A method for estimation of blood-brain transfer and brain water in living human beings.
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Blood-Brain Barrier↗
Biomedical subjects
S Lindgren
Publications and source records attributed to S Lindgren.
Complement components and activation in primary biliary cirrhosis.
Total complement activity was normal in 18 patients with primary biliary cirrhosis using two hemolytic assays capable of distinguishing between defects in classical and alternative pathways. Activation of the classical pathway was demonstrated in all patients by formation of complexes between C1r, C1s, and C1 inactivator. Large amounts of free C1q, not in complex with C1r and C1s, were demonstrated in the majority of patient sera. Furthermore, C4 levels were within the normal range or slightly subnormal. No evidence for alternative pathway activation was found. Increased mean levels of several complement components, in particular C1 inactivator, C2, C3, factor B, factor H, were noted. A significant correlation between these complement factors, derived mainly from the liver, and ceruloplasmin suggests that this elevation might be secondary to cholestasis. In contrast, no significant correlation with levels of early reacting acute phase reactants, immunoglobulins, or circulating immune complex-like material were observed. It is concluded that activation of the complement system by the classical pathway is common in patients with primary biliary cirrhosis.
Antigen-Antibody Complex↗
Ultrasound examination of the small bowel: comparison with enteroclysis in patients with Crohn disease.
BACKGROUND: Screening for inflammatory small bowel disease has hereto relied on barium examination, usually performed after duodenal intubation. A noninvasive technique for imaging of the small bowel in such patients would be preferable. METHODS: A total of 59 patients were included in the study. A small bowel barium examination (SBE) was performed after duodenal intubation using a barium and air double-contrast technique. Ultrasound (US) of the right lower quadrant was performed with a 3.5- or 5-MHz transducer. The patients fasted overnight. RESULTS: In 37 of 39 patients with a normal SBE, US was also normal. In 20 patients, SBE showed lesions compatible with Crohn disease and in 18 of these the US study showed thickening of the bowel wall. One of these patients later tested positive for Yersinia enterocolitica. There were two false-positive and two false-negative US examinations. For detection of inflammatory disease of the small bowel, US was calculated to have a sensitivity of 0.95, specificity of 0.93, accuracy of 0.93, predictive value of a positive test was 0.90, and a predictive value of a negative test was 0.95. CONCLUSIONS: US, therefore, seems to be a reliable method in the workup of patients suspected of having inflammatory small bowel disease. Thereby, US probably can select patients for SBF.
Adolescent↗
No effect of oxygen in vivo on plasma or testis testosterone in rats and no induction of testicular superoxide dismutase.
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Aerobiosis↗
An unusual Donath-Landsteiner antibody detectable at 37 degrees C by the antiglobulin test.
A 14-year-old boy with no history of transfusion experienced a hemolytic crisis attributed to paroxysmal cold hemoglobinuria. The Donath-Landsteiner test was positive. The IgG autoantibody had anti-P specificity but was unique in that it also reacted strongly by indirect antiglobulin test at 37 degrees C.
Adolescent↗
Ambient air quality and occurrence of multiple sclerosis relapse.
Infectious viruses and bacteria can trigger multiple sclerosis (MS) exacerbations. Seasonally changing concentrations of ambient air pollutants are known to predispose to transmissible infections, to induce systemic immune responses and to enhance existing peripheral inflammation. Ambient air quality and monthly MS relapse occurrence in south-western Finland were compared by multivariate logistic regression. The odds ratio of the risk of a relapse onset was over fourfold (4.143, p < 0.001) when the concentration of inhalable particulate matter (PM(10)) was at the highest quartile. Inhalable airborne particulate matter concentrations were connected to relapse occurrence. Poor air quality may enhance the seasonal changes in MS relapse occurrence by an increased susceptibility to transmissible infections.
Air Pollution↗
Chalasia of the upper esophageal sphincter.
Four patients with absence of stable tonus (chalasia) of the pharyngo-esophageal segment, i.e., the cricopharyngeal muscle and the adjacent cervical esophagus, are reported. The tonus between swallows was completely absent in 2 patients and was seriously impaired in 2. All patients had normal peristalsis in the cricopharyngeal muscle but delayed or absent peristalsis in the cervical esophagus. In one patient the relaxation of the cricopharyngeal muscle during the passage of the bolus was incomplete. Various other functional abnormalities in the pharynx were present as well. The observed abnormalities are interpreted in relation to current understanding of motor mechanisms in the area of the pharyngo-esophageal segment.
Aged↗
Gastroesophageal reflux and pharyngeal function.
Pharyngeal function and gastroesophageal reflux were compared in 84 dysphagic patients examined clinically and radiologically. Cricopharyngeal muscle incoordination, assessed cineradiographically, was revealed in 5 of 41 patients (12%) without and 17 of 43 patients (40%) with gastroesophageal reflux assessed clinically (p less than 0.05). Thus, there was a positive correlation between dysfunction of the cricopharyngeal muscle and gastroesophageal reflux. There was no correlation with other types of pharyngeal dysfunction. Our results support the assumption of a positive relationship between gastroesophageal reflux and pharyngeal function in terms of cricopharyngeal dysfunction. The pathogenesis of this relation was, however, not revealed.
Adult↗
Pharyngeal swallowing in patients with paresis of the recurrent nerve.
Pharyngolaryngeal function during swallowing was investigated cineradiographically in 22 patients with paresis of the recurrent nerve. Nineteen of these patients (86%) had defective closure of the laryngeal vestibule: 10 patients had defective apposition of the corniculate cartilages, (paresis of the oblique cricoarytenoid muscle), 9 patients had defective apposition of the arytenoid cartilages, (paresis of the interarytenoid muscle), 13 patients had defective movement of the epiglottis (paresis of, i.a. the thyrohyoid muscle), 1 patient had defective closure of the subepiglottic portion of the vestibule (paresis of the thyroepiglottic muscle), 2 patients had defective closure of the supraglottic portion of the vestibule (paresis of the superior ventricular segment of the thyroarytenoid muscle). Five patients with immobility of the epiglottis also had paresis of the pharyngeal constrictor musculature indicating paresis of the superior laryngeal nerve. Our investigation has shown that patients with paresis of the recurrent nerve who present with dysphagia with or without aspiration should be examined cineradiographically for pharyngolaryngeal function during swallowing.
Adult↗
The prevalence of gallstones in chronic liver disease is related to degree of liver dysfunction.
BACKGROUND/AIMS: Earlier studies have indicated an elevated risk for gallstone disease in patients with cirrhosis. This study aimed to evaluate the prevalence of gallstones in patients with chronic liver disease (CLD) with respect to sex, etiology, and severity of liver disease. METHODOLOGY: Four hundred and thirteen adults (176 women), mean age 51.2+/-14 years, with CLD, who had undergone liver biopsy during 1978-1993, and from whom sera were available, were investigated retrospectively. The results were compared with a population-based ultrasonography study of 556 healthy men and women, in their 40s and 60s. RESULTS: The prevalence of gallstones in patients with CLD did not differ from that in the control population. An increased frequency was observed in patients with CLD initially classified as cryptogenic, of whom the majority (60%) later were reclassified as chronic hepatitis C. The frequency of gallstones was also high in PiZ-heterozygotes for alpha1-antitrypsin deficiency (5/21, 24%) compared to non-PiZ-carriers (17/389, 4.8%), (p<0.001). In 67 patients with histologic evidence of cirrhosis, 30% (20/67) had gallstones (vs. 15% in the general population, p<0.01). The prevalence of gallstones increased significantly from Child's class A (16%) to C (56.2%). The difference was significant in males (18.2% vs. 62.5%, p=0.033), but not in females. Fifty percent of the patients with gallstones were symptomatic. CONCLUSIONS: Progressive liver dysfunction is a risk factor for gallstones particularly in males. HCV infection and PiZ carriership may further increase biliary lithogenesis.
Adult↗
Long term treatment of steroid dependent asthmatic patients with beclomethasone dipropionate.
In the efforts to avoid the side-effects of the peroral cortisone drugs in the treatment of asthma, trials have been made since the early fifties with the administration of steroids in aerosol form applied direct on the bronchial mucosa. Hydrocortisone as well as prednisolone and dexamethasone have been used with a documented effect on the obstruction. However, the drugs were found to be resorbed and thus resulted in suppression of adrenal function and appearance of Cushing syndrome and other well-known steroid side-effects (12). More recently, beclomethasone dipropionate -- a steroid with potent topical activity -- has been used as a pressurised aerosol. In 1972 Morrow Brown et al. (1) as well as Lal et al. (10) reported a good therapeutic effect with this drug and at the same time found evidence for the opinion that its systemic effect, if any, was insignificant. Less ositive results were reported by Choo-Kang et al. (4) and also by Herxheimer (8), who considered beclomethasone spray not to possess any advantages as compared with the earlier steroids. The purpose of the present study was to assess the clinical value of beclomethasone in the treatment of adult patients previously on long-term oral steroids.
Administration, Oral↗
Radiographic findings after cricopharyngeal myotomy.
Single film examinations (iodine and/or barium) were reviewed in 28 patients who had undergone surgery on the cricopharyngeal muscle due to Zenker diverticula (24 patients), cricopharyngeal muscle incoordination (3 patients) and pharyngoesophageal web (one patient). All patients had had a myotomy which included the cricopharyngeal muscle and up to 3 cm of the cervical esophagus. Lateral and anterior deviation of the pharynx and cervical esophagus occurred regularly. A pharyngocutaneous fistula developed in 2 patients which healed within 3 weeks. In 5 patients there was a posterior leak of contrast medium during the first postoperative week which healed within 2 weeks. Six of these seven patients with a fistula or a leak had had either a diverticulum removed or sustained an accidental mucosal perforation. No patient had recurrence of diverticula, although, 9 patients developed a cricopharyngeal muscle impression. Iodine and barium examinations are important for monitoring early and late postoperative changes after cricopharyngeus myotomy.
Aged↗
Urea, creatinine, uric acid, and phosphate spaces and their relationship to total body water during chronic hemodialysis.
The authors determined total body water (TBW) with tritium in 11 patients on chronic hemodialysis and compared this space to that estimated by 60% of body weight, and removal spaces of urea, creatinine, uric acid, and phosphate (PO4). The latter spaces were determined by dividing the total amount of substance (measured in total dialysate) by pre- minus post-dialysis concentrations. Body water X 0.6 was more than 10% less than the tritium space, and showed a maximal variation of 10 liters, or 24%. The removal space of urea was 80% of the tritium space, but correlated closely with it. The difference between total body water and urea removal space was variable and dependent on fluid excess (edema) in the patients. Creatinine, uric acid, and phosphate removal spaces were highly variable and not correlated to total body water. The authors suggest that actual measured TBW should be used, rather than estimations using BW X 0.6, for V in K X T/V, where K = clearance, T = duration of dialysis, and V = the removal space of urea. Furthermore, one may need to introduce a correction factor for urea removal space over TBW in the equation to allow better quantification of dialysis in edematous patients and during very fast dialyses.
Adult↗
Day-to-day variation of bronchodilatory response to an inhaled beta-2-stimulant in asthmatics.
The effect of inhaling 0.25 and 2.0 mg of terbutaline sulphate, a beta-2-stimulant, from a metered dose aerosol was studied in five asthmatic patients during two periods of five days each. During the first period, the patients used a good spontaneous inhalation technique; during the second period, the inhalation technique was optimized and controlled. The variation of basal FEV1 and of the increase (delta FEV1) caused by 0.25 mg of inhaled terbutaline was considerable. The effect was only slightly better and the variation only slightly smaller when the controlled inhalation technique was used. The differences were not significant. In individual patients, there was no or negative correlation between delta FEV1 and the corresponding basal FEV1 value. Accordingly, the most commonly used way of expressing delta FEV1 as a percentage of basal FEV1 value was found to be insensitive. Delta FEV1, expressed as a percentage of the maximum available FEV1 increase on the same day after 2.25 mg terbutaline sulphate, was found to be most sensitive. This way of expressing delta FEV1 will increase the possibilities of detecting differences between treatments in clinical trials.
Administration, Inhalation↗
Polymyositis associated with asymptomatic primary biliary cirrhosis.
We here describe a case of polymyositis associated with asymptomatic primary biliary cirrhosis and a high titer of antimitochondrial antibodies. The patient had remarkable multiorgan engagement: polyarthritis, pericarditis, pleuritis and tachyarrythmia. Atypical changes, suggestive of mitochondrial damage, were observed in a muscle biopsy specimen. Under treatment with azathioprine and steroids, the disease had a favourable outcome.
Anti-Inflammatory Agents↗