ISSN:0001-6101    

DOI:10.1111/j.0954-6820.1988.tb15772.x

出版商:Blackwell Publishing Ltd    

年代:1988

数据来源: WILEY

摘要:

ABSTRACTA study of excessive alcohol consumption was carried out on 2114 adult somatic outpatients. All patients were evaluated by the following methods: Blood‐chemical tests (serum gamma‐glutamyltransferase (S‐GT), serum aspartate aminotransferase (S‐ASAT) and ethanol), patient's and doctor's questionnaires, and analysis of data from psychiatric records, social welfare registers and alcohol ambulatory services. Records from psychiatric clinics detected 48% of the patients. Forty per cent of the alcohol patients had S‐GT levels>0.9 μkat/l. S‐ASAT and blood ethanol levels were of little informative value. The doctors recognized excessive consumption in 25% of the patients. Only 16% of the alcohol patients reported excessive consumption (>280 g of ethanol/week). The combination of S‐GT and questionnaires to patients and doctors detected 63% of the alcohol patients. Both in epidemiological studies and in clinical practice it seems appropriate to use combinations of different methods to detect patients with underlying al

ISSN:0001-6101    

DOI:10.1111/j.0954-6820.1988.tb15773.x

出版商:Blackwell Publishing Ltd    

年代:1988

数据来源: WILEY

摘要:

ABSTRACTAlcohol abuse is a major predictor of premature death, and also an independent risk factor for coronary death. Alcoholics are often heavy smokers. In a large primary prevention trial in middle‐aged men with 7495 participants, registration data were used to identify subjects with alcohol problems. Smokers had slightly lower blood pressure and were somewhat leaner than non‐smokers, but had slightly higher serum cholesterol levels. Alcohol‐registered subjects also tended to have lower blood pressure levels, and higher serum cholesterol. The relative risk of non‐fatal myocardial infarction during the follow‐up period of 11.8 years was essentially doubled in smokers compared to non‐smokers, regardless of registration for alcohol problems. Among the non‐alcoholic subjects, the relative risk of coronary death in smokers was double that of non‐smokers, whereas the risk in non‐smoking alcoholic subjects was not significantly increased. In smoking alcoholics the relative risk was substantially raised to 4.2 (3.0–7.0; 95% c.i.). In multivariate analysis both smoking and alcohol abuse were independently associated with coronary death. A possible mechanism might be through a combination of tobacco‐induced coronary arteriosclerosis and the cardiotoxic effects of alcohol. As to total mortality, a smoking non‐alcoholic man had a relative risk of dying almost double that of a non‐alcoholic non‐smoker. Among non‐smoking alcoholics the risk was three times and, in smoking alcoholics over four times that of

ISSN:0001-6101    

DOI:10.1111/j.0954-6820.1988.tb15774.x

出版商:Blackwell Publishing Ltd    

年代:1988

数据来源: WILEY

摘要:

ABSTRACTIn the period 1970–1984 alcoholic hepatitis was diagnosed by liver biopsy in 52 females. Thirty‐six patients with cirrhosis were generally in a worse clinical and biochemical state than those without cirrhosis. Biochemical tests for liver function showed significant improvement from admission to the time of liver biopsy. At follow‐up liver function tests were generally better in patients who had stopped drinking alcohol compared to those who continued to do so. The 5‐year survival rate was 82% for females without cirrhosis, and 45% for those with cirrhosis (p<0.03). Considering the sex‐related differences in alcohol abuse in the general population we found no evidence of increased susceptibility to the hepatotoxic effect of alcohol i

ISSN:0001-6101    

DOI:10.1111/j.0954-6820.1988.tb15775.x

出版商:Blackwell Publishing Ltd    

年代:1988

数据来源: WILEY

摘要:

ABSTRACTStudies were performed in 10 male patients with untreated essential hypertension, WHO grade I‐II, aged 25–62 years, to explore the acute (single dose) and long‐term (8 weeks) effects of felodipine on sympathetic activity—evaluated by plasma and urinary catecholamines—as related to blood pressure, heart rate and the activity in the renin‐angiotensin‐aldosterone system. The patients were hospitalized for 8 (acute) and 6 (long‐term) days and were maintained on a standardized daily intake of sodium (150 mmol), potassium (75 mmol) and water (2500 ml). Acute felodipine administration (10 mg) significantly reduced blood pressure and increased heart rate. Plasma and urinary noradrenaline, plasma renin activity and angiotensin II increased, whereas plasma and urinary adrenaline, dopamine, aldosterone and plasma vasopressin were unaltered. Long‐term felodipine treatment, 10 mg twice daily, reduced blood pressure to a similar extent as acute felodipine administration, but heart rate was not significantly changed. Plasma noradrenaline 3 and 12 hours after the last dose and urinary noradrenaline were increased, whereas plasma and urinary adrenaline and dopamine were unchanged. Plasma renin activity and angiotensin II were increased 3 hours, but unchanged 12 hours after the last dose. Plasma aldosterone was unchanged but urinary aldosterone increased. Plasma vasopressin was unchanged. The changes in plasma noradrenaline as related to blood pressure, heart rate, plasma renin activity and angiotensin II during long‐term felodipine treatment may reflect decreased cardiac and renal β‐adrenoceptor‐mediated responses. Increased renal clearance of aldosterone could partly explain the unaltered plasma aldosterone level in spite of increased plasma angiotensin II following long

ISSN:0001-6101    

DOI:10.1111/j.0954-6820.1988.tb15776.x

出版商:Blackwell Publishing Ltd    

年代:1988

数据来源: WILEY

摘要:

ABSTRACTIn a randomized, cross‐over study 27 patients had diastolic blood pressure of ≥ 96 mmHg during four visits without treatment. Following captopril 25 mg b.i.d. nine patients' blood pressure was ≤ 90 mmHg. The remaining 18 were randomized into two treatment modalities, captopril and moderate dietary salt reduction, and captopril and hydrochlorothiazide 25 mg daily. Following a wash‐out period the groups crossed over to the alternative treatment. At the end of the control period the average blood pressure was 151/100 ± 12/6 mmHg recumbent and 140/91 ± 11/7 standing, following captopril 144/94 ± 13/5 and 132/92 ± 12/6, respectively, with low salt diet addded to captopril 140/91 ± 12/6 and 128/89 ± 11/6 and with hydrochlorothiazide and captopril 133/86 ± 12/7 and 120/84 ± 11/7 mmHg supine and erect, respectively. It is concluded that moderate dietary salt reduction, which is easily advised, will significantly potentiate the blood pressure fall following captopril treatment in moderate arteri

ISSN:0001-6101    

DOI:10.1111/j.0954-6820.1988.tb15777.x

出版商:Blackwell Publishing Ltd    

年代:1988

数据来源: WILEY

摘要:

ABSTRACTMuscle thermogenesis was measured by direct microcalorimetry in hypertensive patients randomly treated with either metoprolol or placebo. Samples from rectus abdominis were taken after muscle relaxation during surgery, which was accompanied by a significant increase in arterial plasma noradrenaline. Thermogenesis was significantly lower in the metoprolol group compared with both the hypertensives given (p<0.05), and a normotensive group without treatment (p<0.005). Metoprolol also provoked a significant fall in body temperature in comparison with the two other groups (p<0.01). In the hypertensives given placebo, heat production was inversely related to plasma adrenaline (r= ‐0.89), indicating a role of the sympatho‐adrenal system in muscle thermogenesis. No such correlation appeared during metoprolol treatment. In the present acute stress situation it is suggested that muscle thermogenesis was decreased indirectly by metoprolol via blockade of β1‐receptors in adipose tissue, causing a relative inhibition of lipolysis with diminished substrate supply to the m

ISSN:0001-6101    

DOI:10.1111/j.0954-6820.1988.tb15778.x

出版商:Blackwell Publishing Ltd    

年代:1988

数据来源: WILEY

摘要:

ABSTRACTBy using111In‐labelled platelets and dynamic gamma camera scintigraphy, platelet production rate and intrasplenic platelet kinetics were determined in 13 patients at 1 and 4 months after aortic reconstructive vascular surgery with implantation of dacron prostheses. A significant decrease in platelet production rate and venous platelet count was recorded over time after surgery. Irrespective of whether the exchangeable splenic platelet pool was estimated from initial recovery of platelet‐bound radioactivity or from compartmental analysis, the size of this pool was significantly lower at the first study; a change in intrasplenic platelet transit time accounted for the observed difference. Platelet mean life‐span increased over time after surgery but the difference between the duplicate studies was not statistically significant. It can be concluded that there is a reduction of platelet production rate and venous platelet count over time after major reconstructive vascular surgery. The early postoperative elevation in the platelet count is mainly the result of an increased platelet production and to a lesser degree due to redistribution of platelets between the splenic platelet pool and general circul

ISSN:0001-6101    

DOI:10.1111/j.0954-6820.1988.tb15779.x

出版商:Blackwell Publishing Ltd    

年代:1988

数据来源: WILEY

摘要:

ABSTRACTInsulin resistance was assessed after a hypoglycemia induced by insulin (1.5 mU×kg‐1×min‐1) between 7 and 8 a.m. in 10 well‐insulinized patients with insulin‐dependent diabetes mellitus (IDDM). Blood glucose levels during a somatostatin (100 μg×h‐1)‐insulin (0.4 mU×kg‐1×min‐1)‐glucose (4.5 mg×kg‐1)‐infusion test (SIGIT) performed between 11 a.m. and 3 p.m. served as an indicator of total body insulin resistance. Plasma epinephrine, growth hormone, and Cortisol increased in response to hypoglycemia, while blunted responses of glucagon were simultaneously registered. At the start of the subsequent SIGIT, blood glucose and plasma‐free insulin concentrations were similar to those obtained in the control study without preceding hypoglycemia, and at this point all counter‐regulatory hormones had returned to basal. During the SIGIT close to identical levels of plasma‐free insulin and counter‐regulatory hormones were registered, despite which a significant hyperglycemia was seen 2 hours after the start of the SIGIT when preceded by hypoglycemia. In a separate study, the SIGIT was shown to have a good reproducibility in IDDM patients. We conclude that hypoglycemia evokes a state of insulin resistance for several hours, as demonstrated by elevated blood glucose levels during a somato

ISSN:0001-6101    

DOI:10.1111/j.0954-6820.1988.tb15780.x

出版商:Blackwell Publishing Ltd    

年代:1988

数据来源: WILEY

摘要:

ABSTRACTThe effect of growth hormone (GH) on the glucose homeostasis following nocturnal hypoglycemia was studied between 4 a.m. and noon in eight male patients with insulin‐dependent diabetes mellitus (IDDM) by a somatostatin (250 μg/h)‐insulin (0.4 mU/kg/min)‐glucose (6 mg/kg/min)‐infusion test (SIGIT). The patients participated in two experiments in which hypoglycemia at 4 a.m. was induced by i.v. insulin (1.5 mU/kg/min). In both experiments the endogenous secretion of GH was suppressed by somatostatin (250 μg/h) and glucagon (0.5 ng/kg/min) was given as substitute for the somatostatin‐induced suppression of endogenous glucagon secretion. GH (20 mU/kg/h) or saline was given for 60 min from nadir blood glucose in random order. Mean nadir glucose values were the same in both studies (1.7 ± 0.2 vs. 1.7 ± 0.1 mmol/l) and no differences were registered in plasma‐free insulin, glucagon and the responses of adrenaline and Cortisol to hypoglycemia. The infusion of GH resulted in plasma GH levels of about 50 μg/l at the end of the infusion, thereafter decreasing to low or immeasurable levels within 2 hours. Infusion of GH evoked a marked hyperglycemia within 4 hours. It is concluded that when hypoglycemia is accompanied by a transient increase in plasma GH, insulin resistance occurs after a lag period of approximately 4 hours and that this effect persists for at least

ISSN:0001-6101    

DOI:10.1111/j.0954-6820.1988.tb15781.x

出版商:Blackwell Publishing Ltd    

年代:1988

数据来源: WILEY