bluuebunny/crossref_metadata_2025 huggingface dataset:
Interleukin‐17‐producing γδ+ T cells protect NOD mice from type 1 diabetes through a mechanism involving transforming growth factor‐β
Authors: Han Gencheng , Wang Renxi , Chen Guojiang , Wang Jianan , Xu Ruonan , Wang Liyan , Feng Jiannan , Li Xia , Guo Renfeng , Fu Li , Shen Beifen , Li Yan
Published: August 2009

Whether interleukin (IL)‐17 promotes a diabetogenic response remains unclear. Here we examined the effects of neutralization of IL‐17 on the progress of adoptively transferred diabetes. IL‐17‐producing cells in non‐obese diabetic (NOD) mice were identified and their role in the pathogenesis of diabetes examined using transfer and co‐transfer assays. Unexpectedly, we found that in vivo neutralization of IL‐17 did not protect NOD–severe combined immunodeficiency (SCID) mice against diabetes transferred by diabetic splenocytes. In NOD mice, γδ+ T cells were dominated by IL‐17‐producing cells and were found to be the major source of IL‐17. Interestingly, these IL‐17‐producing γδ T cells did not exacerbate diabetes in an adoptive transfer model, but had a regulatory effect, protecting NOD mice from diabetes by up‐regulating transforming growth factor (TGF)‐β production. Our data suggest that the presence of IL‐17 did not increase the chance of the development of diabetes; γδ T cells protected NOD mice from diabetes in a TGF‐β‐dependent manner, irrespective of their role as major IL‐17 producers.
T‐bet‐dependent regulation of CD8+ T‐cell expansion during experimental Trypanosoma cruzi infection
Authors: Cobb Dustin , Guo Siqi , Lara Ana M. , Manque Patricio , Buck Gregory , Smeltz Ronald B.
Published: August 2009

The transcription factor T‐bet (T‐box, expressed in T cells), promotes type I immunity to pathogens through effects involving T cells and dendritic cells. In CD8+ T cells, many of the functions of T‐bet are redundant with those of eomesodermin (Eomes), a paralogue of T‐bet. We therefore investigated the role of T‐bet in immunity to Trypanosoma cruzi, an intracellular pathogen that causes Chagas disease, and which requires CD8+ T cells for resistance. T‐bet‐deficient mice (tbx21−/−) were highly susceptible to T. cruzi infection, marked by severe liver pathology. CD8+ T cells from infected tbx21−/− mice expressed typical markers of activation, including CD44 and CD25. In striking contrast, there was a 10‐fold reduction in the number of antigen‐specific CD8+ T cells in tbx21−/− mice. This reduction was not a consequence of increased apoptosis or altered tissue‐specific migration. Further, antigen‐presenting cell (APC) functions in tbx21−/− mice were normal as we observed comparable levels of B7‐1, B7‐2 and CD40 expression as well as normal antigen‐driven proliferation of wild‐type CD8+ T cells in infected tbx21−/− mice. However, adoptive transfer of naïve T cells from tbx21−/− donors into infected Rag‐2‐deficient mice (tbx21+/+) demonstrated a similar quantitative defect in CD8+ T‐cell expansion. These data demonstrate that T‐bet facilitates immunity to T. cruzi by promoting the expansion of T. cruzi‐specific CD8+ T cells in a T cell‐intrinsic manner. They also serve to further illustrate the multifaceted functions of T‐box proteins in regulating quantitative aspects of T‐cell immunity, in addition to qualitative components such as cytokine production.
The phoenix process: a substantive theory about allegations of unprofessional conduct
Authors: Pugh Dale
Published: August 2009

Title. The phoenix process: a substantive theory about allegations of unprofessional conduct.

Aim. This paper is a report of a grounded theory study of how nurses deal with an allegation of unprofessional conduct.

Background. Limited research has been conducted into the experiences of nurses reported to a nurse regulatory authority for an allegation of unprofessional conduct. Previous research reveals that having an allegation of unprofessional conduct made against a nurse and being reported for it can have devastating and prolonged psychosocial and professional consequences. This lack of previous research was the impetus for this study.

Method. Grounded theory methods including the constant comparative method were used to analyse data from in‐depth interviews with 21 Australian Registered Nurses who were reported to a nurse regulatory authority for an allegation of unprofessional conduct. Data were collected between March 2004 and September 2005.

Findings. A substantive theory, the phoenix process, was generated. This describes a transformation of the personal and professional self which the nurse both ‘engages in’ and ‘goes through’. This transformation is formed through complex deconstructive and reconstructive processes of the personal and professional self. This transformation of the individual is influenced by the degree of deconstruction initially experienced and the interplay with the influencing factors of vulnerability, resilience and support.

Conclusion. A new understanding of unprofessional conduct is needed, together with continued support of a systems approach to error management and support for nurses who err rather than punishing them.
Glucose intolerance in acute infections
Authors: SAMMALKORPI K.
Published: August 2009

Abstract. To evaluate the influence of an infective agent, severity of infection and the age of the patient on infection‐induced glucose intolerance, concentrations of fasting blood glucose, serum insulin (n = 31) and plasma glucagon (n = 22) were measured and the oral glucose tolerance test (OGTT) was carried out (n = 26) during acute and convalescence phases and after complete recovery in patients with viral (n = 17) or bacterial (n = 14) infections. Serum insulin was increased (P < 0.001) but plasma glucagon was decreased (P < 0.01) both during acute infection and the convalescence period. In the acute stage, 2‐h values of blood glucose (P < 0.01) and serum insulin concentrations (P < 0.001) during OGTT were elevated. The index of insulin resistance (glucose x insulin) was increased by 33% during infection and by 28% during convalescence (P < 0.001). The observed changes did not correlate with the severity of infection, were more pronounced in younger patients than in older ones and were not dependent on the infective agent. It is clinically important to recognize that the restoration of insulin sensitivity takes longer than the immediate recovery period from the infection.
Acute respiratory failure in anorexia nervosa with hypophosphataemia
Authors: GUSTAVSSON C. G. , ERIKSSON L.
Published: August 2009

Abstract. A 19‐year‐old woman with anorexia nervosa developed respiratory failure during parenteral nutrition. Serum phosphate concentration was low and the patient had several symptoms typical of hypophosphataemia. It is well known that parenteral refeeding may cause severe hypophosphataemia and this has earlier been described to cause respiratory failure in alcoholics and in patients with intestinal disease. This is, to our knowledge, however, the first reported case of respiratory failure in association with hypophosphataemia occurring in a patient with anorexia nervosa and parenteral nutrition.
Hyposelenaemia: patients with gastrointestinal diseases are at risk
Authors: BJERRE B. , VON SCHENCK H. , SÖRBO B.
Published: August 2009

Abstract. A retrospective study of serum selenium determinations performed in a hospital laboratory revealed 47 cases of hyposelenaemia (defined as a serum selenium level below 0.74 μmol l−1). Moderate hyposelenaemia (serum selenium 0.30–0.55 μmol l−1) was found in 11 patients and seven of these suffered from gastrointestinal diseases. Furthermore severe hyposelenaemia (serum selenium below 0.30 μmol l−1) was detected in three patients, who were all affected by gastrointestinal disease. We concluded that patients with gastrointestinal diseases are especially at risk of developing selenium deficiency and should be monitored by repeated determinations of serum selenium. Patients with moderate or severe hyposelenaemia should receive selenium treatment.
Increased skeletal muscle Na/K‐ratio in obese men, but not in women, with glucose intolerance
Authors: LANDIN K. , LINDGÄRDE F. , SALTIN B. , WILHELMSEN L.
Published: August 2009

Abstract. Obesity is associated with glucose intolerance. Glucose is to a large extent disposed in the skeletal muscle. Peripheral insulin resistance, as well as decreased enzymatic activity in the skeletal muscle, has been suggested in type II diabetes. Potassium is essential for such enzymatic reactions.

In this study, obese men, but not women, with glucose intolerance tended to have a lower total body potassium per kg body weight, indicating a smaller muscle mass, than weight‐matched normoglycaemic men. They also had a lower skeletal muscle potassium content per 100 g dry weight (P < 0.05) and a higher muscle Na/K‐ratio (P < 0.05) compared with obese men with normal glucose tolerance. Muscle fat and muscle sodium content were higher in obese men than in women with the same body mass index (P < 0.01).

The muscle electrolyte changes can be explained by a decrease in the insulin mediated Na/K‐pump activity across the cell membrane or a smaller number of insulin receptors on the skeletal muscle cell in patients with glucose intolerance.
M‐mode echocardiographic findings in apparently healthy, non‐athletic Norwegians aged 20–70 years. Influence of age, sex and body surface area
Authors: KNUTSEN K. M. , STUGAARD M. , MICHELSEN S. , OTTERSTAD J. E.
Published: August 2009

Abstract. In order to assess M‐mode echocardiographic recordings in a normal Norwegian population, 190 apparently healthy subjects (95 women and 95 men) aged 21–69 years were examined with an Irex Meridian system. Measurements were performed according to criteria recommended by the American Society of Echocardiography. Absolute values for all parameters except for left ventricular (LV) shortening fraction (SF) were greater in men (P < 0.001). When corrected for body surface area (BSA), the differences between the two genders were far less pronounced. Women had greater left atrium (LA) (P < 0.01) and LV end‐diastolic diameter (EDD) (P < 0.001), whereas the interventricular septum in end‐diastole (IVS‐ED) (P < 0.05) and LV posterior wall (PW) in ED (P < 0.001) were thicker in men.

Only weak correlations between age and the various echocardiographic parameters with r‐values ≤ 0.30 were observed.

It is recommended that BSA corrected values should be preferred since the differences between men and women are negligible. When absolute values are used, different normal ranges for both sexes should be applied.
Haemorrhagic and thromboembolic complications in patients with atrial fibrillation on anticoagulant prophylaxis
Authors: LUNDSTRÖM T. , RYDÉN L.
Published: August 2009

Abstract. We studied clinically relevant haemorrhagic and thromboembolic events in 213 patients with atrial fibrillation (AF) during 818 patient‐years of anticoagulant (AC) treatment.

The incidence of complicating events per 100 patient‐years of treatment in three groups of patients, those with mitral valve disease (MVD; n = 34), without MVD (n = 102) and those with previous thromboembolism (TE; n = 77) was: major peripheral haemorrhages 3.1, 3.3 and 8.2 (non‐MVD vs. TE group, P < 0.05), cerebrovascular events 3.9, 3.0 and 3.0 (NS), and peripheral arterial thromboembolism 0, 0 and 1.5 (non‐MVD vs. TE group, P < 0.05). The proportion of thrombotest values < 5 and/or > 20% at regular check‐ups was 9.8% in patients with and 6.9% in patients without major peripheral haemorrhages (P < 0.01).

Major peripheral haemorrhages are frequent in patients with AF receiving AC treatment. They are most likely to occur in those with previous thromboembolism and among those with unstable AC control.
Pancytopenia—a rare manifestation of folic acid deficiency
Authors: HANSEN P. B. , JØRGENSEN L. M.
Published: August 2009

Abstract. In the western world folic acid deficiency is a relatively rare cause of anaemia in the elderly population. A 79‐year‐old woman presented with pancytopenia (haemoglobin 3.4 mmol l−1, leucocytes 1.2 · 109 l−1, thrombocytes 22 · 109 l−1 due to folic acid deficiency. The deficiency was caused by an extremely low dietary intake. The case was complicated with infection and haemorrhagic manifestations. Administration of folic acid increased the number of erythrocytes, leucocytes and thrombocytes markedly. Beside vitamin B12 deficiency folic acid deficiency must be borne in mind in megaloblastic anaemias complicated with leucopenia and/or thrombocytopenia. Since the body stores of folic acid are low, rapid diagnosis and treatment are important.
Tick‐borne viral encephalitis in Finland. The clinical features of Kumlinge disease during 1959–1987
Authors: WAHLBERG P. , SAIKKU P. , BRUMMER‐KORVENKONTIO M.
Published: August 2009

Abstract. During 1959–1987, 126 patients in Åland Islands and main Finland had serologically verified infections with the virus of tick‐borne encephalitis (Kumlinge disease). The most useful test for specific virological diagnosis was haemagglutination inhibition‐IgM (HI‐IgM). Most cases were from Åland Islands and nearby south‐western main Finland. Two of the infections were imported. There were three laboratory infections and two transfusion infections. The disease occurred mainly from July to September. Detailed hospital records of 108 of the patients could be obtained. Ninety‐five per cent of the patients had headaches, 82% had lymphocytosis of the cerebrospinal fluid, and 81% had high fever. Forty‐four per cent had a confirmed biphasic course of disease. Seventeen per cent were severely ill. There were no deaths. The sequels were psychic irritability and fatigue for up to 1 year. There were eight cases of paresis, two of which became permanent.
Circulating anti‐neutrophil cytoplasm antibodies in patients with rapidly progressive glomerulonephritis and extracapillary proliferation
Authors: NÄSSBERGER L. , SJÖHOLM A. G. , BYGREN P. , THYSELL H. , HØJER‐MADSEN M. , RASMUSSEN N.
Published: August 2009

Abstract. We investigated 39 patients with rapidly progressive glomerulonephritis and extracapillary proliferation for the presence of circulating anti‐neutrophil cytoplasm antibodies (ANCA) by indirect immunoflourescence. Patients with antibodies against the glomerular basement membrane, systemic lupus erythematosus or with glomerulonephritis following infection and where renal disease could be ascribed to treatment with drugs were not included.

IgG class ANCA producing diffuse cytoplasmic immunostaining were detected in 54% of the patients. With reservation for the difficulties involved in distinguishing between different forms of systemic vasculitis, these autoantibodies were present in patients with Wegener's granulomatosis (12 out of 17 patients), polyarteritis nodosa (4/6), idiopathic extracapillary glomerulonephritis (1/4), and with less distinct syndromes (4/10), but not in Henoch‐Schönlein's purpura (0/2). Another 18% of the patients showed ‘granulocyte‐specific anti‐nuclear antibodies’ with perinuclear immunostaining. This pattern was recently reported to indicate the presence of antibody against myeloperoxidase of alcohol‐fixed neutrophils. Autoimmune mechanisms, particularly those involving components of neutrophil granulocytes, could play a significant role in development of extracapillary glomerulonephritis.
Familial hypocalciuric hypercalcaemia: a study of four kindreds
Authors: TOSS G. , ARNQVIST H. , LARSSON L. , NILSSON O.
Published: August 2009

Abstract. Four kindreds with hereditary hypercalcaemia have been investigated. Thirty‐seven of 72 subjects examined had hypercalcaemia with an autosomal dominant pattern of inheritance. Hypercalcaemic patients had total serum calcium of 2.91 ± 0.12 mmol l−1. Serum parathyroid hormone (PTH) was normal while daily urinary calcium excretion was subnormal (below 2.5 mmol) in 45%. Comparison with an age‐matched group of patients with primary hyperparathyroidism gave a small overlap regarding serum human PTH, urinary calcium and the ratio between calcium clearance and creatinine clearance. Family screening therefore is of diagnostic importance.

Twelve subjects had been subjected to parathyroid surgery before the correct diagnosis was settled, none of the cases had an adenoma. Three patients became normocalcaemic and the others had persistent hypercalcaemia. One male non‐abuser had seven episodes of acute pancreatitis before surgery and none after.

The findings in all four kindreds are compatible with familial hypocalciuric hypercalcaemia (FHH). This hereditary disorder of unknown aetiology, therefore, also exists in Scandinavia. It is of importance to consider FHH in the differential diagnosis of hypercalcaemia, since this disorder usually has a benign prognosis if untreated.
Primary biliary cirrhosis presenting as idiopathic thrombocytopenic purpura with deterioration after splenectomy
Authors: WALLERSTEDT S. , WESTIN J. , HANSSON G.
Published: August 2009

Abstract. A case of primary biliary cirrhosis (PBC) presenting as idiopathic thrombocytopenic purpura is described. The patient, a 59‐year‐old woman, had, at the time when thrombocytopenia was first observed, an asymptomatic PBC. She responded only temporarily to corticosteroids, and splenectomy had to be performed later. After this operation the platelet count was normalized, but a marked and rapid deterioration of her previously indolent PBC occurred. The time‐relationship indicates that the removal of the spleen may be considered the cause of the disease's progression. Possible mechanisms behind this adverse effect of the splenectomy are discussed. After initiation of azothioprine therapy a good response in clinical and laboratory features of the PBC was obtained, although the histological picture has remained unchanged.
Viral and bacterial infections in patients with acute myocardial infarction
Authors: MATTILA K. J.
Published: August 2009

Abstract. The association of both viral and bacterial infections with acute myocardial infarction was investigated in a case‐control study involving 40 consecutive patients with an acute myocardial infarction, 41 random controls and 30 patients with chronic coronary heart disease. All individuals were males aged 50 years or less. A rise in enterobacterial common antigen antibodies (15/40) and a recent influenza‐like illness (11/40) were significantly more common among patients with acute myocardial infarction compared with the other groups. No differences were observed between the groups in the occurrence of antibodies against eight other bacterial antigens or 16 viruses.
One year's experience of early defibrillation in Stockholm
Authors: JAKOBSSON J. , REHNQVIST N. , NYQUIST O.
Published: August 2009

Abstract. The effects of resuscitation on patients who died suddenly out of hospital were evaluated after the introduction of early defibrillation performed by ambulance personnel using semi‐automatic defibrillators. Resuscitation attempts were initiated in 548 patients during the 1‐year study period. Mean ambulance delay was 7.5 min, 22% of the cardiac arrest patients had received bystander cardiopulmonary resuscitation (CPR). Sensitivity and specificity for the semi‐automatic defibrillator in the interpretation of ventricular fibrillation was found to be 97 and 100% respectively. Only 28 (14%) of the 206 defibrillated patients regained circulation and were admitted for further hospital care. Only three survived to be discharged. Among the 342 patients in whom defibrillation was not indicated, 16 (5%) regained circulation and were admitted for further hospital care and one (0.3%) survived to be discharged. Semi‐automatic defibrillators seem reliable, safe and inexpensive: however, the isolated addition of defibrillation to basal ambulance service seems to be inadequate in Stockholm. We need to evaluate what further resources are of importance to guarantee a successful outcome.
Focal intracerebral oedema in hypertensive encephalopathy visualized by computerized tomographic scan
Authors: JESPERSEN C. M. , RASMUSSEN D. , HENNILD V.
Published: August 2009

Abstract. A previously healthy man was admitted due to a severe rise in the arterial blood pressure. The patient was found confused and drowsy, but the neurological investigation was otherwise normal. A computerized tomographic scan of cerebrum showed widespread areas of diminished density in the brain. After normalization of the arterial blood pressure, a new computerized tomographic scan did not show any pathological enhancement. The total regression of signs and symptoms after the normalization of the blood pressure support the assumption that a severe increase in blood pressure leads to formation of focal cerebral oedema.
Coexistence of sarcoidosis and myeloproliferative disease: a case of sarcoidosis preceding polycythaemia vera with a literature review
Authors: BRINCKER H.
Published: August 2009

Abstract. A patient with the chronic active type of sarcoidosis developed polycythaemia vera 20 years later. A review of the literature shows that sarcoidosis preceding myeloproliferative disease tends to be of the chronic active variety. The same pattern is observed in associations of sarcoidosis with malignant lymphoproliferative disease and solid tumours, in which sarcoidosis appears to be the underlying cause of the subsequent malignancy.
In‐vitro lipolysis of small very low density lipoproteins from human plasma. Dependence of characteristics of end products on the serum triglyceride concentration
Authors: TORNVALL P. , CARLSON L. A.
Published: August 2009

Abstract. Isolated, small very low density lipoproteins (VLDL) from males with plasma concentrations of VLDL triglycerides ranging between 0.92 and 8.65 mmol l−1 were incubated with lipoprotein lipase. There were no differences in the size of the VLDL particles isolated from normo‐respectively hypertriglyceridaemic plasmas. After incubation, 4.5 ± 3.5% (mean±SD) of the initial glyceride‐glycerol remained in the incubate. This amount did not vary with the plasma VLDL concentration. The incubation mixture was separated into three density fractions: VLDL, low density lipoprotein (LDL) and a high density lipoprotein (HDL) respectively. The lipid contents of these were determined. The distribution of cholesterol and phospholipids after lipolysis was highly dependent on the plasma VLDL level. The amount of cholesterol and phospholipids recovered in the LDL density region increased with the rising plasma VLDL level, the correlation coefficients for this relationship were 0.80 and 0.66, respectively. The results thus indicate that small, similar size VLDL from normo‐respectively hypertriglyceridaemic plasmas have different properties.
A double‐blind trial of Dextran‐haemodilution vs. placebo in claudicants
Authors: ERNST E. , KOLLAR L. , MATRAI A.
Published: August 2009

Abstract. Haemodilution is often recommended for peripheral arterial disease, yet little data is available to support its clinical efficacy. This study was designed to prove or disprove the effectiveness of Dextran‐haemodilution in intermittent claudication. Twenty claudicants with long, well‐collateralized arterial occlusions were randomized into groups 1 and 2. Group 1 received isovolemic haemodilution with Dextran 40 (500 ml per session) during 3 weeks, which was followed by a wash‐out period, followed by placebo treatments for 3 weeks. In group 2 this sequence was reversed. Pain‐free and maximal walking distances were measured by standardized treadmill tests along with plethysmographic blood flow, Doppler pressures, haematocrit, blood and plasma viscosity as well as fibrinogen. Walking distances increased significantly by about 50% during haemodilution in both groups. This was paralleled by a fall in haematocrit and blood viscosity. All other variables remained constant. During placebo treatments there were no significant changes of any variable. The treatment was tolerated without complications. Thus Dextran‐haemodilution seems safe and effective in selected peripheral occlusive arterial disease (POAD) patients. Potential responders might be identifiable before the start of therapy by angiographic investigations. The clinical effectiveness of Dextran 40 is comparable to that of hydroxyaethyl starch 200 as reported in the literature.
Job strain variations in relation to plasma testosterone fluctuations in working men ‐ a longitudinal study
Authors: THEORELL T. , KARASEK R. A. , ENEROTH P.
Published: August 2009

Abstract.Job strain, a high level of psychological demands combined with a low level of decision latitude, has been hypothesized to induce mobilization of energy and inhibition of anabolism. In the present project this hypothesis was tested using four repeated observations every third month in a group of 44 men working in six widely different occupations. On each occasion scores of self‐reported demands and decision latitude were calculated for every participant. An earlier report has shown that systolic blood pressure during work hours ‐ an indicator of mobilization of energy ‐ increased with increasing job strain (ratio between demands and decision latitude). Blood samples were drawn in the morning at the work site. For each man the plasma testosterone levels ‐ representing the general level of anabolic activity ‐ on the two occasions with the worst strain (ratio between demands and decision latitude) were compared with the plasma testosterone levels on the two occasions with the least strain. The results indicated that total plasma testosterone (but not free testosterone) levels increased when strain diminished in sedentary but not in physically demanding work. Subjects with a family history of hypertension showed a greater decrease in testosterone levels than others when job strain increased.
Termination of intractable hiccups with digital rectal massage
Authors: ODEH M. , BASSAN H. , OLIVEN A.
Published: August 2009

Abstract. A 60‐year‐old man with acute pancreatitis developed persistent hiccups after insertion of a nasogastric tube. Removal of the latter did not terminate the hiccups which had also been treated with different drugs, and several manoeuvres were attempted, but with no success. Digital rectal massage was then performed resulting in abrupt cessation of the hiccups. Recurrence of the hiccups occurred several hours later, and again, they were terminated immediately with digital rectal massage. No other recurrences were observed. This is the second reported case associating cessation of intractable hiccups with digital rectal massage. We suggest that this manoeuvre should be considered in cases of intractable hiccups before proceeding with pharmacological agents.
Epidemiology of biopsy‐proven giant cell arteritis (GCA)
Authors: NORDBORG E. , BENGTSSON B. Å.
Published: August 2009

Abstract. During a 10‐year period from 1st January 1977 to 31st December 1986, a temporal artery biopsy was performed in 2307 patients in the city of Göteborg. The biopsy revealed giant cell arteritis (GCA) in 284 (12.5%) of patients. The average annual incidence of biopsy‐proven GCA was 6.7 per 100 000 inhabitants. For women and men it was 9.9 and 3.5 per 100 000 inhabitants, respectively. In individuals aged 50 years or older, the average incidence was 18.3 per 100 000 inhabitants, with values of 25 and 9.4 for women and men, respectively. The annual incidence rate increased significantly (P < 0.01) for women, but not for men: this result was not explained by demographic changes in the population.
Temporal arteritis: the silent presentation and delay in diagnosis
Authors: DESMET G. D. , KNOCKAERT D. C. , BOBBAERS H. J.
Published: August 2009

Abstract. To determine the frequency of the so‐called silent or occult presentation of temporal arteritis (presentation with mere constitutional symptoms) and the resulting delay in diagnosis in this particular group, the medical records of all patients (n = 82) with temporal arteritis or polymyalgia rheumatica, presenting between 1982 and 1988 at the Department of General Internal Medicine of the University Hospital, were retrospectively analysed. Only biopsy‐proven cases (n = 34) were studied further.

Of the 34 patients with temporal arteritis, 13 (38%) presented with the silent or occult form. In this group the mean delay in diagnosis was 21.5 d (range 2–105) in contrast to a delay of 8.5 d (range 1–40) in the other group (P < 0.05).

Increased awareness of this presentation should lead to earlier diagnosis and treatment of this potentially life‐threatening disease, resulting in a shorter hospital stay and fewer technical investigations, with a considerable financial saving.
Prevalence of obesity in Sweden: cross‐sectional study of a representative adult population
Authors: KUSKOWSKA‐WOLK A. , RÖSSNER S.
Published: August 2009

Abstract. In order to facilitate research on body weight related diseases, and to plan suitable prevention and intervention programmes, data concerning the prevalence of overweight and obesity are required on a nationwide scale. In this study, data for weight and height from a representative sample (n = 14549) of adult Swedes (16–84 years of age) were analysed. Data were obtained from the Study on Living Conditions conducted by Statistics Sweden, and body mass indices (BMI, kg m−2) were calculated from these interviews. They were then calibrated, since we had previously found that reported anthropometric measurements must be corrected so as to conform to recorded height and weight values, and we have developed equations accordingly. The overall mean BMI (±SE) was 24.02±0.99 kg m−2 for women and 24.56±0.88 kg m−2 for men. However, with regard to age, striking differences between the sexes were observed using this cross‐sectional approach. Whereas in men there was a moderate increase in BMI with age, there was a sharp increase in women from 45–54 years onwards.

If obesity is defined according to WHO recommendations (BMI for men > 30.0 kg m−2, and for women > 28.6 kg m−2), then 34.5% of all men in our sample were found to be overweight and 6.6% were found to be obese. The corresponding figures for women are 31.2% and 13.1%. Our data suggest that, on a nation‐wide scale, overweight and obesity are common in men and women, but in women there is a marked increase from the menopause onward, for reasons that have yet to be clarified.
Reduced plasminogen activator inhibitor activity in high consumers of fruits, vegetables and root vegetables
Authors: NILSSON T. K. , SUNDELL I. B. , HELLSTEN G. , HALLMANS G.
Published: August 2009

Abstract. We studied a cross‐sectional sample of 260 subjects aged 30–60 years, in order to assess the relation between food intake habits and factors of the fibrinolytic system. Plasma samples of tissue plasminogen activator (tPA) antigen, and plasminogen activator inhibitor (PAI‐1) activity were obtained for the assay. The dietary pattern was determined using a food frequency questionnaire, according to which the subjects were grouped as high, low or medium consumers. The subjects who were high consumers of fruit, vegetables, and root vegetables showed the lowest levels of PAI‐1, those who were low consumers had the highest levels, whereas the medium consumers showed intermediate values. The tPA levels did not differ between the three groups, and there were no significant differences in other variables that covaried with PAI‐1 levels, such as age, anthropometric variables, or serum lipid levels, which could confound the PAI‐1/food pattern relationship. The data, which show that a frequent intake of fruit, vegetables, and root vegetables — foodstuffs rich in vitamin C and fibre — is associated with lower PAI‐1 levels, are consistent with increased activity of the fibrinolytic system and thus a reduced risk of thromboembolic and cardiovascular disease in subjects who exhibit this food intake pattern.
Prevention of myocardial infarction and stroke in patients with intermittent claudication; effects of ticlopidine. Results from STIMS, the Swedish Ticlopidine Multicentre Study
Authors: JANZON L. , BERGQVIST D. , BOBERG J. , BOBERG M. , ERIKSSON I. , LINDGÄRDE F. , PERSSON G.
Published: August 2009

Abstract.The Swedish Ticlopidine Multicentre Study (STIMS) was a double‐blind placebo‐controlled trial designed to determine whether ticlopidine, a platelet antiaggregatory agent, reduces the incidence of myocardial infarction, stroke and transitory ischaemic attacks in patients with intermittent claudication. A total of 687 patients was monitored for a minimum of 5 years or until an end‐point was reached. The number of end points (99 vs. 89), analysed according to the intention‐to‐treat principle, was 11.4% lower in the ticlopidine group (P= 0.24). The mortality rate was 29.1% lower in the ticlopidine group (64 vs. 89,P= 0.015); this observation could be accounted for by a reduced mortality from ischaemic heart disease. On‐treatment analysis showed there to be significantly fewer end points in the ticlopidine group (47 vs. 76,P= 0.017). Diarrhoea was the most common side‐effect. Reversible leucopenia or thrombocytopenia was reported in seven patients on ticlopidine. It is concluded that the high morbidity and mortality from cardio‐ and cerebrovascular disease in patients with intermittent claudication can be reduced by long‐term treatment with ticlopidine.
Phenotypic expression of the HLA linked iron‐loading gene in males over the age of 40 years: a population study using serial serum ferritin estimations
Authors: MEYER T. , BAYNES R. , BOTHWELL T. , JENKINS T. , JOOSTE P. , DU TOIT E. , MARTELL R. , JACOBS P.
Published: August 2009

Abstract.The frequency of the HLA linked iron‐loading gene was assessed in 1783 Afrikaner men over the age of 40 years living in the South Western Cape. Measurements, made on three occasions over a 4.5 year period, included the serum ferritin concentration, a screening test for reduced unsaturated iron‐binding capacity and the percentage transferrin saturation. The serum γ‐glutamyl transferase concentration was used as a marker of alcohol abuse. The diagnosis of homozygosity was based on a serum ferritin concentration that was persistently > 400 μg l−1and a percentage transferrin saturation > 55%. Using these criteria, 17 subjects were diagnosed as homozygous, corresponding to a disease frequency of 0.0095, a gene frequency of 0.0976 and a heterozygote frequency of 0.176 (95% confidence limits: 0.135–0.213). None of the subjects had overt clinical haemochromatosis. Typing for the HLA‐A, ‐B, ‐C and ‐DR loci showed that the HLA‐A3 allele (frequency 0.6471 and relative risk 4.4) was the only independent marker for the iron‐loading gene in this asymptomatic population. Using the present approach it was not possible to distinguish between heterozygotes, alcohol abusers and normal subjects with serum ferritin concentrations at the upper end of the normal range.
Eighty‐year‐old men without cardiovascular disease in the community of Malmö.: Part II. Smoking characteristics and ultrasound findings, with special reference to glutathione transferase and pyridoxal‐5‐phosphate
Authors: PESSAH‐RASMUSSEN H. , JERNTORP P. , STAVENOW L. , ELMSTÅHL S. , HANSEN F. , SEIDEGÅRD J. , GALVARD H. , BRATTSTRÖM L. , HAMFELT A.
Published: August 2009

Abstract. A total of 1280 80‐year‐old men in the community of Malmö were questioned about smoking habits and the occurrence of cardiovascular disease (CVD). After a careful medical and duplex ultrasound examination, four groups were selected for further studies: (1) no CVD, non‐smokers; (2) no CVD, smokers; (3) CVD, smokers; (4) CVD, non‐smokers. In total 122 individuals participated. The average tobacco consumption by smokers was 13 g d−1 for 59 years. In the CVD group 45% of subjects had atherosclerotic symptoms at more than one site. Smoking was found to be correlated with lower extremity atherosclerosis, cholesterol and LDL cholesterol were correlated with carotid artery lesions and pathological ankle/arm index, and blood pressure was correlated with lower extremity lesions. In contrast with middle‐aged populations, individuals with an increasing degree of lesions in the lower extremities had a larger percentage of high glutathione transferase activity than subjects without CVD. Smokers had significantly lower pyridoxal‐5‐phosphate levels than non‐smokers. It is concluded that some heavy smokers might reach an advanced age in good health. Smoking was also operative as a risk indicator for lower extremity atherosclerosis in 80‐year‐old individuals.
Treatment of hyperkalaemia in renal failure with salbutamol inhalation
Authors: MONTOLIU J. , ALMIRALL J. , PONZ E. , CAMPISTOL J. M. , REVERT L.
Published: August 2009

Abstract. The aim of this study was to investigate whether beta‐2‐adrenergic stimulation with inhaled salbutamol is therapeutically useful in hyperkalaemia. Ten patients with renal failure and hyperkalaemia (serum potassium concentration > 6 mmol l−1) were given 1 5 mg salbutamol via a nebulizer over a 30‐min period. Serum potassium was measured 30. 60, 180 and 360 min thereafter. All patients had end‐stage renal failure on chronic hospital haemodialysis. Serum potassium levels decreased significantly from a pretreatment value of 6.5 ± 0.6mmol l−1 to 5.6 ± 0.6mmol−1 after 30 min, and this level was maintained for 3 h. Six hours after treatment, the serum potassium concentration was 6 ± 0.7 mmol l−1. There was a modest increase in heart rate and blood glucose level, but otherwise salbutamol was well tolerated and no serious side‐effects occurred. It is concluded that the administration of salbutamol by inhalation is a simple, safe and reasonably effective method for treatment of hyperkalaemia in renal failure.
Insulin sensitivity in alcoholics in a withdrawal state
Authors: ADNER N. , NYGREN A.
Published: August 2009

Abstract. Insulin sensitivity in non‐diabetic alcoholics in a withdrawal state was investigated using a euglycaemic clamp technique on two occasions with an interval of 1 week. Insulin was infused at a rate of 40 mU m−2 min−1 (n = 9) and 20 mU m−2 min−1 (n = 9). Hepatic glucose production was estimated with tritiated glucose in six subjects. The fasting glucose level at the first examination, 5.1 ± 0.2 mmol l−1 exceeded that found at the second examination, 4.7 ± 0.1 mmol l−1 (P < 0.05), although the C‐peptide concentration was higher at the first examination (2.7 ± 0.3 vs. 1.6 ± 0.2 ng ml−1: P < 0.001). Both glucose uptake (5.0 ± 0.6 vs 6.2 ± 0.7 mg kg−1 min−1: P < 0.05) and tissue sensitivity (M/I; 0.08 ± 0.02 vs. 0.1 ± 0.02 mg kg−1 min−1/mU l−1; P < 0.05) increased between the first and second euglycaemic clamp (40 mU m−2 min−1). At the low insulin infusion rate (20 mU m−2 min−1), the tissue sensitivity to insulin increased (0.09 ± 0.01 vs. 0.13 ± 0.02 mg kg−1 min−1/mU l−1; P < 0.05). Hepatic glucose production did not change during the examination period (2.2 ± 0.2 vs. 2.3 ± 0.1 mg kg−1 min−1), neither was there a change in the suppression of hepatic glucose output during hyperinsulinaemia (40 mU m−2 min−1). Our findings indicate that, in non‐diabetic alcoholics, insulin sensitivity in peripheral tissues is decreased during the early part of a withdrawal period.
Acute renal failure and non‐Hodgkins lymphoma in a patient with minimal change glomerulonephritis
Authors: CRONIN C. , CARMODY E. , RYAN F. , CARMODY M.
Published: August 2009

Abstract. Two rare features of minimal change glomerulonephritis occurring together in an adult patient are described. A 70‐year‐old man presented with acute renal failure and the nephrotic syndrome. Investigation revealed minimal change glomerulonephritis and non‐Hodgkins lymphoma. Anti‐lymphoma treatment reversed both the renal failure and the nephrotic syndrome. Minimal change glomerulonephritis, as a cause of acute renal failure and as a manifestation of malignancy, is briefly reviewed.
Global assessment of patients — a bedside study. II. Inter‐observer variation and frequency of clinical findings
Authors: GJØRUP T. , HENDRIKSEN C. , BUGGE P. M. , JENSEN A. M.
Published: August 2009

Abstract. Three physicians independently assessed 201 hospital in‐patients for the presence of 10 basic physical characteristics, and made an overall assessment of whether or not the patients appeared ill. There were significant differences between the physicians in the average number of observations recorded for each patient (P < 0.001). There was a significant difference (P < 0.05) between the physicians regarding the number of positive diagnoses of anaemia, abnormal nutritional state, breathing difficulties and the overall assessment. Inter‐observer variation was estimated by a pairwise comparison of the three physicians. Overall agreement rates ranged from 0.65 for abnormal nutritional state to 0.99 for presence of pain. After adjusting for random agreement, kappa values between 0.09 (elevated body temperature) and 0.88 (consciousness impaired) were found. No tendency towards a higher level of agreement in the overall assessment than in the basic findings was observed.
Effects of nicotinic acid on serum cholesterol concentrations of high density lipoprotein subfractions HDL2, and HDL3, in hyperlipoproteinaemia
Authors: WAHLBERG G. , WALLDIUS G. , OLSSON A. G. , KIRSTEIN P.
Published: August 2009

Abstract. Nicotinic acid was given in a 4‐g daily dose for 6 weeks to 41 weight‐stable patients of mean age (f SD) 52 +_ 9 years, with type IIa, type IIb or type IV hyperlipoproteinaemia (HLP), in order to study its effects on serum cholesterol concentrations of high density lipoprotein (HDL) subfractions 2, and HDL3,. The triglyceride and cholesterol levels of serum very low density (VLDL) and low density (LDL) lipoproteins decreased during treatment (P < 0.001). Serum HDL and HDL, cholesterol levels increased by 37% and 135%, respectively. These changes were positively correlated (r = 0.93; P < 0.001). There was no significant change in mean serum HDL, cholesterol concentration. A negative correlation existed between changes in HDL, and HDL, cholesterol levels (r = −0.54; P < 0.001). Multiple stepwise linear regression analyses revealed that the initial HDL, cholesterol predicted more than 30% of the increase in HDL, cholesterol. Changes in the concentrations of HDL, and HDL, cholesterol after 6 weeks of drug treatment were not related to the type of HLP, neither were these effects of nicotinic acid correlated with changes in VLDL or LDL lipid levels. The concept has previously been proposed, on the basis of in vitro data, that HDL, is formed from HDL, particles in the blood. Our results suggest that, in man, this reaction is stimulated in vivo by prolonged nicotinic acid therapy.
Cigarette smoking and glomerular filtration rate in insulin‐treated diabetics without manifest nephropathy
Authors: EKBERG Dr.G. , GREFBERG N. , LARSSON L.‐O. , VAARA I.
Published: August 2009

Abstract. A sample of 120 insulin‐treated diabetics, 20‐40 years of age, with a glomerular filtration rate (GFR) exceeding −2 SD of the age‐adjusted value and without albuminuria > 300 mg 24 h−1, and with a diastolic blood pressure not > 90 mmHg, were studied in order to evaluate the possible effect of smoking on glomerular filtration rate. The patients reported their smoking habits, use of oral snuff, use of alcohol, physical exercise and heredity for hypertension in a simple questionnaire. GFR was assessed with 51Cr‐EDTA‐clearance and glomerular hyperfiltration was defined as a value exceeding + 2 SD of the age‐adjusted normal value. We found a significantly higher prevalence of glomerular hyperfiltration in smokers than in non‐smokers (41% vs. 18%), but no increased prevalence in users of oral snuff. In cigarette smokers a multivariate analysis revealed that GFR was positively related to body mass index (BMI), and negatively related to the number of cigarettes smoked per week and the mean blood pressure. In non‐smokers GFR was dependent only on age. We conclude that in insulin‐treated diabetics glomerular hyperfiltration is related to smoking, and that the GFR in smoking diabetics is directly dependent on the smoke doses. As glomerular hyperfiltration is regarded as a risk factor for diabetic nephropathy, our findings should be relevant to preventive measures in clinical work.
Acute chest pain without obvious organic cause before the age of 40 years: response to forced hyperventilation
Authors: ROLL M. , ZETTERQUIST S.
Published: August 2009

Abstract. A hyperventilation provocation test (HVPT) was performed on a group (n = 63) of consecutive patients, below the age of 40 years, attending an emergency care unit complaining of chest pain without obvious organic cause. The results were compared with those for a control group (n = 32). There was no tendency to hyperventilate in the patient group, either after discontinuing hyperventilation or during the ensuing relaxation period. PETCO2 measurements during this time thus showed no significant differences between the patient group and the control group. During the HVPT, 44% of patients reported three or more listed symptoms familiar to them from earlier occasions and regarded as typical of hyperventilation, compared to 23% of the controls (P < 0.05). In a previously reported study, 38% of the patients were found to have similar symptoms during standardized mental stress, despite lack of hypocapnia. It is concluded that, on the basis of PETCO2 measurements, there were no signs of abnormal hyperventilation in the patient group. Moreover, the HVPT did not appear to be specific for diagnosis of hyperventilation syndrome, since mental stress itself was able to reproduce symptoms without concomitant hypocapnia, and since the provocation test was ‘positive’ in many control subjects.
Mortality in non‐consenters in a post‐myocardial infarction trial
Authors: SMITH P. , ARNESEN H.
Published: August 2009

Abstract. Follow‐up of 270 subjects who declined to participate in a trial of oral anticoagulant therapy after acute myocardial infarction revealed a higher mortality (25.6%) than that for participants in the placebo group (20.2%). The excess mortality in terms of odds ratios was 1.35 (90% confidence interval 1.02‐1.79). Age was the only predictor of death. The event rate from ischaemic cardiovascular disease was lower among non‐consenters than among participants (49.3% vs. 74.8%), as was the rate of death during the first year of follow‐up. In conclusion, the differing mortality and dissimilar patterns of specific causes of death in non‐consenters and placebo‐treated participants emphasize the need for caution in extrapolation of treatment effects to the non‐consenting group. Thus the size of the non‐consenting group has implications for generalization of the overall results.
Renal artery embolism: thrombolysis with recombinant tissue‐type plasminogen activator
Authors: MÜGGE A. , GULBA D. C. , FREI U. , WAGENBRETH I. , GROTE R. , DANIEL W. G. , LICHTLEN P. R.
Published: August 2009

Abstract. The case of a patient with acute occlusion of the right renal artery due to an embolus is described. Using transoesophageal echocardiography, the left atrial appendage could be identified as the source of embolism. Twenty hours after the onset of symptoms, the embolus could be successfully dissolved with an intra‐arterial low‐dose infusion of recombinant tissue‐type plasminogen activator (10 mg loading dose, 20 mg continuous infusion within 12 h).
Fat distribution and steroid hormones in women with alcohol abuse
Authors: PETTERSSON P. , ELLSINGER B.‐M. , SJÖBERG C. , BJÖRNTORP P.
Published: August 2009

Abstract. Anthropometric, hormonal and liver function parameters were examined in 18 premenopausal women with a history of early alcohol abuse, and compared with the data for randomly selected controls of the same age. The alcoholic women showed slightly elevated levels of transaminases, but no clinical or laboratory signs of advanced liver damage. These women were characterized by an increased waist‐to‐hip ratio, due to enlarged waist circumference. Several endocrine abnormalities were found, including irregular or absent menses as well as low oestrogen, progesterone and Δ‐4‐androstendione levels. The concentration of free testosterone was high and that of sex‐hormone‐binding globulin was low. These data suggest abdominal distribution of body fat, as well as hyperandrogenicity in alcoholic, premenopausal women. It is postulated that the endocrine abnormalities might be responsible for the abdominal fat distribution.