bluuebunny/crossref_metadata_2025 huggingface dataset:
Primary Hyperparathyroidism in Patients with Organic Brain Syndrome
Authors: JOBORN CHARLOTTE , HETTA JERKER , FRISK PELLE , PALMÉR MATS , ÅKERSTRÖM GÖRAN , LJUNGHALL SVERKER
Published: August 2010

ABSTRACT. In a retrospective study of 552 patients operated on for primary hyperparathyroidism (HPT) the effects of parathyroid surgery were selectively investigated in 13 elderly patients with organic brain syndrome. With a few exceptions, these 13 patients had mild or moderate hypercalcaemia but severe mental impairment. Ten patients had a clinical diagnosis of senile dementia and 12 had been admitted from a mental hospital. Postoperatively, eight patients improved mentally and seven of them were able to return to their homes or could be transferred to somatic units. The eight patients who showed improvement, either temporary or more permanent, had a relatively short duration of mental symptoms preoperatively, all less than 2 years, while those who did not improve mentally after surgery had a longer history of mental illness. Screening for HPT was subsequently performed in a psychogeriatric clinic to investigate the prevalence of HPT in this population. Hypercalcaemia and probable HPT was found in five (5%) of 101 patients. The results indicate that parathyroidectomy may improve the mental state in patients with HPT and organic brain syndrome. As a substantial number of patients in a psychogeriatric population seem to have HPT, the disease should be searched for in patients with newly diagnosed organic brain syndrome.
A Prospective, Blind Investigation of Immunological Reactions in Chronic Inflammatory Bowel Disease
Authors: DAVIDSEN B. , KRISTENSEN E.
Published: August 2010

ABSTRACT. In a paired, blind and prospective study including 36 patients with chronic inflammatory bowel disease, i.e. ulcerative colitis (UC) and Crohn's disease (CD), and 36 healthy volunteers, the immune capacity has been examined by three different test systems using peripheral blood mononuclear cells: spontaneous mitotic activity (SMA), concanavalin A (con A) activated lymphoblast transformation test (LTT) and autologous mixed lymphocyte reaction (AMLR). The same patients and controls were examined simultaneously for their suppressor activity by a con A induced suppressor activity (CAISA) test. SMA was similar in UC patients and controls. The lymphoblast transformation (LT) in UC patients was significantly reduced with submaximal concentrations of con A (1 and 2 μg), whereas AMLR was only non‐significantly decreased. However, the results registered by these two test systems revealed a significantly positive correlation. CAISA in UC patients was significantly enhanced, but this finding showed no correlation to the reduced LTT and AMLR, indicating a primary defect in the mitotic capacity independent of the observed increment in CAISA. SMA, con A activated LT, AMLR and CAISA were similar in CD patients and controls.
Effects on Angina Pectoris and Exercise Tests of a 2% Nitroglycerin Gel Adhesive in Patients on Chronic β‐Blockade
Authors: REHNQVIST NINA , BLOM MAY , OLSSON GUNNAR , LINDVALL KAJ
Published: August 2010

ABSTRACT.Twenty patients on chronic β‐blockade for angina pectoris were included in a double‐blind randomized cross‐over placebo‐controlled study on a 2% nitroglycerin gel administered transdermally by an adhesive, Topinitro. The dose, 2.5–10 mg/day, was individually titrated and each treatment period was 28 days. The effect was evaluated by exercise tests and diary cards for anginal attacks and nitroglycerin tablets consumed.Results. In the 17 patients who completed the trial, active treatment did not influence systolic and diastolic blood pressure or resting and maximal heart rate. Maximal performance increased insignificantly from 92±23 to 96±20 W. The level at which 1 mm of ST depression appeared increased from 62±26 to 73±28 W (p< 0.05). The number of attacks decreased significantly, from 92±30 to 14128/4 weeks. The reduction in the number of sublingual nitroglycerin tablets consumed was insignificant.Conclusion. Nitroglycerin adhesive, in individual dosages, may improve signs and symptoms of ischemia.
Prognosis in Treated Hypertension
Authors: STRATE MICHAEL , THYGESEN KRISTIAN , RINGSTED CHARLOTTE , HANSEN LISE , HARVALD BENT
Published: August 2010

ABSTRACT. The aim of this study has been to demonstrate to what extent antihypertensive treatment reduces the survival gap between hypertensives and the general population. In 673 outpatients treated for arterial hypertension, the 10‐year survival has been assessed by actuarial methods and compared with expected survival of a matched background population computed from the life tables of the Danish population. In primary hypertension WHO stage I, survival did not differ from that of the background population, a congruence which of course may be a mere chance but excludes any major difference. However, when severe organ involvement was present, as in WHO stage III and renal hypertension, treatment did not eliminate the survival gap. The survival rate did not differ between sexes or between patients with high and low body mass, but decreased with increasing age. Myocardial infarction was the most frequent single cause of death, whereas stroke accounted for less than 10% of all fatalities.
Prognosis in Glomerulonephritis
Authors: GERSTOFT J. , BALSLØV J. T. , BRAHM M. , BRUN C. , JØRGENSEN F. , JØRGENSEN H. E. , LARSEN M. , LARSEN S. , LORENZEN I. , LØBER M. , THOMSEN Å. C.
Published: August 2010

ABSTRACT.The course of the renal function and mortality were analysed in 395 patients with biopsy‐proven glomerulonephritis (GN), using Cox's proportional hazards model. Seventeen clinical, biochemical and histopathological parameters were analysed for prognostic information. The patients were grouped according to their serum creatinine levels. Increase in serum creatinine, decrease in serum creatinine, cure and death were used as endpoints for the analysis. Caplan Meyer curves were made for 7 transitions between different groups and the variables were reduced by a step‐wise procedure to a final model. Thirteen of the variables considered offered significant prognostic information (p<0.05) for at least one of the transitions. Short duration of disease, young age, non‐nephritic urinary sediment and preceding streptococcal infection were predictors of cure. Extracapillary, membranoproliferative and unclassifiable GN, old age and arterial hypertension predicted increase in serum creatinine in patients with low serum creatinine, while male sex, short duration of disease and pathological electrocardiogram favoured a further increase in patients with high serum creatinine. A later decrease in serum creatinine was signified by a preceding streptococcal infection, short duration of disease, absence of arterial hypertension and low urinary protein excretion. Death without uremia was predicted by high age, connective tissue disease and extracapillary GN. Using these parameters and the models, it is possible to make a prognostic forecast for the individual GN patient. Examples of such a forecast are described.
Glipizide Does Not Affect Absorption of Glucose and Xylose in Diabetics without Residual β‐Cell Function
Authors: LINS PER‐ERIC , KOLLIND MAGNUS , ADAMSON ULF
Published: August 2010

ABSTRACT. We have previously demonstrated that oral glipizide suppresses the absorption of xylose in diabetics treated with diet alone. We suggested that glipizide might influence postprandial glucose levels by interfering with absorptive mechanisms. In the present study we have extended our observations to insulin‐dependent diabetics (IDDM) Nine non‐obese diabetics without residual β‐cell function and with normal respiratory sinus arrhythmia and Valsalva ratio were studied on two occasions. Their ordinary insulin treatment was discontinued 24 hours before the study and glucose control was maintained by i.v. insulin infusion. The experiments began at 8 a.m. after an overnight fast. Insulin was given as a continuous i.v. infusion of 0.01 U/kg/h at 8–11 a.m. and 0.005 U/kg/h at 11 a.m.‐2 p.m. At 8 a.m. the patients ingested 25 g of xylose and 15 g of glucose in 300 ml of water. Glipizide (5 mg) or placebo were given 30 min prior to the glucose‐xylose load in random order, each patient serving as his own control. Blood samples were taken every 60 min for analysis of glucose, xylose, C‐peptide and glipizide. The rise in blood glucose in the control experiment was similar to that previously seen in non‐insulin‐dependent diabetics (NIDDM) given the same xylose‐glucose load. Glipizide did not exert any effects on either blood C‐peptide, glucose or xylose levels. We conclude that oral glipizide administered in a therapeutic dose does not reduce xylose absorption in IDDM, in contrast to its previously demonstrated effect in NIDDM.
Yellow Nail Syndrome—the Triad of Yellow Nails, Lymphedema and Pleural Effusions
Authors: NORDKILD P. , KROMANN‐ANDERSEN HANS , STRUVE‐CHRISTENSEN EIVIN
Published: August 2010

ABSTRACT. The yellow nail syndrome, combination of yellow discoloured nails, lymphedema and pleural effusions, is a rare clinical condition. A review of the literature, including 97 patients, is presented. Most patients developed yellow nail syndrome in early middle age, and the overall male: female ratio was 1: 1.6. The etiology of the syndrome is obscure, while the pathogenesis seems to involve impaired lymphatic drainage. A patient, whose recurrent pleural effusions were effectively controlled by chemical pleurodesis, is also presented.
Analysis of Arrhythmias Based on Atrial Wall Motion
Authors: EGEBLAD HENRIK , RASMUSSEN VERNER
Published: August 2010

ABSTRACT. The usefulness and feasibility of recording atrial wall motion by M‐mode echocardiography guided by two‐dimensional examination was evaluated in three groups of consecutive patients'. 7 with undefined tachyarrhythmias, 25 in sinus rhythm, and 20 with atrial flutter or fibrillation. Atrial systole was recorded in the left and right atrium in 58 and 98% of the patients, respectively (p < 0.05). Six of the patients with undefined tachyarrhythmias exhibited electrocardiographic atrioventricular dissociation revealed by preceding echocardiography in all. The precise timing of left and right atrial systole could be recorded in patients in sinus rhythm; right atrial contraction preceded left atrial systole by 42±31 msec (mean ± SD). Among patients with atrial flutter or fibrillation, one case of dissimilar atrial rhythms was revealed by echocardiography. Thus, recording of atrial wall motion is feasible in the majority of patients and provides information which is otherwise available only by esophagus ECG or by invasive means.
Amylase, Pancreatic Isoamylase and Lipase in Serum before and after Endoscopic Pancreatography
Authors: FJØSNE U. , WALDUM H. L. , ROMSLO I. , KLEVELAND P. M. , JOHNSEN H. , ENGEBRETSEN L. F.
Published: August 2010

ABSTRACT. Serum amylase, isoamylase and lipase were determined in 17 patients with pancreatic or biliary diseases before and after endoscopic retrograde pancreatography (ERP). Within ½‐2 hours after cannulation of the pancreatic duct, serum lipase was increased to approximately 4 times the upper reference level and normalized almost completely at 24 hours. A much smaller increase was found in amylase and isoamylase. The elevation in enzyme activities was less in patients with abnormal than with normal ERP. The results suggest that lipase is a more sensitive indicator of pancreatic injury than amylase and isoamylase.
Long‐term Effects of Pindolol on Serum Lipoproteins in Hypertensive Patients
Authors: GRETZER INGER , RÖSSNER STEPHAN
Published: August 2010

ABSTRACT. Serum lipoproteins were analysed in 11 hypertensive patients before and after 2 and 16 months on pindolol therapy. In all patients significant blood pressure reductions were achieved with a mean pindolol dose of 13 mg (range 5–30) per day at 16 months' follow‐up. After 2 months a significant increase by 35% was found in VLDL TG and cholesterol concentrations, but after 16 months all lipoprotein values had reverted to pretreatment levels. HDL did not change during pindolol therapy. It is not established whether the lack of long‐term effects of pindolol on serum lipoprotein is specifically due to its high degree of intrinsic sympatomimetic activity.
Myotonic Dystrophy Treated with Selenium and Vitamin E
Authors: ÖRNDAHL GUSTAV , SELLDÉN ULLA , HALLIN SVERKER , WETTERQVIST HAKON , RINDBY ANDERS , SELIN EVA
Published: August 2010

ABSTRACT. We have previously reported the successful treatment of a patient with myotonic dystrophy with selenium and vitamin E. This paper deals with the treatment of a further five patients with myotonic dystrophy in different stages. All five patients improved subjectively and objectively in two or more respects. All improved their grip strength according to vigorimeter measurements (Martin), two normalized their gait, another two can now sit down on their heels and stand up, one patient can now walk on his toes, one can now get up from lying on the floor without using a chair and two patients have improved their physical capacity. Patients in early stages of the disease improved faster and more markedly than those in late stages. Electromyographical measurements also showed improvements, in that the myotonic discharges had diminished. The daily dose was 4 mg of Na2SeO3 and 600 mg of vitamin E. Serum concentration of selenium increased in all patients at the beginning of the treatment, but stabilized at a level slightly above the normal. No side‐effects were observed.
Ethanol Reduces Myoglobin Release during Isokinetic Muscle Exercise
Authors: LUNDIN LENNART , HÄLLGREN ROGER , LIDELL CHRISTER , ROXIN LARS ERIC , VENGE PER
Published: August 2010

ABSTRACT.Changes in serum myoglobin concentrations were studied in 12 healthy males performing a standardized isokinetic 2‐min exercise test. The test was performed on three separate occasions: in the habitual state, during moderate ethanol intoxication and one day after ethanol intake. Although the performed muscle work, maximal heart rate, and blood lactate levels did not differ between the three test occasions, the serum myoglobin increments after exercise were significantly reduced (p< 0.05) in the ethanol‐intoxicated state and also 10–15 hours after ethanol intake. The reduction of the exercise‐induced myoglobin increment was not explained by increased elimination of the protein. The mechanism, therefore, is likely to be a reduction of myoglobin release from skeletal muscle due to an ethanol‐induced alteration of the muscle cell membrane, possibly by means of adenylate cyclase activation.
Hemodynamic Effects at Rest and during Exercise in Long‐term Treatment with Prazosin in Chronic Congestive Heart Failure
Authors: WESTHEIM ARNE , KOSS ARNE , SIVERTSSEN EGIL
Published: August 2010

ABSTRACT.The long‐term effects of prazosin in chronic congestive heart failure were studied in 10 patients (New York Heart Association class III‐IV) in a double‐blind cross‐over study. Patients with systolic blood pressure > 120 mmHg and left ventricular filling pressure > 15 mmHg were included. Prazosin lowered the arteriovenous oxygen difference both at rest and during exercise (p< 0.05), increased cardiac index (p< 0.01) and reduced right atrial pressure and systemic vascular resistance (p< 0.05) during exercise. Left ventricular filling pressure was also reduced, but not significantly, during exercise. Our data show that prazosin has beneficial long‐term effects during exercise in patients with chronic congestive heart failure.
Overprescription and Underprescription of Digitalis
Authors: IMPIVAARA OLLI , IISALO ESKO , AROMAA ARPO , MAATELA JOUNI , REUNANEN ANTTI
Published: August 2010

ABSTRACT. As part of a health examination of a representative sample (n= 8000) of the adult Finnish population, cardiac state was assessed in the 747 digitalis users and the 6329 non‐users who participated in the survey. Ninety per cent of the digitalis users were in sinus rhythm and 50% were in sinus rhythm and had a normal roentgenographic heart volume. About 20% of those in sinus rhythm had a normal heart volume and a “subtherapeutic” serum digitalis concentration. The age‐adjusted prevalence of digitalis therapy in the presence of sinus rhythm was 8% in men and 10% in women. The total number of these patients in Finland was estimated at 246 000 (95% confidence limits 225 000–267 000). Half of the men and two thirds of the women on digitalis received concomitant diuretic therapy. Atrial fibrillation and/or markedly enlarged heart were observed in 1.5% of the men and 0.9% of the women not receiving digitalis. Their total number in the Finnish population was estimated at 23 000 (±7000). The results suggest that questionable digitalis therapy is very common since several authors have reported successful withdrawal of maintenance digitalis therapy in at least half of the patients in sinus rhythm. On the other hand, underprescription of digitalis seems to be uncommon.
Increase in Plasma Atrial Natriuretic Peptides during Acute Volume Expansion in Hypertensive Man
Authors: HEDNER JAN , HEDNER THOMAS , TOWLE ANDREW C. , PETTERSSON ANDERS , PERSSON BENGT , WYSOCKI MARIAN , ANDERSSON OVE K.
Published: August 2010

ABSTRACT. A new hormonal system originating from cardiac atria has recently been discovered. These peptide hormones have important functions in the regulation of blood volume and fluid homeostasis. We have measured plasma concentrations of atrial natriuretic peptides (ANP) in two patients during acute volume expansion. ANP concentrations increased in relation to an increase in right atrial pressure, and significant diuresis/natriuresis was observed. We conclude that hormonal as well as neuronal mechanisms are activated by acute volume loading in man.
Hemostatic Factors and Renin in Greenland Eskimos on a High Eicosapentaenoic Acid Intake
Authors: JØRGENSEN KAJ ANKER , NIELSEN ARNE HØJ , DYERBERG JØRN
Published: August 2010

ABSTRACT. The Fifth UmanaK expedition compared the fatty acid composition of platelets, bleeding times before and after ingestion of acetylsalicylic acid, 24‐hour urinary tetranorpros‐tanedioate, creatinine and Na output, as well as plasma renin, serum electrolytes and anti‐thrombin III in 20 Greenland Eskimos and 20 Danes. The results indicate that the prostaglandin production was not inhibited in the Eskimos, and that the antiaggregatory prostanoids predominate in Eskimos compared to Danes. Although blood pressure and 24‐hour urinary Na output were similar, the plasma renin level was significantly higher in the Eskimos on a high eicosapentaenoic acid intake. Acta Med Scand 1986; 219: 473–9.
Erythrocyte Mean Cell Volume—Correlation to Drinking Pattern in Heavy Alcoholics
Authors: TØNNESEN HANNE , HEJBERG LISSIE , FROBENIUS STEEN , ANDERSEN JENS RIKARDT
Published: August 2010

ABSTRACT. Erythrocyte mean cell volume (MCV) correlates well to alcohol intake in moderate alcoholism, but only about 50% of heavy drinkers have increased MCV. To evaluate the influence of the duration and extent of a drinking episode on MCV, 64 addictive alcoholics were investigated prospectively within two weeks after a drinking period. Their daily alcohol intake was 120–480 g and the actual drinking period has lasted for 1–104 weeks. For comparison, 21 non‐active alcoholics were investigated. There was no correlation between MCV of active alcoholics and daily alcohol consumption or smoking habits, whereas a significant positive correlation was found between MCV and both duration of actual drinking episode and total alcohol intake in this period. We conclude that MCV is probably of greater value in estimating the duration and extent of actual drinking episodes in heavy alcoholics than in screening for alcoholism.
A 20‐Year Follow‐up Study of 64 Subjects with M‐components
Authors: AXELSSON UNO
Published: August 2010

ABSTRACT. Sixty‐four persons with M‐components in serum were detected in a health survey of 6995 subjects in 1964. After 20 years, data could be obtained on all 64. The 45 who had died included two cases of myeloma and one of malignant lymphoma. One of the myeloma cases had started as chronic lymphatic leukemia. Three of the 19 persons alive had an increase in the size of the M‐component and depression of the background immunoglobulin, but they could not be diagnosed as myeloma cases. One had a rather large but not increasing M‐component and an excess of light chains. She could be a third case of myeloma in this series.
The Influence of Exercise Training on Plasma Lipids and Lipoproteins in Health and Disease
Authors: HASKELL WILLIAM L.
Published: August 2010

ABSTRACT. There is a very high probability that lipoprotein metabolism plays a central role in the etiology of coronary heart disease. In sedentary persons one way to favorably alter lipoprotein metabolism and possibly delay the progression of coronary atherosclerosis is by an increase in their habitual physical activity. More physically active persons tend to have lower plasma triglycerides and very low density lipoprotein concentrations, and a greater high‐density lipoprotein mass due to higher concentrations of the subfraction HDL2 and apoprotein A‐I. Plasma low‐density lipoprotein concentrations usually are not significantly reduced by exercise unless accompanied by weight loss, but there may be important changes in the distribution among the low‐density subfractions. These exercise effects are most likely mediated by alterations in the activity of enzymes involved in the synthesis, transport and catabolism of the various lipoproteins including lipoprotein lipase, hepatic lipase and lecithin: cholesterol acyltransferase. In healthy persons as well as in patients with ischemic heart disease, diabetes and renal failure, an increase in moderate‐intensity, endurance‐type activity requiring an expenditure of approximately 4 MJ (1 000 kcal) per week usually produce favorable lipoprotein changes. Above this level a dose‐response relationship exists, with greater changes occurring up to energy expenditures of 19 MJ (4500 kcal) per week.
Effects of Exercise on Glucose Tolerance and Insulin Resistance
Authors: HOLLOSZY JOHN O. , SCHULTZ JOAN , KUSNIERKIEWICZ JUDITH , HAGBERG JAMES M. , EHSANI ALI A.
Published: August 2010

ABSTRACT. With aging, glucose tolerance (GT) declines, plasma insulin concentration increases, and sensitivity to the action of insulin declines. Evidence is accumulating that this decline in glucose tolerance and insulin sensitivity can be prevented by regularly performed vigorous exercise. Preliminary results are presented in this paper showing that prolonged, strenuous and frequent exercise can also completely normalize GT by decreasing resistance to insulin in some patients with mild non insulin dependent diabetes mellitus (NIDDM) and in some individuals with impaired glucose tolerance (IGT). Exercise appears to be effective in normalizing GT only in patients who still have an adequate capacity to secrete insulin, and in whom insulin resistance is the major cause for abnormal GT. The amount of exercise required to normalize GT in such patients appears to be in the range of 25 to 35 km per week of running, or a comparable amount of another form of exercise, performed on a regular basis.
Effect of Exercise on Obesity
Authors: GARROW J. S.
Published: August 2010

ABSTRACT. The changes in fitness and body composition which accompany physical training in people of normal weight would be very valuable in the treatment of obesity. However, one of the most marked disabilities arising from obesity is a reduced exercise tolerance, so severely obese patients are unable to perform the exercise which would bring these benefits. It has been suggested that exercise may confer benefits on the obese person by reducing voluntary food intake, or by causing a prolonged elevation of metabolic rate. There is no good evidence for these claims. Obesity is best treated by a combination of dietary restriction and exercise: the more severe the obesity the more important the diet component of treatment, but exercise becomes more important with the management of mild obesity or the prevention of obesity.
Role of Muscles in Protecting Athletes from Injury
Authors: RADIN ERIC L.
Published: August 2010

ABSTRACT. Athletics create impact load which can be deleterious to the musculoskeletal system. These impact loads are attenuated by either deformation of materials external to the body, deformation of tissues, or tearing of tissue and fracture of bone. Muscles act to lower the bending stress on bone and to attenuate the peak dynamic loads from unprotected impulsive loads that can damage musculoskeletal tissues. Athletes should be advised to avoid impulsive loads for which they are unprepared, and to not participate in athletics when their muscles are fatigued.
Lower Extremity Overuse Injuries
Authors: MICHELI LYLE J.
Published: August 2010

ABSTRACT. Increased number of overuse injuries, particularly of the lower extremity, occurs in exercise. It is important for the physician who prescribes exercise to understand the mechanism of injury‐repetitive microtrauma‐and the risk factors for occurrence of these injuries. In the lower extremity, risk factors include inappropriate progression of the rate, intensity and duration of training; anatomic malalignment; muscle‐tendon imbalances of strength, endurance, or flexibility; shoewear; surface; and pre‐existent disease states. Specific recommendations for training progression, technique, and sports equipment may have to come from the physician, since the recreational athlete often does not have access to coach or athletic trainer. These are described.
Exercise Physiology in Geriatric Practice
Authors: YOUNG ARCHIE
Published: August 2010

ABSTRACT. Between now and the end of the century, we can expect a 45% increase in the proportion of the population aged 85 and over. The age‐related loss of muscle mass and diminishing exercise tolerance mean that a large and increasing number of elderly people will be living at or near ‘thresholds’ of physical ability, needing only a minor intercurrent illness to render them dependent. Although much of the decline is obligatory, the effects of physical training are much the same, proportionally, in old age as in youth. Not only can exercise reverse the effects of immobilization, it can readily produce a further 10 to 20% improvement in strength and aerobic power, effectively postponing functionally important thresholds for some 10 to 20 years. There is an urgent need for close collaboration between exercise physiologists and geriatric clinicians. The relationship between disability in activities of daily living and age‐related impairment of physical performance is especially ripe for study.
BLOOD PLATELET RELEASE CORRELATES WITH SERUM LIPIOS IN 50 YEAR OLD MEN WITH ESSENTIAL HYPERTENSION
Authors: Gjesdal Knut , Kjeldsen Sverre Erik , Lande Knut , Westheim Arne , Aakesson Ingvar , Foss Olav P. , Leren Paul , Eide Ivar K.
Published: August 2010

ABSTRACT. 50 year old men with moderate, essential hypertension (n=39) were compared to normotensive males of similar age (n=31). The hypertensive men were heavier (10 kg in average, p<0.01), and had a higher pulse rate (5 beats per minute (p<0.05). Plasma β‐thromboglobulin a marker of platelet release reaction, was 49% higher in the hypertensive group (p<0.01). Total cholesterol, LDL +VLDL cholesterol and serum triglycerides were not significantly different between the groups. In the hypertensive group, plasma β‐thromboglobulin concentration correlated significantly with total cholesterol (r=0.47, p<0.01) as well as with LDL+VLDL cholesterol (r=0.50, p<0.01). In the normotensive group no such correlation was found. The results suggest activation of platelets in hypertension, and suggest that in hypertension, even a normal cholesterol concentration may influence platelet function.
PATHOPHYSIOLOGIC ASPECTS ‐ HEMODYNAMICS
Authors: Persson Stig
Published: August 2010

Abstract The hemodynamic situation in congestive heart failure (CHF) is greatly influenced by compensatory mechanisms within the heart itself as well as released from die central nervous system and from the kidneys. These measures are intended to maintain the cardiac output at a level as beneficial as possible and to distribute the blood flow to regions with the largest metabolic demands. Thus the hemodynamic consequences of CHF are reflected in the central circulation as well as in the periphery.

Within the heart the Frank‐Starling mechanism, adrenergic stimulation causing increase of heart rate and contractility, and during the chronic course also myocardial hypertrophy are operating. The central nervous and peripheral adaptive measures include increased sympathetic outflow bringing about an increased vasomotor tone with augmentation of pre‐ and afterload, and activation of the renin‐angiotensin‐aldosterone system, where angiotensin II further augments vasoconstriction directly and through central nervous stimulation. This vasoconstriction may be counteracted by humoral factors with vasodilatory properties, such as dopamine, bradykinin, acetylcholine and the metabolic products adenosine and lactic acid. The exact role of these and the possible importance of the antidiuretic hormone, arginine vasopressin, the prostaglandin system and the recently discovered atriopeptin remains to be established.

As the compensatory mechanisms may maintain a fairly satisfactory hemodynamic situation at rest, investigations should be performed not only at rest but also during exercise to get an over‐all impression of the cardiac functional state It should be realized, however, that adaptive mechanisms cause the hemodynamics in chronic heart failure to differ from those in the acute phase in many respects. This is true particularly during physical exercise.

The great importance of neurohumoral and endocrine factors in the compensatory regulation of the failing circulation warrants the definition of heart failure to be extended to “a failure of the heart to maintain cardiac output at a level which is adequate to meet the metabolic demands of the tissues, with preserved normal filling pressures and with undisturbed neurohumoral and endocrine equilibrium”.
ROLE OF THE KIDNEY IN CONGESTIVE HEART FAILURE
Authors: Stanton Robert C. , Brenner Barry M.
Published: August 2010

Abstract The changes in renal function observed in congestive heart failure include altered pressures and flows and increased reabsorption of sodium and water leading to expanded extracellular fluid volume. These renal effects are mediated by a variety of volume and pressure sensors that stimulate various effectors which act on the kidney. The role of these sensors and effectors, the relationship between left ventricular function (LVF) and urinary sodium excretion (UNaV) and the role of angiotensin II in mediating the renal hemodynamic changes are reviewed. Rats with experimentally induced myocardial infarction (MI) were studied 3 weeks after infarction. Although UNaV decreased as LVF worsened, the decrease in UNaV was evident even in rats with MI and minimal LVF impairment. Infusion of teprotide (an inhibitor of angiotensin I converting enzyme) returned the hemodynamic parameters to or toward values seen in rats without MI, thereby documenting an important role for angiotensin II in congestive heart failure.
THE RENIN SYSTEM AND ATRIAL NATRIURETIC HORMONE IN CONGESTIVE HEART FAILURE
Authors: Laragh John H. , Cody Robert J. , Covit Andrew B. , Atlas Steven A.
Published: August 2010

Abstract The renin angiotensin system is activated in the majority of patients with chronic congestive heart failure of moderate to severe symptomology. Renin release may result from one of several different stimuli: renal tubular sodium delivery and sensing by the macula densa, sympathetic nervous system activity, and baroreceptor to changes in renal blood flow. Difficulties arise with an analysis of renin angiotensin system activity due to the necessity for diuretic therapy in the majority of these patients. Despite the presence of diuretic therapy, however, there is a wide range of renin angiotensin system activity. In evaluating this activity the administration of a converting enzyme inhibitor will block the contribution of angiotensin mediated vasoconstriction, thereby confirming the importance of the renin angiotensin system activity as a mediator of the long‐term consequences of heart failure In situations of low plasma renin activity, vasoconstriction is mediated by an alternate mechanism. The mechanisms of this non‐renin mediated vasoconstriction are less apparent, but may include calcium mediated vasoconstriction, and the effects of increased cytosolic content. This low renin group of patients appear to be very sensitive to reversal of vasoconstriction by calcium channel antagonists, especially when converting enzyme inhibitors are ineffective. In an analysis of the factors that may result in renin release, tubular delivery of sodium to the macula densa may emerge as the most important regulator of renin release. In milder forms of heart failure, or in the absence of diuretic therapy, the renin angiotensin system does not show the degree of activation that occurs in the more severe form of heart failure when diuretics are given. From a theroretical standpoint, endogenous atrial natriuretic factor may emerge as an important regular of sodium and water excretion, acting either independently, or as a regulator of the renin angiotensin system, It will therefore be necessary to evaluate the impact of atrial natriuretic factor in patients with congestive heart failure particularly in relation to the renin angiotensin system.
POSITIVE INOTROPIC DRUGS–DIGITALIS
Authors: Steiness Eva
Published: August 2010

AbstractDigitalis glycosides inhibit Na+K+‐ATPase in the cells and have been used for scientific studies of cation transport over cell membranes. Furthermore, digitalis has a positive inotropic and antiarrhythmogenic effect. Specific binding sites for digitalis glycosides have been observed in erythrocytes, the myocardium and the central nervous system. Transcellular transport of digoxin has been found in the kidney, since digoxin is excreted by tubular secretion. Recent studies have discovered an endogenous digitalis‐like substance both inhibiting Na‐K‐ATPase and displacing digoxin from specific binding sites at the erythrocytes. The concentration of this component in plasma seems to be higher in hypertension than in normotension. Future studies will have to disclose other effects of this substance in order to evaluate whether it can be used as a drug in heart failure.
SOME NEW POSITIVE INOTROPIC AGENTS
Authors: Anderson K.‐E.
Published: August 2010

AbstractIn the search for new effective positive inotropic agents for the treatment of congestive heart failure (CHF), interest has focused mainly on two groups of agents namely adrenoceptor agonists and drugs inhibiting phosphodiesterase Common for drugs belonging to both groups is that their positive inotropic effects seem to involve an increase in the intracellular concentration of cyclic AMP. Drugs acting by stimulation of β1‐ and/or β2‐adrenoceptors (e.g. dopamine, dobutamine, prenalterol, pirbuterol, salbutamol, terbutaline, fenoterol) have initial beneficial effects, but seem to be ineffective for long‐term treatment. This has been suggested to be due to desensitization of the β‐adrenoceptors, and means, if this effect can be definitely established, that β‐adrenoceptor stimulation should be restricted to the acute treatment of CHF. Among drugs inhibiting phosphodiesterase, sulmazole, amrinone, milrinone, and fenoximone all have been shown to improve cardiac performance in patients with CHF during short‐term treatment. However, results of long‐term treatment with most of these drugs seem less encouraging. It has been suggested that these drugs may not be an effective approach to treatment of patients with CHF, since even if it is possible to achieve short‐term gains, the long‐term effects on the myocardium may be detrimental. Their ultimate place in the treatment of CHF remains to be established.
Vitamin D Deficiency after Highly Selective Vagotomy
Authors: NILAS LISBETH , CHRISTIANSEN CLAUS
Published: August 2010

ABSTRACT While bone disease is occasionally seen after gastrectomy, the influence of vagotomy on calcium and vitamin D metabolism is uncertain. We have, therefore, investigated 23 male patients who had undergone highly selective vagotomy for ulcer 4.3±1.2 years previously. The 25OHD concentrations were decreased (p<0.05), the 1,25(OH)2D concentrations elevated (p<0.05) and the immunoreactive parathyroid hormone concentrations normal. Local and total bone mass were normal compared to age‐matched men, and there was no biochemical evidence of increased bone turnover. We suggest that the changes in calcium absorption, which are described in the literature after vagotomy, are mediated by 1,25(OH)2D. Although the changes in vitamin D metabolism do not lead to calcium‐metabolic disturbances in selected patients, we believe that some will eventually develop vitamin D deficiency and that vitamin D supplementation should be considered. Keywords: vitamin D, bone mass, calcium homeostasis, vagotomy.
The Effect of the Calcium‐entry Blocker Nifedipine on Cold‐induced Digital Vasospasm
Authors: NILSSON H. , JONASON T. , LEPPERT J. , RINGQVIST I.
Published: August 2010

ABSTRACT. Nilsson H, Jonason T, Leppert J, Ringqvist I (Department of Internal Medicine, Fagersta Hospital, Fagersta, Department of Clinical Physiology, Västerås Central Hospital, Västerås, Department of General Medicine, Västerås Western Hospital, Västerås and Department of Clinical Physiology, Västerås Central Hospital, Västerås, Sweden). The effect of the calcium‐entry blocker nifedipine on cold‐induced digital vasospasm. A double‐blind crossover study versus placebo. Acta Med Scand 1987; 221:53–60.

The effects of the calcium‐entry blocker nifedipine 20 mg, two 10 mg capsules, t.i.d. in patients with cold‐induced digital vasospastic disease of idiopathic or traumatic origin was tested in 28 patients, using double‐blind crossover technique on both symptoms and test results. The effect of treatment on digital blood pressure during local cooling was assessed using the Nielsen‐Lassen method. Symptomatic improvement was reported by 5 patients during placebo treatment and 17 during nifedipine treatment (p<0.01). The symptomatic improvement was significant in the total group of patients and in the group of patients with idiopathic vasospastic disease. The digital blood pressure during local cooling improved significantly with nifedipine at 5, 10, 15 (p<0.001) and 20°C (p<0.05) for the total study population and for the two subgroups except for the change at 20°C in the IDIOP group. At a digital temperature of 10°C, 2 patients reached normal digital blood pressure during placebo treatment compared to 16 during nifedipine treatment (p<0.001). The number of side‐effects increased significantly (p<0.05) during nifedipine treatment. We consider the use of nifedipine in patients with cold‐induced digital vasospastic disease to be of great value, especially in patients with digital vasospastic disease of idiopathic origin.
Pulmonary Embolism: Long‐term Follow‐up after Treatment with Full‐dose Heparin, Streptokinase or Embolectomy
Authors: LUND OLE , NIELSEN TORSTEN TOFTEGAARD , RØNNE KNUD , SCHIFTER SØREN
Published: August 2010

ABSTRACT. Lund, O, Nielsen, TT, Rønne, K, Schifter S (Departments of Thoracic and Cardiovascular Surgery, Cardiology, Respiratory Diseases, and Clinical Physiology and Nuclear Medicine, Aarhus University Hospital, Aarhus, Denmark). Pulmonary Embolism: Long‐term follow‐up after treatment with full‐dose heparin, streptokinase or embolectomy. Acta Med Scand 1987; 221:61–71.

The study comprises 74 patients alive 30 days after the start of treatment of pulmonary embolism with heparin (n=32), streptokinase (n=22) or embolectomy (n=20). The cumulative 5‐year survival was 100% in the embolectomy group, compared to 75±7% (SE) in the medically treated patients (p<0.05). Cancer caused 78% of the late deaths. At follow‐up 0.5–8.7 years after treatment the treatment groups were indistinguishable as regards right‐sided heart catheterization data, pulmonary artery rest‐obstruction, right ventricular diameter and wall thickness, ventilatory function and ECG changes. The embolectomized patients were in a more favourable NYHA classification level than the medically treated. Chronic pulmonary artery hypertension was found in 75 % of patients with ≤3 anamnestic recurrent embolic episodes before diagnosis compared to 8 % of patients with ≥2 recurrent episodes (p<0.001). Patients with irreversible cardiocirculatory shock before embolectomy all had abnormal pulmonary vascular resistance (>1.5 mmHg/1/min), depressed ventilatory function and more than 25% reduced pulmonary perfusion at follow‐up. The major prognostic factors thus were cancer, the number of recurrent episodes and the degree of cardiocirculatory affection in the acute event. Although the embolectomized patients were the most affected initially, they had a good prognosis. This led us to extend our indications for embolectomy to include all patients with central emboli, irrespective of the degree of cardiocirculatory impairment.
Survival of Extreme Hyperkalemia
Authors: HYLANDER B.
Published: August 2010

ABSTRACT. Hylander B (Department of Internal Medicine, Karolinska Hospital, Stockholm, Sweden). Survival of extreme hyperkalemia. Acta Med Scand 1987; 221:121–3.

Severe hyperkalemia has been reported to lead to typical ECG changes, often reflecting cardiac abnormalities which finally lead to death in arrythmias. The present report describes a 77‐year‐old male, who developed extreme hyperkalemia because of treatment with a potassium saving diuretic in combination with potassium supplementation and subsequent development of urinary retention. In spite of a maximal potassium value of 10.1 mmol/1 only non‐specific ECG‐changes were found. The patient survived after an uneventful dialysis. Thus, extreme hyperkalemia may occur without typical ECG changes and serum potassium values exceeding 10 mmol/1 may be survived.

Hyperkalemia is a well‐known feature of acute renal failure. The most important toxic effects are cardiac arrythmias. In Harrison's Principle of Internal Medicine, severe hyperkalemia is defined as plasma potassium exceeding 8 mekv/l or if electrocardiographic abnormalities include absent P waves, widened QRS complexes or ventricular arrythmia (1). The following case report describes extreme hyperkalemia due to a combination of potassium saving diuretics, potassium supplementation and post‐renal failure but without specific effects on the ECG.
Improved Survival in Multiple Myeloma with Renal Failure
Authors: WAHLIN ANDERS , LÖFVENBERG EVA , HOLM JAN
Published: August 2010

ABSTRACT. Forty‐four myeloma patients with large tumour cell mass and impairment of renal function (S‐creatinine >2 mg/dl, stage III B) were studied. Seven patients, who received no active treatment, neither cytostatics nor plasmapheresis, survived for >1 month (median). Twenty‐one patients who were treated with chemotherapy combination (M‐2 protocol: melphalan, vincristine, BCNU, cyclophosphamide, prednisone) plus plasma exchanges for three days at the start of each 5‐week cycle survived longer (median 17 months, p<0.01) than 16 pateints who were treated with melphalan‐prednisolone alone (median 2 months). However, better supportive care, dialysis, and improved antibiotic treatment may also have contributed to the improved results. It is concluded that intensive chemotherapy in full dosage, plasmapheresis, and active uremia treatment including dialysis should be considered in patients with advanced myeloma and renal failure.
Water Intoxication Associated with Non‐steroidal Anti‐inflammatory Drug Therapy
Authors: PETERSSON INGEMAR , NILSSON GöRAN , HANSSON BENGT‐GöRAN , HEDNER THOMAS
Published: August 2010

ABSTRACT. Two cases of rheumatoid arthritis, who developed severe hyponatremia after treatment with non‐steroidal anti‐inflammatory drugs (NSAID) are presented. Early diagnosis was followed by rapid correction with hypertonic saline. It is suggested that NSAIDs, like piroxicam, di‐clofenac and indomethacin, may be added to the list of drugs which can induce syndrome of inappropriate antidiuretic hormone (SIADH).
The Enigma of Coronary Heart Disease and Its Prevention
Authors: WERKÖ LARS
Published: August 2010

“The sceptics in medicine have a hard time of it. It is much more difficult to be convincing about ignorance concerning disease mechanisms than it is to make claims for full comprehension, especially when the comprehension leads, logically or not, to some sort of action. When it comes to serious illness, the public tends, understandably, to be more sceptical about the sceptics, more willing to believe the true believers.” (Lewis Thomas)
Alcohol Consumption and Sudden Coronary Death in Middle‐aged Finnish Men
Authors: SUHONEN OLLI , AROMAA ARPO , REUNANEN ANTTI , KNEKT PAUL
Published: August 2010

ABSTRACT. Suhonen O, Aromaa A, Reunanen A, Knekt P (Research Institute for Social Security, the Social Insurance Institution, Helsinki, Finland). Alcohol consumption and sudden coronary death in middle‐aged Finnish men.

The association between consumption of alcoholic beverages (spirits, beer and wine) and coronary heart disease (CHD) mortality, especially the incidence of sudden coronary death (SCD), was investigated in a 5‐year prospective population study comprising 4532 men aged 40–64 years. The amount of alcohol used was estimated on the basis of answers to a self‐filled structured questionnaire. The incidence of SCD was statistically significantly lower among abstainers than among alcohol consumers. The relative risk of SCD of alcohol consumers in comparison with abstainers was largest in the oldest age group and it became more apparent after a follow‐up of a couple of years. Only the consumption of spirits was positively associated with the incidence of SCD. Among non‐smokers the incidence of SCD was statistically significantly higher in consumers than in abstainers, a similar but not significant trend was observed among current smokers. The positive association between alcohol consumption and incidence of SCD was detected both in CHD‐free men and in men with prior CHD. Consumption of alcoholic beverages, and in particular of spirits, is associated with an increased risk of SCD in Finnish men.
Reduced High Density Lipoproteins as a Risk Factor after Acute Myocardial Infarction
Authors: FRANZÉN JOHAN , JOHANSSON BENGT W. , GUSTAFSON ANDERS
Published: August 2010

ABSTRACT. FranzÉn J, Johansson BW, Gustafson A (Department of Internal Medicine, University Hospital, Lund and Section of Cardiology, Department of Internal Medicine, MalmÖ General Hospital, MalmÖ, Sweden). Reduced high density lipoproteins as a risk factor after acute myocardial infarction.

In a group of normocholesterolemic, non‐diabetic middle‐aged males surviving an acute myocardial infarction for 4±2 years (mean ± SD), we have previously described a low apolipoprotein A‐1 and a deficient fibrinolytic activity as two major characteristics. In the present study we have followed morbidity and mortality risk factors for five years in these males. Mortality was 40% in a hypertensive group and 16% in a normotensive group. In the normotensive group mortality was related to reinfarction. Furthermore, patients with a poor prognosis in the normotensive group had lower high density lipoprotein (HDL) cholesterol and lower apolipoprotein A‐I concentration in plasma than patients with a good prognosis. Unexpectedly, in the hypertensive group death was related to a low (p<0.05) cortisol concentration in urine. It is concluded that a low HDL level may be a bad prognostic sign in males who have sustained an acute myocardial infarction and show no evidence of other risk factors, such as diabetes, hypercholesterolemia or hypertension.