bluuebunny/crossref_metadata_2025 huggingface dataset:
Sense of coherence in parents of children with different developmental disabilities
Authors: Olsson M. B. , Hwang C. P.
Published: March 2003

Background

The aim of the present study was to test if Antonovsky's theory of sense of coherence can facilitate understanding: (1) individual differences in psychological adaptation in parents of children with intellectual disability (ID); and (2) why parents of children with ID generally experience higher levels of stress and depression than parents of children who develop normally.

Methods

Sense of coherence (SoC) and depression were assessed using the short SoC scale (13 items) and the Beck Depression Inventory in 216 families of children with ID and/or autism, and in 213 control families.

Results

It is argued that: (1) parents of children with ID with low SoC are at increased risk for developing depression compared to control parents with low SoC not experiencing this stressor; and (2) the life situation of parenting a child with ID may have a negative impact on parents’ SoC levels that, in turn, will make them more vulnerable to experiencing stress and depression.

Conclusion

The SoC theory is valuable in understanding individual differences in psychological adaptation in parents of children with ID.
Challenging behaviour and insecure attachment
Authors: Clegg J. , Sheard C.
Published: March 2003

Background

The present authors investigated a database about people with severe intellectual disability (ID) to explore whether secure/insecure attachment plays a role in challenging behaviour.

Methods

The study took the form of a survey of staff and carers involved with a cohort of 54 school‐leavers with severe ID.

Results

Thirty‐four per cent of students were rated by placement staff as ‘over‐investing in one or a few relationships which become a source of jealousy’. Students without such problems were significantly less likely to show challenging behaviours, while those with them were significantly more likely to be living outside the family home.

Conclusions

These preliminary results justify more detailed and longitudinal research into the relationship between attachment status and challenging behaviour.
Screening for coeliac disease in adult insulin‐dependent diabetes mellitus
Authors: SJÖberg  , Eriksson  , Bredberg  , Wassmuth  , Eriksson
Published: March 2003

Sjöberg K, Eriksson KF, Bredberg A, Wassmuth R, Eriksson S (University of Lund, University Hospital, Malmö, Sweden; and University of Erlangen‐Nürnberg, Erlangen, Germany). Screening for coeliac disease in adult insulin‐dependent diabetes mellitus. J Intern Med 1998; 243: 133–40.

Objectives

To study, by sequential screening for gliadin antibodies (GA) and endomysial antibodies (EMA), the prevalence and clinical characteristics of coeliac disease (CD) in adult IDDM patients.

Subjects and measurements

A series comprising 1664 diabetes patients [848 with IDDM, 745 with non‐insulin‐dependent diabetes (NIDDM) and 71 with secondary diabetes] were screened for GA. IgA‐ or IgG‐GA positive sera were analysed for EMA.

Results

IgA‐GA were more frequent in all the diabetes subgroups (13.7% in IDDM,12.3% in NIDDM and 23.9% in secondary diabetes, P < 0.001 in all three cases) than among healthy blood donors (4.7%). Two patients with NIDDM had CD. Of the IDDM group (n= 848), 8 had previously diagnosed CD and 14 more (of whom 7 could be biopsied) were EMA positive. All had villous atrophy. The minimum prevalence of CD (including probable cases) in IDDM was 2.6% (22/848). Patients with previously known CD had more symptoms (P < 0.001), more deficiency states (P < 0.001) and more autoimmune diseases (P < 0.04) than those identified by screening. IDDM patients with a diabetes duration of 31‐40 years were characterised by a higher prevalence of CD than patients with a duration of less than 30 years (6.7% vs. 1.7%; P < 0.02).

Conclusions

Serial analysis of GA and EMA confirmed a high prevalence of CD in adult IDDM (2.6%). False‐positive IgA‐GA test results are frequent in patients with diabetes, irrespective of type. EMA analysis is the preferable screening tool for CD in diabetes.
Diagnostic and therapeutic criteria in patients with Zollinger–Ellison syndrome and multiple endocrine neoplasia type 1
Authors: Mignon  , Cadiot
Published: March 2003

: Mignon M, Cadiot G (Bichat and Claude Bernard Hospital, Paris, France). Diagnostic and therapeutic criteria in patients with Zollinger–Ellison syndrome and multiple endocrine neoplasia type 1 (Minisymposium: MEN & VHL). J Intern Med 1998; 243: 489–94.

About 25% of patients with ZES have MEN‐1. Except for diarrhoea, less frequent in patients with ZES MEN‐1 than in sporadic ZES, and specific MEN‐1‐related signs, clinical characteristics are similar in both ZES types. Acid output and gastrin level are also similar whether in the basal state or after secretin. Primary hyperparathyroidism (pHPT) exists in the majority of ZES MEN‐1 patients, 30% have pituitary adenoma (prolactinomas for half), 30% adrenal involvement, 25–30% have ECLomas: bronchial and thymic carcinoids have probably been underevaluated.

Gastrinomas are multiple predominantly located in the duodenal wall, but also in the pancreas in association with clinically silent endocrine tumours.

The spread of the disease metastases to the liver (LM), mediastinum, bones, is evaluated best by Octreoscan. Associated endoscopic ultrasonography evaluates the number, size and anatomical characteristics of gastrinomas. Patients without LM have an excellent prognosis. Surgery never cures ZES, but is necessary in cases of associated life‐threatening conditions such as insulinoma.

Although the size of the tumour, when located in the pancreas >3 cm, favours metachronous LM occurrence, surgery in our experience has not been able to prevent LM development.
Current concepts in the surgical management of multiple endocrine neoplasia type 1 pancreatic‐duodenal disease. Results in the treatment of 40 patients with Zollinger–Ellison syndrome, hypoglycaemia or both
Authors: Thompson
Published: March 2003

Thompson NW (University of Michigan, Ann Arbor, MI, USA). Current concepts in the surgical management of multiple endocrine neoplasia type 1 pancreatic‐duodenal disease. Results in the treatment of 40 patients with Zollinger– Ellison syndrome, hypoglycaemia or both (Minisymposium: MEN & VHL). J Intern Med 1998; 243: 495–500.

The management of multiple endocrine neoplasia type 1 (MEN‐1) pancreatic‐duodenal disease, particularly when the Zollinger–Ellison syndrome (ZES) is the presenting manifestation, has remained controversial. The management of hypoglycaemia and other syndromes as well as large tumours detected by imaging is less controversial, although standardized surgical techniques have not been generally adapted. The rationale for an aggressive operative management plan for ZES and other syndromes is based on the facts that neuroendocrine tumours of both the pancreas and the duodenum have malignant potential and that the functional manifestations can be controlled with appropriate surgical procedures based on current concepts of the MEN‐1 disease. Of the ten concepts presented, the one critical to the surgical treatment of ZES is that a duodenotomy is essential in detecting the source of hypergastrinaemia in most MEN‐1 patients. The complete operation is multifaceted and includes peripancreatic lymph node dissection (ZES), enucleation of any head or uncinate tumours and a distal pancreatectomy. Our results in 40 MEN‐1 patients with functional syndromes treated with these procedures are encouraging. Ten patients with hypoglycaemia (four with concomitant ZES) have been ‘cured’ with follow‐up as long as 18 years. Sixty‐eight per cent of 34 patients with ZES have remained eugastrinaemic during follow‐up as long as 19 years. One patient developed a solitary liver metastasis that was excised a year ago without other evidence of recurrence. There has been no operative mortality and three subsequent deaths were due to unrelated disease.
Diet and pravastatin in moderate hypercholesterolaemia: a randomized trial in 215 middle‐aged men free from cardiovascular disease
Authors: Bak  , Huizer  , Leijten  , Rila  , Grobbee
Published: March 2003

Abstract. Bak AAA, Huizer J, Leijten PA, Rila H, Grobbee DE (Utrecht University Medical School, Utrecht; Andro Medical Research, Rotterdam; and Bristol‐Myers Squibb, Woerden, The Netherlands). Diet and pravastatin in moderate hypercholesterolaemia: a randomized trial in 215 middle‐aged men free from cardiovascular disease. J Intern Med 1998; 244: 371–8.

Objective

To evaluate the effect of diet and drug intervention separately and combined in the treatment of primary hypercholesterolemia.

Design

The study was conducted as a randomized, placebo‐controlled factorial trial, double‐blinded for drug intervention.

Setting

Subjects were recruited from a population‐based cholesterol screening programme.

Subjects

215 middle‐aged men with primary hypercholesterolemia, free from cardiovascular disease.

Interventions

Subjects were randomized to one of four intervention groups: (1) placebo and US National Cholesterol Education Program step 1 diet; (2) placebo and step 2 diet; (3) pravastatin 20 mg day−1 and step 1 diet; or (4) pravastatin 20 mg day−1 and step 2 diet. The intervention period was 6 months.

Main outcome measurements

Efficacy measurements included: serum total cholesterol, HDL cholesterol, triglycerides, apolipoproteins A1 and B. LDL cholesterol was calculated. For safety, values of ALAT, ASAT and CK were measured.

Results

In the group receiving the step 1 diet only, lipid values were stable during the study period. In the placebo group on the step 2 diet, total cholesterol decreased by 6.3% (0.47 mmol L−1 (95% CI: 0.28, 0.67)) during 6 months. In the group receiving both pravastatin and the step 1 diet, there was a mean reduction in serum total cholesterol of 19.4% (1.46 mmol L−1 (95% CI: 1.20, 1.72)). In the group treated with pravastatin and the step 2 diet, the 6 months of data show a reduction of 20.7% (1.55 mmol L−1 (95% CI: 1.30, 1.80)).

Conclusions

If drug therapy with a HMG‐CoA reductase inhibitor is considered necessary, a step 2 diet has no additional lipid‐lowering effect compared with a step 1 diet in men with primary hypercholesterolaemia. However, favourable ‘side‐effects’ of a lipid‐lowering diet, such as weight loss and lowering of blood pressure, may still warrant a low‐fat diet in these cases.
Perceived symptoms amongst hypertensive patients in routine clinical practice – a population‐based study
Authors: Kjellgren K. I. , Ahlner J. , DahlÖF B. , Gill H. , Hedner T. , SÄljÖ R.
Published: March 2003

Kjellgren KI, Ahlner J, Dahlöf B, Gill H, Hedner T, Säljö R (Faculty of Health Sciences, Linköping; Sahlgrenska University Hospital, Göteborg; and Linköping University, Linköping, Sweden). Perceived symptoms amongst hypertensive patients in routine clinical practice – a population‐based study. J Intern Med 1998; 244: 325–332.

Objectives

.To compare perceived symptoms between patients undergoing antihypertensive therapy and hypertensive patients without drug treatment, and to assess reasons for change of antihypertensive medication in routine clinical practice.

Design

.Population‐based multicentre study. Consecutive patients from a randomized sample of centres were given a standardized questionnaire to assess symptoms as well as opinions about their antihypertensive drugs.

Setting

.Fifty‐five Swedish primary health care centres and 11 clinics of internal medicine.

Patients

.One thousand and thirteen hypertensive patients on their individually prescribed antihypertensive medication and 135 without antihypertensive therapy.

Main outcome measures

.Prevalence and perception of symptoms with and without antihypertensive drug therapy, changes of medication and reasons for this.

Results

.Amongst the group of patients on antihypertensive medication, 57% spontaneously reported having had symptoms of high blood pressure before they started their drug therapy. Amongst the patients without antihypertensive drugs, 52% reported having such symptoms. When answering direct questions about different symptoms related to current drug treatment or increased blood pressure, patients with and without medication reported symptoms to a similar extent: 80 and 85%, respectively. A majority of patients (64%) had changed their medication during the course of treatment (range 0–61 years). The mean number of changes was 2.4 times over 12 years. The most common reported cause for changing drug treatment was side‐effects (42%).

Conclusions

.The study shows that patients in general perceive symptoms from hypertension. Antihypertensive medication decreases the frequency and intensity of symptoms that might be related to high blood pressure but adds other symptoms linked to the medication. Changes in medication were mostly related to side‐effects. The follow‐up should pay attention to patients' experience of treatment. A sign of a well‐managed hypertension population would be a decrease of symptoms over time.
Under‐reporting of dietary intake by smoking and non‐smoking subjects counselled for hypercholesterolaemia
Authors: Tonstad S. , Gørbitz C. , Sivertsen M. , Ose L.
Published: March 2003

Objectives.  We asked whether under‐reporting of energy and cigarette smoking were associated with choice of foods and dietary composition amongst subjects with hypercholesterolaemia who had received dietary instruction to lower serum cholesterol.

Design, setting and subjects.  Dietary intake was assessed with a 4‐day weighed food record in 205 women and 141 men, aged 20–73 years, being treated at a lipid clinic (tertiary referral centre). Under‐reporting was assessed by calculating the ratio of energy intake (EI) to estimated basal metabolic rate (BMR).

Results.  The median EI/BMR was 1.1 for both men and women. EI/BMR did not differ according to smoking status, but correlated negatively with body mass index (Spearman’s ρ = –0.32, P = 0.0001). EI/BMR was inversely associated with energy‐adjusted intakes of potatoes, vegetables, fish and low‐fat meats, and positively associated with intakes of nuts, potato crisps, chocolate, sour and ice cream, oils, fatty meat spreads, cakes and biscuits, and with alcohol. Thus, low EI/BMR was associated with increased energy‐adjusted intakes of protein, thiamine, riboflavin, niacin, iron and cholesterol and with decreased intakes of sugar, poly‐ and monounsaturated fats and vitamin E (all P < 0.05). Cigarette smokers had a higher energy percentage (E%) from fat than non‐smokers (29 ± 6 vs. 26 ± 6), a lower E% from carbohydrates (50 ± 7 vs. 54 ± 7) and a lower intake of vitamin C (11 ± 7 vs. 16 ± 9 mg MJ–1; all P = 0.0001), reflecting an increased intake of fatty meats and a decreased intake of skimmed cheese, fruit, rice and pasta, and cakes and biscuits (all P < 0.05).

Conclusion.  Weighed dietary records reflected a ‘healthier’ intake of fat, protein, sugar, alcohol and some micronutrients amongst under‐reporters, suggesting that self‐reported dietary intakes are biased in patients with hypercholesterolaemia. Lack of responsiveness to the diet should not be assumed when dietary data are based on self‐report. Smokers report a higher intake of fat and lower intake of vitamin C than non‐smokers, even after dietary counsel, and may require more intensive interventions to optimize the diet.
Genetics of human obesity: lessons from mouse models and candidate genes
Authors: Echwald S. M.
Published: March 2003

Abstract. Echwald SM (Steno Diabetes Centre and Hagedorn Research Institute, Gentofte, Denmark). Genetics of human obesity: lessons from mouse models and candidate genes. (Minisymposium: Genes & Obesity). J Intern Med 1999; 245: 653–666.

Obesity is a common disorder with potentially serious negative implications on health and quality of life and a rising prevalence worldwide, warranting effective treatments. The disorder runs in families, and important knowledge is expected to follow the identification of human obesity genes. Although statistical analysis of inheritance of obesity in humans suggests a large genetic component in obesity, up to 80%, few actual obesity genes have been identified so far. However, a number of obesity causing genes have successfully been cloned from rodents with monogenic forms of obesity, and it is probable that new knowledge in the field of human obesity will result from these findings.
Improvement in quality of life differs between women and men after coronary artery bypass surgery
Authors: Sjöland H. , Wiklund I. , Caidahl K. , Hartford M. , Karlsson T. , Herlitz J.
Published: March 2003

Abstract. Sjöland H, Wiklund I, Caidahl K, Hartford M, Karlsson T, Herlitz J (Sahlgrenska University Hospital, Göteborg, and Astra Hässle AB, Mölndal, Sweden). Improvement in quality of life differs between women and men after coronary artery bypass surgery. J Intern Med 1999; 245: 445–454.

Objective. To study improvement in quality of life (QoL) after coronary artery bypass grafting (CABG) in relation to gender.

Background. Women generally report worse QoL after CABG than men. However, women are older and more symptomatic prior to surgery, which should be considered in comparative analyses.

Methods. We studied consecutive patients who underwent CABG between 1988 and 1991 [n = 2121] with a QoL questionnaire containing the Physical Activity Score, the Nottingham Health Profile and the Psychological General Well‐being Index prior to, 3 months, 1 year and 2 years after surgery.

Results. Females were older than men with more concomitant diseases preoperatively. QoL was improved on all postoperative occasions for both sexes. Improvement in the Physical Activity Score was somewhat, although not significantly, greater in males. Improvement in the Nottingham Health Profile was greater in females. General well‐being showed no consistent pattern for improvement.

Conclusions. QoL is significantly improved after CABG in both sexes throughout follow‐up. There is a complex association between improvement in various aspects of QoL and gender.
Ventricular arrhythmias during 24‐h ambulatory ECG recording: incidence, risk factors and prognosis in men with and without a history of cardiovascular disease
Authors: Engström G. , Hedblad B. , Janzon L. , Juul‐Möller S.
Published: March 2003

Abstract.Engström G, Hedblad B, Janzon L, Juul‐Möller S (Malmö University Hospital, Malmö, Sweden). Ventricular arrhythmias during 24‐h ambulatory ECG recording: incidence, risk factors and prognosis in men with and without a history of cardiovascular disease.J Intern Med1999;246:363–372.

Objective.To study incidence, prognosis and risk factors of ventricular arrhythmias in men with and without asymptomatic non‐invasively detected cardiovascular disease (CVD).

Design.Prospective cohort study with 11 years’ follow‐up. The subjects went through 24‐h ambulatory electrocardiographic (ECG) registrations and non‐invasive examinations of leg and carotid arteries at the baseline examination.

Setting.Malmö, Sweden.

Subjects.Four hundred and forty‐three randomly selected 68‐year‐old men.

Main outcome measures.Mortality and cardiac event rates during an 11‐year period.

Results.Frequent or complex arrhythmias (Lown class 2–5) were common in men both with and without CVD. However, the associated prognoses were different. In men with CVD, frequent or complex arrhythmias were associated with increased cardiac event rates (P = 0.001) and increased mortality (P = 0.054). This pattern was also found in men with asymptomatic leg and carotid artery disease, although the frequency of arrhythmia in Lown class 2–5 was similar to that in men without CVD. Men with angina pectoris or previous myocardial infarction in combination with leg or carotid artery disease had the most arrhythmias and the worst prognosis. No relationship between frequent or complex arrhythmias and mortality or cardiac events was found in men without CVD. In a logistic regression, smoking and diabetes mellitus were significant and independent determinants of frequent or complex arrhythmias in men with CVD. High alcohol consumption was associated with arrhythmias in men without CVD.

Conclusion.Ambulatory ECG recording is a feasible method to improve risk assessment in men with CVD. In this group, frequent or complex arrhythmias are associated with smoking and diabetes mellitus.
The health care costs of heart failure in Sweden
Authors: Rydén‐Bergsten T. , Andersson F.
Published: March 2003

Abstract. Rydén‐Bergsten T, Andersson F (AstraZeneca R&D, Lund; and AstraZeneca R&D, Mölndal; Sweden). The health care costs of heart failure in Sweden. J Intern Med 1999; 246: 275–284.

Aim. Heart failure is a common and serious condition requiring extensive health care resources. The aim of this study is to estimate the total treatment costs of heart failure in Sweden.

Methods and results. The study is a prevalence‐based cost‐of‐illness study. It includes costs of institutional care (hospitals and nursing homes), outpatient care, surgery and drugs. The costs are estimated based on official Swedish statistics, and on various clinical and epidemiological studies. The results are expressed in 1996 prices. The total annual treatment costs for heart failure are approximately Swedish kronor (SEK) 2000–2600 million , or nearly 2% of the Swedish health care budget. Institutional care is the single largest component, amounting to SEK 1300–1900 million , or about 65–75% of the costs of heart failure treatment.

Conclusions. The results from this study indicate that heart failure is a costly condition. Efforts to develop effective management programmes that can reduce the need for expensive institutional care, without a negative impact on quality of life, morbidity and mortality, should be given high priority.
Quality of life after cerebrovascular stroke: a systematic study of patients’ preferences for different functional outcomes
Authors: Hallan S. , Åsberg A. , Indredavik B. , Widerøe T. E.
Published: March 2003

Abstract.Hallan S, Åsberg A, Indredavik B, Widerøe TE (University Hospital of Trondheim, Trondheim, Norway). Quality of life after cerebrovascular stroke: a systematic study of patients’ preferences for different functional outcomes.J Intern Med1999;246:309–316.

Objectives.To elicit valid quality of life estimates and the highest acceptable treatment risk of different outcomes after stroke. This is a prerequisite for rational medical decision‐making, especially when considering treatments like thrombolysis.

Subjects.Healthy people, non‐stroke medical patients and stroke survivors aged 20–84 years (n = 158)

Interventions.Subjects were interviewed by a physician using three different methods (‘standard gamble’, ‘time trade‐off’ and ‘direct scaling’) supported by an interactive computer program.

Main outcome measures.We measured utility, a numerical value ranging from 0.00 (death) to 1.00 (perfect health), representing the strength of the patient’s preference for an outcome. When using the standard gamble method, risk is also introduced into the measurement.

Results.People’s preferences for stroke outcomes varied widely, and the estimates were influenced by assessment method. We found that previous stroke, marital status and age were the only independent variables influencing the utility given. Subjects in our population over the age of 45 were very comparable to the real population at risk for acute stroke regarding these three variables, and they assigned a median utility of 0.91 (10th percentile, 0.65; 90th percentile, 0.99) to a minor stroke and 0.61 (10th percentile, 0.08; 90th percentile, 0.95) to a major stroke using the standard gamble method.

Conclusions.Most people do not feel that suffering from stroke is an overwhelming catastrophe and they do not accept treatment options with very high risks.
Gas chromatographic–mass spectrometric analysis of urinary glycyrrhetinic acid: an aid in diagnosing liquorice abuse
Authors: Kerstens M. N. , Guillaume C. P. F. , Wolthers B. G. , Dullaart R. P. F.
Published: March 2003

Abstract. Kerstens MN, Guillaume CPF, Wolthers BG, Dullaart RPF (University Hospital Groningen, Groningen, The Netherlands). Gas chromatographic–mass spectrometric analysis of urinary glycyrrhetinic acid: an aid in diagnosing liquorice abuse. J Intern Med 1999; 246: 539–547.

Objectives. Liquorice abuse can lead to severe clinical complications, caused by its active compound 18β‐glycyrrhetinic acid (18βGA). 18βGA inhibits dehydrogenase activity of 11β‐hydroxysteroid dehydrogenase (11βHSD). This enzyme catalyses the interconversion between cortisol and cortisone and normally protects the mineralocorticoid receptor from being activated by cortisol. Diagnosing liquorice abuse can be notoriously difficult. The aim of our study was to develop an accurate and clinically applicable 18βGA urinary assay.

Design. We developed a urinary 18βGA assay based on gas chromatography and mass spectrometry (GCMS) with sufficient sensitivity to detect 18βGA at low concentrations. The assay was validated in four volunteers consuming different amounts of liquorice. We applied its use in two patients with hypokalaemic hypertension and suppressed plasma renin activity and serum aldosterone, who were suspected of liquorice abuse.

Results. The detection limit for 18βGA of the GC assay was 10 µg L–1, which was lowered to 3 µg L–1 by subsequent application of MS. In all volunteers, urinary 18βGA was detected during liquorice intake. Urinary 18βGA remained detectable until 5 days after stopping continued liquorice intake and until at least 51 h after ingestion of a single large amount. Urinary 18βGA was demonstrated in both patients, establishing a diagnosis of liquorice abuse. One patient showed changes in urinary cortisol metabolites, consistent with 11βHSD inhibition. Changes in cortisol metabolites were less pronounced in the other patient.

Conclusion. Liquorice abuse can result in hypokalaemic hypertension with prolonged suppression of plasma renin activity and aldosterone concentration. This is caused by 18βGA‐mediated inhibition of 11βHSD, resulting in activation of the renal mineralocorticoid receptor by cortisol. Urinary 18βGA measurement by GCMS is a useful aid in establishing liquorice abuse.
QT interval measurement: Q to TApex or Q to TEnd?
Authors: Davey P. P.
Published: March 2003

Abstract. Davey PP (John Radcliffe Hospital, Oxford, England, UK). QT interval measurement: Q to TApex or Q to TEnd? J Intern Med 1999; 246: 145–149.

Objective. To study QT interval. QT interval is frequently measured, though there is variation in the literature as to whether it is more appropriate to measure from the Q wave to the apex of the T wave, which is methodologically easy, or to measure to the end of the T wave.

Hypothesis.
For Q–TApex interval to be used as a measure of repolarization, the variability of the Q–T interval should lie in this early phase. This should be true in health and in disease, at rest and with physiological interventions such as exercise. If there is variability in the TApex –TEnd interval, this should be reflected by the variability in the Q–TApex interval.

Methods. Fifty‐six subjects were recruited: 24 with heart failure, 16 with left ventricular hypertrophy and 16 controls. Q–TApex, Q–TEnd and TApex–TEnd intervals were measured at rest and on exercise.

Results. Q–T
Apex intervals at rest were not different amongst the three groups studied, being 339 ± 7 ms for controls, 341 ± 6 ms in left ventricular hypertrophy and 351 ± 6 ms in heart failure. The Q–TEnd interval at rest was 421 ± 6 ms in controls, 420 ± 6 ms in hypertrophy and 461 ± 9 ms in failure (P < 0.05 for failure versus hypertrophy or control). Thus the TApex–TEnd interval was prolonged in heart failure at rest. However, at peak exercise there was no difference between the TApex–TEnd intervals in the different groups. Variability in the TApex–TEnd interval induced by disease or by exercise was not related to variability in the Q–TApex interval.

Conclusion. Q–T
End rather than Q–TApex should be used when Q–T interval measurement is required.
Psychosocial variables in relation to various risk factors in patients with stable angina pectoris
Authors: Billing E. , Eriksson S. V. , Hjemdahl P. , Rehnqvist N.
Published: March 2003

Objectives.To evaluate relationships between psychosocial variables and common risk factors such as age, concomitant diseases (hypertension, diabetes mellitus, myocardial infarction, heart failure) and smoking habits in patients with stable angina pectoris.

Setting.University Hospital.

Subjects.Participants in the Angina Prognosis Study in Stockholm (APSIS), which comprised 809 patients (248 females) <70 years of age, with chronic stable angina pectoris, of whom 767 (236 females) participated in the present report. Patients with angina pectoris occurring only at rest constituted one group, patients with angina pectoris on effort with or without angina at rest were stratified according to signs of marked ischaemia on exercise and/or clinical signs of heart failure.

Methods.Psychosomatic symptoms, job strain, Type‐A behaviour, sleep disturbances and overall life satisfaction were evaluated by a structured interview, which also included questions regarding how the patients usually felt, and health related problems, according to a standardized check‐list.

Results.Age correlated with several psychosomatic symptoms and tendency to worry. When adjusted for age and sex, patients with previous myocardial infarction and heart failure described more psychosomatic symptoms, but worried less about the future than patients without these diseases. In the group with angina pectoris at rest only there were fewer smokers than amongst other groups, regardless of risk stratification.

Conclusions.Smoking habits and concomitant diseases influence psychosocial variables in patients with stable angina pectoris. The severity of angina pectoris does not seem to relate to life satisfaction and attitudes towards the future.
Activity of cardiopulmonary baroreceptors, peripheral resistance and cutaneous microcirculation in patients with peripheral obstructive arterial disease
Authors: Arosio E. , De Marchi S. , Prior M. , Zannoni M. , Lucchese L. , Lechi A.
Published: March 2003

Abstract. Arosio E, De Marchi S, Prior M, Zannoni M, Lucchese L, Lechi A (Division of Vascular Medicine and Rehabilitation, University of Verona, Italy). Activity of cardiopulmonary baroreceptors, peripheral resistance and cutaneous microcirculation in patients with peripheral obstructive arterial disease. J Intern Med 2000; 247: 471–478.

Objectives. To assess the effects of cardiopulmonary baroreceptors on the haemodynamics of the humeral and common carotid arteries in patients suffering from peripheral artery disease (PAD) and to discover whether the stimulation of these receptors modifies the cutaneous microcirculation in the forearm.

Design. We studied a group of patients suffering from peripheral artery disease and two groups as controls.

Setting. Patients were examined at the ambulatory for Vascular Research, Division of Vascular Medicine and Rehabilitation, University of Verona.

Patients. We studied 15 patients with peripheral artery disease of the lower limbs at Fontaine stage II (group C), 10 free of arterial pathologies (group B) and 10 young people (group A).

Main outcome measures. We subjected the patients to passive elevation of the legs and the trunk in a horizontal position with pressure monitoring and measurement of the calibre and flow in the brachial and common carotid arteries using a colourDoppler ultrasound. We also studied the cutaneous microcirculation with laserDoppler flowmetry.

Results. During the test, arterial pressure and cardiac frequency remained constant in group A, systolic pressure values showed a slight, but statistically significant increase in group B, whilst the increase in systolic pressure values at this stage was marked in group C. Diastolic pressure values and cardiac frequency remained unchanged in all groups. The calibre of the humeral artery increased in the control groups. Carotid resistance was unchanged in the three groups. Humeral resistance during the test decreased in the two control groups whilst it increased in group C. The number of perfusion units felt in the control groups; no variations in group C.

Conclusions. Our study demonstrates, in patients with peripheral artery disease, a reduction in the activity of the cardiopulmonary baroreceptors with an increase in the humeral resistance during the test and impairment of the mechanisms of cutaneous microcirculatory vasoregulation in the forearm.
Myocardial hypertrophy in transgenic mice overexpressing the bovine growth hormone (bGH) gene
Authors: Fu M. L. X. , Törnell J. , Schulze W. , Hoebeke J. , Isaksson O. G. P. , Sandstedt J. , Hjalmarson Å.
Published: March 2003

Abstract. Fu MLX, Törnell J, Schulze W, Hoebeke J, Isaksson OGP, Sandstedt J, Hjalmarson A (Sahlgrenska University Hospital and University of Göteborg, Göteborg, Sweden; Max‐Delbrück‐Centrum, Berlin, Germany; and IBMC, Strasbourg, France). Myocardial hypertrophy in transgenic mice overexpressing the bovine growth hormone (bGH) gene. J Intern Med 2000; 247: 546–552.

Objectives. The main purpose of the present study was to characterize cardiac muscle hypertrophy using both qualitative and quantitative microscopy in mice overexpressing the bovine growth hormone.

Results. Measurements of 30 fibres from each group revealed that fibre diameter in transgenic hearts was significantly larger than in control hearts. There was a significant decrease in interfibrillar space in transgenic hearts as compared with control hearts. The enlarged transgenic hearts displayed unchanged organelles such as normal myofibrils and mitochondria in a normal pattern, suggesting balanced growth. Myelin structures were occasionally observed between normal myofibrils. Moreover, myocardial β‐adrenergic receptors and muscarinic receptors in the hearts of transgenic mice overproducing GH were studied to see whether they are involved in the hypertrophic process. It was shown that the density of muscarinic receptors had decreased and the super‐high affinity of muscarinic receptors was lost, without any significant changes in either the density or the affinity of β‐adrenergic receptors, as compared with controls.

Conclusions. These results demonstrate that a GH excess was able to induce significant myocardial hypertrophy and that there was a downregulation of muscarinic receptors.
Could attacks of abdominal pain in cases of acute intermittent porphyria be due to intestinal angina?
Authors: Lithner F.
Published: March 2003

Abstract.   Lithner F (Department of Medicine, University Hospital, Umeå, Sweden). Could attacks of abdominal pain in cases of acute intermittent porphyria be due to intestinal angina? J Intern Med 2000; 247: 407–409.

Abdominal pain is by far the most serious symptom in attacks of acute intermittent porphyria. Its cause is unknown. This case study suggests visceral ischaemia as a possible cause of the abdominal pain. A 31‐year‐old woman with recurrent bouts died during an attack; the autopsy revealed a 20‐cm necrotic gangrene in the ileum. A protracted intestinal vasospasm could have been the immediate cause of death. It is discussed whether intestinal angina could be the cause of the abdominal pain in acute intermittent porphyria.
Distribution and determinants of ischaemic heart disease in an urban population. A study from the myocardial infarction register in Malmö, Sweden
Authors: Engström G. , Berglund G. , Göransson M. , Hansen O. , Hedblad B. , Merlo J. , Tydén P. , Janzon L.
Published: March 2003

Abstract.Engström G, Berglund G, Göransson M, Hansen O, Hedblad B, Merlo J, Tydén P, Janzon L (Malmö University Hospital, Malmö, Sweden). Distribution and determinants of ischaemic heart disease in an urban population. A study from the myocardial infarction register in Malmö, Sweden.J Intern Med2000:247; 588–596.

Objective.Age adjusted incidence of myocardial infarction has been found to vary substantially between the residential areas of the city of Malmö. The objective of this study was to assess the extent to which major biological risk factors and socio‐economic circumstances account for the differences in incidence of and mortality from myocardial infarction.

Design.Ecological study of risk factor prevalence and incidence and mortality from myocardial infarction.

Setting.Seventeen administrative areas in Malmö, Sweden.

Subjects.Assessment of risk factor prevalence was based on 28 466 men and women, ranging from 45 to 73 years old, who were recruited as participants in the Malmö Diet and Cancer study. Information on serum lipids was available in a random subsample of 5362 subjects. Information about socio‐economic level of the residential area was based on statistics from the Malmö City Council and Statistics Sweden.

Main outcome measures.Weighted least square regressions between prevalence of risk factors (i.e. smoking, hypertension, obesity, diabetes, hypercholesterolemia and hypertriglyceridemia), a myocardial infarction risk score, a socio‐economic score and incidence and mortality from myocardial infarction.

Results.The risk factor prevalence and myocardial infarction incidence was highest in areas with low socio‐economic level. Prevalence of smoking, obesity and hypertension was significantly associated with myocardial infarction incidence and mortality rates amongst men (allr > 0.60). Prevalence of smoking was significantly associated with incidence and mortality from myocardial infarction amongst women (r = 0.66 andr = 0.61, respectively). A myocardial infarction risk score based on four biological risk factors explained 40–60% of the intra‐urban geographical variation in myocardial infarction incidence and mortality. The socio‐economic score added a further 2–16% to the explained variance.

Conclusion.In an urban population with similar access to medical care, well‐known biological cardiovascular risk factors account for a substantial proportion of the intra‐urban geographical variation of incidence of and mortality from myocardial infarction. The socio‐economic circumstances further contribute to the intra‐urban variation in disease.
The association between C‐reactive protein on admission and mortality in patients with acute myocardial infarction
Authors: Nikfardjam M. , Müllner M. , Schreiber W. , Oschatz E. , Exner M. , Domanovits H. , Laggner A. N. , Huber K.
Published: March 2003

Abstract. Nikfardjam M, Müllner M, Schreiber W, Oschatz E, Exner M, Domanovits H, Laggner AN, Huber K (Vienna General Hospital, University of Vienna, Austria). The association between C‐reactive protein on admission and mortality in patients with acute myocardial infarction. J Intern Med 2000; 247: 341–345.

Objective. In patients presenting with acute myocardial infarction the pathophysiologic and prognostic value of serum C‐reactive protein is not well defined. This study assessed the association between serum C‐reactive protein levels on admission and mortality in patients admitted because of acute myocardial infarction.

Design. Retrospective cohort study.

Setting. Tertiary care centre.

Patients. A total of 729 patients with acute myocardial infarction admitted within a period of 3 years.

Main outcome measures. C‐reactive protein levels on admission, cardiovascular risk factors and survival within the observational period.

Results. Within the 3‐year observational period, 118 patients died of a cardiovascular cause. With increasing serum C‐reactive protein levels (<0.5, 0.5 to <2, 2 to <5, 5–10 and >10 mg dL–1) mortality also increased (14%, 19%, 20%, 39% and 28%, respectively). When controlling for the confounding effect of age, thrombolytic treatment, the time interval between onset of pain and admission, smoking, diabetes mellitus, hypercholesterolemia, hypertension, and elevated creatine kinase on admission in a multivariate Cox regression model, there was only a weak and nonsignificant association between increased serum C‐reactive protein and the risk of death.

Conclusions. Patients with elevated concentrations of serum C‐reactive protein admitted to the hospital because of acute myocardial infarction are at an increased risk of dying. This association is however, largely explained by other baseline variables, in particular by an estimate of the duration of myocardial ischaemia. If C‐reactive protein measured by means of an ultra‐sensitive assay is more suitable for risk stratification of unselected patients with acute myocardial infarction, needs further study.
Chronic systemic capillary leak syndrome. Report of a case and review of the literature
Authors: Airaghi L. , Montori D. , Santambrogio L. , Miadonna A. , Tedeschi A.
Published: March 2003

Abstract. Airaghi L, Montori D, Santambrogio L, Miadonna A, Tedeschi A (IRCCS Ospedale Maggiore Policlinico, Milan, Italy). Chronic systemic capillary leak syndrome. Report of a case and review of the literature (Case Report). J Intern Med 2000; 247: 731–735.

Systemic capillary leak syndrome (SCLS) is a rare condition characterized by recurrent episodes of generalized oedema and severe hypotension, associated with paraproteinaemia. In addition to the acute form, a few cases of chronic SCLS have been reported. We describe a 64‐year‐old woman who was hospitalized because of a 6‐month history of progressive generalized oedema with pericardial and pleural effusions, associated with a serum paraprotein. Clinical and laboratory findings were consistent with a chronic form of SCLS. Treatment with prednisone, furosemide and theophylline was started, which led to a gradual improvement in 2 weeks and a persistent remission after 9 months. This report indicates that SCLS may occur in a chronic form, which seems to be responsive to a therapeutic regimen with prednisone, furosemide, and theophylline.
Effectiveness of heparin treatment for progressing ischaemic stroke: before and after study
Authors: Rödén‐Jüllig Å. , Britton M.
Published: March 2003

Abstract. Rödén‐Jüllig Å, Britton M (Danderyd Hospital, and the Swedish Council on Technology Assessment in Health Care, Stockholm, Sweden). Effectiveness of heparin treatment for progressing ischaemic stroke: before and after study. J Intern Med 2000; 248: 287–291.

Objectives. During the acute phase of stroke, symptoms progress in 25% of patients, resulting in a worse outcome. Could heparin treatment improve the situation?

Design. Before and after study. During the first period, no treatment was given to patients with progress of symptoms, whereas heparin was used regularly in the second period. A comparison of outcome was performed.

Setting. Patients with acute stroke cared for in stroke units of two big emergency hospitals in Stockholm. Besides heparin treatment, the groups were taken care of according to the same basic principles.

Subjects. Consecutive patients admitted to a stroke unit during two periods of time. The first study comprised 314 patients with ischaemic stroke and the second 907.

Intervention. In the treatment period, patients with ischaemic stroke and objectively recognized progression received heparin infusion for at least 5 days.

Main outcome measures. Continued progression, length of stay, unaided walking at discharge, discharge destination and mortality.

Results. The progression rate was non‐significantly higher in the first period: 28 vs. 21%. One‐third continued to progress regardless of treatment given. Patients with progression, treated and untreated alike, had 40% longer stay in the stroke unit compared with stable patients, whereas mortality was unaffected. Treatment did not reduce the proportion of patients who needed aid for walking at discharge (77 vs. 74%) or those who needed further institutionalized care (65 vs. 66%).

Conclusion. Progression of focal stroke symptoms still constitutes a serious clinical problem for which heparin has insufficient effectiveness in clinical practice. New therapies, ideally preventive, are needed.
Consumption of French‐press coffee raises cholesteryl ester transfer protein activity levels before LDL cholesterol in normolipidaemic subjects
Authors: De Roos B. , Van Tol A. , Urgert R. , Scheek L. M. , Van Gent T. , Buytenhek R. , Princen H. M. G. , Katan M. B.
Published: March 2003

Abstract. de Roos B, van Tol A, Urgert R, Scheek LM, van Gent T, Buytenhek R, Princen HMG, Katan MB (Wageningen University; Erasmus University, Rotterdam; and Gaubius Laboratory, Leiden; Wageningen Centre for Food Sciences, The Netherlands). Consumption of French‐press coffee raises cholesteryl ester transfer protein activity levels before LDL cholesterol in normolipidaemic subjects. J Intern Med 2000; 248: 211–216.

Objectives. To determine the long‐term effects of unfiltered coffee consumption on the activity levels of cholesteryl ester transfer protein (CETP), phospholipid transfer protein (PLTP) and lecithin:cholesterol acyltransferase (LCAT) and to assess a possible role of CETP activity levels in the rise in serum LDL cholesterol.

Subjects and design. Forty‐six healthy normolipidaemic subjects consumed 0.9 L of either French‐press or filtered coffee for 24 weeks. Fasting blood samples were obtained after 0, 2, 12 and 24 weeks of intervention and after and 12 weeks of follow‐up.

Main outcome measures. Serum activity levels of CETP, PLTP and LCAT.

Results. Relative to baseline, French‐press coffee significantly increased average CETP activity by 12% after 2 weeks, by 18% after 12 weeks, and by 9% after 24 weeks. PLTP activity was significantly increased by 10% after 12 and 24 weeks. LCAT activity was significantly decreased by 6% after 12 weeks and by 7% after 24 weeks. The increase in CETP clearly preceded the increase in LDL cholesterol, but not the increase in total triglycerides. However, consumption of French‐press coffee caused a persistent rise in CETP activity, whereas the rise in serum triglycerides was transient.

Conclusions. Consumption of cafestol and kahweol cause a long‐term increase in CETP as well as PLTP activity; the increase in CETP activity may contribute to the rise in LDL cholesterol.
Mycobacterium genavense infection in a patient with long‐standing chronic lymphocytic leukaemia
Authors: Krebs T. , Zimmerli S. , Bodmer T. , Lämmle B.
Published: March 2003

Abstract. Krebs T, Zimmerli S, Bodmer T & Lämmle B (Central Hematology Laboratory, Inselspital, University Hospital of Bern; Institute of Medical Microbiology, University of Bern, Bern, Switzerland). Mycobacterium genavense infection in a patient with long‐standing chronic lymphocytic leukaemia (Case Report). J Intern Med 2000; 248: 343–348.

We describe the first case of disseminated infection with Mycobacterium genavense in an HIV‐seronegative patient with a chronic haematological disorder. Our patient, an 80‐year‐old woman, had been under long‐term treatment with chlorambucil (partially in combination with prednisone) for B‐cell chronic lymphocytic leukaemia (B‐CLL). When she developed general fatigue and progressive anaemia, as well as progressive lymphadenopathy and splenomegaly, bone marrow biopsy revealed granulomas with acid‐fast bacilli, and cultures of both bone marrow and blood grew M. genavense. The patient’s CD4+ cell count was approximately 100 µL–1. Treatment with clarithromycin, ethambutol and rifabutin resulted in improvement of anaemia and general health as well as in regression of lymphadenopathy and splenomegaly.