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Biomedical subjects

B Holmberg

Publications and source records attributed to B Holmberg.

At least 19 recordsLinked to original sources
PubMed2006

Inadvertent malposition of a transvenous pacing lead in the left ventricle.

We report the case of inadvertent malpositioning of a pacemaker lead in the left ventricle. The lead went through an open foramen ovale from the right to the left atrium and through the mitral valve into the left ventricle. After a review of the literature, we decided to anticoagulate the patient and leave the electrode in place. During a follow-up period of 16 months, there were no clinical complications.

Arrhythmia, Sinus↗
PubMed2006

Minimized weight gain between hemodialysis contributes to a reduced risk of death.

UNLABELLED: The risk of death is higher in dialysis patients compared to age matched healthy subjects, the main reason being cardiovascular. This prospective study investigated if the extent of ultrafiltration was of importance for the outcome. MATERIAL AND METHODS: 88 hemodialysis patients were included and followed prospectively. The outcome was registered in regard to death, acute myocardial infarction or coronary vascular intervention. The extent of ultrafiltration needed at dialysis was calculated as a mean during the observation period as were other variables. The mean extent of ultrafiltration was compared for patients who had survived without end-points (group 1, n=53) versus those who reached any end-point during the period (group 2, n=35). RESULTS: In total, 40% of the patients reached end-point during the observation period. There was no difference at baseline between the groups in regard to age, prevalence of diabetes mellitus or history of previous cardiovascular disease, KT/V, residual renal function ultrafiltration need, C-reactive protein, s-albumin, cholesterol, LDL-cholesterol, HDL-cholesterol, appetite or wellbeing, while triglyceride was lower in group 2 (p=0.035). The observation period for group 1 was at a mean 24.7 months (SD13.1) and for those in group 2 at a mean 13.8 (+/-11.7 months, p<0.001). Patients representing group 1 at 24 and 30 months had less need of ultrafiltration than those in group 2. Thus, the need of ultrafiltration was about 27% lower at 24 months (for 29 persons in group 1: 3.63+/-1.93 weight% versus 4.97+/-1.70 weight% for 9 patients from group 2, p=0.046) and 46% at 30 months (for 18 from group 1: 3.48+/-1.95 versus 6.45+/-1.55 for 3 from group 2, p=0.030). C-reactive protein did not differ significantly between the groups during the period. CONCLUSION: After a prolonged period of 24 months the extent of ultrafiltration need seems to be important for the outcome of the patients. Thereby those with higher need of ultrafiltration had worse prognosis. It seems important to motivate patients to reduce the extent of fluid intake between dialysis to prolong survival.

Adult↗
PubMed2005

Duodenal levodopa infusion monotherapy vs oral polypharmacy in advanced Parkinson disease.

OBJECTIVES: To compare daytime intraduodenal levodopa/carbidopa infusion as monotherapy with individually optimized conventional combination therapies in patients with advanced Parkinson disease (PD) for motor fluctuations and quality of life (QoL). METHODS: Twenty-four patients with motor fluctuations and dyskinesia were studied in a randomized crossover design to compare individualized conventional treatment and intraduodenal infusion of a levodopa/carbidopa gel for 3 + 3 weeks. Video scoring of motor function was assessed by blinded assessors on a global Treatment Response Scale from -3 to 0 to +3 (from severe "off" to "on" to "on" with severe dyskinesia). Patient self-assessment of motor performance and QoL was done using an electronic diary. RESULTS: Median percentage of ratings in a functional "on" interval (-1 to +1) was increased from 81 to 100% by infusion therapy (p < 0.01). This improvement was accompanied by a decrease in "off" state (p < 0.01) and no increase in dyskinesia. Median Unified Parkinson's Disease Rating Scale score decreased from 53 to 35 in favor of infusion (p < 0.05). QoL was improved, using the two instruments: Parkinson's Disease Questionnaire-39 and 15D Quality of Life Instrument (p < 0.01). Adverse events were similar for both treatment strategies. CONCLUSIONS: Continuous intraduodenal infusion of the levodopa/carbidopa enteral gel as monotherapy is safe and clinically superior to a number of individually optimized combinations of conventional oral and subcutaneous medications in patients with motor fluctuations. Intraduodenal infusion of levodopa offers an important alternative in treating patients with advanced Parkinson disease.

Administration, Oral↗
PubMed2005

Safety and efficacy of atorvastatin in patients with severe renal dysfunction.

OBJECTIVE: To investigate the efficacy and safety of a daily dose of 10 mg of atorvastatin in patients with chronic kidney disease (CKD) stages 4 and 5 and a glomerular filtration rate of <30 ml/min. MATERIAL AND METHODS: This was an open, prospective, randomized study. A total of 143 patients were included: 73 were controls and 70 were prescribed 10 mg/day of atorvastatin. As efficacy variables, total cholesterol, low-density lipoprotein (LDL) cholesterol, high-density lipoprotein (HDL) cholesterol and triglyceride levels were determined at the start of the study and at 1, 3, 6, 12, 18, 24, 30 and 36 months. RESULTS: The follow-up period was a mean of 20+/-14.4 months (range 1-36 months) for those on atorvastatin versus 22+/-12.7 months (range 0.5-36 months) for the controls. Compared with baseline values, patients treated with atorvastatin had significantly lower concentrations of total cholesterol at Month 36 (5.8 vs 4.4 mmol/l; -23%; p<0.001), of LDL cholesterol at Month 36 (3.6 vs 2.2 mmol/l; -35%; p<0.001) and of triglycerides at Months 24 (2.5 vs 1.9 mmol/l) and 36 (2.5 vs 1.8 mmol/l). The controls had significantly reduced levels of total cholesterol at Month 36 (p<0.21) and of LDL cholesterol at Months 30 and 36. Compared with the controls, the atorvastatin group had lower levels of total cholesterol and LDL cholesterol at Months 1-30. Fifteen patients (21%) stopped taking their medication as they could not tolerate the side-effects, the most frequent complaints being gastrointestinal discomfort and headache. CONCLUSION: Although the medication caused no severe adverse events, we recommend caution when using atorvastatin for severe CKD patients until further evidence of its safety and efficacy is verified.

Aged↗
PubMed2004

Association between the estrogen receptor beta gene and age of onset of Parkinson's disease.

The purpose of this study was to investigate the potential contribution of genetic variants in the estrogen receptor beta gene to the aetiology of Parkinson's disease (PD). Several lines of evidence from human and animal studies suggest a protective role for estrogen in PD. Recently the estrogen receptor beta subtype was reported to be an important mediator of estrogen actions in the nigrostriatal dopamine system. Two single nucleotide polymorphisms at position 1730 and 1082 in the ER beta gene were genotyped, using pyrosequencing, in 260 patients with PD and 308 controls recruited from the Swedish population. Neither of the two estrogen receptor beta polymorphisms was associated with an increased risk for PD. However, the G allele of the A1730G polymorphism was more frequent in patients with an early age of onset than in patients with a late age of onset of PD (P = 0.006). Patients carrying the GG genotype had an odds ratio of 2.2 for having an early onset of PD compared to non-carriers. In conclusion, our results indicate that genetic variation in the estrogen receptor beta gene may influence the age of onset of PD.

Adult↗
PubMed2001

Cardiovascular reflex testing contributes to clinical evaluation and differential diagnosis of Parkinsonian syndromes.

The differentiation between Parkinson's disease (PD), progressive supranuclear palsy (PSP), and multiple system atrophy (MSA) may be difficult but is important for prognostic and therapeutic purposes. Varying degrees of autonomic failure have been described in PD and MSA, whereas its involvement in PSP remains controversial. The aim of this study was to investigate autonomic function in patients fulfilling strict clinical diagnostic criteria for the disorders above, to evaluate the diagnostic capacity of laboratory autonomic tests. The study group was consecutively recruited among patients referred to a movement disorder unit. Thirty-four patients with PD, 15 patients with PSP, and 47 patients with MSA were compared with 18 healthy age-matched controls. Autonomic tests included analysis of heart rate variability (HRV) in temporal domain, at rest and during forced respiration, as well as blood pressure (BP) changes during 75 degrees head-up tilt. HRV did not differ between groups during quiet breathing but was significantly reduced during forced respiration in MSA (P < 0.01), while PD and PSP groups did not differ from controls. Hypotensive responses during orthostatic provocation were seen in PD (P < 0.01) and MSA (P < 0.001), whereas BP remained stable in most PSP patients, not differing from the healthy control group. On an individual basis, decreased HRV and severe hypotensive responses were seen in MSA patients regardless of age and disease duration, whereas PD patients showed this combination only at high age and long duration. In PSP, only a few cases with decreased HRV and limited hypotensive responses were found. We conclude that cardiovascular reflex tests can supplement the clinical differentiation of Parkinsonian syndromes.

Aged↗
PubMed2001

CSF-neurofilament and levodopa tests combined with discriminant analysis may contribute to the differential diagnosis of Parkinsonian syndromes.

The differentiation between Parkinson's disease (PD), progressive supranuclear palsy (PSP) and multiple system atrophy (MSA) is important for prognostic and therapeutic purposes. In order to evaluate the diagnostic capability of two tests reflecting these items, patients fulfilling strict clinical criteria for PD (n=35), MSA (n=36) and PSP (n=14), were consecutively included. An analysis of neurofilament protein (NFL), a marker of axonal degeneration in the cerebrospinal fluid (CSF) and a levodopa test, recorded with optoelectronic technique were performed. Using discriminant analyses, the test's abilities to predict the clinical PD or non-PD (MSA and PSP) diagnoses were compared. Whereas the CSF-NFL and levodopa tests predicted 79 and 85% correct diagnoses respectively, the combined test predicted 90% correct diagnoses. We conclude that the CSF-NFL and levodopa tests provide detailed information of clinical variables on which the clinical diagnostic criteria are based. As they are pathologically unrelated, the diagnostic precision increases compared to clinical diagnoses when they are combined.

Adult↗
PubMed1998

Mammary tumours in Sprague-Dawley rats after initiation with DMBA followed by exposure to 50 Hz electromagnetic fields in a promotional scheme.

In order to test whether a transient-producing intermittent magnetic field (MF) acts as a promoter in rat mammary tumour development, a study of a 50 Hz sinusoidal MF with flux densities of 0.25 and 0.5 mT was performed on female Sprague-Dawley rats. A single administration of 7 mg of 7,12-dimethyl-benz[a]anthracene (DMBA) was given by gavage to 52-day-old animals. After 1 week, exposure to an intermittent (15 s on/15 s off) transient-associated magnetic field was started. MF exposure was performed for 19 or 21 h per day up to 25 weeks, when the study was terminated. Twice a week a careful examination with palpation for tumours was done. Tumour incidence, the number of tumours per animal, tumour volume and tumour weight were recorded. A total of 70% of MF-exposed animals developed tumours. For animals exposed to DMBA alone the correspondent figure was 71.7%. No statistical differences were seen either for tumour-bearing animals or for the total number of tumours. A slightly larger total tumour weight and tumour volume was seen for animals exposed to 0.25 mT MF. These differences were not statistically significant.

9,10-Dimethyl-1,2-benzanthracene↗
PubMed1998

Increased cerebrospinal fluid levels of neurofilament protein in progressive supranuclear palsy and multiple-system atrophy compared with Parkinson's disease.

More reliable tools are needed for the differentiation of Parkinson's disease (PD) from other parkinsonian disorders. The neurofilament protein (NFL) and the glial fibrillary acidic protein (GFAP) are main structural proteins of axons and fibrillary astroglial cells. By using enzyme-linked immunosorbent assays, these proteins were quantified in the cerebrospinal fluid (CSF) of 49 patients referred to the Department of Neurology for diagnostic consideration or treatment of parkinsonism of different etiologies. All patients were first diagnostically evaluated by strict clinical criteria. The procedure included a neurologic and neuro-ophthalmologic examination as well as computed tomography or magnetic resonance imaging. These were performed independently and in advance of the CSF analysis. A total of 19 patients were diagnosed as having PD, 12 had progressive supranuclear palsy (PSP), and 10 had multiple-system atrophy (MSA). Eight were diagnosed as having other diseases, such as arteriosclerotic parkinsonism and undefined parkinsonian syndromes. The content of NFL was significantly higher both in the PSP group (p < 0.001) and in the MSA group (p < 0.0001) compared with the PD group. The high values of NFL indicate an ongoing neuronal degeneration affecting mainly the axonal compartment in the PSP and MSA groups, whereas there was no difference in glial involvement as measured by GFAP in the PD, PSP, and MSA groups. There was a relation between high CSF levels of NFL in the various patient groups and the occurrence of pyramidal symptoms (p < 0.001), possibly reflecting the axonal damage to the corticospinal tract. Furthermore, mortality at 24-month follow up was associated with high NFL levels (p < 0.01). We conclude that analysis of NFL in CSF may become useful in the differential diagnosis of parkinsonian syndromes.

Adult↗
PubMed1995

The effects of long-term oral administration of ethanol on Sprague-Dawley rats--a condensed report.

For a period of 2 years Sprague-Dawley rats received 3% and 1% ethyl alcohol or an equicaloric amount of glucose in a semisynthetic liquid diet. Thereafter the tumour incidence was recorded. For male rats no neoplastic lesions were observed to be related to ethanol exposure. For females, when individual group comparisons were made, an increase in mammary gland tumours was seen for females receiving the low ethanol containing diet. In some tumour frequency comparisons the opposite, namely a decrease in the rate of incidence, was obtained. The overall information seems to indicate the absence of a carcinogenic activity of ethyl alcohol per se after long-term oral administration. Liver and bile duct injury was seen among males. Inflammatory reactions were seen among males in pancreas and for females in the clitoral gland. Hyperplasia was observed in the thyroid gland in both sexes and in the adrenal glands among females. Peripheral nerve degeneration was common in both sexes.

Animals↗
PubMed1995

Exposure to extremely low frequency electromagnetic fields and the risk of malignant diseases--an evaluation of epidemiological and experimental findings.

Epidemiological and experimental studies concerning extremely low frequency electromagnetic field exposure and malignant diseases published up to 1 July 1994 were evaluated to assess the possible carcinogenicity of electromagnetic fields and the scientific basis for environmental and occupational standard setting. We concluded that there are possible associations between (i) an increased risk of leukaemia in children and the existence of, or distance to, power lines in the vicinity of their residence, (ii) an increased risk of chronic lymphatic leukaemia and occupational exposure to low frequency electromagnetic fields and (iii) an increased risk of breast cancer, malignant melanoma of the skin, nervous system tumours, non-Hodgkin lymphoma, acute lymphatic leukaemia or acute myeloid leukaemia and certain occupations. There is no scientific basis for occupational or environmental standard setting for low frequency electric or magnetic fields.

Adult↗
PubMed1995

Magnetic fields and cancer: animal and cellular evidence--an overview.

A few animal studies on the possible carcinogenic effect of magnetic fields have been published. They have been designed to reveal a possible tumor promotion obtained by applying continuous or pulsed alternating fields at flux densities varying between 0.5 microT and 30 mT on mice or rats initiated with different initiators. One study with 2 mT applied on DMBA-initiated mice may suggest a copromotive effect together with the promoter TPA. Another study on rats suggests an inhibitory effect by a magnetic field on rat liver foci formation, induced with DENA. Cell studies show that magnetic fields at some frequencies, amplitudes, and wave forms interact with biological systems. Thus effects have been seen, e.g., on enzymes related to growth regulation, on calcium balance in the cell, on gene expression, and on pineal metabolism and its excretion of the oncostatic melatonin. Cellular and physiologic studies thus suggest effects that may be related to cell multiplication and tumor promotion.

Animals↗
PubMed1994

Intermittent 50 Hz magnetic field and skin tumor promotion in SENCAR mice.

A number of epidemiological studies have indicated association between exposure to extremely low frequency electromagnetic fields and a variety of cancers, including leukaemia and brain tumours among residentially exposed children and among occupationally exposed adults. In order to test if intermittent magnetic fields (MF) act as a tumour promoter, a long-term skin carcinogenicity study of 50 Hz sinusoidal MF with flux densities of 50 muT and 0.5 mT, continuous as well as with an intermittence of 15 s on/off, was performed. Female SENCAR mice were divided into eight groups of 50 animals in each and treated according to an initiation- promotion scheme. 7,12-dimethylbenz[a] anthracene (DMBA) in acetone was applied to the dorsal skin at a subcarcinogenic dose, as an initiator and exposure to MF was performed for 19-21 h/day during 104 weeks starting 1 week after the initiator treatment. The phorbol ester 12-O-tetradecanoylphorbol-13-acetate (TPA) was used as a positive control for skin tumour promoting activity. Two animals from each group were assigned for skin hyperplasia analysis at 2, 6, 12, 18 and 21 months. The animals were observed daily. The appearance of skin lesions and neoplasms were carefully followed and histopathological diagnosis was made for all neoplasms present at death. The experiment was terminated after 105 weeks. DMBA-treatment alone yielded altogether two skin tumours in two tumour-bearing animals and the animals exposed to acetone alone had one skin tumour. The animals exposed to continuous fields showed no skin tumour. Five animals exposed to 0.5 mT on/off had a total of 13 skin tumours and in the group exposed to 50 microT on/off four animals had a total of four skin tumours. The on/off exposed groups differed significantly from the continuously exposed groups (P = 0.014) but the difference between the on/off exposure groups and the DMBA group was not statistically significant when tumour-bearing animals and cumulated skin tumours were compared. There was a statistically significant dose trend (P = 0.045) with flux density and Tesla-h for intermittent MF exposure for cumulated skin tumours per tumour-bearing animals. The epithelial thickness of DMBA + MF-treated animals was of the same magnitude as for DMBA-treated animals indicating that, in the case of a promoting effect being present, another mechanism than one involving sustained hyperplasia may be involved.

9,10-Dimethyl-1,2-benzanthracene↗