Annals of clinical research最新文献

Left ventricular wall mass and thickness were investigated by echocardiography in 80 insulin dependent diabetic patients with no signs of ischaemic heart disease and in 40 healthy controls. In diabetics with duration of disease greater than 30 years, with urinary albumin excretion rate greater than 200 micrograms/min (clinical nephropathy), with proliferative retinopathy or with autonomic neuropathy both the posterior wall thickness and the septal thickness were increased compared to controls. The posterior wall thickness and the septal thickness were positively correlated to blood pressure (p less than 0.001), duration of disease (p less than 0.001), urinary albumin excretion rate (p less than 0.001) and negatively correlated to the heart rate variation during deep respiration (p less than 0.01). The left ventricular wall mass was correlated to both blood pressure (p less than 0.01) and to urinary albumin excretion rate (p less than 0.01). By multiple regression analysis urinary albumin excretion rate, duration of disease and heart rate variation during deep respiration did not add significantly to the correlation between left ventricular wall mass/wall thickness and blood pressure. In conclusion, left ventricular wall thickness and wall mass were related to blood pressure in insulin dependent diabetics.

Although sauna bathing is a traditional means of treating rheumatism, its effects on rheumatic diseases have not been studied. Animal studies suggest that hyperthermia could have a favourable effect in cases of chronic rheumatic inflammation. More than fifty percent of patients find that sauna bathing alleviates rheumatic pain and improves joint mobility. The effect is similar in both inflammatory and non-inflammatory disorders. Nearly all men experience sauna bathing as helpful, whereas one-fourth of women find it detrimental. Rheumatic pain is exacerbated and joint mobility decreases on the day after a sauna. Exacerbation of pain is more obvious in non-inflammatory diseases, especially in fibromyalgia, than in inflammatory diseases, and more obvious in women than men. It can be prevented by proper cooling.

A brief review is given on the definition, prevalence and strength of type A behaviour as an ischemic heart disease risk factor. Special emphasis is placed on the results of a Finnish population study. Type A behaviour has unequivocally been shown to be a relevant risk factor in middle-aged American populations. The evidence for its function in other populations is still equivocal. Some components of type A behaviour, e.g. hostility and impatience, may be more important than other features as predictors of ischemic heart disease.

The medical profession must take strong responsibility in the field of coronary heart disease prevention. Among other things, it is necessary to develop and implement effective strategies for non-pharmacologic treatment of high cholesterol levels, in order to avoid unnecessary medicalization. It is evident that the normal level of care for this is primary care. Important cornerstones for the process of project implementation are suggested, partly based on experience from a hypertension project. These cornerstones are reorganization of care and development of local project ownership. Experience from a postgraduate Swedish National education program is used to promote the concept of problem-oriented education.

International mortality trends for ischaemic heart disease are summarized for the period 1972 to 1984, comparing the most recent with earlier changes in total mortality. A review of data on changes in incidence, short-term and long-term prognosis indicate that major declines in coronary heart disease mortality must have been due primarily to prevention, but improvements in short-term prognosis and, according to some studies, long-term prognosis have most likely contributed to the downward trends. Based on information available to date, changes in life styles, health-promoting or detrimental as the case may be, correlate with changes in risk factors and observed trends in coronary heart disease mortality.

The effect of ethanol together with a meal on the mucosa of the stomach and duodenal bulb was studied in nine healthy volunteers. The pre-study gastroscopy was performed after an overnight fast. Two to four weeks later the volunteers drank 72-136 g (mean 111.2 +/- 18.3 SD) alcohol together with a meal. They underwent endoscopy again on the following morning. The endoscopic and histological changes were evaluated by scoring the lesions (0-4). Alcohol caused slight to moderate endoscopically detected changes in the stomach of seven volunteers, the difference being statistically almost significant (p congruent to 0.05) in the case of haemorrhagic lesions. In two subjects slight hyperaemia was seen in the duodenal bulb. The histological study did not reveal significant changes after alcohol drinking. The bile acid concentrations of the gastric juice did not change after drinking. It is concluded that ethanol with a meal causes only slight changes in the mucosa of the stomach, haemorrhagic ones being the most prominent.

Gastrointestinal functions such as food intake, propulsive peristalsis, inhibition of reflux, secretion, digestion and defecation are controlled by a complex autonomous neurohumoral system, which is influenced by higher cortical impulses. Life stress may modulate these impulses and in this way cause two types of gastrointestinal reactions. Psychophysiological reactions involve accentuations, inhibition or distortion of the pattern of function of gastrointestinal organs without changes in their structure. Examples of this type of reaction are often painful accentuation of bowel movements in patients with the irritable bowel syndrome, and increased gastric secretion elicited by emotional stress. Psychosomatic reactions lead to morphological changes in the end organ, e.g. activation of peptic ulcer or ulcerative colitis. Psychophysiological reactions may be important in the onset of symptoms in some functional diseases, e.g. in the irritable bowel syndrome. These patients need support from the physician, but specific psychiatric therapy is required only in cases with severe psychopathology, e.g. in patients with anorexia nervosa. The role of psychosomatic reactions in the development of organic gastrointestinal diseases is still unclear, as is the value of specific psychiatric therapy in the treatment of diseases such as peptic ulcer or ulcerative colitis. If this kind of therapy has some effect, it may be directed mainly towards subjective symptoms.

The primary purpose for identifying psychosocial risk factors is to prevent disease and disease complications. For 30 years, we have been doing research in this field and have been successful in identifying such risk factors as Type A behavior, social isolation, stressful life events, and various psychological patterns. However, our success in using this information to help prevent disease has been much more limited. One reason for this limited success is that we have focused virtually all of our attention on the study of individuals and almost no attention on the social environment within which people live. There are two major limitations of such a one-to-one approach: it is difficult for people to change their behavior and their life situation and even if some people do change, others enter the "at risk" population because no action has been taken to change those forces in society that stimulated the problem in the first place. In discussing the social determinants of disease, it is important that we develop a new approach that permits us to study not only individuals but also the social environment. An example of this approach is provided by researchers who were successful in preventing infectious diseases. The work of these researchers focused not on clinical entities or on individuals but on the environment. This resulted in a disease classification system that included concepts such as air-borne, food-borne, water-borne, and vector-borne diseases. We have no such system for the study of non-infectious diseases. Considerable data already are available to help us to think about such a new classification system.(ABSTRACT TRUNCATED AT 250 WORDS)

Among 287 cases of diabetic ketoacidosis, 212 patients were alert, 48 drowsy, 10 stuporous and 17 comatose. The mean blood hydrogen ion concentrations in these 4 groups of patients were 50.0; 72.8; 106.8 and 109.9 nmol/l, respectively. Increased blood hydrogen ion concentration seems to be an important factor in lowering the level of consciousness in diabetic ketoacidosis.