bluuebunny/crossref_metadata_2025 huggingface dataset:
Sudden Death Precipitated by Psychological Stress
Authors: Olsson Gunnar , Rehnqvist Nina
Published: August 2010

ABSTRACT. A 70‐year‐old man, taking part in a post infarction study, died suddenly out of hospital while Holter‐monitored. Death was preceded by immediate major psychological stress but there were no cardiac symptoms. ECG showed a 15 min period of sinus tachycardia with increased ventricular ectopic activity prior to the initiation of ventricular fibrillation. There were no signs of recent myocardial damage at autopsy. It is proposed that an increased catecholamine stimulation due to psychologic stress, in combination with myocardial ischemia, may have precipitated the fatal arrhythmia.
Plasma Insulin and C‐peptide in Normal and Glucose Intolerant Males: the Role of Hepatic Insulin Uptake
Authors: Malmquist J. , Lindgärde F. , Nordén G.
Published: August 2010

ABSTRACT. Plasma immunoreactive insulin and C‐peptide were measured in the basal and glucosestimulated state in middle‐aged males. Normals were compared with individuals with mild to moderate glucose intolerance. The results demonstrate the value of C‐peptide measurements in the assessment of “true” insulin secretion and suggest that a reduced hepatic insulin extraction is a feature of the glucose intolerant state.
Chlorpropamide‐alcohol Flushing in Relation to Macroangiopathy and Peripheral Neuropathy in Non‐insulin Dependent Diabetes
Authors: Jerntorp P. , Almér L.‐O.
Published: August 2010

ABSTRACT. Seventy patients with non‐insulin dependent diabetes (NIDD) were studied for the chlorpropamide‐alcohol flush (CPAF), first degree family history of diabetes, macroangiopathy and for peripheral neuropathy. Positive CPAF challenge tests were found in 65% of the tested subjects and in 77% if there was a family history of diabetes. Signs of macroangiopathy (loss of foot pulses) were significantly (p<0.05) less common in the CPAF positive than in the CPAF negative diabetics with a duration of diabetes of ten years or less. With a longer duration this difference between the two groups was reduced. Also signs of peripheral neuropathy (abnormal vibration sense) were less common (p<0.05) in the CPAF positive diabetics than in the CPAF negative. Previously a low prevalence of retinopathy in the CPAF positive non‐insulin dependent diabetics has been reported. We have shown that this is also true of peripheral macroangiopahy and peripheral neuropathy. Chlorpropamide‐alcohol flushing seems to be related to a relative protection against late complications in diabetes and the test might be used to find patients at risk.
Influence of a Psyllium‐based Fibre Preparation on Faecal and Serum Parameters
Authors: Burton R. , Manninen V.
Published: August 2010

ABSTRACT. A fibre made of psyllium husk was given to 12 elderly patients for 4 months in order to investigate their faecal output and selected serum parameters. The fibre significantly improved bowel function and faecal output confirming its value as a non‐irritant, harmless bulk‐forming laxative. Serum cholesterol was decreased by 20% while triglycerides remained unchanged. There was a significant reduction in serum calcium after withdrawal of the fibre supplement. There were no significant changes in serum iron, total iron binding capacity, fibrinogen, or in the haematological parameters (ESR, haemoglobin, leucocyte count) attributable to the fibre. The high phytate content of the fibre does not appear to have any clinically significant effect on mineral absorption. It is suggested that dietary fibre (at least psyllium‐based fibre preparations) may have significant cholesterol lowering capacity due to the binding of bile‐acids in the intestine.
Potassium and Magnesium Balance in Thiazide‐Treated Cardiac Patients with Special Reference to Diet
Authors: Kohvakka Antti , Heinonen Liisa , Pietinen Pirjo , Salo Hannu , Eisalo Antti
Published: August 2010

ABSTRACT. One hundred and four digitalized patients with chronic heart failure (71 females, 33 males, mean age 62 years) earlier treated with diuretics were administered 50 mg hydroclorothiazide b.i.d. for six weeks. Serum potassium and magnesium values and ECG were followed throughout the study. Total body potassium was determined at the end. Serum potassium fell below 3.6 mmoll‐1 in 46% of the patients during the treatment. Hypokalemia (S‐K ≤ 3.5 mmoll‐1) was more common in females, in patients with initially low potassium values and in patients with a simultaneous concomitant decrease in serum magnesium values. The ECG‐changes and symptoms of defective potassium balance were attributable to serum potassium rather than to total body potassium. There were no differences in total body potassium nor in the daily dietary intake of potassium and magnesium between normokalemic and hypokalemic patients. The daily dietary intake seems sufficient to maintain normokalemia if a patient has no tendency to develop hypokalemia. On the other hand, subjects prone to hypokalemia should be administered potassium supplementation or potassium sparing agents. Some patients seem to require magnesium supplementation, too, in order to maintain their potassium balance.
Tienilic Acid in Patients with Impaired Renal Function
Authors: Eisalo A. , Tötterman K. J. , Haapanen E.
Published: August 2010

ABSTRACT. Diuretic therapy is usually accompanied by biochemical changes, such as hypokalemia, impaired glucose tolerance and hyperuricaemia. Tienilic acid is a new long‐acting diuretic with antihypertensive effect, combined with uricosuric property. For the purpose of evaluating the effect of tienilic acid in patients with impaired renal function, eleven patients with hypertension and slight to moderate renal impairment were randomized to either hydrochlorothiazide or tienilic acid therapy. During eight weeks of treatment no changes occurred in serum‐creatinine, creatinine‐clearance, serum‐sodium, or urea. Despite renal impairment, serum uric acid decreased during tienilic acid treatment. Compared with placebo, a significant decrease in uric acid was seen as early as after one week of treatment (p < 0.01) and after 8 weeks the difference was still of the same order (p < 0.01). During hydrochlorothiazide therapy, serum uric acid increased progressively. The difference was p < 0.002 at 4 weeks and p < 0.0005 at 8 weeks of treatment, compared with placebo. The results of this study show that the uricosuric effect of tienilic acid is maintained in patients with mild to moderate renal impairment.
A Comparison of Two Cardioselective Beta‐Blockers with Different Ancillary Properties in the Treatment of Hypertension
Authors: Mänttäri M. , Eisalo A.
Published: August 2010

In a double‐blind crossover study the antihypertensive effect of acebutol (I.S.A. and M.S.A.) 400 to 800 mg daily was compared with that of metoprolol (non‐I.S.A. and non‐M.S.A.) 200 to 400 mg daily. Blood pressure and heart‐rate were measured sitting, lying and post‐exercise. Twenty‐eight patients entered the trial, but 4 were withdrawn for reasons not connected with active treatment. There was no significant difference between the drugs in their ability to reduce the systolic and diastolic blood pressure sitting, lying or post‐exercise or reduce the heart‐rate post‐exercise. Metoprolol reduced the heart‐rate sitting and lying to a significantly greater degree (p < 0.05) than acebutolol. While the antihypertensive effect seems to be entirely dependent on beta‐blockade, the I.S.A. may still have some value for patients with a low heart rate at rest.
β‐adrenoceptor blockade and physical activity: cardiovascular and metabolic aspects
Authors: Koch Günter , Franz Ingomar‐Werner , Gubba Angelika , Lohmann Friedrich Wilhelm
Published: August 2010

ABSTRACTThis paper assesses mechanisms that may contribute to the higher incidence of increased muscle fatigue during exercise and reduced exercise performance as observed with selective compared with non‐selective β‐adrenoceptor antagonists. Published data and the results obtained in 8 healthy subjects (mean age 23 years) studied before and after acute β‐adrenoceptor blockade with pindolol (nonselective, 10 mg) and metoprolol (β1‐receptor selective, 100 mg) suggest that the differences in the cardiovascular and respiratory effects between the 2 types of antagonists are marginal and cannot explain the discrepancies concerning exercise perception and performance. Conversely, basic differences between the 2 types of antagonists were shown in different groups of hypertensive men (mean age 32 years) studied before and after 4 weeks of treatment with pindolol (15 mg), and with metoprolol (200 mg) and acebutolol (cardioselective, 500 mg), by single crossover technique. Whereas lipolysis was similarly inhibited by both selective and non‐selective antagonists, hypoglycaemia occurred only under nonselective blockade. It apparently reflects the inhibition of glycogen breakdown; concomitant rises in plasma adrenaline and ACTH probably reflect counter‐regulatory mechanisms.
Etiology of Mild Acute Infectious Myocarditis
Authors: Karjalainen Jouko , Heikkilä Juhani , Nieminen Markku S. , Jalanko Hannu , Kleemola Marjaana , Lapinleimu Kaisa , Sahi Timo
Published: August 2010

The etiology of mild myocarditis, diagnosed on the basis of serial ECG changes during an acute infection, was studied in 126 consecutive conscripts. A fourfold rise in the antibody titers in the paired serum samples was required for a positive etiologic diagnosis. An etiologic diagnosis was made probable in 47 % of the patients. Adenovirus was incriminated in 19 patients, vaccinia in 12, influenza A in eight, β‐hemolytic Streptococcus in six, mononucleosis in five and Mycoplasma in three. Chlamydia, influenza B and Coxsackie B4 were each found in two patients; parainfluenza, mumps and adult Still's disease were each found in one patient. The incidence of vaccinia myocarditis was 1/10000 smallpox vaccinations. Clear‐cut myo‐pericarditis was usually noted during vaccinia, mononucleosis, Mycoplasma, Chlamydia and Coxsackie B4 infections. Adenovirus and influenza A myocarditis was most often subclinical, being mostly detected only because of ECG screening of patients without cardiac symptoms. Frequent recent ventricular extrasystoles were most often triggered by a β‐hemolytic Streptococcus infection. The etiology of infectious myocarditis seems to reflect the overall profile of viruses and other infective agents in the study population at that particular time. Cardio‐trophic viruses such as Coxsackie B only rarely cause myocarditis outside epidemics.
Self‐Poisoning with Prazosin
Authors: Rygnestad Tarjei K. , Dale Ola
Published: August 2010

A 75‐year‐old man ingested 80 mg prazosin 3 hours before admission to hospital. On admission, plasma prazosin level was 2350 nmol/l—more than 20 times the maximum level after a therapeutic single dose of 5 mg. Supportive treatment was given and the patient made an excellent recovery. This case indicates that prazosin is a drug with low acute toxicity.
Treatment of Gastroduodenal Ulcers with Cimetidine in Combination with Low‐Dose Propantheline
Authors: Paerregaard Anders , Hendel Lene , Schultz‐Larsen Kirsten , Tobiasen Klaus , Mosbech Johannes
Published: August 2010

ABSTRACT Fifty‐eight adult outpatients with endo‐scopically verified gastric, prepyloric or duodenal ulcers completed a double‐blind trial of treatment with either Cimetidine, 1 g daily, plus propantheline, 45 mg daily (group A) or Cimetidine, 1 g daily, plus placebo (group B). After neither three nor six weeks of treatment was there any significant difference between the two groups with regard to ulcer healing or symptomatic relief. The ulcers of 22 (79%) of the 28 patients in group A and 25 (83%) of the 30 patients in group B were healed after six weeks, and 93 % of the patients in both groups became painfree. We were thus not able to show any advantage in combining Cimetidine treatment for ulcer healing with low‐dose propantheline. In a small open trial the patients with healed ulcers received prophylactic treatment for 12 months with 1) Cimetidine 800 mg daily, 2) Cimetidine 400 mg at bedtime plus propantheline 45 mg daily or 3) propantheline 90 mg daily. No significant differences were found between the ulcer recurrence rates, but it cannot be excluded that a larger number of patients in each group might have yielded real differences.
The Drug‐Consuming Patient and His Drugs
Authors: Holmberg L. , Böttiger L. E.
Published: August 2010

ABSTRACT The drug consumption pattern and patients' knowledge about their drugs have been studied in 506 patients, acutely admitted to hospital. The patients took a mean of 3.2 drugs before hospitalization, the majority of them being used for more than one year. Calculated on all 506 interviewed patients, women took more drugs than men, but among the 406 users there was no significant difference in the number of drugs taken by men or women. The number of drugs increases markedly with age. The drugs most commonly used were digoxin (30% of the patients), nitrazepam (19%), furosemide (18%), potassium (17%) and nitroglycerin (14%). Dosage reduction with advancing age was registered i.a. for digoxin. Judging from the number of adverse drug reactions (ADRs) and subjective side‐effects, the dosage reduction should probably have been even greater. Twenty‐six patients (5 %) were admitted because of an ADR, another 10 (2 %) with an ADR. For the majority of drugs (84 %) the patients had some understanding of the expected effect, but knowledge about possible side‐effects was reported for 26 % of the drugs only.
Effects of Dietary Fiber Intake before Meals on Weight Loss and Hunger in a Weight‐Reducing Club
Authors: Hylander Britta , Rössner Stephan
Published: August 2010

ABSTRACT The effects of dietary fiber on subjective hunger ratings and weight losses were studied in 135 members of a weight loss club. After a run‐in week, 100 members were randomly given one sachet of either bran or ispaghula granulate before meals for two weeks. Thirty‐five controls only rated hunger. One hundered and eight members completed the trial: 23 controls, 45 on ispaghula and 40 on bran. No change in hunger ratings was found in the controls. Both fiber preparations lowered hunger ratings during weeks 2 and 3 compared to the run‐in week. Ratings were similarly reduced at all meals. The mean (±SD) weight reductions during the trial were 4.6±2.7 kg for the controls, 4.2±3.2 kg for the ispaghula group and 4.6±2.3 kg for the bran group (p>0.05 for all). In spite of recent changes in the diet towards food rich in dietary fibers, addition of extra dietary fiber immediately before meals reduced hunger feelings but had no effect on weight reduction.
Non‐Traumatic Perforation of Gastric Ulcer in a Hiatal Hernia to the Pericardium
Authors: Sailing Niels , Falensteen Anne M. , Larsen Lise Grupe
Published: August 2010

ABSTRACT A patient with ulcer in a hiatal hernia with perforation to the pericardial sac is reported. The symptoms and signs of non‐traumatic perforation from esophagus or stomach to the pericardium or heart are described on the basis of a brief review of the literature. A prominent feature of our patient was long‐standing pain in the left shoulder. We suggest that this symptom may be a warning of threatening pericardial perforation.
Can Adequate Control of Diabetes Prevent the Development of Vascular Complications?:
Authors: Östman Jan
Published: August 2010

ABSTRACT. Altogether, histologic findings in animals and in man with diabetes mellitus, together with clinical findings in man with this disease and with biochemical abnormalities, suggest that the main cause of microangiopathy in persons with diabetes mellitus lies in metabolic disorders. The possibility that genetic and environmental factors are influential cannot, however, be ruled out. In a small although steadily increasing number of diabetics early microangiopathic and neuropathic abnormalities have proved to be reversible. This improvement includes functional abnormalities of the retina, glomeruli and nerves. Early morphologic changes of the retina also, seem to be preventable. On the other hand, more severe morphologic' changes such as proliferative retinopathy, and severe diabetic neuropathy have proved resistant to intensified insulin treatment. It remains to establish whether continuous optimal control by insulin treatment generally can prevent early although clinical microangiopathy. The development of instruments and other aids for improved metabolic control, such as transplantation of insulin‐producing tissue, would seem to be a logical step in this direction.
Dietary Fibre in the Diabetic Diet
Authors: Philipson Henriette
Published: August 2010

ABSTRACT. The diabetic diet is still in its developing stage. The functions of the different fiber fractions is inadequately known. Today, we recommend the diabetic patient to have a high carbohydrate intake such as increasing the intake of starchy foods with higher fiber context. For example eating whole meal bread instead of white bread, eating fruits instead of drinking juice etc. It is also wise to increase fiber content in the diet by choosing high fiber content foods than to use supplements or fiber medications. With a high fiber diet, the diabetic patients can eventually decrease their insulin or tablet medication.
Intake of Drugs among Elderly People in a Danish Municipality, Rødovre
Authors: HENDRIKSEN CARSTEN , LUND ELLINOR , STRØMGÅRD EDITH
Published: August 2010

ABSTRACT. Drug intake has been studied among a random group of persons, aged 75 or over, in Rødovre Municipality. Two hundred and eighty‐three elderly persons living in their own homes have been visited and interviewed about their daily intake of prescribed and non‐prescribed drugs (including so‐called natural drugs). Similar information was gathered from 146 elderly persons living in nursing homes. Thirty‐one per cent of the elderly living in their own homes and 3% of those living in nursing homes did not use prescribed drugs daily. The median daily amount of different types of drugs used was 1.8 (range 0–10) for elderly persons living in their own homes and 4.5 (range 0–11) (p<0.001) for those living in nursing homes. Women living at home had a higher intake of drugs than men, especially diuretics. The most frequently used drugs were diuretics, sedatives/hypnotics, analgesics, digitalis and electrolytes. For all types of drugs a higher consumption, especially of phenothiazines, was found among elderly persons living in nursing homes. Drug consumption was independent of age and social stratification in both groups. The use of non‐prescribed drugs ranges from 0 to 9 different types in the group living in their own homes, and from 0 to 5 in the group living in nursing homes—laxatives being the type most frequently used.
The Day‐to‐Day Variation in Serum Digoxin Concentration
Authors: SERUP JØRGEN , HARTLING LENE , OVESEN JAN
Published: August 2010

ABSTRACT. Serum digoxin concentration was measured in 70 medical patients 7 and 8 days after admission to hospital. The digoxin treatment taken at home was continued in hospital. There was no statistically significant difference between mean digoxin concentrations in samples taken at day 7 (1.52 nmol/l) and day 8 (1.48 nmol/l). The variation in serum digoxin concentration from day to day expressed as SD was 0.25 nmol/l; 95% confidence limits were +0.51 nmol/1, and 99% confidence limits +0.67 nmol/1. Variations in serum digoxin concentration were not correlated to age, sex, body weight, serum creatinine and the oral dose of digoxin.
Digoxin and the Geriatric In‐Patient
Authors: BOMAN KURT
Published: August 2010

ABSTRACT. The effects of oral digoxin and placebo in 41 geriatric in‐patients were compared using a randomized, double‐blind, cross‐over method. The patients were in sinus rhythm or had atrial fibrillation. The observation period was two months on digoxin or placebo. Patients with symptoms of cardiac failure at rest or during light physical activity, X‐ray signs of pulmonary congestion, proven need of digoxin therapy following earlier withdrawal, atrial fibrillation with a ventricular rate >95 beats/min and patients in whom digitalis intoxication was suspected were excluded from the study. Five (14%) of 37 patients deteriorated during the placebo phase. Four of these developed rapid atrial fibrillation and one patient developed sinus tachycardia and symptoms of heart failure.
Screening of an Elderly Female Population for Hypo‐ and Hyperthyroidism by Use of a Thyroid Hormone Panel
Authors: FALKENBERG MELCHER , KÅGEDAL BERTIL , NORR ANDERS
Published: August 2010

ABSTRACT. The elderly female population living in a rural primary health care district in the south of Sweden was screened for hypo‐ and hyperthyroidism. A total of 1 442 (97.3 %) of the 1 482 women 60 years of age or older attended the study. By use of a computer‐evaluated thyroid hormone panel, 178 women (12.3%) were identified as probably abnormal. Among them, 8 women (0.55% of total) with previously unknown thyroid disease were detected as overtly hypothyroid. If also 13 women with spontaneous subclinical hypothyroidism were included, the prevalence of earlier unknown hypothyroidism was 21/1 442 (1.5%). The number of subjects with hyperthyroidism discovered by screening was 28/1 442 (1.9%). Although much remains to be elucidated regarding medical, social and economic factors, the high figures obtained for newly discovered abnormal thyroid function suggest that screening for hyper‐ and hypothyroidism may be worthwhile in such an elderly female population.
Familial Amyloidosis with Polyneuropathy
Authors: STEEN LARS , EK BÖRJE
Published: August 2010

ABSTRACT. In a longitudinal study, 21 patients with familial amyloidosis with polyneuropathy (FAP) were followed up for more than three years. Gastrointestinal symptoms ultimately evolved in all patients. In the advanced stage of the disease, 13 patients had diarrhea together with anal incontinence. Weight loss was very common and related to both malabsorption and motility disturbances with anorexia and also to muscular atrophy. Steatorrhea was found in 19 patients at least once during the follow‐up. The duration of the disease was significantly correlated to fecal fat output. The conclusion was drawn that the gastrointestinal involvement in FAP is very common and of great clinical importance. The consequences of malnutrition also influence the outcome of the disease.
Peripheral Responses to Thyroxine in Hypothyroid Subjects as a Function of Dose and Duration of Substitution
Authors: HYLANDER B. , ROSENQVIST U.
Published: August 2010

ABSTRACT The aim of this study was to explore the differences in normalization between different organ functions in hypothyroid patients during substitution. The study included 21 hypo‐thyroid patients who were substituted with gradually increasing doses of thyroxine (T4) and studied repeatedly for up to 20 or 32 weeks. The different peripheral organ functions were compared with regard to the dose and duration of substitution necessary for a 50 % therapeutic effect. The circulatory response to an orthostatic test, the decrease in low density lipoprotein cholesterol and thyroid stimulating hormone concentrations, the lipoly‐tic effect of physical exercise and the increase in triiodothyronine concentration showed a 50% response to substitution within 3.3–4.6 weeks of therapy and at a T4 dose of 0.04‐0.06 mg/day. In contrast, the 50% therapeutic effect on the lipolytic response to an intravenous l‐noradrenaline infusion and the maximal working capacity on ergometer bicycle was not observed until 6.2–9.0 weeks of therapy and T4 doses of 0.08‐0.11 mg/day. The differences observed in the peripheral responses might be of clinical importance when severely hypothyroid patients must be substituted rapidly.
Plasma Vasopressin, Cortisol, and Growth Hormone Concentrations in Relation to Surgery in the Suprasellar Region
Authors: SØRENSEN PER SOELBERG , HAMMER MOGENS , LINDHOLM JØRGEN , RIISHEDE JOHN
Published: August 2010

Abstract Posterior and anterior pituitary functions were assessed in 8 patients before, during, and after surgery for tumors in the suprasellar region. Preoperatively, all patients but one responded adequately to an osmotic stimulus with a rise in plasma vasopressin (AVP) and all but one showed adequate cortisol response to adrenocorticotropic hormone (ACTH) and hypoglycemia. During surgery a transient rise was seen in plasma levels of AVP (5 out of 8 patients), cortisol (7 out of 8 patients) and growth hormone (4 out of 8 patients). This response could be predicted from the preoperative stimulation tests. Postoperatively the AVP response to osmotic stimuli was impaired in 4 out of 5 patients, although urine volume had returned to normal after a transient polyuric phase. The response of plasma cortisol to ACTH was still adequate but lower than preoperatively.
Improved Cardiac Performance during Exercise Following Hydralazine Treatment in Chronic Heart Failure
Authors: CONRADSON THOR‐BJØRN , RYDÉN LARS
Published: August 2010

AbstractNine male patients with stable chronic heart failure of different etiology and optimally treated with digoxine and diuretics were given hydralazine. 50 mg b.i.d., during three months. Hemodynamic parameters were evaluated during upright submaximal exercise. An increase in cardiac index due to an increased stroke volume was noted following the first dose of hydralazine. After three months' treatment, cardiac index was further increased. The arteriovenous oxygen difference was initially unchanged, but significantly decreased following long‐term treatment. These findings may indicate different effects of hydralazine acutely and after long‐term treatment. It is suggested that the initial increase in blood flow is directed mainly to regions other than the exercising muscles, while more blood is directed to the muscles after long‐term treatment. A possible mechanism to explain this postulated difference is discussed.
Serum Level of Complement Factor D in Systemic Lupus Erythematosus—an Indicator of Glomerular Filtration Rate
Authors: STURFELT G. , TRUEDSSON L. , THYSELL H. , BJÖRCK L.
Published: August 2010

Abstract Serum levels of complement factor D, a low molecular weight (LMW) protein, were high and inversely correlated with glomerular filtration rate (GFR) determined in 19 patients with lupus glomerulonephritis (LGN). Factor D was significantly closer correlated with S‐creatinine than were two other LMW proteins, β2‐microglobulin and γ‐trace in 22 LGN patients. Close correlations between each of the LMW proteins and S‐creatinine were found in patients with a non‐inflammatory disorder, polycystic kidney disease. Slightly increased β2‐microglobulin concentrations were found in 15 of 20 systemic lupus erythematosus (SLE) patients without renal involvement, while factor D and γ‐trace showed normal values in most of these patients. The findings imply that serum concentrations of complement factor D in SLE are mainly determined by the GFR.
Responses of Plasma Catecholamines to Tilt in Patients with Diabetes Mellitus
Authors: SUNDKVIST GÖRAN , LILJA BO , MANHEM PER , ALMÉR LARS‐OLOF
Published: August 2010

Abstract The immediate heart rate acceleration, blood pressure reaction, plasma adrenaline (PA), and plasma noradrenaline (PNA) responses to a 90° and 2 sec tilt were evaluated in 13 male patients with type I diabetes. A disturbed immediate acceleration, as measured by a previously described acceleration index (AI), was found in 5 patients. All patients with normal AI but only one of those with abnormal AI showed an increase in PA during the first minute after tilt (p<0.02). A late diastolic blood pressure fall occurred in 6 patients and the fall was minor (5 mmHg) in 5 of these. Patients with a late diastolic blood pressure fall showed a significantly lower increase in PNA 1–8 min after tilt than those without (55+13% versus 163+24% (mean + SE), p<0.005). An abnormal immediate acceleration to tilt is associated with an impaired sympatho‐adrenal reaction, and even a minor diastolic blood pressure fall indicates peripheral sympathetic denervation.
Nicholson Score for Prescribing Digoxin Compared with Jellife Nomogram
Authors: SERUP JØRGEN , HARTLING LENE , OVESEN JAN
Published: August 2010

Abstract A series of 84 medical inpatients were treated in random order with oral digoxin in doses calculated according to the newly introduced Nicholson score and the Jellife formula and nomogram. The daily dose of digoxin was lower (p<0.01) according to the Nicholson score (mean 2.1 digoxin tablets of 62.5 μg daily). The mean serum concentration of digoxin was also lower (p<0.01) according to the Nicholson score (1.27 nmol/l) than according to the Jellife nomogram (1.84 nmol/l). Estimated by the Nicholson score the serum concentration of digoxin was not optimal (p<0.01) and not within an acceptable therapeutic range (p<0.01) in more patients than when estimated by the Jellife nomogram. It is concluded that the Nicholson score is not suitable for medical inpatients.
Venous Volume in Offspring of Hypertensive Patients
Authors: SALLERFORS B. , NORDENFELT I. , OHLSSON O.
Published: August 2010

AbstractTwenty normotensive healthy male offspring of hypertensive patients were compared to 20 adequate controls regarding venous volume, the effect of ouabain on venous volume and signs of left ventricular hypertrophy. Among offspring there were slightly increased amplitudes in the orthogonal ECG as compared to controls but the differences were not statistically significant. Using a plethysmographic technique we found a significantly lower venous volume of the forearm in the offspring than in controls. There was, however, no effect of ouabain on the venous volume. The decreased venous distensibility among normotensive offspring might be an early manifestation of essential hypertension.
Survival in End‐stage Diabetic Renal Disease
Authors: Larsson Owe , Attman Per‐Ola , Aurell Mattias , Frisk Bengt , Brynger Hans
Published: August 2010

Abstract The results of renal transplantation in patients with diabetes mellitus were studied in 100 consecutive patients transplanted between Dec. 1972 and June 1982. The study period was divided into two parts, 1972–76 (era I, 21 patients, 18 with juvenile onset diabetes) and 1977–82 (era II, 79 patients, 72 with juvenile onset diabetes). A group of 168 non‐diabetic patients, aged 20–54 years, receiving primary grafts during the same period served as controls to the 72 juvenile onset diabetics from era II. The three‐year actuarial patient survival of transplanted diabetics improved from 48 % during era I to 76 % during era II and was then not significantly inferior to that of the non‐diabetic controls. The three‐year actuarial graft survival rate was significantly higher for recipients of kidneys from living related donors than for those who had received kidneys from cadaveric donors (CD) among both diabetic and non‐diabetic patients. However, the three‐year graft survival rate was significantly higher (56%) for non‐diabetic than diabetic CD recipients (37%). The overall survival in diabetes mellitus was strongly influenced by the outcome of retransplantation during era II (12 patients). Thus, 69 patients were alive, 64 with a functioning graft, at the end of the observation period.
Purine Metabolizing Enzymes in Lymphocytes from Patients with Solid Tumors
Authors: MEJER JOHANNES , HØRBOV STEEN , NYGAARD PER
Published: August 2010

ABSTRACT The activities of five clinically important enzymes of purine metabolism have been determined in lymphocytes from 62 patients with various types of solid tumors. The activity of purine nucleoside phosphorylase was increased in all patient groups studied, i.e. small cell bronchogenic carcinoma (n=30), carcinoma of the breast (n=17) and other tumors (n=15), compared to cells form normal donors. Activities of adenosine deaminase, adenine phosphoribosyltransferase (APRT), hypoxanthine (guanine) phosphoribosyltransferase (HGPRT), and 5′‐nucleotidase (5′‐NUC) vary little from control values, except for lower levels of APRT in lymphocytes from patients with carcinoma of the breast. In patients with small cell bronchogenic carcinoma, enzyme levels were also determined in granulocytes, where increased APRT activity was found. Following cytostatic treatment of these patients, significant decreases were seen in lymphocytic HGPRT and 5′‐NUC activities.
Electrocardiographic Prediction of the Severity of Aortic Valvular Stenosis
Authors: FORSSELL GUNILLA , JONASSON RUNE , NORDLANDER ROLF , ORINIUS ERIK
Published: August 2010

ABSTRACT The ECG at rest and at 4 min after a symptom‐limited exercise test was studied in 52 patients who were catheterized because a significant aortic valvular stenosis was suspected. The calculated valve area ranged from 0.2 to 1.1 cm2/m2 BSA. QRS amplitude criteria did not discriminate between slight and severe stenoses but a negative or biphasic T wave in lead V6 did, especially after exercise. Thirty‐three of the 37 patients with an area of 0.5 cm2/m2 BSA showed negative/biphasic TV6 after exercise but only 4 of the 15 with an area of 0.6 cm2/m2 BSA. Thus, this criterion had a sensitivity for stenoses 0.5 cm2/m2 BSA of 89%, a specificity of 73% and a predictive value of a positive test of 89% (the pre‐test likelihood being 71%). The left ventricular pressures measured during supine exercise in 38 patients did not correlate to the TV6 patterns after exercise.
Increased Plasma Vasopressin and Serum Uric Acid in the Low Renin Type of Essential Hypertension
Authors: SKJØTØ JOHN , AAKESSON INGVAR , OS INGRID , KJELDSEN SVERRE ERIK , EIDE IVAR , LEREN PAUL
Published: August 2010

ABSTRACTIn 22 50‐year‐old men with long‐standing, untreated essential hypertension of the low renin type, venous plasma vasopressin concentrations were about three times those of 15 matched normotensive control subjects (p<0.005). These patients also had increased arterial concentrations of noradrenaline and adrenaline (p<0.05) but there was no direct association between these two catecholamines and vasopressin. On the other hand, adrenergic β‐receptor blockade with oxprenolol reduced both blood pressure and plasma vasopressin (p<0.01) while venous plasma dopamine concentrations significantly increased. In addition, the hypertensives had highly significantly increased serum uric acid (p<0.001) that correlated positively with venous vasopressin concentrations (p<0.05). According to these data, patients with the volume‐sustained low renin type of essential hypertension have increased plasma vasopressin concentrations that probably are inversely related to dopaminergic nervous activity. The data also indicate that increased plasma vasopressin correlates with serum uric acid, most probably through increased tubular reabsorption of this acid.
Hypothermia and Infection in Wernicke's Encephalopathy
Authors: HANSEN B. , LARSSON C. , WIRÉN J. , HALLGREN J.
Published: August 2010

ABSTRACT Two cases of acute Wernicke's encephalopathy with severe hypothermia as the major presenting feature are reported. Treatment with thiamine was rapidly introduced, but hypothermia nevertheless persisted for several weeks, at times masked by intercurrent infections.
Mycoplasmal Pneumonia Associated with Mesangiocapillary Glomerulonephiritis Type II (Dense Deposit Disease)
Authors: VON BONSDORFF MARTIN , PÖNKÄ ANTTI , TÖRNROTH TOM
Published: August 2010

ABSTRACT A 20‐year‐old man developed pneumonia and glomerulonephritis concomitantly with significantly rising Mycoplasma pneumoniae complement‐fixing antibody titres. Renal biopsy showed mesangiocapillary glomerulonephritis type II (dense deposit disease). Attempts to demonstrate mycoplasmal antigen in the glomeruli failed. This is the third of five previously reported cases of glomerulonephritis associated with Mycoplasma pneumoniae and exhibiting dense deposit disease.
Comparative Investigation of the Antiarrhythmic Effect of Propafenone (Rytmonorm) and Lidocaine in Patients with Ventricular Arrhythmias during Acute Myocardial Infarction
Authors: REHNQVIST NINA , ERICSSON CARL‐GÖRAN , ERIKSSON SVEN , OLSSON GUNNAR , SVENSSON GÖRAN
Published: August 2010

ABSTRACT Propafenone, a new class I antiarrhythmic drug, given as a bolus injection followed by oral medication, or lidocaine were given to 20 consecutive patients admitted with chest pain suggesting acute myocardial infarction and showing high grades, i.e. multiform, pairs or R‐on‐T premature ventricular complexes or short runs of ventricular tachycardia. Before institution of therapy the mean number (±1 SD) of premature ventricular contractions (PVCs) per hour was 169±123 in the lidocaine group and 324±440 in the propafenone group. During the next 24 hours lidocaine reduced the numbers of PVCs by 73% and propafenone by 75%. The mean number (±1 SD) of 5‐minute periods with high grade PVCs was 4.3±2.9 in the lidocaine group and 5.8±4.5 in the propafenone group. During therapy this number was equally reduced in both groups to 2.4. One patient in the lidocaine group developed ventricular fibrillation and three patients in the propafenone group were excluded because of increasing numbers of PVCs. One patient in the propafenone group showed a torsade‐de‐pointes ventricular tachycardia.
Collagenous Colitis
Authors: MOGENSEN ANNE M. , OLSEN JENS HENNING , GUDMAND‐HØYER EIVIND
Published: August 2010

ABSTRACT Collagenous colitis is a very rarely recognized disease characterized clinically by watery diarrhoea and histologically by a broad, band‐like deposition of collagen under the surface epithelium of the colon and rectum. Two cases of collagenous colitis are reported in this paper. After treatment of one of the patients with metronidazole, the symptoms cleared up and biopsy specimens from the colon showed regression of the pathological picture. The pathogenesis of the diarrhoea is discussed. The aetiological agent seems to be infectious, but is still unknown.
Behçet's Disease and Close Contact with Pigs
Authors: LARSSON HANS , BENGTSSON‐STIGMAR ELISABETH
Published: August 2010

ABSTRACT Six male patients out of seven with Behçet's disease were found to have a very similar and close contact with pigs and pork. These six cases are reported and we ask the question whether the contacts with pigs are just coincidental findings or whether an external agent, e.g. a virus, could be forwarded to man from pigs and pork. Immune complex associated vasculitis is described e.g. in patients with hepatitis B and the same mechanisms might be operating in patients with Behçet's disease.
Pharmacokinetics of Calcium Blockers in Patients with Renal Insufficiency and in Geriatric Patients
Authors: L. Larsen Storstein , Midtbø A. , Sævareid L K.
Published: August 2010

Calcium antagonists have been used in the treatment of various medical disorders for more than 10 years, but their pharmacokinetics properties are poorly investigated. Available data on the pharmacokinetics of calcium antagonists in normal men are summarized in the present paper. Information on the influence of renal impairment and old age on the handling of calcium‐antagonists are only available for verapamil. Patients with advanced renal disease had a significant reduction in the apparent volume of distribution, a shortened serum elimination half life, a decreased total body clearance of verapamil due to a decrease in the renal excretion of verapamil and its active metabolite norverapamil and also to a decrease in metabolic clearance. Pharmacokinetic parameters obtained after oral administration were not significantly different from those after intravenous dosing. The mean biologic availability (22.8%) was in the same range as reported for normal persons, but individual variations would seem to be greater. Elderly patients with a mean age of 87 years also had a significantly reduced volume of distribution of verapamil and decreased total body clearance of the drug, although this last change did not reach statistical significance. The biologic availability in the elderly was higher than in younger persons with a mean value of 37.69% and a wide range from 9.16 to 82.76%. These findings imply that verapamil dosage should be reduced in patients with impaired renal function and elderly patients.
Evaluation of Verapamil and High Dose Nifedipine in Patients with Chronic Stable Angina with Objective Methods
Authors: Subramanian V. Bala , Bowles M.J. , Khurmi N. S. , Davies A. B. , Raftery E. B.
Published: August 2010

The efficacy and safety of verapamil and nifedipine were objectively assessed in patients with chronic stable angina. Twenty four patients entered a double blind randomized cross over trial of nifedipine (10 mg thrice daily) and placebo. In this dosage nifedipine did not show any significant change in exercise duration and the variables obtained using computer assisted exercise testing when compared to placebo. The next stage consisted of another double blind randomized cross over trial comparing the effects of verapamil (120 mg thrice daily) and nifedipine (20 mg thrice daily) with an initial placebo run‐in period in 32 patients. At this dose level nifedipine showed a definite and significant improvement in all the objective variables; however an increase in side effects was observed resulting in withdrawal of the drug in seven patients. A common problem was tachycardia precipitating angina after nifedipine ingestion. On the other hand verapamil produced a marked improvement in exercise tolerance and other variables as compared to placebo and nifedipine, was well tolerated and produced a mild bradycardia. This study clearly indicates that verapamil is distinctly superior to nifedipine in efficacy side effects and safety in patients with chronic stable angina. This may be attributable to the differential effect on heart rates induced by these drugs.
Effects of Intravenous Verapamil on the Haemodynamic Response to Exercise in Patients with Angina Pectoris
Authors: Sadick N. M. B. , Roubin G.S. , Harris P.J. , Hiroe M. , Meares S. , Bautovich G. , Kelly D.T.
Published: August 2010

The effects of intravenous Verapamil (V) on exercise haemodynamics and ventricular function were compared in 13 patients with stable effort angina. Intravascular pressures, thermodilution cardiac output and radionuclide ejection fraction were measured simultaneously at rest and during exercise.

At rest Verapamil produced systemic vasodilation. During exercise at identical workloads compared to control, Verapamil increased cardiac index (CI) and decreased AVO2 difference. Pulmonary artery wedge pressure was lower. Ejection fraction was higher (control‐55 ±11% vs V‐64 ± 11%) as the disproportionate increase in end systolic volume relative to the end diastolic volume was prevented.

Verapamil is effective in exercise induced angina and alters haemodynamics primarily through its vasodilating properties associated with an increased CI.
The Role of a Slow Channel Inhibitor, Verapamil, in the Management of Hypertension
Authors: Gould B.A. , Mann Stewart , Kieso H. , Balasubramanian V. , Raftery E.B.
Published: August 2010

The ‘Oxford’ system for continuous monitoring of the ambulatory blood pressure was used to assess the changes in blood pressure following therapy with the slow channel inhibitor, verapamil.

Sixteen patients were studied on no therapy and following a minimum of 6 weeks therapy (dose range 120–160 mg t.d.s.). During each study patients underwent standardized physiological tests including tilt, isometric handgrip and dynamic bicycle exercise.

Verapamil was demonstrated to produce a consistent reduction of blood pressure over most of the 24 h period studied but this was most marked during the day. Heart rate was also reduced.

There was no postural hypotension and the absolute responses to dynamic and isometric exercise were reduced.

The results demonstrate the antihypertensive efficacy of ‘slow channel inhibitors’ as represented by verapamil.
Relation between Drug Utilization and Morbidity
Authors: Skegg D. C. G.
Published: August 2010

ABSTRACT. A study was carried out to determine whether it would be feasible to use record linkage for monitoring adverse effects of drugs. For a total population of 43 117 people, all prescriptions dispensed during a two‐year period were linked with records of hospital admissions, obstetric deliveries, and deaths (in or out of hospital). For another population of 10453 people, prescriptions were linked with information about illnesses recorded by general practitioners. In both cases, the data were analysed to reveal associations between drugs and diagnoses. It was concluded that record linkage would be valuable for detecting unsuspected hazards of drugs, and for testing hypotheses from other sources. The opportunities for this type of research are greatest in countries with highly organized health services, such as the Scandinavian countries and the United Kingdom.
Medicaid Drug‐event Data: An Emerging Tool for Evaluation of Drug Risk
Authors: Jones Judith K. , Van de Carr Stephen W. , Rosa Franz , Morse Lee , LeRoy Aida
Published: August 2010

ABSTRACT. Post‐marketing surveillance (PMS) of drugs requires access to multiple data resources covering the spectrum of drug exposures and drug‐associated events. In the U.S., the Federal/State third party payment system for medical care to welfare recipients, Medicaid, maintains drug‐event data by date of service. The FDA has explored this data for drug utilization studies, generation of signals of drug risk, and strengthening of hypotheses of drug associated problems. Thus far, studies suggest the data from Michigan and Minnesota, covering 1.5 million patients for 18 months, can be a useful, multifunctional tool for PMS studies. Examples of use to date are presented.
Metabolism in Ischemic Muscles before and after Treatment with Glucose‐Insulin‐Potassium Infusion
Authors: FALHOLT KAREN , FALHOLT WALTHER
Published: August 2010

ABSTRACT.Arteriosclerosis, arterial thrombosis and emboli in the lower extremities of man result in metabolic disorders in the muscles due to a deficit between oxygen required and oxygen made available. Furthermore, diminished perfusion pressure results in diminished exchange of substrates and electrolytes across the capillary walls. In the muscle cells there is a depression of glycolytic enzyme function and a stimulation of lipid activity, resulting in accumulation of free fatty acids and acidosis within the cells. In order to increase R.Q. in the muscles in question, infusion of glucose‐insulin‐potassium were installed via a catheter introduced into the superior vena cava for 3 days. Following this, muscle samples showed significant increase of carbohydrate metabolism as compared to lipid metabolism and nearly normalization of intracellular content of free fatty acids. This was accompanied by improvement of the clinical condition of the patients and loss of pain in the extremities affected.
Cells in Human Adipose Tissue Developing into Adipocytes
Authors: PETTERSSON PER , CIGOLINI MASSIMO , SJÖSTRÖM LARS , SMITH ULF , BJÖRNTORP PER
Published: August 2010

ABSTRACT Sedimentable cells from human adipose tissue of different origins were cultured under conditions when cell multiplication was prevented but lipid filling optimized (suspension culture). In this way an estimation was obtained of the number of in vivo determined adipose precursor cells (preadipocytes) which were not filled with lipid. Under these conditions no cells from adult, non‐obese subjects developed to adipocytes. Cells developing to adipocytes constituted less than 0.02% and 1% of adipocytes in tissues from obese adults and from children, respectively. It was concluded that in vivo determined adipocyte precursor cells (preadipocytes, lipid‐free fat cells) are not present in a significant number in human adipose tissue either from adults or from children as tested with the method employed, allowing detection of a large number of such cells in adipose tissue from small rats.