bluuebunny/crossref_metadata_2025 huggingface dataset:
Skin Lesions of the Legs and Feet and Skeletal Lesions of the Feet in Familial Amyloidosis with Polyneuropathy
Authors: Lithner Folke
Published: August 2010

ABSTRACT Twenty‐one patients with familial amyloidosis and polyneuropathy have been examined for the presence of skin lesions, localized to the lower legs and feet. The lesions were classified as atrophic skin lesions, hypertrophic scar‐like skin lesions, rubeosis plantarum, spontaneous blisters, necrotic skin lesions, yellow nails, traumatic skin lesions, purpura and abundant pigmented small non‐atrophic spots. Skeletal destructions in the feet were also demonstrated. In many respects these lesions are similar to those of long‐standing diabetes mellitus. I studied the cutaneous reactions to local thermal trauma with heat and cold to the legs and forearms in 11 patients. Petechiae were observed within the area of traumatization with either heat or cold more often in patients than in controls. Four of the 11 patients developed atrophic circumscribed skin lesions at the site of traumatization.
The Thyroid in Ulcerative Colitis and Crohn's Disease
Authors: Järnerot G. , Kågedal B. , von Schenck H. , Truelove S. C.
Published: August 2010

ABSTRACT The concentrations of triiodothyronine (T3), thyroxine (T4) and thyroxine binding globulin (TBG) have been measured in serum of 20 patients with ulcerative colitis or Crohn's disease. The patient group was compared with 20 healthy control subjects matched for sex and age. The concentrations of T3 and T4 were similar in the two groups but TBG in serum was higher in the patient group, mainly due to the high TBG levels in the female patients. The concentration of T3 in serum was lower in the severely ill patients than in those who were mildly‐moderately ill, while T4 and TBG were not affected by the severity of the disease. The concentration of T3 was lower in the corticosteroid‐treated patients than in those who did not have such treatment, just like the TBG level. However, TBG was not subnormal in the corticosteroid‐treated patients, whereas the serum concentration of T3 was. T4 in serum was not affected by treatment with corticosteroids. These findings indicate that the metabolisms of T4 and T3 are influenced differently by corticosteroids.
Myxedematous Madness without Myxedema
Authors: Nordgren L. , von Schéele C.
Published: August 2010

ABSTRACT A young woman, whose psychiatric history covered 16 years, has been treated several times as in‐patient for psychotic depressions, which were finally cured with thyroid replacement therapy. Recent reports of the connection between depression and disturbances in the hypothalamic‐pituitarythyroid axis are discussed. The authors question the suggestion that selective pituitary insufficiency and a defect in TSH release on TRF loading are rare phenomena.
The Effect on Serum Enzymes of Intramuscular Injections of Digoxin, Bumetanide, Pentazocine and Isotonic Sodium Chloride
Authors: Andersen K. E. , Damsgaard T.
Published: August 2010

ABSTRACT Intramuscular injections of digoxin, bumetanide, pentazocine or isotonic sodium chloride have been given to 39 patients. We followed the serum concentrations of creatine kinase (CK), aspartate aminotransferase (ASAT), lactate dehydrogenase (LDH) and LDH isoenzymes for 4 days. Ten patients receiving 500 μg digoxin showed a significant rise in CK, which lasted for 48 hours, and 6 of them had CK values exceeding the upper normal limit. Pentazocine in a dose of 30 mg given to 9 patients caused a significant rise in CK and LDH isoenzyme 1, but in no case did the level exceed the upper normal limit. No rise in ASAT or total LDH was found after digoxin and pentazocine injections. No changes in enzymes were discovered after bumetanide or isotonic sodium chloride. In the diagnostic evaluation of acute myocardial infarction, a moderate rise in CK must be assessed with caution when the patients have received i.m. injections of drugs with osmolarity and pH outside the physiological limits.
Characteristics of Representative Male Survivors of Myocardial Infarction Compared with Representative Population Samples
Authors: Elmfeldt Dag , Wilhelmsson Claes , Vedin Anders , Tibblin Gösta , Wilhelmsen Lars
Published: August 2010

ABSTRACTA series of 299 men, aged 27–67, who had survived their first myocardial infarction (MI), have been compared with representative population samples with respect to tobacco consumption, alcoholic intemperance, physical activity during work and leisure time, occurrence of hypertension, and cholesterol and triglyceride levels in serum. The infarction patients comprised 90% of all surviving, diagnosed cases of primary MI in men aged 67 years or below during 1968–70 in Göteborg, Sweden. The comparison between infarction patients and general population samples revealed that the patients smoked more, and were less physically active during leisure time but not during work. They had more often a positive history of hypertension and treatment for high BP and their serum cholesterol and serum triglyceride values were higher. For all these variables the difference decreased with increasing age and was generally not statistically significant above the age of 60 years. Alcoholic intemperance was more common among infarction patients who died outside hospital, but there was no difference in this respect between surviving patients and the general population.
Significance of Cardiac Arrhythmias Preceding First Cardiac Arrest in Patients with Acute Myocardial Infarction
Authors: Saunamäki K. I. , Pedersen Asger
Published: August 2010

ABSTRACT In 417 consecutive cases of acute myocardial infarction (AMI) within a minimum of 21 days' stay in the Coronary Care Unit (CCU), primary cardiac arrest occurred in 41 patients (9.9%), the first episode occurring during ECG monitoring in 24 patients. After cessation of ECG monitoring, and within 2–25 days after admission, it occurred in 17 patients. Cardiac arrhythmias before the first cardiac arrest were analysed in these two groups of patients, and compared with the occurrence of cardiac arrhythmias within the first 5 days in 100 consecutive patients with AMI without complicating cardiac arrest. No significant difference in the frequency of cardiac arrhythmias could be demonstrated between the two groups with cardiac arrest and the control series. Moreover, complete absence of rhythm disturbances right up to the beginning of cardiac arrest was as frequent in the patient groups as in the control series (around 20%). As there is not sufficient evidence that treatment with antiarrhythmic drugs can provide safe prophylaxis against the occurrence of cardiac arrest, it is concluded that all patients with AMI should be kept in the CCU and monitored, by cable or by telemetry, for the duration of their stay. To achieve this, the cost in financial terms, manpower and reorganization is not a deterrent. Furthermore, this study does not give any support to the usual practice of confining possible attempts of prophylactic antiarrhythmic treatment to patients with arrhythmias of certain frequencies and/or types.
Is the Use of Hypnotics, Sedatives and Minor Tranquillizers Really a Major Health Problem?
Authors: Boethius G. , Westerholm B.
Published: August 2010

ABSTRACT An analysis has been made of individual purchases of hypnotics, sedatives and minor tranquillizers made during 1973 by patients who had bought such drugs either only once (group S, n = 417) or regularly (group R, n = 76) during a 16‐month period five years earlier from pharmacies in the town of Östersund, county of Jämtland, Sweden. By 1973, 17% of the patients in each group had either died or moved out of the county and were therefore excluded from the comparison. In group S, 81 patients (23%) bought the above drugs once or more in 1973, while the corresponding figure for group R was 55 (87%). Compared with 1968–69, there was a decrease in the number of prescriptions and also in the number of tablets obtained per individual. Furthermore, the number of tablets per prescription was lower in 1973. Among the drugs prescribed, benzodiazepines dominated during both periods, followed by barbiturates. In 1973 there was a substantial increase in the use of nitrazepam, mostly at the expense of diazepam and combined products. One patient in group S and one in group R showed a tendency to decrease the interval between purchases. The latter was already known to be a drug abuser five years earlier. Without knowing the reason why the drugs were prescribed and to what extent they were actually taken, it is impossible to say whether the other patient should be classified as drug abuser or not. Although the number of patients in this study is limited, it might be concluded that the risk of an occasional user of hypnotics, sedatives and minor tranquillizers living in this area becoming an abuser of such drugs within a five‐year period is less than 1/345.
Sheehan's Syndrome of Hypothalamic Origin in a Woman with Juvenile Diabetes Mellitus
Authors: Herbai Georg , Werner Ivar
Published: August 2010

ABSTRACT A 25‐year‐old woman with severe diabetes mellitus since the age of 7 developed anterior pituitary insufficiency after pregnancy toxaemia with hypofunction of the thyroid, ovaries and adrenal cortex. Following the development of Sheehan's syndrome, her insulin requirement decreased dramatically. I.v. administration of TRH, LRH and vasopressin induced nearly normal pituitary response levels of TSH, LH and plasma Cortisol, indicating a hypothalamic damage as the primary aetiological factor.
1‐Alpha‐hydroxycholecalciferol Treatment of Adults with Chronic Renal Failure
Authors: Madsen Søren , Ølgaard Klaus
Published: August 2010

ABSTRACT. Five adult patients with chronic renal failure and associated renal osteodystrophy have been treated for 6 months with 1‐alpha‐hydroxycholecalciferol (1α‐OH‐D3), a synthetic vitamin D analogue. All 5 patients had severe metabolic bone changes as estimated by bone scintigraphy. Three patients were hypocalcemic, 4 had elevated serum alkaline phosphatases, 5 had elevated serum immuno‐reactive parathyroid hormone (i‐PTH) concentration and 3 had bone pains. During treatment serum calcium increased in all patients (mean 11.4%) and 3 originally hypocalcemic patients became normo‐calcemic. Serum alkaline phosphatases decreased (mean 27.3%) and became normal in 4 patients, who initially had elevated values. A pronounced decline in the serum concentration of i‐PTH (mean 53%) was seen in all patients and 1 patient obtained normal i‐PTH levels after 4 months of treatment. The intestinal calcium absorption, which was low initially, even when calcium intake was considered, rose almost threefold (mean 273%) and reached normal values in all cases. The bone mineral content increased in all patients, but the changes were small (mean 4.9%) and insignificant. Finally, bone pain disappeared in 2 patients and improved in 1 of the 3 patients exhibiting this symptom. A linear correlation (r=0.48, p<0.001) was found between the dose of 1α‐OH‐D3 and serum calcium. But in spite of this and the frequent control, all patients developed one episode of hypercalcemia. This disappeared within 48 hours after discontinuing the drug. It is concluded that treatment with 1α‐OH‐D3 appears to be of therapeutic value in metabolic bone disease associated with chronic renal failure, but frequent control of blood biochemistry seems mandatory.
Renal Handling of Phosphate in Relation to Serum Parathyroid Hormone Levels
Authors: Madsen S. , Ølgaard K. , Ladefoged J.
Published: August 2010

ABSTRACT. The relation between the renal handling of phosphate, expressed as the maximal tubular reabsorption of phosphate (TmP)/glomerular filtration rate (GFR) index, and the serum concentration of immunoreactive parathyroid hormone (i‐PTH) has been investigated in 15 patients with a very wide range of GFR, TmP/GFR and i‐PTH. Seven patients had well functioning kidney allografts, with GFR ranging from 43.1 to 64.9 ml/min, while eight had varying degrees of chronic nephropathy, with GFR ranging from 26.7 to 2.3 ml/min. The TmP, the i‐PTH concentration, the 51Cr EDTA clearance, the extracellular volume and the serum concentrations of calcium and standard bicarbonate were estimated during conditions where tubular reabsorption of phosphate was maximal. An inverse significant correlation was demonstrated between TmP/GFR and i‐PTH (p<0.001), while none of the other investigated factors correlated to the TmP/GFR index. It is therefore concluded that the parathyroid hormone has a key role in the regulation of the tubular handling of phosphate in patients with impaired renal function.
The Functional Pattern of the Transplanted Kidney during the First Year
Authors: Hansen H. E. , Skov P. E.
Published: August 2010

ABSTRACT. Prospective studies on kidney function have been carried out 1–14 months after transplantation in two groups of recipients of renal transplants. Both groups were characterized by immediate graft function. The first group had transplants from living donors, the second had received cadaveric kidneys. In the first group a functional maximum (as measured by 125iothalamate, creatinine and 131I‐hippuran clearances) was reached during the first three weeks after transplantation, approximating 70% of the donors' bilateral preoperative function. In the second group kidney function was constant during the period of study, the values being almost identical with those observed in the first group. At investigation 12–14 months after transplantation, the two groups were compared with the remaining cadaveric transplants carried out during the period of study, the latter being primarily graft anuric. Graft function in the primarily anuric grafts was found to be poorer than in those with initial function. Graft survival, too, was poorer at one year in the group characterized by primary graft anuria than in the other groups. Graft survival at one year was 68% in cadaveric kidney transplants with good initial function.
Late Complications after Primarily Successful Renal Transplantation
Authors: Kuhlbäck B. , Lilius P.
Published: August 2010

ABSTRACT. The occurrence of late renal and extrarenal complications of primarily successful kidney transplantations is surveyed. All cases in which some surgical or clinical complication, a rejection or complication of the treatment of rejection had occurred were omitted. Primarily, 46 out of 177 transplantations (26%) were completely successful. After six months, the continued course was entirely uneventful in 21 of these cases, while in 25 some kind of complication occurred 6–72 months after the primarily successful course, 19 renal in 17 patients and 23 extrarenal in 16. The complications could not be correlated to histocompatibility, sex, age or basic disease. It may be concluded that a favourable course during the first six months gives good hope of an uneventful continuation, although even serious complications may occur occasionally.
Cytostatic Treatment of Glomerular Diseases
Authors: Balsløv J. T. , Brun C. , Halberg P. , Jensen K. Birger , Jørgensen F. , Jøgensen H. E. , Larsen M. , Larsen S. , Lorenzen I. , Thomsen Å. Chr.
Published: August 2010

ABSTRACT. Fifty patients with renal glomerular diseases entered a double‐blind cross‐over study on the effect of cyclophosphamide; 38 had received neither corticosteroids nor cytostatic drugs before joining the study. Cyclophosphamide was given for 4 months in doses decreasing from 3 to 1.5 mg/kg b.wt. Cyclophosphamide caused a 46% decrease in the 24‐hour excretion of urinary protein and a decrease in serum creatinine within the normal range. Albumin, transferrin and IgA in urine, as well as albumin clearance and the sieving coefficient of albumin, changed parallel to the total urinary protein. The initial values of proteinuria and serum complement were of prognostic significance for the effect of cyclophosphamide on serum creatinine. We were unable to demonstrate a prognostic significance for the variables: clinical diagnosis, renal histology, arterial BP, initial values of serum creatinine and IgG, IgA and IgM in serum and urine. ESR appeared to be the most reliable acute phase reactant. No differences were found between the changes in renal histology during cyclophosphamide or placebo.
Day and Night Work: Changes in Cholesterol, Uric Acid, Glucose and Potassium in Serum and in Circadian Patterns of Urinary Catecholamine Excretion
Authors: Theorell Töres , Åkerstedt Torbjörn
Published: August 2010

ABSTRACT. Two groups of railway workers (n=16 and n =17) have been followed on their place of work during a period of shifts between day and night work. Catecholamine excretion in the urine and blood levels of lipids, glucose, uric acid, potassium and calcium were followed during the different phases of shift work. Dramatic fluctuations were noted in the diurnal pattern of catecholamine excretion during and after night work. Significant elevations in the serum levels of cholesterol, glucose, uric acid and potassium were observed during the first week after a night shift, and these changes could not be explained on the basis of shifts in the diurnal pattern or changes in dietary or other habits.
Treatment of Hypercholesterolaemia and Hypertriglyceridaemia with Magnesium
Authors: Petersen B. , Christiansen C. , Hansen P. From
Published: August 2010

ABSTRACT. A daily intake of 3 g magnesium (as magnesium oxide) for six weeks had no effect on serum cholesterol and serum triglyceride in 17 patients suffering from hypercholesterolaemia and/or hypertriglyceridaemia.
The Composition of Food Consumed by Greenland Eskimos
Authors: Bang H. O. , Dyerberg J. , Hjørne N.
Published: August 2010

ABSTRACT. Food specimens have been collected, by means of the double‐portion technique, from Greenland Eskimo hunters and their wives, in all seven persons, on seven consecutive days. Their food was found to contain more protein and less carbohydrates than average Danish food and an almost equal amount of fat. Compared with Danish food, the fatty acid pattern of the consumed lipids—essentially of mammalian marine origin—showed a higher content of long chain polyunsaturated fatty acids (especially C20:5) and lower contents of linoleic and linolenic acids. However, the sum of the polyunsaturated fatty acids was smaller than in Danish food. Using Keys' formula, describing the serum cholesterol level as a function of the nutritional fatty acids, the essentially lower serum cholesterol level found in Greenland Eskimos was not explained by our findings. It is suggested instead to be a special metabolic effect of the long chain polyunsaturated fatty acids from marine mammals. There might be a similar effect on the plasma triglyceride and very low density lipoprotein concentrations, explaining the much lower plasma concentrations of these components in Eskimos than in Western populations. Our findings might have an essential bearing on the difference in morbidity from coronary atherosclerotic disease between these populations.
Peritoneal Dialysis in Hypernatraemic, Ketoacidotic Diabetic Coma
Authors: Kølendorf Klaus , Møller Birger Broch
Published: August 2010

ABSTRACT. Hypertonic dehydration in a 13‐year‐old boy with ketoacidotic diabetic coma has been treated successfully with peritoneal dialysis and isotonic fluids. Modes of treatment with either hypotonic or isotonic fluids are discussed, as is the feasibility of peritoneal dialysis. We recommend isotonic solutions composed of equal parts of 5.5 % glucose and 0.9 % sodium chloride combined with peritoneal dialysis in order to secure a relatively slow correction of the hypertonic state.
Immunoreactive Insulin in Portal and Hepatic Venous Blood in Patients with Insuloma
Authors: Eriksson M. , Erwald R. , Hed R. , Nygren A. , Patricny J. , Röjdmark S. , Sundblad L. , Wiechel K.‐L.
Published: August 2010

ABSTRACT. The insulin level has been determined simultaneously in portal and hepatic venous blood in four patients with insuloma before and after administration of glucose and tolbutamide. Three patients displayed a higher insulin level in hepatic than in portal blood, although no hepatic metastases could be detected by radiologic examination. In contrast, portal insulin concentrations always exceeded hepatic in four control patients investigated in a similar way. The implications of these results are discussed.
Skeletal Lesions of the Feet in Diabetics and their Relationship to Cutaneous Erythema with or without Necrosis on the Feet
Authors: Lithner Folke , Hietala Sven‐Ola
Published: August 2010

ABSTRACT. Seventy patients with cutaneous erythema of the feet with or without necrosis were the subjects of this investigation. Sixty‐five of them had open diabetes. The glucose tolerance of the remaining five patients was altered in a diabetic direction. Twenty‐seven of the 70 patients had roentgenologically demonstrable destruction in the bones of the feet. These 70 patients were compared with 61 diabetic control patients of corresponding age and duration of diabetes but without these skin lesions of the feet. Only four of the 61 control patients had destruction in the bones of the feet and all these destructions were small. Precipitating factors were identified in general for the skin lesions, the most common being cardiac decompensation. A higher frequency of precipitating factors was seen in patients with skeletal destructions than in those without. The skeletal destructions and cutaneous necrosis are supposed to be equivalent lesions, localized to different tissues in the feet. When patients presenting skin lesions of the feet in the form of distal gangrene were compared with those who had cutaneous erythema and necrosis of the feet, but no distal gangrene, no differences were found with respect to age, duration of diabetes, occurrence of precipitating factors and the occurrence of skeletal destruction. Cutaneous erythema without necrosis is understood to be incipient diabetic gangrene.
Urinary Cyclic AMP
Authors: Madsen S. Nistrup , Badawi I. , Jörgensen F. Schönau , Skovsted L. , Transbøl I.
Published: August 2010

ABSTRACT. In 21 healthy volunteers, mean excretion of cyclic adenosine 3′,5′ monophosphate (cAMP) in urine was 4.2+1.0 (S.D.) μmol cAMP/24 hours, 3.0+1.2 μmol/g creatinine and 3.8+1.2 μmol/24 hours/100 ml/min renal clearance of creatinine (CCr). An inverse correlation exists between the excretion of cAMP and serum calcium corrected for variations in serum albumin, most clearly demonstrated when cAMP is expressed as μmol/24 hours/100 ml/min of CCr (r= ‐0.630, p<0.01). In 21 patients with operatively verified hyperparathyroidism, the mean urinary excretion of cAMP/24 hours was 5.0+1.9 μmol uncorrected, 4.8+1.8 μmol/g creatinine and 6.6+2.1 μmol/100 ml/min of CCr. The latter two of these parameters differ significantly from the normal group (p<0.001), but conceal the fact that many patients with hyperparathyroidism excrete normal amounts of cAMP in the urine, independent of the mode of calculation. However, when cAMP is correlated to albumin‐corrected serum calcium, this overlap between hyperparathyroidism and normality disappears completely. The results support the concept that cAMP excretion is influenced to a considerable degree by the biological activity of circulating parathyroid hormone. They also indicate that the simultaneous measurement of cAMP in urine and albumin‐corrected calcium in serum is a useful aid in distinguishing hyperparathyroidism from the state of normality.
Book Review
Authors: Vahlquist Bo
Published: August 2010

Pediatrics. 2nd ed. Edited by Mohsen Ziai with Charles A. Janeway and Robert E. Cooke
A Comparison of Two Methods for Estimating Bone Loss
Authors: Christiansen C. , Rødbro P. , Drewsen B.
Published: August 2010

ABSTRACT. The presence or absence of osteopenia, as judged by routine X‐ray examination of the lumbar spine supplemented by X‐ray evaluation of calcaneus, has been investigated in 73 female subjects who also had photon absorptiometry done on calcaneus and antebrachiúm. Comparison of the two methods reveals that there is no close relationship between the results. Photon absorptiometry for evaluating bone mineral content has proven its precision and accuracy, while conventional X‐ray film evaluation of bone mineral seems to lack a proper foundation.
A New Pattern of Multiple Endocrine Adenomatosis
Authors: Berg Bertel , Biörklund Anders , Grimelius Lars , Ingemansson Stig , Larsson Lars‐Inge , Stenram Unne , Åkerman Måns
Published: August 2010

ABSTRACT. A female patient was found to have a chemodectoma, a GH‐producing pituitary tumour and a bronchial carcinoid combined with hyperplasia of the parathyroids and of antral and duodenal gastrin cells. This combination of endocrine tumours and hyperplasias does not fit with the two multiple endocrine adenomatosis syndromes recognized at present. The case stresses the importance of scanning the patient for other endocrine tumours, once one has been diagnosed.
Sarcoidosis of the Spleen
Authors: Selroos Olof
Published: August 2010

ABSTRACT.To determine the frequency of splenic involvement in sarcoidosis, fine‐needle aspiration biopsies of the spleen have been performed on 77 patients with verified sarcoidosis. Spleen size was normal in 71 patients and enlarged in 6. Splenic sarcoidosis was demonstrated in 53% of all patients, and in 67 % of those with and in 47 % of those without known extrathoracic manifestations. No complications occurred with this simple bedside procedure. In sarcoidosis, fine‐needle aspiration biopsy of the spleen is a valuable diagnostic tool, especially when visible or palpable lesions are absent. Its use is recommended before the use of mediastinoscopy, bronchoscopy, lung biopsy or laparoscopy.
Observations on the Different Calcium Metabolic Patterns in Sarcoidosis
Authors: Hornum Ib , Transbøl Ib
Published: August 2010

ABSTRACT. Combined calcium balance and 47Ca turnover studies in sarcoidosis (4 patients) and vitamin D intoxication (1 patient) disclosed three different patterns of calcium metabolism. One patient with sarcoidosis had a normal metabolism of calcium, and two patients presented the usual pattern of intestinal hyperabsorption, hypercalcemia, and hypercalciuria. The fourth patient with sarcoidosis and the patient with vitamin D intoxication, both studied during spontaneous remissions, presented the third pattern. The main features here were hypercalcemia despite normal intestinal absorption of calcium, enlarged exchangeable calcium pool, accelerated accretion and resorption rates, hypercalciuria, and a distinctly negative calcium balance. This pattern of remission seems to represent a mobilization of extraosseous or metastatic calcifications, rather than a resorption of bone calcium.
1‐Alpha‐hydroxycholecalciferol‐induced Changes in the Renal Handling of Phosphate and the Serum Parathyroid Hormone Level
Authors: Madsen S. , Ølgaard K. , Ladefoged J.
Published: August 2010

ABSTRACT. The effect of 1‐alpha‐hydroxycholecalciferol (lα‐OH‐D3) on the renal handling of phosphate and the immunoreactive parathyroid hormone in serum (i‐PTH) has been studied in 10 patients with a wide range of glomerular filtration rate (GFR), maximal tubular reabsorption of phosphate (TmP) and i‐PTH. The patients were treated with 2 μg 1α‐OH‐D3 per day for approximately 80 days. Before and after this period of treatment, the TmP, i‐PTH, 51Cr EDTA clearance, extracellular volume, standard bicarbonate, and serum calcium were measured in each patient. The TmP/GFR ratio was used as an index of the renal handling of phosphate. The index increased significantly (mean 26.5%, p<0.01) during the treatment, while i‐PTH decreased significantly (mean 37.0%, p<0.01). An inverse significant correlation was demonstrated between TmP/GFR index and i‐PTH both before (r= ‐0.87, p<0.001) und after (r=‐0.79, p<0.01) the administration o α‐OH‐D3, while none of the other factors investigated were correlated to the index. It is concluded that 1α‐OH‐D3 increases the TmP/GFR index and reduces i‐PTH in a parallel manner and it is therefore suggested that the 1α‐OH‐D3‐induced changes in the renal handling of phosphate may be explained as being mediated solely via the suppression of i‐PTH.
Acetylator Phenotype in Patients with Hydralazine‐induced Lupoid Syndrome
Authors: Strandberg Inger , Boman Gunnar , Hassler Leo , Sjöqvist Folke
Published: August 2010

ABSTRACT.The acetylator phenotype has been determined (isoniazid half‐life) in 31 patients, 25 of them women, who had exhibited a lupus erythematosus‐like syndrome during treatment with hydralazine. Twenty‐nine patients were slow acetylators, one was rapid (probably spontaneous SLE) and one uncertain. Only two patients had been given more than 200 mg of hydralazine daily. The mean duration of therapy was 32 months at the onset of symptoms. These were not serious but rather long‐standing. Our study confirms that patients who risk developing hydralazine lupus are slow acetylators, especially females, treated with more than 100 mg daily. Rapid acetylators seem to develop this side‐effect rarely, if at all.
Immediate and Long‐term Results of Emergency Aortic Valve Replacement in Acute Bacterial Endocarditis
Authors: Alstrup P. , Fröysaker T.
Published: August 2010

ABSTRACT. A surgically treated material comprising 18 patients with heart failure from aortic insufficiency during acute endocarditis has been reviewed. At the time of operation the mean duration of heart failure was 3 weeks and duration of endocarditis 9 weeks. Blood culture was positive in half of the patients, 39% had predisposing valve disease, 14 (78%) had a preoperative heart catheterization. The peroperatively measured regurgitation averaged 55%. All 18 patients had an artificial valve implanted, and the mean observation time for 13 long‐term survivors was 3 1/3 years. There were 3 postoperative and 2 late deaths. A long‐term survival rate of 73% strongly supports early surgical treatment in patients with aortic insufficiency and heart failure during acute endocarditis.
Immunoglobulins and Complement in Chronic Myocardial Disease
Authors: Hatle Liv , Melbye O. J.
Published: August 2010

ABSTRACT. Autoimmune mechanisms have been suggested to be of significance in chronic myocardial diseases. However, the frequency and importance of these factors are unknown. In the present study, endomyocardial biopsy specimens from 21 patients with chronic myocardial disease have been examined by direct immunofluorescence for the presence of immunoglobulins and complement factor C3. Positive staining for immunoglobulin and/or complement was observed in 7 cases. None of the specimens stained for albumin or amyloid. The immunoglobulin deposits were located on the surface of the myofibre and in all but one case, complement was found in the same location. The presence of the complement together with immunoglobulin, and also the lack of albumin, may suggest an immune reaction and not just a passive deposition secondary to heart muscle damage. The localization along the fibres further suggests that the deposits represent an autoimmune reaction to antigens on the fibres and not a trapping of circulating antigen‐antibody complexes. It is not known whether the deposits are primary or secondary events, but they may be of importance in initiating or maintaining derangement in heart function.
Oesophageal Dysfunction in Male Patients with Angina‐like pain
Authors: Tibbling Lita , Wranne Bengt
Published: August 2010

ABSTRACT.Twenty‐eight male patients referred to work ECG due to chest pain, all with a positive oesophageal symptom questionnaire believed to detect oesophageal dysfunction (OD), have been subjected to a graded work test and an oesophageal manometry test and answered a questionnaire believed to detect effort angina. Ischaemic heart disease (IHD) was defined as earlier infarction on ECG at rest or a pathological effort ECG. OD was defined as a positive acid perfusion test, hernia or a clear dysmotility in combination with a lower sphincter incompetence. Twenty patients had a positive effort angina questionnaire. Among these, OD was more common (n= 13) than IHD (n=8). Five of the 20 patients had signs of both IHDandOD. Eight patients had a negative effort angina questionnaire; OD was found in 7 and IHD in 1 of these patients. It is concluded that in cases with angina‐like chest pain OD should be considered.
Treatment of Malignant Metastatic Pancreatic Insulinoma with Streptozotocin
Authors: Herbai Georg , Lundin Åsa
Published: August 2010

ABSTRACT. The possibilities of treating different types of pancreatic islet cell cancer with the active drug streptozotocin have been studied in reports of 21 patients published during the last 8 years. The unusual features of the symptomatology, dosage and injection methods, side‐effects after different infusion schedules and complications of streptozotocin therapy, are compared. A new case with pancreatic carcinoma and liver metastases was treated with a total dose of 14 g streptozotocin, divided into 7 injections with an increasing interval between them. This patient underwent a marked amelioration of the disease, without serious side‐effects of the streptozotocin treatment. She has been apparently well for the 22 months which have now elapsed since the beginning of treatment. This seems to be one of the longest remission periods yet published in the insulinoma literature.
Complications with Permanent Endocardial Electrode Systems
Authors: OHM OLE‐JØRGEN , SEGADAL LEIDULF , SKAGEN DANKERT W.
Published: August 2010

ABSTRACT. The different complications of endocardial electrode systems in 185 patients during the last seven years are discussed. The surgical technique for the now routinely used cephalic route is described. The choice of anaesthesia is discussed. In the last 39 implantations there have not been any displacements or retractions. Of the total numer of patients only 3 required replacement of endocardial by myocardial electrodes. This was caused by unstable position and high stimulation threshold.
Routine pacemaker control, and selective replacement of pulse generators. A cost/benefit analysis
Authors: GRENDAHL HELGE
Published: August 2010

ABSTRACT. Two hundred and fifty patients with permanent pacemaker have been followed up with routine pacemaker controls in a pacemaker clinic for a 21 months period 1/3–73 to 1/1–75. Ninetyfive pulsegenerators were replaced. Sixtytwo of the replacements were due to impending battery exhaustion, nine elective and 24 for other reasons. Signs discovered by the patients led to replacements in 21 cases for impending battery exhaustion and in 17 cases for other reasons. Fortyone replacements for impending battery exhaustion and 7 other replacements followed a scheduled visit to the pacemaker clinic. The selective replacement policy resulted in an average gain of pulsegenerator lifetime of 6.5 months, compared to a 24 minths elective replacement policy.

Increased safety is obtained by routine control of pacemaker patients in a pacemaker clinic.
Pacemakers and External Interference
Authors: ELMQVIST H.
Published: August 2010

ABSTRACT. This paper is an attempt to identify and describe the most common sources and effects of external electromagnetic interference on cardiac pacemakers in as nontechnical terms as possible. The normal function of an inhibited pacemaker is also discussed.
SEVERE ARTERIAL HYPERTENSION (GRADE III AND IV)
Authors: Gudbrandsson Thorkell , Snorrason Snorri P.
Published: August 2010

The aim of this study was to evaluate the number, outcome, survival time, and causes of death of patients with severe arterial hypertension who were admitted to the Department of Medicine at Landspitalinn [National Hospital) in Reykjavik during the years 1957 to 1971.

During this period 117 patients were found to have severe arterial hypertension (12.6% of all cases of hypertension diagnosed) according to the grading of Keith and wagener, 20 patients with grade IV retinopathy and 97 patients with grade III.

The case histories were analysed according to age and sex distribution, blood urea, electrocardiographic changes, heart size by X‐ray at the time of diagnosis and final outcome.

The survival calculations were done by the decrement method (life tables) and aim taken from patient age 65 years and less. Relatively fewer patients with severe arterial hypertension were admitted during the last five year period (1967–1971) than during the two previous five year periods. The main causes of death were cerebrovascular accidents (26.6%), myocardial infarctions (22.8%), and renal failure (22.8%).

Approximately 50% of the men and 60% of the women survived five years. Elevated blood urea values and signs of left ventricular hypertrophy on ECG at the time of diagnosis carried a more sinister prognosis.
Aldosterone Response to ACTH Stimulation in Anephric and Non‐nephrectomized Patients on Regular Hemodialysis
Authors: ølgaard K. , Madsen S.
Published: August 2010

ABSTRACT The effect of ACTH on plasma aldosterone concentration (PAC) and plasma cortisol concentration (PCC) has been investigated in 5 anephric and 6 non‐nephrectomized patients on regular hemodialysis. Basal PAC was significantly lower (p<0.01) in the anephric (mean 37.6 pg/ml) than in the non‐nephrectomized group (mean 117.5 pg/ml), whereas basal PCC (18.6 and 16.5 μg/100 ml, respectively) did not differ significantly (p>0.05). Following administration of synthetic β1–24 ACTH, the maximal percentage increase in PAC was significantly lower (p<0.001) in the anephric (105%) than in the non‐nephrectomized group (286%). The rise in PCC, 118%, in both groups showed no significant difference (p>0.05). The higher basal level of PAC and the more pronounced response to ACTH in non‐nephrectomized patients correlated with higher basal levels of plasma renin activity compared with the anephric group. An influence of the remaining renin‐angiotensin system on the ability to react to an ACTH stimulation is therefore suggested.
Human Atrial Conduction with Reference to Heart Rate and Refractory Periods
Authors: Brorson Leif , Olsson S. Bertil
Published: August 2010

ABSTRACT Atrial conduction time (ACT) between a stimulating pacemaker electrode and an “impulse‐detecting” monophasic action potential (MAP) electrode has been determined in 20 healthy males. A small increase in ACT was found with increasing paced heart rates. Using the extra stimulus technique, ACT was found to increase when the early ectopics approached the atrial effective refractory period (AERP). The degree of ACT prolongation was similar at long and short basic ACTs, indicating that the slowing of impulse propagation probably occurred near the simulating electrode and presumably within 1/2–1 cm from that electrode. The increase in ACT close to the AERP was of importance when determining the atrioventricular refractory period. In three recordings a supernormal phase of conduction was found. The small errors of the MAP recordings in detecting the time of excitation make the method sensitive enough to detect small differences in ACT.
Ventricular Arrhythmias in Acute Myocardial Infarction
Authors: Åbjörn Christer , Karlsson Erling , Sonnhag Christine
Published: August 2010

ABSTRACT A continuous ECG recording has been made in 31 myocardial infarction patients during the first 24 hours after admission to hospital. The number and severity of ventricular arrhythmias were recorded in great detail. Before discharge from hospital the patients were submitted to 20 hours of ECG tape recording, an exercise test on a bicycle ergometer and a static work test (handgrip). Another exercise test was performed one month after discharge. During the first day in the Coronary Care Unit (CCU) all 31 patients had ventricular arrhythmias and in 27 of them the arrhythmia was classified as major (calling for treatment according to Lown's criteria). At the exercise tests 23 patients showed ventricular arrhythmias, 12 of them considered as major. No antiarrhythmic therapy was given during the investigation. No correlation was found between the degree of arrhythmia during the first day in the CCU and during the exercise tests. Tape‐recorded ECGs appeared to be inferior to dynamic exercise tests in the ability to disclose a latent tendency to ventricular arrhythmia. Static work did not provoke any ventricular arrhythmias. At a 2‐year follow‐up 5 patients had died, 4 of them suddenly. Examination of additional material on 11 patients with ventricular tachycardia or ventricular fibrillation during the CCU stay, showed that 2 had died, but only one suddenly. Frequency and severity of arrhythmias during the first day after the infarction seemed to correlate poorly to a persistent tendency to arrhythmias or to the risk of sudden death during the following 2 years. A dynamic exercise test performed before discharge would appear to be more effective in selecting patients in need of long‐term prophylaxis. However, very few patients seem to need such a specific antiarrhythmic prophylaxis.
An Eleven‐year Follow‐up on 64 Subjects with M‐components
Authors: Axelsson Uno
Published: August 2010

ABSTRACT In a medical health survey in 1964 of 6 995 subjects, 64 persons with M‐components were detected by serum electrophoresis. One had clear‐cut signs of myelomatosis and one had lymphatic leukemia. Eleven years later 27 persons had died. In the case with lymphatic leukemia the disease had changed after 6 years into a myelomatosis. One person died after 9 years from a malignant lymphoma. Among the 37 persons still alive there seemed to be no clustering of diseases. The whole series represents an observation time of 487 years. No more myelomas or lymphomas were detected. One M‐component had disappeared.
Leucocyte Migration Inhibitory Activity of Concanavalin‐A‐stimulated Lymphocytes
Authors: Coeugniet Edouard , Bendtzen Klaus , Søeberg Bjørn , Bendixen Gunnar
Published: August 2010

ABSTRACT Lymphocytes from 14 patients treated with a combination of acetylsalicylic acid (ASA) and dipyridamole (DIPY) showed a decreased ability to produce leucocyte migration inhibitory activity (LMIA) when stimulated with concanavalin‐A (Con‐A). The combined treatment also produced a decrease of leucocyte response to a standard LMIA‐containing culture supernatant. Treatment with only one of the two drugs did not cause detectable alteration of the lymphocyte response to Con‐A or the leucocyte response to LMIA. In vitro, both DIPY and ASA were independently effective in decreasing the LMIA production of Con‐A‐stimulated lymphocytes and the leucocyte response to a standard LMIA‐containing culture supernatant.
Giant‐cell Arteritis, Temporal Arteritis and Polymyalgia Rheumatica
Authors: Sørensen Per Soelberg , Lorenzen Ib
Published: August 2010

ABSTRACTThe initial clinical symptoms, the course of the disease, and the effect of corticosteroid treatment have been analyzed in a retrospective study of 63 patients with temporal arteritis or polymyalgia rheumatica. The relationship between the physical examination of the temporal regions, the ophthalmological examination, and biopsy from the temporal artery with respect to the diagnostic value were examined. Histological examination of biopsy specimens from the temporal artery in 58 patients revealed arteritis in 46. Half of the patients had only local symptoms from the temporal regions; one fourth presented such symptoms as well as myalgias, and one fourth had myalglas only. Patients presenting local symptoms of temporal arteritis as well as of myalgias had always had myalgias as the initial symptom and developed local symptoms of temporal arteritis 1–24 months later. Permanent reduction of vision occurred in 20 % of the patients. Symptoms of generalized arteritis were observed in several patients. The overlapping of the clinical symptoms, the positive biopsy findings in patients with polymyalgia rheumatica as the only local symptom and the identical reaction to corticosteroid treatment support the conception of temporal arteritis and polymyalgia rheumatica as two manifestations of the same disease. The physical and the ophthalmological examinations were of limited diagnostic value. Positive biopsy findings were seen in 25 patients with normal palpatory findings, and in 46 patients without eye symptoms the ophthalmoscopic examination revealed no signs of arteritis. If the first biopsy from the temporal artery is negative, biopsy from the contralateral temporal artery should be performed. Correctly timed corticosteroid treatment in adequate doses can prevent reduction of vision in giant‐cell arteritis. The treatment is a long‐term therapy, its average duration in the present study being more than two years.
Granulomatous Giant Cell Arteritis (Temporal Arteritis) in a Young Female
Authors: de Faire Ulf , Mellstedt HÅkan , Nordenstam Hans
Published: August 2010

ABSTRACT A 23‐year‐old woman with a classical granulomatous giant cell arteritis—temporal arteritis—is described. She displayed both clinical and biopsy characteristics of the “arteritis of the aged”.
Pattern of Acute Drug Poisoning in Oslo
Authors: Petersen H. , Brosstad F.
Published: August 2010

ABSTRACT All 1742 admissions occasioned by acute drug poisoning to a medical ward in Oslo during the periods 1958–60, 1963–65, 1966–69 and 1970–73 have been reviewed. The number of admissions per annum in these periods was 99, 119, 128 and 144, respectively. Because the hospital situation and number of inhabitants in the city remained fairly constant from 1958 to 1973, the increasing figures were assumed to reflect a corresponding increase in the incidence of acute drug poisoning in Oslo. The incidence was estimated to be within the range of 1–2 per 1000 inhabitants per annum. No female predominance was noted except for the age group under 30 years. The occurrence of barbiturate poisonings decreased markedly during the periods studied, whereas those due to non‐barbiturate hypnotics, tranquillizers and tricyclic antidepressants showed a proportionate increase. Slightly less than one fourth of the females and half of the males had taken alcohol. More males (43%) than females (13%) also were alcoholics. A suicidal intention was, however, found more frequently among females (70%) than males (43%). The hospital mortality was approximately 1%. No death was associated with tricyclic antidepressants, which in the last study period had been ingested by approximately 10% of all patients.
Choreoathetosis during Phenytoin Treatment
Authors: Rasmussen Sten , Kristensen Mogens
Published: August 2010

ABSTRACT A patient with symptomatic epilepsy receiving only phenytoin developed choreoathetosis and orofacial dyskinesias. These movement disorders disappeared when the drug was stopped and reappeared when the patient was challenged. Throughout the period of treatment, concentrations of phenytoin in serum were consistently low within the therapeutic range. Interfering symptoms from the cardiovascular system and the absence of some classic symptoms of phenytoin intoxication (nystagmus and dysarthria) contributed to delay the diagnosis. The patient died in hospital and autopsy of the brain showed rather localized encephalomalacies of corpus striatum. The pathogenic action of phenytoin and the role of preexisting brain lesions are discussed. Phenytoin must be suspected as the cause, when patients on this drug present with uncontrollable epilepsy or neurological or mental deterioration.
Lactose Malabsorption and Bone Mineral Content
Authors: Alhava E. M. , Jussila J. , Karjalainen P. , Vuojolahti P.
Published: August 2010

ABSTRACT Bone mineral has been measured by the Am‐241 gamma ray attenuation method in 12 men and 22 women with lactose malabsorption and in 17 men and 17 women with normal lactose absorption, and compared with previously established normal values. Although lactose malabsorption led to reduced milk consumption and calcium intake, it did not cause osteoporosis.