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Biomedical subjects

J Karlsson

Publications and source records attributed to J Karlsson.

At least 145 records · Page 8Linked to original sources
PubMed1996

Postoperative analgesic effects of an external cooling system and intra-articular bupivacaine/morphine after arthroscopic cruciate ligament surgery.

The aim of this study was to evaluate the analgesic effect of an external cooling system with or without the combined effect of intra-articularly administered bupivacaine/morphine after arthroscopic anterior cruciate ligament (ACL) reconstruction. Fifty patients with isolated ACL insufficiency operated on under general anaesthesia were randomized to three different postoperative treatment groups. Group I was treated with the cooling system during the first 24 h after surgery and an intra-articular injection of 20 ml of physiological saline given at the completion of surgery; in group II, the cooling system was combined with an intra-articular injection of 20 ml bupivacaine 3.75 mg/ml and 1 mg of morphine at the end of the operation; while group III (placebo group) received an intra-articular injection of 20 ml of physiological saline at the completion of surgery. Pain was assessed using a visual analogue scale (VAS) at 1, 2, 4, 6, 24 and 48 h postoperatively. Supplementary analgesic requirements were registered. In group I 80% (16/20) and in group II 90% (18/20) of the patients were satisfied with the postoperative pain control regimen (NS). This was significantly better than in group III, where 30% (3/10) were satisfied. The pain scores were significantly lower in the two treatment groups compared with the placebo group during the entire postoperative period. The pain score was significantly lower in group II than in group I at 24 and 48 h after surgery. The supplementary analgesic requirements were also lower in the two treatment groups compared with the placebo group. No complications due to the use of the cooling system or the intra-articular injections of bupivacaine/morphine were observed. The external cooling system used in this study provides an effective method of obtaining pain relief after arthroscopic surgery. The combination with an intra-articular injection of morphine and bupivacaine results in a slightly greater analgesic effect than the cooling system alone.

Adolescent↗
PubMed1996

Eleven year follow-up of patello-femoral pain syndrome.

OBJECTIVE: To evaluate the long-term results in patients with patello-femoral pain syndrome after expectant management. DESIGN: Retrospective, case-control study. SETTING: Community study in Sweden from 1981 to 1994. PATIENTS: Forty-eight patients with patello-femoral pain syndrome were followed for a mean period of 11 years. MAIN OUTCOME MEASURES: Patello-femoral joint evaluation scale (0-100 points) was used to evaluate the functional results. Arthroscopy for evaluation of cartilage damage according to Outerbridge, and clinical assessment of knee stability and, range of motion and Q-angle. RESULTS: The functional results were excellent or good in 41 of 48 (85%) and poor in seven (15%). There was no correlation between the degree of cartilage damage and the level of knee function. Retropatellar cartilage damage was found in 28 patients during arthroscopy. There was no correlation between the degree of cartilage damage and the level of knee function. No patient has Outerbridge frade IV cartilage damage. The Q-angle was 2-23 degrees. There was no significant difference in Q-angle between patients with excellent/good results compared to those with poor. CONCLUSION: Patients with patello-femoral pain syndrome should be managed nonsurgically as the natural course is benign in most cases. Surgical intervention should be used only if correction of anatomical malalignment is necessary and if the surgical methods have proven successful in well-controlled studies with a long follow-up period.

Adolescent↗
PubMed1996

Bilaterality in slipped capital femoral epiphysis: importance of a reliable radiographic method.

One hundred patients treated for slipped capital femoral epiphysis (SCFE) were reviewed to evaluate the incidence of bilateral slipping of the epiphysis at an average follow-up time of 32 years. When the patients were examined during adolescence, repeat lateral radiographs of the hips had been obtained by the frog lateral view in 33 patients and by the standardized lateral view according to the method of Billing in 67 patients. At re-examination, 59 patients (59%) were judged to have had a previous bilateral SCFE; in 42 of these 59 patients (71%), slipping of the contralateral hip was asymptomatic. In 23 patients (23%), the diagnosis of bilateral slipping was established at primary admission, in 18 (18%) later during adolescence, and in 18 (18%) not until the patients were reexamined as adults and the primary radiographs were reviewed. The incidence of bilateral slipping was higher in patients in whom the Billing standardized lateral view was used (63%) than in patients in whom the frog lateral view was used (52%). We conclude that the incidence of bilateral slipping of the epiphysis in patients with SCFE is approximately 60% in Sweden. If repeat radiographs of the contralateral hip are obtained with the Billing standardized lateral view until physeal closure occurs, even minor slipping of the epiphysis, which is often advisable to treat, will be apparent.

Adolescent↗
PubMed1996

Loss of hip motion in slipped capital femoral epiphysis: a calculation from the slipping angle and the slope.

The range of hip motion in 128 hips of 108 patients was measured at an average of 32.7 years after slipping of the capital femoral epiphysis (SCFE). Only hips without signs of osteoarthrosis were selected for the study. The hips were divided into three groups depending on treatment (i.e., fixation in situ, no treatment, osteotomy) and compared with those of a group with no slipping (normal hip). The slipping angle (SA) between the basis of the epiphysis and the perpendicular to the anteversion plane on lateral radiographs and the slope (S) between the basis of the epiphysis and the perpendicular to the axis of the femur on anteroposterior (AP) radiographs were measured. The only significant loss of hip motion evident in comparison of normal hips and hips with previous SCFE, was loss of external rotation in hips treated with osteotomy. Hips with no treatment and hips treated with fixation in situ showed no significant loss of hip motion as compared with normal hips. The greatest loss of hip motion in hips treated with fixation in situ was loss of internal rotation (LIR), which can be calculated using the radiographs as sin LIR = sin SA * sin S. The average difference between clinically established and calculated LIR was 1.15 degrees. We conclude that the loss of hip motion after SCFE is slight and in most patients not clinically relevant. Therefore, early surgical intervention, e.g., femoral osteotomy, due to expected loss of hip motion cannot be justified.

Adolescent↗
PubMed1996

Cryotherapy in sports medicine.

The use of cryotherapy, i.e. the application of cold for the treatment of injury or disease, is widespread in sports medicine today. It is an established method when treating acute soft tissue injuries, but there is a discrepancy between the scientific basis for cryotherapy and clinical studies. Various methods such as ice packs, ice towels, ice massage, gel packs, refrigerant gases and inflatable splints can be used. Cold is also used to reduce the recovery time as part of the rehabilitation programme both after acute injuries and in the treatment of chronic injuries. Cryotherapy has also been shown to reduce pain effectively in the post-operative period after reconstructive surgery of the joints. Both superficial and deep temperature changes depend on the method of application, initial temperature and application time. The physiological and biological effects are due to the reduction in temperature in the various tissues, together with the neuromuscular action and relaxation of the muscles produced by the application of cold. Cold increases the pain threshold, the viscosity and the plastic deformation of the tissues but decreases the motor performance. The application of cold has also been found to decrease the inflammatory reaction in an experimental situation. Cold appears to be effective and harmless and few complications or side-effects after the use of cold therapy are reported. Prolonged application at very low temperatures should, however, be avoided as this may cause serious side-effects, such as frost-bite and nerve injuries. Practical applications, indications and contraindications are discussed.

Acute Disease↗
PubMed1996

Recurrent dislocation of the peroneal tendons.

Peroneal tendon dislocations occur in sports, particularly in skiing and soccer. This paper presents the outcome of 15 patients with post-traumatic recurrent peroneal tendon dislocations, operated on with a soft-tissue reconstruction of the superior peroneal retinaculum, i.e. reattachment and reinforcement, in combination with a retrofibular groove deepening. Mean follow-up was 3.5 (2-7) years after surgery. There were no redislocations and no neurovascular injuries. The functional results were satisfactory in 13/15 (87%) patients, with full range of ankle motion and no pain. The two patients with unsatisfactory functional results had restricted ankle motion and pain on exertion. This simple reconstruction seems to be a good alternative to other more complex procedures and can be recommended in patients with recurrent peroneal tendon dislocations. Conservative treatment is not an option in patients with recurrent peroneal tendon dislocations, due to persistent symptoms of instability and pain.

Adolescent↗
PubMed1996

Ankle arthroscopy under local and general anaesthesia for diagnostic evaluation and treatment.

Improvements in techniques and instrumentation are extending the diagnostic and therapeutic indications for ankle arthroscopy. We aimed to study the diagnostic and therapeutic benefits and complication rate from 112 consecutive ankle arthroscopies performed between 1991 and 1994 under local and general anaesthesia. One-hundred and twelve outpatient ankle arthroscopies were performed in 72 male and 37 female patients, 16-64 years old. The patients were comparable in terms of gender and age in the arthroscopies done under local (n = 69) and the arthroscopies done under general anaesthesia (n = 43). The indications for surgery were pain in 75%, instability in 15%, limited function in 7% and swelling in 4%, and these criteria were similar in both groups. Antero-medial and anterolateral portals were used in all cases. No tourniquet was used and an external distractor was used in one case only. In 64 cases (57%) surgery was performed and included synovectomy, removal of loose bodies, shaving drilling of osteochondritic or other cartilage lesions, resection of impinging osteophytes, fibrosis and meniscoid lesions. In 95 ankles (85%) a definite diagnosis was established. Comparable diagnostic and therapeutic potentials were found between local and general anaesthesia. The complication rate was low. One patient who was operated on under general anaesthesia sustained a deep infection, and three suffered minor superficial nerve injuries. In conclusion, ankle arthroscopy may be performed under local or general anaesthesia with similar diagnostic value and with a low complication rate.

Adolescent↗
PubMed1996

Early functional treatment for acute ligament injuries of the ankle joint.

Eighty-six patients with acute (< 24 h) grade II or III lateral ligament ruptures were randomized into two different non-surgical treatment groups. The main difference in treatment protocols between the two groups was during the first week after injury. Group I (n = 46) was to receive functional treatment using specially designed compression pads, elevation of the injured foot (24 h), repeated elastic wrapping (compression bandage followed by ankle tape), early full weight-bearing and proprioceptive range-of-motion training. Group II (n = 40) was to receive conventional treatment with an elastic bandage, partial weight bearing and crutches until the pain subsided. One week after the injury, patients from both groups were given identical rehabilitation instructions. No early surgery was performed. The mean follow-up period was 18 months. The functional results were satisfactory in 91% of the patients in group I and in 87% of the patients in group II (NS). Five patients had been operated on due to recurrent instability, two in group I and three in group II (NS). The mean sick leave was significantly shorter in group I; 5.6 +/- 4.2 days compared with 10.2 +/- 6.8 days in group II. Return to sports activities was also significantly earlier in group I, 9.6 +/- 4.8 days compared with 19.2 +/- 9.5 days in group II. In this study, non-surgical treatment of acute grade II and III ligament injuries of the ankle produced satisfactory results in the majority of patients. Early functional treatment resulted in shorter sick leave and facilitated an earlier return to sports, but it did not influence the final results.

Absenteeism↗
PubMed1996

Diet and muscle glycogen concentration in relation to physical performance in Swedish elite ice hockey players.

The effects of carbohydrate (CHO) loading on physical characteristics including muscle fiber distribution, muscle glycogen concentration, and physical performance were studied in two top Swedish ice hockey teams. Players were randomly allocated to two groups: those consuming a CHO-enriched diet (CHO group) and those consuming a mixed diet (controls). Biopsies from the vastus lateralis muscle were taken three times: after Game 1, before Game 2, and after Game 2. Muscle fiber distribution averaged 50 +/- 2% slow twitch fibers (mean +/- 1 SEM). Muscle glycogen concentrations (measured in mmol glucose units . kg-1 wet muscle) were as follows: after Game 1, 43 +/- 4 (all players); before Game 2, 99 +/- 7 (CHO group) and 81 +/- 7 (controls); and after Game 2, 46 +/- 6 (CHO group) and 44 +/- 5 (controls). Distance skated, number of shifts skated, amount of time skated within shifts, and skating speed improved with CHO loading. It was concluded that individual differences in performance could be related to muscle glycogen metabolism.

Adult↗
PubMed1996

The incidence of physiolysis of the hip: a population-based study of 175 patients.

We studied the epidemiology of physiolysis of the hip (or slipped capital femoral epiphysis) between 1946 and 1992 in 175 patients from a well-defined population. The incidence of physiolysis of the hip was calculated using the attack rate method, i.e., the sum of the annual incidences in each 1-year group. The risk of developing physiolysis was 1:998 for boys, 1:1756 for girls and 1:1267 for both sexes and did not change significantly during this period. The average age at diagnosis was 13.6 (7-17) years in boys and 12.1 (8-15) years in girls and did not change to a significant degree during this period. The difference in the boy:girl ratio (1.8:1) and in the preponderance of the left hip being affected first (64% for boys and 52% for girls) did not change significantly during this period. No significant monthly variation was found in the onset of symptoms of physiolysis of the hip.

Adolescent↗
PubMed1996

Smoking, plasma antioxidants and essential fatty acids before and after nutratherapy.

OBJECTIVE: To study the effect of smoking on plasma antioxidants with and without antioxidant vitamin nutratherapy. DESIGN: Chronic smokers (n = 10, 16 +/- 4 cigarettes a day) and nonsmokers (n = 17) of both sexes were recruited from patients with arthritis-like symptoms. After baseline studies of plasma antioxidant vitamins Q (ubiquinone) and E (alpha-tocopherol) and essential fatty acids (EFA, vitamin F), three months' nutratherapy with vitamins Q (90 mg) and E (350 mg) was administered and plasma reanalyzed. RESULTS: No sex differences were seen in smoking habits or plasma nutrients. Smokers had normal Q (0.71 +/- 0.07 mg/L) but depressed E (9.4 +/- 0.6 mg/L, P < 0.01). EFA were the same in both groups. Nutratherapy increased Q by about 90% in both groups and E by 47% in smokers and 101% in nonsmokers (P < 0.01). In nonsmokers, nutratherapy protected omega-3 fatty acids (vitamin F1)-plasma docosahexaenoic acid increased by 39%. The vitamin F index (omega-6:omega-3, ratio) remained unchanged in the smokers but decreased in the nonsmokers and became related to the individual plasma vitamin Q but not to vitamin E. CONCLUSIONS: There was no difference between smokers and nonsmokers before nutratherapy. Nonsmokers may have suffered from passive smoking. After nutratherapy the quantitatively most important antioxidant, ie, vitamin E, increased more in nonsmokers than in smokers. This resulted in less vitamin F1 peroxidation. Nutratherapy cannot overcome disadvantages associated with smoking. Nonsmokers might achieve an antioxidant protection with nutratherapy, which could mean a possible reduced risk of developing cardiovascular disease.

Adult↗
PubMed1996

Long-term results after realignment operations for slipped upper femoral epiphysis.

We reviewed the long-term results of the treatment of slipped upper femoral epiphysis (SUFE) using realignment procedures in 36 patients (37 hips) at an average follow-up of 33.8 years (26 to 42). There were serious short-term complications in seven of the 22 hips treated by subcapital osteotomy, three of the 11 hips treated by intertrochanteric osteotomy and three of the four hips treated by manipulative reduction. At re-examination, the clinical and radiological results were excellent or good in 41% of the hips treated by subcapital osteotomy, in 36% treated by intertrochanteric osteotomy and in none treated by manipulative reduction. In all, seven hips (19%) had had arthrodesis or total hip replacement. The natural history of SUFE was probably not improved by any of the treatments used in our study. We therefore discourage the use of subcapital and intertrochanteric osteotomy as well as manipulative reduction in the primary treatment of chronic SUFE.

Adolescent↗
PubMed1996

Endurance athletes, insulin secretion and muscle quality.

OBJECTIVE: To study how muscle ubiquinone content (MUQ) and percentage slow twitch (%ST) of muscle fibres in the thighs of male healthy subjects with a low or high insulin response to glucose infusion tests (GIT) affected blood glucose control (BGC). DESIGN: People with a low insulin response were recruited from sedentary low insulin responders (LIRs) or endurance trained LIRs. A group of men with high insulin response (HIRs) was used for comparison. In addition to GIT, glucose metabolism was estimated with somatostatin-insulin-glucose infusion tests (SIGIT; insulin sensitivity). RESULTS: Sedentary LIRs and HIRs had low exercise capacities and an increased BGC with increased exercise capacity. BGC in sedentary LIRs, in contrast to HIRs increased with MUQ and/or %ST. Only trained LIRs showed an elevated peripheral insulin receptor sensitivity despite a decreasing MUQ with %ST. This relationship indicated muscle metabolic lesions in trained LIRs with a high %ST and additional compensatory BGC mechanisms in trained LIRs. CONCLUSION: BGC in HIRs was maintained with insulin and an exercise-regulated insulin sensitivity, BGC in sedentary LIRs with a good muscle membrane and metabolic control due to adequate MUQ depots, and BGC in trained LIRs with an elevated insulin sensitivity. Trained LIRs rich in %ST had a low MUQ indicative of muscle lesions such as from 'overuse injury'.

Adult↗
PubMed1995

Purification and characterisation of an intracellular carbonic anhydrase from the unicellular green alga Coccomyxa.

An intracellular carbonic anhydrase (CA; EC 4.2.1.1) was purified and characterised from the unicellular green alga Coccomyxa sp. Initial studies showed that cultured Coccomyxa cells contain an intracellular CA activity around 100 times higher than that measured in high-CO2-grown cells of Chlamydomonas reinhardtii CW 92. Purification of a protein extract containing the CA activity was carried out using ammonium-sulphate precipitation followed by anion-exchange chromatography. Proteins were then separated by native (non-dissociating) polyacrylamide gel electrophoresis, with each individual protein band excised and assayed for CA activity. Measurements revealed CA activity associated with two discrete protein bands with similar molecular masses of 80 +/- 5 kDa. Dissociation by denaturing polyacrylamide gel electrophoresis showed that both proteins contained a single polypeptide of 26 kDa, suggesting that each 80-kDa native protein was a homogeneous trimer. Isoelectric focusing of the 80-kDa proteins also produced a single protein band at a pH of 6.5. Inhibition studies on the purified CA extract showed that 50% inhibition of CA activity was obtained using 1 microM azetazolamide. Polyclonal antibodies against the 26-kDa CA were produced and shown to have a high specific binding to a single polypeptide in soluble protein extracts from Coccomyxa cells. The same antiserum, however, failed to cross-react with soluble proteins isolated from two different species of green algae, Chlamydomonas reinhardtii and Chlorella vulgaris. Correspondingly, antisera directed against pea chloroplastic CA, extracellular CA from C. reinhardtii and human CAII, showed no cross-hybridisation to the 26-kDa polypeptide in Coccomyxa.(ABSTRACT TRUNCATED AT 250 WORDS)

Amino Acid Sequence↗
PubMed1995

Postoperative analgesic effects of intra-articular bupivacaine and morphine after arthroscopic cruciate ligament surgery.

Intra-articular administration of local anaesthetics such as bupivacaine can produce short-term postoperative analgesia in patients undergoing diagnostic arthroscopy or arthroscopic meniscectomy. A peripheral anti-nociceptive effect may also be induced by the administration of intra-articular opiates interacting with local opioid receptors in inflamed peripheral tissue. In the present study we aimed to study the analgesic effects of intra-articularly given bupivacaine and morphine sulphate (as well as the combination of both drugs) on postoperative pain. In a prospective, randomized, double-blind manner 40 patients received one of the following: (a) morphine (1 mg in 20 ml NaCl), (b) bupivacaine (20 ml, 0.375%), (c) combination of both or (d) saline (20 ml, control group) intra-articularly at the end of arthroscopic anterior cruciate ligament (ACL) reconstruction. The postoperative pain was assessed via a visual analogue scale (VAS) during the first 48 h after surgery, and supplemental analgesic requirements were noted. All comparisons were made versus the control group receiving saline. The pain scores were significantly lower in the morphine group at 24 and 48 h, and in the bupivacaine group at 2, 4 and 6 h after surgery. In the group that received a combination of both bupivacaine and morphine, the pain scores were significantly reduced throughout the whole postoperative observation period. No side-effects or complications from therapy were seen in any of the groups. The conclusion of this study is that intra-articular morphine is effective in the postoperative period after arthroscopic ACL reconstruction.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1995

Early range of motion training after ligament reconstruction of the ankle joint.

Early range of motion training after ligament reconstruction of the ankle ligaments for chronic ankle joint instability was evaluated. Forty patients were operated on with anatomic reconstruction of the lateral ankle ligaments, i.e. shortening, imbrication and reinsertion. The patients were randomized postoperatively between two groups: (1) immobilization for 6 weeks in a plaster cast and (2) early range of motion training, in a Walker-Boot. Both groups underwent an identical rehabilitation program, with peroneal strengthening and co-ordination training after 6 weeks. The functional results were evaluated using a scoring scale and the mechanical stability with standardized stress radiographs. The minimum follow-up was 2 years. The functional results were satisfactory in 16 (80%) of the patients in group I, and 19 (95%) in group II. The mean values of anterior talar translation and talar tilt were not significantly different between the groups preoperatively nor at follow-up. The mean time period for sick leave was significantly shorter for group II, 6.5 +/- 1.6 weeks compared with 8.5 +/- 1.8 weeks for group I. The mean time period for return to sports activity was significantly shorter for group II, 9.5 +/- 2.2 weeks, compared with 12.5 +/- 2.6 weeks for group I. Early range of motion training is recommended after ligament reconstruction of the ankle, as it will enable earlier return to sports activities, shorter sick leave and preserved mechanical stability.

Adolescent↗
PubMed1995

The Swedish SF-36 Health Survey--I. Evaluation of data quality, scaling assumptions, reliability and construct validity across general populations in Sweden.

We document the applicability of the SF-36 Health Survey, which was translated into Swedish using methods later adopted by the International Quality of Life Assessment (IQOLA) Project procedures. To test its appropriateness for use in Sweden, it was administered through mail-out/mail-back questionnaires in seven general population studies with an average response rate of 68%. The 8930 respondents varied by gender (48.2% men), age (range 15-93 years, mean age 42.7), marital status, education, socio-economic status, and geographical area. Psychometric methods used in the evaluation of the SF-36 in the U.S. were replicated. Over 90% of respondents had complete items for each of the eight SF-36 scales, although more missing data were observed for subjects 75 years and over. Scale scores could be computed for the vast majority of respondents (95% and over); slightly fewer in the oldest subgroup. Item-internal consistency was consistently high across socio-demographic subgroups and the eight scales. Most reliability estimates exceeded the 0.80 level. The highest reliability was observed for the Bodily Pain Scale where all subgroups met the 0.90 level recommended for individual comparisons; coefficients at or above 0.90 were also observed in most subgroups for the Physical Functioning Scale. Tests of scaling assumptions including hypothesized item groupings, which reflect the construct validity of scales, were consistently favorable across subgroups, although lower rates were noted in the oldest age group. In conclusion, these studies have yielded empirical evidence supporting the feasibility of a non-English language reproduction of the SF-36 Health Survey. The Swedish SF-36 is ready for further evaluation.

Adolescent↗