Acta medica Scandinavica最新文献

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 the sum of the S wave in V1 and R wave in V5 or V6, the echocardiographic left ventricular mass and cross-sectional area, the presence or absence of asymmetrical septal thickening, granular and sparkling myocardial appearance, thickened heart valves, systolic anterior motion of the mitral valve, and 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 greater than 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.

The prevalence of sleep complaints and somatic diseases was estimated in a random sample of 4064 Swedish men aged 30-69 years. Great difficulty initiating sleep (DIS) was experienced by 6.9% and moderate problems in DIS by 14.3%. Complaints of major difficulty maintaining sleep (DMS) were reported by 7.5% of the men and of moderate DMS by 14.9%. DMS was more frequent with increasing age. Excessive daytime sleepiness (EDS) was reported by 5.7%. Altogether 879 men were attending regular medical examinations for somatic diseases. Among the 299 hypertensive men, major complaints of DMS (13.5%), DIS (8.4%) and EDS (8.8%) were more common, but the 167 men treated with beta-blockers rather showed a proportionally somewhat lower prevalence of sleep complaints. Men with obstructive pulmonary disease (n = 113) had a higher prevalence of DMS (18.8%) and EDS (12.4%). Diabetic men (n = 74) complained also more often of DMS (21.9%), DIS (21.1%) and EDS (12.2%). Men with rheumatic disease (n = 176) and obesity (n = 221) also had increased prevalence of sleep complaints.

A group of middle-aged male hypertensives, derived from a random sample of a Swedish urban population, has been treated and followed for 10 years. The development of angina pectoris, intermittent claudication and congestive heart failure have been analysed. The initial prevalence and the average yearly incidence of angina pectoris was 3.9% and 1.3% p.a., of intermittent claudication 1.7% and 0.6% p.a. and of heart failure 1.0% and 0.8% p.a. ECG signs indicating subclinical heart disease (major Q wave, ST depression, T wave inversion) were risk factors for development of angina pectoris and congestive heart failure. Heart enlargement on chest X-ray was also a risk factor for development of congestive heart failure, as were a high serum creatinine, body mass index, serum uric acid and proteinuria. Smoking was found to be a strong and independent risk factor for any one of these cardiovascular disorders. After 10 years about one fourth of all patients, still attending the clinic, had at least one cardiovascular complication. Hence, the risk of developing cardiovascular disorders is substantial and seems to be potentiated by the same risk factors known to operate in the general population.

A survey of thyroid and breast diseases was performed in 477 women representative of a middle-aged female population in Malmö, Sweden. Fifty-four women (11.3%) were found to have palpable goitre; 45 of these were unaware of their disorder. All goitres were considered to be benign. One woman with goitre had a mild thyrotoxicosis; the goitres in the other 53 women were atoxic. Seventy-six women (16.0%) had been subjected to surgical breast biopsy 1-25 years before the present survey (median 9 years). The histological diagnoses were: cancer 1, fibroadenoma 8, cystic disease 48, fibrosis 9, and miscellaneous 10. A correlation between atoxic goitre and histologically verified benign breast disease was found (p less than 0.05). The correlation was explained solely by an association between goitre and fibrosis of the breast (p less than 0.001). This study shows a correlation between fibrosis of the breast and atoxic goitre in middle-aged women. The correlation is considered to be a true one, and a possible explanation is briefly discussed.

Blood and bone marrow changes induced by continuous low-dose hydroxyurea treatment are described. A linear increase in mean red cell volume was observed after onset of therapy. The entire normocyte population was replaced by abnormally large erythrocytes within 150 days. The bone marrow morphology changed in megaloblastic direction. Bone marrow iron stores and number of sideroblasts increased, findings compatible with ineffective erythropoiesis. Serum folate and cobalamin levels remained normal. These morphologic changes might cause confusion when examining blood or bone marrow samples from patients treated with hydroxyurea.

An epidemiological study of 439 cases (184 males, 255 females) of pheochromocytoma (paraganglioma) diagnosed in Sweden from 1958-81 is presented. From the mid 1960's an average of 22 cases have been diagnosed each year. In 255 cases, the pheochromocytoma was diagnosed by clinical examination and/or surgery. In 184 cases (40%), the diagnosis was achieved by autopsy and out of which 60 (14% of all cases) were reported as incidental findings. Ninety-five pheochromocytomas (22%) were located outside the adrenals. The average (+/- SD) age at diagnosis for the total study population was 55.8 +/- 17.7 years. Clinically diagnosed tumour cases were significantly younger (48.5 +/- 16.3 years) compared to cases diagnosed at autopsy (65.8 +/- 14.0). Pheochromocytomas were more common among women than among men. The age specific incidence rate increased continuously for both sexes from the youngest to the oldest age groups. The average incidence of pheochromocytoma in the 24 counties of Sweden was 2.1 cases per million inhabitants per year, range 0.9-5.3. A North to South gradient was noted with a higher incidence in the Southern parts of the country. Whether this is due to a real geographical variation of incidence, to a larger number of unreported cases in the Northern parts, or to presence of families with Sipple's syndrome in the South is unclear.

Aiming at a better control of hypertension, a medical care program including nurse-run outpatient hypertension clinics was implemented in one half of the County of Skaraborg (265000 inhabitants), the other half forming a control area. The program was evaluated during a 5-year trial. Among patients registered and followed up for a minimum of one year (n = 2806), systolic and diastolic blood pressure decreased significantly, regardless of the patients' status of treatment prior to admission to the clinics. A baseline and a terminal population study revealed an increasing effectiveness in the treatment of hypertension in the study area. A consistent difference (mean 8/5 mmHg) was found in average blood pressure between patients treated at the hypertension clinics and patients treated in regular care. It is concluded that the medical care program increased the effectiveness of care and that this was due to the program organization.

The influence of caffeine on overall cell metabolism was studied in human platelets by measurement of cell heat production rate. One hour after administration of 100-200 mg of caffeine, corresponding to 1-2 cups of coffee, significantly increased values (p less than 0.001) were found, 12 +/- 7%. A return to normal values was noted 1 hour later. The cell metabolic stimulation is presumably due to increased catecholamines. A temporary significant rise in systolic (p less than 0.02) and diastolic (p less than 0.05) blood pressure was observed 1 hour after ingestion of caffeine.

All newly diagnosed cases of diabetes mellitus aged 15-34 years in Sweden, where the population in this age interval is about 2.3 million, were registered on standardized forms. During 1983, the first year of the study, there were 311 males and 161 females, excluding 280 with gestational diabetes. The annual incidence of diabetes was 26.2 per 100,000 in males and 14.2 in females. The respective figures for type I were 18.5 and 10.1, and for type II 5.7 and 2.9. The incidence of type I diabetes was similar for the four age groups (15-19, 20-24, 25-29, 30-34 years), while for type II it was highest in the oldest group. Types I and II, but not the sexes, differed as regards the cumulative distribution curves of the maximum blood glucose concentration during the first two weeks after diagnosis. The present incidence of diabetes in Sweden is higher, particularly in males than the rates for similar age groups in Oslo (1925-64) and Denmark (1970-77).

The course of the renal function and mortality were analysed in 395 patients with biopsy-proven glomerulonephritis (GN), using Cox's proportional hazards model. Seventeen clinical, biochemical and histopathological parameters were analysed for prognostic information. The patients were grouped according to their serum creatinine levels. Increase in serum creatinine, decrease in serum creatinine, cure and death were used as endpoints for the analysis. Caplan Meyer curves were made for 7 transitions between different groups and the variables were reduced by a step-wise procedure to a final model. Thirteen of the variables considered offered significant prognostic information (p less than 0.05) for at least one of the transitions. Short duration of disease, young age, non-nephritic urinary sediment and preceding streptococcal infection were predictors of cure. Extracapillary, membranoproliferative and unclassifiable GN, old age and arterial hypertension predicted increase in serum creatinine in patients with low serum creatinine, while male sex, short duration of disease and pathological electrocardiogram favoured a further increase in patients with high serum creatinine. A later decrease in serum creatinine was signified by a preceding streptococcal infection, short duration of disease, absence of arterial hypertension and low urinary protein excretion. Death without uremia was predicted by high age, connective tissue disease and extracapillary GN. Using these parameters and the models, it is possible to make a prognostic forecast for the individual GN patient. Examples of such a forecast are described.