Rejection: FK 506 for rescue or maintenance.
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Adult↗
Biomedical subjects
L Backman
Publications and source records attributed to L Backman.
Baylor update: outcome analysis in liver transplantation.
An analysis of the first 740 liver transplants performed at Baylor is presented, including all cases to the end of calendar 1992. Kaplan-Meier curves are extended to nine years posttransplant. Our focus on outcome analysis has led us to review our experience with diabetics, with elderly patients, causes and patterns of late graft loss, long-term renal function. Quality of life data tracked for 2 years posttransplant is outlined. Clinical correlates to whole blood and plasma assays of FK506 are reviewed. Concerns remain over the disappointing results of liver transplantation for cholangiocarcinoma and those of patients with hepatitis-B antigenemia under current protocols.
Academic Medical Centers↗
Swedish obese subjects (SOS)--an intervention study of obesity. Baseline evaluation of health and psychosocial functioning in the first 1743 subjects examined.
This part of an on-going intervention trial analyses impacts of obesity on psychosocial factors and health. The study sample comprised 800 obese men (BMI > or = 34 kg/m2) and 943 women (BMI > or = 38 kg/m2) ranging in age from 37 to 57 years. All participants completed standardized health-related quality of life measures, a validated obesity-specific eating inventory and study-specific questionnaires on current and past health status, use of medical care and medications, socioeconomic status, dietary habits, physical activity habits, weight history and familial history of obesity. Chronic patients and population samples were used as reference. The obese reported distinctly poorer current health and less positive mood states than the reference subjects, women being worse than men. Anxiety and/or depression on a level indicating psychiatric morbidity were more often seen in the obese and again women reported more affliction than men. Furthermore, the average poor mental well-being was worst than in chronically ill or injured patients, such as rheumatoid, cancer survivors and spinal cord injured persons. Predictors of perceived health and psychosocial functioning could be discerned using a comprehensive system of statistical analyses (16-28% explained variance). A background of both somatic and psychiatric morbidity was decisive for the health and psychosocial functioning in the obese; joint symptoms and angina pectoris dominated among somatic variables. Physical inactivity was the most prominent of traditional risk factors. The number of dieting attempts and body image were important weight correlates. Our results provide further evidence to the effect that severe obesity is a crippling condition.
Adult↗
De novo malignancy following liver transplantation: a single-center study.
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Adult↗
Characterization of calcium binding to spectrins.
Calcium binding to brain and erythrocyte spectrins was studied at physiological ionic strength by a calcium overlay assay and aqueous two-phase partitioning. When the spectrins were immobilized on nylon membranes by slot blotting, the overlay assay showed that even though both spectrins bound 45Ca2+, the brain protein displayed much greater affinity for calcium ions than erythrocyte spectrin did. Since the observed binding was weaker than that displayed by calmodulin under similar conditions, the overlay assay results indicated that the binding must be weaker than 1 microM. The phase partition experiments showed that there are at least two sites for calcium on brain spectrin and that calcium binding to one of these sites is reduced significantly by magnesium ions. From the partition isotherm, the dissociation constants were estimated as 50 microM for the Mg(2+)-independent site and 150 microM for the Mg(2+)-dependent site. The phase partition results also showed that erythrocyte spectrin bound calcium ions at least 1 order of magnitude weaker. By examining calcium binding to slot-blotted synthetic peptides, we identified two binding sites in brain spectrin. One mapped to the second putative calcium binding site (EF-hand) in alpha-spectrin and the other to the 36 amino acid residue long insert in domain 11. In addition, a tryptic fragment derived from the C-terminal of erythrocyte alpha-spectrin, which contained the two postulated EF-hands, also bound calcium. These findings suggest that the calcium signal system may also involve direct binding of calcium to spectrin beside known calcium modulators such as calmodulin and calpain.(ABSTRACT TRUNCATED AT 250 WORDS)
Amino Acid Sequence↗
[Sclerotherapy in bleeding stomach ulcers--an effective therapeutic method].
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Humans↗
Inflammatory response to subcutaneously implanted Marlex and GORE-TEX in massively obese patients.
In both vertical banded gastroplasty and in gastric banding, synthetic bands are used to reinforce the outlet from the pouch to the rest of the stomach. Two materials commonly used for these bands are polypropylene (Marlex) and polytetrafluoroethylene (GORE-TEX). As a measure of their suitability, human inflammatory response to subcutaneous implants was investigated. In a randomized series of 17 superobese patients a patch of GORE-TEX was implanted subcutaneously in one groin under local anaesthesia and Marlex mesh was implanted in the other groin. After about 2 months the implants were exstirpated and investigated in a single blind procedure by an experienced pathologist. Marlex gave a significantly greater chronic inflammatory reaction and fibrosis than GORE-TEX. The foreign body giant cell reaction was, however, significantly greater with GORE-TEX. The possible implications of these results are discussed.
Adult↗
Long term home parenteral nutrition using a subcutaneous venous access.
Home parenteral nutrition (HPN) utilising a subcutaneous venous access (SVA) infusion system (port-a-cath((R)) (PAC)), allows patients with a nonfunctioning bowel to lead a relatively normal life with full nutritional support. A patient with pseudo-obstruction of the bowel due to scleroderma was treated with HPN for 1192 consecutive days. During this time the patient underwent 6 catheter or port changes due to occlusion of the infusion system. The infusion regime was modified several times in an attempt to prevent occlusion. Infusing carbohydrate and protein daily, with a lipid infusion twice weekly increased the patency of the infusion system. In 2 other patients, rinsing the infusion system with 2ml of a 45% alcohol solution after use increased the patency of the infusion system further. This regime has now been in use for 924 consecutive days with no occlusions.
Journal Article↗
Swedish obese subjects (SOS). Recruitment for an intervention study and a selected description of the obese state.
SOS (Swedish obese subjects) is an on-going intervention trial designed to determine whether the mortality and morbidity rates among obese individuals who lose weight by surgical means (gastric banding, vertical banded gastroplasty and gastric by-pass) differ from the rates associated with conventional treatment. For this purpose, the study is recruiting a sample of obese men and women who constitute a registry of potential subjects from which the participants are drawn. Eligibility criteria for participation in the registry were: age at application 37-57 years and BMI greater than or equal to 34 kg/m2 for men and greater than or equal to 38 kg/m2 for women. Before receiving a health examination, all patients complete extensive questionnaires on current and past health status, utilization of medical care and medications, socio-economic status, psychological profiles, dietary habits, physical activity, weight history, and familial disposition to obesity. Each surgical case is matched to its optimal control in the registry, to ensure that the two groups do not differ systematically with respect to any of 18 matching variables that may affect prognosis. The first 1006 subjects included in the registry have been studied with respect to morbidity and compared with on-going population studies of men and women in Göteborg, Sweden. The relative risks of prevalent disease and symptoms associated with obesity in 50-year-old males and females respectively were 4.3 and 4.7 (dyspnoea), 14.7 and 11.8 (angina), 6.3 (myocardial infarction, males only), 2.1 and 4.5 (hypertension), 5.2 and 6.6 (diabetes), 4.6 and 26.1 (claudication) and 1.7 and 1.8 (gall bladder disease). Correspondingly, obese males and females display elevations of systolic and diastolic blood pressure, fasting glucose, insulin, triglyceride, and uric acid levels. However, total cholesterol was not increased in obese males and was in fact significantly lower in obese compared with reference women. HDL-cholesterol was lower in obese than reference men (data were not available in reference women). The rate of taking sick pensions was over twice as high in SOS obese patients than in population controls. Finally, comparison of measurements with self-reported prevalence estimates revealed a considerable amount of previously undiagnosed hypertension and diabetes in the obese subjects. These data suggest that the excess health risks associated with obesity may not be fully appreciated.
Adipose Tissue↗
Formation and properties of spectrin containing a truncated beta-chain, generated by an endogenous calcium-dependent protease.
Spectrin chromatographically isolated from human red cell membranes contains a proteolytic activity, inhibited by leupeptin, with a dependence on calcium ions characteristic of a calpain I. The activity accompanies the spectrin on two successive gel filtration columns and is present in both the dimer and the tetramer. It is cryptic in the ghost membrane and in purified membrane skeletons until these are dissociated, apparently because the spectrin is resistant to attack in the tetrameric state. The activity is more strongly expressed in spectrin preparations from young than from old cells. Since the bound enzyme does not detectably change the elution volume of spectrin in gel filtration, it is likely that its molecular weight is low. Its activity reveals itself only in the formation of a modified spectrin, lacking the COOH-terminal, phosphorylated portion of the beta-chain. The phosphorylated fragment (15-20 kDa) can be identified by gel electrophoresis. The proteolytically modified spectrin dimers are unable to associate with like molecules, but are univalent with respect to formation of hybrid tetramers with native spectrin. The association constant for this process is lower than that for self-association of native spectrin by a factor of only 2. The proteolytically modified spectrin behaves similarly in this respect to a truncated spectrin mutant found in a form of hereditary elliptocytosis. The latter also resembles the proteolytic product in that both give rise to the same altered NH2-terminal tryptic fragment from the alpha-chain.
Autoradiography↗
Experience of long-term intraperitoneal insulin treatment using a new percutaneous access device.
A pilot study was conducted to determine the efficacy of a new percutaneous device, designed to help to deliver insulin from an external, multiprogrammable pump to the abdominal cavity in patients with Type 1 (insulin-dependent) diabetes. Six patients received intraperitoneal insulin therapy for 15-24 months, a total experience of 9.4 patient-years. Glycosylated haemoglobin stabilized at 7.6 +/- 0.7% with no change in insulin dose. Four patients had to submit to reimplantation after 30 to 60 weeks. One patient met with inconvenient location of the device and three had blockage of the system. In four patients treatment had to be interrupted due to blockage of the intraperitoneal catheter by omental-tissue encapsulation. In two of those patients this blockage was combined with deeper infections. In another patient treatment had to be interrupted due to chronic, local, subcutaneous infection.
Adult↗
Jejunoileal Bypass Operations With a Side-to-side Anastomosis in the Treatment of Morbid Obesity.
In order to avoid a stagnant loop syndrome in intestinal bypass operations for morbid obesity, we have tried a jejunoileal bypass with a side-to-side anastomosis in a pilot study. Seven patients were operated on with this method, which resulted in a very high incidence of liver damage. The study puts a question mark to the blind loop syndrome as an etiological factor in producing liver damage.
Journal Article↗
Prevention of relapse of reflux esophagitis after endoscopic healing: the efficacy and safety of omeprazole compared with ranitidine.
Ninety-eight patients with erosive and/or ulcerative esophagitis unhealed after at least 3 months' treatment with standard doses of cimetidine (greater than or equal to 1200 mg daily) or ranitidine (greater than or equal to 300 mg daily) were primarily included in an acute healing phase study, and 51 were allocated to 40 mg omeprazole once daily and 47 to 300 mg ranitidine twice daily. After 12 weeks of treatment, 46 (90%) patients given omeprazole were healed, compared with 22 (47%) allocated to ranitidine. Healed patients were then given maintenance treatment with either 20 mg omeprazole once daily or 150 mg ranitidine twice daily for 12 months. Plasma gastrin was determined and gastric mucosal biopsy specimens were obtained during the entire study to assess the structure of the exocrine and endocrine cell populations of the oxyntic mucosa. Sixty-seven per cent of the total number of patients randomized to omeprazole were maintained in clinical and endoscopic remission throughout the 12-month study period as compared with only 10% among those given ranitidine (p less than 0.0001). After 4 weeks of omeprazole treatment basal gastrin levels were slightly increased, with a 95% confidence interval for the change of from 8.6 to 16.9 pmol/l. No further increase in basal gastrin levels was observed during the ensuing study months. No significant histopathologic lesion was found in the oxyntic gland mucosa. In conclusion, omeprazole was far superior to ranitidine in preventing recurrence, a goal achieved without adverse events and significant abnormalities in the oxyntic mucosal exocrine or endocrine cells but with a moderate increase in basal gastrin levels.
Adult↗
The effect of excessive weight reduction on peripheral and central nervous functions. A study in obese patients treated by gastric banding.
Twenty-four obese patients were studied before and 3, 6, and 12 months after gastric banding to see if the excessive weight reduction caused any dysfunction of the peripheral or central nervous system or both. Postoperatively the patients were assumed to be able to keep their intake to 800-1000 kcal/day together with a multivitamin supplement. Electromyography, electroneurography and vibratory thresholds were used to assess the peripheral, somatosensory and visual evoked potentials to assess the central nervous and synaptic functions. Regular clinical and neurological assessments were made as well as laboratory examinations including total potassium estimations to calculate lean body mass. The mean weight loss and the mean lean body mass reduction amounted to 20.5% and 18.4% at 3 months, and to 30.3% and 10.2% at 12 months, respectively. Electromyography showed signs of acute denervation in the anterior tibial muscle in one patient 3 and 6 months after operation, but restitution after 12 months despite continuous weight loss. In the left peroneal nerve the electroneurography showed a trend with slight successive reduction of the conduction velocity in the postoperative period. No abnormalities of the vibratory thresholds were found postoperatively. Somatosensory and visual evoked potentials were normal in all patients and no significant changes were observed during the postoperative period. The present study did not reveal any significant dysfunction of the peripheral or central nervous system as a result of excessive weight loss in obese adults undergoing weight reducing surgery.
Adult↗
Eosinophilic gastroenteritis--a rare cause of severe abdominal pain. Case report.
A 48-year-old man with a long history of recurrent severe abdominal pain developed moderate drug dependence before the diagnosis of eosinophilic gastroenteritis was established. The symptoms quickly responded to corticosteroid treatment.
Abdominal Pain↗
Influence of excessive weight loss on respiratory function. A study of obese patients following gastroplasty.
The influence of excessive weight loss, with decreased muscle mass, on pulmonary function was evaluated in 16 obese patients without clinical evidence of respiratory disease. Weight loss was induced with vertical banded gastroplasty. Six nonobese age-matched patients undergoing elective cholecystectomy acted as controls. Preoperative values for static and dynamic lung function variables and for pulmonary gas distribution and respiratory muscle strength were compared with postoperative values after approximately 10% and 18% weight reduction. Before gastroplasty the dominant abnormality of respiratory function was slight restrictiveness, with reduced lung volumes. Body weight and lean body mass decreased significantly during the study period, and respiratory muscle strength was significantly reduced after 10% weight loss. Lung function tests nevertheless showed significant increase of vital capacity, functional residual capacity, total lung capacity and maximal voluntary ventilation. No correlation was found between the reduction of respiratory muscle strength and that of lean body mass. The controls did not diminish the body weight after surgery and the lung volumes and respiratory muscle strength was not changed.
Adult↗
The effect of omeprazole and ranitidine on ulcer healing, relief of symptoms, and incidence of adverse events in the treatment of duodenal ulcer patients.
In a Swedish double-blind multicenter study involving 143 patients, the new proton pump inhibitor omeprazole (30 mg taken as a single morning dose) was compared with ranitidine (400 mg b.i.d.). Clinical assessment and laboratory investigations were carried out at 2 and 4 weeks, and again at 6 weeks if patients had not healed earlier. Endoscopy was repeated at two-weekly intervals until the ulcer was healed. The patients in the two treatment groups were well matched prior to treatment. There was a higher ulcer healing rate in the omeprazole group (70%) than in the ranitidine group (55%) after two weeks of treatment. This difference reached statistical significance in 128 patients adhering to the protocol as shown by a logit model analysis with drug, ulcer size and smoking as the prognostic factors (p = 0.04). There were no major differences between the two treatment groups in terms of symptomatic relief. Both drugs were generally well tolerated, and the number of adverse events in the two treatment groups were similar. After healing, 127 patients entered a follow-up study, with endoscopy either after 6 months or on recurrence of symptoms. There was no significant difference between the two treatment groups, with the relapse frequency within 6 months being 39% in the omeprazole group and 47% in the ranitidine group. These results, with a 15 percentage points higher ulcer healing rate for omeprazole as compared with H2-receptor antagonists after two weeks, are in accordance with results reported in other studies.
Duodenal Ulcer↗
HIV seroprevalence among childbearing women in Connecticut.
A seroprevalence survey of human immunodeficiency virus (HIV) among childbearing women in Connecticut is being conducted as one of the family of HIV seroprevalence surveys funded by the Centers for Disease Control (CDC). Between 1 April 1989 and 30 March 1990 dried blood specimens submitted from all newborns (45,890) for metabolic screening were examined for HIV antibodies by standard laboratory techniques in a blinded manner. The overall HIV prevalence rate was 0.30% (138 newborns). Rates did not differ significantly by mother's age group in the overall population. Rates of seropositivity were higher among blacks (1.2%) and Hispanics (0.69%) than among whites (0.10%). Seropositivity by town was highest in New Haven (1.6%) where one in every 63 residents who gave birth was infected. Based upon this survey, we estimate that 45 HIV-infected children were born in Connecticut during the one-year study period and that approximately 2,300 women of childbearing age are currently infected.
Adult↗