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Biomedical subjects

T Lindholm

Publications and source records attributed to T Lindholm.

At least 55 records · Page 3Linked to original sources
PubMed1984

Feasibility of extracorporeal on-line large-scale plasma adsorptions on protein A-sepharose columns in cancer patients.

The feasibility of extracorporeal adsorption of 1.5-3 L plasma on protein A-Sepharose was investigated in six patients with advanced cancer. Anticoagulation with heparin was associated with respiratory distress syndrome in two patients, most likely caused by complement activation as indicated by a transient leukopenia during plasma reinfusion and appearance of C3 degradation products in the extracorporeal circulation. Addition of citrate abolished the respiratory symptoms, C3 degradation, and leukopenia, and no adverse reactions were observed. No objective tumor regression was observed in any of the patients. Three patients progressed during therapy. In one of these, multifocal central tumor necrosis was observed as a possible, although unproven, therapeutic effect. Increased natural killer and/or killer cell activities were recorded in three patients and increased complement-dependent serum cytotoxicity in one patient. The level of circulating immune complexes decreased significantly (18-28%) in three patients studied. It is concluded that extracorporeal plasma adsorption on protein A-Sepharose is feasible when citrate is added to the extracorporeal system, but its therapeutic efficacy is uncertain.

Adsorption↗
PubMed1983

Improved outcome in rapidly progressive glomerulonephritis by plasma exchange treatment.

During the last 3.5 years we have had facilities to perform effective plasma exchange treatment (PE). During this period of time 12 patients of idiopathic and 19 patients of collagenous rapidly progressive glomerulonephritis (RPGN) appeared, Goodpasture's syndrome excluded. In an attempt to evaluate the separate effect of immunosuppression (IS) and PE, PE was if possible withheld for two weeks. In 3 patients IS alone had a satisfactory effect and therefore no PE was performed. In 2 severely ill patients IS and PE were instituted simultaneously. In 6 patients PE was started 5-12 days and in 17 patients at least 14 days after the start of IS. In 3 patients PE was started first because of suspected septicemia. 23 of the 31 patients improved; 6 from IS alone, 3 from IS and probably also from PE, 1 from PE and probably from IS, 5 both from IS and PE and 1 from PE alone. In 7 patients the individual effect of IS and PE could not be evaluated. At follow up 1-37 (median 13) months 13 patients had a S-creatinine below 200, 2 patients 200-300 and 1 patient 510 mumol/l. 3 patients went into RDT immediately and 7 after 4-22 months. 5 elderly patients died, only 1 from uremia, the others from cardiovascular diseases. The outcome was unpredictable from clinical and laboratory data. Addition of PE in the treatment of RPGN seems to have improved the outcome considerably.

Adult↗
PubMed1982

Immunosuppression and the additive effect of plasma exchange in treatment of rapidly progressive glomerulonephritis.

Attempts were made to evaluate the separate effect on kidney function of immunosuppressive treatment (IS) and plasma exchange (PE) in 27 patients with rapidly progressive glomerulonephritis (RPGN). Twenty-four of the patients were treated with PE. Initial IS was supplemented with PE within 6-12 days in 5 patients, and after at least 14 days in 13. Because of suspected septicemia, 2 patients were first treated with PE, and IS was not initiated until the possibility of septicemia had been excluded. In 4 severely ill patients wih rapid clinical deterioration, both treatments were started simultaneously. Twenty patients improved during one or both treatments, 4 with IS alone, 2 with IS and doubtfully with PE, 3 with IS and probably also with PE, 5 both with IS and PE and one with PE alone. In 5 patients the individual effects of IS and PE could not be evaluated. In another 2 patients the combined treatment seemed to influence the course favourably. In the remaining 7 patients the effect of the treatment was doubtful or nil. Two further patients with Goodpasture's syndrome were treated. They were admitted late, and both kinds of treatment were instituted simultaneously. One of them died in respiratory insufficiency, the other remained oliguric while the pulmonary changes faded. Thus, PE added a positive effect to IS in several patients with RPGN. The treatment had few and mostly mild side-effects.

Adult↗
PubMed1982

The effect of D,L-carnitine supplementation on muscle metabolism, neuropathy, cardiac and hepatic function in hemodialysis patients. A pilot study.

Three patients on regular hemodialysis treatment were perorally supplemented with D.L-carnitine, 900 mg/d, during four weeks. Before treatment, muscle carnitine concentrations were low and the patients showed signs of hypometabolism in skeletal muscle, cardiomyopathy, impaired hepatic function and a moderate hyperlipoproteinemia. After treatment, the skeletal muscle metabolism normalized. The results further indicate improvement of the cardiac and hepatic function and of the neuropathy on the sensory side. No improvement was found, however, in plasma lipoprotein pattern or in variables reflecting plasma lipid transport (lipoprotein lipase activity and intravenous fat tolerance).

Adult↗
PubMed1982

Continuous maternal glucose measurements and fetal glucose and insulin levels after administration of terbutaline in term labor.

Maternal blood glucose and fetal blood glucose and insulin levels were studied in 16 women at full-term labor after administration of terbutaline 250 microgram i.v. The maternal blood glucose level was registered by a continuous blood glucose monitoring unit. In all patients studied, the terbutaline injection was followed by a rise in maternal blood glucose within 15 min, lasting for at least one hour. The fetal glucose levels paralleled those of the mothers, but on a lower level. None of the infants demonstrated hypoglycemia during the first 90 min after birth. We conclude that terbutaline administrated in this way has a direct effect on the maternal blood glucose release, and report that no harmful effects on fetal carbohydrate metabolism could be demonstrated.

Blood Glucose↗
PubMed1982

A ten-year follow-up of a hepatitis B epidemic in a dialysis unit.

A hepatitis B epidemic at the hemodialysis unit of the University Hospital of Lund, Sweden, occurred in 1968-71. Since then all patients on regular hemodialysis have been tested with regard to hepatitis B. 196 patients were followed for more than 6 months (5 for more than 10 yr). 50 patients (26 males/24 females) became HBsAg-positive. The majority, 40 (25/15), never lost their HBsAg during the observation period. 35 of these chronic HBsAg; carriers were also chronic HBeAg carriers. 10/50 HBsAg-positive patients lost their HbsAg; females in much higher frequency than men. Six HBsAg-negative patients developed anti-HBs and anti-HBc. The highly infectious carriers constituted a continuous source of infection. Nevertheless, it was possible to keep the spread of infection under control in the unit. The most effective precaution from spread to the staff is probably protective gloves during all handling of patients. As regards the patients the most important measure was the introduction of separate units for HBsAG-positive and HBsAg-negative patients.

Antibody Formation↗
PubMed1981

Long-term clinical followup after pyelocystostomy.

In March 1971 a 32-year-old man with necrosis of the ureter to a kidney allotransplant underwent anastomosis of the transplant renal pelvis to the bladder. The kidney is functioning normally 9 years later. This surgical technique has been used recently in 3 additional case. Further applications of this procedure are suggested.

Adult↗
PubMed1981

Bone marrow morphology in patients in long-term treatment with azathioprine.

The bone marrow was morphologically analysed in 25 patients receiving long-term azathioprine therapy for chronic renal diseases or after a renal transplantation. There were no significant changes within the granulopoietic or lymphopoietic part of bone marrow even after 10 years of treatment. However, there was a significant "shift to the left" within erythropoiesis as well as greater frequencies of megaloblasts and sideroblasts. A significant increase of "erythroblastic islands" may indicate an increased death rate of defective erythroblasts. The changes within erythropoiesis in some of the patients were so pronounced that the possibility of a preleukaemic condition cannot be excluded.

Azathioprine↗
PubMed1981

Glomerular filtration rate and calcium metabolism in long-term lithium treatment.

Does long-term lithium treatment induce an irreversible renal damage, and does polyuria or changes in the calcium metabolism indicate this? To elucidate these questions GFR, diuresis, S-Ca, S-Mg, S-PTH and bone mineral content (photonabsorptiometry) were determined in 29 consecutive patients on long-term lithium therapy for 2.5--12 years and in 4 patients, who had been admitted to the Renal Clinic with lithium-induced polyuria. Only 1 of the patients had had a known lithium intoxication (S-Li > 2 mmol/l). None had a history of renal disease or significant analgesic consumption. In the consecutive series the GFR was not significantly reduced and no correlations were found between this parameter and the duration of lithium therapy, average S-Li, highest S-Li noted, diuresis or any of the calcium parameters. The morning diuresis was significantly increased in comparison with a control group with normal kidney function. 2 of the 4 polyuric patients had a decreased GFR, but in 1 case it was normalized on desmopressin supplementation. Renal biopsy in the patient with one S-Li of 2.35 and a low GFR in the consecutive series, and in 3 of the polyuric patients, revealed focal interstitial fibrosis and nephron atrophy. The mean S-Ca, S-Mg, S-PTH and bone mineral content were increased, but no significant intercorrelations between these parameters were found. Neither were any intercorrelations found between the calcium parameters and time on lithium therapy, average S-Li, highest S-Li noted or morning diuresis. In conclusion a relatively well-managed lithium therapy for up to 12.5 years does not seem to influence the GFR, even if renal biopsy in 4 of our patients revealed interstitial nephritis and data in the literature indicate a progressive interstitial nephritis. The present study did not support the proposition that polyuria is an alarming sign of pronounced renal lesion. Calcium metabolism is influenced by lithium therapy but from the clinical point of view no negative effects could be found. S-Ca should probably be checked regularly in patients on long-term lithium therapy.

Adult↗
PubMed1981

Hemodialysis in schizophrenia: psychiatric aspects of treatment failure in a pilot study.

In order to examine the reported curative effects of hemodialysis in patients with chronic schizophrenia a pilot study approved by the Committee of Ethics at the University of Lund was initiated in September 1977. 13 patients, 10 men and 3 women, 21--44 years old, were treated. All but one were diagnosed as chronic schizophrenia. The duration of illness was 4--20 years. All the patients functioned defectively psychosocially, and conventional therapy had failed. Our goal was to give at least one dialysis treatment a week during 13 weeks. 10 patients completed the treatment series. The patients were scored according to the Brief Psychiatric Rating Scale and the Rockland and Pollin scale before, during and after the treatment. Conventional therapy was given throughout. Analysis of hemofiltrates for endorphins did not reveal any abnormal levels. 1 patient reported a distinct and hitherto lasting improvement. Marginal and temporary improvements were noted in 3 patients. Therefore placebo effects or spontaneous remission seemed probable. The ratings showed no significant changes in any patient during the treatment period. All patients including those who showed improvement remained seriously incapacitated by their psychiatric illness. Different psychiatric aspects of our failure to reproduce the American findings including cultural discrepancies in diagnostic criteria are discussed.

Adult↗
PubMed1980

Methylprednisolone concentrations in patients with renal transplants as determined by high pressure liquid chromatography.

It is well known that in healthy individuals as well as in patients with diseases receiving glucocorticoids in a given dosage, there is a wide variation in blood concentrations. These may be of importance not only for the efficacy of treatment, but also for the occurrence of side effects. Pharmacokinetic information on glucocorticoids, is scarce mainly because of lack of suitable methods of analysing these drugs in body fluids. A high pressure liquid chromatography (HPLC) method has previously been used for determination of methylprednisolone in plasma (Garg et al., 1977). After modification, this method has been used for determination of methylprednisolone in plasma in healthy subjects and patients with renal transplants. Preliminary data are presented showing a good reproducibility of the method.

Adult↗
PubMed1979

Free plasma 11-hydroxycorticosteroids and the response to beta1-24-corticotrophin in regular haemodialysis patients.

The adrenocortical function of 59 patients on regular hemodialysis treatment was tested on 105 occasions by measuring the 30-min response of free plasma 11-hydroxycorticosteroids (11-OHCS) after intramuscular injection of 0.25 mg Synacthen (beta1-24-corticotrophin). The morning basal levels of 11-OHCS were within the normal range. The increase of 11-OHCS after injection of Synacthen was less than normal in 25% of the patients. In 9 patients with a low response an extended Synacthen test was performed. This caused a normal increase in plasma 11-OHCS but the response came later than in normal persons. After 0.25 mg Synacthen intramuscularly the 30-min response of 11-OHCS seemed to be lower on the first day than on the second day after dialysis. The present study supports the view that the pituitary-adrenocortical system is essentially intact in patients on regular hemodialysis treatment.

11-Hydroxycorticosteroids↗