bluuebunny/crossref_metadata_2025_split huggingface dataset:
Contrasting effects of angiotensin converting inhibitor and alpha‐1‐antagonist on albuminuria in insulin‐dependent diabetes mellitus patients with nephropathy
Authors: HOLDAAS H. , HARTMANN A. , BERG K.J. , LANGBERG H. , BLYSTAD L. , FAUCHALD P. 
Published: August 2009

Abstract. Objective. The main aim of this study was to examine the effects of an angiotensin converting inhibitor, enalapril, and an alpha‐1 (α‐1) antagonist, doxazosin, on albumin excretion, renal haemodynamics and tubular function in insulin‐dependent diabetes mellitus patients with nephropathy.Design. The study consisted of a four‐week run‐in period, a four‐week active treatment period, a four‐week wash‐out period and a second four‐week active treatment period.Setting. The study was performed in the out‐patient clinic at a university hospital.Subjects. Ten patients with insulin dependent diabetes mellitus with macroalbuminuria (> 200 μg min−1), mild to moderate hypertension (diastolic blood pressure 85–115 mmHg) and serum creatinine level below 200 μmol L−1 were included in the study.Main outcome measures. The effect of the drugs on albumin and total protein excretion, β‐2‐microglobulin, proximal tubular enzyme markers and renal haemodynamics.Results. Systolic and diastolic blood pressure were equally reduced by both drugs. Enalapril reduced albumin excretion from 1090 ± 281 μg min−1 to 742 ± 246 μg min−1 (P < 0.01) and total protein excretion from 2.0 ± 0.4 g per 24 h to 1.3 ± 0.4 per 24 h whereas doxazosin was without effect. Glomerular filtration rate and effective renal plasma flow were unchanged by either drug. Doxazosin increased filtration fraction from 0.21 ± 0.02 to 0.23 ± 0.01 (P < 0.05). The urinary excretion of the proximal enzyme markers N‐acetyl‐beta‐glucosaminidase and alkaline phosphatase were elevated as well as urinary excretion of β‐2‐microglobulin. However, neither the excretion of β‐2‐microglobulin nor the enzyme markers were affected by either drug.Conclusions. Enalapril, but not doxazosin, reduces albuminuria in insulin dependent diabetes mellitus patients with nephropathy. The drugs exert differential effects on renal haemodynamics.
Heart failure: a growing public health problem
Authors: ERIKSSON H. 
Published: August 2009

Abstract. At a time when deaths from coronary heart disease and stroke are markedly declining, mortality from heart failure is increasing. Heart failure is a costly and devastating disease, and throughout much of the industrialized world, escalating health‐care costs constitute a serious burden on both public and private systems of financing health care, and about one‐third of all heart failure patients are admitted to hospital each year.Both prevalence and incidence of heart failure increase steeply with increasing age. The prevalence rate is about 1% at the age of 50, whilst at the age of 80 and above, almost one out of 10 persons will suffer from heart failure. Until recently, the goals for heart failure treatment were to relieve symptoms and enhance functional capacity. Recently, some large scale studies have shown that ACE inhibitors can reduce mortality, prevent development of heart failure, avoid the need for hospitalization and improve prognosis. ACE inhibitors may therefore have promising effects both on patients and on society.A challenge for the future must be early recognition and timely and adequate treatment of heart failure. Such a strategy might have great economic benefits as far as public health is concerned. However, the most rewarding efforts for the population will be to prevent the underlying causes of coronary heart failure as well as risk factors for heart failure.This review will study the magnitude of heart failure as a growing public health problem, the underlying causes, risk factors and treatment.
The putative role of alpha‐1‐antitrypsin in the disaggregation of amyloid lambda fibrils
Authors: ERIKSSON S. , JANCIAUSKIENE S. , MERLINI G. 
Published: August 2009

Abstract. Background and objectives. Interactions between hydrophobic compounds like cholesterol and lithocholic acid and alpha‐1‐antitrypsin (α‐1‐AT) have previously been described. We studied the putative interaction between α‐1‐AT and the insoluble, hydrophobic, β‐pleated sheet, light‐chain‐derived fibrils that predominate the tissue deposits in primary immunocytic (AL) related amyloidosis.Subjects and methods. Amyloid fibrils were isolated from two cases with lambda and two cases with kappa AL amyloidosis.Results. The lambda fibrils could be completely disaggregated (as shown by light and electron microscopy and Congo red uptake) by α‐1‐AT added in the molar ratio 1:5, whereas fibrils with predominantly kappa chains remained unaffected. The lambda‐chain interaction was accompanied by characteristic changes of the physicochemical and biological properties of α‐1‐AT apparent in an increased thermal stability and loss of elastase‐inhibitory activity. These findings are compatible with a transition of α‐1‐AT from a native, stressed conformation to a relaxed form.Conclusions. Disaggregation of lambda AL amyloid fibrils can be achieved by addition of α‐1‐AT. The findings may have therapeutic implications in primary amyloidosis.
Diagnostic features of acute myocardial infarction – changes over time from 1983 to 1990: results from the FINMONICA AMI register study
Authors: SALOMAA V. , MIETTINEN H. , PALOMÄKI P. , ARSTILA M. , MUSTANIEMI H. , KUULASMAA K. , TUOMILEHTO J. ,   FINMONICA AMI Register Study Group
Published: August 2009

Abstract. Objectives. To examine, whether the acute myocardial infarctions (AMIs) are becoming smaller.Design. Analysis of electrocardiogram (ECG) and enzyme findings of community‐based AMI registers in three geographical areas of Finland during the 8‐year period 1983–90.Setting. In the FINMONICA AMI Register, all suspected coronary events in persons aged 25–64 years have been registered since 1983 according to the protocol of the WHO MONICA project in the provinces of North Karelia and Kuopio in eastern Finland and Turku/Loimaa area in south‐western Finland.Subjects. Each consecutive case of suspected AMI originating from the monitored populations. During the study period, 11487 definite or possible AMIs were registered.Main outcome measures. Trends in ECG findings classified as definite or probable, and trends in enzyme findings classified as abnormal or equivocal.Results. Of the registered AMIs, 8439 (73.5%) reached the hospital alive and survived ≥ 24 h from the beginning of the symptoms. They were included in the analyses of this report and divided further, to first ever AMIs (n = 5392) and to recurrent AMIs (3047). During the study period, the proportion of ECG findings classified as definite on the basis of the serial Minnesota coding declined in men 3.1% year−1 (P < 0.0001) on average for first AMIs and 1.9% year−1 (P = 0.004) for recurrent AMIs. In women, the corresponding declines were 1.9% year−1 (P = 0.007) and 1.6% year−1 (P = 0.02), respectively. Also, the proportion of enzymes classified as abnormal declined amongst men 2.2% year (P < 0.0001) for first AMIs and 2.8% year−1 (P < 0.0001) for recurrent AMIs. In women, the corresponding declines for abnormal enzymes was 1.3% year−1 (P = 0.13) and 3.0% year−1 (P = 0.02). These findings were consistent in all three areas with different registration teams and different laboratories. The proportion of definite ECG findings amongst patients hospitalized for AMI declined almost by half and the proportion of abnormal enzyme findings declined almost by one‐third during the study period.Conclusions. Our findings are compatible with the clinical observation that the hospitalized AMIs are becoming smaller. The timing and magnitude of the changes suggest that they are mainly caused by decreased risk‐factor levels in the population. Improved treatment of coronary heart disease and changed hospital admission policy are likely to be contributing factors.
Body fat as a predictor of the antihypertensive effect of nifedipine
Authors: STØA‐BIRKETVEDT G. , THOM E. , AARBAKKE J. , FLORHOLMEN J. 
Published: August 2009

Abstract. Objective. The aim of this study was to investigate the relationship between the blood pressure response and body fat in patients treated with the calcium entry blocker nifedipine.Subjects. Forty untreated subjects with moderate hypertension completed the study.Interventions. Height, weight, body mass index (BMI) and body fat (measured by near infrared spectrophotometry using Futrex 5000) were measured before the start of the study. Based on blood pressure measurements before and 30 min after one capsule of 10 mg nifedipine, the patients were allocated to treatment with 10 mg nifedipine daily in the re‐sponder group (reduction in diastolic blood pressure ≥ 10 mmHg) and with 20 mg nifedipine daily in the non‐responder group. Finally, the blood pressure was measured after 1 week.Results. Twelve patients were classified as responders and 28 patients as non‐responders. The responder/non‐responder groups were comparable with respect to the blood pressure readings initially and to age, whereas the non‐responders had higher weight (P < 0.01) and BMI (P < 0.01), more body fat (P < 0.01) and were smaller in height (P < 0.01). After 1 week no additional antihypertensive effect was observed in either group. The blood pressure reduction was negatively correlated to the body fat mass in kilogrammes (P < 0.05 for systolic and P < 0.01 for diastolic blood pressure) in the responder group but not in the non‐responder group, whereas no significant correlations were found to BMI in either group.Conclusion. Our data indicate that the body fat can be used to predict the antihypertensive effect of nifedipine.
Imaging of the sella in the syndrome of inappropriate secretion of antidiuretic hormone
Authors: PAPAPOSTOLOU C. , MANTZOROS C. S. , EVAGELOPOULOU C. , MOSES A. C. , KLEEFIELD J. 
Published: August 2009

Abstract. Objective. The syndrome of inappropriate secretion of antidiuretic hormone (SIADH) results either from ectopic production or inappropriate release of antidiuretic hormone from the neurohypophysis. Although magnetic resonance imaging (MRI) has provided new insights into the morphological changes of the hypophysis in health and disease, no previous studies have evaluated its use in SIADH. The aim of this study was to evaluate the MRI appearance of the neurohypophysis in patients with SIADH.Design. Retrospective case‐control study.Setting. Tertiary care teaching hospital.Subjects. We studied retrospectively eight patients with SIADH who had been hospitalized in Boston's Beth Israel between 1984 and 1994 and who had MRI scans including the sella turcica. We also evaluated prospectively the MRIs of the heads of 23 consecutive control patients who had no pituitary pathology and no serum osmolality or electrolyte abnormalities.Interventions. Clinical evaluation as well as sagittal and axial T1‐MR images.Main outcome measures. Presence or absence of the high intensity signal of the neurohypophysis.Results. In seven out of eight patients (87.5%) the normal high intensity signal of the neurohypophysis was not present. In one patient (12.5%), two interpreting radiologists disagreed about its presence. The high intensity signal was present in the neurohypophysis of 20 out of 23 controls (87.5%).Conclusions. Our data indicate an association of SIADH with the absence of the normal hyperintense signal of the neurohypophysis, confirming the usefulness of MRI as a tool to visualize ADH processing. These data also raise the possibility that the absence of the high intensity signal may be a useful diagnostic tool in cases of SIADH that are difficult to diagnose clinically. Additional studies to correlate this signal with various forms of SIADH will be needed.
Microalbuminuria, insulin sensitivity and haemostatic factors in non‐diabetic treated hypertensive men
Authors: AGEWALL S. , FAGERBERG B. , ATTVALL S. , LJUNGMAN S. , URBANAVICIUS V. , TENGBORN L. , WIKSTRAND J. ,   Risk factor Intervention Study Group
Published: August 2009

Abstract. Objective. To examine whether microalbuminuria in non‐diabetic, treated hypertensive men is associated with insulin resistance and measures of endothelial function, thrombogenesis and fibrinolysis.Design. Cross‐sectional study.Setting. Outpatient clinic in city hospital.Patients. Ninety‐two treated hypertensive men, aged 57–77 years, either with a serum cholesterol of ≥ 6.5 mmol L−1 or smokers, or both. Patients with diabetes mellitus or overnight urinary albumin excretion of > 100 mg 12 h−1 were excluded.Main outcome measures. Overnight urinary albumin excretion, insulin‐mediated glucose disposal (hyper‐insulinaemic euglycaemic clamp), blood glucose and plasma insulin during oral glucose tolerance test, fibrinogen, von Willebrand factor and plasminogen activator inhibitor activity.Results. Microalbuminuric patients had increased blood glucose concentrations during the oral glucose tolerance test and higher plasma fibrinogen levels compared with the normoalbuminuric patients. In a randomly selected subgroup (n = 36), insulin‐mediated glucose disposal was lower in microalbuminuric than in normoalbuminuric patients, and an inverse relationship between insulin sensitivity and albuminuria (r = –0.37; P = 0.028) was found. This relationship was not significant after adjustment for body‐mass index (P = 0.098). In the univariate analyses including all patients, albuminuria was associated with blood glucose, serum creatinine, body‐mass index, systolic blood pressure, fibrinogen, von Willebrand factor and cholesterol (negatively). In a multiple regression analysis, only the body‐mass index was independently related to urinary albumin excretion.Conclusions. Microalbuminuria was associated with insulin resistance but obesity was a confounding factor. Relationships between microalbuminuria and fibrinogen as well as von Willebrand factor were found, but only in univariate analysis.
Improvement of serum lipids and blood pressure during intervention with n‐3 fatty acids was not associated with changes in insulin levels in subjects with combined hyperlipidaemia
Authors: GRUNDT H. , NILSEN D. W. T. , HETLAND Ø. , AARSLAND T. , BAKSAAS I. , GRANDE T. , WOIE L. 
Published: August 2009

Abstract. Objectives. To investigate the effect of an omega‐3 fatty acid concentrate K85 on serum lipids, lipoproteins, insulin metabolism and blood pressure in subjects with combined hyperlipidaemia.Design. After a run‐in dietary period of 10 weeks, subjects were randomly allocated to receive either encapsulated K85 (n = 28) or corn oil (n = 29). The intervention was double‐blind.Setting. An outpatient centre in Stavanger, Norway.Subjects. Fifty‐seven of 141 individuals, who, after the run‐in period continued to meet the inclusion criteria: serum triglycerides of ≥ 2.0 mmol L−1 and total serum cholesterol of ≥ 6.0 mmol L−1.Intervention. Encapsulated K85, containing 85% eicosapentaenoic acid (EPA)/docosahexaenoic acid (DHA), or corn oil, both administered in a daily dose of 4 g for 12 weeks.Main outcome measures. Change in metabolic and haemodynamic parameters related to intervention. Results. Serum EPA and DHA increased significantly in the K85 group during the treatment period. The body‐mass index remained unchanged. A 28% reduction in serum triglycerides was noted in the K85 group from the first 4 weeks. Total serum cholesterol was significantly reduced with both regimens. Serum high‐density lipoprotein cholesterol increased significantly during the first 8 weeks in the K85 group. Significant reductions in systolic and diastolic blood pressures were noted in subjects on K85. The treatment did not affect serum glucose, plasma insulin and proinsulin levels. Insulin: glucose and proinsulin: glucose ratios remained unchanged.Conclusions. The atherogenic risk profile was improved with K85 in subjects with combined hyperlipidaemia, but n‐3 fatty acids supplementation did not affect glucose/insulin homeostasis.
Daytime sleepiness, snoring and gastro‐oesophageal reflux amongst young adults in three European countries
Authors: JANSON C. , GISLASON T. , DE BACKER W. , PLASCHKE P. , BJÖRNSSON E. , HETTA J. , KRISTBJARNASON H. , VERMEIRE P. , BOMAN G. 
Published: August 2009

Abstract. Objectives. To study the geographical variation in daytime sleepiness, snoring and disrupted breathing during sleep and to identify and compare risk factors using the same method in four European cities.Design. A cross‐sectional, multicentre epidemiological survey.Setting. Reykjavik in Iceland, Uppsala and Göteborg in Sweden and Antwerp in Belgium.Participants. A random population sample of 2202 subjects who participated in the European Community Respiratory Health Survey.Main outcome measures. Sleep disturbances and daytime symptoms.Results. At all the centres, 5% of the men and 2–3% of the women reported snoring every night. Daytime sleepiness (DS) was more often reported in Uppsala [odds ratio (OR) and 95% confidence interval: 1.6 (1.2–2.1)] than in the other centres, whilst daytime tiredness (DT) was most common in Reykjavik [OR 1.8 (1.4–2.1)]. Snoring was positively correlated with age, male gender and body‐mass index in all areas. Symptoms of gastro‐oesophageal reflux were associated with DS: OR 2.6 (1.5–4.4) and DT: OR 4.5 (2.7–7.6) and disrupted breathing: OR 3.8 (1.4–10). DS and DT were reported more often by women than by men.Conclusion. The prevalence of snoring was about the same in all four areas, whilst there was a geographical variation in daytime sleepiness and tiredness. As complaints of DS and DT and disrupted breathing were more common in subjects who reported symptoms of gastro‐oesophageal reflux, we suggest that polysomnographic studies comparing sleep patterns in adult patients with and without reflux should be conducted.
Effects of smoking and physical activity on body weight: developments in Sweden between 1980 and 1989
Authors: WOLK A. , RÖSSNER S. 
Published: August 2009

Abstract. Objectives. To study the effects of changes in smoking and exercise habits on body weight in Sweden.Design. Analysis of factors affecting relative body weight by construction of regression equations using two models: one adjusted for age, education, socioeconomic group, geographical region and nationality, the other further adjusted for cigarette smoking and leisure‐time physical activity.Setting. Cross‐sectional interview data derived from the ‘Undersökning om LevnadsFörhållanden’ (Living Conditions) survey 1980–81 and 1989–89.Subjects. Nationally representative samples of Swedish men and women aged 16–84.Main outcome measures. Changes in body‐mass index (BMI) in Sweden during the 1980s.Results. Using the first model, an increase in the BMI of 0.23 kg/m2 in men and 0.17 kg/m2 in women, from 1980 to 1989, was found. When controlling for smoking and physical activity, these values were 0.20 and 0.18 kg/m2, respectively, (P at least < 0.003).Conclusions. These findings indicate that the reported decrease in smoking and changes in physical activity during the 1980s only marginally explain the BMI increase in the adult Swedish population. The health programmes launched during the 1980s seem to have little beneficial effects on body‐weight development, in particular in younger generations of both sexes.
Chronic mesenteric ischaemia: diagnostic challenges and treatment options
Authors: HOOGENBERG K. , VAN ESSEN L. H. , VAN DEN DUNGEN J. J. A. M. , LIMBURG A. J. , BOEVE W. J. , KLEIBEUKER J. H. 
Published: August 2009

Abstract. Objectives. A description of the clinical presentation, diagnostic procedure and mode of therapy in three patients suffering from chronic mesenteric ischaemia.Design and interventions. In all cases, the diagnosis was made on the basis of abdominal complaints in combination with angiographic findings. The primary treatment objective was restoration of blood flow via a revascularization procedure, for the patient in whom this could not be accomplished an enteral feeding programme was undertaken.Results. One patient had a panmalabsorption syndrome which was treated with an aortomesenteric bypass operation, the second one presented with multiple gastric ulcerations which only improved after a percutaneous transluminal angioplasty. In the third patient, neither surgery or angioplasty were feasible and a tentative enteral feeding programme was given, after which the ability to consume a normal oral diet without abdominal distress was regained.Conclusions. These three cases illustrate the diverse clinical pictures by which chronic mesenteric ischaemia may present itself. This diagnosis should be kept in mind when other more common causes of a patient's abdominal complaints cannot be found, hence giving consideration to abdominal angiography as the next diagnostic procedure. With respect to therapy, restoring blood flow through surgery or angioplasty is the primary form of treatment. However, if neither of these therapeutic options is feasible, it is suggested that such patients may benefit from a nutritional training programme.
Erythrocyte porphobilinogen deaminase activity and primary liver cancer
Authors: KACZYNSKI J. , HANSSON G. , THUNELL S. , WETTERBERG L. , WALLERSTEDT S. 
Published: August 2009

Abstract. Objectives. To study whether primary liver cancer (PLC) could be associated with acute intermittent porphyria (AIP) carriership and whether the activity of erythrocyte porphobilinogen deaminase (PBGD) could be used as a tumour marker for PLC.Design. Prospective study.Setting. Medical and surgical wards in two general hospitals in Göteborg, Sweden.Subjects. All patients with a strong suspicion of PLC (n = 109) who came to the authors' attention.Main outcome measures. Measurement of PBGD activity in erythrocytes. Comparison of the PBGD activity in groups with various final diagnoses – hepatocellular carcinoma (n = 58), cholangio‐cellular carcinoma (n = 2), malignancy other than PLC (n = 18), benign liver disorders (n = 11) – and according to presence of cirrhosis.Results. None of the patients had a clinical or family history of AIP. Four cases with low PBGD activity, suggesting AIP gene carriership, were found, which is more than expected. However, the cases were evenly distributed amongst the groups. The mean activity of PBGD was higher in cirrhotic patients, irrespective of the presence of PLC, than in others.Conclusions. (i) Acute intermittent porphyria gene carriership might be associated with an increased risk not only for PLC but also for secondary malignancies and benign tumours in the liver, (ii) High activity of PBGD is not unusual in liver cirrhosis and the reason for this needs to be elucidated, but it seems to be of no clinical value as a tumour marker for PLC.