bluuebunny/crossref_metadata_2025 huggingface dataset:
Thiazide Prophylaxis of Urolithiasis
Authors: LÆRUM EVEN , LARSEN STIG
Published: August 2010

ABSTRACT Fifty recurrent stone formers were included in a double‐blind randomized study (median 3 years) performed in a Norwegian general practice to compare twice daily administration of 25 mg hydrochlorothiazide versus placebo. The number of patients with new stones was significantly higher in the placebo group than in the thiazide group (p=0.05, one‐tailed test). If a new stone was formed, thiazide, but not placebo, had the effect of prolonging the stone‐free interval (p≤0.01). The probability of not forming a new stone during the treatment period was 45% for the placebo group and 75% for the thiazide group. The thiazide effect seemed to be independent of urinary calcium, but was less beneficial in patients with hyperuricosuria. The placebo group also showed a substantial decrease in the expected number of new stones (p≤0.01), emphasizing the importance of an adequate control group.
Benign Monoclonal Gammapathy
Authors: WALDENSTRÖM JAN G.
Published: August 2010

ABSTRACT The natural history of benign monoclonal gammapathy (BMG) has been followed by repeated studies of patients with M components through periods up to two decades. The disappearance of an M component is quite exceptional—in this material only once. Populations with increase in IgG, IgA and IgM have been studied separately. Slow, but steady, increase through many years may be found without development of myeloma (MM). Rapid transition from a steady state of the M component to progression is rare and usually, but not always, indicates the development of clearcut myeloma. Intermediate patterns are not uncommon and make it very difficult in rare individual cases to draw a sharp line between myeloma that should be treated and the benign state that should only be observed. The cause of pain may be difficult to judge. Osteolytic foci in the skull are usually diagnostic for MM, but vertebral fracture may also occur in osteopenia. It is evident that a period of at least three years of close observation without treatment should be the routine. “Prophylactic” treatment of BMG with cytostatic drugs should never be attempted.
Plasmapheresis and Cold Sensitivity of Immunoglobulin Molecules
Authors: WALDENSTRÖM JAN G.
Published: August 2010

ABSTRACTThe indications for plasmapheresis in the different hyperviscosity syndromes are discussed on the basis of data on relative serum viscosity at 13 and 37°C. Beside monoclonal macroglobulinemia there are conditions with a high content of polyclonal IgM and also of IgG and IgA where hyperviscosity is a dominant symptom. The importance of what may be called macroglobulinemia polyclonalis spuria is stated and a number of patients belonging to this type are discussed. Polyclonal increase in IgG, even at high levels, usually does not cause severe hyperviscosity. Case histories of patients with rheumatoid disease and marked hyperviscosity constitute one group. Another is formed by diseases leading to the development of immune complexes. Such complexes are usually caused by binding of polyclonal IgG to monoclonal IgM, but other combinations are also known. A number of clinical examples of these different disease conditions, some probably indicating intense plasmapheresis, are analyzed. The limited value of plasmapheresis alone without cytostatic treatment is stressed as regards hyperviscosity. Another indication is removal of noxious protein components.
The Kockum Study: Twenty‐two‐year Follow‐up
Authors: PERSSON BERTIL , JOHANSSON BENGT W.
Published: August 2010

ABSTRACT The Kockum study of risk factors for coronary heart disease (CHD) consists of 464 individuals, one third white collar workers, one third heavy workers and one third well trained firemen, all of whom have now been followed for 22 years. Important risk factors for CHD seem to be heredity, smoking, stress, lack of physical activity, diabetes mellitus, hypertension, high body weight, ECG abnormalities, hypercholesterolemia, hypertriglyceridemia and baldness. In addition to the common risk factors, baldness seems to be of importance. A high cholesterol value predisposes for an increased death rate not only due to CHD but also to malignant disease. A Cox analysis shows a markedly decreased life expectancy in multirisk factor patients caused not only by CHD but also by cancer.
Serum Lipid Changes after Gastroplasty for Morbid Obesity
Authors: RANLØV POUL JØRGEN
Published: August 2010

ABSTRACT Forty‐six patients with obesity exceeding 75% (according to Natvig's tables) were subjected to gastroplasty which after 12 months had resulted in an average weight loss of 32 kg. Preoperatively, serum levels of triglycerides, total cholesterol, and LDL cholesterol were significantly raised, while HDL cholesterol was significantly lower than in non‐obese controls. One year after surgery, mean serum triglyceride levels had normalized while mean HDL cholesterol had increased steadily to levels not different from those in the non‐obese controls. Regarding total cholesterol and estimated LDL cholesterol, no significant changes were recorded. It is concluded that gastroplasty affects serum lipid patterns in obese patients in a fashion quite different from that caused by jejunoileal bypass operations. As the incidence of coronary heart disease is known to be inversely related to serum HDL cholesterol, gastroplasty may offer an additional advantage over jejunoileal shunt operations in improving the long‐term prognosis in morbid obesity.
GENERATION AND ELIMINATION OF ANGIOTENSINS I AND II IN THE KIDNEY, LIVER AND LUNG.
Authors: Hesse Birger , Rasmussen Sten , Høilund‐Carlsen Poul Flemming , Nielsen Meta Damkjær , Hartling Ole J. , Marving Jens , Giese Jørn
Published: August 2010

ABSTRACT. Inflow and outflow concentrations of angiotensins I (AI) and II (All) from both kidneys, the liver and the lung were measured in 3o hypertensive patients, the majority having lateralization of the renin secretion. In the renin secreting kidney the data indicated a high generation rate of AI. In the contralateral kidney and splanchnic region both AI and All were eliminated1, and in the lungs the results confirmed previous evidence of converting enzyme activity.
Effect of Verapamil on Serum Lipoproteins in Patients with Angina Pectoris
Authors: Walldius Göran
Published: August 2010

Since several β‐blocking agents increase the atherogenic VLDL‐triglycerides and decrease the atheroprotective HDL‐cholesterol we studied if verapamil also affects these lipoproteins or the most atherogenic LDL‐cholesterol. Twelve patients (three females), mean age 56 years, with angina pectoris or hypertension/tachyarrhythmias were treated with verapamil 240–320 mg/day. Serum lipoproteins were measured before and after 6 and 24 weeks of therapy. Initial total serum cholesterol averaged 7.27 mmol/1. After 6 weeks of treatment it decreased by 9%, p<0.02. These results remained significant, p<0.01 after 24 weeks. The decrease was due to a fall in LDL‐cholesterol by 12%, p < 0.01. The reduction in LDL‐cholesterol was correlated to initial LDL‐cholesterol concentration, r=‐ 0.73, p < 0.01. Within LDL there was a parallel decrease in phospholipids, p < 0.05. There were no changes in total or VLDL‐triglycerides or total HDL‐cholesterol. In the HDL fraction HDL2 decreased insignificantly but HDL3 cholesterol increased by 12%, p<0.05.

We conclude that verapamil has a beneficial effect on serum lipoproteins in that it lowers the atherogenic LDL‐cholesterol and does not affect the other lipoproteins in an undesirable way.
Serum lipoproteins after treatment with verapamil for 6 months
Authors: Færgeman Ole , Meinertz Hans , Fischer Hansen Jørgen
Published: August 2010

Fasting levels of serum lipids and lipoproteins were measured in survivors of acute myocardial infarction after 6 months of treatment with placebo (n = 19) or verapamil 360 mg daily (n = 13). There were no significant differences between the groups and values had not changed in the verapamil group 2 weeks after cessation of treatment.
Effects of Verapamil in Hypertensive Patients
Authors: de Leeuw P.W. , Birkenhäger W.H.
Published: August 2010

In fifteen patients with uncomplicated essential hypertension verapamil reduced systolic as well as diastolic blood pressure by virtue of a decrease in total peripheral vascular resistance. Renal vascular resistance also fell, but renal perfusion was well maintained. Although levels of renin and angiotensin II remained unchanged, aldosterone levels fell significantly. Noradrenaline levels rose slightly, but changes were not significant. On the other hand adrenaline was significantly reduced. Renal sodium excretion was markedly enhanced, perhaps secondary to aldosterone suppression. Despite sodium loss, plasma volume increased suggesting that verapamil not only lowers arterial but also venous resistance.
Antihypertensive Effect of Verapamil in Patients with Newly Discovered Mild to Moderate Essential Hypertension
Authors: Hedbäck B. , Hermann L. S.
Published: August 2010

The antihypertensive effect of verapamil (Isoptin®) 120 mg × 3 for four weeks was compared with that of placebo in a randomized, double‐blind, cross‐over investigation. Twenty patients with newly discovered, not previously treated, mild to moderate essential hypertension were included in the study. Verapamil significantly reduced the diastolic and systolic blood pressure in the supine and standing positions, as well as the heart rate. One patient discontinued the treatment because of rash. Otherwise, only constipation was registered as a side effect of Isoptin. No orthostatic reactions were observed and the PQ‐interval was unchanged. Compliance was excellent.
Patterns in Drug Utilization–National and International Aspects: Antidiabetic Drugs
Authors: Štika Ludvik
Published: August 2010

ABSTRACT. Data on the prevalence of diabetes in the Czech socialist republic and on the age and sex structure of the diabetic population are presented in this paper as well as the distribution of patients according to type of therapy. The time period studied was 1972 through 1980. The following factors were supposed to affect the level of antidiabetic drug consumption in Czechoslovakia: prevalence of diabetes; organisation of health care; demographical indices and therapeutic traditions. Differences in age and sex structure of the population are probably a major reason for the observed differences in antidiabetic drug consumption between the Czech and the Slovak socialist republics. A good reciprocity was found between the sale of antidiabetic drugs measured as number of defined daily doses (DDD) per 1000 inhabitants per day and the prevalence of diabetics treated with the corresponding drugs.
Drug Utilization Data in Benefit Analysis of Drugs
Authors: Liljestrand Åke
Published: August 2010

ABSTRACT. The usefulness of drug utilization data from the medical point of view is closely related to possibilities for benefit analysis of drug treatment. In drug regulatory work this analysis may be facilitated by more recent evaluations in connection with reviews when granting marketing of new drugs. The general difficulties in benefit analysis have been especially noticed following observations on international differences in the utilization of certain groups of drugs. These difficulties are discussed and the importance of new attempts taken to assess the benefit of the treatment is emphasized.
Vital Capillary Microscopy for Assessment of Skin Viability and Microangiopathy in Patients with Diabetes Mellitus
Authors: FAGRELL BENGT , HERMANSSON INGA‐LILL , KARLANDER SVEN‐GUNNAR , ÖSTERGREN JAN
Published: August 2010

ABSTRACT. Vital capillaroscopy is useful in clinical practice to study the nutritional skin capillaries and for evaluating the risk for skin necrosis in patients with peripheral ischemia. This method is especially valuable in the investigation of patients with diabetes mellitus (DM) in whom the arterial inflow to the foot can be almost normal despite the development of skin necrosis due to impaired nutritional circulation. When the capillary morphology in the feet of asymptomatic diabetic patients was investigated, significantly more areas with widely dilated capillaries were present both in insulin and tablet treated patients compared to controls. By using dynamic capillaroscopy the flow velocity in skin capillaries can be determined under physiological conditions. Fourteen diabetic patients were compared with matched non‐diabetic controls. The capillary blood flow during resting conditions was equal in the two groups but a delay in the postocclusive reactive hyperemia response was seen in the diabetic patients. The reason for this may be a vasomotor dysfunction in the precapillary arterioles or an increased blood viscosity. Further studies using dynamic vital capillaroscopy may improve our knowledge of the complex mechanisms responsible for diabetic microangiopathy.
Diabetic Macroangiopathy
Authors: NEUBAUER B. , CHRISTENSEN N. J. , CHRISTENSEN T. , GUNDERSEN H. J. G. , JØRGENSEN J.
Published: August 2010

ABSTRACT. Five quantitative studies performed to disclose and measure diabetic abnormalities in the leg arteries are reported and briefly discussed. A medial as well as an intimal disease was found in the diabetic leg arteries. Thus roentgenological medial calcification correlated to glucose intolerance in older non‐diabetics and to diabetes duration in young insulin dependent diabetics. An intimal roughness was disclosed by arteriography in young insulin‐dependent diabetic patients. The roughness grew worse the longer the diabetes persisted. The development of this abnormality did not take place simultaneous with the medial calcification, but was closely connected with another disclosed abnormality, a uniform arterial narrowing, quite unlike the well known abrupt narrowing in older patients. The existence of a uniform arterial narrowing in diabetic patients was confirmed by ultrasonography and the use of this technique further revealed arterial stiffness as a long‐term diabetic phenomenon. A functional abnormality of the leg arteries of diabetic patients was disclosed by measurement of the postischemic peak blood flow in the leg in a 45° feet‐down position. A vast destruction of the autonomic nerves of the peripheral arteries was demonstrated by measurement of the norepinephrine content post mortem in long‐term diabetic patients. The results reported suggest a specific element in the large‐vessel disease of diabetic patients.
An Epidemiological Survey of Diabetic Foot Problems in the Stockholm County 1982
Authors: ROSENQVIST U.
Published: August 2010

ABSTRACT. Diabetic foot disease is a severe complication to diabetes mellitus. Preventive measures can reduce its occurrence and consequences. The present study was performed in order to assess the prevalence of diabetic foot disease in an urbanized area with well developed medical facilities. The study was based on a mail questionnaire to a stratified, randomized sample of 742 diabetics living in the Stockholm county. Only one third of these patients were free of diabetic foot symptoms. Many patients with severe signs found it difficult to take care of their feet, were living alone and did not seek professional help for their foot problems. Only 66% of the patients with severe foot disease utilized hospitals for their diabetes care. Furthermore, only half of them relied on some type of professional care for their feet.
Reconstructive Vascular Surgery in Diabetic Patients with Peripheral Arterial Insufficiency
Authors: ÄNGQUIST K.‐A. , TRUEDSON H.
Published: August 2010

ABSTRACT. Peripheral arterial insufficiency in diabetic patients is for vascular surgeons a special problem as there even may be a distal diabetic angiopathy in the leg arteries. Preoperative adequate evaluation and selection of the patients is necessary before vascular reconstruction. Of 100 consecutive patients operated on with femoropopliteal bypass 33 were diabetic and 67 nondiabetic. Eleven of the diabetic patients were one year later asymptomatic, eight improved but eight were amputated.
65Zn Turnover in Short‐term Alloxan Diabetic Rats
Authors: HALLMANS G. , NYSTRÖM Å. , WING K. , LITHNER F.
Published: August 2010

ABSTRACT.65Zn was injected subcutaneously in eleven rats with alloxan diabetes of five days duration and in nine control rats. Fifty hours after the injection of65Zn the animals were killed with an overdose of ether. In the alloxan diabetic rats signs of an altered zinc metabolism were found with an increased excretion of zinc in urine and possibly also faeces and an elevated zinc concentration in the liver compared to controls. The results also indicate an altered distribution of serum zinc in alloxan treated rats. Future studies will be necessary to demonstrate whether changes in zinc metabolism are secondary to the onset of diabetes or a primary effect of alloxan treatment.
The Primary Preventive Study in Uppsala
Authors: LITHELL HANS , ÅBERG HANS , SELINUS INGEMAR , HEDSTRAND HANS
Published: August 2010

ABSTRACT A health survey of middle‐aged men was carried out in 1970‐73 in the municipality of Uppsala. Subjects with hypertension, hyperlipidaemia, reduced glucose tolerance, and smokers were invited to join various therapy groups. By 1980 this multifactorial intervention programme had thus been running for 10 years. This report describes the results of a follow‐up undertaken to evaluate the efficacy of the programme. The annual rate of fatal myocardial infarction (MI) was lower among the participants (n=2322) in the health examination as well as among participants and non‐participants (n=446) combined than among the male Swedish population of the same age (162 and 187 compared with 296 per 100 000 men, respectively). The annual rate of non‐fatal MI among participants and non‐participants combined was 295 per 100 000 men, which is lower than in other Swedish cities. In the hypertensive group (n=126), six men had fatal and seven non‐fatal MI. These 13 men had higher blood pressures (BPs) from the start than the other hypertensives. In addition, their BP reduction was smaller than in a control group randomly selected among the hypertensive subjects. In the hyperlipidaemic treatment group (n=363) there were eight fatal and 10 non‐fatal MIs. Nine of these events occurred in individuals who had dropped out from therapy. It is suggested that the low total mortality and the low rates of fatal and non‐fatal MI in this middle‐aged male population may be related to the multifactorial intervention programme, as the incidences were also low among the treated high‐risk groups.
Serum Magnesium in Greenland Eskimos
Authors: JEPPESEN BJARNE BO , BLACH ANNIE , HARVALD BENT
Published: August 2010

ABSTRACTSerum magnesium in Greenland Eskimos living in Greenland is significantly higher (p<0.001) than in Greenlanders and Danes living in Denmark. Danes living in Greenland show intermediate values. The higher serum magnesium may be due to a high intake of nutrients from fish and sea mammals. A more complete intestinal absorption of magnesium caused by a low dietary calcium should also be considered. The high serum magnesium may contribute to the rare occurrence of urinary calculi in Grenlanders.
ADP‐induced Platelet Aggregation and Metoprolol Treatment of Myocardial Infarction Patients
Authors: VILÉN LARS , KUTTI JACK , SWEDBERG KARL , VEDIN ANDERS
Published: August 2010

ABSTRACT The effect of metoprolol on platelet aggregation was investigated in a group of postmyocardial infarction (MI) patients. The study was double‐blind and included 63 subjects; 30 patients were maintained on metoprolol and 33 received placebo treatment. Adenosine diphosphate (ADP)‐induced platelet aggregation was carried out in each subject close to 4 weeks after the acute MI. It was demonstrated that metoprolol as compared to placebo did not influence ADP‐induced platelet aggregation in the present clinical setting.
Platelet Counts in Myocardial Infarction, Angina Pectoris and Peripheral Artery Disease
Authors: FAGHER BIRGER , SJÖGREN ANDERS , SJÖGREN ULF
Published: August 2010

ABSTRACTSerial determinations of peripheral venous platelet counts were performed in 43 consecutive patients with acute chest pain. On admission, patients with acute myocardial infarction (AMI) had a significantly lower mean platelet count (p<0.05) than patients without AMI, whereas hematocrit was higher (p<0.025). Thereafter a further reduction was seen with steadily reduced platelet counts by about 20%, both in comparison with healthy controls (p<0.001) (n=113) and patients with peripheral artery disease (PAD) without heart symptoms (p<0.005) (n=54). The platelet number increased one week after admission and even thrombocytosis was observed. The changes in platelet number during AMI seem to parallel the changes in platelet function. Patients with PAD had normal mean platelet counts. Female patients as well as healthy subjects had significantly higher values than men (p<0.01).
The Effect of Education and Self‐monitoring of Blood Glucose on Glycosylated Hemoglobin in Type I Diabetes
Authors: TERÉNT A. , HAGFALL O. , CEDERHOLM U.
Published: August 2010

ABSTRACT The influence on glycosylated hemoglobin (HbA1) of formal education as compared with self‐monitoring of blood glucose (SMBG) was studied in a randomized 18‐month trial. All adult type I diabetics in a community were identified. Forty‐one of these patients had had diabetes for 20 years or less. Thirty‐seven patients were included in the study and finally randomized into four groups. Ten patients received individual formal education followed by SMBG, eight patients were instructed in SMBG without pre‐education, nine patients were given only formal education and 10 patients made up a reference group. Education did not improve the mean HbA1 values. SMBG resulted in a decrease by 2% in HbA1 from 12 to 10% (p<0.05). The final HbA1 level, however, did not differ significantly between any of the groups. SMBG was accepted by 80% of the patients. The liability to hypoglycemia was about equal in the four groups. It was concluded that SMBG, but not education, improved metabolic control to a certain degree.
Investigation of TSH Dependency, Circulating Thyroid Autoantibody, and Morphological Features of Recurrent Nontoxic Goitre
Authors: HUSBY STEFFEN , BLICHERT‐TOFT MOGENS , BANG ULLA , NIELSEN BERNT
Published: August 2010

ABSTRACT Pathogenetical factors possibly responsible for recurrence of nontoxic goitre in a nonendemic area are evaluated. A group of 22 female patients admitted for surgical treatment of recurrent nontoxic goitre was compared with a control group of 86 female nontoxic goitrous patients not operated upon before. Preoperative serum baseline thyrotrophin levels in the recurrent goitre group were low normal and did not differ significantly from those in the control group. Circulating thyroid microsomal autoantibodies, thyroglobulin antibody titers, and the densities of lymphocytic aggregation in goitrous tissue did not differ significantly in the two groups. Thus, none of the parametres studied were likely explanations of regrowth of goitre.
Cushing's Syndrome Due to an ACTH‐producing Neuroendocrine Tumour in the Nasal Roof
Authors: WERNER SIGBRITT , JACOBSSON BJÖRN , BOSTRÖM LENNART , CURSTEDT TORE , WEGER ADOLF , BIBERFELD PETER
Published: August 2010

ABSTRACT A patient with ectopic adrenocorticotrophic hormone (ACTH) production from a neuroendocrine tumour of the nasal roof is presented. By indirect immunoperoxidase techniques the tumour cells were shown to be distinctly positive for ACTH and β‐endorphin but negative for other peptides derived from pro‐opiomelanocortin. Neither corticotropin releasing hormone (CRF) found in some tumours associated with ectopic Cushing's syndrome, nor gastrin immunoreactivity, which coexists with ACTH in normal rat pituitary and in rat and human gastrointestinal cells, were demonstrable in the tumour. A review of other, previously recognized locations of CRF/ACTH producing tumours is given to increase the awareness of the ectopic Cushing's syndrome, which may lack the classical features and is characterized by fulminant clinical course, extreme fatigue, weakness, pale facial swelling, oedema and hypokalaemic alkalosis.
Cardiac Performance in Hyperthyroidism Assessed by Systolic Time Intervals and Radionuclide Ventriculography
Authors: MANGSCHAU ARILD , SOLEM JAN H. , KARLSEN RAGNAR LUND
Published: August 2010

ABSTRACT Systolic time intervals (STI) and radionuclide ventriculography (RNV) were used in the assessment of cardiac performance in 22 patients with hyperthyroidism before and after antithyroid treatment. STI as well as RNV showed enhanced myocardial contractility which was normalized after antithyroid treatment. Beta‐blocker treatment did not influence the hypercontractility in hyperthyroidism. This implies that β‐blockers alone cannot be regarded as satisfactory long‐term treatment and that mechanisms other than increased sympathoadrenal drive are involved in the hypercontractility in hyperthyroidism. RNV suggested valvular regurgitation, probably of the mitral valve, in 11 patients. Possible hemodynamic consequences are discussed.
Primary Amyloidosis with Increased Plasma Carcinoembryonic Antigen Concentration
Authors: FORSLUND T. , TEPPO A.‐M. , TÖRNROTH T. , MAURY C. P. J. , WEGELIUS O.
Published: August 2010

ABSTRACT A patient with suspected malignant disease had increased concentration of plasma carcinoembryonic antigen (CEA). Amyloidosis was demonstrated at autopsy. The amyloid fibril composition was characterized by immunohistochemical and immunochemical techniques and proved to be of the lambda light chain (AL) type. CEA was demonstrated in the liver parenchyma by using antihuman CEA antiserum. Increased plasma CEA concentration in a patient with primary amyloidosis has, to our knowledge, not been reported before.
Venous Function Five to Eight Years after Clinically Suspected Deep Venous Thrombosis
Authors: LINDHAGEN A. , BERGQVIST D. , HALLBÖÖK T. , EFSING H. O.
Published: August 2010

ABSTRACT One hundred and fifty‐four patients, who had been subjected to phlebography 5–8 years previously because of clinical suspicion of deep venous thrombosis (DVT), were investigated to evaluate the frequency of deep venous insufficiency (DVI). The evaluation included clinical examination, registration of subjective complaints and objective measurements with plethysmography, venous pressure and Doppler ultrasound. DVT had been present in 75 legs. There were no statistically significant differences between legs with and without earlier DVT apart from more venous outflow obstruction in the former. DVI was as common after calf vein thrombosis as after more proximal DVT. DVI was more frequent in elderly patients and in patients with a history of previous DVI or DVT. The sufficiency of the popliteal vein seemed to be of great importance in the development of DVI. More than one third of legs without DVT had developed DVI at follow‐up.
Utility of a Population‐based Case‐Control Study Model with a Limited Number of Patients in Estimating Risks of Hypertension
Authors: LINDHOLM LARS , LITHMAN THOR
Published: August 2010

ABSTRACTA population‐based case‐control study of the risks of hypertension was carried out in a primary care district where data on all patients have been registered in out‐ and in‐patient computer schemes and where extensive studies and treatment programs regarding blood pressure have been performed for more than a decade. The results of the study, which comprised a limited number of patients, accord with those of more extensive and prospective studies. The hypertensives had high risks of developing myocardial infarction and stroke even though they were treated according to internationally accepted norms regarding blood pressure. The estimated population‐attributable risk of hypertension in men was 30% with regard to myocardial infarction and 68% with regard to stroke. Smoking and hypertension were found to be independent risk indicators of myocardial infarction in men and hypertension was a strong risk indicator of stroke. Thus, a case‐control study carried out in this way in a primary care district gives valid results regarding the efficacy of an antihypertensive treatment program and may therefore serve as a model for future studies in primary health care.
Echocardiographic Left Atrial Dimension as a Predictor of Maintaining Sinus Rhythm after Conversion of Atrial Fibrillation
Authors: HÖGLUND C. , ROSENHAMER G.
Published: August 2010

ABSTRACT Twenty‐six patients with lone atrial fibrillation were studied prospectively by M‐mode echocardiography less than two months before and one month after cardioversion (CV). Seven patients had reverted to atrial fibrillation (AF) one month after CV. These patients (AF group) differed significantly with regard to mean left atrial dimension (LA) from the 19 patients (73%) who maintained sinus rhythm (S group) (p<0.001). Initial LA was 38.6±4.9 mm in the S group and 47.6±2.3 mm in the AF group. These values had not changed significantly in either group when measured one month after CV. The radiological heart size index showed a closely corresponding pattern. On the other hand, the mean heart size in both groups (441±100 and 544±98 ml/m2 BSA, respectively) was well below the upper normal limit (700 ml/m2) that is conventionally used as exclusion criterion from CV. In conclusion, in patients with AF and only moderate cardiac enlargement on chest X‐ray, the echocardiographic LA can be used as predictor of maintaining sinus rhythm for at least one month following CV.
Digoxin–Trimethoprim Interaction
Authors: PETERSEN PALLE , KASTRUP JENS , BARTRAM REINHOLD , HANSEN JENS MØLHOLM
Published: August 2010

ABSTRACT Nine patients (median age 78 years, range 62–92) treated with a constant oral dosage of digoxin were evaluated for the effect of trimethoprim on serum digoxin values. Serum digoxin increased by 22% during trimethoprim treatment (p<0.05). Subsequently, 6 healthy subjects (median age 29 years, range 24–31) were evaluated for the effect of trimethoprim on digoxin pharmacokinetics after an i.v. dose. Trimethoprim administration did not affect total body clearance of digoxin and the glomerular filtration rate. The renal clearance of digoxin decreased by 17% (p<0.05) and the extrarenal clearance of digoxin increased by 14% (N.S.). Biological half‐life of digoxin and apparent volumes of central and peripheral compartments were unchanged during the study. It is suggested that the increase in serum digoxin in the elderly patients is due to decreased renal tubular secretion of digoxin and not to disturbance of the extrarenal clearance.
Embolization from Angiographic Catheter during Angiography Simulating Vascular Spasm
Authors: FALK ERLING , BORIS PETER
Published: August 2010

ABSTRACT The initiating event in the pathogenesis of acute coronary thrombosis, especially the role played by vasospasm, remains controversial. Recently an angiographic sequence of events has been reported which should conclusively prove that spasm of a normal coronary artery might lead to occlusive thrombosis. The patient survived, and thus this conclusion was reached without morphological verification. The present report describes an almost identical angiographic sequence of events in a cerebral artery initially interpreted in the same way: spasm leading to thrombosis. The patient died, and an embolus derived from the angiographic catheter was found at postmortem examination exactly where angiography had shown “spasm”. A “catheter embolus” simulating vascular spasm could as well explain the basic angiographic findings in the previously reported case. Thus, it still remains to be proved that spasm of a normal artery may lead to occlusive thrombosis.
Blood Pressure Changes in Man during Infrasonic Exposure
Authors: DANIELSSON ÅKE , LANDSTRÖM ULF
Published: August 2010

ABSTRACT.Danielsson Å. LandstrÖm U. (Department of Internal Medicine, University Hospital, and National Board of Occupational Safety and Health, UmeÅ, Sweden.) Blood pressure changes in man during infrasonic exposure.

Twenty healthy male volunteers were exposed to infrasound in a pressure chamber especially designed for the experiments. The effects on blood pressure, pulse rate and serum cortisol levels of acute infrasonic stimulation were studied in a series of different experiments. Varying frequencies (6, 12, 16 Hz) and pressure levels (95, 110, 125 dB(lin)) were tested. Significantly increased diastolic and decreased systolic blood pressures were recorded without any rise in pulse rate. The increase in diastolic blood pressure reached a maximal mean of about 8 mmHg after 30 min exposure. The results suggest that acute infrasonic stimulation induces a peripheral vasoconstriction with increased blood pressure, previously shown to occur in conjunction with industrial noise. Chronic long‐term exposure to environmental infrasound may be of importance for the development of essential hypertension in predisposed individuals.
Long‐term β1‐Selective Adrenergic Blockade and Adrenergic Receptors in Human Subcutaneous Adipocytes
Authors: WAHRENBERG HANS , ARNER PETER , ENGFELDT PETER , HAGLUND KJELL , RÖSSNER STEPHAN , ÖSTMAN JAN
Published: August 2010

ABSTRACT. Wahrenberg H, Arner P, Engfeldt P, Haglund K, RÖssner S, Östman J. (Department of Internal Medicine and Research Centre, Huddinge Hospital, Karolinska Institute, Huddinge, and Department of Internal Medicine, Karolinska Hospital, and King Gustaf V Research Institute, Stockholm, Sweden.) Long‐term β1‐selective adrenergic blockade and adrenergic receptors in human subcutaneous adipocytes.

The influence of β‐adrenergic blockade with metoprolol, a β1‐selective agent, on the adrenergic regulation of lipid mobilization was explored in subcutaneous adipocytes removed from 13 patients with essential hypertension. Treatment with metoprolol, which was associated with adequate β‐adrenergic blockade and an antihypertensive effect, resulted in a significant increase (p<0.05) in the binding of the β‐adrenergic antagonist (‐)‐(3H)‐dihydroalprenolol and a 50% increase (p<0.01) in the maximum lipolytic response to the β‐adrenergic agonist isopropylnoradrenaline. In 7 patients with normotriglyceridaemia the total plasma triglyceride level increased significantly (p<0.025) during metoprolol treatment, a change that was due to an increase in the very low density lipoprotein triglycerides. The findings suggest that chronic treatment with the β1‐selective adrenergic blocker metoprolol leads to a significant increase in β‐adrenoceptor density and an increase in the lipolytic response to β‐adrenergic agonists. This latter finding may, in some measure, account for the increased plasma triglyceride level observed.
Morbid Obesity, Gastric Plication and a Severe Neurological Deficit
Authors: SOMER HANNU , BERGSTRÖM LEA , MUSTAJOKI PERTTI , ROVAMO LIISA
Published: August 2010

ABSTRACT. SomerH, BergstrÖm L, Mustajoki P, Rovamo L. (Department of Neurology, Third Department of Internal Medicine and Children's Hospital, University of Helsinki, Helsinki, Finland.) Morbid obesity, gastric plication and a severe neurological deficit.

A 39‐year‐old man had protracted vomiting after gastric plication for morbid obesity. Within three months he lost 53 kg in weight and developed neuromuscular weakness, especially in the lower extremities. Clinical and laboratory studies suggested both radicular and peripheral neuropathy. One year later the condition was only marginally improved: he took only few steps unsupported. The apparent etiology is malnutrition but the primary cause remained unknown.
Renal Effects of Chronic Exposure to Organic Solvents
Authors: KRUSELL LARS , NIELSEN HANS KRÆMMER , BÆLUM JESPER , LUNDQVIST GUNNAR , OMLAND ØYVIND , VÆTH MICHAEL , HUSTED STEEN E. , MOGENSEN CARL ERIK , GEDAY ERLING
Published: August 2010

ABSTRACT. Chronic effects of organic solvents on renal function were measured by creatinine clearances and urinary excretion rates of β2‐microglobulin and albumin. Forty‐three male printing trade workers occupationally exposed to different organic solvents for 9–25 years were compared with 43 age‐matched male controls. No differences were found either in creatinine clearances or average basal levels of β2‐microglobulin and albumin excretion rates, whereas a positive relation could be demonstrated between alcohol consumption on the day before the trial and urinary excretion rate of albumin. This investigation did not reveal any adverse renal effects of moderate chronic exposure to organic solvents in a group of active trade workers.
Serum Bone Gla Protein and Other Biochemical Estimates of Bone Turnover in Early Postmenopausal Women during Prophylactic Treatment for Osteoporosis
Authors: PØDENPHANT JAN , CHRISTIANSEN CLAUS , CATHERWOOD B. D. , DEFTOS LEONARD J.
Published: August 2010

ABSTRACT. Serum bone Gla protein (BGP) and conventional biochemical indices of bone metabolism were determined in 66 early postmenopausal women during a double‐blind therapeutic trial performed to investigate the effect of oestrogen, calcium and 1,25 (OH)2D3 on postmenopausal osteoporosis. The biochemical variables were determined before, during and after withdrawal of therapy. We found a very high correlation between serum BGP and serum alkaline phosphatase—a measure of bone formation, less high correlation between serum BGP and the remaining parameters—indices of bone resorption. It is concluded that serum BGP probably reflects bone formation and may prove to be a useful new biochemical marker.
Immune Phenotype and Prognosis in Chronic B‐Lymphocytic Leukaemia and Leukaemic Immunocytoma
Authors: JULIUSSON GUNNAR , ÖST ÅKE , BIBERFELD PETER , ROBÈRT KARL‐HENRIK , GAHRTON GÖSTA
Published: August 2010

ABSTRACT. Fifty‐nine patients with a leukaemic B‐lymphocytic malignancy (“CLL”) were studied. According to the Kiel classification, 29 patients had chronic lymphocytic leukaemia (CLL) and 30 had immunocytoma (IC). Cell surface immunoglobulin staining showed μ heavy chain phenotype in 14 patients, μ∂ in 35, gamma in 7; in cells from 3 patients the staining was too weak to permit identification. The light chain phenotype was kappa in 39 patients, lambda in 17, and unidentified in 3. The immunoglobulin isotypes differed between the diagnoses. The gamma chain phenotype was found only in IC patients (p < 0.02), and more CLL than IC patients showed a lambda chain phenotype (p < 0.04). Blood lymphocytes from IC patients contained more T cells than CLL cell samples (p < 0.002). No prognostic difference was found between the CLL and IC group. Compared to the lambda phenotype, the kappa phenotype was associated with a poorer prognosis in the IC group, but with a better prognosis in the CLL group. IC patients with μ phenotype had a poorer prognosis than those with gamma phenotype. Low relative T cell numbers were associated with a poor survival (p < 0.01).
Role of Coronary Spasm in Different Anginal Syndromes
Authors: Yasue H. , Takizawa A. , Nagao M. , Horie S. Nishida M. , Kubota J.
Published: August 2010

ABSTRACT. Angina pectoris is a clinical syndrome caused by transient myocardial ischaemia due to an imbalance between myocardial oxygen demand and supply. It is now evident that coronary artery spasm plays an important role in the pathogenesis of various forms of angina pectoris. Angina pectoris that is mainly caused by coronary artery spasm (coronary spastic angina) has one or more of the following characteristics: 1) the attack occurs at rest, 2) the attack is associated with ST‐segment elevation in the ECG, 3) the attack has a variable exercise threshold, and 4) the attack is suppressed by Ca‐antagonists but not by beta‐adrenergic blocking agents. On the other hand, angina pectoris that is caused by increased myocardial oxygen demand in the presence of severe and extensive organic stenosis (orcanic angina) has the following characteristics: 1) the attack is induced by constant amount of exertion irrespective of hour and day and is relieved by rest, 2) the attack is associated with ST‐segment depression in the ECG, and 3) the attack is suppressed by beta‐adrenergic blocking agents, which decrease myocardial oxygen demand.
Left Ventricular Function During Transluminal Angioplasty: A Haemodynamic and Angiographic Study
Authors: Serruys P. W. , Wijns W. , van den Brand M. , Mey S. , Slager C. , Schuurbiers J. C. H. , Hugenholtz P. G. , Brower R. W.
Published: August 2010

ABSTRACT. The response of left ventricular function, was studied in a series of patients undergoing percutaneous transluminal coronary angioplasty (PTCA). From 4 to 6 balloon inflations procedures per patient were performed with an average duration per occlusion of 51 ± 12 sec (mean ± SD), total occlusion time 252 ± 140 sec. Analysis of left ventricular (LV) haemodynamics showed that the relaxation parameters peak negative rate of change in pressure and the early time constant of relaxation responded earliest to acute coronary occlusion while other parameters such as peak pressure, LV end‐diastolic pressure, and peak positive rate of change of pressure responded more gradually and suggested a progressive depression in myocardial mechanics during the entire procedure. LV angiogram available in 14 patients indicate an early onset of asynchronous relaxation concurrent with the early response in peak ‐dP/dt and the time constant of early relaxation. All haemodynamic parameters fully recovered within minutes after the end of PTCA.

The results of this study indicate no permanent dysfunction to global or regional myocardial mechanics, after PTCA with 4 to 6 coronary occlusions each lasting 40 to 60 seconds.
Effects of Long‐term Therapy with Labetalol on Lipoprotein Metabolism in Patients with Mild Hypertension
Authors: HYLANDER BRITTA , ELIASSON K. , NILSSON‐EHLE P. , RÖSSNER S.
Published: August 2010

ABSTRACT. The effects of labetalol on serum lipoproteins, the intravenous fat tolerance test (IVFTT) and lipoprotein lipase (LPL) and hepatic lipase (HL) activities were studied in 16 patients with mild hypertension before and after 6 months of therapy. Most patients were found to be normotensive on 200 mg labetalol/day. Before therapy the mean concentration of serum TG was 0.75 ± 0.21 (SD) mmol/1, of total cholesterol 5.41 ± 1.25 mmol/1 and of HDL cholesterol 1.67 ± 0.61 mmol/1. After labetalol no significant changes were found in the concentrations of TG and cholesterol in the VLDL, LDL and HDL fractions. The mean values for the IVFTT and for LPL and HL activities were in the normal range and remained unchanged during therapy.
Arachidonic Acid Levels in Serum Phospholipids of Patients with Angina Pectoris or Fatal Myocardial Infarction
Authors: SKULADOTTIR GUDRUN , HARDARSON THORDUR , SIGFUSSON NIKULAS , ODDSSON GUDMUNDUR , GUDBJARNASON SIGMUNDUR
Published: August 2010

ABSTRACT. The fatty acid composition and concentrations of serum phospholipids (PL) were examined in 14 normal subjects (NS), 10 patients with coronary heart disease (CHD) and stable angina pectoris, and in 12 patients with acute, fatal myocardial infarction (MI). The NS and patients with CHD and stable angina pectoris were matched with respect to age, height, body weight, blood pressure and serum cholesterol. Serum PL of patients with CHD and of patients with acute, fatal MI contained significantly more arachidonic acid (20: 4n6, AA) than serum PL of the NS. Docosahexaenoic acid (22:6n3, DHA) was also increased in serum PL of patients with acute, fatal MI. AA and DHA levels in serum PL reflect changes in lipid metabolism that may relate to the cause and/or consequences of CHD.
Hemodynamics in Diabetic Renal Failure
Authors: BERGLUND JONAS , JONASSON RUNE , PEHRSSON S. KENNETH
Published: August 2010

ABSTRACT. Cardiac performance was assessed by left ventricular catheterization in ten insulin‐dependent diabetics with non‐dialysis‐requiring uremia. None of the patients had a history or clinical signs of ischemic or valvular heart disease or congestive heart failure. Cardiac output at rest was normal in all patients. During exercise, one patient had somewhat low cardiac output and nine showed impaired ability to increase stroke work. This impairment was accompanied by elevation of the left ventricular end‐diastolic pressure. The abnormal cardiac performance could not be ascribed to the degree of anemia or uremia or to volume overload. Arterial hypertension possibly contributed. The observations suggest that in diabetic patients with moderate uremia there is also left ventricular dysfunction. Renal transplantation should therefore be considered for these patients earlier than is customary for uremics without diabetes.
Hodgkin's Disease in Sarcoidosis: A Case Report and a Review of the Literature
Authors: TRIER HANS , CHRISTENSEN MOGENS
Published: August 2010

ABSTRACT. A patient with Hodgkin's disease preceded by sarcoidosis is presented and the difficulties introduced by the lack of specificity for the sarcoid‐like granulomas to differentiate between the dual pathology are discussed. A review of the literature disclosed 9 similar case reports. It is suggested that the finding of non‐caseating epithelioid cell granulomas in relatively old patients with lymphadenopathy, systemic symptoms and absolute neutrophil leucocytosis could be warning signals of the appearance of Hodgkin's disease.
Detection of Coronary Artery Disease by Means of Exercise ECG in Patients with Aortic Stenosis
Authors: LINDERHOLM HÅKAN , OSTERMAN GÖRAN , TEIEN DAG
Published: August 2010

ABSTRACT. In a preoperative evaluation, 35 consecutive patients with aortic stenosis were examined by means of exercise ECG, Doppler and direct manometric measurements of the pressure difference over the aortic valve (ΔP) and angiocardiography. Coronary artery disease (CAD) was found in 43% of the patients. Those with CAD had a lower mean maximum physical performance expressed as a percentage of the normal value (Wmax%), larger ST depressions and a higher effort angina (EA) score at the exercise test than the non‐CAD group. Mean ΔP was equal in the two groups. A myocardial coronary obstruction score covariated positively with a coronary insufficiency index (CT index = 100‐STdepr/ Wmax%) and the EA score. There was no correlation between AP and the EA score or the CI index. A CI index < 3 and an EA score < 2 were found in 49% of the patients and excluded the presence of CAD with a predictive accuracy of 88 %, a better diagnostic complement to coronary arteriography than a history of EA.
Evidence for Deficiency of High Density Lipoprotein Lecithin: Cholesterol Acyltransferase Activity (α‐LCAT) in Fish Eye Disease
Authors: CARLSON LARS A. , HOLMQUIST LEIF
Published: August 2010

ABSTRACT.In a rare familial condition, fish eye disease, there is a low relative content of cholesteryl esters in the plasma high density lipoproteins (HDL) but a normal content of these lipids in the very low (VLDL) and low (LDL) density lipoproteins. Lecithin: cholesterol acyltransferase (LCAT) is the enzyme which mediates the esterification of free cholesterol in the plasma lipoproteins. In the present investigation, isolated HDL from our two fish eye disease patients were found to be excellent substrates during in vitro incubations with normal LCAT as present in lipoprotein depleted plasma from control subjects. Almost all free cholesterol of these HDL fractions became esterified and concomitantly the abnormally small fish eye disease HDL particles increased to a size in the range of that of normal HDL particles. Lipoprotein depleted plasma from fish eye disease, however, lacked the property of normal plasma to esterify the free cholesterol of HDL isolated from plasma of fish eye disease patients or control subjects. These results have led to the formulation of a new concept implying that two different LCAT activities exist in normal plasma. One of these activities, denotedα‐LCAT, is specific for HDL (α‐lipoproteins) and the other,β‐LCAT, is specific for VLDL‐LDL (preβ‐andβ‐lipoproteins). Fish eye disease according to this notion is classified as anα‐LCAT deficiency in contrast to the classical LCAT deficiency which probably lacks bothα‐ andβ‐LCAT activities.