ISSN:0954-6820    

DOI:10.1111/j.1365-2796.1995.tb00893.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

ISSN:0954-6820    

DOI:10.1111/j.1365-2796.1995.tb00894.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

Abstract.The standard risk factors ‐ dyslipidaemia, hypertension and smoking ‐ provide little help in explaining the raised cardiovascular risk in diabetes. It can be calculated that intervening for disturbances of these risk factors could do little to rectify the loss of life expectancy of around 10 years for a middle‐aged diabetic man. Three new risk factors are discussed, which together may contribute to some of the excess cardiovascular risk in diabetes. Plasminogen activator inhibitor is an inhibitor of fibrinolysis which is elevated in concentration in diabetic subjects, and may increase both the incidence of thrombotic events and the risk of reinfarction after the initial infarct. Recent work also suggests that high activity of this substance may impair pharmacological fibrinolysis. Proinsulin‐like molecules are elevated in concentration in diabetic patients and correlate with levels of a number of other risk factors. Whilst these correlations may represent cause and effect for plasminogen activator inhibitor, there is no evidence that changes in levels of proinsulin‐like molecules influence levels of other risk factors. Microalbuminuria provides a powerful indicator of cardiovascular risk in both diabetic and non‐diabetic subjects, but whilst the mechanisms for this association are unclear, they are again unlikely to be mediated through changes in levels of standard risk factors. Recent observations of an association between short stature and microalbuminuria suggest that intrauterine or early infant nutrition may represent a common antecedent, these having also been shown to predict both components of the insulin resistance syndrome and cardiovascular disease in

ISSN:0954-6820    

DOI:10.1111/j.1365-2796.1995.tb00895.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

Abstract.Objectives.The majority of post‐thrombotic women are barred from using oral contraceptives. We evaluated this policy for its clinical relevance.Design.A meta‐analysis of controlled studies between 1960 and 1993.Setting.A Medline computer search, from 1966 to 1993, in multiple languages, with the following index terms: thrombosis, thrombopheblitis, vein, venous, pulmonary embolism, contraceptives, oestrogen, oral.Study selection.A total of 588 articles or abstracts were reviewed for controlled studies, in which an index group was compared with a control group. Included were one randomized trial, six follow‐up studies and eight case‐control studies.Main outcome measures.Summary thrombosis risk for oral contraceptive users, number needed to discontinue oral contraceptives to prevent one (recurrent) thrombosis, comparison of additional unwanted pregnancies and postpartum thrombosis between alternative birth‐control methods.Results.The studies proved highly heterogeneous with regard to size and direction of the risk estimate. The summary relative risk of first thrombosis during oral contraceptive use was 2.9 (95% CI, 0.5–17). Since the risk of thrombosis recurrence is not well known, we estimated alternatives, making various hypothetical assumptions, wherein women would continue to take oral contraceptives after a first episode of thrombosis, or stop and switch to use of an intra‐uterine device, condom or the progestogen‐ only pill. Depending on the assumptions with regard to recurrence risk and the existence of possible subgroups with genetic coagulation defects, the cost‐ benefit ratio of advising against the use of oral contraceptives after a first thrombosis varied tremendously.Conclusions.Our analysis shows that we lack the necessary data for recurrence risk of venous thrombosis during continuing use of oral contraceptives, or after switching to other modes of contraception. This reflects the clinical uncertainties that result in highly contradictory advice to young women who have experienced a first thrombosis. Only follow‐up studies on recurrence risk wi

ISSN:0954-6820    

DOI:10.1111/j.1365-2796.1995.tb00896.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

Abstract.Objectives.To test the efficacy of hormone replacement therapy (HRT) and dietary therapy, compared to dietary therapy, in lowering LDL cholesterol levels among postmenopausal women.Design.A prospective parallel randomized study of sequential 17β‐oestradiol and norethisterone acetate or placebo for 48 weeks.Setting.A University outpatient lipid clinic.Subjects.A total of 76 postmenopausal women, aged 43–60 years, with LDL cholesterol level ≥ 4.2 mmol I−1treated with a lipid‐lowering diet.Main outcome measures.Levels of lipids, lipoproteins, apolipoproteins, fibrinogen and glucose tolerance.Results.Adherence to the diet was similar in both groups. Total and LDL cholesterol levels were reduced by 14% (95% CI, 11–17%) and 19% (95% CI, 14–23%), respectively, in the HRT group vs. 3% (95% CI. 0–7%) and 5% (95% CI, 0–11%) in the diet group. HRT reduced the levels of apolipoprotein B and lipoprotein(a). Levels of HDL cholesterol, HDL2, HDL3, triglycerides, lipoprotein populations and apolipoproteins. AI and AII remained unchanged. No adverse effects on glucose tolerance or on fibrinogen levels were observed. The reduction in LDL cholesterol was positively correlated with initial levels of LDL cholesterol and negatively correlated with body mass index.Conclusions.HRT is effective in reducing elevated LDL cholesterol levels, and should be considered in the treatment of hyperlipidaemic postmenopausal women, in addition

ISSN:0954-6820    

DOI:10.1111/j.1365-2796.1995.tb00897.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

Abstract.Objectives.To investigate left ventricular hypertrophy (LVH) in relation to 24‐h ambulatory blood pressure (24‐ABPM) and insulin levels in borderline hypertension.Design.A case‐control study.Subjects.Borderline hypertensive men (diastolic blood pressure (DBP) 85–94 mmHg,n= 69) and age‐matched normotensive controls (DBP ≤ 80 mmHg.n= 69) from a population screening programme.Main outcome measures.Echocardiography (M‐mode). insulin (RIA) and 24‐APBM (Del Mar P‐IV) levels.Results.The borderline group showed a significant increase in septal thickness (10.4±1.5 vs. 9.7±1.5 mm.P<0.01), peak systolic wall stress (218±38 vs. 202±38 103dynes cm−2,P<0.05) and a decrease in LV ejection time (28.4±2.5 vs. 29.5±2.1s,P<0.01). The septum vs. posterior wall thickness ratio was significantly higher in the borderline group (1.13±0.14 vs. 1.06±0.14,P<0.01). Casual BP levels did not correlate with LVH indices, while 24‐ABPM systolic levels correlated strongly with LVH indices in the borderline group (r= 0.22–0.52,P<0.05) but not in the normotensive group. Insulin levels correlates strongly with LVH indices in the normotensive group (r= 0.34–0.47,P<0.01) but not the borderline, group.Conclusions.Signs of asymmetric LVH and altered ventricular function are already detectable in borderline hypertension. The data also suggest that early structural cardiac changes are related to ambulatory blood pressure profile, but not to casual blood pressure o

ISSN:0954-6820    

DOI:10.1111/j.1365-2796.1995.tb00898.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

Abstract.Objectives. There have been reports on a bleeding tendency in hypothyroidism resembling von Willebrand's disease. The aim of the present study was to investigate whether altered primary haemostasis is a general phenomenon in thyroid disease.Design/setting.A total of 10 patients with hyperthyroidism and nine patients with hypothyroidism were studied at diagnosis, and during treatment with carbimazole or L‐thyroxine. respectively, when euthyroidism had been achieved.Results.In untreated hypothyroidism, template bleeding time was prolonged (median 9.3 min, range 3.8–20.0 min) compared to that in controls (median 4.0 min, range 3.0–6.0 min;P<0.05). whereas maximal agglutination velocity induced by ristocetin was decreased (38% min−1, range 4–52% min−1vs. 70% min−1, range 60–81% min−1,P<0.05). The level of von Willebrand factor antigen in plasma from hypothyroid patients was less than half of the value in hyperthyroid patients. This difference disappeared after euthyroidism was achieved.Conclusions.We found that changed primary haemostasis is a general feature of hypothyroidism, and that it is resolved after levoth

ISSN:0954-6820    

DOI:10.1111/j.1365-2796.1995.tb00899.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

Abstract.Objectives.To investigate the interrelationship between sleep complaints and hypnotics in relation to general health and somatic diseases.Design.An epidemiological survey conducted by means of a questionnaire.Setting.The counties of Västerbotten and Norrbotten in northern Sweden.Subjects.All 10216 members of the Swedish Pensioners' Association.Main outcome measures.Sleep disturbances, health, somatic diseases and hypnotic medication.Results.General ill health, cardiovascular diseases, different painful diseases and increased nocturnal voiding frequency were all associated with poor sleep and increased treatment with hypnotics. Hypnotics were used by 13.5% of the men and 22.3% of the women. Of the men aged<70 years, 7.9% were receiving such treatment, of those aged 70–80 years 14.4% were using hypnotics, and of those aged ≥ 80 years 21.8% were taking hypnotics (P<0.0001). The corresponding frequencies among women were 15.0%, 23.0% and 34.9%, respectively (P<0.0001). Half of all men and women treated with hypnotics in all age groups reported a good night's sleep. Among these both angina pectoris and cardiac arrhythmia were twice as common as among elderly subjects who experienced poor sleep and were receiving treatment with hypnotics.Conclusions.Poor health and different somatic diseases are over‐represented in elderly persons treated with hyp

ISSN:0954-6820    

DOI:10.1111/j.1365-2796.1995.tb00900.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

Abstract.Objectives.To measure blood pressure (BP), plasma endothelin‐1 (ET‐1), atrial natriuretic peptide (ANP), antidiuretic hormone (ADH) and aldosterone (ALDO) concentration, and plasma renin activity (PRA) in patients treated with a low‐dose cyclosporin A (CyA).Design.An open study of patients with rheumatoid arthritis (RA) or palmoplantar pustulosis (PPP).Setting.Out‐patient clinics at the Central Hospital of Jyväskylä and Helsinki University Central Hospital.Subjects.CyA was given to 25 patients with RA and to 10 patients with PPP.Intervention.RA patients were given CyA at a dose of 2.5±0.13 mg kg−1body weight (BW) to 3.47±0.79 mg kg−1BW (mean values±SD) at the start of the study and after 6 months, respectively, and the CyA dose was 2.67±0.13 mg kg−1BW decreasing to 2.07±0.96 mg kg−1(P<0.001) after 4 months in PPP subjects.Results.Systolic (sBP) and diastolic blood pressure (dBP) increased from 127.8±13.6/79.7±8.4 mmHg to 140.0±19.8/83.8±9.7 mmHg during the study (P<0.03). Plasma ET‐1, ANP, ALDO and ADH concentration and PRA did not change during 4 to 6 months of CyA treatment. The plasma ANP concentration was constantly higher in CyA‐treated RA patients (112±87 ng l−1) to 118±78 ng l−1) than in PPP patients (37.3±26 ng l−1to 47.7±39.9 ng l−1;P<0.02). The serum creatinine concentration remained within the normal range, but increased from baseline (76.7±11.9 μmol l−1), to 90±15.4 μmol l−1(P<0.001). The serum magnesium concentration decreased significantly (P<0.005) after 6 months of CyA treatment in RA patients. No correlation was found between serum creatinine and plasma ET‐1 concentration.Conclusions.Increased blood pressure during CyA treatment was independent of circulating ET‐1 levels. A low dose of CyA did not induce increased ET‐1 synthesis as judged from plasma samples. The high plasma ANP level observed in RA patients could be due to fluid retention caused by concomitant treatment with non‐steroid anti‐inflammatory drugs. Fluid retention and decreased magnesium levels could also be involve

ISSN:0954-6820    

DOI:10.1111/j.1365-2796.1995.tb00901.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

Abstract.This report describes the case of a male patient with progressive dysphagia, epigastric pain, odynophagia, generalized weakness and a mid‐oesophagus ulceration in which biopsies showed acid‐fast bacilli and histological evidence of tuberculosis. Culture of the biopsies and the sputum revealed mycobacterium tuberculosis. There were no respiratory symptoms, and radiographs did not reveal evidence of pulmonary tuberculosis. The patient responded well to antituberculous therapy and he is alive and well 7 years later, without any signs of relapse. The involvement of the oesophagus as the only demonstrable localization of tuberculosis is an extremely rare condition, which should always be considered as differential diagnosis in dyspepsia of unknown ori

ISSN:0954-6820    

DOI:10.1111/j.1365-2796.1995.tb00902.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY