bluuebunny/crossref_metadata_2025 huggingface dataset:
A Stroke Unit in a Medical Department
Authors: von Arbin M. , Britton M. , de Faire U. , Helmers C. , Miah K. , Murray V. , Wester P. O.
Published: August 2010

ABSTRACT. A non‐intensive stroke unit of 10 beds has been started in the Medical Department, Serafimerlasarettet, Stockholm. The aim is to make diagnostic and therapeutic studies in unselected stroke patients. Patients with suspect cerebrovascular disease in the Casualty Department are admitted to the unit non‐selectively and without any age limit. Relevant physical findings and laboratory data are followed and registered by code on special charts to make evaluation by computer possible. A preplanned investigative programme is adhered to. Strict criteria for diagnosis and treatment are followed. The experience and results from the first 100 patients treated in the Stroke Unit indicate that the unit is a good basis for both education and research.
Influence of High Plasma Concentrations of Free Fatty Acids on Heart Rhythm in Healthy Fasting Men
Authors: Wang Harald , Rasmussen Knut , Vik‐Mo Harald , Mjøs Ole D. , Grendahl Helge
Published: August 2010

ABSTRACT. Ten healthy male students in regular sinus rhythm fasted for 66 hours. Their overnight fasting plasma concentration of free fatty acids (FFA) was 455±104 μmol/l (mean ± S.E.M., n=7), the reference value of our laboratory, measured in another normal population of young men, being 344±28 μmol/l (n = 10). After 42 and 66 hours of fasting, the plasma concentration of FFA rose to 1198±181 (p>0.01, n=10) and 1471±89 μmol/l (p>0.001, n = 10), respectively. During the last 24 hours of fasting, the heart rhythm was monitored continuously by means of a Holter recorder and computer. No arrhythmias were observed, indicating that elevated plasma concentrations of FFA, exceeding those reported in patients with acute myocardial infarction, are well tolerated by the healthy human myocardium.
Serum Ethanol, Hepatic Enzymes and Length of Debauch in Chronic Alcoholics
Authors: Wadstein J. , Skude G.
Published: August 2010

ABSTRACT. The serum concentration of ethanol and the activities of aspartate aminotransferase, alanine aminotransferase and γ‐glutamyltransferase (GT) in 40 male chronic alcoholics were determined on admission to hospital. The serum activities of the enzymes were highest in patients with established alcoholism for less than 5 years. The serum concentration of ethanol, however, was lowest among these patients and gradually increased with the duration of alcoholism. No correlation was found between the serum ethanol level and the activity of any of the enzymes. The duration of the current debauch, which was shortest in cases of long‐standing alcoholism, showed a positive correlation with the S‐GT activity.
Mycoplasma Pneumoniae Infection Associated with Affection of the Central Nervous System
Authors: Lind Klaus , Zoffmann Henrik , Larsen Severin Olesen , Jessen Ove
Published: August 2010

ABSTRACT. A total of 371 patients with acute, febrile, non‐bacterial affection of the CNS hospitalized between Nov. 1, 1971, and June 1, 1976, were examined for Mycoplasma (M.) pneumoniae infection. Nineteen of the patients showed evidence of a current M. pneumoniae infection, 32 of a previous infection, and 320 no evidence. In patients with a current infection due to M. pneumoniae, suggestive evidence is presented that this agent might be involved in the pathogenesis of the neurological syndromes. Compared to cases without the infection, these cases and, to a lesser degree, those with a previous M. pneumoniae infection showed an increased frequency of pathological values, found by various laboratory and instrumental parameters, and a slightly higher frequency of neurological sequelae. Respiratory illness was present in only 11 of the 19 patients infected with M. pneumoniae, a classical respiratory tract pathogen. The overall incidence of current M. pneumoniae infections among patients with neurological syndromes was 5%, with a maximum of 10% during the 1972 epidemic. This is a much higher figure than expected from a mere coincidence of the two conditions.
The Evolution of Asymptomatic Monoclonal Gammopathies.
Authors: Fine J. M. , Lambin P. , Muller J. Y.
Published: August 2010

ABSTRACT. Twenty cases of “asymptomatic” monoclonal gammopathies were detected by routine electrophoresis in patient's sera or in blood donors and were followed over 3–14 years. Four cases have shown a malignant evolution—two evolved toward Waldenström's macroglobulinemia after 3 years and two could be classified as myeloma 3 and 7 years, respectively, after detection of the monoclonal protein. The remaining cases were still “asymptomatic” 4 years later (7 cases), 7–9 years later (8 cases) and 14 years later (1 case). A malignant evolution occurred in approximately 20% of cases.
A Patient with Cronkhite‐Canada Syndrome, Myxedema and Muscle Atrophy
Authors: Størset Ø. , Todnem K. , Waldum H. L. , Burhol P. G. , Kearney M. S.
Published: August 2010

ABSTRACT. A case of Cronkhite‐Canada syndrome is presented. The patient had alopecia, onychodystrophy and gastrointestinal polyposis, mainly in the stomach and duodenum, with transient diarrhea and hypoproteinemia. Marked atrophy and weakness of the shoulder girdle muscles due to myopathy were also present. In addition she had primary hypothyroidism. The outcome of the disease is usually fatal within months, but so far our patient is alive four years after the onset of symptoms. The pathological changes, pathophysiology, symptoms, course and treatment of this rare disorder of unknown etiology are discussed.
Reversibility of Cardiovascular Changes in Extreme Obesity.
Authors: Backman L. , Freyschuss U. , Hallberg D. , Melcher A.
Published: August 2010

ABSTRACT. The effects of marked weight reduction on cardiovascular function in extreme obesity were studied before and on average 2 years after jejunoileostomy. In 17 female and 5 male patients, mean age 36 years, with obesity as the sole diagnosis, circulatory data were obtained at rest and during exercise through right heart catheterization. Blood volume and heart volume were measured and ECG was recorded at rest and during exercise. A mean weight loss of 58.1 kg reduced percentage overweight from 104 to 39%. Resting oxygen consumption and cardiac output fell in proportion to weight loss. A slightly hyperkinetic central circulation was observed during exercise. Stroke volume fell parallel to the decrease in blood volume and heart volume. Systemic arterial pressure declined, while systemic arterial resistance did not change. Left ventricular stroke work diminished. Although lower than preoperatively, the filling pressures of the right and left side of the heart were high in relation to cardiac output compared with healthy subjects. ECG at rest and during exercise remained normal. Thus, despite reductions in heart size and left ventricular stroke work, evidence of left ventricular dysfunction persisted. The observations indicate that the circulatory effects of gross obesity are largely reversible over weight loss periods of up to 3.5 years, apart from signs of a reduced myocardial wall compliance. The clinical implication seems to be that therapeutic weight‐reducing intervention should be made at a younger age.
Corticosteroids and Thyroid Function
Authors: Gamstedt Anders , Järnerot Gunnar , Kågedal Bertil , Söderholm Bror
Published: August 2010

ABSTRACT. The influence of glucocorticosteroids on plasma volume, thyroid hormones and thyroid hormone‐binding proteins was studied in 17 patients. Plasma volume was not affected either by i.v. betamethasone (6 mg daily) or by oral prednisolone (45–180 mg daily) given for 5 days. The serum T3 concentration decreased while rT3 increased independently of the route of administration of corticosteroids. Serum T4 concentration decreased after i.v. but not after oral administration of corticosteroids. Oral steroids as compared to i.v. increased the 125I‐triiodothyronine uptake test value. The serum TBG concentration decreased independently of the route of administration, while the serum TBPA concentration increased after oral corticosteroids but was unchanged after i.v. treatment. The serum TSH concentration was slightly reduced. About half of the patients were given both corticosteroids and nutrition i.v. and the other half were given all treatment by mouth. The part played by the route of administration of corticosteroids and calories, respectively, cannot be evaluated at present but these factors seem to be of importance.
Sarcoidosis Presenting with Diabetes Insipidus Followed by Acute Cranial Nerve Syndrome
Authors: Bruning Peter F. , Koster Hans G. , Hekster Ruben E. M. , Luyendijk Willem
Published: August 2010

ABSTRACT. Diabetes insipidus in a previously healthy 16‐year‐old girl led to surgical exploration of a pituitary stalk intumescence detected by oxygen cisternography with the use of tomography. Biopsy of the pituitary stalk contained chronically inflamed brain tissue. Subsequent liver and bone biopsies showed characteristic granulomata, confirming the diagnosis of sarcoidosis. Subfrontal craniotomy was followed by a rapidly progressive basal meningoencephalitis with multiple cranial nerve involvement. The need to establish a causal diagnosis in diabetes insipidus is stressed. The rarity of the disorder and the presumed role of subfrontal craniotomy with regard to the flare‐up of the sarcoidosis of the brain are discussed.
Severe Asthmatic Reaction During Long‐Term Treatment with Disodium Cromoglycate Powder Inhalations
Authors: Serup Jørgen
Published: August 2010

ABSTRACT. Inhalation of inert particles may in susceptible subjects with bronchial asthma result in reflex bronchoconstriction mediated through the vagal nerves. A case of severe asthmatic reaction with bronchial spasm in a 60‐year‐old man with intrinsic asthma after inhalation of disodium cromoglycate powder (Lomudal®) during long‐term treatment is reported. The mechanism is considered to be reflexogenic. Because of the variability in individual susceptibility during long‐term treatment, inhalation therapy should always be given with close attention to asthmatic exacerbations.
Hyperthermia and Rhabdomyolysis in Self‐Poisoning with Paracetamol and Salicylates
Authors: Skjøtø John , Reikvam Aasmund
Published: August 2010

ABSTRACT. A young woman ingested large amounts of different analgesics, mainly salicylate and paracetamol. On admission about 17 hours later, clearly toxic serum levels of both drugs were demonstrated. She was comatose with respiratory failure for 5 days. During the first day there was a period of several hours of therapy‐resistant hyperthermia. A severe bleeding tendency was probably related to profound coagulation defects. Persistingly elevated serum levels of ASAT and ALAT for two weeks were presumably caused by a toxic effect of paracetamol on the liver. When consciousness was regained, widespread pareses of skeletal muscles, predominantly of the lower limbs, were demonstrated. These were related to extensive rhabdomyolysis as evidenced by extremely elevated serum levels of CPK for 6 weeks, and by muscle necrosis in biopsy specimens. There was a gradual improvement, but walking disturbances were still present after one year. The hyperthermia was probably related to the cerebral effects of salicylates or the combination of multiple drugs. The rhabdomyolysis might be related to a deleterious effect of hyperthermia on the muscles or to an effect of paracetamol on the skeletal muscles similar to that which might occur in the myocardium, or to a combination of these mechanisms.
Mortality and Morbidity during 13.5 Years' Follow‐up in Relation to Blood Pressure
Authors: Svärdsudd Kurt , Tibblin Gösta
Published: August 2010

ABSTRACT. A total of 973 50‐year‐old men, randomly selected from the general population in Göteborg, Sweden, were invited to a survey in 1963. Altogether 855 men (88%) participated. They have been followed up for 13.5 years, and this report presents mortality and morbidity during this time in relation to BP at the time of the initial examination. BP was strongly associated with mortality regardless of its cause. This was due to a close relation of BP to mortality from ischaemic heart disease and a weak but significant relation to mortality from cancer. BP was also strongly related to morbidity from myocardial infarction, stroke and angina pectoris, showed a tendency towards relation to morbidity from intermittent claudication and kidney stone, and was negatively related to morbidity from neoplasm for survivors. BP was also related to pension but not to sick leave. There is no indication of a decreasing importance of BP as a risk factor in this age period.
Left Atrial Myxoma Moving from Right Atrium to Left Ventricle.
Authors: Hamer J. P. M. , Nieveen J. , Bergstra A. , Blickman J. R. , van der Heide J. N. Homan
Published: August 2010

ABSTRACT. A case of left atrial myxoma, prolapsing through a large atrial septal defect during systole and through the mitral valve orifice during diastole, is presented. To our knowledge this is the third such case and only the second one in which the diagnosis was made before operation. Echocardiography and phonocardiography were of great value in establishing the diagnosis of left atrial myoxoma; the features before and after operation are presented. In this patient the “swinging” of the tumor in the left atrium and in the left ventricle was echocardiographically visible. Correlations of tumor movement and heart sounds could be made. The diagnosis of a 36% left‐to‐right shunt on atrial level could not be made with the help of non‐invasive techniques alone; cardiac catheterization revealed the shunt. The role of non‐invasive techniques and of cardiac catheterization is discussed, together with a review of the relevant literature.
Mortality from Chronic Interstitial Nephritis and Phenacetin Consumption in Denmark
Authors: Mabeck Carl Erik , Wichmann Birthe
Published: August 2010

ABSTRACT. After 1950, a pronounced increase in the mortality from chronic interstitial nephritis among women was registered in Denmark. This was suspected to be caused by a contemporary increase in the consumption of drugs containing phenacetin. Restrictions were therefore imposed on the sale of such drugs in 1961 and consumption decreased sharply. This report, based upon death certificates from 1941–76, shows that the mortality rate from chronic interstitial nephritis has decreased gradually among women in Denmark since 1960, and has now reached the same level in younger women as in the 1940's.
Serum Ferritin During Infection.
Authors: Birgegård Gunnar , Hällgren Roger , Killander Andreas , Venge Per , Wide Leif
Published: August 2010

ABSTRACT. In order to follow the dynamics in the reaction of iron kinetic variables to acute infection, 8 renal transplantation patients were followed with test samples every second or third day for about two months. It was found that they just as previously shown in otherwise healthy subjects, responded to acute infection with a rise in serum ferritin levels, sometimes to very high values. In most cases the ferritin elevation started within two days after the onset of fever. The peak was reached within a week, except when very high values were obtained. The fall in serum ferritin after recovery from infection was much faster than in previously investigated groups of patients: the plasma half disappearance time for ferritin in one case was but 1.5 days. Transferrin did not change in response to infection. The expected fall in serum iron during infection was often absent and sometimes obscured by unexpected, sharp peaks in serum iron, which bore a temporal relationship to episodes of transplant rejection in 7 of 12 cases.
Relationship Between Biochemical and Clinical Features in an English Anderson‐Fabry Family
Authors: Hamers M. N. , Wise D. , Ejiofor A. , Strijland A. , Robinson D. , Tager J. M.
Published: August 2010

ABSTRACT The relationship between biochemical parameters and clinical symptoms in angiokeratoma corporis diffusum universale (Anderson‐Fabry's disease) has been studied in an extensive English family. The biochemical parameters measured were α‐galactosidase activity in urine and in single hair roots and the urinary glycosphingolipid excretion per 24 h. The clinical symptoms evaluated included the occurrence of pain, the prevalence of skin lesions, an abnormal ECG, cornea verticillata and other features. Nine male patients and 13 female carriers were studied. No correlation between biochemical parameters and the severity of the clinical symptoms could be found either in the hemizygotes or in the heterozygotes. The urinary α‐galactosidase activity in all the heterozygotes lay within the normal range. All the obligate heterozygotes (mothers and daughters of hemizygotes) could be detected by analysis of hair roots. Additional heterozygotes were recognized on the basis of clinical symptoms and hair root analysis.
Angiotensin‐Converting Enzyme in Sarcoidosis
Authors: Rømer Frode K.
Published: August 2010

ABSTRACT Using a spectrophotometric assay with l‐hippuryl‐l‐histidyl‐l‐leucine as substrate, s‐angio‐tensin‐converting enzyme (SACE) was determined in 85 sarcoidosis patients, 116 healthy controls and 150 patients with various non‐sarcoid diseases. The controls showed no sex or age variation and had SACE levels of 24.4±6.2 U/ml (mean ± 1 S.D.), giving a normal range (mean ± 2 S.D.) of 12.0–36.8 U/ml. In contrast, the sarcoidosis patients had SACE values of 38.4 ± 14.4 U/ml, with the highest values in cases with active sarcoidosis and duration of disease longer than two years (49.0±12.7 U/ml). A total of 41% of the sarcoidosis patients had elevated SACE, in the chronic active group 85%. Patients with renal failure, Hodgkin's disease and other malignant lymphoma had low SACE, whereas patients with lung cancer and tuberculosis had normal SACE values. Among 266 patients with non‐sarcoid diseases and healthy controls, only two had slightly elevated SACE, but so far we have not found SACE above 40 U/ml in other than sarcoidosis patients. An elevated SACE is rather specific in sarcoidosis and seems to be a useful supplement to existing diagnostic measures.
The Expression of a Human B‐Lymphocyte Antigen and Surface Membrane Immunoglobulin by Lymphoid cells from Patients with Lymphocytic Lymphoma, Multiple Myeloma and Benign Monoclonal Gammapathy
Authors: Turesson Ingemar , Berntorp Erik , Zettervall Olle
Published: August 2010

ABSTRACT Lymphoid cells from patients with lymphocytic lymphoma, multiple myeloma or benign monoclonal gammapathy (BMG) were examined by direct immunofluorescence for the expression of surface membrane immunoglobulin (sIg) and B‐cell antigen defined by a rabbit antiserum against chronic lymphocytic leukaemia lymphocytes. This antiserum has been shown to detect a B‐cell antigen different from Ia‐like antigen. In well differentiated lymphocytic lymphoma, the cells carried the B‐cell antigen as well as one class of heavy and light Ig chain. A circulating monoclonal lymphocyte population was regularly found in the blood although the lymphocyte number was not increased. In multiple myeloma the number of circulating cells carrying mu chains was small, the depression being most pronounced in patients who had been treated with cytostatics. A monoclonal population of lymphocytes expressing the Ig isotype(s) of the M‐component was found in the blood in 6/15 cases and more often in patients with advanced disease. The number of cells with B‐cell antigen agreed fairly well with the number of Ig‐positive cells, indicating that the B‐cell antigen was expressed on normal as well as myeloma‐related lymphocytes. A dissociation of the expression of the antigens was however observed in two cases (one lymphocytic lymphoma, one myeloma) with a large number of cells with B‐cell antigen but a small number of cells with sIg. The B‐cell antigen was usually not detected on the surface membrane of Ig‐containing plasma cells from patients without monoclonal gammapathy or from the majority of patients with BMG but on a varying proportion of myeloma cells. The tentative conclusion is drawn that the B‐cell antigen is a differentiation antigen, which is gradually lost during B‐lymphocyte differentiation but is retained to some extent on myeloma cells as an expression of a lower degree of maturity.
Emergency Room Resuscitation of Patients with Cardiac Arrest outside Hospital
Authors: Erhardt Leif R. , Sederholm Magnus , Gertz Ingrid
Published: August 2010

ABSTRACT Resuscitation was attempted in 319 patients brought to hospital with cardiac arrest during a 5‐year period. Primary successful results were achieved in 50 patients (15.7%). Twelve patients were long‐term survivors (3.4%), 10 of whom had normal brain function, whereas 2 had mild cerebral dysfunction. To improve prognostication in patients with initially successful resuscitation, Bayes' theorem was applied using 4 clinical findings after 24 hours' treatment: reactions to painful stimuli, pupillary size, light reactions and BP. Bayes' theorem as well as coma depth after 24 hours gave valuable information regarding individual prognosis.
The Q‐T Syndrome—A Family Description
Authors: Andersson P. , Lundkvist L.
Published: August 2010

ABSTRACT This paper describes a family of nine siblings of whom five suffer from the surdocardiac syndrome. All five are deaf‐mute and have medical histories typical of the syndrome, with frequent syncopal attacks during the childhood, often caused by stress. Two of these five siblings have not suffered more than single attacks since puberty and are still alive. The other three had had continuous frequent attacks into adult years and died in connection with syncopes at 20, 27 and 37 years of age. The diagnosis, pathogenesis, treatment and genetics of the syndrome are discussed.
Blood Pressure in 60‐Year‐Old Men
Authors: Waern U. , åberg H.
Published: August 2010

ABSTRACT A population survey of 60‐year‐old men (n=331) was performed in Uppsala. The prevalence of hypertension defined as established hypertension and those having an unknown diastolic blood pressure (DBP) of ≥105 mmHg was 19.3%. Of the hypertensive population, 35.9% had not been detected previously. In the treated group, 43.9% were poorly controlled regarding the BP level. Thus 64.1% of the total hypertensive population at the age of 60 years were either undetected or inadequately controlled. Excretion of urinary electrolytes was also evaluated in this work. All participants of the health survey except four performed a 24‐hour collection of urine following the health examination. Care was taken with endogenous creatinine clearance. Negative and significant correlations were noted between excretion of sodium and potassium in urine and DBP levels in the group (n=23) of untreated hypertensives. In a population sample (n=135) of healthy subjects devoid of medical treatment in the same population survey, a positive and significant correlation was noted between the systolic BP and the urinary excretion of sodium. Thus up to a certain BP level there is a pressure diuresis and at higher BP levels the kidney retains electrolytes.
Intraaortic Balloon Pumping in the Treatment of Cardiogenic Shock Complicating Acute Myocardial Infarction
Authors: Forssell G. , Nordlander R. , Nyquist O. , Schenck‐Gustavsson K.
Published: August 2010

ABSTRACT A 5.1% incidence of cardiogenic shock was found in a consecutive series of 680 patients with acute myocardial infarction (AMI) during a five‐year period. The hospital mortality was 94%. Shock was treated according to a stepwise policy including assisted circulation with intraaortic balloon pumping (IABP). During the five‐year period, only five patients, 14% of the shock patients, had shock for more than three hours (the minimal time for attempting medical therapy and preparing for assisted circulation), were below 75 years of age and without terminal diseases. Together with ten AMI patients in shock referred from or treated in other hospitals, altogether 15 patients were given IABP during 1–318 hours (mean 58). Shock was reversed in 12 (80%) of these patients and five (33%) could be weaned off IABP and discharged from the CCU. However, only two patients (13%) were long‐term survivors.
Erythrocyte Sedimentation Rate in a Population Sample of Women with Special Reference to its Clinical and Prognostic Significance
Authors: Rafnsson Vilhjalmur , Bengtsson Calle , Lennartsson Jan , Lindquist Olof , Noppa Henry , Tibblin Elisabeth
Published: August 2010

ABSTRACT A comprehensive population study of women aged 38–60 was carried out in Göteborg, Sweden in 1968‐69. The same women were re‐studied six years later, in 1974‐75. Erythrocyte sedimentation rate (ESR) was studied on both occasions. A statistically significant rise in ESR with age was noted both cross‐sectionally and longitudinally, which means that the increase was related to age and was not a cohort effect. The mean annual increase in ESR was about 0.6 mm/h, but there was a significant difference between the ages studied, the increment being larger in the upper age groups. Women with high ESR (here defined as ESR ≥30 mm/h) had lower Hb and Hct values than other women. Leucocyte counts were higher in women with ESR ≥30 mm/h than in the others, but differences were statistically significant only in the upper age groups. Serum iron levels were lower in women with high ESR, while TIBC values were similar to those in the other women. Significant differences were found for transferrin saturation (lower in women with high ESR). Cholesterol levels were similar, while triglyceride levels either tended to be or were significantly higher in women with high ESR. About half of the women with ESR ≥30 mm/h had a possible explanation for their increased ESR. In no case did an increased ESR give rise to a new diagnosis of clinical significance, either in 1968‐69 or in 1974‐75. Nor had any diagnoses been missed in women with a high ESR in 1968‐69, according to the re‐examination six years later. All except one woman, in whom the diagnosis of neoplastic disease was made in the interval between the two examinations, had ESR ≥30 mm/h in 1968‐69, and women in whom a neoplastic disease was found later had on average no higher ESR in 1968‐69 than the others. It is concluded that for screening purposes, ESR is of very limited value.
Streptozotocin Treatment of a Pancreatic Tumour Producing VIP and Gastrin Associated with Verner‐Morrison Syndrome
Authors: öberg K. , Boström H. , Fahrenkrug J. , Dymling J. F. , de Muckadell O. B. Shaffalitsky , Lundqvist G.
Published: August 2010

ABSTRACT A 57‐year‐old male patient with metastasizing non‐beta islet cell carcinoma of the pancreas is described. Both gastrin and VIP levels were elevated and the patient suffered from a syndrome of pancreatic cholera and hyperacidity. The tumour contained gastrin and VIP as demonstrated by immunofluorescence. The patient also had a history of familial renal stone formation and parathyroid nodular hyperplasia. Resection of pancreatic tumour in 1973 resulted in four years without symptoms. In 1977 definite signs of multiple hepatic metastases appeared. These signs disappeared after streptozotocin given in a dosage of 2 g three times at weekly intervals. The patient has remained well for 20 months after this treatment. The causative agents for the clinical syndrome in this case are discussed in view of circulating hormone levels.
Glibenclamide and Glipizide in Maturity Onset Diabetes
Authors: Blohmé G. , Waldenström J.
Published: August 2010

ABSTRACT The effects of glibenclamide and glipizide on the concentrations of S‐glucose, S‐insulin and S‐lipids and on the 24‐hour urinary glucose excretion were studied in 37 patients with maturity onset diabetes. A double‐blind, cross‐over, double‐dummy technique was used. The fasting S‐insulin concentration was higher during glibenclamide therapy, while the increase in insulin concentration one hour postprandially was stronger during glipizide therapy, supporting the concept that glibenclamide has a more prolonged and glipizide a more fast‐acting effect on insulin secretion. The S‐glucose concentration was lower in the fasting state as well as one hour postprandially during glibenclamide therapy which, together with a lower 24‐hour urinary glucose excretion, indicates that glibenclamide has a stronger blood glucose‐lowering effect. Although statistically significant, the differences were marginal from a clinical point of view. The lipid levels remained unchanged.
Systemic Capillary Leak Syndrome with Monoclonal IgG and Complement Alterations
Authors: Löfdahl C.‐G. , Sölvell L. , Laurell A.‐B. , Johansson B. R.
Published: August 2010

ABSTRACT A case of the rare systemic capillary leak syndrome (SCLS) is described. The patient suffered 9 attacks with muscle pain, weakness and profuse sweating. He showed increased Hct values up to 79% and a decreasing plasma volume to about 50% of normal. During the attacks the patient was in a state of shock and BP was unmeasurable. Studies with 131I‐labelled albumin during attack showed an increased transcapillary escape rate to about 20%/ hour, compared to 6% when he was without symptoms. A monoclonal IgG with a constant concentration of about 5 g/l was found. Studies of the complement system during attack showed low C4 values, disproportions among the C1 subcomponents and C1r‐C1s‐C1IA complexes, suggesting a complement activation via the classic pathway. Hereditary angioedema was excluded by normal C1IA values. The complement activation might be part of the pathogenesis of the increased macromolecular permeability in this syndrome. A short review of cases described earlier is given.
Rheumatoid Arthritis, Immune Complex Disease, and Hypereosinophilic Syndrome
Authors: Hillerdal G. , Marjanovic B. , åerg H.
Published: August 2010

ABSTRACT A patient with typical rheumatoid arthritis is presented. After a short period of the disease a hypereosinophilic syndrome (HES) developed with vasculitis, pulmonary fibrosis, and thrombosis, and the disease took a malignant course. The patient died within a year after the diagnosis of HES. High titres of rheumatoid factor were manifested and total complement (CH50) was very low, indicating an active immune disease. As HES has been suggested to have an autoimmune aetiology, these findings are interesting, as positive rheumatoid serology has very rarely been reported in patients with this syndrome.
Diagnostic Sign of Hyperglycemia: Persistent Movement of Neutrophil Granules
Authors: Juhlin L. , Shelley W. B.
Published: August 2010

ABSTRACT This study describes a functional marker in the blood of diabetics: the motility of neutrophil granules in vitro. When heparinized blood from patients with diabetes mellitus was kept in capillary tubes for 24 hours, a rapid and intense movement of the granules in the neutrophil leucocytes was regularly seen. In blood from normoglycemic diabetics and normal subjects, no granular motion was seen at 24 hours, but in these cases prolonged motion could be induced by the prior addition of glucose.
Influence of a Myocardial Infarction on Blood Pressure and Serum Cholesterol
Authors: McCall Michael , Elmfeldt Dag , Vedin Anders , Wilhelmsson Claes , Wedel Hans , Wilhelmsen Lars
Published: August 2010

ABSTRACT Blood pressure (BP) was measured before and after acute myocardial infarction (MI) in 21 men aged 49–60 years from a random population sample. Men on drugs affecting BP before MI or during follow‐up were excluded. Pre‐ and postinfarction cholesterol levels were analyzed in 49 men not on hyperlipidemic treatment recruited from the same population sample. The mean fall in systolic BP (SBP) was 14 mmHg both five weeks and one year after the acute event, but 10 mmHg after two years. The mean fall in diastolic BP (DBP) was 10 mmHg five weeks after the MI and remained at this level for two years. The decreases in SBP and DBP were significant. There was a positive correlation between the maximum rise in SGOT during the acute phase of MI and the decrease in DBP between preinfarction readings and readings five weeks after the MI. Serum cholesterol was unchanged three months, and one and two years after the MI as compared to the preinfarction level.
Myocardial Infarction Complicated by Heart Block—Treatment and Long‐Term Prognosis
Authors: Forsberg S. å. , Juul‐Möller S.
Published: August 2010

ABSTRACT A number of 597 patients with acute myocardial infarction (AMI) were treated with continuous ECG monitoring of the heart rhythm in a coronary care unit for at least three days. We found 84 patients with heart block, 39 with complete, 29 with at most second degree and 16 with at most first degree heart block. The treatment was primarily conservative; 22 of the 39 patients with complete heart block were given isoproterenol and two received temporary pacemakers. Survival was traced over two years in the whole patient group with myocardial infarctions. Heart block implied a worsened prognosis over the two years, but survival was independent of the degree of heart block. Among those with complete heart block, survival did not differ from that of a comparable patient series from Copenhagen, where all patients were given pacemakers. This does not support indiscriminate artificial pacing of patients with AMI and complete heart block. Our results ought to be controlled in a randomized study.
Central and Renal Circulation, Renin and Aldosterone in Plasma during Prazosin Treatment in Essential Hypertension
Authors: Falch D. K. , Paulsen A. Quist , ødegaard A. E. , Norman N.
Published: August 2010

ABSTRACT The hemodynamic adaptation and the change in the renin‐aldosterone system during treatment with a new vasodilating drug, prazosin (Peripress®), were studied in 14 patients with essential hypertension before and after 2 and 4 months of treatment. The mean daily dose was 2 mg/day for the first 2 months and was increased individually up to 7.0 mg/day during the last 2 months in those patients whose mean arterial blood pressure (MAP) remained elevated. The reduction of MAP was mainly due to a decline in peripheral resistance, but also to a decrease in cardiac output in 4 of the patients. Effective renal plasma flow increased from 220 to 254 ml/min m2, probably as a result of a fall in vascular resistance in the kidneys. The plasma volume showed a small, transient increase after 2 months, from 19.0 to 20.0 ml/cm body height, whereas pulmonary plasma volume was unchanged, indicating a slight redistribution of plasma between the pulmonary and the systemic circulation. Body weight increased from 75.1 to 77.1 kg which, although a crude parameter, might indicate volume expansion. Plasma renin activity showed a small, transient increase after 2 months, from 0.46 to 0.65 nmol A1/I h, whereas plasma aldosterone concentration was unchanged, indicating that a volume expansion was not a result of a stimulated renin‐aldosterone system. The serum sodium and chloride concentrations fell from 142.7 to 140.2 mmol/l and from 105.9 to 103.1 mmol/***l, respectively.
Labetalol‐Induced Peyronie's Disease?
Authors: Kristensen Bent østergaard
Published: August 2010

ABSTRACT Peyronie's disease (induratio penis plastica) has been observed in a 58‐year‐old man 8 months after initiation of treatment with the new combined α‐ andβ‐blocking agent, labetalol. During the last 2 months before onset of symptoms he had received 2400 mg labetalol daily. He showed no other signs of abnormal fibrous tissue production and the ANF test was negative. Cessation of the drug revealed no improvement. Peyronie's disease has also been observed in relation to treatment with propranolol, practolol and metoprolol and might be due to an impaired balance between α‐ andβ‐receptors in connective tissue, but there may also be an immunological basis for the fibrosis. A possible coincidence is stressed, as the ages of the reported cases are within the range where this disease most often develops.
Serum and Urinary Myoglobin in Alcoholics
Authors: Hällgren R. , Lundin L. , Roxin L.‐E. , Venge P.
Published: August 2010

ABSTRACT. The serum levels of myoglobin were measured in 106 male alcoholics. Subnormal levels were found in 31 % of the alcoholics with no alcohol consumption for the last 2–4 weeks, while none of them had elevated levels. Of the alcoholics on ambulatory control and with varying current alcohol intake, 18% had increased levels compared to healthy controls. Serial myoglobin levels were determined in 19 patients following the cessation of heavy drinking sprees. Despite the fact that none of the patients had clinical evidence of acute myopathy, marked myoglobin elevations were noted in five patients; their serum levels gradually declined and normalized within 4–7 days. Comparing the three groups, similar frequencies of subnormal or elevated serum CK levels were observed. Myoglobin levels were not raised due to impaired glomerular filtration rates. No correlation was found between serum myoglobin and laboratory signs of liver affection. Although hypophosphatemia, hypomagnesemia and hypokalemia were occasionally noted, decreased serum electrolytes did not have any relation to elevated serum myoglobin. A transient, slightly increased urinary excretion of myoglobin parallel with increased excretion of β2‐microglobulin was observed in 2/17 alcoholics, suggesting that instances of myoglobinuria in alcoholics with heavy recent drinking may be due to a transient minor tubular dysfunction.
Episodic Cardiac Arrhythmia and Femoral Neck Fracture
Authors: Abdony Nils Johan , Nilsson Bo E.
Published: August 2010

ABSTRACT. Fifty‐eight consecutive patients admitted to hospital for fracture of the upper end of the femur were examined by continuous ECG monitoring for 22–24 hours. More than one third of the patients had occult, previously unknown episodic arrhythmias severe enough to cause dizzy spells and syncope. These patients had more often a history of dizziness and syncope and could less frequently than patients without serious arrhythmias return to their homes at the time of discharge despite uncomplicated fracture treatment.
Structure and Function of Neutrophil Leukocytes from Patients with the Immotile‐Cilia Syndrome
Authors: Afzelius Björn A. , Ewetz Lena , Palmblad Jan , Udén Ann‐Mari , Venizelos Nikolaos
Published: August 2010

ABSTRACT. The various clinical manifestations of the recently characterized immotile‐cilia syndrome can be traced to one cause—a structural defect of the cilia, making them immotile. It was regarded of interest to examine whether other aspects of cell motili‐ty may also be involved. For this reason the functions and structure of the neutrophil leukocytes were examined. Cells from eight patients with the immotile‐cilia syndrome and healthy controls were investigated with regard to random and stimulated locomotion under agarose, orientation during migration, adherence, bactericidal capacity, and chemo‐luminescence. Four patients showed abnormally short migration distances of the leading front neu‐trophils after stimulation with serum and/or an E. coli bacterial factor (BF). Ascorbic acid did not restore the defective migration. Migrating neutrophils were significantly less oriented towards the serum‐containing agarose well compared with the controls (p<0.01). Adherence, bactericidal capacity for Staphylococcus aureus, chemoluminescence, random migration, and orientation during BF‐induced migration were all normal. The number of microtubules in the pericentriolar region of the neutrophil granulo‐cytes was unusually low in four of the eight patients. We conclude that the increased frequency of respiratory tract infections in patients with this syndrome is possibly due to defects in the granulocyte locomotory system, as well as to the defective mucociliary clearance of the airways.
High Immune Responsiveness in a Family with Multiple Paraproteinaemia and Autoimmune Thyroid Disease
Authors: Weits J. , de Gast G. C. , The T. H. , Van der Giessen M. , Ockhuizen Th. , Festen J. J. M. , Mandema E.
Published: August 2010

ABSTRACT. Immune responsiveness was investigated in a family comprising 12 first‐ and second‐degree relatives, one of whom had k‐myelomatosis, one igA‐λ paraproteinaemia, two Graves' disease and a further two thyroid antibodies without disease. Relatives by marriage served as controls. Parameters of immune capacity studied were the humoral and cellular immune response to haemo‐cyanin of Helix pomatia (HPH), dinitrochloroben‐zene (DNCB) skin reactivity and in vitro lymphocyte proliferation capacity to phytohaemagglutinin (PHA). Mean antibody titres to HPH were higher in the family than in the control group in all main Ig classes and IgG subclasses after primary and secondary immunization, and the difference was statistically significant for IgG, IgG2 and IgG4 titres. This could not have been predicted from the (normal) serum Ig levels in this family. In vitro lymphocyte proliferation capacity to HPH after primary and secondary immunization was also significantly increased. DNCB skin reactivity also tended to be high in the family, whereas PHA‐induced lymphocyte proliferation was normal. These findings support the idea that myelomatosis clusters in families with immune dysregulation.
The Epidemiology of Thyrotoxicosis in Denmark
Authors: Mogensen Erik F. , Green Anders
Published: August 2010

ABSTRACT. In a study based on a review of all thyroid function tests performed in the Funen region in Denmark over a three‐year period, from Jan. 1, 1972 to Dec. 31, 1974, the annual incidence rates of thyrotoxicosis were found to be 46.5/100000 for women and 8.7/100000 for men. In both sexes the age‐specific rates rose with age. An analysis of the geographical distribution of the cases showed a significantly lower incidence rate among women from an urban than from rural areas. It is estimated that the life‐time risk of developing thyrotoxicosis is 5 % for women and 1 % for men and that the prevalence rate of existing and previously diagnosed thyrotoxicosis is 1.4% for Danish women and 0.3% for Danish men.
Thallium‐201 Scintigraphy after Acute Myocardial Infarction
Authors: Bone Dianna , Carlens Per , Holmgren Alf , Johnsson Hans , Jonasson Rune , Kandilas Janis , Mogensen Lars , Nordlander Rolf , Orinius Erik
Published: August 2010

ABSTRACT. Fifty‐five patients with acute myocardial infarction were examined with thallium‐201 scintigraphy before discharge from hospital. Fifty‐one showed significant scintigraphic defects. The number of abnormal Q waves in a 12‐lead ECG but not the maximal ASAT value for each patient were correlated to the total estimated image defect. Mortality during the follow‐up period of 14–28 months was not related to the estimated total image defect, but the two early deaths occurred among patients with the most dilated left ventricles.
Effect of Metoprolol on QTC Intervals after Acute Myocardial Infarction
Authors: Ahnve S. , Erhardt L. , Lundman T. , Rehnqvist N. , Sjögren A.
Published: August 2010

ABSTRACT. The effect of metoprolol on corrected QT interval (QTc) was studied retrospectively in 111 survivors of AMI below 70 years of age. Prior to discharge the patients were stratified by age, infarction size and ventricular arrhythmias and randomized. Metoprolol, 100 mg b.i.d., or placebo were given double‐blindly to 59 and 52 patients, respectively. QTc intervals were measured four times prior to randomization and three times during the follow‐up year. The highest QTc mean was registered on the second day in the CCU. QTC intervals subsequently decreased significantly in both groups between discharge and the three‐month control (p<0.001). Patients on metoprolol had significantly shorter QTc intervals during the follow‐up year than those on placebo (0.394±0.028 vs. 0.406±0.034 sec, p<0.001). The QTc‐shortening effect of β‐receptor blockade was most marked in patients with prolonged QTc intervals at discharge. Patients who died suddenly had prolonged QTC intervals prior to discharge. In this group the proposed beneficial effect of β‐receptor blockade on QTc interval cannot be evaluated as most of these patients had died before the First control.
Granulomatous Hepatitis in a Patient Receiving Carbamazepine
Authors: Levander Hans G.
Published: August 2010

ABSTRACT. A 60‐year‐old woman, previously in good health, received carbamazepine in a total dose of 10 g during 1 month. Fever, upper abdominal pain and abnormal liver function appeared after 3 weeks. Liver biopsy showed non‐caseating granulomas. One week after withdrawal of carbamazepine the patient was clinically well with normal liver function. Carbamazepine was then reinstituted for 4 days, resulting in fever, upper abdominal pain and deteriorating liver function. One month after this provocation test the patient was clinically well with normal liver function and normal liver biopsy showing only slight fatty vacuolization but no granulomas. A reversible positive mitochondrial antibody test was seen.
Sinus Node Dysfunction in 128 Patients
Authors: Simonsen E. , Nielsen J. Stræde , Nielsen B. Lyager
Published: August 2010

ABSTRACT. A retrospective study covering all admissions during a 6‐year period revealed 128 patients with sinus node dysfunction (SND). The patients were grouped according to the ECG criteria chosen: group I 33 patients with sinus bradycardia, group II 37 with sinoatrial block/sinus arrest, group HI 58 with brady‐tachy syndrome. Additional heart disease, predominantly ischaemic, was found in 56%. The frequency and severity of symptoms increased from group I to group III. Pacemaker treatment was given to 40% of the cases, while medical treatment alone was successful in 17%. A follow‐up including 104 patients was carried out after a mean observation period of approximately three years. Sixteen patients had died. The cause of death may have been SND per se in only one case. Five patients died of apoplectic insults or complications to such. In total, nine possible or proven systemic embolic events were found—all occurring in patients with brady‐tachy syndrome. A progression of the ECG abnormality from a lower to a higher group took place in nine patients during the observation period. It is concluded that SND is a condition with a broad clinical spectrum and a stationary or slowly progressive course. In general, it carries a good prognosis. A substantial number of deaths or disabilities in patients with brady‐tachy syndrome may be ascribed to systemic embolism. Long‐term anticoagulant therapy is proposed in this subgroup of patients with SND.
The Clinical Impact of Long‐Term ECG Recording
Authors: Eriksson Leif , Pahlm Olle
Published: August 2010

ABSTRACT. One‐hundred and fifty patients referred for long‐term ECG (LECG) recording at a university hospital were monitored for 12 hours or more. The referring physicians' patient records were studied 12 months or more after monitoring in an attempt to establish if and how LECG had affected patient management. Seventeen patients were treated with permanent pacemakers and 13 with antiarrhythmic drugs as a direct result of LECG. Thirteen patients who experienced symptoms with concomitant cardiac arrhythmia at the time of recording were considered not to require treatment. In 17 patients who experienced symptoms without concomitant arrhythmia during monitoring, cardiac arrhythmia could be ruled out as the cause of the symptoms. In 9 more patients, LECG was considered to have contributed “valuable clinical information” (which could not be obtained by other diagnostic methods) to the referring physician. Thus, LECG was considered to have affected the referring physician's management of the patients in 69 cases (46 %).
Flexible Fiberoptic Bronchoscopy in Sarcoidosis
Authors: Stjernberg N. , Björnstad‐Pettersen H. , Truedsson H.
Published: August 2010

ABSTRACT.Twenty‐nine patients with clinical signs, chest X‐ray and histology consistent with sarcoidosis have been studied with flexible fiberoptic bronchoscopy (FFB) and scalene node biopsy. The diagnostic yield from bronchial mucosal biopsies was 41%, and from transbronchial lung biopsy 43%. 52% of the patients showed epithelioid cell granulomas with FFB (lung and/or mucosal biopsies) compared with 79% with scalene node biopsy. Three patients showed extensive bronchial mucosal changes with stenosing processes due to sarcoidosis. Sarcoidosis of the bronchial mucosa is a frequent finding, and FFB is the best method for discovering bronchial mucosal sarcoidosis with or without stenosing processes. In our opinion, FFB has a place as a routine method in diagnosing sarcoidosis.