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Biomedical subjects

H Thysell

Publications and source records attributed to H Thysell.

At least 91 records · Page 5Linked to original sources
PubMed1985

Plasma lipoproteins, liver function and glucose metabolism in haemodialysis patients: lack of effect of L-carnitine supplementation.

The effects of L-carnitine administration (2 g i.v. three times weekly for 6 weeks) were studied in a double blind trial comprising 2 X 14 patients on regular haemodialysis treatment. The initial plasma carnitine concentrations were normal in the male, but slightly lowered in the female participants and rose more than ten-fold in the patients receiving active treatment. The majority (15/28) of patients had moderate hypertriglyceridaemia, whereas plasma HDL cholesterol levels were normal. Activities of hepatic and lipoprotein lipase were decreased and fat tolerance impaired. The S-triiodothyronine and/or thyroxine levels were subnormal in 11 patients. Four patients had fasting hyperinsulinemia, and 6 demonstrated abnormal B-glucose patterns after a peroral glucose load. The galactose elimination rate demonstrated moderately impaired hepatocyte function in four patients. No effects of carnitine treatment on any of the variables could be detected.

Adult↗
PubMed1985

Carnitine and left ventricular function in haemodialysis patients.

Left ventricular function was non-invasively studied in 28 randomly selected haemodialysis patients before and after administration of L-carnitine, 2 g i.v. three times per week or saline in a double blind designed study over a six-week period. Cardiac function variables showed no relationship to muscle (vastus lateralis) and plasma carnitine concentrations. No apparent deficiency in muscle carnitine was found, whereas total plasma carnitine was lower in female patients than in female controls, p less than 0.002. The echocardiographic left ventricular end-diastolic diameter was initially increased in about one third and the ejection fraction was depressed in about one fifth of the patients. An increased A:H ratio was found in 15%. Systolic time intervals were deranged in 30% of the patients. After carnitine administration, marked increases of muscle and plasma carnitine levels were found, p less than 0.01, but no effects were recorded in any of the cardiac tests. Muscle carnitine increased from 14.6 mmol/kg dry weight to a median of 23.7 mmol/kg. We found no support for the hypothesis that carnitine depletion is responsible for cardiac dysfunction in haemodialysis patients.

Adult↗
PubMed1984

Serum level of complement factor D in systemic lupus erythematosus--an indicator of glomerular filtration rate.

Serum levels of complement factor D, a low molecular weight (LMW) protein, were high and inversely correlated with glomerular filtration rate (GFR) determined in 19 patients with lupus glomerulonephritis (LGN). Factor D was significantly closer correlated with S-creatinine than were two other LMW proteins, beta 2-microglobulin and gamma-trace in 22 LGN patients. Close correlations between each of the LMW proteins and S-creatinine were found in patients with a non-inflammatory disorder, polycystic kidney disease. Slightly increased beta 2-microglobulin concentrations were found in 15 of 20 systemic lupus erythematosus (SLE) patients without renal involvement, while factor D and gamma-trace showed normal values in most of these patients. The findings imply that serum concentrations of complement factor D in SLE are mainly determined by the GFR.

Adolescent↗
PubMed1984

Feasibility of extracorporeal on-line large-scale plasma adsorptions on protein A-sepharose columns in cancer patients.

The feasibility of extracorporeal adsorption of 1.5-3 L plasma on protein A-Sepharose was investigated in six patients with advanced cancer. Anticoagulation with heparin was associated with respiratory distress syndrome in two patients, most likely caused by complement activation as indicated by a transient leukopenia during plasma reinfusion and appearance of C3 degradation products in the extracorporeal circulation. Addition of citrate abolished the respiratory symptoms, C3 degradation, and leukopenia, and no adverse reactions were observed. No objective tumor regression was observed in any of the patients. Three patients progressed during therapy. In one of these, multifocal central tumor necrosis was observed as a possible, although unproven, therapeutic effect. Increased natural killer and/or killer cell activities were recorded in three patients and increased complement-dependent serum cytotoxicity in one patient. The level of circulating immune complexes decreased significantly (18-28%) in three patients studied. It is concluded that extracorporeal plasma adsorption on protein A-Sepharose is feasible when citrate is added to the extracorporeal system, but its therapeutic efficacy is uncertain.

Adsorption↗
PubMed1983

Circulating immune complexes and C1 activation in patients with rapidly progressive glomerulonephritis, before and after treatment with immunosuppression and plasma exchange.

Well-known assays for detection of circulating immune complexes (CIC) (C1 q binding assay, C1q deviation test, solid-phase C1 q binding assay, solid-phase conglutinin binding assay, and the platelet aggregation test) were used in 30 patients with different kinds of rapidly progressive glomerulonephritis. In 89% of the patients evidence of CIC was found in at least one of the assays. 81% of the patients were positive in the C1q binding assay and/or the conglutinin binding assay with addition of complement. CIC were more often detected by several assays, and with higher values in patients with systemic disease than in patients with renal involvement alone. CIC were found in 2 patients with Goodpasture's syndrome. 15 patients were reexamined after treatment with plasma exchange, when the disease was clinically inactive. The patients were still on immunosuppressive treatment. In most of these, CIC were detectable, but with lower values than at the start of treatment. Before treatment, high levels of C1r-C1s-C1 inactivator complexes suggested increased C1 activation in 93% of the patients. C-reactive protein was raised, and the concentrations of C1 q, C1s, C4, C3 and factor B were normal or high in most of the patients. Pronounced hypocomplementemia was found only in 2 patients with systemic lupus erythematosus (SLE). After treatment, the levels of C-reactive protein, C1 q, C1s, C3 and factor B had decreased in the non-SLE patients, while the average levels of C4 and C1r-C1s-C1 inactivator complexes were essentially unchanged.

Antigen-Antibody Complex↗
PubMed1983

Improved outcome in rapidly progressive glomerulonephritis by plasma exchange treatment.

During the last 3.5 years we have had facilities to perform effective plasma exchange treatment (PE). During this period of time 12 patients of idiopathic and 19 patients of collagenous rapidly progressive glomerulonephritis (RPGN) appeared, Goodpasture's syndrome excluded. In an attempt to evaluate the separate effect of immunosuppression (IS) and PE, PE was if possible withheld for two weeks. In 3 patients IS alone had a satisfactory effect and therefore no PE was performed. In 2 severely ill patients IS and PE were instituted simultaneously. In 6 patients PE was started 5-12 days and in 17 patients at least 14 days after the start of IS. In 3 patients PE was started first because of suspected septicemia. 23 of the 31 patients improved; 6 from IS alone, 3 from IS and probably also from PE, 1 from PE and probably from IS, 5 both from IS and PE and 1 from PE alone. In 7 patients the individual effect of IS and PE could not be evaluated. At follow up 1-37 (median 13) months 13 patients had a S-creatinine below 200, 2 patients 200-300 and 1 patient 510 mumol/l. 3 patients went into RDT immediately and 7 after 4-22 months. 5 elderly patients died, only 1 from uremia, the others from cardiovascular diseases. The outcome was unpredictable from clinical and laboratory data. Addition of PE in the treatment of RPGN seems to have improved the outcome considerably.

Adult↗
PubMed1983

Plasma exchange in two cases of minimal change nephrotic syndrome with acute renal failure.

One idiopathic and one nonsteroidal anti-inflammatory drug associated case of minimal change nephrotic syndrome with acute renal failure are described. Both patients were severely ill and needed dialysis. Treatment with corticosteroids and azathioprine for 19-21 days was ineffective. After start of plasma exchange treatment both patients rapidly recovered. The suggested effect of plasma exchange in these conditions can hardly be ascribed only to correction of the colloid oncotic pressure. An elimination of a circulating factor(s) of pathogenetic importance must also be suspected.

Acute Kidney Injury↗
PubMed1982

Immunosuppression and the additive effect of plasma exchange in treatment of rapidly progressive glomerulonephritis.

Attempts were made to evaluate the separate effect on kidney function of immunosuppressive treatment (IS) and plasma exchange (PE) in 27 patients with rapidly progressive glomerulonephritis (RPGN). Twenty-four of the patients were treated with PE. Initial IS was supplemented with PE within 6-12 days in 5 patients, and after at least 14 days in 13. Because of suspected septicemia, 2 patients were first treated with PE, and IS was not initiated until the possibility of septicemia had been excluded. In 4 severely ill patients wih rapid clinical deterioration, both treatments were started simultaneously. Twenty patients improved during one or both treatments, 4 with IS alone, 2 with IS and doubtfully with PE, 3 with IS and probably also with PE, 5 both with IS and PE and one with PE alone. In 5 patients the individual effects of IS and PE could not be evaluated. In another 2 patients the combined treatment seemed to influence the course favourably. In the remaining 7 patients the effect of the treatment was doubtful or nil. Two further patients with Goodpasture's syndrome were treated. They were admitted late, and both kinds of treatment were instituted simultaneously. One of them died in respiratory insufficiency, the other remained oliguric while the pulmonary changes faded. Thus, PE added a positive effect to IS in several patients with RPGN. The treatment had few and mostly mild side-effects.

Adult↗
PubMed1982

The effect of D,L-carnitine supplementation on muscle metabolism, neuropathy, cardiac and hepatic function in hemodialysis patients. A pilot study.

Three patients on regular hemodialysis treatment were perorally supplemented with D.L-carnitine, 900 mg/d, during four weeks. Before treatment, muscle carnitine concentrations were low and the patients showed signs of hypometabolism in skeletal muscle, cardiomyopathy, impaired hepatic function and a moderate hyperlipoproteinemia. After treatment, the skeletal muscle metabolism normalized. The results further indicate improvement of the cardiac and hepatic function and of the neuropathy on the sensory side. No improvement was found, however, in plasma lipoprotein pattern or in variables reflecting plasma lipid transport (lipoprotein lipase activity and intravenous fat tolerance).

Adult↗
PubMed1982

Successful treatment of hemolytic uremic syndrome and thrombotic thrombocytopenic purpura with fresh frozen plasma and plasma exchange.

Four patients with hemolytic uremic syndrome (HUS) and seven with thrombotic thrombocytopenic purpura (TTP) were treated with infusions of fresh frozen plasma (FFP). In one patient with HUS and five patients with TTP this treatment was combined with plasma exchange (PE). The additional treatment varied; corticosteroids, antiplatelet drugs, heparin and blood exchange. All but one patient recovered completely in spite of severe illness with uremia, oliguria and/or cerebral symptoms during the acute phase. The results were surprisingly good in comparison with other published series. The success must in the first place be attributed to early diagnosis and to the infusions of FFP. PE seemed to potentiate the effect of FFP.

Adolescent↗
PubMed1982

Urinary beta-hexosaminidase excretion in patients treated with lithium, thymoleptic and/or neuroleptic drugs.

In order to evaluate the nephrotoxic effect of serum lithium within the therapeutical range, the urinary excretion of beta-hexosaminidase was studied in 44 well-managed long-term lithium treated patients and in 27 healthy controls. In addition, six patients on thylmoleptic and 16 patients on neuroleptic drugs were studied. The enzyme excretion was slightly increased in the lithium treated patients, but not in the patients only treated with thymoleptic or neuroleptic drugs. The findings are consistent with the suggestion that long-term lithium treatment causes a slowly progressive nephropathy. To follow the urinary beta-hexosaminidase excretion might be a measure to identify patients at higher risk. In two cases of lithium intoxication the enzyme excretion was considerably increased.

Adult↗
PubMed1982

Continuous maternal glucose measurements and fetal glucose and insulin levels after administration of terbutaline in term labor.

Maternal blood glucose and fetal blood glucose and insulin levels were studied in 16 women at full-term labor after administration of terbutaline 250 microgram i.v. The maternal blood glucose level was registered by a continuous blood glucose monitoring unit. In all patients studied, the terbutaline injection was followed by a rise in maternal blood glucose within 15 min, lasting for at least one hour. The fetal glucose levels paralleled those of the mothers, but on a lower level. None of the infants demonstrated hypoglycemia during the first 90 min after birth. We conclude that terbutaline administrated in this way has a direct effect on the maternal blood glucose release, and report that no harmful effects on fetal carbohydrate metabolism could be demonstrated.

Blood Glucose↗
PubMed1981

Urinary beta-hexosaminidase excretion in polycystic kidney disease.

The urinary excretion of beta-hexosaminidase in relation to creatinine was studied during one year in 30 consecutive patients with polycystic kidney disease (S-creatinine 75-1 000 micro mol/l) and 30 healthy controls. The excretion of beta-hexosaminidase was significantly increased in the patients and was positively correlated to S-creatinine and to the relative increase in S-creatinine during the year of the study. No correlation was found between the enzyme excretion and age, mean blood pressure, number of antihypertensive drugs, proteinuria or pyuria. A significant rise in beta-hexosaminidase excretion was observed in two patients with acute cyst bleeding and/or kidney infarction.

Adult↗
PubMed1981

Bone marrow morphology in patients in long-term treatment with azathioprine.

The bone marrow was morphologically analysed in 25 patients receiving long-term azathioprine therapy for chronic renal diseases or after a renal transplantation. There were no significant changes within the granulopoietic or lymphopoietic part of bone marrow even after 10 years of treatment. However, there was a significant "shift to the left" within erythropoiesis as well as greater frequencies of megaloblasts and sideroblasts. A significant increase of "erythroblastic islands" may indicate an increased death rate of defective erythroblasts. The changes within erythropoiesis in some of the patients were so pronounced that the possibility of a preleukaemic condition cannot be excluded.

Azathioprine↗
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

Hemodialysis in schizophrenia: psychiatric aspects of treatment failure in a pilot study.

In order to examine the reported curative effects of hemodialysis in patients with chronic schizophrenia a pilot study approved by the Committee of Ethics at the University of Lund was initiated in September 1977. 13 patients, 10 men and 3 women, 21--44 years old, were treated. All but one were diagnosed as chronic schizophrenia. The duration of illness was 4--20 years. All the patients functioned defectively psychosocially, and conventional therapy had failed. Our goal was to give at least one dialysis treatment a week during 13 weeks. 10 patients completed the treatment series. The patients were scored according to the Brief Psychiatric Rating Scale and the Rockland and Pollin scale before, during and after the treatment. Conventional therapy was given throughout. Analysis of hemofiltrates for endorphins did not reveal any abnormal levels. 1 patient reported a distinct and hitherto lasting improvement. Marginal and temporary improvements were noted in 3 patients. Therefore placebo effects or spontaneous remission seemed probable. The ratings showed no significant changes in any patient during the treatment period. All patients including those who showed improvement remained seriously incapacitated by their psychiatric illness. Different psychiatric aspects of our failure to reproduce the American findings including cultural discrepancies in diagnostic criteria are discussed.

Adult↗