ISSN:0954-6820    

DOI:10.1111/j.1365-2796.1993.tb00755.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

ISSN:0954-6820    

DOI:10.1111/j.1365-2796.1993.tb00756.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

ISSN:0954-6820    

DOI:10.1111/j.1365-2796.1993.tb00757.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

ISSN:0954-6820    

DOI:10.1111/j.1365-2796.1993.tb00758.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

ISSN:0954-6820    

DOI:10.1111/j.1365-2796.1993.tb00759.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

ISSN:0954-6820    

DOI:10.1111/j.1365-2796.1993.tb00760.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

Abstract.It is proposed that an intracellular cycle exists to limit or terminate the insulin signal. The cycle involves increased synthesis ofsn‐1,2‐diacylglycerol (DAG) in response to insulin. The DAG activates protein kinase C (PKC) which phosphorylates glycogen synthase either directly or through other protein kinases to render it inactive. Protein kinase C may also inhibit the insulin receptor by phosphorylation of receptor serine residues.Insulin resistance could then arise as a consequence of a persistent increase in DAG levels. Such an increase could occur in three different ways. Chronic hyperinsulinaemia could increase DAG levels byde‐novosynthesis from phosphatidic acid, by hydrolysis of phosphatidylcholine, or by hydrolysis of glycosyl‐phosphatidylinositol; DAG is also formed by hydrolysis of phosphatidylinositol 4,5‐biphosphate (PIP2). This reaction, known as the ‘PI response,’ may be the connection between hypertension and insulin resistance. A third mechanism for an increase in DAG involves neural abnormalities. Thus, muscle denervation in the rat is characterized both by a profound insulin resistance and a large increase in DAG. It is possible that a similar increase occurs in humans and may explain the association between denervation, inactivity, and insul

ISSN:0954-6820    

DOI:10.1111/j.1365-2796.1993.tb00761.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

Abstract.Objectives. Tendon xanthomas cause thickening of the tendon and are an important sign in monogenic familial hypercholesterolaemia (FH). The aim of our study was to investigate the usefulness of achilles tendon sonography in detecting FH patients. Special attention was paid to structural abnormalities of the achilles tendon.Design. A clinical study with methodological testing.Setting. Patients suspected of having FH were sent to the out‐patient Department of Medicine from other departments of Turku University Central Hospital and from primary care units. The patients were studied by high‐frequency ultrasound before more exact typing of the lipid disorder. An additional study of normolipidaemic volunteers and a phantom study were also carried out.Subjects. Forty FH patients, 51 non‐FH hypercholesterolaemia patients and 41 normolipidaemic volunteers were included in the study.Main outcome of measures. The thickness of the tendon was measured and the tendon structure and its echogenicity were recorded.Results. Twenty‐five out of 40 (63%) FH patients had distinctly thickened tendons (men more than 10 mm, women more than 9 mm). Thirty‐six (90%) had a typical structural alteration of low or mixed echogenicity of the tendon. Three non‐FH patients were found to have xanthomas on sonography.Conclusions. We conclude that ultrasonography is a sensitive method of detecting xanothomas that reveals the altered tendon structure even in xanthomatous tendons of norma

ISSN:0954-6820    

DOI:10.1111/j.1365-2796.1993.tb00762.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

Abstract.Objectives. To evaluate the efficacy of a structured behaviour therapy programme on smoking cessation in diabetic patients.Design. Prospective, randomized, controlled intervention study.Setting. University out‐patient diabetes clinic.Subjects. A total of 794 consecutive insulin‐treated smoking diabetic patients were invited to participate in a smoking cessation programme. Eighty‐nine patients agreed to participate and were randomized in two groups.Interventions. Forty‐four patients were randomized to a structured extensive behaviour therapy anti‐smoking intervention and 45 patients to a control group that received a single unstructured anti‐smoking advice session given by a physician.Main outcome measures. After 6 months, nine patients were confirmed not to be smoking (i.e. urine cotinine concentration below 20 ng ml−1, 2 [5%] in the behaviour therapy intervention group and 7 [16%]in the control group.Conclusions. In diabetic patients an extensive behaviour therapy intervention for smoking cessation is no more successful than an unstructured physi

ISSN:0954-6820    

DOI:10.1111/j.1365-2796.1993.tb00763.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

Abstract.Objectives. To study aspects of management and views about hyperlipidaemia and its treatment amongst different categories of physicians.Design. A postal questionnaire was sent to selected physicians. Reminders were used.Setting. The study included physicians in primary health care (PHCPs), occupational health care (OHCPs), and in departments of internal medicine in hospitals (IMPHs).Subjects. All 146 PHCPs in the south‐western region of Stockholm, 147 OHCPs, randomly selected from the directory of occupational health care offices, and all 157 IMPHs in six hospitals, in the greater Stockholm area, were offered the questionnaire.Main outcome measures. Differences in views, attitudes and treatment policy amongst different categories of physicians.Results. Response rate was 70% (61–81%). Intervention was initiated by the OHCPs at lower levels of cholesterol than by the other two groups, with diet (P<0.001) and with drug intervention as primary (P<0.01) and secondary prevention (P<0.005). When other cardiovascular risk factors were present, intervention was started earlier by the OHCPs only in comparison with the PHCPs (P<0.01). Knowledge of one's own cholesterol level was more common amongst the OHCPs than in the other two groups (P<0.001). Patient follow‐up was the same in all groups.Conclusions. Disagreement amongst physicians about hyperlipidaemia leads to conflicting information being given to patients. It is important to be aware of these differences when trying to reach a consensus on this topic. Corresponding knowledge and attitudes amongst members of the public should also be st

ISSN:0954-6820    

DOI:10.1111/j.1365-2796.1993.tb00764.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY