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Biomedical subjects

L Lind

Publications and source records attributed to L Lind.

At least 163 records · Page 9Linked to original sources
PubMed1994

Electrocardiographic changes during antihypertensive treatment with diltiazem in relation to the achieved serum levels of the drug.

Diltiazem is a calcium channel blocker with antihypertensive and antiarrhythmic actions. In the present study 24 hypertensive patients were treated with diltiazem (180-360 mg daily) for 6 months. The effects on the electrocardiogram (ECG) were studied and were related to the serum levels of diltiazem. Treatment with diltiazem induced a non-significant reduction in heart rate with 3 beats min-1 and decreased blood pressure (-11/-9 mm Hg, p < 0.001). The treatment also induced a prolongation of the PQ-interval (+1.4 cs, p < 0.02), a prolongation only being weakly related to the plasma levels of diltiazem (r = 0.28, not significant) and its metabolite MA (r = 0.37, p = 0.07). Neither was the induced increase in the QT-interval (+0.9 cs, p < 0.05), significantly related to the plasma levels of diltiazem. In conclusion, the plasma levels of diltiazem were not clearly related to the induced changes at the ECG during antihypertensive treatment.

Adult↗
PubMed1994

Impaired glucose and lipid metabolism seen in intensive care patients is related to severity of illness and survival.

OBJECTIVE: To relate glucose and lipid metabolism to the severity of illness and survival in critically ill patients. DESIGN: Cross-sectional and prospective cohort study. SETTING: Secondary referral ICU. PATIENTS: Forty-four consecutive patients admitted to the ICU. MEASUREMENTS AND MAIN RESULTS: An intravenous glucose tolerance test (IVGTT) and serum lipoprotein determinations were performed within the first 24 hours in the ICU. An APACHE II score was also determined. Basal serum lactate, glucose and insulin were all elevated in ICU patients compared to healthy controls (p < 0.001) and were all correlated to indices of severity of illness (r = 0.36-0.42, p < 0.05-0.01 vs the APACHE II score). However, the early insulin response to IVGTT was inversely correlated to the APACHE II score (r = -0.50, p < 0.01). Triglyceride and cholesterol levels in serum were generally decreased when compared to controls (0.88 +/- 0.63 mmol/l for serum triglycerides and 2.46 +/- 0.97 mmol/l for serum cholesterol, p < 0.01 vs controls). However, as could be judged from the levels of free serum glycerol (0.27 +/- 0.23 mmol/l), lipolysis was increased in the critically ill. Serum triglyceride levels, as well as serum FFA and glycerol, correlated to the severity of illness (r = 0.36-0.62, p < 0.05-0.001), HDL-cholesterol was inversely related to the APACHE II score (r = -0.40, p < 0.05). Serum glucose, FFA, glycerol and triglycerides in serum, VLDL and LDL were all elevated (p < 0.05-0.001), while HDL-cholesterol was decreased (p < 0.05) in septic patients (n = 17) compared to those without sepsis. Serum lactate (p < 0.05) and free glycerol (p < 0.01) were both elevated in patients who did not survive (n = 6) when compared to survivors. Multiple logistic regression analysis showed free glycerol (p < 0.05) to be additive to the APACHE II score (p < 0.01) in predicting mortality. CONCLUSION: In a sample of unselected critically ill patients indices of both glucose and lipid metabolism were found to be related to the severity of illness as well as to the occurrence of sepsis and survival.

APACHE↗
PubMed1994

On the use of ambulatory blood pressure recordings and insulin sensitivity measurements in support of the insulin-hypertension hypothesis.

OBJECTIVE: To determine the possible correlations between ambulatory blood pressure and insulin sensitivity, compared with correlations between office blood pressure and insulin. DESIGN: Observational study. SETTING: Policlinic at the Department of Geriatrics, Uppsala, Sweden. PATIENTS: Caucasian patients (n = 149) of both sexes with untreated essential hypertension. MAIN OUTCOME MEASURES: The hyperinsulinaemic euglycaemic clamp and office blood pressure in all subjects. In subgroups, also the oral glucose-tolerance test (n = 96) and 24-h ambulatory blood pressure (n = 84). RESULTS: Significant correlations were seen between the insulin sensitivity index and ambulatory blood pressure recordings, whereas fasting plasma insulin levels were uncorrelated with office blood pressure. The insulin sum and the 2-h insulin level of the oral glucose-tolerance test were more closely correlated with ambulatory blood pressure recordings than was the fasting insulin level. In multiple regression analyses the night-time diastolic blood pressure showed a significant correlation with the insulin sensitivity index even after controlling for the effects of sex, age and body mass index. CONCLUSION: The apparent association between blood pressure and insulin resistance not only is obscured by measurement error, but is also affected by the particular measures of insulin resistance and blood pressure used. The present study provides further evidence that a relationship exists between blood pressure and hyperinsulinaemia or insulin resistance.

Blood Pressure↗
PubMed1994

Relationship between abnormal regulation of cytoplasmic calcium and elevated blood pressure in patients with primary hyperparathyroidism.

Primary hyperparathyroidism (HPT) is characterised by a defective calcium sensitivity of the parathyroid glands. HPT is, furthermore, associated with a high prevalence of hypertension. In the present study BP was measured before operation, during surgery and after operation in 42 HPT patients and in 15 control subjects operated for non-toxic goitre. Parathyroid tissue was removed from all patients and the concentration of cytoplasmic calcium [Ca2+]i was determined in vitro in dispersed single cells by means of microfluometry at extracellular calcium concentrations of 0.5 mM and 3.0 mM. The SBP levels were found to be raised both before (158 +/- 23 (SD) mmHg vs. 144 +/- 24 mmHg in controls, P < 0.05), during surgery (maximal level 167 +/- 22 mmHg vs. 146 +/- 16 mmHg in controls, P < 0.01) and after operation (maximal level 180 +/- 26 mmHg vs. 148 +/- 20 mmHg in controls, P < 0.001) in the HPT subject when compared with controls. SBP during surgery was found to be related to the in vitro measured [Ca2+]i in the parathyroid cells at 3.0 mM extracellular calcium concentration or to the ratio of [Ca2+]i at 3.0 mM-0.5 mM (r = -0.25 and -0.27, respectively; P < 0.05). The degree of suppression of PTH release in vitro at 3.0 mM extracellular calcium was found to be related to both systolic and diastolic BP (r = 0.57 and r = 0.53, respectively; P < 0.05) before surgery. In conclusion, BP was found to be raised in HPT patients both before operation as well as during surgery and after operation.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1993

Decreased peripheral blood flow in the pathogenesis of the metabolic syndrome comprising hypertension, hyperlipidemia, and hyperinsulinemia.

Major cardiovascular risk factors, such as hypertension, hyperlipidemia, and diabetes, often cluster in the same individuals. It has been claimed that obesity, hyperinsulinemia, insulin resistance, and a deranged intracellular handling of ions have pathogenetic importance in the development of this metabolic syndrome. However, a decrease in peripheral blood flow is another factor found in all the different facets of this syndrome. An increased peripheral resistance and a rarefaction of skeletal vessels are often seen in hypertensive subjects. Also, the insulin resistance so commonly seen in hypertension may be a consequence of a decreased blood flow because insulin resistance is associated with a decreased capillarization in skeletal muscle. Furthermore, the activity of skeletal muscle lipoprotein lipase, the key enzyme involved in the removal of triglycerides from the circulation, is known to be related to skeletal muscle vascularization. Because enhanced sympathetic activity has been associated with vascular hypertrophy and rarefaction of vascularization, overactivity in this part of the autonomic nervous system may lead to structural changes that will decrease the blood flow in peripheral tissues and thereby induce the metabolic syndrome of cardiovascular risk factors, particularly in individuals who, for genetic reasons, have decreased capillarization at the onset.

Hemodynamics↗
PubMed1993

Interfering alpha-streptococci as a protection against recurrent streptococcal tonsillitis in children.

Recurrent streptococcal tonsillitis/pharyngitis is a great problem, especially in certain epidemiological situations. Patients treated with antibiotics often have a disturbed normal throat flora and may lack, e.g., alpha-streptococci known in vitro to have an interfering activity against group A streptococci. Thirty-one patients with recurrent streptococcal tonsillitis were given antibiotics for 10 days. At the end of this treatment they were sprayed in their mouths with four selected alpha-streptococcal strains known to have strong growth inhibiting activity in vitro against most beta-streptococci group A. The follow-up period after this colonization was 3 months. After alpha-streptococcal treatment, none of the patients attracted a new tonsillitis during the follow-up period while 8% of the controls had a second tonsillitis. Treatment of streptococcal tonsillitis/pharyngitis with antibiotics followed by recolonization with alpha-streptococci seems to hinder further recurrences.

Adult↗
PubMed1993

On the diversity of insulin secretion and sensitivity in subjects with impaired glucose tolerance.

Insulin secretion and sensitivity are basic characteristics determining the glucose tolerance. The aim of this study was to investigate if derangements in these two main characteristics were generally found in subjects with impaired glucose tolerance (IGT). The early insulin response at the intravenous glucose tolerance test (IVGTT) in 42 subjects with IGT was found to be correlated to the glucose tolerance (r = -0.38, p < 0.01 vs, fasting glucose and r = 0.35, p < 0.02, vs the k-value of IVGTT) while fasting insulin was found to be closely correlated to insulin sensitivity, measured by the euglycemic clamp method (r = -0.83, p < 0.003, n = 11). Using data obtained at the IVGTT's in the IGT subjects, different patterns of insulin secretion were found representing different combinations of impairments in insulin secretion and sensitivity. However, in the majority of the IGT subjects a marked decrease in the early insulin response and a fasting hyperinsulinemia were found. The present study suggest such a characterization by the IVGTT to be of importance for a better understanding of the dynamic interplay between insulin secretion and sensitivity in IGT subjects.

Blood Glucose↗
PubMed1993

On the relationships between mineral metabolism, obesity and fat distribution.

Alterations in calcium metabolism have been associated with cardiovascular risk factors. An altered binding of calcium to plasma proteins and raised levels of parathyroid hormone (PTH) have been described in morbid obesity. In the present study, indices of mineral metabolism were related to obesity (body mass index, BMI) and fat distribution (waist to hip ratio, w/h) in 194 subjects with a wide range of BMI and w/h. The ratio of total serum calcium to plasma ionized calcium (Ca2+) was found to be significantly correlated to both BMI (r = 0.20, P < 0.02) and w/h (r = 0.22, P < 0.005). Serum phosphate was also correlated to both of the indices of obesity in an inverse way (r = -0.24, P < 0.0008 for BMI and r = -0.33, P < 0.0001 for w/h). These relationships were still significant when the influences of age, sex and serum creatinine were included in the multiple regression analysis. This kind of analysis also disclosed that w/h was superior to BMI as a determinant of serum phosphate and the total calcium/Ca2+ ratio in serum. PTH was not significantly correlated to any of the indices of obesity. In conclusion, fat distribution rather than obesity per se was found to be associated with an altered mineral metabolism.

Adipose Tissue↗
PubMed1993

Relations between mixed venous oxygen saturation and hemodynamic variables in patients subjected to abdominal aortic aneurysm surgery and in patients with septic shock.

In order to study if oxygen saturation in mixed venous blood (SvO2) could be used as a marker for heart performance, oxygen delivery (DO2) or consumption (VO2) in critically ill patients 134 hemodynamic measurements were performed by a thermodilution pulmonary catheter in 23 patients after abdominal aortic aneurysm surgery. These data were compared to 200 measurements performed in 30 patients with septic shock. When analysed on an individual basis SvO2 was only closely related to DO2 or VO2 in a minority of the patients. Neither could SvO2 be used as a reliable marker for heart rate, hemoglobin concentration, stroke volume or cardiac index. On the other hand SvO2 was found to be an excellent marker for oxygen extraction (OER) in both groups of patients (median r = 0.98. p < 0.0001). In conclusion, the present study shows that SvO2 could not be used as a reliable marker for the important hemodynamic variables CI, DO2 or VO2 in critically ill patients. However, SvO2 was found to be an excellent marker for OER.

Aortic Aneurysm, Abdominal↗
PubMed1993

Is it hyperinsulinemia or insulin resistance that is related to hypertension and other metabolic cardiovascular risk factors?

AIM OF STUDY: Epidemiologic and clinical studies have shown a close association between hypertension, hyperlipidemia and glucose intolerance. A metabolic imbalance has been proposed. As both hyperinsulinemia and insulin resistance appear to be of pathogenetic importance in this metabolic syndrome, we studied these features in hypertensive and normotensive subjects. METHODS: Glucose disposal under a hyperinsulinemic clamp was measured and different indices of hyperinsulinemia were obtained with the intravenous glucose tolerance test. The results were evaluated in relation to different cardiovascular risk factors assessed in 194 adult subjects selected from a health screening. RESULTS: Both hyperinsulinemia and the glucose disposal (clamped) value were significantly correlated with blood pressure (r = 0.36 and -0.42, respectively; both P < 0.0001), free fatty acids (r = 0.20 and -0.29, respectively; both P < 0.0005), serum triglycerides (r = 0.33 and -0.39, respectively; both P < 0.0001), high-density lipoprotein (HDL) cholesterol (r = -0.31 and 0.41, respectively; both P < 0.001) and fasting glucose (r = 0.45 and -0.44, respectively; both P < 0.0001). Multiple regression analysis with age, sex and obesity as confounding variables showed that insulin resistance was superior to hyperinsulinemia in the relationships with blood pressure and indices of hyperlipidemia (elevated free fatty acids, serum triglycerides and low HDL cholesterol), but both insulin sensitivity and hyperinsulinemia were significantly related to fasting glucose. CONCLUSIONS: Insulin sensitivity was more closely related to blood pressure, serum triglycerides and HDL cholesterol than hyperinsulinemia, but both insulin sensitivity and the insulin levels were associated with fasting glucose. Thus, insulin resistance is more important than hyperinsulinemia as a determinant of the constellation of cardiovascular risk factors comprising hypertension, glucose intolerance and hyperlipidemia.

Adult↗
PubMed1993

Calcium metabolism and sodium sensitivity in hypertensive subjects.

A pattern of negative calcium balanced with lowered levels of serum ionized calcium (Ca2+) and increased urinary excretion of calcium has been reported in hypertensive men. In the present study, ten untreated hypertensive subjects were salt loaded (20 g NaCl) for one week after a week on a low salt diet (< 3 g). The change in mean blood pressure (MBP) at the end of the high compared with the low salt diet was called salt sensitivity and was related to indexes of mineral metabolism. It was found that salt sensitivity was significantly correlated with both plasma ionized calcium (Ca2+) and serum calcium concentrations (both r = 0.64, P < 0.05) on the different diets. These relationships were strongest when sodium sensitivity was measured in the standing position during the low salt intake suggesting a role for an increased sympathetic tone. Salt loading increased the urinary excretion of calcium by 95% and also induced reductions in haemoglobin, serum albumin and serum calcium (P < 0.001). Ca2+, on the other hand, remained constant after salt loading. In conclusion, low levels of plasma ionized calcium and serum calcium were mainly found in hypertensive subjects with a low sensitivity to salt. Salt loading induced an increased calciuresis, haemodilution and possibly a shift of calcium from its protein-bound to its ionized form. The findings support the view that calcium metabolism is related to the regulation of BP.

Aged↗
PubMed1993

Alpha-streptococci as supplementary treatment of recurrent streptococcal tonsillitis: a randomized placebo-controlled study.

Recurrences are a common finding after antibiotic treatment of acute group A streptococcal tonsillitis. This has been attributed to several factors, among others a disturbed normal throat flora and especially a lack of alpha-streptococci. It thus seems logical in patients with recurrent streptococcal tonsillitis, to restore the normal alpha-streptococcal flora by reimplantation of alpha-streptococci. This was performed in a double blinded, randomized, placebo-controlled study. 36 patients with recurrent streptococcal group A tonsillitis were treated with antibiotics followed by either placebo (19 patients) or a pool of 4 selected alpha-streptococcal strains (17 patients) with good interfering activity against clinical isolates of beta-streptococci. No patient recurred during the first 2 months of follow-up in the alpha-treated group, but 7 in those treated with antibiotics and placebo. After 3 months 1 in the patient group treated with antibiotics and alpha-streptococci and 11 in the placebo-treated group recurred. These results are statistically highly significant and show that recolonisation with alpha-streptococci seems to offer a new way to lower the rate of recurrence in streptococcal throat infections.

Adolescent↗