bluuebunny/crossref_metadata_2025_split huggingface dataset:
Secular trends in social patterning of cardiovascular risk factor levels in Sweden. The Northern Sweden MONICA Study 1986–1994
Authors: Peltonen  , Huhtasaari  , Stegmayr  , Lundberg  , Asplund  
Published: March 2003

Peltonen M, Huhtasaari F, Stegmayr B, Lundberg V, Asplund K (Umeå University Hospital, Luleå‐Boden Hospital, Kalix Hospital, Sweden). Secular trends in social patterning of cardiovascular risk factor levels in Sweden. The North Sweden MONICA Study 1986–1994. J Intern Med 1998; 244: 1–9.ObjectivesIn the Northern Sweden MONICA Study, levels of cardiovascular risk factors were determined in 1986, 1990 and 1994. The aim of this study was to assess the trends in cardiovascular risk factors, and to analyse the relationship between levels of risk factors and level of education.DesignCardiovascular risk factors were determined in cross‐sectional population studies of randomly selected 25–64 year old men and women in 1986, 1990 and 1994 (a total of 4742 individuals).ResultsThroughout the years 1986 to 1994, cardiovascular risk factor levels showed a marked social pattern, generally being more favourable among people with a university education. Serum cholesterol levels declined in all educational groups, but blood pressure declined significantly only in women with a university education. Body mass index increased, most markedly in men with university and in women with a secondary school education. Prevalence of cigarette smoking decreased significantly in young men. It increased markedly in low‐educated women so that the social gaps in smoking widened substantially over time. The improved level of education in the population at large was calculated to explain only a little of the risk factor changes between 1986 and 1994.ConclusionsTrends in risk factor levels in different educational groups have been more diverging for women than for men. The most marked change in risk factor levels has been the decline in total serum cholesterol for both men and women in all educational groups.
Septic arthritis with Listeria monocytogenes during low‐dose methotrexate
Authors: Jansen T. L. Th. A. , Van Heereveld H. A. E. M. , Laan R. F. L. M. , Barrera P. , Van De Putte L. B. A. 
Published: March 2003

Jansen TLThA, van Heereveld HAEM, Laan RFLM, Barrera P, van de Putte LBA (University Hospital Nijmegen, Nijmegen, The Netherlands). Septic arthritis with Listeria monocytogenes during low‐dose methotrexate (Case Report). J Intern Med 1998; 244: 87–90.We describe a 22‐year‐old female with systemic lupus erythematosus and lymphopenia, who developed septic arthritis of the right knee with Listeria monocytogenes type 1/2 A, whilst on low‐dose methotrexate (MTX). So far, septic arthritis due to this microorganism has been reported in two other patients treated with low‐dose MTX, one having rheumatoid arthritis and the other psoriatic arthritis. No reports exist on patients treated with other cytotoxic antirheumatic therapies.
Clinical, biochemical and immunological characteristics of relapsers and non‐relapsers of thyrotoxicosis treated with anti‐thyroid drugs
Authors: Chowdhury T. A. , Dyer P. H. 
Published: March 2003

Chowdhury TA, Dyer PH (Birmingham Heartlands Hospital, Birmingham, UK). Clinical, biochemical and immunological characteristics of relapsers and non‐relapsers of thyrotoxicosis treated with anti‐thyroid drugs. J Intern Med 1998; 244: 293–297.ObjectivesThis study aims to correlate clinical, biochemical and immunological factors seen at diagnosis of thyrotoxicosis with subsequent relapse within 5 years.DesignRetrospective review of case notes, and biochemical assessment at least 5 years after cessation of treatment.SettingA large general hospital endocrine clinic.SubjectsPatients presenting with a first episode of thyrotoxicosis between 1988 and 1991 who were treated with antithyroid drugs for at least 18 months.Main outcome measures. Relapse was determined by examination of hospital records, general practice records, patient questionnaire and thyroid function tests.ResultsA total of 216 subjects presented for the first time with thyrotoxicosis, of whom 89 (41.2%) suffered a relapse of the disease. On univariate analysis, clinical factors associated with increased relapse include younger age at diagnosis, goitre, marked tachycardia, requirement for higher maintenance dose of carbimazole, higher FT4 levels at diagnosis and smoking. Factors not predictive of relapse include presence of thyroid eye signs, positive family history, atrial fibrillation or congestive cardiac failure, acropachy or pretibial myxoedema, and presence or absence of thyroid autoantibodies. Logistic regression analysis showed relapse was predominantly determined by an FT4 > 56.2 nmol L−1, pulse rate > 110, presence of goitre and a positive smoking history (R2= 0.36, P < 0.001). Presence of these four factors predicted relapse in 76 (85.4%) of the 89 patients who relapsed.ConclusionsIncreased ‘toxicity’ of thyrotoxicosis, goitre and smoking are associated with relapse of thyrotoxicosis, and this may be helpful in determining which patients may be better managed with early ablative therapy.
The additional effects of acipimox to simvastatin in the treatment of combined hyperlipidaemia
Authors: Hoogerbrugge  , Jansen  , De Heide  , Zillikens  , Deckers  , BirkenhÄger  
Published: March 2003

Hoogerbrugge N, Jansen H, de Heide L, Zillikens MC, Deckers JW, Birkenhäger JC (University Hospital Dijkzigt, Rotterdam, The Netherlands). The additional effects of acipimox to simvastatin in the treatment of combined hyperlipidaemia. J Intern Med 1997; 241: 151–56.ObjectivesNicotinic acid, an effective drug for treatment of combined hyperlipidaemia, is often not tolerated because of side‐effects. Acipimox is a nicotinic acid like lipid lowering drug with less side‐effects. We studied whether the addition of acipimox to simvastatin improves the lipid profile in patients with a combined hyperlipidaemia.DesignRandomized double‐blind placebo controlled crossover trial.SettingOutpatient lipid clinic of a tertiary referral centre.SubjectsEighteen patients with combined hyper‐ lipidaemia treated with diet and 20–40 mg simvastatin for at least 3 months.Intervention.<> Acipimox in a daily dose of 3 × 250 mg for 12 weeks.Main outcome measuresEffects on the concentration of LDLc, TG, HDLc, Lp(a) and Apolipoprotein B, as well as on LDL‐size and LDL‐resistance to oxidative modification.ResultsAcipimox reduced Lp(a) levels by 8% (P < 0.05). A substantial but not statistically significant change in TG (−32%) and HDLc (+6%) levels was seen. All patients were found to have small dense LDL, with a size of 229 ± 4 Å. LDL size and the resistance to oxidation, reflected in the lag phase during in vitro oxidation, were not affected by the addition of acipimox. In a subgroup of 8 patients with the most severe hypertriglyceridaemia (baseline TG > 4 mmol L‐ [1]), acipimox induced a significant increase in HDLc (+15%, P < 0.01). The effects on TG (−41%), LDLc (−10%) and lag phase (+17%) were also more pronounced than in the group with a lower baseline TG, but none of these changes reached the level of significance.Conclusions. Adding acipimox to simvastatin reduced Lp(a) and substantially but not significantly lowered TG. However, in patients with the highest TG levels, HDLc was also significantly improved.
Prevalence of APC resistance and its relationship to arterial and venous thromboembolism in a general population sample of elderly Swedish men: The Study of Men Born in 1913
Authors: Hansson P.‐O. , Eriksson E. , Welin L. , Eriksson H. 
Published: March 2003

Abstract. Hansson P‐O, Eriksson E, Welin L, Eriksson H (Sahlgrenska University Hospital‐ÖSTRA, Göteborg, Sweden). Prevalence of APC resistance and its relationship to arterial and venous thromboembolism in a general population sample of elderly Swedish men: The Study of Men Born in 1913. J Intern Med 1999; 245: 593–600.Background. Most studies of hereditary resistance to activated protein C (APC resistance) as a risk factor for venous thromboembolism are derived from case–control studies of hospitalized patients, whilst the importance of this condition in the general population has been only sparsely investigated.Objective. To study the prevalence of APC resistance and its relationship to morbidity and mortality in a general population sample of elderly men.Design. Cross‐sectional and prospective follow‐up study.Setting. General community: The Study of Men Born in 1913.Subjects. A random population sample of 404 men, all 75 years of age.Main outcome measures. Four hundred and four men participated in a screening examination in 1988. The APC ratio was analysed in 382 of them. All the men were followed up for 5 years. Medical records were reviewed for all the men with a history of deep vein thrombosis, pulmonary embolism, myocardial infarction or stroke.Results. Twenty‐five men (6.5%) were found to have APC resistance. The incidence of venous thromboembolism, myocardial infarction or stroke did not differ between men with or without APC resistance, either retrospectively or during follow‐up. Only two men experienced a deep vein thrombosis before the age of 80 and there was no case of pulmonary embolism. Mortality during 5 years of follow‐up did not differ between men with and without APC resistance.Conclusion. The prevalence of APC resistance was 6.5% in this study of Swedish men. Although the size of the population sample is somewhat small, the study shows that, amongst elderly men, the association between APC resistance and venous thromboembolic disease was weak and men with this hereditary condition did not have any increase in morbidity or mortality compared with men without APC resistance.
Alarmingly high occurrence and case fatality of acute coronary heart disease events in Estonia: results from the Tallinn AMI register 1991–94
Authors: Laks T. , Tuomilehto J. , Jõeste E. , Mäeots E. , Salomaa V. , Palomäki P. , Pullisaar O. , Karu K. , Torppa J. 
Published: March 2003

Objective. The purpose of this study was to produce stable estimates for the incidence, attack and mortality rates and case fatality of acute myocardial infarction (AMI) in Tallinn, the capital of Estonia.Research design and methods. The Tallinn AMI register covers the population aged 25–64 years and official residents of Tallinn. The register follows the WHO MONICA project protocols in the data collection and diagnostic evaluation of the suspected AMI events and CHD death.Results. Age‐standardized annual incidence, attack rate and mortality in men aged 35–64 years were high, varying from (per 100 000 per year) 352, 499 and 208, respectively, in 1991 to 438, 628 and 317, respectively, in 1993. In addition, in women, annual incidence, attack rate and mortality were high, varying from (per 100 000 per year) 82, 100 and 31, respectively, in 1991 to 110 and 142 in 1993 for the incidence and attack rate, and to 61 in 1992 for mortality. The percentage of out‐of‐hospital coronary death (sudden death) increased in men from 33 to 52% and in women from 24 to 42% during 1991–94, and the 28‐day case fatality increased in men from 42 to 58% and in women from 32 to 50%. In Tallinn, women with AMI were treated as actively as men with invasive treatment (thrombolysis, angioplasty, bypass surgery) during the acute phase of MI.Conclusions. The incidence, attack rate and mortality of AMI were high in both men and women in Tallinn. The high 28‐day case fatality observed was primarily due to the high proportion of out‐of‐hospital deaths.
Plasma thrombopoietin levels in liver cirrhosis and kidney failure
Authors: Stockelberg D. , Andersson P.‐O. , Björnsson E. , Björk S. , Wadenvik H. 
Published: March 2003

Abstract. Stockelberg D, Andersson P‐O, Björnsson E, Björk S, Wadenvik H (Sahlgrenska University Hospital, Göteborg University, Göteborg, Sweden) Plasma thrombopoietin levels in liver cirrhosis and kidney failure (Review). J Intern Med 1999; 246: 471–475.Background. Recently, c‐Mpl ligand (thrombopoietin, TPO) has been cloned by several groups and found to be a primary regulator of thrombopoiesis. Its mRNA expression has been detected in several organs including kidneys, bone marrow stroma cells, muscles, and is very strongly expressed in the liver.Objective. To clarify thrombopoiesis and the regulation of TPO in severe liver and renal failure.Design. We analysed plasma TPO levels in patients with biopsy verified liver cirrhosis (n = 18; mean platelet count 115 ± 54 × 109 L–1), in patients on chronic haemodialysis as a result of end‐stage renal failure (n = 20; mean platelet count 295 ± 94 × 109 L–1), and in healthy individuals (n = 20; mean platelet count 250 ± 40 × 109 L–1). Plasma was prepared from EDTA‐anticoagulated whole blood and a commercially available ELISA kit was used for the analysis.Results. The mean plasma TPO concentration amongst the normal individuals was 50 ± 14 pg mL–1. In the patients with liver cirrhosis and in patients on haemodialysis the mean TPO levels were 62 ± 19 pg mL–1 and 46 ± 17 pg mL–1, respectively. The mean plasma TPO concentration for the cirrhotic patients was significantly higher than the mean recorded for the healthy volunteers (P = 0.031), whereas no statistically significant differences in plasma TPO were seen between the group of end‐stage renal failure and normals.Conclusion. Our results suggest that TPO production is maintained in liver cirrhosis and in renal failure, and that the thrombocytopenia in liver cirrhosis is not due to an impaired TPO production.
Beneficial effects of exercise training in heart failure patients with low cardiac output response to exercise – a comparison of two training models
Authors: Gordon A. , Tyni‐Lenné R. , Jansson E. , Jensen‐Urstad M. , Kaijser L. 
Published: March 2003

Abstract.Gordon A, Tyni‐Lenné R, Jansson E, Jensen‐Urstad M, Kaijser L (Karolinska Institute at the Huddinge University Hospital, SE‐141 86 Huddinge, Sweden) Beneficial effects of exercise training in heart failure patients with low cardiac output response to exercise – a comparison of two training models.J Intern Med1999;246: 175–182.Background.Exercise capacity of patients with chronic heart failure (CHF) correlates poorly with estimates of cardiac function. Yet, it has been suggested that only patients without severely impaired cardiac output (CO) benefit from exercise training. Comparisons of different training models have not been made in the same study.Aims.To evaluate whether the response to different training models diverges according to the cardiac output response to exercise in patients with chronic heart failure.Methods.Sixteen CHF patients (63 ± 11 years) with an ejection fraction of 30 ± 11% underwent a baseline cardiopulmonary exercise test, right heart catheterization and leg muscle biopsy. Cardiac output (CO) response to exercise was defined as the ratio between CO increase and the increase in oxygen uptake (CO response index) during exercise. Patients were randomized into two training regimens, differing with regard to active muscle mass, i.e. whole body and one‐legged exercise.Results.Baseline exercise capacity expressed as W kg–1correlated with the CO response index (r = 0.51,P < 0.05). Exercise capacity on the cycle ergometer increased in both groups but more in the one‐legged than in the two‐legged training group (P < 0.05). The improvement in exercise capacity did not correlate with base‐line exercise capacity. It correlated with CO response index in the one‐legged (r = 0.75,P < 0.01) but not in the two‐legged training group. CO response index correlated negatively with the pulmonary capillary wedge pressure at peak exercise (r = – 0.60,P < 0.05). The increase in leg muscle citrate synthase activity after training correlated negatively with the baseline CO response index (r = – 0.50,P < 0.05).Conclusions.The improvement of exercise capacity after one‐legged training correlates with the CO increase in relation to the O2uptake before training. In patients with low CO response, individualization of the exercise regimen is needed and the benefits of training a limited muscle mass at a time deserve further study.
A case of neurofibromatosis type 1 with an aldosterone‐producing adenoma of the adrenal
Authors: Biagi P. , Alessandri M. , Campanella G. , Castro R. , Totteri A. , Fanciullacci M. 
Published: March 2003

Abstract. Biagi P Alessandri M, Campanella G, Castro R, Totteri A, Fanciullacci M (Abbadia San Salvatore Hospital, Abbadia San Salvatore; Misericordia Hospital, Grosseto; University of Florence, Florence, Italy). A case of neurofibromatosis type 1 with an aldosterone‐producing adenoma of the adrenal (Case Report). J Intern Med 1999; 246: 509–512.Neurofibromatosis type 1 is a phacomatosis. Neurofibromas are the most common tumours associated with the disease, and along with other tumours, make neurofibromatosis type 1 the most common tumour predisposing syndrome in humans. Hypertension may be coincidental, but at least two specific neurofibromatosis related causes must be considered, namely neurofibromatous involvement of the renal artery and pheochromocytoma. We have described the first known case of a patient with neurofibromatosis type 1 who developed hypertension due to an aldosterone‐producing adenoma of the adrenal. The question of whether this association was coincidental or due to the tumour predisposition of neurofibromatosis type 1 was debated.
Bone mineral density and blood pressure in patients with asymptomatic hyperparathyroidism. The Tromsø Study
Authors: Jorde R. , Sundsfjord J. 
Published: March 2003

Abstract. Jorde R, Sundsfjord J (University Hospital of Tromsø, Tromsø, Norway). Bone mineral density and blood pressure in patients with asymptomatic hyperparathyroidism. The Tromsø Study. J Intern Med 2000; 247: 325–330.Objective. To evaluate bone mineral density and blood pressure in asymptomatic hyperparathyroidism.Design. A case‐control study.Setting. The participants obtained from an epidemiological survey in Tromsø 1994–95, that included more than 27 000 subjects. The re‐examination in 1998 was performed at the University Hospital of Tromsø, Norway. Participants. Thirty‐nine subjects with hyperparathyroidism and 72 control subjects were studied.Main outcome measures. Bone mineral density measurements of the lumbar spine and the proximal femur (femoral neck, Ward’s triangle, and trochanter). Systolic and diastolic blood pressure.Results. In the hyperparathyroidism group bone mineral density was significantly lower measured at the lumbar spine (1.000 ± 0.181 vs. 1.079 ± 0.194 g cm–2, mean ± SD, P < 0.01) and at the femoral neck (0.806 ± 0.121 vs. 0.852 ± 0.141 g cm–2, P < 0.05). In the females, but not in the males, blood pressure was significantly higher in the hyperparathyroidism group than in the control group [systolic blood pressure 146.7 ± 18.6 vs. 137.4 ± 23.0 mmHg (P < 0.05) and diastolic blood pressure 88.1 ± 11.8 vs. 82.2 ± 10.6 mmHg (P < 0.05)]. In the females the number of subjects on antihypertensive medication was significantly higher in the hyperparathyroidism group than in the control group (32.1% and 16.6%, respectively, P < 0.01).Conclusions. Subjects with asymptomatic hyperparathyroidism have moderately reduced bone mineral density. In females with hyperparathyroidism there is an increase in blood pressure.
Physicians’ use of plasma methylmalonic acid as a diagnostic tool
Authors: Hvas A.‐M. , Vestergaard H. , Gerdes L. U. , Nexø E. 
Published: March 2003

Abstract. Hvas A‐M, Vestergaard H, Gerdes LU, Nexø E (Randers Hospital, Randers, and Aarhus University Hospital, Aarhus, Denmark). Physicians’ use of plasma methylmalonic acid as a diagnostic tool. J Intern Med 2000; 247: 311–317.Objectives. To investigate physicians’ reasons for requesting plasma methylmalonic acid and their reactions to an increased concentration of plasma methylmalonic acid.Design. Study of medical records.Setting. Three somatic district hospitals in Denmark.Subjects. Medical records of 198 patients with a plasma methylmalonic acid measurement above the reference interval. Information on diagnostic decisions was available for 177 patients.Main outcome measures. Reasons for requesting plasma methylmalonic acid and the reactions to the finding of elevated plasma methylmalonic acid.Results. An explicit reason for requesting plasma methylmalonic acid was stated in 57% of 198 examined medical records, known or suspected anaemia being the most frequent reason. No further action was taken in 109 (62%) of the 177 cases available for follow‐up. Amongst the remaining 68 patients, the finding of an increased plasma methylmalonic acid led to diagnosis of cobalamin deficiency in 46 patients. Six patients with a markedly increased plasma methylmalonic acid (above 0.99 µmol L–1) and clearly decreased plasma cobalamins (below 200 pmol L–1) were not recognized as having cobalamin deficiency.Conclusions. This lack of response to an increased plasma methylmalonic acid raises an important question. Is the clinical response inadequate, or is the connection between an increased level of plasma methylmalonic acid and signs of clinical significant cobalamin deficiency less clear?
Associations of leptin, insulin resistance and thyroid function with long‐term weight loss in dieting obese men
Authors: Näslund E. , Andersson I. , Degerblad M. , Kogner P. , Kral J. G. , Rössner S. , Hellström P. M. 
Published: March 2003

Abstract. Näslund E, Andersson I, Degerblad M, Kogner P, Kral JG, Rössner S, Hellström PM (Danderyd Hospital, Huddinge University Hospital and Karolinska Hospital, Karolinska Institutet, Stockholm, Sweden; and the Health Science Center at Brooklyn, New York, USA). Associations of leptin, insulin resistance and thyroid function with long‐term weight loss in dieting obese men. J Intern Med 2000; 248: 299–308.Objective. The aim of the present study was to identify predictors of weight loss in obese men participating in a 2‐year behaviour modification programme.Design. Longitudinal, clinical intervention study of a behaviour modifying weight loss program.Setting. University Hospital, Stockholm, SwedenSubjects. Forty‐four obese men (age, 42.7 ± 1.1 years; BMI, 37.1 ± 0.6 kg m–2, mean ± SEM) followed for 2 years.Interventions. Behaviour modification weight loss programme.Main outcome measures. Associations between plasma leptin and thyroid function tests, insulin resistance by homeostatic model assessment (HOMA), dietary recall and anthropometrically determined body composition.Results. At baseline, there were significant correlations between plasma leptin and body mass index (BMI), fat‐free mass (FFM) and insulin resistance. Median weight loss over 2 years was 4.9 kg (range, – 27.2 to + 11.9). Baseline serum leptin concentrations adjusted for BMI (leptin/BMI ratio) were significantly correlated with 2‐year weight change (r = 0.34, P = 0.04). A subset of seven of the 44 men gained weight over the 2 years. These ‘gainers’ differed significantly in initial leptin/BMI ratio (0.62 ± 0.07) compared with the 37 ‘losers’ (0.42 ± 0.03, P < 0.05). In a multiple regression model, baseline leptin, insulin and age predicted 22% of the variance in weight change with no additional significant contribution from BMI, FFM, waist:hip ratio, thyroid function tests or energy intake. There was a strong correlation between the change in leptin concentrations and the change in insulin resistance from baseline to 2‐year follow‐up (r = 0.54; P < 0.001).Conclusion. Baseline plasma leptin concentrations predicted long‐term weight loss. Inappropriate leptin secretion or disposal, corrected for BMI, was associated with failure to maintain weight loss in obese men in a behaviour modification weight loss programme.