bluuebunny/crossref_metadata_2025 huggingface dataset:
The effect of carbonic anhydrase inhibition on calcium and bone homeostasis in healthy postmenopausal women
Authors: GRAM J. , BOLLERSLEV J. , NIELSEN H. K. , LARSEN H. F. , MOSEKILDE L.
Published: August 2009

Abstract.Carbonic anhydrase localized in bone resorptive cells generates the protons necessary for bone resorption. Inhibition of the enzyme is a potential mechanism for decreasing bone resorption. Eight healthy post‐menopausal women received oral acetazolamide 250 mg twice daily for 28 d. Bone resorption, evaluated by serum acid phosphatase activity and the renal excretion of hydroxyproline, was unaltered, as was bone formation estimated by serum levels of alkaline phosphatase and osteocalcin. The fasting renal excretion of calcium was increased, whereas serum ionized calcium was unchanged. The maximal renal reabsorption of phosphate decreased, but it was not an effect of PTH as it decreased significantly during the treatment period. In conclusion, no significant effect on biochemical markers of bone remodelling could be detected during the study period. The observed changes in calcium and phosphate metabolism may be secondary to the renal effect of acetazolamide.
Continuous subcutaneous insulin infusion (CSII), multiple injections (MI) and conventional insulin therapy (CT) in self‐selecting insulin‐dependent diabetic patients. A comparison of metabolic control, acute complications and patient preferences
Authors: HAAKENS K. , HANSSEN K. F. , DAHL‐JØRGENSEN K. , VAALER S. , AAGENÆS Ø. , MOSAND R.
Published: August 2009

Abstract. Continuous subcutaneous insulin infusion (CSII) and multiple injections (MI) have been shown to have metabolic advantages in highly‐selected insulin‐dependent diabetics (IDDs), but there have been few comparative studies in self‐selected IDDs. With MI, the optimal insulin preparation for overnight insulin delivery has not been defined. We compared conventional 2‐3 injection therapy (CT), CSII and MI with human isophane insulin (MI/human isophane) and human ultralente insulin (MI/human ultralente), respectively, at bedtime in self‐selected IDDs. Of 275 IDDs who were invited to participate, 52 individuals (18.9%) entered the study. Most indices of glycaemic control showed better values on CSII and also on MI compared to CT, but the differences were small. Fasting blood glucose was higher on MI/human ultralente than on MI/human isophane. Only one subcutaneous abscess and one case of ketoacidosis requiring hospitalization occurred on CSII. Serious hypoglycaemic episodes were non‐significantly increased on intensified therapy. Most patients clearly preferred intensified insulin therapy; approximately one half CSII.
Coronary artery disease in Chinese males without hypercholesterolaemia
Authors: SHIEH S.‐M. , FUH M. M.‐T. , SHEN D.‐C. , CHEN Y.‐D. I. , REAVEN G. M.
Published: August 2009

Abstract. The aim of this study was to determine the frequency of various metabolic risk factors for coronary artery disease (CAD) in 246 male patients studied over a 2‐year period. CAD was diagnosed on the basis of a history indicative of angina pectoris, an electrocardiogram diagnostic of myocardial ischaemia, and a positive coronary angiogram. Thirty‐eight per cent of this population had diabetes, hypertension or both. Of the remaining individuals, 39% had a plasma cholesterol concentration ≥ 5.2 mmol l−1, whereas 23% had a cholesterol concentration < 5.2 mmol l−1. Plasma lipid and lipoprotein levels of a nonsmoking subset of those subjects with a total cholesterol concentration < 5.2 mmol l−1 were compared with values of a matched group of individuals who did not have significant vessel disease as revealed by angiography. The results of these investigations indicated that patients with CAD and a plasma cholesterol concentration < 5.2 mmol l−1 exhibited an increase in plasma triglyceride concentration and a decrease in plasma HDL‐cholesterol concentration. Since these subjects were not diabetic, hypertensive or hypercholesterolaemic, it is suggested that the observed changes in triglyceride and HDL metabolism made a major contribution to the CAD in these individuals.
Ischaemic heart disease among men in Norway during the period 1966‐1985: two counties with different mortality time trends
Authors: KRÜGER Ø. , WESTI S. , NYMOEN E. H.
Published: August 2009

Abstract. We have examined regional differences in mortality from ischaemic heart disease, including sudden, unexpected death (IHD/SUD), among Norwegian men aged 30‐69 years, during the period 1966‐1985. Mortality time trends were considered. The two counties with the most widely differing IHD/SUD mortality time trends were Rogaland and Oppland. Rogaland, located in south‐western Norway, experienced a 24.1% IHD/SUD mortality rate decrease between 1966‐1970 and 1981‐1985, while Oppland, in central south‐eastern Norway, experienced a mortality rate increase of 12.4%. Marked regional differences within these counties were found. The highest IHD/SUD mortality rate increase occurred in rural areas of Oppland. Urban areas of Rogaland had sharply decreasing rates. Knowledge of such regional mortality differences could provide useful information regarding aetiological factors and serve as a basis for preventive measures and health‐care planning.
Nisoldipine—effects on the renin‐angiotensin‐aldosterone system and catecholamines. Studies in normotensive and hypertensive subjects
Authors: OTTOSSON A.‐M. , KARLBERG B. E.
Published: August 2009

Abstract.We have studied the effects of nisoldipine, a new calcium channel antagonist, on the renin‐angiotensin‐aldosterone system and on plasma catecholamines in 10 healthy volunteers and in 29 patients with primary essential hypertension. Of these 29 patients, thirteen had normal renin hypertension (NRH), and sixteen had low renin hypertension (LRH). Eight healthy volunteers received placebo. Short‐term (24 h) effects were measured in all subjects and long‐term (up to 6 months) effects of 10‐40 mg nisoldipine daily were monitored in the 29 hypertensive patients. Plasma renin activity (PRA) increased slightly, although this rise was not statistically significant, 1 h after the first dose of nisoldipine in both normotensive subjects and hypertensive patients. After 2 h PRA had returned to the pre‐treatment level. No change in PRA was observed after administration of placebo. Plasma angiotensin II (AII) levels showed considerable variation after nisoldipine administration. Plasma aldosterone levels decreased despite the increase in PRA and AII concentrations. However, no concomitant reduction in urinary aldosterone excretion was observed. Plasma noradrenaline levels increased slightly 2‐4 h after administration of nisoldipine, and decreased again thereafter, but no changes in plasma adrenaline levels were seen. Nisoldipine had no long‐term effects on the renin‐angiotensin‐aldosterone system or on serum catecholamine levels.
The role of tumour necrosis factor‐α in acquired immunodeficiency syndrome
Authors: ODEH M.
Published: August 2009

Abstract. Tumour necrosis factor‐α (TNF) is a primary mediator in the pathogenesis of infection, tissue injury and inflammation. It is synthesised by various activated, phagocytic and non‐phagocytic cells, and a wide variety of infectious or inflammatory stimulae are capable of triggering TNF biosynthesis. Recent studies indicate that overproduction of TNF in septicaemia is a critical step in triggering septic shock and multiple organ damage. Intravenous administration of recombinant human TNF induced the same types of derangement in cardiovascular homatologic, inflammatory and metabolic homeostasis that are found with endotoxic or septic shock. Chronic TNF production causes a potentially lethal syndrome of cachexia, anaemia, and protein and lipid wasting. Several investigators have recently demonstrated elevated levels of serum TNF in patients with acquired immunodeficiency syndrome (AIDS), these levels being closely correlated with the severity of the disease. This review discusses the role of TNF in the pathophysiology of AIDS and of several disorders associated with the latter. In addition, it discusses the interactions between TNF and several agents used in AIDS therapy, and suggests the use of TNF‐antagonists in combination as a therapeutic regimen for AIDS patients.
Influence of dietary cod liver oil on fatty acid composition of plasma lipids in human male subjects after myocardial infarction
Authors: SKÚLADÓTTIR G. V. , GUDMUNDSDÓTTIR E. , ÓLAFSDÓTTIR E. , GUDMUNDSSON T. V. , HARDARSON T. , KRISTINSSON Á. , ÁSVALDSDÓTTIR H. , SNORRASON S. P. , GUDBJARNASON S.
Published: August 2009

Abstract. A randomized crossover study was carried out to investigate the fatty acid profile and concentrations of plasma lipids in male patients with myocardial infarction (MI) who supplemented their diet with 20 ml cod liver oil daily for 6 weeks. Subjects were divided into two groups, A and B. Group A received cod liver oil daily for 6 weeks after hospital discharge, but none for the subsequent 6 weeks. Group B did not start taking cod liver oil until 6 weeks after hospital discharge, and they then took cod liver oil for 6 weeks. Diet, medication or smoking habits were kept as constant as possible during the study. During the period of cod liver oil intake, eicosapentaenoic acid (20:5 (n‐3), EPA) and docosahexaenoic acid (22:6 (n‐3), DHA) increased significantly in phospholipids (PL), triglycerides (TG) and cholesterol esters (CE), whereas linoleic acid (18:2 (n‐6), LA), dihomo‐gamma‐linolenic acid (20:3 (n‐6), DHGLA) and arachidonic acid (20:4 (n‐6), AA) were significantly decreased in phospholipids. The plasma level of TG was significantly decreased during the cod liver oil intake. Total cholesterol, high density lipoprotein (HDL) cholesterol, and levels of apolipoproteins A1 and B were not affected by cod liver oil in these MI patients.
Atrioventricular plane displacement in severe congestive heart failure following dilated cardiomyopathy or myocardial infarction
Authors: ALAM M. , HÖGLUND C. , THORSTRAND C. , PHILIP A.
Published: August 2009

Abstract. Echocardiographic recording of the atrioventricular (AV) plane displacement during the cardiac cycle was used to assess left ventricular (LV) global function in patients with congestive heart failure (CHF). The study population consisted of 70 patients with chronic CHF (NYHA functional groups III and IV) following dilated cardiomyopathy (DCM) or myocardial infarction (MI), and 35 age‐matched healthy subjects. The AV plane displacement was recorded from the apical 4‐ and 2‐chamber views at four LV sites located about 90 degrees apart and representing the septal, anterior, lateral and posterior parts of the LV wall. A mean value was calculated from the above sites (AV‐mean). Patients with CHF showed a significant generalized reduction of AV plane displacement compared to healthy subjects (5.6 mm vs. 14.5 mm, P < 0.001). Thirty CHF patients also underwent radionuclide angiography in order to determine the ejection fraction (EF). The correlation between AV‐mean and EF was good (r=0.82, P < 0.001). The selection of an AV‐mean of < 7 mm to define a severely depressed LV function (EF < 30%) gave a sensitivity of 92% and a specificity of 67%. It is concluded that the AV plane displacement can be used to estimate LV systolic function in patients with CHF.
Drugs and femoral neck fracture: a case‐control study
Authors: JENSEN J. , NIELSEN L. H. , LYHNE N. , HALLAS J. , BRØSEN K. , GRAM L. F.
Published: August 2009

Abstract. Two hundred consecutive patients with femoral neck fractures (FNF) and 200 controls matched by age, sex, nursing home residency and number of admissions within the last 2 years, were interviewed about recent drug use. The matching criteria were chosen to achieve case and control groups that were comparable with regard to overall physical disability. Thus a preliminary study had shown FNF to be strongly associated with nursing home residency and to be correlated with the number of recent hospital admissions. FNF was found to be negatively associated with use of coronary drugs (OR = 0.27; 95% CI = 0.11‐0.70) and positively associated with drug use in general (OR = 2.00: 95% CI = 1.04‐3.05). The OR for the various classes of psychotropic drugs was consistently > 1., although this was not statistically significant. An inherent problem in interpreting such findings is that underlying disease may predispose the subject to both FNF and drug use, thus creating a non‐causal relationship.
A form of familial hypobetalipoproteinaemia not due to a mutation in the apolipoprotein B gene
Authors: FAZIO S. , SIDOLI A. , VIVENZIO A. , MAIETTA A. , GIAMPAOLI S. , MENOTTI A. , ANTONINI R. , URBINATI G. , BARALLE F. E. , RICCI G.
Published: August 2009

Abstract. Familial hypobetalipoproteinaemia (FHBL) is a dominant disorder of lipoprotein metabolism characterized by levels of apolipoprotein B‐carrying lipoproteins (VLDL, IDL and LDL) which are 50% of the normal levels in the heterozygotes and almost absent in the homozygotes. Several reports have recently shown that the underlying defect in FHBL involves different mutations in the apo B gene which lead to reduced levels of apo B mRNA or to the production of truncated forms of apo B having either a lower synthetic rate or a higher catabolic rate than normal apo B. We here present a three‐generation family with several FHBL members in which the linkage analysis shows absence of co‐segregation between apo B gene alleles and the hypocholesterolaemic phenotype. We conclude that a dominantly transmitted mutation in a gene other than that for apo B is responsible for the low plasma cholesterol levels.
Pancreatic autoantibodies and pancreatic function in Sjögren's syndrome
Authors: SUNDKVIST G. , LINDAHL G. , KOSKINEN P. , BOLINDER J.
Published: August 2009

Abstract. Pancreatic autoantibodies were determined in 49 patients with Sjögren's syndrome and related to functional parameters. Pancreatic duct autoantibodies (PDA) were detected in the sera of three patients, and all showed abnormal exocrine pancreatic function. Islet cell antibodies (ICA) were not detected in the sera of the 49 patients, including two individuals with diabetes mellitus. In conclusion, PDA occur in patients with Sjögren's syndrome, and may be associated with exocrine pancreatic dysfunction.
Effect of recombinant human erythropoietin treatment on blood pressure and some haematological parameters in healthy men
Authors: BERGLUND B. , EKBLOM B.
Published: August 2009

Abstract.The aim of this study was to evaluate the effect of treatment with subcutaneous injections of recombinant human erythropoietin (rhEpo), 20‐40 IU kg−1body weight, 3 times a week, on resting blood pressure, blood pressure response during submaximal exercise, some haematological parameters, and subjective side‐effects in 15 healthy male subjects. RhEpo increased both haemoglobin (Hb) concentration and haematocrit (Hct) significantly, the values for Hb being 152 ± 4.2 g l−1before treatment and 169 ± 9.3 g l−1(mean values ± SD) after 6 weeks of rhEpo treatment (P< 0.001). The corresponding values for Hct were 44.5 ± 1.5% and 49.7 ± 1.9% (P< 0.001), respectively. The systolic and diastolic blood pressure values at rest were unchanged after rhEpo treatment. A marked increase in systolic blood pressure was observed during submaximal exercise at 200 W, the initial and final values being 177 ± 14.2 mmHg and 191 ± 19.5 mmHg (P< 0.01), respectively. Heart rate during exercise at 200 W was significantly lower after rhEpo treatment than before it: 144 ± 15 beats min−1compared to 136 ± 8 beats min−1(P< 0.001). The leucocyte count remained unchanged after rhEpo treatment, but there was a significant decrease (P< 0.05) in the number of lymphocytes. Reticulocyte and platelet counts were unchanged. Serum (S) ferritin decreased from 87.3 ± 41.8 mmol l−1to 59.3 ± 27.8 mmol l−1after rhEpo treatment (P< 0.001). Serum‐Na, S‐K, S‐Ca, S‐creatinine, S‐bilirubin, S‐aspartate aminotranferase (ASAT), S‐alanine aminotranferase (ALAT), and S‐lactate dehydrogenase (LD) were unchanged after rhEpo treatment. No subjective side‐effects were reported. In conclusion, low doses of rhEpo increased Hb levels and Hct by more than 10% after 6 weeks. Blood pressure at rest was unchanged, but rhEpo induced a markedly accentuated blood pressure reaction during exercise. A minor decrease in the lymphocyte count was observed, but electrolyte and creatinine levels remained unchanged after rhEpo treatment.
Diurnal variation in the levels of antidiuretic hormone in the elderly
Authors: ASPLUND R. , ÅBERG H.
Published: August 2009

Abstract. The secretion of antidiuretic hormone (ADH) and the serum osmolality were measured at 4‐h intervals throughout a 24‐h period in 69 healthy elderly volunteers. In male subjects the concentrations of plasma ADH were always twofold higher than in female subjects. The normal diurnal rhythm, with increased ADH secretion during the night, was not seen in this group of elderly subjects, with the exception of elderly men who did not urinate during the night, in whom a substantial increase in plasma ADH levels occurred. In as many as 25% of all the ADH measurements performed (n = 455) ADH was not detectable by the method used. The lack of a definite diurnal rhythm in most of the elderly subjects could to some extent explain the increased diuresis during the night in the elderly.
Skeletal muscle depressed calcium and phosphofructokinase in chronic heart failure are upregulated by captopril ‐ a double‐blind, placebo‐controlled study
Authors: SYLVÉN C. , JANSSON E. , CEDERHOLM T. , HILDEBRAND I. L. , BEERMANN B.
Published: August 2009

Abstract. The effects of the angiotensin converting enzyme inhibitor captopril, after treatment for 5‐6 weeks with 25 mg t.i.d., were studied in 12 patients with stable moderate heart failure. Five patients received placebo treatment, and the two groups were comparable at baseline. Angiotensin II levels decreased in response to captopril therapy. Skeletal muscle potassium, magnesium and chloride levels did not differ from reference values. Calcium was subnormal (P < 0.0001), but increased to the reference range during captopril treatment. Phosphofructokinase, a rate‐limiting glycolytic enzyme, was in the lower reference range and increased (P < 0.04) in response to captopril therapy. In conclusion, stable moderate heart failure is associated with low levels of skeletal muscle calcium and phosphofructokinase activity, these metabolic changes tending to return to normal levels with captopril treatment.
Steady‐state concentrations and dosage of digoxin in relation to kidney function in hospitalized patients over 70 years of age
Authors: ALGOTSSON A. , SANZ E. , ALVÁN G.
Published: August 2009

Abstract. Steady‐state serum digoxin concentrations were determined and related to renal function in 62 hospitalized patients 70–93 years of age. Renal function was assessed by serum creatinine concentration, and creatinine clearance was estimated by a formula employing the serum creatinine concentration and adjusting for body weight, sex and age. The steady‐state digoxin concentration was inversely related to the estimated creatinine clearance. As there was no correlation between serum creatinine and age, a simplified estimation of creatinine clearance capacity, disregarding age and sex and allowing only for body weight and serum creatinine, was applied. It is suggested that this simplified calculation is suitable for bedside use. If the body weight/serum creatinine ratio is < 0.5 (kg × 1/μmol), approximately one‐third of our patients would have digoxin concentrations that are close to or above the upper reference limit (2.6 nmol l−1) at the maintenance dose of 0.13 mg digoxin daily. A digoxin dose of 0.07 mg daily thus appears to be suitable for many patients aged > 70 years when the body weight/serum creatinine ratio is < 0.5, and also when the serum creatinine level is normal or only slightly elevated. The half‐life of digoxin in serum was determined in 12 patients for whom digoxin treatment was withdrawn due to clinical signs of intoxication, and these half‐lives were markedly prolonged: 3.5–6 days at a body weight/serum creatinine ratio of 0.5–0.3. The seven patients with prolonged half‐lives had serum creatinine concentrations in the range 80–140 μmol l−1.
Central hypothyroidism due to isolated TRH deficiency in a depressive man
Authors: MORI M. , SHODA Y. , YAMADA M. , MURAKAMI M. , IRIUCHIJIMA T. , OHSHIMA K. , KOBAYASHI I. , KOBAYASHI S.
Published: August 2009

Abstract. A depressive man was evaluated for developing chronic fatigue and cold intolerance, in whom laboratory findings showed decreased thyroid hormone levels (T4, 2.7 μg dl−1; T3, 0.76 ng ml−1) with normal blood levels of TSH. A single bolus injection of TRH (500 μg) significantly stimulated prolactin secretion, but did not cause an increase in blood TSH levels (basal level, 1.2 μU ml−1 vs. 1.3 μU ml−1 30 min after injection). By contrast, TRH‐induced TSH stimulation occurred after repeated injection of TRH for 4 consecutive days (basal level, 1.5 μU ml−1 vs. 5.6 μU ml−1 30 min after injection). Blood thyroid hormone concentrations were restored to normal levels after long‐term administration of TRH. Other pituitary functions remained unchanged. A diagnosis of central hypothyroidism due to isolated TRH deficiency was made in this case, and the data presented here indicate that partial resistance of pituitary thyrotrophs to TRH may be associated with depression.
Counterregulatory hormonal response to insulin‐induced hypoglycaemia in insulin‐dependent diabetic patients: a comparison of equimolar amounts of porcine and semisynthetic human insulin
Authors: BENDTSON I. , BINDER C.
Published: August 2009

Abstract. The aim of the present study was to compare the degree of hypoglycaemia, the hypoglycaemic symptom score and counterregulatory responses to equimolar amounts of intravenously administered porcine and semisynthetic human insulin in a double‐blind crossover study in insulin‐dependent diabetic patients. After overnight stabilization of blood glucose to approximately 6 mmol l−1 insulin was infused from 06.00 hours at such a rate as to keep the blood glucose concentration constant at 6 mmol l−1. At 09.00 hours hypoglycaemia was induced by increasing the infusion rate to give a blood glucose level of 2 mmol l−1 within about 60 min. The individual infusion rate from the first test was repeated in the second test, 1 week later. Blood glucose minimum levels were 2.1 (range, 1.3–2.9) and 2.1 (1.3–2.8) mmol l−1 for porcine and human insulin, respectively. The insulin concentrations at blood nadirs were 107 (66–180) and 107 (56–184) pmol l−1, respectively, for porcine compared to human insulin (NS). Symptom scores at minimum blood glucose concentrations were 43 and 46, respectively, with a maximal difference in intensity of 1 point in each patient. There were no statistical differences in the counterregulatory responses of glucagon, epinephrine, norepinephrine, Cortisol, growth hormone, prolactin, beta‐endorphine or in serum‐potassium decreases. Patients were unable to discriminate between the two forms of insulin. It is concluded that there are no differences between porcine and semisynthetic insulin with regard to glucose fall, hormonal counterregulation or symptom scores, when the two forms of insulin are administered intravenously in equimolar amounts.
Hypofibrinolysis in patients with hypertension and elevated cholesterol
Authors: JANSSON J.‐H. , JOHANSSON B. , BOMAN K. , NILSSON T. K.
Published: August 2009

Abstract. To test the hypothesis that increased blood pressure and hyperlipidaemia result in changes in the fibrinolytic system, 84 subjects with both hypertension and elevated serum cholesterol levels (the high risk group) were compared with 55 controls matched with respect to age, sex and body mass index (BMI). Plasminogen activator inhibitor (PAI‐1), and tissue plasminogen activator (tPA) antigen and activity were measured before and after venous occlusion. In the high risk group, tPA activity was significantly lower both before and after venous occlusion and PAI‐1 levels were significantly higher. In a multivariate analysis the triglyceride levels, diastolic blood pressure and cholesterol levels were independently associated with the PAI‐1 levels. Diastolic blood pressure was independently and inversely associated with resting tPA activity. We conclude that patients with hypertension and hyperlipidaemia have a reduced activity of the fibrinolytic system, an effect which is unrelated to differences in age, sex, smoking or BMI.
Cause of death in unsuccessful prehospital resuscitation
Authors: SILFVAST T.
Published: August 2009

Abstract. During 1987–1988, prehospital resuscitation was unsuccessful in 204 of 381 patients who suffered a witnessed cardiac arrest due to presumed coronary heart disease in Helsinki. The cause of death was verified by autopsy in 80 (39%) of the 204 patients. Their cause of death could not be estimated on the basis of previous patient history, and their autopsy diagnoses were then related to the initial cardiac rhythm recorded at the scene. At autopsy, coronary heart disease was considered to have been the cause of death in 78% of the patients with ventricular fibrillation, in 43% of the patients with electromechanical dissociation (EMD), and in 60% of the patients in asystole. Cardiac tamponade or massive pulmonary embolism was the cause of death in 15 of the 28 patients with EMD who underwent autopsy. These findings support previously noted relationships between some causes of cardiac arrest and the initial cardiac rhythm, and also in prehospital cardiac arrest patients with unsuccessful resuscitation.
Acupuncture in angina pectoris: does acupuncture have a specific effect?*
Authors: BALLEGAARD S. , MEYER C. N. , TROJABORG W.
Published: August 2009

Abstract. To overcome the methodological problems of blinding the patients and the acupuncturist in acupuncture trials, 33 patients with stable angina pectoris, who were randomized to either genuine or sham acupuncture, received electroacupuncture by another acupuncturist, and the change in skin temperature was recorded. It was found that the change in skin temperature correlated significantly with the degree of improvement following both genuine and sham acupuncture. Fourteen patients with no decrease in skin temperature exhibited a significantly better response to acupuncture than 19 patients who showed a decrease in skin temperature (G II). In the former group, there was a 15 % median improvement in exercise tolerance (G II 0%), a 67% improvement in anginal attack rate (G II 38%), and an 84% improvement in nitroglycerine consumption (G II 50%). A significant correlation was found between the duration of disease and the effect of acupuncture. It is concluded that both genuine and sham acupuncture have a specific effect on some angina pectoris patients in addition to the effect of pharmacological therapy.
Third‐degree atrioventricular block in an athlete
Authors: HERNÁNDEZ‐MADRID A. , MORO C. , HUERTA E. MARÍN , RAYO I.
Published: August 2009

Abstract. There is a wide spectrum of changes in the resting electrocardiograms of athletes. We here present a case of third‐degree atrioventricular block in an asymptomatic young athlete.
Adrenocortical insufficiency: a rare presentation of Non‐Hodgkin's lymphoma
Authors: POOL M. OUDKERK , JANSSEN M. J. , VAN DER VALK P. , GROENEVELD A.B.J.
Published: August 2009

Abstract. A 77‐year‐old man presented with adrenocortical insufficiency, for which a cause could not be identified during life. Six weeks after the diagnosis, the patient died, while receiving adequate Cortisol therapy, from a fulminant gastrointestinal bleeding. A pleural effusion, found shortly before death, later showed malignant lymphoid cells. At autopsy, a widely spread, diffuse, malignant B‐cell lymphoma with destruction of, amongst others, both adrenals was found. The retroperitoneal, but not the peripheral lymph nodes were involved, thereby explaining failure of diagnosis while the patient was living. This is the first description of a diffuse B‐cell Non‐Hodgkin's lymphoma presenting with adrenocortical insufficiency. Potentially curable malignant invasion of the adrenals can present with adrenocortical insufficiency, and may thus justify imaging of the adrenals with sensitive techniques in elderly patients with unexplained primary adrenocortical insufficiency.
Thyroid disease in middle‐aged and elderly Swedish women: thyroid‐related hormones, thyroid dysfunction and goitre in relation to age and smoking
Authors: PETERSEN K. , LINDSTEDT G. , LUNDBERG P.‐A. , BENGTSSON C. , LAPIDUS L. , NYSTRÖM E.
Published: August 2009

Abstract. The prevalence of thyroid disease and the concentration of thyroid hormones and thyrotropin were studied in a random population sample of 1154 women, aged 50–72 years, with special reference to the effect of age and smoking. The prevalence of spontaneous hypothyroidism was 3.3% (previously unknown overt and mild disease 1.3%) and the prevalence of hyperthyroidism was 2.5% (previously unknown disease 0.2%). Clinically suspected hyper‐ or hypothyroidism (very weak to strong) was recorded in 288 women, but was only verified in three cases. The prevalence of visible and palpable thyroid enlargement was 2.1% and 13–14%, respectively. Total thyroxine concentrations increased and free tri‐iodothyronine levels decreased significantly with age (P < 0.001). The serum thyrotropin concentrations were lower in smoking women than in non‐smokers in the 50‐ and 58‐year age groups (P < 0.05). There was no increase in the prevalence of thyroid disease or goitre in the women who were smokers at the time of the study.
Prevalence of renal artery stenosis in diabetes mellitus — an autopsy study
Authors: SAWICKI P. T. , KAISER S. , HEINEMANN L. , FRENZEL H. , BERGER M.
Published: August 2009

Abstract. The prevalence of renal artery stenosis in diabetic patients is unknown, since no noninvasive and valid screening procedures are available. We have therefore evaluated 5194 consecutive autopsy protocols from patients who died between 1980 and 1988. In addition, all available clinical records for patients with renal artery stenosis (RAS) and a random sample were evaluated. It was found that 73% of patients with RAS were hypertensive, and 53% had diabetes, all but one being Type 2 (non‐insulin‐dependent). Renal artery stenosis was present in 225 (4.3%) of all patients [95% confidence interval (95% CI), 3.8–4.9], and was not reported in the patients' clinical records in 93% of cases. RAS was present in 8.3 % of all diabetic patients (95% CI, 6.8–9.8 %), the odds ratio being 3.5 (95% CI, 2.6–4.6). The frequency of renal artery stenosis in diabetic patients with hypertension was 10.1 %. Bilateral renal artery stenosis was found in 43% of patients with RAS and diabetes, and in 30% of non‐diabetic patients with RAS (P = 0.059). Our results indicate that renal artery stenosis often goes undetected before autopsy. The presence of non‐insulin‐dependent diabetes mellitus increases the risk of renal artery stenosis. The risk of bilateral renal artery stenosis is greater in diabetic patients. These results may be of significance with regard to the diagnostic evaluation and choice of antihypertensive treatment in hypertensive non‐insulin‐dependent diabetic patients.
High frequency of asymptomatic visual field defects in subjects with transient ischaemic attacks or minor strokes
Authors: FALKE P. , ABELA B. M. , KRAKAU C. E. T. , LILJA B. , LINDGÄRDE F. , MALY P. , STAVENOW L.
Published: August 2009

Abstract. The hypothesis that asymptomatic visual field defects can be found in patients with carotid transient ischaemic attacks (TIA) or minor strokes was tested. Twenty‐two consecutive male patients with TIA and 18 patients with minor strokes from the carotid artery territory were examined by perimetry, cerebral computerised tomography and regional cerebral blood flow. Asymptomatic visual field defects were found in many TIA and minor stroke patients, 29% (5/17) and 57% (8/14), respectively (NS). Eighty‐five per cent (11/13) of the scotomas were solely or predominantly located in the upper part of the visual field (P = 0.008 for absolute defects and P = 0.03 for relative defects). We conclude that both carotid territory TIA and minor stroke patients have a high frequency of asymptomatic visual field defects, predominantly located in the upper part of the visual field.
Left ventricular function and wall thickness in long‐term insulin‐dependent diabetes mellitus: an echocardiographic study
Authors: SCHMIDT A. , GROSMANN G. , HAUNER H. , KOENIG W. , JANSEN T. , STAUCH M. , HOMBACH V.
Published: August 2009

Abstract. Left ventricular function and wall thickness were evaluated in 111 type I diabetic subjects (mean age 25.5 ± 9 years, mean duration of diabetes 13.4 ± 6.2 years), using 2‐D‐derived M‐mode echocardiography. Patients were carefully selected for the absence of major coronary risk factors or manifest cardiac disorders, and compared with 91 age‐ and sex‐matched control subjects. Fractional shortening and the maximal velocity of circumferential fibre shortening did not differ significantly between the two groups. Furthermore, no differences were found in the diastolic functional parameter of velocity of circumferential fibre extension. Posterior wall thickness was significantly increased in the diabetic patients compared to the controls (9.5 ± 1.8 mm vs. 8.4 ± 1.3 mm, P < 0.01). As the thickness of the interventricular septum was also moderately increased (9.2 ± 2.2 mm vs. 8.9 ± 1.7 mm, NS), these findings provide evidence for an early structural change of the myocardium in young diabetic patients without clinically relevant functional consequences.
Zinc sulphate therapy for Wilson's disease after acute deterioration during treatment with low‐dose D‐penicillamine
Authors: VEEN C. , VAN DEN HAMER C. J. A. , de LEEUW P. W.
Published: August 2009

Abstract. A 30‐year‐old woman with Wilson's disease was treated with low‐dose D‐penicillamine. After 12 days, treatment was changed to zinc sulphate because of severe neurological deterioration. The patient subsequently improved within a few days. During a follow‐up period of 20 months, the effectiveness of therapy was evaluated by measuring copper and zinc levels in plasma and urine, and by 64Cu‐loading tests. We conclude that sulphate therapy may be a satisfactory alternative, even when rapid deterioration occurs in the early stages of D‐penicillamine treatment.
Cardiovascular risk factors in primary hyperparathyroidism: a 15‐year follow‐up of operated and unoperated cases
Authors: LIND L. , JACOBSSON S. , PALMER M. , LITHELL H. , WENGLE B. , LJUNGHALL S.
Published: August 2009

Abstract.The need for treatment of mild and apparently asymptomatic primary hyperparathyroidism (HPT) is questioned, but a raised incidence of cardiovascular disease has been regarded as evidence in favour of surgery. While it is well known that several risk factors for cardiovascular disease (hypertension, hyperlipidaemia and diabetes mellitus/impaired glucose tolerance) are overrepresented in HPT, it is not known whether surgery provides long‐term normalization in these respects and reduces the risk of premature death. In a 15‐year follow‐up of a cohort of 172 subjects in whom mild hypercalcaemia was initially detected during a health screening, it was found that 56 subjects had died, 17 individuals had been operated on for HPT, 47 individuals were persistently hypercalcaemic, while 45 subjects had serum calcium within the normal range (seven individuals were lost to follow‐up). There had been no significant differences in blood pressure between these groups of mildly hypercalcaemic patients and age‐ and sex‐matched controls at the initial screening, but at follow‐up blood pressure was significantly higher not only in subjects with persistent hypercalcaemia, but also in those who had been successfully operated on for HPT. Neither of the hypercalcaemic groups showed any significant deviations from the controls with regard to indices of lipid or glucose metabolism. These findings suggest that there is no simple cause‐and‐effect relationship to account for the propensity toward high blood pressure in primary HPT. Consequently it cannot be assumed that surgery for HPT will eliminate the increased risk of cardiovascular disease in patients with mild HPT.
Abnormal tubular handling of sodium and water induced by atrial natriuretic peptide in essential hypertension
Authors: EISKJÆR H. , JENSEN J. D. , JESPERSEN B. , SØRENSEN S. S. , PEDERSEN E. B.
Published: August 2009

Abstract. Atrial natriuretic peptide (ANP) was given as an intravenous bolus injection (2.0 μg kg−1) to 12 essential hypertensive patients (EH) and 13 normotensive control subjects (C) in order to study the effect of ANP on renal glomerular and tubular function using the lithium clearance technique. Urinary sodium excretion (EH, + 370% vs. C, + 120%; P < 0.001) and urine volume (EH, + 137% vs. C + 62%; P < 0.01) increased significantly more in EH than in controls after ANP injection. Glomerular filtration rate, renal plasma flow, and plasma concentrations of angiotensin II, aldosterone and arginine vasopressin remained almost unchanged after ANP injection, whereas the filtration fraction increased to the same extent in both groups. Both proximal (EH, − 15% vs. C, − 5%; P < 0.01) and distal fractional reabsorption (EH, − 12% vs. C, − 5%; P < 0.01) of sodium decreased more markedly after ANP in EH than in controls. The increase in plasma cGMP and urinary excretion of cGMP was the same in the two groups. Mean blood pressure decreased and heart rate increased to the same extent in both groups. It is concluded that the increase in urinary sodium excretion and urine volume induced by ANP bolus injection is exaggerated in EH due to a more pronounced reduction in the reabsorption of sodium and water in both the proximal and the distal tubule.
Reversible hypertriiodothyroninaemia due to adrenal insufficiency
Authors: COMTOIS R. , HÉBERT J. , SOUCY J.‐P.
Published: August 2009

Abstract. It is well known that an excess of glucocorticoids affects thyroid tests. The effect of adrenal deficiency on thyroid hormones is less well defined. We here describe the case of a 33‐year‐old woman with Cushing's disease who was cured by trans‐sphenoidal surgery. During the postoperative period, a secondary adrenal insufficiency developed. The thyroid blood tests then revealed elevated L‐triiodothyronine (T3) levels and a decrease in reverse T3. These findings suggest that secondary adrenal deficiency may be associated with high T3 levels, which may be due to an increase in the peripheral conversion of thyroxine (T4) to T3.
Thalassaemia trait and myocardial infarction: low infarction incidence in male subjects confirmed
Authors: GALLERANI M. , SCAPOLI C. , CICOGNANI I. , RICCI A. , MARTINELLI L. , CAPPATO R. , MANFREDINI R. , DALL'ARA G. , FAGGIOLI M. , PARESCHI P. L.
Published: August 2009

Abstract. A total of 4401 subjects admitted to the Medical Division of St Camillo Hospital in Comacchio (Ferrara, Italy) over a period of 7 years were prospectively evaluated in order to determine whether the heterozygous beta‐thalassaemic trait (HBT) could be considered as a protective factor against the occurrence of acute myocardial infarction (AMI). Of the total patient sample, 3954 subjects were non‐beta‐thalassaemics (NBTs), and 447 subjects were heterozygous beta‐thalassaemics (HBTs). AMI was diagnosed in 384 patients, of whom 17 individuals were HBTs and 367 subjects were NBTs. The prevalence of HBTs in this group was significantly lower than expected (4.43%, P < 0.0001). Furthermore, an analysis by sex showed that this lower prevalence could be attributed to male patients. Moreover, only in male subjects was a significant negative correlation observed between AMI and HBT. The mean age at which AMI occurred in male HBTs was significantly higher than in male NBTs (72 ± 2.69 vs. 63 ± 0.7 years, P < 0.05), while no differences were found in the mean age at which AMI occurred between HBT and NBT female subjects. This study demonstrates that the thalassaemic trait may afford some protection against the occurrence of AMI in men.
Excess mortality in giant cell arteritis
Authors: BISGÅRD C. , SLOTH H. , KEIDING N. , JUEL K.
Published: August 2009

Abstract.A 13‐year departmental sample of 34 patients with definite (biopsy‐verified) giant cell arteritis (GCA) was reviewed. The mortality of this material was compared to sex‐, age‐ and time‐specific death rates in the Danish population. The standardized mortality ratio (SMR) was 1.8 (95% confidence limits, 1.1–2.8). During the same period 146 patients with probable (not biopsied, but clinically diagnosed in the department) GCA and 85 cases of possible (diagnosed and treated before admission) GCA had been admitted to the department. Those two groups did not differ from the biopsy‐verified group with respect to SMR, sex distribution or age. In the group of patients with department‐diagnosed GCA (definite + probable = 180 patients), the 95% confidence interval for the SMR of the women included 1.0. In all other subgroups there was a significant excess mortality. Excess mortality has been found in two of seven previous studies on survival in GCA. The prevailing opinion that steroid‐treated GCA does not affect the life expectancy of patients is probably not correct.
Obstructive sleep apnoea syndrome in morbidly obese patients
Authors: RAJALA R. , PARTINEN M. , SANE T. , PELKONEN R. , HUIKURI K. , SEPPÄLÄINEN A. ‐M.
Published: August 2009

Abstract. Twenty‐seven morbidly obese patients (13 men and 14 women) with body mass index ≥ 40 kg m−2 were examined. The mean age of the subjects was 36.9 ± 8.2 years (range 23–51 years), and the mean BMI was 50.2 ± 6.2 kg m−2 (range 40.0–62.9 kg m−2). A whole‐night sleep recording was made for all patients with signs or symptoms indicative of possible obstructive sleep apnoea syndrome (OSAS). If the first nocturnal sleep recording was abnormal, it was controlled after 1 year. Eleven (10 men and one woman) of the 27 patients had an oxygen desaturation index (ODI) of 10 h−1. They were symptomatic with excessive daytime sleepiness or other daytime symptoms of OSAS. The occurrence of OSAS in men and women was 76.9 and 7.1%, respectively. Arterial hypertension was associated with OSAS, but not with smoking or the degree of obesity. Antihypertensive treatment was received by nine of the 27 patients; six of them had OSAS. Thus six of the 11 (54.5%) patients with OSAS and three of the 16 (18.8%) nonapnoeic patients were treated for arterial hypertension (Fisher exact test, P = 0.042). The odds ratio of OSAS for arterial hypertension is 5.2 (95% CI, 0.71–43.6). Vertical‐banded gastroplasty was performed in 14 patients, three of whom had OSAS. The selection of patients for gastroplasty was made without taking into account the results of sleep recordings. In the three OSAS patients, a 30–38% reduction in BMI was achieved by surgery. Eight patients with OSAS were treated with an intensified dietary regimen, and the reduction in BMI ranged from –2.6 to 33%. OSAS was either cured or significantly improved in six (55%) patients, with a mean reduction in BMI of 27%, while in patients with persistent OSAS the mean reduction in BMI was only 7%.
The sleep apnoea syndrome in obesity: risk of sudden death
Authors: RÖSSNER S. , LAGERSTRAND L. , PERSSON H. E. , SACHS C.
Published: August 2009

Abstract. A total of 34 severely obese men with a history of heavy snoring and excessive daytime sleepiness indicative of obstructive sleep apnoea syndrome (OSAS) were studied prospectively. Their mean age was 46 years, and mean body mass index was 41.6 kg m−2. During a 4‐year follow‐up, 15% (5/34) of these subjects died (three cases of acute myocardial infarction and two cases of pulmonary oedema), all of them suddenly and unexpectedly, outside hospital. On autopsy the degree of atherosclerosis was found to be moderate in all cases. In 68% (15/22) of the men a pathological apnoea index (mean value 46 ± 20) confirmed the OSAS diagnosis. Exercise tests and neurological examinations did not reveal any other causes of daytime sleepiness. Mean blood pressure at rest and during exercise was normal, and mean serum lipid and blood glucose levels were normal. Spirometry revealed intrapulmonary restrictive changes that could not be attributed to the heavy thoracic wall. Compliance was reduced to about 50% of reference values, and the mean pCO2 level (5.8 kPa) was close to the upper reference limit. Blood tests suggested that high alcohol consumption may be an important factor contributing to OSAS. These results demonstrate that morbidly obese men with a history of OSAS have a high risk of sudden cardiovascular death, despite the absence of other conventional risk factors.
Long‐term effects of simvastatin in familial dysbetalipoproteinaemia
Authors: STUYT P. M. J. , MOL M. J. T. M. , STALENHOEF A. F. H.
Published: August 2009

Abstract. The long‐term effects (66 weeks) of simvastatin (40 mg in one or two doses per day), an inhibitor of HMG CoA‐reductase, were evaluated in 12 patients with familial dysbetalipoproteinaemia (type III hyperlipoproteinaemia). Simvastatin had a persistent hypolipidaemic effect: the mean reduction in serum cholesterol was 36–51%, and the mean reduction in serum triglycerides was 32–55%. The decrease in serum lipids was caused by a decline in VLDL‐cholesterol and LDL‐cholesterol levels; the mean ratio between VLDL‐cholesterol and serum triglycerides decreased significantly from 1.06 to 0.73. There was no significant difference between the once‐a‐day and twice‐a‐day regimens. Simvastatin was well tolerated; no serious side‐effects were observed. These data demonstrate the usefulness of simvastatin in the therapy of familial dysbetalipoproteinaemia.
Evaluation of a structured treatment and teaching programme on asthma
Authors: MÜHLHAUSER I. , RICHTER B. , KRAUT D. , WESKE G. , WORTH H. , BERGER M.
Published: August 2009

Abstract. The objective of this study was to evaluate a structured treatment and teaching programme for adult patients with moderate to severe asthma. The design consisted of a prospective, before‐after trial; the same consecutive patients were studied before and after intervention with observation periods 1 year before and 1 year after intervention. The investigation took place within a tertiary care centre (university hospital). A total of 142 consecutive patients were referred for in‐patient treatment of their asthma, of whom 132 (93%) patients participated in the follow‐up examination. The intervention consisted of a structured 5‐d in‐patient treatment and teaching programme presented by a specialized nurse educator. The aim of the programme was for the patient to assume greater responsibility for disease management, including self‐monitoring of peak expiratory flow and qualified self‐adaptation of drug therapy. The main outcome measures were the frequency of severe asthma attacks, hospitalization and absenteeism from work (data provided by health insurance companies), patients' compliance and management skills. During the year before and the year after the intervention 71% and 36%, respectively, of patients had one or more severe asthma attacks (mean difference 35%, 95% CI: 25–45%, P < 0.0001). The percentage of patients who were hospitalized because of asthma decreased from 39% to 22% (mean difference 17%, 95% CI: 7–27%, P < 0.002). The percentage of employed patients (n = 67) who were absent from work because of asthma decreased from 60% to 43% (mean difference 17%, 95% CI: 4–30%, P < 0.04). The patients' adherence to maintenance drug therapy and their management skills improved significantly. It was concluded that the participation of patients with moderate to severe asthma in a structured treatment and teaching programme resulted in a substantial reduction in asthma morbidity in the year following the intervention.