Biomedical subjects
Publications and source records attributed to M Larsson.
A method has been devised for coupling cysteine-containing peptides to pre-formed immune stimulating complexes (iscoms). Four different peptides were used and the peptide-iscom conjugates were evaluated as immunogens in mice. It was demonstrated that highly immunogenic peptide-iscom conjugates can be prepared provided that the peptides are successfully linked to the carrier iscoms.
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Cyclosporin A (CyA)-induced nephrotoxicity is still a serious clinical problem. The nephrotoxicity seems to be more pronounced when CyA (solubilized in water with Cremophore EL, as in Sandimmun) is given intravenously than when it is given orally. Using soybean oil in which CyA was dissolved, we prepared an intravenous fat emulsion without an artificial detergent, such as Cremophore EL. The renal effects of our new formula were compared with those of Sandimmun and Cremophore EL in a rat model. CyA in the fat emulsion did not significantly affect the glomerular filtration rate (GFR). Both Sandimmun and Cremophore EL significantly reduced the GFR. These results suggest that a change in the vehicle may obviate the acute nephrotoxic side effects caused by intravenous administration of CyA solubilized by Cremophore EL.
The results following primary and delayed primary repair in zone 2 flexor tendon injuries were evaluated in 85 fingers of 79 patients using immediate controlled mobilization post-operatively. In 31 patients a conventional Kleinert technique was used. In the remaining 48 patients a modified technique was used with rubber band traction to all fingers instead of only to the injured one. Also a shorter dorsal splint was used in order to secure extension of the PIP and DIP joints. The results were improved and the time of treatment was reduced.
Young, young-old, and old adults were examined in immediate and delayed episodic recognition of common odors. Items were presented in 3 different formats: name-only, odor-only, or odor-name. Ss made familiarity ratings for all items at study. In the delayed recognition test, Ss were asked to name the odors. Young Ss outperformed the 2 older age groups in both recognition tests, although the 2 older groups did not differ. Performance was higher in the odor-name condition than in the single-format conditions. Both familiarity and naming were related to recognition in all age groups. Most important, when naming was statistically controlled, age differences in odor recognition disappeared, suggesting that access to verbal labels largely determine age differences in recognition of common odors. Finally, the finding that recognition was enhanced in both young and older Ss in the odor-name condition suggests that odor memory may involve a similar degree of plasticity as other varieties of episodic memory.
Cerebrospinal fluid (CSF) neopterin levels were determined by RIA in individuals with central nervous system (CNS) or human immunodeficiency virus (HIV) infections and in healthy controls. The mean CSF neopterin concentrations were 63.0 nmol/L in 15 patients with acute bacterial meningitis, 54.9 nmol/L in 15 patients with Lyme neuroborreliosis, 32.5 nmol/L in 10 patients with viral meningitis, 130.9 nmol/L in 8 patients with viral encephalitis, 13.9 nmol/L in 15 patients with asymptomatic HIV infection, 26.0 nmol/L in 11 patients with AIDS without dementia, 65.4 nmol/L in 4 patients with AIDS dementia, and 4.2 nmol/L in 24 healthy controls. Although patients with viral encephalitis had higher mean neopterin levels than any other patient category studied, the CSF neopterin concentrations cannot be used to discriminate between viral and bacterial infections. Analysis of CSF levels of neopterin may be useful as guidance in following clinical course and effect of treatment and can provide information of value in addition to CSF cell count as a measurement of CNS immune stimulation.
Peripheral blood dendritic cells (BDC) are potent antigen-presenting lymphoid cells. In the present study, we have examined the in vitro adhesion of BDC to human umbilical cord venous endothelial cells (HUVEC) and studied the expression of CD molecules and oligosaccharide haptens on BDC and endothelial cells. Immunohistochemistry showed that BDC were strongly positive for antibodies against HLA-DR, CD11c, CD18, CD44 and CD54, and moderately positive for anti-CD11a, CD31, CD43 and CD58. In addition, BDC were moderately positive for anti-Sialyl Lewis a and strongly positive for anti-Sialyl Lewis x and CD77 (Gal alpha 1-4Gal beta 1-4Glc) Non-stimulated HUVEC were positive for anti-CD29, CD31 and CD77. An in vitro adhesion assay showed that only a small percentage of radiolabelled BDC bound to non-stimulated HUVEC (16.9 +/- 5.9%, mean +/- SD). Stimulation of the HUVEC with IL-1 for 4 h produced a significant increase (P < 0.002) in the percentage of radiolabelled BDC that bound to HUVEC (42.3 +/- 7.1%). Preincubation of HUVEC with antibodies against E-selectin (10 micrograms/ml) significantly inhibited (P < 0.02) the binding of radiolabelled BDC to activated HUVEC (32.2 +/- 1.3%) whereas preincubation of BDC with antibodies against CD54, CD18, CD11b, CD11c and Sialyl Lewis x did not produce any significant inhibition. Preincubation of BDC with Sialyl Lewis a antibody and with isotype-matched control antibodies did not affect the increased binding of BDC to IL-1-activated HUVEC. Thus, E-selectin seems to be involved in adhesion of BDC to IL-1-stimulated HUVEC.
The importance of adapting incontinence aids according to the patients leakage volume and comfort was investigated in 28 urinary incontinent 85-year-old men and women who were living at home. The patients incontinence was quantified by a 48-hour pad test and was graded as slight (max. leakage per pad < 5 g; total leakage/48 h < 30 g), moderate (max. leakage per pad 5-15 g; total leakage/48 h 30-70 g) or severe (max. leakage per pad > 15 g; total leakage/48 h > 70 g). Four women had slight urinary incontinence, eight were moderately incontinent and nine were severely incontinent. The corresponding figures for the seven men were as follows: slight, one; moderate, one; severe, five. After the primary assessment, incontinence aids were prescribed based on the measured leakage volumes. The correctly selected and adapted incontinence aid brought the patient better comfort and security. The importance of careful information and instructions how to apply the pad is emphasised. There is also a need to see the patient again at intervals as leakage volumes may vary. Thus, smaller packages of pads should be supplied as the choice of pad may need to be modified. The latter is also important from a financial point of view as the expense of otherwise wasted pads would unnecessarily increase costs.
The aim of the present study was to develop a theoretical understanding of quality of care from a patient perspective, using a grounded theory approach. Thirty-five interviews were conducted with a sample of 20 adult hospitalized patients (mean age: 60 years) in a clinic for infectious diseases. Data were analysed according to the constant comparative method. A model was formulated according to which quality of care can be understood in the light of two conditions, the resource structure of the care organization and the patient's preferences. The resource structure of the care organization consists of person-related and physical- and administrative environmental qualities. The patient's preferences have a rational and a human aspect. Within this framework, patients' perceptions of quality of care may be considered from four dimensions: the medical-technical competence of the caregivers; the physical-technical conditions of the care organization; the degree of identity-orientation in the attitudes and actions of the caregivers and the socio-cultural atmosphere of the care organization. The model is discussed in relation to existing theories in the field.
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A total of 308 major and 519 minor accidents involving 588 patients occurred during one year at a somatic long-term care hospital and its associated nursing homes. In relation to the number of patients, the incidence of accidents was nearly three times higher in the nursing homes than in the hospital. The most prevalent injuries in female patients were fractures and hematomas, while open wounds were more frequent among male patients. Hip fractures were about as common in women as in men, while fractures of the extremities were three times more frequent in women. The majority of the accidents occurred during daytime, in the patient's room and in many cases soon after admission. Most of the injuries were caused by falls and in more than 90% no staff was present. Accidents were reported most frequently in October-December, and least often in July-September. Two thirds of the severely injured had to be transferred to an emergency hospital for surgery or other treatment. Patients who had had major accidents also had a higher mortality rate six months after the accidents as compared to a control group. The medical and functional consequences for the patients were considerable. Measures to reduce the number of accidents among geriatric patients are therefore urgently needed.
Young (mean age = 27.3 years), young-old (mean age = 66.3 years), old (mean age = 74.8 years), and old-old adults (mean age = 84.0 years) learned organizable words and objects with standard instructions or organizational instructions. Immediate and delayed free recall and delayed cued recall were assessed. Results indicated equal cue benefits for all age groups for words, although cue benefits increased with increasing age for objects. Instructions to organize the items enhanced memory only for the old-old adults. Young adults forgot fewer items from immediate to delayed free recall than the older age groups. In addition, organizational instructions affected word recall, but not object recall, for all age groups. Although these data indicate both similarities and differences in patterns of performance among age groups, the overall pattern of outcome suggests an age-related increase in the level of cognitive support required to optimize episodic remembering.
The pharmacokinetics of omeprazole and its metabolites were studied in 8 healthy elderly volunteers using [14C]omeprazole. In another 6 healthy elderly volunteers, the pharmacokinetics of omeprazole were studied using unlabelled drug. Each volunteer received single doses of omeprazole intravenously (20mg) and orally (40mg) as solutions in a randomized crossover design. The plasma concentrations and urinary excretion of omeprazole and metabolites were followed for 24 and 96h, respectively. The results indicate that the average metabolic capacity of omeprazole is decreased in the elderly compared with that found in earlier studies of healthy young individuals. This was reflected in an increase in bioavailability from 56 to 76%, a reduction in mean systemic clearance by approximately 50% (0.25 L/min) and a prolongation of the mean elimination half-life from 0.7 to 1.0h compared with the young. Despite these findings, the considerable overlap in these parameters between young and old volunteers, together with data from previous pharmacodynamic studies and the wide therapeutic range of omeprazole, indicate that dosage reductions are not needed in the elderly.