bluuebunny/crossref_metadata_2025 huggingface dataset:
Verapamil increases serum alkaline phosphatase in hypertensive patients
Authors: SJÖDÉN G. , ROSENQVIST M. , KRIEGHOLM E. , NORDENSTRÖM J. , BJÖRKHEM I.
Published: August 2009

Abstract. In rats, verapamil decreases intestinal absorption of calcium, increases serum parathyroid hormone (PTH), and induces osteopenia. In this prospective study, verapamil 80‐120 mg three times daily was given for 2 months to 20 patients with hypertension, and the effects on calcium homeostasis were recorded. This dose of verapamil significantly reduced supine systolic and diastolic blood pressure (±SD) from 158/100 ± 9/8 mmHg to 146/89 ± 14/8 mmHg (P=0.001). Serum alkaline phosphatase (ALP) increased significantly from 2.77 ± 1.06 μkat l−1 to 3.19 ± 1.22 μkat l−1 (P=0.004), and isoenzymes of ALP of skeletal origin appeared after verapamil treatment. The excretion of sodium in the urine increased (Na/creatinine ratio 8.95 ± 6.01 before and 13.16 ± 8.26 after verapamil; P=0.04), while the excretion of calcium, phosphate and potassium was not changed. PTH was slightly increased at the end of verapamil treatment (1.09 ± 0.54 vs. 0.98 ± 0.74 μg l−1; P=0.07), and s‐1,25(OH)2D3 was also somewhat increased (22.3 ± 14.4 vs. 17.6 ± 4.9 ng l−1; P=0.26). Serum Ca was not affected by verapamil (before verapamil 2.43 ± 0.11 mmol l−1, after verapamil 2.40 ± 0.12 mmol l−1; P=0.28). The increase in serum ALP demonstrates that verapamil affects bone cell metabolism in man. This effect could be secondary to the enhancement of PTH secretion.
Metabolite and hormonal profiles in heat stroke patients at Mecca Pilgrimage
Authors: AL‐HARTHI S. S. , KARRAR O. , AL‐MASHHADANI S. A. , SADDIQUE A. A.
Published: August 2009

Abstract. Sera obtained during the Hajj seasons of 1985, 1986, 1987 and 1988 from 125 heat stroke patients were collected and subjected to chemical analysis which included determination of glucose, lactate, cholesterol, and triglycerides, as well as assay of T3, T4, TSH and Cortisol. Hyperglycaemia and lactic acidaemia were found to be the most frequent metabolic abnormalities. The changes in cholesterol did not exhibit a specific pattern. Triglycerides were significantly elevated in only 6% of patients. Cortisol levels were very significantly elevated in precooled patients. Although the mean T3 levels remained within the normal range, the mean concentration on admission was significantly higher than the post‐cooling mean. TSH and T4 levels did not show significant changes.
Kidney function and cardiovascular risk factors in non‐insulin‐dependent diabetics (NIDDM) with microalbuminuria
Authors: SCHMITZ A. , CHRISTENSEN T. , MØLLER A. , MOGENSEN C. E.
Published: August 2009

Abstract. Microalbuminuria in non‐insulin‐dependent diabetes (NIDDM) is a strong predictor of increased mortality. The major causes of death are cardiovascular, whereas end‐stage renal failure is of low frequency. To define kidney function and the presence of some assumed cardiovascular risk factors, we compared a group of 19 microalbuminuric NIDDM patients (M), of mean age (±SD) 65 ± 4 years, and known duration of diabetes 8 ± 7 years, with 19 randomly selected matched normoalbuminuric patients (N). Seven macroalbuminuric patients (P) were also studied. Glomerular filtration rate (GFR) did not differ between N and M, whereas kidney volume was increased in M (260.3 ± 54.1 ml 1.73 m−2) compared to N (220.4 ± 44.8 ml 1.73 m−2; P=0.018). The frequency of cardiac disease increased with increasing albuminuria. Glycaemic control did not differ between the groups, but fasting plasma C‐peptide levels increased from 2.8 ± 1.1 μg l−1 in N, to 3.7 ± 1.7 μg l−1 in M (P=0.08), and to 4.2 ± 1.9 μg l−1 (P=0.03) in P. The lipoprotein profile showed no significant differences, although the LDLcholesterol/HDLcholesterol (LDL‐C/HDL‐C) ratio tended to rise. A significant correlation was found between C‐peptide and LDL‐C/HDL‐C (r=0.5; P < 10−3). In conclusion, GFR was not increased, and did not differ between N and M, whereas kidney volume was enhanced in M. Several assumed cardiovascular risk factors showed values of M intermediate between those of N and P.
Interrelationship between coagulant activity and tissue‐type plasminogen activator (t‐PA) system in acute ischaemic heart disease. Possible role of the endothelium
Authors: MUNKVAD S. , JESPERSEN J. , GRAM J. , KLUFT C.
Published: August 2009

Abstract. Patients with unstable angina pectoris (UAP; n=20) and acute myocardial infarction (AMI; n=34) were studied in the acute phase of ischaemic heart disease. We found significantly higher levels of thrombin‐antithrombin‐III (TAT) complexes, lower levels of systemic tissue plasminogen activator (t‐PA) activity, and higher levels of plasminogen activator inhibitor (PAI) activity in the AMI patients compared to the UAP patients. In contrast to these specific changes, general acute phase reactants such as C‐reactive protein, fibrinogen and von Willebrand factor did not differ significantly between the two groups. Studies of the relationship between coagulation (TAT‐complexes) and fibrinolysis data revealed a significant positive correlation between plasma antigen concentrations of TAT‐complexes and t‐PA (P < 0.02), and between TAT‐complexes and PAI‐I (P < 0.002). These observations indicate a common pathophysiological mechanism underlying the changes in coagulation and fibrinolysis, suggesting that coagulation activity and t‐PA‐related fibrinolysis are interrelated processes in vivo, and probably take place at the level of the endothelial cell.
Drug related admissions to a cardiology department; frequency and avoidability
Authors: HALLAS J. , HAGHFELT T. , GRAM L. F. , GRODUM E. , DAMSBO N.
Published: August 2009

Abstract.Three hundred and sixty‐six consecutive patients admitted to a department of cardiology were evaluated for drug events as a cause of admission. The drug events considered were adverse drug reactions (ADR) and dose‐related therapeutic failures (DTF). ‘Definite’ or ‘probable’ drug events accounted for 15 admissions (4.1%, 95% confidence limits 2.3‐6.7%), of which eleven were ADR and four were DTF. With the inclusion of six ‘possible’ drug events, the rate of drug‐related hospitalizations (DRH) was 5.7%. DRHs were characterized by a preponderance of acute admissions and elderly patients. Hypokalaemia (< 3.5 nut) was observed in 27 (16%) patients receiving diuretics, and could be related to four cases of arrhythmias (two ‘probable’ and two ‘possible’ ADR). The average serum potassium level was similar in diuretic treated patients with or without drugs to counteract hypokalaemia, irrespective of the drugs chosen. Among the 15 ‘definite’/‘probable’ DRHs, five were considered to be due to an error in prescription, and a further five cases were judged to have been avoidable had appropriate measures been taken by prescribing physicians. A DRH educational intervention programme should primarily deal with non‐compliance or with prescription of diuretics or digoxin, since these problems constitute the majority of cases of DRH. No specific group of doctors could be targeted as responsible for DRH, avoidable or not.
Skeletal scintigraphy in coeliac disease
Authors: PAUL R.
Published: August 2009

Abstract. A patient with undiagnosed, long‐standing coeliac disease had multiple hot spots on skeletal scintigraphy, similar to those observed in malignant disease metastatic to the skeleton. A gluten‐free diet corrected the pathological laboratory values, and a repeat skeletal scintigram 15 months after the first one was normal. It is important to identify the secondary hyperparathyroidism of coeliac disease as a cause of multiple hot spots in skeletal scintigraphy—the finding resembles malignancy, but is due to a benign, curable condition.
Gall‐bladder perforation after long‐term dapsone therapy
Authors: CHOY A. M. , LANG C. C.
Published: August 2009

Abstract.A 65‐year‐old man on maintenance dapsone therapy for dermatitis herpetiformis for 30 years was admitted to hospital with acute abdominal pain and vomiting. Investigations revealed a Heinz body haemolytic anaemia. Worsening symptoms prompted an emergency laparotomy that revealed a perforated gall bladder with pigmented biliary calculi. In previous reviews of the haematological abnormalities associated with dapsone therapy, life‐threatening cholecystitis has not been described.
The growth hormone, prolactin and TSH response to TRH and L‐dopa in patients with hyperprolactinaemia and a normal‐sized sella turcica may denote a pituitary adenoma
Authors: BRISMAR K. , HULTING A‐L. , WERNER S.
Published: August 2009

Abstract. Forty‐one patients with hyperprolactinaemia and suspected prolactinomas were studied. Growth hormone (GH) and thyrotropin (TSH) secretory patterns after thyrotropin releasing hormone (TRH) were affected in the majority of patients. The disturbances were observed regardless of tumour size as indicated by the radiological sella size. In patients with hyperprolactinaemia and normal‐sized sella turcica, an abnormal GH and TSH response to TRH can be helpful in the diagnosis of a microadenoma. The hyperprolactinaemia per se and its effect on dopaminergic hypothalamic neurones may be the cause of the GH and TSH response. By contrast, many patients with macroprolactinomas showed insufficient GH secretory capacity.
Are blood pressure levels increasing in Denmark?
Authors: CLAUSEN J. , JENSEN G.
Published: August 2009

Abstract. The Copenhagen City Heart Study is a prospective cardiovascular population study designed to evaluate the incidence of and risk factors for cardiovascular disease. A random population sample comprising approximately 20000 individuals was invited to participate. Blood pressure was measured, and information regarding the use of antihypertensive medication was collected in an initial survey during the period 1976‐1978 (attendance rate 74%) and from a second survey during the period 1981‐1983 (attendance rate 70%). A significant increase in systolic and diastolic blood pressure between survey 1 and survey 2 was found among both men and women ≥ 40 years of age and not using antihypertensive medication. The increase in blood pressure in the follow‐up survey could not be explained by changes in methods, changes in the prescription of antihypertensive medication, or selection bias. Factors associated with changes in systolic and diastolic blood pressure were examined by multiple linear regression analysis. Both increase in body mass index and increase in alcohol consumption were positively correlated with changes in systolic and diastolic blood pressure, while use of antihypertensive medication, a high value of body mass index at survey 1 and a high level of education were negatively correlated with changes in systolic and diastolic blood pressure. Female sex and advanced age were also negatively correlated with changes in diastolic blood pressure. Consumption of tobacco and alcohol, income and changes in consumption of tobacco were not significantly correlated with changes in systolic and diastolic blood pressure.
A randomized trial of the effect of three non‐steroid antiinflammatory agents in ameliorating cancer‐induced fever
Authors: TSAVARIS N. , ZINELIS A. , KARABELIS A. , BELDECOS D. , BACOJANIS C. , MILONACIS N. , KARVOUNIS N. , KOSMIDIS P.
Published: August 2009

Abstract. Paraneoplastic fever is well known, and is not an uncommon problem in daily practice. In an effort to ameliorate tumour‐induced fever we randomized 48 patients to receive three different non‐steroid anti‐inflammatory drugs: Naproxen (500 mg d−1), Indomethacin (75 mg d−1) or Diclophenac sodium (75 mg d−1). All patients had solid tumours, and microbial infection had been excluded. All three drugs were equally effective in bringing the temperature down to normal for a period of 30‐33 d. Naproxen had the most rapid effect. In cases of fever relapse with the first drug, when the other two drugs were given instead, both proved equally effective. No side‐effects were observed. We conclude that Naproxen, Indomethacin and Diclophenac sodium are equally effective in ameliorating paraneoplastic fever. In relapse, a second drug given subsequently can be effective as well.
Diagnostic applicability of intact and midregion/C‐terminal parathyroid hormone assays in calcium metabolic disorders
Authors: RUDNICKI M. , McNAIR P. , TRANSBØL I. , LINDGREN P.
Published: August 2009

Abstract.We compared measurements of parathyroid hormone (PTH) using two assays, in order to detect intact PTH and midregion/C‐terminal PTH (M/C‐PTH) in a variety of calcium metabolic disorders. The series consisted of a total of 101 patients, including subjects with primary hyperparathyroidism (n=24), hypoparathyroidism (n=18), hypercalcaemia of malignancy (n=10), moderate chronic renal failure (n=14), chronic renal failure undergoing haemodialysis (n=19), and small bowel disorders (n=16). The intact PTH assay was superior to the M/C‐PTH assay in reflecting parathyroid function in primary hyperparathyroidism, hypoparathyroidism and hypercalcaemia of malignancy. In patients with chronic renal failure, both assays were indicators of a comparable number of patients with elevated PTH levels. Intact PTH proved most reliable in detecting changes in parathyroid hormone secretion in response to variations in ionized calcium induced by haemodialysis. In patients with extensive intestinal resection, both assays showed increased levels of PTH. It is concluded that measurement of intact PTH is a more reliable index of parathyroid function than measurement of midregion/C‐terminal PTH. Thus such an approach should be the one of choice for clinical evaluation of calcium homeostasis.
Elevation of skeletal muscle isoform of serum creatine kinase in heterozygous familial hypercholesterolaemia
Authors: BHATNAGAR D. , DURRINGTON P. N. , NEARY R. , MILLER J. P.
Published: August 2009

Abstract. Serum creatine kinase (CK) is an important adjunct in the diagnosis of myocardial infarction or in monitoring for the side‐effects of drugs. We report elevation of CK in patients with untreated heterozygous familial hypercholesterolaemia (FH) with no evidence of myocardial infarction. Of a group of 30 patients, 60% had elevated CK values on one occasion. In 40% of patients elevated CK activity was observed on most occasions. This was not related to exercise or previous lipid‐lowering therapy. These observations are of importance in view of the potential for misdiagnosis of myocardial infarction or premature withdrawal of lipid‐lowering therapy.
Rebound increase in serum thyrotropin, anti‐‘microsomal’ antibodies and thyroglobulin after discontinuation of L‐thyroxine
Authors: NYSTRÖM E. , LUNDBERG P.‐A. , LINDSTEDT G.
Published: August 2009

Abstract. We assayed serum thyrotropin (TSH), antimicrosomal antibodies (MSA), antithyroglobulin antibodies and thyroglobulin in seven individuals with subclinical autoimmune hypothyroidism during two 6‐month periods with L‐thyroxine substitution and placebo, respectively. Serum TSH decreased during L‐thyroxine administration, with a rebound increase in serum TSH of about 6 months duration during placebo treatment, and a parallel increase in serum thyroglobulin. In agreement with previous observations by other groups, we found decreased serum concentrations of MSA during L‐thyroxine treatment in three individuals. In addition, a slow but significant transient increase in serum MSA was recorded during placebo administration in the four individuals who showed the most pronounced increase in serum TSH (≥ 20 mU l−1). This association between serum levels of MSA and TSH is most probably related to antigen presentation at the surface of the thyrocyte. We conclude that changes in serum TSH concentration should be taken into account in the interpretation of MSA in patients with thyroid disease, whether untreated or treated with L‐thyroxine.
Metabolic control and complications over 3 years in patients with insulin dependent diabetes (IDDM): the Stockholm Diabetes Intervention Study (SDIS)
Authors: REICHARD P. , BRITZ A. , CARLSSON P. , CARS I. , LINDBLAD L. , NILSSON B. Y. , ROSENQVIST U.
Published: August 2009

Abstract. In a planned 5‐year study, 97 patients with insulin dependent diabetes mellitus (IDDM), non‐proliferative retinopathy and unsatisfactory blood glucose control were monitored for 3 years. The patients were randomized to an intensified conventional treatment (ICT, n=44) or a regular treatment (RT, n=53) group. HbA1c (normal range 3.9‐5.7%) was reduced from 9.5 ± 0.2 (mean value±SEM) to 7.4 ± 0.1% in the ICT group (P=0.0001), and from 9.4 ± 0.2 to 9.0 ± 0.2% in the RT group (P=0.004). Nerve conduction velocities in the sural and peroneal nerves (P=0.01‐0.0001) were impaired in the RT group, but not in the ICT group. Retinopathy increased in both groups. The condition of 22 ICT patients (50%, 95% confidence interval 34‐66%) and 37 RT patients (73%, 61‐84%) deteriorated with regard to at least one microvascular complication (retinopathy, nephropathy, neuropathy) (P=0.024). Lower HbA1c levels during the study significantly reduced the risk of deterioration (P=0.01). In total, 57% of the ICT patients had at least one episode of serious hypoglycaemia, compared with 23% in the RT group (P=0.001). The patients in the ICT group also gained weight (P=0.0001). Improved blood glucose control slowed down the progression of microangiopathy during a 3‐year period in patients with non‐proliferative retinopathy, but at the price of an increased frequency of serious hypoglycaemic episodes, and some gain in body weight.
Components of delay time in suspected acute myocardial infarction with particular emphasis on patient delay
Authors: HARTFORD M. , HERLITZ J. , KARLSON B. W. , RISENFORS M.
Published: August 2009

Abstract. Two hundred and thirty‐four patients admitted to a coronary care unit (CCU) were interviewed a few days after arrival in hospital to determine reasons for patient delay and the various components of total delay time from onset of symptoms to arrival in CCU. Of the three major components of delay, decision time (time from onset of symptoms to decision to go to hospital), and hospital procedure time (time from arrival in hospital to arrival in the CCU), were of the same magnitude, 1 h 15 min and 1 h 30 min (median), whereas the median time for preparation and transportation to hospital was somewhat shorter, being 45 min. Decision time appeared to be similar in patients with confirmed and non‐confirmed acute myocardial infarction (AMI) and was not associated with intensity of pain or infarct size. Half of the patients hesitated to go to hospital, which resulted in a prolonged decision delay (3 h). It is concluded that patient indecision to seek medical help is the most important reason for delay in hospital arrival in patients with suspected AMI.
Retroperitoneal fibrosis after surgery for aortic aneurysm in a patient with periarteritis nodosa: successful treatment with corticosteroids
Authors: HAUTEKEETE M. L. , BABANY G. , MARCELLIN P. , GAYNO S. , PALAZZO E. , ERLINGER S. , BENHAMOU J.‐P.
Published: August 2009

Abstract. A 54‐year‐old man with hepatitis B virus‐related periarteritis nodosa developed retroperitoneal fibrosis with bilateral hydronephrosis 2.5 months after placement of an aortobifemoral prosthesis for abdominal aortic aneurysm. Retroperitoneal fibrosis disappeared after treatment with corticosteroids. This observation is interesting in the light of the hypothesis that retroperitoneal fibrosis is caused by vasculitis.
Treatment of drug‐induced agranulocytosis with recombinant GM‐CSF
Authors: PALMBLAD J. , JONSON B. , KANERUD L.
Published: August 2009

Abstract. A 53‐year male patient, treated for rheumatoid arthritis with sulphasalazine, developed a total agranulocytosis. When this state had prevailed for at least 10 d no bone marrow granulocyte progenitor cells were detectable. Intravenous GM‐CSF treatment was initiated 5 d later, and the patient recovered within the next 6 d. GM‐CSF treatment for severe agranulocytosis deserves further investigation.
Unnecessary deaths from valvular aortic stenosis
Authors: OLSSON M. , ROSENQVIST M. , FORSSELL G.
Published: August 2009

Abstract. The annual mortality from aortic valvular stenosis was calculated among potential candidates for surgical replacement of the aortic valve. From the Swedish Central Register of Causes of Death, 70 patients below the age of 80 years who had died from aortic stenosis during a 1‐year period in the County of Stockholm (population 1.5 million), were identified. A retrospective analysis of their medical records showed that 37 individuals were suitable candidates for surgery. The presence of aortic stenosis had been verified at autopsy in 31 (84%) patients. The remaining six patients (16%) had their aortic stenosis diagnosis established by a thorough non‐invasive investigation performed before death. Although typical signs and symptoms of aortic stenosis were recorded in all 37 patients, only six (16 %) of them had been considered by their physicians to be suitable candidates for surgery prior to death. The deceased patients were compared with a group of 68 patients who had undergone aortic valve replacement for aortic stenosis during the same period. There were no significant differences between the two groups with regard to symptoms and clinical findings, except for a higher incidence of syncope in the operated group. It is concluded that, of 105 (68 surgically treated and 37 deceased) eligible patients with aortic stenosis, 37 individuals did not receive surgical care in time. The reason for this was probably insufficient knowledge of the curability of the disease.
High urinary cAMP in hypertensives despite careful drug treatment—an epidemiological study from the Dalby population
Authors: NILSSON P. , LINDHOLM L. , WINTHER K. , SCHERSTÉN B. , HESCH R. D.
Published: August 2009

Abstract. The correlation between serum calcium (S‐Ca), plasma parathyroid hormone (P‐PTH) and hypertension was determined in a population‐based, cross‐sectional study of carefully treated hypertensives (n=391; diastolic blood pressure 90.2 mmHg; 57 years) compared with normotensive controls (n=328; diastolic blood pressure 82.1 mmHg; 57 years). Levels of urinary cyclic‐adenosinemonophosphate (U‐cAMP), but not of plasma cAMP (P‐cAMP), were higher (P < 0.001) in hypertensives than in controls. This was the case regardless of the type of drug treatment and the blood pressure level that was reached. U‐cAMP correlated with adrenaline in multivariate analyses. S‐Ca levels were higher (P < 0.001) and S‐Mg levels were lower (P < 0.001) in hypertensives than in controls. This was not explained by thiazide treatment. Thus, despite ‘adequate’ blood pressure reduction, substantial differences in S‐Ca, S‐Mg and U‐cAMP still exist between hypertensives and normotensive controls.
Increased whole blood viscosity combined with decreased erythrocyte fluidity in untreated patients with essential hypertension
Authors: SANDHAGEN B. , FRITHZ G. , WAERN U. , RONQUIST G.
Published: August 2009

Abstract. Erythrocyte fluidity and other haemorheological variables were studied in 22 patients with essential hypertension and compared with age‐ and sex‐matched healthy controls. Hypertensive patients displayed a significantly lower erythrocyte fluidity (P < 0.001). Similarly, significantly elevated values for haematocrit, plasma and whole blood viscosity, as well as aggregation tendency were observed compared to controls. Although differing in these respects from controls, there were no obvious relationships between these rheological variables and either systolic or diastolic blood pressure. The significantly lower erythrocyte fluidity and other changes in haemorheological variables of red blood cells found in hypertensive patients may be explained by an enlarged metabolic pool of free calcium ions in these red blood cells. It is suggested that the molecular mechanisms underlying the evolution of essential hypertension are multifactorial rather than being based on a single molecular derangement. Primary events resulting in altered physicochemical properties of the red blood cells may work in concert in the development of essential hypertension, in addition to the increased availability of calcium ions and their potential role in smooth muscle contraction.
Fatal pulmonary embolism caused by streptokinase treatment of deep venous thrombosis of the leg?
Authors: HOLMSTRÖM M. , BRATT G. , TÖRNEBOHM E. , RHEDIN A.‐S. , LOCKNER D.
Published: August 2009

Abstract. During the last 10 years, four of 150 (2.7%) patients with deep venous thrombosis (DVT) treated with streptokinase (SK) at our department have died of pulmonary embolism (PE). A retrospective study of 1393 DVT patients treated with heparin during the period 1973‐1986 showed that five (0.36%) of these patients died of PE while still on heparin. In this paper we describe the four patients treated with SK who developed fatal PE. In our opinion this increase in mortality does not warrant the use of SK in routine treatment of DVT of the leg before a proper trial has been conducted to compare the frequencies of pulmonary embolism after both treatments.
Forty years of neuroglycopenia: neuropsychiatry for the internist
Authors: WOUTERS E. , VAN GAAL L. , de LEEUW I.
Published: August 2009

Abstract. The case of a 65‐year‐old patient with an insulin‐secreting pancreatic tumour and a 40‐year history of neuropsychiatric disease is reported. The physiopathology and clinical features of acute, subacute, and chronic neuroglycopenia in patients with endogenous insulin hypersecretion are discussed.
Sudden death and sleeping history among Finnish men
Authors: SEPPÄLÄ T. , PARTINEN M. , PENTTILÄ A. , ASPHOLM R. , TIAINEN E. , KAUKIANEN A.
Published: August 2009

Abstract.An autopsy was performed in 460 consecutive cases of sudden death among 35‐to 76‐year‐old men. The closest cohabiting individual known to each deceased subject was interviewed. Snoring history was obtained in 321 of the 371 interviews. In 86 cases there was a history of ‘habitual’ (almost always or always) snoring, and 88 men snored ‘often’. The mean age of subjects was 55.4 years. The mean body mass index (BMI) was 26.3 kg m−2. Among the obese snorers (n= 82), apnoeas had been observed ‘occasionally’, ‘often’, or ‘habitually’ in 49 cases. Death was classified as cardiovascular in 186 (40.4%) cases. Cardiovascular cause of death was more common among those who snored habitually or often than among those who snored occasionally or never (P < 0.05). ‘Habitual’ snorers died more often while sleeping (P< 0.05). Habitual snoring was found to be a risk factor for morning death (P< 0.01). The possibility of obstructive sleep apnoea as a cause of sudden death should at least be considered if the deceased is known to have been a habitual snorer.
Combined zidovudine and interferon‐alpha treatment in patients with AIDS‐associated Kaposi's sarcoma
Authors: de WIT R. , DANNER S. A. , BAKKER P. J. M. , LANGE J. M. A. , SCHATTENKERK J. K. M. EEFTINCK , VEENHOF C. H. N.
Published: August 2009

Abstract. The effectiveness of addition of interferon‐alpha (IFN‐alpha) to zidovudine in patients with AIDS‐associated Kaposi's sarcoma was assessed in a non‐randomized, phase II clinical trial. Twenty‐one patients were treated with oral zidovudine (600 mg daily) and IFN‐alpha (9 MU subcutaneously daily) for 8 weeks. In patients with progressive disease, IFN‐alpha was increased to 18 MU daily for another 4 weeks. Only one of the 20 evaluable patients achieved a partial response at 8 weeks, that lasted for 3 months. Despite IFN‐alpha dose escalation in six patients, no further responses were seen. While myelotoxicity was mild, fatigue was the dose‐limiting side‐effect that prevented dose escalation in seven eligible patients. The combined treatment did not result in a decrease in HIV‐Ag. In summary, our results indicate that the addition of IFN‐alpha to zidovudine in patients with AIDS‐associated Kaposi's sarcoma is not an efficacious treatment.
Serum erythropoietin levels in the anaemia of chronic disorders
Authors: CAMACHO J. , ARNALICH F. , ZAMORANO A. F. , VAZQUEZ J. J.
Published: August 2009

Abstract. Serum erythropoietin (S‐EPO) levels were measured in 50 patients with anaemia of chronic disorders (ACD), classified into three groups according to their aetiology: inflammatory (n = 20), infectious (n = 15) and neoplastic (n = 15). The inflammatory group showed a higher mean S‐EPO level (mean value ± SEM, 69 ±11 ml) ml−1) than the neoplastic (43 ± 5 mU ml−1; P < 0.05) and infectious groups (27 ± 4 mU ml−1; P < 0.01). The S‐EPO level in the inflammatory group also differed from that of 32 healthy controls (36 ± 3 mU ml−1: P < 0.05). Fourteen patients with added iron deficiency (12 subjects from the inflammatory group) showed the highest S‐EPO concentration (72 ± 17 mU ml−1). Conversely, S‐EPO levels were lower in febrile subjects (12 patients with infection and five with malignancy) than in non‐febrile patients (28 ± 4 mU ml−1 vs. 55 ± 7 mU ml−1; P < 0.01). In the infectious group, the logarithm of S‐EPO correlated directly with the haemoglobin and haematocrit values. We conclude that differences in S‐EPO concentration in ACD may be further related to the patient's iron stores and temperature. A decrease in EPO production may contribute to the pathogenesis of ACD secondary to infection.
Assessment of hypothalamic‐pituitary function in patients with familial amyloidotic polyneuropathy
Authors: OLOFSSON B.‐O. , GRANKVIST K. , OLSSON T. , BOMAN K. , FORSBERG K. , LAFVAS I. , LITHNER F.
Published: August 2009

Abstract. This study was performed to evaluate hypothalamic‐pituitary hormone regulation in patients with familial amyloidotic polyneuropathy. Twenty‐two patients without clinically overt endocrinological dysfunction were studied. A thyrotropin‐releasing hormone test revealed abnormal growth hormone regulation in 9 of 17 (53%) patients, and abnormal prolactin regulation in 9 of 18 (50%) patients. Abnormalities in either growth hormone or prolactin regulation were found in 12 of 17 (71%) patients. Serum somatomedin C levels were normal in all 22 patients. In 3 of 18 (17%) patients the plasma arginine vasopressin levels were low relative to the serum osmolality levels. Thus abnormalities in hypothalamic‐pituitary hormone regulation may be common in familial amyloidotic polyneuropathy.
Prophylactic effect of self‐administered pump‐driven subcutaneous IgG infusion in patients with antibody deficiency: a triple‐blind cross‐over study comparing P‐IgG levels of 3 g l−1 versus 6 g l−1
Authors: REMVIG L. , ANDERSEN V. , HANSEN N. E. , KARLE H.
Published: August 2009

Abstract. Eight adult patients with hypoimmunoglobulinaemia were randomly allocated to initiation of low‐ or high‐level IgG‐substitution. IgG was administered subcutaneously, at 50 or 150 mg ml−1, 20 ml per infusion, by means of a pocket‐portable electric infusion pump. Infusions were given 2 to 4 times weekly for 24 months, with a change of dose regimen after 12 months. The desired plasma IgG levels were reached after a mean lag phase of 3 months (range 1‐5 months). The median (and ranges) of the individual mean plasma IgG levels during the ensuing 9‐month periods were as follows: high‐level period, 6.5 g l−1 (range 6.2‐7.8 g l−1); low‐level period, 3.2 g l−1 (range 3.0‐4.0 g l−1). During the high‐level period, compared to the low‐level period, there was a significant decrease in the following parameters: ‘days in bed at home', ‘days missed work’ and ‘days with fever’. No serious side‐effects were observed. It is concluded that a plasma IgG concentration of 6 g l−1 can readily be achieved by subcutaneous IgG substitution, and the prophylactic effect is superior to that obtained with a plasma IgG concentration of 3 g l−1.
Platelet fatty acids and function in two distinct regions of Belgium: relationship to age and dietary habits
Authors: RENAUD S. , de BACKER G. , THEVENON C. , JOOSSENS J. V. , VERMYLEN J. , KORNITZER M. , VERSTRAETE M.
Published: August 2009

Abstract. We compared the dietary habits, fatty acid composition of plasma and platelet phospholipids, and platelet function in two groups of healthy Belgian male subjects, known to differ in their mortality rate from coronary heart disease (CHD). In the Walloon subjects, there was a larger intake of saturated and a lower intake of (n‐6) polyunsaturated fats, confirmed by the fatty acid composition of plasma and platelet phospholipids. While plasma HDL and total cholesterol were similar in the present samples of the two communities, platelet aggregation to epinephrine was significantly higher in the Walloon subjects. When the two populations were divided into younger (28‐54 years) and older (55‐73 years) age groups, the older Walloon subjects exhibited platelet hyper‐aggregability to most of the agonists, compared to the other three groups. In addition to dietary fats, alcohol and smoking habits, age was an important determinant of platelet phospholipid fatty acids and platelet reactivity. The present results reinforce those of previous studies, indicating that platelet behaviour is significantly affected by the main risk factors for CHD.
High cardiac output as a paraneoplastic syndrome
Authors: SOMVILLE J. F. , LENAERS A. P. , ABRAMOWICZ M. , NÈVE P. E.
Published: August 2009

Abstract. A high cardiac output (171 min−1) was recorded in a young man suffering from lymphoplasmatocytotic lymphoma. The evolution of the blood disease was characterized by two relapses, during which clinical signs of heart failure were prominent but resolved with efficient blood chemotherapy. The known aetiologies of high cardiac output were excluded. The complete normalization of the cardiac parameters with blood remission suggests that the high cardiac output represented an unusual paraneoplastic syndrome, the pathogenesis of which still remains unknown, although several hypotheses were tested.
Mechanical ventilation in medical and neurological diseases: 11 years of experience
Authors: LUDWIGS U. G. , BAEHRENDTZ S. , WANECEK M. , MATELL G.
Published: August 2009

Abstract. Mechanical ventilation (MV) is imperative in many forms of acute respiratory failure (ARF). The aim of this work was to review all episodes of MV in a Medical Intensive Care Unit (MICU) during the 11‐year period 1976‐1986. Four per cent (n = 1008) of 24 899 admissions to the MICU were treated with MV. The mean age of ventilator‐treated patients was 53 ± 18 years, and obviously it increased during the period of study. The average duration of MV was 4.7 d. MICU mortality, hospital mortality and 2‐year mortality rates for patients subjected to MV were 33%, 38% and 46%, respectively. The mortality rate did not change during the study period. Cerebrovascular and malignant diseases carried the highest mortality rates, 75 and 79%, respectively, whereas mortality in patients ventilated because of drug overdose (n = 313) was only 2%. The results of this study confirm previously published findings concerning the outcome of MV, and we conclude that the effects of MV remain discouraging in medical and neurological patients. Improved quality of ventilator therapy and monitoring, as well as continued research directed at the causes of ARF, are equally important in reducing the mortality in ARF.
Prostacyclin production in myocardial infarction in the acute phase and during follow‐up
Authors: RASMANIS G. , VESTERQVIST O. , GRÉEN K. , EDHAG O. , HENRIKSSON P.
Published: August 2009

Abstract. Twenty‐five patients with myocardial infarction were monitored in the acute phase and during follow‐up with regard to the in vivo production of prostacyclin (PGI2) and thromboxane (TxA2), by measurement of their major urinary metabolites, 2,3‐dinor‐6‐keto‐PGF1α and 2,3‐dinor‐TxB2, respectively. In 22 of these patients PGI2 and TxA2 production were also assessed before, during and after an exercise test performed 6 weeks after discharge. In approximately 24% of patients the in vivo production of prostacyclin did not increase during the acute phase of the infarction process. This inability was usually associated with a decrease in the release of heart muscle enzymes, and was mostly frequently observed in women. During the exercise tolerance test, none of the patients showed any increase in prostacyclin production, in contrast to healthy volunteers, in whom a significant increase was seen. There were no differences between patients with and without an increase in prostacyclin production during the acute phase. At the follow‐up 2 years after the myocardial infarction, eight cardiac events had occurred, all of which were noted among patients who exhibited an expected increase in prostacyclin production in association with the infarction. This would seem reasonable, since most of the patients in this group had larger primary infarctions.
Rapid and correct diagnosis of myocardial infarction: standardized case history and clinical examination provide important information for correct referral to monitored beds
Authors: JONSBU J. , ROLLAG A. , AASE O. , LIPPESTAD C. T. , ARNESEN K. E. , ERIKSSEN J. , KOSS A.
Published: August 2009

Abstract. The value of thorough examination of the case history as a diagnostic tool on hospitalization of patients with suspected myocardial infarction was investigated in three independent prospective studies. Use of a limited number of pain‐related elements (= ‘criteria’), that had already been obtained in the emergency room, could improve the decision on whether or not to admit patients to the coronary‐care unit. As an example, in one of the studies, use of such criteria would have reduced the number of ‘unnecessary’ coronary‐care‐unit admissions from 298 to 162, a 46% reduction (P < 0.001). In the same patient sample, use of the criteria could have reduced the number of patients with definite acute myocardial infarction, admitted to the general wards, from 47 to 22, a 53% reduction (P < 0.01). These favourable results were confirmed in the two independent, smaller‐scale studies.
Observer variation in the clinical assessment of the thyroid gland
Authors: JARLØV A. E. , HEGEDÜS L. , GJØRUP T. , HANSEN J. M.
Published: August 2009

Abstract. In order to evaluate the reliability of clinical assessment of the thyroid gland, two specialists in endocrinology and two younger doctors independently examined 53 patients twice, and assessed whether they had a diffuse goitre, a multinodular goitre, a solitary nodule or a normal gland. In 30% of the patients all four observers were in agreement, whereas in 47% and 23% of the patients, two and three different diagnoses were given, respectively. Inter‐observer variation was determined and kappa values between −0.04 and 0.54 were found. Intra‐observer variation was smaller, revealing kappa values between 0.44 and 1.00. The present study suggests that clinical assessment of the thyroid gland may lead to misclassification of the type of thyroid disease, and thereby to a less than optimal choice of therapy.
Contrasting effects of lisinopril and nifedipine on albuminuria and tubular transport functions in insulin dependent diabetics with nephropathy
Authors: HOLDAAS H. , HARTMANN A. , LIEN M. G. , NILSEN L. , JERVELL J. , FAUCHALD P. , ENDRESEN L. , DJØSELAND O. , BERG K. J.
Published: August 2009

Abstract. An open, randomized, cross‐over study was undertaken to assess the effects of lisinopril and nifedipine on albumin excretion, renal haemodynamics and segmental tubular reabsorption in overt diabetic nephropathy. The study consisted of a 4‐week run‐in period, a 3‐week active treatment period, a 4‐week wash‐out period and a second 3‐week active treatment period. Twelve patients with type 1 diabetes with albuminuria, mild to moderate hypertension and a serum creatinine level of < 200 μmol l−1 were included. Lisinopril reduced albumin excretion from 1343 ± 337 μg min−1 to 879 ± 299 μg min−1 (P< 0.01), whereas nifedipine was without effect, 1436 ± 336 μg min−1 vs. 1319 ± 342 μg min−1. Glomerular filtration rate (GFR) was unchanged by either drug. Both drugs increased effective renal plasma flow (ERPF) by about 20%. No differences between the drugs were observed with regard to their effect on renal haemodynamic parameters. By contrast, nifedipine exerted an inhibitory effect on several proximal tubular transport markers, whereas lisinopril was without effect. The different actions on tubular transport mechanisms exerted by lisinopril and nifedipine may contribute to the observed effect on albumin excretion.
Serum creatinine: an independent predictor of survival after stroke
Authors: FRIEDMAN P. J.
Published: August 2009

Abstract. We prospectively studied the relationship between serum creatinine and survival among 492 elderly subjects admitted for stroke and monitored for a mean period of 18 months post‐stroke. In multivariate proportional hazards models, serum creatinine remained an independent predictor of mortality (P= 0.0001) after accounting for other important predictors such as level of consciousness. Mini‐Mental State Score, age, leucocyte count, presence of heart disease, diabetes, heart failure, atrial fibrillation and use of cardiovascular medication. This association between elevated serum creatinine and mortality was also found in patient subgroups with CT‐proven infarction and intracerebral haematoma. It is concluded that serum creatinine is an independent predictor of survival after stroke. Further studies are required to confirm this relationship and to elucidate the underlying mechanism.
Treating insulin resistance in hypertension with metformin reduces both blood pressure and metabolic risk factors
Authors: LANDIN K. , TENGBORN L. , SMITH U.
Published: August 2009

Abstract. Insulin resistance and hyperinsulinaemia may play an important role in both the development of hypertension and its accompanying metabolic aberrations. In order to investigate this possibility, nine non‐obese, non‐diabetic, non‐smoking, middle‐aged men with untreated hypertension were treated with metformin 850 mg b.i.d. for 6 weeks as a pilot study and within‐patient comparison. Metformin decreased total and LDL‐cholesterol (P< 0.01), triglyceride (P< 0.01), fasting plasma insulin (P< 0.01) and C‐peptide levels (P< 0.02). Glucose disposal, an indicator of insulin action measured by means of the euglycaemic clamp technique, increased (P< 0.001). Tissue plasminogen activator (t‐PA) activity increased (P< 0.02), and t‐PA antigen decreased (P< 0.01), whereas plasminogen activator inhibitor (PAI‐1) and fibrinogen were unaffected by metformin treatment. Body weight remained unchanged. Withdrawal of metformin was associated with the return of both blood pressure and metabolism towards the initial levels. In conclusion, metformin treatment increased insulin action, lowered blood pressure, improved the metabolic risk factor profile and tended to increase the fibrinolytic activity in these mildly hypertensive subjects. These results support the view that insulin resistance plays a role in hypertension, and may open up a new field for the alleviation of abnormalities associated with cardiovascular disease.
Pneumothorax in a patient with Wegener's granulomatosis during treatment with immunosuppressive agents
Authors: OGAWA M. , AZEMOTO R. , MAKINO Y. , MORI Y. , UEDA S. , WAKASHIN M. , OHTO M.
Published: August 2009

Abstract. We present the case of a 16‐year‐old woman with Wegener's granulomatosis, who developed a pneumothorax while receiving treatment with cyclophosphamide and glucocorticoids. The lung was re‐expanded by tube drainage, and the patient recovered completely while the immunosuppressive treatment was continued in combination with sulphamethoxazole‐trimethoprim. A possible role for this antimicrobial drug in the treatment of Wegener's granulomatosis is briefly discussed.
Gastric lymphoma causing granulocytopenia and cold intolerance, with recovery after treatment
Authors: STAVEM P. , RØRVIK T. , BRANDTZAEG P. , BROSSTAD F. , NORDHAGEN R. , GRABNER P.
Published: August 2009

Abstract. A 34‐year‐old man was found to have granulocytopenia with a white blood count of 2.3 × 109 l−1, consisting of 10% segmented neutrophils, 50% monocytes and 40% lymphocytes. A bone marrow aspirate showed 20% promyelocytes and 10% blasts with monoblastic features, and a smouldering myelomonocytic leukaemia was considered to be a possible diagnosis. In cold weather the patient experienced cold intolerance with acrocyanosis and small ulcerations on the ears. The test for heparin‐precipitable protein ('cryofibrinogen') was strongly positive. During the following year, these signs and symptoms persisted, and the patient also developed constant moderate pain in the epigastric region. Gastroscopy revealed a large lymphoma of the stomach, which was a high‐grade malignant centroblastic type of non‐Hodgkin's lymphoma. After successful removal of the tumour, and six courses of potent cytostatic combinations, the patient recovered completely, and the granulocytopenia and cold intolerance disappeared.
Familial hypobetalipoproteinaemia complicated by cerebellar ataxia and steatocystoma multiplex
Authors: ARAKI W. , HIROSE S. , MIMORI Y. , NAKAMURA S. , KIMURA J. , OHNO K. , SHIMADA T.
Published: August 2009

Abstract. A 55‐year‐old man with cerebellar ataxia and steatocystoma multiplex was found to have reduced serum concentrations of total cholesterol, betalipoprotein and apolipoprotein B. Computed tomography revealed atrophy of the cerebellum and brain stem. Of the six family members examined, four had hypobetalipoproteinaemia, and one had mild ataxia. Similar skin lesions were noted in five male relatives. This case represents a rare combination of familial hypobetalipoproteinaemia, cerebellar ataxia and steatocystoma multiplex.
Atrial natriuretic peptide in dialysis patients under various conditions of volume homeostasis
Authors: PLUM J. , GRABENSEE B.
Published: August 2009

Abstract. Atrial natriuretic peptide (ANP) and plasma renin activity (PRA) were studied in 19 patients with end‐stage renal disease (ESRD) under haemodialysis (HD). On the basis of clinical findings, patients were divided into three groups: group A, 6 patients, of mean age 41 + 15 years, without heart failure and in need of ultrafiltration (658 ± 282 ml h−1); group B, 6 patients, of mean age 54 ± 15 years, without heart failure under isovolaemic HD; group C, 7 patients, of mean age 60 ± 3 years, with heart failure (NYHA III‐IV) and in need of ultrafiltration (607 ± 120 ml hr−1). The highest predialysis ANP levels were found in group C (1534 ± 471 pg ml−1) followed by group A (476 ± 168 pg ml−1) and group B (236 ± 138 pg ml−1) (normal range 62 ± 27 pg ml−1). Systolic and diastolic blood pressure and heart rate did not correlate with ANP levels in either of the groups. However, iso‐osmotic reduction of the body weight by ultrafiltration was correlated with decreasing ANP levels during HD (for groups A and C, r = 0.88 and 0.98, respectively). Isovolaemic HD did not alter ANP concentrations (group B). All patients received a volume bolus at the end of HD, and they responded with an instant increase in ANP concentration, which was most pronounced in patients with concomitant heart failure. PRA was not significantly correlated with ANP levels during HD. In conclusion, the results of this study indicate that there is a sensitive response of ANP levels to changes in body fluid status in ESRD.