Biomedical subjects

B Hylander

Publications and source records attributed to B Hylander.

At least 55 records · Page 3Linked to original sources

PubMed1988

Interposition graft fistulas for hemodialysis.

When a radiocephalic arteriovenous (AV) fistula is not feasible for vascular access in hemodialysis, the second choice is interposition AV fistula using synthetic graft. Experience concerning patency and complications of interposition graft fistula and need for additional surgery in 49 grafts (41 patients) is reviewed. All 40 polytetrafluoroethylene (PTFE) and nine bovine grafts were placed in the forearm--22 straight between the radial artery and an antecubital vein and 27 as loops connecting the brachial artery to an antecubital vein. At the end of follow-up (mean 13, range 1-46 months), nine grafts were still in use and nine had failed, 15 patients had received a renal transplant and 15 were dead. One patient was lost to follow-up. Reoperation was necessitated by complications in 30 instances and permitted resumption of dialysis in 25. Reoperation was more common with straight than with loop graft (p less than 0.01). Interposition PTFE loop graft fistula is recommended as second choice for angioaccess, after radiocephalic fistula.

Adult↗

PubMed1988

Long and short term patency of radiocephalic arteriovenous fistulas.

Eighty-three radiocephalic fistulas in 71 uremic patients were retrospectively investigated. The fistulas were grouped according to construction, viz. side of radial artery to side of cephalic vein and end of cephalic vein to side of radial artery. The aim was to find and evaluate factors influencing fistula patency rate, with special emphasis on type of anastomosis. The early failure rate was significantly higher in the end-to-side group. The late failure rate was not influenced by mode of fistula construction. The fistula failure rate showed no correlation to patient age. Diabetes did not influence failure rate, but significantly shortened the mean patency time.

Adult↗

PubMed1987

Survival of extreme hyperkalemia.

Severe hyperkalemia has been reported to lead to typical ECG changes, often reflecting cardiac abnormalities which finally lead to death in arrhythmias. The present report describes a 77-year-old male, who developed extreme hyperkalemia because of treatment with a potassium saving diuretic in combination with potassium supplementation and subsequent development of urinary retention. In spite of a maximal potassium value of 10.1 mmol/l only non-specific ECG-changes were found. The patient survived after an uneventful dialysis. Thus, extreme hyperkalemia may occur without typical ECG changes and serum potassium values exceeding 10 mmol/l may be survived.

Acute Kidney Injury↗

PubMed1987

Comparison of hydrochlorothiazide and slow release furosemide as adjuvant therapy to beta-blockers in the treatment of moderate hypertension.

Fifty hypertensive patients on beta-blocker therapy with supine blood pressure greater than or equal to 95 mmHg were included in a parallel group, double-blind study for 12 weeks to compare blood pressures, metabolic and adverse effects of additional treatment with diuretics. Hydrochlorothiazide (HCT) 25 mg daily was added to one group and furosemide 30 mg daily in a slow-release preparation, Lasix Retard (LR), to the other. Blood pressure decreased significantly and similarly in both groups from about 155/101 to about 144/95 mmHg (p less than 0.01). Diastolic blood pressure was lowered to less than or equal to 90 mmHg in 29% of the HCT patients and in 59% of the LR patients. Serum potassium decreased significantly from 4.05 mmol/l to 3.62 mmol/l on HCT, while the decrease on LR from 4.13 mmol/l to 4.05 mmol/l was not significant. Serum urate increased significantly, although within the normal range, on HCT. No change in fasting blood glucose or HbA1C was observed in any group. The patients were asked to report 40 different possible side-effects on a visual analogue scale at every visit. The side-effects already observed on beta-blockers did not change consistently on additional therapy with either HCT or LR. Thus, additional treatment with HCT or LR to patients already treated with beta-blockers results in an equal further blood pressure reduction, but in contrast to treatment with HCT, addition of LR does not affect serum potassium concentrations.

Adrenergic beta-Antagonists↗

PubMed1987

Long-term ECG recordings in thyroxine-substituted hypothyroid subjects.

Bradyarrhythmias are sometimes observed in hypothyroid patients. This phenomenon could either be due to the disease process with structural changes of the heart or to an abnormal hormone level. The purpose of the present paper was to study the prevalence of bradyarrhythmias in hypothyroid patients on long-term substitution therapy. Nineteen subjects were studied 9-53 months after they had reached the final thyroxine substitution level. Ambulatory ECG registrations were performed during 48 hours. Ventricular ectopic beats were observed in 10 of the 19 patients, but no bradyarrhythmias were detected. The results support the notion that arrhythmias found in hypothyroid patients are at least mainly due to the low thyroid hormone level.

Adult↗

PubMed1987

Responses to mental stress and physical provocations before and during long term treatment of hypertensive patients with beta-adrenoceptor blockers or hydrochlorothiazide.

1 Cardiovascular and sympatho-adrenal responsiveness to mental stress (CWT; a colour word test), orthostatic testing (ORT) and a cold pressor test (CPT) were examined in three groups of hypertensive patients (n = 14-16) before and after 6 months treatment with metoprolol (243 +/- 26 mg daily), propranolol (149 +/- 16 mg daily) or hydrochlorothiazide (50 +/- 8 mg daily) in an open trial design. 2 Treatment reduced outpatient blood pressures in the three groups similarly (from approximately 155/102 to 135/90 mm Hg). During treatment resting blood pressures in the laboratory were clearly reduced by beta-adrenoceptor blockade but not by thiazide treatment. Metoprolol and propranolol caused similar reductions of basal heart rates and plasma glycerol levels, whereas only propranolol reduced cyclic AMP concentrations in plasma. 3 Before treatment CWT and CPT increased systolic and diastolic blood pressures by about 30%. Heart rate increased by about 30 beats min-1 during CWT and 10-15 beats min-1 during CPT and ORT. Small venous plasma adrenaline responses were evoked by all tests, whereas noradrenaline was elevated mainly by CPT and ORT. Dopamine levels did not change. 4 Heart rate responses to all stressors were markedly and similarly reduced, whereas blood pressure responses were essentially unchanged during metoprolol or propranolol treatment. In the thiazide group circulatory responses to CWT were slightly attenuated, whereas responses to ORT and CPT were unchanged. 5 The systolic blood pressure levels were reduced throughout the test session in all three groups, although less so in the hydrochlorothiazide group. Both beta-adrenoceptor antagonists clearly reduced diastolic blood pressure and heart rate levels at rest and during stress, whereas thiazide treatment caused no significant changes in these respects. 6 The rate pressure product, which increased by 80-100% in response to CWT before treatment, was more markedly reduced by beta-adrenoceptor blockade than by thiazide treatment both at rest and during stress. 7 Self ratings (visual analogue scales) of stress and irritation were increased by CWT in a similar fashion before and during treatment in all groups. beta-adrenoceptor blockade was associated with higher subjective ratings of tiredness at rest, but not after CWT. Performance in the CWT increased slightly more in the thiazide group. The physiological responses to CWT were not correlated to the subjective responses.(ABSTRACT TRUNCATED AT 400 WORDS)

Adrenergic beta-Antagonists↗

PubMed1986

Reactivity to mental stress and cold provocation during long-term treatment with metoprolol, propranolol or hydrochlorothiazide.

In a study aimed at comparing the effects of beta-blockers and thiazide diuretics on responses to stressful provocations, 45 essential hypertensives (WHO I-II) were treated with either the selective beta-blocker metoprolol (METO), the non-selective beta-blocker propranolol (PROP) or hydrochlorothiazide (HTZ) for 6 months. Blood pressure, heart rate and plasma catecholamines were measured in connection with a mental stress test and a cold pressor test before and during therapy. All drugs reduced outpatient blood pressure similarly, but beta-blockade reduced blood pressure and heart rate levels more efficiently at rest and during stress in the laboratory. Heart rate reactivity to stress was reduced mostly by beta-blockade during mental stress. Blood pressure and sympatho-adrenal reactivity were unchanged by therapy. Stress reactivity failed to predict antihypertensive responses. The results suggest that beta-blockade may be more effective than diuretic treatment in reducing blood pressure levels and cardiac workload as assessed by the rate pressure product in stressful situations.

Adult↗

PubMed1985

Effect of beta 1-selective and nonselective beta blockade on blood pressure relative to physical performance in men with systemic hypertension.

Eleven physically active men with systemic hypertension were studied after 5 weeks of treatment with placebo, atenolol or propranolol. A double-blind, crossover randomized design was used. Blood pressure (BP), heart rate (HR), physical performance capacity, rate of perceived exertion and blood lactate concentrations were measured during rest, exercise to exhaustion and postexercise, at 8 and 24 hours after intake of the last dose. Blood pressure at rest and during exercise was similarly decreased with both drugs (8 and 24 hours), and there was no difference between 8 and 24 hours with any of the treatments. Heart rate (8 hours) was decreased similarly by both drugs, but after 24 hours, HR at increased workloads (above 120 watts) was higher with atenolol compared with propranolol. Maximal HR was lower with propranolol than atenolol at both 8 and 24 hours. Maximal exercise loads (8 and 24 hours) were 231 and 232 watts with placebo, 211 and 212 with propranolol and 228 and 227 with atenolol. That is, maximal workload was decreased with propranolol compared with placebo and atenolol at both 8 and 24 hours. No difference was found between placebo and atenolol at either 8 or 24 hours. The rate of perceived exertion values were higher with propranolol than atenolol. Blood lactate concentrations did not differ according to treatments. The results indicate that atenolol, when given in a dose that decreases resting and exercise BP to the same extent as propranolol, limits physical performance less than propranolol.

Adult↗

PubMed1985

Effects of long-term therapy with labetalol on lipoprotein metabolism in patients with mild hypertension.

The effects of labetalol on serum lipoproteins, the intravenous fat tolerance test (IVFTT) and lipoprotein lipase (LPL) and hepatic lipase (HL) activities were studied in 16 patients with mild hypertension before and after 6 months of therapy. Most patients were found to be normotensive on 200 mg labetalol/day. Before therapy the mean concentration of serum TG was 0.75 +/- 0.21 (SD) mmol/l, of total cholesterol 5.41 +/- 1.25 mmol/l and of HDL cholesterol 1.67 +/- 0.61 mmol/l. After labetalol no significant changes were found in the concentrations of TG and cholesterol in the VLDL, LDL and HDL fractions. The mean values for the IVFTT and for LPL and HL activities were in the normal range and remained unchanged during therapy.

Adult↗

PubMed1985

Treatment of myxoedema coma--factors associated with fatal outcome.

Treatment of myxoedema coma has been associated with a high mortality. The causes of death were analysed in this paper by retrospective study of the records of 11 myxoedema coma patients. The serum thyroxine (T4) and triiodothyronine (T3) levels were estimated retrospectively from the amounts of hormone given to the patients by a two-compartment model. Seven patients died and 4 survived. The patients who died were significantly older (78.9 +/- 2.2 years, mean +/- SEM) than those who survived (66.8 +/- 3.7 years). The initial heart rate was lower in the decreased group, but both groups had increased their heart rate on treatment. The surviving patients showed an increase in body temperature during the first 3 days of treatment, in contrast to the patients who eventually died. The deceased patients had received larger amounts of thyroid hormone and had calculated levels of T3 that were nearly twice as high as those of the surviving patients. Old age and a high serum level of T3 are determinants for the fatal outcome of myxoedema coma. Our analysis underscores the importance of using a cautious replacement regimen in myxoedema coma patients.

Aged↗

PubMed1984

Therapeutic and metabolic effects of sotalol.

In a single-blind, randomized study, the cardiovascular and metabolic effects of sotalol, 40 to 160 mg/day, in six patients with mild essential hypertension were compared to those of placebo at rest and during submaximal dynamic exercise. Resting blood pressure was controlled by sotalol but not the pressor response to exercise, despite reduction of tachycardia. The major metabolic finding on sotalol was an approximately 40% decrease in lipid mobilization during exercise. Alterations in muscle lactate concentrations were much like those caused by other beta-blockers. Plasma concentrations of norepinephrine and epinephrine were doubled during exercise on sotalol, epinephrine disposition more so. No effects on serum lipoproteins were observed after 6 wk on sotalol in therapeutic doses. Despite its special electrophysiologic properties, sotalol appears to induce the same cardiovascular and metabolic changes during exercise as do other beta-blockers.

Adult↗

PubMed1984

Raynaud's phenomenon caused by beta-receptor blocking drugs. Improvement after treatment with a combined alpha- and beta-blocker.

Twenty-four hypertensive patients reported vasospastic symptoms in their hands during treatment with beta-blocking drugs with different pharmacological properties. Twenty patients had symptoms when staying indoors and 11 did not always experience complete relief of symptoms following active rewarming attempts. Finger systolic blood pressures were measured after standardized local cooling. In 15 patients, blood pressure decreased to a pathological level during this procedure. Previous beta-blockade was changed to combined alpha- and beta-blockade with labetalol given twice daily in a mean dose of 259 mg/day for 3 months. After this period, most patients showed a decreased temperature sensitivity both objectively and subjectively. Blood pressure control was maintained at the previous level. Heart rate increased significantly during treatment with labetalol. Labetalol offers an alternative treatment to patients suffering from vasospastic side-effects of beta-blockers.

Adrenergic beta-Antagonists↗

PubMed1984

Effects of glycerol addition to diet in weight-reducing clubs.

As a weight-losing adjunct, 7.5 g glycerol in a 25 per cent solution was administered before meals to members of a commercial weight-reducing club. The same amount of glucose served as placebo. Members were randomly given either solution for six weeks. Body weight and hunger ratings were recorded weekly. Thirty-one members completed the study. Initial mean body weight was 77.5 +/- 12.9 (s.d.) kg corresponding to a Broca index of 1.16 +/- 0.18. Members on glycerol lost 4.1 +/- 2.2 kg and those on glucose lost 3.2 +/- 2.4 kg (n.s.). At the onset of the meal, plasma glycerol concentration was about ten times above baseline values. The study extends previous observations made in smaller groups that glycerol does not improve weight loss in subjects on a hypocaloric diet.

Adult↗

PubMed1983

The cardiovascular response at rest and during exercise in hypothyroid subjects to thyroxine substitution.

Rapid and intense thyroxine substitution can lead to heart failure and myocardial infarction in hypothyroid patients. We have analyzed the normalization of the circulatory system in hypothyroid subjects on a gradual thyroxine substitution. Fourteen hypothyroid patients were studied repeatedly with an orthostatic test and a standardized symptom-limited exercise test during substitution. ST and T abnormalities were observed in 51 and 33%, respectively, before substitution. Many of these changes were normalized upon substitution at a dose level of 0.15 mg/d thyroxine. The pulse reaction to standing was enhanced early during substitution. The capacity to perform work, on the other hand, responded more slowly to thyroxine substitution, and was significantly increased only after six months of full substitution. This difference in the time course of recovery may be of clinical importance when substituting patients with hypothyroidism and ischemic heart disease.

Adult↗

PubMed1983

Effects of dietary fiber intake before meals on weight loss and hunger in a weight-reducing club.

The effects of dietary fiber on subjective hunger ratings and weight losses were studied in 135 members of a weight loss club. After a run-in week, 100 members were randomly given one sachet of either bran or ispaghula granulate before meals for two weeks. Thirty-five controls only rated hunger. One hundred and eight members completed the trial: 23 controls, 45 on ispaghula and 40 on bran. No change in hunger ratings was found in the controls. Both fiber preparations lowered hunger ratings during weeks 2 and 3 compared to the run-in week. Ratings were similarly reduced at all meals. The mean (+/- SD) weight reductions during the trial were 4.6 +/- 2.7 kg for the controls, 4.2 +/- 3.2 kg for the ispaghula group and 4.6 +/- 2.3 kg for the bran group (p greater than 0.05 for all). In spite of recent changes in the diet towards food rich in dietary fibers, addition of extra dietary fiber immediately before meals reduced hunger feelings but had no effect on weight reduction.

Adolescent↗

PubMed1983

Peripheral responses to thyroxine in hypothyroid subjects as a function of dose and duration of substitution.

The aim of this study was to explore the differences in normalization between different organ functions in hypothyroid patients during substitution. The study included 21 hypothyroid patients who were substituted with gradually increasing doses of thyroxine (T4) and studied repeatedly for up to 20 or 32 weeks. The different peripheral organ functions were compared with regard to the dose and duration of substitution necessary for a 50% therapeutic effect. The circulatory response to an orthostatic test, the decrease in low density lipoprotein cholesterol and thyroid stimulating hormone concentrations, the lipolytic effect of physical exercise and the increase in triiodothyronine concentration showed a 50% response to substitution within 3.3--4.6 weeks of therapy and at a T4 dose of 0.04--0.06 mg/day. In contrast, the 50% therapeutic effect on the lipolytic response to an intravenous l-noradrenaline infusion and the maximal working capacity on ergometer bicycle was not observed until 6.2--9.0 weeks of therapy and T4 doses of 0.08--0.11 mg/day. The differences observed in the peripheral responses might be of clinical importance when severely hypothyroid patients must be substituted rapidly.

Adult↗

PubMed1982

Time course effect of thyroxine on serum lipoprotein concentrations in hypothyroid subjects.

In order to analyse the time course effect of thyroxine replacement therapy on lipoprotein concentrations, 12 hypothyroid subjects were studied before and repeatedly during therapy. The substitution dose was increased gradually every fourth week until the plasma level of TSH became normal. The concentrations of cholesterol and triglycerides were analysed in whole serum and in the three major lipoprotein fractions VLDL, LDL and HDL. The main abnormality before treatment was an increased LDL cholesterol concentration. Normalization of serum LDL was established at a dose level which normalized TSH. The onset of the effect of thyroxine on LDL cholesterol was rapid and could be noted already after two weeks.

Adult↗

PubMed1981

Three year's follow-up of members of a Swedish commercial weight-reducing club.

The weight changes of 676 members of a commercial weight loosing club were analysed and a questionnaire was given to a subgroup of 150 participants. The median age at entry was 48 years. The Broca index (kg/cm - 100) ranged from 0.85 to 1.70. Only 15 males participated. The initiative to join the club came from the member herself in 59% of the cases; only 3% were referred by a physician. The drop-out frequency during an 8-week "Slim Club" course was 55%. Members who participated in more than 4 of the 8 weekly sessions had a mean weight loss of 6.2 kg (range 0.5 - 15). Members with higher initial weights lost more than those who were less overweight. The mean cost of each kg lost was about 40 Sw. cr./kg (approximately 9 US$). After 3 years, 367 members could be contacted for an interview. Their initial mean weight (+/- S. D.) was 76.1 +/- 9.8 kg. After the initial course the mean weight was 70.5 +/- 9.4 kg (p less than 0.001). Three years later the reported mean weight was 72.3 +/- 10.1 kg (p less than 0.001 versus initial weight). Thus even a short course may have significant long-term effects on weight loss. The weight-reducing club may therefore be a helpful tool in the treatment of overweight subjects.

Adolescent↗