Biomedical subjects

P Bjerring

Publications and source records attributed to P Bjerring.

At least 19 recordsLinked to original sources

PubMed1997

The flashlamp-pumped dye laser and dermabrasion in psoriasis--further studies on the reversed Köbner phenomenon.

Eleven patients with chronic plaque psoriasis were treated with the flashlamp-pumped pulsed dye laser and 6 of the same patients were at the same time treated by dermabrasion. Complete remissions were observed in 3 patients following laser-treatment and in 5 of 6 after dermabrasion. The observation periods were from 4 to 9 months. Our data suggest that the mechanism of the reversed Köbner phenomenon, which is thought to be responsible for the results of dermabrasion, is partly due to destruction of the dermal papillary vasculature. Partial responses were seen in 6 laser-treated and in one patient treated by dermabrasion. Two patients showed no response to laser treatment. These clinically unsatisfactory results can be explained by the great variety in thickness of plaques and in variability of penetration of the laser light. Measurements of absorption and scattering properties of plaques scheduled for laser treatment could probably allow improvements in the technique by optimizing laser beam diameter and pulse duration as well as wavelength and energy levels. The use of the dye laser is far less traumatic to the patient than dermabrasion.

Adult↗

PubMed1996

Effects of psychologic intervention on psoriasis: a preliminary report.

BACKGROUND: Case reports have indicated that psychologic treatments may have a beneficial effect on psoriasis activity. OBJECTIVE: Our purpose was to further investigate the hypothesis that psychologic intervention has a beneficial effect on psoriasis activity in a blinded, controlled manner. METHODS: Fifty-one patients with psoriasis vulgaris were randomly assigned to a treatment or a control group. Patients in the treatment group participated in seven individual psychotherapy sessions in 12 weeks. Intervention techniques included stress management, guided imagery, and relaxation. The Psoriasis Area Severity Index (PASI), Total Sign Score (TSS), and Laser Doppler Skin Blood Flow (LDBF) of a selected reference plaque was measured in a blinded fashion at baseline (week 0), week 4, week 8, and after treatment (week 12). RESULTS: Slight, but significant, changes in TSS and LDBF were found in the treatment group but not in the control group. When analyses were performed for both groups separately, the treatment group displayed significant reductions for all three psoriasis activity measures, whereas no changes were seen in the control group. CONCLUSION: Our preliminary results suggest that psychologic intervention may have a moderate beneficial effect on psoriasis activity.

Adult↗

PubMed1996

Human mastication modulated by experimental trigeminal and extra-trigeminal painful stimuli.

This paper describes the modulation of human deliberately unilateral mastication by trigeminal and extra-trigeminal standardized painful stimuli. Series with 15 s of gum-chewing before induction of pain, during pain and after pain were quantitatively assessed by jaw-closing muscle electromyography (EMG) and kinematics of the lower jaw. Four different painful stimuli were used: cold stimulation of the frontal region, cold stimulation of the dominant hand, capsaicin stimulation of the hard palate, and pressure pain stimulation of the temporomandibular joint (TMJ). Intensity and quality of perceived pain were rated on visual analogue scales (VAS) and McGill's Pain Questionnaires (MPQ). Analysis of the data showed that frontal cold stimulation was the least painful test and was associated with the fewest changes in masticatory function. Cold stimulation of the hand and palatal capsaicin stimulation caused significant increases in peak amplitudes of EMG bursts from all jaw-closing muscles and faster jaw movements whereas TMJ pressure pain produced significantly lower peak EMG amplitudes. The present results suggest that nociceptive input from different tissues and even extra-trigeminal regions may modulate trigeminal motor function in selective ways. Thus, clinical observations of changes in masticatory function may not always be due to pain in the orofacial region and therefore do not necessitate orofacial treatment.

Adult↗

PubMed1996

Analgesic effect in humans of subanaesthetic isoflurane concentrations evaluated by evoked potentials.

The aim of this study was to see if an analgesic effect of subanaesthetic concentrations of isoflurane could be detected with evoked potentials elicited by nociceptive stimuli. We studied 10 healthy volunteers breathing three steady-state subanaesthetic concentrations of isoflurane (0.08, 0.16 and 0.24 vol% end-tidal). Reaction time, subjective pain intensities and evoked vertex potentials to laser (LEP) and electrical (SEP) stimuli were recorded and compared with auditory evoked potentials (AEP). Compared with baseline, the subanaesthetic concentrations of isoflurane did not change the latencies of the evoked potentials, but caused a significant reduction in the amplitudes of the LEP and SEP at 0.16 and 0.24 vol% and of the AEP at all three concentrations. There were no changes in perceived pain intensity, and isoflurane produced similar reductions in evoked potentials elicited by both nociceptive and non-nociceptive stimuli. The reaction time was increased significantly at 0.24 vol% isoflurane. The results demonstrated that subanaesthetic isoflurane concentrations caused similar changes in evoked potentials with both painful and non-painful stimuli, with no effect on perceived pain intensity.

Acoustic Stimulation↗

PubMed1996

Regional variations in skin perfusion and skin thickness may contribute to varying efficacy of topical, local anaesthetics in neonates.

The national Swedish screening programme for inborn errors of metabolism includes blood sampling from all neonates. Heel lancing has hitherto been the method of choice for these screening tests. Studies have recently been done to find out whether the use of EMLA can alleviate pain caused by heel lancing. EMLA had little, if any effect when applied to the heel of full term babies. Similar results were reported concerning preterm infants. Other authors have found that differences in skin thickness or in skin blood perfusion may influence the effect of EMLA. The aim of this study was to establish whether differences in skin thickness or in skin blood perfusion were present in three regions: the forehead, the dorsum of the hand and the heel. Ten healthy full term neonates were included in the study on skin perfusion. Measurements were made with a laser Doppler flux meter. Twenty-seven healthy full term neonates were included for measurements of skin thickness using a high frequency B-mode ultrasonic meter. The heel skin perfusion was two to three times higher than the skin perfusion at the dorsum of the hand and at the forehead but there was no significant difference when comparing skin thickness of the heel with the dorsum of the hand and the forehead. A rapid clearance of a topically applied local anaesthetic, due to high cutaneous blood flow, may explain why EMLA seems to be of little value when it is applied to the neonatal heel.

Anesthesia, Local↗

PubMed1996

Treatment of ischaemic digital ulcers and prevention of gangrene with intravenous iloprost in systemic sclerosis.

Twelve patients with systemic sclerosis were treated with intravenous infusions of the prostacyclin-stable analogue iloprost 0.5-2.0 ng/kg/min for 6 h from 8 to 13 days. Imminent gangrene was stopped in 2 patients and followed by healing. In 4 of 6 patients iloprost led to complete healing of ischaemic ulcers and in the remaining 2 patients to partial healing. One patient with severe Raynaud's phenomenon discontinued the study after 3 days due to severe headache. The 2 remaining patients with Raynaud's phenomenon as an indication improved, while no improvement was recorded in a patient with vasculitis of the lower leg. Side-effects such as headache, nausea and flushing were the reason that only 5 patients reached the maximum infusion rate. No statistical differences were recorded in digital bloodflow before and after the study or in plasma endothelin in the 9 patients investigated. Three of the 6 patients with healing ulcers, however, showed a pronounced decrease in plasma endothelin. Iloprost appears useful as a treatment of imminent gangrene and ischaemic ulcers in systemic sclerosis. This reparatory capacity could also be of a more general importance in therapy of this disease.

Adult↗

PubMed1996

Plasma endothelin in psoriasis: possible relations to therapy and toxicity.

Plasma endothelin levels were studied in 71 patients suffering from severe psoriasis. The psoriatics were treated either with topical therapy alone (n = 18) or with cyclosporin A (n = 26), methotrexate (n = 21), or with hydroxyurea, acitretin or ranitidin (n = 6) with or without topical therapy. The psoriatics had a significantly higher average plasma endothelin than 40 healthy controls. The patients treated with cyclosporin A had the highest values and these were in contrast to patients on methotrexate and other systemic therapy higher than patients treated with topical therapy alone. There was not significant difference between endothelin levels in patients treated with methotrexate compared to those in patients only receiving topical treatment. Whether the increased endothelin levels in plasma are derived from keratinocytes or enlarged vessels need to be investigated. An increased plasma endothelin level could be related to therapy and for patients on cyclosporin A be of importance for toxicity.

Acitretin↗

PubMed1995

The use of serologic markers for collagen synthesis and degradation in systemic sclerosis.

BACKGROUND: Systemic sclerosis is characterized by excessive accumulation of collagen in all involved organs. Serum markers of collagen synthesis and degradation, the aminoterminal propeptide of type III procollagen (PIIINP), the carboxyterminal propeptide of type I procollagen (PICP), and the crosslinked telopeptide of type I collagen (ICTP), can be measured. OBJECTIVE: Our purpose was to investigate these markers in different subgroups of untreated patients with systemic sclerosis and in patients before and after various types of therapy. PIIINP and PICP were also investigated in blister fluid from involved and uninvolved skin. METHODS: Sera from 97 patients and suction blister fluid from 13 patients were radioimmunoassayed. RESULTS: The highest levels of PIIINP and PICP were found in blister fluid from involved skin. Patients with systemic sclerosis had higher serum levels of PIIINP than control subjects. The highest levels were found in patients with diffuse cutaneous systemic (type III) sclerosis; increased serum PIIINP was also characteristic of type II limited cutaneous systemic sclerosis. Most patients with limited cutaneous type I systemic sclerosis had normal levels. Serum PICP was within normal limits in all three types of systemic sclerosis. Variations in ICTP type I collagen degradation in general followed PICP. Immunosuppressive drugs significantly reduced PIIINP, whereas no significant decrease was found after photopheresis. PICP and ICTP also diminished after treatment with D-penicillamine and cyclophosphamide given together with prednisone. CONCLUSION: PIIINP can be recommended for monitoring collagen synthesis in systemic sclerosis. Our data support the use of immunosuppressive therapy for this disease.

Biomarkers↗

PubMed1995

Analgesic effect in humans of subanaesthetic isoflurane concentrations evaluated by experimentally induced pain.

The analgesic effect of subanaesthetic concentrations of ether, trichloroethylene, methoxyflurane and halothane has been investigated previously using either clinical assessment or pain threshold measurements, but with conflicting results. The purpose of the present study was to evaluate the analgesic effect of isoflurane using experimental pain models. We studied 12 healthy volunteers at three randomly chosen subanaesthetic isoflurane concentrations: low (0.10-0.14 vol%), middle (0.16-0.20 vol%) and high (0.22-0.26 vol%). We used thermal pain detection and pain tolerance thresholds to argon laser stimulation, pressure pain detection and pain tolerance thresholds, immersion of the hand in ice water, and the nociceptive reflex to single and repeated (temporal summation) electrical stimulations, as experimental models to assess analgesia. There were no significant changes in the response to heat, cold or mechanical pressure at any of the subanaesthetic concentrations of isoflurane used. The nociceptive reflex thresholds to single stimulations, but not the thresholds for repeated stimulations, were significantly increased in all three isoflurane groups compared with baseline values. The difference between the different isoflurane concentrations was not statistically significant. In experimental pain models, subanaesthetic isoflurane concentrations have little or no analgesic potency.

Adult↗

PubMed1995

The effect of N-methyl-D-aspartate antagonist (ketamine) on single and repeated nociceptive stimuli: a placebo-controlled experimental human study.

Ketamine is a noncompetitive N-methyl-D-aspartate (NMDA) receptor channel blocker known to inhibit "wind-up" and hence central hyperexcitability of dorsal horn neurons. We sought to assess the effect of ketamine on single and repeated nociceptive stimuli. A placebo-controlled, human (12 volunteers) experimental study was conducted in which several psychophysical (pain detection and tolerance thresholds, magnitude ratings) and electrophysiologic (withdrawal reflex) techniques were used 1) to investigate whether a ketamine (0.5 mg/kg) bolus followed by a 20-min infusion (9 micrograms.kg-1.min-1) inhibits central temporal summation to repeated nociceptive electrical stimuli, and 2) to assess quantitatively the hypoalgesic potency using several experimental nociceptive stimuli (argon laser, pressure, electrical). Facilitation of the withdrawal reflex to and pain rating of repeated electrical stimuli (five pulses at 2 Hz) were inhibited by ketamine. Reflex and pain rating to a single stimulus did not change. The pressure pain detection and tolerance thresholds were increased significantly by ketamine, whereas the laser heat pain and tolerance thresholds remained stable compared with placebo. The stimulus response function showed that ketamine reduced the responses to the highest electrical stimulus intensities (1.4, 1.6, and 1.8 times the reflex threshold). We conclude that ketamine inhibits central temporal summation in humans and has a marked hypoalgesic effect on high intensity nociceptive stimuli.

Analgesics↗

PubMed1995

Photopheresis in the red man or pre-Sézary syndrome.

BACKGROUND: The beneficial effect of extracorporeal photochemotherapy has clearly been established for patients with cutaneous T-cell lymphoma with Sézary's syndrome. But this treatment has not been used in the red man syndrome or pre-Sézary syndrome. Some of these patients do not respond sufficiently or do not tolerate other therapies. OBJECTIVE: The purpose of this open study was to evaluate the clinical efficacy of photopheresis in this group of patients. METHODS: Seven patients with the red man syndrome were treated on 2 consecutive days every 4 weeks for 6-22 months. Six had been on systemic steroids and 3 had also received retinoids without sufficient effects. All were initially treated with topical nitrogen mustard but no longer tolerated this treatment. RESULTS: All signs of erythroderma disappeared in 6 of the 7 patients. All systemic therapy could be discontinued in all but 2 patients. No side effects were observed. CONCLUSION: Photopheresis may be an effective alternative treatment for this group of patients, when other types of therapy have failed.

Acitretin↗

PubMed1995

Glucose content in human skin: relationship with blood glucose levels.

In order to ascertain the dynamic relationship between the extracellular glucose in upper skin layers and blood glucose, skin suction blisters were raised in six Type 1 diabetic patients during a three-step glucose clamp. Blister glucose closely paralleled venous glucose (mean of r = 0.998). However, in three patients blister glucose was constantly lower than plasma glucose and this appeared to be related to their slower formation of skin blisters. A substantial difference in skin blister suction time was noted among patients and it was found that suction time was linearly correlated to glycosylated haemoglobin (HbA1C) (n = 6, r = 0.865, p = 0.026). It is concluded that a non-invasive blood glucose monitoring system could be successfully based on measurement of alterations in skin glucose contents.

Adolescent↗

PubMed1994

Laser-induced pain-related brain potentials and sensory pain ratings in high and low hypnotizable subjects during hypnotic suggestions of relaxation, dissociated imagery, focused analgesia, and placebo.

Pain reports and amplitudes of painful argon laser-induced brain potentials were obtained for 10 high and 10 low hypnotizable volunteers following placebo and a randomized sequence of four hypnotically induced conditions of (a) neutral hypnosis, (b) deep relaxation, (c) pleasant dissociated "out of body" imagery, and (d) focused analgesia of the hand. Both high and low hypnotizable subjects exhibited significant reductions of reported pain during conditions of neutral hypnosis, relaxation, dissociated imagery, and focused analgesia. High hypnotizable subjects displayed significantly greater reductions than low hypnotizables in all conditions except placebo. Both high and low hypnotizables exhibited significant reductions of reported pain in all five conditions as well as in the posthypnotic condition, when amplitudes of evoked potentials were compared to the prehypnotic baseline. Only the high hypnotizable group showed significant reductions in amplitudes when the data were recalculated to reflect relative changes compared to the average amplitude of the pre- and postconditions to compensate for a possible habituation effect indicated by the significantly lowered amplitudes in the posthypnotic condition. The results are discussed in light of a number of hypotheses concerning mechanisms of hypnotic analgesia.

Adult↗

PubMed1994

Ondansetron does not inhibit the analgesic effect of alfentanil.

5-Hydroxytryptamine (5-HT) causes antinociception via presynaptic 5-HT3 (5-HT subtype 3) receptors on primary afferent nociceptive neurones in the spinal cord dorsal horn. Therefore, ondansetron (a 5-HT3 receptor antagonist) may increase the perception of a noxious stimulus or decrease the effects of concurrently administered antinociceptive drugs. Using a randomized, double-blind, crossover study design, we have tested this hypothesis in eight healthy volunteers who, on three different days, received either ondansetron and placebo, ondansetron and alfentanil or placebo and alfentanil. Experimental pain was induced with heat, cold, mechanical pressure and electrical stimulation. Ondansetron alone did not change the response to any of the experimental tests, but alfentanil and the combination ondansetron-alfentanil significantly changed the response compared with ondansetron alone. There was no difference between alfentanil alone and the combination ondansetron-alfentanil. We conclude that ondansetron does not change the response to pressure, heat, cold or electrical nociceptive stimuli or antagonize the analgesic effect of alfentanil.

Adult↗

PubMed1994

Morphine does not affect laser induced warmth and pin prick pain thresholds.

The aim of this double-blind, placebo-controlled study was to evaluate the effect of intravenously administered morphine in humans using an argon laser to induce experimental pain. Thirty volunteers were randomised to receive a total of 0.15 mg.kg-1 morphine intravenously or saline. The argon laser was used to determine the possible change in warmth thresholds and pin prick pain thresholds. Measurements were performed before and at 10, 20, 30 and 40 min after the injection. During the observation period the warmth thresholds increased 20.7% (P < or = 0.05) from baseline (0.82 W +/- 0.42 W) in the morphine group while an increase of 14.3% (P > or = 0.05) was seen in the placebo group (Baseline: 0.91 +/- 0.37). The pinprick pain thresholds of the morphine group increased 9.4% (P < or = 0.05) from baseline (1.39 W +/- 0.7 W) while the corresponding thresholds of the placebo group was 4.6% (P > or = 0.05) (baseline: 1.73 W +/- 0.44 W). The differences seen between the morphine group and the placebo group were not statistically significant and thus it was demonstrated that morphine had no effect of either the feeling of warmth or the pain elicited by the argon laser. The present study supports other investigations and clinical experience suggesting that intermittent pain is not relieved by morphine unlike continuous pain, which can be relieved by morphine.

Adult↗

PubMed1994

Plasma endothelin and the aminoterminal propeptide of type III procollagen (PIIINP) in systemic sclerosis.

Forty-four patients with systemic sclerosis and 3 patients with localized scleroderma were investigated for plasma endothelin and aminoterminal propeptide of type III procollagen (PIIINP). Although there was an overlap between plasma levels of endothelin in patients with systemic sclerosis and healthy controls, the mean value of the patients was significantly higher than in controls. Plasma endothelin was normal in all 3 patients with localized scleroderma. The highest levels of plasma endothelin were found in patients with type II and III systemic sclerosis with the largest cutaneous involvement, and in patients with the scleroderma-specific antibodies Scl-70 and anticentromere antibodies. Extremely high values were found in a patient who experienced a renal crisis and in a patient who had her lower leg amputated due to severe vasculitis. A positive correlation was found between plasma endothelin and serum PIIINP. This, together with the fact that in systemic sclerosis the vascular lesions are the earliest, would seem to support the theory that endothelial cell damage could lead to increased secretion of endothelin and subsequent fibrosis in this disease.

Aged↗

PubMed1994

Skin scoring in systemic sclerosis: a modification--relations to subtypes and the aminoterminal propeptide of type III procollagen (PIIINP).

Forty-one patients with systemic sclerosis were investigated with a new and simple skin score method measuring the degree of thickening and pliability in seven regions together with area involvement in each region. The highest values were, as expected, found in diffuse cutaneous systemic sclerosis (type III SS) and the lowest in limited cutaneous systemic sclerosis (type I SS) with no lesions extending above wrists and ancles. A positive correlation was found to the aminoterminal propeptide of type III procollagen, a serological marker for synthesis of type III collagen. The skin score is considered simpler than previous methods and is recommended for more general use.

Arm↗

PubMed1994

Onset and duration of hypoalgesia following application of lidocaine spray on genital mucosa.

Lidocaine spray is used as a topical analgesic prior to minor surgical procedures performed on genital mucosa. In this study onset and duration of hypoalgesia on the genital mucosa was investigated by spraying lidocaine solution on the mucous membranes of female genitals with subsequent measurements of pin prick pain thresholds induced by argon laser stimulation. A dosage of 50 mg of lidocaine spray was administered to the genital mucosa of the inside of the labiae minora. Repeated measurements of pain threshold were performed until normal sensitivity was reached. Analgesia to 1.5 W laser stimulation was obtained in all volunteers after an average of 2.7 min +/- 1.3 min (s.d.) (Range: 1-4 min). The effect lasted 29.7 min +/- 8.9 min (s.d.) (Range 12-45 min). The application of lidocaine spray produced a painful, smarting sensation which, however, disappeared again after 15-30 seconds. The study suggests that minor surgery should not be performed earlier than 4 min after application of lidocaine spray and it is recommended that it should be remembered that the duration of analgesia varies between individuals and thus may be very short in some patients.

Administration, Topical↗