bluuebunny/crossref_metadata_2025 huggingface dataset:
Inadequacies in Hospital Drug Handling
Authors: Bergman Ulf , Norlin Allan , Wiholm Bengt‐Erik
Published: August 2010

ABSTRACT. Successful pharmacotherapy is dependent on a long chain of considerations, decisions and actions. Some routines in the prescription, recording and administration procedures for drugs were found to be inadequate in our hospital. New procedures were developed, based on the following principles: 1) Drug prescriptions, written and signed by the doctors/nurses, included the indication(s) for starting or stopping the treatment. 2) No transcriptions of drug prescriptions were allowed. 3) The medication times were adapted to pharmacokinetic principles. 4) All doses taken by the patients were recorded and countersigned by a nurse. The system was tested during a three‐month period in two medical wards. The 274 patients obtained 1653 prescriptions, 83% by physicians. Of the prescriptions, 7% were never administered. One half of the patients did not take all of the prescribed drug therapy. This accounted for an average of one‐tenth of the prescribed doses. An average number of 5.1 “drug exposures” were prescribed and 4.7 given. These figures are lower than those reported from other countries. Corresponding prescribing errors of the physicians were 4 and 42% with the test and the old system, respectively. We conclude that the principles of the test system allow increased safety and accuracy in hospital drug handling. The recording of drug intake makes the evaluation of pharmacotherapy more reliable. A thorough system of drug handling can be used in the education of patients and students.
Iodine‐Induced Hypothyroidism and Its Effect on the Severity of Asthma
Authors: Korsager S. , Kristensen H. P. Østergaard
Published: August 2010

ABSTRACT. Among 1 107 patients with asthma or chronic asthmatic bronchitis and 96 with hypothyroidism we found 12 patients with both diseases. Seven of these patients had hypothyroidism induced by iodine‐containing expectorants. Five of 209 patients with hyperthyroidism had coexistent asthmatic lung disease, but none of these five had been taking iodine. The severity of asthma is considered in relation to changes in thyroid function following withdrawal of iodine. Three patients had an exacerbation of their asthma, while another three had no change in their asthma when the iodine treatment was discontinued and the euthyroid state subsequently restored. All six patients had a marked improvement of their general wellbeing when the euthyroid state was re‐established. It is concluded that treatment with iodine‐containing expectorants causing hypothyroidism is unwise and should be withdrawn even when the patients praise the beneficial effect of iodine on the asthma per se.
Phasic Voltage Alternation in Spontaneous Left‐Sided Pneumothorax
Authors: Hallengren Bengt
Published: August 2010

ABSTRACT. Marked phasic voltage alternation is described in a man with spontaneous left‐sided pneumothorax. This ECG change in association with pneumothorax has been described in only one patient previously.
Renal Transplantation in Amyloidosis
Authors: Kuhlbäck B. , Falck H. , Törnroth T. , Wallenius M. , Lindström B. L. , Pasternack A.
Published: August 2010

ABSTRACT. During a three‐year period renal transplantation was performed in 12 patients with amyloidosis. This disease was primary (or the cause unknown) in two cases and secondary in ten. In the latter cases the primary disease was rheumatoid arthritis in six, ankylosing spondylitis in one, osteomyelitis in two and tuberculosis in one. Five of the 12 patients were alive one year after transplantation. Two years after transplantation four out of seven were alive. Graft survival was the same. At the end of the three‐year period five patients were alive. In two of these cases renal biopsy showed amyloid deposits in the transplant two and three years, respectively, after the transplantation.
Haemolytic Anaemia in Alcohol Abuse
Authors: Wislöff F. , Boman D.
Published: August 2010

ABSTRACT. Clinical and haematological data on 14 patients (8 women and 6 men) with alcohol‐induced haemolytic anaemia and mild to moderate liver injury are presented. Nine of the patients were obvious drinkers, while 5 were socially well adjusted individuals in whom alcohol dependence was not suspected on admission to hospital. Four patients presented with a typical Zieve's syndrome. Two further patients had a moderate transient stomatocytosis, as assessed by microscopy of dried blood smears and by scanning electron microscopy. The majority of the patients, however, did not fit into any of the syndromes proposed in the literature. Indeed, the validity of both Zieve's syndrome and the “transient stomatocytosis with hemolysis” syndrome is questioned.
Ectopic Atrial Tachycardia on Swallowing
Authors: Landmark Knud , Storstein Ole
Published: August 2010

ABSTRACT. A female patient who suffered from atrial tachycardia associated with the ingestion of food or drink was examined in our department. No signs of organic heart disease were discovered, oesophageal motility was normal, but X‐ray revealed a small hiatal hernia. The arrhythmia started with an atrial extrasystole arising well outside the functional refractory period of the AV node, and it could be reproduced by inflation of a balloon. It is suggested that the arrhythmia is induced by a mechanical effect of the passage of food on the left atrial wall. Several drugs were tried in order to stop or relieve the complaints. None of them prevented or stopped the atrial tachycardia but verapamil and edrophonium chloride caused 2: 1 AV block, and follow‐up study has shown that sufficient doses of verapamil are able to relieve the patient's complaints.
Temperature Regulation in Anorexia Nervosa Patients during Prolonged Exercise
Authors: Davies C. T. M. , Fohlin L. , Thorén C.
Published: August 2010

ABSTRACT. The thermal responses to prolonged exercise on a stationary bicycle ergometer have been studied in 10 anorexia nervosa (AN) patients and 5 normal subjects. The patients were young (12–18 years) females (except for 1 case) and had less than 10% of their body weight as fat. The basic experiments were conducted in a moderate environment (24°C) at approximately 65% maximal aerobic power output on all patients and controls. In addition, 2 patients were studied in warm (32°C) conditions, 1 patient in cool (12°C) conditions and 2 patients after being heated for 30 min in a sauna at a temperature of approximately 50°C. Measurements included oxygen uptake, metabolic (M) and total heat production, evaporative sweat loss (E), rectal (Tre) and mean skin temperatures. The results showed that Tre (for a given M) was higher and E lower in the patients than the controls. Passively heating the anorexia patients before exercise increased resting Tre and E but did not affect the “plateau” value of Tre obtained at the end of work. In the warm environment, Tre rose to the same level as observed at 24°C but did not rise above the resting value in cool conditions. Thus it would appear that although patients with AN can regulate their body temperature adequately in a moderate environment, loss of body fat which reduces thermal insulation may decrease the range of ambient temperatures over which Tre can be maintained during exercise. Our data do not support the theory of a loss of central (hypothalamic) thermoregulatory control in anorexia.
Abnormal Gamma Globulin Binding of Thyroid Hormones
Authors: Jørgensen Preben Holme , Skovsted Lis , Jensen Kai Axel
Published: August 2010

ABSTRACT. Thyroid hormone levels were studied in a thyrotoxic patient, who was treated with propylthiouracil. He had heavily increased triiodothyronine concentrations, measured by radioimmunoassay, in spite of only mild clinical symptoms of thyrotoxicosis. A moderately increased serum triiodothyronine concentration was observed in another patient, who was euthyroid and who had recently recovered from subacute thyroiditis. By gel electrophoresis and precipitation tests with human anti‐IgG and anti‐IgA, a binding to the gamma globulins of both triiodothyronine and thyroxine was detected in patient 1, and of triiodothyronine in patient 2. Such abnormal binding may result in serious errors in the determination of thyroid hormone concentration by radioimmunoassay.
Heart and Kidney Involvement and Prognosis in Hypertension.
Authors: Hartford Marianne , Ljungman Susanne , Andersson Ove , Wikstrand John , Berglund Göran
Published: August 2010

ABSTRACT. Severity of hypertension, frequency of secondary hypertension and prognosis have been compared in two groups of hypertensive men. The first group (n=686) was taken from a blood pressure screening of a total population sample. The other group (n=154) consisted of hypertensive men, referred to a hypertension clinic by physicians. The mean age of the groups was the same, (X¯=52 years, range 46–59 years). All went through the same investigations and were followed up and treated in a similar way at the hypertension clinic. The referred men had more severe hypertension, as shown by significantly more heart and kidney involvements. They also had a higher incidence of myocardial infarction, implying a poorer prognosis with regard to cardiovascular disease. The analysis shows the importance of a detailed description of studied groups, not only in terms of blood pressure, age and sex, but also with respect to the frequency and degree of present and previous signs of heart and kidney involvement. With such a description it is possible to compare results from different studies regarding pathophysiological mechanisms and the effect of treatment in hypertension.
Serum Calcitonin in Patients with Chronic Renal Disease
Authors: Nielsen H. E. , Christensen C. K. , Olsen K. J.
Published: August 2010

ABSTRACT. The relationship between serum calcitonin, calcium–phosphorus metabolism and renal function was studied in 66 patients with chronic renal disease. Serum calcitonin was significantly elevated both in non‐dialysed patients and in patients on chronic hemodialysis. In the non‐dialysed patient group a highly significant inverse correlation was found between serum calcitonin and creatinine clearance. Between serum concentrations of calcitonin and phosphorus a significant positive correlation was found. In the dialysed patients a significant inverse correlation was found between serum calcium and serum calcitonin. It is concluded that the elevated serum calcitonin in patients with chronic renal disease might be explained by a reduced renal degradation of calcitonin and/or an increased production due to stimulation by serum phosphorus.
Iron Absorption and Iron Status in Patients with Chronic Uremia on Regular Peritoneal Dialysis
Authors: Milman Nils , Christensen Thomas , Bartels Ulla , Larsen Lars
Published: August 2010

ABSTRACT. Gastrointestinal iron absorption was measured by whole body counting in 18 patients on regular peritoneal dialysis. Ten patients received regular oral iron treatment prior to the study (iron treated group), 8 patients did not receive iron treatment (non‐iron treated group). Whole body retention 14 days after oral administration of 10 μCi 59Fe together with a carrier dose of 10 mg Fe2+ was used as an estimate of absorption. The erythrocyte iron incorporation, i.e. the percentage of administered 59Fe incorporated into the total erythrocyte mass, was measured. Geometric mean iron absorption in the non‐iron treated groups was 7.4±3.3 (S.D.) % and in the iron treated group 2.8±2.5% (p>0.01). Absorption in the non‐iron treated group did not differ significantly from the value in a normal control group (p<0.3). Absorption in the iron treated group was distinctly lower than in the controls (p>0.01), due to the high iron supplementation. Several patients in the non‐iron treated group had latent or overt iron deficiency, while patients in the iron treated group had satisfactory iron status. The correlation between iron absorption and erythrocyte iron incorporation was highly significant (r=0.95, p>0.001). Peritoneal dialysis patients on the whole have a normally functioning iron absorption. However, due to increased iron losses and insufficient dietary iron intake, the maintenance of a satisfactory iron balance implies an adequate oral iron supplementation.
Mortality, Arrhythmias and Pump Failure in Acute Myocardial Infarction in Relation to Estimated Infarct Size
Authors: Nordlander R. , Nyquist O.
Published: August 2010

ABSTRACT Serial estimations of total serum creatine kinase (S‐CK) were made in 194 consecutive patients with acute myocardial infarction (AMI). By itself, the maximum CK value could not separate patients in terms of high and low mortality but when the maximum CK value was related to age for patients with and without a history of previous AMI, two subgroups became apparent, one with 46% mortality (high‐risk group) and another with 6% (low‐risk group) during the hospital stay plus the next 90 days. In 114 of the patients, infarct size could be calculated. A good correlation was found between maximum CK and calculated infarct size (r = 0.93). Calculated infarct size alone could not distinguish between high and low mortality but when it was related to age for patients with and without a history of previous AMI, two subgroups emerged, one with 43% mortality and another with 3% during the hospital stay plus the next 90 days. The incidence of ventricular tachycardia during the stay in the Coronary Care Unit did not differ between the two risk groups separated either by maximum CK value or calculated infarct size. However, the incidence of shock and severe left heart failure during the acute phase was higher in the high‐risk groups.
Carditis Associated with Mycoplasma Pneumoniae Infection
Authors: Pönkä Antti
Published: August 2010

ABSTRACT Among 560 patients with serologically confirmed Mycoplasma pneumoniae infection, 25 (4.5%) had carditis (19 perimyocarditis, 6 pericarditis). During the acute phase 9 patients required intensive care. After an average of 16 months follow‐up 11 patients with no previous signs of heart disease still had cardiac symptoms or signs. Thus carditis associated with M. pneumoniae infection is a serious disease, having cardiac sequelae more often than has hitherto been supposed. The pathogenesis of the carditis associated with M. pneumoniae infection is discussed, including the possibility that in some cases the elevated titre in the complement fixation test is non‐specific. A summary is given of the 33 cases previously presented in the literature.
Comparison of Streptokinase with Heparin: Late Results in the Treatment of Deep Venous Thrombosis
Authors: Johansson Lilian , Nylander Göran , Hedner Ulla , Nilsson Inga Marie
Published: August 2010

ABSTRACT Nineteen cases were reinvestigated 8–14 years after treatment with SK or heparin. Judging from personal interviews, foot volumometry and phlebography, treatment with SK appears to be more preferable since it was less often followed by late severe postthrombotic changes.
Familial Occurrence of Intracranial Aneurysms
Authors: Stavenow Lars
Published: August 2010

ABSTRACT Intracranial aneurysms occurring in three families are reported. As a result of the discovery of splenic artery aneurysms in one of the family members the relation between intracranial aneurysms and aneurysms in other sites is discussed. It is put forward that aneurysms might be a part of a generalized connective tissue disease, and the relation between aneurysms and some connective tissue diseases is stressed. At present extensive angiographic investigations in family cases cannot be recommended in every family.
Procainamide‐Induced Lupus Erythematosus‐like Syndrome in Relation to Acetylator Phenotype and Plasma Levels of Procainamide
Authors: Sonnhag C. , Karlsson E. , Hed J.
Published: August 2010

ABSTRACTTo investigate the relationship between acetylator phenotype and the development of procainamide (PA)‐induced systemic lupus erythematosus (SLE‐like syndrome, 28 patients with chronic ventricular arrhythmias treated with PA were followed for one year. The therapy was guided by plasma monitoring in all patients in order to obtain the proposed therapeutic plasma level of PA. Nine patients (30%), both slow and rapid acetylators, developed the SLE‐like syndrome within one year. PA plasma levels were similar in both slow and rapid acetylators and there was no difference in total dose or duration of therapy before development of the syndrome. Thus, the acetylator phenotype is probably of no or minor predictive importance when PA therapy is guided by plasma monitoring. On the other hand, the antinuclear antibodies appeared significantly more rapidly in patients developing the syndrome and could possibly be used as an indicator of the risk. The results support the hypothesis that the primary amino group structure of PA may be of importance in the induction of the SLE‐like syndrome.
Dobutamine in Left Heart Failure after Acute Myocardial Infarction
Authors: Rehnqvist N. , Lundman T.
Published: August 2010

ABSTRACT Dobutamine, a new positive inotropic drug, was given as i.v. infusion at a rate of 2.5–7.5 μg/kg/min to nine male patients with a moderately severe left heart failure. The patients were treated in our CCU for acute myocardial infarction (AMI) and had PEP/LVET above 0.40 on routine registrations of systolic time intervals, PEP (preejection phase), PEPI (PEP corrected for heart rate), LVET (left ventricular ejection time) and LVETI (LVET corrected for heart rate). Dobutamine increased contractility, measured as shortening of PEP and PEPI, and also increased ejection fraction, measured as PEP/LVET. Concomitantly, heart rate increased significantly but no changes were noted in systolic or diastolic BPs. The positive inotropic effect of dobutamine was thus accompanied by a positive chronotropic effect, which limits the usefulness of the drug in patients with recent AMI.
Atenolol Administered once Daily in Primary Hypertension
Authors: Nilsson Ove R. , Karlberg Bengt E. , Ohlsson Ola , Thulin Thomas , Tolagen Kerstin
Published: August 2010

ABSTRACT The antihypertensive effect of the selective β‐1‐adrenoceptor blocking agent, atenolol, given in doses of 100 and 200 mg once daily, was evaluated in 37 patients with primary hypertension. The drug induced an efficient reduction of BP, and in the whole patient series there was no difference in BP on either dosage. Exercise tests, performed in 10 patients, showed the same degree of partial β‐blockade 24 hours after intake of 100 and 200 mg atenolol. PRA decreased during treatment with atenolol but there was no correlation between the stimulated pretreatment renin level and the antihypertensive effect of atenolol. Side‐effects were few and 35 out of 37 patients continued on atenolol treatment. Central nervous side‐effects were not seen.
The Effect of Sulfasalazine and Its Active Components on Human Polymorphonuclear Leukocyte Function in Relation to Ulcerative Colitis
Authors: Molin Lars , Stendahl Olle
Published: August 2010

ABSTRACT Sulfasalazine and its active components, 5‐aminosalicylic acid (5‐ASA) and sulfapyridine (SP), are potent modulators of inflammatory reactions but with somewhat different modes of action. Investigating the effect of these compounds on normal human polymorphonuclear leukocytes in vitro, we show inhibition of different stages in the phagocytic process, such as migration (sulfasalazine and SP), superoxide production (sulfasalazine and SP), myeloperoxidase‐mediated iodination and cytotoxicity (5‐ASA and SP). It is thus suggested that sulfasalazine is not just a vehicle for delivering its active components in the colon, but that its therapeutic effect in ulcerative colitis and other inflammatory reactions is a result of the concurrent action of the three compounds.
Non‐Invasive Methods in the Evaluation of Obliterative Disease of the Subclavian or Innominate Artery
Authors: Ekeström Stig , Eklund Brita , Liljeqvist Lars , Nordhus Otto
Published: August 2010

ABSTRACT The preoperative investigation of 25 patients referred for evaluation of subclavian artery obliteration is reported. Non‐invasive methods were used prior to angiography to assess arm circulation and the direction of blood flow in the vertebral artery. A retrograde flow in one vertebral artery was found in 18 patients, but only 7 had symptoms judged to be caused by the reversal of flow. In only one patient was the arm circulation so impaired as to justify the diagnosis of arm claudication. A high frequency of carotid lesions was found on the angiograms. The report demonstrates that in cases of suspected subclavian steal and/or arm claudication due to a subclavian artery obliteration, non‐invasive methods should be used to screen the patients before angiography. In many cases it will be found that symptoms cannot be attributed to steal or impairment of the arm circulation and therefore angiography is not indicated. However, in some cases signs of a coexistent carotid lesion may still necessitate angiography.
Adipose Tissue Cellularity—Metabolic Aspects
Authors: Noppa Henry , Bengtsson Calle , Isaksson Björn , Smith Ulf
Published: August 2010

ABSTRACT A representative population sample of middle‐aged women was studied in 1974–75. In a subsample, body composition and adipose tissue cellularity variables were determined and individuals with a particular clinical disorder were compared with the total subsample. Women with diabetes mellitus had more body fat and higher fat cell weights and larger fat cell numbers, whereas these variables did not differ in women with IHD or hypertension compared with the total subsample. Total body fat correlated with arterial BPs, fasting blood glucose, serum lipids and serum uric acid. The correlations were stronger than those reported previously by us between weight index and these variables. In univariate analyses, fat cell weight correlated with systolic BP, serum triglycerides and serum uric acid, and fat cell number with diastolic BP, fasting blood glucose and serum uric acid. In multivariate analyses, when due allowance was made for total body fat, the correlations between these variables and fat cell weight or fat cell number did not reach statistical significance.
On Acquired Hemophilia A
Authors: Nilsson Inga Marie , Lamme Stefan
Published: August 2010

ABSTRACT. Acquired hemophilia A due to antibodies of factor VIII procoagulant activity is rare. This paper reports 11 such patients followed up for long periods. They exemplify various forms of associated disorders. Four of them have died from hemorrhages, 4 have had complete remission and 3 are still alive with persistent inhibitors. The inhibitor activity was recovered in the immunoglobulin fraction in all the patients studied. Various forms of treatment were tried but remission related to therapy was seen in only one woman affected post partum. Spontaneous remissions are common and the aim of therapy must be to control acute severe hemorrhage.
Lymphocytopenia Preceding Chronic Lymphocytic Leukemia
Authors: Brandt L. , Nilsson P. G.
Published: August 2010

ABSTRACT. In 11 patients with an average peripheral blood lymphocyte count of 21.1times109/1 at the time of diagnosis of chronic lymphocytic leukemia (CLL), WBC and differential counts had been recorded on 1–26 occasions more than 5 years before the diagnosis. The median lymphocyte count in the preleukemic period was 1.3times 109/1, which is significantly lower than 2.4times 109/l found in a sex‐ and age‐matched control series. In 3 patients lymphocytopenia coexisted with normal levels of serum immunoglobulins in the preleukemic period. It is suggested that the preleukemic lymphocytopenia was mainly due to low numbers of T‐cells and that a deficiency in T‐lymphocytes may favour the development of the malignant, monoclonal B‐cell proliferation characteristic of CLL.
Hydralazine in Arterial Hypertension
Authors: Wulff Karl , Lenz Kristina , Krogsgaard Arne R. , Hoist Birgit
Published: August 2010

ABSTRACT.Blood pressure (BP) control and tol‐erability of three two‐week dosage regimens of hydralazine—conventional hydralazine q.i.d., conventional hydralazine b.i.d. and slow‐release hydralazine b.i.d.—were compared in a double‐blind, randomized, cross‐over trial in 20 out‐patients with arterial hypertension controlled with hydralazine in combination with other antihypertensive drugs. The efficacy of the treatments was assessed during the last two days of each treatment period by determination of BP and pulse rate every hour between 8 a.m. and 6 p.m. No statistically significant differences in BP and pulse rate were found between the three treatment regimens, either in the variation during the day or in the mean value for the day. There was a tendency to lowest BPs on conventional hydralazine q.i.d. and to highest on conventional hydralazine b.i.d. Mean differences in supine BP between conventional hydralazine b.i.d. and slow‐release hydralazine b.i.d. were 3.2 systolic and 0.5 mmHg diastolic. In this short‐term study, mean values with 95 % confidence limits indicate that conventional hydralazine in a q.i.d. dosage can be replaced by the same preparation or slow‐release formulation in a b.i.d. dosage. Acetylator phenotype was determined and had no significant influence on the results, although there was a tendency to more widespread variability in systolic pressure and to a lower pulse rate in fast acetylators. Unwanted effects were few and did not differ obviously between the treatments. Whether the frequency of late toxicity of hydralazine is lower with slow‐release formulation remains to be evaluated in long‐term studies.
QTC Intervals at Discharge after Acute Myocardial Infarction and Long‐Term Prognosis
Authors: Ahnve S. , Helmers C. , Lundman T.
Published: August 2010

ABSTRACT. QTC. intervals were measured retrospectively in 463 survivors of AMI with a mean age of 65 years. The measurement was made once at discharge from hospital. Patients with anterior infarcts had significantly longer QTc intervals than those with inferior or uncertain infact localization. A weak but significant correlation was found between S‐GOT maximum and QTc interval. Patients with ventricular arrhythmias in the CCU had longer QTc intervals. Patients with a poor long‐term prognosis had significantly shorter QTC intervals. This finding was explained by digitalis therapy. Among patients without bundle branch block, digitalis and quinidine, those below 66 years of age who died within the first six months tended to have longer QTc> intervals than the survivors. It is concluded that measurements of QTc interval at discharge have no long‐term predictive value. This factor may, however, have some bearing on the short‐term prognosis in younger patients without therapy which affects the QTC interval.
Ventricular Arrhythmias During Exercise Testing and 24‐Hour ECG Tape Recording in Patients with Ischaemic Heart Disease and in Normal Individuals
Authors: Møller M. , Thayssen P.
Published: August 2010

ABSTRACT. The occurrence of ventricular arrhythmias (VA) during resting ECG, maximal bicycle exercise testing and 24‐hour ECG tape recording (24‐ETR) was studied in 24 patients and 24 matched normal persons. The patients were on treatment with β‐receptor blocking agents or verapamil for ischaemic heart disease (IHD), verified by coronary angiography. The matched persons showed no signs of heart disease. VA did not occur in any of those studied on a 60‐second resting ECG. During exercise testing, one patient and six normal subjects had VA. During 24‐ETR, VA were found in 16 patients and 11 normal persons. The maximum heart rate during exercise and the average heart rate during ETR did not differ significantly between individuals with and without VA in the groups of patients and normal subjects, respectively. It is concluded that in IHD patients receiving β‐blocking agents or verapamil, 24‐ETR is a more reliable indicator of VA than exercise ECG testing. In normal individuals the two methods are of similar value.
Serum Reverse‐T3 Determinations in the Laboratory Diagnosis of Hyperthyroidism
Authors: Ljunggren Jan‐Gustaf , Kallner Gunnar
Published: August 2010

ABSTRACT. The relative discriminatory value of the estimation of the serum reverse‐T3 levels for the laboratory diagnosis of hyperthyroidism was investigated in 47 patients with clinical signs or symtoms of hyperthyroidism. The results were compared with those from the determination of the total serum levels of T3 and T4 prior and after correction for the bindig proteins. Twenty‐three of the patients had normal thyroid function and 24 had hyperthyroidism. The estimation of the total serum T3 level was superior to both the determination of the total serum T4 and reverse‐T3 levels even subsequent to correction for the binding proteins.
Report on a Patient with Watery Diarrhoea Syndrome Caused by a Pancreatic Tumour Containing Neurotensin, Enkephalin and Calcitonin
Authors: Gutniak M. , Rosenqvist U. , Grimelius L. , Lundberg J. M. , Hökfelt T. , Rokaeus å. , Rosell S. , Lundqvist G. , Fahrenkrug J. , Sundblad R. , Gutniak E.
Published: August 2010

ABSTRACT. A patient with watery diarrhoea syndrome (WDS) is described. A pancreatic tumour was found containing many cells with immunoreactivity to enkephalin and neurotensin, a few with immunoreactivity to calcitonin but none to vasoactive intestinal peptide (VIP). High levels of calcitonin, neurotensin, VIP and pancreatic polypeptide (PP) were present in plasma as measured by radioim‐munoassay. After removal of the tumour, the plasma levels of the first three peptides returned to normal and the WDS disappeared. On the other hand, plasma PP did not change. No specific symptoms could be attributed to the new spectrum of peptides found in the tumour. This is the first report of a pancreatic tumour containing high levels of neurotensin.
Demonstration and Partial Characterization of an Atypical Protein in the Urine of a Patient with Primary Amyloidosis
Authors: Wille Leif E. , Olsen Egil , Ferre øystein , Sletten Knut , Jentoft Hilmar
Published: August 2010

ABSTRACT. A paraprotein has been isolated from the urine of a patient with primary amyloidosis. Im‐munologically it was classified as a free λ light chain. The molecular weight was 22 500 daltons. N‐terminal amino acid analysis demonstrated homology with λ IV variable subgroup in 19 of the first 20 amino acids. Extensive homology with λ IV chains was demonstrated also in the hypervariable region of the light chain. An antiserum produced against the paraprotein was rendered idiotype‐specific by absorption with pooled human light chains. This antiserum stained tissue specimen from the rectum and liver of the patient by the indirect immunofluores‐cence technique. This strongly indicates that the free λ light chains that can be isolated from the urine are also deposited in the tissues as amyloid substance.
Enzyme Activities in Serum after Extensive Exercise, with Special Reference to Creatine Kinase MB
Authors: Schnohr Peter , Grande Peer , Christiansen Claus
Published: August 2010

ABSTRACT. It is well documented that elevations of serum enzymes used as criteria in establishing the diagnosis of acute myocardial infarction (AMI) often show a pattern of AMI after physical exercise without other clinical signs of myocardial damage. Since a clinical condition resembling AMI sometimes appears after strenuous physical exercise, this study was designed to show if the new, almost heart‐specific, isoenzyme creatine kinase MB (CK‐MB) would solve the diagnostic problems. Ten well trained volunteers took part in a 26 km jogging race. None of them had any cardiovascular symptoms, but the 'old' cardiac enzymes rose in some of them above the discriminatory levels, whereas CK‐MB was below these levels in all cases. It is concluded that CK‐MB determination is a valuable diagnostic tool, also in patients who have recently exercised extensively.
Coronary Ischaemia and Occlusion in Giant Cell (Temporal) Arteritis
Authors: Paulley J. W.
Published: August 2010

ABSTRACT. Reports of coronary artery involvement in giant cell (temporal) arteritis‐polymyalgia rheumatica (GC(T)A‐PMR) together with other large arteries arising from the aorta have been numerous over the past 40 years, but on this the specialist cardiac literature has been virtually silent. This article summarises that evidence, and records nine additional patients from a large group of cases with both GC(T)A‐PMR and ischaemic heart disease (IHD) observed since a previous report in 1960. The case histories illustrate the benefit from corticoste‐roids and the hazards of non‐diagnosis and premature cessation of such treatment. It seems that many patients with arteritic IHD (and claudication) are not being identified before or after death. Possible reasons for this oversight by clinicians and pathologists are offered, and suggestions are made with regard to points in history‐taking and important physical signs which may help to alert the clinician. There is autopsy evidence from Malmö, Sweden, that the prevalence of GC(T)A‐PMR is much higher than at present suspected on clinical grounds.
Elevated Bone Phosphorus/Hydroxyproline Ratio Following Jejunoileal Bypass Surgery
Authors: Hey H. , Tougaard L.
Published: August 2010

ABSTRACT.The degree of bone mineralization, estimated as the bone phosphorus/hydroxyproline ratio (P/Hypro), was studied in 33 patients who had undergone jejunoileal bypass surgery for massive obesity. Low values of bone P/Hypro are expected in osteomalacia. We found an elevated mean bone P/ Hypro (p<0.001) with the highest values in patients with the longest postoperative periods (rs=0.65,p<0.001). The study indicates that bypass surgery, in spite of vitamin D deficiency, is associated with an increased average degree of bone mineralization or a defect in bone collagen synthesis.
The Diagnosis of Atrial Myxomas
Authors: Schlossman D. , Selin K. , Wallin J. , Wallentin I.
Published: August 2010

ABSTRACT. Altogether seven patients with the preoperative diagnosis of atrial myxoma were admitted to our hospital in 1968–78 and referred for surgery. In two patients no tumour was found at operation. In one of them the reason for the misinterpretation was severely malformed mitral leaflets. In the other the contrast medium was injected into a pulmonary vein, which caused a contrast defect due to inadequate mixing.

Acta Med Scand 208: 349, 1980.
Hypoglycemia in Alzheimer's Disease
Authors: Adolfsson Rolf , Bucht Gösta , Lithner Folke , Winblad Bengt
Published: August 2010

ABSTRACT. Glucose tolerance tests (GTT) were performed on patients with a) dementia of Alzheimer type, b) distal gangrene, c) cerebrovascular disease, and d) on non‐diabetic controls. Fasting blood sugar was significantly lower and the areas under the GTT curves were significantly smaller in the dementia group than in the other three groups. It is discussed whether Alzheimer's disease is a generalized disease not only confined to brain tissue and whether the reduced blood glucose levels could impair the brain transmitter levels.
Circulating Protein Complexes in D‐Penicillamine Therapy of Rheumatoid Arthritis
Authors: Norberg Renée , Wollheim Frank A. , Gedda Per O.
Published: August 2010

ABSTRACT. Eighteen of 24 patients with rheumatoid arthritis showed intermediate IgG‐con‐taining complexes on preparative ultracentrifugation before treatment with D‐penicillamine. Serial analyses of these showed strikingly close correlation in reduction of IgG as well as α1‐antitrypsin‐IgA complexes. Three patients did not respond to treatment clinically, and retained both types of complexes. Complexes virtually disappeared in all responders. Only small changes were found in total IgG or IgM levels and the reduction of IgA levels was moderate, except for one case who developed IgA deficiency. The importance of further analysis of non‐responders is stressed.
Spontaneous Reversion from Long‐Lasting Atrial Fibrillation to Sinus Rhythm
Authors: Olsson S. Bertil , Örndahl Gustaf , Eneström Sverker , Eskilsson Jan , Persson Stig , Grennert Marie‐Louise , Johansson Bengt W.
Published: August 2010

ABSTRACT. We have collected 23 cases with atrial fibrillation (AF) of 3–29 years' duration with spontaneous reversion to sinus rhythm (SR). We have also identified 22 similar cases in the literature. Several of our patients spent several years with different atrial arrhythmias before a stable SR was established. Of all the 45 cases, 39 had significant rheumatic mitral valve disease. In the majority of these patients the ECG shows first degree AV block after return to SR and a low‐amplitude P‐wave—as if the left atrial P component was lacking. There are no signs of left atrial mechanical activity after re‐establishment of SR in our mitral valve disease group, as judged from phonocardiograms, apexcardiograms, echocardiograms and left atrial pressure recordings in selected patients. Heart muscle biopsy was obtained from two patients who underwent mitral valve surgery. Left atrial specimens showed almost complete lack of all muscle structures. There is thus electrical, mechanical and histological evidence of left atrial muscle deterioration. It is likely that the electrophysiological factors responsible for initiation and maintenance of AF have disappeared with this deterioration, thereby allowing SR to be re‐established. The return of SR might indicate a progress of the heart disease although the patient may benefit from normalization of cardiac rate and regularity. The easy identification of our 23 patients makes us believe that the phenomenon of appearance of late SR is far more common than suggested up to now.
Influenza Al Myocarditis in Conscripts
Authors: Karjalainen Jouko , Nieminen Markku S. , Heikkilä Juhani
Published: August 2010

ABSTRACT. The incidence of viral myocarditis was studied prospectively at the Central Military Hospital 1 in Finland in connection with an A1 virus influenza epidemic in Jan. 1978. Of 104 conscripts taken consecutively to hospital because of a sudden respiratory infection, 41 had serologically confirmed influenza A, 37 were serologically negative, while in 26 it was not possible to carry out complete virological analyses. Six of the serologically confirmed influenza patients had acute myocarditis on the basis of serial electrocardiographic ST segment and/or T wave changes, unresponsive to β‐blockade. The incidence of the influenza A myocarditis was thus 9% of the 67 verified and suspected cases of influenza taken together. Multidirectional echocardiography revealed regional myocardial dysfunction in all the influenza patients with myocarditis; the MB‐CK isoenzyme was elevated in 3 of them. The ECG changes found in connection with influenza thus commonly indicate the presence of myocardial involvement, usually a mild one.
Penicillamine Treatment in Rheumatoid Arthritis
Authors: Börjesson Olof , Knutsson Lars‐Peter , Svensson Björn
Published: August 2010

ABSTRACT. Out of 64 patients with rheumatoid arthritis (RA), 42 were treated with D‐penicillamine (D‐Pa) for more than 6 months and 22 for less than 6 months. The latter patients were excluded from the evaluation of the effect. The former patients were treated with doses of 600–1250 mg daily for 6–41 months (mean 16.8). The clinical effect was retrospectively assessed as favourable in 24 patients, 12 did not respond and the effect could not be assessed in 6. The clinical assessment was supported by significant reductions of ESR and orosomucoid. Adverse reactions, although rarely serious, led to withdrawal of the drug in 25 (39%) of the 64 patients. It is concluded that D‐Pa is a valuable drug in the treatment of severe RA.
Effect of an H2‐Receptor Blocking Agent on Diarrhoeas after Extensive Small Bowel Resection in Crohn's Disease
Authors: Aly Andreas , Bárány Franz , Kollberg Bo , Monsén Ulla , Wisén Olof , Johansson Catja
Published: August 2010

ABSTRACT. The effect of an H2‐receptor blocking agent, cimetidine, on faecal losses of fluid, electrolytes and fat was examined in 10 patients with Crohn's disease, who had diarrhoeas after extensive small bowel resection. A randomized, double‐blind and cross‐over design was applied, and patients were hospitalized and on a defined diet during the study. Cimetidine, 4X400 mg, significantly reduced diarrhoeal volumes by an average of 22% (p&0.05) and faecal sodium by 27% (p&0.05). Patients with severe diarrhoeas responded better to treatment. No side‐effects were recorded. The reported data suggest that cimetidine may be useful in symptomatic treatment of patients with severe diarrhoeas after extensive ileal resection. Due to deficient drug absorption, higher doses may be needed for optimal effect.
Diet, Lipids and Atherosclerosis
Authors: Malmros Haqvin
Published: August 2010

ABSTRACT.During the Second World War there was a temporary reduction in the frequency of myocardial infarction in Finland, Norway and Sweden. This was probably due to the reduced consumption of saturated fat. The total amount of dietary fat and cholesterol presumably played only a minor role. Today it is easier to obtain reliable mortality figures and information about the fat composition of the food in a given country. A compilation of such data has shown that mortality from myocardial infarction is higher in countries with a high consumption of saturated fat. Polyunsaturated fats seem to have an opposite effect. There is no reason to dissuade people from using fat‐modified food products with a lower fat content and replacement of part of the saturated fat by polyunsaturated. Refugees from countries where the diet contains very little fat should be warned against using too much of the high‐fat food products widely consumed in their new countries.
Pregnancy in Patients with Renal Disease
Authors: Klockars Matti , Saarikoski Seppo , Ikonen Ensio , Kuhlbäck Börje
Published: August 2010

ABSTRACT. The outcome of pregnancy for both mother and child was studied in 30 patients with renal disease. Glomerulonephritis had been verified by biopsy before pregnancy in 20 patients, three had severe chronic pyelonephritis, two polycystic renal disease and five had undergone a renal transplantation. Morphological or clinical preconception predictors of a riskful pregnancy were hypertension and renal functional impairment and, in the patients with glomerulonephritis, a biopsy finding known to indicate a poor or guarded prognosis in the non‐pregnant state or as judged from the patient's poor response to corticosteroid therapy. However, none of the patients with glomerulonephritis, pyelonephritis or polycystic renal disease who had conceived while their renal function was normal showed any evidence, during pregnancy, of a deterioration of this function. Among 29 pregnancies in the 20 patients with a history of glomerulonephritis, 5 foetuses were lost. No abortions occurred in the other patient groups. Six children were born to the five patients with a renal transplant. All these patients received immunosuppressive therapy during pregnancy. No newborn was malformed. In one patient with hypertension and renal insufficiency at the start of pregnancy, a progressive renal insufficiency developed and haemodialysis was started after delivery. In most instances, the counseling of women with pre‐existing renal disease who want to have children can be guardedly optimistic.
Treatment of Osteoporosis with 1‐Alpha‐Hydroxycholecalciferol and Calcium
Authors: Hoikka Veijo , Alhava Esko M. , Aro Antti , Karjalainen Paavo , Rehnberg Veikko
Published: August 2010

ABSTRACT. A double‐blind comparative study of 1α‐OHD3 and placebo was performed on 37 patients with osteoporotic hip fracture without clinical osteomalacia. 1α‐OHD3, in a dose of 1 μg/day together with 2.5 g CaCO3 did not heal osteoporosis as judged from determinations of bone mineral density and histomorphometric analyses during four months of treatment. However, 1α‐OHD3 seemed to have an effect on fracture healing as concluded from the posttreatment alkaline phosphatase level. Hypercalcemia was common, occurring in six out of 19 patients treated with 1α‐OHD3. It is concluded that treatment of osteoporosis with 1α‐OHD3 and calcium is ineffective and potentially dangerous because it frequently causes hypercalcemia.
Body Fluid Volumes and the Response of Renin and Aldosterone to Short‐ and Long‐Term Thiazide Therapy of Essential Hypertension
Authors: van Brummelen P. , Schalekamp M. A. D. H.
Published: August 2010

ABSTRACT. Plasma volume (PV), extracellular fluid volume (ECV) serum electrolytes, renin and aldosterone were measured before and after 1 week and 4 months of hydrochlorothiazide (HCT) treatment, 50 mg twice daily, in nine male patients with uncomplicated essential hypertension. All studies were carried out under strictly standardized conditions in a metabolic ward. After 1 week of HCT treatment, significant reductions were found in PV and ECV, but after 4 months only ECV was significantly reduced. During HCT therapy, renin and aldosterone were permanently elevated whereas serum sodium and potassium were lowered. After 1 week, renin was inversely correlated with PV and ECV and directly correlated with heart rate. After 4 months, renin was inversely correlated with serum sodium. These results indicate a permanent decrease in ECV during long‐term HCT therapy. It is further suggested that the mechanisms responsible for the renin response during short‐ and long‐term HCT treatment are different, changes in body fluid volumes and increased neural activity being responsible for the initial rise in renin, and serum sodium being the predominant factor during chronic treatment.
No Effect of Cimetidine on Calcitonin Secretion from Medullary Thyroid Carcinoma
Authors: Emmertsen K. , Nielsen H. E. , Mosekilde L. , Hansen H. Hvid
Published: August 2010

ABSTRACT. The effect of cimetidine on basal and pentagastrin‐stimulated serum immunoreactive calcitonin (S‐iCT) concentrations was studied in six patients with medullary carcinoma of the thyroid (MCT). Basal S‐iCT was elevated in all patients and showed a marked increase after i. v. injection of pentagastrin, 0.5 μg/kg b. wt. Cimetidine, 200 mg i. v., 30 min before administration of pentagastrin had no effect on either basal or pentagastrin‐stimulated S‐iCT. Thus, the mechanisms of basal and pentagastrin‐stimulated calcitonin secretion from MCT do not seem to involve agonism with histamine H2‐receptors.
Morphological Variants of Acute Myocardial Necrosis and their Relationship to Coronary Artery Thrombosis
Authors: Woolf N. , Davies M. J.
Published: August 2010

ABSTRACT. This communication describes the two chief morphological variants of acute myocardial necrosis and discusses the pathophysiological mechanisms underlying them. The frequency of occlusive thrombosis in anatomically related coronary arteries in acute regional infarction is stressed.