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Biomedical subjects

E Pettersson

Publications and source records attributed to E Pettersson.

At least 19 recordsLinked to original sources
PubMed1992

Metabolic control and progression of complications in insulin-dependent diabetic patients after kidney transplantation.

Patient survival and progression of complications were monitored for 3 years after kidney transplantation in 29 type-1 diabetic patients. Ten age-matched, non-diabetic kidney-transplanted patients served as controls. Five diabetic patients died during follow-up (three cardiovascular events, two infections), three diabetic patients had a non-fatal myocardial infarction and four developed cerebrovascular complications after transplantation. Of the diabetic patients, 69% suffered from proliferative retinopathy before transplantation; 20% of them improved, 65% remained unchanged and 15% deteriorated after transplantation. Motor but not sensory conduction velocity measured from the nervus medianus improved after transplantation. Autonomic neuropathy was observed in 50% of the patients and was unaffected by transplantation. Glycaemic control did not improve significantly during follow-up (HbA1, 10.6 +/- 0.5% before and 9.5 +/- 0.6% 3 years after transplantation). Body weight increased in both diabetic and non-diabetic patients within 3 years after transplantation (from 68 +/- 2 to 77 +/- 6 kg in diabetics, P less than 0.01; from 167 +/- 4 to 77 +/- 6 kg in non-diabetics, P less than 0.01). Subcutaneous fat thickness measured from computer tomography scans of the calf increased in diabetic patients from 5.0 +/- 0.6 to 6.1 +/- 0.9 mm (P less than 0.05). However, the cross-sectional areas of triceps and calf muscles did not increase, suggesting that the increase in body weight was solely due to an increase in fat. It is clear that diabetes-related complications continue to progress and are not influenced by a successful kidney transplant.

Adult↗
PubMed1992

Antineutrophil cytoplasmic antibody (cANCA and pANCA) titers in relation to disease activity in patients with necrotizing vasculitis: a longitudinal study.

The significance of the antineutrophil cytoplasmic antibodies, cANCA or pANCA, in relation to disease activity in various types of necrotizing vasculitis was assessed in a longitudinal study. Twenty patients, 14 cANCA positive and 6 pANCA positive were followed for up to seven years. Eleven of the 14 cANCA positive and two out of the 6 pANCA positive patients had Wegener's granulomatosis, two other cANCA patient and one pANCA patient had systemic vasculitis, whereas one cANCA and three pANCA positive patients had disease limited to the kidneys. Disease activity was expressed as a numerical index DAI, based on extent and type of organ involvement (DAI greater than or equal to 5 = active disease). At the time of disease debut the DAI ranged between 11 and 32, cANCA titers between 18 and greater than 1000 U/l, and pANCA titers between 51 and 630 U/l in individual patients. With clinical recovery both c- and pANCA titers declined. Clinical remission (DAI less than 5) occurred within a mean of 2.5 months (range 1 to 4). Almost simultaneously cANCA titers turned negative (less than 10 U/l), although one patient remained positive for seven years. pANCA titers remained positive for long periods of time in 5/6 patients. Five cANCA patients had clinical exacerbations, which in two patients were preceded by seroconversions from - to +, lasting 3 and 12 months before the clinical relapse. One additional cANCA patient had two serological relapses without signs of clinical activity during a 2-year follow-up. In conclusion, we saw a close correlation between DAI and cANCA titers in individual patients: with decreasing clinical activity (DAI), the cANCA titers decrease. Interindividual variation is great; despite a high DAI, the cANCA titers may be relatively low. Serological relapses may indicate forthcoming clinical relapses. Relapses may develop as late as 5-6 years after onset. pANCA titers, on the other hand, tend to remain positive for long periods, despite clinical remission.

Antibodies, Antineutrophil Cytoplasmic↗
PubMed1991

Evidence of aluminium accumulation in aluminium welders.

Using atomic absorption spectrometry the aluminium concentrations in blood and urine and in two iliac bone biopsies obtained from welders with long term exposure to fumes containing aluminium were measured. The urinary excretion of two workers who had welded for 20 and 21 years varied between 107 and 351 micrograms Al/l, more than 10 times the concentration found in persons without occupational exposure. Urinary aluminium excretion remained high many years after stopping exposure. Blood and bone aluminium concentrations (4-53 micrograms Al/l and 18-29 micrograms Al/g respectively) were also raised but not to the same extent as urine excretion. It is concluded that long term exposure to aluminium by inhalation gives rise to accumulation of aluminium in the body and skeleton of health persons, and that the elimination of retained aluminium is very slow, in the order of several years.

Aluminum↗
PubMed1991

Synthesis, NMR and function of an O-phosphorylated peptide, comprising the RGD-adhesion sequence of osteopontin.

The bone phosphoprotein osteopontin owes its cell adhesion property to the RGD-sequence. In order to determine whether a phosphate substituent on the serine following the RGD-sequence interferes with cell binding, we have synthesized GRGDSL along with the corresponding peptide phosphorylated on serine. The latter peptide showed significantly lower cell binding as measured by inhibition of adhesion of R1 cells to surfaces coated with BSP. GRGDSL and phosphorylated GRGDSL show NMR spectra which resemble each other more than that of GRGDSP derived from the fibronectin sequence.

Acetylglucosaminidase↗
PubMed1991

Nutritional assessment in anemic hemodialysis patients treated with recombinant human erythropoietin.

Nutritional status was assessed in 25 anemic hemodialysis patients before and during erythropoietin treatment. Nutritional assessment included regular blood chemistry determinations, anthropometric measurements, analysis of protein content in skeletal muscle, and estimation of daily protein intake from protein catabolic rate determinations (using urea kinetic modelling) and dialysis efficiency for urea. These measurements were done immediately prior to erythropoietin treatment, after anemia correction and after one year of maintenance erythropoietin treatment. Both relative body weights and subcutaneous fat stores were low at the start, but increased significantly (p less than 0.05) during the study. Sixteen of the 25 patients gained weight and eight patients lost weight. The patients with weight gain had at the start of the study low weight indices (body weight 89.9 +/- 7.6% of ideal body weight, body mass index 20.6 +/- 1.6), significantly (p less than 0.005) lower than the patients with weight loss. Although protein malnutrition was not obvious from arm anthropometrics, alkali soluble protein/DNA ratio or from serum albumin determinations, ASP/DNA ratio, increased in three of five patients investigated after one year on erythropoietin treatment. Neither protein catabolic rate nor dialysis efficiency changed significantly during the study. We conclude that anemia correction with erythropoietin has a positive effect on malnutrition in hemodialysis patients. In patients with underweight, an adjustment of fat stores was initially observed, followed possibly by an improvement in muscle protein content.

Adult↗
PubMed1990

Erythropoietin treatment improves quality of life in hemodialysis patients.

The influence of anemia on quality of life was investigated in 11 hemodialysis patients (three male, eight female, mean age 37 +/- 13 years) undergoing erythropoietin (EPO) therapy. This was done using coded self-report questionnaires given to the patients prior to EPO therapy (mean hemoglobin 75 +/- 12 g/l) and again when the target hemoglobin value of 100 g/l was reached (1-5 months). The questionnaire included 93 multiple choice questions to measure physical, social and emotional wellbeing. As expected physical wellbeing improved (p less than 0.05). In addition a significant improvement was seen in social and emotional wellbeing (p less than 0.05). The greatest improvements were seen in health satisfaction (p less than 0.01), physical activity of daily life (p less than 0.05) and emotional wellbeing (p less than 0.05).

Adult↗
PubMed1990

Abnormally thin glomerular basement membrane and the Goodpasture epitope.

Using indirect immunofluorescence, cryostat sections from renal biopsy specimens of 14 adult patients showing marked diffuse thinning of the glomerular basement membrane (GBM) on ultrastructural analysis were examined for the presence of the Goodpasture (GP) epitope M2 using anti-M2 antiserum. In no case was a total absence of M2 noted. The fluorescence pattern was fine but homogeneously linear along the GBM in 12 cases, intensity varying from +-++, as compared with for the control specimen GBM. A faint, broken line of stain, intensity+, was observed in biopsy specimens of two patients, one of whom had family members with progressive hereditary nephritis, type Alport's syndrome. Clinical presentation was dominated by hematuria (10/14 patients) but also included three patients with isolated proteinuria. Two patients had nephrotic range proteinuria. Other than the GBM changes, histological findings were sparse, with either no abnormalities or only slight mesangial increase in most. One case of focal segmental sclerosis and hyalinosis was also found. The findings from this study suggest that the abnormally thin GBM does not lack the GP epitope, but it may be reduced.

Adult↗
PubMed1990

[Diagnosis in hematuria].

In investigation of hematuria the aim is as much to exclude serious illness as to establish the diagnosis. Hematuria which is demonstrated by a test strip should always be verified by examination of sediment. The further investigation comprises depiction of the kidneys with ultrasound examination together with cytological inspection of the urine and cystoscopy. The investigation is supplemented at need with computer tomography or angiography. Hematuria and simultaneous proteinuria or the incidence of pathological cylinders indicate parenchymatous kidney disease where the diagnosis is verified by renal biopsy. Hematuria in young individuals is usually due to infection, concrement or parenchymatous kidney disease. Already at age 40, however, cancer must be considered.

Adult↗
PubMed1989

Proteinuria and haematuria are frequently present in patients with lung cancer.

The aim of the study was to ascertain whether there is an increased occurrence of proteinuria and/or haematuria among lung cancer patients. As a control group we selected patients with bronchial asthma treated at the same hospital and during the same period as the lung cancer patients. The study comprised a retrospective part, where observations were made at two hospitals on 166 and 284 lung cancer patients. Proteinuria was observed in 9% and 13% and haematuria in 5% and 9% of these patients. The prevalences were significantly greater than among the asthmatic patients. This result prompted a prospective case-control study involving 150 consecutive patients with lung cancer and asthma, respectively. Twelve patients in the cancer group and one asthmatic patient had a daily urine protein excretion exceeding 100 mg (P less than 0.004); haematuria was noted in 14 and one, respectively (P less than 0.002). We conclude that the occurrence of proteinuria and haematuria is unexpectedly increased among patients with lung cancer.

Aged↗
PubMed1989

Reversal of postoperative somnolence using a two-rate infusion of physostigmine.

In order to antagonize immediate postoperative somnolence, 24 surgical patients were given a two-rate infusion of physostigmine, aiming at a constant plasma concentration in the range of 1 to 10 ng/ml. Plasma concentrations of physostigmine were determined during infusion and after infusion and the effects of physostigmine on analgesia and postoperative sedation, and its side effects were monitored throughout. On the 1st postoperative day some of the patients (n = 8) were given 5 mg physostigmine orally, after which plasma concentrations as well as effects were measured. Steady-state concentrations were generally lower than predicted. Clearance varied between 10 and 85 ml/min x kg with a mean of 40.8 +/- 21.0 ml/min x kg. Oral bioavailability was 25.3 +/- 11.1%. Physostigmine administered as an intravenous infusion antagonized immediate postoperative somnolence in 21 out of 24 patients. Effects were poorly correlated with the established steady-state concentration of physostigmine. The patients' experience of postoperative pain relief was mostly satisfactory and the side effects of physostigmine infusion were generally limited. The effects of physostigmine in the immediate postoperative period seemed dependent on the dose as well as on the time which had elapsed since administration of anticholinergic drugs. After oral physostigmine administration the following morning, the majority of patients experienced side effects such as nausea and abdominal pain. In conclusion, physostigmine given as infusion antagonizes postoperative somnolence. However, the arousal effect was considered not better than that resulting from a bolus dose of the drug, although the infusion regimen allowed a prolonged clinical effect duration.

Administration, Oral↗
PubMed1987

The evolution of membranous glomerulonephritis reconsidered: new insights from a study on relapsing disease.

Membranous glomerulonephritis (MGN) has a highly variable clinical course. The morphological basis for this variability has not been fully elucidated. We studied 10 patients with relapsing MGN and compared the findings with those in other clinical courses. The mean duration of follow-up was 10.4 years. Clinical remission occurred, on average, 1.5 years and relapse, on average, 5.6 years after onset. Thirty-one renal biopsies obtained at various clinical phases were studied, 22 of them electron microscopically. The ultrastructural and clinical alterations paralleled each other closely. Subepithelial electron-dense deposits were present during the primary nephrotic phase, were replaced by intramembranous lucent deposits during remission, and reappeared again during relapse. Light microscopic changes (projections, thickening) of the glomerular capillary basement membrane (GBM) were variable. Both ultrastructural and light microscopic changes were unreliable indicators of the duration of illness. A comparative analysis of the present and previous findings suggests that the length of time during which new deposit material is formed determines the evolution of the membranous lesion and the corresponding clinical course. Thus, a short duration results in a single generation of deposits, a morphologically and clinically healing course, and no thickening of the GBM. A repeated formation of deposit material results in a new generation of subepithelial deposits, and a relapsing course. A prolonged formation results in a continuous presence of subepithelial deposits, a thickening of the GBM, and a protracted or progressive course. The morphologic staging currently in use pertains to one particular evolution and course of MGN and therefore should not be used.

Adult↗
PubMed1986

CMV infection, class II antigen expression, and human kidney allograft rejection.

After successful transplantation, the major histocompatibility complex (MHC) antigens of kidney parenchymal cells are lost and no longer detectable in the graft, presumably due to administration of glucocorticosteroids. During rejection, the MHC antigens reappear in the graft parenchymal cells. The upregulation is possibly due to gamma-interferon released in situ by the allograft activated T (blast) cells. In this communication we demonstrate that cytomegalovirus (CMV) infection is invariably associated with an upregulation of the antigen display in the graft. In 12 of 14 (86%) cases with proved CMV disease, the display of class II antigens was associated with a cytological and/or clinical episode of rejection. In 223 transplant recipients without proved CMV disease transplanted during the same period, the frequency of late rejections was 17% (P less than 0.001). The results suggest that the display of class II antigens on the graft, mediated presumably by gamma-interferon as a consequence of CMV infection, is the reason for graft rejection in context of CMV disease.

Cytomegalovirus Infections↗