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Biomedical subjects

M Hellgren

Publications and source records attributed to M Hellgren.

At least 37 records · Page 2Linked to original sources
PubMed1988

Comparison of four continuously administered progestogen plus oestradiol combinations for climacteric complaints.

Sixty women with climacteric complaints who had not menstruated for at least 1 year were randomly allocated to receive one of four hormonal replacement regimens. All four formulations were administered daily and continuously and each contained 2 mg of micronized oestradiol-17 beta in combination with either norethisterone acetate 1 mg (group A) or 0.5 mg (group B) or megestrol acetate 5 mg (group C) or 2.5 mg (group D). The clinical efficacy was the same although the alleviation of vasomotor symptoms was somewhat slower in those women receiving preparation A. The endometrium was atrophied in nearly all biopsies. Irregular uterine bleeding was almost entirely confined to the earlier phase of the study and was substantially less with the formulation containing 1 mg norethisterone acetate. It is concluded that a continuous oestradiol-progestogen combination can be used for long-term treatment of climacteric complaints in postmenopausal women and that after 4 months the clinical efficacy is the same irrespective of the type and dose of progestogen administered.

Adult↗
PubMed1985

Changes in blood coagulation and fibrinolysis in the normal puerperium.

Blood coagulation and fibrinolysis variables have been studied in the normal puerperium in order to facilitate the decision to discontinue thrombosis prophylaxis after delivery. 16 women were followed longitudinally from the 1st to the 6th week post partum. Factor VIII activity and related antigen, fibrinogen, fibrinopeptide A, antithrombin III, plasminogen, tissue plasminogen activator (t-PA), fast inhibitor of t-PA, alpha 2-antiplasmin, urokinase inhibitors, fragment B beta 15-42 and kallikrein inhibition were analyzed. Both blood coagulation and fibrinolysis were significantly increased during the first 2 weeks, although simultaneously increased inhibitor capacity of both systems was present. 3 weeks post partum, blood coagulation and fibrinolysis were generally normalized, although the inhibitors remained raised compared to nonpregnant controls throughout the observation period.

Antigens↗
PubMed1985

Blood coagulation and fibrinolytic factors as well as their inhibitors in trauma.

Tests generally accepted in the diagnosis of DIC were evaluated in 13 patients with multiple trauma. The blood samples were drawn on admission before treatment with blood, blood products or heparin. The tests included platelet count, prothrombin complex (Normotest/Thrombotest), Factor V, Factor VIII:C, fibrinogen, fibrinogen degradation products (FDP), thrombin and Reptilase times as well as the ethanol gelation test (fibrin monomer). Based on the results of the tests, the patients were categorized into DIC, suspected DIC and no DIC groups. It was found that those patients who were referred to the DIC group were also those who later developed the most severe organ dysfunction and who stayed the longest time in the Intensive Care Unit. Thus, the clinical and laboratory findings agreed. The Normotest/Thrombotest ratio, thrombin times and Reptilase times, and presence of fibrin monomers were of limited value for the diagnosis of DIC. To make a correct diagnosis, the results of several of the conventional tests had to be combined. Additional tests were then evaluated. An increase of the fibrinopeptide A (FPA) level and the Factor VIIIR:Ag (vWF:Ag)/Factor VIII:C ratio in all the DIC patients as well as a decrease of the antithrombin (AT) level in some DIC patients indicated thrombin activity and a risk of thromboembolic events. A decrease of plasminogen and alpha 2-antiplasmin indicated activation of the fibrinolytic system. It is concluded that these new tests are useful in the diagnosis and treatment of DIC and similar proteolytic states.

Adolescent↗
PubMed1985

Analyses of factor XII, prekallikrein and kallikrein inhibitory capacity in patients with laboratory signs of DIC.

We investigated 22 severely ill patients (21 surgical, 1 medical) at the intensive care unit. Analyses of platelet count, Normotest, antithrombin III, FDP and fibrinogen were used to divide the patients into three diagnostic groups: DIC (3 positive tests), suspected DIC (2 positive tests) and No DIC. Using these criteria 9, 8 and 5 patients were referred to these diagnostic groups, respectively. Factor XII and prekallikrein did not differ significantly between the three diagnostic groups. On the other hand the capacity of the patient plasma to inhibit kallikrein was significantly lower in the DIC group. The decrease of kallikrein inhibitory capacity was correlated to the decrease of antithrombin III and alpha 2-antiplasmin. Out of the 22 patients in the study 8 patients died, 5 of these were in the DIC group. Non-surviving patients showed lower values of the protease inhibitors than survivors. It is concluded that in this type of patients and with the laboratory methods used contact phase factors do not seem to be affected in DIC. Analyses of the kallikrein inhibitory capacity, antithrombin and alpha 2-antiplasmin on the other hand seem to be of interest to measure, though the decrease of these inhibitors could be due to consumption as well as to reduced protein synthesis. Further studies are needed to prove the prognostic value of assaying these protease inhibitors.

Critical Care↗
PubMed1984

Blood coagulation and fibrinolytic factors and their inhibitors in critically ill patients.

In a search for new variables, for the diagnosis of disseminated intravascular coagulation (DIC) and for guidelines of therapy in such conditions, 22 severely ill patients were studied. The diagnosis of DIC was based on determinations of platelet counts, prothrombin complex (Normotest), antithrombin (AT), fibrinogen degradation products and fibrinogen. Nine patients were diagnosed as having DIC, eight patients were referred to a suspected DIC group and five to a group of no DIC. The laboratory findings were found to agree with the clinical status. In addition several new parameters were investigated: factor XII, prekallikrein, Simplastin A--another prothrombin complex factor method, factor X, plasminogen (PLG), antiplasmin (AP) and kallikrein inhibitors (KI). Platelet counts, prothrombin complex and antithrombin were mostly pathological in DIC-patients. Of the alternative tests prothrombin complex, fibrinopeptide A and the kallikrein inhibitor as well as the two tests for fibrinolysis (PLG and AP) were significantly altered in DIC-patients. The inhibitor capacity (AT, APV and KI) was lower in patients who died than in survivors and decreased still further in those of the non-survivors who had DIC. Thus the inhibitors can be used as predictors of outcome and hopefully for guiding therapy. To establish the diagnosis of DIC we suggest measurement of platelet count, prothrombin complex, plasminogen as well as of the inhibitors.

Adolescent↗
PubMed1983

Severe acquired antithrombin III deficiency in relation to hepatic and renal insufficiency and intrauterine fetal death in late pregnancy.

Acute fatty liver (AFLP) is a rare complication of late pregnancy. The maternal and fetal mortality has earlier been reported to be about 75%, but during the last decade a reduced mortality to about 30 and 50%, respectively, has been reported in the literature. Disseminated intravascular coagulation (DIC) has been suggested as a contributing cause to the high mortality. The treatment of DIC has long been under debate, and recently the administration of antithrombin III (AT) concentrate in addition to other supportive treatment has been reported successful. This paper presents the survival of 1 patient with severe liver and renal failure indicating AFLP complicated by severe disturbances in blood coagulation and fibrinolysis. The patient was treated with AT concentrate and small doses of heparin, blood coagulation factors, large amounts of glucose intravenously and supportive intensive care. The pregnancy was terminated by cesarean section. The child was stillborn and 75% of the placental parenchyma was fibrosed.

Acute Kidney Injury↗
PubMed1982

Changes in maternal serum aldosterone, potassium and prolactin levels during beta-receptor agonist treatment in third trimester pregnancies.

Beta-receptor agonist (terbutalin or isoxsuprin) administration to pregnant women either because of premature labor (therapy group; T; n = 8) or as prophylactic treatment (prophylaxis group; p; n = 8) resulted in a marked drop in serum potassium (p less than 0.001) during the first two hours of infusion in all patients. In five diabetic women in the P group the prolactin was significantly decreased (P less than 0.01) as was serum aldosterone levels (p less than 0.01). These changes were not observed in the T group. The two groups of pregnant women responded with a significant increase in free fatty acids (FFA) and glucose but the magnitude and the time coarse differed. Thus in T women, FFA reached a peak after 30-60 minutes into treatment and then returned to baseline levels. A closer analysis revealed that this pattern was only obtained in patients receiving terbutalin. Among women given prophylactic treatment with terbutalin, a continuous increase in FFA was noted over the initial two hours (p less than 0.001). The increase in serum glucose was continuous in the two patient groups (p less than 0.001). It is suggested that beta-receptor agonists in diabetic women induces a dopaminergic type of response since serum prolactin levels but not TSH concentrations were affected. The possibility that an increased PGE2 synthesis at the expense of PGF2 alpha might mediate this effect of beta-receptor agonists in discussed. It is also suggested that an increased prostaglandin synthesis might interfere with aldosterone secretion. The possibility that falling serum potassium levels may activate dopaminergic systems via PGE2 synthesis is also emphasized.

Adult↗
PubMed1982

Pregnancy in women with congenital antithrombin III deficiency: experience of treatment with heparin and antithrombin.

The incidence of thromboembolic complications (TE) during pregnancy in women with congenital antithrombin III (AT) deficiency has retrospectively been estimated to be about 70%. 8 women with congenital AT deficiency were studied during 9 pregnancies. Subcutaneous or intravenous heparin in doses to prolong the activated partial thromboplastin time (APTT) was given during pregnancy as prophylaxis or therapeutic treatment. During delivery and abortion the AT level was brought to normal by infusion of AT concentrate and the heparin was reduced or withdrawn. Four pregnancies were uncomplicated with regard to TE and resulted in 4 healthy children. Five pregnancies were terminated by induced or spontaneous abortion. 1 woman had TE during heparin prophylaxis and 2 women had TE before the prophylaxis was started. 1 of the latter suffered from a new TE during continued heparing treatment. Insufficient prolongation of APTT was registered at the time of TE in both women with TE during heparin treatment.

Adult↗
PubMed1982

Long-term therapy with subcutaneous heparin during pregnancy.

35 pregnant women (37 pregnancies) were treated with subcutaneous and/or intravenous heparin because of acute thromboembolic complications (TE) or as prophylaxis against TE. 25 pregnancies were uncomplicated. The most frequent complication was incipient premature labor, which occurred in 7 women. Other complications were retention placentae, twin pregnancies, ablatio placentae and minor hematomas. No serious bleeding complications occurred. The treatment did not seem to affect the children. The antithrombin III (AT) level measured with the chromogenic substrate, S-2238, and platelet counts were analyzed in 16 women. Liver function was studied in 13 of them. A significant decrease in AT occurred initially in both groups and normalization was noted during long-term heparin treatment. Platelet count and liver function were mainly unchanged.

Antithrombin III↗
PubMed1982

Thrombectomy and arteriovenous fistula for iliofemoral venous thrombosis in fertile women.

Thirteen women of fertile age with left-sided iliofemoral venous thrombosis were treated with thrombectomy and a temporary arteriovenous fistula in the groin. In nine patients, the appearance of thrombosis could be related to pregnancy; in three of these, obstetric complications occurred. Diagnosis was obtained by antegrade and retrograde phlebography. After three months, the arteriovenous fistula was closed. Anticoagulant treatment was given from the time of diagnosis and for a total of six months. Patency of the iliac vein was determined by phlebography or venous occlusion plethysmography, or both. Based upon these findings, a short term patency rate of 85 per cent was achieved. Analysis of the material indicates a multifactorial pathogenic mechanism in the development of iliofemoral venous thrombosis. Important factors are pregnancy, obstetric complications, mechanical factors causing flow resistance in the iliac vein, hormonal factors and defective fibrinolysis.

Adult↗
PubMed1981

Studies on blood coagulation and fibrinolysis in pregnancy, during delivery and in the puerperium. I. Normal condition.

Blood coagulation and fibrinolytic variables were investigated with recently developed laboratory methods during normal pregnancy, at delivery and during puerperium. The state of hypercoagulability was registered by an increase in activity of factors XII, X and VIII, in VIII antigen, in ratio between VIII antigen and activity as well as in fibrinogen. Activation of blood coagulation at delivery results in decreasing levels of factors XII and XI and an increase in fibrinopeptide A. However, normal mean values of antithrombin and platelets were observed. An increase is noted in the plasminogen level as well as in urokinase inhibitor during pregnancy. In addition alpha 2-antiplasmin and prekallikrein were studied; however, no marked changes were noted.

Adult↗
PubMed1978

Anticholeretic effect of substance P in anesthetized dogs.

Nine anesthetized dogs were provided with acute common duct fistulas after exclusion of the gallbladder. Synthetic Substance P was administered as caval infusions in a dosage of 0.5-20 ng x kg-1 x min-1, duration 10 min. The output of hepatic bile, sodium and amylase decreased during infusion by 40-52 per cent at the highest doses. After termination of infusion all 3 parameters increased by 19-60 per cent above the basal level. The biliary concentration of sodium was constant, while that of amylase increased during infusion. The responses were dose-related. The anticholeresis induced by substance P might be due to inhibition of the canalicular bile fraction, which presumably is mediated by active sodium transport and independent of bile salt excretion.

Amylases↗
PubMed1977

Effects of local thrombinaemia and endotoxinaemia on hepatic circulation in the anaesthetized dog.

The acute response of the hepatic circulation to thrombinaemia and endotoxinaemia were investigated in the anaesthetized dog. Small amounts of thrombin were infused into the hepatic artery and portal vein. The effects of thrombin were compared to those of minor amounts of portally infused endotoxin. Portal pressure increased significantly following portal infusion of thrombin and endotoxin. Both substances decreased the blood flow markedly in the hepatic artery, while that in the superior mesenteric artery and portal vein decreased only slightly. Heparin and polyphlorethin phosphate (PPP) abolished all effects of thrombin. Bradykinin infused simultaneously inhibited only the effect on the hepatic artery. Vasoactive intestinal peptide, which has the same vasodilatory effect in the liver, did not. It is believed that thrombin and perhaps endotoxin exert a vasoconstrictive effect mediated by products released from platelets.

Anesthesia↗