bluuebunny/crossref_metadata_2025 huggingface dataset:
Metabolic disturbances in hypertension: results from the population study ‘ Men born in 1913’
Authors: ERIKSSON H. , WELIN L. , WILHELMSEN L. , LARSSON B. , OHLSON L.‐O. , SVÄRDSUDD K. , TIBBLIN G.
Published: August 2009

A clustering of metabolic disturbances has been indicated in hypertension. The distribution of such factors was assessed among hypertensives and normotensives in a general population sample of 644 men aged 67 years. Fasting serum insulin, glucose and triglyceride levels were measured. In this study hypertension was defined as DBP ≥ 95 mmHg or present use of antihypertensives. Impaired glucose tolerance (IGT) or diabetes mellitus, hyperinsulinaemia (≥ 20 mU l−1) and hypertriglyceridaemia (≥ 2.3 mmol l−1) were defined as metabolic disturbances. When all these disturbances were present simultaneously a complete ‘metabolic syndrome’ was considered to be present. Hypertension was found in 185 (29%) men, IGT in 15%, diabetes mellitus in 11%, hyperinsulinaemia in 18% and hypertriglyceridaemia in 19%. Among hypertensives, 11 (6%) men had a ‘metabolic syndrome’, compared to 12 (3%) men in the normotensive group (P = 0.039). At least one metabolic disturbance was present in 109 (59%) of the hypertensive men, and in 173 (38%) of the normotensive men (P < 0.001). The prevalence rates of metabolic disturbances did not differ significantly between lean (BMI < 26 kg m−2) and obese (BMI ≥ 26 kg m−2) hypertensives. Only hypertriglyceridaemia was more frequent in obese than in lean hypertensives (20% vs. 37%, P = 0.015). The ‘metabolic syndrome’ was found in 6% of all hypertensives, which was twice as common as in the normotensive population. The ‘metabolic syndrome’ was uncommon in both lean and obese hypertensives (5% vs. 7%, NS). These findings indicate that hypertension and metabolic disturbances may have a common underlying cause, at least in some individuals.
The relationship between the transfer factor obtained at rest, and arterial oxygen tension during exercise, in patients with miscellaneous pulmonary diseases
Authors: ANDERSEN S. J. , ARVIDSSON U. , FRANSSON L. , NEMCEK K. , SVENSSON S.‐E.
Published: August 2009

Forty‐one consecutive patients with the symptom ‘exertional dyspnoea’ were referred to the Department of Clinical Physiology for evaluation. Pulmonary fibrosis and chronic obstructive pulmonary disease were the most common diagnoses but other diagnoses were also represented. Some patients had no clinical diagnosis or radiological signs. All patients underwent exercise testing with sampling of arterial blood for blood gas analysis and pulmonary function testing including measurement of the transfer factor (carbon monoxide diffusing capacity) at rest. Independent of spirometric findings and diagnosis a significant correlation (r = 0.80. P < 0.001) was shown to exist between the transfer factor measured at rest and the arterial oxygen tension at maximal exercise level. We recommend measurement of the transfer factor as a screening test for exertional hypoxaemia and suggest that exercise blood gas analysis only seems necessary in patients with a transfer factor between 55% and 80% of the predicted value.
Amylase‐producing IgD‐type multiple myeloma
Authors: DELANNOY A. , HAMELS J. , MECUCCI C. , FALLY P. , WALLEF G. , de FOOZ C. , CARLIER B.
Published: August 2009

We describe the case of a 63‐year‐old woman with an IgD‐type multiple myeloma and hyperamylasaemia. The evolution of the amylase concentration, the immunohistochemical data and the intracellular amylase contents of the plasma cell were consistent with secretion of amylase by the malignant clone. Moreover, cytogenetic analysis of the bone marrow revealed two structural rearrangements involving chromosome 1 near the amylase locus. Multiple myeloma should be added to the amylase‐secreting tumours. This rare entity is not confined to Japan, where it was first recognized.
Physical fitness or physical activity as a predictor of ischaemic heart disease? A 17‐year follow‐up in the Copenhagen Male Study
Authors: HEIN H. O. , SUADICANI P. , GYNTELBERG F.
Published: August 2009

Abstract. Physical fitness and leisure time physical activity are strongly correlated, and both are inversely correlated with risk of ischaemic heart disease. Does this mean, however, that a very fit man has a lower risk of ischaemic heart disease (IHD), even if he is inactive? And does it also mean that an unfit, but active man, does not have a lower risk of IHD than an unfit, inactive man? In the Copenhagen Male Study, we analysed the joint effect of fitness and leisure time activity. In 1970/71, 4999 men aged 40–59 years, were classified according to level of physical fitness, i.e. indirectly measured maximal oxygen uptake, and physical activity, and their mortality was recorded over the following 17 years. In sedentary men, fitness was no predictor of future risk of IHD whatsoever. Age‐adjusted baseline values were similar in later IHD cases and survivors (32.3 and 32.1 ml O2 kg−1 min−1, respectively; P = 0.91). In medium or highly active men, however, fitness was a strong predictor. The corresponding fitness values were 33.1 and 34.8 ml O2 kg−1 min−1 (P < 0.001). The least fit (two least fit quintiles) physically active men had a lower IHD mortality rate (6%) than the least fit sedentary men (10%). Adjusted for age, social class and smoking in a multiple logistic regression equation, this was estimated to an RR (95% C.I.) of 1.67 (1.06‐2.64) (P = 0.027). The two major new findings of this study were (a) that being very fit, provides no protection against IHD—nor all‐cause mortality—in sedentary men, and (b) that unfit but sedentary men have a higher risk of IHD than unfit but active men, i.e. those performing light physical activity for at least 4 h per week.
The prevalence of hypertrophic cardiomyopathy in men: an echocardiographic population screening study with a review of death records
Authors: AGNARSSON U. T. , HARDARSON T. , HALLGRIMSSON J. , SIGFUSSON N.
Published: August 2009

Abstract. The purpose of this study was to estimate the prevalence of hypertrophic cardiomyopathy (HCM) in 3607 men from the Reykjavik study of 1979‐81. Of these, 452 men had an abnormal (group A) and 3155 a normal electrocardiogram. An echocardiographic control group of 128 men was selected from cohorts with a normal electrocardiogram (group B). Until 1987, 189 deaths had occurred, 59 from group A and 130 from cohorts with a normal ECG including 4 from group B. To identify subjects with HCM, survivors of groups A and B were examined by echocardiography and by review of all autopsy data and death certificates. HCM was found in 14 subjects from group A but none in group B. Two additional cases were found at autopsy in cohorts with a normal ECG.

The prevalence of HCM in men with an abnormal and normal ECG was 3.6% and 0.8%, respectively. The overall prevalence was calculated to be 1.1% with a 95% confidence interval of 0.3‐3.2%. Men with HCM reported more symptoms than others in groups A and B (P < 0.05‐0.001), 25% were without symptoms. Asymptomatic ventricular arrhythmias were detected by Holter monitoring in 45% of men with HCM. The total annual mortality was 1.6% compared with 0.5% in the group with a normal ECG (P < 0.001).
Does exercise‐induced ST‐segment depression predict benefit of medical intervention in patients recovering from acute myocardial infarction?
Authors: JESPERSEN C. M. , HAGERUP L. , HOLLÄNDER N. , HVEN P. E. , LAUNBJERG J. , LINDE N. C. , NIELSEN J. , STEINMETZ E. ,   THE DANISH STUDY GROUP ON VERAPAMIL IN MYOCARDIAL INFARCTION.
Published: August 2009

Abstract. The present study tested the hypothesis that the increased risk in patients with exercise‐provoked ST‐segment depression recovering from acute myocardial infarction could by abolished by anti‐ischaemic medical intervention. Prior to discharge a symptom‐limited exercise test was carried out. Patients were then double‐blindly randomized to treatment with either verapamil 120 mg t.i.d. or placebo, and observed for up to 18 months (mean 17 months). End‐point was first major event: i.e. non‐fatal reinfarction or death. Two‐hundred‐and‐ninety‐eight patients were included. Forty‐four patients with and 111 without exercise‐induced ischaemia were randomized to verapamil and 39 and 104 respectively, to placebo. The overall number of events was 12.5%. In patients without ST‐segment depression, 12.5% in the placebo group (hazard = 1) and 12.6 % in the verapamil group (hazard = 1.13) had an event (NS). In patients with ST‐segment depression 15.4% in the placebo group (hazard = 1.20) and 9.1% in the verapamil group (hazard = 0.85) had an event (NS). The latter reduction (41%) supports the hypothesis that patients with ST‐segment depression, i.e. residual myocardial ischaemia, are those who benefit from anti‐ischaemic intervention after myocardial infarction.
Design and feasibility
Authors: BERGLUND G. , ELMSTÅHL S. , JANZON L. , LARSSON S. A.
Published: August 2009

Abstract. The Malmö Diet and Cancer study is a 10‐year prospective case‐control study in 45–64‐year‐old men and women (n = 53.000) living in a city with 230000 inhabitants. One objective is to clarify whether a western diet is associated with certain forms of cancer whilst taking other life‐style factors into account. Another broad question is whether oxidative stress and the activity in DNA‐repairing systems influence the impact of diet on the development of all or certain forms of cancer. The study is also to act as a resource available for testing new hypotheses emanating from other studies.

Initially food intake, heredity, socio‐economic factors, life‐style pattern, occupational situation, previous and current diseases, symptoms and medications, will be determined. Viable lymphocytes, granulocytes, erythrocytes, and plasma/serum will be stored in a biological bank together with tumour specimens gathered from cases. The incidence and mortality of all cancer forms will then be followed for 10 years by existing registries. Data from the initial examination in these cases will then be compared with those of control subjects not having developed any form of cancer. A biomarker programme, utilizing the biological bank, has been developed and is aimed at finding predictors and/or precursors of cancer. A high participation rate (> 70%) and a high quality biological bank are prerequisites for a successful project. The experience gathered so far indicates that these goals are feasible.
The Malmö biological bank
Authors: PERO R. W. , OLSSON A. , BERGLUND G. , JANZON L. , LARSSON S. A. , ELMSTÅHL S.
Published: August 2009

Abstract. Currently there are no available biological markers that have been satisfactorily validated clinically as ‘intermediate end‐points’ for evaluation of the impact of diet on cancer. Therefore, there is high scientific value in banking biological specimens for future use in the Malmö Diet and Cancer Study. The banking procedures we have developed are adequate for assessing factors that estimate dietary intake (e.g. vitamins, lipids or micronutrients) as well as non‐dietary variables (e.g. immunologic and ecogenetic factors of biologically effective doses of xenobiotic exposures) that may regulate the biological expression of dietary variables. This approach is further justified by state‐of‐the‐art technology that includes assessment of the concept of gene‐environment interactions. Purified viable mononuclear leucocytes, granulocytes, erythrocytes, plasma and serum are being stored from each individual entering the study under the guidelines of a strict quality control programme. Storage of tumour/normal tissues from incident cancer cases are also being stored and quality controlled. It is hoped that these banking procedures will encourage a high activity in biomarker development in the future.
Syndrome of inappropriate antidiuretic hormone secretion (SIADH) and enalapril
Authors: CASTRILLÓN J. L. P. , MEDIAVILLA A. , MÉNDEZ M. A. , CAVADA E. , CARRASCOSA M. , VALLE R.
Published: August 2009

Abstract. A 69‐year‐old woman with a history of diabetes and hypertension, was referred to the Hospital of Laredo because of hyponatraemia. She had weakness and slight dyspnoea with no evidence of extracellular fluid volume depletion or oedema. Serum sodium level on admission was 125 mol l−1, plasma osmolality 270 mosmol kg−1, simultaneous urine osmolality was 580 mosmol kg−1 and urine sodium 32.6 mmol l−1. She had been treated with enalapril (20 mg) daily for 4 months. She was diagnosed with the Syndrome of inappropriate secretion of antidiuretic hormone (SIADH) that was reversed after cessation of treatment with enalapril and reappeared on reintroduction of the drug at the same daily doses.
Day and night variation in ambulatory blood pressure in type 1 diabetes mellitus with nephropathy and autonomic neuropathy
Authors: TORFFVIT O. , AGARDH C.‐D.
Published: August 2009

Abstract. The objective was to study ambulatory blood pressure and heart rate variability between day and night in patients with type 1 (insulin‐dependent) diabetes mellitus with different degrees of diabetic nephropathy, and to evaluate the influence of autonomic neuropathy and type of antihypertensive treatment.

Twenty type 1 diabetic patients with diabetic nephropathy and antihypertensive treatment were studied with 24‐h ambulatory blood pressure monitoring using an oscillometric method. They were compared with eight insulin‐treated diabetic patients with short duration of diabetes (1–5 years) and with 10 apparently healthy subjects. The degree of autonomic neuropathy was evaluated by measuring the RR‐interval during deep breathing and uprising.

The 24‐h blood pressure was generally higher in patients with diabetic nephropathy compared to those other two groups. These patients also had a lower ratio between day and night in diastolic blood pressure compared to the control subjects (1.15 ± 0.12 vs. 1.25 ± 0.76, P < 0.05) and heart rate compared to the diabetic patients without nephropathy, as well as the control subjects (1.15 ± 0.08 vs. 1.26 ± 0.09 vs. 1.27 ± 0.08, P < 0.01, respectively). All patients with diabetic nephropathy had clinical signs of autonomic neuropathy as judged by RR‐interval measurements during deep breathing and uprising.
Stroke morbidity in patients treated for hypertension—The Skaraborg Hypertension Project
Authors: LINDBLAD U. , RÅSTAM L. , RANSTAM J.
Published: August 2009

Abstract.Stroke incidence was analysed in a Swedish cohort of male (n = 1428) and female (n= 1812) hypertensive patients in comparison with age‐ and sex‐matched population controls (1:1) and with normotensive untreated subjects (1249 men and 1247 women). Mean follow‐up was 8.3 years. Patients were aged 40–69 at the start of follow‐up in 1977–1981. Relative risks (95% confidence interval [CI]) for stroke morbidity were 1.63 (1.16, 2.29) for men and 1.40 (0.94, 2.09) for women compared to population controls. Corresponding figures for stroke mortality were 1.96 (1.01–3.82) and 1.48 (0.71–3.06). Compared to the normotensive sample with adjustment for smoking and body mass index relative risks for stroke morbidity were 3.07 (1.96–4.80) for men and 2.56 (1.46–4.51) for women. The prognosis of treated hypertension with respect to stroke is better than anticipated from previous studies, a fact that should be considered when treatment guidelines are developed.
Sixteen years of plasma exchange in a homozygote for familial hypercholesterolaemia
Authors: LEREN T. P. , FAGERHOL M. K. , LEREN P.
Published: August 2009

Abstract. This report describes 16 years of plasma exchange in a female familial hypercholesterolaemia homozygote. During childhood she had values for total serum cholesterol of 25–30 mmol l−1. She developed tendon and skin xanthomas before the age of 12 months. Because her total serum cholesterol level was not satisfactorily changed by lipid lowering drugs, plasma exchange was started in 1976. Since then she has had plasma exchange every 3 weeks. She has now reached the age of 42. Her pre‐exchange values for serum cholesterol have been 11.1 mmol l−1 (6.79–28.8), while her post‐exchange values have been 4.17 mmol l−1 (1.65–10.47). There has been a considerable regression of her xanthomas, and her xanthelasmas have disappeared. No side‐effects have been observed during the 16 years of plasma exchange.
Hypercalcaemia and elevated levels of parathyroid hormone‐related protein in cutaneous squamous/basal cell carcinoma
Authors: MARINO M. T. , ASP A. A. , BUDAYER A. A. , MARSDEN J. S. , STREWLER G.J.
Published: August 2009

Abstract. A patient with mixed squamous/basal cell carcinoma of the skin presented with hypercalcaemia and elevated serum levels of parathyroid hormone‐related protein (PTH‐rP). The tumour was resected, PTH‐rP levels declined and the patient became normocalcaemic. This is the first case to associate squamous cell carcinoma of the skin with hypercalcaemia and significant levels of PTH‐rP.
Determination of urinary N‐acetyl‐beta‐glucosaminidase in patients with hypertension and renal artery stenosis
Authors: STERNER G. , WEIBULL H. , HULTBERG B. , BERGQVIST D. , HULTHÉN L. , ISAKSSON A. , MANHEM P.
Published: August 2009

Abstract. The purpose of the study was to measure the urinary excretion of N‐acetyl‐beta‐glucosaminidase (U‐NAG) in patients suspected of having renovascular hypertension and to compare the enzyme excretion before and after active intervention with operation or percutaneous transluminal renal angioplasty (PTRA).

Eighty‐one patients with severe, therapy‐resistant hypertension were examined with regard to renal artery stenosis (RAS). At least one significant renal artery stenosis was found in 61 patients, whilst the remaining 20 patients were classified as having essential hypertension.

Enzyme levels were found to be significantly higher in RAS patients as compared with patients with severe hypertension lacking significant renal artery stenosis, 0.66 (0.41–0.91, median value, 1st and 3rd quartiles) versus 0.35 (0.27–0.54); P < 0.01. Both groups of patients had significantly higher U‐NAG values than a healthy reference population (0.2, 0.13–0.27; P < 0.01). Forty of the RAS patients were randomized to surgery or PTRA and followed prospectively for 2 years. After either renal vascular surgery or PTRA a significant rise in U‐NAG excretion was observed 7–10 days after treatment. Urinary NAG excretion remained elevated during long‐term follow‐up. It is suggested that U‐NAG should be determined in patients with therapy‐resistant hypertension with suspicion of renal artery stenosis.
Sonography of the achilles tendon in hypercholesterolaemia
Authors: KOIVUNEN‐NIEMELÄ T. , ALANEN A. , VIIKARI J.
Published: August 2009

Abstract. Objectives. Tendon xanthomas cause thickening of the tendon and are an important sign in monogenic familial hypercholesterolaemia (FH). The aim of our study was to investigate the usefulness of achilles tendon sonography in detecting FH patients. Special attention was paid to structural abnormalities of the achilles tendon.

Design. A clinical study with methodological testing.

Setting. Patients suspected of having FH were sent to the out‐patient Department of Medicine from other departments of Turku University Central Hospital and from primary care units. The patients were studied by high‐frequency ultrasound before more exact typing of the lipid disorder. An additional study of normolipidaemic volunteers and a phantom study were also carried out.

Subjects. Forty FH patients, 51 non‐FH hypercholesterolaemia patients and 41 normolipidaemic volunteers were included in the study.

Main outcome of measures. The thickness of the tendon was measured and the tendon structure and its echogenicity were recorded.

Results. Twenty‐five out of 40 (63%) FH patients had distinctly thickened tendons (men more than 10 mm, women more than 9 mm). Thirty‐six (90%) had a typical structural alteration of low or mixed echogenicity of the tendon. Three non‐FH patients were found to have xanthomas on sonography.

Conclusions. We conclude that ultrasonography is a sensitive method of detecting xanothomas that reveals the altered tendon structure even in xanthomatous tendons of normal thickness.
Behaviour therapy versus doctor's anti‐smoking advice in diabetic patients
Authors: SAWICKI P. T. , DIDJURGEIT U. , MÜHLHAUSER I. , BERGER M.
Published: August 2009

Abstract. Objectives. To evaluate the efficacy of a structured behaviour therapy programme on smoking cessation in diabetic patients.

Design. Prospective, randomized, controlled intervention study.

Setting. University out‐patient diabetes clinic.

Subjects. A total of 794 consecutive insulin‐treated smoking diabetic patients were invited to participate in a smoking cessation programme. Eighty‐nine patients agreed to participate and were randomized in two groups.

Interventions. Forty‐four patients were randomized to a structured extensive behaviour therapy anti‐smoking intervention and 45 patients to a control group that received a single unstructured anti‐smoking advice session given by a physician.

Main outcome measures. After 6 months, nine patients were confirmed not to be smoking (i.e. urine cotinine concentration below 20 ng ml−1, 2 [5%] in the behaviour therapy intervention group and 7 [16%] in the control group.

Conclusions. In diabetic patients an extensive behaviour therapy intervention for smoking cessation is no more successful than an unstructured physician's advice.
Effects of transdermal 17β‐oestradiol combined with oral progestogen on lipids and lipoproteins in hypercholesterolaemic postmenopausal women
Authors: SLOWIÑSKA‐SRZEDNICKA J. , ZGLICZYÑSKI S. , CHOTKOWSKA E. , SRZEDNICKI M. , STOPIÑSKA‐GLUSZAK U. , JESKE W. , BRZEZIÑSKA A. , ZGLICZYÑSKI W. , ADOWSKI Z. S.
Published: August 2009

Abstract. Objectives. The purpose of the study was to evaluate the effect of transdermal 17β‐oestradiol with oral progestogen on the plasma levels of lipids, lipoproteins and apolipoproteins in hypercholesterolaemic postmenopausal women.

Design. During 6 months of replacement therapy with transdermal 17β‐oestradiol combined with oral progestogen, plasma lipids, lipoproteins and apolipoproteins after 3 and 6 months were measured and compared with pretreatment values by Student's t‐test.

Setting. From January 1992 until September 1992 patients were diagnosed and treated in an outpatient clinic of the Department of Endocrinology Medical Centre for Postgraduate Education, Warsaw.

Subjects. The patients studied were 11 non‐obese postmenopausal women with hypercholesterolaemia based on the World Health Organization criteria.

Interventions. Venous blood samples were obtained before and 3 and 6 months after the beginning of cyclic replacement therapy with transdermal 17β‐oestradiol (E2 100 μg day−1 combined with oral chlormadinone acetate (2 mg day−1 for 7 days in each cycle).

Main outcome measures. The antiatherogenic effect of transdermal oestrogen replacement therapy exerted by increased levels of high‐density lipoprotein sub‐fraction 2 cholesterol (HDL2‐C) leading to the decrease of the total cholesterol level was anticipated.

Results. After 6 months of the treatment the concentrations of HDL2 cholesterol (HDL2‐C) increased from 0.45 ± 0.07 mmol l−1 to 0.73 ± 0.03 mol l−1 (P < 0.05) but the levels of HDL3 cholesterol (HDL3‐C) decreased from 1.15 ± 0.06 mmol l−1 to 0.89 ± 0.07 mmol l−1 (P < 0.05). The concentrations of total cholesterol decreased from 6.9 ± 0.13 mmol l−1 to 6.2 ± 0.2 mmol l−1 (P < 0.05). No changes were observed in the plasma levels of total triglycerides, HDL cholesterol, low‐density lipoprotein (LDL) cholesterol, very‐low‐density lipoprotein (VLDL) cholesterol, VLDL triglycerides, apolipoproteins A‐I and B.

Conclusions. In hypercholesterolaemic postmenopausal women, transdermally administered 17β‐oestradiol 100 μg daily in combination with oral chlormadinone acetate has a beneficial effect through raising the level of the antiatherogenic HDL2‐C subfraction and decreasing the level of total cholesterol.
Altered adrenocorticotropin and Cortisol secretion in abdominal obesity: implications for the insulin resistance syndrome
Authors: HAUTANEN A. , ADLERCREUTZ H.
Published: August 2009

Abstract. Objectives. To investigate the relationship between the pituitary‐adrenocortical function, abdominal obesity, and insulin resistance syndrome.

Design. A prospective study.

Setting. Helsinki University Hospital, Finland.

Subjects. Sixty‐six healthy males aged 30–55 years.

Main outcome measures. Insulin, C‐peptide, Cortisol and ACTH responses during the oral glucose tolerance test (OGTT), and the Cortisol response to dexamethasone suppression and intravenous adreno‐corticotrophic hormone (ACTH) stimulation.

Results. The subjects in the highest tertile of the waist‐to‐hip ratio (WHR) had lower high‐density lipoprotein cholesterol (HDLC) (P < 0.05), but higher triglyceride (TG), insulin, and C‐peptide levels, ACTH response to glucose at 2 h, and Cortisol response to ACTH (P < 0.01) than those in the lowest tertile. The Cortisol response to ACTH correlated positively, but Cortisol levels during the OGTT correlated negatively with WHR. The ratio of these Cortisol determinations correlated positively with the body‐mass index (BMI) (r = 0.554; P < 0.001), WHR (r = 0.536; P < 0.001), TG (r = 0.397; P = 0.001), fasting insulin (r = 0.534; P < 0.001) and C‐peptide (r = 0.458; P < 0.001), and negatively with HDLC (r = 0.353; P = 0.004). In multiple regression analyses, BMI and the 2‐h ACTH response to glucose were significant predictors of WHR and, in addition, the Cortisol ratio, WHR, and BMI of insulin.

Conclusions. Abdominal obesity may be associated with subtle central adrenal insufficiency, which might also affect insulin and lipoprotein metabolism.
Complete membranous obstruction of the inferior vena cava: clinical characteristics of Chinese patients
Authors: CHAN P. , LEE C. P. , YANG C. Y. , HUNG J. S.
Published: August 2009

Abstract. Objectives. To analyse the clinical presentations of membranous‐type Budd‐Chiari syndrome and the long‐term outcome of balloon angioplasty.

Design. A case‐control study. Patients who received abdominal sonography and were suspected of having hepatic venous outflow obstruction were advised to receive cardiac catheterization and angiography.

Setting. Patients were collected from Chung Hisao Hospital and Chang Gung Medical Centre. Angioplasty was done at Chang Gung Medical Centre.

Subjects. Seventeen patients who had the symptoms and signs of portal hypertension were suspected of having hepatic venous outflow obstruction after abdominal sonography and a radionuclide liver scan and eight of them were confirmed as having membranous‐type obstruction.

Interventions. Simultaneous catherization and contrast angiography was performed via the right brachial and femoral veins. Angioplasty was performed afterwards.

Main outcome measures. The remission of clinical symptoms and signs and a decrease of the pressure gradient between the right atrium and inferior vena cava were used as indicators of successful intervention.

Results. All patients had remarkable remission of symptoms and signs. The average pressure gradient between right atrium and inferior vena cava dropped from 16.5 ± 1.6 to 6.5 ± 1 mmHg (mean ± su).

Conclusion. The clinical presentations of membranous‐type Budd‐Chiari syndrome are somewhat different from hepatic vein occlusion. Balloon angioplasty may be a modality for curing this disease. A larger patient population is necessary to confirm this study.
Distinguishing acyclovir neurotoxicity from encephalomyelitis
Authors: RASHIQ S. , BRIEWA L. , MOONEY M. , GIANCARLO T. , KHATIB R. , WILSON F. M.
Published: August 2009

Abstract. Objectives. To define the clinical characteristics of acyclovir neurotoxicity and to outline how to distinguish it from viral encephalitis.

Design. Case series of acyclovir neurotoxicity.

Setting. All cases reported in Index Medicus or in bibliographic reviews of acyclovir neurotoxicity plus two representative studies of Varicella zoster and Herpes simplex virus encephalitis.

Subjects. Thirty‐five patients who developed neuropsychiatry symptoms during acyclovir therapy.

Interventions. Analysis of the patients' demographics, risk factors, acyclovir dosages and duration, clinical and laboratory findings and outcome.

Main outcome measures. All clinical and laboratory findings that were statistically significantly different from viral encephalitis.

Results. The median age was 53.3 years. The most common predisposing factors were the use of other potentially neurotoxic medications (17 cases) and acute or chronic renal failure (15 cases). Acyclovir levels were frequently found above the therapeutic range. The characteristic manifestations were confusion (15 cases), hallucination or delirium (9 cases), agitation (8 cases) and lethargy (10 cases). Few patients had associated tremors (11 cases). Fever, headache, seizures and focal neurologic findings were distinctly rare. Cerebrospinal fluid and computed tomography were normal except in patients with other central nervous system disorders. Symptoms appeared within 2 days of therapy in the majority and resolved completely within several days of discontinuing acyclovir.

Conclusions. Acyclovir neurotoxicity is a self‐limiting, dose‐dependent phenomenon which is more common in the elderly, in patients with renal failure or in association with other neurotoxic medications. It is distinguished from viral encephalitis by its sudden onset, absence of fever or headache, lack of focal neurologic findings and normal cerebrospinal fluid.
Recombinant human granulocyte colony‐stimulating factor (rhG‐CSF; filgrastim) treatment of clozapine‐induced agranulocytosis
Authors: NIELSEN H.
Published: August 2009

Abstract. After 10 weeks of treatment with clozapine, severe agranulocytosis was diagnosed in a 33‐year‐old female. The patient was treated with filgrastim (granulocyte colony‐stimulating factor [G‐CSF]) 5 μg kg−1 day−1. The neutrophil count was 0.234 × 109 l−1 on admission, with a further decrease the next day to < 0.050 × 109 l−1, and this complete agranulocytosis continued for 10 days. As no response was obtained after 1 week the dosage of filgrastim was increased to 10 μg kg−1 day−1 with immediate improvement. A rapid and pronounced leucocytosis developed with maximal value of neutrophil granulocytes (including immature forms) of 33.108 × 109 l−1 on day 12 after admission. The patient only had minor infectious complications during the neutropenic period. In conclusion, early treatment with filgrastim seems warranted in severe cases of clozapine‐induced agranulocytosis. A dosage of 10 μg kg−1 day−1 can be recommended.
Apparent absence of stroke and ischaemic heart disease in a traditional Melanesian island: a clinical study in Kitava
Authors: LINDEBERG S. , LUNDH B.
Published: August 2009

Abstract. On the island of Kitava, Trobriand Islands, Papua New Guinea, a subsistence lifestyle, uninfluenced by western dietary habits, is still maintained. Tubers, fruit, fish and coconut are dietary staples. Of the total population, 1816 subjects were estimated to be older than 3 years and 125 to be 60–96 years old. The frequencies of spontaneous sudden death, exertion‐related chest pain, hemiparesis, aphasia and sudden imbalance were assessed by semi‐structured interviews in 213 adults aged 20–96. Resting electrocardiograms (ECG's) were recorded in 119 males and 52 females. No case corresponding to stroke, sudden death or angina pectoris was described by the interviewed subjects. Minnesota Code (MC) items 1–5 occurred in 14 ECG's with no significant relation to age, gender or smoking. ST items (MC 4.2 and 4.3) were found in two females and Q items (MC 1.1.2, 1.3.2 and 1.3.3) in three males. Stroke and ischaemic heart disease appear to be absent in this population.
Porphyric neuropathy: prevention of progression using haeme‐arginate
Authors: Muthane Uday B. , VENGAMMA B. , BHARATHI K. C. , MAMATHA P.
Published: August 2009

Abstract. We report on a patient with acute intermittent porphyria (AIP) who, during treatment with hypertonic glucose, developed peripheral neuropathy. Once haeme‐arginate was started, the progression of the neuropathy was attenuated. This suggests that hypertonic glucose may be inadequate in preventing the development of neuropathy in a patient with porphyria. However, haeme‐arginate, if started early, can attenuate the progression of porphyric neuropathy.
The Helsinki Heart Study: coronary heart disease incidence during an extended follow‐up
Authors: Heinonen O. P. , Huttunen J. K. , Manninen V. , Mänttäri M. , Koskinen P. , Tenkanen L. , Frick M. H.
Published: August 2009

Abstract. Objectives. To confirm that coronary heart disease (CHD) can be prevented by gemfibrozil treatment and to estimate the long‐term effect of the treatment.

Design. All participants of the Helsinki Heart Study, a controlled 5‐year CHD primary prevention trial with gemfibrozil and placebo, were offered gemfibrozil treatment and biannual follow‐up for 3.5 more years.

Setting. By the end of the multi‐clinic double‐blind trial, a 34% difference in definite cardiac events (56 vs. 84; P < 0.2) had developed between the gemfibrozil and placebo groups.

Subjects. There were 2046 dyslipidaemic men in the gemfibrozil group at randomization, 1961 started the extended follow‐up; the comparison group comprised 2035 men, and 5 years later 1928 men.

Interventions. Gemfibrozil was selected by 66.3% of gemfibrozil and 68.5% of placebo men without previous CHD end‐points.

Main outcome measures. Definite fatal and non‐fatal CHD events are reported, possible CHD events were recorded but reported selectively.

Results. During the post‐trial period the numbers of definite CHD events in both groups (54 vs. 47; NS) were smaller than expected without treatment, namely a reduction of around 40% for the original treatment groups. The mean incidence rates were in fact similar to that in the placebo group 5 years earlier. The post‐trial CHD incidence was lowest amongst the placebo group men who later selected gemfibrozil. Cardiovascular mortality over the entire study period was similar but all‐cause mortality was slightly higher amongst men of the original gemfibrozil group compared to the placebo group men (P = 0.19).

Conclusions. Thus prolonged gemfibrozil treatment postpones cardiac events. This protective effect presumably involves both attenuation of atherosclerosis and mechanisms related to acute cardiac events.
Tissue plasminogen activator for hepatic vein thrombosis in paroxysmal nocturnal haemoglobinuria
Authors: McMullin M. F. , Hillmen P. , Jackson J. , Ganly P. , Luzzatto L.
Published: August 2009

Abstract. Paroxysmal nocturnal haemoglobinuria (PNH) is an acquired clonal disorder thought to arise in a multipotent haemopoietic stem cell. A distinct clinical feature is a tendency to thrombosis, with a particular predilection for the hepatic veins (Budd‐Chiari syndrome).

We report here on two patients with PNH who developed hepatic vein thrombosis (HVT) and who were treated with tissue plasminogen activator (t‐PA). Both patients had a marked clinical and radiological improvement following the t‐PA treatment and remain well over 2 years and 6 years after the treatment. This method of thrombolysis for HVT occurring in PNH has only been reported in two previous patients with limited follow‐up. We suggest that this therapy is a useful first‐line treatment for PNH patients who develop HVT.
Haematocrit, hypertension and risk of stroke
Authors: Wannamethee G. , Perry I. J. , Shaper A. G.
Published: August 2009

Abstract. Objectives. To assess the relationship between haematocrit and risk of stroke.

Design. Prospective study of a cohort of men followed up for 9.5 years.

Setting. General practices in 24 towns in England, Scotland and Wales (British Regional Heart Study).

Subjects. A total of 7735 men aged 40–59 years at screening, selected at random from one general practice in each of 24 towns.

Main outcome measures. Fatal and non‐fatal strokes.

Results. During a follow‐up period of 9.5 years for all men there were 123 stroke events (33 fatal) in the 7346 men in whom the haematocrit level had been determined. In the cohort as a whole, risk of stroke was significantly raised at haematocrit levels ≥ 51% (relative risk [RR] = 2.5; 95% confidence intervals [CI] 1.2–5.0) after adjustment for age, social class, smoking, body mass index, physical activity, presence of diabetes and pre‐existing ischaemic heart disease. Further adjustment for systolic blood pressure did not attenuate this association (RR = 2.4; 95% CI 1.2–4.9). A raised haematocrit was associated with an increase of stroke only in men with hypertension (systolic blood pressure ≥ 160 mmHg or diastolic blood pressure ≥ 90 mmHg or on regular antihypertensive treatment). No increased risk of stroke was seen at the higher haematocrit level (≥ 51%) in normotensive men. At haematocrit levels below 51%, hypertension was associated with a three‐fold increase in risk of stroke compared with normotension (RR = 3.4, 95% CI 2.3, 5.1). At haematocrit levels 51%, hypertension was associated with a nine‐fold increase in risk of stroke compared with normotension (RR = 9.3; 95% CI 4.2, 21.0). Exclusion of men receiving regular antihypertensive therapy did not alter the strong associations seen.

Conclusion. The data suggest that an elevated haematocrit is an independent risk factor for stroke and that it interacts synergistically with elevated blood pressure.
Sarcoidosis and agnogenic myeloid metaplasia
Authors: Reich J. M.
Published: August 2009

Abstract. Agnogenic myeloid metaplasia (AMM) was recognized 3 years after a diagnosis of sarcoidosis in a 45‐year‐old man. This is the second reported instance of that association, and the 15th reported case in which systemic granulomata have been associated with a myeloproliferative disorder (MPD). In the client population at risk, this connection would be expected to occur by chance once in 1700 years. Therefore, it is unlikely that the association is fortuitous.

Systemic granulomata may represent an immunologic response to antigens of neoplastic origin in MPD
Carcinoma of the pituitary in association with pulmonary stenosis and microcephaly
Authors: Saadeh I. K. , Houlston R. S. , Ellison D. W. , Lees P. , Lawton N. F. , Hughes P. J.
Published: August 2009

Abstract. We report a 31‐year‐old female with microcephaly and pulmonary stenosis who developed a pituitary carcinoma: this combination of anomalies has not been described previously.
Osteonecrosis of the femoral head in refractory coeliac disease
Authors: Di Sario A. , Corazza G. R. , Cecchetti L. , Tarozzi C. , Gasbarrini G.
Published: August 2009

Abstract. Osteonecrosis has been described occurring in many clinical conditions that require steroid administration. Mechanisms by which steroids produce osteonecrosis are not well known and the importance of the underlying disease has been recently emphasized.

We report on a 48‐year‐old woman with coeliac disease who developed osteonecrosis of the femoral head after being treated with steroids for non‐response to gluten withdrawal. We stress the possible role of osteoporosis and osteomalacia, frequently found in patients with coeliac disease, in the pathogenesis of this complication, and advise using drugs other than steroids in the treatment of refractory coeliac disease.
Creatine kinase‐MB mass concentration versus creatine kinase‐B activity for the detection of acute myocardial infarction in patients with slightly elevated total creatine kinase activity in serum
Authors: Hulting J. , Waldenlind L. , Onica D. , Wallinder H.
Published: August 2009

Abstract. Objective. The diagnostic value of creatine kinase‐MB mass concentration (CK‐MB mass) was compared with that of creatine kinase‐B (CK‐B) activity in patients with suspected acute myocardial infarction (AMI) but with total serum CK activity only slightly above the reference range.

Design. One hundred consecutive blood samples with total CK activity between 120 and 360 U I‐1 and CK‐B activity ≥ 9 U I‐1 were analysed. Electrophoresis of CK isoenzymes was also performed.

Setting. Patients from all departments of the hospital were included. About half of the patients originated from the coronary care unit.

Subjects. The blood samples derived from 49 patients. Thirteen patients had at least one serum sample with total CK activity above 360 U I‐1. These and another three patients were omitted from the study.

Results. Acute myocardial infarction had been diagnosed clinically (with CK and CK‐B methods) in 12 of 33 patients. However, using the CK‐MB mass concentration of the reference method, five of these 12 patients did not have myocardial infarction whereas nine patients with small infarctions were undetected. A good correlation was seen between the results from CK‐MB mass concentration and CK isoenzyme electrophoresis, but there was a poor correlation between these methods and CK‐B activity including the CK‐B/CK ratio. A relatively high proportion (24%) of the selected patients had increased levels of macro CK.

Conclusion. CK‐B activity was inaccurate for the detection of probable myocardial infarction in patients with slightly elevated total CK activity. Increased levels of macro CK interfering with the CK‐B assay was one explanation for this observation.
Resting venous plasma adrenalin in 70‐year‐old men correlated positively to survival in a population study: the significance of the physical working capacity
Authors: Christensen N. J. , Schultz‐Larsen K.
Published: August 2009

Abstract. Objective. The aim of the study was to evaluate plasma noradrenalin (NA) and plasma adrenalin (A) as predictors of mortality in a population study.

Subjects. All subjects were 70 years of age in 1984. They were selected from the National Person Register. Altogether, 804 subjects participated in a comprehensive medical examination.

Interventions. Plasma NA and A were measured in blood samples collected after the subjects had rested in the supine position for 15 min. The subjects have now been followed for 7 years.

Main outcome measures. Seven years later, 115 men and 63 women had died.

Results. Cox regression analysis showed that the mortality in the male group was positively correlated to plasma NA (P < 0.002) and inversely correlated to forced vital capacity (P < 0.0000) and plasma A (P < 0.02). A positive correlation was obtained between physical working capacity and plasma A. When an index of physical working capacity was included in the Cox regression analysis, both plasma NA and plasma A became insignificant, whereas a strong positive correlation appeared between physical working capacity and survival (P < 0.0000). Those who had low plasma A values in 1984 tended to die from cardiovascular diseases in the follow‐up period, whereas in those who died from cancer, plasma A values were similar to those of the general population.

Conclusions. Subjects with high plasma A values had the best survival rate during the 7 year follow‐up period, probably because they also had the best physical working capacity. High plasma NA values, as expected, were associated with a reduced survival rate. Measurements of physical working capacity may be an inexpensive measure of probable survival in 70‐year‐old subjects.
Short‐term effects of eating on vasoactive hormones and haemodynamics in patients with heart failure
Authors: Berglund H. , Nyquist O. , Beermann B. , Jensen‐Urstad M. , Theodorsson E.
Published: August 2009

Abstract. Objectives. To investigate if eating can influence the measurements of vasoactive hormones or their relationship to important haemodynamic variables

Design. Haemodynamic variables and plasma concentrations of atrial natriuretic peptide (ANP), arginine vasopressin and angiotensin enzyme (ACE) activity were measured. During the 24‐h study period the patients ate ordinary hospital meals and thus were studied both in the absorptive and post‐absorptive phases.

Setting. Two university hospitals in Sweden participated in the study.

Subjects. Ten patients with heart failure, due to ischaemic heart disease.

Intervention. Eating.

Main outcome measures. Change in haemodynamic variables and plasma concentrations of vasoactive hormones related to eating.

Results. After a meal (absorptive phase) pulmonary capillary wedge pressure and plasma concentrations of ANP were significantly lower compared to the postabsorptive phase, 13±1.7 vs. 16±1.9mmHg and 57±9.5 vs. 72±12.2 pmol I‐1, respectively. The relationship between ANP and its main predictor, pulmonary capillary wedge pressure, was not altered during the study period. Plasma concentration of arginine vasopressin, ACE activity and mean right atrial pressure decreased with time and the cardiac index increased with time over the study period.

Conclusions. A meal may significantly influence plasma concentrations of ANP. Studies on vasodilator treatment and its interactions with ANP should take account of these basal fluctuations. The present data confirm previous reports on haemodynamic improvement during the first 24 h of supine cardiac catheterization in patients with heart failure, and add new information about decreasing concentrations of arginine vasopressin and ACE.
Synovectomy for haemophilic arthropathy: 6–21 years of follow‐up in 16 patients
Authors: Teigland J. C. , Tjønnfjord G. E. , Evensen S. A. , Charania B.
Published: August 2009

Abstract. Objectives. To assess the efficacy of synovectomy in reducing recurrent haemarthroses and joint pain in patients suffering from haemophilic arthropathy. Moreover, to study whether synovectomy could improve joint mobility or postpone progression of joint destruction.

Design. A retrospective study was conducted addressing joint‐related symptoms and findings, and the need of orthopaedic surgery during follow‐up.

Setting. Oslo Sanitetsforenings Rheumatism Hospital/The National Hospital, the National Centre for Orthopaedic Surgery for approximately 180 Norwegians suffering from severe congenital coagulation deficiencies.

Subjects. Twelve patients with haemophilia A, two patients with von Willebrand's disease and two patients with factor VII deficiency in which 21 synovectomies (nine knees. six ankles and six elbows) were performed.

Main outcome measures. Joint pain, joint mobility, frequency of haemarthroses and radiographic joint scores at follow‐up were compared to preoperative figures, and the number of joints in need of total joint replacement or arthrodesis was evaluated.

Results. Synovectomy proved efficacious in reducing recurrent haemarthroses and joint pain in all patients. The total range of motion was not improved, but correction of extension deficiency of the knee was accomplished. The progression of arthropathy was not arrested by synovectomy as judged by the radiographic assessment; and in four patients arthroplasty of the knee, and in two patients arthrodesis of the ankle, had been performed. A major wound haemorrhage and subsequent wound rupture was seen in one patient who developed high‐titred neutralizing antibodies to factor VIII.

Conclusions. Synovectomy for haemophilic arthropathy is safe and efficacious in reducing recurrent haemarthroses and joint pain. Synovectomy should not be performed to improve joint mobility. The progression of the arthropathy is not arrested, and subsequently many patients will be candidates for arthroplasty or arthrodesis.