bluuebunny/crossref_metadata_2025 huggingface dataset:
EARLY INTRAVENOUS ATENOLOL TREATMENT IN SUSPECTED ACUTE MYOCARDIAL INFARCTION
Authors: Sleight Peter , Yusuf Salim , Peto Richard , Rossi Paulo , Ramsdale David , Bennett David , Bray Colin , Furse Lynette
Published: August 2010

All patients suitable for beta blockade entering the coronary care units at Oxford and Manchester were studied in a randomised trial to determine whether administration of intravenous atenolol within 12 hours of chest pain reduced infarct size and ventricular arrythmias.

Infarct size was measured using cumulative CKMB release and R wave changes from the standard ECG. The preliminary report on the first 214 patients showed prevention of infarction and a mean one third reduction in infarct size in patients with initial definite infarction (Yusuf et al, 1980).

Reanalysis of the data when 400 patients were randomised confirmed the observations of the initial analysis. In patients with initial threatened infarction (n = 143), 59 % of control patients developed infarction compared to 37 % in the atenolol treated patients (2p <0.01). In 247 subjects with initial definite infarction, the percentage of the original R wave remaining was 34.5 ± 8 in the atenolol treated subjects (2 p < 0.0001). In 247 subjects with initial definite infarction, the percentage of the original R wave remaining was 34.5 ± 2.1 in the controls compared to 43.4 ± 2.1 in the atenolol treated patients (2p < 0.003).

Although bradycardia and hypotension were commoner in atenolol treated subjects (44 and 23 respectively) compared to controls (18 and 8 respectively), this was easily reversible by stopping the drug or using atropine. Inotropic drugs were only needed in 4 atenolol and 2 control subjects. More control patients needed treatment for heart failure compared to the atenolol group in hospital and at discharge (2p < 0.10 and 2p < 0.05).

Ventricular arrythmias were recorded using a 24 hour Medilog recorder in 47 atenolol and 47 control subjects. There was a significant reduction in the incidence of R on T (prematurity index < 1.0) ventricular ectopics (41 % AT v 90 % controls 2p < 0.001), a significant slowing of the rate of sustained ventricular tachycardia (mean 144 in AT v 165 beats / min control 2p < 0.02), a significant delay in the prematurity index of VT (1.70 in AT v 1.34 in controls (2p < 0.01) and coupling interval of VT (680 msec in AT v 503 msec in controls 2p < 0.01).

In conclusion, early IV Atenolol decreases infarct size and reduces the incidence and severity of ventricular arrythmias in patients with acute myocardial infarctions. A larger study is required to assess if these physiological benefits lead to a reduction in early and long term mortality.
BETA BLOCKADE AND THE SECONDARY PREVENTION OF MYOCARDIAL INFARCTION
Authors: Hampton J. R.
Published: August 2010

In 1965 Snow reported a clinical trial in which treatment with propranolol significantly reduced mortality following myocardial infarction. Unfortunately the design of this trial was inadequate by modern standards, and the results must be discounted. None of the studies published since then have provided convincing evidence that beta blockers are useful following myocardial infarction.

Survival after a myocardial infarction depends principally upon the amount of heart muscle that has been destroyed, and it is probably unreasonable to expect any treatment to reduce mortality by more than 20 or 30 %. In patients who survive an infarction for more than 48 hours, the expected fatality rate in the next year is approximately 15 %. To detect a reduction of this mortality to 10%, 2300 patients would be needed in the trial.

The analysis of several of the published trials has been made difficult by a lack of data, the failure on the part of authors and journal editors to agree on a common method of presenting results, and disagreement as to whether results should be analysed on an «all patients – intention to treat» basis or by considering only «clinical effectiveness» among patients who remained on treatment. Examples of these problems will be given, together with a suggested scheme for data presentation.

The 95 % confidence intervals of all the randomised and double blind studies of beta blockers after myocardial infarction show that by «intention to treat» analysis, none demonstrate a statistically significant reduction in mortality among treated patients. Only the practolol trial was of a reasonable size, but even here total mortality was not significantly reduced; the result is in any case of only theoretical interest. The trials showing a reduction of mortality in association with alprenolol treatment are not convincing, and the stratified trial design of one of these may have given misleading results because of the relatively small number of patients involved.
LIPID LOWERING AND ISCHAEMIC HEART DISEASE
Authors: Oliver M. F.
Published: August 2010

There is a non‐linear discontinuos relationship between serum cholesterol, and LDL cholesterol, with IHD. There is no sound evidence that reduction of serum cholesterol below 200–210 mg/dl will reduce IHD incidence.

It has not yet been shown that regression of advanced lesions in middle‐aged men can occur, but regression of cholesterol‐induced atheromatous lesions has been achieved in juvenile monkeys by discontinuing atherogenic diets.

While the three major primary prevention trials of lowering raised serum cholesterol were all associated with reduction in non‐fatal mortality from IHD ‐ thereby supporting the lipid hypothesis ‐ all also showed an increase in non‐cardiovascular mortality.

It is legitimate to raise doubts about the consequences on normal biological function of ageing cells of reducing cholesterol concentrations over many years.

It is probably of little value to reduce raised serum cholesterol concentrations in patients with overt IHD, since their prognosis is largely determined by the extent of myocardial damage sustained and of coexisting thrombogenic tendency.

Patients with familial hypercholesterolemia should be vigorously treated with a diet with a PIS ratio 1–5, cholestyramine and perhaps nicotinic acid also. The general population should be advised to reduce fat calories to below 30 per cent of total energy with no more than one‐third from saturated fat.
HEMODYNAMIC AND METABOLIC EFFECTS OF VASODILATORS, NITRATES, HYDRALAZINE, PRAZOSIN AND CAPTOPRIL IN CHRONIC ISCHEMIC HEART FAILURE
Authors: Chatterjee Kanu , Rouleau Jean‐Lucien
Published: August 2010

Vasodilators like nitrates, hydralazine, captopril and prazosin all improve left ventricular function of patients with chronic ischemic heart failure. The influence of these vasodilator agents on coronary hemodynamics and myocardial oxygen consumption, however may bot be similar. With nitrates and captopril, improved left ventricular function is associated with decreased myocardial oxygen consumption; in contrast, with prazosin or hydralazine no consistent or significant change in myocardial oxygen consumption is observed. Thus, the metabolic cost for the improved left ventricular function with these vasodilator agents is not similar.
ORAL ANTICOAGULATION IN THE SECONDARY PREVENTION OF MYOCARDIAL INFARCTION
Authors: Loeliger E.A.
Published: August 2010

Evidence in favour of oral anticoagulant therapy (OAT) in patients suffering from an acute myocardial infarction has been published in 1977 by Chalmers and co‐workers (New Engl. J. Med.297, 1091). For OAT after discharge an International Review Group (IRG) concluded in 1970 that «anticoagulant therapy probably prolongs survival at least over two years, but that benefit is as a rule restricted to patients with a history of angina or previous infarction» (The Lancet,1, 203). Since the IRG finished their analysis, favourable results of four additional comparative studies have been published, three of which were double‐blind and performed in the Netherlands. These four studies demonstrated a beneficial effect of adequate oral anticoagulation. The latest study was performed to assess benefits and untoward reactions of long‐term OAT in the elderly. Results were published in November 1980 (The Lancet, 2,989). Mortality in the 738 patients who entered the trial, all of whom older than sixty years, having survived a transmural infarction, and having been on OAT for at least six months (mean: six years), was lower in patients on active treatment (p=0.016), due to the important difference in recurrent myocardial infarction (RMI). Fifty‐eight RMI's occurred in the placebo group as compared to only twenty in the AC group (p < 0.01). Fatal cerebrovascular accidents were evenly distributed over the two groups, with a preponderance of haemorrhage in patients on active treatment. No fatal extracranial haemorrhage occurred. Incidence and severity of bleeding complications were in agreement with good patient compliance. No significant relationship was found between the recurrence of infarction and either the age of the patient or the length of treatment before entering trial. The steadiness of the widening gap between the mortality and RMI's observed in the two groups indicates that the efficacy of OAT persisted throughout the entire observation period of two years.
COST‐BENEFIT ASPECTS OF POST‐MYOCARDIAL INFARCTION INTERVENTION
Authors: Wilhelmsson C. , Vedin A. , Wilhelmsen L.
Published: August 2010

After myocardial infarction the mortality during the first post hospital year declines from approximately 10 per cent to 5 per cent during the second year. The rates of non‐fatal recurrencies are similar. Mortality is related to age but not to the same extent to sex. Nonfatal recurrencies are, however, not related to age.

Prediction of mortality is feasible by several prognostic models. Factors related to size of myocardial damage stand out as the important secondary risk factors for the years immediately after infarction. Most of these factors are not generally related to the risk of non‐fatal recurrencies. The proportion of cardiovascular deaths is 90 per cent during the first years and declines thereafter.

Simplistically it may be said that the prognosis during the first years is related to the extent of the myocardial damage and thereafter primary risk factors become more important.

Thus, it seems logical in the short‐term perspective to influence myocardial factors and related arrhythmias and in the long‐term perspective to influence primary risk factors which more likely operate on the vascular factors.

Three preventive methods have demonstrated a positive benefit: 1) chronic beta‐blockade, 2) cessation of smoking, 3) by‐pass surgery in certain categories.

After careful calculations it may be argued that at least half of the total mortality may be inhibited by beta‐blockade and cessation of smoking. The impact of coronary surgery, lipid lowering and reduction of high blood pressures is more difficult to assess.
Improvement of Glucose Tolerance by Verapamil in Patients with Non‐Insulin‐Dependent Diabetes Mellitus
Authors: Andersson D. E. H. , Röjdmark S.
Published: August 2010

ABSTRACT.To study the effect of verapamil on the glucose tolerance and insulin response to oral glucose, 6 healthy subjects and 15 patients with non‐insulin‐dependent diabetes mellitus (NIDDM) were investigated. In the healthy individuals, 3 tests were performed on separate days: 1) A standardized oral glucose load, 2) an identical glucose load during i.v. infusion of verapamil, and 3) a third oral glucose load after one week of oral verapamil treatment. No significant differences were found when the insulin and glucose responses with and without verapamil were compared. The patients with NIDDM were divided into three groups. Two tests were performed on separate days in each patient: group 1, a standardized oral glucose load and an identical glucose load during i.v. verapamil infusion; group 2, a standardized oral glucose load and a similar glucose load after one week of oral verapamil treatment; group 3, the protocol of group 2 was followed but oral placebo was given instead of verapamil. In groups 1 and 2, verapamil improved the tolerance for oral glucose, whereas the insulin response remained unaffected. In group 3, no significant differences were found in the insulin and glucose responses to the two oral glucose loads. These findings thus imply that verapamil improves the tolerance for oral glucose regardless of the route of verapamil administration in patients with NIDDM. They also indicate that this is accomplished by an effect of verapamil on other glucose regulatory factors than insulin.
Natural History of Coronary Artery Disease Studied by Coronary Arteriography
Authors: Storstein O. , Enge I. , Erikssen J. , Thaulow E.
Published: August 2010

ABSTRACT. Seven hundred and ninety‐five consecutive patients with the diagnosis of angina pectoris were studied by coronary angiography and followed for 2–7 years. The prognosis is greatly determined by the extent of coronary artery involvement. Concomitant mitral insufficiency or ventricular aneurysm influence the prognosis adversely. There was no significant difference in prognosis between men and women. As regards patients with three‐vessel disease and elevated left ventricular end‐diastolic pressure, the prognosis was better in operated than in non‐operated patients. The prognosis seems to have improved when angina pectoris materials collected in the 70s are compared with materials from the 60s.
Glucose‐Insulin‐Potassium‐Albumin Infusion in the Early Phase of Acute Myocardial Infarction—A Controlled Study
Authors: Sundstedt Carl‐David , Sylvén Christer , Mogensen Lars
Published: August 2010

ABSTRACT.Fifty consecutive patients with acute myocardial infarction admitted to a coronary care unit within 6 hours from onset of symptoms were randomly assigned either to a treatment group (n=27) receiving glucose‐insulin‐potassium‐albumin (GIKA) or to a control group (n=23), comparable regarding clinical data, receiving 5.5% glucose. Both infusions were given intravenously at a rate of 1.2 ml/kg b.wt./hour during 48 hours. The GIKA solution contained 40 mEq K+, 10 ml 20% albumin and 16 IU regular crystalline insulin per 1000 ml 10% glucose. Before the infusion, the treatment group received an i.v. loading dose of 50 ml 50% glucose. Serum time activity curves for creatine kinase (CK) and myoglobin (MG) were established from frequent blood level determinations. A 15‐minute single‐lead ECG was recorded every fourth hour and subsequently analysed for ventricular arrhythmias. The two patient groups did not differ regarding cumulative MG and CK release. The GIKA group had significantly more patients with high MG/CK ratios (p<0.02). No clinically significant difference was found between the two patient groups regarding ventricular arrhythmias, even if ventricular extrasystoles tended to occur less frequently in the GIKA group.
Changes in Intrarenal Sodium Handling during Saluretic Treatment in Patients with Essential Hypertension
Authors: Roos J. C. , Mees E. J. Dorhout , Koomans H. A. , Geyskes G. G. , Boer P.
Published: August 2010

ABSTRACT. The effect of 50 mg chlorthalidone on blood pressure, body fluid volumes and renal functional parameters was determined in 8 patients with essential hypertension. After 3 days there were signs of volume depletion with little change in mean arterial pressure (MAP). Maximal free water clearance (CH2O) was decreased and fractional proximal sodium reabsorption was increased, but no correlations between these parameters were found. After 3 months there was in inverse relationship between both changes in MAP and the indices of volume depletion and CH2O. It is concluded that when MAP decreases after prolonged saluretic treatment, there is a partial recovery of the initially induced volume depletion and less stimulation of proximal tubular sodium reabsorption. The continuing inhibitory action of chlorthalidone on “distal” sodium reabsorption is partially compensated for, probably by the stimulating effect at this site of the decrease in MAP.
Blood Monocytes and Serum and Bone Marrow Lysozyme in Sarcoidosis
Authors: Koivunen Elli , Grönhagen‐Riska Carola , Klockars Matti , Selroos Olof
Published: August 2010

ABSTRACT. Serum lysozyme (LZM) concentrations were correlated to the number of neutrophils and monocytes in patients with sarcoidosis and nongranulomatous diseases. In sarcoidosis patients with an increased activity of serum angiotensin converting enzyme (ACE), a positive correlation was noted between LZM and blood monocytes. In sarcoidosis patients with normal ACE activity, as well as in patients with non‐granulomatous diseases, a correlation was found between blood neutrophils and LZM, but not between blood monocytes and LZM. LZM was found in bone marrow plasma and in serum in a ratio of 1.5 to 1. Sarcoidosis patients had 30% higher LZM levels than healthy controls. The concentration of LZM in bone marrow plasma did not correlate to detectable granulomas in bone marrow specimens. The positive correlation between blood monocytes and LZM in patients with clinically active sarcoidosis is possibly due to recruitment of bone marrow monocytes for the granuloma formation.
Correlation between Disease activity, One‐Year Prognosis, and Angiotensin‐Converting Enzyme in Untreated Sarcoidosis
Authors: Rømer Frode K.
Published: August 2010

ABSTRACT. The correlation between S‐angioten‐sin‐converting enzyme (SACE) and disease activity was examined in 185 observation periods in 85 untreated sarcoidosis patients. An agreement between SACE and chest roentgenographic changes was found in 42 % of the observations, although less frequently in patients with erythema nodosum. The most convenient interval between enzyme measurements seems to be 3 months in patients with active disease, but more frequent check‐ups are advised in patients with erythema nodosum. In 24 patients followed for one year after diagnosis, SACE correlated fairly well to the clinical course, and the pattern of enzyme variation may be a prognostic indicator in sarcoidosis.
Sulfadimidine Acetylation in Norwegians
Authors: Olsen Harald , Mørland Jørg
Published: August 2010

ABSTRACT.The acetylation of sulfadimidine was studied in 152 healthy volunteers (29 Lapps, 73 Norwegians and 50 South Norwegians) by means of fraction acetylated sulfadimidine and drug half‐life. The distribution of rapid acetylators was different among Lapps (72%) and South Norwegians (44%) (p<0.01). The North Norwegians resembled the South Norwegians, but some regional approach to the Lappish pattern was found. Great interindividual differences in the half‐lives were demonstrated. The mean half‐life (±S.E.M.) was 384±17 min in slow acetylators and 148±8 min in rapid acetylators. Among participants with half‐lives of sulfadimidine less than 420 min an intraindividual correlation with fraction acetylated sulfadimidine was found. The distribution of fraction acetylated sulfadimidine was bimodal while the distribution of halflives was suggested to be trimodal.
Diagnostic Value of Total and Differential Leukocyte Counts in Pleural Effusions
Authors: Pettersson Tom , Riska Henrik
Published: August 2010

ABSTRACT. Total and differential leukocyte counts in pleural fluid were determined prospectively in 140 consecutive patients undergoing diagnostic thoracentesis. The total number of leukocytes was higher in exudates than in transudates. Lymphocytes predominated overwhelmingly (more than 80% of all leukocytes) in 29 of the 31 effusions with verified or probable tuberculous etiology and in 18 of the 24 with malignant etiology, as well as in 20 exudative pleural effusions of other causes. The significant differences in the percentage of lymphocytes distinguished tuberculous effusions from parapneumonic (p<0.001), nonspecific (p<0.001) and rheumatoid effusions (p<0.005), as well as from effusions caused by undefined connective tissue disease (p<0.001). Eosinophilia (more than 10%) of the pleural fluid was not present in any patient with proven tuberculosis and in only one patient with malignant effusion (malignant mesothelioma) but did occur in 12 of the 26 patients with nonspecific effusion. These results show that a great lymphocytic predominance is characteristic particularly of tuberculous but also of malignant pleural effusions, although this predominance cannot be regarded as disease‐specific. Eosinophilia of the pleural fluid—usually a nonspecific sign—indicates nontuberculous, nonmalignant etiology.
Polymorphic Acetylator Phenotype and Systemic Lupus Erythematosus
Authors: Johansson E. , Mustakallio K. K. , Mattila M. J.
Published: August 2010

ABSTRACT. Out of 69 patients with spontaneous systemic lupus erythematosus (SLE), phenotyped for polymorphic acetylation with sulphadimidine, 52 (75%) were slow acetylators. In the subgroup of SLE patients with chronic biologically false positive seroreactions for syphilis the percentage of slow acetylators was even higher, 88%. In the majority of the slow acetylators the disease had started later and had followed a milder course than in rapid acetylators. Cutaneous reactions suspected to be drug‐induced were seen in 19 (17 slow acetylators) during an observation period of 3–7 years. The reactions were mostly of exanthematous or urticarial type but also fixed type of eruption was seen. Provocation tests with the suspected drug were performed in 14 patients. In 5 cases it could be demonstrated that the eruption was caused by the drug. The predominance of slow acetylators among our patients with spontaneous SLE was the same as has been observed in drug‐induced SLE. This suggests a similar genetic background.
Acute Hemodynamic and Long‐Term Clinical Effects of Prazosin in the Treatment of Chronic Congestive Heart Failure
Authors: von der Lippe Gerhard , Ohm Ole‐Jørgen , Lund‐Johansen Per
Published: August 2010

ABSTRACT. The effect of prazosin in congestive heart failure was assessed in 10 patients (age 39–69 years) with ischemic heart disease or cardiomyopathy in functional class II‐IV (NYHA). All patients were treated with digitalis and diuretics in optimal doses. Mean (± S.E.M.) cardiac index (CI) was 2.2±0.2 l/min/m2 before and 2.3±0.1 one hour after oral administration of 2–4 mg prazosin (given as tablets) (p>0.10). Mean pulmonary capillary wedge pressure (PWP) fell from 24±4 to 20±4 mmHg (p>0.10). Prazosin seemed to have a more beneficial effect on patients with markedly elevated PWP or reduced CI before prazosin administration. The effect of prazosin on heart rate and systolic blood pressure was insignificant. During a follow‐up period of 1–20 months (mean 7.3), 2 of 7 patients treated with prazosin (2–4 mg daily) improved their clinical condition, one patient was unchanged and 4 patients died in progressive cardiac failure. The results indicate that some patients with severe heart failure may benefit from prazosin when conventional treatment has failed.
Chronic Myeloid Leukemia in Myasthenia Gravis after Long‐Term Treatment with 6‐Mercaptopurine
Authors: Wanders J. , Wattendorff A. R. , Endtz L. J. , den Nijs J. J. , Leeksma C. H. W.
Published: August 2010

ABSTRACT. A woman with myasthenia gravis and a thymoma did not respond sufficiently to thymectomy. She was treated with 6‐mercaptopurine. Withdrawal of this treatment was several times followed by an aggravation of myasthenic symptoms. After more than 12 1/2 years treatment she developed Ph1 ‐positive chronic myeloid leukemia (CML). No other case of CML following immunosuppressive treatment has been described. Because the therapeutic agent is potentially leukemogenic, the possibility cannot be definitely excluded that the development of CML is not a mere coincidence.
Microclot Generation (MCG) Test in Disease
Authors: Juhlin Lennart , Shelley Walter B.
Published: August 2010

ABSTRACT. Heparinized blood was taken up into capillary tubes and kept in vertical position at 37°C for 24 hours to allow the red cells to sediment. Microclots appearing as radiant fibrin stars were seen under phase microscopy in the plasma portion of blood from certain patients. Such a positive microclot generation (MCG) test occurred in patients with some inflammatory diseases and cancer as well as in patients with certain skin disorders. The data suggest that the MCG test may serve in the detection of endotoxemia.
Severe Backache as a Presenting Sign of Bacterial Endocarditis
Authors: Härkönen Mauno , Olin Paul‐Erik , Wennström Johan
Published: August 2010

ABSTRACT. We report on two patients whose presenting sign of bacterial endocarditis was a sudden and severe backache. According to the literature, 25–44% of patients with bacterial endocarditis have musculoskeletal symptoms and in about 27% these symptoms are the first sign of the disease. The most probable pathogenetic mechanism of these symptoms is arterial microembolization consisting of bacteria and immune complexes.
Studies on Kidney Function in Subjects Exposed to Organic Solvents
Authors: Askergren Alf , Brandt Ragnar , Gullquist Roger , Silk Birgitta , Strandell Tore
Published: August 2010

ABSTRACT. Glomerular filtration rate (GFR) was studied by measuring the 51‐Cr‐EDTA clearance with single bolus injection technique in 107 men exposed to styrene, toluene or toluene and xylene in their professions and in 48 non‐exposed male controls. The clearance values of the controls were significantly related both to body surface area (BSA) and age. These relations were used to calculate expected clearances for the exposed subjects. The clearances of the exposed subjects were on an average 3.8% higher than expected, according to BSA and age in this group. This divergence was not significant. Thus, no reduction in GFR was found in the subjects exposed to organic solvents.
The Effect of Fluid Deprivation, Antidiuretic Hormone and Forced Fluid Intake on 51‐Cr‐EDTA Clearance
Authors: Askergren Alf , Brandt Ragnar , Gullquist Roger , Silk Birgitta , Strandell Tore
Published: August 2010

ABSTRACT. The effect of fluid deprivation, antidiuretic hormone (DDAVP) and forced fluid intake on glomerular filtration rate (GFR) was studied in 41 healthy males by determining 51‐Cr‐EDTA clearance after a single bolus injection. GFR was the same on forced and on free fluid intake. A small, clinically insignificant decrease in GFR (‐6.5%), compared to values on free fluid intake, was registered during the period of fluid deprivation plus DDAVP. There seem to be no objections to combining a clearance study with a concentrating ability test when screening groups of subjects with normal or near normal GFR.
Analysis of Systolic Vibrations of Interventricular Septum in Patients with Aortic Valvular Stenosis
Authors: Vukas M. , Wallentin I. , Hjalmarson Å.
Published: August 2010

ABSTRACT. Systolic vibrations of interventricular septum are described in 30 patients with congenital aortic valvular stenosis. No such vibrations were found in 8 patients with similar enlargement of the heart but without valvular defects. The frequency and amplitude of vibrations seem to correlate with the severity of aortic valvular stenosis, degree of dilatation, hypertrophy and filling pressure of the left ventricle.
A Study of 136 Cases of Adder Bite Treated in Swedish Hospitals during One Year
Authors: Persson Hans , Irestedt Birgitta
Published: August 2010

ABSTRACT.The adder (Vipera berus) is the only naturally occurring poisonous snake in Sweden. During one year, 136 patients were hospitalized due to adder bites in a population of 5.3 mill. (63% of the total population). These patients could be traced through the central register on diagnosis codes and have been studied retrospectively. The main purpose of the investigation was to study the epidemiology and to estimate the degree of poisoning, thereby getting an idea of the frequency of really severe cases. Minor local symptoms occurred in 27% of the patients, whereas 46% suffered mild, 15% moderate and 12% severe poisonings. The average duration of hospitalization was 1.6, 3.8, 5.5 and 7.6 days, respectively, for these four groups. Shock, CNS disturbances, anaphylactic reactions, extensive edemas, renal dysfunction and severe anemia were typical findings in the group with severe reactions. Although no deaths occurred, the proportion of severe cases contrasts with the current conception that severe envenomation after adder bites is rare. The mortality due to adder bite has been low during the last decades. Earlier the situation was different, and during 1911‐78 altogether 44 deaths due to adder bite were registered in Sweden.
Men Evacuated after the Second World War from the Carelian Isthmus to Southwest Finland: Risk Group for Myocardial Infarction?
Authors: Kalliomäki J. L. , Nyrke Tauno
Published: August 2010

ABSTRACT. More myocardial infarctions occurred and the prevalence of diabetes mellitus and hypercholesterolemia (>9.5 mmol/1) was higher among men evacuated in 1944 from Metsäpirtti (Carelian Isthmus) to Vehmaa (Southwest Finland) than among men of the same age native to Vehmaa. Blood pressure, smoking habits, fat intake, physical activity at leisure and mental stress were—according to the questionnaires—equal in both groups. Metsäpirtti and its surroundings was a genetic isolate as compared to Vehmaa. The population of Vehmaa is more mixed and has been influenced by the Germanic (Swedish) race for a long time.
Incidence and Cause of Aplastic Anemia, Hemolytic Anemia, Agranulocytosis and Thrombocytopenia
Authors: Böttiger Lars Erik , Böttiger Blenda
Published: August 2010

ABSTRACT. A total of 745 patients with cytopenia (aplastic anemia 157, hemolytic anemia 101, agranulocytosis 136, thrombocytopenia 351) were diagnosed during a 5‐year period in a health care region comprising 16% of the Swedish population. The total incidence was for aplastic anemia 24.6, hemolytic anemia 15.8, agranulocytosis 21.3 and thrombocytopenia 55.0 cases per 106 and year. Compared to 10 years earlier, aplastic anemia and agranulocytosis have become more common, thrombocytopenia occurs with unchanged frequency while hemolytic anemia is rarer. The overall incidence is 5 times higher in elderly (>65 y.) than in younger patients and 1.3 times higher in women than in men, figures that make total incidence figures rather meaningless. The most common cause is “unknown” (45%), the next drug‐induced (25–36% including cytostatic drugs). Disregarding cytostatics, the drugs most often encountered are oral diuretics, analgesics, antiphlogistics and sulfonamides.
Plasma Exchanges in the Treatment of Rapidly Progressive Glomerulonephritis Associated with Chronic Dental Infection
Authors: Kupari Markku , Teerenhovi Lasse
Published: August 2010

ABSTRACT. A patient is described in whom rapidly progressive, crescentic (in 80 % of the glomeruli) glomerulonephritis was associated with chronic dental infection. Eradication of the infection as the sole form of therapy failed to arrest the rapidly advancing renal failure. Institution of plasma exchanges and immunosuppression was accompanied by an abrupt reversal of the renal function and a remission, which until now has lasted for two years.
HLA Antigens in Two Siblings with Autoimmune Addison's Disease
Authors: Valdemarsson Stig , Hedner Pavo , Löw Bengt
Published: August 2010

ABSTRACT. The diagnosis of autoimmune Addison's disease was established in two siblings by demonstration of serum antibodies against adrenal cortex antigen, elevated P‐ACTH combined with a low P‐cortisol, and the absence of P‐cortisol response to exogenous ACTH. HLA typing in the two siblings and their parents revealed the same HLA phenotype in the two patients. This is compatible with an autosomal recessive mode of inheritance and indicates that a supposed trait for autoimmune Addison's disease may segregate with the HLA complex in the familial form of autoimmune Addison's disease.
A Case of Giant Cell Myocarditis
Authors: Boesen Klaus , Hansen Birgit Fischer
Published: August 2010

ABSTRACT. A rapidly developing fatal case of giant cell myocarditis with unusually extensive and widespread myocardial damage is reported. The etiology of this disease still remains obscure.
Hyponatraemia due to a Thiazide Diuretic
Authors: Husby Steffen , Marthedal Niels Jørgen
Published: August 2010

ABSTRACT. The time course of profound hyponatraemia has been followed in a patient who developed this condition after 6 weeks' treatment with a thiazide diuretic, bendroflumethiazide. The case is related to the syndrome of inappropriate secretion of antidiuretic hormone.
Oesophageal Function and Chest Pain in Male Patients with Recent Acute Myocardial Infarction
Authors: Areskog Magnus , Tibbling Lita
Published: August 2010

ABSTRACT.Oesophageal function and symptoms were investigated in 52 male patients 2–6 months after an acute myocardial infarction. Oesophageal function was tested by manometry, pH recording and acid perfusion test. Signs of oesophageal dysfunction (OD) were found in 17 patients (33%). This frequency did not differ significantly from that in a random male population sample, but was lower than in a group of male coronary care unit patients with no signs of a new or earlier myocardial infarction at discharge from hospital (p> 0.05). All but two patients affirmed chest pain by questionnaire. At a verbal interview, 38 patients (73%) had a history of angina pectoris after discharge from hospital. Thirty‐five (92%) of these patients had an ischaemic ECG reaction and/or recurrence of their anginal chest pain during the exercise test, one of them also had evidence of oesophageal origin of his chest pain. There were no signs of OD in the remaining three patients with a history of angina pectoris. Therefore, OD does not constitute a common problem in the differential diagnosis of anginal chest pain in patients with recent myocardial infarction.
Pre‐Beta1‐Lipoprotein in Patients with Ischemic Heart Disease
Authors: de Faire U. , Dahlén G. , Liljefors I. , Lundman T. , Theorell T.
Published: August 2010

ABSTRACT. The genetic determination of pre‐β1 lipoprotein and its relation to insulin response was studied in 18 male monozygotic and 13 male dizygotic twin pairs, aged 51–74. They had been selected from the Swedish Twin Registry by means of an angina pectoris questionnaire. Results revealed a heritability index for the pre‐β1‐lipoprotein, determined quantitatively, to be as high as 0.94. The subjects in whom pre‐β1‐lipoprotein was present exhibited a significantly delayed early insulin response compared to subjects without this lipoprotein fraction. Our data seem to justify the use of pre‐β1‐lipoprotein as a genetic marker. Data also indicate that important metabolic differences may exist between pre‐β1 + and pre‐β1‐individuals, and it is possible that such differences may explain in part an increased susceptibility to ischemic heart disease for those possessing the pre‐β1 fraction.
A 5‐Year Follow‐up of Young Men with Primary T Wave Aberrations in Their Electrocardiograms
Authors: Atterhög Jan‐Henrik
Published: August 2010

ABSTRACT. Forty‐eight subjects (group T) with primary T wave aberrations in their electrocardiograms (e.g. notches, flattening or inversion in leads II, CR4 and CR7 but without a concomitant ST depression) and 38 controls (group C), examined previously at the age of 18–19 years, were re‐examined after 5.4 and 7.5 years respectively. The incidence of heart disease between the two examinations was lower in group T than in the controls. The T wave aberration had decreased in severity in 22 subjects in group T, but 66% of them still showed T wave aberrations at rest. Only one subject was free from T wave aberrations during orthostasis. Beta‐adrenergic blockade in 27 subjects in group T suggested that 3 possibly had organic genesis to the aberrations. The earlier reported signs of high sympathetic tone in group T had decreased, but a somewhat higher heart rate and diastolic blood pressure than in the controls still remained. The systolic time intervals suggested larger stroke volumes in group T than in the controls and did not indicate decreased myocardial performance in group T. The attenuated differences between groups T and C in T wave abnormality, heart rate and blood pressure over the follow‐up period suggest that T wave abnormality as an isolated finding in young men is a benign finding.
Hypernephroma and Hypertension
Authors: Dahl Trond , Eide Ivar , Fryjordet Arne
Published: August 2010

ABSTRACT. Evaluation for hypertension revealed a hypernephroma in two patients and increased plasma renin concentrations (PRC) of 2.8 and 3.1 GU * 10‐4/ml, respectively. In one of the patients, bilateral renal venous catheterization showed lateralization of PRC toward the tumor side in the ratio 10: 3. She had secondary hyperaldosteronism with a plasma aldosterone concentration (PAC) of 738 pmol/l, and hypokalemia with a serum potassium level of 3.0 mmol/l. In the other patient, who had malignant hypertension, PAC was not measured but serum potassium was subnormal (3.3 mmol/l). After nephrectomy, blood pressure (BP), PRC and serum potassium returned to normal in both as did PAC in one of the patients. At regular follow‐ups through one year after nephrectomy, BP, PRC, PAC and serum potassium remained normal and metastases were not discovered. The increased incidence of hypernephroma in hypertensive patients underscores the importance of acknowledging this possibility during evaluation for hypertension.
Hypertrophic Protein‐Losing Gastritis (Ménétrier's Disease) Treated with Cimetidine
Authors: Vendelboe Mogens , Jespersen Jørgen
Published: August 2010

ABSTRACT. A man aged 46 developed Méné trier's disease with massive hypertrophic gastritis and significantly elevated gastrointestinal protein clearance. During treatment with cimetidine the protein loss decreased markedly and the gastric mucosa normalized.
Skin Lesions in Waldenström's Macroglobulinaemia
Authors: Bergroth Ville , Reitamo Sakari , Konttinen Yrjö T. , Wegelius Otto
Published: August 2010

ABSTRACT. A patient with Waldenström's macroglobulinaemia presenting with numerous red or brownish‐red, round, papulous lesions of the skin is reported. Skin biopsy revealed a massive infiltrate of immature lymphatic cells of the dermis down to the subcutaneous fat. Approximately 80 % of these cells were positive for intracellular IgM and k light chains as shown by the immunoperoxidase method. This finding established the skin lesions as part of Waldenström's macroglobulinaemia.
T Wave Changes after Acute Myocardial Infarction Predicting Reinfarction
Authors: Löfmark Rurik , Orinius Erik
Published: August 2010

ABSTRACT. Of 420 consecutive patients with acute myocardial infarction who survived the coronary care unit period, 57 developed 63 reinfarctions with 16 deaths within three months (reinfarction group). Of the remaining 363 patients, 28 died without evidence of reinfarction during the same observation period and 335 survived. The last ECGs before discharge, or prior to a reinfarction in hospital, of the reinfarction patients were studied and compared with time‐matched ECGs from the 335 survivors without reinfarction. In ECGs without interfering patterns, the slope of the ascending limb of a negative T wave was measured as the angle to the vertical plane (interobserver variation ≤5° in 95%). Of the 63 reinfarctions, 40% had a steeply ascending limb of a negative T wave (T wave angle ≤55° in lead II, ≤35° in CR4 and/or ≤40° in CR7) and a QRS complex without signs of infarction in the same lead (abnormal Q waves or abnormal R wave progression). The same criteria were fulfilled by 6% of the 335 survivors without reinfarction (p > 0.001) and by one of the 28 patients who died without reinfarction. Thus, a steeply ascending limb of a negative T wave in the acute phase of a myocardial infarction heralds a reinfarction if the QRS complex of the same lead does not show signs of infarction (3‐month sensitivity 40 % and predictive value 53%). A T wave angle ≤35° in CR4 corresponds to ≤40° in V4. CR7 is not transferable to V6 but was the least predictive lead.
Pancreas Affection in Association with Enteritis due to Campylobacter Fetus ssp. Jejuni
Authors: Pönkä A. , Kosunen T. U.
Published: August 2010

ABSTRACT. A woman with pancreas affection during diarrhoea due to Campylobacter fetus ssp. jejuni is presented. The patient recovered within 8 days without specific treatment. In addition, 5 other cases with pancreas affection associated with Campylobacter infection are cited.
A Case with Severe Diarrhoea and Strongyloides stereoralis infection
Authors: Moesgaard Flemming , Steven Kenneth , Engbæk Kraesten
Published: August 2010

ABSTRACT. A case with severe diarrhoea and Strongyloides stercoralis infection is described. Further examination showed that the patient also had abnormal colonization of the duodenum with Hafnia alvei and that this disappeared when the Strongyloides infection was treated with mebendazole. Symptoms such as abdominal pain, diarrhoea, “skin rash” and malabsorption in association with blood eosinophilia should arouse suspicion of strongyloidiasis.
An Alternate‐Day Corticosteroid Regimen in Maintenance Therapy of Giant Cell Arteritis
Authors: Bengtsson Bengt‐Åke , Malmvall Bo‐Eric
Published: August 2010

ABSTRACT. It is well established that the side‐effects of corticosteroid treatment can be reduced by administering the steroid on alternate days. Twenty‐seven patients with giant cell arteritis were given daily treatment initially, followed by a gradual transition to alternate‐day treatment. It was possible to maintain 18 (67 %) of 27 patients on this regimen. In 9 (33%) the regimen was abandoned because of clinical symptoms on the “day off”. These patients, however, could be maintained with a single morning dose of the corticosteroid. Morning plasma Cortisol levels on the treatment day were normal in all patients treated with 20 mg prednisolone or less every other day.
The Use of Thallium‐201 Myocardial Scintigraphy for the Diagnosis of Previous Infarction
Authors: Gustafson A. , Stubbe I. , Svensson S.‐E. , Tylén U. , Westling H.
Published: August 2010

ABSTRACT. The ability of thallium‐201 scintigraphy to detect previous infarction (>6 months ago) was studied in 43 patients with coronary artery disease, 39 with valvular heart disease, and 5 with cardiomyopathy or myocarditis. All patients had undergone selective coronary arteriography and left ventricular angiography. Thallium‐201 scintigraphy at rest proved a very sensitive method for detecting previous infarction, also clinically silent. Scintigraphy was more sensitive than a recent ECG. However, scintigraphy can give falsely positive results.
Concurrent Medullary and Papillary Thyroid Carcinoma in the Same Thyroid Lobe and in Siblings
Authors: Lamberg B.‐A. , Reissel P. , Stenman S. , Koivuniemi A. , Ekblom M. , Mäkinen J. , Franssila K.
Published: August 2010

ABSTRACT. Simultaneous occurrence of medullary and papillary thyroid carcinoma in the same gland is obviously extremely rare. One such patient is reported here and two pairs of sibs are described, one with medullary and the other with papillary thyroid carcinoma.
Blood Pressure, Heart Rate and Plasma Albumin in Relatives of Hypertensive Patients
Authors: Ohlsson O. , Henningsen N. C. , Malmquist I.
Published: August 2010

ABSTRACT. A total of 1075 relatives of 106 individuals (probands) with treated essential hypertension and heredity for this disease have been investigated concerning the existence of hypertension. The prevalence of hypertension or hypertensive diseases was near 50%. Of the deceased relatives, 77% had a positive history for hypertension. Of the deceased relatives with cerebrovascular diseases, 52% had expired before 65 years of age. We have examined 307 relatives of these probands. They had significantly higher systolic blood pressure, heart rate and serum albumin concentration than age‐ and sex‐matched controls without heredity for hypertension and a screened population. Screening of relatives belonging to families with a high frequency of hypertension seems to have a potential practical value and may furthermore provide information about the etiology of the disease.
Relief of Osteoporotic Backache with Fluoride, Calcium, and Calciferol
Authors: Grove O. , Halver B.
Published: August 2010

ABSTRACT. In a prospective randomized clinical trial comprising 22 postmenopausal women with backache and a halisteretic spine with crush fracture(s), 12 women completed a 12‐week therapy with sodium fluoride, calcium and calciferol and 10 with placebo. A statistically significant improvement (p > 0.05), evaluated by a four‐stage scale on pains, infirmity, and consumption of analgesics, was observed in the actively treated patients.
Lactic Acidosis during Metformin Treatment in an Elderly Diabetic Patient with Impaired Renal Function
Authors: Hermann L. S. , Magnusson S. , Möller B. , Casey C. , Tucker G. T. , Woods H. F.
Published: August 2010

ABSTRACT. In recent years, lactic acidosis has been described in association with metformin therapy in diabetics. We report a fatal case in an elderly diabetic patient with impaired renal function and cardiac insufficiency. The patient presented with an elevated plasma metformin concentration and a concomitant digitoxin intoxication.
Neurogenic and Psychological Factors in Coronary Heart Disease: an Introductory Overview
Authors: Härtel G.
Published: August 2010

ABSTRACT. Some of the major nervous and psychological factors affecting the functioning of the heart are briefly reviewed. Emphasis is placed on the autonomic nervous system and its response to stressful situations. Possible pathways by which mental processes and behaviour might influence cardiovascular pathology and sudden death are outlined. Differences observed in the pattern of response are emphasized, as are the factors upon which these differences depend. The Type A behaviour pattern is considered and the importance of marital and social support is also discussed.
Beta–Sympathetic Blockade with Chronotropic Compensation in the Management of Heart Disease
Authors: Geddes J. S.
Published: August 2010

ABSTRACT.This presentation briefly describes the sympathetic and parasympathetic control of the heart, particularly in relation to coronary vascular effects. Autonomic disturbances following myocardial infarction and their significance are discussed. The influence of the autonomic system in chronic coronary heart disease is considered, particularly in relation to the beneficial effects which may be obtained by the combined use of beta–blocking drugs and cardiac pacing.

Nine anginal patients with spontaneous or drug–induced bradycardia received temporary pacing and 27 others had pacemakers implanted. Pain was well controlled in the former group. Long term pacing produced worth–while benefit in 67% of the patients followed for periods up to 6 months, the figure falling to 50% among those followed for 24 months. Eight of the 27 relapsed. Thus, correction of bradycardia by pacing often produced a beneficial long term effect.

A second group of 14 patients with ventricular arrhythmias was treated with beta–blocking agents combined with pacing. So far, 10 of these 14 have had their arrhythmias controlled either by the initial or by a modified drug regime.

The results indicate that among patients with chronic coronary artery disease, beta–blockade to minimize cardiac sympathetic activity, coupled with pacing to prevent loss of chronotrophic control, often represents an effective combination for the management of refractory angina or arrhythmias.