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Biomedical subjects

G Granerus

Publications and source records attributed to G Granerus.

At least 37 records · Page 2Linked to original sources
PubMed1995

Obstructive effect of a closed 12F urethral catheter during the emptying phase of cystometry in patients with a spinal reflex bladder.

In spinal cord injured patients with a reflex urinary bladder urodynamic evaluation of the detrusor pressure during the emptying phase is important, but the methods are not yet standardised. The aim of this study was to examine whether the detrusor pressure is significantly affected by the presence of a catheter in the urethra. In seven patients with a spinal reflex bladder, the maximum detrusor pressure and the duration of detrusor contractions in cystometry with a suprapubic technique were compared with the corresponding measurements when a closed 12F catheter was added to mimic a transurethral cystometric technique. Four cystometries were performed with about 10 min intervals and the mean values from two cytometries without the urethral catheter were compared with the mean values from two cystometries with the catheter. After addition of the urethral catheter there was an increase of the mean maximum detrusor pressure form 8.4 to 10.5 kPa (P = 0.009). The mean duration of the detrusor contraction increased from 122 to 191 s (P = 0.031) and the mean time during which the detrusor pressure exceeded 4 kPa, in each contraction, increased from 60 to 150 s (P = 0.009). The average flow rate, calculated as the voided volume divided by the duration of a contraction, decreased from 1.4 to 0.6 ml s-1 (P = 0.009).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1995

Is computer-aided interpretation of 99Tcm-HMPAO leukocyte scans better than the naked eye?

In order to compare visual interpretation of inflammation detected by leukocyte scintigraphy with that of different computer-aided quantification methods, 34 patients (25 with ulcerative colitis and 9 with endoscopically verified non-inflamed colonic mucosa), were investigated using 99Tcm-hexamethylpropyleneamine oxime (99Tcm-HMPAO) leukocyte scintigraphy and colonoscopy with biopsies. Scintigrams were obtained 45 min and 4 h after the injection of labelled cells. Computer-generated grading of seven colon segments using four different methods was performed on each scintigram for each patient. The same segments were graded independently using a 4-point visual scale. Endoscopic and histological inflammation were scored on 4-point scales. At 45 min, a positive correlation was found between endoscopic and scan gradings in individual colon segments when using visual grading and three of the four computer-aided methods (Spearman's rs = 0.30-0.64, P < 0.001). Histological grading correlated with visual grading and with two of the four computer-aided methods at 45 min (rs = 0.42-0.54, P < 0.001). At 4 h, all grading methods correlated positively with both endoscopic and histological assessment. The correlation coefficients were, in all but one instance, highest for the visual grading. As an inter-observer comparison to assess agreement between the visual gradings of two nuclear physicians, 14 additional patients (9 ulcerative colitis, 5 infectious enterocolitis) underwent leukocyte scintigraphy. Agreement assessed using kappa statistics was 0.54 at 45 min (P < 0.001). Separate data concerning the presence/absence of active inflammation showed a high kappa value (0.74, P < 0.001). Our results showed that a simple scintigraphic scoring system based on assessment using the human eye reflects colonic inflammation at least as well as computer-aided grading, and that highly correlated results can be achieved between different investigators.

Adolescent↗
PubMed1994

No relationship between histamine release measured as metabolite excretion in the urine, and serum levels of mast cell specific tryptase in mastocytosis.

To test the hypothesis that histamine release in mastocytosis patients generally occurs without activation of the mast cells, histamine turnover, measured as histamine metabolite excretion in the urine, was compared with the serum level of mast cell specific tryptase, which is released only during active discharge of mast cell granular contents. Twenty mastocytosis patients with a wide range of histamine turnover rates were investigated. Slightly increased levels of tryptase were found in seven patients with no obvious relationship to histamine metabolite excretion. In contrast, there seemed to be a connection between the tryptase level and the severity of symptoms. These results strengthen the view that histamine in mastocytosis is predominantly released from the mast cells without any accompanying active release process. This does not exclude the possibility that, in some mastocytosis patients, a limited number of mast cells, or a subpopulation, may be actively secreting histamine together with tryptase.

Adult↗
PubMed1994

Effect of nifedipine on cystometry-induced elevation of blood pressure in patients with a reflex urinary bladder after a high level spinal cord injury.

In 10 patients with a reflex urinary bladder after a cervical or high thoracic spinal cord injury, the effect of nifedipine on the cystometry-induced elevation of blood pressure was studied. The blood pressure was measured every 30 s in four consecutive cystometries before and after administration of 10 mg nifedipine sublingually. In each patient there was a decrease in the maximum systolic and diastolic blood pressure after the administration of nifedipine. In the whole group the mean maximum systolic pressure decreased significantly from 147 mmHg (range 119-165, SD 14) to 118 mmHg (range 99-145, SD 14). The mean maximum diastolic pressure decreased from 110 mmHg (range 96-124, SD 10) to 83 mmHg (range 71-99, SD 10). The effect of nifedipine was significant in each of the four cystometries that were performed. The decrease in blood pressure was due to both a significant decrease of the baseline pressure and a significant decrease of the blood pressure reaction during cystometry. Nifedipine may be useful in order to prevent dangerous blood pressure reactions, e.g. during cystoscopy and other diagnostic or therapeutic procedures in spinal cord injured patients with autonomic dysreflexia.

Adolescent↗
PubMed1994

Determination of split renal function from gamma camera renography: a study of three methods.

Three different methods for calculation of the split kidney function from gamma camera renography with 99Tcm-DTPA are surveyed in this study, the integral, the slope and the uptake index methods. The reproducibility in calculating the relative renal function was very good with all three methods (coefficient of variation 2-4%). Single kidney glomerular filtration rate (GFR) was assessed by the three methods and 51Cr-EDTA clearance prior to nephrectomy, giving the accuracy of each method. The slope and uptake index methods showed high accuracy (0.9-2.0 ml min-1), while it is significantly reduced with the integral method (4.6 ml min-1), compared to the postoperative 51Cr-EDTA clearance. The uptake index method enables calculation of a ratio between the kidneys (alpha/UI)SR, which relates each kidney's intrarenal blood volume (alpha) to its renal function (UI). This ratio was compared in a group consisting of 38 patients with kidney tumours and in a control group of 32 patients. It was rather constant in the control group but significantly higher and within a wider range in the group with renal tumours. These discrepancies may indicate an abnormal intrarenal blood volume. Furthermore, the correlation between results assessed by the three calculation methods in the control group was good, while the correlation in the group with renal tumours deteriorated.

Adolescent↗
PubMed1994

Gamma camera renography with 99Tcm-DTPA: the impact of variations in input plasma curve on estimated GFR.

In an attempt to improve the reliability in estimating glomerular filtration rate (GFR) from gamma camera renography without blood sampling, we have investigated the impact of plasma input region of interest (ROI) size and location and the effect of the time delay between the circulation peak in the renal curves and in the plasma curve. An uptake index (UI) was calculated using plasma ROIs of five different sizes (8-56 cm2) and compared with measured 51Cr-EDTA clearance. The spread of the estimated GFR was not affected by the variations in plasma ROI size but different relations were obtained between UI and GFR. The plasma ROI markedly affected the estimated GFR (a deviation of 3.5 cm from the maximal region led to an overestimation of the GFR of 36%). Furthermore, the most reliable GFR estimate (S.D. 10.5 ml min-1) was achieved by including the whole circulation peak in the calculation time interval of the time delay-adjusted renogram, except the first frame. The time delay adjustment also enabled the calculation of a factor alpha, which represents the ratio between the blood volume within the renal ROI and that within the plasma input ROI. An abnormal alpha/UI ratio would suggest an unreliable GFR estimation.

Adult↗
PubMed1993

Reliability of ACE inhibitor-enhanced 99Tcm-DTPA gamma camera renography in the detection of renovascular hypertension.

Twenty consecutive patients with renovascular hypertension, proven by cure or improvement of hypertension at 1-year follow-up after percutaneous transluminal angioplasty or surgical repair, were studied before intervention by means of gamma camera renography with 99Tcm-diethylenetriaminepentaacetic acid (99Tcm-DTPA) at baseline and after angiotensin-converting enzyme (ACE) inhibition. Sixteen patients underwent bilateral renal vein catheterization for measurement of renal vein renin release and extraction ratios of para-amino-hippurate (PAH) and 51Cr-EDTA before and after acute ACE inhibition. With the limit for a significant change in relative side distribution of 5% or more after ACE inhibition on gamma camera renography 13 patients responded (Group 1), while seven patients (Group 2) had unchanged side distribution. Glomerular filtration rate (GFR), measured with 99Tcm-DTPA, in the affected kidney decreased in Group 1 from 26 +/- 16 ml min-1 to 11 +/- 12 ml min1 (P < 0.0005), while GFR was unchanged in the affected kidney in Group 2, 26 +/- 13 ml min-1 versus 29 +/- 13 ml min-1. Extraction ratios of PAH and 51Cr-EDTA for the affected kidney in Group 1 decreased from 80 +/- 18 to 73 +/- 21% (P < 0.05) and from 16 +/- 5 to 7 +/- 5% (P < 0.005), respectively, while in Group 2 the PAH extraction ratio was not significantly changed, 86 +/- 5 versus 81 +/- 14%, but the 51Cr-EDTA extraction ratio for the affected kidney also decreased from 16 +/- 3 to 8 +/- 4% (P < 0.005). All patients had lateralization of renal vein renin to the affected kidney.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1992

Subtraction of extra-renal background in 99mTc-DTPA renography: comparison of various regions of interest.

Quantitative evaluation of renal function in 99mTc-DTPA isotope renography is hampered by high background activity. This study compares various background regions of interest (ROIs) to obtain the most accurate estimate of the extra-renal background, taking both total counts (integral value) and change by time (slope) into account. Gamma camera renography was performed in 21 patients with a single kidney. Time-activity histograms obtained from 8 different background ROIs were compared in the time interval corresponding to the uptake phase of the renogram with the histogram obtained from a ROI over the empty kidney area. A significant difference could be demonstrated between the slope values of the histograms of the right and left empty kidney ROIs, but not for the integral values. Backgrounds taken over the heart, liver, between the kidneys, and under the kidneys had significantly different characteristics than the one in the empty kidney area. Only background ROIs surrounding each kidney area gave integral and slope values with close resemblance to those recorded over the empty kidney area. The results emphasize the necessity for an individual background ROI for each kidney and the need to separate extra- and intra-renal background activities before subtraction.

Adult↗
PubMed1992

Do technetium-99m hexamethylpropylene amine oxime-labeled leukocytes truly reflect the mucosal inflammation in patients with ulcerative colitis?

Twenty-five patients with ulcerative colitis and nine controls with macroscopically non-inflamed colon were investigated with technetium-99m hexamethylpropylene amine oxime-labeled leukocyte scintigraphy and colonoscopy with biopsies. The interval between leukocyte scintigraphy and colonoscopy was < or = 14 days in all patients with ulcerative colitis and < or = 30 days in eight of nine controls. Scintigrams were obtained at approximately 45 min and 4 h after injection of labeled leukocytes. One nuclear physician, one internist, and one pathologist graded blindly and independently of each other the degree of active inflammation in seven different colonic segments for each patient, using 4-grade scales for scans and macroscopically and histologically viewed inflammation, respectively. A positive correlation between endoscopic and histologic grading of all colonic segments and scan gradings for all subjects and for ulcerative colitis patients separately was found (all, p < 0.001). By means of kappa statistics, the inter-observer agreement between scintigraphic grading at 45 min and endoscopy was, for all subjects, 0.32 (95% confidence interval (CI), 0.20-0.44; p < 0.001) and, for patients with ulcerative colitis, 0.19 (CI, 0.07-0.31; p < 0.001). When 17 patients who had complete colonoscopies were divided into those with total, extensive, or distal colitis, leukocyte scintigraphy underestimated the extension of active inflammation. A simple scintigraphic scoring system reflects the colonic inflammation viewed endoscopically and histologically in patients with ulcerative colitis but underestimates the presence of active inflammation in individual colonic segments.

Adolescent↗
PubMed1991

Effects of extra-renal background subtraction and kidney depth correction in the measurement of GFR by gamma camera renography.

99Tcm-DTPA gamma camera renography was performed in 83 patients with a wide range of renal function. An uptake index (UI) proportional to the single kidney glomerular filtration rate (GFR) was calculated from the renograms according to two different algorithms, one based on a blood background taken from a region of interest (ROI) over the heart (method I), and the other a modification of that procedure including an extra-renal background subtraction (method II). The extra-renal background was defined by a ROI closely surrounding the kidney, making the separation between the extra-renal background and intra-renal blood background possible. Method II was further evaluated by comparing the results without and with correction for kidney depth (method III), the skin-kidney distance being measured by sonography. Calculated UI from the renograms was compared with measured 51Cr-EDTA plasma clearance as the reference method. Method I overestimated GFR at low kidney function. Addition of the extra-renal background subtraction (method II) eliminated that error and correction for kidney depth improved the accuracy (the standard error of the estimate was reduced from 18.2 min-1 to 12.3 min-1). It is concluded that the measurement of GFR by gamma camera renography is improved by these additional operations.

Adult↗
PubMed1990

Plasma noradrenaline and dopamine in renin-mediated hypertension.

Noradrenaline (NA) and dopamine (DA) have opposite effects on the kidney; NA causes vasoconstriction and increased sodium reabsorption while DA promotes vasodilation and natriuresis. In 15 patients investigated for renin-mediated hypertension measurements of plasma renin activity (PRA), NA and DA concentrations were made in arterial and renal venous blood from both kidneys before and after acute stimulation of renin release by i.v. dihydralazine. Nine patients had unilateral renin secretion and were classified as renin-positive, while the remaining six patients were renin-negative. Renin-positive patients had higher arterial and renal venous PRA, NA and DA levels than the negative ones. In the renin-positive group V-A differences for NA and DA were present on both sides despite unilateral secretion of renin. NA but not DA levels were higher in the renin-secreting kidney, which can partly be explained by the reduced plasma flow to the involved kidney. After dihydralazine the arterial NA and DA rose similarly in renin-positive and renin-negative patients, while PRA rose only in the renin-positive cases. In the renin-positive patients where stimulation of renin secretion caused a marked increase of the PRA gradient on the affected side only, renal gradients for NA and DA increased bilaterally. The increase in DA was more pronounced than that of NA yielding a rise in DA/NA ratio on the affected side. Arterial PRA was positively correlated to the plasma concentrations of NA and DA. V-A differences for PRA and NA or DA were positively correlated on the involved renin-secreting side. In summary, patients with renin-dependent hypertension have elevated plasma NA and DA concentrations. Stimulation of renin release by dihydralazine increases the DA/NA ratio in arterial and renal venous blood indicating release of 'precursor dopamine' from noradrenergic fibres and/or activation of dopaminergic nerves. There seems to be a relationship between renal nerve activity and renin release in renin-dependent hypertension.

Adolescent↗
PubMed1990

In vivo catabolism of histamine in the human stomach.

The importance of the stomach in the magnitude of excreted amounts of the major histamine metabolite in the urine was studied during total parenteral nutrition in five patients before and after total gastrectomy. In all subjects, a reduction in the 24-h urinary excretion of methylimidazoleacetic acid was observed. No corresponding effect was seen after an operation because of abdominal aortic aneurysm. In patients with duodenal ulcer disease and those submitted to a cholecystectomy because of cholecystolithiasis, we studied the catabolism of histamine in the stomach by injecting 14C-histamine directly into the portal vein and, simultaneously, 3H-histamine intra-arterially to the corpus fundus region of the stomach and subsequently determining the urinary excretion of 14C. 3H-histamine and their basic and acid metabolites, respectively. We found no apparent difference in the pattern of excreted 14C and 3H metabolites between the two patients groups, indicating that the catabolism of histamine in the stomach of patients with duodenal ulcer disease is similar to that in 'healthy' controls.

Aged↗
PubMed1989

Serum levels of neutrophil and eosinophil chemotactic activities in mastocytosis.

Neutrophil and eosinophil chemotactic activities (NCA and ECA) were measured in serum from twenty-two patients with urticaria pigmentosa or systemic mastocytosis. NCA was also measured after heating serum to 56 degrees C (heat-stable NCA). Although these factors were increased in about half of the patients there was no correlation with histamine release as estimated by the excretion of the main histamine metabolite methylimidazoleacetic acid (MelmAA) in urine. A significant increase in heat-stable NCA, however, was found in patients with pruritus and abnormal high values of MelmAA. It is concluded that only heat-stable NCA is a specific mast cell mediator, but that the heat-labile NCA and ECA are dependent on mast cells for their production by a different cell, tentatively identified as the macrophage.

Adult↗
PubMed1989

Renal function after autotransplantation with direct pyelocystostomy. Long-term follow-up.

The function of 20 human autologous kidney grafts was studied for 4 to 8 years (mean 5 1/2) after autotransplantation with a direct pyelocystostomy. The indications for the operation were low-grade, low-stage tumour of the renal pelvis and/or ureter, frequently recurrent renal stones and remaining outflow obstruction after pyeloplasty for hydronephrosis. The wide pyelocystostomy implies reflux of urine from the urinary bladder to the renal pelvis but no significant changes were found in glomerular or tubular function, studied with 51Cr-EDTA clearance, 131I-Hippuran renography, analysis of beta 2-microglobulin and total protein excretion in urine, and determination of concentration ability after administration of desmopressin. No increase in the severity or frequency of urinary tract infections was observed.

Adult↗
PubMed1989

Evaluation of intermittent drainage of the renal pelvis as seen in the isotope renogram.

Intermittent drainage (ID) of the renal pelvis is probably due to episodes of aperistalsis in the pelvo-calyceal system. The incidence of ID in adult patients referred for renography for various nephro-urological conditions was found to be 4.5%. Presence of ID was not related to sex or age but more common at a low urine flow. It was then usually bilateral and interpreted as a normal phenomenon. If the urine flow at the renographic examination exceeded 2 ml min-1, ID was typically unilateral and there was often a history of obstructive uropathy and dilatation of the renal pelvis. However, there were no signs of obstruction or flank pains in connection with the recording of ID and follow-up studies did not disclose any deterioration of renal function. It is concluded that ID seen at renography during diuresis should not be regarded as evidence of obstruction of pelvic outflow but merely as an indication of a dilated upper urinary tract.

Adult↗
PubMed1987

Acute systemic and renal haemodynamic effects and long-term antihypertensive action of cadralazine in patients pretreated with beta-blockers and diuretics.

The antihypertensive effects of the hydralazine-related compound cadralazine (2-(3-[6-(2-hydroxypropyl)ethylamino]pyridazinyl)ethyl carbazate, ISF 2469), were investigated in 16 patients with primary hypertension concurrently treated with beta-blockers and diuretics. The protocol included a double-blind placebo controlled haemodynamic evaluation after the first tablet and two 4-week double-blind placebo controlled cross-over periods followed by an open evaluation during 2 months. Cadralazine induced a moderate, prolonged fall in blood pressure that was associated with vasodilatation and slight increases in cardiac output (dye-dilution) and heart rate. Renal plasma flow (PAH) and glomerular filtration rate (51Cr-EDTA) were not significantly influenced, but the filtration fraction was reduced. Plasma concentrations of noradrenaline and adrenaline rose, whereas plasma renin activity was unchanged. The haemodynamic parameters were not correlated with the plasma concentrations of cadralazine. During chronic cadralazine treatment the supine blood pressure was significantly lower than during the double-blind placebo phase (160/93 vs 174/102 mmHg). The compound was generally well tolerated but the body weight increased slightly (1.1 kg), probably because of fluid retention. Several patients who had previously experienced side effects with hydralazine, including one with hydralazine-syndrome, tolerated cadralazine well. This suggests that cadralazine does not cross-react with hydralazine.

Acute Disease↗
PubMed1987

The effect of a histamine synthesis inhibitor on the immediate nasal allergic reaction.

We studied the effect of alpha-fluoromethyl histidine, an irreversible histamine synthesis inhibitor, on the immediate nasal reaction to antigen challenge in a double-blind, placebo controlled, randomized, parallel study using 13 subjects. The patients received either active drug 100 mg twice daily or placebo, for 3 weeks. A nasal allergen challenge was performed before and after at weekly intervals. Symptoms at challenge were assessed and the levels of histamine, TAME-esterase activity and kinins were measured in nasal lavages before and after antigen challenge. Skin tests were also performed at weekly intervals. In addition, the urinary excretion of the main histamine metabolite, telemethylimidazole acetic acid, was measured before and after 3 weeks of treatment. The active treatment induced 60% reduction in histamine levels in the lavage fluids before and after antigen challenge, as well as a reduction in the histamine levels in the lavage fluids before and after antigen challenge, as well as a reduction in the main urinary histamine metabolite. However, no reduction was found in nasal symptoms obtained after antigen challenge. The levels of kinins and TAME-esterase activity were not significantly reduced.

Adult↗