bluuebunny/crossref_metadata_2025 huggingface dataset:
Neurocirculatory asthenia revisited: elevated arterial pressure at presentation is a marker for subsequent hypertension
Authors: LEV E. , TORDJMAN K. , PINES A. , FISMAN E. Z. , DRORY Y. , STERN N.
Published: August 2009

Abstract. Neurocirculatory asthenia (NCA) is a fairly common functional disorder often encountered among military recruits. Symptoms in NCA tend to appear in waves, and are believed to disappear completely with the passage of time. Elevated arterial pressure is known to occur as part of the various haemodynamic manifestations of NCA. However, the exact prevalence of hypertension, as well as its long‐term prognosis, is still unknown. The present case‐control study was designed to address these two issues. The target population consisted of 370 patients with NCA representing two separate cohorts: patients diagnosed in 1979, 10 years prior to this study, and patients diagnosed in 1983‐84, 5 years prior to the study. An overall 20% prevalence rate of mild hypertension at diagnosis was calculated for the entire study population. In total, 100 patients representing equal numbers of hypertensive and matched normotensive subjects from each cohort were re‐evaluated. At follow‐up, hypertension was present in 27% (1979 cohort) and 30% (1983‐84 cohort) of patients originally considered to be hypertensive. Hypertension was either non‐existent (1979 cohort) or limited to a single case (1983‐84 cohort) among originally normotensive individuals. In parallel, resting heart rate was higher in the hypertensive subjects of the 1979 cohort both at presentation (85.5 ± 3.2 vs. 73.7 ± 2.4 beats min‐1; P < 0.005) and at follow‐up (79.6 ± 3.2 vs. 70.0 ± 2.5 beats min‐1; P < 0.01). These results indicate that hypertension complicates the diagnosis of NCA in 20% of patients and that, contrary to common belief, it cannot be regarded as another transient manifestation of this condition. Thus hypertension in this context is, as in the younger members of the population in general, a major risk factor for lifelong hypertension, rather than an inconsequential phenomenon.
Acute and chronic liver disease associated with Yersinia enterocolitica infection: a Norwegian 10‐year follow‐up study of 458 hospitalized patients
Authors: SAEBØ A. , LASSEN J.
Published: August 2009

Abstract. During the period 1974–1983, Yersinia enterocolitica infection was diagnosed in 458 hospitalized patients by antibody response or isolation of the micro‐organism. A total of 54 (11.9%) patients had acute liver infection, with significantly elevated serum levels (> 2‐fold) of bilirubin and/or enzyme levels. Serious liver disease with cellular necrosis was observed in biopsy specimens from two of 12 patients examined; six had unspecific changes. The patients were followed up for 4–14 years (until 1987). A total of 22 (4.9%) patients were readmitted with chronic liver disease; in one case non‐specific microscopic changes developed into granulomatous hepatitis over a period of 3 years. In both the acute and chronic stages of disease, liver involvement was associated with involvement of other organ systems, and some patients developed multi‐organ disease. Chronic liver disease was associated with positive tests for antinuclear antibody and rheumatoid factor, and with a high mortality.
Aspirin to prevent growth of vegetations and cerebral emboli in infective endocarditis
Authors: TAHA T. H. , DURRANT S. S. , MAZEIKA P. K. , NIHOYANNOPOULOS P. , OAKLEY C. M.
Published: August 2009

Abstract. The incidence of stroke on cranial computed tomography (CT) and change in echocardiographic vegetation area was prospectively compared in a preliminary observational study involving nine patients with infective endocarditis randomized to either low‐dose aspirin (75 mg d‐1, Group I, n = 4) or no aspirin (Group II, n = 5). Two symptomatic cerebral infarcts and one myocardial infarct occurred in the controls, compared to no events in patients on aspirin during a total observation period of 343 d (range 28–49 d). The mean vegetation area decreased in the aspirin group (mean change = ‐0.24 cm2), compared to an increase in controls (mean change = ± 0.35 cm2). The platelet half‐life (normal range 5–6 d), which was measured using Indium‐111 radiolabelling, tended to be lower in Group II (4.6 ± 0.2 vs. 3.9 ± 0.5 d). No side‐effects or complications attributable to aspirin were observed. A possible role for adjunctive aspirin therapy in the prevention of embolic complications in infective endocarditis is suggested, and warrants further study.
Elevated serum transcobalamin levels in anaemia of rheumatoid arthritis: correlation with disease activity but not with serum tumour necrosis factor alpha and interleukin 6
Authors: VREUGDENHIL G. , LINDEMANS J. , VAN EIJK H. G. , SWAAK A. J. G.
Published: August 2009

Abstract. Transcobalamin (TCII) and haptocorrins (TCI and III), tumour necrosis factor alpha (TNF), interleukin‐6 (IL6) and parameters of disease activity were assessed in 20 rheumatoid arthritis (RA) patients without anaemia and 19 subjects with anaemia of chronic disease (ACD) in order to determine if there was a possible correlation between these parameters. TCII, TNF and IL6 correlated positively with RA disease activity parameters, whereas their serum levels were higher in the ACD patients. TC levels were not correlated with cytokine levels. Vitamin B12 serum levels were lower in ACD. We conclude that in RA, elevated serum TCII levels are possibly mediated by increased RA disease activity, but probably not by actions of TNF or IL6. Increased TCII levels found in ACD may be explained by the higher degree of RA activity in these patients, and could also be viewed as a compensatory reaction to anaemia or reduced vitamin B12 levels. However, these preliminary findings require further confirmation.
Protracted cholestasis probably induced by oral contraceptive
Authors: WEDÉN M. , GLAUMANN H. , EINARSSON K.
Published: August 2009

Abstract. The case of a patient with intrahepatic cholestasis, probably induced by an oral contraceptive agent, is reported. Initially, early primary biliary cirrhosis was suspected, but this diagnosis could not be verified either clinically or by immunological tests. Re‐examination and re‐evaluation of the liver biopsy revealed some eosinophilia and sinusoidal dilatation, changes indicative of drug‐induced liver injury. The cholestasis gradually disappeared as indicated both biochemically and histologically, but the elevation of serum alkaline phosphatase levels persisted for some 10 years after termination of drug therapy. Oral contraceptive agent‐induced jaundice or cholestasis is generally reported to disappear when the drug is stopped, and we are unaware of similar cases in the literature with a protracted course such as that described here. Still, the circumstances of this patient suggest that a correlation between the oral contraceptive agent and the hepatic reaction is most likely, and we consider it important that colleagues pay attention to this possibility.
Aplastic anaemia: pathogenetic mechanisms and treatment with special reference to immunomodulation
Authors: BJÖRKHOLM M.
Published: August 2009

Abstract. Aplastic anaemia (AA) has been defined as a syndrome in which the presence of pancytopenia is accompanied by marrow hypocellularity. Ample laboratory data and clinical observations continue to make immune mediation of bone‐marrow failure an attractive hypothesis. Recent progress in the practice of bone‐marrow transplantation has led to a survival rate of approximately 80% in the best cases, but such a treatment is only amenable in young patients (< 45–50 years) with HLA‐identical bone‐marrow donors. Anti‐lymphocyte and thymocyte globulin treatment has been surprisingly effective for AA, resulting in transfusion independence in 40–80% of patients. The mechanism of action is unknown, although effects on immunosuppression appear to be the most likely candidates. Long‐term results for patients receiving cyclosporin A treatment will soon be available, and preliminary data show an effect similar to that of antithymocyte globulin. In contrast to successful bone‐marrow transplantation, improvement following immunomodulation leaves quantitative abnormalities in all haematopoietic cell lines, and patients are prone to develop clonal (malignant) disease.
A 3‐month double‐blind cross‐over study of the effect of benazepril and hydrochlorothiazide on functional class in symptomatic mild heart failure
Authors: NORDREHAUG J. E. , OMSJØ I. H. , VOLLSET S. E.
Published: August 2009

Abstract. The non‐sulfhydryl selective angiotensin‐converting enzyme inhibitor benazepril (20 mg daily) was compared with hydrochlorothiazide (50 mg daily) in post‐infarction (6–24 months) patients with symptomatic (NYHA functional class 2) mild heart failure. No concomitant drug therapy was given. The study had a double‐blind cross‐over design with 3‐month treatment periods. Both drugs were well tolerated, and both caused a similar reduction in systolic blood pressure. Heart rate was higher with the diuretic. Benazepril improved the NYHA functional class in 17 out of 29 (59%) patients, whereas one patient improved with hydrochlorothiazide (P = 0.0004). With regard to global efficacy score, benazepril was also superior. Thus, angiotensin‐converting enzyme inhibitors may be superior to diuretics as first‐choice therapy in symptomatic mild heart failure.
Enhanced platelet function in acute myocardial infarction is attenuated by streptokinase treatment
Authors: SYLVÉN C. , KARLBERG K.‐E. , CHEN J. , HAGERMAN I. , EGBERG N. , BERGSTRÖM K.
Published: August 2009

Abstract. The aim of this study was to determine whether platelets are activated and aggregation is increased in myocardial infarction treated with streptokinase. Twelve consecutive patients were studied. Before streptokinase infusion (1.5 times 106 IU i.v. over a period of 1 h), 7 ± 4 h after the onset of symptoms, fibrinogen, leucocyte and platelet functions were enhanced compared to reference values. Plasma fibrinogen was 3.1 ± 0.6 g l‐1 (P < 0.03), leucocyte count was 14.3 ± 3.3 times 103 l‐1 (P < 0.0005), elastase was 39 ± 8 μg l‐1 (P < 0.0002), β‐thromboglobulin was 68 ± 71 μg l‐1 (P < 0.0001) and filtragometer platelet aggregation time was 137 ± 40 s (P < 0.0001). After streptokinase the leucocyte count, elastase and β‐thromboglobulin levels increased further, by about 40% (P < 0.02), 130% (P < 0.02) and 140% (P < 0.005), respectively. Fibrinogen was almost eliminated. Despite signs of increased activation, platelet aggregation was decreased as indicated by both filtragometer aggregation time, which increased by about 480% (P < 0.003), and whole‐blood aggregometry, in which electrical impedance decreased by about 65% (P < 0.01).
Why should the relationship between diet and cancer be investigated in prospective studies?
Authors: SARACCI R.
Published: August 2009

Abstract. Prospective studies on diet and cancer are needed for five reasons: (i) unlike xenobiotic agents which, if found to be carcinogenic, can at least in principle be dispensed with, food of some kind is indispensable; (ii) our present knowledge on the role of diet in cancer is limited and permits only tentative recommendations; (iii) plausible biological hypotheses for this role are available, as well as biological markers allowing their exploration in epidemiological studies; (iv) these studies demand a prospective approach—a number of prospective studies, each involving several tens of thousands of adults, are now being started in Europe: and (v) diet affects not only cancers but also a spectrum of other diseases, which need to be investigated in parallel, to acquire knowledge on which to base firm recommendations on a diet capable of maximizing benefits and minimizing the risk to health.
The Malmö biomarker programme
Authors: PERO R. W. , BERGLUND G. , CHRISTIE N. T. , COSMA G. N. , FRENKEL K. , GARTE S. J. , JANZON L. , OLSSON A. , SEIDEGÅRD J. , SMULSON M. E. , TROLL W.
Published: August 2009

Abstract. Evaluation of pro‐oxidant/antioxidant dietary factors in relation to individual susceptibility to cancer and cardiovascular disease is justified based on a review of the literature. This working hypothesis is amendable to further scientific validation from biomarkers with end‐point sensitivity to oxygen radicals. So far, the biomarker programme developed around this theme may be divided into three distinct classes:

(1) Markers of genotoxic exposure estimate DNA damage either directly as a bilogically effective dose, or indirectly by estimating aberrant cellular functions that lead to accumulation of DNA damage. The examples included are ADP‐ribosylation in mononuclear leucocytes (R. Pero, A. Olsson), oxidative DNA damage (K. Frenkel), gene expression in lymphocytes (S. Garte. G. Cosma), serum alpha macroglobulin (W. Troll) and oxidized DNA damage and repair (N. Christie).

(2) Markers of genetic predisoposition have been shown to have genetic inheritance patterns that relate to individual susceptibility to cancer or cardiovascular disease. The examples included are glutathione transferase mu phenotyping (R. Pero. J. Seidegård) and poly (ADP‐ribose) polymerase pseudogene polymorphism (M. Smulson).

(3) Markers of dietary status have been validated to estimate the amount of a particular nutrient or xenobiotic in the diet that has been taken up and metabolized or distributed to body fluids or tissues. The example included here is niacin nutriture (E. Jacobson. M. Jacobson). This biomarker is presented in Section 5 (pp. 59–62) of the Malmö Diet and Cancer Programme Minisymposium reported in this issue of the journal.
An epidemiologic perspective on biomarkers
Authors: SCHATZKIN A. , FREEDMAN L. , SCHIFFMAN M.
Published: August 2009

Abstract. The authors discuss biological markers from an epidemiologic perspective, emphasizing the importance of integrating biomarkers into large‐scale observational and intervention studies. Whereas any biologic phenomenon can be considered a biomarker, an intermediate end‐point is defined as being on the causal pathway between exposure and disease. An intermediate end‐point is a valid surrogate for a disease in relation to a given exposure if, and only if, that exposure causes a similar change in the occurrence of both the intermediate end‐point and the disease. Cancer studies using surrogate end‐points may be shorter, smaller and cheaper than those using malignancy per se as an outcome. Three types of studies may be carried out to determine whether a given biomarker is an intermediate end‐point and whether it can serve as a surrogate: (i) exposure‐marker studies, (ii) marker‐disease studies, and (iii) studies comprising all three elements, exposure, marker, and disease. The authors discuss statistical aspects of these three types of studies and provide examples from investigations of alcohol‐hormones‐breast cancer, diet‐epithelial proliferation markers‐large bowel adenomatous polyps, and reproductive risk factors‐human papillomavirus infection‐cervical cancer.
Moclobemide overdose
Authors: MYRENFORS P. G. , ERIKSSON T. , SANDSTEDT C. S. , SJÖBERG G.
Published: August 2009

Abstract. Moclobemide is a recently introduced short‐acting, selective and reversible monoamine oxidase inhibitor, type A, with few and mild side‐effects at therapeutic doses. Fifteen reported cases of moclobemide overdose were studied in detail and are presented here. While pure mechanism overdosage seems benign, a combination with tricyclic antidepressants may result in serious poisoning even when the moclobemide overdose is modest.
Left ventricular thrombosis and arterial embolism in acute anterior myocardial infarction
Authors: KONTNY F. , DALE J. , NESVOLD A. , LEM P. , SØBERG T.
Published: August 2009

Abstract. To study left ventricular thrombus (LVT) formation and arterial embolism (AE), 106 consecutive patients with a first acute anterior myocardial infarction (AAMI) underwent two‐dimensional echocardiography before discharge. Repeated assessments for detection of AE were performed. Patients were non‐randomly allocated to either no heparin, low‐dose heparin or high‐dose heparin.

LVT was found in 25 (26.9%) of 93 patients with technically satisfactory echocardiograms. Left ventricular (LV) wall motion impairment (P = 0.0017) and treatment with either heparin or low‐dose heparin (P = 0.0019) were independent predictors of LVT formation.

AE, all strokes, occurred in 10 patients (9.4%) and was strongly associated with high age (P = 0.0013).

In conclusion. LVT and AE are frequent complications to AAMI. LV wall motion impairment predisposes for LVT and low‐dose heparin seems not to prevent these complications.
The prevalence of coronary heart disease in the multiethnic and high diabetes prevalence population of Mauritius
Authors: TUOMILEHTO J. , LI N. , DOWSE G. , GAREEBOO H. , CHITSON P. , FAREED D. , MIN Z. , ALBERTI K. G. M. M. , ZIMMET P.
Published: August 2009

Abstract. The prevalence of coronary heart disease (CHD) was determined in a population survey in Mauritius where the prevalence of non‐insulin dependent diabetes and mortality from CHD are amongst the highest in the world. Men and women aged 35–74 years of all major ethnic groups were included: Asian Indians (Hindus and Muslims). Creoles and Chinese. ECG abnormalities suggesting either ‘probable CHD’ or ‘possible CHD’ were defined using standard criteria. The overall prevalence of probable CHD was 2.7% in men and 0.9% in women, and that of probable or possible CHD together 17.8% in men and 33.3% in women. The prevalence of CHD did not vary significantly between the four ethnic groups. In the multivariate analyses, age and high blood pressure were the most important independent predictors of ECG abnormalities. Neither diabetes nor serum insulin seemed to contribute independently to the prevalence of CHD.

This survey confirmed the high ranking of Mauritius in international mortality statistics. The high rates of CHD seen in Asian Indians, African‐origin Creoles and Chinese in the rapidly developing country of Mauritius may be a pointer to future problems in their regions of origin.
Granulocyte‐macrophage colony‐stimulating factor as a cause of paraneoplastic leukaemoid reaction in advanced transitional cell carcinoma
Authors: WETZLER M. , ESTROV Z. , TALPAZ M. , MARKOWITZ A. , GUTTERMAN J. U. , KURZROCK R.
Published: August 2009

Abstract. Increasing evidence suggests that paraneoplastic syndromes may be mediated by tumour‐related cytokine release, although the specific factor(s) involved remain poorly defined. Colony‐stimulating factors (CSF) and interleukins (IL) promote colony growth in semi‐solid media and, when administered in recombinant form, increase blood counts in patients. However, normal serum CSF levels in individuals with physiologic blood counts and the relationship between specific serum CSF levels and paraneoplastic leukaemoid reaction are not well established. In this study, we found that normal serum levels of granulocyte‐macrophage CSF (GM‐CSF), as measured by ELISA, were generally < 55 pg ml−1; IL‐3, < 30 pg ml−1; and granulocyte CSF (G‐CSF), < 50 pg ml−1. In contrast, high levels of GM‐CSF (132 pg ml−1), but not G‐CSF or IL‐3, were found in a patient with a transitional cell carcinoma of the renal pelvis and increased leukocytosis correlating with the tumour burden. The GM‐CSF was biologically active, as demonstrated by its ability to stimulate colony growth in vitro. Based on these results it appears that autonomous production of GM‐CSF is one possible pathophysiologic mechanism underlying leukaemoid reaction in cancer patients.
Lipoprotein(a) and treatment of chronic renal disease
Authors: BUGGY D. , BREATHNACH A. , KEOGH B. , COOKE T. , FEELY J.
Published: August 2009

Abstract. Objectives. To compare lipoprotein(a) [Lp(a)] and albumin concentrations in patients with chronic renal disease receiving different forms of treatment and to determine, if any, the relationship between these variables.

Design. A prospective cross‐sectional, case‐controlled study.

Setting. A tertiary referral nephrology and dialysis unit.

Subjects. Forty‐four consecutive non‐diabetic patients with chronic renal failure treated by renal transplantation (n = 18), haemodialysis (n = 18), continuous ambulatory peritoneal dialysis (CAPD; n = 8), and 30 healthy controls from subjects drawn from University personnel were studied.

Interventions. Fasting morning venous blood was analysed for Lp(a), albumin, total cholesterol and glucose concentrations.

Main outcome measures. Comparison of plasma levels of these variables between the sub‐groups. Results. Concentrations (median; 95% CI) of Lp(a) were significantly (P < 0.05) higher (38.4 mg dl−1; range 15.4–72.0) and of albumin lower (31.6 g l−1; range 28–35.2) in the CAPD group compared with both control subjects and other groups of chronic renal disease patients.

Conclusions. The elevated Lp(a) concentrations seen only in association with reduced albumin concentrations in CAPD patients suggest a regulatory role for albumin with albumin losses stimulating production of Lp(a).
Lipids and lipoproteins as risk factors for coronary heart disease in men with abnormal glucose tolerance: the Honolulu Heart Program
Authors: LAWS A. , MARCUS E. B. , GROVE J. S. , CURB J. D.
Published: August 2009

Abstract. Objectives. To evaluate lipids and lipoproteins as risk factors for coronary heart disease (CHD) in older men with non‐insulin‐dependent diabetes (NIDDM) or abnormal glucose tolerance compared with normoglycaemic men.

Design. A prospective, population‐based cohort study based on the lipoprotein examination (1970–72) of the Honolulu Heart Program. Follow‐up was through to December 1988.

Setting. Honolulu, Hawaii.

Subjects. Japanese‐American men, ages 51–72 at baseline: 2042 with 1 h glucose < 12.5 mmol l−1 (normal group); 376 on oral hypoglycaemic agents or with 1 h glucose ≥ 12.5 mmol l−1 after 50 g oral glucose challenge (abnormal glucose tolerance group). None had prevalent coronary heart disease (CHD) or stroke at baseline.

Main outcome measures. Incident CHD: definite nonfatal myocardial infarction (MI) or fatal CHD.

Results. There were 221 incident cases in the normal group, and 65 in the abnormal glucose tolerance group. Total and high‐density lipoprotein (HDL) cholesterol were significant predictors of incident CHD in men with NIDDM or abnormal glucose tolerance after controlling for age, body‐mass index, systolic blood pressure, pack‐years of cigarettes and alcohol consumption (P < 0.05). Total, low‐density lipoprotein (LDL) and very‐low‐density lipoprotein (VLDL) cholesterol were significant predictors in normal men, and HDL cholesterol was of borderline significance.

Conclusions. Abnormal lipids and lipoproteins are significant, independent predictors of CHD in subjects with NIDDM or abnormal glucose tolerance. Attention to lipid and lipoproteins as CHD risk factors should be part of clinical management of these patients.
Streptokinase, but not tissue plasminogen activator, attenuates platelet aggregation in patients with acute myocardial infarction
Authors: KARLBERG K.‐E. , CHEN J. , HAGERMAN I. , BERGSTRÖM K. , WALLIN R. , SALDEEN T. , SYLVÉN C.
Published: August 2009

Abstract. Objectives. To investigate if tissue plasminogen activator (tPA) and streptokinase given during acute myocardial infarction (AMI) have different effects on platelet aggregation which could contribute to the higher reocclusion rate observed after tPA.

Design. Open labelled on consecutive patients.

Setting. Coronary care unit.

Subjects. Twenty patients with chest pain and ST elevations on an electrocardiogram suggestive of AMI.

Interventions. Ten patients were treated with tPA (100 mg 3 h−1), 10 patients with streptokinase (1.5 × 106 IU 1 h−1).

Main outcome measures. Before, immediately after and 24 h after fibrinolytic therapy, platelet aggregation was estimated with filtragometry and whole blood aggregometry. Fibrinogen, β‐thromboglobulin, elastase and the fibrinogen‐derived peptide Bβ 30–43 were also measured.

Results. The groups were comparable at baseline. Directly after treatment, streptokinase prolonged aggregation time in filtragometry with 112 ± 140 s (P < 0.03) and reduced conductance in whole blood aggregometry by 6.2 ± 6.1 Ω (P < 0.03), both tests indicating inhibited platelet function. Fibrinogen decreased 2.5 ± 1.0 g l−1 (P < 0.02). In the tPA‐treated group corresponding changes were 68 ± 225s (NS) and 2.5 ± 7 Ω (NS) with no significant reduction in fibrinogen. After 24 h, at which time every patient was on acetylsalicylic acid, aggregation was inhibited in both groups as measured by aggregometry. Directly after fibrinolytic treatment, neutrophils were similarly activated in both groups with increments of elastase and Bβ 30–43 by 26 ± 46 μg l−1 (P < 0.03) and 280 ± 381 pmol l−1 (P < 0.03) respectively (streptokinase) and by 12 ± 6 μg l−1 (P < 0.02) and 919 ± 856 pmol l−1 (P < 0.02) respectively (tPA).

Conclusions. Despite similar degrees of platelet and leucocyte activation, streptokinase but not tPA treatment appears to inhibit platelet aggregation. One possible reason could be a streptokinase‐induced pronounced decrease of fibrinogen and increase of fibrinogen split products. Therefore, further development of adjuvant antiplatelet therapy could be of clinical importance.
High frequency of antibodies to Hantaan virus and hepatitis C virus in chronic haemodialysis patients Coincidence or cross‐reaction?
Authors: TSIANOS E. V. , DALEKOS G. N. , ELISAF M. , ZERVOU E. , Siamopoulos K. C.
Published: August 2009

Abstract. Objectives. To address the question of whether there is any coincidence or cross‐reaction between hepatitis C virus (HCV) and Hantaan virus (both RNA arboviruses), as well as to assess the frequency of antibodies to the above viruses amongst chronic haemodialysis patients in our region.

Design. Collection of serum samples from consecutive unselected chronic haemodialysis patients.

Setting. A tertiary referral center (University Hospital).

Subjects. One hundred and fourteen chronic haemodialysis patients were investigated for the presence of antibodies to HCV (anti‐HCV) and Hantaan virus disease (anti‐HVD). Eleven unselected non‐haemodialysis patients with well‐defined haemorrhagic fever with renal syndrome (HFRS) were also investigated for the anti‐HCV antibodies comprising the disease control group.

Interventions. None.

Main outcome measures. The utility of an anti‐HVD positive test in chronic haemodialysis patients.

Results. Seventeen patients (14.9% 95% confidence interval [CI] 8.4–21.4%) were anti‐HCV positive, whereas 15 (13.2%, 95% CI 6.9–19.3%) were anti‐HVD positive. An anti‐HCV positive test was confirmed by recombinant immunoblot assay (RIBA II) in 88.2%. The presence of anti‐HCV antibodies was not associated with transfusions but with the longer duration of haemodialysis (62.8 ± 29.8 vs. 31.2 ± 29.3 months, P < 0.001). Anti‐HVD antibodies were not associated with transfusions or with the duration of haemodialysis. Three patients were positive for both anti‐HCV and anti‐HVD antibodies. None of the 11 patients with well‐defined HFRS had anti‐HCV antibodies.

Conclusions. Chronic haemodialysis patients are a high risk group for HCV infection in association with the duration of haemodialysis and, at least for our geographical area, these patients have to be examined for anti‐HVD antibodies especially when a definite causative agent for chronic renal failure is not found. The HVD and HCV infection are not exceptional amongst haemodialysis patients in our region, whereas the possibility of a cross‐reaction between these two RNA arboviruses is rather excluded as there was no evidence of HCV infection amongst the patients with well‐defined HFRS.
Blood pressure, physical fitness and physical activity in 17‐year‐old Danish adolescents
Authors: ANDERSEN L. B.
Published: August 2009

Abstract. Objective. To test the relationship between physical activity and physical fitness, and the relationship between these variables and the primordial risk factor blood pressure (BP).

Design. A cross‐sectional study of all Danish pupils in the same grade at ‘gymnasium’ (the Danish upper secondary school).

Setting. Tests and questionnaires were administered by physical education and biology teachers according to a prescribed scheme.

Subjects. Study subjects were 13810 adolescents with a mean age of 17.1 years. Physical activity, smoking habits, and physical performance were measured in 4862 boys and 6573 girls. Blood pressure was measured in 2474 boys and 3535 girls. No difference was found in BP, physical activity and fitness variables between this group and a representative group of Danish school children at the same age.

Main outcome. Blood pressure and health‐related physical performance such as strength, muscle endurance, flexibility and maximal oxygen uptake (VO2max) estimated from heart rate at submaximal workload were measured. Sports activity, other physical activity and smoking habits were assessed by questionnaires.

Results. There was a negative relationship between BP and VO2max up to the 50% percentile (50 ml min−1 kg−1) in boys and up to the upper 80–90% percentile (45 ml min−1 kg−1) in girls. In a multiple regression model with BP as dependent variable, VO2max related highly significant, also after adjustment for body weight and physical activity (P < 0.001). Other performance variables only explained a small part of the variance in BP. No relationship was found between BP and total physical activity or sports activity.

Conclusion. In the adolescent population VO2max related negatively to BP after adjustment for body weight, physical activity, other fitness measures and sex, but physical activity or other fitness measures did not relate. Lower blood pressure was found with higher VO2max until levels of 50 and 45 ml min−1 kg−1 in boys and girls, respectively.
Standardized radioiodine therapy in Graves' disease: the persistent effect of thyroid weight and radioiodine uptake on outcome
Authors: de BRUIN T. W. A. , CROON C. D. L. , de KLERK J. M. H. , VAN ISSELT J. W.
Published: August 2009

Abstract. Objective. To assess the incidence of hypothyroidism, euthyroidism, and recurrent hyperthyroidism following a standard dose of Na131I (3.7 MBq or 100 μCi) per g thyroid tissue, adjusted for radioiodine tracer uptake.

Design. A single‐centre prospective follow‐up study from January 1990 to December 1992.

Setting. Academic Hospital in Utrecht, the Netherlands.

Subjects. Newly diagnosed patients with Graves' disease (n = 148).

Interventions. Radioiodine treatment at a standard dose of 3.7 MBq or 100 μCi per g thyroid tissue.

Main outcome measures. Confidence interval testing of resulting thyroid status, defined by biochemical criteria.

Results. The overall cure rate was 70% (103 of 148 subjects), confidence interval (CI) 62–77%. A 90% incidence of hypothyroidism was found in patients with a small thyroid (less than 20 g). Recurrent hyperthyroidism was found significantly more often in subjects with a thyroid weight exceeding 60 g compared to those who had a thyroid of 9–59 g. More recurrences were found in subjects in the highest tertile of a 24‐h radioiodine uptake test (> 80% uptake) compared to those in the lowest tertile (< 60% uptake).

Conclusions. No uniform treatment results expressed per thyroid weight category were obtained, in spite of standardizing the treatment Na131I dose (3.7 MBq per g thyroid). Graves' patients with a thyroid smaller than 20 g and those with less than 60% 24‐h radioiodine uptake have a 50–90% chance of hypothyroidism at the 12‐month follow‐up.
Fever of unknown origin in HIV‐infected patients: a critical analysis of a retrospective series of 57 cases
Authors: BISSUEL F. , LEPORT C. , PERRONNE C. , LONGUET P. , VILDE J.‐L.
Published: August 2009

Abstract. Objectives. The aim of the study was to assess the incidence and aetiology of fever of unknown origin in human immunodeficiency virus (HIV)‐infected patients, and to evaluate the usefulness of the main diagnostic procedures.

Design. A retrospective study.

Setting and subjects. We reviewed the records of 270 HIV‐infected patients who were hospitalized for the first time in a department of infectious and tropical diseases during the 27 month study period.

Main outcome measures. Fifty‐seven patients (21 %) had a history of fever of unknown origin.

Results. The aetiology was found in 49 cases (86 %). The major cause of the fever was mycobacteriosis: atypical mycobacteria in 10 cases, Mycobacterium tuberculosis in 10, mycobacteria of unspecified type in two, and BCG strain in one. A liver biopsy and a thoracic CT scan greatly contributed to the diagnosis of mycobacterial infection. Seventeen patients were given empiric antimycobacterial therapy as a therapeutic test, of whom seven had a favourable response. The other main causes of fever were cytomegalovirus infection in five patients, leishmaniasis in four, and lymphoma in four.

Conclusions. Fever of unknown origin is a frequent occurrence in the course of HIV infection, and mycobacterial infection should be considered as a first‐line diagnosis in such cases. The place of empiric antimycobacterial therapy in the diagnostic strategy requires further evaluation, but appears to be an alternative to multiple investigative procedures.
The occurrence of polyglandular autoimmune syndrome type III associated with coeliac disease in patients with sarcoidosis
Authors: PAPADOPOULOS K. I. , HÖRNBLAD Y. , HALLENGREN B.
Published: August 2009

Abstract. Objectives. To study whether an association between polyglandular autoimmune (PGA) syndrome type III [including autoimmune thyroid disease (ATD) and insulin‐dependent diabetes mellitus (IDDM)], coeliac disease and sarcoidosis, exists.

Design. In patients with documented sarcoidosis, the presence of the disease constellation of ATD, IDDM and coeliac disease was examined.

Setting. The patients were recruited at the Department of Pulmonary Medicine, and the study was conducted at the Department of Endocrinology, Lund University Clinics, General Hospital, Malmö, Sweden.

Subjects. Of all patients (n = 89) with documented sarcoidosis attending the Department of Pulmonary Medicine between January 1980 and December 1991, 78 patients (44 males, 34 females; median age at the time of the study 48 years, range 22–81 years; median observation time since the diagnosis of sarcoidosis 120 months, range 1–468 months) were examined in the present study.

Results. Amongst the 78 patients with documented sarcoidosis, one female patient was found with PGA syndrome type III, coeliac disease and sarcoidosis.

Conclusions. This present patient further indicates the existence of an association between polyglandular autoimmune (PGA) syndrome type III, coeliac disease and sarcoidosis. To determine whether this disease constellation might constitute a new syndrome, further studies on larger groups of patients with sarcoidosis are demanded.
A case of central diabetes insipidus with spontaneous remission after 8 years of the disease
Authors: Nagae A. , Kohara K. , Iwata T. , Okura T. , Ohtsuka T. , Kukita H. , Hrwada K.
Published: August 2009

Abstract. A 55‐year‐old male smoker developed polyuria and polydipsia in November 1983. A water deprivation study revealed a defect in the urine concentrating function, which was corrected by vasopressin. Plasma antidiuretic hormone (ADH) was not increased by smoking. His condition was well controlled by deamino‐d‐arginine vasopressin. However, since February 1992 he has become completely free from the need for medication to control his urine volume. Re‐evaluation studies with water deprivation and smoking revealed dramatic improvements in the urine concentrating function and ADH response.

A patient with idiopathic diabetes insipidus with spontaneous remission after 8 years is reported.
Hypercalcaemic crisis after excessive topical use of a vitamin D derivative
Authors: Hoeck H. C. , Laurberg G. , Laurberg P.
Published: August 2009

Abstract. Topical application of the vitamin D analogue calci‐potriol has been found to be of clinical value in the treatment of dermatological disorders. This is considered to be safe with respect to alterations in calcium homeostasis. We report a 17‐year‐old female patient who developed hypercalcaemic crisis after excessive use of calcipotriol for ichthyosis. The clinical condition and serum calcium improved after cessation of calciprotiol treatment and rehydration with intravenous fluids and electrolytes. The case emphasizes the importance of limiting the topical use of calcipotriol as recommended by the manufacturer.
Overtreatment and undertreatment of hypertension
Authors: Furberg C. D. , Berglund G. , Manolio T. A. , Psaty B. M.
Published: August 2009

Abstract. Furberg CD, Berglund G. Manolio TA, Psaty BM (Department of Public Health Sciences, Bowman Gray School of Medicine, Winston‐Salem, NC, Epidemiology and Biometry Program, Division of Epidemiology and Clinical Applications. National Heart, Lung and Blood Institute, Bethesda, MD, Department of Medicine, Epidemiology and Health Services, University of Washington, Seattle. WA, USA; Department of Medicine, Lund University, Malmo, Sweden). Overtreatment and undertreatment of hypertension (Frontiers in medicine). Journal of Internal Medicine 1994; 235: 387–397.

Results from a large number of randomized clinical trials document conclusively that treatment of elevated systolic and/or diastolic blood pressure markedly reduces the risk of cardiovascular complications such as stroke and acute myocardial infarction. Detection, treatment and control of hypertension have major public health implications. A review of the literature suggests the existence of both overtreatment (defined as improper or incorrect diagnosis of hypertension, overaggressive and potentially dangerous blood pressure lowering and the use of expensive antihypertensive drugs with unproven mortality/morbidity benefits) and undertreatment (defined as unrecognized, untreated and poorly controlled hypertension). These current major issues in medicine are discussed.
von Willebrand factor and fibrinolytic variables are differently affected in the insulin resistance syndrome
Authors: NILSSON T. K. , BOMAN K. , BJERLE P. , HALLMANS G. , HELLSTEN G.
Published: August 2009

Abstract. Objectives. To test whether von Willebrand factor, a new cardiovascular risk factor, belongs to the group of risk factors forming part of the insulin resistance syndrome.

Design. A population‐based, age‐stratified, cross‐sectional study.

Setting. A primary health care centre.

Subjects. All subjects aged 35, 45, 55, and 65 years in Norsjö municipality (n = 265) were invited, and 68% (82 males, 93 females) entered and completed the study.

Results. von Willebrand factor did not correlate with any measured lipid, anthropometric, or glucose metabolism variable. The higher levels of cardiovascular risk factors found in the subgroup of patients with electrocardiographical signs of ischaemic heart disease did not confound this result.

Conclusion. von Willebrand factor plasma concentration is unrelated to the metabolic factors involved in the insulin resistance syndrome. Thus, it may be difficult to reduce elevated von Willebrand factor levels by conventional non‐pharmacological cardiovascular high‐risk intervention schemes.
The personality patterns in patients with duodenal ulcer and ulcer‐like dyspepsia and their relationship to the course of the diseases
Authors: JESS P. , ELDRUP J. ,   Hvidovre Ulcer Project Group
Published: August 2009

Abstract. Objectives. To compare personality characteristics in duodenal ulcer patients and patients with ulcer‐like dyspepsia from the primary health sector with duodenal ulcer patients from a hospital and to evaluate the relationship of the personality characteristics to the course of the diseases.

Design. A prospective study using the Minnesota Multiphasic Personality Inventory (MMPI) with retesting of a subgroup of patients after a median observation period of 14 months.

Setting. Departments of Medical and Surgical Gastroenterology, Hvidovre University Hospital, and the primary health sector in Roskilde County, Denmark.

Subjects. Sixty hospital patients with duodenal ulceration and 17 patients with duodenal ulceration plus 2 5 patients with ulcer‐like dyspepsia from the primary health sector.

Main outcome measures. MMPI scores.

Results. The hospital patients differed from the two other groups of patients by having higher scores of depression and anxiety (P < 0.05). Twenty‐eight of the patients were retested with MMPI. Contrary to the patients with persisting complaints, abnormal personality characteristics disappeared in patients without complaints (P < 0.05‐0.001).

Conclusions. The results indicate that abnormal personality characteristics in patients with functional and organic upper dyspepsia are consequential rather than causal factors.
Deaths from pulmonary tuberculosis in a low‐incidence country
Authors: NAALSUND A. , HELDAL E. , JOHANSEN B. , KONGERUD J. , BOE J.
Published: August 2009

Abstract. Objectives. To study the validity of official mortality statistics regarding deaths from pulmonary tuberculosis, and to identify factors contributing to death.

Design. A retrospective study.

Setting. Cases were enrolled from the data of the Central Bureau of Statistics from where the official mortality statistics are issued, the National Tuberculosis Register and all Autopsy Registers in the region.

Subjects. Case and autopsy reports from all patients who died from active pulmonary tuberculosis in two Norwegian counties between 1977 and 1989.

Main outcome measures. Patients identified from all three registers with active pulmonary tuberculosis, concomitant diseases/risk‐factors, chest X‐rays, symptoms, number of patients investigated and treated for tuberculosis, duration from hospital admission until start of treatment and/or death.

Results. Ninety‐six patients, median age 75 years, died from pulmonary tuberculosis, 51 without treatment. Thirty‐four patients had not been registered at the Central Bureau of Statistics. Thirty‐nine patients had cough on admission. Weight loss and generalized malaise occurred just as frequently. Forty‐two patients had infiltrates on chest X‐ray located elsewhere than in the apical region. In 42 patients, no diagnostic tests for tuberculosis were performed. The median length of stay in hospital was 24 days before death in the untreated group, and 21 days before start of treatment in the treated group.

Conclusion. Reliable figures of patients who died from pulmonary tuberculosis could not be obtained from the official statistics because of under‐notification and erroneous codification of diseases. Deaths occurred mainly because the diagnosis was established too late: in half of the patients at autopsy. Eighty‐one patients had concomitant diseases known to lower resistance against tuberculosis. Lack of diagnostic suspicion may have been caused by nonspecific symptoms and atypical chest X‐ray findings.
Direct effect of insulin on 45calcium uptake in human erythrocytes
Authors: PETTERSSON L. , FRITHZ G. , RONQUIST G.
Published: August 2009

Abstract. Objective. High blood pressure is prevalent in obesity and non‐insulin dependent diabetes mellitus: both conditions, with insulin resistance and essential hypertension, have been associated with increasing intra‐erythrocytic levels of calcium ions. We tested the hypothesis of whether insulin itself might be responsible for the abnormal red cell cytosolic free calcium.

Design. The ionic effects of insulin were studied on the kinetics of 45calcium uptake in vitro in normal human erythrocytes.

Setting. The study was performed in the outpatient clinic of a central hospital.

Subjects. Sixteen healthy, normotensive individuals with normal body mass index were recruited for the study.

Main outcome measures. Blood from eight individuals was used for time‐dependent studies of 45calcium uptake in erythrocytes and blood from another eight individuals was used for dose‐dependent studies of insulin effect.

Results. The rate of 45calcium influx in red blood cells has two components, a fast component (0–10 min), which measures the initial rate of 45calcium influx, and a slow component (10–60 min) probably reflecting a relatively large backflux of calcium (calcium efflux), which accordingly determines an apparent low rate of 45calcium influx between 10–60 min. The uptake was linear with time between 10–120 min regardless of insulin being present or not. Insulin at a concentration of 120 mUL‐1 significantly decreased the 45calcium uptake in a timedependent fashion between 10–120 min. The uptake was 508 (±59) at 60 min in the presence of insulin vs. a control value of 529 (±59) pmol mL red blood cells‐1 (P < 0.001). The corresponding figures at 120 min were 742 (±log) and 767 (±127), respectively (P = 0.02). Inconsistent results were obtained on 45calcium uptake at 60 min by varying insulin concentrations from 40–640 mUL‐1 and a dual effect of insulin on 45calcium uptake could not be excluded, one at a fairly low concentration of insulin (40–120 mUL‐1) and another at a high concentration (160–640 mUL‐1).

Conclusion. The data indicate a direct role of insulin in the transport process of calcium into normal human erythrocytes.
Paraneoplastic vasculitic neuropathy: immunohistochemical studies on a biopsied nerve and post‐mortem examination
Authors: MATSUMURO K. , IZUMO S. , UMEHARA F. , ARISATO T. , MARUYAMA I. , YONEZAWA S. , SHIRAHAMA H. , SATO E. , OSAME M.
Published: August 2009

Abstract. We studied a patient with paraneoplastic vasculitic neuropathy (PVN) associated with a carcinoma of the common bile duct. Immunohistochemical analysis of the biopsied sural nerve showed that the cellular infiltrates in the vascular lesions were composed primarily of CD8‐positive T lymphocytes and macrophages. Pathogenic significance of the T‐cell‐mediated immunological reaction was suggested. Post‐mortem examination revealed the absence of systemic vasculitis, which may be a characteristic feature of PVN. The patient responded to immunosuppressive treatment. We discuss the efficacy and the risk of immunosuppressive therapy for PVN.
Serum sialic acid concentration is elevated in IDDM especially in early diabetic nephropathy
Authors: YOKOYAMA HIROKI , JENSEN JAN S. , JENSEN TONNY , DECKERT TORSTEN
Published: August 2009

Abstract. Objectives. Elevated serum sialic acid concentration is a strong predictor of cardiovascular mortality in non‐diabetic subjects. Because patients with insulin‐dependent diabetes mellitus (IDDM) and albuminuria have a highly increased cardiovascular morbidity and mortality, we hypothesized that IDDM patients with albuminuria would have an increased concentration of serum sialic acid.

Design. Cross‐sectional study.

Setting. Outpatient clinic at Steno Diabetes Centre, Gentofte, Denmark.

Subjects. Twenty‐six non‐diabetic controls and 74 IDDM patients with normoalbuminuria (urinary albumin excretion [UAE] < 30 mg 24 h−1; n = 37), incipient nephropathy (UAE 30–300 mg 24 h−1; n = 20) and clinical nephropathy (UAE > 300 mg 24 h−1; n = 17), matched for sex, age and body mass index (BMI).

Main outcome measures. Serum sialic acid concentration, concurrent fasting blood glucose, glycated haemoglobin (HbA1c), serum creatinine, plasma fibrinogen and erythrocyte sedimentation rate.

Results. Normoalbuminuric patients had a higher serum sialic acid concentration (mmol L−1) than non‐diabetic controls (1.83 ± 0.24 vs. 1.67 ± 0.26; P < 0.02). Serum sialic acid concentration was further increased in patients with incipient nephropathy (2.02 ± 0.37; P < 0.03) and in patients with clinical nephropathy (2.13 ± 0.33; P < 0.002) compared with normoalbuminuric IDDM patients. Serum sialic acid correlated strongly with plasma fibrinogen (r = 0.78; P < 0.0001) and erythrocyte sedimentation rate (r = 0.62; P < 0.0001). In a multiple regression analysis including UAE, retinopathy status, fasting blood glucose, HbA1c, mean blood pressure, serum creatinine, age, BMI, duration and smoking, UAE and fasting blood glucose were the independent variables which correlated significantly with serum sialic acid concentration (P < 0.0001 and P < 0.05, respectively).

Conclusion. Serum sialic acid is elevated in IDDM especially in albuminuric patients. Whether elevated serum sialic acid is predictive for early diabetic nephropathy and cardiovascular disease in IDDM has to be shown in the future.