bluuebunny/crossref_metadata_2025 huggingface dataset:
Non‐invasive assessment of left ventricular diastolic function in patients with systemic sclerosis
Authors: KAZZAM E. , WALDENSTRÖM A. , LANDELIUS J. , HÄLLGREN R. , ARVIDSSON A. , CAIDAHL K.
Published: August 2009

Abstract. To evaluate the extent of left ventricular (LV) diastolic impairment in systemic sclerosis, we examined 30 consecutive patients (15 men and 15 women) with this condition, and compared the findings with the data for 48 age‐ and sex‐matched randomly sampled controls. All patients were investigated by phonocardiography, pulse curve recording, and M‐mode echocardiography. Twenty‐three of 30 (77%) patients had LV hypertrophy and/or diastolic impairment. Interventricular septum (P= 0.0001), LV posterior wall (P< 0.05), and the wall thickness to cavity dimension ratio (P< 0.001) were increased in patients compared to controls, as was LV mass index (P< 0.002). Five patients had asymmetric septal hypertrophy. LV end‐diastolic dimension did not differ between groups. LV distensibility was impaired, as judged from apexcardiographic a/H ratio (P< 0.05) and from an increased left atrial index (P< 0.005). LV early filling was impaired, with a reduced left atrial emptying index (P= 0.0001), and a reduced rate of dimension increase in digitized M‐mode (P< 0.02). We found no evidence of impaired LV relaxation. Blood pressure did not differ between patients and controls. With longer duration of the disease, left atrial dimension appeared to increase (r = 0.42, P< 0.05), while other variables were not related to disease duration. The impaired LV filling was not secondary to systolic dysfunction. We conclude that systemic sclerosis patients have an increased LV wall thickness, with impaired early filling properties and LV distensibility.
Comparison of the side‐effects of pindolol and atenolol in the treatment of hypertension
Authors: ABRAHAMSEN A. M. , DIGRANES Ø. , GISHOLT K.
Published: August 2009

Abstract. A double‐blind multicentre study of 349 hypertensive patients was performed to compare the side‐effects of the two beta‐blockers atenolol (selective beta1‐blocker) and pindolol (beta1‐ and beta2‐blocker with Intrinsic sympathomimetic activity (ISA)) in equipotential doses (100 mg atenolol vs. 15 mg pindolol). Male and female patients aged 20‐65 years with essential hypertension WHO stages I and II were included. Patients were examined 1 and 6 months after the start of treatment, and side‐effects were recorded. The antihypertensive effect was similar for the two drugs. After 1 month there was significantly less bradycardia (P < 0.01), cold hands and feet (P < 0.05) and tiredness (P < 0.02) in the pindolol group, and less sleep disturbance (P < 0.02) in the atenolol group. After 6 months there was no significant difference in sleep disturbance, but the differences in the other side‐effects remained significant.
Lower serum magnesium level after exposure to cold in women with primary Raynaud's phenomenon
Authors: LEPPERT J. , ÅBERG H. , LEVIN K. , RINGQVIST I.
Published: August 2009

Abstract.Serum levels of magnesium (s‐Mg), calcium (s‐Ca), potassium (s‐K) and sodium (s‐Na) were measured in 80 women with primary Raynaud's phenomenon (RP) and in 24 age‐matched female controls recruited from a population survey. The blood samples were taken after a 40‐min standardized whole body cooling test. The mean s‐Mg level in the group with RP was significantly lower than in the controls (0.81 ± 0.05 vs. 0.86 ± 0.07 mmol l−1,P< 0.05). One year later, 66 members of the RP group and 22 members of the control group were investigated further, but without any exposure to cold. No differences in mean s‐Mg values were found between the groups. The mean s‐Mg level was significantly higher in the blood samples taken later without cold exposure than at the initial examinations after exposure to cold in the RP group, but not in the controls. The s‐Mg level was lower after exposure to cold in 82% of the women with RP, compared to 45% of the controls (P< 0.001). No differences in the other electrolytes were found. It is concluded that exposure to cold under standardized conditions may decrease the s‐Mg level in women with primary RP. Further studies of the role of magnesium in patients with RP are required.
Salt resistant lipase activity in human adrenal gland is increased in Cushing's disease
Authors: BERG A.‐L. , HANSSON P. , NILSSON‐EHLE P.
Published: August 2009

Abstract. Salt resistant lipase (also designated hepatic lipase) is present in normal human adrenal cortex at activity levels of about 1 mU g−1 tissue wet weight. In hyperplastic adrenocortical tissue from four patients with Cushing's disease the salt resistant lipase activity was found to be about 5‐fold higher than this value. The activity of salt resistant lipase in postheparin plasma was elevated in two of the patients, indicating that the high enzyme activity in adrenal cortex may originate from the liver. Lipoprotein lipase activity in postheparin plasma was clearly depressed in all patients with Cushing's disease and was associated with moderate hypertriglyceridaemia and slightly lowered HDL cholesterol levels. Thus high ACTH and/or corticosteroid levels appear to affect lipoprotein metabolism by a number of mechanisms.
The efficacy and safety of pravastatin, compared to and in combination with bile acid binding resins, in familial hypercholesterolaemia
Authors: HOOGERBRUGGE N. , MOL M. J. T. M. , VAN DORMAAL J. J. , RUSTEMEIJER C. , MULS E. , STALENHOEF A. F. H. , BIRKENHÄGER J. C.
Published: August 2009

Abstract. Forty patients with familial hypercholesterolaemia (FH) were treated with 40 mg pravastatin once daily. Pravastatin decreased serum total and low density lipoprotein cholesterol (LDL) after 8 weeks of treatment by 28% and 33%, respectively, while high density lipoprotein cholesterol increased by 8% and triglycerides decreased by 14%. In 30 patients LDL cholesterol had not decreased below 5.0 mmol l−1 after 8 weeks of treatment, and in these patients resins were added to pravastatin, resulting in an additional decrease in total and LDL cholesterol of 8% and 12%, respectively. A control group of 22 FH patients was treated with placebo for 10 weeks, after which time resins were added, and they induced a decrease in total and LDL‐cholesterol of 17% and 22%, respectively. Our results over a 24‐week treatment period indicate that 40 mg pravastatin is more effective than 3 packets of resins in lowering LDL cholesterol, whereas the combination is most effective of all and can be used safely.
Diabetes mellitus in North Sweden: prevalence assessed from prescriptions for anti‐diabetic agents
Authors: FORREST R. D.
Published: August 2009

Abstract. A prescription inventory was performed over a period of 3 months in all pharmacies in Sweden's northernmost province, Norrbotten, in order to assess the prevalence of diabetes treated with insulin and oral anti‐diabetic agents. A total of 4869 prescriptions were collected from 3482 individuals, of whom 1746 (50.1%) were men. The prevalence of drug‐treated diabetes was thus 13.27/1000 inhabitants (95% confidence interval (CI) 12.8‐13.7) in the province. Nearly half (47.9%) of all drug‐treated diabetics were treated with insulin and the majority (74%) were over 55 years of age, with only 449 (13%) being less than 40 years old. The prevalence of diabetes was highest in individuals aged 75‐84 years; in this age group it was 55.47/1000 (95% CI 50.9‐58.7). There was considerable regional variation in the prevalence of diabetes in Norrbotten, with a mean prevalence of 23.84/1000 (95% CI 22.1‐25.6) in the municipalities in the Torneå Valley, compared to 13.08/1000 (95% CI 1.19‐1.28) for the remainder of Norrbotten. While there was no difference in the prevalence of drug‐treated diabetes between men and women in the province as a whole, a slightly higher prevalence was found in women (27.41 vs. 24.73/1000) in the Torneå Valley. The prevalence of diabetes mellitus in individuals over 40 years of age was 36.62/1000 (95% CI 3.73‐4.36) in the Torneå Valley, 24.38/1000 (95% CI 22.8‐24.7) in the remainder of Norrbotten, and 27.88/1000 (95% CI 2.50‐2.68) in the province as a whole. The estimated prevalence of diabetes mellitus in Norrbotten, including patients treated by diet alone, was of the order of 20.21/1000, with a prevalence of 40.00/1000 in subjects over the age of 40 years. Thus the prevalence of diabetes appears to be higher in the Torneå Valley than in the rest of Norrbotten, while it is apparently lower than has been reported in North Finland.
Effects of long‐term treatment with metoprolol and hydrochlorothiazide on plasma lipids and lipoproteins
Authors: MONMANY J. , DOMINGO P. , GOMEZ J. A. , SANZ F. , ROCA‐CUSACHS A. , NOLLA J. , JANE F.
Published: August 2009

Abstract. In order to evaluate the effects of one‐year antihypertensive treatment on plasma lipids and lipoproteins, 65 patients whose diastolic blood pressure was in the range 95‐120 mmHg were randomly allocated to groups that received either hydrochlorothiazide or metoprolol, or both drugs when the response to one of them was insufficient to control blood pressure. Blood pressure was effectively reduced in all groups. Patients on hydrochlorothiazide showed a significant increase (P < 0.01) in low‐density lipoprotein cholesterol (LDL‐C) after 3 months of treatment. A significant increase in triglycerides was observed after 6 and 12 months, together with a decrease in high‐density lipoprotein cholesterol (HDL‐C) after 12 months (P < 0.05) of treatment in patients on metoprolol. In patients treated with both hydrochlorothiazide and metoprolol, total cholesterol increased after 3 (P < 0.001) and 6 months (P < 0.05), triglycerides increased after 6 (P < 0.01) and 12 months (P< 0.01), and LDL‐C increased after 3 (P< 0.05), 6 (P < 0.001) and 12 months (P < 0.01) of treatment, respectively. In 61% of the patients, three or more lipid parameters were affected during the study period. We conclude that long‐term antihypertensive treatment with hydrochlorothiazide, metoprolol, and particularly with both drugs, can induce lipid effects that deserve recognition, because in some cases these might counteract the possible benefit of a reduction in blood pressure on the prevention of coronary heart disease.
Wives of coronary high‐risk men — are they also at higher risk? The Tromsø Heart Study
Authors: KNUTSEN S. F. , KNUTSEN R.
Published: August 2009

Abstract. Blood lipids, blood pressure, body mass index (BMI), smoking, dietary and exercise habits were studied in 911 wives of men with high risk for coronary heart disease (CHD). Following the 1979/80 Tromsø Survey, 1373 men, aged 30‐54 years, were identified as having high risk for CHD (HDL‐cholesterol/total cholesterol ≤ 17.6% and/or total cholesterol ≥ 7.86 mmol l−1). Of the 1373 men, 911 individuals had wives who also attended the screening. These wives were compared to age‐matched, married women in the general population. A significantly higher total cholesterol level (5.98 mmol l−1 vs. 5.78 mmol l−1), lower HDL‐cholesterol/total cholesterol (30.01% vs. 31.58%), higher BMI and higher coronary risk score (4.55 vs. 3.82) was found among the wives of the high‐risk men. Furthermore, a higher proportion of these individuals were daily cigarette smokers (47.3% vs. 42.1%), and had received fewer years of education. They also had more dietary habits associated with increased risk of CHD than other married women in the general population. Our findings support the hypothesis that members of the same household as a person with increased risk for CHD also have increased risk. This is most probably due to shared lifestyle.
Trimethoprim‐sulphamethoxazole‐associated blood dyscrasias. Ten years'experience of the Swedish spontaneous reporting system
Authors: KEISU M. , WIHOLM B.‐E. , PALMBLAD J.
Published: August 2009

Abstract. During the 10‐year period 1976‐1985, a total of 154 cases of blood dyscrasia were reported in Sweden which were evaluated as having a probable or possible causal relationship with trimethoprim‐sulphamethoxazole (T‐SM). There were 61 cases of leucopenia (of which 16 had agranulocytosis), 28 cases of thrombocytopenia, and two of non‐haemolytic anaemia. There were also 32 cases of bicytopenia and 31 cases of tricytopenia. The median age varied from 38 years in the leucopenia group to 81 years in those with tricytopenia. The overall fatality rate was 17%, ranging from 2% in the group with mild leucopenia to 52% in the group with tricytopenia. In relation to sales and prescription data, the overall incidence of reported T‐SM blood dyscrasias was 5.3 per million defined daily doses, and among out‐patients the incidence was one case per 18000 prescriptions. Thus the overall incidence of any blood reaction to T‐SM appears to be low. In relation to prescription data, elderly people were overrepresented among the serious reactions.
The relationship between clinically confirmed cobalamin deficiency and serum methylmalonic acid
Authors: MOELBY L. , RASMUSSEN K. , JENSEN M. K. , PEDERSEN K. O.
Published: August 2009

Abstract. Over a 1‐year period, we examined 42 consecutive patients with low serum cobalamin levels detected by primary screening test (S‐protein binder, RIA). In 31 patients (74%) clinical cobalamin deficiency was confirmed, whereas the remaining 11 patients (26%) were characterized clinically as non‐cobalamin deficient. The serum methylmalonic acid level was higher than 0.34 μmol l−1 (3 SD above the mean in normal controls) in 30 of the 31 clinically characterized cobalamin‐deficient subjects, and below this level in 10 of the 11 non‐deficient patients. We conclude that the serum methylmalonic acid assay provides an appropriate means of discrimination between cobalamin deficiency and non‐cobalamin deficiency (efficiency=0.95), and we recommend that the assay be adopted as the standard test for diagnosis of tissue cobalamin deficiency.
Glucose tolerance and hyperinsulinaemia in obese women: role of adipose tissue distribution, muscle fibre characteristics and androgens
Authors: KROTKIEWSKI M. , SEIDELL J. C. , BJÖRNTORP P.
Published: August 2009

Abstract. The separate independent statistical contribution of abdominal distribution of fat, hyperandrogenicity and muscle morphology to glucose intolerance and hyperinsulinaemia was analysed in 88 obese women. In univariate analyses the waist/hip circumference ratio (WHR), body fat and lean body mass were all positively associated, and SHBG levels were negatively associated with insulin and glucose values. Muscle fibre areas were positively correlated with insulin but not with glucose concentrations. Adjustment for other variables did not remove the positive association between WHR and fasting insulin and glucose concentrations. SHBG, free testosterone and type IIb fibre areas were, however, significant confounding factors in the relationship between WHR and summed insulin and glucose concentrations. We conclude that fat distribution in obese women is associated with fasting hyperglycaemia and hyperinsulinaemia, independently of androgens and muscle fibre morphology, but that reduced SHBG concentrations and increased type IIb fibre areas may partly explain increased glucose and insulin responses to an oral glucose load in abdominally obese women.
Renal reserve filtration capacity before and after kidney donation
Authors: WEE P. M. TER , TEGZES A. M. , DONKER A. J. M.
Published: August 2009

Abstract. Renal reserve filtration capacity (RRFC) was investigated in 20 kidney donors before and within 3 months after uninephrectomy. Glomerular filtration rate (GFR) was measured by the clearance of 125I‐iothalamate, and effective renal plasma flow (ERPF) was determined by the clearance of 131I‐hippurate. RRFC was tested by infusion of a low dose of dopamine, by intravenous administration of an amino acid solution and, finally, by combined infusion of amino acids and low‐dose dopamine. After kidney donation, the median value of the GFR was 65% of its initial value. The median value of the ERPF was 69% of its value before uninephrectomy. The filtration fraction declined significantly from 0.251 to 0.238 (medians: P < 0.02). Median values for dopamine‐induced increases in GFR were 13.8% before and 5.3% after kidney donation (P < 0.005). Infusion of amino acids led to an increase in GFR of 11.2% before and 9.6% after donation (NS). During combined infusion, the median values for the increases in GFR were 20.0% before and 12.6% after uninephrectomy (P < 0.02). Median changes in ERPF before and after kidney donation were 33.4 vs. 23.0% during dopamine infusion (P < 0.005), 10.0 vs. 8.3% during amino acid infusion (NS), and 36.2 vs. 24.3% during the combined infusion of dopamine and amino acids (P < 0.02). Infusion of dopamine induces a decrease in renal vascular resistance, resulting in a rise in glomerular blood flow. Since RRFC tested by means of dopamine infusion was significantly decreased after kidney donation, it is concluded that glomerular hyperfiltration after kidney donation is at least partially due to a rise in glomerular blood flow.
Treatment of severe colitis in Behcet's syndrome with thalidomide (CG‐217)
Authors: LARSSON H.
Published: August 2009

Abstract. A 35‐year‐old male patient, known in our department since 1979 on account of a severe and complete Behcet's syndrome, was treated with thalidomide (CG‐217) as a final pharmacological measure to avoid colectomy during a severe attack of Behcet colitis. Prior to the administration of thalidomide, the patient had been treated for 7 weeks with full parenteral nutrition and high doses of steroids intravenously without a satisfactory effect on the colitis. Treatment with sulphasalazin was unsuccessful because of a decreasing number of platelets on this drug. After a few days on thalidomide, 300 mg given once daily at bedtime, the patient's stools were normalized and without reaction for blood, his oral ulcers and pleural effusion disappeared, and his steroid doses could be reduced. Gradually he was put on oral nutrition again, and his rectal mucosa became normalized. The dose of thalidomide was reduced to 200 mg, and then to 100 mg daily when the patient was discharged from hospital, less than 3 weeks after institution of the drug treatment. After 5 months as an out‐patient his condition is still satisfactory and without symptoms of his former disease. Thalidomide has previously been reported to be of value in treatment of Behcet's syndrome, but to my knowledge never with such a dramatic effect on a severe colitis as reported in this case.
Serum lipoproteins, apolipoproteins and very low density lipoprotein subfractions during 6‐month fibrate treatment in primary hypertriglyceridaemia
Authors: PAUCIULLO P. , MAROTTA G. , RUBBA P. , CORTESE C. , CARUSO M. G. , GNASSO A. , FISCHETTI A. , MOTTI C. , MANCINI M.
Published: August 2009

Abstract. Serum lipoproteins and apolipoproteins were studied in 14 hypertriglyceridaemic (HTG) patients during a 24‐week period of treatment with gemfibrozil, and after a 6‐week washout period. A marked decrease in very low density lipoprotein (VLDL) cholesterol and triglyceride was observed. There was an increase in high density lipoprotein (HDL) cholesterol, particularly the HDL3 component. A slight increase in low density lipoprotein (LDL) cholesterol was observed after 12 weeks, but this had almost disappeared after 24 weeks. The treatment resulted in an increase in serum apolipoprotein A‐II levels and a reduction in serum apo C‐III and apo E. VLDL subfractionation by density gradient centrifugation in four subfractions of decreasing size (A, B, C and D) showed a predominant reduction of the large subfractions A, B and C, while the decrease in VLDL‐D was less marked. Percentage changes from the baseline level of VLDL‐A and VLDL‐D cholesterol were found to be inversely correlated with percentage changes in HDL and LDL cholesterol, respectively. This might reflect a transfer of cholesterol from VLDL‐A to HDL, and from VLDL‐D to LDL. The above data suggest fibrate‐induced stimulation of lipoprotein lipase, and indicate that the enhanced transfer of cholesterol from VLDL to LDL, induced by fibrates in HTG patients, is less pronounced after a prolonged period of treatment.
Milk: does it affect blood pressure? A controlled intervention study
Authors: VAN BERESTEIJN E. C. H. , VAN SCHAIK M. , SCHAAFSMA G.
Published: August 2009

Abstract. In a double‐blind trial, the effect on blood pressure of supplementation of normal milk (1180 mg Ca2+, 1650 mg K+ and 110 mg Mg2+ d−1) vs. ‘mineral‐poor’ milk (95 mg Ca2+, 580 mg K+ and 10 mg Mg2+ d−1) was studied. Young healthy normotensive female students consumed one of the two supplements while on a low calcium diet (< 500 mg Ca2+ d−1) for a period of 6 weeks. In both the normal milk‐ and ‘mineral‐poor’ milk‐supplemented groups systolic blood pressure decreased slightly. However, this decrease was persistently greater in the milk‐supplemented group. The individual mean systolic blood pressure change during normal milk treatment (‐4.1%) was significantly greater (P=0.03) than that during ‘mineral‐poor’ milk treatment (‐1.3%). An effect of normal milk supplementation on diastolic blood pressure could not be demonstrated. The results of the present study indicate a small hypotensive effect of milk consumption, which is attributable to its content of essential minerals.
Bartter's syndrome and diabetes mellitus
Authors: RAMAN G. VENKAT , ALBANO J. D. M. , MILLAR J. G. B. , LEE H. A.
Published: August 2009

Abstract. We here report a case of Bartter's syndrome occurring in association with diabetes mellitus. The patient, an insulin‐dependent diabetic, presented with hypokalaemia, inappropriate kaliuresis and metabolic alkalosis. He had high plasma renin activity, relatively low plasma aldosterone, and resistance to infused angiotensin II. A high potassium diet raised total body potassium and serum potassium, did not affect plasma renin activity, but raised plasma aldosterone significantly and did not alter the resistance to angiotensin II. Indomethacin administered acutely reduced urinary potassium and kallikrein excretion and, on chronic administration, lowered plasma renin activity, urinary chloride excretion, and raised serum potassium. Salt restriction resulted in a prompt and significant reduction in urinary sodium and chloride excretion. Urinary kallikrein excretion was very high throughout, increased with sodium restriction, and decreased with sodium loading. Oral potassium supplementation partially corrected the hypokalaemia, but did not affect blood sugar control. In this patient the primary defect appears to have been primary urinary potassium wasting, rather than sodium or chloride wasting. The striking effects of indomethacin suggest that prostaglandins may play a fundamental role in the genesis of the syndrome.
Alcohol consumption and synthesis of ethyl esters of fatty acids in adipose tissue
Authors: BJÖRNTORP P. , DEPERGOLA G. , SJÖBERG C. , PETTERSSON P. , HALLGREN P. , BOSTRÖM K. , HELANDER K.‐G. , SEIDELL J.
Published: August 2009

Abstract. Ethyl esters of fatty acids (EEFA) have been found to be formed during ethanol metabolism. Human adipose tissue contains high concentrations of free fatty acids, the substrate for EEFA synthesis, and might therefore be a tissue with great potential for EEFA formation. In order to explore their potential usefulness as markers of alcohol abuse, the EEFA concentration and the activity of EEFA‐synthesizing enzyme were therefore determined in adipose tissue from men belonging to the following categories: teetotallers, social drinkers, alcoholics under treatment, or established alcoholics found to have died as a result of alcohol intoxication. In order to estimate the half‐life of EEFA and the synthase activity induction, the alcoholics were examined after different time periods of abstinence from alcohol. Comparisons were also made with several established markers of alcohol abuse. EEFA were not found in teetotallers, and were found in low concentrations in some of the social drinkers. EEFA were found in several alcoholics, and the forensic cases had high concentrations. EEFA‐synthesizing enzyme activity was found in all subjects, increasing from teetotallers to social drinkers, and being 2‐fold higher in alcoholics and 5‐fold higher in dead alcoholics. The induction of the enzyme after abstinence appeared to have a half‐life of the order of several weeks. Correlations were found between EEFA synthase activity and previously established markers of alcohol abuse known to remain for a long time period after abstinence, such as mean erythrocyte corpuscular volume. This preliminary study suggests the possibility that EEFA synthase induction in adipose tissue might have a longer half‐life than previously used markers of alcohol abuse. It is therefore suggested that the induction of EEFA synthase might be a potentially useful new marker for alcohol abuse because of its apparent proportionality to alcohol intake over a prolonged time period, its presumed specificity, and long‐term elevation after alcohol abstinence. This potential marker should be analysed further.
Effect of sodium selenite and vitamin E treatment in myotonic dystrophy
Authors: BÄCKMAN E. , HENRIKSSON K. G.
Published: August 2009

Abstract.Fifteen patients with myotonic dystrophy, seven men and eight women, of age range 15‐55 years, were treated with sodium selenite and vitamin E for 2 years. The patients were examined using a number of tests to assess muscle force and function at the start of the treatment period and 6, 12 and 24 months thereafter. Myotonia gives an increased relaxation time. The latter was measured in the adductor pollicis. There was a significant decrease in half relaxation time before treatment compared with the values during treatment. In summary, the results indicate that selenium and vitamin E therapy may have an effect on myotonia. The effects of treatment on motor functions were minimal, and overall motor performance was not improved.
Elevation of plasma neuropeptide Y‐like immunoreactivity and noradrenaline during myocardial ischaemia in man
Authors: ULLMAN B. , FRANCO‐CERECEDA A. , HULTING J. , LUNDBERG J. M. , SOLLEVI A.
Published: August 2009

Abstract. Plasma levels of neuropeptide Y‐like immunoreactivity (NPY‐LI) and noradrenaline were studied for 25 h in 22 patients with acute ischaemic heart disease. On admission, NPY‐LI levels were above normal in 16 patients, and 20 patients had increased noradrenaline levels. The initial plasma NPY‐LI did not differ between patients with acute myocardial infarction (AMI) and angina pectoris. Initial plasma noradrenaline levels were higher in patients with AMI than in those with angina pectoris. Plasma levels of noradrenaline remained elevated in AMI patients, but decreased towards normal values in patients with angina pectoris. Levels of NPY‐LI returned to normal within 25 h in all patients. Tachycardia and left ventricular failure were related to high NPY‐LI and noradrenaline levels. A positive correlation was found between noradrenaline and NPY‐LI in plasma. It is suggested that neuropeptide Y (NPY), an endogenous vasoconstrictor peptide, should be considered as one of the mediators involved in the cardiovascular response to sympathetic activation induced by myocardial ischaemia.
Antihypertensive drugs and glucose metabolism: comparison between a diuretic, a beta‐blocker and felodipine, a new calcium antagonist in subjects with arterial hypertension and diabetes
Authors: LUNDGREN H. , BENGTSSON C. , LAPIDUS L. , BENGTSSON L.
Published: August 2009

Abstract. Felodipine*, a new antihypertensive calcium antagonist, was compared with metoprolol, a beta‐blocker, and hydrochlorothiazide, a diuretic, with respect to glucose tolerance in a randomized double‐blind cross‐over study consisting of 11 patients, of age range 50‐70 years, who had developed diabetes during antihypertensive treatment. Each treatment period lasted for 10 weeks. The blood pressure was similar irrespective of treatment. Serum glucose levels during the oral glucose tolerance test were significantly lower when the patients were treated with felodipine than when they were taking hydrochlorothiazide. Serum insulin levels appeared to decrease at an earlier stage of the test when the patients were treated with felodipine, the calcium antagonist, than with the other two antihypertensive substances, which suggests that glucose tolerance is impaired to a lesser extent during treatment with the calcium antagonist. Glucose tolerance was never completely normalized with any of the drugs tested.
Very high blood pressure in acute stroke
Authors: BRITTON M. , CARLSSON A.
Published: August 2009

Abstract.In a study sample consisting of 388 unselected, consecutive acute stroke patients, 27 with systolic blood pressure ≥ 200 mmHg and diastolic blood pressure ≥ 115 mmHg were compared with the other 361 patients. The patients with high blood pressure were younger (65 vs. 73 years) and much more often had a history of hypertension (78 vs. 42 %). Cardiac and vascular hypertensive manifestations were more frequent, particularly when only those patients with a history of hypertension were compared in the two groups. Alcohol abuse was mentioned in a higher proportion of hypertensives in the summaries of their medical records. No definite conclusions could be drawn with regard to the size and location of the brain lesions. Clinical symptoms did not differ between the groups, neither did the proportion of patients who could be discharged from hospital immediately. Mortality was higher in the high blood pressure group (30 vs. 14%, P < 0.05). Thus the characteristics of patients with very high blood pressure were: younger age, much more frequent and severe previous hypertension. Alcohol abuse might be an important factor. The type, size and location of the brain lesion itself could not be statistically related to the high blood pressure, but very large lesions, particularly haemorrhages, might be associated with a reactive blood pressure response.
Increased arterial adrenaline is related to pain in uncomplicated myocardial infarction
Authors: HUSEBYE E. , KJELDSEN S. E. , LANDE K. , GJESDAL K. , OS I. , EIDE I.
Published: August 2009

Abstract. Plasma levels of catecholamines, β‐thromboglobulin (BTG) and arginine vasopressin (AVP), and degree of pain were examined in 22 patients with suspected uncomplicated myocardial infarction within 24 h following onset of chest pain. Sixteen patients developed infarction with peak creatine phosphokinase at 1280 UI−1 (range 293‐3770 UI−1). Fifteen healthy men served as controls (C). Arterial adrenaline levels were significantly higher in patients with pain (1.15 ± 0.23 nmol I−1, n=8, mean value ± SEM) than in those without pain (0.60 ± 0.10nmol l−1, n=14, P < 0.05). Plasma catecholamines were moderately but significantly elevated in myocardial infarction; the concentration of arterial adrenaline was 0.83 ± 0.14 nmol I−1 and that of arterial noradrenaline was 2.70 ± 0.28 nmol I−1 compared with 0.44 ± 0.04 nmol I−1 (P < 0.025) and 1.47 ± 0.05 nmol I−1 (P < 0.0005), respectively, in C. One week later, plasma catecholamines had returned to baseline levels. Plasma BTG showed borderline elevation (1.0 ± 0.1 pmol I−1) compared with C (0.6 ± 0.1 pmol I−1, P=0.04), and remained unchanged 1 week later. Plasma AVP was at baseline level. Uncomplicated myocardial infarction, regardless of size, was associated with only moderately increased sympathetic tone. Plasma adrenaline was related more to the degree of pain than to the presence of acute myocardial infarction. Arterial adrenaline may be a sensitive marker of sympatho‐adrenal activity related to pain.
Acetazolamide‐associated aplastic anaemia
Authors: KEISU M. , WIHOLM B.‐E. , ÖST Å. , MORTIMER Ö.
Published: August 2009

Abstract. Eleven cases of acetazolamide‐associated aplastic anaemia were reported in Sweden during a 17‐year period. There were six women and five men with a median age of 71 years (range 63‐85 years). The median dose of acetazolamide was 500 mg, and the median duration of treatment was 3 months (range 2‐71 months). Ten of the eleven patients died, all within 8 weeks after detection of their aplastic anaemia. The relative risk of developing aplastic anaemia when taking acetazolamide was 13.3 (95% confidence limits (CL); 6.8‐25.3). The estimated incidence of reported acetazolamide‐associated aplastic anaemia is approximately one in 18000 patient years. The results strongly indicate that acetazolamide treatment is associated with a substantial increase in the risk of developing aplastic anaemia.
Modern haemophilia treatment: medical improvements and quality of life
Authors: ROSENDAAL F. R. , SMIT C. , VAREKAMP I. , BRÖCKERVRIENDS A. H. J. T. , VAN DIJCK H. , SUURMEIJER T. P. B. M. , VANDENBROUCKE J. P. , BRIËT E.
Published: August 2009

Abstract.Adequate replacement therapy in haemophilia has been available for two decades. This has led to considerable improvements in the life expectancy and physical status of haemophilia patients. A study was conducted to investigate whether this has also led to improvements in quality of life. With this aim, information was obtained from 935 Dutch haemophiliacs by mailed questionnaires on relationships, marriage, family life and employment. Haemophilia patients were less often married than men in the general population (13% fewer) and had a lower total number of children (30% lower, 17% for those who were married). Twenty‐two per cent of the patients were not employed and received an income from the disability funds. While severity of haemophilia, joint damage and age increased the risk of disability, it was noted that home treatment was associated with a 50% reduction in this risk. Remarkably, haemophilia patients did not differ from the general population in their view of the quality of their own health. The results of this study show a positive influence of modern haemophilia treatment on quality of life. At present, AIDS overshadows all optimistic feelings one may have about this field. However, the results described here demonstrate the benefits that can be achieved with adequate replacement therapy, and justify the expectation of further improvements in the near future.
The relationship between symptomatic and biochemical hypoglycaemia in insulin‐dependent diabetic patients
Authors: PRAMMING S. , THORSTEINSSON B. , BENDTSON I. , BINDER C.
Published: August 2009

Abstract. The relationship between symptomatic (subjective feelings) and biochemical (blood glucose concentration < 3 mmol I−1) hypoglycaemia was studied in 66 randomly selected insulin‐dependent diabetic out‐patients under normal conditions of daily life with conventional insulin injection regimens. The patients (a) collected 7‐point diurnal blood glucose profiles at home on three consecutive days and then once weekly for 3 weeks, (b) indicated whether they felt hypoglycaemic at sampling times, and (c) collected extra samples if they felt hypoglycaemic at any time during the study period. The weekly frequencies of symptomatic and biochemical hypoglycaemia were 0.99 and 1.75 per patient, respectively. Biochemical hypoglycaemia was present in 29% of the symptomatic episodes, and symptomatic hypoglycaemia accompanied 16% of the biochemical episodes. Symptomatic hypoglycaemia was experienced at a median blood glucose concentration of 3.4 mmol I−1 (range 1.4‐14.9 mmol I−1). Fifty per cent of both symptomatic and biochemical episodes occurred before lunch, while the remainder were evenly distributed throughout the day. The occurrence of biochemical hypoglycaemia, but not of symptomatic hypoglycaemia, was inversely correlated with HbA1c and median blood glucose concentration. Thus symptomatic hypoglycaemia is an unreliable indicator of biochemical hypoglycaemia and of the degree of glycaemic control. Blood glucose measurements are a prerequisite for the diagnosis of hypoglycaemia.
A double‐blind gastroscopic evaluation of the effects of etodolac and naproxen on the gastrointestinal mucosa of rheumatic patients
Authors: PORRO G. BIANCHI , CARUSO I. , PETRILLO M. , MONTRONE F. , ARDIZZONE S.
Published: August 2009

Abstract. The aim of this clinical, endoscopical study was to evaluate the therapeutic efficacy and the gastric tolerability of etodolac, a new anti‐inflammatory, non‐steroidal drug, compared with naproxen. The study was conducted on 48 patients suffering from rheumatoid arthritis, 44 of whom completed the trial. After an initial oesophago‐gastroduodenoscopy to exclude the presence of gastric mucosal lesions, patients were randomly allocated to double‐blind treatment with either etodolac 200 mg b.i.d. or naproxen 500 mg b.i.d. for a period of 4 weeks. Endoscopic control followed this treatment period. Both drugs proved effective in relieving clinical symptoms, without a statistically significant difference. Gastric mucosal lesions were observed in 15% of etodolac‐treated patients and in 46% of patients treated with naproxen (P < 0.05) (95% CI 0.01‐0.60). Painful dyspepsia was observed in 15% of patients treated with etodolac vs. 38% of patients on naproxen therapy. This study demonstrates that etodolac is at least as active as naproxen in relieving rheumatic symptoms, and its administration results in a significantly lower degree of gastric damage.
Hypoglycaemic episodes during intensified insulin treatment: increased frequency but no effect on cognitive function
Authors: REICHARD P. , BERGLUND A. , BRITZ A. , LEVANDER S. , ROSENQVIST U.
Published: August 2009

Abstract. Ninety‐seven patients with insulin dependent diabetes mellitus (IDDM) were randomized to intensified conventional treatment (ICT, n = 44) or regular treatment (RT, n = 53). The mean HbA1c level (± SEM) was reduced from 9.5 ± 0.2% to 7.4 ± 0.1% in the ICT group (P < 0.001), and from 9.4 ± 0.2% to 9.0 ± 0.2% (P < 0.01) in the RT group. The difference between the groups was significant (P < 0.001). During a period of 3 years, 57% of the ICT patients (95% confidence interval 44‐73%) and 23% of the RT patients (95% CI, 11‐34%) (P < 0.001) had at least one episode of serious hypoglycaemia, with the need for third‐party assistance or resulting in coma. Eighteen of the 32 ICT patients who initially had adrenergic symptoms during hypoglycaemia changed to predominantly neuroglycopenic symptoms. This was the case with only 8 of 38 RT patients (P < 0.01). The change in symptoms was related to the increased frequency of serious hypoglycaemia, but neither symptoms nor frequency of hypoglycaemia bore any relationship to insulin dose, body mass index, duration of diabetes or autonomic nerve function. The results of several neuropsychological tests did not differ between the groups at baseline, and did not change during the study. There were no signs of deteriorating cognitive function in the patients with serious hypoglycaemic episodes.
Effects of cigarette smoking on thyroid function and the prevalence of goitre, thyrotoxicosis and autoimmune thyroiditis
Authors: ERICSSON U.‐B. , LINDGÄRDE F.
Published: August 2009

Abstract. The effect of smoking habits on thyroid function and the prevalence of thyroid diseases was studied in two birth cohorts (1928 and 1941) of men and women. A total of 1555 individuals (836 men and 719 women) were smokers, 1048 individuals (604 men and 444 women) were ex‐smokers and 1497 individuals (560 men and 937 women) were non‐smokers. The serum thyrotropin (TSH) concentration was significantly lower in smokers than in ex‐smokers and non‐smokers (P = 0.05 and P = 0.001, respectively). Smoking habits did not affect the serum triiodothyronine (T3) concentrations. The prevalence of non‐toxic goitre and toxic diffuse goitre was significantly higher in smoking women than in non‐smoking women (P = 0.005 and P = 0.04, respectively). Thiocyanate may be the goitrogenic factor responsible for the increased prevalence of nontoxic goitre. The cause of the increased prevalence of toxic diffuse goitre is less obvious. Hypothetically, an increase in sympathetic activity in smokers may promote the development of thyrotoxicosis in predisposed individuals, but immunological disturbances caused by smoking are another possibility.
Two IgM paraproteins bearing cryoglobulin and anti‐smooth muscle activities in a patient with Waldenström's macroglobulinaemia
Authors: RUIZ‐PALOMO F. , REVILLA Y. , PORQUE P. GONZALEZ , RIOS M. SERRANO
Published: August 2009

Abstract. A 52‐year‐old white male subject with typical clinical and laboratory findings of Waldenström's macroglobulinaemia is described. Two paraprotein peaks of IgM lambda class, with different physical and chemical properties and different amino acid compositions, in both heavy and light chains, were found in the patient's serum. One of the IgM components (M1) was a cryoglobulin, and the other (M2) showed strong anti‐smooth muscle activity. As far as we know, this is the first report of double paraproteins each of which has different properties.
Potential role of insulin in the clearance of remnant lipoproteins in dysbetalipoproteinaemia
Authors: DUELL P. B. , BIERMAN E. L.
Published: August 2009

Abstract. Dysbetalipoproteinaemia is a genetic disorder characterized by accumulation of lipoprotein remnant particles in the plasma, accelerated atherosclerosis, and the abnormal apoprotein E2. Uncontrolled diabetes mellitus can aggravate the hyper‐lipidaemia associated with this disorder, presumably by increasing triglyceride synthesis and reducing very low density lipoprotein catabolism by lipoprotein lipase. This report documents the gradual amelioration of dysbetalipoproteinaemia in uncontrolled diabetes mellitus following therapy with exogenous insulin alone. Although the beneficial effects of insulin therapy in this patient may include inhibition of triglyceride synthesis and improved triglyceride catabolism, we propose that insulin may also stimulate clearance of atherogenic remnant lipoprotein particles.
Reflexogenic neuronal and humoral responses to selective stimulation of low‐pressure cardiopulmonary receptors in man
Authors: AGEWALL S. , RHEA B. , PERSSON B. , KARLBERG B. , WALLIN G. , ANDERSSON O. K.
Published: August 2009

Abstract. This study was conducted to determine the relative importance of efferent muscle sympathetic nerve activity (MSA), vasopressin (ADH) and atrial natriuretic peptide (ANP) in the short‐term neurohumoral response to moderate changes in low‐pressure cardiopulmonary receptor activity. The low‐pressure receptors were stimulated and unloaded, respectively, by autotransfusion of blood (450 ml) and the application of lower body negative pressure (LBNP, −20 mmHg), and in 11 healthy men we measured MSA in the left peroneal nerve, indirect blood pressure, ECG, central venous pressure (CVP) and venous plasma concentrations of ANP and ADH (radioimmunoassay). Total MSA rose by 30% during LBNP and decreased during a rapid autotransfusion of blood, and the changes in MSA were significantly related to changes in CVP. The plasma concentrations of ADH and ANP were not significantly affected by either procedure. It is suggested that during moderate short‐term changes in venous return, MSA responded more rapidly and/or at a lower threshold than the ADH and ANP systems.
Determinants of carotid intima‐media thickness: a population‐based ultrasonography study in Eastern Finnish men
Authors: SALONEN R. , SALONEN J. T.
Published: August 2009

Abstract. We investigated the determinants of maximal intima‐media thickness of common carotid arteries in a population‐based sample of 1224 Eastern Finnish men aged 42, 48, 54 or 60 years. A high‐resolution B‐mode ultrasonographic examination was performed as part of the Kuopio Ischaemic Heart Disease Risk Factor Study (KIHD). The maximal intima‐media thickness (IMT) varied between 0.48 mm and 4.09 mm (mean value ± SD, 0.94 mm ± 0.38 mm). Age (standardized partial coefficient, beta = 0.238, P < 0.0001), ambulatory pulse pressure (beta = 0.130, P < 0.0001), cigarette‐years of smoking (beta = 0.125, P < 0.0001), serum LDL cholesterol concentration (beta = 0.125, P < 0.0001), history of ischaemic heart disease (beta = 0.125, P < 0.0001), pre‐exercise systolic blood pressure (beta = 0.070, P = 0.0113) and diabetes (beta = 0.068, P = 0.0072) were most strongly associated with IMT. This study confirms the role of systolic blood pressure, smoking and serum LDL cholesterol levels as major risk factors for increased carotid intima‐media thickness.
Felodipine in the treatment of hypertensive type II diabetics: effect on glucose homeostasis
Authors: KJELLSTRÖM T. , BLYCHERT E. , LINDGÄRDE F.
Published: August 2009

Abstract. The effect of felodipine on glucose tolerance was evaluated in 18 male type II diabetic patients treated with diet alone, who were hypertensive despite β‐blocker treatment. The study was a double‐bind cross‐over comparison of placebo and felodipine in addition to β‐blockade. Oral glucose tolerance tests were performed at randomization and at the end of each 4‐week double‐blind treatment period. The doses of felodipine given were 5 mg b.i.d. for 2 weeks followed by 10 mg b.i.d for a further 2 weeks. Blood pressure was significantly reduced during felodipine treatment, whereas heart rate remained unaltered. HbA1c and fasting insulin levels did not change during the treatment periods. Fasting and maximal blood glucose levels were not altered between any of the treatment periods. However, there was a small but statistically significant increase (median increase 4%) in the area under the glucose concentration vs. time curve after felodipine as compared to placebo treatment. This increase was not considered to be clinically significant in the short term, but the finding merits further investigation in a rigorous long‐term study.
Determinants of mild fasting hypertriglyceridaemia in non‐insulin‐dependent diabetes
Authors: BAYNES C. , HENDERSON A. D. , HUGHES C. L. , RICHMOND W. , JOHNSTON D. G. , ELKELES R. S.
Published: August 2009

Abstract. Factors contributing to fasting hypertriglyceridaemia were studied in 20 patients with non‐insulin‐dependent diabetes—nine with normal triglyceride concentrations [fasting triglyceride 0.94 (range 0.58–1.23) mmol l−1] and eleven with mild fasting hypertriglyceridaemia [fasting triglyceride 2.4 (1.82–4.0) mmol l−1]. The patients with hypertriglyceridaemia were more obese [body mass index 29.0 (24.6–33.8) vs. 25.7 (21.9–30.1) kg m−2, P < 0.05] and demonstrated impaired glucose disposal in response to exogenous insulin at isoglycaemia [insulin sensitivity index, SIp 0.7 (0.27–2.5) vs. 2.4 (0.62–5.1) ml m−2 min per mU l−1, P < 0.01]. Basal non‐esterified fatty acid (NEFA) and glycerol concentrations were higher and were suppressed to a lesser extent during isoglycaemic hyperinsulinaemia. Fasting glucose and apolipoprotein B concentrations were higher in the hypertriglyceridaemic patients, but lipoprotein lipase activities were similar in the two groups. When the effect of obesity was removed (by weight‐matching six normotriglyceridaemic with seven hypertriglyceridaemic patients) basal NEFA and glycerol concentrations and the suppression of NEFA in response to insulin remained significantly different between the two groups. We propose that defects in both the glucoregulatory and antilipolytic actions of insulin contribute to mild fasting hypertriglyceridaemia in NIDDM, and that these defects cannot be attributed solely to obesity. These disorders of insulin action may also have important implications for the postprandial metabolism of triglyceride‐rich lipoproteins and hence atherogenesis.