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Twenty-three healthy males, aged 23 to 62 years, were examined by M-mode echocardiography and systolic time intervals for 3 h after (1) ethanol 1 g/kg by mouth taken over 60 minutes; (2) atenolol 100 mg by mouth; (3) ethanol (1 g/kg) + atenolol (100 mg). The peak mean blood ethanol (± s.e.) was 112 ±4 mg/100 ml in test 1 and 104 ± 7 mg/100 ml in test 3. During increasing blood ethanol, heart rate (HR), systolic blood pressure (BP), cardiac output (CO) and echocardiographic indices of left ventricular (LV) function were significantly augmented, while total peripheral resistance (TPR) decreased. During declining blood ethanol, systolic BP, L V end-diastolic and end-systolic diameters, stroke volume (SV) and circumferential wall stress were significantly reduced; echocardiographic indices of LV function were unaltered, but the pre-ejection period/LV ejection time ratio was increased, Atenolol decreased llR, systolic BP, SV, CO, and all estimates of LV function, but increased TPR. Ethanol + atenolol tended to cause smaller depressions in the indices of LV function than did atenolol alone, in spite of similar plasma atenolol concentrations (n = 6). It is concluded that ingestion of modest doses of ethanol evokes vasodilation and enhances LV function during increasing blood ethanol, and reduces LV preload and afterload during decreasing blood ethanol without impairing contractility. Social drinking and beta blockade seem not to have any harmful acute combined effects on the heart and circulation, at least in normal subjects. [ABSTRACT FROM PUBLISHER]

From 1967 to 1982, 305 femoral tibial bypasses were performed. Of these 180 (59%) were performed on limb salvage indication. A reversed autogenous saphenous vein was used in 134 instances, among 46 vein substitutes there were 15 vein allografts, 13 human umbilical cord vein grafts, 12 PTFE grafts and six dacron grafts. Hospital mortality was six patients. An additional 37 patients died during the follow-up period. The patency rates for saphenous vein bypass grafts were 62.5%, 48%, and 25% at one, five, and ten years, respectively, and 33% and 25% at one and five years, respectively, for the vascular substitutes. The mean +/- SD follow-up time was 62.27 +/- 5.7 months. During the early postoperative period 23 legs (12.7%) had to be amputated. During the follow-up period an additional 14 legs (7.8%) were lost giving a limb salvage rate of 79.5%.

The results of 305 femorotibial bypass grafts performed in 246 patients are presented. Of these operations 246 were primary and 58 secondary or tertiary. A total of 66 diabetic patients were in the series. An autogenous saphenous vein graft was employed in 196 primary operations, the other grafts used being PTFE, human umbilical cord vein graft, venous allograft and knitted dacron velour graft. Hospital mortality was 8 patients (2.6%), while late mortality was 73 patients, 39 of them having had patent grafts. There were 89 (29.2%) immediate or early hospital failures. Two-hundred-sixteen grafts were followed for a mean observation time of 62.3 +/- 5.7 months. The cumulative patencies were analyzed using the life-table method. One, five, and ten year overall patencies for saphenous vein grafts as indicated by claudication were 73%, 53% and 35%, respectively. In rest pain, the patency rates were 62%, 46% and 40% at similar intervals. In impending gangrene the patencies were 43%, 35% and 20%, respectively. The patencies for arterial substitutes were generally poor, i.e., 35% and 15% at one and five years. None of the graft substitutes were followed for up to ten years. Diabetic patients had a significantly lower patency rate than nondiabetics (p = 0.002). The impact was remarkable if impending gangrene co-existed. In all these situations the early graft failure ensued. Both the run-off and inflow status affected the patency rates. This was significantly lower (p = 0.001) when only one distal branch was visualized in angiography.

Unlabelled: In order to investigate whether there is an association between the HLA system and type 2 diabetes, we have determined HLA-A, B- and C-antigens in 227 patients with onset of diabetes between the ages of 35 and 70 years and compared them with the HLA-antigen frequencies in Finnish blood donors. One hundred and sixty-eight patients (74%) were treated with diet or oral antidiabetic drugs (non-insulin dependent), whereas 59 patients (26%) were treated with insulin (insulin-dependent). The HLA-antigen Cw4 was found in 38.7% of the non-insulin dependent patients (relative risk 2.67, p = 0.00005) and in 15.6% of the insulin dependent diabetics (relative risk 0.785 NS) compared with 19.1% in blood donors. In addition, there was an increase in the frequency of HLA-Bw35 antigen among the non-insulin dependent patients (relative risk 1.6, P = 0.007), which could be explained by the known positive linkage disequilibrium between HLA-Bw35 and HLA-Cw4. In insulin-dependent patients there was a decrease in the frequency of HLA-B7 (relative risk 0.226, P = 0.001) and an increase in the frequencies of HLA-B8 (relative risk 1.91, P = 0.031), B12 (relative risk 2.22, P = 0.01) and B15 (relative risk 2.04, P = 0.019) compared with blood donors., Conclusion: these data provide evidence that genes in the HLA region may have some influence in genetic susceptibility to type 2 diabetes. They further suggest that maturity onset (type 2) diabetes is a heterogeneous disease in terms of HLA antigens.(ABSTRACT TRUNCATED AT 250 WORDS)

The time course of body temperature (T), white blood cell count (WBC) and serum C-reactive protein (CRP) following uncomplicated open-heart surgery and the value of these three parameters in the diagnosis of postoperative infectious complications were analyzed in 153 patients. Preoperatively, all the patients had a normal T and the WBC level was under 10 X 10(9)/l. The CRP was elevated (over 20 mg/l) in five patients without having an influence on their postoperative courses. Postoperatively, T, WBC and CRP reached their maximum values during the first three days, decreasing gradually thereafter. Great individual variations in this average response to open-heart surgery were seen. Development of minor postoperative infections, mainly wound infection, (in 22 patients) were poorly reflected by these three parameters. However, a temperature exceeding 38 degrees C after the 6th postoperative day suggested presence of infection; less than 5% of patients without an infection had a temperature over this value. A secondary rise in CRP after the third postoperative day occurred in 20 patients and correlated well with postoperative complications; in 14 patients (70%) an infection became apparent, in three instances a probable infection was present, while two patients suffered from non-infectious complications. Only in one case (5%) did the cause for a secondary rise in CRP remain unknown. In major infections, i.e. mediastinitis, a CRP response occurred in all 12 patients, a temperature response in 11 patients (92%) and a WBC response in 10 patients (83%).

The data of 331 women with breast cancer treated in the Second Department of Surgery, Helsinki University, during the period 1976-1980 (patient material, treatment, prognostic factors) is evaluated and compared with an equally large patient material treated during the period 1951-1961 in the same hospital. A breast lump was the main symptom in 94% and the tumour was found by the patient in most cases. Only two patients were younger than 30 years. The median delays to the first medical contact and to operative treatment were 30 and 20 days respectively. The delay had no influence on the prognosis. Also, the age of the patients and the localization of the tumour had no significant effect on the prognosis. Simple mastectomy with axillary lymph node excision was the main operative treatment in the present material whereas Halsted's radical mastectomy was frequently performed in the previous study. Operative radicality was the same in both studies. The prognosis has improved in all clinical stages. The present relative five year survivals in stages I-IV were 95, 83, 53 and 18%, whereas in the previous study they were 75, 58, 41 and 0%, respectively. The improvement in stage II-IV breast cancers is probably due to advances in radio- and chemotherapy. However, the improvement in the prognosis of stage I and to a lesser extent of stage II breast cancers cannot be explained on this basis alone. Neither do the shorter delays in treatment fully explain the differences in the prognosis. The most frequent sites of metastasis were bone and lung/pleura where almost half of the total metastasis occurring during the follow-up were found.

Thirteen patients (6 females and 7 males) who were secondary failures on oral drug therapy were randomly allocated to either 2 months of treatment with insulin + glibenclamide or insulin + placebo. Thereafter the treatment schedules of the two groups were switched over for another two months. The combination of insulin and glibenclamide was more effective in lowering the fasting blood glucose (P = 0.026) and 24 h urine glucose (P = 0.042) than the combination of insulin and placebo. The combination therapy with insulin and glibenclamide revealed higher basal (P = 0.021) and glucagon-stimulated C-peptide concentrations (P = 0.037) than therapy with insulin and placebo. However, insulin binding to erythrocytes did not differ between the two study periods. The results indicate that the addition of glibenclamide to insulin in type II diabetics poorly controlled by oral antidiabetics alone may slightly improve diabetic control. The mechanism of this action is due at least partly to sulphonylurea-induced stimulation of endogenous insulin secretion. The effectiveness of the combination treatment during long-term therapy still remains to be proven, however.

One hundred consecutive patients were analysed who had been treated with total gastrectomy in the Second Department of Surgery, Helsinki University Central Hospital, for malignancies of the stomach from 1977 to 1982. Hospital mortality was 8%. The 5-year survival rate in this selected group of patients was 43% and 34% for patients with gastric cancer. Patients with metastases died within 42 months, more than half of them within one year. However, palliative total gastrectomy is recommended in proximally located obstructing tumours. Radical operations on patients with tumour growth to adjacent tissue and organs had no effect on the 5-year survival rates compared to those on patients with metastases. Surgical removal of the primary tumour is recommended in these cases as well. Patients without lymph node metastases had a survival rate of 67% but the prognosis was even better in cases with intact serosa (96%).

A novel format for a growth chart is proposed to facilitate early detection of aberrant growth. Normal growth is shown as a horizontal line and any deviation from this indicates abnormal change in growth. The vertical scales show relative height (height SDS) and relative weight (% deviation of weight from the mean weight for height) directly. Weight is recorded against height rather than age.

One hundred consecutive patients treated for gastric cancer by total gastrectomy from 1977 to 1982 at the second department of surgery of the Helsinki University Central Hospital were analyzed. The mean age of the patients was 61.5 years. Gastroscopy proved to be diagnostically superior to roentgenographic examination, particularly in cases of proximally located cancer. The mean length of postoperative hospital stay was 19.7 days, and the hospital mortality was 8 percent. Respiratory complications accounted for nearly half of the complications, and postoperative intraabdominal complications were recorded in 15 patients. Reoperation was performed on eight patients during the initial hospital stay due to complications. The results suggest that total gastrectomy is a safe procedure with an acceptable mortality rate, and it can be recommended both as a curative and a palliative operation in patients with gastric cancer.

A total of 24 normal children's hearts with their great vessels were examined at autopsy and the diameters of the pulmonary veins measured. The values so obtained were plotted against patient height, body-surface area, weight, and age and were subjected to multi-variate regression analysis. Height gave the best correlation with pulmonary venous diameter. For practical purposes, the normal diameter of each pulmonary vein (in millimeters) = 0.07 X height (in centimeters).

The relationships between the presence of female sex steroid receptors and their concentrations, and the histological grade were investigated in primary breast carcinoma specimens from 151 patients. The concentrations of estrogen receptor were significantly lower in grade III tumours than in the more differentiated ones from pre- and post-menopausal patients, whereas the same was observed for progesterone receptor concentrations only between grades III and I in post-menopausal patients. Generally estrogen and progesterone receptor-positive, estrogen receptor rich tumours frequently belonged to well-differentiated tumour categories. Whereas most of the tumours belonging to grade III group were receptor-negative, approximately three fourths of receptor-negative tumours belonged to grade I and II categories. It is therefore suggested that estrogen receptor-negativity or low receptor concentrations and grade III histological appearance of breast carcinoma are independent risk indicators, and their concomitant use is recommended in designing treatment strategies for individual patients.

Determination of glycohemoglobin in blood (HbA1) represents an established measure of glycemic control in diabetic patients. In patients with uremia, however, the determination can be subject to pitfalls which may limit its reliability. In order to evaluate the clinical usefulness of HbA1 determinations in diabetic patients with nephropathy, concentrations of HbA1 and its subfractions HbA1c and HbA1a+b were measured by micro- and macrocolumn chromatography in 58 diabetic and 80 non-diabetic patients with impaired renal function. Fifteen diabetic patients without nephropathy and 15 healthy subjects served as controls. The concentrations of HbA1 and its subfractions were significantly higher in non-diabetic patients with nephropathy than in healthy controls. A positive correlation was seen between HbA1 and plasma glucose concentrations in all subjects, and between HbA1 and serum urea and creatinine concentrations in the non-diabetic subjects. When measured repeatedly in the same patient there was a positive correlation between HbA1 and plasma glucose concentrations in diabetic patients with azotemia. There was no change in HbA1 concentrations measured immediately before and after hemo- or peritoneal dialysis. The increase of chromatographically determined HbA1 concentrations in azotemic patients is most likely due to the joint action of carbamylation of hemoglobin with urea derived cyanate and deterioration of glycemic control induced by azotemia. Despite these problems, chromatographically determined HbA1 is still a clinically useful measure of glycemic control in diabetic patients with nephropathy. This presumes repeated measurements in the same patient and the use of appropriate reference levels which consider the degree of renal impairment.

The peroperative exploration of axillary content gave wrong result from the stage of axillary nodes in every fourth case compared with the final result of axillary evacuation. There were no locoregional recurrences in stage I-patients irradiated after mastectomy. In postoperatively irradiated stage II-patients there were locoregional recurrences in 2.5% of cases, which was 1/8 of recurrences of patients not irradiated postoperatively.

This study was designed to evaluate the influence of age, duration of diabetes, relative body weight and glycaemic control on beta-cell function and insulin sensitivity in 250 patients with onset of nonketotic diabetes between the age of 35 and 70 years (Type 2 diabetes). Beta-cell function was assessed by measuring serum C-peptide concentrations after 1 mg of glucagon iv. It was not influenced by age, age at onset of diabetes nor by the duration of the disease. This suggests that progressive deterioration of beta-cell function with time is not a consistent finding in Type 2 diabetes. Insulin sensitivity, measured as the glucose disappearance rate, KITT, in response to iv-insulin, was not significantly influenced by age or age at onset, but decreased consistently with the duration of the disease (P less than 0.001). Beta-cell function was not correlated to fasting blood glucose and HbA1 concentrations. In contrast, there was a strong inverse relationship between glycaemic control and insulin sensitivity (P less than 0.001) indicating that decreased insulin sensitivity contributes to poor glycaemic control in these patients. Attempts to improve glycaemic control in patients with Type 2 diabetes should therefore include means to improve insulin sensitivity.