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Biomedical subjects

R Olsson

Publications and source records attributed to R Olsson.

At least 91 records · Page 5Linked to original sources
PubMed1995

Autonomic nerve dysfunction in patients with bolus-specific esophageal dysmotility.

The pathogenetic mechanisms causing esophageal dysmotility is not well understood. We examined 13 patients with solid bolus dysphagia in a radiologic barium study including the swallowing of a 14-mm tablet. In all 13 patients the tablet was caught in the proximal or midesophagus. In 8 patients, the entrapment was associated with symptoms (Group 1) whereas in 5 patients (Group 2), no symptoms were reported. All 13 patients together with a control group of 56 healthy, nondysphagic subjects were tested for autonomic nerve function. Autonomic nerve function tests included registration of electrocardiographic R-R interval variation during deep breathing test (E/I ratio), a test of parasympathetic, vagal, nerve function. The results showed that the E/I ratio was significantly lower in patients with symptoms of bolus-specific esophageal dysmotility (-2,19 [1.76]) (median [interquartile range]) compared with patients without symptoms (0.05 [2, 87], p = 0.0192) and controls (-0.25 [1.26], p = 0.0009). In conclusion, symptomatic bolus-specific esophageal dysmotility is associated with vagal nerve dysfunction.

Adolescent↗
PubMed1995

Colchicine treatment of primary sclerosing cholangitis.

BACKGROUND/AIMS: There is no medical treatment of documented benefit in primary sclerosing cholangitis (PSC). Colchicine has been observed to reduce mortality in primary biliary cirrhosis in one study. The aim of this study was to examine the effect of colchicine in PSC. METHODS: Eighty-four patients with PSC were randomized to receive 1 mg of colchicine daily (n = 44) or placebo (n = 40) in a double-blind 3-year study. The effect of treatment was evaluated through blind scoring of 10 variables in prestudy and poststudy liver biopsy specimens, daily recording of symptoms, and biochemical tests (serum bilirubin, alkaline phosphatase, aspartate aminotransferase, alanine aminotransferase, albumin, immunoglobulins, ceruloplasmin, alpha 1-antitrypsin, and plasma prothrombin levels) at 6-month intervals. RESULTS: There was no evidence of a favorable effect of colchicine on survival, symptoms, serum biochemistry, or liver histology in patients with PSC. CONCLUSIONS: One milligram of colchicine daily is ineffective in PSC.

Adult↗
PubMed1995

HLA-DR and HLA-DQ are not markers for rapid disease progression in primary sclerosing cholangitis.

BACKGROUND/AIMS: The association between primary sclerosing cholangitis (PSC) and the HLA haplotype A1, B8, DR3, DQ2 is well established. During the last few years, several additional HLA associations have been suggested in PSC. Furthermore, two different HLA-DR specificities have been reported to be markers for rapid disease progression. Our aim was to critically evaluate all of the current and as yet mostly unconfirmed HLA class II issues in PSC. METHODS: Seventy-five Swedish patients with PSC were HLA-DR and HLA-DQ genotyped. RESULTS: Of the recently described HLA associations in PSC, the association with the DRB1*1301, DQA1*0103, DQB1*0603 haplotype was decisively confirmed, whereas the DRB1*04 specificity was only slightly under-represented and the frequency of DR2 was neutral. The association with codon 38 of DRB genes was secondary to the DRB3*0101 association. HLA-DR and HLA-DQ alleles were not found to be markers of disease progression. CONCLUSIONS: The HLA-associated genetic susceptibility to PSC cannot be attributed to specific amino acid positions of the DR beta chains. The highly discrepant results obtained in two previously reported studies and the present investigation indicate that HLA class II alleles are not markers for a more aggressive clinical course in PSC.

Alleles↗
PubMed1995

Videomanometry of the pharynx in dysphagic patients with a posterior cricopharyngeal indentation.

RATIONALE AND OBJECTIVES: Patients with a posterior indentation in the pharyngoesophageal segment (PES) are generally considered to have an abnormality of the cricopharyngeal muscle (CPM). In this study we determined the actual width of the PES and the pressure circumstances during swallowing within the pharynx and PES in such patients. METHODS: Simultaneous videofluoroscopy and solid state manometry, radiologic examination of the pharynx, PES, and cervical esophagus were performed in 16 dysphagic patients with a cricopharyngeal (CP) bar. In eight patients the indentation was 25-50%, and in eight it was more than 50% of the adjacent gullet. Sixteen dysphagic patients without a CP bar were used as control subjects. In each patient swallows of 10-ml barium bolus were recorded. RESULTS: Patients with CP bars had a significantly wider PES above (p = .0005) and below (p = .02) the CPM, whereas the diameter at the level of the CPM was smaller only in the patients with more than 50% indentation compared with the patients without a CP bar. The contraction pressure above the CP bar (i.e., at the level of the inferior pharyngeal constrictor) was significantly (p = .002) weaker in patients with a CP bar (131 +/- 16 mm Hg) than in those without a CP bar (222 +/- 20 mm Hg). CONCLUSION: Our findings in patients with a posterior CP bar suggest that the major abnormality is weak constrictors with outpouching of the gullet above and below. Only in patients with more than 50% indentation was there a slight narrowing at the level of the CP bar. The CPM showed no manometric abnormalities in terms of resting pressure, relaxation, and contraction pressure. Therefore, the CPM is likely to relax and distend normally during swallowing in patients with a CP bar.

Deglutition↗
PubMed1995

Sampling variability of percutaneous liver biopsy in primary sclerosing cholangitis.

AIMS: To study sampling variability of percutaneous liver biopsy in primary sclerosing cholangitis (PSC). METHODS: One hundred and twelve biopsy specimens (that is, 56 pairs) from 44 patients with PSC, confirmed by cholangiography, were evaluated blindly. Six different features, qualitative grading of four other features and staging according to Ludwig were assessed. RESULTS: Quantitative sampling variability was confined mainly to just one grade or stage, although 11% (six of 56) of the biopsy specimen pairs differed by more than one stage (7% (one of 15) in pairs > 2 cm in length). Qualitative sampling variabilities were between 18 and 71%. Advanced disease (stages 3 or 4) was missed in 40% (two of five) of the biopsy specimens while cirrhosis was missed in 37%. CONCLUSION: Paired liver biopsy specimens should be taken in clinical studies of PSC using liver histology for evaluation or prognosis.

Biopsy, Needle↗
PubMed1995

[The pharyngoesophageal segment].

The pharyngoesophageal segment (PES) is a striated muscular structure separating the relatively wide pharynx from the narrow cervical esophagus. There is a substantial axial and longitudinal asymmetry within the PES, as well as basal resting pressure that is substantially influenced by a variety of stimuli as well as deglutition.

Deglutition↗
PubMed1995

[Simultaneous video radiography and "solid state" intraluminal pharyngeal manometry during barium swallow; video manometry].

Recent advances in technology, including computerized analysis, have renewed interest in pharyngeal manometry. Simultaneous fluoroscopy and videography have been recommended by many authors. This article reviews the history of pharyngeal manometry and highlights some of the technical difficulties involved. We also report the current status of the simultaneous technique and summarize our own results as well as those reported by other research groups.

Barium Sulfate↗
PubMed1995

1,3-Dipropyl-8-[2-(5,6-epoxy)norbornyl]xanthine, a potent, specific and selective A1 adenosine receptor antagonist in the guinea pig heart and brain and in DDT1MF-2 cells.

The objective of this study was to characterize the adenosine receptor (AdoR) antagonistic properties of a newly synthesized alkylxanthine, 1,3-dipropyl-8[2-(5,6-epoxy)norbornyl]xanthine (ENX), and compare them to those of 1,3-dipropyl-8-(cyclo-pentyl)xanthine (CPX), 1,3-dipropyl-8-(3-noradamantyl)xanthine (NAX) and (+/-)-N6-endo-norbornan-2-yl-9-methyladenine (N-0861). The potencies and selectivities of ENX, CPX, NAX and N-0861 were determined by functional studies of guinea pig isolated perfused hearts, and by radioligand binding assays for A1 and A2a AdoRs in the guinea pig forebrain and striatum. ENX competitively antagonized A1 AdoR-mediated prolongations of atrioventricular nodal conduction time caused by Ado or by 2-chloro-N6-cyclopentyladenosine, but not those caused by carbachol (0.14 microM) or MgCl2 (3 mM). Schild analysis of 2-chloro-N6-cyclopentyladenosine-antagonist competition curves yielded pA2 values for ENX, CPX and NAX of 8.45 +/- 0.19, 8.55 +/- 0.28 and 8.79 +/- 0.15, respectively. ENX (30 microM) and N-0861 (30 microM) did not attenuate the A2 AdoR-mediated increase in coronary conductance caused by adenosine. CPX and NAX attenuated the coronary vasodilation caused by adenosine with IC50 values of 1.5 and 7.1 microM, respectively. Radioligand binding assays revealed that ENX, CPX and NAX and N-0861 had a 400-, 209-, 110- and 10-fold greater affinity, respectively, for A1 than for A2a AdoRs of guinea pig brain membranes. Thus, ENX was equipotent with CPX and NAX and more potent than N-0861 (pA2 = 6.2) as an antagonist at A1 AdoRs, but had lower affinity for A2 AdoRs in guinea pig hearts and brain striatum than did either CPX or NAX. In DDT1 MF-2 cells, all three alkylxanthines had similar affinities for A1 AdoRs, whereas the affinity of N-0861 for A1 AdoRs was significantly lower. ENX appears to be the most A1 AdoR subtype-selective of the alkylxanthine class of AdoR antagonists reported to date.

Adenosine↗
PubMed1994

Pharyngeal solid-state manometry catheter movement during swallowing in dysphagic and nondysphagic participants.

RATIONALE AND OBJECTIVES: The movements of the soft palate and the larynx are crucial in pharyngeal manometry because of the potential risk of manometry sensor dislocation. METHODS: Twenty dysphagic patients and 20 nondysphagic volunteers were examined with simultaneous videoradiography and intraluminal pharyngeal solid-state manometry. The movements of the manometric sensors were analyzed from lateral videorecording. RESULTS: Two different types of catheter movement were found. The sensor in the upper esophageal sphincter (UES) could either be lifted cranially during the closure of the soft palate (type 1) or stay unaltered in the sphincter until the beginning of the laryngeal elevation and then follow the sphincter cranially during laryngeal elevation with no previous response to soft palate closure (type 2). Type 1 movement was found in eight of 20 patients but in only one of the 20 volunteers. The resting pressure of the upper esophageal sphincter was significantly higher in type 2 (P = 0.004). Nineteen of the 20 patients with a high resting pressure of the UES (83+ mm Hg) were found to have the type 2 movement. CONCLUSION: High resting pressure in the UES permitted the sphincter to grasp the manometry catheter and caused the sensor to follow the cranial movement during laryngeal elevation. Sensor movement is important during pharyngeal manometry, and sensor dislocation out of the sphincter can be misinterpreted as sphincter relaxation. Simultaneous videoradiography provides control of sensor positioning and allows for correction.

Adult↗
PubMed1994

An experimental manometric study simulating upper esophageal sphincter narrowing.

RATIONALE AND OBJECTIVES: Elevated intrabolus pressure above a pharyngeal narrowing has been postulated as an important finding in patients with cricopharyngeal bars. To elucidate the significance of intrabolus pressure around lumen narrowings in the pharynx, intraluminal pressure characteristics were evaluated in a laboratory model simulating upper esophageal sphincter narrowing. METHODS: Intraluminal solid-state manometry was performed in an experimental model in which variable narrowing was created in an expandable balloon simulating the pharyngeal walls. RESULTS: Intrabolus pressure was dependent on the position of the manometric sensor, degree of lumen narrowing, bolus volume, flow rate, and fluid viscosity. CONCLUSIONS: Elevated intrabolus pressure is an important finding. Intrabolus pressure is dependent on many parameters, and hence, is difficult to evaluate. If results found with this model hold true in patients, manometric sensor positioning is crucial, and concurrent fluoroscopy is highly recommended to achieve a standardized manometric technique in pharyngeal manometry.

Deglutition↗
PubMed1994

Liver reactions from trimethoprim.

OBJECTIVE: To study whether there are adverse liver reactions to trimethoprim and, if found, to describe the biochemical pattern of these reactions. DESIGN: We surveyed all liver reactions from trimethoprim to SADRAC (Swedish Adverse Drug Reactions Advisory Committee) from 1980 to 1989. MAIN OUTCOME MEASURE: Incidence of reported adverse liver reactions [number of reported adverse liver reactions/sales of trimethoprim in defined daily dose (DDD)]. RESULTS: During 1980-1989, 21 suspected liver reactions from trimethoprim were reported. A causal relationship was considered probable in 10 of these reports, which gives an incidence of 1/1360000 DDD. The distribution of reaction types for trimethoprim was virtually identical to that found in corresponding adverse reports for trimethoprim-sulfonamides, whereas the sulfonamides as single drugs displayed a significantly higher proportion of more severe hepatocellular reactions.

Adult↗
PubMed1994

Risk factors for bone loss in chronic active hepatitis and primary biliary cirrhosis.

BACKGROUND: Data on risk factors for bone loss in chronic active hepatitis (CAH) and primary biliary cirrhosis (PBC) are scanty and/or conflicting. METHODS: Bone mineral density (BMD) in the distal forearm was measured using single-photon absorptiometry in 39 patients with CAH and 32 patients with PBC. We also attempted to identify risk factors for bone loss by means of a questionnaire and through a wide range of biochemical analyses. RESULTS: In the CAH patients BMD is inversely related to the duration of steroid treatment and to age at menarche. In the PBC patients there was a strong correlation between BMD and serum gastrin concentrations. CONCLUSIONS: Bone loss in CAH is to some extent explained by steroid treatment and delayed menarche. Bone loss in PBC may be reduced by increased calcitonin secretion induced by gastrocalcin.

Adrenal Cortex Hormones↗
PubMed1994

Cancer risk in primary biliary cirrhosis: a population-based study from Sweden.

A cohort of 559 patients in Sweden who satisfied predetermined criteria for the diagnosis of primary biliary cirrhosis was followed with respect to the incidence of cancer during the period of 1958 to 1988. The mean follow-up time from the time of primary biliary cirrhosis diagnosis was 9.0 +/- 5.4 yr. During the follow-up period, 148 patients died and the primary cause of death was liver insufficiency. An overall excess risk for cancer, standardized incidence ratio 1.6; 95% confidence interval, 1.1 to 2.2, was found in the cohort. In contrast to previous reports, we found no excess risk for breast cancer (standardized incidence ratio, 0.9; 95% confidence interval, 0.3 to 2.1). The number of hepatocellular cancers in the primary biliary cirrhosis cohort did not significantly differ from expected (standardized incidence ratio, 2.91; 95% confidence interval, 0.4 to 10.5).

Adult↗
PubMed1994

Simultaneous videoradiography and computerized pharyngeal manometry--videomanometry.

To obtain more information about muscle function in patients with dysphagia, simultaneous barium swallow and computerized pharyngeal manometry with solid-state pressure transducers was employed for the evaluation of the pharynx and the pharyngoesophageal segment (PES) in 30 consecutive patients. The manometry catheter was positioned under fluoroscopic control, providing localized measurements of the intraluminal pressures in the pharynx. Sixteen patients had a normal barium swallow. In 5 (31%) of these the manometry disclosed PES dysfunction, i.e. increased resting pressures between swallows in 3 patients (mean 120 +/- 13 mm Hg), and increased contraction pressures during peristalsis in 2 (mean 297 +/- 21 mm Hg). Barium swallow and manometry are complementary: the former reflecting transport through the pharynx and penetration to the airways, the latter the intraluminal pressures created by the pharyngeal wall. The combination of barium swallow and manometry gives information about pressure in relation to bolus transport, which may elucidate pharyngeal dysfunction.

Adult↗
PubMed1994

Fracture of the occipital condyle as an incidental finding during CT-evaluation of a maxillary fracture.

A 43-year-old male presented with blunt facial trauma after a motor-vehicle accident. CT-evaluation revealed a right-sided maxillary fracture and a fracture of the left occipital condyle. The fracture of the occipital condyle is potentially unstable and fatal cases have been described. Plain radiographs are not diagnostic. This occipital condyle fracture was an incidental finding during CT-evaluation of a maxillary fracture and is probably the first case with coronary CT scans of this type of fracture.

Adult↗
PubMed1993

Pharyngeal constrictor paresis: an indicator of neurologic disease?

Pharyngeal constrictor paresis (PHCP) is sometimes found in videoradiography of the swallowing act in patients complaining of dysphagia. Ten patients with PHCP and 10 dysphagic, age- and sex-matched controls with normal videoradiography were neurologically evaluated and examined with magnetic resonance imaging (MRI) of the brain and brainstem in order to learn the pathogenetic process behind PHCP. The study revealed 8 PHCP patients and 1 dysphagic control with abnormal clinical neurological findings such as myopathy, cerebrovascular disease, or extrapyramidal disease. The neurological examination revealed considerable information of prognostic and therapeutic value in PHCP patients. The MRI was abnormal in 7 PHCP patients and 4 dysphagic controls. However, the findings in MRI were nonspecific but the examination was found to be valuable in selected cases. It is concluded that PHCP is an indicator of neurological disease and accordingly, such patients should be examined by a neurologist to establish the cause of the disease.

Adult↗