bluuebunny/crossref_metadata_2025_split huggingface dataset:
Heparin‐induced thrombocytopenia (HIT) due to heparin flushes: a report of three cases
Authors: Kadidal V. V. , Mayo D. J. , Horne M. K. 
Published: March 2003

Abstract. Kadidal VV, Mayo DJ, Horne MK (National Institutes of Health, Bethesda, MD 20892, USA) Heparin‐induced thrombocytopenia (HIT) due to heparin flushes: a report of three cases (Case Report). J Intern Med 1999; 246: 325–329.Three cases of heparin‐induced thrombocytopenia (HIT) are reported that were provoked by daily heparin flushes of central venous access devices. Each case had confounding features that delayed recognition of the problem. A review of the literature revealed only 29 previously reported cases of HIT secondary to heparin flushes. However, the true incidence of this problem is unknown. A high index of suspicion and confirmatory laboratory tests are necessary to make the diagnosis.
Increased QT dispersion during hypoglycaemia in patients with type 2 diabetes mellitus
Authors: Landstedt‐Hallin L. , Englund A. , Adamson U. , Lins P.‐E. 
Published: March 2003

Abstract. Landstedt‐Hallin L, Englund A, Adamson U, Lins P‐E (Karolinska Institute, Danderyd Hospital, Danderyd; and Uppsala University Hospital, Uppsala, Sweden). Increased QT dispersion during hypoglycaemia in patients with type 2 diabetes mellitus. J Intern Med 1999; 246: 299–307.Objectives. To study effects of insulin‐induced hypoglycaemia on the cardiac repolarization, using QT interval measurements, in patients with type 2 diabetes.Design. Hypoglycaemia was induced by an i.v.

insulin‐infusion and blood glucose was clamped at 2.7 mmol L–1 for 60 min (T = 90–150 min) in two experiments, with (+GLIB) and without (–GLIB) glibenclamide. In a third experiment, with similar hyperinsulinaemia, glucose was clamped at a euglycaemic level (

5 mmol L–1). ECG was continuously recorded for arrhythmia‐monitoring, and 12‐lead ECGs were recorded at T = 0 and 150 min. QT intervals were measured, and we determined QT dispersion (difference between the maximum and the minimum QT interval) reflecting interlead variability of repolarization.Subjects. Thirteen patients with type 2 diabetes, on combined insulin and glibenclamide treatment, were studied during hypoglycaemia, and eight of them participated in the euglycaemic experiment.Results. No significant arrhythmias were seen during hypoglycaemia but the mean QT intervals and QT dispersion increased significantly (P < 0.001), with no differences between –GLIB and +GLIB. During the euglycaemic clamp all QT measurements remained unchanged. Serum potassium decreased significantly (P < 0.001) during all three clamps, but the decrease was more pronounced during hypoglycaemia. The change in potassium was not correlated to the degree of QT prolongation or QT dispersion.Conclusions. Significant changes in the repolarization of the heart can be seen during hypoglycaemia in patients with type 2 diabetes, indicating an increased risk of arrhythmia at low blood glucose levels.
Effects of hypocaloric dietary treatment enriched in oleic acid on LDL and HDL subclass distribution in mildly obese women
Authors: Zambon A. , Sartore G. , Passera D. , Francini‐Pesenti F. , Bassi A. , Basso C. , Zambon S. , Manzato E. , Crepaldi G. 
Published: March 2003

Zambon A, Sartore G, Passera D, Francini‐Pesenti F, Bassi A, Basso C, Zambon S, Manzato E, Crepaldi G (University of Padova , Padova, Italy). Effects of hypocaloric dietary treatment enriched in oleic acid on LDL and HDL subclass distribution in mildly obese women. J Intern Med 1999; 246: 191–201.Objective. To study the effects of a carbohydrate‐enriched (HiCarbo) or olive‐oil‐enriched (HiMUFA) hypocaloric diet on plasma lipoprotein levels and physical properties.Design. A six‐month follow‐up dietary intervention study with a HiCarbo diet providing 60% of total calories as complex carbohydrates, 15% as proteins and 25% as fats [10% saturated (SFA); 7% monounsaturated (MUFA); 8% polyunsaturated fatty acids (PUFA)]; or a HiMUFA diet with 40% complex carbohydrates, 15% proteins and 45% fats (10% SFA; 27% MUFA; 8% PUFA).Subjects. Twenty consecutive, mildly obese, normolipidemic premenopausal women (11 on HiCarbo and nine on HiMUFA diets) and 14 age‐ and sex‐matched, lean controls.Measurements. Body mass index (BMI), waist/hip ratio, plasma lipoproteins, apolipoprotein (apo) AI and B, LDL and HDL density distribution, and phospholipid fatty acid composition at baseline, and after 3 and 6 months on dietary treatment.Results. Body weight progressively decreased during the first 3 months and then it stabilized during the following 3 months (–11% vs. baseline in both groups; P < 0.01). LDL‐Cholesterol decreased significantly in both groups. HDL‐Cholesterol increased significantly in the HiMUFA group, whereas a decreased level was observed in the HiCarbo group. At baseline the obese women had higher very low density lipoprotein (VLDL)
and dense LDL‐Cholesterol, and lower HDL2 cholesterol levels than the controls;
these abnormalities persisted in the HiCarbo diet, whilst a significant decrease in the dense LDL associated with an increase in the HDL2 cholesterol was seen in the HiMUFA diet. HDL3 was not affected by either diet. The LDL/HDL‐Cholesterol ratio was not affected by the HiCarbo diet, whilst it was significantly reduced after 6 months of HiMUFA diet as compared with baseline. Apo AI increased in the HiMUFA group, and decreased in the HiCarbo group.Conclusions. Both diets were effective in decreasing body weight. At steady weight conditions, only the HiMUFA diet improved LDL and HDL subclass distribution abnormalities present in mildly obese normolipidemic women.
Elevated serum levels of methylmalonic acid and homocysteine in elderly people. A population‐based intervention study
Authors: Björkegren K. , Svärdsudd K. 
Published: March 2003

Abstract. Björkegren K, Svärdsudd K (University Hospital Uppsala; Skutskär Primary Health Care Center, Skurskär, Sweden). Elevated serum levels of methylmalonic acid and homocysteine in elderly people. A population‐based intervention study. J Intern Med;246: 317–324.Objectives.   There is uncertainty amongst clinicians about the definitions of cobalamin and folate deficiency and therefore about the indications for treatment. In this report we present the results of systematic cobalamin and folic acid treatment based upon serum cobalamin, total homocysteine (tHcy) and methylmalonic acid (MMA) analyses in a population‐based sample.Subjects. A 20% random sample of persons 70 years or older in a defined geographical area were invited to a survey (n = 266). Sixty‐nine persons who had serum cobalamin < 300 pmol L–1 and serum MMA ≥0.37 µmol L–1 or serum tHcy ≥15 µmol L–1 and who had no cobalamin or folic acid substitution were selected for treatment.Interventions. Initially all 69 patients were given cobalamin orally or intramuscularly. Those who remained high in tHcy were in addition given folic acid treatment.Main outcome measures. Serum cobalamin, serum MMA and serum tHcy.Results. After 6 months of cobalamin treatment, serum MMA became normal in 13 out of 15 persons. Mean serum tHcy decreased but was normalized in only 15 out of 56 persons. After 3 months of folic acid treatment added to those who still had an abnormal serum tHcy, serum tHcy had normalized in all but one person.Conclusions. Cobalamin treatment normalizes increased MMA values and combined cobalamin and folic acid treatment normalizes tHcy, suggesting a pretreatment deficiency of tissue cobalamin and folate in spite of normal serum cobalamin and folate values in the majority of cases.
Relative importance of improved hospital treatment and primary prevention. Results from 20 years of the Myocardial Infarction Register, Göteborg, Sweden
Authors: Wilhelmsen L. , Rosengren A. , Lappas G. 
Published: March 2003

Abstract.Objective.  To analyse to what extent declines in incidence and mortality of coronary artery disease can be attributed to improved hospital and post‐hospital treatment in contrast to how much is due to primary prevention.Design.  A register for non‐fatal and fatal myocardial infarction and sudden coronary death registered in in‐hospital as well as out‐of‐hospital events between 1975 and 1994.Setting.  City of Göteborg, Sweden, with 450 000 inhabitants.Results.  Seventy‐one per cent of the decline in attacks could be attributed to a decline in first infarctions. Of the decrease in coronary deaths, 63% was due to a decline in out‐of‐hospital mortality. Previous registrations for myocardial infarction were considerably more common amongst people who died in hospital (29%) than amongst those who died out‐of‐hospital (11–16%) or who survived an infarction (11–13%). Out‐of‐hospital resuscitation contributed to about half of the reduction in out‐of‐hospital mortality. Thus, most of the decline in incidence and about half of the decline in sudden coronary deaths was due to primary preventive measures. Population data on risk factors indicate a decline of 37% between 1963 and 1995 in coronary risk amongst consecutive cohorts of 50‐year‐old men in the community.Conclusion.  Out‐of‐hospital resuscitation, treatment in coronary care units and post‐infarct treatment improved considerably, but changes in primary risk factors were also of major importance for the decline in incidence and mortality.
Fatal hepatitis and renal failure during treatment with nimesulide
Authors: Schattner A. , Sokolovskaya N. , Cohen J. 
Published: March 2003

Abstract. Schattner A, Sokolovskaya N, Cohen J (Kaplan Medical Center, Rehovot, and the Hebrew University‐Hadassah School of Medicine, Jerusalem, Israel). Fatal hepatitis and renal failure during treatment with nimesulide (Case Report). J Intern Med 2000; 247: 153–155.A healthy 70‐year‐old woman who took nimesulide for 5 days, presented 2 weeks later with jaundice for which no other cause was found. Laboratory evidence of coagulopathy, hypoalbuminaemia and hypoglycaemia were present on admission, and liver biopsy showed massive necrosis of hepatocytes and severe inflammatory infiltrate. Despite supportive and corticosteroid treatment, her jaundice deepened and progressive acute renal failure developed, characterized by a ‘prerenal’ profile changing into irreversible acute tubular necrosis pattern, coma, occult Gram‐negative sepsis and death. Although rare, nimesulide‐associated hepatotoxicity and nephrotoxicity may occur and should be recognized as early as possible, to ensure immediate drug withdrawal and treatment.
Mechanisms behind gender differences in circulating leptin levels
Authors: Hellström L. , Wahrenberg H. , Hruska K. , Reynisdottir S. , Arner P. 
Published: March 2003

Abstract. Hellström L, Wahrenberg H, Hruska K, Wahrenberg H, Reynisdottir S, Arner P (Danderyd Hospital and Karolinska Institute, Stockholm, Sweden). Mechanisms behind gender differences in circulating leptin levels. J Intern Med 2000; 247: 457–462.Objectives. To investigate gender differences in circulating leptin levels and adipose tissue production of leptin.Design setting and subjects. Thirty‐two men and 63 women with a large interindividual variation in body mass index (BMI), but otherwise healthy, were investigated after an overnight fast. Body fat (bioimpedance), abdominal subcutaneous adipose tissue secretion of leptin in vitro and serum leptin were determined.Results. Although there was no gender difference in mean BMI or fat cell size, mean percentage body fat was 49 in women and 36 in men (P < 0.001). At each level of BMI, serum leptin levels were about two times higher in women than in men (P < 0.001). Adipose tissue secretion rate of leptin in men was two‐thirds of that in women (P < 0.05). The gender differences in body fat content, serum leptin and leptin secretion were observed in obese (BMI > 27 kg m–2) as well as non‐obese subjects. Serum leptin levels (P < 0.001) and leptin secretion rate (P < 0.01) correlated positively with body fat content in either sex. However, the gender differences in serum leptin (P < 0.001) and leptin secretion rate (P < 0.01) remained statistically significantly different even when the values were adjusted for body fat.Conclusion. The gender difference in circulating leptin concentrations can be due to at least two different mechanisms. A higher proportion of adipose tissue and increased production rate of leptin per unit mass of adipose tissue might explain why women have higher circulating leptin levels than men.
The role of habitual snoring and obesity in the development of diabetes: a 10‐year follow‐up study in a male population
Authors: Elmasry A. , Janson C. , Lindberg E. , Gislason T. , Tageldin M. A. , Boman G. 
Published: March 2003

Abstract. Elmasry A, Janson C, Lindberg E, Gislason T, Tageldin MA, Boman G (Uppsala University, Akademiska Sjukhuset, Uppsala, Sweden; Ain Shams University, Cairo, Egypt; and Viffilsstadir Hospital, Gardabær, Iceland). The role of habitual snoring and obesity in the development of diabetes: a 10‐year follow‐up study in a male population. J Intern Med 2000; 248: 13–20.Objectives. There are many similarities between diabetes (mainly type 2) and sleep breathing disturbances regarding risk factors, anthropometric criteria and consequences of morbidity and mortality. The aim of this study was to investigate whether the association between habitual snoring and diabetes is entirely dependent on obesity.Design. A population‐based prospective study.Setting. The municipality of Uppsala, Sweden.Subjects and methods. In 1984 and in 1994, 2668 men aged 30–69 years at baseline answered questionnaires concerning sleep breathing disturbances and somatic diseases.Results. Of those with habitual snoring in 1984, 5.4% reported that they had developed diabetes during the 10‐year period compared with 2.4% of those without habitual snoring (P < 0.001). Amongst obese snorers, 13.5% developed diabetes compared with 8.6% of obese non‐snorers (P = 0.17). In a multiple logistic regression model, the odds ratio (95% confidence interval) for development of diabetes was higher in obese snorers [7.0 (2.9–16.9)] than in obese non‐snorers [5.1 (2.7–9.5)] after adjustment for age, weight gain, smoking, alcohol dependence and physical inactivity.Conclusions. We conclude that, in males aged 30–69 years, habitual snoring is associated with an increased incidence of diabetes within 10 years. Although obesity is the main risk factor for developing diabetes, coexistent habitual snoring may add to this hazard.
Prospects for progress in diagnostic imaging
Authors: Potchen E. J. 
Published: March 2003

Abstract. Potchen EJ (Michigan State University, Michigan, USA). Prospects for progress in diagnostic imaging (Internal Medicine in the 21st Century). J Intern Med 2000; 247: 411–424.New fast‐imaging MRI systems designed specifically for cardiac magnetic resonance enable new applications of noninvasive vascular imaging. The use of functional MRI and diffusion tensor imaging to map brain function and structure offers a new dimension to an understanding of the human condition. Clinical applications of functional MRI will influence many specialties including surgery, education, and rehabilitation. Functional imaging has the potential to visualize the regional concentration of specific proteins. This imaging at the level of molecules may be possible by use of a contrast material whose signal is changed by local enzymatic activity.The three‐dimensional digital data collected in modern imaging techniques allow for virtual endoscopy in the respiratory, alimentary, and cardiovascular systems. Virtual endoscopy may replace many of the more invasive diagnostic methods in the near future. The measurement of clinical decision‐making through observer performance studies better informs both the physician and the patient on how to improve upon the quality of clinical practice. These prospects for progress reinforce diagnostic imaging as a cornerstone in medical informatics. The history of creating images used in medicine reveals the invention of diagnostic tools which may provide new information but premature use can result in improper application of a poorly understood technology. Research into the use of new technology may be as important as the technology itself in improving the human condition.
Medical ethics in the 21st century
Authors: Parker M. , Hope T. 
Published: March 2003

Abstract. Parker M, Hope T (Institute of Health Sciences, Headington, Oxford, UK). Medical ethics in the 21st century. J Intern Med 2000; 248: 1–6.Objectives. To foresee how medical ethics may develop in the 21st century.Design. We have looked into our crystal ball to see what factors are likely to drive medical ethics over the next few decades. We have given examples of how such factors might affect specific issues.Results. Those factors that we identified as likely to shape the future of medical ethics are: Globalization. Medical ethics is likely to have to grapple increasingly with ethical issues arising from the huge discrepancies in the level of health care available in different countries. Increase in longevity. We predict that there will be, at least amongst the richer nations, a significant increase in life expectancy. This will result in issues of resource allocation becoming increasingly problematic within medicine. Child enhancement. Developments in genetics combined with control of reproduction will make it possible to select our children for a broad range of characteristics. There are optimistic and pessimistic predictions as to how such power will be used. In either case, this area will be an important focus of concern in medical ethics. The biological determination of behaviour. Genetic research will lead to an increasing sense that undesirable behaviour is genetically determined. This will lead to a re‐examination of such concepts as criminal responsibility. Therapeutic research and clinical practice. We predict that an increasing amount of clinical practice will be within the setting of clinical trials. The ethics of therapeutic research and clinical practice will need to be brought within a coherent framework.
Infections as a major preventable cause of human cancer
Authors: Kuper H. , Adami H.‐O. , Trichopoulos D. 
Published: March 2003

Abstract. Kuper H, Adami H‐O & Trichopoulos D (Harvard School of Public Health, Boston, MA, USA; Karolinska Institute, Stockholm, Sweden; University of Athens Medical School, Greece). Infections as a major preventable cause of human cancer (Internal Medicine in the 21st Century). J Intern Med 2000; 248: 171–183.Infections may be responsible for over 15% of all malignancies worldwide. Important mechanisms by which infectious agents may induce carcinogenesis include the production of chronic inflammation, the transformation of cells by insertion of oncogenes and inhibition of tumour suppressors, and the induction of immunosuppression. Common characteristics shared by infectious agents linked to malignancies are that they are persistent in the host, often highly prevalent in the host population and induce cancer after a long latency. The associations between a selection of infectious agents and malignancies are covered in detail.
Biliary dysplasia, cell proliferation and nuclear  DNA‐fragmentation in primary sclerosing cholangitis with and without cholangiocarcinoma
Authors: Bergquist A. , Glaumann H. , Stål P. , Wang G.‐S. , Broomé U. 
Published: March 2003

Abstract. Bergquist A, Glaumann H, Stål P, Wang G‐S, Broomé U (Huddinge University Hospital, Huddinge; and Karolinska Institute, Stockholm; Sweden). Biliary dysplasia, cell proliferation and nuclear DNA‐fragmentation in primary sclerosing cholangitis with and without cholangiocarcinoma. J Intern Med 2001; 249: 69–75.Objectives. To study the extent of biliary dysplasia, and the degree of cell proliferation and apoptosis in bile duct cells (BDC) from patients with primary sclerosing cholangitis (PSC), with and without cholangiocarcinoma (CC).Methods. Specimens of liver tissue from 16 patients suffering from PSC and CC, and 16 patients with end‐stage PSC without cancer, were investigated. Histological evaluation of presence of biliary dysplasia and bile duct proliferation was made. Immunohistochemistry, applying antibodies against Ki‐67, p53 and bcl‐2, was used. Nuclear DNA fragmentation was assessed by in situ DNA labelling (ApopTag). The numbers of positive cells expressed as a percentage of the total number of BDCs constituted the labelling index (LI).Results. Bile duct dysplasia was significantly more frequent in nontumorous liver tissue from patients with PSC and CC than from patients having end‐stage PSC without cancer (P < 0.05). Patients with biliary dysplasia had a higher frequency of marked bile duct proliferation (P < 0.01) than patients without dysplasia. In tumour tissue, the LI for Ki‐67 positive nuclei was more than four times the LI of nuclear DNA fragmentation (P < 0.01). Ki‐67, bcl‐2, p53 or DNA fragmentation were not significantly different in nontumorous liver tissue from patients with and without CC. Immunohistochemical staining for p53 was positive in 75% of the tumours, whilst in nontumorous tissue no such overexpression was found.Conclusion. PSC patients with CC more often display biliary dysplasia than those with end‐stage PSC, indicating that biliary dysplasia may be a precancerous stage in PSC. Additionally, p53 mutation seems to be a late event in tumour development, since no p53 expression was found in the premalignant areas with nontumorous BDC.
Serum cobalamin, folate, methylmalonic acid and total homocysteine as vitamin B12 and folate tissue deficiency markers amongst elderly Swedes – a population‐based study
Authors: Björkegren K. , Svärdsudd K. 
Published: March 2003

Abstract. Björkegren K, Svärdsudd K (Uppsala University, University Hospital, Uppsala and Skutskär Primary Health Care Centre, Skutskär, Sweden). Serum cobalamin, folate, methylmalonic acid and total homocysteine as vitamin B12 and folate tissue deficiency markers amongst elderly Swedes. A population‐based study. J Intern Med 2001; 249: 423–432. Objectives. The possibilities of detecting tissue cobalamin and folate deficiency are under debate. In this report the levels of serum cobalamin, folate, methylmalonic acid (MMA) and total homocysteine (tHcy) and their interrelations in a representative random population sample are presented. Design. Cohort study. Setting. A general mid‐Swedish population. Subjects. A 20% random sample of persons 70 years or older in a defined geographical area were invited to a survey. A total of 235 (85%) persons responded, out of whom 224 had no interfering diseases. Main outcome measures. Serum cobalamin, folate, MMA and tHcy. Results. The serum levels of cobalamin, folate, MMA and tHcy were all correlated to cobalamin and folic acid treatment. They were also correlated to the intake of multivitamin preparations. In addition, serum cobalamin was higher in untreated women than in men but not correlated to age. Serum folate was correlated neither to sex nor age. Serum tHcy and MMA were both directly correlated to age but MMA not to sex. MMA was inversely correlated to serum cobalamin but not to serum folate, whereas serum tHcy was inversely correlated to serum cobalamin, folate and creatinine. Neither serum cobalamin, folate, MMA nor tHcy had any significant correlation to haemoglobin, erythrocyte volume fraction (EVF) or mean red cell volume. Half of the study population had abnormal MMA or tHcy levels, suggesting a latent or overt tissue deficiency of cobalamin or folate. Conclusions. A substantial proportion of the elderly general population had signs of low tissue levels of cobalamin or folate. Amongst those who took multivitamin preparations this proportion was much lower.