bluuebunny/crossref_metadata_2025 huggingface dataset:
TEMPtEd: development and psychometric properties of a tool to evaluate material used in patient education
Authors: Clayton Laura H.
Published: August 2009

Title.  TEMPtEd: development and psychometric properties of a tool to evaluate material used in patient education.

Aim.  This paper describes the development and psychometric properties of a Tool to Evaluate Materials Used in Patient Education (TEMPtEd), which was designed to assist healthcare professionals to evaluate and select printed patient educational materials for their clients.

Background.  Previously‐developed instruments include attribute checklists, readability formulae and rating scales, but they have not been shown to be valid or reliable. The TEMPtEd is an attempt to overcome the limitations of previously developed instruments.

Method. The instrument was developed using Strickland’s framework, with pilot testing conducted from 2004 to 2007.

Results.  The overall ratings of a heart failure educational brochure between the TEMPtEd and the Suitability Assessment of Materials, a previously developed instrument, were not statistically significantly different. Statistically significant correlations were noted between the two instruments in the overall scale and four of the five subscales. The internal consistency of the TEMPtEd was 0·68; however, a reduction in the number of rating scale options resulted in an internal consistency of 0·83–0·84. Exploratory factor analysis identified a six‐factor solution and accounted for 74% of the variance. Study participants preferred the TEMPtEd.

Conclusion.  As a result of psychometric testing, the TEMPtEd appears to be a promising instrument for the evaluation of patient educational material.
Core measures for developmentally supportive care in neonatal intensive care units: theory, precedence and practice
Authors: Coughlin Mary , Gibbins Sharyn , Hoath Steven
Published: August 2009

Title.  Core measures for developmentally supportive care in neonatal intensive care units: theory, precedence and practice.

Aim.  This paper is a discussion of evidence‐based core measures for developmental care in neonatal intensive care units.

Background.  Inconsistent definition, application and evaluation of developmental care have resulted in criticism of its scientific merit. The key concept guiding data organization in this paper is the United States of America’s Joint Commission’s concept of ‘core measures’ for evaluating and accrediting healthcare organizations. This concept is applied to five disease‐ and procedure‐independent measures based on the Universe of Developmental Care model.

Data sources.  Electronically accessible, peer reviewed studies on developmental care published in English were culled for data supporting the selected objective core measures between 1978 and 2008. The quality of evidence was based on a structured predetermined format that included three independent reviewers. Systematic reviews and randomized control trials were considered the strongest level of evidence. When unavailable, cohort, case control, consensus statements and qualitative methods were considered the strongest level of evidence for a particular clinical issue.

Discussion.  Five core measure sets for evidence‐based developmental care were evaluated: (1) protected sleep, (2) pain and stress assessment and management, (3) developmental activities of daily living, (4) family‐centred care, and (5) the healing environment. These five categories reflect recurring themes that emerged from the literature review regarding developmentally supportive care and quality caring practices in neonatal populations. This practice model provides clear metrics for nursing actions having an impact on the hospital experience of infant‐family dyads.

Conclusion.  Standardized disease‐independent core measures for developmental care establish minimum evidence‐based practice expectations and offer an objective basis for cross‐institutional comparison of developmental care programmes.
Serum immunoglobulins and IgG subclasses in patients with glomerulonephritis
Authors: ALMROTH G. , SJÖSTRÖM P. , SVALANDER C. , DANIELSSON D.
Published: August 2009

Abstract. The serum concentrations of IgG, IgA, IgM and of the four subclasses of IgG were determined by radial immunodiffusion in 103 patients, mean age 42 (range 16–72), with various types of glomerulonephritis. Forty‐nine healthy blood donors, mean age 41 years (range 19–65), served as controls. Kidney biopsies were obtained from all the patients for examination by histopathology and by immunofluorescence. The glomerulopathies were classified according to WHO criteria.

The serum immunoglobulin patterns were different for the various clinical groups of patients. Patients with Wegener's granulomatosis, rapidly progressive glomerulonephritis and SLE had a significant increase in total IgG and of IgG4 (P < 0.05–0.001). Patients with minimal change disease had low concentrations of IgG (P < 0.001) with a significant decrease in IgG1 and IgG2 (P < 0.001 and 0.01. respectively). Highly significant increases in IgA were noted for patients with IgA nephritis (P < 0.001) but high levels were also seen in patients with chronic glomerulonephritis. The findings might have diagnostic implications.
Serum electrolytes and parathyroid hormone in patients in a coronary care unit
Authors: JOBORN H. , LUNDIN L. , HVARFNER A. , JOHANSSON G. , WIDE L. , LJUNGHALL S.
Published: August 2009

Abstract. A prospective study was carried out in 499 patients admitted to a coronary care unit (CCU) in order to evaluate the incidence of clinically significant electrolyte disturbances. Low serum potassium values (< 3.6 mmol l) occurred in 7% of the CCU patients and low serum magnesium values (< 0.70 mmol l−1) in 6%. Few patients had low values of both these ions (1.9%). In 49 patients the contents of these electrolytes in muscle biopsies were similar to the values of control subjects and were unrelated to treatment with diuretics. Serum calcium was determined in 444 of the patients and was above the reference range in 11 (2.5%). If we consider their concomitant parathyroid hormone (PTH) values, primary hyperparathyroidism was likely to occur in at least seven patients (1.5%). Patients with acute myocardial infarction (AMI) had mean PTH and electrolyte values similar to those of individuals without this disease. In conclusion, the present study indicates that clinically important disturbances of magnesium, potassium or calcium homeostasis are rare among unselected patients admitted to a CCU.
Experiences of clodronate treatment of multifocal eosinophilic granuloma of bone
Authors: ELOMAA I. , BLOMQVIST C. , PORKKA L. , HolmströM T.
Published: August 2009

Abstract. Clodronate, an inhibitor of osteoclast function, reduces bone resorption in osteolytic metastases and in multiple myeloma. We have evaluated its ability to decrease bone destruction in patients with multifocal eosinophilic granuloma of the skeleton. Two patients, whose multifocal bone granulomas appeared with a frequency of about 6 months, received 1.6 g day−1 oral clodronate for 6 months. Both patients had a reduction in serum calcium level which was accompanied by a decline in the fasting urinary hydroxyproline/creatinine and calcium/creatinine ratios and a slight increase in parathyroid hormone (PTH) level. Pain relief was observed in both patients. No new bone lesions were seen during the treatment and the old lesions healed. After discontinuing the therapy, however, new painful lesions appeared after 5 years in patient 1 and after 3, 4 and 5 years in patient 2. We suppose that clodronate delayed the appearance of new granulomas.
Computer‐detected ventricular tachycardia in the coronary care unit: prognosis in patients with and without acute myocardial infarction
Authors: FELEKE E. , HULTING J.
Published: August 2009

Abstract. Survival (for up to 6 years) in coronary care unit (CCU) patients with ventricular tachycardia (VT) was studied with the aid of an automated arrhythmia monitoring system. Ventricular tachycardia was denned as four or more consecutive ventricular beats with a rate above 120 per min. During an 18‐month period, VT was observed in 102 individuals (13%) out of 800 patients without acute myocardial infarction (AMI). The 102 patients were compared with age‐ and sex‐matched patients with AMI and VT and a group with AMI but without VT.

Hospital mortality was 27% in patients with AMI and VT, 23% in patients with AMI without VT, and 16% in non‐AMI patients with VT (NS). First year mortality after discharge was 20% in the non‐AMI group compared to 12% in the AMI groups (NS). The 1–6 years survival curves also did not differ significantly between the groups with a yearly mortality of between 5 and 6%.

Acute myocardial infarction patients with rapid VT (> 150 min−1) or long VT (more than 10 beats) had a higher hospital mortality, otherwise the number or type of VT episodes did not relate to short‐ or long‐term prognosis in the studied groups. Ventricular tachycardia in the CCU did not seem to be an indicator of poor long‐term prognosis. It is concluded that long‐term prognosis in patients with VT in the CCU was little influenced by a current diagnosis of AMI.
Platelet sodium and potassium ATP activity and noradrenaline efflux rate in relation to autonomic and peripheral nerve function in insulin‐dependent diabetic patients
Authors: BERGSTRÖM B. , MATTIASSO I. , ROSÉN I. , LILJA B. , SUNDKVIST G.
Published: August 2009

Abstract. Low sodium and potassium adenosine triphosphatase (ATPase) activity has been proposed as a mechanism behind diabetic neuropathy. In this study the platelet ATPase activity and platelet noradrenaline efflux rate were determined in 47 insulin‐dependent diabetes mellitus (IDDM) patients and 20 controls. Ulnar motor conduction velocities, tested in a subgroup, were lower in patients than in controls (52.7 ± 1.3 m s−1 vs. 61.3 ± 1.4 m s−1; P < 0.001). Platelet ATPase activity tended to be increased in the patients compared with the controls (29.9 ± 1.0 times 10−3 min−1 vs. 26.9 ± 1.1 times 10−3 min−1; NS). In ulnar nerve function tested subjects, ATPase activity was higher in patients than in controls (31.2 ± 1.7 times 10−3 min−3 vs. 25.9 ± 1.3 times 10−3 min−1; P < 0.01). The platelet noradrenaline efflux rate tended to be higher in patients with lower brake indices, a sign of autonomic neuropathy, than in controls (29.0 ± 3.0 times 10−3 min−1 vs. 21.2 ± 0.9 times 10−3 min−1; P < 0.05). The platelet ATPase activity was not decreased in IDDM patients, however, a connection between diabetic autonomic neuropathy and platelet transmittor leakage was indicated.
Effects of felodipine on plasma digoxin levels and haemodynamics in patients with heart failure
Authors: KIRCH W. , LASKOWSKI M. , OHNHAUS E. E. , ABERG J.
Published: August 2009

Abstract. The interaction between felodipine and digoxin was studied after a single oral dose and at steady state in 14 patients with congestive heart failure. Felodipine (10 mg) was randomly given as an extended release (FER) tablet in a double‐blind, placebo‐controlled, cross‐over fashion. In addition, felodipine (10 mg) was given openly as a plain tablet, following the double‐blind period. Each period lasted for 7 d. Felodipine ER did not alter the pharmacokinetics of digoxin when given as a single dose or at steady state compared with placebo. At steady state the felodipine plain tablet resulted in an 11% increase (P < 0.05) in peak plasma concentrations of digoxin. Systolic time intervals as noninvasively measured haemodynamic parameters were not significantly altered following the felodipine ER period, while the felodipine plain tablet significantly decreased the preejection/left ventricular ejection time ratio compared to placebo.
Prevalence of hereditary haemochromatosis in two Swedish urban areas
Authors: HALLBERG L. , BJÖRN‐RASMUSSEN E. , JUNGNER I.
Published: August 2009

Abstract. The prevalence of hereditary haemochromatosis (HH) was studied in Stockholm and Göteborg, the two largest cities in Sweden, using screening with transferrin saturation in combination with serum ferritin and further clinical and laboratory examinations. In Göteborg, none of 1660 men aged 50 and 51 years, randomly selected from the census register, was found to have HH. In Stockholm, nine out of 11920 male hospital inpatients were diagnosed as having HH. The calculated mean and 95% confidence ranges were consistent with earlier findings in two studies on men in Malmö, the third largest urban area in Sweden. Pooling results from these three main urban areas, the mean prevalence was 0.073% (17/23, 355), which is considerably lower than figures reported from one area in northern Sweden and from pedigree analyses in several other areas in the world. Screening of the US population in the N‐HANES II study also showed much lower figures. The reasons for these discrepancies are discussed and it is suggested that the average prevalence of HH in Caucasian populations is probably around 0.1 %.
Doppler echocardiographic assessment of the valve area in patients with atrioventricular valve stenosis by application of the continuity equation
Authors: KARP K. , TEIEN D. , ERIKSSON P.
Published: August 2009

Abstract. The orifice area was non‐invasively assessed in 19 patients with mitral or mitral and tricuspid stenosis by combined cross‐sectional and Doppler echocardiography. Stroke volume was calculated as the product of aortic or pulmonic cross‐sectional area and the time velocity integral of the flow across that valve, and the stenotic valve area was obtained as the stroke volume divided by the time velocity integral of the stenotic valve. In addition, the mitral valve area was estimated by the pressure half‐time method of Hatle et al. The non‐invasive determinations were compared with those calculated by the Gorlin formula at cardiac catheterization.

The valve area obtained by combined cross‐sectional and Doppler echocardiography showed a close correlation with the Gorlin area, r = 0.90, SEE = 0.13 cm2, n = 20. In contrast, the valve area estimated by the pressure half‐time method showed only a moderate correlation with the Gorlin area, r = 0.68, SEE = 0.38 cm2, n = 18. and estimates by this method tended to significantly overestimate the Gorlin area.

In conclusion, non‐invasive valve area determinations based on combined cross‐sectional and Doppler echocardiography can be used to accurately quantify the severity of the lesion in patients with atrioventricular valve stenosis, while determinations by the pressure half‐time method may show errors of a magnitude that limits its clinical applicability.
Do X‐ray determined cardiac volume and signs of congestive heart failure provide additional prognostic information after myocardial infarction if the left ventricular ejection fraction is known?
Authors: ROLLAG A. , MANGSCHAU A. , JONSBU J. , AASE O. , NERDRUM H. J. , ERIKSSEN J.
Published: August 2009

Abstract. Cardiac volume (CV) was measured and indices of pulmonary congestion (PCG) were judged from routine chest films taken post myocardial infarction (AMI) in a consecutive series of 477 patients (340 first and 137 recurrent AMIs). Cardiac volume (CV) and signs of PCG were compared to left ventricular ejection fraction (LVEF), measured with isotope technique, and the prognostic value of all the parameters was assessed after 1 and 5 years. The accuracy of CV and PCG in predicting impaired LVEF was low (62% and 50% respectively). Although specificity is suboptimal, however, these parameters provided valuable prognostic information. For example, patients with signs of PCG had a very high 1 and 5 years' mortality, and two‐thirds of those who died during the first year of observation had enlarged CV. The independent value of LVEF determination was mainly observed in re‐AMI patients. A more restricted use of this expensive procedure may therefore be recommended.
Coagulation inhibitor levels in pneumonia and stroke: changes due to consumption and acute phase reaction
Authors: SANDSET P. M. , ANDERSSON T. R.
Published: August 2009

Abstract. The well‐known coagulation inhibitors antithrombin and protein C, and the more recently described inhibitors, heparin cofactor II and extrinsic pathway inhibitor, were measured in plasma during a 7‐day observation period, from patients with pneumonia (n = 13), and in stroke patients with infarction (n = 9) and haemorrhage (n = 9). In patients with pneumonia, elevated fibrinopeptide A levels and subnormal antithrombin and protein C levels suggested some degree of consumption of the inhibitors. Later, an increase was observed for all the inhibitors, but was most conspicuous for heparin cofactor II which reached high normal values. C‐reactive protein, initially markedly elevated, decreased rapidly. This finding suggests that heparin cofactor II might act as a delayed acute phase reactant. In stroke patients only small, not statistically significant, changes occurred during the observation period, except for heparin cofactor II which increased in patients with haemorrhagic stroke.
Circulating tumour necrosis factor‐α (cachectin) in myocardial infarction
Authors: MAURY C. P. J. , TEPPO A.‐M.
Published: August 2009

Abstract. In a prospective study, 22 patients with prolonged chest pain were monitored by serial serum tumour necrosis factor‐α (TNF; cachectin) measurements. In five patients serum TNF markedly increased, peaking at ≥ 145 ng l−1; all these patients had large infarcts complicated by hypotension, pulmonary oedema and/or arrythmia. Two of these patients died. In contrast, TNF levels were either normal or only slightly raised in patients with small or uncomplicated infarcts and in patients with prolonged angina without evidence of infarction. The results show that extensive myocardial infarction induces the release of the monocyte/macrophage‐derived polypeptide hormone TNF into circulation. This finding may be clinically relevant with respect to systemic metabolic consequences of myocardial infarction.
Liver abscesses due to Yersinia enterocolitica in patients with haemochromatosis
Authors: OLESEN L. L. , EJLERTSEN T. , PAULSEN S. M. , KNUDSEN P. R.
Published: August 2009

Abstract. Liver abscesses due to Yersinia enterocolitica usually occur in patients with a pathological iron overload. A case of multiple liver abscesses in a patient with haemochromatosis is reported and the literature is reviewed.
Peripheral atherosclerosis in familial hypercholesterolaemia
Authors: PERHONIEMI V. , GYLLING H. , SALMENKIVI K.
Published: August 2009

Abstract. Unlike coronary artery disease, peripheral atherosclerosis is considered to be infrequent in heterozygous familial hypercholesterolaemia. The authors studied 20 consecutive asymptomatic familial hypercholesterolaemic patients and an age‐ and sex‐matched control group of consecutive normolipidaemic and asymptomatic patients admitted to the hospital for elective non‐vascular surgery. The patients and the controls were studied non‐invasively by measuring the ankle‐arm systolic blood pressure ratio at rest. Peripheral atherosclerosis was common in this study population in contrast to the control group: an abnormal (< 0.97) pressure ratio was found in 13 patients (65%) in the study group but in only one person in the control group. Eight out of 20 patients had coronary artery disease, and seven of them had an asymptomatic concomitant peripheral artery disease. Neither the classical risk factors, i.e. age, smoking, obesity, hypertension and glucose intolerance, nor serum lipid or lipoprotein status or the parameters of cholesterol metabolism correlated with peripheral atherosclerosis. It is concluded that atherosclerosis in familial hypercholesterolaemia is a multilevel disease that frequently affects also the peripheral arteries.
Long‐term follow‐up of patients treated with the QT interval sensing rate‐responsive pacemaker
Authors: HEDMAN A.
Published: August 2009

Abstract. Thirty‐seven patients (mean age 70 years) with QT‐interval sensing (TX) rate‐responsive pacemakers were followed for a mean of 27 months. This pacemaker measures the QT interval of the paced beat and, if the QT shortens, the pacing rate increases according to a programmed relationship, the ‘slope’. With TX pacing the heart rate was 56% and the exercise tolerance 15% higher than with fixed‐rate ventricular‐inhibited (VVI) pacing during exercise. Holter ECG monitoring showed a physiological rate variability. Six patients (16%) have died during follow‐up, and programming to the VVI mode was necessary in six patients (16%). The remaining patients were alive with a subjectively adequate TX function at the end of follow‐up. Including the five patients who were on TX pacing at the time of death, satisfactory TX pacing was obtained in 84% of the patients. Although the TX pacemaker has been reliable and provides an adequate rate response during exercise, complaints of worsening angina pectoris and the somewhat complicated programming of the device are problems with the current models.
Creatine kinase isoenzyme BB in the cerebrospinal fluid of patients with acute neurological diseases
Authors: BÖĐVARSSON Á. , FRANZSON L. , BRIEM H.
Published: August 2009

Abstract. In order to predict the outcome of patients with acute neurological symptoms at discharge, the concentration of creatine kinase isoenzyme BB (CK‐BB) was determined by radioimmunoassay in the cerebrospinal fluid (CSF) of 115 consecutive patients. On admission and over the next 3 days the concentration of CK‐BB was significantly increased in patients with brain death and other neurological sequelae compared with those with favourable outcome. There was a variation in time in concentrations of CK‐BB between diseases causing neurological sequelae. Thus, cerebrovascular haemorrhages caused highest concentrations on admission, but cerebral ischaemia due to cardiac arrest caused highest concentrations 3 days after admission. On admission the CK‐BB measurements were highly specific with high predictive value of positive result when distinguishing patients with brain death and other neurological sequelae from those without complications at discharge. However, when distinguishing patients with brain death from those with other neurological sequelae, the test was most specific and had highest predictive value of a positive result 3 days after admission.
Platelet count, mean platelet volume and their relation to prognosis in cerebral infarction
Authors: D'ERASMO E. , ALIBERTI G. , CELI F. S. , ROMAGNOLI E. , VECCI E. , MAZZUOLI G. F.
Published: August 2009

Abstract. The study was performed on patients with ischaemic cerebral infarction in order to obtain information on serial changes of some platelet parameters and to test their prognostic significance.

Platelet count, obtained within 48 h after cerebral infarction, was significantly lower than in the control group (213611±65652 mm−3 vs. 299525±60611 mm−3, P < 0.001), reaching the normal level on the ninth day and thereafter. The mean platelet volume was significantly greater than in the controls (11.26±1.29 fl vs. 8.93±0.93 fl. P < 0.001), and normalization generally occurred on the forty‐fifth day.

The mean platelet count was significantly lower in the patients who died than in those who survived (P < 0.025 and P < 0.05 respectively on the first to second and fourth day after infarction).

The reduction of platelet count and the increase of mean volume appear to be related to an increased platelet consumption in the infarction area, associated with an in vivo platelet activation, as larger platelets are more responsive to platelet activity and aggregability tests.

The lower mean platelet count observed in the patients who died suggests that the platelet value might be considered as a prognostic index of cerebral infarction.
Autoimmune progesterone dermatitis
Authors: TEELUCKSINGH S. , EDWARDS C. R. W.
Published: August 2009

Abstract. Hypersensitivity to progesterone is rare, but the occurrence of skin rash in the luteal phase of the menstrual cycle or during pregnancy should alert one to this possibility. The diagnosis can be readily confirmed by intradermal testing and is eminently treatable by ovulation suppression.
Changes in plasma lipoproteins in acute malaria
Authors: NILSSON‐EHLE I. , NILSSON‐EHLE P.
Published: August 2009

Abstract. Plasma lipid and lipoprotein concentrations were monitored in 16 patients with acute malaria. Plasma high density lipoprotein (HDL) levels decreased dramatically during the first 3 d after diagnosis to around 0.2 mmol l‐1 (reference range 0.8–1.6 mmol l‐1). The low HDL levels were related to parasitaemia, and rapidly recovered after successful therapy. Plasma triglyceride concentrations were moderately increased and plasma low density lipoprotein (LDL) cholesterol concentrations decreased during the course of infection. The mechanisms underlying the selective and pronounced decline in HDL cholesterol concentration remain obscure, but the reproducible phenomenon may be useful as an additional diagnostic tool in suspected malaria infection.
Mediastinal tumour as the presenting manifestation of Wegener's granulomatosis
Authors: BOUDES P.
Published: August 2009

Abstract. A 42‐year‐old man presented with a mediastinal tumour. On histological examination, tuberculosis was evoked, but no definitive conclusion could be drawn. The patient thereafter developed throat ulcerations and rapidly progressing renal insufficiency due to necrotizing glomerulonephritis. After reviewing the histological material, it was concluded that all of these manifestations were related to Wegener's granulomatosis. The presentation of Wegener's granulomatosis as a mediastinal tumour is very rare, but this form of the disease must be recognized, as early treatment with cyclophosphamide is essential for a favourable outcome.
Novel gene mutations at the low density lipoprotein receptor locus: FH‐Kanazawa and FH‐Okayama
Authors: KAJINAMI K. , MABUCHI H. , INAZU A. , FUJITA H. , KOIZUMI J. , TAKEDA R. , MATSUE T. , KIBATA M.
Published: August 2009

Abstract. Gene mutations at the low density lipoprotein (LDL) receptor locus were screened in 210 alleles of Japanese patients with familial hypercholesterolaemia (FH). In the present study, two types of novel mutation were identified by genomic Southern blotting using human LDL receptor cDNA probes.

An approximately 12 kb deletion including exons 2 and 3 (and possibly 4) was identified in a patient (M.I.). The patient with this mutant gene will be referred to as ‘FH‐Kanazawa’.

Two patients born in Okayama Prefecture in Japan had another unique 13 kb partial deletion, from exons 7 to 14, in their LDL receptor genes (FH‐Okayama). This mutant allele is the first reported case in which the central portion of the LDL receptor gene, the epidermal growth factor (EGF) precursor homology region, is eliminated.
Correlation of serum cytokine levels with haematological abnormalities in human immunodeficiency virus infection
Authors: MAURY C. P. J. , LÂHDEVIRTA J.
Published: August 2009

Abstract. Mononuclear phagocyte‐derived cytokines are important regulators of haemopoiesis in inflammatory conditions. By means of radioimmunoassay we measured the levels of two cytokines, tumour necrosis factor‐α and interleukin 1β in sera from subjects infected with human immunodeficiency virus, and related the levels to the presence and severity of haematological abnormalities. The levels of tumour necrosis factor‐α were significantly higher in patients with anaemia (142 ± 17 (SE) pg ml−1), lymphopenia (107 ± 20 pg ml−1) or both (137 ± 21 pg ml−1) than in individuals without anaemia (18 ± 5 pg ml−1; P < 0.001), without lymphopenia (16 ± 7 pg ml−1; P < 0.001) or without either disorder (19 ± 7 pg ml−1; P < 0.001). A strong negative correlation was found between tumour necrosis factor‐α and haemoglobin values (r = − 0.83, P < 0.001) and absolute lymphocyte count (r = − 0.66, P < 0.001) in human immunodeficiency virus infection. The changes in the levels of serum interleukin 1β were less pronounced but followed the same general trend as the changes in tumour necrosis factor‐α. The results show that the production of mononuclear phagocyte‐derived cytokines is enhanced in acquired immunodeficiency syndrome, and that the levels of these factors are correlated with the presence of certain haematological abnormalities.
Cardiac involvement in bone marrow transplantation: serial changes in left ventricular size, mass and performance
Authors: KUPARI M. , VOLIN L. , SUOKAS A. , HEKALI P. , RUUTU T.
Published: August 2009

Abstract. Forty‐five consecutive adult patients with haematological malignancies were studied prospectively to evaluate cardiac involvement in bone marrow transplantation (BMT). Echocardiography and measurement of systolic time intervals were performed before conditioning with cyclophosphamide (CY) (120 mg kg−1) and total body irradiation (10–12 Gy), and repeated 1 month and 1 year after BMT. The left ventricular (LV) changes at the 1‐month study included increases in mass index (85.1 ± 4.0 g m−2 vs. 76.1 ± 3.3 g m−2, mean ± SE; P < 0.001) and in the pre‐ejection period/ejection time ratio (0.46 ± 0.01 vs 0.36 ± 0.01, P < 0.001), and decreases in fractional shortening (24.9 ± 1.0% vs. 27.9 ± 0.8%, P < 0.01) and in the peak normalized diameter lengthening rate (2.2 ± 0.1 s−1 vs. 2.6 ± 0.1 s−1, P < 0.01). Four patients developed congestive heart failure. Twenty‐four patients were alive and relapse‐free 1 year after BMT. The LV measurements were then no longer different from the pre‐transplant readings. Thus BMT that is preceded by conditioning with CY and total body irradiation results in increased LV mass and impaired systolic and diastolic LV function. These changes are mostly subclinical, and are also reversible if the recipient survives the initial months after transplantation.
Temporal arteritis with normal erythrocyte sedimentation rate
Authors: GRODUM E. , PETERSEN H. A.
Published: August 2009

Abstract.A case of active temporal arteritis with persistently normal erythrocyte sedimentation rate is presented.
Infection of mural thrombus: a case report and literature review
Authors: CHEUNG A. , CHOI A.
Published: August 2009

Abstract. Infection of mural thrombus over an area of old myocardial infarct was found in an elderly woman with cholangitis. This case is unique since cholangitis was thought to be the cause of septicaemia and ventricular aneurysm was not present.
Pre‐ and postoperative evaluation of renal function with five different tests in patients with primary hyperparathyroidism
Authors: KRISTOFFERSSON A. , BACKMAN C. , GRANQVIST K. , JÄRHULT J.
Published: August 2009

Abstract. Renal function was investigated immediately before and 1 year following parathyroidectomy in 19 patients with moderate hypercalcaemia. On both occasions, all patients underwent five different tests of glomerular and tubular function: plasma creatinine, creatinine clearance, 51Cr‐EDTA‐clearance, β2‐microglobulin excretion and the desmopressin test.

Glomerular filtration rate, as assessed by plasma creatinine and clearance of both creatinine and 51Cr‐EDTA, was normal in most patients, and was little affected by restoration of normocalcaemia.

Renal concentrating capacity, as determined by the desmopressin test, was abnormally low in 14 of 19 patients, but increased significantly after surgery.

It is concluded that serious renal damage is seldom encountered in present‐day HPT patients, but that a treatable decrease in renal concentrating capacity often exists.
Carbamazepine‐induced pseudolymphoma and immune dysregulation
Authors: SINNIGE H. A. M. , BOENDER C. A. , KUYPERS E. W. , RUITENBERG H. M.
Published: August 2009

Abstract. Pseudolymphoma is a condition that closely resembles malignant lymphoma, both clinically and on histopathological examination. Immunological cell typing is necessary for correct diagnosis.

We present here the case of a patient with carbamazepine‐induced generalized lymphadenopathy, hepatosplenomegaly, anaemia, abnormal differential leucocyte count, and hypergammaglobulinaemia. There was evidence of severe immune dysregulation. All abnormalities subsided spontaneously after withdrawal of carbamazepine and the patient remained in good health afterwards.
Plasma fibrinogen — an independent cardiovascular risk factor
Authors: ERNST E.
Published: August 2009

Abstract. Apart from being an acute phase reactant, fibrinogen appears to play an important although not widely recognized role in athero‐/thrombogenesis. Arteriosclerotic diseases are associated with elevated levels of plasma fibrinogen. Strategies that lower the cardiovascular risk also lower fibrinogen levels. Virtually all accepted risk factors are associated with hyperfibrinogenaemia, while low risk populations usually have low fibrinogen levels. Epidemiological studies show that fibrinogen is a predictor of arteriosclerotic diseases. Its predictive power seems to be as high as or higher than accepted risk factors. These findings and other circumstantial, as well as experimental, evidence suggest that fibrinogen is a powerful, independent cardiovascular risk factor.
The effect of serum lipid regulation on the development of femoral atherosclerosis in hyperlipidaemia: a non‐randomized controlled study
Authors: OLSSON A. G. , RUHN G. , ERIKSON U.
Published: August 2009

Abstract. The development of femoral atheroma after 1 year of treatment with diet and nicotinic acid plus fenofibrate was studied in 45 asymptomatic, hyperlipidaemic, middle‐aged male subjects in a non‐randomized controlled study. The median serum very low density lipoprotein (VLDL) cholesterol concentration and the low density lipoprotein (LDL) cholesterol concentration were lowered by 67% and 36%, respectively, in the treatment group. The median serum high density lipoprotein (HDL) cholesterol concentration was increased by 23%.

Femoral atheroma was estimated by overall atherosclerosis score (OAS). Changes in femoral atherosclerosis were estimated by intrapair comparison of angiograms. Progression was found in 24% and 40% in the treatment and control groups, respectively. Regression occurred in 29% and 0%, respectively.

The OAS decrease correlated with reductions in VLDL cholesterol and systolic blood pressure.
Use of anabolic‐androgenic steroids among body builders — frequency and attitudes
Authors: LINDSTRÖM M. , NILSSON A. L. , KATZMAN P. L. , JANZON L. , DYMLING J.‐F.
Published: August 2009

Abstract. A total of 138 male body builders who regularly attended a gym participated anonymously in a study of the use of anabolic‐androgenic steroids in relation to side‐effects, blood pressure, body mass index (BMI; kg m−2), training frequency, social background, occupation, knowledge and attitudes to steroid use. Fifty‐three of the 138 body builders had used anabolic‐androgenic steroids for a median duration of 2 years. Steroid use was linked to a higher BMI and more frequent training. Seventy‐five per cent (n = 18) of those attending body building for competition, and 24% (n = 11) of those attending to improve their sense of well‐being, used anabolic‐androgenic steroids. Of all body builders, 94% considered anabolic‐androgenic steroids to be dangerous. Of the users, 81% experienced side‐effects, but 74% still intended to continue steroid medication.
Consumption, overdose and death from analgesics during a period of over‐the‐counter availability of paracetamol in Denmark
Authors: OTT P. , DALHOFF K. , HANSEN P. B. , LOFT S. , POULSEN H. E.
Published: August 2009

Abstract.During the period 1978–1986, annual sales of paracetamol in Denmark increased from 1 million defined daily doses (DDD) (3 g) to 47 million DDD, while the number of admissions and deaths from overdose increased from 26 to 202 and from 1 to 3–4, respectively. The corresponding figures for salicylates are a decrease in sales from 113 to 94 million DDD, an increase in admissions from 282 to 595, and an increase in deaths from 5 to 22. From 1 January 1984 paracetamol became available on an over‐the‐counter basis. The figures for 1983 and 1984 were an increase in sales from 14 to 28 million DDD, an increase in admissions from 114 to 198, and an increase in deaths from 0 to 4. The number of deaths from opioid overdose remained constant at a value of about fifty during this period, the mortality per dose being about 20‐fold higher than for paracetamol and salicylates. Dextropropoxyphene‐related deaths increased twofold to 121 in 1986, with unchanged sales figures. A campaign launched by the National Board of Health resulted in a reduction in the number of deaths from dextropropoxyphene to 66 in 1987. The main effect of over‐the‐counter release of paracetamol was a dramatic increase in sales, without the epidemic of deaths observed a decade ago in the UK. It is suggested that the higher mortality of paracetamol poisonings in the UK compared to Denmark is related to the dextropropoxyphene content of the combination product, which is not available in Denmark. From an epidemiological toxicological viewpoint such combinations are not justified.
A prospective study of the diagnostic value of urinary thromboxane in patients presenting with acute chest pain
Authors: LORENZ R. L. , HAMM C. W. , RIESNER H. , BLEIFELD W. , WEBER P. C.
Published: August 2009

Abstract. In chance single‐case observations thromboxane excretion has been reported to increase several days prior to myocardial infarction. To test its frequency and potential diagnostic value we prospectively measured thromboxane excretion in 166 consecutive patients who had presented to the emergency unit with acute chest pain indicative of ischaemia. Thromboxane excretion at presentation was increased, sometimes dramatically, in 17 of 33 (52%) patients with unstable angina, in 42 of 73 (57%) patients with definite myocardial infarction, but in only two of 14 (14%) patients with stable angina. Nineteen of 29 patients undergoing early angiography had detectable intracoronary thrombi, and these patients excreted significantly more thromboxane than patients without thrombi. Ongoing platelet activation may be detected by increased thromboxane excretion in more than 50% of the patients presenting with unstable angina and myocardial infarction, particularly in those with intracoronary thrombi, but it is not a general phenomenon that can be used in diagnosis.
Azathioprine and allopurinol: a potentially dangerous combination
Authors: RAMAN G. VENKAT , SHARMAN V. L. , LEE H. A.
Published: August 2009

Abstract. We report the association of leucopenia and anaemia in five patients given a combination of azathioprine and allopurinol. Three subjects were renal transplant recipients with mild to moderate impairment of graft function. The complication appeared between 4 and 6 weeks following initiation of the combination therapy. Discontinuation of one of the two drugs resulted in full recovery within 4–8 weeks.
Measurement of leukotriene B4 in arterial blood of asthmatic patients during wheezing attacks
Authors: SHINDO K. , MATSUMOTO Y. , HIRAI Y. , SUMITOMO M. , AMANO T. , MIYAKAWA K. , MATSUMURA M. , MIZUNO T.
Published: August 2009

Abstract.To investigate whether leukotriene B4 is present in the arterial blood of asthmatic patients during wheezing attacks. 20 ml of arterial blood was drawn from the inguinal artery of five patients. Leukotriene B4 was detected in all five individuals, and its identity was confirmed by a combination of high pressure liquid chromatography and radioimmunoassay techniques. The concentration of leukotriene B4 was 48.34 ± 16.27 pg ml−1(mean value ± SE). However, in five control subjects the leukotriene B4 concentration was found to be 9.43 ± 5.44 pg ml−1. Thus there was a significant difference between the two groups (P < 0.05). These results suggest that leukotriene B4 may be important in elucidation of the pathogenesis of bronchial asthma.
The predictive capability of the glycaemic response to spaghetti in non‐insulin dependent (NIDDM) and insulin dependent (IDDM) diabetic subjects
Authors: RASMUSSEN O. , GREGERSEN S. , HERMANSEN Dr.K.
Published: August 2009

Abstract. To evaluate the predictive capability of the postprandial blood glucose response after consumption of a starch‐rich meal, we compared the glycaemic effects of spaghetti (60 g) taken alone and with bolognese sauce (167 g). The study was carried out in both NIDDM (n = 6) and IDDM (n = 6) subjects. The latter had achieved normoglycaemia 120 min prior to the test meal by means of an artificial pancreas (Biostator®) which provided constant insulinaemia during the observation period of 4 h. We found that the areas of blood glucose (above basal) were identical irrespective of whether spaghetti was taken alone or as part of a mixed meal in both NIDDM (484 ± 1 54 mmol l−1 240 min−1 vs. 393 ± 126 mmol l−1 240 min−1) and IDDM subjects (6.10 ± 143 mmol l−1 240 min−1 vs. 770 ± 135 mmol l−1 240 min−1). The insulin levels were identical in the IDDM diabetics. By contrast, the mixed meal caused a more marked insulinaemic response than spaghetti per se in the NIDDM subjects (3187 ± 637 mU l−1 240 min−1 vs. 1940 ± 235 mU l−1 240 min−1; P < 0.05). In conclusion, the predictive capability of the glycaemic response to spaghetti was good in both IDDM and NIDDM diabetic subjects, at least under the conditions of the present study.
Neuroendrocine pancreatic tumours: clinical presentation, biochemical and histopathological findings in 84 patients
Authors: ERIKSSON B. , ARNBERG H. , LINDGREN P.‐G. , LÖRELIUS L.‐E. , MAGNUSSON A. , LUNDQVIST G. , SKOGSEID B. , WIDE L. , WILANDER E. , ÖBERG K.
Published: August 2009

Abstract. A prospective study has been performed on 84 patients with endocrine pancreatic tumours evaluated at the Medical Department in Uppsala. Available information concerning the patients' presenting symptoms, age at diagnosis, clinical syndrome, tumour location, location of metastases, diagnostic radiology, biochemical and histopathological findings has been analysed. Our results indicate that most patients initially show rather vague and non‐specific symptoms, with dyspepsia and pain being the most frequent presenting features. The median delay between appearance of the first symptom and diagnosis was 2 years; the delay was 3 5 months in sporadic cases and 14.5 months in familial cases. In spite of improvements in diagnostic methods, the median age at diagnosis (53 years) has not been reduced, and most patients are encountered when the tumour has reached an advanced stage. There is a need for a method of screening patients with still uncharacteristic abdominalsymptoms for a neuroendocrine tumour. The presence of elevated levels of plasma chromogranin in all patients with a proven tumour suggests that such possibilities exist, and the use of this biochemical marker in the future might reduce the age at diagnosis and thus improve the likelihood of cure and survival of patients with endocrine pancreatic tumours.
Phlegm production in plain cigarette smokers who changed to filter cigarettes or quitted smoking
Authors: LANGE P. , GROTH S. , NYBOE J. , MORTENSEN J. , APPLEYARD M. , SCHNOHR P. , JENSEN G.
Published: August 2009

Abstract. Data from a prospective epidemiological study that included 2025 plain cigarette smokers were analysed to investigate the effect on phlegm production of changing to filter cigarettes or quitting smoking. During a 5‐year follow‐up, 189 subjects quitted smoking, 312 changed to filter cigarettes, while 1524 continued to smoke plain cigarettes. Multiple logistic regression was used to adjust for age, duration of smoking, number of cigarettes smoked, socio‐economic status and alcohol consumption. Smokers with morning phlegm at enrolment, who changed to filter cigarettes during the follow‐up, had a probability ratio of 1.9 of phlegm production ceasing, compared with smokers who continued to smoke plain cigarettes (P < 0.05). However, the probability ratio of developing morning phlegm among smokers who changed to filter cigarettes compared to those who continued to smoke plain cigarettes was 1.6 (P < 0.05). The overall prevalence of morning phlegm at the end of the follow‐up was the same in smokers who changed to filter cigarettes as in persistent plain cigarette smokers. The trends for chronic phlegm were similar, although they did not reach statistical significance. The smokers who stopped smoking had a probability ratio of 0.4 of developing morning phlegm (P < 0.01) and a ratio of 7.7 for ceasing to produce it (P < 0.001) compared to the smokers who continued to smoke plain cigarettes. Our results suggest that changing from plain to filter cigarettes is associated with a higher frequency of cessation of phlegm production, but offers no protection against the development of phlegm.
Erythrocyte sodium transport in malignant hypertension
Authors: HERLITZ H. , HILME E. , JONSSON O. , GUDBRANDSSON T. , HANSSON L.
Published: August 2009

Abstract. Twenty‐three patients with treated malignant hypertension (MH), 23 patients with treated non‐malignant hypertension (NMH) and 46 normotensive control subjects were investigated with regard to intraerythrocyte sodium (Na) and potassium (K) levels, as well as transmembrane fluxes of sodium (Na‐influx and Na‐efflux rate constant). Intraerythrocyte Na and K concentrations were determined by flame photometry. The Na‐influx and Na‐efflux rate constant were calculated from uptake values for 22Na in vitro. In NMH the Na‐influx and Na‐efflux rate constant were significantly higher while intraerythrocyte Na and K levels did not differ from the controls. Patients with MH tended to have an elevated intraerythrocyte Na concentration, but an unchanged Na‐influx and Na‐efflux rate constant relative to controls. The increased rate of erythrocyte membrane transport of Na in treated NMH could be due to a stimulatory effect of antihypertensive treatment on cellular Na transport. Patients with treated MH do not show this effect and, in addition, tend to have an elevated intraerythrocyte Na concentration, which is compatible with the existence of a more pronounced abnormality of cellular ion transport in MH.
Do‐not‐resuscitate orders in Swedish medical wards
Authors: ASPLUND Dr.K. , BRITTON M.
Published: August 2009

Abstract. In a nation‐wide survey, procedures related to do‐not‐resuscitate (DNR) orders in Swedish medical wards were investigated by means of a questionnaire given to internists‐in‐charge. The response rate was 89% (286 out of 323), of whom all but 2% (seven individuals) stated that DNR orders were used in their wards. The most common procedure was an oral direction to the nurse, who documented the order in the nurses' day‐to‐day work sheet. The DNR orders were signed by 28% of the physicians. A wide range of symbols and code words were used, and there was considerable disagreement regarding the meaning of a DNR order. Such orders were often associated with withdrawal and withholding of life‐sustaining treatments other than cardiopulmonary resuscitation. Most physicians stated that they never discuss DNR order with the patients, and that only in a minority of DNR decisions do they involve family members. There was considerable conflict with regard to DNR ordering procedures not only between internists in different hospitals, but also within individual hospitals.
Urinary free Cortisol excretion shortly after ischaemic stroke
Authors: OLSSON Dr.T.
Published: August 2009

Abstract. The Cortisol axis and catecholamine excretion were studied in 20 patients within the first week after acute ischaemic stroke. Urine free Cortisol and plasma Cortisol levels after dexamethasone were significantly higher in stroke patients than in 80‐year‐old volunteers (n = 32; P= 0.03 and P= 0.003, respectively). Catecholamine excretion was found to be significantly correlated with urine Cortisol concentration (r = 0.54, P< 0.05) and limb paresis (r = 0.52, P< 0.05). In a multiple regression analysis, urine Cortisol values were shown to be positively associated with limb paresis (P= 0.003), disorientation (P= 0.03) and body temperature (P= 0.03). High Cortisol excretion was associated with a poorer functional outcome in a discriminant analysis (P= 0.001). Thus acute ischaemic stroke is associated with an increased activity in the Cortisol axis. This may have a number of negative effects on organ functioning, and is a predictor of a poorer functional outcome.