Anterior tibial stress fracture treated with intramedullary nailing: a case report.

This article describes the use of intramedullary rodding as a treatment for an anterior tibial stress fracture in a patient with high functional demands: a professional ballet dancer. In our patient, a year of conservative treatment and later tibial drilling was unsuccessful. After sustaining a complete fracture at the site of the stress fracture, he was treated with intramedullary rodding and was able to dance 21 weeks after surgery. The fracture went on to complete healing. The role of prophylactic intramedullary nailing in this difficult fracture is discussed.

Electrocardiographic changes during antihypertensive treatment with diltiazem in relation to the achieved serum levels of the drug.

Diltiazem is a calcium channel blocker with antihypertensive and antiarrhythmic actions. In the present study 24 hypertensive patients were treated with diltiazem (180-360 mg daily) for 6 months. The effects on the electrocardiogram (ECG) were studied and were related to the serum levels of diltiazem. Treatment with diltiazem induced a non-significant reduction in heart rate with 3 beats min-1 and decreased blood pressure (-11/-9 mm Hg, p < 0.001). The treatment also induced a prolongation of the PQ-interval (+1.4 cs, p < 0.02), a prolongation only being weakly related to the plasma levels of diltiazem (r = 0.28, not significant) and its metabolite MA (r = 0.37, p = 0.07). Neither was the induced increase in the QT-interval (+0.9 cs, p < 0.05), significantly related to the plasma levels of diltiazem. In conclusion, the plasma levels of diltiazem were not clearly related to the induced changes at the ECG during antihypertensive treatment.

Nutrient intake and health status of lactovegetarians: chemical analyses of diets using the duplicate portion sampling technique.

Six middle-aged lactovegetarians (three men and three women) collected copies of four 24-h diets using the duplicate portion sampling technique. By chemical analyses, the nutrient composition of the lactovegetarian diet was determined in detail and compared with that of a mixed Swedish diet (normal) and a vegan diet (vegan) studied previously. The nutrient composition of the lactovegetarian diet expressed per 1000 kcal represented an average between normal and vegan diets. It was in closer agreement with Swedish recommended dietary allowances than the normal Swedish diet. Thus, the lactovegetarian diet contained 35% of the energy as fat and was rich in polyunsaturated fatty acids, especially linoleic acid, which resulted in a polyunsaturated/saturated fat ratio of 0.6. The lactovegetarian diet had a cholesterol concentration only half of that of a normal diet. Protein content and amino acid composition were well above recommendations. The lactovegetarian diets contained less sucrose than normal and vegan diets, but the sum of the intake of low molecular weight carbohydrates was comparable to normal and vegan diets. Dietary fiber was three times higher than in a normal diet. Essential minerals and trace elements, ie, Ca, Mg, Na, K, Fe, Zn, Cu, Se, satisfied current requirements. The intake of vitamin B12 by the lactovegetarians was around 1.4 micrograms daily, which is below the recommendations. The intake of folates was high, 300 to 400 micrograms daily. The clinical and biochemical investigation of the subjects revealed no signs of nutritional deficiency. Their plasma lipoproteins and the blood pressures were low for their age, in agreement with observations made earlier in a group of vegans.

Dietary fibre in bread and corresponding flours--formation of resistant starch during baking.

Dietary fibre, assayed with an enzymatic/gravimetric method, was higher in wheat/rye bread than in the corresponding flours. The increase was most pronounced in crumbs from bread baked with mainly low-extraction-rate flour, and could be accounted for to a large extent as "resistant starch", i.e. a starch fraction available to amyloglucosidase only after solubilization with 2 m-KOH. The resistant starch was formed at dough-making and/or baking and did not increase further during freezing or storage at room temperature. The chemical modifications leading to resistant starch formation remain to be investigated. Starch-lipid complexes are probably not involved, since these are hydrolyzed by the heat-stable amylase used in the dietary fibre assay.

Nutrient intake and health status of vegans. Chemical analyses of diets using the duplicate portion sampling technique.

A strict vegetarian diet [vegan diet (VD)] was investigated. Six middle-aged vegans (three men and three women) collected copies of 24-h diets using the duplicate portion sampling technique. By chemical analyses, the nutrient composition was determined in detail and compared with corresponding figures of a normal mixed Swedish diet. In the VD 30% of the energy originated from fat compared with 40% in normal Swedish mixed diet (MD). Linoleic acid was the dominant fatty acid (60% of total fat in VD versus 8% in MD). The VD contained 24 g protein/1000 kcal compared to 30 g/1000 kcal in MD, but the intake of essential amino acids by the vegans exceeded the recommendations. Dietary fiber was about 5 times higher in the vegan diet (29 versus 6 g/1000 kcal) and sucrose similar to MD (18 versus 21 g/1000 kcal). Among the inorganic nutrients the concentration of calcium (351 versus 391 mg/1000 kcal) and sodium (53 versus 49 mmol/1000 kcal) were similar in both types of diets but the amount of potassium (56 versus 30 mmol/1000 kcal, magnesium (300 versus 110 mg/1000 kcal), iron (9 versus 6.5 mg/1000 kcal), zinc (6.5 versus 4.7 mg/1000 kcal), and copper (2 versus 0.7 mg/1000 kcal) were nearly doubled. Iodine (39 versus 156 micrograms/1000 kcal and selenium (5 versus 17 micrograms/1000 kcal) were much lower in the VD, selenium even being undetectable in several 24-h diets. The VD was rich in folic acid (301 versus 90 micrograms/1000 kcal in MD) but the intake of vitamin B12 was only 0.3 to 0.4 microgram/day (MD: 3 to 4 micrograms/day). No clinical signs of nutritional deficiency were observed in the vegans. Serum protein levels of the vegans as well as their serum lipoproteins were near the lower range of the reference group. In addition, none of the vegans was overweight and their blood pressures were low for their age.

Pharmacokinetics of propranolol.

The pharmacokinetics of propranolol after the administration of 40, 80, and 120 mg p.o. and 10 mg i.v. was studied in nine healthy male volunteers. Propranolol was analyzed after extraction and derivatization by gas-liquid chromatography. A multiexponential curve-stripping program was used for the pharmacokinetic analysis. The volume of distribution was about 6 liters . kg-1, bioavailability around 25%, with a mean terminal half-life of 6 hr. There was no evidence of either dose dependent disposition kinetics or an oral threshold dose. A slight increase in urine volume was observed after propranolol administration.

Pharmacokinetics of bendroflumethiazide after low oral doses.

The pharmacokinetics of bendroflumethiazide after oral administration of 1.25, 2.5, and 5.0 mg were studied in nine healthy male volunteers. Bendroflumethiazide was analyzed by GLC after extractive alkylation. After the lowest dose, the plasma concentration, could be followed to 14 hr, and the data were adequately fitted by a one-compartment model; the half-life was 3.1 hr. After the 2.5 and 5.0 mg doses, the plasma concentration was followed for 24 hr, and the data were fitted by a two-compartment model with half-lives of 8.9 hr. The urinary sodium concentration was doubled after bendroflumethiazide intake, but the urinary potassium concentration remained almost constant. The renal clearance of bendroflumethiazide was around 30 ml . min-1.

Dietary fibre in type II diabetes.

Recent studies have indicated that diets rich in digestible carbohydrates and dietary fibre might be beneficial in the regulation of type II non insulin dependent diabetes (NIDD). Addition of the gel forming type of dietary fibre such as pectin and guar gum to meals or glucose solutions reduces post-prandial glucose and insulin response. Addition of cereal fibres in the form of bran seems to have long term beneficial effect improving glucose tolerance. Little is known, however, concerning effects of dietary fibre naturally occurring in food on postprandial glucose and hormone response. In the present study we prepared two breakfast meals which were similar regarding digestible carbohydrates but differed in their dietary fibre content. One of the meals, including whole grain bread and whole apples, contained 8.4 g of dietary fibre, and the other one, containing white bread and apple juice, 3.1 g. When given to eight NIDD, the fibre rich breakfast gave significantly lower blood glucose increment during the three hours following ingestion. The results indicate that foods rich in dietary fibre might be useful in the regulation of type II diabetes.

The incidence of coeliac disease in children in south-east Sweden.

Among children born between 1969 and 1977 in two areas of south-east Sweden an initial flat small intestinal mucosa was found in 84 cases, 64 of whom were considered to have coeliac disease (CD) diagnosed mostly according to the criteria formulated by the European Society for Paediatric Gastroenterology and Nutrition. The incidence of CD was 1/859, which is in agreement with that of a recent report from south Sweden. This suggests that the incidence of CD is the same in the whole of Sweden. In the present study all patients with an initial flat mucosa improved clinically and histologically after 1 year or more on a gluten-free diet. When challenged with gluten, 19% did not relapse within 2 years, thus fulfilling the criteria for so-called transient gluten intolerance. These patients had a lower mean age of symptom debut and for first biopsy, compared with the patients with CD.