Anders E. Henriksson

The isolation and some liganding properties of lactoperoxidase

Lactoperoxidase is an animal protein which participates in antimicrobial mechanisms [I]. Its electron donor profile differs from that of plant peroxidases regarding halide ions [2]. Isolation procedures are available but somewhat tedious [3--S]. Plant isoperoxidases with different affinities for aromatic substrates can be separated on phenylSepharoseR [6]. This observation has now been developed into an isolation procedure for LP. Its essential features are alternations between column materials with ionic and hydrophobic binding forces. The opposite requirements for ionic strength minimize the number of dialyses. The binding of LP to phenyland octyl-Sepharose is compared to the binding of horseradish peroxidase to both Sepharoses. Attempts are made to relate these adsorptions to optically operable equilibria between the peroxidases and free, aromatic ligands. Plant peroxidases can be isolated by means of affinity chromatography on hydroxamic acid-BioGel AR [7]. An imidazolecarrying polysaccharide binds hemoglobin and myoglobin specifically and unspecifically [8]. Sepharose-concanavalin A binds the glycoprotein HRP [9,10].

Helicobacter pylori and the Relation to Other Risk Factors in Patients with Acute Bleeding Peptic Ulcer

BACKGROUND The influence of ulcer risk factors is well known in chronic peptic ulcer disease. In this study the risk factors were investigated in patients with peptic ulcer complicated by an acute bleeding episode. METHOD In 106 consecutive patients with acute bleeding peptic ulcer, age, previous history of ulcer disease, presence of dyspeptic symptoms, smoking habits, consumption of nonsteroidal anti-inflammatory drugs (NSAIDs), and haemoglobin concentration at admission were recorded. Helicobacter pylori infection was detected by means of two serologic tests in samples obtained at admission for the acute bleeding episode. RESULTS Three-quarters of both gastric ulcer and duodenal ulcer patients were shown to have H. pylori antibodies. NSAID use and smoking habits were similar in patients with and without H. pylori antibodies. CONCLUSIONS The results indicate that H. pylori infection, NSAID use, and smoking habits act as largely independent risk factors in patients with acute bleeding peptic ulcer.

Fibrinolysis in patients with an abdominal aortic aneurysm with special emphasis on rupture and shock

Summary.  Background: A ruptured abdominal aortic aneurysm (AAA) is associated with high mortality. Postoperative complications such as hemorrhage, multiple organ failure, myocardial infarction, and thromboembolism are common. An active and balanced hemostatic system is essential to avoid bleeding as well as thrombosis. When these activities are not properly regulated the patient is at risk of developing either excessive bleeding or thrombosis‐related complications. Previous studies have shown a state of activated coagulation in patients with ruptured AAA. However, there are conflicting results regarding the fibrinolytic response. Objectives: The aim of the present study was to investigate the fibrinolytic state pre‐operatively in patients with ruptured and non‐ruptured AAA in relation to the clinical outcome with special regard to the influence of shock. Methods: A prospective study was performed on 95 patients who underwent surgery for a ruptured AAA with shock (n = 43), a ruptured AAA without shock (n = 12), and a non‐ruptured AAA (n = 40). Forty‐one controls without an aneurysm were matched to the AAA patients according to age, gender and smoking habits. Plasma levels of tissue plasminogen activator antigen (tPAag), and plasminogen activator inhibitor type‐1 (PAI‐1) were measured as markers of fibrinolytic activity. D‐dimer, a marker of fibrin turnover, was also measured. Results: D‐dimer was significantly higher in patients with a non‐ruptured AAA compared with controls without AAA. There were significantly higher levels of D‐dimer, tPAag, and PAI‐1 in patients operated for ruptured compared with non‐ruptured AAA. tPAag was also significantly higher in ruptured AAA patients with shock compared with without shock. No deaths occurred in patients operated on for a non‐ruptured AAA or ruptured AAA without shock. There were 12 deaths after repair of a ruptured AAA with shock, of which two patients died from bleeding and the remaining 10 from multiple organ failure and cardiac failure. Conclusion: Our results indicate a state of activated coagulation in patients with a non‐ruptured AAA, the state being intensified by rupture. The present data show normal fibrinolytic activities in patients with a non‐ruptured AAA, but increased systemic fibrinolysis, as demonstrated by elevated tPAag level, in patients with a ruptured AAA. The elevated PAI‐1 level indicates a simultaneous inhibition of the systemic fibrinolysis. Furthermore, the hyperfibrinolytic state was reinforced by shock in this study. However, the clinical outcome, with a relatively high incidence of thrombosis‐related deaths, indicate a prothrombotic state instead of a hyperfibrinolytic state as a major point of attention in patients with shock as a result of a ruptured AAA.

Haemostatic markers in patients with abdominal aortic aneurysm and the impact of aneurysm size.

INTRODUCTION Abdominal aortic aneurysm is a common condition with high mortality when rupturing. However, the condition is also associated with nonaneurysmal cardiovascular mortality. A possible contributing mechanism for the thrombosis related cardiovascular mortality is an imbalance between the activation of the coagulation system and the fibrinolytic system. The aim of the present study was to investigate haemostatic markers in patients with nonruptured abdominal aortic aneurysm with special regard to the influence of aneurysm size and smoking habits. METHODS Seventy-eight patients with infrarenal aortic aneurysm and forty-one controls without aneurysm matched by age, gender and smoking habits were studied. Thrombin-antithrombin (TAT), prothrombin fragment 1+2 (F 1+2)--markers of thrombin generation, and von Willebrand factor antigen (vWFag)--considered as a reliable marker of endothelial dysfunction--were measured. Plasma levels of tissue plasminogen activator antigen (tPAag), and plasminogen activator inhibitor type 1 (PAI-1) were measured as markers of fibrinolytic activity. D-dimer, a marker of fibrin turnover, was also measured. RESULTS There were significantly higher levels of TAT and D-dimer in patients with abdominal aortic aneurysm. The highest level of TAT and D-dimer were detected in patients with large compared to small AAA. CONCLUSIONS The present data indicate a state of activated coagulation in patients with abdominal aortic aneurysm which is dependent by aneurysm size. The activated coagulation in AAA patients could contribute to an increased cardiovascular risk in patients also with small AAA. The possible impact of secondary prevention apart from smoking cessation has to be further evaluated and is maybe as important as finding patients at risk of rupture.

Proinflammatory and Anti-inflammatory Cytokine Balance in Patients With Abdominal Aortic Aneurysm and the Impact of Aneurysm Size

Abdominal aortic aneurysm is a common condition with high mortality due to rupture; however, the condition also is associated with nonaneurysmal cardiovascular mortality. A possible contributing mechanism for the cardiovascular mortality is an imbalance between the proinflammatory and anti-inflammatory systemic response. In the present study, 78 patients with abdominal aortic aneurysm and 41 controls without aneurysm matched by age, gender and smoking habits were investigated. Cytokines such as interleukin-6, interleukin-10, and monocyte chemoattractant protein-1 were measured in plasma. There was significantly higher level of interleukin-6 in patients with AAA compared to controls. The interleukin-6/ interleukin-10 ratio was highest in patients with large compared to small abdominal aortic aneurysm. In conclusion, the present data indicate a proinflammatory response and a proinflammatory to antiinflammatory imbalance in patients with abdominal aortic aneurysm which is dependent by aneurysm size.

Steal syndrome of the hemodialysis vascular access: diagnosis and treatment.

Purpose Steal syndrome is an uncommon but serious condition of arterial insufficiency distal to a permanent hemodialysis fistula. The management of the condition is a great challenge to the surgeon because of the conflicting goals of preserving the fistula and treat the ischemia. In this review the purpose was to analyze the clinical problem and treatment possibilities. Methods Medline and Embase databases were searched for studies relevant to diagnosis and management of steal syndrome of the hemodialysis vascular access. Results The diagnosis of steal syndrome is largely based on clinical features and non-invasive studies. In same cases angiography may be necessary to find out the real causes of the steal syndrome. The cause is usually high fistula flow but other causes as steal phenomenon, inflow, outflow or anastomotic stenosis have to be considered and even combination of causes. The main treatment options are some form of flow reducing procedure or the distal revascularization interval ligation method. In some cases simple distal arterial ligation is the method of choice. Furthermore, in some patients a stenosis has to be treated as the first treatment option. Conclusion For an appropriate treatment of a steal syndrome a careful analysis of the cause is important.

Discovery of a Novel Circulating Biomarker in Patients with Abdominal Aortic Aneurysm: A Pilot Study Using a Proteomic Approach

Abdominal aortic aneurysm (AAA) is a common condition with high mortality when ruptured. Most clinicians agree that small AAAs are best managed by ultrasonographic surveillance. However, it has been stated in recent reviews that a serum/plasma biomarker that predicts AAA rupture risk would be a powerful tool in stratifying patients with small AAA. Identification of such circulating biomarkers has been to date unsuccessful. In this study, we used a proteomic approach to find new, potential plasma AAA biomarker candidates. Prefractionated plasma samples were analyzed by two‐dimensional differential in‐gel electrophoresis to identify differentially expressed proteins between four patients with small AAA and four controls without aneurysm. Protein spots that differed significantly between patients and controls were selected and identified by mass spectrometry. Three protein spots had significantly different expression between patients and controls. The most interesting finding was that patients with small AAA had increased levels of the enzyme glycosylphosphatidylinositol‐specific phospholipase D (GPI‐PLD) compared with the controls without aneurysm. In conclusion, by using a proteomic approach, this pilot‐study provides evidence of GPI‐PLD as a novel potential plasma biomarker for AAA. Clin Trans Sci 2012; Volume 5: 56–59

Assessment of autonomic nerve function in myotonic dystrophy

The function of the autonomic nervous system was studied in 23 patients with myotonic dystrophy, from a defined population in northern Sweden with an extremely high prevalence of this disease. Heart rate variability tests showed only minor signs of parasympathetic dysfunction. Blood pressure and plasma noradrenaline measurements in recumbent and upright positions showed no signs of sympathetic neuropathy. Increased plasma levels of noradrenaline was an unexpected finding. Our study does not support the hypothesis that cardiac arrhythmias, orthostatic hypotension, gastrointestinal motility disturbances and urinary bladder dysfunction in myotonic dystrophy are caused by autonomic neuropathy, and we believe that these symptoms should rather be ascribed to a defective function of the target organs.

Postgame elevation of cardiac markers among elite floorball players

Cardiac biomarker release after exercise is well documented in endurance sports, but neither the impact of intermittent high‐intensity exercise nor the reproducibility has yet been established. Floorball, a popular sport in Scandinavia, involves intermittent periods of high‐intensity exercise. This study aimed to determine the prevalence and reproducibility of elevated cardiac marker levels among elite floorball players after two games. Twenty‐three healthy male elite floorball players of median age 19 years (range 16–34 years) participated in two standard games. Blood was drawn at three time points: pregame, immediately after, and 2 h after the game. Creatine kinase MB (CK‐MB), myoglobin, and high‐sensitivity cardiac troponin T (hs‐cTnT) were measured. The results showed significantly elevated median postgame values in all markers. In both games, hs‐cTnT exceeded the cutoff for myocardial damage (≥ 14 ng/L) 2 h postgame in the same six players. The major findings were that postgame cardiac hs‐cTnT values among elite floorball players were significantly elevated and reproducible. The findings imply that extended investigations should incorporate evaluation of myocardial function and myocardial perfusion during exercise to seek the clinical significance and underlying mechanisms of elevated cardiac troponin after high‐intensity exercise.

Abdominal Aortic Aneurysm and the Impact of Infectious Burden

OBJECTIVES Little is known about the biological processes causing aortic aneurysm rupture. Chronic Chlamydophila pneumoniae infection has been suggested as a possible contributing factor to the development and expansion of abdominal aortic aneurysm (AAA). The importance of infection in AAA may be related to the previous pathogen burden, that is, the number of significant titres of antibodies against infectious pathogens rather than to single infectious agents. The aim of this study was to examine the relationship between infectious burden and AAA rupture. METHODS In a case-control study, 119 patients with abdominal aortic aneurysm and 36 matched controls without aneurysm were prospectively investigated for specific IgG class antibodies against C. pneumoniae, Helicobacter pylori, Cytomegalovirus, and Herpes simplex virus. RESULTS Patients with ruptured AAA have similar levels of pathogen burden as patients with nonruptured electively operated AAA, small AAA, and controls without aneurysm. CONCLUSION The present study fails to demonstrate a connection between infectious burden and abdominal aortic aneurysm rupture.