bluuebunny/crossref_metadata_2025 huggingface dataset:
Normoalbuminuria ensures no reduction of renal function in type 1 (insulin‐dependent) diabetic patients
Authors: HANSEN K. W. , PEDERSEN M. MAU , CHRISTENSEN C. K. , SCHMITZ A. , CHRISTIANSEN J. S. , MOGENSEN C. E.
Published: August 2009

Recent reports have suggested that impaired renal function in type 1 diabetic patients may be present despite normal urinary albumin excretion (UAE). We have studied kidney function by means of a constant‐infusion technique in normoalbuminuric type 1 diabetic patients without antihypertensive medication (UAE < 20 μg min−1, n = 134), in microalbuminuric patients (20 ≥ UAE < 200 μg min−1, n = 50) and in 27 non‐diabetic control subjects. Mean UAE was 4.5 μg min−1 (range 1.0–19.3 μg min−1) in normoalbuminuric patients, 53.1 μg min−1 (range 20.8–147.5 μg min−1) in microalbuminuric patients, and 4.0 μg min−1 (range 2.1–17.9 μg min−1) in controls. Glycosylated haemoglobin A1c was significantly higher in microalbuminuric patients (8.9%, range 5.9–12.6%) than in normoalbuminuric patients (7.9%, range 5.5–11.5%) (P < 0.0001). Glomerular filtration rate in normoalbuminuric patients (135 ml min−1, range 97–198 ml min−1) was significantly higher than in controls (118 ml min−1, range 94–139 ml min−1) (P < 1 times 10−6), and significantly lower than in microalbuminuric patients (142 ml min−1, range 100–186 ml min−1) (P < 0.05). Mean arterial blood pressure was lower in normoalbuminuric patients (91 mmHg, range 78–108 mmHg) than in microalbuminuric patients (98 mmHg, range 82–131 mmHg) (P < 1 times 10−6), but not significantly different from that of controls (89 mmHg, range 73–103 mmHg). We conclude that normal UAE is a reliable indicator of well‐preserved renal function. Glomerular hyperfiltration, elevated blood pressure and poor metabolic control are characteristic features of microalbuminuric patients.
Syncope in young adults: evidence for a combined medical and psychiatric approach
Authors: KOENIG D. , LINZER M. , PONTINEN M. , DIVINE G. W.
Published: August 2009

To determine the principal causes and effects of syncope in young adults, we prospectively evaluated 197 consecutive patients referred to a Syncope Specialty Clinic, comparing young (age 16–39 years, n = 71), middle‐aged (age 40–65 years, n = 70) and elderly (> age 65 years, n = 56) patients. Psychiatric aetiologies were significantly more common in young patients (39% vs. 20% in middle‐aged, and 3.6% in the elderly; P < 0.001), while cardiac aetiologies were rare in the young (2.8% vs. 12% in the middle‐aged, and 16% in the elderly; P < 0.04). These differences were still significant after controlling for gender. Because psychiatric causes are so common in young patients, we evaluated hyperventilation as a bedside test for syncope patients and found it to have a positive predictive value of 59% for psychiatric causes of syncope. Syncope interfered with daily activities in 62% of young patients, and resulted in anxiety or depression in 70% of the young (no difference when compared with other age groups). Thus syncope in young adults can be a disabling medical condition requiring a unique medical and psychological approach to diagnosis and treatment.
Thyrotropin‐releasing hormone increases serum levels of growth hormone‐releasing hormone and growth hormone in patients with acromegaly
Authors: HULTING A.‐L. , THEODORSSON E. , WERNER S.
Published: August 2009

The effect of intravenous injection of thyrotropin‐releasing hormone (TRH) on the plasma concentrations of growth hormone (GH) and growth hormone‐releasing hormone (GHRH) was studied in seven patients with acromegaly and in five control subjects. TRH had no effect on plasma GH or GHRH in the five control subjects. A ‘paradoxical’ increase in plasma GH in response to TRH was observed in four of the seven patients with acromegaly. In these four patients plasma GHRH also increased in response to TRH. No TRH‐induced increase in GHRH levels was observed in the other three patients with acromegaly who did not display an increase in GH in response to TRH. The present results imply that GHRH may be involved in the plasma GH response to TRH in patients with acromegaly.
Decreased erythrocyte cholesterol/phospholipid ratio in untreated patients with essential hypertension
Authors: RONQUIST G. , FRITHZ G. , GUNNARSSON K. , ARVIDSON G.
Published: August 2009

The erythrocyte cholesterol/phospholipid ratio was determined in eight patients with untreated essential hypertension and compared with that of eight age‐matched control subjects. The ratio was significantly lower in patients (Wilcoxon's paired rank test; P < 0.01), and a correlation existed between the ratio and serum cholesterol concentration in patients (r = 0.63) but not in controls (r = 0.02). A reduction in the cholesterol/phospholipid ratio may play a direct role in destabilizing the plasma membrane, which will in turn result in an increase in membrane permeability in essential hypertension.
Demonstration of a relationship between white blood cell count, insulin resistance, and several risk factors for coronary heart disease in women
Authors: FACCHINI F. , HOLLENBECK C. B. , CHEN Y. N. , CHEN Y‐D. I. , REAVEN G. M.
Published: August 2009

In order to evaluate the relationship between peripheral white blood cell (WBC) count, insulin‐mediated glucose uptake, and several risk factors for coronary heart disease (CHD), WBC, plasma glucose and insulin responses to a 75‐g oral glucose challenge, fasting plasma cholesterol, high‐density‐lipoprotein (HDL)‐cholesterol, and triglyceride concentration, and systolic and diastolic blood pressure were determined in 63 consecutive female volunteers with normal glucose tolerance. The results demonstrated the presence of statistically significant correlation coefficients between WBC count and both insulin‐mediated glucose disposal (r = 0.50, P < 0.001) and insulin response to oral glucose (r = 0.50, P < 0.001). Furthermore, WBC count correlated with plasma glucose response to oral glucose (r = 0.48, P < 0.001), fasting plasma triglyceride (r = 0.37, P < 0.005) and HDL‐cholesterol concentrations (r = −0.38, P < 0.005), and systolic (r = 0.22, P < 0.1) and diastolic (r = 0.27, P < 0.05) blood pressure. However, the only two variables significantly correlated with WBC count in multivariate regression analysis were insulin resistance (r = 0.49, P < 0.01) and insulin response (r = 0.35, P < 0.05). These data indicate that WBC count is significantly correlated with changes in carbohydrate and lipoprotein metabolism and blood pressure that increase the risk of CHD. However, it appears that these relationships are secondary to resistance to insulin‐mediated glucose uptake and hyperinsulinaemia.
Ultrasound appearances in de Quervain's subacute thyroiditis with long‐term follow‐up
Authors: BRANDER A.
Published: August 2009

In order to determine whether permanent echo abnormalities are produced by subacute thyroiditis, ultrasound examination of the thyroid was performed repeatedly after a mean interval of 23 months in 17 subjects (8 women and 9 men) aged 31–52 (mean 41) years, suffering from subacute thyroiditis. The diagnosis was based on typical clinical symptoms, and cytological confirmation was obtained in all subjects but one. In the primary phase the ultrasonic finding was in all cases abnormal, showing either diffuse or focal hypoechogenicity and enlargement of thyroid lobes. At follow‐up, a homogenous echo structure was found in 15 patients. Nodularity was detected in only two subjects. It is concluded that permanent focal echo abnormalities are generally not produced by subacute thyroiditis. Consequently, thyroid nodules in subjects with a history of SAT should not be ignored.
Fasting insulin, calcium metabolism and the electrocardiogram in hypertensive subjects
Authors: LIND L. , HVARFNER A. , POLLARE T. , LITHELL H. , LJUNGHALL S.
Published: August 2009

Changes in both calcium and insulin metabolism have been described in essential hypertension. Low levels of plasma ionized calcium (Ca2+) and high levels of insulin have previously been associated with vascular complications and coronary heart disease. In the present study, indices of calcium metabolism and fasting serum insulin were related to electrocardiographic (ECG) variables in 58 patients with untreated hypertension. Fasting insulin was found to be related to heart rate (r = 0.47, P < 0.001), diastolic interval (r = −0.39, P < 0.004) and electrical axis (r = −0.29, P < 0.03) while Ca2+ was found to be correlated with the QRS amplitude (r = −0.32, P < 0.03) and diastolic interval (r = 0.37, P < 0.02). Furthermore, non‐ionized serum calcium was correlated with the QRS duration (r = 0.36, P < 0.02), ST‐segment interval (r = −0.49, P < 0.002) and QT interval (QoT, r = −0.42, P < 0.008). These correlations were still significant when the influences of age, sex, obesity, blood pressure and heart rate were taken into account in the multiple regression analysis. In conclusion, the present study demonstrates that calcium and insulin metabolism are related to several basic characteristic functions of the heart, such as the systolic and diastolic function, as well as to signs of left ventricular hypertrophy.
Increasing parathyroid hormone concentrations in untreated primary hyperparathyroidism
Authors: RUDNICKI M. , TRANSBøL I.
Published: August 2009

Twenty‐four patients with mild to moderate primary hyperparathyroidism were followed for an average of 2.45 years with serial determinations of serum ionized calcium and intact parathyroid hormone (PTH). For the entire group serum ionized calcium remained stable, whereas serum PTH increased significantly. Eleven patients (group 1) demonstrated a significant increase in PTH with time. The remaining 13 patients formed group 2. Comparison of the changes (%) in each subgroup showed a small but significant increase in serum ionized calcium of 2.6% with time in group 1, while serum PTH increased by 78%. In group 2 serum ionized calcium remained stable whereas PTH increased modestly by 22%. Serum concentrations of creatinine were stable throughout the follow‐up period in both groups.

Despite the greater precision of serum ionized calcium, measurements of intact PTH are evidently more sensitive than measurements of serum ionized calcium for the detection of progression in primary hyperparathyroidism.
Diagnosis of acute symptomatic aortic aneurysm—ultrasonography an important tool
Authors: HÖJER J.
Published: August 2009

Symptomatic aortic aneurysm is an extremely acute condition with manifest or threatening aortic rupture. The mortality is high and urgent surgery is essential and often life‐saving. A correct diagnosis needs to be made without delay, a fact which places great demands on the doctor—often not a surgeon—who is first consulted by the patient. The differential diagnosis and emergency management are discussed here against the background of the course of events in four patients with aortic aneurysm who were referred erroneously for admission to a coronary intensive care unit during a 12‐month period. Two of the patients died. The ultrasonographic findings were decisive for the outcome in the two surviving patients and yielded a rapid diagnosis in one further case. Ultrasonography is recommended as the method of first choice for verifying or excluding this condition when it is suspected on clinical grounds.
Haematologic effects of granulocyte‐macrophage colony stimulating factor in a patient with thiamazole‐induced agranulocytosis
Authors: BJÖRKHOLM M. , PISA P. , ARVER S. , BERAN M.
Published: August 2009

A 61‐year‐old female patient, treated for hyperthyroidism with thiamazole, developed a severe maturation arrest in the granulocytic lineage and a total agranulocytosis. Subcutaneous GM‐CSF was started immediately and given for 6 days. Bone marrow samples were taken before GM‐CSF therapy and on days 3 and 8. An increased number of colonies per 105bone marrow cells documented before institution of GM‐CSF treatment was followed by a gradual decline to normal values. An increase of granulocyte count to > 0.5 times 109l−1was recorded on the 4th day of treatment and was preceded by an increase in the number of immature granulocyte precursors in the bone marrow on day 3. The patient was discharged on day 8 and experienced no adverse effects of GM‐CSF treatment. Haematopoietic growth factor therapy has a place in the management of patients with drug induced neutropenia/agranulocytosis, which should be further delineated by prospective studies.
The bone mineral density in acquired growth hormone deficiency correlates with circulating levels of insulin‐like growth factor I
Authors: JOHANSSON A. G. , BURMAN P. , WESTERMARK K. , LJUNGHALL S.
Published: August 2009

Insulin‐like growth factor I (IGF‐I) is an important anabolic factor for osteoblasts in vitro. Low plasma levels of IGF‐I have been observed in young men with osteoporosis. In the present study, we have studied bone mineral density (BMD) and the circulating levels of IGF‐I and growth hormone (GH) in adults with acquired GH deficiency. BMD was determined by dual‐energy x‐ray absorptiometry in 17 men and 12 women (age 27–54 years). Spinal BMD was positively correlated with the plasma levels of IGF‐I (r = 0.43, P = 0.019), with the median of GH values obtained by repeated sampling at night (r = 0.43. P = 0.0019), and with the peak of GH values during GHRH provocation test (r = 0.49, P = 0.039). The total BMD was positively related to plasma IGF‐I and median of GH values, but not to peak GH by GHRH provocation. In a multiple regression analysis model, IGF‐I, peak GH by GHRH provocation test and duration of GH deficiency explained 49% of the variation in spinal BMD. As compared to healthy controls, total, but not spinal, bone mass was lower in men with GH deficiency, but no clinical symptoms of osteoporisis were observed. The positive relationships between BMD and circulating IGF‐I and other indices of GH secretion suggest that IGF‐I has an endocrine effect on bone mass.
Testosterone/epitestosterone ratio in urine: a possible diagnostic tool in the disclosure of exogenous testosterone administration
Authors: KAPELRUD H. , JOHANNESEN ø. , OFTEBRO H.
Published: August 2009

A 37‐year‐old woman presented with a history of secondary amenorrhoea and hirsutism for 4 years. She had elevated serum levels of testosterone and dihydrotestosterone, and decreased serum levels of sex hormone binding globulin and oestradiol. Almost daily use of a testosterone‐containing ointment in the vulvar region for 6 years was disclosed as the cause of the hyperandrogenism. Serum testosterone, testosterone excretion rate in urine and testosterone/epitestosterone ratio in urine were determined at fixed intervals 24 h before and 48 h after application of the testosterone‐containing ointment. There was a rapid increase in serum testosterone, with a peak level after 4–6 h. The testosterone excretion rate and the testosterone/epitestosterone ratio in urine peaked after 2–4 h. After 48 h the serum testosterone level was still about twice the basal value. The testosterone/epitestosterone level was over the ‘doping limit’ of 6 for 28 h. We conclude that determination of the testosterone/epitestosterone ratio in urine would have disclosed exogenous testosterone administration in this patient. We recommend this test for patients in whom exogenous testosterone administration is suspected.
Two UV‐induced episodes of myelitis in a patient with systemic lupus erythematosus
Authors: NIVED O. , STURFELT G. , RYBERG B.
Published: August 2009

Two flares of acute myelitis were observed in a 31‐year‐old woman with previously known mild SLE. The two myelitic episodes both occurred within 1 week after intense sun exposure, and for this reason photobiological induction of the manifestation is considered likely. The diagnostic utility of MRI in the acute situation and the possible influence of sex‐steroids on SLE manifestations are also illustrated by this case.
The Lewis blood group—a new genetic marker of ischaemic heart disease
Authors: HEIN H. O. , SØRENSEN H. , SUADICANI P. , GYNTELBERG F.
Published: August 2009

Abstract. In a cohort of 3383 men aged 53 to 74 in the Copenhagen Male Study we investigated the association between ischaemic heart disease (IHD) and the Lewis blood group, assigned to chromosome 19. Among men with the Le(a ‐ b ‐) phenotype, 8% had a history of non‐fatal myocardial infarction, among others the frequency was 4%. The corresponding odds ratio was (95% confidence interval: CI) 1.9 (1.2–3.0) P < 0.01. men with Le(a ‐ b ‐) had a risk‐factor profile and pattern of disease resembling that of Reaven's syndrome X. In a subsequent prospective study 343 men with arteriosclerotic stigmas were excluded. The men had their morbidity and mortality recorded over the next 4 years. One‐hundred‐and‐one men suffered IHD; 26 dying from IHD. In total 162 men died. Men with Le(a ‐ b ‐) had an increased risk of death from IHD compared with others. Adjusted for age, relative risk (RR) (95% CI) was: 4.4 (1.9–10.3), P < 0.001, and for all causes of mortality: RR = 1.6 (1.0–2.6), P < 0.05. Men with the Le(a‐b‐) phenotype had an increased risk of an IHD event compared to men with other phenotypes (RR = 1.6 (0.9‐2.8), P = 0.10) and a significantly higher IHD case fatality rate (RR = 2.8 (1.5‐5.2), P = 0.0]). The finding that the Le(a‐ b‐) phenotype is a genetic marker of IHD risk may have implications in terms of prevention. The Le(a‐b‐) phenotype may also contribute to providing an explanation for the substantial ethnic differences found in the incidence of IHD. The similar risk‐factor profile and pattern of disease found between Le(a ‐ b ‐) men and individuals with Reaven's syndrome X is hypothesized to be due to a close genetic relationship on chromosome 19.
Deterioration in renal function associated with angiotensin converting enzyme inhibitor therapy is not always reversible
Authors: DEVOY M. A. B. , TOMSON C. R. V. , EDMUNDS M. E. , FEEHALLY J. , WALLS J.
Published: August 2009

Abstract. Fifteen patients presented between January 1986 and January 1991 with deterioration in renal function coincident with the introduction of angiotensin converting enzyme inhibitors. There was evidence of extrarenal vascular disease in 12 patients and preexisting renal impairment in 13. Four patients remained dialysis‐dependent and died within 4 weeks of presentation. Five patients required short‐term dialysis. Serum creatinine remained above pre‐treatment values in seven patients. Conventional explanations of the decline in renal function with ACE inhibition do not account for irreversible decrements in renal function. Possible mechanisms for this observation and clinical guidelines to identify patients at risk are suggested. We conclude that these agents should be used with great care in patients in whom atherosclerotic vascular disease is likely.
Tongue necrosis in temporal arteritis provoked by ergotamine
Authors: BONDESON J. , ERICSSON U.‐B. , FALKE P. , MATTIASSON I. , NYMAN U. , LINDELL E. , BERNOW J.
Published: August 2009

Abstract. A case of tongue necrosis in a patient with temporal arteritis who was taking ergotamine is described, and the role of ergotamine tartrate in provoking the tongue necrosis is considered. The literature on this unusual complication is critically reviewed, and the value of a carotid angiography in assessing the tongue ischaemia is exemplified.
Patients with persistent elevation of aminotransferases: investigation with ultrasonography, radionucleide imaging and liver biopsy
Authors: HULTCRANTZ R. , GABRIELSSON N.
Published: August 2009

Abstract. Eighty‐three patients, submitted for investigation of the liver due to persistently elevated activities of serum aminotransferases were included in a study in order to compare the relative merits of liver biopsy, ultrasound and radionucleide imaging.

From the liver biopsy it was found that 45 patients had fatty liver, 14 had cirrhosis and 11 had chronic inflammation, 3 had haemochromatosis and 10 had unspecific changes or normal findings.

An investigation with ultrasound yielded pathological findings in 65% of the patients. The sensitivity was highest in patients with fatty liver (82%) and more than 10% fat in the liver always resulted in increased echogeneicity. Alterations in the liver due to cirrhosis and chronic inflammation were detected with ultrasound in only 50% and 57% of the cases, respectively.

Radionucleide imaging was positive in 44% of the patients with fatty liver, 64% of those with cirrhosis and 21% of the patients with chronic inflammation. It was only possible to distinguish fatty liver from cirrhosis in those patients who had an increase in the size of the spleen (four patients).

The study demonstrates that in patients with a persistent elevation of serum aminotransferases ultrasound has a high sensitivity for detecting more than 10% fat in the liver. However, both the ultrasound and a liver scintigram had a rather low sensitivity and a very low specificity for making a diagnosis for this group of patients. With the aid of a liver biopsy it was possible to establish a diagnosis in 90% of the patients.
Sex differences in essential hypertension
Authors: OS I. , KJELDSEN S. E. , NORDBY G. , EIDE I. , LANDE K. , HJERMANN I. , WESTHEIM A.
Published: August 2009

Abstract. A group of 41‐year‐old hypertensive men (n = 35, blood pressure (BP) 149.9 ± 2.1/ 98.9 ± 1.1 mmHg, mean ± SEM) who had never received treatment for their condition were compared with hypertensive women of the same age (n = 18, BP 155.9 ± 4.3/ 98.1 ± 1.6 mmHg) with comparable body mass index (BMI. 25.9 ± 0.5 vs. 24.9 ± 4.5 kg m−2) who, also, had never received treatment. The lipid profile was more atherogenic in the men, with lower HDL cholesterol (1.21 ± 0.04 vs. 1.38 ± 0.06 mmol l−1 P = 0.04), higher total cholesterol (6.04 ± 0.14 vs. 5.54 ± 0.18 mmol l−1. P = 0.04) and triglycerides (1.80 ± 0.16 vs. 0.96 ± 0.10 mmol l−1, P < 0.001). The hypertensive men had higher haemoglobin (P < 0.001) and haematocrit. Plasma catecholamines were inversely related to BMI in the women only (r = −0.52, P < 0.05 for both noradrenaline and adrenaline). Women with BMI above 25 kg m−2 had significantly lower arterial plasma adrenaline and noradrenaline than those with BMI below 25 kg m−2 (28 ± 5 vs. 78 ± 16 pg ml−1, P < 0.01 and 101 ± 17 vs. 206 ± 33 pg ml−1, P < 0.01 respectively). A negative curvelinear relationship appeared between arterial adrenaline and insulin (r = 0.49, P= 0.05).

These results suggest a male propensity for athero‐thrombogenic risk factors in otherwise comparable hypertensive subjects. A close relationship between metabolic risk factors within the normal range seems to exist even in hypertensive women. The decreased sympathetic activity at rest in the obese hypertensive women indicates different pathophysiological mechanism for hypertension in lean and obese. Decreased sympathetic activity and thus reduced energy expenditure, promotes a risk for weight gain, and could explain the inverse relationship between insulin and adrenaline.
Identification of alcoholic liver disease or hidden alcohol abuse in patients with elevated liver enzymes
Authors: PRYTZ H. , MELIN T.
Published: August 2009

Abstract. The aim of this prospective study was to identify alcoholic liver disease or covert alcohol abuse in unselected consecutive patients referred to a gastroenterologic out‐patient's clinic for elevated liver enzymes. One‐hundred‐and‐thirteen patients were questioned about alcohol consumption, trauma history and loss of driver's licence. Laboratory tests claimed to reflect alcohol consumption and liver biopsy were taken. Using data from patients with the highest (26 patients) and lowest (29 patients) stated consumptions, logistic regression analysis identified violence score (trauma score + driver's licence score) and a laboratory index combining MCV, ASAT/ALAT ratio and IgA values as significant independent predictors of alcohol abuse (index = 2.3 × violence score + 1.08 × laboratory index— 3.19). Twenty‐six patients openly admitted alcohol abuse (> 300 g week−1) and 85% of these had alcoholic liver damage. The index identified a further 12 patients as abusers who stated an intermediate alcohol consumption (25–300 g week−1). Half of these had alcoholic liver damage. Thus, a total of 34% of the patients were identified as abusers and in one‐third of these the abuse was covert.
Dietary assessment methods evaluated in the Malmö food study
Authors: CALLMER E. , RIBOLI E. , SARACCI R. , ÅKESSON B. , LINDGÄRDE F.
Published: August 2009

Abstract. A study to evaluate the relative validity of two dietary assessment methods, to be used in a prospective cohort study on diet and cancer, was conducted in a random sample of the Malmö population during 1984–1985. The study compared (i) a long, self‐administered ‘food‐use questionnaire’ (about 250 food items), asking for frequency of consumption of food and beverages and for usual portion size estimated with the help of a booklet of food pictures, and (ii) a combined method involving a shorter food frequency questionnaire (about 130 food items) and a 2‐week diet diary, with (iii) a reference method requiring 18 days of weighed food records. The results indicated that subject compliance was quite good for both methods and, in particular, that the diet diary was well accepted. Both methods produced fairly good correlations with the reference method, of the order of 0.40 to 0.60 for most nutrients after adjustment for energy. Both methods tended to overestimate intake of fat, protein and carbohydrates as well as of vitamins and minerals.
A biomarker for the assessment of niacin nutriture as a potential preventive factor in carcinogenesis
Authors: JACOBSON E. L. , JACOBSON M. K.
Published: August 2009

Abstract. The study of protective cellular responses to DNA damage has led to the working hypothesis that optimal niacin nutriture is a preventive factor in cancer. Described here is the development of a biomarker for determining niacin status termed Niacin Number. The combination of this biomarker with diet and cancer epidemiology will allow evaluation of the possible role of this nutrient in cancer risk.
Oral magnesium supplementation restores the concentrations of magnesium, potassium and sodium‐potassium pumps in skeletal muscle of patients receiving diuretic treatment
Authors: DØRUP I. , SKAJAA K. , THYBO N. K.
Published: August 2009

Abstract. In 76 consecutive patients who had received diuretics for 1–17 years for arterial hypertension or congestive heart failure, muscle concentrations of magnesium, potassium, and sodium‐potassium pumps were significantly reduced compared to 31 age‐ and sex‐matched controls. Thirty‐six patients with muscle magnesium and/or potassium below the control level received oral magnesium hydroxide supplement for 2–12 weeks (n = 20) or 26 weeks (n = 16). After short‐term (2–12 weeks) magnesium supplementation muscle parameters were increased, but far from normalized. After magnesium supplementation for 26 weeks, the muscle concentrations of magnesium, potassium and sodium‐potassium pumps were normalized in most cases. Oral magnesium supplementation may restore diuretic‐induced disturbances in the concentrations of magnesium, potassium and sodium potassium pumps in skeletal muscle. A supplemental period of at least 6 months seems to be required before complete normalization can be expected.
Elevated level of erythropoietin in congestive heart failure Relationship to renal perfusion and plasma renin
Authors: JENSEN J. D. , EISKJÆR H. , BAGGER J. P. , PEDERSEN E. B.
Published: August 2009

Abstract. Background. In animal experiments reduction of renal perfusion can stimulate erythropoietin production. The relationship between renal haemodynamics and erythropoietin production is unknown in congestive heart failure.

Objective. The aim was to study the relationship between serum erythropoietin and renal haemodynamics, plasma renin activity and haematocrit in patients with congestive heart failure and in healthy control subjects.

Patients and methods. Serum erythropoietin, renal plasma flow, glomerular filtration rate and plasma renin activity were determined in 14 patients with acyanotic congestive heart failure, and 36 healthy controls.

Results. Serum erythropoietin was significantly elevated in congestive heart failure 26.6 U l−1 (median) compared with controls 17.0 U l−1 despite a normal haematocrit, and increased with the severity of congestive heart failure (New York Heart Association class II: 17 U l−1 [n = 4]; class III: 30 U l−1 [n = 5]; class IV: 45 U l−1 [n = 5]). Significant inverse correlations between serum erythropoietin and renal plasma flow (r = −0.60, P < 0.03), and between serum erythropoietin and glomerular filtration rate, were found in congestive heart failure but not in the control subjects. A significant positive correlation (r = 0.71, P < 0.03) was demonstrated between serum erythropoietin and plasma renin activity in congestive heart failure.

Conclusion. A severe reduction in renal perfusion in congestive heart failure appears to cause an increase in serum erythropoietin.
Fructose and insulin sensitivity in patients with type 2 diabetes
Authors: KOIVISTO V. A. , YKI‐JÄRVINEN H.
Published: August 2009

Abstract.The effect of dietary fructose (20% of carbohydrate calories, 45–65 g day−1for 4 weeks) on glycaemic control, serum lipid, lipoprotein and apoprotein A‐I and A‐II concentrations and on insulin sensitivity was studied in 10 type 2 diabetic patients. The study was done in a randomized, double‐blind fashion with crystalline fructose or placebo administered evenly during 4 meals or snacks per day. The patients were hospitalized throughout the study periods. The fasting plasma glucose concentration decreased during the fructose (from 10.7 ± 1.4 mmol l−1to 8.0 ± 0.8 mmol l−1,P< 0.02) and the control diet (from 10.1 ± 0.9 mmol l−1to 8.0 ± 0.7 mmol l−1P< 0.05). The mean diurnal blood glucose concentration also fell both during the fructose (from 10.8± 0.5 mmol l−1to 8.4 ± 0.3 mmol l−1,P< 0.001) and the control diet (from 10.3 ± 0.3 mmol l−1to 8.8 ± 0.9 mmol l−1,P< 0.01). The HbA1concentration improved (P< 0.02) only during the fructose diet. Insulin sensitivity increased by 34% (P< 0.05) during the fructose diet, but remained unchanged during the control period. Serum insulin, triglyceride, apoprotein A‐I and A‐II concentrations, body weight, blood pressure and blood lactate remained unchanged during both diets. In conclusion, substitution of moderate amounts of fructose for complex carbohydrates can improve glycaemic control and insulin sensitivity in patients with type 2 diabetes.
Apolipoprotein E phenotypes in familial hypercholesterolaemia: importance for expression of disease and response to therapy
Authors: BERGLUND L. , WIKLUND O. , EGGERTSEN G. , OLOFSSON S.‐O. , ERIKSSON M. , LINDÉN T. , BONDJERS G. , ANGELIN B.
Published: August 2009

Abstract. To study the possible importance of variation at the apolipoprotein (apo) E gene locus for the clinical expression of heterozygous familial hypercholesterolaemia (FH), we determined apo E phenotype and serum lipoprotein pattern in 120 patients with FH. The allele frequency of the patients studies were: ε2 0.033, ε3 0.733, and ε4 0.233. There was no influence of apo E phenotype on the serum concentrations of total, VLDL, LDL or HDL cholesterol, triglycerides, or of apo AI, B or (a). Serum concentrations of apo E were significantly higher in patients with the apo E 3/3 phenotype compared to those with apo E 4/3 or 4/4, and the highest concentrations were found in patients carrying the ε2‐allele. The cholesterol‐lowering response to therapy with cholestyramine or pravastatin was not related to apo E phenotype. It is concluded that variation at the apo E gene locus is not of major importance for the expression of heterozygous FH.
Hypoglycaemia caused by atypical insulin antibodies in a patient with benign monoclonal gammopathy
Authors: ARNQVIST H. J. , HALBAN P. A. , MATHIESEN U. L. , ZAHND G. , VON SCHENCK H.
Published: August 2009

Abstract. We describe a 48‐year‐old woman with recurrent severe hypoglycaemia apparently caused by a paraprotein with insulin‐binding capacity. Very high fasting values were found for serum insulin (170 and > 250 mU l−1) as well as for proinsulin 125 pmol l−1 and an insulinoma was suspected. Hypoglycaemia developed after an oral glucose tolerance (OGTT) test but not during fasting for 48 h. Free insulin and C‐peptide were normal during OGTT whereas serum insulin was very high. 125I‐insulin binding to serum, determined with a polyethylene glycol (PEG) precipitation method was high (40%), and equally high after addition of 1.7 × 10−5 mol l−1 cold insulin to estimate non‐specific binding. By adding very high concentrations of cold insulin, displacement of 125I‐insulin bound to serum was found (50% displacement at 4 × 10−5 mol l−1). No immunoglobulin G (IgG) insulin antibodies were detected by radio‐immunoelectrophoresis. On agarose electrophoresis a small paraprotein (4 g l−1) in the γ‐globulin fraction was detected. 125I‐insulin binding to this paraprotein was demonstrated. We conclude that if insulin autoantibodies are suspected as a cause of hypoglycaemia screening for insulin antibodies should always be done with a PEG‐precipitation method.
Different effects of two methods of low‐density lipoprotein apheresis on the coagulation and fibrinolytic systems3
Authors: KNISEL W. , DI NICUOLO A. , PFOHL M. , MÜLLER H. , RISLER T. , EGGSTEIN M. , SEIFRIED E.
Published: August 2009

Abstract. Objective. Immunoadsorption (IMA) and dextran sulfate adsorption (DSA) are two methods for selective extracorporeal elimination of low‐density lipoproteins which are known as LDL apheresis. Their influence on haemostasis until now is widely unknown.

Design. The effects of both LDL apheresis procedures on the coagulation and fibrinolytic systems were compared amongst five patients treated with IMA and four patients who received a DSA therapy.

Subjects. All patients with severe heterozygous familial hypercholesterolaemia were participants in a long‐term LDL apheresis programme with treatments every 1–2 weeks.

Intervention. Combined anticoagulation with heparin and citrate in IMA, and also heparin exclusively in DSA were used for the extracorporeal circulation.

Measures. Blood samples were taken immediately before and after a single LDL apheresis and five times during the weekly interval until the next therapy.

Results. DSA had a significantly greater effect on standard clotting tests than IMA at the end of plasma therapy despite identical dosages of heparin. DSA caused a considerable reduction of the coagulation factors V, VIII:C, vWF:Ag, XI, XII, and prekallikrein by 48–99% at the end of apheresis treatment whereas only factor VIII:C showed a marked decrease of 72% after IMA. All abnormalities of the global coagulation tests and of most clotting factors were restored 1 day after treatment in both procedures followed by a moderate rebound phenomenon of single coagulation factors during the next few days in IMA‐treated patients.

Conclusion. DSA exerts a more profound effect on the coagulation system than IMA by a substantial co‐elimination of various clotting factors in addition to the desired removal of atherogenic lipoproteins.
Haematocrit: a predictor of cardiovascular mortality ?
Authors: ERIKSSEN G. , THAULOW E. , SANDVIK L. , STORMORKEN H. , ERIKSSEN J.
Published: August 2009

Abstract.Objectives. The main purpose of the study was to assess a possible association between haematocrit (Hct) and long‐term cardiovascular disease (CVD) mortality.

Design. An extensive examination programme was carried out in 2014 men, defined as apparently healthy, during the period 1972 to 1975, including Hct measurements in a 25% random subsample. Sequential, cause‐specific mortality was followed prospectively over a period of 16 years.

Setting. The survey was conducted at Medical Department B, Rikshospitalet, Oslo, Norway.

Subjects. The participants represented 86% of all eligible apparently healthy men working in five preselected companies in Oslo.

Interventions. No intervention was given by the study group during follow‐up.

Main outcome measures. Complete, cause‐specific mortality figures after 8–16 years were obtained from the Norwegian Central Bureau of Statistics.

Results. Hct measures were obtained in 488 men (24.2%). Mean Hct was 47.2% (sd2.9%). After correcting for differences in age, plasma cholesterol, systolic blood pressure, erythrocyte sedimentation rate and smoking habits (Cox proportional hazards model), an increase in Hct by 2 SDS was associated with an increase in CVD mortality by a factor ranging between 2.9 at 10, and 1.9 at 16 years (P< 0.05). A similar increased risk was observed earlier during follow‐up but the number of deaths was too small for meaningful statistical analysis. No association was found between Hct and non‐CVD mortality.

Conclusions. Our data show that increased Hct is associated with an increased risk of dying from CVD—independent of conventional CVD risk factors.
Unusual thrombotic‐like retinopathy (Coats' disease) associated with congenital plasminogen deficiency type I
Authors: PATRASSI GIOVANNI M. , SARTORI M. T. , PIERMAROCCHI S. , VIERO M. , BOERI G. , GIROLAMI A.
Published: August 2009

Abstract. A new kindred with heterozygous plasminogen deficiency type I is described. The proband, a 17‐year‐old male, showed a peculiar thrombotic‐like retinal picture compatible with Coats' disease. Extensive coagulation studies revealed decreased levels of both plasminogen activity and antigen to about 50% of normal values. Five out of 13 family members from the paternal side showed the same fibrinolytic defect. In two cases, a history of recurrent phlebites of the lower limbs was present. One unaffected patient also had a superficial phlebites at a young age; her plasminogen levels were shown to be within normal limits, but a long‐standing oestroprogestinic intake could have influenced and normalized the results. No other family member showed retinal abnormality.

This is the first case of hypoplasminogenaemia associated with Coats' disease. A possible role of the fibrinolytic defect in the pathogenesis of this unusual retinopathy is suggested. Finally, the occurrence of thrombotic manifestations in other affected family members supports the opinion that plasminogen deficiency should be considered as a potential risk factor for thrombosis.
Autoimmune polyglandular failure associated with malabsorption and gastric carcinoid tumour
Authors: LEIBOWITZ G. , AMIR G. , LOSSES I. S. , ELIAKIM R.
Published: August 2009

Abstract. A 21‐year‐old female with autoimmune polyglandular failure (APG) manifested by insulin‐dependent diabetes mellitus (IDDM), hypothyroidism and pernicious anaemia developed severe malabsorption due to exocrine pancreatic insufficiency. Supplemental pancreatic enzymes resulted in marked improvement of steatorrhea. There was also an incidental finding of gastric carcinoid tumour. We identified only 13 other patients in our institution with either type 2 or 3 APG, one of which had significant steatorrhoea. Another patient with IDDM, hypothyroidism and pernicious anaemia had an asymptomatic gastric carcinoid tumour. The possible mechanisms for malabsorption in APG are discussed.
Light and biological rhythms
Authors: Wetterberg L.
Published: August 2009

Abstract. Chronobiology—derived from chronos (time), bios (life), and logos (study of)—is the objective description of biological time structures and plays an important role in medicine. Circadian rhythms regulate the behaviour, physiology and function of living organisms at many biochemical levels. The influence of the rhythmic manifestation of life may be shown in the constructive effects of growth, development and maturation and is named anachronobiology. In contrast catachronobiology denotes deleterious effects of time and rhythm which may lead to a diseased state. This article summarizes some new data about light as a synchronizer of biological rhythms. A time‐keeper—biological clock—is used by the body for readjustment of rhythms when this is desirable. More recently, light has been used to adjust the biological clock following changes of circadian rhythms during shift work or jet lag occurring when flying from one time zone to another. Light may be used to treat depression, sleep disorders, menstrual dysregulations and other illnesses with disturbed circadian and seasonal rhythms. Examples of the importance of chronopharmacology (time‐dependent changes in drug metabolism and drug effect) are also presented. New findings indicate that circadian oscillators are under genetic control; a light‐influenced regulatory role for cellular immediate‐early genes in circadian behaviour has been discovered. This suggests that light is of importance in regulation of macromolecular synthesis at all levels of the circadian system.
Antivenom treatment in Vipera berus envenoming—report of 30 cases
Authors: Karlson‐Stiber C. , Persson H.
Published: August 2009

Abstract. Objectives. To assess efficacy and safety of two equine F(ab')2 antivenoms currently used to treat envenoming by European vipers.

Design. Retrospective case review study.

Setting. Case records collected by the Swedish Poison Information Centre concerning patients treated in Swedish hospitals for bites by the common European adder, Vipera berus.

Subjects. Patients presenting with V. berus envenoming treated with antivenom (n = 30) and two groups of patients not given antivenom (n = 16 and n = 38).

Main outcome measures. Clinical course and time in hospital were retrospectively studied and compared in patients treated or not treated with antivenom.

Results. There was a significantly lower incidence of extensive oedema (23 vs. 88%) and anaemia (10 vs. 50%) in the antivenom‐treated group, and the hospital stay was shorter (median: 3 vs. 6 days). Antivenom treatment also resulted in prompt clinical improvement in the acute phase. Adverse effects consisting of urticaria and serum sickness occurred in 10% of the patients given antivenom.

Conclusions. Antivenom treatment was associated with a reduced morbidity in severe V. berus envenoming. However, the occurrence of allergic side‐effects is not negligible with this type of antivenom.
Intestinal type of thromboangiitis obliterans (Buerger's disease)
Authors: Schellong S. M. , Bernhards J. , Ensslen F. , Schäfers H. J. , Alexander K.
Published: August 2009

Abstract. Thromboangiitis obliterans (TAO) is a recurrent, inflammatory, segmental occlusive disease of distal limb arteries which may involve veins as well. Young smokers are predisposed to TAO. The intestinal vessels are rarely affected. We report the clinical, angiografic and histologic findings of a 23‐year‐old smoker with extended thrombophlebitis who developed severe abdominal angina and liver hypoxia due to occlusion of the coeliac artery and subtotal occlusion of the superior mesenteric artery. Two surgical bypassing procedures were followed by early graft occlusion. Subsequently, a plastic patch of the superior mesenteric artery and an aortohepatica bypass were performed. The literature since 1945 pertinent to intestinal TAO is reviewed.
A catastrophic antiphospholipid syndrome: the importance of high levels of warfarin anticoagulation
Authors: Ruffatti A. , De Silvestro G. , Ghirardello A. , Calligaro A. , Del Ross T. , Thiene G. , Todesco S.
Published: August 2009

Abstract. We report the clinical observation of a 23‐year‐old woman affected by the so‐called ‘catastrophic antiphospholipid syndrome’. Within a 3‐month period she suffered a number of thrombotic events and haemolytic anaemia with thrombocytopenia and had high levels of immunoglobulins G and M and anticardiolipin antibodies associated with lupus anticoagulant activity. The severity of the clinical and laboratory changes is described and diagnostic and therapeutic difficulties are discussed. The apparent control of thrombotic events only with high levels of warfarin anticoagulation is stressed.
Can laboratory testing improve screening strategies for deep vein thrombosis at an emergency unit?
Authors: Hansson P.‐O. , Eriksson H. , Eriksson E. , Jagenburg R. , Lukes P. , Risberg B.
Published: August 2009

Abstract. Objectives. To study various markers of blood coagulation and fibrinolysis in relation to the extension of deep vein thrombosis (DVT), and to compare the diagnostic usefulness of these markers as screening tests for excluding DVT.

Design. A clinical study of patients admitted to an emergency unit.

Setting. Östra Hospital, Göteborg, Sweden.

Subjects. One hundred and five patients with a clinical suspicion of DVT.

Main outcome measures. Phlebography was used as the reference method for a diagnosis of DVT. Small distal thromboses as well as large proximal thromboses were included. Plasma D‐dimer as well as other markers of coagulation and fibrinolysis were analysed.

Results. Twenty‐eight proximal and 20 distal DVTs were found. Plasma D‐dimers (one ELISA and two latex assays), fibrin monomer, prothrombin fragment 1 + 2 (F1+2), thrombin‐antithrombin III complex (TAT) and the t‐PA‐PAI‐1 complex were all significantly correlated to the extension of DVT, whilst fibronectin, tissue‐type plasminogen activator (t‐PA), single‐chain urokinase‐type plasminogen activator (scu‐PA) and plasminogen activator inhibitor 1 (PAI‐1) were not. The sensitivity was 94% for the D‐dimer ELISA and one of the latex methods (latex‐B), at a specificity of 60% and 68%, respectively. The negative predictive value was 92% for ELISA and 93% for latex‐B, and both assays showed a negative predictive value of 100% for proximal DVTs. Fibrin monomer, F1+2, TAT, D‐dimer (latex‐S) and the t‐PA‐PAI‐1 complex all showed lower negative predictive values (88, 84, 79, 78 and 65% respectively).

Conclusions. Sensitivity and negative predictive values for a latex assay (D‐dimer latex‐B) was similar to that of a D‐dimer ELISA. With a sensitivity of 94% (100% for proximal DVTs) such a latex assay may be included in a screening strategy for DVT at an emergency unit. However, the safety of such an approach has to be tested in other prospective studies.
Urinary thromboxane A2 metabolites in patients presenting in the emergency room with acute chest pain
Authors: Foegh M. L. , Zhao Y. , Madren L. , Rolnick M. , Stair T. O. , Huang K. S. , Ramwell P. W.
Published: August 2009

Abstract. Objectives. The diagnosis of acute myocardial infarction (MI) is difficult in emergency rooms where large groups of patients present with chest pain. Confirmation of the diagnosis of MI based on the myocardial band of creatine phosphokinase may take a day. A more rapid diagnostic screening procedure is desirable and for this reason we evaluated urine thromboxane.

Design. The study consisted of patients presenting with chest pain. Urine samples were obtained in the emergency room and on the following 5 days for those patients who were admitted to the hospital. The urine samples were used to determine the levels of immunoreactive 11‐dehydro‐thromboxane B2 (i‐11‐dehydro‐TXB2) and 2,3‐dinor‐thromboxane B2 (i‐2,3‐dinor‐TXB2). Myocardial infarction was defined as an increase in the myocardial band fraction of plasma creatine phosphokinase (> 5% of the total) and changes in the electrocardiogram. The patients' diagnoses were retrospectively correlated with thromboxane metabolite levels.

Setting. The present study took place in the emergency rooms of two major hospitals: Georgetown University Medical Center. Washington DC, and Fairfax Hospital, Virginia, USA.

Subjects. The study comprised 369 patients presenting with acute chest pain and consisted of 247 men and 122 women aged 30–94 years.

Main outcome measures. The outcome measure of this study was the predictive value of i‐11‐dehydro TXB2 and i‐2,3‐dinor‐TXB2, for the diagnosis of MI, in patients presenting in the emergency room with chest pain.

Results. Patients undergoing an MI had significantly higher levels of both thromboxane metabolites in their urine in the emergency room, when compared to patients undergoing a cardiac event other than an MI or to patients with unstable angina. Thromboxane metabolite levels rapidly returned to normal on the days following admission to the hospital. Aspirin intake appeared to significantly decrease the levels of i‐11‐dehydro‐TXB2, but not that of i‐2,3‐dinor‐TXB2.

Conclusions. The measurement of thromboxane metabolites in the urine may provide a more rapid, accurate and cost‐effective means of diagnosing MIs in patients presenting with chest pain.