bieger Robert , van Wermeskerken Robert K. A.
Published: August 2010

ABSTRACT. The cause of macrocytosis (mean corpuscular volume (MCV) ≥105 fl) was investigated over a period of 16 months in the 70 known cases of ± 4000 patients seen by the Department of Internal Medicine. By means of simple laboratory investigations the cause of elevated MCV was found in more than 90% of the cases. We found vitamin B12 or folic acid deficiency in 27 patients, alcohol abuse in 19, chronic persistent hepatitis in 2, hematological (pre‐) malignancy in 9, hemolysis in 4, hypothyroidism in 2, and a drug effect in one patient. In 6 cases the elevated MCV could not be explained. Macrocytosis, a frequent finding that is not related to the hemoglobin concentration, is an indicator of serious pathology. The MCV level can be used to differentiate between the diagnostic categories. Only 21 patients (30%) had megaloblastic erythropoiesis that was difficult to recognize in the peripheral blood. Among the findings at routine laboratory investigations an elevated MCV may be the only indicator of vitamin deficiency, preleukemia or alcoholism.
Serum Ferritin in Alcoholics and the Relation to Liver Damage, Iron State and Erythropoietic Activity
Authors: Lundin L. , Hällgren R. , Birgegård G. , Wide L.
Published: August 2010

ABSTRACT. Serum ferritin was measured in two groups of alcoholics; one comprised 71 individuals on ambulatory control and with varying current alcohol intake and the other 19 alcoholics followed with serial determinations during two weeks of abstinence Serum ferritin was elevated in 26 subjects in the larger group, and 22 of them had elevated ASAT and ALAT values. Low‐grade but significant correlations were found between serum levels of ferritin and serum concentrations of some variables used to detect liver affection (ASAT, ALAT, bilirubin and γ‐GT). Serum ferritin and ASAT declined in a parallel fashion in the 19 patients studied longitudinally, so that the ferritin: ASAT ratio described a straight line. No correlation was found between serum ferritin or the serum ferritin: ASAT ratio and serum iron. Neither was any correlation observed between the magnitude of the changes in serum ferritin and the changes in serum iron, serum transferrin or circulating platelets or reticulocytes observed in the serially followed alcoholics. These data indicate that elevated serum ferritin in alcoholics is associated with the degree of liver affection and not with the degree of erythropoietic activity.
178 Fatal Cases of Pulmonary Embolism in a Medical Department
Authors: Nielsen Hans Kræmmer , Bechgaard Poul , Nielsen Peter From , Husted Steen Elkjær , Geday Erling
Published: August 2010

ABSTRACT. The diagnosis of pulmonary embolism was established during a 6‐year period in 284 patients hospitalized in medical departments of a general hospital. Of the 183 patients who died, 178 were autopsied. A retrospective study was performed on the autopsy‐verified fatal cases to correlate their clinical state to relevant postmortem findings. Two groups made thorough, independent evaluations of data from the medical and pathological records. In 95% of the patients a confirmed fatal pulmonary embolism constituted only a slight modification of life expectancy, because of concomitant complicating, severe, terminal disease. Reflecting this poor clinical state, only 26 patients (15%) had a diagnosis of pulmonary embolism premortally and of these patients, 13 died within 5 hours after onset of symptoms and 10 were treated with antithrombotic drugs. Our results seem to indicate an increase in the incidence of terminal diseases in the popultaion of elderly, hospitalized patients and change the concept of fatal pulmonary embolism into an agonal incident in a terminal‐care medical patient.
Free Light Chains of Immunoglobulins in Serum from Patients with Rheumatoid Arthritis, Sarcoidosis, Chronic Infections and Pulmonary Cancer
Authors: Sølling K. , Sølling J. , Rømer F. K.
Published: August 2010

ABSTRACT. Free light chains of immunoglobulins were measured in serum from 181 patients with rheumatoid arthritis (RA), sarcoidosis, pulmonary tuberculosis, pulmonary cancer and chronic bronchitis, i.e. patients with long‐term stimulation of the immune system. Increased concentrations of light chains were found in patients with active sarcoidosis, and the light chain level appeared to be a marker of disease activity in sarcoidosis. The mean (±S.D.) concentration of kappa plus lambda chains in active sarcoidosis of more than two years' duration was 38.3± 13.7 mg/l, that is twice the concentration of 19.4±5.5 mg/l found in normals. Some patients with seropositive RA also had increased serum values. The light chain concentrations in seropositive RA were correlated to the severity of the disease measured by clinical staging and laboratory tests. A modest increase in light chains was observed in one patient with tuberculosis, and in two patients each with chronic bronchitis and pulmonary cancer.
Mitral Annulus Calcification, Systolic Anterior Motion of the Anterior Mitral Leaflet and Outflow Obstruction in Two Patients without Hypertrophic Cardiomyopathy
Authors: Lindvall Kaj , Herrlin Bo
Published: August 2010

ABSTRACT. Systolic anterior motion of the anterior mitral leaflet (SAM) and concomitant left ventricular outflow obstruction (LVOFO) are commonly seen in hypertrophic cardiomyopathy. However, SAM has also been described together with extensive anteroseptal wall infarction, pericardial exudation and in hypovolemic situations. This report presents two patients examined with M‐mode echocardiography which demonstrates that SAM with LVOFO can also occur in association with mitral annulus calcification (MAC). A possible mechanism behind this entity would firstly be the anterior displacement of the mitral ring commonly seen in MAC. Secondly, extension of calcifications to the posterior wall will furthermore impair the LV contraction leading to loosely stretched chordae tendineae during systole and hence a motion of the anterior mitral valve along the blood stream (SAM) leading to LVOFO.
Secondary Hematological Changes Mimicking the Preleukemic Syndrome
Authors: Hast Robert , Beran Miloslav
Published: August 2010

ABSTRACT. Two women with hematological and clinical features typical of the preleukemic syndrome, including low marrow myeloid colony and cluster formation in vitro, showed unexplained spontaneous improvement with normalization of both peripheral blood values and in vitro cloning efficiency after 2–4 years. One patient had and the other developed later an autoimmune disorder. It is therefore suggested that secondary hematopoietic changes might have mimicked the preleukemic syndrome.
The Pathophysiology of Acute Renal Failure after Chlorprothixene Overdosage
Authors: Rossen Benni , Steiness Ib
Published: August 2010

ABSTRACT. Renal failure after an overdose of chlorprothixene has been attributed to a direct nephrotoxic effect of the drug. We report a carefully investigated case. No evidence of specific nephrotoxicity was revealed and we suggest that the renal failure is due to ischaemia during a transitory syncope, a well known side‐effect of chlorprothixene.
Catecholamine Neurotransmitters and the Heart
Authors: Brown M. J. , Macquin I.
Published: August 2010

ABSTRACT.The possible role of adrenaline as a cardiac neurotransmitter was studied following its infusion in 6 healthy volunteers. After the end of the infusion, heart rate remained elevated for several hours despite a rapid fall in plasma adrenaline concentration. Stimulation of sympathetic activity by standing caused a further marked increase in heart rate, which was greater than that found on a control occasion. These effects were abolished or reduced by pretreatment with either desipramine or (in the dog) alpha–methyl–p–tyrosine, suggesting that they depend both on uptake of the adrenaline into sympathetic nerve endings during infusion and on increased release of endogenous noradrenaline. These results are consistent with stimulation of the beta–presynaptic receptor by adrenaline when re–released from sympathetic nerves.
Control of Circulation by Cerebral Catecholaminergic and Histaminergic Mechanisms
Authors: Karppanen Heikki
Published: August 2010

ABSTRACT.Catecholamines are formed, released and metabolized in the cerebral regions known to regulate the cardiovascular system. The release of catecholamines in these brain areas is associated with changes in cardiovascular function. Injections of exogenous catecholamines into certain brain regions induce cardiovascular changes and mimic the effects of the release of endogenous catecholamines in the same regions. In addition, drugs with selective effects on cerebral catecholamine functions also induce cardiovascular changes. Changes in cerebral catecholamines have also been found in arterial hypertension. Taken together, these observations provide strong evidence that cerebral catecholaminergic mechanisms have a crucial role in both the normal and pathological control of circulation. Cerebral catecholaminergic mechanisms also mediate, at least in part, the therapeutic effects of clonidine, alpha–methyldopa and some other antihypertensive drugs.

Recent findings suggest that histaminergic mechanisms in the brain may also be important in the control of circulation and in the mediation of drug effects. Since the cerebral mono–aminergic systems are necessary for the physiological control of circulation, it is likely that the cerebral catecholaminergic and possibly histaminergic pathways are also involved in the mediation of the effects of psychosocial stress factors on the cardiovascular system.
Pathogenetic Mechanisms of Coronary Vasospasm
Authors: Chierchia Sergio
Published: August 2010

ABSTRACT.Coronary vasospasm plays a role in several manifestations of coronary heart disease, though its causes still remain to be established. Among suggestions made to account for it are normal increases in vasomotor tone, particularly in stenosed arteries, and local vascular hypersensitivity reactions. Stimuli known to precipitate spasm are discussed, particularly the role of the sympathetic nervous system and the possible involvement of platelet aggregation. Coronary vasospasm is stimulated by a number of different triggering mechanisms which vary between patients and even within patients at different times. However, it is concluded that vasospasm is the result of an interaction between hypersensitive vascular smooth muscle and a number of specific constrictor stimuli.
Psychosocial Risk Factors for Coronary Heart Disease
Authors: Jenkins C. David
Published: August 2010

ABSTRACT. Four clusters of psychosocial risk factors for coronary heart disease (CHD) are reviewed. Socio–economic disadvantage acts through a number of influences to increase CHD risk. In advanced industrialized nations those in the lower social strata now have much higher CHD risk than persons in middle and upper social classes.

Sustained disturbing emotions represent a second cluster. Anxiety, depression and other indices of neuroticism have frequently been found in association with angina pectoris and cardiac death, though not with myocardial infarction (MI). However, sleep disturbances are associated with angina, cardiac death and MI.

The Type A behaviour pattern results from an interaction between a self–activating individual and an environment which rewards hurried and competitive activity. Despite a small number of negative findings, the Type A pattern has been shown in cross–sectional, retrospective and prospective studies by many research teams to be associated with a variety of manifestations of CHD.

A fourth, and more recently recognized cluster of psychosocial risk factors, may be grouped together under the general heading of »overload«. Many investigations have now shown, for example, that excessive workload is a powerful predictor of CHD risk.

It is suggested that all four clusters share the common property of exposing the individual, either chronically, or in frequently recurring episodes, to excessive psychological demands. They appear to exert their pathogenic influence through long–term mechanisms such as atherosclerosis or plaque formation, rather than by precipitating sudden coronary events.
Psychological and Physiological Responses of Individuals Displaying Type A Behaviour*
Authors: Glass David C.
Published: August 2010

ABSTRACT. Earlier findings on the relationship between the coronary–prone behaviour pattern Type A and coronary heart disease (CHD) are briefly reviewed, with particular reference to the underlying pathophysiological mechanisms linking the two.

Results obtained during the playing of competitive games with or without harassment from the opponent suggest that competition alone does not distinguish between Type A and Type B individuals. The Type A pattern appears to be associated with exaggerated cardiovascular responses only as the result of hostile interactions.

The primary need to study the Type A pattern as a psychological construct is emphasized. Analysis of structured interview responses suggests that hostility and competitive drive are the two components of the pattern associated with cardiovascular disease. A model is proposed in which Type A subjects, faced with threats to their control, exhibit first hyper–responsive and then hypo–responsive efforts to regain it, and experimental evidence in support of this model is presented. However, such hyper–responsive reactions might be linked more closely to coping and defence mechanisms than they are to Type A. It is proposed that the Type A pattern be regarded as an aspect of the per son–situation interaction and that efforts be made to establish those classes of environmental stimuli likely to elicit it.
Antihypertensive and metabolic effects of increasing doses of atenolol and labetalol. A comparative study in primary hypertension
Authors: Nilsson Ove R. , Karlberg Bengt E. , Henningsen Nels C. , Thulin Thomas
Published: August 2010

ABSTRACT. Thirty–two patients with primary hypertension were studied in a double–blind crossover comparison between the cardioselective β1–blocking agent atenolol and the combined α–and β–blocking agent labetalol. The doses used were atenolol 50–150 mg twice daily and labetalol 200–600 mg twice daily. Both drugs effectively reduced blood pressure and heart rate. Dose increments every second week resulted in a higher proportion of patients with normal blood pressure (≤ 150/90 mm Hg) with both drugs. Labetalol was somewhat more effective in lowering upright blood pressure while atenolol caused a more pronounced heart–rate reduction. Both agents decreased plasma renin activity and urinary aldosterone excretion. Scalp tingling on labetalol (2 patients) and cold fingers with atenolol (1 patient) caused withdrawal of the drugs. Cold fingers were reported in another four patients during treatment with atenolol and in one when on labetalol. Tiredness and postural symptoms were more common during intake of labetalol.
Compartment model of prenalterol
Authors: Klein G. , Wirtzfeld A. , Bozler G. , Rönn O. , Graffner C.
Published: August 2010

In previous pharmacokinetic studies in healthy subjects the time course of plasma concentration of prenalterol was described by a short distribution phase (α–phase) with a mean half–life of about 8 minutes and an elimination phase (β–phase) with an average half–life of about two hours [1, 2]. The aim of this joint study was to check the pharmacokinetic data obtained after intravenous single dose administration with the computer program TOPFIT [3] using different compartment models and to test the predictive power of the chosen kinetic model for plasma concentration data after repetitive intravenous prenalterol dosing.
Electrophysiological studies with prenalterol
Authors: Weisswange A. , Csapo G. , Kalusche D. , Keck M.
Published: August 2010

Electrophysiological studies with prenalterol in 19 patients (6 women, 13 men, 5 with sinus node disease, 4 with AV node disease, 7 with double node disease, 2 with conduction disturbance below His bundle, 1 normal) showed that sinus node function (heart rate, sinus node recovery time) is uniformly improved by this β–stimulator.

Also AV conduction is significantly and uniformly improved (shortening of AH interval and of the functional refractory period of AV conduction).

There is no or little influence on intra–atrial conduction and on conduction below the His bundle. However, spontaneous depolarisation in His–Purkinje fibers – as tested in patients with complete AV block and ventricular demand pacemaker – is increased through β–stimulation with prenalterol as reflected by shorter escape intervals and higher frequency escape rhythm.

Prenalterol may be of clinical use in patients with cardiomyopathies who developed bradycardia under digitalisation or patients with severe bradyarrhythmia either with or without digitalis.

It might also be useful in rare emergency situations, when complete pacemaker failure develops.
Haemodynamic effects of prenalterol in patients on dialysis
Authors: Lustenberger N.
Published: August 2010

Haemodialysis hypotension occurs with particular frequency in bilateral nephrectomised patients. This reflects the importance of the renin–angiotensin–aldosterone system for maintaining normal blood pressure. Failure of vascular access (due to clotting and thrombosis of shunts) and ischaemic necrosis of transplanted kidneys in hypotensive patients prompted us to treat them orally with a new β1–adrenergic agent (prenalterol). Blood pressure was normalised in 4 out of 5 patients. Because of delayed renal elimination of the drug, daily dosage must be reduced to prevent symptoms of adrenergic stimulation. A study of the pharmacokinetics of prenalterol in uraemia is in preparation.
Echocardiographic comparison between prenalterol and dobutamine
Authors: Wester H. A. , Oltmanns D.
Published: August 2010

Prenalterol, a new cardioselective β1–adrenoceptor agonist, was compared with the β–stimulator dobutamine by computer–assisted echocardiography. Prenalterol decreased preload, increased heart rate and induced an increase in contractility for a longer time in comparison with dobutamine. The small influence on blood pressure and after load indicates selective β1–receptor–effect by a result of slight changes in the peripheral vascular resistance.
Short and long–term effects of hydralazine and combined hydralazine and prenalterol therapy in patients with congestive heart failure
Authors: Drexler H. , Löllgen H. , Just H.
Published: August 2010

We evaluated the acute and chronic (3–4 weeks) effects of slow–release hydralazine (HSR) and combined hydralazine and prenalterol (HSR+P) therapy in patients with severe congestive heart failure at rest (R) and at exercise testing (E) with supine bicycle ergometer (n=6).

Measurement of haemodynamics (Swan–Ganz thermistor catheter) including pulmonary wedge pressure (PCP), cardiac output (CO), heart rate (HR) and systemic arterial pressure (MAP), was performed before, after HSR–treatment and after combined HSR+P–therapy. C = control.
Streptokinase or Heparin in the Treatment of Deep Vein Thrombosis
Authors: Arnesen Harald , Høiseth Arne , Ly Bernt
Published: August 2010

ABSTRACT. In a previous study on 42 patients with acute deep vein thrombosis, randomly allocated to treatment with streptokinase or heparin, we found that 71.4% of the streptokinase‐treated patients achieved phlebographically significant thrombolysis as compared to 23.8% in the heparin group. These patients have been reevaluated after a mean observation period of 6 1/2 years. Seven patients had died and there were no other drop‐outs. Thus, 35 patients were subjected to the follow‐up study consisting of phlebography and clinical examination. The evaluations were performed without knowledge of the initial therapy. Seven patients had phlebographically normal veins, and all belonged to the streptokinase group. This difference between the treatment groups is statistically highly significant (p<0.01). At clinical examination, 13 of the 17 patients in the streptokinase group had normal legs and 4 exhibited moderate postthrombotic changes. In contrast, 3 of the heparin‐treated patients showed serious postthrombotic changes with open leg ulcers, and only 6 of 18 patients in this group had normal legs. The present results strongly support the assumption that streptokinase therapy is the best treatment at present in patients with acute deep vein thrombosis. This has been shown for the initial thrombolysis, and now also for the avoidance of late postthrombotic changes.
Serum Total Cholesterol, HDL Cholesterol and Blood Pressure Levels in 13‐Year‐Old Children in Eastern Finland
Authors: Vartiainen Erkki , Puska Pekka , Salonen Jukka T.
Published: August 2010

ABSTRACT. North Karelia Youth Project is a community and school‐based intervention study of 13‐year‐old schoolchildren in Eastern Finland. This paper deals with serum total cholesterol, HDL cholesterol and blood pressure levels with some important background variables in the baseline survey in 1978. A total of 966 children were studied. A high mean serum cholesterol level (5.1 mmol/1) among both boys and girls was an outstanding finding. The cholesterol level was higher in the rural than urban areas. Different diet can explain this difference. Mean blood pressure was 117/67 mmHg among girls and 117/63 among boys. The high risk factor levels at this age support strongly the idea that the prevention of cardiovascular diseases should be started already in childhood.
Defects in Osmoregulation of Vasopressin Secretion
Authors: Hammer Mogens
Published: August 2010

ABSTRACT. Four patients are presented, all having pathologic responses in plasma vasopressin concentration to changes in plasma osmolality. Clinically, three of them had the syndrome of inappropriate antidiuretic hormone secretion (SIADH). The fourth had diabetes insipidus associated with an increased threshold for plasma osmolality. Two of the patients with SIADH had lowered thresholds for ADH secretion and one of these also had increased sensitivity to increments in osmolality. The latter patient, like another earlier reported similar case, had a defective blood—cerebrospinal fluid barrier. The third SIADH patient had no response at all to changes in osmolality from 230 to 305 mOsm/kg and had a small cell carcinoma of the lung. These examples illustrate that both the setting and the sensitivity of osmoreceptors and AVP‐secreting neurons probably are under complex control from the CNS, and that CNS diseases can affect one or several of these pathways thereby affecting the setting of the osmoreceptor‐vasopressin system.
48‐Lead Electrocardiogram in the Diagnosis of Non‐Acute Myocardial Infarction
Authors: Forssell Gunilla
Published: August 2010

ABSTRACT. A 48‐lead ECG including six extremity leads and seven vertical rows of six chest leads was registered in patients with myocardial infarction (MI) and controls. Patients with Wolff‐Parkinson‐White syndrome, bundle branch block or ventricular hypertrophy were excluded. The control group consisted of 75 healthy persons, aged 21–38, and 37 older patients who had never had MI, as verifed later at autopsy. The R wave amplitude was measured in each of the 42 chest leads and the normalized amplitude difference between each two adjacent leads (“quotient”) was calculated in horizontal and vertical direction. The ranges of these 71 quotients constituted, occasionally after exclusion of an extreme value, the reference to which 192 patients with MI were compared. The MIs were diagnosed by serum enzyme estimations, in 119 patients about one week and in 52 about one year prior to the ECG recording. In another 21 patients the diagnosis was subsequently confirmed at autopsy. The highest number of excluded extreme values in any control was three and, consequently, the presence of 4 quotients or more per ECG falling outside the reference range was used as the MI criterion of the 42 chest leads. Together with common Q wave criteria applied to the extremity leads it detected 70% of the 192 MIs. Fifty‐nine per cent fulfilled the common criteria applied to the 13‐lead ECG included in the 48‐lead recording (extremity leads and CR4R–1–2–3–4–5–7). In order to estimate the specificity of this 48‐lead ECG, the control group was randomly divided into two halves. For one half, new reference ranges for the 71 quotients were estimated. The quotient values of the other half as well as of the MI patients were compared to this new reference range for each quotient. At 70% sensitivity—as found above—the specificity was 95%. The specificity of the 13‐lead ECG was 96%.
Surgical Treatment of Renovascular Hypertension in the Elderly Patient
Authors: Delin K. , Aurell M. , Granerus G. , Holm J. , Scherstén T.
Published: August 2010

ABSTRACT. There have been many reasons for hesitating when faced with the decision whether or not to operate upon a renal artery stenosis in an aged person. Arteriosclerotic disease carries a poorer prognosis than does fibromuscular dysplasia, and in old persons arteriosclerosis is the usual cause of renal artery stenosis, and is likely to be generalized. In this study of 24 patients above 60 years of age with renovascular disease, 11 were operated upon; 9 because of renovascular hypertension and 2 with the main aim of arresting the deterioration of renal function. The selection of candidates was mainly determined by the renin secretion pattern. After operation for renovascular hypertension, 67% of the patients improved. In these patients renal function remained stable or recovered. Of the two patients operated upon because of decreasing renal function, one died postoperatively and the other suffered from technical complications resulting in a further impairment of renal function without any beneficial effect on the high blood pressure. Of the 13 patients not operated upon, 4 were clearly renin‐positive and would have been candidates for surgery had it not been for complicating factors. Three of these patients died of coronary disease within one year of the investigation. The results of our and other studies, together reviewing the fate of 56 patients above 60 years of age operated upon for renovascular hypertension, do not indicate that old age per se should be considered a contraindication to surgery when proper attention is paid to co‐existing risk factors. The majority of patients operated upon for renovascular hypertension will benefit from the surgical treatment.
A Trial of Metoprolol in Hypertensive Insulin‐Dependent Diabetic Patients
Authors: Kølendorf K. , Bonnevie‐Nielsen V. , Broch‐Møller B.
Published: August 2010

ABSTRACT. Twenty‐four insulin‐dependent, hypertensive diabetic patients were treated with a β1‐selective blocking agent (metoprolol) to evaluate its influence on diabetic state and arterial blood pressure (BP). Two groups were delineated after exclusion of one patient. Twelve patients (group A) obtained normotension with metoprolol alone, whilst 11 (group B) required concomitant treatment with thiazides, 7 of them both with thiazides and hydralazine. BP fell significantly in group B, by 15% (p<0.01), compared with pretreatment levels. Postprandial blood glucose levels, glucose excretion and insulin requirements were unchanged during treatment in all patients. Neither quantitative nor qualitative changes in the recognition of the effects of insulin were observed by 15 diabetics familiar with this sensation. Side‐effects were few. One episode of severe hypoglycaemia, probably unrelated to the β‐blockade, was encountered. We suggest that antihypertensive treatment with metoprolol is a reasonable alternative in the treatment of hypertensive insulin‐dependent diabetic patients.
Idiopathic Chronic Active Hepatitis and Hepatic Cell Carcinoma
Authors: Bjarnason Ingvar , Magnusso Bjarki , Bjornsson Sigurdur
Published: August 2010

ABSTRACT. Only two patients with co‐existing idiopathic (autoimmune) chronic active hepatitis and hepatic cell carcinoma have been reported hitherto. Two further cases are described. This complication may be more common than previously thought.
Intraerythrocytic Sodium and Potassium Concentrations during Acute and Chronic Digitalization
Authors: Pedersen K. E. , Koldkjær O. , Berndtz N. H. , Hvidt S. , Kjær K. , Midtskov C. , Sanche G.
Published: August 2010

ABSTRACT.To assess the cellular effects of digoxin, intraerythrocytic sodium and potassium concentrations were measured in 17 patients during the early phase of digitalization, in 45 patients on long‐term therapy and in 64 non‐digitalized control patients. Acute digitalization raised intraerythrocytic sodium from 11.6±0.4 to 16.7±1.0 mmol/1 (mean ± SEM) (p<0.01) and reduced intraerythrocytic potassium from 100.1 ±1.3 to 95.9±1.8 mmol/1 (p<0.01). These changes were strongly correlated with the steady‐state plasma digoxin concentration. During a few weeks of digoxin therapy, the intraerythrocytic cation composition normalized gradually. In patients on chronic treatment, neither intraerythrocytic sodium (11.3±0.3 mmol/1) nor potassium concentrations (100.0±0.6 mmol/1) differed significantly from the values of the control group (11.4±0.2 and 99.9±0.5 mmol/1, respectively). The changes in intraerythrocytic cation concentrations, induced by acute digitalization, seem to disappear during chronic administration of the drug.
Serum Amyloid P‐Component and C‐Reactive Protein in Serum of Healthy Icelanders and Members of an Icelandic Family with Macroglobulinaemia
Authors: Jensson ÓA. , Björnsson ÓA. G. , Árnason A. , BirgisdÓAttir B. , Pepys M. B.
Published: August 2010

ABSTRACT. Serum levels of amyloid P‐component (SAP) and C‐reactive protein (CRP) were determined in 260 asymptomatic Icelanders of both sexes and various age groups and in 60 members of a family with macroglobulinaemia. In the normal group the SAP levels were normally distributed but slightly higher than in a comparable British group. Elevated levels of SAP and CRP were found in four elderly sibs of the macroglobulinaemia family. Two of them had benign monoclonal macroglobulinaemia (BMM), one had Waldenström's macroglobulinaemia and one increased polyclonal IgA. In addition, a notable small increase (2–20 μg/ml) in the levels of CRP was found in 6 children and 3 grandchildren of two elderly sibs with BMM. This increase in serum CRP levels was also found in five of six family members when investigated four years later. The HLA haplo‐types present in the family members, including B7, are not closely associated with the various abnormal protein changes detected in the elderly sibs of the second generation or their descendents. Likewise, the increased levels of SAP, CRP or IgM are not associated with any particular type of the genetic protein markers or blood group systems tested.
Effect of Metoprolol and Alprenolol on the Metabolic, Hormonal, and Haemodynamic Response to Insulin‐Induced Hypoglycaemia in Hypertensive, Insulin‐Dependent Diabetics
Authors: östman Jan , Arner Peter , Haglund Kjell , Juhlin‐Dannfelt Anders , Nowak Jacek , Wennlund Anders
Published: August 2010

ABSTRACT.Insulin hypoglycaemia was induced three times in 6 insulin‐dependent, hypertensive diabetics: before instituting antihypertensive long‐term treatment and after obtaining a satisfactory blood pressure with either alprenolol or metoprolol given in a randomized order. The blood glucose concentration (1.6–1.9 mmol/1) at which the hypoglycaemia necessitated intravenous administration of glucose was almost identical on all three occasions. During hypoglycaemia the systolic and diastolic blood pressures increased significantly by a mean maximal rise of 27/14 mmHg on alprenolol treatment, but remained unchanged on metoprolol. The responses of adrenaline, noradrenaline, cortisol, and growth hormone did not differ significantly on the three occasions. None of the β‐adrenergic drugs counteracted the early hormone defence mechanisms in hypoglycaemia and the signs of hypoglycaemia were not masked. The haemodynamic response was altered only by the non‐selective (alprenolol) and not by the selective β‐adrenergic blocking agent (metoprolol).
Indices of Inflammatory Cell Activity and Pulmonary Function in Different Stages of Sarcoidosis
Authors: Schmekel B. , Hällgren R. , StÅlenheim G. , Venge P.
Published: August 2010

ABSTRACT. The present study was carried out to compare radiological and physiological changes in sarcoidosis with biochemical markers for inflammatory cell populations. Of 58 patients with sarcoidosis, 28 had respiratory symptoms and 30 past or present bilateral hilar adenopathy without symptoms. A clinical score based on lung function tests and radiological findings correlated well with elevations of lysozyme and β2‐microglobulin in serum, indicating increased inflammatory cell activity in patients with more severe lung affection. A covariation between β2‐microglobulin and lysozyme was found, suggesting concomitant activation of macrophages and lymphocytes in sarcoidosis. Serum levels of lactoferrin were elevated in patients with a disease of short duration but did not correlate with the severity of the lung affection. The closing volume also seems to be abnormal in the early course of the disease, while elevated lysozyme and β2‐microglobulin levels rather seem to reflect the extent of the pulmonary affection.
The Effect of D,L‐Carnitine Supplementation on Muscle Metabolism, Neuropathy, Cardiac and Hepatic Function in Hemodialysis Patients
Authors: Fagher B. , Thysell H. , Nilsson‐Ehle P. , Monti M. , Olsson L. , Eriksson M. , Lindstedt S. , Lindholm T.
Published: August 2010

ABSTRACT. Three patients on regular hemodialysis treatment were perorally supplemented with D,L‐carnitine, 900 mg/d, during four weeks. Before treatment, muscle carnitine concentrations were low and the patients showed signs of hypometabolism in skeletal muscle, cardiomyopathy, impaired hepatic function and a moderate hyperlipoproteinemia. After treatment, the skeletal muscle metabolism normalized. The results further indicate improvement of the cardiac and hepatic function and of the neuropathy on the sensory side. No improvement was found, however, in plasma lipoprotein pattern or in variables reflecting plasma lipid transport (lipoprotein lipase activity and intravenous fat tolerance).
Oral Vitamin D and Ultraviolet Radiation for the Prevention of Vitamin D Deficiency in the Elderly
Authors: Toss G. , Andersson R. , Diffey B. L. , Fall P. A. , Larkö O. , Larsson L.
Published: August 2010

ABSTRACT. Different methods for the prevention and treatment of vitamin D deficiency were studied in 42 institutionalized elderly people. One group received ultraviolet radiation (UVR) on a large area of the body surface once a week for three months. The results were compared with those in groups receiving either 450 IU vitamin D2 together with 420 mg calcium daily, 420 mg calcium alone, or no treatment. A significant increase in serum 25‐hydroxyvitamin D was obtained with UVR. A similar increase was obtained with oral vitamin D2. A small but significant decrease in serum alkaline phosphatase was observed in subjects receiving vitamin D and calcium or calcium alone. No effects on serum phosphate, urinary cyclic adenosine monophosphate and urinary calcium were seen. Though brief UVR at one‐week intervals is an efficient and safe method for prevention of vitamin D deficiency in the elderly, it is in our experience time‐consuming for the ward staff and thus less convenient than oral vitamin D supplementation.
Familial Plasma Lecithin: Cholesterol Acyltransferase Deficiency
Authors: Sakuma M. , Akanuma Y. , Kodama T. , Yamada N. , Murata S. , Murase T. , Itakura H. , Kosaka K.
Published: August 2010

ABSTRACT. A 43‐year‐old woman and her 47‐year‐old brother were studied because of corneal opacity. They showed a marked decrease in plasma high density lipoproteins (HDL) and a decrease in the ester ratio of plasma total cholesterol. Discoidal particles were found in the HDL2 fraction (d 1.063–1.125). A marked heterogeneity of low density lipoproteins was disclosed in both patients by electron microscopy. Apoprotein analysis revealed an increase in apo E and a decrease in apo A‐I and A‐II in both patients. These abnormalites were similar to the data reported in other cases with hereditary lecithin: cholesterol acyltransferase (LCAT) deficiency. However, several interesting dissimilarities have been disclosed as compared with the previously reported cases. Neither patient had proteinuria, and their kidney functions were within the normal limits. The ester ratios of plasma cholesterol of both patients were the highest among the cases reported thus far. Their plasma LCAT activities were 14.4 and 15% of the normal mean values determined by Glomset‐Wright's common‐substrate method. The enzyme activities determined by Stokke‐Norum's self‐substrate method were 40.2 and 29%, respectively. These results may indicate that this inherited disorder is not characterized by absence of plasma LCAT or presence of inhibitory factors in plasma, but by the presence of partially inactive LCAT in the patients' plasma.
Increase in Blood Glucose in Insulin‐Dependent Diabetics after Intake of Various Fruits
Authors: Vaaler Stein , Wiseth Rune , Aagenæs Øystein
Published: August 2010

ABSTRACT. The increase in blood glucose in insulin‐dependent diabetics after different fruit meals was investigated. Apple, banana and orange loads were compared with an equal amount of glucose dissolved in water. The postprandial blood glucose responses to pure glucose, apple and banana were almost identical, while the response after orange was somewhat weaker. We therefore conclude that though these fruits contain considerable amounts of fructose, they represent an important source of rapidly absorbable carbohydrate and should mainly be used in mixed meals.
Changes of Panorama in Renal Disease Mortality in Finland after Phenaeetin Restriction
Authors: Sillanpää Matti , Kasanen Antero , Elonen Arto
Published: August 2010

ABSTRACT. The purpose of the present study was to examine the effect of phenaeetin consumption and its restriction on the mortality from nephropathy. Changes in this mortality in Finland during 1951–77 were investigated. The second part of the study was concerned with the frequency of papillary necrosis in cases autopsied in the Department of Medicine, Turku University Central Hospital, during 1952–79. These figures were studied in relation to increased phenaeetin consumption after World War II, its restriction in 1962 and its complete banning in 1965. Both the epidemiologic survey of the mortality from nephropathy in Finland and the autopsies showed a clear and strong correlation both with increased phenaeetin consumption and with its discontinuation. The banning of phenaeetin led within 2–4 years to a decline in the mortality from nephropathy to its pre‐phenacetin level.
Blood Pressure, Cardiac Output and Systemic Vascular Resistance during Rest, Muscle Work, Cold Pressure Test and Psychological Stress
Authors: Ohlsson O. , Henningsen N. C.
Published: August 2010

ABSTRACT. Haemodynamic changes in the early phases of hypertensive diseases have mainly been described in so‐called borderline hypertensives. Their cardiac output (CO) has mostly been found to be elevated, but the peripheral vascular resistance (PRI) normal. In this study of the offspring (26 subjects) of hypertensive individuals, CO and intravascular pressures were measured during rest, muscular work, psychological stress and cold pressure test. For comparison, the same measurements were performed in a control group of healthy volunteers without known hypertension in their families. The offspring had higher blood pressure at rest than the controls throughout the study except during the cold pressure test and the highest dynamic work loads. Although there was no statistically significant difference between offspring and controls as regards PRI, the resistance was slightly higher in the group of offspring throughout the study. Arterial blood pCO2 in offspring was significantly lower at rest, during psychological stress and dynamic muscle work. Possible mechanisms behind this finding are considered.
Evaluation of Serial Bone X‐ray Examination in Multiple Myeloma
Authors: Wahlin Anders , Holm Jan , Osterman Göran , Norberg Bo
Published: August 2010

ABSTRACT. Fifteen patients with multiple myeloma stage III were treated with a combination of cytostatics and plasmapheresis in a sequential trial running for 60 weeks. Thirteen patients showed clinical improvement and ten a reduction of their myeloma protein by at least 50%. Bone X‐ray examination was performed every 15 weeks. Progression of bone lesions was seen in one patient, whereas the radiographic picture was unchanged in the others. It is concluded that bone X‐ray, although essential in the diagnosis and staging of multiple myeloma, is not suitable for the monitoring of patients during treatment.
Remission by Chemotherapy of the Eaton‐Lambert Myasthenic Syndrome in a Patient with Small Cell Bronchogenic Carcinoma
Authors: Berglund S. , Eriksson M. , von Eyben F. E. , Hellekant C. , Mattsson W.
Published: August 2010

ABSTRACT. A 70‐year‐old man developed symptoms compatible with the Eaton‐Lambert syndrome, and a small cell bronchogenic carcinoma was diagnosed. During treatment with cytostatics his muscular strength was restored and the lung tumour as well as the electrophysiologic findings characteristic of the Eaton‐Lambert syndrome disappeared. To our knowledge, it has not been reported before that chemotherapy alone of a small cell bronchogenic carcinoma has resulted in clinical, roentgenologic, and electrophysiologic remission of the Eaton‐Lambert syndrome.