bluuebunny/crossref_metadata_2025_split huggingface dataset:
Direct medical costs for patients with type 2 diabetes in Sweden
Authors: Henriksson F. , Agardh C.‐D. , Berne C. , Bolinder J. , Lönnqvist F. , Stenström P. , Östenson C.‐G. , Jönsson B. 
Published: March 2003

Abstract. Henriksson F, Agardh C‐D, Berne C, Bolinder J, Lönnqvist F, Stenström P. Östenson C‐G, Jönsson B (Centre for Health Economics, Stockholm; Department of Endocrinology, University Hospital MAS, Malmö; Department of Internal Medicine, Uppsala University Hospital; Centre for Metabolism and Endocrinology and SmithKline Beecham Pharmaceuticals AB, Karolinska Institute; Diabetes Prevention Unit, Karolinska Hospital, Stockholm, Sweden). Direct medical costs for patients with type 2 diabetes in Sweden. J Intern Med 2000; 248: 387–396.Objectives. To estimate the total direct medical costs to society for patients with type 2 diabetes in Sweden and to investigate how different factors, for example diabetic late complications, affect costs.Design. Cross‐sectional data regarding health care utilization, clinical characteristics and quality of life, were collected at a single time‐point. Data on resource use cover the 6‐month period prior to this time point.Setting. Patient recruitment and data collection were performed in nine primary care centres in three main regions in Sweden.Subjects. Only patients with an age at diabetes diagnosis ≥ 30 years (type 2 diabetes) were included (n = 777).Results. The total annual direct medical costs for the Swedish diabetes type 2 population were estimated at about 7 billion SEK (Swedish Kronor) in 1998 prices, which is about 6% of the total health care expenditures and more than four times higher than the former Swedish estimate obtained when using diabetes as main diagnosis for calculating costs. The annual per patient cost was about 25 000 SEK. The largest share of this cost was hospital inpatient care. Costs increased with diabetes duration and were higher for patients treated with insulin compared to those treated with oral hypoglycaemic drugs or with life style modification only. Patients with both macro‐ and microvascular complications had more than three times higher costs compared with patients without such complications.Conclusions. Type 2 diabetes is a serious and expensive disease and the key to reducing costs seems to be intensive management and control in order to prevent and delay the associated late complications.
Amplification of IS6110 sequence for detection of Mycobacterium tuberculosis complex in HIV‐negative patients with fever of unknown origin (FUO) and evidence of extrapulmonary disease
Authors: Ritis K. , Tzoanopoulos D. , Speletas M. , Papadopoulos E. , Arvanitidis K. , Kartali S. , Sideras P. 
Published: March 2003

Abstract. Ritis K, Tzoanopoulos D, Speletas M, Papadopoulos E, Arvanitidis K, Kartali S, Sideras P (Democritus University of Thrace, Regional Hospital of Alexandroupolis, Alexandroupolis, Greece, and University of Umeå, Umeå, Sweden). Amplification of IS6110 sequence for detection of M. tuberculosis complex in HIV‐negative patients with fever of unknown origin (FUO) and evidence of extrapulmonary disease. J Intern Med 2000; 248: 415–424.Objectives. Extrapulmonary tuberculosis (TB) constitutes the main cause of classic fever of unknown origin (FUO) in many populations. The aim of this study was to improve the diagnostic field of the disease using a nested polymerase chain reaction (PCR) assay, specific for the IS6110 insertion element of Mycobacterium tuberculosis complex, in order to achieve a more timely diagnosis and treatment.Setting. Twenty‐four, HIV‐negative classic FUO patients who were admitted to the Regional Hospital of Alexandroupolis between April 1997 and July 1999.Subjects and design. The above patients were considered as putative extrapulmonary TB after 3 weeks of in‐patient investigation and underwent exhaustive examination for diagnosis of the disease. For this purpose, specimens were obtained from peripheral blood and bone marrow from these patients, as well as from damaged tissues, and analysed by both PCR and conventional methods. Anti‐tuberculous treatment was initiated in 16 out of 24 patients and the response to this regimen was considered as the final criterion for diagnosis of tuberculosis.Results. Extrapulmonary TB was established in 11 patients. The PCR‐based methodology, when applied to samples derived from bone marrow aspirations and suspected damaged tissues, was able to diagnose 10 of them, whereas the conventional methods were able to detect only two.Conclusions. Our results confirm the diagnostic value of molecular detection of M. tuberculosis in cases of FUO, thus supporting the application of PCR in tissue samples suspected of bacillus infection. Furthermore, our studies demonstrate that bone marrow aspiration specimens constitute an alternative, easy, safe and reliable source for such PCR analysis.
Ehlers–Danlos syndrome type IV with a unique point mutation in COL3A1 and familial phenotype of myocardial infarction without organic coronary stenosis
Authors: Nishiyama Y. , Nejima J. , Watanabe A. , Kotani E. , Sakai N. , Hatamochi A. , Shinkai H. , Kiuchi K. , Tamura K. , Shimada T. , Takano T. , Katayama Y. 
Published: March 2003

Abstract. Nishiyama Y, Nejima J, Watanabe A, Kotani E, Sakai N, Hatamochi A, Shinkai H, Kiuchi K, Tamura K, Shimada T, Takano T, Katayama Y (Nippon Medical School, Tokyo, and Chiba University School of Medicine, Chiba, Japan). Ehlers–Danlos syndrome type IV with a unique point mutation in COL3 A1 and familial phenotype of myocardial infarction without organic coronary stenosis (Case Report). J Intern Med 2001; 249: 103–108.We report on a 43‐year‐old male patient with Ehlers–Danlos syndrome (EDS) type IV with acute myocardial infarction (MI) without organic coronary stenosis. The disease was complicated with pneumothorax, subcutaneous and mediastinal emphysema, and splenic artery rupture. Three of the patient’s family members suffered sudden cardiac death or MI. A diagnosis of EDS type IV was confirmed by decreased production of type III collagen by 86%. Mutation analysis revealed a point mutation in the COL3A1 gene that substituted glycine for aspartate at amino acid position 877. This mutation had not been reported as pathogenic for EDS type IV. These findings suggest close linkage between the mutation and the phenotype with familial MI.
Aphasia in acute stroke and relation to outcome
Authors: Laska A. C. , Hellblom A. , Murray V. , Kahan T. , Von Arbin M. 
Published: March 2003

Abstract. Laska AC, Hellblom A, Murray V, Kahan T, von Arbin M (Danderyd Hospital, Danderyd, Sweden). Aphasia in acute stroke and relation to outcome. J Intern Med 2001; 249: 413–422. Objectives. The natural course of aphasia in unselected, consecutive stroke patients is not well established. We investigated morbidity, mortality and recovery for different types of aphasia in consecutive unselected aphasic patients with acute stroke. Setting and subjects. In 119 aphasic patients, the type and degree of aphasia were assessed acutely and at 3, 6 and 18 months after stroke onset, using Reinvang’s ‘Grunntest for afasi’ and Amsterdam‐Nijmegen‐Everyday‐Language‐Test. Results. About one‐third of patients with acute stroke had presented with aphasia. Mortality among the aphasic patients during the 18‐month follow‐up was twice that in non‐aphasics (36 vs. 16%). Presence of atrial fibrillation was associated with poorer prognosis. At 18 months, 24% of the 119 aphasic patients had recovered completely, 43% still had significant aphasia, and 21% had died. The proportion with global aphasia decreased from almost 25% acutely to a few per cent after 18 months, that with Wernicke’s aphasia from 25% to less than 10%, whereas conduction aphasia increased from 13 to 23% during follow‐up. Among those with initial mild aphasia, 70% recovered completely. Great improvement was observed in patients with initial low degree of speech function. Younger patients recovered to a greater extent than older patients. Conclusion. The high long‐term mortality among aphasics may be seen as an indirect sign of advanced cardiovascular disease. A combination of different and adjusted aphasia tests provided the possibility to assess almost all acute aphasic patients. Irrespective of type and degree of aphasia, great improvements were seen in almost all aphasic patients. Even patients with severe speech impairment have a considerable potential for recovery, particularly in the first 3 months after stroke.
Cell adhesion molecules and secretory type II phospholipase A2 in relation to carotid atherosclerosis in patients with hypercholesterolaemia
Authors: Wiklund O. , Hulthe J. , Bondjers G. , Hurt‐Camejo E. 
Published: March 2003

Abstract. Wiklund O, Hulthe J, Bondjers G, Hurt‐Camejo E (Sahlgrenska University Hospital, Göteborg University, Gothenburg, Sweden). Cell adhesion molecules and secretory type II phospholipase A2 in relation to carotid atherosclerosis in patients with hypercholesterolaemia. J Intern Med 2001; 249: 441–449. Objective. There has been no previous study investigating the relationship between subclinical atherosclerosis, as measured by ultrasound, and circulating levels of cell‐adhesion molecules and snpPLA2 in patients with hypercholesterolaemia. The main aims of the present study were therefore to investigate the relationship between subclinical atherosclerosis, cell‐adhesion molecules and snpPLA2 in a group of subjects with hypercholesterolaemia and also in a healthy control group; and to investigate the relationship between conventional riskfactors, cell‐adhesion molecules and snpPLA2 in these groups. Methods. Study subjects were recruited from the general population (50 subjects with hypercholesterolaemia and all 105 controls) and from the lipid clinic of Sahlgrens Hospital, Gothenburg (55 subjects with hypercholesterolaemia). Cell‐adhesion molecules and snpPLA2 were analyzed by ELISA. Results. The levels of sICAM turned out to be positively and significantly associated with plaque occurrence and plaque size in the carotid artery in the patient group, but not in the control group. There were no significant relationships between sVCAM, sE‐selectin or snpPLA2 and atherosclerosis, as measured by ultrasound. However, sICAM was significantly associated with sVCAM, sE‐selectin and snpPLA2 both in the patient and in the control groups. In the patient group sICAM was positively and significantly associated with triglyceride levels and also negatively associated with high density lipoprotein (HDL) levels. Conclusions. The present study showed that sICAM‐1 was significantly associated with atherosclerosis, as measured by ultrasound, in the carotid artery in patients with hypercholesterolaemia. Furthermore, sICAM‐1 levels were associated with plasma levels of snpPLA2 (r=0.44, P < 0.001), which recently have been shown to predict coronary events. Finally, high sICAM‐1 levels were associated with an atherogenic lipid profile including high triglyceride levels and low HDL levels.
Betablocker treatment in diabetes mellitus
Authors: Sawicki P. T. , Siebenhofer A. 
Published: March 2003

Sawicki PT, Siebenhofer A (St Franziskus Hospital in Cologne, Germany; Karl‐Franzens University in Graz, Austria). Betablocker treatment in diabetes mellitus (Review). J Intern Med 2001; 250: 11–17. Objectives. Betablockers have been convincingly shown to reduce total and cardiovascular morbidity and mortality of hypertensive diabetic patients. In diabetic patients, after myocardial infarction, these agents confer a twice as high protective effect when compared to non‐diabetic patients. However, most paradoxically, betablocking agents are used less frequently in diabetes. Control of hypertension is insufficient in most of the diabetic patients, probably because a combination of antihypertensive agents including betablockers is frequently needed to sufficiently control blood pressure but is not used in these patients. The fear of betablocker‐associated side effects in diabetes may be partly responsible for the frequent antihypertensive mono‐therapy and the resulting poor quality of blood pressure control among diabetic patients. Design. We have performed an analysis of the literature to assess whether possible adverse metabolic effects, a higher risk of hypoglycaemia or less nephroprotective effects of ß1‐selective betablocking agents could justify the reticence in prescribing these antihypertensive agents to diabetic patients. Results. A thorough review of the literature does not indicate that ß1‐selective betablocking agents have important adverse effects on glucose metabolism, prolong hypoglycaemia or mask hypoglycaemic symptoms. In diabetic nephropathy, betablockers are as nephroprotective as angiotensin converting enzyme inhibitors. Conclusions. The unnecessary less frequent prescription of ß1‐selective betablockers in diabetes mellitus may contribute to the higher cardiovascular mortality among these patients.
Effects of intramyocardial injection of phVEGF‐A165 as sole therapy in patients with refractory coronary artery disease – 12‐month follow‐up: Angiogenic gene therapy
Authors: Sarkar N. , Rück A. , Källner G. , Y‐Hassan S. , Blomberg P. , Islam K. B. , Van Der Linden J. , Lindblom D. , Nygren A. T. , Lind B. , Brodin L.‐Å. , Drvota V. , Sylvén C. 
Published: March 2003

Abstract. Sarkar N, Rück A, Källner G, Y‐Hassan S, Blomberg P, Islam KB, van der Linden J, Lindblom D, Nygren AT, Lind B, Brodin L‐Å, Drvota V, Sylvén C (Karolinska Institute, Huddinge University Hospital, Novum, Stockholm, Sweden). Effects of intramyocardial injection of phVEGF‐A165 as sole therapy in patients with refractory coronary artery disease: 12‐month follow‐up. Angiogenic gene therapy. J Intern Med 2001; 250: 373–381. Objective. To test the safety and bioactivity of phVEGF‐A165 after intramyocardial injection during 12‐month follow‐up. Design. Open‐labelled study. Subjects. Inclusion criteria were angina pectoris, Canadian Cardiovascular Society (CCS) class III–IV, unamenable to further revascularization, ejection fraction (EF) >30%, perfusion defects extending over >10% of the anterolateral left ventricle wall detectable with adenosine single photon emission computerized tomography (SPECT) and at least one patent vessel visible by coronary angiography. Seven of 39 patients referred for gene therapy were included. Intervention. Via a mini‐thoracotomy under general anaesthesia, phVEGF‐A165 was injected directly into the myocardium at four sites in the anterolateral region of the left ventricle. Results. Operative procedures were uneventful. Perioperative release of myocardial markers and electrocardiogram (ECG) changes were detected in two patients. There were no perioperative deaths but one patient died 7 months postoperatively because of myocardial infarction. Plasma vascular endothelial growth factor (VEGF)‐A levels increased two to threefold peaking 6 days postoperatively (P < 0.004) and returning to baseline by day 30. A significant reduction in angina pectoris was reported. The CCS class improved from 3.3 ± 0.2 to 1.9 ± 0.3 (P < 0.01) and nitroglycerine intake decreased from 39 ± 15 to 12 ± 5 tablets week–1 (P < 0.001) 2 months after gene transfer. Improvements remained after 12 months when nitroglycerine consumption approached zero. Improved myocardial function in the phVEGF‐A165 injection region was documented in all patients (P < 0.016) by tissue velocity imaging (TVI). Reduced reversible ischaemia was detected by adenosine SPECT in four patients. Improved collateralization was detected in four patients with coronary angiography. Conclusion. Intramyocardial injection of phVEGF‐A165 is safe and may lead to improved myocardial perfusion and function with longstanding symptomatic relief in end‐stage angina pectoris. Based on these results this therapeutic potential is being tested in a double‐blind placebo controlled multicentre trial, EUROINJECT ONE.
Cholesterol and triglyceride concentration as risk factors for myocardial infarction and death in women, with special reference to influence of age
Authors: Lindquist P. , Bengtsson C. , Lissner L. , Björkelund C. 
Published: March 2003

Abstract. Lindqvist P, Bengtsson C, Lissner L, Björkelund C (Department of Primary Health Care, Göteborg University, Gothenburg, Sweden). Cholesterol and triglyceride concentration as risk factors for myocardial infarction and death in women, with special reference to influence of age.J Intern Med2002;251: 484–489.Objective. To evaluate the importance of serum cholesterol and triglyceride concentrations as predictors of myocardial infarction and death in women of different ages.Design. Prospective observational study, initiated in 1968–69.Setting. Gothenburg, Sweden, with about 430 000 inhabitants.Subjects. A population‐based sample of 1462 women aged 38, 46, 50, 54 and 60 years at start of the study, followed up for 24 years.Main outcome measures. Within each age group, myocardial infarction and death were predicted by serum cholesterol and triglyceride concentrations and smoking in a multivariate model.Results. In the total population only serum triglyceride concentration was a strong independent risk factor for both end‐points studied. Serum triglyceride concentration measured in 38‐ and 46‐year‐old women had no predictive value with respect to 24‐year incidence of myocardial infarction or death. In 50‐, 54‐ and 60‐year‐old women, high serum triglyceride concentration consistently predicted myocardial infarction and total mortality. Serum cholesterol concentration, on the other hand, showed evidence of direct association for 24‐year all‐cause mortality in the younger premenopausal group. Serum cholesterol had no predictive value for myocardial infarction or mortality in the peri‐ and postmenopausal ages.Conclusions. There appears to be age‐specificity in association between serum lipids and these end‐points in women, serum cholesterol concentration being more important for younger women and serum triglyceride concentration more important for postmenopausal women as risk factors, observations which need further attention.
Validity of D‐dimer tests in the diagnosis of deep vein thrombosis: a prospective comparative study of three quantitative assays
Authors: LARSEN T. B. , STOFFERSEN E. , CHRISTENSEN C. S. , LAURSEN B. 
Published: March 2003

Abstract. Larsen TB, Stoffersen E, Christensen CS, Laursen B (Aalborg Hospital, Aalborg, Denmark). Validity of D‐dimer tests in the diagnosis of deep vein thrombosis: a prospective comparative study of three quantitative assays. J Intern Med 2002; 252: 36–40. Objectives. To assess the diagnostic reliability of a new quantitative D‐dimer assay (VIDAS New®) and an established quick test (Nycocard® D‐dimer assay) in the diagnosis of deep vein thrombosis (DVT) compared with ultrasonography. A third assay (Auto Dimer®) became available during sample collection and has been included in the final assessment. The diagnostic performance of the Auto Dimer® assay was evaluated on three different coagulation analysers. Design. A clinical prospective study of patients admitted to hospital for evaluation of DVT. Setting. The admission ward at Aalborg Hospital. Subjects. A total of 113 outpatients with suspected DVT. Main outcome measures. Compression ultrasonography was used as the reference method for a diagnosis of DVT and compared with different D‐dimer assays. The results were expressed as sensitivity, specificity, positive predictive value and negative predictive value (NPV). Results. Deep vein thrombosis was established in 49 patients (43%). Two D‐dimer assays (VIDAS New® and Auto Dimer®) showed sensitivities of 90 and 88%, specificities of 42 and 44%, and NPV's of 85 and 83%, respectively. The Nycocard® D‐dimer assay showed a sensitivity of 63%, specificity of 67% and NPV of 71%. Conclusions. The diagnostic performance of VIDAS New® and the Auto Dimer® D‐dimer assays is almost identical, but this study suggests that neither of the D‐dimer assays is suitable as the only screening method for DVT, in a situation with a high pretest probability of DVT. This call for a differential strategy that distinguishes between cases of low and high clinical probability using either a D‐dimer test or ultrasonography. Abbreviations DVT, deep venous thrombosis, NPV, negative predictive value, PPV, positive predictive value
Homocysteine, malondialdehyde and endothelial markers in dialysis patients during low‐dose folinic acid therapy
Authors: Apeland T. , Mansoor M. A. , Seljeflot I. , Brønstad I. , Gøransson L. , Strandjord R. E. 
Published: March 2003

Abstract. Apeland T, Mansoor MA, Seljeflot I, Brønstad I, Gøransson L, Strandjord RE (Rogaland Central Hospital, Stavanger; and Ullevål University Hospital, Oslo; Norway). Homocysteine, malondialdehyde and endothelial markers in dialysis patients during low‐dose folinic acid therapy. J Intern Med 2002; 252: 456–464.Objectives. Haemodialysis patients have elevated levels of the atherogenic amino acid homocysteine. We wanted to assess the effects of small doses of intravenous folinic acid (the active form of folic acid) on some biochemical risk factors of cardiovascular disease.Design. Longitudinal and open intervention study.Setting. Two dialysis units in the County of Rogaland.Subjects. All patients on maintenance haemodialysis were invited, and 32 of 35 patients gave their informed consent.Interventions. After each dialysis session, the patients were given 1.0 mg of folinic acid intravenously thrice a week for a period of 3 months. Prior to and during the study, all patients were on maintenance supplementation with small doses of vitamins B1, B2, B3, B5, B6 and B12.Main outcome measures. Changes in the levels of (i) plasma total homocysteine (p‐tHcy) and folate, (ii) circulating endothelium related proteins – markers of endothelial activation and (iii) serum malondialdehyde (S‐MDA) – a marker of oxidative stress and lipid peroxidation.Results. The p‐tHcy levels were reduced by 37% (P < 0.0001), whilst the serum and erythrocyte folate levels increased by 95 and 104%, respectively (P < 0.0001 for both). The circulating levels of endothelium related cellular adhesion molecules and haemostatic factors remained high and unchanged, except the thrombomodulin (TM) levels increased (P = 0.0004). The high levels of S‐MDA were reduced by 26% (P = 0.003).Conclusions. Low doses of folinic acid given intravenously to dialysis patients reduced their levels of p‐tHcy and S‐MDA and thus improved their cardiovascular risk profile. The concurrent increment in TM levels was unexpected and of unknown clinical significance.