bluuebunny/crossref_metadata_2025 huggingface dataset:
Complications of nephropathia epidemica: three cases
Authors: FORSLUND T. , SALTEVO J. , ANTTINEN J. , AUVINEN S. , BRUMMER‐KORVENKONTIO M. , KORHONEN A. , POUTIAINEN M.
Published: August 2009

Haemorrhagic fever with renal syndrome (HFRS) in Scandinavia is called nephropathia epidemica (NE), and is caused by the Puumala‐virus, which belongs to the Hanta‐virus genus. The clinical course of NE is mostly benign, complications are uncommon, and deaths are rarely observed. We report the cases of three patients who developed serious complications in the course of NE caused by the Puumala‐virus. One patient died within 24 h after admission, another developed progressive neuromuscular dysfunction (Guillain‐BarrÉ syndrome) which required auxiliary ventilation for several weeks before a slow recovery, and a third patient developed empty sella syndrome with pituitary gland insufficiency. In the first two cases the diagnosis of NE was confirmed by a rapid avidity assay for IgG antibody against Puumala‐virus. In the third case the clinical course, and demonstration of NE immunity 16 years later, suggested that NE might have caused the hypopituitarism. Some patients with NE caused by the Puumala‐virus may require intensive‐care treatment, and the development of late complications such as empty sella syndrome and hypopituitarism should be taken into consideration.
Drug‐induced hepatic injury: an analysis of 1100 cases reported to The Danish Committee on Adverse Drug Reactions between 1978 and 1987
Authors: FRIIS H. , ANDREASEN P. B.
Published: August 2009

The Danish Committee on Adverse Drug Reactions received 1100 reports of suspected drug‐induced hepatic injury during the decade 1978–1987. The causal relationship between drug and hepatic injury was classified as definite in 57 (5.2%) reports, probable in 989 (89.9%) reports, possible in 50 (4.5%) reports and unclassifiable in four (0.4%) reports. Hepatic injuries accounted for 5.9% of all adverse drug reactions reported, and 14.7% of the lethal adverse drug reactions. A total of 47.2% were classified as acute cytotoxic, 16.2% as acute cholestatic and 26.9% as abnormal hepatic function. In 52 (4.7%) cases the hepatic injury was lethal; only 14 (1.3%) cases were chronic. Halothane accounted for 25% of the cases. The incidence of halothane‐induced hepatic injury is decreasing, and only one lethal case has been reported since 1981. Next to halothane, sulfasalazine was the drug most often suspected during the last 2 years of the decade. Based on consumption data, the incidence of hepatic injury due to sulindac was estimated to be 18‐fold higher than that due to ibuprofen. Paracetamol was reported to induce acute cytotoxic as well as cholestatic reactions in non‐alcoholic subjects taking therapeutic doses.
Reproducibility of symptom‐limited exercise‐stress testing performed 2 and 6 weeks after myocardial infarction
Authors: de COCK C. C. , VISSER F. C. , ROOS J. P. , VAN EENIGE M. J.
Published: August 2009

To assess the reproducibility of variables with prognostic value from exercise testing, two symptom‐limited treadmill exercise tests were performed in 76 consecutive patients at 2 weeks (predischarge) and 6 weeks after myocardial infarction. In addition, cardiac catheterization was performed at 6 weeks. Exercise duration showed a moderate increase from 7.9±4.4min to 8.8 ± 3.0 min (NS). The rate‐pressure product increased from 22377 ± 5491 to 24832 ± 7261 (P < 0.001). Reproducibility of ST‐segment depression was dependent on the initial response: among the group of 25 patients with ST‐segment depression at 2 weeks, only 13 (52%) patients had a reproducible result, whereas among the group of 51 patients without initial ST‐segment depression, 40 (78%) patients showed reproducibility. There was no difference in coronary anatomy or ejection fraction between the groups with and without reproducibility results. Among the 30 patients with initial ST‐segment elevation, 15 (50%) patients showed reproducibility, while among the 46 patients without initial ST‐segment elevation, 42 (91%) patients showed reproducibility: the ejection fraction was significantly higher in the latter group than in the group of patients with lower reproducibility. Thus predischarge exercise testing in postinfarction patients identifies a different group of patients at risk compared to exercise testing after 6 weeks, due to considerable variation between the two tests.
A prospective study of the incidence of deep‐vein thrombosis within a defined urban population
Authors: NORDSTRÖM M. , LINDBLAD B. , BERGQVIST D. , KJELLSTRÖM T.
Published: August 2009

In a prospective study all positive phlebographies within the well‐defined population of the city of MalmÖ, Sweden, during 1987 were studied in order to determine the incidence of deep venous thrombosis (DVT). Epidemiological data were analysed for the detection of patient groups at increased risk of DVT. The incidence was found to be equal for both sexes, i.e. 1.6 per 1000 inhabitants and year. Risk factors were found to be in accordance with earlier studies. The median age for men was 66 years, compared to 72 years for women. At diagnosis of DVT, 19% of subjects had a known malignancy and within 1 year 5% (19 cases) developed a new malignancy. Of the men, 29% had postoperative or post‐traumatic (fracture) DVT, compared to 46% of the women. Fewer patients with DVT than expected (39%) belonged to blood group 0 (31%) (P < 0.005). Pulmonary embolism (PE) was clinically suspected in only 5% of cases, and diagnosis was verified scintigraphically in 2% of cases. None of these died of PE, but of 6 patients who were found to have PE at autopsy, four died about 4 weeks after the DVT was diagnosed.
Autoimmune reactions in patients with M‐component and peripheral neuropathy
Authors: JøNSSON V. , SCHRøDER H. D. , TROJABORG W. , JENSEN T. STAEHELIN , HIPPE E. , HANSEN M. MøRK
Published: August 2009

A study of 17 patients with autoimmune axonal or demyelinating peripheral neuropathy in combination with M‐component is described. The M‐component was associated with MGUS (monoclonal gammopathy of undetermined significance) in 12 patients, CLL in one patient, WaldenstrÖm's disease in one patient, and myeloma in three patients. Immunohistological examination with direct and indirect fluorescence showed binding of antibodies to nerve structures of the same class and light chain as seen in the M‐component. In five cases of IgM M‐component, the demyelinating neuropathy was caused by binding of the IgM M‐protein and complement C3b to myelin‐associated glycoproteins (MAG). In 12 cases with axonal neuropathy, binding of IgG to the connective tissue of the peri‐ and endoneurium was found in 50% of cases, IgM in five cases, and IgD in one case. None of the patients had central nervous system (CNS) symptoms. The clinical and therapeutic difficulties are discussed; only two patients with an acute course responded to immunosuppression. A marked co‐expression of other autoimmune phenomena is interpreted in the light of cross‐reactions between the autoantibody and similar tissue autoantigens.
Prednisolone in the treatment of severe malignant hypercalcaemia in metastatic breast cancer: a randomized study
Authors: KRISTENSEN B. , EJLERTSEN B. , HOLMEGAARD S. N. , KRARUP‐HANSEN A. , TRANSBøL I. , MOURIDSEN H.
Published: August 2009

To determine the effect of prednisolone on severe hypercalcaemia in women with metastatic breast cancer, 30 patients with serum ionized calcium above 1.60 mmol l−1 (reference range 1.15–1.35 mmol l−1) entered a randomized trial. Performance status before entry to the trial and survival time after hypercalcaemia were also noted. All patients received 4 l of isotonic saline daily and 80 mg intravenous furosemide three times daily for 2 d; thereafter they received 3 l of isotonic saline daily and 80 mg furosemide twice daily for 6 d. Fifteen patients were randomized to receive prednisolone, 25 mg orally, three times daily for 8 d. Serum ionized calcium decreased significantly in both groups, but most markedly in the prednisolone group. The median difference was 0.28 mmol l−1 (95% confidence interval (CI), 0.09–0.52) on day 4 and 0.2l mmol l−1 (95% CI, 0.12–0.44) on day 8. In seven prednisolone‐treated patients serum ionized calcium normalized, compared to none in the control group (Fisher's exact test; P = 0.028). No severe adverse effects were observed. Prior to detection of hypercalcaemia all patients were severely immobilized, primarily due to bone pain. Only 10 patients were still living after 3 months. Prednisolone, furosemide and rehydration is superior to furosemide and rehydration alone in severely hypercalcaemic patients with metastatic breast cancer in whom immobilization appears to be an early warning sign of life‐threatening hypercalcaemia. The short survival time was not influenced by prednisolone.
Metabolic control and progression of complications in insulin‐dependent diabetic patients after kidney transplantation
Authors: EKSTRAND A. , GROOP L. , PETTERSSON E. , GRÖNHAGENRISKA C. , LAATIKAINEN L. , MATIKAINEN E. , SEPPÄLÄINEN A.‐M. , LAASONEN E. , SUMMANEN P. , OLLUS A. , AHONEN J.
Published: August 2009

Patient survival and progression of complications were monitored for 3 years after kidney transplantation in 29 type‐1 diabetic patients. Ten age‐matched, non‐diabetic kidney‐transplanted patients served as controls. Five diabetic patients died during follow‐up (three cardiovascular events, two infections), three diabetic patients had a non‐fatal myocardial infarction and four developed cerebrovascular complications after transplantation. Of the diabetic patients, 69% suffered from proliferative retinopathy before transplantation; 20% of them improved, 65% remained unchanged and 15% deteriorated after transplantation. Motor but not sensory conduction velocity measured from the nervus medianus improved after transplantation. Autonomic neuropathy was observed in 50% of the patients and was unaffected by transplantation. Glycaemic control did not improve significantly during follow‐up (HbA1, 10.6 ± 0.5% before and 9.5 ± 0.6% 3 years after transplantation). Body weight increased in both diabetic and non‐diabetic patients within 3 years after transplantation (from 68 ± 2 to 77 ± 6 kg in diabetics, P < 0.01; from 167 ± 4 to 77 ± 6 kg in non‐diabetics, P < 0.01). Subcutaneous fat thickness measured from computer tomography scans of the calf increased in diabetic patients from 5.0 ± 0.6 to 6.1 ± 0.9 mm (P < 0.05). However, the cross‐sectional areas of triceps and calf muscles did not increase, suggesting that the increase in body weight was solely due to an increase in fat. It is clear that diabetes‐related complications continue to progress and are not influenced by a successful kidney transplant.
Proinflammatory cytokines in cardiac myxomas
Authors: WIEDERMANN C. J. , REINISCH N. , FISCHER‐COLBRIE R. , VOLLMAR A. M. , HEROLD M. , KNAPP E.
Published: August 2009

Serum levels of various cytokines were measured in three patients with cardiac myxomas presenting with and without constitutional symptoms, immunological features and elevated plasma levels of interleukin‐6. Interleukin‐6 but not other cytokines (interleukin‐1, tumour necrosis factor‐α, interferon‐γ) relate to immunological features of the patients. Circulating levels of atrial natriuretic peptide correspond to haemodynamic changes but not to the tumour‐bearing state itself.
Pulse cyclophosphamide therapy in Wegener's granulomatosis: a pilot study
Authors: DROSOS A. A. , SAKKAS L. I. , GOUSSIA A. , SIAMOPOULOS K. C. , MOUTSOPOULOS H. M.
Published: August 2009

Five patients with Wegener's granulomatosis (WG) have been treated with 6‐ to 8‐monthly pulses of intravenous cyclophosphamide (CP) and glucocorticoids in an open pilot study. One patient achieved complete remission sustained during 30 months of follow‐up; one patient had features of active disease after 28 months of remission; two patients after an initial remission had an exacerbation of the disease and received continuous oral administration of CP, and one patient required continuous oral CP to control the symptoms. These results suggest that this regimen may not achieve a high degree of sustained remission in patients with WG.
Standardized use of simple criteria from case history improves selection of patients for cardiac‐care unit (CCU) admission
Authors: ROLLAG A. , JONSBU J. , AASE O. , ERIKSSEN J.
Published: August 2009

A simple algorithm, which improves the diagnostic performance in patients arriving with acute chest pain in the emergency room, has been developed. The algorithm is solely based on information immediately available to the physician and includes elements from ECG, clinical findings and case history. As postulated, a stepwise use of all these variables improved the diagnostic accuracy and reduced the false positive cardiac‐care unit (CCU) referral rate in a prospective study of 1450 patients admitted with acute chest pain. Compared to previous hospital practice during a preceding control period, sensitivity in diagnosing patients with unstable ischaemic heart diseases increased from 86% to 94% (P < 0.01), and specificity increased from 44% to 56% (P < 0.001). Accordingly, accuracy increased from 67% to 81% (P < 0.001), and false positive CCU‐admission rate decreased from 35% to 19%. The greatest improvement in physician's diagnostic decisions was observed among patients without clear‐cut signs of acute ischaemic heart disease on admission.
Dietary intake of 70‐ to 89‐year‐old men in eastern and western Finland
Authors: RÄSÄNEN L. , MUTANEN M. , PEKKANEN J. , LAITINEN S. , KOSKI K. , HALONEN S. , KIVINEN P. , STENGÅRD J. , NISSINEN A.
Published: August 2009

A detailed dietary history interview of 70‐ to 89‐year‐old men, 98 from eastern and 129 from western Finland, was obtained as part of a 30‐year follow‐up survey within the Seven Countries Study. The average energy intake was similar in level, about 2700 kcal, in both areas. The percentage of total energy intake from fat was 39.1 % in the west, and 36.5% in the east. The P/S ratio was about the same, 0.27 and 0.29, in eastern and western areas, respectively. The intake of most micronutrients was similar in the two cohorts. Only the intake of vitamins A and C and phosphorus, manganese, copper and zinc was higher in eastern Finland than in western Finland. The nutritional density of the diet of the eastern cohort was slightly higher than that of the western one due to their higher consumption of rye products, vegetables and berries, and also sour milk and fish and fish products. The diet met the general recommendations and was comparable to that of younger age groups.
Evaluation of regional body fat distribution: comparison between W/H ratio and computed tomography in obese women
Authors: ZAMBONI M. , ARMELLINI F. , MILANI M. P. , TODESCO T. , de MARCHI M. , ROBBI R. , MONTRESOR G. , BERGAMO A. I. A. , BOSELLO O.
Published: August 2009

Measurements of regional body fat distribution as determined by waist‐to‐hip ratio and visceral‐to‐subcutaneous adipose tissue ratio were compared in 63 obese women. Subjects were divided into three CT‐evaluated tertiles on the basis of visceral‐to‐subcutaneous adipose tissue ratio (group I, 0.05–0.231; group II, 0.232–0.344; group III, 0.345–0.781). The three groups showed no appreciable differences in body weight. body mass index or total abdominal adipose tissue. Waist‐to‐hip ratio values were significantly lower in group I than in groups II and III. There was no statistically significant difference between groups II and III. Visceral abdominal adipose tissue was significantly and progressively higher in the three groups. Subcutaneous abdominal adipose tissue was significantly lower in group III than in group I. All metabolic variables and systolic and diastolic blood pressure were higher when visceral‐to‐subcutaneous adipose tissue ratio cut‐off values were increased. Waist‐to‐hip ratio was significantly correlated with total adipose tissue, body mass index, visceral abdominal adipose tissue and subcutaneous abdominal adipose tissue. Visceral‐to‐subcutaneous adipose tissue ratio was correlated with visceral abdominal adipose tissue (r = 0.84, P < 0.01) and subcutaneous abdominal adipose tissue (r = −0.28, P < 0.05). There was no correlation between visceral‐to‐subcutaneous adipose tissue ratio and body mass index or total abdominal adipose tissue. Visceral‐to‐subcutaneous adipose correlated more closely with metabolic variables than did waist‐to‐hip ratio. Partial correlations between waist‐to‐hip ratio and visceral‐to‐subcutaneous adipose tissue ratio and metabolic variables, adjusted for body mass index, showed statistically significant relationships for visceral‐to‐subcutaneous adipose tissue ratio, but not for waist‐to‐hip ratio. Visceral‐to‐subcutaneous adipose tissue ratio correlated with waist‐to‐hip ratio in the study population as a whole, but only in group I did the correlation between visceral‐to‐subcutaneous adipose tissue ratio and waist‐to‐hip ratio prove statistically significant. The present study demonstrates that visceral‐to‐subcutaneous adipose tissue ratio is a better index of body fat distribution than waist‐to‐hip ratio.
Lipoprotein [Lp(a)] and peripheral vascular disease
Authors: TYRRELL J. , COOKE T. , REILLY M. , COLGAN M. , MOORE D. , SHANIK D. G. , BERGIN C. , FEELY J.
Published: August 2009

Lipoprotein(a) [Lp(a)], which combines structural elements of the lipid and fibrinolytic systems, is a major independent risk factor for the development of coronary heart disease. Eighty‐four consecutive patients with peripheral vascular disease (of whom 42 had concomitant ischaemic heart disease) and 43 healthy controls were enrolled in a case‐control study. We found that the mean Lp(a) concentration in male patients with peripheral vascular disease (PVD) was almost threefold higher than that of controls, while in female patients the Lp(a) concentration was more than twice that of controls. This marked difference was borne out in patients with and without concomitant ischaemic heart disease (IHD). A multivariate logistic regression analysis indicated that Lp(a) is independently associated with PVD when adjusted for age and sex (odds ratio per 100 mg l−1 increase in Lp(a) = 1.35; P < 0.01). A similar association is observed for patients with concomitant IHD (odds ratio per 100 mg l−1 increase in Lp(a) = 1.65; P < 0.01).
Isolated left coronary ostial stenosis as the sole arterial involvement in Takayasu's disease
Authors: KIHARA M. , KIMURA K. , YAKUWA H. , MINAMISAWA K. , HAYASHI S. , UMEMURA S. , NIHEI T. , SHIONOIRI H. , ISHII M.
Published: August 2009

A 24‐year‐old woman with Takayasu's disease developed unstable angina pectoris. Angiographic studies demonstrated an isolated left coronary ostial stenosis without any other systemic arterial involvement. She is unique in that the coronary lesion, which is rarely the major manifestation of Takayasu's disease, is the sole arterial involvement of the disease.
Self‐limited primary cytomegalovirus colitis in an immunocompetent individual
Authors: MAIGNAN M. , WAHL D. , THIAUCOURT D. , BACH D. , de KORWIN J.‐D. , VAILLANT G. , PAILLE F. , SCHMITT J.
Published: August 2009

Cytomegalovirus colitis in immunocompetent patients has rarely been reported without another severe illness. The prognosis is usually bad, leading to toxic megacolon or death due to multi‐organ system failure. We report a case of a self‐limited cytomegalovirus colitis in a young patient with no risk factor for CMV infection or associated disease. This suggests that self‐limiting CMV colitis may be more frequent than is usually believed, and its prognosis may be better in young patients with normal immune functions. Therefore it should be sought systematically even in immunocompetent young patients.
Autosomal dominant ‘Mediterranean fever’ in a Finnish family
Authors: KARENKO L. , PETTERSSON T. , ROBERTS P.
Published: August 2009

A 23‐year‐old Finnish man was examined because of an 8‐year history of recurrent bouts of fever and abdominal pain. His father had been repeatedly investigated because of similar episodes since he was 24 years old, and one of the father's sisters was reported to have had recurrent periods of fever. The clinical features closely resembled those of familial Mediterranean fever (FMF), a syndrome rarely described in families of European descent. Unlike typical FMF, which is inherited as an autosomal recessive trait, the mode of inheritance of the syndrome in our family may be regarded as dominant. During a recent attack, serum concentrations of interleukin‐1‐beta, interleukin‐6 and acute phase reactants, including serum amyloid A protein, were high. No signs of amyloidosis were detected in our patients.
Survival in 91 adults with acute myelogenous leukaemia treated with 1–6 intensive courses of chemotherapy
Authors: EVENSEN S. A. , BRINCH L. , STAVEM P. , TJøNNFJORD G.
Published: August 2009

Ninety‐one patients with acute myelogenous leukaemia (AML) aged 17–59 years were treated with a chemotherapy programme which could be completed within 30 weeks for patients who achieved complete remission (CR). Four courses included daunorubicin, cytarabine and thioguanine, while two courses included amsacrine, etoposide and cytarabine. Sixty‐five patients obtained CR (71%), more often in patients below (82%) than above (60%) 40 years of age (P = 0.03). Five patients underwent allogenic bone‐marrow transplantation, and one patient received an autologous bone‐marrow transplant after relapse. Five patients developed central nervous system leukaemia. The overall actuarial 3‐ and 5‐year survival was 29% and 21%, respectively; for patients who obtained CR the corresponding survival rates were 40% and 30%, respectively. Patients below 40 years of age appeared to fare better (5‐year survival 26%) than older patients (5‐year survival 16%). The estimated disease‐free survival rate was 26% at 3 years and 22% at 5 years. The main advantage of this regimen is that results compare favourably with those obtained with other regimens were achieved, without exposing patients to long periods of maintenance therapy.
Immunoreactive interleukin‐6 in serum of patients with B‐lymphoproliferative diseases
Authors: PETTERSSON T. , METSÄRINNE K. , TEPPO A.‐M. , FYHRQUIST F.
Published: August 2009

Serum immunoreactive interleukin‐6 (ir‐IL‐6) concentration was measured by radioimmunoassay in nine patients with chronic lymphocytic leukaemia (CLL), 16 patients with multiple myeloma (MM), 12 patients with monoclonal gammapathy of undetermined significance (MGUS), 22 patients with primary SjÖgren's syndrome (SS), and in 32 control subjects. Measurable quantities of ir‐IL‐6 were detected in every sample studied. Patients with MGUS and SS had significantly higher serum ir‐IL‐6 (mean ± SD) concentrations (337 ± 92 ng l−1 and 299 ± 100 ng l−1, respectively) than controls (92 ± 77 ng l−1) and patients with CLL and MM (120±32 ng l−1 and 113±58 ng l−1, respectively). Longitudinal studies of ir‐IL‐6 concentration in a few patients with MM showed a decrease before remission and an increase prior to relapse, but no consistent pattern was detected. In conclusion, we found that serum ir‐IL‐6 levels are higher in patients with benign hypergammaglobulinaemic states than in patients with malignant neoplastic B‐cell disorders.
Effects of amlodipine on plasma lipid and lipoprotein levels in hypertensive patients
Authors: AHANEKU J. E. , TAYLOR G. O. , AGBEDANA E. O. , WALKER O. , SOWUNMI A. , SALAKO L. A.
Published: August 2009

Abstract. Lipids and lipoprotein levels were determined in the plasma of 20 adult hypertensive patients, after 12 weeks treatment with amlodipine. No significant variation was observed in the mean values of the lipids and lipoprotein fractions before and after amlodipine treatment for the patients on either 5 mg or 10 mg of amlodipine. A further long‐term study has been suggested in order to confirm the inertness of amlodipine on lipids and lipoprotein metabolism.
Exercise‐provoked ST‐segment depression and prognosis in patients recovering from acute myocardial infarction. Significance and pitfalls
Authors: JESPERSEN C. M. , HAGERUP L. , HOLLÄNDER N. , LAUNBJERG J. , LINDE N. C. , STEINMETZ E.
Published: August 2009

Abstract. The importance of maximal versus submaximal exercise testing and the significance of heart failure on the prognostic value of exercise‐provoked ST‐segment depression ≥ 0.1 mV was studied in 143 patients recovering from acute myocardial infarction. Patients were exercise tested prior to discharge and follow up lasted for up to 18 months (mean 17 months). End‐point was first major event (i.e. first non‐fatal reinfarction or death). A symptom‐limited exercise test was superior to a heart‐rate‐limited test in detecting ST‐segment depressions (27% vs. 20%; P < 0.5), and patients with ST‐segment depression at lower heart rates did not have an increased risk of subsequent events compared with patients with ST‐segment depression at higher heart rates (14% vs. 27%; NS). Heart failure surpassed ST‐segment depression as a risk predictor (34% vs. 18%).

Based on a meta‐analysis including 13 studies (1987 patients) exercise‐provoked ST‐segment depression possessed an increased risk of subsequent major events (P < 0.0001; risk ratio = 1.90: 95% confidence limits 1.43.2.51).

Thus, ST‐segment depression provoked by a symptom‐limited test selects patients with an increased risk of subsequent major events. In patients with a history of heart failure exercise‐provoked ST‐segment depression is of limited value.
Response to antituberculous chemotherapy after splenectomy
Authors: NAYYAR V. , RAMAKRISHNA B. , MATHEW G. , WILLIAMS R. R. , KHANDURI P.
Published: August 2009

Abstract. A case of a 17‐year‐old Indian male with disseminated tuberculosis is reported. While on chemotherapy, he was detected to have splenic abscesses. The patient remained unresponsive to antituberculous drugs until a splenectomy was performed.
Azathioprine‐associated pure red cell aplasia
Authors: CREEMERS G. J. , VAN BOVEN W. P. L. , LOWENBERG B. , VAN DER HEUL C.
Published: August 2009

Abstract. Azathioprine‐associated pure red cell aplasia in patients with a renal allograft is a rare complication. Although immunological inhibition of erythroid progenitor cell has been suggested, the cause of this phenomenon remains unclear. The patient we describe showed a decrease in the number of erythroid progenitor cells and no evidence for the presence of a serum inhibitor of these precursor cells. Discontinuation of azathioprine was associated with a complete recovery from anaemia as well, with an increase in the number of erythroid progenitor cells.
Opportunistic infections of the oesophagus in AIDS patients: clinical and therapeutic problems
Authors: PORRO G. BIANCHI , PARENTE F.
Published: August 2009

Abstract. The gastrointestinal tract is frequently involved in the acquired immunodeficiency syndrome. One of the most common digestive manifestations is dysphagia/odynophagia which constitutes the presenting feature of the syndrome in a number of patients and occurs in many others during the subsequent phases of the illness. In the majority of cases it is due to an oesophageal infection by opportunistic pathogens (fungi or viruses or both) and may be successfully treated, at least temporarily, by specific antimicrobials. The present article examines the most recent acquisitions in terms of diagnosis and treatment of such common clinical problem.
Hallucinogenic mushroom use by Danish students: pattern of consumption
Authors: LASSEN J. F. , LASSEN N. F. , SKOV J.
Published: August 2009

Abstract. A survey among Danish students revealed that 33 (7.2%) of the respondents had experience with hallucinogenic mushrooms (HM). Afterwards these students answered an extended questionnaire about habits and pattern of consumption. It seems that mushroom use is experimental and may be due to risk‐seeking behaviour but is mostly recreational and restricted to a few events. Age over 25 years and male sex were statistically related to a higher lifetime consumption rate of HM. The age of first time users was significantly lower for marijuana than for HM. Only 15 of the respondents wanted to continue use. Most of them were males and they had significantly more friends with HM experience than those who would not continue. We recommend that surveys of drug abuse include questions concerning HM to monitor the trends and extent of HM abuse.
Hepatic cytosolic oestrogen receptors in patients with liver disease
Authors: BECKER U. , ANDERSEN J. , POULSEN H. SKOVGAARD , HORN T.
Published: August 2009

Abstract.Patients with liver disease present many of the features of ‘feminized’ hepatic metabolism. Oestrogens exert their effects through interaction with specific cellular high‐affinity receptors (ER). We measured hepatic ER in 102 needle biopsies from patients with chronic alcoholic and non‐alcoholic liver disease using an enzyme immunoassay. Fifteen patients with no or minimal changes in liver histology served as controls.

The hepatic ER concentrations were significantly (P= 0.05) lower in the 44 men (median 13 fmol mg−1protein, interquartile range 7–17 fmol mg−1protein) compared to the 58 women (median 15 fmol mg−1protein, interquartile range 10–21 fmol mg−1protein). Patients with alcoholic liver disease (n= 63) had significantly (P< 0.05) lower ER concentrations than controls (n= 15) (median 13 fmol mg−1protein, interquartile range 7–17 fmol mg−1proteinvs. median 16 fmol mg−1protein, interquartile range 10–26 fmol mg−1protein), and compared with patients with non‐alcoholic liver disease (n= 24) (P< 0.05, median 20 fmol mg−1protein, interquartile range 11–24 fmol mg−1protein).

ER concentrations were significantly lower (P< 0.05) in patients with alcoholic liver disease and alcoholic hepatitis (n= 21) compared to those without alcoholic hepatitis (n= 42) (medians 10vs. 14 fmol mg−1protein, interquartile ranges 6–15 fmol mg−1proteinvs. 9–18 fmol mg−1protein), while ER concentrations did not differ significantly (P> 0.05) between actively drinking (median 13 fmol mg−1protein, interquartile range 7–17 fmol mg−1protein) and abstaining alcoholic patients (median 13 fmol mg−1protein, interquartile range 7–18 fmol mg−1protein).

In summary, the small but significant variation in hepatic ER concentrations reflects variation in liver function rather than an effect of ethanol.
Serum cholesterol and high density lipoprotein cholesterol distributions in patients with acute myocardial infarction and in the general population of Kuopio Province, Eastern Finland
Authors: LEHTO S. , PALOMÄKI P. , MIETTINEN H. , PENTTILÄ I. , SALOMAA V. , TUOMILEHTO J. , JAUHIAINEN M. , PYÖRÄLÄ K.
Published: August 2009

Abstract. As part of the FINMONICA project, serum total cholesterol (TC) and high density lipoprotein cholesterol (HDLC) concentrations were determined in 1216 AMI patients (937 men. 279 women) aged 35–64 years in the province of Kuopio in eastern Finland during the 5‐year period 1983–87. The distributions were compared with the corresponding distributions in a representative sample of the general population of the same area (1026 men, 1021 women). The mean serum TC levels did not differ between the AMI patients and the normal population. Only the prevalence of a very high serum TC level (> 8.0 mmol l−1) among women was significantly higher in the AMI group than in the population sample. On the other hand, in both sexes the age‐adjusted mean HDLC was significantly lower in the AMI group than in the population sample. Our findings emphasize the importance of HDLC measurement as a part of the assessment of the lipid risk factor profile in patients with AMI.
The acute‐phase response and associated lipoprotein abnormalities accompanying lymphoma
Authors: BLACKMAN J. D. , CABANA V. G. , MAZZONE T.
Published: August 2009

Abstract. Lipoprotein abnormalities seen in patients with inflammatory diseases are thought to develop secondary to circulating cytokines and the accompanying acute‐phase response. Patient's with lymphoma may develop similar lipoprotein abnormalities but the mechanism is unclear. We report a patient with B‐cell lymphoma who presented with an HDL cholesterol level of 3 mg dl−1, an ApoA level of 17.4 mg dl−1, elevated triglyceride level (272 mg dl−1) and an elevated ApoB level of 156 mg dl−1. Density gradient analysis of the patient's lipoproteins demonstrated a virtual absence of an identifiable HDL particle. Serum amyloid A and C‐reactive protein were also elevated. All of the lipoprotein abnormalities resolved with chemotherapy and resolution of the acute‐phase response. The acute‐phase response may be associated with striking lipoprotein abnormalities in a subset of patients with lymphoma. Lymphoma should be included in the differential diagnosis of patients with hypertriglyceridaemia and low HDL cholesterol.
Diacylglycerol/protein kinase C signalling: a mechanism for insulin resistance?
Authors: SHMUELI E. , ALBERTI K. G. M. M. , RECORD C. O.
Published: August 2009

Abstract. It is proposed that an intracellular cycle exists to limit or terminate the insulin signal. The cycle involves increased synthesis of sn‐1,2‐diacylglycerol (DAG) in response to insulin. The DAG activates protein kinase C (PKC) which phosphorylates glycogen synthase either directly or through other protein kinases to render it inactive. Protein kinase C may also inhibit the insulin receptor by phosphorylation of receptor serine residues.

Insulin resistance could then arise as a consequence of a persistent increase in DAG levels. Such an increase could occur in three different ways. Chronic hyperinsulinaemia could increase DAG levels by de‐novo synthesis from phosphatidic acid, by hydrolysis of phosphatidylcholine, or by hydrolysis of glycosyl‐phosphatidylinositol; DAG is also formed by hydrolysis of phosphatidylinositol 4,5‐biphosphate (PIP2). This reaction, known as the ‘PI response,’ may be the connection between hypertension and insulin resistance. A third mechanism for an increase in DAG involves neural abnormalities. Thus, muscle denervation in the rat is characterized both by a profound insulin resistance and a large increase in DAG. It is possible that a similar increase occurs in humans and may explain the association between denervation, inactivity, and insulin resistance.
Hyperlipidaemia—management and views amongst physicians in general practice, in occupational health care and in internal medicine
Authors: DANIELSSON B. , ÅBERG H.
Published: August 2009

Abstract. Objectives. To study aspects of management and views about hyperlipidaemia and its treatment amongst different categories of physicians.

Design. A postal questionnaire was sent to selected physicians. Reminders were used.

Setting. The study included physicians in primary health care (PHCPs), occupational health care (OHCPs), and in departments of internal medicine in hospitals (IMPHs).

Subjects. All 146 PHCPs in the south‐western region of Stockholm, 147 OHCPs, randomly selected from the directory of occupational health care offices, and all 157 IMPHs in six hospitals, in the greater Stockholm area, were offered the questionnaire.

Main outcome measures. Differences in views, attitudes and treatment policy amongst different categories of physicians.

Results. Response rate was 70% (61–81%). Intervention was initiated by the OHCPs at lower levels of cholesterol than by the other two groups, with diet (P < 0.001) and with drug intervention as primary (P < 0.01) and secondary prevention (P < 0.005). When other cardiovascular risk factors were present, intervention was started earlier by the OHCPs only in comparison with the PHCPs (P < 0.01). Knowledge of one's own cholesterol level was more common amongst the OHCPs than in the other two groups (P < 0.001). Patient follow‐up was the same in all groups.

Conclusions. Disagreement amongst physicians about hyperlipidaemia leads to conflicting information being given to patients. It is important to be aware of these differences when trying to reach a consensus on this topic. Corresponding knowledge and attitudes amongst members of the public should also be studied.
Central hypothyroidism presenting with pericardial and pleural effusions
Authors: PARKER D. R. , SHABOURY A. H.
Published: August 2009

Abstract. Serous cavity effusions occur in primary thyroid failure; we describe a patient in whom pleural and pericardial effusions were presenting features of central thyroid failure.
Follow‐up study of patients with clinically suspected deep venous thrombosis and a normal venogram
Authors: PEDERSEN L. M. , LERCHE A. , JØRGENSEN M. , URHAMMER S. , STEENBERG P. , JENSEN R.
Published: August 2009

Abstract. Objectives. To evaluate the clinical course in patients with clinically suspected deep venous thrombosis (DVT) of the leg and a normal venogram.

Design. Prospective study over 15 months with a follow‐up of 4–12 (median 8.6) months after a normal venogram. A questionnaire survey was performed at follow‐up. Information from general practitioners and medical records was reviewed. An alternative diagnosis was established at presentation and at the time of follow‐up.

Setting. The Department of Internal Medicine in a Danish university hospital.

Subjects. A total of 133 consecutive out‐patients referred with clinical suspicion of DVT and a normal venogram.

Main outcome measures. The state of symptoms at follow‐up. The frequency of referrals to hospitals and contacts with general practitioners or medical specialists in the follow‐up period. Clinical diagnoses provided at presentation and at follow‐up.

Results. The follow‐up response rate was 78% (n = 104). The symptoms were still present at follow‐up in 53 (51%) patients. More than half of the patients had been referred to medical facilities for the same disorder. Diagnoses could be established in 93 (70%) of the 133 patients at presentation and in 119 (89%) at follow‐up.

Conclusions. The majority of patients with clinical signs and symptoms of a DVT and a normal venogram may require a follow‐up surveillance programme to ensure correct diagnosis and adequate treatment. Further studies are recommended to confirm our results and to assess the cost‐effectiveness.
Diabetic lipohypertrophy treated with suction‐assisted lipectomy
Authors: SAMDAL F. , AMLAND P. F. , SANDSMARK M. , BIRKELAND K. I.
Published: August 2009

Abstract. Objectives. To investigate the effectiveness of liposuction as treatment for lipohypertrophy in insulin‐treated diabetic patients.

Design. Open clinical study.

Setting. Norwegian National Hospital, Oslo.

Subjects. Five consecutive diabetic patients operated on for insulin‐induced lipohypertrophy.

Interventions. Syringe‐assisted liposuction under local anaesthesia.

Main outcome measures. Change in contours assessed by pre‐ and postoperative photographs, and by the patients' and surgeon's evaluations according to a four‐point graded scale.

Results. Good or excellent results were obtained in all patients. Small surface irregularities were seen in two patients who had large volumes of fat removed from the proximal anterior thighs. Apart from this no side‐effects or complications occurred.

Conclusions. Insulin‐induced lipohypertrophy (‘insulin tumours’) can be treated successfully with liposuction.
Paraneoplastic polymyositis associated with a renal carcinoma
Authors: WURZER H. , BRANDSTÄTTER G. , HARNONCOURT K. , KULLNIG P. , KLEINERT R.
Published: August 2009

Abstract. A 56‐year‐old patient was admitted to hospital because of difficulties in swallowing and in opening his mouth. The serological transaminases were increased. Over the next 6 weeks a bioptically proven polymyositis (more proximally located) caused a respiratory insufficiency which had to be treated by artificial respiration. A tetraplegia connected with a large increase of creatine‐kinase was also seen. The general investigations were focused on malign processes with a particular search for bronchial carcinoma. At first a kidney cyst detected by ultrasound but was classified as harmless by several investigators. Finally, a computer tomogram of the abdomen demonstrated a cystic degenerated renal carcinoma, which had been cytologically tested also. The clinical course showed a typical aspect of a paraneoplastic syndrome: after extended nephrectomy a distinct regression of the musculary symptoms developed, but with the development of metastases the symptoms increased again. The interdependence of polymyositis and primary renal carcinoma would appear to be proven.
Polyautoimmune syndrome in common variable immunodeficiency
Authors: TANUS T. , LEVINSON A. I. , ATKINS P. C. , ZWEIMAN B.
Published: August 2009

Abstract. Common variable immunodeficiency (CVI) is a heterogenous disorder with hypogammaglobulinaemia and multiple bacterial infections primarily involving the sinopulmonary tract. CVI patients have been known to have an increased tendency to develop autoimmune manifestations. Commonly associated autoimmune diseases include immune thrombocytopenic purpura, autoimmune haemolytic anaemia, and rheumatoid arthritis. In this paper we report a case of CVI presenting with multiple unusual autoimmune diseases including parotitis, vitiligo, atrophic gastritis, pernicious anaemia, and primary biliary cirrhosis. To our knowledge, this is the first case of CVI with polyautoimmunity and anti‐mitochondrial antibody. Recognition of this association is important because early diagnosis and treatment can greatly influence the prognosis.
The risk of hip fractures in patients with primary hyperparathyroidism: a population‐based cohort study with a follow‐up of 19 years
Authors: Larsson Karin , LJUNGHALL S. , KRUSEMO U. B. , NÆSSÉN T. , LINDH E. , PERSSON I.
Published: August 2009

Abstract. Objective. To evaluate primary hyperparathyroidism (HPT) as a risk factor for hip fractures.

Design. A population‐based, record‐linked, prospective study with a mean observation time of 17 years (women) and 16.5 years (men).

Setting. A cohort obtained from a register of hospital admissions in the Uppsala Health Care Region, Sweden, 1965–1983.

Participants. All patients (1373 women and 551 men) who were admitted to hospital with the diagnosis of HPT during the period. Comparisons were made with the entire background population.

Measurements. Cohort subjects were followed with regard to a first instance of hip fracture prior to or after the diagnosis of HPT. The observed number of cases was compared with that expected on the basis of person‐years of observation and incidence rates in the background population. Analyses were made for cervical and trochanteric fractures, and for patients operated and not operated for HPT.

Main results. (i) Women. During 23 341 person‐years of observation, 67 cases of first hip fractures occurred, yielding a relative risk (RR) of 0.93 (95% confidence interval [CI] 0.72–1.19). The RR for cervical fractures was 0.77 (CI 0.54–1.06), and for trochanteric fractures 1.33 (CI 0.88–1.93). Operation for HPT did not influence the risk of hip fracture. (ii) Men. The total person‐years was 9091. Eleven fractures were observed—compared with the expected 7.90 (RR 1.39; CI 0.69–2.50). Men operated for HPT had an increased risk for cervical hip fractures (RR 2.73; CI 1.18–5.39). Owing to the few fractures in this group (n = 8) the relevance of this is uncertain.

Conclusions. This study indicates that HPT is not a risk factor for hip fractures in women.
Response of hypertension to conventional antihypertensive treatment and/or steroidogenesis inhibitors in Cushing's syndrome
Authors: FALLO F. , PAOLETTA A. , TONA F. , BOSCARO M. , Sonino Nicoletta
Published: August 2009

Abstract. Objectives. To evaluate the effect of conventional antihypertensive drugs and/or inhibitors of steroid production in the management of hypertension in Cushing's syndrome.

Design. A retrospective open clinical study with pre‐and post‐treatment assessment.

Setting. A university hospital, where patients were initially admitted and then followed‐up in an ambulatory clinic over a period of 6 years.

Subjects. Forty consecutive hypertensive patients with Cushing's syndrome.

Interventions. Patients were divided into two groups according to the different management of hypertension. The first group (group 1) of 28 patients included those treated with antihypertensive drugs at full dose (diuretics, calcium antagonists, angiotensin converting enzyme [ACE] inhibitors, as single agents or in combination). The second group (group 2) of 12 patients received ketoconazole alone.

Main outcome measures. Blood pressure variations compared to pre‐treatment levels.

Results. Blood pressure normalization was obtained in four of the 28 patients of group 1. In 12 of the remaining patients, ketoconazole, an inhibitor of steroid production, was subsequently added and this normalized blood pressure in all but the one in whom Cortisol was not decreased. In the 12 patients of group 2, ketoconazole alone lowered blood pressure within normal limits in all but one who had longstanding hypertension.

Conclusions. In hypertensive patients with Cushing's syndrome, conventional antihypertensive therapy is mostly ineffective. Blood pressure response is satisfactory only after the restoration of normal Cortisol levels, indicating the need for a specific treatment for hypertension in this disorder.
Polycythaemia vera and cerebral blood flow: a preliminary study with transcranial Doppler
Authors: FIERMONTE GIANCARLO , SPIRITI M. A. ALOE , LATAGLIATA R. , PETTI M. C. , GIACOMINI P.
Published: August 2009

Abstract. Objectives. The purpose of this study has been to investigate by ultrasonographic methods the flow velocities of cerebral arteries because increased blood viscosity due to haematocrit elevation can cause neurological symptoms in polycythaemia vera patients, because of the resulting decrease in cerebral flow.

Subjects and design. Twenty newly diagnosed patients, with haemoglobin values of > 18 g dl−1 and/or an haematocrit of > 50%, were examined by transcranial Doppler. Recordings were performed in basal conditions and after pharmacological and/or phlebotomic treatment, when haematocrit values were ≤ 50%. Blood velocities were evaluated in middle (MCA), anterior (ACA), posterior (PCA) cerebral arteries and in the basilar (BA) artery.

Results. Basal recordings showed decreased velocities (MCA: 39.40 ± 9.34 cm s−1; ACA: 34.05 ± 10.25 cm s−1; PCA: 31.46 ± 5.97 cm s−1; and BA: 27.47 ± 7.42 cm s−1); pre‐ and post‐treatment value differences observed in MCA, ACA and BA were highly significant (P < 0.001).

Conclusions. A decrease in cerebral flow could be a risk for multifocal micro‐ischaemic cerebral infarctions leading, after several years, to a multi‐infarct dementia; an early reduction in erythrocyte burden should be very useful in polycythaemic patients in preventing lacunar lesions.