bluuebunny/crossref_metadata_2025_split huggingface dataset:
Calcific degeneration of the aortic valve in old age: is the development of flow obstruction predictable
Authors: IIVANAINEN A. M. , LINDROOS M. , TILVIS R. , HEIKKILÄ J. , KUPARI M. 
Published: November 2003

Objective. Aortic valve calcification and stenosis become increasingly common with advancing age. This work aimed at assessing whether a time‐dependent reduction of aortic valve area is detectable in an unselected elderly population and whether the rate of reduction can be predicted from clinical or biochemical characteristics. Design. A population‐based prospective echocardiographic follow‐up study. Setting. A university hospital. Subjects. In 1990, randomly selected persons born in 1904, 1909 and 1914 (total n=501) underwent a Doppler echocardiographic study of aortic valve and biochemical tests of glucose, lipid and calcium metabolism. In 1993, echocardiography was repeated in 333 survivors of the original cohorts. These individuals constitute the present study population. Main outcome measures. Three‐year changes in the aortic valve area and velocity ratio (peak outflow tract velocity/peak aortic jet velocity) determined by Doppler echocardiography. Results. Aortic valve area decreased from a mean of 1.95 cm2 (95% confidence interval of mean, 1.88–2.03 cm2) to 1.78 cm2 (1.71–1.85 cm2) within 3 years (P<0.001). Concomitantly, the velocity ratio decreased from 0.75 (0.73–0.77) to 0.68 (0.67–0.70) (P<0.001). The changes in aortic valve area and velocity ratio were unrelated to age, sex, presence of hypertension, coronary artery disease or diabetes, and to all assessed biochemical characteristics. A weak positive statistical association was found between the decrease in aortic valve area and the body mass index at entry (r=0.16, P<0.01). Conclusions. A time‐dependent reduction of the aortic valve flow orifice can be demonstrated in persons representing the general elderly population. The deterioration of aortic valve function within a span of 3 years is neither clinically nor biochemically predictable. A longer follow‐up may be necessary to identify the risk factors of aortic valve stenosis in old age.
Effects of smoking on blood pressure and proteinuria in patients with diabetic nephropathy
Authors: SAWICKI P. T. , MÜHLHAUSER I. , BENDER R. , PETHKE W. , HEINEMANN L. , BERGER M. 
Published: November 2003

Objectives. To investigate the effects of smoking on blood pressure and proteinuria in hypertensive diabetic patients with nephropathy. Design. Controlled, randomized, cross‐over study. Setting. Tertiary care centre, University Hospital of Düsseldorf, Germany. Subjects. A total of 25 subjects were recruited, each of whom smoked at least 20 cigarettes a day: 10 normotensive healthy volunteers and 15 hypertensive type 1 (insulin‐dependent) diabetic outpatients with diabetic retinopathy and persistent micro‐ or macroalbuminuria; 10 diabetic patients had normal autonomic function test, whilst five patients showed signs of autonomic neuropathy. Interventions. Controlled smoking or nonsmoking over a period of 8 h on separate days. Main outcome measures. Blood pressure was measured every 10 min with an automatic device and urine samples were collected every 3 h. Results. Systolic blood pressure increased during smoking in controls (mean) (11.5 mmHg, P=0.0001) and in diabetic patients without autonomic neuropathy (7.9 mmHg; P=0.018), but not in patients with autonomic neuropathy (‐2.4 mmHg; P=0.792). Diastolic blood pressure increased during smoking in controls (6.2 mmHg; P=0.019) but not in diabetic patients (2.5 mmHg; P=0.204. 0.2 mmHg; P=0.956). During smoking, median proteinuria and albuminuria increased in diabetic patients without autonomic neuropathy (8.1 mg mmol‐1 creatinine, P=0.002; and 2.6 mg mmol creatinine, P=0.084). No significant changes in albuminuria or proteinuria occurred in the other two groups. Conclusions. Smoking increases blood pressure values in healthy subjects and in hypertensive patients with diabetic nephropathy and without autonomic neuropathy. This effect of smoking may be partly responsible for the faster progression of diabetic nephropathy in smoking diabetic patients.
Intermittent intravenous followed by intermittent oral 1α(OH)D3 treatment of secondary hyperparathyroidism in uraemia
Authors: BRANDI L. , DAUGAARD H. , EGSMOSE C. , TVEDEGAARD E. , KJÆRULFF NIELSEN P. , OLGAARD K. 
Published: November 2003

Brandi L, Daugaard H, Egsmose C, Tvedegaard E, Kjærulff Nielsen P, Olgaard K (Medical Department P, Division of Nephrology, Rigshospitalet, University of Copenhagen, Denmark). Intermittent intravenous followed by intermittent oral 1α(OH)D3 treatment of secondary hyperparathyroidism in uraemia. J Intern Med 1996; 239: 353–60. Objectives. To examine whether intermittent oral 1α(OH)D3 treatment of patients on haemodialysis with secondary hyperparathyroidism (HPT) was able to maintain the marked suppression of PTH, which previously had been induced by an intermittent intravenous administration of 1α(OH)D3. Simultaneously, the effect of the different routes of administration of 1α(OH)D3 on the circulating levels of N‐and C‐terminal PTH fragments was measured. Design. An open study of patients on chronic haemodialysis. Setting. Renal division, Rigshospitalet, Copenhagen, Denmark. Subjects. A total of 26 patients started and five patients completed the total protocol. Interventions. The treatment protocol was divided into three parts: (i) 1α(OH)D3 administered intravenously for >300 days; then (ii) 1α(OH)D3 administered orally for 100 days, followed by (iii) 1α(OH)D3 administered intravenously again for another 100 days. 1α(OH)D3 was given three times a week at the end of each dialysis. Main outcome measures. Intact PTH, N‐ and C‐terminal PTH. Results. Intact PTH levels were significantly (P<0.0001) suppressed by 90.4±3.3% after 56 days of intermittent intravenous 1α(OH)D3 treatment. This degree of suppression remained stable during the following period of oral treatment and did not change further when intravenous treatment was reinstituted. The circulating levels of intact PTH and N‐ and C‐terminal iPTH were not influenced by the administered route of 1α(OH)D3. Conclusions. Intravenous 1α(OH)D3 treatment of the secondary HPT in dialysis patients can safely be changed to oral treatment at the time when optimal suppression of PTH has been achieved.
Acute administration of metoprolol and enalaprilat reduces insulin‐stimulated thermogenesis and skin blood flow
Authors: TUOMINEN J. A. , ERIKSSON J. G. , KOIVISTO V. A. 
Published: November 2003

Tuominen JA, Eriksson JG, Koivisto VA (Department of Medicine, Helsinki University Central Hospital, and National Institute of Public Health, Helsinki, Finland). Acute administration of metoprolol and enalaprilat reduces insulin‐stimulated thermogenesis and skin blood flow. J Intern Med 1996; 239: 399–406. Objective. To examine the acute effects of intravenous metoprolol and enalaprilat on energy expenditure, thermogenesis, blood flow and insulin sensitivity. Design. Randomized, single‐blind, placebo‐controlled trial. Setting. Helsinki University Central Hospital, Finland. Subjects. Seven moderately insulin‐resistant nondiabetic subjects. Interventions. Each subject was studied three times at 2–3 weeks intervals; metoprolol (5 mg), enalaprilat (2 mg) or saline infusions were used. Methods. A 150‐min euglycaemic/hyperinsulinaemic clamp combined with indirect calorimetry and blood flow measurements were performed. Main outcome measures. Glucose uptake, forearm and skin blood flow, and energy expenditure. Results. Blood pressure was decreased to the same degree by both drugs. Forearm blood flow (plethysmography) was lower with metoprolol compared to enalaprilat (2.1±0.2 vs. 2.8±0.4 mL per 100 mL min‐1; P<0.05). Glucose‐plus‐insulin‐stimulated thermogenesis and total energy expenditure were reduced both by metoprolol (71 and 5.2%; P<0.05 in both) and enalaprilat (59%, P= 0.06; and 7.6%, P<0.05) as compared to the control study. Skin blood flow (laser Doppler) increased by 100% (P<0.01) during the glucose‐plus‐insulin infusion, but this increment was inhibited by both drug infusions. Forearm and whole‐body glucose uptake was not influenced by metoprolol or enalaprilat administration. Conclusions. (i) Both metoprolol and enalaprilat inhibit glucose‐plus‐insulin‐induced thermogenesis and a rise in skin blood flow. (ii) Metoprolol further reduces forearm blood flow compared to enalaprilat. (iii) Neither drug has any acute effect on insulin sensitivity. (iv) The interference of a physiological response to insulin by ACE inhibitors or beta‐blocking agents may have implications both for energy balance and thermoregulation during periods of hyperinsulinaemia in man.
Nitrogen dioxide pneumonitis in ice hockey players
Authors: KARLSON‐STIBER C. , HÖJER J. , SJÖHOLM Å . , BLUHM G. , SALMONSON H. 
Published: November 2003

Karlson‐Stiber C, Höjer J, Sjöholm Å, Bluhm G, Salmonson H (Swedish Poison Information Centre, the Department of Internal Medicine, Söder Hospital, and the Department of Environmental Health and Infectious Disease Control, Karolinska Hospital, Stockholm; and the Department of Internal Medicine, Löwenströmska Hospital, Upplands Väsby; Sweden). Nitrogen dioxide poisoning with toxic pneumonitis in ice hockey players (Case report). J Intern Med 1996; 239: 451–6.Exposure to the toxic gases carbon monoxide and nitrogen dioxide (NO2) in indoor ice arenas occasionally occurs and may result in severe symptoms. The gases are produced by ice resurfacing machines operating on hydrocarbons, and in certain conditions toxic levels accumulate. The damage to lung tissues caused by NO2 may not be evident until after a latency time of ½–2 days. The role of corticosteroids in the treatment is controversial, but there are clinical experiences as well as experimental data supporting their use.We report two cases of toxic pneumonitis, with delayed onset, due to NO2 exposure during an ice hockey game in an indoor arena. Signs and symptoms were cough, dyspnoea, haemoptysis, hypoxaemia and reduced peak expiratory flow. Chest radiographs showed parenchymatous infiltrative lesions and alveolar consolidation. Both patients were treated with high doses of corticosteroids by inhalation and orally or intravenously. Their condition rapidly improved and pulmonary function was restored.
Fibrinogen, coronary heart disease and mortality from all causes in smokers and nonsmokers. The Study of Men Born in 1933
Authors: ROSENGREN ANNIKA , WILHELMSEN LARS 
Published: November 2003

Objective. To analyse the relation between fibrinogen concentration and incidence of coronary heart disease and mortality from all causes. A secondary aim was to investigate whether the effect of fibrinogen, as in previous cross‐sectional analyses from this population, was restricted to nonsmokers. Design. Prospective population study. Setting. City of Göteborg, Sweden. Subjects. A total of 664 men from a population sample of 1016 men aged 50 in 1983, without prior myocardial infarction. Main outcome measures. Development of coronary heart disease (myocardial infarction, coronary death or, in men with angina, revascularization, or scintigraphic evidence of coronary disease) and death from all causes, in relation to fibrinogen concentration and smoking status at baseline, during 9 years' follow‐up. Results. Rates of coronary heart disease during follow‐up in the lowest, middle and highest third of the fibrinogen distribution were 4.6, 6.4 and 10.3%, respectively, but this did not remain significant after controlling for smoking and other risk factors (adjusted odds ratio [OR] for the highest, compared to the lowest third 1.5 [0.7–3.4]). Percentages of men who died from any cause were 3.2, 5.9 and 10.7 in the lowest, middle and highest thirds of fibrinogen, respectively. After adjustment for smoking and other risk factors, this difference remained significant (relative risk 2.6 [1.2–5.9]). In men who were smokers at baseline, fibrinogen was not significantly related to coronary heart disease or mortality. Men who did not smoke in the lowest, middle, and highest third of the fibrinogen distribution had rates of coronary heart disease of 1.8, 3.6 and 10.3%, respectively, and of deaths from all causes of 1.8, 2.9 and 8.4%, respectively. The adjusted OR remained significant at 5.4 (1.4–20.0) for coronary heart disease, as did the adjusted relative risk for mortality at 3.8 (1.01–14.4). Conclusion. Plasma fibrinogen is an independent predictor of premature death, and also of coronary heart disease, in middle‐aged men and in nonsmokers. A high fibrinogen concentration, particularly in a nonsmoker, deserves attention.
Thrombocytopenia induced by noncytotoxic drugs in Denmark 1968–91
Authors: PEDERSEN‐BJERGAARD U. , ANDERSEN M. , HANSEN P. B. 
Published: November 2003

Objectives. To analyse the distribution of noncytotoxic drugs reported as cause of thrombocytopenia during a 24‐year period, and to draw attention to the most commonly involved drugs in modern clinical practice. Design/setting. Retrospective study of spontaneous case reports from the Danish reporting system on adverse drug reactions. Subjects. A total of 309 critically reviewed cases of drug‐induced thrombocytopenia reported during the period from 1968 to the end of 1991. Results. Sodiumaurothiomalate and the combination sulfamethoxazole with trimethoprim were the most commonly reported single drugs, and nonsteroid anti‐inflammatory drugs were the most frequently reported category of drugs. A pronounced shift in the spectrum of causal drugs was observed due to the introduction of new drugs and alterations in drug consumption. At present, valproic acid and measles–mumps–rubella vaccine are most numerously reported. The still‐growing list of thrombocytopenia‐inducing agents contained 110 different drugs. At present, 20% of reported cases concern drugs not previously registered as causing thrombocytopenia in Denmark. Twenty‐five per cent of all cases were caused by drugs which appeared only sporadically in the material. Conclusions. The spectrum of drugs reported as causing drug‐induced thrombocytopenia is broadening and changing progressively, reflecting changes in drug consumption. The most frequently reported drugs at present are valproic acid and measles–mumps–rubella vaccine.
The cost effectiveness of lipid lowering in Swedish primary health care
Authors: JOHANNESSON MAGNUS , BORGQUIST LARS , JÖNSSON BENGT , LINDHOLM LARS H. 
Published: November 2003

Objective. To evaluate the cost‐effectiveness of two types of advice (usual and intensive) to lower cardiovascular risk, with or without pharmacological medication aimed at lowering cholesterol levels. Design. Prospective, randomized, controlled clinical study of 18 months' duration. Setting. Thirty‐two primary health care centres in Sweden. Subjects. A total of 384 males, aged 30–59 years, with at least one cardiovascular risk factor in addition to moderate primary hyperlipidaemia; of these, 355 completed the 18‐month follow‐up. Interventions. Intensive advice consisted of group sessions led by a health care professional; the usual level of advice was given at follow‐up visits. The pharmacological intervention consisted of pravastatin. The goal was to achieve a 15% reduction in cholesterol. Main outcome measures. Cost per life‐year gained based on the change in serum cholesterol and the net intervention cost of the four treatment options. Results. The usual level of advice and intensive advice in combination with pharmacological treatment achieved no incremental effects and were not considered in the cost‐effectiveness analysis. The cost per life‐year gained of pharmacological treatment compared with intensive advice decreased. The cost per life‐year gained of pharmacological treatment compared with no treatment was about $61 000, if no adverse consequences on noncardiovascular mortality were assumed. Conclusions. According to the results of the CELL trial, intensive advice is not a cost‐effective strategy compared with lipid‐lowering drug treatment. However, it is also doubtful whether drug treatment as primary prevention is cost‐effective compared with no treatment in the studied patient population.
Intrapulmonary administration of insulin to healthy volunteers
Authors: JENDLE J. H. , KARLBERG B. E. 
Published: November 2003

Objectives. To study the biological effects of nebulized insulin, administered intrapulmonary, to healthy volunteers. Design. A double‐blind, randomized, controlled intervention study. Setting. The department of Internal Medicine, University Hospital, Linköping, Sweden. Subjects. Eight healthy, non‐smoking volunteers, with a mean age of 28 (range 22 to 56) years. Interventions. Regular human insulin 100 U mL‐1 (Actrapid®) or 0.9% saline was given randomly as an oral inhalation. Insulin was given in three different doses (40, 80 and 160 U). Aerosol was generated by a new jet nebulizer. Main outcome measures. Blood glucose, serum insulin, and serum C‐peptide. Results. After the 160 U insulin dose the blood glucose concentration (mean±SE) fell from 4.3±0.2 to 2.8±0.2 mmol L‐1 (P <0.001), concomitant with an increase in mean serum insulin concentrations, rising from 9.5±1.5 to 26.1±2.5 mU L‐1 (P <0.001). Serum C‐peptide concentrations simultaneously decreased from 0.48±0.03 to 0.12±0.02 mmol L‐1 (P <0.001). All changes were dose dependent. No adverse reactions were noted and no significant changes in lung function tests. Conclusions. Intrapulmonary insulin administration to healthy subjects can induce a significant hypoglycaemia and cause a clinically relevant increase in serum insulin concentrations. If similar results can be obtained when administering insulin to diabetic subjects, this insulin administration route can be a future complement to certain groups of patients.
Chronic consumers of boiled coffee have elevated serum levels of lipoprotein(a)
Authors: URGERT R. , WEUSTEN‐VAN DER WOUW M. P. M. E. , HOVENIER R. , LUND‐LARSEN P. G. , KATAN M. B. 
Published: November 2003

Objectives. Lipoprotein(a) consists of an LDL‐particle attached to apolipoprotein(a), which is made by the liver. Diterpenes present in boiled coffee raise serum levels of LDL cholesterol and of the liver enzyme alanine aminotransferase in man. We investigated the association between intake of boiled coffee and serum levels of lipoprotein(a). Design, setting and subjects. Healthy Norwegians 40–42 years of age, who habitually consumed five or more cups of boiled coffee per day (n=150) were compared with matched filter coffee consumers (n=159) in a cross‐sectional study, as part of the Norwegian National Health Screening in 1992. Results. The median lipoprotein(a) level was 13.0 mg dL−1 (10th and 90th percentile: 2.5 and 75.0 mg dL−1, respectively) on boiled and 7.9 mg dL‐1 (10th and 90th percentile: 1.9 and 62.5 mg dL−1, respectively) on filter coffee (P=0.048). Means±SE were 25.8±2.4 mg dL−1 and 19.6±2.0 mg dL−1, respectively (P=0.04). Although not statistically significant, subjects consuming nine or more cups of coffee per day had higher lipoprotein(a) levels than those drinking five to eight cups per day in both coffee groups. Conclusion. Chronic consumers of unfiltered, boiled coffee have higher serum levels of lipoprotein(a) than filter coffee drinkers.
Exploring the declining case fatality in acute stroke. Population‐based observations in the northern Sweden MONICA Project
Authors: STEGMAYR B. , ASPLUND K. 
Published: November 2003

Objectives. Declining case fatality in acute stroke has been reported from many western countries. The aim of this study was to explore in what subset of patients the decline in case fatality has occurred. Setting. In a population‐based study, acute stroke events were recorded in the age group 25–74 years in northern Sweden during the years 1985–1993 within the framework of the WHO MONICA Project. Subjects. In total 3486 men and 2212 women with a first‐ever stroke (except subarachnoid haemorrhage) were included. Main outcome. Change in stroke incidence, case fatality and neurological deficits at onset over a 9‐year period. Results. The incidence (first‐ever stroke) did not change over the years, while the overall case fatality decreased from 18.2% in 1985–1987 to 13.5% in 1991–1993. In both men and women with non‐haemorrhagic stroke, a trend was seen towards an increasing incidence of mild stroke events over the years. In both sexes, a significant decline in case fatality was seen in patients with minor deficits at onset, while no change in case fatality was seen in patients with extensive deficits. There was no change in incidence of intracerebral haemorrhage, but the case fatality in patients with intracerebral haemorrhage declined significantly from 36% to 29% during the study period. Conclusions. A declining case fatality was observed in both men and women. Among patients with non‐haemorrhagic stroke, the decline was confined to patients with minor deficits. The declining case fatality can be attributed both to a shift in the severity towards more patients presenting with mild symptoms, and an improved prognosis in patients with minor deficits at onset, probably because of improved medical management.
Infective endocarditis, 1984 through 1993: a clinical and microbiological survey
Authors: Benn M. , Hagelskjær L. H. , Tvede M. 
Published: November 2003

Benn M, Hagelskjær LH, Tvede M. (Viborg Hospital, Denmark). Infective endocarditis, 1984 through 1993: a clinical and microbiological survey. J Intern Med 1997; 242: 15–22.ObjectivesTo characterize the epidemiology and the clinical and microbiological spectrum of infective endocarditis in a Danish population.DesignA retrospective review.SettingAll episodes hospitalized of infective endocarditis from 1984 to 1993 in Viborg County were reviewed. The county is served by one general and four local hospitals.SubjectsOne hundred and nine episodes of suspected infective endocarditis with 62 episodes in 59 patients fulfilling the diagnostic criteria by von Reyn.ResultsAn overall incidence of 27 episodes per million per year was found. The incidence was 17.4 episodes per million per year in the first part of the decade and 36.5 episodes per million per year in the second part (P < 0.001). Microscopic haematuria was found in 70.2% of the patients with infective endocarditis, compared to 16.7% of the patients in whom the diagnosis was rejected (P < 0.01). Staphylococcus aureus was found in 38.9%, non‐β‐haemolytic streptococci in 24.1% and Enterococcus faecalis in 16.7%. The overall mortality was 35.5%. The mortality decreased significantly from 50.0% in the first part of the decade to 28.6% in the second part (P < 0.01). The mortality was 23.1% in patients in whom the diagnosis was established whilst they were alive. This finding was significantly lower than the overall mortality (P < 0.05).ConclusionThe incidence of infective endocarditis increased during the decade. The frequency of non‐β‐haemolytic streptococci was lower than normally reported. Mortality is still high, with the main mortality within the first week in hospital, which stresses the importance of early case detection and treatment.
Pyridoxin‐responsive anaemia in a patient with a history of polycythaemia vera
Authors: VAN GAMEREN I. I. , WIJNJA L. , LOUWES H. , de WOLF J. Th. M. 
Published: November 2003

van Gameren II, Wijnja L, Louwes H, de Wolf JTHM (Martini Hospital and University Hospital, Groningen, The Netherlands). Pyridoxin‐responsive anaemia in a patient with a history of polycythaemia vera (Case Report). J Intern Med 1997; 242: 79–81.Pancytopenia in the course of polycythaemia vera (PV) following the proliferative and stable phase, ultimately leads to a spent phase characterized by extensive marrow fibrosis. We describe a patient with a history of PV and pancytopenia caused by myelodysplasia, before a genuine end stage myelofibrosis had occurred. The related anaemia was responsive to pyridoxin.