bluuebunny/crossref_metadata_2025 huggingface dataset:
Comparative assessment of growth of Trypanosoma danilewskyi (Laveran & Mesnil) in medium containing fish or mammalian serum
Authors: Bienek D R , Belosevic M
Published: November 2003

The objective of this study was to determine the growth of Trypanosoma danilewskyi (Laveran & Mesnil, 1904) from goldfish, Carassius auratus (L.), in medium containing no serum, or in medium supplemented with either 10% fish serum (goldfish, carp, or tin foil barb) or 10% mammalian serum (horse or foetal bovine). After 10 days, the number of trypanosomes in flasks containing tin foil barb serum increased by nearly 700% over the initial inoculum. Similarly, a substantial increase in the number of parasites was seen after 10 days in the cultures containing carp and goldfish serum. After 6 weeks, there was more than a 15‐fold increase of T. danilewskyi in cultures containing goldfish serum. Medium containing no serum or mammalian serum failed to support the growth of parasites. Therefore, serum‐related factors within fish blood are required for the propagation of T. danilewskyi isolated from infected goldfish. Since T. danilewskyi can be propagated in vivo and in vitro in the presence of homologous proteins, cultured and wild‐type forms can be compared to determine if cultured parasites can be used as analogues of natural life‐cycle stages.
Production and characterization of monoclonal antibodies against Pasteurella piscicida, the causative agent of fish pasteurellosis
Authors: Bakopoulos V , Adams A. , Richards R. H
Published: November 2003

Six monoclonal antibodies (mabs) produced against Pasteurella piscicida whole cells, cultured under iron limitation conditions, were characterized and specificity tested. Two of the mabs (WE15H1D7 and WE3D6C11) appeared to be specific for P. piscicida lipopolysaccharide, while mabs WE14C10F9 and WE12D7D8 crossreacted with Photobacterium species. The remaining two mabs, WE9D6D8 and VP4B11, crossreacted with other bacterial genera. All mabs reacted with material present in the extracellular products of the pathogen as well as to whole cells, suggesting that the antigens to which antibodies are directed slough off the cell membranes or are secreted to the culture medium. The potential of the mabs as tools for the diagnosis of pasteurellosis is discussed.
Protective immunity against enteric septicaemia in channel catfish, Ictalurus punctatus (Rafinesque), following controlled exposure to Edwardsiella ictaluri
Authors: Shoemaker C A , Klesius P H
Published: November 2003

Protective immunity against enteric septicaemia of catfish (ESC) following immunization with Edwardsiella ictaluri bacterins and exposure to live E. ictaluri was investigated. Mean cumulative percentage survival was significantly higher (P 0.05) in controlled live vaccinates (100%) than in immersion and oral bacterin vaccinates (68.3% and 50.0%, respectively). Bactericidal activity against E. ictaluri by peritoneal macrophages from controlled live vaccinates (85.9%) was significantly greater (P 0.05) than bactericidal activity of macrophages from immersion bacterin vaccinates (71.4%) or non‐vaccinates (68.1%). No significant (P > 0.05) difference was found in the bactericidal activity of macrophages from oral bacterin vaccinates and macrophages from controlled live vaccinates. The E. ictaluri‐specific antibody response of controlled live (0.08 OD) and immersion bacterin vaccinates (0.11 OD) was significantly higher (P 0.05) than that of oral bacterin vaccinates and non‐vaccinates (0.01 OD) 15 days post‐vaccination. A significantly higher antibody response was seen in controlled live vaccinates (0.17 OD), when compared to other vaccinates or non‐vaccinates 33 days after vaccination. Neither immersion nor oral bacterins protected the vaccinates against ESC. Controlled live E. ictaluri immunization of channel catfish resulted in production of specific antibodies, increased macrophage bactericidal activity and protection against ESC.
Branchial lesions associated with intermittent formalin bath treatment of Atlantic salmon, Salmo salar L., and rainbow trout, Oncorhynchus mykiss (Walbaum)
Authors: Speare D.J. , Arsenault G. , MacNair N. , Powell M.D.
Published: November 2003

Two trials were conducted to assess the effects of repeated prophylactic formalin treatments on the gill structure of salmonids. In trial 1, which involved Atlantic salmon, Salmo salar L., approaching smoltification in a commercial facility, fish were treated with either 167 or 250 mg l‐1 formalin for 90 min every 2 weeks for 12 weeks. Formalin‐treated salmon had slight, but not significant, increases in the frequency of lamellar fusion, numbers of lamellar mucous cells, and numbers of an endemic gill ciliate, Trichophyra piscium, after 6 and 12 weeks of treatment. In trial 2, which involved juvenile rainbow trout, Oncorhynchus mykiss (Walbaum), fish were treated with 200 mg l‐1 formalin for 60 min twice weekly for 12 weeks. Significant effects were limited to an increase in the numbers of mucous cells present on gill lamellae. In both trials, there was no evidence of lamellar oedema or necrosis of lamellar epithelial cells.
Absorption of immunomodulating β(1,3)‐glucan in yolk sac larvae of Atlantic halibut, Hippoglossus hippoglossus (L.)
Authors: Strand H.K. , Dalmo R.A.
Published: November 2003

A soluble immunomodulating β(1,3)‐glucan, laminaran, was given in drinking water to yolk‐sac larvae of Atlantic halibut, Hippoglossus hippoglossus L. The larvae absorbed laminaran when the concentration was 25 mg l–1. After 5 days exposure to laminaran, each larva contained 2.3 ng and 46 ng of 3H‐ and 125I‐labelled laminaran, respectively. After 10 days exposure, each larva contained 4.5 ng and 47 ng of 3H‐ and 125I‐laminaran, respectively. The absorption was confirmed by fluorescence microscopy of larvae exposed to fluorescein‐labelled laminaran (FITC‐laminaran). The fluorescence was localized to cells in the intestinal epithelial layer and the skin epithelial layer.
Clubbing and necrosis gill (CNG) syndrome in sea‐caged Atlantic salmon, Salmo salar L., in Tasmania: an initial report
Authors: Clark A. , Nowak B. , Handlinger J. , Munday B.L. , Percival S.
Published: November 2003

In autumn 1993, an outbreak of gill disease occurred in Atlantic salmon, Salmo salar L., smolts farmed in the Huon estuary in southern Tasmania, Australia. Histologically, the presumptive primary lesion appeared as focal, sometimes full thickness, gill necrosis, which showed no host reaction in the initial stages. Healing of these damaged areas gave rise to conspicuous expanded tips or clubbing of gill filaments. The term clubbing and necrosis gill (CNG) syndrome is suggested to include both these histological features. Fusion of lamellae proximally along the filament, often with vascular dilation, was also a feature of the condition. Similar lesions have been described previously in the literature, but the initial necrosis followed by the very prominent clubbing of filaments was sufficiently different from previous descriptions to warrant designation of this condition as a distinct entity.
Inhibition of the attachment of Flavobacterium branchiophilum to the gills of rainbow trout, Oncorhynchus mykiss (Walbaum)
Authors: Ostland V E , Lumsden J S , MacPhee D D , Derksen J A , Ferguson H W
Published: November 2003

Preliminary experiments are described which aimed to identify compounds that could inhibit the attachment of Flavobacterium branchiophilum strains LAB4a and ATCC 35035 to the gills of rainbow trout. Total inhibition was never achieved, regardless of the compound tested. Formalin‐killed or acetone‐killed F. branchiophilum cells retained at least some of their adherent nature, relative to untreated (live) cells. Adherence was reduced by 22–33% following immersion of fish in one litre of water containing 0.21 mg of a homologous crude fimbrial extract. When fish were immersed in water containing hyperimmune rainbow trout antiLAB4a serum, a dose‐dependent decrease in attachment (a reduction of 15% to 63%) of LAB4a to the gills was observed. Rainbow trout anti‐LAB4a serum also reduced the attachment of ATCC 35035 to the gills, but this reduction was not significant. Adherence of LAB4a was not inhibited following exposure of fish to group 1 carbohydrates (arabinose, mannose and xylose), group 2 carbohydrates (dextrose, galactose and lactose), group 3 carbohydrates (galactosamine, glucosamine and fucose) or group 4 carbohydrates (N‐acetyl‐D‐glucosamine, N‐acetyl‐D‐galactosamine, N‐acetyl‐neuraminic acid and the globoceramide glycolipid from human erythrocytes). In contrast, when rainbow trout erythrocytes were incubated with the bacteria prior to bath challenge, this resulted in an 87% and 53% reduction in gill‐associated LAB4a and ATCC 35035 antigen, respectively, following immersion of rainbow trout in this suspension.
The contribution of specific dietary patterns to energy and nutrient intakes in 7–8‐year‐old Scottish schoolchildren. I. Milk drinking
Authors: Ruxton C.H.S. , Kirk T.R. , Belton N.R.
Published: November 2003

Energy and nutrient intakes were estimated in 136 7–8‐year‐old Scottish schoolchildren using the 7‐day weighed inventory method. The contribution of liquid milk was assessed by (a) expressing energy and nutrient intake from milk as a percentage of overall intakes; (b) comparing dietary intakes in children with different patterns of milk consumption and (c) investigating the relationships between milk drinking, anthropometry and growth. The average intake of milk in this study was 2.11 l per week and more full‐fat than semi‐skimmed milk was drunk. Milk contributed around 10% of energy, 13% fat, 30% vitamin A, 36% vitamin B12 and 42% calcium to overall diets. Children with weekly milk intakes of more than 3 l had higher daily intakes of energy and certain micronutrients compared with children with weekly milk intakes of less than 1 l. The overall daily diets of children drinking semi‐skimmed milk at home were lower in percentage energy from fat than those of children drinking full‐fat milk at home. There was no significant relationship between the type or volume of milk drunk and either anthropometry or growth. It was concluded that (a) intakes of milk in excess of 3 l per week are beneficial in terms of increased micronutrient intakes and (b) the use of semi‐skimmed milk may help to decrease intakes of fat in this age group, yet have no adverse effects on anthropometry or growth.
The contribution of foods from outside the home to the nutrient intake of young adolescents
Authors: Adamson A.J. , Rugg‐Gunn A.J. , Butler T.J. , Appleton D.R.
Published: November 2003

Eating patterns in the UK are changing, not least of these changes is the increase in food availability and choice outside the home. Eating outside the home is not a new phenomenon; limited data are available for adults and for the population as a whole, but no such data exist for children. Information on food choices and purchasing is valuable in identifying relevant targets for effective change. This paper reports the dietary intake and the percentage of total intake from home and away from home (identifying as outside sources, school meals, other homes, school tuck‐shops and shops or cafes for 379 11–12‐year‐old schoolchildren in 1990), as well as the nutrient density of intakes from each food source. Each child completed two 3‐day dietary records between January and July 1990, and was interviewed after each 3‐day record by one dietitian. The purpose of the interview was to verify and enlarge upon the information recorded in order to obtain a quantitative record of food intake and to determine the source of each food item. Food tables were used to calculate nutrient intake. Sources of food outside the home accounted for approximately 30% of their total energy intake. Food from home had the highest micronutrient density of all the sources. The nutrient density of school meals compared well with food from home; school meals were lower in non‐milk extrinsic sugars although higher in fat and lower in protein, non‐starch polysaccharides, iron and retinol equivalents. Foods purchased from shops/cafes or school tuck‐shops were of poor nutrient quality for all nutrients measured. Children from ‘low’ social groups had intakes of a lower nutrient density from home than children from ‘high’ social groups and also obtained a greater proportion of their total diet from shops or cafes. Although the popularity of the different food sources outside the home varied with gender and social group, the quality of intake obtained did not, suggesting that children followed peer group food preferences outside the home rather than food habits taught at home.
Nutritional status and pulmonary function in patients with cystic fibrosis with and without Burkholderia cepacia colonization: role of specialist dietetic support
Authors: Peckham Daniel , Leonard Clare , Range Simon , Knox Alan
Published: November 2003

We have studied the impact of the introduction of a specialist dietetic service and colonization on nutrition and lung function in cystic fibrosis (CF) patients in Nottingham, over a 3‐year period from 1990 to 1993. We performed cross‐sectional analyses of all patients attending the adult clinic (42 in 1990 and 48 in 1993) and longitudinal analysis of the 34 patients who were present in both years. Nutritional status improved in the whole clinic population following the introduction of a specialist dietetic service in 1991. The presence of colonization with Burkholderia cepacia was associated with an accelerated decline in lung function compared with patients colonized with other organisms. Despite this decline, nutritional status was well maintained in both groups of patients. This study shows that the introduction of a specialized dietetic service can result in better nutrition even in patients with declining lung function.
Does provision of additional dietary information affect actual or only reported compliance to a low‐fat diet over 12 weeks in hyperlipidaemic individuals? Report of a pilot study
Authors: Grace Clare , Summerbell Carolyn
Published: November 2003

This randomized controlled pilot study was designed to measure the effect of additional dietary information on change in reported percentage energy from fat (% fat), total daily energy intake (TDEI), body mass index (BMI) and serum cholesterol in 13 hyperlipidaemic subjects, referred from the Cardiology Unit of St. Bartholomew's Hospital, over 12 weeks. At baseline (visit 1), % fat and TDEI were assessed using a validated food frequency questionnaire (Paisley et al., 1996), and BMI and fasting lipids were measured. «Standard» low‐fat dietary advice was given to all patients. Subjects were randomized at 4 weeks (visit 2) to receive either further «standard» dietary advice (control group) or further «standard» dietary advice plus an additional information package (intervention group). At 12 weeks (visit 3), % fat, TDEI, BMI and fasting lipids were reassessed. Both groups reported a significant reduction in % fat; a 23% reduction (P=0.00) in the intervention group, and an 11% reduction (P=0.005) in the control group. However, there was no significant difference in the reported % fat at the end of the study between the two groups (P=0.57). Plasma cholesterol was not significantly reduced in either the intervention or the control group (mean 7.3–6.7 mmol/l, 7.2–6.6 mmol/l, respectively). Reported energy intake was significantly reduced in both groups, but the extent of energy reduction was not reflected in the degree of weight lost. These results suggest that the provision of additional dietary information affects reported rather than actual compliance to a low‐fat diet.
A team approach to the audit of nutritional care in community hospitals
Authors: Carson M. , Close J.
Published: November 2003

This paper discusses a collaborative multidisciplinary exploratory audit project to examine the nutritional care received by patients within Norwich Community Health Partnership NHS Trust. A project team was formed to identify the key areas and develop an audit tool. An audit assistant was employed to assist the team with this particular project. Eleven community hospitals were involved; catering, nursing, dietetic staff and patients took part. The key areas that the audit project examined were nutritional adequacy, documentation and recording of nutritional assessments, nurses» nutritional knowledge base, patients» perceptions of the meal service, and good nutritional practice. Overall the results were better than initially anticipated. Where pertinent issues were identified, discussions are taking place within the Trust to write an action plan, implement recommendations and re‐audit.
Secondary prevention in coronary heart disease
Authors: Haq I.U. , Minnis R.C. , Jackson P.R. , Yeo W.W. , Ramsay L.E.
Published: November 2003

After myocardial infarction, beta‐blockers, aspirin and (in selected patients) ACE inhibitors all reduce substantially the risk of further myocardial infarction or coronary death. With regard to life‐style changes, giving up cigarette smoking reduces coronary risk by about 50%. Weight reduction and regular exercise are advised, although the effect of these measures on prognosis is uncertain. Recently, two major trials, the Scandinavian Simvastatin and West of Scotland Pravastatin studies, have radically changed ordinary medical practice. In these trials HMG CoA reductase inhibitor (statin) treatment reduced coronary events by 30–40%, reduced all‐cause mortality, and proved safe and well‐tolerated. The accepted policy now is to treat all patients with coronary heart disease, who have a cholesterol concentration 5.5 mmol/l or higher, with a statin. Where does this leave cholesterol‐lowering dietary advice in secondary prevention? The benefits of statin treatment were attained by reducing serum cholesterol by an average of 25%. Diet change rarely attains such a fall in cholesterol and should therefore be used only as an adjunct to drug therapy. When recommending a lipid‐lowering diet there is a danger that patients may be denied highly‐effective drug treatment because of the «threshold» effect. A decision on the need for cholesterol reduction should be made before diet change is advised. Once the decision is made the target is a 25% cholesterol reduction, which will require drug therapy in addition to diet changes.
Nutrition education in the treatment of eating disorders: a suggested 10 session course
Authors: Merriman Sheila
Published: November 2003

Research has shown that many patients with eating disorders have poor nutritional knowledge. A dietitian can provide nutritional information and guidance to enable the patient to make food choices based on fact, not fear. The 10 session schedule presented here is designed to present factual information, then the opportunity for the individual to apply this to themselves. The format makes particular reference to the low body weight patient. The course can be used either in individual or group sessions.
Abnormal feeding behaviours in phenylketonuria
Authors: MacDonald A. , Harris G. , Rylance G. , Asplin D. , Booth I. W.
Published: November 2003

The strict low phenylalanine diet used in the treatment of phenylketonuria (PKU) may adversely affect feeding behaviour and nutritional status in PKU children. The feeding behaviour of 15 unselected PKU children (12 girls, 3 boys) aged 1–5 years (mean age 3 years) was studied. Each child was matched with an unrelated age‐ and sex‐matched non‐PKU control child. All the PKU children were on a strict low phenylalanine diet. The mothers of all the children completed a validated feeding assessment questionnaire examining maternal perceptions of the incidence and type of feeding problems, feeding behaviour and parental management. A scored video recording of each child eating a midday meal was made, and mothers recorded a 3‐day dietary assessment. Mothers of PKU children perceived their children to have more feeding problems than the mothers of the control children. They said that they were more likely to have a poor appetite (P<0.05), and have more gastrointestinal symptoms (P<0.05). The PKU group were more likely to be given their midday meal separately from the rest of the family (PKU group 67%, control group 20%; P<0.05), were less likely to start their meal without prompting (P<0.005) and received less parental feeding directed verbalization (P<0.05). Although there was no significant difference in energy intake between the two groups, the PKU group had a significantly lower weight z score than the control group: median (range) weight for age, PKU group z score −0.81 (−2.23 to 2.21); control group 0.65 (−0.81 to 1.83) (P<0.05), but no differences were noted for height z score. This study is the first to report on the extent of feeding difficulties in young PKU children. An awareness of the consequences of rigid diet therapy should prove helpful in improving management strategies.
An audit of adult patients on home enteral tube feeding in a region of Northern Ireland
Authors: L’Estrange F.
Published: November 2003

Background: Increasing numbers of patients on enteral tube feeding (ETF) are being cared for in the community. This study surveyed patients receiving home ETF (HETF) in order to provide a clinical profile of patients, compare energy requirements with actual intake and to assess the patients’ and carers’ perspective.Method: A structured interview conducted with patients and carers in their homes or nursing homes.Results: Thirty‐nine patients were studied, 19 living at home and 20 living in nursing homes. Thirty‐four patients (87%) were fed via a gastrostomy tube, with the enteral feed being the sole source of nutrition in 29 (74%). The mean length of time on HETF was 18 months (s.d. 14.5 months). It was felt that eight (20%) patients were on feeding regimens that were not suitable for their energy requirements, but there was no significant difference between the patients living at home and those living in a nursing home (P < 0.05). Of those patients and carers at home, 15 (79%) were satisfied that the training they received had adequately prepared them for HETF, however, only 12 (63%) were satisfied with support since discharge, whereas 16 nursing home patients (80%) were satisfied with support.Conclusions: This study profiles adult patients on HETF, highlighting that patients may not be on the most appropriate feeding regimen and the wide range of concerns that patients and carers have relating to their support. The production of a HETF post‐discharge protocol, as recommended by the British Association of Enteral and Parenteral Nutrition (Elia, 1994b), would help to address these issues.
Anthropometry in a children's hospital: a study of staff knowledge, use and quality of equipment
Authors: Bunting J. , Weaver L. T.
Published: November 2003

Aims: The aims of this study were to investigate the extent of documentation of anthropometric measurements in a children's hospital records, the response of ward staff to children with heights and weights below the 3rd centile, and the availability and accuracy of measuring equipment. Also to assess the nutritional knowledge of medical staff. Methods: A prospective study was carried out in which 305 medical case notes were reviewed for records of anthropometric measures and action taken. A survey was undertaken of the availability of anthropometric equipment and its accuracy assessed over a range of weights and heights. A sample of medical staff (n=25) were interviewed about clinical nutrition. Results: Eighty‐three per cent of the nursing notes and 13% of the medical notes contained records of weights, and 12% of the nursing notes and 8% of the medical notes contained records of heights. Only 40% of case notes had growth charts present, of which 54% had weights recorded and 32% had heights recorded. Surgical ward notes more frequently had inadequate records of weights, heights and growth charts than those of medical wards (surgical wards had 17% growth charts present compared to 65% growth charts on the medical wards). Overall, most wards and clinics had working and accurate weighing equipment (82% were accurate within 1%) and height equipment (43% were 100% accurate). Over 80% of ward staff appeared to have adequate knowledge of the theory behind anthropometry and recognized the value of growth charts. Conclusions: The weights and heights of children continue to be recorded inadequately in hospital notes, suggesting a need for in‐service training and education on the importance of the nutritional assessment of paediatric patients.
A behavioural approach to the treatment of non‐retentive encopresis in adults with learning disabilities
Authors: Smith L. J.
Published: November 2003

Problems such as encopresis are perceived as ‘normal’ for some populations. For example, within the field of learning disability, little serious study has been devoted to either prevalence or aetiology of encopresis. Treatment issues have been obscured by problems of definition and aetiology. Treatment reports are rare despite the apparent magnitude of the problem, and involve a disproportionate number of cases with a mild intellectual disability or secondary encopresis. The following report describes a reinforcement‐based treatment programme for primary, non‐retentive encopresis in five young adult men with mainly more severe learning disabilities. Major soiling accidents were eliminated in four out of five cases and substantially reduced in the fifth. Treatment times were long. Issues relating to the use of aversive techniques are discussed, as are the limitations of the present study.
Staff strategies and explanations for intervening with challenging behaviours
Authors: Hastings R. P.
Published: November 2003

Behavioural models identify the actions of others as an important factor in the development and maintenance of challenging behaviours. In the present study, 109 care staff were asked about their immediate and longer‐term intervention strategies for a fictitious young man's challenging behaviour. Staff descriptions of long‐term interventions were largely consistent with the aims of psychological interventions. However, their immediate intervention strategies were similar to the counter‐habilitative strategies Identified in previous observational and self‐report research. The implications of these results for models of staff behaviour, staff training, the design of behavioural programmes and future research are discussed.
The epidemiology of hepatocellular carcinoma in patients with acute intermittent porphyria
Authors: ANDERSSON C. , BJERSING L. , LITHNER F.
Published: November 2003

Objective. To describe the epidemiology, pathogenesis and clinical features of hepatocellular carcinoma (HCC) in patients with acute intermittent porphyria (AIP).

Design. A retrospective population‐based mortality study.

Subjects. All inhabitants who died between 1978–1990 (2122) including 33 with AIP, in two municipalities in northern Sweden with a high prevalence of AIP.

Interventions. Death certificates and hospital records were examined. Histological re‐examination of paraffin‐embedded specimens from patients with HCC was performed and hepatitis B virus content analysed.

Results. HCC was found in 27% of patients with AIP versus 0.2% of the deceased non‐AIP subjects, P< 0.0001. HCC was more common in women (men:women 1:2) and in manifest AIP (manifest: latent 2:1). Liver cirrhosis was more common in AIP patients (12%), especially in women, compared with controls (0.5%), P<0.0001.

Conclusions. AIP patients seem to have an increased risk of developing HCC. This tumour is more common in patients with manifest AIP and in women, a reversal of the usually reported gender ratio for HCC. No cause for developing HCC other than AIP was found. The pathogenesis may be explained by abnormalities in porphyrin metabolism and by intrinsic production of mutagenic substances, resulting in a condition of systemic overload of oxidative stress, enhancing mutation rate and liver cell injury. Liver cirrhosis appears to be more common in AIP patients and may be a preliminary stage to HCC. All AIP gene carriers aged 55 should be screened for HCC.
Dissociation between urinary albumin excretion and variables associated with insulin resistance in a healthy population
Authors: ZAVARONI I. , BONINI L. , GASPARINI P. , ZUCCARELLI A. , DALL'AGLIO E. , BARILLI L. , CIONI F. , STRATA A. , REAVEN G. M.
Published: November 2003

Objectives. To see if the cluster of metabolic and haemodynamic variables defined as comprising Syndrome X varied as a function of urinary albumin excretion (UAE) rate in a healthy population.

Design. A cross‐sectional, population‐based study.

Setting. A factory in Italy.

Subjects. Two hundred and twenty‐five healthy volunteers, 115 men and 110 women.

Outcome measures. Measurements were made of the plasma glucose and insulin responses to oral glucose, fasting triglyceride (TG) and high density lipoprotein (HDL)‐cholesterol concentrations, blood pressure, and UAE rates.

Results. Only five of the 225 volunteers had microalbuminuria, defined as a UAE rate >2 μg min‐1, and the UAE rate was <5 μg min‐1 in 80% of the volunteers. Significant variations in the metabolic and haemodynamic variables measured were not associated with any differences in UAE. Finally, significant relationships were found between various measures of plasma insulin concentration and plasma glucose response to oral glucose, plasma TG and HDL‐cholesterol concentrations, and mean arterial blood pressure, independent of variations in age, body mass index, ratio of waist‐to‐hip girth, and UAE rates.

Conclusion. The widespread variability in plasma glucose and insulin responses, plasma TG and HDL‐cholesterol concentrations, and blood pressure that are seen in the population at large cannot be attributed to variations in UAE rate.
Sarcoidosis mimicking toxoplasmosis with severe hypercalcaemia and normal 1,25‐dihydroxy vitamin D
Authors: LEVY Y. , HAYEK T. , FINKELSTEIN R.
Published: November 2003

We report a case of a female patient with sarcoidosis who presented with a generalized lymphadenopathy and a strong IgG serological test of toxoplasmosis. Progressive lymphadenopathy with a rising plasma calcium (up to 15 mg dL‐1) with a normal plasma 1,25‐dihydroxy vitamin D concentration occurred later. Corticosteroid therapy resulted in prompt clinical and biochemical responses with normalization of plasma calcium and a significant reduction in 1,25‐dihydroxy vitamin D concentration. This is an exceptional presentation of sarcoidosis with severe hypercalcaemia and normal vitamin D metabolites.
Dietary protein restriction and the progression of chronic renal insufficiency: a review of the literature
Authors: HOLM E. A. , SØLLING K.
Published: November 2003

It is well known that dietary protein restriction can delay the appearance of uraemic symptoms and give symptomatic relief in patients with chronic renal failure. During the last decade, several investigators have argued that protein restriction instituted at an early phase in renal disease may influence the rate of progression of renal failure favourably. Animal experiments have given strong evidence that, in the case of nephron loss, high dietary protein promotes further loss of renal function. Many studies have been conducted to investigate the possible favourable effect of a protein‐restricted diet in patients with renal disease. However, the scientific proof that long‐term protein restriction delays the progression of chronic renal insufficiency in man is still missing.
Lusoria dysphagia in a patient with retroperitoneal fibrosis and Riedel's thyroiditis
Authors: ELEWAUT D. , RUBENS R. , ELEWAUT A. , KUNNEN M.
Published: November 2003

The case history of a 68‐year‐old woman with progressive dysphagia caused by extrinsic compression of the oesophagus by an aberrant right subclavian artery or arteria lusoria is presented. Previous history mentioned a Riedel's thyroiditis, idiopathic retroperitoneal fibrosis and an aortic sclerosis. The authors want to report the case because it is an example of an association between lusoria dysphagia and retroperitoneal fibrosis, the connective tissue disease responsible for Riedel's thyroiditis, and perhaps, aortic sclerosis. This is the first report of this particular association.
Impaired haemostatic kinetics and endothelial function in Behçet's disease
Authors: HAZNEDAROGILU İ. C. , ÖZCEBE O. İ , ÖZDEMIR O. , ÇELIK İ. , DÜNDAR S. V. , KIRAZLI Ş.
Published: November 2003

Objectives. This study was planned to explore the alterations of endothelial functions in the prethrombotic state of Behçet's disease (BD) patients.

Design. Plasma levels of endothelial secretory markers, in vivo molecular haemostatic and fibrinolytic parameters were cross‐sectionally determined in the study group.

Setting and subjects. In our tertiary referral centre, 30 (13 men, 17 women) BD patients, mean age 31±7 years, and 15 (eight men, seven women) healthy volunteers, mean age 26±9 years, were eligible for inclusion in the study after obtaining their written consents.

Interventions. All plasma samples for the assays of haemostatic parameters were obtained before and after an endothelial stimulant, desmopressin acetate (DDAVP).

Results. We have shown that in the procoagulant phase of BD patients: (1) basal thrombomodulin concentrations are increased and could not be provoked by DDAVP infusion; (2) both thromboxane B2 and 6‐keto prostaglandin F1α increments occur concurrently; (3) in vivo coagulation markers are elevated and raised plasmin‐α2 antiplasmin complex indicates a subclinical concomitant fibrinolysis; (4) the fibrinolytic process is conveyed in a somewhat complex manner in which plasminogen activator binding kinetics might be also altered.

Conclusions. Endothelial cell injury, augmented thrombotic risk with compensatory excessive fibrinolysis and alterations in endothelial cell receptor–fibrinolytic marker relations might take place in the pathogenesis and thereby modulate the natural course of haemostatic processes of BD.
Bilateral isolated adrenal coccidioidomycosis
Authors: PAPADOPOULOS K. I. , CASTOR B. , KLINGSPOR L. , DEJMEK A. , LORÉN I. , BRAMNERT M.
Published: November 2003

A case of bilateral isolated adrenal coccidioidomycosis in a previously healthy and immunocompetent 43‐year‐old Caucasian male is presented. He had never travelled to a coccidioidomycosis endemic area. Subclinical adrenal dysfunction was found with elevated plasma ACTH and mineralocorticosteroid and androgen pathway abnormalities. The implement of the fungal infection on adrenal function, and the diagnosis and management of adrenal coccidioidomycosis are discussed.
Association between plasma renin activity and metabolic cardiovascular risk factors in essential hypertension
Authors: ALLIKMETS K. , PARIK T. , TEESALU R.
Published: November 2003

Objectives. To study the relationships between plasma renin activity and metabolic cardiovascular risk factors in patients with essential hypertension.

Subjects and design. Patients with uncomplicated essential hypertension (n=36) with a diastolic blood pressure of 95–115 mmHg were studied. Assessment of plasma renin activity (PRA) related to urinary sodium excretion was used to define subgroups with high (n=12), medium (n=16) and low renin profiles (n=8).

Main outcome measures. Fasting plasma lipid levels were determined. Glucose, insulin and C‐peptide responses to standard oral glucose tolerance test (OGTT) were measured.

Results. Patients with high PRA had higher levels of plasma cholesterol (6.13±0.81 versus 4.67±0.7 mmol L‐1, P<0.05) and triglycerides (2.14±0.18 versus 0.98±0.13 mmol L‐1, P<0.05), than the low PRA group. HDL‐cholesterol levels were lower in the high renin group than in the low renin group (1.05±0.04 versus 1.26±0.09 mmol L‐1, P<0.05). Insulin and C‐peptide sums were higher in high PRA group (33.8±1.2 versus 25.1±0.9 and 2.6±0.3 versus 1.9±0.4 ng L‐1, P<0.05), than in the low PRA group.

Conclusions. Essential hypertensive patients with a high renin profile display more pronounced dyslipidaemia and higher levels of plasma insulin than patients with a low renin profile. This may be one explanation for higher incidence of cardiovascular disease previously reported in high PRA group.
Increased incidence of thyrotoxicosis in Malmö during the years 1988–1990 as compared to the years 1970–1974
Authors: BERGLUND J. , ERICSSON U.‐B. , HALLENGREN B.
Published: November 2003

Objective and design. To compare the total and age‐specific incidence of thyrotoxicosis, as well as the incidence of the individual types of thyrotoxicosis [i.e. thyrotoxicosis of Graves' type (GD), toxic nodular goitre (TNG) and solitary toxic adenoma (STA)] in Malmö during the years 1988–1990 to those of a previous study in 1970–1974.

Setting. The town of Malmö in southern Sweden.

Subjects. All patients from the Malmö population treated for thyrotoxicosis (GD, TNG and STA) for the first time during the 3‐year period 1988–1990 were included.

Results. Overall, 299 (263 females and 36 males) new cases of thyrotoxicosis were diagnosed in 1988–1990, corresponding to a mean annual incidence of thyrotoxicosis of 43.0 per 100000 inhabitants. The incidence of GD was 22.3, of TNG 16.0 and of STA 4.8 per 100000 per year. Comparing age‐ and sex‐standardized incidences to the results in 1970–1974, there was a significant increase (P<0.001) in the mean annual incidence of thyrotoxicosis in the total material as well as in TNG. In addition, there was an increase in GD in females younger than 50 years (P<0.01), whereas in TNG/STA, an increase was seen in females of 50 years or older (P<0.001). The incidence figures in males were not significantly changed. There was a higher proportion of smokers in females with GD compared to females with TNG (P<0.001) and STA (P<0.05).

Conclusions. The total incidence of thyrotoxicosis, as well as the incidence of GD in females younger than 50 years and the incidence of TNG/STA in females of 50 years or older, has increased in Malmö during the period from 1970 to 1990. The increase was probably caused by several factors such as more sensitive diagnostic tools and GD changes in smoking habits, but additional unknown factors might also be of importance.
Mediastinal mass following chemotherapy in patients with Ewing sarcoma and osteosarcoma
Authors: PANADERO M. A. , CRUZ J. J. , GOMEZ A. , FONSECA E. , GARCIA M. J. , GARCIA J. , MARTIN G. , SANCHEZ P. , DUEÑAS G. A.
Published: November 2003

Panadero MA, Cruz JJ, Gomez A, Fonseca E, Garcia MJ, Garcia J, Martin G, Sanchez P, Dueñas GA (Medical Oncology Department, University Hospital, Salamanca, Spain). Mediastinal mass following chemotherapy in patients with Ewing sarcoma and osteosarcoma (Case report). J Intern Med 1996; 239: 457–60.

Thymic hyperplasia following combination chemotherapy for malignant disease is very uncommon in adolescents and adults. Our experience includes a thymic enlargement noted on the sequential computed tomography (CT) in three patients who were disease‐free after chemotherapy for Ewing sarcoma (2) and osteosarcoma (1). The development of an anterior mediastinal mass after successful chemotherapy does not always imply relapse of malignant disease. To prevent inappropriate treatment, the possibility of a benign aetiology must be considered.
Cyclophosphamide‐induced acute liver failure requiring transplantation in a patient with genetically deficient debrisoquine metabolism: a causal relationship?
Authors: GUSTAFSSON L. L. , ERIKSSON L. S. , DAHL M. L. , ELEBORG L. , ERICZON B. G. , NYBERG A.
Published: November 2003

Severe liver damage can occur after treatment with cyclophosphamide. The possible linkage to genetically deficient drug metabolic capacity is unknown. A 58‐year‐old woman with rheumatoid arthritis was treated with oral cyclophosphamide 50 mg twice daily for 2 months. Due to poor response the dose was doubled and liver failure requiring transplantation developed within weeks. After surgery PCR amplification using DNA from leukocytes showed that she was homozygous for the mutated allele CYP2D6B, which is predictive of the poor metaboliser phenotype for debrisoquine, occurring in 7% of Caucasians. Our patient may have accumulated high levels of the hepatotoxic 4‐hydroxylated cyclophosphamide metabolite. Pharmacogenetic methods can help in exploring mechanisms of unexpected severe adverse effects.
Clinical outcome of radioiodine treatment of hyperthyroidism: a follow‐up study
Authors: BERG G. , MICHANEK A. , HOLMBERG E. , NYSTRÖM E.
Published: November 2003

Objectives. To study the clinical outcome of treatment of hyperthyroid patients with radioiodine.

Design. Records of patients treated for hyperthyroidism with radioiodine from 1989 to 1992 were examined in 1994, and a questionnaire was sent to patients 70 years with Graves' disease (GD) and toxic nodular goitre (TNG) to obtain information regarding thyroxine substitution, smoking habits and present state of health.

Setting. Outpatients in a thyroid unit; follow‐up by primary care.

Subjects. Seven hundred and fifty‐four patients with hyperthyroidism treated with radioiodine, 327 receiving the questionnaire, 72% response rate.

Intervention. Radioiodine treatment using a delivered absorbed dose method, aiming at an absorbed dose to the thyroid of 100–120 Gy.

Main outcome measures. Statistical analysis of clinical records and results from questionnaire.

Results. Only 10% of the patients needed more than one treatment. At the time of follow‐up, thyroxine supplementation was given to 178 (93%) of the GD and to 21 (47%) of the TNG patients. Smoking was more common in GD patients than in the general population (44% vs. 26%; P<0.001). Smoking GD patients experienced eye discomfort more often than smoking TNG patients (53% vs. 7%; P<0.001). Weight gain after therapy was a problem in 79% of the hyperthyroid individuals.

Conclusions. Few patients needed retreatment and most of the GD patients had thyroxine after 1–5 years after therapy. Smoking patients, especially those with GD, had more eye symptoms. At follow‐up, the euthyroid patients still consider themselves having a poorer health than individuals in the general population.
Heart failure – implications of the true size of the problem
Authors: DARGIE H. J. , McMURRAY J. J. V. , McDONAGH T. A.
Published: November 2003

Dargie HJ, McMurray JJV, McDonagh TA (Department of Cardiology, Western Infirmary, Glasgow, and Department of Cardiology, Western General Hospital, Edinburgh, UK). Heart failure –  implications of the true size of the problem (Minisymposium: Heart failure). J Intern Med 1996;239: 309–15.

We review current knowledge on the true size of the clinical condition known as ‘heart failure’ in terms of epidemiological information and in relation to the true clinical burden.

Population studies, together with data from physician and general practitioner records, reveal a range of estimated heart‐failure prevalence of 1–10%. Estimated incidence rates vary from approximately 0–1% per annum. Reasons for variation include age, sex and, possibly, methodology.

In community studies, the five‐year mortality is between 50–60% while, in patients requiring hospital admission, the annual mortality is 10–20% in those with mild–moderate symptoms, and as high as 40–60% in severe heart failure.

While angiotensin‐converting enzyme (ACE) inhibitor treatment does significantly improve mortality in all grades of symptomatic heart failure, the annual mortality in severe patients was still 36% in CONSENSUS I.

It is obvious that the term ‘heart failure’ is insufficiently descriptive or specific to be an acceptable label for all patients who might benefit from treatment.

As ‘clinical’ heart failure is often an advanced and irreversible state, studies of its antecedents are important in developing strategies aimed at retarding the progression from the asymptomatic to the symptomatic conditions. The true prevalence of the most common antecedent, left ventricular dysfunction, has received relatively little attention.
Treatment of heart failure
Authors: KJEKSHUS J. , SWEDBERG K.
Published: November 2003

Kjekshus J, Swedberg K (Department of Medicine, The National Hospital, University of Oslo, Oslo, Norway, and Department of Medicine, Östra University Hospital, Göteborg University, Göteborg, Sweden). Treatment of heart failure (Minisymposium: Heart failure). J Intern Med 1996; 239: 335–43.

Effective treatment of heart failure depends on a correct functional and aetiological diagnosis. In asymptomatic patients with cardiac dysfunction following myocardial infarction, treatment is directed to prevent recurrent infarction by aggressive lipid lowering with statins and antiplatelet drugs. Beta blockers are important to reduce sudden death. In symptomatic heart failure, clinical improvement is obtained by inhibition of the renin–angiotensin and sympathetic system. Angiotensin‐converting‐enzyme inhibitors in combination with diuretics reduce morbidity and mortality caused by progression of the myocardial dysfunction and recurrent myocardial infarction. Drugs that activate the neurohormonal systems are clearly counteractive. Digitalis has a definite favourable effect on systems, and in patients with atrial fibrillation, but its effect on mortality is still unsettled. Beta blockers in routine treatment of symptomatic heart failure still remains controversial, but may benefit selected patients.
Hyperlipidaemia in renal transplant patients
Authors: AAKHUS S. , DAHL K. , WIDERØE T. E.
Published: November 2003

Aakhus S, Dahl S, Widerøe TE (Sections of Cardiology and Nephrology, Department of Medicine, University Hospital of Trondheim, Trondheim, Norway). Hyperlipidaemia in renal transplant patients. J Intern Med 1996; 239: 407–15.

Objectives. The aim of study was to assess the prevalence and severity of hyperlipidaemia in renal transplant patients in a Nordic country.

Design. Multicentre, cross‐sectional study.

Setting. Outpatients and ward inpatients registered from 23 hospitals covering all regions of the country.

Subjects. Renal transplant patients with a functioning graft were registered: 406 patients in all; that is, 43% of the national renal transplant population. All patients used prednisolone, 71% used cyclosporine, either with (51%) or without (20%) azathioprine. Total cholesterol values from general population were obtained from a national survey.

Main outcome measures. Blood lipids and their relation to clinical parameters.

Results. Total cholesterol was significantly higher in transplant patients than in the general population for both genders and all age groups (P<0.01). Female patients had higher total cholesterol (mean±SD: 7.49±1.61mmolL‐1) than males (7.01±1.55mmolL‐1; P<0.001), and also higher HDL cholesterol (1.55±0.43 vs. males: 1.32±0.46mmolL‐1; P<0.001). Triglycerides were equally elevated in both genders, and 33% had values above 2.2mmolL‐1. Reduced creatinine clearance, a high body‐mass index, female gender, hypertension, and coronary artery disease were independently associated with higher total cholesterol. Beta blockers were associated with lower HDL cholesterol and higher triglycerides, and diuretics with higher triglycerides. Blood lipid levels were not associated with cyclosporine immunosuppression.

Conclusion. Hyperlipidaemia is prevalent after renal transplantation, and is associated with impaired graft function, hypertension, and with the use of beta blockers and diuretics, but not with the use of cyclosporine.