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Biomedical subjects

L Lind

Publications and source records attributed to L Lind.

At least 199 records · Page 11Linked to original sources
PubMed1991

No major metabolic alterations accompany the hypotensive effect of active vitamin D.

A hypotensive effect of active vitamin D treatment (alphacalcidol 1 mg daily) has previously been reported in three double-blind, placebo-controlled studies over 4-6 months in subjects with mild primary hyperparathyroidism (HPT), intermittent hypercalcemia and essential hypertension. The commonly used antihypertensive drugs, thiazides and betablockers, both induce impairments in both glucose and lipid metabolism and the thiazides are known to cause an elevation of serum urate. The effects of vitamin D treatment on these metabolic variables were recorded in these studies. Alphacalcidol did not induce any changes in fasting glucose HbA1c or insulin, serum triglycerides, cholesterol or serum urate in any of the treated groups. Neither was HDL cholesterol affected, except for a rise seen in the HPT subjects. It is therefore concluded that no major metabolic alterations in glucose or lipid metabolism or serum urate accompany the hypotensive effect of vitamin D.

Aged↗
PubMed1991

Hypertension in primary hyperparathyroidism in relation to histopathology.

Hypertension in primary hyperparathyroidism (HPT) was previously attributed to hypercalcemia per se or to impaired kidney function. Of 441 consecutive patients operated on for HPT over 24 years, 57% were hypertensive. Preoperative blood pressure remained fairly constant during the study period, despite otherwise markedly changing clinical picture with, latterly, more asymptomatic patients. The preoperative systolic blood pressure (SBP) was significantly correlated to both serum calcium (p less than 0.001) and serum creatinine (p less than 0.05), but not when the influence of age was taken into account in a multiple regression analysis. Other pathogenetic factors in hypertension were therefore probable. When the statistical analysis was adjusted for differences in age and serum calcium, blood pressure was lower in the HPT patients with parathyroid hyperplasia than in those with adenoma (153 +/- 31/90 +/- 14 vs. 163 +/- 29/91 +/- 14 mmHg, p less than 0.01 for SBP). The concept that parathyroid hyperplasia represents a mild (early) form of HPT that may precede adenoma formation is corroborated by our observations, which also indicate that there is no simple cause-and-effect relationship accounting for hypertension in primary HPT.

Adult↗
PubMed1990

Peritonsillar abscess in spite of adequately performed tonsillectomy.

We describe a rare case of peritonsillar abscess in a woman, in spite of an adequately performed tonsillectomy 35 years earlier. Cultures from aspirated pus yielded a heavy growth of Streptococcus milleri and Bacteroides species. No remaining tonsillar tissue could be seen. We conclude that a peritonsillar abscess might develop in spite of adequately performed tonsillectomy.

Female↗
PubMed1990

Ear discharge after insertion of transmyringeal tubes.

The peroperative bacteriology and cytology of the middle ear have been studied in 103 ears in 65 children operated on due to longstanding secretory otitis media. Within one month postoperatively, 12 ears (12%) showed signs of infection with discharge from the tube. Ten out of these 12 ears showed peroperative growth of Hemophilus influenzae, Branhamella catarrhalis, pneumococci or staphylococci in the middle ear effusions, a significant difference compared to ears without postoperative discharge. The peroperative cytological evaluation of the middle ear effusions from 10 out of the 12 patients with postoperative ear discharge showed presence of phagocytes as a sign of infection. It is concluded that pre-existing bacteria in the middle ear effusion of patients with longstanding secretory otitis media might increase the risk of postoperative infection within the first month after insertion of transmyringeal tubes.

Bacteria↗
PubMed1990

Delayed hypersensitivity in primary and secondary hyperparathyroidism. Treatment with active vitamin D.

The vitamin D endocrine system, besides its traditional role in mineral metabolism, also affects the immune system. A recent study demonstrated that vitamin D supplementation restored a blunted delayed hypersensitivity response (DH) in elderly vitamin D-deficient subjects. In the present study the DH, as measured by the tuberculin test (PPD), was studied in two groups of patients with a disturbed vitamin D system, i.e. primary hyperparathyroidism (HPT) and secondary HPT due to chronic renal failure. A significant reduction in DH was found in the patients with chronic renal failure when compared to control subjects (4.1 +/- 5.3 vs 12 +/- 9.3 mm, p less than 0.05) whereas only a non-significant tendency to a reduced DH was seen in the HPT patients (9.5 +/- 9.2 mm). Treatment with alphacalcidol, a synthetic analogue to the active vitamin D metabolite over 3-6 months did not affect the DH in any of the hyperparathyroid patient groups. Thus it seems likely that other factors than vitamin D were involved in their reduced DH response.

Calcitriol↗
PubMed1990

Indices of mineral metabolism in subjects with an impaired glucose tolerance.

An altered mineral metabolism has been described both in insulin dependent and non-insulin dependent diabetes mellitus. In order to investigate if a disturbed mineral homeostasis was an early feature in the development of diabetes, 52 middle-aged men who all had recently developed an impaired glucose tolerance (IGT) were compared to healthy control persons. The IGT subjects showed higher levels of serum calcium (2.38 +/- 0.081 mmol/l (SD) vs 2.35 +/- 0.065 in controls) but similar levels of plasma ionized calcium indicating an increased protein binding of serum calcium in IGT. Serum magnesium was significantly lower in the IGT subjects (0.79 +/- 0.060 mmol/l vs 0.85 +/- 0.065, p less than 0.001) while serum phosphate was unaltered. This study demonstrates indices of an impaired mineral metabolism in IGT subjects similar in characteristics to what has previously been reported in manifest diabetes mellitus suggesting that an alteration of mineral homeostasis could be part of a primary event.

Electrolytes↗
PubMed1990

Cytological and bacteriological aspects of secretory otitis media.

Bacteriological and cytological examinations were performed on 105 middle ear secretions from 66 children with middle ear effusion (MEE) of more than 3 months' duration. The secretions were searched for granulocytes and the activity of these cells was judged by their capacity for random locomotion and their ability to reduce nitroblue tetrazolium. The functional characteristics of the granulocytes were compared with the bacteriological findings on cultures from MEE. Bacteria commonly regarded as pathogens in middle ear infections (Hemophilus influenzae, Branhamella catarrhalis or Streptococcus pneumoniae) were found in 25% of the secretions. Granulocytes with activity or lacking activity, virtually dead, were found in all secretions where these bacteria were isolated. In secretions where bacteria commonly regarded as commensals, mainly staphylococci, were isolated, about two thirds of the secretions showed phagocytes with or without activity. No relation between bacterial growth and the functional state of the granulocytes was observed. In contrast, no phagocytes were found in over 60% of MEE lacking bacterial growth. These findings suggest a role for bacteria in the development and maintenance of secretory otitis media.

Child↗
PubMed1990

Hypercalcemia in pulmonary tuberculosis.

Tuberculosis can affect calcium metabolism, mainly through an enhanced production of active vitamin D. The incidence of hypercalcemia among unselected patients with active pulmonary tuberculosis was investigated, retrospectively, during a ten-year period. Among 67 patients, the mean serum calcium concentration on admission was significantly raised compared to healthy controls (2.51 +/- 0.16 (SD) vs 2.43 +/- 0.07 mmol/l; p less than 0.001) and 25% of the patients had hypercalcemia. After one year of successful tuberculostatic treatment the serum calcium values had normalized.

Aged↗
PubMed1989

Reduction of blood pressure during long-term treatment with active vitamin D (alphacalcidol) is dependent on plasma renin activity and calcium status. A double-blind, placebo-controlled study.

Patients with essential hypertension, in particular those with low plasma renin activity (PRA), are reported to have lowered plasma-ionized calcium and elevated parathyroid hormone levels. In this study 1 microgram alphacalcidol (1 alpha-hydroxy-vitamin D3) was given in a double-blind, placebo-controlled fashion over four months to 39 subjects with mild to moderate hypertension. There was a significant rise in PRA in the treatment group when compared to placebo (P less than .05), but the mean blood pressure response was similar in the two groups. When the treatment group was divided according to pretreatment PRA it was, however, seen that subjects with low PRA displayed a reduction in diastolic blood pressure, whereas those with high PRA raised their blood pressure compared to placebo. Also subjects with low pretreatment values for plasma-ionized calcium and high levels of parathyroid hormone showed a reduction in diastolic blood pressure. This study supports the idea of a relationship between calcium metabolism and the renin-aldosterone system in essential hypertension and describes a beneficial effect of vitamin D supplementation on blood pressure in low-renin hypertension.

Blood Pressure↗
PubMed1989

Treatment with active vitamin D (alphacalcidol) in patients with mild primary hyperparathyroidism.

The parathyroid gland possesses receptors for 1,25-dihydroxyvitamin D3, the active metabolite of the vitamin D system, and in vitro experiments have shown that 1,25-dihydroxyvitamin D3 can inhibit the secretion of PTH. In this study 31 subjects who had displayed persistent mild hypercalcemia for 14 years and presumably had mild primary hyperparathyroidism (HPT) were challenged with 1.0 microgram alphacalcidol (1 alpha-(OH)-vitamin D3) over 6 months in a double-blind, placebo-controlled study. Before initiation of therapy, the hyperparathyroid subjects showed lower serum levels of 1,25-dihydroxyvitamin D in relation to PTH or calcium when compared with age- and sex-matched controls. Treatment induced a slight rise in serum calcium (0.05 mmol/l), but no significant decrease of the PTH levels. Eighteen of the subjects thereafter entered an open study with a higher dose of alphacalcidol (2.0 micrograms) over 1 year. Although this high dose induced a marked rise in serum calcium (0.17 mmol/l), there was only a transient reduction of the PTH levels. Thus, during long-term condition there was an escape from the suppressive action of the elevated calcium concentrations and no evidence of a specific inhibition of PTH secretion by a small oral dose of active vitamin D.

Aged↗
PubMed1989

Increased fracture risk in hypercalcemia. Bone mineral content measured in hyperparathyroidism.

In the present study, 39 women with mild hypercalcemia, which had been detected 18 years earlier during a health survey, and presumably caused by primary hyperparathyroidism (HPT), were investigated together with 34 age-matched controls. The bone mineral content (BMC) of the nondominant distal forearm was measured by single-photon absorptiometry, and the occurrence of fractures was recorded. Among women up to the age of 70 years, those with hypercalcemia had lower BMC than the controls (P less than 0.05), whereas among the older women, there was no difference. Twelve of the women with probable primary HPT had suffered a distal radius fracture as compared with 3 of the controls (P less than 0.05). Thus, also mild hypercalcemia is a risk factor for bone loss and distal forearm fractures. The findings constitute arguments in favor of early detection and treatment of primary HPT.

Aged↗
PubMed1989

An association between mineral metabolism and the renin-aldosterone system in human hypertension.

In recent years abnormalities of calcium metabolism have been described in human hypertension. In this study, the relationships between indices of calcium metabolism and the renin-aldosterone system were studied in 39 subjects with untreated essential hypertension. No significant associations were found between the major determinants of calcium metabolism (plasma ionised calcium, parathyroid hormone and 1,25(OH)2-vitamin D) and the renin-aldosterone system. Serum magnesium was, however, positively correlated to plasma renin activity (PRA) (r = 0.38, P less than 0.05) while both 24 h urinary excretion of calcium and cAMP were found to be correlated to both PRA and urinary aldosterone in a positive way (r = 0.39-0.42, P less than 0.01 and r = 0.33-0.57, P less than 0.01, respectively). In this study there was no other evidence of any major influence of the renin-aldosterone status on the calcium balance in human hypertension. The urinary leak of calcium might be determined by the action of the renin-aldosterone system.

Adult↗
PubMed1989

Plasmids and serogroups in Campylobacter jejuni.

For epidemiological purposes identification of Campylobacter strains is usually based on surface antigen characteristics. Two different systems, one for heat-stable (HS) and one for heat-labile (HL) antigen have dominated. In earlier studies we found a great variability in the two antigen systems. The aim of the present investigation was to analyse the frequency of plasmids in Campylobacter strains in the light of their possible use as an epidemiological tool as well as the relation between the presence of plasmids and surface antigens (HS and HL). Two hundred and forty-two strains from the same number of patients with diarrhea were analysed. In 70 (28.9%) plasmid(s) were found, in general one or two. Most of the plasmids were found in the molecular weight interval between 21-40 Md. There was no relation between the presence or size of plasmids and serogroup. We conclude that plasmid determination can be used as a complement to serotyping in epidemiological studies.

Adolescent↗
PubMed1989

Long-term treatment with active vitamin D (alphacalcidol) in middle-aged men with impaired glucose tolerance. Effects on insulin secretion and sensitivity, glucose tolerance and blood pressure.

There are specific receptors for the active metabolite of vitamin D on the pancreatic beta cells and severe vitamin D deficiency can inhibit insulin secretion. In the present study 14 middle aged men with impaired glucose tolerance and low glucose-stimulated insulin values received 2 micrograms alphacalcidol daily for 18 months. On treatment there was a transient increase of both the peak and the late insulin response to intravenous glucose while neither intravenous nor oral glucose tolerance were consistently altered. Nor was the peripheral insulin sensitivity, measured by the euglycemic clamp technique, significantly affected. In the untreated state there was a positive relationship (r = 0.77) between the tissue insulin sensitivity and the serum concentrations of 25-hydroxyvitamin D. There was also an inverse relationship (r = 0.61) between systolic blood pressure and the serum levels of 1,25-dihydroxy vitamin D. Although the subjects were normotensive and not overweight, treatment with alphacalcidol tended to lower both systolic (6 +/- 12 mmHg) and diastolic blood pressures (5.8 +/- 9.1 mmHg) and there was a small reduction (0.9 kg) in body weight. In conclusion, subjects with impaired glucose tolerance without vitamin D deficiency do not benefit from vitamin D supplementation, which however has some hypotensive action also in normotensive individuals.

Blood Glucose↗
PubMed1989

Self-rated psychiatric symptoms in patients operated on because of primary hyperparathyroidism and in patients with long-standing mild hypercalcemia.

Self-rated psychiatric symptoms were investigated in 30 patients referred for surgery because of primary hyperparathyroidism (HPT) (serum calcium, 2.87 +/- 0.21 mmol/L) in 38 subjects detected in a health screening, with 15 years of mild hypercalcemia and probable HPT (serum calcium, 2.66 +/- 0.09 mmol/L), and in 38 normocalcemic control subjects. The psychiatric symptomatology was evaluated by use of the Hopkins Symptom Checklist (HSCL-56), a self-rating symptom scale. The patients with verified HPT had the highest mean HSCL score, 89.1 +/- 20.1 before surgery, compared with 76.6 +/- 17.0 (p less than 0.01) in the health survey hypercalcemic patients and 73.8 +/- 16.0 (p less than 0.001) in the controls. The factors for anxiety, depression, and cognitive symptoms were the most pronounced in the HPT patients and were also increased among the mildly hypercalcemic persons of the health survey, compared with the controls. Somatic symptoms such as headache, back pain, chest pain, and weakness were equally common in HPT and in the controls, and measurements of isometric muscle strength of knee extension did not demonstrate reduction of muscle strength in the health survey hypercalcemic patients. Follow-up of the HPT patients 1 year after parathyroid surgery revealed a marked improvement in mental health (HSCL score 73.2 +/- 13.7, p less than 0.001). In the health survey hypercalcemic patients, neither the psychiatric symptomatology nor the muscle strength were influenced by 6 months of oral vitamin D therapy (alphacalcidol). The results demonstrate that psychiatric symptoms are experienced frequently by patients with HPT and minimum to moderate increases in the serum calcium level and that these disturbances are reversed by parathyroid surgery.

Adult↗