bluuebunny/crossref_metadata_2025 huggingface dataset:
Methods in Assessing Drug Compliance
Authors: Norell Staffan E.
Published: August 2010

ABSTRACT. Methods and problems in assessing drug compliance are related to the selection of study sample and observation period as well as to methods used to measure patient behaviour in taking medications. Patients under treatment with a certain drug regimen are different from the patients for whom that regimen was originally prescribed. Medication compliance during short periods of time, such as 1–2 weeks before or after a visit to the clime, is likely to be different from that found over longer periods of time. Several studies indicate that estimates by clinical staff are no more accurate than chance selections in determining medication compliance. Patient interviews have usually identified 25–50% of noncompliant patients, but interview data on spacing between doses seem to be more accurate. Pill counts are useful in assessing drug compliance, although compliance may sometimes be overestimated. Medication monitors provide more detailed information on patient behaviour in taking medications.
The Concept of Medical Auditing
Authors: Crooks James
Published: August 2010

ABSTRACT. The contribution of drug utilisation studies on national, regional and local levels, to the quality control or audit of drug therapy is discussed. Two major types of audit, self‐audit and peer‐group audit, are outlined and examples presented illustrating how the concept of audit may be applied to therapeutics with special reference to drug information centres, feedback of drug prescribing data, and drug formularies. When drug information on prescribing practice from these sources is disseminated to the prescribers without value judgements being made, the component of self‐audit is predominant in contrast to drug information dealing with prescribing appropriateness, in which peer‐group opinion is expressed. Methods of capturing and disseminating data on prescribing practice which could be used in the auditing process are described. However, the greatest contribution to therapeutic audit lies with those responsible for medical training who should foster the quality of selfcriticism and the quest for high standards of prescribing practice in their students.
Extremes in Drug Utilization Patterns
Authors: Jakovljević Vida , Stanulović Milan
Published: August 2010

ABSTRACT. According to data expressed in defined daily doses (DDD), the utilization of antihypertensives is lower in the district of Novi Sad (Yugoslavia) than in other settings studied so far. The number of actually treated persons is even lower than that indicated by the DDD value, which in 1981 was 23.4 DDD/1000 inhabitants/day. Currently, the participating members in the WHO coordinated MONICA‐project are considering the possibility to incorporate the defined daily dose approach to evaluate drug usage in relation to morbidity data. This offers a realistic prospect for identifying the medical consequences of the regional differences in prescribing patterns.
Relation between Drug Utilization and Morbidity Pattern: Antihypertensive Drugs
Authors: Hjort Peter F. , Holmen Jostein , Waaler Hans Th.
Published: August 2010

ABSTRACT. Drug utilization studies are a valuable tool in health services research aiming to improve quality of health care and use of resources. We first present a simple model for drug utilization studies and then give practical examples from our studies in Norway, mainly dealing with the treatment of hypertension. There are marked differences in drug utilization between hospitals, counties, and the five Nordic countries. The medical consequences of these differences are probably small, but they have important economic implications. The marked regional differences in drug utilization argue for better organization of health care, for standardized treatment programs, and for continuing education of doctors.
Prescription‐Event Monitoring
Authors: Inman William H. W.
Published: August 2010

ABSTRACT. Prescription‐Event Monitoring (PEM) has been established at the Drug Surveillance Research Unit of the University of Southampton as a low‐cost technique for ascertaining the pattern of events, whether drug‐related or not, in large general practice cohorts. The reporting of “events” without the need for an opinion about the probability that they may be adverse drug reactions (ADRs) removes much of the uncertainty inherent in voluntary ADR reporting systems. Numerators (adverse events) and denominators (the number of prescriptions), enable estimates of incidence to be derived from the data. Where related drugs are studied concurrently, differences in the pattern of events may signal important differences in their safety or efficiacy. A successful large‐scale preliminary exercise involving nearly 9000 doctors and 16000 patients is described.
Influence of Autonomic Neuropathy on Leg Circulation and Toe Temperature in Diabetes Mellitus
Authors: SUNDKVIST GÖRAN , ALMÉR LARS‐OLOF , LILJA BO
Published: August 2010

ABSTRACT. The relationship between neuropathy and peripheral circulation was assessed in 26 patients with a short to moderate duration (<20 years, mean 11 years) and in 26 patients with a long duration (>20 years, mean 35 years) of diabetes mellitus. Peripheral nervous function was evaluated from measurements of vibration thresholds and ankle reflexes and autonomic nervous function from deep breathing, Valsalva, and tilt table tests. Peripheral circulatory tests included plethysmography, systolic blood pressure ratios, and thermography. A markedly delayed toe temperature increase after cooling followed by indirect heating occurred in diabetics of short duration with autonomic neuropathy (AN). Judging from blood flows and pressure ratios, functional vasospasm caused abnormal toe temperature reactions in short duration diabetics. No correlation existed between AN and abnormal toe temperature reactions in diabetics of long duration. Macroangiopathy rather than AN seemed to be responsible for abnormal toe temperature reactions in long duration diabetics. Thus, an abnormal toe temperature reaction indicates AN in patients with a short duration and macroangiopathy in patients with a long duration of diabetes.
Skeletal Lesions and Arterial Calcifications of the Feet in Diabetics
Authors: LITHNER FOLKE , HIETALA SVEN‐OLA , STEEN LARS
Published: August 2010

ABSTRACT. A radiological study of the feet was performed in 162 unselected diabetic patients with gangrene. They were compared with 59 diabetic patients without gangrene, 45 patients with familial amyloidosis and polyneuropathy and 30 healthy controls. The patients with familial amyloidosis had severe distal neuropathy but normal oral glucose tolerance test curves. Radiographic findings, e.g. skeletal destructions (diabetic osteopathy) and arterial calcification of the medial type were classified without knowledge of the clinical findings. Osteopathy was more common in diabetic patients with gangrene than in the other groups of patients. Medial arterial calcification was more common among diabetics with gangrene compared to patients with amyloidosis and to controls. There were no differences between diabetics without gangrene and patients with amyloidosis, but both of these groups had more calcifications than the controls. Our study suggests that diabetic osteopathy is not caused by peripheral neuropathy per se. The skeletal and skin lesions in diabetic patients are probably equivalent lesions localized to different tissues in the feet. It has been suggested that medial degeneration in the arterial wall is due to neuropathy. In agreement with this suggestion, the patients with familial amyloidosis and neuropathy had medial calcification. However, in diabetic patients this does not exclude other etiological agents.
Zinc Metabolism in Long Term Alloxan Diabetic Rats after Thermal Trauma
Authors: NYSTRÖM Å. , HALLMANS G. , LITHNER F.
Published: August 2010

ABSTRACT.Alloxan treated rats with diabetes of 6 weeks' and 15 months' duration respectively were submitted to local cutaneous traumatization with heat and the changes in zinc and copper metabolism were studied. All diabetic animals were hyperzincemic before the traumatization. Previous experiments have demonstrated a fall in serum zinc concentration after traumatization, and this reaction was more pronounced in short term diabetic rats than in controls. In the present study this reaction was less pronounced in the diabetic rats than in the non diabetic controls 15 months after alloxan injection. A time‐dependent factor in the development of granulocytic dysfunction is suggested as a cause for the differences in zinc metabolism found between rats with short term and long term alloxan diabetes respectively. The only change in copper metabolism found in this study was a slight increase in copper concentration in the liver after traumatization of rats with alloxan diabetes of 15 months' duration.
Effect of 1,25‐Dihydroxyvitamin D3 on Biochemical Indices of Bone Turnover in Postmenopausal Women
Authors: TJELLESEN L. , CHRISTIANSEN C. , RØDBRO P.
Published: August 2010

ABSTRACT Bone metabolism was estimated by serum alkaline phosphatase (index of bone formation) and fasting urinary excretions of calcium and hydroxyproline (indices of bone resorption) in a group of early postmenopausal women and a group of 70‐year‐old women, during 12 months' treatment with 1,25‐dihydroxycholecalciferol (1,25(OH)2D3), and compared to oestrogen/gestagen treatment or placebo treatment. The groups treated with 1,25(OH)2D3 did not show any change in bone metabolism, neither in bone resorption nor in bone formation, during the treatment period when compared to the placebo group, whereas treatment with female hormones decreased both bone resorption and bone formation.
The Value of Serum Myoglobin Determinations in the Early Diagnosis of Acute Myocardial Infarction
Authors: ROXIN L.‐E. , CULLHED I. , GROTH T. , HÄLLGREN T. , VENGE P.
Published: August 2010

ABSTRACT Myoglobin has been measured in sera from 305 consecutive patients with suspected acute myocardial infarction (AMI) to study the clinical value in relation to other diagnostic methods. On admission the frequency of false negative (i.e. the diagnostic sensitivity) myoglobin values was 28% in the AMI group as compared with 60% for serum creatine kinase (CK) and 46% for serum aspartate aminotransferase (ASAT). Four hours after admission the corresponding figures were 2, 31 and 29%. This makes the diagnostic sensitivity of the myoglobin test 0.98, which is significantly higher (p<0.001) than that of the two enzyme tests. The predictive value of a negative myoglobin test was 0.97 and also significantly higher (p<0.001 and p<0.01) than for CK and ASAT. S‐myoglobin was further related to the number of complications and the prognosis of the patients, and high levels appeared to be an unfavourable sign, particularly in combination with an anterior wall infarct. This study has demonstrated and confirmed the superior diagnostic sensitivity of myoglobin determination in early AMI. The inclusion of S‐myoglobin in the routine diagnosis of AMI warrants serious consideration.
Continuous Ambulatory Peritoneal Dialysis in the Treatment of End‐stage Diabetic Nephropathy
Authors: GREFBERG NILS , DANIELSON BO G. , NILSSON PER
Published: August 2010

ABSTRACT The results of treatment with continuous ambulatory peritoneal dialysis (CAPD) of 24 unselected patients with end‐stage diabetic nephropathy are reported. The total treatment time was 346 months. Six patients died, eight received a kidney allograft, two returned to CAPD after graft failure, six were transferred to other forms of dialysis and one to another centre. Five patients remained on CAPD. Good control of symptoms, biochemical values and hypertension was achieved. Intraperitoneal administration of insulin resulted in very good metabolic control of diabetes. In view of the unfavourable prognosis of uremic diabetics, the results of this study indicte that CAPD is a suitable method for treatment of uremia in end‐stage diabetic nephropathy.
Long‐term Effects of Captopril and Atenolol in Essential Hypertension
Authors: ANDRÉN LENNART , KARLBERG BENGT E. , SVENSSON ANDERS , ÖHMAN PETER , NILSSON OVE R. , HANSSON LENNART
Published: August 2010

ABSTRACTFifty patients with mild or moderate essential hypertension were randomized (double‐blindly) to treatment with either captopril (n=26) or atenolol (n=24). Their mean supine diastolic blood pressure after placebo was 100–125 mmHg. The study included an initial dose finding phase (12 weeks) during which the dosages of captopril and atenolol were increased stepwise every second week in order to obtain normotension (supine diastolic blood pressure <95 mmHg). Hydrochlorothiazide was added when necessary. During the second phase of the study the patients were followed on active treatment for 2 years. After the initial 12 weeks of active treatment, recumbent and standing blood pressures had fallen significantly both in the captopril group (by 31/20 and 33/19 mmHg,p<0.001) and in the atenolol group (by 24/18 and 30/20 mmHg,p<0.01 (systolic),p<0.001 (diastolic)). The antihypertensive effect was maintained in both groups during long‐term treatment. The antihypertensive effect of both agents was potentiated to the same extent by addition of hydrochlorothiazide. Side‐effects were few and mild. It can be concluded that both captopril and atenolol are safe and effective antihypertensive drugs.
Influence of Protein Intake on Renal Hemodynamics and Plasma Hormone Concentrations in Normal Subjects
Authors: BERGSTRÖM JONAS , AHLBERG MARIANNE , ALVESTRAND ANDERS
Published: August 2010

ABSTRACT Glomerular filtration rate (GFR) by clearance of inulin and creatinine and effective renal plasma flow (ERPF) by para‐aminohippurate clearance was investigated in 8 normal volunteers on low protein (LP) and high protein (HP) diet for 6 days in the basal state and after a mixed protein‐rich test meal. Plasma immunoreactive insulin (IRI), glucagon (IRG) and growth hormone (IRHGH) were followed before and after the test meal. GFR was higher on HP than on LP diet and increased within one hour after the test meal. ERPF also increased significantly after the meal on LP diet. IRI increased maximally at 60 min after the test meal and then declined gradulally. IRG increased after a latency period of 90 min and IRHGH consistently did not change. Since the increase in GFR was significant already one hour after the test meal, i.e. before IRG was changed, we conclude that glucagon is not a mediator of the protein‐induced increased in GFR. Neither insulin nor growth hormone appeared to be involved.
Thyrotoxicosis in Iceland 1980–1982
Authors: HARALDSSON ASGEIR , GUDMUNDSSON SIGURDUR TH. , LARUSSON GUDJON , SIGURDSSON GUNNAR
Published: August 2010

ABSTRACT A nationwide survey of the incidence of clinical thyrotoxicosis in Iceland was made during the three‐year period 1980–1982. An annual incidence of 23.6 per 100 000 inhabitants was found, females outnumbering males by 4.2: 1; 72% of all patients were aged 20–49. Graves' disease was considered the cause in 83.3% of the patients.
Arterial Blood Pressure and General Sympathetic Activation in Essential Hypertension during Stimulation
Authors: FREDRIKSON MATS , DIMBERG ULF , FRISK‐HOLMBERG MARIANNE , STRÖM GUNNAR
Published: August 2010

ABSTRACT We asked whether exaggerated blood pressure (BP) reactivity in patients with essential hypertension (HT) is a sign of specific activation of the cardiovascular system or of generalized sympathetic activation. Fourteen patients with essential hypertension and 14 matched normotensive (NT) controls were subjected to tasks involving attentional demands, mental arithmetic, a cold pressor test and isometric muscular contraction. Systolic and diastolic BPs, skin and muscle blood flows, heart rate, skin conductance level and fluctuations during each task were recorded. Urine samples for determination of epinephrine and norepinephrine excretion were collected after task completion. All tasks caused BP increases in both groups. HT showed greater absolute and percentage BP reactivity than NT during isometric muscle contraction. Variables for which reactivity differences were observed were poorly correlated across tasks both in HT and NT, whereas resting values prior to each task were highly correlated in both groups. Skin conductance activity, epinephrine and norepinephrine excretion rates being examples of non‐cardiovascular sympathetic nervous system (SNS) indicators did not separate HT from NT. Thus, the exaggerated pressor response in HT is not accompanied by signs of generalized SNS activation.
Echocardiographic Findings in a Patient with Left Ventricular Pseudoaneurysm
Authors: ERIKSSON SVEN , LINDVALL KAJ , BÖÖK KIM
Published: August 2010

ABSTRACT A 57‐year‐old woman, treated for a large anterior transmural myocardial infarction, was readmitted after 8 weeks because of progressive cardiac failure. Chest X‐ray showed cardiomegaly with an atypical cardiac silhouette. Two‐dimensional echocardiography disclosed a large left ventricular pseudoaneurysm. The patient underwent resection of the false aneurysm with repair of the left ventricular wall and recovered gradually. Different methods for diagnosing pseudoaneurysm are discussed.
Immunological Abnormalities in Massive Cutaneous Hyalinosis
Authors: MAURY C. P. J. , TEPPO A.‐M.
Published: August 2010

ABSTRACT Immunological studies in a patient with massive cutaneous hyalinosis, a disease characterized by principally dermal and subcutaneous accumulations of monoclonal kappa light chains and a gliadin‐binding mannose‐rich 90 kD glycoprotein, show that the ratio of helper to suppressor T cells is decreased and the proliferative responses of the peripheral mononuclear cells to T cell and T cell‐dependent B cell mitogens are depressed. High levels of circulating immune complexes were demonstrated by Clq‐binding and rheumatoid factor enzyme linked immunoassays. IgM and IgA class antibodies against the hyalin components, the mannosyl‐90 kD glycoprotein and type I collagen, and against keratin and gluten were present in high titres. The reactivity of mononuclear cells to phytohemagglutinin normalized and the antibody levels to hyalin proteins, keratin and gluten fell during low‐dose steroid therapy. However, the concanavalin A response was not reversed, neither did the levels of circulating immune complexes and anti‐intercellular substance antibodies decrease. The results demonstrate a very complex dysfunction of the immune system in massive cutaneous hyalinosis.
Plasma HDL Cholesterol and Blood Glucose in Non‐insulin‐dependent Diabetics Related to Liver Lipids and Microsomal Enzyme Activity
Authors: LUOMA P. V. , SAVOLAINEN M. J. , SOTANIEMI E. A. , ARRANTO A. J. , PELKONEN R. O.
Published: August 2010

ABSTRACT.Luoma PV, Savolainen MJ, Sotaniemi EA, Arranto AJ, Pelkonen RO. (Clinical Research Unit, Department of Medicine, and Departments of Medical Biochemistry, Pathology and Pharmacology, University of Oulu, Oulu, Finland.) Plasma HDL cholesterol and blood glucose in non‐insulin‐dependent diabetics related to liver lipids and microsomal enzyme activity.

The major lipid predictors of coronary events, plasma high density lipoprotein cholesterol (HDL‐C) and the HDL‐C/total cholesterol (T‐C) ratio, and blood glucose (BG) in 12 subjects with non‐insulin‐dependent diabetes mellitus were related to hepatic lipids, proteins and microsomal enzyme activity assessed by liver cytochrome P‐450 (P‐450). Non‐insulin‐dependent diabetics had low HDL‐C/T‐C ratio, liver phospholipid (PL) and P‐450 and high serum and liver triglyceride (TG) concentrations. Plasma HDL‐C was decreased, and BG high, especially in subjects with reduced PL and P‐450. The HDL‐C/T‐C ratio was directly proportional to liver PL and P‐450 and unrelated to hepatic TG. Increases in liver PL and microsomal enzyme activity may be favorably reflected both in cholesterol distribution and diabetic control.
Haemostatic Parameters in Cushing's Syndrome
Authors: IKKALA E. , MYLLYLÄ G. , PELKONEN R. , RASI V. , VIINIKKA L. , YLIKORKALA O.
Published: August 2010

ABSTRACT.Ikkala E, MyllylÄ G, Pelkonen R, Rasi V, Viinikka L, Ylikorkala O. (Finnish Red Cross Blood Transfusion Service and Helsinki University Central Hospital, Helsinki, Finland.) Haemostatic parameters in Cushing's syndrome.

We have studied haemostatic parameters in 12 patients with Cushing's syndrome. Three patients had prolonged bleeding times, and in all seven patients whose bleeding times were measured 3–6 months after surgical treatment the postoperative bleeding times were shorter (mean 7.5 min) than the pretreatment times (mean 12.3 min). In ADP‐ or adrenaline‐induced aggregation the second wave was lacking in six and the degree of aggregation was borderline or subnormal in five patients. One patient had, in addition, a severe defect in collagen‐induced aggregation. However, thromboxane B2production of the platelets from both endogenous and exogenous arachidonic acid was unaffected. Factor VIII:C, RAg and Rcof activities were all elevated, and in patients with severe disease F VIIIR:Ag and F VIII:Rcof activities were markedly more elevated than F VIII:C activity. The changes in both primary haemostasis and in factor VIII activities correlated clearly with the clinical severity of the disease.
Low Density Lipoprotein Receptor Activity in Human Leukemic Cells—Relation to Chromosome Aberrations
Authors: LINDQUIST RAGNHILD , VITOLS SIGURD , GAHRTON GÖSTA , ÖST ÄKE , PETERSON CURT
Published: August 2010

ABSTRACT. Lindquist R, Vitols S, Gahrton G, Öst Å, Peterson C. (Division of Clinical Hematology and Oncology, Department of Internal Medicine, Huddinge Hospital and Karolinska Institute, Huddinge, Department of Medical Cell Genetics, Medical Nobel Institute, Department of Pharmacology, Karolinska Institute, and Department of Pathology, Karolinska Hospital, Stockholm, Sweden.) Low density lipoprotein receptor activity in human leukemic cells—Relation to chromosome aberrations.

Chromosome analysis and low density lipoprotein (LDL) receptor activity of leukemic cells from 38 patients with acute non‐lymphocytic leukemia were correlated. Clonal chromosome aberrations were found in 22 patients, and an extra chromosome 8 was found in 7 of them. LDL receptor activity was significantly higher in patients with an extra chromosome 8 than in patients with other abnormalities or a normal karyotype. Chromosome 8 may harbor genes of importance for the expression of the LDL receptor.
Use of Cardiac Glycosides in Finland
Authors: IMPIVAARA OLLI
Published: August 2010

ABSTRACT. The prevalence and number of persons receiving cardiac glycosides were estimated in connection with a general health survey. A population sample (n = 8000) representative of the adult Finnish population was studied. According to a questionnaire and an interview, about 10 % of men and 11 % of women were receiving cardiac glycosides. The total number of glycoside users in Finland was estimated at 311 000 (95% confidence limits 289 000–333 000). A significant serum digitalis concentration definitely indicating digitalis use was observed in about 9% of men and 10% of women. By this method the minimum number of persons receiving digitalis therapy was estimated at 248 000 (95 % confidence limits 227 000–269 000). About 90% of all glycoside consumption appeared to take place outside institutions. The prevalence of glycoside use increased greatly with advancing age and tended to be higher in women than in men. The prevalence varied significantly between regions within the country. Further research is required to explain the unusually prevalent and geographically variable use of cardiac glycosides in Finland.
Incidence and Management of Pacemaker‐related Complications during Dual‐chamber Pacing
Authors: NORDLANDER ROLF , PEHRSSON S. KENNETH
Published: August 2010

ABSTRACT. To evaluate the complication rate during AV universal pacing (DDD), 41 consecutive patients with complete heart block were studied and followed up for 2–30 (mean 10.8) months. The Cordis Sequicor Theta was used in 6 patients and the Siemens‐Elema 674 in 35. Clinical problems related to the pacemaker treatment occurred in 12 patients (pacemaker tachycardia triggered by retrograde atrial activation in 2, atrial oversensing in 3 and undersensing in 2, ventricular oversensing in 2 and undersensing in 1). Ventricular fibrillation occurred during threshold measurement in one patient. Seven of the problems could be ascribed to the DDD mode. Four of these 7 problems could be solved by reprogramming the pacemaker. A nonprogrammable atrial refractory period in the Cordis Sequicor was found to be a limitation in patients with endless loop tachycardia. In 3 cases reoperation had to be performed. In another 3 cases there were problems with ventricular sensing which in one could be solved by reprogramming. Apart from ventricular fibrillation, which could not be ascribed to the DDD mode, there were no serious problems in the clinical management of the patients.
Low Prevalence of Abdominal Aortic Aneurysm in Hypertensive Patients
Authors: LINDHOLM LARS , EJLERTSSON GÖRAN , FORSBERG LILLEMOR , NORGREN LARS
Published: August 2010

ABSTRACT. The prevalence of abdominal aortic aneurysms (AAA) was estimated by ultrasonography in hypertensives in the age group 50–70 years in a geographically defined population. Only one case of AAA was found among 245 patients. This rather unexpected result implies a probability of less than 5% that the true prevalence of AAA is as high as 2% in hypertensives. Our population‐based study indicates a lower prevalence than earlier studies based on necropsies and is an example of research cooperation between primary health care and specialized hospital care.
Smoking and Health in Old Age
Authors: AGNER ERIK
Published: August 2010

ABSTRACT. The implications for health of smoking habits at entry were evaluated in a 10‐year longitudinal study of a population of men and women aged exactly 70 at entry and otherwise selected only according to geography. Seventy‐six per cent of the men and 39% of the women were smokers at 70, 32% of the male and 20% of the female smokers were inhalers. In men, heavy smoking (≥15 g tobacco per day and inhalation) was statistically associated with low systolic blood pressure, intermittent claudication, chronic bronchitis, low body mass index and low serum insulin, but not with forced expiratory volume in first second (FEV1). In the 10‐year follow‐up period heavy smoking in men was associated with excess total mortality, excess mortality from malignant neoplasms, excess mortality from non‐malignant pulmonary diseases and increased decrease in FEV1. In women, but not in men, inhalation was statistically associated with excess total mortality.
Hypoglycaemic Coma in Severe Primary Hypothyroidism
Authors: HERMANSEN K. , JOHANNSEN L. G. K. , RASMUSSEN O. B.
Published: August 2010

ABSTRACT. A 76‐year‐old woman was admitted to the hospital in comatous condition. Her blood glucose was 1.7 mM. Immediately after intravenous glucose treatment she attained normal consciousness. The diagnosis of severe primary hypothyroidism was subsequently made and no sign of other diseases was detected. After thyroid replacement therapy fasting blood glucose levels rose to normal and no further hypoglycaemic episodes occurred. It is emphasized, that hypoglycaemia may be the direct cause of severely impaired consciousness in hypothyroidism requiring immediate and specific therapy.
Transcapillary forces in normal pregnant women
Authors: Øian Pål , Maltau Jan Martin
Published: August 2010

ABSTRACT. Plasma and interstitial fluid colloid osmotic pressure (COP) and interstitial fluid hydrostatic pressure (Pi) were measured in 10 normal pregnant women in first and third trimester. Interstitial fluid COP was measured by a “wick” technique and Pi by a “wick‐in‐needle” technique. The COP was significantly lower both in plasma and interstitial fluid in the third trimester compared to that in the first trimester. However, the fall in COP was more marked in the interstitial fluid than in plasma. Only small changes in Pi were observed. Our results support the view that reduction of COP in interstitial fluid is a major local edema‐preventing mechanism. This compensates for the increased capillary pressure and the hypoproteinemia in late pregnancy. The relatively low interstitial fluid COP in third trimester women without edema implies a reduced safety margin against edema formation and may explain why 40 ‐ 80 % of normal pregnant women experience edema.
Adrenaline and Preeclampsia
Authors: ØIAN PÅL , KJELDSEN SVERRE ERIK , EIDE IVAR , NORMAN NILS
Published: August 2010

ABSTRACT. Twenty‐one preeclamptic women had increased venous plasma‐free adrenaline (45 ± 5 vs 27 ± 2 pg/ml, mean ± SE, P < 0.01) and plasma‐free dopamine (137 ± 25 vs 55 ± 6 pg/ml, P < 0.01) compared with fifteen normotensive pregnant women. Plasma renin activity (P < 0.001) and aldosterone concentration (P <0.02) were depressed in the preeclamptic and serum potassium increased (P < 0.02). Plasma adrenaline correlated with blood pressure (r = 0.80, P < 0.001) supporting increased sympathetic nervous tone in the development of preeclampsia.
Rubidium Uptake of Mononuclear Leukocytes From Normotensive and Borderline Hypertensive First Degree Relatives to Patients With Essential Hypertension
Authors: Johansen Torben , Nielsen Jens Rokkedal , Poulsgard Lars , Knudsen Torben , Pedersen Knud E. , Klitgaard Niels A.
Published: August 2010

Uptake of 86Rubidium of mononuclear leukocytes (MNL) was used as a measure of cellular sodium‐potassium pump activity. 86Rb‐uptake was determined with the pump stimulated mainly from inside the cells by sodium as well as with a combined stimulation from inside by sodium and from outside by Rb. In the first case there was an increased pump activity in MNL from borderline hypertensive offspring of hypertensive patients (BHO), and this may be related to an increased number of pump sites observed previously (10). Estimation of maximal pump activity (Vmax) of MNL suggested that Vmax of each pump site in MNL from BHO may be decreased compared to control value of MNL from healthy normotensive subjects.
HEMODYNAMIC EFFECTS OF COMBINED BETA‐ADRENOCEPTOR BLOCKADE AND PRECAPILLARY VASODILATATION IN HYPERTENSION
Authors: Eggertsen Robert , Sivertsson Ramon , Andrén Lennart , Hansson Lennart
Published: August 2010

ABSTRACT. Carvedilol (BM14190) is a new compound with combined properties of nonselective betaadrenoceptor blockade, devoid of ISA, and precapillary vasodilatation. Its acute hemodynamic effects were studied with invasive technique (dye‐dilution using Cardio‐Green) in 10 patients taking 25 mg orally and noninvasive (fore‐arm plethysmography) in 10 patients taking 25 mg and in 10 patients taking 50 mg orally, all with essential hypertension. Significant reductions of systolic and diastolic blood pressures (p < 0.05 — 0.001) were observed in all groups. TPR did not change acutely whereas resistance in the fore‐arm was reduced by 16% (p < 0.05).

When a comparison with propranolol (80 mgx2) was made in a randomized, double‐blind placebo controlled trial comprising 30 patients with essential hypertension, carvedilol acutely reduced blood pressure significantly 13/6 mm Hg (25 mg) and 17/10 mm Hg (50 mg) in contrast to propranolol. Resistance in the fore‐arm (plethysmography) fell significantly with carvedilol 50 mg whereas propranolol caused a significant rise. After 4 weeks both compounds had reduced blood pressure significantly and to the same extent. Blood flow was still reduced with propranolol in contrast to the findings with carvedilol.

We conclude that carvedilol given orally has a useful antihypertensive effect both acutely and during prolonged treatment. It has an attractive hemodynamic profile.
The Possible Role of the Ancillary Properties of Beta Adrenoceptor Antagonists in the Management of Angina Pectoris
Authors: Fitzgerald J.D.
Published: August 2010

ABSTRACT.Beta adrenoceptor antagonists are effective in the symptomatic management of angina pectoris. This paper examines critically the possible influence of the ancillary properties of β1selectivity, partial agonism and membrane‐stabilizing action on the response in anginal patients. The response is categorized according to experimental, pharmacological and clinical end‐points, placing emphasis on the possible errors which may arise from extrapolation from the former to the latter. It is concluded:

That selective beta adrenoceptor antagonism confers limited, but tangible advantages over non‐selective antagonists in regard to patients with reversible airways obstruction, and also in the metabolic and haemodynamic response to acute hypoglycaemia.

Cardioselectivity does not influence the central haemodynamic response to exercise, but lessens adrenaline‐mediated hypertensive responses to smoking and hypoglycaemia.

Non‐selective partial agonists cause less reduction in resting ventricular function, but their effects on cardiac output during exercise are indistinguishable from full antagonists.

Membrane stabilizing properties have a marked influence on the tolerability of these agents in terms of unwanted, nonspecific central nervous system symptoms.

Unresolved questions relate to the influence of partial agonism on fatigue, metabolic responses, especially blood lipids and glucose, and the possibility of lesser efficacy in angina compared to full antagonists.
Incidence of Different Manifestations of Coronary Heart Disease in Middle‐aged Finnish Men and Women
Authors: REUNANEN ANTTI , SUHONEN OLLI , AROMAA ARPO , KNEKT PAUL , PYÖRÄLÄ KALEVI
Published: August 2010

ABSTRACT. The incidence of myocardial infarction and symptoms of coronary heart disease (CHD) were investigated in a prospective Finnish population study. Drawn from four geographical areas in Finland the study population comprised 5 438 men and 4 924 women aged 30–59 at entry. The results are based on a re‐examination of the study population after a mean follow‐up time of six years. The average annual incidence of coronary death was 3.8/1 000, and that of non‐fatal infarction 6.5/1000 in men and 0.4/1000 and 2.1/1000 in women. Ten per cent of all infarctions were silent, revealed only by ECG changes. Cases of new angina pectoris comprised 40% of all the new events in men but 80% in women. This descriptive report serves as the basis for subsequent analyses comprising risk factors for different CHD manifestations.
Aortic Regurgitation Associated with Ventricular Septal Defects in Adults: Clinical Course, Haemodynamic, Angiographic and Echocardiographic Findings
Authors: OTTERSTAD JAN ERIK , IHLEN HALFDAN , VATNE KARLEIF
Published: August 2010

ABSTRACT. In 125 consecutive patients, aged ≥10 years (mean 27, range 10–64), evaluated for isolated ventricular septal defects (VSD) the initial prevalence of aortic regurgitation (AR) was 12/125. Forty‐one patients were operated on, and post‐operative mortality was 3/6 in patients operated on for VSD and AR and 1/35 in those operated on for VSD alone. All but one of the patients have been followed until death or beyond the age of 30 years (mean 42, range 31–73) and a prospective restudy has been performed after a mean observation time of 15 years (range 4–21). The incidence of new cases of AR arising during this period was 10/111. AR was severe in 5 cases (one died from heart failure), moderate in 1 and mild in 4. Surgical repair of AR and VSD was performed in 3 cases. Common characteristics of patients who developed AR were advanced age, male sex, history of bacterial endocarditis, small subaortic VSDs and tricuspid aortic valves without prolapse. Echocardiography revealed larger aortic root diameter (p < 0.001), increased eccentricity factor (p < 0.001) and increased left ventricular dimensions (p < 0.02) in those with complicating AR. AR in adults with VSD may have an unpredictable clinical course; it may be difficult to assess clinically and the need for close clinical control is emphasized. Echocardiography remains of considerable value in selected cases.
Pulmonary Arteriovenous Fistulas in Hereditary Hemorrhagic Telangiectasia
Authors: VASE POUL , HOLM MOGENS , ARENDRUP HENRIK
Published: August 2010

ABSTRACT. We reviewed all available chest X‐rays of 95 patients with hereditary hemorrhagic telangiectasia (HHT). The diagnosis of pulmonary arteriovenous fistula (PF) had previously been made in 13 patients, nine of whom had been operated on. Another three cases were found in the review. The 16 patients with HHT and PF came from eight families, one of which contributed seven patients. Median observation time between the first and the latest chest X‐ray examination was 11 years (range 1/2–35). Growth of the PF was seen in four patients and spontaneous regression in one. Four of the 16 patients with PF had symptoms consistent with cerebral embolism, while only two of the 79 patients without PF had such symptoms. This study is part of an epidemiological investigation of HHT—to our knowledge not carried out before. The calculated period prevalence of simultaneous HHT and PF in the decade 1964–74 in the county of Fyn (429 207 inhabitants) was 2.6 per 100 000.
Effect of Improved Glycemic Control by Continuous Subcutaneous Insulin Infusion on Hormonal Responses to Insulin‐induced Hypoglycemia in Type 1 Diabetics
Authors: LINS PER‐ERIC , CLAUSEN NINA , ADAMSON ULF , KOLLIND MAGNUS , HAMBERGER BERTIL , EFENDIC SUAD
Published: August 2010

ABSTRACT. Glucose counter‐regulatory capacity and the hormonal responses to insulin‐induced hypoglycemia were studied in eight type 1 diabetics before and after improvement of metabolic control by continuous subcutaneous insulin infusion (CSII). The intensified treatment resulted in a decrease in mean glycosylated hemoglobin from 11.6 ± 0.5 to 9.3 ± 0.4% within a mean period of 14 weeks. During a constant rate infusion of insulin (2.4 U/h), steady state levels of glucose appeared in all subjects. The steady state glucose level was identical before and after CSII. The counter‐regulatory hormonal responses showed significantly higher epinephrine levels, while glucagon, growth hormone, and Cortisol were not influenced. In parallel with the heightened epinephrine response the pulse rate response was significantly enhanced. The restitution of blood glucose after insulin hypoglycemia was not modified. It is concluded that a more vigorous catecholaminergic response to hypoglycemia is achieved after improved metabolic control by CSII.
Aggravation of Thiamine Deficiency by Magnesium Depletion: A Case Report
Authors: DYCKNER T. , EK B. , NYHLIN H. , WESTER P. O.
Published: August 2010

ABSTRACT. A patient with Crohn's disease and long‐standing diarrhea resulting in a combined thiamine and magnesium deficiency is presented. Despite massive doses of thiamine i.v., the symptoms of thiamine deficiency could not be suppressed until the magnesium deficiency was corrected as well. This case report emphasizes the dependence of thiamine on magnesium for an adequate function in the body.
Treatment of Hypertension in Obese Patients: Efficacy and Feasibility of Weight and Salt Reduction Programs
Authors: RISSANEN A. , PIETINEN P. , SILJAMÄKI‐OJANSUU U. , PIIRAINEN H. , REISSEL P.
Published: August 2010

ABSTRACT. The effect of three different nutrition counselling programs on well established hypertension was studied in 64 obese patients regularly attending a hypertension clinic. The 12‐month program of weekly‐monthly group sessions focused on weight reduction (W group, n = 24), salt restriction (S group, n = 17) or both (WS group, n = 23). The mean (± SEM) weight decreased by 6.9 ± 0.7 kg in the W group (p < 0.001) and by 5.0 ± 0.6 kg (p < 0.001) in the WS group during the first three months of the study and levelled off thereafter. The weight changes in the S group were small during the trial. The mean 24‐hour urinary sodium excretion in the WS and S groups was reduced by about 35 and 50 mmol, respectively, during the first months of the study, and fell thereafter somewhat in the S group but not in the WS group. Sodium excretion remained unchanged in the W group. Systolic and diastolic blood pressure (BP) fell significantly in the W and WS groups during the first months of the study. BP remained thereafter stable in most patients but declined further in one fifth of them. BP changed little during the trial in the S group. By 12 months, BP control was improved in 67, 61 and 12% of the patients in the W, WS and S groups, respectively. Improved BP control was strongly related to weight loss but not to reduced sodium excretion. Weight reduction programs with even modest success help most obese patients with established hypertension, whereas moderate salt intake restriction gives little added benefit.
Effect of Quinine on Plasma Digoxin Concentration and Renal Digoxin Clearance
Authors: PEDERSEN KNUD ERIK , MADSEN JAN LYSGAARD , KLITGAARD NIELS ANDERS , KJÆR KAREN , HVIDT STEFFEN
Published: August 2010

ABSTRACT. In order to explore the digoxin‐quinine interaction, digoxin steady state pharmacokinetics was studied before and during quinine coadministration in seven healthy subjects. Quinine (250 mg/day) increased mean plasma digoxin concentration from 0.64 ± 0.12 to 0.80 ± 0.18 ng/ml (p < 0.05) within one week. Urinary digoxin recovery rose from 154.0 ± 18.8 to 181.5 ± 22.6 μg/24 h (p < 0.01), whereas renal digoxin clearance was unaltered in the presence of quinine (181.5 ± 24.2 vs. 174.1 ± 26.5 ml/min). An increase in quinine dose (to 750 mg/day) caused further increments in plasma digoxin levels, whereas renal digoxin clearance remained unchanged. Quinine elevates plasma digoxin concentrations in a stepwise fashion probably due to an impairment of extrarenal digoxin clearance.
Familial Occurrence of Coronary Heart Disease According to Clinical Manifestation
Authors: RISSANEN AILA M.
Published: August 2010

ABSTRACT. Occurrence of different clinical manifestations of coronary heart disease (CHD) was assessed among the parents and siblings of 309 men with CHD (case probands), including 103 men with fatal and 100 with nonfatal myocardial infarction (MI), and 106 men with angina pectoris (AP) and among the relatives of 106 reference men. CHD was equally common among relatives of all case probands. It was four times as common in case brothers and twice as common in case sisters as in the respective reference siblings. There were differences between the various case groups as to the predominant clinical manifestation of CHD. Cardiac deaths were commonest in the sibs of men with fatal MI, and uncomplicated angina in the men with AP. The familial resemblance in the clinical manifestations of CHD suggests familial influence in the mechanisms determining the clinical expression of the disease.
Primary Cytomegalovirus Infection Following Open Heart Surgery
Authors: ENDRESEN KNUT , GJESDAL KNUT , ØRSTAVIK IVAR , SIVERTSSEN EGIL , REIKVAM ÅSMUND , ULSTRUP JAN C. , AALEN ODD O.
Published: August 2010

ABSTRACT. Among 674 patients undergoing open heart surgery in 1981–82, 86 (13 %) were cytomegalovirus (CMV) antibody‐negative when tested by an enzyme‐linked immunosorbent assay prior to operation. At follow‐up, 54 (67 %) of 80 patients restudied had seroconverted after the operation, and 35 of the 54 seroconvertants had been ill with fever and elevated liver enzymes. Among the latter 35 patients, 26 demonstrated a significant rise in CMV antibody titre, most often detected in the third week following the onset of illness. The older patients were more susceptible to illness and seroconversion, and there was a positive correlation between age and the number of blood units given. Thus, at least one third of the seronegative patients developed symptomatic CMV illness after open heart surgery. This is a much higher incidence than earlier reported.
Blood Glucose, Glucose Tolerance and Manifest Diabetes in Relation to Cardiovascular Disease and Death in Women: A 12‐Year Follow‐up of Participants in the Population Study of Women in Gothenburg, Sweden
Authors: LAPIDUS LEIF , BENGTSSON CALLE , BLOHMÉ GÖRAN , LINDQUIST OLOF , NYSTRÖM ERNST
Published: August 2010

ABSTRACT. A longitudinal population study of 1462 women, aged 38–60, was carried out in Gothenburg, Sweden in 1968–69. Women with initially manifest diabetes mellitus had significantly increased 12‐year incidence of myocardial infarction and increased mortality while no increased incidence of angina pectoris, ECG changes indicating ischaemic heart disease or stroke was observed. The association to myocardial infarction remained in multivariate analyses and was independent of age, body fat distribution, smoking, serum cholesterol and systolic blood pressure. The association to mortality was independent of these factors and also of serum triglycerides. Women who were diagnosed as “new diabetics” during the 12‐year follow‐up had a significantly increased 12‐year incidence of myocardial infarction but no significant increase was observed for any of the other end‐points studied. When women with initially manifest diabetes mellitus were excluded, no association was found between initial fasting blood glucose concentration and the end‐points studied. A negative significant association was found between initial fasting blood glucose concentration and smoking.
Plasma Insulin as Coronary Heart Disease Risk Factor: Relationship to other Risk Factors and Predictive Value during 9½‐year Follow‐up of the Helsinki Policemen Study Population
Authors: Pyörälä Kalevi , Savolainen Eero , Kaukola Sirkka , Haapakoski Jaason
Published: August 2010

ABSTRACT. In the Helsinki Policemen Study based on a cohort of 982 men aged 35—64 years and free of coronary heart disease (CHD) at entry plasma insulin level (fasting, 1‐hour and 2‐hour plasma insulin after oral glucose load) showed during a 9½‐year follow‐up a nonlinear association to the incidence of »hard criteria» CHD events (CHD death or non‐fatal myocardial infarction) with highest incidence in the top decile of plasma insulin. Plasma insulin levels showed positive correlations, besides to blood glucose levels, to body mass index, plasma triglyceride level and blood pressure and inverse correlations to leisure time physical activity and objectively measured physical fitness. In multivariate analyses the predictive value of high plasma insulin with respect to CHD risk was found to be independent of other risk factors, including blood glucose levels.
Ten Years of the North Karelia project
Authors: Puska Pekka , Tuomilehto Jaakko , Nissinen Aulikki , Salonen Jukka
Published: August 2010

ABSTRACT. Medical and epidemiological research into the aetiology of CHD has drawn attention to the likely causal role of certain risk factors, especially elevated serum (LDL) cholesterol and blood pressure levels, and smoking. Conventional trials to establish the causality have come up against problems of feasibility and study design. Community‐based studies have considerable potential in introducing changes to the general lifestyle and risk factors in large numbers of people (since the risk factors are closely related to the way of life and other features of the community). Thus a well evaluated community‐based study can augment our knowledge on the role of the risk factors. Furthermore, a community study examines how the existing service structure and community resources can be used and assesses the overall feasibility and consequences of such an intervention.

The North Karelia project, started in eastern Finland in 1972, has been a major communitybased study on the prevention of CHD. The results of the 10‐year evaluation of the project illustrate the feasibility and consequences of the approach. During the 10‐year period 1972—82 the following net changes (i.e. adjusted for changes in the reference area) occurred in the risk factor means of the population aged 30—59 in North‐Karelia: —28% for smoking (p <.001), —3% for serum cholesterol (p <.001) and —3% for systolic BP (p <.001). During the period 1974—79 the age‐standardized CHD mortality of men aged 30—64 was reduced by 22% in North Karelia, 12% in the reference area and 11% in the rest of Finland (p <.05 compared with NK). Other results of the evaluation are also presented to support the feasibility of the approach and to demonstrate that the programme has led to a number of positive changes in the health of the target population.