bluuebunny/crossref_metadata_2025 huggingface dataset:
Meals and energy intake among elderly women – an analysis of qualitative and quantitative dietary assessment methods
Authors: Andersson J. C. , Gustafsson K. , Fjellström C. , Sidenvall B. , Nydahl M.
Published: March 2003

Objective:

The objective of this study was to analyse whether a qualitative method, in relation to traditional dietary assessment methods, was adequate to establish sufficient energy intake and energy content in separate meals in a population of elderly women.

Methods:

One hundred and thirty‐five elderly women, aged 63–88 years, living at home from three communities in mid‐eastern Sweden participated in the present study. The quantitative methods used were a combination of repeated 24‐h recall and a 3‐day estimated food diary. The qualitative method used was the Food‐Based Classification of Eating episodes model (FBCE).

Results:

The mean intake of energy estimated by the 5‐day registration was 6.8 ± 1.9 MJ. The total number of eating events was 5.22 ± 1.04 per day. On a group level, FBCE was useful to describe the diet among a group of elderly women; however, on an individual level, some complete meals were low or very low in energy, due to small portion sizes.

Conclusion:

The main conclusion was that a qualitative method, such as FBCE, must be supplemented with a dietary assessment method giving the energy intake to ensure that it is sufficient, especially when studying groups at risk for malnutrition.
The French longitudinal study of growth and nutrition: data in adolescent males and females
Authors: Deheeger M. , Bellisle F. , Rolland‐Cachera M. F.
Published: March 2003

Objectives  To assess nutritional intake, growth parameters, physical activity and television viewing in French adolescents.

Method  A longitudinal study of dietary intake and anthropometric data recorded in the same children (n = 94) from 10 to 16 years of age is presented here.

Results  Energy intake increased from age 10–16 years in boys, whereas it decreased in girls from the age of 14. Height and weight increased in both males and females over the same period of time. Energy intake was positively associated with age at menarche. Nutritional intake, such as fat and calcium, did not meet recommendations for French adolescents. Height was higher than reference values, but the difference was not significant for girls between 14 and 16 years. Overweight (BMI > 97th percentile of the French reference) was found to be 13–14% between age 10 and 16 years. Time watching TV/computer increased with age from 1.4 to 2.2 h day−1 from 10 to 16 years. Active children had nutritional intake closer to recommendations.

Conclusion  In conclusion, this study shows that during adolescence, some nutritional variations can be explained by normal individual growth processes. Low intake of calcium in girls and sedentary lifestyle are of particular concern.
Rubinstein‐Taybi syndrome and psychiatric disorders
Authors: Levitas A. S. , Reid C. S.
Published: March 2003

Major psychiatric disorders have a complex genetic aetiology. The study of psychiatric phenotypes in individuals with malformation syndromes may allow one to search for the genes that confer an increased risk for the same psychiatric disorders in the general population. The present authors report on the psychiatric evaluations of 13 patients with classic or incomplete features of Rubinstein‐Taybi syndrome (RTS), a multiple congenital anomaly syndrome mapped to 16p13.3, whose psychiatric diagnoses fell within a consistent spectrum, suggesting a possible relationship between RTS and these psychiatric disorders. The diagnoses clustered into mood disorders and the tic/obsessive compulsive disorder (OCD) spectrum; all tic/OCD diagnoses occurred in patients with classical RTS. It was of interest that neuroleptic‐induced movement disorders and neuroleptic malignant syndrome were common. While no conclusions can be drawn about the prevalence of psychiatric disorders in RTS, the pattern of psychiatric diagnoses in these patients appear non‐random, and the occurrence and severity of neuroleptic side‐effects is striking. Given the suspected relationship of these complications with the serotonergic and dopaminergic systems, the present authors suggest that the gene locus for RTS should be investigated for genes related to the regulation of these neurotransmitters.
Reliability and validity of the Mini PAS‐ADD for assessing psychiatric disorders in adults with intellectual disability
Authors: Prosser H. , Moss S. , Costello H. , Simpson N. , Patel P. , Rowe S.
Published: March 2003

The Mini PAS‐ADD is an assessment schedule for psychiatric disorders in people with an intellectual disability. It is designed to provide a link between the mental health expertise of psychiatrists and psychologists, and the detailed knowledge of individual service users possessed by support staff. In broad terms, the aim of the Mini PAS‐ADD is to enable non‐psychiatrists accurately to recognize clinically significant psychiatric disorders in the people who they care for, so that they can make informed referral decisions, The instrument comprises 86 psychiatric symptoms and generates a series of subscores on: depression, anxiety and phobias, mania, obsessive‐compulsive disorder, psychosis, unspecified disorder (including dementia), and pervasive developmental disorder (autism). The present paper reports the results of a study investigating internal consistency, inter‐rater agreement and validity in relation to clinical opinion, using a sample of 68 people with intellectual disability who were in contact with psychiatric services. In terms of the instrument fulfilling its main intended function, i.e. accurate case recognition, the crucial question was whether the support workers, with their lesser knowledge of psychopathology, were also able to correctly identify cases identified by expert clinicians. The validity results in this respect (81% agreement on case recognition) were sufficiently good that it is to be anticipated that the Mini PAS‐ADD should have a significant impact on the identification of psychiatric disorders in the community of people with intellectual disability.
The characteristics and residential situations of people with severe intellectual disability and the most severe challenging behaviour in Wales
Authors: Lowe K. , Felce D. , Perry J. , Baxter H. , Jones E.
Published: March 2003

A total population study of people in Wales with severe intellectual disability and the most severe challenging behaviour was undertaken to identify their characteristics, and the nature of their residential arrangements and service support. Forty‐one participants were identified: five living in family homes, 17 in community housing, 17 in hospitals and two in hostels. The family home group had slightly higher adaptive behaviour scores than residents in community housing. Both groups had significantly higher scores than the hospital and hostel residents combined. Assessments of challenging behaviour showed the groups to be similar and to have a considerable range and extent of severely problematic behaviour. Co‐occurrence of several forms of frequent severe problem behaviour was the norm and there was a marked association with social impairment. The five people living in their family homes had nominated service keyworkers, but reported professional input was low. The residential situations comprised two main service types: (1) traditional services, which were characterized by large living unit and facility size, atypical architectural design, relative isolation from the community, a greater level of buildings adaptations, low staff:resident ratios, a relatively high percentage of qualified staff, and a relative absence of systematic approaches to goal planning and structured activity; and (2) new community houses, which were characterized by small size, domestic design, location within the community, a lower level of buildings adaptations, much higher staff:resident ratios, and less emphasis on qualified staff but a greater emphasis on systematic working methods. Community settings were similar in having ‘specialist’ resident groupings based on challenging behaviour or conditions like autism in which challenging behaviours are common. A policy to provide for people with these characteristics being resettled from traditional settings in this way seems to have been established.
Prader–Willi syndrome and cycloid psychoses
Authors: Bouras N. , Verhoeven W. M. A. , Curfs L. M. G. , Tuinier S.
Published: March 2003

The psychiatric symptomatology of people with Prader–Willi syndrome (PWS) has mainly been described in case reports and some large‐scale descriptive studies. Unfortunately, there is still no systematic description of all the psychiatric symptoms which accompany this chromosomal error. Symptoms of mood disorder and anxiety dominate the picture of PWS, although some reports also mention psychotic symptoms with variations in prevalence of between 15% and 60%. The present paper presents six case reports of adult male subjects with a diagnosis of PWS and psychiatric symptoms who fulfill the criteria for cycloid psychosis (ICD‐10 F.23.0). This psychotic disorder requires a specific psychopharmacological approach with mood stabilizing agents, particularly Lithium. It is concluded that subjects with PWS may be especially vulnerable to the development of cycloid psychosis, which suggests the existence of a specific ‘psychopathological phenotype’.
Inpatient care and its outcome in a specialist psychiatric unit for people with intellectual disability: a prospective study
Authors: Raitasuo S. , Taiminen T. , Salokangas R. K. R.
Published: March 2003

The outcome of treatment in care units has been thought to reflect the effectiveness of treatment. There have been only a few studies describing inpatient care and its outcome in patients with intellectual disability and psychiatric symptoms. The present study describes the psychiatric inpatient treatment in the specialist psychiatric unit of the Special Welfare District of South‐west Finland and the need for aftercare among people with intellectual disability and psychiatric disorders (n = 40). As an outcome measure of care, the level of psychiatric symptoms was evaluated either with the Brief Psychiatric Rating Scale (BPRS) or with the Diagnostic Assessment for the Severely Handicapped (DASH) scale; self‐reports (visual analogue scale) were also used. Patients’ psychotic symptoms were reduced significantly on the BPRS during inpatient care and aftercare, but non‐psychotic symptoms were reduced significantly only during aftercare. For one patient, the psychiatric symptoms were reduced significantly during inpatient care on the DASH scale, while the psychiatric symptoms remained the same for three patients. Patients and their primary carers considered the patient’s psychiatric condition to have improved significantly during inpatient care, but not during aftercare. The specialist unit filled the gap in the care of people with intellectual disability and psychiatric problems in Southwest Finland. It is concluded that psychotic patients particularly benefit from the inpatient care in the specialist psychiatric unit. The care in the unit should include support for primary carers. All patients’ outpatient treatment should also be re‐evaluated. The present study poses two important questions. Firstly, could these treatment outcomes have been achieved with other interventions? Secondly, what are the necessary services for people with intellectual disability?
Oral self‐mutilation in a patient with rhombencephalosynapsys
Authors: Verri A. , Uggetti C. , Vallero E. , Ceroni M. , Federico A.
Published: March 2003

Rhombencephalosynapsis (RS) is a rare cerebellar malformation. Its essential features are the absence of the incisura cerebelli posterior, fusion of the cerebellar hemispheres, the absence of the velum medullare anterius and nuclei fastigii, and fusion of the dentate nuclei, which are shifted towards the mid‐line. Clinically, affected patients present with signs of cerebellar and motor disturbances. The present report describes a new patient affected by RS. The subject first presented at the age of 22 years because of a psychiatric symptomatology which was characterized by obsessive oral self‐mutilation associated with an intellectual disability. Objective evaluation documented dysmorphic features, while neurological examination showed only a slight truncal ataxia. The subject's IQ was 74 on the Wechsler Scale (verbal IQ = 79, performance IQ = 74). Psychiatric evaluation with DSM‐IV criteria documented an obsessive‐compulsive personality disorder associated with emotional instability and oral self‐mutilation. The typical picture of rhombencephalosynapsis was evident on magnetic resonance imaging. Both chromosomal analysis and routine biochemical investigations were normal. The relationship between oral self‐injurious behaviour and cerebellar malformations is discussed with particular regard to the behavioural aspects of cerebellar congenital pathology in affective disorders and in autism.
Intellectual characteristics of Prader–Willi syndrome: comparison of genetic subtypes
Authors: Roof E. , Stone W. , MacLean W. , Feurer I. D. , Thompson T. , Butler M. G.
Published: March 2003

Advances in genetics have led to an increased understanding of the role of the genotype on behavioural functioning. The purpose of the present study was to examine differences in intellectual functioning in individuals with Prader–Willi syndrome (PWS) with a paternal 15q11–q13 deletion versus maternal uniparental disomy (UPD) of chromosome 15. Measures of intelligence and academic achievement were administered to 38 individuals with PWS (24 with deletion and 14 with UPD). The subjects with UPD had significantly higher verbal IQ scores than those with deletion (P0.01). The magnitude of the difference in verbal IQ was 9.1 points (69.9 versus 60.8 for UPD and deletion PWS subjects, respectively). Only 17% of subjects with the 15q11–q13 deletion had a verbal IQ≥70, while 50% of those with UPD had a verbal IQ≥70. Performance IQ scores did not differ between the two PWS genetic subtype groups. This is the first report to document the difference between verbal and performance IQ score patterns among subjects with PWS of the deletion versus the UPD subtype.
Incidence And Course Of Dementia In People With Down's Syndrome: Findings From A Population‐Based Study
Authors: Holland A. J. , Hon J. , Huppert F. A. , Stevens F.
Published: March 2003

The prevalence rate of Alzheimer's disease (AD) in people with down's syndrome (DS) increases significantly with age. However, the nature of the early clinical presentation, course and incidence rates of dementia are uncertain. The aims of the present study were to investigate the characteristics of age‐related clinical changes and incidence rates for dementia in a population‐based sample of people with DS aged 30 years and older at the age of risk for dementia. A modified version of the cambridge examination for mental disorders of the elderly informant interview was used to determine the extent and nature of changes in memory, personality, general mental functioning and daily living skill 18 months after a similar assessment. At the time of the first assessment, the initial changes reported were predominately in behaviour and personality. At the second assessment, overall estimated incidence rates for frontal‐like dementia were high (0.24), mainly in the younger groups, with incidence rates of AD, meeting both ICD‐10 and DSM‐IV criteria, of 0.04 predominately in the older groups. The present authors have hypothesized that the observed personality changes and the high estimated incidence rates of frontal‐like dementia in the younger groups may indicate that functions served by the frontal lobes are the first to be compromised with the progressive development of Alzheimer‐like neuropathology in people with DS.
Diagnosis of depression in people with severe/profound intellectual disability
Authors: Tsiouris J. A.
Published: March 2003

The Marston 30 Symptoms Checklist for detecting depression was used to determine whether or not the notion of ‘depressive equivalents’ can provide a few of the core characteristics necessary for the diagnosis of depressive disorders in people with severe/profound intellectual disability (ID). Diagnoses of major depression were made by a psychiatrist using the DSM‐III‐R criteria, combined with information from records, staff, team, parents, behaviour profiles, direct observations, mental status and follow‐up visits. Twenty‐two people with ID fulfilled the selection criteria from a larger sample of 150 patients who had been evaluated in 350 contact visits. Scores on the checklist for major depression for 15 subjects with severe/profound ID were similar to the core characteristics for diagnosis of major depression by DSM‐III‐R criteria. Evidence was found for the presence of depressive equivalents in the subjects, but these appeared to be secondary. The 15 participants with severe/profound ID were observed mostly during the depressive phase of bipolar I and bipolar II disorder, and major depression, recurrent type. Melancholic features were prominent in their presentation. Further studies of people with ID are needed to determine whether depressive equivalents are more prominent in cases of major depression with atypical features than in cases of major depression with melancholic features.
Benefits of the Treatment and Education of Autistic and Communication Handicapped Children (TEACCH) programme as compared with a non‐specific approach
Authors: Panerai S. , Ferrante L. , Zingale M.
Published: March 2003

Background Two educational treatments were compared, the Treatment and Education of Autistic and Communication Handicapped Children (TEACCH) programme and the integration programme for individuals with disabilities.

Methods Two groups of eight subjects were matched by gender, chronological and mental age, and nosographic diagnosis (i.e. autism associated with severe intellectual disability, DSM‐IV criteria and Childhood Autism Rating Scale scored. The TEACCH programme was applied to the experimental group, while the control group was integrated in regular schools with a support teacher. The Psycho‐Educational Profile – Revised and the Vineland Adaptive Behaviour Scale were administered twice with a one‐year interval between assessments.

Results The scores of the experimental group increased more than the control group scores. Statistically significant differences were obtained in both groups because of the differences in the two approaches.
Evaluating the use of multiple microswitches and responses for children with multiple disabilities
Authors: Lancioni G. E. , O’Reilly M. F. , Singh N. N. , Oliva D. , Piazzolla G. , Pirani P. , Groeneweg J.
Published: March 2003

Background The present study assessed the feasibility of (1) establishing multiple microswitches and responses (some of which had not been used before) with two children with multiple disabilities, and (2) maintaining such microswitches and responses in the children’s daily contexts.

Methods The microswitches were introduced individually and then combined. During the last part of treatment and the follow‐up, each child had three microswitches.

Results The data show that both children learned to use all three available microswitches. Moreover, they retained fairly high levels of responding with the microswitches in their daily contexts during follow‐up periods of 4 and 6 months.

Conclusions The personal and practical implications of these findings are discussed.
Psychological treatment of reported sleep disorder in adults with intellectual disability using a multiple baseline design
Authors: Gunning M. J. , Espie C. A.
Published: March 2003

Background The literature on sleep disturbance in adults with intellectual disability (ID) is sparse. Although prevalence rates for sleep disorders appear similar to those of non‐disabled populations, previous treatment studies have largely been comprised of uncontrolled cases. Therefore, the present study adopted a single‐case experimental methodology to evaluate behavioural sleep intervention.

Methods A screening questionnaire was posted to 384 adults with ID and the sleep pattern of respondents with possible sleep disorders was further assessed using a structured diagnostic schedule. From the sleep‐disordered subgroup, 12 participants were selected for a 4‐week behavioural sleep intervention that was evaluated using randomly allocated, multiple‐baseline, across‐subjects designs and within‐subject interrupted time series analyses (ITSAs).

Results A total of 155 adults with ID (83 females and 72 males; mean age = 32 years, SD = 16.5 years), or their carers, completed the questionnaire (return rate = 40%). The application of sleep diagnostic criteria revealed that 17% had clinically significant difficulty getting to sleep and 11% had difficulty remaining asleep. Nine out of the 12 participants recruited for the intervention completed all the experimental phases, thus providing three sets of three multiple‐baseline designs. Visual inspection of within‐ and between‐subject effects suggested beneficial treatment‐specific effects across a range of target variables. The ITSA confirmed significant effects (P < 0.05) or trends (P < 0.10) for six out of the nine participants.

Conclusions Behavioural sleep management may improve sleep pattern or sleep‐related functioning in the majority of adults with ID who have significant sleep problems. The single‐case methodology is helpful in addressing the heterogeneity of individual presentation, although clinical trial methodology is required to confirm these findings on a larger scale.
Prevalence of psychiatric disorders in children and adolescents with and without intellectual disability
Authors: Emerson E.
Published: March 2003

Background  There have been very few population‐based studies of the prevalence of psychiatric disorders among children and adolescents with and without intellectual disability (ID).

Methods  Secondary analysis of the 1999 Office for National Statistics survey of the Mental Health of Children and Adolescents in Great Britain was performed. This survey collected information on a multistage, stratified, random sample of 10 438 children between 5 and 15 years of age across 475 postcode sectors in England, Scotland and Wales.

Results  The prevalence of any diagnosed ICD‐10 disorder, conduct disorder, anxiety disorder, hyperkinesis and pervasive developmental disorders were significantly greater among children with ID than among their non‐ID peers. There were no statistically significant differences between children with and without ID with regard to the prevalence of depressive disorders, eating disorders or psychosis. Factors associated with an increased risk of psychopathology among children and adolescents with ID included age, gender, social deprivation, family composition, number of potentially stressful life events, the mental health of the child's primary carer, family functioning and child management practices.

Conclusions  Children and adolescents with ID are at significantly increased risk of certain forms of psychiatric disorder. Careful consideration of the social and economic adversity facing such families will be necessary to ensure that support services are responsive to both the needs of child as well as the needs of the family in which they are living.
Working with sex offenders with intellectual disability: evaluation of an introductory workshop for direct care staff
Authors: Taylor J. L. , Keddie T. , Lee S.
Published: March 2003

Background  Sexual aggression by men with intellectual disability (ID) is a serious problem requiring attention from the relevant agencies. Training for staff working with this problem is often not given sufficient attention and is rarely evaluated. In the present study, an introductory workshop for direct care staff that aimed to increase knowledge and improve attitudes towards work with this client group was evaluated.

Method  Sixty‐six staff working in inpatient and community settings completed a 2.5‐day workshop. Before training began, the participants completed a survey questionnaire concerning their experiences of work with this client group. An assessment of their knowledge and attitudes was carried out prior to and at the end of training in order to evaluate any changes. The participants also rated the effectiveness of the workshop and their level of satisfaction with the training at the end of the workshop.

Results The participant s’ knowledge and attitudes improved significantly following the workshop. Staff with greater experience over time and those who had worked with fewer sex offender clients responded to different aspects of the training. The participants’ ratings indicated that they were highly satisfied with the training and found it to be effective.

Conclusions  Brief workshop training is acceptable to and can be effective in improving the knowledge, attitudes and confidence of direct care staff working with sex offenders with ID. However, because the results are based on participant self‐report, caution should be exercised concerning their external validity.
Helicobacter pylori seropositivity is not associated with inflammatory parameters, lipid concentrations and degree of coronary artery disease
Authors: RegnstrÖM  , Jovinge  , BÅvenholm  , Ericsson  , DE Faire  , Hamsten  , Hellenius  , Nilsson  , Tornvall
Published: March 2003

Regnström J, Jovinge S, Båvenholm P, Ericssond C‐G, de Faire U, Hamsten A, Hellenius M‐L, Nilsson J, Tornvall P (Karolinska Hospital and Danderyd Hospital, Stockholm, Sweden). Helicobacter pylori seropositivity is not associated with inflammatory parameters, lipid concentrations and coronary artery disease. J Intern Med 1998; 243: 109–13.

Objectives

To determine the prevalence of chronic infection with Helicobacter pylori (HP) in patients with established coronary artery disease (CAD) and in healthy controls. Furthermore, to investigate whether HP infection is associated with inflammatory parameters, lipid concentrations and degree and progression of CAD.

Design

A case–control study combined with a prospective angiographic study.

Setting

Stockholm Metropolitan Area, Sweden.

Patients and methods

A material consisting of 92 young men aged 40.9 ± 3.2 (mean ± SD) years, with previous myocardial infarction and documented coronary atherosclerosis, and 95 healthy sex‐matched controls, aged 43.2 ± 3.0 (mean ± SD) years, with similar socio‐economic status and ethnic background was analysed for the prevalence of HP seropositivity, plasma concentrations of the inflammatory parameters fibrinogen, tumour necrosis factor alpha and orosomucoid, and serum concentrations of lipids. The impact of HP seropositivity on degree and progression of CAD, as assessed by quantitative coronary angiography, was also determined.

Results

The study population of mainly Scandinavian origin had a low prevalence of HP seropositivity in comparison with previously published European populations. No significant increase in HP seropositivity was found in patients compared with controls (42.2 vs. 32.6%). Furthermore, HP infection was not associated with increased levels of inflammatory parameters, lipid concentrations or with degree of angiographically determined CAD at baseline, or progression of CAD and clinical events over 5 years.

Conclusions

HP infection is not associated with inflammatory parameters and lipid concentrations and could not be confirmed as a risk factor for CAD.
Endoscopic and pathological manifestations of the gastrointestinal tract in familial amyloidotic polyneuropathy type I (Met30)
Authors: Yoshimatsu Shin‐ichi , Ando Yukio , Terazaki Hisayasu , Sakashita Naomi , Tada Shuji , Yamashita Taro , Suga Moritaka , Uchino Makoto
Published: March 2003

Yoshimatsu S, Ando Y, Terazaki H, Sakashita N, Tada S, Yamashita T, Suga M, Uchino M, Ando M (Kumamoto University School of Medicine; and Saiseikai Hospital, Kumamoto, Japan). Endoscopic and pathological manifestations of the gastrointestinal tract in familial amyloidotic polyneuropathy type I (Met30). J Intern Med 1998; 243: 65–72.

Objectives

To evaluate the characteristic changes in the gastrointestinal tract in familial amyloidotic polyneuropathy (FAP) (Met30), both fibre gastroscopy and colonoscopy studies were performed in FAP (Met30) patients. Microscopic changes were also examined in autopsied and biopsied materials from patients with FAP, and compared with data from autopsied samples from patients with AL amyloidosis, and secondary amyloidosis patients.

Design

Endoscopic and histopathological study.

Setting

Kumamoto University Hospital, Kumamoto, Japan.

Subjects

Nine patients with FAP (Met30) underwent fibre gastroscopy and colonoscopy. Six autopsied and 23 biopsied gastrointestinal samples from FAP patients, four from autopsied amyloidosis (including two myeloma associated form), and two from autopsied secondary amyloidosis patients were examined for histopathological study.

Main outcome measures

Fibre gastroscopy and colonoscopy were employed for macroscopic study. Congo red and H‐E staining were performed for histopathological study. Macroscopic changes in the gastrointestinal tract and microscopic differences in the amyloid distribution pattern were compared between the different types of amyloidosis.

Results

Fibre gastroscopy and colonoscopy for nine FAP patients revealed that four showed a fine granular appearance in the duodenum, three showed lack of lustre, and two showed mucosal friability in the gastrointestinal tract; however, no macroscopic abnormality was observed in four other FAP patients. Histopathological examination of tissue from FAP patients revealed that, although a small amount of amyloid was recognized in the submucosa perivascular layer, a significant amount of amyloid was seen in and around the nerves of the gastrointestinal tract, but very little in Auerbach's nerve plexus. In total, the amount of deposited amyloid in the tissues was small compared with that in other types of systemic amyloidosis, such as AL and secondary amyloidosis.

Conclusion

These results suggest that the major reason why FAP patients show such severe gastrointestinal symptoms, compared with other types of systemic amyloidosis, may be because of the deposition of a significant amount of amyloid in the nerves in the gastrointestinal tract.
Hypertriglyceridemia and insulin resistance
Authors: HÖlzl  , Paulweber  , Sandhofer  , Patsch
Published: March 2003

Hölzl B, Paulweber B, Sandhofer F, Patsch JR (St Johanns Spital, Salzburg; and University of Innsbruck, Innsbruck; Austria). Hypertriglyceridemia and insulin resistance (Case Report). J Intern Med 1998; 243: 79–82.

Although the association between insulin resistance and hypertriglyceridemia has long been recognized, the question of the causal relationship of these two entities is still a matter of debate. To gain more insight into the relationship between hypertriglyceridemia and insulin resistance, we studied insulin sensitivity in two severely hypertriglyceridemic subjects in whom insulin resistance as a cause for hypertriglyceridemia could be positively ruled out. Rather, lipoprotein lipase deficiency due to a mutation in the lipoprotein lipase gene was identified as the cause. In the two study subjects, whole body glucose utilization was measured during a continuous infusion of somatostatin, glucose and insulin. Mean values of plasma glucose and insulin concentrations at 150, 160, 170 and 180 minutes were used to calculate steady state plasma glucose (SSPG) and steady state plasma insulin (SSPI) concentrations. SSPG of the two hypertriglyceridemic patients was in the range of those reported in the literature for healthy subjects without insulin resistance did not differ from those of two control subjects with normal plasma lipid levels. Therefore, the dyslipidemic state of the two patients, characterized by extreme elevation of triglyceride rich plasma lipoproteins and a severe reduction of HDL cholesterol, was clearly not associated with insulin resistance. From these findings we conclude that hypertriglyceridemia per se is not an obligatory cause for insulin resistance.
Diagnosis of pulmonary embolism by measurement of alveolar dead space
Authors: Olsson  , Jonson  , Olsson  , Wollmer
Published: March 2003

Olsson K, Jonson B, Olsson CG, Wollmer P (Malmö University Hospital and Lund University Hospital, Sweden). Diagnosis of pulmonary embolism by measurement of alveolar dead space. J Intern Med 1998; 244: 199–207.

Objective

Pulmonary embolism (PE) gives rise to alveolar dead space, which can be measured with a single breath test for CO2 (SBT‐CO2). The characteristics of the SBT‐CO2 are different in PE and other common conditions giving rise to alveolar dead space, notably airways disease. An analysis of alveolar dead space focusing on the late part of the breath (fDlate) has been suggested as a method for diagnosis of PE. Our aim was to evaluate this technique by comparison with lung scintigraphy.

Methods

We randomly selected patients with clinical suspicion of PE. SBT‐CO2 and lung scintigraphy were performed on the same day. The scintigraphies were reviewed and classified as high, intermediate and low probability of PE.

Results

Out of 223 patients able to be evaluated, there were 20 of the high, 29 of the intermediate and 174 of the low probability category. There were large differences between the means of fDlate in the high and the intermediate and in the high and the low categories. We obtained a sensitivity of 85% and a specificity of 93% for diagnosis of PE, based on high and low probability categories. If a patient with previous PE, but no scintigraphic evidence of current PE, is excluded the sensitivity increases to 90%.

Conclusions

This study provides further support for the measurement of fDlate by the SBT‐CO2 as a diagnostic test in patients with suspicion of PE. The test should be especially useful in small hospitals without access to pulmonary scintigraphy or pulmonary angiography.
Sheehan's syndrome: differential diagnosis in the acute phase
Authors: Dejager  , Gerber  , Foubert  , Turpin
Published: March 2003

Dejager S, Gerber S, Foubert L&Turpin G (La Pitié Salpétrière, Paris, France). Sheehan's syndrome: differential diagnosis in the acute phase (Case Report). J Intern Med 1998; 244: 261–66.

Many studies have been done in the later course of Sheehan's syndrome, but very few have documented the acute phase with clinical, endocrine and imaging data. We present the case of a young woman complaining of severe headache after delivery, who developed hypopituitarism. Magnetic resonance imaging (MRI) disclosed the presence of an enlarged non haemorrhagic pituitary gland. Follow‐up MRI showed a spontaneous and rapid shrinkage of the pituitary, within 20 days, which appeared as an empty sella 3 months later. Sheehan's syndrome may initially closely mimic hypophysitis, or the necrosis of an adenoma. We discuss the differential diagnoses, important for the best therapeutic management.
Evidence of gastrointestinal immune reactivity in patients with sarcoidosis
Authors: Papadopoulos K. I. , Sjöberg K. , Lindgren S. , Hallengren B.
Published: March 2003

Objectives.  The aim of the present study was to explore the frequency of clinical and serological manifestations of gastrointestinal immune reactivity in a large group of Swedish patients with sarcoidosis.

Design.  In patients with documented sarcoidosis, the presence of pernicious anaemia and coeliac disease was examined. Antibodies to H+/K+ ATPase, gliadin (AGA‐IgA/IgG) and endomysium (IgA‐EMA) were analysed. In H+/K+ ATPase antibody‐positive patients, serum gastrin levels were measured and, when elevated, gastrointestinal biopsy was offered (biopsy performed in 6/9 patients); biopsy was also offered to those with positive EMA or AGA of either class (biopsy performed in 8/12 patients). Subjects from national and local studies were used as controls.

Setting.  The patients were recruited at the Department of Pulmonary Medicine, and the study was conducted at the Department of Endocrinology, University of Lund, Malmö University Hospital, Malmö, Sweden.

Subjects.  Of all patients (n = 89) with documented sarcoidosis attending the Department of Pulmonary Medicine between January 1980 and December 1991, 78 [34 females and 44 males; median age at the time of the study, 48 (range 22–81) years; median observation time since the diagnosis of sarcoidosis, 120 (range 1–468) months] were examined.

Results.  Twenty‐nine patients (37.2%) had signs of gastrointestinal immune reactivity. H+/K+ ATPase antibodies were detected in 19 patients (24.4 vs. 4% in controls, P = 0.00015). Serum gastrin levels (median 45, range 22–720 pmol L–1) in those patients correlated with antibody titre (r2 = 0.882). Gliadin antibodies were detected in 12 patients (15.4 vs. 8.1% in controls, P = 0.042), of whom 11 (14.1 vs. 4.5% in controls, P = 0.00114) had AGA‐IgA alone. One patient had pernicious anaemia and another coeliac disease (EMA‐positive).

Conclusion.  We have demonstrated a high frequency of gastric autoimmunity and gluten‐associated immune reactivity in patients with sarcoidosis, occurring in almost 40% of the cases, the former being the most frequent gastrointestinal immune manifestation. Despite a high frequency of humoral autoimmunity, the frequencies of clinical disease, pernicious anaemia and coeliac disease were not increased as compared with the control population.
Can one really measure magnesium deficiency using the short‐term magnesium loading test?
Authors: Rob P. M. , Dick K. , Bley N. , Seyfert T. , Brinckmann CH. , Höllriegel V. , Friedrich H. J. , Dibbelt L. , Seelig M. S.
Published: March 2003

Abstract.Rob PM, Dick K, Bley N, Seyfert T, Brinckmann CH, Höllriegel V, Friedrich HJ, Dibbelt L, Seelig MS (Medizinische Uniersität zu Lübeck, Freie Universität Berlin, Germany and University of North Carolina, Chapel Hill, USA). Can one really measure magnesium deficiency using the short‐term magnesium loading test?J Intern Med1999246: 373–378.

Objective.To compare a 1‐h‐version of a magnesium‐loading‐test (MLT) designed for outpatients in healthy controls with the 8‐h standard; to establish the test in patients after renal transplantation prone to develop magnesium (Mg) deficiency; to correlate femur Mg‐concentration and percentage retention of the given load.

Design.Comparision of mean values from healthy controls with respective from the literature; a prospective, randomized, controlled 4‐month study; an intra‐individual correlation of Mg‐serum values and loading‐test data with femur‐Mg concentrations.

Setting.One centre study in a medical university; outpatients from the transplant unit; inpatients from the orthopedic unit.

Subjects.Twenty‐four healthy controls aged 36.7 ± 7.4 years; 34 patients after renal transplantation (46.5 ± 14.3 years); 41 patients with hip replacement therapy (63.9 ± 18.6 years).

Intervention.Baseline Mg values were measured by atomic absoprtion spectroscopy (AAS) in serum and urine. An intravenous Mg load with 0.1 mmol Mg‐aspartate hydrochloride per kilogram bodyweight was given during 1 h. In 24 h‐urine, the amount of excreted Mg was measured by AAS and the percentage retention of the given load calculated according to the formula: 1 −[Mg 24 h‐urine/Mg test dose] × 100. Femur Mg was measured by AAS in a peace of the femur neck. Patients after renal transplantation were randomized after the first Mg load to either obtain daily 5 mmol Mg‐aspartate hydrochloride per kilogram bodyweight, or placebo. Four months later a second loading‐procedure was performed.

Main outcome measure.Serum Mg, percentage retention of the given Mg load (%Ret) and femur Mg concentration.

Results.Mean serum Mg values were within the normal range. In controls, %Ret was –18 ± 21 and not different from the literature. In the first MLT after renal transplantation, %Ret was 47 ± 43. In patients under Mg medication it decreased significantly to 16 ± 26, but was 58 ± 27 in the placebo group. Femur Mg concentration was 62.6 ± 20.9 mmol kg–1dry substance and the corresponding %Ret was 14 ± 28 withr = – 0.7093.

Conclusion.The short‐term version of the MLT is as good as the standard and was easily applied in outpatients. The indication from the good correlation between bone‐Mg and %Ret and a marked decrease in %Ret in patients after Mg medication was that one can really measure magnesium deficiency.
Effects of short‐term administration of growth hormone in healthy young men, women, and women taking oral contraceptives
Authors: Edén Engström B. , Burman P. , Johansson A. G. , Wide L. , Karlsson F. A.
Published: March 2003

Abstract. Edén Engström B, Burman P, Johansson AG, Wide L, Karlsson FA (University Hospital, Uppsala, Sweden). Effects of short‐term administration of growth hormone in healthy young men, women, and women taking oral contraceptives. J Intern Med 2000; 247: 570–578.

Objective. Effects of short‐term administration of growth hormone (GH) with respect to gender and oral contraceptives (OCs) were investigated in healthy young adults.

Design. Open, prospective 2‐week study.

Setting. Clinical research centre, university hospital.

Subjects. Three groups of healthy young adults were included: six men, six women with normal menstrual cycles, and six women taking OCs.

Interventions. The subjects were given recombinant human GH subcutaneously for 2 weeks: 1 U m–2 body surface daily during the first week, and 3 U m–2 daily during the second week.

Main outcome measures. Serum samples were drawn in the morning after overnight fasting on days 0, 3, 7, 10 and 14, and were analysed for GH, insulin‐like growth factor 1 (IGF‐1), insulin, testosterone, sex hormone‐binding globulin (SHBG), lipids and markers of bone metabolism. Second‐void morning urine was analysed for deoxypyridinoline (Dpyr).

Results. During administration of GH, serum IGF‐1 increased in the men and in the women without OCs (86 and 52%, respectively). In the OC women, IGF‐1 did not change significantly. Serum insulin increased in all three groups, with the largest change (122%) in the men and the smallest (47%) in the OC women. Blood glucose was unchanged. Total cholesterol, low‐density lipoprotein (LDL) cholesterol and the LDL/high‐density lipoprotein cholesterol ratio were reduced in the men only. Biochemical markers of bone resorption (serum procollagen type I, urinary Dpyr) increased in the men, and markers of bone formation (serum osteocalcin and telopeptide of collagen type I) increased in the men as well as in the women not taking OCs. The testosterone/SHBG ratio increased in the men on account of a reduction in SHBG.

Conclusion. The response to short‐term administration of GH differed in the three groups, with the largest effect in the men and the smallest in the OC women. The inhibitory influence of contraceptives underlines the role of sex steroids in modulating the susceptibility to GH.
Ten‐year mortality amongst patients with a very small or unconfirmed acute myocardial infarction in relation to clinical history, metabolic screening and signs of myocardial ischaemia
Authors: Karlson B. W. , Wiklund O. , Hallgren P. , Sjölin M. , Lindqvist J. , Herlitz J.
Published: March 2003

Abstract. Karlson BW, Wiklund O, Hallgren P, Sjölin M, Lindqvist J, Herlitz J (Sahlgrenska University Hospital, Göteborg, Sweden). Ten‐year mortality amongst patients with a very small or unconfirmed acute myocardial infarction in relation to clinical history, metabolic screening and signs of myocardial ischaemia. J Intern Med 2000; 247: 449–456.

Aim. To evaluate the long‐term prognosis amongst patients with a very small or unconfirmed acute myocardial infarction (AMI) in relation to clinical history, metabolic screening and signs of myocardial ischaemia at exercise test.

Methods. Patients with a very small or unconfirmed AMI, aged < 76 years, were selected and given a clinical evaluation, metabolic screening and checked for ischaemia at an exercise test 4 weeks after admittance. The 10‐year mortality was related to age, sex, clinical history, body weight, serum (S) cholesterol, S‐triglycerides, S‐gammaglutamyltranspeptidase (GT), S‐glucose and various indices of myocardial ischaemia at exercise test.

Results. In all, 714 patients participated in the evaluation. The median age was 63 years and 33% were women. The overall 10‐year mortality was 33%. In univariate analysis, the following factors appeared as risk indicators for death: age (P < 0.0001), a history of previous AMI (P < 0.0001), angina pectoris (P < 0.001), diabetes mellitus (P < 0.0001), congestive heart failure (P < 0.0001), smoking (P = 0.030), S‐triglycerides (P < 0.0001), S‐gamma GT (P < 0.0001) and S‐glucose (P < 0.0001).

In multivariate analysis, the following remained as independent risk indicators for death: age (P < 0.0001), S‐gamma GT (P < 0.0001), previous AMI (P < 0.0001), smoking (P < 0.0001) and S‐glucose (P = 0.010).

Conclusion. Amongst patients with a very small or a unconfirmed AMI, factors reflecting their clinical history, including age, a history of AMI and current smoking, as well as factors reflecting their metabolic status, including S‐gamma GT and S‐glucose, were important predictors for the long‐term outcome.
Markers of hypercoagulation and von Willebrand factor in postmenopausal women with unstable coronary artery disease. Discriminatory ability regarding unstable coronary artery disease and coronary atherosclerosis using receiver operating characteristics
Authors: Nielsen N. E. , Siegbahn A. , Swahn E.
Published: March 2003

Abstract. Nielsen NE, Siegbahn A, Swahn E (University Hospital, Linköping, and University Hospital, Uppsala, Sweden). Markers of hypercoagulation and von Willebrand factor in postmenopausal women with unstable coronary artery disease. Discriminatory ability regarding unstable coronary artery disease and coronary atherosclerosis using receiver operating characteristics. J Intern Med 2000; 248: 151–158.

Objectives. Many women with typical anginal chest pain have normal coronary angiograms. The pathogenetic mechanisms behind the chest pain in these patients are unknown but may be due to increased thrombogenicity. We evaluated markers of hypercoagulation and thrombosis in women with clinical signs of unstable coronary artery disease (CAD).

Methods and results. A total of 158 patients with unstable CAD and 101 controls were examined: 16% of the patients had normal vessels and 84% had coronary atherosclerosis at coronary angiography. Mean plasma concentrations of von Willebrand factor antigen, soluble fibrin (SF), thrombin–antithrombin complex and d‐dimer were significantly higher, whereas there was no difference regarding prothrombin fragment 1+2 between patients and controls. Patients with coronary atherosclerosis had higher mean plasma levels for most variables compared with those with normal coronary vessels, although only significantly higher for SF. d‐Dimer was significantly higher in patients with normal coronary vessels compared with the control group. Although multivariate analyses showed strong significant correlations of the haemostatic variables to the diagnosis of unstable CAD, receiver operating characteristics (ROC) revealed that none of the variables represented high diagnostic accuracy in separating patients with unstable CAD. Likewise, none of the variables was particularly good at identifying coronary atherosclerosis.

Conclusion. Our results are in favour of a hypercoagulable state in postmenopausal women with unstable CAD and coronary atherosclerosis, whereas this does not seem to be the case in patients with normal vessels. ROC revealed no variable to be particularly clinically useful in separating patients from controls or patients from those without coronary atherosclerosis.