bluuebunny/crossref_metadata_2025_split huggingface dataset:
Bone metabolism in ochronotic patients
Authors: Aliberti G. , Pulignano I. , Schiappoli A. , Minisola S. , Romagnoli E. , Proietta M. 
Published: August 2003

Abstract. Aliberti G, Pulignano I, Schiappoli A, Minisola S, Romagnoli E, Proietta M (Università di Roma ‘La Sapienza’, Rome, Italy). Bone metabolism in ochronotic patients (Case report). J Intern Med 2003; 254: 296–300.We investigated skeletal involvement in five male and two female patients with ochronosis, aged 26–82 years. The main parameters of mineral metabolism, together with biochemical markers of bone resorption (urinary N‐telopeptides of type I collagen) and formation (serum bone isoenzyme of alkaline phosphatase and serum osteocalcin) were evaluated. In the same subjects lumbar spine and femoral bone mineral density (BMD) were also measured by dual energy X‐ray absorptiometry. All patients but the younger 26‐year‐old patient had lower than normal bone mass at femoral neck and total hip, showing marked osteopenia in three cases and osteoporosis in the remaining three cases. However, at lumbar spine BMD measurement provided spuriously overestimated results, because of intervertebral disc calcification and osteophyte formation. As far as biochemical markers of bone turnover are concerned, the most relevant finding was the increased N‐telopeptides of type I collagen urinary excretion. Our results suggest that ochronosis may be associated with increased bone resorption rate leading to an accelerated bone loss. A role of the homogentisic acid polymer deposit in bone matrix and cells, possibly with osteocyte damage and interference in collagen metabolism, might be hypothesized.
Hereditary transthyretin amyloidosis from a Scandinavian perspective
Authors: Suhr O. B. , Svendsen I. Hastrup , Andersson R. , Danielsson Å. , Holmgren G. , Ranløv P. J. 
Published: August 2003

Abstract. Suhr OB, Svendsen IH, Andersson R, Danielsson Å, Holmgren G, Ranløv PJ (Umeå University Hospital, Umeå, Sweden; Rigshospitalet, København Ø, Denmark; Örnsköldsviks Hospital, Örnsköldsvik, Sweden; and Hørsholm Hospital, Hørsholm, Denmark). Hereditary transthyretin amyloidosis from a Scandinavian perspective (Review). J Intern Med 2003; 254: 225–235.Hereditary transthyretin (TTR) amyloidosis is a rare often fatal form of systemic amyloidosis, that until recently was considered intractable, with the patients dying from the disease 5–15 years after onset. The phenotype of the disease varies according to the type of mutation, but generally the heart and/or the nervous system is affected. Liver and in some cases heart transplantation has now been shown to stop the progress of the disease, but the outcome depends on the patients’ status at the time of operation, as no substantial improvement of the patients’ symptoms has been noted after the procedure. Thus an early diagnosis is of importance for the outcome.In the following, we summarize our knowledge of the amyloidogenic TTR mutations found in the Scandinavian countries, their symptoms, how to settle the diagnosis and the outcome of transplantation. Besides, the problems arising from our capability to genetically test asymptomatic members of affected families for the trait will be discussed.
Morbidity in cardiovascular diseases in immigrants in Sweden
Authors: Gadd M. , Johansson S.‐E. , Sundquist J. , Wändell P. 
Published: August 2003

Abstract. Gadd M, Johansson S‐E, Sundquist J, Wändell P (Family Medicine Stockholm, Karolinska Institutet, Huddinge, Sweden). Morbidity in cardiovascular diseases in immigrants in Sweden. J Intern Med 2003; 254: 236–243.Introduction. Although immigration to Sweden has increased in the last few decades, the incidence rates of cardiovascular disease and coronary heart disease in immigrants are unknown. The aim of the present study is to estimate whether place of birth affects the incidence rates of cardiovascular disease and coronary heart disease.Material and methods. The study was designed as a follow‐up study on morbidity in cardiovascular disease and coronary heart disease between 1 January 1997 and 31 December 1998, including three and a half million persons with age range 35–64 years, of whom 550 000 were born abroad, from the database MigMed consisting of the whole Swedish population. Incidence rates and relative risks were estimated by indirect standardization and a proportional hazard model.Results. The age‐adjusted risk of coronary heart disease was higher in most foreign‐born groups than in Swedes. For example, in nine of 12 male groups, the relative risks varied between 1.1 and 2.2, and in seven of 12 female groups, the relative risks varied between 1.4 and 2.5. When also adjusting for level of education and employment status, the risks were still high, but on a lower level.Conclusions.  Foreign‐born people possess an over‐risk of cardiovascular or coronary heart disease(CVD/CHD) compared with Swedish‐born persons, also when level of education and employment status are taken into account.
Prognostic value of plasma C‐reactive protein and fibrinogen determinations in patients with acute myocardial infarction treated with thrombolysis
Authors: Bennermo M. , Held C. , Hamsten A. , Strandberg L.‐E. , Ericsson C.‐G. , Hansson L.‐O. , Tornvall P. 
Published: August 2003

Abstract. Bennermo M, Held C, Hamsten A, Strandberg L‐E, Ericsson C‐G, Hansson L‐O, Tornvall P (Danderyd Hospital; The Atherosclerosis Research Unit at King Gustaf V Research Institute, Karolinska Hospital; and Norrtälje Hospital, Karolinska Institute, Stockholm, Sweden). Prognostic value of plasma C‐reactive protein and fibrinogen determinations in patients with acute myocardial infarction treated with thrombolysis. J Intern Med 2003; 254: 244–250.Objectives. To investigate the prognostic value of plasma C‐reactive protein (CRP) and fibrinogen determinations in patients with acute myocardial infarction treated with thrombolysis.Design. Longitudinal study of morbidity and mortality.Setting. Coronary care unit at Danderyd Hospital, Stockholm, Sweden.Subjects. A total of 222 patients aged 75 years or below, treated with thrombolysis because of typical symptoms of myocardial infarction and electrocardiogram showing ST‐segment elevation or bundle branch block were included in the study. The patients were followed for 24–60 months (mean 40 ± 16 months).Main outcome measures. Cardiovascular death or new myocardial infarction.Results. Concentrations of CRP were significantly higher at 48 h than at 3 months, whilst the levels of fibrinogen were similar. CRP and fibrinogen concentrations measured during the acute phase of myocardial infarction were associated with cardiovascular death or a new myocardial infarction during follow‐up in univariate analysis. CRP levels measured 3 months after the acute event were not associated with subsequent events whereas fibrinogen concentrations showed a borderline prognostic significance (P = 0.05). When CRP and fibrinogen were entered into multivariate analysis together with the previously established prognostic factors in the patient group (age, diabetes mellitus and left ventricular function), these markers of inflammation did not add further prognostic information.Conclusion. C‐reactive protein and fibrinogen do not carry the same independent prognostic information after acute myocardial infarction treated with thrombolysis as in studies previously reported for patients with unstable angina or non‐Q‐wave myocardial infarction.
Increasing body mass index at diagnosis of diabetes in young adult people during 1983–1999 in the Diabetes Incidence Study in Sweden (DISS)
Authors: Littorin B. , Nyström L. , Gullberg B. , Råstam L. , Östman J. , Arnqvist H. J. , Björk E. , Blohmé G. , Bolinder J. , Eriksson J. W. , Scherstén B. , Sundkvist G. 
Published: August 2003

Abstract.  Littorin B, Nyström L, Gullberg B, Råstam L, Östman J, Arnqvist HJ, Björk E, Blohmé G, Bolinder J, Eriksson JW, Scherstén B, Sundkvist G (University of Malmö/Lund, Malmö/Lund; Umeå University, Umeå; University Hospital, Uppsala; Söder Hospital, Stockholm; Huddinge Hospital, Huddinge; Faculty of Health Sciences, University of Linköping, Linköping and University Hospital, Umeå; Malmö University Hospital, Malmö, Sweden). Increasing body mass index at diagnosis of diabetes in young adult people during 1983–1999 in the Diabetes Incidence Study in Sweden (DISS). J Intern Med 2003; 254: 251–256.Objective.  To study trends in body mass index (BMI) at diagnosis of diabetes in all young Swedish adults in the age range of 15–34 years registered in a nation‐based registry.Design.  The BMI was assessed at diagnosis in diabetic patients 15–34 years of age at diagnosis, for a period of 17 years (1983–1999). Islet cell antibodies (ICA) were measured during three periods (1987–1988, 1992–1993 and 1998–1999).Setting.  A nationwide study (Diabetes Incidence Study in Sweden).Subjects.  A total of 4727 type 1 and 1083 type 2 diabetic patients.Main outcome measures.  Incidence‐year specific BMI adjusted for age, gender and time of diagnosis (month).Results.  Body mass index at diagnosis increased significantly both in type 1 (21.4 ± 3.6 to 22.5 ± 4.0; P < 0.0001) and in type 2 (27.4 ± 6.8 to 32.0 ± 6.0; P < 0.0001) diabetic patients, also when adjusted for age, gender and month of diagnosis. A similar significant increase in BMI was found in type 1 diabetic patients and in type 2 diabetic patients in the periods 1987–1988, 1992–1993 and 1998–1999; years when ICA were assessed and considered in the classification of diabetes. Despite this increase in BMI, there was no increase in the incidence of diabetes in young‐adult people in Sweden.Conclusion.  Body mass index at diagnosis of diabetes in subjects 15–34 years of age has substantially increased during 1983–1999 in Sweden when adjusted for age, gender and month of diagnosis.
Impact of clinical experience on quantification of clinical signs at physical examination
Authors: Drager L. F. , Abe J. M. , Martins M. A. , Lotufo P. A. , Benseñor I. J. M. 
Published: August 2003

Abstract.  Drager LF, Abe JM, Martins MA, Lotufo PA, Benseñor IJM (School of Medicine, University of São Paulo, São Paulo, Brazil). Impact of clinical experience on quantification of clinical signs at physical examination. J Intern Med 2003; 254: 257–263.Purpose.  Although physical examination is a fundamental component of medical decision making, relatively few studies have evaluated how physicians quantify clinical signs and whether different methods of assessment have different effects on clinical practice.Objectives.  To evaluate a possible impact of clinical experience when attending physicians, medical residents and medical students quantify qualitative signs of physical examination in a teaching hospital.Setting.  Hospital das Clínicas, University of São Paulo, Brazil.Subjects.  A total of 244 randomly selected physicians and medical students completed a reliable and consistent eight‐item questionnaire.Main outcome measures.  To compare how they quantified clinical signs of cyanosis, anaemia, jaundice, oedema and dehydration, why they used the method(s) they described, and whether the method used could affect diagnosis, further testing or patient management. A chi‐square test was used to calculate differences between the groups.Results.  Whilst the majority of those surveyed tended to use a four‐level evaluation for these clinical signs, attending staff physicians were more likely to employ two‐level evaluations than were residents or medical students. For all five signs, attending physicians’ use of dichotomous evaluations was significantly higher than that of residents or medical students: anaemia (P = 0.004), cyanosis (P < 0.001), oedema (P = 0.005), dehydration (P < 0.001) and jaundice (P = 0.002).Conclusion.  Although medical students and residents are routinely taught to use a four‐level evaluation for these clinical signs, many of those surveyed tend to abandon this experience for a dichotomous approach. Given that the clinicians in this survey tended not to change their initial approach to a patient based on the intensity of this semi‐quantitative method, increased emphasis on teaching dichotomous approach evaluations in medical school should be encouraged.
Effect of metabolic control on homocysteine levels in type 2 diabetic patients: a 3‐year follow‐up
Authors: Passaro A. , Calzoni F. , Volpato S. , Nora E. Dalla , Pareschi P. L. , Zamboni P. F. , Fellin R. , Solini A. 
Published: August 2003

Abstract.  Passaro A, Calzoni F, Volpato S, Dalla Nora E, Pareschi PL, Zamboni PF, Fellin R, Solini A (University of Ferrara; Diabetes Division Arcispedale S. Anna, Ferrara; and University of Pisa, Italy). Effect of metabolic control on homocysteine levels in type 2 diabetic patients: a 3‐year follow‐up. J Intern Med 2003; 254: 264–271.Objectives.  Hyperhomocysteinaemia has emerged as a novel risk factor for cardiovascular disease. The determinants of total homocysteine (tHcy) levels in type 2 diabetic patients (D2p) have not been studied in detail. We examined prospectively the effect of different degrees of metabolic control on plasma tHcy in D2p with preserved kidney function.Subjects and main outcome measurements.  Ninety‐five D2p were studied. Clinical parameters, fasting plasma glucose, HbA1c, serum lipids, blood urea nitrogen (BUN) and creatinine, vitamin B12 and folate and tHcy were measured at the baseline and after 36 months. The methylentetrahydrofolate reductase (MTHFR) C677T polymorphism was also determined. Subjects were categorized according to δHbA1c into group A (±1 point), B (>1 point increase) or C (>1 point decrease).Results.  Total homocysteine was reduced in subjects whose HbA1c decreased with time, whilst patients showing a worsened metabolic control had an increased tHcy in respect to baseline. A larger response to the improved metabolic control in terms of tHcy reduction was noted in wild type patients versus those homozygous for the mutation. A multivariate analysis revealed MTHFR polymorphism and HbA1c as strong determinants of changes in tHcy with time.Conclusions.  The findings suggest that in D2p tHcy decreases even with modest improvement of glycaemic control; moreover patients homozygous for the MTHFR C677T mutation show the largest changes in tHcy levels with concomitant changing of HbA1c. These results define a further mechanism through which hyperglycaemia might promote cardiovascular damage in diabetic patients.
A dietary and behavioural programme for the treatment of obesity. A 4‐year clinical trial and a long‐term posttreatment follow‐up
Authors: Lantz Helén , Peltonen Markku , Ågren Liselotte , Torgerson Jarl S 
Published: August 2003

Abstract.  Lantz H, Peltonen M, Ågren L, Torgerson JS (Sahlgrenska University Hospital, Göteborg, Sweden). A dietary and behavioural programme for the treatment of obesity. A 4‐year clinical trial and a long‐term posttreatment follow‐up. J Intern Med 2003; 254: 272–279.Objectives.  To evaluate weight loss maintenance after 4 years of nonpharmacological, nonsurgical obesity treatment, including a very low calorie diet (VLCD), diet and behavioural support. Furthermore, to assess weight development amongst completers and noncompleters beyond the active 4‐year treatment period.Design.  Clinical trial.Setting.  Two Swedish county hospitals.Subjects.  A total of 113 patients were randomized to a 2‐year treatment programme with or without an initial VLCD period. The 87 patients who completed the 2‐year programme were offered the chance to continue a support programme for another 2 years. A total of 55 patients completed the entire 4‐year programme.Interventions.  All the patients took part in a comprehensive support programme, including a hypocaloric diet and behavioural support, either as single treatment (non‐VLCD group) or following the VLCD period (VLCD group).Results. Significant 4‐year weight losses were found in both groups, 7.6 ± 12.2 kg (VLCD group) and 6.3 ± 8.5 kg (non‐VLCD group), (P < 0.01, n.s. between groups). The completers (n = 55) had maintained a weight loss of 3.3 ± 10.7 kg (P < 0.05) 8 years after randomization. After 6 years, the noncompleters (n = 58) had gained 3.2 ± 9.7 kg compared with baseline (P < 0.05). The difference in weight change between completers and non‐completers was highly significant (P < 0.01).Conclusions.  Highly significant weight losses can be maintained after a 4‐year comprehensive treatment programme, including a hypocaloric diet and behavioural support. An initial VLCD period did not significantly affect the long‐term weight loss. The posttreatment long‐term weight loss was larger amongst completers than amongst patients who did not complete the treatment.
Community‐acquired febrile urinary tract infection in diabetics could deserve a different management: a case–control study
Authors: Horcajada J. P. , Moreno I. , Velasco M. , Martínez J. A. , Moreno‐Martínez A. , Barranco M. , Vila J. , Mensa J. 
Published: August 2003

Abstract.  Horcajada JP, Moreno I, Velasco M, Martínez JA, Moreno‐Martínez A, Barranco M, Vila J, Mensa J (Hospital Clínic Universitari‐IDIBAPS, Barcelona, Spain) Community‐acquired febrile urinary tract infection in diabetics could deserve a different management: a case–control study. J Intern Med 2003; 254: 280–286.Objective.  To investigate if there are relevant differences in clinical, microbiological and outcome characteristics of community‐acquired febrile urinary tract infection (UTI) between diabetic and nondiabetic patients.Design.  A prospectively matched case–control study.Setting.  An 800‐bed tertiary care university‐affiliated hospital.Subjects.  A total of 108 patients (54 diabetic and 54 nondiabetic patients matched by age and gender) admitted between January 1996 and September 1999 with febrile UTI.Methods.  Clinical, analytical, microbiological and outcome variables were analysed by means of McNemar test (categorical) or Wilcoxon matched pairs signed rank test (continuous).Results.  Mean age (SD) in both groups was 67.9 (14.4) years. In comparison with controls, diabetic patients were more likely to have fever without localizing symptoms (27% vs. 9%, P ≤ 0.0001), diminished consciousness level at admission (25% vs. 10%, P = 0.03), aetiological microorganism different from Escherichia coli (17% vs. 0, P = 0.0004), and quinolone‐resistant bacteria (17% vs. 3.7%, P = 0.07). Duration of fever after the onset of treatment was 1.75 (1) days in diabetics and 1.5 (1.1) days in nondiabetics (P = 0.17). However, diabetic patients had a longer hospitalization [5.2 (3.3) days] than nondiabetics [3.9 (2.6) days, P = 0.006].Conclusions.  In diabetic patients, febrile UTIs have clinical and microbiological peculiarities that may have diagnostic and therapeutic implications.
Serum γ‐glutamyltransferase and development of impaired fasting glucose or type 2 diabetes in middle‐aged Japanese men
Authors: Nakanishi N. , Nishina K. , Li W. , Sato M. , Suzuki K. , Tatara K. 
Published: August 2003

Abstract.  Nakanishi N, Nishina K, Li W, Sato M, Suzuki K, Tatara K (Osaka University Graduate School of Medicine, Osaka; and Japan Labor and Welfare Association, Tokyo; Japan). Serum γ‐glutamyltransferase and development of impaired fasting glucose or type 2 diabetes in middle‐aged Japanese men. J Intern Med 2003; 254: 287–295.Objective.  To investigate the association between serum γ‐glutamyltransferase (GGT) and risk for development of diabetes.Design.  Longitudinal study (followed from 1994 to 2001).Setting.  A work site in Japan.Subjects.  A total of 2918 Japanese male office workers aged 35–59 years who did not have impaired fasting glucose (IFG) (a fasting plasma glucose concentration of 6.1–6.9 mmol L−1), type 2 diabetes (a fasting plasma glucose concentration of 7.0 mmol L−1 or receipt of hypoglycaemic medication), medication for hypertension or hepatitis, alanine aminotransferase concentrations higher than three times the upper limit of the reference range or a history of cardiovascular disease at study entry.Main outcome measure.  Incidence of IFG or type 2 diabetes over a 7‐year period.Results.  With adjustment for potential risk factors for diabetes, the relative risk for IFG compared with serum GGT <16 U L−1 was 1.23 (95% CI, 0.79–1.90), 1.50 (CI, 0.97–2.32) and 1.70 (CI, 1.07–2.71) with serum GGT of 16–24, 25–43 and 44 U L−1, respectively (P for trend = 0.014). The respective relative risks for type 2 diabetes compared with serum GGT <16 U L−1 were 2.54 (CI, 1.29–5.01), 2.64 (CI, 1.33–5.23) and 3.44 (CI, 1.69–6.70) (P for trend = 0.002). From stratified analyses by body mass index (BMI) and alcohol intake, a stronger linear association between serum GGT and development of IFG or type 2 diabetes was found in men with a BMI 23.2 kg m−2 in both those who drank <46 and 46 g day−1 of ethanol.Conclusions.  The risk for development of IFG or type 2 diabetes increased in a dose‐dependent manner as serum GGT increased in middle‐aged Japanese men. The increased relative risk for IFG or type 2 diabetes associated with serum GGT was more pronounced in obese men.
Causes and consequences of proteinuria: the kidney filtration barrier and progressive renal failure
Authors: Tryggvason K. , Pettersson E. 
Published: August 2003

Abstract.  Tryggvason K, Pettersson E (Karolinska Institute, Stockholm, Sweden). Causes and consequences of proteinuria: the kidney filtration barrier and progressive renal failure (Review). J Intern Med 2003; 254: 216–224.The past few years have witnessed a major breakthrough in the understanding of the molecular mechanisms and ultrastructural changes behind the development of proteinuria. The discovery of several proteins in the glomerular podocyte and slit diaphragm, where mutations lead to disease, has revealed the importance of this cell with its diaphragm as the major filtration barrier as opposed to the glomerular basement membrane (GBM) previously ascribed this function. Furthermore, accumulating clinical as well as experimental evidence points to the harmful effects of proteinuria, irrespective of the original damage. The purpose of this review is to shed light on what we know today about the two sides of this ‘coin’, the causes and the consequences of proteinuria.
Antibacterial peptides: basic facts and emerging concepts
Authors: Boman H. G. 
Published: August 2003

Abstract.  Boman HG (Microbiology and Tumor Biology Center, Karolinska Institutet, Stockholm, Sweden). Antibacterial peptides: basic facts and emerging concepts (Review). J Intern Med 2003; 254: 197–215.Antibacterial peptides are the effector molecules of innate immunity. Generally they contain 15–45 amino acid residues and the net charge is positive. The cecropin type of linear peptides without cysteine were found first in insects, whilst the defensin type with three disulphide bridges were found in rabbit granulocytes. Now a database stores more than 800 sequences of antibacterial peptides and proteins from the animal and plant kingdoms. Generally, each species has 15–40 peptides made from genes, which code for only one precursor. The dominating targets are bacterial membranes and the killing reaction must be faster than the growth rate of the bacteria. Some antibacterial peptides are clearly multifunctional and an attempt to predict this property from the hydrophobicity of all amino acid side chains are given. Gene structures and biosynthesis are known both in the fruit fly Drosophila and several mammals. Humans need two classes of defensins and the cathelicidin‐derived linear peptide LL‐37. Clinical cases show that deficiencies in these peptides give severe symptoms. Examples given are morbus Kostmann and atopic allergy. Several antibacterial peptides are being developed as drugs.