bluuebunny/crossref_metadata_2025 huggingface dataset:
Normotensive young men with family histories of hypertension gain weight and decrease their intraerythrocyte sodium content during a 5‐year follow‐up
Authors: WIDGREN B. R. , HERLITZ H. , JONSSON O. , BERGLUND G. , WIKSTRAND J. , ANDERSSON O. K.
Published: August 2009

Abstract. Young normotensive men matched for age and body mass index with (n = 16) and without (n = 13) family histories of hypertension were investigated at baseline and after 5 years of follow‐up with respect to blood pressure, body weight and intracellular sodium content. Subjects with positive family histories of hypertension increased significantly in body weight (from 81.9 ± 11.5 kg to 89.5 ± 11.4 kg, P < 0.001) compared to subjects with negative family histories of hypertension (from 79.9 ± 10.8 kg to 80.7 ± 12.2 kg, NS). Their blood pressure did not differ initially (137 ± 12/75 ± 11 mmHg vs. 135 ± 8/72 ± 9 mmHg), but was reduced in subjects without family histories of hypertension (to 125 ± 3/68 ± 13 mmHg) in the follow‐up examination. At follow‐up, body mass index showed a positive correlation with blood pressure among subjects with positive family histories of hypertension (r = 0.77, P < 0.001). At baseline, subjects with hypertensive fathers had significantly higher intraerythrocyte sodium levels than subjects with normotensive parents. At re‐examination 5 years later, this difference was no longer present. We conclude that normotensive subjects with positive family histories of hypertension are predisposed to gain weight rather than to show an increase in blood pressure at this age. Normalization of intracellular sodium content, as found in the present study, could be a consequence of this weight gain and the ensuing metabolic adaption.
Effect of cholestyramine treatment on biliary lipid secretion rates in normolipidaemic men
Authors: CARRELLA M. , ERICSSON S. , DEL PIANO C. , ANGELIN B. , EINARSSON K.
Published: August 2009

Abstract. This study was designed to clarify the effect of bile acid sequestrant treatment on the total biliary output rates of cholesterol, phospholipids and bile acids in man, and to correlate these changes with the alterations in plasma lipoprotein levels. For this purpose nine healthy, normolipidaemic men were treated with 16 g of cholestyramine daily over a period of 4 weeks, and the biliary secretion rates were measured by a duodenal perfusion technique. Resin therapy, which profoundly increases de novo synthesis of bile acids, resulted in a lowering of total plasma cholesterol levels, mainly due to a 35% reduction in low density lipoprotein (LDL) cholesterol, and in a 33% increase in plasma triglyceride levels, reflecting enhanced very low density lipoprotein (VLDL) triglyceride concentrations; high density lipoprotein (HDL) levels did not change. However, these lipoprotein changes did not correlate with any alterations in biliary lipid output. Total hepatic secretion rates of the biliary lipids remained generally unchanged during treatment, with a tendency towards lower cholesterol output, resulting in a lower molar percentage of cholesterol in hepatic bile, 3.4 ± 0.4 vs. 2.9 ± 0.2 mol %. This is probably due to an increased rate of conversion of cholesterol to bile acids in the hepatocyte. It is concluded that, in man, the liver may adapt well to changes in the enterohepatic circulation of bile acids, thereby maintaining output rates of biliary lipids at a relatively constant level.
Atrial fibrillation and left atrial enlargement: cause or effect?
Authors: ANDERSEN J. S. , EGEBLAD H. , ABILDGAARD U. , ALDERSHVILE J. , GODTFREDSEN J.
Published: August 2009

Abstract. In a blinded controlled study, 58 consecutive patients with definite left atrial enlargement (M‐mode dimension of at least 45 mm) were followed up after 1–2 years. The aim of the study was to examine the following: (a) the prospective risk of developing atrial fibrillation (AF); and (b) the effect of the heart rhythm on the left atrial size. Of 36 patients in sinus rhythm, one developed paroxysmal AF and one developed persistent AF during a median follow‐up period of 20 months. Thus the incidence of new AF was 5% per year. Eighteen patients died before scheduled echocardiographic follow‐up, but in the remaining subjects the left atrial dimension did not change significantly: the median increment was 1 mm in 20 patients who sustained sinus rhythm vs. 2 mm in 16 patients with chronic AF (P > 0.05). Although left atrial dilation may cause AF and vice versa, this study demonstrated that the incidence of new AF is low, despite the fact that the left atrial dimension is substantially increased. Similarly, AF per se does not appear to have any major impact on the left atrial dimension.
Early thrombolytic treatment reduces analgesic requirement in patients with myocardial infarction
Authors: KRISTENSEN K. S. , HAARBO J. , MUNKVAD S. , STOLTENBERG M.
Published: August 2009

Abstract. The duration and amount of analgesics required were investigated in 67 patients with myocardial infarction treated with intravenous recombinant tissue‐type plasminogen activator (rtPA) or placebo in a randomized double‐blind trial. Infusion of rtPA (100 mg)/placebo was started within 5 h after the onset of symptoms, and the requirement for analgesics during the following 48 h was recorded. Sixty‐seven per cent of the 30 rtPA‐treated patients required analgesic treatment for less than 6 h, compared to 38% of the 37 patients in the placebo group (P = 0.04). During the study period, patients in the rtPA group used the equivalent of 5.3 mg (median value) intravenous morphine, which was significantly less than the 11.2 mg used in the placebo group (P = 0.04). In conclusion, the present study suggests that early thrombolysis with intravenous rtPA reduces the amount and duration of analgesic treatment required by patients with myocardial infarction.
Antibodies to neutrophil granulocyte myeloperoxidase and elastase: autoimmune responses in glomerulonephritis due to hydralazine treatment
Authors: NÄSSBERGER L. , JOHANSSON A.‐C. , BJÖRCK S. , SJÖHOLM A. G.
Published: August 2009

Abstract. Autoantibodies against myeloperoxidase and elastase were found in a study of nine patients who had developed glomerulonephritis after treatment with hydralazine, but not in patients who were treated with hydralazine without side‐effects. Circulating IgM isotype antibodies against myeloperoxidase, and IgM and IgG anti‐elastase, were mainly present during the initial months after withdrawal of the drug. By contrast, IgG isotype antibodies against myeloperoxidase, initially found in seven patients, had increased in concentration and were present in all patients at follow‐up after 4–12 years.
A case of severe pancytopenia caused by ibuprofen
Authors: LINDBLAD R. , RÖDJER S.
Published: August 2009

Abstract. We here present the case of a patient with severe neutropenia, haemolytic anaemia and thrombocytopenia associated with long‐term use of ibuprofen. The blood parameters rapidly normalized when the drug was discontinued, and no further treatment, except for a short course of antibiotics, was required.
Dilated cardiomyopathy associated with Chlamydia trachomatis infection
Authors: ODEH M. , OLIVEN A. , RAUCHFLEISCH S. , BASSAN H.
Published: August 2009

Abstract. A 26‐year‐old man was admitted to hospital with acute myocarditis complicated by congestive heart failure, and atrial and ventricular arrhythmias. Detailed investigations to determine the aetiological factors involved yielded negative results, except for serological evidence of infection with Chlamydia trachomatis. During the follow‐up period, dilated cardiomyopathy developed. To the best of our knowledge a similar case has not been reported previously.
Weight‐for‐height standards in adulthood
Authors: KARLBERG J. , MOSSBERG H.‐O.
Published: August 2009

Abstract. Although there are some Swedish studies giving reference values for height and weight in adulthood, no values of weight for height (W/H) are available. W/H is an essential measurement, as it permits comparison of weight independent of the height of an individual. We here present a method of constructing W/H standards, illustrated by a material sample of 4438 healthy individuals, 20–80 years of age, living in the Uppsala County during the period 1964–1971. In setting standards of W/H, the ‘normal’ increase in weight during adulthood and the distribution skewness of weight are both shown to be important. This weight gain starts at about 40 years of age, and is completed at approximately 55 years of age. It can be regarded as a ‘normal’ pattern, but not necessarily the optimum healthy one. Using ordinary growth charts for weight and height, a simple means of expressing W/H in standard deviation scores is outlined. It is difficult to find a representative Swedish sample, owing to geographical and psychosocial differences, and also to the secular trend phenomenon. However, the mean values for weight and height obtained in the present study fall between the mean values of two other recently conducted Swedish studies.
Effect of fish diet versus meat diet on blood lipids, coagulation and fibrinolysis in healthy young men
Authors: MARCKMANN P. , JESPERSEN J. , LETH T. , SANDSTRÖM B.
Published: August 2009

Abstract. Twelve healthy young men followed a 10‐d controlled diet that included 210 g of fatty fish d−1. The diet was repeated after 18 d, but with lean meat substituted for fish. Blood samples were collected for assessment of serum lipids and haemostatic variables in the plasma. Both experimental diets caused serum triglycerides and plasma factor VIIc to decline to the same extent. The meat diet was also associated with significant changes in plasma levels of tissue plasminogen activator (t‐PA) antigen, PA inhibitor type I (PAI‐1) antigen, PAI activity, and t‐PA activity of the euglobulin fraction of plasma. The fish diet left these variables unchanged from initial values. Thus, in a paired comparison of the two diets, the fish diet was associated with higher levels of t‐PA antigen (5.4 vs. 4.7 g ml−1), which is considered to be beneficial with regard to prevention of cardiovascular disease. However, the fish diet was concurrently associated with the putative unfavourable higher levels of PAI‐1 antigen (3.0 vs. 1.2 ng ml−1) and PAI activity (6.1 vs. 3.2 IU ml−1), and lower t‐PA activity (80 vs. 140 mlU ml−1). Thus it is unclear which of the two diets has the greatest potential in the prevention of cardiovascular disease.
Degree of coronary artery disease predicted by exercise testing
Authors: AURSNES I. , BENESTAD A. M. , SIVERTSSEN E. , SKJÆGGESTAD Ø. , GRØNSETH K.
Published: August 2009

Abstract. The ability of exercise testing to predict the extent of coronary artery disease was examined in 268 male patients undergoing both coronary angiography and bicycle testing with electrocardiography before coronary artery bypass surgery. When maximal ST‐depressions limited by symptoms increased from 0 to 4 mm or more, the percentage of patients with ‘serious’ coronary disease, defined as either triple vessel disease or left main stem stenosis, increased from 50% to 80% (P = 0.0001). The patients in the lowest third of physical work capacity showed only a slightly increased risk of serious disease. This tendency was abolished in patients who were using β‐blockers, whereas the relationship between ST‐depression and disease was not affected by this medication. The probability of finding left main stem stenosis in a patient increased from 5 to 30% with increasing ST‐depression; β‐blockers did not affect this relationship, but there was no additional predictive effect of implicating the level of physical work capacity. It is concluded that traditional electrocardiography during exercise is of value when selecting patients for angiography, but that the physical work level obtained during the test does not predict the degree of coronary pathology.
Bleeding complications to oral anticoagulant therapy: multivariate analysis of 1010 treatment years in 551 outpatients
Authors: LAUNBJERG J. , EGEBLAD H. , HEAF J. , NIELSEN N. H. , FUGLEHOLM A. M. , LADEFOGED K.
Published: August 2009

Abstract. One thousand and ten patient years of oral anticoagulant therapy with vitamin‐K‐antagonists were reviewed with regard to major bleeding complications. The incidence of bleeding that necessitated hospital admission was 2.7% per year (95% confidence limits, 1.7–3.7%). The major source of bleeding was the alimentary tract, whereas no cases of intracranial bleeding were found. Various factors with potential effects on the bleeding risk were evaluated by multivariate statistical analysis, and the following independent risk factors were identified: age > 75 years and hypertension increased the bleeding risk by 10.5% and 4.5%, respectively. Each recorded prothrombin value significantly below the therapeutic range increased the bleeding risk by 3.9%, and each year of treatment increased the risk by 2.0%. These figures may be used to estimate the risk of major bleeding in an individual patient. Current treatment with thiazide diuretics was found to increase the bleeding risk by 5.2%. However, this observation requires further documentation and analysis. Although no lethal episodes of bleeding occurred, the developing field of indications for oral anticoagulant therapy should be considered on the basis of a continuous substantial risk of major bleeding.
Erythropoietin deficiency in acute crescentic glomerulonephritis and in total bilateral renal cortical necrosis
Authors: THAYSEN J. H. , NIELSEN O. J. , BRANDI L. , SZPIRT W.
Published: August 2009

Abstract. Six patients with acute renal failure, in five cases due to acute crescentic glomerulonephritis and in one case due to total bilateral renal cortical necrosis, were studied. All had serum erythropoietin (EPO) concentrations in the normal range, despite a relatively severe anaemia. Half‐life and plasma clearance of intravenously injected recombinant human erythropoietin (rhEPO) were determined. The results indicate that the lack of compensatory increase in serum EPO to the anaemic stimulus is not due to increased catabolism, but to decreased synthesis of the renal hormone. Two patients were treated with rhEPO (Eprex®). In marked contrast to untreated controls, both patients responded with vigorous reticulocytosis and normalization of haemoglobin levels while they were still in severe renal failure. These results are similar to our previous findings in patients with acute renal failure due to tubular necrosis. Under all three conditions the defective EPO synthesis is probably the dominant pathogenetic factor for the largely aregeneratory anaemia of prolonged cases, and for the sluggish restoration of red cell mass during recovery of renal function. It is concluded that defective synthesis of EPO is not only a permanent and irreversible feature of severe chronic renal failure, but that it is also present, usually in a transient and reversible form, in different types of acute renal failure.
High incidence of multinodular toxic goitre in the elderly population in a low iodine intake area vs. high incidence of Graves' disease in the young in a high iodine intake area: comparative surveys of thyrotoxicosis epidemiology in East‐Jutland Denmark and Iceland
Authors: LAURBERG P. , PEDERSEN K. M. , VESTERGAARD H. , SIGURDSSON G.
Published: August 2009

Abstract. Little is known about the optimum level of iodine intake for iodine supplementation programmes, or about the effects of the high levels of iodine intake that are found in some countries. We compared the incidence of different types of hyperthyroidism in East‐Jutland Denmark with a low average iodine intake but no endemic goitre, and the incidence in Iceland with a relatively high iodine intake. Hyperthyroidism was more common in East‐Jutland than in Iceland, due to a much higher incidence of multinodular toxic goitre and also of single toxic adenoma. Most of the patients with these diseases were over 50 years of age. By contrast, the incidence of Graves' disease was significantly higher in Iceland than in East‐Jutland. This difference was most marked in the younger age groups, in which hyperthyroidism was more than twice as common in Iceland as in East‐Jutland. These results demonstrate that even mild iodine deficiency has a significant effect on population health, since it leads to a high incidence of autonomous thyroid nodules with hyperthyroidism in the elderly population. However, population iodine intake probably should not exceed a level much higher than that necessary to avoid iodine deficiency, otherwise Graves' disease may be induced in the young population.
Characteristics of patients resistant to antihypertensive drug therapy
Authors: ISAKSSON H. , DANIELSSON M. , ROSENHAMER G. , KONARSKI‐SVENSSON J. C. , ÖSTERGREN J.
Published: August 2009

Abstract.In order to determine the features that characterize refractory hypertension (RH), patients aged < 65 years in a hypertension clinic were screened. Thirty‐six patients on triple drug therapy with a supine diastolic blood pressure (DBP) of ≥ 5 mmHg above an identified target pressure (90–100 mmHg), or a systolic blood pressure (SBP) ≥ 170 mmHg for the last 6 months (≥ 3 measurements) underwent a thorough clinical investigation. The frequency of renal artery stenosis (RAS) in the RH patients was 30%. The non‐RAS patients had a low occupational status, 76% being either manual workers or unskilled non‐manual workers (reference group: 42%:P< 0.01). They were more obese (body mass index (BMI) 28.8 vs. 25.8;P< 0.01), and had a longer duration of hypertensive disease. RH patients had a higher prevalence of non‐insulin‐dependent diabetes mellitus (18 vs. 6%;P< 0.05), and showed a higher prevalence of nervous complaints and mental distress (44% vs. 12%:P< 0.001) and musculo‐skeletal pain (39% vs. 7%;P< 0.001). It is suggested that refractory hypertension should be investigated and treated bearing psychosocial factors in mind, concurrently with a screening for secondary hypertension.
Collagenous colitis: a prospective trial of prednisolone in six patients
Authors: SLOTH H. , BISGAARD C. , GROVE A.
Published: August 2009

Abstract. In a prospective study, the clinicopathological effect of prednisolone was evaluated in six patients with collagenous colitis. Prednisolone was associated with a signflcant decrease in stool frequency. However, the effect was transitory, since the diarrhoea recurred when prednisolone treatment was discontinued. There was a trend toward a diminished inflammatory response in the post‐treatment biopsies, but the thickness of the collagen band remained unchanged, except in one patient. Until the results of further studies are available, we recommend that treatment with prednisolone be restricted to periods of acute diarrhoeal episodes.
The effect of the calcium antagonist, isradipine, on working capacity, pulmonary function, morbidity and survival rate in patients with severe chronic obstructive pulmonary disease (COPD): a randomized, double‐blind, placebo‐controlled study
Authors: GALLØE A. M. , GRAUDAL N. , PETERSEN J. R. , LETH P. , GALLØE M.
Published: August 2009

Abstract. Beneficial effects of calcium antagonists on the pulmonary haemodynamics of patients with chronic obstructive pulmonary disease (COPD) have been observed in several studies. Such effects include a decrease in pulmonary vascular resistance, an increase in cardiac output, and an increase in oxygen delivery. The clinical implications of these effects are uncertain. The randomized, double‐blind, placebo‐controlled, long‐term study described here is the first to investigate the clinical effects of a calcium antagonist on patients with COPD. The aim was to test the hypothesis that the calcium antagonist, isradipine, could increase working capacity and lung function, and decrease morbidity and mortality. Fifty‐two patients with COPD were investigated. During a 22‐month observation period no statistically significant differences between the isradipine group and the placebo group were found with regard to these parameters. It is concluded that the existing evidence does not justify the introduction of calcium antagonists as part of the routine treatment of COPD.
Plasma chromogranin A + B, neuropeptide Y and catecholamines in pheochromocytoma patients
Authors: GRÖNDAL S. , ERIKSSON B. , HAMBERGER B. , THEODORSSON E.
Published: August 2009

Abstract.Plasma levels of chromogranin A + B, neuropeptide Y and catecholamines were analysed before, during and after surgery in seven patients with pheochromocytoma. The aim of the study was to determine the diagnostic sensitivity of these plasma amines and peptides, and to investigate their peroperative fluctuations. Chromogranin A + B in plasma was increased preoperatively in all patients, showed no significant increase during surgery, and normalized postoperatively. Neuropeptide Y, which alone can induce hypertension, was present in high levels in plasma from three patients preoperatively, increased further in four patients during surgery, and was postoperatively low in all patients. Fractionated plasma catecholamines were increased in five patients before surgery, increased in all patients during tumour dissection, and normalized postoperatively. It may be concluded that plasma chromogranin A + B exhibited as high a sensitivity for pheochromocytoma as fractionated urinary catecholamines in the patients studied.
Osteomyelitis of the wrist in a patient with Hodgkin's disease
Authors: HAYES T. G. , GILL E. P. , SWARNA U.
Published: August 2009

Abstract. Osteomyelitis of the carpal bones is extremely uncommon. We here report a case of Staphylococcus aureus osteomyelitis involving the wrist in a patient with Hodgkin's disease, and review the existing literature on this subject. The case illustrates the importance of considering pertinent clinical evidence in a patient with disseminated malignancy.
Cholestatic liver reaction during heparin therapy
Authors: OLSSON R. , LEONHARDT T.
Published: August 2009

Abstract. Three patients are reported who developed liver enzyme abnormalities of a cholestatic pattern, without jaundice, after 10–28 d of heparin treatment. The values normalized within 4 months in all patients. Thus heparin should be added to the list of drugs that may cause a cholestatic liver reaction.
On lowering lipids in the post‐infarction patient
Authors: LEWIS B.
Published: August 2009

Abstract. In patients with coronary heart disease (CHD) elevated serum cholesterol levels, like other classical risk factors, remain predictive of further coronary events. The excess risk attributable to raised cholesterol levels is considerable, and greater than that in subjects without CHD. A recent meta‐analysis of all eight qualifying trials of secondary prevention of CHD by cholesterol lowering is reviewed. There were significant reductions in recurrent non‐fatal and fatal CHD, with a downward trend in total mortality. Mechanisms underlying the relationship between cholesterol lowering and secondary prevention are reviewed. The implication of this analysis of trials for clinical practice is that hypercholesterolaemia should be sought and effectively treated in patients with CHD, unless contraindications are present.
Thrombocytosis in adults: analysis of 777 patients
Authors: SANTHOSH‐KUMAR C. R. , YOHANNAN M. D. , HIGGY K. E. , AL‐MASHHADANI S. A.
Published: August 2009

Abstract. A total of 777 patients with thrombocytosis, defined as a platelet count of > 500 × 109 l−1, seen in a University hospital over a 1‐year period, were studied prospectively for aetiology. The most frequent causes of thrombocytosis were infection (21.9%), rebound thrombocytosis (19.4%), tissue damage (17.9%), chronic inflammatory disorders (13.1%) and malignancy (5.9%). Thrombocytosis associated with multiple causative factors, occurring simultaneously, was seen in 6.1 % of cases. Thrombocytosis of ≥ 1 million × 109 l−1 was found most frequently in patients with multiple aetiological factors occurring at the same time, in myeloproliferative disorders, or in postsplenectomy patients.
The Tromsø Study: the positive predictive value of gamma‐glutamyltransferase and an alcohol questionnaire in the detection of early‐stage risk drinkers
Authors: NILSSEN O. , FØRDE O. H.
Published: August 2009

Abstract. Based on the measurement of gamma‐glutamyltransferase and a questionnaire on frequency of alcohol intake, 338 early‐stage risk drinkers were identified from more than 20000 participants in a health survey programme. Two‐thirds (225) of these subjects were questioned regarding their ‘true’ alcohol intake at the first consultation. Positive predictive values were calculated for true daily intake of 30 and 40 g alcohol d−1 for men (20 and 30 g alcohol d−1 for women) on the basis of gamma‐glutamyltransferase activity and the response to a questionnaire. The positive predictive values for a risk intake of 30 gd−1 in men increased from 0.49 to 0.88, with increasing values for gamma‐glutamyltransferase activity and increasing frequency of alcohol intake. The corresponding values for a risk intake of 40 g d−1 were 0.34–0.75. In women, increasing gamma‐glutamyltransferase activity gave no increase in positive predictive values. The estimates for increasing frequency of alcohol intake were unreliable due to small numbers.
Autonomic nerve antibodies and autonomic nerve function in Type 1 and Type 2 diabetic patients
Authors: SUNDKVTST G. , LIND P. , BERGSTRÖM B. , LILJA B. , RABINOWE S. L.
Published: August 2009

Abstract. Complement‐fixing adrenal medulla (CF‐ADM), sympathetic ganglion (CF‐SG), and vagal (CF‐V) nerve antibodies were determined in diabetic patients. Among 74 patients with Type 1 diabetes, CF‐ADM was detected in 7 (10%) cases, CF‐SG in 14 (19%) cases, and CF‐V in 8 (11%) cases. Among 38 patients with Type 2 diabetes, CF‐ADM was detected in 5 (13%) cases, CF‐SG in 4 (11%) cases, and CF‐V in 6 (16%) cases. There were associations between autonomic nerve antibodies and autonomic nerve function. CF‐ADM and/or CF‐SG were significantly (P < 0.002) less prevalent in Type 1 diabetic patients with autonomic neuropathy than in those without [5/44 (11%) vs. 14/30 (47%)] and, in agreement with this, the brake index, a sign of parasympathetic and sympathetic autonomic nerve function, was significantly (P < 0.005) higher (more normal) in these patients (–0.56 ± 0.13 vs. –1.04 ± 0.12). In Type 2 diabetic patients, the E/I ratio, an index of parasympathetic nerve function, was significantly (P < 0.03) lower (more abnormal) in those with CF‐V than in those without (–1.81 ± 0.17 vs. –1.20 ± 0.11). In conclusion, the frequency of sympathetic nerve antibodies was decreased in Type 1 diabetic patients with autonomic neuropathy, while in Type 2 diabetic patients parasympathetic nerve antibodies were related to severe parasympathetic neuropathy.
Interleukin‐6 concentrations in the serum of patients with AIDS‐associated Kaposi's sarcoma during treatment with interferon‐alpha
Authors: DE WIT R. , RAASVELD M. H. M. , BERGE R. J. M. TEN , VAN DER WOUW P. A. , BAKKER P. J. M. , VEENHOF C. H. N.
Published: August 2009

Abstract. Interleukin‐6 (IL‐6) levels were determined in the serum of 14 HIV‐1‐infected patients with Kaposi's sarcoma. 10 HIV‐1‐infected patients without symptoms, and 10 healthy male subjects. IL‐6 levels were also determined in the serum of the 14 patients with Kaposi's sarcoma during treatment with high‐dose human recombinant interferon‐alpha (IFNα). Serum IL‐6 levels were significantly higher in the patients with Kaposi's sarcoma than in the HIV‐infected patients without symptoms and the controls. There was no consistent pattern of changes of IL‐6 levels during IFNα treatment. These results support the view that IL‐6 is a cytokine involved in the pathogenesis of AIDS‐associated Kaposi's sarcoma, but appear to argue against an effect of IFNα on the production or release of IL‐6 as an important mechanism of action of IFNα.
Sulphasalazine‐induced reversible hypersensitivity pneumonitis and fatal fibrosing alveolitis: report of two cases
Authors: LEINO R. , LIIPPO K. , EKFORS T.
Published: August 2009

Abstract. The cases of two patients with ulcerative colitis are described who developed pulmonary infiltrates during the early months of treatment with sulphasalazine. The first patient had a hypersensitivity pneumonitis, which was confirmed by challenge. Recovery was complete. The second patient developed a fibrosing alveolitis type reaction, with fatal outcome.
Risk factors for benign oesophageal disease in a random population sample
Authors: ANDERSEN L. I. , JENSEN G.
Published: August 2009

Abstract.The association of sex, age, relative weight, smoking and drinking habits, chronic obstructive pulmonary disease (COPD) and economic and marital status, with benign oesophageal disease (BOD) was investigated by means of a point‐prevalence study of BOD in a Danish population. A total of 346 individuals, representing subjects who gave positive responses to the discriminating questions pertaining to BOD and risk factors in a previously described questionnaire, as well as control subjects, were invited to participate in a clinical examination. Invasive investigation was accepted by 175 subjects, 114 of whom were diagnosed as having BOD. A statistically significant relationship between BOD and COPD was demonstrated by univariate analysis, and later confirmed by multivariate analysis (P< 0.01). Odds ratios suggested a non‐significant association between BOD and smoking at least 20 g tobacco a day and consuming ≥ 50 alcoholic drinks per week. Obesity, sex, age, marital and economical status were not risk factors for BOD.
Lovastatin therapy in heterozygous familial hypercholesterolaemic patients: effect on blood rheology and fibrinogen levels
Authors: BEIGEL Y. , FUCHS J. , SNIR M. , LURIE Y. , GREEN P. , DJALDETTI M.
Published: August 2009

Abstract. Thirteen heterozygous familial hypercholesterolaemic patients were treated with lovastatin for 1 year, and were investigated for the effect on lipid profile, blood rheology and fibrinogen levels. A significant dose‐dependent reduction in serum levels of total and LDL‐cholesterol, Apo B and the ratio of total cholesterol to HDL‐cholesterol was noted. Improvement in red blood cell filterability and an increase in fibrinogen levels were also observed. We conclude that the hypocholesterolaemic effect of lovastatin in familial hypercholesterolaemia is accompanied by changes in blood rheology. While some of these haemorheological changes may be considered beneficial, others may be regarded as unfavourable. The net effect of lovastatin therapy on the coronary risk of familial hypercholesterolaemic patients warrants further investigation.
Cimetidine and ranitidine may not cross‐react to cause thrombocytopenia
Authors: SHALEV O. , SEROR D.
Published: August 2009

Abstract. We report the case of a patient with peptic ulcer disease who developed cimetidine‐induced thrombocytopenia. The thrombocytopenia resolved spontaneously following discontinuation of cimetidine, and did not recur with ranitidine. We concluded that cimetidine and ranitidine do not necessarily cross‐react to induce thrombocytopenia. Thus the exclusion of both H2‐blockers in the event that one has caused thrombocytopenia may not be justified.
Intensified conventional insulin treatment retards the microvascular complications of insulin‐dependent diabetes mellitus (IDDM): the Stockholm Diabetes Intervention Study (SDIS) after 5 years
Authors: REICHARD P. , BERGLUND B. , BRITZ A. , CARS I. , NILSSON B. Y. , ROSENQVIST U.
Published: August 2009

Abstract. Ninety‐six patients with insulin‐dependent diabetes mellitus (IDDM) and non‐proliferative retinopathy were randomized to intensified conventional treatment (ICT) (n = 44) or regular treatment (RT) (n = 52), and followed up for 5 years. HbA1c decreased from 9.5 ± 0.2% (mean value ± SEM) to 7.2 ± 0.1% in the ICT group, and from 9.4 ± 0.2% to 8.7 ± 0.1% in the RT group (difference between the groups, P < 0.001). Retinopathy increased in both groups (P < 0.001), but after 5 years it was worse in the RT group (P < 0.05). The urinary albumin excretion rate was higher in the RT group than in the ICT group after 5 years (239.9 ± 129.7 μg min−1 vs. 46.0 ± 26.1 μg min−1, P < 0.05). Eight RT patients developed manifest nephropathy, compared with none in the ICT group (P < 0.01). After 5 years the conduction velocities of the sural (P < 0.05), peroneal (P < 0.01) and tibial (P < 0.001) nerves were lower in the RT group. The respiratory sinus arrhythmia was 12.1 ± 1.2 beats min−1 in the RT group and 16.7 ± 1.4 beats min−1 in the ICT group at the end of the study (P < 0.01). The increases in retinopathy (P < 0.01), nephropathy (P < 0.01) and neuropathy (P < 0.001) were all related to the mean HbA1c value during the study. Smoking habits only influenced the progression of retinopathy (P < 0.05). Serious hypoglycaemia occurred in 34 ICT patients and 29 RT patients (242 and 98 episodes, respectively) (P < 0.05). Whereas weight was stable in the RT group, the body mass index increased by 5.8% in the ICT group (P < 0.01). In conclusion, microvascular complications of diabetes were retarded by intensified conventional insulin treatment. However, such treatment increased the frequency of serious hypoglycaemia, and led to an increase in body weight.
Sinemet (CR4): an open‐label study in moderately severe Parkinson's disease
Authors: MING A. , TEMLETT J. A. , FRITZ V. U.
Published: August 2009

Abstract. Almost all patients with idiopathic Parkinson's disease respond to levodopa and progress steadily, requiring an increased overall dosage with time. Sinemet CR4 offers a theoretically attractive method of achieving gradual sustained release of levodopa over time which may be more physiological to striatal dopamine receptors in the early stages of the disease. This study evaluated 20 patients with moderate to severe Parkinson's disease who were treated with Sinemet CR4 over a 1‐year period. Eleven patients completed the full year on therapy, and nine subjects withdrew. Of the withdrawals, two subjects died from non‐Parkinson's disease‐related illness, three showed no therapeutic benefit, and four responded well for a minimal 6‐month period, but then lost therapeutic benefit and developed more severe dystonias. A higher overall levodopa dosage was required by all patients, and side‐effects of levodopa were still present in most patients. However, the nocturnal benefit of this long‐acting preparation was observed by all the patients in the study. Slow onset of action of Sinemet CR4 resulted in early‐morning immobility. Sinemet CR4 cannot replace standard Sinemet, but appears to be a useful form of adjunct therapy in selected patients.
Increased occurrence of arrhythmias in men with ischaemic type ST‐segment depression during long‐term ECG recording. Prognostic impact on ischaemic heart disease: results from the prospective population study ‘Men born in 1914’, Malmö, Sweden
Authors: JUUL‐MÖLLER S. , HEDBLAD B. , JANZON L. , JOHANSSON B. W.
Published: August 2009

Abstract. The objective of this long‐term ECG (LTER) study in 394 68‐year‐old men, selected at random from the general population of Malmö, Sweden, was to determine the prevalence and occurrence of cardiac arrhythmias and their impact on morbidity and mortality from IHD. According to Lown classification, 29.4% (116 men) had ventricular arrhythmia (VA) group 4–5. Serious ventricular arrhythmia (Lown group 4–5) was more common in men with asymptomatic ischaemic type ST‐segment depression (STD) than in those without it (37.8% vs. 26.7%; P < 0.05). During the mean follow‐up period of 53.1 months there were seven IHD deaths (6%) among the 116 patients with VA, Lown 4–5, and nine IHD deaths (3.2%) among the 278 patients without serious VA, Lown 0–3, (P = 0.26). Six and three of these deaths, respectively, were considered to be sudden (P = 0.022). The increased cardiac event rate (fatal or non‐fatal MI or deaths due to chronic IHD) associated with a serious ventricular arrhythmia disappeared when history of IHD at baseline and occurrence of STD during LTER were taken into account. The study did not provide any evidence to suggest that ventricular arrhythmia was triggered by myocardial ischaemia. Five of 9 (56%) deaths due to IHD in men with STD occurred among the 38% (37/98) of patients who belonged to Lown class 4–5. It is concluded that the prognostic information derived from LTER can be improved by combined monitoring of STD and ventricular arrhythmias.
Nephrocalcinosis in Sjögren's syndrome: a late sequela of renal tubular acidosis
Authors: MOUTSOPOULOS H. M. , CLEDES J. , SKOPOULI F. N. , ELISAF M. , YOUINOU P.
Published: August 2009

Abstract. Sjögren's syndrome (SS) is an autoimmune exocrinopathy that develops into systemic autoimmune disease in 25% of patients, leading to general complications, one of which is kidney involvement. It presents mainly as interstitial nephritis, disclosed by hyposthenuria, distal renal tubular acidosis (RTA) and diabetes insipidus. We here describe five cases of SS with type‐1 RTA (hyperchloraemic metabolic acidosis with an anion gap and alkaline urine pH) who developed nephrolithiasis, nephrocalcinosis and renal insufficiency. Hypercalciuria due to acidosis was the main nephrocalcinosis‐prone factor in four patients; four subjects displayed diminished renal concentrating capacity, and two had hypokalaemia.
Visceral fat accumulation: the missing link between psychosocial factors and cardiovascular disease?
Authors: BJÖRNTORP P.
Published: August 2009

Abstract. Neuroendocrine responses to psychosocial pressures have been well characterized. The defence reaction is followed by increased activity of the sympathetic nervous system. Essential hypertension might be induced by such mechanisms. The defeat reaction is characterized by increased activity along the corticotropin releasing factor‐adreno‐corticotropin hormone‐cortisol axis, resulting in the inhibition of gonadotropin secretion. Such endocrine disturbances are followed by metabolic aberrations, and probably also by the accumulation of visceral fat. Subjects with abdominal fat accumulation (high waist/hip circumference ratio, WHR) have recently been found to exhibit a number of psychosocial handicaps, together with endocrine aberrations characteristic of the defence and, in particular, the defeat reaction, as well as the associated circulatory and metabolic aberrations. Such abnormalities, including the WHR itself, are established risk factors for cardiovascular disease and diabetes. It is postulated that increased WHR is a symptom of chronic hypothalamic arousal as a result of a defeat reaction to psychosocial pressures. This might lead to the development of disease via circulatory and metabolic derangements.
Non‐invasive evaluation of long‐term cardiac effects of captopril in systemic sclerosis
Authors: KAZZAM E. , CAIDAHL K. , HÄLLGREN R. , GUSTAFSSON R. , WALDENSTRÖM A.
Published: August 2009

Abstract. Impairment of left ventricular (LV) function has previously been reported in patients with systemic sclerosis (SScl). An intermittent vasospastic process in the mycocardium may contribute to the development of myocardial dysfunction. Vasodilators may therefore be potentially useful in the treatment of cardiac dysfunction in patients with SScl. This study was designed to evaluate the long‐term effects of captopril on the myocardial function of patients with SScl. Twenty‐two patients with SScl (15 patients with diffuse scleroderma and 7 patients with CREST syndrome, i.e. calcinosis, Raynaud's phenomenon, oesophageal hypomotility, sclerodactyly, telangiectasia) were investigated by means of Doppler and echophonocardiography before and after treatment with captopril (1.3 mg kg−1 body weight d−1) for 11–15 months. There were no significant differences in heart rate, systolic and diastolic blood pressure, end‐systolic blood pressure, total peripheral resistance or LV diameters before or after treatment. However, captopril treatment exerted significant effects on LV function: the pre‐ejection period (PEP) and the ratio of pre‐ejection period to LV ejection time decreased significantly (P < 0.05). Mitral E‐point septal separation decreased significantly (P < 0.01), even after adjustment for LV end‐diastolic diameter (P < 0.01). The ejection fraction increased significantly (P < 0.05), and the isovolumic relaxation time decreased (P < 0.01). The left atrial emptying index increased (P < 0.01). The Doppler peak late to early ventricular filling velocity decreased (P < 0.05), and the isovolumic index was also reduced (P < 0.05). We conclude that both systolic and diastolic LV function indices improved in patients with SScl after captopril treatment for a mean period of 1 year. The effects of captopril might be due to vasodilation of the myocardial vessels and/or a direct effect on the renin‐angiotensin system of the heart.
Hand‐free stethoscope — method and instrument for more reliable blood pressure measurements
Authors: LJUNGVALL P. , THULIN T.
Published: August 2009

Abstract. Measurement of blood pressure is subject to two sources of variation: biological and measurement variation. It is important to bear in mind that the ability to interpret the Korotkoff sounds correctly determines the levels of both systolic and diastolic blood pressure. To improve the ability to distinguish between the Korotkoff phases, the hand‐free stethoscope and the hand‐free method were developed. The improved stethoscope head was fixed under the edge of the cuff, thus reducing the noise generated from physiological tremor and other movements. This resulted in more distinct Korotkoff sounds. Furthermore, the new method reduced the spreading of blood pressure values. In 107 patients the average systolic blood pressure recording was 3.1 mmHg higher and the average diastolic blood pressure was 3.5 mmHg lower. We conclude that the new stethoscope and technique provide a means of significantly improving the indirect measurement of blood pressure.
Antihypertensive efficacy and tolerability of enalapril and slow‐release verapamil in essential hypertension: a double‐blind, cross‐over study
Authors: FAGHER B. , KATZMAN P. , HULTHÉN U. L. , HENNINGSEN N. C. , THULIN T.
Published: August 2009

Abstract. The antihypertensive efficacy and tolerability of enalapril (E) and slow‐release verapamil (V) were compared in a 2‐month double‐blind cross‐over study in 22 patients with mild to moderate essential hypertension. After 1 month, significantly lower systolic (P < 0.01) and diastolic (P < 0.02) blood pressures (BP) were achieved with E, 20 mg d−1, compared with V, 240 mg d−1. After 2 months of treatment, BP reductions were similar after E, 40 mg d−1, and V, 240 mg twice a day. The fall in supine mean BP after 2 months of treatment with V was significantly greater in patients aged ≥ 50 years of age (P = 0.02) (median 18 mmHg) than in patients aged < 50 years (10 mmHg). E showed similar effectiveness in both age groups. Statistical group analysis of a quality‐of‐life questionnaire showed no significant differences between the active drugs and the placebo. It is concluded that E and V are equally effective as antihypertensive agents, and that both drugs are well tolerated.
Ionized calcium in blood: studies on patients with pulmonary disease
Authors: VADSTRUP S. , WANDRUP J.
Published: August 2009

Abstract. A new automatic ionized calcium analyser ICA 2 (Radiometer, Copenhagen, Denmark) was used for studies of ionized calcium (CCa2+) in the arterial blood of patients with a compensated respiratory acidosis due to chronic lung disease. The data for 16 patients showed an unexpectedly high level of variation in CCa2+ (range, 1.01–1.25 mmol l−1) despite the fact that there was only a small degree of variability in pH (range, 7.38–7.51). CCa2+ was not correlated with pH as has been observed in acute respiratory disturbances. A highly significant negative correlation was found between CCa2+ and base excess (BE) (r = − 0.81, P < 0.0001), and between CCa2+ and carbon dioxide tension (pco2) (r = 0.71, P < 0.002). These correlations differed from those reported previously in acute respiratory disturbances. CCa2+ showed a significant positive correlation with oxygen tension (PO2) (r = 0.71. P < 0.002). It is concluded that CCa2+ in arterial blood from patients with chronic lung disease is correlated with acid‐base and gas quantities in an entirely different manner to that observed in acute acid‐base disturbances in normal adults.
Intravenous prostacyclin in thrombotic thrombocytopenic purpura: case report and review of the literature
Authors: TARDY B. , PAGE Y. , COMTET C. , TARDY‐PONCET B. , ZENI F. , DECOUSUS H. , BERTRAND J. C.
Published: August 2009

Abstract. The use of prostacyclin infusion in thrombotic thrombocytopenic purpura is consistent with the hypothesis that patients may lack a plasma factor stimulating prostacyclin production. However, prostacyclin therapy, alone or in combination with aspirin, dipyridamole, steroid and plasmapheresis, failed in many cases. We here describe the case of a patient who responded dramatically to a combination of prostacyclin and plasma infusions, after conventional therapy had failed (plasmapheresis, fresh frozen plasma infusions). Prostacyclin was infused intravenously initially for 120 h from 4 to 9 ng kg min−1 and then continuously for 48 h at 9 ng kg min−1. Despite the scarcity of case reports in the literature, we conclude that the failure of prostacyclin in thrombotic thrombocytopenic purpura appears to be related to insufficient doses and/or duration of therapy.
Cost‐benefit analysis of non‐pharmacological treatment of hypertension
Authors: JOHANNESSON M. , Åberg H. , AGRÉUS L. , BORGQUIST L. , Jönsson B.
Published: August 2009

Abstract. In this study a non‐pharmacological treatment (NPT) programme and conventional drug treatment of hypertension was compared in a cost‐benefit analysis. The NPT programme involved 400 patients and was conducted at 8 health centres during the period 1984–1986. It consisted of monthly visits by a nurse, visits by a doctor every 6 months, home blood pressure (BP) measurements, dietary advice, relaxation, physical activity, etc. The patients were also followed up for 2 years after the study to assess whether the programme still worked, and whether future treatment costs were affected. The treatment costs were about SEK 5300 higher per patient for the NPT programme. The benefits, in the form of reduced treatment costs for the period 1986–1988 and willingness to pay (WTP) for the NPT programme, were about SEK 3200. Thus the NPT programme resulted in a loss of about SEK 2100 per patient. However, a longer follow‐up period is needed for any specific conclusions to be drawn about the costs and benefits of the NPT programme, as compared with conventional drug treatment.
Adenosine provokes myocardial ischaemia in patients with ischaemic heart disease without increasing cardiac work
Authors: Strååt E. , HENRIKSSON P. , EDLUND A.
Published: August 2009

Abstract. Intravenous infusion of adenosine in patients with ischaemic heart disease (IHD) has been shown to induce chest pain and ST‐depression. The aim of this study was to determine whether such myocardial ischaemia could be due to an increase in myocardial work. Thus patients with stable angina pectoris (n = 8) were randomly allocated to exercise or adenosine infusion, with a 1‐h rest period before the second test. The maximal tolerable work load was 120±13 W, where all patients but one experienced typical angina pectoris. ECG revealed ST‐depressions in all patients. The maximal tolerable dose of adenosine was 108±6 μg kg−1 min−1. All patients experienced chest pain typical of habitual angina pectoris, and all but one developed ST‐depressions. During exercise there was a gradual and marked increase in the rate pressure product (RPP), in parallel with the development of ST‐depression. By contrast, during infusion of adenosine there was only a minor increase in RPP (P = 0.0001). In conclusion, infusion of adenosine provokes signs and symptoms of myocardial ischaemia in patients with IHD with only a minor increase in cardiac work compared to exercise. These results are consistent with the hypothesis of a myocardial steal.