ISSN:0954-6820    

DOI:10.1046/j.1365-2796.1996.17842000.x

出版商:Blackwell Science    

年代:1996

数据来源: WILEY

摘要:

Recent studies have demonstrated that replacement of C‐peptide to normal physiological concentrations in insulin‐dependent diabetic (IDDM) patients on a short‐term basis (1–3 h) results in decreased glomerular hyperfiltration, augmented glucose utilization and improved autonomic nervous function. More prolonged administration (1–3 months) of C‐peptide to IDDM patients is accompanied by improvements in both renal and autonomic nervous function. Moreover, bothin‐vitroandin‐vivostudies indicate that C‐peptide may have a role in the regulation of insulin secretion. The effects of C‐peptide may in part be explained by its ability to stimulate Na+,K+‐ATPase activity. In conclusion, the combined findings indicate that C‐peptide is a biologically active hormone. The possibility that C‐peptide therapy in IDDM patients may be benefi

ISSN:0954-6820    

DOI:10.1046/j.1365-2796.1996.19841000.x

出版商:Blackwell Science    

年代:1996

数据来源: WILEY

摘要:

Objectives.To establish age‐ and sex‐specific reference limits for the erythrocyte sedimentation rate (ESR) in asymptomatic Norwegian adults.Design.Single ESR recordings were obtained by the classical or a modified Westergren method from 2145 men and 1765 women (93% being blood donors) with age range 20–90 years, and analysed statistically.Results.There was a significant positive association between ESR level and age, consistent with a parabolic pattern in men but a linear one in women. The mean values for men were about 3 mm h‐1at 20 years, 6 mm h‐1at 55 years, and 10 mm h‐1at 90 years, and 6, 9, and 11 mm h‐1respectively for women. These averages (predicted by regression lines) were significantly higher in women up to the age of 75 years, after which the estimated sex‐specific 95% confidence limits for mean values were found to overlap.Conclusions.The upper reference levels expected to be exceeded only by chance in 5% of single individual recordings at the ages of 20, 55 or 90 years, respectively, were estimated to be 12, 14 and 19 mm h‐1for men, and 18, 21 and 23 mm h‐1for women. Higher values should be controlled and, if confirmed, lead to a clinical check‐up. However, about 76% of our overall material had ESR values lower than 9 mm h‐1. Knowledge of each person's baseline ESR value might increase the disease‐predictive ability of the test. If several measurements over years reveal a steeper rise with age than depicted in our population‐based curves, it should be taken seriously, even when each reading is below the popula

ISSN:0954-6820    

DOI:10.1046/j.1365-2796.1996.30295851000.x

出版商:Blackwell Science    

年代:1996

数据来源: WILEY

摘要:

Objectives.A diagnosis of renal cell carcinoma (RCC) early enough for potentially curative surgery is difficult. We wanted to establish whether the erythrocyte sedimentation rate (ESR) in RCC patients had begun to risebeforethe appearance of any symptoms or signs and, if so, when.Design.A retrospective study of the evolution of the ESR in 236 randomly selected RCC patients during several yearsbeforediagnosis, comparing the results with previously obtained population‐based control values.Results.It is generally held that RCC patients have a high ESR at diagnosis. In our material, however, 29.7% of the RCC cases had an ESR that at this time was at or below the population‐based upper reference limit; it had not increased significantly, neither with time before diagnosis, nor with age. In 70.3% of RCC patients the ESR was increased and had been significantly rising for up to 6 years or more before diagnosis. This had not been adequately responded to, probably because the physicians lacked knowledge of the patients' baseline ESR, and because none of the prediagnostic readings had been above the population‐based reference limit.Conclusions.Systematic ESR graphic recordings over time will enable a physician to determine each individual's baseline value, and hence note any continuously rising trend, which should lead to further investigations, e.g. an ultrasound kidney examination. This may provide an early clue to many otherwise non‐symptomatic RCC cases. It is time for a reappraisal of the predictive value of the ESR to discover early RCC, and possibly other diseases

ISSN:0954-6820    

DOI:10.1046/j.1365-2796.1996.30195852000.x

出版商:Blackwell Science    

年代:1996

数据来源: WILEY

摘要:

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

ISSN:0954-6820    

DOI:10.1046/j.1365-2796.1996.519857000.x

出版商:Blackwell Science    

年代:1996

数据来源: WILEY

摘要:

Objectives.To see if the cluster of metabolic and haemodynamic variables defined as comprising Syndrome X varied as a function of urinary albumin excretion (UAE) rate in a healthy population.Design.A cross‐sectional, population‐based study.Setting.A factory in Italy.Subjects.Two hundred and twenty‐five healthy volunteers, 115 men and 110 women.Outcome measures.Measurements were made of the plasma glucose and insulin responses to oral glucose, fasting triglyceride (TG) and high density lipoprotein (HDL)‐cholesterol concentrations, blood pressure, and UAE rates.Results.Only five of the 225 volunteers had microalbuminuria, defined as a UAE rate>2 μg min‐1, and the UAE rate was<5 μg min‐1in 80% of the volunteers. Significant variations in the metabolic and haemodynamic variables measured were not associated with any differences in UAE. Finally, significant relationships were found between various measures of plasma insulin concentration and plasma glucose response to oral glucose, plasma TG and HDL‐cholesterol concentrations, and mean arterial blood pressure, independent of variations in age, body mass index, ratio of waist‐to‐hip girth,andUAE rates.Conclusion.The widespread variability in plasma glucose and insulin responses, plasma TG and HDL‐cholesterol concentrations, and blood pressure that are seen in the population at large cannot be attributed to v

ISSN:0954-6820    

DOI:10.1046/j.1365-2796.1996.23849000.x

出版商:Blackwell Science    

年代:1996

数据来源: WILEY

摘要:

This report describes a male patient who was found to have proteinuria at age 31. Renal biopsy showed glomerular hypercellularity with enlarged, lipid‐filled endocapillary cells. On subsequent lipid analysis there was elevation of cholesterol and triglyceride, with apolipoprotein E genotype E2/E2. The clinical course was complicated by pancreatitis and onset of diabetes. After treatment with gemfibrozil and some improvement of the lipid profile, a second renal biopsy showed marked reduction of the glomerular foam cells, despite an increased level of proteinuria. This case emphasizes the potential role that lipid abnormalities may play in renal dysfunctio

ISSN:0954-6820    

DOI:10.1046/j.1365-2796.1996.501855000.x

出版商:Blackwell Science    

年代:1996

数据来源: WILEY

摘要:

The first case of cobalamin deficiency with megaloblastic anaemia in a patient under long‐term omeprazole therapy is presented. This patient received omeprazole at a daily dose of 40–60 mg for 4 years as treatment for a gastro‐oesophagal reflux complicated by peptic oesophagitis. Seric vitamin B12 was dramatically decreased at 80 pmol L‐1. The Schilling test was normal (13%) with crystalline [57Co] cobalamin and it was at 0% with [57Co] cobalamin‐labelled trout meat. All other assimilation tests were normal except an expiratory hydrogen breath test performed with lactulose. The haematological status was restored after intramuscular treatment with cobalamin. In conclusion, prolonged omeprazole therapy can be responsible for a cobalamin deficiency due to protein‐bound cobalamin ma

ISSN:0954-6820    

DOI:10.1046/j.1365-2796.1996.20846000.x

出版商:Blackwell Science    

年代:1996

数据来源: WILEY

摘要:

We report a case of a female patient with sarcoidosis who presented with a generalized lymphadenopathy and a strong IgG serological test of toxoplasmosis. Progressive lymphadenopathy with a rising plasma calcium (up to 15 mg dL‐1) with a normal plasma 1,25‐dihydroxy vitamin D concentration occurred later. Corticosteroid therapy resulted in prompt clinical and biochemical responses with normalization of plasma calcium and a significant reduction in 1,25‐dihydroxy vitamin D concentration. This is an exceptional presentation of sarcoidosis with severe hypercalcaemia and normal vitamin D metabo

ISSN:0954-6820    

DOI:10.1046/j.1365-2796.1996.24850000.x

出版商:Blackwell Science    

年代:1996

数据来源: WILEY