bluuebunny/crossref_metadata_2025 huggingface dataset:
Non‐Invasive Beat‐to‐Beat Analysis of Stroke Volume and Digital Pulse Volume in Patients with Complete Heart Block and Artificial Pacing
Authors: Fagrell B. , Lindvall K.
Published: August 2010

ABSTRACT. This study presents a beat‐to‐beat analysis of digital arterial pulse volume (DAPA), left ventricular end‐diastolic diameter (LVEDD), and stroke volume (SV) and their correlation to PQ interval in ten patients with complete heart block and artificial cardiac pacing. DAPA was measured by strain‐gauge plethysmography and LVEDD/SV by echocardiography. A close relationship was found between SV and DAPA (r = 0.83–0.97) in seven patients, who all drew considerable benefit from atrial contraction as regards SV and DAPA (increase with 35–94%). The optimal PQ interval was calculated to approximately 240 msec for DAPA and 180 msec for LVEDD and SV. It may be concluded that the present study demonstrates a close relationship between beat‐to‐beat variations of SV measured by echocardiography and plethysmographically recorded digital arterial pulse volume. These variables may be useful in clinical practice for assessing the hemodynamic effect of atrial contribution in patients with various forms of cardiac conduction disturbances. The two methods may, for instance, be useful for screening in order to pick out patients who may benefit from AV synchronous rather than ventricular pacing.
Insulin in Portal, Hepatic and Peripheral Venous Blood after Glucose, Tolbutamide and Glipizide Stimulation
Authors: Hed R. , Nygren A. , Röjdmark R. , Sundblad L. , Wiechel K. L.
Published: August 2010

ABSTRACT. Insulin in portal, hepatic and/or peripheral venous blood was determined in 16 patients admitted to a surgical ward for various diseases. Portal venous blood was obtained via a catheter introduced into the portal vein either through the umbilical vein remnant or transhepatically. Four subjects were given a peroral load of glucose, followed after 60 min by i.v. tolbutamide. In simultaneous blood samples, two of these subjects showed higher insulin concentrations in peripheral venous blood than in portal venous blood. Twelve subjects were given i.v. glipizide. In one subject blood samples were drawn from the portal vein, a hepatic vein and a peripheral vein; in five subjects from the portal vein and a peripheral vein and in six subjects from the portal vein and a hepatic vein. Two subjects showed higher insulin concentrations in peripheral venous blood than in portal venous blood. The mean peripheral insulin response (six subjects) was of the same magnitude as the mean hepatic insulin response (six subjects). It is suggested that these findings reflect a release of previously bound insulin from peripheral tissues.
Development of Biclonal Gammopathy in a Patient with von Recklinghausen's Neurofibromatosis
Authors: Wille Leif E. , Østborg Jens
Published: August 2010

ABSTRACT. A well established case of von Recklinghausen's neurofibromatosis, in which a biclonal gammopathy developed, has been studied. One of the paraproteins was characterized as IgG kappa, the other as IgG lambda. This combination of anomalies has not been described previously in the literature.
Angina Pectoris in Aortic Valvular Disease and Its Relation to Coronary Pathology
Authors: Storstein Ole , Enge Ivar
Published: August 2010

ABSTRACT. Angina pectoris is a common symptom in aortic valvular disease. In our study of 100 consecutive patients it was found more commonly in patients with aortic stenosis than in those with aortic insufficiency. Only 21 of 80 patients with angina pectoris had significant narrowing (more than 75%) of one or several coronary arteries. Angina pectoris in aortic valvular disease thus seems to be most often functional due to disproportion between myocardial oxygen supply and demand. On the other hand, 5 of 20 patients without angina pectoris had significant coronary artery stenosis. As coronary artery involvement may jeopardize the results of aortic valve replacement in these patients, coronary angiography should always be carried out in patients evaluated for surgery of aortic vavlular disease. Coronary bypass surgery should be carried out during the same operation if the stenosis is severe and bypass is technically feasible.
Micromethods for Analysis of Lipids in Endomyocardial Biopsy Specimens
Authors: Belfrage Per , Johansson Bengt W. , Torp Alf , Åkesson Björn
Published: August 2010

ABSTRACT. Triglycerides and phospholipids extracted from endomyocardial biopsy specimens were quantitated with sensitive photometric methods and the fatty acid composition of phospholipids was determined after separation of the methyl esters by gas chromatography. The degree of triglyceride accumulation was expressed as the molar ratio triglyceride/phospholipid since in most cases the phospholipid concentration is relatively constant. The representativity of the analysis of endomyocardial biopsy was investigated by comparing lipid analyses of large and small myocardial specimens obtained at necropsy. The methods described may be valuable tools in studies on metabolic disturbances in different cardiomyophaties.
Citrate in Plasma and Urine During Total Fasting
Authors: Nielsen T. Toftegaard , Sørensen N. Schwartz
Published: August 2010

ABSTRACT. Plasma citrate was determined in 12 obese subjects who underwent total fasting for 10 days. Mean plasma citrate concentration rose significantly from 128 before to 205 μmol/l on the 10th day of fasting. Plasma citrate rose continuously during fasting in seven subjects in whom daily determinations were carried out. The 24‐hour urinary citrate excretion was followed in six subjects. A significant decrease was found from 2.91 mmol/24 h in the prefasting state to 0.25 mmol/24 h at the end of the fast. Intravenous glucose tolerance tests were performed before and on the 10th day of fasting. KIVUTT decreased significantly and was inversely related to plasma citrate concentration on the 10th day of fasting. The results agree well with the concept that an increased citrate level of tissues is of regulatory importance for the decreased glucose utilization during fasting in man.
Immunoglobulin Deposits in the Dermo‐Epidermal Junction Zone.
Authors: Permin Henrik , Juhl Frede , Wiik Allan
Published: August 2010

ABSTRACT. A material comprising 500 biopsies from clinically uninvolved skin of patients suffering from a number of medical diseases was studied by the direct immunofluorescence technique for immunoglobulins A, M, G, D, and E, complements Clq and C3, as well as fibrinogen as deposits in the dermo‐epidermal zone. Granular deposits were found in about 3/4 of the biopsies from patients with systemic lupus erythematosus (SLE), rheumatoid arthritis, patients suspected of having a connective tissue disease, patients on medication known to induce at times an SLE syndrome, and patients with diabetes mellitus. As to infectious diseases and renal diseases, deposits were found in about one half. About 1/3 of patients with allergic diseases and malignancies had deposits. Among patients with arteritis and among controls, deposits were observed in about 10%. In all groups but one, diabetes mellitus, the deposits were predominantly of the IgM class, somewhat less commonly of IgG, and rarely of the IgA or IgD classes. Complement C3 and fibrinogen‐antigenic material were also commonly found to have been deposited in connective tissue diseases, drug‐induced, allergic, and malignant diseases, whereas Clq occurred mainly in SLE and never in endocrine diseases, allergic diseases, or in patients on medication. IgG deposits were most often found in diabetes mellitus, SLE, and drug‐induced diseases. The granular appearance and the content of the deposits indicate that they may represent immune complex deposition. There was no correlation between immune deposits and the presence of antinuclear antibodies or rheumatoid factors in the serum at the time of biopsy. Thus, skin biopsy from clinically normal skin, studied for Ig and complement deposits of the granular type, does not essentially contribute to the differential diagnosis between a number of diseases within internal medicine. The explanation is perhaps the presence of circulating immune complexes in several of these conditions.
Zinc Supplementation in Alcoholic Cirrhosis.
Authors: Weismann Kaare , Christensen Erik , Dreyer Viggo
Published: August 2010

ABSTRACT. A double‐blind clinical trial with zinc sulfate, 0.2 g three times daily, and a placebo was performed in 30 patients with biopsy‐proven alcoholic liver cirrhosis. The disease was in a stable phase, and none of the patients showed evidence of a decompensated liver function. Parameters of liver function, taste acuity, dark adaptation and of zinc and vitamin A metabolism were followed for six weeks. In the zinc‐treated group of 16 patients, serum zinc rose from a normal mean value of 13.3 to 17.4 μmol/l, whereas the mean serum vitamin A level remained practically unaltered within the normal range, 1.89 at the entry and 1.83 μmol/l at the end of the study. Plasma prothrombin and serum alkaline phosphatase levels of the zinc group increased and serum bilirubin and serum carotene decreased significantly. The dark adaptation did not change, but the taste function was significantly improved during zinc treatment. The results indicate that zinc supplementation causes alleviation of certain abnormalities of cirrhotics, which deserves further attention.
Fractional Intestinal Calcium Absorption in Epileptics on Anticonvulsant Therapy.
Authors: Mosekilde Leif , Hansen Hans Hvid , Christensen Merete Sanvig , Lund Birger , Sørensen Ole Helmer , Melsen Flemming , Normany Anthony W.
Published: August 2010

ABSTRACT. Fractional intestinal 47Ca calcium absorption (α) in 12 epileptic outpatients receiving chronic high‐dose anticonvulsant therapy was reduced (p>0.05) compared to 12 matched normal controls. Six of the epileptics were treated orally with 0.5 μg of 1,25‐dihydroxycholecalciferol (1,25‐DHCC) per day and six with 10 μg of 25‐hydroxycholecalciferol (25‐HCC) per day for 10 days. The α was determined before and after treatment and compared with the effect of 0.5 μg of 1,25‐DHCC per day given for 10 days to 6 controls. An increase of the same order in α was found in all groups (p>0.05). No changes were observed in the serum levels of calcium, phosphorus, alkaline phosphatase or iPTH during treatment. Urinary calcium excretion was low in the epileptic patients and rose during treatment. The investigation demonstrates that the sensitivity of the intestine to 1,25‐DHCC is normal in epileptic patients on anticonvulsant therapy and that 1,25‐DHCC and 25‐ HCC in the given doses had an equal effect on the reduced intestinal calcium absorption.
Treatment and Prognosis in Polymyalgia Rheumatica and Temporal Arteritis
Authors: von Knorring Johan
Published: August 2010

ABSTRACT. The course of the disease and the effect of corticosteroid treatment were studied in 53 patients in whom polymyalgia rheumatica (PMR) or temporal arteritis (TA) had been diagnosed between 1967 and 1977. The mean interval between the onset of symptoms and confirmation of the diagnosis was 7 months. The starting dosage of prednisolone was 30–40 mg daily for patients with evidence of cranial arteritis and 10–20 mg daily for those without. The mean daily maintenance dose of prednisolone was 7.5 mg, usually 5 mg for patients with uncomplicated PMR and 10 mg for patients with TA. Only 7 (16%) patients with symptoms due to PMR continued to feel well and had no relapse of symptoms on 2.5 mg prednisolone daily. Corticosteroids were withdrawn from 19 patients 1 month to 4 years (mean 16 months) after the start of treatment. By 1977, 34 patients had received prednisolone continuously for 8 months to 9 years (mean 3 years). Attempts to witdraw cortico‐steroids provoked 33 relapses in 20 patients, and 21 patients had a total of 33 relapses while on maintenance dosage. In 5 of the latter a definite relapse of clinical symptoms was not accompanied by a concomitant rise in ESR. No serious complications of the disease occurred in this series after the start of therapy, and complications attributable to treatment were infrequent. The duration of the active stage of the disease varies widely. It is rarely advisable, however, to end treatment with corticosteroids before the end of 1 year, and most patients need such treatment for at least 2–3 years.
Temporal Arteritis—Progressive Affection of Vision During High‐Level Corticosteroid Therapy
Authors: Hugod Carl , Scheibel Morten
Published: August 2010

ABSTRACT. A case of giant cell arteritis (temporal arteritis) is presented in a 73‐year‐old male patient in whom lasting reduction of vision developed during high‐level prednisone treatment (60 mg daily) at a time when clinical improvement in other respects had appeared.
Syncope Caused by Lithium Treatment
Authors: Hagman Anders , Arnman Krister , Rydén Lars
Published: August 2010

ABSTRACT. Lithium salts have been widely used for several years in the treatment of manic‐depressive psychosis. Various side‐effects of lithium salts have been described. The present case reports present two patients in whom sinus node dysfunction leading to syncope was caused by lithium. One of the cases showed signs of depressed sinus node function even when not on lithium, but no symptoms arose until lithium treatment was commenced. The second case showed no signs of depressed sinus node function when lithium was withdrawn. To study the prevalence of sinus node dysfunction in patients on lithium therapy, 97 consecutive patients on lithium were examined. The examination included case history, ECG and carotid massage. In two patients lithium could not be ruled out as being responsible for sinus node depression and in one patient the same was true for the atrioventricular node. None of these patients had any symptoms. It is concluded that lithium treatment may result in sinus node dysfunction. This side‐effect is, however, not common. Lithium treatment can obviously be instituted in all patients without a history suggesting sinus node dysfunction. Patients with a history of dizziness and/or syncope should not be given lithium until thorough cardiological examination has been carried out. Likewise, a cardiological examination should be performed if patients on lithium develop symptoms of this type.
Blood Pressure Reduction and Vascular Adaptation
Authors: Sivertsson R. , Andersson O. , Hansson L.
Published: August 2010

ABSTRACT. Systemic BP reduction, calf blood flow and vascular resistance in the calf were determined in forty‐two previously untreated patients with mild to moderate essential hypertension (WHO I‐WHO II) before and after 6 weeks, 6 months and 18 months of BP‐lowering treatment with mefruside (25 mg daily) or atenolol (100–400 mg daily). Blood flow was determined with venous occlusion plethysmography using a mercury‐in‐rubber strain gauge technique in the supine patient. Auscultatory BP was measured on the right arm simultaneously with the flow determinations and resistance was calculated from the flow and pressure. BP was reduced significantly and to the same extent by the two drugs. In the atenolol group a rise in resting resistance and a corresponding fall in resting blood flow was seen initially. These changes were entirely normalized during continued treatment for 18 months. In the mefruside group no significant haemodynamic changes during treatment were observed at rest apart from the BP fall. None of the drugs reduced resistance at “maximal” vasodilatation, indicating that no regress of the hypertensive structural changes of the calf blood vessels had taken place.
Platelet Survival and Platelet Production in Acute Myocardial Infarction
Authors: Kutti Jack , Weinfeld Aleksander
Published: August 2010

ABSTRACT. Thrombokinetic studies were carried out on 26 consecutive patients with myocardial infarction (MI) admitted to a coronary care unit in the acute stage during a two‐month period. The results were compared with those of an age‐matched control group. In the MI patients, platelet mean life‐span was 5.0±0.3 days and significantly shorter (p>0.01) than in the controls (6.4±0.4 days). The mean platelet production rate for the patients with MI was significantly higher (p>0.005) than for the controls. On the basis of results reported by others as well as the present data, it is suggested that during the acute phase of MI there is no additional measurable reduction in platelet survival above that observed in chronic coronary artery disease.
Verapamil‐Induced Ventricular Regularity in Atrial Fibrillation
Authors: Khalsa Amrith , Olsson S. Bertil
Published: August 2010

ABSTRACT. The effects of physical exercise, isoproterenol and atropine upon the ventricular rate and regularity were studied in 12 patients with atrial fibrillation (AF) during verapamil‐induced regular ventricular rhythm. Physical exercise, isoproterenol and atropine all caused a gradual loss of ventricular regularity during AF. Verapamil caused a reduction of exercise heart rate during AF and, to a minor extent, even during sinus rhythm. The regular ventricular rhythm induced by verapamil during AF is interpreted as a total AV‐nodal block with nodal escape rhythm. Possible clinical benefits of this rhythm are discussed.
Why Do Crystalline Precipitates in Plasma Cells always Coalesce with Parallel Light and Dark Lines Strictly End‐to‐End and Side‐to‐Side?
Authors: Stavem P. , Ly B. , Førre Ø. , Tøyen I.
Published: August 2010

ABSTRACT.During transmission electron microscopy of plasma cells from two patients with plasma cell proliferative disorders, we observed a large number of small crystals, most of which showed a striation with alternating light and dark parallel lines. Ultraphotos strongly suggested that smaller crystals often coalesced to larger ones. The coalescence occurred in such a way that the parallel lines of the respective smaller crystals always met each other end‐to‐end and hardly ever end‐to‐side. A similar pattern can be seen on previously published ultraphotos from other patients with plasma cell proliferative disorders and intracellular crystals, although not commented upon by the respective authors. The parallel lines of the smaller crystals certainly must correspond to defined structures of the crystal. The stability of a certain configuration is therefore in all likelihood due to electrical potentials created by the crystal structure.
A Follow‐up Study of Hypertensive Patients after Operative Treatment of Unilateral Renovascular or Renal Disease
Authors: McNair A. , Nielsen M. Damkjær , Gammelgaard P. A. , Giese J. , Ibsen H. , Kappelgaard A. M. , Lund J. O. , Mathiesen F. , Munck O. , Tønnesen K. H.
Published: August 2010

ABSTRACT. A study of 44 hypertensive patients with unilateral renovascular or renal parenchymal disease is presented. All patients underwent corrective surgery. Out of the 44 operated patients, five did not participate in the follow‐up examination. The remaining 39 patients constitute the study population. The effects of surgery on the hypertensive state could be evaluated in 35 patients, whereas four died less than two months after the operation. Follow‐up studies were carried out at 8–60 months after the operation. The average period of observation was 32 months; 24 patients were observed for more than two years. As a group, the patients had severe hypertension with extensive target organ damage and widespread atherosclerosis. A fairly rigorous selection process was applied, and an unsatisfactory response to medical management was considered a point of major importance. In the majority of cases, renovascular lesions were atherosclerotic, with only two cases of fibromuscular dysplasia. Unilateral nephrectomy was performed in 32 patients, whereas seven underwent reconstructive vascular surgery. Out of 35 patients, 22 (63%) were cured, 8 (23%) improved and 5 (14%) unaltered. A gratifying regression of hypertensive lesions in target organs was observed in patients who were cured or improved by surgery. The frequency and severity of postoperative complications were related to the presence of extrarenal vascular disease.
Identification of Renal Tubular Epithelial Cells in Urine with Immunofluorescence
Authors: Holm Stig , Wahlin Anders
Published: August 2010

ABSTRACT. Rabbits were immunized with human kidney homogenate. The rabbit sera, after absorption with human liver homogenate, showed antibody activity against human kidney, renal pelvis and urinary bladder. The sera were then absorbed with human renal pelvis and urinary bladder mucosa and subsequently showed no antibody activity against urinary bladder or renal pelvis. Immunofluorescence examinations showed fluorescing cells in kidney tubules, but not elsewhere. The finally absorbed antihuman kidney sera were used for indirect immunofluorescence examination of urinary sediments from patients with renal disease. Phase contrast microscopy was used simultaneously. Fluorescence was found in cells which in phase contrast microscopy were judged to be renal tubular cells. Fluorescing cells were often found in casts, but free cells were also seen. Immunofluorescence may thus provide a means of identifying renal tubular cells in urine.
Renal Function and Plasma Aldosterone during Acute Lithium Intoxication
Authors: Hansen H. E. , Pedersen E. B. , Amdisen A.
Published: August 2010

ABSTRACT.Studies on plasma aldosterone, total serum protein, electrolytes, osmolal concentrations in serum and urine, creatinine, lithium and osmolal clearances were carried out on 14 patients suffering from lithium intoxication. The determinations were done on samples obtained on admission and during the following twelve days of treatment with hemodialysis, sodium chloride loading, or forced diuresis. Plasma aldosterone and total serum protein were increased; serum sodium concentrations and creatinine clearances were decreased on admission. Serum osmolality was normal; urine osmolal concentration was just above that in plasma. The results showed that the lithium intoxicated patients were moderately depleted of sodium and water on admission. Plasma aldosterone, total serum protein and serum sodium were normalized during treatment. Creatinine clearance increased but did not normalize in all patients. Renal concentrating tests were performed in five patients three to four weeks after lithium intoxication. The renal concentrating ability was reduced in all. The elevated plasma aldosterone seen in lithium intoxication might have been a result of sodium and water depletion. It is suggested that impaired renal concentrating ability induced by lithium may make some patients more susceptible to conditions which can lead to sodium and water loss, and thereby to lithium intoxication.
Renal Function in Primary Hyperparathyroidism and in Non‐Hyperparathyroid Hypercalcemia
Authors: Lins Lars‐Eric
Published: August 2010

ABSTRACT. Renal function was studied in 18 patients with moderate hypercalcemia. Eight patients had primary hyperparathyroidism while 10 patients suffered from malignancies, vitamin D intoxication or sarcoidosis. Glomerular filtration rate was significantly higher (p>0.01) in patients with primary hyperparathyroidism (mean serum calcium concentration 3.00 mmol/l) than in patients with hypercalcemia of non‐hyperparathyroid origin (mean serum calcium concentration 3.02 mmol/l). Renal plasma flow was 45% higher in hyperparathyroid patients than in non‐hyperparathyroid patients, but the difference was not significant. Filtration fraction was higher (p>0.05) in patients with primary hyperparathyroidism than in other patients. In seven patients with primary hyperparathyroidism, renal function was studied before and after parathyroidectomy. In spite of a decrease in mean serum calcium concentration from 3.01 to 2.26 mmol/l, glomerular filtration rate and renal plasma flow remained unchanged. In six patients with non‐hyperparathyroid hypercalcemia, correction of the hypercalcemia (mean serum calcium concentration decreased from 2.99 to 2.34 mmol/l) was followed by significantly increased glomerular filtration rate (p>0.01) and renal plasma flow (p>0.05). Filtration fraction remained unchanged after correction of hypercalcemia in patients with primary hyperparathyroidism as well as in patients with non‐hyperparathyroid hypercalcemia. These results suggest a different effect of calcium on the glomerular filtration rate and renal plasma flow in patients with primary hyperparathyroidism and in patients suffering from hypercalcemia of non‐hyperparathyroid origin. These results also suggest that the presence of circulating parathyroid hormone in patients with primary hyperparathyroidism diminishes the depressive effect of calcium on the glomerular filtration rate.
Tuberculosis and Kidney Transplantation
Authors: Riska Henrik , Kuhlbäck Börje
Published: August 2010

ABSTRACT. Immunosuppressive treatment enhances the risk of pulmonary and other infections. Tuberculosis is a predictable complication in transplanted patients. The present material comprises 584 kidney transplantation patients, ten of whom had had a previous history of tuberculosis. After transplantation ten patients presented with pulmonary tuberculosis during immunosuppressive treatment. One of the patients to whom no prophylactic antituberculous treatment had been given presented with a relapsing tuberculosis. The results of routine antituberculous treatment were excellent, but graft and patient survival were disappointing among the tuberculosis patients.
Non‐Selective and Selective β‐1‐Adrenoceptor Blocking Agents in the Treatment of Hyperthyroidism
Authors: Nilsson Ove R. , Karlberg Bengt E. , Kågedal Bertil , Tegler Lennart , Almqvist Sven
Published: August 2010

ABSTRACT Treatment for one month with propranolol or atenolol, a selectiveβ‐1‐adrenoceptor blocking agent, was evaluated in 20 hyperthyroid patients. The patients improved to the same extent on either drug, as shown by a clinical diagnostic index. Basal metabolic rate decreased by 11% during both treatments, while it was unchanged in seven untreated hyperthyroid controls. Thyroxine concentration did not change during any treatment. During propranolol treatment T3 decreased from 4.6 to 3.9 nmol/l, while no changes were observed during atenolol treatment or in the control group. No significant changes were seen in free T4, free T3 or rT3 concentrations on any treatment, although free T3 was observed to decrease slightly during propranolol treatment. Thus, the improvement of the clinical symptoms of hyperthyroidism cannot be explained by diminished thyroid hormone concentrations in serum, since the reduction was small during propranolol and absent during atenolol treatment.
The Expression of a Human B‐Lymphocyte Antigen on Cells in Different Types of Leukaemia
Authors: Turesson Ingemar , Berntorp Erik , Zettervall Olle
Published: August 2010

ABSTRACT The expression of a B‐cell antigen on the surface of leukaemic cells from patients with various forms of leukaemia was studied by direct immunofluorescence using a rabbit antiserum against chronic lymphocytic leukaemia (CLL) cells. The antigen was found on normal peripheral blood B‐lymphocytes and on the majority of lymphocytes from patients with CLL. Most normal peripheral blood monocytes and blasts from patients with acute myeloblastic leukaemia, acute myelomonocytic leukaemia or acute lymphoblastic leukaemia of T‐cell type did not carry the antigen but a minority of such cells were weakly stained. In two of three patients with blast transformation of chronic myelocytic leukaemia, a high proportion of the blasts carried the antigen. It was also found on the surface of the hairy cells from two cases of leukaemic reticuloendotheliosis. These cells also carried Fc‐receptors and immunoglobulin with restricted heterogeneity (mu, lambda and alpha, mu, delta, kappa, respectively). The cellular distribution of the B‐cell antigen differs to some extent from that of Ia‐like antigens detected by antisera against purified B‐cell membrane products. The demonstration of the antigen as well as immunoglobulin of a single light chain type on the surface of hairy cells strongly supports the B‐lymphocyte origin of these cells.
Self‐Poisoning Treated in the ICU
Authors: Heath Andrew , Selander Dag
Published: August 2010

ABSTRACT This retrospective study compares number and type of self‐poisonings admitted to the intensive care units (ICU) at Sahlgren's Hospital, Gothenburg, during 1972 and 1976. The total number of patients requiring intensive care was unchanged, but a change in the pattern of self‐poisoning was seen. In 1976 the number of patients requiring intensive care following acute alcohol intoxication had increased, whereas the number of barbiturate and methaqualone poisonings decreased. Tricyclic antidepressants formed the largest group in both years. Fewer patients needed endotracheal intubation and IPPV in 1976 than in 1972. Also, fewer complications were seen, and the death rate among ICU‐treated patients decreased. In the Gothenburg area barbiturates accounted for one half of all deaths due to self‐poisoning and tricyclic antidepressants for one fifth. Any expected decrease in intensive care as a result of fewer barbiturate and methaqualone poisonings was obscured by an increase in severe alcohol intoxication.
Effects on Muscle Electrolytes of Potassium and Magnesium Infusions, Spironolactone Medication and Operation in a Case of Primary Aldosteronism
Authors: Dyckner Thomas , Wester P. O.
Published: August 2010

ABSTRACT Serum and muscle electrolytes were determined in a case of primary aldosteronism before and after potassium and magnesium infusions as well as spironolactone treatment and following surgery. Repeated potassium infusions resulted in a transient normalization of the muscle potassium (K/m), followed within 3–4 days by a return to the previously low K/m. Magnesium infusions did not give any increase in muscle magnesium (Mg/m). On the contrary, there was a decrease in Mg/m concomitant with a decrease in K/m. Treatment with spironolactone for one month was followed by a normalization of both serum and muscle electrolytes. Following surgery the serum potassium and K/m remained normal, but the serum magnesium (Mg/s) and Mg/m showed a decrease to subnormal values. Despite the initial findings of normal Mg/s and Mg/m as well as excretion of more than 80 % of the i.v. magnesium dose, this may indicate that there was a magnesium deficiency in the skeletal pool.
Sick Sinus Syndrome Treated with Permanent Pacemaker in 109 Patients
Authors: Breivik Kjell , Ohm Ole‐Jørgen , Segadal Leidulf
Published: August 2010

ABSTRACTDuring the last decade implantation of permanent pacemakers has become the treatment of choice for patients suffering from the sick sinus syndrome (SSS). We have followed up 112 SSS patients treated with permanent pacemakers in Haukeland Hospital in the period 1966‐76. The pacemakers were later removed from three of the patients. In the remaining 109 patients the SSS was characterized by tachy‐bradyarrhythmias (TBA) in 44 and bradyar‐rhythmias (BA) in 65. Before implantation, 68 patients had syncopes and 27 severe dizziness. After implantation, symptomatic improvement was apparent in 104 patients; only three still had syncopes. During the follow‐up period (mean 34.4 months), 29 patients died (yearly mortality 9.3%). There was no significant difference in total mortality between patients with TBA and with BA. Concomitant disturbances in atrioventricular (AV) conduction occurred in 35.8% of the patients. Among 79 of 80 patients still alive, five had developed total AV block, 19 had stable atrial fibrillation, 12 of these were possibly pacemaker‐independent (ventricular rate >60/min). Systemic embolization was observed in 16 patients, more frequently in the TBA (12/44) than in the BA group (4/65) (p<0.001). It is concluded that permanent pacemakers have an excellent symptomatic effect in patients with SSS. The prognosis is mainly determined by the presence or absence of coronary heart disease and/or heart failure.
Immune Complex Glomerulonephritis in Chronic Granulomatous Disease
Authors: van Rhenen D. J. , Koolen M. I. , Feltkamp‐Vroom Th. M. , Weening R. S.
Published: August 2010

ABSTRACT An 18‐year‐old girl is described who developed advanced renal sclerotic lesions, probably preceded by local focal glomerulonephritis, which coexisted with a Staphylococcus aureus abscess. It is hypothesized that immune complex glomerulonephritis developed, provoked by long‐term antigenic stimulation of Staphylococcus aureus. The cause of these long‐term bacterial infections was a defect of the phagocytic cells to kill bacteria effectively, a disease known as chronic granulomatous disease. Therapy with intracellularly active antimicrobial agents restored the renal function till no more haemodialysis was necessary.
Effect of Physical Training on Different Categories of Patients with Intermittent Claudication
Authors: Jonason Tommy , Jonzon Berit , Ringqvist Ivar , öman‐Rydberg Aina
Published: August 2010

ABSTRACT The effect of supervised training was studied in 68 patients with intermittent claudication. Maximal walking distance was measured on a treadmill. Eight of the patients had resting pain in the leg when recumbent (group A), 25 had an initial walking distance of less than 500 m (group B), 11 had an initial walking distance of 500–1000 m (group C), 24 had coronary insufficiency (group D). The study shows that training should be undertaken for at least three months. In some patients with resting pain, training led to relief of pain and surgical treatment was not necessary. Almost all patients without signs of coronary insufficiency increased their walking distance, compared to only 14 of the 24 patients with coronary insufficiency. Walking distance increased significantly in groups B and C and no significant difference was found between patients with proximal or distal arterial stenosis.
Risk Factors for Myocardial Infarction in the Stockholm Prospective Study
Authors: Carlson Lars A. , Böttiger Lars Erik , åhfeldt Per‐Erik
Published: August 2010

ABSTRACT A 14‐year follow‐up of the Stockholm prospective study is reported. A number of 130 new myocardial infarctions (MI) were found in a prospective group of men (n = 3189) and another 46, i.e. a total of 176 MI, in the total group (n =3 486). Different types of multivariate statistical analyses show that age, blood pressure, smoking, fasting plasma concentrations of cholesterol and triglycerides, ESR and Hb were independent risk factors for MI, while the weight/height index was not. Elevated BP became an important risk factor only after the age of 50. When only age, BP, smoking and the two plasma lipids were entered into the logistic multivariate analysis, plasma triglycerides were more important as a risk factor than cholesterol. Quintile analysis showed that the rate of new MIs increased more with increasing triglyceride than increasing cholesterol levels. In the prospective group, the average rate of new Mis for men below 60 years was 32 per 1000. In the bottom and top quintile these rates were 16 and 65 for plasma triglycerides and 27 and 47 for cholesterol. When the men were divided into 4 groups with regard to both plasma lipids, the rate of new MIs increased successively from group to group along this chain: both lipids normal, only cholesterol high, only triglycerides high and both plasma lipids high.
Clinical Features in Patients with Recurrent Myocardial Infarction
Authors: Löfmark Rurik
Published: August 2010

ABSTRACT A retrospective investigation of 420 patients who had survived the acute phase of myocardial infarction revealed 63 reinfarctions (in 57 patients) within three months. Twenty‐eight patients died without reinfarction during the same period, and 335 survived three months without reinfarction. The reinfarction patients were significantly more often women, had more frequently a history of previous myocardial infarction and hypertension, and their myocardial infarctions were more often non‐transmural and localized to the anterior wall of the heart. The ECG of each patient that was registered nearest prior to the reinfarction during hospitalization or prior to discharge showed more often negative T‐waves.
Ultrastructure of the Microvessels in Skeletal Muscle in a Case of Systemic Capillary Leak Syndrome
Authors: Johansson Bengt R. , Löfdahl Claes‐Göran
Published: August 2010

ABSTRACT The microvessels of skeletal muscle were examined electron microscopically in a case of systemic capillary leak syndrome (SCLS). One biopsy was taken in a free interval of the disease and one about 6 hours after the onset of an attack with hypovolemia. The microvascular endothelium exhibited a large number of multivesicular bodies, especially in the specimen obtained during an attack. Possibly this indicates a high heterophagic activity of the endothelium. A blebbing of the luminal surface of arteriolar endothelium was observed in the attack specimen. Since a complement activation seemed to occur during attacks, the blebbing is tentatively interpreted as a sign of a complement‐mediated injury to the endothelium, leading to a breakdown of the endothelial barrier. This mechanism might explain the dramatic increase of microvascular permeability to plasma proteins during an attack of SCLS. The findings did not indicate that the increase might depend on some disturbance of the transendothelial vesicular transport function, nor could any openings of endothelial junctions, as in inflammation, be demonstrated. Regionally the periendothelial basal lamina appeared thickened, a finding which seems common in angiopathies of different kinds.
Miliary Tuberculosis
Authors: Stenius‐Aarniala Brita , Tukiainen Pentti
Published: August 2010

ABSTRACT Twenty‐six cases of miliary tuberculosis were studied in retrospect. The mean age of the patients was 62 years. Eighteen patients suffered from another underlying chronic disease. Nine had been treated with corticosteroids or cytotoxic agents. A limited manifestation of tuberculosis had been previously verified or suspected in ten cases. Fever was present in 85% of the patients, frequently combined with fatigue or abdominal pain. Serum alkaline phosphatase was elevated in 81% of the cases. Minor haematological abnormalities (anaemia, etc.) were found in 16 cases and pancytopenia, stimulated lymphocytes or chronic myeloid leucaemia in six. Miliary mottling was found in the chest radiographs of 13 patients. Other findings were pleural effusion, mediastinal node enlargement, opacities suggesting pneumonia or old, possibly tuberculous lesions. Antituberculosis therapy was initiated in 12 patients, two of whom died within a few days. There was a high frequency of liver or system involvements. It is concluded that laparoscopy or liver needle biopsy are valuable diagnostic procedures in patients with fever and elevated alkaline phosphatases of unknown aetiology. A therapeutic test with antituberculous drugs should be undertaken in suspected cases.
Blood Pressure and Renal Function
Authors: Ljungman Susanne , Aurell Mattias , Hartford Marianne , Wikstrand John , Wilhelmsen Lars , Berglund Goran
Published: August 2010

ABSTRACT.The relationship between blood pressure (BP) and renal function was studied in samples of 49‐year‐old men. Of 3205 49‐year‐old men, 2376 (74%) took part in a BP screening. By systematic sampling, based on diastolic BP levels varying from very low to very high, 120 subjects were selected for this study. Only subjects who were not on antihyper‐tensive treatment were included. Renal blood flow (RBF), renovascular resistance (RVR), glomerular filtration rate (GFR), filtration fraction (FF) and renal concentrating capacity were studied in 111 subjects, none of whom had advanced hypertension. With increasing BP there was a decrease in RBF (r=‐0.34) and an increase in RVR (r=0.81) and FF (r=0.35). The changes in renal haemodynamics occurred gradually from low to high BP, and did not start at any particular BP level. With increasing BP, GFR was unchanged. An “autoregulation of GFR” was thus found at all BP levels studied. Renal concentrating capacity was unchanged. These findings indicate that renal haemodynamics in essential hypertension are adjusted mainly to ensure a constant GFR.
The Effects of Cimetidine (Tagamet®) on Renal Function in Patients with Renal Failure
Authors: Larsson Rutger , Bodemar Göran , Kågedal Bertil , Walan Anders
Published: August 2010

ABSTRACT. Cimetidine has been administered during 7 days to 28 patients with different degrees of renal failure. Thirteen of these patients had a further week's treatment at least one month later. The daily dose of cimetidine was reduced in relation to pretrial values of creatinine clearance. There was a clear rise in serum creatinine all through the trial (22.3±2.6% at day 7) (p<0.001). Maximal decreases in creatinine clearance occurred on day 2 (21.8±2.2 %) and day 3 (23±2.0%) (p<0.001), but were still present on days 6 (16.4±±2.9%) and 7 (17.3±2.8%) (p<0.001). There was a small rise in serum uric acid all through the trial (p<0.05). Three days after finished treatment there were no significant differences in serum creatinine, creatinine clearance and serum uric acid when compared to pretrial values. The pattern of changes in serum creatinine and creatinine clearance was the same in both mild and severe renal failure. Glomerular filtration rate determined by [51Cr] EDTA clearance before, on day 3 of treatment and 3 days after treatment did not show any differences. No change was seen in serum β2‐microglobulin during the trial. The decrease in creatinine clearance during treatment with cimetidine is probably not caused by a reduction of glomerular filtration rate, but could be explained by competition by cimetidine for tubular secretion of creatinine. Treatment with cimetidine of patients with renal failure may invalidate measurements of serum creatinine and creatinine clearance as standard routine tests for glomerular filtration rate.
Effect of Guar Gum on Body Weight and Serum Lipids in Hypercholesterolemic Females
Authors: Tuomilehto Jaakko , Voutilainen Erkki , Huttunen Jussi , Vinni Seija , Homan Kaija
Published: August 2010

ABSTRACT. The effect of guar gum (15 g/day) on serum lipids and body weight of middle‐aged hypercholesterolemic females was studied in a double‐blind controlled trial. No consistent changes were observed in serum cholesterol, triglycerides or HDL cholesterol in patients taking guar gum, placebo or no medication at all. A highly significant decrease in body weight (62.9±2.1 vs. 60.4±2.2 kg, p<0.0005, paired comparison) was seen in subjects receiving guar gum, whereas body weight remained constant in the other two groups. It is concluded that the daily ingestion of 15 g of guar gum results in a permanent weight loss, but does not influence serum lipids in females with hypercholesterolemia.
Antiarrhythmic Properties of a Neuroleptic Butyrophenone, Melperone, in Acute Myocardial Infarction
Authors: Mogelvang Jens Christian , Petersen Erling Niels , Folke Poul Erik , Ovesen Lars
Published: August 2010

ABSTRACT. In vitro animal studies suggest melperone, a neuroleptic butyrophenone, to be a type III antiarrhythmic drug according to the classification of Vaughan Williams. It has no negative inotropic effect on cardiac muscle. A double‐blind trial of 3 hours' duration was carried out with melperone and placebo in 26 patients admitted to the CCU with suspected acute myocardial infarction (AMI) and ventricular arrhythmias. Melperone, 50 mg i.v., was superior to placebo in reducing the total number of ventricular ectopic beats (VEB) as well as the number of minutes with either frequent, multifocal, R‐on‐T‐type or runs of VEB. The reduction became statistically significant in the second treatment hour in patients with definite AMI. Melperone induced sedation and reduction of systemic BP in most of the patients. Two patients with low initial systolic BP achieved a further reduction and had BP levels below 90 mmHg. Two patients experienced minor side‐effects. In conclusion, melperone administered in large i.v. doses to patients with AMI induced sedation, acute BP reduction and some reduction of ventricular arrhythmia.
Episodic Cardiac Arrhythmia and Accident Rate
Authors: Nilsson Bo E. , Abdon Nils Johan
Published: August 2010

ABSTRACT. The rate of accidents severe enough to require a roentgen examination was investigated in a series of patients with episodic cardiac arrhythmia of types causing Adams‐Stokes' syndrome. The accident rate was doubled compared with controls without known Adams‐Stokes' syndrome but the associated increase in fracture rate was not significant.
Preoperative Localization of Aldosterone‐Producing Adenomas
Authors: Adamson U. , Efendić S. , Granberg P. O. , Lindvall N. , Lins P. E. , Löw H.
Published: August 2010

ABSTRACT. The efficiency of six different methods available for topographical diagnosis of primary al‐dosteronism was analysed in retrospect from 11 surgically verified cases and by an analysis of 360 cases reported in the literature. Differentiation between hyperplasia and adenoma was most safely predicted by monitoring the diurnal rhythm of plasma aldo‐sterone and its reaction to posture. Adrenal vein catheterization with aldosterone determinations was helpful in establishing the presence of hyperplasia in approximately 70 % of these cases. Correct localization of aldosterone‐producing adenomas was made in more than 90% by vein catheterization while veno‐graphy and radio‐cholesterol scintigraphy had lower diagnostic accuracy. It is therefore suggested that determination of plasma aldosterone both by vein catheterization and by peripheral monitoring should be used ahead of other diagnostic procedures for topographical examinations in primary aldoste‐ronism.
A Case of Hypocalcemia, Heart Failure and Exceptional Repolarization Disturbances
Authors: Murros Juhani , Luomanmäki Kimmo
Published: August 2010

ABSTRACT. Little attention has been given to the question whether clinical heart failure can be a manifestation of hypocalcemia. A patient with hypopara‐thyroidism and heart failure prompted us to analyse the reports on this subject. The conclusion was that if associated with an underlying myocardial disease, hypocalcemia may be a rare contributing factor to heart failure. Hypocalcemic heart failure without coexisting heart disease has been suggested as a cause of hypotension in two special situations in which a sudden fall of serum ionized calcium is induced: massive transfusions of citrated blood and rapid correction of uremic acidosis. In addition to hypocalcemia and heart failure, our patient had exceptional repolarization disturbances: rate‐dependent variation of T wave amplitudes during sinus arrhythmia and unexpected prolongations of the Q‐T interval with attacks of ventricular tachycardia.
Predominant B‐Lymphocyte Deficiency in a Case with Lymph Node Disease Resembling Angioimmunoblastic Lymphadenopathy
Authors: Persson Bertil , Rausing Alf , Turesson Ingemar , Zettervall Olle
Published: August 2010

ABSTRACT. A case with clinical and histological features resembling angioimmunoblastic lymphadenopathy, but with a very marked decrease in B‐lymphocytes instead of T‐lymphocytes is presented.