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  • Arbman, Gunnar (författare)
  • Colorectal cancer in Östergötland : risk factors, diagnosis, and quality of treatment
  • 1996
  • Doktorsavhandling (övrigt vetenskapligt)abstract
    • <p>In this investigation colorectal cancer in the county of Östergötland has been studied with emphasis on risk factors, diagnostic efforts, and the results of treatment.</p><p>In two case-control studies on food and colorectal cancer, a decreased risk was associated with a high intake of cereal fibre, total fibre, and calcium per unit energy consumed as well as a high intake of raw vegetables. Processed meat was associated with an increased lisk for colon cancer and alcohol with an increased risk for rectal cancer. Drug consumption was also found to influence the cancer risk.</p><p>In a case-control study on occupational factors and the risk for colorectal cancer, some occupations seemed to influence the risk for colon and rectal cancer in different ways. Twenty years of physically active work significantly decreased the risk for left-sided colon cancer but increased the risk for rectal cancer. Accordingly, twenty year of sedentary work significantly decreased the risk for rectal cancer.</p><p>Known risk factors were found in 12% of colorectal cancer patients, though previous cholecystectomy did not turn out to be a risk factor.</p><p>The symptoms of colon cancer are vague and unspecific, whereas bleeding is prominent and a dominating symptom in rectal cancer. Conflicting results have been presented regarding the importance of a short delay between onset of symptoms and treatment. In our study, a more favourable stage distribution was found for rectal cancer with a very short delay between start of symptoms and treatment, but not for colon cancer.</p><p>Results of treatment for colorectal cancer show considerable variation in different series, which can be due to differences in selection and classification as well as in treatment. A computerized system for quality assurance of colorectal cancer was introduced in Östergötland in 1984. All cases diagnosed 1984-1986 were registered in this system, making it possible to study outcome of treatment for an unselected population. The results of treatment in terms of postoperative mortality and five year survival were comparable to the results from specialised international centres, but local recunence rate after operation for rectal cancer was high (20%).</p><p>To reduce this local recurrence rate, the technique of total mesorectal excision was introduced in three of the surgical departments in the county. Using the system for quality assurance, the local recunence rate during a three year period before the change in technique was compared with a three year period when the new technique was used. The local recunence rate was significantly reduced in the later period without any change in postoperative complications.</p><p>In conclusion this study shows an environmental influence on cancer-risk that may be different for colon and rectal cancer. The usefulness of a continuous quality assurance system to detect shmtcomings in diagnosis and treatment and to evaluate new techniques is also shown. Finally, total mesorectal excision reduces the local recurrence rate for rectal cancer in an unselected population treated in different kinds of hospital.</p>
  • Bergman, Hanna (författare)
  • Intraocular and intracranial transplantation of neural tissue : Studies on hypothalamic and hippocampal neuros
  • 1995
  • Doktorsavhandling (övrigt vetenskapligt)abstract
    • <p>Previous studies has demonstrated the possibility to transplant monoaminergic neurons intracranially and to the anterior chamber of the eye, where these neurons continue to develop into functional, transmitter expressing cells. In the present study, investigations were undertaken to examine the development of transplanted hypothalamic and hippocampal neurons in the rat. The intention was to examine synaptic maturation in the isolated brain tissue and the possibility of histaminergic neurons to survive transplantation intraocularly and intracranially into the denervated hippocampus. Properties such as fiber ingrowth into eo-transplanted tissue, electrophysiological activity and histaminergic H3-receptor response, and influence of hypothalamic tissue on eo-transplanted tissues were evaluated. Synaptic maturation was studied using an immunoblot assay of the synapsin I and II proteins and synapsin immunohistochemistry. The hypothalamic grafts were examined with immunohistochemistry and histamine assay of the levels of histamine in the transplants. Electrophysiological recordings of single cell activity was used to study the effect of H3-receptor agonist and antagonist. The isolated intra ocular transplants of hippocampal tissue developed significant amounts of synapsin proteins with an overall distribution pattern as in the hippocampus in situ. Histaminergic neurons in the hypothalamic transplants survived transplantation both intraocularly and intracranially. The neurons were found to send neurites into the host iris and into eo-grafted CNS tissue. The hypothalamic transplants were also found to have a stimulatory effect on the growth of eo-grafted hippocampal tissue and on pyramidal cell differentiation. Neurons within the hypothalamic transplants exhibited spontaneous activity that was suppressed upon agonist stimulation of H3-receptors. These findings demonstrate that histaminergic neurons grow and develop in transplanted hypothalamic tissue and that neurons in these transplants expressed histamine and functional H3-receptors.</p>
  • Berterö, Carina, 1959- (författare)
  • Living with leukaemia : studies on quality of life, interaction and caring
  • 1996
  • Doktorsavhandling (övrigt vetenskapligt)abstract
    • <p>Leukaemia is one form of cancer disease, comprising both an acute or chronic form, and has a wide range of altemative therapy aids, as well as a highly unpredictable prognosis. This thesis is a study of 27 patients with acute and chronic leukaemia.</p><p>The general aim of the present thesis was to acquire knowledge about quality of life (QOL) from the perspective of the adult individual with leukaemia. It was also to enquire how the health care system and the nursing staff can improve this individual's experienced quality of life. Data have been collected through qualitative interviews (articles I, II and III), observations, follow-up interviews and reflective conversations(articles IV and V). The data have been analysed using constant comparative analysis (articles I, II, IV and V) and narrative qualitative text analysis (article III).</p><p>Quality of life was found to be experienced as 'a positive attitude to life' by those adults with acute leukaemia, and autonomy and interpersonal relationships were of great importance in experiencing this. Those with chronic leukaemia experienced quality of life as 'life satisfaction'. Even here interpersonal relationships played a major role, as did self-esteem, performance ability and social ability. When explaining the differentprofiles in quality of life experienced by those adults with acute and chronic leukaemia, uncertainty was the phenomenon found. Adults with acute leukaemia experienced uncertainty concerning the prognosis, recurrence, aggravations and set-backs. Those with chronic leukaemia were uncertain about adjusting their lives, changing life-styles as well as being in doubt. Both groups described this uncertainty as not feeling secure, not being in control and being undecided.</p><p>Transition, i.e. the individual passing from one phase to another, was the core category found when studying the interaction between adults with leukaemia and their nursing staff. This transition could be described in three stages. First, being a person and trying to maintain a social status. Second, becoming a patient, accepting the disease and feeling insecure in this totally new situation. Finally, the patient becomes a leukaemia patient, isolating her/himself and becoming aware of the disease and its side-effects.</p><p>In the study about the care supplied by the nursing staff and demanded by the leukaemia patients, the findings produced two core categories; routines and interaction. The care supplied was identified as routines, which could be seen as regular courses of procedures and a way of bringing order into daily life. Routines could also be a distancing manoeuvres to manage stress when working with seriously ill people. The care demanded by these leukaemia patients was human interaction. The leukaemia patient wants to be treated as a human being, with mutual respect, concern etc. The patients want to participate and interact while still maintaining their self-respect and individual integrity.</p><p>This thesis points out that the QOL of those adults with leukaemia could be improved by the health care system and the nursing staff through caring for them as fellow beings, with respect and giving them autonomy and self-control. If the nurses and nursing staff are to be able to care for leukaemia/cancer patients, they have to care for themselves. If they become more aware of their own feelings and reactionS, they will also become more attentive to the patients' experiences and needs.</p>
  • Bjartmar, Carl (författare)
  • On the relation between nerve fibres and glial cells
  • 1996
  • Doktorsavhandling (övrigt vetenskapligt)abstract
    • <p>The general aim of this study is to generate knowledge on the normal axo-glial relations in developing and adult vertebrate white matter. CNS and PNS specimens from developing and mature rats and from chickens of various ages were analysed through electron microscopy of single and serial sections, or through immunohistochemistry. Sections from fish, frog and turtle were examined by immunohistochemistry. Teased nerves from adult rats were subjected to light microscopic analysis. In addition, Western blot analysis was performed on material from adult chicken spinal cord.</p><p>At onset of myelination, oligodendrocytes related to prospective large myelinated axons in the ventral funiculus of the spinal cord contact fewer axons than oligodendrocytes related to axons in the cotpus callosum, which are destined to remain small. This difference increases with time. In addition, the data suggest that some spinal oligodendrocytes in the rat reduce the number of sheaths initially elaborated, before formation of compact myelin. In the chicken, the T4-0 antiserum recognizes a single 50 kDa protein. Staining with different markers for glial cells indicate that the T4-0 immunoreactivity is located mainly to a subgtoup of white matter oligodendrocytes in the ventral funiculus, being colocalized with large fibres which myelinate early during development. The T4-0 molecule is expressed after onset of myelination. It can not be detected in fish, amphibian, reptile and mammalian white matter. These results suggest that oligodendrocytes in the rat and in the chicken form a heterogeneous population and that this heterogeneity is related to time of onset of myelination and prospective axon diameter.</p><p>In the ventral root L5 of newborn rats, the average Schwann cell sheath is 60-70 Jlm long at onset of myelination. The corresponding adult myelin sheath length is 1250 Jlm. While the sheaths exhibit a developmental elongation of 17 times, the root elongates 11 times only. In developing rat white matter, uncompacted oligodendroglia! sheaths are 21-33 Jlm long, many sheaths being &lt;10 Jlm. The average sheath containing cytoplasmic segments and compact myelin is 102 Jlm long in the spinal cord and 69 Jlm long in the cotpus callosum. The intercalated naked axon portions present are too short to accomodate the developmental sheath elongation. These data show that PNS and CNS initial sheath lengths are markedly different, and indicate that both sheath types undergo an early remodelling.</p><p>Nodes along thin callosal axons possess tiny node gaps with few or no astrocytic processes. Nodes along thick spinal axons have large node gaps containing scattered astrocytic processes. Antibodies against HNK-1, chondroitin sulfate (CS), tenascin or NSP-4labellarge but not small nodes. These data indicate that the relation between nodal complexity and fibre size is less strict in the CNS than in the PNS and that CS occurs at CNS nodes.</p><p></p>
  • Blom, René (författare)
  • Sarcoma of the female genital tract Histopathology, DNA cytometry, p53 and mdm-2 analysis related to prognosis
  • 1999
  • Doktorsavhandling (övrigt vetenskapligt)abstract
    • <p>Sarcomas of the female genital tract are rare tumors and account for less than 5% of gynecologic malignancies. Traditionally, gynecologic sarcomas have been divided into different tumor types according to their histopathological features. The most common are leiomyosarcoma (LMS), malignant mixed Müllerian tumors (MMMT), endometrial stromal sarcoma (ESS) and (Müllerian) adenosarcoma. The different tumor types are highly aggressive with early lymphatic and/or hematogenous spread. Treatment is difficult and it is believed that sarcomas have a low radio-and chemosensitivity, and the mainstay in treatment is surgical removal of the tumor. The most important prognostic feature has been tumor stage. Nevertheless, there are some early-stage tumors that run a biological course different from that expected and additional prognostic factors indicating high-risk tumors are desirable.</p><p>The study cohort consists of 49 uterine LMS, 44 uterine MMMTs, 17 uterine ESS, 11 uterine adenosarcomas and 26 ovarian MMMTs. The tumors were analyzed in a retrospective manner for DNA ploidy, S-phase fraction (SPF), p53 and mdm-2 expression, as well as traditional clinical and pathological prognostic factors, such as tumor stage. grade, atypia and mitotic index.</p><p>Of the 49 LMS, 36 (86%) were non-diploid and 13 (27%) were p53-positive. Among the 44 uterine MMMTs, 30 (68%) were non-diploid and 27 (61%) had an SPF&gt;10%. Twenty-seven (61%) overexpressed p53 and 11 (25%) were mdm-2 positive. Furthermore, 40 (91%) of the uterine MMMTs had a high mitotic count and 42 (95%) had high grade cytologic atypia. All low-grade ESS were DNA diploid and had a low SPF. Among the four high-grade ESS, three (75%) were DNA aneuploid and three (75%) were p53-positive. Among 1 1 adenosarcomas, eight (73%) were non-diploid. All ovarian MMMTs were non-diploid and all but two had an SPF&gt;10%. 19 (73%) ovarian MMMTs were p53positive.</p><p>The 5-year survival rate was 33% for LMS, 38% for uterine MMMT, 57% for ESS, 69% for adenosarcoma and 30% for ovarian MMMT.</p><p>Thirty-five (71%) patients with LMS died of disease and two of intercurrent disease. Stage was found to be the most important factor for survival (p=0.007); in addition DNA ploidy (p=0.045) and SPF (p=0.041) had prognostic significance.</p><p>Twenty-seven (61%) patients with uterine MMMT died of disease and six (14%) died of intercurrent disease. Stage was the only prognostic factor for survival.</p><p>Nine (53%) patients with ESS died of disease. There was a significant correlation of survival to tumor grade (p=0.007), DNA ploidy (p=0.026), SPF (p=0.048) and stage (p=0.026).</p><p>Of the 11 patients with adenosarcoma, four (36%) patients died of disease and three (27%) patients died of intercurrent disease. There were no variables that correlated with survival.</p><p>Eighteen (69%) patients with ovarian MMMT died of disease and two (8%) patients died of intercurrent disease. In a multivariate analysis, only stage reached independent prognostic significance for survival (p=0.023).</p><p>In summary, stage represents the most important prognostic factor for survival for uterine and ovarian sarcomas. DNA flow cytometry is useful in gaining additional prognostic information for LMS and ESS. P53-and mdm-2 overexpression had no prognostic value for survival rate. Most of the MMMT overexpressed p53 and were non-diploid. Treatment of sarcomatous neoplasms is difficult and the mainstay remains surgical removal of the tumor. For patients with early stage sarcoma there was a high recurrence rate, which suggests that a large proportion of patients may have systemic micrometastasic disease at the time of diagnosis. Recurrent and metastatic uterine sarcoma remains an incurable disease, and treatment must be considered palliative.</p>
  • Blomstrand, Peter (författare)
  • Echocardiographic methods for assessment of coronary artery disease
  • 1995
  • Doktorsavhandling (övrigt vetenskapligt)abstract
    • <p>Upright bicycle exercise echocardiography with digital image acquisition in seated position during exercise and in recumbent position before and immediately after exercise was performed in 66 men, one month after an episode of unstable coronary arte1y disease. It was difficult to obtain images of adequate quality during exercise but new or worsening of wall motion abnormalities not seen in recumbent position after exercise were detected at peak-exercise in patients with good image quality. Therefore, image acquisition seated at peak bicycle exercise and in the recumbent position immediately after exercise are of complementary value.</p><p>Bicycle exercise echocardiography and 201-Tl myocardial perfusion scintigraphy SPECT were compared in 65 men after an episode of unstable coronary artery disease. Reversible abnormalities were seen in 55 patients with cchocardiography and in 43 patients with 201-Tl scintigraphy {p&lt;O.OS). The segmental agreement between the methods was 58%. The additional value of exercise echocardiography and 201-Tl SPECT to exercise test was greatest in patients with one-vessel disease as detected by coronary angiography.</p><p>The hemodynamic alterations induced by dobutamine stress testing were investigated using Doppler-echocardiography and venous occlusion plethysmography in 11 healthy women and 18 female patients. The healthy subjects received a lower peak-dose of dobutamine, 22±7.5 j.lg kg-I miu-1 compared with 33±9.7 j.lg kg- I min-I administered to the patients (p&lt;O.Ol). The increase in hemt rate during dobutamine infusion was significantly greater in the subjects, +68%, compared with the patients, +49%, {p&lt;O.OS). Corresponding figures for changes in systolic blood flow velocity in the left ventricular outflow tracts were +82% versus +50% (p&lt;0.01), cardiac output +93% versus +60% (p&lt;0.05), total peripheral vascular resistance -49% versus -44% and leg peripheral vascular resistance -32% versus -26% (not significant) in subjects and patients respectively. The hemodynamic alterations were age and dose dependant in the subjects. Mean systolic blood pressure for the two groups was unchanged but one subject and four patients developed hypotension (decrease in systolic blood pressure &gt;10 mm Hg). One patient in the hypotension group developed a paradoxical vagal reaction with bradycardia at peak-dose and two patients had a very low increase in cardiac output (12%). The fomth patient with hypotension did not differ in change in cardiac output compared to the other patients. Despite a more pronounced decrease in total peripheral vascular resistance in these four patients compared with other patients, there was no difference in leg peripheral vascular resistance between the groups. The disparity between the pattern of total to legperipheral vascular resistance in patients with hypotension might reflect a baroreceptor mediated compensatmy increase in vasoconstrictor tone of muscle vessels not matched in other vascular territories.</p><p>Echocardiographic M-mode recordings of mitral annulus motion were compared with Doppler registrations of mitral and pulmonary venous flow velocities in 38 patients with heart failure (NYHA ll-IU) after myocm·dial infarction. Patients with an increased atlial component of annulus motion in absolute (a :::::5.1 mm, n::::l9) or relative terms (a/T &gt;57%, n::::l2) had a higher miti·allate to early flow velocity ratio and pulmonmy venoussystolic to diastolic filling ratio (p&lt;O.OS), which is associated with prolonged left ventricular relaxation. Patients with an increased afT ratio also had a more pronounced left ventricular systolic dysfunction compared with others {p&lt;0.01). There was a significant con-dation between afT ratio and AlE ratio (r=0.61, p&lt;0.001) but the information contained in the two indices was not identical.</p>
  • Bohr, Johan (författare)
  • Collagenous colitis : A study of epidemiology, etiology, clinical features and treatment
  • 1996
  • Doktorsavhandling (övrigt vetenskapligt)abstract
    • <p>Collagenous colitis (CC) is characterised clinically by chronic watery diarrhoea and histopathologically by an increased submucosal collagen layer. An epidemiologic study of CC during 1984 to 1993 showed a female:male ratio of 9:1. The median age at diagnosis was 64 (28-78) years. The prevalence was 15.7/105 on December 31, 1993, and the mean annual incidence was 1.8/1()5 inhabitants. Age specific incidence showed a peak of 14.6/105 in females 70-79 years old, which approaches the incidence for ulcerative colitis in the same age group.</p> <p>Faecal stream diversion in 9 patients with severe, medically intractable CC induced histologic and clinical remission. This observation indicates that a noxious agent in the faecal stream constitutes an etiologic factor in CC. Faecal stream diversimi offers a treatment alternative in patients with severe CC who do not respond to medical treatment.</p> <p>Sera from 38 patients with CC and matched controls were analysed for specific autoantibodies, immunoglobulins and complement. The mean value of I gM was significantly increased in patients; 2.5 g!L compared to 1.4 gn ... in controls (p=0.002). ANA and pANCA occurred more frequently in patients, although the difference did not reach statistical significance. The result.;; of all other immunoglobulins, complement factors, and specific antiboctles were similar in patients and controls. The findingsof an increased IgM level in patients, might give some support to a hypothesis of autoimmunity in CC. The ANA- and pANCA positive patients could constitute a subpopulation among CC patients.</p> <p>Procollagen III propeptide (P-III-NP) is a product of collagen Ill metabolism. No significant difference between the serum level of P-III-NP in 38 patients (3.8±2.0 P-g!L) and 38 matched controls (3.7±1.3 ~g!L) was found, and P-III-NP did not correlate to clinical activity. There was a significant correlation, however, between P-III-NP and age in both patients and controls. The study showed that colonoscopy is still required to diagnose CC and cam~-9t be replaced, at present, by a simple blood test.</p> <p>A register of patients with CC was set up at the Örebro Medical Center Hospital. Twenty five Swedish hospitals contributed with patient records to this register which comprised of data from 163 patients. Data showed that CC usually followed a chronic intermittent benign course. The onset was sudden in up to 42% of the patients. The most common symptoms were chronic watery diarrhoea, sometimes nocturnal, abdominal pain and weight loss. Routine laboratory data were most often normaL</p> <p>Evaluation of the treatment showed a response rate of 59% for sulphasalazine, and 40% respectively SO% for olsalazine and mesalazine. Prednisolone was effective in about 80% of the patients, but the required dosage was often high, and the effect not sustained after withdrawal. Metronidazole, erythromycin and penicillin had response rates from 55% to 100%. Cholestyramine and loperamide offer treatmentalternatives of which about two thirds of the patients benefit.</p>
  • Bojestig, Mats (författare)
  • Glycaemic Control and Complications in Type 1 Diabetes
  • 1999
  • Doktorsavhandling (övrigt vetenskapligt)abstract
    • <p>There have been substantial changes in the management of diabetes since the 1960' s.We studied all 213 patients in our catchment area in whom Type I diabetes was diagnosed before the age of 15 years between 1961 and 1980, 92% were followed from the onset of diabetes to 1991 or to the time of death</p><p>The cumulative incidence of diabetic nephropathy has decreased substantially in recent decades from 30% to 9% after 25 year's diabetes duration, probably as a result of improved glycaemic control. Neither the cumulative incidence of severe retinopathy nor hypertension (140/90mmHg) changed during the last decades.</p><p>The risk to develop severe retinopathy or nephropathy was higher in patients with Very Poor glycaemic control (HbA1c;::.8.4%) vs. patients with Poor control (HbA1c ~ 7 .2&lt;8.4% )(p&lt;0.001). Patients with Poor control had an increased risk to develop severe retinopathy vs. patients with Good control (HbA1c&lt;7 .2% )(p&lt;0.008) but there was no difference in the risk for nephropathy. No patients with Good control developed nephropathy and only one patient developed severe retinopathy during 25 years of diabetes. Up to a diabetes duration of 25 years both diabetic nephropathy and severe retinopathy can be avoided but the degree of glycaemic control needed for prevention differs.</p><p>The course of microalbuminuria during the 1980's was studied with a 10-year follow up of 109 Type 1 diabetes patients. Only 5 (19%) of the initially micro-albuminuric patients developed macro-albuminuria during the 10 year follow up period and 15 (58%) patients decreased their AER to normal. The initially micro-albuminuric patients, who normalised their AERimproved their glycemic control. In the majority of patients with micro-albuminuria in whom it is possible to obtain a good glycemic control, micro-albuminuria will disappear and the risk of developing nephropathy is markedly reduced.</p><p>PRA and All concentrations were significantly lower in Type 1 diabetic patients (n=80) than in matched healthy controls (n=75). ANP levels were higher in patients than in controls. In the patients PRA correlated negatively to the mean value of HbA1c during the previous five years. Patients with Type 1 diabetes, specially those with very poor glycaemic control, have a suppressed RAS and increased ANP levels.</p>
  • Bragadóttir, Ragnheiður (författare)
  • The interaction between the neuroretina and the retinal pigment epithelium : an electrophysiological study of the effects of possible messenger substances and their analogues
  • 1996
  • Doktorsavhandling (övrigt vetenskapligt)abstract
    • <p>The retinal pigment epithelium (RPE) is of great importance in photoreceptor homeostasis. The photoreceptors are highly specialized cells which cannot survive without the RPE. It has been postulated that messenger substances are involved in the interaction between the RPE and the inner retina. In the present study, the effects on the light induced electrical responses of the eye of some possible messenger substances and their analogues were investigated. The a-, b- and c-waves of the corneal electroretinogram (ERG) and the standing potential of the eye (SP) were investigated dming simultaneous perfusion of the vitreous cavity of albino rabbit eyes with test substances alternating with a control solution. The contralateral eye of each rabbit was used as a control. To further analyze the effect on the ERG c-wave, a new in vivo method was applied. A microelectrode is advanced through the retina into the subretinal space, enabling recording of the transepithelial potential (TEP) and the slow Pili dming simultaneous perfusion of the vitreous cavity. Phenylephrine, an a.1-adrenergic receptor agonist, in a low concentration increased the c-wave and the SP, whereas clonidine, an o:.z-adrenergic receptor agonist, had similar effects on the c-wave but at higher concentration. The b-wave was also slightly elevated but there was no significant effect on the a-wave. Phenylephrine increased the TEP, while the slow Pili was reduced. These results seem to indicate that a-adrenergicreceptors are present on the apical membrane of the RPE. The effect on the b-wave and the slow Pili suggests a-adrenergic effects also on the inner retina. The stable cyclic AMP analogue, Sp-cAMPS, increased the c-wave amplitude and the SP level There was also an effect on the b-wave, but the a-wave was not affected. Both the TEP and the slow Pili were elevated. The results showed that Sp-cAMPS influences the electrophysiological properties of both the RPE and the inner retina. PhXA41, a PGF2a analogue, which is a new intraocular pressure reducing agent, did not affect the ERG and the SP at low doses. At higher doses, PhXA41 and PGF,. increased the c-wave amplitude and the SP level, while there was no effect on the a- and b-waves. The c-wave elevation was due to a reduction in slow Pili, while the TEP was not affected, indicating that receptor binding sites for PGF2• are present on the Muller cell membrane. Serotonin was shown to affect the c-wave of the ERG and the SP. The c-wave amplitude elevation was caused by an elevation of the TEP while the slow Pili was unaffected. The effects of different serotonin agonists and antagonists were also studied. The results indicate the presence of 5-HTz receptors on the RPE. There is a possibility, however, of other types of serotonin receptors being present on the RPE as well.</p>
  • Brynhildsen, Jan (författare)
  • Low back pain in women in relation to different exposures to female sex hormones
  • 1998
  • Doktorsavhandling (övrigt vetenskapligt)abstract
    • <p><em>Objective</em>: To investigate the effects of increased exposition to female sex hormones and physical strain on the prevalence of low back pain (LBP) in women. To study the etJect of increased exposition to female sex hormones on spinal sagiual mobility.</p><p><em>Background</em>: Scientific data and clinical observations suggest an increased prevalence of LBP in women as compared with men, especially in athletes. Estrogen receptors arc present in the musculo-skeletal apparatus and in the central nervous system and female sex hormones have been suggested to affect the stability of the pelvic joints and the perception of pain. The impaired stability together with a hypermobile spine may cause increased isometric muscular work, and as a consequence, pain. Also the perception of pain may be altered by female sex hormones. Because LBP is more common in female athletes than in male athletes, increased exposition to both female sex hormones and physical strain may affect the occurrence of LBP in women. Such an exposition occurs during pregnancy, with a well-known increase in prevalence of LBP.</p><p><em>Methods</em>: 28 women with an increased exposition to physical strain (female soccer players) and a history of LBP underwent a clinical examination and were then observed prospectively during 6 months to study variations in the occurence and severity of LBP during the different phases of the menstrual cycle. 716 female elite athletes and 113 controls answered a questionnaire with regard to their use of oral contraceptives (OCs) and the occurrence of LBP. 1103 women, 55 or 56 years old, answered a questionnaire concerning the occurrence and severity ofLBP and use of hormone replacement therapy (HRT). 52 women with and 67 women without a history of disabling LBP during a pregnancy in 1983-84 answered a questionnaire concerning LBP during subsequent pregnancies. 24 young, healthy women were followed prospectively over a period of 12 months to measure spinal sagittal mobility before use of OCs and after 3 and 12 months of OC-use.</p><p><em>Results</em>: No differences were observed with regard to occurrence or severity of LBP between the different phases of the menstrual cycle or between OC-users and non-users. LBP was more common in the athletes as compared with the controls. The prevalence ofLBP was slightly increased among the HRT-users (OR 1.30; 95% CI 1.02-1.41) compared with non-users. 94% of the women with previous disabling LBP during pregnancy reported LBP in a subsequent pregnancy compared with 44% of the controls. Also concequenccs of LBP, as sick-leave, were more common in the group of women with disabling LBP during a previous pregnancy. No change in spinal sagittal mobility was observed in the group of women before and after the women began to use OCs.</p><p><em>Conclusions</em>: Use of oral contraceptives does not seem to increase the prevalence of LBP. There is nothing in our results to suggest that women with LBP with an unspecific origin should discontinue their use of oral contraceptives. Postmenopausal women who use HRT had a slightly increased prevalence of LBP, but this increase is probably of no clinical significance. Women who had suffered from LBP during a previous pregnancy run a high risk for LBP in the future, both during a subsequent pregnancy and during the non-pregnant state. Increased exposition to exogenously administered female sex hormones does not increase spinal sagittal mobility in young, healthy, nullipareous women.</p>
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