Thomas Gjørup

Acute effects of alcohol on left ventricular function in healthy subjects at rest and during upright exercise

Six healthy men, aged 23 to 30 years, were studied by radionuclide angiocardiography at rest and at 2 submaximal exercise levels in the upright position during increasing alcohol intoxication. At light intoxication (serum ethanol 23 mmol/liter), the median value of left ventricular (LV) ejection fraction (EF) at rest decreased by 5%. At heavy intoxication (serum ethanol 45 mmol/liter), the median LVEF decreased at rest by 11% and during 75% submaximal exercise by 6%, heart rate at rest increased (median 81 vs 62 beats/min), and systolic blood pressure decreased during 50% submaximal exercise (median 145 vs 163 mm Hg). No significant changes of plasma epinephrine concentrations were recorded, whereas plasma norepinephrine concentrations were increased by 24% at rest during light intoxication and by 30 to 38% during heavy intoxication. No changes of LVEF and plasma catecholamine levels were recorded after ingestion of isovolumic, isocaloric drinks as compared with values obtained before intake. Thus, influences of ingestion per se and repeated investigations of LV function were excluded. These findings suggest that in healthy subjects alcohol intoxication causes a dose-dependent impairment of cardiac contractility. Compensatory mechanisms may account for a reduced influence during exercise.

Is growing old a disease? A study of the attitudes of elderly people to physical symptoms

In a survey of people living at home, aged 77 years and over, a total of 126 women and 77 men were interviewed concerning their attitudes to their physical symptoms. For each organ system the subjects indicated whether their symptoms were considered to be a normal condition for elderly people or a manifestation of a disease. To a large extent symptoms were accepted as a normal condition, however, a highly significant difference in their attitudes to symptoms stemming from different systems was found (p less than 0.001). Generally, compared with severe symptoms, mild symptoms were accepted more readily as a normal condition in old age. Although most of the elderly people had seen a doctor because of their symptoms, a highly significant difference was found in consultation rates among elderly persons with symptoms from different organ systems (p less than 0.001). The attitudes to symptoms influenced the tendency of the subjects to consult a doctor (p less than 0.05). The need for education of elderly people and health professionals is discussed.

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%.

Interobserver variation in the detection of metastases on liver scans

Two specialists in nuclear medicine and two trainees independently read 106 liver scans for abnormalities suggestive of metastases. The four observers made a positive diagnosis with a significantly different frequency. The overall agreement between pairs of observers was 0.83-0.87. After adjusting for the expected chance agreement, kappa-values between 0.66 and 0.74 were obtained. No difference was found in the level of agreement between the two specialists or between the two trainees. After a consensus conference where the observers tried to unify their diagnostic interpretation, another 106 scans were read for abnormalities suggestive of metastases. The conference did not increase the level of agreement. Scintigraphic lesions that especially imply a risk of disagreement are pointed out.

In vivo stability of in vitro labelled 99Tcm-red blood cells for radionuclide determination of left ventricular ejection fractions and volumes

Serial determination of radionuclide left ventricular ejection fraction and volumes require a label that remains highly stable after introduction into the human circulation. We have evaluated the in vivo stability of 99Tcm-red blood cells (99Tcm-RBC) labelled in vitro by preparation with small amounts of a stannous agent in 19 patients with coronary artery disease. The distribution volume of 99Tcm-RBC was virtually identical to that of RBC labelled with Cr. Labelling efficiency expressed as the cell bound/total activity was more than 95% and remained high throughout 1 h after injection of the label. The effective in vivo half-times (T1/2) calculated from venous blood activity and externally recorded left ventricular end-diastolic frame activity were 342±103 min (mean±S.D.) and 306±92 min, respectively.A significant correlation, r = 0.86 (p < 0.01) was found between the T1/2 values calculated from the two methods. Thus, a high in vivo stability of the label was demonstrated with considerable inter-patient variation. The labelling procedure seems suitable for serial performance of radionuclide cardiography within an hour after injection of 99Tcm-RBC. However, serial volume determination necessitates individual calculation of in vivo tracer decay from either venous blood or externally recorded activity in the left ventricular area during steady conditions.

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.

The Endoscopic Diagnosis of Duodenal Ulcer Disease: A Randomized Clinical Trial of Bias and of Interobserver Variation

In a randomized design we examined whether endoscopists are biased by knowledge of the radiologic diagnosis of duodenal ulcer and deformity of the duodenal bulb when recording the corresponding endoscopic diagnoses. A total of 156 patients had a barium meal and were subsequently randomized into 2 groups. In 74 of the cases the 2 endoscopists knew the result of the X-ray examination when doing the endoscopy; in 82 of the cases they did not. One endoscopist was significantly biased by his knowledge of the radiologic diagnosis of deformity of the duodenal bulb. Neither of the endoscopists was biased by his knowledge of the radiologic diagnosis of duodenal ulcer. In addition, the interobserver variation between the two endoscopists with regard to the endoscopic diagnoses of duodenal ulcer, deformity of the duodenal bulb, and duodenitis was examined. The interobserver variation was expressed by the overall agreement and by the kappa statistics, which adjusts the overall agreement for expected chance agreement. For duodenal ulcer, deformity of the duodenal bulb, and duodenitis, the overall agreements and kappa values were 0.91, 0.78, and 0.75, and 0.54, 0.42, and 0.33, respectively.

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.

Can municipality-based post-discharge follow-up visits including a general practitioner reduce early readmission among the fragile elderly (65+ years old)? A randomized controlled trial

Abstract Objective. To evaluate how municipality-based post-discharge follow-up visits including a general practitioner and municipal nurse affect early readmission among high-risk older people discharged from a hospital department of internal medicine. Design and setting. Centrally randomized single-centre pragmatic controlled trial comparing intervention and usual care with investigator-blinded outcome assessment. Intervention. The intervention was home visits with a general practitioner and municipal nurse within seven days of discharge focusing on medication, rehabilitation plan, functional level, and need for further health care initiatives. The visit was concluded by planning one or two further visits. Controls received standard health care services. Patients. People aged 65 + years discharged from Holbæk University Hospital, Denmark, in 2012 considered at high risk of readmission. Main outcome measures. The primary outcome was readmission within 30 days. Secondary outcomes at 30 and 180 days included readmission, primary health care, and municipal services. Outcomes were register-based and analysis used the intention-to-treat principle. Results. A total of 270 and 261 patients were randomized to intervention and control groups, respectively. The groups were similar in baseline characteristics. In all 149 planned discharge follow-up visits were carried out (55%). Within 30 days, 24% of the intervention group and 23% of the control group were readmitted (p = 0.93). No significant differences were found for any other secondary outcomes except that the intervention group received more municipal nursing services. Conclusion. This municipality-based follow-up intervention was only feasible in half the planned visits. The intervention as delivered had no effect on readmission or subsequent use of primary or secondary health care services.

Global assessment of patients — a bedside study. II. Inter‐observer variation and frequency of clinical findings

Abstract. Three physicians independently assessed 201 hospital in‐patients for the presence of 10 basic physical characteristics, and made an overall assessment of whether or not the patients appeared ill. There were significant differences between the physicians in the average number of observations recorded for each patient (P < 0.001). There was a significant difference (P < 0.05) between the physicians regarding the number of positive diagnoses of anaemia, abnormal nutritional state, breathing difficulties and the overall assessment. Inter‐observer variation was estimated by a pairwise comparison of the three physicians. Overall agreement rates ranged from 0.65 for abnormal nutritional state to 0.99 for presence of pain. After adjusting for random agreement, kappa values between 0.09 (elevated body temperature) and 0.88 (consciousness impaired) were found. No tendency towards a higher level of agreement in the overall assessment than in the basic findings was observed.