bluuebunny/crossref_metadata_2025 huggingface dataset:
Intermittent intravenous followed by intermittent oral 1α(OH)D3 treatment of secondary hyperparathyroidism in uraemia
Authors: BRANDI L. , DAUGAARD H. , EGSMOSE C. , TVEDEGAARD E. , KJÆRULFF NIELSEN P. , OLGAARD K.
Published: November 2003

Brandi L, Daugaard H, Egsmose C, Tvedegaard E, Kjærulff Nielsen P, Olgaard K (Medical Department P, Division of Nephrology, Rigshospitalet, University of Copenhagen, Denmark). Intermittent intravenous followed by intermittent oral 1α(OH)D3 treatment of secondary hyperparathyroidism in uraemia. J Intern Med 1996; 239: 353–60.

Objectives. To examine whether intermittent oral 1α(OH)D3 treatment of patients on haemodialysis with secondary hyperparathyroidism (HPT) was able to maintain the marked suppression of PTH, which previously had been induced by an intermittent intravenous administration of 1α(OH)D3. Simultaneously, the effect of the different routes of administration of 1α(OH)D3 on the circulating levels of N‐and C‐terminal PTH fragments was measured.

Design. An open study of patients on chronic haemodialysis.

Setting. Renal division, Rigshospitalet, Copenhagen, Denmark.

Subjects. A total of 26 patients started and five patients completed the total protocol.

Interventions. The treatment protocol was divided into three parts: (i) 1α(OH)D3 administered intravenously for >300 days; then (ii) 1α(OH)D3 administered orally for 100 days, followed by (iii) 1α(OH)D3 administered intravenously again for another 100 days. 1α(OH)D3 was given three times a week at the end of each dialysis.

Main outcome measures. Intact PTH, N‐ and C‐terminal PTH.

Results. Intact PTH levels were significantly (P<0.0001) suppressed by 90.4±3.3% after 56 days of intermittent intravenous 1α(OH)D3 treatment. This degree of suppression remained stable during the following period of oral treatment and did not change further when intravenous treatment was reinstituted. The circulating levels of intact PTH and N‐ and C‐terminal iPTH were not influenced by the administered route of 1α(OH)D3.

Conclusions. Intravenous 1α(OH)D3 treatment of the secondary HPT in dialysis patients can safely be changed to oral treatment at the time when optimal suppression of PTH has been achieved.
Acute administration of metoprolol and enalaprilat reduces insulin‐stimulated thermogenesis and skin blood flow
Authors: TUOMINEN J. A. , ERIKSSON J. G. , KOIVISTO V. A.
Published: November 2003

Tuominen JA, Eriksson JG, Koivisto VA (Department of Medicine, Helsinki University Central Hospital, and National Institute of Public Health, Helsinki, Finland). Acute administration of metoprolol and enalaprilat reduces insulin‐stimulated thermogenesis and skin blood flow. J Intern Med 1996; 239: 399–406.

Objective. To examine the acute effects of intravenous metoprolol and enalaprilat on energy expenditure, thermogenesis, blood flow and insulin sensitivity.

Design. Randomized, single‐blind, placebo‐controlled trial.

Setting. Helsinki University Central Hospital, Finland.

Subjects. Seven moderately insulin‐resistant nondiabetic subjects.

Interventions. Each subject was studied three times at 2–3 weeks intervals; metoprolol (5 mg), enalaprilat (2 mg) or saline infusions were used.

Methods. A 150‐min euglycaemic/hyperinsulinaemic clamp combined with indirect calorimetry and blood flow measurements were performed.

Main outcome measures. Glucose uptake, forearm and skin blood flow, and energy expenditure.

Results. Blood pressure was decreased to the same degree by both drugs. Forearm blood flow (plethysmography) was lower with metoprolol compared to enalaprilat (2.1±0.2 vs. 2.8±0.4 mL per 100 mL min‐1; P<0.05). Glucose‐plus‐insulin‐stimulated thermogenesis and total energy expenditure were reduced both by metoprolol (71 and 5.2%; P<0.05 in both) and enalaprilat (59%, P= 0.06; and 7.6%, P<0.05) as compared to the control study. Skin blood flow (laser Doppler) increased by 100% (P<0.01) during the glucose‐plus‐insulin infusion, but this increment was inhibited by both drug infusions. Forearm and whole‐body glucose uptake was not influenced by metoprolol or enalaprilat administration.

Conclusions. (i) Both metoprolol and enalaprilat inhibit glucose‐plus‐insulin‐induced thermogenesis and a rise in skin blood flow. (ii) Metoprolol further reduces forearm blood flow compared to enalaprilat. (iii) Neither drug has any acute effect on insulin sensitivity. (iv) The interference of a physiological response to insulin by ACE inhibitors or beta‐blocking agents may have implications both for energy balance and thermoregulation during periods of hyperinsulinaemia in man.
Nitrogen dioxide pneumonitis in ice hockey players
Authors: KARLSON‐STIBER C. , HÖJER J. , SJÖHOLM Å . , BLUHM G. , SALMONSON H.
Published: November 2003

Karlson‐Stiber C, Höjer J, Sjöholm Å, Bluhm G, Salmonson H (Swedish Poison Information Centre, the Department of Internal Medicine, Söder Hospital, and the Department of Environmental Health and Infectious Disease Control, Karolinska Hospital, Stockholm; and the Department of Internal Medicine, Löwenströmska Hospital, Upplands Väsby; Sweden). Nitrogen dioxide poisoning with toxic pneumonitis in ice hockey players (Case report). J Intern Med 1996; 239: 451–6.

Exposure to the toxic gases carbon monoxide and nitrogen dioxide (NO2) in indoor ice arenas occasionally occurs and may result in severe symptoms. The gases are produced by ice resurfacing machines operating on hydrocarbons, and in certain conditions toxic levels accumulate. The damage to lung tissues caused by NO2 may not be evident until after a latency time of ½–2 days. The role of corticosteroids in the treatment is controversial, but there are clinical experiences as well as experimental data supporting their use.

We report two cases of toxic pneumonitis, with delayed onset, due to NO2 exposure during an ice hockey game in an indoor arena. Signs and symptoms were cough, dyspnoea, haemoptysis, hypoxaemia and reduced peak expiratory flow. Chest radiographs showed parenchymatous infiltrative lesions and alveolar consolidation. Both patients were treated with high doses of corticosteroids by inhalation and orally or intravenously. Their condition rapidly improved and pulmonary function was restored.
Fibrinogen, coronary heart disease and mortality from all causes in smokers and nonsmokers. The Study of Men Born in 1933
Authors: ROSENGREN ANNIKA , WILHELMSEN LARS
Published: November 2003

Objective. To analyse the relation between fibrinogen concentration and incidence of coronary heart disease and mortality from all causes. A secondary aim was to investigate whether the effect of fibrinogen, as in previous cross‐sectional analyses from this population, was restricted to nonsmokers.

Design. Prospective population study.

Setting. City of Göteborg, Sweden.

Subjects. A total of 664 men from a population sample of 1016 men aged 50 in 1983, without prior myocardial infarction.

Main outcome measures. Development of coronary heart disease (myocardial infarction, coronary death or, in men with angina, revascularization, or scintigraphic evidence of coronary disease) and death from all causes, in relation to fibrinogen concentration and smoking status at baseline, during 9 years' follow‐up.

Results. Rates of coronary heart disease during follow‐up in the lowest, middle and highest third of the fibrinogen distribution were 4.6, 6.4 and 10.3%, respectively, but this did not remain significant after controlling for smoking and other risk factors (adjusted odds ratio [OR] for the highest, compared to the lowest third 1.5 [0.7–3.4]). Percentages of men who died from any cause were 3.2, 5.9 and 10.7 in the lowest, middle and highest thirds of fibrinogen, respectively. After adjustment for smoking and other risk factors, this difference remained significant (relative risk 2.6 [1.2–5.9]). In men who were smokers at baseline, fibrinogen was not significantly related to coronary heart disease or mortality. Men who did not smoke in the lowest, middle, and highest third of the fibrinogen distribution had rates of coronary heart disease of 1.8, 3.6 and 10.3%, respectively, and of deaths from all causes of 1.8, 2.9 and 8.4%, respectively. The adjusted OR remained significant at 5.4 (1.4–20.0) for coronary heart disease, as did the adjusted relative risk for mortality at 3.8 (1.01–14.4).

Conclusion. Plasma fibrinogen is an independent predictor of premature death, and also of coronary heart disease, in middle‐aged men and in nonsmokers. A high fibrinogen concentration, particularly in a nonsmoker, deserves attention.
Thrombocytopenia induced by noncytotoxic drugs in Denmark 1968–91
Authors: PEDERSEN‐BJERGAARD U. , ANDERSEN M. , HANSEN P. B.
Published: November 2003

Objectives. To analyse the distribution of noncytotoxic drugs reported as cause of thrombocytopenia during a 24‐year period, and to draw attention to the most commonly involved drugs in modern clinical practice.

Design/setting. Retrospective study of spontaneous case reports from the Danish reporting system on adverse drug reactions.

Subjects. A total of 309 critically reviewed cases of drug‐induced thrombocytopenia reported during the period from 1968 to the end of 1991.

Results. Sodiumaurothiomalate and the combination sulfamethoxazole with trimethoprim were the most commonly reported single drugs, and nonsteroid anti‐inflammatory drugs were the most frequently reported category of drugs. A pronounced shift in the spectrum of causal drugs was observed due to the introduction of new drugs and alterations in drug consumption. At present, valproic acid and measles–mumps–rubella vaccine are most numerously reported. The still‐growing list of thrombocytopenia‐inducing agents contained 110 different drugs. At present, 20% of reported cases concern drugs not previously registered as causing thrombocytopenia in Denmark. Twenty‐five per cent of all cases were caused by drugs which appeared only sporadically in the material.

Conclusions. The spectrum of drugs reported as causing drug‐induced thrombocytopenia is broadening and changing progressively, reflecting changes in drug consumption. The most frequently reported drugs at present are valproic acid and measles–mumps–rubella vaccine.
The cost effectiveness of lipid lowering in Swedish primary health care
Authors: JOHANNESSON MAGNUS , BORGQUIST LARS , JÖNSSON BENGT , LINDHOLM LARS H.
Published: November 2003

Objective. To evaluate the cost‐effectiveness of two types of advice (usual and intensive) to lower cardiovascular risk, with or without pharmacological medication aimed at lowering cholesterol levels.

Design. Prospective, randomized, controlled clinical study of 18 months' duration.

Setting. Thirty‐two primary health care centres in Sweden.

Subjects. A total of 384 males, aged 30–59 years, with at least one cardiovascular risk factor in addition to moderate primary hyperlipidaemia; of these, 355 completed the 18‐month follow‐up.

Interventions. Intensive advice consisted of group sessions led by a health care professional; the usual level of advice was given at follow‐up visits. The pharmacological intervention consisted of pravastatin. The goal was to achieve a 15% reduction in cholesterol.

Main outcome measures. Cost per life‐year gained based on the change in serum cholesterol and the net intervention cost of the four treatment options.

Results. The usual level of advice and intensive advice in combination with pharmacological treatment achieved no incremental effects and were not considered in the cost‐effectiveness analysis. The cost per life‐year gained of pharmacological treatment compared with intensive advice decreased. The cost per life‐year gained of pharmacological treatment compared with no treatment was about $61 000, if no adverse consequences on noncardiovascular mortality were assumed.

Conclusions. According to the results of the CELL trial, intensive advice is not a cost‐effective strategy compared with lipid‐lowering drug treatment. However, it is also doubtful whether drug treatment as primary prevention is cost‐effective compared with no treatment in the studied patient population.
Intrapulmonary administration of insulin to healthy volunteers
Authors: JENDLE J. H. , KARLBERG B. E.
Published: November 2003

Objectives. To study the biological effects of nebulized insulin, administered intrapulmonary, to healthy volunteers.

Design. A double‐blind, randomized, controlled intervention study.

Setting. The department of Internal Medicine, University Hospital, Linköping, Sweden.

Subjects. Eight healthy, non‐smoking volunteers, with a mean age of 28 (range 22 to 56) years.

Interventions. Regular human insulin 100 U mL‐1 (Actrapid®) or 0.9% saline was given randomly as an oral inhalation. Insulin was given in three different doses (40, 80 and 160 U). Aerosol was generated by a new jet nebulizer.

Main outcome measures. Blood glucose, serum insulin, and serum C‐peptide.

Results. After the 160 U insulin dose the blood glucose concentration (mean±SE) fell from 4.3±0.2 to 2.8±0.2 mmol L‐1 (P <0.001), concomitant with an increase in mean serum insulin concentrations, rising from 9.5±1.5 to 26.1±2.5 mU L‐1 (P <0.001). Serum C‐peptide concentrations simultaneously decreased from 0.48±0.03 to 0.12±0.02 mmol L‐1 (P <0.001). All changes were dose dependent. No adverse reactions were noted and no significant changes in lung function tests.

Conclusions. Intrapulmonary insulin administration to healthy subjects can induce a significant hypoglycaemia and cause a clinically relevant increase in serum insulin concentrations. If similar results can be obtained when administering insulin to diabetic subjects, this insulin administration route can be a future complement to certain groups of patients.
Chronic consumers of boiled coffee have elevated serum levels of lipoprotein(a)
Authors: URGERT R. , WEUSTEN‐VAN DER WOUW M. P. M. E. , HOVENIER R. , LUND‐LARSEN P. G. , KATAN M. B.
Published: November 2003

Objectives. Lipoprotein(a) consists of an LDL‐particle attached to apolipoprotein(a), which is made by the liver. Diterpenes present in boiled coffee raise serum levels of LDL cholesterol and of the liver enzyme alanine aminotransferase in man. We investigated the association between intake of boiled coffee and serum levels of lipoprotein(a).

Design, setting and subjects. Healthy Norwegians 40–42 years of age, who habitually consumed five or more cups of boiled coffee per day (n=150) were compared with matched filter coffee consumers (n=159) in a cross‐sectional study, as part of the Norwegian National Health Screening in 1992.

Results. The median lipoprotein(a) level was 13.0 mg  dL−1 (10th and 90th percentile: 2.5 and 75.0 mg  dL−1, respectively) on boiled and 7.9 mg dL‐1 (10th and 90th percentile: 1.9 and 62.5 mg dL−1, respectively) on filter coffee (P=0.048). Means±SE were 25.8±2.4 mg dL−1 and 19.6±2.0 mg dL−1, respectively (P=0.04). Although not statistically significant, subjects consuming nine or more cups of coffee per day had higher lipoprotein(a) levels than those drinking five to eight cups per day in both coffee groups.

Conclusion. Chronic consumers of unfiltered, boiled coffee have higher serum levels of lipoprotein(a) than filter coffee drinkers.
Exploring the declining case fatality in acute stroke. Population‐based observations in the northern Sweden MONICA Project
Authors: STEGMAYR B. , ASPLUND K.
Published: November 2003

Objectives. Declining case fatality in acute stroke has been reported from many western countries. The aim of this study was to explore in what subset of patients the decline in case fatality has occurred.

Setting. In a population‐based study, acute stroke events were recorded in the age group 25–74 years in northern Sweden during the years 1985–1993 within the framework of the WHO MONICA Project.

Subjects. In total 3486 men and 2212 women with a first‐ever stroke (except subarachnoid haemorrhage) were included.

Main outcome. Change in stroke incidence, case fatality and neurological deficits at onset over a 9‐year period.

Results. The incidence (first‐ever stroke) did not change over the years, while the overall case fatality decreased from 18.2% in 1985–1987 to 13.5% in 1991–1993. In both men and women with non‐haemorrhagic stroke, a trend was seen towards an increasing incidence of mild stroke events over the years. In both sexes, a significant decline in case fatality was seen in patients with minor deficits at onset, while no change in case fatality was seen in patients with extensive deficits. There was no change in incidence of intracerebral haemorrhage, but the case fatality in patients with intracerebral haemorrhage declined significantly from 36% to 29% during the study period.

Conclusions. A declining case fatality was observed in both men and women. Among patients with non‐haemorrhagic stroke, the decline was confined to patients with minor deficits. The declining case fatality can be attributed both to a shift in the severity towards more patients presenting with mild symptoms, and an improved prognosis in patients with minor deficits at onset, probably because of improved medical management.
Determinants of longevity: genetic, environmental and medical factors
Authors: CHRISTENSEN K. , VAUPEL J. W.
Published: November 2003

This review focuses on the determinants of longevity in the industrialized world, with emphasis on results from recently established data bases. Strong evidence is now available that demonstrates that in developed countries the maximum lifespan as well as the mean lifespan have increased substantially over the past century. There is no evidence of a genetically determined lifespan of around 85 years. On the contrary, the biggest absolute improvement in survival in recent decades has occurred amongst 80+ year‐olds. Approximately one‐quarter of the variation in lifespan in developed countries can be attributed to genetic factors. The influence of both genetic and environmental factors on longevity can potentially be modified by medical treatment, behavioural changes and environmental improvements.
Infective endocarditis, 1984 through 1993: a clinical and microbiological survey
Authors: Benn M. , Hagelskjær L. H. , Tvede M.
Published: November 2003

Benn M, Hagelskjær LH, Tvede M. (Viborg Hospital, Denmark). Infective endocarditis, 1984 through 1993: a clinical and microbiological survey. J Intern Med 1997; 242: 15–22.

Objectives

To characterize the epidemiology and the clinical and microbiological spectrum of infective endocarditis in a Danish population.

Design

A retrospective review.

Setting

All episodes hospitalized of infective endocarditis from 1984 to 1993 in Viborg County were reviewed. The county is served by one general and four local hospitals.

Subjects

One hundred and nine episodes of suspected infective endocarditis with 62 episodes in 59 patients fulfilling the diagnostic criteria by von Reyn.

Results

An overall incidence of 27 episodes per million per year was found. The incidence was 17.4 episodes per million per year in the first part of the decade and 36.5 episodes per million per year in the second part (P < 0.001). Microscopic haematuria was found in 70.2% of the patients with infective endocarditis, compared to 16.7% of the patients in whom the diagnosis was rejected (P < 0.01). Staphylococcus aureus was found in 38.9%, non‐β‐haemolytic streptococci in 24.1% and Enterococcus faecalis in 16.7%. The overall mortality was 35.5%. The mortality decreased significantly from 50.0% in the first part of the decade to 28.6% in the second part (P < 0.01). The mortality was 23.1% in patients in whom the diagnosis was established whilst they were alive. This finding was significantly lower than the overall mortality (P < 0.05).

Conclusion

The incidence of infective endocarditis increased during the decade. The frequency of non‐β‐haemolytic streptococci was lower than normally reported. Mortality is still high, with the main mortality within the first week in hospital, which stresses the importance of early case detection and treatment.
Pyridoxin‐responsive anaemia in a patient with a history of polycythaemia vera
Authors: VAN GAMEREN I. I. , WIJNJA L. , LOUWES H. , de WOLF J. Th. M.
Published: November 2003

van Gameren II, Wijnja L, Louwes H, de Wolf JTHM (Martini Hospital and University Hospital, Groningen, The Netherlands). Pyridoxin‐responsive anaemia in a patient with a history of polycythaemia vera (Case Report). J Intern Med 1997; 242: 79–81.

Pancytopenia in the course of polycythaemia vera (PV) following the proliferative and stable phase, ultimately leads to a spent phase characterized by extensive marrow fibrosis. We describe a patient with a history of PV and pancytopenia caused by myelodysplasia, before a genuine end stage myelofibrosis had occurred. The related anaemia was responsive to pyridoxin.
Hyperthyroidism and pulmonary hypertension
Authors: Thurnheer R. , Jenni R. , Russi E.W. , Greminger P. , Speich R.
Published: November 2003

Thurnheer R, Jenni EW, Russi P, Greminger P, Speich R (Department of Internal Medicine, University Hospital, Zürich, Switzerland). Hyperthyroidism and pulmonary hypertension (Case report). J Intern Med 1997; 242: 185–8.

Objectives

To identify patients with hyperthyroidism and coincidental pulmonary hypertension and to document reversibility of pulmonary hypertension after treatment of hyperthyroidism.

Design

Patients with hyperthyroidism referred for transthoracal echocardiography for any reason that showed elevated pulmonary arterial pressures were collected. After therapy for the thyreotoxic state with documented normalization of thyroid hormone (fT4), pulmonary arterial pressure was measured again noninvasively.

Setting

An out‐patient tertiary referral centre.

Subjects

The medical records were used to identify, retrospectively, patients with hyperthyroidism and pulmonary hypertension over a three‐year period (April 1993 to April 1996).

Interventions and main outcome measures

Systolic pulmonary artery pressure (PAPs) was determined by adding up right ventricular systolic pressure (RVSP) and mean right atrial pressure (RAP) measured by continuous‐wave Doppler echocardiography according to standard techniques. All patients were treated for hyperthyroidism to normal fT4 levels. After successful therapy, Doppler echocardiography was repeated.

Results

Four patients with pulmonary hypertension showing elevated PAPs of 40 ± 11 mmHg were identified. After therapy, PAPs decreased in all patients to a mean of 25 ± 6 mmHg.

Conclusion

The observation of four patients with pulmonary hypertension and hyperthyroidism is striking and suggests a possible pathogenetic link of these disorders.
An unusual case of severe combined immunodeficiency with hypereosinophilia
Authors: Dams E. Th. M. , Mascart‐Lemone F. , Schandené L. , van der Meer J. W. M.
Published: November 2003

Dams ETHM, Mascart‐Lemone F, Schandené L, van der Meer JWM (University Hospital Nijmegen, Nijmegen, The Netherlands, and Hôpital Erasme, Brussels, Belgium). An unusual case of severe combined immunodeficiency with hypereosinophilia (Case Report). J Intern Med 1997; 242: 267–9.

Investigation of the cytokine profile in a 26‐year‐old man, suffering from combined immunodeficiency with hypereosinophilia, revealed high levels of interleukin‐4 and interleukin‐5 and relatively low levels of interleukin‐2 and interferon gamma, consistent with a T‐helper type 2 pattern, as has been reported in Omenn's syndrome. However, some distinct clinical and immunological features suggest that this case may represent a unique disease with specific pathogenesis.
Quality of life in patients with ischaemic heart disease: a prospective controlled study
Authors: Westin L. , Carlsson R. , Israelsson B. , Willenheimer R. , Cline C. , McNeiL T. F.
Published: November 2003

Westin L, Carlsson R, Israelsson B, Willenheimer R, Cline C, McNeil TF (University of Lund, University Hospital, Malmö, Sweden). Quality of life in patients with ischaemic heart disease: a prospective controlled study. J Intern Med 1997; 242: 239–47.

Objectives

To assess quality of life in patients after acute myocardial infarction (AMI), coronary artery by‐pass grafting surgery (CABG) and percutaneous transluminal coronary angioplasty (PTCA) as compared with healthy controls.

Design

Self‐administered questionnaires were completed 1 month and 1 year after the event.

Setting

Department of Cardiology, University Hospital, Malmö, Sweden; 1989–1992.

Subjects

296 AMI, 99 CABG, 18 PTCA patients and 88 randomly selected healthy controls were included; 349 patients completed the entire programme.

Main outcome measures

Quality of life in the dimensions of perceived general health, thoracic pain, breathlessness, feeling of arrhythmia, anxiety, depression, self‐esteem, experience of social life and sex life.

Results

Patients differed from controls in both psychological and somatic aspects of QL after 1 month. Furthermore, 1 month after the event AMI patients experienced more anxiety (P= 0.001) than CABG patients, whilst CABG patients experienced a poorer sex life (P < 0.001) than AMI patients. One year after the event patients differed from controls primarily in somatic symptoms; no significant differences were found across patient groups. Patients who sought emergency out‐patient care during the follow‐up year for clinically diagnosed angina pectoris or cardiac incompensation had reported higher levels of thoracic pain (P < 0.001) and breathlessness (P < 0.001) at 1 month follow‐up than patients who did not seek such care.

Conclusions

Quality of life is considerably affected in patients following a cardiac event, especially during the initial recovery phase. Although substantial improvement in quality of life occurs over time, the persistence of residual distress at 1‐year follow‐up is a challenge for clinicians concerned with the full rehabilitation of the cardiac patient.
The ineffectiveness of cyclical oral clodronate on bone mineral density in glucocorticoid‐treated patients with giant‐cell arteritis
Authors: Nordborg E. , Schaufelberger C. , Andersson R. , Bosaeus I. , Bengtsson B‐Å.
Published: November 2003

Nordborg E, Schaufelberger C, Andersson R, Bosaeus I, Bengtsson B‐Å (Sahlgrenska University Hospital, Göteborg, Sweden). The ineffectiveness of cyclical oral clodronate on bone mineral density in glucocorticoid‐treated patients with giant‐cell arteritis. J Intern Med 1997; 242: 367–71.

Objectives and design

The aim of the present study was to determine whether cyclic oral administration of clodronate, a bisphosphonate, every second month prevents rapid bone loss during the first year of glucocorticoid treatment in patients with giant‐cell arteritis (GCA). The trial was designed as a prospective double blind study, assessing total body mineral content (BMC) and bone mineral density (BMD) using DXA technique. Supplementation of calcium was given to both groups of patients.

Setting

The outpatient clinics of the rheumatic and infectious diseases of Sahlgren University Hospital of the city of Göteborg on the west coast of Sweden.

Subjects

Twenty‐seven patients with confirmed GCA were consecutively included during a 15‐month period.

Results

An early influence on bone turnover was found with a temporary decrease in BMC after six months of glucocorticoid treatment, which was normalized after 12 months in both study groups. No significant differences between the patients given clodronate and calcium and the controls, who got supplementation with calcium alone, was observed at any assessment point. However, there was a significant and prolonged depression of the osteocalcin levels in the clodronate‐treated patients.

Conclusions

Oral administration of clodronate in a moderately high dose given cyclically every other month had no additive effect on BMD compared with calcium supplementation alone during the first year of glucocorticoid treatment. A larger material might have revealed some differences between the categories. In most patients with GCA, however, the BMD seems to recover after one year of glucocorticoid treatment, provided there is good control of the inflammation and patients are kept physically active. It needs to be elucidated whether there are subsets of patients who might benefit from bone sparing agents: women near menopause with a high turnover rate of bone, individuals who have low BMD from the start of glucocorticoid treatment or patients requiring high doses of glucocorticoids during a long period of time.
Social and biological predictors of early menopause: a model for premature aging
Authors: NILSSON P. , MÖLLER L. , KÖSTER A. , HOLLNAGEL H.
Published: November 2003

Nilsson P, Möller L, Köster A, Hollnagel H (University of Lund, Lund, Sweden; Glostrup University Hospital, Glostrup, and University of Copenhagen, Copenhagen; Denmark). Social and biological predictors of early menopause: a model for premature aging. J Intern Med 1997; 242: 299–305.

Objectives

To investigate possible social, lifestyle‐related and biological predictors of early menopause in middle‐aged women, followed prospectively for 11 years.

Design

A prospective, population‐based, cohort follow‐up, observational study.

Setting

Glostrup Hospital, Copenhagen, Denmark.

Subjects

A total of 493 female subjects, all aged 40 years at baseline, and divided into three groups according to self‐reported menopausal age (40–45, 46–51, 51+ years), after 12 months of amenorrhoea. Women having had medical or surgical interventions to influence menopausal state were excluded.

Main outcome measures

Body mass index, glucose, insulin, lipids, creatinine, uric acid, thyroid‐stimulating hormone (TSH), lung function tests (forced VC, FEV1, peak flow), blood pressure; a self‐administered questionnaire with questions on psychosocial variables, lifestyle, and self‐rated health.

Results

An early menopausal age correlated in an univariate way with impaired lung function, increased smoking habits and low social class (in childhood or present), as well as with a feeling of tiredness, all measured at the baseline investigation. On the contrary, a later menopausal age correlated with higher serum insulin and uric acid levels. In multiple regression analysis, with menopausal age as the dependent variable, it was found that smoking habits (number of years smoking) was inversely (P < 0.001), and insulin as well as uric acid were positively (P < 0.05) correlated with menopausal age.

Conclusions

Females who smoke run an increased risk of early menopause, whereas relative hyperinsulinaemia is independently associated with later menopause. At the age of 40 years, high insulin levels in females might be just a marker for normal female sex hormone physiology, not for insulin resistance, as seen in postmenopausal female subjects. Early menopause might be useful as a potential model of premature ageing.
Does metformin increase the serum total homocysteine level in non‐insulin‐dependent diabetes mellitus?
Authors: Hoogeveen E. K. , Kostense P. J. , Jakobs C. , Bouter L. M. , Heine R. J. , Stehouwer C. D. A.
Published: November 2003

Hoogeveen EK, Kostense PJ, Jakobs C, Bouter LM, Heine RJ, Stehouwer CDA (Vrije Universiteit, Amsterdam, the Netherlands). Does metformin increase the serum total homocysteine level in non‐insulin‐dependent diabetes mellitus?J Intern Med 1997; 242: 389–94.

Objective

The aim of this study was to estimate the effect of metformin on the serum total homocysteine level in non‐insulin‐dependent diabetes mellitus (NIDDM) patients. An elevated serum total homocysteine level is a risk factor for atherosclerosis. Metformin decreases serum vitamin B12, and may thereby indirectly increase the serum total homocysteine level.

Design

A cross‐sectional study in a primary care setting.

Subjects, main outcome measures

Fasting serum total homocysteine level was measured in 40 NIDDM patients who had received treatment with metformin (500–2550 mg per day) for at least six months, and in 71 NIDDM patients not treated with metformin and matched for sex, age (± 5 years), serum creatinine (± 5 μmol L−1) and current smoking habits. ‘Exposed’ patients were matched with ‘nonexposed’ patients. A two‐way analysis of variance was performed.

Results

The mean serum total homocysteine level was 11.5 μmol L−1 in the metformin‐exposed patients and 10.6 μmol L−1 in the nonexposed patients. Thus, the metformin‐exposed patients had slightly higher serum total homocysteine levels (difference 0.8 μmol L−1, 95% confidence interval (−0.4–2.0 μmol L−1). Results were similar in men and women. Finally, no dose–response relationship between cumulative exposure to metformin (dose × duration of treatment) and the serum total homocysteine level could be demonstrated.

Conclusion

We conclude that the effect of metformin on serum total homocysteine level in NIDDM patients, if any, is likely to be small.
Improving empirical antibiotic treatment: prospective, nonintervention testing of a decision support system
Authors: Leibovici L. , Gitelman V. , Yehezkelli Y. , Poznanski O. , Milo G. , Paul M. , Ein‐Dor P.
Published: November 2003

Leibovici L, Gitelman V, Yehezkelli Y, Poznanski O, Milo G, Paul M & Ein‐dor P (Rabin Medical Centre, Petah‐Tiqva, Sackler Faculty of Medicine, and Faculty of Management, Tel‐Aviv University, Ramat‐Aviv, Tel‐Aviv, Israel). Improving empirical antibiotic treatment: prospective, nonintervention testing of a decision support system. J Intern Med 1997; 242: 395–400.

Objectives

Develop a problem‐orientated and data‐based decision support system (DSS) to improve empirical antibiotic treatment, and compare the performance of the system to that of the physician.

Design

The DSS was tested in a prospective, noninterventional, comparative cohort study.

Setting

University hospital in Israel.

Subjects

Consecutive patients (n = 496) in four departments of internal medicine suspected of harboring a moderate to severe bacterial infection.

Interventions

None.

Main outcome measures

The percentage of appropriate empirical antibiotic treatments.

Results

Out of 496 patients included in the study, 219 had positive cultures or serological tests. The physicians prescribed inappropriate empirical antibiotic treatment in 91 of 219 patients (42%); whilst the recommendations of the system were inappropriate in 50 patients (23%) (P < 0.05). Superfluous treatment was prescribed in 15% of patients by the physician, and in 11% by the system. Out of the 91 patients given inappropriate treatment by the physician, the DSS advised treatment to which the pathogens were susceptible in 61 patients. The advantage of the DSS over the physician was most evident in multiresistant gram‐negative isolates, enterococci and Staphylococcus aureus.

Out of the 277 patients with negative cultures, the DSS advised narrower‐spectrum antibiotic treatment than prescribed by the physicians in 27% of patients, and broader‐spectrum in 13%.

Conclusion

A problem‐orientated, data‐based DSS outperformed physicians in the choice of appropriate empirical antibiotic treatment, and recommended less broad‐spectrum antibiotics.
The influence of age on low density lipoprotein metabolism: effects of cholestyramine treatment in young and old healthy male subjects
Authors: Ericsson S. , Berglund L. , FrostegÅrd J. , Einarsson K. , Angelin B.
Published: November 2003

Ericsson S, Berglund L, Frostegård J, Einarsson K, Angelin B (Karolinska Institute at Huddinge University Hospital, Huddinge; and Karolinska Hospital, Stockholm; Sweden). The influence of age on low density lipoprotein metabolism: effects of cholestyramine treatment in young and old healthy male subjects. J Intern Med 1997; 242:329–37.

Objective.

The plasma concentration of low density lipoproteins (LDL) increases with age, mainly as the result of a reduced clearance of LDL. Because the conversion of cholesterol to bile acids is reduced with age, we hypothesized that the response of plasma LDL to stimulation of bile acid production would be different in young and old subjects.

Design, subjects and setting.

Comparison of the response to cholestyramine treatment in two groups of normolipidaemic, normal weight males: seven young (23–34 years) and eight old (64–73 years). Outpatients at the metabolic ward of a university hospital given a standardized diet of natural type.

Intervention

Cholestyramine was given 8 g b.i.d. for 3 weeks and continued during the second LDL turnover study.

Main outcome measures

Kinetics of autologous radiolabelled LDL before and during treatment. Mean values of lipoprotein lipid levels obtained during the two turnover studies. Changes in LDL particle composition and LDL receptor affinity between the two study periods.

Results

Both age groups responded with decreased levels of LDL cholesterol and apolipoprotein‐B (apoB), the change being more pronounced in the old subjects. The LDL apoB fractional catabolic rate was increased by ≈11% in both groups. In contrast, there was a reduced ability in the old subjects to sustain their production rates for LDL apoB with resin therapy, resulting in a 23% reduction in LDL input. No effect on the apparent LDL apoB synthesis rate was observed in the young subjects. LDL particles isolated from cholestyramine‐treated subjects were triglyceride‐enriched and cholesterol‐depleted, and showed a lowered affinity for the LDL receptor in tissue culture studies.

Conclusions

The results demonstrate that stimulation of bile acid production by cholestyramine treatment decreases LDL cholesterol levels in both young and old subjects. This therapy increases LDL apoB elimination in both age groups, but reduction of apparent LDL apoB production is only seen in old subjects.
Acute papillary muscle rupture in a patient with clostridial sepsis
Authors: SCHULZ R. , ANDREAS S. , WEISE B. , WERNER G. S.
Published: November 2003

We describe the clinical course of a 58‐year‐old man who died from acute papillary muscle rupture as a complication of clostridial sepsis. There was no evidence for myocardial infarction, infective endocarditis, prior chest trauma or other known causes of papillary muscle rupture. Histological specimens taken at autopsy demonstrated clostridial infection of the heart. To our knowledge the occurrence of papillary muscle rupture in the setting of clostridial sepsis has not yet been reported in the literature.
Primary prevention of coronary heart disease: role of cholesterol control in the United States
Authors: GRUNDY S. M.
Published: November 2003

The benefit of cholesterol‐lowering drug therapy in patients with existing coronary heart disease (CHD) is well established through clinical trials. Prevention of recurrent coronary morbidity and mortality in CHD patients is called secondary prevention. In contrast, primary prevention is delaying or preventing altogether new‐onset CHD. There are three categories of primary prevention: high‐risk, moderate‐risk, and long‐term (life‐time). A recent clinical trial has documented benefit of cholesterol‐lowering drugs for prevention of coronary morbidity and mortality and total mortality in hypercholesterolemic, middle‐aged men. This trial lends support for including aggressive cholesterol reduction in high‐risk primary prevention. However, for such therapy to be cost effective at present‐day prices of cholesterol‐lowering drugs, only those patients in the higher ranges of risk can be selected for treatment. This leaves a large number of people at moderately high risk for premature CHD because of high cholesterol levels. These persons deserve increased professional attention to risk reduction. In general the nondrug approach is indicated. The latter approach includes eliminating other risk factors, e.g. cigarette smoking and hypertension, and reducing serum cholesterol levels by decreased intakes of saturated fatty acids, cholesterol, and excess total calories. Some moderate‐risk patients may require low doses of cholesterol‐lowering drugs to achieve the goals for cholesterol reduction. Finally, public health strategies need to be developed for applying the same nondrug approach for the general population for reducing the overall incidence of CHD.
Influence of apolipoprotein A‐1 promoter polymorphism on lipid levels and responses to dietary change in Finnish adults
Authors: MENG QING‐HE , PAJUKANTA P. , VALSTA L. , ARO A. , PIETINEN P. , TIKKANEN M. J.
Published: November 2003

Objectives. To analyse the association between the G/A polymorphism in the apolipoprotein A‐1 (apo A‐1) promoter region and plasma lipid levels, as well as their responses to dietary change, in Finnish adults.

Subjects and design. Blood samples from 86 subjects (42 men, 44 women) who attended a dietary intervention study carried out in North Karelia in 1993 were available for the current analysis. The diet study consisted of a 2‐week baseline period, followed by an 8‐week intervention period, and an 8‐week switchback period.

Intervention. Diet was modified to a low‐fat, low‐cholesterol diet during the dietary intervention.

Main outcome measures. Fasting plasma lipid, lipoprotein and apolipoprotein levels were determined.

Results. At baseline, the high‐density lipoprotein (HDL) cholesterol and apo A‐1 levels were higher (P<0.01) and the triglyceride levels were lower (P<0.05) in men, but not in women, with the A allele. The differences in HDL cholesterol and apo A‐1 levels between genotypes remained during the low‐fat, low‐cholesterol diet and switchback periods. Apart from the difference between responses in apo A‐1 during switchback to the original diet, lipid responses to dietary change did not differ significantly between genotypes.

Conclusion. Our findings indicate a significant association between the apo A‐1 promoter polymorphism and plasma apo A‐1 and HDL‐cholesterol in men. In theory, the higher plasma HDL‐cholesterol and apo A‐1 levels in the GA/AA group may confer some protection against coronary artery disease. The differences in HDL‐cholesterol and apo A‐1 levels between genotypes persisted during different diets suggesting that the possible benefit is independent of fat and cholesterol intake.
Identifying individuals with high fat levels and low P∶S ratios, in their diets, for intensive dietary intervention
Authors: KINLAY S. , ELLIOTT H. , HELLER R. F.
Published: November 2003

Objectives. To assess whether simple scores from a dietary questionnaire could identify those with high dietary fat or low P:S ratio intakes, for intensive dietary intervention.

Design. Cross‐sectional and longitudinal studies.

Setting. Community setting in the Hunter Region of New South Wales, Australia.

Subjects. Two random samples of adults 35–69 years from the electoral roll. In the cross‐sectional study 287/322 (86%) subjects completed the diet questionnaire and a reference standard questionnaire. In the longitudinal study 546/653 (84%) of subjects completed the diet questionnaire, and had blood cholesterol measured on two occasions, 3 months apart.

Main outcome measures. In the cross‐sectional study, the simple scores of total fat intake (Fat Intake Score) and P:S ratio (Unsaturated Score) were compared with the daily intakes of total fat and P∶S ratio obtained from the standard questionnaire. In the longitudinal study, changes in the scores were compared with changes in blood total cholesterol.

Results. A Fat Intake Score of greater than 125 had the best receiver operator characteristics for identifying high total fat intake (>100 g/day; sensitivity=67%, specificity=70%). An Unsaturated Score of less than 0.3 had the best characteristics for identifying a low P:S ratio (<0.5; sensitivity=63%, specificity=60%). Subjects who decreased Fat Intake Score by one category, had a fall in blood cholesterol of 0.14 mmol L−1 (95% confidence interval (CI)=0.01–0.26 mmol L−1), while those decreasing by two categories decreased their blood cholesterol by 0.56 mmol L−1 (95% CI=0.30–0.86 mmol L−1). Subjects increasing their Unsaturated Score category had a fall in blood cholesterol of 0.17 mmol L−1 (95% CI=0.02–0.32 mmol L−1).

Conclusion. Simple dietary scores can identify those with high fat intakes, and monitor changes related to changes in blood cholesterol levels.
Neuroleptic malignant syndrome associated with severe thrombocytopenia
Authors: RAY J. G.
Published: November 2003

The case of a 32‐year‐old woman with neuroleptic malignant syndrome and severe haemorrhagic thrombocytopenia is presented. Detailed investigations were negative, and the thrombocytopenia resolved along with her fever, obtundation, autonomic instability and oculogyric crisis. No prior similar cases have been described in the literature. A discussion of neuroleptic malignant syndrome and neuroleptic‐related thrombocytopenia follows, in addition to the possible mechanisms of the thrombocytopenia in this case.
Decreased pulmonary perfusion in hypersensitivity pneumonitis caused by Shiitake mushroom spores
Authors: MURAKAMI M. , KAWABE K. , HOJO S. , DOBASHI K. , IRIUCHIJIMA T. , HOSOI Y. , NAKAZAWA T. , MORI M.
Published: November 2003

Hypersensitivity pneumonitis is an occupational hazard of mushroom workers. We describe a patient with severe hypersensitivity pneumonitis caused by spores of the Shiitake mushroom (Lentinus edodes) who showed a marked decrease in pulmonary perfusion, as demonstrated by pulmonary scintigraphy. This patient was treated successfully with prednisolone. These results suggest that pulmonary vasculitis may be associated with patients with hypersensitivity pneumonitis, and that steroid therapy may be clinically useful in treatment.
Alteration of arterial distensibility in systemic sclerosis
Authors: CONSTANS J. , GOSSE P. , PELLEGRIN J.‐L. , ANSOBORLO P. , LENG B. , CLÉMENTY J. , CONRI C
Published: November 2003

Objectives. To evaluate the distensibility of large arteries in patients with systemic sclerosis (SSc).

Design. Prospective case‐control study including unselected patients with SSc.

Setting. One cardiology and two internal medicine units in a teaching hospital.

Subjects. Eighteen patients with SSc and controls matched for age, sex, height, weight and 24‐h ambulatory blood pressure (BP).

Intervention. The timing of Korotkoff's sounds (QKD interval), a newly described noninvasive ambulatory method was used to measure arterial distensibility during 24 h.

Main outcome measures. Two endpoints were used: QKD 100–60 (normalized for a heart rate of 100 beats min‐1 and a systolic BP of 100 mmHg) and the slope of QKD against pulse pressure.

Results. The patients with SSc had a lower slope of QKD against pulse pressure than the controls (median 0.55, range 0–1.21, versus 0.92, range 0.5–1.34, respectively; P=0.003), and a lower QKD 100–60 (medians/ranges respectively 191 [162–216] and 203 [169–231]; P=0.01).

Conclusions. These results indicate that arterial distensibility of large arteries is decreased in SSc.
Intra‐abdominal pressure, sagittal abdominal diameter and obesity comorbidity
Authors: SUGERMAN H. , WINDSOR A. , BESSOS M. , WOLFE L.
Published: November 2003

Objectives. To determine relationship of intraabdominal pressure to central obesity and the comorbidity of obesity.

Design. Non‐randomized, prospective.

Setting. University hospital, operating room.

Subjects. Eighty‐four anaesthetized consecutive patients prior to gastric bypass for morbid obesity and five non‐obese patients before colectomy for ulcerative colitis.

Main outcome measures. Weight, body mass index (BMI), co‐morbid history, sagittal abdominal diameter, waist:hip (W∶H) ratio and urinary bladder pressure, as an estimate of intra‐abdominal pressure.

Results. Urinary bladder pressure was greater in the obese than the non‐obese (18±0.7 vs. 7±1.6 cm H2O, P < 0.001), correlated with sagittal abdominal diameter (r = +0.67, P < 0.001) and was greater (P < 0.05) in patients with, than those without, morbidity probably (hypoventilation, gastroesophageal reflux, venous stasis, stress incontinence, incisional hernia) or possibly (hypertension, diabetes) due to increased abdominal pressure. W∶H ratio correlated with urinary bladder pressure in men (r = +0.6, P < 0.05) but not women (r = −0.3).

Conclusions. Increased sagittal abdominal diameter was associated with increased intraabdominal pressure which contributed to obesity‐related comorbidity. W∶H ratio was not a reliable indicator of intraabdominal pressure for women who often have both peripheral and central obesity. Further studies are needed to evaluate the relationship between intraabdominal pressure and Type II diabetes and hypertension.