Biomedical subjects
R Tilvis
Publications and source records attributed to R Tilvis.
Serum calcium and cardiovascular risks.
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Serum plant sterols and lathosterol related to cholesterol absorption in coeliac disease.
The concentrations of the plant sterols, campesterol and beta-sitosterol in serum, normally correlate with the efficiency of cholesterol absorption, whereas the concentration of lathosterol, a cholesterol precursor sterol, closely parallels changes in cholesterol synthesis. In this study we explored whether the plant sterol concentrations in serum in coeliac disease are determined by cholesterol absorption and whether they alone or with the serum lathosterol concentration, could be used for screening the activity of coeliac disease. In six patients the plant sterol concentrations in serum were significantly lower than in 17 control subjects, the reduction being more marked for campesterol than for beta-sitosterol: the serum lathosterol concentration was significantly higher than in the control subjects. The opposite changes in serum plant sterols and lathosterol were recorded in patients on a gluten-free diet. The plant sterol concentrations in serum (nmol/mg of cholesterol) were positively correlated with each other, and with the percentage absorption of cholesterol and with xylose absorption; they were negatively correlated with faecal fat, but not with faecal plant sterols. Thus, the low plant sterol concentrations in serum in coeliac disease were attributable to their impaired absorption, which in turn was closely associated with the absorption of cholesterol. The serum campesterol concentration clearly distinguished the untreated patients from the controls, whereas the use of serum beta-sitosterol, and the serum ratios of lathosterol/plant sterol resulted in some overlapping with the controls. It is suggested that the plant sterols in serum might be worth of determining when screening patients for coeliac disease and especially when testing their adherence to the gluten-free diet.
Is determination of plasma lipids useful in the differentiation of multi-infarct dementia from Alzheimer's disease?
Plasma triglycerides, total cholesterol and high-density lipoprotein cholesterol were studied in patients with Alzheimer's disease (AD, n = 57, mean age 70 years) and multi-infarct dementia (MID, n = 69, mean age 73 years) when the patients were admitted for assessment. Both total cholesterol and high-density lipoprotein cholesterol but not triglycerides were lower in MID than in AD even though there was a considerable overlap. Especially in younger patients and in patients living at home the difference was not statistically significant. Further, the plasma lipid values in neuropathologically confirmed cases with AD (n = 5) and MID (n = 16) were similar at admission. Low total cholesterol and high-density lipoprotein cholesterol were related to cardio- and cerebrovascular disorders, living in institutions, and negatively correlated to age and severity of dementia. Our results suggest that determination of total cholesterol and high-density lipoprotein cholesterol is of minor value in the differential diagnosis between AD and MID and that associated diseases, such as coronary heart disease, cardiac failure and arterial hypertension, are more important in this respect.
Survival and calcaemic status of geriatric inpatients.
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Snoring and dementia.
The frequency of snoring was studied in 46 patients with Alzheimer's disease (AD), 37 with multiinfarct dementia (MID), and in a random sample of 124 elderly community residents without known diseases affecting higher cortical functions. The demented patients were reported to snore twice as frequently as the control subjects (P less than 0.05). No difference in the frequency of snoring was present between the patients with AD and MID. In contrast to younger populations, snoring was not significantly associated with cardiovascular morbidity in this elderly population.
Sleep apnea in multiinfarct dementia and Alzheimer's disease.
Sleep-related hypopneas and apneas were studied in 19 patients with multiinfarct dementia (MID), in 21 patients with Alzheimer's disease (AD), and in 26 healthy control subjects using the Static Charge-Sensitive Bed (SCSB) method. Demented patients had more apneas or hypopneas and more disturbed sleep than the control subjects. Over 10 apneas/hypopneas per hour of sleep were detected in 47.5% of the demented patients and in 19.2% of the control subjects (p less than 0.05). Restlessness comprised 46.7% of the time in bed in patients with AD and 49.6% in those with MID, but only 102.% in the control subjects (p less than 0.001, controls versus demented). The total duration of apneas and hypopneas calculated from the total sleeping time was greater than 10% in 60.0% of the demented patients and in 15.4% of the control subjects (p less than 0.001). Patients with MID tended to have more apneas/hypopneas than those with AD, and apneas/hypopneas tended to increase in direct proportion to the severity of dementia. Age had no effect on the proportion of apneas and hypopneas among demented patients or control subjects, but male controls had more apneas and hypopneas than did female controls.
The incidence and prognosis of cerebrovascular disease in hospital patients in Helsinki, Finland, in the decade 1970-1980.
Over 21,000 hospital episodes due to cerebrovascular disease (CVD, ICD-8 nos. 430-438) were registered in the Helsinki hospitals in 1970-1980. Of those 17,629 were identified as new cases. The age-adjusted incidence of haemorrhagic and thrombotic stroke (430-433) declined during the period 1970-1975 from 221 to 139 cases/100,000 inhabitants, whereafter no further decrease was observed. The decline in incidence was significant in both sexes. Analysis by diagnosis group showed that the decrease was confined to the incidence of haemorrhagic stroke (430-432), whereas the incidence of thromboembolic stroke (433, 434) and transient ischaemic attacks (435) remained virtually unchanged. Survival was mainly determined by patient age and type of CVD. Intracerebral haemorrhage and occlusion of precerebral arteries exhibited the poorest short-term prognosis. About half of the patients hospitalised due to cerebral thrombosis and embolism survived over one year. Long-term prognosis of the major CVD groups was very poor with only 10% of the patients alive after eight years. Transient cerebral ischaemia and subarachnoid haemorrhage had a clearly better prognosis, the survival rates after eight years being 45 and 30%, respectively.
Increased activity of serum gamma-glutamyltransferase in myotonic dystrophy.
The activity of serum gamma-glutamyltransferase (gamma-GT) and its determinants were studied in 17 patients with myotonic dystrophy. The gamma-GT activity was elevated in 11 patients and its mean value was five-fold higher than in healthy controls. The increase in gamma-GT could not be explained by factors generally known to result in a misleading elevation of gamma-GT. Most patients with elevated gamma-GT also had one or more other pathological laboratory tests related to hepatic function but none had a clinically significant liver disease. Serum gamma-GT activity was not related to the disability caused by dystrophy or to the level of serum creatine kinase suggesting that the elevation of serum gamma-GT is not an indication of a general cell membrane dysfunction. It is concluded that the increase in serum gamma-GT activity in patients with myotonic dystrophy is due to a real but mild liver involvement, which should be taken into account in the examination of these patients who often complain of gastrointestinal symptoms.
Cerebrovascular disease: declining incidence but increasing hospital utilisation.
A total of 20,680 patients hospitalised in Helsinki during 1970-1980 due to cerebrovascular diseases were found when screening the Finnish National Hospital Discharge Register. The material was categorised according to three-digit ICD-8 diagnosis codes and age, and was analysed for case-fatality, length of stay and discharge status. By identifying all new cases an assessment of the incidence development during the study period was also possible. A fall in the overall age-standardised incidence of cerebrovascular disease was demonstrated, in accordance with disease register studies. The main reason was decline in incidence of haemorrhagic stoke (ICD-8 no. 431) and less well defined types of stroke (436-438). Ischaemic stroke (433), on the other hand, did not decrease in frequency. The diagnostic shift, occurring parallel with a growing mean age of patients, lead to decreasing acute mortality, increasing institutionalisation rates and longer stays in hospital, thus resulting in growing figures of hospital utilisation in spite of the declining incidence.
Infection with Campylobacter fetus.
Over a 4-yr period (1978-1982) about 1 000 cases of campylobacter infection were diagnosed at our laboratory in Helsinki, but only 4 proved to be due to Campylobacter fetus. All these 4 patients had fever, 3 had diarrhoea and 1 arthritis and thrombophlebitis. The diagnosis was made from blood cultures in all cases; in 1 case the bacterium was also isolated from stools.
Prolonged campylobacter gastroenteritis in a patient with hypogammaglobulinaemia.
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[An infection caused by Campylobacter fetus].
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[Hypokalemic paralysis as an early manifestation of renal tubular acidosis].
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Metabolism of squalene in human fat cells. Demonstration of a two-pool system.
Human adipose tissue has been shown to contain exceptionally high concentrations of squalene. In the present experiments, it was shown that most of adipose tissue squalene is located in the fat cells. Of this squalene, 80% is located in the central neutral lipid droplet and 20% is bound to the microsomal membranes. Upon incubation of isolated fat cells with radiolabeled substrates, both the microsomal and the droplet squalene became labeled. The specific activity of microsomal squalene increased faster than that of droplet squalene. In addition, the microsomal squalene quickly equilibrated to a maximal specific activity, whereas the droplet squalene showed a steady increase in specific activity. These observations indicate rapid turnover of microsomal squalene and slow turnover of droplet squalene. Moreover, they reflect intracellular transfer of labeled squalene from microsomes to the lipid droplet. During a 3-hour incubation of fat cells with labeled substrates, 90% of the newly formed labeled squalene was transferred to the lipid droplet and only 10% was converted into cholesterol. The results demonstrate that adipocyte squalene can be segregated anatomically and functionally into two distinct pools: a small metabolically active pool in the microsomal membranes where squalene is synthesized and a large metabolically inactive pool in the fat droplet where squalene is stored. The intracellular transfer of de novo synthesized squalene into the fat droplet of fat cells is one mechanism of squalene accumulation in adipose tissue.