bluuebunny/crossref_metadata_2025 huggingface dataset:
Extra‐adrenal phaeochromocytoma presenting as fulminant malignant disease with tumour positive sputum cytology
Authors: DE JONG R. S. , VAN DEN BERGEN H. A. , BOENDER C. A. , TJABBES T.
Published: August 2009

Abstract. A case of a 69‐year‐old man with an extra‐adrenal malignant phaeochromocytoma is described. Sputum cytology revealed metastatic cells, which have not been reported previously in malignant phaeochromocytoma. This case is also remarkable for the short duration of disease, rapid progression and extensive spread of metastases, the radiological aspect of metastatic lesions shown by chest X‐ray, hypercalcaemia and extremely high levels of circulating catecholamines and urinary metabolites.
Multiple myeloma and chronic myelomonocytic leukaemia developing in a patient with autoimmune disease
Authors: HABASHI H. M. , SHARP R. A. , PIPPARD M. J.
Published: August 2009

Abstract. A 64‐year‐old lady with a personal and family history of autoimmune disease developed chronic myelomonocytic leukaemia and multiple myeloma simultaneously. Her sister died of acute myelomonocytic leukaemia, but showed no evidence of autoimmune disease. It is possible that chronic immunological stimulation, perhaps by an autoantigen, may predispose toward malignant transformation in both plasma cell and monocyte series. However, the present observations raise the alternative possibility of a primary disorder of monocytes that predisposes toward both autoimmune disease and a clonal disorder of plasma cells.
Microdialysis sampling of the neuronal environment in basic and clinical research
Authors: HAMBERGER A. , JACOBSON I. , NYSTRÖM B. , SANDBERG M.
Published: August 2009

Abstract. Microdialysis is a technique for sampling extracellular fluid (ECF) which has been employed in brain research for about 10 years, and is now in experimental and clinical use in a number of biomedical disciplines. We report on microdialysis of neuroactive amino acids in the central nervous system (CNS) and discuss some technical problems of microdialysis, such as tissue reactions, calibration and the difficulties involved, as well as strategies for determination of the true extracellular concentration of various compounds. Possible mechanisms of nerve cell death in ischaemia and hypoglycaemia are among the factors that have been elucidated using data obtained by microdialysis. The neuronal environment overflows with excitatory amino acids both in brain ischaemia and in hypoglycaemia.
Cigarette smoking and urinary albumin excretion in insulin‐treated diabetics without manifest nephropathy
Authors: EKBERG G. , GREFBERG N. , LARSSON L. O.
Published: August 2009

Abstract. The frequency of microalbuminuria and glomerular hyperfiltration in insulin‐treated diabetics without manifest nephropathy was studied in 76 patients, 20–40 years of age and with a diabetes duration not exceeding 20 years. Clinical determinants of urinary albumin excretion (UAE) with regard to smoking were studied further in a sample of male diabetics (n = 49) without manifest nephropathy. All patients had an age‐related glomerular filtration rate (GFR) exceeding − 2 SD, and their diastolic blood pressure (DBP) did not exceed 90 mmHg. GFR was assessed by 51Cr‐EDTA‐clearance, and UAE was analysed using an immunochemical method. Diabetic smokers with a long diabetes duration (10–20 years) had a significantly higher UAE (39.5 ± 2.4 mg 24 h−1 vs. 17.1 ± 2.4 mg 24 h−1; P = 0.03), a higher mean arterial blood pressure (MAP) (97.9 ± 7.5 mmHg vs. 91.5 ± 6.3 mmHg; P = 0.02) and a higher frequency of microalbuminuria (85.7% vs. 37%; P = 0.028) than non‐smoking diabetics. Smokers with a short diabetes duration (0–10 years) had a significantly higher frequency of glomerular hyperfiltration (64% vs. 15%; P = 0.005) than non‐smokers. The frequency of microalbuminuria or blood pressure did not differ significantly. In male non‐smokers (n = 35) UAE was positively correlated with HbA1c and negatively correlated with age of onset. In male smokers (n = 14) regression analysis showed that UAE was positively correlated only with duration of smoking. We conclude that smoking is associated with two accepted risk factors for nephropathy in insulin‐treated diabetics, namely hyperfiltration and microalbuminuria. A positive linear relationship between smoking parameters and UAE in male diabetics also supports the view that smoking may increase the risk of nephropathy development in insulin‐treated diabetics.
Lack of association of migraine with coronary vasospasm
Authors: PLIML W. , KOMMISSARI I. , PFAFFENRATH V. , VON ARNIM T.
Published: August 2009

Abstract. Previous reports have found an association between coronary vasospasm and migraine. It has been speculated that migraine and variant angina might be manifestations of a generalized vasospastic disorder. To investigate this hypothesis, 74 patients with frequent attacks of migraine were studied using 24‐h continuous ambulatory electrocardiography to identify the presence of coronary vasospasm. Control groups consisted of 19 patients with tension headaches, and 38 healthy individuals. All subjects were free of heart disease. One patient in the migraine group and one patient in the control group had symptomless episodes of ST‐segment depression not indicative of coronary vasospasm. Our data do not support the hypothesis that migraine and variant angina are components of a generalized vasospastic disorder.
Comparison of fosinopril and hydrochlorothiazide in patients with mild to moderate hypertension
Authors: FORSLUND T. , FRANZÉN P. , BACKMAN R.
Published: August 2009

Abstract. Seventeen patients with mild to moderate hypertension, as indicated by a diastolic blood pressure (DPB) of 95–115 mmHg (WHO I), were treated in a randomized, double‐blind, parallel study, with either 5 mg of fosinopril, a new phosphinic acid‐containing angiotensin converting enzyme (ACE) inhibitor, or 25 mg of hydrochlorothiazide administered orally once daily for 4 weeks after a 4‐ to 6‐week run‐in period of placebo. The doses were increased to 10 mg of fosinopril or 50 mg of hydrochlorothiazide if DBP remained above 95 mmHg. The blood pressure (BP) fell from 157 ± 12/104 ± 7 mmHg (mean value ± SD) at the start of the study to 146 ± 21/97 ± 8 mmHg (P < 0.02) after 4 weeks, and to 149 ± 19/97 ± 7 mmHg (P < 0.02) after 8 weeks of fosinopril treatment (n = 8). In the hydrochlorothiazide‐treated patients (n = 9), BP fell from 153 ± 9/105 ± 5 mmHg at the start of the study to 140 ± 11/97 ± 7 mmHg (P < 0.01) after 4 weeks, and to 131 ± 11/94 ± 7 mmHg (P < 0.01) after 8 weeks. After the first dose, DBP fell from 102 to 99 mmHg (NS) in fosinopril‐treated patients, and from 105 to 96 mmHg (P < 0.02) in hydrochlorothiazide‐treated subjects. Serum active fosinoprilate concentration increased to 5.6 ng ml−1, 25.9 ng ml−1, and 43.8 ng ml−1 after 30, 60 and 120 min, respectively, and remained at a level of 6.6–7.7 ng ml−1 after 4 and 8 weeks, respectively. Serum ACE activity decreased from 21.6 ± 11.0 μmol min−1 l−1 at the start to 9.3 ± 13.7, 4.4 ± 4.6, and 2.9 ± 2.8 μmol min−1 l−1 after 30, 60 and 120 min, respectively. No side‐effects and no changes in blood counts, electrolytes or kidney function were attributed to fosinopril during the study. Fosinopril is a safe, long‐acting antihypertensive drug with a smooth onset of action. Hydrochlorothiazide treatment caused potassium loss and an increase in the levels of uric acid and triglycerides. Diastolic blood pressure decreased to the same extent as a result of treatment with either drug, while systolic blood pressure was better controlled by hydrochlorothiazide.
Effect of pancreas transplantation on glucose counterregulation in insulin‐dependent diabetic patients prone to severe hypoglycaemia
Authors: BOLINDER J. , WAHRENBERG H. , PERSSON A. , LINDE B. , TYDÉn G. , GROTH C.‐G. , ÖSTMAN J.
Published: August 2009

Abstract.Pancreatic transplantation was performed in three patients with insulin‐dependent diabetes mellitus in whom recurrent and severe episodes of hypoglycaemia had been found to be due to defective glucose counterregulation. Thus in these patients the spontaneous blood glucose recovery after insulin‐induced hypoglycaemia (0.1 U kg−1h−1i.v. insulin until blood glucose levels fell below 2.8 mmol l−1) was delayed, and the responses of glucagon, epinephrine and growth hormone (GH) were absent or diminished. After pancreas transplantation the patients exhibited essentially normal blood glucose control. When the insulin infusion test was repeated 3 months after the transplantation, the blood glucose level recovered rapidly after insulin withdrawal. The glucagon response was restored, and the responses of epinephrine and GH were improved. Plasma C‐peptide was suppressed by approximately 50%, which is less than is observed in normal subjects. It is concluded that glucose counterregulation improves after pancreas transplantation. This appears to be mainly due to an improvement in the hypoglycaemia‐induced glucagon response, but an amelioration of sympatho‐adrenal and hypothalamic‐pituitary regulatory mechanisms may also be involved. The apparent failure to suppress completely the insulin release from the denervated pancreas transplant indicates that inhibition of beta‐cell secretion during insulin‐induced hypoglycaemia may be partly under neural control.
Adrenomyeloneuropathy—report on a family
Authors: HOLMBERG B. H. , HÄGG E. , HAGENFELDT L.
Published: August 2009

Abstract. A family is reported in which there is one case of adrenomyeloneuropathy, one case of Addison's disease and at least three heterozygous females with spastic paraparesis and peripheral neuropathy. Adrenomyeloneuropathy has not been reported previously in Scandinavia. The differences in the clinical picture between the sexes and at different ages are emphasized. Elevation of the levels of very‐long‐chain fatty acids in plasma is a characteristic feature of the disease and confirms the diagnosis. Some recent reports in the literature seem to provide some hope that the clinical manifestations of adrenomyeloneuropathy/adrenoleukodystrophy may be prevented.
Diclofenac‐induced thrombocytopenic purpura with renal and hepatic involvement
Authors: BONDESON J. , BERGLUND S.
Published: August 2009

Abstract. A case of diclofenac‐induced thrombocytopenic purpura in a 59‐year‐old woman is described. Unlike the majority of earlier cases, ours was associated with renal insufficiency and jaundice. Despite the dramatic clinical picture, with severe thrombocytopenia and marked renal insufficiency, the prognosis appears to be excellent, as is shown in our case and in similar ones reported in the literature. A high dose of steroids is the treatment of choice.
Hyperleukocytic effects on skin capillary circulation in patients with leukaemia
Authors: ÖSTERGREN J. , FAGRELL B. , BJÖRKHOLM M.
Published: August 2009

Abstract. A decrease in capillary flow due to hyperleucocytosis may cause impairment of organ perfusion in patients with leukaemia. In order to evaluate the effects of different cell types of leukaemic cell origin on skin capillary circulation we have studied patients with (a) chronic lymphocytic leukaemia (CLL) (n = 6) and (b) acute non‐lymphocytic leukaemia (ANLL) (n = 6) or chronic granulocytic leukaemia (CGL) (n = 5). Capillary blood cell velocity (CBV) in fingernail‐fold capillaries was measured by videophotometric capillaroscopy. After a 1‐min arterial occlusion at the finger base, the post‐occlusive reactive hyperaemia was evaluated by measuring the peak (p) CBV and the time to pCBV. In patients with ANLL/GGL, both resting CBV and pCBV were lower than in healthy control subjects. In the CLL patients these values were not significantly different compared to controls. In a few patients the time to pCBV was markedly prolonged. Symptoms attributable to hyperviscosity were more common in patients with ANLL/CGL and low CBV values. It is suggested that the cell size of leucocytes may be an important factor in the development of hyperviscosity syndromes and organ malperfusion in leukaemic patients.
Time course of some effects of cigarette smoking on platelets
Authors: DAVIS J. W. , ARNOLD J.
Published: August 2009

Abstract. Eight male habitual smokers smoked two cigarettes over a 20‐min period following a 12‐h period of abstinence. Antecubital venipuncture was performed immediately before, immediately after, and 55 min and 2 h after smoking had ceased. At these times, the mean values (± SD) of collagen‐induced platelet aggregation were 45 ± 5, 68 ± 5, 59 ± 6 and 52 ± 5 chart units, respectively, while the corresponding values for the mean platelet aggregate ratio were 0.91 ± 0.01, 0.82 ± 0.03, 0.87 ± 0.02 and 0.90 ± 0.02, respectively. Mean collagen‐induced platelet aggregation was significantly (P < 0.005) higher immediately after, and 55 min and 2 h after smoking. The mean platelet aggregate ratio was significantly (P < 0.001) lower immediately after and 55 min after smoking. Correlation coefficients between the concentration of nicotine in each of the 24 plasma samples obtained after smoking and the corresponding values of collagen‐induced platelet aggregation and the platelet aggregate ratio were 0.41 (P < 0.05) and −0.50 (P < 0.02), respectively. It is concluded that when habitual smokers abstain from smoking overnight, a 20‐min period of cigarette smoking may enhance platelet aggregability for as long as 2 h.
Lack of association between the apolipoprotein B gene 3‘ hypervariable region alleles and coronary artery disease in Finnish patients with angiographically documented coronary artery disease
Authors: HELIÖ T. , PALOTIE A. , TÖTTERMAN K. J. , OTT J. , KAUPPINEN‐MÄKELIN R. , TIKKANEN M. J.
Published: August 2009

Abstract. Previous studies have suggested that some apolipoprotein B (apoB) 3′ variable number of tandem repeats (3′VNTR) locus alleles are associated with coronary artery disease (CAD). We examined the possible association between the apoB 3′VNTR alleles and CAD in 387 Finnish subjects. Using the polymerase chain reaction and polyacrylamide gel electrophoresis, the 3′VNTR genotype was determined in 187 individuals with severe CAD confirmed by coronary angiography (patients), in 121 individuals with normal coronary angiograms (controls), and in 79 apparently healthy subjects (normals). In contrast to previous reports from other populations, the larger apoB 3′VNTR alleles were not significantly more frequent among CAD patients than among controls or normals. In addition, there was no significant association between the 3′VNTR alleles and serum lipid levels in this Finnish population.
Progressive necrotic myelopathy as a paraneoplastic syndrome: report of a case and some pathogenetic considerations
Authors: GRIGNANI G. , GOBBI P. G. , PICCOLO G. , BERTOLONI D. , ROSSI A. , PIERESCA C. , LEGNANI M. C. , ASCARI E.
Published: August 2009

Abstract. Progressive necrotic myelopathy is a syndrome characterized by a spotty necrotic degeneration of the whole spinal cord in both anterior and posterior horns. This syndrome was recorded in a man suffering from a lymphoplasmatocytoid lymphoma. Whilst the usual evolution of this neurological syndrome is inexorably fatal, our case had a better outcome, due to the good response of the neoplasm to therapy. Progressive necrotic myelopathy is an uncommon complication of cancer, but it is probably incorrectly recognized in a number of cases. Two possible pathogenetic hypotheses are suggested: an autoimmune or an infective mechanism.
Acute haematogenous osteomyelitis of the patella revealed by a pathological fracture in multiple myeloma
Authors: GUERCI A. , MAINARD D. , THIERY D.
Published: August 2009

Abstract. A 57‐year‐old man was followed up for multiple myeloma with no lytic bone lesions. During a septicaema, he presented with a pathological fracture of the patella. Despite a poor haematological status, he received surgical treatment, which allowed diagnosis of haematogenous osteomyelitis of the patella. The outcome was favourable, with a 6‐week plaster immobilization after cerclage and 4 months of intravenous antibiotic therapy. This case emphasizes the fact that one well‐known cause of bone lesions may lead to an erroneous diagnosis. The successful clinical course suggests that accurate therapeutic management may be discussed in haematological malignancies when intensive‐care support is available.
Quantitative assessment of aortic regurgitation by combined two‐dimensional, continuous‐wave and colour flow Doppler measurements
Authors: HOLM S. , ERIKSSON P. , KARP K. , OSTERMAN G. , TEIEN D.
Published: August 2009

The width of the regurgitant jet at the aortic valve plane, i.e. the core flow diameter, the ratio of the jet width to the left ventricular outflow diameter, the regurgitant volume and regurgitant fraction were determined using two‐dimensional, continuous wave and colour flow Doppler echocardiography. The relationship between the non‐invasive measurements and semiquantitative angiographic grading of the regurgitant flow (1 + to 4 +) was examined in a primary group of 20 patients with chronic aortic regurgitation. Cut‐off points for the non‐invasive measurements were selected so as to separate patients with mild or moderate regurgitation (1 + or 2 +) from patients with moderately severe or severe regurgitation (3 + or 4 +). These cut‐off points were prospectively applied in a new group of 35 patients with aortic regurgitation to predict the angiographic grading. Jet width correctly predicted the angiographic grading in 86% of cases, the ratio of the jet width to the outflow diameter in 83% of cases, the regurgitant volume in 86% of cases and the regurgitant fraction in 91% of cases. We conclude that the severity of aortic regurgitation as determined by angiographic grading can be estimated with reasonable accuracy by non‐invasive techniques based on colour flow imaging.
Gallbladder volume and emptying in diabetics: the role of neuropathy and obesity
Authors: PALASCIANO G. , PORTINCASA P. , BELFIORE A. , BALDASSARRE G. , CIGNARELLI M. , PATERNOSTRO A. , ALBANO O. , GIORGINO R.
Published: August 2009

Gallbladder (GB) volume was monitored by real‐time sonography in diabetics (n = 21) and healthy volunteers (n = 55) after a test meal. Seventeen controls and seven diabetics were obese; six patients had both autonomous and somatic neuropathy, and four had somatic neuropathy. Fasting GB volume was similar in controls and diabetics with and without autonomic neuropathy; it was correlated with body mass index (controls, r = 0.43, P < 0.002; diabetics, r = 0.46, P < 0.04), and was increased in obese subjects. Post‐prandial GB emptying was decreased in diabetics. Those with autonomous neuropathy exhibited larger residual volumes than controls (P < 0.03). Post‐prandial GB emptying was slower and less complete in (non‐diabetic) obese subjects and deteriorated further in diabetic obese subjects. GB fasting tone was normal, but GB kinetics were impaired in diabetics; obesity and autonomous neuropathy were correlated with GB hypomotility.
Serum osteocalcin concentrations in patients with multiple myeloma — correlation with disease stage and survival
Authors: CARLSON K. , LJUNGHALL S. , SIMONSSON B. , SMEDMYR B.
Published: August 2009

Multiple myeloma affects bone, and enhanced bone resportion is a characteristic finding. In the present study the serum concentration of osteocalcin, serum bone gla‐protein, which is a protein specific for bone turnover and reflects osteoblast activity, was analysed at diagnosis in 48 patients with multiple myeloma. At that time there was a significant relationship between disease stage (Durie‐Salmon) and osteocalcin levels, lower levels being found in patients with more advanced disease. No relationship was found between osteocalcin and serum calcium levels. To date, 33 patients have died. There was a significant correlation between initial osteocalcin levels and patient survival. These findings suggest that serum osteocalcin could be a marker of prognostic significance for survival in multiple myeloma.
Prednimustin treatment in primary biliary cirrhosis: a preliminary study
Authors: LINDGREN S. , DANIELSSON å. , OLSSON R. , PRYTZ H. , ERIKSSON S.
Published: August 2009

We observed a decrease in serum bilirubin, alkaline phosphatases (ALP) and IgM in five patients with primary biliary cirrhosis (PBC) treated with Prednimustin (Sterecyt®) for 6 months. In contrast to pretreatment findings, C3 activation was undetectable during treatment in three patients where normalization of serum IgM was achieved. After discontinuation of Prednimustin, bilirubin and ALP levels rapidly returned to pretreatment values, although IgM remained normal for up to 6 months in some patients. We conclude that Prednimustin might be of value in patients with symptomatic PBC where liver transplantation is not an option, and that it should be evaluated in a controlled study. However, the rapid reactivation of the disease after conclusion of treatment must be considered.
Effect of calcium intake vs. other life‐style factors on bone mass
Authors: TOSS G.
Published: August 2009

Several life‐style factors are known to or have been suggested to interact with calcium metabolism and bone turnover. Immobilization or a sedentary life‐style may result in substantial bone loss, and physical exercise may increase bone mass, to different extents in different parts of the skeleton. Excessive training and/or slimming may lead to amenorrhoea, which is in turn complicated by rapid bone loss. While calcium supplementation probably cannot override the negative calcium balance induced by immobilization or amenorrhoea, the calcium requirement may be enhanced during recovery from these states. A high body mass index may to some extent protect against bone loss, particularly in post‐menopausal women. Tobacco smoking and high alcohol consumption are probably detrimental to bone mass. Insufficient exposure to daylight and/or insufficient vitamin D intake occur mainly in infants and elderly people, and may impair calcium balance and cause rickets, osteomalacia or osteoporosis. Whether high intake of caffeine, protein, phosphate or fibre is detrimental to the bone mass has not yet been clarified. In many populations smoking and consumption of alcohol or caffeine are negatively correlated with calcium intake, and this exemplifies a source of confounding factors. Increased attention would be paid to important life‐style factors during investigations of calcium requirements in different sex and age categories.
Protein‐loading test, urinary albumin excretion and renal morphology in diagnosis of subclinical diabetic nephropathy
Authors: SHESTAKOVA M. V. , MUKHIN N. A. , DEDOV I.I. , TITOV V. N. , WARSHAVSKY V. A.
Published: August 2009

Abstract. The acute effects of protein loading (1.5 g kg−1) on glomerular filtration rate (GFR) and urinary albumin excretion (UAE) were investigated in 23 type‐I diabetic patients with no clinical nephropathy, and in 7 healthy subjects (controls). The results were compared with renal morphology data. In controls and in 14 diabetic patients (group 1) GFR increased by 27 and 37%, respectively, corresponding to normal renal reserve, but in 9 patients (group 2) GFR decreased by 20%, indicating the absence of a renal reserve. Microalbuminuria was found in none of the patients in group 1 and in 50% of patients in group 2. Two hours after the load UAE increased in all groups, but the increase was most marked in group 2, despite the fall in GFR. The two groups of patients did not differ with regard to the duration and control of diabetes, but differed markedly in terms of baseline GFR (131 vs. 195 ml min−1, P < 0.01, in groups 1 and 2, respectively). Renal morphology showed minimal non‐specific glomerular injury in group 1, and signs of glomerulosclerosis in group 2. We conclude that the impaired renal response to protein load precedes other subclinical manifestations of diabetic renal injury, and may be useful in the diagnosis of latent diabetic nephropathy.
EDTA treatment of intermittent claudication — a doubleblind, placebo‐controlled study
Authors: GULDAGER B. , JELNES R. , JØRGENSEN S. J. , NIELSEN J. S. , KLÆRKE A. , MOGENSEN K. , LARSEN K. E. , REIMER E. , HOLM J. , OTTESEN S.
Published: August 2009

Abstract. A double‐blind, randomized multicentre study was undertaken to evaluate the possible effect of chelation treatment with ethylenediamine‐tetraacetic acid (EDTA) in patients with severe intermittent claudication. A total of 153 patients received 20 intravenous infusions of either 3 g Na2EDTA or placebo during a period of 5–9 weeks. Vitamin, mineral and trace element supplements were administered orally. The changes observed in the pain‐free and maximal walking distances, measured on a treadmill, were similar in the two groups. During the 3‐month (n = 149) and 6‐month (n = 123) follow‐up period, no long‐term therapeutic effect of EDTA could be demonstrated. The anklebrachial blood pressure index remained unchanged throughout the study period. This study failed to demonstrate any effect of EDTA chelation treatment in intermittent claudication.
GM‐CSF therapy for drug‐induced agranulocytosis
Authors: DELANNOY A.
Published: August 2009

Abstract. Five patients with drug‐induced agranulocytosis were treated with recombinant granulocyte‐macrophage colony‐stimulating factor (GM‐CSF)). With the exception of one patient who experienced a very short period of neutropenia, GM‐CSF did not appear to alter the natural course of the disease. From our experience and from a critical review of the literature we conclude that the efficacy of GM‐CSF in agranulocytosis is far from certain, and that the use of growth factors in this condition remains investigational.
Hyperhomocyst(e)inaemia: an independent risk factor for intermittent claudication
Authors: MÖLGAARD J. , MALINOW M. R. , LASSVIK C. , HOLM A.‐C. , UPSON B. , OLSSON A. G.
Published: August 2009

Abstract. The aim of this study was to test the question of hyperhomocyst(e)inaemia as a risk factor for intermittent claudication (IC) independent of other important risk factors for peripheral atherosclerotic disease, such as smoking, hypertension, diabetes mellitus, hypercholesterolaemia, hypertriglyceridaemia, low levels of high‐density‐lipoprotein (HDL) cholesterol and age. The study population was recruited from an epidemiological study in LinkÖping County, Sweden, where all middle‐aged men (n = 15253, 45–69 years of age) were screened for IC. Seventy‐eight subjects with verified IC and 98 healthy sex‐ and age‐matched controls were randomly selected. Plasma levels of homocyst(e)ine (including the sum of free and bound forms of homocysteine and their disulphide oxidation products, homocystine, and homocysteine‐cysteine mixed disulphide) were significantly higher (16.74 ± 5.45 μmol l−1, mean value ± SD, P = 0.0002) in IC subjects than in controls (13.80 ± 3.21 μmol l−1), with 23% of the claudicants above the 95th percentile for controls. Stepwise logistic regression analysis revealed that the difference in plasma homocyst(e)ine was independent of the other above‐mentioned risk factors. Moreover, the elevation of plasma homocyst(e)ine in claudicants was mainly confined to subjects with serum folate levels of < 11.0 nmol l−1. The results suggest that folic acid supplementation should be tried in IC subjects with hyperhomocyst(e)inaemia.
Zidovudine‐induced hepatitis
Authors: GRADON J. D. , CHAPNICK E. K. , SEPKOWITZ D. V.
Published: August 2009

Abstract. A case of acute hepatitis induced by zidovudine in a 38‐year‐old patient with AIDS is presented. The mechanism whereby the hepatitis was induced is not known. However, the patient tolerated well an alternative reverse transcriptase inhibitor, 2′ 3′ dideoxyinosine. Physicians caring for patients with AIDS should be aware of this hitherto rarely reported complication.
AIDS‐associated Kaposi'i sarcoma and the mechanisms of interferon alpha'a activity; a riddle within a puzzle
Authors: DE WIT R.
Published: August 2009

Abstract. As yet, the pathogenesis of Kaposi'i sarcoma in the context of the acquired immunodeficiency syndrome (AIDS) is not completely understood; this is also true for the mechanisms of action of interferon‐alpha against this tumour. The present review focuses on recent developments that may provide some further insight into these issues. These include the angiogenesis of the tumour and the possible role of growth factors, such as the HIV‐transactivating (tat) gene product and interleukin‐6, the possible meaning of immunomodulating activities of interferon‐alpha, such as the rise in the number of CD4+ cells and the increase in beta2‐microglobulin serum concentrations in patients whose tumours respond to treatment, and the observed association between interferon'n antiretroviral activity and tumour responses.
Alcohol and sauna bathing: effects on cardiac rhythm, blood pressure, and serum electrolyte and cortisol concentrations
Authors: ROINE R. , LUURILA O. J. , SUOKAS A. , HEIKKONEN E. , KOSKINEN P. , YLIKAHRI R. , TOIVONEN L. , HÄRKÖNEN M. , SALASPURO M.
Published: August 2009

Abstract. The effect of heavy drinking and sauna bathing on cardiac rhythm, blood pressure, and serum electrolyte and cortisol concentrations was studied in 10 healthy male volunteers. Sauna bathing induced a comparable, significant increase in heart rate with and without alcohol consumption. During sauna bathing without alcohol, systolic blood pressure remained at the baseline level, whereas sauna and alcohol together decreased systolic blood pressure markedly from 136 ± 4 to 113 ± 3 mmHg (P < 0.01). Neither sauna alone, nor sauna combined with alcohol intake, increased the frequency of premature ventricular complexes. Serum potassium, calcium and cortisol concentrations changed slightly during sauna, but alcohol consumption did not contribute further to this. In conclusion, sauna bathing, even in combination with heavy drinking, does not appear to provoke cardiac arrhythmias in healthy young men. However, the risk of hypotension is increased when sauna bathing is combined with alcohol consumption.
Prognosis in glomerulonephritis. III. A longitudinal analysis of changes in serum creatinine and proteinuria during the course of disease: effect of immunosuppressive treatment. Report from Copenhagen Study Group of Renal Diseases
Authors: Brahm M. , BRAMMER M. , BALSLØV J. T. , BRUN C. , JØRGENSEN H. E. , GERSTOFT J. , LORENZEN I. , THOMSEN Å. C.
Published: August 2009

Abstract. A total of 395 consecutive patients with biopsy‐proven glomerulonephritis were followed up for 14 years. At the time of entry to the study the patients were classified as having one of nine states of kidney disease according to serum creatinine levels and proteinuria. The transitions of the patients between the nine states were analysed. The influence of 14 independent variables including treatment with cytostatic drugs and prednisolone was estimated by the Cox proportional hazard model. Treatment with immunosuppressive drugs had an influence that emerged within the first month and continued for the next 2 months. Subsequent treatment with cytostatic drugs in combination with prednisolone delayed further improvement. Treatment with prednisolone or cytostatic drugs as single therapy for up to 6 months increased the risk of improvement of the disease, and had no significant effect on deterioration. The beneficial effect of the treatment persisted after withdrawal of the immunosuppressive drugs. The analysis revealed only a slight influence of the histological character of the glomerular changes. Post‐streptococcal glomerulonephritis carried an increased tendency for improvement. Arterial hypertension affected the process in several states of kidney disease. Heavy proteinuria increased the risk of increasing serum creatinine levels.
Coronary heart disease, cancer and mortality in male middle‐aged light smokers
Authors: ROSENGREN A. , WILHELMSEN L. , WEDEL H.
Published: August 2009

Abstract. We examined the effect of light smoking in relation to incidence of coronary heart disease (CHD) in a general population sample consisting of 6879 men aged 47–55 years and free of previous myocardial infarction (MI) at baseline. After a follow‐up of mean duration 11.8 years, 11.0% of men smoking 1–4 cigarettes daily (n = 228) had suffered a major CHD event, compared to 3.7% of non‐smokers (n = 2049) [adjusted odds ratio 2.8 (1.7‐4.7)]. No further increase in risk was observed in men who smoked more. There was an increasing risk of death from cancer with the number of cigarettes smoked per day. Mortality was increased in all categories of cigarette smokers, particularly among the very heavy smokers, who had a mortality risk of 22% compared to 6% among non‐smokers [adjusted odds ratio 4.4 (2.7‐7.1)]. Data from an examination 4 years later considered only those men who stated that their smoking habits were identical on both occasions (n = 3981). Among these subjects the incidence of CHD after a mean period of 7.1 years was 10.6% in men smoking 1–4 cigarettes per day. compared to 2.6% in non‐smokers [adjusted O.R. 4.6 (2.1–10.1)]. No dose‐response effect was observed. Even very light cigarette smoking considerably increases the risk of CHD in middle‐aged men.
Oral ketoconazole prophylaxis for Candida infections during induction therapy for acute leukaemia in adults: more bacteraemias
Authors: PALMBLAD J. , LÖNNQVIST B. , CARLSSON B. , GRIMFORS G. , JÄRNMARK M. , LERNER R. , LJUNGMAN P. , NYSTRÖM‐ROSANDER C. , PETRINI B. , ÖBERG G.
Published: August 2009

Abstract. We determined whether ketoconazole prophylaxis might reduce Candida colonization and infections in adult patients with acute leukaemia. During first‐remission induction therapy 50 patients were treated with 200 mg ketoconazole administered orally daily, while 57 patients received placebo in a double‐blind, randomized trial. The duration of severe neutropenia (granulocytes < 0.1 times 109 l‐1) represented 36% of the study period in the ketoconazole group and 26% in the placebo group (P = 0.043). Although fewer patients presented with positive Candida surveillance cultures and serological evidence of Candida infection in the ketoconazole group compared to the placebo group, two candidaemias and one Trichosporum fungaemia were observed in the ketoconazole group. Moreover, significantly more bacteraemias were noted in the ketoconazole group (n = 37) than in the placebo group (n = 21) (P = 0.004). Thus, although oral ketoconazole prophylaxis might be associated with less Candida colonization and fewer seroconversions, it also resulted in more bacteraemias and longer duration of severe neutropenia, suggesting that caution should be exercised when ketoconazole (or related drugs) is given to this group of immunocompromised hosts.
Elements of informed consent in clinical research with drugs: a survey of Spanish clinical investigators
Authors: DAL‐RÉ R.
Published: August 2009

Abstract. An anonymous survey was conducted on 302 Spanish clinical investigators in order to determine whether a patient't information sheet should be prepared for each clinical trial, and what items of information should be included. The survey, using close‐response type questions, included 23 proposed items of information. A total of 275 (91%) investigators considered it necessary that a patient't information sheet be prepared for each clinical trial. At least 83% of those investigators considered that seven items of information should always be included: an invitation to participate in a clinical trial, the aim of the study, a description of the predictable benefits and risks, a declaration that participation is voluntary, and a statement that refusal to participate does not imply loss of normal medical care and that the trial has been approved by a Clinical Trials Committee. Only 29% and 53% considered that the patient should always be informed about clinical trial design and data confidentiality, respectively. Overall, the responses obtained are in line with most of the elements of informed consent regarded as ‘basic’ in US regulations and included in the European Community and Nordic Good Clinical Practice guidelines.
Secondary polycythaemia associated with nocturnal apnoea — a relationship not mediated by erythropoietin?
Authors: Carlson J. T. , HEDNER J. , FAGERBERG B. , EJNELL H. , MAGNUSSON B. , FYHRQUIST F.
Published: August 2009

Abstract. A polysomnographic study was undertaken in nine patients with unexplained polycythaemia and nine age‐ and sex‐matched controls. Circulating plasma levels of immunoreactive erythropoietin (IrEPO) were analysed before and after sleep. Seven out of nine polycythaemia patients were found to have sleep‐disordered breathing and fulfilled the criteria for the sleep apnoea syndrome. Erythrocyte volume fraction was by definition higher among polycythaemia patients, and showed a weak positive correlation with minimum oxygen saturation during sleep (P < 0.05). However, plasma IrEPO did not differ between the two groups or between morning and evening samples within the respective groups. In a separate study, IrEPO was repeatedly analysed during sleep in a group of six patients with severe obstructive sleep apnoea and six matched controls. No correlation with severity of sleep‐disordered breathing was found. None of these patients had polycythaemia, and there was no obvious diurnal variation in IrEPO levels. A nocturnal sleep study may be warranted in patients with unexplained polycythaemia. Obstructive sleep apnoea does not appear to be related to increased IrEPO levels, although polycythaemia has been reported as a relatively common finding in this disease.
Frequency of low erythrocyte porphobilinogen deaminase activity in Finland*
Authors: MUSTAJOKI P. , KAUPPINEN R. , LANNFELT L. , LILIUS L. , KOISTINEN J.
Published: August 2009

Abstract. The frequency of low erythrocyte porphobilinogen deaminase (PBGD) activity was investigated in 2234 blood donors and in 30 patients with acute intermittent porphyria. The mean enzyme activities (± SD) were 3.38 ± 0.58 U and 1.82 ± 0.41 U, respectively. Eighteen blood donors without any history of symptoms of porphyria or haematological disease had low PBGD activity (< 2.20 U), and they were studied further. All of them also had subnormal concentrations of the erythrocyte enzyme protein, as determined by an immunological method. Lymphocyte PBGD activity was within the normal range, but this parameter does exhibit a wide overlap between normal and porphyric values. Urinary excretion of porphobilinogen was moderately increased in two of the blood donors. In four of the 18 families of the blood donors with low PBGD activity several first‐degree relatives had low erythrocyte enzyme activity, consistent with a dominant mode of inheritance. The 5‐aminolaevulinic acid loading‐test was normal in the blood donors with familial occurrence of low erythrocyte PBGD. It is concluded that inherited defects in erythrocyte PBGD occurred among Finnish blood donors with a frequency of about I in 500. The defects may be identical with those in acute intermittent porphyria (AIP), but other mechanisms are also possible, e.g. a mutation in the erythroid‐specific part of the PBGD gene.
Screening for antibodies against gliadin in patients with osteoporosis
Authors: Lindh E. , LJUNGHALL S. , LARSSON K. , LAVÖ B.
Published: August 2009

Abstract. Intestinal disease might contribute to osteopenia. Measurements of IgA antibodies to gliadin have been established as an accepted screening procedure for detection of coeliac disease. When we applied these measurements to 92 patients with verified osteoporosis, 11 subjects (12%) were found to have elevated levels. This is markedly higher than the incidence in healthy subjects (3%). However, the patients with raised levels of IgA antibodies displayed no clinical symptoms and no laboratory evidence of calcium malabsorption. Thus their values for serum calcium, phosphate, parathyroid hormone (PTH), alkaline phosphatase and osteocalcin, as well as the fasting urinary excretion of hydroxyproline and calcium, were similar to those found in other patients with osteoporosis. Intestinal biopsy verified coeliac disease in three patients and was normal in another three. This gives an incidence of verified coeliac disease in this patient group that is approximately tenfold higher than that in the healthy population. Subclinical coeliac disease appears to be unusually over‐represented among patients with idiopathic osteoporosis, and screening for gliadin antibodies might therefore be a valuable addition to the routine assessment of the osteopenic patient. The mechanisms underlying the relationship are not clear, but calcium malabsorption is not evident.
Interpretation of the electrocardiogram in suspected myocardial infarction: a randomized controlled study of the effect of a training programme to reduce interobserver variation
Authors: GJØRUP T. , KelbæK H. , NIELSEN D. , KREINER S. , GODTFREDSEN J.
Published: August 2009

Abstract. We examined the effect of a training programme to reduce interobserver variation in interpretation of electrocardiography in suspected myocardial infarction. Sixteen doctors with 6–24 months of clinical training in internal medicine read serial electro‐cardiographic recordings in 107 patients and assessed whether signs indicative of acute myocardial infarction were present. There was disagreement in approximately 70% of cases. Eight of the doctors were randomly allocated to attend an 8‐h intensive course on interpretation of electrocardiography in myocardial infarction. The remaining eight participants were allocated to a control group, received no training, and were not told about the subject of the study. All the doctors then reviewed another series of electrocardiographic recordings. No difference was found in the level of agreement within the two groups before and after the training programme, or between the two groups before and after the training. The raters' ability to discriminate between electrocardiograms with a high and low indication of infarction remained unaffected. We conclude that the training programme did not increase agreement regarding the interpretation of electrocardiographic data in suspected myocardial infarction. Our results suggest that the diagnostic approach of physicians is established at a very early stage in their clinical training. The effect of training programmes should be evaluated by the use of randomized clinical studies.
Familial high‐density‐lipoprotein deficiency causing corneal opacities (fish eye disease) in a family of Dutch descent
Authors: KASTELEIN J. J. P. , PRITCHARD P. H. , ERKELENS D. W. , KUIVENHOVEN J. A. , ALBERS J. J. , FROHLICH J. J.
Published: August 2009

Abstract. Fish eye disease (FED) is an extremely rare familial disorder characterized by severe HDL deficiency and extensive corneal opacities. This disorder appears to be a variant of familial lecithin: cholesterol acyltransferase (LCAT) deficiency in which the enzyme remains partly active yet the ability of the enzyme to esterify cholesterol in high‐density lipoprotein (HDL) has been lost. The rarity of this disorder has limited advances in our understanding of the pathophysiology of the HDL deficiency. However, we here describe the clinical and biochemical presentation of a family with FED who are of Dutch descent. The propositi presented with HDL deficiency and corneal opacity. Subsequently, they were diagnosed as having FED by the absence of LCAT activity against a small proteoliposome substrate despite the presence of half‐normal LCAT mass and a near‐normal ratio of unesterified to total cholesterol in plasma. Heterozygotes presented with half‐normal LCAT activity, but not with decreased HDL. With the identification of this three‐generation family, renewed investigation of this intriguing disorder of HDL is now possible.
Effect of reduction of plasma triglycerides with gemfibrozil on high‐density‐lipoprotein‐cholesterol concentrations
Authors: RUBINS H. B. , ROBINS S. J.
Published: August 2009

Abstract. The aim of this study was to test the hypothesis that the plasma triglyceride (TG) concentration must be reduced below approximately 0.85‐1.13 mmol l‐1 (75–100 mg/dl‐1) in order to achieve a substantial increase in plasma high‐density‐lipoprotein‐cholesterol (HDL‐C) levels. The study design consisted of a non‐randomized clinical trial, which was conducted at an out‐patient clinic at a university‐affiliated VA Medical Center. The participants consisted of 55 ambulatory middle‐aged men with a baseline fasting HDL‐C concentration of < 1.17 mmol l‐1 (45 mg dl‐1) and baseline TG in the range 1.13‐5.6 mmol l‐1 (100–500 mg dl‐1). Subjects were treated with gemfibrozil, 600 mg twice a day for 3 months. Fasting plasma HDL‐C, TG, low density lipoprotein‐cholesterol, and total cholesterol were measured at 1‐month intervals for 3 months. Subjects were divided into three groups on the basis of TG level achieved on therapy: Group 1 (n = 14), TG < 0.85 mmol l‐1 (75 mg dl‐1); Group II (n = 20), TG 0.86‐1.41 mmol l‐1 (76–125 mg dl‐1); Group III (n = 21), TG > 1.41 mmol l‐1 (125 mg dl‐1). The mean increase in HDL‐C in Group I was 0.20 mmol l‐1 (7.8 mg dl‐1), a significantly (P = 0.0067) greater increase than was observed in the other two groups. There was no correlation between the magnitude of change in TG and the magnitude of change in HDL‐C concentration in the group as a whole (Pearson'n correlation coefficient, r = ‐0.06. P = 0.6). In conclusion, the increase in HDL‐C levels observed with gemfibrozil therapy is associated with the absolute level of TG achieved by therapy. Substantial increases in HDL‐C concentration might not be expected to occur consistently unless TG levels are reduced to values that are considered below the usually cited ‘normal’ range.
POEMS syndrome presenting with cardiomegaly and cardiomyopathy
Authors: TANUS T. , MILLER H. J.
Published: August 2009

Abstract. A rare association of multisystemic manifestations with plasma cell dyscrasia has been termed POEMS syndrome, which includes polyneuropathy. organomegaly, endocrinopathy, M‐protein, and skin changes. From literature reports, organomegaly consists of hepatosplenomegaly and/or lymphadenopathy. We here present a case of POEMS syndrome that had most of the typical features of POEMS, except that organomegaly only involved the heart. The patient't multiple clinical manifestations, including cardiomyopathy. improved with chemotherapy, which is characteristic of POEMS syndrome. However, cardiomegaly or cardiomyopathy have not previously been described with POEMS. The present case suggests that cardiomegaly and cardiomyopathy may be added to the organomegaly in POEMS.
Serum hyaluronan and aminoterminal propeptide of type III procollagen in primary biliary cirrhosis: relation to clinical symptoms, liver histopathology and outcome
Authors: NYBERG A. , LINDQVIST U. , ENGSTRÖM‐LAURENT A.
Published: August 2009

Abstract. Hyaluronan (HA) and aminoterminal propeptide of type III procollagen (PIIINP), two biochemical connective tissue markers, were determined in 76 patients with primary biliary cirrhosis (PBC). The HA and PIIINP concentrations were significantly increased compared with controls (P < 0.001). Both HA and PIIINP levels correlated significantly with conventional liver‐function tests. All patients with stage IV PBC showed increased concentrations of both these variables. However, HA was a better marker with regard to prediction of development of cirrhosis as well as prediction of symptoms. Furthermore, HA also showed a negative correlation with time of survival (P < 0.05). The present data indicate that HA is a more sensitive marker of liver damage in PBC than PIIINP.