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Biomedical subjects

B Hylander

Publications and source records attributed to B Hylander.

At least 37 records · Page 2Linked to original sources
PubMed1995

Social support and health-related quality of life in black and white dialysis patients.

OBJECTIVES: To identify factors associated with health-related quality of life (HRQoL) in end stage renal disease (ESRD) patients treated with dialysis, and to identify potential racial differences in HRQoL. DESIGN: Cross-sectional study. SAMPLE/SETTINGS: 256 dialysis patients; 72 black women, 59 black men, 61 white women, and 64 white men at Piedmont Dialysis Center, a university-affiliated dialysis center in northwest North Carolina. METHODS: Information was obtained on perceived social support, social networks, blood chemistries, blood pressure, cause of renal failure, treatment-related factors, and socioeconomic factors. HRQoL indicators included two measures of life satisfaction, limitations in leisure-time activities, and Karnofsky's Physical Functioning Scale. RESULTS: On all HRQoL indicators, blacks consistently rated their HRQoL better than whites. In univariate analyses, lack of social support was consistently related to poorer HRQoL. In multivariate regression analyses, good social support and black race were the two strongest predictors of more positive responses to each of the HRQoL indicators, after controlling for the effects of the other investigated factors. With respect to the Karnofsky scale, younger age and fewer medications taken were additional significant predictors of better functioning. CONCLUSIONS: HRQoL was consistently rated better among blacks than among whites. In addition, perceived social support exerted a strong, independent influence on objectively and subjectively measured HRQoL of ESRD patients.

Black or African American↗
PubMed1994

Interleukin-6 and interleukin-8 in serum and urine in patients with acute pyelonephritis in relation to bacterial-virulence-associated traits and renal function.

Urine and serum concentrations of interleukin (IL)-6 and IL-8 were determined in 43 women with acute pyelonephritis caused by Escherichia coli. Urine and serum samples were also collected 2 weeks after the infection and during a subsequent episode of cystitis (n = 8) or asymptomatic bacteriuria (n = 8). Concentrations of IL-6 and IL-8 were related to the expression of 5 virulence markers of E. coli and glomerular filtration rate (GFR) after pyelonephritis. Patients with acute pyelonephritis had elevated urine and serum IL-6 and IL-8 levels as compared to 37 healthy women (IL-6: p < 0.001 in both cases, and IL-8: p < 0.001 in both cases). Patients infected with E. coli producing hemolysin and/or cytotoxic necrotizing factor (CNF) had significantly higher IL-6 levels in serum during acute pyelonephritis as compared to patients infected with strains without the ability to produce these factors (p = 0.0025 and p = 0.0154, respectively). Patients who had high concentrations of IL-8 in urine during acute pyelonephritis had lower GFR at follow-up as compared to patients with lower levels of IL-8 in urine (r = -0.48, p = 0.0123). In conclusion, acute pyelonephritis is accompanied by elevated urinary and serum IL-6 and IL-8 levels. Bacteria producing hemolysin and CNF seem to induce higher concentrations of IL-6 in serum. The secretion of IL-8 from renal cells may participate in the initiation and maintenance of renal inflammation which in turn may influence renal function.

Acute Disease↗
PubMed1993

Interleukin-6 and interleukin-8 in dialysate and serum from patients on continuous ambulatory peritoneal dialysis.

We investigated interleukin-6 (IL-6) and interleukin-8 (IL-8) in peritoneal dialysate and serum from 17 patients on continuous ambulatory peritoneal dialysis (CAPD) with a total of 24 episodes of peritonitis and from 14 non-infected CAPD controls. Bacterial growth was found in 20 (83%) of the dialysate samples. Staphylococcus epidermidis caused 40% of the culture-verified peritonitis. Samples from dialysate were obtained during the first month of dialysis and during peritonitis from the first three dialysate bags on day 1 (the day of admittance) and from night bags on days 3 and 10. Serum samples were drawn on days 1 and 10. Interleukin-6 was increased in all dialysate samples on day 1. The peak median concentration was 23,500 pg/mL (range 1,710 to 340,000 pg/mL) in the first dialysate. Interleukin-8 was also elevated from all patients in the first dialysate, with a peak median value of 2,000 pg/mL (range, 110 to 185,000 pg/mL). Interleukin-6 and IL-8 concentrations from peritoneal fluid on days 1, 3, and 10 were significantly higher than concentrations from CAPD controls (IL-6 median value, 90 pg/mL, P < 0.001; IL-8 median value, nondetectable, P < 0.001). In serum, IL-6 and IL-8 were detected in 83% and 65% of the episodes, respectively. A correlation (P = 0.007) was seen between IL-6 and IL-8 in the first dialysate sample, but not in the subsequent dialysate samples. The highest acute phase reactant (CRP) level obtained during the peritonitis episode correlated to IL-6 in serum (P < 0.02).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

Bacteriuria, bacterial virulence and host factors in diabetic patients.

The prevalence of bacteriuria as well as bacterial virulence and host factors were studied in 514 diabetic outpatients and 405 nondiabetic controls. The prevalence of bacteriuria was not significantly higher in diabetic women (15/239, 6.3%) than in age-matched nondiabetic women (8/236, 3.4%). In diabetic and nondiabetic men, the prevalence was also similar but lower than in women. E. coli was found in 55% of urine cultures with significant growth from diabetic patients, while in 91% of positive cultures from nondiabetic controls. Most E. coli strains lacked ability of P-fimbriae-mediated adhesion and aerobactin-mediated iron uptake, indicating low bacterial virulence. Long-term metabolic control (HbA1c), prevalence of retinopathy, neuropathy and previous foot ulcers were similar in bacteriuric and nonbacteriuric diabetic patients, matched according to gender, age, and duration of diabetes. Renal function was also similar, though the frequency of proteinuria and elevated blood pressure tended to be higher in the bacteriuric than in the noninfected group. Eight-three percent of the bacteriuric patients reported previous urinary tract infections but only 61% of nonbacteriuric patients (p = 0.07). As compared to non-diabetic women, diabetic women reported significantly more previous urinary tract infections (p < 0.01). In conclusion, the prevalence of bacteriuria in diabetic outpatients was not significantly higher than in non-diabetic outpatients or healthy volunteers. No studied host factor was clearly associated with bacteriuria in diabetic patients, although proteinuria and hypertension tended to be more common. The infecting E. coli strains were of low virulence.

Adult↗
PubMed1992

Eating behavior in continuous ambulatory peritoneal dialysis and hemodialysis patients.

Three groups consisting of 12 subjects each (continuous ambulatory peritoneal dialysis [CAPD] patients, hemodialysis patients, and healthy controls) matched for age, sex, and body weight were invited to a test meal for the study of hunger, fullness, and food preferences. They were served an excess portion of hash served on a plate placed on a hidden scale ("VIKTOR"), which was connected to a computer registering the eating process on-line. The patients filled in visual analogue scales (VAS) concerning appetite and food preferences before and after the test meal. Mean total intake of food (+/- SD) was significantly higher for healthy controls (357 +/- 175 g) compared with hemodialysis patients (295 +/- 105 g), which in turn was higher than in CAPD patients (206 +/- 70 g). Eating velocity was lower in both dialysis groups compared with controls. CAPD patients experienced less hunger and desire to eat compared with hemodialysis patients and controls. The reason for the low eating drive in CAPD patients despite their great need for protein and calories is unknown, but might be explained by gastric retention, insufficient dialysis, metabolic effects of the high sugar load from the dialysate, or combinations of these factors.

Adult↗
PubMed1992

A dietary fibre supplement in the treatment of mild hypertension. A randomized, double-blind, placebo-controlled trial.

OBJECTIVE: To study the effects of a dietary fibre supplement given as monotherapy upon blood pressure in mildly hypertensive patients. DESIGN: The investigation was performed as a prospective randomized, double-blind, placebo-controlled trial for 3 months. SETTING: Patients attending an outpatient hypertension clinic in a hospital. PATIENTS: Hypertensive patients with a minimum of two diastolic blood pressure (DBP) readings greater than 90 mmHg during a 2-week run-in period were included. Of the 65 patients enrolled, 63 were randomized (32 fibre, 31 placebo). Six patients did not complete the trial. INTERVENTION: Patients were treated with either fibre (7 g/day) or matching placebo. MAIN OUTCOME MEASURE: Based on previous studies, the a priori hypothesis was that dietary fibre supplementation could reduce blood pressure in hypertensive patients. RESULTS: Body weight was significantly reduced in the fibre group. Dietary fibre significantly reduced DBP and fasting serum insulin. However, no correlation between changes in body weight and systolic blood pressure or DBP was found. CONCLUSION: A dietary fibre supplement can lower DBP in mildly hypertensive patients independent of changes in body weight.

Adult↗
PubMed1991

Usefulness of peritoneal fluid amylase levels in the differential diagnosis of peritonitis in peritoneal dialysis patients.

Peritonitis continues to be a major cause of morbidity in peritoneal dialysis patients despite recent technological advances (Y systems) that have reduced peritonitis rates to much more acceptable levels. Most of the time when a peritoneal dialysis patient presents with peritonitis, it is infectious in origin. However, these patients occasionally develop other intra-abdominal pathology that requires more intensive medical care or, at times, surgical intervention. To help in the early differential diagnosis of the cause of peritonitis in these patients, peritoneal fluid amylase levels were prospectively obtained from 50 patients presenting to the hospital with peritonitis. Thirty-nine of them had typical infectious peritonitis, and their mean peritoneal fluid amylase level was 11.1 (range, 0 to 90). Six patients had pancreatitis and a mean peritoneal fluid amylase level of 550 U/L (range, 100 to 1,140 U/L). Five patients were found to have other intra-abdominal pathology, and their mean peritoneal fluid amylase level was 816 U/L (range, 142 to 1,746 U/L). In patients who did not respond to initial therapy, sequential peritoneal fluid amylase levels did not increase in patients with typical infectious peritonitis whereas it did increase in patients with other intra-abdominal pathology. In conclusion, it was found that peritoneal fluid amylase levels were helpful in the differential diagnosis of peritonitis in these patients. An elevated level (greater than 100 U/L) differentiated those patients with other intra-abdominal causes of peritonitis from those with typical infectious peritonitis.

Amylases↗
PubMed1991

Changing patient characteristics in chronic hemodialysis.

Patients accepted to chronic hemodialysis have changed. We analyzed these changes and survival, cause of death and other factors during 23 years at the Karolinska Hospital. Between 1965 and 1987, 274 patients were accepted: 60 are alive on dialysis, 75 died, 113 were transplanted, 25 sent to other units and one recovered renal function. The mean age increased from 44 to 55 years (p=0.001), the creatinine level at acceptance decreased from 1191 to 965 mumol/l (p = 0.001), the hemoglobin level rose from 70 to 85 g/l (p = 0.001) and the diastolic blood pressure decreased from 96 to 90 mmHg (p = 0.007). The number of co-morbid conditions increased from 1.2 to 1.4 (p less than 0.005). The diagnoses changed from over 90% primary renal disease to 20% systemic diseases such as nephrosclerosis and diabetes (p = 0.04). The chance of receiving a renal transplant decreased from 46 to 39% (p = 0.28). The transplanted patients were younger than the dialyzed patients 42 vs 47 years (p = 0.03) before 1980 and 49 vs. 56 years (p = 0.0001) after 1980. The cause of death changed. Withdrawal from dialysis increased from 5% of deaths before to 24% after 1980 (p = 0.047), cardiovascular deaths decreased from 85% to 55% (p = 0.01). Although the patients accepted for dialysis after 1980 had more serious renal disease and other degenerative diseases than those before, the mortality rate was reduced to only 1/4 to that before, in all age groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1990

Mortality on dialysis--on the influence of early start, patient characteristics, and transplantation and acceptance rates.

We compared changes from 1965 to 1987 in patients accepted to chronic dialysis, in a Swedish and a US dialysis center, by medical and clinical parameters at the start of dialysis and by duration of the dialysis. We also studied cause of death, outcome, and cumulative survival and tried to relate them to changes in patients and procedures. Finally, we studied how cumulative survival of dialysis patients was dependent on acceptance rates and transplant rates in five European regions and the United States. At both centers, the number of patients accepted grew, but since 1980, the only patient group that has increased has been older patients with many other diseases; these comorbid conditions have increased from approximately 1.2 to 1.4. In both centers, the number of patients with systemic disease, diabetes, and nephrosclerosis doubled. Cause of death showed a decrease in cardiovascular deaths and an increase in deaths due to stopping dialysis. The hemoglobin level increased from 70 to 90 g/L (7.0 to 9.0 g/dL) and the diastolic blood pressure decreased from 100 to 90 mmHg. The creatinine level decreased 30%, with an unchanged urea. Cumulative 3-year survival for patients without complications increased from 60% to approximately 90% and in patients with complications, it improved from 20% to 60% in Sweden and remained at approximately 60% in the US center. In the United States, many more patients were accepted to dialysis and the transplant rate was high. Cumulative survival on dialysis was inversely correlated both to the acceptance rates to dialysis and to the percent of patients transplanted. These factors explained over 90% of the differences in dialysis survival.

Aged↗
PubMed1990

Escherichia coli populations from diabetic and non-diabetic patients with bacteraemia and faecal samples from healthy subjects--a comparative study.

Biochemical reactions, using the PhP-EC system of biochemical fingerprinting, were evaluated in order to group strains into different clusters and to investigate whether a biochemical typing system may be used to distinguish between randomly selected Escherichia coli strains obtained from bacteraemic patients and healthy controls. Fifty epidemiologically unrelated strains isolated from blood of non-diabetic patients and 46 faecal control strains were studied. Separately, 70 E. coli strains from 64 diabetic patients with bacteraemia were investigated. Diversity index was 0.977, 0.969 and 0.941 respectively. The strains were clustered at a similarity level of 0.95. The bacteraemic and control strains were subdivided into 14 different clusters with 2-12 strains each and 40 'outliers'. The largest cluster was dominated by bacteraemic strains (9/12, 75%). Two other clusters were dominated by control strains. In the remaining groups blood and faecal isolates were evenly distributed. No biochemical test was able to distinguish between bacteraemic and faecal control strains. Strains from patients with diabetes mellitus were grouped in 11 clusters containing 2-14 strains and 22 'outliers'. The low diversity index of bacteraemic strains obtained from diabetic patients as compared to other strains indicated a greater homogenicity. However, no correlation was observed between the examined host factors and the clusters.

Adult↗
PubMed1990

Comparison of peritonitis rates during long-term use of standard spike versus Ultraset in continuous ambulatory peritoneal dialysis (CAPD).

Continuous ambulatory peritoneal dialysis (CAPD) is an increasingly popular means of end-stage renal disease replacement therapy. Unfortunately, peritonitis continues to be a major source of both morbidity and mortality. The Ultraset incorporates a "flush-before-fill" concept which should theoretically decrease peritonitis rates when compared to the standard spike procedure, while allowing patients the convenience of disconnect. To investigate the impact of long-term use of the Ultraset on peritonitis rates, we conducted the following study. We prospectively compared 21 new CAPD patients using the standard spike to 20 new CAPD patients using the Ultraset. Peritonitis episodes, episodes of exit-site infection, and the association of peritonitis with exit-site infection were monitored. Peritonitis rates were 7.57 months/episode for the group using the standard spike vs. 27.79 months/episode in the group using the Ultraset. Exit-site infection rates were 22.21 months/infection with the standard spike vs. 37.05 months/infection with the Ultraset. Using Kaplan-Meier plots, there was a statistically significant difference in the estimated time to the first episode of peritonitis, but there was no statistically significant difference regarding the risk of exit-site infections.

Adult↗
PubMed1989

Intralipid removal from plasma of uraemic and intensive care patients.

The removal rates from plasma of Intralipid and (125)I-albumin, simultaneously injected i.v., were analyzed in 10 chronic renal failure (CRF) patients. The results were compared with 9 intensive care unit (ICU) patients and five healthy subjects as controls. The fractional removal rates of Intralipid (k2) were significantly lower for the CRF patients compared to both ICU patients and healthy subjects. The initial plasma concentration of Intralipid, calculated by extrapolation of the elimination curve back to zero-time (y0), showed significantly higher values for CRF patients and healthy subjects compared to ICU patients. Removal curves expressed as ratios between Intralipid and (125)I-albumin paralleled the elimination curves for Intralipid, which suggests that the slope of the curves depends on Intralipid removal and not on leakage of macromolecules from the circulation. The very low initial plasma concentration of Intralipid in the ICU patients cannot be explained by a hyperdynamic circulation, but may be attributed to a rapid first passage disappearance of Intralipid from plasma into tissues such as the pulmonary vasculature.

Journal Article↗
PubMed1989

Functional status and personality in patients on chronic dialysis.

This study describes the functional status of 53 dialysis patients; The Sickness Impact Profile test (SIP), the Karnofsky Activity Scale and Karolinska Scales of Personality (KSP) are used. Our results showed that the dialysis patients had a higher (P less than 0.001) total SIP score when compared to normal controls. Thus, the patients had a worse functional status than the controls. The results of the Karnofsky Activity Scale, estimated by a nurse, were in accordance with the results of the SIP score. The KSP-test showed that both men and women had significantly lower scores in the aggression scale than a control group. We conclude that the dialysis situation has a major influence on the quality of life of dialysis patients. Great attention should be paid to the development of supporting programmes for this patient group.

Activities of Daily Living↗
PubMed1988

Melatonin secretion related to side-effects of beta-blockers from the central nervous system.

In two studies of hypertensive patients the relationship between beta-blocker-induced CNS side-effects and the nightly urinary secretion of melatonin was analysed. In one group (n = 10) placebo, atenolol (mean dose 86 mg/day) or propranolol (mean dose 305 mg/day) were given in a double-blind, randomised design. In the other (n = 13) 100-400 mg metoprolol was given daily (mean dose 197 mg). After 4 weeks of treatment all beta-blockers reduced melatonin excretion, but the effect was significant only for metoprolol. Sleep disturbance records revealed more disturbed nights in the metoprolol group compared with the propranolol and the atenolol groups, even when the difference in age between the groups was controlled for. In the metoprolol group a significant relationship (p less than 0.05) was found between the fall in melatonin and the percentage of disturbed nights. Severe CNS side-effects, such as nightmares, occurred only in patients treated with metoprolol (21%), which in all cases were accompanied by low levels of melatonin. Our data suggest that the CNS side-effects during beta-blockade are related to a reduction of melatonin levels.

Adult↗