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Karlsson, Torbjörn
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Publications (10 of 23) Show all publications
Nyberg, C., Karlsson, T., Hillered, L., Stridsberg, M. & Engström, E. R. (2016). The Early Endocrine Stress Response in Experimental Subarachnoid Hemorrhage. PLoS ONE, 11(3), Article ID e0151457.
Open this publication in new window or tab >>The Early Endocrine Stress Response in Experimental Subarachnoid Hemorrhage
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2016 (English)In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 11, no 3, article id e0151457Article in journal (Refereed) Published
Abstract [en]

Introduction In patients with severe illness, such as aneurysmal subarachnoid hemorrhage (SAH), a physiologic stress response is triggered. This includes activation of the hypothalamic-pituitary-adrenal (HPA) axis and the sympathetic nervous system. The aim of this study was to investigate the very early responses of these systems. Methods A porcine animal model of aneurysmal SAH was used. In this model, blood is injected slowly to the basal cisterns above the anterior skull base until the cerebral perfusion pressure is 0 mm Hg. Sampling was done from blood and urine at -10, +15, +75 and +135 minutes from time of induction of SAH. Analyses of adrenocorticotropic hormone (ACTH), cortisol, aldosterone, catecholamines and chromogranin-A were performed. Results Plasma ACTH, serum cortisol and plasma aldosterone increased in the samples following induction of SAH, and started to decline after 75 minutes. Urine cortisol also increased after SAH. Urine catecholamines and their metabolites were found to increase after SAH. Many samples were however below detection level, not allowing for statistical analysis. Plasma chromogranin-A peaked at 15 minutes after SAH, and thereafter decreased. Conclusions The endocrine stress response after aneurysmal SAH was found to start within 15 minutes in the HPA axis with early peak values of ACTH, cortisol and aldosterone. The fact that the concentrations of the HPA axis hormones decreased 135 minutes after SAH may suggest that a similar pattern exists in SAH patients, thus making it difficult to catch these early peak values. There were also indications of early activation of the sympathetic nervous system, but the small number of valid samples made interpretation difficult.

National Category
Endocrinology and Diabetes Neurology
Identifiers
urn:nbn:se:uu:diva-296872 (URN)10.1371/journal.pone.0151457 (DOI)000372701200055 ()
Available from: 2016-06-20 Created: 2016-06-20 Last updated: 2017-11-28Bibliographically approved
Wiklund, L., Johansson, H. & Karlsson, T. (2015). Martin H: son Holmdahl.. Upsala Journal of Medical Sciences, 120(2)
Open this publication in new window or tab >>Martin H: son Holmdahl.
2015 (English)In: Upsala Journal of Medical Sciences, ISSN 0300-9734, E-ISSN 2000-1967, Vol. 120, no 2Article in journal (Refereed) Published
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-266753 (URN)10.3109/03009734.2015.1044055 (DOI)25941864 (PubMedID)
Available from: 2015-11-10 Created: 2015-11-10 Last updated: 2017-12-01
Karlsson, T. (2015). Mass spectrometry evaluation of the hepcidin-25 assay in the differential diagnosis of iron deficiency anaemia with concurrent inflammation and anaemia of inflammation in elderly patients.. European Journal of Haematology, 95(5), 467-471
Open this publication in new window or tab >>Mass spectrometry evaluation of the hepcidin-25 assay in the differential diagnosis of iron deficiency anaemia with concurrent inflammation and anaemia of inflammation in elderly patients.
2015 (English)In: European Journal of Haematology, ISSN 0902-4441, E-ISSN 1600-0609, Vol. 95, no 5, p. 467-471Article in journal (Refereed) Published
Abstract [en]

In this study, mass spectrometry was used to evaluate the hepcidin-25 assay in the differential diagnosis of iron deficiency anaemia with concurrent inflammation and anaemia of inflammation in elderly patients using the absence of stainable bone marrow iron as the gold standard criterion for iron deficiency (ID). In addition, correlation coefficients for hepcidin-25 vs. haematimetric and biochemical iron parameters, and C-reactive protein (CRP) were determined. The optimal cut-off for hepcidin-25 was 31.5 ng/mL corresponding to a sensitivity and specificity of 82% and 95%, respectively, for ID. For ferritin, a sensitivity and specificity of 70% and 100%, respectively, correspond to an optimal cut-off of 41.5 μg/L. Receiver operating characteristics curve analysis revealed that mass spectrometry analysis of hepcidin-25 does not appear to be superior to ferritin in the diagnosis of ID in elderly anaemic patients with concurrent inflammation. Hepcidin-25 shows a strong positive correlation with ferritin, and also correlates positively with CRP, in this patient population.

Keywords
hepcidin-25; iron deficiency; anaemia of inflammation
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-266756 (URN)10.1111/ejh.12518 (DOI)000363328800013 ()25598191 (PubMedID)
Available from: 2015-11-10 Created: 2015-11-10 Last updated: 2017-12-01Bibliographically approved
Karlsson, T. (2015). Progress and Milestones in Scientific Communication--a 150 years perspective.. Upsala Journal of Medical Sciences, 120(2)
Open this publication in new window or tab >>Progress and Milestones in Scientific Communication--a 150 years perspective.
2015 (English)In: Upsala Journal of Medical Sciences, ISSN 0300-9734, E-ISSN 2000-1967, Vol. 120, no 2Article in journal (Refereed) Published
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-266754 (URN)10.3109/03009734.2015.1022669 (DOI)25872591 (PubMedID)
Available from: 2015-11-10 Created: 2015-11-10 Last updated: 2017-12-01
Karlsson, T. (2015). Secondary haemophagocytic lymphohistiocytosis: Experience from the Uppsala University Hospital. Upsala Journal of Medical Sciences, 120(4), 257-262
Open this publication in new window or tab >>Secondary haemophagocytic lymphohistiocytosis: Experience from the Uppsala University Hospital
2015 (English)In: Upsala Journal of Medical Sciences, ISSN 0300-9734, E-ISSN 2000-1967, Vol. 120, no 4, p. 257-262Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Haemophagocytic lymphohistiocytosis (HLH) is a rare clinical syndrome characterized by fever, hepatosplenomegaly, cytopenia, and progressive multiple-organ failure. HLH in adults is often secondary to autoimmune diseases, cancer, or infections in contrast to familial HLH. Treatment of secondary HLH is directed against the triggering disease in addition to immunosuppressive therapy, the latter commonly according to the HLH-2004 protocol.

METHODS: We conducted a retrospective study to identify triggering diseases, disease-specific and immunosuppressive therapy administered, and prognosis in adult patients with secondary HLH. Patient data were collected from October 2010 to January 2015.

RESULTS: Ten adult patients with secondary HLH were identified. Seven were men, and the median age at diagnosis was 62 years. Five cases were triggered by malignant disease and five by infection. The median patient fulfilled five of the eight HLH-2004 diagnostic criteria. All patients fulfilled the criteria fever, cytopenia, and ferritin >500 µg/L. Median time from hospital admission to HLH diagnosis was 20 days. Four patients received immunosuppressive therapy according to the HLH-2004 protocol. The prognosis was dismal, especially for the patients with malignancy-associated HLH, of whom all died.

CONCLUSION: HLH should be suspected in patients who present with fever, cytopenia, and ferritin >500 µg/L. Secondary HLH has a dismal prognosis. None of the patients with HLH triggered by malignancy survived. Achieving remission of the triggering disease seems to be important for a favourable outcome as, in all surviving patients, the haemophagocytic syndrome resolved after remission of the underlying infection.

Keywords
Haemophagocytic lymphohistiocytosis; HLH-2004 protocol
National Category
Medical and Health Sciences Hematology
Identifiers
urn:nbn:se:uu:diva-266755 (URN)10.3109/03009734.2015.1064500 (DOI)000365684900005 ()26212358 (PubMedID)
Available from: 2015-11-10 Created: 2015-11-10 Last updated: 2017-12-01Bibliographically approved
Nyberg, C., Karlsson, T., Hillered, L. & Ronne-Engström, E. (2014). Metabolic Pattern of the Acute Phase of Subarachnoid Hemorrhage in a Novel Porcine Model: Studies with Cerebral Microdialysis with High Temporal Resolution. PLoS ONE, 9(6), e99904
Open this publication in new window or tab >>Metabolic Pattern of the Acute Phase of Subarachnoid Hemorrhage in a Novel Porcine Model: Studies with Cerebral Microdialysis with High Temporal Resolution
2014 (English)In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 9, no 6, p. e99904-Article in journal (Refereed) Published
Abstract [en]

Background: Aneurysmal subarachnoid hemorrhage (SAH) may produce cerebral ischemia and systemic responses including stress. To study immediate cerebral and systemic changes in response to aneurysm rupture, animal models are needed. Objective: To study early cerebral energy changes in an animal model. Methods: Experimental SAH was induced in 11 pigs by autologous blood injection to the anterior skull base, with simultaneous control of intracranial and cerebral perfusion pressures. Intracerebral microdialysis was used to monitor concentrations of glucose, pyruvate and lactate. Results: In nine of the pigs, a pattern of transient ischemia was produced, with a dramatic reduction of cerebral perfusion pressure soon after blood injection, associated with a quick glucose and pyruvate decrease. This was followed by a lactate increase and a delayed pyruvate increase, producing a marked but short elevation of the lactate/pyruvate ratio. Glucose, pyruvate, lactate and lactate/pyruvate ratio thereafter returned toward baseline. The two remaining pigs had a more severe metabolic reaction with glucose and pyruvate rapidly decreasing to undetectable levels while lactate increased and remained elevated, suggesting persisting ischemia. Conclusion: The animal model simulates the conditions of SAH not only by deposition of blood in the basal cisterns, but also creating the transient global ischemic impact of aneurysmal SAH. The metabolic cerebral changes suggest immediate transient substrate failure followed by hypermetabolism of glucose upon reperfusion. The model has features that resemble spontaneous bleeding, and is suitable for future research of the early cerebral and systemic responses to SAH that are difficult to study in humans.

National Category
Surgery
Identifiers
urn:nbn:se:uu:diva-229957 (URN)10.1371/journal.pone.0099904 (DOI)000338508200053 ()24940881 (PubMedID)
Available from: 2014-08-18 Created: 2014-08-18 Last updated: 2017-12-05Bibliographically approved
Nyberg, C., Karlsson, T. & Ronne-Engström, E. (2014). Predictors of increased cumulative serum levels of the N-terminal prohormone of brain natriuretic peptide 4 days after acute spontaneous subarachnoid hemorrhage. Journal of Neurosurgery, 120(3), 599-604
Open this publication in new window or tab >>Predictors of increased cumulative serum levels of the N-terminal prohormone of brain natriuretic peptide 4 days after acute spontaneous subarachnoid hemorrhage
2014 (English)In: Journal of Neurosurgery, ISSN 0022-3085, E-ISSN 1933-0693, Vol. 120, no 3, p. 599-604Article in journal (Refereed) Published
Abstract [en]

Object. The rupture of an intracranial aneurysm is followed by increased intracranial pressure and decreased cerebral blood flow. A major systemic stress reaction follows, presumably to restore cerebral blood flow. However, this reaction can also cause adverse effects, including myocardial abnormalities, which are common and can be serious, and increased levels of natriuretic peptides, especially brain natriuretic peptide (BNP). The association of BNP with fluid and salt balance, vasospasm, brain ischemia, and cardiac injury has been studied but almost exclusively regarding events after admission. Brain natriuretic peptide has also been measured at various time points and analyzed in different ways statistically. The authors approached BNP measurement in a new way; they used the calculated area under the curve (AUC) for the first 4 days to quantitatively measure the BNP load during the first critical part of the disease state. Their rationale was a suspicion that early BNP load is a marker of the severity of the ictus and will influence the subsequent course of the disease by disturbing the fluid and salt balance. Methods. The study included 156 patients with acute spontaneous subarachnoid hemorrhage (SAH). Mean patient age was 59.8 +/- 11.2 years, and 105 (67%) of the patients were female. An aneurysm was found in 138 patients. A total of 82 aneurysms were treated by endovascular coiling, 50 were treated by surgery, and 6 were untreated. At the time of admission, serum samples were collected for troponin-I analysis and for the N-terminal prohormone of BNP (NT-proBNP); daily thereafter, samples were collected for the NT-proBNP analysis. The cumulative BNP load was calculated as the AUC for NT-proBNP during the first 4 days. The following variables were studied in terms of their influence on the AUC for NT-proBNP: sex, age, World Federation of Neurosurgical Societies grade of SAH, Fisher grade, angiographic result, treatment of aneurysm,'clinical neurological deterioration, verified infections, vasospasm treatment, and 6-month outcome. Results. The AUC for NT-proBNP was larger when variables indicated a more severe SAH. These variables were higher Fisher and World Federation of Neurosurgical Societies grades, high levels of troponin-I at admission, an aneurysm, neurological deficits, and infections. The AUC for NT-proBNP was also larger among women, older patients, and patients with poor outcomes. Linear regression showed that the best predicting model for large AUC for NT-proBNP was the combination of the following: female sex, high levels of troponin-I, an aneurysm, neurological deficits, and advanced age. Conclusions. The cumulative BNP load during the first days after SAH can be predicted by variables describing the severity of the disease already known at the time of admission. This information can be used to identify patients at risk for an adverse course of the disease.

Keywords
subarachnoid hemorrhage, NT-proBNP, vascular disorders, brain natriuretic peptide, troponin-I
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-222748 (URN)10.3171/2013.8.JNS13625 (DOI)000332048800003 ()
Available from: 2014-04-14 Created: 2014-04-14 Last updated: 2017-12-05Bibliographically approved
Rask-Andersen, A. & Karlssson, T. (2013). Gör ett totalt omtag. Läkartidningen, 110(15), 775
Open this publication in new window or tab >>Gör ett totalt omtag
2013 (Swedish)In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 110, no 15, p. 775-Article in journal (Other (popular science, discussion, etc.)) Published
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-219511 (URN)
Available from: 2014-03-03 Created: 2014-03-03 Last updated: 2017-12-05Bibliographically approved
Karlsson, T. (2013). Iron-restricted erythropoiesis in anaemic patients with giant cell arteritis and polymyalgia rheumatica. Open journal of blood diseases, 3, 49-52
Open this publication in new window or tab >>Iron-restricted erythropoiesis in anaemic patients with giant cell arteritis and polymyalgia rheumatica
2013 (English)In: Open journal of blood diseases, ISSN 2164-3199, Vol. 3, p. 49-52Article in journal (Refereed) Published
Abstract [en]

The aim of this observational study was to biochemically characterize the anaemia in GCA (giant cell arteritis) and PMR (polymyalgia rheumatica) patients. Values for mean corpuscular volume, mean corpuscular hemoglobin and solu- ble transferrin receptor were normal, whereas serum iron and total iron binding capacity (TIBC) were subnormal, and mean ferritin was above the upper reference limit. Iron-restricted erythropoiesis (IRE), defined as a bone marrow smear staining positive for iron in combination with transferrin saturation less than 20%, was present in all patients. All pa- tients exhibited clinical and biochemical signs of active inflammation with elevated C-reactive protein and an increased erythrocyte sedimentation rate.

National Category
Clinical Medicine
Identifiers
urn:nbn:se:uu:diva-223966 (URN)10.4236/ojbd.2013.31010 (DOI)
Available from: 2014-04-28 Created: 2014-04-28 Last updated: 2014-08-08Bibliographically approved
Rask-Andersen, A. & Karlssson, T. (2013). Nonchalans när universitet och landsting behandlar känsliga personuppgifter. Läkartidningen, 110(11), 566-567
Open this publication in new window or tab >>Nonchalans när universitet och landsting behandlar känsliga personuppgifter
2013 (Swedish)In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 110, no 11, p. 566-567Article in journal (Other (popular science, discussion, etc.)) Published
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-219505 (URN)
Available from: 2014-03-03 Created: 2014-03-03 Last updated: 2017-12-05Bibliographically approved
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