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Biomedical subjects

J Larsson

Publications and source records attributed to J Larsson.

At least 181 records · Page 10Linked to original sources
PubMed1990

The importance of peripheral pulses, peripheral oedema and local pain for the outcome of diabetic foot ulcers.

In a prospective study, peripheral pulses, claudication, peripheral oedema, and rest pain were evaluated in 314 sequentially presenting diabetic patients with foot ulcers. In the ulcerated limb pedal pulses were found to be present in 44% of the patients, peripheral oedema in 38%, and rest pain in 19%. Twelve per cent had claudication. Presence of pedal pulses was more common in patients whose ulcers underwent primary healing (56%) than in those who healed after amputation (23%) or died (25%, p less than 0.001). Eighty per cent of the patients with pedal pulses present underwent primary healing. However, 49% of patients with absence of pedal pulses also underwent primary healing and 12 patients developed gangrene despite presence of pedal pulses. Peripheral oedema was more common in patients who required amputation (58%) or died (55%) than in patients with primary healing (26%, p less than 0.001). A tentative predisposing factor was identified in 95% of the patients, the most common factors being neuropathy, congestive heart failure, and previous deep venous thrombosis. Rest pain was more common in patients who required amputation (48%) or died (23%) than in those with primary healing (7%; p less than 0.001). Only 50% of patients with gangrene had rest pain and of these patients, only one underwent primary healing. The presence of pedal pulses, oedema, and rest pain give valuable but imperfect information on the possible primary healing of foot ulcers in diabetic patients.

Aged↗
PubMed1990

Total and net muscle protein breakdown in infection determined by amino acid effluxes.

The present investigation was undertaken to study whether, in human infection of varying severity, peripheral 3-methylhistidine efflux and urinary excretion are associated with net protein degradation and to estimate the protein synthesis rate from the combined effluxes of 3-methylhistidine, tyrosine, and phenylalanine. Quadruplicate femoral arteriovenous differences of 3-methylhistidine, tyrosine, and phenylalanine were multiplied by leg plasma flow in 15 infected patients. Leg effluxes for 3-methylhistidine, tyrosine, and phenylalanine were -0.074 +/- 0.011, -2.57 +/- 0.43, and -3.17 +/- 0.44 mumol/min, respectively. There was a significant linear relationship (P less than 0.01) between the effluxes of tyrosine and phenylalanine and the efflux and urinary excretion of 3-methylhistidine. A significant release of tyrosine and phenylalanine was observed in patients studied at the 3-methylhistidine level seen in normal healthy subjects. It is concluded that in infection 1) there is an increased breakdown of skeletal muscle protein and a reduced rate of protein synthesis, with the latter being relatively more important in patients with mild disease; and 2) urinary 3-methylhistidine excretion is associated with net skeletal muscle protein degradation for the patient group studied.

Abdomen↗
PubMed1990

Influence of malnutrition on regeneration and composition of the liver in rats.

Using a new experimental model of protein-calorie starvation, the impact of malnutrition on liver regeneration, and the changes in liver composition during malnutrition and regeneration, were studied. Forty-one rats were allocated to one of 3 groups: group I (n = 13) were normally nourished rats which underwent partial hepatectomy, group II (n = 16) were semistarved rats which underwent partial hepatectomy, and group III (n = 12) were normally nourished rats which underwent sham operations. Liver biopsy specimens were taken at the time of partial hepatectomy and when the rats were killed after 48 hours of regeneration. The samples were used for determination of water, fat, glycogen, protein, DNA, and RNA content. The replication rate of liver cells was measured by autoradiography after continuous incorporation of tritium labelled thymidine. Malnutrition was associated with a higher postoperative mortality and a reduced rate of regeneration. The livers changed during malnutrition with a reduction in both size and glycogen concentration. After 48 hours of regeneration there was a marked change in liver composition with severe fatty degeneration, a fall in glycogen and a rise in water content. RNA concentration was stimulated during regeneration, but during malnutrition the protein content decreased. The results emphasise the importance of an adequate nutritional state for liver regeneration.

Animals↗
PubMed1989

Immunoreactive tachykinins, calcitonin gene-related peptide and neuropeptide Y in human synovial fluid from inflamed knee joints.

We have analysed the concentrations of substance P (SP), neurokinin A (NKA), calcitonin gene-related peptide (CGRP) and neuropeptide Y (NPY) in the synovial fluid from 5 patients suffering from arthritis with inflamed knee joints as well as from 5 healthy control subjects with an earlier traumatic meniscal or cruciate ligament injury. Competitive radioimmunoassay was done using antisera SP2 (SP), K12 (NKA), R8 (CGRP), and NPY1 (NPY). No SP-like immunoreactivity (-LI) was detected in any patient. NKA-LI was found in all control patients but in none of the arthritis patients. CGRP-LI was seen in all arthritis patients as well as in 3/5 control patients, a non-significant difference. NPY-LI was found in a significantly higher concentration in the arthritis group vs the control patients. The results support an involvement of neuropeptides in human joint inflammation.

Adult↗
PubMed1989

Splanchnic and peripheral release of 3-methylhistidine in relation to its urinary excretion in human infection.

The present investigation was undertaken in order to determine the release of 3-methylhistidine (3MH) from the splanchnic region and from the leg, and the contributions these make to the increase in urinary 3MH excretion in infection. Thirteen febrile patients with infection were investigated. After an overnight fast, hepatic vein, femoral vein, and radial artery catheterizations were performed. Splanchnic and leg blood flows were determined by dye dilution technique. Plasma 3MH was analyzed by a modified HPLC method. The release of 3MH from the leg was 0.064 +/- 0.007 mumol/min (+/- SE) and from the splanchnic region 0.012 +/- 0.013 mumol/min. These releases of 3MH constitute 27% +/- 2% and 8% +/- 6% of the individual urinary excretions, respectively. With increasing degree of catabolism, measured as individual 3MH increase above baseline excretion or as the 3MH to creatinine ratio (3MH:Cr), the relative contribution to urinary excretion from the leg was increased (individual increase, P = 0.08; 3MH:Cr, P less than 0.01). Since this contribution was not decreased in the more catabolic patients, as would have been expected if the increase in urinary 3MH originated elsewhere, it is concluded that skeletal muscle is the source, and these results thus validate the use of urinary 3MH excretion as a marker of myofibrillar protein catabolism in infected patients.

Adult↗
PubMed1989

The effect of a fat emulsion on some common clinical chemical analyses.

During infusion of fat emulsion serum becomes turbid. Turbidity interferes in various photometric serum analyses delaying urgent therapeutic decisions. Small laboratories may lack access to an ultracentrifuge to clear turbid samples. To identify the analyses mostly disturbed we collected serum samples containing various concentrations of the compounds or activities commonly requested by the intensive care unit (ICU) and spiked the samples with Intralipid (Kabi Vitrum, Sweden). Glycerol measurements were used as estimate of the amount of Intralipid prevailing in turbid serum. Applying the common instruments Astra 8 (Beckman) and RA 1000 (Technicon) sodium, potassium, phosphate, calcium, creatinine, urea, total bilirubin, amylase, lactate dehydrogenase and albumin were not sensitive to interference. Magnesium and creatinine were slightly lowered whereas glucose was increased. Aspartate amino transferase was not measurable. We suggest (a), that ICU contact the clinical chemistry laboratory to clarify what analyses will be hampered by turbidity in the inhouse instruments; and (b), that high serum glycerol values may be indicative of erroneous results in these analyses; and (c) that charts with confidence limits be established to aid recognition of the magnitude and direction of the errors.

Journal Article↗
PubMed1989

Exchange of 3-methylhistidine in the splanchnic region in human infection.

This investigation was undertaken to determine the splanchnic exchange of 3-methylhistidine (3MH) in infection. Hepatic vein, femoral vein, and radial artery catheterizations were performed in 12 febrile patients with infections of varying severity. Differences in arteriovenous 3MH, analyzed by high-performance liquid chromatography, were multiplied by the plasma flows, determined by a dye dilution technique. The mean splanchnic efflux was 0.062 +/- 0.180 mumol/min (mean +/- SD) with uptake occurring in five patients. The splanchnic uptake was significantly (p less than 0.001) correlated with the urinary 3MH excretion and the peripheral release from the leg. It is concluded that in human infection, splanchnic 3MH release is low and in patients with high rates of myofibrillar catabolism there may even be an uptake. The urinary 3MH excretion is still a marker of myofibrillar protein breakdown because it correlates well with the release from the leg, regardless of whether the patient has a splanchnic uptake or a release.

Chromatography, High Pressure Liquid↗
PubMed1989

Wound classification is more important than site of ulceration in the outcome of diabetic foot ulcers.

The importance of wound classification and site of ulceration was evaluated in 314 consecutive diabetic patients with foot ulcers. The ulcers were classified as superficial (through the full thickness of the dermis; n = 150), deep (n = 50), osteomyelitis and/or abscess (n = 46), minor gangrene (n = 39) or major gangrene (n = 29). Wound healing was defined as intact skin for at least 6 months. In patients with superficial and deep ulcers, primary healing occurred in 88% and 78%, respectively, compared with 57% in those patient who developed an abscess and/or osteomyelitis. Only 2 out of 68 patients with gangrene healed (through mummification) without amputation. Patients with gangrene had lower ankle and toe blood pressure than patients with all other types of ulcers. There were only marginal differences in primary healing rate between different ulcer sites. The highest rate was seen in ulcers localized to the metatarsal heads (78%). Patients with multiple ulcers had the lowest primary healing rate (5%) compared with single ulcers at all sites. These differences were probably due to circulatory factors, since patients with multiple ulcers had lower distal perfusion pressures compared with all other groups.

Blood Pressure↗
PubMed1989

Prognostic value of systolic ankle and toe blood pressure levels in outcome of diabetic foot ulcer.

The prognostic value of distal blood pressure measurements has been studied in 314 consecutive diabetic patients with foot ulcers. Systolic toe blood pressure was measured with a strain-gauge technique, and ankle pressure was measured with strain-gauge or Doppler techniques. Wound healing was defined as intact skin for at least 6 mo. One hundred ninety-seven patients healed primarily, 77 had amputations, and 40 died before healing had occurred. In 294 of 300 patients, it was possible to measure either ankle or toe pressure. Fourteen patients were not available for pressure measurements. Of these, 10 patients healed primarily, and 4 died before healing occurred. Both ankle and toe pressures were higher (P less than .001) among patients who healed without amputation compared with those who underwent amputation or died before healing. No differences were seen in ankle or toe pressure levels among those who had amputations or died. No patient healed primarily with an ankle pressure less than 40 mmHg. An upper limit above which amputation was not required could not be defined. Primary healing was achieved in 139 of 164 patients (85%) with a toe pressure level greater than 45 mmHg, whereas 43 of 117 patients (36%; P less than .001) healed without amputation when toe pressure was less than or equal to 45 mmHg. In conclusion, a combination of ankle and toe pressure measurements is a useful tool to predict primary healing in diabetic foot ulcers.

Aged↗
PubMed1989

Lipid peroxidation products in postischemic skeletal muscle and after treatment with hyperbaric oxygen.

Earlier studies from our laboratory have shown that hyperbaric oxygen (HBO) treatment reduces edema, enhances aerobic metabolism and improves the recovery of the phosphorylase activity in postischemic rat skeletal muscle. However, as it has become increasingly apparent that oxygen in excess may have harmful effects, it was of interest to study if HBO caused an increased formation of oxygen free radicals. Toxic peroxides, as a result of oxygen free radicals, were quantitated in the postischemic skeletal muscle of rat and with HBO treatment by measuring the thiobarbituric acid reaction which includes the lipid peroxides and the alkydes including malondialdehyde (MDA), a key intermediate in the formation of peroxides. A tourniquet model of temporary ischemia of the rat hindlimb was used for 3 hours. Muscle biopsies were taken at various intervals before and after tourniquet release with and without hyperbaric oxygen at 2.5 atmospheres absolute (ATA) for 45 min after tourniquet release. Three hours of anesthesia caused a significant rise of thiobarbituric acid reactive material (TBAR) concentration in muscle compared to normal controls without anesthesia. An increase of similar magnitude was seen after 3 hours of ischemia, with or without reperfusion. These values were normalized after 45 min. HBO in the postischemic phase did not cause a further increase in the TBAR concentration in muscle immediately postischemically. However, the levels remained increased at 45 min after the onset of reperfusion, immediately after HBO treatment and had returned to normal values 2 hours postischemically.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1989

Late sequelae of central pancreatic necrosis. Case report.

Three cases of complete central pancreatic atrophy following acute pancreatitis are described. The isolated pancreatic tail did not regress, but continued to secrete pancreatic juice through a chronic fistula or recurrent pseudocyst. To our knowledge this clinical entity has not previously attracted attention in the literature.

Acute Disease↗
PubMed1988

The use of prediction models for eliminating effects due to regression-to-the-mean in road accident data.

In recent years, various methods have been proposed for estimating the true accident level, i.e. the expected number of accidents m when a total of x accidents have been observed at a junction, road section, etc., during a certain period of time. One such method has been named the Empirical Bayes Method (EB method). A description is given of a variant of the EB method utilizing prediction models for the number of accidents. Input data to the prediction models may consist, for example, of traffic flows in a junction. According to empirical comparisons of accidents in junctions, this variant of the EB method may be preferable in certain cases to the conventional EB method. However, it has not yet been determined how this variant of the EB method should generally take into account the precision of the prediction models. This means, for example, that in a nonexperimental before-and-after study of the effect of a particular action, varying results may be obtained according to the assumptions made concerning the precision of the prediction model.

Accident Prevention↗
PubMed1988

Effects of hyperbaric oxygen treatment in post-ischemic muscle. A quantitative morphological study.

In the post-ischemic muscle, hyperbaric oxygen (HBO) treatments have been shown to reduce post-ischemic edema and enhance aerobic metabolism. In the present paper histological, histochemical and ultrastructural methods were used to study the influences of HBO treatment on the morphology of post-ischemic skeletal muscle. The changes were also quantified using morphometry. The circulation of the rat hindlimb was interrupted for 3 hours and muscle biopsies were taken 5 and 12 hours post-ischemia. Light microscopy showed signs of ischemic changes in the muscle. Morphometrically, the area with activity of the muscle enzyme phosphorylase was greatly reduced post-ischemia. HBO treatment at 2.5 atmospheres of absolute pressure (ATA) for 45 min significantly increased muscle cross sectional area with a positive phosphorylase reaction 5 hours post-ischemia. Three HBO treatments were necessary to maintain this effect, 12 hours post-ischemia. Ultrastructurally, the ischemic changes seen using light microscopy were confirmed. Morphometrically, there was a significant increase of mitochondrial size in the ischemic muscle compared with the control uninjured muscle but HBO did not markedly reduce these ultrastructural changes. It was concluded that the reduction of phosphorylase activity, a sensitive marker for muscle cell damage, is to a great extent prevented by HBO treatment in the post-ischemic phase.

Animals↗
PubMed1988

Muscle changes in work-related chronic myalgia.

Muscle biopsies from the descending portion of the trapezius muscle were studied in 9 healthy subjects and in 10 patients with localized chronic myalgia related to static load during repetitive assembly work for 16 (10-31) years, with 10 (4-26) months of sick leave at the time of biopsy. Both categories showed isolated atrophic muscle fibers and occasional abnormal fibers with internally situated nuclei, some variation in fiber diameter, and fiber splitting. Fibers with a "moth-eaten" appearance due to a multifocal loss of oxidative enzyme activity were frequent both in the healthy and in the myalgic individuals. In contrast, isolated pathologic "ragged red" fibers were only found in the cases with myalgia (8 of 10), strongly suggesting mitochondrial damage. The phenomenon was confined to the Type 1 fibers. The frequency of Type 1 fibers was increased. Levels of adenosine triphosphate and adenosine diphosphate were reduced in myalgia patients, whereas lactate, pyruvate, and glycogen levels were normal, as well as phosphoryl creatine and total creatine.

Adult↗