bluuebunny/crossref_metadata_2025 huggingface dataset:
BEHAVIOR PATTERN A AND COMPLIANCE WITH ANTIHYPERTENSIVE TREATMENT.
Authors: Oddsson Ólafur H. , Bass Martin J. , Donner Allan , McWhinney Ian R.
Published: August 2010

ABSTRACT. An analysis was performed on cross‐sectional data on 512 hypertensive patients to look at the association of behavior pattern A (coronary prone behavior) and compliance with therapy. In a home interview behavior pattern A was assessed by a questionnaire (The Bortner scale), compliance by a vignette, and blood pressure was measured. Noncompliers showed a higher degree of Type A characteristics, that is there was a significant negative association between behavior pattern A and compliance (p = 0.02). It is proposed that a new variable, behavior pattern A, should be considered in future research on compliance.
Progressive Vasomotor Changes in Ischaemic Myocardium
Authors: Gorman M.W. , Wangler R.D. , DeWitt D.F. , Sparks H.V.
Published: August 2010

ABSTRACT. Under certain conditions, a progressive increase in vascular resistance occurs within ischaemic myocardium during the first three hours after coronary artery stenosis. Measurements of vasodilator reserve in the ischaemic region demonstrated that this is at least partly due to an increase in vascular smooth muscle tone. Two hypotheses were suggested as an explanation: release of vasoconstrictors within the ischaemic area, or a decreasing release of vasodilators. Potential coronary constrictors considered included norepinephrine, PGF2α, thromboxane A2, and high K+. Each of these substances was eliminated as the source of the vasoconstriction by pharmacological studies on ischaemic canine hearts. Measurement of adenosine release from isolated guinea pig hearts provided support for the possibility that the vasoconstriction results from a decreasing release of metabolic vasodilatators. Throughout the period of ischaemia, both blood flow and myocardial function were far below the levels that could have been achieved in the presence of the stenosis. We conclude that during moderate ischaemia, myocardial function and blood flow are linked in a positive feedback cycle which promotes reduced ventricular function and coronary blood flow.
Coronary Atherosclerosis Revisited. A Pathologist's View
Authors: Becker A.
Published: August 2010

ABSTRACT. For many years the paradigm of coronary atherosclerosis, set by pathologists, was the far‐advanced lesion containing extensive atheromatosis with calcifications. From the point of view of understanding atherogenesis, however, it is much more rewarding to study the coronary artery in patients without clinical evidence of obstructive coronary artery disease. In fact, the normal coronary artery is most revealing in showing discrete intimal changes, which consist of a splitting of the internal elastic lamina accompanied by a proliferation of vascular smooth muscle cells. This process eventually results in the formation of the musculo‐elastic layer. In time the cellular and muscular appearance of this layer gradually transforms into a more densely packed fibrous texture. It is of interest, from a point of view of atherogenesis, that the early atherosclerotic lesions often display the histologic features of the musculo‐elastic layer at the base of the plaque. Hence, these observations support the concept that the basic lesion in coronary atherosclerosis is a proliferation of vascular smooth muscle cells, most likely as a response to injury. To this extent a dysfunction of the endothelial cell barrier may by crucial.

The observations also indicate that the mechanisms involved in atherogenesis also may alter vascular tone and hence, may contribute to a »spasmic state» of the coronary arteries. A classification of angina pectoris, on the basis of pathogenesis into organic and spasmic may thus prove to be simplistic.
Assessment of »Optimal» Beta Blockade in Treating Patients with Angina Pectoris
Authors: Thadani U.
Published: August 2010

ABSTRACT. Assessment of optimal beta blockade in treating patients with angina pectoris remains a challenge. Reduction in resting heart rate is a poor guide to therapy; the dose response curves are flat and drugs with intrinsic sympathomimetic activity may not lower resting heart rates despite their efficacy. Log plasma concentrations of beta blockers correlate with reduction in exercise tachycardia but not with improvement in exercise tolerance of reduction in myocardial ischaemia. Although useful, reduction in frequency of anginal attacks and nitroglycerin consumption during therapy is a poor guide in assessing optimal beta blockade. The best way to assess optimal therapy is to demonstrate maximum increase in exercise performance in association with reduction in myocardial ischaemia and adequate suppression of exercise‐induced increase in heart rate and blood pressure. This requires repeated exercise testing at multiple work loads after various doses of the drug until there is no further increase in exercise duration or reduction in heart rate. When given in optimal and equipotent doses all beta blockers are equally effective antianginal agents and can be prescribed twice daily.
A Sustained Effect of Coronary Bypass Surgery in Stable Angina Pectoris
Authors: Frick M.H. , Valle M. , Harjola P‐T.
Published: August 2010

ABSTRACT. One hundred patients with angina pectoris were randomly allocated for medical therapy and bypass surgery in groups of 50 patients each. The effect of the respective therapies was assessed by annual exercise testing for up to five years. The surgical group was also studied by postoperative coronary angiograms at three weeks, one year and five years after the operation. The medical group was subjected to repeated coronary angiography five years after randomization. All of the variables depicting exercise tolerance were significantly improved in the surgical group but remained largely at the initial level in the medical group. A subgroup analysis of the surgical series revealed that the sustained improvement was largely confined to the completely revascularized subset of patients. The slowly increasing use of beta blocking compounds in the surgical group also contributed to the favourable results for bypass surgery.
Prophylactic Furosemide Treatment in Acute Myocardial Infarction
Authors: LARSEN FLEMMING F.
Published: August 2010

ABSTRACT.Prophylactic diuretic theraphy in acute myocardial infarction (AMI) was evaluated in 83 consecutive patients without severe left ventricular failure (LVF) on admission. A high dose group (HDG) received 120–160 mg and a low dose group (LDG) 20–40 mg furosemide daily for six weeks. Mortality and reinfarction rates did not differ between the groups. One HDG patient and five LDG patients developed severe LVF. Four HDG patients developed severe dehydration. Serum enzyme activities and electrolytes were similar in both groups. The increased diuresis in the HDG was accompanied by a 4 % hemoconcentration, smaller radiological heart volumes, higher heart rates, a higher demand for nitroglycerin and higher ratings of thirst. Exercise tests yielded similar results in both groups. Later blood volumes and transthoracic electrical impedance were similar in both groups. It is concluded that liberal prophylactic furosemide treatment in AMI offers no major clinical advantage.
Effect of Nifedipine on Cellular Electrolytes in Fourteen Patients with Untreated Primary Hypertension
Authors: ERICSSON FOLKE
Published: August 2010

ABSTRACT. The effect of nifedipine on cellular electrolytes was studied in 14 patients (10 males, 4 females, age 39–62 years) with untreated primary hypertension. Before therapy and after one and three months of treatment, sodium and potassium were analyzed in erythrocytes (ENa, EK). Before and after treatment, potassium and calcium (MK, MCa) were determined in biopsy specimens of skeletal muscle, by use of energy dispersive X‐ray fluorescence spectrometry analysis. Blood pressure decreased from 186 ± 23.5/108 ± 8.4 to 156.1 ± 13.8 (p < 0.001)/88.6 ± 7.5 (p < 0.001) and remained constant till the three‐month control, 151.8 ± 8.0 (p < 0.001)/88.9 ± 6.6 mmHg (p < 0.001). ENa was significantly higher than in normotensive controls (p < 0.001) and decreased from 11.9 ± 2.7 to 10.1 ± 2.0 mmol/1 (p < 0.05). There was no statistical (pairs of differences) change in EK, MK or MCa when the whole patient series was considered. No relation was seen between family history of hypertension and electrolyte changes. For the 10 male patients a decrease was found in MCa from 1.30 ± 0.25 to l.08 ± 0.17 mmol/1 (p < 0.05). No correlation could be shown between any of the parameters studied, neither in the whole group nor in the males separately.
Effects of Synthetic Corticotropin‐releasing Factor in Normal Individuals and in Patients with Hypothalamic‐pituitary‐adrenocortical Disorders
Authors: JØRGENSEN H. , SKARE S. , FREY H. , HANSSEN K. F. , NORMAN N.
Published: August 2010

ABSTRACT. Plasma adrenocortical hormone (ACTH) and Cortisol response to four dose levels (25, 50, 100 and 300 μg) corticotropin‐releasing factor (CRF) were studied in 5 healthy men, and the response to 100 μg CRF in 12 patients with various disorders of the hypothalamic‐pituitary‐adrenocortical function. In normals, mean plasma ACTH and Cortisol concentration rose at all dose levels of CRF and peaked at 30 and 60 min respectively. The increment in plasma Cortisol at 60 and 90 min was significantly higher on 100 and 300 μg CRF than on 25 μg, but the total Cortisol concentration was not. Seven patients had Cushing's syndrome. In 2 patients with adrenocortical carcinoma the basal plasma ACTH was suppressed. After CRF a small increase was seen in plasma ACTH and Cortisol in one patient successfully treated with mitotane, while the other patient did not respond. In 1 patient with ectopic ACTH syndrome an increase in plasma ACTH 15 min after CRF was not accompanied by any increase in plasma Cortisol. One patient with bilateral multinodular adrenocortical hyperplasia did not respond to CRF. The plasma ACTH and Cortisol response to CRF was supernormal in 2 patients with Cushing's disease, while a third patient responded in the normal range. In 2 patients with Nelson's syndrome the plasma ACTH response was excessive. Two out of three hypophysectomized patients did not respond to CRF, while one patient with a slightly positive response to hypoglycemia also responded (subnormally) to CRF. Our data indicate that CRF in doses of 50–100 μg will be a valuable substance in the differential diagnosis of Cushing's syndrome. Some overlap in the response is, however, seen between patients with Cushing's disease and other patients with Cushing' syndrome. CRF will possibly be of value also for the diagnosis of secondary adrenocortical failure.
Hypoglycemia and Low S‐T3—an Experimental Study
Authors: KALLNER GUNNAR
Published: August 2010

ABSTRACT. Ethanol‐induced hypoglycemia after 44 hours of complete fasting was allowed to last for four hours. S‐T3 decreased significantly (p < 0.05), by 16.5%, S‐rT3 remained unchanged and S‐cortisol increased significantly (p < 0.01). No correlation was found between S‐T3 and S‐cortisol. An association was found between S‐T3 and blood glucose (p < 0.05). An acute low S‐T3 was achieved by depressing the peripheral availability and utilization of glucose. No association to a simultaneous increase in S‐cortisol was found. An increase in S‐rT3 failed to appear, probably also due to glucopenia.
Atenolol versus Bendroflumethiazlde in Middle‐aged and Elderly Hypertensives
Authors: ANDERSEN GERT STEEN
Published: August 2010

ABSTRACT. The antihypertensive effect and patient tolerability during 12 weeks' treatment with atenolol and bendroflumethiazide were evaluated in an open, randomized, between‐patient trial. Out of a total of 162 patients, aged 50–75 years, with previously untreated hypertension, 151 completed the trial. They were randomly allocated to two groups. Forty‐nine patients, aged 50–64 years (middle‐aged), and 23, aged 65–75 years (elderly), were treated with atenolol. Forty middle‐aged and 39 elderly were treated with bendroflumethiazide. Significant reductions in blood pressure (BP) were observed during treatment with each drug (p < 0.001). The change in diastolic BP in middle‐aged patients was significant in favour of atenolol (p < 0.01), but otherwise no difference was found between the two drugs. Uric acid increased during treatment with both drugs (p < 0.001). Serum potassium decreased during bendroflumethiazide treatment (p < 0.001). Subjective side‐effects of both drugs were few and expected. The results of this study indicate that atenolol and bendroflumethiazide are equally effective in reducing BP in patients aged 50–75 years.
The Effects of Trimazosin and Pindolol on Serum Lipids, Blood Glucose and Serum Insulin Levels
Authors: LEHTONEN AAPO
Published: August 2010

ABSTRACT. The effects on plasma lipids, blood glucose and serum insulin levels of oral administration of trimazosin and pindolol over a 6‐month period were studied in 11 patients with essential hypertension. Total plasma cholesterol and LDL cholesterol concentrations were higher (p < 0.05) after one month's treatment with trimazosin than basal values, but the significance of changes disappeared with continuation of treatment. The concentrations of plasma triglycerides, VLDL cholesterol, HDL cholesterol and free fatty acids and the HDL cholesterol/total cholesterol ratio remained about constant during treatment with trimazosin. During pindolol treatment the plasma levels of total cholesterol and LDL cholesterol were slightly but not significantly lowered at 3 and 6 months. The levels of plasma triglycerides, VLDL cholesterol and HDL cholesterol remained about constant and the ratio of HDL cholesterol to total cholesterol had increased slightly (p < 0.05) at 3 months. Serum free fatty acid concentration decreased significantly. There were no significant differences between plasma lipid levels during either trimazosin or pindolol treatment. Blood glucose concentrations showed a slight tendency to increase during the treatment periods, but no impairment in insulin release was found.
The Blood Volume in Pheochromocytoma Patients before and during Treatment with Phenoxybenzamine
Authors: STENSTRÖM GUNNAR , KUTTI JACK
Published: August 2010

ABSTRACT. Total blood volume (TBV), red cell volume (RCV) and plasma volume (PV) were determined in 15 pheochromocytoma patients (9 males and 6 females) prior to and during preoperative treatment with phenoxybenzamine. Seventeen healthy male volunteers served as controls. Untreated male patients did not differ from the controls with respect to TBV, RCV or PV. In the total group of pheochromocytoma patients, phenoxybenzamine, in a dose of 145.6 ± 45.2 (SD) mg/day over 14.3 ± 5.7 (SD) days, induced significant increases in TBV (+9.4%) and PV (+14.5%), whereas RCV remained unchanged. During phenoxybenzamine, the mean PV in male patients significantly exceeded the control mean. We conclude that pheochromocytoma patients adapt their TBV to excessive catecholamine production and that they rarely present with profound hypovolemia. Moderate but higher doses of phenoxybenzamine than previously recommended induced marked increases in TBV secondary to PV expansion. Phenoxybenzamine counteracts the development of hypovolemia most effectively, thereby constituting one of several important measures for successful surgical management of pheochromocytoma patients.
Renal Excretion of Electrolytes in Patients on Long‐term Diuretic Therapy for Arterial Hypertension and/or Congestive Heart Failure
Authors: DYCKNER THOMAS , WESTER PER‐OLOV
Published: August 2010

ABSTRACT.Renal excretion, skeletal muscle content and plasma concentration of electrolytes were studied in 108 patients on long‐term diuretic therapy for congestive heart failure and/or arterial hypertension. As reference populations served a group of 16 healthy volunteers and a group of 22 patients with liver cirrhosis, but not on diuretic therapy. Diuretic therapy was found to deprive the patients of their ability to conserve potassium and magnesium when there was a simultaneous cellular depletion of these ions. Magnesium excretion was found to be correlated to the skeletal muscle magnesium content. An inverted Na/K ratio in urine and a low magnesium excretion were fair indicators of cellular magnesium depletion.
Age Dependence of the West/East Gradient in Cardiovascular Mortality of Finnish Males
Authors: TENKANEN LEENA , TEPPO LYLY , HAKULINEN TIMO , LÄÄRÄ ESA
Published: August 2010

ABSTRACT. A cohort of 4475 Finnish men was followed up during 1964–80 in order to study regional differences in mortality from cardiovascular diseases, especially ischaemic heart disease (IHD). The west/east gradient in cardiovascular mortality recorded in several previous studies was greatly age‐dependent. The excess eastern risk was a feature of younger age groups; with increasing age the risk pattern was reversed. The risk factors in IHD in eastern Finland have an element which somehow accelerates the process of this disease.
Both High and Low Blood Pressures Risk Indicators of Death in Middle‐aged Males: Isotonic Regression of Blood Pressure on Age Applied to Data from a 13‐Year Prospective Study
Authors: LINDHOLM LARS , LANKE JAN , BENGTSSON BO , EJLERTSSON GÖRAN , THULIN THOMAS , SCHERSTÉN BENGT
Published: August 2010

ABSTRACT. This study was performed to investigate whether a moderately sized population of men (n = 954) living in a geographically defined area could be utilized and give valid results in a 13‐year prospective study regarding mortality as a function of blood pressure. Isotonic regression of blood pressure on age was used to define groups of men with low, medium, and high blood pressure. Men aged 40–69 years in both extreme groups showed an excess death risk in comparison with those in the medium group. Thus, mortality appeared to be a U‐shaped function of blood pressure in this age group. The mortality ratios of the low and high blood pressure groups vis‐à‐vis the medium group were higher during the first than during the second half of the observation period. Chronic diseases at the time of the initial examination were more common among men who died in the lowest blood pressure group than among those who died in the medium group. In males aged 70–99 years, blood pressure appeared to be of less importance as a risk indicator of death.
Dietary fatty acids, platelets, endothelial cells and coronary heart disease
Authors: Nordøy Arne
Published: August 2010

ABSTRACT. The dietary fatty acids include saturated and unsaturated fatty acids of the n‐9, n‐6 and n‐3 families. Their quantity and quality are reflected in the plasma lipoproteins. The platelet and endothelial cell lipid composition also is influenced by the dietary fatty acids. These changes have consequences for cellular lipid and prostanoid metabolism and other cellular functions which could be related to the thrombosis mechanism. A high intake of saturated and n‐9 unsaturated fatty acids induces changes in plasma, platelets and endothelial cells favouring thrombosis and atherosclerosis. By contrast, both n‐6 and n‐3 fatty acids give rise to plasma lipoprotein and cellular lipid composition that counteract atherosclerosis and thrombosis. The ideal balance between the various dietary fatty acids is not known. Experimental and epidemiological studies support the recommendation of a low saturated fat intake with supplement of both n‐6 and ‐3 polyunsaturated fatty acids.
Coronary Bypass Surgery in Stable Angina Pectoris. A Randomized Study of the Effects on Morbidity, Mortality and Employment
Authors: Frick M.H. , Harjola P‐T. , Valle M.
Published: August 2010

ABSTRACT. The effects of coronary bypass surgery on morbidity, mortality and employment were assessed in a randomized prospective 5‐year study. Exercise tolerance showed an immediate, striking improvement, which was maintained throughout the follow‐up period. Corresponding patients treated with medical therapy showed no change. More than 40 percent of patients in the surgical group were free from symptoms over the five years. The annual mortality of the surgical patients was 0.8 percent as compared with 4.0 percent in the medical patients (p < 0.05). The annual mortality of the intensively treated medical patients with multivessel disease was not significantly higher than the 3.1 percent for a group of patients with single‐vessel disease followed concomitantly. The rate of work at 5 years after bypass surgery was 47 percent as compared with only 18 percent in the randomized medically treated group (p < 0.01).

It is concluded that coronary bypass surgery reduces morbidity and mortality and improves employment.
Severe Hypertension with Cerebral Symptoms Treated with Furosemide, Fractionated Diazoxide or Dihydralazine
Authors: McNAIR ALLAN , KROGSGAARD ARNE R. , HILDEN TAGE , NIELSEN POUL EBBE
Published: August 2010

ABSTRACT Emergency treatment of acute, severe hypertension defined as diastolic blood pressure (DBP) ≥ 135 mmHg combined with cerebral symptoms was prospectively monitored in a randomized multicenter study including 64 patients. Treatment was divided into two periods. In the first hour the patients were observed in the supine position after being given 40 mg furosemide intravenously. If DBP remained >125 mmHg (n=52), the patients were put on fractionated diazoxide administered intravenously (n=28) or dihydralazine administered intramuscularly (n=24). Blood pressure (BP) decreased with diazoxide from an average of 241/149 mmHg to 180/111 mmHg after 5 hours and with dihydralazine from 237/149 to 161/101 mmHg. The inter‐individual BP response varied considerably. A clear and identical regression in neurological symptoms was observed on both drug regimens. No new neurological symptoms were seen to develop. It is concluded that a gradual fall in BP can be obtained after fractionated dosage of diazoxide (i.v.) as well as after dihydralazine (i.m.). The indication of acute parenteral therapy compared to less aggressive oral treatment is discussed.
Prospective Critical Evaluation of in Vitro Thyroid Function Tests
Authors: ERICSSON U.‐B. , THORELL J. I.
Published: August 2010

ABSTRACT A number of 2 325 serum samples from a population of in‐ and outpatients were collected during a six‐month period in order to evaluate the usefulness of various thyroid function tests in the clinical laboratory routine. The samples were analysed with the following thyroid function tests: total triiodothyronine (T3) (TT3), total thyroxine (T4) (TT4), free T3 index (FT3I), free T4 index (FT4I) and thyrotropin (TSH). One to two years after the primary evaluation, a follow‐up was performed and the final diagnoses were checked in the patients' records. The values of these parameters in the diagnosis of hyperthyroidism were: FT3I>FT4I>TT3>TT4. The corresponding results in the diagnosis of hypothyroidism were: TSH>FT4I>FT3I=TT3. No single test could detect both hyper‐ and hypothyroidism effectively. The only one‐step strategy for thyroid evaluation in patients without apparent clinical signs of hyper‐ or hypothyroidism would therefore be the combined determination of T3 and TSH. The study also showed distinct differences between the reference values of the healthy population and patients without thyroid disorders.
Nonalcoholic Steatohepatitis in Obesity: A Reversible Condition
Authors: ERIKSSON STEN , ERIKSSON KARL‐FREDRIK , BONDESSON LENNART
Published: August 2010

ABSTRACTNonalcoholic steatohepatitis is a rare complication of obesity with laboratory and histological features indistinguishable from alcoholic hepatitis. Three patients with 50–60% overweight and steatohepatitis are reported. All responded with normalization of the biochemical and/or histological changes after modest weight reduction.
Clinical Course and Symptomatology of Angina Pectoris in a Population Study
Authors: ROSENGREN ANNIKA , HAGMAN MARIANNE , PENNERT KJELL , WILHELMSEN LARS
Published: August 2010

ABSTRACT The clinical course of angina pectoris was studied in a follow‐up study of 427 patients with angina from a general population sample. The subjects were men aged 56‐65 years at the time of follow‐up. After a mean follow‐up time of 5.8 years. 55% were still suffering from angina pectoris, 15% had died and a further 19% were either free from chest pain or had chest pain considered to be of different origin. In the group with definite angina pectoris at follow‐up (n = 236), 29% had sustained a myocardial infarction. 23% had symptoms of intermittent claudication, 36% were treated for hypertension and 15% had diabetes. Many of the angina patients suffered from other chest conditions in addition to anginal symptoms, Most of the patients (56%) had infrequent attacks (a few times per month or less often) and were not severely incapacitated by their symptoms. Only one fifth worked full time compared with more than half of those in the same age groups in the general population. Only 16 of those interviewed had undergone bypass surgery and a further 16 had disabling angina but, for various reasons, they had not been operated on. The implications are that most angina patients do well on pharmacological treatment alone even though they are limited socially as well as physically. Precipitating factors other than physical activity were also investigated and associations were found between susceptibility to cold, early morning angina, angina at rest and attacks of long duration, possibly indicating a mechanism of vasospasm superimposed on a fixed stenosis.
Free Insulin Profiles in Insulin‐dependent Diabetics Treated with One or Two Insulin Injections per Day
Authors: OLSSON P. O. , ARNQVIST H. , von SCHENCK H.
Published: August 2010

ABSTRACTTwenty‐four hour profiles of free insulin and blood glucose were determined in 12 healthy controls and 10 insulin‐dependent diabetics treated with insulin regimens based on intermediate‐acting insulin injected subcutaneously once or twice a day. The diabetics were ambulatory and in a good glycemic control, i.e. without hyperglycemic symptoms or frequent hypoglycemias and with HbAI <9% (reference value 5.9‐7.8%). Body weight was normal and median age (32 years) was the same in both groups. Free insulin was determined after polyethylene glycol precipitation of antibody‐bound insulin. The controls had a low basal insulin level (median fasting value 3.9 mU/1) and postprandial peaks with a maximum within 30‐60 min. There was no rise in plasma free insulin or blood glucose in the early morning hours. The free insulin profiles in the diabetics were highly unphysiological with hyperin‐sulinemia between the meals and during the night. The highest plasma free insulin value during the 24 hours was reached before lunch (approximately 5‐fold compared to normals,p<0.01). Postprandially the free insulin concentrations did not reach the peak levels of the normals. After breakfast, blood glucose rose considerably in the diabetics (p<0.02 compared to normals) while the rise after lunch and dinner was not higher than in the healthy controls. The difficulties in glycemic control in the diabetic group, i.e. a blood glucose rise after breakfast and hypoglycemias in some patients, could largely be explained by the unphysiological insulin profiles.
C‐reactive Protein in Population Samples
Authors: PALOSUO TIMO , HUSMAN TUULA , KOISTINEN JUKKA , AHO KIMMO
Published: August 2010

ABSTRACT The significance of C‐reactive protein (CRP) was studied in three different sets of specimens. (a) Raised levels (>10 mg/1) were detected in 2.0% of 380 healthy blood donors from whom two blood specimens, taken at an interval of half a year, were tested. Except for two cases, only one of the two specimens was positive, (b) Raised levels were found three times as frequently (in 6.6%) in a random middle‐aged population sample consisting of 531 subjects. More than 40% of the raised levels could be connected to acute respiratory infections, and about 20% to smoking. Five of the 35 subjects (14%) in the population sample with elevated CRP had rheumatoid arthritis, (c) The third set of sera comprised pre‐illness specimens from 22 subjects who developed rheumatoid arthritis a few months to five years later. Although it had previously been proved that the majority of these sera contained rheumatoid factors, the CRP concentration was increased in one specimen only.
Caffeine Stimulates in vivo Overall Cell Metabolism
Authors: AMMATURO VINCENZO , MONTI MARIO
Published: August 2010

ABSTRACTThe influence of caffeine on overall cell metabolism was studied in human platelets by measurement of cell heat production rate. One hour after administration of 100‐200 mg of caffeine, corresponding to 1‐2 cups of coffee, significantly increased values (p<0.001) were found, 12±7%. A return to normal values was noted 1 hour later. The cell metabolic stimulation is presumably due to increased catecholamines. A temporary significant rise in systolic (p<0.02) and diastolic (p<0.05) blood pressure was observed 1 hour after ingestion of caffeine.
Methylxanthines Reduce in vitro Human Overall Platelet Metabolism as Measured by Microcalorimetry
Authors: MONTI MARIO , EDVINSSON LARS , RANKLEV EVA , FLETCHER ROGER
Published: August 2010

ABSTRACTThe effect in vitro of caffeine, theophylline and enprofylline on overall platelet metabolism was investigated by a sensitive microcalorimetric method. Platelet heat production rate was found to be decreased significantly in the presence of any of the three methylxanthines in mM concentrations. Also lower caffeine concentration, as occurring during normal coffee intake, reduced platelet metabolism. These results show that, firstly, methylxanthines have a direct influence on platelet metabolism, and secondly, microcalorimetry can be used as a new and sensitive tool for investigating the influence of drugs on blood cell metabolism.
Treatment of Graves' Ophthalmopathy with Cyclosporin A
Authors: KVETNY J. , FRANDSEN N. E. , JOHNSEN T. , DIEPERINCK H. , MOGENSEN E.
Published: August 2010

ABSTRACT Six patients with Graves' ophthalmopathy (2 with acute and 4 with chronic alterations) were treated with cyclosporin A (10 mg/kg/day) for 5 weeks. This treatment had no effect on either the ocular manifestations (protrusion, eye muscle function) or subjective well‐being of the patients. In contrast, creatinine clearance decreased from 83.5 to 55.5 ml/min during treatment, but normalized (94.9 ml/min) after cessation of the drug. A transient increase in serum 4‐androstenedione was observed in 3 patients. We conclude that cyclosporin A has no convincing effect in the treatment of Graves' ophthalmopathy, but rather exerts serious renal effects.
Effects of Betamethasone on Serum lodothyronines and Thyroid Hormone‐binding Proteins in Graves' Disease
Authors: GAMSTEDT ANDERS , JÄRNEROT GUNNAR , KÅGEDAL BERTIL , TEGLER LENNART
Published: August 2010

ABSTRACTThe influence of betamethasone on iodothyronines and their binding proteins in serum was studied in 18 patients with Graves' disease. Betamethasone, 6 mg daily, was given orally for 5 days. Serum triiodothyronine (T3) concentration decreased, reverse triiodothyronine increased, while thyroxine (T4) and thyroid‐stimulating hormone were unchanged. Thyroxine‐binding globulin (TBG) decreased and thyroxine‐binding prealbumin increased. In accordance with the decrease in TBG, the in vitro T3uptake increased and out of the indirect measures of the free thyroid hormones, the free T4index increased and the free T3index decreased. We suggest that the decrease in serum T3during betamethasone administration supports the view of glucocorticoids being benefical as additional treatment in some patients with thyrotoxic crisis.
A Follow‐up Study of 68 Patients with Anti‐mitochondrial Antibodies (AMA)
Authors: JORDE ROLF , REKVIG OLE P. , BOSTAD LEIF
Published: August 2010

ABSTRACT During the period 1976‐83, anti‐mitochondrial antibodies (AMA) were detected in 68 patients out of about 48 000 sera (0.14%) analyzed for a repertoire of autoantibodies at the Department of Immunology, University Hospital of Tromsø. Fifty‐five of these patients were women, and only 10 had unequivocal primary biliary cirrhosis (PBC). At follow‐up in 1984, 48 out of these 68 patients were accessible for complementary testing. The AMA test became negative in 17 of these 48 patients during the observation period. Eleven of these 17 had originally a titer of 50. Seven of the 31 patients with persistent AMA were without detectable liver pathology. One patient had antibodies against smooth muscle, one against cell nucleus, whereas 35 had an increased serum IgM level. In conclusion, most patients with AMA do not have obvious PBC, a low AMA titer is likely to be transient, and there is a strong association between AMA and an increased serum IgM level.
Latamoxef versus Carbenicillin plus Gentamicin or Carbenicillin plus Mecillinam in Leukopenic, Febrile Patients with Solid Tumors
Authors: HANSEN STEEN W. , FRIIS H. , ERNST P. , VEJLSGAARD R. , HANSEN HEINE H.
Published: August 2010

ABSTRACT Sixty‐six febrile episodes associated with leukopenia were observed in 56 patients with solid tumors, WBC >1.5x109/l and temperature ≥38.5°C. Stratification to antibiotic treatment regimen was made with regard to prior cis‐dichlorodiamineplatinum (cis‐platinum) treatment or not. Patients who had received no cis‐platinum were randomized between carbenicillin 10 g every 8 h plus gentamicin 80 mg every 8 h or latamoxef 2 g every 8 h (group I). Patients having received cis‐platinum were treated with carbenicillin 10 g every 8 h plus mecillinam 800 mg every 8 h or latamoxef 2 g every 8 h (group II). The first dose of latamoxef was preceded by 10 mg of vitamin K i.v. In group I, clinical response was observed in 10 of 19 febrile episodes (52.6%) treated with carbenicillin plus gentamicin and in 10 of 14 (71.4%) treated with latamoxef (p>0.05). In group II, 6 of 14 febrile episodes treated with carbenicillin plus mecillinam responded (42.9%) while 11 of 19 (57.9%) responded to latamoxef (p>0.05). No bleeding due to antibiotic treatment was observed. No statistical difference between standard antibiotic therapy and latamoxef was seen in this subset of patients.
Clinical Findings and Prognostic Factors in Chronic Myeloid Leukemias
Authors: WEDELIN C. , BJÖRKHOLM M. , MELLSTEDT H. , GAHRTON G. , HOLM G.
Published: August 2010

ABSTRACT Ninety‐one previously untreated patients with chronic myeloid leukemia admitted to three Stockholm hospitals 1973–1978 were studied. There were 49 men and 42 women with a mean age of 56 years (range 15–93). Sixty‐five patients were Philadelphia chromosome (Ph1) positive and 17 were Ph1 negative (mean age 51 and 70 years, respectively). After a mean observation time of 5.2 years, 64 patients had deceased, 45 of them in blast transformation. A low hemoglobin value and a high total blast cell count at diagnosis were associated with a poor prognosis in the Ph1 positive group. Other routine clinical and laboratory variables were of subordinate prognostic importance. Early splenectomy in 15 Ph1 positive patients did not improve survival. Median survival from diagnosis was 38 months for Ph1 positive patients as compared to 12 months for the Ph1 negative group.
The Influence of Insulin on the Raised Plasma Fibronectin Concentration in Human Obesity
Authors: DEJGÅRD ANDERS , ANDERSEN TEIS , GLUUD CHRISTIAN
Published: August 2010

ABSTRACT Plasma concentrations of fibronectin, free insulin, C‐peptide and plasma glucose were determined in 40 morbidly obese subjects and in 51 normal weight controls, matched for sex and age. All plasma concentrations were significantly elevated (p<0.01) among the obese subjects. A significant correlation (r=0.34, p<0.05) between plasma fibronectin and plasma free insulin was found among the obese patients, but not among the controls (r=‐0.02, p>0.05). No significant correlation was found between plasma fibronectin and plasma C‐peptide, neither in the obese patients nor in the controls (obese r=0.06, controls r=0.02; p>0.05). Plasma fibronectin was insignificantly correlated with body weight (obese r=0.21, controls r=0.15; p>0.05) and percentage overweight (obese r=0.27, controls r=0.04; p>0.05). The raised level of circulating insulin may in part explain the excess of plasma fibronectin of obese subjects.
Peroral Glucose Tolerance Test
Authors: DYCKNER THOMAS , WESTER PER‐OLOV
Published: August 2010

ABSTRACTSeventy patients on long‐term diuretic therapy for arterial hypertension and/or congestive heart failure were investigated with regard to skeletal muscle electrolytes and the results of a peroral glucose tolerance test. A significant correlation was observed between the muscle content of potassium and the ability to handle a glucose load. Thirty patients underwent a second set of samples six months after the first one, 23 of whom had a reduction of their muscle potassium content relative to the first biopsy. They simultaneously demonstrated a significant impairment of glucose tolerance.
Effects of β1‐Adrenoceptor Blockade in the Treatment of Hypertension during Pregnancy in Diabetic Women
Authors: OLOFSSON PER , MONTAN SVEN , SARTOR GUNNAR , SJÖBERG NILS‐OTTO
Published: August 2010

ABSTRACT The effects of β1‐blockade were investigated in 18 hypertensive pregnant diabetic women. The same women served as controls, covering a period just before therapy. The blood pressure was reduced in 14 women (p<0.01). The change in blood glucose homeostasis was statistically not different from the control period. Insulin doses were not affected. The fetal heart rate was affected by therapy, causing a decrease in baseline rate (p<0.05) and in acceleration amplitude (p<0.05). Although the incidence of suspect fetal distress, intrauterine growth retardation and preterm delivery was high, all surviving infants had normal Apgar scores at 5 and 10 min. Perinatal mortality consisted of one stillbirth. Except for respiratory problems, the incidence of neonatal complications was low. All survivors were healthy at follow‐up. We found β1‐blockade to be effective and safe in this group of high‐risk pregnancies, and suggest it as an alternative for anti‐hypertensive therapy in diabetic pregnancy.
Alcohol Intemperance and Social Disability as Risk Factors for Different Causes of Death
Authors: ÅBERG HANS , LITHELL HANS , SELINUS INGEMAR , HEDSTRAND HANS
Published: August 2010

ABSTRACT At a follow‐up 7–10 years after a health screening of 50‐year‐old men in Uppsala, 101 of the 2322 participants and 51 of the 446 non‐participants had died. The incidence was thus almost three times as high among non‐participants as among participants. Registration at the Temperance Board and/or the Bureau of Social Services was 2–3 times more common among the deceased subjects than among the living irrespective of participation in the health screening. A multiple logistic analysis revealed that non‐participation and both types of registration were associated with an increased risk of death. For death from neoplasm only registration at the Bureau of Social Services, and not that at the Temperance Board, was a risk factor. For ischaemic heart disease (IHD), on the other hand, registration at the Temperance Board was the strongest risk factor, the other type of registration being secondary, and non‐participation in the screening was a non‐significant risk factor. The importance of alcohol intemperance as a risk factor for IHD was reflected in the fact that every second subject dying a sudden death (classified as IHD death) was registered at the Temperance Board. These results indicate that alcohol intemperance entails an increased risk of developing fatal complications to IHD, and social disability may carry with it a risk of both neoplasm and, to a lesser extent, death from IHD.
Acute Phase Reactants in the Initial Phase of Giant Cell Arteritis
Authors: ANDERSSON RUNE , MALMVALL BO‐ERIC , BENGTSSON BENGT‐ÅKE
Published: August 2010

ABSTRACT The erythrocyte sedimentation rate (ESR), C‐reactive protein (CRP), fibrinogen and haptoglobin were followed weekly during the initial phase of corticosteroid treatment in 18 patients with 19 episodes of giant cell arteritis (GCA). Fibrinogen and CRP decreased most rapidly, with normal values in 67% of the patients after two weeks of treatment. After two weeks 56% of the patients had normal ESR values and 76% after five weeks. Haptoglobin normalised most slowly, no patient having a normal value after one week, 29% after two weeks and 75% after six weeks. For routine clinical use, we found the ESR alone sufficient for monitoring the initial steroid treatment.
Defective Monocyte Function in Legionnaires' Disease Complicating Hairy Cell Leukaemia
Authors: NIELSEN HENRIK , BANGSBORG JETTE , RECHNITZER CATHERINE , JACOBSEN NIELS , BUSK HANS ERIK
Published: August 2010

ABSTRACT We describe a case of Legionnaires' disease in a 64‐year‐old man, in which hairy cell leukaemia was diagnosed after the onset of the infection. Immunological studies revealed a complete suppression of blood monocyte chemotactic and oxidative burst activities. We suggest that in hairy cell leukaemia both monocytopenia and defective functions of monocytes underlie the increased susceptibility to intracellular infections including Legionnaires' disease.
Warfarin and Uric Acid after Myocardial Infarction
Authors: SMITH PÅL , ARNESEN HARALD
Published: August 2010

ABSTRACTIn order to assess the influence of warfarin on serum urate concentration, changes in serum urate were studied in 50 patients after myocardial infarction. The patients studied were part of a prospective, randomized placebo‐controlled study of warfarin after myocardial infarction. Twenty‐three of the patients were treated with warfarin and 27 received placebo. The mean uric acid level fell in both groups during an average of 10 months (range 6‐20 months), the reduction being of the same order of magnitude in either group. This implies that warfarin, in contrast to some other oral anticoagulants, does not exert any uric acid lowering effect.
Variability of Blood Pressure in Ambulatory Hypertensive Patients: Effects of Verapamil on Twice and Thrice Daily Dose Regimens
Authors: DE FAIRE ULF , FORSLUND LENNART , ODÉN ANDERS
Published: August 2010

ABSTRACT The antihypertensive effects of verapamil over 24 hours were assessed on twice and thrice daily dose regimens on 12 patients (25–65 years of age; mean age 50) with essential hypertension (WHO stages I–II) in a randomised, double‐blind, cross‐over trial. After a dose titration period starting with either verapamil 80 mg tid or 120 mg bid the patients kept their maintenance dose (240, 360 or 480 mg daily) for 4 weeks before crossing over to the other administration schedule. Repeated ambulatory blood pressure (BP) curves were recorded in 10 patients with a non‐invasive portable device (Pressurometer III, Del Mar Avionics). The BP reductions (causal BP values) obtained by 2‐ and 3‐dose regimens were of similar magnitude (from 170±19/105±8 on placebo to 140±17/87±7 and to 146±14/88±8 by 2‐ and 3‐dose respectively). Analyses of BP curves revealed close similarity in profiles on the two dose regimens, although DBP was significantly (p<0.05) lower by 3‐dose as compared to 2‐dose regimen during the period 0.00–2.59 a.m. Long‐term (circadian rhythm) and short‐term variability did not differ between the regimens. Despite the slight difference in DBP curves after midnight, the overall impression is that verapamil given both twice and thrice daily provides adequate BP control throughout 24 hours.
Low‐dose Antihypertensive Treatment with a Thiazide Diuretic Is Not Diabetogenic
Authors: BERGLUND GÖRAN , ANDERSSON OVE , WIDGREN BENGT
Published: August 2010

ABSTRACT Blood pressure (BP) and metabolic variables were determined initially and after 1, 2, 4, 6 and 10 years' treatment in two groups of hypertensive men (n = 53 each) randomized to bendroflumethiazide 2.5–5 mg/day or propranolol 160–320 mg daily. There was no significant differences in BP or metabolic variables between the two groups at entry. BP was reduced to the same degree by both treatments. Five men in the propranolol group and one man in the thiazide group developed clinically overt diabetes during follow‐up. Fasting blood sugar increased slightly but significantly though equally in both groups. Oral glucose tolerance was initially impaired to the same degree in both groups but improved significantly during treatment with both drugs. Fasting insulin increased slightly but to the same degree. While serum potassium decreased significantly in the thiazide group, the total body potassium was unchanged in this group. In the propranolol group, serum potassium rose, while total body potassium decreased significantly. Serum urate increased in both groups, though slightly more during thiazide treatment. One case of gout was found in each group. There was no difference in serum lipids between the two groups. The findings in this long‐term trial indicate that in middle‐aged men with mild to moderate hypertension a low‐dose thiazide diuretic like bendroflumethiazide is as effective and safe an antihypertensive agent as the β‐blocker propranolol is and that it does not induce diabetes. The total clinical picture favors the retention of thiazide diuretics as a first choice drug in hypertension.
Familial α1‐Antichymotrypsin Deficiency
Authors: ERIKSSON STEN , LINDMARK BERTIL , LILJA HANS
Published: August 2010

ABSTRACT We studied patients and their relatives with partial deficiency, approximately 50% of normal plasma levels, of α1‐antichymotrypsin (ACT), an acute phase reactant with anti‐cathepsin G activity. Six of eight ACT deficient individuals, over 25 years of age, had liver and three of eight lung manifestations, varying from severe disease to subtle laboratory abnormalities. The ACT of deficient individuals (who are heterozygotes for a rare gene, q=0.003) had normal crossed immunoelectrophoretic properties. The abnormal gene is inherited in an autosomal, dominant way. The results suggest that deficiency of this antiprotease, which also has immune response modulating properties, may predispose to liver and lung disease.
Platelet Function in Patients with Primary Sjögren's Syndrome
Authors: OXHOLM PETER , WINTHER KAJ , MANTHORPE ROLF
Published: August 2010

ABSTRACT. Platelet function tests were performed in 15 patients with primary Sjögren's syndrome (SS) and in 15 normal controls. Platelet counts were within the normal range in all except two patients in whom they were only slightly decreased. P‐β‐thromboglobulin was increased in several patients compared to controls, although not significantly (p < 0.1). Platelet aggregation was enhanced in patients when measured upon stimulation with epinephrine (p < 0.05), ADP (p < 0.01) and collagen (p < 0.01). No correlation was found between enhanced platelet activity and sex, age, duration of disease, extraglandular manifestations, positive ANA test, elevated P‐IgG or P‐immune complexes. Enhanced platelet activity in patients with primary SS is a new observation. Future studies are needed to elucidate the pathogenetic background.