bluuebunny/crossref_metadata_2025 huggingface dataset:
Choosing Death
Authors: ROBERTS JOHN C. , KJELLSTRAND CARL M.
Published: August 2010

ABSTRACT We analyzed patients who died on chronic dialysis because they stopped the treatment, although there was no technical dialysis complication or new medical complication. These patients preferred death to the stress of dialysis. This occurred in 26/1766 (1.5%) patients, and was responsible for 26/704 (4%) of all deaths. We compared these 26 patients to 40 competent patients who discontinued treatment when a medical complication arose. The patients were similar in most respects (age, sex, diagnosis, duration of dialysis, living situation, and type of dialysis) and had the same number of medical complications when starting dialysis. However, the patients who stopped dialysis were more often on home dialysis, 8/24 vs. 3/40 of the other patients (p < 0.05). Overall, stopping was three times more common in home than in center patients (3.0% vs. 1.1%) (p < 0.02). Relatives responding to a written interview felt that nurses and social workers but not physicians had been helpful in the difficult time surrounding the patient's decision and death. This study indicates that particularly home dialysis patients are at a high risk of discontinuing dialysis because of the stress of the dialysis procedure. A realistic introduction to and realization of their dialysis problems, better training and better psychological support, particularly from physicians, are necessary to eradicate this avoidable cause of death in chronic dialysis patients.
Effects of Plasmapheresis on the Plasma Concentration of Proteins Used to Monitor the Disease Process in Multiple Myeloma
Authors: WAHLIN ANDERS , GRUBB ANDERS , HOLM JAN , MARKLUND STEFAN L.
Published: August 2010

ABSTRACT We studied the influence of plasmapheresis on the plasma concentrations of proteins (IgG, IgA, β2‐microglobulin) used for estimation of tumour cell mass in patients with multiple myeloma. Simultaneously, the effects of plasmapheresis on plasma concentrations of proteins (CRP, α1‐antitrypsin, haptoglobin) used for the assessment of inflammatory processes were studied. Also, changes in the plasma concentration of protein HC, a recently described protein occurring both as a free protein and as an IgA complex, were studied. The influence of plasmapheresis varied for the different proteins. The plasma levels of IgG, IgA, CRP, α1‐antitrypsin, and haptoglobin decreased during plasmapheresis. The simultaneous reduction of the level of protein HC was smaller than that of IgG, IgA and haptoglobin. The plasma concentration of β2‐microglobulin did not decrease during plasmapheresis. The recovery rates of the proteins were found to be approximately inversely related to their molecular weights.
Once Daily Dosing of Enalapril in Congestive Heart Failure
Authors: AHLNER JOHAN , BERGDAHL BJÖRN , DAHLSTRÖM ULF , OHLSSON JAN
Published: August 2010

Enalapril 40 mg or tolerated dose was given once daily to 21 patients with congestive heart failure (CHF), NYHA class III, in addition to treatment with digoxin and/or diuretics. After an 8‐week open period, 19 patients were randomized to continue enalapril or to receive a placebo in a double‐blind manner. After the first enalapril dose of 10 mg, maximal reduction of blood pressure (BP) occurred after 4 hours (mean 34/17 mmHg;p<0.001). No further reduction was found after higher doses. After the open period significant improvement was shown as judged by NYHA class (p<0.01), stroke volume (p<0.05), maximal working capacity (p<0.05), heart volume (p<0.01) and maximum rate pressure product (RPPmax) (p<0.001). Urinary aldosterone markedly decreased (p<0.01), whereas serum potassium and serum creatinine slightly increased (p<0.05). At the end of the blind period enalapril was superior to placebo concerning NYHA class (p<0.01), heart volume (p<0.05) and RPPmax (p<0.05). Other parameters, including aldosterone in urine, did not differ between the groups. Carry‐over effects may have diminished the differences between enalapril and placebo. Diarrhoea (n=5) and hypotension (n=5) were the most common side‐effects. Overall, enalapril was well tolerated and seems to be useful in single daily doses in the treatment of CHF.
The Effect of Enalapril and Timolol on Blood Lipids: A Randomized Multicenter Hypertension Study in General Practice in Norway
Authors: Leren Paul , FOSS PER OLAV , NORDVIK BJØRN , FOSSBAKK BENDT
Published: August 2010

In a 24‐week randomized, single‐blind study Timolol (n=63) and Enalapril (n=57) proved to be potent and safe antihypertensive drugs. However, the effect on lipid metabolism was fundamentally different, despite the fact that the effect on total serum cholesterol did not significantly differ between the two groups. Enalapril had no adverse effect on any lipid fractions, while Timolol increased very low (VLDL) + low (LDL) density lipoprotein cholesterol by 7.6% (p<0.001) and total triglycerides by 34.5% (p<.001), and decreased the favorable high density lipoprotein (HDL) cholesterol by 11.3% (p<0.001). Thus, the ratio HDL/VLDL + LDL cholesterol was reduced by 17.1 % (p<0.001). Enalapril reduced uric acid by 3.4% (NS), while Timolol increased uric acid by 4.0% (p<0.05). The difference between the groups was statistically significant (p<0.01). The first steps in any attempt to solve the hypertension‐coronary dilemma should be to take into consideration all pharmacologic effects of antihypertensive drugs.
Effects of Chronic Iron Deficiency Anaemia on Myoglobin Content, Enzyme Activity, and Capillary Density in the Human Skeletal Muscle
Authors: CELSING FREDRIK , EKBLOM BJÖRN , SYLVÉN CHRISTER , EVERETT JAN , ÅSTRAND PER‐OLOF
Published: August 2010

The influence of chronic iron deficiency anaemia on myoglobin content, maximal enzyme activities and capillarization in the human skeletal muscle was investigated. Muscle samples from musculus vastus lateralis were screened in an Indonesian population. The causes of iron deficiency were chronic intestinal bleeding or repeated pregnancy combined with low iron intake. The maximal activities of iron‐dependent and non‐iron‐dependent glycolytic and oxidative enzymes as well as myoglobin showed similar values in the iron‐deficient group and the matched control group. The activities of the oxidative enzymes in both the iron‐deficient group and the controls were lower, however, compared even to untrained Swedish subjects. The capillary density was essentially within a normal range in both groups. It is concluded that chronic iron deficiency anaemia of a moderate or severe degree, with Hb concentrations of about 80–100 g.1‐1, does not cause an impaired biochemical function of the human skeletal muscle.
Amiloride Prevents Thiazide‐induced Intracellular Potassium and Magnesium Losses
Authors: DYCKNER THOMAS , WESTER PER‐OLOV , WIDMAN LARS
Published: August 2010

ABSTRACT To study the effect of a combination of amiloride, 5 mg, and hydrochlorothiazide, 50 mg (Moduretic®), on plasma and skeletal muscle electrolytes in patients on long‐term diuretic therapy (>1 year) for arterial hypertension and/or congestive heart failure, 58 patients were recruited. Fifty‐five patients completed the study, 27 controls and 28 in the treatment group. The Moduretic® group demonstrated a significant increase in skeletal muscle potassium and magnesium values and a significant decrease in systolic blood pressure after 6 months on therapy. There was no significant change in these parameters in the control group. It is concluded that this combination of amiloride and hydrochlorothiazide is capable of preserving the internal and external balance of potassium and magnesium on a long‐term basis in the patient categories studied.
Role of Hypervolemia and Renin in the Blood Pressure Control of Patients with Pyelonephritic Renal Scarring
Authors: JACOBSON STEFAN H. , KJELLSTRAND CARL M. , LINS LARS‐ERIC
Published: August 2010

ABSTRACT Patients with pyelonephritic renal scarring are at risk of developing renal failure and hypertension. We studied glomerular filtration rate (GFR), renal plasma flow (RPF), filtration fraction (FF), systolic (SBP) and diastolic (DBP) blood pressure, fractional sodium, potassium and phosphate excretion, peripheral renin activity (PRA), plasma aldosterone (p‐Aldo), urinary albumin excretion (U‐Alb) and urinary β2‐microglobulin excretion (β2‐M) in hydropenia and during transition to 3% volume expansion with isotonic saline infusion in 22 female patients with renal scarring due to pyelonephritis and 9 healthy controls. The patients had significantly lower GFR, higher SBP and higher PRA in hydropenia, but there was no significant difference in RPF, FF, DBP or p‐Aldo. After volume expansion, SBP, DBP, PRA and p‐Aldo were significantly higher in patients than in controls. Transition to 3% volume expansion was associated with a similar increase in SBP in both patients and controls, whereas DBP increased significantly more in the patients (p<0.01). Volume expansion resulted in a significant suppression of PRA and p‐Aldo in both patients and controls. The patients with renal scarring had the same capacity to excrete sodium and water during transition to volume expansion as the healthy controls. The renin‐aldosterone system seems abnormally activated and is probably more important than hypervolemia in the development of hypertension in this group of patients.
Withdrawing Life Support—the Survivors
Authors: ROBERTS JOHN C. , SNYDER R. , KJELLSTRAND CARL M.
Published: August 2010

ABSTRACTWe studied the impact of withdrawal of life support on surviving relatives and families of patients who died when chronic dialysis was disocntinued. Fifty‐four (57%) relatives answered a written questionnaire. The relatives of 70% of home dialysis patients and 27% of center dialysis answered the questionnaire. The answering relative felt most angry and uncomfortable with the decision, ascribed the least anger and most comfort to the patient and an intermediate value to the rest of the family. Staff physician and resident ranked highest in involvement in making the decision, social workers and chaplains the lowest. Once the decision was made, social workers and nurses were most caring and helpful, residents and chaplains were rated the lowest. The relatives felt that they and the patients were the ones who most often brought up the decision to stop and also made the final decision. The relatives thought that the incompetent patients were most angry and uncomfortable but that they felt that decision to be right. The family and relatives were particularly angry and uncomfortable when the patient had discontinued dialysis for the stress of the procedure alone and not any medical complications. In these cases there was most family disagreement and the staff received startling low scores, both for involvement and caring and helpfulness. In answers to open‐ended questions, the relatives expressed disappointment with physicians who were unwilling to talk to them, were overly optimistic and continued too long with treatment. They wished for more openness and truthfulness. No long‐term psychological harm seems to have come to the relatives and families with one exception. Our finding suggests that more meetings with families and patients and openness about problems and complications during chronic dialysis and follow‐up and counseling of families after the patients have died should be helpful.
Leukemia in the Central Nervous System
Authors: BRINCH LORENTZ , EVENSEN STEIN A. , STAVEM PER
Published: August 2010

ABSTRACT The frequency of central nervous system (CNS) leukemia was studied in patients aged 15–59 with acute leukemia, who had received induction treatment in the years 1971–1986. Twelve out of 103 patients with acute lymphoblastic leukemia (ALL) developed CNS leukemia in spite of prophylaxis consisting of intrathecal methotrexate. Ten out of 217 patients with acute myelogenous leukemia (AML) developed CNS leukemia. None had been given preventive treatment. Leukemic blasts with either M4 or M5 morphology appeared to increase the risk of CNS relapse. Treatment was adjusted to the clinical problem of each patient, but always included intrathecal methotrexate. Median survival after a diagnosis of CNS leukemia was 8 and 6 months in ALL and AML respectively, with bone marrow failure due to hematologic relapse as the leading cause of death. CNS leukemia, if properly treated, does probably not shorten survival. An active approach to diagnosis and treatment is therefore mandatory.
Serum Neopterin and β2‐Microglobulin Concentrations in Monoclonal Gammopathies
Authors: FINE JEAN‐MARIUS , LAMBIN PATRICK , DESJOBERT HELÈNE
Published: August 2010

ABSTRACT Serum neopterin and β2‐microglobulin concentrations were investigated in 46 patients with multiple myeloma and in 28 patients with asymptomatic monoclonal gammopathy followed for long periods (median 9.6 years) and showing an absence of evolution. Seventy‐two per cent of the patients with multiple myeloma showed β2‐microglobulin concentrations higher than 3 mg/1 with a mean of 6.84 mg/1, whereas all the patients with asymptomatic monoclonal gammopathies had concentrations lower than 3 mg/1 with a mean of 1.64 mg/1. Concerning serum neopterin concentrations, 91% of the patients with multiple myeloma had values with in pathological limits (>8 nmol/1) with a mean of 34 nmol/1, whereas all but one of the patients with asymptomatic monoclonal gammopathy had normal values with a mean of 5.19 nmol/1. The differences thus observed in these two groups of patients are highly significant (p<0.001). Serum neopterin concentration, unrelated to renal insufficiency, seems to be useful in the differentiation of malignant or benign asymptomatic monoclonal gammopathies.
Coronary and Skeletal Muscle Enzyme Changes during a 14 km Run
Authors: AGNER ERIK , KELBæK HENNING , FOGH‐ANDERSEN NIELS , MØRCK HENNING I.
Published: August 2010

ABSTRACT Increasing coronary enzyme values have previously been demonstrated after physical exercise. In the present study serum values of aspartate aminotransferase (ASAT), lactate dehydrogenase (LDH), LDH isoenzymes, creatinine kinase (CK), and the myocardialbound fraction of this enzyme (CK‐MB) were measured in a random sample of healthy non‐smoking, physically fit men before and immediately after a competitional 14 km run. All enzyme values increased during the run, ASAT by 7 %, LDH by 25 %, CK by 38 %, and CK‐MB by 53%. Measurement of LDH isoenzymes showed special increments of the non‐cardiac fractions. However, absolute increments of the cardiac fractions of the LDH isoenzymes together with other serum enzyme elevations do not exclude a cardiac source of enzyme release during and following physical exercise.
Acute Effects of Short‐term Fasting on Blood Pressure, Circulating Noradrenaline and Efferent Sympathetic Nerve Activity
Authors: ANDERSSON BJÖRN , WALLIN GUNNAR , HEDNER THOMAS , AHLBERG ANN‐CHARLOTTE , ANDERSSON OVE K.
Published: August 2010

ABSTRACT Eleven moderately obese women, aged 46–62 years, with a body mass index of 29–34 and with borderline hypertension (repeated diastolic blood pressure >90 mmHg) fasted for 48 hours. Before the fast and after 48 hours of fasting, plasma noradrenaline, urinary noradrenaline, urine potassium, urine sodium and weight were measured. In six of the patients muscle nerve sympathetic activity was recorded from the peroneal nerve by tungsten micro‐electrodes for 15 min each time. The efferent muscle sympathetic activity (MSA) was expressed as the number of bursts/min. The recordings were done before the fast and after 48 hours of fasting. We found significant decreases in body weight from 88.4±2.5 kg to 86.4±2.5 kg. Systolic blood pressure (BP) was reduced from 158±3 mmHg to 146±5 mmHg (p<0.001) and diastolic BP from 96±3 mmHg to 89±3 mmHg (p<0.01) during the fast. MSA was significantly increased from 42.0±5.5 bursts/min to 44.5±5.8 (n=6), while plasma and urine noradrenaline concentrations (n = 11) showed a non‐significant tendency to increase. We conclude that the hypotensive response during the first days of extensive caloric reduction is not due to a decreased sympathetic activity. If anything, there may be weak increase of efferent sympathetic nerve activity and venous plasma levels of circulating noradrenaline. The mechanisms behind the acute hypotensive response to negative caloric balance are thus still unclear, but obviously different from long‐term adaptation of the blood pressure.
Activation of Classical Pathway Complement in Chronic Inflammation
Authors: PETERSEN NIELS ERIK , ELMGREEN JENS , TEISNER BØRGE , SVEHAG SVEN‐ERIK
Published: August 2010

ABSTRACT Split products of complement component 3 (C3) and complement component 4 (C4) derived from activation of the alternative and classical complement pathways were measured in untreated outpatients, 20 with Crohn's disease and 19 with rheumatoid arthritis. Elevated levels of the d split product of C4 (C4d) were observed in 12 of 19 patients with rheumatoid arthritis and in 9 of 20 patients with Crohn's disease. Levels of the d split product of C3 (C3d) were increased in 14 of 19 patients with rheumatoid arthritis and in 6 of 20 Crohn's disease patients. The median values of C4d and C3d were significantly increased in both groups of patients. C3d concentrations correlated positively with C4d levels (rs=0.51–0.56, p<0.005). The complement activation was not reflected in reduced plasma levels of native C3 and C4. The data indicate activation of the classical complement pathway in both rheumatoid arthritis and Crohn's disease.
Nutritional Status in Patients with Acute Stroke
Authors: AXELSSON KARIN , ASPLUND KJELL , NORBERG ASTRID , ALAFUZOFF IRINA
Published: August 2010

ABSTRACT By measuring three anthropometric variables (relative weight, triceps skinfold thickness and arm muscle circumference) and three circulating proteins (albumin, transferrin and prealbumin), nutritional status was assessed in 100 consecutive patients with acute stroke. On admission to hospital, two or more indicators showed subnormal values for 16%; this was associated with the female sex, high age and a history of atrial fibrillation. At discharge, 22% had two or more subnormal indicators. Poor nutritional status during the hospital stay appeared to be related to infections, the male sex, the intake of cardiovascular drugs and high age. Fewer of the patients with two or more subnormal nutritional indicators were able to return home than of the patients with none or one subnormal nutritional indicator. We conclude that undernutrition is not uncommon at the onset of stroke and that certain risk groups for the development of undernutrition during hospital stay can be identified.
Incidence of Severe Hypoglycemia and Its Causes in Insulin‐treated Diabetics
Authors: NILSSON ANDERS , TIDEHOLM BO , KALÉN JOHAN , KATZMAN PER
Published: August 2010

ABSTRACT In a one‐year prospective study in insulin‐treated diabetics, 61 episodes of severe hypoglycemia demanding medical assistance were registered in 46 patients. The incidence of severe hypoglycemia was estimated at 0.07 per patient and year. Mean age (50±16.9 yr), diabetes duration (19±11.6 yr), HbAk (7.8±1.8%) and daily insulin dose (0.63±0.23 IU/kg) in these patients (SH group) did not differ from a control group matched for sex and age. However, the patients in the SH group were treated with relatively less short‐acting insulin than the patients in the control group (25±13.8% vs. 39±24.5%; p<0.01). This finding may indicate that multiple injection therapy with a higher relative amount of short‐acting insulin could reduce the risk of severe hypoglycemia, provided the metabolic control is unaltered.
Transient Myocardial Ischaemia during Ambulatory Monitoring Out of Hospital in Patients with Chronic Stable Angina Pectoris
Authors: EGSTRUP KENNETH
Published: August 2010

Abstract. Transient myocardial ischaemia during daily life, detected by ambulatory electrocardiographic monitoring, was investigated in 42 patients with chronic stable angina and documented coronary artery disease. Ambulatory monitoring was initiated for 36 hours after all prophylactic antianginal medication had been withdrawn for 5 days. There were 196 episodes of ST‐segment depression, 145 (74%) of which were not accompanied by angina. As well, a tendency to more prolonged and greater ST‐segment change with symptomatic ischaemic episodes was noted. A diurnal variation in transient ischaemia both with and without symptoms was observed, the highest frequency being in the morning hours. Transient myocardial ischaemia was more frequent in patients with double or triple vessel disease, compared with single vessel disease, but with a great variation. Heart rate at the onset of ischaemia during ambulatory monitoring was significantly lower than heart rate at the onset of ST‐segment change during exercise testing (100.2±14.6 vs. 115.8±19.6 beats/min, p<0.01), which may indicate different pathophysiological mechanisms. Transient impairment in coronary oxygen supply seems to be of importance during ischaemic episodes out of hospital.
The Antihypertensive Effect of Pinacidil versus Prazosin in Mild to Moderate Hypertensive Patients Seen in General Practice
Authors: STERNDORFF BENT , JOHANSEN PETER
Published: August 2010

Abstract.The antihypertensive effect of a new vasodilating drug, pinacidil, was compared with prazosin in a randomized, open study in general practice including 131 patients with a sitting diastolic blood pressure (DBP) between 100–115 mmHg. At inclusion 108 patients were untreated and the remaining patients were on treatment with thiazide diuretics and/or β‐blockers. The aim was to reduce the sitting DBP to ≤95 mmHg, which was achieved in 85% of the patients treated with pinacidil and in 77% of the patients treated with prazosin (NS). In the responding patients the reductions were (mean±SD) 16±7 mmHg (p<0.001) and 13±6 mmHg (p<0.001) in the pinacidil group (n=60) and the prazosin group (n=46), respectively (p<0.10). During 5 months of maintenance therapy no statistically significant differences in blood pressures between the two treatment groups were present. Side‐effects were typical of vasodilator therapy, i.e. headache, dizziness, tachycardia and edema, leading to discontinuation of therapy in 10 patients in each treatment group. Heart rate (HR) was increased with pinacidil and unchanged with prazosin. Edema was frequently seen with pinacidil and dizziness with prazosin. Because of edema a thiazide diuretic was given to nine patients in the pinacidil group and two patients in the prazosin group. No clinically significant changes in ECG and biochemical variables were observed. In conclusion, the study has demonstrated that pinacidil is as effective an antihypertensive agent as prazosin. Pinacidil may be used as monotherapy. However, the study suggests that pinacidil should be used as add‐on therapy to thiazide diuretics.
Non‐invasive Estimation of Pulmonary Capillary Wedge Pressure at Rest and during Exercise by Electrocardiography, Phonocardiography and Doppler Echocardiography
Authors: KARP KJELL , TEIEN DAG , ERIKSSON PETER
Published: August 2010

Abstract. Non‐invasive estimation of the mean pulmonary capillary wedge pressure was accomplished by simultaneous electrocardiographic, phonocardiographic and continuous wave Doppler echocardiographic recordings. The interval from the onset of the QRS complex to the Doppler determined mitral valve closure (Q‐MC) and the interval from the phonocardiographic aortic component of the second heart sound to the Doppler determined mitral valve opening (A2‐MO) were measured. The non‐invasive registrations were carried out simultaneously with direct measurements of the wedge pressure. In an initial group of 22 patients, a significant correlation was observed between the intervals alone and the wedge pressure, r=0.60, SEE=±6.9 mmHg, p<0.01, for the Q‐MC interval and r=–0.70, SEE=6.2 mmHg, p<0.001 for the A2‐MO interval. A closer correlation was observed between the ratio Q‐MC/A2‐MO and the measured wedge pressure, r=0.93, SEE=±3.1 mmHg, p<0.001. The linear regression equation, PCW=19.5 (Q‐MC/A2‐MO)+3.0 (mmHg), was applied prospectively to a second group of 23 patients. Again the relationship between estimated and measured wedge pressure was highly significant, r=0.90, SEE=±3.1 mmHg, p<0.001. Twenty‐two patients were also studied during an exercise test, and acceptable noninvasive recordings were obtained in 19 of them. The change in estimated wedge pressure during activity related closely to the change in actual wedge pressure, r=0.80, SEE=±5.7 mmHg, p<0.001. A simplified equation suitable for routine clinical practice, PCW=24 (Q‐MC/A2‐MO) (mmHg), yielded almost equally accurate estimates of the wedge pressure over a wide range of pressures. The simplicity and reasonable accuracy of Doppler‐assisted estimation of the wedge pressure makes it useful in the evaluation and follow‐up of patients with suspected cardiac disorders. The method may assist in evaluating the effects of diagnostic or therapeutic procedures, since it is sufficiently sensitive to detect acute directional changes in wedge pressure.
The Effect of Flumazenil (Ro 15–1788) in the Management of Self‐induced Benzodiazepine Poisoning
Authors: HÖJER JONAS , BAEHRENDTZ SVANTE
Published: August 2010

Abstract. A double‐blind randomized study was performed to evaluate the efficacy and safety of flumazenil, a benzodiazepine antagonist. The study comprised 52 patients admitted to an intensive care unit because of suspected pure or mixed benzodiazepine poisoning. The degree of consciousness was assessed according to a modified Glasgow Coma Scale (MGCS), graded from 4 to 20, immediately before and at consecutive intervals after an i.v. injection of flumazenil or placebo. If there were no clear signs of arousal within 5 min after the blind injection, an injection of flumazenil was given in open design. Five minutes after the blind administration of active drug the MGCS score was increased by an average of 7.4 (p<0.001) in the flumazenil group. In the placebo group the average MGCS score of 7.8 on admission was not significantly increased by placebo, but 5 min after flumazenil injection it had increased by 7.3 to 15.1 (p<0.001). Patients who had ingested both alcohol and benzodiazepines were aroused as promptly and clearly (MGCS +8.8; p<0.001) as those who had taken benzodiazepines alone (MGCS +8.4; p<0.001). The patients poisoned with a combination of benzodiazepines and other hypnotic drugs responded less, but still highly significantly (MGCS +5.8; p<0.001). Flumazenil was well tolerated and the safety of the antidote seems acceptable. It is concluded that flumazenil can facilitate differential diagnosis and that it is an effective tool in the treatment of drug overdosage when benzodiazepines are involved.
Thyroid Hormones and Thyroxine‐binding Globulin in Relation to Liver Function and Serum Testosterone in Men with Alcoholic Cirrhosis
Authors: BECKER ULRIK , GLUUD CHRISTIAN , BENNETT PAUL
Published: August 2010

Abstract. In 73 euthyroid male patients with histologically verified alcoholic cirrhosis, thyroid hormones, thyroxine‐binding globulin (TBG) and testosterone concentrations (total, non‐protein‐ and non‐SHBG‐bound) were studied in relation to each other and to the degree of liver dysfunction. Serum concentrations of triiodothyronine (T3) decreased significantly (p<0.05) and thyroid‐stimulating hormone (TSH) increased with progressing liver dysfunction. Serum concentrations of tetraiodothyronine (T4), TBG and T4/TBG ratio did not correlate significantly with liver function. Serum T3 concentrations correlated significantly (Kendall Tau‐β=–0.33, p=0.001) with total serum testosterone concentrations, while there was a negative correlation (Kendall Tau‐β=–0.20, p=0.025) between testosterone and TSH values. No correlation was found between testosterone concentrations and serum levels of TBG. It is proposed that the association between T3 and TSH on one hand and testosterone concentrations on the other reflects a covariation of these variables with liver function. The TBG level was normal in most patients and was not correlated to testosterone concentrations.
Protein C in Acute Renal Failure
Authors: SØRENSEN PER JOHAN , KNUDSEN FLEMMING , NIELSEN ARNE HØJ , DYERBERG JØRN
Published: August 2010

Abstract. In 16 patients with acute renal failure we studied protein C activity, both coagulant and amidolytic, as well as protein C antigen level. Protein C coagulant activity was markedly decreased in acute renal failure. Furthermore, changes in kidney function were paralleled by alterations in protein C coagulant activity. The amidolytic activity and antigen level of protein C were normal in most cases, and the changes observed in a few patients seem clearly related to changes in liver function. This defective protein C could contribute to the thrombotic tendency reported in patients with acute renal failure.
Decreased Blood Natural Killer Cell Activity and Immunoglobulin Synthesis in vitro in Aplastic Anemia
Authors: PORWIT ANNA , HAST ROBERT , STENKE LEIF , WASSERMAN JERZY , REIZENSTEIN PETER
Published: August 2010

Abstract. Natural killer (NK) cell numbers and T lymphocyte subpopulations in peripheral blood were evaluated in six patients with aplastic anemia (AA). The immunophenotyping results were correlated to in vitro tests of NK cell cytotoxicity against K562 cells and of immunoglobulin (Ig) production after pokeweed mitogen (PWM) stimulation. A significant decrease was found both in the percentage of Leu 11 positive cells and in NK cell activity as compared to age‐ and sex‐matched healthy controls. The decrease in NK cell activity could not be entirely compensated by an increase in effector/target cell ratios, thus suggesting not only a quantitative but also a functional defect in NK cells of the AA patients. Three of four AA patients tested showed no major increase of Ig production after PWM stimulation. All these three patients also had fewer “functional T helper” cells (Leu3+/Leu8–) and increased numbers of T suppressor/cytotoxic cells (Leu2+) when compared to controls. No significant differences in numbers of B lymphocytes (B1+) could be found. Our findings suggest a possible linkeage between quantitative and qualitative abnormalities in lymphocyte subsets in aplastic anemia. However, no evidence was found to support the hypothesis of increased NK cell activation behind the hemopoietic depression in this disease.
Predicting Long‐term Mortality after a Myocardial Infarction from Routine Hospital Data
Authors: MÆLAND JOHN G. , MEEN KNUT
Published: August 2010

Abstract.Among 528 patients under 67 years of age discharged alive after a myocardial infarction (MI), the cumulative survival rates after 3, 5, and 7 years were 84.1%, 75.9% and 68.6%, respectively. Compared with the “normal” population, the relative mortality risk was 4.8 for the first year, 3.1 for the second, and on average 2.1 for the next 5 years. Significant age differences were not observed for relative mortality. A multivariate Cox proportional hazards model showed long‐term mortality to be independently related to higher age, a reduced working activity before the MI, previous cardiovascular disease, and a higher in‐hospital complication score, which was computed by summing eight defined clinical events weighted for severity. The results indicate that a reasonable prediction of long‐term survival after a MI can be made from routine hospital data.
Diagnosis of Deep Vein Thrombosis with a New Radionuclide Method—99Tcm‐Albumin Test
Authors: BORNHOV STIG , DAHLSTRÖM JAN ANDERS , NILSSON JAN , OHLIN PER , RUBIN BJÖRN , SALLERFORS STEFAN
Published: August 2010

Abstract. The diagnostic efficiency of 99Tcm‐albumin test (AT), a new radionuclide method, was evaluated in 90 consecutive patients with suspected deep vein thrombosis (DVT) admitted to the medical emergency ward. Phlebography was used as reference method. The sensitivity of the AT test was 92% and the specificity was 61%. As the method is objective, rapid and convenient for the patients, it can be recommended as an initial examination method to be followed by phlebography, in cases with a positive test result. Criteria with high specificity, 98%, have also been defined but these criteria should be further investigated.
One‐year Sequential Follow‐up of Venous Emptying Rate and Leg Temperature Profiles after Acute Deep Vein Thrombosis
Authors: HOLMGREN KAJ , ANDERSSON GUNNAR , FAGRELL BENGT , JOHNSSON HANS , LÖFSJÖGÅRD‐NILSSON ERLING , ZETTERQUIST STAFFAN
Published: August 2010

Abstract. In order to study the natural course of venous flow and temperature reaction in the legs after symptomatic first episode of deep vein thrombosis (DVT), 65 patients (57 with proximal DVT) without further thromboembolic complications during the observation period were followed for 1 year by repeated plethysmography (PG) and thermography (TG). Regarding the non‐invasive parameters substantial individual variations were observed during the observation period. After 1 year pathologic PG and TG were still demonstrated in 39% (Iμ (95%) = /0.43±0.05/) and 65% (Iμ (95%) = /1.18±0.11/), respectively, of the patients after proximal DVT. Only a minority of the patients were normalized permanently in both PG and TG during the first year. The high frequency of remaining venous obstruction and especially, persistent thermoactivity is notable and may be of clinical importance.
Diagnostic Strategy in Suspected Duodenal Ulcer Disease
Authors: GJØRUP THOMAS , HARTLING OLE JOHANNES
Published: August 2010

Abstract. In a questionnaire study of 89 Danish gastroenterologists the current diagnostic strategy in patients suspected of having duodenal ulcer disease was elucidated. A case summary concerning a patient with upper abdominal pain was presented. It was assumed that the patient had had a double‐contrast barium meal examination or an upper gastrointestinal endoscopy performed. If the X‐ray had revealed a deformity of the duodenal bulb, 30% of the gastroenterologists would offer the patient specific medical treatment (H2‐blocking agent etc.), but a significantly higher number of gastroenterologists, 45%, (p<0.05) would offer specific medical treatment if a deformity was revealed at endoscopy. There was also a significant difference (p<0.01) between those who would offer specific treatment if X‐ray (84%) or if endoscopy (100%) had revealed an ulcer. Considerable variation was found among experts in their decisions on the basis of X‐ray and endoscopy in patients with suspected duodenal ulcer disease. Gastroenterologists generally rely more on endoscopic than on radiographic findings.
Clinical and Immunological Features of Sjögren's Syndrome in Patients with Primary Biliary Cirrhosis with Emphasis on Focal Sialadenitis
Authors: HANSEN BJARNE U. , LINDGREN STEFAN , ERIKSSON STEN , HENRICSSON VINCENT , LARSSON ÅKE , MANTHORPE ROLF , WARFVINGE GUNNAR
Published: August 2010

Abstract. Serological and pathological findings in 21 patients with primary Sjögren's syndrome (primary SS) were compared with those in 32 patients with primary biliary cirrhosis (PBC). In ELISA, anti‐SS‐B/La antibodies were detected in sera from 14 (67%) of the patients with primary SS, but only from 12 (38%) of those with PBC. With the Ouchterlony test, anti‐SS‐A/Ro antibodies were found in sera from 15 (71%) of the primary SS patients, but in no PBC patient. Of those PBC patients investigated prospectively with objective tests, four of 11 (36%) had keratoconjunctivitis sicca, and five of 15 (33%) had pathological sialometry results. In contrast, all PBC patients but one (i.e., 14 of 15 or 93%) showed evidence of focal sialadenitis. In immunochemical study of PBC patients, IgM immunoreactivity was found in the stroma, particularly adjacent to excretory ducts and acini in salivary glands (5 of 5), whereas no such IgM deposits were observed in patients with primary SS (3 of 3), nor in healthy controls (n=20). We conclude that the frequency of anti‐SS‐A/Ro and anti‐SS‐B/La antibodies in serum is lower in PBC patients than in patients with primary SS. The incidence of focal sialadenitis is high in PBC, though only one third of the PBC patients studied here showed clinical evidence of glandular dysfunction. With immunochemical techniques, sialadenitis associated with PBC is distinguishable by its significant IgM reaction from sialadenitis in primary SS.
Adenine Phosphoribosyltransferase Deficiency in Iceland
Authors: LAXDAL THRÖSTUR , JÓNASSON TÓMAS Á.
Published: August 2010

Abstract. Two children and two adults of four unrelated families were on regular light microscopic examination found to exhibit identical, spherical urine crystals. Their characteristic appearance led to the diagnosis of 2,8‐dihydroxyadenine crystalluria by spectrophotometric or gas‐chromatographic/mass‐spectrometric analysis. Total deficiency of adenine phosphoribosyltransferase was confirmed by direct measurements of the enzyme activity in lysed red blood cells. Close family members were also examined for the enzyme defect, revealing no additional homozygotes, but 13 heterzygotes among 14 relatives. We suggest that round, brownish urine crystals, even without radiolucent kidney stones, should alert the physician to search for the existence of 2,8‐dihydroxyadenine. Proper treatment could then be instituted without delay, preventing eventual kidney damage.
Latching onto life: living in the area of tension between the possibility of life and the necessity of death
Authors: Sæteren Berit , Lindström Unni Å , Nåden Dagfinn
Published: August 2010

Aim. To present one of the findings from a large‐scale hermeneutic research project focusing on promoting a deeper understanding of health and suffering because of serious cancer disease.

Background. Although suffering is a main concern for caring science, there is limited research focusing on the suffering of the patients with a serious cancer disease from the patients’ perspective and few studies focusing on the patient’s health recourses and the dialectic between these.

Design. The study has a hermeneutic design inspired by Gadamer’s ontological hermeneutics.

Method. Fifteen Norwegian patients with cancer disease were interviewed. They were informed about the seriousness of their situation and that there was no more curative treatment to offer.

Results. The results show that the patients lived their lives in a dialectic oscillation, a struggle between health and suffering. They expressed health through striving towards normal life, aspiring for hope, taking responsibility for their own life and experiencing belongingness with their next of kin. Suffering was expressed through experiences of bodily aversion, uncertainty and fear of the future, sorrow and needs, anxiety, despair and loneliness. The patients were lonely in this struggle, as conversations about existence and death did not occur, neither with the nurses nor with their next of kin. Death remained veiled in silence.

Conclusions. In confronting one’s own death, there seems to be striving for health, striving for wholeness and for becoming a self in a life dominated by suffering. Becoming a self implies a desire to be a responsible human being and to experience integrity and dignity in life despite increasing dependency on others.

Relevance to clinical practice. There seems to be a great need in clinical practice to give priority to, and increase, the consciousness and competence of nurses to see and respond to the spiritual/existential concerns of patients with a serious cancer disease.
New mutations inZFPM2/FOG2gene in tetralogy of Fallot and double outlet right ventricle
Authors: De Luca A , Sarkozy A , Ferese R , Consoli F , Lepri F , Dentici ML , Vergara P , De Zorzi A , Versacci P , Digilio MC , Marino B , Dallapiccola B
Published: August 2010

De Luca A, Sarkozy A, Ferese R, Consoli F, Lepri F, Dentici ML, Vergara P, De Zorzi A, Versacci P, Digilio MC, Marino B, Dallapiccola B. New mutations inZFPM2/FOG2gene in tetralogy of Fallot and double outlet right ventricle.

Conotruncal defects (CTDs) represent 15–20% of all congenital heart defects. Mutations in a number of genes have been associated with CTD in humans and animal models. We investigated the occurrence and the prevalence ofGATA4,NKX2.5,ZFPM2/FOG2,GDF1, andISLET1gene mutations in a large cohort of individuals with CTD, including tetralogy of Fallot with or without pulmonary atresia (TOF, 178 patients), double outlet right ventricle (DORV, 13 patients), and truncus arteriosus (11 patients). Denaturing high‐performance liquid chromatography (DHPLC) analysis followed by bidirectional sequencing disclosed no putative pathogenic mutation inGATA4,ISLET1, andGDF1genes. Two novel (Ile227Val, Met544Ile) and one previously reported (Glu30Gly) possibly pathogenic missense variants were identified in theZFPM2/FOG2gene in 3 sporadic patients of 202 (1.5%) with CTD, including 1 of 178 (0.6%) with TOF and 2 of 13 (15.4%) with DORV. Mutation analysis also detected one known missense change (Arg25Cys) inNKX2.5gene in two (1.1%) sporadic patients with TOF. These sequence alterations were found to be absent in 500 population‐matched controls. In conclusion, the present results (i) indicate and confirm that mutations in theGATA4,GDF1, andISLET1genes are not major determinants in the pathogenesis of TOF, (ii) provide supportive evidence of an association betweenZFPM2/FOG2gene and TOF/DORV, and (iii) provide additional examples of the possible contribution of the Arg25Cys change in theNKX2.5to a small number of TOF cases.
Disruption of the SCN2A and SCN3A genes in a patient with mental retardation, neurobehavioral and psychiatric abnormalities, and a history of infantile seizures
Authors: Bartnik M , Chun‐Hui Tsai A , Xia Z , Cheung SW , Stankiewicz P
Published: August 2010

Bartnik M, Chun‐Hui Tsai A, Xia Z, Cheung SW, Stankiewicz P. Disruption of the SCN2A and SCN3A genes in a patient with mental retardation, neurobehavioral and psychiatric abnormalities, and a history of infantile seizures.

Mutations in genes encoding voltage‐gated sodium channels are significant factors in the etiology of neurological diseases and psychiatric disorders, including various types of idiopathic epilepsy. Using a clinical exon‐targeted oligonucleotide array comparative genomic hybridization (aCGH), we have identified a de novo∼110‐kb deletion involving exons 1–2 of SCN2A and non‐coding exon 1a of SCN3A in a 25‐year‐old female with mental retardation, neurobehavioral and psychiatric abnormalities, and a history of infantile seizures with abnormal EEG. We propose that haploinsufficiency of SCN2A may play an important role in the genetic basis of neurodevelopmental and neurobehavioral disorders and emphasize the efficacy of detecting exonic copy‐number variation (CNV) by exon‐targeted oligo aCGH.
How did the Great Auk raise its young?
Authors: HOUSTON A. I. , WOOD J. , WILKINSON M.
Published: August 2010

The extant auks show three strategies of chick rearing – precocial (chicks leave the nest site when a few days old), intermediate (young raised to a mass of around 20% of adult mass) and semi‐precocial (young raised to a mass of around 65% of adult mass). It is not known which strategy the extinct Great Auk used. In this paper, we investigate this issue by a novel combination of a time and energy budget model and phylogenetic comparison. The first approach indicates that for reasonable estimates of the equation parameters, the Great Auk could have followed an intermediate strategy. For a limited range of parameters, the Great Auk could have followed the semi‐precocial strategy. Phylogenetic comparison shows that it is unlikely that the Great Auk followed a precocial strategy. The results suggest that the Great Auk followed an intermediate strategy as does its presumed closest extant relative the Razorbill.
Population differentiation in the swordtail characin (Corynopoma riisei ): a role for sensory drive?
Authors: ARNQVIST G. , KOLM N.
Published: August 2010

Sensory drive, where the efficacy of a sexual signal depends on the environment in which it is employed, is a potential mechanism behind divergent evolution of secondary sexual traits. Male swordtail characins are equipped with a narrow and transparent extension of the gill cover with a flag‐like structure at its tip. This opercular flag mimics a prey item and is employed by males as a ‘lure’ to attract the attention of females during mating attempts. We conducted a study of genetic and morphological differentiation across swordtail characin populations throughout their native range in Trinidad. The morphology of the opercular flag varied across populations and several aspects of this variation match the predicted hallmarks of sensory drive. First, morphological differentiation of the flag across populations was unrelated to genetic similarity at neutral genetic markers. Second, the shape of the flag covaried with those aspects of body shape that should reflect adaptation to different feeding regimes. Third, and most importantly, the shape of the flag covaried across populations with those environmental characteristics that should most closely reflect differences in local prey abundance. Overall, our results are consistent with a scenario where the evolution of this male sexual signal tracks food‐related shifts in female sensory biases across populations, thus providing at least provisional support for a role for sensory drive in population differentiation.
Spatial seed and pollen games: dispersal, sex allocation, and the evolution of dioecy
Authors: FROMHAGE LUTZ , KOKKO HANNA
Published: August 2010

The evolutionary forces shaping within‐ and across‐species variation in the investment in male and female sex function are still incompletely understood. Despite earlier suggestions that in plants the evolution or cosexuality vs. dioecy, as well as sex allocation among cosexuals, is affected by seed and pollen dispersal, no formal model has explicitly used dispersal distances to address this problem. Here, we present a game‐theory model as well as a simulation study that fills in this gap. Our model predicts that dioecy should evolve if seeds and pollen disperse widely and that sex allocation among cosexuals should be biased towards whichever sex function produces more widely dispersing units. Dispersal limitations stabilize cosexuality by reinforcing competition between spatially clumped dispersal units from the same source, leading to saturating fitness returns that render sexual specialization unprofitable. However, limited pollen dispersal can also increase the risk of selfing, thus potentially selecting for dioecy as an outbreeding mechanism. Finally, we refute a recent claim that cosexuals should always invest equally in both sex functions.
Sex‐specific selection on energy metabolism – selection coefficients for winter survival
Authors: BORATYŃSKI Z. , KOSKELA E. , MAPPES T. , OKSANEN T. A.
Published: August 2010

Selection for different fitness optima between sexes is supposed to operate on several traits. As fitness‐related traits are often energetically costly, selection should also act directly on the energetics of individuals. However, efforts to examine the relationship between fitness and components of the energy budget are surprisingly scarce. We investigated the effects of basal metabolic rate (BMR, the minimum energy required for basic life functions) and body condition on long‐term survival (8 winter months) with manipulated densities in enclosed populations of bank voles (Myodes glareolus). Here, we show that survival selection on BMR was clearly sex‐specific but density‐independent. Both the linear selection gradient and selection differential for BMR were positive in females, whereas survival did not correlate with male characteristics. Our findings emphasize the relative importance of individual physiology over ecological factors (e.g. intra‐specific competition). Most current models of the origin of endothermy underline the importance of metabolic optima in females, whose physiology evolved to fulfil demands of parental provisioning in mammals. Our novel findings of sex‐specific selection could be related to these life history differences between sexes.