bluuebunny/crossref_metadata_2025 huggingface dataset:
Antacid‐induced osteomalacia: a case report with a histomorphometric analysis
Authors: KASSEM M. , ERIKSEN E. F. , MELSEN F. , MOSEKILDE L.
Published: August 2009

Abstract. The case of a 75‐year‐old woman with severe osteomalacia secondary to ingestion of large amounts of an aluminum‐containing antacid is reported. Biochemical analysis revealed signs of phosphate malabsorption and increased levels of bone markers (S‐alkaline phosphatase and U‐hydroxyproline). A 99mTc‐bone scan revealed multiple areas of increased uptake. The patient was normocalcaemic, with normal serum levels of intact parathyroid hormone and 25‐hydroxyvitamin D. Serum 1,25‐dihydroxyvitamin D was high normal. A transiliac bone biopsy from the patient showed severe osteomalacia. Symptoms, biochemical parameters, bone scan and bone morphology were all normalized 1 year after stoppage of antacid ingestion and treatment with vitamin D2, calcium phosphate and sodium fluoride because of severe osteopeni. The characteristics of this condition and the role of phosphate depletion and aluminum in the pathogenesis of bone lesions are discussed.
Blood analyses and survival in symptom‐ and survey‐detected lung cancer patients
Authors: HANNISDAL E. , ENGAN T.
Published: August 2009

Abstract.Commonly recorded blood analyses as indicators of low‐ and‐high risk patients with lung cancer were studied by comparing symptom‐ and survey‐detected patients. During the period 1976–1985, in 41 of 189 non‐small‐cell lung cancer patients in Western Norway, lung cancer was detected by chest X‐ray survey performed in the preventive tuberculosis screening programme. After adjusting for other variables, including developmental stage, erythrocyte sedimentation rate (ESR) was the only blood analysis which discriminated symptom‐detected patients (high ESR) from survey‐detected patients (low ESR). Survey‐detected patients had a better short‐term survival. In multivariate survival analyses leucocyte count, lactate dehydrogenase activity and ESR were significant prognostic factors, in addition to advanced stage and detection due to symptoms. We conclude that common blood analyses such as ESR provide supplementary information concerning low‐and high‐risk lung cancer patients.
Glycaemic thresholds for hypoglycaemic symptoms, impairment of cognitive function, and release of counterregulatory hormones in subjects with functional hypoglycaemia
Authors: SNORGAARD O. , LASSEN L. H. , ROSENFALCK A. M. , BINDER C.
Published: August 2009

Abstract. Nine patients with food‐relieved hypoglycaemic symptoms, in whom insulinoma and other organic diseases presenting with hypoglycaemia had been ruled out, and nine matched controls, participated in the study. Subjects were studied during a 5‐h controlled (Biostator) insulin‐induced (1–2 mU kg−1 min−1) hypoglycaemic clamp. After 1 h of euglycaemia, we aimed to lower the glucose level in arterialized venous blood in a stepwise manner at 30‐min intervals to 3.5, 3.0, and 2.0 mmol l−1, and to withhold these levels for a further 30 min. At euglycaemia and at the end of the latter steps, the visual reaction time and cognitive function (digit span, letter cancellation and trail making) were tested, together with recording symptoms and signs of hypoglycaemia. Counterregulatory hormones were measured at 20‐min intervals. In the patients, clinical signs and symptoms of hypoglycaemia developed at median blood glucose levels of 2.6–2.8 and 2.8–3.1 mmol l−1, respectively. By contrast, the blood glucose levels were 0.4–0.8 mmol l−1 lower in control subjects (P < 0.05). Similarly, the median threshold for deterioration of visual reaction time was 2.8 mmol l−1 in patients and 2.1 mmol l−1 in controls (P < 0.01). A similar trend was observed for the results of the neuropsychological tests. Visual reaction time deteriorated in all subjects, whereas the cognitive function of some of the subjects in each group remained unchanged during hypoglycaemia. The glycaemic thresholds for release of Cortisol, glucagon and growth hormone were significantly higher in patients (P < 0.05), whereas the thresholds for catecholamine release showed no significant difference from controls. Despite the comparable glucose infusion rates required to sustain each of the hypoglycaemic levels in the two groups, the control subjects achieved lower glucose levels, suggesting that there is resistance to insulin or glucose in functional hypoglycaemia. In conclusion, the present study suggests that the existence of a higher threshold for symptoms and signs, as well as for deterioration of brain function, may explain every‐day hypoglycaemic symptoms, despite normal glucose levels, in subjects with functional hypoglycaemia. However, the hypothesis should be tested further using a blinded approach, including euglycaemic control studies.
A case of pheochromocytoma associated with meningioma
Authors: TANAKA S. , OKAZAKI M. , EGUSA G. , TAKAI S. , MOCHIZUKI H. , YAMANE K. , HARA H. , YAMAKIDO M.
Published: August 2009

Abstract. We have recently observed a rare case of pheochromocytoma associated with meningioma. To determine the mechanism of such a coexistence in this particular case, we compared the constitutional and pheochromocytoma genotypes of the patient using polymorphic four DNA markers, and we found a loss of heterozygosity at the D1S7 locus. A loss of heterozygosity at this locus has previously been reported by Mathew et al. in pheochromocytoma patients, and our results were in agreement with that study. Therefore the allelic deletion at the D1S7 locus may be an important step in the tumorigenesis of pheochromocytoma in this case.
Diversity in receptor signalling: cellular individuality and the search for selective drugs
Authors: FREDHOLM B. B.
Published: August 2009

Abstract. Recent developments in the molecular pharmacology of receptor signalling are reviewed. Receptors and other signalling molecules belong to superfamilies characterized by variations on given themes. A remarkable degree of diversity is generated by unique combinations of molecular entities, and there are also interactions between parallel signal transduction pathways. Molecular biology techniques have revealed new targets for drug development, as well as new methods of drug testing. However, it is not yet clear whether molecular and biochemical specificity always correspond to clinical selectivity.
Low density lipoprotein density and composition in hypercholesterolaemic men treated with HMG CoA reductase inhibitors and gemfibrozil
Authors: TILLY‐KIESI M. , TIKKANEN M. J.
Published: August 2009

Abstract. The effects of HMG CoA reductase inhibitor (lovastatin or simvastatin) and gemfibrozil treatment on low density lipoprotein (LDL) density distribution and composition were studied in male patients with heterozygous familial hypercholesterolaemia (FH) (n = 17) or non‐familial hypercholesterolaemia (non‐FH) (n = 14). In FH patients the HMG CoA reductase inhibitors reduced ‘light’ LDL particles (density 1.022–1.033 g ml−1) significantly more than ‘heavy’ LDL (density 1.033–1.059 g ml−1), while a more uniform reduction of ‘light’ and ‘heavy’ LDL occurred in non‐FH patients. HMG CoA reductase inhibitor treatment increased the apolipoprotein B (apoB) content and decreased the cholesterol/apoB ratio of LDL in FH patients. Gemfibrozil significantly reduced ‘heavy’ LDL but not the ‘light’ LDL fraction in both FH and non‐FH patients, and the mean cholesteryl ester content of LDL increased, while the Tg content decreased, in both FH and non‐FH patients. The results indicate that HMG CoA reductase inhibitor and gemfibrozil treatment have distinctly different effects on the physico‐chemical properties of LDL, reflecting their different modes of action on lipoprotein metabolism.
The incidence of recurrence and hypothyroidism following treatment with antithyroid drugs, surgery or radioiodine in all patients with thyrotoxicosis in Malmö during the period 1970–1974
Authors: BERGLUND J. , CHRISTENSEN S. B. , DYMLING J. F. , HALLENGREN B.
Published: August 2009

Abstract. The incidence of recurrence and of hypothyroidism was determined in all new patients treated for thyrotoxicosis during the period 1970–1974 in an unselected, well‐defined urban population. A total of 309 patients were followed up for a median time period of 108 (1–192) months. There was a cumulative incidence of 51% recurrence in patients who were treated with antithyroid drugs for Graves' thyrotoxicosis, whereas after surgery or radioiodine treatment there were few recurrences, but 32% and 78% cumulative incidences of hypothyroidism. There were no recurrences after surgery or radioiodine treatment in patients with toxic multinodular goitre or solitary toxic adenoma, but 29% and 40% cumulative incidences of hypothyroidism following radioiodine treatment. Late hypothyroidism occurred after surgery for Graves' thyrotoxicosis, and in all groups treated with radioiodine. Thus it is advisable that all patients with Graves' thyrotoxicosis, regardless of treatment, and all patients with toxic multinodular goitre or solitary toxic adenoma treated with radioiodine, should be followed up for many years, and probably for life.
Impaired blood rheology: a risk factor after stroke?
Authors: ERNST E. , RESCH K. L. , MATRAI A. , BUHL M. , SCHLOSSER P. , PAULSEN H. F.
Published: August 2009

Abstract. The hypothesis that blood rheology is of prognostic value in stroke patients was tested in a prospective study. A total of 523 patients in the rehabilitation phase of stroke (outside the acute phase reaction after stroke) were tested for blood, serum and plasma viscosity, haematpcrit, fibrinogen, red cell aggregation and deformability, ESR, white cell count, cholesterol and triglycerides. Endpoints were defined as a second stroke (lethal or not) within 2 years after the initial examination. Patients suffering such endpoints exhibit elevated blood viscosity, red cell aggregation, plasma and serum viscosity, fibrinogen and cholesterol levels, compared to patients without endpoints. It is concluded that rheological factors are associated with the prognosis after a first stroke.
The value of MCA, CA 15–3, CEA and CA‐125 for discrimination between metastatic breast cancer and adenocarcinoma of other primary sites
Authors: DE WIT R. , HOEK F. J. , BARKER P. J. M. , VEENHOF C. H. N.
Published: August 2009

Abstract. MCA, CA 15–3, CEA and CA 125 were determined in the serum of 49 patients with metastatic breast cancer and 38 patients with metastatic adenocarcinoma of other primary sites. By using the 99th percentile of the normal value distribution as the cutoff point, the positive predictive value (PV +) was found to be 85% (95% CI 76–94) for MCA, and 71% (95% CI 61–81) for CA 15–3. When receiver‐operating‐characteristic (ROC) curves were constructed, the PV + for CA 15–3 was increased to 82% (95% CI 72–92), using 60 U ml−1 as the cut‐off point. With the exception of two patients who had a slightly elevated MCA, MCA and CA 15–3 identified the same patients with breast cancer. By combining a positive MCA or CA 15–3 with a negative CEA and CA 125, further improvement of the PV+ could be achieved; 100% (95% CI 91–100). We conclude that MCA and CA 15–3 may play a useful role in discrimination between patients with metastatic breast cancer and those with adenocarcinoma of other primary sites.
A case of systemic mastocytosis; therapeutic efficacy of ketotifen
Authors: PÓVOA P. , DUCLA‐SOARES J. , FERNANDES A. , PALMA‐CARLOS A. G.
Published: August 2009

Abstract. A 68‐year‐old man presented with a 6‐month history of fatigue, rhinorrhoea, pruritic skin lesions, left pleural effusion, ascites, oedema and weight loss of 10 kg. Investigations revealed hepatosplenomegaly, retroperitoneal lymphadenopathy, anaemia, leucocytosis with eosinophilia, hypoprothrombinaemia, hypocholesterolaemia and elevation of both gamma glutamyltransferase and alkaline phosphatase. Biopsies of a skin lesion, bone marrow and liver revealed mast cell infiltration, allowing the diagnosis of systemic mastocytosis (SM). Hydroxyzine plus ranitidine were given without success. Hydroxyzine treatment was stopped, and ketotifen was initiated; substantial symptomatic improvement was observed within 8 d. This case report indicates the effectiveness of ketotifen in the symptomatic treatment of SM.
Haemodynamic effects of coffee and caffeine in normal volunteers: a placebo‐controlled clinical study
Authors: CASIGLIA E. , BONGIOVÌ S. , PALEARI C. D. , PETUCCO S. , BONI M. , COLANGELI G. , PENZO M. , PESSINA A. C.
Published: August 2009

Abstract. The acute haemodynamic effects of Italian coffee and 200 mg purified caffeine were investigated in 15 healthy non‐coffee‐drinkers compared to individuals who consumed placebo (highly decaffeinated coffee for regular coffee, and china bitter extract for caffeine). Before coffee and caffeine consumption and 30, 60, 90 and 120 min afterwards, rest flow and blood pressure were measured, and peripheral resistance in the arm was calculated: an echocardiogram was also performed before and 60 and 120 min after caffeine consumption. Both coffee and caffeine significantly decreased rest flow, and increased peripheral resistance. Systolic blood pressure increased by 10% and diastolic pressure increased by 5% for at least 2 h. No variation in heart rate or cardiac contractility was found. No effects were observed after placebo treatment. It is concluded that Italian coffee and caffeine increase blood pressure via vasoconstriction.
Long‐term diet modification and platelet activity
Authors: BESWICK A. D. , FEHILY A. M. , SHARP D. S. , RENAUD S. , GIDDINGS J.
Published: August 2009

Abstract. Platelet activity was assessed in a sub‐sample of 56 participants in the MRC Diet and Reinfarction Trial (DART). Men whose diets contained a high ratio of polyunsaturated to saturated fatty acids (a P:S ratio of > 0.5) showed reduced secondary platelet aggregation to adenosine diphosphate (ADP) in platelet‐rich plasma (PRP), and diminished platelet aggregation to ADP in whole blood. A trend of reduced secondary platelet aggregation to ADP with increasing dietary eicosapentaenoic acid was noted, but this was not statistically significant. The results of this study and the MRC Diet and Reinfarction Trial suggest a mediatory role for platelet activity in the relationship between diet and ischaemic heart disease.
The effect of dietary vitamin K on warfarin‐induced anticoagulation
Authors: PEDERSEN F. M. , HAMBERG O. , HESS K. , OVESEN L.
Published: August 2009

Abstract. We examined the effect of vitamin‐K‐rich vegetables, vitamin‐K‐poor vegetables and phytomenadione on the stability of warfarin‐induced anticoagulation. Patients on stable anticoagulant treatment were randomized to either 1 (n = 5), 2 (n = 7) or 7 (n = 13) d with high intake of vitamin‐K‐rich vegetables (median daily vitamin K intake 1100 μg) or high intake of vitamin‐K‐poor vegetables (daily vitamin K intake 135 μg) for 6 d (n = 7), or habitual diet supplemented with 1000 μg of phytomenadione daily (n = 5). Nine patients (69%: 95% CI, 39–91%) who consumed vitamin‐K‐rich vegetables for 7 d reached activities above the therapeutic level. Two (40%; 95% CI, 5–85%) and three patients (43%: 95% CI, 10–86%) who consumed vitamin‐K‐rich vegetables for 1 and 2 d, respectively, exceeded the upper therapeutic limit. No changes were observed in the vitamin‐K‐poor group. All patients who received phytomenadione exceeded the upper therapeutic limit. Dietary vitamin K should be regarded as an important environmental factor contributing to unwanted disturbances in warfarin‐induced anticoagulation.
Effects of felodipine ER and hydrochlorothiazide on blood rheology in essential hypertension—a randomized, double‐blind, crossover study
Authors: KOENIG W. , SUND M. , ERNST E. , HEHR R. , BINNER L. , ROSENTHAL J. , HOMBACH V.
Published: August 2009

Abstract. The haemorheological effects of felodipine extended release (ER), a new dihydropyridine calcium antagonist, were compared with hydrochlorothiazide (HCTZ) in 28 mild to moderate hypertensives (18 men and 10 women, aged 30–70 years) in a randomized, double‐blind, crossover trial. Antihypertensive drugs were gradually discontinued. Felodipine ER, 10 mg, was given once daily for 2 weeks, and after another wash‐out period of 1 week, patients were switched to 25 mg HCTZ, once daily, and vice versa. Whole blood viscosity (BV) at three different shear stresses, haematocrit (Hct), plasma viscosity (PV), red blood cell (RBC) aggregation, RBC deformability, and fibrinogen were measured under standardized conditions 2.5 h after medication, and after 2 weeks of treatment (24 h post‐dosing). Felodipine ER improved BV acutely, but not during treatment over a 2‐week period. By contrast, HCTZ did not affect BV, but decreased RBC deformability 2.5 h after medication intake. After 2 weeks of treatment, the negative effect on RBC deformability had increased slightly. Furthermore, fibrinogen and PV were significantly elevated at this stage. In summary, felodipine ER did not improve blood rheology over a 2‐week treatment period in this study. HCTZ exhibited marginal but significant negative effects on fibrinogen, PV and indices of RBC deformability, but not on RBC aggregation.
Apathetic thyrotoxicosis in adolescence
Authors: TEELUCKSINGH S. , PENDEK R. , PADFIELD P. L.
Published: August 2009

Abstract. We here describe a case of apathetic thyrotoxicosis in a 16‐year‐old female subject who presented with a range of non‐specific symptoms. Apart from a history of significant weight loss, there were no other signs or symptoms indicative of hyperthyroidism. The diagnosis was made incidentally upon thyroid function testing, and there was a prompt clinical response to anti‐thyroid therapy. The diagnostic pitfalls of this unusual presentation in the young are highlighted. A history of weight loss and a clinical index of suspicion will lead to the diagnosis, which is readily confirmed biochemically.
Bilateral adrenal tumours in primary aldosteronism: localization of a unilateral aldosteronoma by dexamethasone suppression scan
Authors: HOLLAK C. E. M. , PRUMMEL M. F. , TIEL‐VAN BUUL M. M. C.
Published: August 2009

Abstract. In a patient with primary aldosteronism, in which the postural endocrine tests suggested the presence of an aldosteronoma rather than hyperplasia, bilateral adrenal tumours were found by computer tomography. Adrenal scintigraphy using 6–131I‐iodomethyl‐19‐norcholesterol (NP59) during dexamethasone suppression showed early unilateral adrenal visualization on the left side. After removal of the left adrenal gland, which contained a 2 × 2 × 2 cm adenoma, the blood pressure and aldosterone levels returned to normal. A CT‐scan, performed 1 year after the pre‐operative CT‐scan, showed no change in size of the right adrenal tumour, consistent with a non‐functioning adenoma. In this patient, the NP59 scan adequately distinguished a non‐functioning from an aldosterone‐producing adrenal tumour.
Pathogenetic mechanism of stroke in non‐valvular atrial fibrillation: follow‐up of stroke patients with and without atrial fibrillation
Authors: GUSTAFSSON C. , BRITTON M.
Published: August 2009

Abstract.Stroke patients with brain infarction and non‐valvular atrial fibrillation (NVAF,n= 88) or sinus rhythm (SR,n= 188), treated at a population‐based stroke unit, were studied for 5 years. Within 1 month, 13% of NVAF and 2% of SR patients (P< 0.01) had either a stroke recurrence or systemic embolism. After 5 years, the corresponding figures were 26 and 25%, respectively. The 1‐month and 5‐year mortality values were 35 and 78% in the NVAF group vs. 7 and 52% in the SR group (P< 0.01). Age, ischaemic heart disease and function group on arrival at the hospital were independent risk factors for death. The main cause of death was ischaemic heart disease in the NVAF group, and complications to the initial stroke or a stroke recurrence in the SR group. Thus a higher risk of death, stroke recurrence and peripheral embolism was evident only during the first month after stroke.
Cardiovascular risk factors in young snuff‐users and cigarette smokers
Authors: ELIASSON M. , LUNDBLAD D. , HÄGG E.
Published: August 2009

Abstract. We studied cardiovascular risk factors in 21 young men who were habitual snuff‐users, and compared them with the same risk factors in 18 non‐tobacco‐users and 19 cigarette smokers of the same age and body mass index. Both snuff‐users and smokers showed increased levels of alcohol and coffee consumption and a decreased level of physical exercise compared to non‐users. Both groups of tobacco‐users showed increased serum insulin levels compared to the control group at similar blood glucose concentrations. In contrast to the smokers, snuff‐users showed no significant elevation of diastolic blood pressure, haemoglobin concentrations, white cell count, serum cholesterol or triglyceride levels. Snuff users had higher plasma fibrinogen levels than non‐users (P = 0.07). The use of snuff by young men appears to have less impact than smoking on cardiovascular risk factors, with the possible exception of elevated serum insulin and plasma fibrinogen levels.
Early postoperative basal serum GH level and the GH response to TRH in relation to the long‐term outcome of surgical treatment for acromegaly: a report on 39 patients
Authors: VALDEMARSSON S. , BRAMNERT M. , CRONQUIST S. , ELNER Å. , ENEROTH C. M. , HEDNER P. , LINDVALL‐AXELSSON M. , NORDSTRÖM C. H. , STRÖMBLAD L. G.
Published: August 2009

Abstract. During a 10‐year period 39 patients with acromegaly, aged 23–73 years, underwent selective adenomectomy via a trans‐sphenoidal or transfrontal (one case) approach. Six to 12 months after the operation, the serum level of growth hormone (GH) was reduced to < 5 μg l−1 in 28 patients (74%) in at least two of three random samples and/or suppressed to < 3 μg l−1 during an oral glucose load, thus fulfilling the commonly used criteria for a successful operation. In 10 patients these criteria for adequate GH reduction were not fulfilled, but their median S‐GH level was reduced from 38 to 11 μg l−1 (P < 0.01) after the operation. Surgery was successful in 11 of 13 (85%) patients with a microadenoma (< 10 mm in diameter), in 10 of 14 (71%) patients with an adenoma of diameter >> 10 mm but still enclosed in the sella, and in seven of 11 (64%) patients with locally invasive tumours. Impaired pituitary function was observed in 23% of the patients after surgery, independent of tumour size. In one patient the postoperative period was complicated by a lethal intracranial infection. During follow‐up for 1–10 years, four patients relapsed, after 1, 1.5, 6 and 9 years, respectively. Patients for whom surgery appeared to have been ineffective at the evaluation 6–12 months postoperatively, or who later relapsed were identified by early (within 7 d) postoperative serum GH with a sensitivity of 90 %. The accuracy for identification of a satisfactory outcome of surgery was 85%, and the predictive value was 90%. The corresponding values for the GH response to TRH measured 6–12 months postoperatively were 47, 40 and 54%, respectively. It is concluded that the basal level of serum GH measured 1–7 d postoperatively has higher sensitivity and specificity than the GH response to TRH 6–12 months postoperatively for evaluation of the effect of surgery on GH overproduction, and that it has a higher predictive power with regard to the long‐term outcome of surgery for acromegaly.
Coronary artery vasoregulation and left ventricular function in patients with angina pectoris‐like pain and normal coronary angiograms
Authors: LAGERQVIST B. , BYLUND H. , GÖTELL P. , MANNTING F. , SANDHAGEN B. , WALDENSTRÖM A.
Published: August 2009

Abstract. Twenty patients with angina pectoris‐like pain, normal coronary angiography and abnormal exercise 201Tl scans were investigated by means of haemodynamic, coronary sinus blood flow and lactate determinations before and after cold provocation, pacing and dipyridamole infusion. Radionuclide angiography, a new exercise 201Tl scan and noninvasive hyperventilation and ergonovine tests were performed. Intracoronary infusions of acetylcholine were given in increasing doses and a second coronary angiogram in combination with a 201Tl scintigram was performed. Despite a previously pathological 201Tl scintigram, with reversible perfusion defects, only ten of the patients had reversible perfusion defects at the second investigation. Hyperventilation and ergonovine tests did not result in ECG signs indicative of coronary spasm. Intracoronary infusion of acetylcholine resulted in a diffuse coronary constriction in 3 of 14 patients, and in one patient a perfusion defect was observed on thallium scintigram. In conclusion, although most of the common methods for inducing coronary vasospasm were used, no consistent pattern of reaction was found to explain the chest pains experienced in this group of patients.
Coffee, coronary heart disease and mortality in middle‐aged Swedish men: findings from the Primary Prevention Study
Authors: ROSENGREN A. , WILHELMSEN L.
Published: August 2009

Abstract. The effect of coffee consumption on the incidence of coronary heart disease (CHD) was studied prospectively in a population sample of 6765 men aged 51–59 years at baseline during the period 1974–1977, and free of myocardial infarction (MI) prior to the screening. During a 7.1‐year follow‐up there were 230 non‐fatal myocardial infarctions, 169 coronary deaths and 478 deaths from all causes. Among men who were smokers at baseline there was no relationship between either non‐fatal MI or death from CHD, and coffee consumption. Among non‐smokers, a weak but far from significant trend towards an increasing incidence of CHD in heavy consumers of coffee was observed. There was an inverse relationship between mortality from all causes and coffee consumption.
Unusual clinical presentation of malignant histiocytosis in a 70‐year‐old woman
Authors: KOMATSU M. , KATAKURA M. , AIZAWA T. , YUKIMURA Y. , YAMADA T. , SAITO H. , FURUTA S. , ITO N. , ONISHI Y.
Published: August 2009

Abstract. A 70‐year‐old woman was admitted for evaluation of hepatosplenomegaly, fever and elevated serum LDH levels. A biopsy specimen of the liver revealed histiocytic proliferation at the portal triad, and a mild degree of hepatitis. A bone marrow biopsy specimen showed proliferation of histiocytes with minimal immaturity and atypism, and haemophagocytosis by the proliferated histiocytes. Fever, hepatosplenomegaly and elevation of LDH levels all disappeared spontaneously, and presumptive diagnosis of benign reticulosis with haemophagocytosis was made. One year later, fever, hepatosplenomegaly and elevation of LDH levels redeveloped, and the liver and bone marrow biopsy specimen showed proliferation of unequivocally malignant histiocytes. The patient died as a result of disseminated intravascular coagulation with shock 20 d later. We concluded that, in this case, malignant histiocytosis first presented as benign haemophagocytic reticulosis and, 1 year later, there was a typical malignant presentation.
L‐tryptophan‐induced eosinophilia‐myalgia syndrome
Authors: ARNOUTS P. J. , COLEMONT L. J. , VAN OUTRYVE M. J. , VAN MOER E. M.
Published: August 2009

Abstract. This report describes three Belgian cases of the eosinophilia‐myalgia syndrome associated with the use of L‐tryptophan‐containing products. Three women, aged 51, 53 and 73 years, were taking L‐tryptophan for 2 months to 2 years, at 500, 1500, and 2250 mg d−1 respectively. All developed disabling myalgias, fatigue, and a variable skin rash, in association with marked eosinophilia. In one patient, symptoms and eosinophilia reappeared after rechallenge with L‐tryptophan. Discontinuation of the drug resulted in gradual disappearance of the symptoms, signs and laboratory abnormalities in two patients. One patient was treated with corticosteroids because of persisting myalgias. Because of the non‐specific clinical manifestations, clinicians from all subspecialties of internal medicine might be confronted with such patients and should be aware of this new entity.
Serum lipid and apolipoprotein levels in non‐hypertensive lean NIDDM patients
Authors: IKEDA T. , OCHI H. , OHTANI I. , FUJIYAMA K. , HOSHINO T. , TANAKA Y. , TAKEUCHI T. , MASHIBA H.
Published: August 2009

Abstract. To determine the possible role of a glycaemic control in lipid metabolism in non‐insulin‐dependent diabetes mellitus (NIDDM) patients, serum lipid and apolipoprotein levels were measured in well‐controlled and poorly controlled lean NIDDM without proteinuria and hypertension. A sample of 96 lean NIDDM patients (body mass index < 25 kg m−2 in men and < 27 kg m−2 in women) were divided into two groups: group I, where the HbA1c concentration had been < 6% for the previous 3 months, and group II, where the HbA1c concentration had been > 8% for the previous 3 months. Serum total cholesterol, triglyceride, and HDL‐cholesterol levels showed no significant differences between groups I and II. Furthermore, serum levels of apolipoproteins AI, AII, B, CII, CIII, and E did not differ significantly between groups I and II. These results suggest that glycaemic control did not influence lipid metabolism in lean NIDDM patients.
Characteristics of cirrhosis undiagnosed during life: a comparative analysis of 73 undiagnosed cases and 149 diagnosed cases of cirrhosis, detected in 4929 consecutive autopsies
Authors: GRAUDAL N. , LETH P. , MÅRBJERG L. , GALLØE A. M.
Published: August 2009

Abstract. In 4929 consecutive autopsies performed during a period of 4 years, 222 cases (4.5%) of cirrhosis were found, of which 149 (3%) were detected while the patients were alive (diagnosed cirrhosis) and 73 (1.5%) were not detected while the patients were living (undiagnosed cirrhosis). Fifty‐three of the 73 undiagnosed patients appeared to be completely without signs of cirrhosis (silent cirrhosis). In the diagnosed group, 70% of patients died from hepatic causes, in contrast to 16% in the undiagnosed group. At autopsy, the following complications of cirrhosis were found more frequently in the diagnosed group than in the undiagnosed group: ascites (41% vs. 8%), oesophageal varices (44% vs. 10%), splenomegaly (52% vs. 29%). The prevalence of hepatocellular carcinoma did not differ significantly in the two groups (12% vs. 8%). It is concluded that cirrhosis without obvious signs occurs relatively frequently, and that no sensitive noninvasive screening methods are available at present.
Adrenocortical insufficiency with normal serum cortisol levels and hyporeninaemia in a patient with acquired immunodeficiency syndrome (AIDS)
Authors: COBBS R. , PEPPER G. M. , TORRES J. G. , GRUENSPAN H. L.
Published: August 2009

Abstract. The acquired immunodeficiency syndrome (AIDS) has been associated with abnormalities of adrenocortical function [1–4], and hypoaldosteronism due to hyporeninaemic hypoaldosteronism (HHA) [15]. We here report the case of a woman with AIDS associated with orthostatic hypotension, persistent hyponatraemia and hyperkalaemia, in whom basal serum cortisol levels were normal and serum renin activity was low. Subsequent post‐mortem examination revealed almost complete adrenocortical destruction. A possible explanation of this apparently contradictory combination of findings is discussed, together with the therapeutic implications for similar cases.
Expression of type III hyperlipoproteinaemia in a subject with secondary hypothyroidism bearing the apolipoprotein E2/2 phenotype
Authors: FEUSSNER G. , ZIEGLER R.
Published: August 2009

Abstract. Post‐surgical hypothyroidism developed in a now 43‐year‐old woman with complete insufficiency of the anterior pituitary gland who discontinued levothyroxine replacement therapy. Serum cholesterol and serum triglyceride levels increased in parallel, and classical type III hyperlipoproteinaemia (HLP) with xanthoma striata palmaris developed. The patient is homozygous for apolipoprotein (apo) E2. The case reported here represents the first example of manifestation of type III hyperlipoproteinaemia in a subject with secondary hypothyroidism bearing the apo E2/2 phenotype.
Folic acid absorption in patients infected with the human immunodeficiency virus
Authors: REVELL P. , O'DOHERTY M. J. , TANG A. , SAVIDGE G. F.
Published: August 2009

Abstract. To determine the folic acid absorption characteristics of patients with human immunodeficiency virus (HIV) infection, a prospective, controlled, result‐blind single‐dose oral absorption study was conducted. A total of 25 subjects were fasted and given 5 mg oral folic acid; blood samples were taken at time zero and after 30, 60, 90 and 180 min. Absorption of folic acid appears to be significantly impaired in HIV disease, irrespective of the stage of the disease and notwithstanding gastro‐intestinal complaints, pathogen‐negative diarrhoea or drug treatment. We here present functional data, complementary to previously reported structural and biochemical findings, to support the hypothesis that the virus can cause an enteropathy in the absence of opportunist infection. Folinic acid is absorbed by the same gut mechanism as folic acid, so caution may be needed when employing oral folinic acid rescue procedures in these patients, even when resting serum and red cell folate levels appear to be normal.
Sleep difficulties, pain and other correlates
Authors: MOFFITT P. F. , KALUCY E. C. , KALUCY R. S. , BAUM F. E. , COOKE R. D.
Published: August 2009

Abstract.A multiple regression analysis was used with variables relevant to sleeping problems from a large community health survey in South Australia. The variables that were found to be most strongly correlated with sleep problems were, in order of importance, pain, anxiety, age, somatic health and annual household income, all of which accounted for 22% of the variance. Weight problems, depression and sex of the respondent were not so important in this analysis. Arthritis, which often increases with age, appeared to be most strongly associated with pain, explaining in part why sleeping problems increase with age. Anxiety, pain and poor somatic health were most strongly associated with lying awake at night or sleeping badly, and anxiety and pain were most strongly correlated with taking longer to get to sleep. Poor somatic health and anxiety were most strongly associated with waking early, and age and pain were the most important variables in taking tablets to aid sleep.
Patients admitted to the emergency room with symptoms indicative of acute myocardial infarction
Authors: KARLSON B. W. , HERLITZ J. , PETTERSSON P. , EKVALL H.‐E. , HJALMARSON Å.
Published: August 2009

Abstract. All 7157 patients (55% men) admitted to the emergency room with chest pain or other symptoms indicative of acute myocardial infarction during a period of 21 months were registered consecutively. Chest pain was reported by 93% of the patients. On the basis of history, clinical examination, and electrocardiogram in the emergency room, all patients were prospectively classified in one of four categories: (i) obvious infarction (4% of all patients): (ii) strongly suspected infarction (20%): (iii) vague suspicion of infarction (35%); and (iv) no suspected infarction (41%). In patients with no suspected infarction (n = 2910), musculoskeletal (26%), obscure (21%) and psychogenic origins (16%) of the symptoms occurred most frequently. We conclude that few of the patients had an obvious infarction on admission, and that a musculoskeletal origin of the symptoms occurred most frequently in patients with no suspected infarction.
Colonic epithelial dysplasia or carcinoma in a regional group of patients with ulcerative colitis of more than 15 years duration
Authors: VILIEN M. , JØRGENSEN M. J. , OUYANG Q. , SCHLICHTING P. , LINDE J. , RIIS P. , BINDER V.
Published: August 2009

Abstract. Colonoscopic screening for neoplasia was performed in a regional group of ulcerative colitis patients with a disease duration of ≥ 15 years. A total of 121 patients, aged < 80 years, were invited to participate, of whom 100 (83%) accepted colonoscopy, including biopsies in 15 standard locations of the entire colon, plus additional biopsies from all visible lesions. Unequivocal dysplasia was found in one patient with extensive colitis and a disease duration of 31 years. A polyp with highly differentiated adenocarcinoma was found in the sigmoid colon of a patient with intermittent rectum involvement, 37 years after the ulcerative colitis diagnosis had been made. Biopsy specimens from the remaining 98 patients showed no signs of dysplasia or cancer. Thus the frequency of pre‐malignant or malignant changes is very low compared with the results of similar studies, and the rationale for general colonoscopic surveillance programmes for such patients is open to question.
Clinical symptoms in young adults with atypical chest pain attending the emergency department
Authors: ROLL M. , KOLLIND M. , THEORELL T.
Published: August 2009

Abstract. Clinical symptoms were studied in 69 consecutive patients below the age of 40 years who were attending the emergency unit because of unexplained chest pain. In a structured interview a few weeks after the emergency visit, only one‐third of the patients reported that they believed in the doctor's diagnosis; they believed in a psychological or cardiac origin of the pain more often than the doctors. The chest pain was most often described as oppressive and/or stabbing. In 95% of cases it was central or left‐sided. Associated symptoms were commonly reported, breathlessness being most commonly reported by two‐thirds of the patients, followed by dizziness, palpitation and numbness/tingling. Mental symptoms such as tiredness, anxiety and tension were frequently reported. On the basis of the background literature the aetiology is discussed. We conclude that immediate symptom analysis, including psychosomatic symptoms, particularly breathing problems, is of central importance.
Paraproteinaemia in relatives of patients with primary acquired agammaglobulinaemia
Authors: HABASHI H. , HEPPLESTON A. , WINTER J.
Published: August 2009

Abstract.Two instances of the unusual familial association of severe primary acquired hypogammaglobulinaemia and paraproteinaemia are described, and previous reports of familial immunoglobulin dyscrasias are discussed. Our observations lend further support to the possible existence of a genetic predisposition to these disorders.
Coffee drinking and blood cholesterol—effects of brewing method, food intake and life style
Authors: LINDAHL B. , JOHANSSON I. , HUHTASAARI F. , HALLMANS G. , ASPLUND K.
Published: August 2009

Abstract. The strongest correlations between coffee consumption and serum cholesterol levels have been found in countries where people drink coffee brewed by mixing coffee grounds directly in boiling water (boiled coffee). In the present study of a population‐based sample of 1625 middle‐aged subjects (the Northern Sweden MONICA Study), approximately 50% of the participants were drinking boiled coffee, and 50% were drinking filtered coffee. Consumers of boiled coffee had significantly higher serum cholesterol levels than consumers of filtered coffee. Subjects who drank boiled coffee reported a higher intake of fat. A linear multiple regression analysis with serum cholesterol as the dependent variable confirmed that boiled coffee was an important independent determinant of cholesterol levels. We conclude that subjects who drink boiled coffee have higher serum cholesterol levels than those who drink filtered coffee, and that the most likely explanation for this finding lies in the type of brewing method.
The significance of venography in the management of patients with clinically suspected pulmonary embolism
Authors: KRUIT W. H. J. , DE BOER A. C. , SING A. K. , VAN ROON F.
Published: August 2009

Abstract. The accurate diagnosis of pulmonary embolism causes many problems. Clinical signs are non‐specific, and ventilation‐perfusion lung scanning has high sensitivity but variable specificity. In more than 90% of cases a pulmonary embolus is derived from deep venous thrombosis in the lower extremities. We have performed a prospective study to evaluate venography in the management of patients with suspected pulmonary embolism. A total of 169 patients were included in the study, and a ventilation‐perfusion scan was performed in all cases. Forty‐four (26%) patients had a normal scan and treatment was not given (group A). The other 125 (74%) patients, who had an abnormal scan, underwent bilateral venography. Venous thrombosis was demonstrated in 63 patients, and they were treated with oral anticoagulants for 3 months (group B). The remaining 62 patients, who showed no venous thrombosis, did not receive anticoagulant therapy (group C). During follow‐up, 1 patient in group A, 3 patients in group B and 1 patient in group C developed a new deep venous thrombosis. One patient in group B suffered a pulmonary embolus. It is concluded that venography of the lower extremities can be of additional value in the management of patients with pulmonary embolism when the lung scan does not provide sufficient information.
Influence of lovastatin therapy on metabolism of low density lipoproteins in mixed hyperlipidaemia
Authors: VEGA G. L. , GRUNDY S. M.
Published: August 2009

Abstract. To determine the mechanisms whereby HMG‐CoA reductase inhibitors lower the levels of low density lipoproteins (LDL) in patients with mixed hyperlipidaemia. LDL turnover studies were conducted in 12 such patients during placebo and then during treatment with lovastatin. Drug therapy reduced total cholesterol and triglyceride concentrations by 33% and 32%, respectively. During lovastatin therapy, LDL‐cholesterol levels fell by 37%, and LDL‐apo B concentrations decreased by an average of 29%. The decrease in LDL‐apo B concentrations on lovastatin therapy was largely due to an increase in fractional catabolic rates (FCRs) for LDL apo B. The average increase in FCRs was 34%, whereas transport rates (production rates) for LDL apo B remained unchanged. These results strongly suggest that an increase in LDL‐receptor activity is the major mechanism whereby LDL levels are lowered during lovastatin therapy. The data do not indicate that this drug inhibited the input of apo B‐containing lipoproteins, which would have been expected to result in a decrease in the rate of production of LDL.
Microdialysis—principles and applications for studies in animals and man
Authors: UNGERSTEDT U.
Published: August 2009

Abstract.Microdialysis is a technique for sampling the chemistry of the individual tissues and organs of the body, and is applicable to both animal and human studies. The basic principle is to mimic the function of a capillary blood vessel by perfusing a thin dialysis tube implanted into the tissue with a physiological liquid. The perfusate is analysed chemically and reflects the composition of the extracellular fluid with time due to the diffusion of substances back and forth over the membrane. Microdialysis is thus a technique whereby substances may be both recovered from and supplied to a tissue. The most important features of microdialysis are as follows: it samples the extracellular fluid, which is the origin of all blood chemistry; it samples continuously for hours or days without withdrawing blood; and it purifies the sample and simplifies chemical analysis by excluding large molecules from the perfusate. However, the latter feature renders the technique unsuitable for sampling large molecules such as proteins. The technique has been extensively used in the neurosciences to monitor neurotransmitter release, and is now finding application in monitoring of the chemistry of peripheral tissues in both animal and human studies.
The polymerase chain reaction and its potential role in clinical diagnostics and research
Authors: REISS J.
Published: August 2009

Abstract. In‐vitro amplification of deoxyribonucleic acid molecules by means of the polymerase chain reaction (PCR) must be regarded as the most important advance in the life sciences to take place during the last decade. Originally applied to the identification of mutations in well‐known and fully sequenced human genes, its applications have now been extended to a wide variety of biological and medical disciplines, accompanied by significant technical improvements and sophisticated variations of the basic principle. Specialized molecular genetics laboratories were the first to employ this new method, and they still are in the process of extending its potential. Due to its unique properties, applications of PCR quickly spread to other areas of research, and numerous clinical studies have already employed PCR. The field is currently still expanding rapidly.
Angiotensin‐converting enzyme inhibition and physical training in heart failure
Authors: MEYER T. E. , CASADEI B. , COATS A. J. S. , DAVEY P. P. , ADAMOPOULOS S. , RADAELLI A. , CONWAY J.
Published: August 2009

Abstract. A total of 12 patients (mean age ± SEM 63 ± 2.6 years) with moderate to severe heart failure (ejection fraction = 23 ± 3.2%) were included in a placebo‐controlled crossover trial. Patients were randomly allocated to 4 periods of 6 weeks each: placebo, placebo and physical training, lisinopril 10 mg daily, and lisinopril and physical training. The exercise time increased from 13.6 ± 0.9 min with placebo to 15 ± 1 min with training alone, and to 16.1 ± 0.7 min with lisinopril and training. With lisinopril alone there was a nonsignificant increase in exercise time, to 14.5 ± 0.6 min. Improvements in exercise time were accompanied by a similar increase in peak oxygen consumption. Overall, the most significant improvements in symptoms and indices of cardiorespiratory fitness were achieved with a combination of lisinopril and training. Thus physical training is not only a useful adjunct to the existing medical therapy for heart failure, but it may also provide symptomatic benefits in its own right.
A comparison between nicotinic acid and acipimox in hypertriglyceridaemia — effects on serum lipids, lipoproteins, glucose tolerance and tolerability
Authors: TORNVALL P. , WALLDIUS G.
Published: August 2009

Abstract. Serum and lipoprotein lipid levels, oral glucose tolerance and side‐effects were compared in an open cross‐over study of 31 non‐diabetic patients with hypertriglyceridaemia (type II B and IV) before and after 6 weeks of treatment with nicotinic acid (3 g daily) and acipimox (0.75 g daily), a new nicotinic acid‐like drug, respectively. Acipimox was about equally potent in reducing serum and VLDL lipid levels and in increasing HDL cholesterol levels. Acipimox had no significant negative effects on glucose metabolism measured by an oral glucose tolerance test compared with nicotinic acid, which decreased the late glucose tolerance as well as the area under the glucose curve (P < 0.05 for the difference between the two treatments). The incidence and severity of flush or any other recorded side‐effects was higher after nicotinic acid treatment than after acipimox. In addition, no effects on laboratory parameters such as liver enzymes and uric acid were seen after treatment with acipimox. The results of this study demonstrate that acipimox is a satisfactory alternative to nicotinic acid in patients with hypertriglyceridaemia.
A 4‐year prospective follow‐up study of the role of alcohol in recurrences of atrial fibrillation
Authors: KOSKINEN P.
Published: August 2009

Abstract. Alcohol consumption data for 98 consecutive young and middle‐aged patients presenting with new‐onset atrial fibrillation (AF) were obtained on admission to hospital. The patients were subsequently followed up for 4 years in order to study the rate of recurrence of AF and its possible association with alcohol use. Neither recent alcohol intake, assessed as the amount of alcohol consumed during the week preceding AF, nor chronic alcohol use, assessed by the CAGE questionnaire, were significantly related to AF recurrence or development of chronic AF. This was also true for individuals with idiopathic AF. Left atrial diameter on echocardiography was significantly greater among the patients who developed chronic AF than among the others (P = 0.03). In this prospective study chronic alcohol abuse, as assessed by the CAGE questionnaire, was not associated with either subsequent recurrence of AF or development of chronic AF.