bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effects of smoking cessation on insulin and cardiovascular risk factors – a controlled study of 4 months' duration
Authors: NILSSON P. , LUNDGREN H. , SÖDERSTRÖM M. , FAGERSTRÖM K‐O. , NILSSON‐EHLE P. 
Published: November 2003

Objectives. To investigate the effects on serum lipids, plasma fibrinogen, plasma insulin, plasma C‐peptide and blood glucose, of smoking cessation after 4 months. To develop a group‐based smoking intervention programme in primary health care. Setting. Twenty health centres in primary health care in southern Sweden. Subjects. Four hundred habitual smokers (>10 cigarettes per day‐1, >10 years), recruited by advertisement in local papers. Intervention. The smokers were randomized, after stratification for age and sex, to one intervention group (n=200) and one control group (n=200). The intervention group was offered supportive group sessions and free nicotine supplementation (patches, chewing gum). Main outcome measures. All participants were investigated at the start and after 4 months (medical history, physical examination, laboratory evaluation). Blood samples were drawn for determination of glucose, insulin and C‐peptide, both in the fasting state and during an oral glucose tolerance test (OGTT), and for measurement of lipoproteins, fibrinogen, nicotine and cotinine. Results. In the intervention group 98 of the subjects (48%) had quit smoking after 4 months. They were compared with the 156 subjects in the control group (91%) who were still daily smokers during the whole period. There were no significant differences in any variable between the two (total) experimental groups at baseline. Plasma nicotine and cotinine decreased (P<0.001) in the intervention group following smoking cessation, and weight increased by 2.7 kg. In the intervention group HDL‐cholesterol increased by 11% (P<0.001), whereas HbA1c increased by 2% (P<0.05) only in the control group. No changes occurred in levels of glucose, insulin, C‐peptide and fibrinogen. Conclusion. The smoking cessation programme had a success rate of almost 50% over 4 months. Smoking cessation was associated with a marked increase in HDL‐cholesterol levels but did not affect glucose tolerance. A concomitant weight increase may have blunted any independent beneficial effect of smoking cessation on glucose metabolism.
A multicentre comparison of once‐daily subcutaneous dalteparin (low molecular weight heparin) and continuous intravenous heparin in the treatment of deep vein thrombosis
Authors: LUOMANMÄKI K. , GRANKVIST S. , HALLERT C. , JAURO I. , KETOLA K. , KIM H. C. , KIVINIEMI H. , KOSKIVIRTA H. , SÖRSKOG L. , VILKKO P. 
Published: November 2003

Objectives. To compare the efficacy and safety of the low molecular weight heparin (LMWH) dalteparin with unfractionated heparin (UFH) in the acute treatment of DVT patients who had not previously received UFH. Design. An open randomized multicentre trial with blinded analysis of venograms. Setting. Seven hospitals in Sweden, Finland and the USA. Subjects. A total of 330 patients, of 20 years or older, with suspected DVT, verified using venography. Interventions. Fixed‐dose dalteparin (200 IU kg‐1) given as a once‐daily subcutaneous injection, or aPTT adjusted i.v. UFH infusion for 6 to 10 days. Main outcome measures. Change in Marder score in patients with confirmed DVT and two evaluable venograms; PE, bleeding events and follow‐up. Results. Marder scores improved in 51% (95% CI 42–60%) of 92 patients treated with dalteparin and in 62% (95% CI 53–70%) of 98 patients treated with UFH (P =0.152). One dalteparin‐treated patient had a PE confirmed by V/Q scan; another had progressive thrombosis with swelling in the affected limb. Bleeding complications occurred in six patients in each group. One patient treated with dalteparin and five treated with UFH died during the 6‐month follow‐up period as a result of underlying malignancy or heart disease. The 6‐month recurrence rate was low with both treatments (dalteparin, 3/97; UFH, 2/103). Conclusions. Fixed‐dose subcutaneous dalteparin given once daily from the start of treatment is of equivalent efficacy and safety to conventional UFH therapy in the routine management of DVT.
Improved carbohydrate metabolism after physical training and dietary intervention in individuals with the ‘atherothrombogenic syndrome’. Oslo Diet and Exercise Study (ODES). A randomized trial
Authors: ANDERSSEN S. A. , HJERMANN I. , URDAL P. , TORJESEN P. A. , HOLME I. 
Published: November 2003

Objectives. To compare the single and joint effect of 1‐year diet and exercise intervention on carbohydrate metabolism and associated coronary risk variables. Design. Unmasked, randomized, 2×2 factorial intervention trial with 1‐year duration for each participant. Setting. The participants were recruited from a screening examination of 40‐year‐old persons in Oslo, Norway. Subjects. Two hundred and nineteen sedentary men and women, with diastolic blood pressure 86–99 mmHg, HDL cholesterol <1.20 mmol L‐1, triglycerides >1.4 mmol L‐1, total cholesterol 5.20–7.74 mmol L‐1 and BMI>24. Participants were randomly allocated to control (n=43), diet (n= 55), exercise (n=54) and diet+exercise (n=67). Interventions. Exercise: supervised endurance exercise three times a week. Diet: reduce weight, increase the intake of fish and reduce total fat intake. Main outcome measures. One‐year changes in insulin and glucose before and after a standardized glucose load. Results. As compared with controls fasting insulin in pmol L‐1 decreased significantly in the combined diet and exercise group (3.9±6.2 versus ‐22.6±4.7 respectively, P=0.003). Insulin in pmol L‐1 after glucose load decreased significantly in all intervention groups compared to controls (diet: ‐82.2± 49.9 P=0.02; exercise: ‐92.4±60.1 P=0.03; diet+exercise: ‐179.6±45.1 P=0.0004). Fasting glucose in mmol L‐1 decreased significantly in the diet alone group (0.21±0.07 P=0.006) and in the diet+exercise group (‐0.26±0.08 P=0.005). In a subgroup analysis of the good responders, the observed changes with respect to total cholesterol (‐0.76 mmol L‐1), HDL cholesterol (0.16 mmol L‐1), triglycerides (‐0.72 mmol L‐1), systolic and diastolic blood pressure (‐8.5/‐6.8 mmHg) were all statistically significant compared to the control with P<0.001. Conclusions. Exercise and diet intervention and in particular the combination of the two, were effective in improving carbohydrate metabolism. Associated risk factors were also affected in a beneficial direction.
Rising erythrocyte sedimentation rate during several years before diagnosis can be a predictive factor in 70% of renal cell carcinoma patients. The benefit of knowing subject‐based reference values
Authors: IVERSEN O. H. , RØGER M. , SOLBERG H. E. , WETTELAND P. 
Published: November 2003

Objectives. A diagnosis of renal cell carcinoma (RCC) early enough for potentially curative surgery is difficult. We wanted to establish whether the erythrocyte sedimentation rate (ESR) in RCC patients had begun to rise before the appearance of any symptoms or signs and, if so, when. Design. A retrospective study of the evolution of the ESR in 236 randomly selected RCC patients during several years before diagnosis, comparing the results with previously obtained population‐based control values. Results. It is generally held that RCC patients have a high ESR at diagnosis. In our material, however, 29.7% of the RCC cases had an ESR that at this time was at or below the population‐based upper reference limit; it had not increased significantly, neither with time before diagnosis, nor with age. In 70.3% of RCC patients the ESR was increased and had been significantly rising for up to 6 years or more before diagnosis. This had not been adequately responded to, probably because the physicians lacked knowledge of the patients' baseline ESR, and because none of the prediagnostic readings had been above the population‐based reference limit. Conclusions. Systematic ESR graphic recordings over time will enable a physician to determine each individual's baseline value, and hence note any continuously rising trend, which should lead to further investigations, e.g. an ultrasound kidney examination. This may provide an early clue to many otherwise non‐symptomatic RCC cases. It is time for a reappraisal of the predictive value of the ESR to discover early RCC, and possibly other diseases as well.
Population‐based erythrocyte sedimentation rates in 3910 subjectively healthy Norwegian adults. A statistical study based on men and women from the Oslo area
Authors: WETTELAND P. , RØGER M. , SOLBERG H. E. , IVERSEN O. H. 
Published: November 2003

Objectives. To establish age‐ and sex‐specific reference limits for the erythrocyte sedimentation rate (ESR) in asymptomatic Norwegian adults. Design. Single ESR recordings were obtained by the classical or a modified Westergren method from 2145 men and 1765 women (93% being blood donors) with age range 20–90 years, and analysed statistically. Results. There was a significant positive association between ESR level and age, consistent with a parabolic pattern in men but a linear one in women. The mean values for men were about 3 mm h‐1 at 20 years, 6 mm h‐1 at 55 years, and 10 mm h‐1 at 90 years, and 6, 9, and 11 mm h‐1 respectively for women. These averages (predicted by regression lines) were significantly higher in women up to the age of 75 years, after which the estimated sex‐specific 95% confidence limits for mean values were found to overlap. Conclusions. The upper reference levels expected to be exceeded only by chance in 5% of single individual recordings at the ages of 20, 55 or 90 years, respectively, were estimated to be 12, 14 and 19 mm h‐1 for men, and 18, 21 and 23 mm h‐1 for women. Higher values should be controlled and, if confirmed, lead to a clinical check‐up. However, about 76% of our overall material had ESR values lower than 9 mm h‐1. Knowledge of each person's baseline ESR value might increase the disease‐predictive ability of the test. If several measurements over years reveal a steeper rise with age than depicted in our population‐based curves, it should be taken seriously, even when each reading is below the population‐based reference limits.
Atrial fibrillation – new aspects on mechanism and treatment
Authors: BERTIL OLSSON S. 
Published: November 2003

During recent years, the exploration of different aspects of atrial fibrillation (AF) has become increasingly interesting. Thus, knowledge about basic underlying mechanisms, consequences and different modes of treatment has rapidly expanded. At a meeting in Lund, Sweden, in 1993, scientists within different fields of AF research gathered for the exchange of information. This paper is a short summary of some topics discussed at the Lund meeting and some suggestions as to how further research in this field may help to improve our understanding of this arrhythmia and the treatment of patients suffering from it.Underlying pathoelectrophysiological mechanisms in AF have been explored in experimental models in animals and by direct recordings of different atrial myocardial electrophysiological variables both in the catheter laboratory and during open heart surgery in man. Some findings illustrate possible generalized atrial myocardial mechanisms, whilst other findings clearly indicate the possibility of localized pathoelectrophysiological mechanisms. The generally accepted hypothesis that AF is perpetuated by multiple re‐entry mechanisms is, thus, both verified and modified by recent studies.In addition to subjective symptoms and well identified thromboembolic consequences, accumulating evidence tells us that AF may precipitate a myocardial dysfunction which may be misinterpreted as an underlying factor initiating the arrhythmia.Today's treatment of AF includes several newer antiarrhythmic drugs, different ablation techniques, the application of different electrical devices as well as different surgical methods. New, improved and simplified methods are expected.Atrial fibrillation is the single most important supraventricular arrhythmia needing substantial further exploration of mechanisms, consequences and treatment. The Lund symposium contributed to this process by defining the state of knowledge in 1993 and outlining the need for the years to come.
Recovery from severe osteoporosis following cure from ectopic ACTH syndrome caused by an appendix carcinoid
Authors: DOBNIG H. , STEPAN V. , LEB G. , WOLF G. , BUCHFELDER M. , KREJS G. J. 
Published: November 2003

Dobnig H et al. (Department of Internal Medicine, Karl Franzens University, Graz, Austria). Recovery from severe osteoporosis following cure from ectopic ACTH syndrome caused by an appendix carcinoid (Case report). J Intern Med 1996; 239: 365–9.It is well established that endogenous overproduction of glucocorticoids may cause osteoporosis. However, knowledge about potential recovery of the skeleton after cessation of corticosteroid excess is limited. We describe a 34‐year‐old female patient and discuss the complex diagnostic workup that led to the rare diagnosis of carcinoid of the appendix as the cause of Cushing's syndrome. The patient experienced multiple spontaneous rip fractures, and at that time, the bone mineral density of the lumbar spine was 4.3 SD below values for age‐matched healthy controls. After removal of the tumour, the patient completely recovered. Measurements at the lumbar spine showed an increase in area bone density of 79% equivalent to 4 SD over a subsequent 3‐year observation period. This first case of documented bone mass recovery in a patient cured of ectopic ACTH syndrome suggests a potential for excellent reversibility of steroid‐induced osteoporosis and should be considered in the management of such patients.
Hereditary angio‐oedema: new clinical observations and autoimmune screening, complement and kallikrein‐kinin analyses
Authors: NIELSEN E. W. , GRAN J. T. , STRAUME B. , MELLBYE O. J. , JOHANSEN H. T. , MOLLNES T. E. 
Published: November 2003

Objectives. To study clinical and laboratory manifestations of hereditary angio‐oedema (HAE). Subjects. Thirty‐three affected members of a kindred of 63. Results. Oedematous attacks in the skin, mucous membranes and gastrointestinal tract with fluid displacement were elicited by mental and physical stress, minor traumas, dental and surgical procedures, eruption of teeth, tonsillitis, pregnancies, and use of oestrogen‐containing pills including menopausal substitution. Every adult woman with symptomatic HAE (n=11) showed symptoms of urinary tract infections in conjunction with the attacks (P= 0.010), and also experienced more spontaneous abortions or premature labours (P=0.037) than healthy relatives. Patients with HAE of both sexes more frequently reported heartburn or peptic ulcers (P=0.002). Rheumatic complaints were reported by 53% of HAE patients and 12% of their unaffected relatives (P=0.013), but biochemical screening for 18 autoantibodies and quantitation of immunoglobulins did not reveal statistically significant differences between the two groups. C3, prekallikrein, total kininogen, high molecular weight kininogen (HK), alpha‐2‐macroglobulin and factor XII were not significantly different in HAE patients. In contrast, levels of C1‐INH and C4 were depressed and cleaved HK increased in patients compared to unaffected relatives. Conclusions. HAE manifests in a variety of ways, and may influence risk of spontaneous abortions and premature labour.
Relationships between vitamin D, parathyroid hormone and bone mineral density in inflammatory bowel disease
Authors: SILVENNOINEN J. 
Published: November 2003

Objectives. To explore the relationships between vitamin D intake, serum parathyroid hormone (PTH) and 25‐hydroxyvitamin D (250HD) concentrations, and bone mineral density (BMD) in inflammatory bowel disease (IBD). Setting. A university hospital clinic in Finland. Subjects. One hundred and fifty randomly selected patients with IBD from the hospital register and 73 healthy controls. Measurements. BMD of the lumbar spine and the proximal femur was measured with dual energy X‐ray absorptiometry. Vitamin D intake and serum levels of 250HD and PTH were determined. Results. The IBD patients had a lower serum 250HD concentration (28.4 [SD 12.0] nmol L‐1) than the controls (36.1 [16.7] nmol L‐1; P=0.001), whereas no differences in the vitamin D intake or the serum PTH levels were found. The serum 250HD concentrations and the vitamin D intake of the patients with ulcerative colitis (n=67) were similar to those of the Crohn's disease patients (n=76). The patients with Crohn's disease of the small bowel had slightly, but not significantly, lower serum 250HD concentrations (25.6 [11.0] nmol L‐1) than the other Crohn's disease patients (31.4 [14.3] nmol L‐1; P=0.061). In the IBD patients, the vitamin D intake and the serum 250HD and PTH concentrations were not associated with BMD. Conclusions. Patients with IBD have lower serum levels of 250HD than healthy controls, but similar serum PTH concentrations and vitamin D intake. Vitamin D intake, and the serum levels of 250HD and PTH are not associated with BMD, and malabsorption is unlikely to be a major factor in the aetiology of bone loss in unselected IBD patients.
Predictors of enhanced well‐being after coronary artery bypass surgery
Authors: STEINE S. , LÆRUM E. , ERITSLAND J. , ARNESEN H. 
Published: November 2003

Objectives. To assess patients' perception of the therapeutic outcome after coronary artery bypass surgery, and to find predictors for increased well‐being. Design. Self‐administered questionnaires (Family APGAR and GHQ‐30) were completed on admission and at the follow‐up after 12 months, together with functional classification according to the NYHA index. Setting. Ullevål University Hospital, Oslo, Norway, 1990–1992. Subjects. Two hundred and thirteen patients with stable angina admitted for elective coronary artery bypass surgery. Intervention. Elective coronary artery bypass surgery. Main outcome measures. Improved physical and psychosocial functioning after one year. Results. One hundred and ninety‐seven (92%) patients improved their NYHA class, while it remained stable or declined in 16 (8%) patients. Significantly fewer patients with mental distress were found at the follow‐up than at the baseline examination (49 patients [23%] versus 80 patients [38%], respectively, P<0.0001). One hundred and forty‐six patients (69%) reported enhanced psychosocial well‐being, while it was reduced (n=60) or unchanged (n=7) in 67 patients (31%). Predictors for improved psychosocial well‐being following coronary artery bypass surgery were mental distress before surgery (odds ratio 2.8) and being a male patient (odds ratio 2.8). Conclusions. The majority of the patients reported significant improvement in their physical and psychosocial functioning one year after coronary artery bypass surgery. Mental distress and male sex were significant predictors of enhanced well‐being. Questionnaires on psychosocial well‐being such as the GHQ‐30 may, in addition to health status measurements, offer additional useful information when coronary artery bypass surgery is considered.
Advances in osteoporosis: better identification of risk factors can reduce morbidity and mortality
Authors: JOHNELL O. 
Published: November 2003

Johnell O (Department of Orthopaedics, Malmö University Hospital, Malmö, Sweden). Advances in osteoporosis: better identification of risk factors can reduce morbidity and mortality (Review). J Intern Med 1996; 239: 299–304.Osteoporosis is a common disease of postmenopausal women and the elderly. Low bone mass results from genetic, nutritional and lifestyle factors, decreased oestrogen levels, certain medical conditions, and the use of certain drugs. The overall incidence and age‐and sex‐related incidences of osteoporosis are increasing worldwide. Osteoporotic fractures can cause considerable pain, disability, loss of independence and deterioration in quality of life. Many patients lose the ability to perform the activities of daily living. Mortality and morbidity after hip fracture increase with age. Prevention of osteoporosis and osteoporotic fractures is an urgent priority to reduce the burden placed on health care and social welfare systems.
How to evaluate interaction between causes: a review of practices in cardiovascular epidemiology
Authors: HALLQVIST J. , AHLBOM A. , DIDERICHSEN F. , REUTERWALL C. 
Published: November 2003

Hallqvist J et al. (Institute of Environmental Medicine and Department of International Health and Social Medicine, Karolinska Institute, Stockholm, Sweden). How to evaluate interaction between causes: a review of practices in cardiovascular epidemiology (Review). J Intern Med 1996; 239: 377–82.To increase the knowledge of interaction or synergy between risk factors is an important task in medical research. Still, current literature in cardiovascular epidemiology reflects major misconceptions as how to evaluate interaction. This paper presents Rothman's model of causation from which strict empirical criteria of interaction can be derived. In principle, the method to apply consists of comparing risk differences for one risk factor of interest across strata of the other. Commonly used but incorrect approaches are exemplified and discussed. These include reporting risk of disease among those with combined exposure, comparing relative risks for one exposure after stratification by level of the other, and including an interaction term in the regression model and drawing conclusions from its P‐value.
Relationship between sodium–lithium countertransport and insulin sensitivity in mild hypertension
Authors: HERLITZ H. , LANDIN K. , WIDGREN B. 
Published: November 2003

Objectives. To study the relationship between insulin sensitivity and sodium‐lithium countertransport (Na+‐Li+ CT) in mild, essential hypertension, and to investigate the effect of metformin and metoprolol, respectively. Design. A double‐blind, triple cross‐over, placebo‐controlled study over a total period of 18 weeks. Setting. A hypertension out‐patient clinic and research laboratory at Sahlgrenska University Hospital. Subjects. Seventeen non‐obese men with mild essential hypertension and 17 weight‐matched, healthy controls. Interventions. Metformin 850 mg b.i.d., metoprolol CR 100 mg once daily and placebo were given during 18 weeks. Each treatment period was 6 weeks. A euglycaemic clamp was performed and erythrocyte Na+‐Li+ CT measured after each 6‐week treatment period. Main outcome measures. Insulin sensitivity, erythrocyte Na+‐Li+ CT, their interrelation, and the effect of metformin and metoprolol CR on both variables, respectively. Results. The hypertensive men tended to have an elevated Na+‐Li+ CT compared with the control subjects (0.34±0.03 versus 0.26±0.02 mmol L‐1 h‐1, P<0.1). Glucose disposal rate was similar, but plasma insulin levels higher (P<0.05) among the hypertensives than the controls. Na+‐Li+ CT exhibited a positive relationship to BMI (r=0.53, P=0.03) and a negative correlation to glucose disposal rate (r=‐0.66, P=0.008) in the hypertensive subjects. In multiple regression analysis, Na+‐Li+ CT showed a significant correlation to glucose disposal rate only. In the control subjects, there was no relation between glucose metabolism and Na+‐Li+ CT. Neither metformin nor metoprolol influenced Na+‐Li+ CT, glucose disposal rate or plasma insulin. Conclusion. Erythrocyte Na+‐Li+ CT seemed to be closely related to insulin‐glucose metabolism in mild hypertension, but was not influenced by metformin or metoprolol.