Biomedical subjects
Publications and source records attributed to A Bjelle.
Ankylosis of the cricoarytenoid joints due to rheumatoid arthritis can cause severe laryngeal obstruction. With a mobilization and laterofixation procedure, five of six patients were successfully operated upon. Documented improvement of breathing was achieved and the voice function was acceptable after decannulation.
Different methods of measuring whole blood viscosity using a couette rotational viscometer were compared to establish its use in clinical rheumatological practice. The relationship between blood viscosity and hematocrit was approximately exponential and no significant differences in the slopes were found between healthy controls and rheumatoid arthritis patients. Correction of native blood viscosity to a standard hematocrit of 40% by extrapolation from a standard regression curve, established by concentration/dilution of samples from healthy persons to correct for hematocrit differences and at shear rate 92s-1, was the best method for differentiating between viscosities of patients and controls. It was also the least laborious method, requiring the smallest amounts of blood and having the lowest method error. Native blood viscosity, corrected blood viscosity, plasma viscosity and red cell aggregation were all significantly higher and hematocrit significantly lower in rheumatoid arthritis patients than in controls.
Rheumatic diseases affect individuals of all ages. Both incidence and prevalence vary between age groups, and the diagnosis and management of the same rheumatic disease may be very different at the various ages. It is thus important to recognize the spectrum of rheumatic disorders in age-specific groups. The functional decline of cells, tissues and organs does not occur at the same rate in all individuals. This results in an increased variation with aging. It has important clinical consequences in the diagnosis of disease in the elderly with risk of both underdiagnosis and overdiagnosis. The increasing number of elderly, the high prevalence and the specific diagnostic and therapeutic problems of rheumatic disorders in the elderly call for some rheumatologists to focus an interest in geriatric rheumatology.
The effects of NSAIDs on glycosaminoglycan (GAG) metabolism in vitro were studied in isolated chondrocytes from the weight-bearing cartilage of the hindleg knees of five mature rabbits separately. After confluence, secondary cultures were incubated for three days with six different NSAIDs at various concentrations: diclofenac sodium and indomethacin (0.4-50 micrograms/ml), piroxicam, naproxen and ibuprofen (4-100 micrograms/ml) and salicylic acid (8-1000 micrograms/ml). All NSAIDs significantly inhibited total 35S uptake in GAGs both in matrix and in medium in high concentrations. At low concentrations none of the NSAIDs significantly influenced the chondrocyte metabolism of GAG. The NSAID influence on keratan sulphate metabolism was variable.
Morphological and biochemical studies of articular cartilage were performed in 6 members of 3 families with hereditary pyrophosphate arthropathy. Evidence of metabolic disturbance of cartilage matrix was obtained from light and electron microscopic findings and by the content and composition of glycosaminoglycans.
Rheumatological diagnosis encountered at 3 levels of the health care system primary care, district hospital and specialized centers, were registered. The prevalence of rheumatic disorders was calculated from a population survey. Back complaints were the predominant diagnosis of primary care physicians, while inflammatory diseases were the major diagnostic group seen in specialized rheumatology centers. Among in-patients at the district hospital level, back disorders and inflammatory diseases each constituted 1/2 of cases. The utilization of primary care for patients over 65 yr of age decreased for back disorders but was higher for all other types of rheumatic disorders. Young and middle aged patients were seen more frequently by specialists than older patients. Awareness of the high frequency of noninflammatory rheumatic disorders in the population and at all levels of care is important in the planning of health services for the rheumatic disorders.
In 1973 rheumatology was reorganized in northern Sweden and a new center was developed to serve a county of 240,000 inhabitants. The results of this development from 1973 to 1977 are reported. Although the number of rheumatic disease beds available was slightly reduced an increased staff was able to reduce the average duration of hospital stay from 42 to 15 d. This was true for all diagnostic groups, both for conventional hospital wards and a comprehensive day-ward center. Initially, rheumatoid arthritis (RA) had the highest priority and the number of patients with this diagnosis increased. However, after 3 yr RA was diagnosed in only 12% of new out-patients and other rheumatic disorders became more frequent among both out- and in-patients. New patients were referred almost equally from primary care and other hospital departments. Although only 20% of patients came with a provisional diagnosis, half of these were changed after examination by the rheumatology department. An increased demand for diagnostic services and a rapidly changing diagnostic pattern are 2 important factors to be considered in the planning of any new rheumatology center.