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Biomedical subjects

J Wikström

Publications and source records attributed to J Wikström.

At least 37 records · Page 2Linked to original sources
PubMed1993

Reappraisal of HLA in multiple sclerosis: close linkage in multiplex families.

Although association between multiple sclerosis (MS) and HLA-DR2,DQw6 has been well documented, family studies have not established linkage to HLA. Here we have (1) carried out an HLA-DQA1, -DQB1 association study in unrelated patients and controls, and (2) analyzed linkage between MS and HLA in multiplex families using both nonparametric and parametric methods. The subjects and families were derived from the genetically homogeneous Finnish population, and 14 of the 21 families came from a high-risk area with exceptional familial clustering of cases. In the association study, the frequencies of the alleles DQA1*0102 and DQB1*0602 (encoding DR2-associated DQw6 antigen) were significantly increased in MS patients compared to controls. In the families, we observed that the segregation of MS with DQA1*0102 and DQB1*0602 was not HLA haplotype specific, i.e., these alleles were frequently transmitted to MS relatives on different parental haplotypes. Consequently, we found strong evidence for linkage between MS and HLA only when the haplotype-independent segregation of the MS-associated alleles was controlled. This observation may partially explain the lack of linkage evidence in previous family studies. The highest LOD scores were obtained to the DQA1 locus (LODmax = 6.43, theta = 0.00). The linkage analyses suggest that both the patients' HLA haplotypes may contribute to MS susceptibility. In one of a patient's haplotypes, the susceptibility locus was closely associated with DQA1*0102 and DQB1*0602, whereas in the other haplotype no association with any of the individual candidate loci was found. These results demonstrate, for the first time, a close linkage between MS and HLA, and raise the possibility of distinct HLA-linked susceptibility genes in MS.

Base Sequence↗
PubMed1993

Effect of operative choledochoscopy after choledocholithotomy on the incidence of retained stones.

OBJECTIVE: To see whether the introduction of operative choledochoscopy would lower the incidence of retained stones in the common bile duct. DESIGN: Retrospective study. SETTING: Mora Hospital, Mora, Sweden. SUBJECTS: 176 patients who underwent exploration of the common bile duct from 1984-1991. INTERVENTIONS: After exploration of the common bile duct, 109 of the 176 patients underwent choledochoscopy; the remaining 67 had the choledochotomy closed over the T-tube, and an operative cholangiogram done. RESULTS: Six of the 109 patients (6%) who have had common bile duct exploration followed by choledochoscopy were found to have residual stones and in 1 of those 6 no stones had been found on the exploration of the duct. Ten of the 67 patients (15%) who had choledocholithotomy followed by an operative cholangiogram had residual stones, and in two of those no stones had been found on exploration. The annual frequency of choledochoscopy after exploration of the common bile duct increased from 50% to 80% over the period. CONCLUSION: We recommend that operative choledochoscopy should always be done after exploration of the common bile duct to reduce the incidence of retained stones.

Endoscopy, Digestive System↗
PubMed1992

Genetic susceptibility to multiple sclerosis linked to myelin basic protein gene.

Genetic factors have been implicated in the aetiology of multiple sclerosis (MS), but the genes conferring susceptibility to MS have not been identified. We carried out genetic linkage and association analyses by studying polymorphism of the myelin basic protein (MBP) gene on chromosome 18, a candidate gene for MS, in 21 MS families, 51 additional unrelated patients with definite MS, and 85 controls. All subjects were Finnish, and 14 of the families were from an area with an exceptional familial clustering of MS. Magnetic resonance imaging (MRI) was used to examine subclinical disease in symptom-free family members. In the association analysis, the allele frequencies between MS patients and controls differed significantly, p = 0.000049), the difference being attributable mainly to a higher frequency of a 1.27 kb allele among patients. In the linkage analysis, based on an autosomal dominant model and penetrance 0.05, a maximum LOD score of 3.42 (theta = 0.00) was obtained when patients with optic neuritis and their symptom-free siblings with abnormal MRI findings were classified as "affected". When these subjects were classified as "unknown" the maximum LOD scores ranged from 2.99 to 3.25 (theta = 0.00). The results suggest that in this population genetic predisposition to MS is closely linked to the MBP gene and that polymorphism at the MBP locus or an adjacent locus has a role in the aetiology of MS.

Adult↗
PubMed1992

Familial multiple sclerosis: MRI findings in clinically affected and unaffected siblings.

Subclinical demyelinating lesions may occur in the brains of asymptomatic individuals, and the first-degree relatives of multiple sclerosis (MS) patients are at particular risk. Clinical and MRI examinations were performed in nine sibships from families with two or more cases of MS. These included 14 patients with clinically definite MS, three patients with clinically probable MS, and 27 asymptomatic siblings. Systematic criteria were applied to MRI interpretations to increase their specificity for MS. Thirteen (76%) of the 17 patients with MS showed lesions suggesting MS. Lesions were also found in six (38%) of the 16 asymptomatic siblings under age 50 and in eight (73%) of the 11 over age 50. Judged by stringent criteria, the lesions of only three (11%) of the 27 asymptomatic siblings were considered to be due to demyelination. The results demonstrate the occurrence of subclinical demyelination in asymptomatic siblings of MS patients and stress the importance of clinical follow up and MRI studies of the first-degree relatives when classifying them as healthy in family studies.

Adult↗
PubMed1989

Primary survival and prosthetic fitting of lower limb amputees.

During the period 1984-1985 amputation of the lower limb at a level potentially requiring a prosthesis was performed on 577 patients in 16 operative units. The mean age was 75.7 years for females and 68.1 for males. The most common site of the amputation was above the knee (49.9%). The majority of amputations (93.8%) were performed for vascular diseases and diabetes. Survival figures showed that 25.5% of amputees died within 2 months of amputation, 60.7% were alive after one year and 43.2% after two years. Out of a total of 577 patients, 26.9% were fitted with a prosthesis. Out of below-knee and above-knee amputees surviving over 2 months, 61.5% and 27.2% respectively were fitted with a prosthesis. There were markedly fewer prosthetic fittings in the over-60 age group. Diabetic patients of both sexes were fitted with a prosthesis more often than arterio-sclerotic patients. Among tumour patients 82.4% received a prosthesis. In the study area more emphasis must be put on the concept of preserving the knee joint and preoperative assessment of vascular patients for selection of amputation level. Every effort must be made to avoid delay in the postoperative mobilization and rehabilitation. Prosthetic fitting of amputees could be improved by better liaison between surgical unit and specialized rehabilitation unit and by closer team approach of amputee care.

Aged↗
PubMed1988

A follow-up study of very low field MRI findings and clinical course in multiple sclerosis.

Seventy-three consecutive patients with definite multiple sclerosis (MS) were examined with very low field (0.17 and 0.02 tesla) magnetic resonance imaging (MRI) of the brain. Fifty-seven patients were examined a second time after 6 months, 41 patients a third time after 1 year, and 25 patients a fourth time after 2 years. The initial finding was abnormal in 57/73 patients (78%). The number of lesions increased with age, duration of disease, and increasing disability. Plaques were more numerous in progressive than in remitting MS. Of the patients with abnormal MRI 65% had more than 3 lesions, and in 82% lesions were smaller than 2.5 cm in diameter. After follow-ups of 1 year and 2 years the size of MRI lesions remained unchanged in 55% and 64%, respectively. Unchanged plaque numbers were found in 72% and 60%. Unchanged MRI was most common among patients with remitting MS who were in a stable phase. Decrease in size and disappearance of plaques correlated well with clinical remissions. Increase in size was rare even during relapses. New plaques could appear during all phases of clinical course although they reflected better a relapse of remitting or progressive disease.

Adult↗
PubMed1988

Dementia in medical wards.

Patients aged 65 years and over admitted to one Department of Medicine in a University Hospital were evaluated for the frequency and types of dementia, and for the greater workload caused by the demented patients to the hospital. The frequency of moderate and severe dementia among consecutively admitted medical inpatients (N = 282) of all age groups was 12.1%. In the age-group 65-69 years it was 5.7%, and among the patients aged 80 and over 20.7%. Of all the patients at the wards in a one-day sample (N = 85), 40% were moderately or severely demented. Patients with vascular dementia constituted 69.4%, those with primary degenerative dementia 16.1%, and those with dementia due to specific causes 14.5% of all demented patients. The demented patients needed more daily nursing care and their mean hospitalization time was longer than that of the non-demented patients.

Aged↗
PubMed1987

Short Portable Mental Status Questionnaire as a screening test for dementia and delirium among the elderly.

Pfeiffer's Short Portable Mental Status Questionnaire (SPMSQ) is a brief screening test for organic brain syndromes. The validity of the SPMSQ was evaluated in a random sample of 119 community residents and 282 consecutively admitted medical inpatients. The SPMSQ proved to be a sensitive and specific screening test for moderate to severe dementia both in the community and hospital. Using the cut-off point (number of errors accepted) of three errors, the sensitivity of the test was 86.2% and the specificity 99.0% among medical inpatients. The percentages in the community sample were 66.7% and 100%, respectively. The validity of the SPMSQ was not as good for delirium because of its variable clinical picture. For screening purposes lower cut-off points than previously recommended should be used: three errors for dementia and two errors for delirium. Among Finnish elderly people it was not necessary to use correction for education in the SPMSQ.

Aged↗
PubMed1986

Dementia among medical inpatients. Evaluation of 2000 consecutive admissions.

Two thousand consecutive patients aged 55 years and older admitted to a department of medicine in a large university hospital were examined for the presence of dementia. The occurrence of moderate and severe dementia was 9.1% for all age groups. It increased from 0.8% in the age group from 55 to 64 years to 31.2% in patients aged 85 years and older. Of the demented patients, 41.4% were delirious at admission, and 24.9% of all delirious patients were demented. Patients with vascular dementia constituted 72.4%, those with primary degenerative dementia 23.0%, and those with specific causes 4.6% of all demented patients. The mean hospitalization time for demented patients was significantly longer, and they needed significantly more daily nursing care, when compared with nondemented patients.

Aged↗
PubMed1985

Prevalence of severe dementia in Finland.

A sample of 8,000 subjects to represent the population of Finland aged 30 years and over was used to identify patients with severe dementia; 141 cases were found. The prevalence of all types of severe dementia was 1.8% in the whole study population and 6.7% in the population aged 65 years and over. The prevalence increased with advancing age to 17.3% in the age group 85 years and over. Primary degenerative dementia constituted 50% of all cases; multi-infarct and combined dementia, 39%; and secondary dementia, 11%. Fifty-seven percent of the patients lived in institutions.

Adult↗
PubMed1984

Histocompatibility antigens in familial multiple sclerosis in a high-risk area of the disease.

Fourteen Finnish families, each with two or more cases of multiple sclerosis (MS), were analysed for HLA antigens. Seventy family members were studied. They were all born in a high-risk area of MS and came from families with an unusually high frequency of MS. The frequencies of B7, B12 and DR2 were increased both in patients and their healthy relatives, whereas A1, B8 and DR1 were decreased in patients. MS patients shared the HLA haplotypes more often than expected.

Disease Susceptibility↗
PubMed1983

The epidemiology of multiple sclerosis in Finland: increase of prevalence and stability of foci in high-risk areas.

Reliable data on the epidemiology of multiple sclerosis (MS) in Finland are available from 1964 and 1972. They show that the whole country is a high-risk area of MS with clustering in the western part. A reassessment of the prevalence data was carried out in the southern province of Uusimaa and in the western province of Vaasa, the prevalence day being January 1, 1979. The age-adjusted prevalence was 52.9 per 100,000 in Uusimaa and 92.9 per 100,000 in Vaasa, figures that were three times higher than those recorded for the same areas in 1964. The communities with the highest prevalence rates in the province of Vaasa were the same as those in the survey of 1972; some rates exceeded 200 per 100,000. The increase in the prevalence rates may be due to a better registration of MS cases, but it may also represent a true increase, a possibility that only can be answered by further incidence studies.

Adolescent↗
PubMed1983

Accuracy of clinical diagnosis in primary degenerative dementia: correlation with neuropathological findings.

Neuropathological features and causes of death are presented in 27 deceased patients belonging to a prospective series of 71 hospitalised patients with primary degenerative dementia. The clinical criteria for primary degenerative dementia used in the present study were accurate enough to exclude patients with multi-infarct dementia. At necropsy, 82% of the cases had neuropathological changes of Alzheimer's disease. The clinical features of patients with other neuropathological changes are described. The most common immediate cause of death was bronchopneumonia which accounted for 59% of deaths in Alzheimer's disease.

Aged↗
PubMed1982

Classic amyotrophic lateral sclerosis with dementia.

Documented cases of classic amyotrophic lateral sclerosis (ALS) combined with severe dementia are few and come from the isolated populations of the Western Pacific. In this report, three women had a clinically and neuropathologically documented combination of ALS and dementia. In all cases the symptoms and signs of ALS were mainly bulbar. In two of them dementia appeared first, followed by ALS. At autopsy, there was a marked discrepancy between the severe degree of dementia of Alzheimer's type and the sight nonspecific neuropathologic findings without Alzheimer's changes. Our cases bear a close resemblance to recently published Japanese cases. It may be concluded that the combination of sporadic ALS and progressive dementia seems to be a clinical entity without consistent neuropathologic changes and that it also occurs in the western countries.

Aged↗
PubMed1981

[Endocrinological findings in patients with multiple sclerosis (author's transl)].

In 15 patients with multiple sclerosis about half of the patients showed decreased gonadotropin and estrogen values in the urine. A control examination of these findings in 19 additional patients showed normal plasma FSH and LH values. Except for one slightly elevated value the prolactin levels were normal in this group.

17-Ketosteroids↗