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- Angsten, Gertrud, 1948-
(författare)
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Fat metabolism : A clinical and experimental study with special reference to newborns
- 2002
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Lipid emulsion is an important constituent of total parenteral nutrition (TPN). In the investigations described in this thesis the effects of different lipid emulsions in neonates were studied.Twenty neonates in each of two studies, undergoing surgery for oesophago-gastrointestinal malformations, were assigned the day after the operation to receive TPN for 5 days, containing one of the two emulsions. In the first study 10 neonates received PFE 4501 containing gamma-linolenic acid (GLA) and carnitine and 10 were given Intralipid®and served as controls. In the second study 10 received Vasolipid® and 10, the control group, Intralipid®. In both studies linoleic acid and α-linolenic acid increased in plasma lipid esters and adipose tissue in each group. Arachidonic acid decreased in the PFE 4501 group in spite of GLA supplementation. Plasma carnitine increased two-fold in the PFE 4501 group, but decreased in the groups receiving Vasolipid® or Intralipid®. Reference ranges for muscle carnitine concentrations in children 1 days to 14 years of age were determined for comparisons. The results showed that the carnitine concentration in skeletal muscle tissue was greatly dependent on the gestational age in newborns. Accumulation of carnitine in skeletal muscle tissue continued during the first year of life, after which the concentration remained essentially constant. There are several methods for determining carnitine concentrations in plasma and muscle, but in the PET camera measurements are made in vivo. The transfer of long-chain fatty acids into the mitochondria, which relies on the carnitine-dependent transport system, was studied with PET, with labelling of the radioactive isotope carbon-11. Inhibition of carnitine palmitoyltransferase I by oxfenicine almost completely blocked the oxidative pathway of palmitic acid, while short carbon-chain fatty acids, which are independent of carnitine for their transport, were virtually unaffected. The fractional oxidative utilisation of long-chain fatty acids may thus be used as an index of the activity of the carnitine-dependent transport system.
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| 2. |
- Angsten, Gertrud, et al.
(författare)
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Improved outcome in neonatal short bowel syndrome using parenteral fish oil in combination With ω-6/9 Lipid Emulsions
- 2012
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Ingår i: JPEN - Journal of Parenteral and Enteral Nutrition. - : Wiley. - 0148-6071 .- 1941-2444. ; 36:5, s. 587-595
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Tidskriftsartikel (refereegranskat)abstract
- Background:Newborn infants with short bowel syndrome (SBS) represent a high risk group of developing intestinal failure-associated liver disease (IFALD) which may be fatal. However, infants have a great capacity for intestinal growth and adaptation if IFALD can be prevented or reversed. A major contributing factor to IFALD may be the soybean oil-based intravenous lipid emulsions used since the introduction of parenteral nutrition (PN) 40 years ago. Methods:This retrospective study compares the outcome in 20 neonates with SBS treated with parenteral fish oil (Omegaven) in combination with omega-6/9 lipid emulsions (ClinOleic) with the outcome in a historical cohort of 18 patients with SBS who received a soybean oil-based intravenous lipid emulsion (Intralipid).Results:Median gestational age was 26 weeks in the treatment group and 35.5 weeks in the historical group. All patients were started on PN containing Intralipid that was switched to ClinOleic/Omegaven in the treatment group at a median age of 39 gestational weeks. In the treatment group, direct bilirubin levels were reversed in all 14 survivors with cholestasis (direct bilirubin >50 umol/). Median time to reversal was 2.9 months. Only 2 patients died of liver failure (10%). In the historical cohort, 6 patients (33%) died of liver failure and only 2 patients showed normalization of bilirubin levels.Conclusions:Parenteral fish oil in combination with omega-6/9 lipid emulsions was associated with improved outcome in premature neonates with SBS. When used instead of traditional soybean-based emulsions, this mixed lipid emulsion may facilitate intestinal adaptation by increasing the IFALD-free period.
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| 4. |
- Angsten, Gertrud, et al.
(författare)
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Outcome of laparoscopic versus open gastrostomy in children
- 2015
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Ingår i: Pediatric surgery international (Print). - : Springer Science and Business Media LLC. - 0179-0358 .- 1437-9813. ; 31:11, s. 1067-1072
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Tidskriftsartikel (refereegranskat)abstract
- Laparoscopic gastrostomy (LAPG) has gained popularity in children. The aim of this study was to compare the outcome of LAPG versus open gastrostomy (OG) in children with focus on complications, operative times and postoperative length of stay. Retrospective study of children who had gastrostomies inserted at our tertiary Pediatric Surgery Center from 2000 until 2013. The indications for a gastrostomy were an anticipated need for enteral support for at least 6 months. Totally 243 children were included in the study, 83 with LAPG and 160 with OG. We found a significant difference in postoperative length of stay, 3 days in the LAPG group versus 4 days in the OG group but no difference in a sub-group analysis from 2010 to 2013 when both techniques were used. There was no difference in median operative time or complications rates. Granuloma was the dominating complication in both groups. These two feeding-access techniques are comparable regarding complications, operative times and postoperative length of stay. The choice of surgical method should be individualized based on the patient's characteristics and the experience of the surgeon. The favorable results with LAPG in adults are not necessarily transferable to children since there are physiological and anatomical differences.
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| 5. |
- Angsten, Gertrud, et al.
(författare)
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Resolution of infantile intestinal pseudo-obstruction in a boy
- 2017
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Ingår i: Journal of Pediatric Surgery Case Reports. - : Elsevier. - 2213-5766. ; 24, s. 28-34
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Tidskriftsartikel (refereegranskat)abstract
- A term boy with spontaneous passage of meconium exhibited episodes of abdominal distension and diarrhea. Due to failure to thrive and suspicion of Hischsprung's disease he was referred to our university hospital at five months of age. Rectal biopsies were normal. Laparotomy revealed dilation of the small bowel and colon without any mechanical obstruction. Full thickness bowel biopsies were taken and a loop ileostomy was constructed. Histopathology revealed fibrosing myopathy, Cajal cell hypertrophy, and neuronal degeneration in both the large and small bowel. The small bowel showed mastocytosis without inflammation. A central venous catheter was placed for vascular access, replaced three times and later switched to a subcutaneous venous port. Catheters were locked after use with vancomycin-heparin and later taurolidine. The individually tailored home parenteral nutrition contained unsaturated fatty acid lipids to reduce cholestasis. Initial insufficient growth was improved after correction of partial parenteral nutrition based on a metabolic balance study. The ileostomy was revised once and finally taken down at 11 years of age following one year without parenteral support. At follow-up at 13 years of age he has episodes of moderate abdominal pain and has entered puberty and reports a high quality of life. (C) 2017 The Authors. Published by Elsevier Inc.
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| 6. |
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| 7. |
- Hammarqvist, Folke, et al.
(författare)
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Age-related changes of muscle and plasma amino acids in healthy children
- 2010
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Ingår i: Amino Acids. - : Springer Science and Business Media LLC. - 0939-4451 .- 1438-2199. ; 39:2, s. 359-366
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Tidskriftsartikel (refereegranskat)abstract
- The aim of the study was to explore if changes in muscle and plasma amino acid concentrations developed during growth and differed from levels seen in adults. The gradient and concentrations of free amino acids in muscle and plasma were investigated in relation to age in metabolic healthy children. Plasma and specimens from the abdominal muscle were obtained during elective surgery. The children were grouped into three groups (group 1: < 1 year, n = 8; group 2: 1-4 years, n = 13 and group 3: 5-15 years, n = 15). A reference group of healthy adults (21-38 years, n = 22) was included in their comparisons and reflected specific differences between children and adults. In muscle the concentrations of 8 out of 19 amino acids analysed increased with age, namely taurine, aspartate, threonine, alanine, valine, isoleucine, leucine, histidine, as well as the total sums of branched chain amino acids (BCAA), basic amino acids (BAA) and total sum of amino acids (P < 0.05). In plasma the concentrations of threonine, glutamine, valine, cysteine, methionine, leucine, lysine, tryptophane, arginine, BCAA, BAA and the essential amino acids correlated with age (P < 0.05). These results indicate that there is an age dependency of the amino acid pattern in skeletal muscle and plasma during growth.
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| 8. |
- Li, Xiaonan, et al.
(författare)
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Adiponectin and peroxisome proliferator-activated receptor gamma expression in subcutaneous and omental adipose tissue in children
- 2008
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Ingår i: Acta Paediatrica. - : Wiley. - 0803-5253 .- 1651-2227. ; 97:5, s. 630-5
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Tidskriftsartikel (refereegranskat)abstract
- AIM: To compare the expression levels of the adiponectin and peroxisome proliferator -activated receptor gamma (PPARgamma) genes in subcutaneous adipose tissue (SC) and omental adipose tissue (OM) in children with relation to age and anthropometric variables. METHODS: Paired biopsies (SC and OM) were obtained from 53 children (age 0.2-14 years, BMI 12.5-25.8 kg/m(2)). Adiponectin and PPARgamma mRNA levels in adipose tissue were measured by real-time PCR. RESULTS: In overweight, but not in normal weight children, the median adiponectin mRNA level was significantly lower in OM [0.51 (0.1-2.17)] compared to SC [1.29 (0.16-5.08)], (p = 0.03). Adiponectin mRNA levels were strongly associated with PPARgamma mRNA levels in both SC (r = 0.73, p < 0.001) and OM (r = 0.78, p < 0.001). CONCLUSIONS: The lower adiponectin expression in OM relative to SC in overweight children indicates that metabolic-endocrine alterations begin already in childhood. The close association between adiponectin and PPARgamma expression supports the hypothesis this transcription factor is involved in adiponectin gene regulation.
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| 9. |
- Li, X., et al.
(författare)
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Depot-specific messenger RNA expression of 11 beta-hydroxysteroid dehydrogenase type 1 and leptin in adipose tissue of children and adults
- 2007
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Ingår i: International Journal of Obesity. - London : Macmillan. - 0307-0565 .- 1476-5497. ; 31:5, s. 820-828
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To compare expression of messenger RNA (mRNA) coding for the cortisol regenerating enzyme 11-hydroxysteroid dehydrogenase type 1 (11-HSD1), and the adipocytokines leptin and resistin in paired biopsies of subcutaneous adipose tissue (SC) and omental adipose tissue (OM) from children. Design: Paired biopsies (SC and OM) were obtained from 54 children (age 0.17–16 years, body mass index (BMI) 12.5–28.3 kg/m2, BMI standard deviation score (SDS) -2.5–4.5) and 16 adults (age 27–79 years, BMI 19–46 kg/m2) undergoing open abdominal surgery. mRNA levels of 11-HSD1, leptin and resistin were measured using quantitative real-time polymerase chain reaction (PCR). Results: 11-HSD1 mRNA level was higher in OM than in SC (P<0.05), whereas leptin mRNA was higher in SC than in OM (P<0.001). There was no difference in the resistin mRNA level between SC and OM. These results were consistent in children and adults. In children, 11-HSD1 mRNA in SC was positively associated with BMI SDS (P<0.05), whereas in OM it was positively associated with age (P<0.05). The association between 11-HSD1 expression and age remained significant after adjustment for BMI SDS and gender. Leptin mRNA was positively associated with BMI SDS (SC:P<0.001, OM: P<0.001) but not with age in children. In multiple regression analyses, including anthropometric variables and age, BMI SDS was independently associated with mRNA levels of 11-HSD1 (P<0.05) and leptin (P<0.001) in SC. When normal weight and overweight children were analyzed separately, 11-HSD1 mRNA levels were positively associated with leptin in OM in the overweight group (P<0.05). Conclusion: There are depot-specific differences in mRNA levels of 11-HSD1 and leptin in children and adults. The positive association of 11-HSD1 mRNA in OM with age may reflect a causal role in visceral fat accumulation during growth. Increasing 11-HSD1 and leptin mRNA in SC with increasing BMI SDS could suggest that the risk of metabolic consequences of obesity may be established early in life.
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