bluuebunny/crossref_metadata_2025 huggingface dataset:
CHEST PAIN AT EXERCISE AND CORONARY HEART DISEASE
Authors: Areskog Nils‐Holger
Published: August 2010

ABSTRACT.In patients with stable exertional angina the pain reaction during and after exercise has been classified and analyzed with regard to reproducibility, time relationship between pain and ECG reactions with ST‐depression. The pain reaction has a good reproducibility ‐ at least as good as the ECG reaction ‐ both within the day and from day to day. The pain usually appears a few minutes after the appearance of ST‐depression but there are big individual variations. For any given patient the time relationship between pain‐ and ECG‐reaction is fairly constant but beta‐blockers and myocardial infarction may increase the pain threshold in individual cases. To conclude the analysis of the pain reaction adds valuable information to the exercise test both in patients with ischaemic heart disease and in patients with angina‐like pain of other causes.
PRINZMETAL'S VARIANT ANGINA
Authors: Sandøe Erik , Vilhelmsen Regitze , Efsen Frits
Published: August 2010

ABSTRACT. A series of 12 consecutive patients with Prinzmetal's variant angina is presented. There was a preponderance of males (eight/12) and individuals less than 60 years of age (nine/12). Delay in diagnosis was frequent, primarily due to difficulty in achieving a proper 12 lead ECG recording of the attack which often occurred late at night or in the early morning, subsiding within minutes. In some cases, moreover, ST‐depression was observed in the ECG monitoring lead as a reciprocal manifestation of subepicardial ischaemia or due to incorrect polarity in the monitoring lead. The incidence of serious arrhythmias, AV‐block and ventricular tachycardia was high (eight/12); two patients had to be DC‐converted. Coronary arteriography revealed a spectrum from normal or nearly normal coronary arteries to single vessel disease. Nitroglycerin was well suited for treatment of acute attacks. Long‐term treatment with calcium antagonists was effective and without serious side‐effects. The follow‐up time was from 8 months to 5 years (mean 2 years). It is concluded that Prinzmetal's variant angina as such is a rare disease, but that coronary artery spasm is most likely an important contributory factor in the clinical manifestations of coronary artery disease: arrhythmias, sudden death and myocardial infarction.
ANGINA‐LIKE CHEST PAIN IN PATIENTS WITH OESOPHAGEAL DYSFUNCTION
Authors: Tibbling Lita
Published: August 2010

ABSTRACT.Effort‐related chest pain and chest pain fulfilling the criteria of the Rose questionnaire for angina pectoris are often used as evidence for coronary heart disease. In patients with different kinds of oesophageal dysfunction (OD) the frequency of chest pain of angina‐like type was studied and compared to that in the general population. Eighty per cent of patients with hiatal hernia at oesophageal manometry had chest pain, 63% of which was effort‐related. In 217 patients with a positive acid perfusion test, i.e. the provoked heart burn or pain is the same as that experienced in daily life, 82% had a history of chest pain. The chest pain was effort‐related in 70% and in almost half of the cases their chest pain was classified as angina pectoris according to the Rose questionnaire. Since angina‐like chest pain is a predominant symptom in patients with OD and OD is far more common than angina pectoris due to myocardial ischemia in the general population, it is reasonable to assume that the oesophagus and not the heart is the most common source of angina‐like chest pain.
SEGMENTAL THORACIC PAIN IN PATIENTS ADMITTED TO A MEDICAL DEPARTMENT AND A CORONARY UNIT
Authors: Bechgaard Poul
Published: August 2010

ABSTRACT. The frequency of segmental thoracic pain in 1097 patients admitted complaining of chest pain was investigated by specific examination of the thoracic vertebrae and segments. The examination is easily performed with minimal risk to possible coronary patients. Segmental thoracic pain accounts for 13% of chest pains in a medical department, making it the third most common chest pain (behind coronary thrombosis pain 39%, angina pectoris 20%). Treatment by local paravertebral anaesthesia is simple and effective in most cases.
SIGNIFICANCE OF PLATELET FUNCTION AND THROMBOXANE B2 LEVELS ACROSS THE HUMAN MYOCARDIAL VASCULAR BED
Authors: Mehta Jawahar , Mehta Paulette
Published: August 2010

There is an intense interest in the role of platelets in the pathogenesis of myocardial ischemia. To determine platelet function in coronary circulation and the influence of various platelet‐active drugs, we have studied large number of patients with coronary disease (CD) defined as >50 % luminal narrowing and subjects with normal coronary arteries (NCA). Blood samples were collected from aorta (Ao) and coronary sinus (CS) at rest, during and following atrial‐pacing induced tachycardia characterized by ECG changes and symptoms. Platelet aggregation (PAg) using epinephrine (E) and adenosine diphosphate (ADP) as stimulating agents and platelet counts were performed. In CD patients CS blood had lower (Pd<0.01) PAg (E‐59 ± 8, ADP‐49 ± 7 %) than Ao blood (E‐74 ± 6, ADP‐68 ± 7 %). Platelet counts in CS blood (173,000 ± 16,000/mm3) were lower (P<0.01) than in Ao blood (233,000 + 30,000/mm3). In NCA patients, the CS and Ao platelet counts and PAg were not significantly different. During tachycardia stress PAg and counts were unaltered in NCA patients. In contrast in CD patients PAg increased significantly (P<0.05) in CS but not in Ao blood during stress and returned to baseline following tachycardia implying platelet activation during stress‐induced myocardial ischemia. Oral aspirin 650 mg abolished the differences in Ao and CS blood PAg (CS‐E 51 ± 8, ADP 54 ± 7%; Ao‐E 45 ± 8, ADP 55 ± 8 %), and in counts (CS‐221,000 ± 8,000/mm3; Ao‐230,000 ± 71,000/mm3) in CD patients. Aspirin also significantly decreased tachycardia‐related increase in PAg in CS blood. Administration of intravenous dipyridamole 25 mg in 8 other CD patients, resulted in increase in platelet counts in CS from 255,000 ± 29,000 to 286 ± 34,000/mm3 and in PAg from 30 ± 8 to 52 ± 9 %, while Ao blood counts and PAg were unchanged, so that the differences in Ao and CS platelet counts and aggregation were abolished. In other studies, we compared CD patients treated with and without propranolol. Propranolol‐treated patients had lower PAg in Ao as well as CS blood compared to non‐treated patients, but the gradients in PAg and counts between Ao and CS blood was still present. However, tachycardia‐related increase in CS PAg was markedly less in CS blood in propranolol‐treated patients compared to non‐treated patients.

These data show that 1) gradient in platelet counts from Ao to CS exists related probably to platelet aggregate formation in atherosclerotic vessels, 2) activation of platelets leads to low PAg activity in CS blood, 3) tachycardia stress is associated with platelet activation at the level of myocardial vascular bed, 4) aspirin and dipyridamole modify these gradients, 5) aspirin blunts tachycardia‐related increase in CS PAg, 6) propranolol has potent PAg inhibitory effects and modifies platelet response to tachycardia stress.
BETA BLOCKERS IN EXPERIMENTAL MYOCARDIAL INFARCTION
Authors: Nayler Winifred G.
Published: August 2010

Widespread interest has developed in the possibility of using beta‐adrenoceptor antagonists to protect the myocardium against the deleterious consequences of an impaired coronary blood flow. The consequences include loss of active tension generating capacity, impaired mitochondrial function, destruction of tissue ultrastructure and loss of ionic homeostasis. The ionic imbalance includes loss of tissue K* and gain in Na* and Ca2+.

Under conditions of low flow, or when coronary flow is absent, a loss of K* from the cell must result in a localized increase in extracellular K*. This, in turn, may be sufficient to trigger arrhythmias. Theoretically beta‐adrenoceptor antagonists should protect against such an ischaemic induced increase in extracellular K*. To test this hypothesis isolated Sprague‐Dawley rat hearts have been pretreated with either timolol (25 μg/ 1) or propranolol (100 μg/1). The hearts have then been made ischaemic at 37°C for 60 minutes and then reperfused. Coronary effluent collected during the first 5 minutes reperfusion showed a significant (p<0.001) increase in K*. This increase in coronary K* was attenuated by prior β‐blockade. Adding the beta blockers during the phase of reperfusion had no effect on the rate of K* loss. The significance of these results will be discussed with reference to the use of beta‐adrenoceptor antagonists for the protection of ischaemic heart muscle.
EARLY ANGIOGRAPHY DURING INFARCTION: A SEARCH FOR SPASM
Authors: Gold Herman K. , Leinbach Robert C.
Published: August 2010

The predominant cause of continuing injury during transmural myocardial infarction is intracoronary thrombosis linked to plaque rupture or plaque hemorrhage. The initiating events, however, remain unknown primarily because angiography is performed late. Postmortem analysis of patients dying suddenly may not be relevant since it is not known whether a transmural myocardial infarction would have followed. Therefore, we must make conclusions from early therapeutic responses and from angiography performed always with some delay.

Sixty patients were studied. Twenty‐five showed anterior transmural infarction and were evaluated by systemic nitroglycerin response, followed by coronary angiography after six hours to seven days. Only three of twenty‐five showed greater than 50 % reduction in precordial ST segment elevation during the thirty‐minute postnitroglycerin observation period. Angiography showed left anterior descending occlusion in thirteen and high grade stenosis in twelve. Nitroglycerin response was seen only in patients with left anterior descending stenosis. The mechanism of nitroglycerin response, however, was not observed.

Thirty‐five patients with either anterior or inferior transmural infarction received sublingual and intravenous nitroglycerin on admission and coronary angiography within six hours, during which intracoronary nitroglycerin was infused into the obstructed coronary artery. Only two patients responded to systemic nitroglycerin with a greater than 50 % fall in ST segment elevation. At angiography the offending vessel was stenotic and not further dilatable with intracoronary nitroglycerin. Thirty‐two patients receiving intracoronary nitroglycerin showed no reduction in coronary stenosis and no reversal of obstruction. Three patients with coronary occlusion (two with inferior infarction, one with anterior infarction) responded to intracoronary nitroglycerin with slow antegrade flow. This restored flow was adequate to outline intracoronary filling defects but inadequate to reduce injury or to induce ventricular irritability. In these patients streptokinase infusions cleared the defects and augmented antegrade flow.

In conclusion, neither responsivity to nitroglycerin nor early coronary angiography demonstrate that coronary spasm is pronounced after onset of transmural myocardial infarction.
INTRACORONARY STREPTOKINASE INFUSION DURING ACUTE MYOCARDIAL INFARCTION
Authors: Gold Herman K. , Leinbach Robert C.
Published: August 2010

Recent angiographic studies have demonstrated that intracoronary thrombus is present in the majority of patients with acute transmural myocardial infarction. In an attempt to overcome coronary artery obstruction and restore antegrade flow, streptokinase has been infused directly into the obstructed coronary artery supplying the infarct zone. We have recently analyzed the angiographic features of 27 patients with acute transmural myocardial infarction presenting within 3 hours of the onset of persistent pain. All underwent coronary angiography and infusion of streptokinase into the occluded coronary artery. Complete occlusion of the left anterior descending coronary artery was seen in all 14 patients with anterior myocardial infarction. Ten of 13 patients with inferior myocardial infarction showed complete right coronary artery occlusion. The remaining 3 patients had subtotal coronary occlusion. At the time of angiography the majority of patients showed an occlusive intraluminal convex filling defect consistent with intracoronary thrombus. Intracoronary nitroglycerin partially restored antegrade flow in only 1 patient with left anterior descending occlusion and in 1 patient with right coronary artery occlusion. Streptokinase was infused at a rate of 2,000–6,000 IU/ minute. In 20 of 27 patients (74 %) antegrade coronary flow was reestablished within 1 hour of streptokinase infusion. Chest pain was relieved and ST segments were reduced in most, but not all, of these patients. After intracoronary streptokinase infusion, the residual coronary artery stenosis was greater than 60 % in all patients. Two patients demonstrated acute reocclusion at the completion of streptokinase infusion. Five of 20 patients (25 %) developed late reocclusion 4 days to 3 months after successful clot lysis. Coronary patterns associated with reocclusion include ulcerated plaques, multiple distal vessel stenoses, irregular residual stenosis of greater than 90 %.

In conclusion, angiographic studies support the hypothesis that an occlusive intracoronary thrombus is the cause of persistent myocardial injury in many patients with acute myocardial infarction. In the majority of cases, intraluminal thrombus can be identified as a convex filling defect. Selective coronary angiography can be performed safely during the acute phase of myocardial infarction and provides important information regarding the nature of the obstructive lesion in the vessel supplying the infarct zone. The benefits of early angiography and administration of intracoronary thrombolytic therapy requires further study.
NITROGLYCERIN IN THE TREATMENT OF ACUTE MYOCARDIAL INFARCTION
Authors: Bussmann Wulf‐Dirk
Published: August 2010

Nitroglycerin and nitrates have long been contraindi‐cated in the treatment of acute myocardial infarction because of the possibility of an undesirable decrease in arterial blood pressure and the induction of cardiogenic shock. Nowadays nitroglycerin seems to be indicated at least in subgroups of patients with acute myocardial infarction. Intravenous nitroglycerin reduce left ventricular filling pressure up to 40% within several minutes. The effect is most pronounced if filling pressure is elevated. There is no decrease in arterial pressure with low dosage nitroglycerin and a 10 % decrease with higher dosages. Cardiac output and stroke volume were found to increase following nitroglycerin application in patients with left ventricular failure. This may be due to the improved regional ventricular function in areas with decreased coronary flow. A slight, but significant decrease in cardiac output was found in patients not in failure. Nitroglycerin seems to be the drug of choice in acute pulmonary edema, because of its internal bloodletting effect. Following sublingual nitroglycerin, left ventricular filling pressure decreased within 3–5 minutes in conjunction with clinical improvement of the patient.

High blood pressure in such patients is largely reduced. — Nitroglycerin, therefore, seems to be applicable even in patients with acute and marked arterial hypertension.

Clinical improvement was evident in patients with dyspnea or pain following myocardial infarction. The need for morphine was reduced. Myocardial ischemia as assessed by electrocardiographic ST‐segment elevation improved following application of nitroglycerin. This effect is more pronounced in patients with left ventricular failure.

In a randomized prospective study, 31 patients received intravenous nitroglycerin at least for 2 days and were compared to 29 patients with no specific therapy. CK and CKMB infarct size was 30 % less than in the control group. Even with nitroglycerin administration 8 hours after the onset of symptoms, CK and CKMB activities were significantly reduced.

Preliminary results showed early mortality to be reduced in patients receiving nitroglycerin; The rate of reinfarction also was lower. The incidence of angina pectoris 1 1/2 years after the infarct, however, was higher in patients receiving nitroglycerin therapy initially. Following infarct size reduction more ischemic myocardium remains, possible indication for further therapy such as bypass surgery. The improvement in myocardial ischemia seems to be the reason for the reduction in ventricular ectopic beats during treatment. The need for lidocaine was markedly reduced. Even bradycardia seems to be improved, since the use for atropine was only half that for the control patients. These results provide evidence that nitroglycerin and nitrates appear to be indicated in patients with acute myocardial infarction, especially in those with left ventricular failure.
Genetic Heterogeneity in Autoimmune Polyglandular Failure
Authors: Wirfält Anders
Published: August 2010

ABSTRACT. Five cases with candidiasis‐endocrinopathy syndrome are presented. They are clustered in three distantly related families with two pairs of affected sibs and one single case. All cases have idiopathic hypoparathyroidism, four have idiopathic Addison's disease while chronic mucocutaneous candidiasis has appeared in three cases. The mode of presentation argues for an autosomal recessive inheritance. Varying degrees of defective cellular mediated immunity were found. HLA typings revealed no evidence for HLA linkage. These findings discriminate the syndrome as a distinct entity compared to other forms of autoimmune polyglandular failure with HLA‐linked familial tendency.
Influence of Calcium Infusion on Urinary Cyclic AMP and Phosphate in Hyperparathyroidism
Authors: Børresen T. , Jørgensen F. Schønau , Transbøl I. , Madsen S. Nistrup
Published: August 2010

ABSTRACT. Urinary cyclic AMP (cAMP) and phosphate were measured before and after calcium infusion in 12 patients with operatively verified primary hyperparathyroidism (PHP) and in 12 healthy persons. In normal subjects infusion of calcium caused a reduction in urinary cAMP directly correlated to the preinfusion values and inversely correlated to the serum calcium concentration determined as albumin‐corrected serum calcium. In normal subjects with high normal albumin‐corrected serum calcium the infusion of calcium caused no or only a small depression in the urinary excretion of cAMP. Changes in phosphate excretion were not correlated to the calcium concentration. Four of the 12 hyperparathyroid patients showed normal relative suppression in urinary cAMP after the infusion of calcium, and 5 had normal suppression of phosphate excretion. It is concluded that some patients with PHP retain calcium‐sensitive secretion of PTH, and that the classical calcium infusion test is of doubtful value in the diagnosis of PHP.
Metoprolol Treatment after Acute Myocardial Infarction
Authors: Olsson G. , Rehnqvist N. , Lundman T. , Melcher A.
Published: August 2010

ABSTRACT. One hundred and six patients on double‐blind treatment with placebo or metoprolol, 100 mg b.i.d., during the first 6 months after an acute myocardial infaction were investigated. The patients were stratified and randomized to treatment according to type of ventricular arrhythmias on a six‐hour ECG registration, size of infarct estimated by enzyme maximum and age. During the follow‐up period, a further three six‐hour ECG recordings and three exercise tests were performed. In the metoprolol group the incidence of malignant ventricular ectopic beats decreased significantly (p<0.05) after three days' treatment. This decrease lasted for one month but was not observed at the six‐month registration. No difference in working capacity was seen between the two groups, nor were there any differences in ischemic ST depressions on ECG during exercise. The proportion of patients terminating exercise because of angina pectoris was similar, but significantly more patients in the metoprolol group (p<0.05) discontinued exercise at six months because of fatigue. Large heart volumes were observed somewhat more often in the metoprolol group but there was no extended need of treatment for cardiac failure.
Synthesis of Collagen and Sulfated Glycosaminoglycans by Normal and Scleroderma Fibroblasts in Culture, with and without Addition of Cyclofenil
Authors: Kjellström Thomas , Malmquist Jörgen , Persson Bertil
Published: August 2010

ABSTRACT. The influence of the synthetic weak estrogen cyclofenil was studied in vitro on skin fibroblasts from scleroderma patients, normals, and human embryos. The drug had no effect on the synthesis of sulfated glycosaminoglycans or collagen. Collagen synthesis was lower in scleroderma fibroblasts than in normal cells, whereas there was no difference in sulfated glycosaminoglycans synthesis.
Practical Clinical Value of the C‐Peptide Response to Glucagon Stimulation in the Choice of Treatment in Diabetes Mellitus
Authors: Madsbad Sten , Krarup Thure , McNair Peter , Christiansen Claus , Faber Ole K. , Transbøl Ib , Binder Christian
Published: August 2010

ABSTRACT. In order to discriminate between insulin‐dependent and non‐insulin‐dependent patients, serum C‐peptide concentration was determined using antiserum M1230 in the fasting state and 6 min after an i.v. injection of 1 mg glucagon in 215 patients treated with insulin and 53 treated with diet and oral antidiabetics. A patient was considered well controlled without insulin when fasting blood glucose was below 8 mmol/1 and when glucosuria was absent. After re‐evaluation of therapy in hospital it was found that the majority of patients with a poststimulatory serum C‐peptide concentration above 0.60 pmol/ml appeared to have non‐insulin‐dependent diabetes mellitus. When fasting C‐peptide was used, a great overlap was found between the two treatment groups. During evaluation of therapy in hospital, 6 previously insulin‐treated patients could be well treated with diet and tablets and 6 diet‐ and tablet‐treated patients required insulin. The glucagon test seems to be of value in the outpatient clinic to discriminate non‐insulin‐dependent from insulin‐dependent patients.
Endoscopic Polypectomy in the Gastrointestinal Tract
Authors: Cronstedt Jean , Carling Lasse , Vestergaard Peter
Published: August 2010

ABSTRACT. The results of 160 consecutive fibre‐optic endoscopic polypectomies in the gastrointestinal tract are reviewed. Of 22 polyps snared in the upper digestive tract, 16 could be retrieved. One gastric polyp showed early intramucosal carcinoma. Biopsies from a pedunculated duodenal polyp, which was lost after snaring, revealed adenoma with moderate atypia. Of 138 resected colonic polyps, 132 were retrieved. Of these, 104 (79%) were adenomas. Of 49 colonic adenomas smaller than 10 mm, 4 (8%) showed severe atypia (carcinoma in situ) but none invasive carcinoma. Of 36 adenomas sized 10–19 mm, 8 (22%) showed severe atypia and one (3%) invasive carcinoma. Of 19 adenomas larger than 20 mm, 6 (32%) showed severe atypia and one (5%) invasive carcinoma. Of the colonic polyp patients, 87% had only one or two polyps. Synchronous adenomas and non‐neoplastic polyps were found in 6 of 11 cases with 3 or more colonic polyps. It is concluded that endoscopic polypectomy, carefully and properly performed, is a valuable and promising procedure in the diagnosis and treatment of polyps in the gastrointestinal tract, especially in the large bowel.
Relation between Arrhythmic Sensations, Cardiac Arrhythmias and Psychological Profile
Authors: Orth‐Gomér K. , Edwards M.‐E. , Erhardt L. R. , Sjögren A. , Theorell T.
Published: August 2010

ABSTRACT. The relation between arrhythmic sensations and objective findings of ectopic arrhythmic activity was studied in 150 middle‐aged men. Objective arrhythmias were studied by 24‐hour Holter monitoring and subjective symptoms assessed by a questionnaire and a diary protocol during the ECG recording. Psychological characteristics were described by means of a personality inventory, the Emotions Profile Index. No direct relationship was found between subjective symptoms and objective findings of cardiac arrhythmias. Those men, however, who complained of arrhythmic sensations but had no clinically important arrhythmias exhibited a few specific characteristics. They had no signs of organic heart disease and appeared less trustful and more aggressive than those with arrhythmias.
Renin and Body Fluid Volumes in Chronic Renal Disease
Authors: Boer P. , Mees E. J. Dorhout , Roos J. C. , Koomans H. A. , Geyskes G. G.
Published: August 2010

ABSTRACT. In 47 patients with hypertension and chronic renal insufficiency (CRI) and 38 patients with essential hypertension (EH), the following parameters were measured under moderate salt restriction: plasma volume (PV), blood volume (BV), extracellular fluid volume (ECFV), ratio of blood volume to insterstitial fluid volume (BV/IV), recumbent plasma renin activity (PRA), increase in PRA upon standing (ΔPRAst), creatinine clearance (Ccr), and mean arterial pressure (MAP). Mean PRA, ECFV, and MAP values did not differ significantly between the two groups. In the CRI group, MAP showed a weak positive correlation with ECFV (r=0.34). Mean PV, BV and BV/IV ratio were significantly higher than in the EH group, whereas ΔPRAst was markedly blunted (p<0.001) and showed a weak correlation with Ccr (r=0.33). This suggests that patients with CRI on a moderate Na intake have a decreased tissue compliance which results in a relative elevation of BV. On the other hand, although MAP was not significantly correlated with either BV or IV, a negative correlation (r=‐0.31) was found between MAP and BV/IV, indicating that elevation of the blood pressure (BP) tends to depress BV. These oppositely directed effects may explain the failure so far to establish a relationship between BP in renal disease and any haemodynamic parameter or combination of such parameters.
Personal Reflections on the Incidence of Ischaemic Heart Disease in Oslo during the Second World War
Authors: Bang H. O. , Dyerberg J.
Published: August 2010

ABSTRACT. The dietary changes in Norway and especially in Oslo during the Second World War, with reduced fat intake and increased consumption of fish and fish products, was paralleled by a reduced incidence of and mortality from IHD. This was probably caused to a high degree by reduced platelet aggregability leading to a reduced tendency to thrombosis. We suggest that the mechanism behind this reduction was a changed balance between pro‐and anti‐aggregatory prostaglandins towards the anti‐aggregatory side, caused by eicosapentaenoic acid from fish lipids. Furthermore, hypocholes‐terolaemia due to reduced fat intake and increased consumption of polyunsaturated fatty acids certainly contributed to this effect by reducing platelet aggregability.
Natural History of Angina Pectoris, Possible Previous Myocardial Infarction and Intermittent Claudication during the Eighth Decade
Authors: Agner Erik
Published: August 2010

ABSTRACT. A ten‐year longitudinal cardiovascular survey of an unselected population of 70‐ and 80‐year‐old men and women was carried out as part of the Glostrup Population Studies in Denmark. With small reservations, the population at entry was representative of the Danish people of that age group, and representative in terms of mortality during the following decade. The prevalences of three major cardiovascular symptoms are given together with their courses, incidences and relationship to some common cardiovascular risk factors. At 70, the prevalence of angina pectoris was 10% in men and 5% in women, the corresponding values for possible previous myocardial infarction being 5% and 3%, and for intermittent claudication 9% and 3%, with statistically significant differences between the sexes for any of the three symptoms. At 80, the prevalences of all three symptoms in women had risen to equal that of men, which had not changed. Total ten‐year mortality was significantly increased among men who had confirmed angina pectoris or possible previous myocardial infarction at 70 and among women who had confirmed intermittent claudication. Ten‐year mortality from all cardiovascular diseases, and also from acute myocardial infarction alone, showed exactly the same pattern. In those examined at both 70 and 80, the ten‐year incidences of the three symptoms were 3–11%. Few participants who had confirmed a symptom at 70 denied it at 80.
Neutrophil Function in Hypothyroid Patients
Authors: Palmblad J. , Adamson U. , Rosenqvist U. , Udén Ann‐Mari , Venizelos N.
Published: August 2010

ABSTRACT. We investigated whether some in vitro polymorphonuclear (PMN) granulocyte functions were impaired in patients with hypothyroidism, since this disease has previously been associated with an increased susceptibility to infectious agents and decreased leukocyte heat production. PMNs from 9 of 17 hypothyroid patients exhibited a decreased ability to kill Staph. aureus in vitro compared with euthyroid controls (p<0.02). This was normalized in all patients tested after therapy with levothyroxine. In 3 patients, studied repeatedly during the initial phase of therapy, PMN bactericidal capacity was gradually normalized. In addition, PMN adherence to nylon fibers showed a transient decrease approximately 6 weeks after initiation of therapy. PMN chemiluminescence during phagocytosis of Staph. aureus and stimulated and spontaneous migration under agarose were normal and did not change during therapy. Thus, the decreased bactericidal capacity found in half of these hypothyroid patients might confer an increased susceptibility to certain infectious agents.
HbA1c and the Diagnosis of Diabetes Mellitus
Authors: Svendsen P. Aaby , Jørgensen J. , Nerup J.
Published: August 2010

ABSTRACT. To evaluate the usefulness of haemoglobin A1c (HbA1c) determinations in the diagnosis of diabetes mellitus, the outcome of a standard oral glucose tolerance test (OGTT) and HbA1c values were compared in 178 consecutive subjects referred for a diagnostic OGTT. The subjects were mainly in age groups in which non‐symptomatic diabetes mellitus predominates. The prevalences of elevated fasting plasma glucose and abnormal OGTT were found to increase with increasing age. One third of the total series had impaired or diabetic OGTT. In the group with normal OGTT, 16% had fasting plasma glucose concentrations above the upper normal limit, but the range of HbA1c values did not differ from that of healthy controls. In the group with impaired OGTTs (n=20), elevated HbA1c values were found only in subjects with elevated fasting plasma glucose and the highest two‐hour OGTT values (n=4). In the group with diabetic OGTT, 86–94% had HbA1c values above the upper normal limit, and HbA1c was elevated in all subjects with a fasting plasma glucose higher than 10.5 mmol/l or a 2‐hour OGTT glucose value above 14.4 mmol/l. Using the results of the OGTT as the true diagnosis, HbA1c had a diagnostic specificity of 0.78 and sensitivity of 0.96. Only subjects with a substantially reduced glucose tolerance may be diagnosed by HbA1c determinations.
Mesangial IgA Glomerulonephritis in Adults
Authors: Schmekel Birgitta , Svalander Christian , Bucht Härje , Westberg N. Gunnar
Published: August 2010

ABSTRACT. This report evaluates 29 patients with IgA glomerulonephritis. Patients with the least intensity of immunofluorescent staining for IgA had the highest glomerular filtration rate. The pattern or intensity of the staining gave little or no indication of the severity of the morphological changes or of the short‐term prognosis. Histological changes with increased amounts of adherences were found in a significantly higher proportion of kidneys with decreased function. Older patients had a longer history and a higher incidence of low renal function, and they showed more glomerular adherences and global fibrosis than younger patients.
Bone Lesions in Chronic Myelogenous Leukaemia
Authors: Välimäki M. , Vuopio P. , Liewendahl K.
Published: August 2010

ABSTRACT. The incidence and site of bone lesions in 33 patients with chronic myelogenous leukaemia were studied by performing bone scintigraphy and radiography. The scintigrams were abnormal in 67% and the radiographs in 29%. Increased juxta‐articular uptake of radioactivity was observed particularly in acute phase patients, whereas areas of focal uptake were detected in many chronic phase patients. Nearly all patients suffered from bone pains before the development of demonstrable osseous lesions. Hypercalcaemia was found in one patient with blastic transformation and bone lysis. Two patients with extensive bone destruction were treated with vincristine, prednisone and local irradiation in spite of haematological remission. No haematological relapse has occurred in these two patients during follow‐up for 12 and 41 months, respectively.
Three Years' Follow‐up of Members of a Swedish Commercial Weight‐Reducing Club
Authors: Hylander Britta , Rössner Stephan
Published: August 2010

ABSTRACT. The weight changes of 676 members of a commercial weight‐loosing club were analysed and a questionnaire was given to a subgroup of 150 participants. The median age at entry was 48 years. The Broca index (kg/cm ‐ 100) ranged from 0.85 to 1.70. Only 15 males participated. The initiative to join the club came from the member herself in 59% of the cases; only 3% were referred by a physician. The drop‐out frequency during an 8‐week “Slim Club” course was 55%. Members who participated in more than 4 of the 8 weekly sessions had a mean weight loss of 6.2 kg (range 0.5–15). Members with higher initial weights lost more than those who were less overweight. The mean cost of each kg lost was about 40 Sw. cr./kg (≅9 US$). After 3 years, 367 members could be contacted for an interview. Their initial mean weight (± S. D.) was 76.1±9.8 kg. After the initial course the mean weight was 70.5±9.4 kg (p<0.001). Three years later the reported mean weight was 72.3±10.1 kg (p<0.001 versus initial weight). Thus even a short course may have significant long‐term effects on weight loss. The weight‐reducing club may therefore be a helpful tool in the treatment of overweight subjects.
Is Maintenance Digoxin Necessary in Geriatric Patients?
Authors: Boman Kurt , Allgulander Swante , Skoglund Märta
Published: August 2010

ABSTRACT. Digoxin therapy was withdrawn over a four‐year period in the geriatric wards of Skellefteå Hospital, if the indications for it were not clear, the medication was of doubtful value and there were no contraindications to withdrawal. Contraindications comprised symptoms of cardiac failure at rest or during light physical activity, X‐ray signs of pulmonary congestion, a proven need for digoxin therapy following earlier withdrawal, or atrial fibrillation with a ventricular rate higher than 95 beats/min. A patient, who within two months presented signs of cardiac failure or an arrhythmia requiring digoxin, was considered to be in need of digoxin. Digoxin was withdrawn from a total of 141 patients, of whom 134 were examined after two months. According to our criteria, 108 (81 %) of these 134 patients did not require digoxin treatment.
Cor Pulmonale due to Tumor Cell Embolization
Authors: Kupari Markku , Laitinen Liisa , Hekali Pauli , Luomanmäki Kimmo
Published: August 2010

ABSTRACT. Pulmonary hypertension due to tumor emboli is a rare complication of malignant diseases. We present a patient in whom symptoms and signs of acute cor pulmonale were caused by tumor cells and carcinomatous endarteritis occluding the pulmonary microvasculature. A concise review of the previous literature is also presented.
Hemoperfusion in Quinidine Intoxication
Authors: Haapanen E. J. , Pellinen T. J.
Published: August 2010

ABSTRACT. A case report on quinidine intoxication is presented. After having ingested 8.1 g quinidine the patient had clinical and ECG signs of a severe intoxication and a serum quinidine level of 8.5 mg 1. She was treated for six hours with charcoal hemoperfusion. Serum quinidine was on an average 36% lower after than before the cartridge. The mean quinidine clearance of hemoperfusion was 24 ml/min. All clinical and ECG signs of quinidine intoxication were normalized during hemoperfusion. The data justify that hemoperfusion is probably the best way to treat severe quinidine intoxication.
Δ4‐Ethylestrenol in Recurrent Deep Venous Thrombosis
Authors: Nilsson Bengt , Nilsson Inga Marie , Hedner Ulla
Published: August 2010

ABSTRACT. In a study of 21 patients with recurrent venous thrombosis and/or thrombophlebitis, fibrinolytic activity measured after venous occlusion was significantly improved after treatment with 6 mg Δ4‐ethylestrenoI (Orgabolin®) daily. Seven of the 21 patients had abnormally low vessel wall plasminogen activator content, which normalised during treatment. No tendency to develop resistance to the drug was observed during treatment for periods up to 56 months. This improvement was shown to be combined with a significantly lower (p > 0.001) incidence of thrombosis.
Assessment of Thyroid Function in Chronic Alcoholics
Authors: Kallner Gunnar
Published: August 2010

ABSTRACT. The clinical manifestations in chronic alcoholics may sometimes mimic those of hyperthyroidism. However, diagnostic aids are somewhat contradictory in many cases. Ten chronic alcoholics with symptoms from the sympathoadrenal system were investigated. A significant increase (p > 0.01) of T3 at 120 min after TRH stimulation was found despite a blunted TSH response (increment <3 mU/l) in some cases. This increase in T3 indicates a preserved thyroid function in chronic alcoholics despite generally low basal T3 levels. It is concluded that T3 determinations at 120 min in connection with TRH test may be an essential parameter in evaluating euthyroid function in chronic alcoholics.
Glomerulonephritis in Infections with Yersinia Enterocolitica O‐serotype 3
Authors: Friedberg M. , Denneberg T. , Brun C. , Larsen J. Hannover , Larsen S.
Published: August 2010

ABSTRACT. In a consecutive series of 38 patients with acute glomerulonephritis (GN), 17 showed serological or immunological signs of current or previous yersiniosis. None of these 17 patients had raised antistreptolysin‐o titres. Only half of these patients had had clinical symptoms of Yersinia infection. Light microscopic examination revealed that 12 of the 17 patients had proliferative and 4 epimembranous GN. In 8 out of 14 biopsy specimens, Yersinia antigen could be demonstrated by immunofluorescence microscopy at the same site as immunoglobulins and complement. Immunofluorescence microscopic examination of all biopsy specimens containing sufficient tissue for a valid analysis showed deposits of complement and immunoglobulin G, most specimens also immunoglobulins A and M. It is considered highly likely that Y. ent. O:3 may be, and frequently is, an etiological factor for development of acute GN. It would be advisable not only to investigate all patients with acute GN for streptococcal infections, but also to carry out serological and bacteriological tests for Y. ent. O: 3 infection and to institute an active therapeutic approach to acute infections caused by this bacterium.
Frequency and Distribution of Long‐Term ECG‐recorded Cardiac Arrhythmias in an Elderly Population
Authors: Abdon Nils‐Johan
Published: August 2010

ABSTRACT. The prevalence of serious episodic cardiac arrhythmias known to correlate with cerebral symptoms was investigated in 103 elderly, randomly selected persons with the aid of 22 hours of long‐term ECG recording (LTER). Twelve of 26 subjects with dizziness/syncope had serious episodic arrhythmias compared with 5 of 77 subjects without these symptoms. This difference is significant (p > 0.001). Five patients fulfilled strict criteria for pacemaker treatment of symptomatic bradycardias. Three had the sick sinus syndrome and two had third degree atrioventricular block. In 4 subjects, drugs were withdrawn due to bradycardia; and 4 were treated for tachyarrhythmias. Despite the finding of minor arrhythmias in almost all asymptomatic subjects, it is concluded that serious episodic arrhythmias in the elderly are related to cerebral symptoms. It is also concluded that these arrhythmias are more common than previously believed and that LTER should be widely used.
Effect of Peroral Thiamine Treatment on Thiamine Contents and Transketolase Activity of Red Blood Cells in Alcoholic Patients
Authors: Waldenlind Lennart , Borg Stefan , Vikander Britt
Published: August 2010

ABSTRACT. The thiamine contents, transketolase activity and “thiamine diphosphate effect” (TDP effect) of the transketolase activity were measured in the blood of alcoholic patients during withdrawal, before and after thiamine administration (50 mg) for 10 days. The results were compared with those of healthy volunteers. The alcoholic patients showed significantly lower thiamine contents, lower transketolase activity and higher TDP effect in the blood than the healthy volunteers. These biochemical parameters were not significantly changed after 10 days without any exogenous thiamine supplement except the hospital diet. When thiamine was administered in a dose of 50 mg for 10 days, the TDP effect normalized. The transketolase activity and thiamine contents, however, were only slightly increased, probably due to the fact that the apo‐enzyme content and the thiamine‐binding capacity were lower in the blood of the alcoholics. Thus the TDP effect seems to reflect the relative biochemical deficiency while transketolase activity and thiamine contents seem to be dependent on the amount of apo‐enzyme and on the thiamine‐binding capacity as well as the degree of thiamine deficiency.
Prolonged Clonidine Treatment: Catecholamines, Renin Activity and Aldosterone Following Exercise in Hypertensives
Authors: Manhem Per , Hökfelt Bernt
Published: August 2010

ABSTRACT. Eight patients with essential hypertension, WHO grade I—III, were studied under standardized conditions in a metabolic ward, before and after 8–20 weeks of treatment with clonidine in a maintenance dose of 300–600 μg/24 h. Before clonidine, plasma noradrenaline concentration (PNA), plasma adrenaline concentration (PA), plasma renin activity (PRA) and plasma aldosterone concentration (PAC) increased in response to standing and submaximal exercise for 20 min. PNA was positively correlated to pulse rate in the supine position (R = 0.74, p > 0.05) and the increase in PNA to the increase in pulse rate during exercise (min 10, R=0.73, p > 0.05; min 15, R=0.79, p > 0.05; min 20, R=0.74, p > 0.05). No other significant correlations were found between PNA, PA, PRA and PAC on the one hand and blood pressure (BP) and pulse rate on the other. Clonidine reduced BP, pulse rate, PNA and PRA under all conditions studied. PA was reduced in the upright position and in connection with exercise. PAC was reduced during clonidine after exercise but otherwise unaltered. The clonidine‐induced decrease in PNA was positively correlated to the decrease in diastolic BP both in the supine (R=0.76, p > 0.05) and in the upright (R=0.80, p > 0.05) position. Thus, long‐term clonidine treatment lowered the BP and pulse rate, at least partly by reducing sympathetic activity via a central mechanism. However, clonidine did not block the sympathetic reflex mechanisms engaged in the maintenance of BP in the upright position. During clonidine, the adrenaline values were lower than before treatment in the supine and in the upright position and also following exercise, indicating that clonidine exerts an inhibitory effect on the sympatho‐adreno‐medullary system.
Patient Report Validated against Prescription Records for Measuring Use of and Compliance with Antihypertensive Drugs
Authors: Enlund Hannes , Tuomilehto Jaakko , Turakka Hannu
Published: August 2010

ABSTRACT. Drug use and patient compliance in antihypertensive treatment were studied by interview and validated with prescription records in a Finnish population. The original study population consisted of 675 hypertensives identified in a 6.6% random survey of the 25–59‐year‐old population in 1972. At re‐examination in 1977, 310 of the 570 participants had then used antihypertensive drugs during the preceding year. Two thirds renewed prescriptions appropriately within 70% of the correct time (considered as good compliance). Prescription filling patterns of the re‐examination non‐participants did not differ from those of the participants. Eight per cent of the participants reported not having followed prescription instructions. There was 94 % agreement between the re‐examination and prescription records; 5% reported taking fewer drugs than the records showed and 1% reported taking more. Drug history given by the patient gave accurate information about the number and type of drugs in use. However, patient interview gave an overestimation of compliance.
Hypouricaemia and Inappropriate Secretion of Antidiuretic Hormone in Small Cell Bronchogenic Carcinoma
Authors: Østerlind Kell , Hansen Mogens , Dombernowsky Per
Published: August 2010

ABSTRACT. Hypouricaemia has been observed in patients with the syndrome of inappropriate secretion of antidiuretic hormone (IADH). Accordingly, 69 patients with untreated bronchogenic small cell carcinoma were examined for IADH. Serum urate was also measured. IADH was proven in 25 (35%) of the 69 patients. The median serum concentration of urate in these patients was 0.26 mmol/l (range 0.13–0.50), compared to 0.36 mmol/l (0.21–0.60) in the 44 patients wihtout IADH. The difference is statistically significant (p > 0.01), but serum urate—when used alone—is lacking in both sensitivity and specificity for the diagnosis of IADH.
The Folic Acid Absorption Test Compared with Other Laboratory Tests for Malabsorption
Authors: Elsborg Lars
Published: August 2010

ABSTRACT. In 25 patients with malabsorption, the folic acid urinary excretion (TRIFA) test was compared with the degree of steatorrhoea, the Schilling test, and the D‐xylose test. No correlation was found between the faecal lipid excretion, the Schilling test, and the TRIFA test, whereas the TRIFA test did correlate fairly well with the D‐xylose test. It is concluded that the TRIFA test does not replace estimations of faecal lipid excretions in the diagnosis of intestinal malabsorption. As it mainly supplies information about absorptional capacity in the upper small bowel, it is complementary to the Schilling test, which chiefly measures the absorption in the lower intestine. Finally, the TRIFA test has several advantages over the D‐xylose test in practical clinical use.
Toxic Hepatitis Induced by Disulfiram in a Non‐Alcoholic
Authors: Kristensen Mette E.
Published: August 2010

ABSTRACT. A reversible toxic liver damage was observed in a non‐alcoholic woman treated with disulfiram. The causative relationship was proven by challenge.
Prognosis of Giant Cell Arteritis Including Temporal Arteritis and Polymyalgia Rheumatica
Authors: Bengtsson Bengt‐Åke , Malmvall Bo‐Eric
Published: August 2010

ABSTRACT. Ninety patients with giant cell arteritis (GCA) were followed 3–10 years after the diagnosis. The mean observation time was 63 months. Thirteen patients died. Corticosteroids were administered to all but one patient; 35 were still on treatment after a mean observation period of 59 months. In 38 patients, 94 flare‐ups of the disease were recorded during corticosteroid treatment, most of them occurring during the first year of treatment and when a low dose of prednisolone had been given. Thirty‐three relapses, 76 % within 3 months, occurred in 28 patients after withdrawal of treatment. One patient relapsed after more than ten years of disease. Polymyalgia rheumatica was the most common symptom of flare‐up or relapse, regardless of the clinical picture at the time of diagnosis. The duration of treatment should be individualized. One year of treatment is enough in a few patients, whereas others need steroid therapy for more than four years. The rate of intercurrent disease and complications of GCA or its treatment was low. No patient developed severe eye damage due to GCA. The mortality rate was in fact lower than expected with regard to age and sex.