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R Jagenburg

Publications and source records attributed to R Jagenburg.

At least 19 recordsLinked to original sources
PubMed1997

Addition of alpha-ketoglutarate to blood cardioplegia improves cardioprotection.

BACKGROUND: We hypothesized that myocardial content of alpha-ketoglutarate (alpha-KG), an intermediate of the Krebs cycle, can be critically low during heart operations, and that provision of alpha-KG could reduce metabolic abnormalities and lead to improved myocardial protection. METHODS: Twenty-four men aged 46 to 78 years who were undergoing heart operations participated in a prospective, controlled, randomized study. In 13 patients, an average of 28 g of alpha-KG was added to blood cardioplegia. Plasma creatine kinase isoenzyme MB and troponin T, and myocardial extraction of oxygen, substrates, and amino acids were measured. RESULTS: alpha-Ketoglutarate treatment was associated with lower creatine kinase isoenzyme MB (F = 39.6, df = 1.172, p < 0.001) and lower troponin (F = 12.9, df = 1.172, p < 0.001). The values at 4 hours were 31 +/- 2.4 microg/L versus 49 +/- 4.9 microg/L (creatine kinase isoenzyme MB) and 1.1 +/- 0.05 microg/L versus 2.0 +/- 0.34 microg/L (troponin T). Myocardial oxygen extraction was higher during alpha-KG cardioplegia (p < 0.01), but there were no significant differences in myocardial uptake or release of substrates or amino acids. Lactate release was observed in both groups during cardioplegia. Myocardial lactate release had ceased after 30 minutes of reperfusion in nearly half the alpha-KG-treated patients (6 of 13) but remained in all the control patients (11 of 11, p = 0.016). There were no other differences after 30 minutes of reperfusion. CONCLUSION: Provision of alpha-KG during blood cardioplegia improves myocardial protection in patients undergoing coronary operations. This may be linked to enhanced oxidation.

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PubMed1996

Girls prone to urinary infections followed into adulthood. Indices of renal disease.

This study describes blood pressure and renal function, as well as indices of renal disease, in females with and without renal scarring followed from their first urinary tract infection (UTI) in childhood. Of the 111 patients with a median follow-up time of 15 years, 54 had renal scarring (reflux nephropathy) on urography, which was severe in 19 and moderate in 35. The glomerular filtration rate was lower in patients with severe renal scarring and correlated with renal area on urography. However, the filtration rate was decreased below the lower reference limit in only 7 patients, with a lowest value of 70 ml/min per 1.73 m2. The diastolic blood pressure was higher in women with severe scarring. Hypertension of at least 140/90 mmHg was diagnosed in 3 of 54 (5.5%) females with renal scarring, 2 before and 1 at the follow-up examination. The excretion of albumin in urine was low and not correlated to filtration rate. Tubular enzymes in urine were similar in all groups. Thus the renal function was well preserved and the incidence of hypertension low. Within this range of renal function, the level of albumin in urine did not predict the degree of renal scarring.

Acetylglucosaminidase↗
PubMed1995

Alpha-ketoglutarate for myocardial protection in heart surgery.

A low myocardial content of alpha-ketoglutarate during heart surgery might aggravate ischaemic injury. 24 men undergoing coronary surgery participated in a randomised controlled study. 28 g alpha-ketoglutarate was added to blood cardioplegia for intermittent antegrade intracoronary perfusion in 13 cases. alpha-ketoglutarate reduced the appearance in blood of the ischaemic markers creatine kinase MB and troponin T (at 4 h after release of aortic cross-clamp; median [95% CI] 49 [37-60] micrograms/L in controls vs 32 [27-37] micrograms/L for creatine kinase MB, 2.0 [1.2-2.8] vs 1.1 [0.8-1.4] micrograms/L for troponin T). These findings signify attenuated ischaemic injury, possibly secondary to enhanced myocardial oxidative capacity.

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PubMed1995

Prevalence of serum antithyroid peroxidase antibodies in 85-year-old women and men.

Antithyroid peroxidase antibodies (TPOAb) were determined by competitive radioassay in serum samples obtained from a representative population of 85-year-olds (601 women and 285 men). The prevalence of increased TPOAb concentration was significantly higher in the women. In individuals without previously known thyroid dysfunction, 16% of the women and 9% of the men had TPOAb concentration > 100 kilo-units/L, the upper decision limit. We found a direct relationship between TPOAb and thyrotropin (TSH) concentrations and an inverse relationship between TPOAb and free thyroxine (T4) concentrations, but no relationship between TPOAb and defined disorders or treatment with pharmaceutical drugs. Exclusion of individuals with increased TPOAb concentration and conditions influencing TSH and free T4 concentrations resulted in a decrease of the upper reference limit for TSH concentration and an increase of the lower limit for free T4 concentration, indicating that high TPOAb concentration should be taken into account when evaluating normal reference intervals for thyroid-function tests in the elderly.

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PubMed1994

Can laboratory testing improve screening strategies for deep vein thrombosis at an emergency unit?

OBJECTIVES: To study various markers of blood coagulation and fibrinolysis in relation to the extension of deep vein thrombosis (DVT), and to compare the diagnostic usefulness of these markers as screening tests for excluding DVT. DESIGN: A clinical study of patients admitted to an emergency unit. SETTING: Ostra Hospital, Göteborg, Sweden. SUBJECTS: One hundred and five patients with a clinical suspicion of DVT. MAIN OUTCOME MEASURES: Phlebography was used as the reference method for a diagnosis of DVT. Small distal thromboses as well as large proximal thromboses were included. Plasma D-dimer as well as other markers of coagulation and fibrinolysis were analysed. RESULTS: Twenty-eight proximal and 20 distal DVTs were found. Plasma D-dimers (one ELISA and two latex assays), fibrin monomer, prothrombin fragment 1 + 2 (F1+2), thrombin-antithrombin III complex (TAT) and the t-PA-PAI-1 complex were all significantly correlated to the extension of DVT, whilst fibronectin, tissue-type plasminogen activator (t-PA), single-chain urokinase-type plasminogen activator (scru-PA) and plasminogen activator inhibitor 1 (PAI-1) were not. The sensitivity was 94% for the D-dimer ELISA and one of the latex methods (latex-B), at a specificity of 60% and 68%, respectively. The negative predictive value was 92% for ELISA and 93% for latex-B, and both assays showed a negative predictive value of 100% for proximal DVTs. Fibrin monomer, F1+2, TAT, D-dimer (latex-S) and the t-PA-PAI-1 complex all showed lower negative predictive values (88, 84, 79, 78 and 65% respectively). CONCLUSIONS: Sensitivity and negative predictive values for a latex assay (D-dimer latex-B) was similar to that of a D-dimer ELISA: With a sensitivity of 94% (100% for proximal DVTs) such a latex assay may be included in a screening strategy for DVT at an emergency unit. However, the safety of such an approach has to be tested in other prospective studies.

Adult↗
PubMed1994

Influence of increased adrenergic activity and magnesium depletion on cardiac rhythm in alcohol withdrawal.

OBJECTIVE: To investigate the prevalence of arrhythmias in alcoholic men during detoxification and its relation to neuroendocrine activation and electrolyte disturbances. DESIGN: Consecutive case-control study. SETTING: Primary and secondary care, detoxification ward. PATIENTS AND CONTROLS: 19 otherwise healthy alcoholic men (DSM-III-R) with withdrawal symptoms necessitating detoxification in hospital. 19 age matched, healthy non-alcoholic men as controls for Holter recordings. INTERVENTIONS: Treatment with chlomethiazole; additional treatment with carbamazepine in patients with previous seizures. MAIN OUTCOME MEASURES: Computer based analyses of mean heart rate and arrhythmias from 24 hour Holter recordings, 24 hour urinary excretion of adrenaline and noradrenaline, magnesium retention measured by means of intravenous loading test, and serum concentrations of electrolytes. RESULTS: The 24 hour mean heart rate was higher in the alcoholic men (97.4 beats/minute, 95% confidence interval (CI) 91.2 to 103.6) than in the controls (69.6 beats/minute, 95% CI 65.4 to 73.8, P < 0.001). However, there was no difference in diurnal heart rate variation. The prevalence of premature supraventricular depolarisations was lower in the alcoholic men (P < 0.05). Neither atrial fibrillation nor malignant ventricular arrhythmias occurred. The sinus tachycardia in the alcoholic men correlated with the concomitant urinary excretion of catecholamines (P < 0.05). The mean serum magnesium concentration was 0.78 mmol/l (95% CI 0.73 to 0.83) in the alcoholic men and 0.83 mmol/l (95% CI 0.81 to 0.85) in a reference population of 55 men aged 40. Magnesium depletion (defined as magnesium retention > 30%) was detected in 10 alcoholic men (53%). Three alcoholic men had serum potassium concentrations < or = 3.3 mmol/l on admission. CONCLUSION: Increased adrenergic activity, magnesium depletion, and hypokalaemia are often seen after heavy drinking, but in alcoholic men without clinical heart disease these changes were not accompanied by arrhythmias other than sinus tachycardia during detoxification in hospital.

Adult↗
PubMed1994

Measurement of myosin light chain I and troponin T as markers of myocardial damage after cardiac surgery.

The purpose of the study was to test cardiac myosin light chain I (CMLCI) and troponin T (TNT) as markers on myocardial damage after heart surgery. Forty-three patients undergoing cardiac surgery were arbitrarily divided into two groups according to creatine kinase MB isoenzyme (CK-MB) levels and postoperative electrocardiogram (ECG) changes. Group 1: CK-MB > 100 micrograms/L or ECG changes (extensive myocardial damage, 42%); Group 2: CK-MB < 100 micrograms/L and no ECG changes (minimal myocardial damage, 58%). Group 1 was divided into 2 groups (Infarction and Injury groups). CMLCI levels showed strong correlations with TNT levels after the operation. The peak CMLCI and TNT levels in group 1 were significantly higher than in group 2. The peak CMLCI in the Infarction group was significantly higher than in the Injury group. TNT showed different patterns in the Infarction and Injury groups. This study showed that CMLCI and TNT estimation could evaluate myocardial damage over several postoperative days. TNT estimation could identify myocardial damage earlier than CMLCI, however CMLCI could discriminate perioperative infarction better than TNT.

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PubMed1993

Serum deoxythymidine kinase: no help in the diagnosis and prognosis of monoclonal gammopathy.

Serum deoxythymidine kinase activity (S-TK) was determined in the diagnostic evaluation and follow-up of patients with monoclonal gammopathy of undetermined significance (MGUS). During a 4-year period 35 patients were included in the study. Normal concentrations of S-TK were found in 33. Patients with non-progressive monoclonal gammopathy kept a stable, and for the individual, a characteristic level of S-TK during several years of follow-up. A moderately elevated level of S-TK during observation did not indicate progression. Even in four out of five patients developing symptomatic multiple myeloma S-TK remained unchanged. Determination of S-TK does not give diagnostic or prognostic information in monoclonal gammopathy.

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PubMed1992

The predictive value of CKMB mass concentration in unstable angina pectoris: preliminary report.

Unstable angina pectoris is a common clinical problem, and the diagnosis is based on clinical symptoms. However, these symptoms cannot identify high-risk patients. Holter monitoring can identify patients at high risk, but analysis of a large number of patients is time- and resource-consuming, as is angiographic examination. We determined whether creatine kinase MB isoenzyme mass concentration could predict the prognosis for patients with unstable angina pectoris. A total of 101 consecutive patients were studied, and blood samples were collected three times a day for 48 h after admission. Patients with unstable angina and elevated CKMB (but still within the normal range) had a significantly higher risk of developing acute myocardial infarction or requiring revascularization during 6 months of follow-up than patients without elevated CKMB. We conclude that CKMB analysis is a valuable tool that may be of use in selecting high-risk patients with unstable angina pectoris. This finding needs to be confirmed by more extensive studies.

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PubMed1992

High-dose intravenous beta 1-blockade in patients early after cardiac operations. Negative inotropism versus myocardial oxygen economy.

A high adrenergic strain during reperfusion after ischemia impedes functional recovery. Conversely, adrenergic blockade may be beneficial during reperfusion. Negative inotropic effects may outweigh the expected benefit, however. Against this background hemodynamic and metabolic effects of early postoperative infusion with the beta 1-selective agent metoprolol were studied in 22 patients after coronary operations. During basal postoperative conditions, intravenous metoprolol reduced cardiac index and stroke volume index compared with control patients, while other variables were unaffected. During the higher adrenergic level of a dopamine infusion (7 micrograms/kg per minute), the heart rate, rate pressure product, and myocardial oxygen uptake were attenuated in proportion to the plasma level of metoprolol. Intravenous beta 1-blockade did not affect the cardiac output or stroke volume responses to dopamine (the cardiac output was still, however, 19% lower than in control patients). A release of myocardial creatinine kinase isoenzyme myocardial band was observed during dopamine infusion, suggesting that myocardial ischemia was induced. The release was not influenced by metoprolol, but it correlated with heart rate (r = 0.60; p < 0.01). It is concluded that infusion of metoprolol early after coronary operations depresses myocardial contractility with some 19%, which was without clinical significance in straightforward patients; the increased myocardial metabolic demand during a period of increased adrenergic stress was attenuated by metoprolol. This may be of importance for myocardial recovery.

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PubMed1991

Incidence and prevalence of thyroid disease in elderly women: results from the longitudinal population study of elderly people in Gothenburg, Sweden.

The incidence and prevalence of thyroid dysfunction were estimated in a longitudinal study of a representative sample of elderly women at ages 70, 75, 79 and 81. Thyroid-stimulating-hormone concentrations were measured in frozen samples obtained at the ages of 70 and 75 that had been stored for ten and five years, respectively. At the ages of 79 and 81 the serum concentrations of thyroid-stimulating hormone were determined in connection with the sampling. For comparison, thyroid-stimulating-hormone concentrations were also measured in another representative population sample of women at ages 70 (n = 297) and 76 (n = 342), in whom measurements were carried out in direct connection to the clinical study. History of previous thyroid disease, e.g. thyroid surgery and thyroid hormone treatment, was obtained through a questionnaire. Information about previous treatment with radio-iodine was obtained from records. At the age of 70, 1.9% had had thyroid surgery but none had been treated with radio-iodine. L-Thyroxine had been prescribed for 3.5%, and another 3.9% had high thyroid-stimulating-hormone concentrations (greater than 10.0 mU/l) indicating thyroid hypofunction. Between 70 and 79 years of age, eight of the 514 women had developed high concentrations of thyroid-stimulating hormone and another two women had received treatment with L-thyroxine. Three women had received radio-iodine therapy. In addition, one woman at the age of 81 was discovered to have hyperthyroidism. The retrospective analysis showed that markedly elevated TSH concentrations had been present in several women for at least nine years.(ABSTRACT TRUNCATED AT 250 WORDS)

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PubMed1991

Serum cobalamins in the elderly: a longitudinal study of a representative population sample from age 70 to 81.

In a representative population sample (n = 973) born 1901-1902 and examined at the ages of 70, 75, 79, and 81, the change in serum cobalamins with increasing age was studied by trend analysis using values obtained in single individuals at all four examinations. In subsamples without definable disorders, the mean annual decline was: among men 3.4 pmol/l (p less than 0.05), among women 3.2 pmol/l (n.s.). The decline was possibly more pronounced among individuals with low and intermediate concentrations. The health-related lower reference limits (the 2.5 percentile values of subsamples without definable disorders) did not differ significantly between sexes and age groups, but low concentrations or ongoing cobalamin medication became more common with advancing age. The results indicate a slight fall in serum cobalamins between age 70 and 81 but do not call for age-related lower reference limits.

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