bluuebunny/crossref_metadata_2025_split huggingface dataset:
Insulin sensitivity in cardiological syndrome X
Authors: QUIÑONES GALVAN A. , NATALI A. , MUSCELLI E. , CIOCIARO D. , PECORI N. , CAMICI P. G. , FERRANNINI E. 
Published: November 2003

Objectives. To test whether cardiological syndrome X is an insulin‐resistant state. Setting, design and subjects. The coronary care unit of a referral centre for angina pectoris in Pisa, Italy. A case‐control study, involving 10 patients with unequivocal (angiographycally proven) cardiological syndrome X, but normal glucose tolerance, blood pressure and lipid levels, and 13 matched healthy subjects. Main outcome measures. Insulin sensitivity and pattern of substrate oxidation (assessed by the euglycaemic insulin clamp technique in combination with indirect calorimetry). Results. Fasting plasma glucose and insulin levels were 5.05±0.11 versus 4.88±0.11 mmol l‐1 and 68±10 versus 56±6 pmol l‐1, respectively (controls versus patients, ns). During the insulin clamp, glucose disposal rate was nearly identical in patients and controls (25.9±1.8 and 27.2±1.8 μmol kg‐1 min‐1, respectively, P=0.88). Non‐oxidative glucose disposal accounted for similar proportions of total glucose uptake (59 versus 53%, patients versus controls, ns). Resting energy expenditure (13.7±0.6 versus 13.8±0.8 cal kg‐1 min‐1, ns) and insulin‐induced thermogenesis were similar in the two groups. Fasting plasma NEFA concentrations (0.64±0.09 and 0.64±0.06 mmol l‐1, patients and controls, ns) fell in a similar time‐course and to virtually identical nadirs (0.13±0.02 and 0.14±0.02 mmol l‐1) after insulin infusion. Fasting plasma potassium was similar in patients and controls (3.99±0.10 and 4.16±0.04 mmol l‐1, ns), and insulin induced equivalent hypokalaemia (‐14 versus ‐19%). Conclusions. None of the in vivo actions of insulin were impaired in patients with when compared to matched controls. Therefore, we conclude that cardiological syndrome X is not an insulin resistant state per se, and that any decrease in insulin sensitivity found in this condition is likely to be secondary.
New concepts in the pathophysiology of heart failure: beneficial and deleterious interaction of endogenous haemodynamic and neurohormonal mechanisms
Authors: PACKER M. 
Published: November 2003

Packer, M (Division of Circulatory Physiology, Columbia University, College of Physicians and Surgeons, New York, USA). New concepts in the pathophysiology of heart failure: beneficial and deleterious interaction of endogenous haemodynamic and neurohormonal mechanisms (Minisymposium: Heart failure). J Intern Med 1996; 239: 327–33.During most of the last 50 years, physicians have viewed heart failure primarily as an oedematous disorder, in which fluid retention occurs because the heart cannot pump adequate quantities of blood to the kidneys. This conceptual model led to the successful utilization of diuretics for heart failure, but it failed to permit physicians to recognize that heart failure is a chronic progressive disorder that impairs both the quality and quantity of life, even when oedema is adequately controlled.To accommodate this new understanding, a new model has been developed, in which the development and progression of heart failure is viewed as resulting from the interplay of haemodynamic and neurohormonal mechanisms. Both mechanisms support the inotropic state of the heart following an injury to the myocardium, but when sustained for long periods, their ability to augment cardiac contractility wanes, and, instead, these same mechanisms act to enhance ventricular wall stress, thereby impairing ventricular performance. As the heart‐failure state evolves, endogenous mechanisms that are normally activated to control wall stress become exhausted, and peripheral vasoconstriction and sodium retention develop. Unopposed activation of haemodynamic stresses and neurohormonal systems leads to further destruction of the myocardium and progression of the underlying disease.The acceptance of this haemodynamic– neurohormonal model has led to the development of vasodilators and neurohormonal antagonists that have been shown to be useful alone, or when added to diuretics, in the treatment of heart failure.
Cardiovascular risk groups and mortality in an urban Swedish male population: the Malmö Preventive Project
Authors: BERGLUND G. , ERIKSSON K. F. , ISRAELSSON B. , KJELLSTRÖM T. , LINDGÄRDE F. , MATTIASSON I. , NILSSON J. Å. , STAVENOW L. 
Published: November 2003

Objectives. To describe the size, overlap and mortality of four cardiovascular risk groups, in order to give a scientific background for the prevention of cardiovascular disease in a representative urban population. Setting. Section of Preventive Medicine, Department of Medicine, Malmö University Hospital, Malmö, Sweden. Subjects. Between 1974 and 1984 22444 men born between 1949 and 1921, constituting 75% of the total male population in these age groups, took part in a comprehensive screening examination aimed at detecting risk factors for cardiovascular disease. Interventions. Those at high‐risk of developing cardiovascular disease were referred to their general practitioner or to special clinics for hypertension, hyperlipidaemia and diabetes. The follow‐up, which lasted until the end of 1991, averaged 12.2 years. Main outcome measures. Total death (n=1450) and death from ischaemic heart disease (IHD) (n=471). Results. Hypertension was found in 13%, hypercholesterolaemia in 19% and diabetes mellitus in 2.6% of the subjects; 49% of the subjects smoked. Multiple risk factors were found in over 17% of the total cohort.Despite the intervention, all‐cause mortality during follow‐up was increased three‐fold in smokers and in men with hypercholesterolaemia, four‐fold in hypertensive men and five‐fold in men with diabetes, compared to men with no risk factors. The vast majority of deaths (81%) occurred in men who smoked, had hypertension or had high serum cholesterol. Ischaemic heart disease (IHD) was increased five‐fold in smokers, seven‐fold in men with hypercholesterolaemia, nine‐fold in hypertensive men and 12‐fold in men with diabetes. Again, the vast majority of IHD deaths (86%) occurred in the first three categories. Combinations of risk factors substantially increased total mortality as well as IHD mortality. Conclusions. The large proportion (64%) of the population with risk factors for cardiovascular disease and the substantially (5–12‐fold) increased IHD mortality in those risk groups, calls for actions aimed at preventing premature IHD deaths. Such action should include measures directed towards the whole population and comprehensive treatment programmes for high‐risk individuals, including intervention to stop smoking. The substantial overlap between risk factors calls for one high‐risk clinic caring for all risk groups.
Urolithiasis and distal renal tubular acidosis preceding primary Sjögren's syndrome: a retrospective study 5–53 years after the presentation of urolithiasis
Authors: ERIKSSON PER , DENNEBERG TORSTEN , ENESTRÖM SVERKER , JOHANSSON BJÖRN , LINDSTRÖM FOLKE , SKOGH THOMAS 
Published: November 2003

Objectives. Distal renal tubular acidosis (dRTA) can be associated with autoimmune diseases such as primary Sjögren's syndrome (SS). Our objective was to study SS‐associated symptoms, autoantibodies and renal histopathology in patients with urolithiasis and dRTA. Setting. The patients were from the Departments of Nephrology and Rheumatology, University Hospital of Linköping, which is a tertiary referral hospital, as well as a secondary referral centre for the immediate area around the city of Linköping. Subjects. Ten female patients with dRTA, who presented with urolithiasis and not with subjective sicca symptoms, were from the Department of Nephrology, University Hospital, Linköping. Autoantibodies were detected in eight of these patients, and they were studied with respect to clinical and laboratory evidence of SS (urolithiasis group). Fifteen women with SS, who presented with sicca symptoms and not with urolithiasis or dRTA, served as the reference group. Results. In the urolithiasis group, all of the eight patients had anti‐SS‐A antibodies, and SS (or possible SS) developed in seven of the eight patients 1–48 (mean 15) years after the onset of urolithiasis. Histological features of tubulointerstitial nephritis were found in four of five biopsied patients in the urolithiasis group, and in two of four patients (with dRTA) in the reference group. Conclusions. Urolithiasis and dRTA can precede subjective sicca symptoms, and patients with dRTA may have SS in the absence of subjective sicca symptoms. Anti‐SS‐A antibodies are common in patients with urolithiasis and dRTA. Therefore, we hypothesize the possibility of a Sjögren‐related renal disease in these patients.
Comparison of standardized initial doses of two antithyroid drugs in the treatment of Graves' disease
Authors: KALLNER G. , VITOLS S. , LJUNGGREN J. G. 
Published: November 2003

Objectives. To obtain a simple standard regimen, suitable for general practice, and based upon the addition of antithyroid drug plus thyroxine for attaining euthyroidism in patients with Graves' disease. Design. Prospective, randomized trial of patients with Graves' disease followed for 3 months after the initiation of therapy with an antithyroid drug and combined with the later addition of triiodothyronine to keep the patient euthyroid. The patients were randomized, according to birth date, between methimazole and propylthiouracil. Three dose schemes were tested for each antithyroid drug. Setting. The study was performed at the thyroid outpatient units of two general hospitals, with the patients having been referred from primary care. Subjects. Ninety‐four patients with Graves' disease who were suitable for treatment with antithyroid drugs. Interventions. The patients were allocated into six groups. Three groups received methimazole (10 mg every 6th, 8th or 12th h) and three received propylthiouracil (100 mg every 6th, 8th or 12th h). Twenty micrograms of triiodothyronine was added when the patients were euthyroid to avoid hypothyroidism. Main outcome measures. The lowest serum free thyroxine level within 3 months of the initiation of the antithyroid treatment. Results. Fourteen per cent of the patients on methimazole 10 mg every 12th h and 29% on propylthiouracil 100 mg every 12th h did not achieve euthyroidism within the 3‐month observation period. All but one patient on methimazole 10 mg every 8th h or propylthiouracil 100 mg every 8th h reduced the free serum thyroxine levels to the normal or hypothyroid range within the observation period. All of the patients on methimazole 10 mg every 6th h and 56% on propylthiouracil 100 mg every 6th h reduced the serum T4 values into the hypothyroid range within the period. Conclusion. A standard regimen, based upon the addition of methimazole 10 mg every 8th or 6th h or propylthiouracil 100 mg every 8th or 6th h and followed by the addition of thyroxine or triiodothyronine when euthyroid to avoid hypothyroidism, seems to be suitable for attaining euthyroidism within 3 months in patients with Graves' disease. A dose scheme based on methimazole 10 mg every 12th h or propylthiouracil 100 mg every 12th h were found to be unsuitable due to an unacceptably high incidence of failure to attain euthyroidism or hypothyroidism within 3 months.
Aluminium‐containing agents may be toxic in predialysis chronic renal insufficiency patients
Authors: LIN JA‐LIANG , LEU MEI‐LING 
Published: November 2003

Objective. To investigate the possible toxic effects of long‐term low dose aluminium (Al) exposure in predialysis chronic renal insufficiency (CRI) patients (serum creatinine >1.4 mg dL‐1). Design. An open, random, and prospective clinical study. Setting. The study was carried out at Chang Gung Memorial Hospital, a medical centre of Chang Gung Medical College. Subjects. Seventy CRI patients who have regularly attended a nephrology out‐patient department participated in this study. After a 3‐month wash‐out period 50 were given an Al loading test and 20 received no Al‐containing agents. Interventions. We used a low dose of Al(OH)3 (one tablet three times day‐1, about 302 mg aluminium day‐1) for 3 months as an Al loading test. Main outcome measures. The study was divided into two phases: phase 1, a basal study to measure serum Al, iron, ferritin, daily urinary Al excretion and renal function status; and phase 2, in which an Al loading test was performed. The phase 1 parameters were measured again after the Al loading test to compare the differences between pre‐ and post‐study in the two groups. Results. We found significant increments of serum Al and daily urinary Al excretion in all study group patients afterthe Al loading test. The increments of serum Al correlated with basal creatinine clearance (Ccr: r=–0.352, P<0.05) and basal serum ferritin (r=–0.302, P<0.05). Serum ferritin was significantly reduced after the Al loading tests, and the reduction (r=0.357, P<0.05) positively correlated with the increments of daily urinary Al excretion in the study group patients. However, no significant changes of serum Al, ferritin, and daily urinary Al excretion were noted in the control group patients. Conclusions. A long‐term low dose Al exposure can cause significant Al accumulation and iron store depletion in CRI patients. Therefore, Al‐containing agents should be used with caution in patients with CRI.
Helicobacter pylori–can the mechanisms of pathogenesis guide us towards novel strategies for treatment and prevention?
Authors: FALK PER 
Published: November 2003

Falk P (Gastrointestinal Research Laboratory, Department of Medicine, the Karolinska Institute, Stockholm, Sweden and the Department of Molecular Biology and Pharmacology, Washington University School of Medicine, St. Louis, Missouri, USA). Helicobacter pylori—Can the mechanism of pathogenesis guide us towards novel strategies for treatment and prevention? (Review). J Intern Med 1996; 240: 319–32. Helicobacter pylori establishes a chronic infection in the stomach of humans. The infection is associated with a low grade inflammatory response in the epithelium that can develop into chronic active gastritis, peptic ulcer disease or neoplasia. Antibiotics have dramatically decreased the rate of recurrence of peptic ulcers. However, antibiotic resistance is already evident, casting doubts on the future efficacy of these strategies. The link between childhood infection and severe health problems, including increased risk for gastric tumours motivate efforts to develop vaccines. Characterization of the molecular mechanisms of pathogenesis will pave the way for novel strategies for treatment and prevention of H. pylori infection.
Relations between vasoactive hormones and diastolic function in hypertensive uraemic patients
Authors: NAPOLI C. , LIGUORI A. , SORICE P. , DI BENEDETTO A. , CIAFRE S. , POSCA T. , DI IESO N. , D'ARMIENTO F. P. 
Published: November 2003

Background. Arterial hypertension is a significant risk factor for the high rate of cardiovascular disease in chronic uraemic (CU) patients. Any role that hypertension may play in CU patient outcomes assumes added significance. The elevation of some hormonal factors in early clinical stage could represent a valuable marker of cardiac disease in CU. Aim. This study first investigated the role of several hormones on cardiac diastolic properties in CU patients. Moreover, the study investigated the association of hypertension with both diastolic function and release of vasoactive hormones in CU patients. Results. We have reported that the early impairment of diastolic function is correlated with the elevation of both circulating plasma atrial natriuretic factor and endothelin‐1 (ET‐1) in hypertensive CU patients. Since the effect of ET‐1 on diastolic function is still poorly understood, we have investigated also this issue. In eight additional patients with reduced E/A ratio, but without uraemia, hypertension or chronic heart failure, we have showed a high inverse correlation between the values of E/A ratio and ET‐1 plasma concentrations. Conclusions. These results strongly suggest that the elevation in ET‐1 levels was correlated with diastolic dysfunction in man. This phenomenon may have important pathophysiological implications suggesting the possibility of an early therapeutic approach in these patients.
The white blood cell count: its relationship to plasma insulin and other cardiovascular risk factors in healthy male individuals
Authors: TARGHER GIOVANNI , SEIDELL JAAP , TONOLI MARCO , MUGGEO MICHELE , DE SANDRE GIORGIO , CIGOLINI MASSIMO 
Published: November 2003

Targher G, Seidell JC, Tonoli M, Muggeo M, De Sandre G, Cigolini M (Division of Endocrinology and Metabolic Diseases, Institute of Clinical Medicine, University of Verona, Italy; and Department of Chronic Diseases and Environmental Epidemiology‐RIVM, Bilthoven, The Netherlands). The white blood cell count: relationship to plasma insulin and other cardiovascular risk factors in healthy males. J Intern Med 1996; 239: 435–41. Objectives. To evaluate the relationships of total and differential white blood cell (WBC) count to the components of the so‐called insulin resistance syndrome. Subjects and design. The study population consisted of a random sample of 90 38‐year‐old healthy men with normal glucose tolerance. Interventions. A 75 g oral glucose tolerance test was performed in all participants. Main outcome measures. Total and differential WBC count, lipids, blood pressure, plasma glucose, C‐peptide and insulin (at fasting and 2 h after glucose load). Results. Total WBC count correlated consistently with plasma 2‐h glucose (r=0.38; P<0.001), fasting and 2‐h postload insulin (r=0.26 and r=0.33; P<0.01–0.001, respectively) and C‐peptide (r=0.28 and r=0.32; P<0.01–0.001) concentrations. Smokers had significantly higher total leukocytes (P<0.01), neutrophils and lymphocytes than nonsmokers. Furthermore, total WBC count correlated positively with body mass index, blood pressure, plasma triglycerides, fibrinogen, and negatively with HDL cholesterol concentration. As differential WBC count, most variables correlated essentially to neutrophils and/or lymphocytes, whereas plasma insulin and C‐peptide concentrations correlated essentially to lymphocytes and monocytes, but not to neutrophils. In a multiple linear regression analysis, only 2‐h plasma glucose (P<0.01) and fibrinogen (P<0.05) were positive predictors of total WBC count after adjusting for all potentially confounding variables. Conclusions. The results indicate that increased, albeit normal, WBC count associates with the cluster of metabolic and haemodynamic disorders typical of the insulin resistance syndrome, and suggest that increased WBC count may be yet another component of this syndrome.
Hyperkalaemia in acute leukaemia: a sign of adrenocortical insufficiency
Authors: DEMİROğLU H. , DÜNDAR S. 
Published: November 2003

Demiroğlu H & Dündar S (Department of Haematology, Hacettepe University Medical School, Ankara, Turkey). Hyperkalaemia in acute leukaemia: a sign of adrenocortical insufficiency. J Intern Med 1997; 242: 111–15.ObjectivesTo evaluate adrenal cortical reserve function in hyperkalaemic patients with acute leukaemia (AL).DesignIn hyperkalaemic AL patients, after basal blood collection for cortisol, rapid adrenocorticotropic hormone (ACTH) stimulation test was performed with human a1–24‐ACTH 0.25 mg, intravenously. Sixty minutes following injection, additional plasma was obtained for cortisol. Normal response was a peak cortisol level greater than 15 μg dL−1 with an increment greater than 5 μg dL−1.SettingHacettepe University Hospital, Ankara, Turkey.SubjectsNewly diagnosed AL patients with plasma K+ values exceeding 4.5 mmol L−1, who had never received antileukaemia therapy were eligible for entry into the trial. Thirteen patients fulfilled these criteria. Twenty AL patients with normal serum K+ levels were studied as controls.ResultsIn six patients with hyperkalaemia, adrenal cortical response to rapid ACTH test was inadequate. One patient died during induction chemotherapy due to sepsis. Five of the remaining patients entered remission. Repeat ACTH tests during remission revealed normalization of the adrenocortical function in these patients. However, in only one patient with normal serum K+ level, adrenocortical reserve was decreased.ConclusionsWe suggest that in any AL patient with hyperkalaemia, adrenal reserve function should be evaluated with rapid ACTH stimulation test. In states of resistant hypotension and hyperkalaemia, steroids may be life saving.
Danaparoid: an antithrombotic agent without major impact on triglyceride hydrolysis capacity in humans
Authors: van Barlingen H. H. J. J. , van Beek A. , Erkelens D. W. , de Bruin T. W. A. 
Published: November 2003

van Barlingen HHJJ, van Beek A, Erkelens DW, de Bruin TWA (Department of Internal Medicine, Laboratory of Lipid Metabolism, University Hospital, Utrecht University, PO Box 85 500, 3508 GA Utrecht, The Netherlands). Danaparoid: an antithrombotic agent without major impact on triglyceride hydrolysis capacity in humans. J Intern Med 1997; 242: 125–29.ObjectivesHeparin is a widely used antithrombotic drug. Besides its anticoagulant properties, it also has a marked influence on lipid metabolism, by decreasing serum lipolytic activity due to lipase depletion from vascular sites and stores. Especially in haemodialysis patients who receive heparin during every dialysis session, and in hypertriglyceridaemic patients, decreasing lipolytic activity can lead to the accumulation of triglyceride‐rich lipoproteins, which are atherogenic. Replacement of heparin by an antithrombotic drug with less lipase releasing activity might reduce this risk.DesignWe tested danaparoid, a new antithrombotic drug, and compared its ability to displace biotinylated heparan sulphate from lipoprotein lipase in vitro with heparin. Furthermore we compared the in vivo lipase releasing activity.ResultsDanaparoid displaced significantly less biotinylated heparan sulphate from triglyceride‐rich lipoprotein‐lipoprotein lipase complexes in vitro than heparin. Intravenous injection of danaparoid released less than 20% (P < 0.05) of the lipolytic activity released by an equivalent anticoagulant dose of heparin.ConclusionDanaparoid is the drug of choice during the antithrombotic therapy of hypertriglyceridaemic or haemodialysis patients.