ISSN:0954-6820    

DOI:10.1111/j.1365-2796.1992.tb00587.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

Hyponatraemia (HN) can result from a wide range of mechanisms, and therapy must be individualized. Two theories of the origin of HN in acute brain disease have prevailed. The first is the cerebral salt wasting syndrome (CSWS), where excessive natriuresis caused by some unknown cerebral natriuretic factor lowers the total sodium pool of the body and hence the plasma concentration. The second theory is the syndrome of inappropriate secretion of antidiuretic hormone (SIADH), where an increase in total body water is caused by unphysiological secretion of ADH, lowering the concentration of sodium in the plasma. A third possibility is ‘sodium shift’, i.e. a displacement of sodium from the extracellular to the intracellular space with a simultaneous movement of potassium in the opposite direction. The morbidity and mortality associated with HN only arise in cases where the rate of development of HN was 0.5 mmol h−1or more. Symptoms respond promptly when the HN is quickly corrected with furosemide and 3% sodium chl

ISSN:0954-6820    

DOI:10.1111/j.1365-2796.1992.tb00588.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

A simple algorithm, which improves the diagnostic performance in patients arriving with acute chest pain in the emergency room, has been developed. The algorithm is solely based on information immediately available to the physician and includes elements from ECG, clinical findings and case history. As postulated, a stepwise use of all these variables improved the diagnostic accuracy and reduced the false positive cardiac‐care unit (CCU) referral rate in a prospective study of 1450 patients admitted with acute chest pain. Compared to previous hospital practice during a preceding control period, sensitivity in diagnosing patients with unstable ischaemic heart diseases increased from 86% to 94% (P<0.01), and specificity increased from 44% to 56% (P<0.001). Accordingly, accuracy increased from 67% to 81% (P<0.001), and false positive CCU‐admission rate decreased from 35% to 19%. The greatest improvement in physician's diagnostic decisions was observed among patients without clear‐cut signs of acute ischaemic heart disease on admi

ISSN:0954-6820    

DOI:10.1111/j.1365-2796.1992.tb00589.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

A detailed dietary history interview of 70‐ to 89‐year‐old men, 98 from eastern and 129 from western Finland, was obtained as part of a 30‐year follow‐up survey within the Seven Countries Study. The average energy intake was similar in level, about 2700 kcal, in both areas. The percentage of total energy intake from fat was 39.1 % in the west, and 36.5% in the east. The P/S ratio was about the same, 0.27 and 0.29, in eastern and western areas, respectively. The intake of most micronutrients was similar in the two cohorts. Only the intake of vitamins A and C and phosphorus, manganese, copper and zinc was higher in eastern Finland than in western Finland. The nutritional density of the diet of the eastern cohort was slightly higher than that of the western one due to their higher consumption of rye products, vegetables and berries, and also sour milk and fish and fish products. The diet met the general recommendations and was comparable to that of younger a

ISSN:0954-6820    

DOI:10.1111/j.1365-2796.1992.tb00590.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

Ten male patients with familial combined hyperlipidaemia (FCHL) were studied with regard to LDL metabolism and composition. The FCHL patients had higher LDL levels than healthy controls (5.4 ± 1.4 vs. 3.7 ± 0.7 mmol l−1;P<0.005) and a higher rate of production of the lipoprotein (15.8 ± 3.1 mg kg−1d−1in FCHL vs. 13.1 ± 1.8 mg kg−1d−1in the normals;P<0.005). The fractional catabolic rate of LDL was low‐normal in the FCHL patients, with a high level of interindividual variation. The actual individual LDL cholesterol level within the FCHL patient group appeared to be more closely associated with the LDL apoB FCR value than the rate of production of the particle. Analysis of the LDL particles from FCHL patients revealed a relative enrichment in triglycerides, while the cholesterol content of the lipoprotein was normal. Institution of acipimox therapy in 8 patients reversed the high rate of synthesis of LDL (15.2 ± 3.5 mg kg−1d−1) to a more normal level (13.9 ± 4.0 mg kg−1d−1;P= 0.08), while the FCR did not change significantly. In conclusion, patients with FCHL show an apparent overproduction of LDL apoB, while the actual degree of LDL elevation appears to be dependent on the clearance capacity of the lipoprotein, measured as LDL apoB FCR. The overproduction defect of LDL apoB can, at least in part, be managed by treatment with the nicotin

ISSN:0954-6820    

DOI:10.1111/j.1365-2796.1992.tb00591.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

In order to determine whether permanent echo abnormalities are produced by subacute thyroiditis, ultrasound examination of the thyroid was performed repeatedly after a mean interval of 23 months in 17 subjects (8 women and 9 men) aged 31–52 (mean 41) years, suffering from subacute thyroiditis. The diagnosis was based on typical clinical symptoms, and cytological confirmation was obtained in all subjects but one. In the primary phase the ultrasonic finding was in all cases abnormal, showing either diffuse or focal hypoechogenicity and enlargement of thyroid lobes. At follow‐up, a homogenous echo structure was found in 15 patients. Nodularity was detected in only two subjects. It is concluded that permanent focal echo abnormalities are generally not produced by subacute thyroiditis. Consequently, thyroid nodules in subjects with a history of SAT should not be igno

ISSN:0954-6820    

DOI:10.1111/j.1365-2796.1992.tb00592.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

Health hazards associated with the use of smokeless tobacco were evaluated in a cross‐sectional study of 97 586 Swedish construction workers undergoing health examinations in 1971–74. All users of smokeless tobacco only (5014 subjects) and all exclusive smokers of ≥ 15 cigarettes daily (8823 subjects) were compared with all non‐users of any tobacco (23 885). Both smokeless tobacco users and smokers showed higher prevalences of circulatory and respiratory disorders. Hypertension was most common in smokeless tobacco users. In the 45‐ to 56‐years age group, the odds ratio for a diastolic blood pressure of>90 mmHg was 1.8 (95% CI, 1.5–2.1), and for a systolic blood pressure>160 mmHg, 1.7 (95% CI, 1.3–2.1). Smokers showed the lowest prevalence of hypertension. Disability pensions due to cardiovascular disease were nearly 50% more frequent in both smokeless tobacco users and smokers. These findings indicate that an increased cardiovascular risk is also associated with the use of sm

ISSN:0954-6820    

DOI:10.1111/j.1365-2796.1992.tb00593.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

Changes in both calcium and insulin metabolism have been described in essential hypertension. Low levels of plasma ionized calcium (Ca2+) and high levels of insulin have previously been associated with vascular complications and coronary heart disease. In the present study, indices of calcium metabolism and fasting serum insulin were related to electrocardiographic (ECG) variables in 58 patients with untreated hypertension. Fasting insulin was found to be related to heart rate (r= 0.47,P<0.001), diastolic interval (r= −0.39,P<0.004) and electrical axis (r= −0.29,P<0.03) while Ca2+was found to be correlated with the QRS amplitude (r= −0.32,P<0.03) and diastolic interval (r= 0.37,P<0.02). Furthermore, non‐ionized serum calcium was correlated with the QRS duration (r= 0.36,P<0.02), ST‐segment interval (r= −0.49,P<0.002) and QT interval (QoT,r= −0.42,P<0.008). These correlations were still significant when the influences of age, sex, obesity, blood pressure and heart rate were taken into account in the multiple regression analysis. In conclusion, the present study demonstrates that calcium and insulin metabolism are related to several basic characteristic functions of the heart, such as the systolic and diastolic function, as well as to signs of left ventricula

ISSN:0954-6820    

DOI:10.1111/j.1365-2796.1992.tb00594.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

Measurements of regional body fat distribution as determined by waist‐to‐hip ratio and visceral‐to‐subcutaneous adipose tissue ratio were compared in 63 obese women. Subjects were divided into three CT‐evaluated tertiles on the basis of visceral‐to‐subcutaneous adipose tissue ratio (group I, 0.05–0.231; group II, 0.232–0.344; group III, 0.345–0.781). The three groups showed no appreciable differences in body weight. body mass index or total abdominal adipose tissue. Waist‐to‐hip ratio values were significantly lower in group I than in groups II and III. There was no statistically significant difference between groups II and III. Visceral abdominal adipose tissue was significantly and progressively higher in the three groups. Subcutaneous abdominal adipose tissue was significantly lower in group III than in group I. All metabolic variables and systolic and diastolic blood pressure were higher when visceral‐to‐subcutaneous adipose tissue ratio cut‐off values were increased. Waist‐to‐hip ratio was significantly correlated with total adipose tissue, body mass index, visceral abdominal adipose tissue and subcutaneous abdominal adipose tissue. Visceral‐to‐subcutaneous adipose tissue ratio was correlated with visceral abdominal adipose tissue (r= 0.84,P<0.01) and subcutaneous abdominal adipose tissue (r= −0.28,P<0.05). There was no correlation between visceral‐to‐subcutaneous adipose tissue ratio and body mass index or total abdominal adipose tissue. Visceral‐to‐subcutaneous adipose correlated more closely with metabolic variables than did waist‐to‐hip ratio. Partial correlations between waist‐to‐hip ratio and visceral‐to‐subcutaneous adipose tissue ratio and metabolic variables, adjusted for body mass index, showed statistically significant relationships for visceral‐to‐subcutaneous adipose tissue ratio, but not for waist‐to‐hip ratio. Visceral‐to‐subcutaneous adipose tissue ratio correlated with waist‐to‐hip ratio in the study population as a whole, but only in group I did the correlation between visceral‐to‐subcutaneous adipose tissue ratio and waist‐to‐hip ratio prove statistically significant. The present study demonstrates that visceral‐to‐subcutaneous

ISSN:0954-6820    

DOI:10.1111/j.1365-2796.1992.tb00595.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

Lipoprotein(a) [Lp(a)], which combines structural elements of the lipid and fibrinolytic systems, is a major independent risk factor for the development of coronary heart disease. Eighty‐four consecutive patients with peripheral vascular disease (of whom 42 had concomitant ischaemic heart disease) and 43 healthy controls were enrolled in a case‐control study. We found that the mean Lp(a) concentration in male patients with peripheral vascular disease (PVD) was almost threefold higher than that of controls, while in female patients the Lp(a) concentration was more than twice that of controls. This marked difference was borne out in patients with and without concomitant ischaemic heart disease (IHD). A multivariate logistic regression analysis indicated that Lp(a) is independently associated with PVD when adjusted for age and sex (odds ratio per 100 mg l−1increase in Lp(a) = 1.35;P<0.01). A similar association is observed for patients with concomitant IHD (odds ratio per 100 mg l−1increase in Lp(a) = 1.65;

ISSN:0954-6820    

DOI:10.1111/j.1365-2796.1992.tb00596.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY