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  • 101.
    Lindell, Åke
    Linköpings universitet, Institutionen för medicin och vård, Internmedicin. Linköpings universitet, Hälsouniversitetet.
    Clinical studies on cystinuria: With special reference to treatment with tiopronin1996Doktoravhandling, med artikler (Annet vitenskapelig)
    Abstract [en]

    Cystinuria is an inherited disorder of the renal tubular transport of cystine and the dibasic amino acids across cell membranes. Defective renal tubular reabsorption causes a greatly increased urinary excretion of thepoorly soluble cystine, which in turn results in the formation of renal stones. Because of the life-long tendency for stone formation the patients are highly susceptible to complications of renal stone disease. Urinary supersaturation of cystine can be counteracted by reducing the urinary concentration (increased fluid intake, chemical modification with a sulfhydryl compound) or by increasing its solubility (urinary alkalinization).

    Long-tenn treatment with the sulfhydryl compound tiopronin (2-mercaptopropionylglycine) was evaluated in 31 patients with homozygous cystinuria (Papers I, II, IV). The patients were followed over an average of 7.8 years and the treatment was monitored by regular measurements of cystine in 24-hour urine samples by ionexch: mge chromatography, and by X-ray examinations. In 40 cystimnic patients total and split kidney function were investigated by gamma camera renography and measurement of glomerular filtration rate (GFR), mainly51CR-EDTA-clearance (Paper Ill). The diurnal variations in urinary cystine excretion was studied in 8 patients (Paper VI), and the effect of a low sodium intake in 13 (Paper V).

    A urinary free cystine concentration below the assumed level of saturation of 1200 J..Lmol/1 in 24h urine samples was achieved in 90% of patients treated with tiopronin. The required doses varied from 500 to 3000 mg!day which illustrates the necessity for individualization of treatment by regular measurements of the urinary cystine concentration. Increasing doses of tiopronin resulted in an unexpected decrease in the urinary excretion of the soluble tiopronin-cysteine mixed disulphide suggesting an influence on the general metabolism of cystine and cysteine.

    The rate of new stone· formation wa<> reduced by 60% and the need for active stone removal by 72%. Stone fonnation was eliminated in two thirds of the patients. In the remaining third there was some formation ofrenal stones in spite of acceptable concentrations of cystine in 24h samples. This shows that also the therapeutic level of urinary cystine has to be individually adjusted in some patients. Measurements of cystine in6h samples in patients without tiopronin treatment revealed considerable variations with peak concentration exceeding the corresponding 24h concentration by as mUch as 91%. Fractionated urine sampling may therefore be a tool for further adjustment of therapy. Treatment with tiopronin was well tolerated by the majority of patients, and the finding of clinically reversible membranous glomerulonephritis in 3 patients does not disqualify the drug from further use.

    Thirty per cent of 40 patients had light to moderate impainnent of renal function. Only 28% had an entirely normal renal function with both GFR and renography within nonnallimits, but there was no case with severe renal impairment. A renographic comparison between the pre-treatment and treatment periods suggested that the stone-preventing treatment based on monitoring of urinary cystine concentration resulted in preservation of renal function.

    Restriction of sodium intake resulted in a decrease in urinary cystine excretion in patients without tiopronin treatment, whereas the effect was significantly less in patients with tiopronin. In the patients without tiopronin the sodium delivery conveyed by sodium bicarbonate treatment neutralized the increased solubility of cystine obtained by its alkalinizing effect. The excretion of the disulphide between tiopronin and cysteine wasalso sodium dependent suggesting an active tubular reabsorption of this compound.

  • 102.
    Lindgren, Peter
    et al.
    Stockholm.
    Graff, Jennifer
    Nw York.
    Olsson, Anders
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för medicin och vård, Internmedicin. Östergötlands Läns Landsting, Medicincentrum, Endokrin- och magtarmmedicinska kliniken US.
    Pedersen, Terje J
    Ullevål, Oslo.
    Jönsson, Bengt
    Stockholm.
    Cost-effectiveness of high-dose atorvastatin compared with regular dose simvastatin2007Inngår i: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 28, nr 12, s. 1448-1453Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Aims: The aim of the study was to evaluate the long-term cost-effectiveness of high-dose atorvastatin when compared with generic simvastatin for secondary prevention in Denmark, Finland, Norway, and Sweden based on the recently completed IDEAL trial. Methods and results: The IDEAL trial showed that high-dose treatment with atorvastatin was associated with fewer non-fatal myocardial infarctions (MI) or coronary heart disease death (RR 0.89, 95% CI 0.78-1.01) and major cardiovascular events by (RR 0.87, 95% CI 0.77-0.98) or any coronary event (RR 0.84, 95% CI 0.76-0.91) than simvastatin with no significant difference in the number of serious adverse events. Costs during the trial period was estimated based on the trial data and a Markov model was constructed where the risk of MIs and revascularization procedures and the long-term costs, quality of life, and mortality associated with these events was simulated. Costs were based on resource consumptions recorded in the trial multiplied with recent unit costs from each country. Both direct health care costs and indirect costs (costs from lost production due to work absence) were included. Intervention lasted for the duration of the trial (4.8 years) while health-effects and costs are predicted for the lifespan of the patient. The main outcome was quality adjusted life-years (QALY) gained. High-dose treatment was predicted to lead to a mean increase in survival of 0.049 years per patient and 0.033 QALYs gained. The cost to gain one QALY was predicted to 47 197€ (Denmark), 62 639€ (Finland), 35 210€ (Norway), and 43 667€ (Sweden), with cost-effectiveness ratio decreasing with higher risk. Conclusion: In the prevention of cardiovascular events among patients with a previous MI, high-dose atorvastatin appears to be a cost-effective strategy when compared with generic simvastatin 20-40 mg in Denmark, Norway, and Sweden. In Finland, it is cost-effective in high-risk patients. The key driver of the cost-effectiveness is the price-difference between 80 mg atorvastatin and generic simvastatin. © The European Society of Cardiology 2007. All rights reserved.

  • 103.
    Lindström, Torbjörn
    Linköpings universitet, Institutionen för medicin och vård, Internmedicin. Linköpings universitet, Hälsouniversitetet.
    Insulin treatment of patients with type 2 diabetes: Risks and benefits1993Doktoravhandling, med artikler (Annet vitenskapelig)
    Abstract [en]

    Patients with Type 2 diabetes and secondary failure to oral hypoglycaemic agents were characterized before and during insulin treatment. During oral treatment the 24-h area under the curve for free insulin in blood was similar to that in healthy subjects. However, the insulin profile was abnormal, with normal fasting free insulin but insufficient prandial response. Plasma concentrations of triglyceride-rich lipoproteins were elevated, and the high density lipoprotein (HDL) cholesterol concentration was low.

    Insulin treatment caused hyperinsulinaemia, with a 2-3-fold increase in 24-h free insulin concentration. The mean blood glucose concentration and HbAlc were almost normalized, and glycaemic control remained improved even after 2-3 years of insulin treatment. A multi-injection regimen, based on preprandial regular insulin and intermediate-acting insulin at bedtime, gave slightly better prandial glycaemic control than a regimen based on twice-daily injections of mainly intermediate-acting insulin, but the overall glycaemic control was similar in both. Insulin treatment reduced the elevated proinsulin concentration that is present in Type 2 diabetes and also lowered the endogenous insulin secretion. The percentage change in blood C-peptide concentration was closely correlated with the percentage change in blood glucose concentration, but not with the percentage change in free insulin concentration. The lipid profile was improved, with marked reduction in the triglyceride-rich lipoprotein concentration and a small increase in HDL cholesterol. Microalbuminuria was reduced and there was no increase in PAI-l antigen concentration. Weight gain occurred during the first year of insulin treatment but not subsequently. Blood pressure was unchanged after 2-3 years of insulin treatment. Severe hypoglycaemic episodes were rare but such can cause cardiac arrhythmia. Patients reported that they felt better.

    Insulin treatment of patients with Type 2 diabetes and secondary failure to oral hypoglycaemic agents improves glycaemic control and improves or has no adverse effect on the major cardiovascular risk factors.

  • 104.
    Lindström, Torbjörn
    et al.
    Linköpings universitet, Institutionen för medicin och vård, Internmedicin. Linköpings universitet, Hälsouniversitetet.
    Frystyk, Jan
    The Medical Research Laboratories, Clinical Institute and Medical Department M, Aarhus University Hospital, Aarhus, Denmark.
    Hedman, Christina
    Linköpings universitet, Institutionen för medicin och vård, Internmedicin. Linköpings universitet, Hälsouniversitetet.
    Flyvbjerg, Allan
    The Medical Research Laboratories, Clinical Institute and Medical Department M, Aarhus University Hospital, Aarhus, Denmark.
    Arnqvist, Hans
    Linköpings universitet, Institutionen för medicin och vård, Internmedicin. Linköpings universitet, Institutionen för biomedicin och kirurgi, Cellbiologi. Linköpings universitet, Hälsouniversitetet.
    Elevated circulating adiponectin in type 1 diabetes is associated with long diabetes duration2006Inngår i: Clinical Endocrinology, ISSN 0300-0664, E-ISSN 1365-2265, Vol. 65, nr 6, s. 776-782Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective  To study circulating adiponectin concentrations in relation to diabetes duration and endogenous insulin secretion in patients with type 1 diabetes.

    Patients  Patients with haemoglobin A1c (HbA1c) < 6% (reference range 3·6–5·4%) were selected for the study. Twenty-two men and 24 women [age 41·3 ± 13·8 years (mean ± SD), diabetes duration 4 months to 52 years] participated. Healthy controls (15 women and nine men, age 41·3 ± 13·0 years) were also included. Overnight fasting serum samples were analysed for adiponectin, HbA1c, C-peptide and lipoproteins.

    Results  Significant positive associations were found between adiponectin concentrations and diabetes duration in univariate and multiple regression analyses. Serum adiponectin averaged 9·7 ± 5·3 [median 8·1, interquartile range (IQR) 3·6] mg/l in patients with diabetes duration less than 10 years and 17·8 ± 10·7 (median 14·7, IQR 7·5) mg/l in patients with longer duration (P = 0·0001). Among the patients, 24 were without detectable (< 100 pmol/l) and 22 with detectable C-peptide levels (185 ± 91 pmol/l). C-peptide levels in controls averaged 492 ± 177 pmol/l. HbA1c was 5·7 ± 0·6% in patients without detectable C-peptide and 5·6 ± 0·4% in patients with detectable C-peptide (ns). Serum adiponectin was higher in patients without detectable C-peptide than in patients with detectable C-peptide [17·3 ± 11·1 vs. 10·6 ± 5·8 mg/l (P < 0·005)] and in the controls [10·1 ± 2·9 mg/l (P < 0·001 vs. patients without detectable C-peptide)].

    Conclusions  The increase in circulating adiponectin concentrations in patients with type 1 diabetes appears to be strongly associated with long diabetes duration, irrespective of the metabolic control. Among other factors, a putative role for residual β-cell function in the regulation of circulating adiponectin levels can be considered but we did not find sufficient evidence for this in the present study.

  • 105.
    Lindström, Torbjörn
    et al.
    Linköpings universitet, Institutionen för medicin och vård, Internmedicin. Linköpings universitet, Hälsouniversitetet.
    Hedman, Christina
    Linköpings universitet, Institutionen för medicin och vård, Internmedicin. Linköpings universitet, Hälsouniversitetet.
    Arnqvist, Hans
    Linköpings universitet, Institutionen för medicin och vård, Internmedicin. Linköpings universitet, Institutionen för biomedicin och kirurgi, Cellbiologi. Linköpings universitet, Hälsouniversitetet.
    Use of a novel double-antibody technique to describe the pharmacokinetics of rapid-acting insulin analogs2002Inngår i: Diabetes Care, ISSN 0149-5992, E-ISSN 1935-5548, Vol. 25, nr 6, s. 1049-1054Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVE—To measure the contribution of bedtime intermediate-acting human insulin on the morning plasma insulin profiles after injection of the rapid-acting insulin analogs lispro and aspart in patients with type 1 diabetes.

    RESEARCH DESIGN AND METHODS—A total of 14 patients with type 1 diabetes, aged 35 ± 13 years (mean ± SD), participated in this single-blind, randomized crossover study. After taking their usual injection of human intermediate-acting insulin the night before, they were given insulin aspart or insulin lispro (10 units) before a standardized breakfast. The contribution of continuing absorption of the human insulin was measured using a monoclonal antibody not cross-reacting with insulin aspart or lispro, whereas the contribution of the analogs was estimated by subtraction after measurement of all plasma free insulin using an antibody cross-reacting equally with human insulin and both analogs.

    RESULTS—The correlation coefficient of the fasting free insulin concentrations measured with both insulin methods was 0.95. Fasting free insulin was 95 ± 25 pmol/l before administration of insulin aspart, when determined with enzyme-linked immunosorbent assay detecting only human insulin, and 71 ± 20 pmol/l before administration of insulin lispro (NS). Both insulin analogs gave marked peaks of free insulin concentrations, lispro at 40 ± 3 min and aspart at 55 ± 6 min after injection (P = 0.01). The later part of the profiles, from 4.5 to 5.5 h after injection, were similar and showed almost no contribution of the insulin analogs.

    CONCLUSIONS—The combination of insulin assays that detect human insulin only or both human insulin and analogs provides a new tool for studying insulin pharmacokinetics. Using this technique, we showed that 4.5 h after administration of the rapid-acting insulin analogs lispro and aspart, the free insulin levels are almost only attributable to the intermediate-acting insulin given at bedtime.

  • 106.
    Lindström, Torbjörn
    et al.
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för medicin och vård, Internmedicin. Östergötlands Läns Landsting, MKC-2, GE: endomed.
    Nyström, Fredrik
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för medicin och vård, Internmedicin. Östergötlands Läns Landsting, MKC-2, GE: endomed.
    Olsson, Anders
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för medicin och vård, Internmedicin. Östergötlands Läns Landsting, MKC-2, GE: endomed.
    Arnqvist, Hans
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för medicin och vård, Internmedicin. Östergötlands Läns Landsting, MKC-2, GE: endomed.
    Ottosson, A-M
    Med Norrköping.
    The lipoprotein profile differs during insulin treatment alone and combination therapy with insulin and sulphonylureas in patients with type2 diabetes mellitus.1999Inngår i: Diabetic Medicine, ISSN 0742-3071, E-ISSN 1464-5491, Vol. 16, s. 820-826Artikkel i tidsskrift (Fagfellevurdert)
  • 107.
    Lindström, Torbjörn
    et al.
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för medicin och vård, Internmedicin. Östergötlands Läns Landsting, MKC-2, GE: endomed.
    Olsson, P-O
    Arnqvist, Hans
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för medicin och vård, Internmedicin. Östergötlands Läns Landsting, MKC-2, GE: endomed.
    The use of human ultralente is limited by great intraindividual variability in overnight plasma insulin profiles2000Inngår i: Scandinavian Journal of Clinical and Laboratory Investigation, ISSN 0036-5513, E-ISSN 1502-7686, Vol. 60, nr 5, s. 341-348Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Our objective was to investigate the usefulness of human ultralente insulin as basal substitution overnight in patients with Type 1 diabetes treated with multiple insulin injection therapy by evaluating the free insulin and glucose profiles, the day-to-day variability and the impact of the time of injection. Methods: Ten patients with Type 1 diabetes and with good metabolic control (mean HbAlc 6.0%), treated with regular human insulin before breakfast, lunch and dinner and human ultralente (Ultratard«) before dinner or at bedtime, were studied. Plasma profiles of blood glucose and free insulin were measured on three occasions from 16.00 h until noon the next day. On two of these occasions Ultratard« was injected before dinner and once it was injected at bedtime in randomized order. Results: Injection of regular insulin before dinner resulted in a high insulin peak during the evening but no insulin peak was found that could be attributed to ultralente. The plasma concentration of free insulin at 03.00 h was 11.0▒1.9 mU/L and it slowly decreased to 6.4▒1.4 at 12.00 h after administration of ultralente at 17.00 h. There were no differences in the mean plasma insulin profiles compared to the other occasion when insulin was given at 17.00 h or at 22.00 h. On the other hand, the intra-individual day-to-day variability of mean insulin concentration during the night was considerable, often exceeding 50%. No differences were noted in the mean blood glucose profiles between the three occasions. Conclusion: Human ultralente insulin gives an insulin profile suitable for overnight substitution, but the great day-to-day variability limits its usefulness. It can be injected before dinner or at bedtime without any change in the insulin profile during the night.

  • 108.
    Locht, Henning
    et al.
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för medicin och vård, Internmedicin.
    Mölbak, Kåre
    Köbenhamn.
    Krogfelt, Karen
    Köbenhamn.
    High frekquency of reactive joint symptoms after an outbreak of salmonella enteritidis2002Inngår i: Journal of Rheumatology, ISSN 0315-162X, E-ISSN 1499-2752, Vol. 29, s. 767-771Artikkel i tidsskrift (Fagfellevurdert)
  • 109.
    Lorefält, Birgitta
    et al.
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för medicin och vård, Omvårdnad.
    Toss, Göran
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för medicin och vård, Internmedicin. Östergötlands Läns Landsting, Medicincentrum, Endokrin- och magtarmmedicinska kliniken US.
    Granerus, Ann-Kathrine
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för nervsystem och rörelseorgan, Geriatrik. Östergötlands Läns Landsting, Närsjukvården i centrala Östergötland, Geriatriska kliniken.
    Bone mass in elderly patients with Parkinson's disease2007Inngår i: Acta Neurologica Scandinavica, ISSN 0001-6314, E-ISSN 1600-0404, Vol. 116, nr 4, s. 248-254Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective - The objective of the present study was to find risk factors for low bone mineral density (BMD) in patients with Parkinson's disease (PD). Material and methods - Twenty-six PD patients and 26 age-and sex-matched healthy controls were assessed twice within a 1-year period. PD symptoms, body weight, body fat mass, BMD, physical activity, smoking and serum concentrations of several laboratory analyses were investigated. Results - BMD in different locations was lower in PD patients compared with their controls and decreased during the investigated year. BMD was lower in PD patients with low body weight. BMD Z-score of trochanter in the PD group was directly correlated to the degree of physical activity and indirectly to the length of recumbent rest. Total body BMD Z-score in the PD group was directly correlated to the degree of rigidity. Serum 25-hydroxy-vitamin D was slightly lower in PD patients. Conclusion - Low body weight and low physical activity were risk factors for low BMD in PD, while rigidity seemed to be protective. © 2007 The Authors.

  • 110. Lundström, Åsa
    et al.
    Jendel, Johan
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för medicin och vård, Internmedicin. Östergötlands Läns Landsting, MKC-2, GE: endomed.
    Stenström, Birgitta
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för medicin och vård, Radiologi. Östergötlands Läns Landsting, Bildmedicinskt centrum, Avdelningen för radiologi US.
    Toss, Göran
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för medicin och vård, Internmedicin. Östergötlands Läns Landsting, Medicincentrum, Endokrin- och magtarmmedicinska kliniken US.
    Ravald, Nils
    Periodontal conditions in 70-year-old women with osteoporosis.2001Inngår i: Swedish Dental Journal, ISSN 0347-9994, Vol. 25, s. 89-96Artikkel i tidsskrift (Fagfellevurdert)
  • 111.
    Lystedt, Erika
    et al.
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för medicin och vård.
    Westergren, Hanna
    Brynhildsen, Jan
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för molekylär och klinisk medicin, Obstetrik och gynekologi. Östergötlands Läns Landsting, Barn- och kvinnocentrum, Kvinnokliniken i Linköping.
    Lindh-Åstrand, Lotta
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för molekylär och klinisk medicin, Obstetrik och gynekologi. Östergötlands Läns Landsting, Barn- och kvinnocentrum, Kvinnokliniken i Linköping.
    Gustavsson, Johanna
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för biomedicin och kirurgi, Avdelningen för medicinsk cellbiologi.
    Nyström, Fredrik
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för medicin och vård, Internmedicin. Östergötlands Läns Landsting, Medicincentrum, Endokrin- och magtarmmedicinska kliniken US.
    Hammar, Mats
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för molekylär och klinisk medicin, Obstetrik och gynekologi. Östergötlands Läns Landsting, Barn- och kvinnocentrum, Kvinnokliniken i Linköping.
    Strålfors, Peter
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för biomedicin och kirurgi, Avdelningen för medicinsk cellbiologi.
    Subcutaneous adipocytes from obese hyperinsulinemic women with polycystic ovary syndrome exhibit normal insulin sensitivity but reduced maximal insulin responsiveness2005Inngår i: European Journal of Endocrinology, ISSN 0804-4643, E-ISSN 1479-683X, Vol. 153, nr 6, s. 831-835Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Polycystic ovary syndrome (PCOS) has a high prevalence in women and is often associated with insulin resistance and hence with aspects of the so-called metabolic syndrome. Methods: Ten women diagnosed with PCOS were consecutively included (aged 21-39 years, average 30.2±1.9 years, body mass index 28.4-42.5 kg/m2, average 37.5±1.7 kg/m2 (mean±S.E.)). Adipocytes were isolated from the subcutaneous fat and, after overnight incubation to recover from insulin resistance due to the surgical cell isolation procedures, they were analyzed for insulin sensitivity. Results: The patients with PCOS exhibited marked clinical hyperinsulinemia with 3.6-fold higher blood levels of C-peptide than a healthy lean control group (1.7±0.2 and 0.5±0.02 nmol/l respectively, P < 0.0001). The patients with PCOS also exhibited 2.4-fold higher concentrations of serum triacylglycerol (2.1±0.3 and 0.9±0.06 mmol/l respectively, P < 0.0001), but only slightly elevated blood pressure (118±12/76±6 and 113±7/72±6 mmHg respectively, P = 0.055/0.046). However, insulin sensitivity for stimulation of glucose transport in the isolated adipocytes was indistinguishable from a non-PCOS, non-diabetic control group, while the maximal insulin effect on glucose uptake was significantly lower (2.2±0.2- and 3.8±0.8-fold respectively, P = 0.02). Conclusions: Subcutaneous adipocytes from patients with PCOS do not display reduced insulin sensitivity. The findings show that the insulin resistance of PCOS is qualitatively different from that of type 2 diabetes. © 2005 Society of the European Journal of Endocrinology.

  • 112. Löfgren, U B
    et al.
    Rosenqvist, U
    Lindström, Torbjörn
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för medicin och vård, Internmedicin. Östergötlands Läns Landsting, Medicincentrum, Endokrin- och magtarmmedicinska kliniken US.
    Hallert, Claes
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för vård och välfärd, Egenvård och lärande.
    Nyström, Fredrik
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för medicin och vård, Internmedicin. Östergötlands Läns Landsting, Medicincentrum, Endokrin- och magtarmmedicinska kliniken US.
    Diabetes control in Swedish community dwelling elderly: More often tight than poor2004Inngår i: Journal of Internal Medicine, ISSN 0954-6820, E-ISSN 1365-2796, Vol. 255, nr 1, s. 96-101Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective. To determine glycaemic control in elderly patients with diabetes living in community dwelling. Design. Descriptive, cross-sectional and open. Prospective with regard to blood glucose. Setting. Community-dwelling in-patients. Subjects. From a total number of 351 patients in seven Swedish centres of community dwelling we identified and recruited all 45 patients with diabetes receiving treatment with insulin, and/or oral medication. Main outcome measures. Blood glucose was measured fasting, 2 h after breakfast, in the evening and at night, for three consecutive days. Results. Mean HbA1c was 5.9 ± 1.1% (range 3.6-8.6%). The patients were split in three HbA1c-groups for analysis: lower- (3.6-5.3%), middle-(5.4-6.3%) and higher-tertile (6.4-8.6%). The groups where similar with regard to age, time in community dwelling, ability to eat and move around independently, but body mass index was lower in the lower tertile (P < 0.003 and P < 0.04, compared with middle- and higher-tertiles). We recorded 14 episodes with blood glucose ≤4.0 mmol L-1 in eight patients. Blood glucose ≤4.0 mmol L-1 was mostly recorded during night (n = 8) or in the morning (n = 3). Conclusions. Swedish patients with diabetes in community dwelling are over- rather than undertreated and have low HbA1c levels. Despite very regular eating habits and near total compliance with medication, hypoglycaemias are frequent and possibly linked to malnutrition.

  • 113.
    Löfman, Owe
    et al.
    Linköpings universitet, Institutionen för biomedicin och kirurgi, Klinisk kemi. Östergötlands Läns Landsting, Folkhälsovetenskapligt centrum, Folkhälsovetenskapligt centrum. Linköpings universitet, Institutionen för medicin och vård, Internmedicin. Linköpings universitet, Hälsouniversitetet.
    Berglund, K.
    Department of Community Medicine, County Council of Uppsala, Uppsala.
    Larsson, Lasse
    Linköpings universitet, Institutionen för biomedicin och kirurgi, Klinisk kemi. Linköpings universitet, Hälsouniversitetet.
    Toss, Göran
    Linköpings universitet, Institutionen för medicin och vård, Internmedicin. Linköpings universitet, Hälsouniversitetet.
    Changes in Hip Fracture Epidemiology: Redistribution Between Ages, Genders and Fracture Types2002Inngår i: Osteoporosis International, ISSN 0937-941X, E-ISSN 1433-2965, Vol. 13, nr 1, s. 18-25Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    After several reports of increasing hip fracture incidence some studies have suggested a trend-break. In a previous study of hip fractures we forecast a 70% increase in the total number of fractures from 1985 up to year 2000. We therefore studied the incidence trend for the last 15 years and supply a new prognosis up to year 2010. We recorded all incident hip fractures treated in the county of Östergötland, Sweden (≈ 400 000 inhabitants) 1982–96. A total of 11 517 hip fractures in men and women aged 50 years and above were included in the study after cross-validation between a computerized register of radiologic investigations and the hospital records. The projected number of fractures up to year 2010 was estimated by a Poisson regression model, considering both age and year of fracture in every single year 1982–96 for the respective fracture type and gender, and applied to the projected population. The annual number of hip fractures increased by 39% in men and 25% in women during the study period. Amongst men, the age-adjusted incidence of cervical fractures increased from 188 to 220/100 000 and of trochanteric fractures from 138 to 170/100 000. In women the incidence of cervical fractures decreased from 462/100 000 to 418/100 000 and of trochanteric fractures from 407/100 000 to 361/100 000. Cervical/trochanteric fracture incidence rate ratio leveled off, and also the female/male fracture rate ratio declined. A prognosis assuming that the incidence development will continue as during 1982–96, and a population in agreement with the forecast, predicts that the total age- and sex-adjusted number of hip fractures will decrease by 11% up to year 2010 compared with 1996. In women and men, however, a decrease of 19% and an increase of 7% respectively were projected. If the age- and sex-specific incidence remains at the same level as at the end of the study period, no significant change in the total numbers will occur. A trend-break was thus found in hip fracture incidence for women but not for men. Whether this is due to therapeutic and/or preventive measures in women is unknown. According to the most probable scenario a substantial increase in male trochanteric fractures (36%) is expected up to 2010, while all other hip fractures in both genders will decrease by 4–32% resulting in a total reduction of 11%.

  • 114.
    Löfman, Owe
    et al.
    Linköpings universitet, Institutionen för biomedicin och kirurgi, Klinisk kemi. Linköpings universitet, Institutionen för medicin och vård, Internmedicin. Östergötlands Läns Landsting, Folkhälsovetenskapligt centrum, Folkhälsovetenskapligt centrum. Linköpings universitet, Hälsouniversitetet.
    Hallberg, Inger
    Linköpings universitet, Institutionen för medicin och vård, Internmedicin. Linköpings universitet, Hälsouniversitetet.
    Berglund, Kenneth
    Community Medicine, County Council of Uppsala, Uppsala, Sweden.
    Wahlström, Ola
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Ortopedi. Linköpings universitet, Hälsouniversitetet.
    Kartous, Lisa
    Div of Geriatric Medicine, Ryhov Hospital, County council of Jönköping.
    Larsson, Lasse
    Linköpings universitet, Institutionen för biomedicin och kirurgi, Klinisk kemi. Linköpings universitet, Hälsouniversitetet.
    Toss, Göran
    Linköpings universitet, Institutionen för medicin och vård, Internmedicin. Linköpings universitet, Hälsouniversitetet.
    Women with low energy fracture: Case for investigation?Manuskript (preprint) (Annet vitenskapelig)
    Abstract [en]

    Background: The combined use of bone mineral density, fracture history and other risk markers for fracture is advocated for identifying subjects with high fracture risk. An incident fracture is suggested as an accurate indication for osteoporosis investigation, but there are still insufficient data for grading the priority between ages and types of fractures. We therefore decided to examine a consecutive series of 55-75 year old women with an incident fracture for evaluating a standardized clinical routine program and for studying the covariance between fracture history, bone mineral density and other risk markers.

    Materila and methods: We invited 600 consecutive women 55-75 years old with an incident newly diagnosed fracture in distal radius forearm, proximal humerus, vertebra or hip. External drop-out was 33%. Of the 400 responders 31 had a high-energy trauma, 62 were on treatment against osteoporosis and 4 were living in other counties and were therefore excluded. The remaining 303 subjects entered the study. A questionnaire on previous fractures and risk factors was enclosed with the invitation to the osteoporosis unit. At a single visit a short history was assessed and physical examination performed as well as a few laboratory investigations. Bone mineral density was measured at the hip, lumbar spine and forearm by DXA (Hologic QDR 4500A).

    Results: The fracture spectrum was: distal radius 56.4 %, proximal humerus 12.2%, vertebra 18.2% and hip 13.2%. 49% had had at least one previous fracture, 19% at least two previous and 6.3% three or more previous fractures before the recent one. As few spine X-rays were performed, the true prevalence of vertebral fracture is unknown. Patients with fracture in vertebra or hip had lower BMD and more previous fractures than patients with forearm or humerus fracture. The number of previous fractures was inversely correlated to BMD of the hip and forearm, while BMD of the spine had a biphasic relationship.

    The Odds ratio of having either osteopenia and osteoporosis were >20 for patients with hip fracture and 75 for the spine (mean values), whereas the OR of the forearm fracture group was slightly above 10, table 6. The OR were as expected dependent of cut-off limit used. Mean value for the OR was in the hip fracture group 8.2 and 9.2 for !-score -2.5 and -2.0 respectively at the lower end of the confidence interval. For the spine and the forearm, the corresponding odds ratios were 16-17 and 7-9 respectively.

    Conclussion: Vertebral fracture was the strongest and distal radius the weakest predictor of low BMD. The number of previous fractures is a helpful information for finding the most osteoporotic patients. Only 15 % had been treated for osteoporosis before the index fracture. Osteoporosis investigation therefore seems warranted in every woman 55-75 years old with a recent low-energy fracture in distal radius, proximal humerus, spine or hip, with highest priority to those in spine or hip and those with multiple previous fractures.

  • 115.
    Löfman, Owe
    et al.
    Linköpings universitet, Institutionen för biomedicin och kirurgi, Avdelningen för klinisk kemi. Linköpings universitet, Institutionen för medicin och hälsa. Linköpings universitet, Hälsouniversitetet.
    Hallberg, Inger
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för omvårdnad. Linköpings universitet, Institutionen för medicin och vård. Linköpings universitet, Hälsouniversitetet.
    Berglund, Kenneth
    Community Medicine, County Council of Uppsala, Uppsala, Sweden.
    Wahlström, Ola
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för nervsystem och rörelseorgan, Ortopedi och Idrottsmedicin. Östergötlands Läns Landsting, Ortopedicentrum, Ortopedkliniken Linköping.
    Kartous, Lisa
    Department of Geriatrics, Ryhov Hospital, Jönköping, Sweden.
    Rosenqvist, Anna-Maria
    Department of Geriatrics, Ryhov Hospital, Jönköping, Sweden.
    Larsson, Lasse
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Klinisk kemi. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Laboratoriemedicinskt centrum, Klinisk kemi.
    Toss, Göran
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för medicin och vård, Internmedicin. Östergötlands Läns Landsting, Medicincentrum, Endokrin- och magtarmmedicinska kliniken US.
    Women with low-energy fracture should be investigated for osteoporosis2007Inngår i: Acta Orthopaedica, ISSN 1745-3674, E-ISSN 1745-3682, Vol. 78, nr 6, s. 813-821Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Introduction: Treatment of osteoporosis is becoming more effective, but methods to identify patients who are most suitable for investigation and treatment are still being debated. Should any type of fracture have higher priority for investigation of osteoporosis than any other? Is the number of previous fractures useful information? Material and methods: We investigated 303 consecutive women patients between 55 and 75 years of age who had a newly diagnosed low-energy fracture. They answered a questionnaire on previous fractures which also dealt with risk factors. Bone mineral density (BMD) was measured at the hip, lumbar spine, and forearm. Results: The distribution of fracture location was: distal forearm 56%, proximal humerus 12%, vertebra 18%, and hip 13%, all with similar age. Half of the subjects had had at least one previous fracture before the index fracture, 19% had had two previous fractures, and 6% had had three or more previous fractures. Patients with vertebral or hip fracture had lower BMD and had had more previous fractures than patients with forearm or humerus fractures. There was an inverse correlation between number of fractures and BMD. Osteoporosis was present in one-third of patients with forearm fracture, in one-half of those with hip or humerus fracture, and in two-thirds of those with vertebral fracture. Interpretation: Vertebral fractures were the strongest marker of low BMD and forearm fractures the weakest. The number of previous fractures is helpful information for finding the most osteoporotic patient in terms of severity. Investigation of osteoporosis therefore seems warranted in every woman between the ages of 55 and 75 with a recent low-energy fracture, with highest priority being given to those with vertebral, hip, or multiple fractures. Copyright© Taylor & Francis 2007. all rights reserved.

  • 116.
    Löfman, Owe
    et al.
    Linköpings universitet, Institutionen för medicin och vård, Internmedicin. Linköpings universitet, Hälsouniversitetet.
    Larsson, Lasse
    Linköpings universitet, Institutionen för medicin och vård, Internmedicin. Linköpings universitet, Hälsouniversitetet.
    Ross, I.
    Linköpings universitet, Institutionen för medicin och vård, Internmedicin. Linköpings universitet, Hälsouniversitetet.
    Toss, Göran
    Linköpings universitet, Institutionen för medicin och vård, Internmedicin. Linköpings universitet, Hälsouniversitetet.
    Berglund, K.
    Department for Community Medicine and Public Health, County Council, Jönköping, Sweden.
    Bone mineral density in normal Swedish women1997Inngår i: Bone, ISSN 8756-3282, E-ISSN 1873-2763, Vol. 20, nr 2, s. 167-174Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    We examined 429 women, aged 20–80 years, randomly selected from the population register to establish normal values for bone mineral density (BMD) in Swedish women. BMD of the spine and hip was measured by dual-energy X-ray absorptiometry (DEXA; Hologic QDR 1000) and in the forearm by single photon absorptiometry (SPA; Molsgaard ND-1100). The recalled age of menarche was negatively correlated to BMD at all ages. There was no significant change in BMD from 20–49 years at any site except a slight decline at Ward's triangle. Bone loss was rapid at all sites during the first decade after menopause. Thereafter, BMD declined slowly in the trochanter and total hip but more rapidly in the forearm, femoral neck, and Ward's triangle. BMD in the spine even increased in the eighth decade probably due to osteoarthritis. The average change in forearm BMD during the 15 perimenopausal years comprising mean age for menopause ± 2 SD (43–57 years) was −0.4% per year in premenopausal females and −1.6% per year in postmenopausal females. The corresponding annual percental change was, for the spine, +0.2 and −1.7; neck, −0.7 and −1.7; trochanter, +0.5 and −1.5; and Ward's triangle, −0.1% and −2.2%, respectively. Our normal values for lumbar spine BMD prior to menopause did not differ from published values or the manufacturer's normal values; however, our spine BMD values for the first decade after menopause were significantly lower (≈10%) than in other studies. Our femoral neck BMD values for younger women were, like those of several other groups, significantly lower than the manufacturer's normal values, but our sample of young women in this study was small. The prevalence of osteoporosis, if defined as t score < −2.5 is highly dependent on the sampling of the reference population of young adult women, and also on the choice of skeletal site. Further studies on bone mineral density in healthy young adult women are needed.

  • 117.
    Löfman, Owe
    et al.
    Linköpings universitet, Institutionen för biomedicin och kirurgi, Klinisk kemi. Linköpings universitet, Institutionen för medicin och vård, Internmedicin. Östergötlands Läns Landsting, Folkhälsovetenskapligt centrum, Folkhälsovetenskapligt centrum. Linköpings universitet, Hälsouniversitetet.
    Magnusson, Per
    Linköpings universitet, Institutionen för biomedicin och kirurgi, Klinisk kemi. Linköpings universitet, Hälsouniversitetet.
    Toss, Göran
    Linköpings universitet, Institutionen för medicin och vård, Internmedicin. Linköpings universitet, Hälsouniversitetet.
    Larsson, Lasse
    Linköpings universitet, Institutionen för biomedicin och kirurgi, Klinisk kemi. Linköpings universitet, Hälsouniversitetet.
    Common biochemical markers of bone turnover predict future bone loss: A 5-year follow-up study2005Inngår i: Clinica Chimica Acta, ISSN 0009-8981, E-ISSN 1873-3492, Vol. 356, nr 1-2, s. 67-75Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background

    Bone mineral density (BMD) is used to follow gain or loss of bone mass but cannot detect changes within a short period of time. Biochemical markers of bone turnover may be of value for prediction of individual bone loss.

    Methods

    We studied the relation between common inexpensive markers of bone turnover (serum alkaline phosphatase (ALP), osteocalcin (OC), urinary hydroxyproline (OHPr), and calcium (Ca)), BMD, age, and menopause in a combined cross-sectional and longitudinal design comprising 429 pre- and postmenopausal randomly selected women aged 21–79 years (mean 50 years). A follow-up was initiated after 5 years (including 192 of these women), which focused on changes in bone mass and the ability of these four common markers of bone turnover (sampled at baseline) to predict future bone loss.

    Results

    A marked increase was observed for all markers at the beginning of menopause. During the postmenopausal period ALP and Ca decreased to near premenopausal levels, while OC and OHPr remained high even 15 years after menopause. We also found inverse correlations at baseline between the bone markers and BMD, independent of the selected marker or skeletal site, r=−0.14 to −0.46, P<0.05. The correlations between ALP, OC, OHPr, and subsequent bone loss over 5 years, was significant for arm, r=−0.23 to −0.36, P<0.01. Baseline levels of all bone markers correlated significantly at group level with the 5-year follow-up of BMD for all sites. The ability of markers to predict individual bone loss was estimated by a multivariate regression model, which included baseline BMD, age, and body mass index as independent variables. ROC analysis showed a validity of approximately 76% for the forearm model, but was lower for the hip (55%) and lumbar spine (65%).

    Conclusions

    These data show that the common inexpensive biochemical markers of bone turnover ALP, OC, OHPr, and Ca were related to the current bone mass and, moreover, provides information about future bone loss at the individual level. Future investigations should include an evaluation of the clinical relevance of markers of bone turnover in relation to fracture risk.

  • 118.
    Löfman, Owe
    et al.
    Linköpings universitet, Institutionen för medicin och vård, Internmedicin. Linköpings universitet, Institutionen för biomedicin och kirurgi, Klinisk kemi. Östergötlands Läns Landsting, Folkhälsovetenskapligt centrum, Folkhälsovetenskapligt centrum. Linköpings universitet, Hälsouniversitetet.
    Toss, Göran
    Linköpings universitet, Institutionen för medicin och vård, Internmedicin. Linköpings universitet, Hälsouniversitetet.
    Larsson, Lasse
    Linköpings universitet, Institutionen för biomedicin och kirurgi, Klinisk kemi. Linköpings universitet, Hälsouniversitetet.
    Bone Mineral Density in Diagnosis of Osteoporosis: Reference Population, Definition of Peak Bone Mass, and Measured Site Determine Prevalence2000Inngår i: Journal of clinical densitometry, ISSN 1094-6950, E-ISSN 1559-0747, Vol. 3, nr 2, s. 177-186Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    A population-based study was performed in order to compare different definitions of peak bone mass, and to apply the corresponding T-scores for different skeletal sites to a cohort of 70-yr-old women for studying the prevalence of osteoporosis. Bone mineral density (BMD) of the hip, lumbar spine, and forearm was measured by dual X-ray absorptiometry (Hologic 4500) in 296 women ages 16–31 yr and 210 women age 70 yr. Peak bone mass occurred in women in their early 20s at the proximal femur and at 28 and 31 yr at the spine and forearm, respectively. BMD cutoff levels were compared to machine-specific cutoff values for the different sites. When applied to our cohort of 70-yr-old women, the prevalence of osteoporosis at the total hip was 9–25%, depending on which peak bone mass the T-score of – 2.5 was based. The prevalence in the spine was 28–33% and in the forearm 45–67%. Osteoporosis in at least one of the three measured sites was documented in 49–72% of the population sample. Our results show that the use of T-score to define osteoporosis results in a highly different prevalence rate in a given population depending on the reference population and the skeletal sites chosen for measurement.

  • 119.
    Magnusson, Per
    et al.
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för biomedicin och kirurgi, Klinisk kemi. Östergötlands Läns Landsting, Laboratoriemedicinskt centrum, Klinisk kemi.
    Larsson, Lasse
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för biomedicin och kirurgi, Klinisk kemi. Östergötlands Läns Landsting, Laboratoriemedicinskt centrum, Klinisk kemi.
    Magnusson, Martin
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för medicin och vård, Internmedicin. Östergötlands Läns Landsting, Medicincentrum, Njurmedicinska kliniken US.
    Davie, Michael W J
    Sharp, Christopher A
    Isoforms of bone alkaline phosphatase: carachterization and origin in human trabecular and cortical bone.1999Inngår i: Journal of Bone and Mineral Research, ISSN 0884-0431, E-ISSN 1523-4681, Vol. 14, s. 1926-1933Artikkel i tidsskrift (Fagfellevurdert)
  • 120. Malmqvist, K
    et al.
    Kahan, T
    Edner, M
    Held, C
    Hägg, A
    Lind, L
    Nyström, Fredrik
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för medicin och vård, Internmedicin. Östergötlands Läns Landsting, MKC-2, GE: endomed.
    Öhman, P
    Osbakken, D
    Östergren, J
    Regression of left ventricular hypertension with Irbesartan.2001Inngår i: Journal of Hypertension, ISSN 0263-6352, E-ISSN 1473-5598, Vol. 19, s. 1167-1176Artikkel i tidsskrift (Fagfellevurdert)
  • 121.
    Malmqvist, K.
    et al.
    Division of Internal Medicine, Karolinska Inst. Danderyd Hospital, Stockholm, Sweden.
    Öhman, K. Peter
    Linköpings universitet, Institutionen för medicin och vård, Internmedicin. Linköpings universitet, Hälsouniversitetet. AstraZeneca Research & Development, Mölndal, Sweden.
    Lind, Lars
    AstraZeneca Research and Development, Mölndal, Sweden, Department of Medical Sciences, University Hospital, Uppsala, Sweden.
    Nyström, Fredrik
    Linköpings universitet, Institutionen för medicin och vård, Internmedicin. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Medicincentrum, Endokrin- och magtarmmedicinska kliniken US.
    Kahan, Thomas
    Division of Internal Medicine, Karolinska Inst. Danderyd Hospital, Stockholm, Sweden, Institutet Danderyd Hospital, Section of Cardiology, Division of Internal Medicine, S-182 88 Stockholm, Sweden.
    Long-Term Effects of Irbesartan and Atenolol on the Renin-Angiotensin-Aldosterone System in Human Primary Hypertension: The Swedish Irbesartan Left Ventricular Hypertrophy Investigation versus Atenolol (SILVHIA)2003Inngår i: Journal of Cardiovascular Pharmacology, ISSN 0160-2446, E-ISSN 1533-4023, Vol. 42, nr 6, s. 719-726Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    We examined long-term influence of the angiotensin II type 1-receptor blocker irbesartan and the beta1-adrenergic receptor blocker atenolol on some neurohormonal systems implicated in the pathophysiology of cardiac hypertrophy. Thus, 115 hypertensive patients with left ventricular hypertrophy were randomized to receive double-blind irbesartan or atenolol, with additional therapy if needed. Neurohormone measurements and echocardiography were performed at weeks 0, 12, 24, and 48. Left ventricular mass was reduced more by irbesartan than by atenolol (-26 g/m2 versus -14 g/m2, P = 0.024), despite similar reductions in blood pressure. Plasma renin activity and angiotensin II increased (P < 0.001) by irbesartan (0.9 ± 0.7 to 3.4 ± 4.2 ng/mL × h, and 3.0 ± 1.6 to 13.0 ± 17.7 pmol/L), but decreased (P < 0.01) by atenolol (1.0 ± 0.6 to 0.7 ± 0.6 ng/mL × h, and 3.4 ± 1.6 to 3.2 ± 2.2 pmol/L). Serum aldosterone decreased (P < 0.05) by both irbesartan (346 ± 140 to 325 ± 87 pmol/L) and atenolol (315 ± 115 to 283 ± 77 pmol/L). Changes in left ventricular mass by irbesartan related inversely to changes in plasma renin activity, angiotensin II, and aldosterone (all P < 0.05). Plasma levels and 24-hour urinary excretions of catecholamines, plasma leptin, proinsulin, insulin and insulin sensitivity remained largely unchanged in both groups. Thus, the renin-angiotensin aldosterone system appears to be an important non-hemodynamic factor in the regulation of left ventricular mass.

  • 122.
    Malmqvist, Karin
    et al.
    Internmedicin Danderyd Stockholm.
    Öhman, P
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för medicin och vård, Internmedicin.
    Lind, L
    Nyström, Fredrik
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för medicin och vård, Internmedicin. Östergötlands Läns Landsting, MKC - Medicin och kirurgicentrum, EMK-endokrin.
    Kahan, T
    Relationships between left ventricular mass and the renin-angiotensin system, catecholamines, insulin and leptin.2002Inngår i: Journal of Internal Medicine, ISSN 0954-6820, E-ISSN 1365-2796, Vol. 252, s. 430-439Artikkel i tidsskrift (Fagfellevurdert)
  • 123.
    Molander, L
    et al.
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för medicin och vård, Klinisk farmakologi.
    Hansson, A
    Lunell, E
    Alainentalo, L
    Hoffman, Mikael
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för medicin och vård, Klinisk farmakologi. Östergötlands Läns Landsting, Laboratoriemedicinskt centrum, Klinisk farmakologi.
    Larsson, Rutger
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för medicin och vård, Internmedicin. Östergötlands Läns Landsting, Medicincentrum, Njurmedicinska kliniken US.
    Pharmacokinetics of nicotine in kidney failure2000Inngår i: Clinical Pharmacology and Therapeutics, ISSN 0009-9236, E-ISSN 1532-6535, Vol. 68, nr 3, s. 250-260Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Smoking is an important risk factor for cardiovascular and cerebrovascular complications in patients with chronic kidney failure. Very high plasma nicotine concentrations have been reported in patients with severe kidney failure, indicating that the disposition of nicotine in these patients may be different. The purpose of this study was to assess the pharmacokinetics of intravenously administered nicotine in healthy subjects and in patients with kidney failure. Methods: Nine healthy subjects (glomerular filtration rare [GFR], 84 to 143 mL/min/1.73 m2), four patients with mild kidney failure (GFR, 63 to 73 mL/min/1.73 m2), five patients with moderate kidney failure (GFR, 18 to 36 mL/min/1.73 m2), and six patients with severe kidney failure (GFR, 1 to 10 mL/min/1.73 m2) were recruited. Three patients were treated with continuous ambulatory peritoneal dialysis. An intravenous infusion of nicotine (0.028 mg/kg) was given for 10 minutes. Nicotine and cotinine concentrations were measured in plasma, urine, and peritoneal dialysate from 0 to 24 hours after start of infusion Results: There were significant correlations between GFR and total clearance, nonrenal and renal clearance of nicotine, area under the plasma concentration-time curve extrapolated to infinity, terminal elevation half-life, and mean residence time. Nonrenal clearance was 1303 mL/min and 661 mL/min in healthy subjects and patients with severe kidney failure, respectively. Only 1% to 2% of the nicotine dose was excreted unchanged in a 24-hour collection of peritoneal dialysate. The elimination of cotinine was also decreased in patients with kidney failure. Conclusion: Progressive kidney failure is associated with a gradual decrease of renal and nonrenal elimination of nicotine.

  • 124.
    Mölgaard, J
    et al.
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för medicin och vård, Internmedicin. Östergötlands Läns Landsting, MKC-2, GE: endomed.
    Wärjestam-Elf, S
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för medicin och vård, Kardiologi.
    Olsson, Anders
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för medicin och vård, Internmedicin. Östergötlands Läns Landsting, MKC-2, GE: endomed.
    Efficacy and safety of simvastatin for highrisk hypercholseterolemia.1999Inngår i: American Journal of Cardiology, ISSN 0002-9149, E-ISSN 1879-1913, Vol. 83, s. 1043-1048Artikkel i tidsskrift (Fagfellevurdert)
  • 125.
    Mølgaard, Jørgen
    Linköpings universitet, Institutionen för medicin och vård, Internmedicin. Linköpings universitet, Institutionen för medicin och vård, Klinisk fysiologi. Linköpings universitet, Hälsouniversitetet.
    Intermittent Claudication: Prevalence and metabolic risk factors1997Doktoravhandling, med artikler (Annet vitenskapelig)
    Abstract [en]

    The prevalence of intermittent claudication (IC) in middle-aged men (45-69 years old) and metabolic risk factors for this disease was studied in a Swedish community. All 15 253 middle-aged male residents in Linköping community, were screened for symptoms of IC using a postal questionnaire, which included detailed questions about smoking habits and presence of hypertension and diabetes mellitus.

    The overall response rate was 86.6% (n=l3 209). The prevalence of walking-related pain was 9.3% (n=l232), and 4.2%(n=552) had symptoms consistent with peripheral atherosclerotic disease (PAD). All men with leg symptoms according to the classical Rose criteria for IC (1.2%, n=156), and a sample of subjects (0.6%, n=84) with symptoms indicating PAD, but not fully complying with the Rose c.riteria, were invited for further examination.

    Subjects with IC were compared with randomly selected sex- and age-matched controls from the same population. One control group was matched for smoking habits (n=157), and one control group consisted of never-smokers (n=143). Both claudicants and healthy controls underwent objective examination of the peripheral circulation with segmental blood pressure measurements and a short treadmill exercise test.

    IC could objectively be verified in 1.7% (n=219) of all middle-aged men. The prevalence of IC was highly age-dependent and objectively verified IC increased from 0.2% in males 45-49 years old to 3.4% in those 65-69 years old. The prevalence of Rose IC was 0.5% for 45-49 year-old males and 2.0% for 65-69 year-old males. Thus the Rose criteria underestimated the prevalence ofiC in the older age group and overestimated it in the youngest age group. The estimated true average prevalence ofiC was at least 2.8%.

    More than half (57%) of all claudicants had ischaemic heart disease, and 21% had experienced a TIA or stroke.

    The metabolic studies investigated the role of dyslipidaemia and various metabolic abnormalities as risk factors for IC. Claudicants had multiple minor and moderate lipid and lipoprotein abnormalities, the strongest association being with elevated plasma levels of low-density lipoproteins (LDL) cholesterol and low levels of high-density lipoproteins (HDL) cholesterol, after multivariate adjustment for other major risk factors, i.e. hypertension, diabetes mellitus and smoking, and other factors that influence lipid levels. Ve1y-low-density lipoproteins (VLDL) triglycerides had a high univariate association, but did not contribute to risk for IC after multivariate adjustment for the above factors.

    Plasma lipoprotein (a) [Lp(a)] showed a strong association with risk for IC, which in part could be explained by a significant overrepresentation of small apo(a) isoforms, genetically associated with higher Lp(a) concentrations.

    Plasma a- and ~-carotene, Iycopene and retinol, but not a- or y-tocophcrol (vitamin E), showed a multivariate significant association with risk for IC in men. However, when dietary data had been accounted for, only the significance of plasma retinol remained. Lower plasma levels of lipid-soluble antioxidants after adjustment for lipid concentrations may be secondary to the atherosclerotic disease. Moderately elevated levels of plasma homocyst(e)ine, a su\fbydryl-containing amino acid with a known atherogenic potential, were significantly associated with risk of IC after adjustment for other risk factors in multivariate analyses.

    In conclusion, the risk for IC amongst middle-aged males was significantly associated with presence of both major traditional risk factors such as smoking (96%), hypertension (49%), diabetes mellitus (18%) and additional metabol~c risk factors such as dyslipidaemia, hypcrhomocyst(e)inaemia and elevated Lp(a) levels. Plasma levels of tocophero!s (vitamin E) were not associated with risk for IC. Carotenoids do not seem to contribute, whereas the role of plasma retinol remains unclear.

  • 126.
    Nijm, Johnny
    et al.
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för medicin och vård, Kardiologi.
    Olsson, Anders
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för medicin och vård, Internmedicin. Östergötlands Läns Landsting, Medicincentrum, Endokrin- och magtarmmedicinska kliniken US.
    Jonasson, Lena
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för medicin och vård, Kardiologi. Östergötlands Läns Landsting, Hjärtcentrum, Kardiologiska kliniken.
    Impaired cortisol response in patients with coronary artery disease - relation to inflammatory activity2006Inngår i: XIV International Symposium on Atherosclerosis,2006, 2006Konferansepaper (Annet vitenskapelig)
    Abstract [en]

      

  • 127.
    Nijm, Johnny
    et al.
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för medicin och vård, Kardiologi.
    Olsson, Anders
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för medicin och vård, Internmedicin. Östergötlands Läns Landsting, Medicincentrum, Endokrin- och magtarmmedicinska kliniken US.
    Jonasson, Lena
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för medicin och vård, Kardiologi. Östergötlands Läns Landsting, Hjärtcentrum, Kardiologiska kliniken.
    Impaired cortisol response in patients with coronary artery disease - relation to inflammatory activity2006Inngår i: Scandinavian Cardiovascular Journal,2006, 2006, s. 25-Konferansepaper (Fagfellevurdert)
    Abstract [en]

    ISSN: 1401-7458  

  • 128.
    Nilsson, Rudmar
    et al.
    Kommunhälsan, Linköping, Sweden.
    Löfman, Owe
    Östergötlands Läns Landsting.
    Berglund, Kenneth
    Östergötlands Läns Landsting.
    Larsson, Lasse
    Linköpings universitet, Institutionen för biomedicin och kirurgi, Klinisk kemi. Linköpings universitet, Hälsouniversitetet.
    Toss, Göran
    Linköpings universitet, Institutionen för medicin och vård, Internmedicin. Linköpings universitet, Hälsouniversitetet.
    Increased Hip-Fracture Incidence in the County of Östergötland, Sweden, 1940–1986, with Forecasts up to the Year 2000: An Epidemiological Study1991Inngår i: International Journal of Epidemiology, ISSN 0300-5771, E-ISSN 1464-3685, Vol. 20, nr 4, s. 1018-1024Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The incidence of hip fractures in the county of Östergōtland in Sweden has increased dramatically from 1940 to 1986, mainly due to an increase in age-specific incidence of trochanteric fractures. The increase is most pronounced in people over 80 but is present even in age groups down to 50 years. If the age-specific incidence rates continue to increase, and the population of the elderly grows in accordance with the forecast, there will be 70% more hip fractures in the year 2000 than in 1985.

  • 129.
    Nilsson, S F E
    et al.
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för medicin och vård, Farmakologi.
    Mäepea, O
    Alm, A
    Narfström, K
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för medicin och vård, Internmedicin.
    Ocular blood flow and retinal metabolism in abyssinian cats with hereditary retinal degeneration2001Inngår i: Investigative Ophthalmology and Visual Science, ISSN 0146-0404, E-ISSN 1552-5783, Vol. 42, nr 5, s. 1038-1044Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Purpose. To investigate if retinal blood flow decreases with progression of the disease in Abyssinian cats with progressive retinal atrophy (PRA), to examine if the choroidal blood flow was affected by the disease, and to determine the uptake of glucose and formation of lactate in the outer retina. Methods. Local blood flow in different parts of the eye was determined with radioactive microspheres, in 9 normal cats and in 10 cats at different stages of PRA. Three blood flow determinations were made in each animal, during control conditions, after IV administration of indomethacin and after subsequent administration of Nw-nitro-L-arginine (L-NA). Blood samples from a choroidal vein and a femoral artery were collected to determine the retinal formation of lactate and uptake of glucose. Results. In Abyssinian cats with PRA (n = 10), the retinal blood flow was significantly (P = 0.01) lower than in normal cats (n = 9) during control conditions, 6.4 ▒ 1.7 compared with 14.1 ▒ 1.9 g min-1 (100 g)-1. The vascular resistance in the iris and ciliary body was significantly higher in the cats at a late stage of PRA, both compared with normal cats and to cats at an early stage of the disease, whereas the choroidal vascular resistance was not significantly affected. Indomethacin had no effect on ocular blood flows in normal cats, but in cats with PRA, iridal blood flow was more than doubled after indomethacin. The retinal formation of lactate was significantly (P = 0.001) lower in cats with PRA than in normal cats, 0.111 ▒ 0.035 (n = 8) compared with 0.318 ▒ 0.024 (n = 8) ╡mol rain-1. The uptake of glucose was not significantly different in cats with PRA. Conclusions. Retinal blood flow is severely decreased in Abyssinian cats at a late stage of retinal degeneration, whereas the choroidal microcirculation is not significantly affected by the disease. At a late stage of retinal degeneration, vascular resistance in the iris is significantly increased, which at least in part could be caused by cyxlooxygenase products.

  • 130.
    Nyman, Ingvar
    Linköpings universitet, Institutionen för medicin och vård, Kardiologi. Linköpings universitet, Institutionen för medicin och vård, Internmedicin. Linköpings universitet, Institutionen för medicin och vård, Klinisk fysiologi. Linköpings universitet, Hälsouniversitetet.
    Signs and implications of ischemia in unstable coronary artery disease1993Doktoravhandling, med artikler (Annet vitenskapelig)
    Abstract [en]

    Signs and implications of ischemia in ECG at rest and at a predischarge exercise test (ET), were assessed in 911 patients with suspected or definite unstable coronary artery disease (CAD) - i.e. unstable angina or non-Q-wave myocardial infarction (MI). Included in the study were men below 70 years of age admitted to the coronary care units of 8 hospitals,without signs of myocardial dysfunction or other serious disease. Randomization to acetylsalicylic acid (ASA) 75 mg daily or placebo was performed in 796 patients, as a part of the RISC study. A symptom limited predischarge ET was performed by 855 patient,, In initial ECG:s at rest, ST-changes were a more unfavourable sign regarding cardiac eventsthan isolated T-inversion, while those with no ST-segment or T-wave changes had the best prognosis. However, among patients on ASA treatment, ST -depression in ECG at rest was of some, although limited prognostic value.

    Concerning the ET evaluation, multiple logistic regression analysis showed that exercise induced ST -depression and exercise tolerance were independent predictors of MI or death, while ST -depression, exercise tolerance and provoked chest pain were independent predictors of future severe angina. When both ST-depression and work capacity was considered, a 'high risk' response at ET implied a !-year rate for cardiac death of 3.6% and for Ml+death of 15.4%. The corresponding figures for a 'low risk' response were 0% and 3.9%. The differences between patients with 'high risk' and 'low risk' responses at the ET were highly significant also regarding future severe angina. The prognostic value of the ET remained high in subgroups based on cardiac enzyme levels, age, findings in ECG at rest, and medication at time for the ET.

    The risk of cardiac death or MI was comparably increased in all patients with ST-depression at exercise, regardless of the presence or absence of chest pain. Thus, evaluation of prognosis should be based on the presence of myocardial ischemia, whether symptomatic or not. ASA 75 mg daily reduced the risk of MI or death at least as well in patients with 'silent ischemia' as in those with 'symptomatic ischemia' at the ET, and should be a mainstay of the treatment of symptom-free individuals.

    Among patients on ASA treatment, the finding of ST-depression alone at exercise was an insufficient indicator of the irreversible end points, due to the reduced absolute risk of MI or death. When both ST -depression and exercise tolerance were used in the evaluation, it was possible to identify a definite low-risk subset (40% of the ASA group) with a !-year rate ofMI or death of 2.9%, where further invasive investigation does not seem warranted. In ASA treated patients, the 'high risk' response at the ET implied a risk of MI or death of 13.4% during the following year. In this relatively large subset additional prognostic tests would be useful. Until such methods arc readily available and evaluated, early coronary angiography and possible revascularization should be considered in patients with severe ischemia.

  • 131.
    Nyström, Fredrik
    Linköpings universitet, Institutionen för medicin och vård, Internmedicin. Linköpings universitet, Hälsouniversitetet.
    Ambulatory blood pressure and components of the metabolic syndrome in the population: With reference to the renin-angiotensin system, IgF-I, IGFBP-1, neuropentide Y, and leptin1997Doktoravhandling, med artikler (Annet vitenskapelig)
    Abstract [en]

    The term "the metabolic syndrome" has been given to the constellation of insulin resistance, high blood pressure and hyperlipidemia. In western countries it is strongly associated with obesity and atherosclerosis. The cause of the metabolic syndrome is, however, incompletely understood. Ambulatory blood pressure (ABP) is devoid of the so called white-coat effect (WCE) of clinic BP recordings and might thus better estimate the actual BP-load. This is a descriptive study of the renin-angiotensin system, IGF-I, IGFBP-1, neuropeptide Y, and leptin and their relations to ABP and components of the metabolic syndrome.

    A population-based study on 224 subjects 18-70 years old, evenly age-distributed and randomly selected from the population of Linköping, Sweden, was performed. This group was the result of a participation rate of 67%. Venous blood was drawn at 0800 a.m. and clinic BP was recorded as well as anthropometric data such as height and weight. A spacelab ABP recorder was applied. ABP reference data were calculated. It was found that clinic BP rose more steeply with age than did ABP and that predetermined day/night intervals causedmisclassification of the diurnal BP variation. The relation of the WCE, defined as the clinic BP minus daytime ABP, was shown to be positively correlated with the levels of plasma cortisol and only weakly to levels of neuropeptide Y. The renin-angiotensin system was decribed in thepopulation. It was shown that the levels of plasma renin-activity (PRA) were affected by age and oestrogen-medication, although this was not the case for plasma immuno-reactive active renin (IRR). Neither PRA nor IRR showed any age-independent correlations to BP. Refererence values were given for IGF-I and IGFBP-1. It was found that IGF-I declined with age and that it"'s binding protein, IGFBP-1, increased with age. The relations of neuropeptide Y, a BP-elevating and appetite-stimulating polypeptide, to the components of the metabolicsyndrome was described. Although no significant cotTelations were found between plasma neuropeptide Y and BP, body-mass-index (BMI) or C-peptide in either gender, a positive correlation was found between both total and LDL cholesterol and neuropeptide Y in women,but not in men. The levels of the anorexogenic substance leptin was shown to correlate positively with BMI and C-peptide in both genders in the studied population. Leptin correlated negatively with testosterone levels in men. Ten OH-deficient subjects were shown to have higher levels of leptin than controls matched for BM! and gender from the population-study. Substitution of GH lowered the levels of leptin.

    Data from this population-based study will be valuable in the further evaluation of the components of the metabolic syndrome in different populations and in diseases other than OH-deficiency.

  • 132.
    Nyström, Fredrik H.
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Endokrinologi. Linköpings universitet, Institutionen för medicin och vård, Internmedicin. Linköpings universitet, Hälsouniversitetet.
    Öhmar, Peter K.
    Linköpings universitet, Institutionen för medicin och hälsa, Endokrinologi. Linköpings universitet, Hälsouniversitetet.
    Ekman, Bertil Å.
    Linköpings universitet, Institutionen för medicin och hälsa, Endokrinologi. Linköpings universitet, Hälsouniversitetet.
    Österlund, Maria K.
    Linköpings universitet, Institutionen för medicin och hälsa, Endokrinologi. Linköpings universitet, Hälsouniversitetet.
    Karlberg, Bengt E.
    Linköpings universitet, Institutionen för medicin och hälsa, Endokrinologi. Linköpings universitet, Hälsouniversitetet.
    Arnqvist, Hans J.
    Linköpings universitet, Institutionen för medicin och hälsa, Endokrinologi. Linköpings universitet, Hälsouniversitetet.
    Population-based reference values for IGF-I and IGF-binding protein-1: Relations with metabolic and anthropometric variables1997Inngår i: European Journal of Endocrinology, ISSN 0804-4643, E-ISSN 1479-683X, Vol. 136, nr 2, s. 165-172Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Population-based reference values for IGF-I and IGF-binding protein-1 (IGFBP-1) have been established. One hundred and one women and the same number of men, 20–70 years old, were randomly selected from the population registry in the community of Linköping. Participation rate was 67%. Venous blood was drawn in the fasting state. Serum IGF-I was measured by RIA after acid-ethanol extraction and IGFBP-1 was determined by ELISA. IGF-I levels did not differ between genders and the decline with age was similar in men and women (men: Y=366–3·28×age (years), r =−0·61, P<0·0001; women: Y=386–3·49×age, r =−0·57, P<0·0001, P=0·4 for difference in slope). There were negative correlations between IGF-I and plasma lipids and blood pressure in both genders, but none was independent of age. Serum angiotensin-converting enzyme activity correlated positively with IGF-I in men independently from age (r =0·21, P=0·01). The distribution of IGFBP-1 was positively skewed and it was higher in women than in men (5·9±4·8 μg/l and 4·0±3·3 μg/l respectively; Mann–Whitney, P=0·002). In men and in the women not taking oestrogen, IGFBP-1 correlated positively with age (Spearman rank correlation (Spearman): men: r=0·32, P=0·002; women: r=0·24, P=0·03). C-peptide correlated negatively (Spearman: men: r =−0·38, P=0·002; women: r =−0·49, P<0·000) and sex hormone binding globulin positively with IGFBP-1 (Spearman: men: r=0·50, P<0·0001; women: r =0·55, P<0·0001).

  • 133.
    Nyström, Fredrik
    et al.
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för medicin och vård, Internmedicin. Östergötlands Läns Landsting, MC - Medicincentrum, EMT-endo.
    Himmelman, Anders
    Göteborg.
    24-timmars blodtrycksmätning2003Inngår i: 24-timmars blodtrycksmätning. / [ed] Fredrik Nyström och Anders Himmelmann, Linköping: Linköpings universitet , 2003, s. -62Kapittel i bok, del av antologi (Annet vitenskapelig)
  • 134.
    Nyström, Fredrik
    et al.
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för medicin och vård, Internmedicin. Östergötlands Läns Landsting, Medicincentrum, Endokrin- och magtarmmedicinska kliniken US.
    Malmqvist, K
    KI, Stockholm.
    Lind, L
    Universitetssjukhuset i Uppsala.
    Kahan, T
    KI, Stockholm.
    Nurse-recorded clinic and ambulatory blood pressures correlate equally well with left ventricular mass and carotid intima-media thickness2005Inngår i: Journal of Internal Medicine, ISSN 0954-6820, E-ISSN 1365-2796, Vol. 257, nr 6, s. 514-522Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective. To assess relationships between noninvasive ambulatory blood pressure (BP), clinic BP (mean value of three readings in the seated position measured by nurses), structural cardiac indices, intima-media thickness of the common carotid artery and several hormones. Design. Cross-sectional study of 75 subjects with hypertension and left ventricular hypertrophy (HTH) according to echocardiography, 35 subjects with hypertension and normal left ventricular dimensions (HT) and 23 normotensive subjects (NT). Results. We found an excellent correlation between mean 24-h ambulatory BP and clinic BP, the r-value for systolic BP being 0.82 and for diastolic levels 0.78 (both P < 0.0001). Clinic and ambulatory BP correlated equally well with left ventricular (LV) mass index (r-values between 0.55 and 0.64, all P < 0.0001) and to intima-media thickness of the carotid artery (r = 0.18-0.34, P < 0.01). The systolic white-coat effect (clinic BP - day-time BP) was higher in the HTH and HT compared with NT and was weakly correlated to LV mass index (r = 0.18, P = 0.04). Nondippers (mean arterial night/day BP ratio of >0.9) had higher brain (6.1 ± 7.5 pmol L-1 vs. 3.7 ± 3.2 pmol L-1, P = 0.01) and atrial (14 ± 3.4 pmol L-1 vs. 9.3 ± 5.4 pmol L-1, P = 0.04) natriuretic peptide levels, and also exhibited a lower ejection fraction (49 ± 8% vs. 57 ± 9%, P = 0.006), than dippers. Conclusion. Clinic BP recordings performed by nurses as three measurements 1 min apart provide excellent relationship to target organ damage. Nondippers exhibited signs of a more advanced hypertensive organ damage than dippers which corresponds well with the poor prognosis linked to this condition. © 2005 Blackwell Publishing Ltd.

  • 135.
    Nyström, Fredrik
    et al.
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för medicin och vård, Internmedicin. Östergötlands Läns Landsting, MKC - Medicin och kirurgicentrum, EMK-endokrin.
    Malmqvist, Karin
    Öhman, Peter
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för medicin och vård, Internmedicin.
    Kahan, Thomas
    Nurse-recorded and ambulatory blood pressure predicts treatment-induced reduction of left ventricular hypertrophy equally well in hypertension: Results from the Swedish irbesartan left ventricular hypertrophy investigation versus atenolol (SILVHIA) study2002Inngår i: Journal of Hypertension, ISSN 0263-6352, E-ISSN 1473-5598, Vol. 20, nr 8, s. 1527-1533Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective: To compare the relationships of treatment-induced reductions of left ventricular hypertrophy to the changes in clinic and ambulatory blood pressure (BP). Design: Double-blind and randomized treatment with irbesartan or atenolol for 48 weeks. Patients: Patients with hypertension and left ventricular hypertrophy (n = 66) with a seated diastolic BP 90-115 mmHg (average of three measurements one minute apart by nurses). Main outcome measures: Registrations of echocardiographic left ventricular (LV) mass. Clinic and ambulatory BP. Results: In the total material, nurse-measured BP was reduced by 23 +/- 15/16 +/- 7.7 mmHg and 24-h ambulatory BP fell 20 +/- 15/14 +/- 8.5 mmHg by treatment. The correlation between the change in nurse-measured BP and LV mass index (LVMI) induced by treatment was r = 0.35, P = 0.004 for systolic BP and r = 0.26, P = 0.03 for diastolic BP. Corresponding values for 24-h ambulatory BP were r = 0.29, P = 0.02 and r = 0.35, P = 0.004, respectively, with similar correlations for day- and night-time ambulatory BP. The nurse-recorded BP was slightly higher than ambulatory BP (systolic clinic - systolic 24-h ambulatory BP = 5 mmHg). Using 130/80 mmHg as a cut-off value for normal 24-h ambulatory BP, eight subjects had normal diastolic or systolic ambulatory BP, or both. Interestingly, these patients also experienced LVMI regression following treatment (low/normal ABP, -13 +/- 21 g/m2, remaining patients, -18 +/- 22 g/m2, P > 0.5). Conclusions: In patients with hypertension and left ventricular hypertrophy, ambulatory BP is not superior to carefully standardized nurse-recorded seated BP in terms of associations with treatment-induced changes in LV mass.

  • 136.
    Nyström, Fredrik
    et al.
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för medicin och vård, Internmedicin. Östergötlands Läns Landsting, MKC-2, GE: endomed.
    Quon, MJ
    Insulin signalling: Metabolic pathways and mechanisms for specificity.1999Inngår i: Cellular Signalling, ISSN 0898-6568, E-ISSN 1873-3913, Vol. 8, s. 563-574Artikkel i tidsskrift (Fagfellevurdert)
  • 137.
    Nyström, Fredrik
    et al.
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för medicin och vård, Internmedicin. Östergötlands Läns Landsting, MKC-2, GE: endomed.
    Öhman, Peter
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för medicin och vård, Internmedicin. Östergötlands Läns Landsting, MKC-2, GE: endomed.
    Isaksson, H
    Schwan, Å
    Östergren, J
    Less difference between office and ambulatory blood pressure in women than in men both before and during antihypertensive treatment2000Inngår i: Blood Pressure, ISSN 0803-7051, E-ISSN 1651-1999, Vol. 9, nr 6, s. 340-345Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    In 199 subjects (56% women) with a diastolic blood pressure (BP) of 95-115 mmHg, 5 mg of either amlodipine or felodipine extended release (ER) was given for 4 weeks following 4 weeks of placebo-treatment. BP was measured by conventional clinic BP technique and by 24-h ambulatory BP monitoring (Spacelab 90202/90207). Men and women had identical clinic BP at baseline and it was lowered equally much by 4 weeks of treatment (men: 158/101 and 147/93, women: 159/102 and 149/93 mmHg, respectively). However, ambulatory BP was higher in women than in men both before and after treatment (men: 145/91 and 134/85, women: 149/95 and 140/89 mmHg, respectively, p < 0.05 for both comparisons). The difference between clinic BP and daytime ambulatory BP was higher in men than in women (systolic men: 8.1 +/- 14, women: 3.7 +/- 15 mmHg, respectively, p = 0.04, diastolic men: 5.5 +/- 8.0, women: 2.1 +/- 8.3 mmHg, p = 0.004). The correlation between the treatment effect measured by ambulatory and clinic BP was poor (systolic r = 0.26, p < 0.0001, diastolic r = 0.17, p = 0.03) and was unaffected by exclusion of subjects with normal ambulatory BP. The poor correlation between treatment effects measured as clinic and ambulatory BP is intriguing, and suggests that using ambulatory BP instead of clinic BP for monitoring the treatment of hypertension could affect the clinical outcome.

  • 138.
    Olejnicka, Beata Teresa
    Linköpings universitet, Institutionen för nervsystem och rörelseorgan, Patologi. Linköpings universitet, Institutionen för medicin och vård, Internmedicin. Linköpings universitet, Hälsouniversitetet.
    Insulin-Producing Cells, Iron, Oxidative Stress, and Lysosomal Pathology1999Doktoravhandling, med artikler (Annet vitenskapelig)
    Abstract [en]

    Accumulating evidence suggests that injnries caused by oxygen-derived radicals contribute to the destruction of pancreatic islet ß-cells in autoinnnune diabetes mellitus (diabetes type I, or IDDM). Oxidative stress may be caused by an enhanced production of oxygen-derived radicals, or by a decreased scavenging of such molecules. It was recently suggested that iron-mediated intralysosomal oxidative reactions result in the destabilization of lysosomal membranes, leakage of lysosomal contents to the cytosol, cellular destruction and, moreover, that such mechanisms may operate in IDDM.

    In the present study, we have investigated the mechanisms by which hydrogen peroxide induces cell damage, and its possible relationship to intralysosomal iron. The work was done on three insulin-producing insulinoma cell lines: HIT-TI5, NIT-1, and RINmF cells, on mouse pancreatic islets ß-cells, and the macrophage-like J-774 cells. In particular, we studied the influence of induced autophagocytosis (by glucose- and amino acid starvation) on the sensitivity to oxidative stress; the influence of high-glucose growth media on hydrogen peroxide cytotoxicity; the protective effects by starvation-stimulated intracellular fertitin synthesis against oxidative stress; the possible relationship between oxidative stress, lysosomal destabilization and apoptotic/necrotic cell death; and the impact of iron chelation on lysosomal stability, and insulinoma- and ß-cell survival.

    A higb susceptibility to oxidative stress was demonstrated for all the insulin-producing cells. Starvation-induced autophagocytosis increased the concentration of desfertioxarnine-available lowmolecular- weight iron in HIT-T15 cells, as assayed by HPLC. Tbe iron was mainly found in secondary lysosomes, as shown by the autometallography technique when applied at electron nticroscopical level. Starvation enhanced oxidative stress-induced damage of the IDT-T15, RINm5F and J-774 cells, as assayed by the trypan blue dye exclusion test and tests for lysosomal stability (the actidine orange relocation/uptake tests). In contrast, the pronounced starvationinduced autophagocytosis that was shown by the most vulnerable insulinoma cell line (NIT -1) was paralleled by enhanced resistance to oxidative stress, and by increased lysosomal stability as well. A rapid NIT -1 fertitin synthesis was demonstrated by inununocytochentistry under conditions of starvation. It is believed that autophagocytotic lysosomal uptake of non-iron-saturated fertitin will allow such fertitin to act as an iron chelator and stabilize lysosomes against oxidative stress. NIT -1 and B-cells which were subjected to a low level of oxidative stress (30 J.LM H20 2 for 15 min) were still largely intact at the light nticroscopical level ,but 10-20% of the cells exhibited nuclear chromatin condensation as an early sign of apoptosis when examined by the Ho334/PI staining technique, or by TEM, 0.5-1 h after the insult. At the same point of time, a decrease in the number of intact lysosomes was also observed. The rate of oxidative stress-induced lysosomal destabilization progressed with time, and a widespread apoptotic/necrotic-type degeneration/fragmentation ensued, as demonstrated by SEM, TEM, and the TUNEL-reaction. The ntitochondria revealed a mixture of lamelliform and swollen cristae, indicating altered properties of the mitochondrial membranes. Pre-treatment with the iron chelator desfenioxamine attenuated the lysosomal destabilization, and increased cell viability, following exposure to oxidative stress.

    At high-glucose conditions, the ~02-sensitivity of HIT-T15, NIT-I, and B-cells was reduced which, was consistent with a moderately enhanced stability of their lysosomes, as measured by the acridine orange-relocation test, and with reduced amounts of desfenioxamine-available iron.

    We conclude that the decisive role of free lysosomal iron in oxidative stress is strongly supported by the following lines of evidence, provided by the present study (a) glucose- and amino acid-starvation promotes autophagic/crinophagic activity of the cells, resulting in enrichment of intracellular (intralysosomal) desfenioxamine-available iron; (b) high-glucose conditions depress autophagic/crinophagic activity and, consequently, the occurrence of intralysosomal iron; (c) starvation-stimulated fenitin synthesis enhances lysosomal stability during oxidative stress by limiting lysosomal redox-active iron; (d) lysosomal destabilization and related apoptotic cell death are associated with the amounts of intralysosomal iron in redox -active form,

  • 139.
    Olsson, Anders
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för medicin och vård, Internmedicin. Östergötlands Läns Landsting, MKC-2, GE: endomed.
    A new statin: A new standard2001Inngår i: American Journal of Managed Care, ISSN 1096-1860, Vol. 7, s. 152-154Artikkel i tidsskrift (Fagfellevurdert)
  • 140.
    Olsson, Anders
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för medicin och vård, Internmedicin. Östergötlands Läns Landsting, Medicincentrum, Endokrin- och magtarmmedicinska kliniken US.
    A to Z2005Inngår i: Information från Läkemedelsverket, ISSN 1101-7104, Vol. 1, s. 16-17Artikkel i tidsskrift (Annet (populærvitenskap, debatt, mm))
  • 141.
    Olsson, Anders
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för medicin och vård, Internmedicin. Östergötlands Läns Landsting, Medicincentrum, Endokrin- och magtarmmedicinska kliniken US.
    Apolipoprotein A-I kan vara ettnytt verktyg i behandlingen av ateroskleros2004Inngår i: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 101, s. 1196-1197Artikkel i tidsskrift (Annet vitenskapelig)
  • 142.
    Olsson, Anders
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för medicin och vård, Internmedicin. Östergötlands Läns Landsting, Medicincentrum, Endokrin- och magtarmmedicinska kliniken US.
    Are lower levels of low-density lipoprotein cholesterol beneficial? A review of recent data2006Inngår i: Current Atherosclerosis Reports, ISSN 1523-3804, E-ISSN 1534-6242, Vol. 8, nr 5, s. 382-389Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    In the 1960s, epidemiologic studies established a link between elevated serum cholesterol and increased risk of cardiovascular events. Extensive clinical trial data subsequently highlighted 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors (ie, statins) as the most effective pharmacotherapy for lowering low-density lipoprotein (LDL) cholesterol, and showed that statin-mediated LDL cholesterol reductions were associated with significant improvements in cardiovascular outcomes. Such findings are reflected in current cardiovascular disease management guidelines, which focus on LDL cholesterol as the primary therapeutic target. These guidelines recommend target LDL cholesterol levels. However, a number of clinical trials have failed to identify an LDL cholesterol threshold level below which no further cardiovascular risk reduction occurs. Such findings suggest that optimal risk reduction may require greater reductions in LDL cholesterol than are currently being achieved. This review examines recent data highlighting the benefits of more pronounced LDL cholesterol reductions and considers how this could be achieved in clinical practice when many patients are not even reaching current targets. Copyright © 2006 by Current Science Inc.

  • 143.
    Olsson, Anders
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för medicin och vård, Internmedicin. Östergötlands Läns Landsting, MKC-2, GE: endomed.
    Den nya kolesteroldebatten: Är lägst bäst?1999Inngår i: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 96, s. 648-652Artikkel i tidsskrift (Annet (populærvitenskap, debatt, mm))
  • 144.
    Olsson, Anders
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för medicin och vård, Internmedicin. Östergötlands Läns Landsting, Medicincentrum, Endokrin- och magtarmmedicinska kliniken US.
    Det metabola syndromet och dess konsekvenser2005Inngår i: Incitament, ISSN 1103-503X, Vol. 1, s. 25-27Artikkel i tidsskrift (Fagfellevurdert)
  • 145.
    Olsson, Anders
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för medicin och vård, Internmedicin. Östergötlands Läns Landsting, MKC-2, GE: endomed.
    En ny sorts studie behövs.1999Inngår i: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 96, s. 1949-1949Artikkel i tidsskrift (Annet (populærvitenskap, debatt, mm))
  • 146.
    Olsson, Anders
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för medicin och vård, Internmedicin. Östergötlands Läns Landsting, MKC-2, GE: endomed.
    H÷gt kolesterolvΣrde diskrimineras i nya behandlingsrekommendationer2000Inngår i: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 97, nr 16, s. 1995-1996Artikkel i tidsskrift (Annet (populærvitenskap, debatt, mm))
    Abstract [en]

    [No abstract available]

  • 147.
    Olsson, Anders
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för medicin och vård, Internmedicin. Östergötlands Läns Landsting, Medicincentrum, Endokrin- och magtarmmedicinska kliniken US.
    Kontrollerade kliniska prövningar ger bästa svaret2005Inngår i: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 102, s. 2584-2587Artikkel i tidsskrift (Annet (populærvitenskap, debatt, mm))
  • 148.
    Olsson, Anders
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för medicin och vård, Internmedicin. Östergötlands Läns Landsting, MKC-2, GE: endomed.
    Lipidprevention av kranskärlssjukdom utan sänkning av LDL-kolesterol.2000Inngår i: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 97, s. 1368-1370Artikkel i tidsskrift (Annet vitenskapelig)
  • 149.
    Olsson, Anders
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för medicin och vård, Internmedicin. Östergötlands Läns Landsting, Medicincentrum, Endokrin- och magtarmmedicinska kliniken US.
    Lipoprotein Changes and Reduction in the Incidence of Major Coronary Heart Disease Events in teh Scandinavian Simvastatin Survival Study2004Inngår i: Atherosclerosis, ISSN 0021-9150, E-ISSN 1879-1484, Vol. 5, s. 99-106Artikkel i tidsskrift (Fagfellevurdert)
  • 150.
    Olsson, Anders
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för medicin och vård, Internmedicin. Östergötlands Läns Landsting, Medicincentrum, Endokrin- och magtarmmedicinska kliniken US.
    Lägre LDL-kolesterol är bättre! Sikta på 2mmol/l i sekundärpreventiv behandling2006Inngår i: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 103, s. 22-23Artikkel i tidsskrift (Annet vitenskapelig)
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