bluuebunny/crossref_metadata_2025 huggingface dataset:
24‐Hour Blood Glucose Profiles in Insulin‐Dependent Diabetics Treated with Intravenous Insulin Infusion Systems
Authors: Deckert Torsten , Bojsen Jørgen , Christiansen Jens Sandahl , Kølendorf Klaus , Svendsen Per Aaby , Andersen Allan Renard
Published: August 2010

ABSTRACT. The aim of this study was to compare the 24‐hour blood glucose profiles of insulin‐dependent diabetics during treatment with preprogramed insulin delivery systems with those of patients on treatment with the artificial beta cell (Biostator®). Mean blood glucose (MGB) was 4.4±0.5 mmol/l for 15 controls, 5.8 ± 1.0 for 53 patients on open‐loop and 6.0 ± 0.6 for 20 patients on closed‐loop treatment. MBG was significantly higher in diabetics than in non‐diabetics, but the difference between the two diabetic populations was not significant. Mean amplitude of blood glucose excursion was 1.8 ± 0.6, 4.3 ± 1.3 and 3.5 ± 0.8 mmol/l respectively, the difference between the diabetic groups being significant. No hypoglycemia was seen in patients during closed‐loop treatment, whereas this was the case in 10 of 53 patients on treatment with open‐loop systems. Physical exercise resulted in small but normal decreases in blood glucose without hypoglycemia. Plasma insulin was within the normal range during both regimes. It is concluded that blood glucose control during treatment with closed‐loop system is superior to that during treatment with open‐loop systems. However, under standard conditions i.v. insulin infusion with preprogramed pump devices resulted in blood glucose fluctuations comparable with those during Biostator® treatment.
Amiloride‐Induced Hyponatremia
Authors: Tarssanen Leo , Huikko Markku , Rossi Matti
Published: August 2010

ABSTRACT. We present three aged female patients who fulfil the criteria of a syndrome that we call “amiloride hyponatremia”. They became hypona‐tremic during amiloride + hydrochlorothiazide therapy. They needed diuretic therapy and tolerated well hydrochlorothiazide with potassium supplementation as potassium chloride. Patients with hyponatremia during diuretic therapy for cardiovascular diseases can be allocated to three groups: 1) Patients with edema and water retention due to severe impairment of cardiac function and decreased water clearance. They need diuretic therapy and water restriction. 2) Patients with “normal diuretic hyponatremia”. Hypokalemia and extracellular volume contraction seem to be associated with this phenomenon, and the therapy involves discontinuing the unnecessary diuretic treatment. 3) Patients with “amiloride hyponatremia”. They need diuretic treatment and tolerate thiazide therapy, but the hyponatremia can be corrected by changing amiloride to potassium supplementation. “Amiloride hyponatremia” is suggested to be due to a direct effect of amiloride + hydrochlorothiazide on the distal nephrons. The combination amiloride + hydrochlorothiazide must be used cautiously in elderly patients and the possibility of hyponatremia should be born in mind in cases of vague symptoms and CNS disturbances.
The Effectiveness of Clonidine as an Antihypertensive in a Two‐Dose Regimen
Authors: Frisk‐Holmberg M.
Published: August 2010

ABSTRACT. The therapeutic efficacy of clonidine as an antihypertensive in a b.i.d. schedule 150–300 μg daily was evaluated. The blood pressure reduction in patients with essential hypertension was satisfactory on this regimen and the steady‐state plasma concentrations were within the BP‐lowering concentration range at the end of a dosage interval.
Bone Mineral Content in Women with Vertebral Fractures
Authors: Lamke B. , Engfeldt B. , Sjöberg H. E.
Published: August 2010

ABSTRACT. Postmenopausal women, classified as osteoporotics on the basis of clinical and microradiographic findings, were found to have a low bone mineral content as compared with age‐matched controls. The bone mineral content in 12 patients on a dietary supplement of calcium and vitamin D did not decrease during a two‐year follow‐up period.
Clinical Significance of Mitogen‐Induced Responses in Lymphocytes from Patients with Chronic Lymphocytic Leukemia
Authors: Robèrt K.‐H. , Gahrton G. , Möller E. , Nilsson B.
Published: August 2010

ABSTRACT. The mitogenic response patterns as well as surface membrane receptors of peripheral blood lymphocytes were investigated repeatedly during progression of the disease in 27 patients with chronic lymphocytic leukemia. Each patient was characterized by a reproducible mitogenic response pattern. Eleven patients, who required treatment within 0–24 months after diagnosis, had significantly higher cellular responses to dextran sulphate (DxS) and lipopolysaccharide (LPS) than 10 patients who have not required treatment within an observation time of 10–40 months from diagnosis. The high LPS and DxS responses, which may indicate leukemias composed of more immature cells, appear to predict a poor prognosis.
Effect of Cyclofenil Treatment on Arterial Insufficiency Demonstrated in a Patient by Colour Thermography
Authors: Herbai Georg , Boczán John
Published: August 2010

ABSTRACT. Cyclofenil, 200 mg t. i. d., was administered for four months to a 67‐year‐old woman, who suffered from a combination of scleroderma, Osler‐Weber‐Rendu disease and a severe atherosclerotic circulatory insufficiency. The effects on the severely impaired skin circulation in the face and hands were followed and recorded by colour isothermograms, using the AGA monitor system. The treatment resulted in a marked improvement of the arterial circulation with disappearance of the Raynaud phenomenon, complete arrest of gastrointestinal bleeding, disappearance of malabsorption, and relief of the joint stiffness.
Stokes‐Adams Attacks Requiring Pacemaker Treatment in Three Patients with Acute Nonspecific Myocarditis
Authors: Granath A. , Kimby E. , Södermark T. , Volpe U. , Zetterquist S.
Published: August 2010

ABSTRACT. Three patients, aged 16–44 years, with complete heart block in acute myocarditis are reported. The diagnosis of myocarditis was based on the development of transitory repolarization disturbances on the ECG in association with clinical signs of acute infectious disease. All patients were brought to hospital due to repeated Stokes‐Adams attacks and demonstrated ventricular asystoles for up to 25 sec. The patients were all successfully treated with temporary intracardiac pacing but one of them later turned out to require a permanent pacemaker. The possibility of differences in localization and in prognostic importance of conduction disturbances between infectious and ischemic myocardial disease is discussed.
Epilepsy and Myopathy in a Patient with Rothmund–Thomson's Syndrome
Authors: Lessem Jan , Bjerre Ingrid , Forslund Marianne
Published: August 2010

ABSTRACT. A report of a 21‐year‐old female, who has had Rothmund‐Thomson's syndrome since early childhood, is given. In addition to the original disease with skin and tendon manifestations, she has also developed myopathy and epilepsy. It is discussed whether these two recent manifestations are part of her original syndrome or of different pathogenesis.
Hypertension, Levels of Serum Gamma Glutamyl Transpeptidase and Degree of Blood Pressure Control in Middle‐Aged Males
Authors: Henningsen N. C. , Ohlsson O. , Mattiasson I. , Trell E. , Kristensson H. , Hood B.
Published: August 2010

ABSTRACT. Among the first screened 2439 males born in 1926 and 1927, aged 48–49 years at the time of screening and representing 76% of these age cohorts, uncontrolled or partly controlled hypertension was found in 7.5%. Of these individuals, 30% preferred to remain with their physicians, regardless of the degree of control they had achieved. Among those who were referred to the Hypertension Unit (5.2% of the screened population), elevated S‐GT levels (≥1.10 μkat/1) were found in 38.3%, against 18.5% in the two cohorts. During 24 months of treatment and follow‐up only two men among the entire group of hypertensives referred dropped out, both were heavy drinkers (>80 g alcohol daily). The mean BP after treatment was significantly lower among men with normal than high S‐GT values or in those who admitted to heavy drinking. Of the 99 males treated for more than two years, 82 (83%) were responders (supine DBP ≤95 mmHg). C the non‐responders, 70% were either heavy drinkers or had abnormal S‐GT values. The possible role of alcohol in the pathogenesis of essential hypertension in middleaged males is discussed.
Ventricular Arrhythmias and Risk Indicators of Ischemic Heart Disease
Authors: Orth‐Gomér Kristina
Published: August 2010

ABSTRACT. Three groups of men, 50 with manifest ischemic heart disease (IHD), 50 with risk indicators of IHD and 50 healthy men, were examined for ventricular arrhythmias with 24‐hour Holter monitoring during normal work and home life. Ventricular arrhythmias were most frequent in the IHD, intermediate in the risk and least frequent in the control group. Multiform ventricular ectopic beats, but no other qualitative characteristic significantly discriminated the three groups. The following risk indicators were associated with ventricular arrhythmias: ageing, cardiac enlargement and smoking. The results suggest that long‐term ECG monitoring may be of value for the detection of ventricular arrhythmias not only in men with clinical IHD, but also in those with merely risk indicators.
A Familial Syndrome with von Recklinghausen's Neurofibromatosis, Gammopathy and Aorta Outflow Obstruction
Authors: Wille Leif E. , Førre Øystein , Steffensen Roger W.
Published: August 2010

ABSTRACT. Three cases of von Recklinghausen's disease have been observed in the same family comprising four members. Two of the patients, father and son, had aorta outflow obstruction and biclonal gammopathy (IgG(k/Λ) and IgA(K)/IgG(k)). In one of these patients, no concanavalin suppressor cell activity was demonstrated, indicating that the gammopathy may be related to suppressor T‐cell deficiency. Further study of the other family lineages showed that aorta stenosis/mors subita occurred frequently, but genetic marker studies failed to reveal any linkage between these entities. The syndrome, which has not been reported previously, was probably restricted to the first kindred studied. Detailed biochemical and immunological studies of the monoclonal components involved are in progress.
Renal Concentrating Capacity in Long‐Term Lithium Treatment and after Withdrawal of Lithium
Authors: Bucht Gösta , Wahlin Anders
Published: August 2010

ABSTRACT. The urinary concentrating capacity was estimated with the DDAVP test in 87 patients receiving lithium therapy, which was discontinued in all patients. The test was repeated three and eight weeks after withdrawal of lithium in 75 patients and one year after withdrawal in 27 patients. Of the 87 patients, 52 were also treated with neuroleptics, which treatment was continued throughout the study. Two control groups, consisting of 30 patients receiving only neuroleptics and 30 healthy subjects, were studied on one occasion with the DDAVP test. Lithium‐treated patients had significantly lower concentrating capacity and higher serum creatinine than healthy subjects at all examinations. Small but statistically significant correlations were found between urinary osmolality and total dose of lithium, between urinary osmolality and duration of lithium treatment, between the highest serum lithium concentration recorded and urinary osmolality after withdrawal of lithium and between the daily dose of lithium and urinary osmolality, while patients were still on lithium. The concentrating capacity improved significantly during the first two months after withdrawal of lithium, but not later. One year after withdrawal of lithium, 17 of 27 patients still had a concentrating capacity below 800 mOsm/kg. Patients receiving lithium and neuroleptics had lower concentrating capacity than patients treated with lithium alone, and patients treated with neuroleptics alone had lower concentrating capacity than healthy subjects.
Azathioprine and Subacute Myelomonocytic Leukemia
Authors: Vismans Jon J. , Briët Ernest , Meijer Klazina , den Ottolander Gerard J.
Published: August 2010

ABSTRACT. The occurrence of subacute myelomonocytic leukemia is reported in a patient who had been treated with azathioprine for six years because of systemic lupus erythematosus. A review of the literature yielded 16 additional patients with non‐lymphocytic leukemia after the use of azathioprine.
Predicting Response to Combination Chemotherapy in Acute Myeloblasts Leukemia—a Way to Individualize Treatment
Authors: Reizenstein P. , Giannoulis N. E. , Johansson N. O.
Published: August 2010

ABSTRACT. Cytostatics are toxic, and individual variations in drug metabolism large. Therefore the possibility to predict which cytostatic combination should be abandoned because it will not lead to a remission was studied in 58 leukemia patients. A simple following of changes in white blood cell, platelet and blast cell numbers in peripheral blood (combined into so‐called chemotherapy points) makes it possible to predict which patients in the presenting phase of AML will achieve remission, but this was possible neither in the relapse phase of AML, nor in promyelocyte or monocytic leukemias. All 27 patients in the initial phase of AML, who later were to achieve remission, had less than 12 chemotherapy points, and 9 of 11 patients who did not achieve remission had over 13 points. Therefore the cytostatic combination should be changed in patients who, after two courses of treatment, have over 13 points.
Hyperreninemia, Lysozymuria, and Erythrocytosis in Fanconi Syndrome with Medullary Cystic Kidney
Authors: Fyhrquist Frej Y. , Klockars Matti , Gordin Ariel , Törnroth Tom , Kock Boris
Published: August 2010

ABSTRACT. Adult onset Fanconi syndrome with medullary cystic kidney was diagnosed in a 30‐year‐old male with muscular weakness, hypokalemia, normal BP, hyperreninemia, and secondary aldosteronism. He also had non‐specific aminoaciduria, lysozymuria, and β2‐microglobulinuria. Urinary concentrating and acidifying capacity was impaired, and both sodium and potassium were lost into the urine. I. v. pyelography revealed medullary cystic kidney. Renal biopsy showed juxtaglomerular hyperplasia, heavy subintimal deposits and C3 and IgG in preglomerular arteriolar walls, and degenerative changes in the tubules, including loss of brush border and “macula densa‐like” lesions. Polycythemia with elevated serum erythropoietin levels, and raised blood ACTH values with features of cortisolism were also present. Indomethacin therapy decreased plasma renin activity (PRA), plasma aldosterone, and urinary loss of potassium and sodium, while serum potassium approached normal levels. Metoprolol, a β‐adrenergic blocking agent, caused similar effects. Insensitivity to the pressor effect of angiotensin II was reversed by indomethacin treatment. Somatostatin infusion lowered PRA and aldosterone without affecting BP. Several biochemical aberrations of this patient resemble Bartter's syndrome, including the effect of indomethacin.
Blood Coagulation Studies in 45 Patients with Ischemic Cerebrovascular Disease and 44 Patients with Venous Thromboembolic Disease
Authors: Wahlberg Thomas B. , Blombäck Margareta , Övermark Ingela
Published: August 2010

ABSTRACT. Forty‐five patients with ischemic cerebrovascular disease (ICD) and 44 with deep venous thrombosis (DVT) and/or pulmonary embolism (PE) have been investigated in a non‐active state of the disease with VIIIR: Ag, plasminogen activator before and after stasis, antiplasmin, antithrombin (activity, antigen, activity/antigen ratio) and spontaneous platelet aggregation. Control groups of 20 respectively 80 healthy females and males were used in the study. VIIIR: Ag was elevated in the group with deep venous thromboembolic disease compared with the ICD group and a control group. VIIIR: Ag in the ICD group was elevated compared with the control group. Plasminogen activator determined before and after stasis was lowered in the two diseased groups. There was no statistically significant difference in any of the blood coagulation variables between patients on or off coumarol treatment. The patients on coumarol were, however, not reinvestigated when this medication had been withdrawn. Antithrombin levels below the reference interval of the control group of 80 blood donors were found in 11.4% of the patients with DVT/PE, while no patient in the ICD group had low antithrombin values.
Patient Reaction to Information and Motivation Factors in Long‐Term Treatment with Antihypertensive Drugs
Authors: Baksaas Ingebjørg , Helgeland Anders
Published: August 2010

ABSTRACT. In order to learn more about the patient‐physician relationship, various aspects of information and communication, patient desires and complaints, a questionnaire form was mailed to three groups of male hypertensive patients. Group A consisted of 264 patients, response rate 61% (160 patients), originating from the employees' health service at two factories in Norway, and groups B (drug‐treated) and C (not drug‐treated) comprised 441 patients, response rate 82% (362 patients), and 328 patients, response rate 81% (265 patients), respectively, from the hypertension trial of the Oslo Study. Information and/or communication failure was observed in all groups, more in group A than in groups B and C. More information was wanted by 50–75% of the patients, especially in written form. More than one half of the patients expressed complaints which might have been misinterpreted as being due to drug treatment. With the exception of asthenia/drowsiness, impotence and podagra, which occurred more frequently in group B than in group C, the pattern of complaints was similar in these two groups.
The Antihypertensive Effect of Prazosin on Mild to Moderate Hypertension, Changes in Plasma Volume, Extracellular Volume and Glomerular Filtration Rate
Authors: McNair A. , Rasmussen S. , Nielsen P. E. , Rasmussen K.
Published: August 2010

ABSTRACT. Changes in blood pressure, plasma volume (PV) (125I‐albumin space), extracellular volume (ECV) (82Br‐space) and glomerular filtration rate (GFR) (51Cr‐EDTA clearance) were measured in 12 patients with mild to moderate essential hypertension on placebo and during long‐term treatment with prazosin. During the study, BP decreased from an average of 172/107 to 166/102 mmHg (n.s.). PV increased from 3278 to 3324 ml (n.s.) and ECV from 18360 to 18639 ml (n.s.). GFR was almost unchanged, 95 and 93 ml/min, prespectively. An inverse significant correlation was found between the changes in mean BP and changes in ECV, i.e. fluid retention was demonstrated in patients with the smallest BP reduction. It is concluded that inadequate BP response during treatment with prazosin may in part be due to fluid retention. It is therefore suggested that prazosin should in principle be used together with a diuretic in order to prevent fluid retention.
Serum Lipoprotein Composition, Platelet Factor and Arterial Smooth Muscle Cells
Authors: Rönnemaa Tapani
Published: August 2010

ABSTRACT. The incorporation of [3H] thymidine and the synthesis of glycosaminoglycans (GAG) by cultured human aortic smooth muscle cells were studied in the presence of human sera with high HDL cholesterol concentration, high LDL cholesterol concentration or with normal serum lipoprotein concentrations. The sera were prepared either conventionally (CPS, platelet factor present) or from platelet poor plasma by recalcification (PPPS). As compared to normolipidaemic sera, HDL‐aemic CPS decreased the incorporation of thymidine but LDL‐aemic sera had no effect. HDL‐aemic sera decreased markedly the synthesis of sulphated GAG but had no effect on the synthesis of hyaluronic acid (HA). Therefore, the sulphated GAG/HA ratio was decreased. The decrease in sulphated GAG was observed only in the presence of CPS, not in the presence of PPPS. LDL‐aemic sera decreased the synthesis of hyaluronic acid causing an increase in the sulphated GAG/HA ratio. This effect was observed in the presence of both CPS and PPPS.

The results suggest that determination of the sulphated GAG/HA ratio in aortic smooth muscle cell cultures provides a useful method for estimating the atherogeneity of various sera. The anti‐atherogenic effect of HDL‐aemic sera seems to be dependent on the platelet factor while the atherogenic effect of LDL‐aemic sera may be independent of the platelet factor.
β‐Thromboglobulin in Acute Myocardial Infarction
Authors: Rasi Vesa , Torstila Ilkka , Ikkala Eero
Published: August 2010

ABSTRACT. The plasma β‐thromboglobulin level was studied serially in 14 patients with acute myocardial infarction. In 7 patients the plasma β‐thromboglobulin was initially high. The most severely affected patients had the highest values. Three patients with a mild or moderate clinical course had a normal β‐thromboglobulin level at every stage. The remaining patients had a distinct pattern in the evolution of the plasma β‐thromboglobulin values. The initial phase was followed by a uniform fall during the first days and then by an increase. The highest values were in many cases measured at discharge. Platelet counts showed a similar pattern. Signs of activation of platelets were seen before changes in coagulation and fibrinolysis.
Characterization of Foam Cells in Experimental Atherosclerosis
Authors: Fowler Stanley
Published: August 2010

ABSTRACT. A series of biochemical and morphological studies has focused on the properties and origins of lipid laden foam cells in experimentally induced atherosclerosis in rabbits. Lipid inclusions present in these cells occupy half or more of the cytoplasmic volume and are of two kinds: cytoplasmic lipid droplets composed predominantly of cholesteryl esters and lysosomes in which substantial quantities of free cholesterol have accumulated. The foam cells exhibit some properties of macrophages but not others. They possess high levels of acid hydrolases and catalase and Fc membrane receptors can be detected on their surface. Only about one third of the foam cells, however, exhibit C3 receptors and few if any of the cells appear to contain or to secrete lysozyme.
The Clinical Value of HbA1‐Determinations
Authors: Wålinder Olov , Wibell Lars , Boström Harry
Published: August 2010

ABSTRACT. Determination of glycosylated hemoglobin, HbA1, has become of great interest in diabetic patients as the values seem to reflect mean blood glucose values over longer periods of time. Several methods for determination of HbAl are now available. We have used a microchromatographic procedure which seems suitable for routine clinical work. In 94 healthy subjects HbA1 was 6.5±0.8% (mean ± S.D.). The corresponding value obtained in 126 diabetics was 9.6±1.8%. Particularly in patients treated with insulin HbA1 ‐determinations are of value for assessment of the carbohydrate state, since in these patients the glucose values are prone to great variations. The exact relationship between the HbA1‐values and the mean blood glucose level might vary between patients, however. Thus erythrocyte survival and renal function may influence the HbA1‐values and more experience is needed in the interpretation of values. Nevertheless, preliminary data from a study in progress support the expectation that HbA1‐determinations are likely to become a valuable adjunct in the routine management of diabetic patients.
COMPARATIVE EFFICIENCY OF QUINIDINE AND VERAPAMIL IN THE MAINTENANCE OF SINUS RHYTHM AFTER DC CONVERSION OF ATRIAL FIBRILLATION A CONTROLLED CLINICAL TRIAL
Authors: Rasmussen Knut , Wang Harald , Fausa Dagfinn
Published: August 2010

Fiftythree patients with chronic atrial fibrillation participated in a randomized cross‐over trial in order to compare the ability of two drug regimens to establish and maintain sinus rhythm. The patients were given orally either sustained release quinidine 0.4 g twice a day or verapamil 80 mg three times a day. Thirtyone patients tried both regimens. Quinidine was found to have a greater ability to induce conversion to sinus rhythm by drug alone (p <0.05) and also a greater ability to maintain sinus rhythm after conversion (after 3 months p < 0.05). There was, however, also a significantly larger proportion of patients on quinidine who were Withdrawn from the study due to side effects and two patients on quinidine died outside hospital.

The study indicate that quindine is somewhat superior to verapamil both in the establishing and preserving of sinus rhythm in subjects who are able to tolerate the drug.
EFFECT OF INHIBITION OF LIPOLYSIS ON ACUTE MYOCARDIAL INJURY DURING CORONARY OCCLUSION IN NORMAL AND RESERPINIZED DOGS
Authors: Kjekshus John K.
Published: August 2010

Recent studies have shown that β‐pyridylcarbinol is effective in reducing the extent and magnitude of myocardial ischaemia following acute coronary occlusion. The purpose of the present study was to test the possibility that this effect is due to inhibition of lipolysis induced by cate‐cholamine release in the acutely ischaemic myocardium. Epicardial mapping of ST‐segment changes was used to quantitate the ischaemic injury during acute coronary occlusion. Occlusion alone increased ST‐segment elevation from 0.4 ± 0.1 to 5.5 ± 0.8 mV. During β‐pyridylcar‐binol administration, ST‐segment elevation was reduced to 3.0 ± 0.8 mV (P<0.001) following repeated occlusions of the same coronary artery. In animals pretreated with reserpine in order to deplete myocardial catecholamine stores, ST segments during acute coronary occlusion averaged 4.0 ± 0.5 mV before and 4.4 ± 0.6 mV during β‐pyridylcarbinol treatment (NS). Thus, inhibition of lipolysis during coronary occlusion reduces ischaemic changes in the epicardial ECG only when myocardial stores of catecholamines are intact. This supports the hypothesis that release of catecholamines in the acutely ischemic myocardium activates lipolysis from endogenous stores of triglycerides and that free fatty acids contribute to the ischaemic injury, probably because they increase myocardial oxygen demand.
CAPTOPRIL IN PRIMARY HYPERTENSION
Authors: Öhman K. Peter , Karlberg Bengt E. , Nilsson Ove R. , Wettre Staffan
Published: August 2010

The effects of captopril (SQ 14.225), an orally active inhibitor of angiotensin converting enzyme, were investigated in a dose titration study of primary hypertension. In 32 patients 4 weeks titration with captopril gave a mean blood pressure (BP) reduction of 26/16 mmHg supine and 30/16 mmHg standing. No serious side effects were observed. The BP lowering effect was related to pre‐treatment plasma renin activity and was less in low renin hypertension (p < 0.05). Captopril reduced angiotensin II (p < 0.05), plasma (p < 0.005) and urinary aldosterone (p < 0.001) as well as urinary kallikrein excretion (p < 0.005).

Captopril (SQ 14.225) is a competitive inhibitor of peptidyl dipeptide hydrolase, also known as angiotensin converting enzyme (ACE) or kininase II, which converts angiotensin I (A I) into angiotensin II (A II), hydrolyzes des‐Asp‐angiotensin I to angiotensin III (A III) and inactivates bradykinin (BK) (19). Captopril has potent antihypertensive effects when used in human hypertension (review, 3) especially when the renin‐angiotensin‐aldosterone system (RAAS) is activated.

To further investigate the mode of action and the hypotensive effect of captopril, we measured plasma renin activity (PRA), A II, plasma (PA) and urinary aldosterone excretion (UA) and urinary kallikrein excretion (UK) in 32 patients with established primary (essential) hypertension.
Nature of Cardiac Arrhythmias and Electrolyte Disturbances
Authors: Olsson S. Bertil
Published: August 2010

Atrial fibrillation is highly favoured by an accelerated atrial muscle repolarization. In hyperthyroidism, this occurs without changes in resting membrane potential level of the atrial muscle cells and without changes of the ionic composition of the cell. In patients prone to atrial fibrillation but without signs of hyperthyroidism, accelerated atrial repolarization can also be demonstrated. In such patients, a decreased atrial muscle potassium content seems responsible for the electrophysiological changes that highly favours the occurence of atrial fibrillation.
Exchangeable Electrolytes in Heart Disease
Authors: Olesen Knud H.
Published: August 2010

The results of measurements of body sodium, chloride and potassium by isotope dilution or whole body counting in patients with heart disease are reviewed. In patients with cardiac oedema exchangeable sodium and chloride are increased while body potassium tends to be decreased or normal. The findings in normonatraemic hypochloraemia, hypokalaemia and metabolic alkalosis, in diuretic hyponatraemia and in dilutional hyponatraemia are reviewed and their possible consequences in terms of changes in electrolyte gradients are discussed.

The limitations and usefulness of measurements of exchangeable electrolytes in heart disease are mentioned.
Diuretics, Digitalis and Arrhythmias
Authors: Steiness Eva
Published: August 2010

Arrhythmias induced by digitalis are believed to be secondary to changes in ion concentrations in the myocardial cells or changes in the transcellular ion gradient.

Both diuretic induced hypokalemia and digitalis inhibit the membrane‐Na+K+ATPase activity which cause a decrease of the intracellular potassium concentration. This may explain the risk of cardiac arrhythmias during digitalis treatment and during severe hypokalemia, and may further explain the increase for myocardial sensitivity for digitalis when hypokalemia is present.

The myocardial uptake of digitalis however is markedly increased at low extracellular potassium concentration and this may be the explanation of the interaction between digitalis and hypokalemia.

Not only the myocardial digoxin kinetic is changed during hypokalemia but the renal excretion rate of digoxin is markedly reduced during hypokalemia leading to increased serum digoxin concentration and thereby the risk of digitalis intoxication.
In‐hospital Ventricular Fibrillation and its Relation to Serum Potassium
Authors: Hulting Johan
Published: August 2010

Serum potassium (S‐K) has been related to the incidence of ventricular fibrillation (VF) before admission to, and during observation in a coronary care unit (CCU). The series comprises 1315 patients. Acute myocardial infarction (AMI) was diagnosed in 537 patients. VF occurred in 46 patients. Fourteen of these had their VF before admission to the CCU. The incidence of VF within 12 h after CCU admission (early VF) was significantly raised (p < 0.01) in patients with an initial S‐K less than 3.9 mmol 1 I‐1. In this group, the incidence of early VF in all patients and in those with AMI amounted to 3.0 and 5.4%, respectively. Corresponding figures in patients with an initial S‐K of 3.9 mmol 1 I‐1 or above were 0.6 and 1.5%. Thus, a near 5‐fold increase in the incidence of early VF was observed with a S‐K below 3.9 mmol 1 I‐1. Patients with VF occurring later than 12 h after admission had significantly higher S‐K values than those with early VF. In AMI, the risk of primary and secondary VF seemed to be equally increased with low initial S‐K values. There was a strong correlation between myocardial infarction size and the risk of VF. No relationship, however, was noted between infarction size and initial S‐K.
DIAGNOSTIC VALUE OF QUESTIONNAIRES REGARDING ANGINA PECTORIS AND OESOPHAGEAL DYSFUNCTION IN PATIENTS WITH CHEST PAIN
Authors: Areskog Magnus , Tibbling Lita , Wranne Bengt
Published: August 2010

ABSTRACT. Questionnaires aimed at detecting angina pectoris and oesophageal dysfunction (OD) were used in 281 patients with central chest pain of a type which gave suspicion of ischaemic heart disease (IHD). Signs of IHD were found in 208 patients (74%), 172 of whom had a positive angina pectoris questionnaire. The sensitivity of the questionnaire regarding the diagnosis of IHD was 83%, the specificity 48% and the predictive accuracy 82%. OD was found in 137 of the 281 patients (49%). »Do you often have heartburn« was the question which distinguished the OD and non‐OD groups the best (p < 0.001). The sensitivity of this question in detecting OD was 34%, the specificity 93% and the predictive accuracy 82%. In conclusion, the diagnostic value of the angina pectoris questionnaire was limited by a low specificity and the diagnostic value of the oesophageal questionnaire by a low sensitivity in these patients with chest pain. Differential diagnosis of chest pain is an important every day problem in clinical medicine. The difficulties in the differentiation between pain of oesophageal and cardiac origin have been emphasized by several authors (4, 5, 6, 7). In the present report the interest has been focused on the use of questionnaires in the differential diagnosis.
RELATIONSHIP BETWEEN DYSPNEA AND CHEST PAIN IN ISCHEMIC HEART DISEASE
Authors: Hagman Marianne , Wilhelmsen Lars
Published: August 2010

ABSTRACT. Dyspnea may form a differential diagnostic symptom to chest pain in ischemic heart disease (IHD) but may also precede angina pectoris (AP) as a manifestation of IHD. In the Primary Preventive Trial in Göteborg the occurence of AP and its relation to dyspnea has been studied in a random population sample of men aged 47–54 years at entry to the study and followed for 4 years. In the cross‐sectional study dyspnea was reported in 21% of the total population and in 70% of the angina population. Dyspnea at entry to the study was reported in 36% among cases who developed AP alone during the follow‐up time and in 35% among cases who developed AP associated with myocardial infarction. The dyspnea was not related to smoking habits or to low grade of physical activity. The report of dyspnea before chest pain in IHD may be due to misinterpretation in early cases. On the other hand it is also known that intermittent left ventricular failure coincident with attacks of myocardial ischemia will give a subjective feeling of dyspnea. According to our study there is a definite association between AP and dyspnea. In some cases dyspnea precedes AP whereas in others the chest pain precedes the dyspnea. The symptom dyspnea also carries important prognostic information in IHD.
ANGINA PECTORIS IN THE COLD. EFFECTS OF COLD ENVIRONMENT AND COLD AIR INHALATION AT EXERCISE TESTS
Authors: Lassvik Claes
Published: August 2010

ABSTRACT. Patients with effort angina and a history of cold intolerance performed brief sub‐maximal exercise bicycle tests in various room temperatures with separation of inspiration and room air. Exposure to a cold room (−10°C) and inhalation of very cold air (−35°C) in a normal room caused a significant decrease in maximal workload. Heart rate, systolic blood pressure, and rate‐pressure product were significantly higher during exercise when compared with findings in the normal room. The decrease in maximal workload correlated significantly to the increase in heart rate and rate pressure product during exercise in both conditions, and to the increase in systolic blood pressure at exposure to a cold room. Exposure to 10 and 0°C environmental temperature, and inhalation of moderately cold air (−10°C) did not cause any significant changes in maximal workload, heart rate, blood pressure, or rate pressure product during exercise, compared to the findings in the normal room. In conclusion, skin cooling seems to be far more important in its effect on heart load and the working capacity in patients with effort angina than inhalation of moderately cold air; inhalation of very cold air, however, does cause changes in working capacity similar to those of exposure to a cold environment. Increase in heart work during exercise is likely to cause the decrease in working capacity observed both with skin cooling and cold air inhalation.
CHARACTERISTICS OF ESOPHAGEAL PAIN
Authors: Henderson R.D. , Marryatt G.
Published: August 2010

ABSTRACT. Esophageal pain was investigated in 200 consecutive patients prior to surgical correction of reflux. The pain has been analyzed to determine its characteristic and its atypical features. Arm distribution of pain and exercise induced pain were the most atypical features and led to diagnostic difficulty. Although acid perfusion studies reproduced some component of the pain in 94% of patients, reproduction of arm pain was possible in only 37.2% of those with this symptom. The importance of cardiologic evaluation in patients with atypical esophageal pain is emphasized.
HOW OFTEN DOES THE GUT CAUSE ANGINAL PAIN?
Authors: Davies H. Alban , Rhodes J.
Published: August 2010

ABSTRACT. Gastrointestinal disease imitates angina quite commonly and the oesophagus is usually responsible, both in patients presenting as emergencies and also in those who have been extensively investigated for apparent angina. A questionnaire study of 22 patients with oesophageal spasm and 15 patients with coronary artery disease failed to show any feature that discriminates reliably between these groups.
THE IMPORTANCE OF THE COLLATERAL CIRCULATION FOR MYOCARDIAL SURVIVAL
Authors: Schaper W. , Nienaber C. , Gottwik M.
Published: August 2010

In acute coronary occlusion the survival time of ischemic myocardium depends critically upon collateral blood flow and on oxygen uptake at the moment of, and during, occlusion. There are good reasons to believe that ischemic myocardium provides the stimulus for near‐maximal vasodilation of collateral blood vessels. Under these conditions the determinants of collateral blood flow are: a) the anatomically fixed hydraulic resistance of the collaterals proper, b) the arterial driving pressure, c) extravascular resistance (radial stress, pressure transmission across the LV‐wall, tissue pressure) and d) size of the ischemic bed. Under ideal conditions (maximal dilation of collaterals) overall collateral resistance is 3.5 resistance units, i.e. theoretically a perfusion pressure of 350 mmHg is needed to drive 100ml of blood per minute through 100g of tissue. Small ischemic beds receive a relatively larger amount of collateral flow and vice versa. This delays necrosis (but does not prevent it) following occlusion of small coronary arteries. The reason for this is the more favorable ratio of epicardial circumference (of the ischemic area) to ischemic volume because canine collaterals are exclusively located on the epicardial surface. ‐ Tissue pressure in acute occlusion is distributed in such a way that subendocardial collateral flow is lower than subepicardial flow. This leads to an earlier onset of irreversible damage in the subendocardium, earlier damage to subendocardial microvessels, i.e. earlier subendocardial no‐reflow phenomenon. Flow «offered» to but not «taken» by the subendocardium is at the disposal of the subepicardium which thereby increases its chances of survival. As a rule subendocardial flow decreases as a function of time after occlusion and subepicardial flow increases. In certain cases even subepicardial flow is too low shortly after occlusion. In this case it decreases further with time and a truly transmural infarct develops.
BETA BLOCKERS AFTER MYOCARDIAL INFARCTION ‐ ASPECTS ON STUDY DESIGN BASED ON CURRENT KNOWLEDGE
Authors: Vedin Anders , Wilhelmsson Claes
Published: August 2010

The beta‐blocker trials published so far may be subdivided into three different categories: 1) retrospective, 2) prospective non‐conclusive, 3) prospective conclusive studies.

The retrospective studies suffer the weaknesses of the retrospective method and may only be used as supportive evidence.

There have so far been four prospective studies producing positive results, three with alprenolol and one with practolol. The studies presented support the concept that practolol and alprenolol reduce the long‐term mortality due to sudden death from ischemic heart disease after myocardial infarction.

All the studies have been criticized on various grounds and a list of unanswered remaining issues may be made. Acute and long‐term effects of betablockade need not be the same. Our knowledge about the necessary doses and plasma levels is incomplete. All the studies published so far cover a maximum period of two years. If the study observation periods were prolonged it is likely that at some time the relative benefit becomes less. Ideal treatment should be reserved for those patients likely to derive significant benefit from it. At the present time identification of such patients is not sufficiently precise. Whether or not the beta‐blockers have an antiarrhythmic effect, for instance demonstrated on chronic PVC's, this information is of little value in interpreting the proper mechanism of the beta‐blockers in acute ischemia and lethal arrhythmias.

In order to contribute new knowledge future studies should involve sufficiently large numbers of representative groups of patients, a stratified study design and a beta‐blocker with ancillary properties different from alprenolol.
INTERVENTION ON SMOKING AND EATING HABITS IN HEALTHY MEN CARRYING HIGH RISK FOR CORONARY HEART DISEASE. THE OSLO STUDY
Authors: Hjermann Ingvar
Published: August 2010

1232 healthy, normotensive, but coronary high risk men were selected for a 5‐year randomized trial in order to show if lowering of serum lipids and cessation of smoking was followed by prevention of coronary heart disease. The men included in the trial had serum cholesterol between 7.5 mmolll (290 mg/dl) and 9.8 mmol/l (380 mg/dl), coronary risk score (based on cholesterol, smoking and blood pressure) in the upper quartile of the distribution and systolic blood pressure <150 mm Hg.

The men in the intervention group were recommended to stop smoking and to lower their blood lipids by dietary changes.

On average, mean serum cholesterol concentration was 13 per cent lowered in the intervention group compared to the controls during the 5 years of the trial. Mean fasting serum triglycerides decreased by 20 per cent in the intervention group compared to the control group. Tobacco smoking was reduced about 50 per cent in the intervention group in relation to controls. (Eighty per cent of the men in both groups were daily cigarette smokers at the start of the study).

Diagnoses of events of cardiovascular disease during the 5 years were made blindly by a diagnostic board not involved in the study, according to predefined criteria.

At the end of the observation time the incidence of myocardial infarction (fatal and non‐fatal) and sudden death was 47% lower in the intervention group than in the controls (p=0.028, 2‐sided test).

It is concluded that in healthy, coronary high risk, middle‐aged men, advice to change eating habits and to stop smoking, significantly reduces the incidence of a first event of myocardial infarction and sudden death.
Familial Lecithin:Cholesterol Acyltransferase Deficiency
Authors: Gjone Egil , Blomhoff Jan P. , Holme Randi , Hovig Torstein , Olaisen Bjørnar , Skarbøvik Alf J. , Teisberg Per
Published: August 2010

ABSTRACT. The tenth Norwegian patient with familial LCAT deficiency is reported. Her family lives in the same area as the three previously reported Norwegian families. The patient is a 26‐year‐old female with typical findings of the disease—proteinuria and corneal opacities. Total cholesterol was normal, but the main part was present in the free form. Triglycerides were slightly elevated. Kidney function was normal. A large molecular weight fraction of LDL was present in plasma.
Hand Symptoms Associated with Diabetes Mellitus
Authors: Sturfelt Gunnar , Leden Ido , Nived Ola
Published: August 2010

ABSTRACT. A number of 738 patients with diabetes mellitus (DM) and 371 matched controls answered a questionnaire constructed to detect rheumatic hand symptoms. The DM patients showed significantly more palmar thickening, indicating Dupuytren's contracture and flexor tenosynovitis, and a significantly lower frequency of neurological sensations. There was no statistically significant difference in the estimated frequency of rheumatoid arthritis between the total population and our DM population.
Thyroid Disease and High Concentration of Serum Thyrotrophin in a Population Sample of Women
Authors: Nyström Ernst , Bengtsson Calle , Lindquist Olle , Noppa Henry , Lindstedt Göran , Lundberg Per‐Arne
Published: August 2010

ABSTRACT. In a population study in Göteborg, Sweden, comprising women in the age strata 44, 52, 56, 60 and 66 years, serum thyrotrophin (S‐TSH) was determined in 1283 women representative of the general population of women of these ages. No women with previously unknown hypothyroidism were found at the clinical examination; 47 (3.7%) were on thyroxine treatment, 9 (0.7%) because of spontaneous hypothyroidism. Sixteen women (1.2%) had markedly elevated S‐TSH concentration (≥14 mU/l). They were studied further by determination of thyroid hormones and circulating antithyroid microsomal and thyroglobulin antibodies, and those with goiter were subjected to fine‐needle biopsy of the thyroid gland. They were furthermore followed for four years. Four euthyroid women were given thyroxine because of goiter and abnormal laboratory test results. Of nine individuals with high S‐TSH concentration as well as high titers of thyroid antibodies and/or biopsy evidence of autoimmune thyroiditis, seven became hypothyroid within the four years of follow‐up. The other two women had consistently elevated basal S‐TSH concentration and exaggerated S‐TSH response after thyroliberin administration. We conclude that the majority of individuals without previously recognized thyroid disease who have S‐TSH concentration above 14 mU/l with the assay used will require thyroxine therapy within a few years. In one woman, however, with multinodular colloid goiter and high titer of antimicrosomal antibodies, the basal S‐TSH concentration decreased during follow‐up to a high normal value; the S‐TSH response to thyroliberin was high borderline. She remained euthyroid during follow‐up. The results suggest an annual incidence of spontaneous hypothyroidism of 1–2 cases per 1000 middle‐aged females in a Swedish west‐coast population.
The Effects of Pindolol and Prazosin on Hand Blood Flow in Patients with cold Extremities and on Treatment with β‐Blockers
Authors: Ohlsson Ola , Lindell Sven‐Eric
Published: August 2010

ABSTRACT. Hand blood flow and subjective sensitivity to cold were studied in nine hypertensive patients on treatment with β‐blockers. All patients complained of cold extremities. Neither hand blood flow nor sensitivity to cold changed after addition of prazosin, a well known vasodilator to the original β‐blocker. After changing to a β‐blocker with a high degree of intrinsic sympathomimetic activity (pindolol), hand blood flow increased and sensitivity to cold decreased in all patients, except one.
Progression of Bone Marrow Abnormalities in Malignant Hemopoietic Dysplasia
Authors: Lidbeck Jan , Månson Jan Christer
Published: August 2010

ABSTRACT. Progression of bone marrow abnormalities in 12 patients with malignant (fatal) hemopoietic dysplasia (HD) was evaluated retrospectively in sequential bone marrow samples, using a simple morphological scoring technique. Special attention was paid to alterations in cytological abnormalities in the myeloid series. Patients who developed acute myeloid leukemia showed increasing scores during the clinical course and a rapid final increase in particularly myeloid nucleolar abnormalities. Patients who did not develop overt myeloid leukemia but died from bleeding and/or infection had low and stable scoring and showed no progression of cytological abnormalities. Repeated evaluation, especially of cytological changes in the bone marrow, and morphological scoring might be useful as predictive tools to estimate the risk of a leukemic transformation in some patients with HD.
Relationship between Circulating Immune Complexes and Angiotensin‐Converting Enzyme in Pulmonary Sarcoidosis
Authors: Rømer Frode K. , Sølling Jakob
Published: August 2010

ABSTRACT. The relationship between circulating immune complexes (CIC), serum angiotensin‐converting enzyme (SACE) and clinical features was investigated in 119 patients with sarcoidosis. CIC, measured by the C1q‐binding test and a polyethylene glycol precipitation test, were detected in 42% of the patients. A significantly higher level of CIC was found in patients with duration of the disease of more than 2 years and in patients in stage II or III on chest X‐ray. SACE was increased in 45% of the patients, most frequently in those with active disease and in those in stage II or III on chest X‐ray. No positive correlation was found between CIC and elevated levels of SACE.