bluuebunny/crossref_metadata_2025_split huggingface dataset:
The epidemiology of irritable bowel syndrome in a random population: prevalence, incidence, natural history and risk factors
Authors: KAY L. , JØRGENSEN T. , JENSEN K. H. 
Published: August 2009

Abstract. Objectives. The aim of the study was to assess prevalence, incidence, recovery, and risk factors of irritable bowel syndrome according to different definitions in a large random population.Design. A 5 year follow‐up study of a sex‐ and age‐stratified random sample of 4581 Danes interviewed about abdominal symptoms.Setting. The Glostrup Populations Studies Unit at Glostrup County Hospital.Main outcome measures. Prevalence, incidence, recovery, and the association of risk factors to irritable bowel syndrome (IBS). The percentage of subjects common to the populations selected by the various definitions of IBS.Results. According to various definitions, the prevalence of IBS varied from 5 to 65% and the incidence varied from 1 to 36%. At the 5 year follow‐up only 5% of subjects with IBS were completely free of all symptoms. Psychological vulnerability and the experience of having problems were strongly associated with prevalence and incidence of IBS, whereas lifestyle factors only showed a very weak or no relationship to IBS. Populations defined as suffering from IBS according to the various definitions had less than 50% of the subjects in common.Conclusions. Irritable bowel syndrome is frequent but fluctuating in the general population. Psychological factors seem to be of greater aetiological importance to IBS than lifestyle factors. However, a generally accepted and precise definition is essential to make future studies comparable and to allow general conclusions to be drawn. Furthermore, it still needs to be verified whether the syndrome is a disease entity or just an acceptable, common life‐condition.
Hepatitis C virus chronic infection as a common cause of mixed cryoglobulinaemia and autoimmune liver disease
Authors: FERRI C. , LONGOMBARDO G. , LA CIVITA L. , GRECO F. , LOMBARDINI F. , CECCHETTI R. , CAGIANELLI M. A. , MARCHI S. , MONTI M. , ZIGNEGO A. L. , MANNS M. P. 
Published: August 2009

Abstract. Objectives. Mixed cryoglobulinaemia (MC) and autoimmune chronic hepatitis (AI‐CH) are frequently associated with hepatitis C virus (HCV) chronic infection. Because HCV represents a possible common aetiological factor, the aim of the present study is to investigate the clinico‐serological alterations of both MC and AI‐CH and to verify a possible overlap between these disorders.Setting. Patients from three tertiary referral centres.Subjects. Two Italian series of 88 MC patients and 30 AI‐CH type 1 were studied.Results. MC and AI‐CH share several clinico‐sero‐logical features. The patients' mean age (MC vs. AI‐CH: 60 ± 9 vs. 57 ± 13 years), disease duration (10.5 ± 5 vs. 9.6 ± 6 years), and female/male ratio (3.4 vs. 3.3) were very similar in the two series. Typical hallmarks of MC, i.e. purpura, arthralgias, and weakness, circulating mixed cryoglobulins with rheumatoid factor activity, and hypocomplement‐emia were also recorded in a significant number of AI‐CH patients. Similarly, chronic active hepatitis was found in 68% of MC patients and its histological and serological alterations were comparable with those of AI‐CH; moreover, amongst various auto‐antibodies, antinuclear antibodies and/or anti‐smooth‐muscle antibodies were detected in half of the cases of MC. Anti‐HCV antibodies, detected by second‐generation Chiron elisa and riba, were present in a high percentage of both MC and AI‐CH (94 vs. 80%), and frequently associated with HCV viraemia (86 vs. 77%). Finally, anti‐GOR, the HCV‐related autoantibodies, were found in half cases of MC and AI‐CH.Conclusions. On the whole, these data suggest that HCV in combination with other infectious and environmental and genetic factors can trigger a complex immunological disorder with different clinical patterns.
Malignant lymphoma in coeliac disease: various manifestations with distinct symptomatology and prognosis?
Authors: MATHUS‐VLIEGEN E. M. H. , VAN HALTEREN H. , TYTGAT G. N. J. 
Published: August 2009

Abstract. Objectives. To study the different forms of malignant lymphoma complicating coeliac disease in a low‐prevalence area, according to extranodal–nodal and extraintestinal–intestinal manifestations.Subjects and setting. Patients recruited from two University Hospitals (Amsterdam, Leiden) and from PALGA (National Dutch data‐bank) over a 16‐year period.Design. Review of hospital charts with respect to clinical presentation and treatment of both coeliac disease and malignant lymphoma. Re‐evaluation of morphology and staging by immunoperoxidase, enzyme‐ and immunohistochemical stainings on unstained and frozen materials.Main outcome measures. Clinical behaviour and T‐or B‐cell morphology of extranodal intestinal, extranodal extraintestinal and nodal intestinal disease.Results. Fourteen cases of enteropathy‐associated lymphoma could be traced, 10 with a history of coeliac disease, four primarily presenting with malignant lymphoma. The usual extranodal intestinal lymphoma (eight cases) presented with abdominal pain, weight loss, and malabsorption. Six had atypical disease: four presented with extranodal extraintestinal disease, located in the skin or the respiratory tract; two patients had intractable malabsorption and oedema caused by a nodal intestinal lymphoma. Re‐evaluation with additional immunohistochemical stainings in 11 patients showed a pleomorphic malignant infiltrate of histiocyte‐like cells of T‐cell origin, with a pattern of CD3+; CD4–; CD5±; CD7+ and CD8–. It also established a more appropriate diagnosis in four, an 0.6‐year earlier diagnosis in six, and an upgraded stage of disease in two patients. A more extensive spread and poorer outcome appeared to become more probable in the ranking order of extranodal intestinal, extranodal extraintestinal and nodal intestinal lymphoma.Conclusions. A proper and timely diagnosis of enteropathy‐associated lymphoma requires clinical vigilance and unrelentless perseverance to obtain adequate fresh and frozen tissue for histochemical staining. Further research in a larger number of patients is warranted to investigate the relation between the primary site of the lymphoma, i.e. extranodal intestinal, extranodal extraintestinal, or nodal intestinal, and (its impact on) clinical presentation and prognosis.
Short‐term effects of felodipine in hypertensive type II diabetic males on sulfonylurea treatment
Authors: KJELLSTRÖM T. , BLYCHERT E. , LINDGÄRDE F. 
Published: August 2009

Abstract. Objectives. To study the effects on blood pressure and glucose homeostasis of felodipine, a calcium antagonist.Design. A double‐blind randomized cross‐over study comparing felodipine ER and placebo.Setting. A university centre of diabetic care in Malmö, Sweden.Subjects. Seventeen hypertensive type II diabetic males on oral sulfonylurea (glibenclamide) treatment.Interventions. Four‐week treatment periods separated by a 2‐week wash‐out period. Felodipine 10–20 mg once daily was given.Main outcome measures. Blood pressure, heart rate, HbA1c and response to oral glucose tolerance test; glucose, insulin and c‐peptide. Measured before randomization and at the end of each double‐blind treatment period.Results. Blood pressure was significantly reduced during felodipine treatment and heart rate slightly increased. Felodipine did not influence insulin or c‐peptide levels. There was no significant change in glucose levels but an increase in HbA1c.Conclusion. The study demonstrated that felodipine is an effective agent for type II diabetic patients on glibenclamide treatment. The effect on HbA1c is noteworthy even if not of clinical significance in the short term. Controlled long‐term studies in diabetic patients are needed to fully evaluate antihypertensive agents.
Sleep and cardiac diseases amongst elderly people
Authors: ASPLUND R. 
Published: August 2009

Abstract. Objectives. To investigate the interrelationship between sleep cpmplaints and cardiac symptoms.Design. An epidemiological survey by means of questionnaire.Setting. Västerbotten and Norrbotten in northern Sweden.Subjects. All 10216 members of the Swedish Pensioners' Association (SPF).Main outcome measures. Sleep disturbances and cardiac diseases.Results. Of the men who slept well, 3.0% stated they were troubled by both spasmodic chest pain (‘angina pectoris’) and a sensation of irregular heart beats (‘cardiac arrhythmia’), 9.9% had angina pectoris alone, 7.9% suffered from cardiac arrhythmia, and 79.2% had neither of these disorders. Amongst the men who slept poorly, the corresponding frequencies were 7.0%, 8.7%, 12.3% and 72.0% (P < 0.001). Amongst the women who slept well these frequencies were 2.3%, 7.0%, 8.2% and 82.5%, and among those who slept poorly 5.9%, 10.2%, 15.0% and 68.9% (P < 0.0001). Amongst those with reported sleep complaints, there was an increased occurrence of both angina pectoris and cardiac arrhythmia. This increase in cardiac diseases was found in men and women; both in those with trouble falling asleep, those who frequently awoke during the night and those who had difficulty regaining sleep; and also in those with too early final awakening in the morning. Daytime sleepiness was also associated with increased cardiac symptoms.Conclusion. Poor sleep was associated with both an increase in angina pectoris and cardiac arrythmias.
Determinants of femoral and carotid artery atherosclerosis
Authors: MD T. JOENSUU , SALONEN R. , WINBLAD I. , KORPELA H. , SALONEN J. T. 
Published: August 2009

Abstract. Objectives. The aim of the study was to find the most important determinants of early atherosclerosis in the carotid and femoral arteries.Design. Carotid and femoral maximal intima media thickness (IMT) was measured 19 months after the first of 4 risk factor measurements.Setting. Department of Community Health and General Practice, University of Kuopio, and Occupational Health Care in Pyhäsalmi Mine, Finland.Subjects. The subjects comprised 60 male volunteers aged from 32 to 65 years from amongst 277 workers at the Pyhäsalmi Mine, Finland. Subjects were invited for an ultrasound examination, in order of serum total cholesterol content, until the required figure of 60 cases was achieved.Main outcome measures. Carotid and femoral maximal intima media thickness.Results. Systolic blood pressure (P < 0.01), serum total cholesterol (P < 0.01), age (P = 0.01) and pack‐years smoked (P = 0.02) were independent determinants of maximal carotid artery IMT, and total cholesterol (P = 0.01), age (P = 0.03) and pack‐years smoked (P = 0.01) for maximal femoral artery IMT. For the latter, plasma fibrinogen concentration (P = 0.10) was the next factor to enter the multiple regression model. Body mass index, heart rate, serum HDL cholesterol, triglycerides, urate, apolipoprotein A,*** antithrombin III, lipid peroxides, vitamin E and plasma vitamin C had no significant association with either maximal carotid or femoral IMT or the mean of the carotid and femoral IMT.Conclusions. Systolic blood pressure, serum total cholesterol, age and pack‐years smoked are the most important determinants of early atherosclerosis in the carotid artery and total cholesterol, age and pack‐years smoked in the femoral artery. Prevention should take into consideration these findings. The role of plasma fibrinogen and oxidized low density lipoprotein would require re‐evaluation in larger populations studied longitudinally.
Direct and indirect blood pressure in normotensive and hypertensive subjects
Authors: FAGHER B. , MAGNÚSSON J. , THULIN T. 
Published: August 2009

Abstract. Objectives. To compare intrabrachial blood pressure (I‐BP) with simultaneously measured contralateral auscultatory (A‐)BP in hypertensive and normotensive subjects. The question was whether differences between direct and indirect BP are influenced by the BP levels.Subjects. Hypertensive subjects treated with either placebo (n = 10) or metoprolol (n = 8) and agematched normotensive subjects (n = 15), selected from a defined patient population waiting for cholecystectomy or hernia repair. Measurements were performed pre‐induction of anaesthesia.Results. In the hypertensive subjects, cuff systolic BP (SBP) was lower than I‐BP by an average of 8 mmHg (placebo‐) and 7 mmHg (metoprolol‐treated), where‐as diastolic A‐BP (A‐DBP) was 3 and 7 mmHg higher, respectively. In the normotensive subjects, mean A‐SBP and I‐SBP agreed closely, whereas A‐DBP was 11 mmHg higher. Thus, SBP differences (i.e. indirect–direct BP) were significantly less and DBP differences significantly greater in the normotensive than in the hypertensive subjects (P < 0.05). Plasma renin activity and adrenalin showed better correlations with A‐MBP than with I‐MBP.Conclusions. The drift of cuff systolic readings fell progressively below the intrabrachial values when BP increased, whilst diastolic cuff values approached the direct pressures. Since A‐MBP did not significantly differ from I‐MBP in any group, one must ask whether hypertension would be more correctly defined according to MBP criteria.
Validation of four scales for the acute stage of stroke
Authors: RÖDÉN‐JÜLLIG Å. , BRITTON M. , GUSTAFSSON C. , FUGL‐MEYER A. 
Published: August 2009

Abstract. Objectives. To validate whether a simplified scale for the acute stage of stroke–the Scandinavian Stroke Supervision scale–is sufficient for monitoring symptom progression of prognostic importance.Design. The capacity of the scale was compared to that of the Mathew, Toronto and Fugl‐Meyer stroke scales and the Barthel ADL index.Setting. The stroke unit of Danderyd Hospital, which cares for a defined population.Subjects. Fifty noncomatose patients with objectively recorded symptoms at entry were examined over a period of 5 days by one physician (250 ratings/scale). The last 10 patients were also investigated by another doctor in the same manner (50 ratings/scale) and by nurses (50 ratings) the Scandinavian scale only. The amount of time required by each scale was tested in another 10 patients by two nurses (100 ratings/scale).Interventions. Routine investigation and treatment.Main outcome measures. The reliability, validity, time requirement and correlation of the scales were evaluated, as was their ability to reveal progress of symptoms.Results. All scales were highly significantly correlated. The interobserver agreement was excellent between the physicians but not as good between the physician and the nurses. The prediction of the outcome at discharge and after 3 months was very satisfactory for all of the scales with regard to the whole groups of patients, but none of them could predict the outcome for an individual with certainty. The Scandinavian Stroke Supervision scale was least time consuming, and had the fewest uncertainties expressed by the testers. This scale recorded the progression of slightly fewer symptoms, but did record those with a more serious impact on patient outcome.Conclusion. The time‐saving, simplified Scandinavian scale was as reliable and as valid as the other scales, and detected deterioration that was important for patient outcome as satisfactorily as the other scales.
High‐dose methotrexate treatment and liver function in patients with osteosarcoma
Authors: FABBRI A. , MOTTA E. , FERRARI S. , LONGHI C. , MARCHI E. , BACCI G. , FIGUS E. , MD G. MARCHESINI 
Published: August 2009

Abstract. Objectives. To study the effects of short‐term high‐dose methotrexate therapy on liver function in patients with osteosarcoma.Design. Open prospective study.Setting. Department of Internal Medicine and Oncology. Istituto Ortopedico Rizzoli, Bologna, Italy.Subjects. Fourteen patients with osteosarcoma, with no evidence of previous or actual liver disease at the time of diagnosis.Interventions. All patients received a cumulative dose of 30–57 gm−2 of methotrexate within 6 months as neo‐adjuvant chemotherapy (pre‐ and post‐surgery). Each course of chemotherapy included methotrexate at a dose of 8–12 g m−2 and, in addition, adriamycin and cisplatinum.Main outcome measures. Galactose elimination capacity and antipyrine clearance were measured at baseline, after the first course of chemotherapy, at the end of the pre‐operative period and at the end of chemotherapy. In each case they were carried out after transaminase levels had returned to normal.Results. Galactose elimination capacity decreased from 2.45 (±0.48) mM min−1 to 2.04 (±0.60) mM min−1 after the five planned courses of chemotherapy (P = 0.013, Wilcoxon signed‐rank test), without any change in routine liver function tests. No differences in antipyrine clearance and half‐life were demonstrated (n = 8).Conclusions. The data are consistent with a decreased reserve capacity of the liver after short‐term, high‐dose methotrexate. Long‐term survivors deserve monitoring of liver function for safer methotrexate use, in the light of progressive dosage increments to improve prognosis in neoplastic diseases.
Treatment and recovery as perceived by patients with substance addiction
Authors: NORDFJÆRN T. , RUNDMO T. , HOLE R. 
Published: August 2009

Accessible summary

Social relations to therapists and other patients in treatment are important for positive and negative experiences among patients with substance addiction.
Improvements in mental health and substance use were considered as the more important areas of recovery among these patients.
One of the core reasons for premature dropout could be a failure to establish positive social relations and temptations to relapse to substance use.

AbstractResearch concerning patients with substance addiction and how they perceive their treatment remains scant. The objective of this study was therefore to examine positive and negative perceptions of treatment and recovery from the perspectives of these patients. Data were collected with semi‐structured interviews among seven patients who completed treatment and six patients who prematurely dropped out from their programme (n= 13). Patients were strategically sampled from five inpatient facilities and one outpatient opioid maintenance treatment clinic located in two Norwegian counties. All interviews were transcribed and thereafter analysed with contextual content analysis aided by the qsr nvivo 8.0 software. This was carried out to obtain information about the manifest positive and negative content in the interviews. The results showed that the therapeutic alliance and mutual influences among patients were important for perceptions of treatment. Frequent staff turnover also related to these perceptions. The more important domains of recovery were psychosocial functioning and substance use. The implications of the results were discussed in relation to clinical practice and further research.
Unexpected survival advantage in elderly people with moderate sleep apnoea
Authors: LAVIE PERETZ , LAVIE LENA 
Published: August 2009

SummarySleep‐disordered breathing is much more prevalent in elderly people than in middle‐aged or young populations, but its clinical significance in this age group is unclear. This study investigated retrospectively the rates of all‐cause mortality in elderly people (≥ 65 years) with a laboratory diagnosis of sleep apnoea, and compared their rates of mortality with that of age‐, gender‐ and ethnicity‐matched national mortality data. Survival of 611 elderly people was ascertained after a follow‐up of 5.17 ± 1.13 years. Their age was 70.4 ± 4.8 years, body mass index 30.4 ± 5.9 kg m−2 and respiratory disturbance index (RDI) 28.9 ± 20.1 events h−1. Seventy‐five (12.27%) patients died during the follow‐up period. In comparison with the demographically matched cohort from the general population, the standardized mortality rate of the sleep laboratory cohort was 0.67 [95% confidence interval (CI): 0.53–0.88; χ2 = 11.69, P < 0.0006]. When calculated separately for patients with RDI < 20 (no/mild apnoea), RDI 20–40 (moderate apnoea) and RDI > 40 events h−1 (severe apnoea) there was a significant survival advantage for the moderate group with a standardized mortality rate of 0.42 (P < 0.0002), while elderly people with no/mild apnoea tended to have lower mortality and those with severe sleep apnoea had the same mortality as the matched population cohorts. Cox regression analysis revealed that sleep latency and comorbidities but not sleep apnoea severity were associated independently with mortality. The survival advantage of elderly people with moderate sleep apnoea, combined with recent findings on the potential cardioprotective effects of chronic intermittent hypoxia, raise the possibility that apnoeas during sleep may activate adaptive pathways in the elderly.
Diagnostic guidelines for bipolar depression: a probabilistic approach
Authors: Mitchell Philip B , Goodwin Guy M , Johnson Gordon F , Hirschfeld Robert MA 
Published: August 2009

Objectives:  There are currently no accepted diagnostic criteria for bipolar depression for either research or clinical purposes. This paper aimed to develop recommendations for diagnostic criteria for bipolar I depression.Methods:  Studies on the clinical characteristics of bipolar and unipolar depression were reviewed. To identify relevant papers, literature searches using PubMed and Medline were undertaken.Results:  There are no pathognomonic characteristics of bipolar I depression compared to unipolar depressive disorder. There are, however, replicated findings of clinical characteristics that are more common in both bipolar I depression and unipolar depressive disorder, respectively, or which are observed in unipolar‐depressed patients who ‘convert’ (i.e., who later develop hypo/manic symptoms) to bipolar disorder over time. The following features are more common in bipolar I depression (or in unipolar ‘converters’ to bipolar disorder): ‘atypical’ depressive features such as hypersomnia, hyperphagia, and leaden paralysis; psychomotor retardation; psychotic features, and/or pathological guilt; and lability of mood. Furthermore, bipolar‐depressed patients are more likely to have an earlier age of onset of their first depressive episode, to have more prior episodes of depression, to have shorter depressive episodes, and to have a family history of bipolar disorder. The following features are more common in unipolar depressive disorder: initial insomnia/reduced sleep; appetite, and/or weight loss; normal or increased activity levels; somatic complaints; later age of onset of first depressive episode; prolonged episodes; and no family history of bipolar disorder.Conclusions:  Rather than proposing a categorical diagnostic distinction between bipolar depression and major depressive disorder, we would recommend a ‘probabilistic’ (or likelihood) approach. While there is no ‘point of rarity’ between the two presentations, there is, rather, a differential likelihood of experiencing the above symptoms and signs of depression. A table outlining draft proposed operationalized criteria for such an approach is provided. The specific details of such a probabilistic approach need to be further explored. For example, to be useful, any diagnostic innovation should inform treatment choices.