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Biomedical subjects

J Kuylenstierna

Publications and source records attributed to J Kuylenstierna.

15 recordsLinked to original sources
PubMed2002

Workshop 2 (synthesis): driving forces and incentives for change towards sustainable water development.

Water is a key resource in attaining sustainability--in social and economic development as well as in the long-term carrying capacity of the planet's life support systems, but consensus on the meaning and priority of these terms is still needed. Amongst the key points identified for water professionals: it is necessary to challenge compartmentalisation in water policy and management; water management strategies must focus clearly on the interdependence of the environment and socio-economic development; water professionals have a key role but must package the information and insight they can provide in a way that is attractive to intended recipients such as policy makers.

Commerce↗
PubMed2001

Hydrosolidarity intergenerational challenges: long-term commitment for long-term issues.

The year 2000 Young Professionals Seminar focused on long-term intergenerational challenges. Water related problems are symptoms of complex and ultimately societal problems linked to human behaviour, political support and managerial and institutional structures. Although integrated water resources management is presented as a solution, it is not always well understood, and can create a sense of hopelessness among professionals. To make it operational requires long-term commitments among various professionals and the involvement of new actors. A number of key topics crystallised as needing further attention, including ethical dimensions in policy making, the development of a framework for a "Future Generation Impact Assessment" (FGIA), and efforts to achieve true dialogue among stakeholders. Young water professionals must become more involved in political processes and take active part in institutional changes. Such engagement will require changes in the working environment facing many young professionals that causes frustration due to inefficient and conservative hierarchical structures and the lack of transparency.

Conservation of Natural Resources↗
PubMed1996

Medical status and complications in relation to periodontal disease experience in insulin-dependent diabetics.

The aim of this study was to define a population of diabetics exhibiting an increased risk of developing severe periodontitis by comparing the medical status of 2 groups of diabetics, 1 with no/minor periodontal disease and 1 with severe periodontal disease. The case-control study consisted of 2 parts, a baseline study and a follow-up study. 39 case-control pairs were selected. They were adult, long-duration, insulin-dependent diabetics matched according to sex, age and diabetes duration. One individual in each pair (the CASE) exhibited severe periodontal disease while the other (the CONTROL) exhibited gingivitis or only minor alveolar bone loss. The median age of the cases was 58 years (range 36 to 70 years) and of the controls 59 years (range 37 to 69 years). The median disease duration in cases and controls was 24 years and 25 years, respectively. The median follow-up time was 6 years. The medical variables analysed were weight, insulin dose, systolic and diastolic blood pressure, vibratory threshold, triglycerides, total-cholesterol, HDL-cholesterol, creatinine, HbA1, proteinuria, ECG, retinopathy, stroke, transient ischemic attacks (TIA), angina, myocardial infarct, heart failure, hypertension, intermittent claudication, foot ulcer, death, cause of death, and smoking habit. Biochemical analyses and clinical variables used as a routine in the monitoring of diabetics failed to differentiate between diabetics with severe and minor periodontal disease. In the follow-up study, significantly higher prevalences of proteinuria and cardiovascular complications such as stroke, TIA, angina, myocardial infarct and intermittent claudication were found in the case group. An association between renal disease, cardiovascular complications and severe periodontitis seems to exist. This indicates that a closer cooperation between the diabetologist and the dentist is necessary in monitoring the diabetic patient.

Adult↗
PubMed1989

Periodontal conditions in insulin-dependent diabetics.

The aim of this study was to compare the prevalence and severity of periodontal disease in age- and sex-matched adult long- and short-duration insulin-dependent diabetics and non-diabetics. The study involved 82 subjects with long- and 72 with short-duration diabetes and 77 non-diabetics, all aged 20-70 years. The clinical and radiographic examination comprised recordings of the number of existing teeth, absence or presence of plaque and supra- and subgingival calculus, gingival conditions, probing pocket depth and alveolar bone level. There were no significant differences in the number of existing teeth or presence of plaque and supra- and subgingival calculus between long- and short-duration diabetics and non-diabetics. Diabetics, irrespective of the duration of the disease, had a higher prevalence of sites with gingivitis than non-diabetics. Overall, there were no significant differences between the groups regarding the prevalence of tooth surfaces with probing pocket depths of 4 and 5 mm. However, on comparison between age subgroups, long-duration diabetics younger than 45 years had significantly more 4 and 5 mm pockets than non-diabetics. Long-duration diabetics altogether had significantly more tooth surfaces with probing depth greater than or equal to 6 mm than non-diabetics. The radiographs of alveolar bone height exhibited significantly more extensive alveolar bone loss in long-duration diabetics aged 40-49 years than in short-duration diabetics and non-diabetics. This, together with the increased number of subjects belonging to classification groups with severe periodontal disease experience among long-duration diabetics, indicates more periodontal disease in these diabetics.

Adult↗
PubMed1989

Dental care habits and knowledge of oral health in insulin-dependent diabetics.

The aim of this study was to investigate dental care habits and knowledge of oral health in age- and sex-matched adult long and short duration insulin-dependent diabetics and non-diabetics. Ninety-four long and 86 short duration diabetics and 86 non-diabetics, aged 20-70 years, participated in the study. All subjects answered a questionnaire with 38 questions about dental visits, attitudes to and knowledge of dental diseases, toothcleaning, dietary and smoking habits, and oral sensations. Among the diabetics there was a rather large group that did not visit a dentist annually. The diabetics also required more emergency dental care and were not as willing as the non-diabetics to spend time and money on their teeth. The compliance with dietary advice was poor among the diabetics. Oral discomfort such as prickling and burning sensations, metallic and bad taste was rare in both diabetics and non-diabetics. In the diabetics, however, a feeling of mouth dryness was common.

Adult↗
PubMed1988

Antihypertensive effect of felodipine or hydralazine when added to beta-blocker therapy.

In a double-blind randomized study, hydralazine (n = 59) or the new dihydropyridine calcium antagonist felodipine (n = 61) was added to previous treatment with beta-adrenoceptor blocking agents in a group of 120 patients with essential hypertension. Active treatment with either hydralazine or felodipine was given for 8 weeks after a 4-week placebo run-in period, at the end of which all patients had supine diastolic blood pressures greater than 95 mm Hg. Assessment of the results according to the intention to treat principle showed that felodipine was significantly more effective than hydralazine at the doses employed, reducing systolic blood pressure 10-19 mm Hg more than hydralazine and reducing diastolic blood pressure 5-11 mm Hg more than hydralazine (95% confidence intervals). The number of patients complaining of side effects, the number of complaints, and the number of patients that had to be withdrawn from treatment were numerically higher during treatment with hydralazine than with felodipine, but these differences were not statistically significant. Against this background it is concluded that felodipine is superior to hydralazine when added to an antihypertensive regimen consisting of beta-adrenoceptor blocking agents.

Adrenergic beta-Antagonists↗
PubMed1985

Renal prostaglandin E2 and the renin-angiotensin system in hypertensive disorders in man.

We studied renal vein concentrations of prostaglandin E2 (PGE2) and activity of the renin-angiotensin system in 9 normotensive young men (NT), 17 hypertensive patients with unilateral renal artery stenosis (URS), and 26 patients with essential hypertension (EH) of whom 12 had low renin essential hypertension (LRH). The PGE2 concentration, plasma renin activity (PRA), and angiotensin II (A II) were measured in the inferior vena cava and were compared with the mean concentration for both renal veins under basal conditions and without pharmacological interference. The renal vein PGE2 concentrations were higher in NT (p less than 0.01) and URS (p less than 0.05) than in LRH. However, there were no significant differences in A II concentrations between the groups, nor were there any correlations to PGE2 concentrations. The positive correlation between PRA and PGE2 (r = 0.29, p less than 0.02) indicates that PGE2 may contribute to the activation of the renin-angiotensin system or that there may be a common mechanism for stimulation of both hormonal systems. Our results are not compatible with the hypothesis that a reduction of PGE2 production is a specific feature of patients with EH.

Adult↗
PubMed1985

Prostaglandin E2 and the renin-angiotensin system in primary aldosteronism and Cushing's syndrome.

8 patients with primary aldosteronism (PA) and 4 women with Cushing's syndrome (CS) were investigated with estimations of prostaglandin E2 (PGE2), plasma renin activity (PRA), and angiotensin-II (A-II) concentrations in renal venous blood, under resting and strictly standardized conditions and without pharmacological influence. In the PA group all hormone values were extremely low, but with a tendency to higher PRA and A-II concentrations in patients with idiopathic adrenal hyperplasia. Such low PGE2 concentrations have not previously been reported, and may be the consequence of decreased concentration of circulating A-II. However, a yet unidentified mechanism for the parallel suppression of the renin-angiotensin system (RAS) and of products of arachidonic acid metabolism cannot be excluded in hypertensive states where blood pressure is mainly dependent on volume factors. The number of patients in the CS group was too small to permit definitive conclusions, but a specific pattern of the PGE2 production is probably not seen in conjunction with hypercorticism. There seemed to exist only a covariation between PGE2 concentration and the degree of activation of the RAS.

Adult↗
PubMed1985

Hormonal responses to change in posture in hypertensive man. Evaluation by measurements of prostaglandin E2, renin activity, angiotensin II, and norepinephrine in renal venous blood.

The hormonal responses to the stimulus of changing from resting supine to sitting upright for 15 minutes were assessed in 20 patients with hypertension, divided into 2 groups. 8 patients had essential hypertension (EH) and 12 unilateral renal artery stenosis (URS). The prostaglandin E2 (PGE2) concentration, plasma renin activity (PRA), angiotensin II (A-II) concentration, and norepinephrine (NE) concentration were measured in renal vein blood using specific methods. The PGE2 concentration increased after sitting for 15 minutes in all patients (p less than 0.001), but the increment was significant only in those with URS. The PRA was lower both at rest and after sitting up in the EH group than in the URS group. After sitting up the A-II concentration increased more in patients with URS than in those with EH (p less than 0.05). NE levels rose significantly when all patients were included (p less than 0.01), mainly owing to changes in the EH group. Supine and sitting PRA and A-II were correlated (r=0.47 and r=0.52; both p less than 0.05), and also sitting PGE2 and A-II (r=0.46, p less than 0.05). The inverse relation between PGE2 and NE for the difference in hormone concentrations between supine and sitting (r=-0.44, p less than 0.05) may be explained by an inhibitory effect of PGE2 on renal NE release, earlier observed in experiments in vitro. Similar changes in PGE2 and the measured components of the renin-angiotensin system in response to change in posture may indicate these factors are interrelated.

Adult↗
PubMed1984

Prostaglandin E2, renin and angiotensin II in renovascular hypertension.

We studied a group of 12 hypertensive patients (seven men, five women) with unilateral renal arterial stenosis, and evaluated the morphological criteria on renal angiography for the significance of the stenosis and compared them with the prostaglandin-E2 (PGE2), plasma renin activity (PRA), and angiotensin II (ANG II) concentrations in both renal veins. PGE2 and PRA concentrations were significantly higher in renal veins of kidneys with arterial stenosis with patients supine and after sitting up for 15 min, but the ANG II concentration was raised only with the patient sitting. Assuming that a PRA ratio greater than 2 signifies stenosis of haemodynamic importance, correlation to the angiographic classification was seen in 11 of the 12 patients. The PGE2 ratios were better correlated to PRA ratios than to the angiographic findings. ANG II ratios showed an inconstant and variable pattern in relation to the morphological picture. Our results confirm that PGE2 concentrations in renal venous blood increase in parallel to PRA, and may be interpreted as a means of preserving the blood flow in a kidney with arterial stenosis. However, it is unclear whether this increase is the result of dilution factors or of increased net production of PGE2. Determination of PGE2 in renal vein blood apparently gives no additional information about the functional significance of renal arterial stenosis, and PRA determinations remain the best guide in the management of renovascular hypertension.

Adult↗
PubMed1983

Influence of time and physical activity on blood pressure and heart rate during treatment with beta-blocking agents once daily.

In a cross-over study of 52 middle-aged patients with mild to moderate essential hypertension, we have compared the effect and tolerability of 100 mg atenolol and 100 mg metoprolol given once daily. After 1 1/2 and 3 months of treatment, both systolic and diastolic blood pressure 24 hours after drug intake were significantly lower on atenolol. There were no significant differences after 3 months when blood pressure was read 3-4 hours after dose intake. During exercise, systolic blood pressure and heart rate were--at all work-loads--significantly lower on atenolol. Four patients on metoprolol and one patient on atenolol discontinued treatment owing to side-effects. The results support the need for thorough analysis of the duration of action and influence of physical activity and sympathetic tone in comparisons between presumedly equivalent antihypertensive drugs.

Adult↗
PubMedDate not supplied

Clinical and biochemical effects of spironolactone administered once daily in primary hypertension. Multicenter Sweden study.

In a prospective, double-blind, intraindividual, cross-over, placebo-controlled multicenter study, clinical and biochemical effects of once daily postprandial dose regimens of 50, 100, and 200 mg spironolactone were investigated in 45 outpatients with primary hypertension, WHO (World Health Organization) Stage I-II. Each of the three active therapy periods, which were randomly allocated to patients, were of 2 months' duration, with intervening placebo periods, Clinical and biochemical parameters, including furosemide-stimulated plasma renin activity (PRA), were recorded at regular intervals. All three spironolactone doses resulted in statistically significant blood pressure (BP) reductions independent of initial pretreatment levels and yielded satisfactory BP control in more than half of the patients. The 200 mg daily dose of spironolactone was found to be more effective than 50 but not 100 mg. When, correlating blood pressure response (delta MAP) to PRA, the profiling for positive spironolactone responders was characterized by high age and low PRA, irrespective of sex. Spironolactone therapy resulted in decreased serum sodium and magnesium values; potassium, creatinine, urate, and triglyceride levels were increased. However, all treatment values were within normal ranges. Side effects were infrequent and mainly of endocrine nature.

Administration, Oral↗