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Biomedical subjects

B Lilja

Publications and source records attributed to B Lilja.

At least 19 recordsLinked to original sources
PubMed1999

How to interpret differing cerebral blood flow patterns estimated with 99Tcm-HMPAO and 99Tcm-ECD SPET in a healthy population.

Two radiopharmaceuticals, 99Tcm-hexamethyl propylene amine oxime (99Tcm-HMPAO) and 99Tcm-ethyl cysteinate dimer (99Tcm-ECD), are currently used to determine cerebral blood flow. 99Tcm-ECD is, by virtue of its greater stability, superseding 99Tcm-HMPAO for routine examinations. Since the clinical assessment of 99Tcm-ECD images is usually based on experience with 99Tcm-HMPAO, we used both radiopharmaceuticals to compare regional cerebral blood flow in the same individuals. Eleven healthy subjects aged 67.1 +/- 6.3 years (mean +/- S.D.) underwent 99Tcm-ECD followed by 99Tcm-HMPAO single photon emission tomography. Cerebral blood flow was quantified in cortical and central regions of interest (basal ganglia, ventricles, white matter) in relation to cerebellar uptake. The intra-subject comparison of cerebral blood flow in the cortical areas revealed higher levels of perfusion in the posterior parietal, parieto-occipital and temporo-occipital areas using 99Tcm-ECD. In contrast to the cortical areas, cerebral blood flow in the central areas was greater using 99Tcm-HMPAO, especially in the centrum semiovale, basal ganglia, frontal white matter and frontal horns. This difference in cerebral blood flow when imaging healthy individuals with 99Tcm-ECD and 99Tcm-HMPAO should be taken into account in clinical practice when changing from one radiopharmaceutical to the other.

Aged↗
PubMed1999

Orthostatic hypotension in Alzheimer's disease: result or cause of brain dysfunction?

In Alzheimer's disease (AD), an association was found between autonomic dysfunction and frontal hypoperfusion in brain during orthostatic testing. To ascertain whether frontal hypoperfusion is dependent on longitudinal effects of hemodynamic disturbances, or contributes to them, we studied the relationship between the presence of orthostatic hypotension (OH) and resting cerebral blood flow (CBF) in late stages of AD. Twelve women with senile dementia of Alzheimer type (SDAT), and 15 non-demented women (mean age 82.6 years, SD 3.8 vs 81.8 years, SD 3.5) were examined with the orthostatic test. Four of 12 patients with SDAT, and 9 controls had OH (defined as systolic blood pressure fall > or = 20 mmHg). CBF was determined under resting conditions using 600 Mbq 99mTc HMPAO single photon emission computerized tomography (SPECT), and quantified in cortical areas in relation to cerebellum. In patients with SDAT and OH, CBF was lower in frontal and parieto-frontal cortical areas than in SDAT patients without OH. The former group was younger and had a shorter dementia duration. No significant differences in CBF were observed between controls with vs without OH. No differences in SDAT patients with or without OH were observed in the Berger dementia scale or Katz' ADL index. No difference in incidence of symptoms related to autonomic disturbances (diarrhea, obstipation, dysphagia, vertigo) was observed in either the SDAT or control group with regard to OH presence. We conclude that during the course of AD, OH can contribute to frontal brain changes and may exacerbate the disease. The further involvement of frontal dysfunction in aggravating blood pressure dysregulation in the elderly is discussed.

Aged↗
PubMed1998

A prospective study of orthostatic blood pressure in diabetic patients.

To clarify whether orthostatic blood pressure is affected by the type of diabetes, cardiac autonomic neuropathy, and the duration of diabetes, orthostatic blood pressure (passive 90 degrees tilt) was evaluated in 102 patients with insulin dependent diabetes mellitus (IDDM), 51 patients with non-insulin dependent diabetes mellitus (NIDDM), and in 238 control subjects in a first study followed up after 8 to 17 years. The heart rate reaction during deep breathing (E/I ratio) and to tilt (acceleration and brake indices) assessed cardiac autonomic function. In the first study, the lowest systolic blood pressure (LSBP) and the lowest diastolic blood pressure (LDBP) after tilt were significantly lower in IDDM patients compared with NIDDM patients (p < 0.001 for LSBP and p < 0.05 for LDBP) and controls (p < 0.001). LDBP was, however, also significantly lower (p < 0.05) in NIDDM patients than in controls. Hence, although most severe in IDDM, LDBP was disturbed in both types of diabetes. In IDDM, a low E/I ratio was associated with disturbed orthostatic blood pressure. At follow-up examinations, orthostatic blood pressure deteriorated in NIDDM but not in IDDM patients. In conclusion, LSBP and LDBP were impaired in IDDM patients compared with NIDDM and control subjects; however, LDBP was also impaired in NIDDM patients compared with controls. When the duration of diabetes increased, orthostatic blood pressure deteriorated in NIDDM but not in IDDM patients.

Adult↗
PubMed1998

Desmopressin in the treatment of severe nocturnal enuresis in adolescents--a 7-year follow-up study.

OBJECTIVES: To evaluate the role of long-term oral desmopressin (over a 7-year follow-up) in refractory enuretics, particularly in assessing the potential curative effect, and to analyse the results for specific types of patient to obtain clues about possible mechanisms of cure. PATIENTS AND METHODS: The effect of oral desmopressin was investigated in 25 adolescents (aged 11-21 years) with severe monosymptomatic nocturnal enuresis. The long-term study consisted of two 12-week treatment periods, with the efficacy of the drug assessed as the reduction in the number of wet nights per week. Subsequently, the patients were followed-up for up to 7 years. Close contact was maintained with the families over this period ('good doctoring' approach). At 3-, 5- and 7-year intervals after completing the study, patients were assessed for dryness, frequency, treatment and sleeping habits, using postal questionnaires and telephone follow-up. RESULTS: At the end of the long-term study, 35% of the patients remained dry without therapy. Within 2 years of ending treatment, 15 patients were dry, compared with an expected estimate of six by spontaneous resolution, and after 7 years, 19 patients were cured. Nocturia occurred in 75% of the enuretic patients but in only 5% of the healthy controls. CONCLUSIONS: Active treatment of primary nocturnal enuresis with oral desmopressin has a clinically significant effect on the cure rate, which is maintained after ceasing therapy. The cure rate was higher than would be expected from spontaneous recovery alone during the first 2 years of the study and there was a significant further increase in the cure rate 7 years after ending therapy, again greater than the expected spontaneous cure rate. There also seemed to be a better response to treatment when it was prolonged. Furthermore, this therapy is safe when administered in the long-term.

Administration, Oral↗
PubMed1998

Parasympathetic neuropathy associated with left ventricular diastolic dysfunction in patients with insulin-dependent diabetes mellitus.

Patients with insulin-dependent diabetes mellitus (IDDM) may develop autonomic neuropathy (AN) and cardiac complications. The association between AN and cardiac dysfunction was assessed in 34 IDDM patients (age 40 years, diabetes duration 21 years, 15 women) by echocardiography/Doppler and autonomic nerve function tests. The expiration/inspiration ratio (E/I) was used to assess parasympathetic damage, and the acceleration and brake indices for assessment of sympathetic impairment. AN was present in 21 patients. Patients with abnormal E/I (n = 11) had lower E/A ratios than patients without AN; early to atrial peak filling ratio (E/Amax) was median 1.1 (inter-quartile range 0.2) vs 1.4 (0.7), p = 0.022; early to atrial integral filling ratio (E/Aintegral) was 1.7 (0.3) vs 2.3 (1.2), p = 0.006. Patients with AN and normal E/I (sympathetic neuropathy, n = 10) and patients without AN had similar E/A ratios. E/Aintegral was also lower in patients with abnormal E/I compared with patients with AN and normal E/I; 1.7 (0.3) vs 2.2 (0.7), p = 0.008. Systolic function and cardiac dimensions were generally unaffected and similar in the three groups. In conclusion, diastolic dysfunction and parasympathetic neuropathy are related in IDDM patients.

Adolescent↗
PubMed1997

Skin temperature changes and changes in skin blood flow monitored with laser Doppler flowmetry and imaging: a methodological study in normal humans.

The aim of the present study was to elucidate the interrelation between changes in skin temperature and changes in skin blood flow, as measured by laser Doppler techniques. Therefore, 17 healthy volunteers were studied upon immersion of both feet in water of 15 degrees C for 10 min followed by body warming for 30 min. Measurements using laser Doppler flowmetery (LDF) were performed from the nailfold of the big toe, while measurements using laser Doppler imaging (LDI) were performed from the dorsum of the foot. Temperatures were recorded simultaneously from the toe tip and the dorsal foot skin. Temperatures at the toe tip were significantly lower than at the dorsal foot skin. Cooling caused decreased values in all parameters, with restitution during indirect heating. There was an exponential interrelation between LDF and temperature readings from the toe owing to very high LDF values at the end of indirect heating. On the dorsum of the foot, relative changes in LDI and temperature showed a linear relationship (rs = 0.65), although LDI values were consistently higher than temperatures. It is concluded that temperature readings constitute an ambiguous measure of skin blood flow. On the toe tip, blood flow through opened arteriovenous shunts during indirect heating does not correlate with temperature. Cooling of the foot decreases skin temperature, mainly by heat conduction, whereas skin blood flow is only slightly reduced.

Adult↗
PubMed1997

Submaximal early exercise test compared to clinical findings for evaluation of short- and long-term prognosis after the first myocardial infarction. Result from the MONICA Projects in Augsburg and Toulouse.

Clinical and ergometric data were derived from 1098 consecutive exercise tests in patients with a first acute myocardial infarction between 1974-1983. In 1992 a follow-up was performed in order to analyse the importance of a submaximal early exercise test, in combination with clinical data, for the prediction of short- and long-term prognosis of cardiovascular death. The relative value of 20 clinical variables, including medical history, markers of infarction size, medication etc., and 28 variables at exercise test were studied. Univariate, multivariate and survival analysis, for estimation of prognosis and independent prediction of cardiovascular death was used. Independent clinical risk factors for cardiovascular death were (1) Within 1 year: relative heart volume (ml.m-2 body surface area) on chest X-ray. (2) Long-term mortality: maximum heart rate and relative heart volume, diabetes, age and digitalis medication. Independent exercise risk factors were: (1) Within 1 year: heart rate, ventricular arrhythmia and ST depression > or = 1 mm before exercise, diastolic blood pressure at maximum exercise and target heart rate. (2) Long-term mortality: angina pectoris and/or ST depression > or = 1 mm at maximum exercise. In subgroups of patients with clinical risk factors, mortality risk increased if there were signs of angina pectoris and/or ST depression > or = 1 mm during exercise. The risk increased 100% in diabetics, 91% with age > 70 years, 58% with relative heart volume > or = 500 ml.m-2 body surface area, 42% with heart rate > or = 100 at admission, and 34% with digitalis medication. No increase was found in the subgroup of patients without clinical risk factors. Thus, submaximal early exercise stress testing provides important information for short- and long-term prognosis in patients after the first acute myocardial infarction compared to clinical evaluation alone.

Adult↗
PubMed1997

Immediate external compression in the management of an acute muscle injury.

In a prospective, non-randomized study 40 athletes with contusion or distension injuries to the thigh or the calf muscle were followed with tests of range of motion (ROM) of knee or ankle joint, test of serum creatine kinase (CK) and ultrasonography of the injury until completely recovered. An experimental group of 19 injuries where subjects received treatment with application of a maximum compression bandage within 5 min (mean = 2 min) of the injury was compared to a control group of 21 injuries where subjects were treated with rest and elevation only, and in some cases non-maximum compression after 10-30 min. No significant differences were noted with respect to time to complete subjective recovery, ultrasonic size of the injury or time to normal findings on ultrasound between treatment and control groups. Strain injuries, although showing a tendency to be smaller in size, took a longer time to complete recovery than contusion injuries (mean +/- SD = 26 +/- 22 days and 19 +/- 9 days, respectively, P = 0.02). Diagnostic CK values and reductions in ROM were not correlated to the severity of the trauma, while ROM showed weak correlation to the sonographically measured size of the hematoma (r = 0.42: P < 0.01). Injuries displaying a circumscript anechoic, low-echogenic or mixed lesion at the diagnostic ultrasound investigation normalized more slowly (P = 0.001) and took longer to complete recovery (P = 0.001) than injuries with diffuse hyperechogenic lesions. We conclude that in this study the application of a maximum compression bandage within 5 min of a muscle trauma did not significantly reduce the size of the hematoma nor significantly shorten the time to complete subjective recovery compared with no immediate treatment. The diagnostic ultrasound investigation was valuable in predicting the severity of the trauma.

Adolescent↗
PubMed1997

Disturbances of autonomic nervous function in primary Sjögren's syndrome.

Autonomic nervous function was evaluated by deep breathing [expiration/inspiration (E/I) ratio] and tilt table tests [acceleration (AI) and brake indices (BI)] in 19 patients with primary Sjögren's syndrome (pSS) and in 56 age matched controls. The E/I-ratio and systolic blood pressure (at rest, 1, and 8 min after tilt) were found to be significantly reduced (p < 0.001, p < 0.05, p < 0.01, p < 0.01 respectively) in patients with pSS whereas neither AI, BI nor diastolic blood pressure did differ significantly between patients and controls (NS). The van Bijsterveld's score correlated negatively with the AI (r = -0.77, p< 0.001) as well as the BI (r = -0.60, p < 0.01). No correlations were found between the 3 autonomic nerve function parameters (E/I-ratio, AI, BI) and unstimulated whole sialometry or salivary gland scintigraphy. We conclude that autonomic disturbances, mainly affecting the parasympathetic nerves are associated with pSS.

Adolescent↗
PubMed1997

Disturbances of autonomic nervous function in primary Sjögren's syndrome.

Autonomic nervous function was evaluated by deep breathing [expiration/inspiration (E/I) ratio] and tilt table tests [acceleration (AI) and brake indices (BI)] in 19 patients with primary Sjögren's syndrome (pSS) and in 56 age matched controls. The E/I-ratio and systolic blood pressure (at rest, 1, and 8 min after tilt) were found to be significantly reduced (p < 0.001, p < 0.05, p < 0.01, p < 0.01 respectively) in patients with pSS whereas neither AI, BI nor diastolic blood pressure did differ significantly between patients and controls (NS). The van Bijsterveld's score correlated negatively with the AI (r = -0.77, p < 0.001) as well as the BI (r = -0.60, p < 0.01). No correlations were found between the 3 autonomic nerve function parameters (E/I-ratio, AI, BI) and unstimulated whole sialometry or salivary gland scintigraphy. We conclude that autonomic disturbances, mainly affecting the parasympathetic nerves are associated with pSS.

Adolescent↗
PubMed1997

Age-related normal uptake of 99mTc-MDP in the lower spine.

AIM: The uptake of 99mTc-MDP in the lower spine was quantified in connection with ordinary bone scintigraphy. METHODS: Fifty-seven women and seventy-two men (aged 20-69 y), with no signs of metabolic or malignant disease and no history of back pain or atraumatic fractures, were included in the study. RESULTS: The women showed an increase in 99mTc-MDP uptake from the age of 20 y to about 45 y with a decrease from the time of menopause. In contrast to women, the uptake in men showed a slight decrease from the age of 20 y to about 50 y and thereafter a more marked decrease was seen. The major difference between men and women is the high premenopausal uptake in the female skeleton. CONCLUSION: An understanding of age-related changes in 99mTc-MDP uptake, which are indices of the skeletal metabolism, is of importance especially in prevention and treatment of osteoporosis, a common disorder in postmenopausal women.

Adult↗
PubMed1996

Is vibration-induced white finger a reversible syndrome if vibration is stopped?

The purpose of the study was to investigate if vibration-induced white finger may be a reversible symptom after cessation of vibration exposure. Fifty-nine welders, previously employed by a ship building company and who had shown various levels of vibration-induced vasospastic symptoms in the hand were interviewed 5 to 6 years after closure of the company. Out of the 43 patients exposed to no or insignificant vibration subsequently, 28 claimed improvement, 11 claimed unchanged problems and four complained of worse problems. Twelve of these patients had the cold provocation test repeated at follow up. One patient showed the same result as 5 years earlier, six showed improvement and five showed much improvement. Of 16 patients with continued vibration exposure none showed subjective improvement, nine claimed unchanged problems while seven patients were worse. It is concluded that vibration-induced white finger is not a progressive condition following cessation of exposure to vibration. On the contrary it may be static or even reversible to some extent.

Adult↗
PubMed1996

Continuous vectorcardiographic changes in relation to scintigraphic signs of reperfusion in patients with acute myocardial infarction receiving thrombolytic therapy.

OBJECTIVES: Changes in the electrical activity of the heart reflecting the infarct process can be recorded by continuous vector-ECG, a method which is now clinically available for cardiac supervision. Shifts of the ST-segment and QRS-vector reflect ischaemia and necrosis of the myocardium. Continuous vector-ECG changes were evaluated against myocardial scintigraphy in 18 patients with acute myocardial infarction treated with streptokinase in order to study the impact of improved myocardial perfusion. DESIGN: Myocardial perfusion was analysed with 99Tcm-Sestamibi (Cardiolite, DuPont Scandinavia AB, Kista, Sweden) single photon emission computerized tomography (SPECT). Registrations were performed before and after thrombolysis in order to estimate the amount of myocardium with impaired perfusion initially (threatened myocardium) and the degree of perfusion improvement in this myocardial area. X, Y, Z vectors were registered continuously by Frank leads (Ortivus Medical, Täby, Sweden). QRS-vector difference, and the time to plateau phase and the ST-vector magnitude were used as a measurement of ischaemia and size of the myocardial infarction. RESULTS: In seven out of 11 patients treated within 3 h of onset of symptoms, an improvement in myocardial perfusion in the initially hypoperfused areas was achieved in contrast to none of the seven patients treated > 3 h after onset of pain (P < 0.05). In the whole patient material, there was a negative correlation between the time to plateau level for the QRS-vector and the improvement in myocardial perfusion (r = -0.53, P < 0.05). Among patients treated within 3 h, there was a negative correlation between the plateau level for the QRS-vector magnitude compared to the improvement in myocardial perfusion (r = -0.61, P < 0.05) and a negative correlation between the plateau level and the myocardial perfusion level after therapy (r = -0.69, P < 0.05). In these patients, there were also negative correlations between the maximal ST-vector magnitude and the myocardial perfusion both before and after thrombolysis (r = -0.81, P < 0.05 and r = -61, P < 0.05, respectively). CONCLUSION: Patients with marked improvement in myocardial perfusion indicating successful thrombolysis reach their plateau levels of the QRS-change faster and have lower total QRS-vector differences than patients without successful thrombolysis as reflected by myocardial scintigraphy. Patients with a high ST-vector magnitude have low perfusion levels both before and after therapy indicating a pronounced ischaemic damage of the myocardium. Thus, VCG-changes reflect impairment in myocardial perfusion during acute myocardial infarction.

Aged↗
PubMed1996

Islet cell antibodies at diagnosis, but not leanness, relate to a better cardiovascular risk factor profile 5 years after diagnosis of NIDDM.

OBJECTIVE: To evaluate the relationship between islet cell antibodies (ICAs) and the cardiovascular risk profile 5 years after clinical diagnosis of NIDDM. RESEARCH DESIGN AND METHODS: Five years after clinical diagnosis, we evaluated blood pressure (BP) and lipids in 17 NIDDM patients with ICA at diagnosis (age 60 +/- 4 years) and 133 NIDDM patients without ICA at diagnosis (age 61 +/- 1 year). Urinary albumin excretion was evaluated in a subset of 12 NIDDM patients with ICA at diagnosis (age 60 +/- 4 years) and 82 NIDDM patients without ICA at diagnosis (age 61 +/- 1 year). RESULTS: NIDDM patients without ICA showed higher BP (140/86 +/- 2/1 mmHg vs. 128/79 +/- 3/2 mmHg; P < 0.05), total cholesterol (6.10 +/- 0.11 vs. 5.09 +/- 0.29 mmol/l; P < 0.01), LDL-to-HDL ratio (3.85 +/- 0.14 vs. 2.49 +/- 0.18; P < 0.001), and triglycerides (2.58 +/- 0.24 vs. 0.90 +/- 0.06 mmol/l; P < 0.001), lower HDL cholesterol (1.08 +/- 0.03 vs. 1.40 +/- 0.08 mmol/l; P < 0.001), and higher urinary albumin excretion (0.16 +/- 0.06 vs. 0.01 +/- 0.01 g/24 h; P < 0.05) than NIDDM patients with ICA. Among NIDDM patients without ICA, no differences concerning BP or lipids were found between obese and nonobese patients. CONCLUSIONS: ICA at diagnosis of NIDDM is a marker of more favorable cardiovascular risk profile 5 years after clinical diagnosis.

Adult↗
PubMed1996

Alcohol abuse exaggerates autonomic dysfunction in chronic liver disease.

BACKGROUND: Advanced chronic liver disease is characterized by peripheral arterial vasodilation and increased plasma catecholamine concentrations. These haemodynamic alterations may reflect impaired vascular responsiveness due to autonomic nerve dysfunction. METHODS: Three established non-invasive tests based on the heart reactions to deep breathing (expiratory/inspiratory (E/I) ratio) and to tilt (acceleration and brake indices) were used to evaluate age-related autonomic nerve function in 27 patients with chronic alcoholic and non-alcoholic liver disease. Liver function was estimated by demethylating capacity. The results were compared with a control group consisting of 56 healthy individuals. RESULTS: Overall, 12 patients (52%) had autonomic neuropathy (10 of 13 (77%) patients with alcoholic and 2 of 14 (14%) with non-alcoholic liver disease). Variance analysis showed that the age-corrected E/I ratio, but not the acceleration and brake indices, was significantly decreased compared with controls both in patients with alcoholic and non-alcoholic liver disease, indicating vagal nerve dysfunction (P < 0.0001 and 0.0133, respectively). The decrease in E/I ratio was also significantly more pronounced (-1.77 (0.62) (median (interquartile range)) versus 0.76 (0.70); P = 0.049) in patients with alcoholic compared with non-alcoholic liver disease. Furthermore, in contrast to non-alcoholics, patients with alcoholic liver disease were unable to increase their diastolic blood pressure after return to upright from a tilted position, indicating additional sympathetic neuropathy. CONCLUSIONS: Autonomic, mainly vagal, nerve dysfunction is common in patients with liver diseases and is further exaggerated by alcohol abuse. Autonomic neuropathy may contribute to altered vascular responsiveness in patients with chronic liver diseases.

Autonomic Nervous System Diseases↗
PubMed1996

Quantitative bone scintigraphy in patients with prostatic carcinoma treated with LH-RH analogues.

In 14 men with prostatic carcinoma, quantitative scintigraphy of the vertebrae from Th10 to L5 was performed before and 2 weeks and 2 and 6 months after start of treatment with luteinizing hormone-releasing hormone (LH-RH) analogues. Serum prostate-specific antigen (PSA) was also determined. The patients with normal bone scintigram showed no change in gamma camera count rate during the study, but fall in PSA values. The patients with abnormal bone scintigram responded to treatment with flare phenomenon, with increased count rate at 2 weeks, followed by fall to pretreatment level at 2 months. PSA showed decrease as early as 2 weeks after the start of treatment. Bone scintigraphy was found to be useful before therapy, especially in patients with elevated PSA levels, and after 2 months, when the flare phenomenon had subsided. Serial measurement of PSA provided a guide to disease activity.

Aged↗
PubMed1995

Autonomic nerve dysfunction in patients with bolus-specific esophageal dysmotility.

The pathogenetic mechanisms causing esophageal dysmotility is not well understood. We examined 13 patients with solid bolus dysphagia in a radiologic barium study including the swallowing of a 14-mm tablet. In all 13 patients the tablet was caught in the proximal or midesophagus. In 8 patients, the entrapment was associated with symptoms (Group 1) whereas in 5 patients (Group 2), no symptoms were reported. All 13 patients together with a control group of 56 healthy, nondysphagic subjects were tested for autonomic nerve function. Autonomic nerve function tests included registration of electrocardiographic R-R interval variation during deep breathing test (E/I ratio), a test of parasympathetic, vagal, nerve function. The results showed that the E/I ratio was significantly lower in patients with symptoms of bolus-specific esophageal dysmotility (-2,19 [1.76]) (median [interquartile range]) compared with patients without symptoms (0.05 [2, 87], p = 0.0192) and controls (-0.25 [1.26], p = 0.0009). In conclusion, symptomatic bolus-specific esophageal dysmotility is associated with vagal nerve dysfunction.

Adolescent↗