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1521.
  •  
1522.
  • Ödling, Gunvor (författare)
  • Professional caregivers’ experiences of caring for women with breast cancer on a surgical ward
  • 2004
  • Doktorsavhandling (övrigt vetenskapligt)abstract
    • <p>The overall aim of the thesis was to describe caregivers’ experiences of caring for women with breast cancer on a surgical ward. The study was based on interviews with narrative parts and tape-recorded clinical supervision sessions. The interviews and clinical supervision sessions were transcribed verbatim, and analysed by content analysis.</p> <p>Nurses (n=10) described life for women with breast cancer as either having freedom or not having freedom, with both physical and existential suffering. Dying occurred either naturally in patients’ own home or unnaturally in hospital. The nurses felt that it is possible to alleviate suffering during dying through providing adequate pain relief but also, through listening, providing information and changing the caring atmosphere (I).</p> <p>Breast cancer as an illness was described from a dark point of view by caregivers (n=37). The descriptions focused on loss of breasts and control, progression of the illness and annihilation. The illness seemed, in the caregivers’ mind, to often end with a painful death. Caregivers who had the opportunity to follow the total care process described a lighter viewpoint (II).</p> <p>According to nurses (=31) the most important needs among women, their relatives and nurses themselves were the needs to talk and receive information. There was a discrepancy between what was described as important needs and the descriptions of how these needs were provided for. Nurses, whose own needs for support were sometimes unsatisfactorily met (III), seemed almost to be unaware of the needs among women and their relatives.</p> <p>In the clinical supervision sessions caregivers reflected on difficult care situations related to women’s, relatives’, and most often caregivers’ feelings (n=38). The care situations were described as evoking feelings of discomfort, powerlessness and reduced self-esteem. These feelings were described by caregivers as arising in connection with caring for especially women with advanced breast cancer in a changing organisation (IV).</p> <p>Caregivers’ descriptions of caring for women with breast cancer show a lot of negative experiences of powerlessness and frustration. They met women and their relatives who suffered in various ways and had considerable need for support. Caregivers often found themselves unable to meet these needs due to organisational obstacles e.g. lack of time and lack of knowledge about other caregivers’ responsibility in the care.</p>
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1523.
  •  
1524.
  • Ödmark, Inga-Stina, 1948- (författare)
  • Hormone replacement therapy benefits and adverse effects
  • 2004
  • Doktorsavhandling (övrigt vetenskapligt)abstract
    • <p>Background: Numerous studies have shown that estrogen replacement therapy (ERT) is an effective treatment for vasomotor symptoms, insomnia and vaginal dryness. Beneficial effects have also been shown on lipid patterns and on the incidence of osteoporotic fractures. As ERT increases the risk of endometrial adenocarcinoma, combinations with various progestogens have been developed in order to protect the endometrium. However, the addition of progestogens tends to reduce the beneficial effects of estrogens on mood, cognition and lipid metabolism. The added progestogen often causes side effects such as irritability and depression. There is evidence that the effect on wellbeing varies between women and with the type of progestogen used. Women who prefer to avoid withdrawal bleedings can be given continuous combined hormone replacement therapy (HRT). Unfortunately, irregular bleedings are common at the beginning of treatment and reduces compliance. Recently, several studies have reported an increased risk of breast cancer and venous thrombosis, and therefore long-term treatment with HRT for women without climacteric symptoms is no longer recommended. The ongoing debate has, for the time being, resulted in a recommendation that improving quality of life (QoL) by treatment of climacteric symptoms should be the only indication for prescribing HRT.</p> <p>Aims and methods: The aims of the study were to investigate bleeding patterns, changes in wellbeing at onset and during long-term treatment, and lipid and lipoprotein profiles with two different types of continuous combined HRT. In addition, women starting, and women switching from mainly sequential HRT were compared. The design was a randomised, double-blind, one year, prospective, multicentre study including 249 healthy postmenopausal women who were given continuous daily oral treatment with either combined 0.625mg conjugated estrogen (CE) and 5mg medroxyprogesterone acetate (MPA) or combined 2mg 17β - estradiol (E2) and 1mg norethisterone acetate (NETA). Bleedings, if any, were recorded daily throughout the study. The main outcome measures (changes in wellbeing and climacteric symptoms) consisted of daily ratings of 12 items on a validated symptom scale. Serum concentrations of lipids and lipoproteins were measured at baseline and after one year of treatment.</p> <p>Results and conclusions: The majority of drop-outs were confined to the first three months, and the main reasons were bleedings and/or decreased wellbeing. Drop-outs were three times more common in the E2/NETA group. During the first month, 67% of the women reported irregular bleedings. The number of bleeding days decreased on both treatments during the first four months. Treatment with CE/MPA resulted in less irregular bleedings and a shorter time to amenorrhoea compared to E2/NETA.</p> <p>As expected, "starters" experienced more sweats than "switchers" at the onset of treatment, but both groups improved significantly. Side effects such as breast tenderness, swelling, depression and irritability appeared during the first treatment week in both groups. The side effects of HRT appeared much more quickly than the benefits and were more frequent in women with a history of premenstrual syndrome (PMS). Breast tenderness was more common in the E2/NETA group throughout the whole study period. Apart from that, there were no differences between the two treatment regimens as regards effects on well-being at the end of the study.</p> <p>Lipoprotein(a) levels, an important risk factor for cardiovascular disease, decreased in both treatment groups. Triglyceride levels increased in women treated with CE/MPA, and levels of total cholesterol, high density lipoprotein and low density lipoprotein fell in the E2/NETA group.</p> <p>In conclusion, treatment with E2/NETA caused more bleeding problems than treatment with CE/MPA. CE/MPA was better tolerated than E2/NETA at the beginning of the study, but among the women remaining in the study there was no difference in QoL between the two treatment groups. HRT counselling should take into account that a history of PMS increases the likelihood of side effects and that these may precede any beneficial effects. Both treatments produced beneficial effects on lipid and lipoprotein levels, and neither of the regimens was superior in this respect.</p>
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1525.
  • Öfverman, Charlotte, 1970- (författare)
  • Progesterone metabolites learning, tolerance, antagonism &amp; metabolism
  • 2009
  • Doktorsavhandling (övrigt vetenskapligt)abstract
    • <p>Progesterone metabolites as allopregnanolone, isoallopregnanolone and tetrahydrodeoxy-corticosterone (THDOC) are increased in the luteal phase of the menstrual cycle, throughout pregnancy and during stress. Allopregnanolone and THDOC are neurosteroids with 3α-hydroxy, 5α-configurations and positive modulating effect on the GABA<sub>A</sub> receptor. They have similar properties and effect, and share the same binding sites on the GABA<sub>A</sub> receptor. Isoallopregnanolone has a 3β-hydroxy, 5α-configuration and a diverse effect as a proposed antagonist to both allopregnanolone and THDOC. Neurosteroids are thought to exert their effect predominantly at extrasynaptic GABA<sub>A</sub> receptors, containing for example α4- or α5-subunits. Such receptors are involved in the tonic response. Different subunits have diverse distribution pattern in the brain and are involved in different functions. The α5-subunit, mainly expressed in the hippocampus, is involved in learning, while α4 is more widespread and involved in e.g. anxiety and anaesthesia.</p> <p>The aim of the present thesis was to contribute to the knowledge about selected progesterone metabolites and their effects on learning and tolerance development, as well as their metabolism. Also basic characteristics between different α-subunits of the GABA<sub>A</sub> receptor were evaluated.</p> <p>The thesis shows that the effect of bicuculline and pentobarbital is not dependent on the α-subunit isoform of the GABA<sub>A</sub> receptor expressed in oocytes. Acute tolerance developed after allopregnanolone-induced anaesthesia with a decrease at both mRNA and protein levels of the GABA<sub>A </sub>receptor<sub> </sub>α4-subunit in the thalamus VPM nucleus. A negative correlation between the α4 mRNA and the increased dose of allopregnanolone needed to maintain the anaesthesia level was also shown. In addition, allopregnanolone induces a learning impairment in the Morris water maze test, when high concentrations of allopregnanolone are present in the brain. This impairment is not possible to reverse by isoallopregnanolone. In α5β3γ2L-transfected HEK-293 cells THDOC induces a baseline shift of its own and also potentiate the GABA-current. Neither of those THDOC effects can be inhibited by isoallopregnanolone. Instead isoallopregnanolone shows an agonistic effect on the THDOC-potentiation of the GABA-response. The main allopregnanolone metabolites identified, 5α-DHP and isoallopregnanolone, as well as allopregnanolone itself are mainly localized to the brain after an i.v. injection. After an isoallopregnanolone injection there is a more even distribution of the given steroid and the metabolites between plasma and brain. There is an epimerisation between isoallopregnanolone and allopregnanolone and vice versa.</p> <p>In conclusion, the present thesis shows that the α4-subunit in the thalamus VPM nucleus is likely to be involved in the acute tolerance development against allopregnanolone and that allopregnanolone-induced learning impairment is likely to be hippocampus dependent. The lack of antagonistic effect of isoallopregnanolone on the THDOC-induced α5β3γ2L-GABA<sub>A</sub> response, together with epimerisation of isoallopregnanolone to allopregnanolone, could explain why isoallopregnanolone does not work as an antagonist to the allopregnanolone-induced learning impairment in a hippocampus dependent learning task.</p>
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1526.
  • Ögren, Joachim, 1981- (författare)
  • Serious hemorrhage and secondary prevention after stroke and TIA
  • 2018
  • Doktorsavhandling (övrigt vetenskapligt)abstract
    • <p>Background:<strong> </strong>The number of stroke survivors is growing worldwide, and these patients have an increased risk of new vascular events and death. This risk decreases with secondary treatment medications recommended in guidelines. However, the characteristics of unselected stroke patients differ from patients included in randomized controlled trials (RCTs). Thus, the efficacy of these treatments based on RCT results may not be directly transferable to the patients treated in clinical practice. A treatment may be associated with a higher risk of serious side-effects or less benefit than expected:<strong></strong>1) Antithrombotic treatment increases the risk of a serious hemorrhage, a risk that is not well studied in an unselected population with older age and more comorbidities; 2) Treatment of modifiable risk factors after a stroke can be improved. Many patients do not reach treatment targets, which indicates a need for strategies to improve secondary prevention and increase treatment benefit.<strong></strong>It is therefore essential to evaluate recommended treatments through studies in a real-world setting.</p><p>Aims: The aims of this thesis were to assess<strong></strong>incidence, temporal trends, effect on mortality, and factors associated with an increased risk of a serious hemorrhage after ischemic stroke (IS) or transient ischemic attack (TIA); and<strong></strong>if a nurse-led, telephone-based intervention including medical titration could improve modifiable risk factors in patients after stroke or TIA.</p><p>Methods: In paper I, all patients registered with an IS in the national stroke register Riksstroke during 1998–2009 were studied. The register was combined with the In-Patient Register and a diagnosis of intracranial haemorrhage (ICrH) within 1 year after IS was identified. In paper II, any diagnosis of serious hemorrhage was identified during follow-up up to 2015 in all patients with an IS or TIA diagnosis, 2010–2013, at Östersund hospital. The incidences of ICrH (papers I and II) and all serious hemorrhages (paper II) were calculated. Kaplan–Meier analysis was used to assess any temporal trend in paper I and if a serious hemorrhage affected survival in study II. Cox regression analysis was used in both studies I and II to assess any factor associated with hemorrhage.</p><p>In the randomized controlled NAILED stroke trial, all patients with acute stroke or TIA treated at Östersund hospital during 2010–2013 were screened for participation. Patients whose condition permitted a telephone-based follow-up were randomized to either a control group with follow-up according to usual care or to an intervention group with a nurse-led, telephone-based follow-up including titration of medication. Blood pressure (BP) and low-density lipoprotein cholesterol (LDL-C) were assessed at 1, 12, 24, and 36 months. We assessed the effect of the intervention on mean levels of BP and LDL-C and on the proportion of patients reaching treatment targets at 12 months (Study III) and at 36 months (Study IV). Study III also assessed for interactions between group allocation and measurement levels at baseline with BP and LDL-C at the 12-month follow-up. Study IV also explored temporal trends.</p><p>Results: The risk of an ICrH was 1.97% per year at risk, within the first year after IS,  and 0.85% excluding the first 30 days. Between 1998 and 2009, the risk of an ICrH increased during the first 30 days after an IS but decreased during days 31–365. The risk of a serious hemorrhage was 2.48% per year at risk in paper II. It was more common in elderly. The incidence rate was higher in patients discharged with AP compared with RCTs. A hemorrhage increased the risk of death in patients with good functional status but did not affect the already high mortality in patients with impaired functional status. Male sex and previous ICrH were associated with an increased risk of ICrH during the first year after IS, thrombolytic treatment, atrial fibrillation and warfarin were associated with an increased risk in the acute phase. A previous diagnosis of hypertension was associated with an increased risk of all serious hemorrhages. </p><p>The NAILED trial intervention group had a significantly lower mean systolic BP (SBP), diastolic BP (DBP), and LDL-C at 12 and 36 months. The mean SBP at 36 months was 128.1 mmHg (95% confidence interval (CI): 125.8–130.5) in the intervention group, 6.1 mmHg (95% CI: 3.6–8.6; p&lt;0.001) lower than the control group. The interaction analysis at 12 months showed that the effect of the intervention was confined to patients whose values were above the respective targets at baseline and therefore had their medication adjusted. At 36 months, a significantly higher proportion of patients in the intervention group reached treatment targets for SBP, DBP, and LDL-C. The mean differences and differences in proportions reaching treatment target for BP increased during the 36 months of follow-up.</p><p>Conclusion: A serious hemorrhage after an IS or TIA is fairly common. It is more common in elderly and patients with impaired functional status. The incidence is higher in patients discharged with AP compared with RCTs. A serious hemorrhage could affect survival in patients with good functional status. The nurse-led, telephone-based intervention including medical titration used in the NAILED stroke trial improved risk factor levels after stroke and TIA, and more patients reached treatment targets. The effect increased over time. </p>
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1527.
  • Ögren, Kenneth, 1950- (författare)
  • Psychosurgery in Sweden 1944 - 1958 the practice, the professional and media discourse
  • 2007
  • Doktorsavhandling (övrigt vetenskapligt)abstract
    • <p>Background. The pioneering early experiments of prefrontal lobotomy were performed in 1944 by neurosurgeons in Stockholm in collaboration with psychiatrists. There was a rapid implementation of the new surgical approach. In 1946 and 1947 the two state mental hospitals, Umedalen and Sidsjön, introduced prefrontal lobotomy on a large scale. General surgeons now performed operations, a practice which was established all over Sweden. Prefrontal lobotomy was burdened, in certain city hospitals, by an initially high rate of postoperative mortality reaching more than 15 %. Pre-frontal lobotomy was phased out continuously already before 1950 and refined psychosurgical methods were introduced , but prefrontal lobotomy was still continued which lacked specialised neurosurgical units. The aims of the thesis were to contribute to and deepen the knowledge and understanding of the general and specific questions of early psychosurgery in its professional and social context.</p> <p>Specific aims: (Explore the practice of prefrontal lobotomy at the Umedalen State Mental hospital and plot the frequency of psychosurgery operations in Sweden.</p> <p>• Analyze the patients subjected to prefrontal lobotomy at the Umedalen State Mental Hospital 1947-1958, with respect to symptomatology and diagnosis, indications for the operation, gender distribution postoperative mortality, the practice of consent and other clinical factors.</p> <p>• Explore and analyze what was written on psychosurgery, when and how, and to identify differences, similarities and characteristics of the portrayal of psychosurgery in Swedish and American media 1936-1959.</p> <p>• Explore and analyze the confluence of the role of the State authority, The Swedish National Board of Health (Medicinalstyrelsen), the professional discourses on lobotomy and the media portrayal, in dealing with problems of implementation and mortality.</p> <p>Results. Paper I. At the Umedalen State Mental Hospital, 771 prefrontal lobotomies were performed 1947-1958 with an overall postoperative mortality of 7.4 %. Most of the patients operated on from Umedalen were women (61.2%) and most of the patients were diagnosed with schizophrenia. Of all the lobotomies performed in Sweden (approx. 4,500), 28% had been carried out at the Sidsjön and Umedalen State Mental Hospitals.</p> <p>Paper II. A sample of 105 patients, who were studied in detail from psychiatric records. It was found that 79% had been six years in primary school and only 3% had a higher education. In an analysis of the descriptions of behavioural problems stated in the medical records, it was found that the female candidate for prefrontal lobotomy was described as suffering from different problems more often than the male candidate. Disturbing behaviour, fluctuations of mood and violence against others were the most frequently described symptoms most often referred to with respect to the female lobotomy candidate.</p> <p>Paper III. In the comparative media study it was found that most of the articles on lobotomy in the Swedish and American media were positive or neutral towards psychosurgery, while very negative articles were least frequent. Neutral articles were more common in Swedish media (43%) while less common in the American media (19%). Articles being very negative towards lobotomy were considerably more often found in the American material (32%) than in the Swedish (14%).</p> <p>Paper IV. The implementation of lobotomy was rapid in Sweden and more than 4000 lobotomies were performed between 1944 and 1964. It was considered feasible for prefrontal lobotomies to be performed by general surgeons and, from 1951, it can be verified that most hospitals (12/20) had engaged general surgeons for the lobotomy operation while a minority (8/20) had engaged a neurosurgeon. The Swedish State, through the Swedish National Board of Health was responsible of the allocation and surveillance of mental care. With a system consisting of a Chief Inspector of Mental Care, State mental hospitals were inspected annually. Medical superintendents were given full autonomy to decide on the implementation and practice of lobotomy. No indications were found of any significant interference by the Swedish National Board of Health restricting lobotomy.</p> <p>Main conclusion. Medical superintendents were given full autonomy to decide on the clinical practice of lobotomy. Being left in the periphery of neurosurgical facilities, this led to their engaging general surgeons. Patients were operated on in surgical theatres lacking the sophisticated technical equipment of coping securely with haemorrhages, which were common in the early implementation of the operation. The practice of lobotomy in some mental hospitals was extensive and postoperative deaths were numerous but the Swedish National Board of Health took a defensive role and, even with the annual inspections, there was no important interference with the lobotomy question. Swedish media reported mostly positively on lobotomy, underlining the promising prospects of the new method submitted by the early proponents without critical questioning or independent investigations.</p>
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1528.
  • Öhberg, Fredrik (författare)
  • Biomechanical methods and error analysis related to chronic musculoskeletal pain
  • 2009
  • Doktorsavhandling (övrigt vetenskapligt)abstract
    • <p><strong>Background</strong> Spinal pain is one of humanity’s most frequent complaints with high costs for the individual and society, and is commonly related to spinal disorders. There are many origins behind these disorders e.g., trauma, disc hernia or of other organic origins. However, for many of the disorders, the origin is not known. Thus, more knowledge is needed about how pain affects the neck and neural function in pain affected regions. The purpose of this dissertation was to improve the medical examination of patients suffering from chronic whiplash-associated disorders or other pain related neck-disorders.</p> <p><strong>Methods</strong> A new assessment tool for objective movement analysis was developed. In addition, basic aspects of proprioceptive information transmission, which can be of relevance for muscular tension and pain, are investigated by studying the coding of populations of different types of sensory afferents by using a new spike sorting method. Both experiments in animal models and humans were studied to accomplish the goals of this dissertation. Four cats where were studied in acute animal experiments. Mixed ensembles of afferents were recorded from L7-S1 dorsal root filaments when mechanical stimulating the innervated muscle. A real-time spike sorting method was developed to sort units in a multi-unit recording. The quantification of population coding was performed using a method based on principal component analysis. In the human studies, 3D neck movement data were collected from 59 subjects with whiplash-associated disorders (WAD) and 56 control subjects. Neck movement patterns were identified by processing movement data into parameters describing the rotation of the head for each subject. Classification of neck movement patterns was performed using a neural network using processed collected data as input. Finally, the effect of marker position error on the estimated rotation of the head was evaluated by computer simulations.</p> <p><strong>Results</strong> Animal experiments showed that mixed ensembles of different types of afferents discriminated better between different muscle stimuli than ensembles of single types of these afferents. All kinds of ensembles showed an increase in discriminative ability with increased ensemble size. It is hypothesized that the main reason for the greater discriminative ability might be the variation in sensitivity tuning among the individual afferents of the mixed ensemble will be larger than that for ensembles of only one type of afferent. In the human studies, the neural networks had a predictivity of 0.89, a sensitivity of 0.90 and a specificity of 0.88 when discriminating between control and WAD subjects. Also, a systematic error along the radial axis of the rigid body added to a single marker had no affect on the estimated rotation of the head.</p> <p><strong>Conclusion</strong> The developed spike sorting method, using neural networks, was suitable for sorting a multiunit recording into single units when performing neurophysiological experiments. Also, it was shown that neck movement analysis combined with a neural network could build the basis of a decision support system for classifying suspected WAD or other pain related neck-disorders.</p>
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1529.
  • Öhberg, Fredrik, 1969- (författare)
  • Biomechanical methods and error analysis related to chronic musculoskeletal pain
  • 2009
  • Doktorsavhandling (övrigt vetenskapligt)abstract
    • <p><strong>Background</strong> Spinal pain is one of humanity’s most frequent complaints with high costs for the individual and society, and is commonly related to spinal disorders. There are many origins behind these disorders e.g., trauma, disc hernia or of other organic origins. However, for many of the disorders, the origin is not known. Thus, more knowledge is needed about how pain affects the neck and neural function in pain affected regions. The purpose of this dissertation was to improve the medical examination of patients suffering from chronic whiplash-associated disorders or other pain related neck-disorders.</p> <p><strong>Methods</strong> A new assessment tool for objective movement analysis was developed. In addition, basic aspects of proprioceptive information transmission, which can be of relevance for muscular tension and pain, are investigated by studying the coding of populations of different types of sensory afferents by using a new spike sorting method. Both experiments in animal models and humans were studied to accomplish the goals of this dissertation. Four cats where were studied in acute animal experiments. Mixed ensembles of afferents were recorded from L7-S1 dorsal root filaments when mechanical stimulating the innervated muscle. A real-time spike sorting method was developed to sort units in a multi-unit recording. The quantification of population coding was performed using a method based on principal component analysis. In the human studies, 3D neck movement data were collected from 59 subjects with whiplash-associated disorders (WAD) and 56 control subjects. Neck movement patterns were identified by processing movement data into parameters describing the rotation of the head for each subject. Classification of neck movement patterns was performed using a neural network using processed collected data as input. Finally, the effect of marker position error on the estimated rotation of the head was evaluated by computer simulations.</p> <p><strong>Results</strong> Animal experiments showed that mixed ensembles of different types of afferents discriminated better between different muscle stimuli than ensembles of single types of these afferents. All kinds of ensembles showed an increase in discriminative ability with increased ensemble size. It is hypothesized that the main reason for the greater discriminative ability might be the variation in sensitivity tuning among the individual afferents of the mixed ensemble will be larger than that for ensembles of only one type of afferent. In the human studies, the neural networks had a predictivity of 0.89, a sensitivity of 0.90 and a specificity of 0.88 when discriminating between control and WAD subjects. Also, a systematic error along the radial axis of the rigid body added to a single marker had no affect on the estimated rotation of the head.</p> <p><strong>Conclusion</strong> The developed spike sorting method, using neural networks, was suitable for sorting a multiunit recording into single units when performing neurophysiological experiments. Also, it was shown that neck movement analysis combined with a neural network could build the basis of a decision support system for classifying suspected WAD or other pain related neck-disorders.</p>
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1530.
  • Öhberg, Lars, 1947- (författare)
  • The chronic painful Achilles tendon sonographic findings and new methods for treatment
  • 2003
  • Doktorsavhandling (övrigt vetenskapligt)abstract
    • <p>The aim of the present thesis was to evaluate sonographic methods for investigation of the chronic painful Achilles tendon.</p> <p>In a prospective study on patients with chronic painful mid-portion Achilles tendinosis, grey-scale ultrasound (US) showed a decreased tendon thickness and a “normalized” structure in the majority of patients successfully treated with eccentric calf-muscle training. By combining US with colour Doppler examination (CDV), a neovascularisation was shown in the region with structural tendon changes in all painful tendons, but not in any of the pain-free normal tendons. In a small pilot study, the sclerosing agent Polidocanol was injected towards the neovessels under US and CDV guidance. The majority of the patients became painfree and had no remaining neovessels, while the patients with remaining pain had remaining neovessels. The combined findings from US, immuno-histochemical analyses of biopsies, and diagnostic injections, showed that the patients were temporarily pain-free after US and CDV guided injections of local anaesthesia towards the region with neovessels, and biopsies from the region with tendon changes and neovascularisation showed nerve structures in close relation to blood vessels. The presence of neovessels was shown also in patients with chronic pain in the Achilles tendon insertion, and it was found that treatment with sclerosing injections cured the pain in the majority of patients. A good result of treatment was associated with no remaining neovessels.</p> <p>In a prospective study on patients with chronic mid-portion Achilles tendinosis treated with eccentric training, CDV after treatment showed no remaining neovessels in the majority of the pain-free patients. In the patients with remaining tendon pain there were remaining neovessels. In conclusion, the findings in this thesis indicate that neovessels and accompanying nerves might be the source of chronic Achilles tendon pain. Sclerosing injections towards the neovessels, and eccentric training, seem to have a potential to cure the pain.</p>
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