bluuebunny/crossref_metadata_2025 huggingface dataset:
Coronary Artery Disease with and without Angina—Two Different Entities?
Authors: Erikssen J. , Thaulow E. , Myhre E.
Published: August 2010

ABSTRACT. Coronary heart disease (CHD), previously neither diagnosed nor suspected, was strongly suspected in 115 of 2014 men aged 40–59 years during a cardiovascular survey examination. Sixty‐nine of 105 men who underwent diagnostic coronary angiography had pathologic angiograms. Twenty‐six of these 69 had angina pectoris (AP) with and without pathologic exercise ECGs and 43 had pathologic exercise ECG as the only indicator of CHD. The extent of coronary artery changes was similar in the two groups. The men without AP were in almost all respects similar to 1832 men labelled as normals. The men with AP differed in several respects from their non‐AP angiographic counterparts and from the normals: they had more dyspepsia, a higher stress score, higher serum cholesterol and triglycerides, lower antithrombin III levels in the blood and lower blood platelet retention values. These results indicate that coronary artery disease with and without AP may represent somewhat different pathogenetic entities.
Urinary Excretion of β‐Hexosaminidase in Patients with Vesico‐Ureteric Reflux
Authors: Hultberg B. , Wieslander J.
Published: August 2010

ABSTRACT. Urinary excretion of β‐hexosaminidase was studied in 50 patients with vesico‐ureteric reflux (VUR) in order to obtain information on the renal injury in this disease. There was no correlation between urinary enzyme excretion and the degree of VUR. Patients without pyelonephritic changes and with normal serum creatinine values showed normal excretion of β‐hexosaminidase. Patients with pyelonephritic changes but normal serum creatinine had enzyme activity towards the upper limit of the normal range whilst patients with pyelonephritic changes and decreased renal function (high serum creatinine) showed increased excretion of urinary β‐hexosaminidase. Some of the patients with VUR and asymptomatic bacteriuria exhibited increased excretion of urinary β‐hexosaminidase and six with acute pyelonephritis had very high levels. These findings indicate that the infective process plays an essential role, besides VUR, in the development of kidney damage.
Smoking and Circulating IgE in Bronchial Carcinoma
Authors: Hällgren Roger , N⊚u Enn , Arrendal Hans , Hiesche Klaus
Published: August 2010

ABSTRACT. The serum concentrations of total IgE were significantly raised in smokers compared to those who had never smoked (p<0.005) among male patients with bronchial carcinoma, while no differences were found between smoking and non‐smoking female bronchial carcinoma patients. The total IgE levels in male and female patients with non‐malignant pulmonary diseases were not correlated to smoking habits. No significant differences in the IgE levels were observed between smoking males sub‐grouped according to the WHO histological types of bronchial carcinoma. Males with carcinoma who had stopped smoking more than 10 years ago had significantly reduced IgE levels compared to male cancer patients continously smoking (p<0.01). These data, indicating that smoking is associated with elevated IgE levels in males with bronchial carcinoma, might suggest that smoking in certain, preferably male, individuals induces an impaired cellular immunity which is reflected by an enhanced IgE synthesis and a depressed resistance to carcinogens of tobacco smoke.
Time Course Effect of Thyroxine on Serum Lipoprotein Concentrations in Hypothyroid Subjects
Authors: Hylander B. , Rosenqvist U.
Published: August 2010

ABSTRACT. In order to analyse the time course effect of thyroxine replacement therapy on lipo‐protein concentrations, 12 hypothyroid subjects were studied before and repeatedly during therapy. The substitution dose was increased gradually every fourth week until the plasma level of TSH became normal. The concentrations of cholesterol and tri‐glycerides were anlysed in whole serum and in the three major lipoprotein fractions VLDL, LDL and HDL. The main abnormality before treatment was an increased LDL cholesterol concentration. Normalization of serum LDL was established at a dose level which normalized TSH. The onset of the effect of thyroxine on LDL cholesterol was rapid and could be noted already after two weeks.
On the Pathogenesis of Acquired Hypo‐β‐Lipoproteinemia
Authors: Bjerve Kristian S. , Evensen Stein A. , Stray‐Pedersen Sverre , Skrede Sverre
Published: August 2010

ABSTRACT. A 71‐year‐old previously hypercholes‐terolemic woman developed gradually severe hypocholesterolemia of 1.55 mmol/I. Simultaneously she developed progressive sideroblastic anemia, altered erythrocyte morphology and defective platelet function. Hypo‐β‐lipoproteinemia was demonstrated with abnormal lipid composition of both very low density (VLDL), low density (LDL) and high density lipoprotein (HDL) fractions. Other plasma lipids, as well as erythrocyte lipids, were normal. The fractional catabolic rate of homologous 123I‐LDL was increased to 4–5‐fold, while its rate of synthesis was normal. The patient's serum contained autoantibodies directed against LDL. It is concluded that her hypo‐β‐lipoproteinemia was due to autoantibodies towards LDL causing an increased catabolism without any concomitant effect on the rate of LDL synthesis. It is suggested that acquired hypo‐β‐lipo‐proteinemia can be subdivided into two types, one in which the primary defect is an increased catabolism due to immunoelimination, and another in which the primary defect is a decreased rate of LDL synthesis.
Nephrocalcinosis in Angioimmunoblastic Lymphadenopathy
Authors: Søgaard Poul Erik , Molin Jeanne
Published: August 2010

ABSTRACT. We report a patient with angioimmunoblastic lymphadenopathy (AIBL) in whom hypercalcaemia developed due to production of parathyroid hormone from the lymph glands. He died because it was not possible to control his disease and because of uraemia due to nephrocalcinosis. It is recommended to control the level of calcium in AIBL.
Urinary Cyclic AMP Corrected for Glomerular Filtration Rate in the Differential Diagnosis of Hypercalcemia
Authors: Tørring O. , Cavallin M. , Löw H. , Werner S.
Published: August 2010

ABSTRACT. To evaluate the usefulness of urinary cyclic AMP (U‐cAMP) expressed as nmol/100 ml glomerulus filtrate (GF) when discriminating various hypercalcemic states, we studied 99 patients. Patients with primary hyperparathyroidism (PHPT) showed a positive correlation between individual S‐calcium levels and U‐cAMP, nmol/100 ml GF (females r=0.49, n=40, p<0.01 and males r=0.91, n=7, p<0.001). There was also a correlation between U‐cAMP, nmol/100 ml GF, and the weight of the adenomas (females r=0.36, n=32, p<0.05 and males r=0.79, n=6, p<0.05). Patients with PHPT and normal renal function excreted more U‐cAMP than controls, 6.0±1.6 versus 4.3±1.0 nmol/100 ml GF (mean± SD). Of 47 patients with PHPT and normal renal function, 29 showed values below the upper normal limit, 6.3 nmol/100 ml GF (mean±2 SD), of the control group; the overlap was 62%. When U‐cAMP was expressed as μmol/24 hours, the overlap was 40/47 (85%) and, when expressed as μmol/g creatinine, 31/47 (66%). Three patients with sarcoidosis and two with malignancies and hypercalcemia showed excretory values of U‐cAMP, nmol/100 ml GF, above the upper normal limit. Patients with acromegaly or prolactinoma showed normal values of U‐cAMP, nmol/100 ml GF. The present data indicate that all three types of determinations of urinary cAMP based on 24 hour urine collections are of little value in the differential diagnosis of hypercalcemic states.
Dietary Therapy in Diabetes Mellitus
Authors: Huttunen Jussi K. , Aro Antti , Pelkonen Risto , Puomio Marja , Siltanen Irmeli , Åkerblom Hans K.
Published: August 2010

ABSTRACT. This paper contains the description of a recommendation for dietary therapy in diabetes mellitus prepared by the Finnish Diabetes Association's Committee on Dietary Therapy in 1980.
Selective Serum IgA Deficiency in Icelanders
Authors: Úlfarsson Jakob , Guomundsson Sigurör , BirgisdÓAttir Birgitta , Kjeld J. Matthias , Jensson ÓAlafur
Published: August 2010

ABSTRACT. More than 15000 Icelanders (6.1% of the population), mostly healthy male blood donors, were screened in 1974–79 for selective IgA deficiency (SIgAD) by immunodiffusion (Ouchterlony). The frequency of SIgAD among blood donors was 1/633 (0.158%). Population and family screening yielded 35 individuals classified as IgA‐deficient. Immunoglobulins A, G, M and E were measured in 119 family members of 18 propositi found by screening. Pedigree studies suggested both autosomal dominant and recessive modes of inheritance of SIgAD. A trend towards clustering of similar IgG and IgE levels (within the normal ranges) was apparent in several families. An increased IgG level in family members with SIgAD was significantly more frequent (p<0.001) than in members with normal levels of IgA. IgG levels were high in 12 (44%) and normal in 15 of 27 subjects with low or deficient IgA levels who were all healthy when examined, and only 5 gave a history of allergy or recurrent respiratory infections. It is suggested that immune response genes may cause the difference in Ig levels among the SIgAD family members.
Platelet Activation in Response to Phlebotomy
Authors: Eriksson Karl‐Axel , Sigvaldason Andrés , Lindholm Annika , Safai‐Kutti Soodabeh , Kutti Jack
Published: August 2010

ABSTRACT. Plasma concentrations of β‐thromboglobulin (BTG) and platelet factor 4 (PF4) were measured in three consecutive blood samples from 29 healthy male blood donors. The first sample was collected after 15 min of rest, the second immediately after a phlebotomy of 450 ml blood and the third after a further 15 min of rest. The mean baseline plasma BTG and PF4 values were 68 × 5 and 13.8 ± 0.7 ng/ml, respectively. The second sample's mean plasma values of these two platelet‐specific proteins were significantly higher (88 ± 9 and 24.1 ± 4.1 ng/ml, respectively). The plasma concentrations of BTG and PF4 in the last sample, however, had returned to baseline levels. It is concluded that significant but short‐lasting platelet activation and secretion take place in healthy subjects in response to an acute but comparatively mild blood loss even though the platelets do not participate in the process of hemostasia.
Results of Attempted Cardiopulmonary Resuscitation of Patients Dying Suddenly outside the Hospital in Reykjavik and the Surrounding Area, 1976–1979
Authors: Gudjonsson Hallgrimur , Baldvinsson Einar , Oddsson Gudmundur , Asgeirsson Eggert , Kristjansson Haukur , Hardarson Thordur
Published: August 2010

ABSTRACT. Cardiopulmonary resuscitation (CPR) was attempted in 222 cases of sudden death at the City Hospital, Reykjavik, during 1976–79. Of the 68 patients (31%) successfully resuscitated, 47 died in the hospital and 21 (9%) were discharged, 17 in good mental and physical condition. The mean combined response and transport time was 12.1 min and the ambulance mean time of response 7.3 min. The first ECG revealed considerable prognostic indications. Of the 90 patients who had ventricular fibrillation on admission, 42 (47%) were successfully resuscitated and 18 (20%) were subsequently discharged. Among 114 patients with asystole, resuscitation was successful in 23 (20%) and two (2%) were discharged. Immediate first aid in situ had a definite prognostic influence. These results compare favourably with those obtained elsewhere where the organization of first aid and emergency transport is similar. They do not, however, match the results achieved by fully specialized resuscitation teams trained to operate outside the hospital. Results of CPR of patients with cardiac arrest out of hospital in Reykjavik show increasing improvement over the years. This may be partly explained by a considerable public debate on this issue in 1978 and subsequent streamlining of activities.
Successful Treatment of Hemolytic Uremic Syndrome and Thrombotic Thrombocytopenic Purpura with Fresh Frozen Plasma and Plasma Exchange
Authors: Thysell Hans , Oxelius Vivi‐Anne , Norlin Margareta
Published: August 2010

ABSTRACT. Four patients with hemolytic uremic syndrome (HUS) and seven with thrombotic thrombocytopenic purpura (TTP) were treated with infusions of fresh frozen plasma (FFP). In one patient with HUS and Ave patients with TTP this treatment was combined with plasma exchange (PE). The additional treatment varied; corticosteroids, antiplatelet drugs, heparin and blood exchange. All but one patient recovered completely in spite of severe illness with uremia, oliguria and/or cerebral symptoms during the acute phase. The results were surprisingly good in comparison with other published series. The success must in the first place be attributed to early diagnosis and to the infusions of FFP. PE seemed to potentiate the effect of FFP.
Incidence and Prognosis of Ischemic Heart Disease with Respect to Geographical Area
Authors: Romo Matti , Koskenvuo Markku , Kaprio Jaakko , Langinvainio Heimo , Pulkkinen Pekka
Published: August 2010

ABSTRACT. Ischemic heart disease is more common in East Finland than in West Finland, but systematic comparison and follow‐up of incidence figures have not been possible. In 1972 the personal identification number became included in the hospital discharge records, which made it possible to link death certificate data with hospital records from the whole country. The results of this study suggest that high mortality from IHD in some regions is more closely associated with high incidence than a high fatality rate. The proportion of deaths outside hospitals showed large variation by province but this had rather little effect on the total one‐year survival rates.
Antiarrhythmic Efficacy of Amiodarone in Recurrent Ventricular Tachycardia Evaluated by Multiple Electrophysiological and Ambulatory ECG Recordings
Authors: Rasmussen K. , Winkle R. , Ross D. , Griffin J. , Peters F. , Mason J.
Published: August 2010

ABSTRACT. Thirty‐three patients with recurrent drug‐refractory ventricular tachycardia were treated with oral amiodarone during an average period of 6.1 months. In‐hospital monitoring for two weeks or more, electrophysiological tests and ambulatory ECG were used to evaluate the results. Twenty patients are still using the drug with complete control of the arrhythmia. Eleven have failed the drug, ten due to recurrence of documented ventricular tachycardia. Only three patients failed after the first month of therapy. Two patients died, one suddenly. The drug was dicontinued in a further two patients due to side‐effects. Other side‐effects were tolerable or manageable by dose adjustments alone. Five patients showed evidence of inadequate arrhythmia control between days 15 and 32 of therapy but subsequently responded to the drug for 4–9 months, giving further support to the concept that in some patients at least 30 days of therapy is necessary for the full effect of the drug to appear. In 16 of the 20 patients tested by arrhythmia induction study while on the drug, ventricular tachycardia could still be induced. Seven (44%) of these eventually failed the drug. Arrhythmia recurred in one of those four in whom tachycardia could not be induced. Amiodarone is a valuable drug in the management of recurrent ventricular tachycardia, refractory to other antiarrhythmic drugs.
Preleukemic Syndrome Simulating SLE
Authors: Saxne Tore , Turesson Ingemar , Wollheim Frank A.
Published: August 2010

ABSTRACT. A 70‐year‐old man presented with symmetrical arthritis and arthralgias, Raynaud's phenomenon, pleurisy, fever, maeulopapular erythema, leuko‐ and thrombocytopenia, anemia, anti‐nuclear antibodies and hypocomplementemia. His bone marrow morphology was normal. During therapy with corticosteroids he developed pulmonary tuberculosis which responded well to tuberculostatic treatment. Approximately one year after onset of his initial symptoms, myeloblasts were seen in the blood and a few weeks later the bone marrow showed a myeloblastic leukemia. The patient did not respond to cytostatic treatment and died six weeks later. Although this patient presented symptoms suggesting the diagnosis of SLE, in retrospect his condition probably represented an unusual type of preleukemic syndrome.
Glycosaminoglycan Synthesis by Human Diabetic, Normal Adult, and Embryonic Fibroblasts in Relation to Insulin Levels
Authors: Kjellström Thomas
Published: August 2010

ABSTRACT. Sulfated glycosaminoglycan synthesis by human diabetic, non‐diabetic, and embryonic cells was studied. No effect of insulin on net synthesis was noted. Thus, the data do not indicate a role for total sulfated glycosaminoglycan production in the diabetic connective tissue disturbance mediated by insulin.
The Effect of Spironolactone on Lipid, Glucose and Uric Acid Levels in Blood during Long‐Term Administration to Hypertensives
Authors: Falch D. K. , Schreiner A.
Published: August 2010

Spironolactone, an aldosterone antagonist, was given in a daily dose of 100 mg to 15 patients with primary hypertension for one year. Fasting levels of lipids, uric acid, glucose, insulin, potassium and growth hormone were measured before and after 6 and 12 months of treatment. Total cholesterol, LDL cholesterol, glucose, potassium and growth hormone were unchanged, HDL cholesterol fell from (mean±SD) 1.5±0.6 to 1.1 ±0.3 mmol/l (p<0.05) after 6 months of treatment and remained lowered (1.0 ±0.3 mmol/l) (p<0.01) after 12 months of treatment. There was a transient fall after 6 months of treatment in triglycerides from 2.4±1.5 to 2.0±1.1 mmol/l (p < 0.05), uric acid from 380±73 to 342±58 μmol/l (p<0.05) and an increase in insulin from 16±9.5 to 28.6±26.8 mU/l (p<0.05). The blood glucose curves above fasting levels after glucose loading were unchanged during spironolactone treatment, whereas the area under the net insulin curve was higher after 6 months of treatment (163±103 mU · h/l) than before treatment (105±71 mU·h/l), indicating a small and transient insulin resistance. Thus, spironolactone impaired the glucose tolerance transiently and gave small and almost transient changes in fasting serum lipid and uric acid levels.
Is Glucose Intolerance after Pancreatitis Related to Pancreatic Tissue Damage?
Authors: Seligson U. , Cho J.‐W. , Nygren A. , Reichard P.
Published: August 2010

Endoscopic retrograde pancreatography (ERP) was performed in 48 patients who had been hospitalized for pancreatitis. The findings were related to results of oral glucose tolerance tests. Patients with gross changes at ERP tended to have latent or manifest diabetes. In patients with latent or manifest diabetes, the increase in C‐peptide after oral glucose was lower than in healthy subjects, while insulin sensitivity, estimated with euglycemic insulin clamp technique, was within the same range as in healthy subjects. It is concluded that gross changes of the pancreatic ducts after pancreatitis are often accompanied by widespread tissue damage leading to deficient B‐cell function and decreased glucose tolerance.
An Unnecessary Case of Paraffin Oil Pneumonia
Authors: Blöndal Thorstein , Hartvig Per , Bengtsson Allan , Wilander Erik
Published: August 2010

ABSTRACT A 64‐year‐old woman died after 12 years of progressive pulmonary disease which was initially diagnosed as sarcoidosis but later correctly identified as mineral oil pneumonia due to insufflation of paraffin instilled as nasal drops. In view of the potential damaging effect of liquid paraffin on the lungs, the current indications for its use must be strongly questioned.
Serum Creatine Kinase Isoenzymes in Patients with Advanced Malignant Disease
Authors: Ström Stellan , Bendz Rutger
Published: August 2010

ABSTRACT Serum creatine kinase (CK) B subunit (CK‐B) activity, as estimated by the enzymatic anti‐M immunoinhibition method, and the CK isoenzyme pattern after agarose gel electrophoresis, were studied in 28 patients with advanced, untreated malignant disease. CK‐B was above the decision limit, i.e. the discrimination limit used in the diagnosis of acute myocardial infarction (AMI), in 14 patients (50%). Electrophoresis demonstrated, besides CK‐MM, an atypical, cathodically migrating CK band in 10 of these patients. This band may represent mitochondrial CK. The CK‐BB isoenzyme was detected in 9 and CK‐MB in 3 subjects. Histopathologic findings indicated that the occurrence of these isoenzymes was related to tumour burden and the overall severity of the disease. Survival among patients with CK‐B elevation was shorter than among other patients. The present findings are relevant to the enzyme diagnosis of AMI and of potential significance for the evaluation of patients with known or suspected malignant tumours.
Prognostic Factors and Retinopathy in Type 1 Diabetics in Iceland
Authors: Danielsen R. , Helgason T. , Jónasson F.
Published: August 2010

ABSTRACT Prognostic factors, particularly those related to metabolic control, were analysed individually over a period of 12 months prior to fundus photography in 149 type 1 (insulin‐dependent, ketosis‐prone) diabetics in Iceland. Patients without retinopathy in their first 20 years of diabetes visited the Diabetic Clinic significantly more frequently than those with retinopathy (p<0.05). Mean blood sugar values and mean per cent body weight did not differ between patients with or without retinopathy. Few patients were obese. In patients with 5–9 years' duration of diabetes, retinopathy was first seen after 7.7±0.3 years (mean ± SEM). Those with retinopathy were significantly older at the time of the diagnosis of diabetes than those without eye lesions (p<0.025), a tendency also noted in those with 10–19 years' duration (p<0.10). Conversely, patients without retinopathy after diabetes for 20 years or more were significantly older at the time of diagnosis (p<0.02). They used significantly less insulin daily than those with retinal lesions (p<0.005) and 70 % were females. Subsequently, a significant (p<0.047) male excess was found to characterize a group of patients with proliferative retinopathy.
Altered Prednisolone Pharmacokinetics in Patients Treated with Rifampicin
Authors: Bergrem Harald , Refvem Olav Kåre
Published: August 2010

ABSTRACT The pharmacokinetics and protein binding of prednisolone were studied in 7 patients before and after 3 weeks of rifampicin therapy. The elimination half‐time for prednisolone decreased by 45±8.1% (p<0.01), and the total body clearance of prednisolone increased by 91±26% (p<0.01). The area under the time‐concentration curve (AUC) of total (free plus protein‐bound) prednisolone decreased by 48±7.3% (p<0.01) and of free, unbound prednisolone by 57±9.8% (p<0.01). The reduction in AUC was greater for free than for total prednisolone (p<0.05) mainly due to the non‐linear nature of prednisolone protein binding. There was no significant change in the volume of distribution. Because of the marked reduction in total and especially free prednisolone, the dosage should be adjusted accordingly if prednisolone and rifampicin are prescribed concomitantly.
Haemodynamic and Metabolic Effects of Timolol (Blocadren®) on Ischaemic Myocardium
Authors: Simonsen S. , Ihlen H. , Kjekshus J. K.
Published: August 2010

ABSTRACT The effects of timolol (2.5 mg i.v.) on coronary haemodynamics and myocardial metabolism were studied in 26 patients with angina pectoris. Cardiac venous flow (CVF) was measured by thermodilution technique. Blood was sampled for metabolic studies. Angina pectoris was induced by atrial pacing and the same heart rate was regained after timolol. Metabolic ischaemia was defined as reduction in myocardial lactate extraction ratio (MLE) by at least 50% and to a ratio below 0.15. The study was completed in 22 patients, 9 of whom fulfilled the metabolic criteria for ischaemia. This subgroup did not differ from the total group in any other respect than in lactate metabolism. Beta‐adrenergic blockade reduced myocardial oxygen consumption (MVO2) and CVF significantly at rest, but MVO2, CVF, myocardial glucose uptake and MLE were unchanged during pacing despite a decrease in systolic aortic pressure, ejection time and reduced myocardial free fatty acid uptake. Conclusively, timolol did not reduce MVO2 and metabolic ischaemia during pacing‐induced angina.
Description of the Degree and Goodness of Blood Glucose Control in Diabetics and Normal Subjects
Authors: Sestoft Leif , Vølund Aage
Published: August 2010

ABSTRACT. The need for a comprehensive description of blood glucose control on the basis of blood glucose measurement has dramatically increased with the improved methods for blood glucose monitoring and the new devices for blood glucose regulation in diabetics. Blood glucose concentrations measured at approximately equidistant sampling times over a number of consecutive 24‐hour periods were analysed by a computerized method for time series analysis. This enabled an exhaustive, though simple description of the blood glucose variation based upon linear correlations between successive measured values and values measured with 24 hours interval. The method describes the day to day variation in blood glucose control as well as the blood glucose oscillations within the day. This information may be used to define in particular patients, patient groups and in normals the “degree of blood glucose control” which is the quantitative measure of the strength of the linear correlations mentioned above. Quantitative measures of the deviations in blood glucose control in patients from that found under comparable conditions in normal subjects then define the “goodness of blood glucose control”. These methods have been used for an evaluation of the blood glucose control in 10 normal subjects and in 8 type 1 diabetics treated with porcine insulin during one period and with human insulin during another period. Regimes with human and porcine insulin resulted in the same degree of control in the diabetics. The correlations which define the degree of blood glucose control were, on an average, of the same magnitude in the diabetics as in the normal controls. The “goodness of blood glucose control” in terms of mean blood glucose level and the unpredictable blood glucose variation was clearly inferior in the patients compared to the normals. However, a precise definition requires further experience with the method on diabetic patients.
Diabetes—the Cost of Illness and the Cost of Control
Authors: JÖnsson Bengt
Published: August 2010

ABSTRACT. This study estimates the economic cost of diabetes mellitus in Sweden 1978. It also addresses the question of potential savings from improved metabolic control. Economic costs of illness include direct costs for medical care and indirect costs from lost production due to morbidity and premature death. The total costs of diabetes are estimated at 1300 million SEK in Sweden 1978. The direct costs for medical care accounted for 43% of these costs. Lost production due to permanent disability is the dominating indirect costs, and accounts for 60% of indirect costs and one third of the total costs. Institutional care accounts for two thirds of the direct costs. The costs for drugs and medical devices amount to 128 million SEK or 1000 SEK per insulin‐ or oraldependent diabetic. Costs for control of diabetes are estimated to 20% of the total cost and 50% of direct costs. The conclusion is that there are great potential benefits to be expected from improved self control of diabetes.
Insulin Sensitivity and Responsiveness in Vitro and in Vivo
Authors: Lager Ibe , LÖnnroth Peter
Published: August 2010

ABSTRACT. Insulin resistance is evident in several clinical conditions such as obesity, diabetes type II, hypercortisolism. The mechanisms behind this resistance at the level of the target cell can be evaluated with measurements of insulin sensitivity with techniques both in vitro and in vivo. In this review various techniques used to evaluate insulin action are discussed and also some clinical conditions associated with insulin resistance.
Human Insulin
Authors: Heding Lise G.
Published: August 2010

ABSTRACT. Recently an improved process for the production of human insulin from porcine insulin has been described. After being characterized, this insulin has been tested and shown to be safe and effective in diabetics in a short‐term, double‐blind, cross‐over study. The availability of sufficient quantities of this human insulin now permits short‐ and long‐term clinical investigations of the possible benefits of human insulin in the treatment of diabetics.
The Glucose Sensor
Authors: Engkjær Christensen Stig , Schmitz Ole , Hansen Aage Prange , ørskov Hans
Published: August 2010

ABSTRACT. This review goes through the development of the glucose‐controlled insulin infusion systems. The closed‐loop system, Biostator®, is described with discussion of demands on technique and function. It deals with the applicability of the glucose sensor in normalizing the diabetic mal‐metabolism and selection of any glucose control wanted in experimental situations. The role of the glucose‐sensor in clinical use and as a research tool are discussed.
Clonidine Twice Daily in Hypertension
Authors: LILJA MAUNO , HUIKURI HEIKKI , JOUNELA ANTTI J. , JUUSTILA HEIKKI J. , PAALZOW GUDRUN
Published: August 2010

ABSTRACT. The effects of two b.i.d. dosing schedules of clonidine on blood pressure, side‐effects and plasma concentration of clonidine were studied in a randomized cross‐over study. The blood pressures of 10 hypertensive inpatients on diuretic treatment were recorded every 3–4 hours throughout the study. A twice‐daily regimen with 0.075 mg clonidine administered at 8 a.m. and 0.15 mg at 10 p.m. resulted in a wider fluctuation of blood pressure than the same doses given at 8 a.m. and 4 p.m. The most conspicuous finding was the significant rise (p<0.001) of diastolic blood pressure at 8 p.m., when clonidine was given at 8 a.m. and 10 p.m. The overall mean values of supine systolic and diastolic blood pressures were normotensive and did not differ from each other in the two dosing schedules. There were no obvious differences in subjective side‐effects between the two regimens. Predose clonidine concentrations varied interindividually between 0.15 and 1.12 ng/ml, but the fluctuation in one and the same subject was small and related to dose and its timing. Thus, twice‐daily dosing of clonidine seems to result in a satisfactory blood pressure reduction. Fluctuation of blood pressure is greater when the evening dose is given at 10 p.m.
Long‐term Insulin‐dependent Diabetes Mellitus with Secondary Pituitary Insufficiency and Regression of Retinopathy
Authors: BLIDDAL HENNING , THORSTEINSSON BIRGER , MUNKGAARD STIG
Published: August 2010

ABSTRACT. Three women with insulin‐dependent diabetes mellitus (IDDM) from childhood and early development of diabetic retiaopathy are described. Insulin requirement was reduced to 5–12 IU daily in all three after relatively uncomplicated births and all had very brittle diabetes on this dosage. At re‐examination 16–22 years after these births and after 34–42 years of IDDM, regression of retinopathy was observed in two patients, while the third had a light retinopathy at the same level as initially. Other diabetic complications were few and none of the patients had nephropathy. Pituitary examination revealed incomplete hypopituitarism in all cases, human growth hormone (HGH) being the sole common factor lacking. These findings and a review of four similar cases reported previously lend some support to the hypothesis of HGH as a possible pathogenetic co‐determinant in the development of diabetic retinopathy.
Residual C‐Peptide Production in Type I Diabetes Mellitus: A Comparison of Different Methods of Assessment and Influence on Glucose Control
Authors: SJÖBERG STEFAN , GUNNARSSON ROLF , ÖSTMAN JAN
Published: August 2010

ABSTRACT. The aims of the present study were to compare various methods for assessment of residual insulin production and to evaluate its role in the metabolic regulation in insulin‐dependent, type I diabetes mellitus. Glycosylated hemoglobin (HbA1) was used as a measure of the long‐term glycemic control. Twenty‐eight patients with type I diabetes mellitus with onset before the age of 30 and with a duration of less than 6 years were studied. C‐peptide in plasma in the fasting state, after glucagon stimulation, and the 24‐hour urinary excretion were measured. Fasting plasma C‐peptide was detected in 61%, and 39% showed a significant rise after glucagon stimulation. The increment correlated negatively with HbA1 (rs=‐0.57, p<0.001), as did the 24‐hour urinary excretion (rs=‐0.61, p<0.001). The 16 patients with urinary C‐peptide values of at least 1 nmol had a mean HbAa of 8.9+0.3 %, as opposed to 11.6+0.5% for those excreting less (p<0.001). Measurement of the 24‐hour urinary excretion of C‐peptide provides a reliable method for evaluating residual insulin secretion.
THE SIGNIFICANCE OP SYSTOLIC. HYPERTENSION IN THE 1897‐POPULATION IN GLOSTRUP
Authors: Agner E. , Mørck H. I.
Published: August 2010

The predictive value of a high diastolic or systolic blood pressure for presence or development of cardiovascular disease diminishes with age. In the present 10‐year prospective study of 70‐year‐olds a Cox regression analysis for competing risk markers for cardiovascular events in the eighth decade was carried out. This analysis showed that neither high diastolic nor high systolic blood pressure had individual predictive value for death from cardiovascular diseases. Concerning development of cardiovascular diseases, however, high systolic blood pressure had individual predictive value in both sexes.
No Liver 99Tc‐tin‐colloid Uptake in Primary Sclerosing Cholangitis
Authors: ANDERSEN SÖREN PAULIN , RASK HENRIK , STÖCKEL MIKAEL , HAUGE PETER
Published: August 2010

Abstract A 99Tc‐tin‐colloid scintigraphy showed no uptake of the radiopharmaceutical in the liver of a patient with jaundice. The diagnosis was later established as primary sclerosing cholangitis
Effects of Human Interferon Preparations on Neutrophil Function
Authors: UDÉN ANN‐MARI , HAFSTRÖM INGIÄLD , PALMBLAD JAN , ENGSTEDT LARS
Published: August 2010

Abstract We have studied effects of two partially purified human leukocyte (α) interferon (IFN) preparations (PIF‐A and PIF‐B) and a highly purified fibroblast (β) IFN on the functional activity of normal human neutrophils (PMNs). In vitro, PIF‐B conferred a significant and dose‐dependent enhancement of chemiluminescence (CL) induced both by phagocytosis and a soluble stimulus, f‐Met‐Leu‐Phe, and decreased killing of Staph aureus. In contrast, PIF‐A caused only a slight inhibition of bactericidal activity and had no effects on CL. β‐IFN had no effects on either bactericidal activity or CL. Migration under agarose was decreased with all of the IFN but phagocytosis and release of enzymes was not affected. PMNs from seven patients treated with PIF‐A for multiple myeloma exhibited increased CL responses but no other PMN functions were affected. The findings that human IFN preparations affect PMN functions indicate that high‐dose IFN therapy of immunocompromised patients should be carefully evaluated for the possibility of increased infectious complications.
Clinically Suspected Severe Ischaemia‐induced Mitral Regurgitation
Authors: EGEBLAD HENRIK , BERNING JENS
Published: August 2010

Abstract Eighteen patients with clinical signs suggesting severe mitral regurgitation secondary to ischaemic heart disease were assessed by echocardiography. Non‐ischaemic diseases needing specific therapy were revealed in six patients. In the other 12 patients echocardiography demonstrated myocardial lesions explaining the mitral regurgitation. Apart from the distinction between non‐ischaemic conditions and lesions induced by ischaemia, echocardiography seems to be helpful in the demonstration of severe yet operable mitral valve regurgitation due to a small ischaemic lesion. Such cases are opposed to functional mitral regurgitation caused by extensive myocardial injury as demonstrated by two‐dimensional echocardiography and reflected by a minimum mitral valve/septum separation of more than 2 1/2 cm on the M‐mode echocardiogram. These conditions make symptomatic improvement by mitral valve surgery unlikely and carry an extremely high operative mortality. A more precise definition by heart catheterization is required when serious clinical heart failure is not explained by the echocardiographic finding of severe global myocardial impairment.
Raynaud's Phenomenon Progressing to Gangrene after Vincristine and Bleomycin Therapy
Authors: ELOMAA INKERI , PAJUNEN MARJO , VIRKKUNEN PEKKA
Published: August 2010

Abstract Vascular symptoms after vinca‐alcaloids and bleomycin are known. We report a 50‐year‐old woman who was cigarette smoker and who had had the syndrome of Raynaud's phenomenon for two years before she developed non‐Hodgkin lymphoma. She was treated with chemotherapy including vincristine and bleomycin. Immediately after the second course of chemotherapy she had severe vertigo, nystagmus, dysarthria and dysphagia. The fingers remained cyanotic and became extremely painful despite stellatum blockade, intra‐arterial vasodilators and thoracic sympathectomy. Two digits of the left hand were partially amputated because of gangrenous areas on the fingertips. The cerebral symptoms disappeared.
Smoking Habits and Prevalence of Clinical Diabetic Microangiopathy in Insulin‐Dependent Diabetics
Authors: TELMER S. , CHRISTIANSEN J. SANDAHL , ANDERSEN A. R. , NERUP J. , DECKERT T.
Published: August 2010

ABSTRACT All patients having insulin‐dependent diabetes with onset before 30 years of age and a duration of disease of 12–40 years who visited a diabetes centre within one year were registered. 97% (n=668) answered a WHO questionnaire on cigarette smoking. The smoking habits were compared to the frequency of proliferative retinopathy and/or diabetic nephropathy (persistent proteinuria). The prevalence of diabetic nephropathy was significantly higher among heavy smokers (>10 cigarettes a day for more than one year) than among non‐heavy smokers, 19.2% versus 12.1% (p<0.02). An increasing frequency of nephropathy was found with increasing cigarette consumption (p<0.01). No difference in the prevalence of proliferative retinopathy was found between smokers and non‐smokers. It is concluded that cigarette smoking is a risk factor for the development of nephropathy in insulin‐dependent diabetics.
Hematogenous Candida Spondylitis
Authors: POHJOLA‐SINTONEN S. , RUUTU P. , TALLROTH K.
Published: August 2010

ABSTRACT A 58‐year‐old patient with neutropenia due to SLE developed spondylitis of the lumbar region caused by Candida albicans. The spondylitis was probably superinfected with Staphylococcus aureus. The initial one month's intravenous combination therapy with amphotericin B and flucytosine was discontinued because of fever reactions to amphotericin B, suspected myelosuppressive effect of flucytosine and insufficient clinical response. This therapy was followed by four months of oral ketoconazole and clindamycin with good results and without any side‐effects.
Pulmonary Function in Patients with Endobronchial Sarcoidosis
Authors: STJERNBERG NILS , THUNELL MARTIN
Published: August 2010

ABSTRACTSixty‐four patients with clinically, radiologically and histopathologically established sarcoidosis were studied by bronchoscopy and static and dynamic spirometry. Sarcoid bronchostenosis was established by bronchoscopy in nine patients. Twenty‐one had bronchial sarcoidosis without stenosis and 34 had no evidence of bronchial sarcoidosis. Patients with sarcoid bronchostenosis showed a marked impairment of lung function, mostly with an obstructive pattern. There was no improvement in lung function after bronchodilatation in these patients. Obstructive spirometry pattern was also found in three patients with bronchial sarcoidosis stage II without stenosis. None of the patients without bronchial sarcoidosis had an obstructive pattern. All six patients with restrictive spirometry pattern in the two groups without bronchostenosis had stage II sarcoidosis. At follow‐up, lung function had improved in five patients, four with sarcoid bronchostenosis and one patient with stage II without bronchial sarcoidosis. Four of these patients were treated with oral corticosteroids. When clinical signs of airway obstruction are present in patients with sarcoidosis, bronchial sarcoidosis with or without bronchostenosis should be suspected. When bronchial sarcoidosis is present, oral corticosteroid treatment should be tried.
Polymorphism of Complement C3 in Chronic Inflammatory Bowel Disease
Authors: ELMGREEN JENS , SØRENSEN HENNING , BERKOWICZ ADELA
Published: August 2010

ABSTRACT Polymorphism of the third component of complement (C3), occupying a key position in cascade reactions, was investigated in 125 consecutive outpatients, 53 with Crohn's disease and 72 with ulcerative colitis. A sample of 1378 randomly selected healthy volunteers of Danish origin served as controls. Occurrence of the F and FS phenotype of C3 (C3F and C3FS) was increased in the group of Crohn's disease patients (χ2=2.80, p<0.05, one‐tailed test) and in a subgroup of Crohn patients with the gastrointestinal disease process confined to ileum (χ2=6.91, p<0.01). C3 phenotype distribution was unaffected in ulcerative colitis. Only S and F alleles of C3 (C3S and C3F) were recognized and C3F frequencies were 0.33 in Crohn patients with small bowel disease, 0.23 in all Crohn patients, 0.18 in ulcerative colitis patients and 0.17 in healthy volunteers. The results are compatible with a positive association of the C3F gene and Crohn's disease located in the small bowel.
Hemodynamic Effects of Verapamil in Essential Hypertension at Rest and During Exercise
Authors: Lund‐Johansen Per
Published: August 2010

In recent years the calcium antagonist verapamil has been used in the treatment of essential hypertension. Relatively little work has been done to elucidate its long‐term haemodynamic effects at rest and during exercise.

Ten males with previously untreated essential hypertension in WHO stage I, aged 35–55 years, were studied on an outpatient basis. Oxygen consumption, heart rate, cardiac output (Cardiogreen) and intra‐arterial brachial pressure were recorded at rest in the supine and sitting position and during steady state work at 50,100 and 150 W. As expected, the hypertension was associated with an increase in total peripheral resistance.

The subjects were treated with verapamil 120–240 mg daily as the sole drug for one year. The haemodynamic study was then repeated. One subject demonstrated a slight increase in blood pressure at rest and during exercise, while there was a blood pressure reduction in the other 9. The nonresponding patient was excluded from the statistical evaluation. The main results were as follows: There was a statistically significant reduction in systolic, diastolic and mean arterial pressure at rest as well as during exercise. The reductions reached about 10% at rest, slightly less during exercise. The blood pressure reduction was associated with a statistically significant reduction in total peripheral resistance at rest only. During exercise, the reduction in resistance was modest (about 5%). The heart rate was practically unchanged during supine rest, but decreased about 8% at rest sitting and during exercise. The stroke volume was increased 11% at rest sitting (p < 0.05) and also tended to be increased during exercise, but the changes were not statistically significant. The cardiac index was practically unchanged.

It is concluded that the blood‐pressure reduction induced by longterm treatment with verapamil is due to a reduction in total peripheral resistance, no significant change in cardiac index, and a slight decrease in heart rate compensated by an increase in stroke index. This haemodynamic profile differs from the haemo‐dynamic changes induced by long‐term treatment with beta‐blockers.
Drug Utilization and Morbidity Statistics for the Evaluation of Drug Safety in Sweden
Authors: Wiholm Bengt‐Erik , Westerholm Barbro
Published: August 2010

ABSTRACT. For a continuous monitoring and evaluation of drug safety problems in Sweden, the Department of Drugs of the National Board of Health and Welfare has access to a number of computerised patient‐, drug‐, and disease‐oriented registers. The usefulness and limitations of these registers are presented by examples. A recent increase in asthma deaths is presently being analysed by comparing information from death certificates and case records with drug sales and prescription data. A recent analysis of the cancer register showed no increased risk of malignant thyroid tumors after diagnostic or therapeutic doses of 1131. Similarly no increased risk of malformations after occupational exposure to hexachlorophene could be detected by analysing the malformation and medical birth‐record registers in relation to hospital hexachlorophene use. The register of patient discharge diagnoses has been repeatedly used to analyse the incidence and pattern of drug induced blood dyscrasias and thromboembolism associated with oral contraceptives (OC). These analyses have resulted i.a. in the withdrawal of dipyrone and tenalidine and a decrease of the estrogen‐content of OCs. At the same time about 1/3 of these serious adverse drug reactions (ADR) was found to have been reported to the ADR‐register. By combining sales and prescription data with ADR‐reports the risk of inducing lactic acidosis was found to be significantly higher for phenformin than for metformin. Also the incidence of tardive dyskinesia from longterm use of metoclopramide was found to be much higher than hitherto recognized. By use of these registers it is possible to obtain valuable information about the safety of drugs. The raw data must, however, be interpreted with care and often be supplemented with in depth studies of the various problems.
Atrioventricular Conduction Time in Ankylosing Spondylitis
Authors: MØLLER PÅL
Published: August 2010

ABSTRACT The frequency of cardiac conduction disturbance in ankylosing spondylitis is discussed. Risk of such disturbance in the patients' relatives is, to our knowledge, not known. To examine these problems, ECG records of 99 patients with ankylosing spondylitis and 132 of their adult first degree relatives were obtained. P‐R intervals were determined by standardized methods and compared with P‐R intervals of the controls. The distribution of P‐R intervals both in the patients and their relatives was close to the controls'. Four cases of first degree AV block were found among the patients (P‐R intervals 0.21‐0.26 sec), one of them had aortic valve insufficiency. The single case of pronounced conduction delay (P‐R interval 0.42 sec) was recorded in an otherwise healthy HLA B27‐positive relative. One male secondary case of ankylosing spondylitis had a P‐R interval of 0.22 sec. Patients who had experienced acute anterior uveitis had relatively long P‐R intervals, while patients with psoriasis had relatively short P‐R intervals. The conclusion was that cardiac conduction disturbance was not frequent in patients with ankylosing spondylitis or in their relatives.
Plasma Histamine and Serum Pepsinogen I Concentrations in Chronic Myelogenous Leukaemia
Authors: VÄLIMÄKI MATTI , VUOPIO PEKKA , SALASPURO MIKKO
Published: August 2010

ABSTRACT A male patient with multiple gastroduodenal ulcers and gastric hypersecretion due to hyperhistaminaemia associated with extreme basophilia occurring in chronic myelogenous leukaemia (CML) is described. In addition, plasma histamine levels and serum pepsinogen I concentrations, reflecting gastric acid secretion, were studied in 18 CML patients. As compared to controls, plasma histamine levels were clearly increased in CML patients and correlated well with the basophil count. Serum pepsinogen I concentrations were normal in 14 out of 17 cases and did not correlate with plasma histamine levels. This absence of a direct relation between plasma histamine concentrations and serum pepsinogen I levels suggests that a high concentration of circulating histamine does not inevitably lead to increased gastric acid secretion. This offers one explanation of the fact that, in spite of the frequent occurrence of basophilia and hyperhistaminaemia in CML, ulcerogenic diathesis is quite rare in this disease and complicates only cases with extreme basophilia.