ISSN:0954-6820    

DOI:10.1111/j.1365-2796.1992.tb00558.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

ISSN:0954-6820    

DOI:10.1111/j.1365-2796.1992.tb00559.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

Dexfenfluramine, an effective and safe serotoninergic drug with anorectic and possible food‐selection‐tuning properties, was investigated in a placebo‐controlled study of 1 year's duration in severe and refractory obesity. The aim of the study was to assess weight loss, and changes in cardiovascular risk factors, food intake and eating behaviour. Dexfenfluramine‐ and placebo‐treated patients achieved a similar weight loss (>10% of initial weight, by 39.5 and 30.0%,>20% of initial overweight by 42.1% and 32.5% and>10 kg by 41.4 and 33.3%, respectively, of the initial cohorts). Furthermore, the decreases in weight (10.7 vs. 8.0 kg), in body mass index (3.9 vs. 2.9 kg m−2) and in waist/hip ratio (0.04 vs. 0.02) were not significantly different. After discontinuation of the drug, the increase in weight (2.8 vs. 1.0 kg) was significantly higher in the dexfenfluramine‐treated group. Except for a borderline better effect on glucose of dexfenfluramine, both groups showed similar beneficial changes in food intake and cardiovascular risk factors. Eating behaviour in response to emotional and external stimuli was comparable in the two groups, but placebo‐treated patients had to restrain their eating more in order to achieve the same weight loss. Notwithstanding the fact that weight losses and an associated amelioration of health‐risk factors were of similar magnitude in dexfenfluramine‐ and placebo‐treated patients, dexfenfluramine might have a useful role in promoting a less stressed adherence to prolonged restriction of energy intake in the severe and ref

ISSN:0954-6820    

DOI:10.1111/j.1365-2796.1992.tb00560.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

Urinary excretion of 3‐methylhistidine has been proposed as an index of internal protein breakdown provided that the intake of exogenous 3‐methylhistidine (meat) is excluded. To evaluate the potential use of 3‐methylhistidine in the metabolic assessment of patients with advanced renal failure, we studied a group of 11 patients with markedly reduced renal function who were put on a meat‐free diet (the protein intake was kept constant). Steady‐state plasma concentration and urinary excretion of 3‐methylhistidine were not achieved until 14 d after exclusion of meat from the diet. At that time the plasma concentration and urinary excretion of 3‐methylhistidine had decreased by 43% and 60%, respectively. We conclude that the delay in reaching steady state makes the clinical use of urinary excretion of 3‐methylhistidine in patients with advanced renal failure unpracticable as an index of protein breakdown. The exclusion of meat also resulted in a continuous decrease in the plasma level and urinary excretion of creatinine, with the result that plasma creatinine or its reciprocal become misleading for evaluation of changes in renal function until a new steady state h

ISSN:0954-6820    

DOI:10.1111/j.1365-2796.1992.tb00561.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

The Danish Committee on Adverse Drug Reactions received 1100 reports of suspected drug‐induced hepatic injury during the decade 1978–1987. The causal relationship between drug and hepatic injury was classified as definite in 57 (5.2%) reports, probable in 989 (89.9%) reports, possible in 50 (4.5%) reports and unclassifiable in four (0.4%) reports. Hepatic injuries accounted for 5.9% of all adverse drug reactions reported, and 14.7% of the lethal adverse drug reactions. A total of 47.2% were classified as acute cytotoxic, 16.2% as acute cholestatic and 26.9% as abnormal hepatic function. In 52 (4.7%) cases the hepatic injury was lethal; only 14 (1.3%) cases were chronic. Halothane accounted for 25% of the cases. The incidence of halothane‐induced hepatic injury is decreasing, and only one lethal case has been reported since 1981. Next to halothane, sulfasalazine was the drug most often suspected during the last 2 years of the decade. Based on consumption data, the incidence of hepatic injury due to sulindac was estimated to be 18‐fold higher than that due to ibuprofen. Paracetamol was reported to induce acute cytotoxic as well as cholestatic reactions in non‐alcoholic subjects taking therapeu

ISSN:0954-6820    

DOI:10.1111/j.1365-2796.1992.tb00562.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

We studied the effect of sleeping in the head‐up tilt (HUT) position, alone and in combination with fludrocortisone, on orthostatic tolerance and blood pressure (BP) in six patients with hypoadrenergic orthostatic hypotension. A high salt diet of 150–200 mmol Na+ d−1was also administered. Combined treatment reduced orthostatic dizziness in all patients (P<0.001), and increased the maximal standing period to at least 10 min. HUT alone (n= 4) reduced the BP decrease after 1 min of standing from −64/‐42/‐25 ± 29/21/17mmHg to −53/‐37/‐23 ± 31/24/20 mmHg (P<0.01 for systolic BP). Addition of fludrocortisone to HUT (HUT/fludro) (n= 5) further reduced the BP decrease after 1 min of standing from −63/ −40/ −24 ± 20/12/11 mmHg to −21/‐19/‐8 ± 12/10/5 mmHg (P<0.05 for systolic, mean and diastolic BP, respectively). BP at maximal standing time increased from 58/47/42 ± 9/8/7 mmHg initially to 95/69/57 ± 27/22/20 mmHg during combined treatment (P<0.05 for systolic and mean BP), and remained unchanged during the 14‐month (range 8–70 month) follow‐up period. Nocturnal sodium excretion decreased from 8.0 ± 2.3 mmol h−1to 5.9 ± 1.9 mmol h−1with combined treatment; body weight increased by 1.6 kg on average (range 0.5‐2.4 kg) (P<0.01). We conclude that the combination of HUT and fludrocortisone effectively minimizes orthostatic symptoms and increases orthostatic BP in pati

ISSN:0954-6820    

DOI:10.1111/j.1365-2796.1992.tb00563.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

To assess the reproducibility of variables with prognostic value from exercise testing, two symptom‐limited treadmill exercise tests were performed in 76 consecutive patients at 2 weeks (predischarge) and 6 weeks after myocardial infarction. In addition, cardiac catheterization was performed at 6 weeks. Exercise duration showed a moderate increase from 7.9±4.4min to 8.8 ± 3.0 min (NS). The rate‐pressure product increased from 22377 ± 5491 to 24832 ± 7261 (P<0.001). Reproducibility of ST‐segment depression was dependent on the initial response: among the group of 25 patients with ST‐segment depression at 2 weeks, only 13 (52%) patients had a reproducible result, whereas among the group of 51 patients without initial ST‐segment depression, 40 (78%) patients showed reproducibility. There was no difference in coronary anatomy or ejection fraction between the groups with and without reproducibility results. Among the 30 patients with initial ST‐segment elevation, 15 (50%) patients showed reproducibility, while among the 46 patients without initial ST‐segment elevation, 42 (91%) patients showed reproducibility: the ejection fraction was significantly higher in the latter group than in the group of patients with lower reproducibility. Thus predischarge exercise testing in postinfarction patients identifies a different group of patients at risk compared to exercise testing after 6 weeks, due to considerable variation betw

ISSN:0954-6820    

DOI:10.1111/j.1365-2796.1992.tb00564.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

In a prospective study all positive phlebographies within the well‐defined population of the city of MalmÖ, Sweden, during 1987 were studied in order to determine the incidence of deep venous thrombosis (DVT). Epidemiological data were analysed for the detection of patient groups at increased risk of DVT. The incidence was found to be equal for both sexes, i.e. 1.6 per 1000 inhabitants and year. Risk factors were found to be in accordance with earlier studies. The median age for men was 66 years, compared to 72 years for women. At diagnosis of DVT, 19% of subjects had a known malignancy and within 1 year 5% (19 cases) developed a new malignancy. Of the men, 29% had postoperative or post‐traumatic (fracture) DVT, compared to 46% of the women. Fewer patients with DVT than expected (39%) belonged to blood group 0 (31%) (P<0.005). Pulmonary embolism (PE) was clinically suspected in only 5% of cases, and diagnosis was verified scintigraphically in 2% of cases. None of these died of PE, but of 6 patients who were found to have PE at autopsy, four died about 4 weeks after the DVT was diagn

ISSN:0954-6820    

DOI:10.1111/j.1365-2796.1992.tb00565.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

Recent reports have suggested that impaired renal function in type 1 diabetic patients may be present despite normal urinary albumin excretion (UAE). We have studied kidney function by means of a constant‐infusion technique in normoalbuminuric type 1 diabetic patients without antihypertensive medication (UAE<20 μg min−1,n= 134), in microalbuminuric patients (20 ≥ UAE<200 μg min−1,n= 50) and in 27 non‐diabetic control subjects. Mean UAE was 4.5 μg min−1(range 1.0–19.3 μg min−1) in normoalbuminuric patients, 53.1 μg min−1(range 20.8–147.5 μg min−1) in microalbuminuric patients, and 4.0 μg min−1(range 2.1–17.9 μg min−1) in controls. Glycosylated haemoglobin A1cwas significantly higher in microalbuminuric patients (8.9%, range 5.9–12.6%) than in normoalbuminuric patients (7.9%, range 5.5–11.5%) (P<0.0001). Glomerular filtration rate in normoalbuminuric patients (135 ml min−1, range 97–198 ml min−1) was significantly higher than in controls (118 ml min−1, range 94–139 ml min−1) (P<1 times 10−6), and significantly lower than in microalbuminuric patients (142 ml min−1, range 100–186 ml min−1) (P<0.05). Mean arterial blood pressure was lower in normoalbuminuric patients (91 mmHg, range 78–108 mmHg) than in microalbuminuric patients (98 mmHg, range 82–131 mmHg) (P<1 times 10−6), but not significantly different from that of controls (89 mmHg, range 73–103 mmHg). We conclude that normal UAE is a reliable indicator of well‐preserved renal function. Glomerular hyperfiltration, elevated blood pressure and poor metab

ISSN:0954-6820    

DOI:10.1111/j.1365-2796.1992.tb00566.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

To determine the principal causes and effects of syncope in young adults, we prospectively evaluated 197 consecutive patients referred to a Syncope Specialty Clinic, comparing young (age 16–39 years,n= 71), middle‐aged (age 40–65 years,n= 70) and elderly (>age 65 years,n= 56) patients. Psychiatric aetiologies were significantly more common in young patients (39% vs. 20% in middle‐aged, and 3.6% in the elderly;P<0.001), while cardiac aetiologies were rare in the young (2.8% vs. 12% in the middle‐aged, and 16% in the elderly;P<0.04). These differences were still significant after controlling for gender. Because psychiatric causes are so common in young patients, we evaluated hyperventilation as a bedside test for syncope patients and found it to have a positive predictive value of 59% for psychiatric causes of syncope. Syncope interfered with daily activities in 62% of young patients, and resulted in anxiety or depression in 70% of the young (no difference when compared with other age groups). Thus syncope in young adults can be a disabling medical condition requiring a unique medical and psychological approach to diagnosis and

ISSN:0954-6820    

DOI:10.1111/j.1365-2796.1992.tb00567.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY