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Sökning: WFRF:(Anderberg Leif)

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1.
  • Anderberg, Leif (författare)
  • Cervical Radiculopathy: A Study With Selective Nerve Root Blocks
  • 2005
  • Doktorsavhandling (övrigt vetenskapligt)abstract
    • Popular Abstract in Swedish Symtomgivande nervrots påverkan i halsryggen diagnostiseras via sjukhistoria, klinisk undersökning och magnetkamera undersökning av halsryggen (MRI). Hos flera av patienterna som genomgår denna utredning infinner sig svårigheter att identifiera den/de nervrötter som är ansvariga för patientens smärta. Detta beror på att den kliniska undersökningen och undersökningen med MRI inte ger tillräcklig information. Utvärdering av nyttan av information från selektiva diagnostiska nervrots blockader (SNRB) med lokalanestesi hos patienter med nervrotspåverkan i halsryggen är utförd i två prospektiva studier innefattande 20 patienter med disksjukdom på en nivå och på 30 patienter med två nivåers disksjukdom. I en annan prospektiv studie innehållande nio patienter studeras kontrastspridningen från tre olika volymer injicerade i halsryggen med samma teknik som används vid SNRB. Effekten av kortison på nervrotssmärta i halsryggen utvärderas i en prospektiv och randomiserad studie innefattande 40 patienter. Som kontroll användes koksaltlösning. Effekten utvärderas efter 3 veckor. I en nivå studien framkom god korrelation mellan MRI fynd och SNRB. I två nivåer studien framkom information från SNRB som klinisk undersökning och MRI fynd inte kunde ge. Korrelationen mellan SNRB och MRI var 60 % och mellan SNRB och klinisk undersökning 28 %. Positiv effekt av SNRB korrelerade till good/excellent outcome efter behandling i 82 % av patienterna. Kontrast spridning från transforaminala SNRB påverkas av storleken på den injicerade volymen samt arean på rotkanalen som injiceras. Användandet av 0.5 ml vid diagnostiska SNRB är mera selektiv än 1.5 ml. Den nervrot som ligger ovanför den injicerade rotkanalen förefaller vara den som mest riskerar att bli påverkad av oönskad spridning. Ingen skillnad i terapeutisk effekt noterades vid jämförelse av kortison och koksaltlösning vid behandling av nervrotssmärta från halsryggen. Ytterliggare studier krävs för att utvärdera nyttan av kortison tillblandning vid lokal behandling av nervrotssmärta från halsryggen.
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2.
  • Anderberg, Leif, et al. (författare)
  • Distribution patterns of transforaminal injections in the cervical spine evaluated by multi-slice computed tomography.
  • 2006
  • Ingår i: European Spine Journal. - Springer. - 0940-6719. ; 15:10, s. 1465-1471
  • Tidskriftsartikel (refereegranskat)abstract
    • Transforaminal injections are sometimes used for the diagnosis and treatment of painful conditions in the lumbar and to a lesser degree in the cervical spine. The technique is most often used when investigating/treating radiculopathy caused by degenerative disease. But how selective are the nerve root blocks? What possible structures other than the intended nerve root are affected from such injections? This study was undertaken in order to try to answer these questions, as no study focusing on the possible spread from the transforaminal selective nerve root blocks in the cervical spine has been performed earlier. In three groups of patients, each group including three patients, we injected three different volumes (0.6, 1.1 and 1.7 ml) with a transforaminal technique in the cervical spine. In all the injections, a small amount of contrast media was added. The spread of the injections were then investigated using multi-slice computed tomography with reconstructions. The imaging revealed a possible effect on other nerve roots than the intended ones when a larger volume was used for the root blocks. The spread was related to the injected volume as well as to local anatomy (size of foraminal area). In this study, only 0.6-ml injections could be accepted for being selective enough for diagnostic investigations.
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5.
  • Anderberg, Leif, et al. (författare)
  • Selective diagnostic nerve root block for the evaluation of radicular pain in the multilevel degenerated cervical spine.
  • 2006
  • Ingår i: European Spine Journal. - Springer. - 0940-6719. ; 15:6, s. 794-801
  • Tidskriftsartikel (refereegranskat)abstract
    • In patients with radiculopathy due to degenerative disease in the cervical spine, surgical outcome is still presenting with moderate results. The preoperative investigations consist of clinical investigation, careful history and most often magnetic resonance imaging (MRI) of the cervical spine. When MRI shows multilevel degeneration, different strategies are used for indicating which nerve root/roots are affected. Some authors use selective diagnostic nerve root blocks (SNRB) for segregating pain mediating nerve roots from non-pain mediators in such patients. The aim of the present study is to assess the ability of transforaminal SNRB to correlate clinical symptoms with MRI findings in patients with cervical radiculopathy and a two-level MRI degeneration, on the same side as the radicular pain. Thirty consecutive patients with cervical radiculopathy and two levels MRI pathology on the same side as the radicular pain were studied with SNRBs at both levels. All patients underwent clinical investigation and neck and arm pain assessment with visual analogue scales (VAS) before and after the blocks. The results from the SNRBs were compared to the clinical findings from neurological investigation as well as the MRI pathology and treatment results. Correlation between SNRB results and the level with most severe degree of MRI degeneration were 60% and correlation between SNRB results and levels decided by neurological deficits/dermatome radicular pain distribution were 28%. Twenty-two of the 30 patients underwent treatment guided by the SNRB results and 18 reported good/excellent outcome results. We conclude that the degree of MRI pathology, neurological investigation and the pain distribution in the arm are not reliable parameters enough when deciding the affected nerve root/roots in patients with cervical radiculopathy and a two-level degenerative disease in the cervical spine. SNRB might be a helpful tool together with clinical findings/history and MRI of the cervical spine when performing preoperative investigations in patients with two or more level of degeneration presenting with radicular pain that can be attributed to the degenerative findings.
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6.
  • Anderberg, Leif, et al. (författare)
  • Spinal cord injury : scientific challenges for the unknown future
  • 2007
  • Ingår i: Upsala Journal of Medical Sciences. - 0300-9734 .- 2000-1967. ; 112:3, s. 259-288
  • Forskningsöversikt (övrigt vetenskapligt)abstract
    • <p>The history of spinal cord injuries starts with the ancient Egyptian medical papyrus known as the Edwin Smith Surgical Papyrus. The papyrus, written about 2500 B. C. by the physician and architect of the Sakkara pyramids Imhotep, describes "crushed vertebra in his neck" as well as symptoms of neurological deterioration. An ailment not to be treated was the massage to the patients at that time. This fatalistic attitude remained until the end of World War II when the first rehabilitation centre focused on the rehabilitation of spinal cord injured patients was opened. Our knowledge of the pathophysiological processes, both the primary as well as the secondary, has increased tremendously. However, all this knowledge has only led to improved medical care but not to any therapeutic method to restore, even partially, the neurological function. Neuroprotection is defined as measures to counteract secondary injury mechanisms and/or limit the extent of damage caused by self-destructive cellular and tissue processes. The co-existence of several distinctly different injury mechanisms after trauma has provided opportunities to explore a large number of potentially neuroprotective agents in animal experiments such as methylprednisolone sodium succinate. The results of this research have been very discouraging and pharmacological neuroprotection for patients with spinal cord injury has fallen short of the expectations created by the extensive research and promising observations in animal experiments. The focus of research has now, instead, been transformed to the field of neural regeneration. This field includes the discovery of regenerating obstacles in the nerve cell and/or environmental factors but also various regeneration strategies such as bridging the gap at the site of injury as well as transplantation of foetal tissue and stem cells. The purpose of this review is to highlight selected experimental and clinical studies that form the basis for undertaking future challenges in the research field of spinal cord injury. We will focus our discussion on methods either preventing the consequences of secondary injury in the acute period ( neuroprotection) and/or various techniques of neural regeneration in the sub-acute and chronic phase and finally expose some thoughts about future avenues within this scientific field.</p>
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7.
  • Anderberg, Leif, et al. (författare)
  • Spinal cord injury - scientific challenges for the unknown future.
  • 2007
  • Ingår i: Uppsala Journal of Medical Sciences. - Taylor & Francis. - 0300-9734. ; 112:3, s. 259-288
  • Tidskriftsartikel (refereegranskat)abstract
    • The history of spinal cord injuries starts with the ancient Egyptian medical papyrus known as the Edwin Smith Surgical Papyrus. The papyrus written about 2500 B.C.by the physician and architect of the Sakkara pyramids Imhotep, describes "crushed vertebra in his neck" as well as symptoms of neurological deterioration. An ailment not to be treated was the massage to the patients at that time. This fatalistic attitude remained until the end of World War II when the first rehabilitation centre focused on the rehabilitation of spinal cord injured patients was opened. Our knowledge of the pathophysiological processes, both the primary as well as the secondary, has increased tremendously. However, all this knowledge has only led to improved medical care but not to any therapeutic method to restore, even partially, the neurological function.Neuroprotection is defined as measures to counteract secondary injury mechanisms and/or limit the extent of damage caused by self-destructive cellular and tissue processes. The co-existence of several distinctly different injury mechanisms after trauma has provided opportunities to explore a large number of potentially neuroprotective agents in animal experiments such as methylprednisolone sodium succinate. The results of this research have been very discouraging and pharmacological neuroprotection for patients with spinal cord injury has fallen short of the expectations created by the extensive research and promising observations in animal experiments. The focus of research has now, instead, been transformed to the field of neural regeneration. This field includes the discovery of regenerating obstacles in the nerve cell and/or environmental factors but also various regeneration strategies such as bridging the gap at the site of injury as well as transplantation of foetal tissue and stem cells. The purpose of this review is to highlight selected experimental and clinical studies that form the basis for undertaking future challenges in the research field of spinal cord injury. We will focus our discussion on methods either preventing the consequences of secondary injury in the acute period (neuroprotection) and/or various techniques of neural regeneration in the sub-acute and chronic phase and finally expose some thoughts about future avenues within this scientific field.
8.
  • Anderberg, Leif, et al. (författare)
  • Transforaminal steroid injections for the treatment of cervical radiculopathy: a prospective and randomised study.
  • 2007
  • Ingår i: European Spine Journal. - Springer. - 0940-6719. ; 16:3, s. 321-328
  • Tidskriftsartikel (refereegranskat)abstract
    • Steroid injections are often employed as an alternative treatment for radicular pain in patients with degenerative spinal disorders. Prospective randomised studies of the lumbar spine reveal contradictory results and non-randomised and most often retrospective studies of the cervical spine indicate pain reduction from steroid injections. No prospective randomised study on transforaminal steroid injections for the treatment of radicular pain in the cervical spine focusing on short-term results has been performed. Forty consecutive patients were employed for the study. The inclusion criteria were one-sided cervical radiculopathy with radicular distribution of arm pain distal to the elbow and corresponding significant degenerative pathology of the cervical spine at one or two levels on the same side as the radicular pain and visualised by MRI. A transforaminal technique was used for all injections. A positive response to a diagnostic selective nerve root block at one or two nerve roots was mandatory for all patients. The patients were randomised for treatment with steroids/local anaesthetics or saline/local anaesthetic. Only the neuroradiologist performing the blocks was aware of the content of the injection; all other persons involved in the study were blinded. Follow up was made 3 weeks after the randomised treatment by a clinical investigation and with a questionnaire focusing on the subjective effects from the injections. At follow up, there were no differences in treatment results in the two patient groups. Statistical analysis of the results confirmed the lack of difference in treatment effect. Further studies have to be performed before excluding steroids in such treatment and for evaluating the influence of local anaesthetics on radiculopathy in transforaminal injections.
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10.
  • Ekelund, Magnus, et al. (författare)
  • Genetic prediction of postpartum diabetes in women with gestational diabetes mellitus
  • 2012
  • Ingår i: Diabetes Research and Clinical Practice. - Elsevier. - 1872-8227. ; 97:3, s. 394-398
  • Tidskriftsartikel (refereegranskat)abstract
    • Aims: To examine whether genetic variants that predispose individuals to type 2 diabetes (T2D) could predict the development of diabetes after gestational diabetes mellitus (GDM). Methods: 13 SNPs (FTO rs8050136, CDKAL1 rs7754840 and rs7756992, CDKN2A/2B rs10811661, HHEX rs1111875, IGF2BP2 rs1470579 and rs4402960, SLC30A8 rs13266634, TCF7L2 rs7903146, PPARG rs1801282, GCK rs1799884, HNF1A rs1169288, and KCNJ11 rs5219) were genotyped in 793 women with GDM after a median follow-up of 57 months. Results: After adjustment for age and ethnicity, the TCF7L2 rs7903146 and the FTO rs8050136 variants significantly predicted postpartum diabetes; hazard ratio (95% confidence interval 1.29 (1.01-1.66) and 1.36 (1.06-1.74), respectively (additive model) versus 1.45 (1.01-2.08) and 1.56 (1.06-2.29) (dominant model)). Adjusting for BMI attenuated the effect of the FTO variant, suggesting that the effect was mediated through its effect on BMI. Combining all risk alleles to a weighted risk score was significantly associated with the risk of postpartum diabetes (hazard ratio 1.11, 95% confidence interval 1.05-1.18, p = 0.00016 after adjustment for age and ethnicity). Conclusions: The TCF7L2 rs7903146 and FTO rs8050136 polymorphisms, and particularly a weighted risk score of T2D risk alleles, predict diabetes after GDM. Further studies in other populations are needed to confirm our results. (C) 2012 Elsevier Ireland Ltd. All rights reserved.
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