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Biomedical subjects

R Andersson

Publications and source records attributed to R Andersson.

At least 55 records · Page 3Linked to original sources
PubMed2000

Long term results of a randomized study by the Swedish Melanoma Study Group on 2-cm versus 5-cm resection margins for patients with cutaneous melanoma with a tumor thickness of 0.8-2.0 mm.

BACKGROUND: Large, prospective, randomized trials with long term follow-up are required to obtain an unbiased evaluation of the significance of resection margins in patients with cutaneous melanoma. METHODS: The Swedish Melanoma Study Group performed a prospective, randomized, multicenter study of patients with primary melanoma located on trunk or extremities and with a tumor thickness > 0.8 mm and </= 2 mm. Patients were allocated randomly to a 2-cm excision margin or a 5-cm excision margin. In total, 989 patients were recruited during the period 1982-1991. The median follow-up was 11 years (range, 7-17 years) for estimation of survival and 8 years (range, 0-17 years) for evaluation of recurrent disease. RESULTS: The crude rate of local recurrence, defined as a recurrence in the scar or transplant, was < 1% (8 of 989 patients). Twenty percent of the patients (194 of 989 patients) experienced any disease recurrence, and 15% (146 of 989 patients) died of melanoma. There were no statistically significant differences between the two treatment arms. In a multivariate Cox analysis with patients allocated to wide excision as the reference group, the estimated relative hazards for overall survival and recurrence free survival among those allocated to a 2-cm resection margin were 0.96 (95% confidence interval, 0.75-1.24), and 1.02 (95% confidence interval, 0.80-1.30), respectively. CONCLUSIONS: In this long term follow-up study, local recurrences were found to be rare among patients with tumors > 0.8 mm thick and </= 2.0 mm thick. No difference in recurrence rate or survival between the two treatment groups was found. Patients in this category can be treated with a resection margin of 2 cm as safely as with a resection margin of 5 cm.

Adolescent↗
PubMed2000

[Guidelines for management of patients with acute pancreatitis].

During recent years new concepts and methods have been introduced in the management of acute pancreatitis. Severity and risk of complications show wide variation. Outcome is also dependent on the physician's experience and on his local resources. In this light the Swedish Society of Upper Abdominal Surgery has elaborated national guidelines for management. Attention is paid to diagnosis, severity assessment and etiology. Furthermore, guidelines are offered for treatment of mild and severe pancreatitis, as well as for the management of pseudocysts. The role of multidisciplinary intensive care specialist teams in the management of severe disease is emphasized. The guidelines are supported by the Swedish Society of Gastroenterology, the Swedish Society of Gastroenterology, the Swedish Society of Anesthesiology and Intensive Care and by experts from other Nordic countries.

APACHE↗
PubMed2000

Protective DNA vaccination against organ-specific autoimmunity is highly specific and discriminates between single amino acid substitutions in the peptide autoantigen.

DNA vaccines that encode encephalitogenic sequences in tandem can protect from subsequent experimental autoimmune encephalomyelitis induced with the corresponding peptide. The mechanism for this protection and, in particular, if it is specific for the amino acid sequence encoding the vaccine are not known. We show here that a single amino acid exchange in position 79 from serine (nonself) to threonine (self) in myelin basic protein peptide MBP68-85, which is a major encephalitogenic determinant for Lewis rats, dramatically alters the protection. Moreover, vaccines encoding the encephalitogenic sequence MBP68-85 do not protect against the second encephalitogenic sequence MBP89-101 in Lewis rats and vice versa. Thus, protective immunity conferred by DNA vaccination exquisitely discriminates between peptide target autoantigens. No bystander suppression was observed. The exact underlying mechanisms remain elusive because no simple correlation between impact on ex vivo responses and protection against disease were noted.

Animals↗
PubMed2000

Corticosteroids and interferons inhibit cytokine-induced production of IL-8 by human endothelial cells.

IL-8, secreted by endothelial cells at the site of inflammation, participates in recruitment and transmigration of leukocytes. IL-8 may also have pathophysiological consequences in inflammatory and immunological disorders. We have investigated the effect of interferons (IFNs) and glucocorticosteroids (GCs) on cytokine induced secretion and production of IL-8 by human umbilical endothelial cells (HUVEC). There was a low spontaneous secretion of IL-8 by unstimulated HUVEC which increased after 6 or 24 h of stimulation with the pro-inflammatory cytokines TNF-alpha or IL-1beta. IFN-gamma as well as the GCs, Dexamethasone and Budesonide, inhibited TNF-alpha induced IL-8 secretion in a dose-dependent manner. IFNs may have a general modulating effect, since IFN-alpha also inhibited the TNF-alpha-induced IL-8 secretion. There was a slight, but significant, increase in the content of intracellular IL-8 in stimulated HUVEC. However, there was no difference between stimulation with IL-1beta or TNF-alpha alone or in combination with IFNs or GCs, whereas inhibition of IL-8 secretion with monensin increased IL-8 content suggesting that IFNs and GCs inhibit synthesis rather than secretion of IL-8. In conclusion, IFNs or GCs may be useful for inhibiting IL-8 production by endothelial cells and could thus be used for therapeutic modulation of the inflammatory response.

Budesonide↗
PubMed2000

Sense of coherence and lack of control in relation to outcome after orthopaedic injuries.

This study aimed to investigate whether sense of coherence (SOC) and lack of control are related to outcome after moderate orthopaedic injuries. One hundred and eleven patients with orthopaedic injuries were included. The patients were followed up 1 year after the injury (physical examination, Disability Raring Index (DRI), Visual Analogue Scale, Beck's Depression Inventory and SF-36). At a minimum of 2 years after the injury, the patients filled out a questionnaire, which included three SOC questions and one question about sense of lack of control. The results showed that a low sense of coherence, sense of having less control over one's life, and signs of depression were associated with an increased risk of having a less good clinical and functional outcome 1 year after the injury (odds ratios varied between 2 and 11). We conclude that these factors seem to be predictive of the outcome and should be taken into consideration when designing rehabilitation programs for injured patients.

Adaptation, Psychological↗
PubMed2000

Molecular weight, structure, and shape of oat (1-->3),(1-->4)-beta-D-glucan fractions obtained by enzymatic degradation with lichenase.

Oat beta-glucan was partially degraded by lichenase for different periods of time. Weight-average molecular weights were obtained from SEC-RI-RALLS-Visc and ranged from 5300 to 257,200. Weight-average intrinsic viscosities ranged from 7 to 160 mL/g. The determined viscosity equation, [eta] = 5.47 x 10(-3) M 0.82, indicated an extended coil conformation. When the coil was modeled as a wormlike chain a persistent length of 2.30 nm was obtained. 1H and 13C NMR spectroscopy were used to identify the structural units in the partially degraded beta-glucan. The identification of the disaccharide laminaribiose in the hydrolysates may suggest the presence of a new structural feature in cereal beta-glucan.

Avena↗
PubMed2000

Potential of using existing injury information for injury surveillance at the local level in developing countries: experiences from Bangladesh.

Although injury is a major public health problem in Bangladesh, as in other low income countries in the world, it has gained very little attention from policy makers, or even health professionals, mainly due to the lack of valid injury information in these countries. To address the injury problem, there is an urgent need to develop injury surveillance activities, based on existing sources of potential interest for obtaining injury information. This study is an evaluation of existing injury data sources in terms of prevention orientation representativeness, and sustainability with respect to the use of these sources in injury surveillance at the local level in Bangladesh. The regular injury information sources that have been used in this study include hospital records, post-mortem reports, newspaper reports, and police reports. In addition, 60 health practitioners in the area, representing various categories, were interviewed according to questionnaire, and ten others were interviewed in-depth about their opinions regarding their participation in the injury surveillance system. The information sources were then assessed for their potential to be included in the surveillance system. The validity was estimated by means of comparisons of the different sources. All the existing sources of injury information suffer from certain deficiencies such as, lack of representativeness, low prevention orientation and poor sustainability. Post-mortem reports and police reports have been found to be potential sources of mortality data but not morbidity data. Hospital records can be seen as potential sustainable sources of injury morbidity data but suffer from low prevention orientation and representativeness. The injury information was not consistent from source to source and failed to depict the true picture of injury in the area. To develop an injury surveillance system, a combination of data obtained from several different sources is necessary to compensate for inadequacies in the individual sources and to improve the overall usefulness of the system. Updated with E-codes, hospital discharge records could be used for injury morbidity surveillance, and updated police and post-mortem data can be used for mortality data in injury surveillance systems at the local level in developing countries.

Bangladesh↗
PubMed2000

Unintentional injury mortality and socio-economic development among 15-44-year-olds: in a health transition perspective.

Injury imposes one of the greatest health risks in terms of mortality and morbidity among 15-44-y-olds. There is evidence that socio-economic development (SED) is related to injury risk, but the findings are inconsistent. We aimed to study the magnitude, pattern and relative importance of unintentional injury mortality (UIM) in relation to SED in this age group. Cross-sectional data on UIM by age-sex specific groups were obtained for 54 countries from the World Health Statistics Annuals 1993-1995. The relationship between UIM and SED (measured in gross national product (GNP) per capita) was studied using two methods: (1) with regression analysis, and (2) by categorizing the data into four income-based country groups and then comparing the differences in their mean values. The results were: (1) UIM rates were inversely correlated with GNP per capita and the relationship became stronger with increasing age (r=-0.22 for both sexes in the 15-24-y-olds, r=-0.65 for males, r=-0.54 for females in the 35-44-y-olds); (2) there was an increase in UIM rates between low-income and lower-middle-income countries (LoMIC), but a decrease between LoMIC and upper middle-income (UpMIC), and finally also a significant decrease between UpMIC and high-income countries in most age-sex groups (ie P<0.005 for males, P<0.05 for females in the 35-44-y-olds). The highest rates of UIM were in LoMIC for all age-sex groups. Male rates were consistently higher than female in all age groups. In conclusion, SED was inversely related to UIM. There was an initial positive relation between GNP per capita and UIM, which became negative with increasing GNP per capita. We also found a health transition that had taken place in all country groups.

Accidents↗
PubMed2000

Effect of carbon dioxide on cochlear blood flow in guinea pigs.

The influence of carbon dioxide (CO2) on cochlear blood flow (CBF), blood pressure (SBP) and skin blood flow (SBF) was studied in anaesthetized guinea pigs. A transient acute respiratory acidosis was produced by inhalation of CO2 and oxygen (O2) gas mixtures. The blood flows were measured by laser Doppler flowmetry (LDF). High CO2 increased CBF and SBP, and decreased SBF in a dose-dependent manner. The responses of CBF, SBP and SBF to high CO2 were reversible. Our results indicate that high CO2 (and low pH) dilates the smooth muscle of the blood vessels, resulting in an increase in CBF. CO2 also activates the sympathetic nervous system in the whole body, producing an increase in SBP. The distribution of alpha-adrenergic fibres receptors is abundant in skin and scarce in the cochlea. The constrictive effect on blood vessels is much greater in the skin than in the cochlea, thus our results showed a decrease in SBF during stimulation with higher CO2.

Acidosis, Respiratory↗
PubMed2000

Operations for extrahepatic bile duct cancers: are the results really improving?

OBJECTIVE: To find out if our results for the treatment of extrahepatic bile duct cancer have improved we reviewed our latest patients as a comparison to a previously reported series from this department. DESIGN: Retrospective study. SETTING: Tertiary referral centre, Sweden. SUBJECTS: 102 patients who presented with extrahepatic bile duct cancer 1979-1995. MAIN OUTCOME MEASURES: Morbidity, mortality, and short and long term survival. RESULTS: 16 patients had various types of resection, which were radical in 14 according to the surgeon and in 10 according to the pathologist. One patient (6%) died in hospital, and 1 (44%) developed complications. 13 patients had other operations that did not involve resection, 23 had laparotomy alone, 61 had biliary drainage either by percutaneous transhepatic cholangiography (PTC) or endoscopy, and 10 had no active treatment. One patient of the 16 (6%) who had resections has survived for more than five years and another one is still alive after 40 months. CONCLUSION: Long term survival has not improved for patients with extrahepatic bile duct cancer in our hospital during the last decades.

Adult↗
PubMed2000

Phagocytic and intestinal endothelial and epithelial barrier function during the early stage of small intestinal ischemia and reperfusion injury.

The effects of intestinal ischemia and reperfusion (I/R) on small intestinal mucosal endothelial and epithelial barrier integrity and phagocytic function were assessed in rats subjected to 20- or 40-min mesenteric ischemia and a 3-h reperfusion. The results showed that human serum albumin (125I-HSA) flux through the endothelial layer to the interstitial space increased as did 125I-HSA clearance from blood to the gut lumen and 131I-HSA flux from the gut lumen to the interstitial space in rats with I/R. E. coli adhering to microvilli, invading and passing into the microvessels, were noted on the small intestinal mucosa in animals subjected to 40-min ischemia and a 3-h reperfusion. Phagocytic function increased, especially in the small intestinal wall, lungs, liver, and spleen in the groups with I/R, correlating with the length of ischemia. The results imply that both endothelial and epithelial barrier integrity is impaired in the early phase after I/R and that the epithelial barrier more effectively restricts macromolecular leakage compared with the endothelial barrier. I/R impairs the intestinal barrier not only by causing tissue hypoxia but also by activating the phagocytic system and aggravating barrier damage, which finally may result in bacterial translocation and remote organ dysfunction.

Animals↗
PubMed2000

TNF-alpha stimulates alveolar liquid clearance during intestinal ischemia-reperfusion in rats.

Intestinal ischemia-reperfusion commonly occurs in critically ill patients and may lead to the development of remote organ injury, frequently involving the lungs. In the present study, alveolar liquid clearance was studied in ventilated, anesthetized rats subjected to 45 min of intestinal ischemia followed by 3 h of reperfusion. An isosmolar 5% albumin solution was instilled into the lungs, and alveolar liquid clearance was measured from the increase in alveolar protein concentration as water was reabsorbed over 45 min. Intestinal ischemia-reperfusion resulted in a 76% increase in alveolar liquid clearance compared with the control value (P < 0.05). The stimulated alveolar liquid clearance seen after intestinal ischemia-reperfusion was not inhibited by propranolol, indicating stimulation through a noncatecholamine-dependent pathway. Intestinal ischemia-reperfusion did not result in increased intracellular cAMP levels. Amiloride inhibited similar fractions in animals subjected to ischemia-reperfusion and control animals. Administration of a neutralizing polyclonal anti-tumor necrosis factor-alpha antibody before induction of intestinal ischemia completely inhibited the increased alveolar liquid clearance observed after intestinal ischemia-reperfusion. In conclusion, our results suggest that intestinal ischemia-reperfusion in rats leads to stimulation of alveolar liquid clearance and that this stimulation is mediated, at least in part, by a tumor necrosis factor-alpha-dependent mechanism.

Adrenergic beta-Antagonists↗
PubMed2000

Beneficial effects of lexipafant, a PAF antagonist on gut barrier dysfunction caused by intestinal ischemia and reperfusion in rats.

BACKGROUND: Platelet-activating factor (PAF) may play a pivotal role in the pathogenesis of intestinal ischemic injury. METHODS: The potential role of PAF in intestinal ischemia and reperfusion (I/R) and the development of gut endothelial and epithelial barrier dysfunction and distant organ injury were investigated by pretreatment with a PAF antagonist, lexipafant. Bidirectional permeability of the intestinal barrier, enteric bacterial translocation, protease-antiprotease balance and mucosal histology, and also changes in pulmonary and liver endothelial barrier permeability were measured following intestinal ischemia for 40 min with 6 h of reperfusion in rats. RESULTS: Intestinal mucosal endothelial and epithelial permeabilities significantly increased in animals with I/R. Lexipafant prevented the increase in albumin leakage from blood to the mucosal interstitium and the intestinal lumen during reperfusion, and the mucosal albumin leakage from the gut lumen to blood during I/R. Bacterial translocation was frequently noted in animals with I/R, while only a few positive cultures were obtained in animals with I/R administered lexipafant. Less leakage of fluorescein isothiocyanate dextran 70,000 into the interstitial space and gut lumen in I/R animals with lexipafant pretreatment was found under fluorescein microscopy. Lexipafant also partly prevented C1 inhibitor, prekallikrein, and factor X consumption in I/R animals and partly prevented changes in pulmonary and liver albumin leakage. CONCLUSIONS: PAF seems to play an important role in I/R-associated intestinal dysfunction and the development of distant organ dysfunction, probably by triggering endothelial and epithelial barrier dysfunction. Furthermore, PAF seems to be partly involved in activation of the protease-antiprotease system. The use of PAF antagonists may provide a mode of treatment against I/R-associated organ dysfunction.

Animals↗
PubMed2000

Effects of N-acetylcysteine on pulmonary macrophage activity after intestinal ischemia and reperfusion in rats / with invited commentaries.

BACKGROUND/AIMS: Intestinal ischemia and reperfusion (I/R) is considered to be a critical and triggering event in the development of distal organ dysfunction after a variety of insults. It appears that activated leukocytes, especially polymorphonuclear granulocytes (PMNs), and reactive oxygen species are important mediators in the process. In the present study, the aim was to evaluate the behavior of pulmonary macrophages, acute lung injury and pulmonary endothelial permeability after intestinal I/R, together with potential alterations in pulmonary endothelial and epithelial ultrastructure and cellular membrane system integrity. METHODS: Intestinal ischemia for 40 min was followed by reperfusion for 12 h in the rat. Macrophage uptake of radiolabeled bacteria, levels of pulmonary blood content assessed by radiolabeled red blood cells and pulmonary endothelial permeability of radiolabeled albumin, as well as pulmonary endothelial and epithelial ultrastructure and cellular membrane system integrity by the use of scanning electron microscopy and a tracer was evaluated after 12 h reperfusion. Treatment with the free radical scavenger N-acetylcysteine (NAC) administered prior to reperfusion was evaluated. RESULTS: Overactivation of pulmonary macrophages was noted after intestinal I/R, as was a significant decrease in pulmonary blood content. No increase in pulmonary albumin leakage or increase in pulmonary water content was found after intestinal I/R as compared to controls. Treatment with NAC prevented against intestinal I/R-induced overactivation of pulmonary macrophages and a decrease in pulmonary blood content. CONCLUSION: Reactive oxygen species may be involved in the regulation of pulmonary macrophage function and pulmonary circulation after intestinal I/R.

Acetylcysteine↗
PubMed2000

Stable and dynamic differences in injury mortality between the Nordic countries. What do they say about inherent national characteristics with regard to risk?

The aim of this study was to analyse long-term trends and patterns in injury mortality between the Nordic countries and to distinguish differences that are relatively temporary from those that are more durable. Both total injury mortality and special subcategories were examined. Some stable similarities and differences were found. Two kinds of injuries are distinguished: those that largely have a social genesis and those to which environmental causality applies. The general pattern is that there has been an increase in injuries with a social genesis and a decrease in those with an environment-related genesis. Finland has high rates of both types of injuries. Denmark has high rates of injuries with a social genesis, but low rates of those with an environmental genesis. By contrast, Norway has high rates of injuries with an environmental genesis and low rates of those with a social genesis. Sweden has low or medium rates of both types of injuries.

Accidents↗
PubMed2000

Quantification of cytomegalovirus DNA in BAL fluid: a longitudinal study in lung transplant recipients.

STUDY OBJECTIVES: Cytomegalovirus (CMV) infection is common in patients receiving solid organ transplants, and it is associated with increased morbidity as well as risk for development of chronic rejection. A rapid and sensitive diagnostic method would improve the therapeutic management of CMV infection, including the monitoring of treatment effects. We investigated whether longitudinal determinations of CMV DNA quantities in BAL fluid could be useful for this purpose. DESIGN: CMV DNA levels in 340 BAL samples from 35 consecutive lung transplant recipients were studied during a median of 18 months. Seventeen (49%) of the patients developed CMV disease with pneumonitis. Twenty-seven CMV disease episodes were diagnosed. RESULTS: Patients with CMV disease had a significantly higher mean level of CMV copies per milliliter BAL fluid (1,120 +/- 4,379) compared with those without (180 +/- 1,177, p < 0.01). Viral load as well as acute rejection requiring treatment (>/= A2) were independent risk factors associated with CMV disease. Differences between the groups concerning HLA-DR matching, basic immunosuppressive therapy, and CMV serologic status D/R -/+ vs D/R +/+ were not significant. A diagnostic definition of normality based on the mean level of all episodes without CMV disease +2 SD would discriminate only 9 of the 27 CMV episodes. CONCLUSIONS: Although the viral load is increased during episodes of clinical CMV disease in lung transplant recipients, the quantitative PCR assessment of CMV DNA in BAL fluid is not discriminative enough to be useful as a diagnostic tool for CMV disease.

Adult↗
PubMed1999

Fertility patterns after appendicectomy: historical cohort study.

OBJECTIVE: To examine fertility patterns in women who had their appendix removed in childhood. DESIGN: Historical cohort study with computerised data and fertility data for this cohort and for an age matched cohort of women from the Swedish general population. The cohorts were followed to 1994. SETTING: General population. PARTICIPANTS: 9840 women who were under 15 years when they underwent appendicectomy between 1964 and 1983; 47 590 control women. MAIN OUTCOME MEASURES: Diagnoses at discharge. Distributions of age at birth of first child among women with perforated and non-perforated appendix and women who underwent appendicectomy but were found to have a normal appendix compared with control women by using survival analysis methods. Parity distributions at the latest update of the registry were also examined. RESULTS: Women with a history of perforated appendix had a similar rate of first birth as the control women (adjusted hazard ratio 0.95; 95% confidence interval 0.88 to 1. 04) and had a similar distribution of parity at the end of follow up. Women who had had a normal appendix removed had an increased rate of first births (1.48; 1.42 to 1.54) and on average had their first child at an earlier age and reached a higher parity than control women. CONCLUSION: A history of perforated appendix in childhood does not seem to have long term negative consequences on female fertility. This may have important implications for the management of young women with suspected appendicitis as the liberal attitude to surgical explorations with a subsequently high rate of removal of a normal appendix is often justified by a perceived increased risk of infertility after perforation. Women whose appendix was found to be normal at appendicectomy in childhood seem to belong to a subgroup with a higher fertility than the general population.

Adolescent↗