bluuebunny/crossref_metadata_2025_split huggingface dataset:
Gemfibrozil decreases autoantibodies against oxidized low‐density lipoprotein in men with combined hyperlipidaemia
Authors: Hoogerbrugge  , Kerkhofs  , Jansen  
Published: March 2003

Hoogerbrugge N, Kerkhofs LGN, Jansen H (University Hospital Dijkzigt, Rotterdam, The Netherlands). Gemfibrozil decreases autoantibodies against oxidized low‐density lipoprotein in men with combined hyperlipidaemia. J Intern Med 1998; 243: 355–59.ObjectivesGemfibrozil is the most widely used fibric acid for the management of combined hyperlipidaemia. It has beneficial effects in the prevention of coronary heart disease (CHD). The mechanisms by which it exerts this effect are not completely resolved. We studied whether gemfibrozil affects low‐density lipoprotein (LDL) size and LDL oxidation parameters in males with a moderate combined hyperlipidaemia at high risk for progressive atherosclerosis.DesignOpen treatment with 2 × 600 mg gemfibrozil daily for 12 weeks.SettingOutpatient lipid clinic of a tertiary referral centre.SubjectsTwenty‐three patients with combined hyperlipidaemia and CHD or a positive family history for both CHD and hyperlipidaemia.Main outcome measuresEffects on triglyceride (TG), autoantibodies to oxidized LDL, LDL pattern and resistance to oxidative modification.ResultsDuring treatment with gemfibrozil, plasma TG concentration decreased from 2.83 ± 0.85 to 2.02 ± 0.89 mmol L−1 (P < 0.001). All but one patient were shown to have LDL pattern B. The LDL pattern did not change upon treatment with gemfibrozil. The resistance to oxidation, reflected in the lagtime during in‐vitro oxidation slightly decreased from 105 ± 22 to 99 ± 18 min (P= 0.01). The concentration of autoantibodies against oxidized LDL indicates the rate of LDL oxidation in vivo. This concentration significantly decreased from 14.2 ± 9.9 to 13.1 ± 9.2 mg L−1 (P < 0.01).ConclusionsThe beneficial effect of gemfibrozil in reducing CHD may at least in part depend on a decrease of the rate of LDL oxidation in vivo.
Thymic carcinoids in multiple endocrine neoplasia type 1
Authors: Teh  
Published: March 2003

Teh BT (Karolinska Hospital, Stockholm, Sweden). Thymic carcinoids in multiple endocrine neoplasia type 1 (Minisymposium: MEN & VHL). J Intern Med 1998; 243: 501–4.Thymic carcinoid is a rare malignancy with about 150 cases reported to date. It is associated with multiple endocrine neoplasia type 1 (MEN‐1), but compared with other MEN‐1‐related neoplasia little is known about it. We have recently described and studied 20 MEN‐1‐related cases and found that up to 25% of all reported thymic carcinoids are MEN‐1 related. It is an insidious tumour not associated with Cushing's syndrome or carcinoid syndrome. Local invasion, recurrence and distant metastasis are common with no known effective treatment. Its male predominance, the absence of loss of heterozygosity (LOH) in the MEN1 region, clustering in some MEN‐1 families and the findings of different MEN1 mutations in these clustered families suggest the involvement of additional aetiological factors. We propose that computed tomography (CT) or magnetic resonance imaging (MRI) of the chest should be included as part of the clinical workup for all MEN‐1 patients. Prophylactic thymectomy should be considered during subtotal or total parathyroidectomy on MEN‐1 patients to reduce the risk of this malignancy.
Effect of folic acid and betaine on fasting and postmethionine‐loading plasma homocysteine and methionine levels in chronic haemodialysis patients
Authors: Guldener C. , Janssen M. J. F. M. , Meer K. , Donker A. J. M. , Stehouwer C. D. A. 
Published: March 2003

Objectives. To study fasting and postmethionine‐loading (increment and decrement) plasma homocysteine levels in end‐stage renal disease (ESRD) patients in relation to B‐vitamin status and after folic acid treatment without or with betaine.Design. Plasma total homocysteine (tHcy) and methionine levels were measured in chronic haemodialysis patients after an overnight fast, and 6 and 24 h after an oral methionine load (0.1 g kg−1). The patients were subsequently randomized to treatment with folic acid 5 mg daily with or without betaine 4 g daily, and the loading test was repeated after 12 weeks. The patients were then re‐randomized to treatment with 1 or 5 mg folic acid daily for 40 weeks, after which a third loading test was performed.Setting. Haemodialysis unit of university hospital and centre for haemodialysis.Subjects. Twenty‐nine consecutive maintenance (> 3 months) haemodialysis patients, not on folic acid supplementation, 26 of whom completed the study.Results. At baseline, the mean fasting, the 6 h postload and the 6 h postload increment plasma tHcy levels were increased as compared with those in healthy controls (46.8 ± 6.9 (SEM), 92.8 ± 9.1 and 46.0 ± 4.2 μmol L−1, respectively) and correlated with serum folate (r = −0.42, P = 0.02; r = −0.61, P = 0.001 and r = −0.54, P = 0.003, respectively), but not with vitamin B6 or vitamin B12. At week 12, these variables had all decreased significantly. Betaine did not have additional homocysteine‐lowering effects. At week 52, fasting and postload tHcy levels did not differ significantly between patients on 1 or 5 mg folic acid daily. Plasma tHcy half‐life and plasma methionine levels after methionine loading were not altered by folic acid treatment.Conclusions. In chronic haemodialysis patients, fasting as well as postmethionine‐loading plasma tHcy levels depend on folate status and decrease after folic acid therapy. Increased postload homocysteine levels in these patients therefore do not necessarily indicate an impaired transsulphuration capacity only; alternatively, folate may indirectly influence transsulphuration. The elucidation of the complex pathogenesis of hyperhomocysteinaemia in chronic renal failure requires further investigation.
Oral anticoagulation in nonvalvular atrial fibrillation
Authors: Koefoed B. G. , Petersen P. 
Published: March 2003

Abstract.Chronic nonvalvular atrial fibrillation is associated with an overall risk of thromboembolic complications of 4.5% per year. Advancing age, prior stroke or transient cerebral ischaemia, diabetes, hypertension, and impaired function of the left ventricle are known risk factors. Placebo‐controlled trials have demonstrated that oral anticoagulant therapy with warfarin is effective for primary and secondary prevention of ischaemic stroke, reducing the risk by 68%. The effect of aspirin is still controversial, reducing the risk by 18–44%. Recent clinical trials have investigated the effect of warfarin given at a very low intensity alone or combined with aspirin. The results from the SPAF III study demonstrated that a combination of mini‐intensity warfarin plus aspirin was insufficient for stroke prevention in atrial fibrillation. More trials have now confirmed that oral anticoagulation at INR‐values below 2.0 is not effective for prevention of thromboembolic events in these patients. It is currently recommended that patients at a high risk of stroke are treated with warfarin at an intensity of INR 2.0–3.0. Patients younger than 65 years without other risk factors can be given aspirin 325 mg day–1.
The prevalence and prognosis of third‐degree atrioventricular conduction block: the Reykjavik Study
Authors: Kojic E. M. , Hardarson T. , Sigfusson N. , Sigvaldason H. 
Published: March 2003

Objectives. The objectives of this study were to find the prevalence of third‐degree atrioventricular block in representative population sample and to estimate its prognostic significance. Most earlier studies have been performed on hospital patients and some professional groups.Setting and subjects. In the Reykjavik Study, a prospective cardiovascular population study, 9139 men and 9773 women aged 33–79 years were examined in 1967–91. Electrocardiograms were taken and coded according to the Minnesota code. Third‐degree atrioventricular block was found in 11 persons, seven male and four female, an overall prevalence of 0.04%. All of these individuals had signs of dysrhythmia on electrocardiograms taken later, and in addition some other heart disease. The heart block was temporary in seven individuals (64%); six (55%) needed a pacemaker.Conclusions. The prevalence of third‐degree atrioventricular block in this general population was low. The block was temporary in the majority of subjects. All had some underlying heart disease, which may affect the prognosis more than the heart block. Fewer subjects than expected were found to need a pacemaker.
Do ACE‐inhibitors suppress tumour necrosis factor‐α production in advanced chronic renal failure?
Authors: Stenvinkel P. , Andersson P. , Wang T. , Lindholm B. , Bergström J. , Palmblad J. , Heimbürger O. , Cederholm T. 
Published: March 2003

Abstract. Stenvinkel P, Andersson P, Wang T, Lindholm B, Bergström J, Palmblad J, Heimbürger O, Cederholm T (Huddinge University Hospital and Karolinska Institute, Stockholm; Sweden). Do ACE‐inhibitors suppress tumour necrosis factor‐α production in advanced chronic renal failure? J Intern Med 1999; 246: 503–507.Objectives. The serum levels of the catabolic cytokine TNF‐α are often raised in malnourished chronic heart failure patients as well as in chronic renal failure (CRF) patients. Angiotensin‐converting enzyme (ACE) inhibitors are often used in these patients and may decrease TNF‐α and IL‐1β levels in vitro and in vivo. The aim of this study was to find out whether CRF patients with ongoing ACE‐inhibitor treatment have lower TNF‐α levels.Design. Cross‐sectional study.Setting. Tertiary Referral Center and University Hospital.Subjects. Ninety‐six predialysis patients (mean age 52 ± 1 years) with advanced CRF (glomerular filtration rate 7 ± 1 mL min–1).Main outcome measures. Plasma levels of TNF‐α, subjective global assessment of nutritional status and data on ongoing antihypertensive treatment (ACE‐inhibitors, beta blockers, calcium channel blockers and angiotensin II (AII) receptor blockers).Results. Patients treated with ACE‐inhibitors (n = 44) had significantly lower plasma TNF‐α levels (18.5 ± 1.2 vs. 26.6 ± 2.2 pg mL–1; P < 0.01) and were less frequently malnourished, relative to 52 patients not treated with ACE‐inhibitors. No significant difference in TNF‐α levels were observed when comparing patients with or without treatment with beta, calcium channel, or AII receptor blockers, respectively.Conclusions. The present data suggest that the use of ACE‐inhibitors is associated with lower plasma TNF‐α and CRP levels as well as a lower prevalence of malnutrition in patients with advanced CRF. Further studies are needed to establish if there is a casual relationship between these findings and, if so, the molecular mechanism(s).
Gallstone ileus: endoscopic removal of a gallstone obstructing the upper jejunum
Authors: Lübbers H. , Mahlke R. , Lankisch P. G. 
Published: March 2003

Abstract. Lübbers H, Mahlke R, Lankisch PG (Department of Internal Medicine, Municipal Clinic, Lüneburg, Germany). Gallstone ileus: endoscopic removal of a gallstone obstructing the upper jejunum (Case Report). J Intern Med 1999; 246: 593–597.In a 91‐year‐old female patient admitted with an ileus, ultrasound and computed tomography demonstrated the obstruction of the upper jejunum by a large gallstone. Due to concurrent diseases the patient was unfit for surgery. An attempt was made to remove the impacted stone endoscopically. After successful mobilization and fragmentation by mechanical lithotripsy the obstruction was cleared away. Since the patient improved considerably after this procedure, the gallbladder and the cholecystoduodenal fistula were left in place.
The risk of ipsilateral versus contralateral recurrent deep vein thrombosis in the leg
Authors: Lindmarker P. , Schulman S. ,   THE DURAC TRIAL STUDY GROUP
Published: March 2003

Abstract. Lindmarker P, Schulman S, the DURAC Trial Study Group (Karolinska Hospital, Karolinska Institute, Stockholm, Sweden) The risk of ipsilateral versus contralateral recurrent deep vein thrombosis in the leg. J Intern Med 2000; 247: 601–606.Objectives. To investigate the risk of ipsilateral versus contralateral recurrent deep vein thrombosis in the leg.Design. An open prospective long term follow‐up multicentre trial. Patients were followed by frequent outpatient visits at each centre during the first 12 months after inclusion and thereafter annually.Setting. Sixteen hospitals in central Sweden.Subjects. A total of 790 consecutive patients with objectively verified first episode of acute deep vein thrombosis and without diagnosed malignant disease were recruited from a randomized study comparing 6 weeks with 6 months of oral antivitamin K therapy as secondary thromboprophylaxis.Main outcome measures. Deep vein thrombosis in the contralateral leg was confirmed by venography or ultrasound. With regard to the ipsilateral leg, venography was required.Results. A recurrent episode of venous thromboembolism was documented in 192 patients after a mean (±SD) period of 31(±29) months. In 26 additional patients with ipsilateral symptoms the diagnostic critera were not fulfilled. One hundred and eleven patients have deceased and 69 patients withdrew from the study. The 392 patients without recurrent episodes were followed for a median of 96 months with 90% for at least 48 months. An objectively verified recurrent contralateral and ipsilateral deep vein thrombosis occurred in 95 and 54 cases, respectively, and in 41 patients pulmonary embolism was documented. In two patients thromboses with unusual locations were registered. The risk of contralateral versus ipsilateral recurrence was significantly increased with a risk ratio of 1.6 (95% confidence interval 1.4–1.9) in a time to event model. In a multivariate analysis none of the investigated variables were significantly associated with the side of recurrent thrombosis.Conclusions. The risk of a recurrent deep vein thrombosis is increased in the contralateral leg. This brings into question the importance of an impaired venous flow for recurrent episodes of thrombosis.
Early postoperative growth hormone levels: high predictive value for long‐term outcome after surgery for acromegaly
Authors: Valdemarsson S. , Ljunggren S. , Bramnert M. , Norrhamn O. , Nordström C. H. 
Published: March 2003

Abstract. Valdemarsson S, Ljunggren S, Bramnert M, Norrhamn O, Nordström CH (Lund University Hospital, Lund, and Malmö University Hospital, Malmö, Sweden). Early postoperative growth hormone levels: high predictive value for long‐term outcome after surgery for acromegaly. J Intern Med 2000; 247: 640–650.Objectives. To explore the prognostic value of early – within 1 week – postoperative growth hormone (GH) measurements with regard to outcome after surgery for acromegaly in a short‐ and a long‐term perspective.Design. Retrospective study of patients operated on between 1987 and 1998, including follow‐up for up to 60 months.Setting. University hospital.Subjects. Sixty‐eight patients with acromegaly.Intervention. Pituitary surgery aiming at adenomectomy with preservation of pituitary function.Main outcome measures. The effect of the operation was evaluated after 3 months, mostly by means of an oral glucose load or by insulin‐like growth factor 1 (IGF‐1). The specificity, sensitivity and the predictive values of an early postoperative mean GH concentration ≤ 4.8 mU L–1, as well as of the GH response to thyrotropin‐releasing hormone (TRH) 3 months after surgery, were calculated with regard to outcome of the operation in both 3‐month and long‐term perspectives.Results. Fifty patients (73.5%) showed a satisfactory effect at the evaluation 3 months postoperatively; 45 of these were followed between 12 and 60 months. Relapse was registered in five cases: 12, 12, 24, 24 and 48 months after surgery.In the long‐term perspective, the predictive value of an early mean GH ≤ 4.8 mU L–1 was 93.6% with regard to a satisfactory effect of surgery, compared with 90.2% for a normalized somatomedin C (SmC)/IGF‐1 and 90.0% for an absent GH response after TRH. An early mean GH > 4.8 mU L–1 had a 77.8% predictive value for persistent or recurrent disease, compared with 85.7% for persistently increased SmC/IGF‐1 and 68.8% for an abnormal GH release after TRH 3 months after surgery.In the short‐term perspective, the specificity and the predictive value of an early GH ≤ 4.8 mU L–1 were 77.3 and 97.1%, respectively. Early GH > 4.8 mU L–1 had a 94.4% sensitivity but a predicative value of only 63.0% for an unsatisfactory effect.Conclusion. Measurement of GH within 1 week after surgery is highly predictive for outcome of surgery for acromegaly. Specifically, an early mean GH ≤ 4.8 mU L–1 is as predictive for a satisfactory effect of treatment as a normalized IGF‐1 3 months after surgery. Early postoperative GH values > 4.8 mU L–1 have a high sensitivity for persistent or recurrent disease in both the short‐ and long‐term perspectives, but lower predictive value. The usefulness of the TRH test can be questioned.
Insulin resistance and intima–media thickness in the carotid and femoral arteries of clinically healthy 58‐year‐old men. The Atherosclerosis and Insulin Resistance Study (AIR)
Authors: Bokemark L. , Wikstrand J. , Attvall S. , Hulthe J. , Wedel H. , Fagerberg B. 
Published: March 2003

Abstract. Bokemark L, Wikstrand J, Attvall S, Hulthe J, Wedel H, Fagerberg B (Sahlgrenska University Hospital, and the Nordic School of Public Health, Göteborg, Sweden). Insulin resistance and intima–media thickness in the carotid and femoral arteries of clinically healthy 58‐year‐old men. The Atherosclerosis and Insulin Resistance Study (AIR). J Intern Med 2001; 249: 59–67.Objective. To examine whether insulin resistance was associated with ultrasound‐assessed measures of atherosclerosis in men with varying degrees of obesity.Design. A random selection of subjects from the general population were divided into quintiles of a body mass index/blood glucose score that was shown to be a valid and reproducible index of the degree of insulin sensitivity as assessed by the clamp technique. Every fourth man in quintiles 1 and 5 and every 20th man in quintiles 2–4 (in total, 104 men) were selected for an ultrasound examination of the carotid and femoral arteries and a euglycaemic hyperinsulinaemic clamp examination, adjusted for fat‐free mass.Setting. A university hospital.Subjects. A total of 104 clinically healthy 58‐year‐old men of Swedish ancestry.Results. The mean common carotid artery intima–media thickness (IMT), but not the common femoral IMT, correlated significantly with glucose infusion rate (GIR) (r = − 0.20, P < 0.05), systolic blood pressure (r = 0.20, P < 0.05), pulse pressure (r = 0.23 P < 0.01), heart rate (r = 0.20, P < 0.05), HDL cholesterol (r = − 0.18, P < 0.05), log triglycerides (r = 0.28, P < 0.01), apoA1 (r = − 0.20, P < 0.05), apoB (r = 0.21, P < 0.05), LDL particle size (r = − 0.22, P < 0.05) and plasma insulin (r = 0.20, P < 0.05). In a multiple regression, common carotid IMT was independently associated with log triglycerides (β = 0.25, P = 0.012) and pulse pressure (β = 0.21, P = 0.031) (R2 = 8.7%, P = 0.005)Conclusions. Insulin sensitivity, measured with the gold standard euglycaemic hyperinsulinaemic clamp method, showed similar associations with ultrasound‐assessed measures of atherosclerosis in the carotid arteries as established cardiovascular risk factors, but only triglycerides and pulse pressure contributed independently to the variability in the common carotid intima–media thickness.
Almost all institutionalized women are osteoporotic, when measured by heel and finger ultrasound
Authors: Ekman A. , Michaëlsson K. , Ljunghall S. , Mallmin H. 
Published: March 2003

Abstract. Ekman A, Michaëlsson K, Ljunghall S, Mallmin H (University Hospital, Uppsala, Sweden). Almost all institutionalized women are osteoporotic, when measured by heel and finger ultrasound. J Intern Med 2001; 249: 173–180. Objectives. Since there is a need for simple methods to identify individuals with osteoporosis, we investigated bone status (heel and finger) with ultrasound in an institutionalized elderly population and studied the association between these measures, risk factors for osteoporosis and prevalent osteoporotic fractures. Design. Cross‐sectional study. Subjects. Nursing home residents, 237 women and 84 men, mean age 84 years. Results. Altogether 82% of those eligible could undergo heel ultrasound, 65% finger ultrasound and 41% measurements at both sites. Using a transcription of the WHO criterion of osteoporosis, 95% of the women who underwent heel ultrasound were classified as osteoporotic (mean T‐score =–4.8) and 92% had Z‐scores below zero (mean Z‐score=–1.6), whereas 51% of the men were osteoporotic (mean T‐score=–2.6) and 77% had Z‐scores below zero (mean Z‐score=–1.3). Based on finger ultrasound measurements, 99% of the women were classified as osteoporotic (mean T‐score=–5.0) and 93% had Z‐scores below zero (mean –1.6). The variations in ultrasound values were only moderately explained by age, current weight and walking ability. Amongst women, the association with a prevalent osteoporotic fracture decreased by 43% (95% CI=10–63%) for every SD increase in speed of sound (SOS) of the heel, but no such relationship was found for finger SOS. Conclusions. Our results from ultrasound measurements at two different anatomical sites indicate that virtually all institutionalized elderly women could be classified as osteoporotic, when measured by these techniques.
Bioinformatic and experimental tools for identification of single‐nucleotide polymorphisms in genes with a potential role for the development of the insulin resistance syndrome
Authors: Bennet A. M. , Näslund T. I. , Morgenstern R. , De Faire U. 
Published: March 2003

Abstract. Bennet AM, Näslund TI, Morgenstern R & De Faire U (Divisions of Cardiovascular Epidemiology and Biochemical Toxicology, Institute of Environmental Medicine, Karolinska Institute and Department of Medicine, Karolinska Hospital, Stockholm, Sweden). Bioinformatic and experimental tools for identification of single nucleotide polymorphisms in genes with a potential role for the development of the insulin resistance syndrome. J Intern Med 2001; 249: 127–136. Objectives. Genes with a possible role for the development of the insulin resistance syndrome (IRS) were scanned for novel single‐nucleotide polymorphisms (SNPs) using bioinformatics. Methods. GenBank mRNA sequences were compared to the human EST database using gapped BLAST, software that is available on the internet. Mismatches between the search and the EST sequences indicated potential SNPs. Thirty‐two SNPs in 13 genes were randomly chosen for experimental verification. PCR and direct sequencing were used to determine the ‘true’ SNPs. A random sample of 30 Swedish men with slightly elevated diastolic blood pressure (85–94 mmHg) obtained from a population‐based study was selected for the sequencing. After completion of these stages, the potential SNPs were checked against the large and rapidly expanding SNP databases HGBASE and NCBI. Results. EST searches of 146 genes revealed 106 potential SNPs in 44 genes. Experimental analysis of 32 of these potential SNPs verified two SNPs; endothelin receptor A 1471 G/C (3′ UTR) and PAI‐1 Trp514Arg from a T/C exchange. These two SNPs were also identified in the NCBI and HGBASE databases together with two polymorphisms that were not experimentally identified in our homogenous Swedish population. Overall, the HGBASE and NCBI databases contained entries of 22% (23 out of 106) of the SNPs identified through our EST searches. Conclusions. In the search for genetic variations causing complex diseases like IRS in homogenous populations (such as the Swedish one used here), important information can be obtained through bioinformatic searches of human genome databases and experimental verification.