bluuebunny/crossref_metadata_2025 huggingface dataset:
Effect of Saluretic Therapy on Muscle Content of Water and Electrolytes in Relation to Hemodynamic Variables
Authors: Bevegård Sture , Castenfors Jan , Danielson Mats , Bergström Jonas
Published: August 2010

ABSTRACTMuscle content of water and electrolytes (needle biopsy), intraarterial BP and cardiac output (dye dilution technique) were measured in 12 patients with essential hypertension before and after 4 months of mefruside therapy (25 mg/day). Before therapy there were no significant differences in muscle tissue electrolyte and water content compared with normotensive subjects. No correlation was found between central hemodynamic variables and the electrolyte and water content of muscle tissue either before or after therapy. After 4 months of mefruside therapy, muscle tissue water showed a mean decrease which was not significant. Serum potassium and muscle potassium content decreased significantly but there was no significant change in intracellular potassium concentration. Intracellular sodium concentration increased significantly, while muscle sodium content showed a mean increase which was not statistically significant. The change in intracellular sodium concentration showed a significant negative correlation with the decrease in mean arterial BP. The change in total cellular water content showed a significant negative correlation to the changes in total peripheral vascular resistance. Saluretic therapy seems to induce counterregulatory mechanisms that interfere with the hypotensive effect.
A Human Albumin of Placental Origin (Albumin Rhodia) Tested for Tolerance
Authors: Jest P.
Published: August 2010

ABSTRACT Fifty infusions, each containing 125 ml 20% human albumin extracted from placental tissue, were tested in clinical practice. No effects such as changes in the patient's BP, pulse rate and rectal temperature were noted during the observation period, and no side‐effects such as pain, dyspnoea, nasal symptoms, exanthema or thrombophlebitis, nor any other symptoms to suggest that the solution was not well tolerated.
Prostaglandin‐Induced Diarrhoea Treated with Loperamide or Diphenoxylate
Authors: Lange Aksel P. , Secher Niels J. , Amery Willem
Published: August 2010

ABSTRACT Loperamide was compared double‐blind with diphenoxylate and a placebo in 59 women with diarrhoea due to prostaglandin administration for mid‐trimester abortion. Treatment was started with the intake of two capsules two hours before the first intramuscular injection of 15(S‐)15 methyl prostaglandin F2α and was then adapted individually, i.e. one capsule after each unformed stool, with a maximum of ten per 24 hours. Both antidiarrhoeals were significantly more effective than the placebo in preventing diarrhoea, and loperamide was found to be more active than diphenoxylate. The course of abortion, BP and vital signs, or prostaglandin side‐effects other than diarrhoea were not affected by either antidiarrhoeal, nor could any adverse experience be specifically attributed to them.
Thyroid Function in Malignant Lymphoma
Authors: Brinckmeyer Lotte Maagaard , Worm Anne‐Marie , Nissen Nis I.
Published: August 2010

ABSTRACT Thyroid function was studied in 36 patients with various stages of malignant lymphoma. Stage IVB patients exhibited characteristic changes in thyroid biochemistry in the form of lowered triiodothyronine (T3) and elevated free thyroxine (FT4), but normal thyroxine. Moreover, the concentration of thyroxine‐binding prealbumin and albumin was lowered, whereas thyroxine‐binding globulin was normal. Thyroid‐stimulating hormone was slightly elevated but showed a normal increase after administration of thyrotrophin‐releasing hormone. Patients with less extensive disease differed only slightly from the controls. The results agree with previous studies of patients suffering from other chronic diseases. The mechanisms underlying the hormonal changes have been only partially elucidated. When investigating patients with disseminated malignant disease for thyroid disease, the above mentioned changes in thyroid biochemistry must be borne in mind. Single analyses of FT4 and T3 may give rise to a false assumption of hyper‐ or hypothyroid states in patients who are in fact euthyroid.
On the Diagnosis of So‐called Normocalcaemic Hyperparathyroidism
Authors: Transbøl Ib
Published: August 2010

ABSTRACT With the purpose of evaluating their relative efficiency in detecting hypercalcaemia in hyperparathyroidism (HPT), simultaneous determinations have been carried out of serum total calcium (TOCa) in a routine laboratory and serum TOCa, ultrafiltrable (UFCa) and ionized calcium (Ca++) in a research laboratory. All 69 patients in this series, except one, were hypercalcaemic as judged from Ca++ and/or UFCa, and the diagnosis was verified operatively in all. The prevalence of normocalcaemic HPT was 48% as judged from routine TOCa, 14% from research TOCa, 7% from UFCa and 0–1% from Ca++. Thirty‐three patients had normocalcaemic HPT as evaluated by the routine TOCa technic, but in as many as 23 hereof (70%) this “normocalcaemia” appeared to be due to inappropriate normal standards or laboratory errors. Of the remaining 10 patients (30%), being truly normocalcaemic, two had serum calcium‐lowering conditions, while eight appeared to have no other explanation for their normocalcaemia than a modest degree of HPT. Determinations of UFCa and Ca++ were essential in the detection of minimal degrees of hypercalcaemia in nine of the 10 cases of true normocalcaemic HPT and valuable for the establishment of a firm diagnosis in a further 10 cases of borderline hypercalcaemia. Percentages of 10–20 and 0.2, respectively, are given as approximate figures for the prevalences of normocalcaemic patients in HPT, and of HPT, normocalcaemic+hypercalcaemic, in adults attending out‐patient clinics.
Plasma Renin, Plasma Aldosterone and Exchangeable Sodium in Normotensive and Hypertensive Kidney Transplant Recipients with and without Transplant Renal Artery Stenosis
Authors: Kornerup H. J. , Pedersen E. B.
Published: August 2010

ABSTRACT Blood pressure (BP), plasma renin concentration (PRC), plasma aldosterone concentration (PAC) and exchangeable sodium (ES) were studied in 19 kidney recipients on different fixed levels of sodium intake after successful kidney transplantation. The following groups of kidney recipients were investigated: group 1: 7 normotensives, group 2: 7 hypertensives without transplant renal artery stenosis (TRAS), group 3: 5 hypertensives with angiographically verified TRAS. Hypertension in the recipients without TRAS (group 2) was characterized by a positive correlation between BP and ES and a normal response of PRC and PAC to a fixed low (10 mEq/day) and high (150 mEq/day) sodium intake. In contrast, hypertension in the recipients with TRAS (group 3) was characterized by a normal or varyingly increased PRC on a liberal sodium intake and a reduced response of PRC to sodium restriction, whereas PAC did not differ from the other groups of recipients. In one recipient in group 3 who underwent surgical correction for TRAS, PRC and PAC decreased before operation during sodium restriction, but BP remained high until after operation, when it normalized simultaneously with a decrease in ES. The results indicate that sodium retention is involved in the pathogenesis of posttransplant hypertension and suggest that an increased activity of the renin‐angiotensin system is counterbalanced by an accumulation of sodium in TRAS.
Haemodynamic effects of pindolol in hypertensive patients
Authors: Atterhög Jan‐Henrik , Dunér Hans , Pernow Bengt
Published: August 2010

Abstract. Five men and five women, mean age 48 years, with hypertension in stages I or II of the WHO classification, were given peroral treatment with pindolol.

The pindolol treatment lead to a significant decrease in the systolic and diastolic blood pressure, at rest and during work both after 2 months and after 16 months treatment.

Three mechanisms seem to be involved in the antihypertensive effect of pindolol: 1) a negative chronotropic effect on the heart, 2) a decrease in peripheral vascular resistance and 3) an increase in venous capacitance affecting the venous return.

Comparison of the results after 2 and after 16 months of treatment suggests that a decrease in cardiac output is an early mechanism in the lowering of the blood pressure, while a decrease in vascular resistance seems to be more important after long‐term treatment with pindolol.
Pindolol: A Pharmacokinetic Comparison with other Beta‐Adrenoceptor Blocking Agents
Authors: Meier Jürg
Published: August 2010

Abstract. The pharmacokinetic properties of the nine most frequently studied β‐adrenoceptor blocking agents (alprenolol, atenolol, metoprolol, oxprenolol, pindolol, practolol, propranolol, sotalol and timolol) were compared. Some pharmacokinetic parameters were found to be quite similar or at least not relevantly different in this group of drugs: e.g. the rate and the amount of absorption, the distribution volume, the elimination half‐life, the total clearance and the total urinary excretion. However, some other pharmacokinetic parameters: e.g. the daily dosage, the oral bioavailability, the first‐pass effect and the ratio of renal versus hepatic clearance, were surprisingly different in this series of drugs. A good correlation between systemic availability and urinary excretion of unchanged drug could be demonstrated for the beta‐adrenoceptor blocking agents.

The pharmacokinetic comparison in this series of beta‐blockers revealed that pindolol has some relevant advantages. Due to the moderate metabolism, a negligible first‐pass effect results which yields a high oral bioavailability and leads to small interindividual variations in plasma levels and effects. As a result of the balanced clearance by the liver and the kidney and probably some compensating factors, no accumulation of pindolol has to be expected in patients with partial liver or kidney impairment. Therefore, apart from possessing the lowest daily dosage of the studied beta‐blockers, pindolol administration is relatively less likely to be critical in patients with partial renal or hepatic insufficiency.
Investigations with Beta‐Adrenoceptor Blocking Drugs in Healthy Volunteers
Authors: Aellig Walter H.
Published: August 2010

Abstract. Several properties of beta‐adrenoceptor blocking drugs can be investigated in healthy volunteers with simple non‐invasive techniques giving reproducible results.

Beta‐adrenoceptor blocking activity can be evaluated in several ways. One is to compare heart rate during physical exercise before and after drug administration. 5 mg pindolol and 100 mg propranolol were about equiactive in this test.

Another method is to administer i.v. infusions of isoprenaline before and after the administration of the antagonist and to determine the dose of isoprenaline required to increase heart rate to 120 beats/min. Pindolol is about 40 times more potent than propranolol and Sandoz 23–784 about 10 times more potent than pindolol in this test.

The moderate intrinsic sympathomimetic activity (ISA) of pindolol leads to a slight increase in resting heart rate of subjects in the supine position when sympathetic tone is very low. In the sitting position pindolol like propranolol (without ISA) reduces resting heart rate (but to a lesser extent). Sandoz 23–784, a drug with high ISA, increases resting heart rate both in the supine and in the sitting position. For comparative studies on the duration of action of different drugs exercise‐induced tachycardia seems most convenient. Experiments have shown that in equipotent doses pindolol (5 mg) exhibits a longer duration of action than propranolol (100 mg).

Studies on the beta‐adrenoceptor blocking activity of pindolol after oral and after i.v. administration support the results of pharmacokinetic studies showing a nearly complete absorption and a small first pass effect for this drug in man.
Intensive treatment in severe acute attacks of ulcerative colitis
Authors: Schjønsby H. , Heimann P. , Kremer D. , Nordgård K. , Raugstad T. S. , Ringheim F. , Stray O.
Published: August 2010

ABSTRACT The results of intensive treatment including steroids and early surgery in severe colitis in the period 1971 — 1975 were compared to the results from the period 1966 — 1970, when systematic intensive therapy was not given. The period of preoperative medical treatment was reduced on average from 31 to 17 days. Approximately half the patients went into remission in each period. In the period 1971 — 1975 (23 patients) there was no mortality during the acute attacks or in the subsequent follow‐up period. In the period 1966 — 1970, the immediate mortality in 30 patients was 10% (3 patients). One patient died six years later at the age of 81 during a relapse of the colitis, and the overall mortality was 13.3%.
Abnormal Microheterogeneity of Transferrin in Serum and Cerebrospinal Fluid in Alcoholism
Authors: Stibler H. , Allgulander C. , Borg S. , Kjellin K. G.
Published: August 2010

ABSTRACT. The serum and CSF proteins were analyzed by isoelectric focusing in 16 male alcoholics after alcohol intoxication and after 10–14 days of alcohol abstinence. An abnormally marked protein band with pI 5.7 was found in serum in 15 patients and in CSF in 12 at the first examination. On crossed immunoelectrofocusing it appeared as an increased, cathodal, microheterogeneous molecular form of transferrin. The abnormality was reversible and decreased or normalized in serum in all cases after abstinence. In 6 patients with clinical signs of cerebellar degeneration, an abnormal microheterogeneous pattern of CSF transferrin of partly different appearance to that in serum remained after abstinence. Disturbed liver synthesis of transferrin is a probable origin of the serum finding, which may be specifically related to alcohol abuse. Substitution or loss of acidic amino acids and/or decreased iron binding ability are possible structural explanations.
Short‐Term Effects of 1‐Alpha‐Hydroxy‐Vitamin D3 in Patients on Corticosteroid Treatment and in Patients with Senile Osteoporosis
Authors: Lindgren Urban , Lindholm Sam , Sarby Bert
Published: August 2010

ABSTRACT. Six patients with bronchial asthma undergoing long‐term corticosteroid treatment and six patients with senile osteoporosis were given the same oral dose of 1‐α‐hydroxy‐vitamin D3 (1α‐OH‐D3 and calcium. The immediate effect on blood and urine chemistry and on the intestinal calcium absorption rate were studied. Hypercalcaemia occurred frequently among the patients treated with corticosteroids but not among those with senile osteoporosis. We conclude that corticosteroids do not counteract the effects of 1α‐OH‐D3. No correlation was found between the calcium absorption rate and the degree of osteoporosis, nor did the serum PTH levels show any differences that could be attributed to the treatment.
Hypergonadotropic Hypogonadism in Oligophrenia
Authors: Lundberg P. O. , Nilsson A.‐C. , Wide L.
Published: August 2010

ABSTRACT. Eight patients representing five different, probably hereditary neurological syndromes with oligophrenia and hypogonadism as the common features have been examined clinically and endocrinologically. Two sisters suffered from polydeuropathy, one male from ataxia, one male from spastic tetraplegia, two sisters and a brother from myopathy and one male patient from epilepsy and polyneuropathy. The latter patient was diagnosed as having an acute intermittent porphyria. All the patients had degenerative neurological disorders. The karyotypes were normal. The patients all had signs of hypogonadism. Four male patients had marked testicular atrophy but otherwise normal external genitalia. The testosterone levels in the blood were normal or slightly decreased. Three of the females had their menarche at a normal age but a very early menopause. The fourth female has never menstruated. The four females had normal breasts and body hair. All patients had high basal luteinizing hormone (LH) and follicle‐stimulating hormone levels and the response to i.v. LH‐releasing hormone was exaggerated. The prolactin values were normal. None of the examined patients had any signs of thyroid or adrenal insufficiency and the sella turcica was normal. A possible etiology to their hypergonadotropic hypogonadism is discussed.
Thyrotoxicosis in a Patient Treated with Lithium Carbonate for Mental Disease
Authors: Pallisgaard Gunnar , Frederiksen Peer Klose
Published: August 2010

ABSTRACT. In recent years a few cases of hyperthyroidism and several of hypothyroidism which developed during lithium therapy have been described. We give an account of a case of hyperthyroidism, due to painless thyroiditis in a patient on long‐term lithium therapy.
Treatment of Diuretic‐Resistant Fluid Retention with Ultrafiltration
Authors: Asaba H. , Bergström J. , Fürst P. , Shaldon S. , Wiklund S.
Published: August 2010

ABSTRACT. Nine patients with diuretic‐resistant edema, secondary to congestive heart failure, liver cirrhosis, or nephrotic syndrome, were treated with ultrafiltration using high water flux dialyzers. Access to the blood stream was obtained by femoral vein catheterization. As much as 8.3 kg of fluid were removed in 3–4 hours with only transient decline in blood pressure. The procedure was well tolerated and yielded immediate symptomatic relief. The potential for restoration of an edema‐free state in patients with diuretic‐resistant edema suggests that further experience with this technique is justified.
Dialysis Fistulas and Cardiac Failure
Authors: Bergrem Harald , Flatmark Audun , Simonsen Svein
Published: August 2010

ABSTRACT. A haemodialysis fistula may be a factor in the development of cardiac failure, and surgical reduction of fistula blood flow can improve the condition. We have investigated 6 patients with dialysis Pistulas and closed the fistula in one of them, with marked improvement of cadac failure. It is unlikely that a peripheral dialysis fistula can cause cardiac failure by itself, but it may be a contributing factor when the cardiac reserve is reduced due to other causes.
Hemodynamic Effects of the Cardioselective β‐Blocking Agent Metoprolol in Acute Myocardial Infarction
Authors: Málek Ivan , Waagstein Finn , Hjalmarson Åke , Holmberg Stig , Swedberg Karl
Published: August 2010

ABSTRACT. Hemodynamic changes were studied in ten patients with uncomplicated transmural myocardial infection during 24 hours on β‐blockade. The cardloselective β‐adrenergic blocking drug metoprolol was injected (15 mg i.v.) within the first 24 hours after onset of chest pain and was followed by oral therapy (25–50 mg at 6‐hour intervals). There was a decrease in heart rate, systolic BP, and cardiac output, which was most marked after the injection. The stroke volume and diastolic BP for the whole group of patients remained unchanged. The pulmonary artery end diastolic pressure did not change significantly after the injection but a continuous fall was obtained in three out of four patients with initially elevated values. The preejection period, measured born the ECG and carotid pressure curve, was initially short and was prolonged in all patients after administration of the β‐blocking drug. It is concluded that the cardioselective β‐blocking drug metoprolol may be used in selected patients in the acute phase of myocardial infarction without danger of hemodynamic deterioration during the first 24 hours of therapy. The selection of patients can be based on clinical criteria. In this study signs of left heart failure, hypotension, poor peripheral circulation, bradycardia, and AV block were regarded as contraindications.
Single and Multiple Beam Echocardiography in Aortic Valve Endocarditis
Authors: Pedersen Jan Fog , Berning Jens , Haunsø Stig
Published: August 2010

ABSTRACT. Three patients with aortic valve endocarditis were studied. The single beam M‐mode echocardiographic findings comprised the appearance in diastole of a cluster of shaggy echoes at the aortic valve in all three patients. Mitral flutter was seen in two patients and premature closure of the mitral valve in one patient. At multiple beam two‐dimensional echocardiography, the echo cluster could in all three patients be seen to move perpendicular to the sound beams, ascending into the aorta in systole and descending in diastole. At valve replacement, vegetations were found that explained the abnormal echo cluster. The multiple beam echocardiography facilitated the interpretation of the single beam findings and increased the confidence therein. By applying the non‐invasive modality of echocardiography in these patients with their high risk of embolism, cardiac catheterization may possibly be avoided.
Familial Antithrombin III Deficiency as Pathogenesis of Deep Venous Thrombosis
Authors: Johansson Lilian , Hedner Ulla , Nilsson Inga Marie
Published: August 2010

ABSTRACT. A family including 18 members with decreased antithrombin III (AT III), measured with both a biological and an immunochemical method, is described. The pattern found on crossed immunoelectrophoresis, using heparin in the agarose in the first run, was normal, though the peaks were low. This suggests decreased synthesis of a normal protein in the affected members. AT III deficiency occurred in both the paternal and the maternal branch of the propositus. Six, all belonging to the maternal branch, of the above 18 persons had had at least one thromboembolic episode. Some of the episodes had been precipitated by the presence or occurrence of some predisposing event or circumstance. This suggests the possible occurrence of a gene making some of the maternal family members more susceptible to certain trigger factors, such as surgery, infection, pregnancy, and the puerperium. The mode of inheritance filled all the criteria for autosomal dominant transmission. Prophylactic treatment, preferably oral anticoagulants and/or dextran, is recommended for all persons with a low AT III concentration in any situation known to increase the predisposition to thrombosis. The effect of heparin in these patients is impaired since the heparin co‐factor, which is identical with AT III, is lowered.
Clinical Aspects on 64 Cases of Juvenile and Adult Listeriosis in Sweden
Authors: Larsson Sture , Cronberg Stig , Winblad Sten
Published: August 2010

ABSTRACT. In 1958‐74 altogether 64 cases of bacteriologically verified infections of Listeria monocytogenes were diagnosed in Sweden in children, aged more than 27 days, and in adults. Immunosuppression predisposed to the disease. Thus, many patients had co‐existing disorders, such as leukemia and alcoholism. Sixteen patients had been treated with corticosteroids, which were combined with cytostatic drugs in nine. Meningoencephalitis was diagnosed in 52 patients and was fatal in 16. The clinical symptoms did not differ from those in purulent meningitis caused by other bacteria. In the cerebrospinal fluid the cellular response was dominated by polymorphonuclear cells in 29 patients and by mononuclear cells in 20. Ten patients had septicemia, which was fatal in four. Clinical symptoms were dominated by chills, high fever and general prostration. One patient had pleurisy and one an abscess of the neck; both recovered. Serotypes 1 and 4b prevailed and were equally common. Many patients developed raised antibody titers in both the O‐agglutination test and the complement fixation test. The titers were often not positive until after a month. Moderate granulocytosis was the rule and monocytosis was rarely seen. Ampicillin alone or combined with an aminoglycoside seemed to be the drug of choice in the treatment of listeriosis. An alternative drug was tetracycline. Most deaths occurred within six days of onset of the illness. Early diagnosis and treatment were imperative. Most patients recovered and serious sequelae were rare.
Combination Chemotherapy in the Management of Superior Vena Caval Obstruction in Small‐Cell Anaplastic Carcinoma of the Lung
Authors: Dombernowsky Per , Hansen Heine H.
Published: August 2010

ABSTRACT. Among 225 consecutive patients with small‐cell anaplastic bronchogenic carcinoma, 26 (11.5%) had superior vena caval obstruction when the malignancy was diagnosed. Of these 26 patients, a consecutive series of 22 were treated initially with combination chemotherapy (cyclophosphamide, methotrexate and CCNU, in some cases combined with vincristine) alone, and in all these cases resolution of the syndrome was prompt within a median of 7 days. In no case were symptoms increased transiently by the treatment. No difference in response rate was observed between the histologic subtypes of small‐cell anaplastic bronchogenic carcinoma according to the WHO classification, Combination chemotherapy alone is an effective treatment of superior vena caval obstruction in patients with small‐cell anaplastic bronchogenic carcinoma.
Acquired von Willebrand's Disease Caused by a Monoclonal Antibody
Authors: Zettervall Olle , Nilsson Inga Marie
Published: August 2010

ABSTRACT. A 67‐year‐old man with malignant lymphoma and acquired von Willebrand's disease is described. His bleeding symptoms started late in life and at this time a monoclonal IgGK serum protein was found. He had a prolonged bleeding time, decreased platelet adhesiveness, low values for factor VIII clotting activity (VIII: C), factor VIII related antigen (VIIIR: Ag) and ristocetin co‐factor activity (VIII: Rcof). Infusion of factor VIII concentrates (fraction 1‐0) did not correct the abnormalities. No inhibitory activity in vitro of the patient's plasma or IgG fraction could be demonstrated against VIII: C, VIIIR: Ag and VIII: Rcof. In order to demonstrate an antibody that binds factor VIII without inhibiting its biological activities in vitro, advantage was taken of the fact that staphylococcal protein A strongly binds the Fc part of IgG molecules. Addition of staphylococci to mixtures of patient IgG and a factor VIII preparation resulted in removal of all factor VIII activities (VIII: C, VIIIR: Ag, VIII: Rcof) from the supernatant at sedimentation of the bacteria. The active binding principle was the M‐component, i.e. probably a monospecific antibody molecule. We hypothesize that the complex is formed in vivo and eliminated at an accelerated rate.
The Effect of Smoking on Selected Coronary Heart Disease Risk Factors in Middle‐Aged Men
Authors: Erikssen Jan , Enger Sven Chr.
Published: August 2010

ABSTRACT. Associations between smoking and selected factors supposed to promote coronary heart disease (CHD) were studied in 1832 healthy men, 809 of whom were smokers. Triglycerides were 7% higher in smokers; the heaviest smokers had the highest levels. Unfavourable changes were not seen in the other parameters in smokers. There was no trend indicating an influence of smoking on total and HDL cholesterol in the individuals who had abstained from smoking for a few hours just before the examination. Body mass index and weight, blood pressure and resting heart rate were lower in smokers, whereas heart volume, glucose tolerance, thyroid function and ECG findings did not differ significantly in smokers and non‐smokers. The present study indicates that smoking promotes the development of CHD independently of the commonly accepted CHD risk factors.
The Effect of Hemodialysis on Neutrophil Chemotactic Responsiveness
Authors: Björkstén Bengt , Mauer S. Michael , Mills Elaine L. , Quie Paul G.
Published: August 2010

ABSTRACT. After several hemodialysis treatments, neutrophil chemotactic responsiveness is commonly depressed. The median chemotactic index of 34 patients was 21, compared with 47 for 21 controls tested simultaneously. The depressed chemotactic responsiveness was not restored to normal when leukocytes were washed and resuspended in normal plasma, neither did plasma from patients with depressed chemotaxis affect control neutrophils.
Diabetes of Excessively Long Duration with Only Minor Manifestations of Long‐Term Diabetic Complications
Authors: Lithner Folke
Published: August 2010

ABSTRACT. A male patient with ketosis‐prone diabetes of 55 years' duration is described. To our knowledge, this is the longest duration of diabetes reported. His daughter also has a ketosis‐prone diabetes. The low degree of long‐term diabetic complications in both father and daughter is remarkable.
Auricular Tyrosine Hydroxylase and Dopamine‐β‐Hydroxylase Activities and Noradrenaline Content in Ischaemic Heart Disease
Authors: Penttilä O. , Merikallio E. , Pispa J. , Klinge E. , Siltanen P. , Kyösola K.
Published: August 2010

ABSTRACT.Assessments were made of the tyrosine hydroxylase (TH) and dopamine‐β‐hydroxylase (DBH) activities as well as the noradrenaline (NA) content of samples excised from right auricular tissue during cardiac surgery on a total of 55 patients with ischaemic heart disease (IHD), valvular heart disease (VHD), uncomplicated atrial septal defect (ASD) or congestive heart failure (CHF). The NA content was significantly higher in the IHD group than in the other three groups. The TH activity was highest in the IHD group although the difference was statistically significant only compared with the ASD and CHF groups. The DBH activity was also highest in the HID group, but again the difference was statistically significant only compared with the ASD and CHF groups. In the whole material there was a significant positive correlation between the NA content and TH or DBH activity, as well as between TH and DBH activity. In the IHD group there was a significant positive correlation between heart volume and TH activity. The results suggest that at least compared with ASD and CHF, the sympathetic tone is relatively high in IHD, possibly involving an enhanced NA turnover.
Diagnostic Value for Acute Myocardial Infarction of Creatine Kinase and Lactate Dehydrogenase Isoenzymes Compared with Total Enzymes
Authors: Kraft Jette , Aastrup Hilda , Schrøder P.
Published: August 2010

ABSTRACT. The diagnostic value of creatine kinase (CK) and lactate dehydrogenase isoenzymes was investigated in a prospective study of 201 patients with suspected acute myocardial infarction (AMI). The isoenzymes were analyzed with a column chromatographic method. The patients' final diagnoses were made according to the WHO criteria without knowledge of the isoenzyme results. The prevalence of AMI was 50%. The diagnoses were predicted with significantly greater reliability with the isoenzyme than with the total enzyme determinations in most of the patients. However, the greater diagnostic reliability had sufficient therapeutic consequence to justify the extra analytical cost only in patients for whom the diagnosis must be based mainly on the enzyme results. The CK isoenzyme specificity for myocardial damage was studied in populations with low prevalence of heart disease. In a group of 39 patients who had elevated total CK due to non‐cardiac disease there were five with elevated isoenzyme values, but since among 69 young healthy persons none had elevated isoenzymes, this was taken to indicate that the isoenzymes may be leaked into the blood from other organs than the heart.
Coronary Heart Disease—a Possible Risk in Megavoltage Therapy?
Authors: Rasmussen Sten , Døssing Martin , Walbom‐Jørgensen Sven
Published: August 2010

ABSTRACT. A 21‐year old man died of an extensive anteroseptal myocardial infarction 16 months after receiving megavoltage radiotherapy to a mantle field for Hodgkin's disease stage PS IA confined to the midcervical lymph nodes on the left side of the neck. Post mortem findings revealed severe atherosclerotic changes in the coronary arteries. This case and a review of the literature suggest that irradiation to the heart may induce or accelerate atherosclerosis of the epicardial vessels. This should be taken into consideration when starting prophylactic irradiation to the mantle field in patients with Hodgkin's disease stage IA without obvious involvement of the mediastinun. Histologic examination of the heart and coronary vessels should be performed in any fatal case after megavoltage therapy involving the heart.
Relative Value of Sternal Aspiration, Iliac Crest Biopsy and Biopsy Imprint in the Diagnosis of Secondary Cancer Involvement of the Bone Marrow
Authors: Bjørneklett A. , Stavem P. , Elgjo K.
Published: August 2010

ABSTRACT. Sternal aspirates, iliac crest biopsies and biopsy imprints from 31 patients with verified metastatic cancer to bone marrow were reviewed. All three methods were shown to be complementary, as cancer cell deposits were detected in some cases by one procedure and missed by the others.
Reversible Renal Failure Caused by Hypercalcemia
Authors: Lins Lars‐Eric
Published: August 2010

ABSTRACT. The influence of hypercalcemia on renal function was studied retrospectively in 13 patients suffering from primary hyperparathyroidism, sarcoidosis, vitamin D intoxication, malignant lymphoma or chronic lymphatic leucemia. Different kinds of treatment, depending upon the primary disease, often induced a rapid fall in the serum calcium concentration. The serum creatinine concentration always fell simultaneously. The serum phosphate concentration fell in all but two patients. Changes in serum calcium and serum creatinine correlated significantly (p <0.001), as did changes in serum calcium and serum phosphate concentrations (p <0.05). Serum calcium/serum creatinine and serum calcium/serum phosphate ratios were significantly higher in patients with primary hyperparathyroidism than in patients with hypercalcemia of non‐hyperparathyroid origin (p <0.01, p <0.001). This suggests a different effect of calcium on the glomerular filtration rate in hyperparathyroid and non‐hyperparathyroid patients, the latter group being more sensitive to the influence of hypercalcemia. Possible explanations for this difference, such as a protective effect of PTH on the glomerular filtration, are discussed.
Combination of Fibromuscular Hyperplasia, Renal Aplasia, Hypoplasia or Dysplasia and Otosclerosis Occurring in the Same Individual or the Same Family
Authors: Stavenow Lars , Henriques Betty , Ekberg Mats , Bergentz Sven‐Erik , Hood Bertil
Published: August 2010

ABSTRACT. We have found 3 reports of fibromuscular hyperplasia (FMH) of the renal arteries with hypertension occurring in 2 siblings as well as a few instances of renal agenesis and unilateral renal aplasia occurring in the same family. In this paper we report on FMH of the renal arteries in 2 women, one giving birth to a child with renal agenesis, the other to a child with a focally dysplastic hypoplasia of the kidneys. A third family is reported, heavily loaded with hypertension and otosclerosis, in which 2 siblings with FMH and otosclerosis were found. Another 4 patients without known heredity for hypertension, but with FMH combined with renal or urinary tract anomalies, are also reported. The findings are discussed, particularly in relation to the findings in a large material of chronic nonobstructive pyelonephritis, where in those with well maintained renal function, hypertension below the age of 40 was found predominantly in females with a positive family history of hypertension and signs highly suggestive of infected hypoplasia or dysplasia of the kidney.
Acute and Long‐Term Salt Depletion and β‐blockade: Plasma Renin Activity Response and its Relation to Blood Pressure Reduction in Long‐Term Treatment
Authors: Nielsen Ingolf , Steiness Eva , Hesse Birger
Published: August 2010

ABSTRACT. The changes in plasma renin activity (PRA) during short‐term salt depletion (and peroral furosemide on the first day) and after bolus injection of propranolol were compared to the change during long‐term treatment with diuretic and with propranolol in 19 patients with benign primary hypertension. A highly significant correlation was found between PRA on short‐term and long‐term salt depletion (r=0.92). A highly significant correlation was likewise found between initial PRA and decrement of PRA after bolus injection of or long‐term treatment with propranolol. Only a weak inverse correlation was found between PRA reached during short‐term salt depletion or long‐term diuretic treatment and the fall in diastolic BP during long‐term treatment (r=‐0.60). No significant correlation was found between decrease in PRA on propranolol (bolus/long‐term) and diastolic BP reduction. It is concluded that the short‐term PRA response to salt depletion and propranolol in the individual patient gives a good prediction of the PRA level on long‐term diuretic or propranolol treatment, but is of no value in predicting the BP reduction during treatment.
Transitory Renal Failure Following Rapid Administration of a Relatively Large Amount of Hematin in a Patient with Acute Intermittent Porphyria in Clinical Remission
Authors: Dhar G. Jeelani , Bossenmaier I. , Cardinal R. , Petryka Z. J. , Watson C. J.
Published: August 2010

ABSTRACT. Transitory renal failure occurred in a patient with acute intermittent porphyria in clinical remission following i.v. administration of 1000 mg hematin. The clinical and biochemical picture suggested “acute tubular necrosis”, which was followed by a prompt and complete return of renal function without any late sequelae. The renal failure is thought to have resulted from the presence of circulating free hematin, formed as a result of rapid administration of such a relatively large amount. Such a complication has not occurred in patients given hematin for acute porphyric relapse, in whom much smaller amounts have been infused.
A Controlled Clinical Trial of Streptokinase and Heparin in the Treatment of Major Pulmonary Embolism
Authors: Ly B. , Arnesen H. , Eie H. , Hol R.
Published: August 2010

ABSTRACT. Treatment with streptokinase or heparin was allocated randomly to 20 patients with major pulmonary embolism verified by angiography. In addition, 4 patients treated with streptokinase and 1 patient treated with heparin were included in the trial prior to the start of treatment. Streptokinase or heparin was given for 72 hours and pulmonary angiography was repeated. The angiographic evidence of thrombolysis was significantly greater (p <0.01) in the 14 patients treated with streptokinase than in the 11 treated with heparin. In the heparin group, 1 patient died from massive embolism 15 hours after the start of treatment. In another patient who died 4 weeks later from cerebral glibolastoma, persistent massive embolism contributed to the fatal outcome. In the streptokinase group, 1 patient with a metastatic pulmonary carcinoma died 3 weeks after the start of treatment from gangrene of both legs following thrombotic occlusion of the inferior vena cava. Bleeding was more common after treatment with streptokinase than with heparin, but was not a serious problem in any patient. It is concluded that patients with life‐threatening pulmonary embolism should be offered the benefits of streptokinase.
Non‐Invasive Methods for Evaluating the Importance of Heart Rate and Atrial Activity in Cardiac Pacing
Authors: Theorell T. , Edhag O. , Fagrell B.
Published: August 2010

ABSTRACT. Ultralow frequency ballistocardiography (UFB) and digital pulse plethysmography (DPP) were performed in six patients with an external artificial pacemaker system. UFB was used mainly to evaluate the force of contraction of the left ventricle (IJ amplitude) and DPP for evaluating relative changes in the peripheral pulse volume. Four patients were studied at 40, 50, 60, 70, 80, 90 and 100 beats/min. There was a significant decrease (p <0.001) in IJ and pulse amplitudes when the heart rate increased from 40 to 100 beats/min. A positive correlation between relative IJ and pulse amplitude was observed in all cases studied. In beat‐to‐beat analysis it was found that the importance of the PR interval for the IJ and pulse amplitudes varied between patients. It is concluded that both UFB and DPP may be of value in clinical practice for evaluating hemodynamics in patients with slow spontaneous heart rate. The methods may be of help in selecting the most effective type of pacemaker for the individual patient.
Creatine kinase MB isoenzyme in diagnosis of acute myocardial infarction
Authors: Grande Peer , Christiansen Claus , Pedersen Asger
Published: August 2010

In a consecutive series of 401 patients admitted to the Coronary Care Unit of the Copenhagen County Hospital at Glostrup suspected of acute myocardial infarction (AMI) less than 24 hours old, blood samples for enzyme analysis were drawn at admission and 12, 24, 36, 48, and 72 hours later, and ECG in 9 leads was recorded daily during the first week. From usual diagnostic criteria — clinical symptoms, ECG‐findings, and enzyme analyses, not including and not knowing the results of CK—MB analyses — the series was divided into patients with AMI and those without AMI.

Comparison is made between the predictive values in the diagnosis of AMI of a positive and a negative result (PV‐pos. and PV‐neg.) of either of the tests: ECG and serum levels of aspartate aminotransferase (ASAT), lactate dehydrogenase (LD), creatine kinase (CK), and MB‐fraction of CK determined by electrophoresis. The salient features were: PV‐neg. i.e. diagnostic sensitivity was low (0.78) for ECG, but high for all enzyme tests (0.97–1.00). PV‐pos. i.e. diagnostic specificity was rather low for the three standard enzymes (0.73–0.87), but high for CK—MB (0.98) and also for ECG (1.00). Thus, determination of CK—MB seems to offer the best combination of a high sensitivity as well as specificity in the diagnosis of AMI. However, the time factor should be kept in mind, as positive results of CK—MB can only be expected during the first 30–50 hours after the onset of the AMI.
The Role of Catecholamines in Clinical Medicine
Authors: Christensen Niels Juel
Published: August 2010

ABSTRACT The sympathetic nervous system is of major importance for the regulation of several physiological functions. Drugs which inhibit the actions of catecholamines and adrenergic drugs are used in the treatment of many clinical disorders. The potential role of catecholamines in a number of human diseases has, however, until recent years been studied to a limited extent only due to lack of methods for quantitation of sympathetic nervous activity. After the development of enzymatic isotope‐derivative assays, reliable measurements of noradrenaline and adrenaline in plasma became available. Studies in man have shown that plasma noradrenaline is an index of sympathetic nervous activity.

The present survey deals with sympathetic nervous activity and plasma adrenaline in a number of clinical disorders viz. arterial hypertension, duodenal ulcer, thyrotoxicosis, diabetes mellitus and ketotic hypoglycemia.
Radioimmunoassays of T3, r‐T3 and r‐T2 in Human Serum
Authors: Skovsted Lis
Published: August 2010

ABSTRACT Simple radioimmunoassays for 3,3′,5‐triiodothyronine (T3), 3,3′,5′‐reverse‐triiodothyronine (r‐T3) and 3,3′‐diiodothyronine (r‐T′2) in human serum are described. The principle of the methods is the same and based on a system using 8‐anilino‐l‐naphthalene sulfonic acid as an inhibitor of nonspecific protein binding, a simultaneous addition of the antibody and the labelled hormone, an overnight incubation at room temperature and a separation of bound and free hormone with dextran‐coated charcoal. The methods require 15 μl, 50 μl and 100 μl (or 333 μl for ethanol extraction) serum respectively. Serum concentrations (mean ± SD) of T3, r‐T3 and r‐T′2 from normal subjects are 144 ± 19 ng T3/100 ml (n = 52), 32 ± 7 ng r‐T3/100 ml (n = 36), 3.8 ± 0.7 ng r‐T′2/100 ml (ethanol extraction, n = 18) and 8.2 ± 1.6 ng r‐T′2/100 ml (unextracted, n = 16).
Paracetamol (Acetaminophen) Clearance in Patients with Cirrhosis of the Liver
Authors: Andreasen Per Buch , Hutters Lars
Published: August 2010

ABSTRACT The pharmacokinetics of paracetamol were studied in 11 patients with cirrhosis of the liver and 12 controls. The average biological half‐life after oral administration of 1 g paracetamol was significantly prolonged in patients with hepatic cirrhosis compared to the controls (3.7 hr vs. 2.1 hr) and, correspondingly, the average plasma clearance was significantly reduced from 337 ml × min‐1 in the controls to 162 ml × min‐1 in the patients with cirrhosis of the liver.

After subchronic dosing of paracetamol with 1 g paracetamol t. i. d. the plasma half‐lives of paracetamol remained unchanged. Steady‐state levels of paracetamol were significantly increased in the patients with cirrhosis of the liver. A significant correlation between the values of plasma clearance of paracetamol and prothrombin time (r = +0.88), galactose elimination capacity (r = +0.66), plasma albumin (r = +0.47) and plasma clearance of phenazone (r = +0.85) was found. No clinical or biochemical signs of hepatotoxicity were observed during the study.
PHASED ARRAY CARDIAC IMAGING: SYSTEM OPERATION, RESULTS AND CLINICAL ROLE
Authors: KISSLO J.A.
Published: August 2010

Proper clinical use of real‐time, two‐dimensional echocardiography depends upon three major factors: the clinical questions posed of these imaging devices, the interrelationship of this technique with other imaging techniques and the quality of the ultrasonic image. The Duke experience with this technique has been primarily based on results obtained with a focused, phased array imaging system over the last three years. During this period of time we have observed that high‐resolution, cross‐sectional ultrasonic images of cardiac structures provide unique diagnostic information that is not possible by any other method. Similarly, this type of information allows the clinician to pose new questions concerning the use of diagnostic ultrasound in patient care. Improvements in image quality that have accompanied the addition of new scan formats and a broad‐band transducer have enhanced the clinical reliability of diagnostic information.
TECHNICAL ASPECTS OF SINGLE TRANSDUCER ECHOCARDIOGRAPHY
Authors: NIEMINEN M.S.
Published: August 2010

In echocardiographic recordings optimal amplification and A‐mode control should be used. In wall motion analysis greater accuracy is obtained by utilization of enlarged display scale. When these technical aspects are taken into consideration accurate and reproducible recordings are obtained.
CROSS‐SECTIONAL ECHOCARDIOGRAPHIC EVALUATION OF CHANGES IN VENTRICULAR SHAPE IN THE ISCHAEMIC AND NON ISCHAEMIC LEFT VENTRICLE
Authors: WEYMAN A. E.
Published: August 2010

M‐mode echocardiography is a useful method for estimating left ventricular volumes and determining multiple parameters of left ventricular function in the symmetrically contracting, normally shaped ventricle. In many clinical situations, however, the shape of the ventricle may be altered or distorted in such a way that the basic M‐mode diameter or dimension of the ventricle is no longer reflective of overall left ventricular volume or function.

Cross‐sectional echocardiography is a valuable method for detecting abnormalities in left ventricular shape and thereby defining those cases in which the M‐mode method may not accurately reflect ventricular size or performance. In this report two examples of abnormalities in ventricular shape are described. These include the marked alteration in left ventricular conformation which occurs when aneurysm formation complicates ischemic heart disease and the more subtle changes in ventricular shape seen in patients with both absolute and relative right ventricular volume overload, due to alteration in septal position. These examples illustrate the value of cross‐sectional echocardiography in defining abnormalities of left ventricular shape, indicating situations in which the M‐mode ehocardiographic determinations of ventricular volume and function may be misleading and explaining changes in the patterns of wall motion observed by M‐mode echocardiography which are due to alterations in the shape of the left ventricle.