| 1. |
- Feet, B A, et al.
(författare)
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Cerebral excitatory amino acids and Na+,K+-ATPase activity during resuscitation of severely hypoxic newborn piglets
- 1998
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Ingår i: Acta Pædiatrica. - : Wiley. - 1651-2227 .- 0803-5253. ; 87:8, s. 889-895
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Tidskriftsartikel (refereegranskat)abstract
- We tested the hypothesis that early brain recovery in hypoxic newborn piglets is improved by resuscitating with an O2 supply close to the minimum level required by the newborn piglet brain. Severely hypoxic 2-5-d-old anaesthetized piglets were randomly divided into three resuscitation groups: hypoxaemic (n = 8), 21% O2 (n = 8), and 100% O2 groups (n = 8). The hypoxaemic group was mechanically ventilated with 12-18% O2 adjusted to achieve a cerebral venous O2 saturation of 17-23% (baseline; 45 +/- 1%, mean +/- SEM). During the 2h resuscitation period, extracellular aspartate and glutamate concentrations in the cerebral striatum were higher during hypoxaemic resuscitation (p = 0.044 and p = 0.055, respectively) than during resuscitation with 21% O2 or 100% O2, suggesting an unfavourable accumulation of potent excitotoxins during hypoxaemic resuscitation. The cell membrane Na+,K+-ATPase activity of cerebral cortical tissue after 2 h resuscitation was similar in the three groups (p = 0.30). In conclusion, hypoxaemic resuscitation did not normalize early cerebral metabolic recovery as efficiently as resuscitation with 21% O2 or 100% O2. Resuscitation with 21% O2 was as efficient as resuscitation with 100% O2 in this newborn piglet hypoxia model.
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| 2. |
- Feet, B A, et al.
(författare)
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Early cerebral metabolic and electrophysiological recovery during controlled hypoxemic resuscitation in piglets
- 1998
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Ingår i: Journal of Applied Physiology. - 1522-1601. ; 84:4, s. 1208-1216
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Tidskriftsartikel (refereegranskat)abstract
- We tested the hypothesis that controlled hypoxemic resuscitation improves early cerebral metabolic and electrophysiological recovery in hypoxic newborn piglets. Severely hypoxic anesthetized piglets were randomly divided into three resuscitation groups: hypoxemic, 21% O2, and 100% O2 groups (8 in each group). The hypoxemic group was mechanically ventilated with 12-18% O2 adjusted to achieve a cerebral venous O2 saturation of 17-23% (baseline; 45 +/- 1%). Base excess (BE) reached -22 +/- 1 mM at the end of hypoxia. During a 2-h resuscitation period, no significant differences in time to recovery of electroencephalography (EEG), quality of EEG at recovery, or extracellular hypoxanthine concentrations in the cerebral cortex and striatum were found among the groups. BE and plasma hypoxanthine, however, normalized significantly more slowly during controlled hypoxemic resuscitation than during resuscitation with 21 or 100% O2. We conclude that early brain recovery during controlled hypoxemic resuscitation was as efficient as, but not superior to, recovery during resuscitation with 21 or 100% O2. The systemic metabolic recovery from hypoxia, however, was delayed during controlled hypoxemic resuscitation.
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| 3. |
- Hellström, Anna-Lena, 1946, et al.
(författare)
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Micturition habits and incontinence at age 17--reinvestigation ofa cohort studied at age 7.
- 1995
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Ingår i: British journal of urology. - 0007-1331. ; 76:2, s. 231-4
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To study the epidemiology of micturition disturbances in teenagers. SUBJECTS AND METHODS: A subsample of 1034 teenagers previously evaluated at age 7 years was reinvestigated 10 years later. A postal questionnaire was used and a response rate of 71% (736) obtained. Those who reported bladder symptoms were contacted by telephone for a detailed history concerning imperative urge, daytime incontinence, emptying difficulties and bedwetting. RESULTS: There was a general decrease in the frequency and intensity of symptoms from 7 to 17 years of age. At age 17 at least one symptom was reported by 5.9% of the girls and 0.9% of the boys. Overall the symptoms were regarded as mild or moderate. CONCLUSION: At age 17 years, micturition disturbances were reported infrequently and few subjects wanted medical help.
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| 4. |
- Hellström, Lena
(författare)
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Studies on catecholamine function in human fat cells
- 1996
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Human adipose tissue is a heterogeneous organ as regards metabolism. The effects of catecholamines, the main lipolytic hormones in man vary considerably in different regions. Fat cell lipolysis also changes in a number of physiological and pathophysiological states. The aim of the present study was to focus on two factors of importance for the action of catecholamines on lipolysis in vitro - namely, the influence of heredity and catabolism. The well-known enhancement in the number of beta-adrenoreceptors (beta-AR) in abdominal fat as compared to gluteal fat, may be explained by an increased transcription of the genes coding for beta1- and beta2-AR in the abdominal region. Lipolytic sensitivity to isoprenaline a non-selective beta-AR agonist, varied 106-fold and showed a bimodal distribution in 65 healthy subjects of normal weight. This suggests two populations, one with a high and one with a low isoprenaline sensitivity. Subjects with a low sensitivity were resistant to the lipolytic action of noradrenaline and the beta2-AR agonist terbutaline. They further displayed a 50% reduction in the in vivo lipolytic response to exercise and mental stress, despite a 50% increase in plasma noradrenaline and a 3-fold increase in plasma adrenaline levels. The lipolytic catecholamine resistance was explained by a reduction in the number of beta2-AR, in turn the result of decreased transcription of the beta2-gene. Another defect in lipolysis activation was found in healthy subjects of normal weight with a heredity for obesity. They showed a 50% reduction in the maximum lipolytic response to catecholamines and also when lipolysis was stimulated with other drugs acting on both proximal and distal steps in the lipolytic cascade. This may have been due to a decrease in the activity of hormone-sensitive lipase (HSL), the enzyme that regulates the last and rate-limiting step in lipolysis. In obese subjects during four weeks of treatment with a very low-calorie diet (VLCD) lipolysis increased, mainly because of an increase in the basal lipolysis rate, whereas the signalling through the lipolytic cascade remained unchanged on the adrenoceptor and the post- receptor levels. This state was associated with resistance to the antilipolytic and the lipogenic effects of insulin. There was a marked interindividual difference in weight reduction, in spite of satisfactory compliance by all subjects. The sensitivity to the alpha2-adrenoceptor (a2-AR) was thought to be of value for predicting the rate of weight loss during VLCD. In another study of patients with thyrotoxicosis, another catabolic state with high energy expenditure, an increase in catecholamine action was found as regards both lipolytic sensitivity aDd responsiveness. The former was due to a selective upregulation of the number of beta2-AR and the latter was explained by a distal change in the lipolytic chain at the level of the protein- kinase A-HSL complex. In summary, this study has demonstrated that the regional variation in the number of human beta1- and beta2-AR in adipose tissue is regulated by transcription. Lipolytic resistance to catecholamines may occur in otherwise healthy subjects because of a decreased expression of beta2-AR on both the protein and the mRNA levels or to a decreased activity of HSL. Both these lipolytic abnormalities are observed in the so-called metabolic syndrome, which may mean that the defects are early disturbances in the development of this disorder. Finally, lipolysis adapts to various catabolic states by different mechanisms. Lipid mobilization during caloric restriction is mainly due to an increased basal lipolysis rate and resistance to insulin action, whereas in thyrotoxicosis it is accompanied by an increased catecholamine sensitivity and response due to increased expression of beta2-AR and increased function of HSL. Constitutional variations in a2-AR function may predict weight loss during caloric restriction.
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| 5. |
- Hellström-Westas, Lena, et al.
(författare)
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Low risk of seizure recurrence after early withdrawal of antiepileptic treatment in the neonatal period
- 1995
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Ingår i: Archives of disease in childhood. Fetal and neonatal edition. - 1359-2998. ; 72:2, s. 97-101
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Tidskriftsartikel (refereegranskat)abstract
- The risk of seizure recurrence within the first year of life was evaluated in infants with neonatal seizures diagnosed with a combination of clinical signs, amplitude-integrated electroencephalogram (EEG) monitoring, and standard EEG. Fifty eight of 283 (4.5%) neonates in tertiary level neonatal intensive care had seizures. The mortality in the infants with neonatal seizures was 36.2%. In 31 surviving infants antiepileptic treatment was discontinued after one to 65 days (median 4.5 days). Three infants received no antiepileptic treatment, two continued with prophylactic antiepileptic treatment. Seizure recurrence was present in only three cases (8.3%)--one infant receiving prophylaxis, one treated for 65 days, and in one infant treated for six days. Owing to the small number of infants with seizure recurrence, no clinical features could be specifically related to an increased risk of subsequent seizures. When administering antiepileptic treatment, one aim was to abolish both clinical and electrographical seizures. Another goal was to minimise the duration of treatment and to keep the treatment as short as possible. It is suggested that treating neonatal seizures in this way may not only reduce the risk of subsequent seizure recurrence, but may also minimise unnecessary non-specific prophylactic treatment for epilepsy.
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| 6. |
- Hellström-Westas, Lena, et al.
(författare)
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Predictive value of early continuous amplitude integrated EEG recordings on outcome after severe birth asphyxia in full term infants
- 1995
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Ingår i: Archives of disease in childhood. Fetal and neonatal edition. - 1359-2998. ; 72:1, s. 34-38
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Tidskriftsartikel (refereegranskat)abstract
- The background pattern in single channel amplitude integrated EEG recordings (aEEG) was recorded in 47 infants within the first six hours after birth to see if this could predict outcome after birth asphyxia. The aEEG background pattern during the first six hours of life was continuous and of normal voltage in 26 infants. All these infants survived; 25 were healthy, one had delayed psychomotor development. A continuous but extremely low voltage pattern was present in two infants, both of whom survived with severe handicap. Five infants had flat (mainly isoelectric) tracings during the first six hours of life; four died in the neonatal period, and one survived with severe neurological handicap. Burst-suppression pattern was identified in 14 infants, of whom five died, six survived with severe handicap, and three were healthy at follow up. The type of background pattern recorded within the first six postnatal hours in the aEEG tracings predicted outcome correctly in 43 of 47 (91.5%) infants. Use of aEEG monitoring can predict outcome, with a high degree of accuracy, after birth asphyxia, within the first six hours after birth. The predictive value of a suppression-burst pattern was, however, somewhat lower than the other background patterns. The aEEG seems to be a feasible technique for identifying infants at high risk of subsequent brain damage who might benefit from interventionist treatment after asphyxia.
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| 7. |
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| 8. |
- Hjälmås, Kelm, 1933, et al.
(författare)
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Long-term treatment with desmopressin in children with primary monosymptomatic nocturnal enuresis: an open multicentre study. Swedish Enuresis Trial (SWEET) Group.
- 1998
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Ingår i: British journal of urology. - 0007-1331. ; 82:5, s. 704-9
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To study the long-term efficacy and safety of desmopressin treatment in children with primary monosymptomatic nocturnal enuresis. PATIENTS AND METHODS: Children (aged 6-12 years) with nocturnal enuresis were recruited into an open multicentre trial. All children underwent an observation period of 4 weeks before starting a 6-week dose-titration period with desmopressin. If the number of wet nights decreased by more than half during medication, they began long-term treatment on 20-40 microg desmopressin. To test for cure and avoid overtreatment, the medication was interrupted for one week every third month. RESULTS: Of the 399 children forming the intention-to-treat cohort, 245 halved their number of wet nights and started long-term treatment. During the periods off medication, 77 children were dry and at the end of the study another 73 (still on medication) reduced the number of wet nights to < or =10% of that during the observation period. A further 51 children halved the number of wet nights compared with the observation period. No serious adverse events occurred. CONCLUSION: Long-term treatment with nasal desmopressin at a main dose of 40 microg is an effective and safe treatment for monosymptomatic nocturnal enuresis.
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| 9. |
- Holmdahl, Gundela, 1956, et al.
(författare)
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Four-hour voiding observation in healthy infants.
- 1996
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Ingår i: The Journal of urology. - 0022-5347. ; 156:5, s. 1809-12
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: We present the 4-hour voiding observation as a method for basic assessment of bladder function in infants and nontoilet trained children. MATERIALS AND METHODS: Voiding pattern, including number of voidings, voided volume, bladder capacity and residual urine for 4 hours, was determined noninvasively in 43 healthy infants. RESULTS: The infants voided an average of 1 time per hour but with great variability. Bladder capacity increased with age according to the formula, 38 + 2.5 x age (months). Mean residual urine plus or minus standard deviation was 4.6 +/- 3.0 ml. In all infants residual volume was less than 5 ml. at least once during observation. CONCLUSIONS: The 4-hour voiding observation is an easy noninvasive method of characterizing the voiding pattern, focusing especially on emptying difficulties, in infants and nontoilet trained children.
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| 10. |
- Holmdahl, Gundela, 1956, et al.
(författare)
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Four-hour voiding observation in young boys with posterior urethral valves.
- 1998
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Ingår i: The Journal of urology. - 0022-5347. ; 160:4, s. 1477-81
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: We evaluated 4-hour voiding observation as a method of basic assessment of bladder dysfunction in young boys with posterior urethral valves. MATERIALS AND METHODS: Voiding pattern, including number of voids, voided and residual urine volume, and bladder capacity, was determined noninvasively in 24 boys younger than 4 years with posterior urethral valves and compared to that of healthy age matched controls. Results were then compared to those of standard cystometry. RESULTS: The number of voids was higher, voided volume was smaller and residual urine volume was higher in the posterior urethral valve group. There was no difference in voiding pattern before and after removal of the anatomical obstruction. Voided and residual urine volume, and bladder capacity were higher on standard cystometry than on voiding observation. CONCLUSIONS: Four-hour voiding observation is an easy noninvasive method that focuses on emptying difficulties and clearly detects differences in voiding patterns between boys with posterior urethral valves and healthy, nontoilet trained children. We recommend the method as a complement to standard cystometry for the diagnosis and followup of bladder dysfunction in young boys with posterior urethral valves to identify the need for treatment.
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| 11. |
- Kruse, Sonja, 1949, et al.
(författare)
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Daytime bladder dysfunction in therapy-resistant nocturnal enuresis. A pilot study in urotherapy.
- 1999
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Ingår i: Scandinavian journal of urology and nephrology. - 0036-5599. ; 33:1, s. 49-52
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: Bedwetting is the most common form of incontinence in children. Research in recent years suggests that there can be many different factors responsible for the problem of bed wetting, one of which is bladder dysfunction. The aim of this pilot study was to identify infrequent voiding ("hold pattern") and to investigate whether increasing the number of micturitions during the day can improve the nocturnal enuresis in children with several failed treatment attempts. MATERIAL AND METHODS: Twenty-two children with severe bedwetting were treated. Twelve of them had had no other treatment than increasing the number of regular micturitions during the day, while 10 patients had had enuresis alarm or desmopressin added. RESULTS: The number of wet nights after 1 month of treatment decreased in all children and the improvement continued in most of the children during the follow-up period. CONCLUSIONS: This study suggests that bladder training by increasing the number of micturitions during the day can be valuable in the treatment of nocturnal enuresis.
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| 12. |
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| 13. |
- Sillén, Ulla, 1946, et al.
(författare)
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Comparison of urodynamic and free voiding pattern in infants with dilating reflux.
- 1999
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Ingår i: The Journal of urology. - 0022-5347. ; 161:6, s. 1928-33
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: We compared simultaneous investigations of free voiding pattern and urodynamic assessment in infants with dilating reflux to obtain further information on previously suspected bladder dysfunction based on abnormal urodynamic findings. MATERIAL AND METHODS: A total of 33 male and 8 female infants with dilating reflux were included in the study. Free voiding pattern was determined by 4-hour voiding observation compared to previously described voiding pattern studies of healthy infants. Simultaneous invasive urodynamic assessments were performed. RESULTS: The patients were grouped according to urodynamic bladder capacity. Half of the male patients had low bladder capacity with high voiding pressure levels (hypercontractile) and the other half had either normal or high capacity bladders. The low capacity group had frequent small voids and a high rate of interrupted voiding, the high capacity group had infrequent voids of high volumes with high residual urine, and the pattern of the normal capacity group differed only from that of healthy infants by an increase in residual urine. All female infants had the typical characteristics of high capacity bladder on free voiding and urodynamic assessments. CONCLUSIONS: Infants with abnormal invasive urodynamic investigations, including those with a small capacity hypercontractile bladder and those with a high capacity bladder, could be identified on free voiding studies, indicating that an abnormal urodynamic pattern represents bladder dysfunction.
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| 14. |
- Sillén, Ulla, 1946, et al.
(författare)
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The voiding pattern in infants with dilating reflux.
- 1999
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Ingår i: BJU international. - 1464-4096. ; 83:1, s. 83-7
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To determine whether the voiding pattern in infants with dilating vesico-ureteric reflux (VUR) differs from that in healthy infants, thus supporting the existence of bladder dysfunction in infants with VUR. PATIENTS AND METHODS: Forty-one infants (33 boys and eight girls) with dilating VUR (grades 3-5) were studied using a noninvasive 4-hourly voiding record described previously in studies of the voiding pattern of healthy infants, and the results compared with those obtained from healthy infants of similar age. RESULTS: The voiding pattern in the boys with VUR was characterized by small frequent voids and interrupted voids in more patients (36%) than in healthy boys (15%). Conversely, the girls with VUR were infrequent voiders of relatively high volumes. Residual urine was significantly increased in both boys and girls, as was bladder capacity, although not significantly. CONCLUSIONS: The free voiding pattern in infants with dilating reflux differs from that seen in healthy infants of comparable age. The characteristics for boys and girls differed but was in accordance with that seen in invasive urodynamic studies, suggesting refluxing infants to have a bladder dysfunction.
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| 15. |
- Svenningsen, N W, et al.
(författare)
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OSCILLO-oscillating air mattress in neonatal care of very preterm babies
- 1995
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Ingår i: Technology and Health Care. - 0928-7329. ; 3:1, s. 43-46
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Tidskriftsartikel (refereegranskat)abstract
- In this pilot study a new device for respiratory stimulation with undulating oscillations and high frequency vibrations via an air mattress was tested as an additional therapy in 12 preterm infants with recurrent apnoeic episodes. The mean birthweight of the study population was 1760 g and gestational age 31.1 weeks. it was shown that an oscillating air mattress is an effective additional mode of treatment for apnoeic episodes in preterm infants. There was a clear reduction in rate of apnoeas in all 12 infants being transitory in 2 and more persistent in 10 infants. Besides restlessness in a few cases no side effects were observed. Whether this mode of treatment could lessen the need for drug medication with xanthines will require a larger randomized investigation.
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| 16. |
- Toet, M C, et al.
(författare)
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Amplitude integrated EEG 3 and 6 hours after birth in full term neonates with hypoxic-ischaemic encephalopathy
- 1999
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Ingår i: Archives of disease in childhood. Fetal and neonatal edition. - 1359-2998. ; 81:1, s. 19-23
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Tidskriftsartikel (refereegranskat)abstract
- AIM: To assess the prognostic value of amplitude integrated EEG (aEEG) 3 and 6 hours after birth. METHODS: Seventy three term, asphyxiated infants were studied (from two different centres), using the Cerebral Function Monitor (CFM Lectromed). The different aEEG tracings were compared using pattern recognition (flat tracing mainly isoelectric (FT); continuous extremely low voltage (CLV); burst-suppression (BS); discontinuous normal voltage (DNV); continuous normal voltage (CNV)) with subsequent outcome. RESULTS: Sixty eight infants were followed up for more than 12 months (range 12 months to 6 years).Twenty one out of 68 infants (31%) showed a change in pattern from 3 to 6 hours, but this was only significant in five cases (24%). In three this changed from BS to CNV with a normal outcome. One infant showed a change in pattern from CNV to FT and had a major handicap at follow up. Another infant showed a change in pattern from DNV to BS, and developed a major handicap at follow up. The other 16 infants did not have any significant changes in pattern: 11 infants had CLV, BS, or FT at 3 and 6 hours and died (n = 9) in the neonatal period or developed a major handicap (n = 2). Five infants had a CNV or DNV pattern at 3 and 6 hours, with a normal outcome. The sensitivity and specificity of BS, together with FT and CLV, for poor outcome at 3 hours was 0.85 and 0.77, respectively; at 6 hours 0.91 and 0.86, respectively. The positive predictive value (PPV) was 78% and the negative predictive value (NPV) 84% 3 hours after birth. At 6 hours the PPV was 86% and the NPV was 91%. CONCLUSION: aEEG could be very useful for selecting those infants who might benefit from intervention after birth asphyxia.
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