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Biomedical subjects

F Lithner

Publications and source records attributed to F Lithner.

At least 73 records · Page 4Linked to original sources
PubMed1989

Plaster casts in the management of advanced ischaemic and neuropathic diabetic foot lesions.

The outcome of plaster cast treatment of diabetic ulcerations at different sites of the feet in 33 patients was assessed in a prospective study. They were selected for the study because the previous conservative treatment had been unsuccessful. The mean age was 68 years and Type 1/Type 2 ratio was 4/29. Fifteen patients had lesions of grade 2 severity according to Wagner's classification, 9 patients' lesions were grade 3, and 9 patients had grade 4 lesions. The lesions healed in 19 patients (58%). All 10 patients (100%) with plantar lesions healed, while 7 (44%) of the patients with ischaemic lesions on the toes underwent lower leg amputation (p less than 0.01). Other factors that were important in determining which patients underwent amputation included the presence of local pain (p less than 0.001), and ankle/arm pressure index (less than 0.5 vs greater than or equal to 0.5, p less than 0.001). We conclude that plaster cast treatment is more useful in the treatment of advanced foot lesions than has previously been reported.

Casts, Surgical↗
PubMed1988

Glycaemic control, smoking habits and diabetes duration affect the extrinsic fibrinolytic system in type I diabetic patients but microangiopathy does not.

The fibrinolytic system was studied in 43 type I diabetic patients with long duration of the disease, with or without evidence of microangiopathy, and in 26 control subjects. There were positive and independent correlations between tissue plasminogen activator (tPA) activity after venous occlusion and HbA1c, and between triglycerides and plasminogen activator inhibitor (PAI-1) and tPA antigen concentrations before and after venous occlusion. The tPA activities both at rest and after venous occlusion were higher in the patients. There were no differences with regard to sex, hypertension or nephropathy for the levels of fibrinolytic variables in these patients. Subjects with retinopathy did not differ from those without retinopathy. Diabetes duration showed a significant negative association with tPA activity in multivariate regression analysis. Tobacco-smoking diabetics, as compared to non-smoking, had an increased tPA antigen release at venous occlusion, but also higher PAI-1 levels and reduced specific activity of the tPA protein. When assessed with the new specific assays now available, the fibrinolytic parameters appear to be specific indicators of endothelial dysfunction related to smoking and to degree of glycaemic control in type I diabetic subjects.

Adult↗
PubMed1987

Clinical profiles of cerebrovascular disorders in a population-based patient sample.

Clinical features of different types of stroke were investigated in a sample of 409 patients representative of all cases admitted for acute stroke, except subarachnoidal hemorrhages, within a well defined population. A specific cerebrovascular diagnosis was obtained by detailed clinical investigation, including CT scan. In people greater than 50 years old, men/women risk for stroke was estimated to be 1.40:1. The risk was higher in men up to the age of 80; above this age similar risk for the two genders was observed. Eleven per cent had intracerebral hemorrhage, 13% TIA, 51% non-embolic and 25% embolic brain infarction. In all diagnostic categories there were similar proportions of patients who had a history of hypertension and previous stroke, neither did hemoglobin and hematocrit levels differ between the different stroke disorders. TIA preceded intracerebral hemorrhage in 11% and brain infarction in 15-20%. As opposed to patients with ischemic lesions, subjects with intracerebral hemorrhage had higher systolic blood pressure levels and more severe symptoms on admission to hospital. Ischemic stroke was associated with male predominance, different ischemic manifestations of heart diseases and diabetes.

Age Factors↗
PubMed1987

Value of basal plasma cortisol assays in the assessment of pituitary-adrenal insufficiency.

A basal plasma cortisol value taken in a physically unstressed state in 68 patients with or without hypothalamic-pituitary-adrenocortical disease was compared with the maximal plasma cortisol concentration during an insulin tolerance test. There was a strong positive correlation between the values. Basal cortisol levels above 300 nmol/l (RIA method) almost excluded ACTH-cortisol insufficiency and those below 100 nmol/l strongly suggested dysfunction. A repeated basal cortisol estimation within a month was especially valuable in categorizing patients with levels between 100 and 200 nmol/l. We suggest that a basal cortisol measurement may be used as a first laboratory test in patients evaluated for possible hypothalamic-pituitary-adrenocortical insufficiency; in many patients, this approach obviates more sophisticated and expensive testing.

Adolescent↗
PubMed1986

Serum thyroid-stimulating hormone in cerebrovascular disease.

A thyrotropin-releasing hormone (TRH) test with serum thyroid-stimulating hormone (TSH) assays was performed in 22 euthyroid stroke patients without thyroid disease and the results were compared with those in 17 age-matched euthyroid controls. Basal and maximum TSH levels after TRH injection were significantly lower in the stroke group without elevation of basal serum thyroid hormone levels. There was a tendency towards an inverse relationship between TSH levels and the degree of pareses of the extremities. The test was repeated in 7 stroke patients 3-4 months after the onset of stroke with essentially the same results. The abnormal TSH parameters in stroke patients seem to be the result of the brain lesion per se.

Aged↗
PubMed1986

Epidemiology of diabetes mellitus in Sweden. Results of the first year of a prospective study in the population age group 15-34 years.

All newly diagnosed cases of diabetes mellitus aged 15-34 years in Sweden, where the population in this age interval is about 2.3 million, were registered on standardized forms. During 1983, the first year of the study, there were 311 males and 161 females, excluding 280 with gestational diabetes. The annual incidence of diabetes was 26.2 per 100,000 in males and 14.2 in females. The respective figures for type I were 18.5 and 10.1, and for type II 5.7 and 2.9. The incidence of type I diabetes was similar for the four age groups (15-19, 20-24, 25-29, 30-34 years), while for type II it was highest in the oldest group. Types I and II, but not the sexes, differed as regards the cumulative distribution curves of the maximum blood glucose concentration during the first two weeks after diagnosis. The present incidence of diabetes in Sweden is higher, particularly in males than the rates for similar age groups in Oslo (1925-64) and Denmark (1970-77).

Adolescent↗
PubMed1985

Malignant diabetes mellitus--a case report.

A 30-year-old man presented at the diagnosis of an insulin dependent diabetes mellitus with pronounced and multiple complications, such as retino-, nephro-, dermo- and neuropathy. His diabetes had a malignant course and he died from uremia within one year after diagnosis. There were no signs of atherosclerosis at autopsy but in several organs there were pronounced diabetic small vessel lesions.

Adult↗
PubMed1985

Primary hyperparathyroidism in pregnancy.

The history of a pregnant woman with primary hyperparathyroidism is presented. The patient underwent successful operation during the second trimester and the subsequent pregnancy and delivery were completely normal. Previously, 72 women with an established diagnosis of hyperparathyroidism in pregnancy are reported in the English literature. Twenty-three women underwent operation during pregnancy and 18 normal children were born. Fifty women with a total of 79 pregnancies during a hyperparathyroid state bore 35 normal children while 40 births had different kinds of complications. It is thus clearly documented that the risk of severe fetal complications is much higher if the hyperparathyroidism is left untreated than if the mother undergoes operation during the pregnancy. Therefore when the diagnosis is established the mother should undergo operation, if possible during the second trimester, which minimizes the complication rate significantly in both mother and child. Correction of the hypercalcemic state enables the development of adequate parathyroid gland function in the baby.

Adenoma↗
PubMed1984

Gangrene localized to the feet in diabetic patients.

A consecutive series of 189 diabetic patients with manifest gangrenous lesions localized to the feet were studied. These patients had 293 gangrenous lesions localized to 5 different areas: toes 58%, interdigital spaces 6%, dorsa of the feet 10%, metatarsal heads 10% and heels 16%. Cardiac decompensation with edema and edema from other causes were the dominant precipitating factors for the gangrenous lesions. Arterial insufficiency alone or together with other precipitating factors was seen considerably less often. Gangrenous lesions localized to the toes were especially common in patients with long duration of diabetes and in men. In women gangrenous lesions localized to the interdigital spaces and to the heels were more common. Multiple gangrenous lesions were more common in patients with cardiac decompensation, while the occurrence of only one lesion was especially common in patients with signs of arterial insufficiency and in men.

Adult↗
PubMed1984

Hepatocellular carcinoma in patients with acute intermittent porphyria.

In a retrospective study over a 20-year period we found in the Umeå region in Sweden 11 patients (7 women and 4 men, mean age 67 years) with both hepatocellular carcinoma and acute intermittent porphyria. This coincidence was highly significant. Concomitant existence of portal cirrhosis of the liver was demonstrated in those 5 patients in whom it could be examined.

Adolescent↗
PubMed1984

Is hemoglobin concentration a predictor for the outcome of distal gangrenous lesions in diabetics?

The predictive value of some routine laboratory tests given on admission was evaluated in a retrospective study to determine whether any given value could predict the outcome of distal gangrenous lesions and amputations in diabetic and nondiabetic patients. There was no difference in preoperative hemoglobin concentration between successful and unsuccessful amputations in 45 diabetic and 59 nondiabetic patients. In another group of 191 diabetic patients with distal gangrenous lesions, the lesions healed after nonsurgical treatment in 112 patients, 54 patients were submitted to amputation and 25 patients died before the lesions healed. Patients submitted to amputation had lower hemoglobin levels and higher erythrocyte sedimentation rates and white blood counts than patients in whom the lesions healed, whilst there were no differences between these two groups concerning blood glucose concentration or body temperature.

Aged↗
PubMed1984

Skeletal lesions and arterial calcifications of the feet in diabetics.

A radiological study of the feet was performed in 162 unselected diabetic patients with gangrene. They were compared with 59 diabetic patients without gangrene, 45 patients with familial amyloidosis and polyneuropathy and 30 healthy controls. The patients with familial amyloidosis had severe distal neuropathy but normal oral glucose tolerance test curves. Radiographic findings, e.g. skeletal destructions (diabetic osteopathy) and arterial calcification of the medial type were classified without knowledge of the clinical findings. Osteopathy was more common in diabetic patients with gangrene than in the other groups of patients. Medial arterial calcification was more common among diabetics with gangrene compared to patients with amyloidosis and to controls. There were no differences between diabetics without gangrene and patients with amyloidosis, but both of these groups had more calcifications than the controls. Our study suggests that diabetic osteopathy is not caused by peripheral neuropathy per se. The skeletal and skin lesions in diabetic patients are probably equivalent lesions localized to different tissues in the feet. It has been suggested that medial degeneration in the arterial wall is due to neuropathy. In agreement with this suggestion, the patients with familial amyloidosis and neuropathy had medial calcification. However, in diabetic patients this does not exclude other etiological agents.

Aged↗