bluuebunny/crossref_metadata_2025 huggingface dataset:
The structure and content of nutrition education messages
Authors: Wise A. , Farmer L. , Mackenzie S. , McLeish A.
Published: November 2003

The study was designed to investigate the response of people to nutritional messages written in different ways. For Experiment 1, positive and negative statements were constructed in which people were encouraged to «eat» or «avoid», with implicit or unstated alternative, or to «eat and avoid» or «avoid and eat». In total there were 64 statements; each was followed by a brief reason for the action and this was constant for each food. To avoid bias and ensure that the eight foods appeared on each questionnaire in a different order every time, the messages were set out in a Graeco‐Latin square. Subjects were asked to rate the messages on a scale (1–7) for whether they were «reasonable», «practical» and «compelling». Additionally, for each message subjects were asked whether they already perform what is described in the message. The type of message construction appeared to be most important for the word «compelling». It appeared that messages with a single element (whether positive or negative) were less «compelling» than those with two elements (positive and negative). For Experiment 2, 64 messages were written in which the first part was written as a command with a negative aspect followed by a positive one («avoid and eat»). The reason given in support was classified in four ways and written in lay terms or using more technical words. It was concluded that messages including medical terms were most «compelling» and that all messages were reduced in score when incorporating «technical» terms.
Assessing factors influencing food choice among 10–16‐year‐old schoolboys. A pilot study with a stacking box method
Authors: Gummeson Lena , Jonsson Inger , Conner Mark , Svensson Elisabeth
Published: November 2003

A new «stacking box» method to study food choice is presented. Participants are required to select pictures of foods from a large selection according to differing instructions. The applicability of the stacking box methodology to increase understanding of factors affecting food choice decisions among schoolchildren was investigated. Forty‐four school boys from three different age groups were instructed to choose foods for breakfast according to different instructions; for example, «Make up a breakfast you usually eat» and «Make up a breakfast your parents would like you to eat». They were also asked for reasons behind their food choices. Milk, margarine, bread and breakfast cereal choices given in response to differing instructions were compared two by two using a non‐parametric method. Evident systematic components in disagreement of choices could be adequately explained. Aspects of taste, availability and habit dominated among reasons for choices for a usually eaten breakfast.
Are we achieving the dietary recommendations for diabetic patients? An audit of dietary advice to diabetic patients
Authors: Pearson Gill , Rowley Joanne , Walker Louise , Price Paul
Published: November 2003

An audit of the nutritional intake of people with diabetes treated either with insulin or oral hypoglycaemic agents, who had never been taught carbohydrate exchanges was undertaken. A total of 63 diabetic patients completed a 7‐day food diary using household measures. Results indicated that 70% achieved the dietary recommendations for fat intake and 30% the recommendations for carbohydrate intake. The majority of the subjects also achieved the dietary recommendations for both non‐milk extrinsic sugars and cholesterol, but they were less successful at meeting the recommendations for non‐starch polysaccharides and protein. The standards used were the British Diabetic Association Recommendations (1992) and The Dietary Reference Values (1991). These results compare favourably with other studies both of people with diabetes and the general population.
Substitution of dietary monounsaturated fatty acids for saturated fatty acids in a free‐living population: a feasibility study
Authors: Knapper J.M.E. , Tredger J.A. , Webb D. , Culverwell C. , Faulkner W. , Roche H. , Williams C.M.
Published: November 2003

The fatty acid composition of the diet of seven free‐living subjects (five men and two women) aged 41–56 years was altered for 1 month. The aim was to increase the intake of monounsaturated fatty acids (MUFAs) from subjects current habitual levels of 12% dietary energy to a target intake of 18% dietary energy, and to decrease saturated fatty acid (SFA) from habitual levels of 16% dietary energy to target levels of 10% dietary energy. The change in fatty acid intake was achieved by supplying volunteers with foods prepared using MUFA‐containing spreads or olive oil (ready meals, sweet biscuits and cakes) and also by supplying spreads, cooking oil and MUFA‐enriched milk for domestic use. Body weight and plasma total cholesterol measurements were made at baseline and at 2 and 4 weeks on the diet as an aid to maintaining subject compliance. MUFA consumption was significantly increased from 12% dietary energy to 16% dietary energy (P<0.01), and SFA intake was reduced from 16% dietary energy to 6% dietary energy (P<0.01) during the 4‐week intervention. The diet failed to achieve the target increase in MUFA but exceeded the target reduction in SFA. This was due to the fact that subjects reduced their total fat intake from a mean habitual level of 38% dietary energy to a mean level of 30% dietary energy. During the dietary period, mean plasma cholesterol levels were lower at 2 weeks (P<0.01) and at 4 weeks (P<0.01) than the baseline, with a mean reduction of 20% over the dietary period. This study demonstrates the difficulty of achieving increased MUFA intakes (by SFA substitution) in free‐living populations when only a limited range of fatty‐acid modified food products are provided to volunteers.
Monitoring the effect of varying the distribution of phenylalanine exchanges and protein substitute on serum phenylalanine—a preliminary study
Authors: Ferguson Carol
Published: November 2003

Following a low phenylalanine diet for life has been advocated for those with phenylketonuria. The Medical Research Council (MRC) Working Party on phenylketonuria (1993a, 1993b) suggests that serum phenylalanine levels between 120 and 700 μmol/l should be achieved and maintained during adolescence and adult life (other than preconceptionally and during pregnancy). A significant proportion of older children with phenylketonuria struggle to comply with the even distribution of protein substitute and phenylalanine exchanges throughout the day, as advised nationally (Asplin & MacDonald, 1994). This preliminary study sought to compare the control of serum phenylalanine in young people suffering from phenylketonuria who were prescribed the nationally advised regimen (Group A) and youngsters given one of two alternative regimens (Group B and Group C) known to be favoured by some youngsters. These alternative regimens provided all nutritional requirements over the day, but the distribution of protein substitute and phenylalanine exchanges differed in the two groups and was not as even as in Group A. The results show that all three study groups attained serum phenylalanine levels within the range 120–700 μmol/l at all times blood samples were obtained. Whether or not this makes each of the three regimens acceptable is discussed. Despite careful control of the diet prescription, the amount of phenylalanine consumed can greatly exceed the prescription due to the consumption of «free foods». This does not appear to jeopardize control. The mean variation in serum phenylalanine levels over the 24‐h period was different for each group. Not all individuals within any one group gave the same 24‐h serum phenylalanine profile. This suggested that the present practice of monitoring control in phenylketonuria by one blood test at a consistent time of day is not ideal. It is not possible to predict an individual's 24‐h profile from one blood result even when the dietary prescription at each meal is known. Changes in serum phenylalanine levels occurring during an overnight fast were monitored. Further research is required to ascertain the dietary components that reduce the rate of increase in serum phenylalanine on fasting.
Growth retardation and undernutrition in children with spastic cerebral palsy
Authors: Reilly John , Hassan Thoraya , Braekken Anne , Jolly John , Day Ruth
Published: November 2003

Aim: To assess the prevalence of growth retardation and undernutrition in a homogenous group of 30 children with spastic cerebral palsy. Methods: Standard anthropometric assessment and functional assessment of feeding ability. Results: Growth retardation was common and severe: mean length for age standard deviation score (SDS) was −2.1 (SD 1.0) and 60% of the sample were «stunted». Mean weight for height SDS was +0.2 (SD 0.9) and «wasting» was largely confined to those children identified as having feeding problems. Conclusion: Formal assessment of growth and nutritional status is indicated in children with cerebral palsy, even if health and feeding status would otherwise give little cause for concern.
Weight cycling—can dietitians help break the pattern?
Authors: Trotter K.
Published: November 2003

The phenomenon of weight cycling presents dietitians with a dilemma—might attempts to treat obesity sometimes do more harm than good by promoting weight cycling? This paper briefly examines the evidence for the possible harmful effects of weight cycling, and presents a case study to illustrate how dietitians can identify weight cycling, give it appropriate consideration as a factor in deciding on treatment, and help break the pattern.
Infant feeding guidelines: an evaluation of their effect on health professionals» knowledge and attitudes
Authors: Bleakney G.M. , McErlain S.
Published: November 2003

Consensus infant feeding guidelines, which were developed by a multi‐disciplinary working group, were adopted by the Eastern Health and Social Services Board (EHSSB) N. Ireland, in 1991. Implementation of the guidelines was undertaken using a cascade approach. Implementation teams were established in each of the nine Units of Management. These teams were provided with training and extra resources to facilitate the implementation process. In 1991, prior to the implementation of the guidelines, a postal survey was undertaken to establish the knowledge of infant feeding and attitudes to breast‐feeding of health professionals working in the EHSSB area. Knowledge and attitude scales were developed for the questionnaire. The survey was repeated in 1993 to evaluate the impact and penetration of the guidelines. The penetration of the guidelines was good, 81% of respondents had read them. The knowledge of health professionals was significantly greater in 1993 than in 1991 (P<0.0001); reading the guidelines was an independent variable for knowledge score (eta2=0.20, P<0.0001). Health visitors exhibited the highest and general practitioners the lowest mean knowledge scores. Attitude scores in the 1993 survey were almost identical to those found in 1991; reading the guidelines was an independent variable for attitude score (P<0.0001), however the size of the effect was small (eta2=0.04).
Effect of a multi‐disciplinary care team on the management of gastrostomy feeding
Authors: Pattison D. , Young A.
Published: November 2003

Background: This study was undertaken to assess current practice in the management of gastrostomy feeding in two district general hospitals and to perform a clinical audit on agreed standards of patient care.

Methods: A retrospective case note review was followed by a prospective audit of agreed guidelines. Twenty‐four patients (12 women and 12 men) with tube placement prior to the introduction of standards (group A) and 26 patients (16 women and 10 men) with new gastrostomies placed after the introduction of standards (group B) were included. Five standards were agreed: pre‐operative multi‐disciplinary assessment, standard percutaneous endoscopic gastrostomy (PEG) tube, pre‐operative prophylactic antibiotics, surgical outpatient review and information booklets for patient use. Outcome was measured by the incidence of tube failure, stoma site infection and gastrointestinal (GI) complications.

Results: Twenty‐two patients (85%) in group B were assessed pre‐operatively by the multi‐disciplinary team and the standard tube was placed in 73% of cases. Complications occurred in 92% of patients in group A and in 50% in group B (P<0.05). In light of the findings, a patient care plan has been developed which is now in general use.

Conclusion: Appraisal of current practice in the management of gastrostomy feeding has led to the recognition of complications. These have been reduced by the adoption of guidelines used by the multi‐disciplinary team.
Inadequate oral intake in surgical patients: a rational indication for nutritional support
Authors: Townsend Sara , Palmer Diane , MacFie John
Published: November 2003

Seven days or more of inadequate oral intake (IOI) inevitably results in a deterioration in nutritional status. Despite this well‐known fact, little information is available as to the frequency with which such periods of IOI occur in clinical practice. This study results from an audit of IOI in a gastroenterological unit over a 6‐month period. The results demonstrate that 17% of patients sustained significant periods of IOI of 7 days or longer. This has important implications with regard to the provision of adjuvant nutritional support.
A survey of nutrition knowledge, practice, attitudes and behaviour of general practitioner trainees in Ireland
Authors: Duff E. N. , Livingstone M. B. E.
Published: November 2003

Background: Medical research has acknowledged the relationship between nutrition and the development of chronic diseases, as well as the interaction between disease and nutritional status. However, nutrition education in the medical curriculum has been far from adequate. The present study was undertaken to examine the current status of nutrition awareness amongst general practitioner trainees throughout Ireland.Methods: A self‐administered questionnaire (Q1) was used to assess the nutrition knowledge, attitudes, practice and behaviour of one hundred final year general practitioner trainees. A second questionnaire (Q2) was sent to the relevant medical faculties to ascertain the level of nutrition taught within the medical curricula.Results: The overall response rate to Q1 was 52% (34 females, 18 males). Respondents showed little awareness that nutrition had been included in their medical training. Q2 verified that nutrition mostly featured in the biochemistry component of the medical curricula. The results indicate the need to improve basic nutritional knowledge and its application in clinical practice. The disparity between the perceived importance of nutrition and personal lifestyle behaviours concurred with other studies.Conclusion: The general practitioner trainees were ill equipped to appreciate and value the extent of dietetic intervention for nutrition‐related problems in clinical practice.
Nutrient intakes and snacking frequency in female students
Authors: Whybrow S. , Kirk T. R.
Published: November 2003

Background: Snacking can have the negative image of being detrimental to the diet, because snack foods are commonly thought of as providing only ‘empty calories’—high in energy but low in micronutrients. This observational study looked at the nutrient density of snacks and meals, and at the effect of eating frequency on mean daily nutrient intakes in 44 female students (aged 17–26 years).Methods: Baseline dietary data from an existing intervention study were re‐analysed. Eating occasions, taken from 7‐day weighed food diaries, were classified as meals or snacks by time of day, and the composition of meals and snacks compared. Subjects were divided into tertiles by eating frequency and their nutrient intakes compared.Results: As eating frequency increased, the number of snacks and the number of different snack items in the diet increased, while the number of meals remained constant. Snacks, overall, were significantly lower in percentage non‐alcohol energy from fat and higher in percentage non‐alcohol energy from carbohydrate. Snacks had lower nutrient densities than meals for non‐starch polysaccharide (NSP), minerals and vitamins except vitamin C. However, there were no significant differences between the top and bottom tertiles of snacking frequency for overall percentage energy from fat, protein or carbohydrate, or intakes of micro‐nutrients. The top tertile tended to be leaner and have higher energy intakes than infrequent eaters (not significant). There was a significant negative correlation between eating frequency and body mass index (BMI).Conclusions: It is concluded that snacking per se did not compromise diet quality in this group, and that those with a high snacking frequency were eating more in general and choosing a wider variety of foods, resulting in a balanced intake of nutrients.
The development, implementation, monitoring and evaluation of a food and nutrition policy within a local health plan
Authors: Holdsworth M. , Spalding D.
Published: November 2003

Local food and health policies were initiated in the UK in the early 1980s, and this paper traces developments in Leicestershire, England. The first policy was launched in 1987, which promoted the nutrition education messages of that time (less fat, more fibre and less sugar), primarily within the National Health Service. As a result of the publication of the Health of the Nation Green Paper in 1991, a local health plan was developed for Leicestershire, in which nutrition formed an integral part. Wider perspectives on nutrition have evolved reflecting the multidisciplinary approach to developing the Food and Nutrition Policy. In addition, updating of the nutrition messages in the local Food and Nutrition Policy has occurred to reflect the shift in emphasis towards nutritional adequacy and balance. The scope for implementation is now much wider, involving several key settings in the community, and there is an increased emphasis on monitoring and evaluation.
Similarity of food choices among young Finnish couples
Authors: Laitinen S , Högström P , Räsänen L
Published: November 2003

Background: Food choices do not remain stable over time. When young adults set up their own family, spouses have to adjust to a possibly different diet.Methods: In 1992, a total of 684 married, cohabiting or engaged couples filled in questionnaires on food habits and food‐related activities as a part of the follow‐up study ‘Cardiovascular Risk in Young Finns’. Similarity in food choices was assessed as a percentage of pairs with exactly the same choices. Socio‐demographic characteristics of couples with low or high resemblance in food habits were examined and the division of household tasks was described.Results: Similarity between spouses in nine food choice categories varied from 49% to 88%. Resemblance in food choices was higher among couples who had children and ate meals at home. When the couple had children and when the woman's educational level was low, women notably prepared the meals and did the food shopping. One‐third of men took part in meal preparation and less than half of men shopped for food on weekdays either alone or with his spouse.Conclusion: Young couples share a similar diet to some extent. They seem to change food choices when children are born. Nutrition education should be directed at young couples to advise them to make the changes in their diet which promote their own and their children's health.
Exploring the food beliefs and eating behaviour of successful and unsuccessful dieters
Authors: Kirk  , Hill A. J
Published: November 2003

Background: Cognitions about food are important but relatively unexplored determinants of eating behaviour. In order to alter nutrient intakes at an individual or population level, an understanding of the way in which food is viewed is essential for anyone working in nutrition. The Repertory Grid Technique, a psychological device for examining how people construe their lives, was used to examine food beliefs in women who had dieted.Methods: Twenty‐six women were selected from 62 respondents on the basis of their past weight loss to form two groups, successful and unsuccessful dieters. Participants completed a background questionnaire on their weight history and eating style, a 7‐day food record and a specially devised repertory grid using foods as the grid elements.Results: Results showed that the groups differed in their eating style and energy intake. The successful dieters had a lower energy intake but consumed a significantly higher percentage of energy from protein. They also had a higher level of dietary restraint and a more regular eating pattern than the unsuccessful dieters. Both groups held similar and complex food belief systems but differed in their perception of what foods were good tasting. The successful dieters appeared not only to hold complex and rigid beliefs about food but to extend this to their actual eating behaviour.Conclusions: These findings highlight the importance of cognitive factors in the control (and loss of control) of eating and illustrate the potential of the Repertory Grid Technique for use in the field of nutrition.
Do diets high in sugars compromise micronutrient intakes? Micronutrient intakes in the Dietary and Nutritional Survey of British Adults according to dietary concentration of ‘added’, ‘non‐milk extrinsic’ or ‘total’ sugars
Authors: Gibson S. A.
Published: November 2003

Objective: It has been claimed that dietary sugars, particularly added and non‐milk extrinsic sugars, are ‘empty calories’, displacing micronutrients from the diet. Evidence for this hypothesis was examined using data from the Dietary and Nutritional Survey of British Adults (Gregory et al., 1990).Method: Men and women aged 16–64 years were classified into quintiles (fifths) of the distribution of food energy from added sugars, non‐milk extrinsic sugars (NMES) and total sugars. Micronutrient intakes were compared across quintiles for each type of sugars energy.Results: Many nutrients showed a non‐linear relationship with sugars energy (whether added, NME or total), with the highest nutrient intakes among average consumers. The most marginal nutrient (in comparison to dietary reference values) was iron among women; no group achieved the RNI for iron, regardless of sugar level or type. Calcium intakes were below the RNI among women in the first quintile (all types of sugars), although under‐reporting may have led to underestimations of intake in this group. Intakes of several nutrients fell in the 4th and 5th quintiles (all types), but remained adequate in comparison to the RNI (except for iron and folate in women). There were positive relationships between extrinsic and total sugars, and vitamin C, which reflected fruit juice consumption. Diets high in added and NME sugars tended to be of lower nutrient density, but any deficit in nutrient intake was contingent on a low energy intake, which was untypical.Conclusions: These data suggest that NME sugar intakes providing up to about 17% of food energy did not compromise micronutrient intakes in these British adults. Specific advice may be needed to counteract low nutrient intakes (e.g. iron intake in women), particularly where energy intake is restricted.
An evaluation study to assess the potential use of Renamil (formerly named Ren‐o‐mil) for patients with chronic renal failure
Authors: Dare B. K. , Whiteside E. J. , Wilson D. E.
Published: November 2003

Background: Renamil has been formulated as a milk substitute/nutritional supplement for renal patients. This 3‐month study of 16 selected patients, six with chronic renal failure, six on chronic intermittent haemodialysis and four on continuous ambulatory peritoneal dialysis (CAPD), was carried out to evaluate the potential use of Renamil within these patient groups. Methods: An initial dose was recommended and advice provided on the use of Renamil. Palatability and acceptability of the product were assessed by questionnaire. The patients» serum biochemistry and nutritional status were monitored. The prescription of Renamil was adjusted during the trial according to individual dietary requirements, fluid allowance and product tolerance. Results: Ten patients (62.5%) completed the trial. Palatability and ease of use were important factors. Renamil was used in a wide variety of ways and compared favourably with other milk substitutes/nutritional supplements. Conclusions: Our findings suggest that Renamil (until recently named Ren‐o‐mil) does have a role in the nutritional support of renal patients. It is the only milk substitute that has been specifically designed for renal patients. Its formulation makes it useful for the majority of pre‐dialysis patients, a smaller but significant proportion of haemodialysis patients, but only a limited number of patients on CAPD.
A national survey of the diet of children aged 13–14 years living in urban areas of the United Kingdom
Authors: Hackett A. F. , Kirby S. , Howie M.
Published: November 2003

Despite a general agreement on the need to improve the diet of adolescents there is very little information about their eating habits. In particular, there has only been one national survey of the eating habits of school‐aged children, which was conducted in 1982. Part of the reason for this lack is the problematic and expensive nature of conventional dietary surveys. This is a report of an inexpensive method which records the intake of key foods only. Although nutrient intakes were not assessed, all dietary advice has, ultimately, got to be given in terms of which foods to eat more or less of. It is entirely reasonable, therefore, to assess diet in these terms also. A national survey of 13–14 years olds attending schools in urban areas of England, Wales, Scotland and Northern Ireland was conducted. Responses were collected (n=1197) concerning the intake of specific foods, height and weight and whether or not each individual received a free school meal. The results confirm the need for major changes in the eating habits of adolescents, especially those who are the least privileged. In particular, relatively few subjects reported consuming fruit or vegetables and the most popular items were the least desirable foods—confectionery, biscuits and cakes. A surprisingly high proportion of these adolescents admitted drinking alcohol on the previous day, especially in the southeast of England. A substantial change in the national diet is urgently needed, but changes are unlikely unless a variety of policies are put in place to match the provision of information.
Practice guidelines for the clinical assessment and care management of Alzheimer's disease and other dementias among adults with intellectual disability*
Authors: Janicki M. P. , Heller T. , Seltzer G. B. , Hogg J.
Published: November 2003

The AAMR/IASSID practice guidelines, developed by an international workgroup, provide guidance for stage–related care management of Alzheimer's disease, and suggestions for the training and education of carers, peers, clinicians and programme staff. The guidelines suggest a three‐step intervention activity process, that includes: (1) recognizing changes; (2) conducting assessments and evaluations; and (3) instituting medical and care management. They also provide guidance for public policies that reflect a commitment for aggressive care of people With Alzheimers's disease and intellectual disability, and avoidance of institutionalization solely because of a diagnosis of dementia.
Influence of continued smoking and some biological risk factors on restenosis after percutaneous transluminal coronary angioplasty
Authors: KOTAMÄKI MERVI , LAUSTIOLA KAI , SYVÄNNE MIKKO , HEIKKILÄ JUHANI
Published: November 2003

Objectives. To identify possible biological risk factors for restenosis following successful percutaneous transluminal coronary angioplasty (PTCA) in patients having single or multivessel disease. The effect of continued smoking on restenosis was also evaluated.

Design. In this prospective smoking controlled study all subjects had a routine angiographic restudy after 6 months. The biological risk factors assessed before angioplasty were adrenaline, endothelin, fibrinogen, lipoprotein (a) and tissue plasminogen activator.

Subjects. The study population consisted of 122 patients of whom 25% were current smokers.

Main outcome measures. Angiographic restenosis was defined as at least 50% diameter stenosis on the follow‐up angiogram after an initially successful procedure.

Results. Restenosis was observed in 43% of patients. The restenosis rate was significantly lower among current smokers, but they were significantly younger and also had significantly less dilated stenoses. Multivariate analysis revealed the number of dilated stenoses, the mean inflation time, post‐PTCA percentage diameter stenosis and left anterior descending coronary artery to be predictive of restenosis, while continued smoking was not. When only the lesion with the greatest loss in luminal diameter of each patient was considered, the multiple linear regression analysis revealed high endothelin level to be predictive of restenosis.

Conclusions. This study revealed high endothelin levels to be predictive of luminal narrowing after angioplasty. In addition, the number of dilated stenoses, the mean inflation time, post‐PTCA percentage diameter stenosis and stenosis location in the left anterior descending artery were found to be predictive of restenosis. However, continued smoking after angioplasty did not emerge as a risk factor for restenosis.
The android woman – a risky condition
Authors: BJÖRNTORP PER
Published: November 2003

Normal women produce small amounts of active androgens. When androgen levels are elevated, such as for example in the polycystic ovary syndrome, this is followed by the development of male physical characteristics of muscle mass, structure and function as well as android adipose tissue distribution and function. Psychological features and stress reactions also seem similar to those of men. Such women have an increased risk of developing hypertension, non‐insulin‐dependent diabetes mellitus and cardiovascular disease. Recent data have shown that these physical, and psychological characteristics, as well as risk of ill health, are also found in the population of women selected at random. Women in the lowest quintiles of levels of sex‐hormone‐binding globulin – an indicator inversely related to active androgens – are at risk of developing hypertension, non‐insulin‐dependent diabetes mellitus and cardiovascular mortality. The mechanism probably includes muscular insulin resistance, following a relative androgen excess.

It is thus apparent that androgens, even within the highest levels of the nonselected population of women, are powerful predictors of serious disease development. The population at risk might be as large as about 20% of middle‐aged women. This is an area of female disease risk which requires more attention in screening and intervention procedures.
Xenotransplantation
Authors: KEMP E.
Published: November 2003

Kemp E (Department of Nephrology, Odense University Hospital, Odense, Denmark). Xenotransplantation (Review). J Intern Med 1996; 239: 287–97.

Xenotransplantation means transplantation of organs and tissues from animals to human beings. Today, with use of new and more conventional immunosuppressive substances, it is possible to achieve good long‐term survival of organs and cells transplanted between closely related species; for example, between baboon and man. However, large‐scale treatment by xenotransplantation is still not possible because a transplantation between species such as pig and man will still not be successful. Nevertheless, many researchers have tried to solve these problems, and it is hoped that transgenic animals in combination with newer immunosuppressive treatment will make xenotransplantation a realistic possibility. The time horizon for clinically successful xenotransplantation with pig organs is unknown at the moment. Nevertheless, many investigators think that the breakthrough will occur in a few years time.
A compound heterozygote for familial hypercholesterolaemia with a homozygous mother
Authors: FUNAHASHI T. , YAMASHITA S. , MARUYAMA T. , UEYAMA Y. , MENJU M. , NAGAI Y. , TAKEMURA K. , MIYAKE Y. , TAJIMA S. , MATSUZAWA Y.
Published: November 2003

Homozygous familial hypercholesterolaemia (FH) is a rare disorder in which the patients develop severe hypercholesterolaemia and premature coronary atherosclerosis from childhood. Here we report a unique family with clustering of homozygous FH. The proband was a 25‐year‐old man, who showed marked hypercholesterolaemia, multiple xanthomas and severe coronary atherosclerosis. His mother also showed the typical characteristics of homozygous FH. Sequencing analysis of the low‐density lipoprotein receptor gene revealed that he was a compound heterozygote, carrying two different point mutations. One was a novel mutation, FH Wakayama (Cys→A Ser at 317), derived from his mother, and the other was a recurrent mutation, FH Niigata (T→A C at 1845+2, 5′ splice signal in intron 12), derived from his father. The proband we report seems to be a very rare case of an FH homozygote born from a homozygous mother.
Gamma, but not alpha, tocopherol levels in serum are reduced in coronary heart disease patients
Authors: ÖHRVALL M. , VESSBY B. , SUNDLÖF G.
Published: November 2003

Objectives. Low concentrations of alpha tocopherol are claimed to be associated with an increased prevalence of coronary heart disease. This study was undertaken to see whether measurements of serum tocopherol concentrations can contribute to discrimination between subjects with and without coronary heart disease.

Setting. All patients had been referred to the department of cardiology of the University Hospital in Uppsala, Sweden.

Subjects. Male patients (n=69) below 60 years of age with coronary heart disease (CHD) and healthy age‐matched reference subjects (n=138) were compared.

Results. Lipid‐corrected alpha tocopherol concentrations did not differ significantly between the groups, but the CHD group had a lower mean concentration of gamma tocopherol and a higher alpha/gamma ratio. In a stepwise logistic regression analysis, the LDL/HDL ratio was the best independent discriminator between the groups, followed by the proportion of palmitic acid in the cholesterol esters and the alpha/gamma tocopherol ratio.

Conclusions. The lower gamma tocopherol concentration and the high ratio between alpha and gamma tocopherol in the CHD group indicate a difference in antioxidative status between CHD patients and healthy subjects. The lipid‐lowering treatment of these CHD patients is far from optimal.
Interstitial lung disease with pleural effusion caused by Simvastin
Authors: DE GROOT R. E. B. , WILLEMS L. N. A. , DIJKMAN J. H.
Published: November 2003

De Groot REB, Willems LNA, Dijkman JH (Department of Pulmonology, Leiden University Hospital, Leiden, The Netherlands). Interstitial lung disease with pleural effusion caused by Simvastin (Case Report). J. Intern Med 1996; 239: 361–3.

Simvastin, a HMG‐CoA reductase blocker, is used for the treatment of certain forms of hypercholesterolaemia. Simvastin is prescribed to lower high serum levels of cholesterol by inhibiting a specific enzyme, hydroxy‐methylglutarylCo‐enzym‐A (HMG‐CoA) reductase. This ultimately leads to an increase of the number of LDL‐receptors in the liver, and thus, to a decrease of the serum LDL‐cholesterol. To a much lesser extent it lowers the serum VLDL‐cholesterol and makes the serum HDL‐cholesterol level rise. In general, this relatively new compound is well tolerated and only a few, mostly minor, adverse effects have been reported so far. We present a patient who developed interstitial lung disease with pleural effusion most probably as a result of the use of Simvastin.
The incidence of occult cancer in patients with deep venous thrombosis: a prospective study
Authors: BASTOUNIS E. A. , KARAYIANNAKIS A. J. , MAKRI G. G. , ALEXIOU D. , PAPALAMBROS E. L.
Published: November 2003

Objective. This study was undertaken to assess a potential relationship between idiopathic deep venous thrombosis (DVT) and occult cancer.

Design. Prospective study with a 2‐year follow‐up.

Setting. The Angiology Unit of the First Department of Surgery, University of Athens, Greece, a tertiary referral centre.

Subjects. Two hundred and ninety‐three patients with a first episode of venographically or Doppler‐proved DVT were included in the study, of whom 264 were followed up for 2 years.

Interventions. After an initial extensive diagnostic workup, including routine blood counts and chemistries, erythrocyte sedimentation rate, CEA levels, chest X‐ray and abdominopelvic CT scan, all patients were closely followed up and periodically examined.

Main outcome measures. The incidence of cancer amongst patients with idiopathic and secondary DVT, and the validity of our screening programme.

Results. Cancer was diagnosed in 21 out of 84 patients with idiopathic DVT (25%) as compared with eight out of 202 patients with secondary DVT (4%). In 22 out of the 29 cases, cancer was detected during the initial admission, and the remaining seven cases were detected during follow‐up. Cancer was diagnosed in 15 asymptomatic, healthy individuals, but only in seven of them was the diagnosis made by CT scan.

Conclusion. Occult cancer is fairly common in patients with idiopathic DVT, but the routine use of extensive diagnostic studies for its detection remains to be validated by further prospective studies.
Predialysis calcitriol administration: effects on pre‐ and post‐transplant renal osteodystrophy
Authors: DAHL E. , NORDAL K. P. , HALSE J.
Published: November 2003

Twins with parallel loss of kidney function and moderate hyperparathyroid bone disease were participants in a double‐blind study where twin A was given placebo and twin B calcitriol. After 8 months, A's bone disease had not improved, while B's bone had normalized. Thereafter, both received calcitriol until kidney transplantation 11 months later, when both had normal bone structure. Two years after transplantation, both twins had hyperparathyroid bone disease, but A had more pronounced changes. This report illustrates our findings in larger series: When started early in the course of renal failure, calcitriol can reverse pre‐transplant hyperparathyroid bone disease and also influence post‐transplant bone disease.
Long‐term follow‐up of indolent mastocytosis in adults
Authors: KORS J. W. , VAN DOORMAAL J. J. , BREUKELMAN H. , VAN VOORST VADER P. C. , DE MONCHY J. G. R.
Published: November 2003

Objective. To evaluate the natural course of indolent mastocytosis in adults.

Design. A retrospective long‐term follow‐up study.

Setting. The Department of Endocrinology of a University Hospital.

Patients. Sixteen adult patients with a diagnosis of indolent mastocytosis and sufficient biochemical data for statistical analysis. One patient had paediatric‐onset cutaneous mastocytosis, whilst the others had adult‐onset systemic mastocytosis. Ages at the end of follow‐up ranged from 23 to 79, median 50 years. Follow‐up periods per patient lasted from 13 to 135 months, median 90 months.

Measurements. Urinary excretions of the histamine metabolites Nτ‐methylhistamine (MH) and Nτ‐methylimidazoleacetic acid (MIMA), and signs and symptoms of the disease.

Results. The excretion of MH but not MIMA increased in four patients (ages 37, 45, 61 and 65 years) and decreased in two patients (ages 26 and 48 years), including the only patient with paediatric‐onset cutaneous mastocytosis. The excretion of MIMA but not MH increased in none and decreased in one patients (age 51 years). The excretions of both MH and MIMA increased in one patient (age 23 years) and decreased in two patients (ages 65 and 79 years). The excretion of MH and MIMA can be considered to have been stable in one patient (age 49 years). In the five remaining patients, observation periods were rather short. A definite judgement on the course of their disease could not be given. In the two patients in whom the excretion of both MH and MIMA decreased, the enlarged spleen decreased in size, whilst in the other patients, signs and symptoms did not change. There were no accompanying myeloproliferative disorders in any patient. No special treatment aiming at a reduction in mast cell load has been given. Rates of change over the whole follow‐up period ranged from ‐8.4 to +25.1% per year.

Conclusion. The natural course of indolent adult‐onset mastocytosis is not always progressive. Our data show that the activity of adult‐onset indolent mastocytosis, as measured by urinary excretion of MH and MIMA and clinical signs and symptoms, can substantially decline, especially in older patients.
Comparisons of oral propafenone and quinidine as an initial treatment option in patients with symptomatic paroxysmal atrial fibrillation: a double‐blind, randomized trial
Authors: LEE S. H. , CHEN S. A. , CHIANG C. E. , TAI C. T. , WEN Z. C. , WANG S. P. , CHANG M. S.
Published: November 2003

Objective. The main aim of the study was to evaluate the safety and efficacy of propafenone versus quinidine as an initial choice in treatment of symptomatic paroxysmal atrial fibrillation.

Design. The study consisted of a 3‐month treatment with oral propafenone hydrochloride or quinidine sulphate in patients with paroxysmal symptomatic atrial fibrillation, according to a double‐blind randomized system.

Setting. The study was performed in the out‐patient clinic of university hospital.

Main outcome measures. The effects of the two drugs on attack frequency, ventricular rate and symptoms of symptomatic paroxysmal atrial fibrillation.

Results. In the oral propafenone group (n=48), two patients (4%) discontinued the treatment because of dizziness. In the 46 patients who continued the treatment, the attack frequency decreased from 11±3 times per week at baseline to 1±1 times per week after treatment (P<0.01). Forty (87%) out of the 46 patients had effective response to oral propafenone (more than 75% reduction of symptomatic arrhythmic attacks) on a mean dose of 615±10 mg day‐1; the decrease in attack frequency was from 10±3 to 1±1 times per week. Twenty‐three (50%) patients were free from recurrence of symptomatic paroxysmal atrial fibrillation. Comparisons of symptom scores for patients (n=23) with attacks of paroxysmal atrial fibrillation after oral propafenone treatment showed that there was a significantly lower symptom score of palpitation, asthenia, effort dyspnea, dizziness, rest dyspnea and chest oppression in attacks of paroxysmal atrial fibrillation after propafenone treatment (11.05±3.78 versus 7.60±3.46, P<0.01). From the oral quinidine group (n=48), two patients (4%) discontinued treatment because of gastrointestinal discomfort. In the 46 patients who continued the treatment, the attack frequency decreased from 11±4 times per week at baseline to 3±2 times per week after treatment (P<0.01). Twenty‐one (46%) out of the 46 patients had effective response to oral quinidine on a mean dose of 1067±462 mg day‐1, with a decrease in attack frequency from 12±3 to 1±1 times per week. Only 10 (22%) patients were free from recurrence of paroxysmal atrial fibrillation. Comparisons of symptom scores for patients (n=36) with attacks of paroxysmal atrial fibrillation after quinidine treatment showed that there was no significant decrease of symptom score in attacks of atrial fibrillation (10.65±3.92 versus 10.20±3.80, P=0.57). Furthermore, the percentage decrease of ventricular rate during atrial fibrillation was significantly greater in patients with propafenone (‐25±4% versus ‐8±3%, P<0.01).

Conclusions. Oral propafenone appeared to be more effective than quinidine in suppressing attacks and alleviating symptoms of paroxysmal atrial fibrillation.
Calcific degeneration of the aortic valve in old age: is the development of flow obstruction predictable
Authors: IIVANAINEN A. M. , LINDROOS M. , TILVIS R. , HEIKKILÄ J. , KUPARI M.
Published: November 2003

Objective. Aortic valve calcification and stenosis become increasingly common with advancing age. This work aimed at assessing whether a time‐dependent reduction of aortic valve area is detectable in an unselected elderly population and whether the rate of reduction can be predicted from clinical or biochemical characteristics.

Design. A population‐based prospective echocardiographic follow‐up study.

Setting. A university hospital.

Subjects. In 1990, randomly selected persons born in 1904, 1909 and 1914 (total n=501) underwent a Doppler echocardiographic study of aortic valve and biochemical tests of glucose, lipid and calcium metabolism. In 1993, echocardiography was repeated in 333 survivors of the original cohorts. These individuals constitute the present study population.

Main outcome measures. Three‐year changes in the aortic valve area and velocity ratio (peak outflow tract velocity/peak aortic jet velocity) determined by Doppler echocardiography.

Results. Aortic valve area decreased from a mean of 1.95 cm2 (95% confidence interval of mean, 1.88–2.03 cm2) to 1.78 cm2 (1.71–1.85 cm2) within 3 years (P<0.001). Concomitantly, the velocity ratio decreased from 0.75 (0.73–0.77) to 0.68 (0.67–0.70) (P<0.001). The changes in aortic valve area and velocity ratio were unrelated to age, sex, presence of hypertension, coronary artery disease or diabetes, and to all assessed biochemical characteristics. A weak positive statistical association was found between the decrease in aortic valve area and the body mass index at entry (r=0.16, P<0.01).

Conclusions. A time‐dependent reduction of the aortic valve flow orifice can be demonstrated in persons representing the general elderly population. The deterioration of aortic valve function within a span of 3 years is neither clinically nor biochemically predictable. A longer follow‐up may be necessary to identify the risk factors of aortic valve stenosis in old age.
Effects of smoking on blood pressure and proteinuria in patients with diabetic nephropathy
Authors: SAWICKI P. T. , MÜHLHAUSER I. , BENDER R. , PETHKE W. , HEINEMANN L. , BERGER M.
Published: November 2003

Objectives. To investigate the effects of smoking on blood pressure and proteinuria in hypertensive diabetic patients with nephropathy.

Design. Controlled, randomized, cross‐over study.

Setting. Tertiary care centre, University Hospital of Düsseldorf, Germany.

Subjects. A total of 25 subjects were recruited, each of whom smoked at least 20 cigarettes a day: 10 normotensive healthy volunteers and 15 hypertensive type 1 (insulin‐dependent) diabetic outpatients with diabetic retinopathy and persistent micro‐ or macroalbuminuria; 10 diabetic patients had normal autonomic function test, whilst five patients showed signs of autonomic neuropathy.

Interventions. Controlled smoking or nonsmoking over a period of 8 h on separate days.

Main outcome measures. Blood pressure was measured every 10 min with an automatic device and urine samples were collected every 3 h.

Results. Systolic blood pressure increased during smoking in controls (mean) (11.5 mmHg, P=0.0001) and in diabetic patients without autonomic neuropathy (7.9 mmHg; P=0.018), but not in patients with autonomic neuropathy (‐2.4 mmHg; P=0.792). Diastolic blood pressure increased during smoking in controls (6.2 mmHg; P=0.019) but not in diabetic patients (2.5 mmHg; P=0.204. 0.2 mmHg; P=0.956). During smoking, median proteinuria and albuminuria increased in diabetic patients without autonomic neuropathy (8.1 mg mmol‐1 creatinine, P=0.002; and 2.6 mg mmol creatinine, P=0.084). No significant changes in albuminuria or proteinuria occurred in the other two groups.

Conclusions. Smoking increases blood pressure values in healthy subjects and in hypertensive patients with diabetic nephropathy and without autonomic neuropathy. This effect of smoking may be partly responsible for the faster progression of diabetic nephropathy in smoking diabetic patients.