bluuebunny/crossref_metadata_2025 huggingface dataset:
CARDIOVASCULAR PROSTAGLANDINS: SOME COMMENTS ON THEIR INVOLVEMENT IN CIRCULATORY PHYSIOLOGY AND PATHOPHYSIOLOGY
Authors: Wennmalm Åke
Published: August 2010

Abstract There is little, if any, good evidence in the literature to indicate a role for cardiovascular PG in congestive heart failure, either in its pathogenesis or as a consequence of and defense against its manifestations. Usually congestive heart failure is considered to develop as a vicious cycle in which impaired cardiac output, increased peripheral resistance, decreased renal blood flow, increased renin release and further increased peripheral resistance and decreased cardiac output are important constituents. Increased sympathetic activity may promote cardiovascular PG formation through the sympathetic neurotransmitter noradrenaline; such an action has, however, not been documented hitherto. Furthermore, increased plasma renin activity may promote PG formation via increased circulating levels of angiotensin; even such an anion remains, however, to be demonstrated. If the heart failure leads to local tissue ischemia the hypoxia as such, or the subsequent increase in adenosine production, may also facilitate cardiovascular PG formation. All these mechanisms, if operative, would counteract the increased peripheral resistance, by promoting the formation of vasodilator PG. On the other hand PGI2 stimulates renal formation of renin, which would act to elevate the peripheral resistance. These contradictory effects of endogenously formed PG focus on the need for more careful studies on their involvement in the hemodynamic consequences of congestive heart failure: until more data are available it is impossible to know whether an activated synthesis of PG should be regarded as advantageous and worth therapeutical support, or negative and subject to inhibition. Such a statement does by no means neglect the role of renal PG in patients with mild glomerular disease: in such cases an intact renal PG formation should definitely be regarded as beneficial.
ASPECTS ON “TRADITIONAL” VASODILATORS IN THE TREATMENT OF CHRONIC HEART FAILURE
Authors: Rydén Lars , Conradson Thor‐Björn
Published: August 2010

AbstractVasodilator therapy of heart failure has through the last 5–10 years become a well established treatment. Traditionally these drugs have been classified after their primary site of action on the vascular beds. Thus drugs primarily acting on the arteriolar bed are called afterload‐reducing agents and are examplified by hydralazine. Drugs primarily acting on the venous bed have been called preload‐reducing agents and the typical example is nitroglycerine. Other drugs, like prazosine, act on both the arteriolar and venous vascular beds. The classification is, however, not as sharp as originally believed since preload‐ and afterload‐reducing activities mix with each other.

Treatment with vasodilators for chronic heart failure has mainly been advocated in patients with valvular regurgitation, ischemic heart disease and various types of dilated cardiomyopathies.

It seems appropriate today to put some questions concerning vasodilator therapy for heart failure. Among such questions are: When in the natural history of congestive heart failure should vasodilator therapy be commenced? How effective is long‐term administration of vasodilating drugs? May vasodilator therapy decrease mortality in congestive heart failure? What about the efficacy of new vasodilating drugs compared to more traditional ones?

In the review of vasodilating drugs besides ACE inhibitors, these questions will be addressed.
EFFECTS OF ACE‐INHIBITION ON REGIONAL CIRCULATION IN CONGESTIVE HEART FAILURE
Authors: Swedberg Karl
Published: August 2010

Abstract During development of heart failure there are marked changes in the peripheral circulation. The renal and splanchnic circulations are reduced early. The cerebral circulation is maintained by autoregulation. Skeletal muscle blood flow is reduced in relation to the decrease of cardiac output. There are also important metabolic changes in these muscles with reduced mechanical efficiency.

Treatment with arterial vasodilators increase cardiac output. However, most of this increase is usually shunted, probably in the splanchnic circulation. If any, only small increases in muscle blood flow have been reported.

ACE‐inhibition has been shown to have beneficial acute effects on the renal, cerebral and skeletal muscle blood flow with improved flow in these areas. This treatment seems to be the most beneficial vasodilatory alternative available so far.
Long Term Results after Operative Treatment of Isolated Ventricular Septal Defect in Adolescents and Adults
Authors: OTTERSTAD JAN ERIK , ERIKSSEN JAN , FRØYSAKER TOR , SIMONSEN SVEIN
Published: August 2010

A series of 125 consecutive patients with isolated ventricular septal defect (VSD) aged 10 or over, were followed until death or beyond the age of 30 (31–73) years. A prospective restudy was performed after a mean follow‐up of 15 (3–21) years.

Forty‐one patients (group 1) were treated with surgical repair of VSD at a mean age of 23 (10–51) years, and early mortality was 10%, i.e. 3 with severe aortic insufficiency and one wity systemic pulmonary artery pressure. Surgery was initially not regarded indicated in 70 patients with small defects (group 2). A further 14 patients were judged inoperable (group 3).

Long‐term mortality was 5% in group 1, 9% in group 2 and 71% in group 3. When restudied, group 2 patients had significantly higher (p<0.01) and group 1, lower (p<0.01) pulmonary artery pressures than initially. A moderate deterioration in NYHA‐rating was noted in group 2 (p<0.05) vs. a slight improvement in group 1 (p<0.05). The non‐operated patients had a higher incidence of valvular lesions (19% vs. 13%) and bacterial endocarditis (4.3% vs. 2.7%) than the operated but not to a statistically significant level. Spontaneous closure was 6% in group 2 whereas mostly small residual defects were found in 34% of the operated.

Patients with uncomplicated VSDs (absence of valvular lesions or coronary heart disease) had subnormal exercise tolerance as judged from a standardized ergometer bicycle test. These patients also had impaired left ventricular function based upon haemodynamic studies during moderate supine exercise. No major differences were noted between groups 1 and 2, but operated patients with residual VSDs tended to have the poorest cardiac performance.

Non‐cardiac disease represented only a minor problem and no significant differences in psychosocial function were observed between groups 1 and 2. Only 50% in group 1 and 60% in group 2 attended a regular medical clinic. Antibiotic prophylaxis had only been practiced by 50% in both groups.

Although small, but differences between groups 1 and 2 favour surgery. This must be regarded as a positive result of surgical treatment since those operated on had basically larger and thus more severe defects than the others. In view of the very low operative risk associated with modern surgical technique one should direct patients with significant shunts to operative treatment.
Non‐participants in a General Population Study of Men, with Special Reference to Social and Alcoholic Problems
Authors: ROSENGREN ANNIKA , WILHELMSEN LARS , BERGLUND GÖRAN , ELMFELDT DAG
Published: August 2010

ABSTRACT The bias introduced by non‐participation in a study depends on the size and the composition of the non‐participant group. Out of 10000 men invited to a screening examination in a large primary prevention trial in Goteborg, Sweden, 25 % did not come to the examination. The non‐participants could be shown to be registered by the Board of Social Welfare for social problems and alcohol abuse to a greater extent than the participants in the study. The annual mortality among the non‐participants was about twice that of the participants during the entire follow‐up period of 11.8 years. The incidence of non‐fatal myocardial infarction was not significantly higher in non‐participants. Coronary death, on the other hand, was significantly more common among those not attending the examination (3.5 vs. 7.6%). Participants registered for alcoholic problems had coronary death rates approaching those of the non‐participants. Sudden coronary death accounted for most of the excess coronary mortality. Most of the excess mortality in the non‐participant group was from other causes than cardiovascular diseases and cancer but even so, about one third of the excess deaths could be attributed to coronary heart disease. Possible explanations of this excess coronary mortality include that non‐participants may smoke more, more frequently have alcoholic problems and that non‐participation may reflect an unwillingness to seek medical care even in the event of illness.
Primary Aldosteronism
Authors: LINS PER‐ERIC , ADAMSON ULF
Published: August 2010

ABSTRACTA follow‐up examination was performed one month to 20 years after adrenalectomy in 28 cases with surgically treated primary aldosteronism due to adrenal adenoma. The mean age at diagnosis was 45, and the mean duration of hypertension seven years. Severe hypertension with a diastolic blood pressure of 130 mmHg or more was observed in 35%. Postoperatively cerebrovascular catastrophe developed in two cases, both of which belonged to the group of patients with severe hypertension. Normalization of blood pressure was observed in 70% and in the remaining subjects the blood pressure was lower than at diagnosis. The blood pressure response to adrenalectomy appeared unpredictable in view of such parameters as the initial blood pressure, age at diagnosis, and duration of the hypertensive state. Toxicosis during pregnancy and metrorrhagia was observed with unexpectedly high frequency in this study population. Low ambulatory plasma renin activity was recorded at the follow‐up in 15 out of 18 subjects studied in the absence of evidence of hyperaldosteronism.
In Vitro Normalization of Cholesteryl Ester Content and Particle Size of Fish Eye Disease High Density Lipoproteins
Authors: HOLMQUIST LEIF , CARLSON LARS A.
Published: August 2010

ABSTRACT Isolated high density lipoprotein (HDL) from the two living fish eye disease patients have been incubated in vitro with autologous lipoprotein depleted plasma or with lipoprotein depleted plasma from domestic pig (Sus domesticus), with and without the presence of LCAT inhibitor for 24 hours at 0 and 37°C. The lecithin:cholesterol acyltransferase (LCAT) activity in lipoprotein depleted pig plasma increased the abnormally low cholesteryl ester content of the fish eye disease HDL particles from about 20 to 100% and increased their exceptionally small mean particle size, probably by particle fusion, to a range which is representative of normal HDL3. Both esterification and particle enlargement were totally blocked by the LCAT inhibitor. Incubation of concentrated fish eye disease HDL with autologous lipoprotein depleted plasma for 24 hours at 37°C resulted in a small increase in its cholesteryl ester percentage to 37%, without affecting the apparent HDL particle size. This finding confirms a deficiency of HDL lecithin: cholesterol acyltransferase activity (α‐LCAT) in fish eye disease. The observed normalization of both HDL cholesteryl ester percentage and particle size by lipoprotein depleted pig plasma which contains virtually no cholesteryl ester transfer activity indicates that the latter is not a requisite for esterification of the free cholesterol of fish eye disease HDL.
High Occurrence of Mitral Valve Prolapse in Cardiac Catheterization Patients with Pure Isolated Mitral Regurgitation
Authors: DANIELSEN RAGNAR , NORDREHAUG JAN ERIK , VIK‐MO HARALD
Published: August 2010

ABSTRACT. Danielsen R, Nordrehaug JE, Vik‐Mo H (Department of Clinical Physiology, Haukeland Hospital, University of Bergen, Bergen, Norway). High occurrence of mitral valve prolapse in cardiac catheterization patients with pure isolated mitral regurgitation. Acta Med Scand 1987; 221:33–8.

The aetiological spectrum of angiographically verified pure isolated mitral regurgitation (MR) was studied in 48 consecutive adult patients (35 males). Severe MR was found in 35 patients (73%) and moderate MR in 13 patients (27%). Mitral valve prolapse (MVP) syndrome was found in 21 patients (44%). These were younger than the rest of the study population (55±13 vs. 62±6 years, p<0.05) and 15 (71%) of them were men. Endocarditis and chordal rupture occurred in 19% and 43% of the MVP patients. Sixteen patients (33%) had MR secondary to myocardial infarction while only three patients (6%) had MR of rheumatic aetiology. Bacterial endocarditis, hypertensive heart disease, hypertrophic obstructive car‐diomyopathy and mitral annulus calcification were less frequently found. Mitral valve replacement was done in 20 (57%) of the patients with severe MR and MVP was the underlying disease in 15 (75%) of these patients. In conclusion, MVP is a frequent cause of pure isolated MR and of mitral valve replacement. In contrast to the preponderance of young females amongst MVP patients in population surveys, most of the MVP patients with MR in this study are middle‐aged and elderly men.
Differentiation of Cardiac Amyloidosis and Hypertrophic Cardiomyopathy
Authors: ERIKSSON PETER , BACKMAN CHRISTER , ERIKSSON ANDERS , ERIKSSON STURE , KARP KJELL , OLOFSSON BERT‐OVE
Published: August 2010

ABSTRACT. Eriksson P, Backman C, Eriksson A, Eriksson S, Karp K, Olofsson B‐O (Departments of Internal Medicine, Geriatric Medicine, and Clinical Physiology, University Hospital, Umeå, and Institute of Forensic Medicine, University of Umeå, Umeå, Sweden). Differentiation of cardiac amyloidosis and hypertrophic cardiomyopathy. A comparison of familial amyloidosis with polyneuropathy and hypertrophic cardiomyopathy by electrocardiography and echocardiography. Acta Med Scand 1987; 221:39–46.

The clinical and echocardiographic features of cardiac amyloidosis may closely resemble those of hypertrophic cardiomyopathy, and the disorders may thus be mixed up. The present study was undertaken in an attempt to identify features separating the two conditions by analysis of electro‐ and echocardiographic findings in patients with familial amyloid polyneuropathy and hypertrophic cardiomyopathy. Twenty‐nine patients with familial amyloidosis and 22 with hypertrophic cardiomyopathy were studied. Particular attention was given to (1) the sum of the S wave in V1 and R wave in V5 or V6, (2) the echocardiographic left ventricular mass and (3) cross‐sectional area, the presence or absence of (4) asymmetrical septal thickening, (5) granular and sparkling myocardial appearance, (6) thickened heart valves, (7) systolic anterior motion of the mitral valve, and (8) pericardial effusion. A granular and sparkling appearance of the myocardium and thickened heart valves were found to be the best predictors of cardiac amyloidosis, while low QRS amplitudes in relation to echocardiographic left ventricular mass and a pericardial effusion seemed less important. The presence of systolic anterior movement of the mitral valve, a large left ventricular mass and a sum of S in V1 and R in V5 or V6 >35 mm indicated hypertrophic cardiomyopathy. When the four strongest predictors (left ventricular mass, thickened heart valves, a granular sparkling myocardial appearance, and systolic anterior movement of the mitral valve) were used to reclassify the present patients, 28 of 29 amyloidosis patients and 21 of 22 patients with hypertrophic cardiomyopathy were correctly categorized. Noninvasive methods may thus be useful for detecting the myocardial infiltrative process, and cardiac amyloidosis may be confidently diagnosed by typical noninvasive findings together with histopathological documentation of amyloid in an organ other than the heart.
Is It Possible to Characterize Recurrent Urinary Stone Formers Who Benefit from Thiazide Prophylaxis?
Authors: LØRUM EVEN , LARSEN STIG
Published: August 2010

ABSTRACT. Laerum E, Larsen S (Institute of General Practice, University of Oslo, Oslo, and MEDSTAT, Center for Administration Design and Statistical Analysis in Medical Research, Strømmen, Norway). Is it possible to characterize recurrent urinary stone formers who benefit from thiazide prophylaxis? Application of discrimination analysis. Acta Med Scand 1987; 221: 103–8.

Twenty‐three patients with recurrent urinary stones have been treated for 12–54 months with hydrochlorthiazide and 25 with placebo. Discrimination analysis was performed in order to distinguish patients with new stone formation (non‐responders) from those without stone recurrence (responders) during the treatment. The discriminant function classified 16 out of 18 responders as such and 5 non‐responders as such by using a combination of the three intital varibles urinary pH, 24‐h urine volume and serum phosphate. Eighteen other analysed variables and patient factors did not contribute to this discrimination. By using “leaving‐one‐out‐technique”, the probability for erroneously classifying a patient increased from 9 to 17%. Applying the discriminant function on the group receiving placebo, 92% of these patients were classified as responders to thiazide. It is concluded that discrimination analysis may give valuable information in charcterizing patients who will benefit from a special therapy.
The Adherence of Polymorphonuclear Leucocytes to an Albumin‐coated Glass Surface
Authors: DAHLGREN CLAES , NORBERG BO , ERIKSSON STURE
Published: August 2010

ABSTRACT.Dahlgren C, Norberg B, Eriksson S (Department of Medical Microbiology, University Hospital, Linköping, and Departments of Internal Medicine and Geriatric Medicine, University Hospital, Umeå, Sweden). The adherence of polymorphonuclear leucocytes to an albumin‐coated glass surface. Acta Med Scand 1987; 221:109–13.

The Catharantus derivatives are microtubule antagonists employed in immunosuppression and chemotherapy of neoplasms. The role of cytoplasmic microtubules in polymorphonuclear leucocyte (PMN) adherence was studied by means of therapeutic concentrations of the Catharantus derivatives vincristine, vinblastine and vindesine. PMN adherence was measured as retention on an albumin‐coated glass surface. PMN adherence was reduced by 4–54% by the Catharantus derivatives, as compared with control values. The suppression of adherence was statistically significant. Since the Catharantus derivatives are microtubule antagonists, it is reasonable to assume that PMN adherence is a partially microtubule‐dependent process. It is suggested that reduction of PMN adherence could account for at least Dart of the immunosuppressive properties of the Catharantus derivatives.
Ventricular Dysrhythmias in Middle‐aged Hypertensive Men Treated Either with a Diuretic Agent Or a β‐Blocker
Authors: RAGNARSSON J. , HARDARSON T. , SNORRASON S. P.
Published: August 2010

ABSTRACT.The purpose of this study was to identify the frequency of cardiac dysrhythmias in two similar groups of hypertensive middle‐aged males (age 45–66). They had previously been randomized either to a diuretic treatment (n=42), or a β‐blocking agent (n=41). A 24‐hour ambulatory Holter monitoring, and serum potassium, was obtained in all patients, serum magnesium was measured in 35 patients. The mean number of ventricular premature beats (VPBs) and the frequency of complex arrhythmias (19 vs. 5) was significantly higher in the diuretic group (p<0.01). The serum potassium was significantly lower (p<0.001) in the diuretic group, and there was a significant (p<0.005) inverse correlation between the number of VPBs and the serum potassium in all treated patients. The patients with complex arrhythmias were older (p<0.01) than the remainder of the patients. No correlation between serum magnesium and VPBs or complex arrhythmias was found. This study demonstrates increased frequency of VPBs in older hypertensive males, treated with diuretics, and that hypokalaemia predisposes to increased cardiac arrhythmias. We conclude that in older mildly hypertensive men hypokalaemia should be avoided.
On the Usefulness of Fibrinolysis Variables in the Characterization of a Risk Group for Myocardial Reinfarction
Authors: GRAM J. , JESPERSEN J. , KLUFT C. , RIJKEN D. C.
Published: August 2010

ABSTRACT. In a prospective study selected fibrinolysis variables were assessed in plasma samples from 29 consecutive patients recovering a first instance of acute myocardial infarction and the results were correlated with reinfarction during the next four years. Nine patients suffered a reinfarction leaving a group of 20 patients without evidence of relapse. The reinfarction group was characterized by lower tissue plasminogen activator activities in plasma euglobu‐lins (p<0.05), significantly higher plasma concentrations of tissue plasminogen activator antigen (p<0.002) and a tendency to a higher plasma level of plasminogen activator inhibition capacity. There were no significant differences between the groups in plasma concentrations of plasminogen, histidine‐rich glycoprotein, plasminogen kringle‐4‐binding‐protein, and α2‐antiplasmin.
Depressed Melatonin Secretion in Patients with Nightmares Due to β‐Adrenoceptor Blocking Drugs
Authors: BRISMAR K. , MOGENSEN L. , WETTERBERG L.
Published: August 2010

ABSTRACT. Nocturnal urinary melatonin excretion was evaluated in six patients with nightmares and hallucinations during treatment with β‐adrenoceptor blocking agents, and compared to six control patients with similar diagnoses and treatment but without such symptoms from the central nervous system (CNS). Nightly melatonin excretion was lower in all cases with nightly CNS‐symptoms than in the control patients. The results also suggest drug differences and dose dependency. It is concluded that in predisposed patients CNS side‐effects induced by β‐adrenoceptor antagonists are related to depressed nightly melatonin secretion.
Validity of Clinical Symptoms in Benign Esophageal Disease, Assessed by Questionnaire
Authors: ANDERSEN LARS IB , MADSEN POUL VASEHUS , DALGAARD PETER , JENSEN GORM
Published: August 2010

ABSTRACT.A questionnaire designed to test the value of questions identifying benign esophageal disease was sent to patients representing four well‐defined entities: angina pectoris (n=30), benign esophageal disease (n=25), gastroduodenal ulcer or former gallstones (n=27) and normal subjects (n=38). By means of logistic regression, three key‐questions were selected. A combination of an affirmative answer to “difficulty in swallowing solid food” and to “pain in the chest” or “heartburn at night” or both did not occur in the group of normal subjects, while occurring in 68% of the patients with esophageal diseases. The combination occurred in only 10% of the patients with angina pectoris and 15% of those suffering from gastroduodenal ulcer or gallstones. The predictive accuracy of the combination of the three questions is estimated for various hypothetic prevalences of esophageal disease. These questions appear to identify approximately two‐thirds of individuals with esophageal disease with acceptable false‐positive rates and can therefore be used in epidemiological studies.
Insulin and C‐peptide Secretory Responses to Glucagon in Man: Studies on the Dose‐Response Relationships
Authors: AHRÉN BO , NOBIN ANDERS , SCHERSTÉN BENGT
Published: August 2010

ABSTRACT. The present study investigated the insulin and C‐peptide secretory responses to glucagon in non‐diabetic humans. Glucagon induced a transient increase in plasma insulin and C‐peptide concentrations. At the dose level of 0.5 mg, glucagon elicited more efficient responses than at the dose level of 0.25 mg (p<0.05). However, the responses were not further potentiated by glucagon at 1.0 mg. Plasma glucose levels did not change during the first 2 min after glucagon injection, when already a marked increase in plasma insulin and C‐peptide levels were observed. Thereafter, however, plasma glucose levels increased, to be maximal at 20 min after glucagon injection. Calculations of the minute‐to‐minute increase of plasma insulin and C‐peptide levels revealed that plasma insulin levels increased by 32±7% of the increase in plasma C‐peptide levels during the first 2 min, and by 36±6% of the increase in plasma C‐peptide levels during the 3rd and 4th min after injection; the difference being the liver extraction of insulin. We conclude from this study in man 1) that glucagon stimulates insulin secretion through both direct and indirect effects, 2) that following glucagon injection, approximately 65% of the secreted insulin is extracted by the liver, and 3) that the dose level of 0.5 mg glucagon is the optimal dose level for the stimulation of insulin secration.
Postmenopausal Osteoporosis: No Effect of Three Years Treatment with 1,25‐Dihydroxycholecalciferol
Authors: FALCH JAN A. , ØDEGAARD OLE R. , FINNANGER ANNE M. , MATHESON INGRID
Published: August 2010

ABSTRACT. The therapeutic effect of 1.25‐dihydroxycholecalciferol (1.25(OH)2D3) in postmenopausal osteoporosis was tested in a single blind, randomized prospective study. Thirty‐nine women, 50–65 years of age, were treated for three years with 0.5 μg 1.25(OH)2D3 daily. In a control group, 37 women were given 400 IU vitamin D3 daily. There was no significant difference in annual bone loss from the distal or proximal forearm between the groups. New vertebral fractures were evaluated, and in the treatment group, the annual increase in vertebral fractures was 0.18±0.387 and in the control group 0.13±0.330. New long bone fractures were 7 and 5, respectively. None of the observed differences were statistically significant. In the 1.25(OH)2D3 group, 28% had to reduce the dose because of slight hypercalcaemia. We conclude that 1.25(OH)2D3 as used in this study is not effective in the treatment of osteoporosis.
α1Antitrypsin Deficiency and Liver Cirrhosis in Adults
Authors: ERIKSSON STEN
Published: August 2010

ABSTRACT. Eriksson S. (Department of Internal Medicine, University of Lund, Malmö General Hospital, Malmö, Sweden.) α1‐Antitrypsin deficiency and liver cirrhosis in adults. An analysis of 35 Swedish autopsied cases. Acta Med Scand 1987; 221:461–7.

α1‐Antitrypsin (AAT) deficiency in adults predisposes to lung and liver disease, but its natural history is incompletely known. To better characterize the liver disease, all known deceased adult Swedish patients known to us with homozygous (PiZZ) AAT‐deficiency, who had undergone autopsy during the 20‐year period 1963–82 were reviewed. Of 94 such patients, 35 had cirrhosis (27 males and eight females) with a mean age at death of 65.5± 10.5 (SD) years compared to 53.6± 12.8 years (p<0.01) for the 59 non‐cirrhotic patients. The longer survival suggests less severe lung disease in the cirrhotic group. Clinically these patients most frequently presented with ascites or other signs of portal hypertension. Evidence of alcohol overconsumption, chronic viral hepatitis, or autoimmune disease was rare. Aside from low plasma AAT levels, laboratory and other clinical features were indistinguishable from those of decompensated cirrhosis of any etiology. The prognosis was generally grave with a mean survival of two years after diagnosis. Fourteen of the 35 cirrhotics (10 males and four females) had primary liver cancer (PLC) at autopsy. We conclude that cirrhosis and PLC are more frequent complications in elderly patients with AAT‐deficiency than was previously known. These complications had a marked male predominance.
Role of Antilipolytic Mechanisms in Adipose Tissue Distribution and Function in Man
Authors: ARNER PETER
Published: August 2010

ABSTRACT Regional differences have been found in the hormone regulation of adipose tissue lipolysis. Lipolytic activity is greater in omental than in subcutaneous adipocytes owing, in part, to a less marked insulin action and lower α2‐adrenoceptor antilipolytic activity in the omental region. In the subcutaneous region catecholamines are less lipolytic in gluteal/femoral than in subcutaneous abdominal adipocytes, which is partly due to enhanced a2‐adrenoceptor responsiveness in the gluteal/femoral cells. Insulin action also differs in the two subcutaneous adipose regions in a complex way that is influenced by the degree of obesity and nutritional factors. The regional differences in the antilipolytic effects of hormones seem to be caused by site variations in the receptors as well as in the signals from the receptors. The site variations may be involved in the development of regional forms of obesity, such as android or gynoid obesity and may raise the free fatty acid levels in the portal system and therefore impair metabolism of glucose and insulin by the liver.
Physical Training and Changes in Regional Adipose Tissue Distribution
Authors: DESPRÉS JEAN‐PIERRE , TREMBLAY ANGELO , NADEAU ANDRÉ , BOUCHARD CLAUDE
Published: August 2010

ABSTRACT Obesity has been associated with numerous metabolic complications, such as changes in the concentration and/or composition of plasma lipoproteins, glucose intolerance and hyperinsulinemia leading to diabetes and hypertension. The relation of obesity to cardiovascular disease has not, however, been consistently reported. Recent prospective studies have clearly indicated that the distribution of adipose tissue was a significant cardiovascular risk factor and numerous studies have shown that metabolic disturbances were more closely associated with the level of abdominal fat than excess adiposity per se. As obese men generally store their energy excess in the abdominal region and women in the peripheral fat depots, the metabolic complications of obesity seem to be more closely related to adiposity in men than in women. It is suggested that the sex dimorphism observed in adipose tissue localization could partly explain the greater cardiovascular risk associated with obesity in men than in women. Indeed, obese women with a “male” (abdominal) distribution of body fat have greater metabolic complications than women with lower body fat. When aerobic exercise‐training is used to induce weight loss, men generally lose more fat than women. In men, the loss of adipose tissue appears to be central, potentially reducing the risk of cardiovascular disease, whereas a relative resistance to fat loss is observed in women compared to men. Although resistance to fat loss is noted in women, those with a “male” distribution of adipose tissue (high waist‐to‐hip ratio and high intra‐abdominal fat deposition) and with associated metabolic complications greatly benefit from aerobic exercise‐training. As a substantial proportion of obese men, as well as women with excess abdominal fat, appear to be the subgroups of obese subjects showing metabolic disturbances, emphasis should be placed on the tracking and the treatment of these subjects. Exercise‐training appears to be useful in improving the metabolic profile of these subjects, potentially reducing the risk of cardiovascular disease.
Surgical Treatment of Regional Adiposity
Authors: KRAL JOHN G.
Published: August 2010

ABSTRACT Recognition of abdominal fat distribution as a significant risk factor raised the question whether surgical treatment of regional adiposity might be feasible or desirable. This is a review of cosmetic and therapeutic lipectomy in man and experimental lipectomy in rodents examining morphologic and metabolic aspects as well as conditions for growth and regrowth of adipose tissue. Potentially detrimental metabolic effects of lipectomy are discussed in the context of the “metabolic sink” hypothesis. Data are also presented on the distribution of weight loss after gastrointestinal surgery for morbid obesity. An obesity‐related “elephantiasis” syndrome in superobese men is described. “Giant lipectomy” in one such case, removing a record 50 kg during one operation, with pre‐ and postoperative determination of body fat is reported. It is concluded that lipectomy is not a treatment for obesity with very rare exceptions. Regrowth of adipose tissue is possible under special circumstances. Surgically induced massive weight loss does not seem to cause preferential regional weight loss, though risk‐reducing beneficial metabolic effects are achieved after gastrointestinal obesity surgery.
Inhibitory Effect of Normal High Density Lipoproteins on Lecithin: Cholesterol Acyltransferase Activity in Fish Eye Disease Plasma
Authors: HOLMQUIST LEIF , CARLSON LARS A.
Published: August 2010

ABSTRACT. The lecithin: cholesterol acyltransferase (LCAT) activity of lipoprotein depleted normal and fish eye disease (FED) plasma was assayed in a modified Glomset‐Wright incubation system where the enzyme was allowed to act on three different normal lipoprotein substrates consisting of an authentic mixture of very low (VLDL), low (LDL) and high (HDL) density lipoproteins to assay total LCAT activity, HDL to assay α‐LCAT activity and combined VLDL and LDL to assay β‐LCAT activity, respectively. However, using normal plasma depleted of HDL, leaving its combined VLDL and LDL as enzyme substrate, resulted in a more than twofold increase in the LCAT activity of FED plasma from the two patients compared to the activity obtained with HDL present in the incubation mixture, indicating an inhibitory effect of HDL on the β‐EAT activity present in FED plasma. This inhibitory effect of normal HDL could also be demonstrated by autoincubation of FED plasma mixed with isolated HDL2 or HDL3 Both these HDL subfractions had a pronounced inhibitory effect on the cholesteryl ester formation in FED plasma. The present study thus clearly demonstrates that normal HDL inhibits the β‐LCAT activity present in FED plasma, esterifying the free cholesterol of combined VLDL and LDL, derived from controls as well as from the two FED patients.
Mitral Annulus Calcification and Embolism
Authors: JESPERSEN CHRISTIAN M. , EGEBLAD HENRIK
Published: August 2010

ABSTRACT. Of 388 patients consecutively referred to echocardiography, 49 were suspected of having a cardiac source of systemic arterial embolism (SE). Mitral annulus calcification (MAC) was revealed in 27% of the patients with SE and in 8% of the remaining patients (p<0.05). The group of patients with SE were slightly older (median age 67 years) and included more female patients (47%) compared to the group without SE (62 years, p<0.05; 40% female patients, p>0.05). However, the small differences in age and sex distribution did not explain satisfactorily the considerably increased prevalence of MAC in the group of patients with SE. Our preliminary data indicated that thromboembolism caused by left atrial dilatation and atrial fibrillation might be the most important cause of the condition in patients with MAC and SE. However, the significance of the possible mechanisms of embolism in patients with MAC and the incidence of the complication should be further clarified before therapy and prophylaxis can be suggested.
Clinical Outcome of Using Insulin at 40 IU/ml and 100 IU/ml in Pump Treatment
Authors: CHRISTIANSEN JENS S. , SONNENBERG GABRIELLE E. , KVERNELAND ARNE , SCHMITZ ANITA , CHRISTENSEN CRAMER K. , HERMANSEN KJELD , RITZENHOFF ANDREAS , SPRAUL MICHAEL , LOERUP BIRTHE , MOGENSEN CARL E. , BERGER MICHAEL , DECKERT TORSTEN
Published: August 2010

ABSTRACT. In three different diabetes centers the use of insulin at a strength of 40 IU/ml (U40) and 100 IU/ml (U100) in continuous subcutaneous insulin infusion (CSII) treatment of insulin dependent (Type I) diabetic patients was compared in a randomized cross‐over design. Forty‐six Type I diabetic patients, all previously treated with CSII for at least one year, completed consecutively two 13‐week periods of treatment with U40 and U100. Body weight and insulin requirements were identical at the end of the two periods. Slightly higher levels of glycemia were recorded during U40 when compared to U100 treatment: mean blood glucose was 142±34 (SD) vs. 133±34 mg/dl (2 p<0.01). The same tendency was observed in the mean glycosylated hemoglobin value (6.84±1.35 vs. 6.65±1.13%, 2p>0.1). There were no significant differences between U40 and U100 in the number of catheters used and the number of catheter blockages reported, while the development of subcutaneous nodules at the insertion sites was significantly more frequent during U40 treatment. It is concluded that the implementation of insulin in the strength of 100 IU/ml is as effective as the use of insulin in the strength of 40 IU/ml for CSII therapy, and might even be associated with slightly improved glycemic control and less subcutaneous side‐effects.
Factor VII‐Phospholipid Complex in Male Survivors of Acute Myocardial Infarction
Authors: DALAKER KNUT , SMITH PÅL , ARNESEN HARALD , PRYDZ HANS
Published: August 2010

ABSTRACT The presence of an activated form of coagulation factor VII—a factor VII‐phospholipid complex—in male survivors of myocardial infarction is described. The level of this complex did not correlate with age or level of conventional risk factor score, but showed a highly significant positive correlation with serum triglycerides in all the subgroups as well as in the whole study population (r=0.88, p<0.0001). Measurement of this form of activated factor VII may constitute a simple and promising method for additional screening of men at risk for cardiovascular disease.
Cardiac Arrest in Stockholm with Special Reference to the Ambulance Organization
Authors: JAKOBSSON J. , NYQUIST O. , REHNQVIST N.
Published: August 2010

ABSTRACT During a one‐year period all patients with cardiac arrest (CA) taken care of by three ambulances were studied. An incidence of 110 cardiac arrests/100000 inhabitantslyear was found. The majority of CAs affected the elderly and occurred during the day in their homes. The majority of CAs were witnessed but cardiopulmonary resuscitation (CPR) had been initiated by bystanders in only a few cases. The ambulance arrived within a mean time of 7.7±4.0 min. Forty‐eight per cent of the CA patients showed ventricular tachycardia or ventricular fibrillation (VT/VF) on ambulance arrival. Patients with a prolonged ambulance delay showed a lower incidence of VT/VF than patients with a short delay. Patients in whom CPR had been initiated by bystanders showed a significantly higher incidence of VT/VF (67%) than unattended patients (45%). Bystander CPR was furthermore associated with an increased incidence of VT/VF in patients with prolonged ambulance delay. VT/VF was present at the time when the ambulance arrived in 86% of the CA patients who had received CPR from a bystander and were reached within 8 min by the ambulance.
Factors Limiting Physical Working Capacity in Predialytic Uraemic Patients
Authors: CLYNE NAOMI , JOGESTRAND TOMAS , LINS LARS‐ERIC , PEHRSSON S. KENNETH , EKELUND LARS‐GÖRAN
Published: August 2010

ABSTRACT The exercise capacity of 20 predialytic uraemic patients (mean age 43±12 years) was studied prospectively. Nine of these patients were examined twice in a longitudinal study. The maximal working capacity, measured by standardized exercise test on a bicycle ergometer, averaged 74±19% of the expected normal. Normal exercise ECG were registered in 16 out of 20 patients. Total hemoglobinkg body weight (THb) was 67±16% of the expected normal and serum parathyroid hormone concentration (PTH) was 39±39 μg/l (normal range 0.5‐1.5). Partial correlation showed a correlation between exercise capacity and PTH (p<0.05). In the longitudinal study the decrease in steady state exercise capacity was correlated to the decrease in THb (p<0.05), but not to the increase in PTH. In conclusion, patients with predialytic uraemia have a reduced maximal working capacity, due to several possible factors one of which is a reduced THb. Ischaemic heart disease seems to be of minor importance.
Serum Creatine Kinase and Lactate Dehydrogenase during Cardiac Irradiation
Authors: JOENSUU H. , IRJALA K. , ASOLA R.
Published: August 2010

ABSTRACT Thirty patients irradiated to a major part of the heart had serial determinations of serum total creatine kinase (S‐CK), creatine kinase subunit B (S‐CK‐B), total lactate dehydrogenase (S‐LD) and lactate dehydrogenase isoenzyme 1 (S‐LD‐1) activity at the beginning, at the end and 14 months after radiotherapy. One patient had an elevated total S‐CK activity three months after radiotherapy, but none of the patients had an elevated S‐CK‐B activity during follow‐up. Three patients had elevated serum LD before irradiation, two patients during and two patients after radiotherapy, but only one patient had an elevated S‐LD‐1 activity, which decreased during irradiation. We conclude that the heart muscle is not injured by cardiac irradiation to such an extent that CK, CK‐B, LD and LD‐1 activities rise in serum, if moderate doses (39–62 Gy, NSD 1137–1775 rets) are delivered to the heart.
Outcome of Patients with Diabetic Nephropathy after Kidney Transplantation
Authors: EKSTRAND AGNETA , GRÖNHAGEN‐RISKA CAROLA , GROOP LEIF , KUHLBÄCK BÖRJE , AHONEN JUHANI
Published: August 2010

ABSTRACT During the period 1973–1983, 1014 patients with end stage renal failure received a kidney graft at the Helsinki University Central Hospital. As a consequence of diabetic nephropathy, 163 of them (16%) developed renal failure. Ten diabetic (6%) and 72 non‐diabetic (9%) patients received grafts from a living donor. One‐year patient survival did not differ between diabetic and non‐diabetic patients (76% and 79%, respectively). From the second post‐transplant year onwards patient survival was worse in diabetic than in non‐diabetic patients. The two groups did not differ with respect to graft survival. Sixty‐two diabetic patients (38%) died during the follow‐up period, with myocardial infarction as the most common cause of death (31%), followed by infection (15%) and cerebral stroke (13%). Seven myocardial infarctions out of 19 occurred within three months of transplantation. However, significantly more fatal and non‐fatal myocardial infarctions were observed in post‐transplant patients who had returned to dialysis therapy than in patients with a functioning kidney graft. Blindness did not influence the outcome of transplantation. Nor did the transplantation significantly affect the course of this diabetic complication. In conclusion, although the early success rate of kidney transplantation in our study population was acceptable, the later outcome was poor, mainly due to advanced disease‐related complications.
Severe Liver Damage Caused by Therapeutic Doses of Acetaminophen
Authors: FLORÉN CLAES‐HENRIK , THESLEFF PETER , NILSSON ÅKE
Published: August 2010

ABSTRACTTwo patients who ingested therapeutic doses of acetaminophen and who developed a severe hepatotoxicity are reported. Both patients had a rather high alcohol consumption, which probably made them susceptible to the toxic effects of acetaminophen.
Efficacy of Dietary Instructions in Newly Diagnosed Non‐insulin‐dependent Diabetic Patients
Authors: KORHONEN TIMO , UUSITUPA MATTI , ARO ANTTI , KUMPULAINEN TERTTU , SIITONEN ONNI , VOUTILAINEN ERKKI , PYÖRÄLÄ KALEVI
Published: August 2010

ABSTRACT Eighty consecutive newly diagnosed non‐insulin‐dependent diabetic patients were randomly allocated into two groups to compare two different patient education regimens. One group received individual dietary instructions by a nurse and the other a short, written leaflet given by a doctor. The principal aim of the dietary instructions was weight reduction. A significant weight loss and improvement in the control of diabetes occurred in both groups, and these changes were similar in the two groups. At the end of one year's follow‐up, however, only 25% of the patients were satisfactorily controlled (fasting blood glucose ≤6.0 mmol/l). The degree of weight loss correlated only weakly with the improvement in the metabolic control. The degree of obesity and insulin secretion capacity as measured at the beginning of the study did not predict the improvement of glycaemic control during the study. At the end of the study a significant improvement was observed in serum lipids of patients with good control (fasting blood glucose ≤6.0 mmol/l) or weight loss (>5 kg). In conclusion, both brief, written and individual dietary instructions induced a significant weight loss as well as improved glucose and lipid metabolism in newly diagnosed non‐insulin‐dependent diabetic patients, but satisfactory metabolic control was achieved only in a minority of the patients.
Bilateral Papilledema with Normal CT‐scan in Neurosarcoidosis
Authors: JENSEN SØREN , JENSEN IVAN W.
Published: August 2010

ABSTRACT A 74‐year‐old woman was admitted with fever, muscle and joint pain and a mild hypercalcemia. Rather suddenly she turned unconscious and bilateral papilledema was found. A subsequent CT of the brain, however, did not disclose signs of space‐occupying masses or increased intracranial pressure. She died two days later and at autopsy there were no signs of incarceration. Microscopic examination revealed non‐caseating epithelioid granulomas throughout the meninges and brain consistent with sarcoidosis.
Platelet Clumping in Ph‐negative Myeloproliferative Syndromes
Authors: NORBERG BO , NILSSON TORBJöRN K.
Published: August 2010

ABSTRACT. A retrospective analysis of evidence of platelet clumping, an in vitro phenomenon in blood samples anticoagulated by EDTA, was performed in 49 patients with myeloproliferative diseases other than chronic myeloid leukaemia. Evidence of platelet clumping was provided by the H6000 picture, which in the presence of platelet aggregates yields a characteristic “whisk” in a defined region. Out of the 49 patients, 17 (35%) had evidence of platelet clumping which, however, occurred in an unpredictable manner from time to time. Platelet clumping thus provides a confounding factor when automated platelet counts are used to monitor effects of cytotoxic treatment in this type of disorders. In a prospective study, it was shown that the problem can be overcome by optimizing the hospital routine to secure minimum delay between sampling and analysis.
Staphylococcus aureus Bacteremia in Patients with Hematological Malignancies and/or Agranulocytosis
Authors: ESPERSEN FRANK , FRIMODT‐MøLLER NIELS , ROSDAHL VIBEKE THAMDRUP , JESSEN OVE , FABER VIGGO , ROSENDAL KIRSTEN
Published: August 2010

ABSTRACT. A total of 6 253 cases of Staphylococcus aureus bacteremia, including 274 (4.4%) endocarditis cases, were registered in Denmark in the period 1975–1984. Patients with hematological malignancies and/or agranulocytosis accounted for 479 of the bacteremia cases. The incidence of endocarditis in this group of patients was only 0.4% as compared to 4.7% in other patients with staphylococcal bacteremia (p<0.01). The lower incidence of endocarditis complicating bacteremia in these patients may justify a shorter course of therapy than usually recommended for suspected endocarditis. Patients with hematological malignancies and other patients with agranulocytosis had a higher mortality (49 and 46%, respectively) than other patients with S. aureus bacteremia (33%). The highest mortality was found in patients with multiple myeloma (71%, p<0.01), the lowest in patients with acute lymphocytic leukemia (28%, p<0.01). The higher mortality in these patients may indicate that empiric antibiotic regimens in granulocytopenic patients should include a specific anti‐staphylococcal agent.
Is CT scan a valid indicator of brain atrophy in alcoholism?
Authors: Cala Lesley A
Published: August 2010

The effect of ingesting varying quantities of alcohol upon the structure and function of the brain was studied using CT scan and psychometric testing. Nutritional status was also assessed. Alcoholics, heavy, moderate and light social drinkers were examined and their results compared with a normal control series. It was concluded that a daily consumption of more than 40 grams alcohol per day, “the safe level” results in brain damage. The latter may partially reverse with abstinence and having reversed maintain improvement, even though patients then resume drinking at the “safe level”. The role of thiamin in brain function is still unclear.