Karolinska Institute (karolinska + institute)

Distribution by Scientific Domains

Selected Abstracts

The Early History of Cardiac Surgery in Stockholm

Kjell Radegran M.D.
The portal figure is Clarence Crafoord (1899,1983) who already in 1927 had succeeded with the Trendelenburg pulmonary embolectomy operation. He went on to develop lung surgery in general. With foresight he stimulated the chemists of Karolinska Institute to purify heparin, first for prophylaxis against venous thromboembolism and later for use with the heart-lung machine. In 1944 he became the first surgeon to successfully operate on patients with coarctation of the aorta. With Viking Olov Bjork and Ake Senning the heart-lung machine was improved, finally allowing its clinical use in a patient operated in 1954 for a myxoma of the left atrium, with long-term survival. This was the first successful use of the heart-lung machine in Sweden and the second in the world. He and his coworkers, first at the Sabbatsberg hospital and from 1957 at the Karolinska hospital made major contributions to cardiology and radiology, apart from the progresses in cardiac surgery. Contributions such as pressure recording from the left atrium by needle puncture in 1950, the Senning operation for transposition of the great arteries and the first use of a totally implantable cardiac pacemaker in 1958 are indeed medical history. (J Card Surg 2003;18:564-572) [source]

Causes and consequences of proteinuria: the kidney filtration barrier and progressive renal failure

K. Tryggvason
Abstract., Tryggvason K, Pettersson E (Karolinska Institute, Stockholm, Sweden). Causes and consequences of proteinuria: the kidney filtration barrier and progressive renal failure (Review). J Intern Med 2003; 254: 216,224. The past few years have witnessed a major breakthrough in the understanding of the molecular mechanisms and ultrastructural changes behind the development of proteinuria. The discovery of several proteins in the glomerular podocyte and slit diaphragm, where mutations lead to disease, has revealed the importance of this cell with its diaphragm as the major filtration barrier as opposed to the glomerular basement membrane (GBM) previously ascribed this function. Furthermore, accumulating clinical as well as experimental evidence points to the harmful effects of proteinuria, irrespective of the original damage. The purpose of this review is to shed light on what we know today about the two sides of this ,coin', the causes and the consequences of proteinuria. [source]

The risk of ipsilateral versus contralateral recurrent deep vein thrombosis in the leg

P. Lindmarker
Abstract. Lindmarker P, Schulman S, the DURAC Trial Study Group (Karolinska Hospital, Karolinska Institute, Stockholm, Sweden) The risk of ipsilateral versus contralateral recurrent deep vein thrombosis in the leg. J Intern Med 2000; 247: 601,606. Objectives. To investigate the risk of ipsilateral versus contralateral recurrent deep vein thrombosis in the leg. Design. An open prospective long term follow-up multicentre trial. Patients were followed by frequent outpatient visits at each centre during the first 12 months after inclusion and thereafter annually. Setting. Sixteen hospitals in central Sweden. Subjects. A total of 790 consecutive patients with objectively verified first episode of acute deep vein thrombosis and without diagnosed malignant disease were recruited from a randomized study comparing 6 weeks with 6 months of oral antivitamin K therapy as secondary thromboprophylaxis. Main outcome measures. Deep vein thrombosis in the contralateral leg was confirmed by venography or ultrasound. With regard to the ipsilateral leg, venography was required. Results. A recurrent episode of venous thromboembolism was documented in 192 patients after a mean (▒SD) period of 31(▒29) months. In 26 additional patients with ipsilateral symptoms the diagnostic critera were not fulfilled. One hundred and eleven patients have deceased and 69 patients withdrew from the study. The 392 patients without recurrent episodes were followed for a median of 96 months with 90% for at least 48 months. An objectively verified recurrent contralateral and ipsilateral deep vein thrombosis occurred in 95 and 54 cases, respectively, and in 41 patients pulmonary embolism was documented. In two patients thromboses with unusual locations were registered. The risk of contralateral versus ipsilateral recurrence was significantly increased with a risk ratio of 1.6 (95% confidence interval 1.4,1.9) in a time to event model. In a multivariate analysis none of the investigated variables were significantly associated with the side of recurrent thrombosis. Conclusions. The risk of a recurrent deep vein thrombosis is increased in the contralateral leg. This brings into question the importance of an impaired venous flow for recurrent episodes of thrombosis. [source]

Immunomodulation of atherosclerosis: myth and reality

A. Nicoletti
Abstract. Nicoletti A, Caligiuri G & Hansson GK (H˘pital Broussais, Paris, and Karolinska Institute, Stockholm). Immunomodulation of atherosclerosis: myth and reality (Minisymposium). J Intern Med 2000; 247: 397,405. Atherosclerosis is an inflammatory disease which displays features of immune activation both locally and systemically. In the present review, we discuss the evidence for immune activation in human disease and experimental models, and survey candidate antigens associated with atherosclerosis. Studies of atherosclerosis in genetic models of immunodeficiency are analysed, as well as immunomodulating therapies and immunization protocols. Based on recent research, it is concluded that immunomodulation represents an interesting approach to the development of new prevention and treatment methods for atherosclerosis. [source]

Risks of rheumatic diseases in first- and second-generation immigrants in Sweden: A nationwide followup study

Xinjun Li
Objective To examine whether there is an association between country of birth in first-generation immigrants and first hospitalization for a rheumatic disease, and to study whether any such association remains in second-generation immigrants. Methods In this followup study, the Swedish MigMed database at the Karolinska Institute in Stockholm was used to identify all primary hospital diagnoses of rheumatic diseases in first- and second-generation immigrants in Sweden between January 1, 1964 and December 31, 2004. Incidence ratios, standardized with regard to age, geographic region, and socioeconomic status, were estimated by sex in first- and second-generation immigrants. Results First-generation immigrants from Iraq had a higher risk of rheumatoid arthritis than did subjects in the native-born Swede reference group, and the risk of systemic lupus erythematosus was increased in immigrants from Iraq and Africa; these raised risks persisted in the second generation. The lower risk of rheumatoid arthritis in some first-generation immigrants disappeared in the second generation. In groups of second-generation immigrants, the risk of ankylosing spondylitis was similar to the risk in the corresponding parental groups. Polish-born immigrants and second-generation Yugoslavs and Russians showed a significantly increased risk of systemic sclerosis. The raised risk of systemic sclerosis did not persist in the second generation, but was clustered in groups involved in certain blue collar occupations. Conclusion Country of birth affected the risk of rheumatic disease. These findings indicate that both genetic and environmental factors are involved in the etiology of specific rheumatic diseases. [source]