bluuebunny/crossref_metadata_2025 huggingface dataset:
Ventricular Arrhythmias and Left Ventricular Dysfunction in Familial Cardiomyopathy
Authors: LINDVALL K. , LUNDMAN T. , MÖLLER E.
Published: August 2010

ABSTRACT. In familial cardiomyopathy (CM), different forms of myocardial abnormalities including asymmetric and symmetric hypertrophy and dilated left ventricles are presented, mostly showing varying hereditary penetrance. This study presents a family with CM including three major clinical manifestations: severe ventricular arrhythmias, repolarization abnormalitites and left ventricular hypertrophy. This triad was strikingly consistent in the two generations examined. The familial pattern with an autosomal dominant inheritance did not show any linkage to the HLA region.
Excretion of Adrenaline, Noradrenaline, Vanilmandelic Acid and Metanephrines in 64 Patients with Pheochromocytoma
Authors: STENSTRÖM GUNNAR , SJÖGREN BJÖRN , WALDENSTRÖM JOHAN
Published: August 2010

ABSTRACT. Sixty‐four patients with pheochromocytoma were operated upon at Sahlgrenska Hospital during 1956‐82. The excretion of adrenaline and/or noradrenaline as well as their metabolites was high at each observation in 28 subjects with sustained hypertension, one patient, however, showing only slightly increased excretion of adrenaline at one observation. Another of the hypertensive patients consistently displayed normal amounts of vanilmandelic acid and metanephrines. Most of 28 patients with paroxysmal hypertension showed similar results. In five subjects with few attacks, however, normal findings were obtained on one or several occasions. Among the remaining patients the excretion of catechol‐amines was normal in the face of severe hypertension in two, the high blood pressure being probably due to diseases other than pheochromocytoma. Five normotensive subjects without hypertensive attacks presented variable findings. The results from analyses of catecholamines were somewhat more helpful than those from measurements of vanilmandelic acid, which failed completely in one hypertensive patient and in three others with paroxysmal attacks.
Cardioversion during Pregnancy
Authors: CULLHED INGEMAR
Published: August 2010

ABSTRACT. A case of atrial fibrillation during pregnancy in a 20‐year‐old patient with valvular heart disease is presented. Synchronized direct‐current Cardioversion was carried out successfully during monitoring of maternal and fetal ECG. Previously published cases are reviewed.
Deaths in Swedish Hemophiliacs, 1957–1980
Authors: LARSSON S. A. , WIECHEL B.
Published: August 2010

ABSTRACT.One hundred and eighteen patients with hemophilia A or B died in Sweden between 1957 and 1980. The causes and circumstances of death have been the subject of a retrospective study. The most striking feature was the increase in age at death. In severe hemophilia cases the age increased from 19 in the first half of the period to 50 in the second. In moderate and mild hemophilia cases the increases were similar, although less pronounced. The main cause of death was intracranial hemorrhage, which accounted for one‐third of all deaths. In the last 12‐year period, however, no patient below the age of 45 had succumbed to this. Age‐related causes of death, such as malignancy and ischemic heart disease, had increased, as was to be expected from the increase in the mean and median ages of living hemophiliacs. The proportion of deaths unrelated to hemophilia was 36%. Antibodies were found in 5 (16.7%) of the patients with severe hemophilia A.
Sudden Coronary Death in Middle Age and Characteristics of Its Victims in Finland: A Prospective Population Study
Authors: SUHONEN OLLI
Published: August 2010

ABSTRACT. A total of 77 sudden coronary deaths (SCD) in men and seven in women occurred during a 6‐year follow‐up in a population comprising 6510 men and 5800 women aged 30–59 years in four areas of Finland. About 60% of all coronary deaths in men aged 40 and over were SCDs. The most common place of death was home; only six cases reached hospital. The most common time for SCD was at 7 a.m. ‐3 p.m. and the most common day was Friday. Deaths were evenly distributed over the year. At the time of the baseline study—3 1/2 years before death on an average—male SCD victims showed more symptoms and signs suggestive of coronary disease than those who suffered a non‐sudden coronary death or a non‐fatal myocardial infarction. More than half of the SCD victims had probable coronary disease at the time of the baseline study. Heart disease was a more common cause of death among the mothers of male SCD victims than among the adult Finnish female population as a whole. This study indicates that the majority of candidates for later SCD can be detected early enough for secondary prevention to be attempted.
Acute Dapsone Intoxication: Clinical Findings and Effect of Oral Charcoal and Haemodialysis on Dapsone Elimination
Authors: NEUVONEN P. J. , ELONEN E. , HAAPANEN E. J.
Published: August 2010

ABSTRACT.Three patients were treated after ingestion of an overdose of dapsone (1–10 g). A considerable acute cyanosis due to methaemoglobinaemia was followed by a late haemolysis within 1–2 weeks. Activated charcoal given orally in multiple doses (20 g × 4/day) shortened the half‐life of dapsone to 12.7+0.7 hours, i.e. to about 1/3‐1/6 of the preceding control value. The half‐life of dapsone was about 10 hours during each of the three 5‐hour haemodialysis treatments given to one patient. However, owing to the rebound phenomenon between haemodialyses, the half‐life of dapsone from the start of the first to the end of the third haemodialysis was 26 hours. The efficacy of orally administered activated charcoal is fully comparable to that of haemodialysis in increasing the rate of elimination of dapsone and its metabolite monoacetyldapsone. Activated charcoal is cheap, it can be administered anywhere and its administration rarely involves complications.
Digitalis Intoxication in Geriatric in‐Patients
Authors: BOMAN KURT
Published: August 2010

ABSTRACT. A prospective clinical study of 66 geriatric in‐patients mainly on digoxin treatment revealed digitalis intoxication in seven (11%). Over a two‐month period another patient developed digoxin toxicity. The prevalences of anorexia, nausea and vomiting were significantly higher in patients with than without digitalis toxicity. The mean serum drug concentration was significantly higher in overdosed than in non‐overdosed patients, but six patients had serum digoxin concentrations within or below the therapeutic range, and only two slightly above. Notably, maintenance digoxin therapy was unnecessary in five out of eight intoxicated patients. The value of determining serum digitalis concentrations in diagnosing clinical toxicity in geriatric in‐patients is discussed.
Increased Plasma Free Dopamine after Treatment with Atenolol and Oxprenolol in Essential Hypertension
Authors: KJELDSEN SVERRE ERIK , EIDE IVAR , AAKESSON INGVAR , AMUNDSEN RUTH , ERIKSEN INGER LISE , LEREN PAUL
Published: August 2010

ABSTRACT.In 19 men aged 50 with essential hypertension, 18 weeks' treatment with atenolol (n=9) or oxprenolol (n=10) increased supine plasma free dopamine concentrations by 78% (p<0.05) and 121 % (p<0.001) respectively. Increments in plasma dopamine were observed in all patients except for one treated with atenolol. Supine peripheral venous adrenaline and noradrenaline concentrations were not influenced by β‐blockade. The mechanism and significance of the present elevation of plasma free dopamine by β‐blockade are unknown. However, increased plasma free dopamine may be involved in the hypotensive effect of chronic β‐adrenergic blockade, both β‐1 selective and non‐selective, and may lend further support to decreased dopaminergic activity in essential hypertenison.
Hypercatabolism of Complement in Crohn's Disease—Assessment of Circulating C3c
Authors: ELMGREEN JENS , BERKOWICZ ADELA , Sørensen HENNING
Published: August 2010

ABSTRACT. Split products from the main complement component 3 (C3) were investigated in untreated outpatients, 20 with Crohn's disease and 20 with ulcerative colitis. The median plasma concentration of c split product of C3 (C3c) in normals was 2 mg·l‐1, in patients with Crohn's disease 20 mg·l‐1 and in patients with ulcerative colitis 3 mg·l‐1. This tenfold increase in C3c was significant at the 0.005‐level. Plasma C3c exceeded the reference interval in two patients with ulcerative colitis. C3c levels did not correlate to the activity of the disease or to the occurrence of the C3 phenotypes S, FS and F. Substantially elevated plasma C3c in Crohn's disease suggests hypercatabolism of C3, that is, involvement of complement reactions. Further studies are needed to reveal the site of cascade activation and to define the role of complement for the pathogenesis of the disease.
Toxicokinetics of Formate during Hemodialysis
Authors: JACOBSEN DAG , ØVREBØ STEINAR , SEJERSTED OLE M.
Published: August 2010

ABSTRACT.During hemodialysis in a methanol poisoned patient, formate elimination followed first order kinetics with a plasma half‐life of formate of 165 min. The mean dialysator (1.6 m2) clearance of formate was 148 ml/min (n=8, SD ± 11, range 128–161) at a blood flow of 215 ml/min. By applying first order kinetics, a volume of distribution of 0.5 l/kg was found, assuming that the dialysator clearance equals the total body clearance of formate. Formate, the main toxic agent in methanol poisoning, is thus probably more effectively removed by hemodialysis than methanol. This fact, and the very slow endogenous methanol elimination during appropriate ethanol treatment, should be considered when deciding on the treatment of a methanol poisoned patient presenting with metabolic acidosis.
Bone Marrow Necrosis
Authors: HANSEN PETER V. , ANDERSEN JØRN , MYGIND HENRIK
Published: August 2010

ABSTRACT Bone marrow necrosis (BMN) is a rare finding in specimens from living patients. It is most commonly found in patients with neoplastic disorders, severe infections and sickle cell disease. We present a patient with Hodgkin's disease who developed extensive BMN 11 months before death. A concise review of the literature is also presented.
Concentrations of Trace Elements in Human Blood Serum from Different Places in Norway Determined by Neutron Activation Analysis
Authors: BLEKASTAD V. , JONSEN J. , STEINNES E. , HELGELAND K.
Published: August 2010

Abstract The concentrations of As, Fe, Hg, Sb, Se and Zn in 281 serum samples from people living in nine municipalities in Norway were determined by radiochemical neutron activation analysis. The concentrations of Br, Cl, Cs, Na, Rb, Se and Zn were determined in another set of 157 serum samples from four of the municipalities by instrumental neutron activation analysis. Higher arsenic concentrations were found in the coastal districts than in inland municipalities; otherwise no significant difference in mean values was observed between the districts. Except for Na‐Cl and Rb‐Cs, none of the elements was significantly correlated with any other element studied.
Improved Metabolic Control after Supplemented Fasting in Overweight Type II Diabetic Patients
Authors: VESSBY B. , BOBERG M. , KARLSTRÖM B. , LITHELL H. , WERNER I.
Published: August 2010

Abstract Twenty obese type II diabetes patients were treated in a metabolic ward during 4 weeks with a very low calory regimen (200 kcal/day). They were given dietary advice and reexamined 3 months after discharge. Mean body weight decreased by 10 kg during fasting, blood glucose was normalized, urinary glucose disappeared and the K‐value at i.v. glucose tolerance test increased. Fasting serum insulin concentrations decreased by 54%. Serum triglycerides (TG) decreased by 65%, serum cholesterol (Chol) by 28% and high density lipoprotein (HDL) Chol by 14%. Three months later, only serum TG remained significantly decreased (‐47%) while HDL Chol was significantly higher than on admission (+11%). Fasting blood glucose remained significantly lower (‐25%) with a low urinary glucose excretion. Supplemented fasting appears to be a safe and useful tool in the treatment of obese type II diabetics. It causes, at least during a limited follow‐up period, a significant improvement in glucose control and lipoprotein metabolism in spite of a concomitant reduction of the antidiabetic medication.
Toxicity of Plasma from Hemodialysis Patients Treated with Heparin or Prostacyclin
Authors: WESSEL‐AAS TERJE , BERG KNUT J. , WIDERÖE TOR‐ERIK , WIRUM ELIN , NILSEN TURID
Published: August 2010

Abstract Hemodialysis was performed in 6 uremic patients with either a bolus dose of 5 000 IU heparin or prostacyclin at a constant infusion rate of 5 ng/kg/min. Clinical data, plasma triglycerides (TG), free fatty acids (FFA), platelet aggregation, white blood cell count and plasma toxicity were measured prior to and during both procedures. No serious sideeffects were recorded. Heparin induced a fall in plasma TG, a rise in FFA and increased plasma toxicity. Prostacyclin infusion had no effect on these parameters. During both tests a marked drop in white blood cell count was found 15 min after the start of hemodialysis. During heparin dialysis no clotting was observed in the extracorporeal circuit. During prostacyclin dialysis clotting was observed at the venous line in three cases
ECG Changes during Lithium Therapy
Authors: BUCHT GÖSTA , SMIGAN LUDOVIT , WAHLIN ANDERS , ERIKSSON PETER
Published: August 2010

Abstract The influence of long‐term lithium treatment on the ECG was investigated in 53 consecutive patients. An ECG was recorded prior to and 4 and 12 months after institution of lithium therapy. The most frequently observed change during treatment was flattening or inversion of the T wave. Heart rate decreased and P‐Q interval increased slightly during therapy. There was no change in the S‐T segment or the Q‐T interval corrected for heart rate. Our data indicate that well monitored lithium treatment of patients with serum lithium concentrations of about 0.6 mmol/1 does not cause serious ECG abnormalities. In the absence of symptoms or signs of heart disease, routine monitoring of ECG is not necessary during lithium treatment
Gastric Ulcer and Risk of Cancer
Authors: ROLLAG ARNFINN , JACOBSEN CARL DITLEF
Published: August 2010

Abstract In 1976, 121 patients with benign gastric ulcer and 13 with gastric carcinoma were diagnosed in our department by endoscopy, cytology and directed biopsies. At a 5‐year follow‐up, 78 of these patients were re‐examined with endoscopy and biopsies. None had developed gastric cancer during the observation time. Of the 78 patients who underwent endoscopy, 16 had gastric ulcer, 2 duodenal ulcer and 27 atrophic gastritis, including 3 with moderate dysplasia of the gastric mucosa. The patients with ulcer had remarkably few symptoms. Only few data are available concerning the postulated link between gastric ulcer disease and gastric malignancy. The cancer‐ex‐ulcere hypothesis seems to be a medical dogma. However, well planned prospective studies with endoscopic follow‐up of gastric ulcers are needed to elucidate the question properly
Does Iron Deficiency in Treated Polycythemia Vera Affect Whole Blood Viscosity?
Authors: BIRGEGÅD GUNNAR , CARLSSON MAGNUS , SANDHAGEN BO , MANNTING FINN
Published: August 2010

Abstract The relation between whole blood viscosity and iron status was studied in 11 patients with polycythemia vera (PV) who were treated with venesection without iron supplementation. Six were already iron deficient at the start of the study, five were followed from normal iron status to deficiency. Iron status was investigated with serum ferritin, erythrocyte protoporphyrin, mean cell volume and mean cell hemoglobin. There was no correlation between whole blood viscosity at a fixed erythrocyte volume fraction of 44% and any of these variables. The mean whole blood viscosity during iron deficiency and during normal iron state did not differ. Even after several months of iron deficiency there was no increase in whole blood viscosity. It is concluded that iron deficiency in treated PV does not give increased whole blood viscosity.
Isolated Right Ventricular Myocardial Infarction
Authors: VESTERBY A. , STEEN M.
Published: August 2010

Abstract Isolated right ventricular infarction is uncommon. A 73‐year‐old man without previous cardial complaints was admitted pulseless to hospital. An infarct of the left ventricle was suspected. Autopsy showed a fresh thrombus located in a small branch artery of the right coronary artery accompanied by a fresh infarction of the anterior free wall of the right ventricle. Only 8 cases of isolated right ventricular infarction located in the anterior free wall were found in a review of the literature of right ventricular infarction. The diagnosis, treatment and prognosis of right ventricular infarction are discussed.
High Risk of Cerebro‐cardiovascular Morbidity in Well Treated Male Hypertensives
Authors: LINDHOLM LARS , EJLERTSSON GÖRAN , SCHERSTÉN BENGT
Published: August 2010

Abstract In a retrospective study of 121 hypertensives aged 40–59 years in comparison with 138 controls selected from the population in the same primary care district, male hypertensives had a high odds ratio of cerebro‐cardiovascular (CCV) diseases even when their blood pressure had been well treated. The estimated odds ratio (corrected for small numbers) was 13.7 (2.5–76.7). In female hypertensives there was a trend towards more CCV diseases than in their controls. Although the hypertensives' blood pressure was reduced in accordance with what has been internationally accepted, their values were still at least 10–11 mmHg higher than those of the controls. A reduction of this magnitude may be accomplished by (further) weight reduction and, probably, intervention with factors linked to obesity. This may be one way to reduce the excess risk in hypertensives.
Relationship between Enzymatically Estimated Infarct Size and Short‐ and Long‐term Survival after Acute Myocardial Infarction
Authors: HERLITZ J. , HJALMARSON Å. , WALDENSTRÖM J.
Published: August 2010

Abstract In 585 patients with acute myocardial infarction (AMI) and no previous MI the maximal activity of serum heat‐stable lactate dehydrogenase (LD) (EC 1.1.1.27) activity was related to 1‐year and 2‐year mortality rates. All patients participated in a double‐blind trial with metoprolol during the first three months after an AMI. Thereafter both groups were treated in a similar way. A strong relationship was found between LD maximum activity and the in‐hospital prognosis (p<0.001), the 1‐year survival rate (p<0.001) and the 2‐year survival rate (p<0.001). When the patients who were alive after primary hospitalization were analyzed as a separate group, the relationship between LD maximum activity and 1‐year and 2‐year survival rates remained (p<0.001). In a subsample of 171 patients the maximal activity of creatine kinase (CK) (EC 2.7.3.2) and CK subunit B did not correlate either with in‐hospital, 1‐year or 2‐year survival rates. We conclude that, when a sufficiently large number of patients are investigated, there is a strong relationship between serum enzyme maximum activity and short‐ and long‐term survival.
Parental Obesity Combined with Hypertension—an Indicator of Excess Risk of Hypertension in Offspring
Authors: LINDHOLM LARS
Published: August 2010

Abstract A case—control study was performed to estimate the excess risk of hypertension in a defined population. The study comprised 121 hypertensive patients, aged 40–59 years, and 138 non‐hypertensive controls selected from the same primary care district. Parental obesity combined with hypertension proved to be a stronger risk indicator of hypertension in offspring than parental hypertension itself. Other risk indicators were obesity, hypertension in siblings and a positive family history of myocardial infarction. In order to study the size of the problem we estimated the prevalence of hypertension and borderline hypertension in the district. Patients with these diagnoses amounted to about one fourth of the middle‐aged population in the district. More than 80% of the hypertensives had been diagnosed before this study, but only about 20% of the borderline hypertensives were previously known.
Analgesics and Risk of Coronary and other Death in Middle‐aged Men in Eastern Finland
Authors: SALONEN JUKKA T.
Published: August 2010

Abstract The association between oral analgesics and the risk of death from ischaemic heart disease (IHD), cardiovascular disease, disease other than IHD, and any disease was studied in a cohort of 3 551 men aged 30–59 years, based on a random sample from the population of eastern Finland. A number of potential coronary risk factors were allowed for in multiple logistic models. On the basis of these data, a regular use of oral analgesics is associated with a decreased risk of death from IHD. The relative risk was 0.6 with 95 % confidence interval (CI) of 0.2–0.9 for IHD death and 0.6 (95 % CI = 0.4–0.9) for cardiovascular death. No significant association was found between oral analgesics and the risk of death from diseases other than IHD.
Biliary Cystadenoma of the Common Bile Duct with Secondary Biliary Cirrhosis
Authors: THOMSEN PER , MADSEN POUL VASEHUS , MOESGAARD FLEMMING , NIELSEN M. C. LYKKEGAARD
Published: August 2010

Abstract A case of cystadenoma of the common bile duct is described. An erroneous diagnosis made in a young woman caused secondary biliary cirrhosis with fatal outcome. The diagnosis of cirrhosis should never be established without thorough visualization of the entire biliary tract in patients with biochemical or clinical jaundice of unknown origin.
Fatal Mumps Myocarditis
Authors: BAANDRUP ULRIK , MORTENSEN SVEND A.
Published: August 2010

Abstract A case of fatal mumps myocarditis in a 38‐year‐old male is reported. The disease started with orchitis, and severe cardiac symptoms developed within 1 1/2 month. The patient died 5 months later from congestive heart failure. The possible interrelation between late stages of viral myocarditis and dilated (congestive) cardiomyopathy is emphasized.
Effect of a Moderately Energy‐ and Salt‐reduced Diet on Body Compartments and Blood Pressure Control in Obese Men with Mild Hypertension
Authors: FAGERBERG BJÖRN , ISAKSSON BJÖRN , ANDERSSON OVE K.
Published: August 2010

Abstract Ten middle‐aged moderately obese men with untreated mild hypertension were studied during a 6‐week weight maintenance period and a 9‐week period on a diet containing 5 MJ when body mass decreased by 8.4 kg (SE 1.4). According to urinary sodium excretion there was a mean reduction of 89 mmol/day (SE 16) in sodium intake. Mean arterial pressure fell by 2.5 to 14.1 mmHg (95% confidence interval) which was correlated to the reduction of body mass. The sympathetic nervous activity diminished with decreasing noradrenaline excretion and heart rate. There were no changes in the renin‐aldosterone system. Estimation of the body composition with a four‐compartment model utilizing determinations of body mass, total body potassium and total body water (TBW) showed reductions of body fat (8.4 kg (SE 1.4)) and body cell mass (BCM) (2.4 kg (SE 0.6)), but not of TBW. Extracellular water (ECW) increased significantly as judged from ECW/BCM calculations. Plasma volume was determined by Evan's blue and did not change significantly. We suggest that the observed changes in body composition represent one aspect of the adjustment to a weight reducing diet, while blood pressure is lowered by another mechanism in the adaptive response to dieting, i.e. reduction in sympathetic nervous activity.
Urinary Catecholamine Metabolites in Borderline and Established Hypertension
Authors: ELIASSON KEITH , SJÖQUIST BIRGITTA
Published: August 2010

Abstract The urinary excretion of catecholamine metabolites was studied by means of gas chromatography‐mass spectrometry in 38 hypertensive patients on a moderately sodium‐restricted diet during hospitalization. Twenty‐four patients had established hypertension (EHT) and 14 borderline hypertension (BHT) with mean basal morning blood pressures of 155+14/101+8 and 132+9/87+4 mmHg, respectively. In these two groups of hypertensive patients the mean daily excretion of 4‐hydroxy‐3‐methoxymandelic acid (VMA) was 13.3+5.9 vs. 14.0+6.3 nmol/ml and of 4‐hydroxy‐3‐methoxy‐phenylglycol (HMPG) 7.8+4.1 vs. 7.0+3.9 nmol/ml. These concentrations were not significantly different from the corresponding values of 18 normotensive control persons (mean ambulatory blood pressure 121+10/74+9 mmHg, VMA 12.3+5.5 nmol/ml, HMPG 9.6+3.9 nmol/ml). The normotensive individuals excreted 23.7+8.9 nmol/ml of homovanillic acid (HVA), while the two groups of hypertensive patients showed significantly lower HVA excretion, EHT 17.6+6.2 nmol/ml and BHT 16.1+5.9 nmol/ml (p<0.05). Our findings support the view that no generalized increase in sympathetic activity exists in EHT or BHT. In BHT, but not in EHT, there were correlations between catecholamine metabolite excretion and body weight. The biological significance of the lower HVA concentrations in hypertensive patients compared to control individuals is not clear.
Glycolate Causes the Acidosis in Ethylene Glycol Poisoning and is Effectively Removed by Hemodialysis
Authors: JACOBSEN DAG , ØVREBØ STEINAR , ØSTBORG JENS , SEJERSTED OLE M.
Published: August 2010

Abstract Six male patients with severe ethylene glycol poisoning were studied with respect to the origin of the metabolic acidosis. The plasma concentrations of ethylene glycol were 4–41 mmol/l and treatment included alkali, ethanol and hemodialysis. Plasma analysis by isotachophoresis and whole blood lactate determinations showed that glycolate (17.0–29.3 mmol/l), lactate (1.4–6.2 mmol/l) and β‐hydroxybutyrate (≤1.8 mmol/l) were present in elevated concentrations contributing to the acidosis. Oxalate (≤0.33 mmol/l), glyoxylate (<0.2 mmol/l) and formate (<0.4 mmol/l) concentrations were negligible and did not contribute to any significant degree to the acidosis. The elevated plasma glycolate concentration was highly correlated to the anion gap (r=0.923) and the glycolate made up for 96.1% (n=6, range 84.7–108.8) of the increased anion gap. We conclude that glycolate accumulation is the main reason for the metabolic acidosis in ethylene glycol poisoning. The mean dialysator (1.6 m2) clearances of glycolate at a blood flow of 200 ml/min in two patients were 137 ml/min (n=9, SD±8, range 125–149) and 144 ml/min (n=11, SD±8, range 133–158). By applying first order kinetics during hemodialysis a volume of distribution of glycolate of 0.55 l/kg was found, assuming that the dialysator clearance equals the total body clearance of glycolate. Thus glycolate, the probable main metabolite of ethylene glycol, is efficiently removed by hemodialysis.
Heparin Treatment of Deep Venous Thrombosis in 280 Patients: Symptoms Related to Dosage
Authors: HOLM H. ASBJØRN , FINNANGER BJØRN , HARTMANN ANDERS , LÆRUM FRODE , LØHREN ODD , RUUD TOM ERIK , STRAY NJÅL , WOLLAND TERJE
Published: August 2010

ABSTRACT 280 patients with phlebographically proven deep venous thrombosis received intravenous heparin infusion, mean duration 6.8 days, mean dose 370 U/kg/day. In 58 patients (21%) there was no apparent predisposing factor. Leg pain diminished more rapidly than edema. At discharge, 46% had edema. Symptoms suggesting pulmonary embolism (PE) occurred in 13 patients (4.6%) whose mean daily heparin dose was similar to that of the others. The only fatal PE occurred three days after cessation of heparin administration. Eight patients (3%) experienced major bleeding, the only fatal occurring after thoracocentesis. The frequency of major bleeding in patients above 70 years was 8% in females and 4% in males, in those below 70 years it was 0.5%; 22 patients (8%) had minor bleeding. Control phlebography after one week revealed completely cleared thrombus in 3%, partial clearance in 36%, unchanged in 39% and increased thrombosis in 22%. Dosage was significantly correlated to thrombus resolution.
Growth Hormone and Endothelial Function during Exercise in Diabetics with and without Retinopathy
Authors: SUNDKVIST GÖRAN , ALMÉR LARS‐OLOF , LILJA BO , PANDOLFI MAURIZIO
Published: August 2010

ABSTRACT Changes in plasma growth hormone (GH), factor VIII related antigen (VIIIR: Ag), and plasminogen activator activity (PAA) during exercise were evaluated in 50 insulin‐dependent diabetics. In patients with a short to moderately long duration of diabetes (5–19 years, mean 11), GH increased only in those with retinopathy. VIIIR: Ag and PAA increased most pronouncedly in retinopathy patients as well. In diabetics with long duration of the disease (21–49 years, mean 35), GH, VIIIR: Ag and PAA increased almost equally in those with and without retinopathy.
Gangrene Localized to the Feet in Diabetic Patients
Authors: LITHNER FOLKE , TÖRNBLOM NILS
Published: August 2010

ABSTRACT A consecutive series of 189 diabetic patients with manifest gangrenous lesions localized to the feet were studied. These patients had 293 gangrenous lesions localized to 5 different areas: toes 58%, interdigital spaces 6%, dorsa of the feet 10%, metatarsal heads 10% and heels 16%. Cardiac decompensation with edema and edema from other causes were the dominant precipitating factors for the gangrenous lesions. Arterial insufficiency alone or together with other precipitating factors was seen considerably less often. Gangrenous lesions localized to the toes were especially common in patients with long duration of diabetes and in men. In women gangrenous lesions localized to the interdigital spaces and to the heels were more common. Multiple gangrenous lesions were more common in patients with cardiac decompensation, while the occurrence of only one lesion was especially common in patients with signs of arterial insufficiency and in men.
Danish Patients' Attitudes to Scientific‐Ethical Questions: An Interview Study Focusing Therapeutic Trials
Authors: SAURBREY NINA , JENSEN JØRGEN , RASMUSSEN PETER ELMEGAARD , GJØ0RUP THOMAS , GULDAGER HENRIK , RIIS POVL
Published: August 2010

ABSTRACT One hundred and fourteen in‐ and out‐patients from a department of internal medicine were interviewed, on the basis of a questionnaire with the following key questions: 1) Their attitudes to medical trials with man as the subject. 2) Their emphasis on informed consent. 3) Their attitudes to inclusion of patients not being able to give informed consent. 4) Their attitudes to tentative participation in 4 concrete projects. In all, 98% considered doctors' and patients' collaboration on new therapeutical methods both necessary and desirable. Eighty‐eight per cent considered information of patients participating in trials a prerequisite. Eighty‐six per cent accepted participation in scientific trials based on the guarantee of the doctors responsible. Of these 86%, 58% felt that a scientific‐ethical committee's accept of the project implied an extra element of security. Seventy‐five per cent replied that patients not being able to give informed consent themselves could be included in scientific trials. The majority, 77%, added that patients' relatives would then have to accept, 20% that such trials could be based on the participating doctors' responsibility, and only 2% that such a responsibility was to place on scientific‐ethical committees. In the 4 concrete projects, answers followed a uniform trend: full information of patients was demanded by approximately 80%, and acceptance of participation resting with responsible doctors in more than 80%. Less than half of these 80% felt that evaluation by a scientific‐ethical committee would add to patients' security.
Screening for Iron Overload Using Transferrin Saturation
Authors: OLSSON K. S. , ERIKSSON K. , RITTER B. , HEEDMAN P. A.
Published: August 2010

ABSTRACT People with parenchymal iron overload exhibit an elevated serum iron concentration and a raised transferrin (TIBC) saturation early in the course of the disease. They can therefore be detected by simple laboratory tests before organ damage has occurred. In this study running for 2 months, 10512 samples from approximately 8750 patients and blood donors were examined in a county hospital in Central Sweden. Abnormal TIBC saturation (>70%) was found in 1.7% of the samples. This abnormality was caused by physiological fluctuations in serum iron in 44%, liver disease in 22%, blood disorder in 10%, iron therapy in 10.5% and parenchymal iron overload in 11.5%. The diagnosis of iron overload was confirmed by measuring the serum ferritin concentration and by performing the desferrioxamine test, liver biopsy, quantitative phlebotomy and family studies including HLA typing. We found a prevalence of iron overload of 0.24%. This figure is almost certainly too low because some affected patients were probably lost because of TIBC desaturation induced by inflammatory conditions.
Distribution of Apolipoprotein E Isoforms between Very Low and High Density Lipoproteins of Normal Subjects and Hyperlipidemic Patients with Special Reference to Type III Hyperlipidemia
Authors: HOLMQUIST LEIF
Published: August 2010

ABSTRACTSerum very low (VLDL) and high density lipoproteins (HDL) from 17 hyperlipidemic patients and 10 normal subjects have been isolated by preparative ultracentrifugation, and the electrophoretic patterns of apolipoprotein E (apo E) isoforms in the lipoproteins have been examined by isoelectric focusing. Type III hyperlipidemia (dyslipoproteinemia) has been suggested to be a disease caused by an abnormal mutant of the apo E‐3 isoform. In accordance with this, all patients with type III hyperlipidemia in the present study showed lack of apo E‐3 in VLDL. However, all these patients demonstrated a protein zone corresponding to apo E‐3 in their HDL fraction. Patients with other types of hyperlipidemia or normal subjects who showed an apo E‐4 variant in VLDL had an HDL that lacked apo E‐4. The results support the hypothesis that type III hyperlipidemia is due to an abnormal composition of the VLDL particles rather than a result of an abnormal mutant of apo E‐3.
Characterization of Patients with Chlorpropamide‐Alcohol Flush
Authors: GROOP L. , KOSKIMIES S. , TOLPPANEN E.‐M.
Published: August 2010

ABSTRACTOne hundred and sixty patients with onset of non‐ketotic diabetes at the ages of 35–70 were investigated for chlorpropamide‐alcohol flush (CPAF), β‐cell function, insulin sensitivity, human leucocyte antigens (HLA), organ specific antibodies and diabetic complications. A positive flush reaction was defined as an increase in facial skin temperature by at least 1.5°C, which was associated with a visible flush reaction in all patients. In accordance with these cirteria, 38% of the patients were considered CPAF‐positive with a mean rise in facial skin temperature of 2.3±0.1°C compared with 0.6±0.1°C in the CPAF‐negative patients (p<0.001). The CPAF‐positive patients could be distinguished from the CPAF‐negative with respect to: 1) higher frequency of first degree family history of diabetes (p<0.05), 2) lower basal and glucagon‐stimulated C‐peptide concentrations (p<0.02 andp<0.001), 3) increased frequency of HLA‐A2 (p<0.01) and decreased frequency of HLA‐B7 (p<0.01). The findings thus support the genetically determined nature of CPAF. Considering the criteria for maturity onset diabetes in the young, it is unlikely that CPAF acts as a genetic marker for this particular form of genetic diabetes.
Assessment of Left Ventricular Filling Pressure in Myocardial Infarction Using the First Derivative of the Apexcardiogram
Authors: RASMUSSEN KLAUS , GLUD TORBEN
Published: August 2010

ABSTRACT We recorded the apexcardiogram (ACG) and its first derivative (dA/dt) in 24 patients with acute or recent myocardial infarction. From dA/dt, an index I = × 10 dRFW/dS was defined (dRFW and dS = peaks of dA/dt corresponding to the rapid filling wave and to the systolic upstroke of the ACG). A significant correlation was found between I and pulmonary capillary wedge pressure (PCW, mmHg). PCW = 2.3 × I+6.5 (r=0.80, p<0.001). Normal PCW was found in 15 patients who all had an I<2.8. Elevated PCW was found in 9 patients who all had an I>2.8. Thus the ability of I to predict elevated PCW was 100% (95% confidence limit > 66.4%). The ability to predict normal PCW was 100% (95% confidence limit > 76.2%). No significant correlation was found between I and cardiac index (r=0.29, p>0.1).
Adenosine Deaminase in the Diagnosis of Pleural Effusions
Authors: PETTERSSON TOM , OJALA KAARINA , WEBER THEODOR H.
Published: August 2010

ABSTRACT The activity of adenosine deaminase (ADA) was determined in serum and pleural fluid of 90 patients with pleural effusions of various aetiology. Tuberculous pleural effusions, empyemas and rheumatoid pleural effusions demonstrated significantly higher activities of ADA than parapneumonic, nonspecific and malignant pleural effusions and effusions in systemic lupus erythematosus and congestive heart failure. In tuberculosis, empyema and rheumatoid arthritis ADA activity was significantly higher in pleural fluid than in serum, indicating a local synthesis of ADA by cells within the pleural cavity in these diseases.
Raynaud's Phenomenon Caused by β‐Receptor Blocking Drugs
Authors: ELIASSON KEITH , DANIELSON MATS , HYLANDER BRITTA , LINDBLAD LARS ERIK
Published: August 2010

ABSTRACTTwenty‐four hypertensive patients reported vasospastic symptoms in their hands during treatment with β‐blocking drugs with different pharmacological properties. Twenty patients had symptoms when staying indoors and 11 did not always experience complete relief of symptoms following active rewarming attempts. Finger systolic blood pressures were measured after standardized local cooling. In 15 patients, blood pressure decreased to a pathological level during this procedure. Previous β‐blockade was changed to combined α‐ and β‐blockade with labetalol given twice daily in a mean dose of 259 mg/day for 3 months. After this period, most patients showed a decreased temperature sensitivity both objectively and subjectively. Blood pressure control was maintained at the previous level. Heart rate increased significantly during treatment with labetalol. Labetalol offers an alternative treatment to patients suffering from vasospastic side‐effects of β‐blockers.
Systolic Time Intervals and Ejection Fraction in Assessing Left Ventricular Performance Following Acute Myocardial Infarction
Authors: MANGSCHAU ARILD , KARLSEN RAGNAR LUND , LIPPESTAD CARL T. , NERDRUM HANS J.
Published: August 2010

ABSTRACT Left ventricular performance in 54 patients with acute myocardial infarction was studied by means of systolic time intervals (STI) and ejection fraction (EF) determined using radionuclide technique. The data were correlated to clinical parameters of left ventricular heart failure and size of infarction. Thirty‐seven patients were studied in the convalescent period with repeated registrations at 6, 10 and 24 weeks. Patients with left ventricular heart failure had markedly depressed EF, significantly different from EF in the non‐heart failure group. STI did not show any difference. A strong correlation between infarct size and EF could be demonstrated. STI discriminated significantly transmural from non‐transmural infarctions, and presented significant differences between those with normal EF (>50%) and patients with EF below 35%. No significant changes could be found in left ventricular performance during the convalescent period, except for an increase in corrected preejection period (PEPc) probably due to drugs. The correlation between EF and STI was poor, the highest correlation coefficient being 0.55 between EF and the ratio PEP/LVET.
Preoperative Diagnosis of Renovascular Hypertension
Authors: DELIN KRISTER , AURELL MATTIAS , GRANERUS GÖRAN
Published: August 2010

ABSTRACTThe gain in the diagnostic power of the routine preoperative bilateral renal vein renin investigation by the inclusion of an acute stimulation of renin release was studied in 25 hypertensive patients with fibromuscular (FMD) and 44 with arteriosclerotic (AS) renovascular disease. Nine FMD and 17 AS patients had renal vein renin ratios ≥1.50 under unstimulated conditions. Of these 26 patients, 8 in each group improved after surgical treatment. Among the 14 FMD and 24 AS patients with ratios <1.50, another 9 FMD and 7 AS patients improved after operation. After acute stimulation of renin release, no less than 18 FMD and 26 AS patients had a unilateral renin secretion from the diseased kidney and of these, 14 FMD and 14 AS patients were successfully treated with operation of the stenosis. Thus the stimulation was necessary for correct preoperative diagnosis in 38% of 32 successfully operated patients, and at the same time the predictive value of a negative test increased from 0.58 to 0.80. It is concluded that acute stimulation of renin release greatly improves the diagnostic power of the renal vein renin investigation in renovascular hypertension.
HBsAg‐negative Chronic Active Hepatitis and Mixed Connective Tissue Disease Syndrome
Authors: ROLNY P. , GOOBAR J. , ZETTERGREN L.
Published: August 2010

ABSTRACT Two patients are described who suffered from both HBsAg‐negative chronic active hepatitis and mixed connective tissue disease syndrome. The diagnosis of liver disease was made prior to the diagnosis of collagenosis in one of the patients, whereas the opposite was the case in the other. In spite of the fact that symptoms and laboratory data suggesting both diagnoses were present from the moment of presentation, there was a considerable delay in establishing the second diagnosis in both patients. To our knowledge, this is the first report on an association between chronic active hepatitis and mixed connective tissue disease syndrome. It illustrates the difficulties when diagnosing overlap conditions.
Colitis of Behçet's Syndrome
Authors: FALLINGBORG JAN , LAUSTSEN JESPER
Published: August 2010

ABSTRACT A 25‐year‐old previously healthy man developed complete Behçet's syndrome during five weeks. His main complaint was diarrhea with blood. Ulcers resembling aphthous ulcers of the mouth were revealed in the transverse, left and sigmoid colon by X‐ray and sigmoidoscopy. Prednisone therapy was initiated and resulted in complete clinical restitution within three weeks.
Glycolate Causes the Acidosis in Ethylene Glycol Poisoning and is Effectively Removed by Hemodialysis
Authors: JACOBSEN DAG , ØVREBØ STEINAR , ØSTBORG JENS , SEJERSTED OLE M.
Published: August 2010

ABSTRACT Six male patients with severe ethylene glycol poisoning were studied with respect to the origin of the metabolic acidosis. The plasma concentrations of ethylene glycol were 4–41 mmol/l and treatment included alkali, ethanol and hemodialysis. Plasma analysis by isotachophoresis and whole blood lactate determinations showed that glycolate (17.0–29.3 mmol/l), lactate (1.4–6.2 mmol/l) and β‐hydroxybutyrate (≤1.8 mmol/l) were present in elevated concentrations contributing to the acidosis. Oxalate (≤0.33 mmol/l), glyoxylate (<0.2 mmol/l) and formate (<0.4 mmol/l) concentrations were negligible and did not contribute to any significant degree to the acidosis. The elevated plasma glycolate concentration was highly correlated to the anion gap (r=0.923) and the glycolate made up for 96.1% (n=6, range 84.7–108.8) of the increased anion gap. We conclude that glycolate accumulation is the main reason for the metabolic acidosis in ethylene glycol poisoning. The mean dialysator (1.6 m2) clearances of glycolate at a blood flow of 200 ml/min in two patients were 137 ml/min (n=9, SD±8, range 125–149) and 144 ml/min (n=11, SD±8, range 133–158). By applying first order kinetics during hemodialysis a volume of distribution of glycolate of 0.55 l/kg was found, assuming that the dialysator clearance equals the total body clearance of glycolate. Thus glycolate, the probable main metabolite of ethylene glycol, is efficiently removed by hemodialysis.
Treatment of Oral Theophylline Poisoning
Authors: AHLMÉN JARL , HEATH ANDREW , HERLITZ HANS , KVIST LENA , MELLSTRAND TORE
Published: August 2010

ABSTRACT Two patients, 15 and 20 years old, were admitted after an overdose of theophylline in a slow‐release preparation. The gradual occurrence of clinical symptoms reflected the slow gastrointestinal absorption of the drug, and therefore active treatment was not started until 10 and 12 hours after intake, respectively. Peak s‐concentrations were 275 and 1295 μmol/l, respectively. One patient was treated with hemoperfusion only, whereas the more severely intoxicated patient was treated with combined hemoperfusion and hemodialysis. Only about 0.2 g theophylline was eliminated by hemodialysis in this patient compared to a calculated amount of 6.9 g by hemoperfusion. Severely theophylline‐intoxicated patients should be treated with supportive therapy and hemoperfusion.
Paroxysmal Dysarthria and Raynaud's Phenomenon in the Tongue
Authors: NIELSEN HENRIK VAGN , KRISTENSEN JOHANNES KJELDSTRUP , KLEMP PER , STABERG BENT , THOMSEN KRISTIAN
Published: August 2010

ABSTRACT Three patients suffering from systemic scleroderma and Raynaud's phenomenon in the digits as well as the tongue are reported. Following exposure to cold, a vasospasm was observed in the digits and the tongue accompanied by severe dysarthria. These striking oral symptoms had been overlooked for years in the medical ward. It is recommended to question all patients with Raynaud's phenomenon about visceral manifestations during the digital attacks.
Plasmapheresis and Cold Sensitivity of Immunoglobulin Molecules
Authors: WALDENSTRÖM JAN G. , RAIEND ULO
Published: August 2010

ABSTRACTThere is a close connection between molecular changes of the Ig molecule with sinking temperature and the syndrome of hyperviscosity. The cryoglobulins are usually macroglobulins or complexes between IgM and other immunoglobulin classes. Many of these molecules can also be characterized as euglobulins. The connection between precipitation in the cold and in solutions with low electrolyte content is studied. Data on these connections are presented. The dependence of relative viscosity on the temperature has been investigated in a large number of sera from patients with different diseases. It is clear that most of these cold‐sensitive globulins are macroglobulins (IgM). A number of viscosity curves at different temperatures in such sera are given. Also a few sera from patients with IgG myeloma have similar curves. The change in viscosity with lower temperatures implies that relative viscosity has to be determined at 37°C in order to correspond to the condition in the living body. In practice, however, it is usually correct to state that IgM levels above 40 g/l are an indication that plasmapheresis should be considered. The best clinical sign is obtained by ophthalmoscopy. Difficulties with the counting of leukocytes and platelets in electronic counters may be caused by the presence of macroglobulins, usually but not always, cryoglobulins.