bluuebunny/crossref_metadata_2025 huggingface dataset:
HEMODYNAMIC AND HORMONAL CHANGES INDUCED BY NOISE
Authors: Andrén Lennart , Hansson Lennart , Björkman Martin , Jonsson Anders , Borg Karl Olof
Published: August 2010

ABSTRACTEighteen healthy male volunteers with normal hearing were exposed to industrial noise at different sound levels (75, 85 and 95 dB A) in a noise laboratory. Blood pressure, heart rate, stroke volume and cardiac output were recorded with noninvasive techniques. Adrenaline and noradrenaline concentration in venous plasma were analyzed before and during noise exposure. The mean resting blood pressure of the whole group was 120/70 mm Hg. During noise stimulation diastolic blood pressure increased (12.2%, p < 0.001) as did mean arterial pressure (6.6%, p < 0.001) and total peripheral resistance (12.7%, p < 0.001). Stroke volume (7.3%, p < 0.001) and cardiac output (5.0%, p < 0.01) were both reduced at 95 dB A.

Heart rate and systolic blood pressure did not change significantly. At 75 and 85 dB A there were similar but smaller changes in the hemodynamic parameters.

There were no changes in adrenaline and noradrenaline in plasma during maximal noise exposure.

The noise induced hemodynamic changes remained 5 minutes after the noise stimulation was stopped but had disappeared after 10 minutes of rest.
INFLUENCE OF PHARMACOLOGIC INTERVENTION AND VALVULAR HEART DISEASE ON LEFT VENTRICULAR EJECTION PHASE INDICES: A REVIEW.
Authors: HAGAN A.D.
Published: August 2010

Echocardiography represents an established noninvasive technique to evaluate left ventricular (LV) performance. The LV ejection phase indices may be divided into three categories: (1) volume‐dependent, (2) circumferential, and (3) wall thickening. Since the latter two are not volume dependent, they are clinically more useful in patients with dilated left ventricles. These parameters have limited clinical value in the presence of left‐sided volume overload conditions (e g, mitral regurgitation and aortic regurgitation) since significant LV dysfunction may exist in the presence of normal ejection phase indices by echo. The echocardiogram is also a sensitive procedure to detect subtle alterations in LV function following acute or chronic interventions with various types of vasoactive and inotropic drugs.
Early and Sudden Deaths after Myocardial Infarction
Authors: Helmers C. , Lundman T.
Published: August 2010

ABSTRACT. 1329 patients were discharged alive after acute myocardial infarction initially treated in a CCU. In a five‐year follow‐up, 537 (40%) of the patients died. Routine data registered uniformly during the CCU period showed that, apart from age, the most important factors regarding long‐term prognosis in general were previous ischaemic heart disease and direct or indirect signs of heart failure registered in the CCU. The possibilities to predict sudden death (130 patients died within 2 hours of onset of final symptoms during the follow‐up period) were small, although a definite dominance of this mode of death was noted in patients below 60 years of age. The clinical profile of the majority of the 134 patients who died during the first half‐year was distinguished by a history of prior myocardial infarction and signs of left heart failure during the CCU stay. However, in a significant number of patients dying early after discharge, none of the ordinary unfavourable prognostic signs had been registered.
Detection of Asystole, Ventricular Fibrillation and Ventricular Tachycardia with Automated ECG Monitoring
Authors: Hulting Johan
Published: August 2010

ABSTRACT. The performance of an automated arrhythmia monitoring system has been studied with reference to asystole, ventricular fibrillation (VF) and ventricular tachycardia (VT) during two periods of routine monitoring. The system distinguished normal, supraventricular and ventricular ectopic beats with the use of rhythm and QRST data. VF was recognized from the power spectrum of the ECG. A total of 17 arrhythmia diagnoses (alarms) could be made by the system. A write‐out, with a delayed ECG and a diagnostic message in parallel, was recorded at each alarm. In the first part of the study a continuous ECG, used as a reference, was recorded from all patients in the coronary care unit during a 4‐week period. The number of manually recorded episodes of asystole, VF and VT was 24, 4 and 44, respectively. Out of these, 92, 100 and 82%, respectively, were reproduced on the alarm write‐outs. A correct diagnosis was made by the automated system in 33, 75 and 70% of true asystole, VF and VT events, respectively. Three false asystole alarms, all due to loose electrodes, were reported during this part of the study. In the second part of the study all arrhythmia write‐outs were analysed for six months for the occurrence of VF and VT alarms. Out of 22 episodes of VF, 73% were reported as VF and the remaining as VT. Of 534 VT episodes, 82% were diagnosed correctly. The proportions of correct: false positive VF and VT detections were approximately 1: 5 and 4: 1. Compared with conventional monitoring, the automated system seems to specifically improve the detection rate of VT.
Evolution of ST Segment and Q and R Waves during Early Phase of Inferior Myocardial Infarction
Authors: Thygesen K. , Hørder M. , Nielsen B. Lyager , Petersen P. Hyltoft
Published: August 2010

ABSTRACT.Using the aVF lead, the ST segment deviation and the amplitudes of Q and R waves were measured hourly for 48 hours after the onset of symptoms in 14 patients with inferior AMI. The average ST deviation reaches a maximum elevation at about 3 hours and then falls to a uniform level within 12 hours. The average depth of the Q waves began to increase within the first 2 hours, and the increase was linear until around the 12th hour, whereafter the depth was somewhat uneven. The average height of the R waves declined almost linearly from the 3rd to 15th hour, after which the height became fairly uniform. Within a 48‐hour period after the onset of symptoms, there was a significant positive correlation not only between the average amplitudes of the Q and R waves (r= 0.951,p> 0.001), but also between the courses of the individual Q and R waves in 13 of the 14 patients. A significant positive correlation was found between ST elevation at 3 hours and the reduction in the R wave within 24 hours (r= 0.634,p> 0.05), but no correlation existed between ST elevation and the Q wave at these times. It is concluded that within 48 hours of the onset of symptoms, the magnitude of electrically inert myocardial tissue can be determined by the course of the Q or R waves, but that during the first 24 hours the R wave is superior to the Q wave for evaluating the evolution of the infarction process.
Long‐Term Clinical Experience with Atenolol—a New Selective β‐1‐Blocker with Few Side‐Effects from the Central Nervous System
Authors: Henningsen Nels Chr. , Mattiasson Ingrid
Published: August 2010

ABSTRACT. During the last four years we have used a new cardioselective β‐adrenergic blocking substance, ICI 66.082 (atenolol or Tenormin®), alone or in combination with other drugs for treatment of hypertension in a total of 104 patients, including 15 with a chronic obstructive lung disease. Fifty‐one patients started treatment with atenolol because of side‐effects—especially from the central nervous system—during previous treatment with non‐selective β‐blockers, mostly propranolol (Inderal®). Mean duration of treatment was 16 months (range 8–36) and mean dosage 163 mg/day. In 18 patients treatment with Tenormin was withdrawn, but only in 10 of them could this be referred to side‐effects. Of the 51 patients who complained of or showed sideeffects from another β‐blocker, 80% were improved after changing to Tenormin. Of the patients with side‐effects from the central nervous system, 73% improved, especially those who complained of nightmares, hallucinations, insomnia or mild depression.
Menopausal Age in Relation to Smoking
Authors: Lindquist Olof , Bengtsson Calle
Published: August 2010

ABSTRACT. A population study of women revealed more smokers among 50‐year‐old postmenopausal women than among women of the same age who still menstruated. The difference was statistically significant. The postmenopausal smokers had on average smoked as long as or longer than the smokers who still menstruated. The higher number of smokers among postmenopausal women could thus not be explained by these women starting to smoke in connection with the menopause. Non‐smoking women were on average heavier than smoking women. Previous studies indicate that an increased amount of adipose tissue might delay the menopausal age. It is therefore possible that the difference in menopausal age between smoking and non‐smoking women might be explained either by a delayed menopause in non‐smoking women due to an increased amount of adipose tissue in these women, or by a precocious menopause in smokers due to toxic effects from smoking. Probably both factors are of importance, but our results indicate that smoking per se is the main factor. The increased number of smokers among women with precocious menopause can probably explain part of the overrepresentation of women with precocious menopause among those who have myocardial infarction.
The Effect of Cimetidine, a New Histamine H2‐Receptor Antagonist, on Renal Function
Authors: Larsson Rutger , Bodemar Göran , Kågedal Bertil
Published: August 2010

ABSTRACT. Serum creatinine, endogenous creatinine clearance, (51Cr)EDTA plasma clearance and the concentration of β2‐microglobulin in serum and urine were determined in 19 patients before and during treatment with cimetidine for peptic ulcer disease. The mean concentrations of creatinine and β2‐microglobulin in serum increased significantly within normal limits after 2 and 6 weeks' treatment. However, creatinine clearance and (51Cr)EDTA plasma clearance were unchanged during the treatment. Thus, the observed increases in serum creatinine and β2‐microglobulin could not be explained by a diminished glomerular filtration rate. Inhibited tubular secretion of creatinine may explain the observed increase in serum creatinine during cimetidine treatment. Another hypothetical possibility is that a small increase in tubular reabsorption of both creatinine and β2‐microglobulin would account for the observed increases in creatinine and β2‐microglobulin in serum. It is concluded that, although statistically significant, the increases in serum creatinine and β2‐microglobulin are small and therefore of little relevance for the patient's treatment with cimetidine.
Autoantibodies and Serum Immunoglobulins in Chronic Liver Diseases
Authors: Ladefoged K. , Andersen P. , Jørgensen J.
Published: August 2010

ABSTRACT. In a prospective consecutive study, 68 patients with various liver diseases and 67 control persons were examined for the occurrence of smooth muscle antibodies (SMA), antinuclear antibodies (ANA) and mitochondrial antibodies (MTA) of IgG, IgA and IgM class. A determination of serum immunoglobulins (S‐IgG, S‐IgA and S‐IgM) was also performed. IgG‐SMA in titres of >80 occurred in 8 of 12 patients (67%) with hepatitis B antigen (HBag)‐negative chronic active liver disease (CALD) and not in other diseases. Apart from one patient with primary biliary cirrhosis (PBC), IgG‐ANA in titres of >40 were likewise detected only in HBagnegative CALD (33%). The titres of IgG‐SMA and IgG‐ANA varied analogously with the biochemical liver parametres. There was a mutual exclusion between HBag and IgG‐SMA/‐ANA in titres of >20, while IgM‐SMA occurred in titres of 80 in two patients with HBag‐positive CALD. The incidence and titres of IgM‐SMA and ‐ANA were not higher than in the controls. IgA‐SMA and ‐ANA were detected only sporadically. The MTA demonstrated were of IgG class and titres of >40 were found only in patients with PBC (4 of 5). Some of the patients in all groups had an increased concentration of one or more of the serum immunoglobulins. S‐IgG levels were found to be significantly higher in CALD than in the other groups.
The Course of Endocrine Ophthalmopathy during Antithyroid Therapy in a Prospective Study
Authors: Solem J. H. , Segaard E. , Ytteborg J.
Published: August 2010

ABSTRACT. In a prospective study the ocular manifestations of 105 thyrotoxic patients were carefully observed and registered during a 24‐month antithyroid drug therapy. The treatment was supervised very closely and every effort was made to avoid iatrogenic hypothyroidism. None of the patients required any ocular surgery and in none did the ophthalmopathy become significantly worse. This favourable experience may indicate that a careful antithyroid regimen as outlined is not likely to be accompanied by worsening of the endocrine ophthalmopathy.
Fatal Renal Vasculitis and Minimal Change Glomerulonephritis Complicating Treatment with Penicillamine
Authors: Falck Hans M. , Törnroth Tom , Kock Boris , Wegelius Otto
Published: August 2010

ABSTRACT. Two cases with different and not previously described fatal renal complications during treatment with penicillamine are reported. A man with seronegative rheumatoid arthritis with features of systemic lupus erythematosus was treated with penicillamine for six months and developed a mild membranous glomerulonephritis and a severe renal vasculitis leading to uremia and death. A woman with primary biliary cirrhosis was treated with penicillamine for nine months and developed a nephrotic syndrome, the renal biopsy showing minimal change glomerulonephritis. The nephrotic syndrome responded to prednisone but the patient died, probably from septicemia. Penicillamine may thus cause glomerular damage without deposition of immune complexes. A restricted use of the drug is recommended.
Metabolic Studies and Glucagon Gel Filtration Pattern before and after Surgery in a Case of Glucagonoma Syndrome
Authors: von Schenck H. , Thorell J. I. , Berg J. , Bojs G. , Dymling J. F. , Hallengren B. , Ljungber O. , Tibblin S.
Published: August 2010

ABSTRACT. A case of glucagonoma syndrome with necrolytic migratory erythema, glossitis, anemia, hyperglucagonemia and a malignant, pancreatic A‐cell tumour in a 68‐year‐old male is described. Gel filtration of the highly elevated circulating glucagon immunoreactivity (2200 pg/ml) demonstrated 60% pancreatic glucagon and 30% “proglucagon”. Metabolic studies before operation demonstrated suppression of the total plasma glucagon concentration on oral glucose tolerance test, unchanged total plasma glucagon concentration during intravenous glucose tolerance test and insulin‐induced hypoglycemia. Administration of arginine was followed by a rise in both the pancreatic glucagon and the “proglucagon”, whereas alanine increased only the pancreatic glucagon. The plasma somatostatin level was immeasurable preoperatively. Somatostatin infusion completely suppressed the release of the pancreatic glucagon but did not significantly affect the “proglucagon”. After removal of the tumour the skin lesions disappeared and the total plasma glucagon values fell to normal levels (120 pg/ml). Also, other abnormal laboratory findings returned to normal, including the preoperatively observed renal glucosuria.
Comparison of Biopsy Procedures in Intrathoracic Sarcoidosis
Authors: Munkgaard Stig , Neukirch Frits
Published: August 2010

ABSTRACT.A series of 78 patients, mainly young males, with intrathoracic manifestations of sarcoidosis, found on routine chest X‐ray, were examined according to a prescheduled program including different biopsy procedures. In 76% the intrathoracic changes were isolated hilar adenopathy, in 9% isolated pulmonary lesions and in 15% hilar adenopathy plus pulmonary lesions. Lymph nodes containing granulomas were found by mediastinoscopy in 41 of 44 patients and by scalene fat pad biopsy in 20 of 34 patients. In 27 of 76 patients granulomas were found by liver biopsy. Complications to the biopsies were more frequent with mediastinoscopy than with the other two biopsy procedures, but no serious complications occurred. Biopsy through mediastinoscopy is thus preferable in patients of this kind. The necessity of doing biopsies to support the diagnosis of sarcoidosis is discussed on the basis of the literature and our own studies. In younger patients with asymptomatic, bilateral hilar adenopathy without pulmonary lesions it seems justifiable to omit biopsy, whereas biopsy is mandatory in patients with unilateral hilar lymph adenopathy and patients with pulmonary lesions. In all cases the course of the disease should be followed for a rather long period.
Minoxidil in Refractory Hypertension
Authors: Andersson Ove , Sivertsson Ramon
Published: August 2010

ABSTRACT.Ten patients, refractory to antihypertensive treatment with diuretics, β‐adrenergic blocking drugs and hydralazine, were investigated. They had previously shown increased total peripheral resistance as well as increased blood flow resistance at rest and at maximal vasodilatation in a local vascular bed (calf), compared to hypertensive patients responding adequately to the same triple drug treatment. The results showed no differences between the groups in vascular smooth muscle tone at rest or in plasma volume. It was concluded that the inadequate response to therapy was mainly caused by a vascular abnormality interpreted as structural adaptive changes of the arteriolar vessel wall, more pronounced in the patients refractory to treatment. The patients were then treated with minoxidil (15–35 mg/day) as the only vasodilating agent, the dose of the β‐adrenergic blocking agent and the diuretic therapy being kept almost constant. Plasma volume (Evans Blue) measurements and peripheral hemodynamic investigations were made during the previous regimen and when an acceptable BP reduction had been achieved on the combined treatment with minoxidil. Peripheral hemodynamic experiments on the calf blood flow were made with venous occlusion plethysmography at rest (resting flow and resistance) and after arterial occlusion and muslce work (maximal flow and resistance at maximal dilatation). BP was recorded simultaneously with the flow determinations indirectly in the right arm. After the change to minoxidil all patients displayed a reduction of arterial BP and reached adequate levels within two months. This BP reduction correlated positively to an increase in resting blood flow and was associated with decreased peripheral resistance at rest. A tendency towards increased plasma volume was demonstrated. No change was found in the resistance at maximal dilatation. Consequently, no sign of reversibility of the vascular abnormality was demonstrated after 1–2 months of BP‐lowering therapy.
Occurrence of Acute Myocardial Infarction in Stockholm Studied by Two Different Methods
Authors: Ahlbom A. , Rosenqvist U. , Böttiger L. E. , Carlson L. A. , Åfelt P. E.
Published: August 2010

ABSTRACT. Two studies on the occurrence of acute myocardial infarction (AMI) in Stockholm have been made. In one, the study population consisted of patients who attended a health‐control station; cases of AMI were detected retrospectively by a mail questionnaire and by the official cause‐of‐death register. In the other study, the population comprised the total population of Stockholm county; cases of AMI were detected from routine information on hospital care, and from the official cause‐of‐death register. The aims of the present study were to compare the two methods for detection of AMI cases and to compare the AMI morbidity of the two populations. The mail questionnaire method missed a small number of cases but, on the other hand, the register method included some cases in which the diagnostic criteria were not fulfilled. The AMI morbidity in the two populations did not differ significantly.
Oesophageal Dysfunction in Non‐Infarction Coronary Care Unit Patients
Authors: Areskog Magnus , Tibbling Lita , Wranne Bengt
Published: August 2010

ABSTRACT.Oesophageal dysfunction (OD) is a common finding in patients discharged from a coronary care unit without definite diagnosis. Of 55 patients investigated with oesophageal manometry, acid perfusion test and exercise ECG, 32 had signs of OD and 19 signs of ischaemic heart disease (IHD). Symptoms such as heart burn, acid regurgitations, feeling of a lump in the throat, surfeitness after meals, chest pain at night, and relief of chest pain when lying with the head raised were significantly more common in patients with OD than in patients with normal oesophageal function. Chest pain was significantly more often provoked by effort, emotions or cold and more often relieved by nitroglycerine in patients with signs of IHD than in those without. These pain‐provoking factors were, however, also common in patients with OD. A careful case history with specific inquiry directed at not only cardiac but also oesophageal symptoms is important in the differential diagnosis of chest pain.
Maintenance of Potassium Balance during Diuretic Therapy
Authors: Kohvakka Antti , Eisalo Antti , Manninen Vesa
Published: August 2010

ABSTRACT. The relative efficacies of potassium chloride, amiloride, triamterene and spironolactone in maintaining potassium balance were studied in 40 patients with essential hypertension receiving diuretic therapy. The preparations were administered in random order in a cross‐over manner. In 31 patients treated with 50 mg hydrochlorothiazide daily, addition of 1500 mg potassium chloride daily was the weakest and 50 mg spironolactone daily the most effective agent for maintaining serum potassium. Amiloride (5 mg daily) and triamterene (75 mg daily) were less effective and equally so. Similar results were obtained with 9 patients treated with double dosages of the diuretic and supplements. Despite changes in serum potassium, total body potassium remained constant throughout the trial.
Self‐Therapy for Haemophilia in Norway.
Authors: Evensen S. A. , Thaule Ruth , Grøan Kari
Published: August 2010

ABSTRACT.During the years 1975–77, 35 patients with haemophilia A or B (factor level of 1% or less) were instructed to administer concentrates of the deficient factor (mean dose 14 U/kg) i.v. in case of episodic, uncomplicated bleedings without prior consultation with a physician. At Dec. 1977, 33 of these patients (29 with haemophilia A, 4 with B) were taking part in the program. They represent 35% of all Norwegian patients above 7 years of age with severe haemophilia in whom high‐titered antibodies have not been demonstrated. For 13 patients, records from 2 years on self‐therapy have been compared with records from the last year before self‐therapy. During the first year on self‐therapy the number of days lost from work dropped by 77%, while the number of transfusions increased by 22%. During the second year, days lost from work were still low (68% decrease compared to the year preceding self‐therapy) and the transfusion frequency remained unchanged. Significant side‐effects of antihaemophilic concentrates were not observed and vein damage was not a problem. Joint motion studies did not indicate progress of haemophilic arthropathy during self‐therapy. Properly supervised self‐therapy is practical and safe and improves considerably the quality of life.
Kinetics of Hemodynamic and Electrocardiographic Changes Following Intravenous Disopyramide
Authors: Hulting Johan , Rosenhamer Gunnar
Published: August 2010

ABSTRACT. Changes in hemodynamic and ECG variables following disopyramide (1.7 mg=3.9 mmol/kg b.wt.) were studied in 9 patients with ventricular arrhythmias. All patients displayed a marked reduction in the number of ventricular ectopic beats, all except one exhibiting complete abolition of the arrhythmia for at least 30 min. QT and QRS intervals showed statistically significant prolongations, and thereafter decreased exponentially with time. Above a certain concentration threshold that varied between the patients, systolic time intervals and aortic (dp/dt)max showed linear changes with increasing drug serum levels. Changes in diastolic pulmonary artery pressure showed no simple relationship with disopyramide concentration or time after injection. In 3 out of 4 patients studied, there was a good correlation between the lowest level of disopyramide that elicited both an antiarrhythmic effect and a demonstrable decrease in cardiac contractility.
Arrhythmias in Patients with Acute Cerebrovascular Disease
Authors: Britton M. , de Faire U. , Helmers C. , Miah K. , Ryding C. , Wester P. O.
Published: August 2010

ABSTRACT. Cardiac disease is common in patients with cerebrovascular disease (CVD) and cerebral lesions as such may influence cardiac activity and rhythm. To study the indication for continuous ECG surveillance of patients with CVD, 100 consecutive patients admitted to a medical stroke unit were investigated with 24‐hour Holter recordings. The patients' mean age was 73 years and 70% of them had a history of heart disease. Twenty‐three patients had chronic atrial fibrillation and 55% of the remainder showed ventricular ectopic activity. Serious ventricular arrhythmias were comparatively rare and mainly seen in association with signs of congestive heart failure and acute myocardial infarction. A prolonged Q‐T interval was registered in two‐thirds of the patients but there was no significant association between this finding and ventricular ectopic activity. Close observation for cardiac complications is important in patients with CVD and continuous ECG surveillance is indicated in selected high‐risk patients.
Fatal Reactions to Drugs
Authors: Böttiger L. E. , Furhoff A. K. , Holmberg L.
Published: August 2010

ABSTRACT. Drug‐induced deaths (n=274) in Sweden during a 10‐year period have been analyzed. The incidence has been remarkably constant, with 25–30 reported cases per year. There is a marked increase with age in the incidence of fatal reactions, more so than for all drug reactions. Women consume more drugs than men and get more reactions, but not more fatal reactions. Anti‐inflammatory drugs (antibiotics and sulfonamides) are responsible for 21% of the fatal reactions, followed by oral antidiabetics (9%), oral contraceptives (9%) and antiphlogistic drugs (8%). The blood and the bone marrow are the most susceptible organs, responsible for 40% of the fatal reactions, followed by thromboembolism (10%) and hepatocellular damage (9%). It is important to note that rapid changes have occurred with regard to responsible drugs as well as to the types of adverse reactions encountered.
The Erythrocyte Sedimentation Rate and Stress
Authors: Palmblad J. , Karlsson C.‐G. , Levi L. , Lidberg L.
Published: August 2010

ABSTRACT. The effect of a 75‐hour vigil on the erythrocyte sedimentation rate (ESR), i.a., was studied in two experiments with 63 healthy male volunteers. The ESR was increased at the end of the vigil compared with pre‐exposure values. The increases did not correlate significantly with concomitant changes in serum triglycerides, free fatty acids, cholesterol or gammaglobulins, except for a significant, negative correlation with cholesterol changes in one of the two studies. Although the mechanism for the increases in ESR in response to stressor exposure remains unclear, it is concluded that when using the ESR in clinical practice, allowance should be made for situational factors such as the patient having experienced some stressful days and sleepless nights.
Renin–Angiotensin System in Mild Essential Hypertension.
Authors: Ibsen H. , Leth A. , Hollnagel H. , Kappelgaard A. M. , Nielsen M. Damkjær , Christensen N. J. , Giese J.
Published: August 2010

ABSTRACT. Twenty‐five 40‐year‐old patients with mild essential hypertension, identified during a survey of a population born in 1936, were investigated. Basal and postfurosemide values for plasma renin concentration (PRC) and plasma angiotensin II concentration (PA II) did not differ markedly from reference values measured in 40‐year‐old control subjects from the same population. In the untreated sodium replete state, saralasin infusion (5.4 nmol/kg/min) produced an increase in mean arterial pressure (MAP) in the patient group as a whole. Twenty‐one patients were treated with hydrochlorothiazide, mean dose 75 mg/day for 3 months, and the examinations were repeated in 20 patients. Pretreatment furosemide‐stimulated PRC and PA II, and values during thiazide treatment were higher in “non‐responders” to hydrochlorothiazide treatment (n=10) than in “thiazide reponders” (n=11). During thiazide therapy, angiotensin II blockade induced a clearcut decrease in MAP in every single “thiazide non‐responder”, whereas 7 out of 11 “thiazide responders” did not show any fall in BP, and 4 exhibited only a borderline decline in MAP. After thiazide and angiotensin II blockade, significant differences in MAP were no longer present between the two patient groups. It is concluded that in mild untreated essential hypertension, angiotensin II has no decisive role in the maintenance of high BP. The functional significance of the renin–angiotensin system (RAS) emerges after thiazide treatment. Thiazide‐induced stimulation of RAS coutnerbalances the hypotensive effect of thiazide in some 40% of the treated patients. Thus the responsiveness of RAS determines the quantitative BP response to treatment. Assessment of angiotensin II response to acute stimulation could to some extent predict the subsequent response to thiazide treatment. Saralasin infusion serves as a reliable tool for assessing the participation of angiotensin II in BP regulation.
Angiotensin II in Primary Hypertension, Relationship to Plasma Renin Activity, Aldosterone and Urinary Electrolytes
Authors: Tolagen Kerstin , Karlberg Bengt E.
Published: August 2010

ABSTRACT. Plasma concentrations of angiotensin II (A II) were studied in 36 patients with primary (essential) hypertension and 15 normotensive control subjects during basal (1 h supine rest), upright and frusemide‐stimulated (80 mg orally) conditions. Plasma renin activity (PRA) and plasma aldosterone (PA) were determined on the same occasions. A II was then correlated statistically to PRA, PA and 24‐hour urinary excretions of aldosterone (Aldo‐U), sodium and potassium and to the blood pressure (BP) levels. The A II values in the hypertensive patients were not statistically significantly different from those in the normotensive subjects. A close relationship was found between the A II values and the corresponding PRA values in the hypertensive patients (r=0.65–0.76, p>0.001 for all). Correlations between A II and PA, and A II and Aldo‐U were not consistently significant. No correlation was found between A II and BP or between A II and 24‐hour urinary electrolytes. The findings point to an intact function between PRA and A II but a disturbed A II–aldosterone interrelation in primary hypertension.
T4, T3 and Reverse‐T3 Determinations in Connection with the TRH test in the Evaluation of Possible Hyperthyroidism
Authors: Kallner Gunnar , Ljunggren Jan‐Gustaf
Published: August 2010

ABSTRACT One disadvantage of the TRH test is that an absent or blunted TSH response is seen not only in hyperthyroid patients but also in some normal subjects. The aim of the present study was to elucidate whether the discriminatory power between eu‐and hyperthyroidism could be increased by determining the T3 and T4 levels before and after the TRH administration. The study population consists of 30 patients referred for evaluation of suspected hyperthyroidism. The results show that all but one of the patients (n=20) who had T3 levels within the normal reference limits increased these levels after TRH administration, whether their TSH response was normal or blunted. One patient's T3 levels decreased after TRH. A*** the patients (n = 10) who had T3 levels within the hyperthyroid range showed a decrease after TRH. The decrease was significantly correlated (r=0.90) to the magnitude of the increase. No consistent T4 and no change in reverse‐T3 response was obtained. The addition of T3, T4 or reverse‐T3 determinations in connection with the TRH test does not seem to increase the discriminatory power of the test.
The Syndrome of Inappropriate Secretion of Antidiuretic Hormone
Authors: Hägg Erik , Lithner Folke , Lindqvist Bengt , Fyhrquist Frej
Published: August 2010

ABSTRACT A 72‐year‐old woman with the syndrome of inappropriate secretion of antidiuretic hormone of unknown cause during more than one year of observation is reported. Plasma vasopressin levels were excessively elevated, even during a water load test. Her serum electrolyte abnormalities and general state were ameliorated after fluid restriction. During treatment with demeclocycline the patient was able to increase fluid intake without deterioration.
Coronary Arteriography in 486 Patients—Arteriographic Pathology and Prognosis
Authors: Ljungberg Staffan , Forsberg Sven åke , Paulin Sven , Werkö Lars
Published: August 2010

ABSTRACT The coronary arteriographic findings and prognosis in a series of 486 non‐surgically treated patients were analyzed. A semiselective injection was used. The number and causes of deaths were obtained from the census registry after a follow‐up period of 7–12 years. The material comprised normal arteriograms in 26% of the patients, wall irregularities at most in 17%, obstruction of at least half the diameter in 37%, and unclassifiable arteriograms in 19%. A mean of 1.8 obstructed arteries per patient was found in the group with obstructive arterial lesions and among these patients the left anterior descending artery was most often engaged. In the same group the cardiac mortality at seven years was 20%. There were no significant differences between deceased and survivors with regard to clinical data. The arteriograms themselves offered more information about the prognosis. Normal arteries or wall irregularities at most implied excellent prognosis with regard to death in coronary heart disease. The seven‐year mortality was 36% among patients with coronary artery occlusions, which is significantly higher than 14% among those with arterial stenosis. Materials from the USA and Canada have displayed a much higher mortality than our study in spite of comparable arteriographic findings.
Prediction of Survival in Patients with Acute Myocardial Infarction
Authors: Biörck G. , Erhardt L. R. , Lindberg G.
Published: August 2010

ABSTRACT Expected survival after acute myocardial infarction (AMI) in 100 consecutive patients was predicted by three doctors and two nurses at the time of discharge from a CCU. Predictions were compared with various coronary prognostic indices (CPI) and were found to be too optimistic for the first 9 months. Experienced physicians made more reliable predictions than junior physicians and nurses. All patients with a predicted survival of more than 10 years were alive after 1 year and all with predicted death within one month died during the first year. Intermediate predictions were unreliable with reference to the one‐year survival. Regardless of which CPI was used, a low index score carried a very low one‐year mortality and high index a high mortality. Intermediate index scores were unreliable. A comparison between the predictions and index scores showed that there was no difference in sensitivity and specificity between the methods. Our study thus shows that patients with either a very good or a very poor prognosis will be identified regardless of the method used. The problem of identifying the individual with an intermediate risk remains to be solved.
Q Waves and Coronary Artery Disease
Authors: Hansen J. Fischer , Pedersen‐Bjergaard O.
Published: August 2010

ABSTRACT In a consecutive series of 234 patients admitted for selective coronary arteriography, 78 had pathological Q waves. In 32 of these 78 patients, ECG showed left ventricular hypertrophy, QRS duration of ≥0.12 sec, incomplete left bundle branch block, or left axis deviation. Fourteen (44%) of these 32 patients had coronary artery disease (CAD), while 40 (87%) of the remaining 46 patients wiuthout these ECG changes had CAD (p<0.0005). Among the 46 patients, 34 of 35 with angina pectoris had CAD compared to 6 of 11 without angina pectoris (p<0.01). Our study thus shows that Q waves may be reliable predictors of CAD especially in patients with angina pectoris.
Alkaline Phosphatase in Women with Osteoporosis
Authors: Hulth A. G. , Nilsson B. E. , Westlin N. E. , Wiklund P. E.
Published: August 2010

ABSTRACT Altoghether 15 partially independent measurements of bone mass in 100 women with clinical and roentgenological signs of osteoporosis were correlated to the alkaline phosphatase activities of the same individuals. There was a slight but significant negative correlation indicating an increasing alkaline phosphatase activity with decreasing bone mass. This correlation was not caused by interaction of age. There was no correlation between alkaline phosphatase activity and clinical or morphological signs of osteomalacia. The changes could not be explained by fractures. It is suggested that a slight increase in the alkaline phosphatase activity in women with a more severe osteoporosis is related to bone resorption.
Bone Biopsy in Women with Spinal Osteoporosis
Authors: Hulth Anders G. , Nilsson Bo E. , Westlin Nils E. , Wiklund Per Erik
Published: August 2010

ABSTRACT Iliac crest biopsies were obtained from 110 women, 62 of whom had been clinically and radiologically classified as osteoporotics. The amount of osteoid surface was measured by a histological planimetrical method. It was demonstrated that the amount of osteoid does not differ between osteoporotic women and control women and that osteomalacia is rare in both groups.
Drug‐Induced Neutropenias in the Stockholm Region 1976–1977
Authors: Arneborn Per , Palmblad Jan
Published: August 2010

ABSTRACT Previously we reviewed the incidence and causes of drug‐induced neutropenia in the Stockholm region during the years 1973‐75. We here present an equivalent study for the years 1976‐77. The yearly incidence of drug‐induced neutropenia, cytostatics excluded, remained around 0.01%***. About one half of the cases were caused by sulphonamides. Among the other causes, antithyroid drugs and phenothiazines were most frequent. The mortality rate was 27%, in contrast to only 2% in our previous study. Of the seven patients who died, 5 had taken sulphonamides.
Prognostic Significance of Lymphopenia in Sarcoidosis
Authors: Selroos Olof , Koivunen Elli
Published: August 2010

ABSTRACT During 1959‐67, sarcoidosis was diagnosed in a series of 140 patients. All were followed up and 22 developed chronic sarcoidosis. In 134 patients (20 with chronic course) the initial granulocyte, monocyte and lymphocyte counts were known. No differences in granulocyte values were seen between different groups of sarcoidosis patients. Patients with erythema nodosum had significantly increased monocyte levels. Lymphopenia below 1000/μl was seen in only 7.5% of the patients. Lymphocyte counts below 1 500/μl were a common finding, especially in patients developing chronic sarcoidosis. Significantly decreased lymphocyte values were also seen in patients older than 40 years at the time of diagnosis, in patients negative to 10 TU of PPD and in those with a disease requiring treatment with corticosteroids. A correlation was found between initial lymphopenia and less favourable prognosis, 85% of the patients having a very good prognosis. Patients with initial lymphopenia must be carefully followed up. The initial presence of erythema nodosum does not always guarantee a good prognosis.
Clinical Significance of Abnormal Heterogeneity of Transferrin in Relation to Alcohol Consumption
Authors: Stibler Helena , Borg Stefan , Allgulander Christer
Published: August 2010

ABSTRACT An abnormal microheterogeneous component of serum transferrin, with a higher isoelectric point than the normal main component, was studied by means of isoelectric focusing and direct immunofixation in 98 alcoholic patients, 22 patients with liver diseases and 100 controls. Its relation to acute and prolonged ethanol intake was studied in healthy volunteers. The abnormal transferrin component was found to be a sensitive indicator of prolonged, high alcohol ingestion, and was observed in 81% of patients with an admitted consumption of more than 60 g ethanol/day, and normalized after at least 10 days of abstinence. It occurred in 1% of the controls and in none of the cases with liver diseases without current alcohol abuse. There is evidence of a reduced sialic acid content in the abnormal transferrin. No similar change has been found in a number of other glycoproteins. This test may be a useful and sensitive tool for the detection of chronic alcohol consumption.
Free Light Chains of Immunoglobulins in Amyloidosis
Authors: Sølling J. , Sølling K.
Published: August 2010

ABSTRACT Monomeric (M) and dimeric (D) forms of free light chains in serum have been measured by a sensitive radioimmunoassay in eight patients with amyloidosis without monoclonal proteins. Significantly elevated concentrations of D lambda chains were demonstrated in two of four patients with localized amyloidosis. The two patients had a significantly increased D/M ratio of both kappa and lambda chains. One patient with localized amyloidosis and normal concentration of monomeric and dimeric light chains had an abnormal fragment of light chains. A low kappa/lambda ratio was found in patients with localized amyloidosis. Four patients with secondary amyloidosis and renal insufficiency had increased amounts of free light chains. The concentration of light chains and the D/M ratio in this group corresponded to the impairment of renal function.
Pernicious Anaemia as a Risk Factor in Gastric Cancer
Authors: Elsborg Lars , Mosbech Johannes
Published: August 2010

ABSTRACT In order to assess the risk of gastric cancer (GC) developing in patients with pernicious anaemia (PA), the prevalence of PA was analysed in all patients with GC notified to the Danish Cancer Registry in 1972. Among 877 patients with GC, PA had previously been diagnosed in 19 (2.2%). In seven of these, PA had been diagnosed only shortly before GC. Accordingly, the diagnosis of PA could be regarded as unquestionable only in the remaining 12 cases (1.3%). In either case, the frequency of PA was significantly higher than in a reference group of patients with cancer of the colon who had been selected in the same way. Calculation of the incidence of GC in PA patients showed that this was about three times higher than in the general population. The annual risk of GC was calculated to be 0.3%. In PA patients, the tumour was primarily localized to the body and fundus of the stomach, whereas it mainly involved the antral and pyloric region in patients without PA. In view of the low cancer rate it is concluded that routine gastroscopy and barium meal examination are not indicated in PA patients in general. Whenever a patient with PA complains of dyspepsia, examinations with gastroscopy and barium meal should, however, be carried out on liberal indications.
Serum Ferritin during Inflammation A Study on Myocardial Infarction
Authors: Birgegård Gunnar , Hällgren Roger , Venge Per , Wide Leif
Published: August 2010

ABSTRACT The ferritin level in serum was investigated in 9 patients with myocardial infarction, all with a history of chest pain of less than 4 hours before admission. A significant rise in serum ferritin level was found in 8 patients. The rise was generally smaller than that seen in acute infection and not significantly correlated to the size of infarction, as estimated from changes in serum levels of myoglobin, ASAT and LDH. The rise started after a mean of 30 hours, the peak being reached within a week (M 4.3 days). Serum ferritin then fell to 120–300% (M 190) of the initial level, where it remained. An initial rise in serum iron levels was unexpectedly seen within 12 hours in 7 patients.
Effect of Plasma Free Fatty Acid Lowering on Exercise Tolerance and ST Segment Depression in Patients with Angina Pectoris
Authors: Loogna E. , Kaijser L. , Carlson L. A.
Published: August 2010

ABSTRACTThe effect of a single oral dose of a plasma FFA‐lowering drug (5‐(3‐pyridyl) tetrazole), which does not act by conversion into nicotinic acid, on exercise tolerance and ECG reaction was studied on a double‐blind basis in 15 men with stable angina pectoris. Exercise was performed on a bicycle ergometer in the sitting position with a load increase of 10 W/min. In addition to ECG, time to onset of chest pains and to termination of exercise because of strong chest pains was recorded. 5‐(3‐pyridyl) tetrazole decreased plasma FFA during exercise from 523 to 299 μmol/1. It reduced significantly the ST depression at corresponding work loads and permitted the patients to exercise 0.6 min longer, corresponding to a 7% higher work load, before the onset of chest pain. However, absolute exercise time was not significantly increased. The most probable explanation of the improved performance is a decreased lipid and increased carbohydrate oxidation by the ischemic heart, although a contribution may have come from hemodynamic effects of the drug, unrelated to effects on myocardial metabolism but perhaps involving heart rate and BP. The lack of a significant effect on performance time may have been due to general fatigue.
Late Sudden Death after Surgical Correction of Coarctation of the Aorta
Authors: Forfang Kolbjörn , Rostad Hans , Sörland Svein , Levorstad Kjell
Published: August 2010

ABSTRACT Follow‐up studies averaging 12 years postcorrective surgery of 343 patients with coarctation of the aorta disclosed 38 late deaths, 16 of which were sudden, unexpected and probably cardiovascular. All but two patients were normotensive postoperatively, and in 4 of these the cause of death was proven dissecting aneurysm of ascending aorta. In another patient this aneurysm was repaired surgically and in 3 other patients chest X‐ray had shown a dilated ascending aorta before death. At follow‐up the ascending aorta was dilated angiographically in 4 survivors, who had moderate systolic hypertension and aortic valve disease. The high incidence of aneurysm of ascending aorta in patients with coarctation is probably due to hypertension during the growth period, possibly in combination with congenital weakness of the aortic wall, and to concomitant aortic valve lesion.
Oesophageal Symptoms and Manometry in Valvular Heart Disease
Authors: Tibbling Lita , Wranne Bengt
Published: August 2010

ABSTRACT A possible relationship between heart disease, oesophageal dysfunction (OD) and symptomatology was studied in 47 patients with valvular heart disease. They were investigated with oesophageal manometry and oesophageal acid perfusion test. OD was found in 32% of the patients. A local pressure increase in the middle part of the oesophagus, probably an effect of cardiac enlargement and compression of the oesophagus, was found at manometry in 38%. The incidence of OD and of oesophageal symptoms was the same in patients with and without oesophageal compression. We did not find any indications that valvular disease in itself provokes OD, nor that symptoms of chest pain and cough in patients with valvular heart disease are due to OD.
Reduced Vibratory Perception and Corneal Sensitivity and Metabolic Disturbances Following Intestinal Bypass Surgery
Authors: Hey H. , Nielsen N. Vesti , Lund B. , Lund Bj. , Sørensen O. H.
Published: August 2010

ABSTRACTDecreased corneal sensitivity and vibratory perception suggesting a diagnosis of polyneuropathy were demonstrated in some of 26 patients who had undergone intestinal bypass surgery. Psychological tests revealed signs of disturbance of the autonomic nervous system. A deficiency of 25‐hydroxyvitamin D was demonstrated, clearly related to the frequency of stools and to the weight loss. This deficiency might play a role in the pathogenesis of the polyneuropathy.