bluuebunny/crossref_metadata_2025_split huggingface dataset:
Proinflammatory cytokines, measured in a mixed population on arrival in the emergency department, are related to mortality and severity of disease
Authors: CARLSTEDT F. , LIND L. , LINDAHL B. 
Published: November 2003

Carlstedt F, Lind L, Lindahl B (University Hospital of Uppsala, Sweden). Proinflammatory cytokines, measured in a mixed population on arrival in the emergency department, are related to mortality and severity of disease. J Intern Med 1997; 242: 361–5.ObjectivesTo investigate whether serum levels of tumour necrosis factor alpha (TNF‐α) and interleukin 6 (IL‐6) are related to mortality and severity of disease in patients admitted to the Emergency Department (ED).DesignProspective cohort study.SettingEmergency Department of a tertiary university hospital.SubjectsA total of 140 patients admitted to the ED, representing common acute medical diseases, such as stroke, obstructive lung disease, heart failure, myocardial infarction, angina pectoris, infectious diseases and acute abdominal disorders.Main outcome measuresAPACHE II score at admission, hospital mortality and length of stay in hospital (LOS).ResultsA moderate rise in cytokine levels (IL‐6; 50–300 ng L−1, TNF‐α; 10–70 ng L−1) was found in all diagnosis‐groups, with the most pronounced elevation seen in patients with acute abdominal disorders (up to 6900 ng L−1). IL‐6 on arrival to the ED was significantly correlated to the APACHE II score (r= 0.48, P < 0.0001), LOS (r= 0.36, P < 0.0001) and was elevated in nonsurvivors (n=9) compared to those who did survive. TNF‐α on arrival showed a significant correlation to LOS (r= 0.36, P < 0.0001) and APACHE II (r= 0.41, P < 0.0001), but was not associated to later mortality.ConclusionsSerum levels of proinflammatory cytokines collected at admission to the ED were related to the severity of disease and hospital mortality.
The anti‐oestrogen tamoxifen produces haemodilution in normal postmenopausal women
Authors: Grey A. B. , Evans M. C. , Kyle C. , Reid I. R. 
Published: November 2003

Grey AB, Evans MC, Kyle C, Reid, IR (University of Auckland, Auckland, New Zealand). The anti‐oestrogen tamoxifen produces haemodilution in normal postmenopausal women. J Intern Med 1997; 242: 383–8.ObjectivesTo report the effects of the anti‐oestrogen tamoxifen on biochemical and haematological parameters.DesignRandomized, double‐blind comparison of tamoxifen 20 mg per day and placebo, over two years.SettingA university hospital.SubjectsForty‐six healthy late‐postmenopausal women (mean, SD time since menopause; 11, seven years).Main outcome measuresBlood specimens were drawn in the fasting state at baseline, six months and two years for measurement of haemoglobin, haematocrit, erythrocyte mean cell volume, mean erythrocyte haemoglobin, leucocyte count, platelet count, urea, electrolytes, creatinine and albumin.ResultsThere was a significant decline in the haemoglobin concentration in the tamoxifen group (−4.4, 1.2 g/L; mean, SE) and its levels were lower in this group than in those receiving placebo (P= 0.004). Similarly, haematocrit, erythrocyte count and total leucocyte count were lower in those on placebo (P= 0.002, P= 0.01 and P= 0.01, respectively) and platelet count showed a similar trend (P= 0.08). In the tamoxifen group, the level of serum albumin fell significantly (−2.2, 0.4 g/L) and was lower throughout the study than that in the placebo group (P= 0.006). That of serum urea tended to fall (−0.4, 0.2 mmol L) but the between‐groups comparison was not significant (P= 0.18).ConclusionsThese data suggest that tamoxifen exerts a haemodilutory effect in normal postmenopausal women. Since a similar effect has been reported in response to postmenopausal oestrogen therapy, it is likely that the observed changes represent another oestrogenic effect of tamoxifen in postmenopausal women. Haemodilution may contribute to the reduced incidence of cardiovascular disease reported in tamoxifen‐treated women, and, therefore, its assessment in the new oestrogen agonists/antagonists being developed for cardiovascular disease prevention may be important.
Narrow hips and broad waist circumferences independently contribute to increased risk of non‐insulin‐dependent diabetes mellitus
Authors: Seidell J. C. , Han T. S. , Feskens E. J. M. , Lean M. E. J. 
Published: November 2003

Seidell JC, Han TS, Feskens EJM, Lean MEJ (National Institute of Public Health and the Environment, Bilthoven, the Netherlands, and Royal Infirmary, University of Glasgow, Glasgow, UK). Narrow hips and broad waist circumferences independently contribute to increased risk of non‐insulin‐dependent diabetes mellitus. J Intern Med 1997; 242: 401–406.ObjectivesPatients with non‐insulin‐dependent diabetes mellitus (NIDDM) have been shown to be more obese and have higher waist‐to‐hips circumference ratios compared to nondiabetics. In this study, we tried to dissociate obesity, waist and hip circumference from NIDDM.DesignA cross‐sectional population‐based case‐control study.SettingGeneral population.SubjectsControls: 5887 men and 7018 women, aged 20–59 years, without known diabetes or hyperglycaemia. Cases: 93 men and 66 women were diagnosed with NIDDM.Main outcome measuresWe predicted waist and hips' circumference from the body mass index, weight/height2, (BMI) on the basis of linear regression. Differences between observed and expected values (residuals) of waist and hip circumference were categorized into tertiles. The relative odds of having NIDDM in tertiles of waist and hip residuals (middle tertile as reference) were calculated by multiple logistic regression analysis adjusted for each other and for age, smoking, physical activity, alcohol consumption and education.ResultsNIDDM was most prevalent in men and women who had larger waists and in those who had smaller hip circumferences than expected from their BMI. Adjusted odds ratios (95% CI) for NIDDM were 2.9 (1.6–5.1) in men and 2.8 (1.5–5.1) in women who had a larger than expected waist, and were 3.7 (2.1–6.5) in men and 2.1 (1.1–3.8) in women who had smaller than expected hips.ConclusionsOur findings suggest that diabetics have larger waists and smaller hips compared to nondiabetics, irrespective of their degree of obesity, age and life‐style factors. One possibility is that besides abdominal fatness, peripheral muscle atrophy is one of the factors associated with NIDDM.
Medical risk factors amongst drivers in single‐car accidents
Authors: GISLASON T. , TÓMASSON K. , REYNISDÓTTIR H. , BJÖRNSSON J. K. , KRISTBJARNARSON H. 
Published: November 2003

Objectives. To estimate medical risk factors amongst drivers in single‐car accidents with special reference to sleepiness and alcohol abuse. Design. An epidemiological survey by means of multiple‐choice questionnaires that were mailed to drivers and a random control group. Setting. Iceland. Subjects. All drivers in single‐car accidents (n=471) during 1989–91 and a control group from the general population (n=1000). Main outcome measure. Medical health profile and answers to questions concerning sleep disorders and alcohol abuse. Results. Compared to the controls the drivers were younger and there were three times more males. The drivers abused alcohol more often. Chronic disorders such as epilepsy, diabetes mellitus, and cardiac disorders were not over‐represented. Altogether, 15.4% claimed that sleepiness had caused their traffic accident, logistic regression analyses revealed that these ‘sleepy’ drivers more often had alcohol abuse and a history of ‘almost falling a sleep whilst driving’. Conclusions. Compared to controls, drivers in single‐car accidents are more likely to be young, male, have a history of sleepiness whilst driving, and also have a history suggestive of alcoholism. Chronic disorders like epilepsy and diabetes mellitus were not over‐represented amongst the single‐car accidents drivers. These results raise the question of how drivers with a high probability of causing an accident (sleepiness and alcoholism) can be identified in time and proper measures taken to prevent ‘accidents waiting to happen’.
Congestive heart failure in old age: prevalence, mechanisms and 4‐year prognosis in the Helsinki Ageing Study
Authors: KUPARI M. , LINDROOS M. , IIVANAINEN A. M. , HEIKKILÄ J. , TILVIS R. 
Published: November 2003

Objective. To examine the prevalence, underlying diseases, abnormalities of left ventricular function and prognosis in congestive heart failure (CHF) of old age. Design. A population‐based clinical and echocardiographic study with a 4‐year mortality follow‐up. Setting. University hospital. Subjects. Five hundred and one individuals born in 1904, 1909 and 1914 (367 women). Main outcome measures. Presence of CHF by clinical and chest radiograph criteria; left ventricular size and systolic function by echocardiography; grade of aortic and mitral valve lesions by Doppler echocardiography; 4‐year total and cardiovascular mortality. Results. Forty‐one of 501 participants (8.2%) had CHF. Ischaemic heart disease (54%), hypertension (54%) and moderate‐to‐severe mitral or aortic valve disease (51%) were the main underlying conditions; 90% of patients had one or more of these diseases. Most individuals with CHF (28 of 39 patients, 72%) had normal left ventricular contractions at echocardiography. ‘Diastolic CHF’, defined as CHF with normal systolic left ventricular function and no regurgitant valve disease, was found in 51% (20 of 39 patients). The relative 4‐year risk for death associated with CHF, adjusted for age and sex, was 2.1 (95% confidence interval 1.3–3.4) for all‐cause mortality and 4.2 (CI 1.9–5.6) for cardiovascular mortality. Conclusions. The prevalence of CHF in a population aged 75–86 years is approximately 8%. Ischaemic or valvular heart disease and hypertension are the main underlying conditions. At echocardiography, about 50% of the elderly with CHF have normal left ventricular systolic contractions in the absence of valve disease and an additional 20% have normal systolic function with mitral regurgitation. The presence of CHF doubles the age‐ and sex‐adjusted risk of death from all causes, and quadruples the risk of cardiovascular death during 4‐year follow‐up.
Predictors of weight loss during treatment with d‐fenfluramine
Authors: TOORNVLIET A. C. , PIJL H. , HOPMAN E. , WESTENDORP R. G. J. , MEINDERS A. E. 
Published: November 2003

Objectives. To identify parameters predictive of weight loss during treatment with d‐fenfluramine. This may provide a tool to recognize patients who are sensitive to the weight‐reducing effect of d‐fenfluramine and thus prevent unnecessary prescription. Design. An open intervention study during which biweekly control visits were scheduled. The study lasted 12 weeks. Setting. The General Internal Medicine outpatient clinic of the Leiden University Hospital. Patients were recruited through a newspaper advertisement. Subjects. Forty‐eight healthy, obese patients (36 women and 12 men), aged 39±10 years (mean±SD) with a body mass index of 34.3±4.1 kg/m2 enrolled. Interventions.
d‐Fenfluramine 15 mg twice daily for 12 weeks. Main outcome measures. Body weight, height, waist and hip circumference, food intake, smoking habits, obesity history, treatment history, family history of obesity and compliance with the medication scheme were recorded as potential predictors of weight loss. Results. One patient was withdrawn because of depressive symptoms. Thirteen patients did not lose weight. On average, the other 34 patients lost 5.7±2.9 kg or 18.1±9.4% of excess body weight. High compliance with the drug regimen was associated with a twofold greater weight loss (17.7±12.3 vs. 9.0±9.4% of excess weight, ANOVAP=0.0088). Patients with a positive family history of obesity lost twice as much weight as patients without obese relatives (15.8±11.8 vs. 6.0±7.3% of excess weight; ANOVA, P=0.0078). No other potential determinants were predictive for weight loss. Conclusions. Informing patients that compliance with the medication scheme improves treatment outcome will be useful. Previous failures to lose weight should not exclude patients from treatment. A positive family history of obesity needs further evaluation as a possible determinant of weight loss in forthcoming studies.
Do‐not‐resuscitate orders – should the patient be informed?
Authors: LÖFMARK R. , NILSTUN T. 
Published: November 2003

Objectives. To analyse the ethical implications of informing patients about their do‐not‐resuscitate status (DNR). Design. Questionnaire. Setting. Nationwide, 6 months after the publication of guidelines on DNR in 1994. Subjects. A 10% random sample of the members of the Swedish Cardiac Society, 104 physicians and 196 nurses. Main outcome measures. To what extent are patients, physicians and nurses involved in decisions about DNR, and how should the ethical conflict involved in informing patients about their DNR status be described and analysed? Results. Of 73% responding, 84% of the physicians and 8% of the nurses had made a DNR decision. The decision was regarded as ethically right and well timed and it was discussed with 33% of the competent patients. Half of the respondents believed that DNR orders should be discussed with the competent patient, but still only one third of the patients are involved. The ethical conflict is analysed using the principles of autonomy and nonmaleficence as value premises. Conclusions. Many physicians are still reluctant to find out what the patient wants. Being ignorant they risk harming the patient. It is recommended that information about DNR status should be given incrementally and that the attitudes of the old and chronically ill in‐hospital patients are studied. Do they want to be informed, and if so, how and when do they want it to be done?
Glucose and insulin levels in young subjects with different maternal histories of hypertension: The Hypertension in Pregnancy Offspring Study
Authors: HIMMELMANN A. , HIMMELMANN K. , SVENSSON A. , HANSSON L. 
Published: November 2003

Objective: To analyse whether hypertension during pregnancy is associated with early signs of impaired glucose metabolism in the offspring. Design: Longitudinal study with a 5‐year follow‐up. Setting: University Hospital, Göteborg, Sweden. Main outcome measures: Fasting levels of glucose, insulin and C‐peptide. Subjects: Thirty‐six children were born to mothers with hypertension in pregnancy. The children were divided into two groups according to their mothers' blood pressure at follow‐up 7–12 years after pregnancy. Nineteen children had hypertensive mothers (HT), while 17 children had normotensive mothers at follow‐up (NT). A control group (C) comprised 16 children, who were born after normotensive pregnancies to mothers who remained normotensive. Results: Fasting plasma glucose was significantly higher in HT than in NT (5.2 vs. 4.9 mmol L−1; P < 0.05). In C fasting glucose was 5.1 mmol L−1. The same trend was seen for fasting insulin in HT, NT and C, respectively (6.7 vs. 4.7 vs. 5.3 μU mL−1). The C‐peptide level was 1.61, 155 and 1.64 ng mL−1, respectively. Calculated insulin resistance was 1.5 in HT, 1.0 in NT and 1.2 in C. Conclusions: It is suggested that hypertension during pregnancy may be associated with impaired glucose metabolism and elevated fasting glucose levels in the offspring during adolescence.
The concentration of sodium,potassium pumps in chronic obstructive lung disease (COLD) patients: the impact of magnesium depletion and steroid treatment
Authors: RAVN H. B. , DØRUP I. 
Published: November 2003

Objectives. To evaluate the concentrations of magnesium (Mg), potassium (K) and sodium,potassium pumps (Na,K pumps) in skeletal muscle in patients with chronic obstructive lung disease (COLD) treated with or without diuretics. Design. An open cross‐sectional study. Setting. COLD patients admitted to the Medical Department of Vejle Hospital, Denmark. Subjects. Thirty‐six consecutive COLD patients and 23 age‐ and sex‐matched controls. Main outcome measures. Biopsies of skeletal muscle were performed in patients and controls for measurements of Mg, K and Na,K pumps. In a parallel animal experiment the influence of medical treatment on the concentration of Na,K pumps in skeletal muscle was evaluated by infusing 10‐week‐old rats for 14 days with vehicle, terbutaline, or dexamethasone. Results.In the patients, mean muscle Mg and K concentrations were reduced by 22 and 14%, respectively (P<0.001), but in those patients who received diuretics muscle Mg and K were further reduced (by 31 and 27%, respectively, of the control values). The concentration of Na,K pumps was increased by 31% (P < 0.001), with a maximum increase of 61% (P lt;−0.001) in 12 intensive care patients receiving high dosages of glucocorticoids. Linear regression analysis showed a positive correlation between daily glucocorticoid intake and the concentration of Na,K pumps in the biopsy specimens from each patient (r = 0.38, P = 0.02). In the experimental study, dexamethasone induced 27–34% increase in the concentration of Na,K pumps (P < 0.01) in three different muscles, whereas there was no significant change following terbutaline infusion. Conclusions. COLD patients show reduced concentrations of Mg and K in skeletal muscle, associated with an upregulation of the Na,K pump concentration. It is plausible that this upregulation may be caused by glucocorticoid treatment. The clinical benefits of glucocorticoids may in part be due to an increase in the activity and capacity of the Na, K pump and thereby in a possible enhancement of muscle force.
Type I hereditary angio‐oedema. Variability of clinical presentation and course within two large kindreds
Authors: WINNEWISSER J. , ROSSI M. , SPÄTH P. , BÜRGI H. 
Published: November 2003

Objectives. Hereditary angiooedema (C1‐inhibitor deficiency) is a disease with protean manifestations which is often misdiagnosed initially. The purpose of this study was to delineate the clinical spectrum and course of this potentially life‐threatening disease. Setting. Ten members of two unrelated affected kindreds were repeatedly hospitalized in our service with attacks of angiooedema. Among the 271 members of the two kindreds 69 were identified who reported typical attacks. Design and subjects. Detailed information on the clinical course and laboratory data (C1‐inhibitor concentration and activity, C4 concentration) were obtained from 59 of the 69 affected subjects. Results. C1‐inhibitor concentration and activity were low in all affected patients. The disease had become manifest by age 30 years in 98%. Most patients suffered from attacks of subcutaneous swellings and abdominal pain, and half of the patients have had attacks affecting the airways. The frequency of attacks ranged from less than one to over 26 per year. Forty‐two per cent had to be hospitalized at least once. Four have died of acute airway obstruction. Thirty‐eight attacks in 10 patients hospitalized in our service were all treated successfully with fresh frozen plasma or with C1‐inhibitor concentrate. Trauma, stress, insect stings and foodstuff were triggering factors, but the majority of attacks occurred without an identifiable trigger. Oral contraceptives and pregnancy led to worsening of symptoms. Nonetheless, all 36 pregnancies reported were carried to term. Twenty‐five patients were on continuous treatment with attenuated androgens or tranexamic acid, but only seven were free of attacks in the year preceding the survey. Conclusion. Hereditary angiooedema is an autosomal dominant disease with great variability of clinical expression and severity, even within a single kindred. It often goes unrecognized over years, and it may lead to death if, in case of impending airway obstruction, specific therapy is not instituted.
Molecular genetics of familial hypercholesterolaemia in Norway
Authors: LEREN T. P. , TONSTAD S. , GUNDERSEN K. E. , BAKKEN K. S. , RØDNINGEN O. K. , SUNDVOLD H. , OSE L. , BERG K. 
Published: November 2003

Objectives. To characterize mutations in the low density lipoprotein (LDL) receptor gene causing familial hypercholesterolaemia (FH) amongst Norwegian patients. Design. Molecular genetic analyses of the LDL receptor gene have been performed in patients with a clinical diagnosis of FH. Subjects. A total of 742 probands have been studied. Of these, 476 had a diagnosis of definite FH. The rest had a diagnosis of possible FH. Results. Twenty‐three different mutations in the LDL receptor gene as well as the apolipoprotein B‐3500 mutation have been found. Six of the mutations in the LDL receptor gene are novel mutations. A molecular genetic diagnosis was achieved in 295 of the probands with definite FH (62%) and in 317 probands total. Of the 317 probands, 3% carried the apolipoprotein B‐3500 mutation. When family members were included, a total of 624 persons carried a mutation in the LDL receptor gene and 20 carried the apolipoprotein B‐3500 mutation. Conclusions. Approximately 5% of Norwegian FH patients have been provided with a molecular genetic diagnosis. Our data suggest that molecular diagnosis of FH in Norway is feasible and should be implemented in clinical medicine.
First clinical experiences with specific sheep Fab fragments in snake bite. Report of a multicentre study of Vipera berus envenoming
Authors: KARLSON‐STIBER C. , PERSSON H. , HEATH A. , SMITH D. , AL‐ABDULLA I. H. , SJÖSTRÖM L. 
Published: November 2003

Objectives. To evaluate the efficacy and safety of specific, ovine Fab fragments in the treatment of envenoming by the common adder, Vipera berus. Design. Open study with historical controls. Setting. Multicentre study involving patients (n = 30) with V. berus envenoming, treated in 18 Swedish hospitals during 1991–94. Main outcome measures. Initial symptoms, clinical course after treatment, duration of hospital stay and adverse effects of the antivenom were evaluated. Two earlier studied patient groups, given either equine F(ab′)2 antivenom (n = 30) or no antivenom (n = 16), were used as controls. Results. Specific ovine Fab fragments influenced favourably the acute symptomatology as well as the long term clinical course. Acute symptoms such as hypotension, shock, vomiting, diarrhoea and CNS‐depression resolved quickly. The incidence of extensive swelling involving the trunk and the length of hospital stay were both reduced significantly compared to nontreated patients (23 vs. 88% and 3.5 vs. 6 days). Also the incidence of anaemia was reduced (23 vs. 44%). These results were consistent with those obtained with equine F(ab′)2 antivenom, but with ovine Fab there were no immediate anaphylactic reactions or serum sickness. Conclusion. Specific Fab fragments produced from sheep immunized with V. berus venom were safe and effective in counteracting the effects of V. berus bite in humans. These results justify further studies of this new treatment for snake envenoming.