[Treatment of diabetic patients with ischaemic heart disease]. / Behandling af diabetespatienter med iskaemisk hjertesygdom.

Patients with diabetes constitute a large group among patients with ischaemic heart disease, and their risk of repeated cardiovascular events is large. Due to this, there is increasing focus on intervention against the increased risk of cardiac morbidity and mortality in patients with diabetes. Subgroup analyses of patients with diabetes from studies on patients with ischaemic heart disease show that intervention with thrombolysis, aspirin, beta blockers, ACE inhibitors and statins have similar relative benefit among patients with diabetes, but because of the greater risk in these patients, the absolute benefit is increased. In spite of this, intervention is less common among patients with diabetes, a fact that should be corrected. Direct intervention targeted at the metabolic disorder in ischaemic heart disease has only been investigated in the DIGAMI study, where glucose/insulin treatment followed by long term treatment with insulin was compared to conventional treatment. The mortality was lower in the insulin treated group after one to four years of follow up, a promising result which is currently being investigated in the DIGAMI-2 study.

[Chronic Chagas disease--an echo from youth]. / Kronisk Chagas' sygdom--et ekko fra ungdommen.

American trypanosomiasis (Chagas' disease) is uncommon in Europe, but occurs frequently in South and Central America where it causes major problems. A case is presented of a 57 year old woman born in Venezuela who showed signs of chronic Chagas' disease after living 32 years in Denmark. The epidemiology, modes of transmission, clinical manifestations, diagnosis and treatment of Chagas' disease are described.

[Coronary atherosclerosis or diabetic cardiomyopathy? Pathoanatomic changes of blood vessels, nerves and myocardium in patients with diabetes mellitus]. / Koronar aterosklerose eller diabetisk kardiomyopati? Patoanatomiske forandringer of kar, nerver og myocardium hos patienter med diabetes mellitus.

In patients with diabetes mellitus, heart disease is more common that in the background populations and has a more serious prognosis. The reasons are only partially understood. Whether patients with diabetes mellitus have a more diffuse and pronounced coronary atherosclerosis has been the subject of many investigations with diverging results. However, the larger studies suggest that coronary atherosclerosis is more pronounced and diffuse in diabetics compared with non-diabetic patients. The pathoanatomic picture of the atherosclerotic process seems to be identical in patients with and without diabetes mellitus. A number of structural abnormalities in the intramural vessels and interstitial tissue of the heart have been demonstrated in diabetics. However, similar abnormalities have also been reported in non-diabetic patients. With respect to where "diabetic cardiomyopathy" is a specific entity, the existing data are not confirmative. Whether diabetes mellitus per se induces functional changes in the coronary vascular system leading to myocardial ischaemia and dysfunction is a subject for future investigations.

[The yellow nail syndrome]. / De gule negles syndrom.

The yellow nail syndrome is the combination of slow growing yellow discoloured nails, lymphoedema and pleural effusion. The symptoms are supposed to be due to impaired lymphatic drainage. It is a rare clinical condition: through the last 30 years only about a hundred cases have been reported. The treatment is symptomatic (diuretics and pleuradesis). We review the literature and report four cases.

[Bacterial endocarditis at a county hospital department, 1983-1992. Prognosis in relation to bacteriology, disease localization and treatment]. / Bakteriel endokardit på en landsdelsafdeling, 1983-1992. Prognose i relation til bakteriologi, sygdomslokalisation og behandling.

The case records of 69 patients with a diagnosis of bacterial endocarditis were reviewed. Forty-nine patients had native valve endocarditis (NVE) and 20 patients had prosthetic valve endocarditis (PVE). Among patients with NVE left-sided endocarditis was treated surgically more often than right-sided endocarditis. Involvement of the aortic valve was the most important indicator of death and acute/subacute surgical intervention. The mortality was 29%. No patient with right-sided endocarditis died. The infective agent did not seem to influence outcome or frequency of surgical intervention. Among patients with PVE the most frequently isolated organism was coagulasenegative staphylococci. Surgical intervention occurred most frequently in those with infection with coagulase-negative staphylococci or culture negative endocarditis. The mortality was 25%, identical for early and late cases. The patients who died were all infected with staphylococci. The localization did not seem to influence treatment or outcome. In spite of advances in surgical and medical treatment bacterial endocarditis is still a life-threatening disease with a high mortality.

[Patterns of tuberculosis manifestation in the county of Roskilde]. / Tuberkulosens manifestationssmønster i Roskilde Amt.

The epidemiological and clinical features of all adult tuberculosis (tbc) cases in a Danish county over a 12 year period (82 cases) are presented. Most patients with pulmonary disease have thorax X-ray pictures showing pathological changes. Of the patients who only have extrapulmonary disease, 88% have normal X-ray examinations of the lungs. The patients can be divided into two groups: Danes and foreigners. The Danish patients are older, 81% are over the age of forty. They mostly have pulmonary disease (85%). They often have one or several concomitant diseases. The foreigners are younger, 90% are below the age of forty. They frequently have extrapulmonary disease (35%). They seldom have concomitant diseases.