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Biomedical subjects

L Hansson

Publications and source records attributed to L Hansson.

At least 307 records · Page 17Linked to original sources
PubMed1992

Stability of therapeutic alliance and its relationship to outcome in short-term inpatient psychiatric care.

The relationship of therapeutic alliance to patient and treatment characteristics and to outcome, was studied in a sample of 106 patients consecutively admitted to a short-term psychiatric ward. The main finding was that a better therapeutic alliance at discharge was related to a greater improvement in symptoms during treatment. A multivariate model for prediction of outcome revealed a significant contribution from therapeutic alliance at discharge but not from alliance at admission or from changes in alliance during treatment. Improvement in alliance was seen in 41.5% of the patients, no change in 28.3% and a deterioration in 30.2%. Patients who improved their alliance did not differ from the others in background characteristics, but were more often subject to psychopharmacological treatment and were more often treated in a basic activation group. Patients with a stable poor alliance more often stated physically oriented target complaints at admission while patients with a stable satisfactory alliance more often presented interpersonally related complaints. It is concluded that further research in the field would benefit from a closer description of the change in the alliance and its relationship to treatment characteristics and outcome.

Female↗
PubMed1992

Hypertensive retinal vascular changes: relationship to left ventricular hypertrophy and arteriolar changes before and after treatment.

Eye-ground-photos were taken in twenty-eight previously untreated men with mild to moderate essential hypertension. The same eye was evaluated before and after 26 weeks of double-blind treatment with Enalapril or Hydrochlorothiazide. The vascular changes were assessed by using a more elaborate and refined grading than the Keith-Wagener-Barker scale. All photos were examined by the same observer without knowledge of blood pressure, type of treatment or the order in which the photos had been taken. There were significant positive correlations between the vascular alterations in the retina in the untreated state and left ventricular wall thickness (echocardiography), minimal vascular resistance in the calf (plethysmography) and blood pressure respectively. Treatment with Enalapril decreased the reflection of the retinal arterial wall significantly and reduced the narrowing of arteries and arterio-venous crossing phenomena non-significantly. Hydrochlorothiazide did not affect any of the retinal vascular changes. It can be concluded that this relatively simple technique of evaluating eye-ground-photos with a new grading scale, when used in non-malignant hypertension, gives a useful assessment of the degree of hypertensive target organ damage in the retina as well as in other important target organs, i.e. the heart and vascular beds. In addition, Enalapril positively affects hypertensive retinopathy in contrast to Hydrochlorothiazide, reflecting what happens to structural cardiovascular changes in the rest of the body.

Adult↗
PubMed1992

Prospective randomized open blinded end-point (PROBE) study. A novel design for intervention trials. Prospective Randomized Open Blinded End-Point.

A novel design for intervention studies is presented, the so called PROBE study (Prospective Randomized Open, Blinded End-point). This design is compared to the classical double-blind design. Among the advantages of the PROBE design are lower cost and greater similarity to standard clinical practice, which should make the results more easily applicable in routine medical care. Since end-points are evaluated by a blinded end-point committee it is obvious that there should be no difference between the two types of trials in this regard.

Blood Pressure↗
PubMed1992

The stroke preventive effect in elderly hypertensives cannot fully be explained by the reduction in office blood pressure--insights from the Swedish Trial in Old Patients with Hypertension (STOP-Hypertension).

OBJECTIVE: To study whether the cardiovascular preventive effect of antihypertensive therapy can be explained solely by the reduction in office blood pressure, and to what extent the risk of stroke and cardiac events is associated with in-study diastolic blood pressure (DBP) and systolic blood pressure (SBP). DESIGN: The Swedish Trial in Old Patients with Hypertension (STOP-Hypertension) was a prospective, randomized, double-blind, multicentre trial comparing active antihypertensive treatment with placebo in patients aged 70-84 years. The study group comprised 1,627 elderly patients (mean blood pressure 195/102 mm Hg; mean age 75.7, SD 3.7; 63% females). The average follow-up was 25 months (range 6-65 months). No patient was lost to follow-up. METHOD: We applied a Poisson model taking current age, sex, treatment, DBP and SBP into account for all patients in the study. The constants of the model were estimated by the maximum likelihood method. RESULTS: The risk of stroke was significantly lower (42%, p = 0.0402) for a patient on active therapy than for a patient on placebo having the same blood pressure level, age, and sex. There was a corresponding, non-significant, reduction in cardiac events of 21%. In the whole study group the risk of stroke increased by 3% per mmHg (p = 0.0247) with increasing diastolic blood pressure for a given systolic pressure. The corresponding value for cardiac events was 2% per mmHg (p = 0.0376). CONCLUSION: In STOP-Hypertension we found a substantial risk reduction in stroke in actively treated patients, which was not solely explained by the blood pressure reduction obtained by treatment with beta-blockers and a potassium-sparing diuretic combination.

Aged↗
PubMed1992

Cloning and sequencing of human kappa-casein cDNA.

A cDNA encoding kappa-casein of human milk was cloned and sequenced. The kappa-casein cDNA was isolated from a lambda gt11 library generated from mRNA prepared from a mammary gland biopsy obtained from a lactating woman. The library was screened with polyclonal rabbit antibodies raised against purified native kappa-casein. The obtained nucleotide sequence contained an ORF sufficient to encode the entire amino acid sequence of a kappa-casein precursor protein consisting of 182 amino acids. This includes a tentative signal peptide of 20 amino acids and a processed protein of 162 amino acids.

Amino Acid Sequence↗
PubMed1992

Regression of left ventricular hypertrophy--a meta-analysis.

Left ventricular hypertrophy (LVH) is an independent risk indicator of cardiovascular disease. Obtaining reversal of hypertension-induced cardiac hypertrophy seems to be a desirable objective of antihypertensive treatment. A total of 2,357 patients were included in a meta-analysis on the effect of antihypertensive pharmacological therapy on LVH. Overall left ventricular mass (LVM) was reduced by 11.9% (95% confidence interval (CI) 10.1-13.7) in parallel with a reduction of mean arterial pressure of 14.9% (CI 14.0 to 15.8). When evaluating the effect of first-line therapies on calculated LVM using the same formula for all studies, the absolute reductions in g were 44.7 (ACE-inhibitors), 22.8 (beta-blockers), 26.9 (calcium antagonists) and 21.4 (diuretics) when adjusted for differences between studies (ANCOVA). It can be concluded that effective antihypertensive therapy reduces LVM. ACE-inhibitors, beta-blockers and calcium antagonists reduce LVM by reducing wall hypertrophy, the effect of ACE-inhibitors being the most pronounced. Diuretics reduce LVM mainly through an effect on left ventricular inner diameter. How these effects affect prognosis is still an open question.

Adrenergic beta-Antagonists↗
PubMed1992

Cardiovascular responses to stress in young hypertensive women.

OBJECTIVE: The aim of the study was to investigate the haemodynamic effects of hormonal changes during the menstrual cycle in 11 hypertensive women aged between 29 and 38 years. DESIGN: In randomized order, the subjects were examined on days 2-7 (follicular phase) and on days 20-24 (luteal phase). All medication was withdrawn on average 5 weeks prior to the experiment. The results in the hypertensive group were compared with those of a control group consisting of 11 normotensive women aged between 21 and 46 years who had earlier taken part in an identical experiment. METHODS: A standardized mental stress test and a 24-h ambulatory blood pressure and heart rate recording were performed. RESULTS. Prestress resting heart rate was significantly higher in the hypertensive group and a significant difference was maintained throughout the entire stress experiment. Heart rate, systolic and diastolic blood pressure increased highly significantly in both groups during the exposure to mental stress, but no difference in heart rate or blood pressure reactivity between the normotensive and hypertensive groups was found in either phase. Heart rate reactivity did not differ during the two phases in the hypertensive group, in contrast to our previous findings in normotensives. During 24-h ambulatory recording both groups had slightly but significantly higher heart rate and systolic blood pressure in the luteal phase. In the hypertensives the diastolic blood pressure was also higher in this phase. Both groups had significantly higher serum oestradiol and progesterone levels in the luteal phase. CONCLUSIONS: The findings of the present study support the hypothesis that female sex hormones affect cardiovascular control in both normotensive and hypertensive women.

Adult↗
PubMed1992

Urinary kallikrein excretion is low in malignant essential hypertension.

OBJECTIVE: To determine whether the urinary excretion of kallikrein is altered in patients with previously malignant hypertension. DESIGN: Twenty-two patients with malignant hypertension (fundus hypertonicus III or IV) in the Gothenburg area were studied over a 3-year period. After treatment had begun they were investigated for blood pressure control, family history of hypertension, renal function and urinary kallikrein and plasma prekallikrein concentrations. Twenty-two patients with treated non-malignant hypertension and 36 control subjects were investigated concomitantly. The two hypertensive groups were also separated into subgroups of essential and secondary hypertension. METHODS: Prekallikrein was activated and kallikrein determined by a spectrophotometric assay using a synthetic chromogenic substrate. Renal function was estimated by serum creatinine and 51Cr-ethylenediaminetetraacetic acid clearance. RESULTS: Prekallikrein levels tended to be elevated in all groups of hypertensive patients compared with controls whilst urinary kallikrein was significantly decreased in malignant hypertensives. The most pronounced suppression of urinary kallikrein was seen in the group of patients with essential malignant hypertension. The differences persisted when urinary kallikrein was related to the degree of renal impairment or when urinary volume was taken into account. There was no relation between family history of hypertension and low levels of urinary kallikrein. CONCLUSION: Decreased urinary kallikrein could indicate depressed activity in the renal kallikrein-kinin system, which may be associated with the initiation of essential malignant hypertension.

Antihypertensive Agents↗
PubMed1992

Hypertensive therapy--effect on coronary risk factors.

Antihypertensive agents, particularly diuretics and beta-blockers, can "worsen" certain coronary risk factors, e.g. plasma lipids, which could theoretically offset the benefit of lowering blood pressure. However, the use of such surrogate markers may be inappropriate; propranolol has been shown to significantly decrease the frequency of myocardial infarction (MI) as evidenced by the appearance of Q-waves on ECG, and diuretics have significantly reduced the frequency of clinical MI in the elderly patient with isolated systolic hypertension.

Antihypertensive Agents↗
PubMed1992

The key issues in preventive cardiology.

A number of risk factors/indicators for cardiovascular disease, mainly stroke and coronary artery disease, have been established. Most powerful among the traditional risk factors are hypertension, cigarette smoking and elevated serum cholesterol. All three can successfully be modified by therapeutic intervention, which in turn will result in reduced risks. In recent years several novel risk indicators have been identified. The most powerful of these appears to be increased left ventricular mass, particularly when diagnosed with echocardiographic technique. Again, it is possible to reduce this risk factor, for instance by antihypertensive therapy, but the independent risk reduction attributable to this manoeuvre remains to be determined. Other novel risk indicators are male type adipose distribution, reduced insulin sensitivity and a number of newly detected lipoprotein fractions. At present little is known about the value of intervention against these factors in terms of risk reduction. It can be concluded that a structured concerted effort at reducing established risk factors such as arterial hypertension, elevated serum cholesterol and cigarette smoking is desirable for forming the basis of preventive strategies in cardiology. As regards some of the novel risk indicators, some of which appear more powerful than the old established ones, further research is needed before a clear opinion can be formulated regarding the value of intervention.

Adult↗
PubMed1991

Morbidity and mortality in the Swedish Trial in Old Patients with Hypertension (STOP-Hypertension)

Although the benefits of antihypertensive treatment in "young" elderly (under 70 years) hypertensive patients are well established, the value of treatment in older patients (70-84 years) is less clear. The Swedish Trial in Old Patients with Hypertension (STOP-Hypertension) was a prospective, randomised, double-blind, intervention study set up to compare the effects of active antihypertensive therapy (three beta-blockers and one diuretic) and placebo on the frequency of fatal and non-fatal stroke and myocardial infarction and other cardiovascular death in hypertensive Swedish men and women aged 70-84 years. We recruited 1627 patients at 116 health centres throughout Sweden, who were willing to participate, and who met the entry criteria of three separate recordings during a 1-month placebo run-in period of systolic blood pressure between 180 and 230 mm Hg with a diastolic pressure of at least 90 mm Hg, or a diastolic pressure between 105 and 120 mm Hg irrespective of the systolic pressure. The total duration of the study was 65 months and the average time in the study was 25 months. 812 patients were randomly allocated active treatment and 815 placebo. The mean difference in supine blood pressure between the active treatment and placebo groups at the last follow-up before an endpoint, death, or study termination was 19.5/8.1 mm Hg. Compared with placebo, active treatment significantly reduced the number of primary endpoints (94 vs 58; p = 0.0031) and stroke morbidity and mortality (53 vs 29; p = 0.0081). Although we did not set out to study an effect on total mortality, we also noted a significantly reduced number of deaths in the active treatment group (63 vs 36; p = 0.0079). The benefits of treatment were discernible up to age 84 years. We conclude that antihypertensive treatment in hypertensive men and women aged 70-84 confers highly significant and clinically relevant reductions in cardiovascular morbidity and mortality as well as in total mortality.

Adrenergic beta-Antagonists↗
PubMed1991

Biologically active and amidated cecropin produced in a baculovirus expression system from a fusion construct containing the antibody-binding part of protein A.

A synthetic antibody-binding part derived from protein A from Staphylococcus aureus was used as a fusion partner in a eukaryotic expression system employing Autographa californica nuclear polyhedrosis as a vector. This, in conjunction with an efficient signal sequence, facilitated the purification of the antibacterial peptide cecropin A from the medium of Spodoptera frugiperda cells infected with a recombinant virus. In order to increase further the concentrations of fusion protein, Trichoplusia ni larvae were used as host. Cecropin A could be obtained after cleavage of the fusion protein with CNBr. Biological activity as well as the correct structure including the C-terminal amide group was shown using electrophoresis with detection of antibacterial proteins and mass spectroscopy.

Amino Acid Sequence↗
PubMed1991

Review of state-of-the-art beta-blocker therapy.

Beta-adrenoceptor blocking drugs have been used in the treatment of hypertension for more than 2 decades. During this time they have reached the position of first-line therapy for hypertension and are recommended as such by the Joint National Committee (U.S.A.) in 1988 and by the World Health Organization/International Society of Hypertension in 1983 and 1989. This is because of the favorable relationship between the antihypertensive efficacy of these drugs and the rate and severity of their adverse effects. Of particular interest is the possibility that beta blockers may protect against coronary artery disease (CAD). With regard to secondary prevention against CAD, statistically highly significant and clinically relevant reductions of mortality and the risk of reinfarction have been shown in prospective, double-blind, placebo-controlled trials. A primary preventive effect against CAD, on the other hand, has only been shown in open trials without placebo control. However, in spite of the lack of clear proof, this effect still appears to be a logical possibility. Some new findings with beta blockers appear to be of particular interest: beta blockade may reduce myocardial necrosis in patients with marked elevations of plasma catecholamines due to traumatic head injury; a similar protective effect in other situations of severe stress, e.g., acute myocardial infarction, would be of great clinical value. Experimental studies also suggest that beta blockers may have antiatherosclerotic effect in animals fed an atherogenic diet and subjected to stress. Again, clinical confirmation of such results would be of great significance.

Adrenergic beta-Antagonists↗
PubMed1991

Synthesis and secretion of a fibrinolytically active tissue-type plasminogen activator variant in Escherichia coli.

A gene encoding a variant (lacking amino acids 6-173) of human tissue-type plasminogen activator (t-PA), consisting only of the second kringle domain (K2) and the serine protease domain (P), was fused to a DNA segment coding for the signal peptide of staphylococcal protein A and a synthetic gene coding for a protein with ability to bind immunoglobulin G (IgG). The fusion protein which was synthesized in Escherichia coli and secreted into the growth medium, was found to be fibrinolytically active. Purification of the fusion protein was performed in a single step by affinity chromatography with immobilized IgG. Enzymatically active K2P was liberated from the fusion protein by cleavage at a unique Asn-Gly dipeptide sequence using hydroxylamine. These results demonstrate that a variant of human t-PA can be synthesized and secreted by E. coli as a fibrinolytically active fusion protein, which upon specific cleavage yields an active variant t-PA of the expected size.

Amino Acid Sequence↗