Acta medica Scandinavica最新文献

Two cases of traumatic tricuspid insufficiency are presented. Both patients followed a benign clinical course although an associated injury to the intraventricular septum was found in one. A flail anterior tricuspid leaflet was seen on two-dimensional echocardiography in both patients and the diagnosis was confirmed by Doppler cardiography.

Oral body temperature was measured in 816 men, 57 and 67 years old, sampled from the general population of Göteborg, Sweden, and 22 physically highly active men, sampled on clinical grounds. The measurements were taken in the morning for 14 months. After adding 0.3 degrees C to the readings to make them comparable with rectal readings, the mean body temperature was 36.8 +/- 0.4 degrees C. There was a seasonal variation with a peak during the winter and a trough during the summer. Body temperature was inversely correlated with height and positively correlated with weight and body fat but not with lean body mass. High physical activity and sensitivity to heat were associated with a higher than average body temperature. Sensitivity to cold was associated with a lower than average body temperature. Smoking prior to the measurements did not appear to affect body temperature.

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

Between 1967 and 1977, 395 consecutive cases of glomerulonephritis (GN) were collected by a Copenhagen study group. The diagnosis was established by histological and biochemical criteria. Light microscopy investigations of thin silver-stained sections were applied. In a follow-up in 1980 all cases were categorized by one of the following end points: death without uremia, uremia, recovery, or censored cases. The course is presented in figures showing the cumulated distribution of outcomes in relation to observation time. Each histological subgroup of GN had its own characteristic course with respect to initial rates of changes in the renal state, as well as to frequency of recovery, uremia and death. The prognosis was good in minimal changes GN and proliferative GN, bad in unclassified GN and worst in extracapillary GN. When part of a connective tissue disease, GN carried a poor prognosis. We conclude that histological classification of GN based on light microscopy offers a reliable means of predicting the long-term prognosis.

Twenty Danish patients with the acquired immunodeficiency syndrome (AIDS) had been diagnosed by January 1984, 14 of them after 1982. Eighteen patients were male homosexuals, 8 of whom had visited the USA after 1979, 2 were heterosexual males with a history of sexual contacts in Central Africa, suggesting a transmission of AIDS from woman to man. AIDS has not been observed in drug abusers, hemophiliacs or transfused non-risk persons in Denmark. The clinical picture varied according to the presence of Kaposi sarcoma or the type of opportunistic infections, but was in general similar to that reported from the USA. Investigation of T-lymphocyte subsets revealed that the AIDS patients differed from controls and healthy homosexual men by having either a very low number of helper cells or a low helper/suppressor cell ratio. Functional immunological studies revealed a decreased natural killer cell activity and decreased blast transformation by mitogens. The survival two years after diagnosis was 16%.

Six male patients with severe ethylene glycol poisoning were studied with respect to the origin of the metabolic acidosis. The plasma concentrations of ethylene glycol were 4-41 mmol/l and treatment included alkali, ethanol and hemodialysis. Plasma analysis by isotachophoresis and whole blood lactate determinations showed that glycolate (17.0-29.3 mmol/l), lactate (1.4-6.2 mmol/l) and beta-hydroxybutyrate (less than or equal to 1.8 mmol/l) were present in elevated concentrations contributing to the acidosis. Oxalate (less than or equal to 0.33 mmol/l), glyoxylate (less than 0.2 mmol/l) and formate (less than 0.4 mmol/l) concentrations were negligible and did not contribute to any significant degree to the acidosis. The elevated plasma glycolate concentration was highly correlated to the anion gap (r = 0.923) and the glycolate made up for 96.1% (n = 6, range 84.7-108.8) of the increased anion gap. We conclude that glycolate accumulation is the main reason for the metabolic acidosis in ethylene glycol poisoning. The mean dialysator (1.6 m2) clearances of glycolate at a blood flow of 200 ml/min in two patients were 137 ml/min (n = 9, SD +/- 8, range 125-149) and 144 ml/min (n = 11, SD +/- 8, range 133-158). By applying first order kinetics during hemodialysis a volume of distribution of glycolate of 0.55 l/kg was found, assuming that the dialysator clearance equals the total body clearance of glycolate. Thus glycolate, the probable main metabolite of ethylene glycol, is efficiently removed by hemodialysis.