Acta medica Scandinavica. Supplementum
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Acta Med. Scand. Suppl. · Jan 1988
Review Comparative StudyGiving life, giving death: ethical problems of high-technology medicine.
High-technology medicine, such as dialysis and transplantation is limited and nowhere can all potential beneficiaries receive it. Although very successful, high-technology medicine sometimes makes dying to a cruel spectacle and patients whose lives depend on a machine want to stop. The resulting ethical questions revolve around just distribution of life support - giving life, and withdrawal of life support in giving death. ⋯ The decision did not seem to harm the surviving relatives, but the relatives complained of poor physician communication. Old patients had shorter survival on dialysis, were more often excluded from, and stopped dialyses ten times more often than young patients. However, the ratio of mortality on dialysis compared to the mortality in the population at large was higher in young than in old patients and the self-reported quality of life of the old patients was particularly high.(ABSTRACT TRUNCATED AT 400 WORDS)
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Acta Med. Scand. Suppl. · Jan 1988
ReviewThe associations between obesity, adipose tissue distribution and disease.
Recent research has shown the marked differences in association with disease between obesity localized to the abdominal respectively to the gluteal-femoral regions. In this review systematic analyses were performed of the associations between obesity (body mass index, BMI) or abdominal obesity (increased waist-over-hip circumference ratio, WHR) on the one hand, and a number of disease end points, and their risk factors, as well as other factors on the other, WHR was associated with cardiovascular disease, premature death, stroke, non-insulin-dependent diabetes mellitus and female carcinomas. In contrast, BMI tended to be negatively correlated to cardiovascular disease, premature death, and stroke, but positively to diabetes. ⋯ Women with high WHR were found to have a number of symptoms of poor coping to stress. It was therefore suggested that part of the background to this syndrome might be a hypothalamic arousal syndrome developing with stress. It was concluded that obesity and abdominal distribution of adipose tissue constitute two separate entities with different pathogenesis, clinical consequences and probably treatment.
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Acta Med. Scand. Suppl. · Jan 1986
Randomized Controlled Trial Clinical TrialCentral haemodynamics in acute myocardial infarction. Natural history, relation to enzyme release and effects of metoprolol.
The aim of this investigation was to study central haemodynamics in initially uncomplicated acute myocardial infarction (AMI) with respect to natural history, relation to enzyme estimated infarct size, mortality and effects of metoprolol. A total of 212 patients with AMI but without clinical signs of serious heart failure or hypotension and with a mean delay from onset of pain to study entry of about 7 hours were studied. They were randomised to placebo or metoprolol (15 mg i.v. + 50 mg orally q.i.d.) treatment. ⋯ Cardiac index (2.9-2.2 l/min/m2) and stroke volume index (36-32 ml/beat/m2) decreased to a minimum after 30 minutes and gradually rose thereafter. The PCWP increased from 13.7 to 15.4 mmHg, 30 minutes after the injection of metoprolol. This increase was confined to the group with baseline low pressure and the difference compared to the placebo group disappeared after 8 hours.(ABSTRACT TRUNCATED AT 400 WORDS)
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Acta Med. Scand. Suppl. · Jan 1986
Clinical TrialAspects on "traditional" vasodilators in the treatment of chronic heart failure.
Vasodilator therapy of heart failure has through the last 5-10 years become a well established treatment. Traditionally these drugs have been classified after their primary site of action on the vascular beds. Thus drugs primarily acting on the arteriolar bed are called afterload-reducing agents and are exemplified by hydralazine. ⋯ Treatment with vasodilators for chronic heart failure has mainly been advocated in patients with valvular regurgitation, ischemic heart disease and various types of dilated cardiomyopathies. It seems appropriate today to put some questions concerning vasodilator therapy for heart failure. Among such questions are: When in the natural history of congestive heart failure should vasodilator therapy be commenced? How effective is long-term administration of vasodilating drugs? May vasodilator therapy decrease mortality in congestive heart failure? What about the efficacy of new vasodilating drugs compared to more traditional ones? In the review of vasodilating drugs besides ACE inhibitors, these questions will be addressed.
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Acta Med. Scand. Suppl. · Jan 1982
Review Clinical Trial Controlled Clinical TrialRebound phenomena following withdrawal of long-term beta-adrenoceptor blockade.