bluuebunny/crossref_metadata_2025_split huggingface dataset:
Gemfibrozil treatment of the high triglyceride‐low high‐density lipoprotein cholesterol trait in men with established atherosclerosis
Authors: KNIPSCHEER H. C. , NURMOHAMED M. T. , VAN DEN ENDE A. , PLAAT B. , PRUIJS H. J. W. , MULDER W. J. , KASTELEIN J. J. P. 
Published: August 2009

Abstract. Objective. To study the short‐term efficacy, tolerability and safety of the treatment with gemfibrozil 600 mg twice daily or placebo in male patients with established atherosclerosis, with a lipid profile matching the ‘high triglyceride‐low high‐density lipoprotein (HDL) cholesterol trait”.Design. Double‐blind randomized placebo controlled prospective trial.Setting. Amsterdam Lipid Research Clinic at the Academic Medical Centre of the University of Amsterdam and the Slotervaart Training Hospital affiliated to the University of Amsterdam, Amsterdam, the Netherlands.Subjects. Thirty‐five male patients, age 30–70, with established atherosclerosis and the high triglyceride‐low HDL cholesterol trait.Main outcome measures. Plasma total cholesterol, triglycerides, lipoproteins, apolipoproteins A1 and B100, clinical and laboratory safety parameters.Results. Seventeen patients in the gemfibrozil group and 16 patients in the placebo group completed the study period. Compliance was considered adequate. Mean (± standard deviation) plasma HDL cholesterol levels increased 20.3% (±12.22) from 0.82 to 0.99 mmol L−1 in the gemfibrozil group against 9.9% (±18.31) from 0.79 to 0.87 mmol L−1 in the placebo group (P = 0.001). Mean plasma triglyceride level fell 49.5% (±14.27) from 3.65 to 1.82 mmol L−1 in the gemfibrozil group against an increase of 13.6% (±40.31) from 3.62 to 4.01 mmol L−1 in the placebo group (P < 0.001). Although plasma HDL cholesterol and triglyceride levels improved in all patients, normalization of these lipoproteins was only observed in approximately half of them. Plasma total and low‐density lipoprotein (LDL) cholesterol levels, as well as plasma levels of apolipoprotein (apo) A1, B100 and lipoprotein [Lp(a)], did not show significant alterations compared to the placebo. All safety parameters were comparable between the two groups and remained within the reference limits. Gemfibrozil was well tolerated during treatment. Minor inconveniences were equally distributed between the two treatment groups.Conclusions. Gemfibrozil is an effective and safe drug in patients with coronary heart disease (CHD) and the high triglyceride‐low HDL cholesterol trait.
Relation between calcium intake, grip strength and bone mineral density in the forearms of girls aged 13 and 15
Authors: KRISTINSSON J. Ö. , VALDIMARSSON Ö. , STEINGRIMSDOTTIR L. , SIGURDSSON G. 
Published: August 2009

Abstract. Objectives. To evaluate whether there is an association between calcium intake in adolescent girls and bone mineral density (BMD). Also, the relationships between BMD, various anthropometric factors and grip strength were evaluated.Design. Cross‐sectional comparison of BMD, calcium intake and grip strength in 13 and 15 year age groups, randomly selected.Setting. Ten secondary elementary schools in the Reykjavik area.Subjects. One hundred and ninety‐seven Icelandic Caucasian girls aged 13 and 15. One hundred and seventy participated and 162 completed the study.Main outcome measures. Single photon absorptiometry was used to measure BMD and bone mineral content (BMC) in both forearms. Consumption of milk and dairy products was assessed using a food frequency questionnaire. Height and weight were measured and grip strength was determined with a hand‐held dynamometer.Results. Calcium intake was found to be significantly correlated to BMD in the older group after adjustment for menarcheal age and weight (r = 0.24; P < 0.05). Division into three subgroups yielded a significantly greater coefficient of correlation between calcium intake and BMD in the lowest calcium consumption group (r = 0.44; P < 0.05). No association was found in the younger age group.Significant positive correlations between grip strength and regional bone mineral density accounted for up to 16.8% of the variation in BMD (P < 0.001) and 38.4% of the variation in BMC.Conclusions. This study is consistent with the hypothesis that a threshold effect of calcium intake on BMD might exist. Above this threshold (1000–1200 mg) no further effect on BMD was seen. The results show a strong association between grip strength, a measure representative of total body strength, and BMD.
A longitudinal study of orthopaedic outcomes for severe factor‐VIII‐deficient haemophiliacs
Authors: ALEDORT L. M. , HASCHMEYER R. H. , PETTERSSON H. ,   THE ORTHOPAEDIC OUTCOME STUDY GROUP
Published: August 2009

Abstract. Objective. Arthropathy is the major cause of morbidity in haemophilia. In an attempt to establish optimal therapeutic regimens for persons with haemophilia, we hypothesized that no direct relationship exists between increasing factor dosage and orthopaedic outcomes over time.Design. A longitudinal uncontrolled 6 year study was carried out. Ankles, knees and elbows of patients were studied using physical and X‐ray examination scores. Bleeding episodes and treatment regimens were determined. The amount of time lost from work and school, as well as days in hospital, was also monitored.Setting. Twenty‐one international haemophilia centres were used to accrue and follow patients over the 6 year period.Subject. Severe (< 1 %) factor VIII deficient patients under the age of 25 without inhibitors were recruited into the study.Intervention. The status of the six major joints of these patients were measured annually for mobility. X‐ray evaluation of these joints was carried out at the beginning and end of the study. Using a World Federation of Haemophilia joint and X‐ray score, stability, progression or regression of arthropathy was evaluated.Results. Physical and X‐ray examination scores increased significantly with age, and the number of joint bleeds were significant in determining the Δ score. Approximately 10% of patients entered with all six joints normal. Of these, 50% remained so. Year‐long prophylaxis significantly reduced the rate at which joints deteriorate both on physical (P = 0.02) and X‐ray examination (P = < 0.001). Patients on prophylaxis had significantly fewer days lost from work or school, as well as fewer days spent in hospital (P = < 0.01).Conclusions. Higher doses of factor per se do not necessarily produce improved orthopaedic outcomes. However, full time prophylaxis is likely to produce the best orthopaedic outcome. The most critical factor for a good orthopaedic outcome is the reduction of joint bleeds.
Costs over time in conventional treatment of acute myeloid leukaemia: A study exploring changes in treatment strategies over two decades
Authors: STALFELT A. M. , BRODIN H. 
Published: August 2009

Abstract. Objectives. The aim was to analyse the consumption of different items in conventional treatment of acute myeloid leukaemia (AML) and their cost, in order to evaluate the economic consequences of new treatment strategies.Design. Data on items of treatment were gathered retrospectively from case notes, including amount and date. Prices were gathered from price lists made up for internal billing/accounting.Setting. The patients were all treated in a hospital with excellent treatment and service facilities.Subjects. Seventy‐three AML patients treated from 1973 to 1980, all since deceased, were compared with 54 patients treated from 1981 to 1988, of whom 14 were alive at the end of the observation period.Interventions. The patients were treated according to randomized treatment protocols to achieve complete remission. Maintenance treatment or consolidation courses were given. In relapse, new induction treatment was given.Main outcome measures. Complete remission and survival were registered. The costs were divided into basic hospital costs and patient‐specific costs.Results. The mean total treatment cost for an AML patient in the 1970s was 211138 SEK, and in 1980s 356911 SEK. (UK £1 = 10.57 SEK, US$1 = 5.91 SEK 1990). All treatment costs increased between the periods: hospital costs by 20%, and patient‐specific costs by 186%. Antibiotics, cytostatics and outpatient department costs had increased the most. The mean survival time almost doubled, and in the 1980s group there were several long‐term survivors.Conclusions. The costs for AML treatment increased considerably from the 1970s to the 1980s. The effectiveness of these treatments increased as well, resulting in increased rate and duration of survival, and several patients were long‐term survivors. It was not possible to identify the cost consequences of separate new technologies.
Granulocyte—macrophage colony stimulating factor in acute non‐lymphocytic leukaemia
Authors: FANIN R. , BACCARANI M. 
Published: August 2009

Abstract. Background. Granulocyte‐macrophage colony stimulating factor (GM‐CSF) is required to maintain and to regulate granulocyte and monocyte productions. It is potentially useful for accelerating and enhancing haemopoietic recovery and neutrophil function.Results. In acute non‐lymphocytic leukaemia (ANLL) the dependence of blast cells on GM‐CSF and its role in the development and maintenance of leukaemia are still poorly defined. In vitro exposure of fresh leukaemic blast cells to a wide range of concentrations of GM‐CSF leads to a stimulation of cell proliferation in the majority of cases but does not induce any detectable maturation.Conclusions. Granulocyte‐macrophage colony stimulating factor may be used in the management of ANLL and the myelodysplastic syndrome (MDS) with the aim of: (i) accelerating the recovery of normal haemopoiesis; (ii) increasing cell killing by chemotherapy; and (iii) inducing cell maturation. Therefore the application of GM‐CSF can potentially improve treatment outcome in ANLL and is worth testing in a clinical setting.
Heterosexual transmission of hepatitis C virus and the possible role of coexistent human immunodeficiency virus infection in the index case: A multicentre study of 423 pairings
Authors: SOTO B. , RODRIGO L. , GARCIA‐BENGOECHEA M. , SANCHEZ‐QUIJANO A. , RIESTRA S. , ARENAS J. I. , ANDREU J. , RODRIGUEZ M. , EMPARANZA J. I. , TORRES Y. , NAVASCUÉS C. A. , CORTES A. , LISSEN E. 
Published: August 2009

Abstract. Objectives. To define the role that sexual transmission plays in the spread of hepatitis C virus (HCV) infection, and to examine the influence of coexistent human immunodeficiency virus (HIV) infection on this mode of transmission.Design. A multicentre, seroprevalence study of anti‐HCV performed in the stable heterosexual partners (SHP) of index cases reactive for anti‐HCV.Setting. Department of Internal Medicine and Section of Gastroenterology of three University Hospitals, Spain.Subjects. A total of 423 stable heterosexual partners of index cases reactive for anti‐HCV. This included a group of 142 intravenous drug users (IVDU), 120 of whom were coinfected with HIV. Additionally, 2886 first‐time voluntary blood donors selected at random were included to compare the prevalence of anti‐HCV.Main outcome measures. Serum samples were screened for anti‐HCV by a commercially available, second‐generation enzyme‐linked immunoassay. Tests repeatedly reactive for anti‐HCV were analysed by a four‐antigen, recombinant immunoblot assay. Anti‐HIV was tested by enzyme immunoassay and Western blot was used for confirmation of positive cases.Results. The prevalence of anti‐HCV, was 7.1% in SHP and 1.2% in random donors (P < 0.001). This prevalence was higher in SHP of index cases co‐infected with HIV in comparison with that shown in the SHP of index cases only reactive for the anti‐HCV (9.1 vs. 6.3%; P = 0.2), particularly when a younger and more homogeneous group such as the SHP of IVDU index cases was considered alone (9.2 vs. 0%; P = 0.1). However, the SHP of IVDU index cases coinfected with HIV were almost three times more likely to be infected with HIV than HCV (24.2 vs. 9.2%).Conclusions. These data suggest that HCV infection may be sexually transmitted but with low efficiency, and this could be increased in the presence of coexistent HIV infection in the index case.
The influence of thrombolytic therapy on the predictive value of exercise testing 3 weeks after acute myocardial infarction
Authors: ABBOUD L. , HIR J. , EISEN I. , MARKIEWICZ W. 
Published: August 2009

Abstract. Objectives. To evaluate the prognostic value of exercise testing performed soon after acute myocardial infarction (AMI) in patients treated with thrombolytic therapy.Design. A 1‐year prospective follow‐up of 185 subjects treated with thrombolytic therapy who survived AMI, and who performed exercise testing 3 weeks after AMI. These patients were compared with 272 patients not receiving thrombolytic therapy during the same period.Subjects. Patients recovering from AMI, without medical contraindications to exercise testing performed 3 weeks after AMI.Main outcome measures. ST‐segment deviations during exercise testing 3 weeks post‐AMI were related to clinical outcome 1‐year post‐AMI and to the administration of thrombolytic therapy during the acute phase of infarction.Results. In patients treated with thrombolytic therapy, the only exercise‐test‐related parameter predicting subsequent cardiac events was ST‐segment elevation. In contrast, patients not receiving thrombolytic therapy and demonstrating ST‐segment depression of ≥ 1 mm during exercise had more clinical cardiac events than those without this finding (12.3 vs. 3.9%; P < 0.05).Conclusion. This study casts doubt on the ability of exercise testing to select a high‐risk population requiring early intervention to prevent recurrent coronary events after thrombolysis for AMI.
Strong link between the alpha1‐antitrypsin PiZ allele and Wegener's granulomatosis
Authors: ELZOUKI A.‐N. Y. , SEGELMARK M. , WIESLANDER J. , ERIKSSON S. 
Published: August 2009

Abstract. Objectives. To ascertain whether a relationship exists between the PiZ alpha1‐antitrypsin (α1AT) variant and antineutrophil cytoplasm antibodies (ANCA)‐positive vasculitis in a large group of Swedish patients, and whether analysis for the presence of the PiZ variant might be useful for diagnostic or prognostic purposes.Design. Retrospective cross‐sectional study.Setting. The Department of Internal Medicine, Malmö General Hospital, and the Department of Nephrology, University of Lund, Sweden.Subjects and main outcome measures. Serum samples from 105 proteinase 3‐ANCA‐positive patients were analysed using an elisa with a monoclonal antibody specific for the PiZ‐gene product. Complete clinical data were retrieved for 84% (88/105) of the patients, for diagnosis and survival analysis.Results. We identified 17 heterozygotes and one homozygote (P < 0.0001). All 88 patients with available clinical data were considered to have some form of microscopic vasculitis including 66 (75%) diagnosed as having Wegener's granulomatosis (WG), of whom 15 (23%) were PiZ heterozygotes (odds ratio 6.0, 95% confidence interval 3–10). There were no significant differences between PiZ carriers and noncarriers in sex distribution, mean age at onset of disease, interval between onset and inclusion in the study, or in median duration of follow‐up (P > 0.2 for all comparisons). During follow‐up, 38% (6/16) of the PiZ heterozygotes died, compared with 17% (11/66) of noncarriers of the variant (P = 0.02), which suggests that PiZ heterozygosity may be a marker of poor prognosis. PiZ heterozygotes with systemic vasculitis would not appear to be identifiable by their pretreatment plasma α1AT concentrations, as all such patients in the present study had concentrations within or above the normal range.Conclusion. We conclude that heterozygotes for the PiZ variant of the α1AT gene are at greater risk of than the general population of developing WG. Knowledge of such a genetic factor may not only aid our understanding of the mechanism involved in this illness but may also serve as significant prognostic factor in following the course of the disease.
Abdominal aortic aneurysms and alpha1‐antitrypsin
Authors: ELZOUKI A.‐N. Y. , ERIKSSON S. 
Published: August 2009

Abdominal aortic aneurysms and alpha1‐antitrypsin deficiencyAbstract. The incidence of abdominal aortic aneurysms (AAAs) has been reported to be increased in heterozygous (PiMZ) and homozygous (PiZZ) alpha1‐antitrypsin (α1AT) deficiency. We report a further case of AAA in a PiSZ α1AT‐deficient female with primary biliary cirrhosis (PBC). Moreover, to assess the risk of AAA in patients with PiZZ α1AT deficiency, we conducted a retrospective study based on 30 consecutive autopsied adult cases of severe α1AT deficiency identified during the period 1963–1993 in the city of Malmö, Sweden, during which autopsies were performed in 49 548, or 58.4%, of all residents in the city who died. From the homozygote frequency in the general population, 50 of these would be expected to have α1AT deficiency. The disease had been diagnosed in 35, and autopsies had been performed in 30 adults. Each autopsied case was matched with four controls selected from the same autopsy register, and the Mantel‐Haenszel odds ratio (ORmh) was calculated. We found one case of AAA amongst the 30 PiZZ individuals autopsied, and one case amongst 120 autopsied controls (ORmh = 2.65, 95% confidence limits, 0.47–15.0; P = 0.273). We found no significant evidence of the relationship between AAA and the PiZZ polymorphism, although previously reported by others. At least in severe α1AT deficiency, any coexistence of the PiZZ phenotype and AAA would seem to be fortuitous.
Homocyst(e)ine and arterial occlusive diseases
Authors: MALINOW M. R. 
Published: August 2009

Abstract. Homocysteine is a thiol‐containing amino acid resulting from demethylation of methionine. The free and protein‐bound forms of the amino acid derived disulfides are called homocyst(e)ine [H(e)]. Multiple studies have shown elevated H(e) levels in patients with coronary, cerebrovascular, or peripheral arterial diseases; this association is frequent and independent of most other risk factors for atherosclerosis. In the 1993 Frontiers in Medicine Symposium* investigators discussed the genetic, physiological, nutritional, and pharmacological mechanisms involved in the regulation of plasma H(e), the association of H(e) with arterial occlusive diseases, and the relationships of H(e) with nitric oxide and haemostasis.High plasma H(e) levels usually can be reversed with vitamin supplements. Whether vitamin supplements will affect the evolution of arterial occlusive diseases needs to be established in prospective, placebo‐controlled, randomized, clinical trials.
Corticosteroids and peptic ulcer: meta‐analysis of adverse events during steroid therapy
Authors: CONN H. O. , POYNARD T. 
Published: August 2009

Abstract. Objectives. This meta‐analysis was performed to determine whether corticosteroid therapy induces the development of peptic ulcer and other putative complications of steroid therapy.Design. A retrospective investigation in which we analysed all the randomized, double‐blind, controlled trials (RDBCT) in which steroids had been administered that we were able to identify. The number of episodes of peptic ulcer, dermatological effects, sepsis, diabetes, hypertension, osteoporosis, psychosis and tuberculosis reported in both the placebo and steroid groups were compared.Setting. The international medical literature was analysed for any RDBCT in which any steroid or ACTH had been administered in any dosage for any duration, and any putative complication of steroid therapy was reported.Subjects. Of 1857 articles, 93 satisfied our requirements and were analysed by the meta‐analytic techniques of Peto, DerSimonian and Laird. A total of 6602 patients were included.Main outcome measures. The relative frequencies of each of these eight ‘complications’ were compared in the placebo and steroid groups using conventional statistics and meta‐analysis. The relative frequencies of ‘annualized’ subgroups of patients who received treatment for 1 to 7 days, 1 week to 1 month, 1 to 3 months and more than 3 months, were similarly analysed.Results. Nine of 3267 patients in the placebo group (0.3%) and 13 of 3335 patients in the steroid group (0.4%) were reported to develop peptic ulcer (P < 0.05). The dermatological cosmetic effects of steroid therapy were observed more frequently in the steroid group (P < 0.001), as was diabetes (P < 0.001), hypertension (P < 0.001) and psychosis (P < 0.001). Sepsis, osteoporosis and tuberculosis all occurred more frequently in the steroid than in the placebo group, but the differences are not statistically significant.Conclusions. Peptic ulcer is a rare complication of corticosteroid therapy that should not be considered a contraindication when steroid therapy is indicated.
Prognosis in therapy‐resistant hypertension
Authors: ISAKSSON H. , ÖSTERGREN J. 
Published: August 2009

Abstract.Objectives.To study the prognosis in therapy‐resistant hypertension (RH).Design.Patients with RH and age‐ and sex‐matched responding hypertensives, were followed‐up for a period of 7 years.Setting.All subjects were outpatients at a secondary referral centre for hypertension.Subjects.(i) Age ≤ 65 years; (ii) no prior diagnosis of secondary hypertension; (iii) on antihypertensive triple‐drug therapy of optimal dosage; (iv) diastolic blood pressure remaining 5 mmHg above their (age‐related) target pressure; (v) no history of renal failure, heart failure, stroke or myocardial infarction; and (vi) no record of noncompliance. A total of 800 patients were screened. Thirty‐six were finally included. For each study patient, two control patients were randomly selected.Interventions.Continuous efforts to optimize blood pressure control were made in all patients.Main outcome measures.Transient ischaemic attack or stroke, myocardial infarction, congestive heart failure, renal failure, and death. Development of non‐insulin‐dependent diabetes mellitus (NIDDM).Results.At the end of the follow‐up period, RH had a casual functional blood pressure 21/6 mmHg higher than the control hypertensives. RH exhibited an increased incidence of stroke (P< 0.05), renal insufficiency (P< 0.05) and NIDDM (P< 0.05). RH patients had an increased risk of suffering an event during the 7 years [odds ratio (OR) 2.71;P< 0.05].Conclusions.Resistance to antihypertensive therapy may persist even when therapy is aggressively applied in compliant patients. RH is associated to an increased risk of stroke and of target organ damage, foremost renal insufficiency. The apparent association between RH, obesity and NIDDM may imply that hyperinsulinaemia is involved in therapy resistance.
Treatment preferences, return visit planning and factors affecting hypertension practice amongst general practitioners and internal medicine specialists (The General Practitioner Hypertension Practice Study)
Authors: RIBACKE MATS 
Published: August 2009

Abstract. Objectives. To study clinical practice and attitudes in hypertension care amongst general practitioners (GPs) and hospital internal medicine specialists.Design. Mailed case report questionnaires.Subjects. Ninety GPs and 69 internal medicine specialists at randomly selected primary health care centres and hospital outpatient departments.Main outcome measures. Case‐bound treatment preferences, treatment goals and return visit planning, and views on factors influencing practice.Results. The participation rate was 84% and 70%, for GPs and internal medicine specialists, respectively. GPs more often proposed nonpharmacological therapy (P < 0.05), solely and as a complementary treatment, and prescribed more calcium antagonists (P < 0.001), whilst internal medicine specialists prescribed more ACE inhibitors (P < 0.001). Personal experience guides practice more than national consensus and economy, more so with increasing time since specialization.Conclusions. GPs and internal medicine specialists in Sweden report a hypertension practice closely related to each others' and to the intentions of national guidelines.