bluuebunny/crossref_metadata_2025 huggingface dataset:
Cardiac rehabilitation — a cost analysis
Authors: LEVIN L.‐Å. , PERK J. , HEDBÄCK B.
Published: August 2009

Abstract. This economic evaluation is based on a 5‐year follow‐up study comparing a comprehensive cardiac rehabilitation programme with standard care after myocardial infarction (MI). The intervention group consisted of 147 non‐selected MI patients aged < 65 years, who were participating in a rehabilitation programme consisting of follow‐up at a post‐MI clinic, health education and physical training in out‐patient groups. The control group consisted of a non‐selected MI‐population aged < 65 years (n = 158), who were receiving standard care. The rehabilitation programme did not increase the healthcare costs of post‐MI care, as the increase in cost due to participation in the programme was balanced by a decrease in readmissions for cardiovascular diseases. On average, the rehabilitated patient returned to work more frequently, resulting in decreased costs due to loss of production. The mean patient total cost of a 5‐year MI follow‐up was SEK 73 500 lower in the rehabilitated group. The outstanding winner of the rehabilitation programme was the Swedish National Health Insurance System (NHIS). It must be concluded that the comprehensive cardiac rehabilitation programme is a major strategy that leads to both lowered costs and positive health effects. The cardiac rehabilitation programme is therefore highly cost‐effective.
Features of Sjögren's syndrome in patients with primary biliary cirrhosis
Authors: UDDENFELDT P. , DANIELSSON Å. , FORSSELL Å. , HOLM M. , ÖSTBERG Y.
Published: August 2009

Abstract. Twenty‐six consecutive patients with primary biliary cirrhosis (PBC) from northern Sweden were studied regarding the occurrence and features of Sjögren's syndrome (SS). In more than 50% of the patients the rose bengal dye test showed conjunctival and/or corneal staining. In six patients keratoconjunctivitis sicca (KCS) was present with positive rose bengal and Schirmer tests. In a further three patients only the results of the Schirmer tests were abnormal. Radiological findings of sialectasia were demonstrated in six patients, five of whom had KCS. Two of the seven patients who fulfilled our criteria for Sjögren's syndrome were HLA‐B8 positive. A high prevalence of increased immune globulins and rheumatic factor was found, but this did not correlate with the presence of Sjögren's syndrome. Some features of Sjögren's syndrome were found in 73% of PBC patients, and keratoconjunctivitis sicca and/or sialectasia were found in 27% of PBC patients. This constitutes a high frequency of secondary manifestations of the liver disease.
Extensor digitorum brevis in diabetic neuropathy: a controlled evaluation in diabetic patients aged 15–50 years
Authors: LITHNER F. , BERGENHEIM T. , BORSSÉN B.
Published: August 2009

Abstract. A reduction in the bulk of the extensor digitorum brevis muscle (EDB) may be a sign of diabetic neuropathy. We devised a semi‐quantitative scale (normal, reduced or absent) for assessing the bulk of the EDB muscle, and judged it to be a sign of neuropathy in 375 of 395 diabetic patients aged 15–50 years in the county of Umeå, 79% of whom had Type 1 diabetes mellitus (DM), and in 100 healthy controls. Reduced or absent EDB was significantly more common in patients with Type 1 and Type 2 DM than in controls (44 and 48 vs. 12%; P < 0.001). In patients with Type 1 DM, reduced or absent EDB was significantly correlated with age, longer duration of DM, smoking, dry feet, and foot ulcers, but not with fallen forefoot arch, hammer toes or callosities. Reduced or absent EDB was also associated with skin and nail lesions, including Melin's shin spots, purpura and yellow toenails, but not with necrobiosis. Sensory thresholds for vibration, perception and pain were all significantly elevated in Type 1 diabetic patients with impaired EDB, compared to Type 1 diabetics with normal EDB. In controls, impaired EDB was only significantly correlated with smoking. We conclude that the EDB test is easy to perform, and may be used to screen for neuropathy in Type 1 diabetic patients.
Enhanced neutrophil functions in a patient with colony‐stimulating activity‐producing lung cancer
Authors: OHSAKA A. , KITAGAWA S. , IKEDA K. , MOTOYOSHI K. , MIURA Y. , KIRA S. , SAITO M.
Published: August 2009

Abstract. We studied neutrophil functions in a patient with colony‐stimulating activity (CSA)‐producing lung cancer. A 59‐year‐old man had an abnormal chest X‐ray and leucocytosis, predominantly with neutrophils. Pneumonectomy was performed, and the histological diagnosis of the tumour was large‐cell carcinoma of the lung. The tumour induced marked granulocytosis in tumour‐transplanted nude mice, and the conditioned media of the tumour contained very strong human‐active CSA. Superoxide release and membrane depolarization in neutrophils stimulated by the chemotactic peptide, N‐formyl‐methionyl‐leucyl‐phenylalanine, were markedly enhanced in the patient. These findings suggest that CSA produced by the tumour primed neutrophil functions in vivo in the patient.
Misoprostol‐induced urinary incontinence
Authors: FOSSALUZZA V. , DI BENEDETTO P. , ZAMPA A. , DE VITA S.
Published: August 2009

Abstract. In a young woman with rheumatoid arthritis misoprostol induced urinary incontinence. The urodynamic study described here revealed a deficiency in urethral resistance which may explain the phenomenon. This side‐effect may be more common than expected, and misoprostol should be administered with caution to patients suffering from urinary stress incontinence.
High coronary mortality in cold regions of Sweden
Authors: GYLLERUP S. , LANKE J. , LINDHOLM L. H. , SCHERSTÉN B.
Published: August 2009

Abstract. The hypothesis that cold climate is associated with high coronary mortality in Sweden is tested. Cold exposure was calculated in each of the 284 municipalities of Sweden. There was a significant association between cold exposure and coronary mortality in both sexes in all age groups. The strongest association was found in men aged 40–64 years (coefficient of determination k = 0.39). The decile of men aged 40–64 years who lived in the coldest municipalities had a 40% excess mortality. A significant association was also found between cold exposure and mortality from cerebrovascular diseases. We conclude that there is a strong regional association between cold exposure and high coronary mortality.
Acute fungal thyroiditis in a patient with acute myelogenous leukaemia
Authors: FERNANDEZ J. F. , ANAISSIE E. J. , VASSILOPOULOU‐Sellin R. , SAMAAN N. A.
Published: August 2009

Abstract. Acute suppurative thyroiditis of any origin is uncommon, but fungal infections of the gland are particularly rare. Haematogenous spread is the usual route of infection. We here present the case of a recently encountered patient with neutropenic fever and Candida thyroiditis. Fine‐needle aspiration biopsy greatly aided the diagnosis. In immunocompromised patients, the specimens should be treated with special stains to detect the presence of opportunistic organisms; if any are found, appropriate therapy should be initiated.
Radioiodine treatment of recurrent hyperthyroidism in patients previously treated for Graves' disease by subtotal thyroidectomy
Authors: VESTERGAARD H. , LAURBERG P.
Published: August 2009

Abstract. Radioiodine therapy is often employed for treatment of patients with relapse of hyperthyroidism due to Graves' disease, after previous thyroid surgery. Little is known about the outcome of this treatment compared to patients with no previous surgery. A total of 20 patients who had received surgical treatment for Graves' hyperthyroidism 1–46 years previously and with relapse of the hyperthyroidism, and 25 patients with hyperthyroidism due to Graves' disease and no previous thyroid surgery were treated with radioiodine, following the same protocol. Early after treatment the previously operated patients showed a higher sensitivity to radioiodine, with more cases of early hypothyroidism, than non‐operated patients. However, after 50 months of follow‐up the outcome was identical. The results indicate that frequent assessment is necessary after radioiodine treatment of previously operated patients, since some patients develop early hypothyroidism.
Autoantibodies to leucocyte antigens in hydralazine‐associated nephritis
Authors: ALMROTH G. , ENESTRÖM S. , HED J. , SAMUELSSON I. , SJÖSTRÖM P.
Published: August 2009

Abstract. Clinical and laboratory findings and drug history were studied in 17 patients with suspected hydralazine‐associated nephritis, five of whom only had renal disease, while twelve also had extrarenal manifestations. Renal biopsies revealed extracapillary proliferative or focal segmental proliferative glomerulonephritis in 10 patients, and tubulo‐interstitial nephritis in five patients. Antinuclear antibody (ANA) was found in 16 patients, but none of the 14 patients tested had antibodies to DNA. Tests for antibodies to myeloperoxidase (anti‐MPO) and antibodies to neutrophil cytoplasm antigen (ANCA) were performed by ELISA. Twelve of the 14 patients tested had anti‐MPO; five of these 14 patients had ANCA, while one had borderline levels. These findings suggest that hydralazine facilitates the induction of a systemic disease with multiple autoantibody production.
Ten‐year survivors with multiple myeloma
Authors: MURAKAMI H. , NEMOTO K. , MIYAWAKI S. , SHINONOME S. , NOGIWA E. , SHIMANO S. , SATO S. , OMINE M. , NARUSE T. , TSUCHIYA J.
Published: August 2009

Of 130 Japanese patients with symptomatic multiple myeloma who were treated between 1970 and 1989, nine (6.9%) patients survived for more than 10 years. Younger age, low and intermediate tumour mass, chemotherapy with cyclophosphamide, the disappearance of myeloma protein, and a positive response to retreatment were correlated with long‐term survival.
Calcium and peak bone mass
Authors: MATKOVIC V.
Published: August 2009

On the basis of previous epidemiological, clinical and experimental studies, it was demonstrated that adequate calcium intake during growth may influence peak bone mass/density, and may be instrumental in preventing subsequent postmenopausal and senile osteoporosis. Calcium intake during adolescence appears to affect skeletal calcium retention directly, and a calcium intake of up to 1600 mg d−1 may be required. Therefore, adolescent females at the time of puberty probably represent the optimal population for early prevention of osteoporosis with calcium. Young individuals must be in positive calcium balance to provide the calcium necessary for skeletal modelling and consolidation, but the degree of positive balance required to achieve peak bone mass and density is unknown. To assess calcium requirements in young individuals, and also to evaluate the determinants of calcium metabolism during the period of acquisition of peak bone mass, 487 calcium balances from previously published reports have been collected and analysed according to developmental phase and calcium intake. The results of this analysis showed that calcium intake and skeletal modelling/turnover are the most important determinants of calcium balance during growth. The highest requirements for calcium are during infancy and adolescence, and then during childhood and young adulthood. Infants (adequate vitamin D supply) and adolescents have higher calcium absorption than children and young adults to meet their high calcium requirements. Calcium absorption during the periods of rapid bone modelling/turnover is probably mediated by Nicolaysen's endogenous factor. Urinary calcium increases with age, and reaches a maximum by the end of puberty. The results also show that calcium intake has little effect on urinary calcium excretion during the period of most rapid skeletal formation: a weak correlation is present in children and young adults. On the basis of the above studies it was suggested that the RDA for calcium should be higher than currently established for children, adolescents, and young adults, in order to ensure a level of skeletal retention of calcium sufficient for maximal peak bone mass. In addition to nutrition, heredity (both parents) and endocrine factors (sexual development) appear to have profound effects on peak bone mass formation. Most of the skeletal mass will be accumulated by late adolescence, indicating early timing of peak bone mass.
Calcium absorption and calcium bioavailability
Authors: CHARLES P.
Published: August 2009

Calcium is important for bone health. It has been customary to focus on dietary calcium intake, but of central importance for the body needs in the individual patient is the actual calcium absorption. This absorption consists of an active vitamin D‐mediated component and a passive diffusional component. A number of different methods are available for the evaluation of calcium absorption. At present the calcium absorption tests using calcium isotopes (radioactive or stable) appear to be the most reproducible way of determining calcium absorption. The major nutrient sources for calcium are milk and milk products, whereas some of the green vegetables have a low bioavailability of calcium. When deciding whether an increased calcium intake is advisable, the following questions must be answered. What is the calcium absorptive status of the patient? How should the calcium supplement be dispensed? What calcium salt should be used? When should calcium supplements be taken? What is the compliance of the patient? When should the treatment be evaluated? The calcium supplement might be taken as milk (or milk products) or, in patients with lactose intolerance, as calcium supplements. Quite a number of calcium supplements are available on the market, and many of them are marketed without proper knowledge of the bioavailability of the actual preparation. For the benefit of our patients it is now reasonable to demand such investigations before marketing calcium supplements.
Calcium in the prevention and treatment of osteoporosis
Authors: HEANEY R. P.
Published: August 2009

Osteoporotic fractures have many sources. Low bone mass is one such, and inadequate calcium intake, in turn, is one of the causes of low bone mass. Calcium intake may be inadequate because it is low in its own right or, even if ‘normal’, it may not be sufficient to compensate for exaggerated obligatory losses. Inadequate calcium intake may cause bone mass to be low either because calcium intake during growth limits achievement of genetically programmed skeletal mass, or because low intake later in life aggravates involutional loss, or both. Ensuring a generous calcium intake throughout life will prevent both of these consequences. However, it is important to stress that even a calcium surfeit will not prevent or reverse bone loss due to inactivity, gonadal hormone deficiency, alcohol abuse or, indeed, any other factor. Calcium is a nutrient, not a drug. The only disorder it can be expected to alleviate is calcium deficiency. However, the evidence suggests that calcium deficiency is prevalent among Western populations, particularly in North America, and that it thereby contributes substantially to their osteoporotic fracture burden. This component of that burden is therefore entirely preventable.
The scientific basis of recommended dietary allowances for calcium
Authors: SCHAAFSMA G.
Published: August 2009

Dietary calcium is required for bone development during growth (attainment of peak bone mass), for maintenance of skeletal integrity during adult life, and thus for prevention of osteoporosis. The Recommended Dietary Allowance (RDA) of a nutrient for a particular group is considered to cover the needs of 98% of all individuals of that group, and thus takes into account a margin of safety to allow for interindividual variation in minimum requirements. It appears to be possible, on the basis of the available scientific literature, to calculate the daily amount of calcium that must be absorbed from the diet to compensate for the endogenous calcium losses (through urine, faeces and skin) and the calcium retention in bone. Similarly, it seems to be possible to obtain a reasonable estimate of calcium absorption for the different groups of the population. From these data, and taking into account a margin of safety, figures are obtained for calcium intake that are in reasonably close agreement with the authoritative 1989 RDAs of the USA Food and Nutrition Board, with the exception of the USA allowance for girls aged 19–25 years (probably too high) and older adults (possibly too low). With regard to optimal calcium intake, some important questions still remain unanswered. These bear upon the issue of calcium intake and peak bone mass development, and upon the effects of non‐nutritional factors (e.g. genetics and physical activity) and nutritional factors (e.g. sodium, protein, alcohol and caffeine) on calcium requirements. Furthermore, it would appear that bone development and maintenance of bone health may not be the sole criteria for setting RDAs in the near future. These issues are briefly discussed.
Effective modulation of the haematopoietic toxicity associated with zidovudine exposure to murine and human haematopoietic progenitor stem cells in vitro with lithium chloride
Authors: GALLICCHIO V. S. , HUGHES N. K.
Published: August 2009

Abstract. The drug zidovudine (AZT), a synthetic thymidine analogue, has been used in the treatment of acquired immunodeficiency syndrome (AIDS). Clinical use of zidovudine has induced haematopoietic toxicity manifested by anaemia, neutropenia, frequent thrombocytopenia, and overall bone‐marrow suppression. The monovalent cation lithium has been shown to be an effective agent capable of modulating several aspects of haematopoiesis such as the induction of neutrophilia, thrombopoiesis, and protection against suppression of haematopoietic progenitor stem cells following exposure to anticancer drugs and/or radiation in the treatment of malignant disease. We here report the results of studies designed to evaluate the effectiveness of lithium in reversing and/or protecting against either murine or human bone marrow derived haematopoietic progenitors, i.e. (CFU‐GM, CFU‐Meg, and BFU‐E) when co‐cultured in the presence of zidovudine in vitro. Lithium chloride (LiCl) reversed zidovudine toxicity to either murine or human derived CFU‐GM and CFU‐Meg that was optimal at a concentration of 1 mM (P < 0.05). However, the addition of lithium failed to influence zidovudine toxicity toward either murine or human BFU‐E. In summary, these results support the scant clinical studies that have described the presence of neutrophilia and/or thrombopoiesis in zidovudine‐treated AIDS patients receiving lithium. In addition, these data further confirm the need for more detailed evaluation of lithium as an adjuvant agent to reduce the haematopoietic toxicity associated with the use of antiviral therapy in HIV‐infected patients.
Prevalence and geographical distribution of major LDL receptor gene rearrangements in Finland
Authors: AALTO‐SETÄLÄ K. , KOIVISTO U.‐M. , MIETTINEN T. A. , GYLLING H. , KESÄNIEMI Y. A. , SAVOLAINEN M. , PYÖRÄLÄ K. , EBELING T. , MONONEN I. , TURTOLA H. , VIIKARI J. , KONTULA K.
Published: August 2009

Abstract. In order to determine the prevalence of major rearrangements of the low density lipoprotein (LDL) receptor gene in Finland, DNA samples of 199 unrelated Finnish patients with the heterozygous form of familial hypercholesterolaemia (FH) were examined by Southern blot analysis. The FH‐Helsinki mutation, characterized by a 9.5‐kb deletion in the 3′‐end of the LDL receptor gene, was found in 75 (38%) of the patients. The prevalence of this mutation ranged from 26–58% in different areas of Finland. A striking exception was the north karelia region, where only one out of 26 (4%) FH patients was found to carry the FH‐Helsinki allele. Two patients were found to carry other types of large nucleotide rearrangements of the LDL receptor gene. One mutation was a 7.5‐kb deletion eliminating exons 7 to 10, and the other was a 13‐kb deletion covering exons 11 to 16 of the LDL receptor gene. Serum lipoprotein levels were very similar in each category of mutation, i.e. in patients with the FH‐Helsinki gene, those with the two other types of deletion, and the remaining patients with as yet unknown types of LDL receptor gene defects. These results show that, even in genetically uniform populations, FH may be heterogeneous at the DNA level. DNA techniques enable an unequivocal diagnosis for almost 40% of the Finnish patients with the heterozygous form of FH.
Prevalence of hyperinsulinaemia in patients with high blood pressure
Authors: ZAVARONI I. , MAZZA S. , DALL'AGLIO E. , GASPARINI P. , PASSERI M. , REAVEN G. M.
Published: August 2009

Abstract. A total of 41 patients with hypertension were identified in a survey of 732 healthy factory workers. Twenty‐three of these individuals were receiving antihypertensive medication, whereas 18 cases were newly discovered. Plasma glucose and insulin responses to oral glucose and fasting plasma triglyceride (TG), cholesterol, and high‐density‐lipoprotein (HDL) cholesterol concentrations of these 41 individuals were compared with those of 41 other factor workers, with normal blood pressure, matched with the hypertensive group in terms of gender, age, degree of obesity, job in the factory, and leisure‐time activity. Patients with hypertension had significantly higher plasma glucose (P < 0.05) and insulin (P < 0.05) concentrations in response to oral glucose, as well as a higher plasma TG concentration (P < 0.05). Similar findings were obtained when the treated and untreated hypertensive groups were analysed separately and compared with their respective control groups. However, there were no differences between the treated and untreated hypertensive groups. Ninety per cent of the normotensive group had a plasma insulin concentration of < 500 pmol l−1 2 h after the glucose load. Using this value as the criterion for definition of hyperinsulinaemia, 41% of the patients with high blood pressure were hyperinsulinaemic. In addition to meeting this cut‐off point, the patients with hypertension and hyperinsulinaemia were also glucose intolerant and dyslipidaemic. In conclusion, approximately 50% of an unselected group of patients with hypertension were hyperinsulinaemic. Insulin levels were comparable in treated and untreated patients with high blood pressure, and hyperinsulinaemic patients also tended to be glucose intolerant and dyslipidaemic.
Unemployment and blood pressure in Swedish building labourers
Authors: JANLERT U.
Published: August 2009

Abstract. A group of 297 building labourers from the northernmost province of Sweden was monitored for 2 years in order to register health changes associated with unemployment. Blood pressure before and after the observation period was compared with the subjects' experience of unemployment during that period. More than 60% of the men were unemployed during the period studied. At the beginning of the study period no differences in blood pressure levels were observed between groups of subjects who remained employed and those who later became unemployed. However, the blood pressure change during the follow‐up period was significantly greater among individuals who were unemployed during the period than among those who were not. Longer periods of unemployment were associated with greater increases in systolic and diastolic blood pressure. The number of symptoms reported at the start of the study and unemployment at the end of the study were also correlated with a greater increase in blood pressure during the study.
Calcium antagonism in essential hypertension: effect on renal haemodynamics and microalbuminuria
Authors: PERSSON B. , ANDERSSON O. K. , WYSOCKI M. , HEDNER T. , KARLBER B.
Published: August 2009

Abstract. Sixteen middle‐aged men with primary hypertension were treated with the calcium antagonist isradipine over a 9‐week period in a randomized, placebo‐controlled, double‐blind cross‐over manner. At the end of the intervention period the urinary albumin excretion rate, systemic and renal haemodynamics, haemorheological properties of blood and plasma concentrations of atrial natriuretic peptide. noradrenaline and peripheral renin activity were determined. Treatment with isradipine resulted in a substantial reduction in blood pressure due to a reduction in peripheral resistance. The mean albumin excretion rate was not influenced by the isradipine treatment. In a multivariate analysis, changes in the urinary albumin excretion rate were only related to changes in blood pressure.
One‐year response to evening insulin therapy in non‐insulin‐dependent diabetes
Authors: SANE T. , HELVE E. , YKI‐JÄRVINEN H. , TASKINEN M.‐R.
Published: August 2009

Abstract. We studied the 1‐year response and predictors of the response to combination therapy with evening insulin and oral agents in NIDDM patients with a secondary failure. Injection of intermediate‐acting (Monotard HM) or long‐acting (Ultratard HM) insulin was added to previous oral therapy in 17 diabetics (of mean age (± SD) 54 ± 2 years, BMI 27.6 ± 0.5 kg m−2). The initial insulin dose was in the range 10–16 U, and the mean dose was 23 ± 2 U d−1 at 12 months. During the year, combination therapy reduced the mean fasting blood glucose concentration (12.7 ± 0.6 vs. 8.4 ± 0.7 mmol l−1, P < 0.001) and HbA1 (10.7 ± 0.3 vs. 9.8 ± 0.4%, P < 0.01). Body weight increased by 4.4 ± 0.7 kg (P < 0.001). The serum cholesterol concentration decreased by 14% (P < 0.01), but serum triglyceride and HDL‐cholesterol levels remained unchanged. Elevation of serum triglycerides and plasma free fatty acids (FFAs) at baseline predicted a poor long‐term outcome to this mode of therapy. In conclusion, the addition of evening injections of insulin to oral therapy improves glycaemic control in poorly controlled NIDDM patients. However, initial hypertriglyceridaemia predicts a poor long‐term outcome to evening insulin supplementation.
Plasma atrial natriuretic peptide (ANP) in relation to blood pressure in severe hypertension
Authors: EKHOLM D. , EDVINSSON L. , EKMAN R. , THULIN T.
Published: August 2009

Abstract. Atrial natriuretic peptide‐like immunoreactivity in plasma (ANP‐LI) was studied in patients with severe hypertension (n = 21) and in matched healthy control subjects. There was no correlation between ANP‐LI and blood pressure, and the distribution of ANP‐LI values did not differ between the two groups. These results are consistent with the assumption that an increase in ANP is not caused by elevated blood pressure, although elevated ANP‐LI may be found in subgroups of hypertensive subjects with increased atrial pressures due to, for example, cardiac failure.
Stroke following acute myocardial infarction in diabetics
Authors: PULLICINO P. M. , XUEREB M. , AQUILINA J. , PIEDMONTE M. R.
Published: August 2009

Abstract. To investigate the effect of diabetes on stroke after myocardial infarction (MI), we studied consecutive MI patients admitted to the coronary‐care unit prospectively, and compared diabetics with non‐diabetics. Seven per cent (11/148) of diabetics and 3% (8/297) of non‐diabetics had a stroke within 1 month after MI (P = 0.020). Previous stroke and hypertension were significant risk factors for stroke after MI in diabetics, but there were no significant risk factors in non‐diabetics. Hypertension was more frequent in diabetics with (12/14; 86%) than in diabetics without (63/134; 47%) a previous stroke (P < 0.025). Severe hypotension was more frequent in diabetics (9/11) than in non‐diabetics with stroke after MI (0/8) (P = 0.002). We conclude that hypertension is a risk factor for stroke after MI in diabetics, and that diabetics may be at risk for hypotensive stroke after MI. Stroke after MI may be more frequent in diabetics than in non‐diabetics.
Regression of left ventricular hypertrophy during long‐term antihypertensive treatment—a comparison between felodipine and the combination of felodipine and metoprolol
Authors: WETZCHEWALD D. , KLAUS D. , GARANIN G. , LOHR E. , HOFFMANN J.
Published: August 2009

Abstract. Seventy‐six hypertensive patients with left ventricular hypertrophy (LVH) were randomized to receive felodipine or felodipine plus metoprolol in a double‐blind parallel‐group study. The doses of each treatment regimen were titrated to obtain a diastolic blood pressure (BP) of < 95 mmHg. The duration of the treatment was 9 months. At the end of the study, BP was significantly reduced in both groups, and the reduction did not differ between the groups. Left ventricular posterior wall and septum thickness were significantly and similarly reduced in both groups. Left ventricular systolic and diastolic end diameters were not significantly changed. Left ventricular mass (LVM) was significantly and similarly reduced in both treatment groups, as was the ratio of LVM and left ventricular end diastolic volume. In conclusion, felodipine and the combination of felodipine and metoprolol reduced left ventricular hypertrophy to the same extent when BP was similarly reduced.
Serum ionized calcium and the prevalence of primary hyperparathyroidism in age cohorts of 75, 80 and 85 years
Authors: SORVA A. , VALVANNE J. , TILVIS R. S.
Published: August 2009

Abstract. In the elderly, primary hyperparathyroidism (HPT) is often disguised as ‘senility’ which can, however, be alleviated or cured by parathyroid surgery. The prevalence of HPT in the non‐selected 75‐ to 85‐year‐old subjects (n = 610) randomly sampled from census records was estimated by measurements of serum ionized calcium and intact parathyrin levels. The prevalence of cases that require clinical attention seems to be around 3% in women and less than 1% in men. Furthermore, this study indicates that, on average, the serum ionized calcium concentration remains stable even in the elderly.
Complete cure of urinary and faecal incontinence after intravenous vitamin B12 therapy in a patient with post‐gastrectomy megaloblastic anaemia
Authors: KURABAYASHI H. , KUBOTA K. , KAWADA E. , TAMURA K. , TAMURA J. , SHIRAKURA T.
Published: August 2009

Abstract. The case of a 59‐year‐old Japanese woman with post‐gastrectomy megaloblastic anaemia having urinary and faecal incontinence and paraesthesia in four extremities is described. While the haematological abnormalities were improved by administration of a total dose of 17 mg of intramuscular mecobalamin, the neurological abnormalities remained unchanged. Five months later, a total dose of 7.5 mg of mecobalamin was injected intravenously over a period of 5 weeks, although the serum level of vitamin B12 was > 1180 pmol l−1. Immediately after initiation of the therapy, the urinary and faecal incontinence were gradually improved, and were completely cured within 2 months. The peripheral neuropathy was also ameliorated. The effectiveness of intravenous vitamin B12 injection for the neurological abnormalities due to vitamin B12 deficiency is emphasized.
Relationship between smoking and diet: The MONICA‐France project
Authors: NUTTENS M. C. , ROMON M. , RUIDAVETS J. B. , ARVEILER D. , DUCIMETIERE P. , LECERF J. M. , RICHARD J. L. , CAMBOU J. P. , SIMON C. , SALOMEZ J. L.
Published: August 2009

Abstract. The association between smoking habits and diet was examined in a sample of 1126 men, aged 45–64 years, from the general population living in the three French MONICA monitoring areas: Bas‐Rhin (BR) (n = 346), Haute‐Garonne (HG) (n = 400) and Urban Community of Lille (UCL) (n = 380). Diet was assessed by the 3‐day record method. The energy and nutrient intakes were calculated for each of the 3 centres, using the same food composition tables. Alcohol consumption was higher among smokers (P < 0.001). Taking into account alcohol consumption, age, body mass index, centre, educational level and family size, the analyses showed no difference in non‐alcoholic energy intake, proteins, carbohydrates, and total fat. However, smokers had a lower intake of polyunsaturated fatty acids (P < 0.05) and dietary fibre (P < 0.01) than non‐smokers. With regard to food items, smokers had a higher intake of sucrose (P < 0.05) and a lower intake of vegetables (P < 0.001), dairy products (P < 0.05) and cheese (P < 0.05). These results suggest that analyses in future epidemiological research regarding the role of diet in the aetiology of tobacco‐related diseases should consider this association of potential risk factors.
Hyperglycaemic symptoms before diagnosis of non‐insulin‐dependent (type 2) diabetes mellitus in relation to 5‐year outcome
Authors: Niskanen L. , SIITONEN O. , KARJALAINEN J. , UUSITUPA M.
Published: August 2009

Abstract. A group of newly diagnosed patients with non‐insulin‐dependent (type 2) diabetes mellitus (n = 133) were divided into two groups according to the symptoms of diabetes mellitus at diagnosis; a group (26 men and 17 women) with hyperglycaemic symptoms (polydipsia, polyuria, weight loss and tiredness) and a group (44 men and 46 women) without such symptoms. At the time of diagnosis, symptomatic patients tended to be leaner (P = NS), and they were more hyperglycaemic (P < 0.001‐0.06) and had lower insulin responses to an oral glucose load (P < 0.01‐0.05) than asymptomatic patients, but after 5 years no difference in these respects was found. No significant differences in the frequency of islet‐cell antibodies or cardiovascular diseases were found between the two diabetic groups. At the 5‐year examination, the initially symptomatic patients were receiving pharmacological treatment for hyperglycaemia more often than asymptomatic patients. No consistent differences in clinical characteristics and 5‐year outcome were observed between those diabetic patients who were diagnosed on the basis of hyperglycaemic symptoms and those who were diagnosed for other reasons. In conclusion, in middle‐aged patients with newly diagnosed diabetes mellitus classified as non‐insulin‐dependent, diabetic symptoms at diagnosis did not predict the 5‐year outcome of the patients in terms of metabolic control or cardiovascular events.
Plasma ionized calcium and cardiovascular risk factors in mild primary hyperparathyroidism: effects of long‐term treatment with active vitamin D (Alphacalcidol)
Authors: LIND L. , WENGLE B. , LITHELL H. , LJUNGHALL S.
Published: August 2009

Abstract. Primary hyperparathyroidism (HPT) has been associated with hypertension, hyperinsu‐linaemia, hypertriglyceridaemia and hyperuricaemia. In the present study, plasma ionized calcium (Ca2+ was studied in relation to cardiovascular risk factors in 20 subjects with mild hypertension. Plasma Ca2+ was found to be negatively correlated with fasting serum insulin, triglycerides and urate, and with diastolic blood pressure (DBP). However, after the interaction of the different risk factors had been taken into account in the multiple regression analysis, only the relationship between Ca2+ and serum insulin was significant (r = 0.55, P < 0.01). In a previous double‐blind, placebo‐controlled study 1 ug alphacalcidol, a synthetic analogue of 1,25 dihydroxy‐vitamin D3, induced a decrease in blood pressure in mild HPT subjects. In the present study, the highest dose that did not further aggravate the hypercalcaemia was given in a long‐term study over a 12‐month period to 18 mild HPT subjects (average dose, 1.75 μg daily). The treatment induced a reduction in body weight of 0.9 kg (P < 0.05) and an increase in serum urate from 330 ± 92 to 380 ± 104 mmol l‐1 (P < 0.01). A reduction in blood pressure was only observed at the end of the study, from 142 ± 17/86.6 ± 9.1 to 139 ± 13/82.9 ± 8.9 mmHg (P < 0.05 for DBP). The reduction in systolic blood pressure was significantly correlated with the reduction in body weight induced by treatment (r = 0.63, P < 0.02). No consistent changes in glucose or lipid metabolism were induced by treatment.
The predictive value of CKMB mass concentration in unstable angina pectoris: preliminary report
Authors: MARKENVARD J. , DELLBORG M. , JAGENBURG R. , SWEDBERG K.
Published: August 2009

Abstract. Unstable angina pectoris is a common clinical problem, and the diagnosis is based on clinical symptoms. However, these symptoms cannot identify high‐risk patients. Holter monitoring can identify patients at high risk, but analysis of a large number of patients is time‐ and resource‐consuming, as is angiographic examination. We determined whether creatine kinase MB isoenzyme mass concentration could predict the prognosis for patients with unstable angina pectoris. A total of 101 consecutive patients were studied, and blood samples were collected three times a day for 48 h after admission. Patients with unstable angina and elevated CKMB (but still within the normal range) had a significantly higher risk of developing acute myocardial infarction or requiring revascularization during 6 months of follow‐up than patients without elevated CKMB. We conclude that CKMB analysis is a valuable tool that may be of use in selecting high‐risk patients with unstable angina pectoris. This finding needs to be confirmed by more extensive studies.
Cognitive function, insulin‐dependent diabetes and hypoglycaemia
Authors: SACHON C. , GRIMALDI A. , DIGY J. P. , PILLON B. , DUBOIS B. , THERVET F.
Published: August 2009

Abstract. A series of seven psychometric tests, to evaluate mental concentration and the ability to retain selective attention, lexical fluency, wordlist memorizing and psychomotor speed, was performed on 25 non‐diabetic control subjects and 55 insulin‐dependent diabetes (IDD) patients of similar social background and professional status. When tested, none of the diabetics was hypoglycaemic and these patients were divided into two groups:

Group I: 30 IDD patients unaware of hypoglycaemia, and experiencing frequent and severe episodes of hypoglycaemia.

Group II: 25 IDD patients aware of hypoglycaemia.

Groups I and II had experienced the disease for the same period of time (17 ± 13 vs. 14 ± 11 years, respectively) and they had similar HbA1c levels (7.14 ± 1.25% vs. 8.6 ± 1.88%, respectively) and degenerative complications. Compared with the scores of the controls, the Group I scores were lower in four tests: trail‐making part A (psychomotor speed: P < 0.001) and part B (retaining selective attention; P < 0.01), lexical fluency (P < 0.01) and Rey auditory‐verbal learning test (wordlist learning; P < 0.05). Group II scores were lower in two tests: trail‐making part A (P < 0.01) and part B (P < 0.05). In word memorizing, the performance of Group I was inferior to that of Group II (P < 0.05). In general, these psychometric tests showed that IDD scores were lower than those of the controls, with an average of 67% for Group II and 80% for Group I. Chronic hyperglycaemia and severe hypoglycaemia may have a deleterious effect on cognitive performance. In particular, several severe episodes of hypoglycaemia could be responsible for permanent memory impairment.
Responses of atrial natriuretic factor to long‐term sodium restriction in mild to moderate hypertension
Authors: JULA A. , RÖNNEMAA T. , TIKKANEN I. , KARANKO H.
Published: August 2009

Abstract. The effects of long‐term sodium restriction on plasma atrial natriuretic factor (ANF) concentrations, and the role of baseline plasma ANF concentration as an indicator of changes in haemodynamics and left ventricular hypertrophy during this treatment were studied in 40 middle‐aged previously untreated mildly to moderately hypertensive men and women in a 6‐month controlled randomized study. The main emphasis of the treatment programme was to reduce daily sodium intake to less than 70 mmol. Mean sodium excretion decreased from 148 ± 74 mmol 24 h‐1 to 79 ± 71 mmol 24 h‐1 in the treatment group, but remained unchanged in the control group (173 ± 68 mmol 24 h‐1 vs. 186 ± 62 mmol 24 h‐1; P < 0.01 for the difference in changes between the groups). Mean plasma ANF concentrations in the treatment group were 52.4 ± 20.7 (median 50) pg ml‐1 at baseline and 38.7 ± 26.3 (median 42) pg ml‐1 at 6 months, and the corresponding values in the control group were 55.5 ± 20.5 (median 50) pg ml‐1 and 46.1 ± 32.4 (median 50) pg ml‐1, respectively (P = NS for the difference in changes). The ANF concentration decreased from 70 ± 14 pg ml‐1 to 32 ± 26 pg ml‐1 in treated subjects with a high baseline plasma ANF concentration (> 50 pg ml‐1), but increased from 37 ± 11 pg ml‐1 to 45 ± 27 pg ml‐1 in subjects with a low baseline plasma ANF concentration (< 50 pg ml‐1) (difference in changes P < 0.001). Compared with treated subjects with low baseline plasma ANF levels and with controls, treated subjects with high baseline plasma ANF levels showed a decrease (P < 0.05) in interventricular septal and left posterior wall thicknesses, in relative wall thickness, and in peripheral resistance. These results suggest that in mildly to moderately hypertensive subjects long‐term sodium restriction decreases high plasma ANF concentrations concomitantly with regression of concentric left ventricular hypertrophy, probably as a result of changes in haemodynamics.
Ketoprofen and ergotamine in acute migraine
Authors: KANGASNIEMI P. , KAAJA R.
Published: August 2009

Abstract. The objectives of this study were to evaluate and compare the efficacy and tolerability of ketoprofen and ergotamine in the treatment of acute migraine attacks without aura. The study design was a single‐centre, double‐blind, placebo‐controlled, cross‐over comparison of a single dose of ketoprofen (100 mg) and ergotamine (2 mg) suppositories in the treatment of acute migraine attacks. Fifty patients were included in the statistical evaluation. Ketoprofen was found to be more efficient than ergotamine and placebo in reducing the severity of pain. Ketoprofen was found to be more satisfactory than ergotamine and placebo with regard to influence on working ability, and better than placebo in global assessment. We conclude that ketoprofen (100 mg suppository) is superior to ergotamine (2 mg suppository) and placebo in the symptomatic treatment of acute migraine attacks, and has better tolerability.
Hepatotoxicity due to repeated intake of low doses of paracetamol
Authors: ERIKSSON L. S. , BROOMÉ U. , KALIN M. , LINDHOLM M.
Published: August 2009

Abstract.The cases of two patients with fulminant hepatic failure after intake of therapeutic doses (4–8 g) of paracetamol, and who were admitted to hospital for assessment for liver transplantation, are described. In both patients starvation, due to abdominal pain, nausea and vomiting or diarrhoea, was probably contributing to the toxic effect of the drug. One of the patients also had an excessive alcohol intake. Paracetamol should not be prescribed for patients with alcoholism or with low food intake.
One‐year follow‐up on the safety and efficacy of isoprinosine for human immunodeficiency virus infection
Authors: THORSEN S. , PEDERSEN C. , SANDSTRÖM E. , PETERSEN C. S. , NORKRANS G. , GERSTOFT J. , KARLSSON A. , CHRISTENSEN K. C. , HÅKANSSON C. , PEHRSON P. O. , NIELSEN J. O. , JÜRGENSEN H. J. , THE SCANDINAVIAN ISOPRINOSINE STUDY GROUP
Published: August 2009

Abstract. The safety and clinical impact of isoprinosine in HIV‐infected individuals were assessed in a multicentre, randomized, double‐blind, 24‐week study phase, followed by an optional 24‐week open treatment phase, The results of the double‐blind phase have been reported. Of 866 HIV‐seropositive patients randomized, 832 subjects were eligible for efficacy analysis. On completion of the double‐blind phase, 596 patients started open treatment. All patients were evaluated with regard to progression to AIDS and/or death. Within 48 weeks, 10/412 (2.4%) patients assigned isoprinosine and 27/420 (6.4%) patients assigned placebo progressed to AIDS (P = 0.005). Intention‐to‐treat analysis showed identical results. Viewing the open treatment phase in isolation revealed no difference in progression rates between those treated and those not receiving the drug, perhaps reflecting the higher proportion of patients receiving zidovudine or PCP prophylaxis in the latter group. No severe adverse reactions or toxicities were observed. We conclude that HIV‐seropositive patients without AIDS may be safely and effectively treated with isoprinosine.
Suppression of autoantibodies to factor VIII and correction of factor VIII deficiency with a combined steroid‐cyclophosphamide‐porcine factor VIII treatment in a patient with rheumatoid arthritis
Authors: PIGNONE A. , MATUCCI‐CERINIC M. , MORFINI M. , LOMBARDI A. , FERRINI P. L. ROSSI , CAGNONI M.
Published: August 2009

Abstract. The presence of autoantibodies against factor VIII is an unusual but serious complication in rheumatoid arthritis. We describe the case of a patient who developed this kind of complication, with spontaneous bleeding and marked changes in the haematological parameters, that was unsuccessfully treated with a high dose of intravenous gammaglobulin. Subsequently, combined therapy with porcine factor VIII concentrate, cyclophosphamide and steroids led to the disappearance of the anti‐factor VIII autoantibodies.
Simultaneous occurrence of polymyalgia rheumatica in a married couple
Authors: FÆRK K. K.
Published: August 2009

Abstract. The case of a married couple who simultaneously developed polymyalgia rheumatica is presented. Both patients responded to steroid treatment, and when the steroid dose was gradually reduced both patients relapsed. The aetiology and pathogenesis of polymyalgia rheumatica remain unclear; familial aggregation indicates the involvement of genetic factors, whereas conjugal aggregation indicates infectious/environmental agents. In previous reports of polymyalgia rheumatica in married couples, the onset of symptoms in the two patients has usually been separated by a long chronological interval. It is concluded that the present report of simultaneous development of polymyalgia rheumatica in a married couple lends further support to an environmental or contagious aetiology.
Familial hypercholesterolaemia and LDL receptor mutations
Authors: SOUTAR A. K.
Published: August 2009

Abstract. Inherited defects in the gene for the low density lipoprotein (LDL)‐receptor give rise to familial hypercholesterolaemia (FH), a disorder in which defective catabolism of LDL causes a marked increase in its concentration in plasma. As a result, there is excessive deposition of cholesterol in the arterial wall leading to accelerated atherosclerosis and premature coronary heart disease in most patients, although there are differences in its severity. Many different mutations have been found in the LDL receptor genes of FH patients, and although this heterogeneity has provided information about the relationship between structure and function in different domains of the protein, it makes simple DNA‐based diagnosis of the disease impossible. When sufficient groups of patients with defined mutations are available it will be possible to determine the relative importance of any particular mutation compared with other genetic or environmental factors in relation to the severity of their symptoms or their response to treatment.
Genetic basis and pathophysiological implications of high plasma Lp(a) levels
Authors: SCANU A. M.
Published: August 2009

Abstract. Lipoprotein(a) or Lp(a) is a genetic variant of plasma low density lipoproteins (LDL) containing apoB100 covalently linked to apolipoprotein(a) or apo(a), the specific marker of Lp(a). Lp(a) is heterogeneous in size and density, accounting in part for the marked size polymorphism of apo(a), 300 to 800 kDa. The apo(a) size polymorphism is related to the different number of kringle repeats which are structurally similar although not identical to the kringle 4 of plasminogen. Recent studies on a genomic level have indicated that the apo(a) gene contains at least 19 different alleles varying in length between 48 and 190 kb, partially impacting on the plasma levels of Lp(a). High plasma levels of Lp(a) have been found to be associated with an increased prevalence of premature atherosclerotic cardiovascular disease by mechanism(s) yet to be established. Both atherogenic and thrombogenic potentials have been postulated and have been related to the LDL‐like and plasminogen‐like properties of Lp(a), respectively.