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Biomedical subjects

G Lindstedt

Publications and source records attributed to G Lindstedt.

At least 73 records · Page 4Linked to original sources
PubMed1997

Transsphenoidal adenomectomy in Cushing's disease via a lateral rhinotomy approach.

BACKGROUND: Cushing's disease may be treated by surgical pituitary adenomectomy. We present a surgical approach to the pituitary gland that increases the possibilities of a selective adenomectomy, and compare our results with those of other studies. METHODS: A retrospective study of patients with Cushing's disease undergoing transsphenoidal selective adenomectomy via a lateral rhinotomy at Sahlgrenska University Hospital from 1984-93 is presented. Thirty-one patients (26 women, five men; mean age: 44 years, range: 13-75 years) with Cushing's disease were followed for a median time of 4.5 years after operation (range: 1-10 years). Preoperative and postoperative urinary and serum cortisol, and circadian rhythm of serum cortisol were measured. We also measured serum TSH, T4, PRL, FSH, LH, and testosterone as well as urine and plasma osmolality. RESULTS: Our remission rate was 77% and the recurrence rate 3%. Hormonal insufficiency was rare. Hypothyroidism and hypogonadism were present in 3% of the patients, and diabetes insipidus occurred in 6% of the patients. CONCLUSION: Selective adenomectomy with its good opportunities for cure and improvement should be regarded as the treatment of choice for Cushing's disease. Using the lateral rhinotomy approach to the sphenoidal cavity results in good accessibility to the sella turcica and its pituitary adenomas, a low frequency of postoperative pituitary insufficiency, and a high remission rate.

Adenoma↗
PubMed1997

Diurnal variation in serum insulin-like growth factor (IGF)-I and IGF binding protein-3 concentrations during daily subcutaneous injections of recombinant human growth hormone in GH-deficient adults.

OBJECTIVE: Whereas there seems to be little, if any, circadian variation in circulating concentrations of IGF-I and IGFBP-3 in healthy subjects, there are conflicting reports on this issue in GH-deficient patients treated with GH as a daily subcutaneous injection. We have therefore investigated the 24-hour serum profiles of IGF-I and IGFBP-3 concentrations after one week and more than one year of GH treatment. PATIENTS: Eleven subjects, with adult onset GH deficiency mainly caused by pituitary adenomas were included in the study. DESIGN AND MEASUREMENTS: In an open study, six subjects (three women and three men; age (+/-SEM) 41.2 +/- 3.9 years) were investigated after one week of GH therapy and five subjects (three women and two men; age (+/-SEM) 61.4 +/- 3.3 years) were investigated after 13-40 months of GH therapy. The GH injections were given at 2000 h. The subjects were hospitalized for 24-hour blood sampling at 1-hour intervals and serum concentrations of GH, IGF-I and IGFBP-3 were determined. RESULTS: There was a significant diurnal variation in serum IGF-I and IGFBP-3 concentrations both in the subjects who had received GH for one week and in those who had received GH treatment for more than one year. The serum concentrations of IGF-I and IGFBP-3 were highest in the morning and lowest during night-time and early morning. The molar IGF-I/IGFBP-3 ratio varied significantly with time in both groups of patients in a similar way as IGF-I and IGFBP-3 indicating a more pronounced variation in IGF-I compared with IGFBP-3 in response to the GH therapy. CONCLUSION: Significant diurnal variations in serum IGF-I and IGFBP-3 concentrations occur after one week and more than one year of GH treatment with daily subcutaneous injections. The results indicate that the free fraction of IGF-I may exhibit a diurnal variation.

Adult↗
PubMed1997

Cerebrospinal fluid proteins in subclinical and overt hypothyroidism.

PATIENTS AND METHODS: We analysed cerebrospinal fluid (CSF) albumin and immunoglobulin G (IgG) concentrations and psychometric performance in subclinical (n = 6) and overt hypothyroidism (n = 9) before and after 6 months with L-thyroxine. RESULTS: In overt hypothyroidism, CSF albumin and IgG concentrations were increased before therapy [mean(SD): 328(156) mg/l and 69(27) mg/l], but within the reference interval [198(48) mg/l and 39(11) mg/l], P < 0.05, after therapy. In contrast, in subclinical hypothyroidism CSF protein concentrations were within the reference intervals before and after therapy. Psychometric testing indicated an improvement in performance in both groups. CONCLUSION: The increase in CSF proteins in overt hypothyroidism does not appear to be related to thyroid autoimmune disease per se, since we found no increase in CSF proteins in individuals with subclinical hypothyroidism and presence of thyroid antibodies. The increase might rather be caused by a blood-brain barrier dysfunction related to low thyroid hormone concentrations.

Adult↗
PubMed1997

Fetal fibronectin in vaginal fluid of women in prolonged pregnancy.

The aim of this study was to determine fetal fibronectin in vaginal fluid of women in prolonged pregnancy, its relationship to a modified Bishop score and its predictiveness of delivery within 3 days. Vaginal samples were collected from 80 women at 42 weeks of gestation for the fetal fibronectin assay. A modified Bishop score was estimated. Fetal fibronectin was determined by a quantitative enzyme immunoassay. The concentration of fetal fibronectin in vaginal fluid was elevated in only 36 of the 80 women. The Bishop score and the time between sampling and delivery were not associated with an elevated fetal fibronectin (> or = 0.05 mg/l). We conclude that fetal fibronectin is not a good indicator of delivery within 3 days. The findings add to our understanding of the complexity of the etiology of postterm labor.

Adult↗
PubMed1997

Fetal fibronectin and microorganisms in vaginal fluid of women with complicated pregnancies.

OBJECTIVES: To determine vaginal fetal fibronectin in women with pregnancies complicated by preterm labor (PTL), preterm premature rupture of the membranes (PPROM) or bleeding; to investigate possible relationships to the vaginal microflora; and to assess the ability to predict preterm delivery from these measures. MATERIAL AND METHODS: Group comparative study between women of the same gestational age with a normal pregnancy (n = 28) and consecutive women admitted with PTL (n = 63), PPROM (n = 18) and bleeding (n = 21). Samples of vaginal fluid were collected at the time of admission in complicated pregnancies and from the women with normal pregnancies. Fetal fibronectin was determined by enzyme immunoassay and quantitative aerobic and anaerobic microbiological cultures were performed. RESULTS: The number of positive (> or = 0.05 mg/L) vaginal fetal fibronectin values was higher among women with PTL, PPROM and bleeding compared to controls (p < 0.001). A positive fibronectin value was predictive of delivery < or = 34 weeks (sensitivity 64%, specificity 87%). The absence of hydrogen peroxide-producing lactobacilli was predictive for preterm delivery < 34 weeks (sensitivity of 100%, specificity 35%). CONCLUSIONS: The presence of vaginal fibronectin and the absence of hydrogen peroxide-producing lactobacilli was indicative of an increased risk for preterm delivery < 34 weeks.

Adult↗
PubMed1997

Effect of transurethral microwave thermotherapy on serum concentrations of total and free prostate-specific antigen.

This study includes 15 men between 48 and 81 years of age with treatment-requiring symptomatic benign prostatic hyperplasia (BPH). No patient with a urinary infection or prostate cancer was included. The serum concentrations of prostate-specific antigen (PSA), total as well as "free", i.e. noncomplex bound, were repeatedly determined before and up to 3 months after transurethral microwave thermotherapy (TUMT) of the prostate. After TUMT we found significant rises of the ratios of the serum total PSA concentration/prostate volume (up to 55-fold, mean 13.1) and of the serum free PSA concentration/ prostate volume (up to 26-fold, mean 10.2). The highest values for the serum total PSA concentration/prostate volume ratio were found on the first day after TUMT. Maximal serum free PSA concentration/prostate volume ratio occurred 3-6 h after treatment. The serum concentration/prostate volume ratios for total and free PSA returned to normal within 3 months. The results indicate that PSA determinations might be used as effect indicators of TUMT.

Aged↗
PubMed1997

Somatostatin receptor scintigraphy in medullary thyroid carcinoma.

BACKGROUND: 111In-radiolabelled (DTPA-D-Phe1)-octreotide scintigraphy can be used to localize neuroendocrine tumours expressing somatostatin receptors (SSTRs). The aim of this paper was to analyse the importance of tumour volume and growth for the visualization by SSTR scintigraphy of metastases from medullary thyroid carcinoma (MTC). METHODS: Serum calcitonin concentrations were used to estimate volume and growth rate of MTC. Twenty-two patients who had persistent hypercalcitoninaemia after total thyroidectomy for MTC, indicating the presence of metastases, were studied. RESULTS: SSTR scintigraphy visualized 15 tumours in 11 patients. Patients with scintigraphically visualized tumours had higher serum calcitonin and carcinoembryonic antigen concentrations and larger tumours, and the serum calcitonin concentration increased more rapidly with time. Tumour-associated symptoms and death from MTC occurred only in patients with scintigraphically visualized tumours. CONCLUSION: Scintigraphically visualized tumours grow more rapidly and are more aggressive than nonvisualized lesions. SSTR scintigraphy can be helpful in the planning of palliative surgery for MTC and for diagnosing distant metastases, but cannot localize microscopic metastases.

Blotting, Northern↗
PubMed1996

Transient rise in intact parathyroid hormone concentration after surgery for primary hyperparathyroidism.

Two-site immunometric assays for determination of the level of intact parathyroid hormone (PTH) in serum have enabled detailed clinical studies of PTH secretion. Fifty-one patients with primary hyperparathyroidism were studied before surgery and 2 years after operation. PTH levels dropped to low values after operation. A rebound increase in PTH concentration occurred from 10 days to 3 months after surgery. Abnormally raised postoperative PTH concentrations were noted in 31 per cent of the patients, who had lower serum concentrations of ionized calcium (Ca2+) than the rest (P < 0.003). Before operation these patients had a more pronounced hyperparathyroidism than the others. At 2 years after surgery there was still a positive correlation between PTH concentrations before and after surgery (P < 0.001). The rebound increase in the level of PTH was a general phenomenon probably caused by low Ca2+ concentrations at the time of remineralization of bone. This phenomenon was transient. The positive correlation between preoperative and postoperative PTH concentrations shows that effects of hyperparathyroidism can remain for a long time after surgical cure.

Adult↗
PubMed1996

Influence of smoking on hormone secretion in obese and lean female smokers.

Smoking exerts influences on the secretion of several hormones which are abnormal in obesity. Previous studies have mainly been performed in non-obese men, and data from non-obese and obese women are scarce. The aim of the present study was therefore to identify the effect of smoking on hormone secretions in obese and lean female smokers. The study was performed in 10 obese and 8 lean, premenopausal, healthy smokers. All subjects were tested once under experimental and once under control conditions (not smoking) in randomized order. The women smoked two non-filtered cigarettes during 4 minutes each. Blood pressure and heart rate were measured 30 minutes before smoking, at the start of smoking (time 0) and then after 5, 10, 20, 30, 45 and 60 minutes. Blood samples were taken for determination of serum concentrations of adrenocorticotropic hormone (ACTH), cortisol, prolactin (PRL), growth hormone (GH) and thyroid stimulating hormone (TSH) at the same time points except at 5 minutes. Heart rate rose in both groups during smoking. Systolic and diastolic blood pressure was increased only in the obese subjects. Cortisol and ACTH increased in both groups, while TSH, PRL and GH were unchanged in both groups. We conclude that lean and obese smoking women seem to respond rather similarly to smoking in the hemodynamic and endocrine variables measured in this report with the possible exception of blood pressure where the obese women tended to show more pronounced increases.

Adrenocorticotropic Hormone↗
PubMed1996

Continuous subcutaneous infusion of low dose growth hormone decreases serum sex-hormone binding globulin and testosterone concentrations in moderately obese middle-aged men.

OBJECTIVE: Sex-hormone binding globulin (SHBG) is a liver derived protein whose concentration has been shown to be affected by a number of factors. The aim of the present study was to investigate the possible effect of increased basal GH concentrations on serum concentrations of SHBG, testosterone and thyroid hormones. DESIGNS: Recombinant human growth hormone (rhGH) was given as a continuous subcutaneous infusion in a low dose (0.02 U/kg/day) over a period of 14 days in an open study. PATIENTS: Eight middle-aged (42-59 years) overweight (body mass index 26.1-33.8 kg/m2) but otherwise healthy men were studied. MEASUREMENTS: Blood samples were obtained after an over-night fast before and after 2, 7 and 14 days of treatment. Serum was separated and stored at -20 degrees C until assay. RESULTS: Serum GH concentrations increased to a steady level of 2-4 mU/l. Serum SHBG concentration decreased between 2 and 7 days of treatment and serum testosterone concentration changed in parallel. There was no change in the ratio between serum SHBG and serum testosterone. Serum T4 and free T4 concentrations decreased, and that of T3 increased as a result of continuous GH infusion. Simple correlations between changes in SHBG concentrations and other hormonal changes showed positive significant correlations between changes of SHBG and of testosterone. CONCLUSIONS: Low dose continuously infused GH resulted in a parallel decrease in serum SHBG and testosterone concentrations. Thyroid hormone concentrations were affected in a similar way to that previously demonstrated following daily injections of GH.

Adult↗
PubMed1996

Bone density, bone markers and bone radiological features in mastocytosis.

We examined the association between severity of disease in mastocytosis and skeletal manifestation and bone markers in 16 patients varying in extent of mastocytosis as determined by the urine excretion of methylimidazoleacetic acid. Both osteoporosis and osteosclerosis were found. Bone density in the hip was significantly higher (p < 0.05) in both men and women with an enhanced histamine metabolite excretion. Patients with only moderately increased mast cell mass had low bone mineral density in the hip, osteoporosis and vertebral fractures. The different skeletal disease patterns in mastocytosis might be the effect on osteoblasts and osteoclasts of biologically active substances. Mast cells release a number of vasoactive substances, including histamine which promotes osteoblasts and heparin and prostaglandin D2 which induce bone resorption by activation of osteoclasts. Systemic mastocytosis is a rare disease characterized by multi-organ infiltration by mast cells and with varying skeletal manifestations including osteoporosis. Treatment with bisphosphonates may be beneficial in arresting osteoporosis in this disorder.

Acid Phosphatase↗
PubMed1996

The pituitary-gonadal axis and health in elderly men: a study of men born in 1913.

The results of recent studies suggest that a relative hypogonadism in men is associated with several established risk factors for prevalent diseases. Therefore, we determined total and free testosterone, luteinizing hormone (LH), and sex-hormone binding globulin (SHBG) in a cohort of randomly selected men (n = 659) at 67 years of age. These data were analyzed cross-sectionally in relation to blood glucose and serum insulin, which were measured while fasting and after an oral glucose tolerance test, in addition to plasma lipids and blood pressure. The data were also analyzed in relation to impaired glucose tolerance (IGT) and diabetes, which were discovered at examination or earlier diagnosis. Risk factors for the development of diabetes up to 80 years of age were analyzed with univariate and multivariate statistics. Total and free testosterone and SHBG concentrations correlated negatively with glucose and insulin values; total testosterone and SHBG, with triglycerides; and SHBG, with blood pressure (from P < 0.05 to P < 0.01). Men with IGT or newly diagnosed diabetes had higher BMI values (26.2 +/- 0.31 and 27.0 +/- 0.59 [mean +/- SE], respectively) and waist circumference (99.0 +/- 1.03 and 100.5 +/- 1.57) than nondiabetic men (BMI, 25.1 +/- 0.14; waist circumference, 95.4 +/- 0.47; P < 0.05), indicating abdominal obesity. Such men and men with previously diagnosed diabetes had, in general, lower total and free testosterone and SHBG levels, while those for LH were not different. In multivariate analyses that included BMI, waist-to-hip ratio, total and free testosterone, and SHBG, the remaining independent predictors for the development of diabetes were low total testosterone (P = 0.015) and, on the borderline, low SHBG (P = 0.053). In relation to nondiabetic men, the risk ratio for mortality, myocardial infarction, and stroke increased gradually and significantly from 1.18 to 1.68, from 1.51 to 1.78, and from 1.72 to 2.46 in men with IGT, newly diagnosed diabetes, and previously known diabetes, respectively. It was concluded that low testosterone and SHBG concentrations in elderly men are associated with established risk factors for diabetes and in established diabetes. Moreover, low testosterone levels independently predict the risk of developing diabetes. In different degrees of expression, the diabetic state predicts strongly (and gradually mortality from) myocardial infarction and stroke. It has been suggested that a relative hypogonadism might be a primary event, because other studies have shown that testosterone deficiency is followed by insulin resistance, which is ameliorated by testosterone substitution. The data suggest that the relative hypogonadism involved might be of both central and peripheral origin.

Aged↗
PubMed1996

Fetal fibronectin and microorganisms in vaginal fluid of healthy pregnant women.

OBJECTIVE: To determine fetal fibronectin in vaginal fluid from healthy women during uncomplicated pregnancy and to investigate possible relationships to gestational age and the vaginal microflora. MATERIALS AND METHODS: Samples of vaginal fluid were collected for fetal fibronectin determination and for quantitative aerobic and anaerobic microbiological culture from 22 women followed longitudinally at 12, 28 and 37 weeks gestation cross-sectionally in women at 12 weeks (n = 10), 28 weeks (n = 10), 37 weeks (n = 10), and 39 weeks (n = 30) gestation, respectively. Fetal fibronectin was determined by a quantitative enzyme immunoassay (Adeza Biomedical). RESULTS: There were no significant differences between the concentrations of fetal fibronectin in vaginal secretions at any of the four measurement points (12, 28, 37 and 39 weeks gestation). Women with elevated fetal fibronectin concentration (> or = 0.05 mg/L) had less often hydrogen peroxide-producing facultative lactobacilli (p < 0.0001), and more often bacterial vaginosis (p < 0.02) and Peptostreptococcus species (p < 0.002). Bacterial vaginosis (p < 0.01) and Candida albicans (p < 0.01) were more frequently found in women lacking hydrogen peroxide-producing lactobacilli. CONCLUSION: Fetal fibronectin in vaginal fluid was more associated with the vaginal microflora than with the gestational age of the pregnancy. Presence of hydrogen peroxide-producing lactobacilli seems to be the most important factor for a stable vaginal microflora.

Cross-Sectional Studies↗
PubMed1996

Bone mineral and related biochemical variables in patients with Kock ileal reservoir or Bricker conduit for urinary diversion.

PURPOSE: Bone material content was studied with single photon absorptiometry and dual energy x-ray absorptiometry , and the various biochemical parameters related to bone metabolism in patients with Kock reservoirs or Bricker conduits for urinary diversion. MATERIALS AND METHODS: We examined 34 patients with Kock ileal reservoirs to the skin (29) or urethra (5) and 14 with Bricker conduits 2 to 17 years after urinary diversion. Bone mineral density was measured in the radius with single photon absorptiometry, and in th femur, lumbar spine and whole body with dual x-ray absorptiometry. Serum concentrations of 25-hydroxyvitamin D, 1,25-dihydroxyvitamin D, osteocalcin, parathyroid hormone, bone specific alkaline phosphatase and ionized calcium were determined. Arterial blood gases were analyzed. RESULTS: The mean values for bone mineral density did not differ from age-matched controls in either group and no signs of decrease were observed with followup. Vitamin D serum concentration values remained within normal limits in all patients. Most patients had normal blood gas values. Mean values for osteocalcin, parathyroid hormone, bone specific alkaline phosphatase and ionized calcium also were within normal limits, although a few patients had elevated osteocalcin values indicating increased bone turnover. CONCLUSION: Urinary diversion with a Kock reservoir or Bricker conduit did not cause bone demineralization of significant changes in different markers of bone metabolism in patients examined 2 to 17 years after urinary diversion.

Absorptiometry, Photon↗
PubMed1996

Systemic radionuclide therapy using indium-111-DTPA-D-Phe1-octreotide in midgut carcinoid syndrome.

A 55-yr-old woman with a midgut carcinoid syndrome due to metastatic spread of an ileal tumor to the liver, paraortic and mediastinal lymph nodes and to the skeleton was given systemic radionuclide therapy with 111In-DTPA-D-Phe1-octreotide. Before therapy, dosimetric calculations were performed on whole-body scintigraphs and 111In retention was shown to be long-lasting. Excretion was mainly seen during the first 24 hr after injection; thereafter whole-body retention remained stationary at 30%. Indium-111 activity in tumor biopsies and blood was measured using a gamma counter. Very high tumor-to-blood ratios were obtained: 150 for the primary tumor and 400-650 for liver metastases, which further justified radiation therapy. Indium-111-DTPA-D-Phe1-octreotide treatment was given on three separate occasions (3.0, 3.5 and 3.1 GBq) 8 and 4 wk apart. After each therapy, the patient experienced facial flush and pain over the skeletal lesions followed by symptomatic relief, even though no objective tumor regression was found radiologically after 5 mo. After initiation of octreotide treatment, there was a 14% reduction of the main tumor marker, urinary 5-HIAA. After three subsequent radionuclide therapies, there was a further 31% reduction of 5-HIAA levels. No adverse reactions, other than a slight decrease in leukocyte counts, were seen. The mean absorbed radiation dose after the three treatments was estimated to be about 10-12 Gy in liver metastases and 3-6 Gy in other tumors, depending on the size and location of the metastases. Assuming internalization of 111In into tumor cells and a radiobiological effect from short range Auger and conversion electrons, there might be a therapeutic effect on the tumor.

Female↗