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Biomedical subjects

T Gustafson

Publications and source records attributed to T Gustafson.

At least 19 recordsLinked to original sources

Post-herniographic abdominal pain syndrome.

PURPOSE: To disclose the frequency of abdominal pain that led to post-procedure hospitalization and the outcome of this major complication. MATERIAL AND METHODS: 576 patients who had undergone herniography during a 13-year period were retrospectively analysed. RESULTS: Nine out of 576 patients (1.6%) undergoing herniography with an iodine contrast medium developed abdominal pain. The pain resolved within 24 h in 6 patients while 3 patients had pain for up to 3 days. CONCLUSION: Patients who present with this pain syndrome thus only need careful clinical observation until asymptomatic, with no need for laparotomy or X-ray examination. Prior to herniography, the patients should be informed about this potential complication.

Abdominal Pain↗

Synthesis of an organoinsulin molecule that can be activated by antibody catalysis.

We have developed a methodology of prodrug delivery by using a modified insulin species whose biological activity potentially can be regulated in vivo. Native insulin was derivatized with aldol-terminated chemical modifications that can be selectively removed by the catalytic aldolase antibody 38C2 under physiologic conditions. The derivatized organoinsulin (insulin(D)) was defective with respect to receptor binding and stimulation of glucose transport. The affinity of insulin(D) for the insulin receptor was reduced by 90% in binding studies using intact cells. The ability of insulin(D) to stimulate glucose transport was reduced by 96% in 3T3-L1 adipocytes and by 55% in conscious rats. Incubation of insulin(D) with the catalytic aldolase antibody 38C2 cleaved all of the aldol-terminated modifications, restoring native insulin. Treatment of insulin(D) with 38C2 also restored insulin(D)'s receptor binding and glucose transport-stimulating activities in vitro, as well as its ability to lower glucose levels in animals in vivo. We propose that these results are the foundation for an in vivo regulated system of insulin activation using the prohormone insulin(D) and catalytic antibody 38C2 with potential therapeutic application.

3T3 Cells↗

Studies on the cellular basis of morphogenesis in the sea urchin embryo. Directed movements of primary mesenchyme cells in normal and vegetalized larvae.

A time-lapse study has been made of the movements of the primary mesenchyme cells in the developing sea urchin larva. It shows that these cells move by pseudopod formation and contraction, and that a transition takes place--within a few hours--from a more or less random cluster, in the early mesenchyme blastula, to a well-organized, coherent pattern on the ectoderm of the gastrula. This organization is achieved by a striking random exploration of the wall of the larva by the pseudopods, followed by their contraction. The final pattern of the mesenchyme reflects those regions of the wall where the contacts between pseudopods and wall are most stable. The mechanism is thus one of selective fixation rather than of selective conduction. The pseudopodal contacts are seen to be continually made and broken, even when the final pattern is formed. The pseudopods of several cells may fuse to form a common pseudopod, these cells then migrating together. This is particularly evident in vegetalized larvae, but is also typical of the ventral side. Despite considerable variations in the way in which the final pattern is achieved, several main phases can be distinguished. The first is a radial displacement of the cells from the vegetal plate onto the presumptive ectoderm, followed by a phase of dispersion. The cells then gradually accumulate at a characteristic level, and form a ring. During this process, and when the ring is formed, the cells tend to accumulate in two clusters along the ring. The pseudopods of the cells in these clusters join into a cable, the end of which is highly branched; it explores the ectoderm, and extends the cell clusters to form branches from the ring. In vegetalized larvae, the pattern of distribution is simplified, but the same principles apply. It is suggested that the variations in the way in which the pattern is achieved are, in all probability, merely a reflexion of the lack of precision in the time sequence of changes in adhesive properties of the primary mesenchyme and blastocoel wall.

Animals↗

Skeletal muscle magnesium and potassium in asthmatics treated with oral beta 2-agonists.

Dietary magnesium has been shown to be important for lung function and bronchial reactivity. Interest in electrolytes in asthma has so far mainly been focused upon serum potassium, especially linked to beta 2-agonist treatment. It is known that serum levels of magnesium and potassium may not correctly reflect the intracellular status. We therefore investigated whether asthmatics treated with oral beta 2-agonists had low magnesium or potassium in skeletal muscle and serum, and whether withdrawal of the oral beta 2-agonists would improve the electrolyte levels. Magnesium and potassium levels in skeletal muscle biopsies, serum and urine were analysed in 20 asthmatics before and 2 months after withdrawal of long-term oral beta 2-agonists, and for comparison in 10 healthy subjects. Skeletal muscle magnesium in the asthmatics was lower both before (3.62 +/- 0.69 mmol.100 g-1 (mean +/- SD)) and after (3.43 +/- 0.60 mmol.100 g-1) withdrawal of oral beta 2-agonists compared with the controls (4.43 +/- 0.74 mmol.100 g-1). Skeletal muscle potassium and serum magnesium did not differ between the groups. Serum potassium was significantly lower both before (4.0 +/- 0.2 mmol.L-1) and after (3.9 +/- 0.2 mmol.L-1) the withdrawal of oral beta 2-agonists compared with the control group (4.2 +/- 0.2 mmol.L-1). The asthmatics had lower skeletal muscle magnesium and lower serum potassium than the healthy controls, both with and without oral beta 2-agonists. Whether the findings are related to asthma pathophysiology or treatment is currently being investigated.

Administration, Oral↗

Financing and payment reform for primary health care and substance abuse treatment.

One of the most controversial areas for health care reform concerns the treatment of alcohol and other drug problems, which account for some of the most rapidly rising costs in the health care sector. There is arguably no other set of conditions that show such variation in accessibility to treatment on the basis of insurance status, present the same degree of difficulty in providing comprehensive care, or challenge as many public and professional assumptions about behavioral, social and economic determinants. The purpose of this article is to discuss some of the financing and coverage barriers to comprehensive treatment for alcohol and other drug abuse; to discuss some innovative mechanisms for providing and financing comprehensive services; and to suggest some directions for public policy to support the development of new practice models that emphasize cost-effectiveness and efficiency of care.

Alcoholism↗

99mTc-diphosphonate scintigraphy in successful knee arthroplasty and its relation to micromotion.

Nineteen tibial components after successful knee arthroplasty were studied with technetium 99m scintigraphy. All cases were also followed from the operation with roentgen stereophotogrammetric analysis (RSA). All but three cases became stable after an initial period of migration. Scintigraphic uptake was found in all cases, with a ratio as high as seven in the medial compartment and three in the lateral compartment. A group of cases with proven mechanical loosening showed an uptake ratio as high as 6.9 in the medial compartment and 5.5 in the lateral compartment. No correlation was found between scintigraphic uptake and alignment, whether cement was used, or the presence/absence of migration. Technetium 99m scintigraphy is not a useful method for assessing loosening in individual symptomatic cases of knee arthroplasty.

Aged↗

Pharmacological control of muscular activity in the sea urchin larva--IV. Effects of monoamines and adenosine.

1. The muscular activity of the sea urchin pluteus is affected by catecholamines. alpha-Agonists in high concentrations bring about a strong, temporary, stimulation. 2. The stimulation by beta-agonists tends to be masked by different mechanisms. 3. Serotonin brings about a strong stimulation of long duration, even at 10(-7) M. It reactivates larvae where the activity has declined after exposure to catecholamines. A dopamine-effect at 10(-5)-5 x 10(-6) M is similar to that of serotonin. The effect of adenosine is similar to that of dc-c-AMP. 4. The action of the alpha- and beta-agonists and adenosine appears to involve an increased respectively excessive Ca2(+)-influx, directly or indirectly mediated by c-AMP. 5. It is suggested that a strong Ca2(+)-influx induces an outflux of K+ leading to hyperpolarization. Serotonin may decrease the K(+)-outflux.

Adenosine↗

111Indium-labelled leukocytes for measurement of inflammatory activity in arthritis.

Mononuclear leukocytes and granulocytes have been separated and labelled with 111In-oxine (111In). We show that granulocytes as well as monocytes can be labelled with 111In without serious adverse effects on the viability of the cells. The separated and 111In-labelled cells from patients with rheumatoid arthritis and psoriatic arthritis were reinfused into the patients and detection was made with a gamma camera over the inflamed joints. The study shows that images and semi-quantitative indices of leukocyte accumulation in the joints could be obtained in these patients. We suggest that the method may be a sensitive indicator of non exsudative synovitis and allow assessment of inflammation in joints not amenable to physical examination. This method also opens new possibilities to measure the migration of different leukocytes over the synovial membrane.

Adult↗

Pharmacological control of muscular activity in the sea urchin larva. III. Role of cyclic nucleotides.

1. The muscular activity of the sea urchin pluteus is strongly affected by dibutyryl-c-AMP, in a stimulatory or inhibitory manner depending on the concentration, the time of exposure, and the spontaneous level of activity. 2. Dibutyryl-c-GMP, like muscarinic agents and the guanylate-cyclase activators biotin and nitrite, keeps the activity low. 3. It is suggested that the effects of muscarinic agents is mediated by c-GMP, the effects of certain monoamines by c-AMP. 4. The two cyclic nucleotides appear to control the cellular influx of Ca2+ in opposite directions. They therefore interfere with the stimulatory and paralytic effects of nicotinic agents.

1-Methyl-3-isobutylxanthine↗

Three-phase scintimetry in osteonecrosis of the knee.

Three-phase scintimetry with 99mTc MDP was analyzed in 40 patients with a clinical history of spontaneous onset of knee pain and a focal static isotope uptake in the femoral condyle indicating osteonecrosis. A strong correlation was found between pool-phase ratios and the static ratios. The pool-phase study did not add to the information obtained from the flow phase and static studies. There was a characteristic change of the pattern of the early flow-phase curves with the duration since the onset of symptoms indicating hyperemia early in the disease. A persistent high flow-phase and static-uptake ratio 6-12 months after the onset of symptoms correlated positively with a poor clinical and radiographic outcome. The 10 patients with a good prognosis had, as a group, a more rapid decrease in isotope uptake after 6 months. There was a positive correlation between a high static uptake ratio and the size of the lesion, and subsequently with the clinical and radiographic outcome. 30 patients developed arthrosis and/or severe clinical symptoms. Five of the 10 patients who did not develop arthrosis never developed radiographic evidence of osteonecrosis.

Adult↗

Intraperitoneal infusion of 5-FU in liver metastases from colorectal cancer.

Intraperitoneal 5-fluorouracil (5-FU) was given to eight patients with unresectable colorectal liver cancer and to one patient after radical hepatectomy. A subcutaneous intraperitoneal access device was implanted, and treatment consisted of continuous infusion of 1,000 mg 5-FU/d for 5 days, repeated every 6 weeks. Evaluation of treatment was performed after every two cycles of therapy. A total of 32 infusion cycles were given. The mean steady-state concentration of 5-FU was 0.56 +/- 0.04 mumol/l (mean +/- SEM), and the total body clearance was 10.0 +/- 0.71/min mean +/- SEM). The levels of 5-FU in peripheral venous blood were stable and reproducible. When incubated in whole blood at 37 degrees C the concentration of 5-FU fell rapidly and after 2 h, only 22% of the starting level remained. When kept ice-cold, 5-FU samples were stable. Patient acceptance was excellent, and the therapy was free from complications except for slight abdominal discomfort, not enough to require alleviation by analgesic drugs. Computerized tomography (CT) scan showed stationary tumor volume after two cycles of therapy in four of eight patients who could be evaluated. It is concluded that continuous intraperitoneal infusion of 5-FU produces stable and reproducible levels of the drug in peripheral venous blood, that 5-FU is degraded by blood cells at 37 degrees C, that the use of a subcutaneous access device makes the delivery easy and safe, and that the efficacy of the therapy seems to be similar to that obtained with hepatic arterial infusion.

Abdomen↗

Visceral improvement following combined plasmapheresis and immunosuppressive drug therapy in progressive systemic sclerosis.

In a two-year prospective therapeutic trial, 15 patients with progressive systemic sclerosis (PSS) were treated with immunosuppressive drug therapy with or without long-term plasmapheresis. Before the trial all patients had severe involvement of either the esophagus, lungs or kidneys. One patient died of renal failure and another 2 patients withdrew unimproved. In the remaining 12 patients, objective improvement occurred in all but one. The degree and extent of skin involvement decreased significantly (p less than 0.01). Cineradiography revealed increased esophageal motility in 4 patients. Pulmonary function measured as total lung capacity and static lung compliance improved (p less than 0.01). In 4 patients the number of premature atrial or ventricular contractions at 24 h ECG monitoring decreased, as did the concentrations of immunoglobulins and ANA titres in serum. Although it could not be ascertained whether the clinical improvement was associated with combined therapy or immunosuppressive drug treatment alone, our results suggest that immunosuppressive therapy is beneficial in advanced PSS.

Adult↗

Scintimetry in transient synovitis of the hip in the child.

Fifty-five consecutive children presenting with transient synovitis of the hip were examined with 99mTc-MDP scintigraphy and pin-hole collimator technique. Quantitative assessment was performed along a profile of interest across the hip joint. The criteria for the normal scintimetric pattern in the child's hip were established and the pathologic pattern of uptake in the acute phase, as well as in the follow-up after synovitis, was described. A decrease in isotope uptake in the proximal femoral epiphysis was observed in 13 children. This was correlated with a reduced uptake in the growth-plate, indicating a disturbance of blood supply to these regions. A characteristic pattern of isotope uptake with duration of symptoms was observed: a decrease in uptake during the first week followed by rebound hyperemia within 1 month. One child developed osteonecrosis (Legg-Calvé-Perthes disease).

Acetabulum↗

Esophageal dysfunction and radionuclide transit in progressive systemic sclerosis.

Sixty patients with progressive systemic sclerosis (PSS) were studied by radionuclide esophageal transit (RT) and esophageal cineradiography. Fifty-two patients (87%) had abnormal RT with prolonged transit time and 28 (47%) had stagnation of radionuclide. RT was positively correlated to duration of disease (p less than 0.01). A positive correlation between transit time and the presence of dysphagia was observed. Reduced esophageal motility evaluated by cineradiography was observed in 44 patients (73%). In patients with moderate-severe esophageal dysfunction there was a positive association between prolonged RT and hypomotility at the radiological examination (p = 0.001). RT is a safe and non-invasive method which is more sensitive than cineradiography and might be used as a screening test to evaluate esophageal involvement in patients with PSS.

Adult↗

Systemic reactive amyloidosis caused by hepatocellular adenoma. A case report.

Systemic reactive amyloidosis caused by non-malignant tumors seems to be extremely rare. In the present paper a 39-year-old female with systemic reactive amyloidosis caused by a hepatocellular adenoma is described. The patient had a history of using contraceptive drugs. She had a pronounced nephrotic syndrome, a renal biopsy showing reactive (AA) amyloidosis, and a bone scintigraphy (99mTc methylene diphosphonate, TcMDP) showing an increased uptake in soft tissues. Removal of the adenoma was followed by a gradual resolution of the nephrotic syndrome and a normalization of the bone scintigraphy. The tumor was histologically a mixture of focal nodular hyperplasia and liver cell adenoma.

Adenoma↗

Hemarthrosis in undisplaced cervical fractures. Tamponade may cause reversible femoral head ischemia.

In eight undisplaced intracapsular fractures of the femoral neck, an intracapsular hematoma was diagnosed by computed tomography. 99mTc-MDP scintimetry revealed markedly reduced or absent blood supply to the head of femur. The intracapsular pressure was 23 (2.7-43) kPa with the hip in neutral position. Following aspiration of 12 (0.5-36) ml of blood, pressure was reduced to zero, and postaspiration scintimetry revealed restitution of blood supply to the femoral head. Hip joint tamponade in these patients has caused femoral head ischemia, reversible by aspiration.

Aged↗