bluuebunny/crossref_metadata_2025 huggingface dataset:
Hyperuricemia as a Risk Factor for Cardiovascular Mortality
Authors: Reunanen Antti , Takkunen Heikki , Knekt Paul , Aromaa Arpo
Published: August 2010

ABSTRACT.The value of hyperuricemia as a risk factor for cardiovascular mortality was investigated in 3 195 men and 3 160 women aged 40–69 years in Finland. Hyperuricemia was associated with obesity, impaired glucose tolerance, hypertension and history of heart disease. The total mortality of hyperuricemic men and women in 5 years was significantly higher than the mortality of normouricemics. Cardiovascular mortality was not higher in hyperuricemics than in normouricemics. However, in hyperuricemic women without known heart disease cardiovascular mortality was significantly increased in the follow‐up period between 5 and 12 years. Total and cardiovascular mortality rates were significantly higher in hyperuricemic men with known heart disease than in corresponding normouricemic men. A rise of serum uric acid may be secondary to more advanced atherosclerosis. Thus, hyperuricemia may be associated with more advanced heart disease and it is not an independent cause of cardiovascular diseases.
Effect of Low Dose Diuretics on Plasma and Blood Cell Electrolytes, Plasma Uric Acid and Blood Glucose
Authors: Sundberg S. , Salo H. , Gordin A. , Melamies L. , Lamminsivu U. , Nuotto E. , Keränen A.
Published: August 2010

ABSTRACT. The short‐term effects of three diuretic drug regimens on plasma and blood cell electrolytes, plasma uric acid and blood glucose were studied in 11 subjects (aged 35–62 years) with mild hypertension in a double‐blind cross‐over study. Blood cell electrolytes were determined from hemolysed whole blood. The subjects were given 25 mg of hydrochlorothiazide (H), a combination of 25 mg of H and 2.5 mg of amiloride (HA) or a combination of 25 mg of H and 37.5 mg of triamterene (HT) once daily for 4 weeks in a randomized order. Plasma potassium fell slightly from 4.2–4.1 to 4.0–3.9 on each drug (significantly on H and HT, p < 0.05), the drop being most marked after one week. There were no statistically significant differences between the drug regimens. No changes were observed in plasma magnesium, calcium or sodium concentrations during the treatment periods. No statistically significant changes occurred in blood cell potassium or magnesium during any of the diuretic regimens. The increases in blood glucose during the treatment periods were minor, but this was statistically significant (p < 0.05) on HT. Plasma uric acid increased slightly but statistically significantly on each drug regimen (p < 0.05 on H and HA, p < 0.01 on HT). Three subjects who originally had normal or borderline uric acid values became clearly hyperuricaemic on each drug. All drug regimens decreased the systolic and diastolic blood pressure almost equally effectively. It is concluded that the 3 diuretic drug regimens had no clinically significant short‐term effects on plasma electrolytes. However, it is probable that hyperuricaemia cannot be avoided in predisposed subjects even when diuretics are used in low doses.
Adrenergic receptors. Methods of determination and mechanisms of regulation
Authors: Hedberg Anders
Published: August 2010

ABSTRACTThe radioligand binding technique has been proven useful in the study of altered responsiveness after exposure to adrenergic agents. A reduction in receptor number has generally been reported after interventions serving to increase the stimulatory input to the receptors prior to assay. Conversely a decrease in receptor stimulation has been demonstrated to induce an elevation in receptor density. These phenomena have been described for α‐ as well as for β‐adrenoceptors in various tissues under a variety of experimental conditions such as prolonged agonist exposure, chronic receptor blockade, denervation and interference with catecholamine turnover. A number of clinically relevant cardiovascular experimental models have been characterized by altered adrenoceptor densities, possibly reflecting a compensatory resetting of sympathetic tone in response to an aberrant haemodynamic pattern. The mechanisms underlying receptor density changes as those discussed have been suggested to involve an internalization process which may involve phospholipase and transglutaminase activation in the cell membrane.
Adrenergic regulation of insulin release
Authors: Holm Göran
Published: August 2010

ABSTRACTInsulin release is influenced by the autonomic nervous system. In the periphery the regulation occurs via both α‐adrenergic and β‐adrenergic receptors. The parasympathetic nervous system is important in the central regulation of insulin secretion. Nevertheless, adrenergic mechanisms are also concerned. This review discusses the mechanisms for the adrenergic regulation of insulin release and some clinical conditions where these mechanisms are concerned.
Possible adrenergic effects on heart protein metabolism
Authors: Hjalmarson Åke , Källfelt Björn , Swedberg Karl , Waagstein Finn , Waldenström Anders
Published: August 2010

ABSTRACT It is known that the heart will adapt to actual demand by increasing or decreasing its size through different mechanisms. In this presentation, the possible role of catecholamines in regulating heart protein synthesis and developing cardiac hypertrophy and cardiomyopathy is discussed. Injecting animals with catecholamines has been found to induce cardiac hypertrophy. In vitro perfusion of rat heart in the presence of catecholamines has been found to induce a time‐dependent and dose‐dependent stimulation of amino acid transport and incorporation into proteins. Acute haemodynamic effects of catecholamines increase cardiac performance while long‐term treatment seems to cause depression of cardiac function, especially during ischaemic conditions. Chronic β‐blockade in patients with primary congestive cardiomyopathy improved both cardiac function and clinical condition in more than half the patients. Furthermore, a beneficial effect on survival was also found, when compared with a matched control group. It is hypothesised that catecholamines may play a role in developing cardiac hypertrophy as well as congestive cardiomyopathy.
Influence of Beta‐Blocking Drugs on Glucose Metabolism in Hypertensive, Non‐Diabetic Patients
Authors: Groop L. , Tötterman K. J. , Harno K. , Gordin A.
Published: August 2010

Two β‐blocking agents, non‐selective propranolol and β1‐selective metoprolol, were investigated with respect to their effect on glucose metabolism in 11 hypertensive, non‐diabetic patients. They were randomly treated for two weeks in a double‐blind cross‐over manner with propranolol, metoprolol and placebo. Both drugs caused a small but significant increase in basal blood glucose values as compared with placebo (p<0.01). Metoprolol increased the blood glucose concentrations during the first 10 min of an i.v. glucose tolerance test (IVGTT) as compared with placebo (p<0.02) and propranolol (p<0.05). Propranolol raised only the blood glucose values during the later part of the IVGTT (p<0.01). The increase in blood glucose concentrations was, however, not associated with significant changes in peripheral insulin levels. The mean basal glucagon concentrations were lower during propranolol and metoprolol than during placebo (p<0.01). Propranolol also induced a more pronounced reduction of plasma glucagon than placebo (p<0.05) at 10 min of the IVGTT. The mean basal free fatty acid (FFA) concentrations were lower during propranolol (p<0.001) and metoprolol (p<0.05) than during placebo. Both drugs decreased the plasma levels of FFA during the first 10 min of the IVGTT as compared with placebo (p<0.01 andp<0.02, respectively). Pharmacological doses of propranolol and metoprolol increased blood glucose concentrations, decreased plasma glucagon and FFA concentrations, but had no effect on serum insulin levels in hypertensive, non‐diabetic subjects.
Serum Concentrations of Immunoglobulins and Free Light Chains before and after Vascular Events in Essential Hypertension
Authors: Kristensen Bent Østergaard , Sølling Karsten
Published: August 2010

Serum concentrations of immunoglobulins (Ig) and free light chains (LC) of Ig have been determined at regular intervals during five years in patients with essential hypertension and correlated to development of vascular complications. In 6 cardiac event patients serum IgG increased by 11.9% (p<0.05) and LC by 19.8% (p<0.05). IgG levels correlated positively with LC levels (r= 0.59, p<0.001) and changes in IgG correlated positively with changes in LC (r=0.46, p<0.01). The post‐event increments in IgG persisted up to 21 months. No significant changes in serum concentrations of Ig A, IgM, albumin and creatinine were found. In 10 cerebral event patients and in matched groups of 15 uncomplicated hypertensive patients, no significant changes in the above parameters could be demonstrated. It is concluded that heart tissue damage in essential hypertension induces a long‐lasting stimulation of B‐lymphocytes, and it is suggested that the high Ig levels found in as yet uncomplicated hypertensive patients may reflect an ongoing damage of the vascular bed.
Screening for Health Risks
Authors: Sigurdsson Gunnar , Sigfusson Nikulas , Thorsteinsson Thorsteinn , Olafsson Olafur , Davidsson David , Samuelsson Sigurdur
Published: August 2010

The participants in a community health survey in the Reykjavik area answered the question whether a first‐degree relative had had myocardial infarction (MI), hypertension (HT) or cerebral stroke. The mean total serum cholesterol level was 5–10 mg/dl higher in the group with a positive history of MI than in the negative group. The frequency of hyperlipidaemia and the levels of other risk factors measured (blood pressure and body mass index) were similar in both groups. The group with a positive family history (FH) of HT had a mean systolic blood pressure 6–8 mmHg higher and diastolic hypertension (>105 mmHg) on a single measurement twice as frequently as the negative group. The mean systolic blood pressure in the group with positive FH of stroke was 8–10 mmHg higher than in the negative group. The study thus suggests that positive FH of HT or stroke among first‐degree relatives is a worthy indication for blood pressure measurements, at least after the age of 40.
Three‐Day Treatment of Acute Lower Urinary Tract Infections in Women
Authors: Sigurdsson Johann A. , Ahlmén Jarl , Berglund Lillemor , Jerneck Maria , Larsson Lars , Lincoln Knut , Wohrm Atle , Bucht Härje
Published: August 2010

The aim of this study was to determine if a three‐day treatment of lower urinary tract infection (UTI) is effective. 215 women with symptoms of lower UTI, seen in general practice, were randomly allocated to a double‐blind study and given either amoxycillin 1000 mg twice a day for three days or trimethoprim 90 mg/sulphadiazine 410 mg (co‐trimazine) 2 tablets initially, then one tablet twice daily for three days. 157 women (73%) had significant bacteriuria. Therapeutic efficacy was evaluated in 146 patients. One week after treatment had started, 88 % of the women in the amoxycillin group and 100% in the co‐trimazine group were cured (p<0.01). After a follow‐up period of four weeks, the cumulative relapse frequencies were 19% and 9% respectively. Adverse reactions were mild in most cases. Two patients, both on co‐trimazine, had to discontinue treatment because of nausea and vomiting. Vulvovaginal irritation was more often reported by women treated with amoxycillin (n=8) than by those treated with co‐trimazine (n = 1) (p<0.05). It is concluded that a three‐day course of amoxycillin or co‐trimazine in lower UTI is safe, causes few adverse reactions, is simple to administer and comfortable for the patient. Co‐trimazine seems to be more effective than amoxycillin.
Fatal Influenza A Myocarditis with Isolation of Virus from the Myocardium
Authors: Engblom Erik , Ekfors Tauno O. , Meurman Olli H. , Toivanen Auli , Nikoskelainen Jukka
Published: August 2010

A previously healthy 27‐year‐old woman developed an acute cardiac failure one week after onset of influenza‐like respiratory infection, and died on her fourth day in hospital. Intravital differential diagnosis included myocardial infarction because of ECG changes and massive elevation of myocardial enzymes. Autopsy revealed severe myocarditis and intact coronary arteries. At microscopic examination the myocardium was heavily infiltrated with lymphocytes, and there was a marked myo‐cytolysis. Influenza A virus was isolated from the myocardial tissue. An immunological mechanism of myocardial damage is suggested.
Plasma High Density Lipoproteins and Lipolytic Enzyme Activities in Diabetic Patients
Authors: Agardh Carl‐David , Sartor Gunnar , Nilsson‐Ehle Peter
Published: August 2010

Eighty diabetic patients, consecutively selected from an out‐patient clinic, were studied with regard to plasma lipoprotein levels, especially HDL. Patients treated with sulphonylureas had 24% lower HDL cholesterol concentrations (p<0.01) but only about 7% lower apo AI levels (n.s.) than those on insulin treatment. This difference could at least partly be explained by differences in age and type of diabetes. There was no relationship between the degree of diabetic control, as measured by fasting blood glucose levels, and HDL levels. In two subgroups of insulin‐treated diabetics, selected to represent extremely low and high HDL levels (range 0.5–0.8 and 1.8–2.0 mmol/l, respectively) but matched with regard to age, duration of diabetes, insulin dosage and diabetic control, the activities of lipoprotein lipase and hepatic lipase in postheparin plasma were also recorded. The high HDL group had significantly higher lipoprotein lipase activities (p<0.01) and significantly lower hepatic lipase activities (p<0.05) than the low HDL group, supporting the hypothetical roles of these enzymes in HDL metabolism, and offering a tentative mechanism behind the large variability of HDL levels in diabetics.
Prevalence of Iron Overload in Central Sweden
Authors: Olsson K. Sigvard , Ritter Bernd , Rosén Ulf , Heedman Per Axel , Staugård Frants
Published: August 2010

An increase in the iron content of food may be harmful to people with genetic hemochromatosis. We studied the prevalence of this disorder in Sweden, which is the country with the world's highest iron fortification of food. Serum ferritin and transferrin (TIBC) saturation levels were used as initial screening methods. Three (0.5 %) of 623 males aged 30–39 years were found to have genetic hemochromatosis. Family studies revealed 10 additional homozygotic family members. A prevalence of 0.5% of homozygotes (q2) implies a gene frequency (q) of 6.9% or a heterozygote frequency (2×q) of 13.8%. The high gene frequency may be explained by a possible genetic advantage of heterozygotes in the past. We conclude that idiopathic hemochromatosis is not as rare as previously thought. Affected persons should be detected and treated before irreversible organ damage occurs. This study demonstrates that serum ferritin levels together with TIBC saturation levels are adequate methods for screening populations.
B‐Cell Function and Islet Cell and Other Organ‐Specific Autoantibodies in Relatives to Insulin‐Dependent Diabetic Patients
Authors: Nordén G. , Jensen E. , Stilbo I. , Bottazzo G. F. , Lernmark Å.
Published: August 2010

ABSTRACT The pancreatic B‐cell function (glucose tolerance, C‐peptide release) and organ‐specific autoantibodies, including islet cell cytoplasmic and cell surface (mouse), were studied in 45 first‐degree relatives of patients with insulin‐dependent diabetes mellitus diagnosed before the age of 30 years. Compared to 107 healthy persons without any family history of either insulin‐dependent or non‐insulin‐dependent diabetes mellitus, the prevalence of autoantibodies was increased among the relatives. The prevalence of islet cell antibodies did not differ between relatives and controls and none of the individuals had complement‐fixing islet cell antibodies. There was no difference in glucose tolerance or C‐peptide release between relatives and controls, whether they had autoantibodies or not. At a three‐year follow‐up, none of the individuals had developed insulin‐dependent diabetes.
Long QT Interval and Ventricular Tachycardia of “Torsade de Pointe” Type in Hypothyroidism
Authors: Fredlund Bengt‐Olof , Olsson S. Bertil
Published: August 2010

ABSTRACT We have observed two patients with long QT interval, ventricular tachycardias of “torsade de pointe” type and repeated ventricular fibrillation episodes, who also turned out to have significant hypothyroidism. This was suspected from the clinical picture in one patient and after haematological test in the other. In addition to hypothyroidism, both patients had associated factors which may have contributed to the development of the arrhythmia. After having reached an euthyroid state, both patients normalized their QT intervals, were relieved from earlier symptoms of cardiac arrhythmias and exhibited no longer any documented arrhythmia. Before thyroid substitution, both patients had marked signs of delayed ventricular repolarization even by invasive electrophysiological methods. Our observations indicate that hypothyroidism should be considered a possible primary cause in cases with long QT syndrome (LQTS). Furthermore, the possibility of LQTS in patients with hypothyroidism should be considered.
Selenium Therapy of Myotonic Dystrophy
Authors: Örndahl Gustav , Rindby Anders , Selin Eva
Published: August 2010

ABSTRACT A patient with myotonic dystrophy (MD) has been treated for two years with selenium and vitamin E. The serum selenium concentration and other relevant variables were continuously studied. The patient showed a marked subjective and objective improvement with increased muscular strength and regression of pathological electromyographic findings. To our knowledge, this is the first report of successful treatment of MD.
Clinical Aspects of Tricyclic Antidepressant Poisoning
Authors: Hultén Bengt‐Åke , Heath Andrew
Published: August 2010

ABSTRACT Self‐poisoning with antidepressant drugs was studied retrospectively in 225 patients admitted to an intensive care unit. Amitriptyline accounted for the overwhelming majority of cases (70%); 106 patients (47%) had taken two or more drugs, in 81 patients (36%) ethanol was found in the blood. Four patients (2%) died. On admission, 111 patients (49%) were unconscious (grade III). A further 30 patients (13%) were in grade IV coma, and of these 27 had taken amitriptyline. Twenty‐four hours after admission, 22 patients (10%) remained in coma. Thirty‐six patients (16%) required assisted ventilation. Nineteen patients (8%) had convulsions and 6 (3%) aspired stomach contents. Sixty‐one patients (27%) had a widened QRS interval exceeding 100 msec, 18 (30%) of them required assisted ventilation, 21 (34%) were in stage IV coma and 15 (25%) had convulsions. This relationship between a widened QRS interval and the severity of intoxication should be considered in the initial assessment of patients with tricyclic antidepressant poisoning.
Left Ventricular Response to Isometric Exercise in Aortic Valve Diseases and Its Value in the Optimal Timing of Aortic Valve Replacement
Authors: Huikuri Heikki V. , Ikäheimo Markku J. , Linnaluoto Markku K. , Takkunen Juha T.
Published: August 2010

ABSTRACT In order to evaluate the left ventricular response to isometric exercise in different types of aortic valve disease, isometric exercise tests were performed during cardiac catheterization in 14 patients with pure aortic stenosis, 20 with combined aortic stenosis and regurgitation, and 18 with pure aortic regurgitation. Patients with angina pectoris in whom coronary angiography had not been performed were excluded. Thirty‐seven patients were recatheterized 12 months after aortic valve replacement, and the ventricular response to exercise was re‐evaluated. Preoperatively, the ejection fraction did not change significantly during excercise in patients with aortic stenosis, tended to decrease in patients with combined valve lesion, and decreased significantly in patients with aortic regurgitation (p<0.001). In the three patients whose ejection fraction during preoperative exercise decreased to below 0.40, it remained below 0.50 after successful aortic valve replacment. It appears possible to reveal left ventricular dysfunction in many patients with aortic regurgitation and in some with combined aortic valve disease by means of isometric exercise. The severely depressed ventricular dysfunction during exercise does not appear to correct totally after surgery.
Home Blood Glucose Monitoring —the Key to Good Control
Authors: Blohmé GÖran
Published: August 2010

ABSTRACT.Home blood glucose monitoring is one of the corner‐stones in the management of type I diabetes. This paper summarizes the aims and effects of this method and will discuss the pros and cons with simple patient‐adapted meters and visual judgement of the blood glucose strip. It is underlined that a thorough handling of the strip is essential for the result whatever method used. The problem solving capacity of home blood glucose monitoring in unstable diabetes is illustrated.
The Diagnostic Accuracy of CSF Analyses in Stroke
Authors: BRITTON MONA , HULTMAN ERIC , MURRAY VERONICA , SJÖHOLM HANS
Published: August 2010

ABSTRACT. The ability of routine analyses of cerebrospinal fluid (CSF) to differentiate between haemorrhage and infarction was evaluated in 231 stroke patients, whose diagnoses were based on computed tomography or autopsy. In all diagnostic groups the mean protein level was above normal, the highest values being associated with haemorrhage. Taking a protein level >1 g/l to be characteristic of bleeding, sensitivity was 89% and specificity 92%. Spectrophotometric CSF absorbance was measured at wave lengths of 410, 415, 455 and 630 nm. Validity was equal for the first three. Taking absorbance ≥0.040 at 415 nm to be diagnostic for haemorrhage, sensitivity was 72% and specificity 94%. The human eye was almost as sensitive as spectrophotometry in this context. Thus, among 100 patients with stroke, 7–9 out of 10 plausible cases of haemorrhage would be identified by means of routine CSF analyses. At the same time, 5–9 patients with ischaemic lesions would be diagnosed incorrectly as bleedings
Serum Calcium in Greenland Eskimos
Authors: JEPPESEN BJARNE BO , HARVALD BENT
Published: August 2010

ABSTRACT. Serum calcium i Greenland Eskimos living in Greenland is significantly lower than in Greenland Eskimos and Danes living in Denmark (p<0.001). Danes living in Greenland show intermediate values. High vitamin D levels have been found in Eskimos (Canada). Thus vitamin D deficiency is probably not the cause of the low serum calcium levels. A low dietary intake of calcium is a more likely explanation, consistent with the finding of high serum calcium in Greenland Eskimos living in Denmark, especially in adolescents with high consumption of dairy products. The low serum calcium in Greenland Eskimos may explain the early onset of osteoporosis, which is a common trait in Eskimos from all over the Arctic.
Alveolitis during Chrysotherapy for Rheumatoid Arthritis
Authors: FRANZÉN PER , PETTERSSON TOM
Published: August 2010

ABSTRACT. A patient who developed dry cough and increasing breathlessness during chrysotherapy for seropositive rheumatoid arthritis is presented. Chest radiograms were repeatedly normal, but there was a moderate decrease in pulmonary diffusing capacity. Transbron‐chial lung biopsy showed alveolitis. No cellular immunity to gold salts could be demonstrated in vitro. Pulmonary function improved after withdrawal of gold, indicating that chrysotherapy rather than systemic rheumatoid disease was the cause of the alveolitis.
Evaluation of Once Daily Hydralazine in Inadequately Controlled Hypertension
Authors: DANIELSON MATS , KJELLBERG JAN , ÖHMAN PETER , WERNERSSON BÖRJE
Published: August 2010

ABSTRACT.Despite the short plasma half‐life of hydralazine, once daily Slow Apresoline has been shown to maintain blood pressure control in well controlled hypertension. In the present investigation of 118 inadequately controlled hypertensives, we have shown that 50–150 mg Slow Apresoline once daily induces a significant blood pressure reduction and is well tolerated. Normotension, i.e. supine diastolic blood pressure <95 mmHg, was reached in 53 % of the patients. Normotension or a supine diastolic blood pressure reduction of ≥10 mmHg was achieved in 72% of the patients, the hydralazine responders. Sixteen patients discontinued treatment due to symptoms probably related to hydralazine. Acetylator phenotyping showed that slow acetylators predominated in the group of patients discontinuing hydralazine due to side‐effects. In contrast, 90% of the phenotyped non‐responders were rapid acetylators, which suggests a suboptimal use of hydralazine in some rapid acetylators.
THE PROGRESS OF PATIENTS IN THE EUROPEAN WORKING PARTY ON HYPERTENSION IN THE ELDERLY TRIAL
Authors: Amery A. , Beard K. , Birkenhäger W. , Bogaert M. , Brixko P. , Bulpitt C. , Clement D. , de Leeuw P. , De Plaen J.F. , Deruyttere M. , De Schaepdryver A. , Fagard R. , Feltkamp H. , Forette F. , Forte J. , Grauwels R. , Harady R. , Henry J.F. , Koistinen A. , Leonetti G. , Lewis P. , Lund‐Johansen P. , MacFarlane J.P.R. , Meurer K. , Miguel P. , Morris J. , Mutsers A. , Nissinen A. , O'Brien E. , O'Callaghan W. , O'Malley K. , Omvik P. , Petrie J.C. , Puska P. , Terzoli L. , Tuomilehto J. , Varis R. , Webster J. , Williams B. , Willemse P.
Published: August 2010

792 hypertensive patients above the age of 60 have entered the double‐blind multicentre trial of the European Working Party on High blood pressure in the Elderly (EWPHE). Half were treated with hydrochlorothiazide and triamterene and half were given placebo and a second capsule was given and if necessary up to 2 g of methyldopa/day. The measurements in a sample of 157 patients suggested 80–86% compliance rate.

A significant blood pressure difference of 25/10 mm Hg was obtained between the groups and maintained during five years of follow‐up.

The increase in serum creatinine found in the actively treated group was related to the decrease in sitting systolic blood pressure. Changes in serum uric acid correlated with changes in serum creatinine both in the placebo and in the actively treated group. Fasting blood glucose changed significantly in the active treatment group. The balance between this decreased risk on the basis of the blood pressurer eduction and the increase produced by the rise in blood glucose and the other treatment effects remains to be determined. The trial continues and more patients are being admitted.
Lack of Effect of Exogenous or Endogenous Gastric Inhibitory Polypeptide on the Elimination Rate of Intralipid® in Man
Authors: JORDE ROLF , PETTERSEN JON E. , BURHOL PER G.
Published: August 2010

Abstract Six healthy subjects were studied by means of an intravenous fat tolerance test on three occasions, in the fasting state, in the postprandial state, and during an intravenous infusion of gastric inhibitory polypeptide (GIP). No effects on the elimination rate of Intralipid® were seen either by endogenous or exogenous GIP.
Interobserver Variation in Assessment of Respiratory Signs
Authors: GJØRUP THOMAS , BUGGE PER M. , JENSEN ANDERS M.
Published: August 2010

Abstract Interobserver variation was studied for 11 respiratory signs and for the diagnostic conclusions made on the basis of these signs. Two physicians each, with and without knowledge of the patient's history, performed physical examination of the lungs in a total of 202 unselected patients from a department of internal medicine. The interobserver variation was calculated as the kappa coefficient, using a modified method that made it possible to calculate the interobserver variation for a pair of observers made up by varying physicians. No difference was demonstrated between the kappa coefficients obtained for examinations performed with and without knowledge of the history. The kappa values for the signs ranged from ‐0.04 to 0.58, and for the diagnoses from 0.15 to 0.68, i.e., expressed by kappa values, poor agreement. In a questionnaire study we asked a number of physicians from departments of internal medicine to guess the size of the interobserver variation for the 11 respiratory signs examined. A total of 47 physicians (90%) returned the questionnaire and the answers showed that the physicians markedly underestimated the interobserver variation.
High and Low Insulin Responders: Relations to Oral Glucose Tolerance, Insulin Secretion and Physical Fitness
Authors: BERNTORP K. , LINDGÄRDE F. , MALMQUIST J.
Published: August 2010

Abstract High and low insulin responders, a total of 133 non‐diabetic men. matched for age and body weight, were reinvestigated after an average period of 3 1/2 years by means of oral glucose tolerance tests, simultaneous insulin and C‐peptide measurements and submaximal work tests. The number of individuals with impaired glucose tolerance did not increase during the observation period, and none became diabetic. Intergroup differences in glucose and insulin values were largely the same as in the initial screening procedure. although some regression towards the mean was observed. The high insulin group, compared with the low insulin group, had overall higher glucose, insulin and C‐peptide levels, significantly higher increment 0–40 min of insulin but not C‐peptide, and significantly lower maximal oxygen uptake. The present data indicate no difference in insulin secretory capacity but a decreased hepatic insulin extraction and a peripheral insulin insensitivity among the high insulin responders, related to a lower degree of physical fitness
Cardiac Dysrhythmias in Patients with Acute Myocardial Infarction
Authors: DYCKNER THOMAS , HELMERS CLAES , WESTER PER OLOV
Published: August 2010

AbstractA series of 676 patients with acute myocardial infarction were evaluated with regard to initial serum potassium level, prior diuretic therapy and occurrence of cardiac dysrhythmias during their first 24 hours in a coronary care unit. Serious dysrhythmias (ventricular tachycardia, ventricular fibrillation, and asystole) were significantly more frequent in hypokalemic patients. In this regard no differences were observed between patients on or off prior diuretic therapy
Iron Metabolism and “Sports Anemia”
Authors: MAGNUSSON BENGT , HALLBERG LEIF , ROSSANDER LENA , SWOLIN BIRGITTA
Published: August 2010

Abstract A hematological comparison was performed between 43 middle and long distance male runners and 119 male controls. The hematocrit, serum iron, transferrin saturation and serum ferritin values were significantly lower in the athletes. The amount of bone marrow hemosiderin was also lower in the athletes than in a group of non‐athletic men of the same age. Even if these values were clearly lower than in the controls, they were not low enough to indicate iron deficiency. The observations that sideroblast counts in bone marrow smears were normal and that both red cell indices and red cell protoporphyrin were normal strongly support the conclusion that lack of iron had not limitated erythropoiesis or the formation of an optimal red cell mass. Low serum haptoglobin values in most athletes indicated an increased intravascular hemolysis. As the hemoglobin‐haptoglobin complex formed is taken up by heptatocytes, this implies that there is a shift in the red cell catabolism in these athletes from the reticuloendothelial system to the hepatocytes. This shift may explain the paradoxical findings of low serum ferritin concentrations and reduced contents of bone marrow hemosiderin. This is consistent with the observed normal erythropoiesis. It was concluded that runners “anemia” is no true anemia and not caused by iron deficiency. “Sports anemia” is thus no indication for routine iron supplementation
Prenalterol as Long‐term Therapy for Chronic Congestive Heart Failure
Authors: DAHLSTRÖM ULF , ARESKOG MAGNUS , WRANNE BENGT , KARLSSON ERLING
Published: August 2010

AbstractTen patients with severe chronic congestive heart failure (CHF) due to ischaemic heart disease treated with digitalis and diuretics were randomly allocated to oral treatment with prenalterol (100–200 mg daily in addition to their basal treatment) or to intensified treatment with diuretics in a cross‐over trial. A wash‐out period of 1–4 weeks was allowed between the two modes of treatment. Most of the patients demonstrated subjective improvement during prenalterol therapy, but this improvement could not be verified objectively by exercise test, echocardiography, chest X‐ray or weight measurements. No serious side‐effects of either mode of treatment were observed. Heart rate was significantly lower during exercise when the patients were treated with prenalterol than during the control periods or during intensified conventional treatment, indicating that prenalterol acts as a β‐adrenergic receptor blocker during exercise in this patient group. The results indicate that prenalterol is a partial β‐receptor agonist without superior beneficial effects compared to those of intensified conventional treatment in patients with chronic, severe CHF.
Impaired Counter Regulation of Hypoglycemia in a Group of Insulin‐dependent Diabetics with Recurrent Episodes of Severe Hypoglycemia
Authors: ADAMSON ULF , LINS PER‐ERIC , EFENDIC SUAD , HAMBERGER BERTIL , WAJNGOT ALEXANDRE
Published: August 2010

Abstract The counterregulatory response to insulin‐induced hypoglycemia was investigated in 22 insulin‐dependent diabetics (IDD) with recurrent hypoglycemia and in 6 healthy volunteers. Hypoglycemia was induced by a constant rate infusion of insulin (2.4 U/h) up to four hours. Conventional insulin therapy was changed to an i.v. infusion of regular insulin 24 hours prior to the experiment. The presence of diabetic autonomic neuropathy was evaluated by respiratory sinus arrhythmia and Valsalva maneuver. In healthy subjects, blood glucose was decreased to 2.5 mmol, here reaching steady state level and giving rise to marked glucagon and growth hormone (GH) responses. The majority of IDD (group A) reached a slightly lower steady state glucose level and exhibited similar glucagon and GH responses while the epinephrine response was augmented. Six IDD (group B) showed a continuous decrease in blood glucose to 1.2+0.1 mmol/l at which level the infusion of insulin was discontinued due to neuroglucopenic symptoms. These subjects had no glucagon and epinephrine responses while their GH and cortisol responses were normal. A comparison of the diabetic groups revealed a longer duration of diabetes and a more impaired autonomic nervous function in group B while glycosylated hemoglobin was similar. It is concluded that most IDD have normal hormonal responses (epinephrine, glucagon, GH, cortisol) and normal counterregulartory capacity to hypoglycemia induced by a prolonged infusion of a moderate dose of insulin. Some patients with long‐term diabetes and impaired capacity to counteract hypoglycemia exhibit deficient glucagon and epinephrine responses to hypoglycemia.
Validity of Hospital Discharge Data in a Prospective Epidemiological Study on Stroke and Myocardial Infarction
Authors: HELIÖVAARA MARKKU , REUNANEN ANTTI , AROMAA ARPO , KNEKT PAUL , AHO KARI , SUHONEN OLLI
Published: August 2010

Abstract The validity and coverage of hospital records of stroke and myocardial infarction were evaluated in a Finnish epidemiological cohort consisting of 57000 men and women. Information on their hospitalizations after the baseline examination was obtained by record linkage to the National Hospital Discharge Register. As compared to data based on re‐examination of survivors after five years, the discharge register covered 78.2 % of hospital treatments. A specific diagnosis code had been recorded for 81.7% of the definite strokes and for 84.7% of the definite myocardial infarctions. The 5‐year incidence rates based on both hospital records and deaths were clearly lower than the rates previously reported from local registers of stroke and myocardial infarction in Finland. Although hospital discharge information underestimates morbidity in the population, the data are sufficiently valid for many epidemiological purposes, e.g. research on predictors of diseases.
Failure of Long‐term Acclimatization in Smokers Moving to High Altitude
Authors: LINDGÄRDE FOLKE , LILLJEKVIST RAGNHILD
Published: August 2010

Abstract It was found that several foreign experts recruited for an irrigation project in southern Peru could not cope with their work at an altitude of 3 200 m. When we analyzed the haematological acclimatization to high altitude in 109 adult males, we found that the moderate differences in haematorit level (0.9) and haemoglobin concentration (0.2 g/100 ml) between male smokers and non‐smokers at low altitude were almost quadrupled at 3 200 m height. The haemoglobin concentration increased in both groups during the first month, after which it remained constant. Of 51 Swedish employees, 25 smokers and 26 non‐smokers, 14 were obliged to terminate their contracts. All 10 who had failed to cope with their work for other than purely medical reasons were smokers. This group of smoking men also had an overconsumption of alcohol. We therefore conclude that life style determines long‐term acclimatization to high altitude.
Sodium Elimination Rate and Blood Pressure during Normal and High Salt Intake in Subjects with and without Familial Predisposition to Hypertension
Authors: GUDMUNDSSON OTTAR , CEDERBLAD ÅKE , WIKSTRAND JOHN , BERGLUND GÖRAN
Published: August 2010

Abstract We have assessed the elimination rate of 22Na (ER‐22Na), total exchangeable sodium (NaE), blood pressure, plasma volume (PV), haematocrit, urinary noradrenaline (U‐NA) and urinary 3‐methoxy‐4‐hydroxymandelic acid (U‐VMA) in normotensive men with (n=17) and without (n=15) familial predisposition to hypertension. All measurements were done during habitual salt intake and after four weeks of increased salt intake (ordinary intake + 12 g NaC1/daily). On ordinary salt intake, ER‐22Na, NaE, blood pressure, PV, haematocrit, U‐NA and U‐VMA did not differ between the groups thus indicating a normal sodium turnover in both groups and a comparable activity of the sympathetic nervous system. After 10 days of high salt intake those without familial predisposition showed signs of volume expansion and decreased sympathetic activity and those with such predisposition showed insignificant changes in the same direction. After four weeks of increased salt intake, ER‐22Na had increased significantly and equally in both groups, while blood pressure and NaE remained unchanged. This indicates that the predisposed individuals had a normal ability to cope with a prolonged increase in salt intake.
Five‐year Follow‐up of ECG Aberrations, Latent Coronary Heart Disease and Cardiopulmonary Fitness in Various Age Groups of Norwegian Cross‐country Skiers
Authors: Lie Håkon , Erikssen Jan
Published: August 2010

Abstract A cross‐sectional sample of 122 middle‐aged and elderly long‐time active, well‐trained male cross‐country skiers were studied in 1976 to assess the prevalence of possible latent coronary heart disease (CHD). One hundred and seventeen skiers were reexamined five years later to assess the prognostic significance of a number of ECG aberrations encountered in 1976, and to assess the CHD incidence among athletes. One had died and four did not participate in the restudy, but none of these five men had had cardiac disease. The findings at the time of the two surveys were remarkably similar. All had excellent physical performance and a stable life habit pattern. Only three had given up regular training in the observation period. There was a very high prevalence of sinus bradycardia, first degree AV blocks, left ventricular hypertrophy (LVH) and incomplete right bundle branch block. Pathologic exercise ECGs were found on both occasions. Of 23 men with “pathologic” exercise ECG, 21 had LVH. Five had codable Q waves according to the Minnesota code, but none had symptoms of CHD. Two developed angina pectoris during the follow‐up and none had had myocardial infarction. It is concluded that the large number of ECG aberrations found in middle‐aged and elderly athletes are mainly related to physiological adaptation to training and that training seems to protect against CHD.
Long‐Term ECG Recordings in Hyperthyroid Patients before and after Antithyroid Treatment
Authors: JANSSON R. , JONASON T. , NILSSON G. , PETURSSON P. , RINGQVIST I.
Published: August 2010

ABSTRACT Heart rate and heart rhythm were studied in 19 hyperthyroid patients before and after antithyroid treatment inducing a euthyroid state. The mean 24‐hour heart rate in patients with sinus rhythm and without drugs influencing heart rate was 100 beats/min before and 80 after antithyroid treatment. The difference was greatest in the sleeping hours. The heart rate, especially in the sleeping hours, correlated significantly with serum triiodothyronine but not with serum thyroxine concentrations.
The Lupus Inhibitor in Thromboembolic Disease and Intrauterine Death in the Absence of Systemic Lupus
Authors: GÅRDLUND BENGT
Published: August 2010

ABSTRACT This study describes the use of a modified dilute thromboplastin assay for demonstration of the lupus coagulation inhibitor in plasma. A one‐stage clotting inhibition assay is used in which the ability of the test plasma to prolong the clotting time of normal plasma is measured. The method is easy to perform and suitable for routine use. Clinical and laboratory data from five patients with the inhibitor but without systemic lupus erythematosus are presented. Thromboembolic manifestations were observed in three patients and obstetric complications possibly due to placentar thrombosis in two. One patient showed a bleeding tendency, associated with prothrombin deficiency. A number of pathological coagulation analyses and other laboratory data may be due to affinity of the lupus inhibitor for negatively charged phospholipids in vitro.
Morbidity and Mortality in Relation to Blood Pressure and Antihypertensive Treatment
Authors: SIGURDSSON JOHANN A. , BENGTSSON CALLE , LAPIDUS LEIF , LINDQUIST OLOF , RAFNSSON VILHJALMUR
Published: August 2010

ABSTRACT Morbidity and mortality in cardiovascular and cerebrovascular diseases and total mortality have been studied in a longitudinal population study initially comprising 1462 women representative of the general female population. When related to the initial blood pressure (BP) levels of women not on antihypertensive drugs (hypertensives and non‐hypertensives), the distributions of women with myocardial infarction (MI) and stroke during the 12‐year follow‐up period seemed to be U‐shaped, with the highest incidences in women with the lowest and the highest BP levels. Women recognized as untreated hypertensives in the initial study were offered regular control by the study team during the whole 12‐year period and were treated when treatment was considered indicated. They were found to be similar to the non‐hypertensives with regard to the incidence of MI and stroke and total mortality. Our encouraging results may be explained by continuity of medical care, the antihypertensive treatment per se or the types of antihypertensive drugs administered.
Hepatic Glucose‐6‐Phosphatase Activity in Non‐Insulin Dependent Diabetics
Authors: SOTANIEMI EERO A. , STENGÅRD JARI H. , SAARNI HANNU U. , ARRANTO ARNO J. , KEINÄNEN KARI , KEROLA TUOMO , SUTINEN SEPPO
Published: August 2010

ABSTRACTThe role of glucose‐6‐phosphatase (G6Pase) in postreceptional glucose handling in non‐insulin dependent diabetics (NIDDs) was investigated by comparing the enzyme values in diagnostic liver biopsy samples with fasting blood glucose (BG), immunoreactive insulin (IRI) and plasma antipyrine half‐life (T/2). The NIDDs, treated with sulphonylureas, had elevated serum aminotransferase and alkaline phosphatase values associated with fatty liver with or without fibrosis. G6Pase activity was reduced in the NIDDs compared with subjects who had undergone gallstone surgery (p<0.001), insulin dependent diabetics (p<0.001), and age‐ and sex‐matched non‐diabetics (p<0.001). G6Pase was inversely related to BG and antipyrineT/2, but not to IRI or conventional liver function tests. Therapy with phenobarbital and medroxyprogesterone acetate, known inducers, increased G6Pase activity, shortened antipyrineT/2, reduced BG and did not alter IRI, in four NIDDs. Low liver G6Pase activity in NIDDs may hence be one factor underlying the impaired glycemic control.
Analgetic Treatment in Acute Myocardial Infarction
Authors: NIELSEN J. R. , PEDERSEN K. E. , DAHLSTRØM C. G. , NIELSEN B. L. , SECHER B. , JOHANSEN T. , GRAM L. F.
Published: August 2010

ABSTRACT In a randomized double‐blind study with flexible dosage, morphine, nicomorphine and pethidine were compared with regard to analgetic effect, dose requirements, dose intervals and adverse reactions. A total of 275 patients were included, and 28 patients were excluded due to adverse reactions (n= 16) and for practical reasons, etc. Acute myocardial infarction (AMI) was diagnosed in about 60% of the patients, and about 30% had ischemic heart disease without AMI. All three analgesics provided equally efficient pain relief in relative doses of morphine 10, nicomorphine 10 and pethidine 75 mg/ml. Severe adverse reactions were few (allergy 3 cases, respiratory insufficiency 4, severe bradycardia 4), whereas nausea was recorded in 20–30%, vomiting in 5–15% and dizziness in 10–30% of the patients, with no difference between the three drugs. Significant blood pressure drop (>30 mmHg) was seen in 3–8% of the patients, with no significant differences between the drugs.
Relationship between Serum CK‐MB‐Estimated Acute Myocardial Infarct Size and Clinical Complications
Authors: GRANDE PEER , KIILERICH SØREN
Published: August 2010

ABSTRACT The relationship between acute myocardial infarct (AMI) size and morbidity and mortality was estimated in 317 patients followed for one year or until death. Infarct size was estimated from serum creatine kinase (CK)‐MB levels measured thrice daily. The incidence of ventricular arrhythmias, congestive heart failure, cardiogenic shock, and the cardiac performance during exercise were studied during hospitalization. Hospital mortality and one‐year mortality were registered. A positive correlation was found between serum CK‐MB‐estimated infarct size and the incidence of ventricular arrhythmias (p<0.05). Patients with congestive heart failure and patients with cardiogenic shock had significantly larger infarct size than patients without (p<0.05–0.01), although there was a substantial overlap. During exercise test the rise in systolic blood pressure correlated negatively and the rise in heart rate correlated positively to estimated infarct size (p<0.01). Both hospital mortality and one‐year mortality were significantly related to estimated infarct size (p<0.01). Thus the infarct size, as estimated from serum CK‐MB, seems to be of importance for development of the most common and serious complications after AMI.
No Evidence of a Lymphocytopenia State before Manifestation of Chronic Lymphocytic Leukemia
Authors: BJÖRKHOLM M. , GRIMFORS G. , KIMBY E. , HOLM G.
Published: August 2010

ABSTRACT Total lymphocyte counts were determined on an average 13.4 years before establishment of the diagnosis in 20 of 95 consecutive patients with chronic lymphocytic leukemia (CLL). The reasons for performing the white blood cell and differential counts did not include diabetes, autoimmune diseases or verified viral infections which are conditions well known to be associated with lymphocytopenia or lymphocytosis. The mean total lymphocyte count in the patient group was 2.6times109/1 and did not differ from that of an age‐matched control group. There was no significant association between the pretreatment lymphocyte count and the time between test and diagnosis. We conclude that patients with CLL have not a lymphocytopenic state antedating the diagnosis of CLL.