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Biomedical subjects

G Bratt

Publications and source records attributed to G Bratt.

At least 55 records · Page 3Linked to original sources
PubMed1990

Fatal pulmonary embolism caused by streptokinase treatment of deep venous thrombosis of the leg?

During the last 10 years, four of 150 (2.7%) patients with deep venous thrombosis (DVT) treated with streptokinase (SK) at our department have died of pulmonary embolism (PE). A retrospective study of 1393 DVT patients treated with heparin during the period 1973-1986 showed that five (0.36%) of these patients died of PE while still on heparin. In this paper we describe the four patients treated with SK who developed fatal PE. In our opinion this increase in mortality does not warrant the use of SK in routine treatment of DVT of the leg before a proper trial has been conducted to compare the frequencies of pulmonary embolism after both treatments.

Adult↗
PubMed1989

Effects of oestrogen therapy and orchidectomy on coagulation and prostanoid synthesis in patients with prostatic cancer.

Twenty patients with prostatic carcinoma were randomized to therapy with either oestrogens (n = 10) or orchidectomy (n = 10). Activators and inhibitors of coagulation were studied before treatment, 1.5 months and 6 months after the start of treatment. We found that the patients in the oestrogen group had already increased their factor VII level after 1.5 months (P less than 0.001) and this increased level persisted after 6 months. Factor X tended to increase after 1.5 months and this increase reached significance after 6 months (P less than 0.01). In the orchidectomy groups there was a significant increase in factor X at 6 months (P less than 0.01) and, in addition, antithrombin III (AT III) was increased at this time. Furthermore, there was a parallelism between the increase in factor VII and electrocardiographic evidence of increased coronary insufficiency (r = 0.60; P less than 0.025; n = 15). We found a significant increase of thromboxane as evidenced by the major urinary metabolite 2,3-dinorthromboxane B2 in the oestrogen group as compared to the orchidectomy group. In summary, patients with prostatic cancer during long-term oestrogen treatment were found to have increased levels of factor VII, factor VIII:C and fibrinogen. In addition these patients showed increased formation of thromboxane. The changes imply a hypercoaguable state and platelet activation. No such signs were found after orchidectomy. The findings in the oestrogen group might explain the continuously increased risk of cardiovascular complications during long-term oestrogen therapy.

Aged↗
PubMed1989

A prospective study of immunoglobulin changes in relation to human immunodeficiency virus infection in a cohort of homosexual men.

Changes in IgG levels and patterns in association with human immunodeficiency virus, (HIV) infection were characterized in a prospective investigation by studying serum electrophoresis and antibodies to HIV at least once a year in 144 homo/bisexual (HS) men during a 4-year period. Initially, 25 men (17.4%) were HIV-positive, and this increased to 44 at the end of the study period. HIV-negative men had IgG levels of 11.2 +/- 2.2 g/l. In the 19 HIV seroconverters the mean IgG level rose with time according to the equation IgG = 0.054x + 12.56 (x = months after the last HIV-negative test). Oligoclonal IgG bands were found in three of the 19 seroconverters (16%) prior to conversion and in 2/16 (13%), 5/13 (38%), 7/11 (64%), and 3/8 (38%) 1, 2, 3, and 4 years after conversion, respectively. Of the 25 initially HIV-positive men, five have developed acquired immunodeficiency syndrome (AIDS) during the 4.5 year follow-up. At the first investigation these five men had higher mean IgG levels (16.0 +/- 2.7 g/l) than the 20 men who have remained healthy (14.6 +/- 2.8 g/l), and all five had oligoclonal bands as compared to 9/20 of those who did not develop AIDS. Oligoclonal IgG bands reflect the IgG increase and seem to indicate long-standing HIV infection and a poor prognosis.

AIDS-Related Complex↗
PubMed1987

A pilot study; desmopressin (DDAVP) in the treatment of deep venous thrombosis.

In a pilot study on 9 patients with acute deep venous thrombosis of the leg the fibrinolytic response and the possible thrombolytic effect of desmopressin (DDAVP), when given supplementary to standard heparin treatment, was examined. Six injections of 0.3-0.4 microgram DDAVP/kg b.w. at 12 hours intervals were given. No serious side effects were observed. The fibrinolytic variables that followed showed that plasma levels of t-PA increased significantly and most pronounced after the first injection. Rephlebography 4-7 days after hospitalization showed partial thrombolysis in 7 out of 9 patients. The phlebographic score according to Marder was reduced from 22.7 +/- 12.1 to 18.4 +/- 10.1 (p = 0.018), corresponding to a thrombus size reduction of 19%. No correlation between the level of the fibrinolytic variables measured and the degree of thrombolysis in the individual patients, could be demonstrated in this small number of patients.

Antigens↗
PubMed1987

Acute unidentified hepatitis in a hypogammaglobulinaemic patient on intravenous gammaglobulin successfully treated with interferon.

A 59-year-old male with acquired hypogammaglobulinaemia since 1978 developed a fulminant hepatitis. The hepatitis appeared after two years intravenous treatment with Sandoglobulin (Sandoz, Switzerland). No virus markers could be detected in the body fluids or liver tissue. Blood transfusions had not been given within one year before development of the liver disease. There was strong suspicion that the patient had acquired non-A non-B hepatitis from the gammaglobulin infusions. Treatment with alpha-interferon ran parallel to a normalization of the pathological liver enzymes and the histology of the liver. This observation suggests a direct antiviral effect of alpha-interferon, despite the anecdotical and noncontrolled character of these data.

Agammaglobulinemia↗
PubMed1986

Activators and inhibitors of coagulation and fibrinolysis in patients with prostatic cancer treated with oestrogen or orchidectomy.

The treatment of prostatic cancer with oestrogen has been reported to be associated with cardiovascular side effects. Twenty patients with recently diagnosed prostatic cancer were randomly allocated to oestrogen therapy or orchidectomy. As compared to healthy age matched controls the patients with prostatic cancer had increased base-line levels of fibrinogen (5.2 +/- 1.9 g/l versus 3.7 +/- 1.0 g/l; p less than 0.002) and factor VIII:C (166 +/- 62% versus 110 +/- 29%; p less than 0.001). During oestrogen therapy factor VII increased from 99 +/- 22% to 150 +/- 47% (p less than 0.001), while the antithrombin III level fell from 93 +/- 10% to 81 +/- 13% (p less than 0.001). Both these changes are in the direction of a hypercoaguable state. Concomitantly plasminogen increased from 113 +/- 14% to 142 +/- 18% (p less than 0.001), urokinase inhibiting activity fell from 105 +/- 10% to 90 +/- 9% (p less than 0.001) and C1-esterase inhibitor fell from 110 +/- 17% to 86 +/- 22% (p less than 0.05) in the oestrogen therapy group. After orchidectomy there were no changes in the activators and inhibitors of coagulation and fibrinolysis studied as compared to base-line values. Furthermore the D dimer, a specific degradation product of crosslinked fibrin increased from a normal to a pathological value in 4 out of 8 tested patients after 6 weeks of oestrogen therapy, but in none out of 9 tested patients in the orchidectomy group. Briefly stated, patients with prostatic cancer treated with oestrogen have increased levels of factor VII, factor VIII:C and fibrinogen and a decreased level of antithrombin III.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1986

Low molecular weight heparin (KABI 2165, Fragmin): pharmacokinetics after intravenous and subcutaneous administration in human volunteers.

The pharmacokinetics of a low molecular weight heparin (LMWH) with a mean mw of 4000-6000 D (KABI 2165, Fragmin) was studied in 6 healthy volunteers after intravenous (iv) and subcutaneous (sc) administration of 120 U (anti FXa)/kg. The half-life in plasma of the anti FXa activity after iv injection was 119 +/- 17 min, the volume of distribution (Vd) 3.4 +/- 0.5 1 and the total clearence 20.5 +/- 2.5 ml/min. The maximal anti FXa activity determined 3 min after iv bolus injection amounted to 2.2 +/- 0.3 U (anti FXa)/ml with a corresponding increase of the APTT from 31 +/- 7 sec to 113 +/- 35 sec. The elimination of the anti FXa activity was a monoexponential first order process. After sc administration the plasma half-life of the anti FXa activity was longer than after iv injection, 228 +/- 40 min, corresponding to the absorption rate thus found to be the rate limiting step. After sc administration the peak was reached after 4 hours (0.6 +/- 0.1 U (anti FXa)/ml; APTT increase 5 sec). The bioavailability after sc injection was calculated to be 87 +/- 6%. As a consequence of the high bioavailability and long T1/2 of the anti FXa activity, Fragmin administered sc seems to induce adequate levels of heparin-like activity making this regimen worth further investigation as an alternative for the treatment of deep venous thrombosis.

Adult↗
PubMed1986

Intradermal testing with multiple recall antigens for identification of cell-mediated immune deficiency in homosexual men.

In a health screening project for gay men in Stockholm, delayed cutaneous hypersensitivity was tested in 710 men by a commercial kit (Multitest, Mérieux) containing seven recall antigens and related to past hepatitis B virus (HBV) infection, various life style factors, the lymphadenopathy syndrome (LAS), and antibodies to human T-lymphotropic virus type III (HTLV-III). The multiscore (MS: the sum of all positive reactions) was significantly decreased in men with the following characteristics: HBV markers, greater than 50 yearly sexual partners, regular practice of receptive rectal intercourse, regular sex in gay bathhouses, recent sexual encounters in the US, greater than 50 lifetime exposures to inhaled nitrates, LAS, and positive HTLV-III serology. Anergy to tuberculin (TU) but not to any other antigen was more common in men with greater than 20 yearly partners, regular practice of receptive rectal intercourse, exposure to inhalant nitrates, LAS as well as lesser degree of lymphadenopathy, and HTLV-III seropositivity. HTLV-III antibodies were demonstrated in 61 of 416 (14.7%) men. During the 2-year follow-up four men have developed acquired immune deficiency syndrome. All four had MS less than 10 mm and TU anergy. In a BCG-immunized population Multitest only adds marginal information as compared to intradermal testing solely with TU, but may yield prognostic information in evaluating HTLV-III positive individuals with respect to development of manifest AIDS.

AIDS-Related Complex↗
PubMed1986

Pharmacokinetics of intravenously and subcutaneously administered Fragmin in healthy volunteers.

Studies in 8 healthy volunteers showed that the low molecular weight heparin Fragmin KabiVitrum is eliminated according to first order kinetics without dose dependency after intravenous injection of doses between 40 and 120 anti-Xa U/kg. Fragmin remains in the circulation more than twice as long as unfractionated heparin (UFH). Fragmin administered subcutaneously has a bioavailability which is much greater than that of UFH. Fragmin administered subcutaneously twice a day results in a significant anti-Xa activity and provides an alternative to intravenous infusions.

Adult↗
PubMed1986

Intravenous and subcutaneous administration of Fragmin in deep venous thrombosis.

54 patients with venographically verified deep venous thrombosis (DVT) were randomized to treatment with either intravenous infusions of 240 anti-Xa U/kg/12 h unfractionated heparin (UFH) or 240 or 120 anti-Xa U/kg/12 h of the low molecular weight heparin Fragmin. Repeated venographies showed improvement in 48% of the UFH-treated patients and 50 and 77%, respectively, in the Fragmin-treated patients. Progression was seen only in the UFH-treated patients and was observed in 11%. Two bleeding complications were seen in the Fragmin group in 2 patients receiving the very high dose of 240 anti-Xa U/kg/12 h. Anti-Xa activity in plasma and activated partial thromboplastin time (APTT) does not correlate in the Fragmin-treated patients. Fragmin was as effective as UFH in preventing the progress of thrombosis in DVT. In another study 120 anti-Xa U/kg Fragmin given subcutaneously 2 times daily to 13 patients with DVT resulted in adequate anti-Xa activity but with a tendency for accumulation of the Fragmin-induced activity. Subcutaneous injections of Fragmin 2 times daily also appears to prevent the progression of thrombosis effectively.

Adult↗
PubMed1985

A comparison between low molecular weight heparin (KABI 2165) and standard heparin in the intravenous treatment of deep venous thrombosis.

In order to study whether a low molecular weight heparin (LMWH) of mw 4000 D is effective in the treatment of deep venous thrombosis (DVT), patients with DVT verified by phlebography were randomized to treatment by continuous intravenous infusion of either unfractionated heparin (UFH) or LMWH. The initial dose was 240 U (anti F Xa)/kg/12 h. This study (study I) was stopped because of major bleeding in 2 newly operated patients in the LMWH group after 27 patients had been treated. The heparin activity measured as F Xa inhibition assayed in retrospect, was found to be much higher in the LMWH group (mean 1.6-2.0 anti F Xa U/ml) than in the UFH group (mean 0.5-0.8 anti F Xa U/ml). A second study was therefore initiated in which the DVT patients were randomly given UFH (240 U/kg/12 h) or LMWH only 120 U (anti F Xa)/kg/12 h, as initial doses (study II). In this study 27 patients could be evaluated, the mean heparin activity still being higher in the LMWH group (0.9-1.2 anti F Xa U/ml) than in the UFH group (0.5-0.7 anti F Xa U/ml). A second phlebographic investigation showed progression of thrombus size in 3 (11%) of the UFH patients of studies I and II (n = 29) and improvement in 14 (48%). There was no progression in any LMWH patient, 6 (50%) had improved in study I and 10 (77%) in study II. The mean decrease of thrombus size score (according to Marder) during treatment did not differ between the 3 groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1985

A human pharmacological study comparing conventional heparin and a low molecular weight heparin fragment.

The pharmacokinetics of a heparin fragment of low molecular weight (LMWH) of 4000-5000 D and unfractioned standard heparin (UFH) have been studied after i.v. injections of different doses and infusions in 8 humans. The heparin activity was significantly higher and the effect on APTT lower after LMWH fragment as compared to UFH in the same doses. The half-life of heparin activity was about 1 hr for UFH and about 2 hr for LMWH. LMWH was found to be eliminated according to first order kinetics and there were no signs of dose dependency.

Adult↗
PubMed1985

Factors and inhibitors of blood coagulation and fibrinolysis in acute nonlymphoblastic leukaemia.

Factors of coagulation and fibrinolysis have been evaluated in 15 patients with untreated acute nonlymphoblastic leukaemia (ANLL). 10 patients had major bleeding (MB) and 6 had laboratory signs of DIC. 5 patients went into complete remission (CR). Antithrombin III (AT III) was decreased in 7 patients, antiplasmin (AP) in 9, fibronectin (FN) in 6 and factor XIII in 4/12. The ratio between factor VIIIR:Ag and factor VIII:C was over 2.0 in 11 patients, and high values were especially seen in patients with MB and patients with DIC. Spontaneous proteolytic activity, measured with S-2288 was increased in 3 patients who all had MB, and none of whom achieved CR. 2 patients with promyelocytic leukaemia (M3) had low fibrinogen and AP, high FDP and normal AT III, speaking for primary fibrinolysis, which in addition to proteolytic enzymes in the blast cells are important contributing factors regarding MB in ANLL.

Adult↗