[Myxedema coma--a treatment schedule].
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Coma↗
Biomedical subjects
B Hylander
Publications and source records attributed to B Hylander.
Lipolytic and circulatory responses to noradrenaline infusion in hypothyroid subjects before and during thyroxine substitution.
The hypothyroid state in humans is associated with a diminished lipolytic response to noradrenaline in adipose tissue in vitro. In the present study we have investigated the situation in vivo in order to see if such a change in receptor response could be demonstrated in adipose tissue and in the circulatory system. The change in glycerol production rate, induced by an infusion of noradrenaline, was used as an index of adipose tissue adrenergic responsiveness. The results showed that the lipolytic response was decreased by about 50% in the hypothyroid state and that it was normalized when the substitution dose had been increased to 0.10-0.15 mg/day thyroxine. The circulatory response was monitored by measurements of blood pressure and pulse rate. The resting diastolic pressure was transiently lowered by substitution. Similarly the rise in systolic blood pressure induced by l-noradrenaline was transiently increased by substitution. Thus no clear-cut change in receptor response with substitution could be demonstrated by measuring BP and pulse rate only. This result could be due to the fact that the system is more complex than the adipose tissue. The finding of a reduced adrenergic receptor response in vivo in the adipose tissue is in accordance and extends earlier findings in vitro.
Blood Pressure↗
Monocyte-related determinants of inflammation in patients on peritoneal dialysis.
AIMS: We studied markers of monocyte activation, i.e., the cell surface expression of CD11b and CD62L, and the serum concentrations of monocyte chemotactic protein 1 (MCP-1; a monocyte-specific chemoattractant) and soluble vascular cell adhesion molecule 1 (sVCAM-1; an adhesion molecule involved in monocyte recruitment) in 20 patients on peritoneal dialysis (PD), in 25 patients with chronic renal insufficiency, and in 27 healthy subjects. RESULTS: Monocytes obtained from the peripheral blood of PD patients had a significantly higher expression of CD62L (p = 0.02) as compared with monocytes from healthy subjects and a lower CD11b/CD18 expression as compared with monocytes collected from healthy subjects (p < 0.001) and from patients with renal insufficiency (p < 0.001). Monocytes from PD patients had, however, the capacity to increase the expression of CD11b following stimulation with a potent chemotactic factor. The serum concentrations of MCP-1 and sVCAM-1 were higher in PD patients (575 +/- 51 and 1,517 +/- 89 ng/ml) than in healthy subjects (225 +/- 17 and 668 +/- 64 ng/ml, respectively; p < 0.001 for both comparisons). There was a correlation between the levels of sVCAM-1 and MCP-1 (r = 0.48, p < 0.05) in patients on PD, but neither correlated with the monocyte expression of CD11b/CD18 or CD62L. The concentration of C-reactive protein was higher in patients on PD as compared with healthy subjects and correlated significantly with the concentration of sVCAM-1 (r = 0.63, p < 0.01). CONCLUSIONS: Monocytes in the peripheral circulation of patients on PD have a CD62L(high)/CD11b(low) phenotype, indicating that they have not undergone complete differentiation. Patients also have an increase in the systemic chemotactic activity for monocytes in combination with increased levels of sVCAM-1 and C-reactive protein. These inflammatory aberrations may play a pathophysiological role in the response to inflammatory and infectious diseases in patients on PD.
Adult↗
Phenotypic alterations of recruited eosinophils in peritoneal fluid eosinophilia.
OBJECTIVE: To characterize eosinophils and soluble factors in effluent from continuous ambulatory peritoneal dialysis (CAPD) patients and connect these findings to related conditions with eosinophilic accumulation. PATIENTS: Three newly started CAPD patients, two with peritoneal fluid eosinophilia (PFE) and one with bacteria-induced peritonitis. One patient with PFE was followed up for 10 visits during a 7-month period. METHODS: Leukocytes were analyzed in dialysate and peripheral blood from the patients, by flow cytometry, and soluble mediators by ELISA or CAP technique. RESULTS: We found an increased number of neutrophils in the effluent from the patient with bacteria-induced peritonitis; accumulation of eosinophils in combination with negative cultures was noted in the patients with PFE. Increased levels of interleukin (IL)-5 and eosinophil cationic protein, but equal levels of eotaxin, were found in effluent from the PFE patients compared to the patient with neutrophilia. Peritoneal fluid eosinophils were activated by means of EG2, CD11b, CD9, and CD69 expression. Compared to blood eosinophils, the cytokine receptors for IL-5 and granulocyte-macrophage colony-stimulating factor, but not IL-3, were down regulated. CONCLUSION: The finding of activated eosinophils in combination with IL-5 and eotaxin in PFE indicates existing similarities between PFE and conditions found during recruitment of eosinophils in allergic inflammatory responses.
Aged↗
Gastric emptying and electrogastrography in patients on CAPD.
OBJECTIVE: To evaluate if impaired gastric emptying of digestible solids can explain the disturbed eating behavior in continuous ambulatory peritoneal dialysis (CAPD) patients, and if predialytic and dialytic (CAPD and hemodialysis) patients with impaired gastric emptying have a higher prevalence of electrogastrographic (EGG) abnormalities. DESIGN: Cross-sectional study. After ingestion of a 99mTc-labeled test meal, anterior and posterior 1-minute scintigraphic acquisitions were collected every 5 minutes during the first 50 minutes and thereafter every 10 minutes until 2 hours had elapsed. Simultaneously, cutaneous EGG recorded gastric myoelectric activity. SETTING: The Division of Nephrology and the Department of Nuclear Medicine at the same academic teaching hospital. PARTICIPANTS: Thirty outpatients participated in both the gastric emptying and the EGG studies. Dialysis patients should have been on dialysis for more than 3 months. For comparison, 160 healthy control subjects participated in the gastric emptying study. MAIN OUTCOME MEASURES: The following parameters were used to describe gastric emptying: lag phase 90%, half-emptying time (T50), gastric retention at 90 and 120 minutes (Ret 90/120) and gastric emptying rate (GER, %/min). Electrogastrographic measurements were expressed as percentages of normal slow waves [2.4-3.6 cycles/min (cpm)], bradygastria (1.5-2.4 cpm), and tachygastria (3.6-10 cpm). RESULTS: T50 was prolonged, Ret 90 and Ret 120 were higher, and GER was slower in male CAPD patients compared to male controls. No significant differences were found in postprandial EGG. CONCLUSION: Gastric emptying is impaired in male non-diabetic CAPD patients. However, abnormalities in postprandial EGG cannot explain this finding.
Adult↗
Bacteraemia with Escherichia coli in diabetic patients. Studies on bacterial virulence and host factors.
A total of 70 episodes of E. coli bacteraemia occurred in 10 patients with insulin-dependent, and 54 patients with non-insulin-dependent diabetes mellitus. The bacteraemic strains were tested for aerobactin mediated iron uptake, a property that is regarded as a virulence factor of E. coli. Aerobactin mediated iron uptake was present in 60% of the isolated strains from the diabetic patients. A similar prevalence, 54%, was noted in E. coli from a control group of non-diabetic patients with bacteraemia. The prevalence of aerobactin positive strains, isolated from both diabetic and non-diabetic patients, was significantly higher than in faecal E. coli strains (39%) obtained from healthy subjects. In E. coli from diabetic patients, another bacterial virulence factor, P-fimbriae, was present on 62% of the aerobactin positive strains but only on 33% of strains lacking aerobactin mediated iron uptake. No examined host factors in the diabetic patients, such as age, sex, duration of diabetes, serum creatinine and presence of proteinuria, influenced the prevalence of aerobactin mediated iron uptake. In conclusion, bacterial virulence mediated by the aerobactin system occurs as frequently in diabetic as in non-diabetic patients with E. coli bacteraemia, and furthermore seems to co-exist with P-fimbriation.
Diabetes Mellitus, Type 1↗
Interleukin-10, interferon gamma, interleukin-2, and soluble interleukin-2 receptor alpha detected during peritonitis in the dialysate and serum of patients on continuous ambulatory peritoneal dialysis.
OBJECTIVE: To analyze interleukin (IL)-10, interferon gamma (IFN-gamma), IL-2, and soluble IL-2 receptor alpha (sIL-2R alpha) in the dialysate and serum of patients on continuous ambulatory peritoneal dialysis (CAPD). DESIGN AND PATIENTS: Samples from dialysate bags were collected during the initial month of dialysis. During peritonitis, samples were collected from the first three bags on the day of admittance to the hospital and from the night bags on days 3 and 10. Serum samples were drawn on days 1 and 10. RESULTS: IL-10 was detected in all dialysate samples except one on the first day of infection, with a peak median level of 50 pg/mL and a slow decrease thereafter. In serum the median levels never exceeded detectable levels. Patients infected with Escherichia coli or Staphylococcus aureus had higher IL-10 levels in dialysate on day 3 as compared to the remaining patients (p < 0.05). If the catheter had to be drawn, because of persistent cloudy dialysate, the IL-10 levels remained elevated for a longer time (p < 0.05). IFN-gamma and IL-2 were detected only in the dialysate of patients infected with either S. aureus or S. epidermidis. Only one serum sample showed increased IFN-gamma. SIL-2R alpha was found in all the serum and dialysis samples from the first day of infection. Contrary to the analyzed cytokines, the receptor showed severalfold higher levels in serum as compared to the dialysate. During the infection the receptor levels in the dialysate increased, while they remained stationary in the serum, indicating a local production. CONCLUSION: This is the first time IL-10 has been demonstrated in the dialysate during peritonitis in CAPD patients. In view of its role as a suppressor of the immune and inflammatory responses, it is a potentially important observation, which might have clinical implications in the future.
Adult↗
Shedding of soluble interleukin-6 receptor during peritonitis in patients on CAPD.
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Antigens, CD↗
Increase of intra-abdominal fat in patients treated with continuous ambulatory peritoneal dialysis.
OBJECTIVE: To evaluate changes in amount and distribution of body fat in patients treated with continuous ambulatory peritoneal dialysis (CAPD). DESIGN: Prospective study. Computed tomography (CT) and dual energy x-ray absorptiometry (DEXA) were used for determination of body composition at commencement of CAPD, and after a mean of 7.2 months of dialysis treatment. SETTING: CAPD unit at an academic teaching hospital. PATIENTS: The study included 19 consecutive patients who started CAPD during a 15-month time frame. Of these 19 patients, 12 (8 males) with a mean initial age of 60 years completed the study. MAIN OUTCOME MEASURES: Siemens Somatom HiQ (Erlangen, Germany) was used for CT of the abdomen and of the right thigh. Fat and muscle areas were expressed as square centimeters. The proportion of total fat mass was determined by body composition analysis using DEXA (DPX-L densitometer) (Lunar, Madison, WI, U.S.A.) and expressed as percentage of total body weight (FA%). RESULTS: Body weight changed from 67.1 to 68.4 kg (p = 0.20), and the intra-abdominal fat area increased 22.8% (p = 0.02). This increase was predominantly seen in male patients (p = 0.007). The FAT% changed from 27.8% to 30.9% (p = 0.25), without difference between sexes. CONCLUSION: The increase of intra-abdominal fat found in this study may suggest a mechanism by which the established risk for CAPD patients to develop cardiovascular morbidity and mortality may be at least partially explained.
Abdomen↗