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Biomedical subjects

A Schwan

Publications and source records attributed to A Schwan.

At least 19 recordsLinked to original sources
PubMed2000

Less difference between office and ambulatory blood pressure in women than in men both before and during antihypertensive treatment.

In 199 subjects (56% women) with a diastolic blood pressure (BP) of 95-115 mmHg, 5 mg of either amlodipine or felodipine extended release (ER) was given for 4 weeks following 4 weeks of placebo-treatment. BP was measured by conventional clinic BP technique and by 24-h ambulatory BP monitoring (Spacelab 90202/90207). Men and women had identical clinic BP at baseline and it was lowered equally much by 4 weeks of treatment (men: 158/101 and 147/93, women: 159/102 and 149/93 mmHg, respectively). However, ambulatory BP was higher in women than in men both before and after treatment (men: 145/91 and 134/85, women: 149/95 and 140/89 mmHg, respectively, p < 0.05 for both comparisons). The difference between clinic BP and daytime ambulatory BP was higher in men than in women (systolic men: 8.1 +/- 14, women: 3.7 +/- 15 mmHg, respectively, p = 0.04; diastolic men: 5.5 +/- 8.0, women: 2.1 +/- 8.3 mmHg, p = 0.004). The correlation between the treatment effect measured by ambulatory and clinic BP was poor (systolic r = 0.26, p < 0.0001; diastolic r = 0.17, p = 0.03) and was unaffected by exclusion of subjects with normal ambulatory BP. The poor correlation between treatment effects measured as clinic and ambulatory BP is intriguing, and suggests that using ambulatory BP instead of clinic BP for monitoring the treatment of hypertension could affect the clinical outcome.

Adult↗
PubMed1998

Effect of amlodipine versus felodipine extended release on 24-hour ambulatory blood pressure in hypertension.

Amlodipine and felodipine are calcium antagonists of the dihydropyridine type. The elimination half-life of amlodipine is longer than that of felodipine. To study whether the different elimination rates of the drugs were reflected in different duration of blood pressure (BP) control, we compared amlodipine and felodipine extended release (ER) by both conventional clinic BP 24 h after drug intake and 24 h ambulatory BP monitoring (ABPM), with special reference to nighttime and morning blood pressure. Two hundred and sixteen patients with primary hypertension (supine diastolic BP, 95 to 115 mm Hg) were randomized to receive amlodipine or felodipine ER in a multicenter study. The starting dose of both drugs was 5 mg. If the target clinic diastolic BP (90 mm Hg) had not been achieved after 4 weeks the dose was increased to 10 mg. Twenty-four-hour ABPM was performed with the subjects taking placebo medication before randomization and after 4 and 8 weeks undergoing active treatment. Significantly more patients responded after 4 weeks of treatment with amlodipine (50%) as compared with felodipine (33%) (P = .013). ABPM during daytime (07:00 to 23:00) was similar during both treatments, but nighttime systolic (P = .026) and diastolic (P = .019) BP was more effectively reduced by amlodipine than by felodipine. After 8 weeks 82% achieved the target pressure with amlodipine and 69% with felodipine (P = .036 for the difference). Amlodipine seems to be more effective than felodipine when the drugs are compared in the same dose, with regard to the effect on clinic BP 24 h after dosing and to ambulatory BP during the night. The longer elimination half-life of amlodipine as compared to felodipine is the probable reason for this finding.

Amlodipine↗
PubMed1998

Recurrence rate of streptococcal pharyngitis related to hygienic measures.

OBJECTIVE: To test the hypothesis that treatment failures of streptococcal pharyngotonsillitis may be caused by reinfection by the patients' own streptococci remaining on a toothbrush or in the bedclothes. DESIGN: To elucidate the role of streptococcal contamination of the environment, hygienic measures regarding change of toothbrush and bed linen and washing of toys were given to half of the patients/families. Throat specimens were taken from all the patients before treatment with phenoxymethylpenicillin for 5 days, and the patients were followed-up for 1 month. At a home visit after 6-10 days, throat specimens were taken from the patients and all permanent residents of the home. Environmental samples were taken from pillowcases, floors, toothbrushes, dummies, and toys. SETTING: Six health care centres. SUBJECTS: 114 patients of all ages suffering from group A streptococcal pharyngotonsillitis, and 289 family members. MEASUREMENTS AND MAIN RESULTS: 54 patients/families received hygiene instructions. The total number of recurrences was 40 (35%). There was no difference in treatment failure rate between patients/families that had taken or not taken hygienic measures. CONCLUSIONS: Hygienic measures have no decisive influence on the risk of recurrence of streptococcal pharyngotonsillitis.

Adolescent↗
PubMed1997

Acid-catalyzed plasmenylcholine hydrolysis and its effect on bilayer permeability: a quantitative study.

This laboratory has previously shown (Anderson, V.C. and Thompson, D.H. (1992) Biochim. Biophys. Acta 1109, 33-42; Thompson, D.H., Gerasimov, O.V., Wheeler, J.J., Rui, Y. and Anderson, V.C. (1996) Biochim. Biophys. Acta 1279, 25-34), that plasmenylcholine (1-alk-1'-enyl-2-palmitoyl-sn-glycero-3-phosphocholine; PlsPamCho) liposomes release hydrophilic contents upon photooxidation or acid-catalyzed hydrolysis. We now report the kinetics and chemical mechanism of the acid-catalyzed reaction and its effect on calcein leakage rates. Hydrolysis of the plasmenylcholine vinyl ether linkage generates fatty aldehydes and 1-hydroxy-2-palmitoyl-sn-glycero-3-phosphocholine (lysolipid); HPLC and 1H-NMR experiments establish that the former is readily air-oxidized to fatty acids, while the latter undergoes rapid acid-catalyzed rearrangement to 1-palmitoyl-2-hydroxy-sn-glycero-3-phosphocholine. Lysolipid formation obeys first order kinetics, yielding observed pseudo-first order rate constants that are pH-dependent. Bimolecular hydrolysis rate constants, k(bi), have also been determined. Calcein release rates from plasmenylcholine liposomes are strongly dependent on both the dihydrocholesterol (DHC) content and the extent of PlsPamCho hydrolysis within the bilayer. DHC-free plasmenylcholine liposomes (38 degrees C, pH 2.5) require < 5% PlsPamCho hydrolysis to effect > 50% calcein release within 10 min. The presence of > or = 25 mol% DHC, however, greatly reduces the observed calcein release rate; nearly 30% PlsPamCho hydrolysis is required to effect 50% calcein release over a 70-min period in 6:4 PlsPamCho/DHC liposomes. Bacteriochlorophyll a-sensitized photooxidation of plasmenylcholine liposomes also produces fatty aldehyde and another intermediate, tentatively described as 1-formyl-2-palmitoyl-sn-glycero-3-phosphocholine, that hydrolyzes to form the 1-hydroxy lysolipid. These results have important implications for the quantitative description of lysolipid effects on membrane permeability and on the design of triggerable liposomes for drug delivery.

Acids↗
PubMed1997

The role of household contacts in the transmission of group A streptococci.

The intrafamilial spread and recurrence of group A beta-haemolytic streptococci (GAS) infections was investigated. The evaluation was based on 114 patients and their families treated with penicillin for 5 days and followed for 1 month. GAS of the same T-type as that of the isolate from the index case were found in other family members in 33% of the families. Genetic finger-printing using RFLP was performed on 33 of the isolates. The mothers dominated among the index cases, 40 patients experienced recurrences, 27 of them were clinical 28 recurrences occurred within 10 days after the end of treatment. Of 20 T-typed patients with early clinical treatment failures, infected family members were detected in 16 families (p < 0.001). In 19% of the patients GAS could be isolated from the nose. These patients had more ill family members than did other patients. An extensive intrafamilial streptococcal spread was found. Most recurrences of GAS pharyngotonsillitis after penicillin treatment are probably due to "ping pong" infection from family members.

Adolescent↗
PubMed1995

Independent association between fasting plasma insulin and ambulatory blood pressure in 50-year-old women.

The aim of the present study was to investigate correlations between fasting insulin and ambulatory blood pressure in healthy 50-year-old women. Sixty-five women without anti-hypertensive medication were investigated at a Primary Health Care Centre in Enköping, Sweden. Fasting plasma insulin, office blood pressure and heart rate were measured as well as ambulatory blood pressure and heart rate (Spacelab 90202). Log-transformed insulin correlated with all blood pressure recordings (r = 0.3-0.5; p < 0.05) but only with night-time heart rate (r = 0.3; p < 0.05). In multiple regression analyses log-insulin still correlated with night-time systolic blood pressure and heart rate, but not with the other blood pressure variables, after elimination of the influence of body mass index. We conclude that fasting plasma insulin shows an obesity-independent correlation with night-time systolic blood pressure and heart rate in healthy women, possible indicators of a "basic" sympathetic nervous outflow in muscle tissue during sleep.

Blood Pressure↗
PubMed1993

Cardiovascular risk factors in treated hypertensives--a nation-wide, cross-sectional study in Sweden.

Hypertensive patients still face a considerable risk of cardiovascular disease in spite of drug treatment in many studies. This may partly be explained by metabolic disturbances, both primarily linked to hypertension but also secondarily influenced by anti-hypertensive drugs themselves. In order to evaluate residual cardiovascular risk factors we investigated 1915 treated hypertensives (912 males, 1003 females) attending 128 health centres from all parts of Sweden. Mean blood pressure was 148/91 mmHg for males and 151/90 for females, but a substantial proportion of all patients were not well controlled, having a diastolic blood pressures > or = 100 mmHg (17% males, 12% females). Total cholesterol and HDL-cholesterol were 6.03 and 1.25 mmol l-1 for males, and 6.40 and 1.50 for females. The corresponding figures for serum triglycerides were 2.03 and 1.72 mmol l-1, respectively. In all, 38% of the hypertensives had hypercholesterolaemia (> or = 6.5 mmol l-1) and 27% hypertriglyceridaemia (> or = 2.3 mmol l-1). The lipid/lipoprotein findings may also be influenced by the various anti-hypertensive drugs used in Sweden. The prevalence of smoking and diabetes mellitus were 25% and 11% for men, and for women 24% and 9%. In conclusion, Swedish hypertensives show evidence of significant residual cardiovascular risk factors in spite of treatment. This may be of importance for future relative and absolute cardiovascular risk. It is time to re-evaluate the effectiveness of our management and care of hypertensive patients.

Antihypertensive Agents↗
PubMed1993

Postural effects on diastolic blood pressure are differently recorded by a non-invasive ambulatory blood pressure monitor and a standard auscultatory device.

The aim of this study was to determine the influence of change of posture on blood pressure as recorded with an automatic ambulatory blood pressure monitor and a standard auscultatory device. The blood pressure difference between sitting and supine and between standing and supine posture was 1.1/3.9 and 6.5/6.3 mmHg, respectively, for the monitor recordings, and 0.7/6.7 and 7.9/14.8 mmHg, respectively, for the standard recordings. All differences were significant, except the systolic blood pressure difference between sitting and supine posture. There were no significant differences in systolic blood pressure between monitor and standard recordings in any posture. The corresponding differences in diastolic blood pressure were significant in sitting (-4.6 mmHg) and standing postures (-10.3 mmHg), but not in supine posture (-1.8 mmHg). It is concluded that a change of posture contributes to blood pressure variability, and agreement between diastolic blood pressure in supine subjects, as recorded by an ambulatory monitor and a standard device, does not necessarily mean agreement in standing (or sitting) subjects.

Adult↗
PubMed1993

Local and systemic immune response in Helicobacter pylori-associated chronic gastritis before and after treatment.

Ten patients with Helicobacter pylori-associated chronic gastritis were given combination therapy for 6 weeks with a bismuth subnitrate-containing compound and bacampicillin. The eradication rate was 40% 6 weeks after the end of treatment. Two patients remained H. pylori-negative at long-term follow-up after 6 and 17 months; that is, H. pylori was only eradicated in 20% of the patients after long-term observation. By dot blot and immunoblotting both urease and an urease-associated heat shock protein (HSP62) were found to be specific and constant immunodominant H. pylori antigens. The immunohistologic pattern showed induced expression of HLA-DR and HSP62, but not of ICAM-1, in all but two biopsy specimens of gastric epithelial cells. This study suggests i) that long-term observation is important when evaluating the efficacy of anti-H. pylori therapy; ii) that the immune defense mechanisms in the gastric mucosa differ from those in inflammatory conditions affecting other organs, where ICAM-1 and HLA-DR seem to be governed by a common regulator; and iii) that the immunopathologic effects of H. pylori may be caused by autologous and/or bacterial HSPs, which act as triggering factors in the development and persistence of the chronic inflammation in the gastric mucosa.

Adult↗
PubMed1993

Reference values for 24-hour non-invasive ambulatory blood pressure: a population study of men aged fifty.

All 50-year-old men (N = 126) living in a defined neighbourhood were invited to undergo 24-hour ambulatory, non-invasive blood pressure (BP) monitoring. The participation rate was 90%. Seven per cent of the subjects were taking antihypertensive drugs and 19% had a current diagnosis of hypertension or had been so diagnosed sometime previously. The 5th, 50th, and 95th percentiles of the subjects' ambulatory BP are presented. On average, daytime, night-time, and 24-hour ambulatory BP were 135/86, 114/68, 128/80 mmHg, respectively, and the average casual BP was 137/86 mmHg. The ambulatory BP in the present study was higher than in previous reference studies. No attempt was made to select the stratified subjects according to casual BP or any other medical or social variable. This and a high participation rate probably account for the difference in ambulatory BP vis-à-vis those found in other reference studies.

Age Factors↗
PubMed1993

Short-term variation in blood pressure determines the accuracy of simultaneous and sequential recordings in the validation of blood pressure measuring devices.

Short-term intradevice variation of BP was determined by means of consecutive BP recordings. The intradevice variation was mainly the result of spontaneous, random variation in BP and was the same for invasive, automated oscillometric and auscultatory random zero meter recordings. We show that the accuracy of simultaneous and sequential recordings, performed according to the recommendation of the British Hypertension Society's protocol for the evaluation of automated BP devices, can be calculated by means of statistical analysis if the intradevice variation of the BP is known. We found, for both sequential and for simultaneous recordings, a close agreement between the expected and the observed proportion of differences that fall within certain specified limits and that it is more favourable for a test device to be evaluated by sequential than by simultaneous recordings.

Adult↗
PubMed1992

Effect on sleep--but not on blood pressure--of nocturnal non-invasive blood pressure monitoring.

OBJECTIVE: Nocturnal non-invasive ambulatory blood pressure monitoring inevitably causes an undesirable external stimulus due to the cuff pressure and, for some monitors, disturbing compressor sound. The objective of the present study was to determine whether non-invasive automated blood pressure monitoring during sleep provokes arousal and changes in blood pressure and/or heart rate. DESIGN: Sleep response and blood pressure reaction during and immediately after blood pressure monitoring were studied by means of simultaneous electroencephalography and blood pressure recordings. METHODS: Blood pressure and electroencephalogram were recorded simultaneously in 24 subjects (10 hypertensive, 14 normotensive). Blood pressure was registered with a non-invasive automatic blood pressure monitor every 20 min. Inflation and deflation of the cuff were registered on one of the electroencephalogram channels by means of a small pressure meter attached to the cuff. For each subject, blood pressure during uninterrupted sleep was compared with that during arousal provoked by the recordings. RESULTS: Blood pressure recording caused an arousal in 67% of the recordings. During 33% of the recordings, sleep continued. Neither systolic nor diastolic blood pressure differed significantly for recordings during 'uninterrupted sleep' when compared with arousal. Heart rate was significantly faster during arousal than during uninterrupted sleep. Analysed separately, hypertensive subjects showed an overall blood pressure response close to that of normotensive subjects. There was a significant trend towards lower blood pressure, parallel with deeper sleep. CONCLUSIONS: The results of this study show that non-invasive ambulatory blood pressure monitoring during sleep accurately records basal blood pressure and can distinguish blood pressure during superficial sleep from blood pressure during deep sleep. Sleep is often disturbed by blood pressure monitoring but, irrespective of whether recording provokes arousal, monitored blood pressure is the same.

Adult↗
PubMed1992

Neonatal septicemia caused by pneumococci.

Pneumococci (Streptococcus pneumoniae) infrequently cause neonatal septicemia. An increased number of cases have been reported in recent years, but no increase in the relative incidence among neonatal infections has been noted. On the basis of two cases of our own and a review of 40 recently published case reports, the clinical characteristics of pneumococcal septicemia are described and the pathogenesis is discussed. The presenting clinical picture in early-onset pneumococcal septicemia is dominated by respiratory distress, frequently accompanied by leukopenia, and is indistinguishable from that seen in septicemia caused by Group B Streptococci (GBS). The onset is preceded by prelabor rupture of the fetal membranes in almost half of the instances. The mortality is 50%, twice the figure given in recent GBS reports.

Disease Outbreaks↗
PubMed1992

Two cases of neonatal pneumococcal septicemia.

Pneumococci (Streptococcus pneumoniae) infrequently cause neonatal septicemia. An increased number of cases have been reported in recent years, but no increase in the relative incidence among neonatal infections has been noted. Two recent cases that occurred within a short period of time are described. They were found to exhibit most clinical characteristics, previously described, of Group B Streptococci (GBS) septicemia with an early onset, but appear to have a graver prognosis.

Adult↗
PubMed1992

Traditional risk-factor profile fails to explain striking geographical differences in IHD mortality among middle-aged men. The project "myocardial infarction in mid-Sweden".

An east-west gradient in cardiovascular mortality has been reported from the region of mid-Sweden. Postal questionnaire studies found that the risk factor distributions among middle-aged men were similar in areas with striking differences in cardiovascular mortality. In this study, 120 randomly selected 50-year-old men in two high mortality communities in the west and 120 men from two low mortality communities in the east were invited to a health survey in which serum lipids and other risk factors were analysed. Total serum cholesterol, LDL-cholesterol, HDL-cholesterol, and triglyceride levels were similar. Among fatty acids, stearic acid was high and arachidonic acid was low in the high mortality area. The levels of other traditional risk factors were the same. After taking these differences into account, the mortality differences remain large.

Coronary Disease↗