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- Bixo, Marie, 1957-
(författare)
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Ovarian steroids in rat and human brain : effects of different endocrine states
- 1987
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Ovarian steroid hormones are known to produce several different effects in the brain. In addition to their role in gonadotropin release, ovulation and sexual behaviour they also seem to affect mood and emotions, as shown in women with the premenstrual tension syndrome. Some steroids have the ability to affect brain excitability. Estradiol decreases the electroshock threshold while progesterone acts as an anti-convulsant and anaesthetic in both animals and humans. Several earlier studies have shown a specific uptake of several steroids in the animal brain but only a few recent studies have established the presence of steroids in the human brain.In the present studies, the dissections of rat and human brains were carried out macroscopically and areas that are considered to be related to steroid effects were chosen. Steroid concentrations were measured by radioimmunoassay after extraction and separation with celite chromatography. The accuracy and specificity of these methods were estimated.In the animal studies, immature female rats were treated with Pregnant Mare's Serum Gonadotropin (PMSG) to induce simultaneous ovulations. Concentrations of estradiol and progesterone were measured in seven brain areas pre- and postovulatory. The highest concentration of estradiol, pre- and postovulatory, was found in the hypothalamus and differences between the two cycle phases were detected in most brain areas. The preovulatory concentrations of progesterone were low and the highest postovulatory concentration was found in the cerebral cortex.In one study, the rats were injected with pharmacological doses of progesterone to induce "anaesthesia". High uptake of progesterone was found and a regional variation in the formation of 5<*-pregnane-3,20-dione in the brain with the highest ratio in the medulla oblongata.Concentrations of progesterone, 5a-pregnane-3*20-dione, estradiol and testosterone were determined in 17 brain areas of fertile compared to postmenopausal women. All steroids displayed regional differences in brain concentrations. Higher concentrations of estradiol and progesterone were found in the fertile compared to the postmenopausal women.In summary, these studies show that the concentrations of ovarian steroids in the brain are different at different endocrine states in both rats and humans and that there are regional differences in brain steroid distribution.
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| 2. |
- Elmqvist, Lars-Gunnar, 1944-
(författare)
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Chronic anterior cruciate ligament tear : knee function and knee extensor muscle size, morphology and function before and after surgical reconstruction
- 1988
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Knee function was evaluated by knee score, activity level, clinical findings and performance tests, muscle size by computerized tomography (CT), morphology by light (LM) and electron microscopy (EM), muscle function by electromyography (EMG) and isokinetic performance in 29 patients with chronic anterior cruciate ligament (ACL) tear. Preoperatively CT disclosed a significant mean atrophy of the quadriceps and nonsignificant changes of the other muscle areas of the injured leg. Morphology of m vastus lateralis of the injured leg was normal in more than half of the biopsies preoperatively, the rest showed signs of nonoptimal activation. Significant decreases in all isokinetic parameters were noticed together with significantly decreased EMG of the quadriceps muscle of the injured leg.Âfter surgical reconstruction the knees were immobilized in a cast for 6 weeks at either 30° or 70° of knee flexion. After cast removal CT showed significant decreases of all areas which also remained after training. The 30° group showed larger fibres (intracellular oedema) and more frequent morphological abnormalities than the 70° group. Fourteen weeks postoperatively the patients were allocated to either a combination of isometric and progressive resistance training or isokinetic training for 6 weeks. CT showed slightly larger areas at 20 weeks postoperatively than at 6 weeks. Morphological abnormalities were still prominent at 20 weeks postoperatively. Maximum isokinetic knee extensor mechanical output and endurance were markedly decreased at 14 weeks postoperatively but both improved progressively during the one year rehabilitation, mostly during the intensive 6 week training period but irrespective of training programme used. Fatiguability/endurance level improved over the preoperative level. Muscular work/integrated EMG was stable while EMG/t increased indicating neuromuscular relearning.The clinical result at 28 months foliowup was excellent or good in 93% of the patients and clinical stability improved in 66%. Independent upon primary knee immobilization angle or training programmes no differences could be demonstrated with respect to stability, range of motion, function or isokinetic mechanical output. Isokinetic performance was still significantly lower in the injured compared to the noninjured leg and not significantly different from the preoperative values. Morphology, only 6 cases, showed abnormalities similar to preoperative findings.In conclusion, the reason for the decreased maximum and total knee extensor performance in these patients with ACL tears is suggested to be nonoptimal activation of normal functioning muscle fibres depending on changes in knee joint receptor afferent inflow. No differences concerning the markedly improved postoperative clinical result could be seen between the different treatment modalities used. A nonoptimal muscular activation might explain the still decreased isokinetic performance present at followup.
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| 3. |
- Sandman, Per-Olof, 1950-
(författare)
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Aspects of institutional care of patients with dementia
- 1986
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The aim of the present study was to investigate all long-term institutions in the county of Västerbotten, Northern Sweden, to give a detailed description of the institutionalized population with respect to motor functions, vision, hearing, speech, ADL-functions, prevalence of psychiatric symptoms and behavioral disturbances, staff work load, use of psychoactive drugs and prevalence of dementia. Another aim was to select some specific 'problem areas' in the nursing care of demented patients for further descriptive and interventional studies. For this reason, morning care procedure (hygiene, dressing), meal behavior (eating, communication), nutrition, constipation and relocation between institutions were selected.The results of the study have been reported in six papers summarized below:I.The study has shown that the proportion of demented patients is increasing in longterm institutions in Sweden. Furthermore, demented patients were shown to be more impaired in all rated functioning abilities and exhibited more psychiatric symptoms and behavioral symptoms. A high proportion of the demented probands were also prescribed psychoactive drugs, i.e. neuroleptics.II. Five patients with Alzheimer-type dementia were monitored during morning care. A 12-step classification system was developed to be used as a guide to understand and determine abilities essential for performance of morning care for demented patients. The quantitative assessment showed that none of the patients were able to manage morning care independently, but there was a wide variation in their highest level of performance.III. Five patients with Alzheimer-type dementia were observed (video taped) during their meals in a changed meal milieu and with new meal routines. When the patients ate without staff participation, the two least demented patients became 'caregivers'. When two mental nurses joined the group, first in civil clothes and then in white uniforms, the patients dropped their roles as helpers. The patients were able to compose complete meals in 0-79 per cent of the meals. The conversation during the meals could be characterized as incomplete, with short sentences and a lot of breaks. Sixty-three per cent of all utterances were about food and eating and almost all conversation concerned the present time.IV. Thirty-three psychogeriatric patients, with severe constipation were given a high- bran bread instead of their accustomed laxatives. During the high-bran treatment period, the number of bowel evacuations and the volume of faeces increased. The total laxative consumption decreased by 93 per cent.V. Nutritional status and dietary intake were studied in a sample of severely demented, institutionalized patients. Energy and /or protein malnutrition was found in 50 per cent of the patients. The mean energy intake was 2059 kcal. Malnourished patients had had four times as many infectious periods during their hospital stay as patients without malnutrition. Thirty-nine of 44 patients lost weight during their hospital stay.VI. Thirty-three psychogeriatric patients were followed for 36 weeks after relocation from a mental hospital to two newly built nursing homes. An intensive pre-relocation program was performed. No negative effects of the relocation were found. On the contrary, the relocated group improved their ADL-functions after the transfer.Based upon the above cited studies, a model for nursing care of demented patients is presented.
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| 5. |
- Viitanen, Matti, 1950-
(författare)
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Long-term effects of stroke
- 1987
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Stroke, which has an increasing incidence with age, causes an irreversible brain damage which may lead to impairment, disability and decreased life satisfaction or death.Risk factors for death, recurrent stroke and myocardial infarction, were analyzed in 409 stroke patients treated at the Stroke Unit, Department of Medicine, Umeå University Hospital, between Jan. 1, 1978 and Dec. 31, 1982. The causes of death were related with the time of survival. In fully co-operable (n=62) 4-6 year stroke survivors, the occurrence of motor and perceptual impairments, of self-care (ADL) disability and of self-reported decreased life satisfaction due to stroke was determined.The probability of survival was 77% three months after stroke, 69% after one year, and 37% after five years. Multivariate statistical analysis indicated that impairment of consciousness was the most important risk factor for death followed by age, previous cardiac failure, diabetes mellitus, intracerebral hemorrhage and male sex. During the first week, cerebrovascular disease (90%) was the most dominant primary cause of death, from the second to the fourth week pulmonary embolism (30%), bronchopneumonia during the second and third months and cardiac disease (37%) later than three months after stroke. The risk of recurrence was 14% during the first year after stroke and the accumulated risk of stroke recurrence after 5 years was 37% after stroke. The estimated probability of myocardial infarction was 7% at one year and 19% at 5 years. High age and a history of cardiac failure increased the risk of recurrent stroke. The risk of myocardial infarction was associated with high age, angina pectoris and diabetes mellitus. The highest risk of epilepsy was found between 6 and 12 months after stroke. Motor impairment prevailed in 36% of the long-term survivors, perceptual impairments in up to 57% and decreased ADL-capacity in 32%. As regards ecological perception, perceptual function variables were distinctly grouped into low and high level perception which together with motor function explained 71% of the variance of self-care ADL. While levels of global and of domain specific variables of life satisfaction appeared stable in clinically healthy reference populations aged 60 and 80 years, the stroke had produced a decrease in one or more aspects of life satisfaction for 61% of the long-term survivors. Although significantly associated with motor impairments and ADL disability, these changes could not only be attributed to physical problems.
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| 6. |
- Eriksson, Peter
(författare)
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Cardiac involvement in familial amyloidosis with polyneuropathy
- 1984
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Familial amyloidosis with polyneuropathy (FAP) is a neuropathic form of heredofamilial systemic amyloidosis. Clusters of patients have been reported predominantly from Portugal, Japan and Sweden. The present study examines the involvement of the heart in individuals with the Swedish variety of FAP. During long-term ECG recording in 16 patients, a high frequency of disturbances of sinus node function and atrioventricular conduction were observed. Long-term ECG may help considerably in the evaluation of symptoms attributable to disturbances of heart rhythm in FAP. A retrospective survey of 20 patients with FAP treated with a pacemaker showed that the indication for pacing was advanced atrioventricular block (12 cases), dysfunction of the sinus node (5 cases), and atrial fibrillation with a slow ventricular response (3 cases). All patients experienced the effective relief of symptoms attributable to a slow ventricular rate. The long-term prognosis, however, seemed unaffected by this treatment. Histopathological examination of the sinoatrial (9 cases) and atrioventricular (6 cases) parts of the conduction system showed marked amyloid infiltration in all cases, which may explain the high occurrence of disturbances of cardiac rhythm and conduction. Twelve patients were examined by two-dimensional echocardiography and changes of varying degrees, such as highly refractile myocardial echoes (12 cases) and thickened ventricular walls (8 cases) and valves (7 cases), could be observed. Technetium-99m-pyrophosphate scintigraphy of the same patients revealed abnormal myocardial uptake of the isotope only in four. Echocardiography thus seems to be superior to scintigraphy for non-invasive detection of cardiac involvement in FAP. Myocardial samples from regions producing highly refractile myocardial echoes were obtained at in vitro échocardiographie examination of hearts from FAP autopsy cases. Histological examination showed that the highly refractile echoes corresponded to more or less sharply delineated nodules, containing amyloid and collagen in various amounts.
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| 7. |
- Reuterving, Carl-Olof, 1946-
(författare)
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Salivary glands and oral lesions in diabetes mellitus : an experimental and clinical study with special reference to the influence of metabolic control and duration of the disease
- 1987
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Diabetes mellitus is associated with several clinically significant abnormalities in the oral cavity and salivary glands, the most common being periodontitis, salivary gland enlargement and a sensation of dry mouth. The prevalence of dental caries in diabetics is mostly reported to be decreased or unaffected. Since there is a shortage of information concerning the influence of metabolic control and duration of diabetes on these abnormalities, the present studies were performed.Three-month-old rats were made alloxan-diabetic and investigated after one and twelve months’ duration of diabetes for oral lesions and feeding behavior. They had free access to a standard pellet diet and tap water. Streptococcus mutans and lactobacilli were naturally occurring. In diabetic rats the proportion of the oral flora which was lactobacilli was positively correlated to the blood glucose level. Untreated long-term alloxan-diabetic rats developed advanced periodontal disease and root surface caries in the molars at sites of interdental impaction of foreign material. The degree of alveolar bone loss was positively correlated to the blood glucose level. Diabetic rats were hyperphagic and had a longer total eating time, including day-time eating, mainly by having longer meals but no significant increase of meal frequency, as compared with non-diabetic animals. The untreated alloxan-diabetic rats developed reduced salivary gland weight which was of the same degree in short- and longterm diabetic animals. Short- and long-term untreated alloxan-diabetic rats showed a similar degree of morpho- metrically estimated lipid accumulation in the acinar cells of the submandibular glands, and the degree was positively correlated to the blood glucose level. However, lipid inclusion occurred only in rats with a morning nonfasting blood glucose level exceeding 15 mmol/L. The capillaries in the submandibular glands of the untreated long-term alloxan-diabetic rats had a significantly increased thickness of the basement membranes as compared with the observations in short-term diabetic and non-diabetic rats. Untreated alloxan-diabetic rats were also shown to have a decreased salivary flow rate compared with non-diabetic rats, and the decreased flow was negatively correlated to the blood glucose concentration. Salivary flow rate increased with the duration of the disease. The diabetic rats had increased salivary glucose levels, which were positively correlated to blood glucose values when the latter were above 15 mmol/L, suggesting a threshold mechanism for salivary glucose excretion. Insulin therapy reversed salivary flow rate and salivary glucose concentrations toward normal.Salivary investigations were performed in eleven diabetic patients on two occasions with different metabolic control. Salivary flow rate showed marked interindividual differences but was not significantly changed by improved metabolic control although several of the patients initially had severely deranged glucose metabolism. A positive correlation between the glucose concentration in blood and saliva was seen in the parotid saliva during secretory stimulation. No significant change in electrolytes, amylase or antimicrobial factors was found.
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| 9. |
- Bernspång, Birgitta, 1951-
(författare)
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Consequences of stroke : aspects of impairments, disabilities and life satisfaction : with special emphasis on perception and on occupational therapy
- 1987
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Perceptual and motor functions and self-care ability after stroke were assessed within two weeks (n:109; mean age 69±10) and 4-6 years (n:75;70±9) after admission to a non-intensive care stroke unit. Sixty-two of the long-term stroke survivors reported on their life satisfaction (7 items) as experienced (in retrospect) before the stroke and at the time of the investigation. Perceptual functions and actual levels of life satisfaction were registered in 60 clinically healthy subjects aged about 60 or about 80 years.Both early on and late after stroke the 16 items of perceptual function were clearly grouped into two factors, which neatly fitted an ecological perceptual concept. One factor characterized low-order and the other higher-order perception. Impairments of low-order perception occurred for about 10% of the patients, whether investigated early or late after stroke. No one among the reference populations had such impairments. Higher-order perceptual impairments prevailed in 60% early on and in 57% late after stroke and were often more pronounced than those occurring in the reference populations, among whom 35% of the 60 year olds and significantly more - 77% - of the 80 year olds had such impairments. Hence, perceptual impairments are common after stroke, but slight age-dependent reductions should be considered when higher-order perceptual function is assessed and treated after stroke.Together with motor function, which was impaired in 52% of the early and 36% of the late stroke samples, higher-order perceptual function and to a limited extent low-order perception could predict the level of self-care ability in 70% and 62% of the early and late samples, respectively.Whereas levels of global and of domain specific variables of life satisfaction were similar in the two reference populations, the stroke had lead to a reduction in life satisfaction for 61% of the long-term survivors. Reductions were particularly pronounced for global life satisfaction and for satisfaction with leisure and sexuality. Although significantly associated with motor impairment and self-care disability, these reductions could not be attributed only to impairments and disability.The findings are discussed with particular reference to assessment and treatment in occupational therapy.
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| 10. |
- Gerdle, Björn, 1953-
(författare)
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Leisure and muscular performance in health and disease : a study of 40-64-year-old northern Swedes
- 1985
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Categories and frequencies of leisureactivities employed by 156 randomly selected males and females aged 40-44, 50-54, 60-64 were investigated by structured interviews and were related to leisuresatisfaction, to experienced health and socio-economic status. In equal numbers (15) of males and females from each group and in 24 males (60 +_6 years) with intermittent claudication (Cl) isokinetic plantar flexion performance was investigated with registrations of peak torque (PT), contractional work (CW), active range-of-motion (RoM) and integrated electromyograms from all threee triceps surae heads. Subjects performed a few maximum plantarflexions at different velocities of angular motion and also up to 200 consecutive plantar flexions at 60 °/s. The males aged 40-44 were re -investigated after two years additionally using electromyographic power frequency analyses.Leisure choice was mainly age and sex independent and extensively included outdoor activities. Leisure satisfaction was positively associated with relative frequency of activities. Symptoms of bodily discomfort, in particular backpain, were quite common and apparently caused relatively low level of mutual leisure activities. Thus, with in this age span, leisure activities appear rather rigid but often successfully, adhered to . Common ailments influence partnership mutuality negatively.Plantar flexion PT and CW are adequately p re dicta ble by sex, age and crural circumference. Uniformly a 3:2 male/female ratio characterizes mechanical output and iEMG. The latter is velocity independent. Output decreases with increasing age. Hence the output/excitation balance (CW/iEMG) is age, but not sex, dependent. CI-patients produce less PT and CW than do controls. Independently of this disease, of age and sex, PT and CW describe parallel negative exponential functions of velocity.During repeated manoeuvres plantar flexion output and iEMG initially drop, there after to maintain nearly steady-state levels. Throughout up to 200 contractions CW/iEMG was unaltered in the clinically healthy. Test/re-test with two years interval yielded nearly identical results. Leftshifts in mean power frequency in parallel with output-drop imply that the latter probably is due to FT-motor unit fatigue. For CW, but not for PT, the drop became slower and the (relative) steady-state level higher with increasing age, indicating significant increase in endurance with age. In the Cl-patients, output, but not excitation, decreased after a few repititions. Therefore, CW/iEMG fell dramatically, implying intramuscular fatigue. Taken together with findings of close associations between total cumulated work and measured/expected maximum walking tole rance it is suggested that measurements of CW and calculations of CW/iEMG are of clinical value.
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