Pulmonary edema in man: Comparison of capillary filtration pressure, quantification by means of the double indicator-dilution method, and clinical observations

In three groups of patients, one with no signs of pulmonaryedema (n = 11), one with acute myocardial infarction but withoutpulmonary edema (n = 6) and one with recent myocardial infarctionand clinical signs of pulmonary edema (n = 13), investigationswere performed to determine the degree of pulmonary edema: Pulmonary capillary wedge pressure (PC W), plasma colloid osmoticpressure (COP), and critical pressure (CrP) defined as CrP =PCW – COP. The double indicator dilution method with ¹³¹/ albumin as anintravascular indicator and tritiated water (THO) as a diffusingindicator. Clinical estimates such as radiological and auscultatory criteria. Monitoring of PCW and plasma COP appears to give valuable informationon whether or not pulmonary edema fluid is being generated atthe moment when these measurements are being made. On the otherhand, the information obtained by the double indicator-dilutionmethod proved insufficient to warrant its adoption for routineclinical use. Even the difference in mean transit limes of thetwo indicators was found to be a better measurement of the degreeof pulmonary edema.     

Recurrent Herpes Simplex Infection in Multiple Locations in an Otherwise Healthy Boy

Abstract:  An 8-year-old boy developed vesicular lesions on the skin in different parts of the body, occurring four to six times a year. He had a history of eczema herpeticum as a young child. We confirmed a diagnosis of multifocal herpes simplex infection, and hypothesize that this was a result of his previous eczema herpeticum, an unusual complication, in an otherwise healthy and immunocompetent child.     

Urinary Excretion of Kallikrein before and after Operation for Aldosterone-producing Adenoma

ABSTRACT. Hesse B, Rasmussen S, Lund JO, Christensen P, Damkjær Nielsen M. (Department of Clinical Physiology, Glostrup Hospital, and Institute for Experimental Medicine, Copenhagen, Denmark.) Urinary excretion of kallikrein before and after operation for aldosterone-producing adenoma. Urinary kallikrein excretion (UKal), determined by the esterase method, was measured in 10 normotensive volunteers, 10 patients with essential hypertension and in 7 patients with primary aldosteronism before and after operative removal of the adenoma. UKal values were low in 5 of the patients with essential hypertension. Preoperative UKal values in the patients with aldosteronism did not differ significantly from those of the normal subjects, but decreased in all after operation in parallel with changes in urinary excretion of tetrahydroaldosterone and plasma aldosterone concentration. The study supports the assumption of an association between the renal kallikrein-kinin system and the mineralo-corticoid state in man.     

The Prognosis for Patients Referred with Suspected Acute Myocardial Infarction

ABSTRACT. Engby B, Strunge P, Olsen J. (Department of Internal Medicine, Horsens Hospital, Horsens, Denmark.) The prognosis for patients referred with suspected acute myocardial infarction. A follow-up investigation of the prognosis of 381 patients admitted with suspected acute myocardial infarction (AMI) has been carried out in respect of later AMI or death. During hospitalization the patients were divided into groups with particular attention to patients with no demonstrable myocardial infarction but with ischaemic heart disease (non-AMI) and patients with confirmed AMI. All patients were subjected to follow-up for 43 months (range 37–54). The mortality from cardiovascular causes after four years was 26.2% of 130 non-AMI patients and 25.8% of AMI patients. The majority of new infarctions were found in the AMI patients, but with even increase in both groups, 50% occurring within the first 12 months. The groups were studied with regard to earlier manifestations of ischaemic heart disease and heart failure during hospitalization, without any difference being observed. Due to the poor prognosis the question is raised whether non-AMI patients as a group should be offered prophylactic therapy.     

Enhanced sympathetic nervous activity after intravenous propranolol in ischaemic heart disease: plasma noradrenaline splanchnic blood flow and mixed venous oxygen saturation at rest and during exercise

To study the mechanisms by which acute beta-adrenergic blockade may change the activity of the sympathetic nervous system we have measured haemodynamic responses including splanchnic blood flow in twenty-three patients with ischaemic heart disease at rest and during supine exercise before and after i.v. injection of 0.039 mmol (10 mg) dl-propranolol. After propranolol both at rest and on exercise blood pressure, cardiac output and heart rate decreased, while splanchnic vascular resistance increased; mixed venous oxygen saturation decreased whilst arterial oxygen saturation and oxygen uptake were unchanged. Plasma noradrenaline increased after propranolol, values correlating with mixed venous oxygen saturation and splanchnic vascular resistance, both at rest and during exercise before and after propranolol, only at rest was there any correlation with arterial blood pressure. The increase in sympathetic nervous activity after propranolol may be due to a reduction in cardiac output and thereby alteration of the metabolic state (oxygen or related factors) in tissues. Afferent neural signals from the tissues may play a significant role in the regulation of sympathetic nervous activity.     

Acupuncture versus metoprolol in migraine prophylaxis: a randomized trial of trigger point inactivation

Abstract. Objectives . To compare the effects of dry needling of myofascial trigger points in the neck region to metoprolol in migraine prophylaxis. Design . Randomized, group comparative study. patients, investigator and statistician were blinded as to treatment, the therapist was blinded as to results. Setting . Outpatient pain clinic in the northern Copenhagen area. Patients were referred by general practitioners or respondents to newspaper advertisements. Subjects . Included were patients with a history of migraine with or without aura for at least 2 years. Excluded were persons with contraindications against treatment with beta blockers, chronic pain syndromes, pregnancy or previous experience with acupuncture or beta-blocking agents. A total of 85 patients were included; 77 completed the study. Interventions . After a 4-week run-in period, patients were allocated to a 17-week regimen either with acupuncture and placebo tablets or to placebo stimulation and metoprolol 100 mg daily. Results . Both groups exhibited significant reduction in attack frequency (P < 0.01). No difference was found between the groups regarding frequency (P > 0.20) or duration (P > 0.10) of attacks, whereas we found a significant difference in global rating of attacks in favour of metoprolol (P < 0.05). Conclusions . Trigger point inactivation by dry needling is a valuable supplement to the list of migraine prophylactic tools, being equipotent to metoprolol in the influence on frequency and duration (but not severity) of attacks, and superior in terms of negative side-effects.