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Biomedical subjects

A Kallner

Publications and source records attributed to A Kallner.

At least 37 records · Page 2Linked to original sources
PubMed1999

Does the uncertainty of commonly performed glucose measurements allow identification of individuals at high risk for diabetes?

Revised recommendations for diagnosis of diabetes introduce the intermediary risk group of impaired fasting glucose (IFG), defined as individuals with a fasting blood-glucose concentration between 5.6 and 6.0 mmol/l. We apply the concept of uncertainty to identifiable steps of sampling and measuring blood-glucose. Since many instruments in primary health care measure plasma-glucose and report results as blood-glucose and vice versa, factors affecting the transformation are also considered. The study identifies the measurement procedure as the major source of uncertainty, closely followed by preanalytical sources. The estimated uncertainties indicate that the presently available procedures do not allow identification of IFG by a single investigation. The approach to establish an uncertainty budget can be used to evaluate the clinical usefulness of measurements.

Blood Glucose↗
PubMed1998

Concepts for a model of good medical laboratory services.

Several international standards and corresponding interpretation documents for quality management systems have been published. Although these standards are found useful to some extent, they are considered to be insufficient in several areas important for medical laboratories particularly in the pre- and post-examinational phases. The normative document for accreditation of laboratories (ISO/IEC Guide 25) is presently being revised and a document for medical laboratories (ISO/TC 212, CD 15189) is at draft stage. Both aim to include aspects of total quality management. The concept of total quality management is rather vague. Generally, its goal has been defined as "business excellence". This term, however, needs some explanation if applied to medical laboratories. Therefore, a project group of the European Confederation of Laboratory Medicine (ECLM) has developed a model for total quality management, which is based on a comprehensive management concept issued by the European Foundation for Quality Management. In the case of a medical laboratory, the term "business excellence" should be replaced by "good medical laboratory services". The proposed model could serve as a basis for future developments of total quality management standards in laboratory medicine. The goal of the "journey" should be clarified before it starts. To the best of our knowledge, this is the first attempt to develop a model of a good medical laboratory.

Accreditation↗
PubMed1997

Myocardial injury after electrical therapy for cardiac arrhythmias assessed by troponin-T release.

Episodes of ventricular fibrillation with subsequent intracardiac, and to a lesser extent, external defibrillation give rise to a statistically significant increase in S-troponin T, S-CK-MB(mass) and S-myoglobin indicative of a minor myocardial injury or dysfunction. In contrast, no such signs were observed after external direct-current conversion of atrial fibrillation using high energies, or after pace-terminated ventricular tachycardia.

Adult↗
PubMed1997

The effect of vitamin C in high doses on plasma and biliary lipid composition in patients with cholesterol gallstones: prolongation of the nucleation time.

Vitamin C deficiency in guinea pigs leads to cholesterol supersaturation of bile and formation of cholesterol gallstones. It has been suggested that there may also exist an association between vitamin C and cholesterol gallstones in man, but such a relationship has not been studied in gallstone patients. In order to study the possible effects of vitamin C on gallstone disease in humans, plasma lipid levels, hepatic cholesterol metabolism, biliary lipid composition, cholesterol saturation and nucleation time of gallbladder bile were analysed in 16 consecutive gallstone patients, who were planned for laparoscopic cholecystectomy and were treated with vitamin C (500 mg, four times a day) for 2 weeks before surgery. The plasma concentration of vitamin C increased by 42% in the treatment group. The concentrations of plasma lipids did not differ before and after vitamin C treatment; nor did the plasma levels of lathosterol and 7 alpha-hydroxy-4-cholesten-3-one, reflecting cholesterol and bile acid synthesis respectively. The relative concentrations of cholesterol, bile acids and cholesterol concentration of bile did not differ significantly between the two groups, but the relative concentration of phospholipids was slightly higher in the treated group. The bile acid composition was changed; the percentage of cholic acid being lower and those of deoxycholic acid, ursodeoxycholic acid and lithocholic acid higher in the vitamin C-treated patients compared with the untreated group. The nucleation time was significantly longer in the treatment group (7 days) compared with the untreated group (2 days). Our findings indicate that vitamin C supplementation may also influence the conditions for cholesterol gallstone formation in humans.

Ascorbic Acid↗
PubMed1997

Release of creatine kinase, troponin-T, and tissue plasminogen activator in arterial and coronary venous blood during coronary artery bypass surgery.

Tissue plasminogen activator (t-PA) as a possible marker of endothelial injury during elective coronary artery bypass surgery was studied. T-PA antigen and activity were measured in arterial and coronary venous plasma in 14 patients, and compared to the markers of myocyte injury creatine kinase (CK-MB) and troponin-T (TnT). Cardiopulmonary bypass (CPB) lasted 86 (55-107) min, and aortic cross-clamping (cold, crystalloid cardioplegia) lasted 41 (25-62) min (median (central 90% percentile)). Blood flow in the great cardiac vein was measured by retrograde thermodilution, and increased from 49 (27-90) ml/min before CPB to a maximum of 92 (55-125) ml/min 40 min after declamping (not significant). CK-MB, TnT, and t-PA antigen and activity all increased during CPB, and were significantly higher in coronary sinus than arterial plasma after declamping the aorta. Net cardiac release ([coronary sinus-arterial concentration] x coronary flow) of TnT increased after the aorta was declamped, and was higher in the seven patients with the longest cross-clamping time than in the seven with the shortest time (p < 0.01). Cardiac release of CK-MB and t-PA antigen also increased after declamping, but with no significant difference between long and short cross-clamp times. t-PA activity, however, increased more in the patients with the longest cross-clamp times (p < 0.008). In conclusion, CK-MB, TnT and t-PA were released from the postcardioplegic heart. Release of t-PA indicates that postcardioplegic coronary endothelial activation or injury occurred t-PA activity as well as TnT increased more in patients with long times of cross-clamping, indicating that t-PA activity may be a possible marker of postcardioplegic endothelial injury or activation.

Aged↗
PubMed1997

Release of markers of myocardial and endothelial injury following cold cardioplegic arrest in pigs.

Cold cardioplegic arrest causes reperfusion injury to both endothelium and myocardium. We investigated release of troponin-T (TnT), tissue plasminogen activator activity (t-PA) and histamine (HA) from the heart before and after 2h of cold crystalloid cardioplegia in eight Swedish landrace pigs. Coronary sinus blood flow was measured in an external shunt between the coronary sinus and the right atrium. TnT, t-PA and HA were measured concomitantly in arterial and coronary sinus plasma, and the cardiac release was calculated. Cardiac release of TnT increased from 18 (15-25) micrograms/min (median (central 90% percentile)) before cold cardioplegia to maximum 281 (132-510) micrograms/min 30 min after aortic declamping (p < 0.02 vs initial value). t-PA rose from -4 (-52-34) to maximum 249 (75-691) IU/min 2 min after declamping (p < 0.01) and thereafter returned to baseline levels. The net cardiac release of HA was 72 (-80-1321) nmol/min before cardioplegia, rising to 234 (-188-524) after 2 min of reperfusion (p < 0.02) and returning to baseline after 30 minutes. We conclude that the porcine heart releases t-PA, Tn-T and HA during postcardioplegic reperfusion. The differing kinetics of their release may indicate different affection of the myocardium and the endothelium. Tn-T, t-PA and HA are potential markers of myocardial and endothelial injury in the porcine heart.

Animals↗
PubMed1996

Preanalytical procedures in the measurement of ionized calcium in serum and plasma.

To investigate the effects of sampling routines, ionized calcium (corrected for pH) was measured after sampling in different types of tubes and under fasting and postprandial conditions. The results are discussed with respect to analytical goals. Serum samples, collected in vacuum tubes and spun after coagulation, could be safely measured during 24 h. This time window was expanded to 48 hours by using gel-containing tubes. Properly prepared specimens withstand mail transportation. Different brands of gel-containing tubes gave different results, and these differences were clinically significant. An "American-type" breakfast causes an average decrease of corrected ionized calcium ion concentration of 0.04 mmol/l and an increased interindividual variation of results. Characterisation of reference intervals should include the "nutritional status" and the brand of vacuum tube used.

Blood Specimen Collection↗
PubMed1995

Effects of starvation and of selenium deficiency on the urinary excretion of electrolytes, ketone bodies, creatinine, urea and uric acid.

The aim of this study was to investigate whether urinary excretion of other compounds than ketone bodies are also increased in starved, selenium (Se)-deficient rats. Two groups of male rats were fed an Se-deficient diet with 0.009 mg Se/kg, ("Se-deficient" and "Se-repleted") and one group was fed the same diet with 0.23 mg Se/kg as control for eleven weeks. The urinary excretion of ketone bodies was highly enhanced in Se deficiency, with a 7-fold increase in 3-hydroxybutyrate and an 18-fold increase in acetoacetate. Despite this, the plasma concentration of ketone bodies and the glomerular filtration rate were unaffected in the Se-deficient rats. Starvation resulted in a significant decrease in the urinary content of potassium, magnesium and calcium, in both dietary groups of rats and of urea in the Se-adequate group. No Se-dependent difference was noted for the urinary excretion of these compounds or of sodium, phosphate, creatinine and uric acid in any of the groups. This was unexpected in view of certain previous results and indicates that disturbances in the renal handling of compounds are progressive in Se deficiency, with increased excretion of ketone bodies being an early event while more severe deficiency is required to impair the renal handling of electrolytes and other compounds studied.

Animals↗
PubMed1995

Increased concentrations of lactate dehydrogenase in pregnancy with preeclampsia: a predictor for the birth of small-for-gestational-age infants.

Lactate dehydrogenase (LDH), alanine aminotransferase (ALT) and aspartate aminotransferase (AST) concentrations and platelet counts were measured in 26 normal pregnant women and 51 preeclamptic women. In the normal-pregnancy group, no significant changes were found in the results of these tests. In the preeclampsia group, ALT and AST concentrations were not significantly higher than those in normal pregnancy, but the LDH concentrations increased and the platelet counts decreased significantly through the pregnancy. The increases in LDH did not correlate with changes in ALT or AST. Preeclamptic women with small-for-gestational-age (SGA) infants had significantly higher LDH concentrations than those in the appropriate-for-gestational-age (AGA) group, but ALT and AST concentrations did not increase significantly. As reasons for the LDH increase in our subjects, liver damage was excluded and more active glycolysis in addition to severe cell damage due to chronic anoxemia were inferred. It is suggested that an increase in LDH is predictive of SGA infants in preeclamptic pregnancy, especially in those with normal liver function.

Alanine Transaminase↗
PubMed1994

Kinetic measurement of the erythrocyte sedimentation rate.

A method for estimation of the erythrocyte sedimentation from repeated measurements during the initial part of the sedimentation phase is described. Based on the measurements between 18 and 24 minutes after the beginning of the reaction, the sedimentation at 60 minutes is estimated. The estimate is highly correlated to the measured ESR in the range which the conventional ESR permits (up to about 90 mm). Higher ESR will be estimated from the kinetic data and thus give reproducible and meaningful results of samples which will be reported as "falsely low" by conventional methods. Sedimentations of several hundred mm can thus be estimated suggesting a new use for the ESR, particularly in monitoring patients with severe inflammatory reactions.

Blood Sedimentation↗
PubMed1994

Use of a novel measuring technique for the erythrocyte sedimentation rate--a pilot study in patients with neutropenia and fever.

In the present study a new technique for measuring the erythrocyte sedimentation rate (ESR) is clinically evaluated. This technique extends the measuring range above that of the traditional ESR by calculating the sedimentation (S) at 60 minutes from data collected between 18 and 24 minutes. Measurement of ESR, S and C-reactive protein (CRP) was performed prospectively three times a week in 25 patients developing 30 fever episodes following chemotherapy for a hematological malignancy. A good correlation was obtained between S and ESR values up to 90 mm (r = 0.98; p < 0.0001). The use of S may allow the clinician to follow an infectious or inflammatory process more accurately than with ESR. During neutropenia a rise in S preceded fever in all episodes were two samples were obtained before start of fever (n = 13). Changes in CRP and S values showed the same pattern in 11 episodes, in 12 CRP preceded S and in 7 episodes there was no correlation between the results. CRP, opposed to S, discriminated between bacteremias and blood culture negative episodes (p < 0.05) in samples obtained during the first 72 hours after start of fever. In patients with fever during neutropenia determination of S does not offer any clear advantage to CRP.

Adult↗
PubMed1994

Myocardial release of troponin T after coronary bypass surgery.

The temporal changes in cardiac S-troponin T, S-creatine kinase-MB(S-CK-MB)mass and S-myoglobin were studied for 5 days after coronary bypass grafting in 70 patients. Perioperative infarction occurred in ten patients (2 Q wave, 8 non-Q wave). All three markers showed significant increase even in patients without signs of perioperative infarction. Within 8-12 hours their levels rose significantly (p < 0.001) more in the infarction than in the non-infarction cases. Troponin T and CK-MBmass both showed early (< 8-12 h) peaks in patients with perioperative infarction. CK-MBmass returned to near normal levels within 48-72 hours, whereas troponin T remained markedly increased throughout the observation. Myoglobin concentrations varied widely among the infarction cases. In the non-infarction group, troponin T and CK-MBmass (but not myoglobin) were related to the aortic cross-clamp time. Troponin T (but not CK-MBmass) remained elevated throughout the study period in patients with longer cross-clamp times. These findings may indicate continuous release from damaged myocardium in cases of perioperative infarction. Troponin T and CK-MBmass can serve as markers of perioperative infarction and troponin T may also be useful as a marker in studies on myocardial protection.

Aged↗