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- Lindvall, O, et al.
(författare)
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Human fetal dopamine neurons grafted into the striatum in two patients with severe Parkinson's disease. A detailed account of methodology and a 6-month follow-up
- 1989
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Ingår i: Archives of Neurology. - : American Medical Association (AMA). - 0003-9942. ; 46:6, s. 31-615
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Tidskriftsartikel (refereegranskat)abstract
- By using stereotaxic surgical techniques, ventral mesencephalic tissues from aborted human fetuses of 8 to 10 weeks' gestational age were implanted unilaterally into the striata in two patients with advanced Parkinson's disease. The patients were treated with a cyclosporine, azathioprine, and steroid regimen to minimize the risk for graft rejection. They were examined for 6 months preoperatively and 6 months postoperatively and continued to receive the same doses of antiparkinsonian medication. There were no significant postoperative complications. No major therapeutic effect from the operation was observed. However, in the clinical tests, both patients showed small but significant increases of movement speed for repeated pronation-supination, fist clenching, and foot lifting. The rate of walking also increased in the one patient tested. For both patients, there was an initial worsening postoperatively, followed by improvement vs preoperative performance at 1 to 3 months. Both patients also showed significant improvement in the magnitude of response to a single dose of levodopa (L-dopa), but there was no increase in the duration of drug action. The motor readiness potential increased in both patients postoperatively, primarily over the operated hemisphere. Neurophysiological measurements also showed a more rapid performance of simple and complex arm and hand movements on the side contralateral to transplantation in one patient at 5 months postoperatively. Positron emission tomography demonstrated no increased uptake of 6-L-(18F)-fluorodopa in the transplanted striatum at 5 and 6 months. Taken together, these results suggest that the fetal nigral implants may have provided a modest improvement in motor function, consistent with the presence of small surviving grafts. Although our results support further scientific experimentation with transplantation in Parkinson's disease, widespread clinical trials with this procedure are probably not warranted at this time.
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- Löfkvist, U-B, et al.
(författare)
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Individually adapted lightweight walking aids with moulded handles for patients with severely deforming chronic arthritis
- 1988
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Ingår i: Scandinavian Journal of Rheumatology. - 1502-7732. ; 17:3, s. 167-173
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Tidskriftsartikel (refereegranskat)abstract
- Patients with severely deforming rheumatoid arthritis and impaired function of the upper extremity are often unable to use conventional walking aids. This report describes 42 such patients who were equipped with altogether 75 individually manufactured, lightweight walking aids (12 crutches, 12 forearm-crutches, 39 crutch-sticks and 12 sticks). A plaster cast of the patient's grip as well as analysis of the integrated function of the shoulder-elbow-wrist was used when preparing the walking aid. It was thereby possible to produce suitable walking aids for all but one patient. At follow-up after 12-18 months, of use, most patients belonging to functional classes II and III were satisfied with their walking aid(s) and 22 considered it/them indispensable. However, in 4 patients, progressive disease with increased disease activity/deteriorating hand function and in 3 patients increasing shoulder pain reduced their usability. Lack of motivation was one reason for low use intensity. Follow-up demonstrated that most patients were able to use these walking aids without detectable negative effects on the upper extremity. The durability of the walking aid was satisfactory. Thus an individually moulded handle on an adapted lightweight walking aid is important helping patients with severely deforming arthritis to maintain independent ambulation, and should be made more widely obtainable.
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