| 1. |
- Gerdin, E, et al.
(författare)
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Immunohistochemical identification of receptors for epidermal growth factor in tumor endothelium may be affected by cross-reactivity to blood group A antigen.
- 1993
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Ingår i: American Journal of Clinical Pathology. - 0002-9173 .- 1943-7722. ; 99:1, s. 28-31
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Tidskriftsartikel (refereegranskat)abstract
- It has been reported that endothelium in malignant glioma stains with a commercial antibody raised against the receptor for epidermal growth factor (EGFr) on A431 cells (clone 29.1). In this report, this antibody was used to study the immunohistochemical expression of EGFr in benign and malignant ovarian, mid-gut carcinoid, and thyroid neoplasms using the avidin-biotin-peroxidase complex technique. Eighteen of the 37 ovarian neoplasms, 4 of the 10 thyroid neoplasms, and 14 of 28 mid-gut carcinoid tumors expressed strong and distinct endothelial staining, whereas staining results of the remaining tumors were negative. The endothelial nature of the staining was verified by staining serial sections with Ulex europaeus agglutinin-I. The staining was independent of that obtained with an antibody raised against a synthetic peptide consisting of residues 985 to 996 from the cytoplasmic domain of EGFr (clone F4). All positive staining occurred in patients determined to be of blood groups A or AB, whereas samples from patients with blood groups B or O were negative. Immunoabsorption of the antibody with centrifuged erythrocytes from a blood group A donor, but not from a blood group B donor, abolished the positive staining. The data indicate that positive staining of tumor endothelium with this antibody is due to cross-reactivity with blood group A antigen. The results obtained challenge the validity of previously performed immunohistochemical studies in which monoclonal antibodies raised against the EGFr of A431 cells have been used, and in which the epitope for the monoclonal antibody has not been determined.
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| 2. |
- Pisa, P, et al.
(författare)
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Selective expression of interleukin 10, interferon gamma, and granulocyte-macrophage colony-stimulating factor in ovarian cancer biopsies.
- 1992
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Ingår i: Proceedings of the National Academy of Sciences of the United States of America. - 0027-8424 .- 1091-6490. ; 89:16, s. 7708-12
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Tidskriftsartikel (refereegranskat)abstract
- The variable clinical response seen with most cancer immunotherapy suggests that there is a large interindividual variation in immunologic response to tumors. One of the key functional parameters of an immune response is the local production of cytokines. As a method to survey the immune status of tumor-infiltrating cells, we have investigated the constitutive expression of cytokine mRNA in biopsies from epithelial ovarian carcinomas by using a PCR-assisted mRNA amplification assay. Using a set of cytokine-specific primers for 10 different cytokines, we have found selective expression of interleukin 10 (IL-10), granulocyte-macrophage colony-stimulating factor, and interferon gamma mRNA in ovarian tumor tissue as compared to normal ovaries and ovarian tumor cell lines. Such differences could not be explained by the extent of T-cell infiltration, since comparing samples with the same intensity of T-cell receptor (TCR) constant region alpha-chain product from the tumor and normal biopsies demonstrated different cytokine patterns. No IL-2 gene expression was detected in the tumor biopsies. IL-2 mRNA, however, became expressed after stimulation of the tumor-derived cells via the CD3 molecule but not after growth in recombinant IL-2 alone. Using the same methodology, we also analyzed the TCR variable region beta-chain gene repertoire. No restriction or biased expression of these genes was observed.
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| 3. |
- Abu-Zidan, Fikri M.
(författare)
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Role of platelet-activating factor in sepsis and shock : an experimantal study
- 1995
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Objectives: To study the role of platelet-activating factor (PAF) on cardiovascular and pulmonary dysfunction in sepsis and shock.Design: Experimental study. Setting: Trauma research unit, university department of surgery, Sweden.Material: 76 juvenile domestic pigs. Interventions: The effects of a specific PAF receptor antagonist (BB-882) on haemodynamics and on PAF-induced haemodynamic changes were studied (n = 16). BB-882 was given as pretreatment in non-hypotensive Escherichia coli endotoxaemia (n = 9), during resuscitation after severe haemorrhagic shock (n = 7), hefore post-ischaemic shock which was induced by clamping the aorta above the coliac axis for 45 minutes (n = 8), and as pretreatment in post-haemorrhage septic shock: (n = 6). BB~882 groups were compared with controi groups having the same number of animals which received vehicle instead.Major outcome measures: Heart rate, intravascular pressures, cardiac output, pulmonary and systemic vascular resistance, arteriai blood gas tensions, lung thorax compliance, serum lactic acid and blood sugar concentrations, and packed cell volume.Results: BB-882 effectively counleracted the PAF-induced response on the mean systemic and pulmonary arteriai pressures. lt reduced the rise in pulmonary and systemic vascular resistance and improved the cardiac output in non-hypotensive and post-haemorrhage septic shock when given as pretreatment. lt reduced the hypertension in non-hypotensive sepsis and the hypotension in post-haemorrhage septic shock. BB-8B2 did not infiuence the endotoxin-induced hypoxia or reduced lung thorax compliance in non-hypotensive sepsis and post-haemorrhage septic shock. It did not improve the mean arterial pressure or the cardiac output in haemorrhagic shock alone but it reduced the systemic vascular resistanc'e and was associated with tachycardia and acidosis. It did not affect the post-ischaemic shock after clamping the aorta.Conclusion: PAF is a major mediator of the cardiovascular, but not pulmonary dysfunction in sepsis whether associated with shock or not, while its role on the cardiovascular dysfunction in haemorrhagic and post-ischaemic shock is small.
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| 4. |
- Ahrenstedt, O, et al.
(författare)
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Increased luminal release of hyaluronan in uninvolved jejunum in active Crohn's disease but not in inactive disease or in relatives.
- 1992
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Ingår i: Digestion. - 0012-2823 .- 1421-9867. ; 52:1, s. 6-12
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Tidskriftsartikel (refereegranskat)abstract
- Recently obtained data suggest that there is a subclinic inflammatory activity in the apparently uninvolved intestinal mucosa in Crohn's disease (CD). As CD is characterized by an activation of connective tissue and fibrosis, we investigated the extent to which hyaluronan (HA), an essential component of the connective tissue, was released into the lumen of an isolated jejunal segment in CD patients and in relatives. Patients with active CD of the terminal ileum (CD activity index, CDAI, > 150; n = 14), patients with CD in remission (CDAI < 150 n = 10), first-degree relatives of the CD patients (n = 21) and healthy controls (n = 43) were orally intubated with a catheter allowing occlusion and perfusion of a segment of the proximal jejunum. The jejunal fluid concentration of HA was 65 +/- 45 micrograms/l in patients with active CD in the terminal ileum, significantly higher than the value for 43 healthy controls (42 +/- 23 micrograms/l; p < 0.05), and the corresponding values for patients in remission (42 +/- 23 micrograms/l) and for first-degree relatives of the CD patients (53 +/- 52 micrograms/l), were not increased compared to the control group. To localize HA in the tissue, small bowel biopsies were taken during surgery from patients with CD and from controls and affinity stained for HA. There was an intense staining for HA in the lamina propria of the villi, both in biopsies from patients with CD and from controls, but no staining in the epithelium.(ABSTRACT TRUNCATED AT 250 WORDS)
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| 5. |
- Anderson, Malin, et al.
(författare)
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Structure and locomotion of adult in vitro regenerated spiral ganglion growth cones : a study using video microscopy and SEM
- 2006
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Ingår i: Hearing Research. - : Elsevier BV. - 0378-5955 .- 1878-5891. ; 215:1-2, s. 97-107
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Tidskriftsartikel (refereegranskat)abstract
- Neuronal development and neurite regeneration depends on the locomotion and navigation of nerve growth cones (GCs). There are few detailed descriptions of the GC function and structure in the adult auditory system. In this study, GCs of adult dissociated and cultured spiral ganglion (SG) neurons were analyzed in vitro utilizing combined high resolution scanning electron microscopy (SEM) and time lapse video microscopy (TLVM). Axon kinesis was assessed on planar substratum with growth factors BDNF, NT-3 and GDNF. At the nano-scale level, lamellipodial abdomen of the expanding GC was found to be decorated with short surface specializations, which at TLVM were considered to be related to their crawling capacity. Filopodia were devoid of these surface structures, supporting its generally described sensory role. Microspikes appearing on lamellipodia and axons, showed circular adhesions, which at TLVM were found to provide anchorage of the navigating and turning axon. Neurons and GCs expressed the DCC-receptor for the guidance molecule netrin-1. Asymmetric ligand-based stimulation initiated turning responses suggest that this attractant cue influences steering of GC in adult regenerating auditory neurites. Hopefully, these findings may be used for ensuing tentative navigation of spiral ganglion neurons to induce regenerative processes in the human ear.
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| 6. |
- Andersson, Gerhard, et al.
(författare)
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Social competence and behaviour problems in burned children
- 2003
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Ingår i: Burns. - 0305-4179 .- 1879-1409. ; 29:1, s. 25-30
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was to collect follow-up data on social competence and behavioural problems in a sample of Swedish burned children and to compare the results with normative data from a reference group of children comparable in age, socio-economic status and gender. Parents of 44 children (55% response rate) aged 7-12 years were asked to complete a questionnaire booklet including the Children's Behaviour Questionnaire (CBQ) and the Social Competence Inventory (SCI). Data from the children's teachers were also collected for 20 children using the same booklet. In addition, data on TBSA, localisation of injury, and other background factors were collected. Results showed that the burned children were rated by their parents as showing lesser degrees of social initiative and more externalising problems and concentration problems compared with the control group. Teachers rated the burn injured children as having less prosocial orientation, more externalising problems, and more concentration problems. No clear effects were found for gender and characteristics of the burn injury. Results on the Social Competence Inventory were associated with scores on the Children's Behaviour Questionnaire.The findings are consistent with previous research in that the differences found were relatively small. However, they do call for attention to the possible adverse effects of growing up with a burn injury, but also to the possible pre-morbid characteristics that may be related to the injury.
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| 7. |
- Barlow, Lotti, et al.
(författare)
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Nationellt fackspråk för vård och omsorg : Slutrapport
- 2011
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Rapport (populärvet., debatt m.m.)abstract
- SammanfattningEtt tillgängligt och använt nationellt fackspråk ska bidra till en god och säker vård och omsorg. Det ska även medverka till att kvaliteten och resultaten på området ska kunna följas upp och jämföras på ett mer effektivt sätt. Slutrapporten presenterar resultatet av projektet Nationellt fackspråk för vård och omsorg samt förslag till förvaltning och utveckling.ResultatetResultatet innefattar bland annat att det internationella begreppssystemet Snomed CT är översatt till svenska och att det är förberett för förvaltning och distribution. Socialstyrelsen har även tagit fram och testat metoder för förvaltning och utveckling av det nationella fackspråket i sin helhet. Därtill har representanter för målgrupperna informerats och fått kunskap.Rapporten innehåller en utförlig beskrivning av det nationella fackspråkets sammantagna innehåll: Socialstyrelsens termbank, klassifikationer och kodverk, den svenska versionen av Snomed CT, metoder för utveckling och förvaltning samt regler för användning.Förvaltning, införande och resursbehovI rapporten finns förslag till hur hela det nationella fackspråket kan tas omhand av Socialstyrelsen och hur det kan införas i vården och omsorgen. Projektets övergång till en långsiktigt hållbar organisation kräver resurser. Därför redogör rapporten för det förväntade resursbehovet för förvaltning och utveckling. Bland annat föreslås en treårig utbildningsinsats samt stimulansbidrag för införande.Krav på styrning, samordning och förtydligat ansvarRapporten betonar behovet av en samlad och medveten styrning av utvecklingen inom området. Socialstyrelsen vill ha en samordnande roll i utvecklingen och förvaltningen av det nationella fackspråket. Myndigheten föreslås få det initiala ansvaret för att utbilda användare och att driva frågor om det nationella fackspråket.Vidare vill Socialstyrelsen få ett uttalat mandat att samordna de nationella aktiviteter som drivs med koppling till Snomed CT. Rapporten pekar ut några särskilt prioriterade områden som myndigheten borde få i uppdrag att arbeta vidare inom.Kunskapsstyrning och normgivningEn viktig slutsats i rapporten är att användningen av det nationella fackspråket behöver regleras för att målet om ökad säkerhet för klienter och patienter ska kunna uppnås. I dagsläget bedöms föreskrifter vara den metod som bäst kan garantera ett brett genomförande.Målgrupper för slutrapportenSlutrapporten riktar sig till beslutsfattare i kommuner och landsting, vård- och omsorgspersonal med särskilt intresse eller ansvar för dokumentationsfrågor och professionella organisationer. Den riktar sig också till terminologiansvariga i kommuner och landsting, IT-direktörer, IT-leverantörer samt aktörer inom den nationella strategin för eHälsa.
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| 8. |
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| 9. |
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| 10. |
- Belew, M, et al.
(författare)
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Structure-activity studies on synthetic analogs to vasoactive peptides derived from human fibrinogen.
- 1980
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Ingår i: Biochimica et Biophysica Acta. - 0006-3002 .- 1878-2434. ; 632:1, s. 87-94
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Tidskriftsartikel (refereegranskat)abstract
- Counterparts to two vasoactive peptides previously isolated from fibrin(ogen) degraded by plasmin (EC 3.4.21.7) were synthesized by the solid phase procedure. The synthetic undecapeptide (Ser-Gln-Leu-Gln-Lys-Val-Pro-Pro-Glu-Trp-Lys) was isolated in a homogeneous state by chromatography on Sephadex G-25 and DEAE-Sepharose CL-6B and the pentapeptide (Ala-Arg-Pro-Ala-Lys) by chromatography on BioGel P-6 and column zone electrophoresis. The effect of these two peptides and of fifteen analogs to the pentapeptide on microvascular permeability in rat skin was investigated. The two synthetic counterparts were as potent as the natural peptides. With respect to the analogs, the influence of different functional groups was first studied. This was followed by attempts to minimize the active structure, induce or relieve rigidity of the peptide back-bone or otherwise accomplish modifications by a change in chirality at critical positions. Our results show that the tetrapeptide Arg-Pro-Ala-Lys has the same effect on microvascular permeability as the pentapeptide in the assay system used. Basic amino acids at both ends, as well as a proline residue adjacent to the N-terminal amino acid appear important for full or essentially full activity. On the other hand, substitution of the Ala at position 4 with several other amino acids did not result in a significant loss in biological potency.
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| 11. |
- Bertheim, Ulf, 1956-
(författare)
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Impaired reparative processes in particular related to hyaluronan in various cutaneous disorders : a structural analysis
- 2004
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Cutaneous reparative processes, including wound healing, are highly developed procedures in which a chain of actions occurs to reconstitute the function of the wounded tissue. To prevent a delayed or excessive reparative process it is important to understand how this procedure develops and is maintained. One of the major extracellular matrix components of the skin is the glycosaminoglycan hyaluronan (HA). HA contributes to an extracellular environment, which is permissive for cell motility and proliferation, features that may account for HA’s unique properties observed in scarless foetal wound healing. The molecule is found at high concentration whenever proliferation, regeneration and repair of tissue occur. The aims of the present studies were to analyse the distribution of HA and to investigate its possible role in various cutaneous conditions associated with an impaired reparative process like in scar tissue formation in healing wounds, changed skin characteristics in diabetes mellitus and proliferating activity in basal cell carcinomas. Tissue biopsies were obtained from healthy human skin, type-I diabetic skin and various scar tissues. The samples were analysed in the light microscope with a hyaluronan-binding-probe, antibodies for collagen I, III, PCNA and Ki-67. Ultrastructural analyses were performed on the same tissue samples. In normal skin HA was present mainly in the papillary dermis. In epidermis HA was located in between the keratinocytes in the spinous layer. In the different scar tissues the localization of HA varied, with an HA distribution in mature scar type resembling that in normal skin. In keloids the papillary dermis lacked HA, but the thickened epidermis contained more HA than the other scar types. Ultrastructural studies of keloids revealed an altered collagen structure in the dermal layers, with an abundance of thin collagen fibers in the reticular dermis and thicker collagen fibers in the papillary dermis. Furthermore, the keloids displayed epidermal changes, which involved the basement membrane (BM), exhibiting fewer hemidesmosomes, and an altered shape of desmosomes in the entire enlarged spinous layer. These alterations in epidermis are suggested to influence the hydrodynamic and cell regulatory properties of the wounded skin. In diabetic patients, a reduced HA staining in the basement membrane zone was seen. The staining intensity of HA correlated to the physical properties of the skin reflected by their grades of limited joint mobility (LJM). Furthermore, the HA staining correlated with serum concentration of the HbA1c. In basal cell carcinomas (BCC), HA occurred predominantly in the tumour stroma. The distribution was most intense in the highly developed superficial BCC type, and resembled that of the papillary dermis of normal skin. In contrast, in the infiltrative BCC type, the tumour stroma stained weakly in the infiltrative part of the tumour. Moreover, the surrounding dermal layer was deranged and devoid of HA. The findings suggest that the tumour stroma in superficial BCC causes a slow, well-regulated cell growth in which the tumour cells do not substantially disturb the normal skin function. In the infiltrative BCC type, the tumour cells cause a disintegration of the tumour stroma as well as the normal surrounding dermis, which permits further spreading of the tumour. In fact, the behaviour of the infiltrative BCC tumour, growing beyond its boundaries, resembles that of the keloid. The mapping of the distribution of HA could be a useful tool for prognostic information, for evaluating the degree of progress and for deciding the choice of treatment in various diseases of the skin. In skin malignancies such as BCC it can be used to determine the radicality at the surgical excision of the tumour. Keywords: Hyaluronan, scar tissue, diabetes mellitus, basal cell carcinoma, skin, wound healing
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| 12. |
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| 13. |
- Björkenstam, Charlotte, et al.
(författare)
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Excess cause-specific mortality in out-patients with personality disorder
- 2015
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Ingår i: British Journal of Psychiatry Open. - : Royal College of Psychiatrists. - 2056-4724. ; 1:1, s. 54-55
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Tidskriftsartikel (refereegranskat)abstract
- Personality disorders (PDs) are associated with increased overall mortality. In patients hospitalised with a principal diagnosis of PD, this is observed for all clusters and for natural as well as unnatural causes of death. Data from Swedish nationwide registers were used to assess whether this was also true for the majority of patients diagnosed with PDs not severe enough to lead to hospitalisation. There was an increased mortality in all clusters, and for natural as well as unnatural death, also in patients treated as out-patients only, although not to the same extent as in those hospitalised.
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| 14. |
- Björkenstam, Charlotte, et al.
(författare)
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Suicide risk and suicide method in patients with personality disorders
- 2016
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Ingår i: Journal of Psychiatric Research. - : Elsevier BV. - 0022-3956 .- 1879-1379. ; 83, s. 29-36
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Tidskriftsartikel (refereegranskat)abstract
- Objective: The influence of psychopathology on suicide method has revealed different distributions among different psychiatric disorders. However, evidence is still scarce. We hypothesized that having a diagnosis of personality disorder (PD) affect the suicide method, and that different PD clusters would influence the suicide method in different ways. In addition, we hypothesized that the presence of psychiatric and somatic co-morbidity also affects the suicide method. Method: We examined 25,217 individuals aged 15-64 who had been hospitalized in Sweden with a main diagnosis of PD the years 1987-2013 (N = 25,217). The patients were followed from the date of first discharge until death or until the end of the follow-up period, i.e. December 31, 2013, for a total of 323,508.8 person-years, with a mean follow up time of 11.7 years. The SMR, i.e. the ratio between the observed number of suicides and the expected number of suicides, was used as a measure of risk. Results: Overall PD, different PD-clusters, and comorbidity influenced the suicide method. Hanging evidenced highest SMR in female PD patients (SMR 34.2 (95% CI: 29.3-39.8)), as compared to non-PD patients and jumping among male PD patients (SMR 24.8 (95% CI: 18.3-33.6)), as compared to non PD-patients. Furthermore, the elevated suicide risk was related to both psychiatric and somatic comorbidity. Conclusion: The increased suicide risk was unevenly distributed with respect to suicide method and type of PD. However, these differences were only moderate and greatly overshadowed by the overall excess suicide risk in having PD. Any attempt from society to decrease the suicide rate in persons with PD must take these characteristics into account.
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| 15. |
- Björkenstam, Emma, et al.
(författare)
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Excess cause-specific mortality in in-patient-treated individuals with personality disorder : 25-year nationwide population-based study.
- 2015
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Ingår i: British Journal of Psychiatry. - : Royal College of Psychiatrists. - 0007-1250 .- 1472-1465. ; 207:4, s. 339-345
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundAlthough personality disorders are associated with increased overall mortality, less is known about cause of death and personality type.AimsTo determine causes of mortality in ICD personality disorders.MethodBased on data from Swedish nationwide registers, individuals admitted to hospital with a primary diagnosis of personality disorder between 1987 and 2011 were followed with respect to mortality until 31 December 2011. Standardised mortality ratios (SMRs) with 95% confidence intervals and underlying causes of death were calculated.ResultsAll-cause SMRs were increased, overall and in all clusters, for natural as well as unnatural causes of death. The overall SMR was 6.1 in women and 5.0 in men, as high as previously reported for anorexia nervosa, with higher rates in cluster B and mixed/other personality disorders. The SMR for suicide was 34.5 in women and 16.0 in men for cluster B disorders. Somatic and psychiatric comorbidity increased SMRs.ConclusionsThe SMR was substantially increased for all personality disorder clusters. Thus, there was an increased premature mortality risk for all personality disorders, irrespective of category.
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| 16. |
- Borg, T, et al.
(författare)
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A porcine model of early adult respiratory distress syndrome induced by endotoxaemia.
- 1985
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Ingår i: Acta Anaesthesiologica Scandinavica. - 0001-5172 .- 1399-6576. ; 29:8, s. 814-30
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Tidskriftsartikel (refereegranskat)abstract
- To study the pathophysiology of early adult respiratory distress syndrome (ARDS) induced by sepsis, spontaneously breathing pigs under ketamine anaesthesia were investigated. Twenty animals were infused i.v. with E. coli endotoxin (10 micrograms . h-1 . kg-1) over 6 h, and ten control animals received physiological saline. In the controls, cardiac output (Qt) and O2 delivery decreased slightly. There were no changes in pulmonary gas exchange, pulmonary haemodynamics or extravascular lung water (EVLW). The polymorphonuclear (PMN) leucocyte count gradually increased, while the platelet count decreased slightly. Endotoxin infusion caused profound deterioration of pulmonary gas exchange, a marked rise in pulmonary vascular resistance (PVR) and a moderate increase in EVLW. The pulmonary dysfunction was not attributable to the pulmonary oedema per se, whereas a "dry" ventilation/perfusion inequality played an important role. The "responders" (peak venous admixture greater than 20%; n = 14) were characterized by higher Qt and lower PVR than the "non-responders". Qt declined progressively, especially in non-survivors. O2 delivery decreased considerably. Metabolic acidosis probably indicated oxygen deficit. Eleven of 20 animals died during the observation period. Mortality was related more to the imbalance between O2 delivery and oxygen demand than to the deterioration in pulmonary gas exchange. The PMN count decreased markedly while the gradual decline in platelet count was similar to that in the controls. Lung microscopy revealed PMN accumulation in the microvasculature, moderate interstitial oedema and microvascular blood stasis. Our porcine model, which closely mimics early ARDS in man, will be useful in further studies of the pathophysiological pathways and the treatment of this syndrome.
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| 17. |
- Borg, T, et al.
(författare)
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Complement activation and its relationship to adult respiratory distress syndrome. An experimental study in pigs.
- 1984
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Ingår i: Acta Anaesthesiologica Scandinavica. - 0001-5172 .- 1399-6576. ; 28:2, s. 158-65
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Tidskriftsartikel (refereegranskat)abstract
- Pulmonary leucostasis induced by complement activation has been considered an important pathogenic factor in adult respiratory distress syndrome (ARDS). To determine whether complement activation per se could evoke pulmonary dysfunction similar to ARDS, pigs were repeatedly infused with complement-activated plasma (CAP). Complement activation was produced by incubation of plasma with zymosan. Three groups of animals were investigated. Control animals received non-activated plasma. Nine animals (Group II) were given four infusions of CAP at a rate of 7 ml X min-1, and another nine animals (Group III) received two CAP infusions at a rate of 7 ml X min-1 followed by two at a rate of 14 ml X min-1. In the control animals there were no changes in gas exchange or haemodynamic variables and the leucocyte counts gradually increased. Infusion of CAP resulted in transient peripheral leucopenia and a dose-rate-dependent reversible increase in pulmonary vascular resistance in all animals. In one animal of Group II and in six of Group III there was a significant infusion-related decrease in Pao2 due to increased venous admixture. These animals were characterized by an enhanced pulmonary vascular tone before the start of the first CAP infusion. They also displayed a more pronounced pulmonary vascular response to infusion of CAP. The changes in gas exchange variables and pulmonary haemodynamics showed no relation to the degree of leucopenia or decrease in platelet count. The increased venous admixture was caused by "dry" ventilation/perfusion mismatching and not by oedema. These results suggest that additional factors besides complement activation and pulmonary leucostasis are required for the development of increased microvascular permeability and the pulmonary oedema characterizing ARDS.
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| 18. |
- Borg, T, et al.
(författare)
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Prophylactic and delayed treatment with high-dose methylprednisolone in a porcine model of early ARDS induced by endotoxaemia.
- 1985
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Ingår i: Acta Anaesthesiologica Scandinavica. - 0001-5172 .- 1399-6576. ; 29:8, s. 831-45
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Tidskriftsartikel (refereegranskat)abstract
- The effects of prophylactic and delayed treatment with high-dose methylprednisolone were evaluated in a porcine model of early adult respiratory distress syndrome induced by endotoxaemia. Spontaneously breathing pigs under ketamine anaesthesia were infused i.v. with E. coli endotoxin (10 micrograms . h-1 . kg-1) over 6h. Twenty animals received endotoxin without treatment. Eight animals were pretreated with methylprednisolone i.v., 60 mg . kg-1, followed by an i.v. infusion at a rate of 10 mg . h-1 . kg-1. Ten animals received the same dosage of methylprednisolone beginning 2 h after the start of endotoxin infusion. Pretreatment with methylprednisolone prevented the endotoxin-induced impairment in pulmonary gas exchange and the development of pulmonary oedema. The pulmonary hypertension was counteracted. Cardiac output (Qt) and O2 delivery were improved. Mean arterial blood pressure (MAP) increased and was higher than in the untreated endotoxin group. The profound fall in PMN count was inhibited, while the accumulation of these cells in the lung was still substantial. Survival was improved. Delayed methylprednisolone treatment prevented further deterioration in pulmonary gas exchange and tended to restore it towards baseline. The pulmonary oedema and pulmonary hypertension were reduced. Qt and O2 delivery did not improve. MAP was higher than in the untreated endotoxin group towards the end of the observation period. The decline in PMN count and the pulmonary accumulation of these cells were not significantly influenced. Survival was improved. These results indicate that high-dose methylprednisolone, when given early in the course of sepsis, might be of clinical value in prevention of the devastating pulmonary and circulatory complications of this disease.
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| 19. |
- Borg, T, et al.
(författare)
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Prophylactic and delayed treatment with indomethacin in a porcine model of early adult respiratory distress syndrome induced by endotoxaemia.
- 1986
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Ingår i: Acta Anaesthesiologica Scandinavica. - 0001-5172 .- 1399-6576. ; 30:1, s. 47-59
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Tidskriftsartikel (refereegranskat)abstract
- The effects of prophylactic and delayed treatment with indomethacin were evaluated in a porcine model of early adult respiratory distress syndrome (ARDS) induced by endotoxaemia. Spontaneously breathing pigs under ketamine anaesthesia were infused i.v. with E. coli endotoxin (10 micrograms . h-1 . kg-1) over 6 h. Twenty animals received endotoxin without treatment. Eight animals were pretreated with indomethacin i.v., 5 mg . kg-1 in 30 min, followed by further infusion at a rate of 2 mg . h-1 . kg-1. Ten animals received the same dosage of indomethacin beginning 2 h after the start of endotoxin infusion. Pretreatment with indomethacin inhibited the endotoxin-induced impairment in pulmonary gas exchange, but did not prevent pulmonary oedema. The pulmonary hypertension was counteracted. Oxygen delivery did not improve, because of a marked reduction in cardiac output (Qt). Systemic vascular resistance (SVR) increased markedly, and mean arterial pressure (MAP) was higher. Survival was improved. Delayed indomethacin treatment prevented a further deterioration in pulmonary gas exchange and restored it towards the baseline level. The pulmonary oedema was not counteracted, while the pulmonary hypertension was reduced. O2 delivery was not restored, owing to the greater decrease in Qt compared with the untreated endotoxin group. SVR increased considerably, and MAP was better maintained. Survival was not improved. These results indicate that cyclo-oxygenase inhibitors might benefit pulmonary gas exchange in human ARDS. Drugs which interfere with arachidonate metabolism will probably be of great importance in the prophylaxis, in particular, and also in the treatment of ARDS.
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| 20. |
- Borg, T, et al.
(författare)
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The role of polymorphonuclear leucocytes in the pulmonary dysfunction induced by complement activation.
- 1985
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Ingår i: Acta Anaesthesiologica Scandinavica. - 0001-5172 .- 1399-6576. ; 29:2, s. 231-40
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Tidskriftsartikel (refereegranskat)abstract
- To determine the role of polymorphonuclear leucocytes (PMNs) in the pulmonary reaction induced by complement activation, pigs were infused with complement-activated plasma (CAP), cell-free supernatant from PMNs activated in vitro, or washed PMN aggregates produced in vitro. Infusion of CAP resulted in transient peripheral leucopenia, a reversible rise in pulmonary vascular resistance (PVR) and decreased arterial oxygen tension (PaO2). Indomethacin did not influence the CAP-induced drop in PMN count or the accumulation of PMNs in the lung, but significantly counteracted the rise in PVR and fall in PaO2. Antihistamines did not prevent the cellular or pulmonary reactions to CAP infusion. Methylprednisolone did not inhibit the decrease in PMN count, but modified the pulmonary reaction to CAP, although it did not prevent the rise in PVR to the same extent as indomethacin; it counteracted the fall in PaO2. Infusion of supernatant from activated PMNs did not influence the PMN count, but caused a reversible increase in PVR and a drop in PaO2. Indomethacin counteracted the pulmonary reaction to this infusion. Infusion of washed PMN aggregates did not result in any cellular or physiological changes. These findings suggest that the pulmonary reaction induced by complement activation is mediated by humoral components generated and/or released during activation of PMNs. Arachidonic acid metabolites play an important role and it is likely that substance(s) released from activated PMNs trigger prostanoid synthesis in other cells. It is conceivable, however, that PMNs exposed to activated complement factors also directly synthesize and release arachidonic acid metabolites.
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| 21. |
- Bowald, S, et al.
(författare)
-
Pulmonary microembolism during and after aortic cross-clamping in heparinized and non-heparinized pigs.
- 1980
-
Ingår i: Acta chirurgica Scandinavica. - 0001-5482. ; 146:5, s. 351-6
-
Tidskriftsartikel (refereegranskat)abstract
- The occurrence of pulmonary microembolism after aortic clamping and declamping was investigated in 21 young pigs. The prophylactive effect of heparin was also examined. Eight animals were heparinized, while 13 did not receive heparin. In 15 pigs the plasma concentration of fibrinogen was determined before, during and after clamping of the aorta. External detection of 51Cr-labelled platelets and 125I-labelled fibrinogen was performed. Lung tissue from these animals was homogenized and analysed for radioactivity. Specimens were taken from the lungs of all animals for morphological investigation. A significant decrease in plasma fibrinogen concentration was noted during the aortic clamping in non-heparinized animals. Morphological studies of lung tissue revealed numerous fibrin/platelet thrombi, leukocyte and platelet aggregates, atelectases and bleedings. In homogenized lung tissue, areas with elevated radioactivity were found, indicating fibrin/platelet entrapment. No such changes were seen in pigs pretreated with heparin. It was found that pulmonary microembolism occurs frequently after aortic clamping if heparin is not given at an early stage of the procedure.
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| 22. |
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| 23. |
- Bäckström, Josefin, 1977-
(författare)
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Family Members of Patients with Burns : Experiences of a Distressful Episode
- 2013
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- A severe burn is a trauma associated with long lasting consequences, not only for the survivor but also for the family. Although it is recognized that family members are central in providing social support for the patients, previous research has not focused extensively on this group. The aims of this thesis were to increase knowledge about psychological symptoms and health-related quality of life (HRQoL) in family members of patients with burns, as well as to explore their experiences of burn care and rehabilitation. The research questions were approached using quantitative and qualitative methods.The results showed that most family members demonstrate normal to mild levels of psychological symptoms, while one third demonstrate moderate to severe symptoms during care. The symptoms decreased over time and could be predicted to a certain degree by early symptoms.Further, family members’ report of HRQoL is similar to that of the general population. An improvement is seen over time and HRQoL could be predicted in part by earlier life events and psychological symptoms.Family members’ experiences were explored in an interview study. Qualitative content analysis revealed that the time in hospital is stressful, although there were experiences of a positive character. Family members might benefit from being cared for in a more individualized way. The communication between health care providers and the family members could be improved.Finally, a qualitative content analysis revealed that family members’ experiences and views concerning support is highly individual. There were experiences of sufficient support as well as lack of professional support. Treatment of family members should be modified according to personal circumstances, and it is important to actively include family members in the care process, both before and after discharge.In summary, being a family member of a burn survivor is a distressful experience, not only during care but in many cases also after discharge. The treatment of family members within burn care should be individualized. Some persons are more vulnerable than others and it might be possible to identify those in need of support while care is still ongoing.
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| 24. |
- Bäckström, Josefin, 1977-, et al.
(författare)
-
Health-related quality of life in family members of patients with burns
- 2014
-
Ingår i: Journal of Burn Care & Research. - 1559-047X .- 1559-0488. ; 35:3, s. 243-250
-
Tidskriftsartikel (refereegranskat)abstract
- A severe burn not only affects the patients, but may also have a great impact on the lives of family members. It is known that family members of patients with burns experience psychological distress, but health-related quality of life (HRQoL) has not been studied in this group. The aim was to study predictors of HRQoL in family members of patients with burns. Forty-four family members of adult patients treated in a burn center, between 2000 and 2007, completed questionnaires during care, and at 3, 6, and 12 months after injury. HRQoL was assessed with the EuroQol 5D (EQ-5D), which consists of the dimensions: mobility, self-care, usual activities, pain, and anxiety/depression. The questionnaire generates an EQ-5D index and a visual analog scale (VAS) score. Overall, the EQ-5D index was similar to that of the general population. A slight improvement in HRQoL was found in the VAS scores and in the anxiety/depression dimension over time. In regression models, HRQoL was primarily predicted by earlier life events, symptoms of post-traumatic stress disorder, and HRQoL, assessed during the patients’ hospitalization. In summary, HRQoL assessed with VAS scores increased slightly during the first year postburn, and early screening for life events and psychological symptoms, and HRQoL might be useful in identifying family members in need of support.
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| 25. |
- Bäckström, Josefin, et al.
(författare)
-
Prediction of psychological symptoms in family members of patients with burns 1 year after injury
- 2013
-
Ingår i: Journal of Advanced Nursing. - : Wiley. - 0309-2402 .- 1365-2648. ; 69:2, s. 384-393
-
Tidskriftsartikel (refereegranskat)abstract
- AimTo report a study of predictors of psychological symptoms in family members of patients with burns.BackgroundFamily members are important as a source of social support for patients undergoing prolonged rehabilitation. Little is known about psychological symptoms of family members of patients with burns, especially in the long term.DesignThe design of the study was prospective and longitudinal.MethodsForty-four family members of adult patients treated in a burn centre between 2000-2007 completed questionnaires during care and at 3, 6, and 12 months after injury. Psychological symptoms were assessed with the Hospital Anxiety and Depression Scale. Predictors for anxiety and depression were explored in regression analyses.ResultsThe mean scores indicated normal to mild symptoms in general. Moderate and severe symptom levels during care and at 12 months were demonstrated on the anxiety subscale by 15/44 and 5/39, respectively, and on the depression subscale by 5/44 and 0/39 of the family members, respectively. In the final regression models, the primary predictor was psychological symptoms at the previous assessment. Other predictors were previous life events, age, and the coping strategy avoidance.ConclusionFamily members of patients with burns demonstrate normal to mild levels of psychological symptoms that decrease over time. One-third show moderate to severe anxiety symptoms during care and may benefit from counselling. Previous symptoms predict later symptoms, indicating that screening with a validated instrument is useful. The results provide guidance for nurses in assessing and planning adequate interventions for family members.
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| 26. |
- Carlin, G, et al.
(författare)
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Effect of anti-inflammatory drugs on xanthine oxidase and xanthine oxidase induced depolymerization of hyaluronic acid.
- 1985
-
Ingår i: Agents and actions. - 0065-4299. ; 16:5, s. 377-84
-
Tidskriftsartikel (refereegranskat)abstract
- The inhibitory effect of various anti-inflammatory drugs on the xanthine oxidase derived depolymerization of hyaluronic acid was studied. The depolymerization was assayed by repeated viscosity measurements. By using a low xanthine oxidase activity, the decrease in viscosity with time followed first order reaction kinetics and was therefore suitable for kinetic analysis. The xanthine oxidase activity was monitored by assay of O2-consumption with a Clark-electrode and by assay of urate production. We present evidence that salicylic, acetylsalicylic, gentisic and azodisalicylic acid and sulfasalazine inhibit the production of oxygen-derived free radicals by xanthine oxidase. We found that sulfapyridine, 5-aminosalicylic acid, allopurinol, mannitol, glucuronic acid and N-acetylglucosamine in addition to the earlier studied drugs, paracetamol, ibuprofen, benoxaprofen and gentisic acid exert their effect via scavenging of free radicals. These drugs had very little effect on the enzyme activity.
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| 27. |
- Dyster-Aas, Johan, et al.
(författare)
-
Major depression and posttraumatic stress disorder symptoms following severe burn injury in relation to lifetime psychiatric morbidity
- 2008
-
Ingår i: Journal of Trauma - Injury, Infection and Critical Care. - 0022-5282. ; 64:5, s. 1349-1356
-
Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Psychiatric history has been suggested to have an impact on long-term adjustment in burn survivors. A rigorous, prospective, longitudinal approach was used to study psychiatric history in a population-based burn sample and its impact on symptomatology of depression and posttraumatic stress disorder (PTSD) at a 12-month follow-up. METHODS: Seventy-three consecutive patients admitted to the Uppsala Burn Unit were assessed with the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition for psychiatric disorders, of whom 64 were also assessed after 12 months. RESULTS: Forty-eight patients (66%) presented with at least one lifetime psychiatric diagnosis; major depression (41%), alcohol abuse or dependence (32%), simple phobia (16%), and panic disorder (16%) were most prevalent. At 12-months postburn, 10 patients (16%) met criteria for major depression, 6 (9%) for PTSD, and 11 (17%) for subsyndromal PTSD. Patients with lifetime anxiety disorder and with lifetime psychiatric comorbidity were more likely to be depressed at 12 months, whereas those with lifetime affective disorder, substance use disorder and psychiatric comorbidity were more likely to have symptoms of PTSD. CONCLUSIONS: Two-thirds of burn survivors exhibit a history of lifetime psychiatric disorders. Those with a psychiatric history have a higher risk of postburn psychiatric problems.
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| 28. |
- Dyster-Aas, Johan, 1958-
(författare)
-
Psychiatric History and Adaptation in Burn Injured Patients
- 2006
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The intertwined relationship between physical and psychological problems is a topic of much interest in the rehabilitation of severely injured patients, e.g. after a burn. The present study aims at gaining further knowledge concerning the impact of psychological factors and psychiatric morbidity on short and long-term adaptation after burn injury. Outcome was assessed for three main areas: pruritus, return to work and psychiatric health. Three separate samples of previous or current adult patients treated at the Uppsala Burn Unit during different time periods: 1980-1995 (n=248), 1996-2000 (n=86), and 2000-2005 (n=73), were assessed. Chronic burn-related pruritus is more common than previously reported and psychological factors such as anxiety-related personality traits and coping are significantly associated with its presence. Only a small group of former patients with work-related accidents were not working an average of nine years after injury. The unemployed reported more pain and worse perceived health, particularly in psychosocial domains. Returning to work was explained by both injury severity and personality characteristics. Those who were not working had lower health-related quality of life and poorer traumarelated physical and psychological health, and more pain. Preburn psychiatric morbidity is high in a lifetime perspective. Two thirds of the sample had at least one disorder according to the Structured Clinical Interview for DSM-IV Axis I disorders. Affective disorders were especially highly represented. A logistic regression showed that having a history of preburn disorders was associated with a higher risk of both PTSD and depression one year after the injury. In this material it was actually uncommon for a patient without a preburn psychiatric history to develop postburn psychiatric symptomatology. The results have strengthened the overall model for adaptation after burn injury by showing that psychological factors and psychiatric history are important moderators of the adaptation process after the injury.
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| 29. |
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| 30. |
- Ekeblad, Frida, et al.
(författare)
-
Impact of personality disorders on health-related quality of life one year after burn injury
- 2015
-
Ingår i: Disability and Rehabilitation. - : Informa UK Limited. - 0963-8288 .- 1464-5165. ; 37:6, s. 534-540
-
Tidskriftsartikel (refereegranskat)abstract
- Purpose: Personality disorders (PDs) are associated with significant distress, disability, and cause great difficulties in life. PDs have been suggested to influence adaptation after major burns, but the potential relationship has not been fully elucidated. This study aimed to describe the prevalence of PDs in 107 patients with major burn injury, and to identify the impact of PDs on perceived patient outcome assessed as health-related quality of life (HRQoL) one year after burn. Methods: One burn-specific instrument (Burn Specific Health Scale-Brief (BSHS-B)) and two generic instruments (EuroQol Five Dimensions and Short Form 36 Health Survey) were used, and Psychiatric Axis I and II disorders were assessed one year post burn. Results: This study identified an above normal prevalence of PDs among individuals afflicted by burn, and participants with PD had a significantly larger lifetime burden of Axis I disorders compared to participants without PD. Participants with PDs scored significantly lower than those without PD in the BSHS-B domain Skin involvement, and the effect of having a PD was related to the subscale Treatment regimens. There was no relationship between the presence of PD and generic HRQoL. Conclusions: An implication of these observations is that special rehabilitation efforts including more tailored interventions must be offered to these patients to ensure that the obstacles they perceive to caring for themselves in this respect are eliminated.
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| 31. |
- Eriksson, M, et al.
(författare)
-
Angiotensin converting enzyme dependent and non-dependent effects of a fibrinogen-derived pentapeptide on microvascular permeability in rat skin.
- 1983
-
Ingår i: Upsala Journal of Medical Sciences. - 0300-9734 .- 2000-1967. ; 88:2, s. 95-101
-
Tidskriftsartikel (refereegranskat)abstract
- A permeability-increasing pentapeptide, termed peptide 6A, derived from plasmin-degraded human fibrinogen and known to potentiate the increase in microvascular permeability caused by bradykinin was investigated concerning its angiotensin converting enzyme (A.C.E.) related effects. When applied to a rat skin model together with a specific inhibitor of this enzyme, peptide 6A showed a potentiated effect after 30 min. but not after 5 min. The same was also true for bradykinin. These findings suggest that the degradation rate of these peptides is decreased with resulting prolongation of the period of leakage, when the action of A.C.E. is opposed. It is deduced that peptide 6A may act as a partial antagonist of this enzyme in the rat skin model. Addition of peptide 6A to a mixture of bradykinin together with inhibitors of the enzymes degrading bradykinin before application to the rat skin, significantly augmented the extravasation of 125I-albumin. These findings are consistent with data indicating that peptide 6A is a prostacyclin-releaser able to induce vasodilation. This effect of peptide 6A on the microcirculation seems to be separate from its angiotensin converting enzyme-related effects.
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| 32. |
- Eriksson, M, et al.
(författare)
-
Enhancement of the permeability-increasing effect of bradykinin and substance P by a peptide derived from fibrinogen.
- 1983
-
Ingår i: International journal of microcirculation, clinical and experimental. - 0167-6865. ; 2:1, s. 53-9
-
Tidskriftsartikel (refereegranskat)abstract
- Two low molecular weight fibrin(ogen) degradation products, 6A (Ala-Arg-Pro-Ala-Lys) and 6D (Ser-Gln-Leu-Gln-Lys-Val-Pro-Pro-Glu-Trp-Lys) that are known to increase vascular permeability were injected together with bradykinin, substance P, neurotensin, histamine or tuftsin into the dorsal skin of rats. Effects on microvascular permeability were evaluated as leakage of intravenously injected 125I-labelled human serum albumin to tissues. It was found that peptide 6A potentiated the leakage caused by bradykinin and also, to a minor extent, that caused by substance P over a 30 min period, but not of any other substance. Peptide 6D increased bradykinin-induced leakage to a lower degree than did peptide 6A. Thus, it is shown that products resulting from fibrinolysis exert a selective effect upon the action of bradykinin and of substance P.
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| 33. |
- Farzad, A, et al.
(författare)
-
Luminal release of hyaluronan (hyaluronic acid) in intestinal ischemia in the rat.
- 1993
-
Ingår i: Digestion. - 0012-2823 .- 1421-9867. ; 54:3, s. 168-72
-
Tidskriftsartikel (refereegranskat)abstract
- Hyaluronan (HA) is a glycosaminoglycan, the water-binding properties of which are suggested to be pivotal for an optimal hydration of tissues. The lamina propria of the intestinal villi is characterized by a high concentration of HA. Increased amounts of HA are observed in the intestinal lumen in patients with Crohn's disease. We have evaluated whether epithelial denudation as such is sufficient to increase the concentration of HA in the lumen of the small intestine. Epithelial damage was accomplished by reversible ischemia-reperfusion injury to the rat ileum and the concentration of HA was determined in luminal perfusate. The perfusate concentration of HA was increased from 26 +/- 8 micrograms/l before ischemia, to 68 +/- 13 and 41 +/- 12 micrograms/l 0-30 and 30-60 min after a 60-min period of subtotal ischemia without venous stasis (p < 0.05). In sham-operated animals, in contrast, the perfusate concentration of HA was virtually unchanged (31 +/- 18, 13 +/- 3 and 10 +/- 1 microgram/l, respectively). Specific staining for HA on sections revealed loss of HA from the villus tips after ischemia. The results show that epithelial denudation results in loss of HA from the villus interstitium to the intestinal lumen.
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| 34. |
- Forsgren, P, et al.
(författare)
-
Intrapulmonary deposition of aerosolized Evans blue dye and liposomes in an experimental porcine model of early ARDS.
- 1990
-
Ingår i: Upsala Journal of Medical Sciences. - 0300-9734 .- 2000-1967. ; 95:2, s. 117-36
-
Tidskriftsartikel (refereegranskat)abstract
- In early ARDS (Adult Respiratory Distress Syndrome) and other inflammatory pulmonary disorders the lung might benefit from a high local deposition of an active drug, in order to optimize the local concentration without systemic side effects. In this methodological study we used pigs under controlled ventilation. The study was carried out in two steps. In the first part Evans blue dye in NaCl was delivered in aerosolized form. In the second part a dry powder containing FITC (fluorescein-isothiocyanate)-labelled-liposomes in NaCl was delivered in the same way. We evaluated whether there was an even, central, peripheral and/or alveolar deposition, whether the procedure was reproducible, and whether there was an interaction with alveolar macrophages. Sixteen animals under chlormethiazole anaesthesia and intermittent positive pressure ventilation (IPPV) were included in the study. Four animals were sacrificed after nebulization and baseline measurements. Five animals served as controls and received saline i.v. Six animals received endotoxin i.v. (18 micrograms.kg-1.h-1). One animal underwent broncho-alveolar lavage 15 min and 2 h after liposome administration. At the end of each experiment the lungs were inflated with air, excised and dried in a microwave oven. The left lung of each animal was sliced in a reproducible manner and lung-pieces from different regions were analyzed. The Evans blue dye or the phospholipid fraction of the lungs (containing liposomes), was extracted and analyzed spectrofluorometrically. This study shows that it is possible, under reproducible conditions, to administer aerosolized Evans blue dye and liposomes and to achieve a deposition in the terminal airways and/or alveolar spaces. The broncho-alveolar lavage demonstrated an interaction of liposomes with alveolar macrophages. The results imply that liposomes carrying active drugs and administered by inhalation may be used for local pulmonary treatment in early ARDS and other related inflammatory pulmonary diseases.
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| 35. |
- Fredriksson, Camilla, 1969-
(författare)
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Keratinocytes in tissue engineering of human skin: invitro and in vivo studies
- 2008
-
Licentiatavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Full thickness wounds, such as deep burns, need restoration of both the dermal and epidermal layers of the skin. In normal wound healing, re-epithelialization occurs by migration and proliferation of keratinocytes from the wound edges and by differentiation of stem cells from remaining hair follicles. Restoration of dermis occurs by influx of growth factors secreted by macrophages, platelets, and fibroblasts; by fibroblast proliferation and subsequent synthesis and remodeling of collagenous dermal matrix. In the case of full-thickness acute burn injuries and chronic wounds (e.g. pressure ulcers, venous ulcers and diabetic foot ulcers), these processes are defective. With the principles of tissue engineering in mind (to correct, improve and maintain tissues and their functions), researchers have developed promising materials and methods to make it possible to restore either the dermal (Integra® DRT, Alloderm®) or the epidermal layer (split thickness skin grafts (STSG), cultured epithelial autografts (CEA), autologous keratinocytes in single cell suspension). It is now well established that superior results are obtained if both dermal and epidermal components are combined, for example in a bilayered skin equivalent. Apligraf® is recommended for use on venous ulcers and is the only bilayered living skin equivalent currently approved by the FDA. Studies on different factors affecting the wound healing capacity as well as techniques in use provide valuable information for further development.In this licentiate thesis, we evaluated different transplantation techniques for delivering cultured human keratinocytes in single cell suspension, a measure becoming more frequently used in addition to STSG and CEA for restoring the epidermal layer of the skin. We found that the pressure device, commonly used to spray cell suspension onto the wound with pressures as high as 200 kPa, killed around 0% of the cells. In comparison, an ordinary syringe with the attachment of a spray nozzle showed almost 90% viable cells post transplantation and provided an equally good distribution of the cell suspension.We also studied different silver containing dressings regarding silver accumulation in human skin. In addition, we graded the re-epithelialization to evaluate whether the dressings caused any delay in the wound healing process. We found that the silver dressings tested, with few exceptions, caused dermal accumulation of silver, primarily aggregated around blood vessels. We could also show that most of the dressings had negative effect on the re-epithelialization.For the restoration of the dermal layer of the skin, Integra® DRT functions as a scaffold for guided tissue regeneration of the dermis. We had the possibility to study a case of necrotizing fasciitis were the treatment consisted of the use of Integra® DTR together with sub-atmospheric pressure (after initial surgical debridement) and later transplantation of split thickness skin grafts. This measure proved to be safe as well as giving satisfactory pliable and aesthetically acceptable result.
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| 36. |
- Gauffin, Emelie, et al.
(författare)
-
Health-related quality of life (EQ-5D) early after injury predicts long-term pain after burn
- 2016
-
Ingår i: Burns. - : Elsevier BV. - 0305-4179 .- 1879-1409. ; 42:8, s. 1781-1788
-
Tidskriftsartikel (refereegranskat)abstract
- Background: Chronic pain after burn can have severe physical and psychological effects on former patients years after the initial injury. Although the issue of pain after burn has gained increased attention over the past years, prospective, longitudinal studies are scarce. Our aim was to prospectively investigate consecutive burn patients for pain severity over time and to evaluate the prevalence and characteristics of post-burn pain to 2-7 years after the burn. As an additional aim, the effects of burn and individual-related factors, especially health related Quality of Life (HRQoL), were investigated.Method: Sixty-seven consecutive burn patients were assessed during acute care at 3, 6, 12 and 24 months, as well as at 2-7 years post-burn. HRQoL, symptoms of post-traumatic stress disorder (PTSD) and other psychiatric disorders were investigated. During the interviews that took place 2-7 years after the injury (mean 4.6 1.9 years), current chronic post-burn pain was assessed using the Brief Pain Inventory-Short Form (BPI-SF).Results: One-third of the patients still reported pain 2-7 years after the injury. Pain severity and interference with daily life were mainly mild to moderate though they were found to be associated with significantly lower HRQoL. Chronic pain after bum was associated with both burn- and individual-related factors. In logistic regression analysis HRQoL at 3 and 12 months and symptoms of PTSD at 12 months were independent factors in predicting chronic pain after burn.Conclusion: Pain after burn becomes a chronic burden for many former burn patients and decreases HRQoL. A novel finding in this study was that HRQoL assessed early after burn was a predictor for the development of chronic pain. This finding may help to predict future pain problems and serve as an indicator for pain preventive measures.
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| 37. |
- Gauffin, Emelie, et al.
(författare)
-
Prevalence and prediction of prolonged pruritus after severe burns
- 2015
-
Ingår i: Journal of Burn Care & Research. - 1559-047X .- 1559-0488. ; 36:3, s. 405-413
-
Tidskriftsartikel (refereegranskat)abstract
- Years after injury, pruritus is a common and severe problem for many burn patients. However, its characteristics and consequences are often only partially described. The authors therefore performed a prospective detailed examination of burn- and individual-related factors and considered those in relation to pruritus severity. Sixty-seven consecutive burn patients were assessed during acute care, and at 3 and 12 months postburn regarding preburn psychiatric disorders, health-related quality of life, post traumatic stress disorder, and personality traits. Postburn pruritus was subsequently assessed 2 to 7 years postburn using the Questionnaire for Pruritus Assessment. Fifty-one individuals, 76% of the participants, reported burn pruritus any time after the burn. Thirty-three individuals, 49% of the participants, reported ongoing pruritus the last 2 months. Information on the characteristics of pruritus was obtained from 32 of these individuals. Most perceived pruritus as bothersome or annoying and as present every day, 16 (50 %) were considered to have severe pruritus, and 11 (34 %) scratched themselves to the point of bleeding. In logistic regressions, this was independently related to TBSA full-thickness burn and health-related quality of life at 3 months, and to TBSA full thickness burn and the personality trait impulsiveness, respectively. About half of the previous burn patients experienced ongoing pruritus on an average of 4.5 years after injury, and half of them had severe pruritus. Scratching oneself to the point of bleeding is linked both to a certain personality and to pruritus. It is suspected that many patients are left without access to the best available treatment.
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| 38. |
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| 39. |
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| 40. |
- Gerdin, Bengt, 1947-
(författare)
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A case of disguised suicide.
- 1980
-
Ingår i: Forensic Science International. - 0379-0738 .- 1872-6283. ; 16:1, s. 29-34
-
Tidskriftsartikel (refereegranskat)abstract
- A case of disguised suicide is presented. A 77-year-old man had made technical arrangements so that the pistol with which he shot himself was thrown aside by the elasticity of a rubber band, to which it was tied, and was thereby hidden. After the shot the man fell and crushed his head, which initially concealed the bullet wound. A scrutinizing technical investigation at the scene of the death close collaboration between the experts involved, revealed the true circumstances. No explanation for the attempt to conceal the suicide was found.
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| 41. |
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| 42. |
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| 43. |
- Gerdin, Bengt, 1947-, et al.
(författare)
-
Comparison between predicted cause of death and cause of death found at autopsy in medicolegal autopsy material.
- 1980
-
Ingår i: Zeitschrift fur Rechtsmedizin. Journal of legal medicine. - 0044-3433. ; 85:3, s. 181-7
-
Tidskriftsartikel (refereegranskat)abstract
- The question whether an autopsy could have been omitted without adversely affecting diagnostic accuracy in cases in which an unnatural death was not suspected, was investigated by evaluating data from the files of cases handled in 1977 at the Government Department of Forensic Medicine in Uppsala in which the police had requested a simple medicolegal examination. The police report and the result of an external examination were evaluated blindly and cases divided into three groups. In 95 cases (12%) no autopsy, in 360 cases (45%) a partial autopsy, and in 346 cases (43%) a complete autopsy was considered necessary. In three of the 95 cases and in four of the 360 cases a wrong diagnosis was made. In 59 cases (7%) a complete medicolegal examination was performed. In 21 of the latter the circumstances of death were obscure and in 11 of these an unnatural cause of death was found. The investigation confirms that all cases must be handled by skilled medicolegal experts, that the extent of the medicolegal examination can well be assessed by the physician in charge, and that the autopsy procedure can be simplified in many cases and omitted in some, especially in a situation where resources are limited, without significantly affecting diagnostic accuracy in the individual case. However this policy adversely affects scientific studies on larger autopsy material.
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| 44. |
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| 45. |
- Gerdin, Bengt, 1947-, et al.
(författare)
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Deposition and clearance of fibrin in the rat lung following acute haemorrhage.
- 1979
-
Ingår i: Circulatory shock. - 0092-6213. ; 6:4, s. 357-64
-
Tidskriftsartikel (refereegranskat)abstract
- The effect of acute haemorrhage on the deposition and clearance of fibrin in the rat lung after thrombin-induced intravascular coagulation was investigated. Haemorrhage was followed by less embolization of fibrin to the lungs and delayed elimination from the lungs. As lung tissue fibrinolysis was not diminished, the peripheral and pulmonary circulatory disturbance was probably in itself responsible for the observed effects.
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| 46. |
- Gerdin, Bengt, 1947-, et al.
(författare)
-
Dynamic role of hyaluronan (HYA) in connective tissue activation and inflammation.
- 1997
-
Ingår i: Journal of Internal Medicine. - 0954-6820 .- 1365-2796. ; 242:1, s. 49-55
-
Tidskriftsartikel (refereegranskat)abstract
- An increased tissue accumulation of HYA occurs in several human and experimental inflammatory conditions. Such is the case in sarcoidosis, idiopathic pulmonary fibrosis and farmer's lung in man, and experimental bleomycin-induced lung damage in rats. Graft rejection in man and rats, experimental myocarditis in mice and myocardial infarction in rats follow the same pattern. Increased amounts of HYA also appear in gut luminal perfusion fluid in human inflammatory bowel disease. A transient accumulation of HYA is seen in wound healing, which is more sustained in fetuses. An increased accumulation of water and presentation of ligands for receptors on inflammatory cells are two consequences of the HYA accumulation.
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| 47. |
- Gerdin, Bengt, 1947-, et al.
(författare)
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Effect of alpha-receptor blockade on the rate of fibrin elimination from the rat lung.
- 1980
-
Ingår i: Circulatory shock. - 0092-6213. ; 7:1, s. 93-101
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Tidskriftsartikel (refereegranskat)abstract
- In rats with pharmacologically blocked alpha-receptor sites intravascular coagulation was induced by an intravenous injection of thrombin. The fibrin elimination from the lungs was greatly delayed in rats treated with the alpha-receptor blocking agent phenoxybenzamine one hour before the thrombin injection; whereas, in rats given the same substance 48 hours before this injection, no influence on fibrin elimination was seen. Infusion of albumin counteracted the effect on fibrin elimination in the former rats. A synergistic effect of phenoxybenzamine and the fibrinolysis inhibitor AMCA on the elimination of fibrin from the lungs was found. Circulatory mechanisms seem most reasonably to underlie the effect of phenoxybenzamine on fibrin elimination. No changes in fibrinolysis parameters were observed.
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