bluuebunny/crossref_metadata_2025 huggingface dataset:
Blood pressure response during maximal exercise in apparently healthy men and women
Authors: MICHELSEN S. , OTTERSTAD J. E.
Published: August 2009

Abstract. The blood pressure (BP) response during a maximal ergometer bicycle test was studied in 190 apparently healthy subjects (95 men and 95 women) aged 21–70 years. The starting load was 50 W and was increased by 50 W every 4 min until exhaustion. Mean physical performance expressed as cumulative work was 2276±789 W in men and 1109±276 W in women (P < 0.0001). The maximum heart rate was similar in men and women and declined significantly with age (r = − 0.78, P < 0.001 for men and r = − 0.64, P < 0.0001 for women). The mean maximal systolic blood pressure (MSBP) was 193±23 mmHg in men and 171±21 mmHg in women (P < 0.0001). Men aged ≥ 50 years had a MSBP of 201±22 mmHg, compared to 188±22 mmHg in those aged < 50 years (P < 0.01). Women aged ≥ 60 years had a MSBP of 190±21 mmHg compared to 166±19 mmHg in their younger counterparts (P < 0.001). The diastolic BP showed a similar modest increase at all ages and in both sexes.

SBP is dependent on age and gender and this must be taken into consideration when assessing a normal response in individual patients.
Right arm involvement and pain extension can help to differentiate coronary diseases from chest pain of other origin: a prospective emergency ward study of 278 consecutive patients admitted for chest pain
Authors: BERGER J. P. , BUCLIN T. , HALLER E. , VAN MELLE G. , YERSIN B.
Published: August 2009

Abstract. In a prospective study of 278 consecutive patients admitted to an emergency ward for chest pain, the 115 clinical and paraclinical parameters available at the time of admission were evaluated by computer comparison with the final diagnoses. The most valuable items for making the diagnosis were classified according to their sensitivity, specificity and predictive value. Among the 278 patients, 100 individuals had myocardial infarctions (MI), 47 had unstable angina, 25 had stable angina and 106 patients had a non‐coronary disease.

The twelve most sensitive items for distinguishing MI from other conditions were the following: sudden onset of pain (70%): duration of more than 60 min (88%): constriction and squeezing (79%): oppression (75%): prior anginal attacks (61%): sex male (72%): age over 60 years (74%): abnormal heart auscultation (62%): abnormal electrocardiogram (ECG)(98%): segment (ST) disturbances (86%): increased glucose level (77%): CKMB fraction greater than 6% of total creatine kinase (CK) level (63%).

Among the twelve most specific items, also with the best positive predictive value, irradiation in the right arm is of most importance: among the 51 patients with right arm involvement, 48 suffered from a coronary disease and 41 from a myocardial infarction. The largest extension of pain was reported in the latter group.

It is concluded that chest pain with a wide irradiation involving the right arm strongly suggests that a myocardial infarction is ongoing.
Influence of menopause on dietary treatment of obesity
Authors: ANDERSSON B. , SEIDELL J. , TERNING K. , BJÖRNTORP P.
Published: August 2009

Abstract. Obese women (n = 104) were treated with an energy reduced diet (1100 kcal d−1) in a strictly standardized outpatient regime. Body composition, regional adipose tissue distribution, regional fat cell sizes and metabolic variables were followed before treatment, after 5% weight loss and at the stage when there was no further weight loss. Premenopausal women lost less body fat and relapsed earlier after treatment, compared with menopausal women. Fat loss appeared to be more uniform, and included several adipose tissue regions in postmenopausal women, while younger women seemed to lose fat mainly from the epigastrial fat cells. Higher baseline levels of thyroid hormones were associated with increased fat loss and a tendency to lose less lean body mass. Waist/hip and waist/thigh ratios did not change in response to weight loss. The addition of fibre to the diet did not affect the rate of relapse.

These results suggest that obesity treatment by implementation of a negative calorie balance might be more successful in postmenopausal than in younger women, perhaps due to the more uniform availability of body fat in the former.
γ2‐MSH in congestive heart failure: relation to atrial natriuretic peptide, arginine vasopressin and catecholamines
Authors: EDVINSSON L. , EKMAN R. , HEDNER P. , SJÖHOLM A. , VALDEMARSSON S.
Published: August 2009

Abstract. A possible role of the proopiomelanocortin derived peptide γ2–melanocyte stimulating hormone (γ2‐MSH) has been studied in patients with various degrees of congestive heart failure (CHF). The profile of changes in circulating levels of γ2‐MSH‐like immunoreactivity (‐LI) has been compared with those of atrial natriuretic peptide (ANP)‐LI, arginine vasopressin (AVP)‐LI and catecholamines in CHF. Patients with moderate CHF (New York Heart Association stages I‐II) showed significantly higher levels of h‐αANP‐LI and NA (P < 0.05) compared to controls. Patients with severe CHF (stages III‐IV) had significantly higher levels of all hormones measured compared to controls: noradrenaline. P < 0.001: adrenaline, P < 0.001: γ2‐MSH‐LI, P < 0.001: h‐αANP‐LI, P < 0.05: AVP‐LI, P < 0.01. For the catecholamines and γ2‐MSH‐LI there was a significant increase from moderate to severe forms of CHF. A significant correlation was observed between γ2‐MSH‐LI and noradrenaline, and between h‐αANP‐LI and noradrenaline in patients with CHF. The present results show that γ2‐MSH‐LI is increased only in severe forms of cardiac failure, and that this change is more closely related to the increase in circulating levels of noradrenaline than to increased levels of ANP‐LI or AVP‐LI.
Two‐year survival after myocardial infarction
Authors: ERICSSON C.‐G. , ERHARDT L. , REHNQVIST N.
Published: August 2009

Abstract. We have studied 773 consecutive cases (706 individuals) with definite myocardial infarction treated in the Coronary Care Unit at Danderyd Hospital in Stockholm during the period 1984–85. Hospital mortality was 12.9% in all patients and 8.9% in patients under 70 years of age. Six hundred and six patients were discharged from the hospital and followed up for 2 years. The 2‐year mortality in ischaemic heart disease was 14.4% in all patients and 9.5% in patients under 70 years of age and, including all causes of death, 20.3% and 14.6%, respectively. Our policy for medical treatment included frequent use of beta‐adrenergic blocking agents, even in heart failure, and restricted use of antiarrhythmic drugs and digitalis. A short delay of admission may have been beneficial for the result of different kinds of anti‐ischaemic intervention. Furthermore, a routinely performed exercise ECG before discharge and after 6 weeks, as part of a structured follow‐up, has improved our ability to detect complications at an early stage and to optimize medical treatment.
Increased turnover of very low density lipoprotein triglyceride during treatment with cholestyramine in familial hypercholesterolaemia
Authors: ANGELIN B. , LEIJD B. , HULTCRANTZ R. , EINARSSON K.
Published: August 2009

Abstract. Kinetics of very low density lipoprotein (VLDL) triglyceride were determined in seven patients with heterozygous familial hypercholesterolaemia, using a 3H‐glycerol technique. The study was repeated after 5–7 weeks of therapy with the bile acid‐binding resin, cholestyramine. The rate of synthesis of VLDL triglyceride was increased by 85% (P < 0.05) during resin therapy. Simultaneously, the fractional catabolic rate of VLDL was increased by 40% (P < 0.02), so that only a moderate increase in plasma concentration was observed.

Repeated measurements of VLDL size by electron microscopy (before, 1 week, and 5–7 weeks after initiation of therapy) indicated that a transient increase in VLDL size occurred in response to cholestyramine.

The results are consistent with a stimulatory effect of bile acid sequestrants on VLDL triglyceride production and indicate that, in most subjects, a compensatory increase in VLDL triglyceride removal occurs.
Possible induction of systemic lupus erythematosus by interferon‐α treatment in a patient with a malignant carcinoid tumour
Authors: RÖNNBLOM L. E. , ALM G. V. , ÖBERG K. E.
Published: August 2009

Abstract. Interferon‐α (IFN‐α) is currently used in the treatment of various malignant tumours. Development of different autoimmune disorders has been reported in some patients during IFN‐α therapy. Systemic lupus erythematosus (SLE) after treatment with IFN‐α has not been described, although a majority of SLE patients have demonstrable serum levels of IFN‐α, which correlate with disease activity and have been suggested to be of pathogenetic significance.

In this paper we describe a patient with a malignant carcinoid tumour who developed a SLE‐like syndrome during treatment with leucocyte IFN‐α. The patient developed myalgia and low grade arthritis in multiple joints together with a high titre of antinuclear antibodies (ANA) and anti‐dsDNA antibodies. After the treatment was stopped, the symptoms subsided although a moderate ANA titre persisted. However, the tumour continued to regress despite cessation of IFN‐α therapy. During a short course with recominant IFN‐α the syndrome relapsed, supporting the concept that the SLE syndrome was precipitated by IFN‐α. A connection between IFN‐α treatment, the induced autoimmune disorder and regression of the carcinoid tumour is suggested.
Self‐terminating idiopathic ventricular fibrillation presenting as syncope: a 40‐year follow‐up report
Authors: KONTNY F. , DALE J.
Published: August 2009

Abstract. Out‐of‐hospital ventricular tachyarrhythmia has a high mortality. Most patients sustaining this type of arrhythmia have an organic heart disease. In this case report we present a patient with recurrent ventricular fibrillation with the clinical appearance of syncope, where no relevant organic heart disease could be found at autopsy performed 40 years later.
Ratio of cuff width/arm circumference as a determinant of arterial blood pressure measurements in adults
Authors: RÅSTAM L. , PRINEAS R. J. , GOMEZ‐MARIN O.
Published: August 2009

Abstract.Recommendations state that the optimum ratio of blood pressure cuff width/arm circumference (CW/AC) is about 0.4. In this study of middle‐aged men (n= 940) and women (n= 1484), we analysed the effect of CW/AC on blood pressure measurement variability and its interaction with age, body mass index (BMI), pulse rate and room temperature. In univariate polynomial regression, the variability (R2) in blood pressure that was explained by CW/AC was greater for women (systolic 6.3% and diastolic 5.7%) than for men (2.0% and 0.5%). In multivariate analysis the maximum variability explained independently by CW/AC was 2.7% for male and 6.7% for female systolic blood pressure, and 1.1% and 6.0% for male and female diastolic blood pressure, respectively. For systolic blood pressure this represented 10.4% of the explained variability in men and 9.3% of that in women. CW/AC is an important independent contributor to inter‐individual variation in blood pressure measurement. It should therefore be taken into consideration in epidemiological studies and when medical care is being planned.
Elevated fibrinogen and plasminogen activator inhibitor (PAI‐1) in hypertension are related to metabolic risk factors for cardiovascular disease
Authors: LANDIN K. , TENGBORN L. , SMITH U.
Published: August 2009

Abstract. The relationship between hypertension, glucose metabolism, fibrinogen and plasminogen activator inhibitor of endothelial cell type (PAI‐1) was studied under conditions in which the influence of obesity and adipose tissue distribution (waist/hip ratio) were controlled. Twenty‐two non‐obese, middle‐aged men with normal blood pressure (n = 11) and untreated mild hypertension (n = 11), respectively, participated in the study.

Cholesterol, triglyceride and insulin levels were higher in hypertensive men than in the control group. Glucose disposal was studied as an indicator of insulin sensitivity using the euglycaemic clamp technique. The insulin effect tended to be less marked in men with hypertension. PAI‐1 was higher in hypertensive men compared to the controls. A strong positive correlation was observed between PAI‐1 and insulin levels as well as blood pressure. PAI‐1 and fibrinogen levels correlated negatively with the rate of glucose disposal.

Thus, even in these non‐obese and mildly hypertensive individuals, an enhanced metabolic risk factor profile for cardiovascular disease was found. The metabolic aberrations were related to elevated fibrinogen and PAI‐1 levels which, in turn, increase the risk of thrombus formation.
Direct diabetogenic effect of diltiazem ?
Authors: IVERSEN E. , JEPPESEN D. , STEENSGAARD‐HANSEN F.
Published: August 2009

Abstract. In the reported case history, a normotensive and non‐diabetic patient with ischaemic heart disease was treated twice with diltiazem. On both occasions diabetes mellitus developed within a few days; at first this was fully reversible, but on the last occasion it was irreversible.
Increased lipolytic sensitivity to catecholamines in diabetic patients with severe autonomic neuropathy
Authors: WAHRENBERG H. , ARNER P. , ADAMSSON U. , LINS P.‐E. , JUHLIN‐DANNFELT A. , ÖSTMAN J.
Published: August 2009

Abstract. Lipolytic sensitivity to catecholamines was studied in gluteal adipocytes from diabetic subjects with severe (n = 3), mild (n = 6) or no autonomic neuropathy (n = 8). Two of the three patients with severe autonomic neuropathy had a completely abolished plasma epinephrine response to insulin‐induced hypoglycaemia, whereas the third patient showed a reduced and delayed plasma epinephrine response. Lipolytic sensitivity to isoprenaline (P < 0.05), and to epinephrine in the presence of yohimbine (P < 0.0001), was significantly increased in the diabetic subjects with severe autonomic neuropathy, compared to the other study groups. Moreover, the specific binding of the beta‐adrenoceptor antagonist (±)‐4‐(3‐butylamino‐2‐hydroxypropoxyl)‐(5.7‐3H)‐benzimida‐zole‐2‐one‐hydrochloride (3H‐CGP) was markedly exaggerated (P < 0.05) in the patients with severe autonomic neuropathy. These findings demonstrate that the lipolytic sensitivity to catecholamines in adipose tissue was increased only in patients with severe autonomic neuropathy and impaired epinephrine response to insulin‐induced hypoglycaemia. This increased beta‐adrenergic sensitivity could, at least in part, be attributed to an increased density of beta‐adrenergic receptors in the adipocytes.
Long‐term bone loss in insulin‐dependent diabetes mellitus
Authors: MATHIASSEN B. , NIELSEN S. , DITZEL J. , RØDBRO P.
Published: August 2009

Abstract. The bone mineral content (BMC) in patients with insulin‐dependent diabetes is reduced by 10% early in the disease, but due to a lack of long‐term longitudinal studies it is unknown whether this diabetic osteopenia develops further through life.

Over a time period of 11 years we examined the BMC in a group of seven adult insulin‐dependent diabetics, in whom physiological and pathological factors affecting bone metabolism had been excluded; the patients were well regulated without diabetic complications. The BMC was not significantly decreased at the initial examination. The longitudinal study revealed a small but statistically significant fall in BMC, mainly in trabecular bone. The narrow (95%) confidence interval of median end value (93.3–99.0% of initial BMC) indicates that the annual decrease in BMC in such patients is of the order of 0.5%, a reduction that is probably clinically insignificant.
Nifedipine as an antihypertensive drug in patients with renal failure — pharmacokinetics and effects
Authors: ODAR‐CEDERLÖF I. , ANDERSON P. , BONDESSON U.
Published: August 2009

Abstract.Pharmacokinetics and pharmacodynamics of nifedipine were studied in 12 patients with renal failure and hypertension, after a single dose and during an 18‐week treatment period.

The plasma concentrations of nifedipine and its first pyridine metabolite were measured by gas chromatography mass spectrometry. The oral plasma clearance of nifedipine was 1189 ± 876 ml min−1, and the mean plasma half‐life (t1/2) was 5.99 ± 3.05 h. The pyridine metabolite was not retained. Plasma concentrations of nifedipine were found to be significantly correlated with the effects on blood pressure, forearm blood flow and peripheral resistance, and these effects did not vary with the degree of renal failure. Normotension was achieved in eight of the nine patients observed over a period of 4 months with doses in the range 20–40 mg, administered twice daily. The mean Cr‐EDTA clearance remained unchanged during the study (initial value 31.4 ± 12.3 ml min−1; final value 32.7 ± 14.4 ml min−1), and in three patients it increased.

Nifedipine induces a slight increase in metabolic rate in patients with renal failure, but it is not necessary to modify the dose. It is effective in lowering blood pressure, has mild side‐effects and may improve renal function in some patients.
Decreased mitogenic activity in hypercholesterolaemic plasma
Authors: MÖLGAARD J. , CARLSSON M. , NILSSON J. , OLSSON A. G.
Published: August 2009

Abstract. The mitogenic activity on rat aortic smooth muscle cells of plasma from patients with hypercholesterolaemia was compared to that of plasma from a normocholesterolaemic control group and to that obtained after lowering plasma cholesterol levels in the hypercholesterolaemic groups with simvastatin. Mean plasma total and low density lipoprotein cholesterol and apolipoprotein B concentrations in the two groups were 8.62 ± 0.62 mmol l−1, 7.03 ± 0.56 mmol l−1 and 1.96 ± 0.14 g l−1, respectively, and 5.05 ± 0.20 mmol l−1, 3.42 ± 0.18 mmol l−1 and 0.80 ± 0.04 g l−1, respectively, all differences significant at P < 0.001. During simvastatin treatment these parameters decreased to 5.70 ± 0.35, 4.15 ± 0.33 mmol l−1 and 1.33 ± 0.08 g l−1, all changes being significantly (P < 0.001) lower than before treatment. Hyperlipidaemic plasma in untreated patients had a significantly lower mitogenic activity than normolipidaemic control plasma as measured by autoradiographic labelling of DNA after 3H‐thymidine incorporation, 25.7 ± 1.8% vs. 32.0 ± 1.9%, P < 0.05. Lowering plasma cholesterol levels in the hyperlipidaemic patients ‘normalized’ the mitogenic activity to 32.3 ± 1.6%, P < 0.05. The reason for this unexpected finding is not known.
Effects of a new fluid fish oil concentrate, ESKIMO‐3, on triglycerides, cholesterol, fibrinogen and blood pressure
Authors: HAGLUND O. , WALLIN R. , LUOSTARINEN R. , SALDEEN T.
Published: August 2009

Abstract. Eskimos have a very low incidence of cardiovascular disease, at least in part due to a high intake of n‐3 fatty acids. ESKIMO‐3 is a new stabilized (insensitive to oxidation) fluid fish oil concentrate, 30 ml of which contains an amount of eicosapentaenoic acid and total n‐3 fatty acids equivalent to the daily intake among Eskimos.

Thirty‐three volunteers, healthy or with coronary artery disease, were given ESKIMO‐3, at a dose of 15 or 30 ml d−1, corresponding to 2.7 or 5.4 g of eicosapentaenoic acid d−1, or placebo oil, for a period of up to 6 months.

ESKIMO‐3 had a pronounced dose‐dependent effect on several risk factors for coronary artery disease. Intake of one tablespoon (15 ml) daily for 6 months significantly reduced levels of triglycerides (‐64%), total cholesterol (‐8%), plasma fibrinogen (‐23%) and diastolic blood pressure (‐9%). Bleeding time was unchanged. Intake of two tablespoons daily for 4 weeks increased plasma eicosapentaenoic acid levels by 490%, and decreased arachidonic acid by 20%. The HDL concentration increased by 21%. No change in the above mentioned variables was observed after intake of placebo oil.
Can the course of high dose cotrimoxazole for Pneumocystis carinii pneumonia in AIDS be shorter? A possible solution to the problem of cotrimoxazole toxicity
Authors: SCHATTENKERK J. K. M. EEFTINCK , LANGE J. M. A. , VAN STEENWIJK R. P. , DANNER S. A.
Published: August 2009

Abstract. Fifty consecutive patients with confirmed PCP received a high dose of cotrimoxazole for 14 d, or until development of intolerance, directly followed by reduced dose maintenance therapy. Seven individuals died during the high dose course. Twenty (47%) of the 43 survivors showed toxicity reactions that necessitated dose reduction to maintenance level on average after 9.6 d. Thirteen of these 20 individuals tolerated the reduced dose, and seven did not. No further cases of toxicity were observed. In 43 survivors only one early relapse (day 17) was observed in a patient who had received full dose treatment for 14 d.

We conclude (1) that extending high dose cotrimoxazole therapy beyond 2 weeks is usually unnecessary, provided that reduced dose maintenance therapy is given directly, and (2) that dose reduction on appearance of toxicity signs during the second week of treatment is safe and allows two‐thirds of patients to be maintained on cotrimoxazole with satisfactory results.
Erythropoietin deficiency in acute tubular necrosis
Authors: NIELSEN O. J. , THAYSEN J. H.
Published: August 2009

Abstract. Serum erythropoietin (EPO) concentrations were markedly depressed relative to the degree of anaemia in 10 patients with acute tubular necrosis, and remained low long after restoration of excretory renal function as estimated by glomerular filtration rate. Evidence is presented that the low serum EPO level is due to defective synthesis and not to increased catabolism. It is suggested that the predominantly aregeneratory anaemia found in prolonged cases of acute tubular necrosis, and the slow restoration of red cell mass during recovery, are due to the deficient synthesis of EPO. A positive erythropoietic response in a therapeutic trial with recombinant human erythropoietin (rhEPO) appears to support this hypothesis.
Osteoporosis after long‐term corticosteroid treatment of giant cell arteritis
Authors: ANDERSSON R. , RUNDGREN Å. , ROSENGREN K. , BENGTSSON B.‐Å. , MALMVALL B.‐E. , MELLSTRÖM D.
Published: August 2009

Abstract. The mineral content of the heel bone, and signs of osteoporosis on X‐ray of the spine, were evaluated in 26 patients (20 women and 6 men) with giant cell arteritis (GCA), treated with prednisolone for an average period of 5 years. The mean age was 78 years (range 66–95 years). These results were compared with those obtained from a large population study of individuals aged 72, 75, 82 and 85 years.

An increase of obvious and severe spinal osteoporosis from 16 to 85% was observed in the women in the population study between the ages of 72 and 85. No additional osteoporosis that could be attributed to the cortisone treatment was found among the GCA patients. The bone mineral content was not reduced in the patients compared to the general population.

We conclude that there is no justification for attempting non‐steroid treatment in GCA on account of the risk of osteoporosis. Corticosteroids are the only safe treatment for prevention of complications of GCA.
Long‐term nopharmacological treatment for mild to moderate hypertension
Authors: JULA A. , RÖNNEMAA T. , RASTAS M. , KARVETTI R.‐L. , MÄKI J.
Published: August 2009

Abstract. Ninety‐one middle‐aged men and women with untreated mild hypertension were allocated to a nopharmacological treatment group or to a control group. Members of the treatment group were instructed to reduce daily sodium intake to < 70 mmol, to reduce the intake of saturated fat, to lose weight if necessary and to perform regular physical exercise and relaxation training. Adherence to and effects of the programme on blood pressure and serum lipids were monitored for 12 months. In the treatment group, daily sodium excretion decreased to and remained at 50% of its original level (P < 0.001), and there was a significant reduction in saturated fat intake. The average weight reduction was modest. Adherence to physical exercise and relaxation training regimens was poor. The net decreases (difference in changes between treatment and control group) in blood pressure were greatest during the first 3 months: in men the decrease in systolic blood pressure was 11.3 mmHg (P < 0.001) and in diastolic blood pressure 8.3 mmHg (P < 0.001); in women the decrease in systolic blood pressure was 10.8 mmHg (P < 0.01) and in diastolic blood pressure 6.4 mmHg (P < 0.01). However, this decrease diminished during the last 3 months to approximately one half owing to blood pressure reduction in controls. Low density lipoprotein cholesterol levels decreased significantly in treated men and women.
Eighty‐year‐old men without cardiovascular disease in the community of Malmö. Part I. Social and medical factors, with special reference to the lipoprotein pattern
Authors: STAVENOW L. , ELMSTÅHL S. , JERNTORP P. , NILSSON‐EHLE P. , PESSAH‐RASMUSSEN H. , GALVARD H. , HANSEN F. , SAMUELSSON S.‐M.
Published: August 2009

Abstract. A total of 1280 80‐year‐old men were invited to a medical examination to study common risk indicators for cardiovascular disease (CVD) in the elderly. From the pool of 811 responders (63.3%), all 122 individuals who fulfilled our inclusion criteria were assigned to one of four groups: (1) no CVD, non‐smokers; (2) no CVD, smokers; (3) CVD, smokers; (4) CVD, non‐smokers. A telephone interview with 75 non‐responders suggested that this group contained more institutionalized subjects, but otherwise did not differ from the group of participants. Subjects with CVD had higher levels of plasma cholesterol and LDL cholesterol than those without CVD, whereas plasma HDL cholesterol and plasma triglyceride concentrations did not differ between the groups; thus the LDL/HDL ratio was higher in the CVD group. Lipoprotein concentrations did not differ between smokers and non‐smokers. However, the mean cholesterol levels were low (5.19 ± 1.01 mmol l−1), suggesting selective mortality. No differences between the groups were found with regard to Lp(a). The mean blood pressure for the whole group was 149/79 mmHg, and there were no differences between subgroups.

Our study suggests that mechanisms such as selective mortality modify the risk factor pattern in the elderly. In 80‐year‐old individuals, elevated LDL cholesterol levels can still be identified as a risk indicator for CVD, whereas there does not appear to be any association between CVD or low HDL levels or elevated blood pressure in this age group.
Development of postpartum spontaneously resolving transient Graves' hyperthyroidism followed immediately by transient hypothyroidism
Authors: SHIGEMASA C. , MITANI Y. , TANIGUCHI S. , UETA Y. , URABE K. , TANAKA T. , YOSHIDA A. , MASHIBA H.
Published: August 2009

Abstract. A 25‐year‐old woman with a history of Graves' disease, in remission for 8.5 years following 6 months of methimazole therapy, first came to our attention 5 months after her first delivery with clinical and biochemical hypothyroidism, markedly elevated titre of anti‐thyroid microsomal antibody (MCHA; 1: 102400) and mildly elevated activity of thyrotropin‐binding inhibitory immunoglobulins (TBII; 29.5%). After short‐term (3 months) treatment with L‐thyroxine therapy, the development of hyperthyroidism in the first trimester of the second pregnancy, which remitted through the second and third trimesters, was observed. TBII showed a peak value (93.1%) 1 month after the onset of hyperthyroidism, and a normal value (12.4%) 6 d after delivery. One month after the second delivery, the patient developed hyperthyroidism, with an elevation of 99mTc thyroid uptake (5.58%; normal range 0.5–2.5%), which was immediately followed by transient clinical and biochemical hypothyroidism. Concomitant increases in MCHA titre and TBII activity were observed after delivery, and both reached peak levels (1: 409600 and 81.0%, respectively) one and a half months after the onset of hypothyroidism. Thyroid‐stimulating antibody (TSAb), measured using FRTL‐5 thyroid cells, was detected at a weakly positive level (161%) on initial examination, and the serial change in TSAb was almost identical to that in TBII.

Patients with Graves' disease may develop Graves' type hyperthyroidism, followed immediately by transient hypothyroidism due to coexisting destructive autoimmune thyroiditis during the early postpartum period, despite increasing TSAb activity.
Thermography and plethysmography, a non‐invasive alternative to venography in the diagnosis of deep vein thrombosis
Authors: HOLMGREN K. , JACOBSSON H. , JOHNSSON H. , LÖFSJÖGÅRD‐NILSSON E.
Published: August 2009

Abstract. One plethysmographic and two thermographic methods were evaluated against venography in 102 patients with suspected deep vein thrombosis (DVT). Seventy‐one patients had venographically verified DVT, which in 21 cases was restricted to the calf. Plethysmography (PG) gave a sensitivity and specificity of 63% and 94%, respectively. The former was influenced by a limited sensitivity of 14% in the sub‐group with distal DVT. The sensitivity and specificity of temperature profiles (TP) were 87% and 39%, respectively, while the corresponding values for thermo‐camera (TC) were 83% and 55%, respectively. Using a combined diagnostic approach of PG and TP, additional evaluation of posterior and lateral profiles and pattern recognition. 96% sensitivity and 81% specificity were reached. The combination of PG and TP will be an essential diagnostic complement when venography is not possible or inconclusive, as well as having a role in diagnostic screening in a large number of patients.
Low plasma concentrations of atrial natriuretic peptide in untreated hypothyroid patients
Authors: WIDECKA K. , GOZDZIK J. , DUTKIEWICZ T. , MAMOS E. , CZEKALSKI S.
Published: August 2009

Abstract. A group of patients with primary hypothyroidism has been studied, and it is reported that low serum levels of thyroid hormones are accompanied by low plasma atrial natriuretic peptide (ANP) concentrations. While the correlation between ANP and thyroid hormone levels is strong, no correlation was found between ANP and heart rate or arterial blood pressure. It is suggested that thyroid hormones directly stimulate the release of ANP from atrial cardiocytes.
Low succinate dehydrogenase (SDH) activity in a patient with a hereditary myopathy with paroxysmal myoglobinuria
Authors: LINDERHOLM H. , ESSÉN‐GUSTAVSSON B. , THORNELL L.‐E.
Published: August 2009

Abstract. An unusual hereditary myopathy with paroxysmal myoglobinuria has been described previously. We have studied muscle biopsy specimens taken before and after exercise to exhaustion (24 min at 20–25 W) in a young woman with this condition. Marked glycogenolysis with lactate production and marked phosphagen breakdown (ATP + CP) were observed after exercise, and almost all type I fibres were found to be depleted of glycogen. Succinate dehydrogenase (SDH) activity was low, while the activities of 3‐OH‐acyl‐CoA‐dehydrogenase, phosphofructokinase, phosphorylase and lactate dehydrogenase were normal. On electron microscopy, the mitochondria showed abnormalities typical of mitochondrial myopathy. The findings in our patient suggest a limitation of mitochondrial function, probably related to SDH in the tricarboxylic acid cycle and complex II in the electron transport chain. This may explain the inability of ATP regeneration to keep pace with ATP utilization during exercise. Other metabolic defects may coexist.
Drug related hospital admissions: the role of definitions and intensity of data collection, and the possibility of prevention
Authors: HALLAS J. , HARVALD B. , GRAM L. F. , GRODUM E. , BRØSEN K. , HAGHFELT T. , DAMSBO N.
Published: August 2009

Abstract. Three hundred and thirty‐three consecutive patients in a medical ward were evaluated in a high‐intensity monitoring scheme for drug events as a cause of hospitalization. Taking into consideration only ‘definite’ and ‘probable’ drug events, we found 36 cases (10.8%) of all admissions to be drug‐related hospitalizations (DRH). Of these, 8.1% were adverse drug reactions and 2.7% were therapeutic failures due to ineffective dosage. In 8 cases (2.4%) the drug event could definitely have been avoided, and a further 13 cases (3.9%) were considered to have been potentially avoidable if appropriate measures had been taken by the health service. In 19 cases (53%) the referring physician was unaware of the drug‐related problem. Those patients admitted because of a drug event were taking significantly more drugs than other individuals. The avoidable drug events pointed to the primary health care physicians as the appropriate targets for preventive measures in terms of intensified drug education.

The study demonstrated that a reliable estimate of the DRH rate requires active data collection by a qualified health service worker in close collaboration with the patient's family doctor in cases of suspected DRH.
A study of patients with diabetes mellitus (type 1) and end‐stage renal failure: tobacco usage may increase risk of nephropathy and death
Authors: STEGMAYR B. G.
Published: August 2009

Abstract. Thirty‐four consecutive patients with diabetes mellitus as a plausible cause of end‐stage renal failure were investigated with regard to outcome and tobacco consumption. The mean duration of diabetes was 25.5 years. Thirty‐one of the patients had used tobacco regularly for at least 5 years. For 28 patients it was possible to calculate the intake of tobacco as the daily mean and the total consumption (expressed as pack years). The time period (in years) between initiation of tobacco usage and onset of persistent proteinuria, as an early indicator of diabetic nephropathy, was shorter if the daily consumption of tobacco was higher (P < 0.01) and the total consumption (pack years) in these patients was lower (P < 0.05). There was an increased risk of early death (P < 0.01) in patients who were currently smokers when they were uraemic (predialysis), on dialysis or had kidney grafts, compared to those who had never used tobacco or who were ex‐smokers. In conclusion, it appears to be important for insulin‐dependent diabetic patients to avoid tobacco usage and for current smokers to give up the habit in order to reduce the risk of diabetic nephropathy and early death.
Mortality and morbidity during one year of follow‐up in suspected acute myocardial infarction in relation to early diagnosis: experiences from the MIAMI trial
Authors: HERLITZ J. , KARLSON B. W. , HJALMARSON Å.
Published: August 2009

Abstract. From a large randomized multicentre trial of metoprolol in suspected acute myocardial infarction (n = 5778) we report on the outcome during 1 year of follow‐up, in relation to early diagnosis. Patients who developed a confirmed infarction had a 1‐year mortality rate of 12.8%. This was significantly higher than the mortality rate of 6.3% (P < 0.001) in patients with possible infarction and it was also higher than that in patients with no infarction, which was 5.0% (P < 0.001). A multivariate analysis showed that independent risk predictors in the clinical history of patients without confirmed infarction were a history of angina pectoris, chronic use of digitalis and advanced age. After 1 year, angina pectoris was most common in patients with an initial possible infarction. These patients were also in most urgent need of bypass surgery. We thus conclude that the mortality during 1 year of follow‐up among patients with an initially strongly suspected acute myocardial infarction was clearly related to whether or not the patient developed a myocardial infarction.
The captopril test for identification of renovascular hypertension: value and immediate adverse effects
Authors: HANSEN P. B. , GARSDAL P. , FRUERGAARD P.
Published: August 2009

Abstract. To develop a screening test for identification of renovascular hypertension, the blood pressure and plasma renin concentration responses to an oral test dose of captopril (6.25 mg) were studied in 47 hypertensive patients of mean age 61 years (range 34‐85 years). Blood pressure was measured at 15‐min intervals for 90 min after administration of captopril. Blood samples for plasma renin determination were drawn immediately before and 90 min after drug administration. Eleven patients had renal artery stenosis. The fall in diastolic blood pressure in these patients was greater, on average, than in patients with other forms of hypertension (30 mmHg vs. 14 mmHg, P < 0.01), as was the increase in plasma renin concentration (188 mU l−1 vs. 2 mU l−1, P < 0.01). This study demonstrates that the short‐term captopril test is useful for distinguishing patients with renovascular disease from those with other forms of hypertension. During the test, 7 patients (15%) exhibited reversible cerebral symptoms. In two of these subjects digital subtraction angiography was performed, which revealed stenosis of the carotid artery. Consequently, it is suggested that captopril should not be used in patients with arteriosclerotic stenoses of the carotids.
Dietary supplementation with n‐3 fatty acids may impair glucose homeostasis in patients with non‐insulin‐dependent diabetes mellitus
Authors: VESSBY B. , BOBERG M.
Published: August 2009

Abstract. The effects on lipoprotein and glucose metabolism of addition of n‐3 fatty acids were studied in 14 non‐insulin‐dependent diabetic patients who were given 10g of MaxEPA (3g n‐3 fatty acids) or placebo (olive oil) per day in a randomized double‐blind cross‐over study during two consecutive 8‐week periods. After MaxEPA treatment, there was a marked increase in long‐chain polyunsaturated fatty acids of the n‐3 series in the plasma lipid esters and in the platelet phospholipids, while the n‐6 fatty acid content decreased. The very low density lipoprotein (VLDL) triglyceride concentrations decreased significantly (by 22%) on MaxEPA treatment. However, these changes were not significantly different from those observed during the placebo period. The blood glucose concentration tended to increase during MaxEPA treatment, and to decrease during the placebo period, the changes under the two regimes being significantly different (P < 0.01). In addition, the rate constant for glucose disappearance (k value) for the intravenous insulin‐tolerance test, which reflected the peripheral insulin sensitivity, tended to decrease during MaxEPA treatment and increase during administration of the placebo, there being a significant difference (P < 0.03) between the changes during the two treatments. The reason for the observed changes in blood glucose concentration and peripheral insulin sensitivity is still unclear.
Accumulation of anaphylatoxins and terminal complement complexes in inflammatory fluids
Authors: BENGTSSON A. , BENGTSON J.‐P. , RYDENHAG Å. , ROXVALL L. , HEIDEMAN M.
Published: August 2009

Abstract. The presence of anaphylatoxins (C3a and C5a) and terminal complement complexes (TCC) in different inflammatory fluids and plasma was studied in 33 patients. Anaphylatoxins were assayed using a radioimmunoassay technique, and the terminal complement complexes were determined by an ELISA method. Patients with peritoneal (n = 14), pleural (n = 7), pericardial (n = 6) or burn bullae fluid (n = 6) were studied. High C3a and TCC concentrations were found in all these fluids. Elevated C3a and TCC concentrations in inflammatory fluids were found not only in patients with elevated plasma C3a and TCC concentrations, but also in patients with normal plasma levels. No increases in C5a concentration were observed in pleural or burn bullae fluid. In one patient with pericarditis, and in subjects with acute pancreatitis with ascites, high C5a levels were found in the fluid. However, the high TCC concentration in the fluids suggests that C5a had been formed but was probably removed by leucocytes present in the fluid.
Compensated hypothyroidism presenting with galactorrhoea
Authors: SHILO S. , HIRSCH H. J.
Published: August 2009

Abstract. Compensated hypothyroidism was diagnosed in a 36‐year‐old female who presented with breast tenderness and mild galactorrhoea. T4 was 5.8mcg dl−1 and T3RU was 22.5%, while TSH and prolactin were very mildly elevated (6.5mU ml−1 and 26.1 ng ml−1, respectively). The TRH test showed an exaggerated response. TSH increased to 43 mU ml−1, and prolactin levels reached 161 ng ml−1. Treatment with T4 decreased the TSH and prolactin levels to within the normal range, and prevented the galactorrhoea. The case presented here demonstrates that galactorrhoea can be present even with mild hypothyroidism.
Treatment of familial hypercholesterolaemia: a controlled trial of the effects of pravastatin or cholestyramine therapy on lipoprotein and apolipoprotein levels
Authors: WIKLUND O. , ANGELIN B. , FAGER G. , ERIKSSON M. , OLOFSSON S.‐O. , BERGLUND L. , LINDEN T. , SJÖBERG A. , BONDJERS G.
Published: August 2009

Abstract. The efficacy and safety of a new, selective inhibitor of cholesterol synthesis, pravastatin, and the bile acid‐binding resin, cholestyramine, were compared in a randomized, double‐blind study of 120 patients with familial hypercholesterolaemia. After a run‐in period of 8‐10 weeks with assessment of dietary habits, the patients were treated with pravastatin + placebo, placebo + cholestyramine, or placebo alone. Active pravastatin therapy was initiated with 10 mg b.i.d. for 6 weeks, and was increased to 20 mg b.i.d. for the following 6 weeks. Cholestyramine was given at 24 gd−1, or the highest tolerable dose. After 6 weeks of therapy, serum total and LDL cholesterol levels were reduced by 17% and 21%, respectively, on pravastatin treatment, whereas the corresponding reductions with cholestyramine treatment were 24% and 30%, respectively. With an increased dose of pravastatin, serum and LDL cholesterol concentrations were reduced by 23% and 28%, respectively, after 12 weeks; the effect of cholestyramine was unchanged. HDL cholesterol levels increased in response to pravastatin, by 7% and 9% after 6 and 12 weeks, respectively. Concomitant changes in the concentrations of apolipoproteins B and AI were observed. Three patients discontinued the study because of side‐effects: two subjects were treated with pravastatin and one was given placebo. The prevalence of side‐effects (including laboratory abnormalities) was 35% for pravastatin, 30% for placebo, and 53% (significantly higher) for cholestyramine. We conclude that pravastatin, in a 40 mg daily dose, is as effective as cholestyramine in lowering LDL cholesterol in familial hypercholesterolaemia. Since the frequency of side‐effects is higher with cholestyramine, pravastatin offers a promising alternative for the therapy of this genetic disease.
Plasma levels of endothelial‐derived haemostatic factors in autoimmune thrombocytopenia and haemolytic anaemia
Authors: NILSSON T. K. , SONDELL K. M. , NORBERG B. O. , BÄCK O.
Published: August 2009

Abstract. The endothelial cell‐synthesized haemostatic factors tissue plasminogen activator (tPA), plasminogen activator inhibitor (PAI) and von Willebrand factor (vWF) were assayed in a cross‐sectional study of patients with immune thrombocytopenia (ITP) (n = 12) and autoimmune haemolytic anaemia (AIHA) (n = 3), and compared with a simultaneously selected contrast group of other hospitalized patients with obscure blood cytopenia at the time of sampling. All three factors were grossly elevated in both the study group and the contrast group. In the autoimmune patient group, the three haemostatic variables were significantly correlated with orosomucoid levels, demonstrating the acute‐phase nature of the increased levels of vWF, tPA and PAI. These findings support the view that haemostatic factors of the vessel wall are implicated in the pathophysiology of a wide spectrum of diseases.
Septic arthritis of the sternoclavicular joint in healthy adults
Authors: GILLIS S. , FRIEDMAN B. , CARACO Y. , BLANKSTEIN A. , YELLIN A. , FRIEDMAN G.
Published: August 2009

Abstract. Septic arthritis of the sternoclavicular joint (SCJ) is a rare disorder, and is usually associated with predisposing factors such as contiguous foci of infection, heroin addiction, rheumatoid arthritis and diabetes mellitus. Three cases in previously healthy adults are reported here. The aetiology, clinical manifestations and treatment are briefly reviewed. The considerable difficulty in diagnosing this disorder in adults is emphasized. In summary, diagnosis of septic arthritis of the SCJ in adults requires a high index of suspicion, and must be considered not only in patients with predisposing factors, but also in previously healthy adults.
Pituitary‐thyroid axis, prolactin and growth hormone in patients with acute stroke
Authors: OLSSON T. , ASPLUND K. , HÄGG E.
Published: August 2009

Abstract. The pituitary‐thyroid axis, serum prolactin and growth hormone levels were studied in 29 patients within 9 d of onset of acute ischaemic stroke. When compared to a control group of 80‐year‐old volunteers (n=33), stroke patients were found to have elevated free thyroxine indices (P=0.008), after adjustment for age and sex. Seventeen (81%) of the stroke patients showed a paradoxical rise in growth hormone in response to thyrotropin releasing hormone (TRH). In a multiple regression model, disorientation was associated with a low thyrotropin response to TRH (P=0.02 and P=0.04; 20 and 60 min after TRH, respectively). Disorientation was also positively correlated with the prolactin response to TRH (P=0.045 after 60 min). Growth hormone levels were predicted by extensive motor impairment (P=0.02). In conclusion, changes in pituitary and thyroid hormones were commonly observed after stroke and were closely associated with cognitive and/or motor impairment.
Lipoprotein‐related coronary risk factors in patients with angiographically defined coronary artery disease: relation to number of stenosed arteries
Authors: HØSTMARK A. T. , OSLAND A. , SIMONSEN S. , LEVORSTAD K.
Published: August 2009

Abstract. To determine whether an index estimating antagonism between low density lipoprotein (LDL) and high density lipoprotein (HDL) would improve separation between groups with and without coronary atherosclerosis, patients undergoing coronary catheterization (35 women and 99 men) were analysed for total cholesterol (TC), HDL cholesterol (HDLc), apolipoprotein A (apo A) and apolipoprotein B (apo B). The subjects were categorized as groups 0. 1, 2 or 3 according to the number of stenosed arteries (≥ 75% areal stenosis). Thirty of the patients showed no significant coronary atherosclerosis (group O). Serum apo B and TC concentrations were directly related to the number of stenosed vessels, whereas the concentrations of apo A and HDLc were negatively correlated with the number of stenosed arteries. An ‘atherogenic Index’ (ATH index) calculated as the product of serum concentrations of apo B, and TC minus HDLc, divided by the product of apo A and HDLc, proved more satisfactory than individual lipoprotein components for discrimination between subjects with and without stenosis. Accordingly, identification of coronary groups may be improved by using the ATH index.