bluuebunny/crossref_metadata_2025_split huggingface dataset:
Consequences of late referral of patients with end‐stage renal disease
Authors: Gøransson L. G. , Bergrem H. 
Published: March 2003

Abstract. Gøransson LG, Bergrem H (Central Hospital of Rogaland, Stavanger, Norway). Consequences of late referral of patients with end‐stage renal disease. J Intern Med 2001; 250: 154–159. Objectives. The aim of the present retrospective single centre study of patients entering renal replacement therapy (RRT), was to evaluate the effects of different referral patterns on morbidity, choice of therapy, and duration of hospitalization in patients with chronic renal failure. Subjects. A total of 242 patients with chronic renal failure starting their first RRT between 1984 and 1998, were divided into three groups. Group 1 (n=80): RRT started 1984–88, group 2 (n=73): RRT started 1989–93 and group 3 (n=89): RRT started 1994–98. Patients were classified as early referrals (ER) or late referrals (LR) depending on whether they started first RRT more than or less than 3 months after first referral to a nephrologist. Results. The proportion of LR was 27.3% (21 patients) in group 1, 27.4% (20 patients) in group 2 and 28.1% (25 patients) in group 3. In the ER, 35 patients (14.5%) received a predialytic kidney transplant, none in the LR. Comparing clinical details, the LR’s in group 3 were significantly older than ER [median age 72 (53–81) vs. 56 (15–81) years, P < 0.0001], had a lower serum‐albumin [median 33.0 (19.0–42.0) vs. 39 (19.0–48.0) g L−1, P < 0.0001], and serum‐calcium [median 2.0 (1.4–2.6) vs. 2.3 (1.8–2.7) mmol L−1, P < 0.0001]. The ER had a significantly higher use of antihypertensive drugs, calcitriol, phosphate binders, and bicarbonate. Of the patients starting RRT on haemodialysis, all LR started on a temporary vascular access. About 43% of the ER started on a functioning arteriovenous fistula (P < 0.0001). The duration of hospital stay in connection with start of dialysis was 31 days (7–73) in the LR as compared with 7 (1–59) days in the ER (P < 0.0001). Conclusions. We conclude that in our centre, early referral to nephrologist is associated with lower age, a higher likelihood of predialytic transplantation, better metabolic status at start of RRT, a higher proportion starting haemodialysis on a functioning arteriovenous fistula, and a shorter duration of the initial hospital stay. Further research on health care delivery is warranted.
Hospitalizations for atrial fibrillation in the general male population: morbidity and risk factors
Authors: Wilhelmsen L. , Rosengren A. , Lappas G. 
Published: March 2003

Abstract. Wilhelmsen L, Rosengren A, Lappas G (Göteborg University, Göteborg, Sweden). Hospitalizations for atrial fibrillation in the general male population: morbidity and risk factors.J Intern Med2001;250: 382–389.Objectives. To analyse the incidence, prevalence, aetiology, risk factors and prognosis of hospitalizations for atrial fibrillation.Subjects. A random population sample of 7495 men aged 47–55 years was first examined in 1970–73. During follow‐up until 1996 (mean 25.2 years) 754 men were hospitalized with a diagnosis of atrial fibrillation.Results. In the age groups of 55–64, 65–74 and 75–79 years, the incidence rate was 2.0, 5.8 and 17.3 per 1000 person years, and the prevalence 1.2, 4.2 and 8.0%, respectively. Definite or possible coronary heart disease was diagnosed in 46.0%, heart failure in further 20.2% and valvular heart disease or cardiomyopathy in 4.5%. In bivariate analysis adjusted for age, the following factors were significantly associated with future hospitalization for fibrillation: a family history of myocardial infarction, stroke in mother, dyspnoea at entry, alcohol abuse, high body stature and body weight, high blood pressure but not diabetes, high serum cholesterol, high heart rate, smoking, coffee consumption or psychological stress. Significant risk factors in multivariate analysis were age, odds ratio (OR) [95% confidence interval (CI)] – 1.11 (1.07, 1.16) per year, hospitalization for coronary heart disease or heart failure – 6.77 (5.17, 8.87), stroke in mother – 1.49 (1.15, 1.93), high body stature – 1.04 (1.03, 1.06) per cm, high body mass index (BMI) – 1.07 (1.04, 1.10) per kg m–2, as well as hypertension – 1.33 (1.07, 1.65). After a diagnosis of atrial fibrillation, mortality was increased by 3.3 times.Conclusion. In spite of a clinical association with coronary heart disease, risk factors for atrial fibrillation were only partly the same. Prevention includes avoidance of weight gain and control of blood pressure as well as prevention of myocardial infarction and heart failure.
Acute and chronic neutropenias. What is new?
Authors: Palmblad J. , Papadaki H. A. , Eliopoulos G. 
Published: March 2003

Abstract. Palmblad J, Papadaki HA, Eliopoulos G (The Karolinska Institute at Huddinge University Hospital, Stockholm, Sweden and University of Crete Medical School, Heraklion, Greece). Acute and chronic neutropenias. What is new?J Intern Med2001;250:476–491.Recently, some of the mechanisms and consequences in the severe chronic neutropenias (e.g. the neutrophil elastase gene mutations and the risk to progress to myelodysplasia and acute leukaemia) and in drug‐induced agranulocytosis (e.g. the apoptosis‐inducing ability of metabolites of clozapine) have been elucidated, and new aspects of autoimmune and the large granular lymphocyte syndrome were described (e.g. aberrant elaboration of Fas‐ligand causing neutrophil apoptosis). Investigations of the mild to moderate chronic neutropenias have shown the significance of interactions between the myeloid development and the immune network (e.g. relations to immunoglobulin aberrations). Granulocyte‐colony stimulation factor (G‐CSF) is widely used in patients with severe chronic neutropenia, however, its use in other conditions is mostly based on anecdotal evidence. In addition, immune modulating regimens, such as metothrexate, ciclosporine and monoclonal antibodies, are increasingly employed for the autoimmune neutropenias.
Specific bronchoalveolar lavage fluid T cells associate with disease in a pair of monozygotic twins discordant for sarcoidosis
Authors: Grunewald J. , Eklund A. 
Published: March 2003

Abstract. Grunewald J, Eklund A (Karolinska Hospital, Stockholm, Sweden). Specific bronchoalveolar lavage fluid T cells associate with disease in a pair of monozygotic twins discordant for sarcoidosis (Case report). J Intern Med 2001; 250: 535–539.A 49‐year‐old Caucasian woman had an acute onset of sarcoidosis. Bronchoscopy with bronchoalveolar lavage (BAL) showed a pronounced accumulation of BAL fluid CD4+ T cells expressing the T‐cell receptor (TCR) AV2S3 gene. In line with this observation, the patient was HLA‐DR17 positive, previously shown to strongly correlate with lung compartmentalized AV2S3+ T cells. At follow‐up after recovery, reduced numbers of BAL fluid AV2S3+ T cells were found. Interestingly, BAL fluid of a healthy monozygotic twin sister contained normal numbers of AV2S3+ lung T cells. This report shows the T‐cell repertoire of BAL fluid T cells to correlate with the disease (sarcoidosis), indicating a local and specific immune response triggered by an unknown antigen in sarcoidosis.
Oxidative stress and antioxidant status in type 1 diabetes mellitus
Authors: VESSBY J. , BASU S. , MOHSEN R. , BERNE C. , VESSBY B. 
Published: March 2003

Abstract. Vessby J, Basu S, Mohsen R, Berne C, Vessby B (Section for Clinical Nutrition Research, Department of Public and Caring Sciences; and Department of Internal Medicine, Uppsala University, Uppsala, Sweden). Oxidative stress and antioxidant status in type 1 diabetes mellitus. J Intern Med 2002; 251: 69–76. Objectives. To test the hypothesis that type 1 diabetes is associated with increased oxidative stress and/or antioxidant status by investigating concentrations of 8‐iso‐prostaglandin F2α (8‐iso‐PGF2α) in urine and plasma and malondialdehyde (MDA) in plasma as indicators of lipid peroxidation in vivo, and antioxidant status in diabetic subjects compared with healthy control subjects. Design and subjects. Thirty‐eight subjects with type 1 diabetes mellitus and 41 healthy age‐ and sex‐matched control subjects were included in the study. Blood and urine samples were obtained and analysed for 8‐iso‐PGF2α with a newly developed radioimmunoassay, as well as for MDA, total antioxidant capacity (TAOC) and serum tocopherol levels. Results. None of the variables of lipid peroxidation showed any significant difference between the two groups. Similarly, there were no significant correlations between the levels of 8‐iso‐PGF2α or MDA, and degree of glycemic control (HbA1c). Total antioxidant capacity in plasma was 16% lower amongst the subjects with type 1 diabetes than in the control group (P < 0.0005). Lipid corrected levels of α‐tocopherol in serum were significantly increased in type 1 diabetic subjects (P < 0.05), as were γ‐tocopherol levels (P < 0.005). Conclusions. In spite of lower total antioxidant defence, our results do not support the oxidative stress hypothesis for type 1 diabetes mellitus. The higher tocopherol levels suggest that no vitamin E supplementation is necessary for subjects with type 1 diabetes mellitus.
Unusual case of a large midoesophageal diverticulum mimicking unstable angina pectoris
Authors: HOFFMANN J. C. , PISTORIUS G. , MÜLLER P. , ZEITZ M. 
Published: March 2003

Abstract. Hoffmann JC, Pistorius G, Müller P, Zeitz M (Universitätskliniken des Saarlandes, Homburg/Saar, Germany). Unusual case of a large midoesophageal diverticulum mimicking unstable angina pectoris (Case report). J Intern Med 2002; 251: 355–360.We describe a 77‐year‐old lady who presented with progressive retrosternal pain radiating to the left arm and the back. After exclusion of cardiac causes a large midoesophageal diverticulum was found on oesophago‐gastro‐duodenoscopy. Importantly, the retrosternal pain completely disappeared after endoscopic removal of impacted food from the diverticulum. After the surgical resection the patient became fully asymptomatic. This is the first example of angina‐like chest pain which definitively resulted from a midoesophageal diverticulum. Therefore, midoesophageal diverticula should be considered as a rare differential diagnosis of exercise‐induced retrosternal pain.
Thyroid dysfunction during treatment of chronic hepatitis C with interferon alpha: no association with either interferon dosage or efficacy of therapy
Authors: DALGARD O. , BJØRO K. , HELLUM K. , MYRVANG B. , BJØRO T. , HAUG E. , BELL H. 
Published: March 2003

Abstract. Dalgard O, Bjøro K, Hellum K, Myrvang B, Bjøro T, Haug E, Bell H (Aker University Hospital, Oslo; National Hospital, Oslo; Akershus Central Hospital, Nordbyhagen; and Ullevål University Hospital, Oslo, Norway). Thyroid dysfunction during treatment of chronic hepatitis C with interferon alpha: no association with either interferon dosage or efficacy of therapy. J Intern Med 2002; 251: 400–406. Objectives. Treatment of chronic hepatitis C with interferon‐α (IFN‐α) may induce thyroid disorders. We evaluated whether this risk is related to the dosage of IFN‐α or the virological treatment response. Other possible risk factors as well as the evolution of the thyroid abnormalities were also studied. Methods. In this prospective trial (n=254), thyroid‐stimulating hormone (TSH), free thyroxin (fT4) and thyroid peroxidase autoantibodies were measured before, during and after treatment for hepatitis C virus (HCV). The patients were randomized to either induction therapy [IFN‐α 6 million units (MIU) daily for 4 weeks and 3 MIU 3/7 days for 22 weeks] or conventional therapy [IFN‐α 3 MIU 3/7 days for 26 weeks]. In addition, all patients received ribavirin (1000 or 1200 mg) daily. Sustained virological response was defined as loss of detectable HCV RNA at 6 months follow‐up. Thyroid dysfunction was defined as TSH level below or above the normal range (0.2–4.5 MIU L−1). Results. Biochemical thyroid dysfunction developed in 30 (11.8%) of 254 patients. Hypothyroidism (TSH > 4.5 MIU L−1) was seen in 20 and hyperthyroidism (TSH < 0.2 MIU L−1) in 10 patients. Nine of the 30 patients developed symptomatic thyroid disease and HCV treatment was discontinued because of thyroid dysfunction in three of these patients. Thyroid dysfunction occurred in 15 (11.7%) of 128 patients who received high‐dose IFN‐α induction therapy as compared with 15 (11.9%) of 126 patients who received conventional IFN‐α therapy (P=0.96). Amongst 231 patients who completed all 6 months of HCV treatment, a sustained virological response was obtained in 19 (66%) of 29 with thyroid dysfunction and 109 (54%) of 202 without (P=0.24). By multivariate analysis female gender and Asian origin were independent predictors of developing biochemical thyroid dysfunction (P < 0.01). Conclusion. Thyroid dysfunction occurred in 11.8% of patients treated for chronic hepatitis C with IFN‐α and ribavirin. Neither the IFN‐α dosage nor the virological response to treatment were related to the incidence of thyroid dysfunction.
Dyspeptic symptoms in middle‐aged to old adults: the role of Helicobacter pylori infection, and various demographic and lifestyle factors
Authors: BODE G. , BRENNER H. , ADLER G. , ROTHENBACHER D. 
Published: March 2003

Abstract. Bode G, Brenner H, Adler G, Rothenbacher D. (University of Ulm and University of Heidelberg, Germany). Dyspeptic symptoms in middle‐aged to old adults: the role of Helicobacter pylori infection, and various demographic and lifestyle factors. J Intern Med 2002; 252: 41–47. Objectives To evaluate the role of factors supposed to interfere with the gastric mucosa like Helicobacter pylori, smoking and analgesics in symptom generation in a population‐based sample of middle‐aged to old. Subjects A total of 288 subjects aged 50–85 (mean 65 ± 7.2) attending a General Science‐orientated Continuing Education Programme at the University of Ulm. Methods Helicobacter pylori infection was determined by the 13C‐urea breath test. Demographic data, gastrointestinal symptoms and factors supposed to be involved in symptom generation were collected by a standardized questionnaire. The association between various demographic and lifestyle factors with a gastrointestinal symptom score was quantified by odds ratios (ORs) using multiple logistic regression. Results Use of nonsteroidal anti‐inflammatory drugs (OR=1.2; 95% CI=0.7–2.1) was no risk factor for abdominal symptoms, whereas female sex (OR= 1.6; 95% CI=0.9–2.9) and current smoking (OR= 3.7; 95% CI=0.9–15.4) were associated with a high symptom score. Age 70 years and over was significantly associated with a lower symptom score (OR=0.4; 95% CI=0.2–0.9). However, H. pylori infection was a risk factor for a high symptom score in that age group (OR=4.3; 95% CI=1.2–14.8), whereas no such association (and even a tendency to reduced symptom levels in infected subjects) was observed in younger age groups. Conclusion The role of H. pylori infection in symptoms may vary by age. The loss of symptoms in the elderly may delay detection of gastroduodenal pathology and appropriate treatment in older adults.
Enterovirus, mycoplasma and other infections as predictors for myocardial infarction
Authors: Reunanen A. , Roivainen M. , Kleemola M. , Saikku P. , Leinonen M. , Hovi T. , Knekt P. , Leino A. , Aromaa A. 
Published: March 2003

Abstract. Reunanen A, Roivainen M, Kleemola M, Saikku P, Leinonen M, Hovi T, Knekt P, Leino A, Aromaa A (National Public Health Institute, Helsinki and Oulu; Social Insurance Institution, Turku; University Hospital, Turku, Finland). Enterovirus, mycoplasma and other infections as predictors for myocardial infarction. Journal of Intern Med 2002; 252: 421–429.Objectives. To study antibodies against five infectious agents for their prediction of major coronary events in men with and without evidence of coronary heart disease at baseline.Design. A case–control study nested within a prospective population study.Subjects. The study cases included 441 men 45–64 years old with nonfatal myocardial infarction or coronary death within a mean follow‐up time of 10 years. A total of 165 men had already signs of heart disease at baseline, whilst 276 were apparently healthy at the beginning of the study. Two controls for each case were matched for age, heart disease status and place of residence. Antibodies against enterovirus, Mycoplasma pneumoniae, Chlamydia pneumoniae, cytomegalovirus and adenovirus were determined.Results. Men without reported baseline heart disease, but not those with heart disease, showing the highest quartile of antibodies to enterovirus and mycoplasma or increased levels of immune complex‐bound antibodies to chlamydia had a significantly higher risk of coronary events than men with lower level of antibodies. The increased risk demonstrated in men with high levels of antibodies to enterovirus and mycoplasma remained significant after adjustment for other antibodies, acute‐phase reactant and conventional risk factors. Serological evidence of infection by multiple agents was also significantly associated with coronary events.Conclusions. Serological evidence for several infectious agents is associated with the risk of coronary heart disease, but only in men without baseline history of heart disease.
Acquired platelet dysfunction may be an aetiologic factor in Heyde's syndrome – normalization of bleeding time after aortic valve replacement
Authors: Olsson M. , Hultcrantz R. , Schulman S. , Wallgren E. 
Published: March 2003

Abstract.  Olsson M, Hultcrantz R, Schulman S, Wallgren E (Karolinska Hospital, Karolinska Institute, Stockholm Institute, Stockholm, Sweden). Acquired platelet dysfunction may be an aetiologic factor in Heyde's syndrome – normalization of bleeding time after aortic valve replacement. J Intern Med 2002; 252: 516–523.Background.  There is a well‐documented relationship, with unknown aetiology, between aortic valve stenosis and occult gastrointestinal bleeding in elderly patients. Despite several studies attempting to determine the prevalence and to discuss the aetiology, there are still many unanswered questions.Methods.  A total of 288 consecutive patients with valvular aortic stenosis – mean age 73 ± 9 years aortic stenosis group (ASG) – were compared with 129 pacemaker‐treated patients, mean age 73 ± 9 years control group (CG). Screening for occult blood in stools was performed in both groups. Those with a positive Hemocult® test or a history of gastrointestinal bleeding were scheduled for further examination including upper endoscopy and colonoscopy. Template bleeding time was performed on patients in both groups and in patients with a prolonged bleeding time with an extended coagulation evaluation was carried out. Patients referred to aortic valve replacement and with a preoperatively prolonged bleeding time were re‐examined after surgery.Results.  There was a significant difference in the number of subjects with prolonged bleeding time between groups (ASG 19; CG 2; P = 0.028). Re‐examination of the bleeding time after aortic valve surgery revealed normalized values in nine of 12 (P = 0.0003). The number of patients with positive Hemocult® test did not differ between groups (ASG 29; CG 12; NS). Comparison of the pressure gradient over the aortic valve demonstrated a significantly higher maximal gradient amongst patients with a preoperatively prolonged bleeding time (113 mm HG vs. 90 mmHG; P = 0.005).Conclusion.  Prolonged bleeding time is related to valvular aortic stenosis and seems to be caused by acquired platelet dysfunction. The normalization of the bleeding time after valve surgery supports the hypothesis that the calcified cusps may interact with the platelet function.
Birth weight – a risk factor for progression in diabetic nephropathy?
Authors: Jacobsen P. , Rossing P. , Tarnow L. , Hovind P. , Parving H‐H. 
Published: March 2003

Abstract.  Jacobsen P, Rossing P, Tarnow L, Hovind P, Parving H‐H (Steno Diabetes Center, Gentofte, Denmark). Birth weight – a risk factor for progression in diabetic nephropathy? J Intern Med 2003; 253: 343–350.Objectives.  Intrauterine growth retardation, as seen in individuals with low weight at birth, may give rise to a reduction in nephron number. Oligonephropathy has been linked to hypertension and renal disease in adult life. We tested the concept that low weight at birth acts as a risk factor for progression of diabetic nephropathy.Design and subjects.  We performed an observational follow‐up study of 161 (97 men) type 1 diabetic patients with diabetic nephropathy [mean age (SD): 35 (11) years, mean duration of diabetes: 22 (8) years]. All patients had been followed for at least 3 years [median (range): 8 (3–20)] with at least three measurements [9 (3–31)] of glomerular filtration rate (GFR) (51Cr‐EDTA). Information about birth size was obtained from midwife registrations.Settings.  Steno Diabetes Center, a tertiary referral centre.Main outcome measures.  Loss of kidney function according to birth weight and weight/length ratio at birth.Results.  There was no correlation in univariate analysis between birth weight or weight/length ratio and rate of decline in GFR, neither in men nor in women. Furthermore, the 27 patients with birth weights below the 20th centile had a rate of decline in GFR [median (range)] similar to the 134 patients above: 2.6 (−4.7; 9.6) vs. 3.4 (−2.3; 19.3) mL min−1 year−1, respectively (NS). A multiple regression analysis revealed that albuminuria, arterial blood pressure, and haemoglobin A1C during follow‐up showed a significant correlation with the decline in GFR [R2 (adjusted) = 0.34], whereas birth weight and birth weight/length ratio did not.Conclusions.  Our study does not suggest that weight at birth is associated with progression of established diabetic nephropathy in type 1 diabetic patients, whilst several other potential modifiable risk factors were identified.
Crystallographic image processing approach to crystal structure determination
Authors: Li F. H. 
Published: March 2003

It is shown that the crystallographic image‐processing technique based on the weak‐phase object approximation and on the combination of high‐resolution electron microscopy and electron diffraction is applicable to crystal structure determination. The technique consists of two stages: image deconvolution and phase extension. In the first stage an image taken at an arbitrary defocus condition can be transformed into the structure image with the resolution limited by the resolution of the electron microscope. In the second stage the image resolution is enhanced to the diffraction resolution limit so that most unoverlapped atoms can be resolved individually in the final image. Although the experimental diffraction intensities are available for the image deconvolution, they must be corrected for the phase extension. The proposed empirical method of electron diffraction intensity correction seems effective for obtaining a set of corrected diffraction intensities which are approximately equal to square structure factors.When the crystal structure under examination belongs to a known typical type, it is easy to propose the structure model by referring to the deconvoluted image which reveals the low‐resolution structure, and the high‐resolution structure can also be determined by image simulation.