Cardiac performance and thyroid function. The correlation between systolic time intervals, heart rate and thyroid hormone levels.

UNLABELLED: In the search for a clinical correlate to thyroid function, correlations were sought between the plasma level of thyroid hormones and the cardiac function, assessed by heart rate and the systolic time intervals. The present study is the first to 1) use a curvilinear correlation and 2) do so in the entire hormone range. A third degree Chebychew's regression equation was used to enable curvilinear correlation. In a population of 10 hypothyroid, 14 euthyroid, and 25 hyperthyroid patients a statistically significant curvilinear correlation was found between the thyroid hormone levels and the systolic time intervals. The correlation coefficients showed the heart rate equally correlated to the thyroid hormone levels as the best correlated of the systolic time intervals. The correlation between the heart rate and T3 was almost linear, with a heart rate increase of 4 beats/minute with each increase in plasma T3 of 1 nmol/l. CONCLUSION: The thyroid function reflects in the cardiac function in a curvilinear regression between T3 and systolic time intervals and in an almost linear regression between T3 and heart rate. The variation, however, is too great and the slope too low, to suggest the use of the heart rate as a clinical correlate to thyroid function.

The clinical significance of salivary amylase in duodenal aspirates in evaluation of exocrine pancreas function.

Salivary and pancreatic amylases in duodenal aspirates were quantitated in 419 consecutive tests performed on 378 patients suspected of having insufficiency of the exocrine pancreatic function. Salivary amylase was detected in samples from 31% of the tests. However, the amount of salivary amylase was sufficient to cause a misinterpretation in 13 tests only. Five of these tests originated from patients with a history of surgery for peptic ulcer disease. This group of patients tended to have large amounts of salivary amylase in the duodenal aspirates. In the unoperated patients (n = 336) 200 tests yielded values for the total amylase concentration above the lower level of the reference interval, and only in 8 of these tests (4%) did correction for salivary amylase change the results to values below the reference interval. It it concluded that quantitation of isoamylase activity in duodenal samples is unlikely to be of significant value in patients without a history of surgery for peptic ulcer disease.

The effect of coarse wheat bran in the irritable bowel syndrome. A double-blind cross-over study.

Dietary supplementation with wheat bran has been widely advocated as a first-line treatment of patients with the irritable bowel syndrome (IBS). Few controlled trials have been reported, and the results are, furthermore, contradictory. The present study comprised 20 patients with IBS, of whom 18 (14 women, 4 men) completed the trial. The two treatment periods of 6 weeks each, with a daily intake of 30 g coarse wheat bran or 30 g placebo bran, respectively, were randomized in a double-blind cross-over design. Wheat bran significantly (P less than 0.05) increased the stool weight and shortened the intestinal transit time but was without significant effect on the colonic motility index was shown. We conclude that coarse wheat bran used as the only treatment in IBS does not provide a sufficient effect in a 6-week period. However, wheat bran seems to be justified in the treatment of constipation.

Ultrasonography versus roentgenography in suspected instances of cholecystolithiasis.

In a consecutive series of 102 patients with no jaundice and with symptoms of cholecystolithiasis, the predictions from both ultrasonography and cholecystography were compared with the final diagnosis. The accuracy of both examinations was high. However, in 38 per cent, single dose oral cholecystography failed to visualize the gallbladder whereas ultrasonography was conclusive in all patients. Judged by a simple scoring system, ultrasonography obtained a significantly better score than cholecystography (p less than 0.01) and an insignificantly better score than combined oral and intravenous cholecystography (0.05 less than p less than 0.1). Ultrasonography is recommended as the primary investigation in suspected instances of cholecystolithiasis.

Use of bone mineral content determination in the evaluation of osteodystrophy among hemodialysis patients.

During a period of 2 years, bone mineral content (BMC) was measured regularly in patients undergoing regular dialysis treatment (RDT). Low BMC values were found to be correlated to long duration of uremia, raised alkaline phosphatase activity, hyperaluminemia, hypermagnesemia, hypophosphatemia and clinical osteodystrophy. High levels of BMC loss were found among patients with relatively high initial BMC levels and severely calciopenic patients actually gained bone density during the investigation. Serum alkaline phosphatase activity and serum immunoreactive parathyroid hormone (PTH) levels were positively related to bone loss. It is suggested that the low BMC among RDT patients is caused by a predialytic loss that is arrested by entrance into a dialysis programme. Investigations using BMC or total body calcium as a measure of therapeutic effect must take account of this. The role of hypermagnesemia and hyperaluminemia remains undefined. Patients with BMC reduced below ca. 80% of normal may be candidates for treatment with active vitamin D metabolites.

Orthostatic response before and after nitroglycerin in metoprolol- and verapamil-treated angina pectoris.

The orthostatic changes in heart rate (HR) and blood pressure (BP) were recorded in ten patients with stable angina pectoris before and after simultaneous sublingual nitroglycerin administration. All patients were examined three times: without other medication, during chronic metoprolol treatment, and during chronic verapamil treatment. Under control conditions, only minor changes were found in systolic BP following vertical tilting, while diastolic BP increased by approximately 10%. Nitroglycerin augmented these changes to some extent, while neither metoprolol nor verapamil caused significant changes. The orthostatic HR increase was considerably augmented by nitroglycerin. Verapamil treatment did not influence this response, while metoprolol caused significant reductions. These findings seem to explain why some few patients have observed severe orthostatic symptoms while taking nitroglycerin during treatment with beta-adrenergic blocking agents.