bluuebunny/crossref_metadata_2025_split huggingface dataset:
Bronchoalveolar lavage cells from sarcoidosis patients and healthy controls can efficiently present antigens
Authors: Grunewald J. , Eklund A. , Wigzell H. , Van Meijgaarden K. E. , Ottenhoff T. H. M. 
Published: March 2003

Abstract.Objectives. The interaction between antigen‐presenting cells (APC) and T lymphocytes, that recognize the antigen‐HLA complex using its T cell‐receptor for antigen, is of crucial importance for a subsequent specific immune response. In patients with pulmonary sarcoidosis, the local antigen‐ presenting capacity in the lungs has been suggested to be abnormally enhanced, and implicated in the immunopathogenesis of the disease. This study was aimed at increasing the understanding of the capacity to present antigens by APC in the lung compartment.Design and subjects. We used bronchoalveolar lavage (BAL) cells and paired peripheral blood mononuclear cells (PBMC) of six sarcoidosis patients and two healthy controls to stimulate in total eight well characterized T‐cell clones with known HLA and antigen specificities. All subjects were HLA typed.Results.  BAL cells of sarcoidosis patients as well as of healthy controls efficiently induced proliferation of the relevant T‐cell clone in an HLA‐restricted manner when adding either intact antigen or antigenic peptides.Conclusions.  BAL cells have the capacity to process and present antigens adequately, irrespective of whether they are derived from healthy individuals or from patients with sarcoidosis, implying the alveolar space as an important location for active immune reactions.
Urinary albumin excretion rate is independently related to autonomic neuropathy in type 2 diabetes mellitus
Authors: Wirta O. R. , Pasternack A. I. , Mustonen J. T. , Laippala P. J. , Reinikainen P. M. 
Published: March 2003

Abstract.Objective.  To evaluate if urinary albumin excretion rate (UAER) is independently related to subclinical autonomic neuropathy in type 2 diabetes.Design.  A controlled cross‐sectional study.Setting.  Primary health care centre.Subjects.  Consecutive recently diagnosed (<1 year) type 2 diabetic patients (group A, n = 150) and patients with long‐standing (median 11 years) type 2 diabetes (group B, n = 146) chosen at random. A nondiabetic control group (group C, n = 150) matched for age and gender to group A.Main outcome measures.  Neuropathy by cardiovascular reflex tests and UAER by nephelometry.Methods.  Univariate statistics in group A + B (t‐test χ2– or McNemars test) with Valsalva and breathing ratios as categorical grouping variables and the independent variables gender, smoking, systolic and diastolic blood pressure, fasting serum cholesterol, HDL cholesterol, triglycerides, haemoglobin A1c, glucagon stimulated C‐peptide, fasting and postload 1 and 2 h blood glucose and serum insulin, UAER, coronary heart disease and congestive heart failure. Logistic regression analyses in group A + B with Valsalva and breathing ratios as dependent categorical variables and age, systolic blood pressure, congestive heart failure, coronary heart disease, fasting blood glucose, serum triglycerides and UAER as independent variables.Results.  Compared to nondiabetic subjects the diabetic patients of both groups were at increased risk of neuropathy as judged by the Valsalva ratio (P < 0.01). In known diabetic patients with a UAER ≥30 mg 24–1 h neuropathy was more common than amongst their normoalbuminuric counterparts (Valsalva test P = 0.007, breathing test P = 0.02). In logistic regression analysis UAER independently explained abnormal Valsalva (P = 0.015) and breathing tests (P = 0.04) in the group A + B.Conclusions.  UAER is independently related to subclinical autonomic neuropathy in type 2 diabetes.
Chronic fatigue syndrome: new insights and old ignorance
Authors: Evengård B. , Schacterle R. S. , Komaroff A. L. 
Published: March 2003

Abstract. Evengård B, Schacterle RS, Komaroff AL (Karolinska Institute at Huddinge University Hospital, Huddinge, Sweden; and Brigham and Women’s Hospital, Harvard Medical School, Boston, USA). Chronic fatigue syndrome: new insights and old ignorance. J Intern Med 1999; 246: 455–469.Chronic fatigue syndrome (CFS) is a condition characterized by impairment of neurocognitive functions and quality of sleep and of somatic symptoms such as recurrent sore throat, muscle aches, arthralgias, headache, and postexertional malaise. A majority of patients describe an infectious onset but the link between infections and CFS remains uncertain. Findings show an activation of the immune system, abberations in several hypothalamic‐pituitary axes and involvement of other parts of the central nervous system. The origin is bound to be complex and it may well be that the solution will come together with a more generally altered view about mind–body dualism, and the concept of illness and disease.
High prevalence of Hypophosphataemia amongst patients with infectious diseases. A retrospective study
Authors: Håglin L. , Burman L. ‐A. , Nilsson M. 
Published: March 2003

Objectives  To describe the prevalence of hypophosphataemia amongst all patients treated during 1993 for infectious diseases. The associations between serum C‐reactive protein, serum albumin and white blood cells in blood were studied amongst hypophosphataemic patients. Comparisons were made according to the severity of infection.Design.  A retrospective study of the prevalence of hypophosphataemia, and a case‐control study amongst a subgroup of patients.Setting   The Department of Infectious Diseases, University Hospital, Umeå, Sweden.Subjects  For the prevalence study all 967 patients (449 women and 518 men) treated during 1993 were included. In the case‐control study, 108 cases, with serum phosphate ≤ 0.64 mmol L–1, 216 age‐ and sex‐matched controls with serum phosphate > 0.82 mmol L–1 (men) and > 0.86 mmol L–1 (women), respectively, were included.Results  In 402 of 967 patients (42%) at least one serum phosphate value was below the reference level. Hypophosphataemia was found in 573 of 1966 blood samples (29%). Severe hypophosphataemia (< 0.30 mmol L–1) was seen in 1.2% of the patients (0.9% of blood samples). The prevalence of hypophosphataemia was higher amongst women than amongst men. In the case‐control study, the serum C‐reactive protein and the number of white blood cells was higher amongst the cases compared with the controls (124 vs. 94 mg L–1 and 11.4 vs. 9.3 cells/L × 109, respectively). The multiple logistic regression showed a 4‐fold higher risk of having low serum phosphate in patients with severe infection, compared with mild infections. None of the other variables (albumin, days of hospital stay or white blood cells in blood) increased the risk for hypophosphataemia.Conclusions  The high prevalence of low serum phosphate levels and the increased risk of having low levels in severe infections shown in this study needs further attention.
Low‐dose vasopressin restores diuresis both in patients with hepatorenal syndrome and in anuric patients with end‐stage heart failure
Authors: Eisenman A. , Armali Z. , Enat R. , Bankir L. , Baruch Y. 
Published: March 2003

Abstract. Eisenman A, Armali Z, Enat R, Bankir L, Baruch Y (Rambam Medical Center and Technion‐Israel Institute of Technology, Haifa, Israel; and INSERM, Necker Hospital, Paris, France). Low‐dose vasopressin restores diuresis both in patients with hepatorenal syndrome and in anuric patients with end‐stage heart failure. J Intern Med 1999; 246: 183–190.Objectives. The purpose of this study was to confirm earlier reports that low‐dose vasopressin (LDVP) analogues promote urine output in patients with hepatorenal syndrome (HRS) and to check whether this mode of therapy could also be effective in renal shutdown due to nonhepatic conditions.Design. A prospective, open, interventional study.Setting. An intermediate‐level (step‐down) medical intensive care unit within a general medical ward of a large university‐affiliated hospital.Subjects. Eighteen successive hospitalized patients with HRS (mean age 65 ± 13 years) and 11 patients with end‐stage congestive heart failure (CHF) (mean age 81 ± 5 years) who failed to restore urine output with conventional treatment (fluids, dopamine, and diuretics) given for at least 24 h.Interventions. The patients received LDVP (1 IU h−1) continuously in addition to the conventional treatment.Main outcome measures. Urine output and creatinine clearance every 24 h.Results. In the HRS group, before treatment the urine output was 155 ± 9 mL 24 –1h (mean ± SD). After treatment with LDVP for 24, 48, and 72 h, urine output improved to 1067 ± 87, 1020 ± 501, and 1311 ± 988 mL 24 –1h, respectively (P < 0.0001 for all measures; two‐tailed paired t‐test). In the CHF group, before treatment the urine output was 99 ± 99 mL 24 –1h. After treatment with LDVP for 24, 48, and 72 h, this improved to 1125 ± 994 mL 24 –1h (P = 0.0028), 1821 ± 1300 mL 24 –1h (P = 0.004), and 2920 ± 2423 mL 24 –1h (P = 0.0012), respectively. The improvement in urine output was not accompanied by a parallel improvement in creatinine clearance. The overall outcome did not change, and all patients except two in each group succumbed to their end‐stage disease, due to nonrenal causes.Conclusions. LDVP is effective in restoring urine output both in HRS and in CHF. This suggests that LDVP affects mechanisms not specifically related to liver disease. LDVP may be useful in critical patients with renal shutdown whilst awaiting liver or heart transplantation.
Chronic intoxication by doxycycline use for more than 12 years
Authors: Westermann G. W. , Böhm M. , Bonsmann G. , Rahn K. H. , Kisters K. 
Published: March 2003

Abstract.   Westermann GW, Böhm M, Bonsmann G, Rahn KH, Kisters K (Westfälische Wilhelms‐University, Münster, Germany). Chronic intoxication by doxycycline use for more than 12 years (Case Report). J Intern Med 1999; 246: 591–592.We report the clinical case of a 12‐years’ intoxication by doxycycline. A patient with a depersonalization and derealization syndrome took 1 g doxycycline per day. In addition to hepatocellular necrosis with cholestasis, nephrotoxicity, leukopenia, anaemia and skin hyperpigmentation he suffered from hitherto unreported adverse cardiac events as intermittent supraventricular tachycardia and sporadic Wenckebach heart block. Despite a long period of self‐medication these side‐effects were reversible.
Hyperhomocysteinaemia is not associated with isolated crural arterial occlusive disease: The Hoorn Study
Authors: Hoogeveen E. K. , Kostense P. J. , Jakobs C. , Rauwerda J. A. , Dekker J. M. , Nijpels G. , Bouter L. M. , Heine R. J. , Stehouwer C. D. A. 
Published: March 2003

Abstract.  Hoogeveen EK, Kostense PJ, Jakobs C, Rauwerda JA, Dekker JM, Nijpels G, Bouter LM, Heine RJ, Stehouwer CDA (University Hospital Vrije Universiteit, Amsterdam). Hyperhomocysteinaemia is not associated with isolated crural arterial occlusive disease: the Hoorn Study. J Intern Med 2000; 247: 442–448.Objectives.  Hyperhomocysteinaemia is an independent risk factor for peripheral arterial disease (PAD). The localization of peripheral arterial disease is clinically relevant, because proximal (aortoiliac and femoropopliteal) disease is associated with a particularly poor overall prognosis, whereas isolated distal (i.e. crural) disease is associated with a better overall prognosis. The aim of the study was to investigate whether the strength of the association between hyperhomocysteinaemia and peripheral arterial disease differs according to the localization of the anatomical obstruction.Design.  Fasting serum total homocysteine (tHcy) was measured in an age‐, sex‐ and glucose‐tolerance stratified random sample (n = 631) of a 50‐ to 75‐year‐old general Caucasian population. History of a peripheral arterial reconstruction was recorded. Aortoiliac, femoropopliteal and crural arterial obstructions were registered by means of Doppler flow velocity curves.Results.  The median serum tHcy level was 12.2 µmol L–1 (interquartile range: 10.0–15.3) in men and 10.7 µmol L–1 (interquartile range: 9.0–13.3) in women. The prevalences of aortoiliac, femoropopliteal and crural obstructions were 2.1%, 2.7% and 11.9%, respectively. After adjustment for age, sex, systolic blood pressure, current smoking, serum cholesterol and diabetes mellitus, the odds ratios (95% confidence interval) per 5 µmol L–1 tHcy increment were 1.41 (1.05–1.89) for aortoiliac, 1.03 (0.70–1.52) for femoropopliteal and 0.82 (0.59–1.15) for crural obstructions. Finally, diabetes mellitus, HbA1c and current smoking were significantly associated with crural and femoropopliteal disease, whereas systolic blood pressure was significantly associated with aortoiliac obstructions.Conclusions.  The present study indicates that hyperhomocysteinaemia is associated with aortoiliac but not with isolated crural arterial occlusive disease.
Modified LDL – trigger of atherosclerosis and inflammation in the arterial intima
Authors: Pentikäinen M. O. , Öörni K. , Ala‐Korpela M. , Kovanen P. T. 
Published: March 2003

Abstract. Pentikäinen MO, Öörni K, Ala‐Korpela M, Kovanen PT (Wihuri Research Institute, Helsinki, Finland). Modified LDL – trigger of atherosclerosis and inflammation in the arterial intima (Minisymposium). J Intern Med 2000; 247: 359–370.Atherosclerosis is characterized by chronic inflammation of an injured intima. The pathological processes are initiated by accumulation of morphologically distinct, modified forms of LDL, and followed by cellular infiltration and foam cell formation. Activated intimal cells secrete enzymes and agents capable of modifying LDL, and the modified lipids of LDL, in turn, are able to activate intimal cells and to trigger various inflammatory signals. These processes can initiate and maintain a vicious circle in the intima and lead to lesion progression. In this review, we focus on the LDL modifications relevant to the initial lipid accumulation and discuss their pro‐inflammatory effects.
Plasma total homocysteine concentration and the risk of acute coronary events: the Kuopio Ischaemic Heart Disease Risk Factor Studytpdel
Authors: Voutilainen S. , Lakka T. A. , Hämelahti P. , Lehtimäki T. , Poulsen H. E. , Salonen J. T. 
Published: March 2003

Abstract. Voutilainen S, Lakka TA, Hämelahti P, Lehtimäki T, Poulsen HE, Salonen JT (University of Kuopio, Kuopio, Finland; Tampere University Medical School, Tampere, Finland; University of Copenhagen, Copenhagen, Denmark). Plasma total homocysteine concentration and the risk of acute coronary events: the Kuopio Ischaemic Heart Disease Risk Factor Study. J Intern Med 2000; 248: 217–222.Objectives. Results from prospective studies concerning the association between plasma total homocysteine (tHcy) concentration and coronary heart disease (CHD) are conflicting. The purpose of this study was to test the hypothesis that plasma tHcy is associated with an increased risk of acute coronary events in middle‐aged men.Design and subjects. We investigated this association in a prospective nested case–control study among Eastern Finnish men aged 42–60 years. Plasma tHcy measurements were carried out for 163 men who had an acute coronary event during an average 8 years and 11 months follow‐up of the whole cohort and for 163 control subjects. Both the cases and the controls were from a cohort of 2005 men who had no clinical CHD at the Kuopio Ischaemic Heart Disease (KIHD) baseline.Results. Men in the highest plasma tHcy concentration quarter had no increase in the risk of coronary events compared with men with lower tHcy concentrations (odds ratio = 0.88, 95% confidence interval 0.44–1.76). Average follow‐up time before the first coronary event was 4.9 years (SD 3.2) in men in the highest plasma tHcy quarter and 5.5 years (SD 3.1) in men in the three lowest quarters (P = 0.368).Conclusion. We conclude that plasma tHcy is not associated with an increased risk of coronary events in the middle‐aged male population in eastern Finland.
A case of toxic shock‐like syndrome presenting with serious hypoproteinaemia because of a protein‐losing gastroenteropathy
Authors: Tasaki K. , Sasaki M. , Bamba M. , Shintani Y. , Andoh A. , Tsujikawa T. , Koyama S. , Fujiyama Y. , Bamba T. 
Published: March 2003

Abstract. Tasaki K, Sasaki M, Bamba M, Shintani Y, Andoh A, Tsujikawa T, Koyama S, Fujiyama Y, Bamba T (Shiga University of Medical Science, Shiga, Japan). A case of toxic shock‐like syndrome presenting with serious hypoproteinaemia because of a protein‐losing gastroenteropathy (Case report). J Intern Med 2001; 250: 174–179.A 37‐year‐old man was admitted to our hospital because of toxic shock‐like syndrome (TSLS) induced by Streptococcus pyogenes. After the pathogenic bacteria had been eradicated, serious diarrhoea appeared and a protein‐losing gastroenteropathy developed. An immunohistochemical study of the biopsy specimens of both small and large intestines revealed the infiltration of T‐lymphocytes, predominantly CD8+ cells, into the lamina propria of affected mucosa, villus atrophy and crypt hyperplasia. Considering these histological findings, some immunological mechanism which lead the activation of cytotoxic T‐lymphocytes may play an important role in the pathogenesis of this rare intestinal manifestation of TSLS.
Visceral fat and psychosocial stress in identical twins discordant for obesity
Authors: MARNIEMI J. , KRONHOLM E. , AUNOLA S. , TOIKKA T. , MATTLAR C.‐E. , KOSKENVUO M. , RÖNNEMAA T. 
Published: March 2003

Abstract. Marniemi J, Kronholm E, Aunola S, Toikka T, Mattlar C.‐E., Koskenvuo M, Rönnemaa T (Social Insurance Institution, Turku, Finland). Visceral fat and psychosocial stress in identical twins discordant for obesity. J Intern Med 2002; 251: 35–43. Objectives. Accumulation of intra‐abdominal fat has been suggested, but not yet proved, to be basically as a result of chronic psychosocial stress causing arousal of hypothalamic‐pituitary‐adrenal cortex axis. Our objectives were to study the association between psychosocial stress, obesity and body fat distribution when genetic factors are identical. Design. Monozygotic twins discordant for obesity were examined in an in‐patient setting. Subjects. Adult monozygotic twin pairs (12 female, 8 male) with an average intrapair difference of 17 kg in body weight. They were divided into two groups: in group A the visceral fat area of the obese cotwin was higher and, in group B, lower than the gender‐specific median value. Main measures. Hormonal, physiological and psychological distress indicators, and sleep measures. Results. Daily urinary cortisol and noradrenaline excretion were higher in the obese cotwins when compared with the nonobese cotwins in group A but not in group B (P=0.026 and 0.020 when intrapair differences were compared between groups A and B, respectively). In serum cortisol, ACTH and CBG concentrations a similar trend was not statistically significant. In group A, the obese cotwins consumed almost 2.5 times as much alcohol as their lean cotwins, whilst in group B the situation was the opposite. The mean amount of active sleep was significantly higher and that of quiet sleep significantly lower in the obese than the lean cotwins only in group A. Intrapair differences in emotional reactions indicating distress and lack of subjective energy were seen only in group A. Conclusion. When genetic factors are identical, visceral fat accumulation, rather than obesity in general, is associated with increased psychosocial stress and concomitant hormonal changes.
Cerebrotendinous xanthomatosis: molecular characterization of two Scandinavian sisters
Authors: Rystedt E. , Olin M. , Seyama Y. , Buchmann M. , Berstad A. , Eggertsen G. , Björkhem I. 
Published: March 2003

Abstract. Rystedt E, Olin M, Seyama Y, Buchmann M, Berstad A, Eggertsen G, Björkhem I (Karolinska Institutet, Stockholm, Sweden; OchanomizuUniversity, Tokyo, Japan; Medisinsk avdeling, Haukeland sykehus, Bergen). Cerebrotendinous xanthomatosis: molecular characterization of two Scandinavian sisters (Case report). Journal of Internal Medicine 2002; 252: 259–264.Cerebrotendinous xanthomatosis (CTX) is a hereditary disorder, which is inherited as an autosomally recessive disease, causing production of cholesterol and cholestanol xanthomas and mental retardation. The disease is caused by mutations in the gene for sterol 27‐hydroxylase (CYP27A1). The only CTX patients diagnosed in Scandinavia are two Norwegian sisters from a consanguineous marriage. Here we have characterized the mutation and its functional consequences for the enzyme. Analysis of genomic DNA from cultured fibroblasts identified a base exchange C > T in position 1441, causing arginine at amino acid position 441 to be replaced by tryptophan. The same mutation was introduced by mutagenesis in the complimentary DNA (cDNA) for CYP27, ligated into the expression vector pcDNA4/HisMax and transfected into HEK293 cells. The mutated enzyme had less than 5% of the enzyme activity compared with the native enzyme. No abnormal catalytic products could be identified in the cell culture medium. Probably the mutation affects the haem binding within the holoenzyme. The mutation has also previously been reported in a Japanese family. This is the second example of a CTX‐causing mutation that has been recognized in more than one population.
Traffic hypoglycaemias and accidents in patients with diabetes mellitus treated with different antidiabetic regimens
Authors: Harsch I. A. , Stocker S. , Radespiel‐Tröger M. , Hahn E. G. , Konturek P. C. , Ficker J. H. , Lohmann T. 
Published: March 2003

Objectives.  Insulin‐treated patients with diabetes are at a higher risk than the general population in causing traffic accidents due to hypoglycaemias. Preceeding investigations focused on insulin‐treated patients and hypoglycaemia‐induced accidents as ‘end‐points’. We studied the incidence of symptomatic hypoglycaemia and hypoglycaemia‐induced accidents during driving and put it in relation to the different treatment modes of insulin therapy (Conventional Insulin Treatment = CT, Intensified Conventional Insulin Treatment = ICT, Continuous Subcutaneous Insulin Infusion = CSII) as well as to patients treated with oral hypoglycaemia‐inducing agents and the two main types of diabetes mellitus.Design.  Subjects and setting: We investigated 450 patients (122 treated with sulphonylureas, 151 with CT, 143 with ICT and 34 with CSII) by an anonymous questionnaire at different locations to avoid bias. A total of 176 persons had type 1 diabetes, 243 persons had type 2 diabetes, 31 subjects could not be classified.Results.  Symptomatic hypoglycaemias during driving were rare events with an occurrence of 0.19–8.26 (minimal and maximal mean, depending on the mode of treatment), if given as hypoglycaemias per 100 000 km on one treatment regimen, or 0.02–0.63, if given as events per year driven. Their incidence increased significantly with the degree of ‘strictness’ between the treatment groups, except between the patients treated with ICT and CSII. Hypoglycaemia‐induced accidents are rare with 0.01–0.49, if given as events per 100 000 km and 0.007–0.01, if given as events per year driven. These differences were not significant. Significant confounders influencing the traffic safety of the patients were age, duration of diabetes and concomitant antihypertensive medication. Analysing the data in accordance with the type of diabetes revealed a significantly higher rate of hypoglycaemic events in patients with type 1 diabetes. The number of hypoglycaemia‐induced accidents was considerably higher in this group, but failed slightly to reach statistical significance.Conclusions.  Hypoglycaemias during driving are rare events, their occurrence is significantly influenced by the treatment regimen and type of diabetes. Hypoglycaemia‐induced accidents are extremely rare, presumably as a positive effect of patient education in our group.