ISSN:0954-6820    

DOI:10.1111/j.1365-2796.1993.tb00774.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.tb00775.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

Abstract.Objectives. The purpose of the study was to evaluate the effect of transdermal 17β‐oestradiol with oral progestogen on the plasma levels of lipids, lipoproteins and apolipoproteins in hypercholesterolaemic postmenopausal women.Design. During 6 months of replacement therapy with transdermal 17β‐oestradiol combined with oral progestogen, plasma lipids, lipoproteins and apolipoproteins after 3 and 6 months were measured and compared with pretreatment values by Student'st‐test.Setting. From January 1992 until September 1992 patients were diagnosed and treated in an outpatient clinic of the Department of Endocrinology Medical Centre for Postgraduate Education, Warsaw.Subjects. The patients studied were 11 non‐obese postmenopausal women with hypercholesterolaemia based on the World Health Organization criteria.Interventions. Venous blood samples were obtained before and 3 and 6 months after the beginning of cyclic replacement therapy with transdermal 17β‐oestradiol (E2 100 μg day−1combined with oral chlormadinone acetate (2 mg day−1for 7 days in each cycle).Main outcome measures. The antiatherogenic effect of transdermal oestrogen replacement therapy exerted by increased levels of high‐density lipoprotein sub‐fraction 2 cholesterol (HDL2‐C) leading to the decrease of the total cholesterol level was anticipated.Results. After 6 months of the treatment the concentrations of HDL2cholesterol (HDL2‐C) increased from 0.45 ± 0.07 mmol l−1to 0.73 ± 0.03 mol l−1(P<0.05) but the levels of HDL3cholesterol (HDL3‐C) decreased from 1.15 ± 0.06 mmol l−1to 0.89 ± 0.07 mmol l−1(P<0.05). The concentrations of total cholesterol decreased from 6.9 ± 0.13 mmol l−1to 6.2 ± 0.2 mmol l−1(P<0.05). No changes were observed in the plasma levels of total triglycerides, HDL cholesterol, low‐density lipoprotein (LDL) cholesterol, very‐low‐density lipoprotein (VLDL) cholesterol, VLDL triglycerides, apolipoproteins A‐I and B.Conclusions. In hypercholesterolaemic postmenopausal women, transdermally administered 17β‐oestradiol 100 μg daily in combination with oral chlormadinone acetate has a beneficial effect through raising the level of the antiatherogenic HDL2‐

ISSN:0954-6820    

DOI:10.1111/j.1365-2796.1993.tb00776.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

Abstract.Objectives. To compare lipoprotein(a) [Lp(a)] and albumin concentrations in patients with chronic renal disease receiving different forms of treatment and to determine, if any, the relationship between these variables.Design. A prospective cross‐sectional, case‐controlled study.Setting. A tertiary referral nephrology and dialysis unit.Subjects. Forty‐four consecutive non‐diabetic patients with chronic renal failure treated by renal transplantation (n= 18), haemodialysis (n= 18), continuous ambulatory peritoneal dialysis (CAPD;n= 8), and 30 healthy controls from subjects drawn from University personnel were studied.Interventions. Fasting morning venous blood was analysed for Lp(a), albumin, total cholesterol and glucose concentrations.Main outcome measures. Comparison of plasma levels of these variables between the sub‐groups.Results. Concentrations (median; 95% CI) of Lp(a) were significantly (P<0.05) higher (38.4 mg dl−1; range 15.4–72.0) and of albumin lower (31.6 g l−1; range 28–35.2) in the CAPD group compared with both control subjects and other groups of chronic renal disease patients.Conclusions. The elevated Lp(a) concentrations seen only in association with reduced albumin concentrations in CAPD patients suggest a regulatory role for albumin with albumin losses stimulating pr

ISSN:0954-6820    

DOI:10.1111/j.1365-2796.1993.tb00777.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

Abstract.Objectives. To evaluate the clinical course in patients with clinically suspected deep venous thrombosis (DVT) of the leg and a normal venogram.Design. Prospective study over 15 months with a follow‐up of 4–12 (median 8.6) months after a normal venogram. A questionnaire survey was performed at follow‐up. Information from general practitioners and medical records was reviewed. An alternative diagnosis was established at presentation and at the time of follow‐up.Setting. The Department of Internal Medicine in a Danish university hospital.Subjects. A total of 133 consecutive out‐patients referred with clinical suspicion of DVT and a normal venogram.Main outcome measures. The state of symptoms at follow‐up. The frequency of referrals to hospitals and contacts with general practitioners or medical specialists in the follow‐up period. Clinical diagnoses provided at presentation and at follow‐up.Results. The follow‐up response rate was 78% (n= 104). The symptoms were still present at follow‐up in 53 (51%) patients. More than half of the patients had been referred to medical facilities for the same disorder. Diagnoses could be established in 93 (70%) of the 133 patients at presentation and in 119 (89%) at follow‐up.Conclusions. The majority of patients with clinical signs and symptoms of a DVT and a normal venogram may require a follow‐up surveillance programme to ensure correct diagnosis and adequate treatment. Further studies are recommended to confirm our results and to assess

ISSN:0954-6820    

DOI:10.1111/j.1365-2796.1993.tb00778.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

Abstract.Objectives. To investigate the relationship between the pituitary‐adrenocortical function, abdominal obesity, and insulin resistance syndrome.Design. A prospective study.Setting. Helsinki University Hospital, Finland.Subjects. Sixty‐six healthy males aged 30–55 years.Main outcome measures. Insulin, C‐peptide, Cortisol and ACTH responses during the oral glucose tolerance test (OGTT), and the Cortisol response to dexamethasone suppression and intravenous adreno‐corticotrophic hormone (ACTH) stimulation.Results. The subjects in the highest tertile of the waist‐to‐hip ratio (WHR) had lower high‐density lipoprotein cholesterol (HDLC) (P<0.05), but higher triglyceride (TG), insulin, and C‐peptide levels, ACTH response to glucose at 2 h, and Cortisol response to ACTH (P<0.01) than those in the lowest tertile. The Cortisol response to ACTH correlated positively, but Cortisol levels during the OGTT correlated negatively with WHR. The ratio of these Cortisol determinations correlated positively with the body‐mass index (BMI) (r= 0.554;P<0.001), WHR (r= 0.536;P<0.001), TG (r= 0.397;P= 0.001), fasting insulin (r= 0.534;P<0.001) and C‐peptide (r= 0.458;P<0.001), and negatively with HDLC (r= 0.353;P= 0.004). In multiple regression analyses, BMI and the 2‐h ACTH response to glucose were significant predictors of WHR and, in addition, the Cortisol ratio, WHR, and BMI of insulin.Conclusions. Abdominal obesity may be associated with subtle central adrenal insufficiency, which might also affect insulin and

ISSN:0954-6820    

DOI:10.1111/j.1365-2796.1993.tb00779.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

Abstract.Objectives. To evaluate lipids and lipoproteins as risk factors for coronary heart disease (CHD) in older men with non‐insulin‐dependent diabetes (NIDDM) or abnormal glucose tolerance compared with normoglycaemic men.Design. A prospective, population‐based cohort study based on the lipoprotein examination (1970–72) of the Honolulu Heart Program. Follow‐up was through to December 1988.Setting. Honolulu, Hawaii.Subjects. Japanese‐American men, ages 51–72 at baseline: 2042 with 1 h glucose<12.5 mmol l−1(normal group); 376 on oral hypoglycaemic agents or with 1 h glucose ≥ 12.5 mmol l−1after 50 g oral glucose challenge (abnormal glucose tolerance group). None had prevalent coronary heart disease (CHD) or stroke at baseline.Main outcome measures. Incident CHD: definite nonfatal myocardial infarction (MI) or fatal CHD.Results. There were 221 incident cases in the normal group, and 65 in the abnormal glucose tolerance group. Total and high‐density lipoprotein (HDL) cholesterol were significant predictors of incident CHD in men with NIDDM or abnormal glucose tolerance after controlling for age, body‐mass index, systolic blood pressure, pack‐years of cigarettes and alcohol consumption (P<0.05). Total, low‐density lipoprotein (LDL) and very‐low‐density lipoprotein (VLDL) cholesterol were significant predictors in normal men, and HDL cholesterol was of borderline significance.Conclusions. Abnormal lipids and lipoproteins are significant, independent predictors of CHD in subjects with NIDDM or abnormal glucose tolerance. Attention to lipid and lipoproteins as CHD risk factors should be part of clinic

ISSN:0954-6820    

DOI:10.1111/j.1365-2796.1993.tb00780.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

Abstract.Objective. Immunoadsorption (IMA) and dextran sulfate adsorption (DSA) are two methods for selective extracorporeal elimination of low‐density lipoproteins which are known as LDL apheresis. Their influence on haemostasis until now is widely unknown.Design. The effects of both LDL apheresis procedures on the coagulation and fibrinolytic systems were compared amongst five patients treated with IMA and four patients who received a DSA therapy.Subjects. All patients with severe heterozygous familial hypercholesterolaemia were participants in a long‐term LDL apheresis programme with treatments every 1–2 weeks.Intervention. Combined anticoagulation with heparin and citrate in IMA, and also heparin exclusively in DSA were used for the extracorporeal circulation.Measures. Blood samples were taken immediately before and after a single LDL apheresis and five times during the weekly interval until the next therapy.Results. DSA had a significantly greater effect on standard clotting tests than IMA at the end of plasma therapy despite identical dosages of heparin. DSA caused a considerable reduction of the coagulation factors V, VIII:C, vWF:Ag, XI, XII, and prekallikrein by 48–99% at the end of apheresis treatment whereas only factor VIII:C showed a marked decrease of 72% after IMA. All abnormalities of the global coagulation tests and of most clotting factors were restored 1 day after treatment in both procedures followed by a moderate rebound phenomenon of single coagulation factors during the next few days in IMA‐treated patients.Conclusion. DSA exerts a more profound effect on the coagulation system than IMA by a substantial co‐elimination of various clotting factors in addition to the desired removal of atherogenic l

ISSN:0954-6820    

DOI:10.1111/j.1365-2796.1993.tb00781.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

Abstract.Objectives. To investigate the effectiveness of liposuction as treatment for lipohypertrophy in insulin‐treated diabetic patients.Design. Open clinical study.Setting. Norwegian National Hospital, Oslo.Subjects. Five consecutive diabetic patients operated on for insulin‐induced lipohypertrophy.Interventions. Syringe‐assisted liposuction under local anaesthesia.Main outcome measures. Change in contours assessed by pre‐ and postoperative photographs, and by the patients' and surgeon's evaluations according to a four‐point graded scale.Results. Good or excellent results were obtained in all patients. Small surface irregularities were seen in two patients who had large volumes of fat removed from the proximal anterior thighs. Apart from this no side‐effects or complications occurred.Conclusions. Insulin‐induced lipohypertrophy (‘insulin tumours’) can be treated successfully

ISSN:0954-6820    

DOI:10.1111/j.1365-2796.1993.tb00782.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

Abstract.Objectives. The main purpose of the study was to assess a possible association between haematocrit (Hct) and long‐term cardiovascular disease (CVD) mortality.Design. An extensive examination programme was carried out in 2014 men, defined as apparently healthy, during the period 1972 to 1975, including Hct measurements in a 25% random subsample. Sequential, cause‐specific mortality was followed prospectively over a period of 16 years.Setting. The survey was conducted at Medical Department B, Rikshospitalet, Oslo, Norway.Subjects. The participants represented 86% of all eligible apparently healthy men working in five preselected companies in Oslo.Interventions. No intervention was given by the study group during follow‐up.Main outcome measures. Complete, cause‐specific mortality figures after 8–16 years were obtained from the Norwegian Central Bureau of Statistics.Results. Hct measures were obtained in 488 men (24.2%). Mean Hct was 47.2% (sd2.9%). After correcting for differences in age, plasma cholesterol, systolic blood pressure, erythrocyte sedimentation rate and smoking habits (Cox proportional hazards model), an increase in Hct by 2 SDS was associated with an increase in CVD mortality by a factor ranging between 2.9 at 10, and 1.9 at 16 years (P<0.05). A similar increased risk was observed earlier during follow‐up but the number of deaths was too small for meaningful statistical analysis. No association was found between Hct and non‐CVD mortality.Conclusions. Our data show that increased Hct is associated with an increased risk of dying from CVD—independent of conventional C

ISSN:0954-6820    

DOI:10.1111/j.1365-2796.1993.tb00783.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY