Epidemiology of Diabetes Mellitus in Sweden

ABSTRACT All newly diagnosed cases of diabetes mellitus aged 15–34 years in Sweden, where the population in this age interval is about 2.3 million, were registered on standardized forms. During 1983, the first year of the study, there were 311 males and 161 females, excluding 280 with gestational diabetes. The annual incidence of diabetes was 26.2 per 100000 in males and 14.2 in females. The respective figures for type I were 18.5 and 10.1, and for type II 5.7 and 2.9. The incidence of type I diabetes was similar for the four age groups (15–19, 20–24, 25–29, 30–34 years), while for type II it was highest in the oldest group. Types I and II, but not the sexes, differed as regards the cumulative distribution curves of the maximum blood glucose concentration during the first two weeks after diagnosis. The present incidence of diabetes in Sweden is higher, particularly in males than the rates for similar age groups in Oslo (1925–64) and Denmark (1970–77).     

201- Thallium imaging as an indicator of graft patency after coronary artery bypass surgery

In a prospective study, forty one patients underwent myocardialimaging using 201 thallium (²⁰¹ Tl) scmtigraphy before and 6months after coronary artery bypass grafting (CABG). The resultswere compared with the findings at coronary arleriography performedat the same time. ²⁰¹ Tl was injected at peak exercise level performing an exercisescintigram. A thallium image equivalent to a redistributionscan was obtained at rest approximately 4 h after the injectionof²⁰¹ Tl. The overall angiographic patency rate was 0.77. Postoperativemyocardial perfusion was improved in 26 patients (88%) having72 of 83 grafts patent (patency rate 0.87). New perfusion defectsor unchanged ischaemic patterns were found in 5 patients, whohad 2 of 13 grafts patent (graft patency 0.15). Estimation ofthe graft status by ²⁰¹ Tl-scinligraphy showed a sensitivity,specificity, and predictive value of a positive and negativeresult of 0.71, 0.94, 0.79 and 0.91, respectively, using angiographicfindings as a reference. It is concluded, that comparison between preoperative and postoperative²⁰¹ Tl imaging of the myocardium at exercise and rest providesuseful information on graft patency after CABG. The procedureis superior to graft patency estimation based on resting orpostoperative scintigrams only.     

Dose regimen of deprenyl (selegiline) and platelet MAO activities

ABSTRACT — The effect of various doses of deprenyl on thrombocyte MAO activity in parkinsonian patients has been studied. It is suggested that individual differences in the degree of inhibition are due to differences in the metabolic rate of deprenyl. The recovery of thrombocyte MAO activity was linear at a rate of approximately 10 % per day. The linearity of the recovery suggests that the disappearance of the population of thrombocytes is selected with respect to age.     

Failure of Long-term Acclimatization in Smokers Moving to High Altitude

Abstract It was found that several foreign experts recruited for an irrigation project in southern Peru could not cope with their work at an altitude of 3 200 m. When we analyzed the haematological acclimatization to high altitude in 109 adult males, we found that the moderate differences in haematorit level (0.9) and haemoglobin concentration (0.2 g/100 ml) between male smokers and non-smokers at low altitude were almost quadrupled at 3 200 m height. The haemoglobin concentration increased in both groups during the first month, after which it remained constant. Of 51 Swedish employees, 25 smokers and 26 non-smokers, 14 were obliged to terminate their contracts. All 10 who had failed to cope with their work for other than purely medical reasons were smokers. This group of smoking men also had an overconsumption of alcohol. We therefore conclude that life style determines long-term acclimatization to high altitude.     

Condylar adaptation to a change in intermaxillary relationship

Twenty Sprague-Dawley rats were utilized to study the effects of a distal occlusion on the mandibular joint. The experimental period varied from one to four weeks. Cellular behavior and synthesis of new bone was revealed radioautographically after the injection of tritiated thymidine and tritiated proline respectively. The following structures within the joint were studied: (1) the fibrous layer of the articular fossa, (2) the fibrous and (3) the embryonic zone of the condyle. The number of labeled cells decreased in all areas analyzed after the first week of experiment but by two weeks had increased above the control. At four weeks, while still higher than the control, the radioactive index was decreasing. Of the structures studied, the embryonic layer showed the greatest response in number of cells undergoing DNA synthesis due to: (1) growth, (2) age, and (3) distal displacement of the mandible. Within the fibrous layer of the condyle and articular fossa, however, except for the central portion of the latter, the difference in radioactive index between control and experimental groups was negligible. Concomitant with the downward and forward growth of the mandible the number of cells undergoing DNA synthesis was highest in the posterior portion of the condyle. Initially, resorption was observed in the area of the external pterygoid attachment of the condyle followed by new bone formation as evidenced by tritiated proline. From this investigation the following conclusions were drawn: (1) The cells within the embryonic zone of the condylar cartilage can be stimulated, even in the adult, to increase their rate of cellular division to adapt to changes in mandibular position. (2) The articular fossa and disc remain unaltered following distal mandibular displacement. (3) Tension within the external pterygoid muscle will result in gross morphologic alterations on the anterior border of the condyle.     

Serum Thyroid-stimulating Hormone in Cerebrovascular Disease

ABSTRACT. A thyrotropin-releasing hormone (TRH) test with serum thyroid-stimulating hormone (TSH) assays was performed in 22 euthyroid stroke patients without thyroid disease and the results were compared with those in 17 age-matched euthyroid controls. Basal and maximum TSH levels after TRH injeciton were significantly lower in the stroke group without elevation of basal serum thyroid hormone levels. There was a tendency towards an inverse relationship betweeen TSH levels and the degree of pareses of the extremities. The test was repeated in 7 stroke patients 3–4 months after the onset of stroke with essentially the same results. The abnormal TSH parameters in stroke patients seem to be the result of the brain lesion per se.     

Urolithiasis and distal renal tubular acidosis preceding primary Sjögren's syndrome: a retrospective study 5–53 years after the presentation of urolithiasis

Objectives. Distal renal tubular acidosis (dRTA) can be associated with autoimmune diseases such as primary Sjögren's syndrome (SS). Our objective was to study SS-associated symptoms, autoantibodies and renal histopathology in patients with urolithiasis and dRTA.
Setting. The patients were from the Departments of Nephrology and Rheumatology, University Hospital of Linköping, which is a tertiary referral hospital, as well as a secondary referral centre for the immediate area around the city of Linköping.
Subjects. Ten female patients with dRTA, who presented with urolithiasis and not with subjective sicca symptoms, were from the Department of Nephrology, University Hospital, Linköping. Autoantibodies were detected in eight of these patients, and they were studied with respect to clinical and laboratory evidence of SS (urolithiasis group). Fifteen women with SS, who presented with sicca symptoms and not with urolithiasis or dRTA, served as the reference group.
Results. In the urolithiasis group, all of the eight patients had anti-SS-A antibodies, and SS (or possible SS) developed in seven of the eight patients 1–48 (mean 15) years after the onset of urolithiasis. Histological features of tubulointerstitial nephritis were found in four of five biopsied patients in the urolithiasis group, and in two of four patients (with dRTA) in the reference group.
Conclusions. Urolithiasis and dRTA can precede subjective sicca symptoms, and patients with dRTA may have SS in the absence of subjective sicca symptoms. Anti-SS-A antibodies are common in patients with urolithiasis and dRTA. Therefore, we hypothesize the possibility of a Sjögren-related renal disease in these patients.     

VALUE OF BASAL PLASMA CORTISOL ASSAYS IN THE ASSESSMENT OF PITUITARY-ADRENAL INSUFFICIENCY

A basal plasma cortisol value taken in a physically unstressed state in 68 patients with or without hypothalamic-pituitary-adrenocortical disease was compared with the maximal plasma cortisol concentration during an insulin tolerance test. There was a strong positive correlation between the values. Basal cortisol levels above 300 nmol/l (RIA method) almost excluded ACTH-cortisol insufficiency and those below 100 nmol/l strongly suggested dysfunction. A repeated basal cortisol estimation within a month was especially valuable in categorizing patients with levels between 100 and 200 nmol/l. We suggest that a basal cortisol measurement may be used as a first laboratory test in patients evaluated for possible hypothalamic-pituitary-adrenocortical insufficiency; in many patients, this approach obviates more sophisticated and expensive testing.