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Biomedical subjects

G Granérus

Publications and source records attributed to G Granérus.

At least 19 recordsLinked to original sources
PubMed2003

Short-term memory dysfunction in Kleine-Levin syndrome.

BACKGROUND: A previous investigation at our department of a young man with typical Kleine-Levin syndrome revealed short-term memory dysfunction as well as hypoperfusion of the temporal lobes on single photon emission tomography (SPECT) (CERETEC) examination, 6 and 7 years after recovery, suggesting long lasting or even permanent cerebral dysfunction. PATIENTS AND METHODS: We investigated four cases with classical adolescent Kleine-Levin syndrome characterized by hypersomnia and typical associated symptoms. We used neuropsychological testing and SPECT (CERETEC) of the brain. The results from the previous report related to above is included. RESULTS: Examination with SPECT (CERETEC) during remission revealed hypoperfusion of the temporal lobes and fronto-temporal region in two of four cases. There were normal findings in two. Neuropsychological testing performed during remission showed reduction in the short-term memory capacity in all four cases. CONCLUSION: It is striking that all the cases investigated showed short-term memory dysfunction. One patient who had recovered from paroxysmal symptoms (hypersomnia attacks and bulimia) 6 years earlier showed progress in the short-term memory dysfunction. A pathologic condition in the temporal lobes may be suspected in Kleine-Levin syndrome.

Adolescent↗
PubMed2002

A case of Kleine-Levin syndrome examined with SPECT and neuropsychological testing.

A case of Kleine-Levin syndrome with typical periodic hypersomnia and bulimia was diagnosed. On examination with single photo emission tomography (SPECT) (CERETEC) during a relapse period and 2 weeks later there was marked cortical hypoperfusion of the frontal and temporal lobes, especially on the left side as well as in the right parietal lobe. Neuropsychological testing performed 1 week after a relapse showed a reduction in encoding to memory function of verbal learning indicating neocortical damage of the left fronto-temporal region. A follow-up 2 months later after the patient had spontaneously recovered showed only a slight left fronto-temporal disturbance. CT and MRI of the brain were normal although the MRI showed a large and asymmetric mamillary body. Neuropsychological testing 6 years after recovery showed pronounced reduction in short-time verbal and visual memory. Seven years after recovery SPECT demonstrated a normalized frontal perfusion but still a slight hypoperfusion in the left temporal lobe. Our results correlate to autopsy findings in two cases described previously.

Adolescent↗
PubMed2000

ECT in Parkinson's disease-dopamine transporter visualised by [123I]-beta-CIT SPECT.

Parkinson's disease (PD) is characterised by a loss of dopaminergic neurones in the basal ganglia. These neurones may be visualised by single photon emission computed tomography (SPECT) with the cocaine analogue 2beta-carboxymethyl-3-beta-(4-iodophenyl)tropane ([123I]beta-CIT), which labels the dopamine reuptake sites in the nerve terminals. In order to evaluate the possibility to predict the outcome of ECT a prospective study was performed with six PD patients in whom the [123I]beta-CIT uptake was measured before and after an electroconvulsive therapy (ECT) series. The side-to-side difference in the radiotracer uptake was found to be significantly lower in striatum located contralaterally to the part of the body with the most pronounced symptomatology. No significant change in uptake of the radioligand was seen after ECT. Patients with best uptake and thus with less advanced PD improved most after ECT. The possibility to use the [123I]beta-CIT uptake to predict the outcome of ECT treatment has to be further evaluated.

Aged↗
PubMed1996

Histidine decarboxylase expression and histamine metabolism in gastric oxyntic mucosa during hypergastrinemia and carcinoid tumor formation.

Histamine is an important stimulator of gastric acid secretion. In experimental animals, inhibition of acid secretion by long term histamine2 receptor blockade causes hypergastrinemia, proliferation of enterochromaffin-like (ECL) cells, and formation of histamine-producing gastric carcinoids. The aim of this study was to examine the role of gastrin in histamine synthesis and metabolism of the oxyntic mucosa of normal, hyperplastic, and carcinoid-bearing Mastomys natalensis. Administration of exogenous gastrin to normal animals increased histidine decarboxylase (HDC) messenger RNA (mRNA) expression in the oxyntic mucosa within 30 min, indicating that gastrin stimulates histamine synthesis by regulating HDC mRNA abundance. Endogenous hypergastrinemia, induced by short term histamine2 receptor blockade (loxtidine) for 3-29 days, did not induce tumors, but enhanced the expression of HDC mRNA (2- to 4-fold elevated) and histamine contents (2-fold elevated) in the oxyntic mucosa. Long term histamine2 receptor blockade (7-21 months) resulted in sustained hypergastrinemia and ECL tumor formation. Tumor-bearing animals had a 4-fold increase in HDC mRNA expression and histamine contents of the oxyntic mucosa. Urinary excretion of the histamine metabolite methyl-imidazole-acetic acid was 2-fold elevated. Tumor-bearing animals recovering from histamine2 receptor blockade were normogastrinemic and had normal levels of HDC mRNA and histamine in the oxyntic mucosa as well as normal excretion of methyl-imidazole-acetic acid. The results indicate that ECL cell carcinoids developing during hypergastrinemia are well differentiated tumors that respond to high gastrin levels with increased histamine synthesis and secretion.

Animals↗
PubMed1994

Clinical management of gastric carcinoid tumors.

Four types of gastric carcinoids have been identified: (1) multiple small body-fundus carcinoids associated with chronic atrophic gastritis type A (A-CAG); (2) sporadic solitary lesions without specific pathogenetic background (non-A-CAG); (3) carcinoidosis associated with Zollinger-Ellison/MEN 1 syndrome, and (4) rare tumors, e.g. gastrin cell tumors, neuroendocrine carcinomas and mixed endocrine-exocrine tumors. In a retrospective study of 15 patients with gastric carcinoids (11 A-CAG, 3 non-A-CAG and 1 gastrin cell tumor) over a 10-year period, the histopathological and clinical features were assessed. The A-CAG-type carcinoids were clinically silent with lymph node metastases in 2/11 cases but no hepatic metastases. The non-A-CAG-type carcinoids were malignant with disseminated disease, hormonal symptoms and increased urinary excretion of the main histamine metabolite, MeImAA. Five patients with A-CAG tumors were subjected to antrectomy to remove hypergastrinemia, which is thought to be of pathogenetic importance for these tumors. During the observation period (1.5-8 years) 1 patient developed recurrent tumors, while the other 4 showed persistent argyrophil cell hyperplasia. A prospective treatment protocol of these tumors is suggested with endoscopic removal of less numerous, small lesions as first-step therapy, followed by antrectomy at recurrence. Larger lesions should be excised in combination with antrectomy. Gastrectomy is reserved for the rare cases of invasive tumors with lymph node metastases. As evident from the outcome of patients with non-A-CAG tumors radical surgery should be performed whenever practicable.

Carcinoid Tumor↗
PubMed1992

Aspects on diagnosis and treatment of the foregut carcinoid syndrome.

Eight patients with the foregut carcinoid syndrome (two gastric and six bronchial primary tumors) are reported. The patients presented with complex clinical symptoms including ectopic production of adrenocorticotrophic hormone and growth hormone-releasing factors. The most alarming symptoms were facial flush and edema, accompanied by severe bronchoconstriction, which easily was misinterpreted as asthmatic attacks. Conventional bronchodilatory drugs may be potentially dangerous in these patients, in whom combined blockade of histamine receptors and treatment with cortisone and octreotide are recommended. Owing to the patients' age and general condition individualized long-term therapy was instituted. Surgical therapy under optimal protection by drugs can be of substantial value also in patients with advanced disease. One patient with life-threatening hormonal symptoms underwent hyperthermic perfusion of the liver with cytotoxic drugs, resulting in good palliation.

Aged↗
PubMed1992

Blood pressure response to detrusor pressure elevation in patients with a reflex urinary bladder after a cervical or high thoracic spinal cord injury.

In 12 patients with a reflex urinary bladder after a cervical or high thoracic spinal cord injury, blood pressure was measured every 30 s during cystometry. Four consecutive cystometries were performed by means of suprapubical catheters and 50 ml/min filling rate. The aim was to improve the methodological basis for cystometrical studies of paroxysmal hypertension and its treatment. In each cystometry there was an elevation of the systolic (20-60 mmHg) and the diastolic (15-55 mmHg) blood pressure. The maximum blood pressure always occurred during the emptying phase and always in close relation to the peak of the detrusor pressure. The amplitude of the blood pressure response varied intraindividually, but did not change in any particular direction during the series of cystometries. Thus, a cystometrical method which stimulates the detrusor in a physiological way is sufficient to give the typical uninhibited blood pressure reaction in most patients with a reflex bladder and a spinal reflex vasomotor function after a high level spinal cord injury. The blood pressure reaction obtained with this method is probably representative for the daily reaction during physiological reflex emptying of the bladder. To describe the maximum blood pressure reaction, it has to be measured during a well defined emptying phase and close to the occurrence of the maximum detrusor pressure. Since repetition of cystometry did not change the blood pressure response, this cystometrical method is useful for evaluation of pharmacological intervention.

Adolescent↗
PubMed1991

Is the airway epithelium responsible for histamine metabolism in the trachea of guinea pigs?

The aim of the study was to investigate whether or not the epithelium plays an active role in histamine metabolism, via the histaminase and/or methyltransferase pathways. Isolated tracheas from guinea pigs sensitized to egg albumin (EA) were used. The epithelium was either left intact or removed from the preparations. The tracheal tubes were mounted in a chamber, allowing estimation of smooth muscle tension, and perfused with buffer. In some experiments the perfusate was collected for determination of histamine and methylhistamine. Mepyramine was used to evaluate the contribution of histamine to the EA-induced contraction. Mepyramine reduced the contraction by 90% when the epithelium was removed; with intact epithelium the reduction was 47%. Aminoguanidine, a histaminase inhibitor, significantly potentiated the response to EA when the epithelium was left intact. Traces of methylhistamine were detected in tissue extracts and perfusates. We conclude that histaminase is present in the preparation and that it can contribute to the inhibitory effect of the epithelium by means of histamine degradation.

Amine Oxidase (Copper-Containing)↗
PubMed1990

Long-term effects of felodipine on blood pressure and renal hemodynamics in severe hypertension.

Felodipine, a dihydropyridine calcium antagonist, was used to treat eight patients with severe uncontrolled hypertension: five had essential hypertension, two had renovascular disease, and one chronic pyelonephritis. Mean blood pressure (BP) was 221 +/- 14/120 +/- 4 mm Hg despite treatment with three or more antihypertensive drugs. All patients experienced an immediate and pronounced lowering of BP after adding felodipine, which persisted during long-term treatment in combination with previous medication except for vasodilating drugs. In all cases, an increase in glomerular filtration rate (51Cr-EDTA clearance) after 6 and 12 months of felodipine treatment was seen (59 +/- 10 to 63 +/- 7 and 70 +/- 6 ml/min, respectively, p less than 0.05). Renal plasma flow (PAH clearance) exhibited only a slight increase (315 +/- 68 to 340 +/- 63 and 314 +/- 69 ml/min), giving a nonsignificant rise in filtration fraction (18 +/- 1 to 21 +/- 1 and 20 +/- 1%, respectively). It is concluded that felodipine decreases BP dramatically in patients with previously refractory hypertension and that the drug causes an improved renal function in these patients.

Adult↗
PubMed1990

The role of gastric resection in the management of multicentric argyrophil gastric carcinoids.

A patient with pernicious anemia, atrophic non-antral gastritis, hypergastrinemia, and widespread hyperplasia of enterochromaffin-like cells and manifest enterochromaffin-like cell carcinoma was followed up during 39 months, including 15 months after gastric resection. In this case normalization of gastrin levels did not prevent the development of multiple gastric carcinoids in the fundic mucosa, suggesting that factors other than gastrin are of importance in the pathogenesis.

Anemia, Pernicious↗
PubMed1988

Influence of percutaneous renal stone extraction on renal function.

The total and separate renal function was studied in 10 patients by means of 51Cr-EDTA-clearance and gamma camera renography with 99mTc-DTPA before and 2 weeks to 5 months after percutaneous renal stone extraction. There was no major complication related to the operations. There was no significant change of function as measured as the glomerular filtration rate. The stone extraction procedure was well tolerated by the kidneys.

Chromium Radioisotopes↗
PubMed1987

Clinical evaluation of felodipine in patients with refractory hypertension.

The calcium antagonist, felodipine, was used to treat 21 patients with severe uncontrolled hypertension: 13 had renoparenchymatous hypertension, 5 essential hypertension and 3 renovascular hypertension. Mean arterial blood pressure of patients was 195 +/- 8/122 +/- 3mm Hg in spite of treatment with 3 or more antihypertensive drugs. The majority of the patients (n = 17) were treated with an ACE inhibitor. Mean glomerular filtration rate (GFR) for 20 patients was 39 +/- 6 ml/min/1.73m2 body surface area (Cr-EDTA clearance) before felodipine administration. All patients had an immediate blood pressure fall after 5-10mg of felodipine administered orally. This fall persisted when the drug was given 2 or 3 times daily in combination with previous medication except the former vasodilating drugs. 15 patients are on long term treatment with felodipine and their blood pressure after 1 year (n = 14) was 152 +/- 4/89 +/- 2mm Hg. Patients with moderately impaired renal function and no signs of progressive kidney disease (n = 8) improved their GFR significantly after 1 year on felodipine. Six patients stopped felodipine therapy within 3 months (4 because of adverse reactions, 1 died of scleroderma and 1 became normotensive after the start of dialysis treatment). In patients with renoparenchymatous disease and documented progressive deterioration of renal function the addition of felodipine did not prevent a decline in filtration rate but did slow the rate of deterioration (from 9 +/- 2 to 5 +/- 1 ml/min/year).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1987

Felodipine in combination with a beta-blocker and a diuretic in chronic treatment of patients with refractory primary hypertension.

The acute antihypertensive effects of the dihydropyridine calcium antagonist, felodipine, were investigated in 12 male patients aged 43 to 64 years with uncontrolled blood pressure on combined treatment with a thiazide diuretic, a beta-blocker and hydralazine. Central and renal haemodynamics were monitored after acute oral administration (0.075 mg/kg) of felodipine in combination with the beta-blocker and diuretic. Six patients were continued on long term oral felodipine (mean dose 20 +/- 24 mg/day) in combination with the other drugs for 6 to 18 months. Ambulatory blood pressure was measured repeatedly and renal function re-examined once during long term felodipine therapy. In the 6 patients on long term therapy, systolic blood pressure was reduced from 190 +/- 17 to 149 +/- 24 mm Hg and diastolic blood pressure from 116 +/- 12 to 89 +/- 14mm Hg (p less than 0.001). No significant change in heart rate was observed (65 +/- 4 vs 62 +/- 10 beats/min). Renal plasma flow significantly increased from 284 +/- 97 to 425 +/- 131 ml/min/m2 (p less than 0.01) but glomerular filtration rate was unchanged (72 +/- 20 vs 80 +/- 22 ml/min/m2). Hence, the filtration fraction was significantly reduced and normalised in all patients (0.26 +/- 0.04 vs 0.20 +/- 0.03) [p less than 0.05]. Bodyweight was unchanged. It is concluded that felodipine is a highly potent vasodilator with a favourable effect on renal function and is suitable for long term therapy in patients with severe primary hypertension.

Adrenergic beta-Antagonists↗