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- Sjöberg, Inga, 1946-
(författare)
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The vagina : morphological, functional and ecological aspects
- 1991
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The vagina is one organ of the body which has not been studied exhaustively. Moreover, most of the studies found in the contemporary literature have been performed on women affected by a variety of genital diseases.In the present study the vaginal epithelium was examined with a histological method, morphometry, whereby cyclical changes related to hormonal variation during the menstrual cycle were demonstrated. Determination of the quantity of estrogen receptors in the vaginal epithelium on two occasions during the menstrual cycle revealed a significantly greater number in the follicular than in the luteal phase. The results of these studies indicate the presence of a menstrual variation in the vaginal epithelium comparable to that in the endometrium.Phenoxymethylpenicillin (pcV) was used as a marker substance to study the dynamics of the transport mechanisms into the vagina. PcV was found to accumulate in the vaginal fluid and high concentrations persisted for a long period of time. In hysterectomized women, the appearance of pcV in the vaginal fluid followed the same pattern. Consequently, the substance is transported through the vaginal wall and need not enter with the secretions from the internal genitalia. The greatest concentration of pcV was in the distal portion of the vagina, possibly due to the specific internal circulation of fluid within the vagina.Bacterial vaginosis as an example of an ‘ecological disease’ has been studied with regard to the formation of endotoxin, a constituent of the cell wall of Gram- negative bacteria. Large amounts of endotoxin were found and the clinical implication of this finding has been pointed out.Furthermore, the influence of pcV on the vaginal microbial flora of healthy women has been investigated. A change from a situation with predominance of lactobacilli to the appearance of Gram-negative rods was observed. In one of the women the lactobacilli disappeared completely and were replaced by E. coliand high levels of endotoxin in the vaginal fluid were found. This study demonstrates the complexity of the ecological balance of the vaginal microbial flora and illustrates the difficulty of defining a ‘normal’ vaginal condition. Is there any unquestionable state of ‘normality’ even in a healthy woman free from symptoms of genital disease?
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| 2. |
- Berggren, Diana, 1951-
(författare)
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Applications of organ culture of the mouse inner ear
- 1991
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The embryonic mouse inner ear was used as a model with which to study ototoxicity and tissue interactions. The inner ear anlage can be explanted and cultured in vitro from about the 12th gestational day (gd), and will differentiate parallel with the inner ear developing in vivo until a time corresponding to birth (21st gd). During this period the ovoid sac develops into the labyrinth.In the present thesis work, otic anlagen from gd 12, 13, 13.5, 15 and 16 were used. As a rule the explants were kept in culture until a time point equivalent to the 21st gd.Analyses using freeze-fracture technique and transmission electron microscopy showed that in cultured 13th gd otocysts the development of junctional complexes followed the same principal pattern as in vivo. Tight junctions develop into many strands lying parallel to the apical surface of all epithelial cells. Uncoupling of the hair cells occurs with loss of gap junctions. Some tight junctions had an aberrant appearence, with in part very thick strands and strands running at right angles to the apical surface.All aminoglycosides are potentially ototoxic. In the inner ear, outer hair cells of the organ of Corti and vestibular type I hair cells are affected by these antibiotics. The access route to the hair cells and the sites and mechanisms of action of aminoglycosides are not precisely defined.The uptake of tritiated tobramycin in 16th gd inner ears was studied. An initial rapid uptake of the drug, within 10 min, was followed by a slower accumulation, reaching a steady state after 60 min. Most of the tobramycin was bound reversibly, at least after a short period of incubation (2 h). The irreversibly bound fraction was of the same magnitude as the uptake within 10 min. Uptake took place against a concentration gradient.The otocyst can differentiate even without the statoacoustic ganglion. The interaction of the sensory epithelium with the ganglion was investigated by explanting the statoacoustic ganglion without target tissue. Twenty-five percent of the ganglions survived and had outgrowth of neurites but there was no differentiation into either the cochlear or vestibular type of neuron cells.Exposure of cultured otocysts (13 or 13.5 gd) to l-azetidine-2-carboxylic acid, a 1-proline analog that disrupts formation of collagen, resulted in retarded morphogenesis of the labyrinth and a dose- dependent derangement of the basal lamina.The expression of intermediate filaments (IFs) was analysed using monoclonal antibodies. The same IF pattem was found in cultured inner ears as in vivo. Explants were taken on 13th, 15th or 16th gd. Exposure to gentamicin, ethacrynic acid or cisplatin did not alter the IF composition. Cytokeratins (CKs) 8 and 18 were identified in all inner ear epithelia. In addition CKs 7 and 19 were visualized in the epithelia involved in maintaining endolymph homeostasis. The ganglion cells showed coexpression of CK, vimentin and neurofilaments.The elemental composition of the endolymph compartment of 16th gd inner ears cultured for 5 days was studied using energy-dispersive X-ray microanalysis. Na to K ratios characteristic of endolymph were found.
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| 3. |
- Ekholm, Ulla-Britt, 1952-
(författare)
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Premenstrual syndrome : a study of change in cyclicity, severity and sexuality
- 1991
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- 82 women seeking help for the Premenstrual syndrome (PMS) were successively recruited into a research project on PMS. All of them performed daily self-ratings during one menstrual cycle and 54 of them during two cycles.Including the patients with two rated cycles the change between cycles in cyclicity and preovulatory symptoms was studied. They were diagnosed and subgrouped as having ”Pure PMS” with significant cyclicity and only premenstrual symptoms, ”PM aggravation” with significant cyclicity but with additional preovulatory symptoms or ”Non-PMS” without cyclicity. 78% showed the same cyclical pattern in both cycles and 65% were allocated to the same subgroup. The presence or absence of preovulatory symptoms was a more stable factor than the occurence of cyclicity. The cycle more resembling an ”ideal PMS pattern” better separated groups of patients regarding neurotic personality and psychiatric history.When all 54 patients were investigated together there was no change in severity between the two cycles when the whole cycles were compared, and using the premenstrual phase only difference in one symptom. When divided into subgroups it was found that the ”Pure PMS” group felt worse during the first rated cycle while the ”PM aggravation” group felt better during the first cycle.A method for estimating the severity of PMS was developed and tried. A severity-score was calculated and ± 1 SD was used to subdivide the patients into severity-groups giving 20% classified as having mild PMS, 61% as moderate and 19% as severe. The symptoms with the highest correlation to the severity-score were anxiety, tension and irritability.The validity of the severity-score was studied by comparing it with other ways of estimating severity of PMS. There was very good agreement between the severity-score and the prospective rating of influence on family, work and social life, fairly good between the result of a Moos Menstrual Distress Questionaire (MDQ) and the severity-score and also between the retrospective rating of influence and the severity-score. There was good agreement when the severity-score from two rated cycles was compared.Sexual parameters and the relationship to androgen levels and SHBG were studied. All sexual parameters showed cyclical change except the parameter ”unpleasant sexual thoughts” in the group with high levels of androstenedione, testosterone and SHBG when using combined p-value. The patients with a low level of androstenedione had more days with maximum ratings of the parameters ”sexual feelings” and ”pleasant sexual thoughts”. Patients with ”Pure PMS” had a lower level of testosterone compared with the ”PM aggravation” group.Four different methods for diagnosis of PMS, a nonparametric test, effect size, run test and 30% change were compared. Results showed high agreement except for the method of using 30% of the scale as condition for cyclicity, which resulted in fewer patients with cyclicity than the other methods used.
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- Gustafson, Yngve, 1949-
(författare)
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Acute confusional state (delirium) : clinical studies in hip-fracture and stroke patients
- 1991
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Acute confusional state (ACS) or delirium according to DSM-III-R holds a central position in the medicine of old age. ACS is a common and sometimes the only symptom of diseases and medical complications in the elderly patient.The aim of this study was to elucidate ACS in patients with femoral neck fractures and patients with acute stroke with regard to frequency, predictors, possible pathogenetic mechanisms, associated complications, assessment and documentary routines and the clinical outcome for the patients. An intervention program to prevent postoperative ACS based on our results was developed and evaluated.The main findings of the study were high frequencies of ACS in elderly patients with femoral neck fractures (61 %) and in patients with acute stroke (48 %). The main risk factors for ACS in patients with femoral neck fractures were old age, diseases and drug treatment interfering with cerebral cholinergic metabolism. There was no link between anaesthetic technique and ACS but the connection between peroperative hypotension, early postoperative hypoxia and ACS was close.In stroke patients the degree of extremity paresis and old age were independent ACS risk factors. ACS was commonly associated with post stroke complications such as myocardial infarction, pneumonia, urinary infection and urinary retention. In stroke patients there was a close connection between high hypothalamic-pituitary-adrenal axis (HPA-axis) activity and ACS. High HPA-axis activity and disturbances in the cerebral cholinergic system may be two important ACS mechanisms.A correct diagnosis is a prerequisite for proper treatment of ACS and its underlying causes. In the orthopaedic wards both physicians and nurses diagnosed and documented ACS poorly and therefore associated complications were insufficiently treated.The intervention program for postoperative ACS, aimed mainly at protecting the cerebral oxidative metabolism and thereby the cerebral cholinergic metabolism which is especially sensitive to hypoxia. Postoperative complications associated with ACS were also treated. The intervention resulted in reduced frequency, duration and severity of postoperative ACS and in shorter orthopedic ward stay for patients with femoral neck fractures.Key words: Acute confusional state, delirium, elderly
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- Herlitz, Agneta, 1962-
(författare)
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Remembering in Alzheimer's disease : utilization of cognitive support
- 1991
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The aim of the present doctoral thesis was to investigate the ability of patients with Alzheimer's disease (AD) to utilize cognitive support in order to improve episodic remembering. A review of previous research indicated that most studies have failed to find beneficial effects of encoding support on memory in AD patients. The ability to utilize cognitive support (i.e., motoric activities, semantic organization, and semantic knowledge) for episodic remembering was investigated in five studies (Bäckman & Herlitz, 1990; Herlitz, Adolfsson, Bäckman, & Nilsson, in press; Herlitz & Bäckman, 1990; Herlitz & Viitanen, in press; Karlsson et al., 1989). Patients with mild, moderate, or severe AD, and normal older adults participated in the studies. On the basis of the results from these studies and the review of the literature, it was concluded that (a) AD patients, irrespective of dementia severity, perform at a lower level than normal older adults in episodic memory tasks; (b) provided that support is supplied at retrieval, AD patients may be sensitive to manipulations at encoding; (c) the strength of the encoding manipulation determines the size of the memory improvement in AD patients; and (d) depending on dementia severity, the type of encoding support also determines the magnitude of memory improvement obtained.
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