ISSN:0954-6820    

DOI:10.1111/j.1365-2796.1993.tb00737.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

Abstract.Objectives. To review factors associated with development of osteoporosis in patients with rheumatic diseases, as well as the preventive and therapeutic measures.Design. AMEDLINE literature search.Results. 1 Pathogenesis. Rheumatoid arthritis in itself causes reduction of bone mass; this process can be aggravated by glucocorticoid treatment. With glucocorticoid treatment, bone mineral density decrease is most pronounced during the first months of treatment. There is no agreement on the effects of daily dose, cumulative dose, and duration of glucocorticoid treatment on the rate of bone loss. However, with treatment by low doses (<10 mg of prednisone equivalent per day), bone loss appears to be minimal or even undetectable compared to controls. Alternate day treatment, or treatment with steroid ‘pulses’ have not been shown to protect from bone loss. 2 Prevention and treatment. Prophylactic and therapeutic measures for glucocorticoid‐induced osteoporosis include calcium supplementation, vitamin D in physiological doses and oestrogen in perimenopausal female patients. Efficacy has not always been shown in this particular indication but is extrapolated from other forms of osteoporosis. Limited data exist on treatment with anabolic steroids, calcitonin (with an additional analgesic effect) and biphosphonates and reduction of fracture rates has not yet been investigated. At present, there is insufficient evidence to show that altered steroid molecules can dissociate adverse effects on bone from clinically desirable effects.Conclusion. In view of the paucity of study data, prophylaxis and therapy of glucocorticoid‐induced osteoporosis should receive more attention in future clinical

ISSN:0954-6820    

DOI:10.1111/j.1365-2796.1993.tb00738.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

Abstract.The effects of long‐term behaviour modification of obesity on pulmonary function was studied in eight men with obstructive sleep apnoea syndrome (initial mean body mass index [BMI] 41.8 kg m−2) before and after a mean weight loss of 20 ± 7 (SD) kg. Mean arterialPco2fell from 6.3 ± 1.2 to 5.5 ± 0.6 kPa (P<0.05) and concomitant significant improvements were found in vital capacity, total lung capacity, functional residual capacity and forced expired volume (FEV1.0). The study suggests that weight lossper se, rather than the method of choice to achieve weight loss, results in clinically significant improvement of pulmonary function in obe

ISSN:0954-6820    

DOI:10.1111/j.1365-2796.1993.tb00739.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

Abstract.Objectives. The aim of the study was to investigate endogenous growth hormone (GH) secretion in patients with osteoporosis and in patients with degenerative bone diseases or no spinal disease by measuring serum insulin‐like growth factors 1 and 2 (IGFs) and their major binding protein 3 (BP‐3) as an indirect parameter of GH secretion.Design. A cross‐sectional study.Setting. All patients were seen as out‐patients of the Endocrinology Department of the University of Heidelberg where all bone parameters were measured. IGFs and BP‐3 serum levels were measured at the Children's Hospital of the University of Tübingen.Subjects. A total number of 310 patients were studied. The group with primary osteoporosis and vertebral fractures (OPO) consisted of 141 patients (98 females, 43 males). Spinal degenerative bone disease or osteoarthritis (DEG) was present in 108 patients (91 females, 17 males). Sixty‐one control patients (56 females, 5 males) had no spinal disease on X‐ray, but presented with lower back pain.Main outcome measures. Serum levels of IGFs, BP‐3, PTH and 25‐vitamin D3were measured by radioimmunoassay. Bone mineral density (BMD) was determined using absorptiometry; anthropometric parameters and menopausal status were recorded.Results. There was no difference in age and years after menopause between OPO and DEG, but control individuals were younger. Mean IGFs and BP‐3 serum levels in patients with OPO were lower (P<0.001) than those in patients with DEG or in controls. Patients with DEG had significantly higher BP‐3 levels than controls (P<0.001). There was a significant (P<0.05) negative correlation of BP‐3 with age in females with OPO, but not in controls or in DEG patients. The IGFs did not decrease with age in any of the three groups. Binding protein 3 was positively correlated (P<0.05) with BMD in postmenopausal women with OPO but not in controls or DEG patients.Conclusion. We conclude that systemic IGFs and IGF binding protein 3 are decreased in patients with osteoporosis. Further studies are needed to investigate whether this is as a result of diminished secretion of endogenous GH and whether this reflects the local circumstances of IGFs and IGF

ISSN:0954-6820    

DOI:10.1111/j.1365-2796.1993.tb00740.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

Abstract.Objective. To investigate the mode of progression to renal failure in patients with lupus nephritis in relation to disease activity and responsiveness to corticosteroid therapy.Design. Retrospective clinical study.Setting. University hospital.Subjects. Twenty‐eight patients with progressive lupus nephritis (Cr ≥ 1.4 mg dl−1).Interventions. Rapidity of progression was defined as the slope of the reciprocal of serum creatinine values. Lupus activity was scored using the systemic lupus erythematosus disease activity index system.Main outcome measures. Improvement of serum creatinine values after 6 months of therapy.Results. Rapidity of progression, which was calculated during the deterioration in kidney function, reflected systemic and serological disease activity, and moreover closely correlated with response to corticosteroid th

ISSN:0954-6820    

DOI:10.1111/j.1365-2796.1993.tb00741.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

Abstract.Objectives. To estimate the prevalence of insulin resistance and high serum insulin levels and to investigate their relationship to other cardiovascular risk factors.Design. Cross‐sectional cardiovascular risk factor survey.Setting. Northern Sweden.Subjects. A subsample of the population‐based Northern Sweden MONICA Study. This subsample underwent an oral glucose tolerance test after an overnight fast, and consisted of 354 men and 404 women in the 25–64‐year age range.Main outcome measures. Delineation of low insulin sensitivity and high serum insulin by the diagnostic test technique, prevalence of these variables and their associations with cardiovascular risk factors.Results. The participants were classified into four subgroups by an insulin sensitivity index and fasting serum insulin. The combination of low insulin sensitivity and high serum insulin was present in 17% of the male and in 18% of the female 25–64‐year‐old population. In both sexes this combination was closely associated (P<0.001) with body mass index, waist‐hip ratio, blood pressure and serum triglycerides, and correlated inversely with serum HDL cholesterol (P<0.001). When high serum insulin was present as an isolated entity it was as closely associated with other cardiovascular risk factors such as isolated low insulin sensitivity, except that impaired glucose tolerance occurred exclusively in the group with isolated low insulin sensitivity.Conclusions. The combination of insulin resistance and high insulin levels is associated with a marked clustering of cardiovascular risk factors and is present in one‐sixth of the middle‐aged population in

ISSN:0954-6820    

DOI:10.1111/j.1365-2796.1993.tb00742.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

Abstract.Objectives. To assess the peripheral and central haemodynamics, in particular the effect on minimal resistance in the hand, with an ACE inhibitor in comparison with a diuretic.Design. Double‐blind randomized parallel group study.Subjects. Twenty‐eight previously untreated men with essential hypertension (supine diastolic blood pressure>95 mmHg repeatedly on placebo).Methods/intervention. Casual and intra‐arterial blood pressure, dye‐dilution technique, water plethysmography at rest and at ischaemia, enalapril (n= 14), hydrochlorothiazide (n= 14).Results. After 6 months the mean arterial pressure was reduced from 112.7 to 96.9 mmHg (change –15.9 mmHg; 95% confidence interval (CI) –21.9, –9.8) on enalapril and from 110.1 to 101.5 mmHg (change –8.6 mmHg; CI –14.4, –2.8). Heart rate did not change on any of the therapies. Enalapril reduced blood pressure mainly through a reduction in total peripheral resistance (Δ –3.0 PRU100; CI –5.6, –0.4) while hydrochlorothiazide reduced blood pressure mainly through a reduction in cardiac output (Δ –0.8 l/min−1CI –1.5, –0.07). Minimal vascular resistance (mean of right and left hand) displayed a significant time × treatment interaction indicating a different trend with enalapril than hydrochlorothiazide with a change of –0.12 PRU100(CI –0.33, 0.05) on enalapril and a change of 0.14 (CI –0.29, 0.56) on hydrochlorothiazide. The resistance level after 6 months was significantly higher on hydrochlorothiazide than on enalapril (P= 0.0105).Conclusion. Enalapril reduced blood pressure through vasodilatation and hydrochlorothiazide through decreased cardiac output. The two therapies also affected minimal vascular resistance (an indirect measure of vascular wall thickness) differently; with enalapril showing a favourable r

ISSN:0954-6820    

DOI:10.1111/j.1365-2796.1993.tb00743.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

Abstract.The purpose of the study was to measure the urinary excretion ofN‐acetyl‐beta‐glucosaminidase (U‐NAG) in patients suspected of having renovascular hypertension and to compare the enzyme excretion before and after active intervention with operation or percutaneous transluminal renal angioplasty (PTRA).Eighty‐one patients with severe, therapy‐resistant hypertension were examined with regard to renal artery stenosis (RAS). At least one significant renal artery stenosis was found in 61 patients, whilst the remaining 20 patients were classified as having essential hypertension.Enzyme levels were found to be significantly higher in RAS patients as compared with patients with severe hypertension lacking significant renal artery stenosis, 0.66 (0.41–0.91, median value, 1st and 3rd quartiles) versus 0.35 (0.27–0.54);P<0.01. Both groups of patients had significantly higher U‐NAG values than a healthy reference population (0.2, 0.13–0.27;P<0.01). Forty of the RAS patients were randomized to surgery or PTRA and followed prospectively for 2 years. After either renal vascular surgery or PTRA a significant rise in U‐NAG excretion was observed 7–10 days after treatment. Urinary NAG excretion remained elevated during long‐term follow‐up. It is suggested that U‐NAG should be determined in patients with therapy‐resistant hypertension with sus

ISSN:0954-6820    

DOI:10.1111/j.1365-2796.1993.tb00744.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

Abstract.Objective. To study whether the decrease in the content of oestrogen and gestagen in modern low‐dose oral contraceptives (OC) has yielded a lower incidence of adverse liver reactions, and to describe the biochemical pattern of the adverse liver reactions from low‐dose OC.Design. We surveyed all liver reactions from OC reported to SADRAC (Swedish Adverse Drug Reactions Advisory Committee) from 1966 to 1989.Main outcome measure. Incidence of reported adverse liver reactions (number of reported adverse reactions/OC sales in defined daily dose [DDD]).Results. There was a sharp decline in the number of reports during the studied period, suggesting changes in reporting habits. However, there was also a significantly lower incidence of reports for medium‐compared to high‐oestrogen dose OC, and a further decrease, albeit non‐significant, in incidence with low‐oestrogen dose OC. Furthermore, in three comparisons of pairs of OC that differed only in the gestagen dose, there was a strong trend towards a higher reporting rate with higher gestagen dose. Cholestatic and hepatoceullular liver enzyme patterns were equally frequent in patients with adverse reactions from low‐dose oestrogen OC. There was no report of liver tumours related to use of low‐oestrogen dose OC.Conclusion. There seems to be a decrease in the incidence of adverse liver reactions related to lower contents of both oestrogens and gestagens in OC of the combined

ISSN:0954-6820    

DOI:10.1111/j.1365-2796.1993.tb00745.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

Abstract.Objectives. To determine the possibility of very early prognostic stratification based on electrocardiograms (ECGs) at rest and/or cardiac enzyme levels after an episode of suspected unstable coronary heart disease.Design and setting. Men with suspected unstable angina or non‐Q‐wave myocardial infarction were studied in the coronary care units of eight hospitals. The ECGs at rest and creatinine kinase were followed.Subjects. In total 911 men were followed for 12 months. Of 8136 consecutively admitted, 3365 fulfilled the inclusion criteria. Excluded were 2454 patients, mainly because of a larger myocardial damage, signs of myocardial dysfunction, other serious cardiac or non‐cardiac disease or an ECG not possible to interprete regarding ST‐T‐segment changes in the precordial leads.Main outcome measures. End‐points at follow‐up were cardiac death, myocardial infarction and severe (class III or IV) angina.Results. Compared to patients with normal a ECG who had an 8% 1‐year risk of myocardial infarction or death, the risk with isolated negative T waves was 14% (P<0.05), ST elevation 16% (P<0.05), ST depression 18% (P<0.01) and the combination of ST elevation and ST depression 26% (P<0.001). The only finding related to future severe angina was ST depression. The risk of cardiac events was comparably elevated in patients with anterior or inferior site of ECG changes. Cardiac enzyme levels had no predictive value regarding future events.Conclusions. Electrocardiograms at rest obtained during the initial days of hospitalization provide very early and valuble prognostic information in men admitted with suspected unstable coronar

ISSN:0954-6820    

DOI:10.1111/j.1365-2796.1993.tb00746.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY