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Biomedical subjects

J Edgren

Publications and source records attributed to J Edgren.

At least 37 records · Page 2Linked to original sources

Steroid treatment and aseptic necrosis of the femoral head in renal transplant recipients.

The subject of our study was 546 renal transplant recipients with a graft survival for minimum 12 months. Of these, 29 renal recipients (5.3%) developed aseptic necrosis of the femoral head. The examination revealed that there were no significant differences between the renal recipients with hip necrosis and the control group in the total quantities of administered glucocorticosteroids, whereas there was a highly significant correlation between the two groups in the number of the intravenously administered methylprednisolone pulse doses.

Azathioprine

Long-term 1,25-dihydroxycholecalciferol treatment in renal failure.

1,25-Dihydroxycholecalciferol (1,25-DHCC) was administered to four patients on maintenance hemodialysis and to four patients with renal failure not requiring hemodialysis. Secondary hyperparathyroidism was found in both groups of patients. Before initiation of 1,25-DHCC treatment both groups had serum 1,25-DHCC levels below the normal range (33.1 +/- 15.3 pg/ml). During the treatment period, serum 1,25-DHCC concentrations were normalized. Parathormone concentration in serum decreased in both groups during the observation period. Serum calcium concentration was normalized in patients with renal failure and within the upper normal range in patients on maintenance hemodialysis. Bone biopsy and densitometry, of the radius showed a trend towards normalization of bone during the treatment period, while X-ray studies showed no clear effect of 1,25-DHCC treatment. This study shows that changes in bone mineralization can be reversed by normalization of 1,25-DHCC.

Adolescent

Ultrasonic scanning after percutaneous renal biopsy.

Renal ultrasonic scanning was performed before and after 57 consecutive kidney biopsies in order to assess the value of this method in the diagnosis of complications. One large and six small perirenal haematomas were found, corresponding to an incidence of 13%. This figure is considerably larger than the incidence found with conventional diagnostic methods, but smaller than with computed tomography. One hydronephrosis and a blood clot in the urinary bladder were also diagnosed. No clinically significant complications were missed. We recommend ultrasonography as the first diagnostic procedure when biopsy complications are suspected.

Adolescent

Urography with iohexol. Comparison with metrizoate and iodamide.

Comparisons of the non-ionic medium iohexol with the ionic media Na-Ca-Mg metrizoate and meglumine iodamide, were performed in two separate trials. The difference in diagnostic properties between the media was not significant. There was a significantly lower frequency of subjective sensations after iohexol than after metrizoate, whereas the difference between iohexol and iodamide in this respect was small. Regarding other adverse reactions there was a small advantage in favour of iohexol compared with metrizoate, whereas iohexol caused significantly less adverse reactions than iodamide.

Adolescent

Urography and isotope renography following renal transplantation.

The clinical yield from routine urography following renal transplantation was compared with that from isotope renography. In 50 recipients of renal transplants, 59 urograms and 55 renograms were studied. The most common pathologic finding at urography was renal papillary necrosis (in 6 patients). This condition had no obvious correlation with the further fate of the transplant. There were no other significant pathologic changes. It is concluded that isotope renography can be regarded as sufficient for routine follow-up. One baseline urogram is useful, but additional urographies should be carried out only when clinically indicated.

Creatinine

Interobserver variation in the evaluation of radiologic changes of rheumatoid arthritis.

The variation between four radiologists in the evaluation of hand, wrist, and foot radiographs of rheumatoid arthritis was examined. The recognition of individual radiologic changes varied considerably as judged by the findings of the different observers. Erosion and joint space narrowing were interpreted more uniformly than soft tissue swelling and osteoporosis. When the radiographs were graded from 0 to 5 using standard reference radiographs, more than 90% of them were graded uniformly or with a difference of only one grade. The investigation has shown that when applying grading of rheumatoid arthritis according to standard reference radiographs, the interobserver variation is considerably less than when pure individual radiological changes of rheumatoid arhtritis are considered.

Adult

Pulmonary infections after renal transplantation.

The prevalence of pulmonary infections has been assessed in a series of 93 patients who succumbed after renal transplantation. Pneumonia was considered to be the immediate cause of death in 15 patients; microscopic examination revealed further 10 cases, with pneumonic foci in the lungs. Consequently, the prevalence of pulmonary infections was 27%. Pneumonia was diagnosed on chest X-ray in only 48%, with "uraemic lung" as the most common confounding diagnosis. Clinical microbiology disclosed pathogenic bacteria in the sputum in 40% of the cases. It is concluded that the diagnostic yield would be enhanced by more frequent chest X-rays and presumably with more invasive methods of acquiring specimens for microbiological studies. It is also possible that the application of more stringent criteria for the use of high-dose intravenous steroids for supposed rejection will lead to less pneumonia in patients with renal transplants.

Bacteria

Parathyroidectomy in chronic renal failure.

During the period 1971-1976, subtotal parathyroidectomy was performed on 34 patients with chronic renal failure, representing 8% of all uraemic patients treated on the Renal Ward. Preoperative treatment of renal failure was conservative therapy in 6, haemodialysis in 20 and renal transplantation in 8 patients. The operation was indicated by grave clinical symptoms (pruritus, bone pains and mental disturbances), gastric ulcer and radiological abnormalities (osteoporosis, fractures, subperiosteal resorption and metastatic calcifications). The serum immunoreactive parathyroid hormone was determined in 13 cases, and the value was elevated in all. The serum calcium level was elevated in 8 out of 34 cases. Less than 500 mg of parathyroid tissue was removed in 12 cases, between 500 and 6000 mg in 19 and over 6000 mg in 3. Nodular hyperplasia was present in 11 patients, diffuse hyperplasia in 23. Postoperatively marked falls in serum parathyroid hormone and serum calcium values were observed. The bone pains, pruritus and mental disturbances were alleviated, and the general condition was favourably influenced. The operation had a lesser and more retarded effect on the radiological changes. Complete recovery was only achieved with successful renal transplant. Parathyroidectomy often had a favourable effect on the grave symptoms and may, therefore, be considered in some cases of severe hyperparathyroidism secondary to chronic renal failure.

Adolescent

Heart volume and myocardial connective tissue during development and regression of thyroxine-induced cardiac hypertrophy in rats.

To determine whether development and regression of cardiac hypertrophy are accompanied by changes in heart volume and to learn whether a change in heart volume is associated with changes in the myocardial connective tissue, cardiac hypertrophy was induced in rats by administration of thyroxine. Rats were given L-thyroxine for 4 weeks. Heart volume was estimated radiologically in vivo at the start of the experiment and at 1- or 2-week intervals for 7 weeks. At each of these stages a number of rats were killed, their hearts were weighed and determinations were made of the myocardial contents of DNA, of collagen measured as hydroxyproline, and of glycosaminoglycans, measured as uronic acid. After thyroxine treatment the ratio of left heart ventricle weight to body weight and of heart volume to body weight rose significantly. The increase in heart weight was greater than the increase in heart volume. At the same time, there was a significant decrease in the concentration of hydroxyproline. After discontinuation of thyroxine treatment heart volume, heart weight and the concentration of myocardial collagen returned to normal within 2 weeks. However, the total amount of myocardial collagen was still less than normal at 2 weeks. The results suggest that the decrease in the amount of myocardial collagen associated with thyroxine-induced cardiac hypertrophy--because it results in a weakening of the supporting properties of the myocardial connective tissue framework--might contribute to a slight increase in in vivo heart volume.

Animals

Magnification angiography in the evaluation of transplanted kidneys.

Conventional and magnification angiography were performed on 34 occasions in 31 patients with renal allografts. The differential diagnosis between acute rejection and tubular necrosis was uncertain. In chronic rejection, where vascular abnormalities dominate, the diagnosis was easier. The magnification angiography demonstrated the small intrarenal arteries to better advantage, resulting in a more accurate assessment of the condition.

Acute Disease

Kidney function and compensatory growth of the kidney in living kidney donors.

Pre- and postoperative kidney size and kidney function were studied in 46 living kidney donors aged 20-74 years. Kidney size was measured by planimetry and by estimation of a renal index. Kidney function was assessed by endogenous creatinine clearance and serum creatinine. Planimetry was superior to the renal index for expressing changes in renal size. Compensatory renal hypertrophy took place in donors up to the age of 74, but the greatest changes in renal size were observed in donors of under 40. Total renal function decreased postoperatively to about 77% of the initial level; this change in renal function was inversely correlated with age, but in all subjects studied the function remained within normal limits.

Adult

Radiation sensitivity of lymphocytes from human blood and from the thoracic duct.

Peripheral blood and thoracic duct lymphocytes are sensitive to irradiation. However, a distinct population of resistant lymphocytes exists, which is characterized by reactivity to a very low dose of lymphocyte-stimulating lectins in vitro. Blood lymphocytes are rapidly eliminated from the circulation after radiation damage. An analysis of the function of blood lymphocytes is thus of little or no use in assessing the therapeutic effect of extracorporeal irradiation. Lymphocyte activation must accordingly also be unsuitable for use as a biologic dosimeter after accidental total body irradiation.

Blood

Extracorporeal irradiation of thoracic duct lymph as immunosuppressive treatment in rheumatoid arthritis.

Thoracic duct drainage and re-infusion of the irradiated lymph was carried out as immunosuppressive treatment in 2 patients with progressive, therapy-resistant rheumatoid arthritis. In both patients, a marked clinical improvement was achieved even during the first days of treatment. A reduced number of T cells in the blood was seen 3 days after onset of drainage, whereas no significant change in the number of B cells was observed. No recirculation of the infused cells could be detected, nor was the radiation removal of T cells accompanied by rapid proliferation of "new" T cells. As clinical improvement and reduction in T cells occurred simultaneously, there is probably a connection between these two events. The beneficial clinical response and the achievement of T cell suppression by thoracic duct drainage--the result of irradiation and re-infusion of irradiated lymph--encourage further clinical trials with this type of treatment in severe therapy-resistant rheumatoid arthritis.

Arthritis, Rheumatoid

A case of disseminated hemangiomatosis with cutaneous, hepatic and skeletal manifestations and increased urinary excretion of glycosaminoglycans.

A case of disseminated hemangiomatosis with cutaneous hepatic and extensive skeletal manifestations is reported. The diagnosis was established by means of bone X-ray, hepatic angiography, and skin and bone biopsies. A moderately increased urinary excretion of glycosaminoglycans (GAG) was found. The main GAG fraction excreted was tentatively identified as a heparan sulphate.

Angiomatosis