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Biomedical subjects

B Lindergård

Publications and source records attributed to B Lindergård.

At least 19 recordsLinked to original sources
PubMed2001

Decreased levels of ionized calcium one year after hemithyroidectomy: importance of reduced thyroid hormones.

BACKGROUND: Previously we have found reduced levels of total serum calcium and 1,25(OH)2D3 despite an unaltered stimulated parathyroid hormone (PTH) secretion 1 year after hemithyroidectomy. The present study was undertaken to elucidate the possible relationship between calcium homeostasis, thyroid hormones and bone resorption in a group of 45 consecutive patients subjected to hemithyroidectomy because of a solitary nodule. All patients had free T4 and T3 levels within normal range preoperatively. METHODS: Thyroid hormones, bone mineral and biochemical variables known to reflect calcium homeostasis were studied. Patients were divided into three separate groups depending on their pre- and postoperative thyroid hormone status. RESULTS: One year postoperatively, serum levels of free T4 were decreased and that of thyrotropin (TSH) increased in the entire group of patients. The concentration of ionized calcium was reduced from 1.25 +/- 0.05 to 1.22 +/- 0.04 (p < 0.001) despite an unaltered PTH value (2.8 +/- 1.0 vs. 3.1 +/- 1.5, p = 0.50). A significant reduction in C-terminal telopeptide type 1 collagen (1CTP) indicated decreased bone resorption 1 year after surgery (p < 0.05). Subgroup analysis showed that a reduction in ionized calcium was seen only among patients with a postoperative decrease in free T4. Patients with subclinical hyperthyroidism preoperatively presented the lowest postoperative levels of ionized calcium, significantly reduced levels of 1CTP and increased levels of phosphate and creatinine. Multiple linear regression analysis showed that age (p < 0.05) and postoperatively changed serum levels of TSH (p < 0.05), creatinine (p < 0.05), phosphate (p < 0.001) and FT4 (p < 0.01) were independently associated with altered levels of ionized calcium. CONCLUSION: We conclude that the reduction in ionized calcium 1 year after hemithyroidectomy was not due to PTH deficiency. Instead our results suggest that the reduced effects of thyroid hormones on bone and kidney function is essential.

Adult↗
PubMed1999

Relationships among serum cystatin C, serum creatinine, lean tissue mass and glomerular filtration rate in healthy adults.

In an effort to increase our knowledge of the optimal use of serum cystatin C and creatinine as glomerular filtration rate (GFR) markers, these variables, as well as lean tissue mass and GFR, were determined in a population of 42 healthy young adults (men and women with normal GFR). Dual-energy X-ray absorptiometry and measurement of the plasma clearance of iohexol were used to measure lean tissue mass and GFR, respectively. Serum creatinine was significantly correlated to lean tissue mass (r=0.65; p < 0.0001) but not to GFR (1/creatinine vs. GFR: r=0.11; p=0.106). In contrast, serum cystatin C correlated with GFR (1/cystatin C vs. GFR: r=0.32; p=0.0387), especially in men (1/cystatin C vs. GFR: r=0.64; p=0.0055), but not to lean tissue mass. These results might explain previous observations that serum cystatin C seems to be a better marker for GFR than serum creatinine, particularly for individuals with small to moderate decreases in GFR. However, the results also show that the serum concentrations of both creatinine and cystatin C are determined not only by GFR, but also by other factors. Since these additional factors differ for cystatin C and creatinine, it seems justified to use serum creatinine and cystatin C in conjunction to estimate GFR, at least until it is known in what situations serum creatinine or cystatin C is the preferable marker.

Absorptiometry, Photon↗
PubMed1998

Increased biochemical markers of bone formation and resorption in primary hyperparathyroidism with special reference to patients with mild disease.

OBJECTIVES: To evaluate the impact on bone turnover of primary hyperparathyroidism (pHPT) with special reference to patients with mild pHPT, using biochemical markers of bone formation and resorption. DESIGN: A longitudinal study of patients with pHPT before and one year after surgical treatment. SETTING: The Departments of Internal Medicine and Surgery, Lund University Hospital. SUBJECTS: Forty consecutive patients with pHPT. Thirty of these patients had mild pHPT and are reported separately. Data on bone mineral was also compared to a reference population. INTERVENTION: All patients were operated upon and restudied one year later. MAIN OUTCOME MEASURES: Bone resorption and formation was studied by means of the serum concentrations of the telopeptide of the carboxyterminal region of type 1 collagen (ICTP) and of alkaline phosphatase (ALP), osteocalcin and the carboxyterminal propeptide of type 1 procollagen (PICP), respectively. Bone density was measured at the distal radius by single photon absorptiometry (SPA). RESULTS: Bone formation markers consistently decreased after parathyroid surgery: ALP from 3.51 +/- 0.23 to 2.94 +/- 0.21 microkat L(-1) (P < 0.05), osteocalcin from 6.15 +/- 0.53 to 2.89 +/- 0.23 microg L(-1) (P < 0.001) and PICP from 126.4 +/- 10.9 to 96.0 +/- 6.5 microg L(-1) (P < 0.001). In parallel, the ICTP concentration, reflecting bone resorption, decreased from 5.10 +/- 0.54 to 3.94 +/- 0.34 microg L(-1) (P < 0.001). There was not any significant change in distal radius bone mineral 1 one year after surgery. In the subgroup of patients classified as mild pHPT, a significant decrease was noted for osteocalcin, PICP and for ICTP but not for ALP, without significant changes in variables reflecting distal radius bone mineral content. Glomerular filtration rate was inversely correlated to serum levels of intact PTH, ionized calcium, alkaline phosphatase, osteocalcin and ICTP and directly correlated to the 1.25-dihydroxy-vitamin D concentrations. CONCLUSIONS: pHPT is associated with substantial changes in circulating levels of biochemical markers of bone formation and resorption. These findings are also present in patients with mild pHPT. Renal function should be considered in the evaluation of the impact of pHPT on bone turnover.

Absorptiometry, Photon↗
PubMed1995

Long-term metabolic effects of urinary diversion on skeletal bone: histomorphometric and mineralogic analysis.

OBJECTIVES: To evaluate the long-term influence of different types of intestinal urinary diversion on skeletal bone and its mineral content. METHODS: Densitometry was used to estimate bone mineral content, and bone biopsies were analyzed with histomorphometric technique. The study comprised 20 patients with conduit urinary diversion and 19 with cecal continent reservoir, all followed up for more than 5 years, with normal or near-normal renal function. RESULTS: Bone mineral content did not differ significantly between the patients with cecal continent urinary reservoir and those with conduit diversion or between these groups and a reference group. At the cellular level, the histomorphometric analysis revealed no defective bone mineralization or increased bone resorption in either group of patients. The trabecular bone volume was greater than normal in the reservoir group, but not in the conduit group. The appositional rate was significantly below normal in both groups of patients, but did not differ between conduit and reservoir patients. CONCLUSIONS: Subtle changes in electrolytes and acid-base homeostasis identified in adults with intestinal segments incorporated in the urinary tract and with largely normal renal function do not seem to influence bone mineralization in the long term. At the cellular level, a lower than normal appositional rate was found in the patients with conduit or continent urinary diversion. In the latter group, this finding, together with increased trabecular bone volume, may indicate a decrease of bone turnover.

Acid-Base Equilibrium↗
PubMed1995

Long-term metabolic and nutritional effects of urinary diversion.

OBJECTIVES: To evaluate the long-term metabolic and nutritional consequences of interposing intestinal segments in the urinary tract. METHODS: Comprehensive analyses of blood and urine were performed in 20 patients with conduit urinary diversion and in 19 with continent cecal reservoir for urine, all with normal or near-normal renal function. The mean follow-up time was 15 years in the conduit group and 9 years in the reservoir group. RESULTS: In both patient groups, arterial blood gas analysis revealed a tendency to metabolic acidosis with respiratory compensation. Although no hyperchloremia was found in either group, the mean value of serum chloride was significantly higher (P < 0.05) in the reservoir group than in the conduit group. The calciotropic factors, plasma lipids, lipoproteins, and liver function values were normal in both groups. Serum vitamin B12 levels were subnormal in 3 conduit and 2 reservoir patients, but other studied variables of intestinal absorption were within normal limits. Conduits utilizing colonic segments showed calcium excretion on the same level as in reservoirs, which was significantly higher than in conduits made from ileal segments. CONCLUSIONS: Except for increased risk of vitamin B12 deficiency, no major adverse metabolic or nutritional effects of conduit or continent urinary diversion were found at long-term observation in patients with well-preserved renal function. Lifelong surveillance of vitamin B12 levels is necessary in these patients.

Acid-Base Equilibrium↗
PubMed1993

Prediction of changes in bone density after operation for primary hyperparathyroidism.

Primary hyperparathyroidism (pHPT) is associated with osteopenia. However, the individual variation in recovery in bone mass after surgery is large. Therefore, modes of prediction of the increase in bone mass after parathyroid surgery were investigated. Preoperatively and at one year after surgery bone mineral content (BMC) in the distal radius was measured with single photon absorptiometry technique in 40 patients with pHPT. Serum levels of calcium, intact parathyroid hormone (PTH), alkaline phosphatase, osteocalcin and Vitamin D metabolites were also determined. Preoperatively, Z-score of BMC was -0.85 +/- 1.20 SD below the normal mean. There was a modest association between BMC and serum levels of osteocalcin (r = -0.34; P < 0.05), and dihydroxycholecalciferol (r = -0.35; P < 0.05). At one year after surgery, mean BMC increased by 2% (P < 0.05), but with a wide dispersion. Preoperative Z-score of BMC correlated with the relative change in BMC (r = -0.33; P < 0.05). An increase in BMC with 95% confidence was evident in 10 of the patients. None of these patients had a preoperative Z-score of BMC above the mean expected for age and sex. We conclude that the increase in bone mass after surgery for pHPT is small and evident only in a portion (approximately 25%) of patients. Hence, a decrease in bone mass should not be a major indication for surgery in pHPT.

Bone Density↗
PubMed1992

Biochemical variables associated with bone density in patients with primary hyperparathyroidism.

OBJECTIVE: To clarify the association between primary hyperparathyroidism and cortical osteopenia. DESIGN: Open study. SETTING: Department of Surgery, University of Lund, Sweden. SUBJECTS: 38 patients with primary hyperparathyroidism. OUTCOME MEASURES: Correlation between bone density (measured by single photon absorption) and age; sex; serum concentrations of parathyroid hormone and ionised calcium; serum alkaline phosphatase activity; and serum concentration of calcium, phosphate, creatinine, urea, osteocalcin, 25 hydroxycholecalciferol, and 1,25 dihydroxycholecalciferol. RESULTS: There was no difference in bone density between men and women. There was no correlation between bone density and severity of hypercalcaemia or age. No biochemical abnormality was peculiar to the seven patients whose bone density was more than two SD below the population mean. Serum concentrations of 1,25 dihydroxycholecalciferol and osteocalcin both correlated significantly with bone density (p < 0.05) and there was a strong correlation between serum osteocalcin and serum intact parathyroid hormone (p < 0.001). Serum osteocalcin had the strongest correlation with bone density of any of the biochemical variables. CONCLUSION: There is little association between bone density and serum concentration of parathyroid hormone.

Absorptiometry, Photon↗
PubMed1985

Studies of bone morphology, bone densitometry and laboratory data in patients on maintenance hemodialysis treatment.

Bone morphological parameters of renal osteodystrophy such as abundance of osteoid surface, osteoid seam width index, calcification fronts, osteoclast activity and trabecular bone volume were studied in 71 patients on maintenance hemodialysis and compared with bone densitometry, laboratory and clinical data. Increased osteoclast activity (hyperparathyroidism) was by far the most common bone morphological finding. Patients with chronic pyelonephritis or polycystic kidney disease had more than double the amount of osteoid than patients with chronic glomerulonephritis. The trabecular bone volume seemed to be increased in most patients in contrast to the cortical bone volume which was decreased, judged from bone densitometry and previously from X-ray. Despite that patients with polycystic kidney disease were older, their trabecular volume was larger than in patients with glomerulonephritis. The bone mineral content evaluated by bone densitometry was low in most patients, and more associated with bone morphological signs of osteomalacia than with secondary hyperparathyroidism. Serum phosphate (S-PO4) and serum parathyroid hormone (S-PTH) seemed to discriminate better between osteomalacia and secondary hyperparathyroidism than serum alkaline phosphatase (S-Alk. phosph.), which was elevated in both groups. Patients who had been bilaterally nephrectomized were no more abnormal than other patients, and they had lower S-Alk. phosph. The abundance of osteoclasts was found to be a predictor of future development of clinical secondary hyperparathyroidism.

Adolescent↗
PubMed1983

Calcium-loading test and bone disease in patients with urolithiasis.

A group of 121 patients with a history of multiple or complicated calcium urolithiasis were divided into three subgroups: normal, absorptive and renal/resorptive calciuria by means of a calcium-loading test. Patients with renal hypercalciuria had lower bone mineral content (BMC) than the other groups but did not differ in amount of bone or TmPO4/GFR. The 24-hour urine calcium excretion was elevated in patients with renal and absorptive type of hypercalciuria but not in patients with normal calcium-loading test and there was no correlation to BMC. The c-AMP/creatinine seemed to discriminate patients with resorptive calciuria from patients with renal calciuria. It is suggested that only patients with renal hypercalciuria should be treated with calcium-retaining drugs such as thiazides.

Adult↗
PubMed1982

A ten-year follow-up of a hepatitis B epidemic in a dialysis unit.

A hepatitis B epidemic at the hemodialysis unit of the University Hospital of Lund, Sweden, occurred in 1968-71. Since then all patients on regular hemodialysis have been tested with regard to hepatitis B. 196 patients were followed for more than 6 months (5 for more than 10 yr). 50 patients (26 males/24 females) became HBsAg-positive. The majority, 40 (25/15), never lost their HBsAg during the observation period. 35 of these chronic HBsAg; carriers were also chronic HBeAg carriers. 10/50 HBsAg-positive patients lost their HbsAg; females in much higher frequency than men. Six HBsAg-negative patients developed anti-HBs and anti-HBc. The highly infectious carriers constituted a continuous source of infection. Nevertheless, it was possible to keep the spread of infection under control in the unit. The most effective precaution from spread to the staff is probably protective gloves during all handling of patients. As regards the patients the most important measure was the introduction of separate units for HBsAG-positive and HBsAg-negative patients.

Antibody Formation↗
PubMed1981

Glomerular filtration rate and calcium metabolism in long-term lithium treatment.

Does long-term lithium treatment induce an irreversible renal damage, and does polyuria or changes in the calcium metabolism indicate this? To elucidate these questions GFR, diuresis, S-Ca, S-Mg, S-PTH and bone mineral content (photonabsorptiometry) were determined in 29 consecutive patients on long-term lithium therapy for 2.5--12 years and in 4 patients, who had been admitted to the Renal Clinic with lithium-induced polyuria. Only 1 of the patients had had a known lithium intoxication (S-Li > 2 mmol/l). None had a history of renal disease or significant analgesic consumption. In the consecutive series the GFR was not significantly reduced and no correlations were found between this parameter and the duration of lithium therapy, average S-Li, highest S-Li noted, diuresis or any of the calcium parameters. The morning diuresis was significantly increased in comparison with a control group with normal kidney function. 2 of the 4 polyuric patients had a decreased GFR, but in 1 case it was normalized on desmopressin supplementation. Renal biopsy in the patient with one S-Li of 2.35 and a low GFR in the consecutive series, and in 3 of the polyuric patients, revealed focal interstitial fibrosis and nephron atrophy. The mean S-Ca, S-Mg, S-PTH and bone mineral content were increased, but no significant intercorrelations between these parameters were found. Neither were any intercorrelations found between the calcium parameters and time on lithium therapy, average S-Li, highest S-Li noted or morning diuresis. In conclusion a relatively well-managed lithium therapy for up to 12.5 years does not seem to influence the GFR, even if renal biopsy in 4 of our patients revealed interstitial nephritis and data in the literature indicate a progressive interstitial nephritis. The present study did not support the proposition that polyuria is an alarming sign of pronounced renal lesion. Calcium metabolism is influenced by lithium therapy but from the clinical point of view no negative effects could be found. S-Ca should probably be checked regularly in patients on long-term lithium therapy.

Adult↗
PubMed1981

Bone mineral content measured with photon absorptiometry - a methodological study carried out on normal individuals.

Bone mineral content (BMC) was measured by photon absorptiometry in 136 adults and 14 children in order to obtain a reference group. The radiation source was 241 Am (45 mCi) and measurements were made on the midshafts of both forearms. The baseline level for measurements was the photon absorption through a waterfilled rubber cuff applied around the arm. Positive correlations were found between BMC and body parameters such as weight, body surface area, height, arm length and bone width. Negative correlations were found between BMC and fat parameters such as the size of a hump adjacent to the bone in the photon absorption profile, skin fold thickness, body mass index and the photon absorption between the bones. Therefore the measured BMC should be corrected for one of the fat parameters and probably also for a body parameter. As a means to correct for fat tissues a baseline level for photon absorption through soft tissue between the bones was compared to the use of a baseline level through water. BMC seemed to be higher in the dominant than in the non-dominant arm. However, after correction for fatty tissue there was no significant difference. BMC seemed to increase with intake of milk products. No correlation could be shown to physical exercise, pregnancies, duration of lactation, or smoking.

Adult↗
PubMed1981

Changes in bone mineral content evaluated by photon absorptiometry before the start of active uremia treatment.

Bone mineral content (BMC) in the forearm was evaluated by photon absorptiometry in 74 out of 198 patients who were started on active uremia treatment between 1973 and 1979. The BMC was measured repeatedly up to 24 months prior to and 15 months after the start of regular hemodialysis (RDT). The mean change per month was -0.43% before the start and +0.08% after the start, showing that RDT patients have low BMC chiefly because they lose mineral before the start of active uremia treatment. Patients not given extra calcium and/or vitamin D seemed to lose mineral faster than those given this treatment. The mineral content was lower in patients with polycystic kidney disease than in patients with glomerulonephritis.

Adult↗
PubMed1980

Transposition of the basilic vein in the forearm for the construction of haemodialysis arteriovenous fistula.

Twenty-five dialysis patients have been operated 27 times using a modified surgical technique with transposition of the basilic vein for construction of a forearm arteriovenous fistula. The vein is explored at the elbow and dissected free as far distally as possible using small transverse incisions. The vein is cut distally, taken out at the elbow and positioned in a straight, superficial narrow tunnel on the volar side of the forearm for anastomosis to the side of the radial or the ulnar artery. The operation was successful in 19 (76%) cases giving an easily accessible and well-functioning arterialised vein. The surgical technique is simple and is recommended as a primary procedure in patients where the cephalic or other radial or dorsal vein is not available, and as a secondary procedure after failure of a radiocephalic fistula. It is considered of special value for home dialysis patients.

Arteries↗
PubMed1980

Methylprednisolone concentrations in patients with renal transplants as determined by high pressure liquid chromatography.

It is well known that in healthy individuals as well as in patients with diseases receiving glucocorticoids in a given dosage, there is a wide variation in blood concentrations. These may be of importance not only for the efficacy of treatment, but also for the occurrence of side effects. Pharmacokinetic information on glucocorticoids, is scarce mainly because of lack of suitable methods of analysing these drugs in body fluids. A high pressure liquid chromatography (HPLC) method has previously been used for determination of methylprednisolone in plasma (Garg et al., 1977). After modification, this method has been used for determination of methylprednisolone in plasma in healthy subjects and patients with renal transplants. Preliminary data are presented showing a good reproducibility of the method.

Adult↗
PubMed1979

Free plasma 11-hydroxycorticosteroids and the response to beta1-24-corticotrophin in regular haemodialysis patients.

The adrenocortical function of 59 patients on regular hemodialysis treatment was tested on 105 occasions by measuring the 30-min response of free plasma 11-hydroxycorticosteroids (11-OHCS) after intramuscular injection of 0.25 mg Synacthen (beta1-24-corticotrophin). The morning basal levels of 11-OHCS were within the normal range. The increase of 11-OHCS after injection of Synacthen was less than normal in 25% of the patients. In 9 patients with a low response an extended Synacthen test was performed. This caused a normal increase in plasma 11-OHCS but the response came later than in normal persons. After 0.25 mg Synacthen intramuscularly the 30-min response of 11-OHCS seemed to be lower on the first day than on the second day after dialysis. The present study supports the view that the pituitary-adrenocortical system is essentially intact in patients on regular hemodialysis treatment.

11-Hydroxycorticosteroids↗