bluuebunny/crossref_metadata_2025_split huggingface dataset:
Trends in the treatment of patients with myocardial infarction and coronary revascularization procedures in Finland during 1986–92: the FINMONICA Myocardial Infarction Register Study
Authors: Miettinen H. , Salomaa V. , Ketonen M. , Niemelä M. , Immonen‐Räihä P. , Mähönen M. 
Published: March 2003

Abstract. Miettinen H, Salomaa V, Ketonen M, Niemelä M, Immonen‐Räihä P, Mähönen M, of the FINMONICA Myocardial Infarction Register Group (Kuopio University Hospital, Kuopio; National Public Health Institute, Helsinki; North Karelia Central Hospital, Joensuu; Loimaa District Hospital, Loimaa; and Turku University Hospital, Turku, Finland). Trends in the treatment of patients with myocardial infarction and coronary revascularization procedures in Finland during 1986–92: the FINMONICA Myocardial Infarction Register Study. J Intern Med 1999; 245: 11–20.Objectives. To investigate changes in the medical treatment of patients with myocardial infarction and the trends in revascularization procedures in Finland.Design. A population‐based myocardial infarction (MI) register study.Setting. Populations, aged 25–64 years, of the three geographical areas of Finland, provinces of North Karelia and Kuopio in eastern Finland and the Turku‐Loimaa area in south‐western Finland.Main outcome measures. Medical treatment administered prior to the coronary event, during the hospitalization and at discharge from hospital to all patients hospitalized due to suspected myocardial infarction and all CAD deaths occurring during three separate 4‐month periods in 1986, 1989 and 1992. Data on coronary bypass surgery and percutaneous coronary angioplasty in the study areas for 1986–92.Results. The most marked change in the medical treatment of hospitalized myocardial infarction patients was the significant increase in the use of thrombolytic treatment (5% of patients in 1986 and 24% in 1992, P < 0.001 for trend). The use of antiplatelet agents increased from 1986 to 1992 prior to the coronary event, during the hospitalization and at discharge. The use of beta‐blockers and intravenous nitrates increased and the use of calcium‐channel blockers declined significantly in hospitalized patients during the study period. Hospitalized male myocardial infarction patients were treated more often with beta‐blockers, nitrates, antiplatelet agents and thrombolytic agents than female patients, suggesting less intensive medical treatment in women.Conclusion. The results of the large clinical trials regarding the medical treatment of myocardial infarction patients were adopted in the clinical practice rapidly and the treatment of myocardial infarction patients and the number of revascularization procedures changed markedly from 1986 to 1992 in Finland. These changes may in part explain the favourable changes in mortality from CAD in Finland.
Oral anticoagulant treatment in patients with mechanical heart valves: how to reduce the risk of thromboembolic and bleeding complications
Authors: Cannegieter S. C. , Torn M. , Rosendaal F. R. 
Published: March 2003

Abstract.Patients with mechanical heart valves have a high risk of thrombus formation on the valve and subsequent systemic embolism. These patients therefore need to receive life‐long oral anticoagulation (OAC). Despite this treatment, the overall incidence rate of major thromboembolic complications is still about 1–2 per 100 patient‐years. Additionally, these patients have an increased risk of bleeding complications, ranging between 1 and 7 per 100 patient‐years.To reduce both types of often very serious complications, the optimal intensity of anticoagulation needs to be established. We found a fairly wide optimal range between 2.5 and 4.9 INR (international normalized ratio) at which the incidence of both untoward events was minimal. As a target intensity, we recommend opting for the middle of this range (INR 3.0–4.0), thereby providing a safe margin at both ends.In order to further reduce thromboembolic and bleeding complications, two approaches can be considered: first of all, the management of OAC treatment needs to be optimized in order to achieve a stable therapeutic effect in as many patients as possible. Secondly, patient characteristics need to be identified that increase the thromboembolic or bleeding risk. Subsequently, the optimal intensity may need to be adjusted accordingly, at an individual level. Possible risk factors for an increased thromboembolic risk are position and type of the prosthesis. Age may increase both the risk of thromboembolism and the risk of haemorrhage.
Cutaneous necrosis as a terminal paraneoplastic thromboembolic event in a patient with non‐Hodgkin’s lymphoma
Authors: Luboshitz J. , Bairey O. , Blickstein D. , Vaknin H. , Okon E. , Lahav J. , Prokocimer M. 
Published: March 2003

Abstract. Luboshitz J, Bairey O, Blickstein D, Vaknin H, Okon E, Lahav J, Prokocimer M (Rabin Medical Center, Belinson Campus, Petah‐Tikva and Sackler Faculty of Medicine, Tel Aviv University, Israel). Cutaneous necrosis as a terminal paraneoplastic thromboembolic event in a patient with non‐Hodgkin’s lymphoma (Case Report). J Intern Med 1999; 245: 301–5.Thrombotic complications in non‐Hodgkin’s lymphoma often originate in the large veins. We describe a patient with refractory advanced high‐grade lymphoma who presented with the rare complication of extensive cutaneous necrosis due to thrombosis of dermal vessels; there was also a recent new peak of monoclonal IgM‐κ protein. Direct immunofluorescence demonstrated immune deposits with complement in the dermal vessel wall. Based on these observations and on published data, we suggest that these complexes were the trigger for the thrombotic events and that the monoclonal IgM acted as xenoreactive antibodies, initiating a cascade of events. The first step of this cascade was activation of the complement and the membrane attack complex, which caused secretion of IL‐1α by endothelial cells, followed by overexpression of tissue factor on the surface of the dermal vessel wall endothelium. Dermal vessel thrombosis was the final event in this cascade.
Genes involved in animal models of obesity and anorexia
Authors: Schalling M. , Johansen J. , Nordfors L. , Lönnqvist F. 
Published: March 2003

Abstract. Schalling M, Johansen J, Nordfors L, Lönnqvist F (Karolinska Hospital, Stockholm; and Huddinge Hospital, Karolinska Institute, Huddinge, Sweden). Genes involved in animal models of obesity and anorexia. (Minisymposium: Genes & Obesity). J Intern Med 1999; 245: 613–619.Pathological deviations in bodyweight is a major increasing health problem in industrialized societies. It is currently unclear what genetic mechanisms are involved in the long‐term control of human bodyweight and to what extent these genes are involved in pathological deviations of bodyweight control such as anorexia and obesity. Major support for the concept of genetic control of bodyweight has recently emerged from different animal models. A number of new genes have been found during recent years that, when mutated, have a negative effect on bodyweight in animals and sometimes also in man. Although available evidence points toward a multifactorial nature of weight disorders in most human subjects, the single genes isolated in animal models may become powerful tools to elucidate the genetics also in man. In addition, these genes may serve to promote the development of targeted small‐drug pharmaceuticals aimed at novel biochemical pathways. Finally, the uncovering of several quantitative trait loci (QTL) influencing body mass, body fat or fat topography in the mouse and rat has now also made it possible to perform studies of polygenically caused obesity in rodents. The role of the Genome Project in developing a complete gene map will greatly facilitate transforming these QTLs to actual molecules involved in the biology of bodyweight.
Bleeding complications in secondary stroke prevention by antiplatelet therapy: a benefit–risk analysis
Authors: Boysen G. 
Published: March 2003

Abstract. Boysen G (University of Copenhagen, Copenhagen, Denmark). Bleeding complications in secondary stroke prevention by antiplatelet therapy: a benefit–risk analysis (Review). J Intern Med 1999; 246: 239–245.This review analyses the benefit–risk ratio of antiplatelet drugs in secondary stroke prevention and is based on the published data from eight large stroke prevention trials. In patients with prior transient ischaemic attack (TIA) or stroke, aspirin prevented one to two vascular events (stroke, AMI, or vascular death) per 100 treatment‐years with an excess risk of fatal and severe bleeds of 0.4–0.6 per 100 treatment‐years. The gastrointestinal bleeding risk was significantly lower with ticlopidine and clopidogrel, which were both somewhat more effective than aspirin in the prevention of vascular events. The combination of dipyridamole and aspirin prevented 2.82 strokes at the expense of an excess risk of 0.61 (95% CI = 0.27–0.95) fatal or severe bleeds per 100 treatment‐years.In the acute phase of stroke, the aspirin‐associated risk of haemorrhagic complications was much increased compared with that in the stable phase after stroke, with 0.48 (95% CI = 0.13–0.83) fatal or severe bleeds per 100 treated patients for the first 4 weeks after stroke in the Chinese Acute Stroke Trial and 0.41 (95% CI = 0.05–0.77) in the International Stroke Trial. Still, there was a net benefit with the prevention of about one death or non‐fatal ischaemic stroke per 100 treated patients.
Antibodies to platelet‐activating factor are associated with borderline hypertension, early atherosclerosis and the metabolic syndrome
Authors: Wu R. , Lemne C. , De Faire U. , Frostegård J. 
Published: March 2003

Abstract. Wu R, Lemne C, de Faire U, Frostegård J (Karolinska Hospital and Karolinska Institute, Stockholm, Sweden). Antibodies to platelet‐activating factor (PAF) are associated with borderline hypertension, early atherosclerosis and the metabolic syndrome. J Intern Med 1999; 246: 389–397.Objective. Platelet‐activating factor (PAF) is a phospholipid inflammatory mediator which is synthesized by a variety of cells, including monocytes and endothelial cells, and PAF can be retained in activated endothelial cell membranes. Furthermore, PAF‐like lipids are produced in other phospholipid membranes as in oxidized LDL. Atherosclerosis is a chronic inflammation in the artery wall, but little is known about the role of immune reactions in the early stages of development of cardiovascular disease. In the present study we investigated if there are antibodies to PAF (aPAF) that may play a role in borderline hypertension and early atherosclerosis.Design. Seventy‐three men with borderline hypertension (BHT) and 73 age‐matched normotensive (NT) men (diastolic blood pressure 85–94 and <80 mmHg, respectively) were recruited from a population screening programme. Antibody levels were determined by use of ELISA. Carotid intima‐media (IM)‐thickness and atherosclerosis was determined by B‐mode ultrasonography.Results. BHT men had 49.3% higher aPAF levels of IgG
class than NT controls (P = 0.0007). Antibodies to the biologically inactive lysoPAF did not differ between BHT and NT group. aPAF levels were associated with IM‐thickness in the left (P = 0.02) and right (P = 0.009) carotid artery. Furthermore, aPAF levels were enhanced in individuals with the metabolic syndrome (n = 44) as compared to those without (n = 102; P = 0.009), and also significantly associated with insulin levels (P = 0.02) and insulin resistance (P = 0.02).Conclusions. aPAF antibodies may reflect early vascular changes and thus serve as novel markers for disease, and they may also be pathogenic, by eliciting an inflammatory reaction in the vascular wall.
Systemic AL amyloidosis in Gaucher disease. A case report and review of the literature
Authors: Kaloterakis A. , Filiotou A. , Koskinas J. , Raptis I. , Zouboulis C. , Michelakakis H. , Hadziyannis S. 
Published: March 2003

Abstract. Kaloterakis A, Filiotou A, Koskinas J, Raptis I, Zouboulis C, Michelakakis H, Hadziyannis S
(Hippokration Hospital, and ‘Agia Sofia’ Children’s Hospital, Athens, Greece). Systemic AL amyloidosis in Gaucher disease. A case report and review of the literature (Case Report). J Intern Med 1999; 246: 587–590.Chronic Gaucher disease [GD] in association with systemic AL amyloidosis is extremely rare. We describe a 46‐year‐old Greek male with chronic GD confirmed by low glucocerebroside activity in fibroblasts and N370S/L444P mutations at the cerebrosidase gene, who also had systemic AL amyloidosis diagnosed by bone marrow diffuse plasmacytosis, serum monoclonal IgA‐λ, severe total proteinuria with monoclonal IgA‐λ, Bence‐Jones‐λ and amyloid deposits in bone marrow, liver, spleen and kidney biopsy specimens. Treatment with melphalan and prednizolon has dramatically decreased both levels of serum M‐IgA and proteinuria and also improved the clinical symptoms of amyloidosis. He died from restrictive cardiac disease 30 months after the diagnosis of amyloidosis. Previously reported cases of GD in association with AL amyloidosis are reviewed.
N‐terminal atrial natriuretic peptide and left ventricular geometry and function in a population sample of elderly males
Authors: Ärnlöv J. , Lind L. , Stridsberg M. , Andrén B. , Lithell H. 
Published: March 2003

Abstract. Ärnlöv J, Lind L, Stridsberg M, Andrén B, Lithell H (University of Uppsala, Sweden). N‐terminal atrial natriuretic peptide and left ventricular geometry and function in a population sample of elderly males. J Intern Med 2000; 247: 699–708.Objectives. To investigate the relationships between N‐terminal atrial natriuretic peptide (N‐ANP) and left ventricular geometry and function.Design. A cross‐sectional study of a population‐based cohort.Setting. Follow‐up of a health survey in Uppsala county, Sweden.Subjects.   Two hundred and five men aged 70.Main outcome measures. A Delfia sandwich immunoassay was used to measure the plasma levels of N‐ANP. M‐mode and Doppler echocardiographic examinations were used to measure left ventricular dimensions, mass, geometry and systolic function and to classify the subjects into four groups (normal geometry, concentric remodelling, concentric hypertrophy or eccentric hypertrophy). Left ventricular systolic dysfunction was defined as a left ventricular ejection fraction ≤ 0.40.Results. Plasma levels of N‐ANP were significantly increased in subjects with left ventricular dysfunction compared to healthy subjects (702 ± 486, n = 14 vs. 277 ± 201 pmol L−1, n = 118, P < 0.0001), but there was a great overlap between the groups. N‐ANP differed significantly between the four different left ventricular geometric groups (P = 0.02) with the highest N‐ANP levels in the subjects with left ventricular eccentric hypertrophy (n = 40). However, N‐ANP levels were no longer significantly associated with left ventricular geometry when taking the ejection fraction into account.Conclusions. This study showed that N‐ANP levels were significantly elevated in subjects with left ventricular dysfunction, as well as in subjects with left ventricular hypertrophy. However, the increase in N‐ANP seen in the eccentric hypertrophy group was mainly due to a decreased ejection fraction.
Should cardiopulmonary resuscitation be performed on patients with heart failure? The role of the patient in the decision‐making process
Authors: Ågård A. , Hermerén G. , Herlitz J. 
Published: March 2003

Abstract. Ågård A, Hermerén G, Herlitz J (Lund University and Sahlgrens University Hospital, Göteborg, Sweden). Should cardiopulmonary resuscitation be performed on patients with heart failure? The role of the patient in the decision‐making process. J Intern Med 2000; 248: 279–286.Objectives. There is an ongoing debate about patients’ involvement in the decision of whether or not to start cardiopulmonary resuscitation (CPR) in the case of cardiac arrest. The objective here is to analyse on what grounds patients with heart failure, who run a relatively high risk of suffering cardiac arrest, form their attitudes towards CPR and to what extent they want to be involved in making decisions concerning CPR.Design. This study employs a combined qualitative and quantitative interview concerning patients’ knowledge about CPR, their experiences and preferences regarding involvement in making decisions concerning CPR, and their willingness to undergo CPR.Setting. The study was performed at the Department of Cardiology, Sahlgrens University Hospital, Gothenburg.Subjects. The subjects involved were 40 patients with various stages of chronic heart failure.Results. Many of the interviewees lacked fundamental knowledge of CPR. The majority of the patients opted for CPR no matter how small their chances of survival were. The issue had not earlier engaged their thoughts, even less been discussed with physicians. The patients relied on the physician’s ability to judge if CPR was to be regarded as a potentially beneficial intervention or as an unmotivated one. Nevertheless, the patients welcomed the opportunity to take part in the decision‐making process.Conclusion. In order to make ethically justified decisions, physicians should consider bringing up the question of CPR with patients suffering from heart failure at the point in time where the progressive disease gives rise to more severe symptoms, corresponding to NYHA classes IIIb‐IV. In earlier stages of the disease, one can assume that the patient will opt for CPR unless he or she demonstrates a negative attitude towards life.
C‐reactive protein, cardiovascular risk factors and the association with myocardial infarction in men
Authors: Doggen C. J. M. , Berckmans R. J. , Sturk A. , Manger Cats V. , Rosendaal F. R. 
Published: March 2003

Abstract. Doggen CJM, Berckmans RJ, Sturk A, Manger Cats V, Rosendaal FR (Leiden University Medical Center, the Netherlands). C‐reactive protein, cardiovascular risk factors and the association with myocardial infarction in men. J Intern Med 2000; 248: 406–414.Objectives. This study had three objectives: first, to investigate the association of C‐reactive protein levels and myocardial infarction amongst men; secondly, to study the associations of C‐reactive protein levels with cardiovascular risk factors; and thirdly, to adjust the risk of myocardial infarction for such factors.Design and subjects. A case–control study including 560 patients with a first myocardial infarction who had survived at least 6 months, plus 646 control subjects.Results. Patients had significantly higher levels of C‐reactive protein (mean 2.2 mg L−1) than control subjects (mean 1.7 mg L−1; P < 0.001). Persons in the highest quintile of C‐reactive protein had an unadjusted 1.9‐fold increased risk of myocardial infarction compared with persons in the lowest quintile (odds ratio 1.9, 95% CI: 1.3–2.7). C‐reactive protein was, in addition to smoking, associated with several cardiovascular risk factors: age, obesity, diabetes, blood pressure, triglycerides and inversely associated to HDL cholesterol. Adjustment for these variables, especially for total cholesterol, HDL cholesterol and triglycerides, substantially decreased the risk of myocardial infarction for persons in the highest quintile of C‐reactive protein, compared to those in the lowest quintile, to 1.3 (95% CI: 0.9–1.9).Conclusions. Our findings confirm previous reports that C‐reactive protein predicts the risk of myocardial infarction. However, this association does not appear to be causal, since the increase in risk can to a large extent be explained by the presence of other cardiovascular risk factors.
REVIEW The use of nonhuman primate models to improve gene transfer into haematopoietic stem cells
Authors: Dunbar C. E. 
Published: March 2003

Abstract. Dunbar CE (National Heart, Lung, and Blood Institute, National Institutes of Health, Rockville Pike, Bethesda, MD, USA). The use of nonhuman primate models to improve gene transfer into haemotopoietic stem cells. J Intern Med 2001; 249:329–338.Primitive haematopoietic progenitor and stem cells (HSC) have been pursued as highly desirable targets for genetic therapy as technology allowing safe and controllable transfer of exogenous genes into eukaryotic cells was developed a decade ago. Retroviral vectors have been used for the majority of preclinical and clinical studies directed at these cells, because these vectors have a number of the necessary properties, including chromosomal integration, helper‐free production systems, and lack of toxicity. Until recently, however, results with these vectors in clinical trials and large animal models indicated efficiency of gene transfer as a major hurdle to be overcome. We have focused on using the rhesus macaque autologous transplantation model to optimize gene transfer to primitive haematopoietic cells, and investigate questions regarding in vivo stem cell behaviour, in a system with proven predictive value for human haematopoiesis. By optimization of transduction conditions using standard vectors, gene transfer efficiency to primitive repopulating cells has reached the clinically relevant range of 5–20% long‐term. Alternative vector systems, have also yielded promising results. We have also found that relatively simple manipulation of cell cycle status prior to reinfusion of marked cells results in significantly improved engraftment of transduced cells: this finding may have an impact particularly in the nonablative setting. The high level marking has permitted insertion site analysis and clonal tracking in vivo. Inverse PCR and/or a ligation‐mediated PCR procedure have demonstrated that a large number of transduced clones (over 50) contribute to multiple lineages in vivo for up to at least 2 years post‐transplantation. Thus far we have little evidence for rapid clonal succession or lineage‐restricted engraftment of transduced cells. These and other advances should result in successful gene therapy for a variety of acquired and congenital disorders affecting HSCs and their progeny lineages.
Childbearing and the risk of parathyroid adenoma – a dominant cause for primary hyperparathyroidism
Authors: Rastad J. , Ekbom A. , Hultin H. , Wuu J. , Lundgren E. , Hsieh C‐C. , Lambe M. 
Published: March 2003

Rastad J, Ekbom A, Hultin H, Wuu J, Lundgren E, Hsieh C‐C, Lambe M (University Hospital Uppsala, Astra Zeneca R & D, Mölndal, Karolinska Institutet, Stockholm, Sweden, Harvard School of Public Health, Boston, University of Massachusetts Medical Center, Worcester, MA, USA). Childbearing and the risk of parathyroid adenoma – a dominant cause for primary hyperparathyroidism. J Intern Med 2001; 250: 43–49. Objectives. To explore possible associations between the reproductive history amongst women and the risk of parathyroid adenoma (PA). Design. Two nationwide Swedish registries. The Fertility Register included data on more than 3.4 million livebirths between 1943 and 1992 amongst Swedish females born 1925–72. The Cancer Register encompasses more than 1800 women with a diagnosis of PA 1960 until 1992. Setting. All women resident in Sweden 1960–92. Subjects. Cases were all 1800 women born 1925–72 reported to the Swedish Cancer Registry with a histopathological diagnosis of PA. Five controls were selected at random for each case by matching for the month and year of birth. Conditional logistic regression was used to estimate relative risks of PA. Main outcomes. Parathyroid adenoma. Results. High parity (four or more live births) was associated with an increased risk of PA. Amongst women with a diagnosis of PA before menopause (i.e. the age of 50 years) there was an increased risk of PA with younger age at first childbirth. Nulliparous women were at increased risk for PA before menopause, and at decreased risk after menopause. Conclusions. There is an association between childbearing and the risk of PA, which has not previously been demonstrated, but the underlying biological mechanisms remain to be determined.