bluuebunny/crossref_metadata_2025 huggingface dataset:
Hazards of Obesity‐the Framingham Experience
Authors: HIGGINS MILLICENT , KANNEL WILLIAM , GARRISON ROBERT , PINSKY JOAN , STOKES JOSEPH
Published: August 2010

ABSTRACTMeasurements of height, weight, skinfolds and waist girth were used as indicators of general and regional obesity in the Framingham study population of 5209 men and women. Mean values of cholesterol, blood pressure, blood glucose and uric acid increased with increasing body mass index (BMI). Weight gain was associated with increases and weight loss with decreases in these risk factors. Cigarette smoking was more prevalent in men and women with low quintile BMI. Upper quintile values of BMI, subscapular skinfolds, and waist girth were associated with increased relative risks of death from all causes, coronary heart disease (CHD) and cerebrovascular disease but relative risks for intermittent claudication were not increased. General and central obesity each made independent contributions to risk of CHD but central obesity was a better predictor in males. BMI, cholesterol, systolic blood pressure and blood glucose were significantly independent predictors of CHD. These data show that increased relative weight and central obesity are associated with elevated levels of risk factors, with increased incidence of cardiovascular disease and with increased death rates for all causes combined. Mortality rates are also increased among the leanest members of the population, especially among older men.
Regional Obesity as a Health Hazard in Men‐Prospective Studies
Authors: LARSSON BO
Published: August 2010

ABSTRACT Cross‐sectional studies have shown that a central distribution of adipose tissue is associated with increased risk of metabolic complications and cardiovascular morbidity. Four prospective studies in men are reviewed and they consistently indicate that central adipose tissue distribution is a risk factor for coronary heart disease (CHD) and its predictive contribution seems almost to be in the same order as for the major risk factors for CHD. In one study there is an indication of decreasing predictive power of central adipose tissue distribution for CHD with increasing age. Abdominal adipose tissue distribution is also a risk factor for stroke, diabetes and sickness absenteeism, and for all cause mortality. It seems, however, not to be a predictor of degree of well‐being in general. The question of causality is not solved but indices of adipose tissue distribution should be included in future observational and experimental studies in this field.
Stress, Hypothalamic Function and Neuroendocrine Consequences
Authors: FOLKOW BJÖRN
Published: August 2010

ABSTRACT The physiology of the emotional response patterns to “stressful” psychosocial stimuli is surveyed. These limbic‐hypothalamic patterns are basically designed to protect the individual and species from adverse environmental influences in primitive life. Their expressions always form a triad, with a situation‐specific “somatomotor”‐behav‐ioural link, a “visceromotor”‐autonomic and a hormonal link, the latter two adjusting inner organs, metabolism, water‐salt balance, etc., to provide optimal support to the behavioural expression. Because of their uniformity throughout species, animal experiments have greatly contributed to our understanding of how these responses may also importantly contribute to common disorders in modern society, at least when intensely and/or commonly evoked. Thanks to our more advanced neocortex, man differs here from animals mainly in two ways. First, we learn to cope with some environmental stimuli and thus delimit undue emotional engagements; second, when once elicited we can often suppress the behavioural link, when this is socially appropriate. As we cannot suppress the autonomic‐hormonal links, however, they then occur more or less “in vain”, and such socially enforced dissociations of per se normal response patterns may not in the long run be healthy. Finally, the better known among these differentiated responses are briefly outlined, with particular emphasis on the potentially most important ones, the “defence reaction” and the “defeat reaction”.
Regional Obesity and Coronary Artery Atherosclerosis in Females: a Non‐human Primate Model
Authors: SHIVELY CAROL A. , CLARKSON THOMAS B.
Published: August 2010

ABSTRACT The relationships between regional obesity, atherosclerosis and atherosclerosis risk factors were studied in female cynomolgus monkeys (Macaca fascicularis). In a retrospective necropsy study it was found that females with relatively high central: peripheral fat deposition had three times more extensive coronary artery atherosclerosis. In a second experiment it was found that females with high central fat ratios and females with high levels of whole body obesity were relatively hyperglycemic. In a third experiment it was found that females with relatively high whole body obesity, and females with relatively central fat deposition had higher blood pressures. Females with relatively central fat deposition had higher total and lower high density lipoprotein plasma cholesterol concentrations, and exacerbated coronary artery atherosclerosis. Social subordinates were more likely to exhibit a central fat deposition pattern than dominants. These findings suggest that female cynomolgus macaques may be a potential animal model of the health impact of regional obesity.
Hormonal Abnormalities in Obesity
Authors: ZUMOFF BARNETT
Published: August 2010

ABSTRACT We have found a number of interesting hormonal abnormalities in obese men and women: 1) Obese women have normal levels of estrone, total estradiol, and total testosterone, but as a consequence of their subnormal levels of SHBG, their levels of free estradiol and free testosterone are significantly elevated. 2) Massive weight loss in obese women (to still elevated weight) results in normalization of the previously elevated free estradiol and free testosterone. 3) Obese women have normal plasma DHEA levels, but a significant, age‐invariant decrease of the plasma DHEA/T ratio, which could be due to increased tissue activity of 3β‐hydroxysteroid dehydrogenase. 4) Massive weight loss produces an age‐dependent effect on DHEA levels in obese women: the levels increase to supranormal values in women around age 20, with diminishing increases at higher premenopausal ages and no increase at all at perimenopausal age. 5) Obese men have elevated levels of estrone and both free and total estradiol, and subnormal levels of free and total testosterone and of FSH; all these abnormalities are proportional to the degree of obesity. They also have relatively subnormal LH levels, i.e. normal in the face of hypotestosteronemia. The combination of these findings represents a state of mild hypogonadotropic hypogonadism (HHG), which we believe to be induced by the hyperestrogenemia. 6) Normalization of the estrogen levels of obese men, by suppression of adrenocortical secretion of aromatase substrates or by inhibition of aromatase, tends to normalize the HHG. 7) Massive weight loss in obese men normalizes their HHG without any decrease in plasma estrogen levels. This suggests that weight loss in obese men results in diminished sensitivity of the GnRH‐gonadotropin secretory mechanism to suppression by a given concentration of estrogen.
Is Body Fat Distribution Changed by Dieting?
Authors: GARROW JOHN S.
Published: August 2010

ABSTRACT Studies of fat distribution have generally relied on the ratio of circumference measurements, such as waist/hip, or waist/thigh. However, these circumferences do not increase at a uniform rate with increasing obesity, and fat is deposited relatively more in the antero‐posterior axis of the trunk and limbs than laterally. With weight loss the waist/hip ratio does not change, but the waist/thigh ratio decreases. This is to be expected since in obesity there is a relatively greater deposition of fat at the waist than on the thighs. Serial studies of a small number of subjects with unusually large or small fat depots at particular sites suggest that these characteristics persist after weight loss. It is probable on theoretical grounds that (except in special cases, such as lactation) a similar proportion of fat is gained and lost in all fat depots, although the relative size of these depots differs between individuals.
Can Body Fat Patterning Be Changed?
Authors: KROTKIEWSKI MARCIN
Published: August 2010

ABSTRACT Short‐ and long‐term weight reduction programmes both resulted in a significant decrease in the waist/hip ratio (WHR) among obese premenopausal women. In matched groups of women with gynoid and android obesity, the latter demonstrated a greater decrease in WHR after 1 year's weight reduction and, at the same level of body weight loss, a consistently lower decrease in the lean body mass. Gluteal fat cells were found to empty at a slower rate than those in the abdominal region, particularly in gynoid obesity. After 1 year's weight reduction, the decrease in WHR correlated significantly with decreases in body weight, blood pressure and metabolic variables. Six months' physical training with and without reduction of body weight resulted in a significant decrease in WHR, while one‐leg exercise caused a local decrease in the circumference of the trained leg. Reduction of flatulence in obese men was also found to be associated with decreased WHR.
Effects of Metoprolol on the Counter‐regulation and Recognition of Prolonged Hypoglycemia in Insulin‐dependent Diabetics
Authors: CLAUSEN‐SJÖBOM NINA , LINS PER‐ERIC , ADAMSON ULF , CURSTEDT TORE , HAMBERGER BERTIL
Published: August 2010

ABSTRACT. The effect of metoprolol on the counter‐regulation of prolonged hypoglycemia was studied in eight insulin‐dependent diabetics. Insulin was given as an i.v. infusion of 2.4 U/h over 180 min alone, or together with metoprolol (3.0 mg i.v. bolus followed by an i.v. infusion of 4.8 mg/h) in random order. Blood glucose, counter‐regulatory hormones, hypoglycemic symptoms and the cardiovascular responses were assayed over 240 min. Metoprolol did not significantly modify the blood glucose levels. The plasma levels of free insulin, however, were elevated by approximately 20% (p<0.01) by metoprolol during hypoglycemia and the plasma concentrations of epinephrine, norepinephrine, growth hormone and cortisol were enhanced by the drug. Sweating was increased by metoprolol, while other symptoms were unaltered. We conclude that metoprolol administered acutely does not aggravate prolonged hypoglycemia in diabetics with blunted response of glucagon. Moreover, exaggerated responses of counter‐regulatory hormones, provoked by metoprolol, may compensate for the inhibitory effect of this drug on insulin clearance.
Weight Reduction with Dietary Fibre Supplements
Authors: RÖSSNER STEPHAN , VON ZWEIGBERGK DAN , ÖHLIN AGNETA , RYTTIG KJELD
Published: August 2010

ABSTRACT. We report two studies, in which fibre/placebo tablets were added to a weight reduction regimen in the treatment of moderately obese women. In Study I, 60 females were treated for a two‐month period with general dietary advice, providing a mean daily energy intake of 1400 kcal. In addition, the fibre group received a 5 g dietary fibre supplement. In Study II, 45 females were treated for a three‐month period with a similar programme, in which the recommended daily energy intake was 1600 kcal and the fibre supplement 7 g/day. In both groups weight changes, hunger ratings, blood pressure, defecation pattern and possible side‐effects were recorded every second week. Before treatment mean body weight was 95.4 kg (Study I) and 99.3 kg (Study II). Six patients dropped out of Study I, and four out of Study II. In Study I mean weight loss, 7.0 kg, in the fibre group was significantly higher (p<0.05) than 6.0 kg in the placebo group. In Study II mean weight loss in the fibre group of 6.2 kg was significantly higher than the 4.1 kg in the placebo group (p<0.05). No significant difference in hunger feeling between the groups was found. Systolic blood pressure was reduced in all four groups at the end of the treatment, whereas diastolic blood pressure was reduced only in the fibre group in Study II. The results suggest that dietary fibre is of additive value in the treatment of moderately obese patients. The fibre supplement, however, needs to be comparatively high.
The Fatty Acid Composition of Northern‐Canadian Marine and Terrestrial Mammals
Authors: INNIS SHEILA M. , KUHNLEIN HARRIET V.
Published: August 2010

ABSTRACT The low mortality from cardiovascular disease in Greenland Eskimos has been attributed to their consumption of diets rich in ω‐3 fatty acids. These fatty acids are found in fish and marine mammal lipids. Whereas the fatty acid composition of several fish species has been documented, information is more limited on the mammals which feature significantly in the diets of many Arctic populations. This study investigated the fatty acid composition of commonly eaten marine mammals, as well as the polar bear and caribou. The tissue fatty acid composition was species‐dependent, probably reflecting to some degree differences in feeding habits. The marine mammals and the amphibious polar bear, but not the caribou, contained substantial quantities of long chain ω‐3 fatty acids. These studies further document the transfer of ω‐3 fatty acids through the food chain to man and suggest that marine mammal and polar bear lipids are significant sources of ω‐3 fatty acids.
Serum Phosphate Increase during Short‐term β‐Adrenoceptor Blockade in Thyrotoxicosis
Authors: KAYSER L. , PERRILD H. , FOGH‐ANDERSEN N. , HANSEN J. E. MØLHOLM
Published: August 2010

ABSTRACT We studied the changes in blood plasma electrolytes during acute and short‐term treatment with four different β‐adrenergic‐blocking agents in 31 patients with hyperthyroidism. Serum phosphate increased during the first four hours and remained elevated after one week both after cardioselective (acebutolol) and non‐cardioselective (oxprenolol, pindolol and timolol) β‐blockade (p<0.05). Albumin decreased after four hours but no change was found after one week. Serum creatinine increased after one week in the acebutolol‐treated group, while sodium, potassium and albumin‐corrected calcium in serum did not change. The hyper‐phosphatemic effect may be due to blockade of β1‐adrenoceptors. since the effect of the cardioselective acebutolol was no less than that of the non‐cardioselective β‐adrenoceptor blockers.
Hydroxyurea Treatment of Myeloproliferative Disorders
Authors: LÖFVENBERG EVA , NILSSON TORBJÖRN , WAHLIN ANDERS , JACOBSSON LENNART
Published: August 2010

ABSTRACT Blood and bone marrow changes induced by continuous low‐dose hydroxyurea treatment are described. A linear increase in mean red cell volume was observed after onset of therapy. The entire normocyte population was replaced by abnormally large erythrocytes within 150 days. The bone marrow morphology changed in megaloblastic direction. Bone marrow iron stores and number of sideroblasts increased, findings compatible with ineffective erythropoiesis. Serum folate and cobalamin levels remained normal. These morphologic changes might cause confusion when examining blood or bone marrow samples from patients treated with hydroxyurea.
Perforated Peptic Ulcer—a Complication in Acute Salicylate Intoxication
Authors: CHRISTENSEN LISBET A. , SCHMIDT ERIK B.
Published: August 2010

ABSTRACT A patient with perforated peptic ulcer following acute salicylate intoxication is presented. The patient had reversible renal failure requiring dialysis therapy, but no abdominal symptoms were noticed until six days after arrival. At this time haematemesis and melaena were observed. Symptoms and objective findings were vague, but further investigations revealed a perforated prepyloric ulcer, which was successfully treated with cimetidine. The delay from intoxication to symptoms has previously been described and might be due to the analgetic properties of salicylates.
Relationship between Leisure‐time Physical Activity and Risk Factors for Coronary Heart Disease in Middle‐aged Finnish Women
Authors: MARTI BERNARD , TUOMILEHTO JAAKKO , SALONEN JUKKA T. , PUSKA PEKKA , NISSINEN AULIKKI
Published: August 2010

ABSTRACT Risk factors for coronary heart disease (CHD) and levels of leisure‐time physical activity (LTPA) were measured in a random sample of 4059 women aged 25–64 years, residing in four areas of Finland. LTPA indexed as the product of weekly exercise sessions x their usual intensity showed an inverse association with smoking (p=0.02) and with CHD risk estimate which combines the three main risk factors, smoking, serum cholesterol and blood pressure (p=0.06), and a positive association with HDL cholesterol (p=0.002). It was not associated with mean arterial pressure and serum total cholesterol. In a multiple regression analysis LTPA contributed independently, though modestly, to the model for CHD risk estimate. Age and body mass index were the most important independent predictors of both mean arterial pressure and CHD risk estimate. It is concluded that in middle‐aged Finnish women, unlike men of the same population, high LTPA is only weakly related to lower CHD risk factor levels.
Increased Plasma Fibronectin Concentrations in Obesity: Normalization during Weight Loss
Authors: ANDERSEN TEIS , DEJGAARD ANDERS , ASTRUP ARNE , GLUUD CHRISTIAN
Published: August 2010

ABSTRACT In 23 morbidly obese patients we investigated the influence of a large weight loss (30.6 kg, range 17.5–90.8) on the plasma fibronectin concentrations. Further, changes in plasma fibronectin were related to serum insulin levels and to liver biochemistry. Between the measurements patients had been treated with an intermittent very‐low‐calorie formula diet sufficient in respect to protein, minerals and vitamins. They were investigated in weight‐stable states. Before weight reduction, 14 patients (61%, 95% confidence limits 3940%) had elevated plasma fibronectin levels. Plasma fibronectin decreased (medians 1.22 and 0.59 μmol/l before and after weight loss, p<0.01) and was after weight loss within the normal range in 14 patients. The change in plasma fibronectin was unassociated with the magnitude of the weight loss as well as with the reduction of overweight. The resulting plasma fibronectin levels were also uncorrelated with the body weight and with the final degree of overweight. Serum insulin decreased (p<0.01) during the weight reduction and the change correlated (p<0.05) with the change in plasma fibronectin. Serum lactate dehydrogenase, which is associated with the degree of hepatic fatty change, declined (p<0.01), but the individual change was unrelated with the change in plasma fibronectin. In conclusion, the elevated plasma fibronectin levels in morbidly obese subjects seem to normalize during weight loss. We suggest the normalization to be mediated—at least in part—by a reduction of the insulin levels.
The Sensitivity of the Symptom Angina Pectoris as a Marker of Transient Myocardial Ischaemia in Chronic Stable Angina Pectoris
Authors: EGSTRUP KENNETH
Published: August 2010

ABSTRACT Therapeutic decisions in patients with angina pectoris are traditionally based on the history reported by the patient, since objective evidence of myocardial ischaemia during daily life is often not available. In this study, ambulatory ST segment monitoring was performed in 60 patients with a history of chronic stable angina pectoris, positive exercise test and/or positive coronary angiography, and a correlation was made between the episodes of chest pain and ST segment change. The patients were grouped according to the results of exercise testing and coronary arteriography, and one group was studied with and without antianginal medication. Overall, 195 episodes of angina were noted, only 94 of which (48%) were accompanied by ST segment depression. Pain and ST segment changes were best correlated in patients with a positive exercise test, positive angiography and who were not receiving antianginal medication. In 101 episodes of chest pain, ST segment change could not be identified; in 18 (18%) there was sinus tachycardia, in 12 (12%) ventricular premature beats, and in 71 (70%) sinus rhythm solely. Thus, anginal pain appears not to be the reliable indicator of transient myocardial ischaemia as was previously thought, a finding which supports the use of objective methods in identifying episodes of transient myocardial ischaemia in daily life.
Thallium Scintigraphy in Prediction of Occlusion of Bypass Grafts in Asymptomatic and Symptomatic Patients
Authors: HUIKURI HEIKKI V. , IKÄHEIMO MARKKU J. , KORHONEN ULLA R. , HEIKKILÅ JUHANI , TAKKUNEN JUHA T.
Published: August 2010

ABSTRACT To evaluate thallium scintigraphy in predicting coronary artery bypass graft patency, exercise thallium scintigraphy and selective graft and native vessel angiograms were performed in 22 asymptomatic and 29 symptomatic consecutive patients three months after coronary artery bypass grafting (CABG). Twelve out of 22 asymptomatic patients (55%) had reversible thallium defects on postoperative images; in 10 patients the postoperative scans were normal. The graft patency was significantly lower in asymptomatic patients with abnormal thallium perfusion compared to those with normal perfusion after CABG (68% vs. 91%. p<0.05). The rate of graft patency in symptomatic patients was 66/87 (76%). Thallium scintigraphy was 77% sensitive and 78% specific in detecting one or more stenosed or occluded bypass grafts in patients without angina (accuracy 77%). When data from exercise electrocardiography were combined with scintigraphy, all but one patient with incomplete revascularization could be detected (positive predictive accuracy 92%). In symptomatic patients, thallium scintigraphy accurately predicted the presence or absence of graft occlusion in 24/29 (83%) cases. Thus, abnormal myocardial perfusion due to stenosis or occlusion of bypass grafts is common in both asymptomatic and symptomatic patients after CABG. Thallium scintigraphy together with exercise electrocardiography appear to be useful non‐invasive methods in detecting painless myocardial ischemia and in predicting bypass graft occlusion after CABG.
Effects of Cisapride on Gastroparesis in Patients with Insulin‐dependent Diabetes Mellitus
Authors: HAVELUND TROELS , ØSTER‐JØRGENSEN ERIK , ESHØJ OLE , LARSEN MOGENS LYTKEN , LAURITSEN KARSTEN
Published: August 2010

ABSTRACT Fourteen insulin‐dependent diabetics with symptoms and signs of delayed gastric emptying were treated with a new prokinetic agent, cisapride. In a placebo‐controlled cross‐over trial no significant differences from placebo was found regarding overall symptomatic effects and effects on gastric emptying of a mixed solid/liquid isotope marked test meal. Solid emptying was most markedly delayed in diabetics compared with healthy controls, but the emptying rate was not correlated to the severity of symptoms as observed for liquid emptying. During active tratment with cisapride the amelioration of symptoms was correlated to increased emptying rates assessed by combined measure of liquidsolid gastric emptying.
Thyroid Dysfunction after Delivery: Incidence and Clinical Course
Authors: LERVANG H.‐H. , PRYDS O. , KRISTENSEN H. P.ØSTERGAARD
Published: August 2010

ABSTRACT In a prospectively planned study of 591 Danish women thyroid dysfunction after delivery was found in 23 (3.9%). Seven women were hypothyroid and 16 were thyrotoxic. In seven of the thyrotoxic subjects a hypothyroid phase followed. Thyroid dysfunction was mostly transient with complete resolution within a year but persisted in three women (13%). Three months after delivery a positive titre of thyroid microsomal antibodies (TMAb) was found in 38 women (6.4%). Positive titres of TMAb were more often found in women with thyroid dysfunction than in those without (20/38 vs. 3/553). Maximal TMAb titres were seen 5–6 months after delivery and were associated with the occurrence of hypothyroidism. Postpartum thyroid dysfunction was found more often in women with a personal or family history of autoimmune thyroid disorder.
Autopsy‐verified Causes of Death after Stroke
Authors: VIITANEN MATTI , WINBLAD BENGT , ASPLUND KJELL
Published: August 2010

ABSTRACT. In a population‐based sample of 409 stroke patients, autopsy was performed in 82 of the 95 patients who died during the first three months and in 61 of the 128 patients dying thereafter. The dominant causes of death, as verified by autopsy, were cerebrovascular disease in the first week (90%), pulmonary embolism in the second to fourth week (30%), bronchopneumonia during the second and third months (27%) and cardiac disease, mainly myocardial infarction, later than three months after the stroke (37%). Death was attributed to causes other than the brain lesion in 59% of the patients with ischemic and in 24% of the patients with hemorrhagic stroke (p<0.01). Age and sex had little influence on the distribution of causes of death. Fatal pulmonary embolism and bronchopneumonia surprisingly often occurred in ambulatory patients. An intracardiac thrombus was present in 20% of deceased patients with atrial fibrillation, and in 17% of cases with a history of myocardial infarction. When attempts are made to reduce mortality (and morbidity) after stroke, there would seem to be a considerable potential for prevention and early treatment of complications, such as pulmonary embolism, bronchopneumonia and cardiac disorders.
Blood Pressure is Lowered by Vitamin D (Alphacalcidol) during Long‐Term Treatment of Patients with Intermittent Hypercalcaemia
Authors: LIND LARS , WENGLE BO , LJUNGHALL SVERKER
Published: August 2010

ABSTRACT.There is epidemiologic evidence of a relationship between calcium deficiency and hypertension. The present study evaluated the effects of alphacalcidol, a synthetic analogue of active vitamin D, given to 29 patients with marginal, intermittent hypercalcaemia. Before therapy there was aninverserelationship between serum calcium levels and diastolic blood pressure (p<0.02). Treatment with 1 μg alphacalcidol raised the serum calcium by 0.07 mmol/l during a 6‐month, double‐blind, placebo‐controlled trial and caused a significant reduction of diastolic blood pressure by 9.2 mmHg compared with placebo (p<0.01). The study extends previous observations, in normocalcaemic subjects, of inverse relationships between serum calcium and blood pressure indicating a primary disturbance of calcium homeostasis in hypertension. The observation that a physiologic amount of active vitamin D has hypotensive effects agrees with such a concept and suggests a new principle for the treatment of hypertension.
Serum Lipid and Lipoprotein Levels in Long‐term Insulin‐dependent Diabetes Mellitus
Authors: SJöBERG STEFAN , GUNNARSSON ROLF , RöSSNER STEPHAN , öSTMAN JAN
Published: August 2010

ABSTRACT. The aim of the present study concerning patients with long‐term insulin‐dependent diabetes mellitus was to determine whether the serum lipid and lipoprotein concentrations differ in subjects with and without residual insulin secretion. We also investigated whether factors such as sex, smoking, physical activity and microvascular lesions were associated with particular lipoprotein profiles. C‐peptide excretion (≥0.2 nmol) in 24‐hour urine samples was used as an indicator of residual insulin secretion. Twenty‐two pairs of patients with and without residual insulin secretion matched for age at onset and disease duration were participating in the investigations of glycaemic control and microvascular lesions. The HbA1C was significantly lower in C‐peptide excretors than in the non‐excretors (6.9±0.3 vs. 7.9±0.3%, p<0.025). The lipids and lipoprotein fractions were all within normal limits. The HDL2/3 ratio was significantly higher in C‐peptide excretors than in non‐excretors (1.72±0.28 vs. 1.10±0.09, p<0.05). Multiple regression analysis showed that factors, such as physical activity, body mass index and glycaemic control could explain more of the variation in the different lipid and lipoprotein fractions than residual C‐peptide excretion alone. The only fraction correlating with C‐peptide excretion was HDL3 cholesterol. It is concluded that minute residual insulin secretion per se is of minor importance for the regulation of lipids and lipoproteins. Glucose control and residual insulin secretion together with environmental factors seem to be of great importance for the regulation of the lipid and lipoprotein levels in insulin‐dependent diabetes mellitus.
Brain damage in alcoholism: Current concepts
Authors: Lishman William A , Jacobson Robin R , Acker Clare
Published: August 2010

Current views concerning the brain damage occasioned by alcohol abuse are reviewed. Diffuse cerebral changes appear to be common and partially reversible with prolonged abstinence. The possible determinants of such changes, and their relevance to functional deficits are discussed, with illustrations from work currently proceeding at the Institute of Psychiatry. Possible interactions between cortical and subcortical pathologies in contributing to the cognitive deficits shown by alcoholic patients are emphasised.
The roles of alcohol in the epidemiology of cardiovascular diseases
Authors: Criqui Michael H
Published: August 2010

Alcohol, both alone and in concert with deficiencies or excesses of other substances, can produce cardiomyopathy. In addition, alcohol can directly affect the cardiac‐conduction system and produce arrhythmias. A Icohol also affects kno wn risk factors for stroke and coronary heart disease (CHD). Alcohol increases blood pressure, which may lead to hypertension and thus increase the risk of stroke. HDL cholesterol, which is inversely related to CHD risk, increases with alcohol, and LDL cholesterol, which is positively related to CHD risk, may decrease with alcohol, a potentially dually protective effect. However, both case‐control and population based studies indicate only moderate levels of consumption, defined as two drinks per day or less, may be of benefit.

Preliminary data from the Lipid Research Clinics Follow‐up Study suggest that the beneficial effect of moderate amounts of alcohol may be mediated in part by increased HDL cholesterol and in part by another factor, possibly reduced coagulation. Clinical and laboratory data, in addition to epidemiologic data, suggest alcohol intake above two drinks per day leads to excess cardiovascular disease (CVD), probably reflecting hypercoagulability as well as hypertension at higher levels of intake.

Because alcohol can lead to excess morbidity and mortality from CVD as well as several other diseases and conditions, public health policy should continue to discourage the drinking of alcohol, especially non‐moderate consumption.
Alcoholic registration and cardiovascular morbidity and mortality ‐ a prospective study in middle aged Swedish men
Authors: Rosengren Annika , Wilhelmsen Lars
Published: August 2010

The consequences of alcoholic intemperance and economic problems on CHD mortality and morbidity were studied among the participants in a large primary preventive trial. Official register data were used. Subjects registered with the Board of Social Welfare were categorised with respect to increasing load of alcoholic intemperance. Non‐fatal CHD was not related to alcoholic problems. Fatal CHD, on the other hand, was strongly associated with registration for intemperance. This was especially pronounced for cases dying suddenly from CHD. A multivariate analysis was performed, controlling for smoking, systolic blood pressure and scrum cholesterol, which showed that the association between intemperance and fatal CHD was independent of these factors.
What supports the role of alcohol as a risk factor for stroke?
Authors: Hillbom Matti E
Published: August 2010

For more than 30 years, clinical observations to link alcohol abuse and stroke have accumulated in several countries. Studies of general populations have indicated that the risk for stroke increases with increasing alcohol consumption. Studies of young victims of stroke where the classical risk factors of stroke are uncommon, have demonstrated that even occasional heavy drinking carries an increased risk for stroke. In particular, the increased occurrence of strokes during weekends, the very time of heavy alcohol consumption in non‐alcoholics, supports this notion. Alcoholics seem to get their strokes at an earlier age than non‐alcoholics. Paradoxically, the published evidence has implicated drinking in both ischemic and hemorrhagic strokes, which suggests that there may be more than one mechanism by which alcohol can increase the risk. Strokes seem to be precipitated during the alcohol intoxication itself rather than the following withdra wal syndrome, but the contributing mechanisms, except for bleedings caused by external violence, are unknown. Alcohol can produce fluctuations in platelet reactivity and untoward interactions with certain drugs, but it remains to be demonstrated that such effects are temporally related to the onset of ischemic and hemorrhagic strokes.
The consequences of reviewing serial changes in the Minnesota code for diagnosis of acute myocardial infarction
Authors: WOLF H.K. , RAUTAHARJU P.M. , MACKENZIE B.R. , GREGOR R.D. , MILSOM D.S.
Published: August 2010

ABSTRACT. We investigated the effect of reviewing serial electrocardiograms (ECGs) for significance of changes in the Minnesota code, and the influence of this effect on the MONICA diagnosis of myocardial infarction (MI). We used the data from 1340 consecutive admissions to the coronary care units of our MONICA centre and we developed ECG classifications and MONICA diagnoses that were based once on the unreviewed Minnesota code and once on the reviewed code.

A comparison of the two ECG classifications showed that codes for evolution of Q‐waves and injury currents were much more likely to change as a result of a review (46.8 %) than codes for evolution of repolarization changes (12.8 %).

The review of serial Minnesota codes caused a change of the MONICA diagnosis primarily in the category definite Ml (10 %). In a blinded clinical assessment, the cases that changed diagnosis were judged to be different from those that remained constant. It is concluded that the use of ECG classification based on unreviewed Minnesota code changes introduces heterogeneity. The significance of this effect depends on the use of the results.
Comparison of event rates among three MONICA centres
Authors: BEAGLEHOLE R. , DOBSON A. , HOBBS M. , JACKSON R. , JAMROZIK K. , ALEXANDER H. , STEWART A.
Published: August 2010

ABSTRACT. Data from three MONICA centres in Auckland (New Zealand) and Newcastle and Perth (Australia) are used to explore some of the issues involved in comparing event rates and case fatality among MONICA centres. Auckland and Newcastle follow the »hot pursuit» method of identifying and interviewing patients while they are still in hospital. Perth follows the »cold pursuit» method, in which patients are identified by search of computerized hospital records after discharge and all data are abstracted retrospectively from case notes. Fatal cases are identified by the same method in the three centres.

The distribution of events by MONICA diagnostic classification varied among centres, with Perth having the highest proportion of definite myocardial infarction events and the lowest proportion of possible myocardial infarction events. These differences appear to be due to the different methods of event ascertainment and data collection, and to variations in post mortem rates between centres. For comparisons among these three centres, the categories of non‐fatal definite myocardial infarction and of all coronary heart disease deaths (that is those in the MONICA categories fatal definite myocardial infarction, fatal possible myocardial infarction, and fatal cases with insufficient data) appear to be the most useful.
Coronary events in the Hunter Region of New South Wales, Australia: 1984–1986
Authors: DOBSON A.J. , ALEXANDER H.M. , AL‐ROOMI K. , GIBBERD R.W. , HELLER R.F. , LEEDER S.R. , LLOYD D.M. , MALCOLM J.A. , STEELE P.L.
Published: August 2010

ABSTRACT. The results of coronary event registration using the protocol of the World Health Organization MONICA Project are reported for two years for the Hunter Region, the area in and around Newcastle in New South Wales, Australia. The Newcastle MONICA Project monitors all suspected cases of heart attack by identifying patients from hospital admissions and obtaining information while they are still in hospital. For people who die out of hospital, the initial source of information is usually the death certificate. Rates for the most robust MONICA diagnostic categories, non‐fatal definite myocardial infarction and all coronary deaths, differed for the two years reported here. Monthly rates suggested possible seasonal effects, and the possible influence of lower respiratory infections including an epidemic of influenza A. The results demonstrate that consistent monitoring over several years will be necessary to establish clear trends in coronary heart disease.
The cardiovascular risk factor profile in the study area Augsburg. Results from the first MONICA survey 1984/85
Authors: KEIL U. , STIEBER J. , DÖRING A. , CHAMBLESS L. , HÄRTEL U. , FILIPIAK B. , HENSE H.W. , TIETZE M. , GOSTOMZYK J.G.
Published: August 2010

ABSTRACT. The main objective of the first survey was the investigation of the prevalence and distribution of hypertension, hypercholesterolemia and cigarette smoking in the study area. The data‐collection phase lasted from October 1984 to May 1985. A two‐stage cluster sample of 5312 persons of German nationality was drawn from a population of 282,279 inhabitants, aged 25–64. The data were gathered through interview, physical examination and self‐administered questionnaire. A response of 79 % was achieved. Sixteen percent of men and 10 % of women had high blood pressure (BP) values (≥ 160/95 mmHg). Only 16 % of male and 34 % of female hypertensives had controlled BP values. The prevalence of hypercholesterolemia (≥6.72 mmol/L = ≥260 mg/dl) was 26 % in men and 22 % in women. Forty percent of men and 22 % of women reported they were current cigarette smokers. Among participants, aged 25–44, cigarette smoking was the most prevalent risk factor in men and women. Thirty‐seven percent of men and 52 % of women, aged 25–64, had none of the three major risk factors.
Factors influencing total cholesterol and high‐density lipoprotein cholesterol concentrations in a population at high coronary risk
Authors: PATTERSON C.C. , McCRUM E. , McMASTER D. , KERR M. , SYKES D. , EVANS A.E.
Published: August 2010

ABSTRACT. Serum total cholesterol and high‐density lipoprotein (HDL) cholesterol concentrations were measured in 1122 men and 1147 women aged between 25 and 64 years during the first Belfast MONICA survey, and the results subjected to multiple regression analysis. In both men and women, total cholesterol increased with age. Although HDL‐cholesterol showed little variation with age, the values were considerably higher in women than men. Total cholesterol increased with body mass index while HDL‐cholesterol decreased, and these findings persisted after adjustment for age. Regular exercise was associated with higher HDL‐cholesterol values, even after adjustment for age and body mass index. Among men and women who abstained from alcohol, lower values of HDL‐cholesterol were observed. In both sexes, cigarette smoking was associated with significant increases in total cholesterol values and decreases in HDL‐cholesterol values, though some of these findings became apparent only after adjustment for other relevant factors. Perhaps surprisingly, a measure of health knowledge showed no association with blood lipid concentrations.
Pulmonary‐artery Cineangiocardiography and Echocardiography for Detection of Cardiac Sources of Cerebral Embolism
Authors: ERIKSSON STURE , BACKMAN CHRISTER , OSTERMAN GÖRAN
Published: August 2010

ABSTRACT Sixty‐two patients with ischemic stroke possibly due to embolism of cardiac origin were investigated by pulmonary artery‐cineangiography (PACAC) and echocardiography (UCG) to detect intracardiac thrombi. The proportion of intracardiac thrombi found by PACAC was 31% and by UCG 15%. The presence or absence of atrial fibrillation correlated well with PACAC findings of an intraventricular clot but poorly with UCG. Similarly, there was a significant association between ischemic heart disease and intraventricular thrombi detected by PACAC investigations but not with the results obtained by UCG. PACAC seems superior to UCG in the detection of intracardiac thrombi after possible embolic stroke.
Acute Myocarditis
Authors: VIKERFORS TOMAS , STJERNA ANDERS , OLCÉN PER , MALMCRONA RAOUL , MAGNIUS LARS
Published: August 2010

ABSTRACT In a prospective study, 57 patients with a preliminary diagnosis of myocarditis were investigated. Twenty‐four patients were considered to have an acute myocarditis, 14 had a suspected myocarditis, while in 19 patients myocarditis was excluded. Episodes of frequent supraventricular and/or ventricular extrasystoles during hospital stay were seen in 8/24 cases (33%) with myocarditis and in 1/19 cases (5%) without myocarditis. On follow‐up 1 month later, no supraventricular extrasystoles were observed in either group. Echocardiographic signs consistent with left ventricular insufficiency were noted in 7/24 cases (29%) with myocarditis, in 1/14 cases (7%) with suspected myocarditis and in no case without myocarditis. With a “routine” serologic test battery covering influenza viruses A and B, adenovirus, Coxsackie virus group B, ECHO viruses, Chlamydia psittaci, Mycoplasma pneumoniae and hemolytic streptococci group A, a possible etiology could be documented in 9/24 cases (38%) with myocarditis and in 4/19 cases (21%) without myocarditis. Enterovirus‐specific IgM was detected with solid‐phase reverse immunosorbent test (SPRIST) in 12/23 (48%) cases with myocarditis and in 3/16 cases (19%) without myocarditis. In SPRIST‐IgM‐positive cases, IgM antibodies were detected in 15/20 (75%) of the sera taken on admission. The overall serological results indicated a recent infection in 16/24 cases (67%) with myocarditis and in 5/19 cases (26%) without myocarditis (p < 0.05).
Stopping Insulin Treatment in Middle‐aged Diabetic Patients with High Postglucagon Plasma C‐Peptide
Authors: LAAKSO MARKKU , SARLUND HELENA , KORHONEN TIMO , VOUTILAINEN ERKKI , MAJANDER HELEENA , HAKALA PAULA , UUSITUPA MATTI , PYÖRÄLÄ KALEVI
Published: August 2010

ABSTRACT We studied the successfulness of stopping insulin treatment in middle‐aged diabetic patients aged 45–64 with a high postglucagon C‐peptide level and the effects of this change on glycaemic control, serum lipids and lipoproteins. Insulin treatment was successfully stopped in 15 of our 22 patients who satisfied the inclusion criteria for the study and were selected on the basis of a computer file including practically all diabetic patients treated with insulin in the Kuopio University Central Hospital region (population base 250000 inhabitants). Insulin therapy was restarted in seven patients during the first 3 months after discharge. During the following 9 months insulin therapy was restarted in another three patients so that after a 1‐year follow‐up period half of the diabetic patients whose insulin therapy was stopped had been switched back to insulin. Insulin therapy was seldom successfully stopped if the postglucagon C‐peptide value was under the limit of 1.0 nmol/l. Glycaemic control did not change during the follow‐up, although there was a significant weight loss in diabetic patients. No changes were observed in serum lipids or lipoproteins with the exception of LDL cholesterol, which showed a significant reduction during the 3‐month follow‐up. In conclusion, insulin therapy can often be successfully stopped in patients with postglucagon C‐peptide over the limit of 1.0 nmol/l without worsening of glycaemic control and without unfavourable changes in serum lipid and lipoprotein levels.
Cyclic Neutropenia Terminating in Permanent Agranulocytosis
Authors: BOESEN PER
Published: August 2010

ABSTRACT A patient with cyclic neutropenia was followed for 20 years. After 16 years she developed a permanent agranulocytosis, and lived for nearly four years without neutrophils in the peripheral blood. Neither prednisone, lithium nor Jeuco‐ and plasmapheresis had any effect on the neutrophil count.
Splenic Platelet Kinetics and Platelet Production after Major Reconstructive Vascular Surgery
Authors: WADENVIK HANS , ÖRTENWALL PER , KUTTI JACK , RISBERG BO
Published: August 2010

ABSTRACT By using 111In‐labelled platelets and dynamic gamma camera scintigraphy, platelet production rate and intrasplenic platelet kinetics were determined in 13 patients at 1 and 4 months after aortic reconstructive vascular surgery with implantation of dacron prostheses. A significant decrease in platelet production rate and venous platelet count was recorded over time after surgery. Irrespective of whether the exchangeable splenic platelet pool was estimated from initial recovery of platelet‐bound radioactivity or from compartmental analysis, the size of this pool was significantly lower at the first study; a change in intrasplenic platelet transit time accounted for the observed difference. Platelet mean life‐span increased over time after surgery but the difference between the duplicate studies was not statistically significant. It can be concluded that there is a reduction of platelet production rate and venous platelet count over time after major reconstructive vascular surgery. The early postoperative elevation in the platelet count is mainly the result of an increased platelet production and to a lesser degree due to redistribution of platelets between the splenic platelet pool and general circulation.
Glibenclamide Improves the Response to Insulin Treatment in Non‐insulin‐dependent Diabetics with Second Failure to Sulfonylurea Therapy
Authors: LINS PER‐ERIC , LUNDBLAD SIV , PERSSON‐TROTZIG EVA , ADAMSON ULF
Published: August 2010

ABSTRACT The effect of combined insulin‐glibenclamide therapy on glucose control was evaluated in a double‐blind placebo controlled study of 20 patients with non‐insulin‐dependent diabetes mellitus (NIDDM) and second failure to oral antidiabetic therapy with glibenclamide or glipizide. After an observation period of 1–3 months, insulin treatment was initiated which resulted in rapid improvement of the glycemic control within 6 weeks. Thereafter glibenclamide or placebo was added to insulin for a further 12 weeks. Glibenclamide improved the glycemic control as expressed by a diminution of blood glucose and HbA1c. This was observed in spite of the fact that the daily insulin dose was reduced by approximately 30% in the glibenclamide‐treated group of patients. It is concluded that in NIDDM patients with second failure to glibenclamide ot glipizide therapy, the responsiveness to glibenclamide may be at least partially restored by a short period of insulin treatment. It is suggested that therapy with insulin and glibenclamide is an appropriate treatment regimen for NIDDM patients with second failure to sulfonylurea therapy.