bluuebunny/crossref_metadata_2025_split huggingface dataset:
Hyperthyroidism and pulmonary hypertension
Authors: Thurnheer R. , Jenni R. , Russi E.W. , Greminger P. , Speich R. 
Published: November 2003

Thurnheer R, Jenni EW, Russi P, Greminger P, Speich R (Department of Internal Medicine, University Hospital, Zürich, Switzerland). Hyperthyroidism and pulmonary hypertension (Case report). J Intern Med 1997; 242: 185–8.ObjectivesTo identify patients with hyperthyroidism and coincidental pulmonary hypertension and to document reversibility of pulmonary hypertension after treatment of hyperthyroidism.DesignPatients with hyperthyroidism referred for transthoracal echocardiography for any reason that showed elevated pulmonary arterial pressures were collected. After therapy for the thyreotoxic state with documented normalization of thyroid hormone (fT4), pulmonary arterial pressure was measured again noninvasively.SettingAn out‐patient tertiary referral centre.SubjectsThe medical records were used to identify, retrospectively, patients with hyperthyroidism and pulmonary hypertension over a three‐year period (April 1993 to April 1996).Interventions and main outcome measuresSystolic pulmonary artery pressure (PAPs) was determined by adding up right ventricular systolic pressure (RVSP) and mean right atrial pressure (RAP) measured by continuous‐wave Doppler echocardiography according to standard techniques. All patients were treated for hyperthyroidism to normal fT4 levels. After successful therapy, Doppler echocardiography was repeated.ResultsFour patients with pulmonary hypertension showing elevated PAPs of 40 ± 11 mmHg were identified. After therapy, PAPs decreased in all patients to a mean of 25 ± 6 mmHg.ConclusionThe observation of four patients with pulmonary hypertension and hyperthyroidism is striking and suggests a possible pathogenetic link of these disorders.
An unusual case of severe combined immunodeficiency with hypereosinophilia
Authors: Dams E. Th. M. , Mascart‐Lemone F. , Schandené L. , van der Meer J. W. M. 
Published: November 2003

Dams ETHM, Mascart‐Lemone F, Schandené L, van der Meer JWM (University Hospital Nijmegen, Nijmegen, The Netherlands, and Hôpital Erasme, Brussels, Belgium). An unusual case of severe combined immunodeficiency with hypereosinophilia (Case Report). J Intern Med 1997; 242: 267–9.Investigation of the cytokine profile in a 26‐year‐old man, suffering from combined immunodeficiency with hypereosinophilia, revealed high levels of interleukin‐4 and interleukin‐5 and relatively low levels of interleukin‐2 and interferon gamma, consistent with a T‐helper type 2 pattern, as has been reported in Omenn's syndrome. However, some distinct clinical and immunological features suggest that this case may represent a unique disease with specific pathogenesis.
Quality of life in patients with ischaemic heart disease: a prospective controlled study
Authors: Westin L. , Carlsson R. , Israelsson B. , Willenheimer R. , Cline C. , McNeiL T. F. 
Published: November 2003

Westin L, Carlsson R, Israelsson B, Willenheimer R, Cline C, McNeil TF (University of Lund, University Hospital, Malmö, Sweden). Quality of life in patients with ischaemic heart disease: a prospective controlled study. J Intern Med 1997; 242: 239–47.ObjectivesTo assess quality of life in patients after acute myocardial infarction (AMI), coronary artery by‐pass grafting surgery (CABG) and percutaneous transluminal coronary angioplasty (PTCA) as compared with healthy controls.DesignSelf‐administered questionnaires were completed 1 month and 1 year after the event.SettingDepartment of Cardiology, University Hospital, Malmö, Sweden; 1989–1992.Subjects296 AMI, 99 CABG, 18 PTCA patients and 88 randomly selected healthy controls were included; 349 patients completed the entire programme.Main outcome measuresQuality of life in the dimensions of perceived general health, thoracic pain, breathlessness, feeling of arrhythmia, anxiety, depression, self‐esteem, experience of social life and sex life.ResultsPatients differed from controls in both psychological and somatic aspects of QL after 1 month. Furthermore, 1 month after the event AMI patients experienced more anxiety (P= 0.001) than CABG patients, whilst CABG patients experienced a poorer sex life (P < 0.001) than AMI patients. One year after the event patients differed from controls primarily in somatic symptoms; no significant differences were found across patient groups. Patients who sought emergency out‐patient care during the follow‐up year for clinically diagnosed angina pectoris or cardiac incompensation had reported higher levels of thoracic pain (P < 0.001) and breathlessness (P < 0.001) at 1 month follow‐up than patients who did not seek such care.ConclusionsQuality of life is considerably affected in patients following a cardiac event, especially during the initial recovery phase. Although substantial improvement in quality of life occurs over time, the persistence of residual distress at 1‐year follow‐up is a challenge for clinicians concerned with the full rehabilitation of the cardiac patient.
The ineffectiveness of cyclical oral clodronate on bone mineral density in glucocorticoid‐treated patients with giant‐cell arteritis
Authors: Nordborg E. , Schaufelberger C. , Andersson R. , Bosaeus I. , Bengtsson B‐Å. 
Published: November 2003

Nordborg E, Schaufelberger C, Andersson R, Bosaeus I, Bengtsson B‐Å (Sahlgrenska University Hospital, Göteborg, Sweden). The ineffectiveness of cyclical oral clodronate on bone mineral density in glucocorticoid‐treated patients with giant‐cell arteritis. J Intern Med 1997; 242: 367–71.Objectives and designThe aim of the present study was to determine whether cyclic oral administration of clodronate, a bisphosphonate, every second month prevents rapid bone loss during the first year of glucocorticoid treatment in patients with giant‐cell arteritis (GCA). The trial was designed as a prospective double blind study, assessing total body mineral content (BMC) and bone mineral density (BMD) using DXA technique. Supplementation of calcium was given to both groups of patients.SettingThe outpatient clinics of the rheumatic and infectious diseases of Sahlgren University Hospital of the city of Göteborg on the west coast of Sweden.SubjectsTwenty‐seven patients with confirmed GCA were consecutively included during a 15‐month period.ResultsAn early influence on bone turnover was found with a temporary decrease in BMC after six months of glucocorticoid treatment, which was normalized after 12 months in both study groups. No significant differences between the patients given clodronate and calcium and the controls, who got supplementation with calcium alone, was observed at any assessment point. However, there was a significant and prolonged depression of the osteocalcin levels in the clodronate‐treated patients.ConclusionsOral administration of clodronate in a moderately high dose given cyclically every other month had no additive effect on BMD compared with calcium supplementation alone during the first year of glucocorticoid treatment. A larger material might have revealed some differences between the categories. In most patients with GCA, however, the BMD seems to recover after one year of glucocorticoid treatment, provided there is good control of the inflammation and patients are kept physically active. It needs to be elucidated whether there are subsets of patients who might benefit from bone sparing agents: women near menopause with a high turnover rate of bone, individuals who have low BMD from the start of glucocorticoid treatment or patients requiring high doses of glucocorticoids during a long period of time.
Social and biological predictors of early menopause: a model for premature aging
Authors: NILSSON P. , MÖLLER L. , KÖSTER A. , HOLLNAGEL H. 
Published: November 2003

Nilsson P, Möller L, Köster A, Hollnagel H (University of Lund, Lund, Sweden; Glostrup University Hospital, Glostrup, and University of Copenhagen, Copenhagen; Denmark). Social and biological predictors of early menopause: a model for premature aging. J Intern Med 1997; 242: 299–305.ObjectivesTo investigate possible social, lifestyle‐related and biological predictors of early menopause in middle‐aged women, followed prospectively for 11 years.DesignA prospective, population‐based, cohort follow‐up, observational study.SettingGlostrup Hospital, Copenhagen, Denmark.SubjectsA total of 493 female subjects, all aged 40 years at baseline, and divided into three groups according to self‐reported menopausal age (40–45, 46–51, 51+ years), after 12 months of amenorrhoea. Women having had medical or surgical interventions to influence menopausal state were excluded.Main outcome measuresBody mass index, glucose, insulin, lipids, creatinine, uric acid, thyroid‐stimulating hormone (TSH), lung function tests (forced VC, FEV1, peak flow), blood pressure; a self‐administered questionnaire with questions on psychosocial variables, lifestyle, and self‐rated health.ResultsAn early menopausal age correlated in an univariate way with impaired lung function, increased smoking habits and low social class (in childhood or present), as well as with a feeling of tiredness, all measured at the baseline investigation. On the contrary, a later menopausal age correlated with higher serum insulin and uric acid levels. In multiple regression analysis, with menopausal age as the dependent variable, it was found that smoking habits (number of years smoking) was inversely (P < 0.001), and insulin as well as uric acid were positively (P < 0.05) correlated with menopausal age.ConclusionsFemales who smoke run an increased risk of early menopause, whereas relative hyperinsulinaemia is independently associated with later menopause. At the age of 40 years, high insulin levels in females might be just a marker for normal female sex hormone physiology, not for insulin resistance, as seen in postmenopausal female subjects. Early menopause might be useful as a potential model of premature ageing.
Does metformin increase the serum total homocysteine level in non‐insulin‐dependent diabetes mellitus?
Authors: Hoogeveen E. K. , Kostense P. J. , Jakobs C. , Bouter L. M. , Heine R. J. , Stehouwer C. D. A. 
Published: November 2003

Hoogeveen EK, Kostense PJ, Jakobs C, Bouter LM, Heine RJ, Stehouwer CDA (Vrije Universiteit, Amsterdam, the Netherlands). Does metformin increase the serum total homocysteine level in non‐insulin‐dependent diabetes mellitus?J Intern Med 1997; 242: 389–94.ObjectiveThe aim of this study was to estimate the effect of metformin on the serum total homocysteine level in non‐insulin‐dependent diabetes mellitus (NIDDM) patients. An elevated serum total homocysteine level is a risk factor for atherosclerosis. Metformin decreases serum vitamin B12, and may thereby indirectly increase the serum total homocysteine level.DesignA cross‐sectional study in a primary care setting.Subjects, main outcome measuresFasting serum total homocysteine level was measured in 40 NIDDM patients who had received treatment with metformin (500–2550 mg per day) for at least six months, and in 71 NIDDM patients not treated with metformin and matched for sex, age (± 5 years), serum creatinine (± 5 μmol L−1) and current smoking habits. ‘Exposed’ patients were matched with ‘nonexposed’ patients. A two‐way analysis of variance was performed.ResultsThe mean serum total homocysteine level was 11.5 μmol L−1 in the metformin‐exposed patients and 10.6 μmol L−1 in the nonexposed patients. Thus, the metformin‐exposed patients had slightly higher serum total homocysteine levels (difference 0.8 μmol L−1, 95% confidence interval (−0.4–2.0 μmol L−1). Results were similar in men and women. Finally, no dose–response relationship between cumulative exposure to metformin (dose × duration of treatment) and the serum total homocysteine level could be demonstrated.ConclusionWe conclude that the effect of metformin on serum total homocysteine level in NIDDM patients, if any, is likely to be small.
Improving empirical antibiotic treatment: prospective, nonintervention testing of a decision support system
Authors: Leibovici L. , Gitelman V. , Yehezkelli Y. , Poznanski O. , Milo G. , Paul M. , Ein‐Dor P. 
Published: November 2003

Leibovici L, Gitelman V, Yehezkelli Y, Poznanski O, Milo G, Paul M & Ein‐dor P (Rabin Medical Centre, Petah‐Tiqva, Sackler Faculty of Medicine, and Faculty of Management, Tel‐Aviv University, Ramat‐Aviv, Tel‐Aviv, Israel). Improving empirical antibiotic treatment: prospective, nonintervention testing of a decision support system. J Intern Med 1997; 242: 395–400.ObjectivesDevelop a problem‐orientated and data‐based decision support system (DSS) to improve empirical antibiotic treatment, and compare the performance of the system to that of the physician.DesignThe DSS was tested in a prospective, noninterventional, comparative cohort study.SettingUniversity hospital in Israel.SubjectsConsecutive patients (n = 496) in four departments of internal medicine suspected of harboring a moderate to severe bacterial infection.InterventionsNone.Main outcome measuresThe percentage of appropriate empirical antibiotic treatments.ResultsOut of 496 patients included in the study, 219 had positive cultures or serological tests. The physicians prescribed inappropriate empirical antibiotic treatment in 91 of 219 patients (42%); whilst the recommendations of the system were inappropriate in 50 patients (23%) (P < 0.05). Superfluous treatment was prescribed in 15% of patients by the physician, and in 11% by the system. Out of the 91 patients given inappropriate treatment by the physician, the DSS advised treatment to which the pathogens were susceptible in 61 patients. The advantage of the DSS over the physician was most evident in multiresistant gram‐negative isolates, enterococci and Staphylococcus aureus.Out of the 277 patients with negative cultures, the DSS advised narrower‐spectrum antibiotic treatment than prescribed by the physicians in 27% of patients, and broader‐spectrum in 13%.ConclusionA problem‐orientated, data‐based DSS outperformed physicians in the choice of appropriate empirical antibiotic treatment, and recommended less broad‐spectrum antibiotics.
The influence of age on low density lipoprotein metabolism: effects of cholestyramine treatment in young and old healthy male subjects
Authors: Ericsson S. , Berglund L. , FrostegÅrd J. , Einarsson K. , Angelin B. 
Published: November 2003

Ericsson S, Berglund L, Frostegård J, Einarsson K, Angelin B (Karolinska Institute at Huddinge University Hospital, Huddinge; and Karolinska Hospital, Stockholm; Sweden). The influence of age on low density lipoprotein metabolism: effects of cholestyramine treatment in young and old healthy male subjects. J Intern Med 1997; 242:329–37.Objective.The plasma concentration of low density lipoproteins (LDL) increases with age, mainly as the result of a reduced clearance of LDL. Because the conversion of cholesterol to bile acids is reduced with age, we hypothesized that the response of plasma LDL to stimulation of bile acid production would be different in young and old subjects.Design, subjects and setting.Comparison of the response to cholestyramine treatment in two groups of normolipidaemic, normal weight males: seven young (23–34 years) and eight old (64–73 years). Outpatients at the metabolic ward of a university hospital given a standardized diet of natural type.InterventionCholestyramine was given 8 g b.i.d. for 3 weeks and continued during the second LDL turnover study.Main outcome measuresKinetics of autologous radiolabelled LDL before and during treatment. Mean values of lipoprotein lipid levels obtained during the two turnover studies. Changes in LDL particle composition and LDL receptor affinity between the two study periods.ResultsBoth age groups responded with decreased levels of LDL cholesterol and apolipoprotein‐B (apoB), the change being more pronounced in the old subjects. The LDL apoB fractional catabolic rate was increased by ≈11% in both groups. In contrast, there was a reduced ability in the old subjects to sustain their production rates for LDL apoB with resin therapy, resulting in a 23% reduction in LDL input. No effect on the apparent LDL apoB synthesis rate was observed in the young subjects. LDL particles isolated from cholestyramine‐treated subjects were triglyceride‐enriched and cholesterol‐depleted, and showed a lowered affinity for the LDL receptor in tissue culture studies.ConclusionsThe results demonstrate that stimulation of bile acid production by cholestyramine treatment decreases LDL cholesterol levels in both young and old subjects. This therapy increases LDL apoB elimination in both age groups, but reduction of apparent LDL apoB production is only seen in old subjects.
Influence of apolipoprotein A‐1 promoter polymorphism on lipid levels and responses to dietary change in Finnish adults
Authors: MENG QING‐HE , PAJUKANTA P. , VALSTA L. , ARO A. , PIETINEN P. , TIKKANEN M. J. 
Published: November 2003

Objectives. To analyse the association between the G/A polymorphism in the apolipoprotein A‐1 (apo A‐1) promoter region and plasma lipid levels, as well as their responses to dietary change, in Finnish adults. Subjects and design. Blood samples from 86 subjects (42 men, 44 women) who attended a dietary intervention study carried out in North Karelia in 1993 were available for the current analysis. The diet study consisted of a 2‐week baseline period, followed by an 8‐week intervention period, and an 8‐week switchback period. Intervention. Diet was modified to a low‐fat, low‐cholesterol diet during the dietary intervention. Main outcome measures. Fasting plasma lipid, lipoprotein and apolipoprotein levels were determined. Results. At baseline, the high‐density lipoprotein (HDL) cholesterol and apo A‐1 levels were higher (P<0.01) and the triglyceride levels were lower (P<0.05) in men, but not in women, with the A allele. The differences in HDL cholesterol and apo A‐1 levels between genotypes remained during the low‐fat, low‐cholesterol diet and switchback periods. Apart from the difference between responses in apo A‐1 during switchback to the original diet, lipid responses to dietary change did not differ significantly between genotypes. Conclusion. Our findings indicate a significant association between the apo A‐1 promoter polymorphism and plasma apo A‐1 and HDL‐cholesterol in men. In theory, the higher plasma HDL‐cholesterol and apo A‐1 levels in the GA/AA group may confer some protection against coronary artery disease. The differences in HDL‐cholesterol and apo A‐1 levels between genotypes persisted during different diets suggesting that the possible benefit is independent of fat and cholesterol intake.
Identifying individuals with high fat levels and low P∶S ratios, in their diets, for intensive dietary intervention
Authors: KINLAY S. , ELLIOTT H. , HELLER R. F. 
Published: November 2003

Objectives. To assess whether simple scores from a dietary questionnaire could identify those with high dietary fat or low P:S ratio intakes, for intensive dietary intervention. Design. Cross‐sectional and longitudinal studies. Setting. Community setting in the Hunter Region of New South Wales, Australia. Subjects. Two random samples of adults 35–69 years from the electoral roll. In the cross‐sectional study 287/322 (86%) subjects completed the diet questionnaire and a reference standard questionnaire. In the longitudinal study 546/653 (84%) of subjects completed the diet questionnaire, and had blood cholesterol measured on two occasions, 3 months apart. Main outcome measures. In the cross‐sectional study, the simple scores of total fat intake (Fat Intake Score) and P:S ratio (Unsaturated Score) were compared with the daily intakes of total fat and P∶S ratio obtained from the standard questionnaire. In the longitudinal study, changes in the scores were compared with changes in blood total cholesterol. Results. A Fat Intake Score of greater than 125 had the best receiver operator characteristics for identifying high total fat intake (>100 g/day; sensitivity=67%, specificity=70%). An Unsaturated Score of less than 0.3 had the best characteristics for identifying a low P:S ratio (<0.5; sensitivity=63%, specificity=60%). Subjects who decreased Fat Intake Score by one category, had a fall in blood cholesterol of 0.14 mmol L−1 (95% confidence interval (CI)=0.01–0.26 mmol L−1), while those decreasing by two categories decreased their blood cholesterol by 0.56 mmol L−1 (95% CI=0.30–0.86 mmol L−1). Subjects increasing their Unsaturated Score category had a fall in blood cholesterol of 0.17 mmol L−1 (95% CI=0.02–0.32 mmol L−1). Conclusion. Simple dietary scores can identify those with high fat intakes, and monitor changes related to changes in blood cholesterol levels.
Alteration of arterial distensibility in systemic sclerosis
Authors: CONSTANS J. , GOSSE P. , PELLEGRIN J.‐L. , ANSOBORLO P. , LENG B. , CLÉMENTY J. , CONRI C 
Published: November 2003

Objectives. To evaluate the distensibility of large arteries in patients with systemic sclerosis (SSc). Design. Prospective case‐control study including unselected patients with SSc. Setting. One cardiology and two internal medicine units in a teaching hospital. Subjects. Eighteen patients with SSc and controls matched for age, sex, height, weight and 24‐h ambulatory blood pressure (BP). Intervention. The timing of Korotkoff's sounds (QKD interval), a newly described noninvasive ambulatory method was used to measure arterial distensibility during 24 h. Main outcome measures. Two endpoints were used: QKD 100–60 (normalized for a heart rate of 100 beats min‐1 and a systolic BP of 100 mmHg) and the slope of QKD against pulse pressure. Results. The patients with SSc had a lower slope of QKD against pulse pressure than the controls (median 0.55, range 0–1.21, versus 0.92, range 0.5–1.34, respectively; P=0.003), and a lower QKD 100–60 (medians/ranges respectively 191 [162–216] and 203 [169–231]; P=0.01). Conclusions. These results indicate that arterial distensibility of large arteries is decreased in SSc.
Intra‐abdominal pressure, sagittal abdominal diameter and obesity comorbidity
Authors: SUGERMAN H. , WINDSOR A. , BESSOS M. , WOLFE L. 
Published: November 2003

Objectives. To determine relationship of intraabdominal pressure to central obesity and the comorbidity of obesity. Design. Non‐randomized, prospective. Setting. University hospital, operating room. Subjects. Eighty‐four anaesthetized consecutive patients prior to gastric bypass for morbid obesity and five non‐obese patients before colectomy for ulcerative colitis. Main outcome measures. Weight, body mass index (BMI), co‐morbid history, sagittal abdominal diameter, waist:hip (W∶H) ratio and urinary bladder pressure, as an estimate of intra‐abdominal pressure. Results. Urinary bladder pressure was greater in the obese than the non‐obese (18±0.7 vs. 7±1.6 cm H2O, P < 0.001), correlated with sagittal abdominal diameter (r = +0.67, P < 0.001) and was greater (P < 0.05) in patients with, than those without, morbidity probably (hypoventilation, gastroesophageal reflux, venous stasis, stress incontinence, incisional hernia) or possibly (hypertension, diabetes) due to increased abdominal pressure. W∶H ratio correlated with urinary bladder pressure in men (r = +0.6, P < 0.05) but not women (r = −0.3). Conclusions. Increased sagittal abdominal diameter was associated with increased intraabdominal pressure which contributed to obesity‐related comorbidity. W∶H ratio was not a reliable indicator of intraabdominal pressure for women who often have both peripheral and central obesity. Further studies are needed to evaluate the relationship between intraabdominal pressure and Type II diabetes and hypertension.