| 1. |
- Andersson, A. Christer
(författare)
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Acute anterior cruciate ligament injuries : evaluation of surgical och non-surgical treatment
- 1991
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- This study comprising 6 separate papers is concerned with the treatment of patients with acute anterior cruciate ligament (ACL) injury. The aim was to compare primary surgical and non-surgical ACL treatment. Treatment was, therefore, instituted at random in all consecutive patients (n = 293) with ACL injury.Initially all patients were investigated by arthroscopy and examined under anesthesia.After 4 years patients treated by ACL repair with combined intraarticular and extraarticular augmentation had a better stability, fewer knee symptoms and a higher level of activity than patients treated by nonaugmented ACL repair or by repair of the associated injuries alone. The patients in the latter group commonly developed instability symptoms and ACL reconstruction was required in 20"7o ofthem. Also they frequently had subsequent meniscal injuries, and an impaired knee function at one-leg-hop tests for distance. Running tests, however, was not correlated to ACL treatment.Another group of patients with acute ACL injury did not have any primary ligamentous repair. At one year 200Jo of the patients needed reconstructive surgery. Moreover, anteriorposterior laxity at one year was increased compared to the initial measurements. The greatest initial laxity was found in patients with an associated tear of the medial collateral ligament (MCL). The patients with combined ACL and MCL injuries had the worst prognosis.In patients with combined injuries who had primary repair of grade 2-3 MCL tears the outcome was similar as for patients with isolated ACL lesion.A simple device for static measurements of anterior-posterior knee displacement was valuable for evaluating the results of ACL treatment. lt can also be used as an aid in the diagnosis of acute knee injury.
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| 2. |
- Bornfeldt, Karin E.
(författare)
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Actions and interactions of insulin-like growth factor-I and insulin in vascular smooth muscle
- 1991
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Insulin-like growth factor-I (IGF-I) is a polypeptide with structural and biological similarities with insulin, and the receptors for IGF-I and insulin are homologous. The present investigation was devoted to the actions and interactions of IGF-I and insulin in vascular smooth muscle. In vascular smooth muscle from intact arteries and in cultured vascular smooth muscle cells there are abundant IGF-I receptors, but very few insulin receptors. IGF-I and insulin stimulated proliferation of cultured vascular smooth muscle cells, and the effects were probably mediated via the IGF-I receptor. However, the maximal growthpromoting effect of IGF-I was twice the maximal effect of insulin. If an acidic amino acid was substituted for the basic amino acid histidine in insulin B-chain (BlO His:::} Asp), like in IGF-I, the maximal growth-promoting activity reached the effect of IGF-1. The amino acid in position 10 in insulin B-chain may thus be important for the growthpromoting activity of insulin. Vascular smooth muscle cells express IGF-1 mRNA and produce imm1,1noreactive IGF-1 in vitro. Levels of IGF-1 m RNA were decreased by platelet-derived growth factor (PDGF-BB), basic fibroblast growth factor (bFGF) and serum, whereas IGF-1 and high concentrations of insulin increased IGF-I rnRNA and immunoreactive IGF-I. It is thus possible that IGF-1 is able to increase its own production in an autocrine loop withpositive feedback. The growth-promoting effects of IGF-1 and insulin were weak compared to the effects ofPDGF-BB and bFGF. The results indicate qualitative as well as quantitative differences between IGF-1 and insulin compared to PDGF-BB and bFGF. IGF-1 gene expression in aortic tissue was found to be decreased by diabetes and fasting in vivo, and the levels were restored if diabetic rats were treated with insulin. Vascular smooth muscle proliferation induced by balloon catheterization was found to be impaired by diabetes and increased by insulin-treatment in vivo, although not to the levels in normal rats. IGF-1 stimulated vascular smooth muscle proliferation in diabetic rats in vivo without affecting the diabetic state, and IGF-I gene expression was increased in proliferating vascular smooth muscle. The results suggest that IGF-I is involved in vascular smooth muscle proliferation in vivo. In conclusion, insulin is less potent than IGF-1 in stimulating proliferation of vascular smooth muscle, and the growth-promoting effects of insulin are weaker than the effects ofiGF-1, suggesting that insulin in concentrations found in plasma has little direct effect on vascular smooth muscle proliferation. IGF-1 is probably of importance for vascular smooth muscle proliferation, and the results suggest that IGF-1 can be locally produced and regulated in the vascular wall.
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| 3. |
- Croner, Stefan, 1944-
(författare)
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Development of atopic disease from birth to adolescence : Relation to family history and cord blood IgE
- 1991
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- In a cohort of 1701 consecutively born children, 32.5% developed obvious atopic disease up to 11 yr. The predictive capacity of cord blood IgE and a family history (FH) of atopic disease have been studied. Questionnaire (Q) data at 1.5, 7 and 11 yr showed a prevalence of obvious atopic disease of 4.5, 11.5 and 23.7 % respectively. The prevalence of asthma was 0.5, 2.4 and 3.0 %, a slight increase in comparison with figures from the 50's. A high cord blood IgE (~ 0.9 kUJI), identified most children with early, multiple and continuous symptoms as well as an earlier asthma start. The capacity of cord blood IgE to predict the severity of asthma and the IgE levels at 11 yr was low. The sensitivity of the test to detect atopic disease decreased from 77 % at 1.5 yr to 26 % at 11 yr. The sensitivity for obvious allergy of a FH was 49 % at 1.5 yr and 45 % at 11 yr. The specificity of cord blood IgE was 94 % at 11 yr and of the FH 74 %. Cord blood IgE determination alone can not, without modifications, be recommended as a general screening method for atopy. Children with high cord blood IgE, born during peak pollen exposure seem to be at special risk to develop atopic disease. Sensitization to timothy was more common among children born in May as compared to November. The reliability of the Q used at 7 and 11 yr was evaluated by examination of 133 randomly selected children at 11 yr. The Q was found adequate for establishing the prevalence but less so for the cumulative incidence of atopic disease since parents tend to forget symptoms (25%) that their children had some years earlier. The natural history of asthma (AB) was studied in all 89 children and adolescents reporting symptoms of asthma. Fifty-nine were available for clinical examination at 11.5-14.5 yr. AB was found more often in children born during August-October. Inadequate medication, undiagnosed chest deformity and wheezing at examination was found in several children emphasizing the need for more regular control of adolescents having AB. Animal danders and pollens were the most common offending allergens. Sensitivity to mites was more common compared to earlier Swedish studies. A "total asthma score" including both days with impact of AB during last year and present medication was found useful for classification of these children with AB.
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| 4. |
- Follin, Per, 1953-
(författare)
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The primed neutrophil : a friend or a foe in inflammation
- 1991
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Human neutrophils are the most abundant of the white blood cells in circulation and represent the first line of defense against invading microorganisms. With a membrane-bound enzyme system (the NADPH oxidase), these cells can generate reactive oxygen metabolites that serve efficiently in antimicrobial defense. Neutrophils are normally dormant in the circulation but may become primed; in that state they can produce an enhanced respiratory burst response upon activation and thereby strengthen the immune response. During bacterial infections, endogenous inflammatory mediators orbacterial products induce metabolic priming of neutrophils, which thenexpose an increased number of receptors to the peptide f-Meth-Leu-Phe(fMLP). There is, however, no correlation between the increased level ofrespiratory burst response and the level of receptor upregulation, indicating that post-receptor events in the activation sequence are also involved. Neutrophils isolated from an inflammatory focus were found tobe metabolically deactivated as far as the agonists NAP-1/IL 8 and C5awere concerned but primed in relation to tMLP. Further characterizationof exudated cells revealed that the mechanism of priming involves protein kinase C but not a rise in intracellular Ca2+ or a decreased inactivation rate of the oxidase. In primed cells most of the increased production of reactive oxygen species induced by fMLP is located intracellularly, whereas, an increased extracellular release of reactive oxygen species occurs during phagocytosis. The fact that primed cells can both produce and, under certain conditions, release increased amounts of hydrogen peroxide raises the question of whether the primed cell is a friend or a foe in the inflammatory reaction.
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| 5. |
- Gasslander, Thomas, 1952-
(författare)
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Long-term effects of cholecystokinin on exocrine and endocrine pancreas
- 1991
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The gastrointestinal hormone cholecystokinin (CCK) is known to be oneof the most potent stimulators of pancreatic growth. CCK is alsosuggested to be an initiator and/or promotor of pancreatic carcinogenesis. This study was undertaken to elucidate the effects oflong-term stimulation with exogenous and endogenous CCK andexogenous secretin on exocrtne and endocrine pancreatic cell proliferation (in rats and mice) and on . endocrine (B-cell) function (inrats). Cell kinetics were studied autoradiographically by means of 3H-thymidine labeling of DNA synthesizing cells and endogenous increasein plasma CCK level was induced by surgical pancreatico-biliary diversion (PBD). The study showed that long-term stimulation with the CCK analogue cerulein (in mice) as well as endogenously induced hyperCCKemia (in rats) induced pancreatic hyperplasia. The proliferative response was as high, or even higher, in the ductal and centroacinar cell populations than in the acinar one, which traditionally is regarded as the target forCCK. The cells adapt to the continuous CCK stimulation with a decrease in proliferative activity to control level after 14-20 days. Cerulein seems to induce early changes in the centroacinar cell region with signs of transition of cells from acinar to centroacinar position. Secretin, which has the ductal cells as its main target cell, had no growth stimulating effect on any of the studied cell types. Long-term endogenous CCK stimulation does not affect the proliferation of cells in the islands of Langerhans, nor affect the insulin secretory response or the glucose elimination following intravenous glucose loading. The results of the study are of special interest as human pancreatic carcinoma is considered to be ductal and as there are suggestions of early changes in the centroacinar · region in experimental pancreatic carcinogenesis. Funhermore, the PBD model was found to be suitable for studies on longterm CCK effects, as the pancreatic growth response following PBD was exclusively caused by the increased plasma CCK level.
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| 6. |
- Gauffin, Håkan
(författare)
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Knee and ankle kinesiology and joint instability
- 1991
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- This study, comprising 7 separate papers, is concerned with the additional information supplied by a kinesiological approach for evaluation of patients with instability due to old ligamenta us injury to the knee or ankle joint. This approach required development of new methods for kinesiological analysis. Impaired performance in patients with old anterior cruciate ligament (ACL) rupture was mainly found in tests which greatly stress the knee joint, ie figure-of-eight running and one-legged jump for distance. A scaling model approach was constructed and found appropriate in evaluating knee and ankle function in patients with ligarnentous injuries. A dynamic, two-dimensional, biomechanical model was developed and implemented in a motion analysis system together with a force plate and EMG. This model was found useful for evaluation of kinematics, kinetics and muscular activation patterns at the ankle, knee and hip joints during functional movements such as walking and jumping. A movement analysis could reveal adapted movement- and muscular activation patterns for the ACL-deficient knee compared to the noninjured at touch down at one-legged jump. An internal knee model disclosed a simultaneous decrease in sagittal shear load which was interpreted as an adaptation to avoid increased intrinsic joint movements or gross subluxations. Unilateral injury to the lateral ligaments of the ankle is related to both ipsi- and contralateral functional alterations. There is a risk of underestimating the impairment of the injured joint in a function test using the noninjured side as a reference. A perturbation device was construcred and found useful for the analysis of postural strategies, reaction latencies and ankle joint function during single limb stance. The ankle joints were found to be of primary concern for postural corrections to retain equilibrium in single limb stance. A quasi static, three-dimensional ankle model was developed and implemented in a motion analysis system which made possible study of ankle joint function, load and instability. Different motor patterns were found for the functionally unstable foot compared to the stable in single limb stance.
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| 7. |
- Gustafsson, Per, 1950-
(författare)
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Oesophageal function, acid reflux and bronchopulmonary disease : A study on children and adolescents with asthma or cystic fibrosis
- 1991
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- This thesis comprises a literature review of gastro-ocsophageal reflux (GOR) and six studies which aim to determine the prevalence of oesophageal dysfunction (OD) and pathological GOR and their significance concerning the bronchopulmonary disease in children and adolescents with bronchial asthma or cystic fibrosis (CF). Oesophageal function was assessed by manomctry combined with oesophageal provocation tests. 24-hour two-level oesophageal pH monitoring was used to quantify GOR, to study the temporal relationship between acid reflux and asthma symptoms, and to assess the propensity to aspirate. Symptoms of OD and asthma were evaluated by interview and by the use of questionnaires. Severity of bronchopulmonary disease in the CF patients was assessed by radiography and spirometry. A double-blind placebo-controlled trial of ranitidine 150/300 mg per day over four weeks was performed in the asthma group to see if a reduction in acid reflux improved asthma. The relative significance of reflux symptoms and atopic allergy, regarding lung function and bronchial histamine reactivity in asthma, was evaluated. Pathological GOR and OD were significantly more common in asthma and CF patients than in controls. Episodes of acid reflux seemed to provoke asthma symptoms in a few patients. Ranitidine produced a significant but modest reduction in nocturnal/morning asthma symptoms in patients with pathological GOR, when compared to those with normal GOR. Asthma patients with reflux symptoms more frequently experienced asthma attacks initiated by non-specifictrigger factors than patients without such symptoms. The presence of atopic allergy was related to impaired lung function and increased bronchial hyperreactivity. Severity of OD and bronchopulmonarydisease correlated well in CF patients. OD or pathological GOR are found in the majority of children and adolescents with asthma or CF. In CF subjects OD and GOR may be parts of a vicious circle including malnutrition and progressive lung damage. In asthma acid reflux is, on the whole, a mild trigger or a modulatory factor, and appears to influence the airways via oesophago-bronchial reflexes rather than by aspiration. Atopic allergy is still more important than GOR in childhood asthma.
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| 8. |
- Holmlund, Ulla, 1946-
(författare)
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Psychogenic needs and masculinity-femininity across adolescence : their relationschips to dysmenorrhea and psychiatric symptoms
- 1991
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Holmlund, Ulla. 1991. Psychogenic needs and Masculinity-Femininity across adolescence. Their relationships to dysmenorrhea and psychiatric symptoms.Personality traits assessed as psychogenic needs, and psychological Masculinity-Femininity defined as interests and attitudes were examined longitudinally from the age of 15 to 25 years in healthy Swedish women.Across adolescence, the women became more self-confident and assertive, but also more conforming and socially dependent. Women at 25 were also more conventionally feminine than at 15. Those changes were quite uniform for the individuals of the sample as a whole.The relationships between personality variables, psychogenic needs and psychological Masculinity-Femininity, and the occurence of dysmenorrhea were studied. Severe dysmenorrhea was associated to personality variables, mainly high scores in Guilt Feelings and psychological Femininity.Possible relationships between dysmenorrhea and the occurence of symptoms of anxiety and depression, and between personality variables and anxiety and depressive symptoms was examined in a subsample, considered to be representative for psychogenic needs. Women with severe dysmenorrhea were slightly more affected by anxiety and depressive symptoms compared to those who never had experienced dysmenorrhea. High scores in the psychogenic needs Defence of Status and Guilt Feelings assessed in early teenage were associated to the presence of anxiety and depressive symptoms in adulthood. The positiverelationships between the reported experience of good relations to siblings and peers, low scores in Defence of Status and Guilt Feelings, and the abscence of psychiatric symptoms, reflect the importance of a favourable early environment for healthy personality development.
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| 9. |
- Ivarsson, Ingemar, 1951-
(författare)
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On treatment of medial gonarthrosis
- 1991
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- This study, comprising 7 separate papers, is concerned with treatment of medial gonarthrosis.Results after high tibial osteotomy were found to deteriorate 8-9 years after surgery. The best results were seen in knees with preoperative Stage I or II osteoarthrosis and valgus deviation after osteotomy.The rehabilitation period after high tibial osteotomy is long, recovery of the average thigh muscle torque was first seen after 12 months. Stable internal fixation with early mobilization does not seem to be advantageous in this respect.Gait analysis showed signs of insufficient rehabilitation persisting 8-12 months after high tibial osteotomy, with unimproved maximum gait velocity and reduced stride length at constant maximum velocity.Rehabilitation with restitution of muscle torque was faster after unicompartmental arthroplasty and gait parameters did improve.An "anatomical" type of unicompartmental prosthesis seems to be more susceptible to load, with changed strain elicited in external rotationcompared to a meniscus bearing prosthesis.Knees with medial osteoarthrosis showed less rotation clinically duringmotion than healthy knees. The rotation was not significantly affected by a unicompartmental arthroplasty.A radiographic method for detection of prosthetic migration, using tantalum balls implanted in the skeleton, was developed and tested on 20 patients.
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| 10. |
- Jonsson, Brynjolfur
(författare)
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Destructive reumatoid arthritis : Epidemiological, economic, and rheumasurgical aspects
- 1991
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- This study comprising 8 separate papers is concerned with the prevalence of rheumatic disease and different aspects of destructive rheumatoid arthritis in the population. In an epidemiologically representative population subjective joint disease was found in 30% in ages 45 years and over. All those people were clinically examined and diagnosis established. Joint disease becomes commoner with increasing age and causes considerable disability. Destructive rheumatoid arthritis, ARA criteria 5-8, i.e. classical and definite RA, was found in 0.65% of the population. This patient group with joint destructions is the most interesting from rheumasurgical view. A clinical evaluating system, total locomotion score, comprising of a subjective and an objective part, was developed for numerical multifactorial assessment of patients with destructive RA. It is based on WHO's recommandations for disease integration (1980). This system was tested and was found to have good interobserver reliability and showed good correlation between patient's subjective and objective status. All 82 RA patients found in the epidemiological population were evaluated by total locomotion score and for hand function with Sollerman's hand function test and current status emerged. The destructive RA manifestations of the locomotor system, including the hand, were increasing with age, longer disease duration, and were more pronounced in women than men. In this patient group further reconstructive operations were needed in 55% of cases and this care was closely correlated with low total locomotion score. Reconstructive joint and hand surgery was found to prevent deterioration of the disease. The costs of RA were correlated to effects of the disease destructions; patients in working-age had highest indirect costs and elderly patient medical and social costs. Total costs of the disease were better correlated to the status of lower extremities than upper. Elbow replacement in RA reliefs pain well and improves function of arm and hand. Total hip and knee replacement in RA improves status regardless age, sex, and low preoperative total locomotion score. Besides better quality of life, reduced indirect costs and reduced costs of home help are achieved.
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