bluuebunny/crossref_metadata_2025_split huggingface dataset:
Health, health care utilization and living conditions in foreign‐born diabetic patients in southern Sweden
Authors: Hjelm K. , ApelqVist J. , Nyberg P. , Sundquist J. , Isacsson Å. 
Published: November 2003

Hjelm K, Apelqvist J, Nyberg P, Sundquist J, Isacsson Å (Department of Community Health Sciences Dalby/Lund, University of Lund, Sweden, and Department of Internal Medicine, Lund University Hospital, Sweden). Health, health care utilization and living conditions in foreign‐born diabetic patients in southern Sweden. J Intern Med 1997; 242: 131–41.ObjectivesTo compare foreign‐ and Swedish‐born diabetic subjects regarding health care utilization, complications, clinical and socio‐economic characteristics.DesignCross‐sectional study.SettingAll known diabetic patients living in six defined primary health care districts.SubjectsOf 1861 identified subjects aged >25 years 90.1%, 113 foreign‐ and 1564 Swedish‐born subjects participated. Mean time of residence in Sweden was 32 ± 1.2 years, 93% >10 years.Main outcome measuresA standardized interview, a physical examination and an evaluation of medical records.ResultsNo differences were found regarding living conditions or health care utilization, with the exception of higher use of home‐care from public authorities in Swedish‐born subjects (P < 0.05) despite no difference in dependency on help according to Katz's ADL index. There were no major differences in objective health (glycaemic control and complications related to diabetes) with the exception of lower frequency of sensory neuropathy (P < 0.01) and peripheral vascular disease (P < 0.05) in foreign‐born subjects. The prevalence of diabetes was 2.1% (95% CI 1.7–2.5) in the foreign‐born and 2.6 % (95% CI 2.5–2.7) in Swedes. Foreign‐born individuals were five years younger (P < 0.001), were more often diagnosed ≥30 years (P < 0.05), had a two years' shorter duration of disease (P < 0.001) and were less often treated with insulin (P < 0.01). Treatment with insulin was related to the duration and presence of complications related to diabetes.ConclusionsThere were no major differences in objective health or use of health care in European migrants with diabetes mellitus, mainly Scandinavians, with short cultural distance and long residence in Sweden compared to Swedish‐born diabetic patients.
Chronic work stress is associated with atherogenic lipids and elevated fibrinogen in middle‐aged men
Authors: SIEGRIST J. , PETER R. , CREMER P. , SEIDEL D. 
Published: November 2003

Siegrist J, Peter R, Cremer P, Seidel D. (University of Düsseldorf and Ludwig Maximilians University of Munich, Germany). Chronic work stress is associated with atherogenic lipids and elevated fibrinogen in middle‐aged men. J Intern Med 1997; 242: 149–56.ObjectivesTo examine the association between a model of chronic work stress (high efforts in combination with low rewards) and two risk factors of coronary heart disease, low‐density‐lipoprotein (LDL)‐cholesterol and fibrinogen.DesignA cross‐sectional study in a group of 179 healthy middle‐aged (48.5 ± 4.5) male middle managers.SettingA large car‐producing enterprise in Germany.ResultsAfter adjustment for relevant covariates, logistic regression analysis showed independent effects of a composite measure of high effort and low reward at work on the prevalence of elevated (upper tertile, i.e. ≥160 mg dL−1) LDL‐cholesterol (prevalence odds ratio (POR) = 3.57; 95% confidence intervals (CI): 1.24‐10.20) and on elevated (upper quintile, i.e. ≥420 mg dL−1) plasma fibrinogen (POR = 6.71 (CI: 1.57‐28.76). Apart from this core measure, cigarette smoking, overweight and alcohol consumption were the covariates with the relatively strongest contributions to the multivariate model.ConclusionsResults give preliminary evidence on an independent association of chronic work stress with atherogenic lipids and with elevated fibrinogen in an occupationally homogeneous group of healthy middle‐aged men.
Hyaluronan in joint disease
Authors: Engström‐Laurent A. 
Published: November 2003

Engström‐Laurent A (University of Umeå, Umeå, Sweden). Hyaluronan in joint disease (Minisymposium: Hyaluronan). J Intern Med 1997; 242: 57–60.Hyaluronan is a major component of synovial fluid. It is synthesized in the joint and partly degraded in joint capsule and partly carried by lymph to lymph nodes and the general circulation. During various joint disorders, especially inflammatory ones, the amount of hyaluronan in the joint and its turnover rate are increased leading to pathologically high serum levels of the polysaccharide. These levels are a complex function of synovitis mass and the physical activity of the patient. Intra‐articular injection of hyaluronan has been used in the treatment of osteoarthritis. Although it results in a relief of pain, controlled clinical trials have not yet convincingly shown any beneficiary effects of the treatment.
Hyaluronan turnover in relation to infection and sepsis
Authors: BERG S. 
Published: November 2003

Abstract. Berg S (University Hospital, Linköping, Sweden). Hyaluronan turnover in relation to infection and sepsis (Minisymposium: Hyaluronan). J Intern Med 1997; 242: 73–7.Sepsis is a major clinical problem in intensive care. The mortality in septic shock is high, and predominantly due to cardiovascular collapse and multiple organ dysfunction. In sepsis high levels of circulating hyaluronan have been found, correlating to disease severity and prognosis. The reason behind the increased levels could be both decreased hepatic uptake and increased peripheral synthesis. Thus, plasma hyaluronan may be a clinically useful marker of hepatic dysfunction and possibly also an indicator of the increased inflammatory and reparative activity in different organs in septic conditions.
Protection against cardiovascular collapse in an alcoholic patient with thiamine deficiency by concomitant alcoholic ketoacidosis
Authors: BAKKER S. J. L. , MAATEN J. C. TER , HOORNTJE S. J. , GANS R. O. B. 
Published: November 2003

Bakker SJL, ter Maaten JC, Hoorntje SJ, Gans ROB (University Hospital Vrije Universiteit, Amsterdam, and Catharina Hospital, Eindhoven, The Netherlands). Protection against cardiovascular collapse in an alcoholic patient with thiamine deficiency by concomitant alcoholic ketoacidosis (Case report). J Intern Med 1997; 242: 179–83.Hyperlactataemia due to thiamine deficiency has so far only been reported in the setting of full‐blown cardiovascular beriberi with congestive heart failure and systemic vasodilatation. Poor tissue oxygenation and impaired lactate clearance by the liver are generally accepted as underlying causes of the elevated lactate levels. We present an alcoholic patient with thiamine deficiency‐induced hyperlactataemia and accompanying alcoholic ketoacidosis, who did not display the circulatory disturbances that are characteristic of cardiovascular beriberi. The hypothesis will be presented that the concomitant presence of alcoholic ketoacidosis has prevented haemodynamic deterioration. Putative mechanisms that could explain such an effect are discussed in detail, with special reference to the role of acetyl‐CoA and adenosine.
Bambuterol raises high‐density lipoprotein levels in patients with hyperlipidaemia
Authors: FLORÉN C. H. , KJELLSTRÖM T. , BAUER C. A. 
Published: November 2003

Abstract. Florén CH, Kjellström T, Bauer CA (Department of Medicine, Malmö University Hospital, Malmö, Sweden and Astra Draco AB, Lund, Sweden). Bambuterol raises high‐density lipoprotein levels in patients with hyperlipidaemia. J Intern Med 1997; 242: 167–71.ObjectiveThe objective of this study was to investigate the effects of bambuterol (a prodrug of the β2‐agonist terbutaline) on lipid and lipoprotein levels in patients with hyperlipidaemia. Both these drugs are extensively used in the treatment of patients with bronchial asthma. Earlier studies in healthy volunteers and in patients with noninsulin dependent diabetes mellitus have shown that terbutaline and bambuterol increase HDL cholesterol levels, and therefore bambuterol might have beneficial effects on HDL levels in patients with hyperlipidaemia.DesignThe present study was a randomized, double‐blind, crossover study, comparing 20 mg of bambuterol with placebo, each one given for 6‐8 weeks with a 3‐4 week washout period in between.SettingThe study was performed in an out‐patient lipid clinic at Malmö University Hospital.SubjectsThirty‐one patients with hyperlipidaemia (S‐cholesterol >6.5 mmol L−1 and S‐triglycerides >2.0 mmol L−1) were included.Main outcome measurements and resultsThe results showed that bambuterol increased S‐HDL cholesterol levels by 7% (P= 0.012). Increases were 23% for P‐HDL2 and 7% for P‐HDL3 fractions, but no effect was apparent on S‐apolipoprotein A‐1 levels.ConclusionThis study suggests that the β2‐agonist bambuterol might be used as an alternative or as a complement in the treatment of dyslipidemic patients, when an increase in HDL cholesterol is desired.
Large phlebotomy in variegate porphyria
Authors: HARPER P. , HYBINETTE T. , THUNELL S. 
Published: November 2003

Harper P, Hybinette T, Thunell S (Porphyria Centre Sweden, Karolinska Institute, Stockholm and the Department of Internal Medicine, Regional Hospital Kalmar, Sweden). Large phlebotomy in variegate porphyria (Case report). J Intern Med 1997; 242: 255–9.There are no reports on effects of large blood losses in acute hepatic porphyria. In the present study we report the experiences of repeated large therapeutic phlebotomies in a patient with porphyria cutanea tarda coexisting with variegate porphyria. Neither a series of 12 phlebotomies, 300 mL each, resulting in a 17% decrease in blood haemoglobin, nor a single 400 mL phlebotomy activated the acute porphyric condition. It is concluded that the increased bone marrow metabolic throughput resulting from blood loss, in acute types of porphyria does not overload the normoblast or leukocyte precursor haem synthetic pathways in a way which will increase porphyrin precursor excretion or trigger acute porphyric symptoms.
Guidelines and reported practice for the treatment of hypertension and hypercholesterolaemia
Authors: Troein M. , Gardell B. , Selander S. , Råstam L. 
Published: November 2003

Troein M, Gardell B, Selander S, Råstam L (Department of Community Medicine, Lund University, Malmö, and Stockholm Institute of Education, Stockholm, Sweden). Guidelines and reported practice for the treatment of hypertension and hypercholesterolaemia. J Intern Med 1997; 242: 173–8.Objective.To monitor changes in family physicians' reported practice on hypertension and hypercholesterolaemia.Design.Random samples of physicians were selected for telephone interviews on their practice regarding cut‐off levels and pharmacological treatment of hypertension and hypercholesterolaemia, related to a case scenario of a 48‐year‐old man, in 1989, 1991 and 1993.SettingPrimary care facilities in southern Sweden.SubjectsSpecialists in family medicine, employed in public primary health care. Participation rates were in 187/201 (93%) in 1989, 236/264 (89%) in 1991 and 257/298 (86%) in 1993.Main outcome measuresCut‐off levels and drug treatment preferences for hypertension and hypercholesterolaemia.ResultsDuring the period 1989–1993, decreasing mean cut‐off levels for pharmacological treatment of hypertension (P < 0.001) were reported, below the levels of the guidelines. Although betablockers were first choice drug in all three surveys, the proportion preferring this has diminished (P < 0.001), whilst the proportions preferring ACE‐inhibitors and calcium channel blockers have increased (P < 0.001 and P= 0.02, respectively). For drug treatment of hypercholesterolaemia, the mean cut‐off level remained close to guidelines in all three surveys. The proportion of physicians suggesting resins and nicotinic acid as first choice drug had decreased (P < 0.001 and P= 0.03, respectively), whilst the proportion preferring statins and fibrates had increased (P < 0.001 and P= 0.048, respectively).Conclusion.Practice guidelines on hypertension and hypercholesterolaemia have not had the desired impact on physicians' reported practice. The reason for this might be that physicians did not value the guidelines as adequate tools for practice, or that the methods for dissemination, implementation, and maintenance of guidelines were not appropriate.
Brain natriuretic peptide in an elderly population
Authors: Wallén T. , Landahl S. , Hedner T. , Saito Y. , Masuda I. , Nakao K. 
Published: November 2003

Wallén T, Landahl S, Hedner T, Saito Y, Masuda I, Nakao K (Vasa Hospital and Sahlgrenska Hospital, Göteborg University, Sweden; and Kyoto University School of Medicine, Japan). Brain natriuretic peptide in an elderly population. J Intern Med 1997; 242: 307–11.ObjectivesTo study the relationship of brain natriuretic peptide concentrations to ageing, and whether brain natriuretic peptide could reflect current disease states in the general elderly population.DesignBrain natriuretic peptide was measured in two population samples from the general population.SubjectsFive hundred forty‐five 85‐year‐old subjects from the longitudinal population study ‘70‐year‐old people in Gothenburg, Sweden’ were investigated in respect to cardiovascular, renal and metabolic disease, and 191 subjects from the 40‐year‐old male population were examined.Main outcome measuresTo study the influence of ageing on circulating brain natriuretic peptide and the association between concentrations of brain natriuretic peptide and common disease states in the elderly.ResultsBrain natriuretic peptide concentrations were significantly increased in relation to ageing (P < 0.001). Brain natriuretic peptide concentrations were significantly increased in elderly with congestive heart failure (P < 0.001), ischaemic heart disease (P < 0.001), atrial fibrillation (P < 0.001) and renal dysfunction (P < 0.001) but not in hypertension. In multivariate analysis, brain natriuretic peptide concentrations were predictive for ischaemic heart disease (P < 0.001), atrial fibrillation (P < 0.01), renal dysfunction (P < 0.01), congestive heart failure (P < 0.05) and treatment with β‐adrenergic blockers (P < 0.05).ConclusionsPlasma concentrations of brain natriuretic peptide are increased in healthy elderly compared to middle‐aged individuals. In the elderly, measurements of brain natriuretic peptide may provide prognostic information, due to the augmented secretion in cardiovascular diseases commonly seen in this population. It remains to be determined whether routine measurements of circulating brain natriuretic peptide will be of value in predicting current cardiovascular disease for the individual patient.
Erythromelalgia: a clinical study of 87 cases
Authors: KALGAARD O. M. , SEEM E. , KVERNEBO K. 
Published: November 2003

Abstract. Kalgaard OM, Seem E, Kvernebo K (Ullevaal Hospital, Oslo, Norway). Erythromelalgia: a clinical study of 87 cases. J Intern Med 1997; 242: 191–7.We report on aetiological factors, clinical findings and prognosis of 87 patients with erythromelalgia (EM). This is the largest material reported in the western literature. There is a 100% follow up of patients with observation period up to 11 years. There were 61 females and 26 males. About two‐thirds of the patients were primary cases and around three‐quarters had a chronic condition. The condition was more common in lower than in upper extremities. Over time patients with erythromelalgic syndrome gradually get worse, those with primary and secondary acute EM get better, whilst primary and secondary chronic EM remain stable.
Heart failure ketosis
Authors: Lommi J. , Koskinen P. , Näveri H. , Härkönen M. , Kupari M. 
Published: November 2003

Lommi J, Koskinen P, Näveri M, Härkönen M, Kupari M (Helsinki University Central Hospital, Helsinki, Finland). Heart failure ketosis. J Intern Med 1997; 242: 231–8.ObjectiveTo assess whether blood ketone bodies are increased in congestive heart failure (CHF).MethodsThirteen patients with CHF and 11 cardiac patients without CHF took part in the study. Blood acetoacetate and b–hydroxybutyrate levels and the pertinent metabolic and hormonal milieu were measured during 20 h fast and after 2 h glucose infusion.ResultsThe averaged blood ketone body and free fatty acid levels were significantly higher during the fast and also remained higher after glucose infusion in patients with CHF than in the control group. The areas under ketone body concentration time curve over the last 8 h of the fast were 3522 ± 662 μmol L−1 h−1 (SE) and 1789 ± 192 μmol L−1 h−1 in patients with and without CHF, respectively (P = 0.022). Circulating noradrenaline and growth hormone were higher but glucagon lower in patients with CHF than in the controls (P < 0.05 for all differences) whereas the glucose and insulin concentrations were comparable in the study groups. At the time of peak ketonaemia, the glucagon‐to‐insulin ratio was lower in patients with CHF than in patients without CHF (P = 0.04).ConclusionsThese data suggest that severe CHF is a ketosis‐prone state. Augmented supply of free fatty acids for ketogenesis due to increased stress hormone‐related lipolysis is one likely mechanism.
Bradydysrhythmia‐related presyncope secondary to pheochromocytoma
Authors: Zweiker R. , Tiemann M. , Eber B. , Schumacher M. , Fruhwald F.M. , Lipp R. , Lax S. , Pristautz H. , Klein W. 
Published: November 2003

Zweiker R, Tiemann M, Eber B, Schumacher M, Fruhwald FM, Lipp R, Lax S, Pristautz H, Klein W (University of Graz and Hospital of Wagna, Austria). Bradydysrhythmia‐related presyncope secondary to pheochromocytoma (Case report). J Intern Med 1997; 242: 249–53.Pheochromocytoma endures as a life‐threatening disorder. In the absence of systemic hypertension, diagnosis may be difficult. We present a 46‐year‐old normotensive male with a history of presyncope. One of these episodes could be documented, and revealed symptomatic bradycardia suspicious of sinus node arrest. Due to hints of an elevated sympathetic tone (Schellong test, circadian blood pressure pattern without diurnal rhythm) 24‐h urinary catecholamine concentrations were measured and found increased. MIBG‐scintigraphy and abdominal‐ computed tomography indicated the location of the pheochromocytoma. After removal of the tumour, no further episodes of presyncopes or bradydysrhythmias were observed.
Schizophrenic symptoms and SPECT abnormalities in a coeliac patient: regression after a gluten‐free diet
Authors: DE SANTIS A. , ADDOLORATO G. , ROMITO A. , CAPUTO S. , GIORDANO A. , GAMBASSI G. , TARANTO C. , MANNA R. , GASBARRINI G. 
Published: November 2003

De Santis A, Addolorato G, Romito A, Caputo S, Giordano A, Gambassi G, Taranto C, Manna R, Gasbarrini G (Catholic University, Rome, Italy). Schizophrenic symptoms and SPECT abnormalities in a coeliac patient: regression after a gluten‐free diet (Case Report). J Intern Med 1997; 242: 421–23.A 33‐year‐old patient, with pre‐existing diagnosis of ‘schizophrenic’ disorder, came to our observation for severe diarrhoea and weight loss. Use of single photon emission computed tomography, (99mTc)HMPAO SPECT, demonstrated hypoperfusion of the left frontal brain area, without evidence of structural cerebral abnormalities. Jejunal biopsy showed villous atrophy. Antiendomysial antibodies were present. A gluten‐free diet was started, resulting in a disappearence of psychiatric symptoms, and normalization of histological duodenal findings and of (99mTc)HMPAO SPECT pattern. This is the first case in which, in an undiagnosed and untreated coeliac patient with psychiatric manifestations, the (99mTc)HMPAO SPECT demonstrated a dysfunction of frontal cortex disappearing after a gluten‐free diet.
Low circulating leptin levels in protein‐energy malnourished chronically ill elderly patients
Authors: Cederholm T. , Arner P. , Palmblad J. 
Published: November 2003

Cederholm T, Arner P, Palmblad J (Karolinska Institute at the Centre for Inflammation & Hematology Research, and Huddinge University Hospital, Huddinge, Sweden). Low circulating leptin levels in protein‐energy malnourished chronically ill elderly patients. J Intern Med 1997; 242: 377–82.ObjectiveTo evaluate serum leptin, a fat cell‐derived protein, levels in relation to the malnutrition often observed in chronic disease.DesignA comparison of circulating leptin concentrations in malnourished chronically ill elderly and in age‐matched controls.SettingA university‐affiliated teaching hospital in Stockholm, Sweden.SubjectsNineteen protein–energy malnourished elderly patients (74 ± 1 years) with various chronic nonmalignant diseases and 18 healthy controls (72 ± 1 years).Main outcome measuresSerum leptin levels measured by radioimmunoassay technique, nutritional status as expressed by body mass index (kg m−2), triceps skin fold, arm muscle circumference and serum albumin, and serum orosomucoid concentrations indicating inflammatory status.ResultsPatients and controls displayed body mass indexes of 17.4 ± 0.7 and 25.0 ± 1.1 (P < 0.001), respectively. Triceps skin fold (TSF) measurements revealed a pronounced fat depletion in the patients, being 8.5 ± 0.9 and 22.3 ± 1.5 mm (P < 0.001) in female and 6.1 ± 0.7 and 10.8 ± 0.8 mm (P < 0.001) in male patients and controls, respectively. Patient serum leptin concentrations were less than half of the corresponding concentrations in the controls, 4.3 ± 1.1 and 9.3 ± 1.3 ng mL−1 (P < 0.01), respectively. The highest leptin concentrations were registered in female controls, 12.1 ± 1.6 ng mL−1. The serum leptin levels in the controls correlated with TSF (r= 0.74; P < 0.001). No such correlation was found in the patients.ConclusionsSerum leptin levels were low and did not seem to be directly associated with fat and muscle depletion in elderly patients with chronic illness, whereas they appeared to be positively correlated to body fat in healthy elderly.
The effects of thromboxane A2 inhibition (Picotamide) and angiotensin II receptor blockade (Losartan) in primary Raynaud's phenomenon
Authors: Pancera P. , Sansone S. , Secchi S. , Covi G. , Lechi A. 
Published: November 2003

Pancera P, Sansone S, Secchi S, Covi G, Lechi A (University of Verona, Verona, Italy). The effects of thromboxane A2 inhibition (Picotamide) and angiotensin II receptor blockade (Losartan) in primary Raynaud's phenomenon. J Intern Med 1997; 242: 373–6.ObjectivesTo assess the role of thromboxane A2 and of angiotensin II in patients with primary Raynaud's phenomenon.DesignAfter an eight‐day run‐in period, the patients were enrolled in a single‐blind, cross‐over, study.SettingPatients were examined at the Ambulatory for Microcirculatory Diseases of the Clinic of Internal Medicine, University Hospital, Verona.SubjectsFifteen subjects affected by primary Raynaud's phenomenon were included.Main outcome measuresA piezoelectric plethysmography to evaluate the distensibility of the digital arteries as the ratio between peak time (PT) and total time (TT), and an oscillometric blood pressure recorder were used after the run‐in period, and after a two‐week course of picotamide (300 mg b.i.d., i.e. two times daily) or losartan (12.5 mg once daily) with an interval of a week of placebo between the active treatments. The tests were performed after every treatment in basal condition and during mental stress. The patients reported in a diary the number and the severity (from 0 to 4 +) of the vasospastic crises.ResultsThe change in TP/TT ratio appeared statistically significant only after losartan treatment, both in basal condition and during mathematical stress. Both pharmacological treatments, with respect to placebo, showed an improvement of the scores, derived from the number and severity of vasospastic attacks, but only the therapy with losartan determined a statistically significant improvement.ConclusionsThe inhibition of the type 1 receptor for angiotensin II seems highly effective in the reduction of the vasospastic crises in the subjects with primary Raynaud's phenomenon. According to our experience, losartan could be used more extensively in the treatment of these patients besides arterial hypertension.