| 1. |
- Arbman, Gunnar
(författare)
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Colorectal cancer in Östergötland : risk factors, diagnosis, and quality of treatment
- 1996
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- 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.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.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.Known risk factors were found in 12% of colorectal cancer patients, though previous cholecystectomy did not turn out to be a risk factor.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.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%).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.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.
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| 2. |
- Berterö, Carina, 1959-
(författare)
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Living with leukaemia : studies on quality of life, interaction and caring
- 1996
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- 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.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).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.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.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.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.
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| 3. |
- Bjartmar, Carl
(författare)
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On the relation between nerve fibres and glial cells
- 1996
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- 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.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.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 <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.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.
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| 4. |
- Bohr, Johan
(författare)
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Collagenous colitis : A study of epidemiology, etiology, clinical features and treatment
- 1996
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- 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. 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. 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. 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. 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 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.
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| 5. |
- Bragadóttir, Ragnheiður
(författare)
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The interaction between the neuroretina and the retinal pigment epithelium : an electrophysiological study of the effects of possible messenger substances and their analogues
- 1996
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- 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.
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| 6. |
- Chen, Yun
(författare)
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Smooth muscle hypertrophy and the IGF-system
- 1996
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Insulin-like growth factor-! (IGF-I) has both metabolic and mitogenic effects on smooth muscle cells (SMCs). The effects of IGF-I are modified by a group of binding proteins (IGFBPs). The present study was devoted to smooth muscle hypertrophy and the IGF-system in smooth muscle under different conditions. In urinary bladder, smooth muscle hypertrophy, initiated by partial outletobstruction, was associated with a transient increase in IGF-I mRNA, and pronounced, sustained increases oflGFBP-2 and IGFBP-4 mRNA, as well as increased protein contents of IGF-I and IGFBP-2. Regression of smooth muscle hypertrophy was associated with normalization of levels ofiGF-I, IGFBP-2 and IGFBP-4 mRNA. Expression of the IGF-I receptor did not change significantly. In portal vein, IGF-I mRNA and IGF-1 immunoreactivity were increased inhypertrophy induced by partialligation of the portal vein. Abdominal coarctation caused a rapid hypertensive response accompanied by an increased wet weight of aortic media. This was coincident with a progressive increase in aortic IGFBP-2 mRNA, about 10-fold after 14 days. The levels of IGFBP-4 mRNA in different muscle tissues and liver were decreased by diabetes and fasting, while IGFBP-2 mRNA was regulated in an organspecific 1nanner: with a sustained increase in liver and a decrease in aortic smooth muscle. Smooth muscle hypertrophy also occured in the urinary bladder of diabetic rats. DNA synthesis was increased and peaked at 2 days after induction of diabetes. DNA content per bladder wet weight was decreased by 7 days. Initially there was no changes in IGF-I mRNA, while IGFBP-2 mRNA and protein in the bladders were increased and peaked by 7 days. IGFBP-4 mRNA increased only on day 7. The changes of mRNA in bladder differed from that in liver and aorta, and suggested an early effect of stretching of the bladder due to diuresis, and later a contribution by the diabetic state. In cultured vascular SMCs, mechanical strain stimulated protein synthesis, but had little effect on DNA synthesis. However, mechanical strain potentiated the actions of IG:F'-1 and serum on both protein- and DNA synthesis, and influenced the effects of IGFBP-2. In conclusion, development of smooth muscle hypertrophy is associated with specific changes in IGF-I, IGFBP-2 and IGFBP-4, suggesting that the IGF-system may play a role in this process.
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| 7. |
- Chu, Ming
(författare)
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The role of endogenous hypercholecystokininemia and hypergastrinemia in growth and carcinogenesis of the exocrine pancreas
- 1996
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The gut hormones cholecystokinin (CCK) and gastrin are phylogeneticallyand structurally related. Under normal conditions, CCK regulates growth of the exocrine pancreas and gastrin growth of the oxyntic mucosa of the stomach. The effects of chronically increased endogenous secretion ofCCK or gastrin on pancreatic growth and carcinogenesis are not fully investigated. This thesis deals with such studies in rats and hamsters, using pancreaticobiliary diversion (PBD) to accomplish endogenous hypercholecystokininemia and gastric fundectomy to accomplish endogenous hypergastrinemia. PBD caused an immediate and persistent increase in the plasma CCKconcentration without affecting the plasma gastrin concentration. In hamsters, PBD induced an initial hyperplasia (increased [3H]-thymidine labeling index) of acinar cells followed by a persistent hypertrophy (increased weight, protein content, and DNA content) of the pancreas. No such changes were found in PBD operated hamsters receiving a CCK-A receptor antagonist. Longterm (14 months) PBD in rats lead to an increased fraction of aneuploid cells (DNA flow cytometry) in pancreatic tissue, and development of putative pre-neoplastic lesions (PPL) (acidophilic atypical acinar cell foci) and adenoma of the pancreas. No PPL or neoplasia were observed after longterm ( 8 months) PBD in hamsters. When rats were given a pancreatic carcinogen (azaserine), addition of PBD caused an increase in the fraction of aneuploid cells and in the volume fraction and cellular proliferation ( [3H]-thymidine labeling index) of the PPL. When hamsters were given a panceatic carcinogen (N-nitrosobis(2-oxopropyl)amine) (BOP), addition of PBD caused an increase in the incidence of PPL (ductal complexes) and ductal carcinoma in situ was observed. Furthermore, PBD caused an increase in the proliferative activity of the PPL. No increased proliferation in the PPL was seen in PBD operated animals receiving a CCK-A receptor antagonist. Gastric fundectomy caused an immediate and persistent increase in theplasma gastrin concentration without affecting the plasma CCK concentration. In hamsters, fundectomy induced an initial hyperplasia of acinar, ductal, and centroacinar cells followed by a persistent hypertrophy of the pancreas. No such changes were found in fundectomized animals receiving a CCK-B/gastrin receptor antagonist. Longterm (14 months) fundectomy in rats lead to an increase in the fraction of aneuploid cells in pancreatic tissue and development of PPL, but not neoplasia. No PPL or neoplasia were observed after long-standing ( 8 months) fundectomy in hamsters. When rats were given a pancreatic carcinogen (azaserine), addition of fundectomy lead to an increase in the fraction of aneuploid cells and an increase in the volumefraction, but not the proliferative activity, of the PPL. When hamsters weregiven a panceatic carcinogen (BOP), addition of fundectomy did not cause any significant change in the incidence or proliferative activity of PPL, and no neoplasia was observed. In conclusion, PBD induced persistent hypercholecystokininemia andfundectomy persistent hypergastrinemia, both of which induced exocrine tissue hyperplasia leading to persistent hypertrophy of the pancreas in rats and hamsters. The effects of PBD and fundectomy seemed to be mediated by CCK and gastrin, since they were blocked by simultaneous administration of a specific CCK-A and CCK-B/gastrin receptor antagonist, respectively. In longterm studies, both procedures caused development of PPL of the pancreas in rats but not in hamsters. In both rats and hamsters treated with a pancreatic carcinogen, addition of PBD enhanced the development of PPL. In rats, but not in hamsters, addition of fundectomy to carcinogen treatment also enhanced the development of PPL. Overall, the trophic as well as the promotive effects were significantly more pronounced after PBD than after fundectomy. In both rats and hamsters, pancreatic neoplasia was observed after PBD, but not after fundectomy.
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| 8. |
- Ericson, Ann-Charlott, 1965-
(författare)
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Synaptic organization of nociceptive relay nuclei in the cat and primate thalamus
- 1996
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The fine structure of two thalamic nociceptive relay nuclei, the nucleus submedius (Sm) in the cat, and the posterior region in the owl monkey, was investigated using anatomical tract tracing techniques, immunohistochemical staining for neuroactive substances, and threedimensional reconstructions of synaptic circuitry. Ascending lamina I axons, labeled by anterograde transport of Phaseolus vulgaris leucoagglutinin, gave rise to two different types of termination in Sm: large, compact clusters of numerous boutons were predominant in the dense focus of the terminal field after a tracer injection at the site of nociceptive-specific neurons in lamina I, and boutons-of-passage type terminations were conspicuous in the periphery of a lamina I terminal field in Sm and predominant following a tracer injection at the site of thermoreceptive-specific neurons in lamina I. Three-dimensional reconstructions of a sample of these terminations, generated from series of ultrathin sections by using special software on a computer workstation, showed that all boutons of each cluster made synaptic contact with protrusions and branch points on a single dendrite. These contacts involved presynaptic dendrites (PSDs) in triadic arrangements. In contrast, the boutons-of-passage type terminations were generally characterized by contacts with PSDs, and some of the passing varicosities made simple such synaptic contacts. However, an intermediate termination pattern was also found in which boutons-of-passage fanned synaptic complexes with dendritic appendages involving PSD contacts. Postembedding immunogold-labeling techniques showed that the spinal and trigeminal terminals in Sm contained synaptic vesicle-associated glutamate, suggesting that glutamate is an excitatory neurotransmitter in these terminals. Corticothalamic tract terminals were also glutamatergic. Immunoreactivity to gamma-aminobutyric acid (GABA) was observed in PSDs originating from GABAergic intrinsic neurons and in axon tenninals supposed to originate from the reticular thalamic nucleus. A similar organization of glutamatergic and GABAergic elements was seen in the posterior thalamic region of owl monkeys. The different types of synaptic organization seen in Sm are consistent with the possibility that modality-selective nociceptive and thermoreceptive lamina I neurons terminate differentially in this nucleus and suggest a functional integration of cold and pain activity. The presentfindings provide evidence that such activity is transmitted by the excitatory amino acid glutamate and is modulated by inhibitory GABAergic mechanisms. Glutamate and GABA are also involved in the processing of ascending information in the posterior thalamic region of owl monkeys, showing that these substances are important for pain transmission in primates as well.
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| 9. |
- Eriksson, Per, 1958-
(författare)
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Renal disease in primary Sjögren's syndrome
- 1996
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Primary Sjögren's syndrome (SS) is characterised by inflammation in the lacrimal and salivary glands. The kidneys may be involved, e.g. tubulointerstitial nephritis (TIN) and distal renal tubular acidosis (dRTA). dRTA is often associated with hypocitraturia, and both represent risk factors for the development of urolithiasis. The present investigations were undertaken to evaluate renal tubular function (including -dRTA), glomerular filtration rate (GFR), renal histopathology and mechanisms of stone formation, as well as the serum IgG subclass pattern in patients with SS. Furthermore, patients presenting with urolithiasis and dRTA in absence of sicca symptoms, as well as patients with urolithiasis andhypocitraturia, were studied with respect to autoantibodies and clinical features of SS. Renal tubular dysfunction, such as dRTA; impaired urine concentrating ability; hypocitraturia; and decreased tubular reabsorption of phosphate (1RP%), was conunonly detected in the SS-patients. Tubular proteinuria (al-microglobulin) and tubular enzymuria (NAG) were primarily associated with decreased GFR. GFR, investigated with 5Icr-EDTA plasma clearance, was below the reference limit in 33% of SS-patients. An inverse correlation was found between GFR and the extent of tubulointerstitial nephritis (adjusted CTIN score). Decreased GFR was mostly due to TIN, although urolithiasis and upper urinary tract infections may have contributed in some patients. TIN was demonstrated in most biopsied patients with SS, and the histopathological picture was characterised by mainly focal interstitial inflanunation, tubular atrophy, interstitial fibrosis and a varying extent of glomerular sclerosis. Fourty-one percent of the SS-patients had formed at least one stone, and calcium phosphate was the main constituent in most stones. All stone formers had dRTA, and most of them had hypocitraturia. Urinary calcium and urate excretion was also significantly higher than in non-stone formers. The SS-patients often had low serum levels of IgG2, despite high levels of total IgG. Low levels of IgG2 were sometimes associated with infections. A high IgG lngG2 ratio indicated autoimmune disease. Of 10 patients presenting with urolithiasis and dRTA, anti-SS-A antibodies were detected in eight. Subjective sicca symptoms subsequently developed l-48 years after the presentation of urolithiasis, and objective signs of SS were found in 7 patients. In a large population of hypocitraturic stone formers, ANA and anti-SS-A antibodies were commonly detected in the women but not in the men. Four of 14 evaluated hypocitraturic women with anti-SS-A antibodies or ANA, fulfilled the criteria for SS. In conclusion, the present investigations show that 24-hour urinary excretion of citrate is a valuable tool for detection of renal disease in SS, slightly-moderately decreased GFR is not unusual in SS-patients with. renal disease, the "adjusted CTIN score" can be a useful tool for quantifying the extent of tu'bulointerstitial nephritis, and the urine composition in stone formers with SS is similar to that of other dRT A-patients. The possibility of a Sjögren-related renal disease charcterised by urolithiasis and/or dRTA and antibodies to SS-A, regardless of whether subjective sicca symptoms are present or not, is hypothesised.
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| 10. |
- Frennesson, Christina, 1949-
(författare)
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Age-related maculopathy and macular degeneration : New diagnostic and therapeutic procedures
- 1996
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Age-related maculopathy (ARM) may progress into age-related macular degeneration (AMD), which is often disastrous to near vision and reading. Currently used treatment is generally not successful in a long-term perspective. Therefore, searching for an early detection of functional disturbances as well as for prophylactic treatment appears important.Colour contrast sensitivity was measured in patients with soft drusen maculopathy (early ARM). No deterioration in visual function was observed with conventional tests. A highly significant elevation (p<0.001-0.0001) of thresholds for all three colour axes was found, indicating an impairment of retinal function. A tendency towards a bimodal distribution was seen, suggesting a subgroup with a more prominent decrease in foveal sensitivity and possibly at higher risk of progression into the exudative form of the disease. Colour contrast sensitivity appears to be a more sensitive measure of early functional disturbances of the retina than provided by the currently used tests.Contrast sensitivity was measured peripheral to an absolute central scotoma in patients with AMD and was found to be significantly lower (p<0.001) than In normals at the same degree of eccentricity. This finding may explain the variations in the need for magnification in low vision patients with identical visual acuity for achieving the same visual performance.A new system for evaluating paramacular function and establishing the most suitable area for eccentric viewing was designed. The method facilitates the procedure of teaching and training the patient to use the eccentric viewing technique successfully. Reading speed increased significantly (pIn a prospective, randomised study, patients with early ARM were treated with green argon laser photocoagulation perifoveally over the drusen area. Parameters such as visual acuity, colour contrast sensitivity and central visual field were unchanged at the 12-month follow-up. The total drusen area decreased significantly (p<0.0001) after laser photocoagulation over a period of 12 mOnths. No complications were noticed. In a matched control group, the area of drusen tended to increase, and there was a significant difference {p
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