bluuebunny/crossref_metadata_2025 huggingface dataset:
Role of routine transthoracic echocardiography in evaluation and management of stroke
Authors: Beattie  , Cohen  , Manning  , Douglas
Published: March 2003

. Beattie JR, Cohen DJ, Manning WJ, Douglas PS (Harvard Medical School, Harvard‐Thorndike Laboratory, and Department of Health Policy and Management, Harvard School of Public Health, Boston, MA, USA). Role of routine transthoracic echocardiography in evaluation and management of stroke. J Intern Med 1998; 243: 281–91.

Objective

To determine the value of routine transthoracic echocardiography in patients with cerebral ischemia without known cardiac disease.

Design

The literature from 1990 to 1995 was searched and relevant bibliographies from these papers reviewed. Articles reporting the prevalence and/or risk of stroke for myxoma, vegetation, mitral stenosis, left atrial thrombus, left ventricular thrombus or cardiomyopathy, patent foramen ovale, and atrial septal aneurysm were used. Prevalences and recurrent stroke risk were examined for adult patients less than and greater than 45 years.

Results

Both the prevalence of transthoracic echocardiographic findings and recurrent risk of stroke differ by age. The finding of a patent foramen ovale can be expected in nearly half of younger patients with stroke, whilst transthoracic echo can be expected to yield no relevant lesion in three quarters of patients > 45 years. Warfarin anticoagulation appears beneficial in patients with mitral stenosis, left atrial thrombus, left ventricular thrombus, and left ventricular dysfunction, but is of unproven benefit for patent foramen ovale, atrial septal aneurysm, or in the absence of a risk‐associated abnormality.

Conclusion

For most transthoracic echo findings in stroke, optimal management strategies have not been well defined. Future research is needed to evaluate the appropriate therapeutic approaches.
The relations of microalbuminuria to ambulatory blood pressure and myocardial wall thickness in a population
Authors: Nilsson T. , Svensson A. , Lapidus L. , Lindstedt G. , Nyström E. , Eggertsen R.
Published: March 2003

. Nilsson T, Svensson A, Lapidus L, Lindstedt G, Nyström E, Eggertsen R (Mölnlycke Primary Health Care and Research Centre; Göteborg University, Göteborg, Sweden). The relations of microalbuminuria to ambulatory blood pressure and myocardial wall thickness in a population. J Intern Med 1998; 244: 55–9.

Objectives

To examine the relationship between microalbuminuria (20–200 μg min−1) and 24 h ambulatory blood pressure and heart wall thickness, in a representative population sample of men and women aged 56–65 years.

Design

Every second individual aged 56–65 years (n= 488) in the district, was invited for a health examination, which included determination of urinary albumin and creatinine (overnight sample). The highest and lowest decentile of urinary albumin/creatinine ratio were compared.

Setting

The district of the Primary Health Care and Research Centre of Mölnlycke, Sweden.

Subjects

After excluding 2 individuals with a urinary albumin excretion exceeding 200 μg min−1, 26 subjects (group 1) could be compared with 27 subjects in the lowest decentile (group 2).

Main outcome measures

Comparison between the determinations of the ambulatory blood pressure and echocardiographic variables in the two groups.

Results

Group 1 had significantly higher 24 104 ambulatory blood pressure, and heart septum and posterior wall thickness as well as significantly higher fasting blood glucose and serum triglyceride concentrations. The differences in blood pressure (P < 0.05) but not heart wall thickness remained significant (P < 0.05) after excluding subjects with hypertension, angina pectoris, treated diabetes mellitus, and/or history of heart or cerebrovascular disease. When excluding individuals with both treated and untreated diabetes mellitus, fasting blood glucose concentration was higher in group 1. The waist‐hip ratio, weight and body mass index did not differ between the groups.

Conclusions

The findings indicate that microalbuminuria is related to signs of cardiovascular and metabolic influence and therefore could be a valuable tool for grading the risk of later cardiovascular morbidity.
Differential effects of antihypertensive drugs on neurohormonal activation: insights from a population‐based sample
Authors: Schunkert  , Hense  , Bröckel  , Luchner  , Muscholl  , Holmer  , Danser  , Mayer  , Riegger
Published: March 2003

Schunkert H, Hense H‐W, Bröckel U, Luchner A, Muscholl M, Holmer SR, Danser AHJ, Mayer B, Riegger GAJ (University of Regensburg, Regensburg; University of Münster, Münster, Institut für Epidemiologie, Munich‐Neuherberg, Germany; Erasmus University, Rotterdam, The Netherlands). Differential effects of antihypertensive drugs on neurohormonal activation: insights from a population‐based sample.J Intern Med1998;244: 109–19.

Objectives

The clinical course of hypertension or heart failure may be modified by the extent of concurrent neurohormonal activation. Factors that regulate neurohormones in patients with these conditions are complex. In the present study, we examined the relative contribution of antihypertensive therapy to the variability of neurohormonal levels in a well defined population based sample.

Design and setting

Cross‐sectional study of a mixed urban and rural population.

Subjects

Middle‐aged individuals (n= 646) were analysed in order to elucidate determinants of neurohormone levels by uni‐ and multivariate comparisons. The assessment included anthropometric, echocardiographic and, if appropriate, genotype information.

Results

The intake of antihypertensive drugs was related to significant alterations of neurohormone levels that, in part, exceeded the contribution of all other variables studied. Multivariate analyses revealed that renin levels were independently related to the intake of beta blockers (n= 80; –8.4 mU L−1;P= 0.001), angiotensin‐converting enzyme (ACE)‐inhibitors (n= 39; +15.9 mU L−1;P= 0.0001), diuretics (n= 62; +14.3 mU L−1;P= 0.0001), and calcium channel blockers (n= 45; +5.9 mU L−1;P= 0.05). Aldosterone levels were related to ACE‐inhibition (–156.5 pmol L−1;P= 0.04) and diuretic treatment (+422.4 pmol L−1;P= 0.0001) in an opposite fashion whereas beta blockers and calcium channel blockers had no significant independent effects. The levels of the atrial natriuretic peptide were significantly related to the use of beta blockers (+3.9 pmol L−1;P= 0.002) and calcium channel blockers (+3.1 pmol L−1;P= 0.05). Finally, serum angiotensinogen levels and ACE activity were not found to be significantly affected by antihypertensive medication but were rather related to gender or genotype.

Conclusions

The data emphasize that antihypertensive treatment with different classes of drugs may modulate serum levels of neurohormones substantially resulting in distinct patterns of activation. These drug‐related effects may require consideration when neurohormonal activation is of functional relevance or when neurohormones serve as prognostic predictors in patients with cardiovascular disorders.
Patients hospitalized because of small vessel vasculitides with renal involvement in the period 1975–95: organ involvement, anti‐neutrophil cytoplasmic antibodies patterns, seasonal attack rates and fluctuation of annual frequencies
Authors: Tidman  , Olander  , Svalander  , Danielsson
Published: March 2003

Tidman M, Olander R, Svalander C, Danielsson D (Örebro Medical Center Hospital, Örebro and Sahlgrenska Hospital, Gothenburg, Sweden). Patients hospitalized because of small vessel vasculitides with renal involvement in the period 1975–95: organ involvement, anti‐neutrophil cytoplasmic antibodies patterns, seasonal attack rates and fluctuation of annual frequencies. J Intern Med 1998; 244: 133–41.

Objectives

: To study organ involvement, anti‐neutrophil cytoplasmic antibodies (ANCA) patterns, trends in yearly frequencies and seasonal variations of symptom onset in patients hospitalized because of small vessel vasculitides during a 21 year period (1975–95).

Design

A retrospective investigation was conducted of 138 patients hospitalized with a diagnosis of small vessel vasculitides, as defined by the Chapel Hill Consensus Conference, within the County of Örebro, a mixed urban and rural area of central Sweden.

Setting

Örebro Medical Center Hospital, Örebro, Sweden and two district hospitals within the County of Örebro, Sweden.

Results

During the studied period there were 19 patients with a diagnosis of Wegener's granulomatosis (WG), 70 patients with microscopic polyangiitis (MPA), 36 patients with renal limited vasculitis (RLV), two with Churge‐Strauss vasculitis (C‐S), seven with Henoch‐Schönleins purpura (HSP) and four with essential cryoglobulinemic vasculitis (ECV). Renal involvement was present in 123 patients (89.1%). A positive c‐ and/or pANCA was found in nearly 90% of the 111 patients where sera were available. Calculations of frequency data, restricted to the primary catchment area for patients with ANCA associated vasculitis and renal involvement (WG, MPA, RLV) during a 21‐year period (1975–95) gave a mean annual frequency of 1.6 per 100 000 adults (95% CI: 1.2–3.1); for this group of patients with the inclusion of those with C‐S, HSP and ECV during the last 10 year period (1986–95) gave a mean annual frequency of 2.5 per 100 000 adults (95% CI: 1.7–3.4), for male adults 3 per 100 000 (95% CI: 1.6–4.4), and female adults 1.9 (95% CI: 0.9–2.8). A frequency peak of 6.3 per 100 000 was seen for men aged 55–64. A periodic fluctuation of the frequencies with peaks every 3–4 years was noted for patients with ANCA related vasculitis (WG, MPA, RLV) during the 21‐year period 1975–95. Onset of symptoms was predominantly noticed during the winter months (December– February) for patients with a positive cANCA.

Conclusion

The observed frequencies in our study of patients with small vessel vasculitides were higher than those previously documented. We also showed a periodic fluctuation of the annual frequencies and a seasonal variation of symptom onset.
Idiopathic oedema with increased cytokine production: a pathogenetic link?
Authors: Hoffmann  , Fontana  , Steurer  , Bollinger
Published: March 2003

Hoffmann U, Fontana A, Steurer J, Bollinger a (University Hospital, Zurich, Switzerland). Idiopathic oedema with increased cytokine production: a pathogenetic link? (Case Report). J Intern Med 1998; 244: 179–82.

We describe four patients with idiopathic oedema and elevated cytokines. All patients shared increased serum concentrations of soluble interleukin‐2 receptors (sIL‐2R). In three patients tumour necrosis factor alpha (TNF‐alpha), gamma interferon (IFN‐gamma) and interleukin‐2 (IL‐2) were transiently elevated. There was no evidence for an underlying disease. Based on experimental and clinical data it is hypothesized that oedema formation in our patients is the consequence of cytokine induced alteration of endothelial cells.
Metabolic abnormalities related to cardiovascular risk in primary hyperparathyroidism: effects of surgical treatment
Authors: Valdemarsson  , Lindblom  , Bergenfelz
Published: March 2003

Valdemarsson S, Lindblom P, Bergenfelz A (Departments of Internal medicine and surgery, Lund University Hospital, Lund Sweden). Metabolic abnormalities related to cardiovascular risk in primary hyperparathyroidism: effects of surgical treatment. J Intern Med 1998; 244: 241–49.

Objectives

Untreated primary hyperarathyroidism (pHPT) is accompanied by an excessive morbidity in circulatory disorders, associated with blood pressure and diabetes. The aim of the present study was to further penetrate the impact of pHPT on glucose, urate, lipid and lipoprotein concentrations, known to be interrelated metabolic cardiovascular risk factors.

Design

Longitudinal study of patients with pHPT before and 1 year after surgical treatment.

Setting

Departments of Internal Medicine and Surgery, Lund University Hospital.

Subjects

One hundred and seventeen consecutive patients with pHPT referred to surgical treatment. At presentation, 11 patients had previously diagnosed diabetes mellitus.

Intervention

All patients were successfully operated for pHPT.

Main outcome measures

Fasting blood glucose and serum concentrations of cholesterol, triglyceride and urate were determined before and 1 year after surgery. The concentration of LDL‐ and HDL‐cholesterol was separately analyzed in 21 cases. These data as well as the systolic and diastolic blood pressure were related to intact PTH and ionized calcium at presentation. Glomerular filtation was separately measured pre‐operatively and related to the urate values.

Results

While the mean value for glucose remained unchanged among 11 patients with previously diagnosed diabetes at presentation, a significant decrease of glucose from 5.03 ± 0.13 to 4.71 ± 0.08 mmol/L (P < 0.05) was found among patients without known diabetes. Out of these patients, eight had diabetic glucose values at presentation, decreasing from 8.35 ± 0.54 to 5.10 ± 0.35 mmol/L (P < 0.05), and 12 had glucose values indicating impaired glucose tolerance, decreasing from 5.94 ± 0.06 to 5.10 ± 0.38 mmol/L (P < 0.05) after surgery. Total cholesterol and trigylceride concentrations were not changed. However, male patients had significantly lower triglyceride levels at follow‐up, 1.16 ± 0.09 mmol/L compared to 1.57 ± 0.14 mmol/L before surgery (P < 0.05). Significantly lower triglyceride values were also found among patients with glucose values indicating impaired glucose tolerance at presentation. The LDL/HDL cholesterol ratio remained normal. The serum level of urate decreased in both male and female patients after surgery, and was positively correlated to the PTH and ionized calcium values and inversely correlated to renal function before treatment. There was no significant correlation between calcium or PTH and the other metabolic variables studied.
Parasympathetic function during deep breathing in the general population: relation to coronary risk factors and normal range
Authors: May O. , Arildsen H. , Møller M.
Published: March 2003

Abstract. May O, Arildsen H, Møller M (Odense University Hospital, Odense and Horsens Hospital, Horsens, Denmark). Parasympathetic function during deep breathing in the general population: relation to coronary risk factors and normal range. J Intern Med 1999; 245: 287–94.

Objectives. To examine the association between the parasympathetic function assessed by deep breathing‐induced heart rate variability (HRV) and coronary risk factors and to establish a reference range for deep breathing‐induced HRV.

Design. Cross‐sectional population‐based study.

Setting. The municipality of Horsens, Denmark.

Subjects. One hundred and ninety‐four individuals aged 40–67 years without diabetes, atrial fibrillation or a pacemaker randomly selected from the population.

Main outcome measures. During deep breathing at 6 respiratory cycles min−1, an ECG was taken and in three consecutive cycles the longest R–R interval during expiration (E) and the shortest during inspiration (I) were selected. The mean ratio (E/Iratio) and the mean difference in instantaneous heart rate (E/Idiff) were taken as expressions of the parasympathetic function.

Results. In multivariate analysis, E/Idiff was reduced with increasing age (P < 0.0005) and left ventricular mass (P = 0.008), with ECG sign of probable previous myocardial infarction (P = 0.020) and the use of cardiac medication (P = 0.018) and positively correlated to heart rate (P = 0.030). The E/Iratio was diminished with increasing age (P = 0.001), left ventricular mass (P = 0.003), waist–hip ratio (P = 0.044), with ECG sign of probable previous myocardial infarction (P = 0.012) and use of cardiac medication (P = 0.020), but no association was found with heart rate (P = 0.92). In both E/Idiff and E/Iratio, no correlation was found to lipids, blood pressure or alcohol consumption. In the group not on cardiac medication, without left ventricular hypertrophy or ECG sign of probable myocardial infarction, E/Idiff and E/Iratio were still independently correlated to age and left ventricular mass. In this group, equations defining the age‐corrected 5th percentile were calculated.

Conclusions. The parasympathetic function as assessed by deep breathing‐induced HRV in the general population is reduced in older people, and in individuals on cardiac medication, with left ventricular hypertrophy or ECG signs of myocardial infarction. Even in healthy persons the parasympathetic function is inversely associated with age and left ventricular mass. Values of E/Idiff above (4.39–0.033 × age)2 and readings of E/Iratio above 1 + exp (− 1.12–0.0198 × age) can be regarded as normal.
A patient with neurofibromatosis type 1 and watery diarrhoea syndrome due to a VIP‐producing adrenal phaeochromocytoma
Authors: Quarles Van Ufford‐Mannesse P. , Castro Cabezas M. , Vroom T. M. , Van Gils A. P. G. , Lips C. J. M. , Niermeijer P.
Published: March 2003

Quarles van Ufford‐Mannesse P, Castro Cabezas M, Vroom TM, van Gils APG, Lips CJM, Niermeijer P (University Hospital Utrecht, Utrecht, and Gooi‐Noord Hospital Blaricum, the Netherlands). A patient with neurofibromatosis type 1 and watery diarrhoea syndrome due to a VIP‐producing adrenal phaeochromocytoma (Case Report). J Intern Med 1999; 246: 231–234.

A 43‐year‐old patient with neurofibromatosis type 1 suffered from watery diarrhoea syndrome induced by excessive production of vasoactive intestinal polypeptide (VIP) in an adrenal phaeochromocytoma. This case report emphasizes that patients with neurofibromatosis are prone to develop more than one disease induced by tumours originating from the neural crest. Since excessive VIP production in a phaeochromocytoma may mask the symptoms of catecholamine overproduction, and in view of the therapeutic consequences, neurofibromatosis patients with hyperVIP‐aemia must be checked for the presence of a phaeochromocytoma.
Effect of lifibrol on the metabolism of low density lipoproteins and cholesterol
Authors: Vega G. L. , Von Bergmann K. , Grundy S. M. , Blumenschein S. , Carter N. B. , Laeis P. , Lindenthal B. , Von Bergmann J. , Simatupang A. , Lutjohann D. , Adams‐Huet B.
Published: March 2003

Lifibrol is a powerful cholesterol‐lowering drug of unknown mechanism of action. This investigation was carried out to determine whether the major action of lifibrol is to enhance clearance of low density lipoproteins (LDL) through the LDL‐receptor pathway, and if so, whether the drug exerts its action by altering the excretion of bile acids (acidic steroids), the absorption of cholesterol, or the synthesis of cholesterol. In a first study, in two patients with complete absence of LDL receptors, lifibrol therapy had essentially no effect on plasma LDL concentrations; in two others who had a marked reduction in LDL‐receptor activity, response to the drug was attenuated. These findings suggest that lifibrol requires an intact LDL‐receptor pathway to exert its action. In a second study, in patients with primary moderate hypercholesterolemia, isotope kinetic studies showed that lifibrol enhanced the fractional catabolic rate of LDL‐apolipoprotein B (apo B), but had no effect on transport rates of LDL; these observations likewise support the probability that lifibrol acts mainly to increase the activity of the LDL‐receptor pathway. However, in a third study in hypercholesterolemic patients, lifibrol therapy failed to increase acidic steroid excretion, inhibit cholesterol absorption, or reduce net cholesterol balance. Furthermore, lifibrol treatment did not significantly reduce urinary excretion of mevalonic acid. In contrast, in a parallel study, simvastatin therapy, which is known to inhibit cholesterol synthesis, gave the expected decrease in net cholesterol balance and reduction in urinary excretion of mevalonic acid. Thus, lifibrol, like statins, appears to increase the activity of LDL receptors; but in contrast to findings with statins, it was not possible to detect a significant decreased synthesis of cholesterol, either from balance studies or from urinary excretion of mevalonic acid. This finding raises the possibility that lifibrol activates the LDL‐receptor pathway through a different mechanisms which remains to be determined.
Plasma lipoprotein particle concentrations in postmenopausal women with unstable coronary artery disease. Analysis of diagnostic accuracy using receiver operating characteristics
Authors: Nielsen N. E. , Olsson A. G. , Swahn E.
Published: March 2003

Abstract. Nielsen NE, Olsson AG, Swahn E (University Hospital, Linköping, Sweden). Plasma lipoprotein particle concentrations in postmenopausal women with unstable coronary artery disease. Analysis of diagnostic accuracy using receiver operating characteristics. J Intern Med 2000; 247: 43–52.

Background. The contribution of plasma lipids to cardiovascular risk is usually evaluated by measuring plasma concentrations of total cholesterol, triglycerides and HDL cholesterol, and calculating LDL cholesterol concentration. We investigated plasma concentrations of apolipoproteins and lipoprotein particles in women with unstable coronary artery disease (CAD) to evaluate whether these, better than the routine lipid status, could differentiate women with and without coronary atherosclerosis.

Methods. Blood samples for lipid analyses were collected from 119 angiographically examined postmenopausal 49–79‐year‐old women with unstable CAD, and from 101 age‐matched controls. Mean plasma concentrations were compared and the discriminatory ability of the different variables were tested using receiver operating characteristics (ROC).

Results. At coronary angiography 19% had normal vessels and 81% had coronary atherosclerosis. A disturbed triglyceride metabolism was the most pronounced lipid abnormality in women with unstable CAD and coronary atherosclerosis. ROC showed that none of the evaluated variables had a particularly high discriminatory power regarding unstable CAD or coronary atherosclerosis. The ratio cholesterol/HDL cholesterol was best with an ROC area of 0.79. Furthermore, the newer lipid variables, i.e. lipoprotein particles and apolipoproteins, were no better than the traditional variables.

Conclusion. Lipoprotein changes reflecting a disturbed triglyceride metabolism are most pronounced in women with unstable CAD and coronary atherosclerosis. Lipoprotein particles and apolipoproteins alone were no better than lipids and lipoproteins in separating women with from those without coronary atherosclerosis. Our study does not support the measurement of apolipoproteins and lipoprotein particles on the basis of diagnostic accuracy alone.
Secular changes in cardiovascular risk factors over 30 years in Swedish men aged 50: the study of men born in 1913, 1923, 1933 and 1943
Authors: Rosengren A. , Eriksson H. , Larsson B. , Svärdsudd K. , Tibblin G. , Welin L. , Wilhelmsen L.
Published: March 2003

Abstract. Rosengren A, Eriksson H, Larsson B, Svärdsudd K, Tibblin G, Welin L, Wilhelmsen L (Sahlgrenska University Hospital/östra, Göteborg and Uppsala University, Uppsala, Sweden). Secular changes in cardiovascular risk factors over 30 years in Swedish men aged 50: The Study of Men Born in 1913, 1923, 1933 and 1943. J Intern Med 2000; 247: 111–118.

Objectives. To study secular trends in cardiovascular risk factors in men aged 50 over a period of 30 years.

Design. Cross‐sectional studies of successive cohorts of men from 1963 to 1993.

Setting. City of Göteborg, Sweden.

Subjects. Four random population samples of men born in 1913, 1923, 1933 and 1943, aged 50 when they were examined in 1963, 1973, 1983, and 1993 (n = 855, 226, 776, and 798, respectively).

Main outcome measures. Anthropometric measurements, blood pressure, serum cholesterol and triglycerides and smoking habits over three decades.

Results. Over 30 years, men increased in weight from a mean (SD) of 75.9 (11.0) kg to 82.8 (12.1) kg and gained 3.4 cm in height, with a net increase in body mass index from 24.8 (3.2) to 26.0 (3.4) kg m–2 (P < 0.0001), and a concomitant increase in waist circumference. The proportion of men who were overweight but not obese (BMI = 25–30 kg m–2) increased from 38 to 47%, whereas the prevalence of frank obesity (more than 30 kg m–2) increased from 6% in 1963 to 11% in 1993. Despite the increase in weight, mean systolic blood pressure fell by almost 10 mmHg (P < 0.0001). Mean serum cholesterol concentration decreased from 6.42 (1.12) to 5.88 (1.04) (P < 0.0001). Serum triglycerides increased from 1.26 (0.77) to 1.69 (1.04) mmol L–1 (P = 0.001). The proportion of men who smoked decreased from 56% in 1963 to 30% in 1993 (P < 0.0001). This was due more to an increase in smoking cessation rates than to an increase in the proportion of men who had never smoked. In particular, smokers and former smokers are now more obese than the corresponding categories 30 years ago and smokers are no longer leaner than men who have never smoked.

Conclusions. Over a period of 30 years, serum cholesterol as well as systolic blood pressure and the prevalence of smoking decreased. This favourable decline in coronary risk factors was offset by an appreciable increase in body mass index and waist circumference.
Calcaneal ultrasound measurements are determined by age and physical activity. Studies in two Swedish random population samples
Authors: Landin‐Wilhelmsen K. , Johansson S. , Rosengren A. , Dotevall A. , Lappas G. , Bengtsson B.‐Å. , Wilhelmsen L.
Published: March 2003

Abstract. Landin‐Wilhelmsen K, Johansson S, Rosengren A, Dotevall A, Lappas G, Bengtsson B‐A, Wilhelmsen L (Sahlgrenska University Hospital, Göteborg University, Göteborg, Sweden). Calcaneal ultrasound measurements are determined by age and physical activity. Studies in two Swedish random population samples. J Intern Med 2000; 247: 269–278.

Aim. To present reference values and correlations with body composition, blood variables and lifestyle factors.

Subjects. Two random population samples from Göteborg, Sweden, one comprising 184 men and 455 women aged 25–64 years (MONICA) and the other 860 women aged 55–82 years (BEDA) were studied.

Methods. Calcaneal ultrasound measurement (LUNAR Achilles) and bioimpedance were measured. Smoking habits, coffee consumption, physical activity, psychological stress, education and marital status, as well as blood lipids, blood pressure, and fractures were studied.

Results. Broadband ultrasound attenuation and stiffness were higher in men than in women (P < 0.001), but speed of sound did not differ between sexes. Speed of sound, broadband ultrasound attenuation and stiffness decreased with age (P < 0.001).

In both sexes speed of sound, broadband ultrasound attenuation and stiffness correlated positively to body size variables, and negatively with smoking in women after adjustment for age. Speed of sound, broadband ultrasound attenuation and stiffness were positively related to physical activity in both sexes, and these relationships were the only ones that remained in multivariate analyses in addition to age (negative).

Osteoporotic fractures increased with age. Speed of sound, broadband ultrasound attenuation and stiffness were lower amongst women with osteoporotic fractures.

Conclusion. Speed of sound, broadband ultrasound attenuation and stiffness decreased with age and increased with physical activity, but body weight and height were not correlated in multivariate analyses. Osteoporotic fractures increased with age and were associated with lower calcaneal ultrasound values.
Genetic background of Lewis negative blood group phenotype and its association with atherosclerotic disease in the NHLBI Family Heart Study
Authors: Salomaa V. , Pankow J. , Heiss G. , Cakir B. , Eckfeldt J. H. , Ellison R. C. , Myers R. H. , Hiller K. M. , Brantley K. R. , Morris T. L. , Weston B. W.
Published: March 2003

Abstract. Salomaa V, Pankow J, Heiss G, Cakir B, Eckfeldt JH, Ellison RC, Myers RH, Hiller KM, Brantley KR, Morris TL, Weston BW (National Public Health Institute, Helsinki, Finland, University of North Carolina, University of Minnesota, Boston University School of Medicine, USA). Genetic background of Lewis negative blood group phenotype and its association with atherosclerotic disease in the NHLBI Family Heart Study, J Intern Med 2000; 247: 689–698.

Objectives. To examine the prevalence of four mutations, T59G, T1067A, T202C and C314T, of the human α(1,3/1,4) fucosyltransferase 3 (FUT 3) gene amongst persons with Lewis negative and those with Lewis positive blood group phenotype. An additional objective was to explore the hypothesis that these mutations are associated with coronary heart disease and inflammatory reaction.

Design. A population‐based cross‐sectional study.

Setting. Analysis of samples and data from the National Heart Lung and Blood Institute Family Heart Study.

Subjects. All Lewis (a–b–) participants (n = 136) and a sample of Lewis positive participants (n = 136) of the Family Heart Study; all were of Caucasian ethnicity.

Main outcome measures. The prevalence of examined mutations by Lewis phenotype.

Results. The examined mutations were common and strongly associated with the Lewis (a–b–) phenotype. Accordingly, 90–95% of Lewis (a–b–) individuals amongst Caucasians can be identified by screening for these four mutations. Exploratory analyses suggested that with the exception of T59G, all examined mutations were positively associated with prevalent coronary heart disease, although not statistically significantly, perhaps due to the small number of prevalent coronary heart disease cases. C‐reactive protein tended to be higher amongst persons with a TC or CC genotype at position 202 (3.07 ± 0.41 vs. 2.08 ± 0.32 mg L–1, P = 0.06).

Conclusions. Four specific mutations of fucosyltransferase 3 gene are responsible for the vast majority of Lewis (a–b–) phenotypes in Caucasians. These mutations are common in the population at large and may be associated with increased risk of coronary heart disease. Further studies using larger samples are warranted.
Quality of life of chronic stable angina patients 4 years after coronary angioplasty or coronary artery bypass surgery
Authors: Brorsson B. , Bernstein S. J. , Brook R. H. , Werkö L.
Published: March 2003

Abstract. Brorsson B, Bernstein SJ, Brook RH, Werkö L (The Swedish Council on Technology Assessment in Health Care, Stockholm, Sweden; Norrland University Hospital, Umeå, Sweden; Veterans Affairs Health Services Research and Development Field Program, Ann Arbor, MI, USA; University of Michigan, Ann Arbor, MI, USA; Instituto de Salud Carlos III, Madrid, Spain; University of California, Los Angeles; and RAND Corporation, Santa Monica, CA, USA). Quality of life of chronic stable angina patients 4 years after coronary angioplasty or coronary artery bypass surgery. J Intern Med 2001; 249: 47–57.

Objective. To evaluate the quality of life experienced by chronic stable angina patients with one‐ or two‐vessel coronary artery disease treated with percutaneous transluminal coronary angioplasty (PTCA) or coronary artery bypass graft (CABG).

Design. Prospective survey and review of medical records.

Patients. Consecutive series of 601 Swedish chronic stable angina patients with one‐ or two‐vessel disease who underwent CABG (n = 252) or PTCA (n = 349) between May 1994 and January 1995.

Main outcome measures. We assessed five components of the Swedish Quality of Life Survey, anginal frequency, sublingual nitroglycerin use, and survival at 6, 21 and 48 months following coronary revascularization.

Results. Anginal frequency and sublingual nitroglycerin use decreased for all patients by 6 months, but more amongst surgery patients than amongst angioplasty patients (P < 0.05). At 48 months, more bypass patients reported that they had not used sublingual nitroglycerin during the preceding 4 weeks (73.1 vs. 63.4%, P < 0.05). At 6 months, bypass patients had greater levels of improvement in physical functioning (15.3 vs. 10.5, P < 0.05) and general health perception (16.5 vs. 10.2, P < 0.05) than angioplasty patients. Bypass patients also had better relief from pain (19.4 vs. 14.6, P < 0.05), quality of sleep (17.6 vs. 4.6, P < 0.05) and general health perception (17.3 vs. 12.1, P < 0.05) at 21 months. By 48 months follow‐up, there was no longer any difference in these measures between groups.

Conclusions. Both bypass surgery and angioplasty lead to improved quality of life for patients with chronic stable angina and one‐ or two‐vessel coronary artery disease. Bypass surgery is associated with better quality of life at 6 months, but by 48 months quality of life is similar for patients initially treated by either procedure.
Insulin resistance adds to endothelial dysfunction in hypertensive patients and in normotensive offspring of subjects with essential hypertension
Authors: Žižek B. , Poredoš P.
Published: March 2003

Abstract. Žižek B, Poredoš P (University Medical Centre, Ljubljana, Slovenia). Insulin resistance adds to endothelial dysfunction in hypertensive patients and in normotensive offspring of subjects with essential hypertension. J Intern Med 2001; 249: 189–197.

Objectives. To evaluate whether endothelium‐dependent (nitric oxide‐mediated) dilation of the brachial artery (BA) is impaired in patients being treated for essential hypertension (EH), and whether this abnormality can be detected in normotensive offspring of subjects with EH (familial trait, FT); and to investigate the interrelationship between flow‐mediated vasodilation (FMD) and hyperinsulinaemia/insulin resistance.

Design. Cross‐sectional study.

Setting. Angiology department at a teaching hospital.

Subjects. The study encompassed 172 subjects, of whom 46 were treated hypertonics aged 40–55 (49) years, and 44 age‐matched, normotensive volunteers as controls. We also investigated 41 normotonics with FT aged 20–30 (25) years and 41 age‐and sex‐matched controls without FT.

Main outcome measures. Using high‐resolution ultrasound, BA diameters at rest, during reactive hyperaemia (endothelium‐dependent dilation) and after sublingual glyceryl trinitrate (GTN) application (endothelium‐independent dilation) were measured.

Results. In hypertonics FMD was significantly lower than in controls [2.4 (2.9) vs. 7.4 (2.5)%; P < 0.00005], as was GTN‐induced dilation [12.1 (4.3) vs. 16.1 (4.6)%; P=0.0007]. In subjects with FT, FMD was also decreased compared with the control group [5.8 (4.1) vs. 10.0 (3.0)%; P < 0.00005]. The response to GTN was comparable in both groups of young subjects. FMD was negatively related to insulin concentration in all subjects studied (P < 0.00005).

Conclusions. In treated patients with EH, flow‐mediated dilation of the BA as well as endothelium‐independent dilation are decreased. In individuals with FT the endothelial function of the peripheral arteries is also altered in the absence of elevated blood pressure. Endothelial dysfunction is related to hyperinsulinaemia/insulin resistance, which could be one of the pathogenetic determinants of EH and its complications.
Gene therapy for genetic haematological disorders and immunodeficiencies
Authors: Kohn D. B.
Published: March 2003

Abstract. Kohn DB (Children’s Hospital and Keck School of Medicine, Los Angeles, CA, USA). Gene therapy for genetic haematological disorders and immunodeficiencies. J Intern Med 2001; 249: 379–390.

Gene transfer and autologous transplantation of haematopoietic stem cells (HSCs) from patients with genetic haematological disorders and immunodeficiencies could provide the same benefits as allogeneic HSC transplantation, without the attendant immunological complications. Inefficient gene delivery to human HSCs has imposed the major limitation to successful application of gene therapy. A recently reported clinical trial of gene transfer into HSCs of infants with X‐linked severe combined immunodeficiency (SCID) has achieved immune restoration because of the selective outgrowth of the gene‐corrected lymphocytes. Newer methods for manipulating HSCs may lead to efficacy for other disorders. The problems and progress in this area are reviewed herein.
Increased levels of tPA antigen and tPA/PAI‐1 complex in myotonic dystrophy
Authors: Johansson Å. , Boman K. , Cederquist K. , Forsberg H. , Olsson T.
Published: March 2003

Abstract. Johansson Å, Boman K, Cederquist K, Forsberg H, Olsson T (Umeå University Hospital, Umeå, Skellefteå County Hospital, Skellefteå, and Boden Hospital, Boden, Sweden). Increased levels of tPA antigen and tPA/PAI‐1 complex in myotonic dystrophy. J Intern Med 2001; 249: 503–510.

Objective. To assess the fibrinolytic system in myotonic dystrophy (DM1), a disease connected to features of the metabolic syndrome, including a prominent insulin resistance, increased body fat mass, and hypertriglyceridaemia. We hypothesized that abnormalities in the fibrinolytic system are linked to metabolic dysfunction in DM1.

Design. Circulating morning levels of tissue plasminogen activator (tPA) and plasminogen activator inhibitor type 1 (PAI‐1) antigens, tPA/PAI‐1 complex, lipids and insulin were determined. Genetic analyses, including calculation of allele size, were performed in all patients. Body fat mass was estimated with bioelectrical impedance analysis.

Setting. Out‐patient clinic in collaboration with Umeå University Hospital.

Subjects. A total of 42 otherwise healthy patients with DM1 (22 men, 20 women; median age 41.5 years) and 50 controls (27 men, 23 women; median age 42.0 years).

Main outcome measures. The tPA and PAI‐1 antigens, tPA/PAI‐1 complex, blood lipids and body fat mass.

Results. The tPA antigen and tPA/PAI‐1 complex levels were significantly increased in DM1 patients (P < 0.001 and P < 0.05, respectively) whilst levels of PAI‐1 did not differ from controls. Triglyceride levels were increased (P < 0.001) whereas HDL cholesterol levels were lower in DM1 patients (P < 0.05). Body fat mass was increased in DM1 patients (P < 0.001).

Conclusions. The fibrinolytic system is disturbed in DM1 patients, with increased levels of tPA and tPA/PAI‐1 complex but paradoxically unaltered levels of PAI‐1, in spite of a severely increased body fat mass. This may imply an abnormal function of adipose tissue in DM1, and calls for further studies of the fibrinolytic system in this disease.
Heart rate variability and n‐3 polyunsaturated fatty acids in patients with diabetes mellitus
Authors: Christensen J. Hagtrup , Skou H. Aarup , Madsen T. , Tørring I. , Schmidt E. Berg
Published: March 2003

Abstract. Hagstrup Christensen J, Aarup Skou H, Madsen T, Tørring I, Berg Schmidt E (Aalborg Hospital, Aalborg; and Hjørring/Brønderslev Hospital, Hjørring, Denmark). Heart rate variability and n‐3 polyunsaturated fatty acids in patients with diabetes mellitus. J Intern Med 2001; 249: 545–552.

Objectives. Dietary n‐3 polyunsaturated fatty acids (PUFA) derived from fish may reduce the incidence of sudden cardiac death (SCD). The aim of the present study was to examine associations between n‐3 PUFA and 24‐h heart rate variability in patients with type 1 and type 2 diabetes mellitus (DM).

Design. Observational study.

Setting. The out‐patient’s diabetic clinic at Hjørring Hospital, Hjørring, Denmark.

Subjects. Forty‐three patients with type 1 DM and 38 patients with type 2 DM.

Main outcome measures. The patients fulfilled a food‐questionnaire regarding fish consumption, whilst the content of n‐3 PUFA in platelets was measured and 24‐h heart rate variability (HRV) was obtained.

Results. The patients fish consumption was strongly related to their content of n‐3 PUFA in platelets. Furthermore, in patients with type 1 DM a close positive association was found between the content of n‐3 PUFA in platelets and 24‐h HRV. This association was not significant in patients with type 2 DM.

Conclusions. The positive association between n‐3 PUFA in platelets and HRV may indicate a beneficial effect of n‐3 PUFA on HRV in patients with type 1 DM. Further studies are warranted to clarify whether supplementation with n‐3 PUFA reduce the risk of SCD amongst patients with DM.
Antidiabetogenic action of glucagon‐like peptide‐1 related to administration relative to meal intake in subjects with type 2 diabetes
Authors: Gutniak M. K. , Svartberg J. , Hellström P. M. , Holst J. J. , Adner N. , Ahrén B.
Published: March 2003

Gutniak MK, Svartberg J, Hellström PM, Holst JJ, Adner N, Ahrén B (Södersjukhuset, Stockholm, Sweden; University Hospital of Tromsö, Tromsö, Norge; Karolinska Hospital, Stockholm, Sweden; PANUM Institute, Copenhagen, Denmark; and Lund University, Lund, Sweden). Antidiabetogenic action of GLP‐1 related to administration relative to meal intake in subjects with type 2 diabetes. J Intern Med 2001; 250: 81–87.

Objective. To establish the antidiabetogenic effect of glucagon‐like peptide‐1 (GLP‐1) when differently administered relative to meal intake in subjects with type 2 diabetes.

Design. The study was a placebo‐controlled comparison with random assignment to treatment sequence. A 3‐h stepwise infusion of GLP‐1 (17 nmol) was started either at the onset of a standard meal (550 kCal) (A) or at 30 min (B) or 60 min (C) after the start of the meal.

Setting. The study was conducted at a university hospital.

Subjects. Eight patients with type 2 diabetes (four women and four men), age 62 ± 3.9 years (range 47–74 years), weight 79.8 ± 5.4 kg (range 62–104 kg), BMI 26.2 ± 1.3 kg m–2 (range 21–31 kg m–2), diabetes duration 10.5 ± 2.0 years (range 3–19 years) and HbA1c levels 6.1 ± 0.3% (range 4.7–7.7%) participated in the study. All patients were treated with oral sulphonylureas.

Results. Glucagon‐like peptide‐1 significantly lowered postprandial glycaemia by a similar degree in all three situations versus the control meal (P < 0.05). Postprandial insulin levels were not different in the four experimental series, whereas the postprandial glucagon levels were significantly lowered by GLP‐1 in (A) and (B) (P < 0.03) but not in (C). Gastric emptying, as determined by the paracetamol test, was retarded by GLP‐1 only in (A) (P < 0.01), but not affected in (B) or (C).

Conclusions. GLP‐1 reduced postprandial hyperglycaemia in subjects with type 2 diabetes regardless of administration at the onset of meal intake or at 30 or 60 min after start of meal intake, although the mechanism of the antidiabetogenic action of GLP‐1 depended on administration versus meal intake. Thus, when administered at the start of a meal, GLP‐1 was antidiabetogenic mainly through retarding gastric emptying, whereas when given at 30 or 60 min after meal ingestion, changes in islet hormone secretion seem to be predominant.
ANCA‐positive periaortic vasculitis: does it fall within the spectrum of vasculitis?
Authors: Vaglio A. , Manenti L. , Allegri L. , Ferrozzi F. , Corradi D. , Buzio C.
Published: March 2003

Abstract.  Vaglio A, Manenti L, Allegri L, Ferrozzi F, Corradi D, Buzio C (University of Parma, Parma, Italy). ANCA‐positive periaortic vasculitis: does it fall within the spectrum of vasculitis? (Case Report). J Intern Med 2002; 251: 268–271.

Retroperitoneal fibrosis (RPF) is a disease of unknown aetiology that has sometimes been reported in association with connective tissue disorders and systemic vasculitis. We report here two cases of antineutrophil cytoplasmic antibody (ANCA)‐positive RPF showing clinical evidence of rapidly progressive glomerulonephritis. Although treatment with prednisone and cyclophosphamide led to a remission of RPF in both cases, renal function was restored in only one patient and the other progressed to chronic renal failure. The paper reviews the literature concerning ANCA‐positive RPF and discusses the relationship between ANCA‐positive vasculitis and RPF.
A randomized controlled trial of shared care versus routine care for patients receiving oral anticoagulant therapy
Authors: Holm T. , Lassen J. F. , Husted S. E. , Christensen P. , Heickendorff L.
Published: March 2003

Objectives.  To evaluate the effect of a shared careprogramme (SCP), defined as a scheme based on shared responsibility, enhanced information exchange, continues medical education and explicit clinical guidelines, between general practitioners (GPs) and a hospital outpatient clinic (HOC), on oral anticoagulant therapy (OAT).

Design.  The study was a 2‐year prospective, randomized, controlled trial, preceded by a 1‐year period of observation.

Setting.  The HOC, GPs, and OAT patients in the admission area of Aarhus University Hospital, Aarhus County, Denmark, covering 310 300 inhabitants.

Subjects.  A total of 207 GPs, including their enlisted patients on OAT, were invited, and 61.4% accepted participation. They were randomized into an intervention group [group‐INT: 64 GPs and 453 patients (170 patients on OAT throughout the study period, i.e. full follow‐up)], and a control group [group‐CON: 63 GPs and 422 patients (173 with full follow‐up)]. The remaining 80 GPs served as a nonresponder group (group‐NON) of 485 patients (184 with full follow‐up).

Main outcome measure.  Therapeutic control of OAT in terms of time spent by the patients within the therapeutic interval (TI) of an international normalized ratio (INR) between 2.0 and 3.5.

Results.  The groups did not differ significantly with regard to age, sex, OAT indication, anticoagulant drug used, or the therapeutic control at baseline. In a comparison based on intention‐to‐treat principles, the therapeutic control increased statistical significance amongst patients with full follow‐up in group‐INT compared with group‐CON (median time within TI: group INT = 86.6% vs. 80.5%, P = 0.007).

Conclusion.  An SCP of anticoagulant management is effective in reducing patient time outside the therapeutic INR interval in OAT patients randomly assigned to an SCP, as compared with a control group.
Recurrent myopericarditis in association with Crohn's disease
Authors: Hyttinen L. , Kaipiainen‐Seppänen O. , Halinen M.
Published: March 2003

Abstract. Hyttinen L, Kaipiainen‐Seppänen O, Halinen M (Kuopio University Hospital, Kuopio, Finland). Recurrent myopericarditis in association with Crohn's disease (Case report). J Intern Med 2003; 253: 386–388.

Myopericarditis is a rare extraintestinal complication of inflammatory bowel disease (IBD). It has also been described as a side‐effect of the treatment of IBD. We report a 37‐year‐old‐woman with Crohn's disease who had several mild episodes of myopericarditis, two of which were associated with a pleural effusion, and two with conduction abnormalities in the atrioventricular node. During the last episode, a nodal rhythm was followed by a third‐degree atrioventricular block and a prolonged pause, resulting in loss of consciousness and convulsions. A permanent pacemaker was implanted. Our patient is also human lymphocyte antigen (HLA) B27‐positive. HLA B27 is known to be associated with conduction disturbances in the AV node. Recurrent myopericarditis can be a sign of IBD.