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Biomedical subjects

F Lithner

Publications and source records attributed to F Lithner.

At least 19 recordsLinked to original sources
PubMed2001

[Diabetic metabolism protective in severe acute intermittent porphyria].

In AIP attacks there is an escalating metabolic chain reaction leading to heme deficiency and increased levels of porphyrin precursors. This reaction is inhibited by treatment with glucose or heme arginate. In a population-based study in the two most northerly counties of Sweden (Norrbotten and Västerbotten), out of 319 patients > 18 years of age with DNA-verified AIP, 16 had type-2 diabetes. None of the 16 patients showed AIP symptoms after the onset of their diabetes. Three patients had suffered recurrent, severe attacks for many years, but after onset of diabetes their ALA and PBG levels decreased and the AIP symptoms resolved, to the relief of the patients. In a study of the 30 AIP patients with hepatocellular carcinoma (HCC) none had diabetes. This implies that diabetic metabolism may prevent the development of HCC in patients with AIP. The prevalence of AIP patients with diabetes was lower than the prevalence of diabetic patients in the general population. This study shows that diabetes mellitus may be beneficial for patients with severe AIP.

Adolescent↗
PubMed2001

[Neuropathy of the lower legs and feet in acute intermittent porphyria. A comparison of patients with type 1 diabetes and patients with AIP].

Distal neuropathy was assessed in 339 patients with acute intermittent porphyria (AIP). The chronic neurological signs were symmetrical and similar to those in Type 1 diabetic patients. Significant impairment was found concerning perception, extensor digitorum brevis test, lower leg pain, ankle and knee tendon reflexes but not concerning dry feet, loss of forefoot arch and hammer toes, when comparing patients with manifest vs. latent AIP. The neurological signs were more severe in the diabetic patients (n = 298). Five AIP patients had permanent quadriplegia and renal failure after severe attacks. Patients with manifest AIP had significantly more signs of distal chronic, symmetrical neuropathy of axonal type than had patients with latent AIP. More serious neurological lesions appear to develop after severe attacks.

Adult↗
PubMed2001

[Unsatisfactory pain treatment in attacks of acute intermittent porphyria. Vasodilation an alternative if the pain is shown to be the pain of intestinal angina].

Abdominal pain is by far the most serious symptom in attacks of acute intermittent porphyria (AIP). Its cause is unknown. This case suggests visceral ischemia as a possible cause of the abdominal pain. A 31-year-old woman with recurrent bouts died during an attack; the autopsy revealed a 20 cm necrotic gangrene in the ileum. A protracted intestinal vasospasm could have been the immediate cause of death. The question as to whether intestinal angina could be the cause of abdominal pain in acute intermittent porphyria is discussed.

Abdominal Pain↗
PubMed2001

Increased mortality in diabetes during the first 10 years of the disease. A population-based study (DISS) in Swedish adults 15-34 years old at diagnosis.

OBJECTIVES: To study, prospectively, in young adult patients, the mortality during the first years after the diagnosis of diabetes. DESIGN: The Diabetes Incidence Study in Sweden (DISS) aims to register all incident cases aged 15-34 years. During a 10-year period all deaths were identified by record linkage to the national Cause of Death Registry. SUBJECTS: During the period, 4097 new cases were registered and classified as type 1 diabetes (73%), type 2 (16%), secondary (2%) and unclassified (9%). The median follow-up was 5 years (21 001 person-years). MAIN OUTCOME MEASURES: Calculation of the standardized mortality ratio (SMR) and 95% confidence interval (CI). Evaluation of all deceased by scrutiny of clinical records, death certificates and autopsy protocols. RESULTS: Fifty-eight patients died, corresponding to an SMR of 3.5 (CI=2.7-4.5), which increased from 1.5 at 15-19 years to 4.1 at 30-34 years. SMR was 2.7 in primary diabetes: 2.3 (1.6-3.3) in type 1 and 4.1 (2.6-6.7) in type 2. In secondary diabetes, alcohol-associated pancreatitis a common cause, SMR was 32 (CI=24-45). Evidence of alcohol or drug misuse, mental dysfunction or suicide was found in 40 of all 58 deceased cases. Less often, hypoglycaemia (n=7) or hyperglycaemia-ketoacidosis (n=11) was present at death. Unexplained 'dead in bed' was found once. CONCLUSIONS: In the investigated population-based cohort the early mortality was about threefold increased. Hypoglycaemia and ketoacidosis per se played a relatively small role compared with a heavy impact from social and mental dysfunction, and from careless use of alcohol or drugs.

Adolescent↗
PubMed2000

Women's experience of suffering repeated severe attacks of acute intermittent porphyria.

The aim of this study was to elucidate the experiences of the women with severe, recurrent attacks of porphyria and how they coped with them successfully. A total of five women were interviewed and were encouraged to describe their experiences. Thematic content analysis was used to interpret the significance of their narratives. The result demonstrated that the women's experience was of living in deepest darkness with inexpressible pain, both physical and mental. Coming into contact with health care had its good and bad points. It was often difficult to cope with life during severe periods of the disease. The process of maturation towards a more positive existence seemed to follow a pattern of accepting the disease, continuing the fight until it was finally possible to discover a pattern and meaning in life that suited the individual concerned.

Abdominal Pain↗
PubMed2000

Could attacks of abdominal pain in cases of acute intermittent porphyria be due to intestinal angina?

Abdominal pain is by far the most serious symptom in attacks of acute intermittent porphyria. Its cause is unknown. This case study suggests visceral ischaemia as a possible cause of the abdominal pain. A 31-year-old woman with recurrent bouts died during an attack; the autopsy revealed a 20-cm necrotic gangrene in the ileum. A protracted intestinal vasospasm could have been the immediate cause of death. It is discussed whether intestinal angina could be the cause of the abdominal pain in acute intermittent porphyria.

Abdominal Pain↗
PubMed2000

Signs of neuropathy in the lower legs and feet of patients with acute intermittent porphyria.

OBJECTIVE: To assess signs of distal neuropathy in patients with acute intermittent porphyria (AIP). DESIGN: A population-based study. SUBJECTS: All patients with DNA-verified AIP >/= 18 years of age in the four most northerly counties of Sweden. INTERVENTION: Validated neuropathic signs and tests such as monofilament test, neuropathic pain, dry feet, extensor digitorum brevis (EDB) test, loss of forefoot arch, hammer toes and ulceration. RESULTS: A total of 356 patients were registered and 339 of them (95%) participated in the neuropathy study. The chronic neurological signs were symmetrical and similar to those in type 1 diabetic patients. Significant impairment was found concerning perception, EDB test, lower leg pain, ankle and knee tendon reflexes, but not concerning dry feet, loss of forefoot arch and hammer toes, on comparing patients with manifest versus latent AIP. The neurological signs were more severe in the diabetic patients (n = 298). Five AIP patients had permanent quadriplegia after severe attacks. CONCLUSIONS: Patients with manifest AIP had significantly more signs of distal chronic, symmetrical neuropathy of axonal type than did patients with latent AIP. More grave neurological lesions appear to develop after severe attacks.

Adolescent↗
PubMed2000

Renal symptomatology in patients with acute intermittent porphyria. A population-based study.

OBJECTIVE: Can renal insufficiency in subjects with acute intermittent porphyria (AIP) be due solely to DESIGN: A population-based study. SUBJECTS: Subjects with AIP > or = 18 years of age (n = 386) in the four most northerly counties of Sweden. INTERVENTIONS: Screening with creatinine clearance at 24 h. Patients below the lower reference level underwent a repeat clearance test and, if still low, also chromEDTA clearance. RESULTS: 286 (74%) subjects performed the creatinine clearance test and in 57 clearance was low; the second clearance proved normal in 23 who were then excluded. Eighteen subjects with other possible medical reasons for renal insufficiency, ethical reasons or refusing further examinations were also excluded. The 16 remaining subjects with no explanation for their renal insufficiency other than AIP were then studied in detail. All 14 women, mean age 52 years, and two uraemic men, 58 and 67 years, had manifest AIP. Twelve patients had hypertension (HT) and four were normotensive in spite of renal insufficiency. Histological findings of renal biopsies revealed diffuse glomerulosclerotic and interstitial changes with additional ischaemic lesions. CONCLUSION: Protracted vasospasm in attacks of AIP may be a cause of renal lesions. This is discussed.

Adolescent↗
PubMed2000

The W198X and R173W mutations in the porphobilinogen deaminase gene in acute intermittent porphyria have higher clinical penetrance than R167W. A population-based study.

In northern Sweden, 468 patients with DNA-verified acute intermittent porphyria (AIP) were registered. A higher prevalence of manifest AIP was found in patients with mutations W198X and R173W when separately compared with mutation R167W, indicating higher clinical penetrance. Signs of increased seriousness of the disease were also found in patients with the W198X and R173W mutations in relation to the number and duration of attacks, impaired renal function and chronic disability. One explanation could be lower PBGD enzyme activity resulting from the W198X and R173W mutations than from the R167W mutation, though other factors might also be the cause.

Female↗
PubMed2000

Prognostic factors for the course of beta cell function in autoimmune diabetes.

This study presents a 2-yr follow-up of 281 patients, aged 15-34 yr, diagnosed with diabetes between 1992 and 1993. At diagnosis, 224 (80%) patients were positive for at least one of the following autoantibodies: islet cell antibodies (ICAs), glutamic acid decarboxylase antibodies (GADAs), or tyrosine phosphatase antibodies (IA-2As); the remaining 57 (20%) patients were negative for all three autoantibodies. At diagnosis, C-peptide levels were lower (0. 27; 0.16-0.40 nmol/L) in autoantibody-positive patients compared with autoantibody-negative patients (0.51; 0.28-0.78 nmol/L; P: < 0. 001). After 2 yr, C-peptide levels had decreased significantly in patients with autoimmune diabetes (0.20; 0.10-0.37 nmol/L; P: = 0. 0018), but not in autoantibody-negative patients. In patients with autoimmune diabetes, a low initial level of C-peptide (odds ratio, 2. 6; 95% confidence interval, 1.7-4.0) and a high level of GADAs (odds ratio, 2.5; 95% confidence interval, 1.1-5.7) were risk factors for a C-peptide level below the reference level of 0.25 nmol/L 2 yr after diagnosis. Body mass index had a significant effect in the multivariate analysis only when initial C-peptide was not considered. Factors such as age, gender, levels of ICA or IA-2A or insulin autoantibodies (analyzed in a subset of 180 patients) had no effect on the decrease in beta-cell function. It is concluded that the absence of pancreatic islet autoantibodies at diagnosis were highly predictive for a maintained beta-cell function during the 2 yr after diagnosis, whereas high levels of GADA indicated a course of decreased beta-cell function with low levels of C-peptide. In autoimmune diabetes, an initial low level of C-peptide was a strong risk factor for a decrease in beta-cell function and conversely high C-peptide levels were protective. Other factors such as age, gender, body mass index, levels of ICA, IA-2A or IAA had no prognostic importance.

Adolescent↗
PubMed1999

Retinopathy in diabetic patients aged 15-50 years in the county of Umeå, Sweden.

PURPOSE: To examine the prevalence of diabetic retinopathy and its relation to certain risk factors (glycosylated hemoglobin, blood pressure, serum creatinine, proteinuria, smoking) in a population-based study on a specific age-group of patients with diabetes mellitus in the county of Umeå, Sweden. METHODS: All diabetic patients aged 15-50 years living in the county of Umeå were invited to the study. A standard clinical and eye examination was performed, and seven-field stereoscopic photographs were taken of each eye. Blood and urine samples were collected. Univariate and multivariate statistical analyses were performed. RESULTS: Of the eligible 395 patients 285 (91%) participated in the study. 285 patients (79%) had diabetes mellitus type 1, 71 (20%) subjects had diabetes mellitus type 2, and 3 patients (1%) had secondary diabetes. In the statistical analysis performed on patients with type 1 diabetes mellitus, duration, presence of hypertension, systolic blood pressure, plasma glucose, glycosylated hemoglobin, serum creatinine, proteinuria and smoking all were significantly related to increasing degree of retinopathy when a univariate model was applied. However, when a multivariate analysis was performed only duration, proteinuria, glycosylated hemoglobin and male gender were statistically significantly associated with severeness of retinopathy. CONCLUSION: Increased duration of diabetes, inadequate metabolic control as measured by glycosylated hemoglobin, proteinuria and male gender are factors that are associated with a higher incidence of diabetic retinopathy in diabetes mellitus type 1.

Adolescent↗
PubMed1999

The association of hyperlipidemia with retinopathy in diabetic patients aged 15-50 years in the county of Umeå.

PURPOSE: To study possible associations between serum lipid levels and degree of retinopathy in a population-based study on a specific age-group of patients with diabetes mellitus in the county of Umeå, Sweden. METHODS: All patients with diabetes mellitus aged 15-50 years living in the county of Umeå were invited to the study. The participating subjects had a standard clinical examination and an eye examination performed. Seven-field stereoscopic photographs were taken of each eye, and the photos were sent to Grading Center, Hammersmith Hospital, London, U.K. for grading of the retinopathy. Blood samples were drawn for analysis of lipoprotein(a), high density lipoprotein (HDL) cholesterol, cholesterol and triglycerides. Univariate and multivariate statistical analyses were performed. RESULTS: In the present study only patients with type 1 diabetes mellitus were included, and 285 of the invited 308 diabetic subjects (93%) took part. When univariate analysis was applied we found statistically significant associations between higher lipoprotein(a) levels, higher triglyceride levels, higher cholesterol levels, lower HDL cholesterol/total cholesterol ratios and increasing severeness of retinopathy. However, in the multivariate analysis triglyceride levels lost their importance while all other significant associations were still present. CONCLUSION: Associations were found between higher levels of serum total cholesterol, declining ratios of high density lipoprotein (HDL) cholesterol/total cholesterol, higher levels of serum lipoprotein(a) and more severe retinopathy in diabetes mellitus type 1. No such association was found between serum triglycerides and degree of retinopathy.

Adolescent↗
PubMed1999

Effects of diabetes mellitus on patients with acute intermittent porphyria.

OBJECTIVES: To study the effects of diabetes mellitus in patients with acute intermittent porphyria (AIP). Haeme deficiency in the liver of AIP patients stimulates an increase in ALA-synthase which triggers an escalating metabolic chain reaction, leading to an increase in the porphyrin content. This reaction can be reduced by treating AIP patients with haeme arginate or with glucose. DESIGN: A population-based study of all patients > 18 years of age having DNA-verified AIP (n = 328) living in the two most northerly counties of Sweden (Norrbotten and Västerbotten, with 550,000 inhabitants) of whom 16 had type 2 diabetes. Prevalence of diabetes was studied retrospectively in 26 AIP patients with hepatocellular carcinoma (HCC). RESULTS: None of the patients showed symptoms of AIP after the onset of their diabetes. Three patients had had recurrent, severe attacks for many years but when their diabetes became manifest, their urinary ALA and PBG levels decreased and the AIP symptoms resolved, to the relief of the patients. Amongst the 26 AIP patients with HCC, only one with signs of diabetes was identified (impaired glucose tolerance test). CONCLUSIONS: This study raises the possibility that diabetes mellitus may be beneficial for patients with severe AIP.

Age of Onset↗
PubMed1999

Prevalence of gastrointestinal symptoms in young and middle-aged diabetic patients.

BACKGROUND: Gastrointestinal disorders have been reported in patients with diabetes mellitus. The present investigation was carried out to evaluate the frequency of gastrointestinal symptoms in out-clinic diabetic patients in the county of Umeå, Sweden. METHODS: Diabetic patients aged 24-59 years residing in Umeå County (population, 136,000) were included in the study (n = 489), as were 200 sex- and age-matched healthy controls. A questionnaire was mailed to the patients and controls, and a reminder was sent 5 months later. The questionnaire contained 28 questions concerning gastrointestinal symptoms, bowel habits, and medication during the preceding year. RESULTS: Fifty-nine per cent of the patients and 53% of the controls responded. The total number of reported gastrointestinal symptoms was significantly greater in patients (1.25 +/- 0.10; mean +/- standard deviation) than in control subjects (0.50 +/- 0.08). This increase was seen in both type-1 (1.12 +/- 0.11) and type-2 (1.52 +/- 0.25) diabetic patients. Female diabetic patients reported significantly more symptoms than did male patients (1.59 +/- 0.17 and 0.81 +/- 0.12, respectively). Patients with neuropathy had significantly more symptoms than the other patients. Symptom frequency was not correlated with nephropathy or retinopathy or with the duration of diabetes, body mass index, glycosylated haemoglobin, or insulin dose. Heartburn, constipation, and nocturnal urge to defecate were significantly more frequent in patients than in controls. Furthermore, a feeling of incomplete defecation, a need to strain at defecation, and urgency were significantly more common in patients. CONCLUSION: Diabetic patients had more gastrointestinal symptoms than non-diabetic population. These symptoms did not correlate with duration of the disease, metabolic control, or any other complication except neuropathy. Heartburn and constipation were among the symptoms that occurred more frequently in diabetic patients than in the non-diabetic population.

Adult↗
PubMed1999

Islet cell and glutamic acid decarboxylase antibodies present at diagnosis of diabetes predict the need for insulin treatment. A cohort study in young adults whose disease was initially labeled as type 2 or unclassifiable diabetes.

OBJECTIVE: To clarify the predictive value of islet cell antibody (ICA) and GAD65 antibody (GADA) present at diagnosis with respect to the need for insulin treatment 6 years after diagnosis in young adults initially considered to have type 2 or unclassifiable diabetes. RESEARCH DESIGN AND METHODS: The patient material was representative of the entire Swedish population, consisting of patients who were 15-34 years old at diagnosis of diabetes in 1987-1988 but were not considered to have type 1 diabetes at onset. At follow-up, 6 years after the diagnosis, it was noted whether the patient was treated with insulin. The presence of ICA was determined by an immunofluorescence assay, and GADAs were measured by a radioligand assay. RESULTS: Six years after diagnosis, 70 of 97 patients were treated with insulin, and 27 of 97 patients were treated with oral drugs or diet alone. At diagnosis, ICAs and GADAs were present in 41 (59%) of 70 patients and 41 (60%) of 68 patients, respectively, of those now treated with insulin, compared with only 1 (4%) of 26 patients and 2 (7%) of 27 patients who were still not treated with insulin. For either ICA or GADA, the corresponding frequencies were 50 (74%) of 68 for patients who were later treated with insulin and 3 (12%) of 26 for those who were still not treated with insulin, respectively. The sensitivity for later insulin treatment was highest (74%) for the presence of ICA or GADA, and the specificity was highest (100%) for ICA and GADA. The positive predictive value was 100% for the combination of ICA and GADA, 98% for ICA alone, and approximately 95% for GADA alone. CONCLUSIONS: Determination of the presence of ICA and GADA at diagnosis of diabetes improves the classification of diabetes and predicts the future need of insulin in young adults.

Adult↗