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Biomedical subjects

L Wallin

Publications and source records attributed to L Wallin.

At least 19 recordsLinked to original sources
PubMed1992

The effect of graded activity on patients with subacute low back pain: a randomized prospective clinical study with an operant-conditioning behavioral approach.

The aim of this study was to determine whether graded activity restored occupational function in industrial blue-collar workers who were sick-listed for 8 weeks because of subacute, nonspecific, mechanical low back pain (LBP). Patients with LBP, who had been examined by an orthopedic surgeon and a social worker, were randomly assigned to either an activity group (n = 51) or a control group (n = 52). Patients with defined orthopedic, medical, or psychiatric diagnoses were excluded before randomization. The graded activity program consisted of four parts: (1) measurements of functional capacity; (2) a work-place visit; (3) back school education; and (4) an individual, submaximal, gradually increased exercise program, with an operant-conditioning behavioral approach, based on the results of the tests and the demands of the patient's work. Records of the amount of sick leave taken over a 3-year period (ie, the 1-year periods before, during, and after intervention) were obtained from each patient's Social Insurance Office. The patients in the activity group returned to work significantly earlier than did the patients in the control group. The median number of physical therapist appointments before return to work was 5, and the average number of appointments was 10.7 (SD = 12.3). The average duration of sick leave attributable to LBP during the second follow-up year was 12.1 weeks (SD = 18.4) in the activity group and 19.6 weeks (SD = 20.7) in the control group. Four patients in the control group and 1 patient in the activity group received permanent disability pensions. The graded activity program made the patients occupationally functional again, as measured by return to work and significantly reduced long-term sick leave.

Absenteeism↗
PubMed1992

Mobility, strength, and fitness after a graded activity program for patients with subacute low back pain. A randomized prospective clinical study with a behavioral therapy approach.

Patients with nonspecific mechanical low back pain (n = 103), examined by an orthopaedic surgeon and a social worker, were randomized to an activity group (n = 51) and a control group (n = 52). Patients with defined orthopaedic, medical, or psychiatric diagnoses were excluded before randomization. No patients were excluded due to place of birth or difficulties in speaking or understanding the Swedish language. The purpose of the study was to compare mobility, strength and fitness after traditional care and after traditional care plus a graded activity program with a behavioral therapy approach. A graded activity program, with a behavioral therapy approach was given under the guidance of a physical therapist. The endpoint of the graded activity program was return to work. This program significantly increased mobility, strength, and fitness more than could be explained by only a time recovery effect, especially in males. The patients in the activity group returned to work earlier than did the patients in the control group. Spinal rotation, abdominal muscle endurance time and lifting capacity were significantly correlated to rate of return to work. Traditional care plus a graded activity program were superior to only traditional care, evaluated in terms of mobility, strength and fitness. The graded activity program proved to be a successful method of restoring occupational function and facilitating return to work in subacute low back pain patients. The patients in the graded activity program learned that it is safe to move, while regaining function.

Back Pain↗
PubMed1991

Twelve hour overnight oesophageal pH monitoring in patients with reflux symptoms.

Results of continuous 12 hour overnight pH monitoring (duration of pH less than 4) were reviewed in 112 patients with heartburn or regurgitation, or both, and in 56 normal subjects. Patients had more reflux than normal subjects. Medically controlled patients (n = 51) had less acid reflux than patients who subsequently underwent reflux surgery (n = 61), but there was a considerable overlap between those two groups. Surgery was followed by a reduction in acid reflux to a value similar to that in normal subjects. Patients in whom surgery was deemed to have failed had more reflux after the operation than those in whom it was successful, but no difference could be found in the preoperative reflux values of these two subgroups. Monitoring pH is not of value in selecting candidates for surgery since the results are not a good predictor of outcome, but it is useful in the objective evaluation of surgical results.

Esophagus↗
PubMed1991

Ambulatory 23 hour recording of intraoesophageal pressures in normal volunteers: a propagation analysis from one proximal and two distal recording sites.

pH data were obtained from one level and pressure data from three levels in the oesophagus over 23 hours in 24 healthy volunteers, followed by automatic propagation analysis of motility data and analysis of time with pH less than 4. Apart from periods of meal ingestion, isolated pressure complexes were found more frequently in the distal than in the proximal oesophagus. This was especially common in the recumbent position at night. Most contractions of the proximal oesophagus were propagating. In the distal oesophagus were propagating. In the distal oesophagus propagating pressure waves were more frequent during the day than during the night and most frequent during meals. The state of consciousness rather than body position per se is important in determining the frequency of simultaneous contractions in the distal oesophagus.

Adult↗
PubMed1990

Steroid sex hormones and cardiovascular function in healthy males and females: a correlational study.

The relationship of serum estradiol and testosterone levels to systolic (SBP) and diastolic blood pressure (DBP) and heart rate (HR) was examined in healthy nonsmoking males (n = 30) and females (n = 22), 30-50 years of age (mean age for men = 41.2, women = 39.9). Postmenopausal women and women taking oral contraceptives had been excluded. Testosterone levels in women were positively correlated with SBP, DBP and HR, after removing the effects of age and body mass. Positive correlations were also found between estradiol and SBP and HR in women. No systematic relationships were found between steroid sex hormones and cardiovascular measurements in men. The findings suggest a role of steroid sex hormones in cardiovascular function of women, whereas the relationship in men is less clear.

Adult↗
PubMed1990

Reflux patterns and related oesophageal motor activity in gastro-oesophageal reflux disease.

Simultaneous intraoesophageal pH and pressure monitoring were performed for 12 hours in 20 patients with abnormal acid gastrooesophageal reflux or oesophagitis and in 10 healthy volunteers to determine characteristic reflux patterns with time. Increased acid exposure was not the only factor that characterised patients with oesophagitis. Indeed an overlap existed between patients with and without oesophagitis regarding total acid exposure time. Patients with oesophagitis suffered reflux nearly as much at night and in the morning as during the postprandial period. They also had as much reflux as a result of small and slow changes in pH around the pH limit of 4 as they had due to proper reflux episodes. This did not change over time after the postprandial period. More 12 hour acid exposure was related to more frequent night time reflux. In normal subjects compared with patients reflux triggered increased contractile activity, and contractile activity at a normal pH was greater in patients than in normal subjects.

Adult↗
PubMed1990

Recombinant leukocyte interferon alpha-2a and medroxyprogesterone in advanced renal cell carcinoma. A randomized trial.

In a randomized study of advanced renal cell carcinoma 60 patients were allocated to treatment with either recombinant interferon alpha-2a or medroxyprogesterone acetate. Correlation between the dose of interferon alpha-2a and plasma-concentration indicated linear kinetics. Survival was similar in the two treatment groups. Only one complete and one partial response were seen in the interferon group and only one complete response in the medroxyprogesterone group, indicating a low therapeutic potential of both interferon and medroxyprogesterone. Interferon influenced the serum liver enzyme levels; increased transaminases were seen in 17 patients treated with interferon but in only four patients in the medroxyprogesterone group. Two patients had very high serum liver-enzyme levels concomitant with intolerable tiredness, in both patients the symptoms disappeared and the enzymes normalized after discontinuation of the interferon treatment. Antibodies to interferon developed frequently in patients receiving high dose oligomeric interferon therapy but rarely in patients receiving low dose monomeric interferon treatment.

Adult↗
PubMed1990

The loads on the lumbar spine during work at an assembly line. The risks for fatigue injuries of vertebral bodies.

This study was performed in an attempt to determine the total spinal compressive load during assembly line work to find a possible association with the many complaints of back pain. A flexion analyzer was used to register trunk movements, and analysis of postures and lifted weights was done from video recordings. The load on the spine at the L3 level was calculated through a biomechanical model, meant for analysis of static, sagittally symmetric postures and lifting tasks. Maximum lift tests were performed before and after a full work day. The peak load on the L3-L4 level when lifting corresponded to an average 22% of the load at the lift test. The mean load during a work cycle was 818 N. It was concluded that the many complaints of back pain could not be attributed to high peak loads, repetitivity of the lifts, or large load doses. Monotony, stress, and low job satisfaction are more likely factors of greater importance.

Adult↗
PubMed1989

Blood lipids as related to cardiovascular and neuroendocrine functions under different conditions in healthy males and females.

Correlations were calculated between, on the one hand, total serum cholesterol, low-density (LDL) and high-density (HDL) lipoprotein cholesterol, and triglycerides, and, on the other hand, systolic (SBP) and diastolic blood pressure (DBP), heart rate (HR), urinary epinephrine, norepinephrine, and cortisol in 30 healthy males and 30 healthy females, aged 30-50. The cardiovascular and neuroendocrine measurements were obtained under different real-life and laboratory conditions. The most striking finding was that, in men, but not in women, total serum cholesterol was significantly positively correlated with SBP in all conditions (LDL and HDL cholesterol followed the same pattern). In women, but not in men, epinephrine and norepinephrine during laboratory-induced mental stress were significantly positively correlated with total cholesterol, LDL and triglycerides.

Adult↗
PubMed1989

Fluorescein angiography and distal arterial pressure in patients with arterial disease of the legs.

Fluorescein angiography (FA) of the foot soles was performed in 119 patients with arterial disease of the legs. Fluorescein was injected rapidly intravenously and sequential photographs were taken of the foot soles. Densitometric measurements were performed on three areas of each foot image: the big toe, the foot pad (just proximal to the little toe) and the heel. The relationships between different FA measurements and systolic arterial pressure in the ankle or the big toe were analysed. The appearance times of fluorescence correlated inversely with ankle pressure (P less than 0.001). The initial slopes of the fluorescence-time curves at all three sites of measurement correlated with ankle pressure (P less than 0.001). The initial slopes of fluorescence-time curves of the big toe and the foot pad correlated with toe pressure (P less than 0.001). In 12 patients effective arterial pressure was lowered by elevation of the feet, and in eight patients external pressure was applied to the foot by enclosing it in a box. The changes in FA evoked by these manoeuvres further strengthened the relationship between arterial pressures and FA measurements. We conclude that FA is a good method for evaluating circulation in the foot when neither ankle nor toe pressure is obtainable. In addition, FA may be useful when vascular disease is suspected in the presence of normal pressures, because the fluorescence distribution pattern was clearly abnormal in 11 of 16 such feet.

Adult↗
PubMed1989

Fluorescein angiography for predicting healing of foot ulcers.

Fluorescein angiography (FA) was performed on 83 patients (68 diabetics) with foot ulcer or gangrene. Densitometric measurements were made on the FA images, and different FA parameters were defined. These parameters, as well as systolic ankle and toe blood pressures, were evaluated for predicting the future course, i.e., whether healing would occur or whether major amputation below or above the knee had to be performed. The toe slope (i.e., the rate of increase of fluorescence on the big toe during the first 10 seconds after its appearance on the toe) predicted healing correctly in 0.83 and major amputation in 0.88. The ankle and toe pressures had only slightly lower predictive value. The combination of ankle pressure and toe slope predicted healing correctly in 0.91 and major amputation in 0.88. When ankle pressure cannot be measured, FA is the method of choice. Further, FA provides information on regional blood flow unobtainable by any other method.

Adult↗
PubMed1979

The influence of cimetidine on basal gastro-oesophageal sphincter pressure, intargastric pH, and serum gastrin concentration in normal subjects.

A pressure and pH-sensitive probe has been constructed for simultaneous measurement of gastro-oesophageal sphincter pressure and intragastric pH. The coefficient of variation for measurements of the gastro-oesophageal sphincter was 0.24, and for the intragastric pH, 0.09. After peroral ingestion of 400 mg of cimetidine or placebo, simultaneous measurements of gastro-oesophageal sphincter pressure and intragastric pH were made at fixed time intervals, and at the same time blood samples were taken for determination of serum gastrin and serum cimetidine concentrations. No demonstrable difference was found in the time-course of the gastro-oesophageal sphincter pressure after ingestion of cimetidine or placebo. After ingestion of cimetidine a significant rise in intragastric pH (p less than 0.05) occurred after 40 min, and this increased pH was maintained for the remainder of the experimental period, corresponding to a serum cimetidine concentration of over 1.00 mg/l. Similarly, there was a significant rise (p less than 0.05) in serum gastrin concentration after 150 min. There was a significant direct correlation between corresponding measurements of intragastric pH and serum gastrin (p less than 0.001), between intragastric pH and serum cimetidine (p less than 0.001), and between serum gastrin and serum cimetidine (p less than 0.05). Ingestion of cimetidine results in an increase in the serum gastrin concentration in healthy subjects, presumably as a result of reduced secretion of acid in the stomach. Neither the endogenous increase in serum gastrin concentration nor the increase in intragastric pH causes alteration in the gastro-oesophageal sphincter pressure.

Adult↗
PubMed1979

12-Hour simultaneous registration of acid reflex and peristaltic activity in the oesophagus. A study in normal subjects.

Twelve-hour simultaneous registration of acid gastro-oesophageal reflux and peristaltic activity in the oesophagus was carried out on 30 healthy subjects. The intensity of the acid gastro-oesophageal reflux was determined by automatic integration of the pH variation. Acid gastro-oesophageal reflux to pH less than or equal to 4 occurs in normal subjects within a range of 0--2.4% of the total registration period. The intravariation was measured in 10 investigations on 1 subject, and lay within the intervariation. To maintain the pressure-measuring system intact, 3 ml H2O/h were fed to the proximal and distal pressure catheters, respectively; it has been shown that this small quantity of water has no influence on the pH variation. Peristaltic activity for the entire measuring period was recorded and related to the individual reflex episodes. The total activity was found to be dependent on the level of consciousness, with little activity occurring during sleep. A positive correlation was found between the lowest pH during a reflux episode and the peristaltic activity in the oesophagus (p less than 0.001), between the lowest pH during a reflux episode and the duration of the reflux episode (p less than 0.001), and between the peristaltic activity and the duration of the reflux episode (p less than 0.001). During long-term registration of oesophageal pH it appears that pH less than or equal to 4 is a usable parameter for distinguishing between pathological and non-pathological acid gastro-oesophageal reflux. Sudden falls in pH to below 4 release increased peristalsis in the oesophagus.

Adult↗