bluuebunny/crossref_metadata_2025 huggingface dataset:
Muscle fibre composition and glycogen synthase activity in hypertension‐prone men
Authors: Endre  , Mattiasson  , Berglund  , HulthÉn
Published: March 2003

Endre T, Mattiasson I, Berglund G, Hulthén UL (Malmö University Hospital, Lund University, Malmö; Sweden). Muscle fibre composition and glycogen synthase activity in hypertension‐prone men. J Intern Med 1998; 243: 141–147.

Objectives

To study muscle fibre characteristics and glycogen synthase activity in relation to peripheral glucose disposal in skeletal muscle in hypertension‐prone men.

Design

The hyperinsuliemic euglycemic clamp method was used to calculate insulin sensitivity index (M/I). Muscle biopsies were performed for the analysis of slow‐twitch (ST) and fast twitch (FT, low insulin sensitivity and low capillarisation compared to ST fibres) muscle fibres, capillarisation (number of capillaries per fibre) and diffusional index (mean area per fibre divided by capillarisation) of muscle fibres, capillary density (capillaries mm−2 muscle fibre) and glycogen synthase activity.

Subjects

Thirty‐two young, healthy, normotensive men with a family history of hypertension (REL) were compared to 25 age‐matched men with no family history of hypertension (CON) and similar body mass index (BMI).

Results

REL had a lower M/I (P = 0.021), lower capillarisation (P = 0.04) and a tendency of a lower diffusional index of subgroup b of FT muscle fibres (P = 0.10) compared to CON. Glycogen synthase activity did not differ between the groups.

Conclusions

Men with a family history of hypertension have less capillaries per FTb fibre and greater diffusion distance from the capillary to the muscle cell compared to controls, which may be a contributory factor to the lower insulin sensitivity in the former group. However, additional investigations are needed to study the casuality in this association.
Individuals with high total cholesterol/hdl cholesterol ratios are insulin resistant
Authors: Jeppesen  , Facchini  , Reaven
Published: March 2003

Jeppesen J, Facchini FS, Reaven GM. (The Department of Medicine, Stanford University School of Medicine, Stanford, and Shaman Pharmaceuticals Inc., South San Francisco, CA, USA). Individuals with high total cholesterol/hdl cholesterol ratios are insulin resistant. Journal of Internal Medicine 1998; 243: 293–98.

Objectives

To define the pathophysiologic characteristics of patients at high risk for coronary heart disease due to an increased ratio of total cholesterol (TC) to high density lipoprotein‐cholesterol (HDL‐C).

Design

Cross‐sectional.

Setting

Clinical Research Center.

Subjects

One hundred‐20 healthy, non‐diabetic, normotensive, volunteers were screened for this study. From this pool, 40 individuals (20 females and 20 males) with the highest and the lowest TC/HDL‐C ratios were selected for comparison.

Main Outcome Measures

Values for body mass index (BMI), ratio of waist to hip girth (WHR), and blood pressure were obtained on all patients. In addition, measurements were made of fasting lipid and lipoprotein concentrations, plasma glucose and insulin responses to an oral glucose challenge, and insulin resistance as assessed by the insulin suppression test.

Results

Age, BMI, and WHR were the same in the two groups. However, the group with a high TC/HDL‐C ratio had higher (P < 0.05) systolic and diastolic blood pressures. In addition, patients with a high TC/HDL‐C ratio had significantly higher (P < 0.001) very low density (VLDL) and low density lipoprotein (LDL)‐cholesterol concentrations and lower HDL‐cholesterol concentrations, with significant (P < 0.001) correlations between the TC/HDL‐C ratio and VLDL (r= 0.60), LDL (r= 0.54), and HDL (r=− 0.73) cholesterol concentrations. Patients with a high TC/HDL‐C ratio were also significantly (P < 0.05–0.001) more insulin resistant, glucose intolerant with a greater plasma insulin response to oral glucose, and hypertriglyceridemic.

Conclusions

The results indicate that an increase in LDL‐cholesterol concentration is not necessarily the major contributor to a high ratio of TC/HDL‐C. Furthermore, individuals with this epidemiologic designation are insulin resistant, and liable to all the other abnormalities associated with this metaboic defect.
Nephron‐sparing surgery and renal transplantation in patients with renal cell carcinoma and von Hippel–Lindau disease
Authors: Goldfarb
Published: March 2003

Goldfarb DA (Cleveland Clinic Foundation, Cleveland, Ohio, USA). Nephron‐sparing surgery and renal transplantation in patients with renal cell carcinoma and von Hippel–Lindau disease (Minisymposium: MEN & VHL). J Intern Med 1998; 243: 563–7.

Renal cell carcinoma is a common manifestation of von Hippel–Lindau disease and an important cause of mortality in these patients. A contemporary approach to the treatment of localized renal cell carcinoma is outlined based upon several recently conducted multicentre reviews. When technically feasible nephron‐sparing surgery can preserve renal function without compromising long‐term survival in most patients. For those who develop end‐stage renal failure as a result of treatment for renal cell carcinoma, excellent results with a limited risk for development of recurrence can be obtained with renal transplantation.
Does admission to a department of internal medicine improve patients' quality of life?
Authors: Eriksen  , Kristiansen  , Nord  , Pape  , Almdahl  , Hensrud  , Jæger  , Mürer  , Robertsen  , Thorsen
Published: March 2003

Abstract. Eriksen BO, Kristiansen IS, Nord E, Pape JF, Almdahl SM, Hensrud A, Jæger S, Mürer FA, Robertsen R, Thorsen G (University Hospital of Tromsø; University of Tromsø; National Institute of Public Health, Oslo; Kommunelegekontoret i Bardu, Bardu; Nordland Central Hospital, Bodø; Rana Hospital, Mo; Åsgård Psychiatric Hospital, Tromsø; and Harstad sykehus, Harstad, Norway). Does admission to a department of internal medicine improve patients' quality of life?J Intern Med 1998; 244: 397–404.

Objectives

The Tromsø Medical Department Health Benefit Study was designed to estimate health gains from admissions to a department of internal medicine. We have previously reported that the hospital stays had no effect on the life expectancy of 61% of the patients. However, it has been claimed that modern medicine has a greater effect on quality of life (QoL) than on life expectancy. The aim of the present study was to investigate this issue by estimating gains in QoL for patients admitted to a department of internal medicine.

Design

The time trade‐off method (TTO) was used for assessing QoL gain from consecutive admissions during a 6‐week period. The assessments were made by one of two expert panels, each consisting of an internist, a surgeon and a general practitioner, on the basis of summaries of all relevant clinical information about the patients. Short‐term improvements in QoL during the stay or shortly after discharge were scored on an ordinal scale.

Results

Of the admitted patients, 41% had gains in QoL measured with the TTO (mean gain = 0.06; 95% confidence interval = 0.05–0.07; n = 422), and eight of these had gains equal to or greater than 0.50. Another 40% had gains in health‐related short‐term QoL measured with the ordinal scale. In a multivariate linear regression analysis, emergency admissions, high age and the disease categories ‘endocrinological diseases’ and ‘pneumonia and influenza’, were associated with higher gain, and ‘undiagnosed symptoms’ and ‘cerebrovascular diseases’ with lower gain.

Conclusions

As judged by the expert panels, the investigated department of internal medicine was effective in improving the QoL of 81% of the admitted patients. Whilst most of the patients achieved small gains, a minority had gains in QoL corresponding to the treatment of life‐threatening diseases.
Hereditary haemorrhagic telangiectasia: a population‐based study of prevalence and mortality in Danish patients
Authors: Kjeldsen A. D. , Vase P. , Green A.
Published: March 2003

Introduction. Hereditary haemorrhagic telangiectasia (HHT) is a dominantly inherited disease characterized by telangiectatic lesions. The disease manifestations are variable and include epistaxis, gastrointestinal bleeding, pulmonary arteriovenous malformations and cerebral arteriovenous malformations. Early death due to these complications has been described.

Design. We report a study on the prevalence and mortality of HHT in a Danish population based on two cross‐sectional surveys in combination with a long‐term follow‐up study.

Settings and subjects. Prevalent cases of HHT as of 1 January 1974 in the County of Fyn, Denmark, were identified. In 1995–97 a follow‐up study of mortality was performed of the initial patient sample, and a new point prevalence rate of HHT as of 1 January 1995 was calculated. All live patients and their families were invited to attend a detailed clinical examination.

Results. The prevalence of HHT in the County of Fyn was 13.8 per 100 000 on 1 January 1974 and 15.6 per 100 000 on 1 January 1995. In the HHT group as a whole, we found a slightly increased mortality; however, amongst the HHT patients younger than 60 years at inclusion the mortality of HHT patients was twice the expected. The excess mortality could be fully explained by severe HHT symptoms.

Conclusion. This study suggests that HHT is more prevalent than previously believed. In young patients the disease is associated with an excess mortality which is fully attributable to HHT. Future research should aim at the identification of HHT patients at particular risk of developing severe complications.
The snack is critical for the blood glucose profile during treatment with regular insulin preprandially
Authors: Orre‐Pettersson A.‐C. , Lindström T. , Bergmark V. , Arnqvist H. J.
Published: March 2003

Objectives. To evaluate how a snack influences the blood glucose profile during treatment with preprandial regular human insulin.

Design. In a randomized study a mid‐morning snack either was or was not served. Insulin was given 30 min before the usual breakfast of the patients. Plasma free insulin and blood glucose were repeatedly determined for 5 h.

Setting. Outpatient clinic at a university hospital.

Subjects. Twenty patients with type 1 diabetes treated with multiple injections of regular insulin (Actrapid®) and eight non‐diabetic subjects.

Interventions. A mid‐morning snack either was or was not served 2 h after the usual morning insulin injection.

Main outcome measures. A difference in the blood glucose profile after a mid‐morning snack.

Results. With a snack there was no difference in blood glucose fasting and at 12.30 h, whilst without a snack there was a decrease of almost 4 mmol L−1, several patients experienced low blood glucose and three had hypoglycaemia. An extended peak of free insulin was reached 30 min after the insulin injection with a slow decrease to the fasting level after 5 h. After the insulin injection a significant decrease in blood glucose occurred within 30–45 min

Conclusions. A snack 2 h after the insulin injection results in a smoother blood glucose profile and reduces the risk of hypoglycaemia in patients with type 1 diabetes treated with preprandial regular human insulin. Furthermore, the recommended interval of 30 min between insulin injection and a meal may be too long.
The response to inhaled and oral steroids in patients with stable chronic obstructive pulmonary disease
Authors: Weiner P. , Weiner M. , Rabner M. , Waizman J. , Magadle R. , Zamir D.
Published: March 2003

Background. A significant minority of patients with COPD have favourable response to corticosteroid treatment. In addition, the benefit of corticosteroid treatment may be outweighed by the side‐effects. Long‐term administration of inhaled steroids is a safe means of treatment. However, only a few studies have addressed the role of inhaled steroids in patients with COPD, with conflicting results.

Methods. Forty‐four patients with stable COPD were defined as ‘responders to bronchodilators’ (increase in FEV1 > 20% following administration of β2‐agonist) (group A), and 124 as ‘non‐responders to bronchodilators’ (group B). All patients were randomized to receive a 6‐week course of either a daily dose of 800 μg of inhaled budesonide or placebo, separated by 4 weeks when no medication was taken; were randomized again to receive a 6‐week course of either 1600 μg day−1 of inhaled budesonide, or 800 μg day−1 of inhaled budesonide plus placebo; and were randomized once again to receive a 6‐week course of either 40 mg day−1 of prednisone or placebo. All stages were performed in a double‐blind cross‐over design.

Results. Following administration of 800 μg day−1 of inhaled budesonide, there was an increase in the mean FEV1 from 1.40 ± 0.20 to 1.92 ± 0.22 L (P < 0.001) and a significant decrease in inhaled β2 agonist consumption in group A. These changes remained almost stable during the increased dose of inhaled budesonide or during prednisone treatment. The mean FEV1 did not change during the placebo period, or in group B in either treatments.

Conclusions. Treatment with inhaled steroids improved spirometry data and inhaled β2‐agonist consumption in about one‐quarter of patients with stable COPD, and this rate increased to about three‐quarters in patients who responded to β2‐agonist inhalation. There was no additional benefit in using a higher dose of inhaled budesonide or prednisone.
The survival and well‐being of patients treated for Cushing’s syndrome
Authors: Pikkarainen L. , Sane T. , Reunanen A.
Published: March 2003

Abstract. Pikkarainen L, Sane T, Reunanen A (Helsinki University Hospital and National Public Health Institute, Helsinki, Finland). The survival and well‐being of patients treated for Cushing’s syndrome. J. Intern Med 1999; 245: 463–468.

Objective.  The main aim of the study was to evaluate the survival, well‐being and working capacity of patients treated for Cushing’s syndrome.

Design.  The study was carried out by retrospectively analysing patient records from years 1981–94. Follow‐up time was extended from the time of diagnosis to the end of 1996. A questionnaire dealing with symptoms prior to and after therapy, and the quality of life estimated on a Visual Analogue Scale (VAS) was sent to all surviving patients.

Setting.  The study was performed in a university hospital.

Main outcome measures.  Survival, subjective well‐being, working capacity before and after treatment and disappearance of symptoms after treatment of Cushing’s syndrome.

Results.  During the follow‐up time 10 patients died out of a total of 74. The overall standardized mortality ratio (SMR) was 168% (95% CI 81–309%). The SMR of patients with pituitary disease was 267% (89–525%), and in patients with adrenal adenoma it was 135% (16–489%). Forty‐six per cent of the surviving patients stated that they felt fully recovered from the disease, but the proportion of patients having persisting symptoms after treatment was also noteworthy. The mean VAS score (range 0–100) was 19 (SD 14) before treatment and 82 (SD 18) after treatment (P < 0.001). After treatment, 81% of the patients were able to return to work, 11% retired because of disability, 5% retired because of age and 3% were on sick‐leave at the time of answering the questionnaire. During the follow‐up time, 42% of the patients with pituitary disease suffered a relapse. However, the effect of the relapse on well‐being was not significant.

Conclusions.  The mortality risk of patients treated for Cushing’s disease was not significantly increased compared with that of the general population. Many symptoms persisted even years after therapy. After clinical recovery, working ability was not always regained.
Normohomocysteinaemia and vitamin‐treated hyperhomocysteinaemia are associated with similar risks of cardiovascular events in patients with premature peripheral arterial occlusive disease. A prospective cohort study
Authors: De Jong S. C. , Stehouwer C. D. A. , Van Den Berg M. , Geurts T. W. , Bouter L. M. , Rauwerda J. A.
Published: March 2003

Objectives. Mild hyperhomocysteinaemia (HHC), fasting or after methionine loading, is associated with an increased risk and severity of atherosclerotic vascular disease. Post‐methionine and fasting HHC are responsive to treatment with vitamin B6 and folic acid. We performed a prospective cohort study amongst normohomocysteinaemic and vitamin‐treated (vitamin B6, 250 mg plus folic acid, 5 mg daily) hyperhomocysteinaemic patients with premature peripheral arterial occlusive disease and assessed the incidence of cardiovascular events.

Design. We studied 273 consecutive patients with clinically manifest peripheral arterial occlusive disease with onset before the age of 56, 79 (28.9%) of whom had postmethionine HHC. Follow‐up was obtained in 232 (85%) patients. At baseline, 70 (30%) were hyperhomocysteinaemic after methionine loading and started treatment with vitamin B6 and folic acid; 162 (70%) were normohomocysteinaemic (reference group).

Results. During the follow‐up period (median 20, range 1–63 months), 48 (29.6%) and 23 (32.9%) of the normo‐ and the hyperhomocysteinaemic patients, respectively, had a new cardiovascular event. Most (75%) involved the peripheral arterial system. The crude incidence rate for any cardiovascular event was 0.16 (95% CI, 0.12–0.21) per person per year in the normohomocysteinaemic and 0.16 (95% CI, 0.09–0.22) per person per year in the hyperhomocysteinaemic group.

Multivariate Cox regression analyses showed that higher plasma homocysteine levels were associated with an increased risk of new cardiovascular events in the normohomocysteinaemic patients (relative risk [RR] per 1 µmol L–1, 1.17 [CI, 1.05–1.30] for fasting and 1.06 [CI, 1.01–1.12] for postmethionine levels), but not in the hyperhomocysteinaemic (vitamin‐treated) patients. The adjusted RR for new cardiovascular events in the hyper‐ as compared to the normohomocysteinaemic patients was 0.76 (CI, 0.33–1.74).

Conclusions. These data are consistent with a protective effect of treatment with vitamin B6 and folic acid in patients with premature peripheral arterial occlusive disease and postmethionine HHC. Double‐blind randomized trials are necessary to confirm this.
Meal pattern and risk factor evaluation in one‐year completers of a weight reduction program for obese men – the ‘Gustaf’ study
Authors: Andersson I. , Lennernäs M. , Rössner S.
Published: March 2003

Abstract Andersson I, Lennernäs M, Rössner S (Huddinge University Hospital, Huddinge; and Swedish Dairy Association, Stockholm, Sweden). Meal pattern and risk factor evaluation in one‐year completers of a weight reduction program for obese men – the ‘Gustaf’ study. J Intern Med 2000; 247: 30–38.

Objectives To evaluate changes in meal patterns and in obesity related risk factors after 1 year of treatment in obese men.

Design Data from two 24‐h dietary recalls, performed at base‐line and after 1 year of treatment, were related to changes in medical risk factors.

Setting Academic obesity unit.

Subjects Sixty‐three men, aged 44 (eight) years (mean [SD]) and Base‐line Body Mass Index (BMI) 37.4 (4.6) kg m–2, who had completed 1 year of treatment. The men were subdivided by tertiles according to weight change: tertile I (n = 21), mean +0.3 kg, tertile II (n = 21), mean –5.8 kg and tertile III (n = 21), mean –14.2 kg.

Main outcome measures Weight loss, changes in meal patterns and in obesity related medical risk factors.

Results The reported mean energy intake decreased after treatment in tertiles II and III by 700 (1300) kcal (P < 0.05) and 700 (900) kcal (P = 0.001), respectively. In tertile III the energy‐% from fat decreased (P < 0.05) with a reciprocal increase in energy‐% from protein (P < 0.05). The frequency of snacks of a low nutritional quality decreased (P < 0.01) in tertile III together with an increase in energy‐% from ‘hot meals of good quality’ (P < 0.05). Obesity related risk factors (anthropometry, blood pressure, serum lipid concentrations, blood glucose and plasma insulin) improved in a beneficial way only in tertile III.

Conclusions The weight loss in the successful tertile III men was to a great extent explained by fewer low quality snacks but more energy from high quality meals. These changes reflected the behaviour modification strategy recommended.
Prevalence of carotid artery kinking in 590 consecutive subjects evaluated by Echocolordoppler. Is there a correlation with arterial hypertension?
Authors: Pancera P. , Ribul M. , Presciuttini B. , Lechi A.
Published: March 2003

Abstract.Pancera P, Ribul R, Presciuttini B, Lechi A (Università di Verona, Italy). Prevalence of carotid artery kinking in 590 consecutive subjects evaluated by Echocolordoppler. Is there a correlation with arterial hypertension?J Intern Med2000;248:7–12.

Objective.To assess a possible correlation between high blood pressure and prevalence of kinking in carotid arteries.

Design.Between July 1, 1997 and December 31, 1998, we evaluated the subjects submitted to Echocolordoppler examination of carotid arteries.

Setting.Patients were examined at the Laboratory for Noninvasive Vascular Diagnostics of the University Hospital in Verona.

Subjects.&590 consecutive subjects (M/F ratio, 1/1.2; mean age, 67 years; range, 36–86 years).

Main outcome measures.An Echocolordoppler ultrasonograph to evaluate by means of the standard longitudinal and transverse scans the usual parameters of both intima‐to‐lumen interface and flow. Moreover, particular attention was paid to the analysis of the conformational characteristic of the vessels. Kinking has been classified in three classes according to the degree of bending. All the subjects were asked to compile a questionnaire that provided us with the clinical history.

Results.The prevalence of hypertension in the subjects with kinking appeared higher than in subjects without this abnormality (χ2 = 6.44,P < 0.02). We found also a significant association between kinking and transitory ischaemic attacks (χ2 = 6.987,P < 0.01).

Conclusions.The high prevalence of kinking in the hypertensives agrees with the pathogenetical hypothesis ascribing a role to the high endoluminal pressure. The presence of hypertension and kinking of the internal carotid artery suggests that they could be additive risk factors in the pathophysiology of a transitory ischaemic attack.
Mortality, risk indicators of death, mode of death and symptoms of angina pectoris during 5 years after coronary artery bypass grafting in men and women
Authors: Herlitz J. , Brandrup‐Wognsen G. , Karlson B. W. , Sjöland H. , Karlsson T. , Caidahl K. , Hartford M. , Haglid M.
Published: March 2003

Abstract. Herlitz J, Brandrup‐Wognsen G, Karlson BW, Sjöland H, Karlsson T, Caidahl K, Hartford M, Haglid M (Sahlgrenska University Hospital, Göteborg, Sweden). Mortality, risk indicators of death, mode of death and symptoms of angina pectoris during 5 years after coronary artery bypass grafting in men and women. J Intern Med 2000; 247: 500–506.

Aim. To describe mortality, risk indicators of death, mode of death and symptoms of angina pectoris during 5 years after coronary artery bypass grafting in women and men.

Sample. All patients in western Sweden who underwent coronary artery bypass grafting without concomitant valve surgery and without previously performed coronary artery bypass grafting between June 1988 and June 1991.

Results. In all, 2000 patients participated in the evaluation, 381 (19%) of whom were women. Compared to men, who had a 5‐year mortality of 13.3%, women had a relative risk of death of 1.4 (95% CI 1.0–1.8; P = 0.03). Renal dysfunction interacted significantly (P = 0.048) with gender, in that the differences were more marked in patients without renal dysfunction. When adjusting for differences at baseline, the relative risk of death amongst women was 1.0 (95% CL 0.7–1.3). Compared to men, women had an increased risk of in‐hospital death and death associated with stroke. However, amongst the patients who died, the place and mode of death appeared to be similar in women and men. Amongst survivors after 5 years, women had more symptoms of angina pectoris than men.

Conclusion. During 5 years after coronary artery bypass grafting, women had an increased mortality compared to men; renal dysfunction seemed to interact with female gender regarding mortality. Women had a higher risk of in‐hospital death and death associated with stroke. However, the adjusted relative risk of death during 5 years was equal in women and men. Amongst survivors, women suffered more from angina pectoris than men.
Immunomodulation of atherosclerosis: myth and reality
Authors: Nicoletti A. , Caligiuri G. , Hansson G. K.
Published: March 2003

Abstract. Nicoletti A, Caligiuri G & Hansson GK (Hôpital Broussais, Paris, and Karolinska Institute, Stockholm). Immunomodulation of atherosclerosis: myth and reality (Minisymposium). J Intern Med 2000; 247: 397–405.

Atherosclerosis is an inflammatory disease which displays features of immune activation both locally and systemically. In the present review, we discuss the evidence for immune activation in human disease and experimental models, and survey candidate antigens associated with atherosclerosis. Studies of atherosclerosis in genetic models of immunodeficiency are analysed, as well as immunomodulating therapies and immunization protocols. Based on recent research, it is concluded that immunomodulation represents an interesting approach to the development of new prevention and treatment methods for atherosclerosis.
Multiple endocrine neoplasia type 2 syndromes may be associated with renal malformations
Authors: Loré F. , Talidis F. , Di Cairano G. , Renieri A.
Published: March 2003

Loré F, Talidis F, Di Cairano G, Renieri A (Endocrinology Unit; Medical Genetics Unit, University of Siena, Italy). Multiple endocrine neoplasia type 2 syndromes may be associated with renal malformations.J Intern Med2001;250:37–42.

Objective. TheRETproto‐oncogene is known to be the susceptibility gene for various disease phenotypes, including multiple endocrine neoplasia type 2 (MEN 2). Recent studies have also suggested an involvement ofRETin the development of the mammalian kidney. Although kidney agenesis or dysgenesis has been observed in mice lacking functionalret, no clinically relevant kidney abnormalities have been reported in individuals with knownRETmutations and familial medullary thyroid carcinoma (FMTC). We have studied a family with five members affected with isolated FMTC. DNA analysis was performed and the involvedRETmutation was identified. Amongst these patients were a woman and her son.

Design. Case report.

Setting. University department.

Patients. A 32‐year‐old woman and her son with FMTC and unilateral renal agenesis.

Results. The woman’s abdominal ultrasound findings demonstrated unilateral renal absence of the left kidney. Her son, when only a few months old, had undergone surgical treatment for Hirschsprung’s disease. Abdominal ultrasonography was performed recently, and left‐side renal absence was diagnosed. Intravenous pyelography confirmed the agenesis of his left kidney, whilst the contralateral kidney displayed compensatory hypertrophy.

Conclusions. The involvement of theRETproto‐oncogene in the early growth and differentiation of the human kidney is now generally accepted. We believe that at least a proportion of patients with MEN 2 may have undiagnosed renal malformations. We suggest therefore that noninvasive imaging techniques, such as ultrasonography, should be used to explore the presence of renal abnormalities in subjects with demonstratedRETmutations.
Treatment of abdominally obese men with a serotonin reuptake inhibitor: a pilot study
Authors: Ljung T. , Ahlberg A.‐C. , Holm G. , Friberg P. , Andersson B. , Eriksson E. , Björntorp P.
Published: March 2003

Abstract. Ljung T, Ahlberg A‐C, Holm G, Friberg P, Andersson B, Eriksson E, Björntorp P (Sahlgrenska University Hospital and University of Göteborg, Göteborg, Sweden). Treatment of abdominally obese men with a serotonin reuptake inhibitor: a pilot study. J Intern Med 2001; 250: 219–224.

Objective. To investigate the effects of a selective serotonin reuptake inhibitor (SSRI) on the neuroendocrine and autonomic nervous system perturbations found in abdominal obesity.

Design. Treatment for 6 months with citalopram and for 6 months with placebo using a double‐blind, cross‐over design, with a 2‐month wash‐out period between treatment periods.

Subjects. Sixteen healthy men, 45–60 years, moderately obese and with an abdominal fat distribution.

Measurements. Anthropometry, three different depression rating scales, serum lipids, testosterone, IGF‐I, oral glucose tolerance test (OGTT), pituitary stimulation with corticotropin releasing hormone (CRH), arithmetic stress test, and excretion of cortisol and metoxycatecholamines in urine, collected during 24 h.

Results. Cortisol concentrations in the morning were low before treatment, indicating a perturbed function of the hypothalamic‐pituitary‐adrenal (HPA) axis. After treatment with citalopram morning cortisol concentrations rose to normal. Cortisol concentrations after stimulation with CRH or stress were elevated by citalopram treatment, but urinary cortisol excretion was unchanged. The glucose concentrations after OGTT (120 min) tended to be reduced, with unchanged insulin concentrations, whilst other metabolic values did not change during treatment. Heart rate after administration of CRH, and during laboratory stress test, decreased by treatment with citalopram. Diurnal urinary excretion of metoxycatecholamines tended to decrease. Neither body mass index nor waist/hip circumference ratio decreased. Depression scores were within normal limits before treatment and did not change.

Conclusion. The results of this pilot study indicate improvements in the regulation of neuroendocrine‐autonomic systems as well as metabolism in abdominal obesity during treatment with an SSRI.
Adrenocorticotrophic hormone exerts marked lipid‐lowering effects in simvastatin‐treated patients
Authors: Hardarson A. , Sigurdsson G. , Olafsdottir E. , Dallongeville J. , Berg A.‐L. , Arnadottir M.
Published: March 2003

Abstract. Hardarson A, Sigurdsson G, Olafsdottir E, Dallongeville J, Berg A‐L, Arnadottir A (Landspitali University Hospital, Reykjavik, Iceland; Institut Pasteur, Lille, France; and University Hospital, Lund, Sweden). Adrenocorticotrophic hormone exerts marked lipid‐lowering effects in simvastatin‐treated patients. J Intern Med 2001; 250: 530–534.

Objective. Recently, it was reported that treatment with adrenocorticotrophic hormone (ACTH) has a strong lipid‐lowering effect in healthy individuals. The mechanism behind this has not been established. The aim of the present investigation was to study the effect of ACTH on the plasma lipoprotein pattern in patients treated with a 3‐hydroxy‐3‐methylglutaryl‐coenzyme A reductase inhibitor.

Design. The ACTH treatment was given to 10 patients who were on long‐term treatment with simvastatin 40 mg daily. ACTH1‐24 was administered at the dose of 1 mg daily for four consecutive days. Blood samples for analyses of lipids, lipoproteins and apolipoproteins were collected before and after treatment. Second baseline was obtained 2 weeks after the end of treatment.

Results. The serum concentrations of cholesterol, triglycerides, low density lipoprotein (LDL) cholesterol, apolipoprotein B and lipoprotein(a) fell significantly by 16, 23, 23, 10 and 38%, respectively. The serum apolipoprotein E concentration increased significantly by 39%; the fraction that was not associated with apolipoprotein B increased by 47% whereas the fraction that was did not change significantly. There were no changes in the serum concentrations of high density lipoprotein (HDL) cholesterol and apolipoprotein AI. At the second baseline, the lipid variables had generally returned to previous levels.

Conclusions. In patients on long‐term simvastatin treatment, ACTH had marked lowering effects on the lipoproteins that contain apolipoprotein B. Moreover, the serum apolipoprotein E concentration increased significantly in response to ACTH treatment.
Effect of apoE genotype on the hypolipidaemic response to pravastatin in an outpatient setting
Authors: Peña R. , Lahoz C. , Mostaza J. M. , Jiménez J. , Subirats E. , Pintó X. , Taboada M. , López‐Pastor A. ,   and The Rap Study Group
Published: March 2003

Abstract. Peña R, Lahoz C, Mostaza JM, Jiménez J, Subirats E, Pintó X, Taboada M, López‐Pastor A, The RAP study group (Hospital Carlos III; Instituto de Salud Carlos III, Madrid; Hospital de Puigcerdá, Gerona; Hospital de Bellvitge, Barcelona; Centro de Salud de Fuencarral; Hospital La Paz, Madrid, Spain). Effect of apoE genotype on the hypolipidaemic response to pravastatin in an outpatient setting. J Intern Med 2002; 251: 518–525.

Background. Considerable variability exists in the plasma lipid and lipoprotein response to statin treatment due, in part, to genetic factors. The gene for apolipoprotein E (ApoE) is polymorphic and the different genotypes modulate baseline lipid levels. The objective of the present study was to evaluate the effect of the apoE genotype on the lipoprotein response to pravastatin treatment in an outpatient population followed‐up in several different clinics across Spain.

Subjects and methods. Subjects (n=401; 56% female; mean age 57 years), who were hypercholesterolaemic despite a diet poor in saturated fat and cholesterol, were treated according to NCEP‐ATP II guidelines. Plasma lipids and lipoproteins were measured centrally before and after 16 weeks of treatment with 20 mg day−1 of pravastatin.

Results. ApoE genotype distributions were 3.2% with ɛ2/3, 73.1% with ɛ3/3 and 22.4% with ɛ3/4 or ɛ4/4. ApoE genotype did not have any effect on baseline lipid levels except on triglycerides such that the carriers of the ɛ2 allele had concentrations significantly greater than those subjects with ɛ3/3 genotype and carriers of the ɛ4 allele after adjustment for age, gender and body mass index (BMI) (P < 0.001). Once adjusted for age, gender, BMI and baseline lipid levels, the apoE polymorphism did not significantly influence the plasma lipid and lipoprotein response to pravastatin.

Conclusion. ApoE genotype appears not to influence the hypolipidaemic effect of pravastatin in patients monitored in a general outpatient setting.
Duration of warfarin sodium therapy prior to electrical cardioversion of atrial fibrillation
Authors: Ryman J. , Frick M. , Frykman V. , Rosenqvist M.
Published: March 2003

Abstract.  Ryman J, Frick M, Frykman V, Rosenqvist M (South Hospital and Karolinska Hospital, Stockholm, Sweden) Duration of warfarin sodium therapy prior to electrical cardioversion of atrial fibrillation. Journal of Intern Med 2003; 253: 76–80.

Objectives.  To evaluate the duration of anticoagulation treatment with warfarin sodium before elective DC‐cardioversion and to identify clinical variables predicting short‐term versus long‐term waiting times.

Design.  Retrospective.

Subjects.  Patients with a known start date for warfarin sodium, a known duration of atrial fibrillation (AF) and who underwent DC‐cardioversion were included.

Main outcome measures.  Duration of treatment with warfarin sodium prior to DC‐cardioversion.

Methods.  The hospital records of 288 consecutive patients with AF scheduled for elective cardioversion at two hospitals in Stockholm were reviewed. Only patients with a known start date for warfarin sodium and known duration of AF were included in the study.

Results.  The median age was 70 (26–85) years and the duration of AF at time of cardioversion were 18 weeks (5–273) weeks. The median treatment duration prior to cardioversion with warfarin sodium was 12 weeks. Sinus rhythm was established in 224 (78%) patients of which 90 (40%) remained in sinus rhythm 1 month after cardioversion. In multivariate analysis, the only independent predictor of short waiting times for cardioversion (8 vs. 15 weeks) was if a cardiologist instituted the treatment with warfarin sodium (P < 0.001, 95% CI 5.0–9.0).

Conclusion.  The average waiting time from start of warfarin sodium treatment to elective cardioversion exceeds by far the recommended 3–4 weeks on therapeutic international normalized ratio (INR). In order to minimize the time period until cardioversion significant changes in the out‐of‐hospital care logistics has to be undertaken.
Surface‐weighted star volume: concept and estimation
Authors: Reed  , Howard
Published: March 2003

The estimation of ‘size’ for an interconnected nonconvex phase is an ongoing problem in materials science and biomedicine. Examples of this type of phase include the pore space in a porous rock such as sandstone or the marrow space found in cancellous bone. A reasonable definition of size for this type of phase is provided by the mean volume‐weighted star volume. This is defined as the average volume of the phase of interest seen unobscured from a typical point within the phase. One practical advantage of this definition of size is that it is easy to estimate stereologically. In this paper we extend the concept of star volume to consider the mean surface‐weighted star volume. The mean surface‐weighted star volume is the volume of a continuous phase seen unobscured from a typical point of the interface. We expect that this parameter could be useful in biological problems involving mass transfer across an interface. The stereological estimation of mean surface‐weighted star volume is described and the method is illustrated on piglet lung tissue.
Beam damage of polypropylene in the environmental scanning electron microscope: an FTIR study
Authors: Kitching  , Donald
Published: March 2003

The environmental scanning electron microscope allows the examination of virtually any specimen in a gaseous environment without the need for coating or drying. Experimental evidence, however, suggests that significant electron beam damage occurs in hydrated specimens. It is thought that water molecules, ionized by the electron beam, produce hydrogen and hydroxyl free radicals which attack the organic material of the sample. In order to elucidate the beam damage mechanisms, areas of polypropylene films were exposed to the electron beam at varying doses and exposure times under both hydrating and dehydrating conditions. The chemical changes occurring as a result of electron‐beam irradiation were determined using Fourier transform infra‐red microscopy. Direct interaction of the electron beam with the polymer results in extensive cross‐linking. In the presence of water, free‐radical‐initiated reactions lead to hydrolysis and oxidation of the polymer.
Desktop X‐ray microscopy and microtomography
Authors: Sasov  , Van Dyck
Published: March 2003

Recent developments in X‐ray microtomography have made it possible to miniaturize a CT scanner into a versatile and cost‐effective desktop system that fits into any laboratory environment. The possibilities of the technique are demonstrated for a range of applications. It is also shown how an existing scanning electron microscope with an X‐ray detector can, with a specially developed attachment, be transformed into an X‐ray microscope and microtomograph.
Efficient texture analysis of binary images
Authors: Ohser J. , Steinbach B. , Lang C.
Published: March 2003

A new method of determining some characteristics of binary images is proposed based on a special linear filtering. This technique enables estimation of the area fraction, the specific line length and the specific integral of curvature. Furthermore, the specific length of the total projection is obtained, which gives detailed information about the texture of the image. The influence of lateral and directional resolution depending on the size of the applied filter mask is discussed in detail. The technique includes a method of increasing directional resolution for texture analysis while keeping lateral resolution as high as possible.
Rapid staining of ultrathin sections with the use of a microwave oven
Authors: CAVUsOglu  , Kahveci  , Sirmali
Published: March 2003

The microwave oven has many potential applications, ranging from tissue fixation to staining for light and electron microscopy. This study was planned to speed up the staining of ultrathin sections. The first set of grids was stained conventionally with uranyl acetate and Reynold's lead citrate solutions. The other grids were stained with the same solutions by microwave irradiation. The electron micrographs of grids stained using the microwave technique were as satisfactory as the grids stained conventionally. Microwave‐treated grids demonstrated more uniform staining and less precipitate. The use of a microwave oven shortened staining time by ≈ 38 min.
Development of a high energy resolution electron energy‐loss spectroscopy microscope
Authors: TERAUCHI  , TANAKA  , TSUNO  , ISHIDA
Published: March 2003

We have developed a high energy resolution electron energy‐loss spectroscopy (EELS) microscope, which can take spectra from specified small specimen areas and specified small reciprocal space areas to investigate detailed electronic structures. The EELS microscope is equipped with retarding Wien filters as the monochromator and the analyser. The filters are designed to achieve a stigmatic focus. The energy resolutions are 12 meV and 25 meV for cases without and with a specimen, respectively. Spatial and momentum resolutions are 30–110 nm in diameter and 1.1 nm−1 in angular diameter, respectively. EELS spectra are presented to show the performance of this instrument.
The quantitative characterization of SiGe layers by analysing rocking profiles in CBED patterns
Authors: ZIPPRICH  , FÜLLER  , BANHART  , SCHMIDT  , EBERL
Published: March 2003

Convergent beam electron diffraction is used for the quantitative determination of layer thickness, composition and strain in pseudomorphic Si/SiGe two‐ and three‐layer systems grown by molecular beam epitaxy. By using plan‐view specimens, we are able to avoid the influence of surface relaxation which generally complicates the determination of strains in cross‐sectional specimens. For quantitative strain determination, rocking curves of Bragg lines in energy‐filtered convergent beam electron diffraction patterns are analysed. The experimentally obtained rocking curves are compared with kinematical calculations by a computerized fit procedure. The resulting layer parameters are then further refined by a dynamical simulation. Results for the strains obtained with this technique are in good agreement with theoretical values. With this method layer thickness is measured down to monolayer precision. The accuracy of the strain analysis depends on the sequence and thickness of the layers.
Quantitative analysis of ultrathin doping layers in semiconductors using high‐angle annular dark field images
Authors: LIU  , PRESTON  , BOOTHROYD  , HUMPHREYS
Published: March 2003

It is well known that the high‐angle annular dark field (HAADF) technique in scanning transmission electron microscopy is an incoherent imaging process in the lateral (xy) plane. However, as a consequence of the existence of partial coherence in the z direction, accurate quantitative interpretation of image intensity is difficult. The effects of coherence in the z direction can be reduced by increasing the inner collector angle of the annular detector so that the scattering from atoms in the z direction is essentially incoherent. We thus show that it is feasible to quantify the total As concentration of ultrathin InAsxP1−x layers in InP in a simple but accurate way using a thickness integrated Bloch wave calculation including phonon scattering with a large inner collector angle of the annular detector of around 150 mrad. We compare the As composition derived from this approach with that from the Fresnel method and high resolution imaging. We also show that the non‐linear variation of the HAADF intensity with thickness is consistent with our simpler simulations for such conditions. Therefore, this approach enables us easily and quickly to quantify compositions using HAADF images. The tetragonal distortion due to lattice mismatch is also shown to influence the contrast and has been included in the calculations.
Identification of intergranular phases in ceramic nanocomposites
Authors: SCHMID H. K.
Published: March 2003

Analytical FEG‐TEM was used for nanostructural and nanochemical characterization of Al2O3–TiN (composite I) and Si3N4–TiN (composite II) ceramic composite systems. The presence of vitreous intergranular phases in pockets at multiple grain junctions and in thin films (≈ 0.8 nm thick) at grain boundaries was revealed by high resolution and Fresnel fringe imaging techniques. The existence of a Ti‐rich thin intergranular film at alumina grain boundaries was revealed by EDS line‐scanning across internal interfaces at the 1.5 nm lateral resolution level. Extracting interface specific information at subnanometre levels by means of quantitative spatial difference EELS allowed an identification of intergranular phases. Ti sub‐oxide existed in thin films at Al2O3 and TiN grain boundaries, whereas a mixed Al–Ti–O–N glassy phase was observed in pockets at triple grain junctions in composite I. In composite II, residual siliceous oxide and oxynitride glass phases were identified in thin films at Si3N4 grain boundaries and multiple grain junctions, respectively. These observations indicated that the chemistry of the intergranular phase in thin grain boundary films is notably different from that in larger pockets at multiple grain junctions.
Relativistic calculations of intensity distributions in elemental maps using contrast transfer functions
Authors: KNIPPELMEYER  , KOHL
Published: March 2003

The interpretation of highly resolved elemental maps is not straightforward: one has to consider the quantum mechanical nature of the scattering process as well as the influence of the microscope. Existing calculations of the contrast in elemental maps are based on a non‐relativistic approach, while in most of the currently installed electron microscopes, the electrons penetrate the specimen with relativistic energies ≥ 200 keV. Therefore, we have recalculated the intensity distribution in elemental maps based on a fully relativistic theory. Using the concept of contrast transfer functions, the simulations account for lens aberrations as well as the defocus. Surprisingly, the results exhibit considerable deviations between the relativistic and non‐relativistic calculations even in the region of low acceleration voltages such as 100 kV. These differences increase with increasing acceleration voltage and are strongly dependent on aperture and energy loss. Quantitative simulations and evaluations of highly resolved elemental maps should therefore make use of a fully relativistic theory.