bluuebunny/crossref_metadata_2025 huggingface dataset:
The Role of Endogenous Cortisol in Patients with Non‐Thyroidal Illness and Decreased T3 Levels
Authors: Kallner Gunnar , Ljunggren Jan‐Gustaf
Published: August 2010

ABSTRACT The aim of the study was to elucidate if endogenous cortisol, as previously suggested, could be involved in the mechanism behind the reduced serum T3 levels seen in euthyroid patients with various non‐thyroidal illnesses. The correlation between the serum levels of T3 and cortisol was investigated in 41 hospitalized patients with non‐thyroidal illness during hyperpyrexia. The results showed a correlation coefficient of ‐0.94, indicating a close reciprocal association between the two hormones. Cortisol may thus be one factor associated with the decreased T3 levels seen in euthyroid patients with non‐thyroidal illness. The results also indicate a close parallelism between the total and free T3 levels during hyperpyrexia.
Noninvasive Diagnosis of Acute Deep Vein Thrombosis
Authors: Watz R. , Ek I. , Bygdeman S.
Published: August 2010

ABSTRACT Fifty‐five patients with clinical signs of acute DVT were investigated with thermography, plethysmography and phlebography. A comparison between phlebography and thermography showed a diagnostic agreement of 84%. Thermography was found, however, to have a low reliability for the localization of acute thrombi and was therefore combined with plethysmography in an attempt to obtain better results in this respect. Compared to the invasive phlebography, the noninvasive combination of thermography and plethysmography adequately located acute DVT in 95% of the cases.
Malignant Hypertension—Improving Prognosis in a Rare Disease
Authors: Gudbrandsson T. , Hansson L. , Herlitz H. , Andren L.
Published: August 2010

ABSTRACT A follow‐up was made of 69 patients diagnosed as having malignant hypertension during 1969‐76, essential in 26, secondary in 39 and unclassified in 4. A clear male dominance was seen (41 men, 28 women), particularly in the group with essential hypertension (18 men, 8 women). The mortality in this series was less than in previously published series. Thus, the 5‐year survival rate was 75% in the patients with essential and 72% in those with secondary hypertension. In part this was due to hae‐modialysis and renal transplantation. The importance of renal function at the time of diagnosis was evident in this study. In most patients with essential hypertension and serum creatinine levels below 300 μmol/1, renal function could be maintained or improved when antihypertensive treatment was instituted, whereas progression of the renal damage was seen in those with serum creatinine levels above 300 μmol/1 in spite of antihypertensive treatment with 3 or more drugs. The incidence of new cases of malignant hypertension tended to decrease during the observation period, particularly as regards essential hypertension.
Amyloid Deposits in Bone Marrow Aspirates in Primary Amyloidosis
Authors: Stavem Per , Larsen Ingegerd Frøyshov , Ly Bernt , Rørvik Tore O.
Published: August 2010

ABSTRACT. Amyloid deposits aspirated from the bone marrow have a characteristic appearance in May‐Grünwald‐Giemsa‐stained smears, and almost specific fibrillar pattern when viewed in an electron microscope.
Multifocal Idiopathic Fibrosclerosis
Authors: Nielsen Hans Kræmmer
Published: August 2010

ABSTRACT. The concomitant occurrence of retroperitoneal fibrosis (RF) and Riedel's thyroiditis is reported in two patients, one of whom presented with anuria. The etiology is discussed, and it is concluded that immunological mechanisms with arteritis might be of importance. The associations between Riedel's thyroiditis, RF, mediastinal fibrosis, slcerosing chol‐angitis, retroorbital fibrosis and fibrosis in other organ systems are thought to be different manifestations of a so‐called multifocal idiopathic fibrosclerosis. The benefical effect of glucocorticoids in early stages of the disease is mentioned.
Symptomatic Diabetes Mellitus Cured by Potassium and Withdrawal of Polythiazide in a Hypokalemic Hypertensive Woman
Authors: Nilsson Göran
Published: August 2010

ABSTRACT.A case of symptomatic diabetes mellitus in a 65‐year‐old woman with 14 years of polythiazide treatment and hypokalemia is described. The condition was cured by potassium administration and withdrawal of the thiazide diuretic.
Osteosclerotic Myeloma with Polyneuropathy
Authors: Reitan Jon B. , Pape Eivind , Fosså Sophie D. , Julsrud Ole‐Jørgen , Slettnes Olav N. , Solheim øyvin P.
Published: August 2010

ABSTRACT. Five cases of histologically verified plasma cell myeloma in sclerotic skeletal foci and polyneuropathy are reported. Thirty similar cases were collected from the literature. They illustrate a special form of plasma cell neoplasia. The characteristic features are osteosclerosis, polyneuropathy resembling polyradiculitis, approximately normal hemoglobin concentration, bone marrow smears and ESR, low concentration of M‐protein, and absence of Bence‐Jones' proteinuria. Slow progression of the disease is a possible additional feature. It is hypothesized that autoimmune mechanisms are involved in the pathogenesis. This hypothesis is based on the observation of circulating immune complexes, positive Waaler's reaction and relative increase in the number of circulating B‐lymphocytes.
The Relation between the Levels of HDL Cholesterol and the Capacity for Removal of Triglycerides
Authors: Sauar Jostein , Skrede Sverre , Erikssen Jan , Blomhoff Jan P.
Published: August 2010

ABSTRACT. In twenty‐two men with “normal” findings clinically, by exercise ECG and laboratory tests, we performed an i.v. fat tolerance test, measurement of LCAT activity and the activities of post‐heparin triglyceride lipases, and estimated serum lipids. HDL cholesterol was positively correlated to lipoprotein lipase (r=0.50, p<0.05) and to the fractional removal rate of exogenous fat (r=0.59, p<0.01), and negatively to the fasting levels of triglycerides (r=‐0.65, p<0.01). LCAT was neither correlated to HDL cholesterol nor to the fat removal rate. Our results confirm that a high triglyceride removal capacity is closely correlated to a high level of HDL. The association between the catabolism of triglyceride‐rich lipoproteins and HDL was thus further substantiated.
Excessive Sensitivity to the Hyponatremic effect of Chlorpropamide in a Patient with Diabetes mellitus and Anterior Pituitary Insufficiency
Authors: Aasen Gunnar , Frey Harald M. M.
Published: August 2010

ABSTRACT. A 67‐year‐old diabetic woman with un‐diagnosed anterior pituitary insufficiency developed hyponatremic coma within 5 weeks after initiation of chlorpropamide therapy. A provocation test with 500 mg chlorpropamide orally led within five hours to hyponatremia and sopor with high urinary sodium excretion. This rapid development of the hyponatremic syndrome excludes water retention due to ADH as the dominant cause. It is more probable that known defects in renal sodium conservation, brought about by the anterior pituitary failure, have been potentiated by chlorpropamide.
Effects of Mefruside Treatment in Hypertension
Authors: Henningsen N. C. , Bergengren B. , Malmborg O. , Pihl O. , Renmarker K. , Strand L.
Published: August 2010

ABSTRACT. Fifty‐two middle‐aged patients with essential hypertension were treated for five months with 25 mg mefruside as the only antihypertensive drug. Blood pressure, heart rate, fasting blood glucose, cholesterol, triglycerides, uric acid, electrolytes and weight were controlled regularly before and during treatment. Blood pressure normalized in 43 cases (82.7%). The decrease was more marked in the females and their maximal response appeared later. No significant changes were seen in cholesterol and triglycerides. Serum uric acid levels increased significantly in both sexes (p<0.001) but no patient developed gout. A significant decrease (p<0.001) in serum potassium was seen; only one male, with heredity for diabetes mellitus, showed a decreased glucose tolerance.
Skeletal Scintigraphy with Technetium Diphosphonate in Multiple Myeloma‐a Comparison with Skeletal X‐Ray
Authors: Lindström Eva , Lindström Folke D.
Published: August 2010

ABSTRACT. Twenty‐one patients with multiple myeloma were examined in close time relation with skeletal X‐ray survey and bone scanning using technetium diphosphonate. Results indicate that X‐ray is superior to bone scan in detecting myelomatous bone lesions. Approximately twice as many lesions were detected by X‐ray as by bone scan. An exception to this general finding is the lumbar spine and rib cage, in which the two methods are equally reliable Thus, a negative bone scan does not exclude the possibility of a myelomatous bone lesion.
Gangrene Localized to the Lower Limbs in Diabetics
Authors: Lithner Folke , Törnblom Nils
Published: August 2010

ABSTRACT. Over a period of eight years, 247 un‐selected patients with more or less widespread areas of obvious cutaneous erythema on the lower legs and/or feet (incipient gangrene) or corresponding areas with cutaneous necrosis (manifest gangrene) were examined at our department. Of these patients, 34% had incipient and 66% manifest gangrene. It was found that 75% had open diabetes; the others were classified as non‐open diabetics. In 75% of the 247 patients these lesions accompanied cardiac decompensation with or without edema, edema of other causes or—in some cases—arterial insufficiency. The gangrene developed in most patients a short time after the onset of these precipitating factors. Arterial insufficiency alone or together with other precipitating factors was seen considerably less often. Edema was thus the main precipitating factor for these lesions. Cardiac decompensation as well as edema of the legs due to other causes respond well to treatment. When treating such patients with open or non‐open diabetes, it should be taken into consideration that gangrene is a serious condition.
The Outcome of Patients with Transient Ischemic Attacks and Stroke Treated with Anticoagulants
Authors: Terént A. , Andersson B.
Published: August 2010

ABSTRACT. Long‐term anticoagulant treatment was given to 25 patients with transient ischemic attacks (TIA) and 49 stroke patients with reversible ischemic neurological deficit or cerebral embolism. Another 16 TIA patients were observed without anticoagulant treatment. Life table analyses, comparing the observed with the expected frequency, revealed increased mortality in the TIA patients irrespective of whether or not they had received anticoagulants. The stroke patients treated with anticoagulants also had a higher mortality than expected. On the other hand, the incidence of subsequent stroke was not higher than expected in the TIA and stroke patients treated with anticoagulants, while it was significantly increased in the TIA patients not treated with anticoagulants. Thus, the risk of stroke, but not the risk of death, was normalized by the anticoagulant treatment. Unacceptably serious bleeding complications were seen in the group of stroke patients with anticoagulant treatment. Bleeding complications, in both TIA and stroke patients, seemed to be related to lengthy treatment, high blood pressure on admission or insufficient patient compliance.
Multiple Myeloma and Gastric Carcinoma
Authors: Peters Marion , Mackay Ian R.
Published: August 2010

ABSTRACT. A man, aged 34, was treated in 1954 for duodenal ulcer by antroduodenectomy followed by X‐irradiation to the stomach in a dose of 2 000 rads. Over two decades, he developed several conditions attributable to the previous irradiation, including the physical appearances of premature ageing, shrinkage of the left kidney due to irradiation nephritis, immune deficiency, multiple meyloma of IgA type, and lastly, carcinoma of the stomach. The kidneys, especially the left, the bone marrow and stomach would have been in the field of X‐irradiation. These effects of local X‐irradiation are discussed in relation to the known effects of total body irradiation in causing decreased longevity in animals and inducing cancer in man.
Angiotensin‐Converting Enzyme in Newly Detected Sarcoidosis
Authors: Rømer Frode K.
Published: August 2010

ABSTRACT.Serum angiotensin‐converting enzyme (SACE) was measured in 56 patients with sarcoidosis within three months after diagnosis. Serial analyses were performed in 42 patients, who were followed for two months to one year. SACE was elevated in 49 (70 %) of the patients at some time during the period of observation. Erythema nodosum (EN) was present in 14 patients. Only one out of seven had elevated SACE during EN, but four months later SACE was elevated in all 14. In this group there was a negative correlation between SACE and S‐lysozyme. Among 42 patients without EN the frequency of SACE elevation was rather constant, about 60%. In half of the patients SACE was normal at first examination, and subsequent elevation was observed in 19%. SACE and S‐lysozyme were positively correlated. Enzyme activity was independent of mode of presentation, but a non‐significant trend toward higher SACE in patients with pulmonary involvement was observed, and changes in SACE were roughly correlated to roentgenological changes. Among healthy controls, significantly higher SACE levels were found in children up to 17 years of age (reference interval 21.2–42.2 U/ml) than in adults aged 18–65 years (12.0–36.8 U/ml). The observations on patients with sarcoidosis demonstrate that a unique pattern of SACE occurs in those with EN, different from that of patients without EN. The findings support the view that EN is a hallmark of acute‐onset sarcoidosis. The value of serial SACE analyses is emphasized.
Prodromal Ventricular Premature Beats Preceded by a Diastolic Wave
Authors: Ejvinsson Gunnar , Orinius Erik
Published: August 2010

ABSTRACT. In a prospective study of quinidine syncope, 71 patients with atrial fibrillation/flutter were ECG monitored for four days after the start of quinidine therapy. Six patients developed ventricular tachycardia (VT) or ventricular fibrillation (VF) during the first 48 hours in sinus rhythm. Q‐T prolongation was seen in most patients with and without VT/ VF and was non‐predictive in this respect. However, a diastolic wave (DW) of larger amplitude than the preceding T wave and usually followed by a ventricular premature beat (VPB) appeared in five of the six VT/VF patients (13–185 min before the first event) and in none of the remaining 63 patients reaching sinus rhythm. For comparison, two of our own cases and nine from the literature with idiopathic long Q‐T or alternating T wave syndromes were studied for these DW‐VPBs. They were found in all ten cases with a VPB recording, but among 19 patients with acute myocardial infarction and VT/VF no such case was seen. As VT/VF was more common after large and VPB after small amplitude DWs, it is discussed whether the DW not only precedes but also initiates the ventricular tachyarrhythmias.
Blood Pressure Control in a Middle‐Aged Male Population
Authors: åberg Hans , Hedstrand Hans , Lithell Hans
Published: August 2010

ABSTRACT. A health examination survey comprising 2322 men born in 1920–24 was carried out in 1970–73 at the University Hospital, Uppsala. Untreated subjects with a diastolic BP ≥ 105 mmHg and those already on treatment for hypertension were considered hypertensives. If a BP elevation was verified at a second screening and the patient had no established contact with a physician, he was offered treatment. Thus, 83 men have been followed up for at least 6 years. The overall reduction in SBP after 6 years was 29.0 mmHg and in DBP 19.6 mmHg. Six men have died, four of them from myo‐cardial infarction, five have dropped out for other reasons. The percentage of non‐responders (DBP≥ 105 mmHg) 1, 2, 3, 4 and 5 years ±3 months after the start of treatment was high, about 20% on the average. On the other hand, when the mean BP for the non‐responders at all visits to the hypertension clinic was compared with their pretreatment value, a reduction of 29.3 mmHg in SBP and 17.0 mmHg in DBP was achieved. The results with regard to compliance and BP reduction are encouraging and would seem to justify more widespread screening and treatment.
α1‐Antitrypsin and other Acute Phase Reactants in Liver Disease
Authors: Carlson Joyce , Eriksson Sten
Published: August 2010

ABSTRACT. The plasma acute phase reactant pattern was studied in 124 patients with liver disease and 16 healthy individuals undergoing liver biopsy. α1‐ Antitrypsin levels were found to correlate positively with the extent of hepatocellular damage, inflammatory activity and total biopsy score. Haptoglobin levels correlate negatively with these parameters and particularly with characteristics conducive to portal hypertension. Orosomucoid and fibrinogen were unaffected by extent of disease and activity. These changes result in a typical acute phase reactant pattern, seen most frequently in viral hepatitis and chronic active hepatitis and less frequently in alcoholic liver disease. When present, it has a high specificity and predictive value for detection of liver disease.
Diagnostic Significance of Lysosomal Enzymes in Different Types of Leukemias
Authors: Hultberg B. , Sjögren U.
Published: August 2010

ABSTRACT. The activities of seven different leukocyte hydrolases were studied in 19 patients and ten controls. There was a strong positive correlation between the monocyte count and the activities of the lysosomal enzymes (N‐acetyl‐β‐glucosaminidase, α‐fucosidase, β‐galactosidase, and α‐mannosidase). High α‐fucosidase and α‐mannosidase activities were also found in the eosinophilic granulocytes. Using simple commercially available synthetic substrates, it is possible to study the activities of the lysosomal enzymes in different types of leukemias and to recognize the monocytic leukemias even when they present with very immature precursor cells in the peripheral blood.
Scalene Node Biopsy in Sarcoidosis
Authors: Stjernberg N. , Truedson H. , Björnstad‐Petersen H.
Published: August 2010

ABSTRACT.Scalene node biopsy was performed by a trained surgeon in 39 patients with established sarcoidosis. The diagnostic yield in this group was compared with the results in 43 patients with established sarcoidosis who had been subjected to routine scalene node biopsies at the same clinic. Sarcoid tissue was found in 82% of the patients operated on by the trained surgeon compared with 47% in the other group. It is concluded that, in the hand of a trained surgeon with a good operating technique, scalene node biopsy is a good alternative for obtaining tissue from sarcoidosis patients for histopathological examination.
Acquired Angioedema and Hypocomplementemia in a Patient with Myelofibrosis
Authors: Nilsen Arvid , Matre Roald
Published: August 2010

ABSTRACT. This paper reports the findings of an “acquired” hereditary angioedema‐like syndrome in a patient with myelofibrosis. No previous personal or family history of angioedema was present. The serum complement pattern showed a marked reduction of CI esterase inhibitor, Clq and C4. All family members had a normal complement profile. Because of frequent attacks of laryngeal angioedema, prophylactic treatment with danazol was started. A striking clinical response was observed as well as a normalizing effect on the underlying biochemical abnormality.
Minor Signs and Symptoms of Toxicity in a Young Woman in Spite of Massive Thyroxine Ingestion
Authors: Nyström Ernst , Lindstedt Göran , Lundberg Per‐Arne
Published: August 2010

ABSTRACT. The serum concentrations of thyroxine, 3, 5, 3′‐triiodothyronine and 3, 3′, 5′‐triiodothyronine were followed during nine days in a case of acute thyroxine intoxication. On admission the concentrations were 11–12 times, 5–6 times and 16 times the normal mean, respectively. There was a striking discrepancy between the high concentrations of active hormones and the minor clinical symptoms.
Established Beta‐Adrenergic Receptor Blocking Therapy and Acute Myocardial Infarction
Authors: Dahlström Ulf , Berglund Ulf , Karlsson Erling
Published: August 2010

ABSTRACT. In order to evaluate the risks and benefits of continuing established therapy with β‐adrenergic receptor blocking drugs during acute myocardial infarction (AMI), 183 consecutive patients, 63 with (β‐blocker group) and 120 without (control group) this therapy, were studied. Detailed information on previous diseases, present symptoms, established medication, clinical and laboratory findings on admission and during the first 12 hours in the CCU was collected. The incidences of congestive heart failure, hypotension, AV blocks and ventricular arrhythmias were not significantly different in the two groups. The incidence of anterior wall infarction was the same in both groups (38%) but inferior wall infarction was significantly more common in the control group (8 vs. 28%, p<0.01). Thus, continuation of established therapy with β‐adrenergic receptor blocking drugs does not seem to increase the risk of complications after hospital admission for AMI. The reason for the low incidence of inferior wall infarction in the β‐blocker group is not clear but it cannot be excluded that when patients on β‐adrenergic receptor blocking therapy develop an inferior AMI, they may run a greater risk of sudden death.
Enteric Coated Quinidine Compared to Sustained Release Preparations during Repeated Administration
Authors: Bakke O. M. , Aanderud L. , Aslaksen A.
Published: August 2010

ABSTRACT.The concentration of quinidine in plasma was measured in 12 healthy subjects during multiple administration of an enteric coated tablet (Systodinr̀) and two sustained release preparations (Kinidin Duretterr̀ and Kinilentinr̀). In a second study, involving another 12 subjects, the enteric coated tablet and the most widely used sustained release preparation (Kinidin Duretterr̀) were compared with plain uncoated quinidine sulphate tablets in order to calculate the relative bioavailability of the formulations used for maintenance therapy. The largest area under the plasma concentration‐time curve (AUC12 h) during a dosage interval (12 hours) was obtained with the plain tablets and with the enteric coated formulation. The variation of the plasma concentrations during the dosage interval was not larger with the enteric coated tablets than with the sustained release preparations. The time of appearance of peak concentration after administration was longer and more variable with the enteric coated tablets. In relation to the plain quinidine tablets, the bioavailability of Systodin and Kinidin Duretter was 96% and 84%, respectively. In 21 out of 24 crossover experiments with Kinidin Duretter and Systodin the AUC12 hwas larger with the latter formulation. Enteric coating appears to be a simple and reliable means of achieving delayed absorption and stable quinidine plasma levels during maintenance therapy.
Dyspnea in 70‐Year‐Old People
Authors: Landahl S. , Steen B. , Svanborg A.
Published: August 2010

ABSTRACT.In the population study “70‐year‐old people in Göteborg” 45.5% of the probands were found to have an increased exertional dyspnea or to be short of breath at the medical examination. We have found it interesting to estimate to what extent a subjective experience of dyspnea at the age of 70 is related to disease and whether it is available for treatment. Out of these probands, 64% of the males and 48% of the females suffered from cardiac failure or pulmonary disease, compared to 48% of males, and 24% of females without dyspnea. Among dyspnoic probands without cardiac failure and pulmonary disease, ischemic heart disease was significantly more common than in probands without dyspnea. Probands with dyspnea but without cardiopulmonary disease felt less healthy and were more tired than others, although an objective health screening showed no difference between the two groups. They also had a significantly lower peak flow rate. A dyspnea that was not statistically related to disease was found in 30% of the males and in 43% of the females. During a 5‐year follow‐up there was no statstically significant difference in mortality between dyspnoic probands without cardiopulmonary disease and others.
Rectal Carcinoma Metastasizing to a Toe
Authors: Härkönen Mauno , Olin Paul‐Eric
Published: August 2010

ABSTRACT. We report on a 63‐year‐old patient with rectal carcinoma that metastasized to a toe. Although bone metastases from malignant tumors are common, metastatic lesions of the small bones of extremities are very rare. We have found in the literature only 29 cases of carcinoma which have metastasized to the small bones of the feet. Twenty of these cases are verified histologically. The differential diagnosis includes osteomyelitis, gout, and Reiter's disease. The roentgenographs features and the possible pathogenetic mechanisms of peripheral metastases are discussed.
Skin Cholesterol and DNA in Young Patients with Myocardial Infarction
Authors: Björnheden T. , Wiklund O. , Bergstrand R. , Bondjers G.
Published: August 2010

ABSTRACT. Disturbances in cholesterol metabolism are connected with an increased risk of clinical complications to atherosclerosis. Serum cholesterol has been used as an index of such disturbances. However, recently the significance of local tissue, and cellular factors in cholesterol metabolism and atherogenesis have been better appreciated. As easily accessible sources of cells and tissues, skin biopsies have been suggested to increase the possibilities to assess the extent of atherosclerosis in an individual. In order to test this hypothesis, skin biopsies were taken from 24 male patients, who had sustained a myocardial infarction before the age of 40, and from 42 healthy, randomly selected male volunteers, matched for age and serum cholesterol. Cholesterol and DNA contents were measured in epidermis and dermis separately; no significant differences were found between the groups. A significant, positive correlation between serum and dermis cholesterol was found in both groups. Our data do not support the hypothesis that skin biopsies discriminate individuals with atherosclerosis better than serum cholesterol. It is possible that previous data, suggesting a correlation between skin cholesterol and atherosclerosis, might reflect the well known correlation between serum cholesterol and atherosclerosis.
Treatment of Dilutional Hyponatremia in Congestive Heart Failure
Authors: Forssell G. , Nordlander R. , Orinius E.
Published: August 2010

ABSTRACT. Water restriction is a slow and difficult way to treat dilutional hyponatremia during diuretic therapy of congestive heart failure. An i.v. infusion of 400–1400 mmol hypertonic saline combined with repeated i.v. injections of loop diuretics was used instead in 9 cases (6 patients). In 4 cases with dominating left heart failure the serum sodium concentration increased and the heart failure was not aggravated as judged from pulmonary rales and body weight. Two of the five cases with dominating right heart failure responded in the same favourable way, but body weight increased 1–2 kg and hyponatremia reappeared in three. The only difference observed between responders and non‐responders was that the re‐sponders were free from leg edema. This treatment of dilutional hyponatremia seems worth further cautious use in situations in which water restriction is troublesome, but it should probably be reserved for patients without severe right heart failure.
Two Patients with Recurrent Pneumonias in One Lung
Authors: van der Weide M. , Haasbeek F. , Hohmann F. R. , Hulst S. G. Th.
Published: August 2010

ABSTRACT. Case histories are described of two young patients, both known to have recurrent infections of one pulmonary lobe. Further investigations (especially aortography) disclosed the cause in both to be an intrapulmonary sequestration. Surgical intervention made both patients symptom‐free. The aetiology, clinical and investigational findings as well as therapy are discussed. The need for further investigations in patients with recurring infections of one pulmonary lobe is stressed.
Localization of Aldosterone‐Producing Tumours in Primary Aldosteronism by Adrenal and Renal Vein Catheterization
Authors: Lund J. O. , Nielsen M. Damkjaer , Giese J. , Gammelgaard P. A. , Hasner E. , Hesse B. , Tønnesen K. H.
Published: August 2010

ABSTRACT. Regional venous plasma aldosterone concentrations were determined and assessed against concurrent arterial levels in 16 patients with primary aldosteronism. The results obtained by sampling from the left adrenal vein or the left renal vein allowed correct side prediction of the presupposed adenoma in each patient. The problems caused by intermittent secretion of aldosterone by the tumour and the importance of correct positioning of the catheter are emphasized. Repeated sampling and continuing reference to systemic, arterial aldosterone levels proved valuable.
Plasma ACTH in Patients with Bronchogenic Carcinoma
Authors: Torstensson Sören , Thorén Marja , Hall Kerstin
Published: August 2010

ABSTRACT. Immunoreactive ACTH before and five hours after administration of 2 mg of dexamethasone was determined in patients examined in hospital for abnormalities on chest X‐ray. Thirty patients had primary bronchial cancer, 15 had other lung conditions, mostly inflammatory infiltrations. The mean total ACTH and ACTH after dexamethasone suppression were significantly higher in the patients with bronchial cancer than in patients with other lung lesions or healthy controls. ACTH in plasma after administration of glucocorticoids was predominantly big ACTH. Several of the cancer patients bad, however, ACTH levels within the same range as the other subjects. These results indicate that plasms ACTH determinations are of limited value as tumour markers for the detection of lung cancer although it is still possible that repeated sampling in patients with elevated ACTH levels may be of value when monitoring the therapy.
The Effects of Long‐Term Antithyroid Drug Treatment on Serum Reverse T3 in Patients with Graves' Disease
Authors: Dahlberg P. A. , Karlsson F. A. , Wide L.
Published: August 2010

ABSTRACT. The effects of long‐term treatment with antithyroid drugs, carbimazole (CMI) or propylthiouracil (PTU), on serum reverse triiodothyronine (rT3) levels were studied in 23 patients with Graves' disease. Nineteen patients were given CMI and four PTU for a minimum of six months. After one month of treatment the serum levels of thyroxine (T4), triiodothyronine (T3) and rT3 had normalized in both groups. When L‐thyroxine was added to the regimens after two months of therapy, both serum T4 and rT3 levels increased, whereas serum T3 level continued to fall. The serum levels of rT3 seemed to be dependent on and followed the T4 levels so closely that determinations of rT3 in the medical management of patients with Graves' disease will be of little clinical use.
Hyperaminoaciduria in Mild Phosphate Diabetes in Adults
Authors: Holmgren Gösta , Lindqvist Bengt , Lundberg Erik
Published: August 2010

ABSTRACT. Quantitative urinary amino acid excretion has been studied in 23 adult patients with mild phosphate diabetes (MPD), in 22 adult control patients with various renal disorders and in 15 children, 7–19 years old, with atopic disorders (normal controls). Statistically significant increases in urinary excretion of glutamine (p<0.01), glycine (p<0.01) and cystine (p<0.05) were found in the MPD patients compared to the normal controls. The urinary excretion of glutamine was significantly increased while the increases in cystine and glycine excretions were non‐significant when MPD patients were compared to the control patients. In addition to clinical signs and analyses of plasma and urinary phosphate, a quantitative evaluation of urinary amino acids might be a tool in the diagnosis of MPD. The significance of the increased urinary amino acid excretion in MPD is discussed.
Fibronectin and Atherosclerosis
Authors: Stenman Svante , von Smitten Karl , Vaheri Antti
Published: August 2010

ABSTRACT. Fibronectin is a polymorphic glycoprotein of plasma, other body fluids and connective tissue, and it occurs in an insoluble and a soluble form. Insoluble fibronectin is found associated with basement membranes and in loose connective tissue matrix as well as in the pericellular matrix formed around cultured adherent cells, such as endothelial, fibroblastic and smooth muscle cells. In these positions fibronectin apparently functions as a substrate for cell attachment and as a scaffold for cell migration and movement. Soluble fibronectin, present e.g. in the circulation (300 μg/ml) exhibits some important interactions with other proteins. It is covalently cross‐linked to fibrin during thrombus formation and binds to collagen. Fibronectin is released from platelets during their aggregation and soluble fibronectin potentiates the action of plasminogen activator. We have detected fibronectin in the sub‐endothelium, in the matrix of smooth muscle cells of the media and in the adventitia of arteries. By using immunohistological techniques we have further found that fibronectin is prominent in atherosclerotic lesions of the intima, especially in developing fibrous plaques. Fibronectin was also prominent in experimentally induced atherosclerotic lesions. These findings suggest that fibronectin is an indicator of connective tissue formation in atherosclerotic processes and that the protein can have a role in their pathogenesis.
A RENAL BIOPSY STUDY wITH LIGHT AND IMMUNO‐FLUORESCENT MICROSCOPY IN RHEUMATOID ARTHERITIS
Authors: Ørjavik O. , Brodwall E. K. , Øystese B. , Natvig J. B. , Mellbye O. J.
Published: August 2010

Renal biopsies were performed on 14 patients with active rheumatoid arthritis and proteinuria of whom 7 patients had reduced creatinine clearance.

Glomerular hypercellularity was found in six and amyloid in seven biopsies. Immunofluorescence microscopy revealed glomerular deposits of immunoglobulins and complement in 10 of 12 biopsies, indicating an active immunologic process causing the impaired renal function.
CORONARY RISK FACTORS AND PHYSICAL FITNESS IN HEALTHY MIDDLE‐AGED MEN
Authors: Erikssen Jan , Forfang Kolbjørn , Jervell Jak
Published: August 2010

In 1832 healthy men aged 40–59 years subjected to a near maximal bicycle exercise test, physical fitness declined with age. Higher levels of physical fitness were in all agegroups associated with lower cigarette consumption, blood pressure, serum triglycerides, hemoglobin and with better pulmonary function. Serum cholesterol, however, was independent of changes in physical fitness. In view of the beneficial effect of high physical acitivty on the well‐known coronary risk factors, it is surprising that it has proved so difficult to show a protective effect of increased physical fitness and activity on coronary heart disease and its manifestations.
STUDIES ON DIGITALIS 15. BIOAVAILABILITY OF DIGITOXIN
Authors: Storstein Liv , Johnsgård Marit
Published: August 2010

The bioavailability of one Norwegian (NAF) and one Swedish (ACO) commercial digitoxin brand was studied in 6 healthy control subjects, aged 26–43 years, 3 females and 3 males and compared with data after intravenous injection to the same subjects. Digitoxin (0.6 mg) was given as tablets or injection in the fasting state. A standard breakfast was given after 1/2 hour and a standard lunch after 3 1/2 hours. Blood samples were drawn after 0, 30, 60, 90 minutes and 2, 3, 4, 6 and 24 hours. Serum digitoxin concentrations were determined with a modified86Rb method. In vitro dissolution of tablets was tested according to United States Pharmacopeia (USP) recommendations. Peak concentrations observed 60 minutes after tablet intake were significantly higher after intravenous than peroral administration. The area under the serum concentration curve (AUC) during the first 24 hours was significnatly lower after NAF (84.7%), and ACO (89.7%) tablets than after intravenous injection. Absolute bioavailability for the two digitoxin brands, when AUC was calculated unto infinity was 90.6% for NAF and 91.2% for ACO tablets. Dissolution rate met USP requirements for both brands, dissolution being complete after 60 minutes.

The present study has shown high bioavailability of two commercially available Scandinavian digitoxin brands.
Blood Pressure Reduction by Change in Life Style. The CVD Intervention Study in Glostrup
Authors: Gyntelberg F. , Mørck H. I. , Agner E. , Brendstrup T. , Hollnagel H. , Schroll M.
Published: August 2010

Abstract: In a controlled, primary intervention, cardiovascular survey of 928 men and women aged exactly 30, 40, 50 & 60 years, a significant reduction (about 5 mmHg) was found in systolic blood pressure mean difference before and after intervention between the intervention‐ and control group. The observation time was 7 months. Most of the twentynine drop outs were excluded for personal reasons or because of antihypertensive treatment. A reasonable explanation for the blood pressure reduction is a change in life style, in the intervention group. The subjects in the intervention group increased physical activity and decreased fat and salt intake in contrast to the control group (p < 0.001, 0.005).
Determination of Electrolytes—Methodological Problems
Authors: Bergström Jonas
Published: August 2010

To avoid errors in plasma potassium determination clenching of the fist should be avoided and heparinized blood should be used. The patient should be fasting and samples taken at the same time of the day. When evaluating intracellular potassium from plasma potassium acid based status should be considered. The clinical status should also be considered, since severely ill patients may have a low transmembrane potential leading to loss of cell potassium and increase in plasma potassium. Measurements of exchangable sodium and potassium with radioactive tracers or whole body potassium (40K) are inprecise for determination of absolute cellular concentrations but more suitable for longitudinal studies. Determination of red cell electrolytes is of limited value, since these cells are not typical for the body cells. Electrolyte determination in leukocytes may give more accurate information. Muscle water and electrolytes can be determined in needle biopsy material. The concentration of intracellular electrolytes are expressed in relation to different bases of reference (FFS, GFFS, alkali‐soluble protein, phosphorous, and intracellular water); the advantages and fallacies in using these references are discussed.
Magnesium Deficiency. Etiology and Clinical Spectrum
Authors: Flink Edmund B.
Published: August 2010

Magnesium deficiency may complicate many diseases. The causes include the following: inadequate intake during starvation or increased requirement during early childhood, pregnancy, or lactation; excessive losses of magnesium as a result of malabsorption from the gastrointestinal tract or from the kidneys during use of diuretics; and to a combination of the two, as in alcoholism. Most often the etiological factors have been operative for a month or more. Acute hypo‐magnesemia can occur without previous Mg deficiency after epinephrine, cold stress and stress of serious injury or extensive surgery.

The clinical manifestations depend on the age of the patient and may begin insidiously or with dramatic suddenness, or there may be no overt symptoms or signs. The manifestations can be divided into the following categories: totally non‐specific symptoms and signs ascribable to the primary disease; neuromuscular hyperactivity including tremor, myoclonic jerks, convulsions, Chvostek sign, Trousseau sign (rarely), spontaneous carpopedal spasm (rarely), ataxia, nystagmus and dysphagia; psychiatric disturbances from apathy and coma to some or all facets of delirium; cardiac arrhythmias including ventricular fibrillation and sudden death; hypocalcemia which is responsive only to Mg therapy; and hypokalemia which is not easily nor completely corrected without Mg therapy. The diversity of etiologies and the multiplicity of manifestations result in confusion and controversy.

The documentation of normal renal function is absolutely necessary for maximum doses. The order of magnitude of dose is 1.0 meq Mg/kg on day 1, and 0.3 to 0.5 mEq/kg per day for 3 to 5 days. In emergencies such as convulsions or ventricular arrhythmias, a bolus injection of 1.0 gm (8.1 meq) of MgSO4 is indicated. Therapy of Mg deficiency in the presence of renal insufficiency requires smaller doses and frequent monitoring. Complete repletion occurs slowly.
Magnesium and Potassium Interrelationships Experimental and Clinical
Authors: Whang Robert , Oei Tjien O. , Aikawa Jerry K. , Ryan Michael P. , Watanabe August , Chrysant Stephen G. , Fryer Alice
Published: August 2010

1) Coexisting Mg and K deficiency may occur with greater frequency than has been previously appreciated. 2) Profound hypokalemia, or refractoriness to K repletion or coexisting hypokalemia and hypocalcemia should suggest the possibility of concurrent Mg and K depletion. 3) The identification and treatment of concurrent K and Mg depletion is especially important in patients with congestive heart failure because of problem of digitalis toxicity. 4) We believe that the role of magnesium in optimizing cardiac function remains to be elucidated, identification and treatment of coexisting Mg and K depletion will be facilitated by making serum Mg a routine electrolyte determination together with Na, K, CI, CO2.
EVALUATION OF ESOPHAGEAL FUNCTION IN PATIENTS WITH CENTRAL CHEST PAIN
Authors: Brand Douglas L. , Ilves Riivo , Pope Charles E.
Published: August 2010

ABSTRACT. Esophageal motor function tests were performed in 160 patients presenting with central chest pain clinically resembling myocardial ischemia. Motor abnormalities consisting of high amplitude, long duration peristaltic waves, diffuse spasm, or simultaneous contractions were found in 63 of those patients Direct correlation of the motor patterns with chest pain was possible in fourteen patients; another fourteen patients had reproduction of their pain with intraluminal acid. Clinical criteria could not differentiate those with esophageal pain from others. Esophageal function test can help in the diagnosis of central chest pain, but they have low sensitivity.
THE ACID PERFUSION TEST AS DIFFERENTIAL DIAGNOSTIC AID IN PATIENTS WITH CHEST PAIN
Authors: Wranne Bengt , Areskog Magnus , Tibbling Lita
Published: August 2010

ABSTRACT.A short review of the literature of the acid perfusion test is first given. Data from 67 patients with chest pain investigated with an acid perfusion test during ECG‐surveillance in close connection to an exercise test are then presented. Arrhythmias or ST‐T changes on ECG were not induced by the acid infusion. Six patients had a »positive related« acid perfusion test which in this context means that they recognized the chest discomfort elicited by the acid infusion as that which had brought them to the exercise test. The acid perfusion test in close connection to an exercise test is in selected patients a safe and useful technique for establishing whether or not the symptoms have an oesophageal component.
DIAGNOSIS AND PROGNOSIS OF CHEST PAIN WITH NORMAL CORONARY ARTERIOGRAMS
Authors: Dart A.M. , Davies H. Alban , Dalal J. , Ruttley M. , Henderson A.H.
Published: August 2010

ABSTRACT. Ninety‐eight patients previously investigated for suspected angina but shown to have normal coronary arteriograms were reviewed. The prognosis for life expectancy was excellent but 76% were still symptomatic after average follow up of three years. 41% of those re‐evaluated were still thought to be describing cardiac‐like pain. Full re‐investigation showed coronary artery spasm or other causes of myocardial ischaemia to be rare whereas oesophageal spasm was a common cause of the pain.
ERGOMETRINE PROVOCATION IN THE DIAGNOSIS OF OESOPHAGEALSPASM
Authors: Davies H. Alban , Dart A.M. , Lowndes R.H. , Rhodes J. , Henderson A.H.
Published: August 2010

ABSTRACT. Twenty‐two patients with chest pain and normal coronary angiograms were given intravenously ergometrine while oesophageal manometry was being carried out. Thirteen of the patients had neither pain nor significant motility disturbance after ergometrine. Ergometrine provocation enabled a diagnosis to be made in nine patients in whom routine investigations of the oesophagus were normal.
METABOLIC ASPECTS OF RHYTHM DISTURBANCES
Authors: Russell D. C. , Lawrie J. S. , Riemersma R. A. , Oliver M. F.
Published: August 2010

Profound alterations in metabolism occur within the first few minutes of myocardial ischaemia which may induce or modulate myocardial electrophysiological abnormalities and arrhythmogenesis, Fatty acid oxidation is inhibited with accumulation of long‐chain acyl CoA esters and glycolysis is stimulated but later inhibited. This may be worsened by a peripheral sympathetic response. In particular regional variations in glycolytic ATP productions which can modulate «slow channel» ion flux and hence slow conducting «slow response» potential activity, could influence patterns of slowed conduction in ischaemic myocardium of importance in generating early re‐entrant arrhythmias.

This possibility has been examined in open chest anaesthetised dogs following experimental coronary occlusion by detailed computer aided analysis and construction of three dimensional maps of regional metabolism, blood flow and epicardial activation patterns at the time of early ventricular arrhythmias. Activation patterns were obtained using an electronic multiplexing system, flow using tracer microspheres and metabolic changes by analysis of multiple tissue samples for lactate and indices of glycolytic activity after rapid excision and freezing of the heart. Marked spacial inhomogeneities in flow, lactate and glycolytic activity were associated with delayed and fragmented activation in the central ischaemic region. Within the border region of flow, however, glycolytic activity was enhanced and conduction generally little impaired.

It is suggested that transient changes in the homogeneity of myocardial metabolism and flow are critical in determining patterns of conduction and hence arrhythmogenesis. This may provide a basis for understanding anti‐arrhythmic effects of metabolic interventions.
EFFECT OF TIMOLOL ON PLATELET AGGREGATION IN CORONARY HEART DISEASE
Authors: Thaulow Erik , Kjekshus John , Erikssen Jan
Published: August 2010

The immediate effect of beta‐blockers versus placebo in platelet function was studied in ten healthy men one hour after either 40 mg propranolol, 5 mg timolol or placebo was given. Both beta‐blockers had similar platelet effects. They increased the ADP‐threshold in a platelet aggregation test and reduced the plasma level of beta‐thromboglobulin whereas the primary aggregation remained unchanged. Forty‐four patients were given timolol 10 mg twice daily or corresponding placebo medication in a secondary prevention trial after a myocardial infarction. At rest and also immediately after a near maximal exercise test the platelet function was similar on timolol and placebo. During exercise a lower ADP‐threshold and a higher plasma level of beta‐thromboglobulin was observed irrespective of whether the patients received placebo or timolol. Thus, the acute platelet inhibiting effect of timolol observed after a single dose disappeared during chronic timolol treatment. During 24 hours continuous ambulatory ECG monitoring patients on timolol treatment had significantly less arrhythmias than patients on placebo. A general effect on platelets cannot explain this antiarrhythmic effect of timolol during chronic therapy.