Predictors of coronary heart disease and death in NIDDM: the Diabetes Intervention Study experience.
Explore the source record for details and available documents.
Adult↗
Biomedical subjects
J Lindner
Publications and source records attributed to J Lindner.
[Transposition of the basilic vein in the arm for vascular access in hemodialysis].
The author presents an account on a less frequently used vascular approach suitable in particular in patients with repeated a-v shunts. The group comprises 10 patients operated in 1994-1995. The patency up to one year was 80%, after two years 7 shunts are patent, one female patient died one year after establishment of the shunt with the shunt in a functional state. One shunt closed after six months and the second one 11 months after operation. Complications were recorded in three patients, in none of them abolition of the shunt was necessary. Based on the author's experience and data in the literature the authors assume that this approach is a useful alternative to secondary vascular approaches with better results than those of vascular prostheses.
Arm↗
Pattern of non-steroidal anti-inflammatory drug use in Australia 1990-1994. A report from the Drug Utilization Sub-Committee of the Pharmaceutical Benefits Advisory Committee.
OBJECTIVE: To determine the pattern of use of non-steroidal anti-inflammatory drugs (NSAIDs) in the Australian community, 1990-1994. DESIGN: Data from the national drug utilisation database were expressed in defined daily doses per 1000 population per day (DDDs/1000 population per day). Temporal trends were assessed and comparisons were made with NSAID use in other countries. Epidemiological data were used to estimate the likely impact of changing NSAID use on peptic ulcer hospitalisation rates. SETTING: Australian community (excluding hospitals). MAIN OUTCOME MEASURES: Estimated consumption of prescription NSAIDs, expressed in DDDs/1000 population per day. RESULTS: NSAID use in the Australian community fell from 50.1 DDDs/1000 population per day in 1990 to 34.6 DDDs/1000 population per day in 1994 (down 31%). From this reduced exposure we estimated that the number of admissions for NSAID-related upper gastrointestinal complications will have fallen by about 400 per year. Market research data for this period show a lower percentage use of NSAIDs for osteoarthritis and a decrease in the proportion of use in age groups over 50 years. CONCLUSIONS: The level of use of non-steroidal anti-inflammatory drugs in Australia has been high in comparison with other countries, but in recent years has fallen markedly. This fall occurred in conjunction with regulatory interventions, educational campaigns and increased concern in the medical and lay press regarding the risks associated with the use of NSAIDs.
Adult↗
Risk factors for myocardial infarction and death in newly detected NIDDM: the Diabetes Intervention Study, 11-year follow-up.
The Diabetes Intervention Study (DIS) is a prospective population-based multicentre trial of newly detected cases of non-insulin-dependent diabetes mellitus (NIDDM). This report analyses the risk factors for subsequent coronary heart disease and all-cause death during the 11-year follow-up. The prognostic significance of the categories of the NIDDM Policy Group was validated with respect to the incidence of coronary heart disease and mortality. At baseline 1139 subjects, aged 30-55 years at the time of diabetes detection and classified as diet controlled after a 6-week screening phase, were included. Of the patients 112 (15.2%) suffered from myocardial infarction, 197 (19.82%) of 994 had died. The odds ratio for all-cause mortality compared to the general population for males at the age of 36-45 years was 5.1 and for females 7.0. In multivariate analysis age, blood pressure and smoking were independent risk factors for myocardial infarction and male sex, age, blood pressure, triglycerides, postprandial blood glucose and smoking for death, respectively. The categories of the NIDDM Policy Group target parameters for blood glucose, triglycerides and blood pressure were significant predictors of both CHD and death. Thus, it appears that in NIDDM good control of blood glucose, blood pressure and triglycerides is associated with a lower incidence of coronary heart disease and death rate respectively.
Adult↗
Expression of alpha 2-adrenergic receptor subtypes in the mouse brain: evaluation of spatial and temporal information imparted by 3 kb of 5' regulatory sequence for the alpha 2A AR-receptor gene in transgenic animals.
The present studies characterize the expression of the alpha 2A, alpha 2B and alpha 2C adrenergic receptor subtypes via in situ hybridization analysis of messenger RNA expression in the adult mouse brain, as well as the pattern of expression of alpha 2A adrenergic receptor messenger RNA at embryonic day E9.5, the earliest time for detection of the messenger RNA encoding this receptor subtype. alpha 2A adrenergic receptor messenger RNA is highly expressed in the sixth layer of the cortex and the locus coeruleus, alpha 2B adrenergic receptor messenger RNA predominantly in the thalamus and in the Purkinje layer of the cerebellum, and alpha 2C adrenergic receptor messenger RNA in the putamen caudate region of the mouse brain. Both alpha 2A and alpha 2C adrenergic receptor messenger RNA demonstrate strong expression in the amygdaloid complex, hypothalamus, olfactory system and the hippocampal formation. To develop a molecular understanding of the unique cellular expression of messenger RNA encoding the alpha 2A adrenergic receptor subtype, 2.83 kb of the upstream regulatory sequence for the alpha 2A adrenergic receptor gene was fused to the LacZ gene as a reporter gene and expression of beta-galactosidase activity was assessed in transgenic offspring. Although the spatial expression of the transgene in the adult brain often overlaps that for the endogenous alpha 2A adrenergic receptor, both ectopic expression and the absence of appropriate expression were noted; in contrast five of the six lines show temporal expression characteristic of the endogenous alpha 2A adrenergic receptor gene. The present studies provide the first characterization of messenger RNA localization for the three alpha 2 adrenergic receptor subtypes in the mouse CNS. Because the functional roles of the prazosin-sensitive alpha 2B adrenergic receptor and alpha 2C adrenergic receptor subtypes have been masked in most earlier physiological and pharmacological analyses of alpha 2 adrenergic receptor function, identifying the multiple loci alpha 2 adrenergic receptor subtype expression is an important prelude to understanding the functional roles of these three independent receptor populations in the mouse CNS. The findings in the transgenic animals indicating that approximately 3 kb of regulatory sequence has imparted faithful temporal but not spatial expression for the alpha 2A adrenergic receptor gene suggest that additional regulatory information is necessary for appropriate cell specific expression of messenger RNA for the alpha 2A adrenergic receptor subtype.
Amino Acid Sequence↗
[Obturator hernia].
Obturator hernias are a rare type of hernias. Their incidence reported in large studies is 0.7% of all hernias. An obturator hernia may be the cause of otherwise unexplainable long-term dyspeptic complaints or subileous complaints and in the acute stage the cause of etiologically obscure obturation ileus. The difficulty of diagnosis is apparent also from the fact that a correct preoperative diagnosis is made only in 25-33%. Usually the diagnosis is established on operation of acute ileus. In these patients the mortality varies within a wide range of 12-70%. The authors recommend therefore to focus attention in chronic repeated dyspeptic or subileous conditions on predisposing factors in the case-history (female sex, 7th-8th decade, concurrent chronic disease, marked weight loss) and to examine also the only specific symptom of this hernia (Howship-Romberg sign).
Aged↗
Environmental ozone field study on pulmonary and subjective responses of assumed risk groups.
Lung function parameters (measured with a body plethysmograph) and subjective votes on irritations of eyes or airways were taken from subjects belonging to four assumed ozone risk groups and one control group (40 subjects each: senior citizens, juvenile asthmatics, forestry workers, athletes, and clerks). Every subject was examined on 8 days both in the morning and in the afternoon. The intention was to obtain an equal distribution of measuring days with elevated and low ozone concentrations, respectively, for each subject. On average the ozone concentrations reached 0.070 ppm on "ozone days" [maximum concentration 0.112 ppm for clerks (outdoors), 0.100 ppm for senior citizens, 0.091 for juvenile asthmatics, 0.086 ppm for athletes, and 0.077 ppm for forestry workers] and 0.028 ppm on "control days" (minimum 0.001 ppm). The results show no relevant ozone effect for the group with the lowest ventilation rate (senior citizens) and only marginal reductions of respiratory flows and volumes for athletes. Pulmonary decrements of juvenile asthmatics on ozone days were small but larger than those documented in the literature for healthy children. Forestry workers and clerks had significantly higher airway resistances on ozone days, although having been exposed to the lowest ozone concentrations of all groups. Thus, on days with moderately elevated levels of ozone in the environment it is assumed that ozone itself has a minor influence on pulmonary responses compared to that of other constituents of the air in certain locations like in forests or indoors on these days. These could be reaction products of ozone with motor tool exhausts in the case of forestry workers or substances originating from ozone deposition on the surfaces of the offices.
Adolescent↗
Effects of environmental ozone on the lung function of senior citizens.
Measurements with a body plethysmograph of lung function parameters and reports of unusual complaints or irritations were taken from 41 senior citizens in the situations where they usually spend their daytime hours. The subjects belonged to a group commonly assumed to be at risk from ozone. Each subject was examined on 8 days both in the morning and in the afternoon. The object was to obtain for every subject an equal distribution of measuring days between those with elevated ozone concentrations (maximum 0.5 h mean values between 1.00 and 4.00 p.m. of at least 0.050 ppm) and those with low ozone concentrations (maximum 0.5 h mean values between 1.00 and 4.00 p.m. of at most 0.040 ppm). The results showed no relevant ozone related effects on the lung function parameters or the subjective reports of irritations. Thus there was no indication that senior citizens represent a group at particular risk with respect to moderately elevated concentrations of environmental ozone, as occur in central Europe.
Aged↗
[Acute phase proteins in acute pancreatitis].
The submitted investigation deals with the value of assessment of selected reactants of the acute stage in patients with acute pancreatitis and their follow-up in the course of the disease. For the investigation C-reactive protein, alpha-1-antitrypsin and haptaglobin were selected. In addition to the prognostic impact the authors focused attention on assessment of the dynamics of individual proteins and their importance for the early detection of complications in acute pancreatitis with different etiologies. The high CRP level on admission of severe cases of pancreatitis--mean 166.9 mg/l (range from 100 to 320 mg/l)--correlated with other signs suggesting severe pancreatitis and the latter was confirmed by computed tomography (CT), surgery or post-mortem examination in 90% of the patients with a CRP level above 100 mg/l. This correlation was not confirmed for alpha-1-antitrypsin or haptaglobin.
Acute Disease↗
[Lung function and prevalence of irritation of eyes and respiratory airways on days with elevated ozone concentrations].
In order to evaluate potential health effects on days with elevated ozone concentrations, lung function parameters and subjective votes on irritations of eyes and airways were taken repeatedly from subjects belonging to four assumed ozone risk groups and one control group (at least 40 subjects each) - senior citizens, juvenile asthmatics, forestry workers, athletes and clerks - in comparison of days with elevated (at least 100 micrograms/m3) and low ozone concentrations (at most 80 micrograms/m3). The results show no relevant ozone effects for the groups, "senior citizens" and "athletes", only minor pulmonary effects for "juvenile asthmatics", but significantly higher airway resistances on "ozone days" for "forestry workers" (by 21%) and "clerks" (by 16%). On days with moderately elevated levels of ozone in the environment it is assumed that ozone itself has minor influence on pulmonary responses compared to that of other constituents of the air in certain location like forest or indoors.
Adolescent↗
Identification of the site of uptake of the E. coli heat-labile enterotoxin, LTB.
The results of this study demonstrate that the B subunit of the E. coli heat labile toxin (LTB) binds to the brush border of intestinal epithelial cells in a highly specific, lectin-like manner. Uptake of LTB and transcytosis to the basolateral side of the enterocytes can be observed within 1 h after feeding, and occurs through both the villous epithelial cells and the epithelial cells overlying lymphoid follicles and Peyer's patches. Binding and uptake most probably occur via receptor-mediated endocytosis, with GM1 ganglioside and galactoproteins on the enterocyte cell surface acting as specific ligands to which the LTB binds. Cell ELISA data, together with the observed distribution of immunocompetent cells and the localization of LTB binding, suggest that LTB which is taken up by the villous enterocytes enters the circulation and subsequently generates an IgG immune response in the spleen. At the same time, LTB which is taken up via the patch associated epithelium generates a local IgG and IgA immune response within the Peyer's patches and intestinal lymphoid follicles.
Animals↗
[Evaluation of laparoscopic and laparotomy cholecystectomy by comparing the dynamics of acute phase proteins].
The authors investigated in two groups of surgical patients subjected to laparoscopic (n = 10) and laparotomic (n = 10) cholecystectomy changes in the levels of nine acute stage proteins. The objective was to evaluate the extent of surgical stress of the two surgical procedures with regard to changes of serum levels of albumin, transfirrin, prealbumin, alpha 1-antitrypsin, alpha 1-acid glycoprotein, alpha 2-macroglobulin, haptoglobin, ceruloplasmin and C-reactive protein. Before operation no significant differences (p < 0.05) were found between the investigated indicators. Changes of acute stage proteins up to the third day following surgery indicate a lower surgical trauma and more favourable course during the early postoperative period in patients operated by the laparoscopic route.
Acute-Phase Proteins↗
[The importance of perforators in surgical treatment of varices of the lower extremities].
The authors discuss the role of insufficient perforating veins in the surgical treatment of primary varicosities of the lower extremities. They evaluated the frequency and site of insufficient perforating veins in 284 patients, operated in 1989-1991. Insufficient perforating veins were found in 21.8% operated patients. Most frequently insufficiency of perforating veins of Cockett's group was found, i.e. in 77.4%. Patients who were operated on account of a relapse of varicosities had insufficient perforating veins in 38% and in patients with trophic skin changes insufficient perforating veins were found in 78.5%. The haemodynamic role of perforating veins and their importance with regard to relapses of varicosities is discussed. The authors describe their own diagnostic and therapeutic procedure.
Adult↗
[Propofol, isoflurane and neuroleptanesthesia. Ophthalmic surgery in geriatric patients].
Ophthalmic surgeons require anaesthesia to ensure that the patient is completely relaxed for microsurgical operations and that the intraocular pressure is reduced. These conditions must be maintained throughout the operation. In addition to these requirements, the anaesthetist mostly deals with elderly patients with multiple diseases. Although earlier studies have shown which general or local anaesthesia is preferred for which patients and operations, studies on which general anaesthesia technique is ideal to fulfil these requirements are still lacking. The aim of this study was to show which technique causes the least stress for a geriatric patient undergoing an ophthalmic operation, propofol/fentanyl anaesthesia, isoflurane anaesthesia or neuroleptanaesthesia. PATIENTS AND METHODS. Sixty patients aged 60 years and above were included in this study. After being randomly allocated to either propofol/fentanyl (continuous propofol infusion), isoflurane or neuroleptanaesthesia, they underwent ophthalmic surgery. Intraoperative complications (cardiocirculatory changes) and surgical conditions were recorded. After the operation, patient vigilance and post-operative pain reactions (nominal pain score) were assessed over 8 h by means of simple reaction tests and the Juhl index. Within the first 2 h after surgery, cardiocirculatory changes were also documented and arterial blood gases measured. RESULTS. The treatment groups did not differ with respect to general biometric data, preoperative risk or operations carried out. Intraoperative cardiocirculatory changes and the resulting therapy (positive inotropic drugs, volume replacement fluids) were similar in all groups. The surgical conditions were equally good in all groups. Apart from a lower rate pressure product in the first 60 min after propofol/fentanyl anaesthesia, there were no postoperative differences in cardiocirculatory parameters or blood gases. After isoflurane anaesthesia the time until the patients were able to give their names and perform the finger-nose test properly was longer than that after neurolept-anaesthesia or propofol anaesthesia. After propofol anaesthesia the patients could perform simple tests earlier and were more alert over the whole monitoring period than after isoflurane or neuroleptanaesthesia. On the other hand, the patients in the neuroleptanaesthesia group had fewer pain complaints than those in the two groups compared. DISCUSSION. None of the anaesthesia techniques used in this study showed an intraoperative advantage. This is not surprising since all anaesthetics, with the exception of ketamine, reduce intraocular pressure. The prerequisite, however, is careful monitoring of anaesthesia in elderly patients in order to avoid cardiocirculatory changes, mild hyperventilation and coughing and pressing at the end of the operation. Until this point in time no change in the depth of anaesthesia is allowed. Therefore, it seems on the whole that there are benefits from propofol-fentanyl anaesthesia because of the fact that in comparison with the rather techniques, elderly patients become alert again faster. However, sufficient postoperative pain therapy is necessary to free the patients of pain to the same degree as with neuroleptanaesthesia. In most cases peripherally acting analgesic substances with no interference with vigilance are sufficient.
Aged↗
Low incidence of antibody formation due to long-term interferon-alpha 2c treatment of cancer patients.
In order to study the long-term immunogenicity of interferon-alpha 2c (Berofor) in cancer patients, serum was collected starting in 1983 from study patients with various proliferative diseases who received interferon-alpha 2c at different doses, according to different schedules, and via different routes. A total of 1992 samples were tested for the presence of anti-interferon-alpha 2c antibodies. Due to long-term interferon-alpha 2c treatment, 346 patients were eligible for induction of neutralizing anti-interferon antibodies over a treatment period of 2-52 months. Most patients were treated for longer than 6 months. Of the 346 patients, three patients (0.87%) exhibited measurable titers of neutralizing antibodies following therapy with interferon-alpha 2c. One hundred and sixty-three patients suffered from non-Hodgkin lymphomas, leukemias, and preleukemias. One patient with chronic myeloid leukemia experienced antibody induction under therapy. The other 183 patients had solid tumors. Two of them reacted with antibody production. All titers were very low (1:12, 1:8, and 1:64). Compared with figures reported for other interferon-alpha preparations, the propensity of interferon-alpha 2c to induce neutralizing antibodies seems to be very low. This property might be related to arginines occurring as critical residues in positions 23 and 34 of the interferon-alpha 2c molecule.
Antibody Formation↗
[Coronary heart disease and insulin concentration in type II diabetic patients--results of a diabetes intervention study].
There is experimental, clinical and epidemiological evidence that elevated insulin levels are associated with development of atherosclerosis. Early results came from studies in non-diabetics, but the situation with respect to diabetes is more complex and not so clear. The Diabetes Intervention Study is a population-based follow-up study in newly detected type II diabetics (30- to 55-yr-old). After 5 years 431 men and 320 women received a complex check up with oral glucose tolerance tests and measurements of plasma insulin and glucose levels, fasting and 2h post-load. Regarding the metabolic parameters, the fasting and postprandial insulin levels were higher among the patients having coronary heart disease (15% of men, 36% of women), as compared to patients without this disease. In multivariate analysis sex, age, antihypertensive treatment, blood pressure, body mass index, and fasting insulin levels were independently associated with the prevalence of coronary heart disease in patients with non-insulin dependent diabetes mellitus (NIDDM) treated with diet and/or oral antidiabetics. Body mass index and triglycerides were the only variables that independently correlated to insulin: fasting insulin = 0.4 (body mass index) + 0.1 (triglycerides) - 4,2. In future prospective studies of diabetics relating insulin concentrations to the development of vascular disease are of particular interest and necessity. Because hyperinsulinemia may contribute to accelerated atherosclerosis in NIDDM-patients, the aim of the treatment of type II-diabetes should be to correct hyperglycemia without aggravating insulin levels and other cardiovascular risk factors.
Adult↗
[Postural problems of dentists].
Explore the source record for details and available documents.
Adult↗
Combined administration of a gonadotropin-releasing hormone antagonist and testosterone in men induces reversible azoospermia without loss of libido.
GnRH antagonists suppress pituitary and gonadal function by competing with endogenous GnRH for binding to receptors on pituitary gonadotrophs. We studied the effects of GnRH antagonist administration to men in a protocol simulating a likely male contraceptive regimen combined with a low dose of testosterone. The GnRH antagonist Nal-Glu was given daily (10 mg, sc) for 20 weeks to eight normal men, and a low dose of testosterone enanthate (25 mg, sc) was given every week. Sperm counts started declining during week 4, and complete azoospermia was reached within 6-12 weeks in six of the eight subjects. Subjects 7 and 8, whose sperm counts and serum gonadotropin levels were not suppressed after 10 weeks, were given 20 mg Nal-Glu starting at week 10. One became azoospermic at week 16, while the other's total sperm counts continued declining and reached a nadir of 1.4 million by week 20. Sperm motility and viability in this subject were completely suppressed after week 14. Sperm counts returned to baseline levels 12-14 weeks after the end of Nal-Glu administration. The mean serum LH level of the first six subjects decreased from 3 +/- 03. U/L at baseline to less than 0.1 U/L until week 20, and then levels returned to baseline. FSH levels similarly decreased from a combined mean of 3.6 +/- 0.9 U/L at baseline to below 0.3 U/L after 4 weeks of Nal-Glu administration. Serum mean testosterone levels between weekly injections of testosterone enanthate ranged from 27.4 +/- 5.9 to 4.8 +/- 1.4 nmol/L, but remained in the hypogonadal range (less than 10 nmol/L) for 4 of the 7 days. None of the subjects, however, complained of decreased libido or potency, as assessed by a questionnaire. No systemic or significant local side-effects were observed, other than a minimal reaction at the injection site. These data suggest that complete sustained azoospermia can be achieved in man, without loss of libido, by chronic administration of a GnRH antagonist plus testosterone.
Adult↗