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Biomedical subjects

R Olsson

Publications and source records attributed to R Olsson.

At least 73 records · Page 4Linked to original sources
PubMed1997

Functional assessment of the pharynx at rest and during swallowing in partially paralyzed humans: simultaneous videomanometry and mechanomyography of awake human volunteers.

BACKGROUND: Functional characteristics of the pharynx and upper esophagus, including aspiration episodes, were investigated in 14 awake volunteers during various levels of partial neuromuscular block. Pharyngeal function was evaluated using videoradiography and computerized pharyngeal manometry during contrast bolus swallowing. METHODS: Measurements of pharyngeal constrictor muscle function (contraction amplitude, duration, and slope), upper esophageal sphincter muscle resting tone, muscle coordination, bolus transit time, and aspiration under fluoroscopic control (laryngeal or tracheal penetration) were made before (control measurements) and during a vecuronium-induced partial neuromuscular paralysis, at fixed intervals of mechanical adductor pollicis muscle train-of-four (TOF) fade; that is, at TOF ratios of 0.60, 0.70, 0.80, and after recovery to a TOF ratio > 0.90. RESULTS: Six volunteers aspirated (laryngeal penetration) at a TOF ratio < 0.90. None of them aspirated at a TOF ratio > 0.90 or during control recording. Pharyngeal constrictor muscle function was not affected at any level of paralysis. The upper esophageal sphincter resting tone was significantly reduced at TOF ratios of 0.60, 0.70, and 0.80 (P < 0.05). This was associated with reduced muscle coordination and shortened bolus transit time at a TOF ratio of 0.60. CONCLUSIONS: Vecuronium-induced partial paralysis cause pharyngeal dysfunction and increased risk for aspiration at mechanical adductor pollicis TOF ratios < 0.90. Pharyngeal function is not normalized until an adductor pollicis TOF ratio of > 0.90 is reached. The upper esophageal sphincter muscle is more sensitive to vecuronium than is the pharyngeal constrictor muscle.

Adult↗
PubMed1997

Moderate exercise at energy balance does not affect 24-h leucine oxidation or nitrogen retention in healthy men.

Short-term metabolic experiments have revealed that physical exercise increases the oxidation of leucine, which has been interpreted to indicate an increased requirement for dietary protein in physically active subjects. Because it may be inaccurate to extrapolate measurements of amino acid oxidation made over a few hours to the entire day, we have carried out a continuous 24-h intravenous [1-13C]leucine/[15N]urea tracer study in eight healthy adult men. Their diet supplied 1 g protein.kg-1.day-1, and exercise (mean maximal O2 consumption 46%) was for 90 min during the 12-h fast and 12-h fed periods of the day. Subjects were adapted to the diet and exercise regimen for 6 days. Then, on day 7, they were dressed in the University of Uppsala energy metabolic unit's direct calorimeter suit, were connected to an open-hood indirect calorimeter, and received the tracers. Exercise increased leucine oxidation by approximately 50 and 30% over preexercise rates for fast and fed periods, respectively. This increase amounted to approximately 4-7% of daily leucine oxidation. Subjects remained in body leucine equilibrium (balance -4.6 +/- 10.5 mg.kg-1.day-1; -3.6 +/- 8.3% of intake; P = not significant from zero balance). Therefore, moderate exercise did not cause a significant deterioration in leucine homeostasis at a protein intake of 1 g.kg-1.day-1. These findings underscore the importance of carrying out precise, continuous, 24-h measurements of whole body leucine kinetics; this model should be of value in studies concerning the quantitative interactions among physical exercise, energy/protein metabolism, and diet in humans.

Adult↗
PubMed1997

Ursodeoxycholic acid treatment in patients with primary biliary cirrhosis. A Swedish multicentre, double-blind, randomized controlled study.

BACKGROUND: Ursodeoxycholic acid (UDCA) has been shown to improve serum levels of liver enzymes and bilirubin in primary biliary cirrhosis (PBC). However, it is still uncertain whether UDCA treatment also improves symptoms, liver histology, and survival without liver transplantation. METHODS: We randomized 116 patients with PBC to receive 0.5 g UDCA (n = 60) or placebo (n = 56) daily for 2 years. During the next 2 years, 80% of the UDCA-treated patients and 65% of the placebo-treated patients continued to take UDCA. RESULTS: UDCA improved serum enzyme values but not survival, symptoms, serum bilirubin levels, or liver histology. There was no significant difference in response between initially symptomatic and asymptomatic patients. CONCLUSIONS: UDCA in a dosage of 7.7 mg/kg body weight is of little benefit in PBC. This does not exclude the possibility that larger doses have beneficial effects.

Bile Acids and Salts↗
PubMed1997

Liver reactions to oral low-dose tetracyclines.

BACKGROUND: We report on a case of severe liver reaction associated with doxycycline in a previously healthy subject. Furthermore, we estimate the incidence of oral low-dose tetracycline-related liver reactions in relation to sales figures in Sweden and study the clinical and biochemical features of low-dose tetracycline-associated liver injury, on the basis of reports to SADRAC (Swedish Adverse Drug Reactions Advisory Committee) and on the reports in the literature. METHODS: All liver reactions reported to SADRAC from 1965 to 1995 were surveyed, and articles on liver reactions resulting from tetracycline published during the period 1966-95 were reviewed. RESULTS: During this 30-year period, 23 liver reactions with a suspected casual relationship to oral, low-dose tetracycline derivatives were reported to SADRAC. A causal relationship was considered likely in 3 and possible in 8 cases, giving an incidence of roughly 1 in 18 million DDD (defined daily doses). No deaths were observed from these liver reactions, and liver enzyme activities normalized in all cases without any serious clinical consequences. A total of three cases of reported tetracycline liver damage were found in the literature. Of these, two were classified as having a likely relationship, and in one a causal relationship was not determinable because of other concomitant drug administration. The liver injury was designated as cholestatic, hepatocellular, and mixed, with similar frequencies. CONCLUSIONS: Low-dose, oral tetracyclines constitute a likely cause of acute liver damage with a variable biochemical profile. Such reactions are probably very rare.

Adult↗
PubMed1996

Quantitative aspects of swallowing in an elderly nondysphagic population.

The prevalence of swallowing impairment increases with age and is a major health care problem in the elderly. It has been assumed that age-related changes in nerves and muscles hamper muscle strength and coordination of swallowing. However, it is unclear what impairment is related to primary aging and what is the consequence of diseases prevalent in the elderly (secondary aging). In order to quantify swallowing in nondysphagic elderly we used the noninvasive ROSS (Repetitive Oral Suction Swallow) test. A total of 53 individuals aged 76 +/- 5 years (mean +/- SD) were examined. We found that the nondysphagic elderly demonstrated significant differences compared with young individuals in 10 of 17 measured variables, i.e., decreased peak suction pressure, increased frequency of multiple swallows after one ingestion, increased frequency of polyphasic laryngeal movements, increased frequency of inspiration after swallowing, and increased frequency of coughing during or after swallowing. Therefore, primary aging mainly seems to influence coordination of swallowing, but oral and pharyngeal swallow per se seem to be unaffected.

Adult↗
PubMed1996

Videomanometric aspects of pharyngeal constrictor activity.

Pressure changes were registered with videomanometry (simultaneous manometry and barium swallow) in the pharynx and in the pharyngoesophageal segment (PES) during swallowing. A considerable longitudinal asymmetry was found. Peak pressure was highest in the PES, lower in the inferior constrictor area, and lowest at the level of the tongue base. The rate of pressure rise was highest at the level of the PES. The speed of propagation of the contraction wave was 13 (+/- 2) cm/sec. There was no correlation between the measured variables (i.e., peak pressure, rate of pressure rise, and speed of contracting wave). Our findings can partly be explained by different mechanical constraints at different levels of the pharynx but may also reflect the organization of neural control of swallowing in the brainstem. Knowledge of transducer position and orientation is essential for the evaluation of pharyngeal pressure during swallowing. Such knowledge is best achieved by performing manometry simultaneously with fluoroscopy, i.e., videomanometry.

Adult↗
PubMed1996

Quantitative assessment of swallowing in healthy adults.

Swallowing has hitherto been evaluated during physical examination, radiologic barium studies, manometry, and cervical auscultation. Radiography principally demonstrates qualitative aspects of oral and pharyngeal function, whereas quantitative aspects have primarily been documented by manometry. To evaluate swallowing quantitatively, without using invasive methods or radiation, we have applied a combined test of water drinking, i.e., the Repetitive Oral Suction Swallow test (ROSS). The test provides reliable measurements of suction pressure, bolus volume, timing of important events in oral and pharyngeal swallow, and respiration. The test is described and results from 292 healthy, non-dysphagic subjects are presented. We found a mean bolus volume of 25.6 +/- 8.5 ml during single swallow and 21.1 +/- 8.2 ml during stress (forced, repetitive swallow). During forced, repetitive swallow, the bolus volume was more strongly associated with suction time (r2 = 0.55) than with peak suction pressure (r2 = 0.04), indicating that suction time is more important than suction pressure in determining the bolus volume. The oral-pharyngeal transit time decreased: single swallow 0.56 +/- 0.36 sec, forced repetitive swallow 0.23 +/- 0.11 sec, as did the coefficient of variation (48% and 64%, respectively) indicating a more automatic neural process for pharyngeal function in forced, repetitive swallow. The postswallow respiration started with inspiration in 10% of studied individuals, but did not correlate with deviations in other variables in the test. Thus, postswallow inspiration must be considered as normal. The ROSS test offers a rapid and easy quantitative assessment of swallowing.

Adolescent↗
PubMed1996

Swallowing in hereditary sensory ataxia.

The oral, pharyngeal, and esophageal stages of swallowing were evaluated in 8 patients with recessively or dominantly inherited pure sensory ataxia. Six patients had swallowing difficulties: solid bolus obstruction, coughs during eating, and choking episodes. One patient had chronic bronchitis and another had recurrent pneumonia. The patients underwent a biphasic radiological barium swallow, including videofluoroscopy. No patient had a completely normal swallow. All had normal oral function, whereas pharyngeal function was abnormal in 6 patients. Esophageal function was abnormal in 6 patients. The swallowing dysfunction did not correlate with the severity of motor or sensory dysfunction in the limbs, nor with age or duration of ataxia. Our study shows that swallowing dysfunction is common in hereditary sensory ataxia. This dysfunction is likely to be due to involvement of the nucleus of the solitary tract in the brainstem. Despite some of the patients having suffered from choking episodes and others from bronchopulmonary complications, they did not spontaneously admit dysphagia. Swallowing should be evaluated thoroughly in patients with hereditary sensory ataxia since dysphagia in these patients might bring serious and potentially fatal complications.

Adult↗
PubMed1996

Quantitative assessment of oral and pharyngeal function in Parkinson's disease.

Oral and pharyngeal dysfunction is common in Parkinson's disease. To reveal the frequency of swallowing dysfunction and correlate swallowing dysfunction with locomotor disturbances, we studied 75 patients with Parkinson's disease staged I-IV according to the Hoehn and Yahr score. We assessed oral and pharyngeal swallow during optimal medication by a quantitative test of swallowing (the ROSS test) measuring the suction pressure, bolus volume, swallowing capacity, and time for important events in the swallowing cycle. We found abnormal results in 7/12 patients (58%) in stage 1 of the Hoehn and Yahr score, in 13/14 patients (93%) in stage 2, in 29/32 patients (91%) in stage 3, and in 16/17 patients (94%) in stage 4. Abnormal test results in stages, 1, 2, and 3 were seldom related to swallowing difficulties noticed by the patients. In advanced disease (Hoehn and Yahr stage 4), the abnormal results were often considerable, with swallowing difficulties obvious to the patient. Two of 17 patients coughed during or immediately after the test and 3/ 17 patients were unable to complete the test. The degree of swallowing disturbance increased during stress (forced, repetitive swallow). The Hoehn and Yahr score and the results in the ROSS test did not correlate, indicating that swallowing disturbances are due to nondopaminergic degeneration. Silent swallowing impairment may interfere with the nutrition and quality of life in Parkinson's disease, thus it is of interest to monitor this in clinical practice.

Adult↗
PubMed1996

Dynamic cranioplasty for brachycephaly.

In craniofacial surgery, the most common techniques for treatment of brachycephaly have been either to let the forehead float on the brain or to fix it in an advanced position. Since neither of these techniques renders acceptable results with enough consistency, we have developed a different way of addressing the problem. In principle, the design of the operation is to restrict upward and transverse growth of the cranium but to allow anterior and posterior expansion. This is accomplished by producing transverse tension across the skull and letting it expand anteriorly by means of a superiorly hinged fronto-orbital flap and posteriorly by an inferiorly based occipital flap. To prevent upward expansion at the squamosal sutures when still open, these junctions are bridged with miniplates. This surgical technique has brought definite improvement to the results even in some Apert syndrome children. During a 2-year period, we have treated 14 infants with this technique and followed 10 of them with roentgencephalometry, 3 for more than 1 year, and 4 for more than 6 months. The diagnoses were the following: nonsyndromal bicoronal synostosis (4), Apert (7), bicoronal synostosis with midline cleft, Saethre-Chotzen, and Antley-Bixler (1 each). The mean age of surgery was 6.6 months (range 3 to 16 months). There were no major complications.

Acrocephalosyndactylia↗
PubMed1996

Pregnancy in patients with primary sclerosing cholangitis.

A deterioration of liver function may occur during pregnancy in patients with chronic liver disorder. Primary sclerosing cholangitis (PSC) is a chronic progressive liver disorder with a highly variable and fluctuating course. This study aims at investigating the outcome of pregnancy in patients with PSC and, conversely, the effect of pregnancy on the disease. Thirteen pregnancies in 10 patients with PSC (4 with liver cirrhosis, 6 with mild liver disease) were observed. Seven patients had PSC before pregnancy, 2 developed the disease during pregnancy, and one patient developed PSC 2 months after a normal pregnancy with a normal delivery. Clinical symptoms and biochemical analyses were routinely evaluated during the pregnancy. No gastrointestinal haemorrhage was observed during the pregnancy. Two patients had pruritus and 2 abdominal pain before pregnancy, and these symptoms continued during pregnancy. Abdominal pain was noted in 3 patients lacking this symptom before pregnancy. Four patients without pruritus prior to pregnancy developed this symptom during the pregnancy. In two patients, pruritus was so intense as to bring on premature delivery. Liver tests did not indicate any deterioration during pregnancy. No fetal loss occurred. The outcome for all babies was normal. In patients with PSC pregnancy does not seem to have a negative effect on the disease process, neither mothers nor babies showed any ill effects. PSC has not worsened during the pregnancy in our patients.

Adult↗
PubMed1996

Natural history and prognostic factors in 305 Swedish patients with primary sclerosing cholangitis.

BACKGROUND/AIMS--The course of primary sclerosing cholangitis (PSC) is highly variable and unpredictable. This study describes the natural history and outcome of PSC. These data were used to construct a prognostic model for patients with PSC. METHODS--A total of 305 Swedish patients with PSC were studied. The median follow up time was 63 (1-194) months and all patients could be traced for follow up. Some 79 patients died or had a liver transplant. The prognostic significance of clinical, biochemical, and histological findings at the time of diagnosis were evaluated using multivariate analysis. RESULTS--The estimated median survival from time of diagnosis to death or liver transplantation was 12 years. Cholangiocarcinoma was found in 24 (8%) of the patients and 134 (44%) of the patients were asymptomatic at the time of diagnosis. The estimated survival rate was significantly higher in the asymptomatic group (p < 0.001). However, 29 (22%) of the asymptomatic patients became symptomatic during the study period. It was found that age, serum bilirubin concentration, and histological stage at the time of diagnosis were independent predictors of a bad prognosis. These variables were used to construct a prognostic model. CONCLUSIONS--This prognostic model developed from a large homogeneous population of PSC patients should be of value for the timing of transplantation and patient counselling in PSC.

Adolescent↗
PubMed1996

Minor role of hepatitis B and C virus infection in the etiology of hepatocellular carcinoma in a low-endemic area.

BACKGROUND: The etiologic role of hepatitis B (HBV) and C virus (HCV) for hepatocellular carcinoma (HCC) in a low-endemicity area is obscure. METHODS: Patients suspected of having primary liver cancer (PLC) in Göteborg, Sweden (n = 113), were tested serologically for HBV surface antigen and antibodies to HBV surface and core antigens. The presence of HBV surface and core antigens in cancer and non-neoplastic liver tissue in HCC cases was investigated immunohistochemically. Antibodies to HCV were tested by third-generation tests. The prevalence of HBV and HCV infection was compared in 73 patients with HCC and 32 patients with a final diagnosis other than PLC. RESULTS: No patient had signs of chronic HBV infection. Seven of 64 (11%) HCC patients were anti-HCV-positive, compared with 1 of 31 (3%) without PLC. All seven patients with HCC and HCV infection had liver cirrhosis, and two were alcoholics. Alcoholism was judged the commonest (42%) cause of cirrhosis. CONCLUSION: Contrary to areas with a high incidence of HCC, chronic viral hepatitis, particularly HBV, seems to play a minor etiologic role for HCC in Sweden compared with alcohol-related cirrhosis.

Aged↗
PubMed1996

Prevalence of Crohn's disease and simultaneous occurrence of extraintestinal complications and cancer. An epidemiologic study in adults.

BACKGROUND: Very dissimilar prevalence figures for Crohn's disease (CD) have been reported from different regions of Scandinavia. There are few reports on the occurrence of liver, joint, skin, and eye disease and gastrointestinal cancer in CD. METHODS: All patients > or = 16 years old with CD living in a well-defined catchment area on 1 March 1990 were identified from the previous 10 years' registers of inpatients and outpatients. The records were screened for evidence of extraintestinal complications and fistulas. RESULTS: The prevalence of CD was 94/10(5) (95% confidence interval, 84-104) inhabitants > or = 16 years old. Signs of liver disease were encountered in 1 of 10 patients, and other extraintestinal complications and intestinal cancer occurred in 1-3%. The true prevalence of primary sclerosing cholangitis could not be assessed. CONCLUSION: The prevalence of CD was midway between recent figures from Orebro and Copenhagen. Fistulas and pathologic liver laboratory test results were more prevalent when CD involved both the large and small bowel.

Adolescent↗
PubMed1996

Hepatitis and cancer: genetic aspects.

Hepatocellular carcinoma (HCC) is one of the most common tumours in the world. It is the seventh most common cancer in men and the ninth in women with an estimated 500,000 to 1,000,000 new HHC cases per year. However, there are considerable variations in the incidence of HCC throughout the world, related to geographical areas, socioeconomic factors, sex and age-specific incidence rates, suggesting genetic differences in susceptibility to HCC.

Age Factors↗
PubMed1995

Simultaneous videoradiography and pharyngeal solid state manometry (videomanometry) in 25 nondysphagic volunteers.

Recent technological advances in manometry, including solid state transducers and computerized analysis, allows for reliable interpretation of intraluminal pharyngeal pressures. Simultaneous videoradiography (barium swallow) provides fluoroscopic control of the manometric sensors (videomanometry), thereby eliminating the uncertainty of sensor dislocation during laryngeal elevation. This is the first study describing normal manometric parameters in videomanometry during barium swallow. Seven manometric parameters and six videoradiographic parameters were analyzed. We included 25 nondysphagic volunteers with normal videoradiographic parameters in the study. The examination was performed in an upright physiologic position during 10-ml barium and dry swallows. Mean resting pressure in the upper esophageal sphincter was 89.6 +/- 32.6 (+/- 2 SD) mmHg. Mean residual pressure during relaxation of the upper esophageal sphincter was 7.2 +/- 8.0 (+/- 2 SD) mmHg during barium swallow and 3.8 +/- 6.2 (+/- 2 SD) mmHg during dry swallow. The mean duration of upper esophageal sphincter relaxation was 601 +/- 248 (+/- 2 SD) msec. The mean peristaltic contraction of the upper esophageal sphincter was 253.8 +/- 142.8 (+/- 2 SD) mmHg. Fourteen (56%) of the 25 had a measurable intrabolus pressure (mean 33.2 +/- 17.3 mmHg) at the level of the inferior pharyngeal constrictor. A specific finding was discovered when the epiglottis tilts down hitting the manometric sensor. This epiglottic tilt was identified in 7 subjects (28%) and caused pressures of around 600 mmHg. A standardized manometric technique is important in videomanometry, and normal values as described in this study are essential in clinical use.

Adult↗