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Biomedical subjects

B Ljunggren

Publications and source records attributed to B Ljunggren.

At least 91 records · Page 5Linked to original sources
PubMed1986

Nimodipine and early aneurysm operation in good condition SAH patients.

A prospective open multicenter study on the preventive effect of nimodipine on symptomatic vascular spasm was performed in 120 (consecutive) patients with aneurysmal subarachnoid haemorrhage (SAH). All patients underwent early surgery (i.e. within 72 hours post SAH) and were in neurological grades I-III in Hunt and Hess. Grade IV and V as well as patients with significant intracerebral haematoma are not included. On preoperative CT, SAH was mild in 28 cases, moderate in 56 and severe in 36 cases. 25 patients (21%) were in grade I, 63 patients (53%) in grade II and 32 patients (26%) in grade III. The ruptured aneurysm was located on the anterior cerebral artery complex in 57 patients, on the internal carotid artery complex in 35, on the middle cerebral artery in 24 patients and on the basilar artery in 4 patients. After occlusion of the ruptured aneurysm, the lipophilic calcium channel blocker nimodipine was administered in the following manner: Intraoperative, topical irrigation of the exposed arteries. Intravenous infusion until day 7-14 after SAH followed by peroral medication for another week. Nimodipine was well tolerated and neither significant hypotension nor any other adverse reaction attributable to the drug was observed. Ischaemic cerebral dysfunction of delayed onset with permanent neurological deficit occurred in 2 patients (2%). Another 8 patients showed transient ischaemic symptoms. At 6 months follow-up, 93% of the patients were classified as having made a full recovery, 16% as being minimally disabled, 5% as being moderately disabled and 3% as being severely disabled. Three patients had died. The present study supports the concept that preventive nimodipine treatment may reduce delayed ischaemic deficit in early aneurysm surgery.

Administration, Topical↗
PubMed1986

Cerebral vasospasm and calcium channel blockade. Nimodipine treatment in patients with aneurysmal subarachnoid hemorrhage.

In patients with aneurysmal subarachnoid hemorrhage (SAH), delayed ischemic cerebral dysfunction (DID or symptomatic vasospasm) with subsequent fixed neurological dysfunction (FND) is a frequent and most feared complication induced by the hemorrhage. Aneurysm operation during the acute stage with intraoperative evacuation of bloodcontaminated cerebrospinal fluid (CSF) from the basal cisterns and subarachnoid spaces has reduced this complication. Nevertheless despite early operation, DID with FND occurs in 13-20% or more. In a series of 100 individuals with a ruptured supratentorial aneurysm, who were subjected to aneurysm operation in the acute stage and who subsequently received intravenous treatment with the calcium channel blocker nimodipine, the occurrence of DID with FND was reduced to 5%.

Brain Ischemia↗
PubMed1986

Delayed ischemic deterioration in patients with early aneurysm operation and intravenous nimodipine.

A consecutive series of 100 individuals with aneurysmal subarachnoid hemorrhage were subjected to early aneurysm operation followed by subsequent intravenous administration of the calcium antagonist nimodipine during the critical period for symptomatic vasospasm. A total of 85 patients were in Hunt and Hess neurological Grades I through III, and 15 were in Grade IV or V before operation. In 39 individuals the aneurysm was located in the anterior cerebral artery complex (ACA), in 29 it originated from the internal carotid artery complex (ICA), and in 32 individuals the ruptured aneurysm arose from the middle cerebral artery (MCA). Of the patients, 71% made a good neurological recovery; the morbidity was 22%, and the mortality was 7%. Of the Grade I-III patients, 79% made a good neurological recovery, and the mortality was 6%. Delayed ischemic cerebral deterioration with permanent dysfunction occurred in five patients, all with ruptured ACA aneurysms. No single patient in the ICA or MCA populations developed delayed ischemic deterioration with fixed neurological deficit despite the presence of several potential risk factors, especially among the MCA aneurysm patients.

Brain Ischemia↗
PubMed1986

Outcome evaluation following subarachnoid hemorrhage.

Seventy-eight individuals among a population of 1.46 million suffered aneurysmal subarachnoid hemorrhage (SAH) during 1983. Within 24 hours after the bleed, 32 of the 78 patients were in Hunt and Hess neurological Grades I to II, 13 were in Grade III, 21 were in Grades IV to V, and 12 were dead on admission to a hospital or forensic department. When the amount of blood visualized on computerized tomography (CT) scanning was integrated with the Hunt and Hess neurological classification in order to improve prediction of prognosis, only 16 patients were considered to have a good prognosis (CT-modified Grades I to II), 21 had a less favorable prognosis (CT-modified Grade III), and 29 had a poor prognosis (CT-modified Grades IV to V). Assessment at 1 year revealed that only 32 patients (41%) had a good physical recovery. The physical morbidity rate was 22%, and the overall mortality rate was 37%. Twenty-six individuals with a good neurological outcome and five with a fair outcome also underwent reexamination 1 year or more post-SAH, which included a comprehensive evaluation of the quality of life, assessment of cognitive dysfunction, and determination of general adjustment. Five of the patients with a good neurological outcome and all five with a fair outcome (four of whom had had a poor prognosis in the acute stage) showed severe psychosocial and cognitive incapacitation. When functional morbidity, based upon persistent severe cognitive and psychosocial impairment, was included in the outcome assessment, only 33% of the total series was considered to have a favorable outcome. Approximately 60% of the initially good-risk patients (Grades I and II) showed a good physical outcome without concomitant indications of severe cognitive dysfunction and/or psychosocial impairment. Among the good-risk patients with a CT-modified grade, the figure was 70%. It is suggested that in any outcome grading system, persistent cognitive and psychosocial disturbances be taken into account.

Cognition Disorders↗
PubMed1986

Systemic drug photosensitivity.

Photosensitivity as a side effect in treatment with systemic drugs occurs both as a phototoxic, non-immunologic phenomenon and as a photoallergic, immune-dependent reaction. The former principle is the more common one, and is seen with a number of non-related, widely used drug groups such as the tetracyclines, the phenothiazines, nonsteroidal antiinflammatory drugs, nalidixic acid, amiodarone and griseofulvin. For some of these drugs, for quinidine/quinine, and for the sulfonamides and related drugs, the reactions are probably also photoallergic. The majority of photosensitizing drugs have an action spectrum within UVA. Experimental studies have revealed that photoproducts and metabolites in some instances make important contributions to the biological photoreaction. For several of these drug groups, progress is presently underway in elucidating their mechanisms of action, as well as the relationship between chemical structure and in vivo photoactivity.

Amiodarone↗
PubMed1986

Systemic quinine photosensitivity.

A 72-year-old woman developed a photodistributed skin eruption while taking quinine hydrochloride (250 mg) once or twice weekly for recumbency cramps. The histopathology showed an eczematous reaction. Phototesting after quinine therapy had been discontinued for one month revealed normal erythema thresholds for ultraviolet (UV) light in the A range (17 J/cm2) and UV light in the B range (20 mJ/cm2). A second phototest after a ten-day period of reexposure to quinine hydrochloride (250 mg daily) showed a drastically lowered threshold for UV light in the A range (less than 1.0 J/cm2), while the test for UV light in the B range was unchanged. The patient's dermatitis also exacerbated with pronounced itching. The histopathologic results from a positive test site were similar to those of her eczematous lesions. We believe this to be the first documented case of systemic quinine photosensitivity. The clinical picture, the results of the phototests, and the histopathology suggest a photoallergic mechanism.

Administration, Oral↗
PubMed1985

Photohemolytic potency of tetracyclines.

Hemolysis induced by long-wave ultraviolet radiation (UVA) and 8 different commercial tetracycline derivatives was studied in a model using human red blood cells. Demethylchlortetracycline and doxycycline were shown to have pronounced hemolytic properties causing 88% and 85% hemolysis, respectively, at a concentration of 50 micrograms/ml and 72 J/cm2 of UVA. Tetracycline, oxytetracycline, and chlortetracycline caused maximally 18% hemolysis at 200 micrograms/ml and lymecycline only 7% at 100 micrograms/ml. Methacycline showed intermediate hemolytic effect of 36% at 200 micrograms/ml. Minocycline had no hemolytic effect whatsoever. These experimental data correlate very well with clinical reports and comparative phototoxicity trials in humans. Photohemolysis may thus be of value for predicting tetracycline phototoxicity.

Hemolysis↗
PubMed1985

Influence of tetracycline phototoxicity on the growth of cultured human fibroblasts.

The phototoxic effect of 8 different commercial tetracycline derivatives with long-wave ultraviolet radiation (UVA) on the growth pattern of normal human skin fibroblasts in culture was studied. Chlortetracycline and doxycycline both at a concentration of 50 micrograms/ml and 1.9 J/cm2 of UVA resulted in total cell death with no recovery during a 14-day observation period. Demethylchlortetracycline also showed strong photosensitizing properties with an arrested cell division for 7 days followed by a recurrence of cell growth. The other tetracyclines tested under identical conditions had only weak or no phototoxic influence on cell growth. These experimental data correlate very well with clinical reports and comparative phototoxicity trials in humans. This experimental method may thus be of value for predicting tetracycline phototoxicity in humans.

Adolescent↗
PubMed1985

Early operation and overall outcome in aneurysmal subarachnoid hemorrhage.

Over a 3-year period, 251 individuals in a population of 1.46 million were known to have suffered an aneurysmal subarachnoid hemorrhage (SAH). Forty-three individuals (17%) were either found dead or were dead on arrival at a hospital or forensic department. Forty-nine patients (20%) were at no stage in their clinical course considered to be surgical candidates. Six patients (2% of the total series) were initially in good condition, but subsequently deteriorated during the acute phase and were not treated surgically. Nineteen poor-risk patients (8% of the total series) underwent emergency surgery because of a life-threatening intracerebral hematoma; 105 patients (42% of the total series or 69% of the surgically treated patients) were operated on at the acute stage, and 29 patients (11% of the total series or 19% of the surgically treated patients) underwent late surgery. Of the total series, 107 patients (42%) recovered without neurological deficits; the overall morbidity rate was 19%, and the mortality rate was 39%. Of 99 Grade I to III patients who were operated on at the acute stage, 76% recovered without neurological deficits, and 4% died. It is concluded that the overall outcome in aneurysmal SAH remains poor, mainly because of the large group of patients who are permanently devastated by their initial bleed.

Adult↗
PubMed1985

Cognitive impairment and adjustment in patients without neurological deficits after aneurysmal SAH and early operation.

The mortality rate has recently been reduced to only a small percentage of patients selected for early aneurysm surgery. Despite recovery without neurological deficits, however, a diffuse encephalopathy may remain, with emotional and psychological sequelae that will interfere with rehabilitation and social reintegration. The present study evaluates quality of life, degree of cognitive dysfunction, and adjustment of patients with a satisfactory neurological recovery after aneurysm operation in the acute stage following a major subarachnoid hemorrhage (SAH). Of 118 patients with a good neurological recovery, 40 patients were randomly sampled for a cross-sectional study and subjected to a questionnaire relating to their symptoms, a clinical interview, and a comprehensive neuropsychological investigation. The time interval between SAH and assessment varied between 14 months and 7 years, averaging 3 1/2 years. By means of standardized psychometric testing of intellectual capacity, memory functions, visuo-spatial abilities, perceptual speed and accuracy, and concept formation, degrees of cognitive impairment ranging from slight to severe dysfunction were identified. The results suggest that these disturbances may be permanent. The degree of impairment appeared to correlate with the patients' age. Interview data revealed substantial post-hemorrhagic maladjustment with respect to vitality, social management, self-assertion, emotional control, temperament, mood, and cognitive abilities. These findings were considerably at variance with the symptoms reported. It is stressed that, in the absence of gross neurological deficits, vital information on post-hemorrhage adjustment and impairment may easily be overlooked due to psychological defensive measures. It remains an open question whether post-SAH encephalopathy is enhanced by surgery performed in the acute stage.

Activities of Daily Living↗
PubMed1985

Antinuclear antibodies in mice induced by long wave ultraviolet radiation (UVA).

PUVA therapy has been reported to induce antinuclear antibodies (ANA). The generation of ANA following ultraviolet irradiation was studied experimentally in albino mice. When treated with long wave ultraviolet radiation (UVA) from blacklight fluorescent tubes a significant number of animals developed positive ANA titres, whereas no change was noted in groups, treated with PUVA, 8-methoxypsoralen only or medium wave ultraviolet irradiation (UVB) respectively. The tendency for UVA-irradiated mice to develop ANA was stronger when higher ANA titres were compared. UVA induces ANA in mice, and PUVA-induced ANA may be due to the UVA component of this therapy.

Animals↗
PubMed1985

Antinuclear antibodies appearing during PUVA therapy.

Antinuclear antibodies (ANA) were studied in patients receiving PUVA therapy. Ten patients out of 124, (8%), considered for PUVA had ANA prior to therapy. During PUVA treatment ANA appeared in 34 out of 100 patients. Eight patients with ANA initially were treated and in 4 of them a significant increase in ANA titre was noted. A statistically significant difference was noted, when the first and last ANA tests for each patient were compared. No such difference was seen in a control group consisting of 33 patients. All PUVA patients generating ANA were evaluated clinically and with a laboratory screening. This evaluation was negative in all patients except one who developed ANA of the nucleolar staining pattern together with symptoms consistent with a collagen vascular disease. The ANA titres were generally low and the staining pattern was of the homogeneous type in all patients but one.

Adolescent↗
PubMed1985

Propionic acid-derived non-steroidal antiinflammatory drugs are phototoxic in vitro.

Clinical photosensitivity reactions have been reported for several non-steroidal antiinflammatory drugs (NSAID). 11 such commercial preparations were studied spectrophotometrically and assayed for phototoxicity using 2 in vitro methods. Photohemolysis of human red blood cells was measured following exposure to longwave (UVA) and medium-wave (UVB) ultraviolet radiation. Growth inhibition of Candida albicans was assayed after exposure to drug and UVA. A majority of the drugs were phototoxic. Propionic acid-derived NSAIDs were the most active in the photohemolysis assays as well as in the Candida test. With UVA 43.2 J/cm2 ketoprofen was one order of magnitude more potent that the other compounds; with increasing UVB doses and a standard drug concentration of 10 micrograms/ml the same was true for benoxaprofen. Several compounds were protective against UVB hemolysis. Candida growth inhibition was strongest with naproxen. Again, propionic acid derivatives generally were the more effective. No photoactivity was noted for indomethacin, piroxicam and sulindac. Azapropazone caused UVA hemolysis only. Members of the NSAID group, and in particular derivatives of propionic acid, are capable of inducing phototoxic reactions with UVA as well as UVB in vitro. These results confirm clinical reports of photoreactions to members of this group.

Anti-Inflammatory Agents↗
PubMed1985

Effect of ultraviolet irradiation of photopatch test substances in vitro.

The mechanisms behind allergic photocontact reactions are not clear. For certain photoactive substances the generation of photoproducts may be one step in the sequence of events inducing photoallergy. 26 photoactive substances were studied by thin layer chromatography (TLC) before and after long-wave or medium-wave ultraviolet irradiation for 1, 3 and 5 h (10.8, 32.4, 54 J/cm2 and 1.1, 3.2, 5.4 J/cm2). The formation of photoproducts was demonstrated for 13 substances. For 8 of these, photoproducts were formed regardless of type of ultraviolet exposure while for 5 compounds photoproducts were demonstrated only after long-wave ultraviolet irradiation. All photoactive compounds forming photoproducts did so after UVA irradiation which is in accordance with the finding of action spectra for photoallergic reactions in human skin within this region. No photoproducts were demonstrated for 13 of the tested substances.

Allergens↗
PubMed1985

In vivo phototoxicity of non-steroidal anti-inflammatory drugs evaluated by the mouse tail technique.

Skin photosensitivity is a side-effect reported for several non-steroidal anti-inflammatory drugs (NSAID). In vitro studies have revealed phototoxic properties in a majority of these compounds with a preponderance for derivatives of propionic acid. Fourteen NSAIDs, the majority commercial preparations in clinical use, have been assayed by the mouse tail technique for in vivo phototoxicity evaluation. Intraperitoneal single doses in the range 12.5-200 mg/kg were given in combination with UVA irradiation for 5 h (total dose 54 J/cm2). The phototoxic reaction was measured 24 h later as the wet weight increase of tail tissue over non-irradiated, drug-treated controls. Four out of 9 propionic acid derivatives were phototoxic: tiaprofenic acid, carprofen, benoxaprofen and naproxen. Among NSAID compounds of other chemical structure only diclofenac and diflunisal were weakly photoactive. The propionic acid derivatives fenoprofen, flurbiprofen, ibuprofen, indoprofen and ketoprofen were negative, as were azapropazone, piroxicam and sulindac among the unrelated compounds. Phototoxicity is one important aspect of NSAID photosensitization. It is advisable to perform predictive studies including in vivo models, such as the mouse tail technique, before new NSAIDs are introduced on the market.

Animals↗