Acta medica Scandinavica最新文献

A health survey of middle-aged men was carried out in 1970-73 in the municipality of Uppsala. Subjects with hypertension, hyperlipidaemia, reduced glucose tolerance, and smokers were invited to join various therapy groups. By 1980 this multifactorial intervention programme had thus been running for 10 years. This report describes the results of a follow-up undertaken to evaluate the efficacy of the programme. The annual rate of fatal myocardial infarction (MI) was lower among the participants (n = 2322) in the health examination as well as among participants and non-participants (n = 446) combined than among the male Swedish population of the same age (162 and 187 compared with 296 per 100 000 men, respectively). The annual rate of non-fatal MI among participants and non-participants combined was 295 per 100 000 men, which is lower than in other Swedish cities. In the hypertensive group (n = 126), six men had fatal and seven non-fatal MI. These 13 men had higher blood pressures (BPs) from the start than the other hypertensives. In addition, their BP reduction was smaller than in a control group randomly selected among the hypertensive subjects. In the hyperlipidaemic treatment group (n = 363) there were eight fatal and 10 non-fatal MIs. Nine of these events occurred in individuals who had dropped out from therapy. It is suggested that the low total mortality and the low rates of fatal and non-fatal MI in this middle-aged male population may be related to the multifactorial intervention programme, as the incidences were also low among the treated high-risk groups.

The results of renal transplantation in patients with diabetes mellitus were studied in 100 consecutive patients transplanted between Dec. 1972 and June 1982. The study period was divided into two parts, 1972-76 (era I, 21 patients, 18 with juvenile onset diabetes) and 1977-82 (era II, 79 patients, 72 with juvenile onset diabetes). A group of 168 non-diabetic patients, aged 20-54 years, receiving primary grafts during the same period served as controls to the 72 juvenile onset diabetics from era II. The three-year actuarial patient survival of transplanted diabetics improved from 48% during era I to 76% during era II and was then not significantly inferior to that of the non-diabetic controls. The three-year actuarial graft survival rate was significantly higher for recipients of kidneys from living related donors than for those who had received kidneys from cadaveric donors (CD) among both diabetic and non-diabetic patients. However, the three-year graft survival rate was significantly higher (56%) for non-diabetic than diabetic CD recipients (37%). The overall survival in diabetes mellitus was strongly influenced by the outcome of retransplantation during era II (12 patients). Thus, 69 patients were alive, 64 with a functioning graft, at the end of the observation period.

The Kockum study of risk factors for coronary heart disease (CHD) consists of 464 individuals, one third white collar workers, one third heavy workers and one third well trained firemen, all of whom have now been followed for 22 years. Important risk factors for CHD seem to be heredity, smoking, stress, lack of physical activity, diabetes mellitus hypertension, high body weight, ECG abnormalities, hypercholesterolemia, hypertriglyceridemia and baldness. In addition to the common risk factors, baldness seems to be of importance. A high cholesterol value predisposes for an increased death rate not only due to CHD but also to malignant disease. A Cox analysis shows a markedly decreased life expectancy in multirisk factor patients caused not only by CHD but also by cancer.

A series of 676 patients with acute myocardial infarction were evaluated with regard to initial serum potassium level, prior diuretic therapy and occurrence of cardiac dysrhythmias during their first 24 hours in a coronary care unit. Serious dysrhythmias (ventricular tachycardia, ventricular fibrillation, and asystole) were significantly more frequent in hypokalemic patients. In this regard no differences were observed between patients on or off prior diuretic therapy.

A 58-year-old patient with neutropenia due to SLE developed spondylitis of the lumbar region caused by Candida albicans. The spondylitis was probably superinfected with Staphylococcus aureus. The initial one month's intravenous combination therapy with amphotericin B and flucytosine was discontinued because of fever reactions to amphotericin B, suspected myelosuppressive effect of flucytosine and insufficient clinical response. This therapy was followed by four months of oral ketoconazole and clindamycin with good results and without any side-effects.

Twenty-four hypertensive patients reported vasospastic symptoms in their hands during treatment with beta-blocking drugs with different pharmacological properties. Twenty patients had symptoms when staying indoors and 11 did not always experience complete relief of symptoms following active rewarming attempts. Finger systolic blood pressures were measured after standardized local cooling. In 15 patients, blood pressure decreased to a pathological level during this procedure. Previous beta-blockade was changed to combined alpha- and beta-blockade with labetalol given twice daily in a mean dose of 259 mg/day for 3 months. After this period, most patients showed a decreased temperature sensitivity both objectively and subjectively. Blood pressure control was maintained at the previous level. Heart rate increased significantly during treatment with labetalol. Labetalol offers an alternative treatment to patients suffering from vasospastic side-effects of beta-blockers.

The prevalence of signs of heart (Minnesota-coded ECG, chest X-ray) and kidney involvement (proteinuria, abnormal serum creatinine) was studied before and after 5 years' antihypertensive treatment in 686 middle-aged, hypertensive men derived from a screening examination of a random population sample. The prevalences of heart enlargement (X-ray) and abnormally high serum creatinine increased. A pronounced regression of S-T and T wave changes in the ECG was achieved. In a subgroup of 375 patients without digitalis therapy and not having had myocardial infarction, ECG signs of left ventricular hypertrophy decreased.

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.