Bernd Stegmayr

Promotive effect on human sperm progressive motility by prostasomes

SummarySeminal plasma constituents were separated on Sephadex G200 gel columns. The column eluate was analysed with regard to protein content, ATPase activity and promotive activity on sperm progressive motility. Two different chromatographic fractions were also subjected to electron microscopy after sedimentation by preparative ultracentrifugation. A maximum promotive value on sperm progressive motility coincided with a maximum ATPase activity value in a single peak from seminal plasma eluted first on the column and containing less protein than the other peaks appearing later in the chromatogram. This first peak was the only one containing ATPase activity and membrane-surrounded organelles named prostasomes. Other peaks, rich in protein but lacking ATPase and prostasomes, displayed a moderate and rather irregular pattern in reference to promotive activity on sperm progressive motility. Evidence is given that the positive effect by prostasomes is specific on sperm progressive motility. Hence, procedures aiming at a change of membrane integrity of the prostasomes resulted in diminished effects on sperm progressive motility. This could be explained by a probable dissipation of the electrochemical gradient of calcium ions.

Tobacco and myocardial infarction: is snuff less dangerous than cigarettes?

OBJECTIVE--To estimate the risk of myocardial infarction in snuff users, cigarette smokers, and non-tobacco users in northern Sweden, where using snuff is traditional. DESIGN--Case-control study. SETTING--Northern Sweden. SUBJECTS--All 35-64 year old men who had had a first myocardial infarction and a population based sample of 35-64 year old men who had not had an infarction in the same geographical area. MAIN OUTCOME MEASURE--Tobacco consumption (regular snuff dipping, regular cigarette smoking, non-tobacco use) and risk of acute myocardial infarction. RESULTS--59 of 585 (10%) patients who had a first myocardial infarction and 87 of 589 (15%) randomly selected men without myocardial infarction were non-smokers who used snuff daily. The age adjusted odds ratio for myocardial infarction was 0.89 (95% confidence interval 0.62 to 1.29) for exposure to snuff and 1.87 (1.40 to 2.48) for cigarette smoking compared with non-tobacco users, showing an increased risk in smokers but not in snuff dippers. Regular cigarette smokers had a significantly higher risk of myocardial infarction than regular snuff dippers (age adjusted odds ratio 2.09; 1.39 to 3.15). Smoking, but not snuff dipping, predicted myocardial infarction in a multiple logistic regression model that included age and level of education. CONCLUSIONS--In middle aged men snuff dipping is associated with a lower risk of myocardial infarction than cigarette smoking.

An Mg2+ and Ca2+-Stimulated Adenosine Triphosphatase in Human Prostatic Fluid - Part II*

Es wird über die Enzym‐Aktivität eines Mg2+ und Ca2+‐abhängigen ATPase‐Enzym‐systems berichtet, die an eine subzelluläre Organelle geknüpft und in der Prostata‐Flüs‐sigkeit und damit im Seminalplasma vorhanden ist. Die elektronmikroskopische Beobachtung des über 12 h bei 40 000 × G zentrifugierten Sediments aus der Prostata‐Flüssigkeit als auch aus dem Seminalplasma zeigte sekretorische Granulae und Vesiculae, wobei die meisten Partikel von einer dreischichtigen Membran umschlossen waren. Andere jedoch zeigten eine fünfschichtige Membran. Das ATPase‐Enzymsystem wurde charakterisiert; die scheinbare Michaelis‐Konstante (Km) sowie Vmax der Mg2+‐abhängigen ATPase ergab 7,1 × 10−4 M bzw. 4,0 mikromol pro 0,1 ml Prostata‐Flüssigkeit und 5 Min. Die entsprechenden Werte der Ca2+‐abhängigen ATPase ergaben 3,8 × 10−4 M und 3,2 mikromol pro 0,1 ml und 5 Min.

Diabetes as a risk factor for myocardial infarction: population and gender perspectives

Abstract. Lundberg V, Stegmayr B, Asplund K, Eliasson M, Huhtasaari F (Kalix Hospital, Umel University Hospital and Lulei‐Boden Hospital, Sweden). Diabetes as a risk factor for myocardial infarction: population and gender perspectives.

Trends in incidence, case-fatality rate, and severity of stroke in northern Sweden, 1985-1991.

Incidence, case-fatality rate at 28 days, and severity of acute stroke were recorded for 7 years in a large population-based stroke register to understand the reasons for the decline in stroke mortality in northern Sweden. Methods Within the framework of the World Health Organization MONICA Project, acute stroke was monitored in people aged 35 to 74 years in northern Sweden from 1985 through 1991 (target population in 1985, 238 948). Results The annual incidence of stroke decreased by an average of 2.3%/y in men aged 35 to 64 years (P=.074) and increased significantly by 1.1%/y in men aged 65 to 74 years (p=.041). No significant changes in incidence occurred in either age group in women. The 28-day case-fatality rate in first-ever strokes (both sexes together) declined from 21.9% to 15.4% in patients aged 65 to 74 yean (P=.02). Among survivors, the proportion with extensive motor deficits (at any time during the first 28 days) declined in patients younger than 65 years as well as in those older than 65 years (p=.007 and p=.019, respectively). In patients aged 35 to 64 years, the proportion with aphasia/dysphasia also decreased significantly (P=.032), but no such trend was seen in those aged 65 to 74 years. Conclusions A shift toward higher ages has been noted in the occurrence of first-ever strokes in men, while incidence has remained unchanged in women. During the 7 years of observation, stroke has become a less severe disease.

Impact of smokeless tobacco use on smoking in northern Sweden.

Abstract. Rodu B, Stegmayr B, Nasic S, Asplund K (University of Alabama at Birmingham, AL, USA and University Hospital, Umeå, Sweden). Impact of smokeless tobacco use on smoking in northern Sweden. J Intern Med 2002; 252: 398–404.

Septic Shock Induced by Group a Streptococcal Infection: Clinical and Therapeutic Aspects

During 1988 and 1989 > 500 cases of serious group A streptococcal infections were reported in Sweden, many with a fatal outcome. We report here on 11 consecutive patients with septic preshock/shock and multiorgan failure, including acute renal failure. 10 had verified group A streptococci (GAS) serotype T1M1 infections while 1 patient was culture negative but with clinical signs of severe infection and serological evidence of GAS infection. Presenting symptoms were high fever, relative bradycardia, edema and renal failure. In all patients the condition deteriorated despite conventional treatment including volume substitution and antibiotics. Systolic blood pressure was transiently < 80 mmHg in 10 patients and 9 of them needed infusion of inotropic agents to avoid fatal circulatory shock. In 9 patients respiratory aid was instituted and 7 were dialysed. Plasma exchange was performed in 7, while the remaining 4 received transfusions with blood and plasma without plasma exchange. 10 patients improved and were discharged within 8 weeks. One woman died within 2 days after admission to the hospital. Renal function recovered in all survivors, with a follow-up serum creatinine < 80 mumol/l. The complicated clinical picture in these patients with many simultaneous therapeutic events confounds the interpretation of the effect of single actions. The favourable outcome in these severely ill patients suggests that potent inotropic agents, immunoglobulin therapy and plasma exchange might be beneficial in severe streptococcal disease when conventional treatment fails.

Plasma exchange as rescue therapy in multiple organ failure including acute renal failure

OBJECTIVE To describe the outcome of using a rescue therapy including plasma exchange given to patients with a progressive acute disseminated intravascular coagulation and multiple organ dysfunction syndrome. STUDY DESIGN Retrospective study. SETTING University and county hospital. PATIENTS Included were 76 consecutive patients (41 men and 35 women) treated with plasma exchange as rescue therapy besides optimal conventional therapy during a progressive course of disseminated intravascular coagulation and multiple organ dysfunction syndrome, including acute renal failure. Of the 76 patients, 66% needed dialysis. The distribution was hemodialysis in 76%, continuous arteriovenous hemofiltration in 36%, continuous venovenous hemodialysis in 12%, and peritoneal dialysis in 24%. The median organ-failure score was 5 (range, 1-6). Seventy-two percent required mechanical ventilation; septic shock was present in 88%. The median septic shock score was 4 (range, 2-4). Nine patients had another reason than sepsis for the multiple organ dysfunction syndrome. INTERVENTION Plasma exchange (centrifugation technique) was performed until disseminated intravascular coagulation was reversed (median, two times; range, 1-14). Besides antibiotics and fluid administration, most patients received heparin or low molecular weight heparin (77%), steroids (87%), and inotropes (88%). More than one vasoactive drug was used in 57% of the patients. MEASUREMENTS AND MAIN RESULTS Eighty-two percent of the patients survived and could leave the hospital. The previously observed survival rates by others for this category of patients would be <20%, and thus, the outcome in this study is significantly better. CONCLUSION Plasma exchange using plasma as replacement may, in addition to conventional intensive care, help to reverse severe progressive disseminated intravascular coagulation and multiple organ dysfunction syndrome and improve survival.

Wegener granulomatosis in children and young adults. A case study of ten patients.

Abstract This retrospective study reports seven children and three young adults (aged 11–30 years) who suffered from Wegener granulomatosis. Nine represent consecutive patients admitted to the Division of Nephrology over a period of 23 years. All patients had respiratory tract symptoms and renal involvement on admission. In several patients infiltrates on chest X-ray developed within 2 weeks of onset of symptoms. All patients survived. The median observation period was 9 years (range 13 months to 23 years). One patient progressed to end-stage renal disease. Nine patients initially received cyclophosphamide and steroids. After a median period of 9 months (range 6–31 months) the cyclophosphamide was replaced by azathioprine. Relapses occurred after a median of 28 months (range 4–120 months) in 80% of patients, in six of the eight patients causing a definite decrease in kidney function. We believe that early diagnosis and initiation of therapy reduce the extent of organ damage. Since relapses are frequent, these patients should be evaluated frequently.

Evolving patterns of tobacco use in northern Sweden

Abstract.  Rodu B, Stegmayr B, Nasic S, Cole P, Asplund K (University of Alabama at Birmingham, Birmingham, AL, USA; Umeå Hospital, Umeå, Sweden). Evolving patterns of tobacco use in northern Sweden. J Intern Med 2003; 253: 660–665.