ISSN:0954-6820    

DOI:10.1046/j.1365-2796.1996.362687000.x

出版商:Blackwell Science Ltd    

年代:1996

数据来源: WILEY

摘要:

It is well known that dietary protein restriction can delay the appearance of uraemic symptoms and give symptomatic relief in patients with chronic renal failure. During the last decade, several investigators have argued that protein restriction instituted at an early phase in renal disease may influence the rate of progression of renal failure favourably. Animal experiments have given strong evidence that, in the case of nephron loss, high dietary protein promotes further loss of renal function. Many studies have been conducted to investigate the possible favourable effect of a protein‐restricted diet in patients with renal disease. However, the scientific proof that long‐term protein restriction delays the progression of chronic renal insufficiency in man is still miss

ISSN:0954-6820    

DOI:10.1046/j.1365-2796.1996.352739000.x

出版商:Blackwell Science Ltd    

年代:1996

数据来源: WILEY

摘要:

Normal women produce small amounts of active androgens. When androgen levels are elevated, such as for example in the polycystic ovary syndrome, this is followed by the development of male physical characteristics of muscle mass, structure and function as well as android adipose tissue distribution and function. Psychological features and stress reactions also seem similar to those of men. Such women have an increased risk of developing hypertension, non‐insulin‐dependent diabetes mellitus and cardiovascular disease. Recent data have shown that these physical, and psychological characteristics, as well as risk of ill health, are also found in the population of women selected at random. Women in the lowest quintiles of levels of sex‐hormone‐binding globulin – an indicator inversely related to active androgens – are at risk of developing hypertension, non‐insulin‐dependent diabetes mellitus and cardiovascular mortality. The mechanism probably includes muscular insulin resistance, following a relative androgen excess.It is thus apparent that androgens, even within the highest levels of the nonselected population of women, are powerful predictors of serious disease development. The population at risk might be as large as about 20% of middle‐aged women. This is an area of female disease risk which requires more attention in screening and inter

ISSN:0954-6820    

DOI:10.1046/j.1365-2796.1996.364690000.x

出版商:Blackwell Science Ltd    

年代:1996

数据来源: WILEY

摘要:

Objectives.Low concentrations of alpha tocopherol are claimed to be associated with an increased prevalence of coronary heart disease. This study was undertaken to see whether measurements of serum tocopherol concentrations can contribute to discrimination between subjects with and without coronary heart disease.Setting.All patients had been referred to the department of cardiology of the University Hospital in Uppsala, Sweden.Subjects.Male patients (n=69) below 60 years of age with coronary heart disease (CHD) and healthy age‐matched reference subjects (n=138) were compared.Results.Lipid‐corrected alpha tocopherol concentrations did not differ significantly between the groups, but the CHD group had a lower mean concentration of gamma tocopherol and a higher alpha/gamma ratio. In a stepwise logistic regression analysis, the LDL/HDL ratio was the best independent discriminator between the groups, followed by the proportion of palmitic acid in the cholesterol esters and the alpha/gamma tocopherol ratio.Conclusions.The lower gamma tocopherol concentration and the high ratio between alpha and gamma tocopherol in the CHD group indicate a difference in antioxidative status between CHD patients and healthy subjects. The lipid‐lowering treatment of these CHD patients is far from op

ISSN:0954-6820    

DOI:10.1046/j.1365-2796.1996.410753000.x

出版商:Blackwell Science Ltd    

年代:1996

数据来源: WILEY

摘要:

Objectives.To study clinical and laboratory manifestations of hereditary angio‐oedema (HAE).Subjects.Thirty‐three affected members of a kindred of 63.Results.Oedematous attacks in the skin, mucous membranes and gastrointestinal tract with fluid displacement were elicited by mental and physical stress, minor traumas, dental and surgical procedures, eruption of teeth, tonsillitis, pregnancies, and use of oestrogen‐containing pills including menopausal substitution. Every adult woman with symptomatic HAE (n=11) showed symptoms of urinary tract infections in conjunction with the attacks (P= 0.010), and also experienced more spontaneous abortions or premature labours (P=0.037) than healthy relatives. Patients with HAE of both sexes more frequently reported heartburn or peptic ulcers (P=0.002). Rheumatic complaints were reported by 53% of HAE patients and 12% of their unaffected relatives (P=0.013), but biochemical screening for 18 autoantibodies and quantitation of immunoglobulins did not reveal statistically significant differences between the two groups. C3, prekallikrein, total kininogen, high molecular weight kininogen (HK), alpha‐2‐macroglobulin and factor XII were not significantly different in HAE patients. In contrast, levels of C1‐INH and C4 were depressed and cleaved HK increased in patients compared to unaffected relatives.Conclusions.HAE manifests in a variety of ways, and may influence risk of spontaneous abortions and prema

ISSN:0954-6820    

DOI:10.1046/j.1365-2796.1996.418764000.x

出版商:Blackwell Science Ltd    

年代:1996

数据来源: WILEY

摘要:

Objectives.To explore the relationships between vitamin D intake, serum parathyroid hormone (PTH) and 25‐hydroxyvitamin D (250HD) concentrations, and bone mineral density (BMD) in inflammatory bowel disease (IBD).Setting.A university hospital clinic in Finland.Subjects.One hundred and fifty randomly selected patients with IBD from the hospital register and 73 healthy controls.Measurements.BMD of the lumbar spine and the proximal femur was measured with dual energy X‐ray absorptiometry. Vitamin D intake and serum levels of 250HD and PTH were determined.Results.The IBD patients had a lower serum 250HD concentration (28.4 [SD 12.0] nmol L‐1) than the controls (36.1 [16.7] nmol L‐1;P=0.001), whereas no differences in the vitamin D intake or the serum PTH levels were found. The serum 250HD concentrations and the vitamin D intake of the patients with ulcerative colitis (n=67) were similar to those of the Crohn's disease patients (n=76). The patients with Crohn's disease of the small bowel had slightly, but not significantly, lower serum 250HD concentrations (25.6 [11.0] nmol L‐1) than the other Crohn's disease patients (31.4 [14.3] nmol L‐1;P=0.061). In the IBD patients, the vitamin D intake and the serum 250HD and PTH concentrations were not associated with BMD.Conclusions.Patients with IBD have lower serum levels of 250HD than healthy controls, but similar serum PTH concentrations and vitamin D intake. Vitamin D intake, and the serum levels of 250HD and PTH are not associated with BMD, and malabsorption is unlikely to be a major factor in the aetiology of bone loss in unselected I

ISSN:0954-6820    

DOI:10.1046/j.1365-2796.1996.420765000.x

出版商:Blackwell Science Ltd    

年代:1996

数据来源: WILEY

摘要:

Objective.To examine the role of autoimmunity in the development of autonomic neuropathy in diabetes mellitus.Design.Retrospective cross‐sectional study.Setting.The Department of Medicine, University Hospital, Uppsala, and the Department of Endocrinology, University of Lund, Malmö General Hospital, Malmö, Sweden.Subjects and main outcome measures.We examined 135 patients with type 1 (n=96) or type 2 (n=39) diabetes mellitus. Tests for cardiovascular autonomic functions were performed, and patient sera were analysed for the presence of autoantibodies against the adrenal medulla by indirect immunofluorescence, Western blot and immunoprecipitation techniques.Results.Sera from 13% (12/96) of the type 1 and 20% (8/39) of the type 2 patients showed a positive cytoplasmic immunofluorescence (IF) staining of the adrenal medullary cells, as did 20% (30/151) of sera from healthy controls. Fifty‐eight and 64% of type 1 and type 2 patients, respectively, had cardiovascular autonomic neuropathy, but no correlation between autonomic neuropathy and positive IF against the adrenal medulla was observed, with the exception of significant drops in diastolic blood pressure 8 min after tilt (P<0.005) in type 1 patients. The various IF‐positive sera reacted with several different proteins when analysed with Western blot technique using a total homogenate of the bovine adrenal medulla. These did not correspond to any of the proteins involved in the synthesis or storage of catecholamines which were considered as putative autoantigens.Conclusion.The finding of similar frequencies of immunoglobulins binding to adrenal medulla in both type 1 and 2 diabetic patients as well as in normal controls, argues against a role of anti‐adrenomedullary antibodies in the pathogenesis of autonomic diabetic n

ISSN:0954-6820    

DOI:10.1046/j.1365-2796.1996.423766000.x

出版商:Blackwell Science Ltd    

年代:1996

数据来源: WILEY

摘要:

Objectives.To investigate whether serum lipids and lipoproteins are correlated to the results of skin vessel reactivity tests.Design.Healthy, non‐smoking individuals of various ages without atopic constitution and medication were selected for the study.Setting.Subjects blood sampled and examined with iontophoresis and a newly developed laser Doppler perfusion imager at Huddinge University Hospital.Subjects.Thirteen men, 20–80 years of age, and 21 women, 18–76 years of age, who fulfilled the inclusion criteria.Main outcome measures.Normalized perfusion values (%) after iontophoresis of acetylcholine (ACh), nitroprusside and isoprenaline. Fasting concentrations of total cholesterol, high‐density lipoprotein cholesterol and triglyceride values.Results.Skin vessel reactivity tests to ACh and isoprenaline, and to a lesser extent, nitroprusside were positively correlated to high‐density lipoprotein cholesterol (HDL‐C) levels (P=0.014, 0.005 and 0.113, respectively), and negatively correlated to both the ratio of total cholesterol/HDL‐C (P=0.029, 0.011, 0.005) and the level of triglycerides (P= 0.045, 0.011, 0.005) in young and middle‐aged women. There was also a negative correlation between isoprenaline and triglycerides (P=0.042) in elderly women. No correlations between serum lipids and lipoproteins and skin vessel reactivity were found in men.Conclusions.The results of the study suggest that serum lipids and lipoproteins, primarily HDL‐C, influence skin vessel reactivity in healthy women. Furthermore, HDL‐C seems to influence the function of the vascular smooth muscle as well

ISSN:0954-6820    

DOI:10.1046/j.1365-2796.1996.424767000.x

出版商:Blackwell Science Ltd    

年代:1996

数据来源: WILEY

摘要:

Objective.This study was undertaken to assess a potential relationship between idiopathic deep venous thrombosis (DVT) and occult cancer.Design.Prospective study with a 2‐year follow‐up.Setting.The Angiology Unit of the First Department of Surgery, University of Athens, Greece, a tertiary referral centre.Subjects.Two hundred and ninety‐three patients with a first episode of venographically or Doppler‐proved DVT were included in the study, of whom 264 were followed up for 2 years.Interventions.After an initial extensive diagnostic workup, including routine blood counts and chemistries, erythrocyte sedimentation rate, CEA levels, chest X‐ray and abdominopelvic CT scan, all patients were closely followed up and periodically examined.Main outcome measures.The incidence of cancer amongst patients with idiopathic and secondary DVT, and the validity of our screening programme.Results.Cancer was diagnosed in 21 out of 84 patients with idiopathic DVT (25%) as compared with eight out of 202 patients with secondary DVT (4%). In 22 out of the 29 cases, cancer was detected during the initial admission, and the remaining seven cases were detected during follow‐up. Cancer was diagnosed in 15 asymptomatic, healthy individuals, but only in seven of them was the diagnosis made by CT scan.Conclusion.Occult cancer is fairly common in patients with idiopathic DVT, but the routine use of extensive diagnostic studies for its detection remains to be validated by further prospect

ISSN:0954-6820    

DOI:10.1046/j.1365-2796.1996.426000.x

出版商:Blackwell Science Ltd    

年代:1996

数据来源: WILEY

摘要:

Objective.To evaluate the natural course of indolent mastocytosis in adults.Design.A retrospective long‐term follow‐up study.Setting.The Department of Endocrinology of a University Hospital.Patients.Sixteen adult patients with a diagnosis of indolent mastocytosis and sufficient biochemical data for statistical analysis. One patient had paediatric‐onset cutaneous mastocytosis, whilst the others had adult‐onset systemic mastocytosis. Ages at the end of follow‐up ranged from 23 to 79, median 50 years. Follow‐up periods per patient lasted from 13 to 135 months, median 90 months.Measurements.Urinary excretions of the histamine metabolites Nτ‐methylhistamine (MH) and Nτ‐methylimidazoleacetic acid (MIMA), and signs and symptoms of the disease.Results.The excretion of MH but not MIMA increased in four patients (ages 37, 45, 61 and 65 years) and decreased in two patients (ages 26 and 48 years), including the only patient with paediatric‐onset cutaneous mastocytosis. The excretion of MIMA but not MH increased in none and decreased in one patients (age 51 years). The excretions of both MH and MIMA increased in one patient (age 23 years) and decreased in two patients (ages 65 and 79 years). The excretion of MH and MIMA can be considered to have been stable in one patient (age 49 years). In the five remaining patients, observation periods were rather short. A definite judgement on the course of their disease could not be given. In the two patients in whom the excretion of both MH and MIMA decreased, the enlarged spleen decreased in size, whilst in the other patients, signs and symptoms did not change. There were no accompanying myeloproliferative disorders in any patient. No special treatment aiming at a reduction in mast cell load has been given. Rates of change over the whole follow‐up period ranged from ‐8.4 to +25.1% per year.Conclusion.The natural course of indolent adult‐onset mastocytosis is not always progressive. Our data show that the activity of adult‐onset indolent mastocytosis, as measured by urinary excretion of MH and MIMA and clinical signs and symptoms, can substantially decline, e

ISSN:0954-6820    

DOI:10.1046/j.1365-2796.1996.440787000.x

出版商:Blackwell Science Ltd    

年代:1996

数据来源: WILEY