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Biomedical subjects

Göran Lindstedt

Publications and source records attributed to Göran Lindstedt.

At least 19 recordsLinked to original sources
PubMed2005

Prophylaxis against bone loss in Kock reservoir patients with reduced glomerular filtration rate.

OBJECTIVE: We investigated whether treatment with calcium carbonate and vitamin D3 can improve the bone mineral content of patients with ileal reservoirs for continent urinary diversion and a reduced glomerular filtration rate (GFR). MATERIAL AND METHODS: Twenty-six patients with Kock reservoirs were included in the study. Bone mineralization was determined using dual-energy X-ray absorptiometry. Kidney function was estimated from Cr-EDTA clearance and serum cystatin C concentration. Osteocalcin and parathyroid hormone in serum were also measured. Patients with reduced GFR were treated with calcium carbonate and vitamin D3 perorally. RESULTS: Bone mineral density in the femur neck and hip increased in the treatment group, as reflected by an improved T score. CONCLUSION: Patients with ileal reservoirs for continent urinary diversion and reduced kidney function should be supplemented with calcium carbonate and vitamin D3 in order to reduce the long-term risk of osteoporosis.

Bone Density↗
PubMed2005

Insulin-like growth factor-1 is a predictor of blood haemoglobin concentration in 70-yr-old subjects.

UNLABELLED: The role of growth hormone (GH) for maintaining normal erythropoiesis among non-GH-deficient elderly subjects is not known. OBJECTIVES: To determine relationships between the concentrations of serum insulin-like growth factor-1 (IGF-1) and it's carrier protein insulin-like growth factor binding protein 3 (IGFBP-3), as well as plasma erythropoietin (EPO), and blood haemoglobin (Hb) in elderly subjects. METHODS: Serum IGF-1 and IGFBP-3 and plasma EPO were, in addition to basal haematological tests, measured in a community based representative population sample of 70-yr-olds (n = 619; 317 women and 302 men). Statistical analyses were made before and after exclusion of non-healthy subjects. RESULTS: Mean IGF-1 concentration was higher among men than women (155 vs. 138 mug/L, P = 0.0000), and that of IGFBP3 lower (2.21 vs. 2.65 mg/L, P = 0.0000). Exclusion of subjects with demonstrable disorders did not significantly influence the distributions of serum-IGF-1 and serum-BP-3. Hb concentration was positively correlated to concentrations of IGF-1 (r = 0.15, P < 0.01 for the men; r = 0.34, P < 0.001 for the women), and IGFBP-3 (r = 0.07, n.s. for the men; r = 0.27, P < 0.001 for the women), and negatively correlated to EPO concentration (r = -0.34, P < 0.001 for the men; r = -0.42, P < 0.001 for the women). In multivariate analysis, serum concentrations of IGF-1, iron, and plasma concentrations of EPO were independently correlated to Hb among both men and women. CONCLUSION: GH and/or IGF-1 are, independently from EPO and regardless of health status and sex, a significant determinant of Hb in elderly subjects.

Aged↗
PubMed2004

Can brain natriuretic peptide (BNP) be used as a screening tool in general practice?

OBJECTIVE: To investigate plasma brain natriuretic peptide (p-BNP) in consecutive primary care patients for heart failure screening. DESIGN: Open, descriptive. SETTING: Three primary care clinics, university hospital. SUBJECTS: 291 consecutive patients, > or =40 years. MAIN OUTCOME MEASURES: p-BNP and general practitioners estimated probability of CHF. RESULTS: Median p-BNP was 29 ng/L. In 42% p-BNP was >40 ng/L in the first sample. In 41 patients further investigated, median p-BNP was 98 ng/L, with a correlation between p-BNP and physicians' estimation of probability of heart failure (r=0.469, p<0.0001). New York Heart Association class was correlated to p-BNP (r=0.343, p=0.034). No correlation between ejection fraction and p-BNP was seen. CONCLUSION: P-BNP concentrations in unselected primary care patients of 40 years of age or above were elevated in a larger proportion of patients than previously reported. Owing to the low specificity, p-BNP concentration limits have to be defined before the test can be used for screening in primary care.

Aged↗
PubMed2003

The presence of a significant association between elevated PRV-1 mRNA expression and low plasma erythropoietin concentration in essential thrombocythaemia.

Approximately 45% of newly diagnosed patients with essential thrombocythaemia (ET) demonstrate subnormal plasma erythropoietin (EPO) concentrations, which constitutes a risk factor for occlusive vascular events. In 58 ET patients, a possible association between polycythaemia rubra vera-1 (PRV-1) overexpression and subnormal plasma EPO was investigated, which was always measured prior to the institution of platelet lowering agents. At the time when PRV-1 expression was measured, 28 of 58 (48%) ET patients had received platelet lowering treatment. PRV-1 expression was measured by quantitative real-time reverse transcription-polymerase chain reaction assay of mRNA extracted from purified peripheral blood buffy coat. The cycle threshold (CT) value of PRV-1 was determined and was divided with the CT value for the housekeeping GAPDH gene transcript. A quotient <0.93 was defined as PRV-1 positive. Of the ET patients 12 of 58 (21%) were PRV-1 positive and 19 of 58 (33%) demonstrated subnormal plasma EPO. In the 58 ET patients there was a significant association between low plasma EPO and PRV-1 positive results (P = 0.001). The 30 ET patients who had not received any platelet lowering treatment showed a significant (P = 0.005) relation between PRV-1 positivity and subnormal plasma EPO. No such relationship was present in the 28 ET patients who had received prior treatment with the above drugs (P = 0.147).

Adult↗
PubMed2003

Utility of the amino-terminal fragment of pro-brain natriuretic peptide in plasma for the evaluation of cardiac dysfunction in elderly patients in primary health care.

BACKGROUND: The aims of this study were to measure the N-terminal fragment of pro-brain natriuretic peptide (proBNP) in plasma in medical conditions commonly found in primary care and to evaluate the utility of these measurements in identifying impaired cardiac function in elderly patients with symptoms associated with heart failure. METHODS: We studied 415 patients (221 men and 194 women; mean age, 72 years) who had contacted a primary healthcare center for dyspnea, fatigue, and/or peripheral edema. One cardiologist evaluated the patients in terms of history, physical examination, functional capacity, electrocardiography, and suspicion of heart failure. Plasma N-terminal proBNP was measured by an in-house RIA. An ejection fraction < or =40% by Doppler echocardiography was regarded as reduced cardiac function. Abnormal diastolic function was defined as an abnormal mitral inflow defined as reduced ratio of peak early diastolic filling velocity to peak filling velocity at atrial contraction (E/A ratio), or as abnormal pulmonary venous flow pattern. RESULTS: Patients with impaired functional capacity, impaired systolic function, and/or impaired renal function had significantly increased N-terminal proBNP concentrations. By multiple regression analysis, N-terminal proBNP concentrations were also influenced by ischemic heart disease, cardiac enlargement, and certain medications but not by increased creatinine. No gender differences were observed. Patients with isolated diastolic dysfunction attributable to relaxation abnormalities had lower concentrations than those with normal cardiac function, whereas those with pseudonormal E/A ratios or restrictive filling patterns had higher concentrations. CONCLUSIONS: Plasma N-terminal proBNP concentrations increase as a result of impaired systolic function, age, impaired renal function, cardiac ischemia and enlargement, and certain medications. Values are high in diastolic dysfunction with pseudonormal patterns, but not in patients with relaxation abnormalities. An increase in plasma N-terminal proBNP might be an earlier sign of abnormal cardiac function than abnormalities identified by currently used echocardiographic measurements.

Aged↗
PubMed2003

Increased levels of brain and atrial natriuretic peptides after the first palliative operation, but not after a bidirectional glenn anastomosis, in children with functionally univentricular hearts.

We evaluated the concentrations of the brain and atrial natriuretic peptides in the plasma as markers of ventricular function and volume load in children with functionally univentricular hearts. We studied 7 children aged from 0.5 to 0.7 years with functionally univentricular hearts who had undergone a first palliative operation, and 10 children aged from 1.8 to 3.7 years who had undergone a bidirectional Glenn anastomosis at ages ranging from 0.4 to 1.0 year. As a control group, we studied 14 children without heart defects aged from 0.1 to 4.5 years. Levels of the brain natriuretic peptide were measured at 8.3 to 122 ng/l, with a mean of 52.8 ng/l, after the first palliative operation, compared to 0 to 16 ng/l, with a mean of 7.3 ng/l, after a bidirectional Glenn anastomosis, and 0 to 13.8 ng/l, with a mean of 5.9 ng/l, in the children serving as controls. Corresponding values for atrial natriuretic peptide were 17 to 203 ng/l, with a mean of 103 ng/l, after the first palliative operation, compared to 16 to 54 ng/l, with a mean of 29 ng/l, after the bidirectional Glenn anastomosis, and 12 to 52 ng/l, with a mean of 32 ng/l in the controls. Echocardiography showed that all the children with functionally univentricular hearts had normal ventricular function. Blood presssure, pulmonary arterial pressure, and arterial saturations of oxygen did not differ between the groups. We conclude, that in children with functionally univentricular hearts, the volume overload imposed on the heart after the first palliative operation is associated with increased production of brain and atrial natriuretic peptides, while after ventricular unloading, levels of the natriuretic peptides return to control values.

Atrial Natriuretic Factor↗
PubMed2002

[Increased risk of bone-fragility-related fractures in TSH--suppressive thyroxine treatment].

Low concentration of serum thyrotropin (TSH) is a common finding in patients attending primary care as well as in apparently healthy elderly individuals. Low TSH concentration in apparently healthy elderly seems to be a significant risk factor for the development of dementia and for premature mortality. In thyroxine-treated women, TSH < 0.10 mlU/L appears to be a significant risk factor for fractures of the hip and vertebrae. Considering also the decrease in anti-thyroid immunoactivity observed in thyroxine treatment of autoimmune thyroiditis, as measured with antithyroperoxidase antibodies, we conclude that TSH concentrations during thyroxine substitution treatment should be held within the lower end of the health-associated reference interval.

Aged↗
PubMed2002

[Nurse-managed clinic provides a good foundation for heart failure patients].

We report one of the first analyses of modern heart failure treatment in clinical practice, using beta-blockers and ACE-inhibitors, based on computerised evaluation of a nurse-administered outpatient clinic. One hundred thirty-three patients were treated. Up-titration of an ACE-inhibitor was performed in 104 patients, 13% of whom had to discontinue treatment due to intolerance. Beta-blockers were introduced in 42 patients, and 2% had to discontinue. Of those continuing therapy 97% and 89% of the targeted dose was reached, ACE-inhibitors and beta-blockers, respectively. During the titration 52% of the patients receiving an ACE-inhibitor, and 57% of those receiving a beta-blocker, reported symptomatic improvement. In contrast to pharmaceutical studies, our patients were referred with no other selection than that applied by the patient's physician. With a nurse-monitored treatment strategy it was possible to achieve a high rate of treatment compliance with ACE-inhibitors and beta-blockers.

Adrenergic beta-Agonists↗