[Quality assurance of pain relief in terminal care. Diagnose the pain and evaluate therapeutic results!].
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Biomedical subjects
Publications and source records attributed to B Lindström.
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The aim of this study was to investigate whether significant differences in peak torque (PT), mean power frequency of EMG (fmean) and perceived fatigue exist between the dominant and non-dominant knee extensors throughout repeated contractions. The present study forms part of a research project aimed at developing tests for the determination of the degree of motor control in patients with sequelae after CNS injury. A total of 22 clinically healthy subjects (14 males and eight females) took part in the investigation. The subjects performed endurance tests of the lower limbs, consisting of 100 repeated knee extensions using a Cybex dynamometer at 1.57 rad s-1. The patterns of PT, fmean and perception of fatigue throughout the endurance test were investigated. The endurance curves of PT and fmean showed, in common with other studies, an initial steep decrease followed by a stable phase. No significant differences existed between dominant and non-dominant knee extensors with regard to PT, fmean or perception of fatigue. The results indicate that it may be possible to use the contralateral knee extensors as an indicator of motor recovery in hemiplegia in patients with a high degree of recovery.
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The spatial distribution of back scattering from a vertical cross-section of the nuclear area in non-cataractous human lens was investigated. The cross-section was centred on the pupil. There is no significant difference in average nuclear back scattering between sides. The distribution of back scattering along an axis perpendicular to the anatomical axis can be modelled as a second-order polynomial. It is believed that the increase of back scattering in the central region corresponds to the peak protein concentration in the centre of the nucleus. This information was obtained by imaging back scattering with Scheimpflug photography. The back scattering was measured photometrically in a 3 x 10 matrix of measuring areas within the lens nucleus. Each measuring area was 0.20 x 0.20 mm in size. It is anticipated that the established model will allow detection of nuclear cataract with high sensitivity, especially in early stages.
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Quality of life (QOL) is a concept with no generally accepted definition. Most clinical studies have had an individual approach where demographic and socio-economic population aspects have not been considered. QOL has hardly ever been used in studies of children. In this study QOL is defined as the essential resources of a child population, expressed in external, inter-personal and personal conditions. Both objective conditions and the corresponding subjective perceptions are included. A model for an empirical application is demonstrated on a random sample of 15,000 children in the five Nordic countries. The data were collected in a questionnaire mailed to the families of the children. The QOL was analysed in a normative way, where a base value was defined for each variable and the conditions of the children were compared to a Nordic standard for children's QOL. The results showed that children in the Nordic countries have a high QOL. The differences between the countries were rather small. Children in Sweden had the highest QOL, closely followed by children in Denmark and Norway, while children in Finland were in an intermediate position and the Icelandic children had the lowest QOL, mainly due to a lower level of satisfaction. This study can be considered as a base line study which later can be used in studies of time trends or in comparisons of groups of children such as children with special needs.
Studies on children with special needs mainly concentrate on disease-oriented health problems and neglect the positive aspects of quality of life. In this study the quality of life of children with Cystic Fibrosis and Myelomeningocele, 951 children in all, in the five Nordic countries is compared to that of a random sample of 10,290 children. The aim of the study was to see how the issue of equity, a main objective of the WHO health for all policy, has been met in the Nordic countries. Quality of life is defined as one of the essential resources of a population in terms of external, inter-personal and personal conditions. The study shows that children with disabilities have, and perceive that they live in good material and socio-economic conditions. However, the personal psychological conditions are less favourable, which indicates that this is a priority area for future health policies.
Chloroquine is known to bind strongly to melanin and is accumulated in the skin. In dermatology, the drug is mainly used to treat photosensitivity disorders, but it has also been reported to cause sun sensitivity, especially in patients with rheumatoid arthritis. In the present study the concentrations of chloroquine phosphate in plasma and skin suction blister fluid (interstitial fluid in the skin) from 16 patients were studied by HPLC at steady-state (after 2 months' ingestion of 250 mg of the drug daily) and 2, 4 and 6-7 months after cessation of therapy. At steady-state the concentrations were similar in the two compartments, whereas after discontinuation the drug remained much longer in the skin than in the plasma. In tests using cow's eye melanin in vitro, UV irradiation failed to interact with the binding of chloroquine to melanin. It is speculated that the prolonged storage of the drug in the skin could be of importance for its therapeutic as well as adverse effects.
A case of pregnancy and childbirth after cardiac transplantation because of previous post partum cardiomyopathy is described. Immunosuppressive therapy with corticosteroids and cyclosporine was maintained during pregnancy. Apart from increased extrasystolic beats and sensitivity to infection the pregnancy was uneventful. One year after birth the infant developed cardiomyopathy.
The pharmacokinetics of 2 mg ketotifen from four different oral dosage forms were examined in two randomized, balanced cross-over studies. Forty healthy male subjects participated. Each of 20 subjects received two capsule formulations and each of the other 20 subjects received two syrup formulations. Ketotifen concentrations in plasma were determined by a modified GC-MS method. The limit of quantitation was 40 pg ml-1. Inter-day precision and accuracy calculated from quality control samples were 16.3 per cent (-1.9 per cent), 19.8 per cent (+4.5 per cent) and 23.6 per cent (+5.9 per cent) at plasma concentration levels of 86 (n = 18), 215 (n = 19) and 343 (n = 18) pg ml-1, respectively. Ketotifen was rapidly absorbed from all dosage forms reaching Cmax in the order of 400 pg ml-1 after the syrup formulations and 300 pg ml-1 after the capsule formulations within 2 to 4 h. The syrup formulations showed a significantly more rapid rate of absorption as assessed by Tmax. No significant differences in extent of absorption between dosage forms were observed. The terminal elimination half-life of ketotifen varied between subjects from 7 to 27 hours with a mean of about 12 h. The minor pharmacokinetic difference between dosage forms observed in this study is unlikely to be of clinical significance.
The potential of the quality of life (QoL) concept lies in its basically positive meaning and interdisciplinary acceptance. This can be used when the Public Health sector tries to develop health into a resource concept, as is the intention of the WHO Health For All Strategy. Out of different scientific views on QoL this paper synthesizes a theoretical framework of QoL and describes how this concept can be used in practice when evaluating the health resources of a population.
Cytochrome oxidase (CYO), a key enzyme in the respiratory chain, was observed as an indicator of retinal metabolism after an in vivo blue light exposure. Thirty Sprague-Dawley rats were exposed to optic radiation of 404 nm with a retinal dose of 110kJ/m2. Immediately after exposure, the CYO activity in the pigment epithelium, in the outer and inner segments of photoreceptors, and in the outer plexiform layer of the exposed retina, was reduced to one-third-to-half of the control level. However, there was an increase in CYO activity in the exposed retina one day after exposure. One week after exposure, the CYO activity in the inner segment and the outer plexiform layer was higher, while the activity in the other two layers was lower, than that at one day, although still higher than in the control. Two weeks after exposure, the CYO activity in the four retinal layers returned to the level of the control retina, as did the activity four weeks after. After exposure, no ophthalmoscopically visible retinal change and no light-microscopically evident morphological alterations were found. There was no retinal edema or loss of photoreceptor cells. The observed alteration in CYO activity after blue light exposure may represent an inhibition of retinal metabolism. The inhibition was reversible. If this compensation mechanism is overwhelmed, retinal damage may occur.
Little information is available on the toxicity of monochloroacetic acid. We report the case of a 38 year-old man who was splashed with an 80% monochloroacetic acid solution on 25-30% of his body surface. In addition to epidermal and superficial dermal burns, features of systemic poisoning occurred within a few hours including disorientation, agitation, cardiac failure and coma. He later developed severe metabolic acidosis, rhabdomyolysis, renal insufficiency and cerebral edema, and died due to uncal herniation on d 8. The 4 h post exposure plasma monochloroacetic acid concentration was 33 mg/L confirming skin absorption. In addition to its corrosive action, monochloroacetic acid probably blocks the tricarboxylic acid cycle (Kreb's cycle) and may also react with sulfhydryl groups in enzymes, causing severe tissue damage in energy-rich organs.
From a referral area comprising one-fifth of the Swedish female population we investigated possible risk factors for endometrial cancer (EC) in different age groups. Seventy-seven women aged 31-45 with EC were collected retrospectively, and 99 women aged 46-65 were consecutively collected. Both groups were compared to referents randomly selected from a population based study from the city of Göteborg. The referents consisted of 1746 women aged 39-65 years. All cases were studied by hospital record and 82% of the women aged 31-45 years and 85% of those aged 46-65 years were studied by an extensive questionnaire. Among the referents 1409 (81%) were investigated by the above-mentioned questionnaire. Hirsutism, increased body mass index (BMI) and hypertension were significantly more common in both EC groups compared to referents. Nulliparity and infertility were significantly more common in the young EC group. Referents used combined oral contraceptives significantly more often than women developing EC. There was, however, no difference between the groups with respect to the duration of medication with combined oral contraceptives. There was a significant negative correlation between cigarette smoking and the development of EC. These findings indicate that untreated ovarian dysfunction like that present in polycystic ovarian disease (PCO) with unopposed estrogen action on the endometrium is associated with EC in younger women, and that smoking may protect against EC by an 'anti-estrogenic' effect.
1. Codeine and dextromethorphan were N-demethylated in human foetal liver microsomes at high rates which were close to the activities in adult livers. In contrast, foetal liver microsomes did not catalyze the O-demethylation of these drugs at mid-gestation. 2. The metabolic data were in accordance with the absence of P450IID6 and the presence of P450 IIIA as determined by Western blotting with anti-human P450 IID6 (MAb 114/2) and anti-rat P450 IIIA (PCN 2-13-1/C2) monoclonal antibodies, respectively. 3. The inhibitory effects of midazolam and dehydroepiandrosterone support the contention that the N-demethylase is a human foetal form of the cytochrome P450 IIIA family. Consistent with this we found that blotting with the MAb PCN 2-13-1/C2, which recognizes an epitope specific for the P450 III family, correlated well with the N-demethylase activities.
A method for the quantitative measurement of the dry mass density in retinal tissue is presented. Cryosections of rat retinas were freeze-dried and exposed to soft X-rays together with a reference system. The section thickness was measured optically. The X-ray energy absorbed by the retinal tissue was recorded photographically and the microradiographs were evaluated photometrically. These measurements were used to estimate the dry mass density for each retinal layer. Sources of variation were evaluated. The precision was found adequate. The present method allows a localized determination of the dry mass density and of the hydration in the retina at a microscopic resolution.
Lipid and protein density in each retinal layer were determined microradiographically in retinal sections of 10 rats. Lipid in retinal sections was extracted with chloroform. The fraction of dry mass remaining after lipid extraction is mainly protein. The dry mass lost in chloroform processing was calculated to obtain the lipid density, which accounts for about 30% of the total dry mass density. The total dry mass density in each retinal layer is the sum of the lipid and protein density. Lipid should be regarded as an important X-ray absorber when determining the dry mass density in the rat retina with microradiography.