bluuebunny/crossref_metadata_2025_split huggingface dataset:
Pressure‐dependent, enhanced natriuretic response to low‐dose, atrial natriuretic peptide infusion in essential hypertension
Authors: EISKJÆR H. , NIELSEN C. B. , PEDERSEN E. B. 
Published: August 2009

Abstract. Objective. To examine whether the effect of atrial natriuretic peptide (ANP) on renal glomerular and tubular segmental handling of sodium in patients with essential hypertension is pressure dependent.Design. Part 1. The renal effects of a low‐dose continuous infusion (10 ng kg−1 min−1) with ANP for 1 h were compared in 10 untreated essential hypertensives (EH) and 13 normotensive control subjects (CS).Part 2. The hypertensives were studied on another day with ANP infusion during preceding acute BP reduction with sodium nitroprusside infusion (NP). The results were compared with those obtained during infusion with ANP + placebo (Part 1).Methods. Lithium clearance was used to estimate the proximal tubular reabsorption of sodium.Results. Part 1. Atrial natriuretic peptide caused an exaggerated increase in urinary sodium excretion (+ 102 vs. + 38%; P < 0.05), fractional excretion of sodium (+ 80 vs. + 37%; P < 0.05), and urinary output (+ 56 vs. + 8.3%; P < 0.05) in EH compared with CS. Glomerular filtration rate and filtration fraction increased to the same degree in both groups. Absolute lithium clearance (CL1) increased and FEL1 tended to increase (P = 0.061) in EH, but these were unchanged in CS. The increase in plasma cyclic guanosine 5′‐phosphate (cGMP) and urinary excretion of cGMP and the decrease in plasma aldosterone during ANP infusion were the same in the two groups.Part 2. During NP infusion the natriuresis caused by ANP in EH was reduced (+ 51 vs. +99%; P <0.05). The relative changes in GFR, CL1, and FEL1 during ANP infusion were not affected by the preceding BP reduction with NP. Mean arterial pressure was reduced from 122 to 101 mmHg during NP infusion. The relative increase in sodium excretion in EH was significantly correlated to mean arterial pressure.Conclusions. Low‐dose ANP infusion causes an exaggerated natriuresis in untreated essential hypertensives due to a more pronounced reduction in tubular reabsorption. After BP reduction, the natriuresis induced by ANP in essential hypertensives is decreased, probably due to a less pronounced reduction in tubular reabsorption beyond the proximal tubules. We suggest that the enhanced natriuretic response to ANP in EH is secondary in some degree to the elevated systemic pressure.
Incidence of pheochromocytoma in South Galicia, Spain
Authors: FERNÁNDEZ‐CALVET L. , GARCÍA‐MAYOR R. V. G. 
Published: August 2009

Abstract. Objectives. To estimate the incidence of pheochromocytoma in the population of South Galicia (Spain) during the period 1980–1992.Design. A prospective study.Setting. The General Hospital of Vigo, a tertiary referral centre.Subjects. New cases of pheochromocytoma diagnosed in the population during the years 1980–1992. The average population size was 523934 inhabitants, (52% female, 48% male).Main outcome measures. All data were obtained from the Medical Registry, which ensures virtually complete case ascertainment for diagnosed pheochromocytoma in the population. All cases were histologically confirmed. The average annual incidence rate of pheochromocytoma was calculated.Results. For the study period, 14 new cases (eight female and six male) of pheochromocytoma were diagnosed in the population of South Galicia. The average annual incidence rate in the population was 2.06 (range 0.0–3.93) per million. This incidence rate was significantly higher in the female population (2.26 vs. 1.84; P < 0.05). The mean age at diagnosis was 43 ± 12 (range 21–65) years. Thirteen of the 14 cases were diagnosed in living patients (two discovered incidentally at operation) and one case was diagnosed at autopsy. One pheochromocytoma was located outside the adrenals. All but one tumour were benign. One patient had pheochromocytoma as part of the multiple endocrine neoplasia type IIa, and in four patients it was associated with neurofibromatosis (28.57%). Four of the 13 patients surgically treated had residual hypertension.Conclusions. The incidence of pheochromocytoma in our population is similar to that reported from other European countries. Routine screening for this disease is not recommended, but postoperative follow‐up of the patients is needed. A wider study is necessary to confirm the high association with neurofibromatosis in our population.
Systemic polyarteritis nodosa as the initial manifestation of a gastric adenocarcinoma
Authors: POVEDA F. , GONZÁLEZ‐GARCÍA J. , PICAZO M. L. , GIMÉNEZ A. , CAMACHO J. , BARBADO F. J. , VÁZQUEZ‐RODRÍGUEZ J. J. 
Published: August 2009

Abstract. We report a case of systemic polyarteritis nodosa (PAN) leading to the discovery of an as yet asymptomatic, surgically curable gastric adenocarcinoma.PAN is rarely associated with malignancies and in such cases these are more often malignant haemato‐logical diseases than solid neoplasms. The immuno‐pathological findings, the temporal relationship between both conditions, and the spontaneous resolution of vasculitis after tumour removal suggest a paraneoplastic origin of the systemic angitis.
Lipid intolerance in smokers
Authors: AXELSEN M. , ELIASSON B. , JOHEIM E. , LENNER R. A. , TASKINEN M.‐R. , SMITH U. 
Published: August 2009

Abstract.Objectives.Smokers have recently been shown to be insulin resistant and to exhibit several characteristics of the insulin resistance syndrome (IRS). In this study, we assessed fasting and postprandial lipid levels in healthy, normolipidaemic, chronic smokers and a matched group of non‐smoking individuals.Design.A standardized mixed meal (containing 3.78 MJ and 51 g of fat) was given in the morning after an overnight fast. The smokers were either abstinent from tobacco for 48 h or were allowed to smoke freely, including being allowed to smoke six cigarettes during the study.Subjects.Twenty‐two middle‐aged, healthy male subjects, nine habitual smokers and 13 non‐smoking control subjects, were recruited to the study. The smokers had all been smoking at least 10 cigarettes per day for at least 10 years.Results.The smokers exhibited a lipid intolerance in that their postprandial increase in triglyceride levels was more than 50% higher than in the non‐smokers' group. This lipid intolerance could not be discerned in the postabsorptive state because the fasting triglyceride levels were the same in both groups, whilst the smokers had significantly lower high‐density lipoprotein (HDL) cholesterol. The peak postprandial triglyceride level correlated closely and negatively with fasting HDL cholesterol, indicating an impaired lipolytic removal capacity in smokers.Conclusions.Healthy, normotriglyceridaemic smokers exhibit an abnormal postprandial lipid metabolism consistent with lipid intolerance. It is suggested that postprandial hyperlipidaemia is a characteristic trait of the insulin resistance syndrome and that the defect in lipid removal is related to the low HDL cholesterol in this syndrome. The insulin resistance syndrome is likely to be an important reason for the increased propensity for cardiovascular disease in smokers.
Interrelation between risk factors for cardiovascular disease in men aged 33–42: A study from Habo in Skaraborg County, Sweden
Authors: PERSSON L.‐G. , LINDSTRÖM K. , LINGFORS H. , BENGTSSON C. 
Published: August 2009

Abstract. Objectives. The main purpose was to study associations between different risk factors for coronary heart disease in order to find out whether such associations already exist during the fourth decade of life.Setting. A study carried out by the primary healthcare staff in the community of Habo in Skaraborg County in south‐western Sweden.Subjects. All men living in Habo aged 33–42 years who were willing to participate in the study ‐ in total 652 men (participation rate 86%).Main outcome measures. Risk factors for coronary heart disease considered as markers of lifestyle: body‐mass index as a measure of general obesity, waist‐to‐hip circumference ratio as a measure of central obesity, arterial blood pressure, serum cholesterol concentration and serum triglyceride concentration.Results. There were statistically significant correlations between all the factors analysed including anthropometric data, blood pressure and serum lipids.Conclusions. The results indicate associations between different risk factors at an early age and emphasises the need for a multifactorial view on risk as early as at the ages which were the focus of this study.
Hyperinsulinaemia and decreased plasma levels of dehydroepiandrosterone sulfate in premenopausal women with coronary heart disease
Authors: SŁOWIŃSKA‐SRZEDNICKA J. , MALCZEWSKA B. , SRZEDNICKI M. , CHOTKOWSKA E. , BRZEZIŃSKA A. , ZGLICZYŃSKI W. , OSSOWSKI M. , JESKE W. , ZGLICZYŃSKI S. , SADOWSKI Z. 
Published: August 2009

Abstract. Objectives. The purpose of the study was to establish plasma levels of insulin, ovarian sex hormones and dehydroepiandrosterone sulfate (DHEA‐S) and to evaluate their correlations with lipids in premenopausal women with angiographically demonstrated coronary stenosis.Design. Differences in plasma levels of insulin, ovarian sex hormones, DHEA‐S and lipids between groups were compared by analysis of variance.Setting. From January 1993 until December 1993 patients were diagnosed in the Outpatient Clinic of the Department of Endocrinology Medical Centre for Postgraduate Education, Warsaw.Subjects. Premenopausal women with normal oral glucose tolerance test (OGTT) results, with and without coronary stenosis were studied: 21 women after acute myocardial infarction with angiographically demonstrated coronary stenosis (women with CHD), and 14 women with chest pain, a positive exercise test without significant changes of coronary arteries on coronarography (women with normal coronarography, NC). The control group consisted of nine, healthy women with no risk factors for CHD.Main outcome measures. In premenopausal women with CHD, the decreased plasma level of DHEA‐S and hyperinsulinaemia were anticipated.Results. In women with CHD, the plasma levels of DHEA‐S (926.5 ± 83 ng mL−1) were significantly lower than those in women with NC (1375.7 ± 181 ng mL−1) and in healthy controls (1984 ± 127 ng mL−1), P < 0.02 and P < 0.001, respectively. The fasting insulin and insulin response to an OGTT in women with CHD and with NC was higher than in healthy subjects. A significant decrease of high‐density lipoprotein (HDL) cholesterol, HDL‐2 cholesterol and apolipoprotein A‐I, and an increase of total cholesterol, low‐density lipoprotein cholesterol C and apolipoprotein B levels in women with CHD compared to healthy controls were observed. A negative correlation between fasting insulin and the plasma levels of DHEA‐S was established.Conclusion. In premenopausal women, hyperinsulinaemia and decreased DHEA‐S levels may contribute to the development of coronary atherosclerosis.
The medical hierarchy and perceived influence on technical and ethical decisions
Authors: HOLM SØREN 
Published: August 2009

Abstract.Objective.To investigate the influence of hierarchial position and perceived influence on ethical and technical decisions.Design.The study was conducted as a postal questionnaire survey.Subjects.A random sample of 329 Danish physicians working at departments of internal medicine and related subspecialties. Of these, 270 (82%) returned a completed questionnaire.Main outcome measure.Self‐reported perceived influence in discussions about technical and ethical issues in connection with decisions to terminate treatment for patients with terminal malignant illness.Results.The odds ratio for perceived influence between consultants and house officers is 14.9 for ethical issues, 44.9 for technical issues, and 652.3 for questions concerning departmental policy. Gender plays no role, when one controls for hierarchial position.Conclusions.Hierarchial position is the major determinant of perceived influence on technical and ethical decisions. Position seem to play a larger role in technical than in ethical decisions.
Analysis of the MRFIT screenees: a methodological study
Authors: WERKÖ LARS 
Published: August 2009

Abstract. Purpose. To review the methods used in the many publications on the MRFIT screenees.Method. Medline was searched for articles mentioning MRFIT screenees. The articles were collected, abstracted, and the method section and some of the result section were scrutinized in detail. The statements in different articles regarding methods used and the presentation of results were compared.Result. The analyses of the MRFIT screenees seem to be retrospective studies of mortality and risk factors, where the underlying data base has been far from complete. Similar data are presented in slightly different fashions in several papers published in different scientific journals at about the same time. The control of the quality of underlying data has been uneven and is not discussed at all in most of the papers published.Conclusion. The often‐repeated statement that the MRFIT screenees constitute the largest and most exact data base regarding the relation of risk factors to mortality in the healthy male US population has no foundation.
Diminished vitamin B12 levels in patients with severe sickle cell disease
Authors: AL‐MOMEN A. K. 
Published: August 2009

Abstract. Objective. The aim of this study was to estimate the levels of vitamin B12 in patients with severe sickle cell disease compared to normal controls. Complete blood count, iron studies and vitamin B12 levels were obtained in 85 consecutive patients with severe sickle cell disease (56 males, 29 females, aged 14–49 years) and 100 healthy blood donors (67 males, 33 females, aged 17–60 years) as a normal control group.Results. Thirty‐seven of the 85 patients (43.5%) had serum vitamin B12 levels below normal values (mean 84.3 ± 28.7, range 7–145 pmol L−1) without macrocytosis or hypersegmented neutrophils. The mean level of vitamin B12 in the remaining 48 patients (56.5%) was normal (mean 233.3 ± 73.9, range 152–435 pmol L−1) which is below the mean of normal control levels (mean 327.7 ± 168.7, range 178–897 pmol L−1). Patients with low B12 achieved a significant symptomatic improvement when treated with vitamin B12, 1 mg intramuscularly weekly for 12 weeks when compared with patients with normal B12 levels.Conclusion. We conclude that many patients with severe sickle cell disease may suffer from unrecognized vitamin B12 deficiency.
Impaired melatonin secretion in patients with Wernicke‐Korsakoff syndrome
Authors: WIKNER J. , ANDERSSON D. E. H. , WETTERBERG L. , RÖJDMARK S. 
Published: August 2009

Abstract. Objectives. Melatonin (MT) undergoes circadian changes in response to external light conditions and has been implicated in the control of other circadian hormone variations. Alcohol inhibits MT secretion in healthy subjects. The purpose of the present investigation was to elucidate whether patients with Wernicke‐Korsakoff syndrome (WKS) also have impaired MT secretion after a period of prolonged alcohol abstention. If so, it would be of interest to find out whether this affects Cortisol rhythmicity.Design. Seven patients with WKS and 8 healthy controls were included in the study. Venous blood was sampled every 2nd h between 18.00 and 08.00 hours, and urine collected between 22.00 and 07.00 hours.Setting. Department of Internal Medicine, Endocrinology Section, Sódersjukhuset, Stockholm.Main outcome measures. Peak serum MT values during the night, total nocturnal MT secretion (estimated by MT incremental areas), and urinary excretion of MT were determined in each participant. Serum Cortisol levels were determined in the patients at 18.00, 02.00 and 08.00 hours.Results. Patients with WKS had a markedly reduced nocturnal secretion of MT compared to healthy volunteers (MT incremental areas 0.33 ± 0.21 vs. 1.60 ± 0.29 nmol L−1 h−1, mean ± SEM; P < 0.005). Amongst the patients, the serum Cortisol level was higher in the morning than in the afternoon (331 ± 46 vs. 240 ± 52 nmol L−1; P < 0.01), and showed a nadir during the night (138 ± 45 nmol L−1) as in normal individuals.Conclusion. Patients with WKS have markedly reduced nocturnal secretion of MT. The exact mechanism behind this finding has to be further elucidated. However, it is of interest to note that despite the lack of clearcut circadian MT changes, WKS patients retain normal Cortisol secretion, thus suggesting that MT rhythm may not be obligatory for the proper control of circadian Cortisol rhythmicity.
Habitual diet, platelet function, fibrinogen and facto VII coagulant activity in young Finns
Authors: MUTANEN MARJA , KRUSIUS TOM , RÄSÄNEN LEENA , FREESE RIITTA , VAHTERA ELINA , VIIKARI JORMA S. A. 
Published: August 2009

Abstract. Objectives. The objective of the study was to determine whether an association between diet and platelet function, plasma fibrinogen level and factor VII coagulant activity (VII:C) could be established in young subjects.Design. Data on the habitual diet of the subjects were collected either by a questionnaire on food habits (n = 204) or by a 48‐h dietary recall interview (n = 53).Subjects. The subjects were participants in the project ‘Cardiovascular Risk in Young Finns’ (age range 15–30 years). A total of 204 subjects having a questionnaire on food habits participated in the platelet function tests and 53 also participated in a 48‐h dietary recall interview. Plasma fibrinogen concentration and factor VII: C were measured from 79 subjects.Main outcome measures. Platelet function was tested by turbidometric measurement of platelet aggregation using ADP and collagen as aggregation agents.Results. Platelet aggregation with ADP (at up to 4.0 μmol L−1) and collagen (at up to 5.0 μg mL−1 platelet‐rich plasma PRP) showed that the diet characterized as ‘saturated’, i.e. containing high‐fat milk and saturated fat, was associated with platelets less sensitive to aggregating agents in vitro when compared to the unsaturated type of diet. Collagen‐but not ADP‐induced aggregation decreased with age of the subjects (P = 0.026–0.057, regression coefficient). An inverse regression coefficient between plasma factor VII:C (101%; range 64–145%) and serum trigycerides (P = 0.006) and the intake of rye (g 1000 kcal−1; P = 0.03) were found.Conclusions. In this study we showed that platelet reactivity and factor VII: C already differ considerably between subjects at a young age, and diet may explain some of this variation.
Incidentally detected adrenal tumours (incidentalomas): histological heterogeneity and differentiated therapeutic approach
Authors: BENCSIK Zs. , SZABOLCS I. , GÓTH M. , VÖRÖS A. , KASZÁS I. , GÖNCZI J. , KOVÁCS L. , DOHÁN O. , SZILAAGYI G. 
Published: August 2009

Abstract. Objectives. To find a differentiated therapeutical approach to incidentalomas.Design. Prospective study of incidentalomas: their histology, hormonal activity, and growth if primarily non‐operated.Setting. Admissions to an academic tertiary care centre because of incidentaloma.Patients. Thirty‐eight female, 25 male, 27–85 years old.Interventions. Ultrasound, computed tomography and adrenal scintigraphy when appropriate; investigations to exclude malignancy giving metastasis into the adrenal gland; ACTH, Cortisol, aldosterone, renin activity, androgene, catecholamine measurements; surgery or follow‐up.Main outcome measures. Rate of malignancy; linkage of tumour size to probability of malignancy; prevalence of tumours with subtle hormone excess.Results. Cortical adenomas occurred in 13/31, metastases in 7/31 of the histologically confirmed cases. In 10/31 cases, the computed tomography indicated a size that was smaller than the pathological size (mean = 20 mm). 20.6% of all incidentalomas and 61.5% of the 13 operated corticol adenomas showed subtle hormonal activity. Twenty‐seven incidentalomas < 30 mm were folio wed‐up (3–41 months; mean 18 months) and showed growth in only one case. Sensitivity, specificity, and predictive value (PV) of a tumour ≥ 30 mm to indicate malignancy were: 1.0, 0.56 and 0.27, respectively. The PV of a < 30 mm tumour to exclude malignancy was 1.0.Conclusions. Oncological screening tests are necessary in all incidentalomas. Tumours ≥ 30 mm should be operated but smaller ones can be followed‐up, because they are usually benign and rarely show progressive growth. Cortical adenomas with subtle hormonal overproduction and hypertension, diabetes or osteoporosis should be operated, irrespective of their size, but in the absence of relevant clinical symptoms they can be followed‐up.
Oral contraceptives and venous thromboembolism: a quantitative discussion of the uncertainties
Authors: KOSTER T. , SMALL R.‐A. , ROSENDAAL F. R. , HELMERHORST F. M. 
Published: August 2009

Abstract. Objectives. The majority of post‐thrombotic women are barred from using oral contraceptives. We evaluated this policy for its clinical relevance.Design. A meta‐analysis of controlled studies between 1960 and 1993.Setting. A Medline computer search, from 1966 to 1993, in multiple languages, with the following index terms: thrombosis, thrombopheblitis, vein, venous, pulmonary embolism, contraceptives, oestrogen, oral.Study selection. A total of 588 articles or abstracts were reviewed for controlled studies, in which an index group was compared with a control group. Included were one randomized trial, six follow‐up studies and eight case‐control studies.Main outcome measures. Summary thrombosis risk for oral contraceptive users, number needed to discontinue oral contraceptives to prevent one (recurrent) thrombosis, comparison of additional unwanted pregnancies and postpartum thrombosis between alternative birth‐control methods.Results. The studies proved highly heterogeneous with regard to size and direction of the risk estimate. The summary relative risk of first thrombosis during oral contraceptive use was 2.9 (95% CI, 0.5–17). Since the risk of thrombosis recurrence is not well known, we estimated alternatives, making various hypothetical assumptions, wherein women would continue to take oral contraceptives after a first episode of thrombosis, or stop and switch to use of an intra‐uterine device, condom or the progestogen‐ only pill. Depending on the assumptions with regard to recurrence risk and the existence of possible subgroups with genetic coagulation defects, the cost‐ benefit ratio of advising against the use of oral contraceptives after a first thrombosis varied tremendously.Conclusions. Our analysis shows that we lack the necessary data for recurrence risk of venous thrombosis during continuing use of oral contraceptives, or after switching to other modes of contraception. This reflects the clinical uncertainties that result in highly contradictory advice to young women who have experienced a first thrombosis. Only follow‐up studies on recurrence risk will settle the issue.