Gunnar Rosenhamer

Effect of combined clofibrate-nicotinic acid treatment in ischemic heart disease. An interim report.

Abstract Over a three and a half year period beginning in December 1972, 555 survivors of myocardial infarction (442 men and 113 women) under the age of 70 years were recruited from one hospital for a therapeutic trial aimed to reduce serum lipids and to study the effect on subsequent morbidity and mortality. Following a stabilization period of 3 months after infarction, patients were given a dietary program to reduce serum lipids. Patients were then randomly divided into (a) a treatment group which received a combined regimen of nicotinic acid (up to 3 g daily) and 2 g of clofibrate daily, and (b) a control group on diet alone. By April 1979, 59 and 57 patients in the control and drug-treated groups respectively had completed 5 years in the trial. In the same respective groups, 101 and 99 patients continued in the study. In comparison with the control group serum cholesterol and triglycerides showed mean falls of 14 and 19% respectively in the drug-treated group over the 5-year period. During the trial there were 39 and 25 IHD deaths in the control and drug-treated groups respectively ( P = 0.06). Further mortality in the year after leaving the trial brought the totals to 53 and 31 IHD deaths ( P Non-fatal infarcts occurred at rates of 4.6 and 2.5 ( P P

Arteriovenous Fistula Post Nephrectomiam: Clinical Aspects and Surgical Repair

Two cases with arteriovenous fistula of the renal vessels, following nephrectomy more than 20 years earlier, were studied by right heart catheterization both before and 6–7 months after excision of the fistula. The shunt flows, measured during general anaesthesia, were 1.6 and 7.8 1/min, respectively. Pre-operative cardiac outputs were 11.1 and 21.1 1/min, respectively, and stroke volumes 174 and 273 ml. Cardiomegaly and signs of congestive heart failure were present in both cases. The surgical treatment resulted in marked improvements, the heart volume in one case being reduced almost to half its pre-operative value. The systemic arterial blood pressures showed no significant changes, whereas the pulmonary arterial pressures fell markedly. The cardiac output in the two cases fell to 5.1 and 2.7 1/min, respectively, and the stroke volume to 70 and 41 ml. The remarkably]low values in the 2nd case can be explained by impaired cardiac filling resulting from distension of the capacitance vessels due to the pr...