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Biomedical subjects

A Danielsson

Publications and source records attributed to A Danielsson.

At least 91 records · Page 5Linked to original sources
PubMed1993

Oral budesonide in active Crohn's disease.

We studied the efficacy and safety of the topically acting steroid budesonide in an oral preparation for controlled ileal release in an open, uncontrolled trial. Twenty-one patients with active Crohn's disease localized to the distal ileum, ileocaecal region or ascending colon, entered the trial. The median age was 36 years and the median duration of Crohn's disease was 8 years. The patients received budesonide, in a controlled ileal release preparation, in a dose of 3 mg t.d.s. for 12 weeks, followed by a reduction to 2 mg t.d.s. for 6 weeks and finally to 1 mg t.d.s. for an additional 6 weeks. Primary variables were the modified Crohn's disease activity index (mCDAI), laboratory parameters and plasma cortisol levels. The mean mCDAI at entry was 268 (+/- 71 s.d.), dropping to 146 (+/- 91 s.d.) after 4 weeks of treatment and to 122 (+/- 87 s.d.) after a total of 12 weeks on 3 mg t.d.s. (P < 0.001). Following dose reduction, the mean mCDAI increased after 18 and 24 weeks of treatment. The erythrocyte sedimentation rate also fell significantly during the study period. Eighteen patients responded favourably during the first 12-week treatment period, and 13 completed the trial. Seven patients were withdrawn due to failure of treatment after reduction of dose, and four of those were treated surgically. No serious side-effects or significant corticosteroid-related side-effects occurred. The mean plasma cortisol levels decreased, but remained within normal range. Four patients were markedly suppressed on the highest dose of budesonide.(ABSTRACT TRUNCATED AT 250 WORDS)

Administration, Oral↗
PubMed1992

Prednimustin treatment in primary biliary cirrhosis: a preliminary study.

We observed a decrease in serum bilirubin, alkaline phosphatases (ALP) and IgM in five patients with primary biliary cirrhosis (PBC) treated with Prednimustin (Sterecyt) for 6 months. In contrast to pretreatment findings, C3 activation was undetectable during treatment in three patients where normalization of serum IgM was achieved. After discontinuation of Prednimustin, bilirubin and ALP levels rapidly returned to pretreatment values, although IgM remained normal for up to 6 months in some patients. We conclude that Prednimustin might be of value in patients with symptomatic PBC where liver transplantation is not an option, and that it should be evaluated in a controlled study. However, the rapid reactivation of the disease after conclusion of treatment must be considered.

Aged↗
PubMed1992

Bile acid malabsorption caused by gastrointestinal motility dysfunction? An investigation of gastrointestinal disturbances in familial amyloidosis with polyneuropathy.

Gastrointestinal dysfunction due to autonomous neuropathy is a complication described in various diseases such as diabetes mellitus, multiple sclerosis, and familial amyloidosis with polyneuropathy. We present the results of a prospective investigation of bile acid malabsorption in 17 patients with familial amyloidosis by means of 75Se-labelled homocholic-tauro acid (SeHCAT). The diagnosis was in all cases verified by the DNA test for mutation of transthyretin in position 30. Small-intestinal biopsy specimens were examined for deposits of amyloid, and the presence of gastric retention was evaluated by gastroscopy. In addition, the patients were investigated for bacterial overgrowth by means of the bile acid breath test (BABT). A high frequency of abnormal BABT results (44%) was encountered. However, 65% also had abnormal low SeHCAT values, indicating bile acid malabsorption. Only two patients had abnormal BABT and normal SeHCAT results, indicating bacterial contamination of the small intestine. Bile acid losses increased with the duration of gastrointestinal symptoms. Significantly lower SeHCAT values were encountered in patients with gastric retention, whereas the occurrence of amyloid deposits in small-intestinal biopsy specimens was without effect on SeHCAT retention. Bile acid malabsorption is frequently encountered in familial amyloidosis with polyneuropathy and seems to be more closely associated with gastrointestinal motility dysfunction than with amyloid deposits in the intestinal mucosa.

Amyloidosis↗
PubMed1992

A steroid enema, budesonide, lacking systemic effects for the treatment of distal ulcerative colitis or proctitis.

The aim of this study was to evaluate whether budesonide enema (2 mg/100 ml) had a significantly better effect than placebo in the treatment of distal ulcerative colitis or proctitis. The trial was of controlled, randomized, double-blind design and included 41 treated patients. The treatment time was 4 weeks, with revisits after 2 and 4 weeks. If no improvement was seen, the patient could be switched over to open-label therapy with budesonide enema. Sigmoidoscopy, histology, blood chemistry, and diary cards were used for estimating the effect of treatment. The results showed that budesonide was superior to placebo. Sigmoidoscopy and biopsy scores improved significantly (p less than 0.01) in budesonide-treated patients compared with placebo. Significantly more patients switched over to open budesonide treatment in the placebo group owing to lack of efficacy compared with budesonide (p less than 0.001). No drug-related adverse experiences occurred, and there was no decrease in endogenous morning plasma cortisol levels. It is concluded that budesonide enema appears to be an effective and safe treatment for distal ulcerative colitis and proctitis.

Administration, Topical↗
PubMed1991

Fingerprinting of molecular components in individual human cerebrospinal fluid samples with a new micropurification system.

This paper reports a rapid and sensitive microtechnique for fingerprinting as little as 20 microliters of cerebrospinal fluid (CSF) from individual humans. Different molecular components were also isolated from the fluid. The SMART system, a new system optimized for high-recovery micropurification, was used for this purpose. The CSF sample, obtained by lumbar puncture, was applied directly into the system, and the patterns recorded for different individuals under various physiological conditions were compared. The results indicate that the procedure provides a powerful tool for the identification or recovery of CSF components and may also be of importance for diagnostic use.

Biogenic Monoamines↗
PubMed1991

Features of Sjögren's syndrome in patients with primary biliary cirrhosis.

Twenty-six consecutive patients with primary biliary cirrhosis (PBC) from northern Sweden were studied regarding the occurrence and features of Sjögren's syndrome (SS). In more than 50% of the patients the rose bengal dye test showed conjunctival and/or corneal staining. In six patients keratoconjunctivitis sicca (KCS) was present with positive rose bengal and Schirmer tests. In a further three patients only the results of the Schirmer tests were abnormal. Radiological findings of sialectasia were demonstrated in six patients, five of whom had KCS. Two of the seven patients who fulfilled our criteria for Sjögren's syndrome were HLA-B8 positive. A high prevalence of increased immune globulins and rheumatic factor was found, but this did not correlate with the presence of Sjögren's syndrome. Some features of Sjögren's syndrome were found in 73% of PBC patients, and keratoconjunctivitis sicca and/or sialectasia were found in 27% of PBC patients. This constitutes a high frequency of secondary manifestations of the liver disease.

Adult↗
PubMed1991

Chronic diarrhoea after radiotherapy for gynaecological cancer: occurrence and aetiology.

The occurrence of chronic diarrhoea was evaluated in 173 consecutive patients previously treated with radiation for gynaecological cancer. A survey of gastrointestinal symptoms showed a high frequency of diarrhoea; 13% of the patients had 21 or more bowel movements a week and 3% had 28 or more. Significantly more patients who had a cholecystectomy were in the group with diarrhoea (chi 2 = 6.26; p less than 0.02). Twenty patients with chronic or intermittent diarrhoea were subject to extended gastrointestinal investigation. Bile acid malabsorption was evaluated by the 75Selenahomocholic acid-taurine test (SeHCAT). Bile acid malabsorption was found in 13 (65%) of the 20 patients further investigated, of whom seven had extremely low whole body retention values, which is consistent with severe malabsorption. The results suggest that bile acid malabsorption is a common cause of diarrhoea after radiation treatment for gynaecological cancer. Bacterial contamination was diagnosed in nine patients (45%) by the [14C]-D-xylose breath test or by the cholyl-[14C]-glycine breath test in combination with a normal test for bile acid malabsorption. All patients with vitamin B-12 deficiency, who were tested for bile acid malabsorption, had low retention times for the SeHCAT (p = 0.05). A significant decline in the frequency of diarrhoea was found after treatment with antibiotics or bile acid sequestrants, or both, in combination with a reduced fat diet.

Adult↗
PubMed1991

Fractionated irradiation and early changes in salivary glands. Different effects on potassium efflux, exocytotic amylase release and gland morphology.

Irradiation is a potent treatment modality of head and neck cancer. However, the irradiation is usually associated with an influence on salivary glands with ensuing dryness and discomfort for the patients. In the present study we used different in vitro secretory models and morphologic characterization of rat parotid gland. Radiation was given to one gland on a 5-day schedule with 6 MV photons (total dose 20, 30, 35, 40, 45 Gy). The contralateral gland served as control, and the analysis of glands were performed 10 days after the last irradiation treatment. The noradrenaline stimulated electrolyte secretion (86rubidium tracer for potassium) was decreased in relation to the irradiation dose and in comparison to contralateral control glands. Noradrenaline stimulated exocytotic amylase release was not affected by irradiation and, there were no signs of obvious quantitative morphologic alterations after irradiation compared with controls. The results suggest that there are differences in the sensitivity to radiation for the two different secretory processes in salivary glands, and, thus, the structures regulating electrolyte and fluid secretion seem to be more vulnerable to irradiation than the process of exocytosis. The results, however, do not allow discrimination between temporary cellular impairment and irreversible damage leading to cell death.

Amylases↗
PubMed1991

Prevalence of primary sclerosing cholangitis in patients with ulcerative colitis.

All patients greater than or equal to 16 years old with a diagnosis of ulcerative colitis were identified in five well-defined catchment areas, representing 12.7% of the Swedish population. Exactly 1500 patients were retrieved, giving a point prevalence of 170/10(5) inhabitants. It was possible to obtain liver function test results less than 2 years old in 94% of the patients and to obtain endoscopic retrograde cholangiographic results in 65 of the 72 patients with abnormal serum alkaline phosphatase values. Primary sclerosing cholangitis was diagnosed in 55 of the patients (3.7%). The prevalence of the disease was 5.5% in patients with substantial colitis and 0.5% in patients with distal colitis. There was a marked male predominance in cholangitis patients compared with colitis patients without cholangitis. Ninety-five percent of the patients with cholangitis had substantial colitis, which was more than the 62% of patients without cholangitis who had colitis. Female patients with cholangitis were older than male patients at the time of diagnosis of both cholangitis and colitis, which contrasted to the equal age at diagnosis of colitis in male and female patients without cholangitis.

Adolescent↗
PubMed1990

Epidemiology of primary biliary cirrhosis in a defined rural population in the northern part of Sweden.

The northern part of Sweden is sparsely populated and must be regarded as a rural region. An investigation into the incidence and prevalence of primary biliary cirrhosis was conducted and the course of the disease was followed. In total, 111 patients with primary biliary cirrhosis were identified for the 10-yr period 1973 to 1982 in the northern health region of Sweden. The mean annual incidence amounted to 13.3 per million and the point prevalence was 151 per million, which is the highest reported so far. There was a significantly higher prevalence in the most northern county of Sweden, both with respect to total number of primary biliary cirrhosis patients and symptomatic patients. Asymptomatic patients amounted to 37%. During the study period 25 patients out of the 111 died (23%), 14 as a direct consequence of the liver disease. Three patients died of primary hepatocellular carcinoma, one having an asymptomatic liver disease without cirrhosis. Primary biliary cirrhosis seems to be more common in Sweden, especially in the northern part, than it is elsewhere. A high frequency of extrahepatic symptoms (85%), mainly musculoskeletal, was recorded. These symptoms may lead to the first contact with the health service, rather than signs of liver disease. Thus, an increasing number of patients are diagnosed with asymptomatic liver disease, who must be followed to check for the eventual development of symptoms.

Adult↗
PubMed1990

Secretory effects of 5-hydroxytryptamine following neonatal sympathectomy in rat parotid gland.

Unilateral sympathetic denervation of rat parotid glands was performed within 4 h after birth. Nine weeks later the glands were used for in-vitro studies of amylase secretion, and 86Rb+ was used as a marker for potassium efflux. The non-denervated contralateral glands served as controls. The tissue concentrations of 5-hydroxytryptamine and its metabolite 5-hydroxyindole acetic acid were also measured. 5-Hydroxytryptamine caused a significant dose-dependent increase in amylase secretion, which was inhibited by methysergide. There was no difference between controls and denervated glands. 5-Hydroxytryptamine was without effect on potassium efflux from either denervated or control glands. The sympathectomy caused increased levels of 5-hydroxytryptamine and 5-hydroxyindole acetic acid as compared with contralateral controls. The results suggest that 5-hydroxytryptamine influences the two main secretory processes in rat parotid gland differently. A significant amylase discharge was seen following 5-hydroxytryptamine stimulation, whereas no effect was seen on 86Rb+ efflux. Although it is also proposed that there are no 5-hydroxytryptamine-associated nerves in the superior cervical ganglion innervating parotid tissue, it seems that there is a complex connection between the sympathetic pathway and the serotoninergic system.

Amylases↗
PubMed1990

Quantitative ultrastructural studies of gall bladder epithelium in gall stone free subjects and patients with gall stones.

The present study aimed at a further evaluation of the role of glycoproteins in the formation of cholesterol gall stones in man. An electron microscopic morphometric study of the gall bladder epithelium was performed in six gall stone free subjects and 12 gall stone patients. Six of the gall stone patients were treated with ursodeoxycholic acid three weeks before cholecystectomy. The number and the volume density of the mucin containing secretory granules, were not significantly increased in gall stone patients compared with gall stone free subjects. Treatment with ursodeoxycholic acid did not affect the number or volume density of the secretory granules. Thus, these results do not give evidence for that the degree of cholesterol saturation influences mucin content in the gall bladder wall of man. A major new finding was that gall stone patients had a markedly reduced total lysosome area and volume density of lysosomes compared with gall stone free subjects, a finding which may be related to a decreased intracellular degradation of protein and/or mucin.

Adult↗
PubMed1990

Bacterial contamination of the small bowel evaluated by breath tests, 75Se-labelled homocholic-tauro acid, and scanning electron microscopy.

Eighty-one patients with diarrhoea due to suspected bacterial contamination of the small intestine were investigated with the bile acid breath test (BABT) and 75Se-labelled homocholic-tauro acid (SeHCAT). The impact of bile acid malabsorption due to dysfunction of the terminal ileum on BABT was evaluated. The group of patients with abnormal BABT, notably the 6-h accumulated value, showed a high frequency of reduced SeHCAT values (p less than 0.01), indicating that a reliable test for bile acid malabsorption is indispensable for interpreting the BABT in the investigation of small-intestinal bacterial overgrowth. The results of the 14C-D-xylose breath test were compared with the outcome of the combined SeHCAT-BABT in 44 patients. In contrast to previous findings no correlation between the two breath tests was found. On the contrary, a significant negative correlation was encountered (p less than 0.01) for patients in whom either breath test was abnormal. Scanning electron microscopy for demonstration of adherent microorganisms was included in the investigations. No correlations were found with the outcomes of the different breath tests. The effect of antibiotic treatment was evaluated with regard to symptoms and breath tests. The results of the investigation indicate that different tests are needed for the diagnosis of bacterial overgrowth of the small intestine, because of the different metabolic characteristics of the contaminating bacteria.

Bacterial Infections↗
PubMed1990

Alterations in C1 inhibitor and clotting factor concentrations in primary biliary cirrhosis and other chronic liver diseases.

C1 inhibitor and von Willebrand factor (vWF) levels were studied in patients with cholestatic or hepatocellular liver diseases. The vWF levels were greatly increased in hepatocellular liver diseases, whereas C1 inhibitor levels were slightly reduced. In cholestatic disease both the vWF and the C1 inhibitor levels were increased: among patients with primary biliary cirrhosis these increases were more pronounced in symptomatic patients than in asymptomatic ones. When compared with other protease inhibitors, the C1 inhibitor pattern in liver disease most closely resembled that of alpha 1-antitrypsin. Thus, C1 inhibitor levels cannot be used as a measure of residual hepatocyte mass in PBC; our data, however, suggested that antithrombin may be more suitable for that purpose.

Adult↗
PubMed1990

Bile acid malabsorption after intestinal bypass surgery for obesity. A comparison between jejunoileal shunt and biliointestinal bypass.

Seventeen patients were operated on with intestinal shunts for morbid obesity, in eight a biliointestinal bypass (BI) was constructed and in the rest a conventional jejunoileal (JI)-shunt. The reduction in weight was similar in both groups, and so was malabsorption of fat, but the BI-group had significantly less bowel motions with less watery diarrhoea. Bile acid malabsorption was measured both chemically by estimating the total amount of faecal bile acids excreted, as well as indirectly by using a 75Se-labelled synthetic bile acid (SeHCAT). Both techniques revealed a substantial loss of bile acid after both types of operation, but patients with BI bypass surgery had significantly lower elimination time of the bile acid than those with JI-shunts. There was a significant negative correlation between SeHCAT retention and total faecal bile acids. However, some patients with low SeHCAT retention had normal or even reduced output of faecal bile acids. Estimation of faecal bile acids may display false negative results when the bile acid pool is decreased. The SeHCAT-test seems to be a better technique for measuring bile acid losses. The study suggests that BI bypass surgery for obesity seems to be advantageous over the JI shunt in reducing the postoperative loss of bile acids and choleretic diarrhoea, without influencing the weight loss.

Adult↗
PubMed1989

CCK- and VIP-induced glycoprotein secretion from mouse gallbladder epithelium following vagotomy: a quantitative electron microscopic study.

The glycoprotein secretion from the mouse gallbladder epithelium induced by vasoactive intestinal peptide (VIP) and cholecystokinin (CCK) was investigated by electron microscopic morphometry. Both VIP and CCK caused a decrease in the volume density of the glycoprotein-containing granules of the principal cells. The effect on the gallbladder epithelium of a left-sided vagotomy was examined. Three and six weeks postvagotomy, slight decreases in cell and nuclear profile area and secretory granule volume density were noted. CCK induced a secretion of glycoprotein granules, whereas no such secretory effect due to VIP could be detected in animals 3 and 6 weeks after vagotomy. The results demonstrate that VIP, like CCK, is involved in glycoprotein secretion from the mouse gallbladder epithelium, but the secretory effect of VIP would appear to be dependent on an intact vagal innervation. The results are of interest in relation to the hypothesis that glycoprotein release may be a precipitating factor in the production of gallstones.

Animals↗
PubMed1989

Weight loss after gastroplasty: psychological sequelae in relation to clinical and metabolic observations.

Twenty-one grossly obese patients were studied before and repeatedly after gastroplasty. Eighteen months after surgery, three groups of patients were identified which had similar preoperative weights but showed significantly different patterns of weight loss. About one third of the patients were considered unsuccessful (less than 20% weight loss). Psychological assessment, using the meta-contrast technique, showed that signs of regressive defense and of immature identity decreased postoperatively. Mild to moderate depressive reactions were found in two thirds of the patients postoperatively and were significantly more frequent among the successful patients. Acute depressive episodes, severe enough to require professional intervention, occurred in four patients, three of whom belonged to the successful group. No correlation could be found between surgical complications or metabolic alterations after gastroplasty and postoperative depression, implying that these factors do not primarily influence the patient's postoperative psychological status. Rather, we suggest that the marked weight loss as such leads to problems of adaptation which in turn may trigger depressive reactions.

Adjustment Disorders↗