Acta medica Scandinavica最新文献

In a randomized double-blind study with flexible dosage, morphine, nicomorphine and pethidine were compared with regard to analgetic effect, dose requirements, dose intervals and adverse reactions. A total of 275 patients were included, and 28 patients were excluded due to adverse reactions (n = 16) and for practical reasons, etc. Acute myocardial infarction (AMI) was diagnosed in about 60% of the patients, and about 30% had ischemic heart disease without AMI. All three analgesics provided equally efficient pain relief in relative doses of morphine 10, nicomorphine 10 and pethidine 75 mg/ml. Severe adverse reactions were few (allergy 3 cases, respiratory insufficiency 4, severe bradycardia 4), whereas nausea was recorded in 20-30%, vomiting in 5-15% and dizziness in 10-30% of the patients, with no difference between the three drugs. Significant blood pressure drop (greater than 30 mmHg) was seen in 3-8% of the patients, with no significant differences between the drugs.

In four hypertensive patients, acute lowering of blood pressure by therapeutic or diagnostic procedures caused visual disturbances ranging from transient visual hallucinations to severe, long-lasting visual impairment. These symptoms were associated with occipital lobe cerebral infarcts that tended to occur in the border zones between the major cerebral arteries. The infarcts may be seen as the combined result of a "watershed" effect during acute hypotension and the presence of structural hypertensive vascular adaptation. When a hypertensive patient complains of visual disturbances during acute blood pressure lowering, the pressure should be allowed to settle at a level somewhat above normal.

In the first year after registration, 103 reports on suspected adverse reaction to piroxicam (Feldene) were submitted to the Norwegian Adverse Drug Reaction Committee. Eighty-three reactions were classified as probable side-effects, and 73 of these were related to the upper gastrointestinal tract. Peptic ulcer and upper gastrointestinal haemorrhages predominated. Two deaths were classified as probably due to piroxicam. There were 8 life-threatening reactions, all due to haemorrhages. No severe cutaneous reactions were reported. A significant fraction of the gastrointestinal reactions occurred in patients with a previous history of peptic ulcer disease. Nearly every fourth patient with proven ulcer or haematemesis/melaena had simultaneously been taking other drugs with the propensity of causing gastrointestinal haemorrhage. The gastrointestinal adverse reactions to piroxicam can probably be reduced by a more accurate selection of patients.

Morbidity and mortality in cardiovascular and cerebrovascular diseases and total mortality have been studied in a longitudinal population study initially comprising 1462 women representative of the general female population. When related to the initial blood pressure (BP) levels of women not on antihypertensive drugs (hypertensives and non-hypertensives), the distributions of women with myocardial infarction (MI) and stroke during the 12-year follow-up period seemed to be U-shaped, with the highest incidences in women with the lowest and the highest BP levels. Women recognized as untreated hypertensives in the initial study were offered regular control by the study team during the whole 12-year period and were treated when treatment was considered indicated. They were found to be similar to the non-hypertensives with regard to the incidence of MI and stroke and total mortality. Our encouraging results may be explained by continuity of medical care, the antihypertensive treatment per se or the types of antihypertensive drugs administered.

Sixty-four patients over the age of 40 years, undergoing elective surgery of at least one hour's duration, were randomized to treatment with either a thromboembolic deterrent ( TED ) stocking (Kendall Co.) or subcutaneous low-dose heparin 5 000 IU every 12 hours. Serum levels of alanine aminotransferase (S-ALAT), aspartate aminotransferase (S-ASAT), gamma-glutamyl transpeptidase (S-gamma-GT) and alkaline phosphatase (S-ALP) were measured. S-ALAT increased significantly on the 5th and 10th postoperative day, from 27 +/- 2 (x +/- SE) to 40 +/- 4 (p less than 0.01) and 55 +/- 7 U/l (p less than 0.001), respectively, in the heparin group and was significantly higher in the heparin than in the TED group both on the 5th (p less than 0.01) and 10th (p less than 0.05) postoperative day. S-ASAT and S-gamma-GT increased significantly during heparin treatment, but did not differ significantly from the values of the TED group. No change in S-ALP was registered in either group. It is concluded that prophylactic treatment with low-dose heparin induces a significant increase in S-aminotransferase levels, especially in S-ALAT. The phenomenon has profound differential diagnostic implications in conditions such as pulmonary embolism and acute myocardial infarction.

A case of atrial fibrillation during pregnancy in a 20-year-old patient with valvular heart disease is presented. Synchronized direct-current cardioversion was carried out successfully during monitoring of maternal and fetal ECG. Previously published cases are reviewed.

In a longitudinal study, 21 patients with familial amyloidosis with polyneuropathy (FAP) were followed up for more than three years. Gastrointestinal symptoms ultimately evolved in all patients. In the advanced stage of the disease, 13 patients had diarrhea together with anal incontinence. Weight loss was very common and related to both malabsorption and motility disturbances with anorexia and also to muscular atrophy. Steatorrhea was found in 19 patients at least once during the follow-up. The duration of the disease was significantly correlated to fecal fat output. The conclusion was drawn that the gastrointestinal involvement in FAP is very common and of great clinical importance. The consequences of malnutrition also influence the outcome of the disease.

In a 10-year longitudinal study of men and women aged exactly 70 at entry and otherwise only selected according to geography, the predictive value of arterial blood pressure was evaluated concerning cardiovascular disease (CVD) at entry and CVD development or death during the following decade. At 70 the prevalence of arterial hypertension (greater than or equal to 160/95 mmHg) was 46% in men and 45% in women. At 80 these prevalences were 19 and 30%, respectively. In women, this fall could partly be explained by an association between high blood pressure and excess mortality. In both sexes it could partly be explained by an increasing part of the population being treated with antihypertensives/diuretics, partly by an association with myocardial degeneration. In a Cox's regression model for competing risks at 70, high systolic blood pressure had independent, predictive value for excess CVD mortality in the eighth decade in women alone, and for excess CVD development in both sexes. High diastolic blood pressure had no independent predictive value for any of these end points.

Bone marrow necrosis (BMN) is a rare finding in specimens from living patients. It is most commonly found in patients with neoplastic disorders, severe infections and sickle cell disease. We present a patient with Hodgkin's disease who developed extensive BMN 11 months before death. A concise review of the literature is also presented.