bluuebunny/crossref_metadata_2025 huggingface dataset:
The white blood cell count: its relationship to plasma insulin and other cardiovascular risk factors in healthy male individuals
Authors: TARGHER GIOVANNI , SEIDELL JAAP , TONOLI MARCO , MUGGEO MICHELE , DE SANDRE GIORGIO , CIGOLINI MASSIMO
Published: November 2003

Targher G, Seidell JC, Tonoli M, Muggeo M, De Sandre G, Cigolini M (Division of Endocrinology and Metabolic Diseases, Institute of Clinical Medicine, University of Verona, Italy; and Department of Chronic Diseases and Environmental Epidemiology‐RIVM, Bilthoven, The Netherlands). The white blood cell count: relationship to plasma insulin and other cardiovascular risk factors in healthy males. J Intern Med 1996; 239: 435–41.

Objectives. To evaluate the relationships of total and differential white blood cell (WBC) count to the components of the so‐called insulin resistance syndrome.

Subjects and design. The study population consisted of a random sample of 90 38‐year‐old healthy men with normal glucose tolerance.

Interventions. A 75 g oral glucose tolerance test was performed in all participants.

Main outcome measures. Total and differential WBC count, lipids, blood pressure, plasma glucose, C‐peptide and insulin (at fasting and 2 h after glucose load).

Results. Total WBC count correlated consistently with plasma 2‐h glucose (r=0.38; P<0.001), fasting and 2‐h postload insulin (r=0.26 and r=0.33; P<0.01–0.001, respectively) and C‐peptide (r=0.28 and r=0.32; P<0.01–0.001) concentrations. Smokers had significantly higher total leukocytes (P<0.01), neutrophils and lymphocytes than nonsmokers. Furthermore, total WBC count correlated positively with body mass index, blood pressure, plasma triglycerides, fibrinogen, and negatively with HDL cholesterol concentration. As differential WBC count, most variables correlated essentially to neutrophils and/or lymphocytes, whereas plasma insulin and C‐peptide concentrations correlated essentially to lymphocytes and monocytes, but not to neutrophils. In a multiple linear regression analysis, only 2‐h plasma glucose (P<0.01) and fibrinogen (P<0.05) were positive predictors of total WBC count after adjusting for all potentially confounding variables.

Conclusions. The results indicate that increased, albeit normal, WBC count associates with the cluster of metabolic and haemodynamic disorders typical of the insulin resistance syndrome, and suggest that increased WBC count may be yet another component of this syndrome.
Hyperkalaemia in acute leukaemia: a sign of adrenocortical insufficiency
Authors: DEMİROğLU H. , DÜNDAR S.
Published: November 2003

Demiroğlu H & Dündar S (Department of Haematology, Hacettepe University Medical School, Ankara, Turkey). Hyperkalaemia in acute leukaemia: a sign of adrenocortical insufficiency. J Intern Med 1997; 242: 111–15.

Objectives

To evaluate adrenal cortical reserve function in hyperkalaemic patients with acute leukaemia (AL).

Design

In hyperkalaemic AL patients, after basal blood collection for cortisol, rapid adrenocorticotropic hormone (ACTH) stimulation test was performed with human a1–24‐ACTH 0.25 mg, intravenously. Sixty minutes following injection, additional plasma was obtained for cortisol. Normal response was a peak cortisol level greater than 15 μg dL−1 with an increment greater than 5 μg dL−1.

Setting

Hacettepe University Hospital, Ankara, Turkey.

Subjects

Newly diagnosed AL patients with plasma K+ values exceeding 4.5 mmol L−1, who had never received antileukaemia therapy were eligible for entry into the trial. Thirteen patients fulfilled these criteria. Twenty AL patients with normal serum K+ levels were studied as controls.

Results

In six patients with hyperkalaemia, adrenal cortical response to rapid ACTH test was inadequate. One patient died during induction chemotherapy due to sepsis. Five of the remaining patients entered remission. Repeat ACTH tests during remission revealed normalization of the adrenocortical function in these patients. However, in only one patient with normal serum K+ level, adrenocortical reserve was decreased.

Conclusions

We suggest that in any AL patient with hyperkalaemia, adrenal reserve function should be evaluated with rapid ACTH stimulation test. In states of resistant hypotension and hyperkalaemia, steroids may be life saving.
Danaparoid: an antithrombotic agent without major impact on triglyceride hydrolysis capacity in humans
Authors: van Barlingen H. H. J. J. , van Beek A. , Erkelens D. W. , de Bruin T. W. A.
Published: November 2003

van Barlingen HHJJ, van Beek A, Erkelens DW, de Bruin TWA (Department of Internal Medicine, Laboratory of Lipid Metabolism, University Hospital, Utrecht University, PO Box 85 500, 3508 GA Utrecht, The Netherlands). Danaparoid: an antithrombotic agent without major impact on triglyceride hydrolysis capacity in humans. J Intern Med 1997; 242: 125–29.

Objectives

Heparin is a widely used antithrombotic drug. Besides its anticoagulant properties, it also has a marked influence on lipid metabolism, by decreasing serum lipolytic activity due to lipase depletion from vascular sites and stores. Especially in haemodialysis patients who receive heparin during every dialysis session, and in hypertriglyceridaemic patients, decreasing lipolytic activity can lead to the accumulation of triglyceride‐rich lipoproteins, which are atherogenic. Replacement of heparin by an antithrombotic drug with less lipase releasing activity might reduce this risk.

Design

We tested danaparoid, a new antithrombotic drug, and compared its ability to displace biotinylated heparan sulphate from lipoprotein lipase in vitro with heparin. Furthermore we compared the in vivo lipase releasing activity.

Results

Danaparoid displaced significantly less biotinylated heparan sulphate from triglyceride‐rich lipoprotein‐lipoprotein lipase complexes in vitro than heparin. Intravenous injection of danaparoid released less than 20% (P < 0.05) of the lipolytic activity released by an equivalent anticoagulant dose of heparin.

Conclusion

Danaparoid is the drug of choice during the antithrombotic therapy of hypertriglyceridaemic or haemodialysis patients.
Health, health care utilization and living conditions in foreign‐born diabetic patients in southern Sweden
Authors: Hjelm K. , ApelqVist J. , Nyberg P. , Sundquist J. , Isacsson Å.
Published: November 2003

Hjelm K, Apelqvist J, Nyberg P, Sundquist J, Isacsson Å (Department of Community Health Sciences Dalby/Lund, University of Lund, Sweden, and Department of Internal Medicine, Lund University Hospital, Sweden). Health, health care utilization and living conditions in foreign‐born diabetic patients in southern Sweden. J Intern Med 1997; 242: 131–41.

Objectives

To compare foreign‐ and Swedish‐born diabetic subjects regarding health care utilization, complications, clinical and socio‐economic characteristics.

Design

Cross‐sectional study.

Setting

All known diabetic patients living in six defined primary health care districts.

Subjects

Of 1861 identified subjects aged >25 years 90.1%, 113 foreign‐ and 1564 Swedish‐born subjects participated. Mean time of residence in Sweden was 32 ± 1.2 years, 93% >10 years.

Main outcome measures

A standardized interview, a physical examination and an evaluation of medical records.

Results

No differences were found regarding living conditions or health care utilization, with the exception of higher use of home‐care from public authorities in Swedish‐born subjects (P < 0.05) despite no difference in dependency on help according to Katz's ADL index. There were no major differences in objective health (glycaemic control and complications related to diabetes) with the exception of lower frequency of sensory neuropathy (P < 0.01) and peripheral vascular disease (P < 0.05) in foreign‐born subjects. The prevalence of diabetes was 2.1% (95% CI 1.7–2.5) in the foreign‐born and 2.6 % (95% CI 2.5–2.7) in Swedes. Foreign‐born individuals were five years younger (P < 0.001), were more often diagnosed ≥30 years (P < 0.05), had a two years' shorter duration of disease (P < 0.001) and were less often treated with insulin (P < 0.01). Treatment with insulin was related to the duration and presence of complications related to diabetes.

Conclusions

There were no major differences in objective health or use of health care in European migrants with diabetes mellitus, mainly Scandinavians, with short cultural distance and long residence in Sweden compared to Swedish‐born diabetic patients.
Chronic work stress is associated with atherogenic lipids and elevated fibrinogen in middle‐aged men
Authors: SIEGRIST J. , PETER R. , CREMER P. , SEIDEL D.
Published: November 2003

Siegrist J, Peter R, Cremer P, Seidel D. (University of Düsseldorf and Ludwig Maximilians University of Munich, Germany). Chronic work stress is associated with atherogenic lipids and elevated fibrinogen in middle‐aged men. J Intern Med 1997; 242: 149–56.

Objectives

To examine the association between a model of chronic work stress (high efforts in combination with low rewards) and two risk factors of coronary heart disease, low‐density‐lipoprotein (LDL)‐cholesterol and fibrinogen.

Design

A cross‐sectional study in a group of 179 healthy middle‐aged (48.5 ± 4.5) male middle managers.

Setting

A large car‐producing enterprise in Germany.

Results

After adjustment for relevant covariates, logistic regression analysis showed independent effects of a composite measure of high effort and low reward at work on the prevalence of elevated (upper tertile, i.e. ≥160 mg dL−1) LDL‐cholesterol (prevalence odds ratio (POR) = 3.57; 95% confidence intervals (CI): 1.24‐10.20) and on elevated (upper quintile, i.e. ≥420 mg dL−1) plasma fibrinogen (POR = 6.71 (CI: 1.57‐28.76). Apart from this core measure, cigarette smoking, overweight and alcohol consumption were the covariates with the relatively strongest contributions to the multivariate model.

Conclusions

Results give preliminary evidence on an independent association of chronic work stress with atherogenic lipids and with elevated fibrinogen in an occupationally homogeneous group of healthy middle‐aged men.
Hyaluronan in joint disease
Authors: Engström‐Laurent A.
Published: November 2003

Engström‐Laurent A (University of Umeå, Umeå, Sweden). Hyaluronan in joint disease (Minisymposium: Hyaluronan). J Intern Med 1997; 242: 57–60.

Hyaluronan is a major component of synovial fluid. It is synthesized in the joint and partly degraded in joint capsule and partly carried by lymph to lymph nodes and the general circulation. During various joint disorders, especially inflammatory ones, the amount of hyaluronan in the joint and its turnover rate are increased leading to pathologically high serum levels of the polysaccharide. These levels are a complex function of synovitis mass and the physical activity of the patient. Intra‐articular injection of hyaluronan has been used in the treatment of osteoarthritis. Although it results in a relief of pain, controlled clinical trials have not yet convincingly shown any beneficiary effects of the treatment.
Hyaluronan turnover in relation to infection and sepsis
Authors: BERG S.
Published: November 2003

Abstract. Berg S (University Hospital, Linköping, Sweden). Hyaluronan turnover in relation to infection and sepsis (Minisymposium: Hyaluronan). J Intern Med 1997; 242: 73–7.

Sepsis is a major clinical problem in intensive care. The mortality in septic shock is high, and predominantly due to cardiovascular collapse and multiple organ dysfunction. In sepsis high levels of circulating hyaluronan have been found, correlating to disease severity and prognosis. The reason behind the increased levels could be both decreased hepatic uptake and increased peripheral synthesis. Thus, plasma hyaluronan may be a clinically useful marker of hepatic dysfunction and possibly also an indicator of the increased inflammatory and reparative activity in different organs in septic conditions.
Protection against cardiovascular collapse in an alcoholic patient with thiamine deficiency by concomitant alcoholic ketoacidosis
Authors: BAKKER S. J. L. , MAATEN J. C. TER , HOORNTJE S. J. , GANS R. O. B.
Published: November 2003

Bakker SJL, ter Maaten JC, Hoorntje SJ, Gans ROB (University Hospital Vrije Universiteit, Amsterdam, and Catharina Hospital, Eindhoven, The Netherlands). Protection against cardiovascular collapse in an alcoholic patient with thiamine deficiency by concomitant alcoholic ketoacidosis (Case report). J Intern Med 1997; 242: 179–83.

Hyperlactataemia due to thiamine deficiency has so far only been reported in the setting of full‐blown cardiovascular beriberi with congestive heart failure and systemic vasodilatation. Poor tissue oxygenation and impaired lactate clearance by the liver are generally accepted as underlying causes of the elevated lactate levels. We present an alcoholic patient with thiamine deficiency‐induced hyperlactataemia and accompanying alcoholic ketoacidosis, who did not display the circulatory disturbances that are characteristic of cardiovascular beriberi. The hypothesis will be presented that the concomitant presence of alcoholic ketoacidosis has prevented haemodynamic deterioration. Putative mechanisms that could explain such an effect are discussed in detail, with special reference to the role of acetyl‐CoA and adenosine.
Bambuterol raises high‐density lipoprotein levels in patients with hyperlipidaemia
Authors: FLORÉN C. H. , KJELLSTRÖM T. , BAUER C. A.
Published: November 2003

Abstract. Florén CH, Kjellström T, Bauer CA (Department of Medicine, Malmö University Hospital, Malmö, Sweden and Astra Draco AB, Lund, Sweden). Bambuterol raises high‐density lipoprotein levels in patients with hyperlipidaemia. J Intern Med 1997; 242: 167–71.

Objective

The objective of this study was to investigate the effects of bambuterol (a prodrug of the β2‐agonist terbutaline) on lipid and lipoprotein levels in patients with hyperlipidaemia. Both these drugs are extensively used in the treatment of patients with bronchial asthma. Earlier studies in healthy volunteers and in patients with noninsulin dependent diabetes mellitus have shown that terbutaline and bambuterol increase HDL cholesterol levels, and therefore bambuterol might have beneficial effects on HDL levels in patients with hyperlipidaemia.

Design

The present study was a randomized, double‐blind, crossover study, comparing 20 mg of bambuterol with placebo, each one given for 6‐8 weeks with a 3‐4 week washout period in between.

Setting

The study was performed in an out‐patient lipid clinic at Malmö University Hospital.

Subjects

Thirty‐one patients with hyperlipidaemia (S‐cholesterol >6.5 mmol L−1 and S‐triglycerides >2.0 mmol L−1) were included.

Main outcome measurements and results

The results showed that bambuterol increased S‐HDL cholesterol levels by 7% (P= 0.012). Increases were 23% for P‐HDL2 and 7% for P‐HDL3 fractions, but no effect was apparent on S‐apolipoprotein A‐1 levels.

Conclusion

This study suggests that the β2‐agonist bambuterol might be used as an alternative or as a complement in the treatment of dyslipidemic patients, when an increase in HDL cholesterol is desired.
Large phlebotomy in variegate porphyria
Authors: HARPER P. , HYBINETTE T. , THUNELL S.
Published: November 2003

Harper P, Hybinette T, Thunell S (Porphyria Centre Sweden, Karolinska Institute, Stockholm and the Department of Internal Medicine, Regional Hospital Kalmar, Sweden). Large phlebotomy in variegate porphyria (Case report). J Intern Med 1997; 242: 255–9.

There are no reports on effects of large blood losses in acute hepatic porphyria. In the present study we report the experiences of repeated large therapeutic phlebotomies in a patient with porphyria cutanea tarda coexisting with variegate porphyria. Neither a series of 12 phlebotomies, 300 mL each, resulting in a 17% decrease in blood haemoglobin, nor a single 400 mL phlebotomy activated the acute porphyric condition. It is concluded that the increased bone marrow metabolic throughput resulting from blood loss, in acute types of porphyria does not overload the normoblast or leukocyte precursor haem synthetic pathways in a way which will increase porphyrin precursor excretion or trigger acute porphyric symptoms.
Guidelines and reported practice for the treatment of hypertension and hypercholesterolaemia
Authors: Troein M. , Gardell B. , Selander S. , Råstam L.
Published: November 2003

Troein M, Gardell B, Selander S, Råstam L (Department of Community Medicine, Lund University, Malmö, and Stockholm Institute of Education, Stockholm, Sweden). Guidelines and reported practice for the treatment of hypertension and hypercholesterolaemia. J Intern Med 1997; 242: 173–8.

Objective.

To monitor changes in family physicians' reported practice on hypertension and hypercholesterolaemia.

Design.

Random samples of physicians were selected for telephone interviews on their practice regarding cut‐off levels and pharmacological treatment of hypertension and hypercholesterolaemia, related to a case scenario of a 48‐year‐old man, in 1989, 1991 and 1993.

Setting

Primary care facilities in southern Sweden.

Subjects

Specialists in family medicine, employed in public primary health care. Participation rates were in 187/201 (93%) in 1989, 236/264 (89%) in 1991 and 257/298 (86%) in 1993.

Main outcome measures

Cut‐off levels and drug treatment preferences for hypertension and hypercholesterolaemia.

Results

During the period 1989–1993, decreasing mean cut‐off levels for pharmacological treatment of hypertension (P < 0.001) were reported, below the levels of the guidelines. Although betablockers were first choice drug in all three surveys, the proportion preferring this has diminished (P < 0.001), whilst the proportions preferring ACE‐inhibitors and calcium channel blockers have increased (P < 0.001 and P= 0.02, respectively). For drug treatment of hypercholesterolaemia, the mean cut‐off level remained close to guidelines in all three surveys. The proportion of physicians suggesting resins and nicotinic acid as first choice drug had decreased (P < 0.001 and P= 0.03, respectively), whilst the proportion preferring statins and fibrates had increased (P < 0.001 and P= 0.048, respectively).

Conclusion.

Practice guidelines on hypertension and hypercholesterolaemia have not had the desired impact on physicians' reported practice. The reason for this might be that physicians did not value the guidelines as adequate tools for practice, or that the methods for dissemination, implementation, and maintenance of guidelines were not appropriate.
Brain natriuretic peptide in an elderly population
Authors: Wallén T. , Landahl S. , Hedner T. , Saito Y. , Masuda I. , Nakao K.
Published: November 2003

Wallén T, Landahl S, Hedner T, Saito Y, Masuda I, Nakao K (Vasa Hospital and Sahlgrenska Hospital, Göteborg University, Sweden; and Kyoto University School of Medicine, Japan). Brain natriuretic peptide in an elderly population. J Intern Med 1997; 242: 307–11.

Objectives

To study the relationship of brain natriuretic peptide concentrations to ageing, and whether brain natriuretic peptide could reflect current disease states in the general elderly population.

Design

Brain natriuretic peptide was measured in two population samples from the general population.

Subjects

Five hundred forty‐five 85‐year‐old subjects from the longitudinal population study ‘70‐year‐old people in Gothenburg, Sweden’ were investigated in respect to cardiovascular, renal and metabolic disease, and 191 subjects from the 40‐year‐old male population were examined.

Main outcome measures

To study the influence of ageing on circulating brain natriuretic peptide and the association between concentrations of brain natriuretic peptide and common disease states in the elderly.

Results

Brain natriuretic peptide concentrations were significantly increased in relation to ageing (P < 0.001). Brain natriuretic peptide concentrations were significantly increased in elderly with congestive heart failure (P < 0.001), ischaemic heart disease (P < 0.001), atrial fibrillation (P < 0.001) and renal dysfunction (P < 0.001) but not in hypertension. In multivariate analysis, brain natriuretic peptide concentrations were predictive for ischaemic heart disease (P < 0.001), atrial fibrillation (P < 0.01), renal dysfunction (P < 0.01), congestive heart failure (P < 0.05) and treatment with β‐adrenergic blockers (P < 0.05).

Conclusions

Plasma concentrations of brain natriuretic peptide are increased in healthy elderly compared to middle‐aged individuals. In the elderly, measurements of brain natriuretic peptide may provide prognostic information, due to the augmented secretion in cardiovascular diseases commonly seen in this population. It remains to be determined whether routine measurements of circulating brain natriuretic peptide will be of value in predicting current cardiovascular disease for the individual patient.
Erythromelalgia: a clinical study of 87 cases
Authors: KALGAARD O. M. , SEEM E. , KVERNEBO K.
Published: November 2003

Abstract. Kalgaard OM, Seem E, Kvernebo K (Ullevaal Hospital, Oslo, Norway). Erythromelalgia: a clinical study of 87 cases. J Intern Med 1997; 242: 191–7.

We report on aetiological factors, clinical findings and prognosis of 87 patients with erythromelalgia (EM). This is the largest material reported in the western literature. There is a 100% follow up of patients with observation period up to 11 years. There were 61 females and 26 males. About two‐thirds of the patients were primary cases and around three‐quarters had a chronic condition. The condition was more common in lower than in upper extremities. Over time patients with erythromelalgic syndrome gradually get worse, those with primary and secondary acute EM get better, whilst primary and secondary chronic EM remain stable.
Heart failure ketosis
Authors: Lommi J. , Koskinen P. , Näveri H. , Härkönen M. , Kupari M.
Published: November 2003

Lommi J, Koskinen P, Näveri M, Härkönen M, Kupari M (Helsinki University Central Hospital, Helsinki, Finland). Heart failure ketosis. J Intern Med 1997; 242: 231–8.

Objective

To assess whether blood ketone bodies are increased in congestive heart failure (CHF).

Methods

Thirteen patients with CHF and 11 cardiac patients without CHF took part in the study. Blood acetoacetate and b–hydroxybutyrate levels and the pertinent metabolic and hormonal milieu were measured during 20 h fast and after 2 h glucose infusion.

Results

The averaged blood ketone body and free fatty acid levels were significantly higher during the fast and also remained higher after glucose infusion in patients with CHF than in the control group. The areas under ketone body concentration time curve over the last 8 h of the fast were 3522 ± 662 μmol L−1 h−1 (SE) and 1789 ± 192 μmol L−1 h−1 in patients with and without CHF, respectively (P = 0.022). Circulating noradrenaline and growth hormone were higher but glucagon lower in patients with CHF than in the controls (P < 0.05 for all differences) whereas the glucose and insulin concentrations were comparable in the study groups. At the time of peak ketonaemia, the glucagon‐to‐insulin ratio was lower in patients with CHF than in patients without CHF (P = 0.04).

Conclusions

These data suggest that severe CHF is a ketosis‐prone state. Augmented supply of free fatty acids for ketogenesis due to increased stress hormone‐related lipolysis is one likely mechanism.
Bradydysrhythmia‐related presyncope secondary to pheochromocytoma
Authors: Zweiker R. , Tiemann M. , Eber B. , Schumacher M. , Fruhwald F.M. , Lipp R. , Lax S. , Pristautz H. , Klein W.
Published: November 2003

Zweiker R, Tiemann M, Eber B, Schumacher M, Fruhwald FM, Lipp R, Lax S, Pristautz H, Klein W (University of Graz and Hospital of Wagna, Austria). Bradydysrhythmia‐related presyncope secondary to pheochromocytoma (Case report). J Intern Med 1997; 242: 249–53.

Pheochromocytoma endures as a life‐threatening disorder. In the absence of systemic hypertension, diagnosis may be difficult. We present a 46‐year‐old normotensive male with a history of presyncope. One of these episodes could be documented, and revealed symptomatic bradycardia suspicious of sinus node arrest. Due to hints of an elevated sympathetic tone (Schellong test, circadian blood pressure pattern without diurnal rhythm) 24‐h urinary catecholamine concentrations were measured and found increased. MIBG‐scintigraphy and abdominal‐ computed tomography indicated the location of the pheochromocytoma. After removal of the tumour, no further episodes of presyncopes or bradydysrhythmias were observed.
Schizophrenic symptoms and SPECT abnormalities in a coeliac patient: regression after a gluten‐free diet
Authors: DE SANTIS A. , ADDOLORATO G. , ROMITO A. , CAPUTO S. , GIORDANO A. , GAMBASSI G. , TARANTO C. , MANNA R. , GASBARRINI G.
Published: November 2003

De Santis A, Addolorato G, Romito A, Caputo S, Giordano A, Gambassi G, Taranto C, Manna R, Gasbarrini G (Catholic University, Rome, Italy). Schizophrenic symptoms and SPECT abnormalities in a coeliac patient: regression after a gluten‐free diet (Case Report). J Intern Med 1997; 242: 421–23.

A 33‐year‐old patient, with pre‐existing diagnosis of ‘schizophrenic’ disorder, came to our observation for severe diarrhoea and weight loss. Use of single photon emission computed tomography, (99mTc)HMPAO SPECT, demonstrated hypoperfusion of the left frontal brain area, without evidence of structural cerebral abnormalities. Jejunal biopsy showed villous atrophy. Antiendomysial antibodies were present. A gluten‐free diet was started, resulting in a disappearence of psychiatric symptoms, and normalization of histological duodenal findings and of (99mTc)HMPAO SPECT pattern. This is the first case in which, in an undiagnosed and untreated coeliac patient with psychiatric manifestations, the (99mTc)HMPAO SPECT demonstrated a dysfunction of frontal cortex disappearing after a gluten‐free diet.
Low circulating leptin levels in protein‐energy malnourished chronically ill elderly patients
Authors: Cederholm T. , Arner P. , Palmblad J.
Published: November 2003

Cederholm T, Arner P, Palmblad J (Karolinska Institute at the Centre for Inflammation & Hematology Research, and Huddinge University Hospital, Huddinge, Sweden). Low circulating leptin levels in protein‐energy malnourished chronically ill elderly patients. J Intern Med 1997; 242: 377–82.

Objective

To evaluate serum leptin, a fat cell‐derived protein, levels in relation to the malnutrition often observed in chronic disease.

Design

A comparison of circulating leptin concentrations in malnourished chronically ill elderly and in age‐matched controls.

Setting

A university‐affiliated teaching hospital in Stockholm, Sweden.

Subjects

Nineteen protein–energy malnourished elderly patients (74 ± 1 years) with various chronic nonmalignant diseases and 18 healthy controls (72 ± 1 years).

Main outcome measures

Serum leptin levels measured by radioimmunoassay technique, nutritional status as expressed by body mass index (kg m−2), triceps skin fold, arm muscle circumference and serum albumin, and serum orosomucoid concentrations indicating inflammatory status.

Results

Patients and controls displayed body mass indexes of 17.4 ± 0.7 and 25.0 ± 1.1 (P < 0.001), respectively. Triceps skin fold (TSF) measurements revealed a pronounced fat depletion in the patients, being 8.5 ± 0.9 and 22.3 ± 1.5 mm (P < 0.001) in female and 6.1 ± 0.7 and 10.8 ± 0.8 mm (P < 0.001) in male patients and controls, respectively. Patient serum leptin concentrations were less than half of the corresponding concentrations in the controls, 4.3 ± 1.1 and 9.3 ± 1.3 ng mL−1 (P < 0.01), respectively. The highest leptin concentrations were registered in female controls, 12.1 ± 1.6 ng mL−1. The serum leptin levels in the controls correlated with TSF (r= 0.74; P < 0.001). No such correlation was found in the patients.

Conclusions

Serum leptin levels were low and did not seem to be directly associated with fat and muscle depletion in elderly patients with chronic illness, whereas they appeared to be positively correlated to body fat in healthy elderly.
The effects of thromboxane A2 inhibition (Picotamide) and angiotensin II receptor blockade (Losartan) in primary Raynaud's phenomenon
Authors: Pancera P. , Sansone S. , Secchi S. , Covi G. , Lechi A.
Published: November 2003

Pancera P, Sansone S, Secchi S, Covi G, Lechi A (University of Verona, Verona, Italy). The effects of thromboxane A2 inhibition (Picotamide) and angiotensin II receptor blockade (Losartan) in primary Raynaud's phenomenon. J Intern Med 1997; 242: 373–6.

Objectives

To assess the role of thromboxane A2 and of angiotensin II in patients with primary Raynaud's phenomenon.

Design

After an eight‐day run‐in period, the patients were enrolled in a single‐blind, cross‐over, study.

Setting

Patients were examined at the Ambulatory for Microcirculatory Diseases of the Clinic of Internal Medicine, University Hospital, Verona.

Subjects

Fifteen subjects affected by primary Raynaud's phenomenon were included.

Main outcome measures

A piezoelectric plethysmography to evaluate the distensibility of the digital arteries as the ratio between peak time (PT) and total time (TT), and an oscillometric blood pressure recorder were used after the run‐in period, and after a two‐week course of picotamide (300 mg b.i.d., i.e. two times daily) or losartan (12.5 mg once daily) with an interval of a week of placebo between the active treatments. The tests were performed after every treatment in basal condition and during mental stress. The patients reported in a diary the number and the severity (from 0 to 4 +) of the vasospastic crises.

Results

The change in TP/TT ratio appeared statistically significant only after losartan treatment, both in basal condition and during mathematical stress. Both pharmacological treatments, with respect to placebo, showed an improvement of the scores, derived from the number and severity of vasospastic attacks, but only the therapy with losartan determined a statistically significant improvement.

Conclusions

The inhibition of the type 1 receptor for angiotensin II seems highly effective in the reduction of the vasospastic crises in the subjects with primary Raynaud's phenomenon. According to our experience, losartan could be used more extensively in the treatment of these patients besides arterial hypertension.
The effect of metformin on blood pressure and metabolism in nondiabetic hypertensive patients
Authors: Snorgaard O. , Køber L. , Carlsen J.
Published: November 2003

Snorgaard O, Køber L, Carlsen J (Department of Cardiology and Endocrinology, Frederiksberg Hospital, Department of Cardiology, Gentofte University Hospital, and MEDICON A/S, Copenhagen, Denmark). The effect of metformin on blood pressure and metabolism in nondiabetic hypertensive patients. J Intern Med 1997; 242: 407–412.

Objectives

To study the effect of metformin on blood pressure and metabolism in nondiabetic hypertensives.

Design

A six‐week single‐blind placebo wash‐out, followed by a double‐blind placebo‐ controlled parallel group design with skew randomization (2:2:1) to metformin 850 mg b.i.d. (n= 10), metformin 500 mg b.i.d. (n= 10), or placebo b.i.d. (n= 5) for 12 weeks. Office blood pressure (oBP), ambulatory blood pressure (aBP), lipoproteins, and oral glucose tolerance (OGTT) were measured/performed before and during treatment.

Subjects

Sixteen male and nine female nondiabetic (OGTT) patients (median age 57 (39–74) years) with verified hypertension (White‐coat excluded) for 4 (0–20) years.

Results

The possible effect of metformin treatment and dosage was tested with a two‐factor analysis of variance. Treatment induced a significant decline in diastolic oBP, P < 0.05. This decline was, however, not significantly different comparing metformin and placebo. Systolic oBP, diastolic aBP, and systolic aBP showed no significant change by treatment. The decline in diastolic oBP was 5 mmHg in the pooled group of metformin‐ treated patients, P < 0.005. Different gender and the presence of obesity had no impact on the decline in diastolic oBP within this group. Changes in fasting C‐peptide and fasting insulin during treatment were unrelated to blood pressure changes. High fasting insulin (> 60 pmol L−1) or high fasting C‐peptide (> 1000 pmol L−1) at baseline did not favour an effect of metformin on diastolic oBP. Glucose metabolism and lipoproteins were unchanged in all groups.

Conclusions

Although metformin treatment induced a decline in diastolic office blood pressure in nondiabetic hypertensives, the decline was not different from that during placebo treatment. Metformin had no significant effect on ambulatory blood pressure. Thus, metformin has, if any, only a minor clinically insignificant effect on blood pressure in nondiabetic hypertensives. The study does not support the hypothesis that circulating insulin is a major regulator of blood pressure in hypertension.
Homocysteine, atherosclerosis and prevalent cardiovascular disease in the elderly: The Rotterdam Study
Authors: Bots M. L. , Launer L. J. , Lindemans J. , Hofman A. , Grobbee D. E.
Published: November 2003

Bots ML, Launer LJ, Lindemans J, Hofman A, Grobbee DE (Erasmus University Medical School and University Hospital Rotterdam, Rotterdam; Utrecht University, Utrecht; and the National Institute of Public Health, Bilthoven; The Netherlands). Homocysteine, atherosclerosis and prevalent cardiovascular disease in the elderly: The Rotterdam Study. 1997; 242: 339–47.

Objectives

Elevated homocysteine increases the risk of vascular disease, in particular amongst younger subjects (<60 years). Very few studies have been performed amongst older subjects. We evaluated the relation of plasma total homocysteine (tHcy) to atherosclerosis and symptomatic cardiovascular disease amongst older men and women.

Design

A cross‐sectional study.

Setting

General population.

Subjects

A random sample of 630 men and women, participating in the Rotterdam Study, a prospective population‐based cohort study amongst 7983 subjects aged 55 years and over residing in the Ommoord district of Rotterdam, the Netherlands.

Main outcome measures

Carotid atherosclerosis (carotid plaques and common carotid intima–media thickness) assessed by ultrasonography; lower extremity (peripheral) artery atherosclerosis measured by the ratio of the ankle to arm systolic blood pressure; prevalent cardiovascular disease assessed as a history of myocardial infarction or stroke.

Results

Subjects, 55–74 years of age, with elevated tHcy levels (≥18.6 μmol L−1) had a thicker common carotid intima–media (difference 0.037 mm; 95% CI 0.001, 0.073), a lower ankle‐arm index (−0.054; −0.104, −0.004), and an increased risk of cardiovascular disease (odds ratio 3.0; 1.5, 6.1), after adjusting for sex and age. There was no appreciable association of tHcy levels to atherosclerosis and cardiovascular disease in subjects aged 75 years and older.

Conclusions

In subjects aged 55–74 years elevated tHcy is associated with an increased risk of atherosclerosis and cardiovascular disease. The lack of association in those aged ≥75 years most probably reflect selective mortality.
Blood pressure in relation to medical, psychological and social variables in a population of 80‐year‐olds. Survival during 6 years
Authors: JENSEN E. , DEHLIN O. , HAGBERG B. , SAMUELSSON G. , SVENSSON T. , LIDFELDT J.
Published: November 2003

Objectives. To relate elevated blood pressure in 80‐year‐olds to symptoms, life satisfaction and survival.

Design. Examinations of medical, psychological and social factors every year between 80 and 86 years of age.

Setting. Primary health care in the city of Lund in southern Sweden.

Subjects. Three‐hundred and thirty‐three persons living in the city of Lund and born in 1908. Participation rate was 67%.

Intervention. Abnormal findings were further examined and treated.

Main outcome measures. Symptoms, blood pressure, laboratory values, psychological factors, cognition, living conditions, and survival.

Results. Hypertension according to the definition used was found in 70%. Women were over‐represented (P<0.05). Amongst persons with alleged hypertension, diuretics (P<0.001) and ‘other cardiovascular drugs’ (P<0.001) were more often used. Analgesics were more often used amongst assessed hypertensives (P<0.05). Those with assessed hypertension scored better in testing of cognition compared to nonhypertensives (P<0.05), and less often lived in institutions (P<0.001). Assessed hypertensives had a better survival than alleged hypertensives during the following 7 years (P<0.01).

Conclusions. Eighty‐year‐olds with assessed hypertension in the consulting room showed fewer symptoms and had a better cognition and survival than alleged hypertensives (those with a history of hypertension).
The impact of the accessibility of cranial CT scans on patient evaluation and management decisions
Authors: MARIK P. E. , RAKUSIN A. , SANDHU S. S.
Published: November 2003

Objectives. Cranial CT scans are amongst the most frequently performed radiological investigations performed in most developed countries. However, these tests are relatively expensive and economic realities should compel physicians to re‐evaluate the utilization of this technology. The aim of this study was to review the utilization pattern and effect on management decisions of cranial CT scanning.

Design. Retrospective chart review.

Setting. University‐affiliated community teaching hospital.

Subjects. The clinical data on 451 consecutive patients undergoing cranial CT scanning in our radiology department were reviewed. Eighty‐five patients were referred from outside the hospital and were subsequently excluded from further analysis.

Interventions. None.

Main outcome measures. The following data was abstracted from each patient's chart: the presenting clinical syndrome, the physician ordering the scan, details of the neurological examination performed prior to scanning, the CT scan findings and the impact the CT scan findings had on management decisions.

Results. The largest percentage of patients were referred from the emergency department (61%). Chronic intracranial lesions were present in 77 (21%) patients. New pathological findings were found in 91 (25%) patients. The commonest new lesions were ischaemic infarcts (43%), followed by intracerebral haemorrhage (13%) and space occupying lesions (11%). Ninety‐seven per cent of patients presenting with new focal neurological signs had new findings on the CT scan, compared to 28% of patients with severe headache and 27% with a history of loss of consciousness. Head trauma was the presenting problem in 139 patients. New pathological findings were diagnosed in 24 of these patients. Fifty‐four patients had no signs or symptoms referable to the central nervous system. None of these patients had new findings on CT scan. In the vast majority of patients the neurological examination performed prior to CT scanning was incomplete. CT scanning was considered to have altered the management or provided a new diagnosis in 162 (44%) patients; of these patients 61 (67%) were in the group with new findings on CT scanning and 101 (37%) in the group with no new findings.

Conclusion. In this study cranial CT scanning affected clinical management decisions in less than half of the patients. Furthermore, a careful history and neurological examination was performed in the minority of patients undergoing CT scanning. It would therefore appear that the easy accessability of CT scans largely determines the utilization of this diagnostic tool.
Cholesterol issues and management
Authors: GRUNDY S. M.
Published: November 2003

The aim of this Minisymposium is to address current cholesterol issues as viewed from the United States. During the past decade the term ‘cholesterol’ has become a household word in the US. This fact can be attributed in large to the efforts of the National Cholesterol Education Program (NCEP). This program has wide support from a large number of member organizations such as the American Heart Association, the American College of Cardiology, and the American Medical Association. The NCEP has developed programs in both public health and professional education. NCEP efforts have led to increased public and professional awareness of high blood cholesterol as a major risk factor for coronary heart disease, to increased testing for high cholesterol levels, to modification of the American diet, and to increased use of cholesterol‐lowering drugs. The use of drugs has been supported by the recent publication of three major clinical trials: the Scandinavian Simvastatin Survival Study, the West of Scotland Coronary Prevention Study, and the Cholesterol and Recurrent Events study. All three of these trials demonstrated a major reduction in coronary risk accompanying aggressive cholesterol‐lowering therapy. They have been highly influential in thinking about cholesterol management in high‐risk patients in the US.

This Minisymposium considers various issues related to primary and secondary prevention, cholesterol management in special populations, and the problem of adherence to medication.
Secondary prevention of heart disease amongst patients with lipid abnormalities: practice and trends in the United States
Authors: BROWN B. G. , ZHAO XUE‐QIAO , BARDSLEY J. , ALBERS J. J.
Published: November 2003

Patients with established coronary disease and abnormalities of lipid metabolism represent a particularly important subgroup, since their mortality risk is typically 10 times greater than that amongst subjects with comparable risk factors but no clinical history. Such patients are commonly treated initially with anti‐anginal therapy; if ischaemic symptoms persist they often undergo revascularization (bypass or angioplasty). While invasive procedures restore blood flow and relieve ischemia, they do not, in most cases, reduce risk of subsequent MI or death, or alter the underlying atherogenic process(es). Despite this, there has been a progressive 54% decline in age‐adjusted cardiac mortality over the period 1960–1995, which appears best attributable to US lifestyle changes. In particular, the past decade has provided compelling evidence for the merits of a fourth approach: comprehensive risk factor management. Clinical outcome studies have confirmed the substantial merit of aspirin prophyllaxis and of intensive lipid‐lowering therapy in secondary prevention. Prospective angiographic trials and evidence from studies of vascular biology have provided insight into mechanisms of benefit. As a consequence, lipid therapy and aspirin use have increased greatly among middle aged and older US citizens, especially those with CAD. The growth of comprehensive medical management now rivals that of invasive revascularization in secondary prevention.
Cholesterol management in women and the elderly
Authors: LAROSA J. C.
Published: November 2003

Women, like men, die mostly of coronary atherosclerosis, although atherosclerotic death in women occurs 5–10 years later than in men. Major risk factors predict coronary risk in women and men. What evidence is available suggests that women, similar to men, benefit from cholesterol lowering. Older individuals with symptomatic coronary disease but a relatively good prognosis should be offered the same benefits from secondary prevention as younger individuals.
The problem of compliance to cholesterol altering therapy
Authors: INSULL W.
Published: November 2003

This review's purpose is to describe for the practicing clinician the current knowledge about patient compliance to cholesterol‐altering drugs and about procedures for compliance management applicable to clinical practice in the United States. Compliance is defined for four commonly measured major steps and, based on recent electronic monitoring data, for three quantitative categories of active medication‐taking. The concepts and definition of compliance are undergoing evolutionary changes due to the measurement and availability of new dimensions through electronic monitoring of patient compliance. Substantial non‐compliance to cholesterol‐altering drugs has been reported in nine large clinical trials for primary and secondary prevention of coronary heart disease, in two HMOs, and, using electronic monitoring of compliance, in one clinical trial and a selected practice. The risks of treatment discontinuation increased continuously during treatment and totaled from 6 to 30% after 5 years. Patterns of day‐to‐day partial compliance are emerging. Procedures and knowledge for clinical management of compliance are described including methods of measuring compliance, risk factors for non‐compliance, standards for compliance performance, epidemiology of compliance, procedures for managing compliance at the start of therapy and for addressing compliance problems during established treatment, simple office assessment of compliance by brief interview questions, compliance aids, prediction of compliance, and education and training of medical‐care personnel in compliance management.
Associations between atrial natriuretic peptides, echocardiographic findings and mortality in an elderly population sample
Authors: IIVANAINEN A. M. , TIKKANEN I. , TILVIS R. , HEIKKILÄ J. , HELENIUS T. , KUPARI M.
Published: November 2003

Objectives. To examine associations of N‐terminal and C‐terminal components of the proatrial natriuretic peptide [ANP (1–98) and ANP (99–126), respectively], with echocardiographic measurements of left ventricular structure and performance and with the function of the aortic and mitral valves in old age. To compare the predictive value of the atrial peptides and echocardiographic data for short‐term mortality.

Design. A population‐based survey with 1.5‐year mortality follow‐up.

Setting. University hospital.

Subjects. Three‐hundred and thirty‐three people aged 78–88 years.

Main outcome measures. (i) Plasma ANP (1–98) and ANP (99–126); (ii) M‐mode and Doppler echocardiographic measurements of left atrial diameter; left ventricular diameters, mass and fractional shortening; peak transmitral velocities; aortic valve area, aortic regurgitation jet length and mitral regurgitant jet area; (iii) total and cardiovascular 1.5‐year mortality.

Results. ANP (1–98) correlated with left atrial diameter (r=0.33; P<0.001), left ventricular mass (r=0.19; P<0.001), fractional shortening (r=−0.16; P<0.01) and the early‐to‐atrial peak transmitral velocity ratio (r=0.23; P<0.001). Also, ANP (1–98) predicted the degree of aortic valve obstruction and the severity of aortic and mitral regurgitation. Associations of ANP (99–126) with echocardiographic data were much weaker. Aortic valve stenosis and ANP (1–98) were independent predictors of age‐and sex‐adjusted total and cardiovascular mortality at 1.5 years of entry.

Conclusions. Circulating ANP (1–98) correlates with left atrial size, with left ventricular mass and performance and with the severity of aortic and mitral valve dysfunction in persons representing the general elderly population. ANP (1–98) also predicts both total and cardiovascular mortality.