bluuebunny/crossref_metadata_2025 huggingface dataset:
Autoimmunity and extranodal lymphocytic infiltrates in lymphoproliferative disorders
Authors: JØNSSON V. , WIIK A. , HOU‐JENSEN K. , CHRISTIANSEN M. , RYDER L. P. , MADSEN H. O. , GEISLER C. , HANSEN M. M. , THOMSEN K. , VORSTRUP S. , SVEJGAARD A.
Published: March 2003

Abstract. Jønsson V, Wiik A, Hou‐Jensen K, Christiansen M, Ryder LP, Madsen HO, Geisler C, Hansen MM, Thomsen K, Vorstrup S, Svejgaard A (Rigshospital, University of Copenhagen and State Serum Institute, Copenhagen, Denmark). Autoimmunity and extranodal lymphocytic infiltrates in lymphoproliferative disorders. J Intern Med 1999; 245: 277–86.

Objective. To examine the relationship between autoimmunity and extranodal lymphocytic infiltrates in different lymphoproliferative disorders with immunoglobulin alterations.

Subjects and design. A clinical review combined with a retrospective cohort study of 380 patients, 28 with monoclonal gammopathy of undetermined significance, three with common variable immunodeficiency, 147 with chronic lymphocytic leukaemia, 57 with Waldenström's macroglobulinaemia and 145 with non‐Hodgkin's malignant lymphoma.

Setting. A university hospital and The State Serum Institute in Copenhagen.

Intervention. Clinical examination of each patient with special attention to chronic inflammatory and autoimmune manifestations. Biopsies were taken from non‐infectious infiltrates, some of which were additionally tested with PCR analysis for gene rearrangements. Serological screening with a test battery for various autoantibodies was used in combination with techniques for the detection of M‐components and monoclonal B‐cell proliferation.

Main outcome measures. Clinical and/or serological autoimmune manifestations, M‐component and other immunoglobulin alterations, and inflammatory tissue changes were studied in patients with chronic inflammatory, polyclonal or oligoclonal pseudolymphomas and in monoclonal, malignant extranodal lymphomas.

Results. In 380 consecutive patients, 49 (12.9%) had extranodal manifestations, of whom 47 also had autoimmune manifestations. Nearly half of the 47 patients had more than one autoimmune manifestation. There was a strong correlation between clinical signs and corresponding autoantibodies such as anti‐SSA and ‐SSB antibodies in Sjögren's syndrome (10 cases), antithyroid peroxidase antibodies in thyroiditis and Graves' disease (10 cases), and parietal cell antibodies in gastric ulcers with maltoma (12 cases). Clinical and serological signs of autoimmunity correlated strongly with female sex (34, 72% women; and 13, 28% men) and with immunoglobulin alterations.

Conclusions. To our knowledge this is the first systematic review of B‐lymphoproliferative and autoimmune disorders indicating that pseudolymphoma and malignant lymphomas, including maltomas, may develop in the context of a permanent autoantigenic drive.
Sickle cell‐like crisis and bone marrow necrosis associated with parvovirus B19 infection and heterozygosity for haemoglobins S and E
Authors: Eichhorn R. F. , Buurke E. J. , Blok P. , Berends M. J. H. , Jansen C. L.
Published: March 2003

In the literature, heterozygosity for haemoglobins S and E is known as a clinically benign condition. Nevertheless, we present a case of double heterozygosity manifesting as an infarctive sickle cell‐like crisis with acute chest syndrome and reversible bone marrow necrosis. Importantly, these complications were associated with serologically documented parvovirus B19 infection. Reviewing the literature, this case emphasizes a specific role of parvovirus B19 as a precipitating cause. Furthermore, it demonstrates how important the consideration of haemoglobin disorders can be even outside of the historically known areas.
Predicting the outcome of invasive treatment of renal artery disease
Authors: Helin K. H. , Lepäntalo M. , Edgren J. , Liewendahl K. , Tikkanen T. , Tikkanen I.
Published: March 2003

Abstract. Helin KH, Lepäntalo M, Edgren J, Liewendahl K, Tikkanen T, Tikkanen I (Helsinki University Hospital, Helsinki, Finland). Predicting the outcome of invasive treatment of renal artery disease. J Intern Med 2000; 247: 105–110.

Objective. Analysis of the factors influencing the outcome of performed or attempted invasive treatment for renal artery disease (RAD).

Setting. University Hospital.

Study patients. Thirty‐five hypertensive patients with 31 stenoses and 14 occlusions of renal artery.

Interventions. Angioplasty was performed on 25 patients (attempted for 30), primary stenting on one, nephrectomy on three, and renal resection on one patient.

Main outcome measure. A decrease of diastolic blood pressure (DBP) by ≥15 mmHg after intervention.

Results. A DBP response was seen in 24 patients. In 11 patients, invasive treatment did not result in a DBP response or failed technically. Compared with these patients, the responders were younger (55 ± 11 vs. 66 ± 8 years, P = 0.001) and tended to have higher DBP (100 ± 8 vs. 93 ± 11 mmHg, P = 0.065). The function of the affected kidney, or that of the more affected kidney if RAD was bilateral, was better preserved in responders (relative clearance on captopril renography 23 ± 15 vs. 8 ± 4%, P = 0.008). A response was more often seen in unilateral than in bilateral RAD (81% vs. 33%, P = 0.015). A relative clearance of ≤10% on captopril renography had sensitivity of 88% and specificity of 81% for renal artery occlusion.

Step‐wise logistic analysis. (1) When DBP was< 95 mmHg with two antihypertensives, the response rate was 1/6 vs. 24/29 for more severe hypertension (P = 0.004). (2) Elderly patients had a response rate of 2/5 vs. 22/24 in younger patients (P = 0.024). (3) Response rates in bilateral and unilateral disease were not different, nor did the function of the affected kidney impact the DBP response. However, three of the four responders with ≤10% relative clearance had an occluded renal artery and underwent nephrectomy.

Conclusions. Middle‐aged patients with easily controlled hypertension and elderly hypertensives do not usually have a blood pressure response to the performed or attempted invasive treatment of RAD. Therefore, it seems recommendable not to screen such patients for RAD, unless their renal function is deteriorated. If the affected kidney functions poorly on captopril renography, angioplasty is usually not applicable and seldom leads to a blood pressure response.
Hormone replacement therapy in healthy postmenopausal women. Effects on intraplatelet cyclic guanosine monophosphate, plasma endothelin‐1 and neopterin
Authors: Anwaar I. , Rendell M. , Gottsäter A. , Lindgärde F. , Hulthén U. L. , Mattiasson I.
Published: March 2003

Abstract. Anwaar I, Rendell M, Gottsäter A, Lindgärde F, Hulthén UL, Mattiasson I (University of Lund, University Hospital, Malmö, Sweden). Hormone replacement therapy in healthy postmenopausal women. Effects on intraplatelet cyclic guanosine monophosphate, plasma endothelin‐1 and neopterin. J Intern Med 2000; 247: 463–470.

Objectives. To evaluate beneficial effects of postmenopausal hormone replacement therapy (HRT) on endothelial function, measured as intraplatelet cyclic guanosine monophosphate (cGMP, mediator of nitric oxide), cyclic adenosine monophosphate (cAMP, mediator of prostacyclin) and plasma endothelin‐1 (ET‐1), and on monocyte activation, measured as plasma neopterin.

Design. Part 1: double‐blind randomized trial for 3 months; part 2: open study for 9 months.

Setting. The study was performed at the Department of Endocrinology, University Hospital, Malmö, Sweden.

Subjects. Fifty‐one postmenopausal women participated in part 1 and 46 in part 2. Inclusion criteria included a history of amenorrhoea for at least 6 months before the study and body mass index ≥ 24 kg m–2.

Intervention. Randomization for either placebo (n = 24) or HRT (n = 27). HRT was given as 2 mg oestradiol valerate for the first 3 months with the addition of 10 mg medroxyprogesterone for 10 days every third month thereafter.

Measurements. Performed at baseline and after 3 and 12 months of the study.

Results. In the HRT group, intraplatelet cGMP increased from 0.56 (0.35–0.94) to 0.61 (0.42–3.40) and 0.65 (0.43–1.08) pmol (109 platelets)–1 after 3 and 12 months, respectively (P = 0.01), whereas plasma ET‐1 decreased from 3.2 (1.1–6.8) to 2.0 (0.8–5.1) and 1.8 (0.4–15.4) pg mL–1 (P < 0.001). Intraplatelet cAMP and plasma neopterin were unchanged. When smokers (n = 15) and non‐smokers (n = 12) in the HRT group were analysed separately, significant effects were seen only amongst smokers. The control group showed unchanged levels of cGMP, cAMP, ET‐1 and neopterin.

Conclusions. These data suggest beneficial effects of HRT on endothelial function which may account for anti‐atherogenic effects of HRT in postmenopausal women, especially in smokers. No effects of HRT were seen upon monocyte activation.
Acute respiratory failure associated with catastrophic antiphospholipid syndrome
Authors: Wiedermann F. J. , Mayr A. , Schobersberger W. , Knotzer H. , Sepp N. , Rieger M. , Hasibeder W. , Mutz N.
Published: March 2003

Abstract. Wiedermann FJ, Mayr A, Schobersberger W, Knotzer H, Sepp N, Rieger M, Hasibeder W, Mutz N (The Leopold‐Franzens‐University of Innsbruck, Innsbruck, Austria). Acute respiratory failure associated with catastrophic antiphospholipid syndrome (Case Report). J Intern Med 2000; 247: 723–730.

We present a case of multiple organ dysfunction syndrome with acute respiratory failure due to alveolar haemorrhage associated with antiphospholipid antibodies in a 42‐year‐old woman with a medical history of antinuclear antibody‐negative systemic lupus erythematosus and antiphospholipid syndrome. Severe respiratory failure, circulatory shock and acute renal failure necessitated artificial ventilation, inotropic and vasopressor therapy, and continuous venovenous haemofiltration. A tentative diagnosis of haemorrhagic lupus pneumonitis or pulmonary manifestation of antiphospholipid syndrome was made. Lupus anticoagulant, IgG anticardiolipin and anti‐β2‐glycoprotein I antibodies were positive. High‐dose glucocorticoid, anticoagulation with heparin, plasmapheresis and cyclophosphamide improved her clinical condition. Despite this, the patient died several days later of spontaneous intracranial haemorrhage. This case illustrates the uncommon manifestation of acute respiratory failure associated with antiphospholipid syndrome.
Does dialysis therapy improve autonomic and peripheral nervous system abnormalities in chronic uraemia?
Authors: Laaksonen S. , Voipio‐Pulkki L.‐M. , Erkinjuntti M. , Asola M. , Falck B.
Published: March 2003

Abstract. Laaksonen S, Voipio‐Pulkki L‐M, Erkinjuntti M, Asola M, Falck B (University Hospital, Turku, Finland). Does dialysis therapy improve autonomic and peripheral nervous system abnormalities in chronic uraemia? J Intern Med 2000; 248: 21–26.

Objectives. Autonomic nervous system (ANS) dysfunction and peripheral neuropathy occur in patients with chronic renal insufficiency. Adequate renal replacement therapy should prevent development or correct these abnormalities.

Design and subjects. We studied retrospectively ANS and peripheral neuropathy in 32 patients with chronic uraemia who received either haemodialysis (16) or peritoneal dialysis (16) therapy, and compared the observed dialysis efficiency with changes in neurological function.

Methods. Heart rate variability (HRV) time domain indices and peripheral sensory nerve conduction studies were followed for a mean of 2.9 years. The adequacy of haemodialysis (HD) efficiency was estimated by Kt/V, an index of fractional urea clearance. Adequacy of continuous ambulatory peritoneal dialysis (CAPD) was estimated on the basis of the patient’s wellbeing and nutritional status as excellent, satisfactory or poor. Based on observed changes in HRV time domain measures, the observations were divided in three subgroups: improved, unchanged or deteriorated.

Results. The peripheral sensory nerve conduction studies were abnormal in 38% of the patients and did not change significantly during the study. Improvement in HRV time domain measures occurred in HD patients with mean Kt/V > 1.20 or in CAPD patients with satisfactory or excellent response to dialysis treatment. Values of Kt/V < 0.85 in HD patients were associated with progressive deterioration of autonomic neuropathy. Diabetic patients (n = 4) differed from others as their HRV was grossly abnormal and did not improve.

Conclusions. The adequacy of haemodialysis is a predictor of improvement of cardiac autonomic nervous function in chronic uraemia. The same trend of improvement was seen also in CAPD patients.
Cigarette smoking, oral moist snuff use and glucose intolerance
Authors: Persson P.‐G. , Carlsson S. , Svanström L. , Östenson C.‐G. , Efendic S. , Grill V.
Published: March 2003

Abstract. Persson P‐G, Carlsson S, Svanström L, Östenson C‐G, Efendic S, Grill V (Karolinska Hospital and Karolinska Institutet, Stockholm, Sweden). Cigarette smoking, oral moist snuff use and glucose intolerance. J Intern Med 2000; 248: 103–110.

Objective. To investigate the association between cigarette smoking and use of oral moist snuff and impaired glucose tolerance and type 2 diabetes.

Design. We performed a population‐based cross‐sectional study of glucose intolerance and tobacco use in Stockholm during 1992–94. The sample consisted of 3128 men, aged 35–56 years, of whom 52% had a family history of diabetes. In an oral glucose tolerance test, we detected 55 men with type 2 diabetes and 172 with impaired glucose tolerance. Information on cigarette smoking and oral moist snuff use was collected by a questionnaire.

Results. The odds ratio of type 2 diabetes was increased for smokers of 25+ cigarettes day–1 (odds ratio = 2.6, 95% confidence interval = 1.1–5.9) as well as for moist snuff dippers of 3+ boxes week–1 (odds ratio = 2.7, 95% confidence interval = 1.3–5.5). The odds ratio of relatively high (highest tertile) fasting insulin levels in subjects with impaired glucose tolerance associated with cigarette smoking of 25+ cigarettes day–1 was 1.5 (95% confidence interval = 0.7–3.6). The corresponding estimate of a relatively low (lowest tertile) 2 h insulin response was 2.5 (95% confidence interval = 0.9–7.1).

Conclusions. These results indicate that heavy users of cigarettes or moist snuff have an increased risk of type 2 diabetes. The results could suggest that tobacco use is associated with a low insulin response.
The effect of different treatment regimens in reducing fasting and postmethionine‐load homocysteine concentrations
Authors: Van Der Griend R. , Biesma D. H. , Haas F. J. L. M. , Faber J. A. J. , Duran M. , Meuwissen O. J. A. TH. , Banga J.‐D.
Published: March 2003

Abstract. van der Griend R, Biesma DH, Haas FJLM, Faber JAJ, Duran M, Meuwissen OJATh, Banga J‐D (Sint Antonius Hospital, Nieuwegein; University of Utrecht, Utrecht; and the University Medical Center Utrecht, The Netherlands). The effect of different treatment regimens in reducing fasting and post‐methionine‐load homocysteine concentrations. J Intern Med 2000; 248: 223–229.

Objectives. To determine the homocysteine‐lowering effect of different treatment regimens on both fasting and postmethionine‐load plasma total homocysteine (tHcy) concentrations.

Design. Descriptive study of consecutive hyperhomocysteinaemic subjects per treatment regimen. Homocysteine was measured in the fasting state and 6 h after methionine loading, both before and after 8 weeks of vitamin therapy. Hyperhomocysteinaemia was defined as a fasting tHcy and/or increase in tHcy (postmethionine‐load minus fasting tHcy concentration) exceeding the 95th percentile of local controls.

Setting. Outpatient clinic of internal medicine of a large non‐academic teaching hospital.

Subjects. One hundred and seventeen hyperhomocysteinaemic subjects (vascular patients and first‐degree relatives).

Interventions. There were four regimens: pyridoxine, 200 mg; folic acid, 5 mg; combination of folic acid 0.5 mg and pyridoxine 100 mg; and folic acid, 0.5 mg daily.

Results. All regimens, except pyridoxine 200 mg, significantly reduced fasting tHcy without differences in the percentage reduction (32–38%). All regimens produced a significant reduction in the increase in tHcy and postmethionine‐load tHcy. The reduction in postmethionine‐load tHcy was smaller for pyridoxine 200 mg than for combination therapy. No differences were found in the percentage reduction (for both increase in tHcy and postmethionine‐load tHcy) between folic acid 5 mg and folic acid 0.5 mg.

Conclusions. Monotherapy folic acid (0.5 mg daily) is the lowest effective therapy for reducing both fasting and postmethionine‐load tHcy concentrations, with the same results as high‐dose folic acid (5 mg daily). Pyridoxine has no additional value.
Primary biliary cirrhosis: survival of a cohort followed for 10 years
Authors: Uddenfeldt P. , Danielsson Å.
Published: March 2003

Abstract. Uddenfeldt P, Danielsson Å (County Hospital Gävle and University Hospital Umeå, Sweden). Primary biliary cirrhosis: survival of a cohort followed for 10 years. J Intern Med 2000; 248: 292–298.

Objectives. To study the natural course of primary biliary cirrhosis (PBC) in order to be able to design accurate clinical pharmacological studies and evaluate the need for liver transplantation.

Design. A cohort of 86 patients with PBC living in northern Sweden was followed for a 10‐year period during 1983–93. No patients received therapy with ursodeoxy cholic acid or other drugs during the follow‐up period.

Method. At start all patients were investigated personally by the authors. At follow‐up medical notes were scrutinized and special questionnaires to the current responsible physician were applied. End‐points were the time of dropout, liver transplantation, death or end of the study period.

Results. At follow‐up data were available for 84 patients (97%). During the study period 34 patients died, of whom 28 were symptomatic; 15 deaths had no direct connection to PBC. Nineteen deaths were related to PBC of whom two were asymptomatic, the most common cause being end‐stage liver disease with liver coma. During the study period in all eight patients were subjected to liver transplantation.

Conclusions. The survival rate of the 32 asymptomatic PBC patients at the start of the study
was the same as a sex‐ and age‐matched standard background population. Those patients with symptomatic PBC from the beginning of study had a survival rate at 10 years of 50%, and the most ominous sign was a bilirubin greater than 35 µmol
L−1. Liver transplantation was performed in almost 10% in this cohort until 1993. Since then, the indications and referral practice for liver transplantation has changed and is now higher.
Augmented response in plasma brain natriuretic peptide to dynamic exercise in patients with left ventricular dysfunction and congestive heart failure
Authors: Kato M. , Kinugawa T. , Ogino K. , Endo A. , Osaki S. , Igawa O. , Hisatome I. , Shigemasa C.
Published: March 2003

Abstract. Kato M, Kinugawa T, Ogino K, Endo A, Osaki S, Igawa O, Hisatome I, Shigemasa C (Tottori University Faculty of Medicine, Yonago, Japan). Augmented response in plasma brain natriuretic peptide to dynamic exercise in patients with left ventricular dysfunction and congestive heart failure. J Intern Med 2000; 248: 309–315.

Objectives. We have previously demonstrated that patients with symptomatic congestive heart failure (CHF), but not with asymptomatic left ventricular dysfunction (LVD), have augmented plasma atrial natriuretic peptide (ANP) response to exercise. Plasma brain natriuretic peptide (BNP) response to exercise is less extensively studied. The aim of this study was to determine whether responses of plasma BNP during exercise normalized for exercise workload are altered in patients with LVD and CHF.

Subjects and methods. Twenty‐nine patients with LVD, 32 patients with CHF (NYHA classes II–III) and 27 age‐matched control subjects were studied. Ventilatory, plasma ANP and BNP responses were assessed during symptom‐limited cardiopulmonary exercise testing. Plasma natriuretic peptide levels were measured at rest and immediately after peak exercise. The increment in plasma BNP was divided by the increment in oxygen uptake (Vo2) from rest to peak exercise, and this ratio [BNP exercise ratio: (peak BNP – rest BNP)/(peak Vo2– rest Vo2)] was compared amongst the three groups.

Results. Peak Vo2 (Control, LVD and CHF: 28.2 ± 1.7, 21.1 ± 1.8, 16.2 ± 0.6 mL min−1 kg−1, respectively), anaerobic threshold and peak workload became smaller as heart failure worsened. Resting and peak plasma ANP levels were significantly higher only in CHF, whilst resting and peak plasma BNP levels displayed a significant and continuous increase from normal subjects to LVD and CHF. The ANP exercise ratio (1.25 ± 0.36, 2.61 ± 0.57, 7.72 ± 1.65,
anovaP = 0.0002) was significantly higher only in patients with CHF, whilst the BNP exercise ratio (0.35 ± 0.10, 2.60 ± 0.69, 4.98 ± 0.97,
anovaP = 0.0001) was significantly higher in patients with LVD and became progressively higher in patients with CHF.

Conclusions. These data showed that the BNP exercise ratio, an exercise plasma BNP response normalized with exercise workload, was augmented in patients with LVD, and became progressively higher in CHF, suggesting that an augmented exercise BNP ratio exists early in the course of developing CHF.
Controlled drug delivery: therapeutic and pharmacological aspects
Authors: Urquhart J.
Published: March 2003

Abstract. Urquhart J (Department of Epidemiology, Pharmaco‐epidemiology Group, Maastricht University, Maastricht, the Netherlands). Controlled drug delivery: therapeutic and pharmacological aspects (Internal Medicine in the 21st Century). J Intern Med 2000; 248: 357–376.

Concerted work to develop human pharmaceuticals based on rate‐controlled drug delivery systems began in 1970. Today there are over three dozen such products, plus a few for veterinary use. In addition, osmotic minipumps have been extensively used since 1978, resulting in over 6000 publications in the pharmacological, endocrinological and physiological literature. Rate‐controlled delivery provides for drug entry into the bloodstream continuously at either a constant or a modulated rate. By this means, one avoids the usual peak and trough pattern of drug concentrations in plasma, with its echoing peak and trough pattern of drug actions, during the interval between successive doses. In contrast to the happenstance release kinetics of rapid‐release dosage forms, rate‐controlled delivery systems can be designed to provide specific temporal patterns of drug concentration in plasma, for the purpose of optimizing the selectivity of drug action, the interval between successive administerings of drug and the likelihood that the next administering will occur at the proper time.
Multidrug resistance in haematological malignancies
Authors: Sonneveld P.
Published: March 2003

Abstract. Sonneveld P (University Hospital Rotterdam – Dijkzigt, The Netherlands). Multidrug resistance in haematological malignancies (Internal Medicine in the 21st Century). J Intern Med 2000; 247: 521–534.

The development of refractory disease in acute myeloid or lymphoblastic leukaemias (AML, ALL) and multiple myeloma (MM) is frequently associated with the expression of one or several multidrug resistance (MDR) genes. MDR1, MRP1 and LRP have been identified as important adverse prognostic factors in AML, T‐ALL and MM. Recently, it has become possible to reverse clinical multidrug resistance by blocking P‐glycoprotein‐mediated drug efflux. The potential relevance of these reversal agents of MDR and potential new approaches to treat refractory disease are discussed.
Molecular epidemiology
Authors: Boffetta P.
Published: March 2003

Abstract. Boffetta P (Unit of Environmental Cancer Epidemiology, International Agency for Research on Cancer, Lyon, France). Molecular epidemiology (Internal Medicine in the 21st Century). J Intern Med 2000; 248: 447–454.

The use of biomarkers in epidemiology is not new, but recent developments in molecular biology and genetics have increased the opportunities for their use. However, epidemiological studies based on biomarkers, which belong to the discipline defined as ‘molecular epidemiology’ are subject to the same problems of design and analysis as ‘traditional’ epidemiological studies. If biomarkers offer new opportunities to overcome some of the limitations of epidemiology, their added value over traditional approaches should be systematically assessed. Biomarkers should be validated though transitional studies; consideration to sources of bias and confounding in molecular epidemiology studies should be no less stringent than in traditional studies.
A case of POEMS syndrome with high concentrations of interleukin‐6 in pericardial fluid
Authors: Shikama N. , Isono A. , Otsuka Y. , Terano T. , Hirai A.
Published: March 2003

Abstract. Shikama N, Isono A, Otsuka Y, Terano T, Hirai A (Department of Internal Medicine, Chiba Municipal Hospital; and Second Department of Internal Medicine, Chiba University School of Medicine, Chiba, Japan). A case of POEMS syndrome with high concentrations of interleukin‐6 in pericardial fluid. J Intern Med 2001; 250: 170–173.

The POEMS syndrome (plasma cell dyscrasia with polyneuropathy, organomegaly, endocrinopathy of various forms, monoclonal gammopathy, skin changes) is a rare multisystem disorder of unknown pathogenesis. Overexpression of proinflammatory cytokines has been implicated in the pathogenesis of POEMS syndrome, however, it is not known whether there is an association between abnormalities in cytokines and pericardial fluid. We present a case of POEMS syndrome with high concentrations of interleukin‐6 (IL‐6) in pericardial fluid. In our patient, pericarditis developed into cardiac tamponade, and the concentration of IL‐6 in pericardial fluid was remarkably elevated compared with that in serum (1760 vs. 6.57 pg mL–1). We suggest that IL‐6 is associated with the progression or maintenance of pericarditis as a result of POEMS syndrome.
Use of complementary and alternative medicine remedies in Sweden. A population‐based longitudinal study within the northern Sweden MONICA Project
Authors: Nilsson M. , Trehn G. , Asplund K.
Published: March 2003

Abstract. Nilsson M, Trehn G, Asplund K (University Hospital, Umeå, Sweden). Use of complementary and alternative medicine remedies in Sweden. A population‐based longitudinal study within the northern Sweden MONICA Project. J Intern Med 2001; 250: 225–233.

Objectives. Previous studies have shown a high prevalence of users of complementary and alternative medicine (CAM) remedies in Anglo‐Saxon countries. We have explored the use of CAM remedies in Sweden, its distribution in different population groups and time trends during the years 1990–99.

Design and subjects. Within the framework of the population‐based northern Sweden Multinational Monitoring of Trends and Determinants of Cardiovascular Disease (MONICA) Project, randomly selected 25–74‐year‐old participants in risk factor surveys performed in 1990, 1994 and 1999 responded to questions about their use of CAM remedies. The participation rate was 72%.

Results. Amongst 5794 respondents in the 1999 survey, 30.5% reported that they had taken a CAM product (vitamins, minerals or biological CAM remedy) in the preceding 2 weeks. Vitamins/minerals only had been taken by 11.7% and other CAM remedies (dominated by fish oil, ginseng and Q10) with or without vitamins/minerals by 18.8%. Use of CAM remedies was more frequent in women than in men and more frequent in people with high than with low level of education. The prevalence was unrelated to a history of severe cardiovascular disease or diabetes but significantly more common in subjects with poor self‐perceived health, particularly so in women. During 1990–99, the use of CAM remedies increased, more in women than in men.

Conclusions. The prevalence of CAM remedy use (other than vitamins and minerals) is high in Sweden. It has been increasing during the 1990s. Its use is particularly common in women, well‐educated people and in those with poor self‐perceived health.
Screening for adult coeliac disease – which serological marker(s) to use?
Authors: Lagerqvist C. , Ivarsson A. , Juto P. , Persson L. Å. , Hernell O.
Published: March 2003

Abstract. Lagerqvist C, Ivarsson A, Juto P, Persson LÅ & Hernell O (Umeå University, Umeå, Sweden). Screening for adult coeliac disease – which serological marker(s) to use?J Intern Med2001;250:241–248.

Objective. To determine which serological marker(s) to use when screening for coeliac disease.

Design. In a population‐based cross‐sectional study we compared the use of antigliadin antibodies (AGA) of isotypes IgA and IgG, antiendomysial antibodies (AEA) of isotype IgA and antitransglutaminase antibodies (ATGA) of isotype IgA for detecting coeliac disease amongst adults.

Setting. Northern Sweden.

Subjects. A total of 1850 of 2500 (74%) invited adults (aged 25–74 years) who were randomly selected from the population register after stratification for age and sex.

Main outcome measures. The sensitivity, specificity and predictive values of the AGA, ATGA and AEA tests.

Results. Nine cases of biopsy proven, previously undiagnosed coeliac disease were detected by screening. The sensitivity of both ATGA and AEA was 100% whilst AGA IgA and IgG both had a sensitivity of 89%. The AEA test had a specificity of 100% whereas the specificities of the ATGA, AGA IgA and IgG tests were 97, 96 and 78%, respectively. The positive predictive value for the AEA test was 100%, whereas it was considerably lower for the other tests (ATGA > AGA IgA > AGA IgG), with further decreases for all tests when shifting from a clinical to a screening situation.

Conclusions. When screening for coeliac disease we suggest a serial testing approach, i.e. an initial ATGA test and, when positive, followed by an AEA test, provided that IgA deficiency has been excluded. However, assessment of the small intestinal mucosal morphology is still required to ascertain the diagnosis.
Exercise‐induced symptomatic ischaemia predicts a poor long‐term prognosis after acute myocardial infarction
Authors: ABBOUD L. , HIR J. , EISEN I. , MARKIEWICZ W.
Published: March 2003

Abstract. Abboud L, Hir J, Eisen I, Markiewicz W (Rambam Medical Center and Technion School of Medicine, Haifa, Israel). Exercise‐induced symptomatic ischaemia predicts a poor long‐term prognosis after acute myocardial infarction. J Intern Med 2002; 251: 53–60.

Study objectives. To evaluate the long‐term prognostic significance of symptomatic ischaemia during exercise testing performed 3 weeks after acute myocardial infarction (AMI).

Design. A prospective study with long‐term follow‐up.

Setting. A Cardiac Rehabilitation Clinic in a University Hospital.

Subjects. A total of 446 patients were allowed to perform exercise testing 3 weeks after AMI and followed for 72 ± 20 months.

Measurements and results. Patients were divided into three groups according to whether they had no ECG evidence of ischaemia during exercise testing (334 patients), silent ischaemia (90 patients) or symptomatic ischaemia (22 patients). Cardiac death was significantly more frequent in patients with symptomatic ischaemia when compared with silent ischaemia (31.8% vs. 7.8%, P < 0.01) or when compared with no ischaemia (31.8% vs. 10.2%, P < 0.01). The three groups had a low cardiac mortality during the first 48 months of follow‐up. The prognosis of patients with symptomatic ischaemia worsens markedly thereafter. The results of exercise testing did not predict recurrence of myocardial infarction. Coronary revascularization was performed in 34.4% of those without ischaemia, 47.8% of those with silent ischaemia and 45.5% of those with symptomatic ischaemia (P < 0.01).

Conclusions. Patients with symptomatic ischaemia have a good prognosis during the first 4 years of follow‐up. Their prognosis worsens thereafter as opposed to patients with or without silent ischaemia. This high‐risk group of patients with symptomatic ischaemia deserves optimal management including revascularization when appropriate.
Detection and prevention of hepatitis C in dialysis patients and renal transplant recipients. A long‐term follow up (1989–January 1997)
Authors: Almroth G. , Ekermo B. , Månsson A‐S. , Svensson G. , Widell A.
Published: March 2003

Abstract. Almroth G, Ekermo B, Månsson A‐S, Svensson G, Widell A. (University Hospital of Linköping; University Hospital of Malmö, Sweden) Detection and prevention of hepatitis C in dialysis patients and renal transplant recipients. A long‐term follow up (1989–January 1997). J Intern Med 2002; 251: 119–128.

Background. Hepatitis C is frequent problem in dialysis wards.

Design. A long time (1989–97) follow up of hepatitis C virus (HCV) infection in a Swedish nephrology unit was performed with anti‐HCV screening, confirmatory antibody tests, viral RNA detection and molecular characterization. Case histories were reviewed with focus, onset of infection, liver morbidity and mortality.

Results. In October 1991, 10% (19 of 184) of the patients in the unit (haemodialysis‐, peritoneal dialysis and transplanted patients) were verified or suspected HCV carriers, whilst the number at the end of 1996 was 8% (13 of 157). Most patients were infected before 1991 but only in one case from a known HCV‐infected blood donor. No new HCV infections associated with haemodialysis occurred during the study period. A total of 13 of 24 viremic patients had HCV genotype 2b, a pattern suggesting nosocomial transmission. This was further supported by phylogenetic analysis of HCV viral isolates in seven. HCV viremia was also common in patients with an incomplete anti‐HCV antibody pattern as 8 of the 12 indeterminant sera were HCV‐RNA positive.

Conclusions. Awareness, prevention, identification of infected patients and donor testing limited transmission. Indeterminant recombinant immunoblot assays (RIBA)‐results should be regarded with caution as a result of the relative immunodeficiency in uremic patients. Our data indicate nosocomial transmission in several patients.
Development of liver dysfunction after delivery is possibly due to postpartum autoimmune hepatitis. A report of three cases
Authors: Izumi Y. , Kaneko A. , Oku K. , Kimura M. , Tanaka S. , Tada H. , Tatsumi K. , Takano T. , Hidaka Y. , Amino N.
Published: March 2003

Autoimmune diseases, especially autoimmune thyroid disease, frequently develop after delivery due to the immune rebound mechanism. Most cases involve transient dysfunction of affected organs. Weexamined three patients who developed liver dysfunction after delivery. They were all diagnosed with definite or probable autoimmune hepatitis using the scoring system of the International Autoimmune Hepatitis Group. Moreover, all of them had anti‐CYP2D6 antibodies detected by a sensitive radioligand assay. Our findings strongly suggest that liver dysfunction is induced by postpartum autoimmune hepatitis, and clinicians should be aware of this disease.
Relationships between left ventricular mass and the renin–angiotensin system, catecholamines, insulin and leptin
Authors: Malmqvist K. , Öhman K. P. , Lind L. , Nyström F. , Kahan T.
Published: March 2003

Abstract. Malmqvist K, Öhman KP, Lind L, Nyström F, Kahan T (Karolinska Institutet Danderyd Hospital, Stockholm; Faculty of Health Sciences, Linköping; University Hospital, Uppsala, Sweden). Relationships between left ventricular mass and the renin–angiotensin system, catecholamines, insulin and leptin. Journal of Internal Medicine 2002; 252: 430–439.

Objectives. Several neurohormonal systems have been suggested to stimulate myocardial cell growth, and thus take part in the development of left ventricular (LV) hypertrophy. We studied associations between LV mass and markers of the renin–angiotensin–aldosterone system (RAAS), the sympathetic nervous system, glucose homeostasis and leptin.

Design. A total of 115 hypertensive patients with LV hypertrophy and two age‐ and gender‐matched control groups consisting of 38 hypertensive patients without LV hypertrophy and 38 normotensive subjects were included. We examined determinants of the RAAS, plasma levels and 24‐h urinary excretions of noradrenaline and adrenaline, plasma proinsulin, insulin, glucose, leptin and LV mass by echocardiography.

Results. Plasma renin activity (PRA) and serum aldosterone were higher (both P < 0.001) in the LV hypertrophy group than in patients without LV hypertrophy and normotensive subjects (1.0 ± 0.8, 0.2 ± 0.2 and 0.2 ± 0.2 ng mL−1 h−1, and 327 ±126, 269 ± 146 and 221 ± 80 pmol L−1, respectively). PRA and aldosterone both related (P < 0.001) to LV mass index (r = 0.44 and 0.27, respectively). Catecholamine levels and excretions were similar in all three groups and did not relate to LV mass index. Proinsulin, insulin and leptin levels were all elevated in the hypertensive patients (P < 0.01), but proinsulin, insulin, insulin sensitivity (by the homeostasis model assessment) and leptin did not relate to LV geometry, when indexed for body size.

Conclusions. Plasma renin activity and serum aldosterone levels are elevated in hypertensive LV hypertrophy and relate to LV mass index. In addition to blood pressure, activation of the RAAS may be an important nonhaemodynamic mechanism in the control of LV hypertrophy.
Intestinal pseudo‐obstruction and urinary retention: cardinal features of a mitochondrial DNA‐related disease
Authors: García‐Velasco A. , Gómez‐Escalonilla C. , Guerra‐Vales J. M. , Cabello A. , Campos Y. , Arenas J.
Published: March 2003

Abstract. García‐Velasco A, Gómez‐Escalonilla C, Guerra‐Vales JM, Cabello A, Campos Y, Arenas J (Universitary Hospital 12 de Octubre, Madrid, Spain). Intestinal pseudo‐obstruction and urinary retention: cardinal features of a mitochondrial DNA‐related disease (Case report). J Intern Med 2003; 253: 381–385.

The syndrome of mitochondrial myopathy, encephalopathy, lactic acidosis and stroke‐like episodes (MELAS) is a multisystemic disorder associated in most of the patients with an A to G transition at nucleotide position 3243 in the transfer RNA (tRNA)Leu(UUR) (A3243G) of the mitochondrial DNA. This syndrome is characterized by the preponderant involvement of skeletal muscle and central nervous system, but urinary or gastrointestinal symptoms are seldom documented. Here we report an unusual case of a 52‐year‐old woman with a clinical phenotype characterized by encephalopathy, left hemiparesis, urinary retention and gastrointestinal pseudo‐obstruction. She had the classical A3243G mitochondrial DNA point mutation of MELAS syndrome. We also present a clinically heterogeneous multigenerational pedigree with several affected members in the maternal lineage.
Quantitative X‐ray microanalysis of solutes in individual plant cells: a comparison of microdroplet and in situ frozen‐hydrated data
Authors: Hinde  , Richardson  , Koyro  , Tomos
Published: March 2003

Two different approaches to X‐ray microanalysis were tested and compared. These were the analysis of sap droplets extracted from individual cells (plants grown and analysed in Bangor, U.K.), and the analysis of cells in situ in frozen tissue (plants grown and analysed in Hannover, Germany). The data suggest that both these methods can produce quantitative data accurately reflecting in vivo concentrations in cereal leaf epidermal cells. The relative merits of the two procedures are discussed with reference to possible sources of error and their application to other cell types. Bulk wheat leaf tissue concentrations of K and Cl did not differ significantly between the two locations, but Ca concentration was significantly higher in the plants grown in Hannover.

Microdroplet analysis invariably yielded linear responses in the range of concentrations found in plant tissue (r2 for Ca > 0.97, r2 for K, Cl > 0.99), and interference of other components of the sap was minimal. The calibration curves for the frozen‐hydrated material were typically linear in the same range of concentrations (r2 for K, Ca, Cl > 0.95), and the results for K and Cl concentration in these samples were highly consistent with those measured in the microdroplet experiments. In wheat, for example, the cellular Cl concentration varied between 12 m
M and 119 m
M, but no significant differences were found between the two techniques of measurement. The results for cellular Ca differed in a manner which might be predicted from the results of the bulk tissue analyses.
Low‐cost image‐capture system for a scanning electron microscope
Authors: Egerton  , Wan
Published: March 2003

We describe a PC‐based active‐capture system for recording digital images from a scanning electron microscope. The system is based on a National Instruments data‐acquisition board and a Pentium computer, controlled by software that we have written in Visual Basic.
Measurement accuracy in confocal microscopy
Authors: Delorme  , Benchaib  , Bryon  , Souchier
Published: March 2003

Confocal laser scanning microscopy provides optical serial sections through thick biological samples, making it possible to perform both three‐dimensional visualization and three‐dimensional quantitative analysis. On human lymphocytes, we measured geometrical features, cell contents in DNA and in cyclin A and CDK1 proteins, localization and colocalization of these two proteins. Cells were acquired at a vertical sampling step of 0.5 μm, which gives sufficient information about cell labelling. For the purpose of obtaining fast and reliable data at a reduced time cost, we examined various possibilities to simplify acquisition. For example, it might be possible to increase the vertical sampling step to 2.0 μm while preserving an acceptable accuracy of measurements. Further limiting the acquisition to the central sections appeared to give only rough estimations about the whole cells. Finally, we compared confocal microscopy to conventional two‐dimensional epifluorescence microscopy. Confocal microscopy appeared slightly less accurate as regards content estimation, but was an invaluable tool when investigating three‐dimensional structures and, more especially, localization of proteins.
Sensitivity limits of strain mapping procedures using high‐resolution electron microscopy
Authors: Seitz H. , Ahlborn K. , Seibt M. , Schröter W.
Published: March 2003

Strain detection limits achieved by several approaches of strain mapping differing in the procedure of determining positions of intensity maxima have been compared. Algorithms which simultaneously take into account the two‐dimensional intensity distribution around maximum positions yield similar detection limits and are superior to those performing successive one‐dimensional cuts. Investigations of the effect of image recording imply that the use of photographic plates is superior to direct image recording using a slow‐scan CCD camera because of larger sampling rates and a larger field of view. It is finally shown that the choice of specimen preparation technique substantially affects the strain detection limit with cleaved samples yielding results which are a factor of about three better than ion‐milled samples.
Ab‐initio HRTEM simulations of ionic crystals: a case study of sapphire
Authors: Gemming T. , Möbus G. , Exner M. , Ernst F. , Rühle M.
Published: March 2003

Solving the atomistic structure of crystal defects by HRTEM often requires comparison of experimental images with simulated images of trial structures. Although many materials of interest exhibit a strong component of ionic bonding, HRTEM image simulations conventionally rely on the scattering factors of neutral atoms. In the present case study of sapphire we thus examine the influence of ionicity on dynamical electron scattering in the specimen and on the HRTEM image. For this purpose, we compare simulated images obtained with ion electron scattering factors with conventional simulated images, obtained with the scattering factors of neutral atoms. We introduce several approaches to include ionicity in image simulations. The most reliable results were obtained by means of self‐consistent ab‐initio electron bandstructure calculations. After converting the charge density distribution obtained by these calculations into electron scattering factors of the corresponding ions we have implemented the data in our HRTEM image simulation software and used it for simulating HRTEM images. It turned out that these ‘realistic’ simulated images do not differ significantly from simulated images of neutral atoms. At least for sapphire, this result justifies the usage of ‘conventional’ image simulations.
TEM characterization of self‐organized CdSe/ZnSe quantum dots
Authors: KIRMSE  , SCHNEIDER  , SCHEERSCHMIDT  , CONRAD  , NEUMANN
Published: March 2003

CdSe quantum dots (QDs) grown on ZnSe were investigated by various transmission electron microscopy (TEM) techniques including diffraction contrast imaging, high‐resolution and analytical transmission electron microscopy both of plan‐view as well as cross‐section specimens. The size of the QDs ranges from about 5–50 nm, where from the contrast features in plan‐view imaging two classes can be differentiated. In the features of the smaller dots there is no inner fine structure resolvable. The larger ones exhibit contrast features of fourfold symmetry as expected for pyramid‐like islands. Corresponding simulations of diffraction contrast images of truncated CdSe pyramids with the edges of the basal plane orientated parallel to <100> are in relatively good agreement with this assumption. In TEM diffraction contrast imaging of cross‐section samples the locations of the quantum dots are visualized by additional dark contrast features. The QDs have a distinct larger extension in growth direction compared to the almost uniformly thick CdSe wetting layer. The presence of the CdSe QDs was also confirmed by energy‐dispersive X‐ray spectroscopy.
Combined ultramicrotomy for AFM and TEM using a novel sample holder
Authors: Thomann  , Thomann  , Bar  , Ganter  , Machutta  , MÜlhaupt
Published: March 2003

A new sample holder that allows combined microtomy for atomic force microscopy (AFM) and transmission electron microscopy (TEM) is described. The main feature of this sample holder is a small central part holding the sample. This central part fits into the head of an atomic force microscope. AFM measurements can be performed with a sample mounted in this central part of the sample holder. This makes the alignment of a microtomed bulk sample unnecessary, and offers the opportunity of an easy and fast combined sample preparation for AFM and TEM.
Near‐field second harmonic imaging of lead zirconate titanate piezoceramic
Authors: Smolyaninov I. I. , Lee C. H. , Davis C. C.
Published: March 2003

Near‐field optical microscopy has been used to image variations in local optical second harmonic generation (SHG) from the surface of lead zirconate titanate (PZT) piezoceramic. As PZT ceramic is a strongly scattering medium, SHG occurs in the thin layer near the surface of the ceramic. Thus, individual crystalline grains and grain boundaries located near the surface are the main features visible in the images. In general, this technique allows us to determine the local poling direction of individual submicrometre‐sized crystalline grains of ceramic by near‐field SH imaging at different angles of incidence and polarization states of the fundamental excitation light. In some cases ‘hot spots’ of submicrometre size showing enhanced SHG have been observed. This enhancement is believed to result from local cavity resonances.
Near‐field imaging of surface‐enhanced second harmonic generation
Authors: Smolyaninov I. I. , Lee C. H. , Davis C. C. , Rudin S.
Published: March 2003

Surface‐enhanced second harmonic generation from individual topographical defects of an otherwise flat gold film and from metal‐coated diffraction gratings was measured using a near‐field optical microscope. Experimentally measured second harmonic field distributions were compared with theoretical calculations.