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Biomedical subjects

K Midtvedt

Publications and source records attributed to K Midtvedt.

32 records · Page 2Linked to original sources
PubMed1996

Half dose of OKT3 is efficient in treatment of steroid-resistant renal allograft rejection.

Rejection episodes in renal allograft recipients are usually efficiently treated with high doses of intravenous methylprednisolone. Rejection therapy with OKT3 is often reserved for steroid-resistant episodes. However, the optimal dose of OKT3 in the treatment of steroid-resistant rejection is not known. Therefore, we randomized renal transplant recipients with steroid-resistant rejection to treatment with a standard daily intravenous dose of either 5 mg of OKT3 (n=15) or 2.5 mg of OKT3 (n=15) for 10 days. Circulating T cells (measured as CD2+ cells) were adequately and equally depleted in the two groups. Three grafts were lost due to rejection within the first 3 months following OKT3 administration, one in the 2.5 mg OKT3 group and two in the 5 mg OKT3 group. Two nonimmunologic graft losses occurred in the 2.5 mg OKT3 group. Median serum creatinine values were not different between the two groups, neither at the start (median values: 200 micormol/L in the 5 mg OKT3 group vs. 188 micromol/L in the 2.5 mg group) nor immediately after OKT3 rescue therapy (202 micromol/L vs. 185 micromol/L, respectively). Eight cytomegalovirus infections occurred in each group. Two re-rejection episodes occurred in the 5 mg OKT3 group and one occurred in the 2.5 mg OKT3 group. All responded to treatment. Function of the remaining grafts estimated by serum creatinine after a mean long-term follow-up of 18 months (range, 6-36 months) revealed no differences (185 micromol/L in the 5 mg OKT3 group vs. 170 micromol/L in the 2.5 mg OKT3 group). We conclude that OKT3 treatment of steroid-resistant rejections in renal transplant recipients is equally effective in daily doses of 2.5 mg and 5 mg with respect to reversal rate and long-term outcome.

Adult↗
PubMed1996

Bilateral nephrectomy simultaneously with renal allografting does not alleviate hypertension 3 months following living-donor transplantation.

Severe hypertension prior to renal transplantation has traditionally been an indication for bilateral nephrectomy. The reasons for hypertension after successful renal transplantation are however many, and the impact of simultaneous bilateral nephrectomy (BN) in this setting has not been well documented. We retrospectively evaluated 158 living-donor renal graft recipients. BN had been performed in 76 patients at the time of the transplantation and 82 were not nephrectomized (controls). All received a triple immunosuppressive drug regimen. Before transplantation, patients in the BN group used 1.8 +/- 0.9 (mean +/- SD) antihypertensive drugs/day, significantly more than in the control group (1.3 +/- 0.8; P < 0.05). Three months after renal transplantation no difference was found (0.9 +/- 1.0 drugs/day in the BN group vs 1.0 +/- 0.8 drugs/day in the control group). No difference was found with respect to serum creatinine, whole blood cyclosporin A (CsA) concentration or blood pressure between the groups. The number of blood transfusions during the first week after transplantation was significantly increased in the BN group (66 SAG units vs 4 SAG units). The median hospitalization length was also longer in the BN group (21 days vs 16 days). In order to circumscribe the pre-transplant difference in use of antihypertensive medication we studied a subgroup of 62 hypertensive recipients (BN/control = 31/31) matched for number of antihypertensive drugs at the time of transplantation (2.3 +/- 0.5 drugs/day in the BN group, 2.1 +/- 0.3 drugs/day in the control group). Three months after transplantation the use of antihypertensive drugs remained the same in the two groups (1.3 +/- 1.0 drugs/day in the BN group vs 1.3 +/- 0.9 drugs/day in the control group). At 3 months no difference was found between the two hypertensive subgroups regarding serum creatinine, whole blood CsA and haemoglobin concentration or systolic blood pressure. However, the BN patients were younger than the control group (38 +/- 10 years vs 49 +/- 11 years, P < 0.05) and this may explain the marginally lower diastolic blood pressure observed in the BN group (82 +/- 10 mmHg vs 87 +/- 7 mmHg, P < 0.05). It is concluded that, in recipients of living-donor grafts, bilateral nephrectomy performed at the time of transplantation did not influence the number of antihypertensive drugs used 3 months after a successful transplantation. Bilateral nephrectomy did however increase the need of blood transfusions during the first week after transplantation and also the hospitalization length.

Adult↗
PubMed1994

Magnesium status in healthy free-living elderly Norwegians.

OBJECTIVE: Magnesium (Mg) status has previously not been properly assessed among healthy elderly subjects. METHODS: Thirty-six healthy elderly subjects participated. Their Mg status was assessed by serum Mg, basal urinary Mg output, and with a Mg loading test (30 mmol infused during 8 hours; urine sampled 24 hours), and compared with 53 healthy younger subjects. Their dietary intake was assessed by a quantified food frequency questionnaire. Fourteen of the subjects received 300 mmol Mg to study the effect on Mg status. RESULTS: With the exception of vitamin D in women, average energy and nutrient intakes were adequate. All subjects had serum Mg levels within the reference value of the laboratory. Basal urinary Mg excretion was 3.3 +/- 1.1 mmol/day and 24-hour Mg retention after a Mg load was 28 +/- 16% compared to 6 +/- 11% in younger controls, suggesting Mg deficiency in the elderly. In the 14 subjects who received oral Mg supplementation there was a statistically significant increase in basal urinary Mg excretion and creatinine clearance, and decreases in Mg retention, serum Mg and serum creatinine. CONCLUSIONS: This study suggests that a significant subclinical Mg deficit, not detected by serum Mg, was present in many of these healthy elderly subjects. Mg supplementation improved Mg status and renal function.

Aged↗
PubMed1994

The magnesium loading test: reference values in healthy subjects.

The magnesium loading test is a useful tool in the diagnosis of magnesium deficiency. In order to establish a reference range in normal subjects, 88 healthy men and women aged between 18 and 66 years were given 30 mmol magnesium intravenously during eight hours as a loading test, urine was collected from start of infusion for 24 h for measurement of magnesium excretion. The magnesium mean retention was 6.3 +/- 10.3% of the loading dose, and the 0.025 and 0.975 fractiles were -19.5% and 27.5%, respectively. There was no significant difference between the sexes or in the different age groups studied. There was no correlation between the magnesium retention and serum magnesium or with basal urinary magnesium excretion. An excess excretion of magnesium was observed the postload day compared to baseline, but the excretion 24 and 48 h after the magnesium loading were closely correlated, suggesting that 24 h urinary sampling is sufficient. In order to examine the reproducibility of the test 23 of the subjects underwent two magnesium loading tests 4 weeks apart. The mean difference between two repeat magnesium loading tests was 2.0% with a SD of 8.1% and a 95% confidence interval of -1.6-5.5%. Normal saline did not affect baseline magnesium excretion. Concomitant administration of ethanol or physical exercise caused greater variation in magnesium excretion, whereas furosemide was without effect. The 8 h magnesium loading test with 24 h urine sampling seems to be fairly reproducible, is adequate for clinical use, but the normal range is wide.

Adolescent↗
PubMed1991

[Antibiotic prevention in permanent pacemaker implantation in Norway].

In Norway 33 hospitals perform permanent pacemaker implantations. 21 hospitals do not use prophylactic antibiotics as a routine. These hospitals implant approximately 600 pacemakers per year. 12 hospitals use prophylactic antibiotics. These hospitals implant approximately 400 pacemakers per year. None of the hospitals using antibiotics follow the same regime.

Anti-Bacterial Agents↗
PubMed1990

[Penicillin in clinical use--50 years].

Penicillin was first used to combat experimental infections in rats in August 1940. Towards the end of December the same year it was decided to treat seriously ill patients with penicillin. The first patient was given the new drug on the 12 February 1941, nearly 50 years ago. The patient improved considerably, but due to shortage of penicillin later succumbed to staphylococcal sepsis. Penicillins are still the most widely used and least toxic antibiotics. This article briefly reviews the history of penicillin from its discovery in 1928 to 1944, when the drug was first used on a larger scale in Norwegians.

History, 20th Century↗
PubMed1985

Rapid determination of antibiotic susceptibility by a disc diffusion test for urgent clinical situations.

Employing the PDM method, disc diffusion antibiotic susceptibility tests were read after 4 and 8 h and compared to traditional readings after 18 h. Four hours of incubation was not found suitable. After 8 h of incubation, all the 74 strains tested showed visible growth and more than 75% of the readings fell in the same sensitivity groups. Nearly all the discrepancies observed could be classified as minor, and reading the plates after 8 h of incubation should be considered as a valuable alternative when the clinical need for rapid information is obvious.

Anti-Bacterial Agents↗
PubMed1982

Sport and infection.

Infectious diseases are apparently as common among athletes as among the average population. An infection will normally lead to decreased performance, i.e. an athlete will "feel" an infection more than a non-athletic individual. Some infections are, however, more common among athletes. These are often related to the kind of athletic performance an the kind of training methods involved but can usually be prevented. In many areas there is a lack of knowledge and the need for more research is underlined.

Humans↗
PubMedDate not supplied

ABO-incompatible deceased donor liver transplantation with the use of antigen-specific immunoadsorption and anti-CD20 monoclonal antibody.

In patients with fulminant liver failure requiring emergency liver transplantation, the only donor organ that becomes available may be ABO incompatible. The risk of graft failure because of antibody-mediated acute rejection is high, but can be reduced by various means. We reported a deceased donor ABO-incompatible liver allograft recipient who was treated with antigen-specific immunoadsorption in combination with anti-CD20 monoclonal antibody and conventional plasmapheresis and immunosuppression. The patient was a 33-yr-old male with blood group A who presented with subacute liver failure of unknown aetiology and received a blood group AB liver graft. Pretransplant he underwent plasmapheresis and received one dose of rituximab. The immunosuppressive regimen consisted of methylprednisolone, tacrolimus and mycophenolate mofetil. Despite regular post-operative plasmapheresis sessions, anti-B antibody titres increased. Antigen-specific immunoadsorption with depletion of anti-B antibodies was performed from day nine to day 17. Thereafter, anti-B IgM and IgG antibody titres remained low. After one month the patient was reoperated with hepaticojejunostomy because of bile duct necrosis and with reconstruction of a stenotic hepatic artery. A mild rejection was successfully treated with methylprednisolone four months post-transplant. At six months post-transplant there was a stricture of the biliary-enteric anastomosis, but the graft was well functioning. We conclude that antigen-specific immunoadsorption can be an important adjuvant therapy to control recipient anti-A/B antibody levels and prevent acute rejection in ABO-incompatible deceased donor liver transplantation.

ABO Blood-Group System↗