bluuebunny/crossref_metadata_2025 huggingface dataset:
Riedel's thyroiditis: an autoimmune or primary fibrotic disease?
Authors: Zimmermann‐Belsing T. , Feldt‐Rasmussen U.
Published: August 2009

Abstract. Riedel's thyroiditis is a rare condition with an unknown aetiology. The condition was discovered by Riedel in 1883. In 1904, Hashimoto described another condition of invasive fibrous thyroiditis. Since then it has been discussed whether Hashimoto's thyroiditis and Riedel's thyroiditis are one disease in different states or whether they are two different diseases. Hashimoto's thyroiditis is known to have an autoimmune aetiology and can be seen in conjunction with other autoimmune diseases such as pernicious anaemia. The co‐existence of Riedel's thyroiditis and pernicious anaemia is reported for the first time in this case story. Our patient was initially treated with a high dose of steroids and today is well on low‐dose steroids and without relapse. The coexistence mentioned, the good effect of steroid treatment, the frequent presence of thyroid autoantibodies and lymphoid infiltration of the thyroid gland resembling that of Hashimoto's thyroiditis might indicate an autoimmune aetiology. It may be that the action on fibroblasts of cytokines known to be released by infiltrating lymphocytes constitutes a possible fibrogenic mechanism, but the primary lesion is still unknown.
Systemic blood pressure and glomerular leakage with particular reference to diabetes and hypertension
Authors: Mogensen C. E.
Published: August 2009

Both day and night blood pressure have considerable ranges in normal individuals and also in diabetic patients. In addition, there is considerable variation intra‐individually, with considerable excurses in blood pressure, e.g. during exercise, other daily activities as well as on exposure to medical personnel. There is good evidence to suggest that elevated blood pressure is an important factor in the progression of renal disease in diabetes, even from the initial phase of the slight elevation of the albumin excretion rate. From the earliest phase of microalbuminuria, blood pressure may increase by an average of 3–4 mmHg per year in contrast to 1 mmHg per year in healthy controls and in clearly normoalbuminuric individuals. Throughout the course of the complications of diabetes, both insulin‐dependent and non‐insulin‐dependent, there is a correlation between albuminuria and blood pressure in cross‐sectional studies; also there is a significant correlation between blood pressure and the progression of albuminuria. The same findings are available in essential hypertension and also to some extent in the background population, although in the latter the correlation between albuminuria and blood pressure is much less precise, although highly significant.

Several trials conducted over the years uniformly show that antihypertensive treatment reduces albuminuria and, in many studies, progression in renal disease also, as measured by the glomerular filtration rate (GFR) fall. Therefore, it could be considered as a means to reduce blood pressure generally in diabetic individuals, even from the start of diabetes, with the aim of future further prevention of renal complications and possibly other complications. Such a proposal is less attractive in the background population because renal disease is much more rare. Another similar approach would be the prevention of increasing blood pressure in individuals at risk of renal disease, e.g. diabetics. Obviously, abnormalities in the vascular wall of a biochemical/functional nature may make diabetics more pressure‐sensitive, and the indication is that several other risk factors are involved, in particular poor metabolic control. Nevertheless, it is proposed that trials should be conducted very early in the course of diabetes, to see if the same positive effect can be obtained early as that documented later in the course of microalbuminaria and overt renal disease, both in insulin‐dependent and in non‐insulin‐dependent diabetes. In essential hypertension, antihypertensive treatment has a profound effect on albuminuria, and this may be associated with long‐term renoprotection, but this is less well documented.
Metformin and metoprolol CR treatment in non‐obese men
Authors: Landin K. , Tengborn L. , Smith U.
Published: August 2009

Objective. To study the effect of metformin and metoprolol CR on insulin sensitivity, blood lipids, fibrinolytic activity and blood pressure.

Design. A double‐blind, placebo controlled, triple cross‐over study with randomization to either metformin, 850 mg b.i.d., or metoprolol CR 100 mg o.d., or placebo for a period of 18 weeks. The glucose uptake was measured with the euglycaemic clamp technique after every 6 weeks' treatment period. Blood pressure and blood samples were taken every 3rd week.

Subjects. Eighteen non‐obese men (53 ± 6 years of age).

Results. Metformin decreased C‐peptide (P < 0.02), FFA (P < 0.003), total and low‐density lipoprotein cholesterol, tissue plasminogen activator antigen and the urinary potassium excretion (P < 0.05 for all), but not blood pressure compared to placebo. Metoprolol CR reduced diastolic blood pressure and pulse rate; fasting free fatty acids and the urinary potassium increased (P < 0.05 for all). No effect of metformin or metoprolol CR was seen on the glucose disposal rate, blood glucose, plasma insulin, triglycerides, high‐density lipoprotein cholesterol, lipoprotein(a), uric acid or plasminogen activator inhibitor 1 activity or antigen. The glucose uptake was not particularly decreased in these subjects.

Conclusion. The study shows that metformin has some favourable effects on metabolism and that metoprolol CR is fairly neutral in this regard. The lack of effect of metformin on glucose disposal rate and blood pressure can be explained by the fact that the individuals studied were neither insulin resistant nor hypertensive. The data does not preclude an antihypertensive effect by treating a concomitant insulin resistance.
A 5‐year follow‐up study on the incidence of retinopathy in type 1 diabetes mellitus in relation to medical risk indicators
Authors: Agardh E. , Agardh C.‐D. , Torffvit O.
Published: August 2009

Objectives. The aim of the present study was to describe the 5‐year incidence of retinopathy in type 1 diabetes mellitus and to characterize risk indicators for the development and progression of retinopathy.

Design. A cross‐sectional study of type 1 diabetic patients taken care of at a medical department.

Setting. All type 1 diabetic patients attending the Department of Internal Medicine, University Hospital, Lund, during a 2‐year period were offered ophthalmological examination.

Subjects. A total of 396 out of 461 (85.9%) initially examined type 1 diabetic patients formed the basis for this 5‐year follow‐up study.

Main outcome measures. The degree of retinopathy was based on fundus photography or biomicroscopy. Degree of metabolic control was assessed by HbA1c levels, signs of nephropathy by albumin creatinine clearance ratio and urinary albumin levels. Blood pressure was measured in the supine position. Duration of diabetes, age, and insulin dosage were registered.

Results. The incidence of retinopathy was 47.2%, and progression from background to severe retinopathy occurred in 41%. Risk indicators for the development of retinopathy were duration of diabetes (P < 0.001), degree of metabolic control (P < 0.001), insulin dosage (P < 0.05) and signs of nephropathy based on measurements of albumin creatinine clearance ratio (P < 0.01) and urinary albumin concentration (P < 0.05). Two risk indicators could be identified for progression of retinopathy, i.e. the degree of metabolic control (P < 0.01) and diastolic blood pressure (P < 0.05).

Conclusions. The results suggest that apart from poor metabolic control, development of retinopathy in type 1 diabetes is associated with long diabetes duration and clinical signs of diabetic nephropathy. Progression of retinopathy is associated with poor metabolic control and elevated diastolic blood pressure levels.
Pheochromocytoma without hypertension
Authors: SmirČiČ L. , S̈uŠkovićc T. , FerenČić; Z̄.
Published: August 2009

Pheochromocytoma is a rare tumour which is usually suggested by sustained or paroxysmal hypertension. Our patient with a pheochromocytoma was unusual for two reasons: she was normotensive during 3 weeks of close observation in the hospital and the urinary adrenaline level was higher than the noradrenaline level. In the patient's history there were no data on hypertension attacks. The patient had a palpable abdominal mass and the cytological finding was in contrast with a clinical diagnosis of pheochromocytoma. The surgery revealed a tumour and the pathohistologic evaluation established the diagnosis of pheochromocytoma. After surgery, the patient's urinary catecholamine levels reverted to normal. Our patient may have been normotensive because her tumour predominately secreted adrenaline and perhaps other vasodilating substances.
Reflections on misdiagnosis
Authors: KIRCH W. , SCHAFII C.
Published: August 2009

Abstract. It is correct to speak of misdiagnosis when, at the end of the diagnostic procedure, a disease which could not be proved by autopsy is assumed by the physician to be present; furthermore, when the non‐recognition of the true disease leads to a worsening of the patient's prognosis. In contrast, the false positive and the false negative diagnoses have no prognostic relevance. The introduction of new diagnostic technology, such as sonography, scintigraphy and computer tomography, has not reduced the frequency of misdiagnosis appreciably within the last 20 years: now, just as before, its incidence appears to be about 10%. Over‐reliance on the new procedures occasionally contributes directly to misdiagnosis.
Diurnal changes in heparin effect during continuous constant‐rate infusion. A study in nine patients with venous thromboembolism
Authors: KRULDER J. W. M. , VAN DEN BESSELAAR A. M. H. P. , VAN DER MEER F. J. M. , MEINDERS A. E. , BRIËT E.
Published: August 2009

Abstract. Objective. To evaluate the importance of diurnal variations in the effect of a continuous infusion of unfractionated heparin.

Design. Twenty‐four‐hour follow‐up.

Setting. Tertiary referral centre.

Subjects. Patients (five male, four female) with acute venous thromboembolic diseases.

Main outcome measures. Two‐hourly measurement of anti‐IIa activity, anti‐Xa activity, APTT (Cephotest and automated APTT), antithrombin III and cortisol for 24 h.

Results. The maximum anticoagulant effect was found at 04.00–06.00 hours, and the minimum effect at 12.00 hours. The difference was 0.40 U ml‐1 for anti‐IIa activity (95% confidence interval (CI) 0.03–0.78; P < 0.05), 0.36 U ml‐1 for anti‐Xa activity (95% CI–0.05–0.72; not significant [NS]), 15.1 s for Cephotest APTT (95% CI 3.3–26.9; P < 0.03), and 112.9 s for automated APTT (95% CI 7.8–218.0; P < 0.05). Antithrombin III decreased from 97.9% at the start to 82.6% 24 h later (P = 0.001). Cortisol showed a typical diurnal rhythm. Expressed as a percentage of the individual 24‐h mean, a maximum was found at 04.00 hours (anti‐IIa activity), 06.00 hours (both APTTs), and 08.00 hours (anti‐Xa activity) and a minimum at 12.00 hours (all variables). The difference was 26% for anti‐IIa activity (P < 0.05) and anti‐Xa activity (NS), 22% for APTT (Cephotest; P < 0.03), and 44% for APTT (automated APTT; P < 0.05).

Conclusions. A continuous intravenous infusion of unfractionated heparin has a maximum anticoagulant effect between 04.00 and 8.00 hours and a minimum effect at noon. For individual patients the moment of minimum and maximum effect varies widely. Because the most impressive changes occur between 06.00 and 08.00 hours, laboratory control can best be performed at fixed times, e.g. at 10.00 and at 22.00 hours.
Acupuncture versus metoprolol in migraine prophylaxis: a randomized trial of trigger point inactivation
Authors: HESSE J. , MØGELVANG B. , SIMONSEN H.
Published: August 2009

Abstract. Objectives. To compare the effects of dry needling of myofascial trigger points in the neck region to metoprolol in migraine prophylaxis.

Design. Randomized, group comparative study. patients, investigator and statistician were blinded as to treatment, the therapist was blinded as to results.

Setting. Outpatient pain clinic in the northern Copenhagen area. Patients were referred by general practitioners or respondents to newspaper advertisements.

Subjects. Included were patients with a history of migraine with or without aura for at least 2 years. Excluded were persons with contraindications against treatment with beta blockers, chronic pain syndromes, pregnancy or previous experience with acupuncture or beta‐blocking agents. A total of 85 patients were included; 77 completed the study.

Interventions. After a 4‐week run‐in period, patients were allocated to a 17‐week regimen either with acupuncture and placebo tablets or to placebo stimulation and metoprolol 100 mg daily.

Results. Both groups exhibited significant reduction in attack frequency (P < 0.01). No difference was found between the groups regarding frequency (P > 0.20) or duration (P > 0.10) of attacks, whereas we found a significant difference in global rating of attacks in favour of metoprolol (P < 0.05).

Conclusions. Trigger point inactivation by dry needling is a valuable supplement to the list of migraine prophylactic tools, being equipotent to metoprolol in the influence on frequency and duration (but not severity) of attacks, and superior in terms of negative side‐effects.
Diabetic foot ulcers in a multidisciplinary setting An economic analysis of primary healing and healing with amputation
Authors: APELQVIST J. , RAGNARSON‐TENNVALL G. , LARSSON J. , PERSSON U.
Published: August 2009

Abstract. Objectives. To perform an economic analysis of primary healing and healing with amputation in diabetic patients with foot ulcers.

Design. A retrospective economic analysis based on a prospective study of consecutively presenting diabetic patients admitted to the Department of Internal Medicine because of foot ulcer.

Setting. A multidisciplinary foot‐care team.

Subjects. A total of 314 consecutively presenting diabetic patients with foot ulcers. Forty patients died before healing occurred. In those patients who healed primarily (n = 197) or after amputation (n = 77), a retrospective economic analysis was performed.

Interventions. All patients were treated by a multi‐disciplinary foot care team consisting of diabetologist, orthopaedic surgeon, diabetes nurse, podiatrist and orthotist both as in‐ and out‐patients. The patients were followed by the team from admittance until final outcome, i.e. primary healing or healing with amputation or death.

Main outcome measures. Data from both the prospectively collected patient material and from patient records were used to estimate the cost for hospital care, antibiotics, surgery, out‐patient care, staff attendance, drugs and material for ulcer dressings, and orthopaedic appliances.

Results. The total costs were SEK 51000 (3000–808000) for patients with primary healing and SEK 344000 (27000–992000) for healing with amputation. Costs for in‐patient care were 37% of total average costs for primary healing and 82% for patients with amputation. The costs for topical treatment of the ulcers in out‐patient care were 45% of the total average cost for primary healed and 13% for patients who healed with amputation. The costs for products used for ulcer dressings were 21% of total costs for topical treatment, i.e. 9% and 3% of total average costs for primary healing and healing with amputation, respectively. Costs for visits to the foot care team, antibiotics and orthopaedic appliances were low in relation to total costs.

Conclusion. Treatment of diabetic patients with foot ulcers in a multidisciplinary system was associated with relatively low costs. Healing with amputation was associated with high costs mainly due to multiple and extended hospitalization. These findings indicate the potential cost savings of preventive and multi‐disciplinary foot care.
Low‐intensity endurance exercise training, plasma lipoproteins and the risk of coronary heart disease
Authors: Després Jean‐Pierre , LAMARCHE B.
Published: August 2009

Abstract. Physically active individuals generally show a reduced risk of coronary heart disease (CHD) compared to the sedentary population. However, whether such reduction in CHD risk mainly results from the concomitant improvement in cardiorespiratory fitness or from the alterations in CHD risk factors has yet to be clearly established. Furthermore, there is still some controversy regarding the potential associations between endurance training‐induced changes in metabolic variables considered as CHD risk factors (plasma glucose, insulin and lipoprotein levels) and the magnitude of improvement in cardiorespiratory fitness. From the results of several studies discussed in this article, it is proposed that prolonged endurance exercise of low intensity (˜ 50% V̊o2max), performed on an almost daily basis, seems to significantly improve metabolic variables considered as CHD risk factors through mechanisms that are likely to be independent from the training‐related changes in cardiorespiratory fitness. The notion of ‘metabolic fitness’ is introduced and can be defined as the state of a set of metabolic variables relevant to CHD risk and affected by the level of physical activity. Evidence available suggests that these metabolic variables are not closely related to the adaptation of cardio‐respiratory fitness in response to exercise training. The concept of metabolic fitness has several implications for the prescription of exercise and for the primary and secondary prevention of CHD. Indeed, emphasis should not be placed on aiming at increasing V̊o2max through high‐intensity exercise, but rather on producing a substantial increase in daily energy expenditure that will eventually lead to weight loss and related improvements in carbohydrate and lipid metabolism. Therefore, from a practical standpoint, although a 1 h daily walk may not have marked effects on cardiorespiratory fitness, it probably represents an exercise prescription that is likely to substantially improve ‘metabolic fitness’, thereby reducing the risk of CHD.
Metabolic effects of isradipine as monotherapy or in combination with pindolol during long‐term antihypertensive treatment
Authors: LIND L. , BERNE C. , POLLARE T. , LITHELL H.
Published: August 2009

Abstract. Design. Open long‐term study with parallel groups.

Setting. Kungsgärdet Geriatric Hospital, Uppsala, a tertiary referral hospital.

Subjects. Twenty‐six untreated hypertensive subjects.

Interventions. After 4 weeks on placebo, isradipine was titrated up to 10 mg daily to achieve appropriate blood pressure control (n = 11). If this failed, 5–10 mg pindolol was added. The treatments were continued for 2 years.

Main outcome measures. Blood pressure, lipoprotein measurements, intravenous glucose tolerance test, hyperinsulinaemic euglycaemic clamp, HbA***1c, body weight.

Conclusions. The hypotensive effect of isradipine was sustained during long‐term use but was associated with weight gain and an impaired glucose control. When isradipine was combined with pindolol there was also a reduction in insulin sensitivity and an increase in VLDL triglycerides, possibly as effects of the beta‐adrenergic blockade.

Objectives. To evaluate the effects of isradipine alone and in combination with pindolol on glucose and lipid metabolism during long‐term antihypertensive therapy.

Results. Treatment with isradipine alone caused a sustained reduction in blood pressure (‐22/‐10 mm Hg, P < 0.01), but an increase in body weight (+ 2.2 kg, P < 0.05) and HbA***1c (+ 1.5%; P < 0.001) were also noted. Addition of pindolol resulted in a similar degree of blood pressure reduction and weight gain, whilst HbA***1c was less affected (+ 1.0%; P < 0.05, compared to isradipine alone). Insulin sensitivity became impaired in both groups (– 1.2 to – 1.5 mg kg‐1 min‐1; P < 0.01 for M‐value at hyperinsulinaemic clamp) but after adjustment for the change in body weight the impairment was only significant (P < 0.01) in the group with combined treatment. The combined treatment also resulted in an increase in very‐low‐density‐lipoprotein (VLDL) triglyderides (+ 0.37 mmol L‐1; P < 0.05).
Studies in hypertriglyceridaemia 1. Serum triglyceride distribution and its correlates in randomly selected Swedish middle‐aged men
Authors: ASPLUND‐CARLSON A. , CARLSON L. A.
Published: August 2009

Abstract. Objectives. To obtain a randomly selected hypertriglyceridaemic population for detailed further characterization.

Design. Study of randomly selected males.

Setting. Subjects examined and blood sampled at Sollentuna Primary Health Care Centre.

Subjects. Men aged 40–50 years (n = 1564), living in the Stockholm area, who were screened for hypertriglyceridaemia, January 1990‐June 1992.

Main outcome measures. Fasting concentrations of serum triglycerides.

Results. The serum triglyceride concentration distribution showed the expected skew distribution with the 90th and the 95th percentile at 2.51 and 3.05 mmol L‐1, respectively. The mean serum triglyceride level compared well with several population values reported from this laboratory over the last 30 years, indicating stable triglyceride levels over time. There was no significant age‐trend for the triglyceride concentration. Lower mean values for triglyceride, insulin and waist‐to‐hip (W/H) ratio were observed during the summer, whilst apolipoprotein A‐I levels were higher. There was a linear relation between the number of cigarettes smoked and the serum triglyceride concentration. In stepwise multiple linear regression analysis with the triglyceride concentration as the dependent variable the following variables appeared as significant (P < 0.01) contributors: insulin, cholesterol, glucose, apolipoprotein A‐I, number of cigarettes smoked, BMI, W/H ratio and diastolic blood pressure. The regression coefficient for apolipoprotein A‐I was negative; all the others were positive. The multiple regression (R) was 0.68, suggesting that up to 47% of the variation of the serum triglyceride concentration could be predicted by these factors.

Conclusions. A group of randomly selected hypertriglyceridaemic men has been recruited for further clinical, metabolic and genetic studies. Basic characteristics of the population for their recruitment are described.
Metachronous occurrence of seminoma and Hodgkin's lymphoma in the same patient with late‐onset colon cancer
Authors: PORTA C. , MORONI M. , NASTASI G.
Published: August 2009

Abstract. Testicular cancer and Hodgkin's disease are two malignancies sharing many epidemiological similarities, including age class and geographical distribution. However, the association of these tumours in the same patient is an exceptional event; to date, only 14 metachronous and three synchronous cases have been described in the literature. We report on a case of testicular seminoma and Hodgkin's lymphoma association, with the additional occurrence, nearly 20 years later, of a colon carcinoma.
Cardiac pheochromocytoma
Authors: JÖNSSON A. , HALLENGREN B. , MANHEM P. , LILJA B. , STAVENOW L. , STÅHL E. , TÖRNQUIST C.
Published: August 2009

Abstract. Cardiac pheochromocytoma is a rare tumour and may be difficult to localize. We present a 32‐year‐old male with a cardiac pheochromocytoma that was successfully resected. An initial unenhanced CT did not reveal the tumour. MIBG‐scintigraphy indicated the location, but to get full information, a dynamic contrast‐enhanced CT of the chest during adequate alpha and beta blockade was essential. ECG‐gated MRI gave further information about the anatomical details.
Tumour‐induced hypoglycaemia due to ‘big’ IGF–II
Authors: STRAUSS G. , CHRISTENSEN L. , ZAPF J.
Published: August 2009

Abstract. A 57‐year‐old woman with a slowly growing intraabdominal leiomyosarcoma developed life‐threatening hypoglycaemia. Plasma C‐peptide levels were low (0.08 nmol L‐1 and < 0.05 nmol L‐1, reference interval 0.18–0.63 nmol L‐1). Total IGF–II was normal (760 ng mL‐1) whilst ‘big’ IGF–II was markedly elevated (440 ng mL‐1). After surgical tumour reduction, ‘big’ IGF–II levels in plasma normalized (117 ng mL‐1) and the patient experienced no new episodes of hypoglycaemia. Life‐threatening hypoglycaemia due to tumour production of IGF–II can be ameliorated by reduction of the tumour burden and should be kept in mind even in incurable patients.
Relationships between plasma levels of catecholamines and neuropeptides and the survival time in patients with congestive heart failure
Authors: VALDEMARSSON S. , BERGDAHL A. , EDVINSSON L.
Published: August 2009

Abstract. Objectives. To evaluate the importance of various variables reflecting neuroendocrine activation in relation to prognosis in patients with congestive heart failure (CHF).

Design. Plasma levels of noradrenaline, adrenaline, neuropeptide Y, substance P, calcitonin gene‐related peptide, vasopressin and atrial natriuretic peptide were measured in patients presenting with CHF and related to survival time. Survival time was calculated from the time‐point of this investigation until the month when the patient died or until December 1992. The follow‐up period ranged up to 60 months. Seven of the 31 patients were still alive at the end of this period.

Setting.Lund University Hospital, Sweden.

Subjects. Thirty‐one patients with CHF due to ischaemic heart disease. Six patients had a degree of heart failure corresponding to NYHA I‐II and 25 corresponding to NYHA III‐IV. Ten of these 25 patients were on angiotensin converting enzyme (ACE) inhibition in addition to therapy with digoxin and diureutics. The catecholamine and neuropeptide levels were compared to those of a control group of 31 healthy subject aged 20–80 years.

Intervention. There were not any specific intervention in addition to the treatment for heart failure as outlined above.

Main outcome measures. Survival time until death from heart disease or until the end of the follow up period in December 1992.

Results. There were inverse relationships between survival time on one hand and plasma values of noradrenaline (r = ‐ 0.49: P < 0.01) and atrial natriuretic peptide (r = ‐0.49: P < 0.01) on the other hand. There was a significant correlation between the plasma values of noradrenaline and atrial natriuretic peptide (r = 0.50: P < 0.01).

Conclusion. Increased plasma levels of noradrenaline and atrial natriuretic peptide are of major importance as prognostic markers in patients with CHF.
The relationship of fasting insulin levels to vascular risk factors in a general practice in Northern Ireland
Authors: BEATTY O. L. , ATKINSON A. B. , BROWNE J. , CLARKE K. , SHERIDAN B. , BELL P.
Published: August 2009

Abstract. Objective. To investigate the relationship between insulin and vascular risk factors in a healthy male population at high risk of ischaemic heart disease.

Design. Computer‐generated random number selection of subjects.

Setting. A suburban general practice population (total practice population 4500) in Northern Ireland. Subjects. Four hundred male subjects, aged 35–65 years, were randomly selected with 273 responding. Intervention. At interview, each subject completed a questionnaire, had blood pressure measured and a 12‐lead ECG recorded. The next morning, fasting blood samples were taken and a timed overnight urine collection for the albumin excretion rate was returned.

Results. To exclude the confounding effects of other variables on insulin concentrations, a healthy nonobese, nondiabetic, normotensive group with no history of ischaemic heart disease, no family history of diabetes and not taking drugs was identified (n = 120). Within this group there was a significant correlation between insulin and triglyceride (r = 0.30; P < 0.05), high‐density lipoprotein (HDL) cholesterol (r = 0.24: P < 0.05) and glucose (r = 0.30: P < 0.05). A group with higher insulin levels (n = 22) were compared to a group with lower insulin levels (n = 22). Serum triglyceride was higher (1.29 ± 0.1 vs. 1.00 ± 0.08 mmol L‐1; P < 0.05), HDL cholesterol was lower (1.26 ± 0.06 vs. 1.50 ± 0.09 mmol L‐1; P < 0.05) and plasma glucose higher (5.2 ± 0.1 vs. 4.9 ± 0.1 mmol L‐1; P < 0.05) in the group with higher insulin levels.

Conclusions. There is a relationship between insulin and triglyceride, HDL cholesterol and glucose but not blood pressure, cholesterol or low‐density‐lipoprotein (LDL) cholesterol in a healthy population at high risk of ischaemic heart disease.
Paralytic ileus as a result of diltiazem treatment
Authors: MANTZOROS C. S. , PRABHU A. S. , SOWERS J. R.
Published: August 2009

Abstract. Diltiazem is a widely used calcium channel blocker, and has been found to be effective in the treatment of hypertension, stable, variant and unstable angina, as well as oesophageal spasm. Calcium channel antagonists have been shown to diminish the contractility of gut smooth muscle, but have not as yet been reported to cause clinically significant inhibition of gut motility when used alone.

We report a case of reversible functional intestinal obstruction, immediately following diltiazem treatment in a patient with ischaemic heart disease.
Hypertension and renal disease in patients with acute intermittent porphyria
Authors: ANDERSSON C. , LITHNER F.
Published: August 2009

Abstract. Objectives. To assess the association between acute intermittent porphyria (AIP), hypertension and renal disease.

Design. A population‐based matched case‐control study (1:4) in 50 AIP patients (manifest/latent 25/25), a retrospective study of all individuals who died between the years 1978 and 1990 (2122 including 33 with AIP) and a group of eight patients with severe AIP.

Results. Hypertension was found in 56% of patients with manifest AIP, 33% of their controls (P = 0.041) and 16% of patients with latent AIP (P = 0.004). Renal disease was not more common in patients with AIP than in their controls. Three of the eight patients with severe recurrent AIP had impaired renal function, caused in one by systemic lupus erythematosus (SLE) nephritis. In the other two, no cause other than AIP could be found. In the mortality study, hypertension was registered in 68% of patients with manifest AIP compared to 21% of those with latent AIP (P = 0.008) but death from myocardial infarction and stroke was not more common. Uraemia was cited as the cause of death in 9.1% of AIP patients and 1.0% of those without AIP (P = 0.006).

Conclusions. Hypertension is more common in patients with manifest AIP than in those with latent AIP or control subjects. Renal disease may be due to hypertension, to AIP or to SLE. AIP may predispose to other renal diseases.
Upper airway obstruction in hypothyroidism
Authors: PELTTARI L. , RAUHALA E. , POLO O. , HYYPPÄ M. T. , KRONHOLM E. , VIIKARI J. , KANTOLA I.
Published: August 2009

Abstract. Objectives. To determine the occurrence and frequency of nocturnal upper airway obstruction in hypothyroidism.

Design. A case‐control study of patients with newly diagnosed hypothyreosis and euthyroid subjects who had been selected from the population register. The subjects underwent sleep recordings with a static‐charge‐sensitive bed (SCSB).

Setting. Turku University Hospital and Research and Development Unit, Social Insurance Institution, Turku, Finland.

Subjects. Twenty six consecutive patients underwent sleep recordings with SCSB and a pulse oximeter. One hundred and eighty‐eight euthyroid subjects who were previously studied with the SCSB were used as controls.

Main outcome measures. In a multivariate analysis, hypothyroidism, gender, age, and body mass index (BMI) were considered as predictors for the occurrence of nocturnal breathing abnormalities.

Results. Nocturnal breathing abnormalities were frequent in both groups. Fifty per cent of the hypothyroid patients and 29.3% of the control subjects had at least some episodes of partial or complete upper airway obstruction (P = 0.04). Severe obstruction with episodes of repetitive apnoea was present in 7.7% of the patients and in 1.5% of the controls. The multivariate analysis revealed that the presence of hypothyroidism did not significantly (P = 0.06), and independently of age, BMI or gender, predict nocturnal breathing abnormalities, whereas obesity (P < 0.0001) and male gender (P = 0.0001) were independent and significant predictors.

Conclusions. The incidence of nocturnal upper airway obstruction is increased in hypothyroidism, but is related to obesity and male gender rather than to hypothyroidism per se.
Nutritional dose of magnesium in hypertensive patients on beta blockers lowers systolic blood pressure: a double‐blind, cross‐over study
Authors: WIRELL M. P. , WESTER P. O. , STEGMAYR B. G.
Published: August 2009

Abstract. Objectives. To evaluate if magnesium alters blood pressure in hypertensive patients treated with beta blockers and if such effect can be coupled to a change in potassium and magnesium levels in muscle, serum and urine.

Design. A randomized double‐blind, cross‐over study with magnesium and placebo taken orally, each for 8 weeks.

Setting. Outpatient clinic, University Hospital, Umeå, Sweden.

Subjects. Thirty‐nine patients aged 26–69 years with moderate essential hypertension, treated before entry and during the study with continuous, unchanged beta blockers completed the study.

Interventions. Random allocation to receive magnesium aspartate or placebo. Daily magnesium dose was 15 mmol(365 mg) distributed three times a day over 8 weeks.

Main outcome measures. Blood pressure, serum, urine and muscle magnesium and potassium. Measurements performed at the start, after 8 and 16 weeks.

Results. Systolic supine and standing blood pressure significantly decreased when magnesium was supplemented following placebo but not when magnesium was given at start. When magnesium and placebo groups were independently compared there was no significant change in supine and standing systolic and diastolic pressure. Serum and urine magnesium and serum potassium were significantly higher after magnesium treatment, whilst no change was present in urine potassium or in muscle magnesium and potassium.

Conclusions. This study showed that 15 mmol magnesium day‐1 given to mild to moderate hypertensive patients treated with beta blockers could be the cause of a significant decrease in supine and standing systolic blood pressure.
Future challenges to coronary angioplasty: perspectives on intracoronary imaging and physiology
Authors: EMANUELSSON HÅKAN
Published: August 2009

Abstract. Several intravascular techniques have been developed with the purpose of achieving optimal guidance for treatment during coronary angioplasty (PTCA). Although the coronary angiographic technique is well established, there are still some inherent limitations. Due to intimal rupture, tears, dissection and thrombus following PTCA treatment, angiography does not allow exact delineation of the true borders of the vessel.

Coronary angioscopy is currently the most sensitive method to detect coronary thrombus and can also be used to classify atheromatous plaques. Furthermore, coronary dissection can be detected with more accuracy than with angiography. One limitation associated with angioscopy is the need to occlude the vessel during imaging, which may create myocardial ischaemia. Furthermore, there is presently no method for quantifying angioscopic findings.

Intravascular ultrasound produces a cross‐sectional image of the vessel, which permits analysis of the layers of the vascular wall. Characterization and classification of various types of plaque can be made, because thrombus, lipid, fibrous tissue and calcium have different ultrasonic echogenicity.

Flow velocity measurement with the Doppler technique is an interesting approach to the physiological assessment of coronary stenoses. Coronary flow reserve can be estimated with this method and monitoring of the flow signal following angioplasty will aid in the diagnosis of flow‐limiting complications.

The trans‐stenotic pressure gradient is a valuable measure of the haemodynamic importance of a coronary lesion. Trans‐stenotic gradients during maximal hyperaemia obtained with a miniaturized pressure transducer yield reliable information regarding the severity of the stenosis, and the pressure values may be used to calculate the relative coronary flow reserve.

In conclusion, all of these intracoronary diagnostic techniques will to some extent play a role in the future of coronary angioplasty. Safety, cost and complexity are some of the factors which will determine the growth potential of each method.
Circulating autoantibodies as serological markers in the differential diagnosis of pulmonary renal syndrome
Authors: SAXENA RAMESH , BYGREN PER , ARVASTSON BERTIL , WIESLANDER JÖRGEN
Published: August 2009

Abstract. Objectives. Pulmonary renal syndrome (lung haemorrhage and glomerulonephritis) is a fulminant condition that warrants a rapid diagnosis and treatment to prevent mortality and preserve renal functions. However, the patients frequently present with non‐specific pulmonary symptoms in the early phase of the syndrome and the diagnosis is often missed. Recently, several autoantibodies have been described in association with various forms of glomerulonephritis. We evaluated the association as well as the diagnostic and the prognostic significance of these antibodies in pulmonary renal syndrome.

Design. Retrospective clinical study.

Setting. University Hospital.

Subjects. Forty consecutive patients with biopsy verified glomerulonephritis and overt haemoptysis or pulmonary infiltrates compatible with lung haemorrhage.

Interventions. Analysis of proteinase 3 antineutrophil cytoplasm antibodies (PR3‐ANCA), myeloperoxidase (MPO)‐ANCA, antiglomerular basement membrane (GBM) and anti‐entactin antibodies.

Results. Thirty‐six (90%) patients possessed one or more autoantibodies. Twenty‐seven (70%) patients had ANCA (PR3‐ANCA, MPO‐ANCA or both). The remaining positive patients (n = 9) had anti‐GBM antibodies. Only two patients had anti‐entactin antibodies, suggesting a poor association of these antibodies with PRS. The majority of patients with anti‐GBM antibodies had a very poor clinical outcome (five irreversible renal failure; three deaths). On the other hand, despite no significant difference in clinical features or renal morphology from patients with anti‐GBM antibodies, 19 patients (70%) with ANCA recovered completely following treatment.

Conclusions. Our study demonstrated that the presence of autoantibodies is a predominant feature of PRS and that the type of immunologic injury is of paramount importance in determining the course of illness in this syndrome. Analysis of the aforementioned antibodies can help in an early differential diagnosis and thus, in better management of PRS.
Pheochromocytoma in multiple endocrine neoplasia type 2: European study
Authors: Modigliani E. , VASEN H. M. , RAUE K. , DRALLE H. , FRILLING A. , GHERI R. G. , BRANDI M. L. , LIMBERT E. , NIEDERLE B. , FORGAS L. , ROSENBERG‐BOURGIN M. , CALMETTES C. ,   THE EUROMEN STUDY GROUP
Published: August 2009

Abstract. Objectives. Pheochromocytoma (pheo) is the second component of the multiple endocrine neoplasia type 2 (MEN 2) syndrome. Clinical expression is sometimes poor, and chronology between medullary thyroid carcinoma (MTC) and pheo is not well evaluated. Therefore, a retrospective study was done in eight European countries in order to precise the main characteristics of pheo in MEN 2.

Subjects. Data from 300 MEN 2 patients with pheo (274 MEN 2 A and 26 MEN 2 B) were obtained from cases registered by the EuroMen study group, and collected by a medical standardized questionnaire. These cases occurred between 1969 and 1992.

Results. Mean age at diagnosis of pheo was 39.5 years (range 14–68 years) in MEN 2A and 32.4 years (range 15–41 years) in MEN 2B patients. Pheo occurred first in 25.1% of the cases (2–15 years before diagnosis of MTC) and after MTC in 40.2% (2–11 years). In other cases (34.7%), MTC and pheo were diagnosed at the same time. Involvement was bilateral in 67.8% of cases. Malignancy was only 4%. Thirty‐nine deaths occurred in these 300 patients, 64.1% were linked in pheo, 23.1% to MTC and 12.8% to other causes. Surgery was unilateral in 39.7% of the cases and bilateral adrenalectomy was the first procedure in 48.4%. A bilateral adrenalectomy in two steps had to be done in 11.9% of cases. In conclusion, these results justify systematic and prolonged biochemical screening of pheo during follow‐up of MTC and address some questions about the best mode of surgery.
Objective assessments of allergic and nonallergic rhinitis in young children
Authors: Chawes B. L. K. , Kreiner‐Møller E. , Bisgaard H.
Published: August 2009

Background:  Allergic and nonallergic rhinitis are common childhood disorders.

Objective:  To study nasal eosinophilia and nasal airway patency in young children with allergic and nonallergic rhinitis to assess the pathology behind such diagnoses.

Methods:  We investigated 255 children at six years of age from the Copenhagen Prospective Study on Asthma in Childhood birth cohort assessing rhinitis history, specific immunoglobulin E relevant to rhinitis symptoms, nasal eosinophilia and nasal airway patency by acoustic rhinometry before and after decongestion. Associations were studied in a multivariate graphical model corrected for gender, height and nasal steroid usage.

Results:  Allergic rhinitis was significantly and directly associated with irreversible nasal airway obstruction (reduced decongested nasal airway patency) (P = 0.004), whereas nonallergic rhinitis was not. Both allergic rhinitis (P = 0.000) and nonallergic rhinitis (P = 0.014) were directly and significantly associated with nasal eosinophilia, but this association was stronger for allergic rhinitis.

Conclusion:  Allergic rhinitis and nonallergic rhinitis are of different pathologies as suggested from their different associations not only to allergy but importantly also to irreversible nasal airway obstruction and eosinophilic inflammation. Allergic rhinitis was significantly associated with nasal eosinophilia and irreversible nasal airway obstruction suggesting chronic inflammation and structural remodeling of the nasal mucosa in children at the age of 6 years. Nonallergic rhinitis exhibited no change in the nasal airway patency, but some nasal mucosal eosinophilia albeit less than children with allergic rhinitis.
Trisomic rescue causing reduction to homozygosity for a novel ABCA12 mutation in harlequin ichthyosis
Authors: Castiglia D , Castori M , Pisaneschi E , Sommi M , Covaciu C , Zambruno G , Fischer J , Magnani C
Published: August 2009

Harlequin ichthyosis (HI) is the most severe and often lethal form of congenital ichthyosis, characterized by abnormal desquamation and extreme skin thickening and hardening over the entire body. It is caused by recessive loss‐of‐function mutations in the ABCA12 gene located on chromosome 2q34. Here, we report a sporadic HI patient born prematurely due to severe growth delay and oligohydramnios. The diagnosis was confirmed by ABCA12 molecular analysis, which disclosed the novel homozygous mutation p.R287X. Microsatellite analysis and parental segregation study showed that the disease resulted from complete paternal isodisomy. In addition, chorionic villus karyotyping revealed a non‐mosaic chromosome 2 trisomy, while postnatal peripheral blood karyotype resulted normal female. Thus, these findings indicate that trisomic rescue is one step of the mutational cascade leading to reduction to homozygosity for the ABCA12 mutation in the embryo. Our case is the first reported HI patient in whom the disease is due to uniparental isodisomy.
Corticosteroid elimination in simultaneous liver–kidney transplantation recipients
Authors: Weber Nicholas K. , Wiseman Alexander C. , Trotter James F.
Published: August 2009

Abstract:  Background:  Simultaneous liver–kidney transplantation (SLK) has more than doubled since 2002. While less common in kidney transplant alone recipients (KTA), corticosteroid discontinuation is performed routinely in liver transplantation, raising the question of optimal immunosuppression for SLK recipients.

Methods:  A retrospective case series of 16 SLK recipients under a steroid withdrawal protocol was performed to compare short‐term outcomes to a contemporaneous cohort of 32 KTA recipients.

Results:  In 69% of SLK recipients, corticosteroids were eliminated compared to 3% of KTA recipients, p < 0.0001. When comparing SLK and KTA recipients one yr post‐transplant, there were no significant differences in renal graft rejection (23.1% vs. 6.3%), death‐censored renal graft survival (100% vs. 97%), estimated glomerular filtration rate (74.4 vs. 62.6 mL/min), serum creatinine (1.10 vs. 1.39 mg/dL), or maintenance immunosuppression, respectively.

Conclusions:  Corticosteroids may be withdrawn safely in SLK recipients with one‐yr renal outcomes comparable to a KTA cohort.
Allergic rhinitis in the child and associated comorbidities
Authors: Sih Tania , Mion Olavo
Published: August 2009

Sih T, Mion O. Allergic rhinitis in the child and associated comorbidities. Pediatr Allergy Immunol 2010: 21: e107–e113. © 2009 John Wiley & Sons A/S

Allergic rhinitis (AR) typically presents after the second year of life, but the exact prevalence in early life is unknown. AR affects 10–30% of the population, with the greatest frequency found in children and adolescents. It appears that the prevalence has increased in the pediatric population. As the childs’ immune system develops between the 1st and 4th yr of life, those with an atopic predisposition begin to express allergic disease with a clear Th2 response to allergen exposure, resulting in symptoms. In pediatric AR, two or more seasons of pollen exposure are generally needed for sensitization, so allergy testing to seasonal allergens (trees, grasses, and weeds) should be conducted after the age of 2 or 3 years. Sensitization to perennial allergens (animals, dust mites, and cockroaches) may manifest several months after exposure. Classification of AR includes measurement of frequency and duration of symptoms. Intermittent AR is defined as symptoms for <4 days/wk or <4 consecutive weeks. Persistent AR is defined as occurring for more than 4 days/wk and more than 4 consecutive weeks. AR is associated with impairments in quality of life, sleep disorders, emotional problems, and impairment in activities such as work and school productivity and social functioning. AR can also be graded in severity – either mild or moderate/severe. There are comorbidities associated with AR. The chronic effects of the inflammatory process affect lungs, ears, growth, and others. AR can induce medical complications, learning problems and sleep‐related complaints, such as obstructive sleep apnea syndrome and chronic and acute sinusitis, acute otitis media, serous otitis media, and aggravation of adenoidal hypertrophy and asthma.