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Biomedical subjects

L Wibell

Publications and source records attributed to L Wibell.

At least 73 records · Page 4Linked to original sources
PubMed1983

Diuretic effect and pharmacokinetics of tizolemide in subjects with normal and decreased renal function.

Tizolemide, a new sulphonamide diuretic, has alkaline properties and is cleared by a tubular transport system which differs from the PAH-excreting system which transports thiazide diuretics. The effect of this drug on the excretion of sodium and other electrolytes, and its pharmacokinetics, were evaluated in 5 healthy volunteers and in 10 patients with renal disease who had GFRs ranging from 5-98 ml/min. The saluretic effect of tizolemide was compared with that of placebo. The increase in sodium and chloride excretion after a single dose of 50 mg i.v. was clearly dependent on residual renal function but could be observed in all except one patient. It remains to be assessed whether a full diuretic effect can be achieved in patients with renal insufficiency if higher doses are used. The plasma half-life was 3.0 hours in healthy subjects but increased in patients with renal insufficiency to a maximum of 52 hours. In normal subjects total plasma clearance (611 ml/min) mainly depended on the renal clearance (564 ml/min) which decreased in proportion to GFR, whereas non-renal clearance remained unchanged. The large apparent volume of distribution of the drug (166 l/1.73 m2 BSA) did not increase significantly in uremia. Clinical trials with this drug in patients with reduced renal function must take into account the expected prolongation of its half-life.

Adult↗
PubMed1982

Short-term influence of a post-synaptic alpha-adrenoceptor blocking drug (prazosin) on carbohydrate metabolism.

Since sympathetic nervous activity is intimately involved in the regulation of hormonal and metabolic responses, it may be assumed tht antihypertensive drugs acting on adrenergic receptors will interfere with metabolic control mechanisms. We have therefore evaluated the effect of the selective alpha 1-adrenoceptor blocker prazosin on intravenous glucose tolerance and insulin response in a group of 6 healthy subjects. Ninety minutes after a single oral dose of 2 mg prazosin we observed a significant (p less than 0.05) fall in K-value (mean decrease from 1.7 to 1.0), which was accompanied by a blunting of the early insulin response. The acute effects of prazosin closely resemble those observed after 6-8 weeks of treatment with therapeutic doses of prazosin in hypertensive women. It is postulated that the effect of prazosin is mediated by an increase in circulating catecholamines acting on the pancreatic beta-cell alpha 2-adrenoceptors, which are responsible for the well-known inhibitory action of alpha-adrenergic agents upon the release of insulin.

Adrenergic alpha-Antagonists↗
PubMed1982

Adult respiratory distress syndrome and diabetes.

Non-cardiac pulmonary edema in a woman with long-lasting diabetes resulted in a distressing pulmonary fibrosis. It is suggested that pulmonary edema of non-cardiac origin might be more common in diabetes because of increased capillary permeability in this disease. Early recognition is important, and steroid treatment should be instituted to prevent development of pulmonary fibrosis.

Blood Gas Analysis↗
PubMed1982

Chronic pulsatile low dose GnRH therapy for induction of testosterone production and spermatogenesis in a man with secondary hypogonadotropic hypogonadism.

Prolonged intermittent treatment with low doses of GnRH was given to a 23-yr-old man with secondary hypogonadotropic hypogonadism. The patient had experienced sudden onset of diabetes insipidus followed by progressive decrease of gonadotropins and gonadal function. Modern radiological techniques did not reveal any organic genesis. A small portable computerized infusion pump connected to a sc catheter was used for the 220-day GnRH therapy. One microgram gnRH was administered every 90 min during the first 90 days and 5 micrograms GnRH every 90 min during the following 130 days. During the prolonged GnRH treatment testosterone secretion normalized, libido and potency improved, and ejaculation returned. Spermatogenesis became close to normal and the subject's wife became pregnant after 181 days of treatment. The prolonged treatment with the small infusion pump was well accepted and did not interfere with the patient's daily life activations. Thus, chronic pulsatile low dose GnRH treatment can restore normal pituitary-gonadal function in idiopathic male hypogonadotropic hypogonadism.

Adult↗
PubMed1981

Kinetics of indoprofen in patients with renal insufficiency (a preliminary report).

Plasma and urinary indoprofen concentrations were determined by liquid chromatography in healthy subjects and two patients with reduced glomerular filtration rate (GFR) of about 25 ml/min. The plasma half-life of the drug was prolonged in renal insufficiency. Until further studies have been performed indoprofen should be used with care in patients with renal impairment. Tentatively, the size of the dose or interval should be adjusted in proportion to the estimated preserved GFR.

Administration, Oral↗
PubMed1980

Methenamine-hippurate and bacteriuria in the geriatric patient with a catheter.

Oral treatment with methenamine-hippurate (MH) in patients with an indwelling catheter has been found to reduce the need of frequent catheter exchange and the number of symptomatic infections. Bacteriuria, however, persists during MH treatment. The hypothesis that the therapeutic effect is due to a reduction in the number of bacteria, or a change in the pattern of strains was tested in a crossover study (2 x 6 weeks). MH treatment, 1 g twice daily, was compared to control periods in 52 patients. The majority of quantitative and qualitative bacterial cultures at 2-week intervals yielded 2--4 strains. Of the bacterial isolates, 50% were found on 4--6 occasions out of 6 possible. MH treatment had no significant influence on the pattern of various strains. A 30% decrease in the mean total bacterial count during MH treatment did not reach statistical significance (p approximately 0.07). It is suggested that prevention of catheter complications during MH treatment may be due to a physiochemical action on salt formation rather than a direct antibacterial effect.

Aged↗
PubMed1980

The clinical value of HbAI-determinations.

Determination of glycosylated hemoglobin, HbAI, has become of great interest in diabetic patients as the values seem to reflect mean blood glucose values over longer periods of time. Several methods for determination of HbAI are now available. We have used a microchromatographic procedure which seems suitable for routine clinical work. In 94 healthy subjects HbAI was 6.5 +/- 0.8% (mean +/- S.D.). The corresponding value obtained in 126 diabetics was 9.6 +/- 1.8%. Particularly in patients treated with insullin HbAI-determinations are of value for assessment of the carbohydrate state, since in these patients the glucose values are prone to great variations. The exact relationship between the HbAI-values and the mean blood glucose level might vary between patients, however. Thus erythrocyte survival and renal function may influence the HbAI-values and more experience is needed in the interpretation of values. Nevertheless, preliminary data from a study in progress support the expectation that HbA1-determinations are likely to become a valuable adjunct in the routine management of diabetic patients.

Blood Glucose↗
PubMed1980

Turnover in humans of beta 2-microglobulin: the constant chain of HLA-antigens.

The turnover of beta 2-microglobulin, the common subunit of the HLA antigens, has been examined in normal subjects and in some patients with kidney disorders, multiple myeloma and rheumatoid arthritis. All patients displayed elevated serum levels of beta 2-microglobulin. The plasma disappearance curve of 125I-beta 2-microglobulin demonstrated that the protein has a rapid turnover (t 1/2 = 2.1 h; range 1.1-2.8 h) in normal persons and in patients with a normal glomerular filtration rate. In patients with kidney disorders the impaired renal filtration prolonged the turnover time and led to elevated serum levels of beta 2-microglobulin. Simultaneous measurements of 125I-beta 2-microglobulin in serum and urine allowed estimations of the beta 2-microglobulin net reabsorption in the renal tubuli. Two patients with renal disease reabsorbed 84% and 89%, respectively, of the beta 2-microglobulin filtered in the glomeruli. In normal persons the net reabsorption is close to 100%. In patients with normal kidney function increased serum levels of beta 2-microglobulin seem to be due to an increased synthetic rate of the protein as the elimination rate is normal. HLA antigen heavy chains in serum are present in smaller amounts than beta 2-microglobulin. The present data, therefore, suggest an imbalanced synthesis of the two chains.

Adult↗
PubMed1980

Beta 2-microglobulin in chronic lymphocytic leukaemia.

The serum level of beta 2-microglobulin (S-beta 2 m), a cell membrane protein associated with HLA-antigens, was quantitated in a series of 23 consecutive patients with chronic lymphocytic leukaemia (CLL). Markedly elevated values of S-beta 2 m (greater than 4.5 mg/1) were found in 10 patients, while only 3 patients had normal values (less than 3.0 mg/1). High serum values correlated with a large tumour mass, as estimated by Rai's clinical staging and by the total peripheral lymphocyte count. Blood lymphocyte proliferative activity, which has been suggested as reflecting disease activity in CLL, was measured by 3H-thymidine uptake in cells in vitro. The 3H-thymidine uptake was high in 3 patients all of whom were among the 5 patients with the highest S-beta 2m-values. S-beta 2m-determinations seem to be of definite interest in the study of patients with CLL although long term studies will be necessary for evaluation of the practical clinical value.

Aged↗
PubMed1980

Laryngeal granuloma in the early stages of Wegener's granulomatosis.

Non-healing granulomata of the upper or lower respiratory tract often cause diagnostic and therapeutic problems. A case of Wegener's granulomatosis is reported, which during the first year of illness presented only with signs of a laryngeal granuloma. When severe renal disease developed and cytostatic therapy was prompted, the laryngeal lesion showed an excellent response to the treatment. The case illustrates the difficulties encountered in the management of patients with Wegener's granulomatosis.

Granuloma, Laryngeal↗
PubMed1980

beta 2-Microglobulin in clinical medicine.

The production of beta 2-microglobulin in normal subjects is quite constant, about 0.13 mg/h . kg. The catabolism almost exclusively through renal elimination. The protein readily passes the glomerular membrane; subsequently more than 99.9% of the filtered beta 2-microglobulin is reabsorbed and degraded in the proximal tubules, only about 5 micrograms/h of the protein appearing in the final urine. Proximal tubular dysfunction leads to an increased urinary concentration. The serum level of beta 2-microglobulin is determined by the glomerular filtration rate and the rate of synthesis. Increased production, with raised serum levels, is sometimes observed in malignancy--mainly at an advanced state, in conditions with neoplastic proliferation of lymphoid B-cells or in inflammatory disorders connected with an activation of the lymphopoetic system. In body fluids, other than plasma and urine, the content of beta 2-microglobulin seems to often reflect a local production. In this review a presentation of the current status and usefulness of beta 2-microglobulin measurements in clinical medicine is included.

Beta-Globulins↗
PubMed1980

Relation between hemoglobin AI and determinations of glucose in diabetics treated with and without insulin.

The concentration in blood of hemoglobin AI is known to correlate well with glucose regulation if blood and urinary glucose values are carefully documented over several weeks. A slight increase of HbAI with age was found in 94 healthy subjects. In 41 adult diabetics treated with sulfonylurea drugs or diet alone, good correlations were obtained between HbAI and single random measurements of morning blood glucose (r = 0.69) and log urinary glucose/24h (r = 0.79) whereas in 47 adult patients with insulin-treated diabetes the corresponding correlation coefficients were only 0.42 and 0.49, respectively. In 29 insulin-treated children the HbAI-values were not correlated with single morning blood glucose determinations (r = 0.16 n.s.) but a correlation coefficient of 0.83 was found between HbAI and an index for regular testing of urinary glucose (Clinitest) at home. For the long-term monitoring of insulin-treated diabetics, single random determinations of blood and urinary glucose may often provide misleading information and particularly in these patients, routine determinations of HbAI should be of value.

Adult↗
PubMed1979

Hyperparathyroidism associated with distal tubular dysfunction but intact reabsorption of protein in the proximal tubules.

The urinary output of beta 2-microglobulin was measured in ten hypercalcemic patients undergoing surgery because of hyperparathyroidism. In three subjects the beta 2-microglobulin excretion was abnormally increased and in seven patients it was normal before surgery. Three of these seven patients displayed markedly impaired distal tubular function with a reduced urinary concentration capacity. After surgery all patients became normocalcemic and the urinary concentrating capacities improved. The beta 2-microglobulin excretion, on the other hand, remained unchanged. Thus, hypercalcemia per se does not readily affect the proximal tubular function of reabsorbing low molecular weight proteins. "Tubular proteinuria", if found in patients with hypercalcemia, should be suspected to reflect damage to the kidney by additional mechanisms.

Aged↗