bluuebunny/crossref_metadata_2025 huggingface dataset:
Problems with criteria and quality control in the registration of coronary events in the MONICA study
Authors: TUNSTALL‐PEDOE H.
Published: August 2010

ABSTRACT. This paper discusses the practical difficulties experienced in registering and coding coronary events. The populations being monitored for fatal and non‐fatal coronary events in the World Health Organization MONICA study are too large for surveillance of individuals. Routine medical and medico‐legal sources have to be used to indentify potential events, which are then coded and categorized according to standard criteria. Methods are dependent on, and have to be adapted to the local system of medical care. Non‐fatal cases in hospital are identified and registered either through their admission, »hot pursuit», or through their discharge, »cold pursuit». Each method has its own advantages and disadvantages. Local legal and ethical constraints are also responsible for differences between MONICA Collaborating Centres. Adequacy of investigation of events, and the availability and completeness of medical records are major determinants of the ease and quality of registration. Changes in medical care could cause spurious changes in event rates, and so potential biases need to be monitored and allowed for.
The Sino‐MONICA‐Beijing Study: Report on Results between 1984 and 1986
Authors: WU Z.S. , YAO C.H. , CHEN D.Y. , LI N. , ZHANG M. , WU Y.Y. , ZHAO D. , WU G.X. , WU Y.K.
Published: August 2010

ABSTRACT. The Beijing Heart Lung and Blood Vessel Medical Center has participated in the World Health Organisation MONICA project since 1981. Our study, named Sino‐MONICA‐Beijing, has been carried out in Beijing and covers a population approximately of 700,000. After a 2‐year pilot study, the project started formally January 1, 1984. This paper presents the organization and methodology of the study, with emphasis on the monitoring system and on how events were found. The main results of the cardiovascular disease (CVD) event monitoring are as follows: average annual mortality from all causes, for the 3‐year period of 1984–86 was 319/100,000 for men and 238/100,000 for women aged 25–64; from CVD 119/100,000 for men and 101/100,000 for women; from ischemic heart disease 29/100,000 for men and 14/100,000 for women; and from cerebrovascular disease 59/100,000 for men and 52/100,000 for women. Preliminary experience has shown that Sino‐MONICA‐Beijing is a well‐standardized project of long‐term surveillance of CVD in the communities of Beijing.
Myocardial Infarction Register in MONICA‐Czechoslovakia Centre
Authors: ŠKODOVÁ Z. , PÍŠA Z. , BERKA L. , CÍCHA Z. , ČEŘOVSKÁ J. , EMROVÁ R. , HEJL Z. , HRDLIČKOVÁ K. , HOKE M. , PIKHARTOVÁ J. , SKALKA P. , VOJTÍŠEK P. , VORLÍČEK J. , WIESNER E.
Published: August 2010

ABSTRACT. In 1984, 802 coronary events (age 25–64) were registered in six MONICA areas in Czechoslovakia.

According to the MONICA study criteria, 63 % of these coronary events in males and 51 % in females were confirmed as definite myocardial infarction (MI), 26 % of events in both males and females as possible MI, 5 % of events in males and females were fatal cases with insufficient data, and 6 % of events in males and 18 % in females were not confirmed as MI (MONICA diagnostic category = 4).

Age‐standardized annual attack rates of MI per 100,000 population (age 35–64) were 510.4 for males and 99.3 for females.

Age‐standardized annual incidence rates (first ever MI) per 100,000 population (age 35–64) were 387.4 for males and 89.7 for females.

28‐day case fatality was 33.3 % in males and 31.5 % in females.

Of all deaths occurring within 28 days, 75.8 % in males and 69.2 % in females occurred during the first 24 hours.

Of all coronary deaths, 38.5 % of males and 64.1 % of females died in hospital or other institution.
Combining repeated blood pressure measurements to obtain prevalences of high blood pressure
Authors: WIETLISBACH V. , RICKENBACH M. , BURNAND B. , HAUSSER D. , GUTZWILLER F.
Published: August 2010

ABSTRACT. Blood pressure (BP) levels may be classified as normal, borderline, or high with respect to the World Health Organization (WHO) criteria, but most studies like the MONICA project require at least two BP measurements and must tackle the problem of combining, the results of the different readings into a single value for classification. The Swiss MONICA project measured the blood pressure of 1872 individuals in the areas of Vaud and Fribourg. Second BP readings were, on average, lower than the first by 3.2 mmHg for systolic and 1.1 mmHg for diastolic BP. These differences, while trivial at the individual level, nevertheless generate significant effects on prevalences of high BP. The first reading, the second, the mean, and the lowest yield prevalences of 14 %, 10 %, 11 % and 9 % respectively. Therefore, any published prevalence of high blood pressure should specify the method of measurement, the number of readings taken, and the way results were combined.
Effect of Very Early Intravenous Streptokinase Infusion in Patients with Evolving Myocardial Infarction
Authors: WIK BJØRN , DALE JON
Published: August 2010

ABSTRACT The effect of very early infusion of 1.5 × 106 U of streptokinase intravenously was studied in 29 patients with nitroglycerin‐resistant chest pain and ST‐segment elevation. Infarct size was estimated from maximal LD1 isoenzyme levels, and the diagnosis confirmed by CK‐MB determination. Thrombolytic therapy was started within 1 hour of pain onset in 11 patients (group A), between 1 and 2 hours in 10 (group B), and later than 2 hours in eight patients (group C). Marked differences appeared between the groups. Thus, three patients in group A and one patient in group B did not develop infarction, all had critical LAD stenoses. Three patients in group C died in shock without bleeding. Further, the average maximal LD1 values in the 22 patients who survived their infarction differed significantly between the groups, and were 12.6, 19.1 and 36.2 μkat/l in groups A, B and C, respectively. In conclusion, very early intravenous streptokinase infusion probably reduces myocardial necrosis, and possibly prevents infarction in some patients.
Risk Factors for Sudden and Non‐Sudden Coronary Death
Authors: SUHONEN OLLI , REUNANEN ANTTI , KNEKT PAUL , AROMAA ARPO
Published: August 2010

ABSTRACT The impact of risk factors for sudden and non‐sudden coronary death was investigated in 3589 Finnish men aged 40–59 years at entry from a prospective population survey. During a mean follow‐up time of 11 years, 234 coronary deaths occurred, 150 of which were sudden, i.e. ensuing within 1 hour of the onset of symptoms. The severity of the manifestations of CHD at baseline investigation appeared to be a powerful predictor of sudden coronary death. Smoking and high serum cholesterol were significant predictors of sudden coronary death. High serum cholesterol was an equally significant predictor of sudden and non‐sudden coronary death. High blood pressure did not appear to significantly increase sudden coronary death but increased the incidence of non‐sudden death significantly. Obesity and diabetes did not appear to be independent risk factors for sudden coronary death. Smoking and high serum cholesterol were significant risk factors for sudden coronary death in men with manifestations of coronary heart disease. The results suggest that reduction of primary risk factors, especially smoking and high serum cholesterol, is important even after coronary heart disease has become manifest.
Rhabdomyolysis and Acute Renal Failure Following an Overdose of Doxepin and Nitrazepam
Authors: HØJGAARD ASTRID DITTE , ANDERSEN PER THORGAARD , MØLLER‐PETERSEN JENS
Published: August 2010

ABSTRACT A 50‐year‐old woman developed rhabdomyolysis and myoglobinuric renal impairment after an oral dose of 250 mg nitrazepam and 1250 mg doxepin. Serum creatinine increased from 70 μmol/l to 472 μmol/l in two days. Serum creatine phosphokinase reached a maximal level of 391 μkat/l (reference range < 2.5 μkat/l) on the third day and serum myoglobin was maximally 910 nmol/l (reference range < 4.5 nmol/l) on the fourth day after the overdose. Passive and active movements of the knees and ankles became increasingly restricted, but the patient felt no muscle pain. Diuresis decreased to 20–22 ml/hour in spite of repetitive doses of furosemide, but was enforced to > 100 ml/hour by vigorous infusion of saline. Haemodialysis was avoided on this regimen. It is suggested that in patients intoxicated with nitrazepam and/or doxepin, rhabdomyolysis should be suspected when a rapidly increasing serum concentration of creatinine is found, even in the absence of muscle pain.
Alcoholic Hepatitis in Females
Authors: MILMAN NILS , GRAUDAL NIELS , STRØM PETER , FRANZMANN MARIA‐BENEDICTE
Published: August 2010

ABSTRACT In the period 1970–1984 alcoholic hepatitis was diagnosed by liver biopsy in 52 females. Thirty‐six patients with cirrhosis were generally in a worse clinical and biochemical state than those without cirrhosis. Biochemical tests for liver function showed significant improvement from admission to the time of liver biopsy. At follow‐up liver function tests were generally better in patients who had stopped drinking alcohol compared to those who continued to do so. The 5‐year survival rate was 82% for females without cirrhosis, and 45% for those with cirrhosis (p < 0.03). Considering the sex‐related differences in alcohol abuse in the general population we found no evidence of increased susceptibility to the hepatotoxic effect of alcohol in females.
Effects of the Calcium Antagonist Felodipine on the Sympathetic and Renin‐Angiotensin‐Aldosterone Systems in Essential Hypertension
Authors: KATZMAN PER L. , HULTHÉN U. LENNART , HÖKFELT BERNT
Published: August 2010

ABSTRACT Studies were performed in 10 male patients with untreated essential hypertension, WHO grade I‐II, aged 25–62 years, to explore the acute (single dose) and long‐term (8 weeks) effects of felodipine on sympathetic activity—evaluated by plasma and urinary catecholamines—as related to blood pressure, heart rate and the activity in the renin‐angiotensin‐aldosterone system. The patients were hospitalized for 8 (acute) and 6 (long‐term) days and were maintained on a standardized daily intake of sodium (150 mmol), potassium (75 mmol) and water (2500 ml). Acute felodipine administration (10 mg) significantly reduced blood pressure and increased heart rate. Plasma and urinary noradrenaline, plasma renin activity and angiotensin II increased, whereas plasma and urinary adrenaline, dopamine, aldosterone and plasma vasopressin were unaltered. Long‐term felodipine treatment, 10 mg twice daily, reduced blood pressure to a similar extent as acute felodipine administration, but heart rate was not significantly changed. Plasma noradrenaline 3 and 12 hours after the last dose and urinary noradrenaline were increased, whereas plasma and urinary adrenaline and dopamine were unchanged. Plasma renin activity and angiotensin II were increased 3 hours, but unchanged 12 hours after the last dose. Plasma aldosterone was unchanged but urinary aldosterone increased. Plasma vasopressin was unchanged. The changes in plasma noradrenaline as related to blood pressure, heart rate, plasma renin activity and angiotensin II during long‐term felodipine treatment may reflect decreased cardiac and renal β‐adrenoceptor‐mediated responses. Increased renal clearance of aldosterone could partly explain the unaltered plasma aldosterone level in spite of increased plasma angiotensin II following long‐term felodipine treatment.
Selective β1‐Andrenoceptor Blockade and Muscle Thermogenesis
Authors: FAGHER BIRGER , MONTI MARIO , THULIN THOMAS
Published: August 2010

ABSTRACT Muscle thermogenesis was measured by direct microcalorimetry in hypertensive patients randomly treated with either metoprolol or placebo. Samples from rectus abdominis were taken after muscle relaxation during surgery, which was accompanied by a significant increase in arterial plasma noradrenaline. Thermogenesis was significantly lower in the metoprolol group compared with both the hypertensives given (p < 0.05), and a normotensive group without treatment (p < 0.005). Metoprolol also provoked a significant fall in body temperature in comparison with the two other groups (p < 0.01). In the hypertensives given placebo, heat production was inversely related to plasma adrenaline (r = ‐0.89), indicating a role of the sympatho‐adrenal system in muscle thermogenesis. No such correlation appeared during metoprolol treatment. In the present acute stress situation it is suggested that muscle thermogenesis was decreased indirectly by metoprolol via blockade of β1‐receptors in adipose tissue, causing a relative inhibition of lipolysis with diminished substrate supply to the muscles.
Importance of Growth Hormone for Blood Glucose Regulation Following Insulin‐induced Nocturnal Hypoglycemia in Insulin‐dependent Diabetes Mellitus
Authors: KOLLIND MAGNUS , ADAMSON ULF , LINS PER‐ERIC , CURSTEDT TORE
Published: August 2010

ABSTRACT The effect of growth hormone (GH) on the glucose homeostasis following nocturnal hypoglycemia was studied between 4 a.m. and noon in eight male patients with insulin‐dependent diabetes mellitus (IDDM) by a somatostatin (250 μg/h)‐insulin (0.4 mU/kg/min)‐glucose (6 mg/kg/min)‐infusion test (SIGIT). The patients participated in two experiments in which hypoglycemia at 4 a.m. was induced by i.v. insulin (1.5 mU/kg/min). In both experiments the endogenous secretion of GH was suppressed by somatostatin (250 μg/h) and glucagon (0.5 ng/kg/min) was given as substitute for the somatostatin‐induced suppression of endogenous glucagon secretion. GH (20 mU/kg/h) or saline was given for 60 min from nadir blood glucose in random order. Mean nadir glucose values were the same in both studies (1.7 ± 0.2 vs. 1.7 ± 0.1 mmol/l) and no differences were registered in plasma‐free insulin, glucagon and the responses of adrenaline and Cortisol to hypoglycemia. The infusion of GH resulted in plasma GH levels of about 50 μg/l at the end of the infusion, thereafter decreasing to low or immeasurable levels within 2 hours. Infusion of GH evoked a marked hyperglycemia within 4 hours. It is concluded that when hypoglycemia is accompanied by a transient increase in plasma GH, insulin resistance occurs after a lag period of approximately 4 hours and that this effect persists for at least another 4 hours.
Plasma Lipids and Plasma Lipoproteins in Diabetics with and without Proliferative Retinopathy
Authors: AGARDH CARL‐DAVID , AGARDH ELISABETH , BAUER BIRGITTA , NILSSON‐EHLE PETER
Published: August 2010

ABSTRACT The single most important factor related to the development of diabetic retinopathy is the duration of diabetes. Little is known about the underlying mechanisms, but many factors have been suggested to be involved, among them derangements in plasma lipids and plasma lipoproteins. In the present study we examined the relation between plasma lipids, plasma lipoproteins, and the duration of diabetes in Type I diabetics with and without proliferative retinopathy. The duration of diabetes in the two groups was 12.2 ± 2.8 and 21.5 ± 9.0 years, respectively (mean ± SD; p < 0.01). Except for moderately low HDL levels, plasma lipid and lipoprotein concentrations were normal in both groups of patients. The levels of lipids and lipoproteins did not correlate with the duration of diabetes. Furthermore, no differences were seen between patients with and without proliferative retinopathy. Thus, the present study does not indicate that plasma lipids and plasma lipoproteins play any major role in the development of diabetic proliferative retinopathy.
The Effect of Atenolol on the Left Ventricular Performance in Patients with Angina Pectoris Measured with Isotope Technique
Authors: BOSTRÖM PER‐ÅKE , BALLDIN MARIA , LILJA BO , JOHANSSON BENGT
Published: August 2010

ABSTRACT Working capacity, left ventricular ejection fraction (EF), stroke volume and the phase of the left ventricular contraction were tested before and after 3 weeks of atenolol treatment in 14 patients with angina pectoris and coronary insufficiency diagnosed by thallium tomography. Eight patients (group A) increased their EF during exercise and six patients (group B) showed a decrease in EF when tested with placebo. When treated with atenolol the changes in EF during exercise were reversed in the two groups. Group B increased and group A decreased their EF. Atenolol caused an increase in working capacity in group B, but not in group A. In both groups atenolol caused an increased stroke volume and a decreased phase deviation at rest, while no significant volume changes or phase changes occurred during exercise. These results indicate that atenolol treatment had the most marked effect in patients with the most pronounced disease.
Diagnosis and Management of Acute Aortic Dissection, Clinical and Radiological Follow‐up
Authors: GUSTAVSSON CARL GUNNAR , GUSTAFSON ARNE , ALBRECHTSSON ULF , LÁRUSDÓTTIR HRAFNHILDUR , STÅHL ERIK , OLIN CHRISTIAN
Published: August 2010

ABSTRACT A clinical series of acute aortic dissections is presented. Twenty cases were of type A and 10 of type B. Acute severe chest pain was common, in type A also blood pressure difference between the arms and aortic regurgitation. The diagnosis was established by echocardiography, computerized tomography and/or aortography. Antihypertensive therapy was instituted immediately after diagnosis and was in type A cases followed by acute surgery unless definite contraindications existed. Of 14 surgically treated type A patients 13 survived the operation. On follow‐up 1.5–3.5 years later, 12 patients were still alive and doing well, but the false channel remained open in all cases where it had not been resected totally. Only one of six conservatively treated type A patients survived. Type B dissections were operated on only if conservative therapy failed. Four of five conservatively and two of five surgically treated type B patients survived.
Pharmacokinetics of Chloral Hydrate Poisoning Treated with Hemodialysis and Hemoperfusion
Authors: BUUR TOM , LARSSON RUTGER , NORLANDER BJÖRN
Published: August 2010

ABSTRACT In a severe case of chloral hydrate intoxication treated with combined hemodialysis and hemoperfusion the pharmacokinetics of the metabolites trichloroethanol (TCE), trichloroethanol glucuronide (TCE‐Glu) and trichloroacetic acid (TCA) were studied. Indications of delayed absorption and some slowing of metabolism were found. At a blood flow rate of 200 ml/min clearances by hemodialysis and hemoperfusion, respectively, in ml/min were estimated to be 188 and 156 for TCE, 184 and 181 for TCE‐Glu, 142 and 91 for TCA. Clearance by hemoperfusion declined with time. The half‐lives of TCE and TCA were 3.2 and 4.3 hours during combined hemodialysis and hemoperfusion. After termination of treatment the half‐life of TCE was 12.8 hours, whereas TCA was metabolized so slowly, that no reliable calculation could be performed. We conclude that hemodialysis and hemoperfusion are equally and highly efficient in the treatment of chloral hydrate poisoning, but hemoperfusion may increase the risk of gastric bleeding more than hemodialysis. Hemodialysis may therefore be preferable and should be tried in spite of low blood pressure.
A Case of Multiple Extra‐adrenal Pheochromocytomas
Authors: REINHOLDT SUSANNE , PEDERSEN KNUD ERIK
Published: August 2010

ABSTRACT A case report of a 37‐year‐old previously healthy man who contracted hypertension and insulin‐dependent diabetes mellitus. Urinary catecholamine excretion was elevated. A total of nine benign pheochromocytomas with characteristic histological appearance were successfully removed. Most of the tumors were located extra‐adrenally in the upper abdomen and in the pelvis. Two of the tumors were found in organ plexuses in the mesocolon sigmoideum and in the anterior wall of prostata. Because of asynchronous tumor growth a life‐long follow‐up is recommended.
Epidemiology and Long‐term Survival in Acromegaly: A Study of 166 Cases Diagnosed between 1955 and 1984
Authors: BENGTSSON BENGT‐ÅKE , EDÉN STAFFAN , ERNEST INGRID , ODÉN ANDERS , SJÖGREN BJÖRN
Published: August 2010

In 1985, a follow‐up investigation was performed of all patients with acromegaly (n = 166, 89 women and 77 men) seen over a 30‐year period (1955–1984) at our Endocrine Unit, referral centre for the western region of Sweden (population 1.5 million). At the end of 1984, the prevalence of the disease was 6.9 per 105 inhabitants, the average incidence per year was 3.3 per million people. Mean age at diagnosis was 46.3 years and at death (n=62) 64.1 years. About one‐third of the patients (50/153), in whom it had been possible to estimate the total duration of the disease, had survived for more than 25 years. Mortality was, however, increased compared to the normal population. The observed number of deaths from vascular and malignant disorders was 32 and 15, respectively, compared to the expected numbers 9.0 (p<0.001) and 5.6 (p<0.01).
Effects of a Dietary Fibre Supplement to a Weight Reduction Programme on Blood Pressure: A Randomized, Double‐blind, Placebo‐controlled Study
Authors: RÖSSNER STEPHAN , ANDERSSON INGA‐LENA , RYTTIG KJELD
Published: August 2010

Sixty‐two moderately obese (body mass index=34.8), but normotensive females were treated with a balanced hypocaloric diet providing 1600 kcal/day and either a 6.5 g dietary fibre supplement or placebo in a randomized, double‐blind, parallel group design. During a 12‐week treatment programme, weight loss was similar in both groups (4.1 and 4.4 kg, respectively). Initially the blood pressure was 123/76 mmHg in the fibre group compared with 124/74 mmHg in the placebo group (p>0.05). In the fibre‐treated group a significant fall in diastolic blood pressure by 4 mmHg was found (p<0.05). No significant change was seen in the placebo group. It is suggested that dietary fibre may affect blood pressure independently of weight change.
The Long‐term Effect of Alprenolol on Plasma Apolipoproteins A‐I and B
Authors: GERDES LARS ULRIK , JÜRGENSEN HANS JESSEN , GROOT PIETER H. E. , FÆRGEMAN OLE
Published: August 2010

The concentration of lipids, lipoproteins and apolipoprotein A‐I and B was measured in the plasma of 33 patients, enrolled in a double‐blind, controlled trial of alprenolol in myocardial infarction, after one year on the study medication and again after 6 months off the medication. Sixteen patients received 200 mg alprenolol twice daily and 17 received placebo. There were no statistically significant differences between the parameters in the two groups after one year on medication. However, when medication was stopped, the ratio of apolipoprotein B to apolipoprotein A‐I fell by 9% in the alprenolol group and increased by 2% in the placebo group. This difference was statistically significant. Our results suggest that alprenolol, a β‐blocker with weak intrinsic sympathomimetic effect, has slight effects on plasma lipoproteins. These effects were apparent only by measurements of apolipoproteins.
Analgesic Treatment in Acute Myocardial Infarction: A Double‐blind Comparison of Ketobemidone + the Spasmolytic A29 (Ketogan®) and Morphine
Authors: WOLFF TOMAS , LEWARD SUNE , HAGMAN ANDERS , ANDERSSON MATS , LARSSON LEONARD , ELGEN KJELL
Published: August 2010

The analgesic effect of ketobemidone hydrochloride + the spasmolytic component A29 (Ketogan®) and morphine hydrochloride was compared double‐blindly in patients with suspect acute myocardial infarction. The test drugs were administered i.v. in an initial dose of 0.5 ml (2.5 mg Ketogan, 5 mg morphine) followed, if necessary, by additional injections of 0.25 ml. Altogether, 309 patients participated in the trial. The total comsumption of the test drugs showed that 5 mg Ketogan was equipotent with 10 mg of morphine. Treatment with Ketogan resulted in a significantly higher proportion of patients who were completely free of pain 15 and 30 min after the initial injection: 16% and 15% more, respectively, compared to morphine. Within 2 hours after the initial injection, approximately 15% of the patients in both treatment groups had reported nausea and about 7 % had vomited (patients who vomited or were nauseated before treatment were not included in this analysis). The frequency of other side‐effects was low, with no differences between the two treatment groups. Morphine caused a greater reduction of the systolic blood pressure than Ketogan. The effect of both drugs on pulse rate and respiration was the same.
Gastric Inhibitory Polypeptide in Newly Diagnosed Ketotic Type I (Insulin‐dependent) Diabetics
Authors: KRARUP THURE , MADSBAD STEN , MOODY ALISTER J.
Published: August 2010

Plasma concentrations of 5000 daltons (5 kDa) immunoreactive gastric inhibitory polypeptide (IR‐GIP) were measured before and up to 16 hours after the start of low‐dose insulin treatment in newly diagnosed ketotic type I (insulin‐dependent) diabetics. Nine patients were non‐fasting. Before insulin treatment mean IR‐GIP was 31 ±6 pmol/l (range 9–65 pmol/l). Four patients had IR‐GIP concentrations in the normal fasting range (10–25 pmol/l), and nine patients had concentrations below 35 pmol/l. The remaining patients had IR‐GIP concentrations in the normal postprandial range. A meal eaten after the start of insulin treatment caused an increase in IR‐GIP in all patients. All patients had β‐cell function as estimated by plasma C‐peptide. Individual changes in C‐peptide were significantly correlated to changes in blood glucose both after the meal (r=0.80, p<0.01) and during insulin treatment (r=0.85±0.04). No correlation could be found between IR‐GIP and blood glucose, C‐peptide or insulin concentrations. Newly diagnosed ketotic type I diabetics have IR‐GIP concentrations within the normal postprandial level. Hypoinsulinaemia, hyperglycaemia, and hyperketonaemia do not by themselves increase 5 kDa IR‐GIP markedly above normal fasting levels.
Unusual Manifestation of Langerhans' Cell Histiocytosis
Authors: BANK ANDERS , CHRISTENSEN CLAUS
Published: August 2010

An unusual manifestation of the disease Langerhans' cell histiocytosis (LHC) is presented. An 18‐year‐old man was admitted to the Department of Dermatology after he had been suffering for some time from affections of the skin in the scalp and perianal region which were resistant to treatment. Shortly after LHC was diagnosed, he developed spontaneous bilateral pneumothorax. In his past life he had been without cardiopulmonary complaints. In addition to this, he developed a diabetes insipidus, originating in connexion with the present disease. The combination of skin affection in the perianal region, spontaneous bilateral pneumothorax and diabetes insipidus in relation to LHC has not been described previously.
Delayed Hypercalcemia after Non‐oliguric Acute Renal Failure Associated with Rhabdomyolysis
Authors: AGNHOLT JØRGEN , ANDERSEN PER THORGAARD , NIELSEN LARS KJæR
Published: August 2010

ABSTRACT Alterations in the calcium metabolism are a characteristic paraclinical finding in patients with oliguric acute renal failure associated with rhabdomyolysis. A 20‐year‐old male operated on under general anestesia developed non‐oliguric acute renal failure due to malignant hyperthermia with rhabdomyolysis (urine myoglobin>20000 nmol/1; reference range <0.85 nmol/1). On the 20th postoperative day hypercalcemia was found, reaching a maximum serum level of 3.74 mmol/1 (reference range 2.18‐2.65 mmol/1) on the 27th postoperative day. Delayed hypercalcemia in non‐oliguric acute renal failure associated with rhabdomyolysis has not been reported previously. This case suggests that prolonged control of the serum calcium level should be performed in patients with rhabdomyolysis, even in the absence of oliguria.
Increased Whole Blood and Plasma Viscosity in Patients with Angina Pectoris and “Normal” Coronary Arteries
Authors: LARSSON HANS , GUSTAVSSON CARL GUNNAR , ODEBERG HÅKAN , PERSSON STIG
Published: August 2010

ABSTRACT Blood and plasma viscosity was measured in eight patients with typical effort‐induced angina pectoris who did not have coronary artery stenosis at angiography. The same variables were studied in 14 patients with angina pectoris and verified coronary artery disease that in most cases was extensive. Both groups of patients had significantly higher viscosity values in whole blood, at natural hematocrit as well as at standardized hematocrit (45%), than 25 healthy subjects serving as a reference group. Plasma viscosity was also significantly elevated in both patient groups. The patients without coronary artery stenosis had as high blood and plasma viscosity values as had the stenosis group. It is concluded that increased blood and plasma viscosity should be added to the list of pathological findings in patients with angina pectoris in the absence of organic coronary artery stenosis.
The Stockholm Diabetes Intervention Study (SDIS): 18 Months' Results
Authors: REICHARD PER , BRITZ ANDERS , CARS ISOLDE , NILSSON BENGT Y. , SOBOCINSKY‐OLSSON BIRGITTA , ROSENQVIST URBAN
Published: August 2010

ABSTRACT Patients with insulin‐dependent diabetes mellitus (IDDM), non‐proliferative retinopathy and unsatisfactory blood glucose control were randomized to intensified conventional treatment (ICT, 48 patients) or regular treatment (RT, 54 patients) for a 5‐year study. After 18 months the glycosylated hemoglobin (HbAic) was reduced in both groups, but significantly more in the ICT group (p=0.00005). Thirty of the RT patients and 16 from the ICT group deteriorated as to retinopathy (p=0.024). Microalbuminuria appeared more often in the RT patients (p=0.023), and nerve conduction velocities were significantly reduced only in the RT group (p between 0.0005 and 0.047). Serious hypoglycemia was more common in the ICT patients (p=0.003). The progression of diabetic late complications was thus slowed down by intensified treatment, but at the price of an increased frequency of serious hypoglycemia.
Renal Osteodystrophy in Predialysis Patients without Stainable Bone Aluminum
Authors: DAHL EILIF , NORDAL KNUT P. , ATTRAMADAL ARNE , HALSE JOHAN , FLATMARK AUDUN
Published: August 2010

ABSTRACT Histomorphometry was performed on transiliac bone biopsies, double‐labeled with tetracycline, from 60 consecutively admitted patients (20 women) at various stages of chronic renal failure (CRF). Eleven patients (1 woman) had normal bone resorption and formation indices. Bone resorption and osteoid formation increased with progression of renal failure, but abnormal values were seen even at slightly elevated creatinine levels. Mineralization lag time increased with CRF duration; prolonged values were only seen in patients with polycystic kidney disease or chronic pyelonephritis with advanced CRF. All patients with impaired mineralization also had increased bone resorption. Diabetes mellitus did not protect against skeletal lesions. The biochemical tests were too insensitive to predict type or severity of bone disease, and hand X‐rays had no diagnostic value in early stages of renal osteodystrophy.
The Effect of Cod Liver Oil in Two Populations with Low and High Intake of Dietary Fish
Authors: SIMONSEN TERJE , NORDØY ARNE , SJUNNESKOG CHARLOTTE , LYNGMO VEGARD
Published: August 2010

ABSTRACT Two subgroups of healthy males from an inland and a coastal community in Norway with a traditionally low and high consumption of dietary fish were given a dietary supplement of 20 ml cod liver oil rich in n‐3 polyunsaturated fatty acids for 3 weeks. Cod liver oil induced an increase in serum high density lipoprotein (HDL) cholesterol in men from the inland. Both groups showed a prolonged primary bleeding time, whereas platelet aggregation and thromboxane A2 production induced by collagen were mainly unaffected. Platelet phospholipid fatty acids showed similar changes in both groups with a decrease in n‐6 and an increase in n‐3 polyunsaturated fatty acids. No changes were observed in total cholesterol or platelet phospholipid content. This study shows that dietary supplement with cod liver oil induces changes in serum lipids and platelets that may reduce the tendency to thrombosis both in subjects with a low and in those with a high intake of dietary fish. The effects were more pronounced in the subjects with a traditionally low fish consumption.
Increased Fibrinolytic Potential after Diet Intervention in Healthy Coronary High‐risk Individuals
Authors: ANDERSEN PER , NILSEN DENNIS W. T. , BECKMANN SISSEL LYBERG , HOLME INGAR , HJERMANN INGVAR
Published: August 2010

ABSTRACT Twenty healthy individuals (15 men and 5 women) with initial fasting serum triglycerides ≥1.80 mmol/l and euglobulin clot lysis time after venous occlusion ≥60 min (upper normal limit 45 min) were tested for fibrinolytic response to venous occlusion and intravenous injection of desmopressin (DDAVP), serum lipids, serum glucose and relative body weight before and after a minimum of 3 to a maximum of 12 months' diet intervention. In order to be defined as a good diet responder, at least 20% reduction of the initial serum triglyceride concentration was required. At the end of the study, half of the participants (7 men and 3 women) met the criteria of good diet responders. All of these showed an improved fibrinolytic response to DDAVP injection, and 7 out of 10 had a normalized fibrinolytic response to venous occlusion. We conclude that, through dietary measures with substantial reduction of hypertriglyceridaemia, it is possible to improve and even normalize the fibrinolytic potential.
Decreased Skeletal Muscle Potassium in Obesity
Authors: LANDIN KERSTIN , LINDGÄRDE FOLKE , SALTIN BENGT , WILHELMSEN LARS
Published: August 2010

ABSTRACT The effect of body weight on total body potassium, skeletal muscle electrolytes and fat content was studied in seven lean and seven obese middle‐aged men and seven lean and eight obese middle‐aged women. Total body potassium and total body fat increased with body weight (p<0.01 and <0.05 for men, and p<0.05 and p<0.001 for women, respectively). So did muscle fat in men (p<0.01), while muscle tissue potassium was decreased in both obese men (p<0.001) and obese women (p<0.05). The skeletal muscle Na/K‐ratio tended to be higher in obese men (p<0.1) but was not related to body weight in women. Skeletal muscle magnesium was higher (p<0.01) in obese men than in lean men. No differences between lean and obese women were found. Obese men had higher diastolic blood pressure (p<0.05) than lean men, while there was no difference between obese and lean women. Compared with lean subjects, obese subjects thus had lower relative skeletal muscle mass and men, especially, had more fat and less potassium in the skeletal muscle.
Propafenone versus Disopyramide for Treatment of Chronic Symptomatic Ventricular Arrhythmias
Authors: JONASON TOMMY , RINGQVIST IVAR , BANDH STELLAN , NILSSON GÖRAN , NILSSON HANS , LIDELL CHRISTER , BJERLE PER , OLOFSSON BERT‐OVE
Published: August 2010

ABSTRACT The efficacy and safety of propafenone, 150 mg four times daily, were compared with those of disopyramide, 100 mg four times daily, in a randomized single‐blind, cross‐over study in 38 patients with symptomatic premature ventricular complexes (PVCs). The 24‐hour ambulatory ECG, employed for assessing antiarrhythmic efficacy, was analyzed blindly. The median reduction in the number of PVCs was higher with propafenone than with disopyramide (91.4% vs. 63.5%, respectively, p<0.01). A reduction of at least 80% was achieved by propafenone in 22 (59%) and by disopyramide in 16 patients (43%) (NS). Ventricular tachycardias (VTs) were abolished by propafenone in eight out of 11, and by disopyramide in five out of nine patients with VTs (NS) A possible proarrhythmic effect was seen in three patients during disopyramide and in one patient during propafenone treatment. Micturition disturbances (p<0.001) and a dry mouth (p<0.01) were more commonly associated with disopyramide than with propafenone. In conclusion, in the given dosages, propafenone was superior to disopyramide in suppressing PVCs and had fewer side‐effects.
Non‐respondents in a Post‐myocardial Infarction Trial: Characteristics and Reasons for Refusal
Authors: SMITH PÅL , ARNESEN HARALD
Published: August 2010

ABSTRACT We surveyed the 270 survivors of acute myocardial infarction who refused to participate in the Warfarin Re‐Infarction Study (WARIS). Information on medical variables were derived from registration forms completed by hospital staff upon discharge, whereas data on a variety of health conditions and reasons for refusal were gathered by mailed questionnaires, 178 (66%) of which were returned. Some disparities were found when comparing non‐respondents and participants, the former showing more potential bad risk factors. The diversities between participants and non‐respondents are of yet unknown prognostic importance. However, the presence of such differences imply that information on characteristics of non‐respondents in clinical trials is desirable in terms of generalizability of the trial results. Reasons stated for non‐participation reflect poor motivation, low mobility and saturation with focusing on disease. A slight co‐variation between social status and reasons for refusal was noted.
Lung Function Abnormalities in Patients with Primary Biliary Cirrhosis
Authors: UDDENFELDT PER , BJERLE PER , DANIELSSON ÅKE , NYSTRÖM LENNART , STJERNBERG NILS
Published: August 2010

ABSTRACT Twenty‐five patients with primary biliary cirrhosis (PBC) in different stages were investigated with respect to pulmonary function abnormalities. The results were compared with a reference sample of 17 sex‐ and age‐matched healthy subjects. A high prevalence of lung function impairment was found in the PBC patients (14/25 [56%]). Bronchial asthma was present in three patients, and severe lung emphysema in one. These four patients had an abnormal lung function, mainly of obstructive type. There was a statistically significant difference between the remaining 21 PBC patients without chronic obstructive lung disease and the reference subjects with respect to diffusion capacity. Almost all abnormal lung function data were found in the symptomatic PBC patients (i.e. symptoms of pruritus, xanthoma, xanthelasmata, jaundice, hyperpigmentation, hepatosplenomegaly), 13 out of 18 (72%), whereas only one out of seven asymptomatic patients was affected. Nine patients (36%) had reduced diffusion capacity compared with none of the reference subjects. The lung function abnormalities in PBC patients are similar to those found in sarcoidosis, another granulomatous disease.
On‐line Hemodialysis and Hemoperfusion in a Girl Intoxicated by Theophylline
Authors: STEGMAYR BERND G.
Published: August 2010

ABSTRACT In a suicidal attempt, a 15‐year‐old girl had ingested about 40 g of theophylline from sustained‐release preparations. Symptoms of intoxication increased and serum concentrations of theophylline rose from 438 to 1000 μmol/l. Conservative therapy was also combined by the use of hemodialysis as well as charcoal hemoperfusion on line. Treatment successfully reduced side‐effects and S‐theophylline within 12 hours and the patient could leave the hospital without residual sequelae. The combination of hemodialysis and hemoperfusion may reduce the risk of hypopotassiemia and hypocalcemia as well as increase in the clearance of the drug.
10‐Year Trends in Physical Activity in the Eastern Finnish Adult Population: Relationship to Socioeconomic and Lifestyle Characteristics
Authors: MARTI BERNARD , SALONEN JUKKA T. , TUOMILEHTO JAAKKO , PUSKA PEKKA
Published: August 2010

ABSTRACT In a large, community‐based cardiovascular disease prevention study in Eastern Finland, independent random population samples were surveyed in 1972, 1977 and 1982. The leisure‐time physical activity (LTPA), occupational physical activity (OPA), and socioeconomic and lifestyle characteristics were assessed. In men and women aged 30–59, the proportion with high LTPA increased from 1972 to 1982 by approximately one half (p<0.001), whereas that of high OPA decreased during the same period (p<0.001). In both sexes, high overall physical activity fell from 1972 to 1977 (p<0.001), but no more from 1977 to 1982. The proportion of entirely sedentary remained stable. Education, income and younger age showed a positive, body mass index, smoking and OPA a graded, negative association with high LTPA in 1972 and 1982. Significant (p<0.001) differences in 10‐year trends of changes in LTPA were observed: men and women with low education or income increased LTPA more than those with high education and income. Socioeconomic factors, such as income and education, appear to have lost importance as determinants of population‐wide exercise, whereas the clustering of low physical activity with overweight and smoking has increased.
Acute Chest Pain without Obvious Organic Cause before the Age of 40
Authors: ROLL MARTIN , PERSKI ALEKSANDER , THEORELL TÖRES
Published: August 2010

ABSTRACT Reactivity to mental stress and relaxation was studied in 63 consecutive patients below the age of 40 attending the emergency care unit because of chest pain without obvious organic cause. The results were compared with a control group (n=32). Of the patients, 41% reported chest pain or oppression in the chest during mental stress compared to 10% of the control subjects (p<0.01). During relaxation the subjects in the female patient group reported significantly less ability to relax and had significantly higher respiration rate as compared to the female control group. There were no significant differences between the groups regarding heart rate, blood pressure or end‐tidal PCO2 and there was no evidence of hyperventilation, neither during relaxation nor during mental stress. In combination with our earlier findings of high scores for “type A behaviour”, “neuroticism”, “vital exhaustion” and “stressful life events” these findings indicate that psychosomatic mechanisms may be of great importance for the development of chest pain in this group of patients.
Laboratory Tests as Indicators of Alcohol Consumption in Patients with Chronic Low Back Pain
Authors: SANDSTRÖM JOHAN , ALLING CHRISTER , WALLERSTEDT SVEN
Published: August 2010

ABSTRACT The use of laboratory screening tests for the detection of heavy drinking in outpatients implies among other things knowledge about their relation to the degree of alcohol consumption. In this study of 95 patients with chronic low back pain, serum gamma‐glutamyl‐transferase demonstrated the best correlation with the mean daily amount of alcohol consumed (n̈=0.74). Adding other serological tests, such as high density lipoprotein cholesterol, aminotransferases and linoleic acid content in lecithin, did not improve this correlation, although these tests also correlated well with the alcohol intake.
Treatment of Refractory Cancer‐associated Hypercalcemia with Aminohydroxypropylidene Diphosphonate
Authors: HEAF JAMES G. , HANSEN M.
Published: August 2010

ABSTRACT The case history is presented of a 45‐year‐old woman who was receiving chemotherapy for a pulmonary adenocarcinoma and who developed severe symptomatic hypercalcemia. Despite intensive treatment with fluids. loop diuretics, prednisone, calcitonin and repeated doses of mithramycin, she remained hypercalcemic. She was then treated with aminohydroxypropylidene diphosphonate (APD) with consequent rapid normalization of the serum calcium and disappearance of symptoms. We conclude that APD is a valuable supplement to the treatment of malignant hypercalcemia in that it may be effective when traditional therapies have failed.
Echocardiographic‐determined Left Ventricular Wall Characteristics in Insulin‐dependent Diabetic Patients
Authors: THUESEN LEIF , CHRISTIANSEN JENS SANDAHL , MOGENSEN CARL ERIK , HENNINGSEN PER
Published: August 2010

Abstract. Left ventricular wall mass, thickness and movement were investigated by echocardiography in 80 insulin‐dependent diabetic patients with no signs of ischaemic heart disease and in 40 healthy controls. In diabetics with a disease duration of >30 yr, urinary albumin excretion rate >200 μg/min (clinical nephropathy), proliferative retinopathy or autonomic neuropathy, both the posterior wall thickness and the septal thickness were increased compared to controls. The posterior wall thickness and the septal thickness were positively correlated to blood pressure (p<0.001), disease duration (p<0.001), urinary albumin excretion rate (p<0.001), and negatively correlated to the heart variation during deep respiration (p<0.01). The left ventricular wall mass was correlated to both blood pressure (p<0.01) and urinary albumin excretion rate (p<0.01). By multiple regression analysis urinary albumin excretion rate, disease duration and heart rate variation during deep respiration did not add significantly to the correlation between left ventricular wall mass/wall thickness and blood pressure. The septal movement was reduced in diabetics with proliferative retinopathy or clinical nephropathy. In conclusion, left ventricular wall thickness and wall mass were closely related to blood pressure in insulin‐dependent diabetics. Signs of impaired cardiac function, such as reduced septal movement, were seen only in patients with severe microvascular disease.
Prevalence of Hemochromatosis in Finland
Authors: KARLSSON MARKUS , IKKALA EERO , REUNANEN ANTTI , TAKKUNEN HEIKKI , VUORI ERKKI , MÄKINEN JUDIT
Published: August 2010

Abstract. Transferrin saturation was determined in 11431 men and 10639 women aged 15 or more drawn from different areas in southern and central Finland and attending a multiphasic health screening examination in 1967–1972. All the 163 men and 66 women with transferrin saturation ≤70% at the initial examination and still alive at the end of 1983 were invited to a re‐examination. Of the invited persons, 76% attended the re‐examination. Transferrin saturation and serum ferritin were the initial screening methods in the re‐examination. All persons with suspected hemochromatosis were clinically examined and a laparoscopy was performed. Four men and four women were found with unequivocal hemochromatosis. Only one of these cases was diagnosed beforehand. According to these data the prevalence of hemochromatosis in Finland is about 50/100000.
Pseudoaneurysm—a Treatable Form of Cardiac Rupture
Authors: GABRIEL AMON S. , BEVEGÅRD STURE , RUIZ HERNAN
Published: August 2010

Abstract. Pseudoaneurysm is an unusual complication of myocardial infarction. Although its pathogenesis is known, the course of the condition is obscure. The diagnosis is usually made post‐mortally. We present a case of a pseudoaneurysm following a myocardial infarction, diagnosed at a routine policlinical echocardiographic examination in a patient who at the time of diagnosis was free of symptoms. The patient was successfully operated upon.
Visceral Leishmaniasis Complicating Polycythemia Vera
Authors: HELLGREN URBAN , LERNER RICHARD , PALMBLAD JAN
Published: August 2010

Abstract. A case of visceral leishmaniasis is presented, where a pre‐existing polycythemia vera obscured signs of the infection.

Visceral leishmaniasis is a life‐threatening but curable protozoan infection of the reticuloendothelial system. We wish to report a case where symptoms and signs were obscured by a preexisting hematologic disease, polycythemia vera.