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Sökning: hsv:(MEDICIN OCH HÄLSOVETENSKAP) hsv:(Klinisk medicin) hsv:(Lungmedicin och allergi) > (2000-2004)

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1.
  • Steen, Stig, et al. (författare)
  • Transplantation of lungs from a non-heart-beating donor
  • 2001
  • Ingår i: The Lancet. - 1474-547X. ; 357:9259, s. 825-829
  • Tidskriftsartikel (refereegranskat)abstract
    • BACKGROUND: In animals, we have previously done successful lung transplantations using organs from non-heart-beating donors. We have also developed an ex-vivo system of assessing the function of such organs before transplantation. The next stage was to try the technique in human beings. Bearing in mind the sensitive ethical issues involved, our first aim was to find out what procedures would be acceptable, and to use the results to guide a clinical lung transplantation from a non-heart-beating donor. METHODS: The ethical acceptability of the study was gauged from the results of a broad information programme directed at the general public in Sweden, and from discussions with professionals including doctors, nurses, hospital chaplains, and judges. The donor was a patient dying of acute myocardial infarction in a cardiac intensive-care unit after failed cardiopulmonary resuscitation. The next of kin gave permission to cool the lungs within the intact body, and intrapleural cooling was started 65 min after death. Blood samples were sent for virological testing and cross matching. The next of kin then had time to be alone with the deceased. After 3 h, the body was transported to the operating theatre and the heart-lung block removed. The lungs were assessed ex vivo, and the body was transported to the pathology department for necropsy. RESULTS: No contraindications to transplantation were found, and the right lung was transplanted successfully into a 54-year-old woman with chronic obstructive pulmonary disease. The donor lung showed excellent function only 5 min after reperfusion and ventilation, and during the first 5 months of follow-up, the function of the transplanted lung has been good. INTERPRETATION: About half the deaths in Sweden are caused by cardiac and cerebrovascular disease. This group could be a potential source of lung donors. When all hospitals and ambulance personnel in Sweden have received training in non-heart-beating lung donation, we hope that there will be enough donor lungs of good quality for all patients needing a lung transplant.
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2.
  • Saetrum Opgaard, Ole, et al. (författare)
  • Endocardial expression and functional characterization of endothelin-1
  • 2001
  • Ingår i: Molecular and Cellular Biochemistry. - 0300-8177. ; 224:1-2, s. 151-158
  • Tidskriftsartikel (refereegranskat)abstract
    • Endothelin-1 (ET-1), a 21 amino acid peptide exerts a wide range of biological activities including vasoconstriction, mitogenesis and inotropic effects on the heart. In this study, we examined whether endocardial endothelial cells express ET-1 and evaluated its functional properties. Using immunofluorescence localization method, we demonstrated cytoplasmic staining of ET-1 in the human endocardial endothelial cells from the right atrium and left ventricle. Employing reverse transcriptase polymerase chain reaction (RT-PCR) expression of ET-1 mRNA and its receptors ET(A) and ET(B) mRNAs were found in human myocardial as well as in endocardial endothelial cells. Biological activity of endocardial endothelial cells derived ET-1 was established as the conditioned media obtained from cultured porcine endocardial endothelial cells induced a slowly developing, strong and long-lasting contraction of circular rat aortic segments, with similar characteristics to that obtained with exogenous ET-1. Furthermore, the selective endothelin-A receptor antagonist, FR 139317, blocked the conditioned media induced contractions. Our results suggest that endocardial endothelial cells express and release biologically active ET-1 which could play a pivotal role in the regulation of myocardial contractility as well as a circulatory peptide may further act in other peripheral target organs.
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4.
  • Bornmyr, S, et al. (författare)
  • Effect of local cold provocation on systolic blood pressure and skin blood flow in the finger
  • 2001
  • Ingår i: Clinical Physiology. - : Wiley. - 1365-2281 .- 0144-5979. ; 21:5, s. 570-575
  • Tidskriftsartikel (refereegranskat)abstract
    • Demonstration of increased vascular cold reactivity in patients with Raynaud's syndrome is difficult. For medico-legal reasons, it is important to get objective measures of vasospasm in these patients. Evaluation of the degree of vasospasm also provides prognostic information which is useful for patient management. In this study, we compare two methods of arterial circulation measurement. The laser Doppler scanning is a new method, which uses the recently developed laser Doppler perfusion imaging (LDPI) instrument. The aim of the present study was to compare the effect on finger skin blood flow measured with LDPI with changes in finger systolic blood pressure during local cold provocation. The effect of such provocation, skin blood flow and systolic blood pressure, were studied in 15 healthy controls. Six patients with known traumatic vasospastic disease (TVD) were also tested with both methods. Finger skin blood flow was measured with LDPI on the distal phalanx of the index finger of the left hand, every minutes during 6 min of local heating at 40 degrees C followed by local cooling for 3 min at 15 degrees C and then for 3 min at 10 degrees C. Finger systolic blood pressure was measured with strain-gauge method before and after local cooling to 10 degrees C with a cuff perfused with water of desired temperature. The test was performed in the same finger within a week of the laser Doppler scanning. Local finger cooling to 15 degrees C and 10 degrees C caused a significant decrease in blood flow, most marked at 10 degrees C. There was, however, no correlation between the decrease in blood flow and blood pressure. In the TVD-patients decreases in skin blood flow were similar compared with the healthy controls. In contrast, the changes in systolic blood pressure, were outside normal range (systolic quotient <0.65) in five of the six patients (83%), and also in 11 of the 15 healthy controls (73%). In conclusion, there is no correlation between the decrease in finger skin blood flow and systolic blood pressure during local cold provocation. For diagnosis of traumatic vasospastic disease (TVD), local cold-induced changes in finger systolic blood pressure seems superior to changes in skin blood flow, but the ideal clinical method for demonstrating increased cold-induced vasospasm is, however, still lacking.
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5.
  • Liu, Jin-Ming, et al. (författare)
  • Alveolar albumin leakage during large tidal volume ventilation and surfactant dysfunction
  • 2001
  • Ingår i: Clinical Physiology. - : Wiley. - 1365-2281 .- 0144-5979. ; 21:4, s. 421-427
  • Tidskriftsartikel (refereegranskat)abstract
    • Detergent given as an aerosol and large tidal volume ventilation (LTVV) have been observed, by us, to promote lung injury by an additive effect on alveolocapillary barrier function. The surfactant system may be further damaged if protein leakage occurs into the alveoli. The aim was to study the effect of detergent and LTVV on the alveolar leakage of albumin and also the effect of detergent on surface activity of lung washings and lung tissue extracts. Technetium-99m-labelled human serum albumin was given intravenously. The alveolar leakage of albumin was measured after perturbing the surfactant system with the detergent dioctyl sodium sulfosuccinate either singly or in combination with LTVV. Four groups of rabbits were studied after 3 h of experimental ventilation. Surface tension measurements of tissue extracts, lung mechanics and gas exchange did not show any differences between groups. Wet lung weight and albumin leakage were significantly increased in the two groups subjected to LTVV compared with groups given normal tidal volume ventilation. Low doses of detergent did not affect surface activity of lung tissue extracts or alveolar leakage of albumin. LTVV increased alveolar leakage of albumin and produced oedema. No additive effect was seen when detergent and LTVV were combined.
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6.
  • Dellborg, Catharina, 1956, et al. (författare)
  • Quality of life in patients with chronic alveolar hypoventilation
  • 2002
  • Ingår i: European Respiratory Journal. - : European Respiratory Society (ERS). - 1399-3003 .- 0903-1936. ; 19:1, s. 113-20.
  • Tidskriftsartikel (refereegranskat)abstract
    • Measurements of health-related quality of life (HRQL) have not been reported in patients with chronic alveolar hypoventilation (CAH) before starting home mechanical ventilation. The purpose of this study was to investigate quality of life in a population of such patients. Forty-four consecutive patients with CAH due to previous polio, scoliosis, healed pulmonary tuberculosis or neuromuscular disease answered a battery of condition specific and generic (Sickness Impact Profile, Hospital Anxiety and Depression scale, Mood Adjective Check List) self-report questionnaires. Spirometry, arterial blood gases and overnight oxygen saturation were measured. Patients with untreated CAH had significantly impaired HRQL compared to historical data from a healthy reference population. Sleep-related problems were frequent. Age, underlying disease, and standard bicarbonate correlated significantly with HRQL measures, albeit with modest levels of explained variance (8-37%). Patients with chronic alveolar hypoventilation due to neuromuscular or restrictive chest wall disorders had severely impaired health-related quality of life. Age, the underlying disease and severity of hypoventilation are each related to the health-related quality of life decrements. Health-related quality of life measurements add important information to traditional clinical observations.
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7.
  • Karlsson, Anne-Li, et al. (författare)
  • Bet v 1 homologues in strawberry identified as IgE-binding proteins and presumptive allergens
  • 2004
  • Ingår i: Allergy. - : Wiley. - 1398-9995 .- 0105-4538. ; 59:12, s. 1277-1284
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: No strawberry allergen has so far been identified and characterized. Methods: Serum samples were collected from patients with a suggestive case history of adverse reactions to strawberry and other fruits. Extracts from fresh and frozen strawberries were analysed by sodium dodecyl sulphate-polyacrylamide gel electrophoresis (SDS-PAGE), Western blotting and mass spectrometry. Patient blood samples were analysed for inhibition of IgE binding and basophil degranulation. Results: Several IgE-binding proteins could be detected. In more than half of the patient sera, a 20/18-kDa doublet band was observed in Western blotting. These two bands were excised and analysed by mass spectrometry showing the presence of proteins belonging to the Bet v 1 family of allergens. Inhibition of the IgE binding to the 20/18-kDa doublet was obtained by addition of two recombinantly expressed allergens belonging to the Bet v 1 family (Bet v 1 and Mal d 1) and strawberry protein extract. In a cell-based assay of patient blood samples, basophil degranulation could be induced by strawberry protein extract and by Bet v 1 and Mal d 1. Conclusions: We conclude that strawberry homologues to Bet v 1 may be allergens of importance for adverse reactions to strawberry.
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8.
  • Olin, AC, et al. (författare)
  • Increased nitric oxide in exhaled air after intake of a nitrate-rich meal.
  • 2001
  • Ingår i: Respiratory medicine. - : Elsevier BV. - 0954-6111. ; 95:2, s. 153-8
  • Tidskriftsartikel (refereegranskat)abstract
    • Exhaled and nasal NO (ENO, NNO) have been suggested as markers for inflammation in lower and upper respiratory tract respectively. It is still unknown how a number of factors, apart from airway inflammation, can influence NO levels. The aim of this study was to determine the effect of a nitrate-rich meal on ENO and NNO. Sixteen healthy subjects were observed during 1 week on normal diet before a nitrate-restricted diet was introduced in the next. On day 3 of the second week they were made to ingest a nitrate rich meal. ENO, NNO, plasma nitrate and plasma L-arginine were followed before the meal and afterwards for 3 h. ENO and NNO as well as plasma nitrate and plasma L-arginine were significantly elevated after the nitrate-rich meal. The median maximal increase of ENO and NNO was 47% and 13% respectively. We found a moderate but significant correlation between the rise in plasma nitrate and ENO (r(s)=0.57, P=0.027) but none between plasma nitrate and NNO (r(s)=-0.02, P=0.95). As nitrate in the diet seems to substantially influence the levels of ENO it is important either to restrict or register the intake of nitrate-rich food prior to measuring ENO.
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9.
  • Thylén, Anders, 1957 (författare)
  • Hyaluronan in malignant pleural mesothelioma with special reference to diagnosis, tumourbiology and prognosis
  • 2000
  • Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
    • Malignant pleural mesothelioma (MPM), the primary malignant tumour of the pleural cavity, is an uncommon and treatment resistant tumour. The prognosis is poor. In many, but not all cases the concentration of hyaluronan (Hya) is increased in pleural effusion. The clinical relevance of Hya in MPM is not clear. The primary aims of the present study were to examine the role of Hya in the diagnosis, the clinical follow-up, the prognosis and to immunohistochemically characterize Hya-producing MPM. A secondary aim was to evaluate the safety and efficacy of augmenting the antineoplastic effect of cisplatin by combining it with tirapazamine in a phase II trial in patients with MPM.All the cases of MPM in the present study were histologically confirmed. The compatibility of three different methods, a high-performance liquid-chromatographic method (HPLC), a radiometric assay and a semiquantitative precipitationtest for analysis of Hya in pleural effusion was examined. Hya- and non-Hya-producing MPM were immunohistochemically characterized using monoclonal antibodies towards epithelial membrane antigen (EMA), vimentin and cytokeratin (CAM 5.2). Various clinical variables, including Hya in the pleural exudate were evaluated for prognosis in 100 patients with MPM. The relation between circulating Hya and tumourvolume as estimated from serially performed CT scans was investigated in two studies. Twenty-two patients were included into the phase II study.The HPLC-method for analysis of Hya in pleural effusion recognized significantly more cases of MPM than the precipitation test. The HPLC-method and the radiometric assay were comparable in diagnosing MPM although the former in general showed higher values of Hya.The ability of MPM to produce Hya was correlated to strong reactivity towards EMA , CAM 5.2 and weak reactivity against vimentin. Elevated content of Hya in the pleural fluid was identified as a significantly favourable prognostic factor. In the subgroup of Hya producing MPM changes in tumourvolume were related to changes in concentration of Hya in serum. The response to the combination therapy of cisplatin and tirapazamine was poor. In summary, Hya may qualify as a tumour marker for MPM. Analysis of Hya in pleural effusion may serve as a diagnostic aid and analysis of circulating Hya may help monitor patients with increased synthesis of Hya in pleural effusion. The ability of the tumour to produce Hya is a marker for better prognosis. The biological properties, immunophenotype and capacity to synthesize Hya, should be taken into account in future therapeutic trials in MPM
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10.
  • Alexander, JH, et al. (författare)
  • Prognostic importance of new small Q waves following non-ST-elevation acute coronary syndromes
  • 2003
  • Ingår i: American Journal of Medicine. - : Elsevier BV. - 0002-9343. ; 115:8, s. 613-619
  • Tidskriftsartikel (refereegranskat)abstract
    • PURPOSE: to investigate the prognostic importance of new small Q waves following an acute coronary syndrome. METHODS: We assessed 6-month mortality in 10,501 patients with non-ST-elevation acute coronary syndromes who had survived 30 days and had both admission and 30-day electrocardiograms. Patients were stratified by whether they had no new Q waves (n = 9447), new 30- to 40-ms Q waves (n = 733), or new greater than or equal to40-ms Q waves (n = 321). RESULTS: Mortality was higher in patients with 30- to 40-ms Q waves than in those with no new Q waves (3.4% [25/733] vs. 2.4% [227/9447], P = 0.005), and even higher in those with greater than or equal to40-ms Q waves (5.3% [17/321], P = 0.002). After adjustment for baseline risk predictors, mortality remained higher in patients with new 30- to 40-ms Q waves (odds ratio [OR] = 1.30; 95% confidence interval [CI]: 0.85 to 1.98; P = 0.23) and those with new greater than or equal to40-ms Q waves (OR = 1.87; 95% Cl: 1.13 to 3.09; P = 0.01). CONCLUSION: Patients with new small Q waves following a non-ST-elevation acute coronary syndrome are at increased risk of adverse outcomes. These small Q waves should be considered diagnostic of myocardial infarction. Further research should investigate whether even smaller QRS changes are prognostically important. (C)2003 by Excerpta Medica Inc.
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