| 1. |
- Pettersson, Ulrika, 1970-
(författare)
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Bone mass in the young athlete
- 1999
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Bone mass and bone size accumulate during childhood and adolescence and peak in the twenties. The obtained peak bone mass has been suggested to be a major determinant of bone mass even in the very elderly. Although, genetic factors are the main determinants, environmental and lifestyle factors also play a crucial role in modulating maximal bone mass. Assessing these lifestyle factors would be of great importance for the intervention strategies against osteoporosis. The first aim of this thesis was to compare the bone mass and bone size in male and female young adults on a high level of physical activity with males or females on a low level of physical activity. Furthermore, it also aimed to investigate the influence of pubertal maturity, menstrual disturbances, and different body constitutional factors on bone mass and size during adolescence and young adulthood. The female activity groups consisted of cross-county skiers, soccer players, and rope skippers. Compared to their age-matched inactive controls, all these athletic groups demonstrated a significantly higher bone mineral density (BMD) at those sites subjected to the sport-specific loading. Rope-skipping, a very high impact activity was associated with a higher bone size, preferentially in the lower extremity, suggesting an effect of weight-bearing activity also on bone geometry. The effect of menstrual disturbances was evaluated in a group of long-distance runners, where amenorrheic runners had significantly lower BMD in both trabecular and also cortical bone in the lower extremity compared to eumenorrheic runners, suggesting that weight-bearing activity cannot compensate for the shortfall of reduced estrogen levels. The male activity groups consisted of ice hockey players and badminton players. Compared to their age-matched controls, both athletic groups demonstrated a significantly higher BMD at those sites subjected to the sport-specific loading. Especially badminton was associated with a high BMD, suggesting that physical activity, including jumps in unusual directions has a great osteogenic potential. The main determinants of BMD in both male and females were, except for type of physical activity, activity, muscle strength, height, and different body constitutional factors. However, the relationships with muscle strength and body constitution were somewhat weaker in the athletic groups, especially in the males, indicating that impact forces may be of greater importance in regulating bone mass in highly trained athletes. Yet bone size was largely determined by parameters related to body size and less strongly to physical activity. In a prospective study on adolescent boys, the changes in bone mass during late puberty were mainly accounted for by growth and development, including height and pubertal maturation, and less to physical activity level. Thus, the osteogenic effect from physical activity seems to be of importance for bone mass achievement predominantly before late puberty.
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| 2. |
- Levi, Richard, et al.
(författare)
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The Stockholm Spinal Cord Injury Study : 2. Associations between clinical patient characteristics and post-acute medical problems.
- 1995
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Ingår i: Paraplegia. - : Springer Science and Business Media LLC. - 0031-1758. ; 33:10, s. 585-594
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Tidskriftsartikel (refereegranskat)abstract
- The Stockholm Spinal Cord Injury Study (SSCIS) is an extensive evaluation of a sample of 353 subjects with traumatic SCI, constituting 93% of the known regional prevalence population with this diagnosis. In a previous analysis of this group, symptoms such as pain, incontinence, sexual dysfunction and neurological deterioration, as well as secondary complications, such as decubitus ulcers, urinary tract infections, spinal deformity and fractures, were found to be common. In the present report, we investigate associations between a few commonly used patient characteristics, ie gender, age at injury, duration of injury and extent of neurological compromise, and the occurrence of such problems, to assess differences in vulnerability in SCI subgroups. Results generally indicate an increased vulnerability in subjects with extensive neurological deficits, as well as a cumulation of complications with the increasing duration of injury. However, some exceptions are found, possibly indicating differences in temporal patterns of the occurrence of various complications, as well as certain gender-, age-, and lesion-associated variations in vulnerability. Symptoms directly related to the spinal cord lesion, eg neurogenic pain and neurological deterioration, seem to present rather soon post-injury. Males are more prone to experience excessive spasticity and sexual problems. Females experience more fractures and spinal deformity. Younger age at injury is associated with more spinal deformity but less severe pain problems. Higher age at injury is not found to be associated with more medical problems, with the exception of neurogenic pain, among post-acute, post-discharge survivors. The latter finding does not, however, preclude more such problems in the acute stage, since the present study neither addresses the pre-discharge period, nor includes information about mortality. Finally, the ASIA/IMSOP Impairment Scale Grade E-rated subjects were found to report problems to an extent that underlines the restricted sensorimotor sense in which this rating reflects recovery.
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| 3. |
- Levring Jäghagen, Eva, et al.
(författare)
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Persisting dysphagia after uvulopalatoplasty performed with steel scalpel.
- 1999
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Ingår i: The Laryngoscope. - 0023-852X .- 1531-4995. ; 109:1, s. 86-90
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES/HYPOTHESIS: The aim of the present study was to determine the incidence of postoperative persisting dysphagia after uvulopalatoplasty performed with conventional steel scalpel (UPP) and to videoradiographically evaluate the oral and pharyngeal phases of swallowing in patients reporting persisting dysphagia. The hypothesis to be tested was that patients treated with UPP would demonstrate a lower incidence of persisting dysphagia than previously found after uvulopalatoplasty performed with laser technique (LUPP).STUDY DESIGN: Retrospective.METHODS: Sixty-eight of 76 consecutive patients treated with UPP answered a questionnaire concerning outcome and late complications after the operation. The patients who reported postoperative dysphagia were additionally interviewed at a minimum of 1 year postoperatively, and the oral and pharyngeal phases of swallowing were videoradiographically examined in those with persisting dysphagia.RESULTS: The incidence of persisting dysphagia after UPP was 29%. Videoradiographically 71% of the dysphagic patients showed a deviant pharyngeal swallowing pattern.CONCLUSION: The incidence of persisting dysphagia after UPP did not differ from that reported after laser uvulopalatoplasty. Dysphagia after UPP was mostly associated with videoradiographic signs of deviant pharyngeal swallowing function. Patients should be informed that there is a risk of developing dysphagia after uvulopalatoplasty.
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| 4. |
- Sköld, C, et al.
(författare)
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Simultaneous Ashworth measurements and electromyographic recordings in tetraplegic patients.
- 1998
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Ingår i: Archives of Physical Medicine and Rehabilitation. - : Elsevier. - 0003-9993 .- 1532-821X. ; 79:8, s. 959-965
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: A recent prevalence study of 353 spinal cord injured (SCI) individuals in the greater Stockholm area showed problematic spasticity in 30% of this population. To treat spasticity, the evaluation becomes crucial. The modified Ashworth scale (MAS) is the clinically most-used scale to grade degree of spasticity. This study evaluated whether the MAS correlated with electromyographic (EMG) recordings of muscle activity.STUDY DESIGN: This cross-sectional study was performed at an outpatient clinic that has the responsibility to do a standardized, yearly follow-up of all SCI patients in the greater Stockholm area. Thirty-eight SCI individuals met the inclusion criteria; 15 of the 38 were randomly selected for the study. They were all motor-complete tetraplegic men; mean age was 33 years and mean time since injury was 9 years. Spasticity evaluation was performed by flexing and extending the knees during simultaneous EMG recordings and MAS assessment of the thigh muscle activity.RESULTS: Eighty percent of the individual EMG recordings correlated significantly with the corresponding Ashworth measurements. The spastic resistance, as measured both clinically and electromyographically, was stronger and lasted longer during extension than flexion movements. Spearman coefficients for correlation of quantitative spasticity measures with MAS grades were calculated. EMG and clinical measures of spasticity were more closely correlated for flexion movements. Among EMG parameters, duration of movement-associated electrical activity invariably correlated significantly with the MAS grades (p < .05). Furthermore, Ashworth measurements of movement-associated spasticity showed a positive correlation with the EMG parameters mean, peak, and start to peak of electrical activity. Each increasing grade on the MAS corresponded to increasing myoelectric activity levels for each movement.CONCLUSION: EMG parameters were significantly positively correlated with simultaneous MAS measurements of the spastic muscle contraction. The Ashworth scale may therefore accurately reflect the movement-provoked spasticity in motor-complete tetraplegic patients.
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| 5. |
- Pettersson, Ulrika, et al.
(författare)
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A comparison of bone mineral density and muscle strength in young male adults with different exercise level.
- 1999
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Ingår i: Calcified Tissue International. - 0171-967X .- 1432-0827. ; 64:6, s. 490-8
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was to investigate any differences in bone mass at different sites between young adults subjected to a high physical activity and a group of young adults with a low level of physical activity. In addition, we compared the relationship among bone mass, muscle strength, and body constitution in these two groups. The reference group consisted of 20 men, age 24.6 +/- 2.3 years, not training for more than 3 hours per week. The ice hockey players consisted of 20 players, age 23.4 +/- 4.9 years, from an ice hockey team in the second highest national Swedish league, training for about 10 hours per week. The groups were matched according to age, height, and weight. Areal bone mineral density (BMD) was measured in total body, head, humerus, spine, pelvis, femur, femoral neck, Ward's triangle, trochanter, femur diaphysis, proximal tibia, and tibia diaphysis using dual energy X-ray absorptiometry. BMD was significantly higher in the total body (8.1%), humerus (11.4%), spine (12.7%), pelvis (12.4%), femoral neck (10.3%), femur (7.4%), proximal tibia (9.8%), and tibia diaphysis (7.5%) in the high activity group. Fat mass was significantly lower in the high activity group (18.7%). The high activity group also had a significantly higher lean body mass (5.4%) and a significantly higher isokinetic muscle strength of the quadriceps muscle compared with the reference group. In the reference group, there was a general strong independent relationship between muscle strength of the thigh and all BMD sites, except for the head, tibia diaphysis, and proximal tibia. Furthermore, in the same group, body mass index (BMI) independently predicted pelvis BMD. On the contrary, in the high activity group, muscle strength did not predict any BMD site at all. In the same group, body constitutional parameters (weight, height, and fat mass) independently predicted pelvis BMD, and BMI was shown to be an independent predictor of humerus BMD. The differences in BMD between the groups seem to be site-specific and may be associated with the type and magnitude of loading during off season training and preferentially during ice hockey. High physical activity seems to weaken the relationship between BMD and muscle strength. Hence, impact forces may be of greater importance in regulating bone mass than muscle strength in itself in highly trained athletes.
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| 6. |
- 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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| 7. |
- Sjögren, Harmeet, 1954-
(författare)
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Injuries among the elderly : study of fatal and non-fatal injury events
- 1994
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- In view of the expected increase in the proportion of elderly in the population in most western countries, we studied injuries among the elderly (>60 years) by investigating hospital-treated injuries in inpatients and outpatients, and fatal injuries.One-year Hospital Injury Data - Even though the elderly made up only 15% of the injured in one year, they accounted for 42% of the total cost of trauma medical care, showing that injuries among the elderly place a disproportional burden on the health care system. The mean medical care cost increased significantly from the age of 60 years. Serious injuries (MAIS>3) in the elderly cost almost 2.5 times more than those in the younger group (<60 years).Study of 1,313 injury events in 1,268 elderly showed annual injury, fracture, and mortality rates per 1,000 elderly population of 57, 31, and 0.6, respectively. Almost half were injured in the home environment, and 23% in the traffic environment. Most of the severe and critical injuries (MAIS>4) occurred in the traffic environment. Injury rate, severity of injuries, fractures, and the duration of hospitalization increased with age. Almost half of the injuries were fractures; most common were wrist and hip fractures. Women had a higher injury rate, more severe injuries, and longer duration in hospitalization than men had.Study of 621 injury events in 600 elderly injured in the home environment, showed annual injury and fracture rates of 30 and 15 per 1,000 elderly home population, respectively. Injuries were grouped into fall injuries (76%) and non-fall injuries (24%). The fall injury incidence was higher in women than in men. Most falls occurred indoors. Environmental factors played a role in half of the fall injuries, and intrinsic factors in at least one fifth. Intrinsic factors in falls became increasingly important with advancing age. Non-fall injuries were mostly sustained in woodworking. Fall injuries were of a greater severity and accounted for 80% of the cost of medical care of elderly in the home environment.Study of 298 injury events in 297 elderly injured in the traffic environment, showed that pedestrian falls accounted for 52% of the injuries, and vehicle-related events for 44%. The main groups in the vehicle-related injury category were bicyclists (48%), car occupants (34%), and pedestrians (4%). Two thirds of the pedestrian falls involved slipping on ice/snow. Ice/snow-related injuries (all categories) accounted for 37% of the total cost of all injuries in the elderly in the traffic environment. Vehicle-related crashes resulted in the most severe and critical injuries and the most fatalities, and cost (total and mean) more than pedestrian falls.Fatal Injury Data from Northern Sweden - Study of 379 elderly injured in the traffic environment in a ten-year period, showed that the car occupants (43%) made up the largest category followed by pedestrians (28%), bicyclists (15%), and two-wheel-motor-vehicle riders (8%), but the risk of fatal injury per unit distance travelled was highest for pedestrians and bicyclists. Males had double the death rate as females. Most car occupants were killed in multivehicle crashes, mostly in the daylight, and at intersections. Ice/snow was the major (31%) precrash factor. One quarter of pedestrians were injured at pedestrian crossings, and half of them during darkness. One in six pedestrians was under the influence of alcohol. All pedestrians and bicyclists were injured in collisions with motor vehicles and most were injured at intersections. Pedestrians and bicyclists had more serious head injuries than chest injuries.Study of 514 car drivers (>18 years) injured in a 13-year-period, showed that fatalities per unit distance, and per licensed driver were highest for the >70-year-old and 18-19-year-old drivers. Elderly (>60 year old) and <25 year old drivers had similar fatality frequencies. The older drivers (>60 years) initiated the crash more often than younger (<60 years) ones. Fatal head injuries decreased whilst chest injuries increased with age. The older drivers were more likely to die from post-trauma complications than younger ones.In a study of role of disease in 480 fatally injured drivers (>18 years) who died within three days of the crash, a grading system was developed to assess the probability of contribution of medical intrinsic factors (MIF) to the crash. Almost one quarter of the drivers were found to have MIF. Drivers with MIF were more often at fault than those without. Medical intrinsic factors were probably an underlying cause in 1 of 17 fatal crashes in all ages, and 1 of 5 fatal crashes in the elderly; in 4% of the elderly the probability was strong.A "passive automatic" approach which does not require any action on the part of the elderly, is to be recommended when improving safety in the home and in the traffic environments. The elderly drivers can be regarded as the "miner's canary" to indicate which passive safety improvements are needed in the traffic environment. In view of the expected population trends, it is important that authorities and public health workers accept the challenge to continue and intensify the injury preventive work for the elderly.
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| 8. |
- Blind, Per Jonas, 1947-
(författare)
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Carboxylic ester hydrolase in acute pancreatitis : a clinical and experimental study
- 1994
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Diagnosis of acute pancreatitis (AP) is erroneous in up to one third of patients when based on clinical criteria and elevated serum amylase values. Furthermore, according to autopsy reports fatal pancreatitis remains clinically undiagnosed in 22 to 86 % of hospitalised patients. Consequently, search for better methods for the diagnosis of AP seems not only justified but urgent. The pancreas secretes an nonspecific lipase, the carboxylic ester hydrolase (CEH) with molecular properties different from other pancreatic secretory enzymes. These differences may imply that sites and rates of clearances from blood of pancreatic enzymes differ. Except for the pancreas this enzyme is secreted from the lactating mammary gland with milk.A sensitive and reproducible sandwich-ELISA for quantitative determination of CEH was developed. When establishing referent values it was noted that in individuals aged 20 to 65 years serum concentrations of CEH did not depend on age, gender, the time of the day or duration from food intake to blood sampling, or use of nicotine. The mammary gland did not contribute significantly to basal serum levels of CEH; enzyme levels in lactating women or women with mammary tumours were identical to those of the reference population.Seventy percent of patients with the diagnosis AP, based on elevated serum amylase levels and abdominal pain, had elevated CEH values. Among the patients with elevated amylase alone a probable cause of pancreatitis was lacking in the majority of patients. Contrastingly, a likely cause of AP could be identified in all patients presenting with abdominal pain and elevated CEH levels alone. These findings suggested that an elevated CEH level indicated AP more reliably than an elevated amylase level.In patients with AP diagnosed by contrast enhanced computed tomography (CECT) alone, or combined with histopathological diagnosis, serum CEH levels were elevated on admission in all but one patient, and in all within the next 24 h. Furthermore, in patients with severe pancreatitis CEH levels remained at a raised level from the second to at least the 10:th day following admission, whereas a significant decrease was noted in patients with mild pancreatitis. In contrast, serum amylase values were higher in patients with mild pancreatitis during the observation period than in those with severe pancreatitis. CEH levels were higher in patients with three or more Ranson signs than in those with less than three signs from the first day after admission. CEH levels were within referent range in 164 patients without known pancreatic disease admitted due to abdominal emergency conditions, or due to planned surgery for chronic extrapancreatic gastrointestinal diseases, and 16 patients having CECT without pathological findings in the pancreas. This suggests that AP can be excluded with very high degree of probability in presence of non-elevated CEH levels.A sandwich ELISA for determination of Guinea pig CEH and a model for graded pancreatitis in the same species were developed. CEH levels showed proportional to severity of inflammation, thus confirming previous clinical observations. CEH levels in bile were proportional to inflammation, while it was absent in urine. Amylase levels in urine were identical regardless of severity of inflammation, but low in bile. These results suggested differences in sites and rates of clearance between the two enzymes.Seemingly elevated CEH levels allowed identification of clinically significant pancreatitis following ERCP, which amylase levels did not.The presented studies have shown that quantitative determination in serum of CEH by the described method is a more reliable test for the diagnosis of AP than determination of amylase activity. The differences between CEH and amylase are, at least partly, due to differences in molecular properties determining rates and routes of clearances of the two enzymes from serum.
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| 9. |
- Carlsson, A., et al.
(författare)
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Prevalence of coeliac disease in Turner syndrome
- 1999
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Ingår i: Acta Pædiatrica. - 1651-2227 .- 0803-5253. ; 88, s. 933-
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Tidskriftsartikel (refereegranskat)abstract
- This study was undertaken to investigate the prevalence of coeliac disease in children and adolescents with Turner syndrome. Eighty-seven children and adolescents with Turner syndrome were screened for IgA- antiendomysium antibodies (EMA) and IgA-antigliadin antibodies (AGA), 5% (4/87) being found to be EMA-positive, and 15% (13/87) to have AGA levels above normal. Of the 10 patients who were either AGA- or EMA-positive and further investigated with intestinal biopsy, four manifested villous atrophy (i.e. all three of the EMA-positive patients, but only one of the seven AGA- positive patients). The results suggest EMA-positivity to be a good immunological marker for use in screening for coeliac disease, and such screening to be justified in patients with Turner syndrome.
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| 10. |
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