PubMed Health⌕ Search

Biomedical subjects

H Prytz

Publications and source records attributed to H Prytz.

At least 19 recordsLinked to original sources
PubMed2002

HLA class II markers and clinical heterogeneity in Swedish patients with primary biliary cirrhosis.

Genetic susceptibility to PBC can, at least in part, be ascribed to the major histocompatibility complex. The relevance of immunogenetic markers for the clinical presentation and course, however, is unclear. Thus, the aim of this study was to investigate the contribution of HLA class II genes to susceptibility, clinical presentation and course of disease in PBC patients. HLA genotyping for HLA-DRB1, -DQB1 and -DPB1 was carried out in a total of 99 Swedish PBC patients and 158 controls. Clinical parameters including epidemiologic variables, signs and symptoms of PBC-related liver disease and histologic data were collected and analyzed in 92 patients at study entry and at follow-up five years later. Significant clinical heterogeneity was seen among PBC patients upon study entry. Although a significant disease association was seen for HLA DRB1*08 and DQB1*0402, immunogenetic markers identified neither a particular subset of patients nor an association with the clinical course of the disease. HLA-DRB1*08 and DQB1*0402 provide the strongest immunogenetic influence in PBC. However, this association is not restricted to any particular, clinically defined subgroup of patients and it is not predictive for the course of the disease.

Adult↗
PubMed2002

Longitudinal bone loss in postmenopausal women with primary biliary cirrhosis and well-preserved liver function.

OBJECTIVES/DESIGN: Increased rate of bone loss has been reported in women with primary biliary cirrhosis (PBC) and varying degree of liver dysfunction. Whether bone loss is increased in patients without liver dysfunction is unclear. The aim of this study was to estimate retrospectively the rate of bone loss in postmenopausal women with PBC and well-preserved liver function. SUBJECTS/INTERVENTIONS: Forty-three women with PBC, and classified as Child-Pugh class A, were included. Bone mineral density (BMD) was measured by dual energy X-ray absorptiometry at the lumbar spine and the femoral neck. RESULTS: Median time between measurements of BMD was 26 months (range, 12-48 months). Twenty women were not receiving any bone protective treatment, i.e. hormone replacement therapy (HRT), bisphosphonates or vitamin D/calcium supplementation, whilst 23 women received such treatment. Mean annual bone loss in the former group was 0.38 +/- 2.56% and 0.42 +/- 2.29% at the lumbar spine and the femoral neck, respectively. Women receiving treatment, however, increased their BMD by 1.92 +/- 3.76% and 0.15 +/- 2.75% at the lumbar spine and the femoral neck, respectively. At the lumbar spine the difference with regard to changes in BMD between untreated and treated women was statistically significant (P = 0.02). Women who received HRT (n = 11) increased their BMD at the lumbar spine by 2.95 +/- 3.91%, P = 0.03 when compared with untreated women. CONCLUSION: Bone loss in postmenopausal women with PBC and well-preserved liver function is not increased above normal. Treatment with bone protective treatment, mainly HRT, improves BMD at the lumbar spine.

Adult↗
PubMed2001

[Therapeutic program for ascites. Recommendations from the Swedish Society of Gastroenterology and Gastrointestinal Endoscopy].

As ascites is related to liver cirrhosis in 80% of the patients, the present therapeutic guidelines are focused on ascites in liver cirrhosis. A combination of spironolactone and furosemide is recommended as first line therapy in patients with mild to moderate ascites and is effective in 90% of patients. In patients with pronounced or tense ascites, first line treatment is total paracentesis with intravenous infusion of human albumin as colloid replacement. Maintenance therapy for the prevention of recurrent ascites is based on spironolactone with or without furosemide. The indications for peritoneovenous shunt, or transjugular intrahepatic stent-shunt (TIPSS), are limited and only recommended in strictly selected patients with refractory ascites. Ascites in liver cirrhosis is a symptom of advanced liver disease, and liver transplantation should always be considered in eligible patients.

Ascites↗
PubMed1999

Constructing scenarios for validating the electronic health care record architecture.

The CEN TC 251 Electronic Health Care Record Architecture is the first part of a four part communication prestandard intended to facilitate the safe communication of clinical information, irrespective of circumstances related to time, distance, and responsibility. The work has important implications for a diversity of stakeholders and must embody clinical principles if it is to succeed. The issue at hand is how to enable clinicians to validate the reference architecture, which is necessarily a technical document, so that they have confidence that it can meet the clinical requirement for safe communication. A model of communication that has been used to ground the architecture is shown to be useful in creating relevant clinical scenarios to permit the first steps towards coherent validation in a systematic way.

Computer Communication Networks↗
PubMed1998

Effects of smoking on the urine excretion of oral 51Cr EDTA in ulcerative colitis.

BACKGROUND: Smokers have a reduced risk and ex-smokers an increased risk of ulcerative colitis (UC). Stopping smoking often precedes onset and relapses. Smoking reduces the 24 hour urine excretion of oral chromium-51 labelled EDTA in healthy individuals. AIMS: To estimate the effects of smoking on the urine excretion of oral 51Cr EDTA in well characterised patients with UC. SUBJECTS: Sixteen smoking and 16 non-smoking patients with UC in remission were studied. The non-smokers had never smoked. Most were taking 5-aminosalicylic acid. No patient took steroids or immunosuppressants. The control group comprised 25 smoking healthy volunteers and 25 who had never smoked. The median cigarette consumption was equal in the patients and volunteers. METHODS: The 24 hour urine excretion of oral 51Cr EDTA was measured and the results were correlated with smoking habits, number of cigarettes, and disease extent. RESULTS: Patients with UC had significantly higher 24 hour urine recoveries than healthy controls (p = 0.04). This difference was more pronounced when patients who smoked were compared with healthy smokers (p = 0.005) No significant differences were found when comparing non-smoking patients with non-smoking controls or when comparing smoking and non-smoking patients. Urine recoveries did not correlate with number of cigarettes or disease extent. Smoking was more prevalent in patients with a more limited disease extent (p = 0.033). CONCLUSIONS: Effects of smoking on the urine excretion of 51Cr EDTA in health were abolished by the presence of UC. The protective effects of smoking in established UC are not due to a moderating effect of smoking on intestinal permeability.

Adult↗
PubMed1997

Ursodeoxycholic acid treatment in patients with primary biliary cirrhosis. A Swedish multicentre, double-blind, randomized controlled study.

BACKGROUND: Ursodeoxycholic acid (UDCA) has been shown to improve serum levels of liver enzymes and bilirubin in primary biliary cirrhosis (PBC). However, it is still uncertain whether UDCA treatment also improves symptoms, liver histology, and survival without liver transplantation. METHODS: We randomized 116 patients with PBC to receive 0.5 g UDCA (n = 60) or placebo (n = 56) daily for 2 years. During the next 2 years, 80% of the UDCA-treated patients and 65% of the placebo-treated patients continued to take UDCA. RESULTS: UDCA improved serum enzyme values but not survival, symptoms, serum bilirubin levels, or liver histology. There was no significant difference in response between initially symptomatic and asymptomatic patients. CONCLUSIONS: UDCA in a dosage of 7.7 mg/kg body weight is of little benefit in PBC. This does not exclude the possibility that larger doses have beneficial effects.

Bile Acids and Salts↗
PubMed1996

Natural history and prognostic factors in 305 Swedish patients with primary sclerosing cholangitis.

BACKGROUND/AIMS--The course of primary sclerosing cholangitis (PSC) is highly variable and unpredictable. This study describes the natural history and outcome of PSC. These data were used to construct a prognostic model for patients with PSC. METHODS--A total of 305 Swedish patients with PSC were studied. The median follow up time was 63 (1-194) months and all patients could be traced for follow up. Some 79 patients died or had a liver transplant. The prognostic significance of clinical, biochemical, and histological findings at the time of diagnosis were evaluated using multivariate analysis. RESULTS--The estimated median survival from time of diagnosis to death or liver transplantation was 12 years. Cholangiocarcinoma was found in 24 (8%) of the patients and 134 (44%) of the patients were asymptomatic at the time of diagnosis. The estimated survival rate was significantly higher in the asymptomatic group (p < 0.001). However, 29 (22%) of the asymptomatic patients became symptomatic during the study period. It was found that age, serum bilirubin concentration, and histological stage at the time of diagnosis were independent predictors of a bad prognosis. These variables were used to construct a prognostic model. CONCLUSIONS--This prognostic model developed from a large homogeneous population of PSC patients should be of value for the timing of transplantation and patient counselling in PSC.

Adolescent↗
PubMed1996

Lymph nodes in the hepato-duodenal ligament. A comparison between ultrasound and low-field MR imaging.

PURPOSE: We investigated whether a low-field MR unit (0.2 T) could demonstrate and determine the size of the lymph nodes in the hepato-duodenal ligament that were previously found on ultrasound. MATERIAL AND METHODS: Eighteen patients were examined with ultrasound, MR and liver biopsy on consecutive days. RESULTS: Two-thirds of the enlarged nodes detected by ultrasound were also detected with the low-field MR technique. However, the size of the nodes was slightly larger on ultrasound. CONCLUSION: Compared to low-field MR, ultrasound appears to be superior in the evaluation of lymph nodes in the liver hilus.

Adult↗
PubMed1995

Colchicine treatment of primary sclerosing cholangitis.

BACKGROUND/AIMS: There is no medical treatment of documented benefit in primary sclerosing cholangitis (PSC). Colchicine has been observed to reduce mortality in primary biliary cirrhosis in one study. The aim of this study was to examine the effect of colchicine in PSC. METHODS: Eighty-four patients with PSC were randomized to receive 1 mg of colchicine daily (n = 44) or placebo (n = 40) in a double-blind 3-year study. The effect of treatment was evaluated through blind scoring of 10 variables in prestudy and poststudy liver biopsy specimens, daily recording of symptoms, and biochemical tests (serum bilirubin, alkaline phosphatase, aspartate aminotransferase, alanine aminotransferase, albumin, immunoglobulins, ceruloplasmin, alpha 1-antitrypsin, and plasma prothrombin levels) at 6-month intervals. RESULTS: There was no evidence of a favorable effect of colchicine on survival, symptoms, serum biochemistry, or liver histology in patients with PSC. CONCLUSIONS: One milligram of colchicine daily is ineffective in PSC.

Adult↗
PubMed1995

Psychological profile of patients suffering from Crohn's disease and ulcerative colitis.

Patients with Crohn's disease (CD, n = 61) and ulcerative colitis (UC, n = 24) were studied using an interview and a series of percept-genetic tests describing anxiety, defensive strategies, and the self-image. Attention was specifically directed at a subgroup of CD (n = 15) with its inflammation limited to the colon (colon Crohn, CC). There was also a control group (n = 43). CC had more immature parent relations than the other groups. They were more childishly concrete and more alexithymic. While CC differ from other Crohn patients in many respects, the real cleft opens up with regard to UC, in spite of location of their illness. CC patients obviously have a psychological profile of their own.

Adaptation, Psychological↗
PubMed1995

Sampling variability of percutaneous liver biopsy in primary sclerosing cholangitis.

AIMS: To study sampling variability of percutaneous liver biopsy in primary sclerosing cholangitis (PSC). METHODS: One hundred and twelve biopsy specimens (that is, 56 pairs) from 44 patients with PSC, confirmed by cholangiography, were evaluated blindly. Six different features, qualitative grading of four other features and staging according to Ludwig were assessed. RESULTS: Quantitative sampling variability was confined mainly to just one grade or stage, although 11% (six of 56) of the biopsy specimen pairs differed by more than one stage (7% (one of 15) in pairs > 2 cm in length). Qualitative sampling variabilities were between 18 and 71%. Advanced disease (stages 3 or 4) was missed in 40% (two of five) of the biopsy specimens while cirrhosis was missed in 37%. CONCLUSION: Paired liver biopsy specimens should be taken in clinical studies of PSC using liver histology for evaluation or prognosis.

Biopsy, Needle↗
PubMed1995

Hepatic lymph nodes as follow-up factor in primary biliary cirrhosis. An ultrasound study.

BACKGROUND: The aim of this study was to investigate whether changes in lymph node size in the hepatoduodenal ligament reflect changes in biochemical and histologic markers of cholestasis, hepatocellular damage, and humoral immunoreactivity in patients with primary biliary cirrhosis (PBC). METHODS: Twenty-three consecutive patients were examined with repeated liver biopsies, laboratory tests, and ultrasonographic examinations of the hepatoduodenal ligament. The effect of treatment with ursodeoxycholic acid (UDCA) on these factors was also studied. RESULTS: A correlation was found between changes in lymph node size and changes in markers of hepatocellular damage, cholestasis, and humoral immunoreactivity and also with intralobular inflammation. In the UDCA-treated patients the node size decreased slightly during 2 years of treatment, whereas it was unchanged in the control group (p = 0.0528). CONCLUSIONS: Changes in the size of the lymph nodes in the hepatoduodenal ligament may reflect inflammation and cholestasis in PBC and thus be a valuable indicator in the follow-up of patients with this disease.

Adult↗
PubMed1994

Ultrasound, hepatic lymph nodes and chronic active hepatitis.

Thirty-two consecutive patients with a histological diagnosis of chronic active hepatitis were examined with liver biopsy, laboratory tests and ultrasonography of the hepato-duodenal ligament to investigate the possible correlation between enlarged lymph nodes in the hepato-duodenal ligament and biochemical activity, histological activity and/or humoral immunoreactivity. We found a significant correlation between lymph-node size and serum alkaline phosphatase in the total material. In the hepatitis C-virus-associated group of patients a significant correlation between the size of the lymph nodes and gamma-glutamyl transpeptidase was found. In the autoimmune group there was a trend towards a negative correlation between lymph-node size and albumin.

Adult↗
PubMed1994

Oral budesonide for treatment of autoimmune chronic active hepatitis.

OBJECTIVES: To see if budesonide, a second generation glucocorticosteroid with a high topical effect and a high first-pass metabolism of 90% in the healthy liver, can induce biochemical remission in autoimmune chronic active hepatitis before being metabolized, and further to study the effect on endogenous plasma cortisol levels and corticosteroid-related side effects. PATIENTS AND DESIGN: Thirteen patients with autoimmune chronic active hepatitis (11 females) were treated openly for up to 9 months by oral budesonide capsules. The initial dose was 6-8 mg (mean 6.3 mg) daily for 6-10 weeks, and then the dose was individualized. RESULTS: The pre-treatment values of alanine aminotransferase and immunoglobulin (IgG) were 7.1 +/- 1.2 mukat/L (mean +/- S.E.M.) and 26.4 +/- 3.9 g/L, respectively. After 6 weeks of treatment, significant decreases in alanine aminotransferase (to 2.1 +/- 0.9 mukat/L) and immunoglobulin (to 18.4 +/- 2.4 g/L) were recorded. After 9 months the corresponding values (n = 9) were 1.2 +/- 0.9 mukat/L and 15.9 +/- 1.3 g/L, respectively. The mean value of plasma cortisol remained within normal ranges or was only slightly subnormal for the whole group (364 +/- 44 nmol/L at start, 165 +/- 46 after 6 weeks and 138 +/- 48 after 9 months). However, significantly reduced plasma cortisol levels were found in patients with biopsy-proven liver cirrhosis. CONCLUSION: Oral budesonide appears to decrease liver inflammation in autoimmune chronic active hepatitis while causing a low frequency of systemic side effects and a marginal reduction in plasma cortisol in noncirrhotic patients over a study period of 9 months.

Adult↗
PubMed1994

Lysosomes and human liver disease: a biochemical and immunohistochemical study of beta-hexosaminidase.

Liver biopsies from 88 patients with different liver diseases were studied for beta-hexosaminidase activity. Liver specimens with normal light microscopical morphology showed no immunohistochemical reactivity for beta-hexosaminidase. Increased reactions were noted, mainly in hepatocytes, in biopsies from the patients with different liver diseases. A very large interindividual variation of biochemical liver beta-hexosaminidase activity occurred even within the same diagnostic group, and no group of patients showed any significant increase of liver beta-hexosaminidase activity compared with the patients with normal liver histology. Livers with positive immunohistochemistry showed increased biochemical values for beta-hexosaminidase. In patients with cholestasis due to alcohol abuse, the immunohistochemical reaction was intense and the biochemical beta-hexosaminidase activity was significantly increased compared with non-alcoholic cholestatic cases. Furthermore, blood samples taken from 50 patients at the same time as the liver biopsies. These patients showed significantly increased serum beta-hexosaminidase activity compared with normal controls, but no correlation was found between beta-hexosaminidase activities in the liver and serum of these patients.

Adolescent↗
PubMed1994

Cancer risk in primary biliary cirrhosis: a population-based study from Sweden.

A cohort of 559 patients in Sweden who satisfied predetermined criteria for the diagnosis of primary biliary cirrhosis was followed with respect to the incidence of cancer during the period of 1958 to 1988. The mean follow-up time from the time of primary biliary cirrhosis diagnosis was 9.0 +/- 5.4 yr. During the follow-up period, 148 patients died and the primary cause of death was liver insufficiency. An overall excess risk for cancer, standardized incidence ratio 1.6; 95% confidence interval, 1.1 to 2.2, was found in the cohort. In contrast to previous reports, we found no excess risk for breast cancer (standardized incidence ratio, 0.9; 95% confidence interval, 0.3 to 2.1). The number of hepatocellular cancers in the primary biliary cirrhosis cohort did not significantly differ from expected (standardized incidence ratio, 2.91; 95% confidence interval, 0.4 to 10.5).

Adult↗
PubMed1993

Identification of alcoholic liver disease or hidden alcohol abuse in patients with elevated liver enzymes.

The aim of this prospective study was to identify alcoholic liver disease or covert alcohol abuse in unselected consecutive patients referred to a gastroenterologic out-patient's clinic for elevated liver enzymes. One-hundred-and-thirteen patients were questioned about alcohol consumption, trauma history and loss of driver's licence. Laboratory tests claimed to reflect alcohol consumption and liver biopsy were taken. Using data from patients with the highest (26 patients) and lowest (29 patients) stated consumptions, logistic regression analysis identified violence score (trauma score + driver's licence score) and a laboratory index combining MCV, ASAT/ALAT ratio and IgA values as significant independent predictors of alcohol abuse (index = 2.3 x violence score +1.08 x laboratory index-3.19). Twenty-six patients openly admitted alcohol abuse (> 300 g week-1) and 85% of these had alcoholic liver damage. The index identified a further 12 patients as abusers who stated an intermediate alcohol consumption (25-300 g week-1). Half of these had alcoholic liver damage. Thus, a total of 34% of the patients were identified as abusers and in one-third of these the abuse was covert.

Adult↗