bluuebunny/crossref_metadata_2025_split huggingface dataset:
Sleep problems and daytime problem behaviours in children with intellectual disability
Authors: Didden R. , Korzilius H. , Aperlo B. van , Overloop C. van , Vries M. de 
Published: March 2003

AbstractBackgroundSleep problems are common among children with intellectual disability (ID).MethodThe present study assessed the prevalence of severe sleep problems in a sample of children (n=286) with mild to profound ID who lived at home with their parents(s) in the Netherlands. It also explored relationships between severe sleep problems, and family and child variables. Demographic information, data on children's sleep behaviours and parent variables were collected using questionnaires.ResultsSevere settling problems, night waking and early waking were present in 4.2%, 10.8% and 4.2% of cases, respectively; 16.1% of children had at least one type of sleep problem. Children with a severe sleep problem had more severe levels of ID, used medication more often, had a greater frequency of epilepsy, were younger, had a greater frequency of cerebral palsy, and showed more daytime drowsiness and daytime napping than children without a severe sleep problem. Furthermore, children with a severe sleep problem showed more severe levels of daytime problem behaviours; for example, aggression, non‐compliance and hyperactivity.ConclusionThe results of the present study are discussed with regard to the assessment and treatment of sleep problems in children with ID.
Identifying bipolar disorders in individuals with intellectual disability
Authors: Cain N. N. , Davidson P. W. , Burhan A. M. , Andolsek M. E. , Baxter J. T. , Sullivan L. , Florescue H. , List A. , Deutsch L. 
Published: March 2003

AbstractObjective  The aim of the present study was to characterize adults with intellectual disability (ID) and concomitant clinical diagnoses of bipolar disorder (BPD), and determine whether DSM‐IV criteria would distinguish individuals with BPD from patients with other psychiatric diagnoses.Methods  A retrospective chart review was done of a convenience sample of adult patients seen over a 3‐year period in a specialty clinic for adults with ID and psychiatric disorders. The DSM‐IV criteria were used to differentiate individuals with clinical symptoms of BPD from groups of patients with other mood or thought disorders with behavioural symptoms which frequently overlap those of BPD. Behavioural symptoms were also catalogued and used to distinguish the diagnostic groups.Results  Subjects with clinical symptoms of BPD had significantly more DSM‐IV mood‐related and non‐mood‐related symptoms, as well as functional impairments, compared to individuals with major depression, depression with psychosis or schizophrenia/psychosis NOS (not otherwise specified). Likewise, behavioural profiles of the BPD group of patients differed significantly from patients in the other three groups.Conclusions  Bipolar disorder can be readily recognized and distinguished from other behavioural and psychiatric diagnoses in individuals with ID, and DSM‐IV criteria can be useful in the diagnosis of BPD.
Surgical management of patients with persistent or recurrent medullary thyroid cancer
Authors: Moley  , DeBenedetti  , Dilley  , Tisell  , Wells  
Published: March 2003

Moley JF, DeBenedetti MK, Dilley WG, Tisell LE, Wells SA (Washington University School of Medicine, St Louis, MO, USA). Surgical management of patients with persistent or recurrent medullary thyroid cancer (Minisymposium: MEN & VHL). J Intern Med 1998; 243: 521–6.Residual or recurrent medullary thyroid carcinoma (MTC), manifested by elevated calcitonin levels, occurs commonly following primary treatment of MTC. Re‐operation in appropriately selected patients is the only treatment modality which consistently and reliably reduces stimulated calcitonin levels, and results in excellent local disease control. We report improved results of surgical management of recurrent MTC in two consecutive series of patients. In our most recent series (1992–96), 38% of patients (17 out of 45) had normal postoperative stimulated calcitonin levels, compared to 28% (nine of 32) in our first series (1990–92). In the most recent series, only 13% (six of 45) of patients had no decrease in calcitonin levels following re‐operation, compared to 31% (10 of 32) in our first series (P= 0.07, Fisher's exact test). This improvement has mainly occurred through better preoperative selection of patients, and the institution of routine laparoscopic liver examination preoperatively, which identified metastases in 10 patients, nine of whom had normal CT or MRI imaging.
The eye in von Hippel–Lindau disease. Long‐term follow‐up of screening and treatment: recommendations
Authors: Wittebol‐Post  , Hes  , Lips  
Published: March 2003

Wittebol‐Post D, Hes FJ, Lips CJM (University Hospital Utrecht, Utrecht, The Netherlands). The eye in von Hippel–Lindau disease. Long‐term follow‐up of screening and treatment: recommendations (Minisymposium: MEN & VHL). J Intern Med 1998; 243: 555–561.Von Hippel–Lindau disease (VHL) is an autosomal dominant tumour syndrome caused by germline mutations of the VHL tumour suppressor gene located on chromosome 3p25–26. In VHL tumours may occur in 14 different target organs, including the eye. Retinal angiomas are considered the first manifestation of VHL disease in 43% of cases, and the cumulative probability of developing a retinal angioma in one or both eyes rises during each decade of life, reaching 80% for patients over 80 years old. Since 1976 patients with VHL at the University Hospital of Utrecht and their at‐risk relatives have been screened periodically by a multidisciplinary team. Long‐term follow‐up ophthalmological data were analysed with special attention to natural course and results of treatment. In addition, we looked for a genotype‐phenotype correlation. Retinal angiomas were found in all families. In one large family with a missense mutation (V170D) of the VHL gene, in which the complete spectrum of visceral‐ and central nervous system (CNS) features of VHL is present, macular, parapapillary, optic disc and ora serrata angiomas were also found. In general, however, a clear‐cut genotype‐phenotype correlation could not be found. Only early detection and treatment of peripheral retinal angiomas can be expected to decrease the percentage of patients with decreased visual acuity. Therefore, early detection and treatment of these tumours is of paramount importance. Ophthalmological screening of patients and persons at risk should start as early as possible.In patients with apparently sporadic retinal angiomas it is advisable to perform germline DNA analysis, since the risk of developing VHL is high, especially if the angiomas are bilateral, or unilateral and multifocal, if the patient is young, or if there is a family history suggestive of VHL.
Coronary heart disease mortality amongst non‐insulin‐dependent diabetic subjects in Iceland: the independent effect of diabetes. The Reykjavik Study 17‐year follow up
Authors: Vilbergsson S. , Vilbergsson S. , Sigurdsson G. , Sigurdsson G. , Sigvaldason H. , Sigfusson N. 
Published: March 2003

Vilbergsson S, Sigurdsson G, Sigvaldason H, Sigfusson N, (Icelandic Heart Association, University of Iceland, Department of Medicine and Reykjavik Hospital, Reykjavik, Iceland). Coronary heart disease mortality among non‐insulin‐dependent diabetic subjects in Iceland the independent effect of diabetes. The Reykjavik Study 17‐year follow up. J Intern Med 1998; 244: 309–316.ObjectivesThe main aim of this study was to estimate the independent risk for coronary heart disease (CHD) death associated with non‐insulin dependent (Type 2) diabetes (NIDDM) and effect on life expectancy.Design and setting. The Reykjavik Study is a prospective cardiovascular population study which started in 1967. A randomized selection procedure identified individuals for invitation to participate, based on their year and date of birth. Participants were examined in the years 1967–91 in one research clinic in Reykjavik.Subjects and methods. The population in this survey were Icelandic Caucasian males and females, born 1907–35 and therefore 34–79 years old when their examination was performed. Altogether 9139 males and 9773 females attended, and of those 267 males and 210 female were NIDDM as defined by a questionnaire or an oral glucose tolerance test. Other factors measured in the study included systolic and diastolic blood pressure, fasting total cholesterol, triglycerides, uric acid, smoking habits, height, and weight. The causes of death were determined by a review of all death certificates.ResultsThe relative risk of death from CHD (95% confidence limits), independently associated with NIDDM, was 2.0 (1.5–2.6) for males and 2.4 (1.6–3.6) for females. The relative risk of death from all causes was 1.9 (1.6–2.3) and 1.7 (1.3–2.1), respectively, for male and female diabetic patients.Conclusions. Non‐insulin dependent diabetes mellitus carried twice the risk of CHD death in both sexes, independently of other risk factors. The diagnosis of NIDDM at the age 55 years reduced an individual's life expectancy by about five years, mostly because of increased CHD death rate.
Breast cellulitis complicating breast conservation therapy
Authors: Wilhelmsen Lars , Baddour L. M. 
Published: March 2003

Abstract.Breast conservation therapy has gained acceptance as treatment for limited disease due to breast cancer. Unfortunately, a minority of patients who undergo this therapy will develop cellulitis of the breast, often recurrently, months to years later. A definitive pathogen has not been identified in the large majority of cases reported to date. Whilst some patients develop systemic toxicity with local skin changes of cellulitis, others manifest no fever, chills or leukocytosis. Local breast findings gradually clear with antibiotic treatment; when breast changes persist, non‐inflammatory causes, including tumour recurrence, of the breast should be considered. More study is needed to define risk factors for the development of breast cellulitis complicating breast conservation therapy.
Aetiology and clinical significance of thrombocytosis: analysis of 732 patients with an elevated platelet count
Authors: Griesshammer M. , Bangerter M. , Sauer T. , Wennauer R. , Bergmann L. , Heimpel H. 
Published: March 2003

Abstract.Objective.  To determine the aetiology and clinical significance of an elevated platelet count (thrombocytosis) in a large cohort of patients.Design.  A retrospective review of the medical records was performed on all patients, who had at least one platelet count ≥ 500 × 109 L–1.Setting.  Departments of Medicine and Surgery, University of Ulm, Germany.Subjects.  A total of 732 patients with thrombocytosis.Main outcome measures.  Classification of thrombocytosis and thromboembolic complications, and evaluation of laboratory parameters distinguishing between primary and secondary thrombocytosis.Results.  Of the total of 732 patients, 89 (12.3%) had primary and 643 (87.7%) had secondary thrombocytosis. Essential thrombocythaemia was observed in 40 of 89 patients (45%) with primary thrombocytosis. The most frequent causes of secondary thrombocytosis were tissue damage (42%), infection (24%), malignancy (13%) and chronic inflammation (10%). Primary thrombocytosis was significantly associated with a higher platelet count and an increased incidence of both arterial and venous thromboembolic complications. In secondary thrombocytosis, thromboembolic events were restricted to the venous system and occurred only in the presence of other risk factors. Mean values of leucocyte count, haematocrit, erythrocyte sedimentation rate, fibrinogen, serum potassium and lactate dehydrogenase were significantly different in primary and secondary thrombocytosis.Conclusions.  The finding of an elevated platelet count on routine blood examination has diagnostic, prognostic and therapeutic implications. It is of clinical importance to distinguish between primary and secondary thrombocytosis, as thrombotic complications occur more frequently in primary thrombocytosis. Unless additional risk factors are present, secondary thrombocytosis is not associated with a significant risk for thromboembolic events.
The circulating renin–angiotensin system during treatment with metoprolol or captopril in patients with heart failure due to non‐ischaemic dilated cardiomyopathy
Authors: Jansson K. , Dahlström U. , Karlberg B. E. , Karlsson E. , Nylander E. , Nyquist O. , Karlberg K.‐E. 
Published: March 2003

Abstract.  Jansson K, Dahlström U, Karlberg BE, Karlsson E, Nylander E, Nyquist O, Karlberg K‐E (Linköping University Hospital and Huddinge University Hospital, Sweden). The circulating renin–angiotensin system during treatment with metoprolol or captopril in patients with heart failure due to non‐ischaemic dilated cardiomyopathy. J Intern Med 1999; 245: 435–443.Objective.  To investigate the effects of beta‐blocker (metoprolol) or angiotensin‐converting enzyme inhibitor (captopril) treatment on neurohormonal function in a randomized prospective study on patients with heart failure due to dilated cardiomyopathy.Patients.  Fifty‐four patients (42 men and 12 women, mean age 50 years) were studied. There were three patients in NYHA (New York Heart Association) functional class I, 32 patients in class II and 19 patients in class III.Methods.  Measurements of plasma renin activity (PRA), plasma angiotensin II (A II) concentration and plasma atrial natriuretic peptide (ANP) concentration were made at rest and also in a subgroup (n = 32) during exercise. The urinary excretion of aldosterone was also determined. Investigations were performed at baseline, and after 3 and 6 months. Therapy was then stopped and the patients were re‐investigated 1 month thereafter.Results.  The mean level of PRA was normal at baseline, reduced during therapy with metoprolol, and increased during therapy with captopril. The mean plasma concentration of A II was reduced during exercise and there was a trend towards a reduction even at rest in the metoprolol group, but not in the captopril group. The urinary excretion of aldosterone decreased in both groups. The mean plasma concentration of ANP was elevated at baseline and declined during exercise in the metoprolol group.Conclusion.  In patients with dilated cardiomyopathy and only a partly activated renin–angiotensin system, both metoprolol and captopril reduced urinary excretion of aldosterone. Furthermore, metoprolol suppressed the exercise‐induced increase in ANP, suggesting a favourable effect on ventricular performance.
Atherosclerosis seems not to be associated with hyperinsulinaemia in patients with familial hypercholesterolaemia
Authors: Raal F. J. , Panz V. R. , Pilcher G. J. , Joffe B. I. 
Published: March 2003

Objective. To study the relationship between hyperinsulinaemia, insulin resistance, leptin and atherosclerosis in subjects with familial hypercholesterolaemia (FH).Design. Case‐control cross‐sectional study.Setting. Lipid clinic, Johannesburg Hospital, South Africa.Subjects and methods. Fasting serum lipid, glucose, insulin and leptin levels were measured in 24 homozygous FH subjects; 20 FH heterozygotes without coronary artery disease (CAD); 22 heterozygotes with documented CAD; and 20 healthy normocholesterolaemic subjects. Insulin resistance was calculated using the homeostasis model assessment (HOMA) formula.Results. Mean glucose and insulin levels were similar in all 4 groups. There was no significant difference in calculated insulin resistance between any of the groups. There was also no relationship between the degree of insulin resistance and total or LDL‐cholesterol levels. Using Spearman’s correlation coefficient (Rs) calculated insulin resistance correlated with triglyceride (Rs = 0.27; P < 0.05) and inversely with HDL‐cholesterol (Rs = – 0.26; P < 0.05). Fasting insulin concentrations and calculated insulin resistance were similar in FH subjects with overt CAD compared to those without. Leptin levels were higher in the FH subjects with CAD. However, these subjects were older and had a larger body mass index (BMI), and when adjusted for age and BMI, only BMI correlated with leptin levels (multiple r = 0.65; P < 0.001).Conclusions. In the absence of other causes of insulin resistance, FH subjects have normal fasting insulin levels and, in general, they are not insulin resistant. Insulin resistance appears to play little role in the pathogenesis of accelerated atherosclerosis in FH.
Rhabdomyolysis and acute renal failure due to combination therapy with simvastatin and warfarin
Authors: Mogyorósi A. , Bradley B. , Showalter A. , Schubert M. L. 
Published: March 2003

Abstract. Mogyorósi A, Bradley B, Showalter A, Schubert ML (Medical College of Virginia/Virginia Commonwealth University and Hunter Holmes McGuire VAMC, Richmond, Virginia, USA). Rhabdomyolysis and acute renal failure due to combination therapy with simvastatin and warfarin (Case Report). J Intern Med 1999; 246: 599–602.Simvastatin, an inhibitor of 3‐hydroxy‐3‐methylglutaryl coenzyme A (HMG‐CoA) reductase, is widely used to treat hyperlipidaemia. Although myalgias are recognized adverse effects, clinically significant elevations in serum creatine phosphokinase (CPK) levels are uncommon. We describe a case of rhabdomyolysis and acute renal failure associated with concomitant use of simvastatin and warfarin. Rhabdomyolysis and renal failure occurred 7 days after warfarin (5 mg day–1) was added to a chronic stable dose of simvastatin (20 mg day–1) and resolved abruptly after discontinuation of simvastatin. We recommend careful monitoring when warfarin is given to patients receiving simvastatin.
Studies in hypertriglyceridaemia VI: serum lathosterol concentration is raised in hypertriglyceridaemic non‐diabetic males with hyperinsulinaemia
Authors: Asplund‐Carlson A. , Lund E. , Björkhem I. , Carlson L. A. 
Published: March 2003

Abstract.Objectives. To assess the cholesterol synthesis rate in primary hypertriglyceridaemia using the serum unesterified lathosterol concentration as an indicator.Design. A cross‐sectional, case–control study.Setting. The Karolinska Hospital, Stockholm.Subjects. Randomly selected hyper‐ (n = 53) and normotriglyceridaemic (n = 57) males, 40–50 years, with a fasting serum triglyceride concentration (mean ± SD) of 3.81 ± 1.65 and 1.28 ± 0.53 mmol L−1, respectively. The exclusion criterion was diabetes mellitus, defined according to the World Health Organization (WHO) guidelines.Main outcome measures. To compare the fasting serum concentration distributions of lathosterol, a cholesterol precursor, in hyper‐ and normotriglyceridaemic groups.Results. Thirty‐six per cent of the hypertriglycerdaemic group had raised serum lathosterol concentrations, based on the 90th percentile of the lathosterol distribution of the normotriglyceridaemic group. In the hyper‐ but not in the normotriglyceridaemic group, lathosterol concentration was directly correlated with serum insulin responses to oral (r = 0.38; P = 0.007) and intravenous (r = 0.41; P = 0.005) glucose challenges.Conclusions. One‐third of a randomly selected non‐diabetic hypertriglyceridaemic population had an increased serum lathosterol concentration and this might indicate an increased cholesterol synthesis rate compatible with increased production of VLDL particles, possibly as the result of chronic hyperinsulinaemia.
Hypomagnesemia in heart failure with ventricular arrhythmias. Beneficial effects of magnesium supplementation
Authors: Ceremużyński L. , Gębalska J. , Wołk R. , Makowska E. 
Published: March 2003

Abstract. Ceremużyński L, Gębalska J, Wołk R, Makowska E (Klinika Kardiologii CMKP, Szpital Grochowski, Warszawa, Poland). Hypomagnesemia in heart failure with ventricular arrhythmias. Beneficial effects of magnesium supplementation. J Intern Med 2000; 247: 78–86.Objective. To assess the role of electrolyte imbalance in cardiac arrhythmias associated with congestive heart failure.Design. Serum magnesium and potassium levels, urine magnesium excretion and the incidence of ventricular arrhythmias were assessed throughout the study. The patients who displayed complex arrhythmias after the first week of hospital medication were randomized 2 : 1 to double‐blind magnesium supplementation or placebo.Setting. The study was carried out in one municipal hospital, providing primary care.Subjects. A total of 588 consecutive patients were screened for eligibility (clinical heart failure ≥6 months; NYHA class II‐IV; left ventricular ejection fraction ≤40%; sinus rhythm; serum creatinine ≤2 mg dL–1). A total of 78 patients entered and 68 patients completed the study.Interventions. Intravenous administration of magnesium (magnesium sulphate 8 g in 250 mL of 5% glucose) or placebo (250 mL of 5% glucose) over 12 h.Main outcome measures. (i) Incidence of ventricular arrhythmias in patients with hypomagnesemia; (ii) effects of magnesium supplementation on ventricular arrhythmias.Results. On admission, hypomagnesemia was found in 38% and excessive magnesium loss in 72% of patients. Serum magnesium levels were lower and urine magnesium excretion was greater in patients with complex ventricular arrhythmias, both on admission and after treatment for heart failure. Intravenous administration of magnesium caused a significant decrease in the number of ventricular ectopic beats (P < 0.0001), couplets (P < 0.003) and episodes of nonsustained ventricular tachycardia (P < 0.01).Conclusions. Hypomagnesemia, probably related to increased urine magnesium excretion, is an essential feature of heart failure associated with complex ventricular arrhythmias. These arrhythmias can be alleviated/abolished by magnesium supplementation.
The distribution of two different vitamin D receptor polymorphisms (BsmI and start codon) in primary hyperparathyroidism
Authors: Sosa M. , Torres A. , Martín N. , Salido E. , Limiñana J. M. , Barrios Y. , De Miguel E. , Betancor P. 
Published: March 2003

Abstract. Sosa M, Torres A, Martín N, Salido E, Limiñana JM, Barrios Y, de Miguel E, Betancor P (University Hospital Insular, Bone Metabolic Unit, University of Las Palmas de Gran Canaria, Las Palmas and University of La Laguna, Canary Islands, Spain). The distribution of two different vitamin D receptor polymorphisms (BsmI and start codon) in primary hyperparathyroidism. J Intern Med 2000; 247: 124–130.Introduction. The bb genotype of the BsmI polymorphism of the vitamin D receptor (VDR) is more common in primary hyperparathyroidism (HPT) than in the general population in Swedish and German women. However, little is known about the association of HPT with the start codon polymorphism of the VDR (defined by FokI).Objective. To study the distribution of the VDR genotypes in a group of women with HPT compared with a control group. The bone mineral density (BMD) of different genotypes was also investigated.Methods. VDR alleles were typed by polymerase chain reaction (PCR) assay around the polymorphic BsmI or FokI restriction sites in 67 control women (48.5 ± 10 years) and 53 women with HPT (61.4 ± 11 years). They were all Caucasian and born in the Canary Islands. Lumbar and proximal femur BMDs were measured by dual X‐ray absorptiometry (DXA) and quantitative computed tomography (QCT).Results. The ‘bb’ genotype was equally frequent in controls and HPT subjects (46.3 and 45.3%, respectively). There was a trend towards a lower prevalence of the FF genotype amongst women with HPT as compared with controls (41.5 vs. 57.1%; P = 0.09). BMD was lower in patients with HPT compared with controls in the lumbar spine and the proximal femur.Conclusions. The association of the BsmI polymorphism of the VDR gene with HPT is not applicable to all geographical areas. In Canarian postmenopausal women suffering from HPT, VDR genotype distribution is similar to that found in controls. A possible association of HPT with the FokI polymorphism deserves further investigation.