ISSN:0954-6820    

DOI:10.1111/j.1365-2796.1992.tb00602.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.tb00603.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

A clustering of metabolic disturbances has been indicated in hypertension. The distribution of such factors was assessed among hypertensives and normotensives in a general population sample of 644 men aged 67 years. Fasting serum insulin, glucose and triglyceride levels were measured. In this study hypertension was defined as DBP ≥ 95 mmHg or present use of antihypertensives. Impaired glucose tolerance (IGT) or diabetes mellitus, hyperinsulinaemia (≥ 20 mU l−1) and hypertriglyceridaemia (≥ 2.3 mmol l−1) were defined as metabolic disturbances. When all these disturbances were present simultaneously a complete ‘metabolic syndrome’ was considered to be present. Hypertension was found in 185 (29%) men, IGT in 15%, diabetes mellitus in 11%, hyperinsulinaemia in 18% and hypertriglyceridaemia in 19%.Among hypertensives, 11 (6%) men had a ‘metabolic syndrome’, compared to 12 (3%) men in the normotensive group (P= 0.039). At least one metabolic disturbance was present in 109 (59%) of the hypertensive men, and in 173 (38%) of the normotensive men (P<0.001). The prevalence rates of metabolic disturbances did not differ significantly between lean (BMI<26 kg m−2) and obese (BMI ≥ 26 kg m−2) hypertensives. Only hypertriglyceridaemia was more frequent in obese than in lean hypertensives (20% vs. 37%,P= 0.015). The ‘metabolic syndrome’ was found in 6% of all hypertensives, which was twice as common as in the normotensive population. The ‘metabolic syndrome’ was uncommon in both lean and obese hypertensives (5% vs. 7%, NS). These findings indicate that hypertension and metabolic disturbances may have a common underlying caus

ISSN:0954-6820    

DOI:10.1111/j.1365-2796.1992.tb00604.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

Although intimal proliferation of smooth muscle cells (SMC) is recognized as one of the key mechanisms in the development of atherosclerosis, our knowledge of the role of circulating growth factors for SMC in this process is limited. In the present study the plasma levels of platelet‐derived growth factor (PDGF), ß‐thromboglobulin (ß‐TG), platelet factor 4 (PF 4) and total growth factor activity were determined in a group of 30 young postinfarction patients who had participated in an angiographic study of mechanisms associated with progression of coronary atherosclerosis.Significant correlations were found between the total growth factor activity in plasma and progression(r= 0.42,P<0.05), as well as severity (r= 0.52,P<0.01), of global coronary atherosclerosis. Attempts to identify the nature of the total growth factor activity indicated that less than 20% could be attributed to PDGF, the major serum mitogen for SMC. PDGF levels determined by radioimmunoassay were not related to progression or severity of global coronary atherosclerosis, but showed a significant association with the number and severity of distinct stenoses (r= 0.40,P<0.05). Due to the retrospective design of this study, it is not possible to conclude whether there is a causal relationship between circulating growth factors and development of coronary atherosc

ISSN:0954-6820    

DOI:10.1111/j.1365-2796.1992.tb00605.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

Recent studies have shown that one cause of primary moderate hypercholesterolaemia is familial defective apolipoprotein B‐100 (FDB), a condition in which a mutation in apolipoprotein B‐100 (apo B‐100) causes low‐density lipoproteins (LDL) to bind poorly to LDL receptors. One specific mutation, a glutamine‐for‐arginine transformation at position 3500 of apo B‐100, has been reported to produce FDB. However, other mutations in apo B‐100 might also cause FDB. The present study was designed to determine whether some patients with hypercholesterolaemia, who do not have the 3500 defect, may have a slowly cleared subfraction of LDL compatible with other forms of FDB. It was postulated that slowly removed LDL should accumulate excess cholesterol ester and hence be less dense than normal LDL. If so, in patients who are heterozygous for FDB. two forms of LDL might be separable by ultracentrifugation.To test this hypothesis, less‐dense(d= 1.030 g ml−1) and more‐dense (d= 1.040 g ml−1) subfractions of LDL were isolated from a patient with proven FDB (3500 mutation); the two forms of LDL were labelled with different isotopes of radioiodine and re‐injected into the patient. The less‐dense form was removed much more slowly (0.285 pools day−1) than more‐dense LDL (0.570 pools day−1). This finding appeared to confirm the validity of the approach. The same procedure was then applied to 18 other patients having elevated LDL cholesterol but not the 3500 mutation. In 13 patients, the two forms of LDL were removed at essentially identical rates, suggesting that they did not have an abnormal form of LDL. In the other five, less‐dense LDL were removed at a significantly slower rate than more‐dense LDL: this finding suggests that a significant portion of patients with moderate hypercholesterolaemia have an abnormal LDL species, which is not the 3500 mutation, but delays

ISSN:0954-6820    

DOI:10.1111/j.1365-2796.1992.tb00606.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

Forty‐one consecutive patients with the symptom ‘exertional dyspnoea’ were referred to the Department of Clinical Physiology for evaluation. Pulmonary fibrosis and chronic obstructive pulmonary disease were the most common diagnoses but other diagnoses were also represented. Some patients had no clinical diagnosis or radiological signs. All patients underwent exercise testing with sampling of arterial blood for blood gas analysis and pulmonary function testing including measurement of the transfer factor (carbon monoxide diffusing capacity) at rest.Independent of spirometric findings and diagnosis a significant correlation(r= 0.80.P<0.001) was shown to exist between the transfer factor measured at rest and the arterial oxygen tension at maximal exercise level. We recommend measurement of the transfer factor as a screening test for exertional hypoxaemia and suggest that exercise blood gas analysis only seems necessary in patients with a transfer factor between 55% and 80% of the predicted

ISSN:0954-6820    

DOI:10.1111/j.1365-2796.1992.tb00607.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

Twenty‐four patients with mild to moderate primary hyperparathyroidism were followed for an average of 2.45 years with serial determinations of serum ionized calcium and intact parathyroid hormone (PTH). For the entire group serum ionized calcium remained stable, whereas serum PTH increased significantly. Eleven patients (group 1) demonstrated a significant increase in PTH with time. The remaining 13 patients formed group 2. Comparison of the changes (%) in each subgroup showed a small but significant increase in serum ionized calcium of 2.6% with time in group 1, while serum PTH increased by 78%. In group 2 serum ionized calcium remained stable whereas PTH increased modestly by 22%. Serum concentrations of creatinine were stable throughout the follow‐up period in both groups.Despite the greater precision of serum ionized calcium, measurements of intact PTH are evidently more sensitive than measurements of serum ionized calcium for the detection of progression in primary hyperparathyroid

ISSN:0954-6820    

DOI:10.1111/j.1365-2796.1992.tb00608.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

Symptomatic aortic aneurysm is an extremely acute condition with manifest or threatening aortic rupture. The mortality is high and urgent surgery is essential and often life‐saving. A correct diagnosis needs to be made without delay, a fact which places great demands on the doctor—often not a surgeon—who is first consulted by the patient. The differential diagnosis and emergency management are discussed here against the background of the course of events in four patients with aortic aneurysm who were referred erroneously for admission to a coronary intensive care unit during a 12‐month period. Two of the patients died. The ultrasonographic findings were decisive for the outcome in the two surviving patients and yielded a rapid diagnosis in one further case. Ultrasonography is recommended as the method of first choice for verifying or excluding this condition when it is suspected on clinical

ISSN:0954-6820    

DOI:10.1111/j.1365-2796.1992.tb00609.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

Ninety‐one patients with acute myelogenous leukaemia (AML) aged 17–59 years were treated with a chemotherapy programme which could be completed within 30 weeks for patients who achieved complete remission (CR). Four courses included daunorubicin, cytarabine and thioguanine, while two courses included amsacrine, etoposide and cytarabine.Sixty‐five patients obtained CR (71%), more often in patients below (82%) than above (60%) 40 years of age(P= 0.03). Five patients underwent allogenic bone‐marrow transplantation, and one patient received an autologous bone‐marrow transplant after relapse. Five patients developed central nervous system leukaemia. The overall actuarial 3‐ and 5‐year survival was 29% and 21%, respectively; for patients who obtained CR the corresponding survival rates were 40% and 30%, respectively. Patients below 40 years of age appeared to fare better (5‐year survival 26%) than older patients (5‐year survival 16%). The estimated disease‐free survival rate was 26% at 3 years and 22% at 5 years. The main advantage of this regimen is that results compare favourably with those obtained with other regimens were achieved, without exposing patients to long periods of

ISSN:0954-6820    

DOI:10.1111/j.1365-2796.1992.tb00610.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

Serum immunoreactive interleukin‐6 (ir‐IL‐6) concentration was measured by radioimmunoassay in nine patients with chronic lymphocytic leukaemia (CLL), 16 patients with multiple myeloma (MM), 12 patients with monoclonal gammapathy of undetermined significance (MGUS), 22 patients with primary SjÖgren's syndrome (SS), and in 32 control subjects. Measurable quantities of ir‐IL‐6 were detected in every sample studied. Patients with MGUS and SS had significantly higher serum ir‐IL‐6 (mean ± SD) concentrations (337 ± 92 ng l−1and 299 ± 100 ng l−1, respectively) than controls (92 ± 77 ng l−1) and patients with CLL and MM (120±32 ng l−1and 113±58 ng l−1, respectively). Longitudinal studies of ir‐IL‐6 concentration in a few patients with MM showed a decrease before remission and an increase prior to relapse, but no consistent pattern was detected. In conclusion, we found that serum ir‐IL‐6 levels are higher in patients with benign hypergammaglobulinaemic states than in patients with

ISSN:0954-6820    

DOI:10.1111/j.1365-2796.1992.tb00611.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY