bluuebunny/crossref_metadata_2025_split huggingface dataset:
Relation between incidence of pneumonia and protective reflexes in post‐stroke patients with oral or tube feeding
Authors: Nakajoh K. , Nakagawa T. , Sekizawa K. , Matsui T. , Arai H. , Sasaki H. 
Published: March 2003

Abstract. Nakajoh K, Nakagawa T, Sekizawa K, Matsui T, Arai H, Sasaki H (Tohoku University School of Medicine, Sendai, Japan). Relation between incidence of pneumonia and protective reflexes in post‐stroke patients with oral or tube feeding. J Intern Med 2000; 247: 39–42.Objectives. Although attenuated protective reflexes have been implicated in the development of aspiration pneumonia, the relation between the incidence of pneumonia and the state of these reflexes has not been investigated. Furthermore, the role of feeding tube placement in preventing pneumonia in patients with attenuated protective reflexes is unknown. We studied the relationship between the incidence of pneumonia and the state of cough and swallowing reflexes in post‐stroke patients with oral or tube feeding.Design. The incidence of pneumonia was prospectively analysed for 1 year in three groups of post‐stroke patients on the basis of the following clinical conditions: oral feeding without dysphagia (n = 43); oral feeding with dysphagia (n = 48); and nasogastric tube feeding with dysphagia (n = 52). We also studied the incidence of pneumonia in bedridden patients with nasogastric tube feeding (n = 14). Before the start of the study, the swallowing and cough reflexes of each patient were measured. The swallowing reflex was evaluated according to latency of response, which was timed from the injection of 1 mL of distilled water into the pharynx through a nasal catheter to the onset of swallowing. The cough threshold of citric acid aerosols was defined as the concentration at which the patient coughed five times.Results.; The incidence of pneumonia was observed in patients having both a latency of response longer than 5 s and a cough threshold for citric acid higher than a concentration of 1.35 (log mg mL–1). The incidence of pneumonia was significantly higher in patients with oral feeding than in those with tube feeding (54.3 vs. 13.2%, P < 0.001). In bedridden patients with tube feeding, the latency of response was longer than 20 s and no patient coughed at the highest concentration of citric acid. The incidence of pneumonia was 64.3% in such patients.Conclusions. The state of protective reflexes had a significant relation to the incidence of pneumonia. Feeding tube placement may have a beneficial role in preventing aspiration pneumonia in mildly or moderately disabled post‐stroke patients with attenuated protective reflexes. Bedridden patients who were tube‐fed had the highest incidence of pneumonia.
Plasma total homocysteine levels in subjects with hyperinsulinemia
Authors: Bar‐On H. , Kidron M. , Friedlander Y. , Ben‐Yehuda A. , Selhub J. , Rosenberg I. H. , Friedman G. 
Published: March 2003

Objectives. Hyperhomocysteinemia as well as insulin resistance are considered to be risk factors for the development of coronary artery disease. This study was aimed at determining whether any relationship between plasma insulin and glucose levels and total plasma homocysteine (tHcy) concentrations exists in a population based survey performed 10 years apart.Design and Setting. A cross‐sectional study was undertaken during the years 1986–87 to examine risk factors for diabetes and for coronary artery disease (CAD) in the Jewish population of Jerusalem. Ten years later two groups of individuals were invited for re‐examination.Subjects. Two groups of individuals were examined: the first one consisted of nondiabetic subjects (n = 86), who had hyperinsulinemia 10 years previously (at the first visit), the second group consisted of normoinsulinemic nondiabetic individuals (n = 265) who had initially normal glucose and insulin levels.Main outcome measures. Metabolic, biochemical and anthropomorphic features were determined. Fasting and post load glucose, as well as insulin concentrations on fasting and 2 h post glucose load were measured at the first and second visits. Plasma tHcy and folic acid were determined only at the second visit.Results. The results demonstrated a significant negative correlation between plasma tHcy levels and insulin levels at the second visit. No difference was found in folic acid levels between these two groups.Conclusions. In general, hyperinsulinemia and hyperhomocysteinemia are both related to an increased incidence of CAD. In our population most of the subjects examined had tHcy levels within the normal range and only a few demonstrated very high levels. However, negative association between insulin levels and tHcy concentrations was found. Possible explanations for this finding are discussed.
Cortisol axis abnormalities early after stroke – relationships to cytokines and leptin
Authors: Johansson Å. , Ahrén B. , Näsman B. , Carlström K. , Olsson T. 
Published: March 2003

Abstract. Johansson Å, Ahrén B, Näsman B, Carlström K, Olsson T (Umeå University Hospital, Umeå; Malmö University Hospital, Malmö; Karolinska Instituitet, Huddinge University Hospital, Huddinge, Sweden). Cortisol axis abnormalities early after stroke – relationships to cytokines and leptin. J Intern Med 2000; 247: 179–187.Objective. To assess the relationships between circulating levels of proinflammatory cytokines and adrenocortical hormones and leptin early after stroke.Design. Blood samples were collected four times daily the first two days after stroke, twice daily the next 4 days and four times at day 7. Cognitive function and functional outcome was measured at admittance and at day 7.Setting. Consecutive inclusion of patients admitted to the stroke unit at Umeå University Hospital.Subjects. Eight men and 4 women with acute stroke and 10 healthy volunteers.Main outcome measures. Levels and diurnal variations of plasma proinflammatory cytokines interleukin‐6 (IL‐6) and tumour necrosis factor‐α (TNF‐α), serum adrenocortical hormones (cortisol and DHEA) and leptin, and MMSE, SSS, and ADL scores.Results. A significant correlation was present between IL‐6 and cortisol levels the first two days after stroke (P < 0.05). In patients with a disturbed diurnal rhythm of cortisol, cortisol and leptin levels were increased (68% and 81% increase, respectively), whilst DHEA levels were unaltered. Half of the patients displayed an abnormal diurnal rhythmicity of leptin at the end of the week. Median TNF−α levels for the first two days after stroke also correlated to median leptin levels at the end of the week (P < 0.05). Median IL‐6 levels correlated to severity of paresis on days 1 and 7 and to MMSE scores on day 7 (P < 0.05).Conclusions. Neuroendocrine disturbances are common and often profound early after stroke. Cytokines seem to be important modulators of these disturbances, including diurnal rhythmicity of cortisol and leptin.
Autoantibodies to modified LDLs and other phospholipid–protein complexes as markers of cardiovascular diseases
Authors: Vaarala O. 
Published: March 2003

Abstract. Vaarala O (National Public Health Institute, 00300 Helsinki, Finland). Autoantibodies to modified LDLs and other phospholipid–protein complexes as markers of cardiovascular diseases (Minisymposium). J Intern Med 2000 247: 381–384.Recent studies have suggested that antiphospholipid antibodies contribute to the development of atherothrombosis by enhancing atherogenesis and/or by interfering with blood coagulation. The antigenic targets of antiphospholipid antibodies are cardiolipin, oxidized LDL, β2‐glycoprotein I, or prothrombin. Oxidized LDL and β2‐glycoprotein I are found in the atherosclerotic plaque and antibodies to these proteins enhance in vitro the accumulation of modified LDL into macrophages. Autoantibodies binding to modified LDL, cardiolipin and prothrombin have been associated with atherosclerosis and its thrombotic complications in sero‐epidemiological studies. These autoantibodies can be used as markers of atherosclerosis but their possible pathogenic role in the athero‐ and thrombogenesis needs further studies.
Chlamydia pneumoniae in atherosclerosis
Authors: Saikku P. 
Published: March 2003

Abstract. Saikku P (National Public Health Institute, Oulu, Finland). Chlamydia pneumoniae in atherosclerosis (Minisymposium). J Intern Med 2000; 247: 391–396. Chlamydia pneumoniae is currently the infectious agent most often associated with the inflammation found in atherosclerosis. The seroepidemiological association and the actual presence of pathogen in lesions has been confirmed in numerous studies, in which technical difficulties seem to be the only limitation. Besides animal experiments and intervention trials, we need information of possible pathogenic mechanisms. Recently, several studies have suggested mechanisms by which C. pneumoniae infection could participate in the development of atherosclerosis.
IL‐6 and IL‐1 receptor antagonist in stable angina pectoris and relation of IL‐6 to clinical findings in acute myocardial infarction
Authors: Gabriel A. S. , Ahnve S. , Wretlind B. , Martinsson A. 
Published: March 2003

Abstract. Gabriel AS, Ahnve S, Wretlind B, Martinsson A (Karolinska Institute and Huddinge University Hospital, Stockholm, Sweden). J Intern Med 2000; 248: 61–66.Objectives. To determine if increased inflammatory activity, as reflected by interleukin‐6 (IL‐6) and interleukin‐1 receptor antagonist (IL‐1ra) levels, is present in patients with stable angina pectoris and if IL‐6 levels on admission to the coronary care unit in patients with acute myocardial infarction (AMI) are related to heart failure and fever response.Subjects and methods. We studied 28 patients with stable angina pectoris enrolled for coronary angiography, and compared them with sex‐ and age‐matched controls. Thirty‐four patients with AMI were studied and samples for determination of IL‐6 levels were taken on admission within 36 h of onset of symptoms. IL‐6 and IL‐1ra were determined in serum by enzyme immunoassay.Results. Levels of IL‐6 and IL‐1ra were higher in patients with stable angina pectoris than in controls (mean 4.6 ± 3.6 vs. 3.0 ± 2.9 ng L–1, P < 0.03, and 774 ± 509 vs. 490 ± 511 ng L–1, P < 0.01, respectively). IL‐6 and IL‐1ra levels were not related to angiographic findings. IL‐6 levels were high in patients with AMI (38.9 ± 75.6 ng L–1). Patients with prolonged fever (duration > 4 days) had higher IL‐6 levels (94.7 ± 138.2 vs. 21.7 ± 29.7 ng L–1, P < 0.05). IL‐6 levels were not related to heart failure.Conclusions. Our results indicate that increased inflammatory activity is present not only in acute coronary syndromes, but also in a chronic form of ischaemic heart disease, giving further evidence for a central role of inflammatory processes in coronary artery disease. With regard to AMI, we found increased inflammatory activity in patients with prolonged fever.
Intraoperative haemorrhage associated with the use of extract of Saw Palmetto herb: a case report and review of literature
Authors: Cheema P. , El‐Mefty O. , Jazieh A. R. 
Published: March 2003

Abstract. Cheema P, El‐Mefty O, Jazieh AR (University of Arkansas for Medical Sciences, Arkansas and University of Cincinnati, Ohio, USA). Intraoperative haemorrhage associated with the use of extract of Saw Palmetto herb: a case report and review of literature. J Intern Med 2001; 250: 167–169.The significant increase in the use of alternative medicine in general and the herbal and dietary supplement in particular represents a challenge to the health care professionals. Because of their unregulated use, physicians are encountering increasing numbers of toxicities and untoward events. We report a case of severe intraoperative haemorrhage in a patient who was taking the herb Saw Palmetto. His bleeding time which was prolonged, normalized few days after he stopped the herb. This case should increase the awareness of physicians to such possible complications and encourage them to enquire thoroughly about the use of any dietary supplement in all their patients.
Atrial fibrillation – where do we stand today?
Authors: Olsson S. B. 
Published: March 2003

Olsson SB (University Hospital, Lund, Sweden). Atrial fibrillation – where do we stand today? J Intern Med 2001; 250: 19–28.The basic underlying mechanisms behind atrial fibrillation (AF), the most abundant therapy demanding cardiac dysrhythmia, have until recently being largely unknown. Once established, AF is not only self‐perpetuating but also self‐destructive, prompting rapid treatment against possible initiating mechanisms. Recent observations reveal that the ectopic beats, initiating AF, often originate in the walls of the pulmonary veins and that the deterioration of the ectopic impulse to AF may be linked to an impaired inferoposterior interatrial conduction. The underlying mechanisms behind these functional defects are still obscure. The observations has however, permitted evaluation of new types of treatment, directly interfering with the newly verified findings.
Combined hormone replacement therapy improves endothelial function in healthy postmenopausal women
Authors: Gužič‐Salobir B. , Keber I. , Seljeflot I. , Arnesen H. , Vrabič L. 
Published: March 2003

Abstract. Gužič‐Salobir B, Keber I, Seljeflot I, Arnesen H, Vrabič L (University Medical Centre, Ljubljana, Slovenia; Ullevaal University Hospital, Oslo, Norway; and Novo Nordisk A/S, Ljubljana, Slovenia). Combined hormone replacement therapy improves endothelial function in healthy postmenopausal women. J Intern Med 2001; 250: 508–515. Objectives. Large scale epidemiological studies suggest that hormone replacement therapy (HRT) reduces cardiovascular events in postmenopausal women. Improvement in endothelial function may contribute to this protective effect. Design. In a prospective, double blind study, 61 healthy postmenopausal women were randomized to receive either oral continuous combined HRT [oestradiol 2 mg and norethisterone acetate (NETA) 1 mg per day] or placebo. Endothelial function, assessed by flow‐mediated vasodilation (FMD) of the brachial artery and expression of soluble endothelial cell adhesion molecules (CAM) were determined before, after 3 and 6 months of therapy. Results. The FMD was significantly improved in women on combined HRT (from 5.97% to 10.94% after 3 months and to 10.58% after 6 months; both P < 0.01 versus baseline values) and did not change in the placebo group (6.92% at baseline, 5.86% after 3 and 6.26% after 6 months). After 3 months of combined HRT, significant decreases of 24.6% for E‐selectin and 13.9% for intercellular adhesion molecule‐1 (ICAM‐1) were observed (both P < 0.01 versus baseline values) and were sustained after 6 months of therapy, whilst no differences emerged in the placebo group. Conclusions. Oestradiol and norethisterone acetate improve endothelial function by both enhancing FMD and reducing the levels of soluble E‐selectin and ICAM‐1 in healthy postmenopausal women.
Tobacco use, cancer causation and public health impact
Authors: Kuper H. , Adami H.‐O. , Boffetta P. 
Published: March 2003

Abstract. Kuper H, Adami H‐O, Boffetta P (University College London, Torrington Place, London, UK; Karolinska Institutet, Stockholm, Sweden; and International Agency for Research on Cancer, Lyon, France). Tobacco use, cancer causation and public health impact. J Intern Med 2002; 251: 455–466.This review describes global patterns of tobacco use and the mechanisms by which tobacco use is involved in carcinogenesis. A second part will discuss the association between tobacco use and risk of specific cancer types. To bacco use has traditionally been a practice of high‐income countries, but it has recently been taken up in low‐income countries and it is particularly common in men. A wide variety of tobacco products exist, of which cigarettes are most frequently consumed. Tobacco products contain more than 50 established or identified carcinogens and these may increase risk of cancer by causing mutations that disrupt cell cycle regulation, or through their effect on the immune or endocrine systems. Certain factors such as genes, diet and environmental exposures may alter susceptibility to cancer in tobacco users. Today at least 15% of all cancers are estimated to be attributable to smoking, but this figure is expected to increase because of the uptake of tobacco use in low‐income countries.
A new classification tool for clinical differentiation between haemorrhagic and ischaemic stroke
Authors: Efstathiou S. P. , Tsioulos D. I. , Zacharos I. D. , Tsiakou A. G. , Mitromaras A. G. , Mastorantonakis S. E. , Pefanis A. V. , Mountokalakis T. D. 
Published: March 2003

Abstract. Efstathiou SP, Tsioulos DI, Zacharos ID, Tsiakou AG, Mitromaras AG, Mastorantonakis SE, Pefanis AV, Mountokalakis TD (Sotiria Hospital, Athens, Greece). A new classification tool for clinical differentiation between haemorrhagic and ischaemic stroke. J Intern Med 2002; 252: 121–129. Purpose. To develop a simple and reliable diagnostic tool for differentiation of cerebral infarction (CIF) from intracerebral haemorrhage (ICH) in order to aid clinicians to decide about starting antiplatelet therapy in settings where rapid access to computed tomography (CT) is lacking. Methods. Thirty variables regarding each patient admitted with acute stroke were recorded and considered in a logistic regression analysis using ICH as end‐point (internal study). CT was used as the golden standard. The score derived was validated with data from the next consecutive stroke patients and was compared with the three preexisting scores (external validation study). Results. Amongst 235 patients (119 males, mean age 70.6 ± 11.2 years) of the internal study, 43 (18.3%) had ICH. Four independent correlates of ICH were identified and used for the derivation of the following integer‐based scoring system: number of points=6 * (neurological deterioration within 3 h from admission) + 4 * (vomiting) + 4 * (WBC > 12 000) + 3 * (decreased level of consciousness). In the external study [168 patients, 85 males, mean age 70.2 ± 10.8 years, 31 (18.5%) with ICH], when the cut‐offs ≤3 points for CIF and ≥11 points for ICH were used, sensitivity, specificity, and positive and negative predictive values of the score for detection of stroke type were 97, 99, 97 and 99%, respectively; exceeding noticeably the three previously proposed systems. Conclusions. The proposed model provides an easy to use tool for sufficiently accurate differentiation between haemorrhagic and nonhaemorrhagic stroke on the basis of information available to all physicians early after admission.
Effects of cigarette smoking or nicotine replacement on cardiovascular risk factors and parameters of haemorheology
Authors: Haustein K.‐O. , Krause J. , Haustein H. , Rasmussen T. , Cort N. 
Published: March 2003

Abstract. Haustein K‐O, Krause J, Haustein H, Rasmussen T, Cort N (Institute of Nicotine Research and Smoking Cessation, Erfurt, Germany; and Pharmacia Consumer Healthcare, Helsingborg, Sweden). Effects of cigarette smoking or nicotine replacement on cardiovascular risk factors and parameters of haemorheology. J Intern Med 2002; 252: 130–139. Objectives. Cigarette smoking causes cardiovascular (CV) disease, but the relative roles of nicotine and other components of tobacco smoke remain unclear. We investigated the effect of stopping smoking, by using nicotine replacement therapy (NRT), on haemorheology parameters. Design. Open, parallel‐group trial (intervention group and control smokers). Setting. Clinic within university department of pharmacology. Subjects. One hundred and ninety‐seven males, aged 25–45 years, smoking >20 cigarettes per day. Interventions. One hundred and sixty‐four subjects were instructed to stop smoking and received NRT for 12 weeks and 33 acted as controls. After 12 weeks, NRT was discontinued, and all subjects were followed‐up at 26 weeks. At the end of the study, the NRT group was divided into abstainers (self‐reported, verified by exhaled carbon monoxide <10 ppm) and relapsers, who were unable to remain abstinent. Main outcome measures. Plasma viscosity, fibrinogen, erythrocyte deformability, reactive capillary blood flow, transcutaneous partial oxygen tension (tcpO2) and haematocrit, assessed at 4, 8, 12, and 26 weeks. Results. After 6 months, plasma fibrinogen (9.95 vs. 8.24 μmol L–1 at baseline; P < 0.003), reactive capillary flow (t–pmax: 9.3 vs. 11.2 s at baseline; P < 0.005), and tcpO2 (50.4 vs. 34.9 mmHg at baseline; P < 0.0001) were significantly improved in abstainers, but changes in plasma viscosity and erythrocyte deformability were inconclusive. Other CV risk factors, such as haematocrit and white blood cell count, decreased to a greater extent in abstainers than in relapsers. Expired carbon monoxide concentrations reflected the changes in smoking and decreased in abstainers from 30.4 ppm at baseline to 4.2 ppm; P < 0.0001). Conclusions. Smoking cessation improved CV parameters, and use of nicotine medications did not negate these improvements.
Significant predictors of poor prognosis in women aged ≤65 years hospitalized for an acute coronary event
Authors: Al‐Khalili F. , Svane B. , Janszky I. , Rydén L. , Orth‐Gomér K. , Schenck‐Gustafsson K. 
Published: March 2003

Abstract.  Al‐Khalili F, Svane B, Janszky I, Rydén L, Orth‐Gomér K, Schenck‐Gustafsson K (Karolinska Hospital and Karolinska Institutet, Stockholm, Sweden). Significant predictors of poor prognosis in women aged ≤65 years hospitalized for an acute coronary event. J Intern Med 2002; 252: 561–569.Objectives.  The aim of this study was to evaluate the importance of different clinical parameters predicting long‐term cardiac prognosis in younger women with an acute coronary event.Design.  The Stockholm Female Coronary Risk Study is a follow‐up study in women ≤65 years.Setting.  Patients were included between 1991 and 1994 from all 10 coronary care or intensive care units in the greater Stockholm area.Subjects.  A total of 335 consecutive female patients hospitalized for an acute coronary event.Main outcome measures.  Cardiac death and nonfatal myocardial infarction (AMI).Results.  During the follow‐up period of 5 years there were 26 (8%) all cause deaths and 39 (12%) recurrent cardiac events. In the group that participated in the complete study, the following age adjusted parameters were found as strong predictors of adverse outcome: AMI as index event [Hazard Ratio (HR) 9.13, 95% CI 3.09–26.99], diabetes mellitus (HR 4.13, 95% CI 1.68–10.17), left ventricular dysfunction (HR 3.94, 95% CI 1.52–10.17), serum HDL cholesterol <1.0 mmol L−1 (HR 4.01, 95% CI 1.62–6.12), and serum triglycerides >2.0 mmol L−1 (HR 2.46, 95% CI 1.06–5.54). AMI as index event and diabetes mellitus were the most significant predictors in a multivariate statistical model. Diabetes mellitus was the strongest predictor when the analysis was repeated in the total patient cohort, integrating patients that did not participate in the extended investigations.Conclusion.  Women aged ≤65‐year‐old hospitalized for an acute coronary event has a low rate of cardiac events during the following 5‐year period. Easily obtained clinical variables such as diabetes mellitus predict adverse prognosis and implicates a need for a more active diagnostic and treatment strategy.