Showing papers in "Acta Medica Scandinavica in 2009"

Epidemiological studies in the Upernavik district, Greenland. Incidence of some chronic diseases 1950-1974.

Abstract: An epidemiological survey of several chronic diseases in the Upernavik district, Northwest Greenland, is reported. The study population (approx. 1800 inhabitants) is one of the remaining whaling and sealing populations in Greenland. It was observed over the 25-year period 1950-74 as to the incidence of the diseases, which was based on all cases diagnosed in hospital during this period. The disease pattern of the Greenlanders differs from that of West-European populations, having a higher frequency of apoplexy and epilepsy but a lower frequency or absence of acute myocardial infarction, diabetes mellitus, thyrotoxicosis, bronchial asthma, multiple sclerosis and psoriasis. The distribution of cancer types differs from that of the Danish population, but the total incidence of cancer is of the same magnitude. Further comparable studies should be performed in Greenlandic districts that are characterized by more profound changes in life style, in order to elucidate the effect of these changes on the disease pattern.

The composition of food consumed by Greenland Eskimos.

Abstract: Food specimens have been collected, by means of the double-portion technique, from Greenland Eskimo hunters and their wives, in all seven persons, on seven consecutive days. Their food was found to contain more protein and less carbohydrates than average Danish food and an almost equal amount of fat. Compared with Danish food, the fatty acid pattern of the consumed lipids--essentially of mammalian marine origin--showed a higher content of long chain polyunsaturated fatty acids (especially C20:5) and lower contents of linoleic and linolenic acids. However, the sum of the polyunsaturated fatty acids was smaller than in Danish food. Using Keys' formula, describing the serum cholesterol level as a function of the nutritional fatty acids, the essentially lower serum choelsterol level found in Greenland Eskimos was not explained by our findings. It is suggested instead to be a special metabolic effect of the long chain polyunsaturated fatty acids from marine mammals. There might be a similar effect on the plasma triglyceride and very low density lipoprotein concentrations, explaining the much lower plasma concentrations of these components in Eskimos than in Western populations. Our findings might have an essential bearing on the difference in morbidity from coronary atherosclerotic disease between these populations.

Reduction of mortality in the Stockholm Ischaemic Heart Disease Secondary Prevention Study by combined treatment with clofibrate and nicotinic acid.

Abstract: . Consecutive survivors of a myocardial infarction from the Southern Hospital, below 70 years of age, were randomized into a Control group (n=276) and a Treatment group (n=279). The latter was openly prescribed the combination of clofibrate and nicotinic acid for serum lipid lowering. Each patient should remain in the study for 5 years and be seen regularly every 4 months at a special IHD outpatient clinic within the hospital. The concentration of serum cholesterol and triglyceride was lowered by 13% and 19%, respectively, in the Treatment group compared to the Control group. Total mortality was 82 cases in the Control group and 61 in the Treatment group, a 26% reduction (p 1.5 mmol/l (n=216). Secondly, it was most pronounced in the 44% of the treated patients who had a lowering of the serum triglyceride concentration by 30% or more, and in this subgroup the reduction of IHD mortality was 60% (p<0.01). For serum cholesterol there were no such relations. The difference between serum triglycerides and cholesterol concerning these relations to the treatment outcome may be due to the fact that hypertriglyceridaemia was the most common hyperlipidaemia among our patients, occurring in 50%, while hypercholesterolaemia only occurred in 13 %. Caution should be exercised in the interpretation of the results as the trial was not blind. However, the fact that the decrease in IHD deaths was directly related to the degree of serum triglyceride lowering indicates that it was the drug effect on serum lipids that was reponsible for the beneficial effect of the treatment.

Epidemiology and long-term survival in acromegaly. A study of 166 cases diagnosed between 1955 and 1984.

Abstract: In 1985, a follow-up investigation was performed of all patients with acromegaly (n = 166, 89 women and 77 men) seen over a 30-year period (1955-1984) at our Endocrine Unit, referral centre for the western region of Sweden (population 1.5 million). At the end of 1984, the prevalence of the disease was 6.9 per 10(5) inhabitants, the average incidence per year was 3.3 per million people. Mean age at diagnosis was 46.3 years and at death (n = 62) 64.1 years. About one-third of the patients (50/153), in whom it had been possible to estimate the total duration of the disease, had survived for more than 25 years. Mortality was, however, increased compared to the normal population. The observed number of deaths from vascular and malignant disorders was 32 and 15, respectively, compared to the expected numbers 9.0 (p less than 0.001) and 5.6 (p less than 0.01).

Plasma lipids and lipoproteins in greenlandic west coast eskimos

Abstract: The plasma lipid and lipoprotein pattern has been examined in 130 Greenlandic west coast Eskimos with a life pattern, and especially with dietary habits, rather close to those of original Eskimos and essentially different from those of West Europeans. The age groups of the persons examined were chosen so as to be comparable with the age groups in which ischaemic heart disease prevails in West Europeans. The results of determination of plasma lipid and lipoproteins in the 130 Greenlandic west coast Eskimos, 69 women and 61 men, were compared with those of a similar examination in Denmark, including 25 female Eskimos living in Denmark. Significantly lower concentrations of total lipids, cholesterol, triglycerides, β-lipoproteins and pre-β-lipoproteins were found in Eskimos compared with Danish controls. The study on the Eskimos living in Denmark revealed plasma lipid values significantly higher than in Eskimos in Greenland and equal to those of Danish controls. This points strongly against a genetic and towards an environmental cause of the low lipid and lipoprotein concentrations in Greenlandic Eskimos. As in other societies with low plasma lipid concentrations, coronary atherosclerosis is rare among Greenlandic Eskimos. The Eskimos have low plasma lipid concentrations in spite of a high dietary intake of fat. This could be explained by the special composition of the Eskimo diet, with low content of saturated and high content of unsaturated fatty acids. Besides coronary atherosclerosis, diabetes mellitus is very rare among Eskimos. A correlation of this to the very low concentration of plasma triglycerides and pre-β-lipoproteins is tempting, but purely speculative.

The Associations between Obesity, Adipose Tissue Distribution and Disease

Abstract: Recent research has shown the marked differences in association with disease between obesity localized to the abdominal respectively to the gluteal-femoral regions. In this review systematic analyses were performed of the associations between obesity (body mass index, BMI) or abdominal obesity (increased waist-over-hip circumference ratio, WHR) on the one hand, and a number of disease end points, and their risk factors, as well as other factors on the other, WHR was associated with cardiovascular disease, premature death, stroke, non-insulin-dependent diabetes mellitus and female carcinomas. In contrast, BMI tended to be negatively correlated to cardiovascular disease, premature death, and stroke, but positively to diabetes. The established risk factors for these end points were found to correlate to WHR, while this was often not the case with BMI. BMI was positively correlated only to insulin, triglycerides and blood pressure. Together with diabetes mellitus, this seems to constitute a metabolic group of conditions which are thus associated with BMI. Androgens (in women), and perhaps cortisol, seem to be positively, and progesterone negatively correlated to WHR. The WHR was also positively associated with sick leave, several psychological maladjustments, psychosomatic and psychiatric disease. Attempts were made to interpret these findings. In a first alternative an elevation of FFA concentration, produced from abdominal adipose tissue, was considered to be the trigger factor for the pathologic aberrations associated with abdominal distribution of body fat. When obesity is added, the metabolic aberrations may be exaggerated. In a second alternative adrenal cortex hyperactivity was tested as the cause. When combined with the FFA hypothesis, this might explain many but not all of the findings. It seems possible to produce an almost identical syndrome in primates by defined experimental stress. Women with high WHR were found to have a number of symptoms of poor coping to stress. It was therefore suggested that part of the background to this syndrome might be a hypothalamic arousal syndrome developing with stress. It was concluded that obesity and abdominal distribution of adipose tissue constitute two separate entities with different pathogenesis, clinical consequences and probably treatment.

Natural History and Life Expectancy in Severe Alpha1-Antitrypsin Deficiency, Pi Z

Abstract: Clinical data from 246 adult Swedish individuals with severe alpha1-antitrypsin deficiency, Pi Z, diagnosed in 1963--77, were analyzed. Primary emphysema was present in 109 cases. Of 75 Pi Z patients with other types of chronic obstructive pulmonary disease (COPD), all but 7 showed signs of emphysema. Median age at onset of dyspnoea in Pi Z smokers was 40 years, compared to 53 in non-smokers (p less than 0.001). Of the Pi Z individuals over the age of 50, 19% had a diagnosis of liver cirrhosis and 15% signs of glomerular renal damage. Of 91 deceased patients, 56 died from COPD and 12 from liver disease. A greatly reduced survival was demonstrated in Pi Z individuals, regardless of sex. Smoking Pi Z individuals had a significantly lower life expectancy than Pi Z non-smokers (p less than 0.01).

Acute promyelocytic leukemia.

Abstract: Acute promyelocytic leukemia is a form of acute myeloid leukemia, a cancer of the blood-forming tissue (bone marrow). In normal bone marrow, hematopoietic stem cells produce red blood cells (erythrocytes) that carry oxygen, white blood cells (leukocytes) that protect the body from infection, and platelets (thrombocytes) that are involved in blood clotting. In acute promyelocytic leukemia, immature white blood cells called promyelocytes accumulate in the bone marrow. The overgrowth of promyelocytes leads to a shortage of normal white and red blood cells and platelets in the body, which causes many of the signs and symptoms of the condition.

Plasma insulin as coronary heart disease risk factor: relationship to other risk factors and predictive value during 9 1/2-year follow-up of the Helsinki Policemen Study population.

Abstract: In the Helsinki Policemen Study based on a cohort of 982 men aged 35-64 years and free of coronary heart disease (CHD) at entry plasma insulin level (fasting, 1-hour and 2-hour plasma insulin after oral glucose load) showed during a 9 1/2-year follow-up a non-linear association to the incidence of "hard criteria" CHD events (CHD death or non-fatal myocardial infarction) with highest incidence in the top decile of plasma insulin. Plasma insulin levels showed positive correlations, besides to blood glucose levels, to body mass index, plasma triglyceride level and blood pressure and inverse correlations to leisure time physical activity and objectively measured physical fitness. In multivariate analyses the predictive value of high plasma insulin with respect to CHD risk was found to be independent of other risk factors, including blood glucose levels.

Physical activity and muscle training in the elderly.

Abstract: Most elderly people have some kind of regular daily activity, usually closely connected to their daily habits. A six-graded scale for classification of physical activity is presented. Persons with a low physical activity also usually perceive their physical strain as rather light or moderate. There is a reduction with age in muscle volume, muscle strength, and aerobic capacity which are rather parallel. From a muscular point of view there are only moderate qualitative changes up to the ages around 70; at higher ages there will be a tendency to more marked changes in muscle structure. The maximal aerobic power as well as muscle strength can be increased by physical training also in the elderly. At least up to the ages around 70 there will be an adaptation in muscle structure and enzymatic capacity. In very well-trained 70-year-old men high levels of oxidative enzymes are found together with high maximal aerobic power capacity. A positive attitude should be taken towards physical exercise for prevention and rehabilitation also in the elderly.

The study of women in Gothenburg 1968-1969--a population study. General design, purpose and sampling results.

Abstract: A population study of women in Gothenburg, Sweden, is presented. The women were representative of the total female population in Gothenburg in the age strata 38, 46, 50, 54 and 60 years. Altogether 1 462 women participated in the examination, the participation rate being 90.1%. Social data of participants and non-participants are given. The performance of the examination is described and research projects are outlined. It is concluded that the selection of a strictly representative sample, together with careful uniformity of performance and high participation rate, will make it possible to draw valid conclusions about the total population of middle-aged women in Gothenburg.

Serum Concentration of Cystatin C, Factor D and β2-Microglobulin as a Measure of Glomerular Filtration Rate

Abstract: Serum concentrations of creatinine and of the three low molecular weight (LMW) proteins cystatin C, factor D of the complement system and beta 2-microglobulin were measured in 135 consecutive patients, whose glomerular filtration rates (GFR) were determined by Cr-EDTA. In the total patient series, the reciprocals of S-creatinine and S-cystatin C were numerically and, in males, significantly more closely correlated to GFR than the reciprocals of S-factor D. The reciprocals of beta 2-microglobulin showed a weaker correlation to GFR than those of the other three substances. The calculated glomerular elimination rates of creatinine, cystatin C and factor D were normally distributed, in contrast to those of beta 2-microglobulin. According to data presented so far, cystatin C seems to be the LMW protein of first choice when GFR is to be estimated by measuring the plasma concentration of a LMW protein.

Determination of Pressure Gradient in Mitral Stenosis with a Non‐invasive Ultrasound Doppler Technique

Abstract: A 2 MHz continuous waveform non-invasive ultrasound doppler system has been used in the present investigation. With the aid of the audio signals of the frequency shifts, the ultrasound probe was positioned on the external chest so that the axis of the incident ultrasonic beam coincided with the direction of the maximum velocity vectors of the mitral jet. The frequency shifts due to the mitral jet were frequency analyzed and the time course of the maximum frequency shift was determined. The time course of the maximum mitral jet velocity was then determined from the doppler equation and the time course of the mitral pressure gradient from an orifice equation. The usefulness of the technique was evaluated by studying 25 patients with mitral stenosis and 10 without heart disease. The patients with mitral stenosis were studied during cardiac catheterization and the ultrasound data, the pulmonary artery wedge pressure, and the left ventricular pressure were recorded simultaneously. A table is presented where the gradient determined with the ultrasound technique, deltaPU, is compared with the gradient determined from the pressure tracing, deltaPM. Averaged over the 25 patients studied, deltaPU was 1.7 mmHg smaller than deltaPM at 0.08 sec diastolic time and 1.8 mmHg smaller at 0.25 sec diastolic time. The findings in the patients without heart disease differed distinctly from those in the patients with mitral stenosis. The investigation demonstrated that the non-invasive ultrasound technique can be used with confidence to gain an impression of the magnitude of the mitral pressure gradient. The findings also suggest that deltaPU represents the actual pressure gradient more accurately than deltaPM. Another investigation is proposed to assess the accuracy of the technique more completely.

Cessation of smoking in patients with intermittent claudication. Effects on the risk of peripheral vascular complications, myocardial infarction and mortality.

Abstract: The effects of cessation of smoking were studied in 343 patients with intermittent claudication. One year after the initial examination 39 (11%) had stopped smoking and 304 (89%) continued to smoke. The outcome in these two groups was compared. They were comparable regarding baseline characteristics. Rest pain did not develop in any of the non-smokers. In smokers the cumulative proportion with rest pain was 16% after seven years (p less than 0.05). The cumulative proportions with myocardial infarctions after 10 years were 11 and 53%; the cumulative rates of cardiac deaths 6 and 43%; and the 10-year survival 82 and 46% among non-smokers and smokers, respectively. In multivariate Cox regression analyses the association between smoking and infarction (p less than 0.05) and cardiac death (p less than 0.05) was significant. The survival curves deviated and when they were compared after one year's follow-up the association between smoking and mortality was significant (p less than 0.05). The findings provide further evidence for the fact that it is of utmost importance that patients with intermittent claudication stop smoking.

Seventy-year-old people in Gothenburg. A population study in an industrialized Swedish city.

Abstract: The objectives of this cross-sectional population study of 70-year-old people in Gothenburg, Sweden, were to make a survey of the social and medical conditions of the population, to obtain basic data for planning the care of the elderly, to contribute to the knowledge of normal ageing processes and of normal criteria within the age group, and to offer the subjects a thorough medical examination. A representative systematic sample comprised 1 148 propositi (521 males and 627 females). The study comprised a homecall part regarding basic personal data, dwelling conditions, economy, social and physical communications, previous migration, educational level, previous and any present professions, need for care, consumption of health care and drugs. Observations and measurements were done of illumination at the habitual site of reading, and a simple test of visual acuity was performed. Later on, examinations at the Out-patient Department of the Geriatric Hospital were performed, comprising in all probands general medical and ophthalmological examination, blood and urine sampling, ECG and X-ray of heart, lungs, and breasts and on subsamples, psychological, psychiatric, dental, somatometric, and audiometric examination. Furthermore, a dietary interview and a body composition examination were performed on subsamples. This first presentation deals with the design and procedure of the study, analysis of observer variation and a comparison between responders (85%) and non-responders (15%). The general design of the study, the sampling procedure, and general methods of data collection were found to be adequate. The responders were found to be representative for the population as a whole in most respects studied. The results of this study to be reported in subsequent papers will in general allow conclusions regarding the population of 70-year-olds in Gothenburg.

Risk factors for myocardial infarction in the Stockholm prospective study. A 14-year follow-up focussing on the role of plasma triglycerides and cholesterol.

Abstract: A 14-year follow-up of the Stockholm prospective study is reported. A number of 130 new myocardial infarctions (MI) were found in a prospective group of men (n = 3189) and another 46, i.e. a total of 176 MI, in the total group (n = 3486). Different types of multivariate statistical analyses show that age, blood pressure, smoking, fasting plasma concentrations of cholesterol and triglycerides, ESR and Hb were independent risk factors for MI, while the weight/height index was not. Elevated BP became an important risk factor only after the age of 50. When only age, BP, smoking and the two plasma lipids were entered into the logistic multivariate analysis, plasma triglycerides were more important as a risk factor than cholesterol. Quintile analysis showed that the rate of new MIs increased more with increasing triglyceride than increasing cholesterol levels. In the prospective group, the average rate of new MIs for men below 60 years was 32 per 1000. In the bottom and top quintile these rates were 16 and 65 for plasma triglycerides and 27 and 47 for cholesterol. When the men were divided into 4 groups with regard to both plasma lipids, the rate of new MIs increased successively from group to group along this chain: both lipids normal, only cholesterol high, only triglycerides high and both plasma lipids high.