bluuebunny/crossref_metadata_2025 huggingface dataset:
Successful treatment of hepatosplenic candidiasis with a liposomal amphotericin B preparation
Authors: BJÖRKHOLM M. , KÅLLBERG N. , GRIMFORS G. , EKLUND L. H. , EKSBORG S. , JUNESKANS O. T. , UDÉN A.‐M.
Published: August 2009

The case of a granulocytopenic patient with acute undifferentiated leukaemia and hepatosplenic candidiasis who was refractory to conventional deoxycholate amphotericin B (AmpB) and 5‐flucytosine therapy is reported. He experienced severe AmpB‐related side‐effects, and was subsequently successfully treated with a pharmaceutical preparation of AmpB (5.7 g) entrapped in sonicated liposomes, composed of lecithin, cholesterol and stearylamine in a molar ratio of 4: 3: 1. Three months later, during maintenance chemotherapy, liposomal AmpB (5.1 g) was reinstituted due to the finding of biopsies positive forCandida albicansat bronchoscopy. After healing of the patient's fungal infection a left upper lobe resection was performed, which showed advanced fibrosis with signs of inflammation, but no evidence of fungal disease. Since no acute side‐effects and only moderate hypokalaemia were observed, it appears that liposomal AmpB is superior to conventional AmpB treatment in granulocytopenic patients with hepatosplenic candidiasis and unbearable therapy‐related side‐effects.
Long‐term prognosis after early intervention with metoprolol in suspected acute myocardial infarction: experiences from the MIAMI Trial
Authors:   THE MIAMI TRIAL RESEARCH GROUP
Published: August 2009

Abstract. A total of 5778 patients with suspected acute myocardial infarction were randomized to early intravenous metoprolol followed by oral treatment for 15 d, or to placebo. Thereafter, the two groups were treated similarly. During a 1‐year follow‐up period the mortality in patients who were randomized to early metoprolol was 10.6%, compared to 10.7% for placebo (P > 0.2). Among patients with a higher risk of death, the tendency towards a reduced mortality in the metoprolol group that was observed after 15 d remained similar after 1 year. It is concluded that early intervention with metoprolol in suspected acute myocardial infarction did not improve the long‐term prognosis compared to placebo treatment.
Isolated cryptococcosis of the adrenal gland
Authors: LIU YUNG‐CHING , CHENG DEH‐LIN , LIU CHENG‐YI , YEN MUH‐YONG , WANG RAN‐SHANG
Published: August 2009

Abstract. A case of isolated adrenal cryptococcosis is reported. A patient with a history of diabetes mellitus had symptoms of left flank pain. Roentgenological and sonographic findings of the adrenal gland were indicative of a malignant tumour. Tissue obtained from surgery showed fungal granuloma and a poorly encapsulated cryptococcal organism was identified by special stains. A post‐operative serum cryptococcal antigen test was positive, and the patient was successfully treated with surgery and a course of amphotericin B. After a 7‐month follow‐up period, there is no evidence of recurrence or dissemination.
The hypercholesterolaemic factor in boiled coffee is retained by a paper filter
Authors: AHOLA I. , JAUHIAINEN M. , ARO A.
Published: August 2009

Abstract. In order to study the effects of filtering on the serum cholesterol‐elevating effect of boiled coffee, 20 healthy volunteers consumed, in random order, 6–10 dl d−1 of strong boiled coffee (BC) and similarly boiled coffee that had been passed through a conventional paper filter (BFC), for periods of 4 weeks in a crossover design. During periods of BC consumption serum total cholesterol and LDL‐cholesterol levels (P < 0.05), as well as serum triglyceride and apoprotein B concentrations and the LDL/HDL ratio (P < 0.01), were significantly higher than during BFC periods. Serum HDL‐cholesterol and apoprotein A‐I levels remained unchanged. Filtering removed more than 80% of the lipid‐soluble substance that was present in boiled coffee. The results indicate that the hypercholesterolaemic factor in boiled coffee, which is presumably lipid‐soluble, is retained by the paper filter. They also suggest that boiling is not essential for the previously observed difference between the effects on serum lipoproteins of boiled coffee and filtered coffee.
Serum platelet‐derived growth factor and endothelin concentrations in human hypercholesterolaemia
Authors: BATH P. M. W. , MARTIN J. F.
Published: August 2009

Abstract. Platelet‐derived growth factor (PDGF) and endothelin are both smooth muscle cell mitogens, and may have an important role in mediation of the proliferative phase of atherogenesis. Since hypercholesterolaemia is an important risk factor for atherosclerosis, we have measured serum endothelin and PDGF concentrations in matched pairs of hypercholesterolaemic patients and control subjects. Both endothelin and PDGF concentrations were higher in the hypercholesterolaemic patients (23.8±4.3 pm vs. 21.7±2.4pm, P = 0.019, median difference 3.0, 95% confidence limits 0.6–7.3, and 115.4±60.3 pm vs. 64.7±22.7 pm P = 0.033, median difference 27.2, 95% confidence limits 1.3–82.5, respectively), while serum endothelin and PDGF concentrations were positively correlated with each other (r = 0.764, P < 0.0001, 95% confidence limits 0.505–0.897). PDGF concentrations were correlated with the peripheral blood platelet count (r = 0.560, P = 0.007, 95% confidence limits 0.180–0.794). These findings suggest that PDGF, and possibly endothelin, may be involved in hypercholesterolaemia‐ related atherogenesis.
Increased plasma level of substance P in patients with severe congestive heart failure treated with ACE inhibitors
Authors: VALDEMARSSON S. , EDVINSSON L. , EKMAN R. , HEDNER P. , SJÖHOLM A.
Published: August 2009

Abstract. The effects of angiotensin‐converting‐enzyme (ACE) inhibitors on circulatory regulating mechanisms in congestive heart failure (CHF) were studied by comparison of plasma levels of catecholamines, neuropeptide Y‐like immunoreactivity (NPY‐LI), substance P (SP‐LI), calcitonin gene‐related peptide (CGRP‐LI), vasopressin (ADH‐LI), atrial natriuretic peptide (ANP‐LI) and renin activity (PRA) in patients with severe CHF (NYHA III‐IV) with (n = 15) or without (n = 17) ACE inhibitors in addition to digoxin and diuretic therapy. Data were also compared with those for healthy subjects (n = 31) and patients with moderate CHF (NYHA I‐II). Catecholamines and NPY‐LI were increased to the same extent in both groups with severe CHF. CGRP‐LI showed no changes relative to controls in any of the patient groups, and was not affected by ACE inhibitors. The SP‐LI level was significantly increased in all patient groups. Patients with severe CHF on ACE inhibition had a SP‐LI level of 4.05±0.79 pmol l−1, compared to a concentration of 2.28±0.30 pmol l−1 (P < 0.05) in the patient group with a comparable degree of CHF but without ACE inhibition. In the latter group, an inverse relationship appeared between the SP‐LI and the serum sodium levels (r = —0.68, P < 0.05). The patients with severe CHF who received ACE inhibitors had significantly lower ADH‐LI levels than the patients with a comparable degree of CHF who were not treated with ACE inhibitors, while the ANP‐ LI level was increased to a similar extent in both groups.
Severe coagulopathy after a bite from a ‘harmless’ snake (Rhabdophis subminiatus)
Authors: SMEETS R. E. H. , MELMAN P. G. , HOFFMANN J. J. M. L. , MULDER A. W.
Published: August 2009

Abstract. European physicians may occasionally be confronted with cases of snake venom poisoning. The increasing interest in snakes as pets has unfortunately resulted in the importation of a number of venomous snakes. We here report the third known case in the medical literature of a patient who was exposed to severe coagulopathy after being bitten by a ‘harmless’ ringsnake (Rhabdophis subminiatus). The prolonged bleeding diathesis and the complete depletion of fibrinogen observed in our patient are consistent with the presence of a factor X activator in the venom, as has been described in a murine model. In agreement with the two previous case reports, we found no evidence of severe organ damage, despite active intravascular coagulation.
Microdialysis of adipose tissue
Authors: ARNER P. , BOLINDER J.
Published: August 2009

Abstract.Although microdialysis has been available for almost two decades, it has only recently been applied in investigations of adipose tissue. The microdialysis technique enables continuous sampling of metabolites and other small molecules from the extracellular space of subcutaneous adipose tissue from intact animals or man, and the exposure of this compartment locally to metabolically active agents without causing generalized effects. To date, the method has been used to measure the steady‐state interstitial levels of metabolites and to investigate the regulation of lipolysis and carbohydrate metabolismin situin subcutaneous adipose tissue. Apart from a great potential for experimental research, the microdialysis method offers several new possibilities for clinical investigation. Because microdialysis probes are easy to implant and cause little discomfort, they may be used for continuous monitoring of glucose and glycerol (lipolysis index) in the treatment of diabetes, obesity and other disorders characterized by disturbances in lipid and carbohydrate metabolism.
Effect of apolipoprotein E polymorphism and Xbal polymorphism of apolipoprotein B on response to lovastatin treatment in familial and non‐familial hypercholesterolaemia
Authors: OJALA J.‐P. , HELVE E. , EHNHOLM C. , AALTO‐SETÄLÄ K. , KONTULA K. K. , TIKKANEN M. J.
Published: August 2009

Abstract. Despite the well‐documented efficacy of lovastatin, a wide inter‐individual variation in treatment responses has been observed. The aim of the present study was to investigate the possible roles of apolipoprotein E (apo E) phenotype and apolipoprotein B (apo B) Xbal genotype on this variation. The apo E phenotype was determined in 232 subjects (78 cases of familial hypercholesterolaemia [FH] and 154 cases of non‐familial hypercholesterolaemia [non‐FH]) and the apo B Xbal genotype was determined in 211 subjects (67 cases of FH, 144 cases of non‐FH). Depending on their baseline total serum cholesterol levels, these patients used a starting dose of lovastatin of either 20 or 40 mg nightly. After 6 weeks of therapy, slightly but significantly smaller reductions in LDL‐cholesterol were observed in patients with the E4/3 phenotype compared with those with the E3/3 phenotype in non‐FH with lovastatin 20 mg (–20 vs. –28%; P = 0.043) and in total cholesterol in FH with lovastatin 40 mg (–23 vs. –27%; P = 0.023). No significant differences were found in non‐FH patients starting with lovastatin, 40 mg. After doubling of the lovastatin doses, all treatment responses became similar among apo E phenotypes. Moreover, when all patients using lovastatin 40 mg either at 6 or 12 weeks were pooled (n = 224), no differences in treatment responses were observed between the E3/2, E3/3, E4/3 and E4/4 phenotypes. The apo B Xbal genotype did not affect the hypocholesterolaemic efficacy of lovastatin in any of the patient groups. Thus our results indicate that inter‐individual variation in the treatment response to lovastatin in both familial and non‐familial hypercholesterolaemia is mainly due to factors other than the apo E phenotype or apo B Xbal genotype.
Rapidly fatal Addison's disease: three case reports
Authors: RINGSTAD J. , RODGE S. , LØLAND W. , RODE L.
Published: August 2009

Abstract. Recently, three young individuals died unexpectedly outside hospital. Their past medical histories revealed complaints of weakness, anorexia and nausea, none of which had led to adequate medical examination. The present paper calls for vigilance when patients present with non‐specific manifestations such as anorexia and weakness. Autopsies confirmed that the deaths were caused by adrenalitis, a diagnosis unsuspected at the time of death. The value of different post‐mortem laboratory findings is discussed.
Water hardness does not contribute substantially to the high coronary mortality in cold regions of Sweden
Authors: GYLLERUP S. , LANKE J. , LINDHOLM L. H. , SCHERSTÉN B.
Published: August 2009

Abstract. Earlier studies have shown an association between cold climate and high coronary mortality. The aim of this study was to elucidate in more detail the effect of drinking water hardness on this association. Drinking water parameters were obtained from 259 municipalities in Sweden over a 10‐year period. During the same period a ‘cold index’ was calculated for each municipality. Standardized coronary mortality rates in men aged 40–64 years were used. A negative association was found between water hardness and coronary mortality (coefficient of determination k = 0.080). A much stronger association was found between coronary mortality and cold index (D = 0.389). When coronary mortality was explained by both water hardness and cold index, the association was not significantly strengthened (D = 0.391). Water hardness was negatively correlated with cold index (r = 0.55). We conclude that the association between cold climate and coronary mortality was stronger than that between drinking water hardness and coronary mortality, and that it persisted after stratification for water hardness.
The role of paid work in Swedish chronic dialysis patients—a nation‐wide survey: paid work and dialysis
Authors: THEORELL T. , KONARSKI‐SVENSSON J. K. , AHLMÉN J. , PERSKI A.
Published: August 2009

Abstract. The role of paid work in chronic illness has been investigated in this nation‐wide study of all Swedish‐speaking patients on chronic dialysis above the age of 16 years, who were not too tired or severely ill to participate and who had been treated for at least 3 months. Young age and female gender were consistently associated with increased prevalence of self‐reported depression, poor psychological health, psychosomatic symptoms and sleep disturbance. In multivariate analyses paid work, strong emotional support, and care at intermediate or small units were independently associated with a good quality of life. Chronic dialysis patients who did paid work (19.6% of the patients below 65 years of age) perceived their work as more socially supportive than did men and women in the normal working population. It may be concluded that paid work is of particular importance to this patient group because it may give extra social support to patients whose social network is in general rather poor.
N‐acetylcysteine and serum concentrations of lipoprotein(a)
Authors: KROON A. A. , DEMACKER P. N. M. , STALENHOEF A. F. H.
Published: August 2009

Abstract. A high plasma concentration of lipoprotein(a) [Lp(a)], a complex of low‐density lipoprotein linked by disulphide bridges to apoprotein(a), is correlated with premature atherosclerosis. We determined whether the serum Lp(a) concentration could be decreased in vitro and in vivo by the reducing agent N‐acetylcysteine (NAC), a drug used as a mucolytic agent, which acts by cleaving disulphide bonds. High concentrations of NAC (≥ 8 mg ml−1) resulted in dissociation of the Lp(a) antigen in vitro. However, the plasma level of Lp(a) was not changed by administration of NAC 1.2 g d−1 for 4 weeks in 7 subjects with a median Lp(a) concentration of 14.3 mg dl−1 (range 2.1–21.0 mg dl−1) or by doubling the dose to 2.4 g d−1 for a further 2 weeks. In 12 subjects with a high plasma level of Lp(a), median 87.0 mg dl−1 (range 42.0–201.6 mg dl−1), a small but significant decrease in Lp(a) concentration of 7% (P = 0.02) was observed after administration of NAC in a dose of 1.2 g d−1 for 6 weeks. These results indicate that NAC has only a limited capacity to reduce the concentration of Lp(a), which is not clinically significant.
Efficacy of epanolol versus metoprolol in angina pectoris: report from a Swedish multicentre study of exercise tolerance
Authors: RYDÉN L.
Published: August 2009

The efficacy of epanolol vs. metoprolol in stable angina pectoris was compared in 114 patients recruited to a randomized double‐blind cross‐over study, consisting of a 4‐week period on each drug. Epanolol (200 mg) or metoprolol (200 mg) was administered daily. Bicycle ergometry was performed at the end of each treatment period. The maximum workload was 134 ± 18 W on epanolol and 133 ± 37 W on metoprolol (NS). Values for resting heart rate (epanolol, 72 ± 11 beats min−1; metoprolol, 64 ± 12 beats min−1; P < 0.001), systolic blood pressure (epanolol, 143 ± 21 mmHg; metoprolol, 137 ± 21 mmHg; P < 0.05) and diastolic blood pressure (epanolol, 88 ± 10 mmHg; metoprolol, 84 ± 11 mmHg; P < 0.01) were all higher on epanolol treatment. During exercise, the increase in heart rate and blood pressure was of similar magnitude during the two treatment periods, and these parameters did not differ significantly at the last identical workload. The rating of chest pain, fatigue and dyspnoea did not differ between the two drugs during submaximal or maximal exercise. In conclusion, 200 mg of epanolol and metoprolol have similar efficacy with regard to exercise tolerance. As expected from the partial agonist activity present in epanolol but not in metoprolol, the former drug resulted in a higher heart rate and blood pressure at rest. The observed increase in these parameters during exercise was similar for both drugs.
Evidence for an independent relationship between insulin resistance and fasting plasma HDL‐cholesterol, triglyceride and insulin concentrations
Authors: LAWS A. , REAVEN G. M.
Published: August 2009

Abstract.Elevated plasma insulin and triglyceride (TG) and decreased high‐density‐lipoprotein (HDL)‐cholesterol concentrations have been shown to be risk factors for coronary heart disease (CHD). It has been suggested that these metabolic abnormalities are all secondary to resistance to insulin‐stimulated glucose uptake. To examine this in more detail, we divided 18 non‐diabetic, moderately overweight, sedentary men aged 25–50 years into three groups on the basis of their steady‐state plasma glucose levels (SSPG): a low group, (n= 7; SSPG < 8.3 mmol l−1), a middle group, (n= 6; SSPG 8.3–11.1 mmol l−1), and a high group (n= 5; SSPG > 11.1 mmol l−1). The high group had significantly higher fasting (P< 0.05) and post‐oral glucose challenge (P< 0.01) insulin concentrations, higher fasting TG (P< 0.05) and lower fasting HDL‐cholesterol (P< 0.05) concentrations than the other two groups. However, there were no statistically significant differences between the groups with regard to body mass index, waist‐to‐hip ratio or physical endurance capacity as determined by maximal oxygen consumption during a treadmill test. The data suggest that insulin resistance has an effect on the modulation of plasma insulin, TG and HDL‐cholesterol concentrations, independent of generalized, abdominal or physical endurance capacity.
Mortality and recurrences during eight years following stroke
Authors: VON ARBIN M. , BRITTON M. , de FAIRE U.
Published: August 2009

Abstract. A total of 388 patients, of mean age 73 years, with acute cerebrovascular disease (CVD) evaluated in a non‐intensive Stroke Unit, and a sample of 209 age‐ and sex‐matched similarly acutely admitted patients with surgical diseases were followed up for 5–8 years. The CVD patients had a 21‐day hospital mortality of 13%, and 66% mortality during the entire study period, compared to 2% and 48%, respectively, in controls. Old age had only a minor effect on the initial mortality. However, long‐term mortality increased markedly with age. The initial mortality in 120 stroke recurrences was 50%. In CVD patients heart diseases were common causes of death, and circulatory diseases were most predominant of all (86%), with an accumulation during the first months after the occurrence of the initial CVD event. These figures clearly show that stroke patients constitute a group with high risk of stroke recurrence and death. Despite declining figures for stroke mortality, and most probably also for case fatality rate after first stroke episodes, much work remains to be done within the field of secondary prevention after stroke.
Five‐year follow‐up of young adults visiting an emergency unit because of atypical chest pain
Authors: ROLL M. , KOLLIND M. , THEORELL T.
Published: August 2009

Abstract. A five‐year follow‐up, by means of a personal interview, was performed on patients below the age of 40 years with acute chest pain without obvious organic cause (n = 64). They had been consecutively admitted to the emergency unit over a period of 8 weeks, and had all been subjected to a thorough medical and psychosocial investigation with feedback soon after the initial consultation (investigation patient group, IP). For comparison, a non‐investigation patient (NIP) group (n = 51) was recruited over a period of 8 separate weeks. Half of the patients in each group reported at the follow‐up that they continued to suffer from chest pain. Compared to normal subjects, they reported more depression. This means that the initial research programme performed in the investigation group had no sustained therapeutic effect compared to routine care at the emergency unit. Tension, anxiety and number of consultations with a physician, as reported in the initial investigation, were negatively correlated with the outcome at follow‐up. We conclude that acute chest pain without obvious organic cause in young adults is a condition with an excellent prognosis in strictly physical terms. However, a high proportion of the patients continue to suffer from chest pain for several years, and many of them continue to be consumers of medical resources. We therefore suggest that therapeutic programmes should be developed, particularly for those who report psychological symptoms and those with a history of many consultations with physicians.
Systemic lupus erythematosus and related systemic diseases in a nationwide twin cohort: an increased prevalence of disease in MZ twins and concordance of disease features
Authors: JÄRVINE P. , KAPRIO J. , MÄKITALO R. , Koskenvuo M. , Aho K.
Published: August 2009

Abstract. Concordance rates for systemic rheumatic diseases among monozygotic (MZ) and same‐sex dizygotic (DZ) twin pairs ascertained from the older (twins born before 1958) and younger (twins born during the period 1958–1986) parts of the Finnish Twin Cohort were studied. Nine MZ pairs and 10 DZ pairs with at least one member affected by systemic lupus erythematosus (SLE) were identified. Only one MZ pair was concordant for definite SLE by American Rheumatism Association (ARA) criteria. In addition, two more MZ pairs that fulfilled three ARA criteria may have been concordant. None of the DZ pairs were concordant for SLE. MZ twins also had a higher concordance rate for tests of autoantibodies, but the numbers were small. Other systemic rheumatic diseases were infrequent. The cumulative incidence of systemic rheumatic diseases among MZ twin individuals (1.7/1000) was significantly higher than that among DZ twin individuals (0.7/1000).
Radionuclide assessment of left ventricular function in patients with mycardial infarction and diabetes mellitus
Authors: LOMUSCIO A. , BESTETTI A. , VERGANI D. , CHIARAMELLO D. , CHITI A. , RUFFINI L. , POZZONI L. , TAROLO G. L.
Published: August 2009

Abstract. The aim of this study was to compare left ventricular function, assessed by radionuclide angiocardiography, in 54 diabetics and 194 non‐diabetics with acute myocardial infarction (AMI). The most meaningful results concern the inferior AMI group, whose left ventricular ejection fraction (LVEF) and regional wall motion were significantly lower in diabetics than in non‐diabetics (LVEF was 44.2 ± 11 vs. 51.6 ± 9%, P < 0.005; the regional wall motion score was 0.46 ± 1 vs. 1.56 ± 1, P < 0.01, respectively), while no significant difference was observed in the anterior AMI group. However, in the group as a whole, the LVEF was 41 ± 13% in diabetics and 47 ± 13% in non‐diabetics (P < 0.01), the number of abnormally contracting segments was 2.0 ± 0.9 and 1.5 ± 1, respectively, and the wall motion score was 0.2 ± 1.1 and 1.0 ± 1.4, respectively (P < 0.01). These data could be explained by an underlying cardiac dysfunction in diabetes, in addition to AMI. The more marked difference between diabetics and non‐diabetics in inferior AMI might be related to the smaller infarct size in this group.
Levels of cardiovascular risk factors in Type 2 diabetes mellitus are dependent on the stage of proteinuria
Authors: TKÁČ I. , MOLČÁNYIOVÁ A. , TKÁČOVÁ R. , TAKÁC M.
Published: August 2009

Levels of cardiovascular risk factors were determined in 75 patients with Type 2 diabetes mellitus. The patients were divided into three groups according to their urinary protein excretion (UPE): (a) normal proteinuria (≤ 70 mg d−1); (b) microproteinuria (70–500 mg d−1): and (c) macroproteinuria (> 500 mg d−1). A significant stepwise increase in mean systolic blood pressure, LDL‐cholesterol and fibrinogen levels was observed from the first to the third investigated group of patients. Mean apoprotein B levels were significantly increased in the group with macroproteinuria compared to the other two groups. Significant linear correlations were found between UPE and LDL‐cholesterol, total cholesterol, apoprotein B, creatinine, systolic blood pressure and diabetes duration. In summary, it is concluded that the levels of some cardiovascular risk factors increase with the stage of proteinuria in Type 2 diabetes mellitus.
Comparative safety and efficacy of clarithromycin and ampicillin in the treatment of out‐patients with acute bacterial exacerbation of chronic bronchitis
Authors: GUAY D. R. P. , CRAFT J. C.
Published: August 2009

Abstract.In an open, randomized trial, adult non‐hospitalized patients with acute bacterial exacerbation of chronic bronchitis were treated with 500 mg clarithromycin twice daily (n= 53) or 500 mg ampicillin four times daily (n= 50). Causative pathogens includedS. pneumoniae, M. catarrhalis, H. influenzae, H. parainfluenzaeandS. aureus. For clinically evaluable patients, successful outcome (cure or improvement) was noted for 53/53 (100%) clarithromycin‐treated patients and 46/47 (98%) ampicillin‐treated patients. Clinically significant improvement in signs and symptoms was comparable between treatment groups. There was 100% bacteriological eradication in both treatment groups. Eight patients (15%) in the clarithromycin group and 10 patients (20%) in the ampicillin group reported adverse events, the majority of which were mild or moderate in severity; six events in each treatment group were digestive‐system disorders. The new macrolide, clarithromycin, appears to be effective and well‐tolerated in the treatment of acute exacerbation of chronic bronchitis.
Improved working capacity in patients with ischaemic heart disease during a 10‐day treatment with oral theophylline
Authors: STRÅÅT E. , EDLUND A. , HENRIKSSON P.
Published: August 2009

The objective of this study was to assess whether a 10‐d treatment with oral theophylline improves the working capacity in patients with ischaemic heart disease, and to compare theophylline with conventional anti‐anginal therapy. Twenty‐four patients with stable effort‐induced angina were included in the study. The patients received double‐blind treatment in randomized order during 4 consecutive 10‐d periods, separated by a 4‐d wash‐out period, with (a) metoprolol durules 200 mg once daily + theophylline durules 300 mg b.i.d., (b) theophylline + placebo, (c) metoprolol + placebo, and (d) placebo alone. At the end of each period a supine exercise stress test was performed. Maximal workload increased to 111 ± 6W during treatment with theophylline, compared to 106 ± 6 W during placebo treatment (P = 0.01). Metoprolol increased the maximal workload to 117 ± 6 W (P < 0.001). The effects of metoprolol and theophylline were additive, and the working capacity increased to 123 ± 7 W during combined therapy. Neither the degree of ST‐depression nor the scoring of chest pain at maximal workload differed between the four treatment regimens. An improved working capacity was shown in patients with stable effort‐induced angina pectoris during long‐term theophylline treatment. The effect was additive to that of beta‐blockade.
Low plasma levels of insulin‐like growth factor 1 (IGF‐1) in male patients with idiopathic osteoporosis
Authors: LJUNGHALL S. , JOHANSSON A. G. , BURMAN P. , KÄMPE O. , LINDH E. , KARLSSON F. A.
Published: August 2009

Experimental studies in vitro indicate that insulin‐like growth factor 1 (IGF‐1) could be of importance for normal bone growth and remodelling, but the clinical relevance of these observations is unknown. In 12 consecutive young to middle‐aged male patients (mean age (±SD) 46 ± 8 years, range 30–57 years) with symptomatic idiopathic osteoporosis, the plasma concentrations of IGF‐1 were significantly lower than in healthy subjects (0.51 ± 0.25 vs. 0.73 ± 0.23 U ml−1; P < 0.01). The bone mineral densities in the spine, the femoral neck, and the forearm were significantly different between patients and control subjects. There were positive correlations between the plasma IGF‐1 concentrations and the bone densities of the spine and the forearm. Three of the patients received a 5‐d course of human recombinant growth hormone (GH). During this short period significant increases in plasma IGF‐1 levels and in biochemical indices of bone turnover (serum bone‐specific alkaline phosphatase, urinary calcium excretion) were recorded. These observations indicate that circulating IGF‐1 could have an important role in maintaining bone mass, and suggest that impairment of IGF‐1 production is involved in the pathogenesis of osteoporosis.
Autonomic nervous function and its relationship to cardiac performance in middle‐aged diabetic patients without clinically evident cardiovascular disease
Authors: MUSTONEN J. , UUSITUPA M. , LÄNSIMIES E. , VAINIO P. , LAAKSO M. , PYÖRÄLÄ K.
Published: August 2009

Autonomic nervous function was evaluated in 36 patients with insulin‐dependent diabetes mellitus (IDDM), 39 patients with non‐insulin‐dependent diabetes mellitus (NIDDM) and 48 control subjects, all without clinically evident cardiovascular disease. Valsalva ratio and heart rate variation during deep breathing were lower in both diabetic groups than in the control group. Autonomic nervous function score (ANFS) was more abnormal in patients with IDDM than in control subjects, but was not significantly increased in patients with NIDDM. There was a negative correlation between ANFS and left ventricular diastolic filling evaluated by echocardiography or peak heart rate during exercise in both diabetic groups. There were no correlations between ANFS and left ventricular systolic function at rest or during exercise in any of the groups. In conclusion, autonomic nervous function was abnormal in middle‐aged diabetic patients, and it was associated with impaired left ventricular diastolic filling at rest and decreased heart rate response to exercise, but not with left ventricular systolic function.
Detection of serum IgM antibodies to glomerular basement membrane in two cases of nephropathia epidemica
Authors: BILLHEDEN J. , SETTERGREN B. , STEGMAYR B. , JUTO P.
Published: August 2009

We report two serologically verified cases of nephropathia epidemica (NE) who developed high serum levels of non‐Goodpasture IgM antibodies against glomerular basement membrane (anti GBM) in the acute phase of the disease. Moreover, in one of the patients a renal biopsy showed granular deposits of complement factor 3 along the glomerular capillary walls. The possible pathogenic significance of these findings is discussed.
Extrinsic allergic alveolitis due to exposure to esparto dust
Authors: ZAMARRÓN C. , DEL CAMPO F. , PAREDES C.
Published: August 2009

We here describe the case of a patient with a history of exposure to esparto grass for two and a half years, who presented with clinical symptoms, radiological signs, pulmonary function test and histological findings consistent with the diagnosis of hypersensitivity pneumonitis. Signs and symptoms reappeared after re‐exposure. There are few reports of stipatosis in the world literature.
Fatal adult Henoch‐SchÖnlein purpura due to small intestinal infarction
Authors: CHAN J. C. N. , LI P. K. T. , LAI F. M. , LAI K. N.
Published: August 2009

A 57‐year‐old woman presented with classical symptoms of Henoch‐SchÖnlein purpura including arthralgia, abdominal pain, palpable purpuric rash and abnormalities of the urinary sediments. The clinical course was subsequently complicated by severe paralytic ileus leading to respiratory embarrassment. Laparotomy confirmed patchy areas of small bowel infarction due to necrotizing vasculitis. Skin biopsy revealed extensive leukocytoclastic vasculitis with granular deposits of IgA in the blood vessels. Anti‐neutrophil cytoplasmic autoantibodies (ANCA) were not detectable. The patient continued to deteriorate despite bowel resection, intensive immunosuppressive therapy and plasma exchange, and eventually died. Gastrointestinal involvement in adult Henoch‐SchÖnlein purpura has previously been reported to have a favourable clinical course. However, our case illustrates the rare but lethal complication of intestinal infarction in patients who fail to respond to conservative treatment.
Association between high levels of growth factors in plasma and progression of coronary atherosclerosis
Authors: NILSSON J. , VOLK‐JOVINGE S. , SVENSSON J. , LANDOU C. , de FAIRE U. , HAMSTEN A.
Published: August 2009

Although intimal proliferation of smooth muscle cells (SMC) is recognized as one of the key mechanisms in the development of atherosclerosis, our knowledge of the role of circulating growth factors for SMC in this process is limited. In the present study the plasma levels of platelet‐derived growth factor (PDGF), ß‐thromboglobulin (ß‐TG), platelet factor 4 (PF 4) and total growth factor activity were determined in a group of 30 young postinfarction patients who had participated in an angiographic study of mechanisms associated with progression of coronary atherosclerosis. Significant correlations were found between the total growth factor activity in plasma and progression (r = 0.42, P < 0.05), as well as severity (r = 0.52, P < 0.01), of global coronary atherosclerosis. Attempts to identify the nature of the total growth factor activity indicated that less than 20% could be attributed to PDGF, the major serum mitogen for SMC. PDGF levels determined by radioimmunoassay were not related to progression or severity of global coronary atherosclerosis, but showed a significant association with the number and severity of distinct stenoses (r = 0.40, P < 0.05). Due to the retrospective design of this study, it is not possible to conclude whether there is a causal relationship between circulating growth factors and development of coronary atherosclerosis.
Occurrence of species of low‐density lipoprotein with defective clearance in patients with primary moderate hypercholesterolaemia
Authors: VEGA G. L. , GRUNDY S. M.
Published: August 2009

Recent studies have shown that one cause of primary moderate hypercholesterolaemia is familial defective apolipoprotein B‐100 (FDB), a condition in which a mutation in apolipoprotein B‐100 (apo B‐100) causes low‐density lipoproteins (LDL) to bind poorly to LDL receptors. One specific mutation, a glutamine‐for‐arginine transformation at position 3500 of apo B‐100, has been reported to produce FDB. However, other mutations in apo B‐100 might also cause FDB. The present study was designed to determine whether some patients with hypercholesterolaemia, who do not have the 3500 defect, may have a slowly cleared subfraction of LDL compatible with other forms of FDB. It was postulated that slowly removed LDL should accumulate excess cholesterol ester and hence be less dense than normal LDL. If so, in patients who are heterozygous for FDB. two forms of LDL might be separable by ultracentrifugation. To test this hypothesis, less‐dense (d = 1.030 g ml−1) and more‐dense (d = 1.040 g ml−1) subfractions of LDL were isolated from a patient with proven FDB (3500 mutation); the two forms of LDL were labelled with different isotopes of radioiodine and re‐injected into the patient. The less‐dense form was removed much more slowly (0.285 pools day−1) than more‐dense LDL (0.570 pools day−1). This finding appeared to confirm the validity of the approach. The same procedure was then applied to 18 other patients having elevated LDL cholesterol but not the 3500 mutation. In 13 patients, the two forms of LDL were removed at essentially identical rates, suggesting that they did not have an abnormal form of LDL. In the other five, less‐dense LDL were removed at a significantly slower rate than more‐dense LDL: this finding suggests that a significant portion of patients with moderate hypercholesterolaemia have an abnormal LDL species, which is not the 3500 mutation, but delays clearance of LDL from the circulation.
Hypercalcemia in Addison's disease: calciotropic hormone profile and bone histology
Authors: MONTOLI A. , COLUSSI G. , MINETTI L.
Published: August 2009

Abstract. Three cases of hypercalcæmia secondary to acute adrenocortical insufficiency are described; all the patients had moderate to severe renal impairment, one being on chronic dialysis treatment with no residual diuresis. Parathyroid hormone (PTH) and 1,25 dihydroxyvitamin D [1,25(OH)2D] were low, indicating a suppressed PTH‐vitamin D axis. In the two patients with partial renal impairment, urine Ca excretion was increased, indicating increased load of the cation into the extracellular fluid (ECF), most probably from bone. Saline infusion, to correct any ECF depletion and to increase urine Ca excretion, could not fully correct the hypercalcæmia. Complete correction of plasma Ca levels was observed shortly after the institution of hormonal substitutive therapy. Despite the evidence of increased Ca mobilization from bone, bone biopsies in two patients did not show any signs of cell‐mediated bone resorption; instead, bone cell activity appeared to be suppressed. Thus, glucocorticoid deficiency appears to induce Ca mobilization from bone stores by mechanism(s) unrelated to bone remodelling processes.
Angina pectoris patients with normal coronary angiograms but abnormal thallium perfusion scan exhibit low myocardial and skeletal muscle energy charge
Authors: WALDENSTRÖM A. , RONQUIST G. , LAGERQVIST B.
Published: August 2009

Abstract. Seven patients with angina pectoris and 201‐thallium scintigraphy indicative of myocardial perfusion defects, but with normal coronary angiograms, were investigated. Metabolic events were studied in biopsies from myocardium and skeletal muscle (m. quadriceps femoris). Profound metabolic derangement was evidenced by a distinctly lowered energy charge in myocardium (0.88 ± 0.04 in controls vs. 0.48 ± 0.09 in patients: P < 0.001) and skeletal muscle (0.92 ± 0.01 in controls vs. 0.70 ± 0.09 in patients: P < 0.01). Accordingly, low values were recorded for ATP in both types of muscle, where ATP was lower than (myocardium) or the same as (skeletal muscle) ADP. The concentration of myocardial lactate was 115 ± 74 μmol g‐1 dry weight and that of skeletal muscle lactate was 11 ± 3 μmol g‐1 dry weight, compared to normal myocardial lactate of 18 ± 10 μmol g‐1 dry weight and normal skeletal muscle lactate of 11 ± 3 μmol g‐1 dry weight. Unprecedentedly low energy charge levels in both cardiac and skeletal muscle biopsies suggest that a systemic metabolic disease is highly probable. An inverse ATP/ADP ratio found in our patients is indicative of an aetiology different from ischaemia, which would not produce this relationship.
Patients at risk for inappropriate antibiotic treatment of bacteraemia
Authors: LEIBOVICI L. , KONISBERGER H. , PITLIK S. D. , SAMRA Z. , DRUCKER M.
Published: August 2009

Abstract. In order to define patients at high risk for inappropriate antibiotic treatment of bacteraemia, we compared 682 bacteraemic patients, treated with an antibiotic drug to which the infecting micro‐organism was susceptible, with 419 patients who were inappropriately treated. On a multivariate logistic regression analysis including only clinical variables, four factors were found to be both significantly and independently associated with inappropriate antibiotic treatment: hospital‐acquired bacteraemia (oddsratio (OR) of 1.9), antibiotic treatment in the month prior to the bacteraemia (OR 1.9), residence in a nursing home (OR 1.8), and the presence of a central line (OR 1.7). A second model, including bacteriological data, showed four micro‐organisms to be independently associated with inappropriate antibiotic treatment: Candida sp. (OR 14.2), Acinetobacter sp. (OR 5.0), Enterococcus sp. (OR 3.6) and Pseudomonas sp. (OR 2.2). In this model, only two clinical features were included: hospital‐acquired infection and previous antibiotic treatment. Special efforts should be made to improve empirical antibiotic treatment in the groups defined above, and to facilitate early laboratory diagnosis of the micro‐organisms associated with inappropriate treatment.
Pseudomonas infections in patients with AIDS and AIDS‐related complex
Authors: Franzetti F. , CERNUSCHI M. , ESPOSITO R. , MORONI M.
Published: August 2009

Abstract. We identified and reviewed retrospectively all the cases of infection by Pseudomonas and related genera in patients with AIDS and AIDS‐related complex (ARC) who were hospitalized at our Institution over a 36‐month period. We recorded 48 episodes of infection in 34 of 355 patients with AIDS, and in two of 73 patients with ARC: 25 pneumonias (9 community‐acquired and 16 of nosocomial origin), 20 urinary tract infections, two soft tissue infections and one sepsis. In 14 of 16 patients with nosocomial pneumonia but in only one of nine patients with community‐acquired pneumonia did we find coexisting opportunistic lung diseases. The following micro‐organisms were isolated: P. aeruginosa in 41 cases. P. fluorescens in three cases. Xanthomonas maltophilia (P. maltophilia) in two cases, P. putida in one case, Comamonas testosteronis (P. testosteronis) and Comamonas acidovorans (P. acidovorans) in one case. Amikacin and ceftazidime, alone or in combination, appear to be the optimal choice of therapy for severe Pseudomonas infections in HIV‐infected patients, although in our study six of 47 isolates were resistant in vitro to amikacin, and nine of 31 isolates were resistant to ceftazidime.
Frontiers in medicine: New aspects of asthma
Authors: BARNES P. J.
Published: August 2009

Abstract.It has now become apparent that asthma, even in its mildest clinical manifestation, is a chronic inflammatory condition of the airways. There have been important advances in understanding the special features of inflammation in asthmatic airways and the role of critical inflammatory cells such as mast cells (important in the acute inflammatory response) and eosinophils, macrophages and T‐lymphocytes (involved in the chronic inflammatory response). Many inflammatory mediators have been implicated in asthma, and the development of mediator antagonists suggests that sulphidopeptide leukotrienes may play an important role in bronchoconstrictor responses. Cytokines released from many different cells in the airways are likely to be important in orchestrating and perpetuating the chronic inflammatory response. Chronic inflammation has effects on airway vessels, mucus secretion, smooth muscle and nerves, with evidence to suggest that there are structural changes which may lead to persistent airway abnormalities. The therapeutic implication of these new discoveries is that much earlier use of anti‐inflammatory treatments (such as inhaled steroids) is preferable to reliance on bronchodilators which do not control the underlying inflammatory process.
Ischaemic heart disease incidence by social class and form of smoking: the Copenhagen Male Study — 17 years' follow‐up
Authors: HEIN H. O. , SUADICANI P. , GYNTELBERG F.
Published: August 2009

Abstract. The Copenhagen Male Study is a prospective, cardiovascular cohort study initiated in 1970 and consisting of 5249 employed men aged 40–59 years. A total of 4710 men, who had reported their smoking habits and were free of ischaemic heart disease, had their mortality recorded over a 17‐year period: 585 men suffered a first incident of ischaemic heart disease (IHD), and 248 cases were fatal. There was a strong social gradient in the risk of IHD (Kendall'l Tau B = 0.12, P < 0.001). Adjusting for age, blood pressure, physical activity, body mass index and alcohol consumption in a multiple logistic regression equation, men in the lowest social class had a relative risk (95% confidence interval) of IHD of 3.6 (2.5‐5.3) compared to men in the highest social class. We determined whether differences in smoking habits could explain at least some of this large increase in risk. Adjustment for the above factors and also inclusion of the form of tobacco smoked, the amount of tobacco smoked and presence or absence of inhalation, had very little effect on the estimate: the relative risk was 3.5 (2.4–5.2). There was no social gradient in age at the start of smoking. According to smoking habits, comparing social class V with social class I, the relative risk was 7.7 (2.6–22.4) in cigarette smokers, 6.0 (1.1–32.1) in pipe smokers, 3.5 (1.7‐7.1) in mixed smokers, 2.25 (0.4–12.9) in cheroot smokers, 3.8 (2.4–5.9) in all smokers, 1.95 (0.8‐4.6) in ex‐smokers, and 4.7 (1.01–22.2) in non‐smokers. In the upper social classes, 50–75% of IHD events could be ascribed to smoking, and in the lowest classes only about 20%. We conclude that the substantial social inequalities in risk of ischaemic heart disease are not accounted for by differences in smoking habits.
Changes in left ventricular dimensions and systolic function in 100 mildly hypertensive men during one year'r treatment with atenolol vs. hydrochlorothiazide and amiloride (Moduretic): a double‐blind, randomized study
Authors: OTTERSTAD J. E. , FROELAND G. , SOEYLAND A. K. WASENIUS , KNUTSEN K. M. , EKELI T.
Published: August 2009

Abstract. In a randomized double‐blind study to compare the effect of atenolol vs. hydrochlorothiazide and amiloride (Moduretic) on left ventricular dimensions and systolic function, 100 hypertensive men were followed up during 1 year of treatment, 50 subjects being randomized to each drug. Echocardiography was performed at baseline, and after 3 and 12 months of treatment. A significant reduction in left ventricular mass with atenolol was paralleled by a decrease in left ventricular wall thickness and an increase in stroke volume. A similar reduction of left ventricular mass with Moduretic without a change in relative wall thickness and a decrease in stroke volume was observed. Cardiac output decreased in both groups.