Reduction of Mortality in the Stockholm Ischaemic Heart Disease Secondary Prevention Study by Combined Treatment with Clofibrate and Nicotinic Acid

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<0.05). For patients above 60 years of age in the Treatment group the reduction in mortality was 28% (p<0.05). IHD mortality was reduced by 36% (p<0.01)in the Treatment group compared to the Control group. The beneficial effect of the serum lipid lowering treatment was related to the serum triglyceride concentration in two ways. First, it only occurred in patients with a triglyceride level >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.     

Acute effects of acetazolamide on cerbral blood flow in man

We have followed the time course of the effect of the carbonic anhydrase inhibitor acetazolamide injected i. v. in unanesthetized healthy human beings. The dose administered was 500 mg as a bolus. Cerebral blood flow (CBF) was measured continuously before, during and after the injection, using a pulsed ultrasound doppler system, which measured the instantaneous mean velocity across the lumen of the internal carotid artery, just below its entrance into the skull. Ventilation, heart-rate, end-expiratory PCO₂- arterial PCO₂, pH and systemic blood pressure was also measured. We found that acetazolamide caused a rise in CBF which could be detected as early as 2 min after the injection. A maximal average response of 75% increase in CBF was seen after 25 min. The half-time of the declining phase of the response was 95 min. There were no systematic differences in the CO₂ reactivities, given as ACBF/ΔPACO₂ in % of CBF at normocapnia, before and after acetazolamide injection, regardless of the absolute PACO₂ level. The present dose of the drug caused no change in ventilation, alveolar and arterial PCO₂ or in arterial blood pH indicating that the carbonic anhydrase was not fully inhibited. Our observations show that acetazolamide nevertheless caused a rapid vasodilation in the brain and over a wide range of PCO₂′s. We suggest that this agent has a local vasodilator effect on the cerebral arterioles, unrelated to its specific effects as a carbonic anhydrase inhibitor.     

Molecular characterization of CTX‐M‐15‐producing clinical isolates of Escherichia coli reveals the spread of multidrug‐resistant ST131 (O25:H4) and ST964 (O102:H6) strains in Norway

Nationwide, CTX‐M‐producing clinical Escherichia coli isolates from the Norwegian ESBL study in 2003 (n=45) were characterized on strain and plasmid levels. Bla_CTX‐M allele typing, characterization of the genetic environment, phylogenetic groups, pulsed field gel electrophoresis (PFGE), serotyping and multilocus sequence typing were performed. Plasmid analysis included S1‐nuclease‐PFGE, polymerase chain reaction‐based replicon typing, plasmid transfer and multidrug resistance profiling. Bla_CTX‐M‐15 (n=23; 51%) and bla_CTX‐M‐14 (n=11; 24%) were the major alleles of which 18 (78%) and 6 (55%), respectively, were linked to ISEcp1. Thirty‐two isolates were of phylogenetic groups B2 and D. Isolates were of 29 different XbaI‐PFGE‐types including six regional clusters. Twenty‐three different O:H serotypes were found, dominated by O25:H4 (n=9, 20%) and O102:H6 (n=9, 20%). Nineteen different STs were identified, where ST131 (n=9, 20%) and ST964 (n=7, 16%) were dominant. Bla_CTX‐M was found on ≥100 kb plasmids (39/45) of 10 different replicons dominated by IncFII (n=39, 87%), FIB (n=20, 44%) and FIA (n=19, 42%). Thirty‐nine isolates (87%) displayed co‐resistance to other classes of antibiotics. A transferable CTX‐M phenotype was observed in 9/14 isolates. This study reveals that the majority of CTX‐M‐15‐expressing strains in Norway are part of the global spread of multidrug‐resistant ST131 and ST‐complex 405, associated with ISEcp1 on transferrable IncFII plasmids.     

Selected Trace Elements and Proteins in Serum of Apparently Healthy Newborn Infants of Mothers Who Smoked during Pregnancy

ABSTRACT. The serum concentrations of selected trace elements and proteins in cord blood from 17 new-bom infants whose mothers were habitual smokers were compared with values from 22 infants of non-smoking mothers. All the mothers were healthy with normal pregnancies and deliveries. Cigarette smoke exposure was verified by determinations of nicotine, cotinine and thiocyanate concentrations in cord blood. Infants of smoking mothers had a slightly lower mean birth weight (3490±430 g) than control infants (3780±460 g). Infants of smokers had lower serum iron ( p =0.05) and prealbumin ( p ≤0.05), but higher serum copper ( p ≤0.05) and ceruloplasmin ( p ≤0.01) levels than the controls. Infants of smoking mothers tended to have higher levels of the acute-phase reactants alpha-₂-macroglobulin and orosomucoid, but lower levels of albumin, transferrin and retinol-binding-protein, although differences were not statistically significant.     

Echocardiographic Left Atrial Dimension as a Predictor of Maintaining Sinus Rhythm after Conversion of Atrial Fibrillation

ABSTRACT Twenty-six patients with lone atrial fibrillation were studied prospectively by M-mode echocardiography less than two months before and one month after cardioversion (CV). Seven patients had reverted to atrial fibrillation (AF) one month after CV. These patients (AF group) differed significantly with regard to mean left atrial dimension (LA) from the 19 patients (73%) who maintained sinus rhythm (S group) (p<0.001). Initial LA was 38.6±4.9 mm in the S group and 47.6±2.3 mm in the AF group. These values had not changed significantly in either group when measured one month after CV. The radiological heart size index showed a closely corresponding pattern. On the other hand, the mean heart size in both groups (441±100 and 544±98 ml/m² BSA, respectively) was well below the upper normal limit (700 ml/m²) that is conventionally used as exclusion criterion from CV. In conclusion, in patients with AF and only moderate cardiac enlargement on chest X-ray, the echocardiographic LA can be used as predictor of maintaining sinus rhythm for at least one month following CV.     

Inhibition of lactation by cyclofenil and bromocriptine

Summary. In a double blind controlled study of the inhibition of lactation 13 women received 300 mg of cyclofenil and 11 women 2.5 mg of bromocriptine twice daily for 14 days. Lactation was effectively inhibited by both drugs, but with bromocriptine there was a significantly higher frequency of relapse. The plasma concentration of prolactin, which decreased rapidly with bromocriptine, returned to the pretreatment level the day after drug treatment stopped, but with cyclofenil it remained low. Plasma oestradiol followed a similar pattern. Plasma FSH increased more rapidly with bromocriptine than with cyclofenil. There was no significant difference between the treatment groups at any stage for haematology, coagulation or liver function tests. The more sustained effect of cyclofenil on prolactin secretion with a reduced frequency of relapse, and the lower oestradiol level, which might indicate a reduced risk of thromboembolism, suggest that this drug has some advantage over bromocriptine in the inhibition of postpartum lactation.     

PUVA-induced diminution of contact allergic and irritant skin reactions

A pilot study on the efficiency of treatment with 8-methoxypsoralen and longwave ultraviolet light (PUVA) on three patients with allergic contact dermatitis to nickel sulphate, potassium dichromate and to thiuram mix has been performed. Both the contact allergic reactions and the irritative skin reactions induced by dimethyl sulfoxide (DMSO) and tetrahydrofurfuryl nicotinate (Trafuril) were evaluated before and after PUVA. The total UV-A doses were respectively 69–45 and 76J/cm². These doses induced complete clearance of the eczematous lesions in two cases; the third case showed considerable improvement. In contrast to the pronounced skin reactions seen prior to PUVA, the allergic and irritative reactions evaluated after PUVA were decreased or negative.     

Treatment of porphyria cutanea tarda with chloroquine and phlebotomy

Treatment of porphyria cutanea tarda (PCT) with chloroquine risks serious side-effects so we have combined it with phlebotomy. One to four venesections were performed before the administration of chloroquine in to PCT patients. Equally high excretion of urinary porphyrins was achieved but the side-effects were reduced. Chloroquine may be used as a provocative diagnostic test for patients with a questionably latent PCT but this is safe is safe if phlebotomy is performed beforehand.     

Effect of chlorhexidine on animal cells in vitro

abstract – When cultures of human epithelial cells were treated for 5 min at 37°C with chlorhexidine in Eagle's medium without serum added, concentrations from 0.05 mM were found to be toxic as measured by growth inhibition and differential staining. About 20 times higher concentrations were needed to obtain a toxic effect, however, when the cells were treated with chlorhexidine dissolved in calf serum. Human whole saliva collected from a single subject had no such protective effect. The intracellular activities of 5'-nucleotidase, alkaline phosphatase, and NADPH₂+ NADH₂-diaphorases decreased upon treatment of the cells with concentrations of chlorhexidine at 0.2 and 2 mM, whereas 0.02 mM had no measurable effect on these enzymes. Treatment with chlorhexidine at 10⁻⁴mM had no effect on the hypotonic hemolysis of human erythrocytes, 0.001–0.1 mM stabilized the cells, but increasing the concentration to 1 mM gave 100% hemolysis. A concentration-dependent inhibition of the Na⁺–K⁺–ATPase activity was found when erythrocyte membranes were incubated with chlorhexidine in the range of 0.002–0.2 mM.     

Retreatment of endodontic fillings

Abstract— Effects of endodontic retreatment on quality of seal and periapical healing were assessed among 660 previously root-filled roots. The roots were divided into either of two groups according to presence or absence of pathologic alterations in the periapical area. The retreatments, which were carried out by dental students, involved a thorough chemomechanical debridement of the root-canal system aiming to control infection. Following a 2-year observation period 556 roots were reexamined clinically and radiographically. The results showed that root-fillings with technical shortcomings could, following retreatment, be markedly improved as regards effectiveness of seal and distance to the apex. A large number of lumina discernible apical to root-filling could also be treated and filled. Seventy-eight percent of the cases with pathologic lesion present periapically prior to retreatment either completely healed or displayed an obvious size-reduction of the process Retreatments carried out because of technical inadequacies alone were successful in 94% of the cases. It was concluded that renewed endodontic treatment whenever possible is the method of choice when treating defective endodontic fillings complicated with pathologic processes periapically. Apical surgery may be attempted if no signs of healing are apparent following observation.