bluuebunny/crossref_metadata_2025 huggingface dataset:
IgM Deposition in Skin Biopsies from Patients with Primary Biliary Cirrhosis
Authors: Lindgren Stefan , Eriksson Sten , Löfberg Helge , McKay John
Published: August 2010

ABSTRACT. Immunofluorescence studies on skin biopsies from 14 patients with primary biliary cirrhosis (PBC) showed granular papillary deposition of IgM in all. In addition, 6 patients had C3 deposition. Control patients with various other liver diseases, idiopathic high plasma levels of IgM and extrahepatic cholestasis were only sporadically positive for IgM and not at all for C3. IgM deposition in dermal papillae in PBC does not merely reflect high plasma IgM levels or cholestasis but probably represents an immunochemically abnormal IgM population.
Fatal Carbamazepine‐Associated Hepatitis
Authors: Hopen Gunnar , Nesthus Ingerid , Lærum Ole Didrik
Published: August 2010

ABSTRACT. Fatal hepatitis associated with intake of carbamazepine occurred in two females, 37 and 23 years old. The former used carbamazepine to prevent alcohol withdrawal symptoms. She had also been treated with disulfiram. The latter had used the drug as the only medication for epilepsy. This report supports the view that carbamazepine may induce serious hepatic damage.
Detection of Mitral Regurgitation by Doppler Ultrasound
Authors: Knutsen K. M. , Bae E. A. , Sivertssen E. , Høiseth A.
Published: August 2010

ABSTRACT. Sixty‐four patients with various heart diseases were evaluated for mitral regurgitation (MR) by left ventricular angiography and pulsed Doppler ultrasound within 2–3 days. Adequate Doppler recordings were obtained from 60 patients. The sensitivity of Doppler in detecting MR was 94%, specificity 90% and predictive value for a positive and a negative Doppler examination 90 and 93%, respectively. Two of the 3 false positive Doppler recordings were from patients with coronary heart disease, ischemic papillary muscle dysfunction may have caused MR inconsistently. Two false negative Doppler recordings may be related to problems in placing the ultrasonic sample volume at the systolic retrograde blood stream in the left atrial cavity. It is concluded that pulsed Doppler ultrasound, being a transcutaneous, non‐invasive method, is a valuable tool in detecting MR. So far, we have not been able to quantitate the regurgitation.
Supradiaphragmatic Presentation of Non‐Hodgkin's Lymphoma in Men Occupationally Exposed to Organic Solvents
Authors: Olsson H. , Brandt L.
Published: August 2010

ABSTRACT. Using a standardized interview schedule, occupational exposure to organic solvents was investigated in 61 consecutive male patients with the diagnosis of non‐Hodgkin's lymphoma. When exposure was defined as handling of organic solvents every working day for at least one year, 23 patients were exposed and 38 non‐exposed. Of 15 patients with clinical stage I‐II above the diaphragm, 12 (80%) were occupationally exposed to organic solvents. Only 1 (11%) of 9 patients with clinical stage I‐II disease located below the diaphragm was exposed. Thirty‐seven patients had clinical stage III‐IV disease at the time of diagnosis and 10 (27%) of these were exposed. The predominance of exposed patients in the group with stage I‐II disease above the diaphragm is significant and the results indicate a relation between exposure to organic solvents and supradiaphragmatic presentation of non‐Hodgkin's lymphoma. No correlation was found between exposure and the morphology of the lymphomas.
Secondary Hypertension in a Medical Ward
Authors: Säkö Sakari , Sotaniemi Eero A.
Published: August 2010

ABSTRACT. The prevalence of secondary hypertension was evaluated by investigating 400 consecutive patients with arterial hypertension in a medical ward. They were classified into four groups according to the case history. Group A: 104 subjects with therapy‐resistant hypertension, group B: 247 patients who had another concomitant disease as the primary reason for admission, group C: 34 patients referred to the ward for basic investigation due to recently diagnosed hypertension, group D: 15 patients with unwanted reactions to drug therapy. The incidence of secondary hypertension was 15.5% in the entire series, and 14.4%, 18.6%, 2.9% and 0% in groups A–D, respectively. Ten patients (2.5%) were operated on, nine of them from group A and one from group B. The findings demonstrate the importance of a careful examination of patients with therapy‐resistant hypertension, since they might include subjects whose hypertension can be treated by surgery.
Effects of Plasma Exchange on Serum Cholesterol Levels in Heterozygous Familial Hypercholesterolemia
Authors: van de Wiel A. , Kruiswijk T. , Imhof J. W. , Hart H. Ch. , Holtkamp H. C. , Szakaly M.
Published: August 2010

ABSTRACT. This study describes the cholesterol‐lowering effect of plasma exchange (PE) in seven patients with heterozygous familial hypercholesterolemia. All patients followed an identical protocol consisting of one PE per three weeks during 27 weeks. A cholesterol‐lowering diet was prescribed in addition. No supporting cholesterol‐lowering medication was given. PE leads to a momentary marked decrease in serum concentrations of both total cholesterol (Tot‐c) and high density lipoprotein cholesterol (HDL‐c). HDL‐c concentration returns more rapidly to the plateau value than Tot‐c concentration resulting in a transient favourable Tot‐c/HDL‐c ratio that disappears after 10–14 days. No reducing or increasing effect of PE on HDL‐c concentration was observed after 27 weeks of treatment. Nor was any convincing reducing effect on Tot‐c concentration observed.
Urinary β‐Hexosaminidase Excretion in Polycystic Kidney Disease
Authors: Swedenborg P. , Hultberg B. , Thysell H.
Published: August 2010

ABSTRACT. The urinary excretion of β‐hexosaminidase in relation to creatinine was studied during one year in 30 consecutive patients with polycystic kidney disease (S‐creatinine 75–1000 μmol/1) and 30 healthy controls. The excretion of β‐hexosaminidase was significantly increased in the patients and was positively correlated to S‐creatinine and to the relative increase in S‐creatinine during the year of the study. No correlation was found between the enzyme excretion and age, mean blood pressure, number of antihypertensive drugs, proteinuria or pyuria. A significant rise in β‐hexosaminidase excretion was observed in two patients with acute cyst bleeding and/or kidney infarction.
Immune Reactions and Long‐Term Therapy with Human Leukocyte Interferon
Authors: Ingimarsson Snorri , Cantell Kari , Carlström Gun , Dalton Barbara , Paucker Kurt , Strander Hans
Published: August 2010

ABSTRACT. Twenty patients with osteosarcoma were treated with exogenous human leukocyte interferon for periods ranging from 6 to 18 months. Eleven of them remained free from detectable tumour growth during this treatment. Blood samples from all patients were tested for antibodies against interferon and against impurities in the interferon preparations. No patient developed detectable levels of neutralizing antibodies against interferon. All patients formed antibodies against contaminants in the concentrated crude interferon and the partially purified interferon preparation which had been used for treatment.
Therapeutic Splenectomy in Hematologic Disorders
Authors: Ly Bernt , Albrechtsen Dagfinn
Published: August 2010

ABSTRACT. Two hundred and twenty‐one adult patients were splenectomized for various hematologic disorders, including immunologic thrombocytopenia (80 cases), hereditary spherocytosis (15 cases), autoimmune hemolytic anemia (20 cases) chronic lymphatic leukemia (27 cases), lymphosarcoma (27 cases), myelofibrosis (11 cases) and pancytopenia/aplastic anemia (14 cases). Complete and lasting remission was achieved by 72 % of patients with immunologic thrombocytopenia and by 60% of patients with autoimmune hemolytic anemia. Improvement was seen in 74 % of patients with lymphosarcoma, in 55% of those with chronic lymphatic leukemia and in 63 % of those with myelofibrosis, whereas only one of 14 patients with pancytopenia/aplastic anemia had any benefit of splenectomy. Of 8 postoperative deaths (3.6 %), 6 were caused by septicemia and 2 by hemorrhage. Non‐fatal complications, mainly infections and hemorrhages, occurred in 49 patients (22 %) and were most frequent in cases with massive splenomegaly (>1000 g) or severe thrombocytopenia (<20 × 109/l). Also, more complications occurred in chronic lymphatic leukemia and myelofibrosis than in other diseases. Late postsplenectomy fulminant infection was seen in 8 patients (3.6%), the type of infection being septicemia in 6 and meningitis in 2, and 6 of them died. We conclude that splenectomy is often of considerable benefit in the various hematologic disorders presently studied and sufficiently well tolerated to make it applicable as a therapeutic modality. The present results confirm the current view that splenectomy has little if any effect in patients with aplastic anemia.
Influence of Smoking on Thyroid Activity
Authors: Melander A. , Nordenskjöld E. , Lundh B. , Thorell J.
Published: August 2010

ABSTRACT. Serum concentrations of T4, T3, rT3 and TSH were determined before and after cessation of chronic smoking in healthy subjects. Their body weights were measured at the same intervals. Abstention from smoking was monitored through determination of CO content in blood. Cessation of smoking was accompanied by small reductions in serum T4 and rT3 and by a small rise in serum TSH. Serum T3 was not significantly altered. A minor rise in body weight was noticed. It is suggested that smoking promotes a modestly increased secretion of thyroid hormone, which is readjusted to normal following cessation of smoking. The assumed smoking‐induced increase in thyroid hormone secretion is apparently not mediated by enhanced TSH secretion but by some other factor, e.g. the sympathetic nervous system. The hormonal changes might contribute to the increase in body weight frequently seen after cessation of smoking.
Glomerulonephritis in Infections with Yersinia Enterocolitica O‐Serotype 3
Authors: Denneberg T. , Friedberg M. , Samuelsson T. , Winblad S.
Published: August 2010

ABSTRACT. Signs of damage to the glomerular basement membrane appearing as haematuria and proteinuria have been observed in 16 cases of proven acute yersiniosis. The infecting agent was Yersinia enterocolitica serotype O:3 in all. In a few cases a transient deterioration of the renal function was observed. The renal symptoms were not related to the acute febrile state, but seemed to appear about 14 days after the onset of yersiniosis and to be reversible in the observation period. Infection with other microorganisms known as nephritogenic was not found in spite of attemps to do so. Kidney biopsy was performed in one case and immunofluorescence microscopy showed deposits of immunoreactants. Based on these observations we suggest that acute glomerulonephritis can be included in the spectrum of complications of infection with Yersinia enterocolitica serotype O:3. The frequency of complicating glomerulonephritis in yersiniosis could not be estimated from this study.
Changes in Urinary Electrolytes Versus Serum Electrolytes during Treatment of Primary Hypertension with Chlorthalidone alone and in Combination with Spironolactone
Authors: Falch D. K. , Schreiner A. M.
Published: August 2010

ABSTRACT. Chlorthalidone (50 mg/day) was given to 15 males with primary hypertension (WHO stage I or II). After 6 weeks of treatment, the aldosterone‐blocking agent spironolactone was added (100 mg/day). Following control measurements, the men were studied after 2, 4, 6, 10 and 33 weeks of treatment. Blood pressure normalized on chlorthalidone alone, and no further decrease or hypotensive symptoms were observed when spironolactone was added. Serum potassium concentration fell from (mean ± S.D.) 4.2±0.2 to 3.2±1.2 mmol/l (p < 0.01) within 2 weeks of chlorthalidone treatment. Spironolactone tended to normalize the serum concentration and urinary excretion of potassium, although not completely. Measurement of serum potassium concentration was prior to measurement of urine electrolytes as an early warning of potassium loss. The urinary potassium/sodium ratio was unchanged throughout the study. Serum sodium concentration was unchanged during chlorthalidone treatment, but fell from 141.7±2.3 mmol/l (control) to 137.7±2.6 mmol/l (p <0.01) four weeks after addition of spironolactone. The reason for this fall is unclear, but might be a result of increased secretion of antidiuretic hormone, redistribution of sodium or undetectable increase in urinary excretion of sodium. Plasma aldosterone level mainly reflected the renin activity and rose considerably when the drugs were given combined.
Acute Encephalitis
Authors: Koskiniemi M. , Manninen V. , Vaheri A. , Sainio K. , Eistola P. , Karli P.
Published: August 2010

ABSTRACT. The 191 adult patients with acute enephalitis who attended the Department of Neurology, University Hospital, Helsinki, during the 12‐year period 1967–78, were analyzed for epidemiological, clinical, and microbiological features. Young healthy adults of either sex under 30 years of age were the most susceptible. The duration of symptoms varied from some hours to more than one month (≤5 days in half of the patients). Prodromal symptoms were observed in 37.7%, meningeal signs or symptoms in 13.2%, features indicating brain involvement in 64.3% and clear effects on consciousness in 27.7% of the patients. Half (50.8%) recovered, while 43 22.5%) were left with at least moderate disability after the acute phase. Twelve patients (6.3 %) died. Lower socioeconomic status and age over 35 years were associated with increased mortality. The 10 patients with proven or presumptive herpes simplex virus (HSV) etiology had a mortality of 40 % and only one recovered satisfactorily. There were 14 further cases suggestive of HSV. Mumps, Coxsackie B, ideno, and measles were the most frequent identifiable causes after HSV. Other etiological factors, including bacteria, appeared occasionally. The etiology remained obscure in 58.6 % of the cases.
Early Exercise Test in the Assessment of Long‐Term Prognosis after Acute Myocardial Infarction
Authors: Saunamäki K. I. , Andersen J. Damgaard
Published: August 2010

ABSTRACT. Subjective maximal exercise test was performed in 317 patients in the third week after an acute myocardial infarction (AMI); 78 % of the total AMI population could be tested. The long‐term survival was assessed on the basis of data from the exercise test. The average follow‐up time was 5.7 years. Mortality increased significantly among patients with major ventricular arrhythmias and among those with a small increase in the pressure rate product (dPRP) from rest to maximal exercise. Patients with arrhythmias and those with a low dPRP constituted a high‐risk group of 165 patients (52%). The probability of 5‐year survival was 0.551 in this group vs. 0.783 in the others (p > 0.001). The death rate was higher in the high‐risk group than in the other patients throughout the whole observation period.
Muscle Involvement in Sarcoidosis
Authors: Stjernberg N. , Cajander S. , Truedsson H. , Uddenfeldt P.
Published: August 2010

ABSTRACT. In 22 patients with sarcoidosis, symptoms and signs of muscle involvement were scanty, but muscle biopsy showed epithelioid cell granulomas consistent with sarcoidosis in 11 patients (50%). Serial sectioning of the muscle biopsies increased the diagnostic yield. The incidence of muscle involvement was highest among patients with both acute sarcoidosis and erythema nodosum. Involvement of other organs was common in patients with muscle sarcoidosis. In two patients with negative scalene node biopsy and negative bronchial and trans‐bronchial biopsies, muscle biopsy showed histological evidence of sarcoidosis. Muscle involvement is common in patients with sarcoidosis, but in many cases there are few or no symptoms. In patients with both acute sarcoidosis and erythema nodosum, muscle biopsy frequently provides histological evidence of the disease. Good cooperation with the pathologist and serial sectioning of the biopsies are necessary if muscle biopsy is to be used as a routine in the diagnosis of sarcoidosis.
Disseminated Intravascular Coagulation, Antithrombin III, and Complement in Meningococcal Infections
Authors: Laursen Benedicte , Faber Viggo , Brock Axel , Gormsen Johannes , Sørensen Henning
Published: August 2010

ABSTRACT. Serial assessments of some blood coagulation factors, antithrombin HI (AT III), and complement were made in 18 patients with meningococcal (mgc) infection. All patients displayed laboratory evidence of activation of the blood clotting system. Two patients showed clinical signs of disseminated intravascular coagulation. Only AT III differed significantly between patients with and without complications. There was no correlation between changes in blood clotting, activation of the complement system and the course or duration of the disease. These results do not enable one to identify patients who need specific prophylactic therapy. Controlled clinical trials, including administration of heparin, dextran, aprotinin, and others, are still required to ensure optimal treatment in fulminant mgc infections.
Captopril, an Orally Active Converting Enzyme Inhibitor, in the Treatment of Primary Hypertension
Authors: Karlberg Bengt E. , Asplund Johan , Nilsson Ove R. , Wettre Staffan , Öhman K. Peter
Published: August 2010

ABSTRACT. Captopril (SQ 14 225), an orally active inhibitor of angiotensin converting enzyme, was evaluated in the treatment of primary (essential) hypertension in a placebo‐controlled long‐term study. In 24 patients allocated to captopril treatment, mean supine BP fell from 174±18/110±7 to 151±22/96±12 mmHg. Ten patients achieved a supine diastolic BP of ≤90 mmHg with a mean BP fall of 28/22 mmHg after 4 weeks' captopril dose titration (75–450 mg daily). In 14 patients, BP fell 19/9 mmHg. When hydrochlorothiazide (50–100 mg daily) was subsequently added, a total supine BP reduction of 51/20 mmHg was noted. In the placebo control group (n=16), BP changed +1/‐2 mmHg from 171/110 mmHg while addition of hydrochlorothiazide caused a mean supine BP fall of 19/10 mmHg. During long‐term follow‐up (mean 11.8 months), no resistance to therapy developed. A weak correlation, (p > 0.05) was seen between pretreatment plasma renin activity and initial captopril‐induced BP reduction. However, in patients with clearly defined low renin hypertension, the hypotensive effect of captopril was much less than in patients with higher renin values. Captopril induced a significant decrease in urinary aldosterone excretion, which was partially reversed by addition of hydrochlorothiazide. Observed side‐effects were proteinuria (1 case), rash (2 cases) and taste disturbances (3 cases). During long‐term follow‐up, seven patients have dropped out, four due to side‐effects and three because of non‐complicance.
Decreased Radioiodine Uptake Values without Increase in Urinary Iodine Excretion
Authors: Ericsson U.‐B. , Thorell Jan I.
Published: August 2010

ABSTRACT. A total of 12847 radioiodine uptake measurements (RIU), performed for diagnostic purposes at Malmö General Hospital 1955–75, have been reviewed. In agreement with the general trend in Europe and the USA, there was a significant decrease in uptake during this period. The 24‐hour RIU (mean ± S.D.) was 51 ±18% in 1955, 41 ±17% in 1965 and 37±18% in 1975. The 3‐ and 48‐hour uptake values, as well as the protein‐bound radioiodine, fell in a parallel fashion. The fall can not be explained by an increased dietary supply of iodine, because the mean urinary excretion did not show any consistent change from 1965 to 1975, apart from a falling trend from 1967 to 1971. The cause of the decrease in thyroid iodine uptake is not elucidated by this study.
Routine Laboratory Tests in Relation to Spleen Size and Tumour Involvement in Untreated Hodgkin's Disease
Authors: Wedelin C. , Björkholm M. , Holm G. , Askergren J. , Johansson B.
Published: August 2010

ABSTRACT.A number of routine laboratory tests were studied in 39 untreated patients with Hodgkin's disease with respect to size and tumour involvement of the spleen. Eighteen patients with tumour‐engaged spleens had lower total lymphocyte counts and IgG and IgM levels than patients with non‐involved spleens. However, no significant differences in these respects were found between patients with tumour‐involved spleens weighing less than 500 g and patients without splenic tumour involvement. Hemoglobin values were inversely and reticulocyte counts positively correlated with the weight of involved spleens. Remaining laboratory variables under study, e.g. total granulocyte counts, platelet counts, ESR and liver enzymes, were not associated with the size or tumour involvement of the spleen. It may be concluded that routine laboratory tests yield no specific information as to splenic tumour involvement or size.
Myoglobin and Creatine Kinase Release in Coronary Care Patients without Acute Myocardial Infarction
Authors: Sylvén J. Christer H.
Published: August 2010

ABSTRACT. Fifty‐nine consecutive coronary care patients, clinically evaluated as not having acute myocardial infarction (AMI) and with a duration of symptoms of less than 6 hours on admission, were studied. Serum myoglobin (MG) and creatine kinase (CK) were determined sequentially during the first 24 hours. Two groups were identified, one with a pattern of a serum MG peak followed by a CK peak and one without. Twenty‐four patients had a serum MG peak of 137±33 μg * 1‐1 followed by a CK peak of 1.6±0.9 μkat * 1‐1. Values above the reference limits were found in 19 patients for MG and in 5 for CK. After the onset of symptoms, the peaks were observed at 5.3±2.8 (MG) and 12.7±5.3 (CK) hours. Compared to the group without MG and CK peaks, ECG alterations were more frequent in the group with peaks, 20/24 (84%) versus 15/35 (43 %), The entire patient group had the same 2‐year incidence of major coronary events as patients with AMI, but it tended to be higher in patients with MG/CK release.
Oesophageal Ulcers
Authors: Bjarnason Ingvar , Bjornsson Sigurdur
Published: August 2010

ABSTRACT. We report a patient who developed oesophageal ulcerations that were associated with ingestion of co‐trimoxazole. Oesophageal ulcerations due to co‐trimoxazole have not been described before.
Bartter's Syndrome: an Autosomal Recessive Disorder?
Authors: Hogewind Barend L. , van Brummelen Peter , Veltkamp Jan J.
Published: August 2010

ABSTRACT. The diagnosis of Bartter's syndrome was established in four patients of one generation of the same pedigree. The proband affected with Bartter's syndrome appeared to have a brother and two first cousins, who are siblings, with the same condition. All four patients had hypokalemia, hyper‐reninemia, normal blood pressure and a diminished pressor sensitivity to angiotensin II. In contrast to most cases of Bartter's syndrome, the urinary excretion of prostaglandin (PG) E2 was not elevated. The parents and the siblings of the patients were studied in order to detect asymptomatic carriers of the disorder. Abnormal serum potassium levels, plasma renin activities, urinary PG excretions and pressor responses to angiotensin infusion were not found in these relatives. Although consanguinity could not be established between the parents of any of the couples, the distribution of the disorder in the two related families confirms the hypothesis that genetic factors play an important role in Bartter's syndrome and that it is inherited as an autosomal recessive trait.
Studies on Kidney Function in Subjects Exposed to Organic Solvents
Authors: Askergren Alf , Allgén Lars‐Göran , Bergström Jonas
Published: August 2010

ABSTRACT. The renal concentrating ability was studied in 11 subjects by means of 14–16 hours of fluid deprivation, alone and in combination with the vasopressin analogue desmopressin. The effect of desmopressin without fluid deprivation on urinary osmolality was also studied. The combination of desmopressin and fluid deprivation was not superior to fluid deprivation alone for the production of concentrated urine. Desmopressin alone was inferior to the other two methods. No difference in renal concentrating ability could be demonstrated after 14 hours of fluid deprivation, when comparing 118 subjects exposed to various organic solvents with 48 controls.
Evaluation of the Sulphadimidine Acetylator Phenotyping Test in Patients with Reduced Renal Function
Authors: Hall Sten
Published: August 2010

ABSTRACT. The acetylator phenotype of 53 hypertensive patients and 5 patients with ulcerative colitis was assessed by determination of the percentage acetylated sulphadimidine in serum and urine related to creatinine clearance. Of the 58 patients, 30 were slow and 27 rapid acetylators, one patient was indiscriminate. The fraction acetylated sulphadimidine excreted in urine tended to decrease with decreasing creatinine clearance in both slow and rapid acetylators. In a 6‐hour serum sample, on the other hand, the fraction of acetylated sulphadimidine appeared to be independent of the glomerular filtration rate in rapid acetylators. In slow acetylators, however, the acetylated fraction increased with decreasing creatinine clearance. The sulphadimidine acetylation test can be a good discriminator between rapid and slow acetylators even in cases with severe renal insufficiency. Analyses of 6‐hour serum samples are to be preferred but urine samples can also be used if corrected according to creatinine clearance.
Prevalence of Raised Yersinia Enterocolitica Antibody Titre in Unselected, Adult Populations in Denmark during 12 Years
Authors: Agner E. , Eriksen M. , Hollnagel H. , Larsen J. Hannover , Mørck H. I. , Schroll M.
Published: August 2010

ABSTRACT. Yersinia enterocolitica biotype 4, serotype O: 3 is by far the most common human pathogenic Yersinia enterocolitica subtype in Scandinavia. It is extraordinarily immunologically specific, and an elevated antibody titre ≥ 80–160 is known to indicate acute infection. This titre was measured in five population surveys conducted in 1967–78, including 3278 examined adult men and women. The prevalence of titre elevation ≥ 80 was 1.0% in 1967. In 1978 it was significantly higher, 7.7 %, and also the individual course of the titre in a ten‐year longitudinal survey showed a significant increase in this prevalence, indicating an increasing incidence of infection. Significant sex and age differences were seen, women and younger subjects being more frequently affected than men and older subjects. The prevalence of elevated titre showed a seasonal variation with a maximum in the spring and autumn.
Sleep Disorders in Relation to Coronary Heart Disease
Authors: Partinen M. , Putkonen P. T. S. , Kaprio J. , Koskenvuo M. , Hilakivi I.
Published: August 2010

ABSTRACT. In a cross–sectional study of 5419 Finnish adult men, a higher prevalence of diagnosed myocardial infarction was found among those who slept more than 9 hours, whilst those sleeping less than 6 hours per night had more symptomatic coronary heart disease (CHD). This relationship held after controlling hy multivariate analysis for age, sleep quality, use of sleeping pills and tranquillizers, smoking, alcohol use, Type A score, neuroticism, use of cardiovascular drugs and history of hypertension. The cardiovascular physiology and pathophysiology of sleep is reviewed and the relationship of some specific sleep disorders to CHD is discussed.
The Value of Anti–Anxiety Drugs in the Management of Cardiac Disease
Authors: Wheatley David
Published: August 2010

ABSTRACT. In 3 double–blind randomized trials, clorazepate was compared to placebo in post–infarction and pre–infarction patients, and diazepam was compared to placebo added to verapamil. There was a significant reduction in trinitrate requirement in the first clorazepate study but not in the second nor in the third, although this has not yet been completed. Taking all 3 trials together, there were 5 cases of myocardial infarction in 63 patients treated with placebo but not no cases in 64 patients treated with the anti–anxiety drugs (p < 0.05).

Relief of anxiety was accompanied by reduction in the anginal attack rate with both active and placebo medications. In further similar studies in hypertension, relief of anxiety was also accompanied by reduction in blood pressure. However, in a 4–way comparison between lorezepam, bendrofluazide, lorazepam plus bendrofluazide and placebo, mean normotensive levels were only achieved in patients treated with the combination of anti–anxiety and antihypertensive medication.
The Relaxation Response: History, Physiological Basis and Clinical Usefulness
Authors: Benson Herbert
Published: August 2010

ABSTRACT. Considerable emphasis has been placed upon the relation of behavioural factors to the development of coronary artery disease. There is, however, the opposite potential: behavioural processes may lead to the alleviation and reversal of some of the predisposing features of this illness. This paper presents evidence that specific behaviours and thought patterns are associated with the elicitation of an innate physiological capacity termed the relaxation response. It will discuss the history of this response, its physiological basis, clinical usefulness (particularly in prevention) and some recent findings concerning the underlying mechanism of its actions.
Haemodynamic effects of α–receptor blockade during acute administration and chronic treatment
Authors: Rasmussen Knud
Published: August 2010

ABSTRACT.Acute administration of relatively large doses of the postsynaptic α–adrenoceptor blocking agent prazosin results in a marked vasodilatation and blood–pressure reduction, often combined with tachycardia.

Chronic administration results in a decrease in total peripheral resistance and blood pressure at rest and during exercise. Cardiac output is unchanged at rest but shows a slight increase during exercise. Peripheral blood flow is increased during chronic treatment.

It is concluded that α–receptor antagonists may be able to normalize – completely or partly – the pathological haemodynamics of the hypertensive patient.
Rationale for combined α–β–adrenoceptor blockade: haemodynamic considerations
Authors: Koch Günter
Published: August 2010

ABSTRACT.Increased peripheral vascular resistance is the cause of elevated blood pressure in most forms of systemic hypertension. Both structural changes in response to increased wall stress and functional alterations in vascular smooth muscle itself appear to contribute to the elevated resistance. As mediators of the vasoconstrictor responses, α–adrenoceptors apparently play an important if not predominant role in the initiation and/or maintenance of high resistance and pressure.

In contrast to β–receptor blockade alone, combined α–β–receptor blockade lowers blood pressure predominantly by α–receptor–mediated reduction of the systemic vascular resistance, both when induced acutely and, in particular, during long–term administration. Cardiac output is maintained at pretreatment level, as is left ventricular filling pressure.

Since a well–balanced blockade of both α– and β–receptors counteracts the pathophysiological changes causing and/or maintaining hypertension and tends to restore cardiovascular dynamics towards normal, combined α–β–receptor blockade appears at present to be one of the most logical and rational therapeutic approaches to hypertension.
Pharmacodynamic effects of prenalterol in healthy subjects
Authors: Johnsson G.
Published: August 2010

1. Prenalterol induces a dose–dependent effect on different variables reflecting myocardial contractility and heart rate. A clear cut effect can be demonstrated after an oral dose of 2.5 mg. The duration of the effect increases considerably when prenalterol Is administered as a controlled release preparation partly due to an increased bioavailability.

2. Prenalterol induces a lipolytic effect manifested as a rise in free fatty acids and glycerol. Also a slight increase of plasma insulin is recorded while plasma potassium decreases somewhat.

3. When prenalterol is administered together with therapeutic doses of a selective or non–selective β–adrenoceptor blocker it induces the same haemodynamic effects as before the β–blocker but the dose has to be increased ten–fold. These results suggest that prenalterol might be a useful drug to counteract unwanted haemodynamic effects of a β–blocker.

4. In animal studies It has been shown that prenalterol has affinity for both β1 – and β2–adrenoceptors. However, it has a stimulating effect mainly on β1–adrenoceptors. Therefore, theoretically it might act as a β2–adrenoceptor antagonist. Preliminary results from studies in patients with chronic asthma indicate that prenalterol only has an insignificant β2–blocking effect when the drug is administered In doses which induce a significant β1–adrenoceptor stimulating effect.
Metabolic effects of prenalterol in diabetic patients
Authors: Oltmanns D.
Published: August 2010

In 16 non–diabetic and 16 diabetic patients prenalterol, dobutamine and dopamine infusions (5 μg/kg/min for 30 min) were given.

The haemodynamic and metabolic changes were similar in diabetics and non–diabetics. Prenalterol has the most pronounced haemodynamic effect on heart rate (increase 25–47%) and the heart rate–blood pressure–product (increase 54–81%). The metabolic effects were moderate. The slight lipolytic effect of prenalterol documented its functional selectivity for β1–adrenoceptors.
Effects of prenalterol administered orally in patients with congestive heart failure
Authors: Hjalmarson A. , Abelardo N. , Caidahl K. , Reyes C. , Waagstein F. , Wallentin I. , Wikstrand J. , Estrada–Yamamoto M.
Published: August 2010

A single–blind study of prenalterol 20–200 mg daily in a slow–release tablet preparation and a placebo was performed in 15 patients with moderate to severe congestive heart failure (NYHA II–IV) to evaluate the haemodynamlc and clinical effects of oral prenalterol. Non–invasive parameters in the measurement of cardiac output, stroke volume, pre–ejection period index (PEPI), PEP/LVET ratio, ejection fraction and mean Vcf were significantly improved, indicating beneficial effects of prenalterol on cardiac contractility. Systolic blood pressure, heart rate and rate–pressure product were slightly increased at rest but were considerably lower during exercise. Arrhythmogenecity was not seen in the patients studied. Subjective improvement was noted in the majority of patients as evidenced by a decreased frequency of dyspnoea, fatigue and angina. Unwanted effects, such as palpitations and transmitted arm pulsations, were transient and disappeared with dose adjustment, while the inotropic effect of the medication was maintained. The clinical response appeared to be sustained for up to 2 weeks of treatment, indicating non–development of tachyphylaxis.
Effect of intravenous prenalterol on haemodynamics and myocardial lactate extraction in patients with left ventricular failure
Authors: Kupper W. , Schütt M. , Bleifeld W.
Published: August 2010

To assess the immediate haemodynamlc and myocardial metabolic effects of the β1–agonist prenalterol, we studied by cardiac catheterisation the response to 50 and 100 μg/kg given intravenously in 16 patients with congestive heart failure secondary to coronary artery disease or non–ischaemic cardiomyopathy.

At peak effect, cardiac index increased from 2.6–0.5 to 3.210.8 1/min/m2 (mean ± 8D) p < 0.001); peak rate of left ventricular pressure development rose from 963 ± 242 to 1355 ± 4ll mm Hg per second (p < 0.001); left ventricular end–diastolic pressure fell from 27 ± 6 to 13 ± 7 mm Hg (p < 0.001); coronary sinus blood flow increased from 120 ± 39 to 147 ± 55 ml/min (p < 0.01); myocardial oxygen consumption was augmented from 12.9 ± 3.9 to 15.7 ± 5.8 ml/min (p < 0.001); and heart rate increased slightly (76 ± 12 to 86 ± 14 beats per minute, p < 0.05). No significant changes occurred in left ventricular systolic pressure, stroke volume index, myocardial lactate extraction rate, myocardial arteriovenous oxygen difference and no patient developed angina, ECG–changes or ventricular arrhythmias.

Infusion of prenalterol effectively improved the haemodynamlc function and cardiac metabolism in congestive cardiomyopathy.
Fatty Acid Composition of Serum and Adipose Tissue Lipids in Males with Chronic Renal Failure
Authors: Norbeck H. E. , Walldius G.
Published: August 2010

ABSTRACT. We have analysed the fatty acid composition of serum cholesterol esters (CE), phospholipids (PL) and triglycerides (TG) and of adipose tissue (AT) lipids in 72 males with chronic renal failure (CRF). Sixteen patients were treated with protein‐poor diet, 16 with hemodialysis. The results have been related to clinical aspects of the disease and to abnormalities in serum lipid and lipoprotein concentrations. The major findings were a high relative content of oleic acid and a low relative content of linoleic acid in all lipids in the diet‐treated group compared to both controls and to the untreated and dialysed patients. Tendencies in the same directions were seen also in the untreated subjects, significant for oleic and linoleic acid in CE and for oleic acid in PL. These changes did not correlate to serum or lipoprotein lipids or to serum creatinine concentrations in patients not on diet or dialysis, indicating that other factors are more important in modifying the fatty acid metabolism in CRF. The composition of the protein‐poor diet, which was rich in fat but low in linoleic acid in relation to oleic acid, is probably a major factor explaining our findings in the diet‐treated group. Since low levels of linoleic acid in plasma and AT lipids have been suggested to be a risk factor for atherosclerosis, more attention should be paid to the content and composition of dietary fat in order to prevent the occurrence of such low levels.
High Density Lipoprotein Composition versus Heredity for Acute Myocardial Infarction in Middle‐Aged Males
Authors: Franzén Johan , Fex Göran
Published: August 2010

ABSTRACT. The levels of high density lipoprotein (HDL) cholesterol and apolipoprotein AI (Apo AI) were determined in 299 men, 48 years of age. We found a significant negative correlation between HDL cholesterol and serum triglyceride concentrations and a significant correlation between serum triglyceride concentration and the Apo AI/HDL cholesterol ratio. A history of acute myocardial infarction (AMI) was significantly more common than expected among the fathers of men with a low HDL cholesterol level. We also found a relationship between AMI among fathers and high Apo AI level in sons, although this relationship was not as strong as that between AMI among fathers and low HDL cholesterol in sons. No significant relationship was found between AMI among mothers and HDL cholesterol or Apo AI in sons.
Autoantibodies and the C3F‐Gene in Aortic Coarctation
Authors: Sehested Jens , Andersen Poul L. , Bruun‐Petersen Gert
Published: August 2010

ABSTRACT. Fifty‐two patients with aortic coarctation (22 before and 30 after corrective surgery) were compared with 34 age‐matched normal controls with regard to the frequencies of autoantibodies and the C3F‐gene. Contrary to reports on essential hypertension, the study did not show any differences between patients and controls.
Comparison of Left Ventricular Ejection Fraction Assessed by Radionuclide Angiocardiography, Echocardiography and Contrast Angiocardiography
Authors: Albrechtsson Ulf , Eskilsson Jan , Lomsky Milan , Stubbe Ingo , Svensson Sven‐Erik , Tylén Ulf
Published: August 2010

ABSTRACT. The left ventricular ejection fraction (EF) obtained by first pass radionuclide angiocardiography was compared with that determined by contrast angiocardiography in 49 patients. In 35 of the patients a comparison with the EF obtained by M‐mode echocardiography was also made. The EF echo was determined in two ways, from the standard cube formula and the regression equation suggested by Teichholz for left ventricular volume calculations. The latter formula gave an average EF closer to the average EF obtained by isotope technique and cineangiography and was therefore used in the comparison study. Measurements of EF by isotope technique and echocardiography correlated well (r = 0.78). The correlation between these two noninvasive methods for EF determination and their cineangiographic counterpart was almost identical (r = 0.72‐0.74).
Energy‐Rich Phosphagens, Electrolytes and Free Amino Acids in Leg Skeletal Muscle of Patients with Chronic Obstructive Lung Disease
Authors: Möller Peter , Bergström Jonas , Fürst Peter , Hellström Kjell , Uggla Elisabet
Published: August 2010

ABSTRACT. Intramuscular (m. quadriceps) contents of electrolytes, free amino acids and energy‐rich phosphagens were determined in 12 patients (51–81 years of age) with moderate chronic obstructive lung disease. At the time of the study the patients were in their habitual condition. After an overnight rest, 8 patients showed hypoxia and five of these also hypercapnia. Compared to apparently healthy controls of similar age and studied under identical conditions, the patients had increased intramuscular concentrations of sodium, chloride and extracellular water, whereas magnesium was slightly reduced. ATP and phosphocreatine, as well as the ATP/ADP and phos‐phocreatine/total creatine ratios, were reduced. The ATP/ADP ratio correlated significantly to intracellular magnesium. Plasma amino acids were essentially similar in controls and patients but the intramuscular contents of essential amino acids and of the three branched‐chain amino acids were slightly enhanced in the patients.
Bone Marrow Megakaryocytes and Platelet Kinetics in Systemic Lupus Erythematosus
Authors: Kutti Jack , Bergström Anna‐Lisa , Ridell Börje
Published: August 2010

ABSTRACT. The megakaryocyte number and mean megakaryocyte area were determined in histological sections of sternal bone marrow from 26 patients with systemic lupus erythematosus (SLE). Also 20 platelet survival studies were carried out in these patients. The results were analyzed with respect to corticosteroid (CS) and CS+azathioprine (AT) therapy. The mean bone marrow megakaryocyte number was highest in untreated SLE patients, slightly lower in patients receiving CSs and lowest in those receiving CSs + AT. The difference was, however, not significant. The mean megakaryocyte areas were smallest in untreated SLE patients, slightly larger in those treated with CSs and significantly (p<0.05) larger in patients who received CSs + AT than in untreated patients. Platelet production rate was normal in all 3 groups of SLE patients. The results suggest that CS and AT therapy in SLE intervenes with the bone marrow megakaryopoiesis without affecting the production rate of platelets.
Clinical and Diagnostic Considerations in Fabry's Disease
Authors: Ahlmén J. , Hultberg B. , Brynger H. , Sjöblad S. , Svalander C.
Published: August 2010

ABSTRACT. Three patients with Fabry's disease with a similar clinical picture, including recurrent burning sensations in the extremities, hypohidrosis and slowly progressive renal insufficiency, have been investigated metabolically at different stages of renal impairment. One patient died after three unsuccessful renal transplantations in a 4‐year period of intermittent haemodialysis with disabling pains. One successfully transplanted patient is still alive and well, 12 years after the start of therapy. Thermolabile α‐galactosidase has been demonstrated in his urine. The third patient has slowly progressive renal impairment. No therapeutic enzyme replacement available today is ideal. Early diagnosis is therefore necessary to increase the possibilities of prenatal diagnosis and genetic counselling.
Deep Breathing, Valsalva, and Tilt Table Tests in Diabetics with and without Symptoms of Autonomic Neuropathy
Authors: Sundkvist Göran , Lilja Bo , Almér Lars‐Olof
Published: August 2010

ABSTRACT. Autonomic neuropathy (AN) test results (Valsalva manoeuvre, deep breathing, and tilting) are frequently impaired in diabetics without symptoms of AN, particularly in those with peripheral neuropathy (PN). We have investigated 24 asymptomatic diabetics with PN, 17 diabetics with symptoms of AN and 24 healthy controls. The heart rate reactions to the three tests were impaired in both patient groups. The Valsalva manoeuvre could not distinguish between the patient groups. The heart rate reaction to deep breathing, estimated as the expiration/inspiration (E/I) ratio, was slightly more disturbed in patients with AN than in those with PN (1.04 vs. 1.09, p<0.05) but the frequency of abnormally low E/I ratios was high in both groups (76.5 vs. 54.2%, NS). The immediate heart rate reaction to tilting, estimated as the brake index, clearly separated the patient groups. An abnormally low brake index was shown in 82.3% of AN patients and in 33.3% of PN patients (p<0.01). The study shows that the deep breathing test is sensitive for AN but an impaired immediate heart rate reaction to tilting is more specific for symptomatic AN.
Utilization of Analgesics from 1970 to 1978
Authors: Gustafsson Lars L. , Boëthius Göran
Published: August 2010

ABSTRACT. A comparative analysis of the usage of analgesics in the county of Jämtland and in Sweden 1970–78 has been carried out. An attempt was also made to map out the indications for prescribing such drugs. Both in Jämtland and in Sweden as a whole, analgesics sold over the counter accounted for more than half of the total usage. The same was true for fixed drug combinations. Analgesics were prescribed each year to 17% of the population of Jämtland. Fixed drug combinations containing sedatives maintained a large fraction of the amount of analgesics prescribed—31% of defined daily doses (DDDs) in 1978. Arylalkanoic acids (ibuprofen and naproxen), introduced in 1975, soon took a substantial part of the market—13% of DDDs in 1978. Though arylalkanoic acids were registered for treatment of degenerative joint diseases, four of five patients in Jämtland received them only once or twice during a two‐year period. In the national study, every third prescription of these drugs was for degenerative joint diseases. The pattern of usage revealed in this study calls for improved pharmacotherapeutic training of physicians to make drug treatment more rational.
A Hemodynamic Study of Arteriolar Changes in Patients with Previous Malignant Hypertension
Authors: Gudbrandsson T. , Hansson L. , Herlitz H. , Sivertsson R.
Published: August 2010

ABSTRACT. Blood flow resistance was studied in two peripheral vascular beds in 15 patients with previous malignant hypertension and in matched groups of patients with “benign” hypertension and control subjects. Both hypertensive groups had significantly higher resistance in the hands (skin vessel bed) at maximal dilatation (2.5 and 2.5 U, respectively) than the normotensive group (1.9 U) (p<0.01). This increase indicates structural changes in the arteriolar wall in both hypertensive groups. It indicates a similar degree of adaptation of the vascular changes to the present blood pressure level in both hypertensive groups, although the initial blood pressure had been much higher in the group with previous malignant hypertension than in the group with “benign” hypertension. Different findings were made in the calves (muscle vessel bed), and the most severe changes were found in patients with previous malignant hypertension. Resistance at maximal dilatation was 2.4 U compared to 1.9 U in the group with “benign” hypertension (p<0.05) and 1.6 U in the control group (p<0.001 and p<0.05, respectively).
A Hypokalemic Index ECG as a Predictor of Hypokalemia
Authors: Johansson Bengt W. , Larsson Christer
Published: August 2010

ABSTRACT. ECGs of 36 hypokalemic patients (K/s 1.0–3.5 mM/l) were analysed. The sum of the S‐T depression and the U wave amplitude in leads II and V3 was used and constituted the uncorrected hypokalemic index. To correct the hypokalemic index, the figure obtained during normokalemia is subtracted from that obtained during hypokalemia. The corrected hypokalemic index gives an approximation of the K/s irrespective of other factors permanently influencing the ECG, such as treatment with antiarrhythmic drugs, coronary insufficiency, and ventricular hypertrophy. The corrected index was ≥4.0 at a K/s of ≤2.0 mM/l. Eight out of nine patients with a K/s 2.1–2.6 had an index of 1.5–3.5. All patients with a K/s >2.6 mM/l had an index <1.5.