bluuebunny/crossref_metadata_2025 huggingface dataset:
Geographical variation and time trends in the attack rate of coronary heart disease in five Swedish cities
Authors: JOHANSSON S. , NORDIN P. , WILHELMSEN L. , TIBBLIN G. , JOHANSSON B. W. , HANSEN O. , AHLMARK G. , JACOBSSON S. , MICHAELI E. , GILLNÄS T.
Published: August 2009

Abstract.Based upon community myocardial infarction (MI) records in five Swedish cities, geographical variation and time trends in the attack rate of fatal and non‐fatal MI have been evaluated. During the study period 1975–1982, a total of 7699 events were registered among men and 1823 events among women. The mean annual mortality was highest in the north, and a declining gradient in mortality was observed from the northern to the southern part of the country. The out‐of‐hospital death rate was highest in the north, while no difference in in‐hospital mortality was observed. However, the geographical variation in the morbidity of MI was less consistent. Changes over time generally followed the same pattern in all cities. The attack rate of fatal and non‐fatal MI tended to decline among women and men aged 60–64 years. The pattern was less consistent among younger men. Among women aged 50–59 years the mortality remained unchanged, but the attack rate of non‐fatal MI increased in all cities. This increase was not explained by inclusion of less severe infarctions. A considerable proportion, about 85%, were recorded as primary events, emphasizing the possible role of primary prevention in obtaining a decrease in the incidence of the disease. The results of this study support previous findings of an important regional difference in the mortality of MI in Sweden. However, the magnitude of the regional variation in the incidence of coronary heart disease might be overestimated if only the mortality pattern is studied.
Acute and chronic pancreatic disease associated with Yersinia enterocolitica infection: a Norwegian 10‐year follow‐up study of 458 hospitalized patients
Authors: SAEBØ A. , LASSEN J.
Published: August 2009

Abstract. During the period 1974–1983, Yersinia enterocolitica infection was diagnosed in 458 hospitalized patients by antibody response or isolation of the micro‐organism. Eight (1.75%) patients showed signs of acute pancreatitis with elevated serum or urine levels of amylase; two patients had acute insulin‐dependent diabetes. The patients were followed up for 4–14 years (until 1987). Four patients were readmitted with chronic pancreatitis, and one with acute pancreatitis. Diabetes developed in two males and nine females; in seven cases this was associated with chronic conditions of possible autoimmune aetiology. In 1987 a significantly higher than expected prevalence of diabetes was demonstrated among female subjects aged 30–54 years. Yersinia enterocolitica infection constitutes a differential diagnosis in acute pancreatitis, and might be related to the development of chronic pancreatitis and diabetes.
Ketotifen — a therapeutic agent of eosinophilic fasciitis?
Authors: CHING D. W. T. , LEIBOWITZ M. R.
Published: August 2009

Abstract. A 30‐year‐old male with eosinophilic fasciitis (EF) associated with morphoea and vitiligo is described. The patient showed a partial response to prednisone, but did not respond to hydroxychloroquine, D‐penicillamine and cimetidine. In the light of reports of increased plasma histamine levels, and a putative role of mast cells in the pathogenesis of EF, ketotifen (a mast cell stabilizer) was prescribed. This non‐toxic drug has allowed the patient to continue hard physical labour without further relapses and without corticosteroid therapy.
Diabetes incidence in users and non‐users of antihypertensive drugs in relation to serum insulin, glucose tolerance and degree of adiposity: a 12‐year prospective population study of women in Gothenburg, Sweden
Authors: BENGTSSON C. , BLOHMÉ G. , LAPIDUS L. , LISSNER L. , LUNDGREN H.
Published: August 2009

Abstract. As part of a prospective population study in Gothenburg, Sweden, women aged 50 years were subjected to an intravenous glucose tolerance test on entry to the study and followed up for 12 years. Manifest diabetes was the only end‐point registered in this part of the study. Of 352 initially non‐diabetic women, 17 (4.8%) subjects developed diabetes, with a fourfold increased risk in women taking antihypertensive drugs (diuretics or β‐blockers, or both) compared with women who were not taking such medication. The increased risk was observed independently of initially measured glucose metabolism variables and degree of adiposity, although the incidences were higher overall if the use of antihypertensive drugs was combined with fasting hyperinsulinaemia and adiposity. This study provides further evidence to support the view that diuretics and β‐blockers are precipitators of type 2 diabetes mellitus.
Impaired erythrocyte fluidity during treatment of renal anaemia with erythropoietin
Authors: LINDE T. , SANDHAGEN B. , DANIELSON B. G. , WIKSTRÖM B.
Published: August 2009

Abstract. Seventeen haemodialysis patients with renal anaemia were treated with recombinant human erythropoietin (rhEPO) and observed for 30 weeks. The viscosity of whole blood and plasma, the erythrocyte aggregation tendency, and the erythrocyte deformability, measured as fluidity, were analysed every second week. All patients responded with increasing haematocrit and whole‐blood viscosity. The plasma viscosity and the erythrocyte aggregation tendency were already increased before the start of treatment, and remained unchanged during treatment. The basal erythrocyte fluidity tended to be impaired, although not significantly so. During treatment, significant impairment of fluidity was observed at the beginning of the treatment period. After 24 weeks the fluidity started to increase, and it later reached values observed before the start of treatment. Hence, the quality of the erythrocytes formed during the corrective phase of rhEPO treatment differs in some respects from that of cells formed at a normal production rate. The impaired fluidity might have important implications for the flow resistance in small vessels, and contribute to the development or aggravation of hypertension that is often seen during rhEPO treatment.
Apolipoprotein B gene mutations affecting cholesterol levels
Authors: FARESE R. V. , LINTON M. F. , YOUNG S. G.
Published: August 2009

Abstract. In the past 5 years, many different mutations in the apolipoprotein (apo) B gene have been described that affect plasma cholesterol levels. More than 20 different mutations in the apoB gene have been shown to cause familial hypobetalipoproteinaemia, a condition characterized by abnormally low plasma concentrations of apoB and LDL cholesterol. Almost all of the mutations are nonsense or frameshift mutations that interfere with the translation of a full‐length apoB100 molecule. Many, but not all, of these apoB gene mutations result in the synthesis of a truncated species of apoB that can be detected within the plasma lipoproteins. Familial hypobetalipoproteinaemia heterozygotes are almost always asymptomatic and have LDL cholesterol levels about one‐quarter to one‐third of those of unaffected family members. Several homozygotes and compound heterozygotes for familial hypobetalipoproteinaemia have been described. In these individuals, the LDL cholesterol levels are extremely low, usually less than 5 or 10 mg dl−1, and the clinical phenotype is variable, ranging from completely asymptomatic to severe problems related to intestinal fat malabsorption. One missense mutation in the apoB gene (an Arg → Gln substitution at apoB amino acid 3500) is associated with very poor binding of apoB100 to the cellular LDL receptor. This syndrome has been designated familial defective apolipoprotein B (FDB). The amino‐acid substitution at residue 3500 delays the clearance of LDL from the plasma and results in hypercholesterolaemia. In some Western populations, the frequency of FDB heterozygotes appears to be as high as 1 in 500 individuals.
The role of apolipoprotein E genetic variants in lipoprotein disorders
Authors: RALL S. C. , MAHLEY R. W.
Published: August 2009

Abstract. Apolipoprotein E plays a central role in lipoprotein metabolism by serving as a ligand for the binding of lipoproteins to lipoprotein receptors. Both common and rare variants of apoE have been described. The common variants apoE2 and apoE4 have a significant impact on interindividual variation of lipid and lipoprotein levels in normal subjects. The common variant apoE2 and more than half a dozen rare variants are defective in binding to the low‐density lipoprotein (LDL) receptor, and all are causally associated with the lipid disorder type III hyperlipoproteinaemia (HLP). The mode of inheritance of the disorder can be either dominant or recessive, depending on the particular mutation(s) in apoE, although the mechanisms involved are not fully understood. The common variant apoE4 and other rare variants have been reported to be associated with a variety of other lipoprotein disorders, but a causal link has not been established.
Metabolic and genetic control of HDL cholesterol levels
Authors: TALL A. R.
Published: August 2009

Abstract. Variation of HDL cholesterol levels in man shows a strong inverse relationship to the incidence of atherosclerotic vascular disease. Thus the regulation of HDL cholesterol levels has been the subject of intense investigation. Human genetic differences in cholesteryl ester transfer protein and hepatic lipase illustrate the importance of these factors in the normal catabolism of HDL, while metabolic and population studies show that lipoprotein lipase activity plays a central role in the transfer of lipids and apoproteins into HDL. Metabolic turnover studies in humans suggest that variations in the fractional catabolism of the HDL structural proteins, apoA‐I and apoA‐II, account for much of the variation of HDL levels in human populations. Although the catabolism of these apolipoproteins is poorly understood, changes in the core lipid composition of HDL may lead to changes in catabolism of the HDL proteins. The core lipid composition of HDL appears to be determined by lipid transfer processes, and the activities of lipoprotein and hepatic lipase. Thus many genetic and environmental factors that influence HDL levels appear to operate by changing the activities of the lipases or the lipid transfer process.
Hypertriglyceridaemia due to genetic defects in lipoprotein lipase and apolipoprotein C‐II
Authors: FOJO S. S. , BREWER H. B.
Published: August 2009

Abstract. Hypertriglyceridaemia, as defined by fasting triglyceride levels of > 2.8mmol l‐1, is a prevalent dyslipoproteinaemia in our population. The underlying pathophysiological mechanisms that result in elevations of plasma triglycerides are heterogeneous and, in most cases, incompletely understood. However, in a subset of patients presenting with this lipid disorder, the biochemical and genetic defects that lead to hypertriglyceridaemia have been well characterized. These individuals present with the familial chylomicronaemia syndrome, a rare genetic disorder that is inherited as an autosomal recessive trait, and is characterized by severe fasting hypertriglyceridaemia, massive accumulations of chylomicrons in plasma, and recurrent bouts of pancreatitis. The two major causes of the familial chylomicronaemia syndrome are a deficiency of the enzyme, lipoprotein lipase (LPL), or its cofactor, apolipoprotein (apo) C‐II. Together, these two proteins initiate the hydrolysis of triglycerides present in chylomicrons and very low density lipoproteins. In the past decade our understanding of the underlying molecular defects that lead to familial chylomicronaemia has been greatly enhanced by the identification of mutations in the genes for LPL and apoC‐II. Characterization of these defects has provided new insights into the structure and function of apoC‐II and LPL and established the important role that these two proteins play in normal triglyceride metabolism.
Serum lipids and lipoprotein in adult Ghanaians
Authors: NYARKO N. K. , ADUBOFOUR K. O. M. , OFEI F. , POBEE J. O. M. , OWUSU S. K.
Published: August 2009

Abstract. Objectives. To date, no measurement of serum lipid levels in healthy adult Ghanaians have been carried out. This study was undertaken with the objective of providing reference values for serum lipids levels in the Ghanaian population.

Design/setting. Fasting serum lipid levels were measured in 79 adult Ghanaians living in an urban setting. Volunteers were randomly selected from the work force of the University of Ghana in Accra. There were 54 males and 25 females in the study population.

Results. The mean serum cholesterol (SC) for Ghanaian males was 4.27 ± 1.00 mmol L−1. A value of 4.34 ± 1.12 mmol L−1 was obtained for the females in this study. High‐density lipoprotein cholesterol (HDL‐C) in Ghanaian males averaged 1.37 ± 0.44 mmol L−1 and 1.47 ± 0.50 mmol L−1 in females.

There was no statistically significant difference in low‐density‐lipoprotein cholesterol (LDL‐C) and very‐low‐density‐lipoprotein cholesterol (VLDL‐C) levels between the females and males in this study.

Conclusions. Compared to other studies, our results show that populations in Europe and North America have higher levels of total cholesterol and LDL cholesterol than Ghanaians. The levels of HDL cholesterol as well as VLDL cholesterol are higher in Ghanaians than in Europeans and Americans. Further work needs to be done to compare lipid levels in urban and rural Ghanaians as well as in those with cardiovascular disorders.
Types of diabetes treatment in a total, Norwegian, adult population: The Nord‐Trøndelag Diabetes Study
Authors: MIDTHJELL K. , HOLMEN J. , BJøRNDAL A.
Published: August 2009

Abstract. Objectives. To describe types of diabetes treatment in a total, adult population, including those on no antidiabetic medication, and to evaluate use of the defined daily doses in estimation of diabetes prevalence.

Design. Cross‐sectional epidemiologic survey applying patient‐based questionnaires and clinical examinations approaching all inhabitants of ≥ 20 years (85 100).

Setting. Nord‐Trøndelag county in the middle part of Norway.

Subjects. All known diabetic patients in the county (2242) amongst all participants of ≥ 20 years (76855), registered in 1984‐86.

Interventions. Questionnaire data on type of diabetes treatment including drug doses, measurement of height and weight.

Main outcome measures. Distribution of types of treatment and of mean drug doses.

Results. Of the diabetic patients of ≥ 20 years of age, 20% used insulin, 39% oral hypoglycaemic agents and 41% no antidiabetic medication. Corresponding prevalence figures were 0.6%, 1.1% and 1.2%. Mean daily insulin dose per kg body weight was significantly higher in women than in men. Women with no antidiabetic medication stated a more restricted diet than men. The mean prescribed insulin dose was 14% higher than the defined daily dose, but the corresponding oral agent dose was lower than the defined daily dose.

Conclusions. Sales figures is a bad estimate of total diabetes prevalence due to the high proportion of diabetic patients using no antidiabetic medication. Correction is also necessary when the defined daily dose system is used to estimate the prevalence of medically treated diabetes.
Metabolic evolution of type 2 diabetes: a 10‐year follow‐up from the time of diagnosis
Authors: NISKANEN L. , KARJALAINEN J. , SIITONEN O. , UUSITUPA M.
Published: August 2009

Abstract. Objectives. To investigate fasting and post‐load plasma glucose, insulin and C‐peptide levels during oral glucose tolerance tests in patients with type 2 diabetes and in control subjects, and the metabolic evolution of the diabetes.

Design, setting and subjects. A 10‐year prospective study consisting of a representative group of 133 (70 men, 63 women) newly diagnosed type 2 diabetic patients diagnosed at health centres between 1979 and 1981 and 144 (62 men, 82 women) nondiabetic control subjects recruited from the population register. At baseline, diabetic subjects were treated with diet only. The subjects were studied at baseline and after 5 and 10 years.

Main outcome measures. The changes in plasma glucose, insulin and C‐peptide levels in diabetic and control subjects at baseline and after 5 and 10 years follow‐up. Factors associated with the decline in insulin and C‐peptide levels in diabetic patients (e.g. metabolic control, islet cell antibodies).

Results. A slight increase in glucose levels was seen during the follow‐up in both diabetic with diet and/or oral drug treated patients, but post‐glucose insulin (and C‐peptide and 5‐ and 10‐year examination) levels declined in diabetic patients; this was opposite to the controls, in whom the levels tended to increase. The decline in insulin levels (area under the curve) during the follow‐up was greatest in those diabetic patients with poor metabolic control during the follow‐up. The cumulative incidence of requirement for insulin based on various cut‐off levels for post‐glucagon C‐peptide nearly doubled between the 5‐ and 10‐year examinations. Islet cell antibodies were predictive of insulin deficiency.

Conclusions. Type 2 diabetes was characterized by progressive impairment of insulin response to glucose and this decline was associated with poor metabolic control of diabetes.
Personality pattern in peptic ulcer disease: a cohort study
Authors: JESS P.
Published: August 2009

Abstract. Objectives. To investigate the direction of a possible relationship between peptic ulcer disease and personality disorders.

Design. A cohort study of 50‐year old patients, observed for 2 decades.

Setting. Glostrup County, Denmark (population 100000).

Subjects. A representative sample of 50‐year old people born in 1914 (n = 673) were followed for 20 years. All 673 filled in the Minnesota Multiphasic Personality Inventory (MMPI) in 1964 and 513 were retested with MMPI in 1974.

Main outcome measures. Prevalence of peptic ulcer disease 1964, incidence of peptic ulcer disease 1964‐84, MMPI scores.

Results. The prevalence of peptic ulcer disease in 1964 was 7% and the average annual incidence in the period 1964‐84 was 2.1 per 1000 persons. Those with incidental peptic ulcer in 1964‐84 had normal MMPI scores in 1964, whilst those with peptic ulcer in 1964 had a slight but statistically significant increase in one neuroticism scale (HS) only. The group with prevalent ulcer disease in 1974 exhibited statistically significant increases in the three neuroticism scales (HS, D, HY) and in scale Pd and scale Pt at MMPI retesting. In addition they had statistically significantly higher scores in the three neuroticism scales compared with the other persons who still had normal scores in all scales.

Conclusions. Personality disorders in patients with peptic ulcer are consequences of the disease and not causal factors.
Insulin responses to glucose in healthy males are associated with adult height but not with birth weight
Authors: ALVARSSON M. , EFENDIC S. , GRILL V. E.
Published: August 2009

Abstract. Objective. To investigate the relations between height, birth weight and insulin secretion.

Subjects and design. Subjects were selected from a register of all male healthy volunteers who had previously participated in insulin secretion studies. All men in whom a 1‐h glucose infusion test had been performed on two or more occasions were selected (n = 88). Subjects were divided into two equally sized groups according to 0–10‐min insulin responses.

Main outcome measures. Insulin responses were measured by standardized glucose infusion tests. Heights and weights were measured on these occasions. Birth weights were obtained from questionnaires and validated from obstetric records.

Results. The average height for the 50% of subjects with the lowest insulin response was 3.5 cm less [95% confidence interval (CI): 1.1 to 5.9] than in those with the highest response, P < 0.005. These differences were also significant when expressed relative to heights of national cohorts with the same years of birth [1.7% less in those with lowest response (95% CI: 0.3 to 3.0), P < 0.02 for difference]. However, birth weight (known to 69% of subjects) was not associated with insulin response (3706 ± 126 g in the 50% with lower insulin response, 3590 ± 136 g in those with higher insulin response).

Conclusions. An early insulin response to glucose associates with postnatal growth. This suggests that physiological variations in postnatal insulin secretion can influence growth and height in healthy subjects. Furthermore, in the present study group, a low birth weight is not an important determinant of postnatal insulin secretion.
Liver reactions from trimethoprim
Authors: LINDGREN A. , OLSSON R.
Published: August 2009

Abstract. Objective. To study whether there are adverse liver reactions to trimethoprim and, if found, to describe the biochemical pattern of these reactions.

Design. We surveyed all liver reactions from trimethoprim to SADRAC (Swedish Adverse Drug Reactions Advisory Committee) from 1980 to 1989.

Main outcome measure. Incidence of reported adverse liver reactions [number of reported adverse liver reactions/sales of trimethoprim in defined daily dose (DDD)].

Results. During 1980–1989, 21 suspected liver reactions from trimethoprim were reported. A causal relationship was considered probable in 10 of these reports, which gives an incidence of 1/1360000 DDD. The distribution of reaction types for trimethoprim was virtually identical to that found in corresponding adverse reports for trimethoprim‐sulfonamides, whereas the sulfonamides as single drugs displayed a significantly higher proportion of more severe hepatocellular reactions.
Myocardial infarct size and mortality in patients with non‐insulin‐dependent diabetes mellitus
Authors: LEHTO S. , PYÖRÄLÄ K. , MIETTINEN H. , RÖNNEMAA T. , PALOMÄKI P. , TUOMILEHTO J. , LAAKSO M.
Published: August 2009

Abstract. Objectives. To study the infarct size and mortality in patients with non‐insulin‐dependent diabetes mellitus (NIDDM) and in non‐diabetic subjects with their first acute myocardial infarction.

Design. Seven year follow‐up study of large representative cohorts of patients with non‐insulin‐dependent diabetes mellitus and non‐diabetic subjects (study 1) and the FINMONICA acute myocardial infarction register study in 1988‐89 (study 2).

Setting. Populations of the districts of the Kuopio University Hospital and Turku University Central Hospital (study 1). Populations of Kuopio and North Karelia provinces and Turku/Loimaa area (study 2).

Subjects. Study 1: 1059 patients with non‐insulin dependent diabetes mellitus and 1373 non‐diabetic subjects aged 45–64 years at baseline; during the follow‐up 166 patients with non‐insulin‐dependent diabetes mellitus (91 men and 75 women) and 30 non‐diabetic subjects (25 men and five women) were hospitalized for their first acute myocardial infarction. Study 2: 1622 patients aged 25–64 years hospitalized for their first acute myocardial infarction; 144 patients (90 men and 54 women) had non‐insulin‐dependent diabetes mellitus and 1153 (890 men and 263 women) were non‐diabetic.

Main outcome measures. The infarct size was assessed on the basis of maximum levels of serum cardiac enzymes (studies 1 and 2) and QRS‐score (study 1).

Results. No differences were found in maximum levels of serum cardiac enzymes between diabetic and non‐diabetic patients. Similarly QRS‐score gave no suggestion of a difference in infarct size between diabetic and non‐diabetic patients. In both studies mortality before hospital admission was similar in diabetic and non‐diabetic patients, but mortality within 28 days from hospital admission was twice as high in diabetic patients as in non‐diabetic patients. Cardiac failure was the main cause of death significantly more often in diabetic patients than in non‐diabetic patients (study 2).

Conclusions. Poorer prognosis of acute myocardial infarction in diabetic patients appears not to be explained by a larger infarct size but probably by adverse effects of the diabetic state itself on myocardial function.
Comparison of bleeding complications of warfarin and warfarin plus acetylsalicylic acid: a study in 3166 outpatients
Authors: HURLEN M. , ERIKSSEN J. , SMITH P. , ARNESEN H. , ROLLAG A.
Published: August 2009

Abstract. Objective. The aim of the study was to compare the incidence of bleeding complications in patients receiving warfarin alone and those receiving warfarin in combination with acetylsalicylic acid.

Subjects and methods. This retrospective study comprises all outpatients in our hospital receiving warfarin (n = 3166) in the period 1 January 1986 to 31 December 1990. Of these, 2026 patients received warfarin alone, aiming at an international normalized ratio level of 4.2‐2.5, whereas the combination of warfarin and acetylsalicylic acid (150 mg daily) was given to 1140 patients, aiming at an international normalized ratio level of 2.8‐2.2. Total observation time represents 4420 treatment years.

Results. A total of 175 bleeding episodes was observed, 18 of which were fatal, and 96 were serious (requiring hospitalization). The incidence of minor bleedings was significantly higher in the combined therapy group than in the group receiving warfarin alone, 2.9% and 1.4% respectively (P < 0.003). However, there was no difference in the therapy groups regarding the incidence of serious and fatal bleedings. The overall incidence of gastrointestinal bleedings was equal in the two groups.

Conclusions. The combination of warfarin and aspirin 150 mg daily aiming at a less intense level of anticoagulation than in warfarin therapy alone does not increase the risk of major or fatal haemorrhage.
A long‐term, randomized, comparative study of insulin versus sulfonylurea therapy in type 2 diabetes
Authors: BIRKELAND K. I. , HANSSEN K. F. , URDAL P. , BERG K. , VAALER S.
Published: August 2009

Abstract. Objectives. To study the effect of insulin and sulfonylurea (SU) therapy on glycaemic control, insulin resistance and cardiovascular risk factors in type 2 diabetic subjects.

Design. A prospective, parallel, randomized, controlled, long‐term study.

Setting. Outpatient clinic in tertiary referral centre.

Subjects. Thirty‐six type 2 diabetic subjects treated with diet and SU, aged 44–69 years and a duration of diabetes of between 2 and 14 years.

Interventions. Individually adjusted doses of insulin and glibenclamide.

Main outcome measures. Glycosylated haemoglobin (HbA1c), insulin resistance (euglycaemic glucose clamp), levels of lipids, lipoproteins and blood pressure.

Results. Glycaemic control improved during insulin treatment, but deteriorated on SU; HbA1c levels differed significantly between groups after 12 months of therapy (mean ± SEM 7.9 ± 0.3 vs. 9.5 ± 0.4%. P = 0.004). Body mass index increased significantly during insulin treatment (26.4 ± 0.7 to 27.8 ± 0.7 kg/m2, P = 0.0001) and 30% of this increase was a result of an increase in lean body mass. The total glucose disposal rate showed a small increase in the insulin group. Levels of triglycerides and apolipoprotein B were significantly reduced during insulin treatment (1.8 ± 0.2 to 1.5 ± 0.2 mmol L−1, P = 0.03 and 1.58 ± 0.1 to 1.40 ± 0.08 g L−1, P = 0.003), and insulin prevented a reduction in the levels of high‐density lipoprotein (HDL) cholesterol and apolipoprotein A‐1 and an increase in Lp(a) lipoprotein observed in the SU group. Blood pressure levels did not change during therapy.

Conclusions. Insulin therapy was superior to SU treatment in achieving good metabolic control. Despite a modest improvement in cardiovascular risk factors in the insulin‐treated group, no significant differences were observed between the groups after 1 year's treatment.
Serum ferritin and transferrin saturation in patients with chronic alcoholic and non‐alcoholic liver diseases
Authors: BELL H. , SKINNINGSRUD A. , RAKNERUD N. , TRY K.
Published: August 2009

Abstract. Objectives. To compare serum ferritin concentration and transferrin saturation in patients with alcoholic and non‐alcoholic chronic liver diseases.

Design. Concecutive patients with liver diseases.

Setting. The department of internal medicine in a teaching hospital.

Subjects. Three hundred and twelve patients with different liver diseases concecutively admitted between 1987 and 1992.

Interventions. None.

Main outcome measures. Fasting serum iron, transferrin and ferritin.

Results. Serum ferritin was increased above 200 μg L−1 in all 18 patients with haemochromatosis (range 310–6500 μg L−1), in 64 of 111 alcoholics (58%) and in 30 of 137 (22%) with chronic non‐alcoholic liver diseases (P < 0.01). Twelve of 111 alcoholics (11%) had serum ferritin above 1000 μg L−1 compared with one of 137 (0.7%) with chronic non‐alcoholic liver diseases. In 13 alcoholics who abstained after admission, serum ferritin decreased from 1483 μg L1 ± 1134 to 388 μg L−1 ± 237 (P < 0.001) after 1 1/2 to 6 weeks. The transferrin saturation was increased above 62% in 13 of 18 patients (72%) with haemochromatosis, in 16 of 105 alcoholics (15.2%) and in three of 132 (2.3%) with chronic non‐alcoholic liver disease (P < 0.01).

Conclusion. Serum ferritin is more frequently elevated in abusing patients with alcoholic liver disease than in patients with other chronic liver diseases such as autoimmune liver diseases and hepatitis C. Because serum ferritin decreases rapidly during abstinence, the measurement of ferritin for the detection of haemochromatosis in patients abusing alcohol should be postponed until the patients are abstaining. Most of the patients with increased serum ferritin have normal transferrin saturation values which can be used to separate them from haemochromatosis.
Cardiovascular risk factors in a Melanesian population apparently free from stroke and ischaemic heart disease: the Kitava study
Authors: LINDEBERG S. , NILSSON‐EHLE P. , TERÉNT A. , VESSBY B. , SCHERSTÉN B.
Published: August 2009

Abstract. Objectives. To compare cardiovascular risk factor levels between non‐westernized Melanesians, apparently free from stroke and ischaemic heart disease [1], and healthy Swedish populations, and to analyse, among adult Melanesians, relations with age, sex and smoking status.

Design. Cross‐sectional survey.

Subjects. (i) Traditional horticulturalists in Kitava, Trobriand Islands, Papua New Guinea, uninfluenced by western diet. This study tested 151 males and 69 females aged 14–87 years with 76% and 80% smokers over 20 years, (ii) Healthy Swedish reference populations.

Main outcome measures. Sitting systolic and diastolic blood pressure, weight, height, body mass index, circumferences of waist, pelvis and mid upper arm, triceps skinfold thickness, fasting serum total cholesterol, triglycerides, high‐density lipoprotein cholesterol, estimated low‐density lipoprotein cholesterol, apolipoprotein B, apolipoprotein Al and apolipo‐protein (a).

Results. Compared to Sweden, diastolic blood pressure, body mass index and triceps skinfold thickness were substantially lower in Kitava, where all subjects ≥ 40 years were below Swedish medians. Among males ≥ 20 and females ≥ 60 years systolic blood pressure was lower in Kitavans. Fasting serum total cholesterol, low‐density lipoprotein cholesterol and apolipoprotein B were 10–30% lower in Kitavan males ≥ 40 and females ≥ 60 years. Triglycerides were higher in Kitavans aged 20–39. High‐density lipoprotein cholesterol did not differ while apolipoprotein Al was lower in Kitavans. Apolipoprotein (a) tended to be lower in Kitavans, but the differences were small.

Conclusions. Of the analysed variables, leanness and low diastolic blood pressure seem to offer the best explanations for the apparent absence of stroke and ischaemic heart disease in Kitava. The lower serum cholesterol may provide some additional benefit. Differences in dietary habits may explain the findings.
Sucralfate suspension as a treatment of recurrent aphthous stomatitis
Authors: RATTAN J. , SCHNEIDER M. , ARBER N. , GORSKY M. , DAYAN D.
Published: August 2009

Abstract. Design. A prospective randomized, double‐blind, placebo‐controlled, cross‐over clinical trial.

Setting. A university hospital.

Subjects. Twenty‐one patients with symptomatic recurrent aphtous stomatitis (RAS), unresponsive to conventional treatment were enrolled. They were divided into three groups.

Intervention. In a cross‐over trial, the patients received an oral suspension of sucralfate, an antacid solution or a placebo for 2 years.

Results. After 2 years of follow‐up, sucralfate was found to be superior to both placebo and antacid (P < 0.001) with regard to duration of pain, reduction of the healing period, response time to first treatment and duration of remission.

Conclusion. Sucralfate suspension should be added to the armament of treatment modalities of RAS.
Giant‐cell arteritis of the female genital tract
Authors: HOEN B. , BATY V. , AYMARD B. , JUDLIN P. , FOLIGUET B. , CANTON P.
Published: August 2009

Abstract. A 56‐year‐old woman with long‐lasting fever of unknown origin was diagnosed as having a giant‐cell arteritis of the genital tract with no evidence of temporal arteritis. Diagnosis relied on pathological examination, which showed a segmental panarteritis of ovaries, myometrium, endometrium and uterus cervix. Corticosteroid therapy led to clinical cure within a few weeks. Twenty‐five cases of giant‐cell arteritis of the female genital tract have been published of which only four were associated with temporal arteritis. We recommend that such a diagnosis should be considered in women presenting with long‐lasting fever of unknown origin, even in the absence of temporal arteritis and the clinical evidence of genital abnormalities.
Association of isolated hypogonadotropic hypogonadism, pronounced hypodontia and the Wolff‐Parkinson‐White syndrome
Authors: ABS R. , RAES D. , VERCRUYSSE H.
Published: August 2009

Abstract. Diagnosis of idiopathic isolated hypogonadotropic hypogonadism was made in a 22‐year‐old female patient referred for primary amenorrhoea. It was considered a separate entity from Kallmann's syndrome, because it was not accompanied by anosmia or other specific pleiotropic features. On the other hand, the patient showed severe hypodontia and an intermittent Wolff‐Parkinson‐White syndrome. To our knowledge, this association has never been reported before. This unusual phenotype points to a nonrandom association. However, no information in the literature is available to consider a new single gene defect or a contiguous gene syndrome.
Acute cholestatic hepatitis and the sudden rise of the pacing threshold 5 weeks after VVI‐pacemaker implantation
Authors: SCHÜPPEL R. , PROBST M.
Published: August 2009

Abstract. The patient we describe developed a cholestatic hepatitis and an unusual threshold elevation of about 425%, coincidently, 5 weeks after pacemaker implantation. Lead dislocation, myocardial infarction or metabolic disorder could be excluded as a reason for the pacemaker complication. Neither a biliary obstruction nor an infection of the liver could be found to explain the liver injury. Most probably, both disorders were caused by propafenone (450 mg day−1), withdrawal of the drug resulted in normalization of elevated enzyme and threshold levels.
An interaction between Gemfibrozil and alpha1‐antitrypsin
Authors: JANCIAUSKIENE S. , ERIKSSON S.
Published: August 2009

Abstract. Previous studies have demonstrated such hydrophobic compounds as cholesterol and lithocholic acid, to interact with alpha1‐antitrypsin (α1‐AT). We observed a similar interaction between the anionic, hydrophobic lipid‐lowering drug Gemfibrozil and α1‐AT in a deficient (PiZZ) patient, affecting the physico‐chemical and antiproteinase properties of the inhibitor protein. Gemfibrozil treatment in non‐PiZ patients also resulted in a reduction of α1‐AT activity which could be reproduced in vitro.
Gemfibrozil treatment of the high triglyceride‐low high‐density lipoprotein cholesterol trait in men with established atherosclerosis
Authors: KNIPSCHEER H. C. , NURMOHAMED M. T. , VAN DEN ENDE A. , PLAAT B. , PRUIJS H. J. W. , MULDER W. J. , KASTELEIN J. J. P.
Published: August 2009

Abstract. Objective. To study the short‐term efficacy, tolerability and safety of the treatment with gemfibrozil 600 mg twice daily or placebo in male patients with established atherosclerosis, with a lipid profile matching the ‘high triglyceride‐low high‐density lipoprotein (HDL) cholesterol trait”.

Design. Double‐blind randomized placebo controlled prospective trial.

Setting. Amsterdam Lipid Research Clinic at the Academic Medical Centre of the University of Amsterdam and the Slotervaart Training Hospital affiliated to the University of Amsterdam, Amsterdam, the Netherlands.

Subjects. Thirty‐five male patients, age 30–70, with established atherosclerosis and the high triglyceride‐low HDL cholesterol trait.

Main outcome measures. Plasma total cholesterol, triglycerides, lipoproteins, apolipoproteins A1 and B100, clinical and laboratory safety parameters.

Results. Seventeen patients in the gemfibrozil group and 16 patients in the placebo group completed the study period. Compliance was considered adequate. Mean (± standard deviation) plasma HDL cholesterol levels increased 20.3% (±12.22) from 0.82 to 0.99 mmol L−1 in the gemfibrozil group against 9.9% (±18.31) from 0.79 to 0.87 mmol L−1 in the placebo group (P = 0.001). Mean plasma triglyceride level fell 49.5% (±14.27) from 3.65 to 1.82 mmol L−1 in the gemfibrozil group against an increase of 13.6% (±40.31) from 3.62 to 4.01 mmol L−1 in the placebo group (P < 0.001). Although plasma HDL cholesterol and triglyceride levels improved in all patients, normalization of these lipoproteins was only observed in approximately half of them. Plasma total and low‐density lipoprotein (LDL) cholesterol levels, as well as plasma levels of apolipoprotein (apo) A1, B100 and lipoprotein [Lp(a)], did not show significant alterations compared to the placebo. All safety parameters were comparable between the two groups and remained within the reference limits. Gemfibrozil was well tolerated during treatment. Minor inconveniences were equally distributed between the two treatment groups.

Conclusions. Gemfibrozil is an effective and safe drug in patients with coronary heart disease (CHD) and the high triglyceride‐low HDL cholesterol trait.
Relation between calcium intake, grip strength and bone mineral density in the forearms of girls aged 13 and 15
Authors: KRISTINSSON J. Ö. , VALDIMARSSON Ö. , STEINGRIMSDOTTIR L. , SIGURDSSON G.
Published: August 2009

Abstract. Objectives. To evaluate whether there is an association between calcium intake in adolescent girls and bone mineral density (BMD). Also, the relationships between BMD, various anthropometric factors and grip strength were evaluated.

Design. Cross‐sectional comparison of BMD, calcium intake and grip strength in 13 and 15 year age groups, randomly selected.

Setting. Ten secondary elementary schools in the Reykjavik area.

Subjects. One hundred and ninety‐seven Icelandic Caucasian girls aged 13 and 15. One hundred and seventy participated and 162 completed the study.

Main outcome measures. Single photon absorptiometry was used to measure BMD and bone mineral content (BMC) in both forearms. Consumption of milk and dairy products was assessed using a food frequency questionnaire. Height and weight were measured and grip strength was determined with a hand‐held dynamometer.

Results. Calcium intake was found to be significantly correlated to BMD in the older group after adjustment for menarcheal age and weight (r = 0.24; P < 0.05). Division into three subgroups yielded a significantly greater coefficient of correlation between calcium intake and BMD in the lowest calcium consumption group (r = 0.44; P < 0.05). No association was found in the younger age group.

Significant positive correlations between grip strength and regional bone mineral density accounted for up to 16.8% of the variation in BMD (P < 0.001) and 38.4% of the variation in BMC.

Conclusions. This study is consistent with the hypothesis that a threshold effect of calcium intake on BMD might exist. Above this threshold (1000–1200 mg) no further effect on BMD was seen. The results show a strong association between grip strength, a measure representative of total body strength, and BMD.
A longitudinal study of orthopaedic outcomes for severe factor‐VIII‐deficient haemophiliacs
Authors: ALEDORT L. M. , HASCHMEYER R. H. , PETTERSSON H. ,   THE ORTHOPAEDIC OUTCOME STUDY GROUP
Published: August 2009

Abstract. Objective. Arthropathy is the major cause of morbidity in haemophilia. In an attempt to establish optimal therapeutic regimens for persons with haemophilia, we hypothesized that no direct relationship exists between increasing factor dosage and orthopaedic outcomes over time.

Design. A longitudinal uncontrolled 6 year study was carried out. Ankles, knees and elbows of patients were studied using physical and X‐ray examination scores. Bleeding episodes and treatment regimens were determined. The amount of time lost from work and school, as well as days in hospital, was also monitored.

Setting. Twenty‐one international haemophilia centres were used to accrue and follow patients over the 6 year period.

Subject. Severe (< 1 %) factor VIII deficient patients under the age of 25 without inhibitors were recruited into the study.

Intervention. The status of the six major joints of these patients were measured annually for mobility. X‐ray evaluation of these joints was carried out at the beginning and end of the study. Using a World Federation of Haemophilia joint and X‐ray score, stability, progression or regression of arthropathy was evaluated.

Results. Physical and X‐ray examination scores increased significantly with age, and the number of joint bleeds were significant in determining the Δ score. Approximately 10% of patients entered with all six joints normal. Of these, 50% remained so. Year‐long prophylaxis significantly reduced the rate at which joints deteriorate both on physical (P = 0.02) and X‐ray examination (P = < 0.001). Patients on prophylaxis had significantly fewer days lost from work or school, as well as fewer days spent in hospital (P = < 0.01).

Conclusions. Higher doses of factor per se do not necessarily produce improved orthopaedic outcomes. However, full time prophylaxis is likely to produce the best orthopaedic outcome. The most critical factor for a good orthopaedic outcome is the reduction of joint bleeds.
Costs over time in conventional treatment of acute myeloid leukaemia: A study exploring changes in treatment strategies over two decades
Authors: STALFELT A. M. , BRODIN H.
Published: August 2009

Abstract. Objectives. The aim was to analyse the consumption of different items in conventional treatment of acute myeloid leukaemia (AML) and their cost, in order to evaluate the economic consequences of new treatment strategies.

Design. Data on items of treatment were gathered retrospectively from case notes, including amount and date. Prices were gathered from price lists made up for internal billing/accounting.

Setting. The patients were all treated in a hospital with excellent treatment and service facilities.

Subjects. Seventy‐three AML patients treated from 1973 to 1980, all since deceased, were compared with 54 patients treated from 1981 to 1988, of whom 14 were alive at the end of the observation period.

Interventions. The patients were treated according to randomized treatment protocols to achieve complete remission. Maintenance treatment or consolidation courses were given. In relapse, new induction treatment was given.

Main outcome measures. Complete remission and survival were registered. The costs were divided into basic hospital costs and patient‐specific costs.

Results. The mean total treatment cost for an AML patient in the 1970s was 211138 SEK, and in 1980s 356911 SEK. (UK £1 = 10.57 SEK, US$1 = 5.91 SEK 1990). All treatment costs increased between the periods: hospital costs by 20%, and patient‐specific costs by 186%. Antibiotics, cytostatics and outpatient department costs had increased the most. The mean survival time almost doubled, and in the 1980s group there were several long‐term survivors.

Conclusions. The costs for AML treatment increased considerably from the 1970s to the 1980s. The effectiveness of these treatments increased as well, resulting in increased rate and duration of survival, and several patients were long‐term survivors. It was not possible to identify the cost consequences of separate new technologies.
Familial occurrence of two patients with malignant rheumatoid arthritis
Authors: YOKOI K. , HOSOI E. , NAKANISHI M. , UMEMOTO K. , SHIGEKIYO T. , SAITO S.
Published: August 2009

Abstract. In Japan, patients with rheumatoid arthritis associated with severe extra‐articular manifestations due to vasculitis are diagnosed as having malignant rheumatoid arthritis. We report the occurrence of two cases of malignant rheumatoid arthritis in a Japanese family. Both patients, a father and son, expressed HLA‐DR4 (Dw15), and were infected with Epstein‐Barr virus. Moreover, the father developed malignant rheumatoid arthritis during reactivation of the Epstein‐Barr virus. An unaffected male family member with the same HLA haplotypes was not infected by the virus. The possible role of the virus infection in the pathogenesis of malignant rheumatoid arthritis in a genetically susceptible family is discussed.
Marked eosinophilia in an immunosuppressed patient with strongyloidiasis
Authors: SAVAGE D. , FOADI M. , HAWORTH C. , GRANT A.
Published: August 2009

Abstract. Strongyloidiasis in immunocompromized patients is typically associated with a fulminant clinical course and little eosinophilia. We describe an immunocompromized patient with strongyloidiasis in whom the infection was only minimally symptomatic in association with a dramatic increase in eosinophil count.
Granulocyte—macrophage colony stimulating factor in acute non‐lymphocytic leukaemia
Authors: FANIN R. , BACCARANI M.
Published: August 2009

Abstract. Background. Granulocyte‐macrophage colony stimulating factor (GM‐CSF) is required to maintain and to regulate granulocyte and monocyte productions. It is potentially useful for accelerating and enhancing haemopoietic recovery and neutrophil function.

Results. In acute non‐lymphocytic leukaemia (ANLL) the dependence of blast cells on GM‐CSF and its role in the development and maintenance of leukaemia are still poorly defined. In vitro exposure of fresh leukaemic blast cells to a wide range of concentrations of GM‐CSF leads to a stimulation of cell proliferation in the majority of cases but does not induce any detectable maturation.

Conclusions. Granulocyte‐macrophage colony stimulating factor may be used in the management of ANLL and the myelodysplastic syndrome (MDS) with the aim of: (i) accelerating the recovery of normal haemopoiesis; (ii) increasing cell killing by chemotherapy; and (iii) inducing cell maturation. Therefore the application of GM‐CSF can potentially improve treatment outcome in ANLL and is worth testing in a clinical setting.