bluuebunny/crossref_metadata_2025_split huggingface dataset:
Pericardiocentesis guided by 2‐D echocardiography: the method of choice for treatment of pericardial effusion
Authors: Lindenberger M. , Kjellberg M. , Karlsson E. , Wranne B. 
Published: December 2004

Abstract.  Lindenberger M, Kjellberg M, Karlsson E, Wranne B (Linköping University, Linköping, Sweden). Pericardiocentesis guided by 2‐D echocardiography: the method of choice for treatment of pericardial effusion. J Intern Med 2003; 253: 411–417.Background.  Percutaneous pericardiocentesis guided by 2‐D echocardiography has been used at Linköping Heart Centre since 1983.Aim.  To evaluate our experience of this method including a follow‐up and also to determine the aetiology of pericardial effusion.Methods.  A retrospective study including 120 of 252 consecutive patients punctured.Results.  The two most common aetiologies were cardiac surgery (77% valve surgery), followed by malignant disease. The postsurgical effusions became clinically important a median of 12 days after surgery (range 0–56 days). The median survival in the group with malignant disease was 89 days (30‐day survival 87%, 1‐year survival 10%). Indwelling catheter was used in 93% of the patients. There was no mortality but one patient needed a second pericardiocentesis after an accidental puncture of the right ventricle. Nine patients had rhythm aberrations. Recurring effusion that needed puncture was seen in 8%.Conclusion.  Pericardiocentesis guided by 2‐D echocardiography is a safe and efficient method to treat pericardial effusion and also valuable as palliative treatment for patients with malignant aetiology of the effusion.
The hypothalamus–pituitary function after pituitary stereotactic radiosurgery: evaluation of growth hormone deficiency
Authors: Degerblad M. , Brismar K. , Rähn T. , Thorén M. 
Published: December 2004

Abstract.  Degerblad M, Brismar K, Rähn T, Thorén M (Karolinska Hospital, Stockholm, Sweden). The hypothalamus–pituitary function after pituitary stereotactic radiosurgery: evaluation of growth hormone deficiency. J Intern Med 2003; 253: 454–462.Objectives.  Radiation therapy to the pituitary gland means a considerable risk of developing hypopituitarism. The aim of the study was to investigate the growth hormone releasing hormone (GHRH)–growth hormone (GH)–insulin‐like growth factor‐I (IGF‐I) axis after treatment with stereotactic radiosurgery to the pituitary because of Cushing's disease.Setting.  Inpatient ward in university clinic.Subjects.  Eleven adult patients (eight women, three men), 20–65 years of age were studied 2.5–11.3 years after stereotactic radiosurgery (isocentre dose 50–100 Gy lesion−1) and compared with healthy controls.Main outcome measures.  Spontaneous GH secretion was evaluated as 12‐h night GH profiles. Stimulated GH responses were evaluated in seven of 11 patients using arginine–insulin and GHRH tests. Serum IGF‐I levels were measured in fasting serum morning samples.Results.  All patients except one displayed blunted nocturnal GH profiles. After arginine–insulin challenge, six of seven patients displayed low GH release. GH response was higher after GHRH injection compared with both the response to arginine–insulin and to the maximum GH levels in the nocturnal profiles. Seven patients had an IGF‐I standard deviation score (SDS) within the normal range for age. Serum IGF‐I values were correlated to mean GH values in the 12‐h night profile (r = 0.67, P < 0.05) and both these variables were negatively correlated to time elapse since last radiation treatment (r = −0.64, P < 0.05 and r = −0.78, P < 0.05, respectively).Conclusions.  Our patients with Cushing's disease evaluated several years after stereotactic radiosurgery as the primary and only treatment, demonstrated severely blunted spontaneous GH secretion and GH response to arginine–insulin. A disturbed regulation at the hypothalamic level was suggested as mechanism for this. Noteworthy is that serum IGF‐I values correlated to the mean values of the 12‐h GH profile.
Septal alcohol ablation and Heyde's syndrome revisited
Authors: Riis Hansen P. , Hassager C. 
Published: December 2004

Abstract. Riis Hansen P, Hassager C (Gentofte University Hospital, Hellerup, Denmark). Septal alcohol ablation and Heyde's syndrome revisited. (Case Report). J Intern Med 2003; 253: 490–491.We describe a 57‐year‐old male with hypertrophic obstructive cardiomyopathy and occult blood loss. Septal alcohol ablation reduced the left ventricular outflow tract obstruction and eliminated recurrent bleeding. The case resembles Heyde's syndrome, i.e. the association between occult gastrointestinal bleeding and aortic valve stenosis, where resolution of blood loss after corrective aortic valve surgery has also been reported.
Multiple risk factor intervention reduces cardiovascular risk in hypertensive patients with echolucent plaques in the carotid artery
Authors: Schmidt C. , Fagerberg B. , Wikstrand J. , Hulthe J. ,   ON BEHALF OF THE RIS STUDY GROUP
Published: December 2004

Abstract.  Schmidt C, Fagerberg B, Wikstrand J, Hulthe J on behalf of the RIS Study Group (Wallenberg Laboratory for Cardiovascular research, Sahlgrenska University Hospital, Göteborg University, Gothenburg, Sweden for the RIS Study Group*). Multiple risk factor intervention reduces cardiovascular risk in hypertensive patients with echolucent plaques in the carotid artery. J Intern Med 2003; 253: 430–438.Objective.  In a previously published randomized 6‐year study we observed that multiple risk factor intervention reduced cardiovascular risk in high‐risk hypertensive men, and that this effect was confined to patients with carotid artery plaques. Hypothetically, the underlying mechanism might have been a stabilization of echolucent, instable, rupture‐prone plaques. The aim of the present study was to examine plaque characteristics by B‐mode ultrasound in the previous intervention study, and also to investigate the relationship between plaque characteristics at baseline and cardiovascular events during the 6‐year follow‐up in the two randomization groups.Methods.  High resolution B‐mode ultrasound was used to characterize plaque echogenicity in four subgroups – dominantly echolucent, substantially echolucent, dominantly echogenic, and uniformly echogenic.Results.  In the usual care group 17 of 32 (53%) patients with echolucent plaques at baseline suffered from a combined end‐point (any death or nonfatal myocardial infarction or nonfatal stroke) during follow‐up compared with seven of 28 (25%) patients in the intervention group (P = 0.036). The corresponding numbers in patients with echogenic plaques were n = 4/13 (31%) and n = 4/17 (24%), respectively (NS). In the usual care group 11 of 33 (33%) patients with no plaques suffered from a combined end‐point during follow‐up compared with 11 of 30 (37%) in the intervention group.Conclusion.  Our data indicate that the beneficial effect of the multiple risk intervention programme was confined to those patients with echolucent plaques. The data have to be confirmed with a large‐scale trial.
Congestive heart failure is associated with the rate of bone loss
Authors: Nishio K. , Mukae S. , Aoki S. , Itoh S. , Konno N. , Ozawa K. , Satoh R. , Katagiri T. 
Published: December 2004

Abstract.  Nishio K, Mukae S, Aoki S, Itoh S, Konno N, Ozawa K, Satoh R, Katagiri T (School of Medicine Showa University, Hatanodai, Shinagawa‐ku, Tokyo, Japan). Congestive heart failure is associated with the rate of bone loss. J Intern Med 2003; 253: 439–446.Aims.  To characterize relationships between mineral homeostasis, bone turnover, bone mass, and congestive heart failure (CHF), we evaluated 75 women with mild to moderate CHF.Methods and results.  We examined the association in annual rate of change in spinal bone mineral density (BMD) with polymorphism of the vitamin D receptor (VDR) gene. Compared with the control group, the CHF group had reduced left ventricular ejection fraction (LVEF: 68.2 ± 7.5% vs. 60.2 ± 12.9%; P = 0.0249), human atrial natriuretic peptide (hANP) was elevated (hANP: 10.7 ± 4.7 pmol L−1 vs. 25.8 ± 24.2 pmol L−1; P = 0.001) and had lower peak VO2 (22.3 ± 7.5 mL kg−1 min−1 vs. 15.8 ± 7.4 mL kg−1 min−1; P = 0.0429). The CHF patients with the VDR FF genotype had a significantly high annual rate of decrease in BMD. In the CHF patients with the VDR FF genotype, urinary calcium excretion (FECa) was elevated (1.40 ± 0.91% vs. 2.39 ± 1.40%; P = 0.028), and serum bone‐type alkaline phosphatase (B‐ALP) was reduced (62.6 ± 13.7 IU L−1 vs. 47.0 ± 18.6 IU L−1; P = 0.0123). Also, FECa was correlated positively with furosemide dose (R = 0.881; P = 0.0087) and hANP concentrations (R = 0.635; P = 0.0147) and negatively with ΔBMD (R = 0.72; P = 0.044) in the CHF patients with the VDR FF genotype.Conclusion.  The CHF patients with the VDR FF genotype have higher rates of bone loss. These patients may need to increase their calcium intake and BMD may need to be followed more carefully over time.
Intermittent versus on‐demand use of a very low calorie diet: a randomized 2‐year clinical trial
Authors: Lantz H. , Peltonen M. , Ågren L. , Torgerson J. S. 
Published: December 2004

Abstract.  Lantz H, Peltonen M, Ågren L, Torgerson JS (Sahlgrenska University Hospital, Göteborg, Sweden). Intermittent versus on‐demand use of a very low calorie diet: a randomized 2‐year clinical trial. J Intern Med 2003; 253: 463–471.Objectives.  To compare two different very low calorie diet (VLCD)‐based weight maintenance strategies.Design and setting.  A randomized 2‐year clinical trial performed at the Department of Body Composition and Metabolism, Sahlgrenska University Hospital, Sweden.Subjects.  A total of 334 patients, body mass index (BMI) >30 kg m−2, aged 18–60 years.Interventions.  All the patients started with 16 VLCD weeks. Subjects in the intermittent group were then scheduled to use VLCD for 2 weeks every third month, whilst patients in the on‐demand group were instructed to use VLCD whenever their body weight passed an individualized cut‐off level. Irrespective of the treatment group, all the subjects were recommended a hypocaloric diet during VLCD‐free periods.Main outcome measures.  Changes in body weight, body composition, anthropometric variables and cardiovascular risk factors.Results.  Completers in both groups maintained highly significant weight losses after 2 years: 7.0 ± 11.0 kg (6.2 ± 9.5%) in the intermittent group and 9.1 ± 9.7 kg (7.7 ± 8.1%) in the on‐demand group (P < 0.001, ns between groups). Male completers in the on‐demand group lost significantly more weight than men in the intermittent group, 14.5 ± 11.0 kg vs. 4.0 ± 10.5 kg, respectively (P < 0.01). Most cardiovascular risk factors improved during the first year, whilst anthropometric measures, insulin, HDL‐ and LDL‐cholesterol were also significantly improved after 2 years of treatment.Conclusion.  Clinically significant weight reductions were achieved after 2 years of VLCD‐based treatment. The structure of VLCD treatment during the maintenance phase did not affect weight loss in the total study population, whilst male subjects might benefit from the VLCD on‐demand strategy.
Insulinoma presenting with hyperandrogenism: a case report and a literature review
Authors: Stanciu I. N. , Pitale S. , Prinz R. A. , Jakate S. , Webb G. , Steiner D. , Braithwaite S. , Gordon D. , Emanuele M. A. 
Published: December 2004

Abstract. Stanciu IN, Pitale S, Prinz RA, Jakate S, Webb G, Steiner D, Braithwaite S, Gordon D, Emanuele MA (Loyola University Medical Center and Hines VA Hospital, Maywood IL, USA; Rush Presbyterian St Luke's Medical Center, Chicago, IL, USA; University of Chicago, Chicago, IL; and UNC Diabetes Care Center, Durham, NC, USA). Insulinoma presenting with hyperandrogenism: a case report and a literature review (Case Report). J Intern Med 2003; 253: 484–489.An 18‐year‐old woman presented with a 6‐month history of amenorrhoea and hyperandrogenism. Three months later she developed several episodes of fasting hypoglycaemia and was subsequently diagnosed with an insulinoma. Hyperinsulinaemia was observed in association with an elevated serum testosterone level. Surgical removal of the insulinoma resulted in resolution of the clinical and biochemical features of the polycystic ovarian syndrome (PCOS). Polycystic ovarian syndrome is unusual in a patient having an insulinoma. The rarity of this association may be the result of the late age of onset of this type of tumour, intermittent secretion of excessive insulin by the tumour, the degree of hyperinsulinism or other factors extrinsic to the insulin receptor that may facilitate insulin activity. However, we could not discover how our patient differs in having had PCOS from the majority of women with insulinoma who do not. If other patients with insulinoma are subsequently found to have hyperandrogenism, then this tumour might be added to the differential diagnosis of causes of anovulatory cycles and hyperandrogenaemia, although rare the association would be uncommon.
Benefit and risk perceptions in transfusion medicine: blood and blood substitutes
Authors: Lowe K. C. , Ferguson E. 
Published: December 2004

Abstract.  Lowe KC, Ferguson E (University of Nottingham, Nottingham, UK). Benefit and risk perceptions in transfusion medicine: blood and blood substitutes (Minisymposium). J Intern Med 2003; 253: 498–507.Blood transfusion is a remarkably safe, routine procedure in clinical medicine. However, little attention has focused on the perceptions of risk associated with the receipt of blood, blood products or ‘blood substitutes’. It is pertinent to ask (i) what key stakeholder groups know about transfusion, (ii) how safe they perceive blood/blood products to be, (iii) how the latter information might influence their own and others' perceptions of risk linked to transfusion, and (iv) the extent to which approved blood substitutes might be preferred over autologous or donor blood. An appreciation of what stakeholders perceive to be the benefits and risks of the receipt of blood and blood substitutes will inform future transfusion strategies. To obtain such information, a programme of research has been initiated at Nottingham. Surveys have targeted key stakeholder groups, namely, UK adult blood donors and nondonors, anaesthetists, general practitioners and health care journalists. Experimental studies examining message framing and cueing have also been conducted with undergraduate students. Such research will improve misunderstandings about current issues associated with blood donation and transfusion against the backdrop of changing public trust of health care professionals and attitudes and expectations on blood safety and benefits of blood substitutes.
Serum uric acid in traditional Pacific Islanders and in Swedes
Authors: Lindeberg S. , Cordain L. , Råstam L. , Ahrén B. 
Published: December 2004

Abstract.Background.  In some western populations, increased serum uric acid has been positively associated with cardiovascular disease, possibly because hyperuricaemia could be an untoward part of the insulin‐resistant metabolic syndrome. However, there is evidence that uric acid is a free radical scavenger capable of inhibiting LDL oxidation. Amongst the traditional horticulturalists of Kitava, Trobriand Islands, Papua New Guinea, cardiovascular disease, hypertension, hyperinsulinaemia and abdominal obesity are absent or rare. In contrast, serum triglycerides are similar to Swedish levels.Objective.  To compare serum uric acid between nonwesternized and westernized populations.Methods.  Fasting levels of serum uric acid were measured cross‐sectionally in 171 Kitavans aged 20–86 years and in 244 randomly selected Swedish subjects aged 20–80 years.Results.  There were small differences in serum uric acid between the two populations, although a slight increase with age was found only in Swedish males (r = 0.20; P = 0.03) and females (r = 0.36; P < 0.0001). Above 40 years of age, uric acid was approximately 10% lower in Kitavans, a difference which was statistically significant only in males, possibly because of the limited number of females. Regarding hyperuricaemia, two Kitavan males had uric acid above 450 μmol L−1 whilst none of the females was above 340 μmol L−1. Amongst the Swedish subjects, five of 117 males and 19 of 127 females had hyperuricaemia according to these definitions.Conclusion.  The rather similar uric acid levels between Kitava and Sweden imply that uric acid is of minor importance to explain the apparent absence of cardiovascular disease in Kitava.
Oral snuff impairs endothelial function in healthy snuff users
Authors: Rohani M. , Agewall S. 
Published: December 2004

Abstract.Aims.  Oral snuff is a less dangerous drug and therefore a good substitute for cigarette smoking. The aim of this study was to determine whether oral moist snuff induces acute endothelial dysfunction. Previous studies have shown that endothelial dysfunction predicts cardiovascular morbidity.Methods and results.  Twenty healthy middle‐aged snuff users underwent ultrasound assessment of endothelial‐dependent flow‐mediated dilatation (FMD) of the brachial artery. FMD measurements were performed in duplicate at baseline and then 20 and 35 min after the administration of 1 g portion‐bag‐packed moist snuff or placebo. Ten of the subjects were examined twice according to a randomized cross‐over procedure, once with snuff and once with placebo. All images were arbitrarily analysed off‐line by a single blinded observer. FMD values declined significantly from 3.4 ± 2.0% to 2.3 ± 1.3% (P < 0.05) 35 min after the administration of 1 g oral moist snuff. Heart rate, systolic and diastolic blood pressure increased significantly (P < 0.05) after snuff administration. All parameters remained unchanged after placebo.Conclusions.  Oral moist snuff significantly impaired FMD of the brachial artery. As endothelial dysfunction predicts cardiovascular morbidity, use of oral snuff should be discouraged.
Body composition and bone mineral density in long‐standing type 1 diabetes
Authors: Ingberg C.‐M. , Palmér M. , Åman J. , Arvidsson B. , Schvarcz E. , Berne C. 
Published: December 2004

Abstract.Objectives.  To study body composition and bone mineral density (BMD) in adult patients with long‐standing type 1 diabetes mellitus.Research design and methods.  In a population‐based study, body composition and BMD were evaluated by dual energy X‐ray absorptiometry in 38 patients with type 1 diabetes since childhood, compared with 38 age‐ and sex‐matched controls. The mean age was 43 years (range 33–55 years) and the mean duration of diabetes was 33 years (range 28–37 years).Results.  Besides a tendency to a reduced abdominal fat mass in diabetic males, no difference was observed in fat mass, muscle mass, or BMD between the groups. Significant correlations were found between insulin dosage and whole body fat mass in diabetic females and between serum cholesterol levels and abdominal fat mass in diabetic males.Conclusion.  Patients with long‐standing type 1 diabetes with onset in childhood and adolescence seem to show only minor differences in body composition and no difference in BMD compared with closely matched healthy controls.
Pharmacodynamics, chiral pharmacokinetics and PK–PD modelling of ketoprofen in the goat
Authors: Arifah A. K. , Landoni M. F. , Lees P. 
Published: December 2004

There have been few studies of the pharmacodynamics of nonsteroidal antiinflammatory drugs (NSAIDs) using PK–PD modelling, yet this approach offers the advantage of defining the whole concentration–effect relationship, as well as its time course and sensitivity. In this study, ketoprofen (KTP) was administered intravenously to goats as the racemate (3.0 mg/kg total dose) and as the single enantiomers,S(+) KTP andR(−) KTP (1.5 mg/kg of each). The pharmacokinetics and pharmacodynamics of KTP were investigated using a tissue cage model of acute inflammation. The pharmacokinetics of both KTP enantiomers was characterized by rapid clearance, short mean residence time (MRT) and low volume of distribution. The penetration ofR(−) KTP into inflamed (exudate) and noninflamed (transudate) tissue cage fluids was delayed but area under the curve values were only slightly less than those in plasma, whereasMRTwas much longer. TheS(+) enantiomer of KTP penetrated less readily into exudate and transudate. Unidirectional inversion ofR(−) toS(+) KTP occurred. Both rac‐KTP and the separate enantiomers produced marked inhibition of serum thromboxane B2(TxB2) synthesis (ex vivo) and moderate inhibition of exudate prostaglandin E2(PGE2) synthesis (in vivo); pharmacodynamic variables forS(+) KTP wereEmax(%) = 94 and 100; IC50(μg/mL) = 0.0033 and 0.0030;N = 0.45 and 0.58, respectively, whereEmaxis the maximal effect, IC50the plasma drug concentration producing 50% ofEmaxandNthe slope of log concentration/effect relationship. The IC50ratio, serum TxB2:exudate PGE2was 1.10. Neither rac‐KTP nor the individual enantiomers suppressed skin temperature rise at, or leucocyte infiltration into, the site of acute inflammation. These data illustrate for KTP shallow concentration–response relationships, probable nonselectivity of KTP for cyclooxygenase (COX)‐1 and COX‐2 inhibition and lack of measurable effect on components of inflammation.
Peginterferon α‐2a (40 kDa): an advance in the treatment of hepatitis B e antigen‐positive chronic hepatitis B
Authors: Cooksley W. G. E. , Piratvisuth T. , Lee S.‐D. , Mahachai V. , Chao Y.‐C. , Tanwandee T. , Chutaputti A. , Chang W. Yu , Zahm F. E. , Pluck N. 
Published: December 2004

Summary.Current therapies for chronic hepatitis B (CHB) have a number of limitations, and better treatment options are needed. Peginterferon α‐2a (40 kDa) is superior to conventional interferon α‐2a in the treatment of chronic hepatitis C. This is the first report on peginterferon α‐2a (40 kDa) in the treatment of CHB. In this phase II study, 194 patients with CHB not previously treated with conventional interferon‐α were randomized to receive weekly subcutaneous doses of peginterferon α‐2a (40 kDa) 90, 180 or 270 μg, or conventional interferon α‐2a 4.5 MIU three times weekly. Twenty‐four weeks of therapy were followed by 24 weeks of treatment‐free follow‐up. All subjects were assessed for loss of hepatitis B e antigen (HBeAg), presence of hepatitis B antibody (anti‐HBe), suppression of hepatitis B virus (HBV) DNA, and normalization of serum alanine transaminase (ALT) after follow‐up.At the end of follow‐up, HBeAg was cleared in 37, 35 and 29% of patients receiving peginterferon α‐2a (40 kDa) 90, 180 and 270 μg, respectively, compared with 25% of patients on conventional interferon α‐2a. The combined response (HBeAg loss, HBV DNA suppression, and ALT normalization) of all peginterferon α‐2a (40 kDa) doses combined was twice that achieved with conventional interferon α‐2a (24%vs 12%; P = 0.036). All treatment groups were similar with respect to frequency and severity of adverse events. These results indicate that peginterferon α‐2a (40 kDa) is superior in efficacy to conventional interferon α‐2a in chronic hepatitis B based on clearance of HBeAg, suppression of HBV DNA, and normalization of ALT.
A non‐invasive technique for identifying individual badgers Meles meles
Authors: DIXON DAVID R. 
Published: December 2004

ABSTRACTIndividual badgers Meles meles can be reliably identified in the field on the basis of variation in the appearance of the tail. Tests of the technique using video surveillance demonstrated that in 95% of instances individuals were identified correctly on the basis of tail patterns. It is possible that tail patterns and posture may be a significant means of communication in this species.