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Biomedical subjects

F Lithner

Publications and source records attributed to F Lithner.

At least 37 records · Page 2Linked to original sources
PubMed1999

Appearance of islet cell autoantibodies after clinical diagnosis of diabetes mellitus.

Islet cell antibodies (ICA) and glutamic acid decarboxylase antibodies (GAD65Ab) are often present at diagnosis of insulin dependent diabetes mellitus (type I diabetes) and are supposed to decline in level and frequency during the first years of disease. We have analysed ICA and GAD65Ab at onset and after one year in 395 population based randomly selected 15-34 year old patients newly diagnosed with diabetes mellitus, to study how these autoantibodies persist, disappear and appear and their relation to C-peptide levels. Of the 395 samples 212 (54%) were positive for ICA, 250 (63%) were positive for GAD65Ab and 170 (43%) were positive for both. At follow up after one year, 27/183 (15%) of the ICA negative patients and 25/145 (17%) of the GAD65Ab negative patients had converted to positivity. Among the 103 patients negative for both ICA and GAD65Ab, 16 turned positive for one or both antibodies after one year. Patients converting to positivity for one or the other antibody after one year, had lower C-peptide levels after one year than patients who initially were and remained negative, supporting the hypothesis that these patients have a genuine type I diabetes. In conclusion, newly diagnosed patients may be negative for autoantibodies at diagnosis but develop these antibodies later on during the disease.

Adolescent↗
PubMed1998

Assessment of possible nephrotoxicity from iohexol in patients with normal and impaired renal function.

PURPOSE: To evaluate the possible nephrotoxic effects of iohexol in patients with normal and impaired renal function. MATERIAL AND METHODS: A prospective urographic study using iohexol (50 ml, 300 mg I/ml) was performed in 100 patients, 63 with impaired renal function (IRF) and 37 with normal renal function (NRF). The group included 24 patients with diabetes mellitus, 17 of them with IRF. Renal function parameters and adverse events were recorded for one week after the urography. RESULTS: There were no significant changes in serum creatinine, creatinine clearance, or beta-2-microglobulin. The 24-h urine protein excretion showed a statistically significant increase in patients with NRF as well as in patients with IRF. Nine patients experienced adverse events but none of them required any treatment. CONCLUSION: Iohexol was tolerated well in patients with NRF and in patients with IRF without significant overall nephrotoxic effects. Some minor adverse events were recorded.

Adult↗
PubMed1997

Lifestyle as regards physical exercise, smoking and drinking, of adult insulin-treated diabetic people compared with non-diabetic controls.

Chronic complications in diabetes are sometimes associated with living habits. To investigate whether diabetic people's habits of smoking, drinking alcohol and taking physical exercise differed from those of the general population, a questionnaire was sent to 561 insulin-treated diabetic people and to 1,125 controls, matched for age, sex and domicile. Diabetic people were current smokers as often as controls (21% vs 23%; ns), but they drank less alcohol and more of them were non-drinkers (22% vs 13%; p < 0.001). Diabetic people more often took physical exercise than did controls (40% vs 28%; p < 0.001). Diabetic women were more seldom smokers (18% vs 26%; p < 0.05), more often non-drinkers (26% vs 14%; p < 0.001) and exercised regularly more (44% vs 28%; p < 0.001) than female controls. Diabetic men were more similar to male controls in their habits. Young diabetic people drank less alcohol and were more often non-drinkers (22% vs 9%; p < 0.001) compared with their controls. Comparison within the diabetic group showed that men drank alcohol more frequently and in greater amounts, and that more women were non-drinkers (26% vs 18%; p < 0.05). People with chronic complications drank less frequently and exercised less regularly (34% vs 44%; p < 0.05) than those without complications. These findings suggest that diabetic people's smoking, drinking and exercise habits are rather similar to general people's. However, diabetic women seem to take risk factors for developing complications into consideration more than men, which could reflect a true gender pattern and/or be an effect of worrying more about diabetes.

Adult↗
PubMed1996

Patient administrative system as a tool to validate the ascertainment in the diabetes incidence study in Sweden (DISS).

The aim of this study was to evaluate the degree of ascertainment in a nationwide prospective registration of incident cases of diabetes mellitus in the age group 15-34 years (The Diabetes Incidence Study in Sweden (DISS)). Incident cases of diabetes mellitus in DISS during a five year period were compared with inpatients, with the diagnosis of diabetes mellitus, registered in a routine computer-based administrative register. The Patient Administrative System-Inpatient Care (PAS-IC). To clarify this issue the two-sample capture-recapture phenomena was employed in the two southernmost counties in Sweden, Malmöhus and Kristianstad, covering 9.2% of the total of 2.3 million people aged 15-34 years in Sweden. The results showed that the ascertainment level in DISS was 0.86 for insulin dependent diabetes mellitus (IDDM). Hence, the DISS registry is a valid tool to monitor the incidence of IDDM in young (15-34 years) adult subjects.

Adolescent↗
PubMed1996

The epidemiology of hepatocellular carcinoma in patients with acute intermittent porphyria.

OBJECTIVE: To describe the epidemiology, pathogenesis and clinical features of hepatocellular carcinoma (HCC) in patients with acute intermittent porphyria (AIP). DESIGN: A retrospective population-based mortality study. SUBJECTS: All inhabitants who died between 1978-1990 (2122) including 33 with AIP, in two municipalities in northern Sweden with a high prevalence of AIP. INTERVENTIONS: Death certificates and hospital records were examined. Histological re-examination of paraffin-embedded specimens from patients with HCC was performed and hepatitis B virus content analysed. RESULTS: HCC was found in 27% of patients with AIP versus 0.2% of the deceased non-AIP subjects, P < 0.0001. HCC was more common in women (men:women 1:2) and in manifest AIP (manifest: latent 2:1). Liver cirrhosis was more common in AIP patients (12%), especially in women, compared with controls (0.5%), P < 0.0001. CONCLUSIONS: AIP patients seem to have an increased risk of developing HCC. This tumour is more common in patients with manifest AIP and in women, a reversal of the usually reported gender ratio for HCC. No cause for developing HCC other than AIP was found. The pathogenesis may be explained by abnormalities in porphyrin metabolism and by intrinsic production of mutagenic substances, resulting in a condition of systemic overload of oxidative stress, enhancing mutation rate and liver cell injury. Liver cirrhosis appears to be more common in AIP patients and may be a preliminary stage to HCC. All AIP gene carriers aged > or = 55 should be screened for HCC.

Aged↗
PubMed1996

Preventive treatment of foot deformities in type 1 diabetic patients aged 15-50 years--an epidemiological and prospective study.

OBJECTIVES: To prevent worsening of foot deformities in diabetic patients. DESIGN: A population-based and prospective study. SUBJECTS: All patients in the county of Umeå with Type 1 diabetes mellitus (DM) (n = 308) aged 15-50 years. MAIN OUTCOME MEASURES: Examination and individual education was performed. Patients with the most pronounced foot deformities (n = 67) were fitted with custom-made insoles and had repeated foot examinations. An identical examination was used at a 3-year follow-up. RESULTS: Patients who were fitted with insoles had higher sensory thresholds for vibration compared to those with no insoles. They were older and had longer duration of DM. Improvement of foot deformities was significantly more common in patients after treatment with insoles than in patients without. Plantar ulcers did not occur in patients with moulded insoles. CONCLUSION: Information, follow-up examinations and moulded insoles improve neuropathic foot deformities in many patients, even in those with pronounced deformities.

Adolescent↗
PubMed1996

Assessment of autonomic nerve function in acute intermittent porphyria; a study based on spectral analysis of heart rate variability.

OBJECTIVES: To assess the function of the autonomic nervous system in patients with acute intermittent porphyria by spectral analysis of the heart rate variability. DESIGN: A cross-sectional case-control study. SETTING: Patients were examined at the Primary Health Care Centre, Arjeplog and at Umeå University Hospital, where the controls were also examined. SUBJECTS: Twenty-three patients with acute intermittent porphyria verified by DNA analysis and 92 healthy controls were included. MAIN OUTCOME MEASURES: The mid-frequency band power after tilting was used to evaluate sympathetic function, and the high frequency band power during controlled breathing at 12 breaths min-1 and the mid-frequency band power during controlled deep breathing at 6 breaths min-1 were used to evaluate parasympathetic function. RESULTS: There was no evidence of sympathetic dysfunction in the patients. The mid-frequency band power during controlled deep breathing at 6 breaths min-1 was significantly (P = 0.02) lower in the patient group. CONCLUSIONS: Our findings indicate a parasympathetic dysfunction in patients with acute intermittent porphyria. This may be causally related to sudden cardiac death and the life-threatening arrhythmias which have been observed in this disorder.

Adult↗
PubMed1996

Epidemiology and clinical characteristics of seizures in patients with acute intermittent porphyria.

The objectives of this study were to investigate the lifetime prevalence of epileptic seizures in a population with acute intermittent porphyria (AIP) and to characterize the seizures and the seizure-triggering factors. A letter was sent to all patients with known AIP in Sweden registered at the National Porphyria Center (n = 294). The medical records of patients who had had epileptic seizures were reviewed in detail. The letter was answered by 268 patients (91.2%). Ten patients (3.7%) reported epileptic seizures. Eight were women (mean age 54.1 years, range 30-81 years), and 2 were men (mean age 19 years, range 9-29 years). Six patients had tonic-clonic seizures and 4 had partial seizures becoming secondarily generalized. Serum sodium levels were low in 3 patients (mean 110, range 103-120 mM), and normal in 5. Excretion of 5-aminolevulinic acid (ALA) in the urine was increased in 4 patients at the time of the seizures. In 6 patients, the seizures were associated with an acute attack of AIP (all patients with hyponatremia included). The lifetime prevalence of AIP-associated seizures was 2.2% of all those with known AIP and 5.1% of all those with manifest AIP. Epileptic seizures among persons with AIP are less common than has been previously described.

Adolescent↗
PubMed1996

Hepatocellular carcinoma in patients from northern Sweden with acute intermittent porphyria: morphology and mutations.

More than a decade ago an association between acute intermittent porphyria (AIP) and hepatocellular carcinoma (HCC) was reported, but still the cause of the increased prevalence is unknown. Paraffin sections of formalin-fixed HCC from 17 AIP patients were reexamined and also screened for relevant mutations using several methods. The tumor diagnosis was verified, and in several cases precirrhosis and cirrhosis were also found. The clinically founded AIP diagnosis was verified at the gene level in most cases, demonstrating the Norrland type of mutation, i.e., G(593)-to-A substitution in codon 198 of the porphobilinogen deaminase (PBGD) gene. The second allele was neither mutated nor missing, contradicting the possibility that the PBGD gene might function as a tumor suppressor gene. Subsequent sequencing showed that cases not cleaved by the restriction enzyme NheI lacked the specific Norrland mutation. In recent years, selective mutations at codons 249 and 166 of the p53 gene have been described in HCC associated with aflatoxin and hepatitis B virus. In our area, with low exposure to those agents, no mutations in codon 249 were found, and mutation in codon 166 was excluded in all tumors except one; no traces of hepatitis B DNA were observed. Nor did we find mutations in H-ras 12 or 61. Intrinsic aberrations in AIP, including reduced heme synthesis and endogenous oxidative damage to DNA, may incite carcinogenic mutations elsewhere in the genome of liver cells. The increased cell proliferation coupled to precirrhosis and cirrhosis perhaps represents promotion in the initiation-promotion sequence of hepatocarcinogenesis.

Adenine↗
PubMed1995

Diagnosis of acute intermittent porphyria in northern Sweden: an evaluation of mutation analysis and biochemical methods.

OBJECTIVE: To validate the use of a recently observed guanine to adenine mutation in exon 10 in the porphobilinogen deaminase (PBGD) gene as a diagnostic marker of acute intermittent porphyria (AIP). To evaluate the efficiency of the traditional biochemical diagnostic methods. DESIGN: Matched and blinded case-control study (1:4). SETTING: A primary health care centre in Arjeplog, the National Porphyria Research Unit and a department of clinical genetics in Stockholm. SUBJECTS: A total of 48/49 (98%) patients over the age of 15 years living in Arjeplog with AIP, diagnosed according to standard clinical and biochemical criteria. For each AIP patient, four controls were matched for age, sex and geographical area and 164/196 (86%) participated. In the validity study, 35 patients were selected as indisputable AIP gene carriers, according to strict biochemical criteria, and 92 matched controls were selected with strict exclusion criteria. MAIN OUTCOME MEASURES: Validity, specificity and sensitivity of DNA diagnosis for this AIP mutation. Specificity and sensitivity of traditional biochemical methods. RESULTS: Validity study: the mutation was found in all 35 individuals classified as carriers of AIP. None of the 92 controls had the mutation. Evaluation study: all 48 AIP gene carriers, diagnosed by traditional methods, had the mutation, as had one of the control persons. In an inconclusive group of five persons with heredity for AIP, two had a positive DNA test. CONCLUSIONS: The PBGD mutation analysis was found to have full specificity and sensitivity and can be used as the sole diagnostic method in the family complex studied, representing the major AIP mutation in Sweden. The traditional diagnostic methods, used in optimal combinations, work in most cases, but they do not show high precision. However, they must be used when the specific mutation in the PBGD gene is not known.

Adolescent↗
PubMed1995

The association of fibrinolysis and hyperlipidaemia with quantitative sensory tests in an epidemiological study of Swedish type 1 diabetic patients.

Serum levels of cholesterol, HDL-cholesterol, triglycerides, lipoprotein Lp(a), and the fibrinolysis factors tPA (tissue plasminogen activator) and PAI-1 activity (plasminogen activator inhibitor) were compared with sensory thresholds for vibration, electrical current perception, and pain in a population-based study comprising 239 patients with diabetes mellitus Type 1, aged 15-50 years. Univariate regression analyses (n = 180) showed significant correlations between elevated sensory thresholds and age, duration of diabetes, serum cholesterol and triglycerides, and HbA1c. In multivariate regression analysis, age, duration of diabetes, height, and serum triglycerides showed significant independent associations with five or six of the six measured sensory threshold variables. In addition there was a significant association between increased thresholds for vibration and Lp(a) levels. Thus, increased sensory thresholds for vibration, current perception, and pain in patients with Type 1 diabetes are associated with increased serum triglyceride levels, and Lp(a) levels are associated with increased threshold for vibration. Fibrinolytic activity is unrelated to these measures of nerve function in Type 1 diabetic patients.

Adolescent↗