bluuebunny/crossref_metadata_2025 huggingface dataset:
Pulmonary Function in Familial Amyloidosis with Polyneuropathy
Authors: Olofsson B. O.
Published: August 2010

ABSTRACT. Pulmonary function tests were performed in 14 patients with familial amyloidosis with polyneuropathy. Low maximum expiratory and inspiratory pressures were found in all patients with advanced polyneuropathy, indicating that the neuropathy in this disease involves not only the extremities but also the respiratory muscles. The spirometric findings were consistent with a slight restrictive pattern in several patients, but in two of them the expiratory and inspiratory flows were also low. The intrapulmonary gas distribution was uniform in all. The diffusing capacity was reduced in patients who had had the disease for a long time, which suggests alveolo‐capillary block caused by amyloid deposits. The arterial oxygen tension at rest was essentially normal in these patients.
Estrogen Treatment of Hereditary Hemorrhagic Telangiectasia
Authors: Vase Poul
Published: August 2010

ABSTRACT. The effect of estrogen treatment in 31 patients with hereditary hemorrhagic telangiectasia (HHT) or Rendu‐Osler‐Weber disease was evaluated in a randomized double‐blind trial. After a 3‐month control period there was a 3‐month treatment period during which 17 patients were treated with peroral estrogen (estradiol valerate), 4 mg daily, and 14 with placebo. The results showed no significant reduction in the frequency of bleeding or its intensity. The hemoglobin values remained unchanged in the estrogen group compared with the previous control period as well as with the placebo group. The only demonstrable effect of estrogen treatment was a significant fall in transferrin.
Prolactin Secretion in the Empty Sella Syndrome, in Prolactinomas and in Acromegaly
Authors: Brismar K.
Published: August 2010

ABSTRACT. Prolactin (PRL) secretion was studied in 47 patients with empty sella syndrome. Hyperprolactinemia (39–123 μg/l) was found in six of them. Intermittent increases in PRL were noted in another seven patients. In most subjects with empty sella syndrome and hyperprolactinemia, diurnal PRL variation was altered or impaired whereas the PRL response to TRH and L‐dopa was normal. Low doses of bromocriptine (3.75–5 mg/day) normalized PRL. In patients with prolactinoma and acromegaly who had prolactin levels of 30–165 μg/l the diurnal PRL variation and PRL response to TRH were impaired. Patients with prolactinoma failed to suppress PRL during L‐dopa test. The dose of bromocriptine required to normalize PRL ranged between 7.5 and 15 mg/day. It is concluded that in subjects with sellar changes and intrasellar cisternal herniation (“empty sella”), and with moderate increases in PRL, the responses to TRH and L‐dopa and to bromocriptine may help to differentiate between the empty sella syndrome and a coexisting pituitary tumour.
Told by Her Doctor to Drink Large Amounts of Water—Suffered Lead Poisoning
Authors: Mindus Per , Kolmodin‐Hedman Birgitta
Published: August 2010

ABSTRACT. A case of chronic alimentary lead poisoning with abdominal pain, paresis, and mental disturbances is presented. Differential diagnosis, lead burden and results of a long‐term follow‐up are discussed.
The Prevalence of Secondary and Curable Hypertension
Authors: Danielson Mats , Dammström Bo‐Göran
Published: August 2010

ABSTRACT. The prevalence of secondary and curable hypertension was studied retrospectively in 1000 patients. The concept of “secondary hypertension” was used when hypertension was combined with a disease which may have affected the individual's blood pressure. When this definition was applied, 47 of the patients displayed some form of secondary hypertension: stenosis of the renal artery in 10, renoparenchymal disease in 21, hydronephrosis in 3, and endocrine hypertension in 13 (8 of the latter were using oral contraceptives). The blood pressure normalized in 11 and improved in 7 of these patients after operative treatment of the underlying disease or, when appropriate, discontinuance of intake of contraceptive pills. The incidence of secondary hypertension in this and other series is low, and the number of patients with curable hypertension is even lower. In the majority of cases, secondary hypertension can be diagnosed by anamnesis, physical examination and simple tests of blood and urine. If this basic investigation can be extended, the incidence of stenosis of the renal artery should be examined in the first place. Hypertension in young patients and in patients who are difficult to treat often justifies a more extensive investigation.
Myocardial Catecholamines and Their Biosynthetic Enzymes in Various Human Heart Diseases
Authors: Siltanen P. , Penttilä O. , Merikallio E. , Kyösola K. , Klinge E. , Pispa J.
Published: August 2010

ABSTRACT.Myocardial noradrenaline (NA) content, together with the activities of the enzymes tyrosine hydroxylase (TH) and dopamine beta–hydroxylase (DBH) was measured in biopsy specimens taken during cardiac surgery from patients with various heart diseases. Fluorescence histochemical studies were also performed on comparable specimens.

The mean NA content in patients with symptomatic ischaemic heart disease (IHD) was significantly higher than that in patients with valvular heart disease (VHD), atrial septal defect (ASD) or congestive heart failure (CHF). The lowest mean NA content was found in patients with CHF. The activities of TH and DBH were highest in the IHD group, although the differences between IHD and VHD groups were not significant. Histochemical investigations of adrenergic structures showed less fluorescence intensity in the CHF than in the other 3 groups. On the other hand, the density of the adrenergic nerve net and the size and number of varicosities were greatest in patients suffering from IHD.

The significance of these results is discussed in relation to the pathophysiological mechanisms underlying these various disease conditions. In IHD the high myocardial NA content creates local conditions for excessive NA release into the myocardial interstitium at the onset of ischaemia, which is known to result in several adverse local consequences.
Psychological Risk Factors Related to Coronary Heart Disease. Prospective Studies Among Policemen in Helsinki
Authors: Nirkko O. , Lauroma M. , Siltanen P. , Tuominen H. , Vanhala K.
Published: August 2010

ABSTRACT. Psychological investigations carried out on 1326 Helsinki policemen showed that individuals with electrocardiogram (ECG) signs of coronary heart disease (CHD), and those showing symptoms, were more anxious, aggressive, defensive and inhibited than those free from signs or symptoms. It is suggested that the poor prognosis associated with angina pectoris may be related to the psychological characteristics of the patients who suffer from it.

Studies of 5– and 10–year prospective data showed that subjects dying from myocardial infarction differed from survivors on six significant psychological characteristics, including optimism, inhibition and superego strength. Multiple logistic analysis showed an association of lowered self–esteem and high somatization with myocardial infarction.

A particular statistical analysis (»ridit analysis«) revealed the existence of 4 variables (inhibition, neuroticism, differentiaton and certainty) which distinguished to some degree with different manifestations of CHD. The nature of these variables and the correlations involved are discussed. It is concluded that psychological variables have some predictive power not only for the risk of CHD, but also for the risk of clinically different CHD events.
The Recurrent Coronary Prevention Project. Some Preliminary Findings
Authors: Thoresen Carl E. , Friedman Meyer , Gill James K. , Ulmer Diane K.
Published: August 2010

ABSTRACT. The Recurrent Coronary Prevention Project (RCPP) was established as a 5–year clinical trial to examine two basic questions: –

Can the recurrence rate of post–coronary subjects be substantially reduced over a 5–year period by means of a programme of behavioural change, in comparison with treatment by cardiologists focussing on medication, diet, exercise and cardiovascular issues, and with subjects who only receive regular care from their own physician?

Can the Type A behaviour pattern (TABP) be changed and do such changes correspond to reduced recurrences of coronary heart disease (CHD) over a 5 year period?

To answer these questions, four major treatment groups are currently being compared: –

A small group treatment programme (Section I) led by cardiologists emphasizing adherence to medication, diet and exercise, and giving cardiovascular and cardiological information.

A behavioural change treatment programme (Section II) based primarily on a cognitive social learning model and attempting to alter TABP.

A control group of subjects assessed annually and receiving private medical care from their own physicians.

A dropout comparison group composed of subjects voluntarily discontinuing participation in groups led by cardiologists or in behavioural change groups.

Results to date show a significantly reduced rate of recurrence for subjects in the behavioural change group, compared to those in the groups led by cardiologists as well as control and dropout groups. These significantly lower recurrence rates are accompanied by data suggesting that subjects in the behavioural change programme are also altering their TABP as measured by both behavioural questionnaires and videotaped Type A structured interviews. Clinical impressions suggest that treatment programmes to alter TABP should consider the primary importance of the personal meaning of the TABP and other behaviours to the individual concerned, particularly how basic underlying beliefs set the stage for the TABP. The central role of hostility as a pervasive orientation towards self and others is emphasized, as are issues of excessive controllability related to extreme competitiveness and hyper–arousal. The multiple roles of group leaders, especially as social models for coping, and the impact of the small groups settings, is also discussed.

The data generally demonstrate the emerging advantage of a behavioural change treatment programme with respect to the observed reduction in recurrence rates and provide preliminary evidence of reduced levels of the TABP in subjects receiving such treatment. Whether these findings will be substantiated and maintained over the full 5–year period and thereafter remains to be established.
Mode of action of β–adrenoceptor blocking agents in hypertension. A comparison between metoprolol and pindolol with special reference to peripheral vascular effects
Authors: Svensson Anders , Gudbrandsson Thorkell , Sivertsson Ramon , Hansson Lennart
Published: August 2010

ABSTRACT. β–adrenoceptor blocking drugs are generally recognized as being effective in the treatment of hypertension. The mechanisms whereby these drugs reduce blood pressure are, however, not fully understood. In a double–blind, randomized study either metoprolol, 100–300 mg/day, or pindolol, 5–15 mg/day, was given for 6 months and the effects on blood pressure, heart rate and vascular resistance in the calf and forearm were investigated. Measurements were made at rest, during and after physical exercise, and during postischaemic hyperaemia. Both drugs reduced blood pressure to the same extent both at rest and during and after exercise. Metoprolol reduced heart rate to a greater extent than pindolol at rest and after exercise, whereas no difference was seen during physical exercise. Pindolol reduced the vascular resistance in the calf at rest by 14% (p < 0.05), whereas metoprolol tended to increase vascular resistance, the difference in effect being highly significant (p < 0.005). During and after leg exercise, there was no difference in forearm vascular resistance between the two drugs. It may be concluded that pindolol reduced resting blood pressure partly through peripheral vasodilatation. This was probably an effect of β2–adrenoceptor stimulation linked to the pronounced intrinsic sympathomimetic activity (ISA) of pindolol. Metoprolol on the other hand, acted mainly through cardiac mechanisms, as suggested by its pronounced reduction of heart rate.
Metabolic effects of β–adrenoceptor blockade on skeletal muscle at rest and during exercise
Authors: Juhlin–Dannfelt Anders
Published: August 2010

ABSTRACT. β–adrenoceptor antagonists influence the metabolic responses in man at rest and during exercise. Impaired working capacity and muscular fatigue have been reported in patients on β–blockers and this could be due to an altered substrate supply to the muscles.

The results from several studies show that the main effect of β–blockade on metabolism is decreased lipolysis, with less fat available to the muscles. This results in an increased carbohydrate demand to maintain an unchanged aerobic metabolism, and liver and muscle glycogen stores are more rapidly depleted, β–blockade also results in decreased lactate release from the muscles, probably due to a membrane effect and/or changed perfusion.

It is concluded that β–blockade a) decreases fat metabolism in the muscle, which secondarily increases the use of carbohydrates during exercise, resulting in earlier hypoglycaemia and/or depletion of muscle glycogen with reduction of the working capacity, b) impairs lactate transport from the muscle but does not cause lactate accumulation within the muscle which could be responsible for muscular fatigue.
Labetalol in the treatment of hypertension in patients with normal and impaired renal function
Authors: Walstad Rolf A. , Berg Knut J. , Wessel–Aas Terje , Nilsen Odd G.
Published: August 2010

ABSTRACT. Labetalol (Trandate) is a new antihypertensive agent with both α– and β–adrenoceptor blocking properties. In a dobule–blind cross–over study the antihypertensive action and side–effects of labetalol and propranolol were compared in 18 previously untreated outpatients with hypertension, WHO stage I–III. Mean daily dose of labetalol was 667 mg and of propranolol 129 mg. Labetalol reduced systolic and diastolic blood pressure in the seated and upright position significantly more than propranolol. The pulse rate reduction was greater with propranolol. Side–effects were more pronounced with propranolol.

The antihypertensive effect, effect on pulse rate and pharmacokinetics of a single oral dose of 400 mg labetalol were studied in 6 patients with normal and 6 patients with impaired renal function (creatinine clearance < 20 ml/min), all belonging to WHO stage I–II. A significant fall in pulse rate and systolic and diastolic blood pressure was observed in both groups, the duration being more than 25 h. No difference was found between the two groups. From the serum concentration–time curves the elimination rate constant, elimination half–life and area under the curve were calculated. The mean values of the two groups did not differ significantly. A pronounced interindividual variation was found in both groups.
The haemodynamic effects of intravenous prenalterol and ouabain in conscious dogs
Authors: Ek L. , BJörkman J.–A. , Carlsson E. , Johansson B.
Published: August 2010

Experiments were performedon5 resting conscious dogs supplied with an electromagnetic flow probe on the ascending aorta and a chronic aortic catheter for pressure recording. The animals were used repeatedly in four different types of experiment involving i. v. administration of1.saline (controls),2.prenalterol 45 nmol/kg (∞ 10 μg/kg) followed by an additional dose of 135 nmol/kg 20 min later,3.ouabain 50 nmol/kg (∞30 μg/kg) and4.a combination of protocols2.and3.Ouabain and the low dose of prenalterol exerted clear–cut positive inotropic effects as reflected in increased stroke volume and max dF/dt without significant changes in heart rate or arterial pressure. The PQ interval increased with ouabain but decreased with prenalterol. The higher dose of prenalterol caused a further rise in max dF/dt, a further shortening of the PQ time, increased heart rate and reduction in systemic vascular resistance. Higher doses of ouabain could not be given due to side–effects (vomiting). The combined treatment with ouabain and prenalterol showed their inotropic responses to be additive. Arrhythmias did not occur in any of the animals at the applied dose levels of the drugs. The experiments show that prenalterol through its β1–adrenoceptor stimulating action exerts a positive inotropic effect which surpasses that of emetic doses of ouabain. The inotropic response at moderate doses occurs without a change in heart rate. This fact and the apparent lack of influence of prenalterol on vascular α– and β2–adrenoceptors make the substance potentially useful clinically as an inotropic agent in cardiac failure, particularly in view of its relatively long duration of action.
Prenalterol as an antidote to massive doses of meto–prolol – a cardiovascular study in the dog
Authors: Andersson T. , Heath A. , Mattsson H.
Published: August 2010

Fourteen beagle dogs were treated with increasing doses of metoprolol. The first group (n=7) formed part of a preliminary study to establish a suitable dosage regimen. Two of these dogs recovered from plasma concentrations of about 50 000 nmol/1 metoprolol, when metoprolol infusion was stopped. Pour dogs died with plasma concentrations of about 80 000 nmol/1 metoprolol and one dog, in which AV block II developed, recovered from a CO of 300 ml/min after 10 mg/kg prenalterol.

The second group consisted of a control group of three dogs and a prenalterol treated group of four dogs. Both groups were treated with increasing doses of metoprolol for 1.5 hours followed by a continuous infusion of metoprolol throughout the rest of the experiment, reaching plasma concentrations of 50 000 nmol/1 of metoprolol. In the prenalterol group, prenalterol was given i.v. in a dose of 0.5 mg/kg every 10 minutes starting 3 hours after the first dose of metoprolol up to a total dose of 5 mg/kg.

Metoprolol caused an initial decrease in heart rate (HR) which remained stable at 115 beats/min despite increasing plasma concentrations. Blood pressure (BP) and cardiac output (CO) fell, the decrease being directly proportional to plasma concentrations of metoprolol. The central venous pressure (CVP) and pulmonary capillary wedge pressure (PCWP) increased indicating reduced inotropic function of the heart. An initial increase in total peripheral resistance (TPR) was seen followed by a return to almost baseline levels with increasing metoprolol concentrations. The three control dogs died after 4–5 hours. Death was caused by low CO failure, preceded by nodal bradycardia followed by asystole. No characteristic ECG changes were seen until cardiac failure developed. Prenalterol reversed the effect of metoprolol on CO, stroke volume (SV), CVP and PCWP. BP and HR remained below the basal values. These basal values of BP and HR were, however, high because of increased sympathetic activity caused by the chloralose anaesthesia. The return of TPR to basal values was more pronounced in the prenalterol group than in the control group.

The results suggest that neither HR nor ECG can be used to assess the severity of metoprolol poisoning. BP and CVP or PCWP and when possible CO are probably the best clinical aids in assessment.

The present study shows that prenalterol by exerting a pronounced inotropic effect can completely reverse the low CO failure caused by massive doses of metoprolol. However, doses of prenalterol much higher than those normally used are necessary.
The hemodynamic actions of prenalterol in left ventricular failure
Authors: Awan N. A. , Evenson M. K. , Needham K. E. , Mason D. T.
Published: August 2010

The hemodynamic effects of prenalterol, a parenteral cardioselective β1–receptor agonist, were evaluated by cardiac catheterization in patients with refractory severe congestive heart failure (CHP). Prenalterol (PN) (4 mg i.v.) did not alter (p > 0.05) heart rate (HR), mean blood pressure (MBP) or left ventricular filling pressure (LVPP). Concomitantly PN markedly augmented cardiac index (CI) from 1.9 to 2.6 1/min/m2 (p < 0.01) and substantially elevated stroke index (SI) from 24 to 30 ml/beat/m2 p < 0.001). In addition PN raised stroke work index (SWI) from 21 to 26 g.m/m (p < 0.005) and decreased total systemic vascular resistance (TSVR) from 1702 to 1260 dyn.s.cm−5 (p < 0.001). An important finding was that the heart rate × systolic blood pressure product was unchanged (p > 0.05) and precipitation of cardiac dysrhythmias or myocardial ischemia were not observed.

Further PN 1 mg, 4 mg and 8 mg i.v. was sequentially injected and peak hemodynamic effects were determined 10 min after drug administration. PN 1 mg raised CI from 2.1 to 2.5 1/min/m2 (p < 0.01), elevated SI from 24 to 29 ml/beat/m2 (p < 0.01), and augmented SWI from 21 to 25 g.m/m2 (p < 0.01), however, TSVR declined from 1702 to 1392 dyn.s.cm−5. Subsequent incremental PN doses of 4 and 8 mg did not provide (p > 0.05) additional enhancement of cardiac function.

Thus, prenalterol produced markedly beneficial enhancement of cardiocirculatory function without untoward effects and may be useful in the management of patients with severe congestive heart failure. Moreover, dose–response analysis indicates these salutary improvements can be maximally produced by the small dose of 1 mg obviating the need for larger doses.
Intravenous prenalterol in acute and chronic heart failure
Authors: Kirlin P. C. , Pitt B. , Lucchesi B. R.
Published: August 2010

The new inotropic agent prenalterol was administered intravenously in a canine model of acute ischemic heart failure and in patients with severe chronic heart failure. Experimental heart failure in anesthetized dogs was induced by two vessel coronary artery constriction and intravenous prenalterol (0.005–15 μg/kg/min) was compared to dobutamine (0.001–30 μg/kg/min) and saline. Significant dose–dependent increases in left ventricular dP/dtmax′ cardiac output and non–ischemic zone contractile force and significant reductions in systemic vascular resistance were present during infusions of both inotropic agents. High dose dobutamlne caused greater increases in mean arterial pressure and pressure rate product with a trend toward greater increases in heart rate. However, neither inotropic agent significantly improved ischemic zone contractile force. Prenalterol possessed a markedly longer hemodynamic half–life than dobutamlne (3.0 hours compared to 1.7 minutes).

Nine patients with severe chronic heart failure (left ventricular ejection fraction mean ± SD 17 ± 5%, cardiac index 1.7±0.4 1/min/m2) responded to intravenous prenalterol (1, 4, and 8 mg) with significant increases in cardiac index, left ventricular ejection fraction and left ventricular stroke work index. Left ventricular filling pressure, mean right atrial pressure and pulmonary arteriolar resistance were significantly reduced. No significant differences were present among peak responses to the three doses employed. An inverse correlation between basal heart rate and increase in left ventricular ejection fraction following prenalterol was noted.

The mechanisms by which prenalterol causes hemodynamic improvement appear to include a direct inotropic effect, a reduction in left ventricular outflow resistance and a reduction in left and right ventricular filling pressure (venodilating effect). The net result is an upward and leftward shift of the depressed ventricular function curve.

Both prenalterol and dobutamine were associated with sustained ventricular tachyarrhythmias in the experimental acute low output state and two digitalized patients with ischemic cardiomyopathy developed transient ventricular tachycardia after prenalterol administration. These findings indicated that adrenergic stimulants should be administered in severe ischemic states with careful monitoring.
Influence of Beta‐Blocking Drugs on Glucose Metabolism in Patients with Non‐Insulin Dependent Diabetes Mellitus
Authors: Groop L. , Tötterman K.‐J. , Harno K. , Gordin A.
Published: August 2010

ABSTRACT.Two β‐blocking agents, non‐selective propranolol and β1‐selective metoprolol, were investigated with respect to their effects on glucose metabolism in 10 hypertensive patients with non‐insulin dependent diabetes mellitus (NIDDM). The patients were treated randomly for two weeks in a double‐blind cross‐over manner with (a) propranolol, (b) metoprolol, and (c) placebo. Propranolol impaired glucose tolerance when compared to placebo. The increase in blood glucose was associated neither with changes in concentrations of serum insulin, plasma glucagon of free fatty acid nor with alterations in peripheral insulin sensitivity as measured by125I‐insulin binding to mononuclear leukocytes. Although metoprolol had no effect on blood glucose, it increased125I‐insulin binding to mononuclear leukocytes. The increase in insulin binding could contribute to blood glucose control during metoprolol treatment. In search for reasons for poor metabolic control in NIDDM, treatment with non‐selective β‐blockers should be kept in mind.
Glibenclamide and Gliquidone in the Treatment of Non‐Insulin‐Dependent Diabetes Mellitus
Authors: Nikkilä Katriina , Groop Leif
Published: August 2010

ABSTRACT. The effect of glibenclamide and gliquidone on fasting blood glucose, 24‐hour urinary glucose excretion, HbA1 concentrations and on the blood glucose and plasma insulin responses to an oral glucose load were investigated in 11 patients with non‐insulin‐dependent diabetes mellitus. The study was carried out as an open, ambulatory, cross‐over trial during 24 weeks. After a 4‐week diet period the patients were randomly allocated to treatment with either glibenclamide or gliquidone. After a 8‐week period on a constant drug dose, they switched over to the corresponding dose of the other drug, each patient thus being his own control. Glibenclamide and gliquidone reduced fasting blood glucose values (p<0.001), diurnal urine glucose concentrations (p<0.001, resp. p<0.01) and HbA1 concentrations (p<0.02 resp. p<0.05) compared to the values in the diet period. Glibenclamide proved more effective than gliquidone in lowering fasting blood glucose concentrations (p<0.01), but no difference in 24‐hour urine glucose and HbA1 concentrations was seen between the two drugs. Glibenclamide and gliquidone improved the glucose tolerance after an oral glucose load (p<0.01 resp. p<0.05) compared to diet values. The improved glucose tolerance during sulfonylurea treatment was, however, not associated with significant changes in insulin levels.
Injection Sclerotherapy of Bleeding Oesophageal and Gastric Varices Using a Flexible Endoscope
Authors: Stray Njaal , Jacobsen Carl Ditlef , Rosseland Arne
Published: August 2010

ABSTRACT. Thirteen patiens with acute or recent bleeding from gastro‐oesophageal varices were treated by sclerotherapy using flexible fiberoptic endoscope. Primary haemostasis was obtained in 10 of 11 admissions with active bleeding. Three patients have been treated for gastric varices with the same method. Such treatment has not been reported before. During the follow‐up period, three patients died, two of variceal haemorrhage and one of pneumonia. Ten patients are still alive 2–53 months after the first admission. A total of 117 treatment courses were given, on an average 9 per patient. Complications included superficial mucosal necrosis without clinical consequences in several cases, 3 patients developed oesophageal and gastric ulcers and one moderate oesophageal stenosis. Rebleeding occurred in 4 patients, in 2 of them because of ulcers at the sites of injections.
Factors of Importance for QRS Complex Recovery after Acute Myocardial Infarction
Authors: Yusuf Salim , Estrada‐Yamamoto Milagros , Reyes Carlito P. , Herlitz Johan , Hjalmarson Åke
Published: August 2010

ABSTRACT. The regression of the ECG signs of myocardial infarction has been studied in 101 patients. A significant increase in R wave amplitude and decrease in Q wave depth on the standard ECG was observed over three months. In 21% of the patients, Q waves disappeared completely. In inferior infarction, these changes were more apparent in the lateral V leads than in the inferior limb leads. Patients with intraventricular conduction defects were excluded. Two factors associated with the Q and R wave changes have been identified. Lower heart rates appeared to facilitate the recovery of R waves, and smaller infarcts, as assessed by peak LDH, showed greater ECG recovery. This study raises the interesting possibility that modification of the heart rate may affect favourably the healing process after an acute myocardial infarction.
Vectorcardiography in the Diagnosis of Postoperative Myocardial Infarction
Authors: Midtbö Kjell , Andersen Ragnar , Krohg Knut
Published: August 2010

ABSTRACT. Fifty‐three consecutive patients, mean age 63 years, undergoing either peripheral vascular reconstructive surgery (n=40) or lobectomy for bronchial carcinoma (n=13) were examined pre‐ and postoperatively with conventional electrocardiogram (ECG), vectorcardiogram (VCG) and estimation of serum levels of aspartate aminotransferase, alanine aminotransferase, total lactic dehydrogenase and the heat‐stable fraction of lactic dehydrogenase for the diagnosis of per/postoperative myocardial infarction (MI). Six patients (11%) developed signs of acute MI. In 2 patients whose ECG showed only unspecific changes, the VCG was decisive for the diagnosis. The serum enzyme values alone were of limited value in the diagnosis of per/postoperative MI.
Single Versus Multiple Daily Administration of Hydralazine in the Maintenance Treatment of Hypertension
Authors: Henningsen Nels C. , Hanson Arne , Wernersson Börje
Published: August 2010

ABSTRACT.Based on the recent pharmacokinetic and clinical studies on hydralazine, this long‐term study has been performed to compare multiple and single daily administration of hydralazine (Slow Apresoline), with special emphasis on the blood pressure (BP) response and simultaneous steady‐state concentration of hydralazine in plasma. Patients treated with conventional Apresoline, combined with β‐blockers with or without diuretics, were selected for inclusion into the study. Eighteen males with persisting hypertension were studied for approximately two years on once‐daily Slow Apresoline medication, preceded by a two‐month period of twice‐daily administration. The results show that the BP control previously achieved with multiple daily doses of conventional Apresoline is maintained with Slow Apresoline, with no discrepancy between once‐ and twice‐daily administration. The BP control during once‐daily treatment tended to improve with time despite a marginal reduction in the daily dose of Slow Apresoline, suggesting secondary adaptation to maintained BP control. No correlation was found between the BP response and stimultaneous plasma concentration of free and “apparent” hydralazine, either in fast or in slow acetylators. The results from this clinical‐pharmacological study support that the elimination of hydralazine from the smooth muscles of the arterioles is considerably slower than from plasma. Furthermore, and in accordance with studies with β‐blockers, the results indicate that the duration of the BP response is considerably longer than the plasma half‐lives of these antihypertensive substances, indicating that plasma half‐life is of little value for determination of the dosage interval in the treatment of hypertension. The good tolerability to once‐daily administration of Slow Apresoline shows that it can be given in larger single doses than are normally given during treatment with conventional Apresoline without any increased risk of short‐term side‐effects.
Adult Respiratory Distress Syndrome and Diabetes
Authors: Hillerdal Gunnar , Wibell Lars
Published: August 2010

ABSTRACT. Non‐cardiac pulmonary edema in a woman with long‐lasting diabetes resulted in a distressing pulmonary fibrosis. It is suggested that pulmonary edema of non‐cardiac origin might be more common in diabetics because of increased capillary permeability in this disease. Early recognition is important, and steroid treatment should be instituted to prevent development of pulmonary fibrosis.
Myocarditis and Methyldopa
Authors: Seeverens H. , de Bruin C. D. , Jordans J. G. M.
Published: August 2010

ABSTRACT. Six patients with myocarditis and hepatitis, attributed to an allergic reaction to methyldopa, are described. Granulomatous pneumonitis was also found in four of them.
Malignant Evolution of Asymptomatic Monoclonal IgM after Seven and Fifteen Years in Two Siblings of a Patient with Waldenström's Macroglobulinemia
Authors: Fine J. M. , Lambin P. , Massari M. , Leroux Ph.
Published: August 2010

ABSTRACT. This paper reports a rare familial occurrence of Waldenström's macroglobulinemia (WM) in siblings (two brothers and one sister). Examination of the siblings of a patient suffering from WM in 1965 showed that a brother and a sister had an “asymptomatic” monoclonal IgM in their sera without clinical or hematological features. Follow‐up demonstrated a malignant transformation into WM after 7 years in the brother and after 15 years in the sister. This unusual incidence makes the true existence of asymptomatic gammopathies of IgM class questionable.
Systolic Time Intervals in the Evaluation of Thyroid Dysfunction
Authors: Lien Ernst , Aanderud Sylvi
Published: August 2010

ABSTRACT. Systolic time intervals, the pre‐ejection period (PEP), left ventricular ejection time (LVET) and PEP/LVET ratio were studied in ten thyrotoxic and ten hypothyroid patients. LVET and PEP intervals were corrected for heart rate (LVETc and PEPc). The measurements were repeated after 1–28 months when the patients were euthyroid following appropriate therapy. Compared with the euthyroid values, the PEPc intervals and PEP/LVET ratios were significantly decreased (p<0.01) in the thyrotoxic and increased (p<0.001) in the hypothyroid patients. In both groups the LVETc intervals were significantly prolonged (p<0.001). In four of the hypothyroid patients the PEP/LVET ratios were markedly increased (above 0.60, mean 0.66), and above 0.41 in the euthyroid state (reference value 0.35±0.05). In the other hypothyroid patients and in thyrotoxic patients the euthyroid PEP/LVET ratios were within the reference values. The systolic time intervals were not influenced by propranolol therapy in the thyrotoxic patients. Our results suggest increased myocardial contractility unaffected by adrenergic blockade in thyrotoxicosis, and reduced contractility in hypothyroidism.
Release of Hypoxanthine and Phosphate from Exercising Human Legs with and without Arterial Insufficiency
Authors: Sørlie Dag , Myhre Kjell , Saugstad Ola D. , Giercksky Karl‐Erik
Published: August 2010

ABSTRACT. Release of hypoxanthine and phosphate from exercising legs was studied in eight subjects without known obstructive arterial disease and in 20 claudicants. Lower leg blood flow was measured with a thermodilution catheter in the popliteal/distal femoral vein. The catheter allowed blood sampling from the calf before, during and after exhaustive exercise on a bicycle ergometer at a stepwise increasing load. Resting plasma hypoxanthine levels were higher in claudicants than in normal subjects (p<0.05). Hypoxanthine concentrations increased 2–4‐fold during exercise, amounting to values ten times higher than the resting levels 5 and 10 min post exercise, in the venous effluent of the normal legs. A similar rise was found in the claudicants despite half the exercise intensity at exhaustion. Popliteal venous concentrations of phosphate increased by approximately 25% during exercise without significant differences between the two groups. During exercise the release of hypoxanthine increased 38‐fold and of phosphate 21‐fold in the normal lower legs, while a ten‐fold increase in both metabolites was recorded in the claudicating legs. The study demonstrated a high release of hypoxanthine and phosphate from the human lower leg during rhythmic, exhaustive exercise (with maximal vasodilation). The result is compatible with the assumption that metabolites from the catabolism of adenine nucleotides (adenosine) play a role in the autoregulation of blood flow in human skeletal muscle. Increased plasma hypoxanthine concentrations at rest may indicate peripheral arterial insufficiency.
The Effect of Long‐Term Cimetidine Treatment on PRL and TSH Response Capacity to TRH in Male Patients with Duodenal Ulcer
Authors: Knigge Ulrich , Dejgaard Anders , Wollesen Flemming , Christiansen Poul M.
Published: August 2010

ABSTRACT. The effect of long‐term cimetidine treatment for 6 months on basal and thyrotropin‐releasing hormone (TRH)‐stimulated prolactin (PRL) and thyroid‐stimulating hormone (TSH) secretion was studied in eight male patients with duodenal ulcer. They received 1000 mg cimetidine orally per day until ulcer healing and thereafter 400 mg daily for the remaining period. TRH perturbation tests were performed before and after the 6 months of treatment. A significant reduction in the pituitary TSH response capacity was found. No significant changes in basal and TRH‐stimulated PRL, basal TSH, thyroxine and triiodothyronine were found. It is uncertain if the reduction in pituitary TSH response capacity has any clinical implications in euthyroid patients.
Creatine Kinase and Recurrent Myocardial Infarction
Authors: Löfmark Rurik
Published: August 2010

ABSTRACT. Daily measurements of serum creatine kinase (CK) activity have been performed in 31 patients during hospitalization for acute myocardial infarction (MI). If CK was raised, isoenzyme B was analysed as well. In this way one probable silent MI and another two overt MIs were diagnosed. MI recurred within three months after discharge in another five patients. None of these eight patients showed even small increases in the daily CK activity when in hospital. This study does not support the concept that reinfarction is a stepwise damage of the myocardium.
Blood Pressure in Relation to the Renin—Angiotensin—Aldosterone System
Authors: Ljungman Susanne , Aurell Mattias , Hartford Marianne , Wikstrand John , Berglund Göran
Published: August 2010

ABSTRACT. The relationship between blood pressure (BP) and the renin—angiotensin—aldosterone system was studied in a stratified random sample (n = 120) of 49‐year‐old men selected from a BP screening and covering a wide range of BPs. Only subjects not on antihypertensive treatment were included. None had malignant or secondary hypertension. Plasma renin activity, plasma concentrations of angiotensin II, aldosterone, sodium, potassium and noradrenaline and the 24‐hour urinary excretions of sodium, cortisol and noradrenaline were determined. Of these variables, only p‐aldosterone was significantly correlated with BP, both in the whole study group (R=0.22, p<0.02, n = 119) and in the subjects with the highest BP range (R =0.36, p<0.02, n=30). Of the clinical groups compared, the hypertensive subjects had significantly higher mean p‐aldosterone than the borderline and normo‐tensive subjects. Multiple regression analysis showed that the 24‐hour urinary excretion of noradrenaline was the factor most strongly correlated to p‐aldosterone, suggesting that the sympathetic nervous system might stimulate aldosterone secretion. Our findings indicate that aldosterone may be of importance for the development and maintenance of essential hypertension.
Diagnosis of Deep Vein Thrombosis with 99Tcm‐Plasmin
Authors: Adolfsson L. , Nordenfelt I. , Olsson H. , Torstensson I.
Published: August 2010

ABSTRACT. The diagnostic efficiency of 99Tcm‐plasmin test was evaluated by X‐ray contrast phlebography in 110 consecutive patients with suspected deep vein thrombosis (DVT). The test was positive in 50 of 55 patients with DVT (sensitivity 91%) and negative in 18 of 55 without DVT (specificity 33%). The positive plasmin test in patients without DVT was in most cases due to another inflammatory process or a post‐thrombotic state. The 99Tcm‐plasmin test is a rapid and sensitive screening method for the diagnosis of DVT, but as it is based on comparison between the legs, it may be unreliable in cases of bilateral thrombosis. The low specificity makes it less valuable in patients with concomitant inflammatory disease or previous thrombosis in either leg. When the plasmin test is positive, the diagnosis of DVT should in most cases be confirmed by X‐ray contrast phlebography.
Digoxin‐Hydroxychloroquine Interaction?
Authors: Leden Ido
Published: August 2010

ABSTRACT. Interaction between digoxin and the natural cinchona alkaloid quinidine is well documented. A possible interaction between digoxin and the semisynthetic cinchona derivative hydroxychloroquine is reported in this communication.
Risk Factors for Death for Males and Females
Authors: Böttiger L. E. , Carlson L. A.
Published: August 2010

ABSTRACT. In the Stockholm Prospective Study, 531 male and 163 female deaths had occurred during 14.5 years of observation. Deaths were divided into three categories: “ischemic”, “neoplastic” and “other” and their relations to entry characteristics were analyzed. For ischemic vascular deaths age, smoking, systolic blood pressure and triglycerides were independent risk factors for both sexes, while cholesterol and weight/height index were not. For neoplastic deaths age, smoking, systolic blood pressure and ESR were positively and cholesterol and weight/height index negatively associated. This negative association was found especially for colon carcinoma and not for, e.g., prostatic and bronchial carcinoma in men. For other deaths age, blood pressure and ESR were independent risk factors for men, and age, smoking and ESR for women.
The Oral TRH Stimulation Test
Authors: Kirkegaard C. , Jørgense P. Holme , Friis Th. , Siersbæk‐Nielsen K.
Published: August 2010

ABSTRACT. We have developed a 28‐hour TRH stimulation test based on the FT3I response to repeated oral TRH stimulation. The normal FT3I response in 15 controls was ±40 arb.U. Twenty‐five euthyroid patients with multinodular goitre were studied. Fourteen had normal FT3I responses and normal basal levels of serum T4, FT4I, serum T3 and FT3I. Eleven patients had FT3I responses below 20 arb. U. Although the patients' individual basal values of serum T4, FT4I, serum T3 and FT3I were within the normal range, the median values of FT4I, serum T3 and FT3I were significantly elevated compared to the controls, suggesting that these patients were in a “pretoxic” condition. This assumption seems to be supported by the fact that 3 of these patients subsequently became frankly hyperthyroid, whereas all patients with normal FT3I response remained euthyroid. A comparison between the TSH response to i.v. TRH and the FT3I response to oral TRH showed concordance in 21 of the 25 patients studied.
Relapses after Thionamide Therapy for Graves' Disease
Authors: Holm Lars‐Erik , Ålinder Inger
Published: August 2010

ABSTRACT. Between 1969 and 1979 a course of either propylthiouracil or carbimazole was given to 102 patients with Graves' disease. Ten of the patients discontinued the therapy because of adverse reactions or persisting symptoms, and 40 relapsed at some time after cessation of the therapy, giving a proportion of total failures of 49%. The proportion of such failures increased from 45% in 1969‐72 to 57% in 1973‐79. The probability of relapse was significantly higher in 1973‐79 than in the earlier period of study (p<0.01). Patients aged 30–39 years had the highest proportion of failures (55%), but the mean time until relapse (6 months) was shortest in patients older than that. Adverse reactions—agranulocytosis, leukopenia, urticaria and elevated serum levels of liver enzymes—were seen in 12 patients. Six patients developed hypothyroidism after a mean time of 3.5 years after termination of thionamide therapy.
Anion and Osmolal Gaps in the Diagnosis of Methanol and Ethylene Glycol Poisoning
Authors: Jacobsen Dag , Bredesen Jan Erik , Eide Ivar , Østborg Jens
Published: August 2010

ABSTRACT. The diagnostic value of determination of the anion and osmolal gaps was studied in 6 patients poisoned with methanol and in 5 poisoned with ethylene glycol. Increased osmolal gap was present on admission in ail patients, whereas increased anion gap was present in all except one. In the methanol‐poisoned patients the mean blood values were: pH 7.27, anion gap 24 mmol/l, osmolal gap 81 mosmol/ kg H2O, methanol 67 mmol/l, ehtanol 11 mmol/l and in the ethylene glycol‐poisoned patients: pH 6.93, anion gap 38 mmol/l, osmolal gap 35 mosmol/kg H2O and ethylene glycol 24 mmol/l. In the absence of alcoholic acidosis or diabetic coma the finding of a simultaneous increase in both the anion and osmolal gaps indicates methanol or ethylene glycol poisoning. Thus determinations of the anion and osmolal gaps are mandatory whenever facing metabolic acidosis of unknown etiology.
Effect of Somatostatin on Insulin‐Induced hypoglycemia in Man
Authors: Adamson U. , Efendic S. , Lins P. E. , Wajngot A.
Published: August 2010

ABSTRACT. In order to study the interaction of insulin and somatostatin on glucose regulation in the posthypoglycemic phase of a somatostatin infusion we have applied a bolus of i.v. insulin to healthy subjects receiving a continuous infusion of somatostatin. Glucose, insulin and counter regulatory hormones were determined. Somatostatin suppressed the growth hormone and glucagon responses to hypoglycemia but did not augment the hypoglycemic action of insulin. In contrast, the K‐value for the decrease in blood glucose was significantly lower in the presence of somatostatin. Thus, the interaction of insulin and somatostatin on glucose metabolism is complex and time‐dependent. While the peptide potentiates the action of insulin during the first hour of a somatostatin infusion, it counteracts if after two hours. As somatostatin has currently been introduced in the therapy of upper gastrointestinal bleedings, these effects of the peptide must be taken into consideration.
The Effect of Ibuprofen Therapy on Water and Electrolyte Balance
Authors: Agnholt Jergen , Andreasen Frederik
Published: August 2010

ABSTRACT. To elucidate the possibility of fluid retention during the early phase of antirheumatic therapy, 7 women (aged 37–59 years, mean 48) and 5 men (aged 41–74 years, mean 56) were studied during 2 weeks of therapy with ibuprofen, 400 mg t.i.d. They had no symptoms or signs of cardiac or renal failure and were not on diuretics or digoxin. There was a weak but significant correlation (r2 ‐0.50, p<0.01) between duration of therapy and changes in body weight indicating an average increase in body weight of 0.5% after 2 weeks' therapy. The averages of all percentual weight changes measured daily were +0.3% for the women (p<0.01) and .0.15% (NS) for the men. An initial fall in hemoglobin of 4.4% (p<0.01) during the first week was followed by an increase of 4.1% (p<0.05) during the second week. A fall in the erythrocyte volume fraction of 4% (p<0.05) occurred during the first week and was followed by an increase of 2.7% (NS) during the second week. A decreased concentration of albumin in serum was found after the first week (3.9% (p<0.05) for the women and 0.16% (NS) for the men). During the second week an average increase of 4% was seen (4.6% for the women and 3.5% for the men) (p<0.02). The average concentration of potassium in serum fell by 0.6% during the first week (NS), but during the second week an increase of 4% (p<0.02) was seen. In three women the severity of the symptoms allowed the parameters to be determined before, during and after ibuprofen therapy. The results confirmed that ibuprofen induces a moderate fluid retention in subjects with normal kidney function and without symptoms or signs of heart disease.
Pancreatic Affection after Acute Hypotonic Hemodialysis
Authors: Paus Povel N. , Larsen Else Wiik , Sødal Gunnar , Erichsen Aage
Published: August 2010

ABSTRACT. Four male outpatients, all on stable long‐term hemodialysis, were by accident simultaneously exposed to hypotonic dialysate. Three of them developed increased serum amylase values and one died from the consequences of a fulminant pancreatitis, which had been verified by laparotomy.
False Tendons in the Left Ventricle: 2‐Dimensional and M‐Mode Echocardiography Findings
Authors: Lindvall K. , Olsson G. , Sjögren A.
Published: August 2010

ABSTRACT. The M‐mode and 2‐dimensional echocardiography findings in an 18‐year‐old man are described. The findings are compatible with the diagnosis of false tendons in the left ventricle.