The Losartan Intervention For Endpoint reduction (LIFE) in Hypertension study: rationale, design, and methods. The LIFE Study Group.

The treatment of hypertension mainly with diuretics and beta blockers reduces cardiovascular mortality and morbidity, largely due to a decreased incidence of stroke, whereas the beneficial effects of antihypertensive therapy on the occurrence of coronary events have been less than expected from epidemiological studies. Furthermore, treated hypertensive patients still have a higher cardiovascular complication rate, compared with matched normotensives. This is particularly evident in patients with left ventricular hypertrophy (LVH), a major independent risk indicator for cardiovascular disease.

Skeletal muscle alterations in patients with chronic heart failure.

Aims: To investigate skeletal muscle in patients with chronic heart failure and controls, and relate skeletal muscle variables to functional class, exercise capacity, central haemodynamics, muscle strength and medical treatment.

Methods: Biopsy from the lateral vastus muscle was obtained in 43 patients and 20 controls. Right sided heart catheterization was performed in 19 patients and maximal exercise testing in 26 patients.

Endoscopic bile duct stent placement as a predictor of outcome following endoscopic sphincterotomy in patients with suspected sphincter of Oddi dysfunction.

Objectives: To determine whether symptomatic improvement following placement of endoscopic stent across the biliary sphincter could predict the longer-term clinical outcome after endoscopic sphincterotomy (ES).

Methods: Twenty-three post-cholecystectomy patients with suspected sphincter of Oddi dysfunction underwent, sequentially, sphincter of Oddi manometry, endoscopic stent placement, ES, and follow-up for a further 6-12 months.

Results: Eight (35%) patients either did not respond (n = 5), did not tolerate the stent (n = 1) or relapsed during stenting (n = 2).

Non-invasive risk stratification within 48 h of hospital admission in patients with unstable coronary disease.

Aims: In this study we evaluated the prognostic value of three methods of early risk estimation in patients with unstable coronary disease.

Methods And Results: The methods evaluated were: clinical risk estimation at hospital admission, continuous ST analysis with computerized vectorcardiography for 24 h and serial measurements of creatinine kinase-MB for 48 h. Twenty-seven (14%) of the 195 patients died or had a non-fatal infarction within one year.

Serum cholesterol and long-term prognosis in middle-aged men with myocardial infarction and angina pectoris. A 16-year follow-up of the Primary Prevention Study in Göteborg, Sweden.

Objective: To compare the role of serum cholesterol in the long-term prognosis of men with a history of myocardial infarction, in men with clinical angina without myocardial infarction, and men without clinical coronary disease.

Methods: In the second screening of the Primary Prevention Study in Göteborg which comprised 7100 men aged 51 to 59 years at baseline in 1974-1977, 314 men with clinical angina but no myocardial infarction at baseline were identified and 195 men who had survived a myocardial infarction for 0 to 19 years (median 3 years).

Results: Of the men without clinical coronary disease at baseline and cholesterol at or below 5.

Wheezing bronchitis reinvestigated at the age of 10 years.

We have reinvestigated 92/101 children aged 10, who before the age of 2 years were admitted to a paediatric ward due to wheezing bronchitis. At the present time, 70% are symptom-free without medication, 20% have mild asthma, 8% moderate and 2% severe asthma. Persistent asthma correlated significantly to the presence of some other atopic disease in recent years, to early start of wheezing during infancy and to intense obstructive disease as a young child, while initial respiratory syncytial virus infection did not.

Coronary heart disease attack rate, incidence and mortality 1975-1994 in Göteborg, Sweden.

Material And Methods: Data from the Göteborg myocardial infarction register were used to investigate trends in attack rate, incidence of non-fatal myocardial infarction and mortality from coronary heart disease in persons aged 64 and below during the period 1975-1994.

Results: Myocardial infarction was defined according to strict criteria which remained the same throughout the study period. Attack rate and incidence were 3-5 times higher among men than women.

C-reactive protein is more sensitive than erythrocyte sedimentation rate for diagnosis of infective endocarditis.

The objective of this study was to evaluate the sensitivity of C-reactive protein (CRP) elevation compared to erythrocyte sedimentation rate (ESR), leucocyte count and thrombocyte count in the diagnosis of infective endocarditis (IE). It was designed as a prospective study of suspected episodes of IE in adults in tertiary care at a university-affiliated department of infectious diseases. In 89 episodes of IE, CRP was available from the start of treatment.

ST-segment changes and catecholamine-related myocardial enzyme release during alcohol withdrawal.

ST-segment changes and biochemical signs of myocardial injury, and their relation to sympatho-adrenergic activation and cardiac function, were studied in a case series of 19 alcohol-dependent (DSM-III-R) men undergoing in-hospital treatment for alcohol withdrawal. No patient had any clinically apparent heart disease. Analyses of ST-segment depressions > or = 0.

Aminoglycosides do not improve the efficacy of cephalosporins for treatment of acute pyelonephritis in women.

A prospective, coordinated, randomized multicentre trial was conducted to determine whether tobramycin 160 mg intravenously (i.v.) once daily for 2 days would improve the efficacy of cefotaxime 1 g i.

Glucose and insulin levels in young subjects with different maternal histories of hypertension: the Hypertension in Pregnancy Offspring Study.

Objective: To analyse whether hypertension during pregnancy is associated with early signs of impaired glucose metabolism in the offspring.

Design: Longitudinal study with a 5-year follow-up.

Setting: University Hospital, Göteborg, Sweden.

Physical activity protects against coronary death and deaths from all causes in middle-aged men. Evidence from a 20-year follow-up of the primary prevention study in Göteborg.

We set out to examine the long-term effect of work-related and leisure time physical activity on risk of death from coronary heart disease (CHD) and other causes. Data were obtained from a large prospective population study of 7142 participant men aged 47 to 55 years at baseline in 1970-1973 and without symptomatic CHD. Data on physical activity at work and at leisure were assessed by way of a questionnaire.

Detection of thymidylate synthase gene expression levels in formalin-fixed paraffin embedded tissue by semiquantitative, nonradioactive reverse transcriptase polymerase chain reaction.

We describe a new, simple and reliable semiautomated strategy for quantifying mRNA from archival specimens by using oligo(dT)25 paramagnetic beads and the reverse-transcriptase polymerase chain reaction (PCR) coupled with quantitative digital image analysis (Q-DIA). To evaluate the experimental conditions, we examined thymidylate synthase (TS) gene expression in mRNA isolated from both flash-frozen and formalin-fixed paraffin-embedded human biopsy samples using biopsy material obtained from 2 patients prior to chemotherapy with 5-fluorouracil. Following the electrophoretic separation of the PCR products through a 20% polyacrylamide gel, quantitation of the perimeters of the silver-nitrate-stained PCR products will be done by Q-DIA using a video frame-grabber board attached to a CCD camera using Image-Pro+ software.

Early functional treatment for acute ligament injuries of the ankle joint.

Eighty-six patients with acute (< 24 h) grade II or III lateral ligament ruptures were randomized into two different non-surgical treatment groups. The main difference in treatment protocols between the two groups was during the first week after injury. Group I (n = 46) was to receive functional treatment using specially designed compression pads, elevation of the injured foot (24 h), repeated elastic wrapping (compression bandage followed by ankle tape), early full weight-bearing and proprioceptive range-of-motion training.

Diphtheria antitoxin titres six years after basic immunization of adults.

Diphtheria antitoxin titres were analysed in 160 adults (median age 59 years, range 34-70), who completed basic vaccination with three doses of 7.5 Lf or 15 Lf of diphtheria toxoid (D) in a previous vaccination trial in 1987, in serum samples drawn 6 years later. The median titre had decreased from 3.

Sonification as a means of enhancing the detection of gene expression levels from formalin-fixed, paraffin-embedded biopsies.

We describe a novel approach for the isolation and quantification of mRNA from archival specimens by using oligo(dT)25 paramagnetic beads and the reverse transcription polymerase chain reaction (RT-PCR). A preliminary study is conducted to evaluate experimental conditions and the effects of varied periods of sonification on the yield of mRNA isolated from formalin-fixed, paraffin-embedded human biopsy samples. Validation of this approach will involve the comparison of observed beta-actin gene expression levels among different samples from the same patient after various periods of sonification.

Long-term effects of losartan on blood pressure and left ventricular structure in essential hypertension.

In a 12-week, randomized, double-blind study, 24 patients with essential hypertension were given the angiotensin II antagonist losartan, or the beta-adrenoceptor blocker atenolol. Both drugs reduced blood pressure (BP) well, but losartan tended to reduce left ventricular mass (LVM) in contrast to atenolol. Following the double-blind phase 19 patients entered an open treatment period with losartan and additional treatment if BP was uncontrolled.

Skeletal muscle changes in patients with chronic heart failure before and after treatment with enalapril.

To evaluate if enalapril treatment can influence skeletal muscle metabolism and histology we investigated 26 patients with congestive heart failure and 20 normal subjects. The patients were treated with enalapril for 3 months in addition to diuretics and digitalis. Biopsies from the lateral vastus muscle were taken before and after treatment.

Ischaemia detected by continuous on-line vectorcardiographic monitoring predicts unfavourable outcome in patients admitted with probable unstable coronary disease.

Background: Several methods have been suggested for risk stratification of patients with unstable coronary syndromes. However, most of these are applied several days after hospital admission.

Methods: In this study we investigated the prognostic value of continuous ST-segment and QRS vector monitoring with computerized vectorcardiography (VCG), serial measurements of creatine kinase isoenzyme MB (CK-MB), predischarge stress testing and baseline data in patients with unstable angina pectoris or non-Q-wave infarction.