bluuebunny/crossref_metadata_2025 huggingface dataset:
Assessing the dietetic needs of different patient groups receiving enteral tube feeding in primary care
Authors: Madigan S. M. , O'Neill S. , Clarke J. , L'Estrange F. , MacAuley D. C.
Published: March 2003

Aim

To examine the nature of all contacts between adult tube‐fed patients and the dietetic service and to refine the current dietetic protocols to reflect the findings of the study with a view to improving patient care.

Methods

All adult patients referred to the Community Nutrition and Dietetic Service within a 6‐month period were included in the study. Using a proforma developed from a retrospective case‐note analysis, data were collected on the complications that prompted more frequent contacts than the department protocol. Data were analysed using the Statistical Package for the Social Sciences.

Results

The most common indication for home enteral feeding in this group of adult patients was a swallowing disorder resulting from a cerebrovascular accident (59.5%) followed by cancer (21.5%). There was a trend for cancer patients to need more intervention compared with those patients with other medical conditions. A significant difference was observed in the total contacts and telephone calls given to those patients in there own homes (P=0.019) and there was a trend towards more domicilary visits with this group.

Conclusions

The department protocols have been revised to include a planned review within 2–6 weeks of initial dietetic assessment in the community for those patients who were identified to have the greatest need. More intensive dietetic monitoring has clear implications for dietetic services in the community.
Ethical issues involved in the implementation of a differential reinforcement of inappropriate behaviour programme for the treatment of social isolation and ritualistic behaviour in an individual with intellectual disabilities
Authors: Iqbal Z
Published: March 2003

The present case study describes an adult male with a 28‐year history of institutional care underpinned by a moderate intellectual disability (ID), and ritualistic behaviour congruent with features of autism or obsessive‐compulsive disorder. The subject's ID was recognized early in life and he was provided with a special educational placement at 6 years of age, although his increasingly disturbed behaviour had resulted in several psychiatric admissions by early adolescence, and by the age of 20, his presentation necessitated long‐term secure psychiatric care. The present report describes the application and ethical issues pertaining to a differential reinforcement of inappropriate behaviour (DRI) programme for the reduction of ritualistic behaviour and social isolation, the latter being a direct consequence of the former, one year after the subject was admitted to a medium‐secure assessment and treatment residential facility. The results suggest that, although the treatment was successful in targeting ritualization and reducing social isolation, ethical concerns extended to care staff concerns about the reinforcer adopted for the programme and the lack of informed consent from the subject. The former resulted in inconsistent application of the programme and its eventual termination. A follow‐up assessment of the subject's extent of social isolation and ritualistic behaviour suggested a return to a pre‐DRI level of morbidity. Limitations and suggestions for the future treatment of such cases are outlined.
Informing patients and relatives about do‐not‐resuscitate decisions. Attitudes of cardiologists and nurses in Sweden
Authors: lÖfmark  , nilstun
Published: March 2003

Löfmark R, Nilstun T (Länssjukhuset Gävle and Lund University, Lund, Sweden). Informing patient and relatives about do‐not‐resuscitate decisions. Attitudes of cardiologists and nurses in Sweden. J Intern Med 1998; 243: 191–95.

Objectives

To survey the attitudes of Swedish cardiologists and nurses regarding information given to patients and relatives concerning do‐not‐resuscitate (DNR) status.

Method

Questionnaire.

Setting

Nationwide, 2 years after the publication of a proposal of guidelines on DNR.

Subjects

10% random sample of members of the Swedish Cardiac Society, 104 physicians and 196 nurses. Response rate 73%.

Results

According to most Swedish cardiologists and cardiac nurses, patients and relatives should be honestly informed about a patient's DNR status if they ask for information. Almost all (97%) answered that the relatives of a noncompetent patient should be informed when they ask and (67%) believe that the relatives should be informed even if they do not ask. Most of the respondents (61%) stated that the patient, if mentally competent, should be informed about the DNR status first and decide if the information should be passed on to relatives. Only 12% of the respondents were of the opinion that if the relatives asked for this information to be withheld from the patient, this should be respected even if the patient asked for information, and 45% believed it should be respected if the patient did not ask. With reference to the latter, many (31%) were uncertain. The cardiologists and cardiac nurses expressed almost identical opinions in the matter of informing patients and relatives about DNR status.

Conclusions

Current guidelines recommend honest answers to questions and that priority should be given to the autonomy of the patient. However the guidelines do not offer any assistance when no questions are asked. In such cases, there may be an ethical conflict between two requirements: respect for the person and do not harm. Many health care professionals believe that the information could, in some cases, harm the patient. This conflict can hardly be solved by referring to more basic ethical values. More training in informing patients and relatives about delicate matters is probably required, together with more knowledge about the wishes of very ill patients.
Haemangioblastoma of the central nervous system in von Hippel–Lindau disease
Authors: Richard  , Campello  , Taillandier  , Parker  , Resche
Published: March 2003

Richard S, Campello C, Taillandier L, Parker F, Resche F (Hôpital Necker, Paris, CHU Hôpital Caremeau, Nîmes, CHU Hôpital Saint‐Julien, Nancy, CHU Hôpital de Bic tre, Le Kremlin‐Bic tre, Hôpital Laennec, Nantes, France). Haemangioblastoma of the central nervous system in von Hippel–Lindau disease (Minisymposium: MEN & VHL). J Intern Med 1998; 243: 547–53.

Haemangioblastoma of the central nervous system (CNS) is the most characteristic lesion and the most common presenting manifestation of von Hippel–Lindau (VHL) disease and has a striking tendency to multiple occurrence. Its sites of predilection are the posterior fossa (cerebellum++), and the spinal cord. Haemangioblastoma may cause increased intracranial pressure and/or neurological deficits and remains the main cause of morbidity and mortality in VHL. Treatment of symptomatic haemangioblastoma remains neurosurgical and is often in emergency. Haemangioblastoma appears to be more commonly associated with VHL than previously reported and suggests that all patients with ‘sporadic’ haemangioblastoma should be investigated for evidence of VHL disease. From a fundamental point of view, haemangioblastoma is a benign neoplastic entity with a double, vascular and cellular differentiation. Mutational inactivation of both copies of the VHL gene plays a major role in the pathogenesis of haemangioblastoma. Over‐expression of vascular endothelial growth factor (VEGF) and VEGF‐receptors has been recently demonstrated in these tumours, raising the possibility of angioblastic origin, and is of very great interest in view of the direct implication of the VHL gene in negative regulation of VEGF.
Deoxycholic acid treatment in patients with cholesterol gallstones: failure to detect a suppression of cholesterol 7α‐hydroxylase activity
Authors: Hillebrant C.‐G. , Nyberg B. , Angelin B. , Axelson M. , Björkhem I. , Rudling M. , Einarsson C.
Published: March 2003

Abstract. Hillebrant C‐G, Nyberg B, Angelin B, Axelson M, Björkhem I, Rudling M, Einarsson C (Huddinge University Hospital and Karolinska Hospital, Karolinska Institute, Stockholm, Sweden). Deoxycholic acid treatment in patients with cholesterol gallstones: failure to detect a suppression of cholesterol 7α‐hydroxylase activity. J Intern Med 1999; 246: 399–407.

Objectives. Based on animal studies, hydrophobic bile acids have been postulated to be particularly strong inhibitors of bile acid synthesis. The present study was undertaken to characterize in humans the effects of one of the most hydrophobic of the common bile acids, deoxycholic acid (DCA), on the transcriptional regulation and activity of the cholesterol 7α‐hydroxylase, on hepatic cholesterol metabolism and on biliary lipid metabolism and plasma lipids.

Design, subjects and settings. Thirteen patients with cholesterol gallstone disease were treated with DCA (750 mg day–1) for 3 weeks prior to cholecystectomy. Blood samples were collected before and during treatment. At operation, a liver biopsy and gallbladder bile were obtained. Twenty‐eight untreated gallstone patients undergoing cholecystectomy served as controls. The study was carried out at a university hospital.

Results. Deoxycholic acid comprised 72 ± 6% (mean ± SEM) of total biliary bile acids in DCA‐treated patients (n = 8), and 21 ± 2% in the controls (n = 16; P < 0.001). Cholesterol saturation of gallbladder bile averaged 102% in both treated (n = 7) and untreated (n = 16) patients. Cholesterol 7α‐hydroxylase and HMG CoA reductase activities and mRNA levels were not different between DCA‐treated and untreated gallstone patients. The LDL receptor mRNA levels were similar in both groups of patients. Plasma levels of total cholesterol were lowered by 10% upon DCA treatment (P < 0.05).

Conclusions. Treatment with DCA did not significantly affect mRNA levels and activity of hepatic cholesterol 7α‐hydroxylase or HMG CoA reductase in patients with cholesterol gallstones. There was no effect on the saturation of gallbladder bile, Thus, the present study could not verify that the hydrophobicity of the bile acid pool is a major factor regulating human hepatic cholesterol 7α‐hydroxylase activity.
Randomized controlled trials and consensus as a basis for interventions in internal medicine
Authors: Nordin‐Johansson A. , Asplund K.
Published: March 2003

Abstract. Nordin‐Johansson A, Asplund K (Department of Medicine, University Hospital, Umeå, Sweden). Randomized controlled trials and consensus as a basis for interventions in internal medicine. J Intern Med 2000; 247: 94–104.

Objectives. To estimate the proportion of routine clinical interventions in internal medicine that are supported by the results of randomized controlled trials or consensus amongst experienced internists.

Design. Retrospective review of case records allowed one or more major diagnosis–intervention combination(s) to be identified for each patient. The scientific literature was searched for metaanalyses and randomized controlled trials in electronic databases that supported the specific intervention used. When support from randomized trials was lacking, possible consensus on management was sought by asking national expert panels of experienced clinicians.

Setting. Department of Medicine at a Swedish teaching hospital.

Subjects. At total of 197 consecutively admitted medical inpatients.

Results. Fifty per cent of the diagnosis–intervention combinations (186/369) were supported by results from randomized controlled trial evidence and 34% (125/369) were supported by consensus amongst experienced clinicians. The proportion of interventions based on randomised controlled trials was highest in patients with cardiac (64%) and other circulatory diagnoses (73%). There were no important differences between sexes or between age groups.

Conclusions. Half of the interventions used in routine clinical practice amongst medical inpatients are supported by results from randomized controlled trials. These results refute popular claims that only a small proportion of medical interventions are supported by scientific evidence.
Resting energy expenditure, growth hormone indices, body composition and adipose tissue distribution in premenopausal women
Authors: Armellini F. , Zamboni M. , De Pergola G. , Bissoli L. , Turcato E. , Giorgino R. , Bosello O.
Published: March 2003

Abstract. Armellini F, Zamboni M, De Pergola G, Bissoli L, Turcato E, Giorgino R, Bosello O (San Lorenzo Hospital, Valdagno; University of Verona, Verona; and University of Bari, Bari, Italy). Resting energy expenditure, growth hormone indices, body composition and adipose tissue distribution in premenopausal women. J Intern Med 2000; 247: 709–714.

Objectives. A significant growth hormone (GH) contribution to interindividual variance in energy expenditure (REE) in women can be hypothesized. The present study examines the independent association between physiological levels of GH function indices and REE.

Setting. All subjects were hospitalized in the Institute of Internal Medicine of the University of Verona.

Subjects. Twenty‐four premenopausal overweight (BMI = 28–55 kg m–2) women aged 18–49 years.

Interventions. REE was estimated by indirect calorimetry and body composition and fat distribution by single slice computed tomography method. GH activity and GH status were determined by measuring serum levels of insulin‐like growth factor I (IGF‐I) and insulin‐like growth factor binding protein‐3 (IGFBP‐3).

Results. GH indices did not show any significant correlation with REE. The relation between GH indices and REE was also examined by multiple regression analysis to account for possible confounders such as body composition, adipose tissue distribution and age. When body composition was considered, body fat and fat‐free mass were the only significant predictors of REE (R2 = 0.699, P = 0.0001). The contributions of GH indices were not significant.

Conclusions. Our findings do not support the hypothesis that GH in physiological conditions could be an independent determinant of REE in women with obesity.
Renal symptomatology in patients with acute intermittent porphyria. A population‐based study
Authors: Andersson C. , Wikberg A. , Stegmayr B. , Lithner F.
Published: March 2003

Abstract. Andersson C, Wikberg A, Stegmayr B, Lithner F (University Hospital, Umeå, Sweden). Renal symptomatology in patients with acute intermittent porphyria. A population‐based study. J Intern Med 2000; 248: 319–325.

Objective. Can renal insufficiency in subjects with acute intermittent porphyria (AIP) be due solely to AIP?

Design. A population‐based study.

Subjects. Subjects with AIP ≥ 18 years of age (n = 386) in the four most northerly counties of Sweden.

Interventions. Screening with creatinine clearance at 24 h. Patients below the lower reference level underwent a repeat clearance test and, if still low, also chromEDTA clearance.

Results. 286 (74%) subjects performed the creatinine clearance test and in 57 clearance was low; the second clearance proved normal in 23 who were then excluded. Eighteen subjects with other possible medical reasons for renal insufficiency, ethical reasons or refusing further examinations were also excluded. The 16 remaining subjects with no explanation for their renal insufficiency other than AIP were then studied in detail. All 14 women, mean age 52 years, and two uraemic men, 58 and 67 years, had manifest AIP. Twelve patients had hypertension (HT) and four were normotensive in spite of renal insufficiency. Histological findings of renal biopsies revealed diffuse glomerulosclerotic and interstitial changes with additional ischaemic lesions.

Conclusion. Protracted vasospasm in attacks of AIP may be a cause of renal lesions. This is discussed.
Liver fibrosis attributed to lipid lowering medications: two cases
Authors: Punthakee Z. , Scully L. J. , Guindi M. M. , Ooi T. C.
Published: March 2003

Abstract. Punthakee Z, Scully LJ, Guindi MM, Ooi TC (Department of Medicine, Division of Gastroenterology, Department of Pathology and the Laboratory of Medicine and the Division of Endocrinology and Metabolism, The Ottawa Hospital – Civic Campus, University of Ottawa, Ottawa, Canada). Liver fibrosis attributed to lipid lowering medications: two cases (Case Report). J Intern Med 2001; 250: 249–254.

We identified two cases of chronic active hepatitis with liver fibrosis induced by lipid lowering drugs of the statin and fibrate classes despite regular monitoring of transaminases. There are few reports of clinically significant hepatitis induced by these drugs and even fewer cases of fibrosis. Given the growing use of these drugs, there are implications for monitoring patients on long‐term therapy for liver damage.
Effect of second and third generation oral contraceptives on lipid metabolism in the absence or presence of the factor V Leiden mutation
Authors: Kemmeren J. M. , Algra A. , Grobbee D. E.
Published: March 2003

Abstract. Kemmeren JM, Algra A, Grobbee DE (University Medical Center Utrecht, Utrecht, The Netherlands). Effect of second and third generation oral contraceptives on lipid metabolism in the absence or presence of the factor V Leiden mutation. J Intern Med 2001; 250: 441–448.

Objectives. The effect of a second and third generation oral contraceptive and of the progestagens used in these pills on lipid metabolism was studied in the absence or presence of the factor V Leiden mutation.

Design. A single centre, double blind randomized trial.

Setting. University Medical Centre.

Subjects. A total of 51 women without and 35 women with the factor V Leiden mutation.

Interventions. A second generation (30 μg ethinylestradiol/150 μg levonorgestrel) or a third generation (30 μg ethinylestradiol/150 μg desogestrel) oral contraceptive. After two cycles of use and a wash‐out period of two cycles, the participants received the corresponding progestagen‐only preparation containing 150 μg levonorgestrel or 150 μg desogestrel.

Main outcome measures. Mean difference in changes between the treatment groups on total cholesterol, HDL, LDL, triglycerides and total/HDL cholesterol ratio.

Results. Compared with levonorgestrel, desogestrel‐containing oral contraceptives caused in women without the factor V Leiden mutation significant changes in HDL (0.43; 95% confidence interval [CI] 0.25–0.61), LDL (–0.55; 95% CI –0.90 to –0.20), triglycerides (0.19; 95% CI 0.06–0.32) and total/HDL cholesterol ratio (–0.87; 95% CI –1.21 to –0.53). When the progestagen‐only preparations were used, differential changes were found for HDL (0.16; 95% CI 0.03–0.29), LDL (–0.31; 95% CI –0.56 to –0.05) and total/HDL cholesterol ratio (−0.55; 95% CI –0.84 to –0.26). Desogestrel‐only caused changes opposite to those of desogestrel‐containing oral contraceptives. For cholesterol and triglycerides, this effect was also found for levonorgestrel‐only in comparison with levonorgestrel‐combined oral contraceptives. Levonorgestrel appeared to induce the effect on HDL. Almost all results were similar for women with the factor V Leiden mutation.

Conclusion. It appears that desogestrel counteracts the effects of oestrogens to a lesser extent than levonorgestrel. Desogestrel‐containing oral contraceptives have therefore a more favourable influence on cholesterol metabolism in comparison with levonorgestrel‐containing oral contraceptives.
Relationship between anti‐neutrophil cytoplasmic antibody determined with conventional binding and the capture assay, and long‐term clinical course in vasculitis
Authors: Gisslén K. , Wieslander J. , Westberg G. , Herlitz H.
Published: March 2003

Gisslén K, Wieslander J, Westberg G, Herlitz H (Sahlgrenska University Hospital, Göteborg; and Wieslab AB, Lund; Sweden). Relationship between anti‐neutrophil cytoplasmic antibody (ANCA) determined with conventional binding and the capture assay, and long‐term clinical course in vasculitis. J Intern Med 2002; 251: 129–135.

Objectives. To evaluate the relationship between anti‐neutrophil cytoplasmic antibody (ANCA) measured with two different methods and long‐term clinical course in vasculitis.

Design. Retrospective determination of ANCA with two different assays for detection of PR3‐ANCA, conventional direct binding ELISA and capture ELISA using monoclonal antibodies against PR3. The 245 ANCA determinations were performed from frozen blood samples collected three to four times a year in each patient.

Setting. Department of Nephrology at a Swedish University Hospital.

Subjects. A total of 10 ANCA‐positive patients with vasculitis caused by Wegener’s granulomatosis (WG) or microscopic polyarteritis (MPA) and a very long follow‐up time (mean 9 years, range 5–15.5 years).

Results. The total number of episodes with active vasculitis was 29 and all of them (100%) were detected by the capture technique whilst the conventional technique detected 23 (79%). The mean number of episodes with active disease requiring treatment with steroids and cytotoxic drugs was three per patient (range 1–6). At the time of clinical relapse of the vasculitis disease, the ANCA titre using the capture technique was either increasing or showed a very high value in all cases. The pattern of capture ANCA response could be subdivided into three categories: a close (four patients), an intermediate (three patients), and no (three patients) relationship between capture ANCA level and long‐term clinical course.

Conclusion. Detection of PR3‐ANCA by the capture ELISA showed a higher sensitivity than that obtained by the direct ELISA in diagnosing relapse during follow‐up of patients with vasculitis. The specificity of the capture ANCA was, however, low, as high levels occurred in patients without clinical disease activity.
Chlamydia pneumoniae IgA‐ and IgG antibodies in young survivors of myocardial infarction. A comparison of antibody detection by a microimmunofluorescence test and an enzyme immunoassay
Authors: Halvorsen D. S. , Børvik T. , Njølstad I. , Gutteberg T. J. , Vorland L. H. , Hansen J.‐B.
Published: March 2003

Abstract. Halvorsen DS, Børvik T, Njølstad I, Gutteberg TJ, Vorland LH, Hansen J‐B (University Hospital of Tromsø; and Institute of Community Medicine, Tromsø, Norway). Chlamydia pneumoniae IgA‐ and IgG antibodies in young survivors of myocardial infarction. A comparison of antibody detection by a microimmunofluorescence (MIF) test and an enzyme immunoassay (EIA). J Intern Med 2002; 251: 142–147.

Objectives. Chronic Chlamydia pneumoniae infection is considered as a cardiovascular risk factor and antibodies are commonly analysed by the subjective microimmunofluorescence (MIF) test. We wanted to investigate the C. pneumoniae IgA‐ and IgG seroprevalence in young survivors of myocardial infarction and matched controls, and to compare the agreement of detecting antibodies between a MIF test and an enzyme immunoassay (EIA).

Design. A total of 61 patients hospitalized as a result of myocardial infarction, 51 patients hospitalized with chest pain and negative exercise‐ECG and 61 age and sex matched controls (mean age 53.3 years, range 40–60 years) were included in this case–control study. Serological comparisons were expressed as sensitivity, specificity and interrater agreement (K or Kw) of the EIA test related to the MIF test.

Results. Presence of IgA (cut off=16) antibodies was significantly higher in coronary heart patients compared with controls for both assays (P=0.02 by the MIF and P=0.05 by the EIA test). The presence of IgG (cut off=32) antibodies was significantly higher amongst patients (P=0.05) when analysed by the MIF‐test, but not with the EIA‐test (P=0.16). The strength of agreement between the assays was good for both IgA‐ (Kw=0.67) and IgG (Kw=0.79) analyses. However, only 52.8% of the IgA samples classified as strong positive (cut‐off=32) by the MIF test were strong positive by the EIA test (K=0.56). Only 73.2% of the negative IgG samples (<32) by the MIF‐test turned out negative by the EIA‐test (K=0.73).

Conclusions. Dependent on assay and cut‐off level, there is an increased C. pneumoniae IgA‐ and IgG seroprevalence in young survivors of myocardial infarction compared with controls. Despite the subjective interpretation of MIF‐titres, the strength of agreement between the EIA and MIF tests was good for both antibody classes. However, misclassification of highly positive IgA samples and negative IgG samples by the MIF test may influence study conclusions. We conclude that the choice of serological method is of major importance when evaluating a possible relationship between C. pneumoniae and coronary heart disease.
The effect of tibolone on the lipoprotein profile of postmenopausal women with type III hyperlipoproteinemia
Authors: De Beer F. , Smelt A. H. M. , Van Vark L. C. , Hoogerbrugge N. , Havekes L. M. , Gevers Leuven J. A.
Published: March 2003

Abstract. de Beer F, Smelt AHM, van Vark LC, Hoogerbrugge N, Havekes LM, Gevers Leuven JA (Gaubius Laboratory, Leiden; Leiden University Medical Center, Leiden; and University Hospital Dijkzigt, Rotterdam, The Netherlands). The effect of tibolone on the lipoprotein profile of postmenopausal women with type III hyperlipoproteinemia. J Intern Med 2002; 251: 148–155.

Objective. To investigate the short‐term effect of treatment with tibolone on plasma lipid and lipoprotein levels in postmenopausal women with type III hyperlipoproteinemia (HLP).

Design and intervention. Patients were randomized to receive, in a double‐blind cross‐over fashion, a fixed dose of tibolone, 2.5 mg once daily or placebo for 8 weeks. The two treatment periods were separated by a wash‐out period of 6 weeks. At each visit body weight and blood pressure were determined. Before and after each treatment period, fasting venous blood samples were obtained from the patients for biochemical measurements.

Setting. The Leiden University Medical Center.

Subjects. Postmenopausal women with type III HLP (aged ≤65 years) were recruited from the Lipid Clinics of the Leiden University Medical Center, the Amsterdam Medical Center, the Utrecht Medical Center and the University Hospital Rotterdam. Five out of 25 women with type III HLP were eligible to be included in the study. Four of the five included patients completed the study according to the protocol. One patient was excluded from blinded therapy because total cholesterol levels increased above 20 mmol L–1.

Main outcome measures. A significant reduction of plasma triglyceride, total cholesterol, VLDL cholesterol and VLDL triglyceride levels.

Results. Plasma triglyceride and total cholesterol levels decreased from 6.82 ± 3.58 to 2.45 ± 1.36 mmol L–1 and from 13.53 ± 3.64 to 6.61 ± 2.03 mmol L–1, respectively (both P < 0.05). The body mass index remained unchanged. The glycated haemoglobin percentage decreased significantly from 5.8 to 5.3%. Treatment with tibolone resulted in a profound reduction in plasma apolipoprotein E, VLDL cholesterol and VLDL triglyceride levels (mean reductions of 66, 77 and 70%, respectively, P < 0.05).

Conclusions. Tibolone is a valuable adjuvant to current therapy in postmenopausal women with type III HLP.
Body position and blood pressure measurement in patients with diabetes mellitus
Authors: NETEA R. T. , ELVING L. D. , LUTTERMAN J. A. , THIEN TH.
Published: March 2003

Abstract. Netea RT, Elving LD, Lutterman JA, Thien Th (University Medical Center, The Netherlands). Body position and blood pressure measurement in patients with diabetes mellitus. J Intern Med 2002; 251: 393–399.

Aims. World Health Organization (WHO) guidelines recommend that the blood pressure (BP) should be routinely measured in sitting or supine followed by standing position, providing that the arm of the patient is placed at the level of the right atrium in each position. The aim of our study was to test the influence of body and arm position on BP measurement in diabetic patients.

Methods. In 142 patients with diabetes mellitus the BP was measured using a semiautomatic oscillometric device (Bosomat‐R): (i) after 5 min of rest sitting on a chair with one arm supported at the right atrial level and with the other arm placed on the arm support of the chair, (ii) after 5 min of rest lying on a bed with both arms placed on a bed, and (iii) after 30 s and after 2 min of standing with one arm (the same as in sitting position) supported at the right atrial level and with the other arm vertical, parallel to the body.

Results. Both systolic (SBP) and diastolic (DBP) blood pressures were significantly lower in sitting position with the arm at the right atrial level than in supine position (by 7.4 and 6.6 mmHg, respectively, P < 0.01). In sitting and standing positions, SBP and DBP were higher when the arm was placed either on the arm support of the chair or vertical, parallel to the body, than when the arm was supported at the level of the right atrium (by 6–10 mmHg, P < 0.001). Duration of standing did not influence the estimation of orthostatic hypotension.

Conclusions. The data of this study indicate that the WHO recommendation with regard to the equivalence of sitting and supine BP readings is incorrect at least in diabetic patients, as the sitting BP is lower than the supine BP when the arm was positioned at the right atrial level. In addition, incorrect positioning of the arm in standing position results in an underestimation of prevalence of orthostatic hypotension. We conclude that during BP measurement the arm should be placed at the right atrial level regardless of the body position.
Ten‐year mortality for patients discharged after hospitalization for chest pain or other symptoms raising suspicion of acute myocardial infarction in relation to hospital discharge diagnosis
Authors: Herlitz J. , Karlson B. W. , Sjölin M. , Lindquist J.
Published: March 2003

Abstract. Herlitz J, Karlson BW, Sjölin M, Lindqvist J (Sahlgrenska University Hospital, Göteborg, Sweden). Ten‐year mortality for patients discharged after hospitalization for chest pain or other symptoms raising suspicion of acute myocardial infarction in relation to hospital discharge diagnosis. J Intern Med 2002; 251: 526–532.

Aim. To describe the 10‐year prognosis for patients discharged after hospitalization for chest pain or other symptoms giving an initial suspicion of acute myocardial infarction (AMI) in relation to the final hospital diagnosis and furthermore to compare the outcome amongst these patients with the outcome amongst a sex‐, age‐ and community‐matched con‐ trol population.

Methods. All patients who were hospitalized because of chest pain or other symptoms raising a suspicion of AMI and who were discharged alive from hospital. Patients were divided into three groups according to the final diagnosis: (1) confirmed or possible AMI, (2) confirmed or possible myocardial ischaemia and (3) other aetiology. Information on 10‐year mortality was available in 3103 patients. A sex‐, age‐ and community‐matched control population (n=3221) was compared with the study population in terms of 10‐year mortality.

Time of the survey. 15 February 1986 to 9 November 1987.

Setting. Sahlgrenska University Hospital.

Results. Patients with confirmed or possible AMI (n=849) had a significantly higher mortality (59.4%) than patients with confirmed or possible myocardial ischaemia (n=1191) who had a mortality of 49.5% (P < 0.0001). The latter group had a higher mortality than patients with `other aetiology' (n=1063) of whom 40.6% died (P < 0.0001). When comparing the prognosis for patients with AMI and myocardial ischaemia, there was a significant interaction with sex, with a more marked difference in women than in men. Amongst all patients, the 10‐year mortality was 49.1 vs. 37.3% in the control group (P < 0.0001).

Conclusion. The very long term prognosis was strongly associated with diagnosis amongst patients hospitalized and discharged alive because of chest pain or other symptoms raising suspicion of AMI. The absolute mortality difference between patients who were discharged from hospital with confirmed diagnosis of AMI and those whose symptoms were considered to have other aetiology than AMI or ischaemia was nearly 20%. However, the absolute mortality difference between the patients included in the survey and a control population was only 12%.
Rescue percutaneous transluminal coronary angioplasty in a patient with a single coronary artery arising from the right Sinus Valsalvae: previously unreported scenario and review of literature
Authors: ZWEIKER R. , LUHA O. , KLEIN W. W.
Published: March 2003

Abstract. Zweiker R, Luha O, Klein WW (Karl‐Franzens University Hospital, Austria). Rescue percutaneous transluminal coronary angioplasty in a patient with a single coronary artery arising from the right Sinus Valsalvae: previously unreported scenario and review of literature (Case Report). J Intern Med 2002; 252: 84–87.

This is the first description of treatment with coronary stenting of a patient with a single coronary artery originating from the right Sinus Valsalvae and suffering from acute inferior myocardial infarction. Angiography showed the following: the right coronary artery (RCA) had a normal course, whilst the left anterior descending (LAD) as well as the left circumflex (LCX) branches both originated separately from the proximal RCA, which served as a common mixed trunk. The LAD crossed to the left in front of the right ventricular outflow tract, whilst the LCX, taking a retroaortic course to the atrioventricular groove, had a distal occlusion. According to an anatomically based classification considering all imaginable variations, this configuration corresponds to a II‐D‐1 pattern, which previously has been described only in a single postmortem case. After the LCX was reopened with a guide wire, a coronary stent was successfully inserted, resulting in TIMI‐3 flow. Recovery was uneventful.
Insulin resistance is accompanied by increased von Willebrand factor levels in nondiabetic women: a study of offspring of type 2 diabetic subjects compared to offspring of nondiabetic subjects
Authors: Foss C. H. , Vestbo E. , FrØland A. , Ingerslev J. , Gjessing H. J. , Mogensen C. E. , Damsgaard E. M.
Published: March 2003

Abstract. Foss CH, Vestbo E, frøland A, Ingerslev J, Gjessing HJ, Mogensen CE, Damsgaard EM (Aarhus University Hospital, Aarhus, Denmark; Fredericia Hospital Fredericia, Denmark). Insulin resistance is accompanied by increased von Willebrand factor levels in nondiabetic women: a study of offspring of type 2 diabetic subjects compared to offspring of nondiabetic subjects. J Intern Med 2002; 252: 155–163.

Objectives.  To examine whether levels of von Willebrand factor (vWF), fibrinogen and fibronectin are related to a parental history of type 2 diabetes and to determine possible explanatory factors for high versus low vWF and fibrinogen.

Design.  Cross‐sectional study.

Subjects, main outcome measures.  We compared vWF, fibrinogen and fibronectin in 88 nondiabetic offspring of type 2 diabetic subjects (relatives) and 103 offspring of nondiabetic subjects (controls). Other measurements included urinary albumin excretion rate, blood pressure, lipid profile and insulin resistance using homostatis model assessment (HOMAIR).

Results.  There were no significant differences in vWF (1.12 vs. 1.06 IU mL−1, P = 0.296), fibrinogen (3.2 vs. 3.1 g L−1; P = 0.263) or fibronectin (0.39 vs. 0.40 g L−1, P = 0.448) between relatives and controls. With multiple logistic regression we determined explanatory factors for high versus lowvWF and fibrinogen. Age (P < 0.01), urinary albumin excretion rate (P < 0.05), ischaemic heart disease (IHD) (P < 0.05) were found to be significant explanatory factors for vWF above the median (1.10 IU mL−1). Interaction between insulin resistance and sex was found. Odds ratio for high versus low insulin resistance was 18.39 (P < 0.001) for women and 1.92 (P = 0.32) for men. Body mass index (BMI) (P < 0.05), sex (P < 0.01), smoking status (P < 0.05) and IHD (P < 0.01) were significant explanatory factors for fibrinogen above the median (3.1 g L−1).

Conclusions.  Levels of vWF, fibrinogen and fibronectin were not influenced by a parental history of type 2 diabetes. Insulin resistance was found to be a significant risk indicator for high vWF only in women. This may indicate that insulin resistance is a higher risk factor for women than for men, when the outcome is endothelial dysfunction possibly resulting in overt cardiovascular disease.
The G‐455A polymorphism of the fibrinogen BΒ‐gene relates to plasma fibrinogen in male cases, but does not interact with environmental factors in causing myocardial infarction in either men or women
Authors: Leander K. , Wiman B. , Hallqvist J. , Falk G. , De Faire U.
Published: March 2003

Objectives.  To elucidate the association between a genetic polymorphism of the fibrinogen Bβ‐gene (G‐455A) and plasma fibrinogen levels and myocardial infarction (MI), respectively. In addition, to explore potential synergistic gene–environment interactions involving this polymorphism – until now, these data were unavailable.

Design setting and subjects.  This case‐referent study of subjects aged 45–70 and living in Stockholm includes 834 men and 346 women with first‐time MI and 1034 men and 494 women randomly chosen as referents from the population. The cases were identified between 1992 and 1994 at the 10 emergency hospitals in Stockholm County.

Main outcome measures.  MI and plasma fibrinogen levels.

Results.  Crude analyses associated a high level of plasma fibrinogen with an increased risk of MI in both men and women. However, the relative risk decreased after controlling for other risk factors. The multivariate‐adjusted odds ratio (OR) (95% confidence interval) was 1.6 (1.2–2.3) for men and 1.5 (0.9–2.6) for women. Presence of the A allele at the G‐455A polymorphic site indicated higher plasma fibrinogen levels than the presence of the G allele, but the difference was only statistically significant for male cases. The ‐455A allele was not associated with an increased risk of MI. Furthermore, there were no strong indications of synergistic interaction between the G‐455A polymorphism and any of the environmental exposures considered.

Conclusions.  In this large number of MI cases and referents, a high level of plasma fibrinogen was independently associated with increased risk of MI in men but not in women. The presence of the A allele at the G‐455A polymorphism of the fibrinogen Bβ‐gene was not associated with increased risk of MI, and no synergistic gene–environment interactions were detected.
The molecular genetics of cardiovascular disease: clinical implications
Authors: Stephens J. W. , Humphries S. E.
Published: March 2003

Abstract. Stephens JW, Humphries SE (University College London, London). The molecular genetics of cardiovascular disease: clinical implications (Review). J Inter Med 2003; 253: 120–127.

Coronary heart disease (CHD) is one of the main leading causes of death worldwide. CHD is a complex condition resulting from numerous gene–gene and gene–environment interactions. A large number of candidate genes exist. We review the evidence for the role of apolipoprotein E, lipoprotein lipase and interleukin‐6 in CHD and their interaction with smoking (an environmental risk). The main objective of genetic research into CHD is to provide a complete risk assessment, complementing the well‐studied traditional clinical and biochemical risk factors. Unravelling the role that functional gene polymorphisms play in determining risk, and in determining the levels of intermediate phenotypes is crucial to our understanding of the key metabolic pathways and physiology not only in the diseased, but also in the disease‐free state. The identification of new molecules (implicated in the relevant metabolic pathways) may subsequently lead to potential targets for therapeutic intervention. Improving our molecular understanding may also lead to the development of improved diagnostics. Sequencing of the entire genome is now a reality. Advances in technology, such as the development of ‘gene chips’ may allow us to study 100 000 genes at a time on a single chip. Such advances will amplify the power available to us in the realms of research into genetic physiology and interaction with environmental stimuli. The insights that these novel approaches may yield are eagerly awaited.
Ribosome substructure investigated by scanning force microscopy and image processing
Authors: Fritzsche  , Henderson
Published: March 2003

Scanning force microscopy was used to study the ultrastructure of eukaryotic ribosomes from Chironomus pallidivittatus in the polysomal complex. Positively stained polysomes were imaged, and the resulting three‐dimensional ribosomal structures were further processed by statistical analyses of virtual cross‐sections parallel to the substrate plane. Structural investigations were based on parameters which are minimally influenced by the tip geometry, like section plane centre or axis ratio. In the lower part of the structure a shift of the section centres was observed, suggesting an attached structure. The geometry of the sections revealed an elliptical shape in the upper part (axis ratio 1.52 ± 0.22), with a less elongated shape in the lower region (axis ratio 1.41 ± 0.18). A model for the surface topography of a positively stained ribosome exhibiting a small subunit attached along the long side of an elliptical large structure is proposed.
Evaluating the performance of fluorescence microscopes
Authors: Murray
Published: March 2003

A simple means of evaluating the performance of fluorescence microscopes is described. The proposed test gives an overall figure of merit that takes into account all of the important instrumental parameters that determine image quality. The essence of the test is to use a specimen whose photobleaching rate is a measure of the illumination time–intensity integral. When this time–intensity integral is controlled, the signal‐to‐noise ratio in the image of small subresolution objects becomes a system‐independent measure of light throughput, resolution and intrinsic noise.
Fuzzy logic approaches to the analysis of HREM images of III–V compounds
Authors: Hillebrand R.
Published: March 2003

It is known that high‐resolution electron microscopy (HREM) can provide quantitative information on the properties of crystalline materials. The HREM patterns of layered structures of III–V semiconductors vary with the chemical composition of the latter within the sublattices, which is also influenced by interdiffusion. Local variations of the crystal cell similarity are recorded for image analysis and compared with templates of known material composition.

Of the advanced theories of data interpretation, the now well‐established fuzzy logic is highly suited for corresponding image processing techniques. Combining neighbouring image cell similarities, the underlying chemical composition is evaluated by applying fuzzy logic criteria of inference to masks of about 1 nm × 1 nm in size.

The new approach can be used to localize regions of significant changes in composition, i.e. edge detection, and to determine the composition across the interface region. The methods introduced prove successfully applicable to simulated as well as to experimental images of AlAs/AlxGa1−xAs. Similarity/composition relations of nonlinear as well as nonmonotonic characteristics are studied to establish an alternative fuzzy logic approach.
A study of charge distribution in Bi2Sr2CaCu2O8+δ superconductors using novel electron‐diffraction and imaging techniques
Authors: ZHU  , WU  , TAFTO
Published: March 2003

We report our study of the distribution of valence electrons in Bi2Sr2CaCu2O8+δ high‐temperature superconductors using novel electron‐diffraction and imaging techniques. The former method was based on quantitative analyses of the diffraction intensity of many reflections as a function of crystal thickness to determine, with an unprecedented accuracy, the Fourier components of the electron distribution in Bi2Sr2CaCu2O8+δ. The latter was based on examining the effect of charge transfer on many‐beam imaging by comparing the observed and calculated low‐ and high‐resolution images of long‐period displacive and charge modulation of the cuprate. Our study demonstrates that fast electrons have greater sensitivity than X‐rays to valence electrons distribution at small scattering angles, and that electron microscopy is a powerful tool in revealing charge distribution in materials.
Localization of lead in Allium cepa L. cells by electron microscopy
Authors: Antosiewicz  , Wierzbicka
Published: March 2003

The study of mechanisms by which plants tolerate lead requires ultrastructural observations of lead distribution in cells. However, the conventional technique used in electron microscopy brings up the problem of lead translocation from tissues during chemical processing. If most of the lead is washed out of tissues, then the method is not suitable for this type of study; if, however, it remains in the tissues, the method can be used. The amount of lead washed out of Allium cepa root tips during successive stages of fixing and dehydrating was determined in this study. Allium cepa plants were treated with Pb(NO3)2 in hydroponic cultures. The conventional fixing (GA, OsO4) and dehydration (alcohol + propylene oxide or acetone) methods used in the preparation of tissues for electron microscopy were then applied to root tips. The lead content in tissues and in reagents was analysed in the successive stages of the procedure. It was shown that 96.2% of the lead taken up was retained in the tissues and was not washed out during fixing and dehydrating. Of the 3.8% of the lead lost in the chemical procedure, about half was washed out during fixing in osmium tetroxide. This reagent is thus the least suitable for this type of study. Our study showed that the conventional electron microscopy preparative technique is appropriate for studying the distribution of lead deposits in A. cepa root cells, owing to the way in which lead is compartmentalized/sequestered in plant cells.
Evanescent‐wave scattering in near‐field optical microscopy
Authors: Wannemacher R. , Quinten M. , Pack A.
Published: March 2003

Extended Mie theory is used to investigate the scattering and extinction of evanescent waves by small spherical particles and aggregates of such particles. Metallic, dielectric and metal‐coated dielectric particles are taken into consideration. In contrast to plane‐wave excitation, p‐ and s‐polarized spectra differ in the case of evanescent waves due to the inherent asymmetry of both polarizations. Furthermore, contributions from higher multipoles are strongly enhanced, compared with plane‐wave excitation, and the enhancement factors are polarization dependent. The corresponding changes in the scattering and extinction spectra are most pronounced in cases where higher multipoles exhibit resonances in the spectral range considered. This applies, for example, to morphological resonances of dielectric particles with size parameters > 1. The effect of the surface, where the evanescent wave is generated by total internal reflection, on the scattering and extinction spectra is investigated via numerical field calculations employing the multiple multipole method. In an application to apertureless near‐field optical microscopy, the variation of the scattered power is calculated when a silicon particle is scanned across a silver particle in the evanescent field.
A novel fabrication method for fluorescence‐based apertureless scanning near‐field optical microscope probes
Authors: Kramper P. , Jebens A. , Müller T. , Mlynek J. , Sandoghdar V.
Published: March 2003

We report a novel method for the fabrication of probes with localized sub‐wavelength fluorescing media at their extremities. We present our first results and discuss future plans to extend this technique to the systematic fabrication of fluorescent probes for apertureless scanning near‐field optical microscopy.
Field enhancement and apertureless near‐field optical spectroscopy of single molecules
Authors: Azoulay J. , Débarre A. , Richard A. , Tchénio P.
Published: March 2003

We report on fluorescence enhancement in near field optical spectroscopy by apertureless microscopy. Our apertureless microscope is designed around a confocal fluorescence microscope associated with an AFM head. First, we show that the confocal microscope alone allows single molecule imaging and single molecule fluorescence analysis. When associated with the AFM head, we demonstrate, for the first time to our knowledge, that single molecule fluorescence is enhanced under the silicon tip. We tentatively attribute this effect to field enhancement under the tip.