bluuebunny/crossref_metadata_2025 huggingface dataset:
Serum cholesterol concentration before and after streptokinase in acute myocardial infarction
Authors: Chua T. P. , FRY I. D. R. , FRANKEL R. J. , LIM R.
Published: August 2009

Abstract. Objective. To determine if serum cholesterol concentration should be measured before or after streptokinase therapy within the first 24 h of myocardial infarction.

Design. Prospective study of patients receiving streptokinase therapy for acute myocardial infarction (AMI).

Setting. Coronary care unit of a district general hospital.

Subjects. Thirty‐one patients (26 men aged 38–74 years, mean 60 years) admitted with a definite diagnosis of myocardial infarction.

Intervention. Streptokinase therapy given intravenously at a mean of 5 h (range 1.5–15 h) after the onset of chest pain.

Main outcome measures. Serum cholesterol concentration just prior to, and 11.5 h (range 4–20.5 h) after streptokinase administration.

Results. There was a significant mean fall of 0.4 mmol l−1 (P = 0.002, 95% CI = 0.2–0.6) in serum cholesterol concentration from a pre‐streptokinase concentration of 7.0 (range 5.3–9.9) to a post‐streptokinase concentration of 6.6 (range 4.9–9.9). In the patients who showed a fall in cholesterol concentration, the magnitude of fall correlated with the baseline cholesterol concentration (r = 0.66, P < 0.01) but not with peak cardiac enzyme activities (r = 0.05, P > 0.2 for aspartate aminotransferase; r = 0.10, P > 0.2 for lactate dehydrogenase), time from onset of chest pain to post‐streptokinase measurement (r = 0.27, P > 0.2) or time from streptokinase administration to post‐streptokinase measurement (r = 0.01, P > 0.2).

Conclusion. Serum cholesterol concentration may be underestimated when measured after streptokinase therapy, particularly when the true basal value is high. Further management of this risk factor may be based more accurately on its measurement before than after streptokinase therapy within the first 24 h of AMI.
Haemorrhagic bullae induced by oral anticoagulants
Authors: ELLS A. , LISHNER M. , LANG R. , SAVIN H. , Ravid M.
Published: August 2009

Abstract. A 77‐year‐old patient developed haemorrhagic bullae on her fingers 30 months after initiation of anticoagulation treatment with warfarin sodium for chronic atrial fibrillation and mitral insufficiency. The bullae resolved 10 days after discontinuation of the medication. Two weeks after initiation of sintrom, (3‐α‐(4‐nitrophenyl)‐β‐acetylethyl‐4‐hydroxy coumarin), the lesions recurred and resolved again upon cessation of the drug. This adverse skin reaction has not been hitherto reported.
The Helsinki Heart Study: an 8.5‐year safety and mortality follow‐up
Authors: Huttunen Jussi K. , Heinonen O. P. , Manninen V. , Koskinen P. , Hakulinen T. , Teppo L. , Mänttäri M. , Frick M. H.
Published: August 2009

Abstract. Objectives. Earlier monitoring of all symptoms, hospital admissions, cancer diagnoses and causes of death during gemfibrozil treatment had raised some suspicions which called for further follow‐up.

Design. Close monitoring of selected, potentially adverse events amongst treated subjects after a placebo‐controlled trial and comparing occurrences to those in various untreated groups.

Setting. All participants of the Helsinki Heart Study (a controlled, 5‐year, multi‐clinic coronary heart disease (CHD) primary prevention trial with gemfibrozil and placebo) were offered gemfibrozil treatment and twice yearly follow‐up for 3.5 years. Untreated groups in the source population and national cancer statistics were utilized in comparisons.

Subjects. Of the 2046 dyslipidaemic men initially randomized to gemfibrozil, 2002 survivors entered the 3.5‐year follow‐up; of the 2035 initial placebo men, 1992 continued to be monitored.

Interventions. Gemfibrozil was chosen for the follow‐up by 66.3% of the gemfibrozil‐treated and 68.5% of the placebo‐treated men.

Main outcome measures. Gastrointestinal symptoms, surgery, strokes, cancer incidence, mortality by cause.

Results. Gastrointestinal symptoms remained more common in the original gemfibrozil group. After 8.5 years strokes numbered 32 (gemfibrozil) vs. 37 (placebo), violent deaths 16 vs. 14, and cancers 51 in both groups. Total mortality was equal during the original 5 years, but higher in the gemfibrozil group post‐trial, leading to an 8.5 year mortality of 101 vs. placebo 83 (P = 0.19). This was mainly a result of higher cancer mortality in the gemfibrozil (30) than the placebo group (18, P = 0.08). An additional 18‐month post‐study registry follow‐up disclosed 13 placebo and five gemfibrozil cancer deaths, altering the cancer mortality to gemfibrozil 35 vs. placebo 31 at 10 years.

Conclusions. The most plausible explanation for the discrepancy between cancer incidence and cancer‐specific mortality, based mainly on comparison with untreated groups, is delayed diagnosis. The increased cancer and total mortality is most probably due to chance, based on the later reversal of trends.
Endogenous digoxin‐like factor in acute myocardial infarction
Authors: Bagrov A. Y. , Kuznetsova E. A. , Fedorova O. V.
Published: August 2009

Abstract. Objectives. The aim of the study was to test the hypotheses that the concentrations of endogenous digoxin‐like factor (EDLF) are (i) increased in the initial period after acute myocardial infarction (AMI) and (ii) may contribute to the genesis of ventricular arrhythmias.

Design. Consecutive sample study.

Setting. An 800‐bed city teaching hospital, primary hospitalized care centre.

Subjects. Fifty‐four consecutive patients of both sexes with a first transmural AMI, 16 male patients with unstable angina pectoris and eight healthy subjects.

Interventions. None.

Main outcome measures. Time‐course of the changes of plasma concentrations of EDLF (DELFIA digoxin fluoroimmunoassay) in patients during days 1–14 after uncomplicated AMI and AMI complicated with ventricular fibrillation and congestive heart failure.

Results. Plasma concentrations of EDLF in patients on the 1st day after AMI were increased (1.25 ± 0.26 ng ml‐1 digoxin equivalents, P < 0.025) as compared with both healthy controls (0.34 ± 0.06 ng ml‐1) and patients with unstable angina pectoris (0.40 ± 0.08 ng ml‐1). On the 1st day after AMI the plasma levels of EDLF in seven patients with primary ventricular fibrillation were higher (2.54 ± 0.67 ng ml‐1, P < 0.05) than in 47 patients without ventricular fibrillation (1.05 ± 0.27 ng ml‐1). In 14 patients with AMI and congestive heart failure (class III. Killip), plasma concentrations of EDLF were significantly lower (0.32 ± 0.09 ng ml‐1, P < 0.01) than in 40 patients with AMI without congestive heart failure (1.51 ± 0.32 ng ml‐1). Starting from the 2nd day of AMI, plasma EDLF decreased to the level of the control values (0.35 ± 0.04 ng ml‐1) and did not change during a 2‐week period of observation.

Conclusions. The results show an increase of plasma EDLF during the 1st day after AMI, and that higher plasma EDLF may be associated with the development of ventricular arrhythmias.
Familial hypercholesterolaemia‐like syndrome with apolipoprotein E‐7 associated with marked Achilles tendon xanthomas and coronary artery disease: a report of two cases
Authors: Ueyama Y. , Nozaki S. , Yanagi K. , Hiraoka H. , Nakagawa T. , Sakai N. , Jiao S. , Yamashita S. , Matsuzawa Y.
Published: August 2009

Abstract. We observed two patients with hypercholesterolaemia and tendon xanthomas associated with apolipoprotein (apoE‐7) E‐7, a rare variant of the apoE isoforms. Both suffered from coronary artery disease and had undergone a coronary bypass operation. Their cholesterol levels were 268 and 310 mg dl‐1, respectively. Both patients had marked xanthomas in the Achilles tendons. Both also suffered from diabetes. Although their clinical and laboratory findings were compatible with typical familial hypercholesterolaemia (FH), the analysis of low‐density lipoprotein (LDL) receptors in cultured fibroblasts showed no abnormality of binding, internalization or degradation of 125I‐LDL.

Diabetic control with a low‐calorie, low‐fat diet led to the rapid reduction of serum cholesterol. Other family members of the patients with apoE‐7, who were normoglycaemic, showed normal cholesterol levels and no xanthomas. These findings suggest that coexistent diabetes mellitus may induce overt hyperlipidaemia and accumulation of lipids in tissues in subjects with apoE7.
Thymoma with immunodeficiency (Good's syndrome) associated with selective cobalamin malabsorption and benign IgM‐K gammopathy
Authors: Jeandel C. , Gastin I. , Blain H. , Jouanny P. , Laurain M. C. , Penin F. , Saunier M. , Nicolas J. P. , Guéant J. L.
Published: August 2009

Abstract. We have described the first case, to our knowledge, in which recurrent respiratory tract infections were the primary manifestation of thymoma with immunodeficiency (Good's syndrome) associated with cobalamin malabsorption and immunoglobulin M‐K (IgM‐K) M component. The intrinsic factor receptor activity was dramatically decreased in a mucosal homogenate prepared from ileal biopsies. This decreased activity could be the principal cause of the malabsorption of labelled cobalamin which was observed in the presence of intrinsic factor. However, it could be the consequence of the cobalamin deficiency, as it is known that a cobalamin deficiency can affect the assimilation of cobalamin, even in presence of exogenous intrinsic factor.
Fibromyalgia: a clinical challenge
Authors: Lorenzen I.
Published: August 2009

Abstract. The syndrome of fibromyalgia includes an unusually large and heterogeneous number of symptoms apart from the core features of generalized pain and widespread tenderness. Widespread tenderness is the only objective criterion. There is no evidence that fibromyalgia is a disease of the muscles or a rheumatic syndrome. The experience from an Australian epidemic of fibromyalgia indicates that there is an important psychosomatic component in the pathogenesis. Probably, fibromyalgia is not a disease entity; rather, the symptoms reflect difficulties in coping with various types of environmental stress. Secondary to this, sleep disturbances, fatigue, a low level of physical activity and poor physcial fitness may develop, rendering the patients susceptible to muscle pain and tenderness elicited by sleep disturbances. A vicious circle may be responsible for the chronicity of the syndrome. Identification of environmental factors and early intervention should be given a high priority.
The role of diabetes mellitus and hypertriglyceridaemia as coronary risk factors in treated hypertension: 15 years of follow‐up of antihypertensive treatment in middle‐aged men in the Primary Prevention Trial in Göteborg, Sweden
Authors: Samuelsson O. , Hednert T. , Persson B. , Andersson O. , Berglund G. , Wilhelmesen L.
Published: August 2009

Abstract.Objective. To analyse the importance of diabetes mellitus and hypertriglyceridaemia as potential risk factors for coronary heart disease (CHD) in middle‐aged, treated hypertensive men.

Design. A prospective, long‐term observational study

Subjects. Derived from a random population sample—686 hypertensive men aged 47–54 years at entry—followed for 15 years at a special out‐patient hypertension clinic.

Intervention and outcome measures. The patients were mainly treated with beta‐adrenoceptor blockers and/or thiazide diuretics. Cardiovascular morbidity was closely monitored during follow‐up.

Results. In all, 133 subjects suffered a CHD event during follow‐up. The presence of diabetes mellitus at entry more than doubled the CHD risk and a 1 mmol I‐1increment of the serum triglyceride level at entry increased the CHD risk by 21%. In multivariate analyses, smoking, the presence of diabetes mellitus at entry, serum cholesterol and signs or symptoms of hypertensive end organ damage were found to be independent risk factors for CHD. In absolute terms the existence of cardiovascular damage was of much greater prognostic importance than were the presence of various metabolic abnormalities. Of the mean in‐study variables, both the average serum cholesterol level and the achieved diastolic blood pressure were significantly associated with CHD. However, new diabetes mellitus which developed during follow‐up as well as mean serum triglyceride levels were not associated with CHD.

Conclusions. Diabetes mellitus and hypertriglyceridaemia present at the start of treatment have a prognostic impact in treated hypertensive men, whereas when such metabolic disorders develop during drug treatment they seem to be of much less importance. Smoking and already existing evidence of hypertensive end organ damage are of utmost importance for the prognosis in this type of patient.
Egg consumption and high‐density‐lipoprotein cholesterol
Authors: Schnohr P. , Thomsen O. Ø. , Hansen P. Riis , Boberg‐Ans G. , Lawaetz H. , Weeke T.
Published: August 2009

Abstract. Objectives. To examine if increased egg consumption raises serum high‐density‐lipoprotein (HDL) cholesterol in healthy individuals.

Design. A cross‐over study.

Setting. A private clinic for preventive health examinations in Copenhagen.

Subjects. Twenty‐four healthy adults, 12 men and 12 women, aged 23–52 (median 40) years.

Interventions. After a 1‐week control period each person added two bolled eggs to the usual daily diet for 6 weeks. All persons were instructed not to change the lifestyle in other ways during the whole study period.

Main outcome measures. Serum HDL cholesterol, total cholesterol and triglycerides were measured before, during and after 6 weeks of extra egg consumption. The corresponding serum Iow‐density‐lipoprotein (LDL) cholesterol was calculated from the Friedewald formula.

Results. After 6 weeks of extra egg consumption serum HDL cholesterol increased by 10% (P < 0.05) and total cholesterol increased 4% (P < 0.05), whereas the ratio total cholesterol/HDL cholesterol did not change significantly. Serum triglycerides and LDL cholesterol were also unchanged.

Conclusions. A moderate egg intake should not be rigorously restricted in healthy individuals.
Insulin treatment improves microalbuminuria and other cardiovascular risk factors in patients with type 2 diabetes mellitus
Authors: Lindström T. , Olsson A. G. , Von Schenck H. , Wallentin L. , Arnqvist H. J.
Published: August 2009

Abstract. Objectives. Insulin treatment of patients with type 2 diabetes causes hyperinsulinaemia and improves glycaemic control. We have studied how this affects risk factors for cardiovascular disease.

Design. Patients with secondary failure to oral hypoglycaemic agents were studied whilst still taking oral agents and after insulin treatment for 8 weeks in an open study.

Setting. Department of Internal Medicine, University Hospital, Linköping.

Subjects. Ten consecutive patients with type 2 diabetes and secondary failure to oral hypoglycaemic agents.

Interventions. Switching oral treatment to insulin treatment.

Main outcome measures. Effect on several cardiovascular risk factors.

Results. Fasting and postprandial plasma insulin concentrations were increased by insulin treatment whereas C‐peptide concentrations were lowered. HbAlc was reduced from 8.9 ± 0.3% (mean ± SEM) to 6.3±0.2% after 8 weeks. There was a weight gain of 2.8±0.7 kg. Plasma concentrations of total‐ and very‐low‐density‐lipoprotein (VLDL) cholesterol, VLDL‐, low density lipoprotein and high‐density‐lipoprotein triglycerides were all reduced. The plasma concentration of apolipoprotein B was also lowered. Tissue plasminogen activator antigen measured after venous occlusion showed a significant reduction whilst plasminogen activator inhibitor 1 activity was 26.0±9.8 IU ml‐1 on oral treatment and 18.2±4.7 IU ml‐1 on insulin treatment (NS). Albumin excretion in the urine was reduced and the percentage reduction correlated with the percentage lowering of the tissue plasminogen activator antigen concentration after venous occlusion but not with the percentage change of basal tissue plasminogen activator antigen concentration.

Conclusions. Insulin treatment of patients with type 2 diabetes and secondary failure to oral hypoglycaemic agents causes hyperinsulinaemia and improves or has no unfavourable effect on several cardiovascular risk factors.
The epidemiology of a coronary waiting list A description of all of the patients
Authors: Bengtson A. , Herlitz J. , Karlsson T. , Hjalmarson A.
Published: August 2009

Abstract.Objectives. To describe the characteristics and the severity of symptoms amongst patients on the waiting list for possible coronary revascularization.

Design. All the patients were sent a postal questionnaire for symptom evaluation.

Setting. All hospitals in western Sweden.

Subjects. All patients in western Sweden on the waiting list in September 1990, who had been referred for coronary angiography or revascularization (n = 904) and a sex‐ and age‐matched reference group (n= 809).

Results. More than half of the patients had daily attacks of chest pain, whereas 16% reported less than one attack per week or no pain at all. However, other symptoms such as dyspnoea, tachycardia and nervous reactions were also common and 25% of all patients used sedatives. A long waiting time for a given procedure was not associated with more pain but with more nervous symptoms such as restlessness and insomnia (P< 0.0001) and greater use of sedatives and cigarettes (P< 0.05).

Conclusions. We conclude that a long waiting time for possible coronary revascularization is associated with more nervous symptoms but not with more pain.
Petrol octane booster and methaemoglobinaemia
Authors: Cummings M. H. , Day S. , Norton S. , Cook G. , Alexander W. D.
Published: August 2009

Abstract. We highlight the case of a 35‐year‐old male who suffered a respiratory arrest as a result of methaemo‐globinaemia secondary to skin contamination and inhalation of petrol octane booster following a road traffic accident. It is important that petrol octane booster is stored safely in leak‐proof containers and that suitable warnings are displayed to alert the user of potential toxicity.
Continuous infusion of furosemide in the treatment of patients with congestive heart failure and diuretic resistance
Authors: Van Meyel J. J. M. , Smits P. , Dormans T. , Gerlag P. G. G. , Russel F. G. M. , Gribnau F. W. J.
Published: August 2009

Objectives. To assess the value of treatment with continuous intravenous infusion of furosemide (F) in patients with refractory congestive heart failure.

Design. Open uncontrolled dose‐response study.

Subjects. Patients with congestive heart failure (those with New York Heart Association (NYHA) classes III and IV with an assessed amount of oedema of more than 5 kg and diuretic resistance were included [n = 10]). Diuretic resistance was defined as: failure to lose weight and/or inappropriate urinary sodium excretion (50 mmol 24 h‐1) despite bed rest for a period of 2–3 days, salt and water restriction, orally and intravenously administered furosemide in a dose of 250 mg day‐1, digoxin, and when possible an ACE inhibitor. Included patients were treated with continuous F infusion at a delivery rate of 20 mg‐1 over 24 h. The infusion rate was gradually heightened up to a maximum dose of 160 mg h‐1.

Main outcome measures. Daily physical examination, history of side‐effects, determination of serum electrolytes and 24‐h electrolyte excretion during treatment with furosemide.

Results. Weight loss (mean ± sd; 12.5 ± 5 kg) and relief of symptoms was achieved in all patients. Mean (± sd) 24‐h sodium output rose from 19 ± 16 mmol 24 h‐1 (n = 10) on oral therapy with 250 mg F to 137 ± 85 mmol 24 h‐1 (n = 8) during 80 mg h‐1 and to 268 ± 124 mmol 24 h‐1 (n = 3) on the maximal dose of 160 mg h‐1.

Conclusion. Continuous infusion of F under careful monitoring of the patient is a safe, controllable and efficient treatment in patients with severe congestive heart failure and diuretic resistance.
The changes in blood pressure after acute stroke: abolishing the ‘white coat effect’ with 24‐h ambulatory monitoring
Authors: Harper G. , Fotherby M. D. , Panayiotou B. J. , Castleden C. M. , Potter J. F.
Published: August 2009

Objectives. To assess the changes in 24‐h and casual blood pressure (BP) levels following hospitalization for acute stroke.

Design. Prospective study of patients admitted with acute hemispheric stroke and hospitalized controls using casual and 24‐h BP monitoring.

Setting. Medical wards in a large teaching hospital.

Subjects. Thirty‐three patients (median age 77 years, 17 male) and 21 control subjects admitted non‐acutely.

Interventions. All subjects underwent 24‐h BP monitoring within 24 h of stroke onset (patients) or admission (controls) and again at 1 week. Casual BPs were recorded over the same period.

Main outcome measures. The change in BP over the first week in each group. Eleven stroke subjects had 24‐h BP monitoring repeated at 6 months.

Results. In the stroke group, 24‐h systolic BP (SBP) fell by 7 mmHg (95% CI, 0 to 14 mmHg; P < 0.05) and diastolic BP (DBP) by 3 mmHg (95% CI, 0 to 6 mmHg; P < 0.02) over the first week. Mean 24‐h BP levels in the control group did not change during this period. However, casual BP recordings fell in both stroke (18/12 mmHg) and control (19/9 mmHg) groups. Stroke subjects followed to 6 months showed no further change in 24‐h BP (day 7: 137±17/79±13 mmHg; month 6: 138 ± 16/78 ± 11 mmHg).

Conclusions. Although there was a large fall in causal BPs seen in both groups there, was only a small, but a significant fall in mean 24‐h BP over the first week following hemispheric stroke that was not seen in control subjects. Although the ‘white coat effect’ and admission to hospital play an important part in the high casual BP observed in the days following acute stroke they are unlikely to be the sole factors.
Relation of maternal blood pressure during pregnancy to birth weight and blood pressure in children. The Hypertension in Pregnancy Offspring Study
Authors: Himmelmann A. , Svensson A. , Hansson L.
Published: August 2009

Objective. To evaluate the importance of perinatal factors, e.g. low birth weight, reduced gestational period and elevated maternal blood pressure during pregnancy, as well as high maternal blood pressure at follow‐up 7–12 years after pregnancy, on blood pressure in children born after normotensive and hypertensive pregnancies.

Design. Follow‐up study in children from hypertensive pregnancies and a control group of children born after normotensive pregnancies.

Setting. University Hospital, Göteborg, Sweden.

Subjects. Thirty‐six children born after hypertensive pregnancies and a control group of 17 children born after normotensive pregnancies were studied at a mean age of 12.5 years.

Main outcome measure. Blood pressure.

Results. Systolic blood pressure was higher in children born after hypertensive pregnancies. They also had lower birth weight and a shorter gestational period. There was a negative correlation between the highest recorded maternal blood pressure during pregnancy and birth weight of the child and a positive correlation between maternal blood pressure and blood pressure in their offspring. No correlation was found between birth weight and blood pressure in these children.

Conclusions. Children born after hypertensive pregnancies have higher blood pressure compared to children born after normotensive pregnancies. There is a positive relationship between childhood blood pressure and maternal blood pressure during pregnancy.
Chronic lymphocytic leukaemia complicated by chylothorax
Authors: Zimhony O. , Davidovitch Y. , Shtalrid M.
Published: August 2009

Chylothorax is a very rare complication of chronic lymphocytic leukaemia: we describe an 81‐year‐old woman with chronic lymphocytic leukaemia complicated by chylothorax. Treatment with mediastinal irradiation and chemotherapy was unsuccessful. The pleural effusion resolved after talc pleurodesis.
Increased prevalence of insulin‐treated diabetes mellitus in Funen County, Denmark
Authors: ESHØJ O. , GREEN A. , BORCH‐JOHNSEN K. , FELDT‐RASMUSSEN B. , BECK‐NIELSEN H.
Published: August 2009

Abstract. Objective. To determine the prevalence of insulin‐treated diabetes mellitus in Funen County, Denmark as of 1 July 1987 and compare the findings with those of a similar study from 1973.

Design. The population was identified by insulin prescriptions collected during a 1 year period. The identity of the prescription holders, the diagnosis and the date of diagnosis were verified from medical records and public registers.

Results. The estimated degree of ascertainment of the material is 0.95–0.97. The prevalence rates (per 1000 of the population) of insulin‐treated diabetes mellitus as of 1 July 1987 are: 4.74 (95% CI 4.66–4.82) for all cases, 2.08 (95% CI 2.01–2.15) for the group with onset of diabetes before age 30 years and 2.66 (95% CI 2.59–2.73) for the group with onset after age 30 years. These figures correspond to increases of 39, 26 and 51% (P < 0.001) on data collected in 1973.

Conclusions. There was a significant increase in the prevalence of insulin‐treated diabetes mellitus in Funen County, Denmark from 1973 to 1987. Analysis of the data shows that an important factor for this increase is a liability to start insulin treatment of type 2 (non‐insulin‐dependent) diabetes mellitus at an earlier stage than previously. Also, the data suggest that improved prognosis for diabetic patients as well as an increasing incidence of diabetes mellitus are factors involved in the increase.
Age‐dependent influence of heart rate on Doppler indexes of left ventricular filling
Authors: VOUTILAINENM S. , KUPARI M. , HIPPELÄINEN M. , KARPPINEN K. , VENTILÄ M.
Published: August 2009

Abstract. Background and objective. The Doppler indexes of left ventricular filling are related to age and heart rate. The aim of this study was to assess whether the influences of heart rate and age interactions (that is, whether the effect of heart rate on the Doppler indexes) is modified by age.

Subjects and methods. The effects of atropine‐induced heart rate increases on the transmitral velocities were compared in 10 younger healthy subjects aged 26–38 years and 12 older healthy subjects aged 50–67 years.

Results. With a comparable total rise in heart rate (on average 20 beats min‐1), the peak early diastolic velocity decreased likewise in both groups (from 66±9 to 57±9 cm s‐1 in the younger age group and from 58 ± 15 to 47±13 cm s‐1 in the older age group). The peak atrial velocity remained unaltered in the older group (53 ± 16 vs. 52 ± 14 cm s‐1) but rose from 33 ± 6 to 44 ± 12 cm s‐1 in the younger (P = 0.02). The early‐to‐atrial peak velocity ratio decreased from 1.2 ± 0.6 to 1.0 ± 0.4 cm s‐1 in the older subjects and from 2.0 ± 0.5 to 1.4 ± 0.5 cm s‐1 in the younger subjects (P = 0.01). Changes in the other Doppler indexes were similar in both groups.

Conclusions. The effect of heart rate on certain Doppler indexes of left ventricular filling is age‐dependent. The peak velocity ratio cannot be interpreted without adjusting for heart rate in younger subjects, whilst in older people heart rate variation is of less importance.
Diagnostic potential of chest pain characteristics in coronary care
Authors: ERIKSSON B. , VUORISALO D. , SYLVÉN C
Published: August 2009

Abstract. Objectives. To characterize and quantitate the experience of presenting chest pain in coronary care patients in terms of intensity, quality, localization and extension of pain.

Design. Localization of presenting chest pain at a body figure and estimation of intensity according to the Borg CR‐10 scale of five qualities related to pain: (i) aching, (ii) burning, pricking, (iii) pressing, throbbing, (iv) dyspnoea, suffocation and (v) anxiety were done within 24 h from onset of symptoms.

Setting. Coronary care unit (CCU).

Subjects. Eighty consecutive patients of which 40 suffered from acute myocardial infarction (AMI).

Results. The AMI and non‐AMI groups did not differ with regard to (i) the intensity of chest pain being mainly of moderate degree and (ii) the mean number of qualities of the presenting chest pain that were between 3 and 4. Patients with AMI reported extension of chest pain over a wider body area than patients in the non‐AMI group (P < 0.0001). A second type of chest pain in addition to the major type of chest pain was reported by only 25% of the patients with AMI compared to 68% in the non‐AMI group (P < 0.0001).

Conclusions. Intensity, quality and localization of presenting acute chest pain in patients admitted to the CCU do not differentiate between patients with or without AMI. Extension of pain over a major part of the chest‐related body surface and the absence of secondary pain appear to identify at least half of the patients with ongoing AMI.
Malnutrition and gastrointestinal dysfunction as prognostic factors for survival in familial amyloidotic polyneuropathy
Authors: SUHR O. , DANIELSSON Å. , HOLMGREN G. , STEEN L.
Published: August 2009

Abstract. Objectives. To describe the evolution of nutritional and neurological complications in a Swedish population of patients with familial amyloidotic polyneuropathy, and to identify prognostic factors and useful tests for monitoring the progress of the disease.

Design. Prospective and retrospective study of patients with familial amyloidotic polyneuropathy.

Setting. Tertiary referral centre.

Subjects. Twenty‐seven patients with familial amyloidotic polyneuropathy, and a symptomatic onset before the age of 50.

Main outcome measures. Age at onset, duration of disease before death, serum albumin, body mass index (BMI), duration and grade of peripheral neuropathy and gastrointestinal disturbances. Faecal fat, xylose test and 75selenohomocholic acid‐taurine (SeHCAT) test were used for assessment of malabsorption.

Results. Thirteen patients died during the study period after a disease duration of between 9 and 18 years (mean 13). A short time interval between the onset of neurological and of gastrointestinal symptoms had greater impact on survival than age at onset in this selected group of patients (r = 0.65; P = 0.017). Malnutrition was evaluated by multiplying the [body weight (kg)/height2 (m)] with the serum albumin to compensate for oedema. This modified body mass index (mBMI) was significantly correlated to the number of years before death (r = 0.89; P < 0.0005) and to the duration of gastrointestinal symptoms (r = —0.66; P < 0.0005), but not to duration of disease (r = —0.2; P = 0.20). Polyneuropathy was graded according to functional capacity from I to IV (PND score) and was correlated to the number of years before death and mBMI, but not to serum albumin. The SeHCAT test for bile acid malabsorption was significantly correlated to the duration of gastrointestinal symptoms and to mBMI (r = —0.67; P = 0.0003 and r = —0.62; P = 0.003, respectively).

Conclusion. The investigation disclosed that a short time interval between the onset of neurological and of gastrointestinal symptoms is associated with a decreased survival time. The mBMI was closely related to time before death, duration of gastrointestinal disturbances, malabsorption and functional capacity. The mBMI appears to be well suited to monitoring disease progress and gives prognostic information.
Acute myocardial infarction during early pregnancy
Authors: JENSEN S. E. , SIMONSEN E. E. , THAYSSEN P.
Published: August 2009

Abstract. A 29‐year‐old woman with two previous births, suffered a non‐fatal Q‐wave myocardial infarction early in the second trimester of pregnancy. She gave uncomplicated birth to a healthy child 25 weeks later. Post‐partum coronary arteriography revealed a 66% stenosis on the left anterior descending coronary artery. The patient was successfully treated with percutaneous transluminal coronary angioplasty
Acute myocardial infarction during pregnancy caused by coronary artery spasm
Authors: MAEKAWA K. , OHNISHI H. , HIRASE T. , YAMADA T. , MATSUO T.
Published: August 2009

Abstract. A 33‐year‐old pregnant woman suffered from acute anteroseptal myocardial infarction at the 19th gestational week. Despite periodic attacks of myocardial ischaemia after admission, the coronary arteriograms under the use of nitroglycerin were normal. Thereafter, she remained free from the ischaemic events with diltiazem hydrochloride and delivered a healthy baby. The coronary arteriography at puerperium also showed no organic narrowing. However, the provocative test with acetylcholine chloride caused severe spasm of the left anterior descending coronary artery. These findings strongly suggest that acute myocardial infarction in this pregnant woman was caused by coronary artery spasm.
Management of symptomatic hyponatraemia: dependence on the duration of development
Authors: HÖJER J.
Published: August 2009

Abstract. Serious neurological symptoms are common in patients with a serum sodium concentration below 115 mmol l‐1. The treatment is controversial and the most adequate rate of sodium correction to avoid both morbidity due to residual hypo‐osmolality and therapy‐induced neurological sequelae is debated. The management of symptomatic hyponatraemia is discussed here against the background of two cases and a literature review. It is concluded that the treatment should be based on whether the electrolyte disturbance is acute (< 24–36 h) or has developed insidiously. Slow sodium correction (< 0.5 mmol l‐1 h‐1) in patients with chronic hyponatraemia and rapid correction (1–2 mmol l‐1 h‐1) to a moderately hyponatraemic level in those with an acute development are recommended. If available data do not permit differentiation between the two conditions in a patient with seizures or in coma, rapid correction with sodium chloride and furosemide for 3–4 h followed by slow correction therapy is suggested.
The epidemiology of irritable bowel syndrome in a random population: prevalence, incidence, natural history and risk factors
Authors: KAY L. , JØRGENSEN T. , JENSEN K. H.
Published: August 2009

Abstract. Objectives. The aim of the study was to assess prevalence, incidence, recovery, and risk factors of irritable bowel syndrome according to different definitions in a large random population.

Design. A 5 year follow‐up study of a sex‐ and age‐stratified random sample of 4581 Danes interviewed about abdominal symptoms.

Setting. The Glostrup Populations Studies Unit at Glostrup County Hospital.

Main outcome measures. Prevalence, incidence, recovery, and the association of risk factors to irritable bowel syndrome (IBS). The percentage of subjects common to the populations selected by the various definitions of IBS.

Results. According to various definitions, the prevalence of IBS varied from 5 to 65% and the incidence varied from 1 to 36%. At the 5 year follow‐up only 5% of subjects with IBS were completely free of all symptoms. Psychological vulnerability and the experience of having problems were strongly associated with prevalence and incidence of IBS, whereas lifestyle factors only showed a very weak or no relationship to IBS. Populations defined as suffering from IBS according to the various definitions had less than 50% of the subjects in common.

Conclusions. Irritable bowel syndrome is frequent but fluctuating in the general population. Psychological factors seem to be of greater aetiological importance to IBS than lifestyle factors. However, a generally accepted and precise definition is essential to make future studies comparable and to allow general conclusions to be drawn. Furthermore, it still needs to be verified whether the syndrome is a disease entity or just an acceptable, common life‐condition.
Hepatitis C virus chronic infection as a common cause of mixed cryoglobulinaemia and autoimmune liver disease
Authors: FERRI C. , LONGOMBARDO G. , LA CIVITA L. , GRECO F. , LOMBARDINI F. , CECCHETTI R. , CAGIANELLI M. A. , MARCHI S. , MONTI M. , ZIGNEGO A. L. , MANNS M. P.
Published: August 2009

Abstract. Objectives. Mixed cryoglobulinaemia (MC) and autoimmune chronic hepatitis (AI‐CH) are frequently associated with hepatitis C virus (HCV) chronic infection. Because HCV represents a possible common aetiological factor, the aim of the present study is to investigate the clinico‐serological alterations of both MC and AI‐CH and to verify a possible overlap between these disorders.

Setting. Patients from three tertiary referral centres.

Subjects. Two Italian series of 88 MC patients and 30 AI‐CH type 1 were studied.

Results. MC and AI‐CH share several clinico‐sero‐logical features. The patients' mean age (MC vs. AI‐CH: 60 ± 9 vs. 57 ± 13 years), disease duration (10.5 ± 5 vs. 9.6 ± 6 years), and female/male ratio (3.4 vs. 3.3) were very similar in the two series. Typical hallmarks of MC, i.e. purpura, arthralgias, and weakness, circulating mixed cryoglobulins with rheumatoid factor activity, and hypocomplement‐emia were also recorded in a significant number of AI‐CH patients. Similarly, chronic active hepatitis was found in 68% of MC patients and its histological and serological alterations were comparable with those of AI‐CH; moreover, amongst various auto‐antibodies, antinuclear antibodies and/or anti‐smooth‐muscle antibodies were detected in half of the cases of MC. Anti‐HCV antibodies, detected by second‐generation Chiron elisa and riba, were present in a high percentage of both MC and AI‐CH (94 vs. 80%), and frequently associated with HCV viraemia (86 vs. 77%). Finally, anti‐GOR, the HCV‐related autoantibodies, were found in half cases of MC and AI‐CH.

Conclusions. On the whole, these data suggest that HCV in combination with other infectious and environmental and genetic factors can trigger a complex immunological disorder with different clinical patterns.
Malignant lymphoma in coeliac disease: various manifestations with distinct symptomatology and prognosis?
Authors: MATHUS‐VLIEGEN E. M. H. , VAN HALTEREN H. , TYTGAT G. N. J.
Published: August 2009

Abstract. Objectives. To study the different forms of malignant lymphoma complicating coeliac disease in a low‐prevalence area, according to extranodal–nodal and extraintestinal–intestinal manifestations.

Subjects and setting. Patients recruited from two University Hospitals (Amsterdam, Leiden) and from PALGA (National Dutch data‐bank) over a 16‐year period.

Design. Review of hospital charts with respect to clinical presentation and treatment of both coeliac disease and malignant lymphoma. Re‐evaluation of morphology and staging by immunoperoxidase, enzyme‐ and immunohistochemical stainings on unstained and frozen materials.

Main outcome measures. Clinical behaviour and T‐or B‐cell morphology of extranodal intestinal, extranodal extraintestinal and nodal intestinal disease.

Results. Fourteen cases of enteropathy‐associated lymphoma could be traced, 10 with a history of coeliac disease, four primarily presenting with malignant lymphoma. The usual extranodal intestinal lymphoma (eight cases) presented with abdominal pain, weight loss, and malabsorption. Six had atypical disease: four presented with extranodal extraintestinal disease, located in the skin or the respiratory tract; two patients had intractable malabsorption and oedema caused by a nodal intestinal lymphoma. Re‐evaluation with additional immunohistochemical stainings in 11 patients showed a pleomorphic malignant infiltrate of histiocyte‐like cells of T‐cell origin, with a pattern of CD3+; CD4–; CD5±; CD7+ and CD8–. It also established a more appropriate diagnosis in four, an 0.6‐year earlier diagnosis in six, and an upgraded stage of disease in two patients. A more extensive spread and poorer outcome appeared to become more probable in the ranking order of extranodal intestinal, extranodal extraintestinal and nodal intestinal lymphoma.

Conclusions. A proper and timely diagnosis of enteropathy‐associated lymphoma requires clinical vigilance and unrelentless perseverance to obtain adequate fresh and frozen tissue for histochemical staining. Further research in a larger number of patients is warranted to investigate the relation between the primary site of the lymphoma, i.e. extranodal intestinal, extranodal extraintestinal, or nodal intestinal, and (its impact on) clinical presentation and prognosis.
Short‐term effects of felodipine in hypertensive type II diabetic males on sulfonylurea treatment
Authors: KJELLSTRÖM T. , BLYCHERT E. , LINDGÄRDE F.
Published: August 2009

Abstract. Objectives. To study the effects on blood pressure and glucose homeostasis of felodipine, a calcium antagonist.

Design. A double‐blind randomized cross‐over study comparing felodipine ER and placebo.

Setting. A university centre of diabetic care in Malmö, Sweden.

Subjects. Seventeen hypertensive type II diabetic males on oral sulfonylurea (glibenclamide) treatment.

Interventions. Four‐week treatment periods separated by a 2‐week wash‐out period. Felodipine 10–20 mg once daily was given.

Main outcome measures. Blood pressure, heart rate, HbA1c and response to oral glucose tolerance test; glucose, insulin and c‐peptide. Measured before randomization and at the end of each double‐blind treatment period.

Results. Blood pressure was significantly reduced during felodipine treatment and heart rate slightly increased. Felodipine did not influence insulin or c‐peptide levels. There was no significant change in glucose levels but an increase in HbA1c.

Conclusion. The study demonstrated that felodipine is an effective agent for type II diabetic patients on glibenclamide treatment. The effect on HbA1c is noteworthy even if not of clinical significance in the short term. Controlled long‐term studies in diabetic patients are needed to fully evaluate antihypertensive agents.
Sleep and cardiac diseases amongst elderly people
Authors: ASPLUND R.
Published: August 2009

Abstract. Objectives. To investigate the interrelationship between sleep cpmplaints and cardiac symptoms.

Design. An epidemiological survey by means of questionnaire.

Setting. Västerbotten and Norrbotten in northern Sweden.

Subjects. All 10216 members of the Swedish Pensioners' Association (SPF).

Main outcome measures. Sleep disturbances and cardiac diseases.

Results. Of the men who slept well, 3.0% stated they were troubled by both spasmodic chest pain (‘angina pectoris’) and a sensation of irregular heart beats (‘cardiac arrhythmia’), 9.9% had angina pectoris alone, 7.9% suffered from cardiac arrhythmia, and 79.2% had neither of these disorders. Amongst the men who slept poorly, the corresponding frequencies were 7.0%, 8.7%, 12.3% and 72.0% (P < 0.001). Amongst the women who slept well these frequencies were 2.3%, 7.0%, 8.2% and 82.5%, and among those who slept poorly 5.9%, 10.2%, 15.0% and 68.9% (P < 0.0001). Amongst those with reported sleep complaints, there was an increased occurrence of both angina pectoris and cardiac arrhythmia. This increase in cardiac diseases was found in men and women; both in those with trouble falling asleep, those who frequently awoke during the night and those who had difficulty regaining sleep; and also in those with too early final awakening in the morning. Daytime sleepiness was also associated with increased cardiac symptoms.

Conclusion. Poor sleep was associated with both an increase in angina pectoris and cardiac arrythmias.
Determinants of femoral and carotid artery atherosclerosis
Authors: MD T. JOENSUU , SALONEN R. , WINBLAD I. , KORPELA H. , SALONEN J. T.
Published: August 2009

Abstract. Objectives. The aim of the study was to find the most important determinants of early atherosclerosis in the carotid and femoral arteries.

Design. Carotid and femoral maximal intima media thickness (IMT) was measured 19 months after the first of 4 risk factor measurements.

Setting. Department of Community Health and General Practice, University of Kuopio, and Occupational Health Care in Pyhäsalmi Mine, Finland.

Subjects. The subjects comprised 60 male volunteers aged from 32 to 65 years from amongst 277 workers at the Pyhäsalmi Mine, Finland. Subjects were invited for an ultrasound examination, in order of serum total cholesterol content, until the required figure of 60 cases was achieved.

Main outcome measures. Carotid and femoral maximal intima media thickness.

Results. Systolic blood pressure (P < 0.01), serum total cholesterol (P < 0.01), age (P = 0.01) and pack‐years smoked (P = 0.02) were independent determinants of maximal carotid artery IMT, and total cholesterol (P = 0.01), age (P = 0.03) and pack‐years smoked (P = 0.01) for maximal femoral artery IMT. For the latter, plasma fibrinogen concentration (P = 0.10) was the next factor to enter the multiple regression model. Body mass index, heart rate, serum HDL cholesterol, triglycerides, urate, apolipoprotein A,*** antithrombin III, lipid peroxides, vitamin E and plasma vitamin C had no significant association with either maximal carotid or femoral IMT or the mean of the carotid and femoral IMT.

Conclusions. Systolic blood pressure, serum total cholesterol, age and pack‐years smoked are the most important determinants of early atherosclerosis in the carotid artery and total cholesterol, age and pack‐years smoked in the femoral artery. Prevention should take into consideration these findings. The role of plasma fibrinogen and oxidized low density lipoprotein would require re‐evaluation in larger populations studied longitudinally.
Direct and indirect blood pressure in normotensive and hypertensive subjects
Authors: FAGHER B. , MAGNÚSSON J. , THULIN T.
Published: August 2009

Abstract. Objectives. To compare intrabrachial blood pressure (I‐BP) with simultaneously measured contralateral auscultatory (A‐)BP in hypertensive and normotensive subjects. The question was whether differences between direct and indirect BP are influenced by the BP levels.

Subjects. Hypertensive subjects treated with either placebo (n = 10) or metoprolol (n = 8) and agematched normotensive subjects (n = 15), selected from a defined patient population waiting for cholecystectomy or hernia repair. Measurements were performed pre‐induction of anaesthesia.

Results. In the hypertensive subjects, cuff systolic BP (SBP) was lower than I‐BP by an average of 8 mmHg (placebo‐) and 7 mmHg (metoprolol‐treated), where‐as diastolic A‐BP (A‐DBP) was 3 and 7 mmHg higher, respectively. In the normotensive subjects, mean A‐SBP and I‐SBP agreed closely, whereas A‐DBP was 11 mmHg higher. Thus, SBP differences (i.e. indirect–direct BP) were significantly less and DBP differences significantly greater in the normotensive than in the hypertensive subjects (P < 0.05). Plasma renin activity and adrenalin showed better correlations with A‐MBP than with I‐MBP.

Conclusions. The drift of cuff systolic readings fell progressively below the intrabrachial values when BP increased, whilst diastolic cuff values approached the direct pressures. Since A‐MBP did not significantly differ from I‐MBP in any group, one must ask whether hypertension would be more correctly defined according to MBP criteria.
Should children or young adults be screened for serum lipid levels to prevent adult coronary heart disease? Experience from the Cardiovascular Risk in Young Finns Study
Authors: PORKKA K. V. K. , VIIKARI J. S. A.
Published: August 2009

Abstract. Coronary heart disease (CHD) has its origin in childhood. High cholesterol levels measured in children and adolescents are indicative of concurrent atherosclerotic changes and probably predict adult coronary heart disease. We review here the relevance of screening children, adolescents or young adults for serum lipid levels in order to efficiently prevent premature adult coronary heart disease. Data is presented in the light of the large Cardiovascular Risk in Young Finns study and other studies. The authors do not recommend universal screening strategies because of (i) the limited predictive power of serum lipid levels on an individual level, (ii) the limited knowledge on the safety of interventive measures on the growing child, and (iii) the limited knowledge on the ethical aspects of screening (labelling). However, the importance of measuring serum lipids to detect familial dyslipidaemic disorders such as familial hypercholesterolaemia, is stressed. The selection of children or adolescents for serum lipid measurements should be made on the basis of family history of early CHD or dyslipidaemia.