Ole J. Hartling

Controlled double-blind trial of the clinical effect of nifedipine in the treatment of idiopathic Raynaud's phenomenon

Twenty-six patients with idiopathic Raynauds phenomenon participated in a double-blind, crossover clinical trial comparing the clinical effect of nifedipine with that of placebo. Four patients discontinued the study because of side effects and one patient defaulted at the return visit. Nifedipine significantly reduced frequency and severity of attacks (p less than 0.01). In an overall evaluation of drug effectiveness, 19 of 21 patients preferred nifedipine to placebo (p less than 0.01). Nifedipine proved to be effective in the treatment of idiopathic Raynauds phenomenon, but side effects should be expected in some 30%.

Scintigraphic control of pulmonary embolism.

Pulmonary embolism was diagnosed by combined perfusion and ventilation scintigraphy in 30 patients. A control examination 6 months later revealed pulmonary embolism or infarction in 8, in spite of conventional treatment. Therefore, patients treated for pulmonary embolism should be reexamined 3 to 6 months after diagnosis.

Left ventricular function during alcohol intoxication and autonomic nervous blockade

Eight healthy young subjects (6 men, 2 women) entered a controlled investigation of left ventricular (LV) function during alcohol intoxication and autonomic nervous blockade. Radionuclide cardiography was performed at rest and during upright 50% submaximal bicycle exercise. During alcohol intoxication alone (serum ethanol 30 mmol/liter), heart rate at rest increased by 11% (p less than 0.05) and LV ejection fraction (EF) decreased by 6% because of end-systolic dilation. No significant alcohol-induced hemodynamic changes were observed during exercise. Plasma norepinephrine concentration increased by 29% (p less than 0.05), whereas plasma epinephrine concentration did not change. During subsequent autonomic nervous blockade with intravenous metoprolol and atropine infusion, heart rate at rest further increased and systolic blood pressure decreased. These changes were not, however, significantly different from those of a control experiment in which a nonalcoholic isocaloric drink was substituted for alcohol. Plasma norepinephrine levels at rest and during exercise were 25% and 32% higher (both p less than 0.05), respectively, than those during control conditions. Plasma epinephrine concentrations did not change. These findings suggest that alcohol intoxication has a depressant effect on LV function at rest that stimulates autonomic nervous blockade. The increased sympathetic nervous activity during exercise appears to be a toxic rather than a compensatory effect of alcohol.

Controlled double blind trial of nisoldipine in the treatment of idiopathic Raynaud's phenomenon

SummaryIn a controlled double blind trial the symptomatic effect of the calcium channel blocker nisoldipine was assessed in 19 patients with idiopathic Raynauds phenomenon. Nisoldipine significantly reduced the frequency of attacks (p<0.05), whilst having a non-significant tendency (p<0.10) to reduce the severity of attacks. Side-effects were uncommon. It is concluded that nisoldipine is a promising agent for the symptomatic treatment of idiopathic Raynauds phenomenon.

Scintigraphy of kidneys located at different depths: the geometric mean method for determination of differential renal function: case report

In patients with kidneys located at different depths, differential renal function cannot simply be determined with Tc-99m DMSA scintigraphy using the accumulated count rates from each kidney in the anteroposterior or posteroanterior projection. This will give grossly misleading results. In patients with abnormally located kidneys, scintigrams in both the anteroposterior and posteroanterior views may be obtained so that the geometrical mean method can be applied. An example of the use of this method is given.

Cardiac function at rest and during exercise in early and late alcohol intoxication

Seven healthy men, aged 21 to 30 years, were investigated by radionuclide cardiography at rest and during submaximal exercise at heavy (early) and during declining (late) alcohol intoxication. Control studies, in which alcohol was substituted by an isocaloric, isovolumic drink, were performed on a different day. The left ventricular ejection fraction at rest decreased from 59 to 56% during early intoxication (serum ethanol 35 +/- 6 mmol/l), whereas no change was observed in the ejection fraction during exercise. No significant change was recorded in stroke volume after alcohol consumption as opposed to a small increase after ingestion of the caloric drink. Plasma noradrenaline concentrations were elevated during exercise and early intoxication. During late intoxication (serum ethanol 21 +/- 5 mmol/l) the left ventricular ejection fraction at rest was increased by 7% compared with the baseline value. At rest the heart rate was increased from 68 +/- 7 to 84 +/- 15 beats/min, whereas cardiac output had reverted to the baseline value. Plasma noradrenaline at late intoxication was increased both at rest and during exercise compared with the baseline values. Apart from tachycardia and a reduction in left ventricular volumes during late intoxication no alcohol induced hemodynamic changes occurred during exercise.

Bone-scan “cold” lesion caused by an osteolytic metastasis from an adenocarcinoma of the thyroid

A case of a “cold” lesion on sodium pertechnetate Tc 99m (99mTc) bone scan of the pelvis of a patient with an adenocarcinoma of the thyroid gland is reported. X-ray demonstrated an osteolytic metastasis, and biopsy revealed its origin to be a thyroid adenocarcinoma.

Bilateral subdural haematoma demonstrated at scintigraphy of the brain

Bilateral subdural haematoma is not a rare disorder, but only a few cases diagnosed at brain scintigraphy have been reported. Bilateral subdural haematoma was demonstrated at scintigraphy in a 66-year-old man. Subsequent computerized-tomography scanning of the brain also demonstrated the lesion. After bilateral burr-hole aspiration, the patient made a good recovery.