Atrial peptides, ANP(1-98) and ANP(99-126) in health and disease in an elderly population

Circulating immunoreactive atrial natriuretic peptide, Ir ANP(99-126)and the N-terminal fragment of the prohormone, Ir ANP(1–98)were measured in two population samples from the general populationof Gothenburg, Sweden. A group of 85-year olds (974 subjects)and a group of 40-year olds (191 subjects) were investigatedin respect of cardiovascular, renal and metabolic disease. Ir ANP(99-126) and Ir ANP(1-98) were significantly higher inthe 85-year olds compared to tile 40-year olds, and were significantlyincreased in subjects with congestive heart failure, ischaemicheart disease, atrial fibrillation and renal dysfunction butnot in subjects with hypertension. Eighty-five-year-old subjectswho were on treatment with digitalis, ß-adrenergic-blockers,nitrates and diuretics had significantly increased Ir ANP(99-126)and Ir ANP(1-98). In multivariate analysis Ir ANP(99-126) concentrationswere predictive for congestive heart failure, ischaemic heartdisease, atrial fibrillation and treatment with ß-blockersand anti-depressant drugs. Ir ANP(1–98) was predictivefor congestive heart failure, ischaemic heart disease, atrialfibrillation, diabetes mellitus, renal failure and drug treatmentwith ß-blockers and neuroleptics. We conclude that measurements of circulating concentrationsof Ir ANP(99-126) and/or Ir ANP(1-98) may add valuable informationin the diagnosis of congestive heart failure and ischaemic heartdisease in an elderly population. It remains to be determinedwhether routine measurements of circulating Ir ANP(99–126)and Ir ANP(1–98) may be of value in predicting currentcardiovascular disease for the individual patient.     

Prevalence of dental fluorosis in children taking part in an oral health programme including fluoride tablet supplements from the age of 2 years

International Journal of Paediatric Dentistry 2010; 20: 347–352 Aim. To investigate the prevalence of dental fluorosis in children who had participated in an oral health programme between the ages 2–5 years, including fluoride tablets from the age of 2 years. Design. The study group consisted of 135 10‐ to 11‐year‐old children who had participated in the programme, including parent education, tooth‐brushing instruction and prescribed fluoride tablets (0.25 mg NaF) (2–3 years: 1 tablet/day; 3–5 years: 2 tablets/day). The prevalence of dental fluorosis in the study group was compared with that in a nonintervention reference group consisting of 129 children of the same ages. The analysis was based on photos of the permanent maxillary front teeth using the Thylstrup & Fejerskov (TF) Index. Results. No statistically significant difference in prevalence of dental fluorosis was seen between the two groups. Forty‐three percent of the children in the study group and 38% in the reference group had fluorosis, the majority of a mild nature (TF‐score 1). None had a TF score above 2. The pattern was the same after correction for parent reported intake of tablets at 3 and 5 years of age. Conclusion. Introduction of fluoride tablets at the age of 2 years did not result in increased prevalence of dental fluorosis.     

A Longitudinal Study on Growth and Spontaneous Growth Hormone (GH) Secretion in Children with Irradiated Brain Tumors

ABSTRACT. Longitudinal growth was studied in 27 children after radiotherapy for a brain tumor. Growth deviation (1 SD) was found in 56% of the children after 2 years and was most profound in prepubertal children aged between 3 and 8 years at the time of irradiation. In this group growth velocity was markedly reduced and no catch up was seen. In all children studied growth hormone (GH) secretion, measured as the spontaneous secretion over 24 hours, was found to be severely disturbed. Our conclusion is that all children with a growth deviation 1 SD after radiotherapy (40 Gy) to the hypothalamo–hypophyseal region should be considered GH deficient. In such children GH treatment can be initiated without further testing.     

FIBRINOLYSIS IN NEWBORNS

The fibrinolytic system was studied in 207 normal fullterm newborns during the first 5 days of life. A high, but rapidly decreasing plasminogen activator activity was found during the first 4 hours in umbilical vein blood in all of the children studied. The activity in the cord blood was lower and cannot be regarded as representative of the child. Fibrinolytic split products were demonstrated in large and rapidly decreasing amounts in serum samples without the addition of EACA but in at most small amounts in serum when EACA was added at sampling. These findings confirm the high plasminogen activator activity at birth which rapidly falls and furthermore show that there are no significant amounts of split products in vivo in the newborn. The plasminogen level was decreased in accordance with previous investigations. The high activator activity is counterbalanced by adequate inhibitory protection with an increase of the α₂-macroglobulin and inhibitors of plasminogen activation and the adult content of antiplasmin. The mean fibrinogen values in the first 48 hours of life are in the lower part of the normal range, but increase on the third day to a significantly higher level.     

Increase in Plasma Atrial Natriuretic Peptides during Acute Volume Expansion in Hypertensive Man

ABSTRACT. A new hormonal system originating from cardiac atria has recently been discovered. These peptide hormones have important functions in the regulation of blood volume and fluid homeostasis. We have measured plasma concentrations of atrial natriuretic peptides (ANP) in two patients during acute volume expansion. ANP concentrations increased in relation to an increase in right atrial pressure, and significant diuresis/natriuresis was observed. We conclude that hormonal as well as neuronal mechanisms are activated by acute volume loading in man.     

A COMPARISON OF TWO TECHNIQUES TO REACH RELATIVES OF ALCOHOLICS FOR INFORMATION OF AVAILABLE SUPPORT

Two different information techniques to reach spouses and relativesof inpatient alcoholics for information of available support,one standardized and one individualized, were compared. Eachprocedure was tested during 6 months in the same ward. In thestandardized model 18% (20/112) and in the individualized model20% (21/104) of spouses/relatives/friends attended the informationsession. In those living with a spouse, the rates were 46% and41% respectively, and among those who were not cohabiting, buthad relatives or sober friends, the figures were 11% and 17%respectively. There were no sex differences. Among preferredsupport, individual support, marital and family support andprofessional group support received the highest ratings. Atthe 1 year follow-up, more subjects in the individualized informationgroup had received support compared with those in the standardizedgroup. The low rates of informed subjects are in agreement withthe literature and considerably lower than the rates in informationprogrammes for relatives of schizophrenic patients.     

Collagen metabolism in normal and complicated pregnancy: changes in the aminoterminal propeptide of type III procollagen in serum

The turnover of type III collagen, a major constituent of the myometrium and the uterine cervix, during pregnancy was evaluated by monitoring serum antigens related to the aminoterminal propeptide of type III procollagen. Their concentration increased markedly towards term in most uncomplicated pregnancies, while their size distribution throughout the pregnancy resembled that seen in the sera of normal healthy persons. In some patients, however, the level remained low, indicating interindividual variation in the release into serum and metabolism of the propeptide. There were no distinct changes during or immediately after vaginal delivery. Values exceeding the reference range for uncomplicated pregnancies were found during weeks 28-37 in patients with pre-eclampsia, essential hypertension, intrahepatic cholestasis of pregnancy or twin pregnancy. Thus, pregnancy should be taken into account when evaluating results of the serum assay for the aminopropeptide and the use of this assay as an indicator of pregnancy complications warrants further study.     

INCREASED FREQUENCY OF GOITRE IN EPILEPTIC PATIENTS ON LONG-TERM PHENYTOIN OR CARBAMAZEPINE TREATMENT

Thyroid function, the clinical occurrence of goitre and ultrasonically determined thyroid gland volume were investigated in 23 patients with phenytoin- and 28 patients with carbamazepine-treated convulsive disorders and compared with matched healthy controls. In the phenytoin treated group median thyroid volume was 26 ml (range 14-57 ml) compared to 17 ml (range 8-41 ml) in the controls (P less than 0.01). Ten patients and four controls had a goitre (NS). Median serum T4 and FT4I levels were reduced, serum TSH level increased and serum T3, T3RU, FT3I and thyroglobulin levels unaltered compared with the controls. In the carbamazepine treated group median thyroid volume was 25 ml (range 13-66 ml) compared to 16 ml (range 9-44 ml) in the controls (P less than 0.01). Thirteen patients and three controls had a goitre (P less than 0.02). Median serum T4, FT4I and FT3I levels were reduced, serum thyroglobulin increased and serum T3, T3RU and TSH levels unaltered compared with the controls. The increase in thyroid size is probably a compensatory mechanism due to the low free thyroid hormones in serum caused by an increased hepatic degradation of thyroid hormones by phenytoin and carbamazepine.     

Thallium Scintigraphy in Prediction of Occlusion of Bypass Grafts in Asymptomatic and Symptomatic Patients

ABSTRACT To evaluate thallium scintigraphy in predicting coronary artery bypass graft patency, exercise thallium scintigraphy and selective graft and native vessel angiograms were performed in 22 asymptomatic and 29 symptomatic consecutive patients three months after coronary artery bypass grafting (CABG). Twelve out of 22 asymptomatic patients (55%) had reversible thallium defects on postoperative images; in 10 patients the postoperative scans were normal. The graft patency was significantly lower in asymptomatic patients with abnormal thallium perfusion compared to those with normal perfusion after CABG (68% vs. 91%. p<0.05). The rate of graft patency in symptomatic patients was 66/87 (76%). Thallium scintigraphy was 77% sensitive and 78% specific in detecting one or more stenosed or occluded bypass grafts in patients without angina (accuracy 77%). When data from exercise electrocardiography were combined with scintigraphy, all but one patient with incomplete revascularization could be detected (positive predictive accuracy 92%). In symptomatic patients, thallium scintigraphy accurately predicted the presence or absence of graft occlusion in 24/29 (83%) cases. Thus, abnormal myocardial perfusion due to stenosis or occlusion of bypass grafts is common in both asymptomatic and symptomatic patients after CABG. Thallium scintigraphy together with exercise electrocardiography appear to be useful non-invasive methods in detecting painless myocardial ischemia and in predicting bypass graft occlusion after CABG.