bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prediction of five‐year survival for patients admitted to a department of internal medicine
Authors: Eriksen B. O. , Kristiansen I. S. , Pape J. FR. 
Published: March 2003

Abstract. Eriksen BO, Kristiansen IS, Pape JFr (University Hospital of Tromsø and University of Tromsø, Tromsø, Norway). Prediction of five‐year survival for patients admitted to a department of internal medicine. J Intern Med 2001; 250: 435–440. Objective. The effect of many common forms of therapy, as medication for mild hypertension or hypercholesterolaemia, only reaches clinical significance after years of treatment. The meaningful application of such therapy presupposes that physicians can, at least to some extent, predict the remaining lifetime of patients. We investigated whether clinicians from different disciplines were able to predict the 5‐year survival of patients admitted to a department of internal medicine. Design. The members of two groups, each consisting of an internist, a surgeon and a general practitioner, made individual predictions of the expected remaining lifetime of discharged patients from written summaries of clinical information. Each patient was randomized to be assessed by the members of either of the two groups. The predictions were compared with actual 5‐year survival. Setting. Department of internal medicine at a university hospital. Subjects. Patients admitted consecutively during a 6‐week period. Main outcome measures. Sensitivity, specificity, positive and negative predictive values and areas under the receiver operating characteristic (ROC) curves for predictions of 5‐y ear survival for each of the six experts. Results. A total of 402 patients were included. Five‐year survival was 0.63. The sensitivity of the predictions ranged from 0.81 to 0.95, the specificity from 0.61 to 0.77, the positive predictive value from 0.78 to 0.87 and the negative predictive value from 0.68 to 0.87. The areas under the ROC curves ranged from 0.84 to 0.91. Conclusion. The quality of predictions of 5‐year survival made by experienced clinicians should permit the rational use of treatments with long‐term effects.
Parental age and coronary disease in the general male population
Authors: Rosengren A. , Thelle D. , Wilhelmsen L. 
Published: March 2003

Abstract. Rosengren A, Thelle D, Wilhelmsen L (Sahlgrenska University Hospital, Östra; and Göteborg University, Göteborg, Sweden). Parental age and coronary disease in the general male population. J Intern Med 2002; 251: 258–267. Objective. To investigate the role of achieved age in father or mother for long‐term prognosis in men with respect to fatal and nonfatal coronary events, and mortality from cardiovascular disease, cancer, and all causes. Design. Prospective follow‐up study. Setting. City of Göteborg, Sweden. Subjects. A total of 6242 men aged 51–59 out of 7100 men who took part in the second screening of the Primary Prevention Study in 1974–77 and who had stated the age of both mother and father at death, or their current age, if they were still alive. Main outcome measures. Fatal and nonfatal coronary events, and mortality from cardiovascular disease, cancer, and all causes during follow‐up until 1996. Results. Of the men (n=2135) whose father had died before the age of 70, 8.4 per 1000 observation years died from coronary disease during follow‐up. Coronary mortality decreased continuously with increasing age in the father and in those whose father had achieved an age of 90 or more 3.2 per 1000 years died [hazard ratio (HR) after adjustment for coronary risk factors, socio‐economic status, and history of myocardial infarction in either parent, 0.41 (95% CI 0.23–0.73; P for trend <0.0001)]. This was reflected in reduced risk of mortality from any cause (P for trend after adjustment 0.003). No association with cancer death was found. With respect to hospitalization for myocardial infarction men whose father had survived to at least 90 had an adjusted HR of 0.60 (0.40–0.89) compared with men whose father died before 70 (P for trend 0.0006). The effect of achieved age in the mother was weaker and after adjustment trends were weakly significant for death from cardiovascular and all causes (P=0.01 and 0.03, respectively), but not for any other end‐point. Conclusion. Paternal, but not maternal, longevity appears to protect against coronary disease, by mechanisms that are largely unknown.
A rapid increase in β‐cell function by multiple insulin injections in type 2 diabetic patients is not further enhanced by prolonging treatment
Authors: KÄRVESTEDT L. , ANDERSSON G. , EFENDIC S. , GRILL V. 
Published: March 2003

Abstract. Kärvestedt L, Andersson G, Efendic S, Grill V (Stockholm's Sjukhem Foundation; and Karolinska Hospital, Stockholm, Sweden). A rapid increase in β‐cell function by multiple insulin injections in type 2 diabetic patients is not further enhanced by prolonging treatment.J Intern Med2002;251:307–316.Objective. Intensive insulin treatment in type 2 diabetes can improve β‐cell function. It is not known which duration of treatment achieves maximal improvement. We addressed this question in type 2 diabetic patients who displayed features of `secondary failure'.Research design and method. Ten patients were randomized to multiple insulin injection (MI) therapy for 9 weeks. Another 10 patients started with bedtime insulin (BTI) and continued their peroral medication. Following 9 weeks of treatment, patients on MI switched to BTI and glibenclamide.Results. Three days of MI led to a decrease in fasting proinsulin/insulin ratio, 0.43 ± 0.20 vs. 0.29 ± 0.11,P=0.01 and an increase in glucagon‐stimulated C‐peptide over baseline, 0.77 ± 0.43 vs. 1.28 ± 0.44 nmol L–1,P 0.02. Nine weeks of MI treatment successively decreased fasting and nonfasting blood glucose in parallel with increasing insulin dosage. Initial improvements in secretion parameters were upheld but not further enhanced, the 9 week proinsulin/insulin ratio being 99 ± 23% and that of glucagon‐stimulated C‐peptide being 95 ± 24% of the values obtained after 3 days of treatment. Eight weeks after termination of MI there persisted a total weight gain that tended to be larger than after continuous peroral medication with BTI.Conclusion. Improvement of insulin secretion by intensive insulin treatment is rapidly gained with no further effect obtained after a longer treatment period. This finding, as well as undesirable effects of MI on body weight, argues against prolonged MI treatment as a prelude to other therapeutic regimens in type 2 diabetic patients.
Antioxidant vitamins in the prevention of cardiovascular disease: a systematic review
Authors: ASPLUND K. 
Published: March 2003

Abstract. Asplund K (Umeå and Stockholm, Sweden). Antioxidant vitamins in the prevention of cardiovascular disease: a systematic review (Review). J Intern Med 2002; 251: 372–392.Do antioxidant vitamins, in regular food or as food supplements, protect against myocardial infarction and stroke? In this systematic literature review on the effects of antioxidant vitamins in the primary prevention of cardiovascular disorders, studies with ischaemic heart disease, stroke or combined cardiovascular events as end‐points have been included. Studies on the effects of antioxidant vitamins on intermediary end‐points (such as blood lipids and blood pressure) and as secondary prevention in patients with manifest cardiovascular disease are reviewed in a conventional manner.In observational studies (case–control or cohort design), people with high intake of antioxidant vitamins by regular diet or as food supplements generally have a lower risk of myocardial infarction and stroke than people who are low‐consumers of antioxidant vitamins. The associations in observation studies have been shown for carotene, ascorbic acid as well as tocopherol. In randomized controlled trials, however, antioxidant vitamins as food supplements have no beneficial effects in the primary prevention of myocardial infarction and stroke. Serious adverse events have been reported. After an initial enthusiasm for antioxidants in the secondary prevention of cardiovascular disease, recent reports from of several large randomized trials have failed to show any beneficial effects.Thus, the apparent beneficial results of high intake of antioxidant vitamins reported in observational studies have not been confirmed in large randomized trials. The discrepancy between different types of studies is probably explained by the fact that supplement use is a component in a cluster of healthy behaviour. Antioxidant vitamins as food supplements cannot be recommended in the primary or secondary prevention against cardiovascular disease.
A family with IgA nephropathy and hereditary lymphoedema praecox
Authors: USTA M. , DILEK K. , ERSOY A. , ALPER E. , ÖZBEK S. , ÖZDEMIR B. , FILIZ G. , YAVUZ M. , GÜLLÜLÜ M. , YURTKURAN M. 
Published: March 2003

Abstract. Usta M, Dilek K, Ersoy A, Alper E, Özbek S, Özdemir B, Filiz G, Yavuz M, Güllülü M, Yurtkuran M (Uludağ University Medical School, Bursa, Turkey). A family with IgA nephropathy and hereditary lymphoedema praecox (Case Report). J Intern Med 2002; 251: 447–451.Immunoglobulin A (IgA) nephropathy is the most common primary glomerulonephritis worldwide. The pathogenesis is still unknown and treatment has not yet been established. Rarely it can be associated with other disorders. Its association with hereditary lymphoedema is not reported before. We report four patients, a 60‐year‐old father, his two sons and his daughter, with hereditary lymphoedema. The family had nine members and in four of them lymphoedema was evident. The other members had neither lymphoedema nor IgA nephropathy. This is the first report of IgA nephropathy in association with hereditary lymphoedema.
Carotid artery intima‐media thickness and brachial artery flow‐mediated vasodilation in asymptomatic Japanese male subjects amongst apolipoprotein E phenotypes
Authors: Haraki T. , Takegoshi T. , Kitoh C. , Wakasugi T. , Saga T. , Hirai J.‐I. , Aoyama T. , Inazu A. , Mabuchi H. 
Published: March 2003

Abstract. Haraki T, Takegoshi T, Kitoh C, Wakasugi T, Saga T, Hirai J‐I, Aoyama T, Inazu A, Mabuchi H (Fukui Prefectural Hospital, Fukui; Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan). Carotid artery intima‐media thickness and brachial artery flow‐ mediated vasodilation in asymptomatic Japanese male subjects amongst apolipoprotein E phenotypes. J Intern Med 2002; 252: 114–120. Background. Epidemiological studies suggest that apolipoprotein E (apoE) polymorphism influences plasma lipoprotein levels and the development of cardiovascular disease. Objective. To clarify the role of apoE polymorphism as a risk factor for early atherosclerosis. Design. Using a high‐resolution ultrasound method, we investigated the association between apoE phenotypes, carotid intima‐media thickness (CCA‐IMT), and flow‐mediated dilation in the brachial artery (brachial‐FMD) in 96 healthy asymptomatic Japanese men (mean ± SD age, 50 ± 8 years). Results. Serum cholesterol and LDL‐cholesterol levels in subjects with E3E4 were highest and those with E2E3 were lowest (P < 0.05 and P < 0.05, respectively). The CCA‐IMT in E3E4 subjects (0.76 ± 0.17 mm) was greater than that in E2E3 and E3E3 (0.61 ± 0.15 and 0.64 ± 0.14 mm, respectively; P < 0.01). In contrast, there was no difference between brachial‐FMD and apoE phenotypes (P=0.15). By univariate analysis, CCA‐IMT was positively correlated with age (r=0.51, P < 0.01), LDL‐chol/HDL‐chol ratio (r=0.37, P < 0.01), triglycerides (r=0.23, P < 0.05), and negatively correlated with HDL‐cholesterol (r=−0.31, P < 0.01). An association between CCA‐IMT and the presence of E4 allele was also found (P < 0.05). Logistic regression analysis revealed that the presence of E4 allele was a higher risk for increased IMT (relative risk of 4.4, 95% CI 1.5–12.5), even after adjustment for age, LDL‐cholesterol, blood pressure and other known risk factors. A negative correlation between brachial‐FMD and CCA‐IMT was also found in all subjects (r=−0.21, P < 0.05), being most apparent in the E3E4 subjects (r=−0.53, P < 0.02). Conclusion. ApoE4 phenotype was independently associated with an increased risk of carotid atherosclerosis and elevated LDL‐cholesterol levels in asymptomatic middle‐aged Japanese men.
Determination of cardiac involvement in sarcoidosis by magnetic resonance imaging and Doppler echocardiography
Authors: Sköld C. M. , Larsen F. F. , Rasmussen E. , Pehrsson S. K. , Eklund A. G. 
Published: March 2003

Abstract. Sköld CM, Larsen FF, Rasmussen E, Pehrsson SK, Eklund AG (Karolinska Hospital and Institutet, Stockholm, Sweden). Determination of cardiac involvement in sarcoidosis by magnetic resonance imaging and Doppler echocardiography. J Intern Med 2002; 252: 465–471.Objectives. To elucidate whether cardiac magnetic resonance imaging (MRI) could be useful in disclosing structural changes in the myocardium in sarcoidosis patients and to relate echo‐Doppler derived indices of left ventricular function to electrocardiogram (ECG) findings.Design. The MRI was performed in 18 consecutive patients with sarcoidosis. Left ventricular ejection fraction (LVEF), i.e. systolic function, was estimated echocardiographically by Simpson's two‐dimensional method (n = 16). Diastolic function was estimated by age‐corrected Doppler‐derived indices: isovolumetric relaxation time (IVRT), deceleration time (DT) and early filling/atrial contraction ratio (E/A ratio).Results. Eleven patients had conduction defects or dysrhythmias (ECG+) whilst seven patients had a normal ECG (ECG–). In two patients, high signalling, contrast‐enhanced, isolated regions, suggestive of deposits, were seen in the left ventricular myocardium on MRI. Both these patients had abnormal ECGs and signs of systolic and/or diastolic dysfunction on echocardiography. LVEF was subnormal in seven of 10 of the ECG+ patients and in two of six of the ECG–. Signs of diastolic dysfunction were found in 59% and 56% of the measurements in the ECG+ and ECG– patients, respectively.Conclusion. We conclude (i) that myocardial deposits on MRI in sarcoidosis patients have a high specificity for cardiac involvement but a rather low sensitivity; (ii) that a substantial proportion of sarcoidosis patients with abnormal ECGs have echocardiographic signs of systolic and/or diastolic dysfunction.
The cytokine network in sarcoidosis and its clinical relevance
Authors: Ziegenhagen M. W. , Müller‐Quernheim J. 
Published: March 2003

Abstract. Ziegenhagen MW, Müller‐Quernheim J (University Hospital Freiburg, Freiburg, Germany). The cytokine network in sarcoidosis and its clinical relevance (Minisymposium). J Intern Med 2003; 253: 18–30.In recent years, analysis of the cytokine network has substantially improved our knowledge of the immunopathogenesis of sarcoidosis. There is increasing evidence from clinical immunology that analysis of the cytokine network may be helpful for clinicians to assess the extent and activity of sarcoid inflammation. Genetic polymorphisms may contribute to interindividual differences in the regulation of cytokine release. Thus, disease phenotype‐associated haplotypes should exist and their analysis might disclose risk profiles of individual patients. Furthermore, serological assessment of cytokines or soluble cytokine receptors may become suitable parameters in clinical practice to detect an ongoing inflammation in chronic sarcoidosis.
Effects of glucocorticoids on leptin levels and eating behaviour in women
Authors: Uddén J. , Björntorp P. , Arner P. , Barkeling B. , Meurling L. , Rössner S. 
Published: March 2003

Abstract.  Uddén J, Björntorp P, Arner P, Barkeling B, Meurling L, Rössner S (Karolinska Institute at Huddinge University Hospital, Stockholm, Sweden; and Sahlgren's Hospital, Gothenburg, Sweden). Effects of glucocorticoids on leptin levels and eating behaviour in women. J Intern Med 2003; 253: 225–231.Objective.  Long‐term treatment with glucocorticoids induces weight gain and increased risk to develop obesity‐related metabolic complications. The underlying mechanisms are not fully understood. Glucocorticoid therapy has previously been associated with increased levels of circulating leptin. In this study the eating behaviour was therefore studied in relation to leptin levels before and after short‐term prednisolone treatment.Design.  Within‐subject design.Subjects.  Twelve healthy postmenopausal women with a mean body mass index (BMI) of 28.9 kg m−2 (±0.8 SEM) volunteered after recruitment by an advertisement in the local paper.Interventions.  The subjects received 25 mg prednisolone daily for 7 days.Main outcome measurements.  Fasting serum samples were obtained before, during and after treatment for determination of leptin and insulin, glucose and fractionated lipoproteins in plasma. The microstructure of the eating behaviour was registered with a universal eating monitor, VIKTOR. Appetite was estimated by visual analogue rating scales and food intake by a 48‐h recall.Results.  Serum leptin increased after 2 and 7 days of glucocorticoid administration (P < 0.01), and the food intake measured by VIKTOR after 7 days of treatment (P < 0.05). No statistically significant changes were however, found in the 48‐h food‐ recall or in the subjective appetite registrations. Insulin levels were borderline elevated (P = 0.062) after treatment, but no significant changes of fasting glucose were seen. High density lipoprotein cholesterol (HDL) increased (P < 0.05), whilst low density lipoprotein cholesterol (LDL) decreased (P < 0.05).Conclusion.  Food intake was elevated after glucocorticoid administration as observed with an objective, quantitative method, in spite of increased levels of circulating leptin.
Decreased muscle strength and contents of Mg and Na,K‐pumps in chronic alcoholics occur independently of liver cirrhosis
Authors: Aagaard N. K. , Andersen H. , Vilstrup H. , Clausen T. , Jakobsen J. , Dørup I. 
Published: March 2003

Abstract. Aagaard NK, Andersen H, Vilstrup H, Clausen T, Jakobsen J, Dørup I (Aarhus University Hospital; and University of Aarhus, Aarhus, Denmark). Decreased muscle strength and contents of Mg and Na,K‐pumps in chronic alcoholics occur independently of liver cirrhosis. J Intern Med 2003; 253: 359–366.Objectives.  To evaluate the influence of established liver cirrhosis on muscle strength and muscle contents of magnesium (Mg), potassium (K) and sodium, potassium pumps (Na,K‐pumps) in chronic alcoholic patients.Design.  An open cross‐sectional study.Setting and subjects.  Forty consecutive chronic alcoholics (18 with cirrhosis and 22 without cirrhosis) admitted to the Department of Hepatology, Aarhus University Hospital, Denmark, or to a collaborating alcoholism treatment centre, and 36 healthy control subjects.Main outcome measures.  Evaluation of participant's subjective physical ability and measurement of maximum isokinetic muscle strength and muscle mass, as well as measurements of Mg, K and Na,K‐pumps in skeletal muscle.Results.  Maximum isokinetic muscle strength and muscle mass were equally reduced in patients with and without cirrhosis (P < 0.01 all). In keeping with this, both groups of patients felt equally physically restricted. Muscle Mg was reduced to the same extent in the two groups of patients (by 12 and 9%, P < 0.001, both), whereas the muscle K content was only significantly lower in the cirrhotic patients (10%, P < 0.001). The muscle content of Na,K‐pumps was reduced by 14%, (P < 0.01) in the cirrhotic patients and by 8% (P < 0.05) in the noncirrhotic patients.Conclusion.  Our alcoholic patients complained of physical disability, had reduced skeletal muscle mass, isokinetic muscle strength, content of muscle Mg and content of Na,K‐pumps. There was no difference between patients with and without cirrhosis. It appears that it is the heavy alcohol intake, and not the cirrhosis per se, that is responsible for the observed defects.
Helicobacter pylori: resurrection of the cancer link
Authors: Björkholm B. , Falk P. , Engstrand L. , Nyrén O. 
Published: March 2003

Abstract.  Björkholm B, Falk P, Engstrand L, Nyrén O (Swedish Institute for Infectious Disease Control, Solna; AstraZeneca R & D, Mölndal; Karolinska Institute, Stockholm, Sweden). Helicobacter pylori: resurrection of the cancer link (Review). J Intern Med 2003; 253: 102–119. Helicobacter pylori is one of the most common pathogenic bacterial infections, colonizing an estimated half of all humans. In a subset of individuals, the infection leads to serious gastroduodenal disease such as peptic ulcers and gastric adenocarcinoma. The factors contributing to skewing this, in most cases benign, relationship into disease development are largely unknown. However, factors emanating from the bacterium, host and the environment have been shown to affect the risk for disease, although no factor can be singled out to be most important. The known factors are associated with affecting the risk of disease, and are not absolute. Virulence of H. pylori is affected by the existence and regulation of certain genes present in the bacterial population in a stomach. The effects of H. pylori on gastric cancer development have been challenged and the risk associated with infection with virulent (i.e. Cag PAI positive) H. pylori has likely been underestimated.