Search

Objectives. To evaluate beneficial effects of postmenopausal hormone replacement therapy (HRT) on endothelial function, measured as intraplatelet cyclic guanosine monophosphate (cGMP, mediator of nitric oxide), cyclic adenosine monophosphate (cAMP, mediator of prostacyclin) and plasma endothelin-1 (ET-1), and on monocyte activation, measured as plasma neopterin. Design. Part 1: double-blind randomized trial for 3 months; part 2: open study for 9 months. Setting. The study was performed at the Department of Endocrinology, University Hospital, Malmo, Sweden. Subjects. Fifty-one postmenopausal women participated in part 1 and 46 in part 2. Inclusion criteria included a history of amenorrhoea for at least 6 months before the study and body mass index ≥ 24 kg m-2 Intervention. Randomization for either placebo (n = 24) or HRT (n = 27). HRT was given as 2 mg oestradiol valerate for the first 3 months with the addition of 10 mg medroxyprogesterone for 10 days every third month thereafter. Measurements. Performed at baseline and after 3 and 12 months of the study. Results. In the HRT group, intraplatelet cGMP increased from 0.56 (0.35-0.94) to 0.61 (0.423.40) and 0.65 (0.43-1.08) pmol (109 platelets)-1 after 3 and 12 months, respectively (P = 0.01), whereas plasma ET-1 decreased from 3.2 (1.1.-6.8) to 2.0 (0.8-5.1) and 1.8 (0.4-15.4) pg mL-1 (P < 0.001). Intraplatelet cAMP and plasma neopterin were unchanged. When smokers (n = 15) and non-smokers (n = 12) in the HRT group were analysed separately, significant effects were seen only amongst smokers. The control group showed unchanged levels of cGMP, cAMP, ET-1 and neopterin. Conclusions. These data suggest beneficial effects of HRT on endothelial function which may account for anti-atherogenic effects of HRT in postmenopausal women, especially in smokers. No effects of HRT were seen upon monocyte activation.

Objectives. To assess the effect on the fibrinogen concentration of sleep disturbance and mental stress, taking into account the effect of 21 other variables related to the risk of cardiovascular disease. Design. A cross-sectional study on men threatened by redundancy, and controls. Setting. A health screening programme in Malmo, Sweden. Subjects. Four hundred and eighty five workers in a shipbuilding yard, scheduled for closure, and 190 age-matched men. The subjects were randomly selected from a larger group of shipyard workers and controls invited to a health screening programme. Mean age was 51.6 years (range 38–62 years). Main outcome measures. Plasma fibrinogen concentration, serum Cortisol concentration, body composition, blood pressure, heart rate, blood lipids, platelet number and size, white blood cell count, haemoglobin concentration, vital capacity, liver enzymes, blood glucose concentration fasting and after an oral glucose tolerance test. Questionnaire designed to evaluate muscle tension, sleep disturbance, anxiety, depression, job stress, alcohol and smoking habits and perceived health. Results. In stepwise regression analysis fibrinogen concentration was found to be correlated to white blood cell count, muscle tension, heart rate, body mass index, age and serum cholesterol concentration in non-smokers, which together explained 14.9% of the variation in fibrinogen concentration. In smokers, platelet count, heart rate, serum triglyceride concentration, age and fasting glucose explained 22.5% of the variation in fibrinogen concentration. The fibrinogen concentration was inversely correlated to the psychological variables, but unrelated to the serum Cortisol concentration or to factors connected with the job situation, and it was decreased in moderate alcohol consumers. Conclusions. Our interpretation of the findings is that an increase in the plasma fibrinogen concentration reflects the presence of a low-grade inflammatory process, and poor physical fitness.

The physical activity pattern among 43 subjects (25 women, 18 men) from the Intervention Study of Elderly in Gothenburg (IVEG) has been evaluated by means of heart rate monitoring, rating of perceived exertion and recording activities over a 30-hour period. These subjects had previously been interviewed about their activity pattern, including the duration of their daily walks. In 91% of the participants the average heart rate was below 100 beats/min during walking. Considerable individual variations were noted in the duration of domestic activities and of walks. Using heart rate levels equal to or above the average heart rate during walking as a criterion, it was found that 68% of the women, but only 17% of the men, spent more time on domestic activities than on walking. Nonetheless, it is suggested that in addition to walking, domestic activities, owing to their duration, are important in maintaining physical fitness in the elderly, especially among women. This should be taken into account when physical activity is being classified (to avoid bias in favour of men). A modified version of a previously published six-grade scale for the classification of physical activity has been suggested. (Aging 2:191–198,1990)

Clinical diagnosis of pulmonary embolism is difficult and often dependent on radiological methods. In Sweden scintigraphy has hitherto been the method most commonly used, though all too often it leaves the diagnosis in doubt. Spiral computed tomography, performed during continuous infusion of contrast medium, clearly depicts the pulmonaries arteries, emboli appearing as filling defects. The examination takes less than one minute. Although the method has yet to be fully evaluated, it is already available at most Swedish hospitals. Results presented so far suggest that the technique has great potential, and may become the method of choice in the diagnosis of pulmonary embolism.

A case of tongue necrosis in a patient with temporal arteritis who was taking ergotamine is described, and the role of ergotamine tartrate in provoking the tongue necrosis is considered. The literature on this unusual complication is critically reviewed, and the value of a carotid angiography in assessing the tongue ischaemia is exemplified.

Low sodium and potassium adenosine triphosphatase (ATPase) activity has been proposed as a mechanism behind diabetic neuropathy. In this study the platelet ATPase activity and platelet noradrenaline efflux rate were determined in 47 insulin-dependent diabetes mellitus (IDDM) patients and 20 controls. Ulnar motor conduction velocities, tested in a subgroup, were lower in patients than in controls (52.7 +/- 1.3 m s-1 vs. 61.3 +/- 1.4 m s-1; P less than 0.001). Platelet ATPase activity tended to be increased in the patients compared with the controls (29.9 +/- 1.0 x 10(-3) min-1 vs. 26.9 +/- 1.1 x 10(-3) min-1; NS). In ulnar nerve function tested subjects, ATPase activity was higher in patients than in controls (31.2 +/- 1.7 x 10(-3) min-3 vs. 25.9 +/- 1.3 x 10(-3) min-1; P less than 0.01). The platelet noradrenaline efflux rate tended to be higher in patients with lower brake indices, a sign of autonomic neuropathy, than in controls (29.0 +/- 3.0 x 10(-3) min-1 vs. 21.2 +/- 0.9 x 10(-3) min-1; P less than 0.05). The platelet ATPase activity was not decreased in IDDM patients, however, a connection between diabetic autonomic neuropathy and platelet transmittor leakage was indicated.