ISSN:0954-6820    

DOI:10.1111/j.1365-2796.1993.tb00638.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.tb00639.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

Abstract.Eighty‐three patients, submitted for investigation of the liver due to persistently elevated activities of serum aminotransferases were included in a study in order to compare the relative merits of liver biopsy, ultrasound and radionucleide imaging.From the liver biopsy it was found that 45 patients had fatty liver, 14 had cirrhosis and 11 had chronic inflammation, 3 had haemochromatosis and 10 had unspecific changes or normal findings.An investigation with ultrasound yielded pathological findings in 65% of the patients. The sensitivity was highest in patients with fatty liver (82%) and more than 10% fat in the liver always resulted in increased echogeneicity. Alterations in the liver due to cirrhosis and chronic inflammation were detected with ultrasound in only 50% and 57% of the cases, respectively.Radionucleide imaging was positive in 44% of the patients with fatty liver, 64% of those with cirrhosis and 21% of the patients with chronic inflammation. It was only possible to distinguish fatty liver from cirrhosis in those patients who had an increase in the size of the spleen (four patients).The study demonstrates that in patients with a persistent elevation of serum aminotransferases ultrasound has a high sensitivity for detecting more than 10% fat in the liver. However, both the ultrasound and a liver scintigram had a rather low sensitivity and a very low specificity for making a diagnosis for this group of patients. With the aid of a liver biopsy it was possible to establish a diagnosis in 90% of the patient

ISSN:0954-6820    

DOI:10.1111/j.1365-2796.1993.tb00640.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

Abstract.A group of 41‐year‐old hypertensive men (n =35, blood pressure (BP) 149.9 ± 2.1/ 98.9 ± 1.1 mmHg, mean ± SEM) who had never received treatment for their condition were compared with hypertensive women of the same age (n= 18, BP 155.9 ± 4.3/ 98.1 ± 1.6 mmHg) with comparable body mass index (BMI. 25.9 ± 0.5vs. 24.9 ± 4.5 kg m−2) who, also, had never received treatment. The lipid profile was more atherogenic in the men, with lower HDL cholesterol (1.21 ± 0.04vs. 1.38 ± 0.06 mmol l−1P= 0.04), higher total cholesterol (6.04 ± 0.14 vs. 5.54 ± 0.18 mmol l−1.P= 0.04) and triglycerides (1.80 ± 0.16vs. 0.96 ± 0.10 mmol l−1,P<0.001). The hypertensive men had higher haemoglobin (P<0.001) and haematocrit. Plasma catecholamines were inversely related to BMI in the women only (r= −0.52,P<0.05 for both noradrenaline and adrenaline). Women with BMI above 25 kg m−2had significantly lower arterial plasma adrenaline and noradrenaline than those with BMI below 25 kg m−2(28 ± 5vs. 78 ± 16 pg ml−1,P<0.01 and 101 ± 17 vs. 206 ± 33 pg ml−1,P<0.01 respectively). A negative curvelinear relationship appeared between arterial adrenaline and insulin (r= 0.49,P= 0.05).These results suggest a male propensity for athero‐thrombogenic risk factors in otherwise comparable hypertensive subjects. A close relationship between metabolic risk factors within the normal range seems to exist even in hypertensive women. The decreased sympathetic activity at rest in the obese hypertensive women indicates different pathophysiological mechanism for hypertension in lean and obese. Decreased sympathetic activity and thus reduced energy expenditure, promotes a risk for weight gain, and could explain the inverse rel

ISSN:0954-6820    

DOI:10.1111/j.1365-2796.1993.tb00641.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

Abstract.The aim of this prospective study was to identify alcoholic liver disease or covert alcohol abuse in unselected consecutive patients referred to a gastroenterologic out‐patient's clinic for elevated liver enzymes. One‐hundred‐and‐thirteen patients were questioned about alcohol consumption, trauma history and loss of driver's licence. Laboratory tests claimed to reflect alcohol consumption and liver biopsy were taken. Using data from patients with the highest (26 patients) and lowest (29 patients) stated consumptions, logistic regression analysis identified violence score (trauma score + driver's licence score) and a laboratory index combining MCV, ASAT/ALAT ratio and IgA values as significant independent predictors of alcohol abuse (index = 2.3 × violence score + 1.08 × laboratory index— 3.19). Twenty‐six patients openly admitted alcohol abuse (>300 g week−1) and 85% of these had alcoholic liver damage. The index identified a further 12 patients as abusers who stated an intermediate alcohol consumption (25–300 g week−1). Half of these had alcoholic liver damage. Thus, a total of 34% of the patients were identified as abusers and in one‐third of these

ISSN:0954-6820    

DOI:10.1111/j.1365-2796.1993.tb00642.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

Abstract.The importance of maximalversussubmaximal exercise testing and the significance of heart failure on the prognostic value of exercise‐provoked ST‐segment depression ≥ 0.1 mV was studied in 143 patients recovering from acute myocardial infarction. Patients were exercise tested prior to discharge and follow up lasted for up to 18 months (mean 17 months). End‐point was first major event (i.e. first non‐fatal reinfarction or death). A symptom‐limited exercise test was superior to a heart‐rate‐limited test in detecting ST‐segment depressions (27% vs. 20%;P<0.5), and patients with ST‐segment depression at lower heart rates did not have an increased risk of subsequent events compared with patients with ST‐segment depression at higher heart rates (14%vs. 27%; NS). Heart failure surpassed ST‐segment depression as a risk predictor (34%vs. 18%).Based on a meta‐analysis including 13 studies (1987 patients) exercise‐provoked ST‐segment depression possessed an increased risk of subsequent major events (P<0.0001; risk ratio = 1.90: 95% confidence limits 1.43.2.51).Thus, ST‐segment depression provoked by a symptom‐limited test selects patients with an increased risk of subsequent major events. In patients with a history of heart failure exercise‐provoked ST‐s

ISSN:0954-6820    

DOI:10.1111/j.1365-2796.1993.tb00643.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

Abstract.The present study tested the hypothesis that the increased risk in patients with exercise‐provoked ST‐segment depression recovering from acute myocardial infarction could by abolished by anti‐ischaemic medical intervention. Prior to discharge a symptom‐limited exercise test was carried out. Patients were then double‐blindly randomized to treatment with either verapamil 120 mg t.i.d. or placebo, and observed for up to 18 months (mean 17 months). End‐point was first major event: i.e. non‐fatal reinfarction or death. Two‐hundred‐and‐ninety‐eight patients were included. Forty‐four patients with and 111 without exercise‐induced ischaemia were randomized to verapamil and 39 and 104 respectively, to placebo. The overall number of events was 12.5%. In patients without ST‐segment depression, 12.5% in the placebo group (hazard = 1) and 12.6 % in the verapamil group (hazard = 1.13) had an event (NS). In patients with ST‐segment depression 15.4% in the placebo group (hazard = 1.20) and 9.1% in the verapamil group (hazard = 0.85) had an event (NS). The latter reduction (41%) supports the hypothesis that patients with ST‐segment depression, i.e. residual myocardial ischaemia, are those who benefit from anti‐ischaemic interve

ISSN:0954-6820    

DOI:10.1111/j.1365-2796.1993.tb00644.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.tb00645.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

Abstract.Prospective studies on diet and cancer are needed for five reasons: (i) unlike xenobiotic agents which, if found to be carcinogenic, can at least in principle be dispensed with, food of some kind is indispensable; (ii) our present knowledge on the role of diet in cancer is limited and permits only tentative recommendations; (iii) plausible biological hypotheses for this role are available, as well as biological markers allowing their exploration in epidemiological studies; (iv) these studies demand a prospective approach—a number of prospective studies, each involving several tens of thousands of adults, are now being started in Europe: and (v) diet affects not only cancers but also a spectrum of other diseases, which need to be investigated in parallel, to acquire knowledge on which to base firm recommendations on a diet capable of maximizing benefits and minimizing the risk to healt

ISSN:0954-6820    

DOI:10.1111/j.1365-2796.1993.tb00646.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

Abstract.The Malmö Diet and Cancer study is a 10‐year prospective case‐control study in 45–64‐year‐old men and women (n= 53.000) living in a city with 230000 inhabitants. One objective is to clarify whether a western diet is associated with certain forms of cancer whilst taking other life‐style factors into account. Another broad question is whether oxidative stress and the activity in DNA‐repairing systems influence the impact of diet on the development of all or certain forms of cancer. The study is also to act as a resource available for testing new hypotheses emanating from other studies.Initially food intake, heredity, socio‐economic factors, life‐style pattern, occupational situation, previous and current diseases, symptoms and medications, will be determined. Viable lymphocytes, granulocytes, erythrocytes, and plasma/serum will be stored in a biological bank together with tumour specimens gathered from cases. The incidence and mortality of all cancer forms will then be followed for 10 years by existing registries. Data from the initial examination in these cases will then be compared with those of control subjects not having developed any form of cancer. A biomarker programme, utilizing the biological bank, has been developed and is aimed at finding predictors and/or precursors of cancer. A high participation rate (>70%) and a high quality biological bank are prerequisites for a successful project. The experience gathered so far indicates that these

ISSN:0954-6820    

DOI:10.1111/j.1365-2796.1993.tb00647.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY