Biomedical subjects
B Sjölund
Publications and source records attributed to B Sjölund.
Walking training of patients with hemiparesis at an early stage after stroke: a comparison of walking training on a treadmill with body weight support and walking training on the ground.
OBJECTIVE: To compare the effect of walking training on a treadmill with body weight support (BWS) and walking training on the ground at an early stage of rehabilitation in patients with hemiparesis after stroke. DESIGN: Randomized controlled experimental study. SETTING: Multicentre design; three departments of rehabilitation medicine. SUBJECTS: Seventy-three consecutive first stroke patients admitted to a rehabilitation clinic were randomized into a treatment group and a control group. INTERVENTIONS: The treatment group received walking training on a treadmill with BWS for 30 minutes, 5 days a week. The control group received walking training according to the Motor Relearning Programme (MRP) on the ground for 30 minutes 5 days a week, not including treadmill training. During the time in the rehabilitation department (about two months), all patients in the study also received professional stroke rehabilitation besides the walking training in the two groups. MAIN OUTCOME MEASURES: Functional Independence Measure (FIM), walking velocity for 10 m, Functional Ambulation Classification (FAC), Fugl-Meyer Stroke Assessment and Berg's Balance Scale. The assessments were performed at admission, at discharge and at 10-month follow-up. RESULTS: There were no statistically significant differences between the groups at discharge or at the 10-month follow-up with regard to FIM, walking velocity, FAC, Fugl-Meyer Stroke Assessment, and Berg's Balance Scale. Patients in both groups improved in these variables from admission to the 10-month follow-up. CONCLUSIONS: Treadmill training with BWS at an early stage of rehabilitation after stroke is a comparable choice to walking training on the ground.
[Analgesia specialists wonder: why are you afraid of us?].
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[Pain relief. A new medical specialty focused on prolonged pain].
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Capsaicin-evoked release of pituitary adenylate cyclase activating peptide (PACAP) and calcitonin gene-related peptide (CGRP) from rat spinal cord in vivo.
Capsaicin-evoked release of pituitary adenylate cyclase activating peptide (PACAP)-like immunoreactivity (LI) from rat spinal cord was examined in vivo. In anaesthetized rats, a catheter was inserted through the atlanto-occipital membrane into the subarachnoid space at the level of the sacral spinal cord for infusion of artificial cerebrospinal fluid. Another catheter was placed in the cisternal opening for outflow. Blood pressure was monitored and kept stable during the experiment. Perfusion samples were analyzed for PACAP and calcitonin gene-related peptide (CGRP) by radioimmunoassay. The addition of capsaicin (10 microM) to the perfusate elevated the concentrations of PACAP-27-LI in the artificial cerebrospinal fluid by 177%, PACAP-38-LI by 93% and CGRP-LI by 692%. In view of the presence of PACAP-immunoreactive nerve fibres in the superficial layers of the dorsal horn and the expression of PACAP in the small sized neurons in the dorsal root ganglia, the findings suggest that PACAP is released into the artificial cerebrospinal fluid from C-fibres in the spinal cord. PACAP conceivably plays a modulating role in nociception.
The effect of pituitary adenylate cyclase activating peptide (PACAP) on the nociceptive formalin test.
Recent studies have suggested that pituitary adenylate cyclase activating peptide (PACAP) may be involved in nociceptive transmission. The present study examined the effect of low-dose PACAP-27 on nociceptive behavior using the formalin test. PACAP-27 was administered intrathecally. Twenty minutes later, formalin (50 microliters, 5%) was injected subcutaneously into the dorsal surface of the right hind paw. Intrathecal PACAP-27 at 0.6 pmol suppressed the second phase response to formalin, while 5 pmol depressed both phases. PACAP-27 at 5 pmol did not impair motor function. Hence, the data suggest that the effect of PACAP-27 on formalin-induced pain-related behavior is specific. The findings may lead to a better understanding of the role of PACAP in nociceptive transmission.
Nerve blocks with local anesthetics and corticosteroids in chronic pain: a clinical follow-up study.
During 4 years, 45 patients with various chronic pain conditions were treated with nerve blocks in our clinic. The blocks consisted of injections of local anesthetic and a corticosteroid on one or several occasions. At the end of this time period, the patients' pain was classified from their records as nociceptive, neurogenic, or unknown, according to International Association for the Study of Pain (IASP) criteria. The long-term treatment results were evaluated retrospectively with a questionnaire. Twenty-nine patients had neurogenic pain, 11 patients had nociceptive pain, and, in the remaining 5 patients, the type of pain could not be determined. Only 6 of the 45 patients had pain relief for longer than 1 month. It is concluded that treatment with nerve blocks alone is not very effective as a long-term treatment for chronic pain. Further experimental and systematic clinical studies are necessary to define the ultimate place for nerve blocks in the treatment of chronic nonmalignant pain.
[To manage chronic pain. Rehabilitation is a possible therapeutic alternative].
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Favorable Long-term Results with the End-to-Side Jejunoileal Bypass.
BACKGROUND: Although jejunoileal bypass (JIB) causes long-standing weight loss, it is no longer recommended as a surgical treatment of morbid obesity due to adverse effects. METHODS: JIB was performed on 87 morbidly obese subjects with a mean age of 35 years. Complete follow-up on 95% of the patients included monitoring weight, metabolic parameters and liver biopsies up to 25 years postoperatively. RESULTS: The mean (+/- SD) Body Mass Index (BMI) was reduced from 41.5 +/- 5.8 kg m(2) preoperative, to 26.7 +/- 3.8 kg m(2) at 2 years and 29.7 +/- 3.9 kg m(2) at 16 years follow-up. More than 60% loss of initial excess weight was achieved by 88% of the patients at four years and by 75% at 16 years follow-up. Reversal of the bypass was performed in 3% of the patients and revisions in 8% of the patients. There was no 30-day hospital mortality but there was one (1 %) late bypass-related death. Complications included urinary calculi in 39% of the patients, electrolyte disturbances in 25% and transient liver failure in 5.5%. Liver biopsies taken more than 13 years postoperatively in 44 patients revealed no cirrhosis. All patients were normoglycemic and normolipemic at follow-up. CONCLUSIONS: The majority of the patients have an acceptable weight reduction, few serious adverse effects but several beneficial effects after more than 16 years. The JIB deserves a reconsideration as an alternative in obesity surgery.
Pituitary adenylate cyclase activating peptide is a sensory neuropeptide: immunocytochemical and immunochemical evidence.
Pituitary adenylate cyclase activating peptide (PACAP) is a vasoactive intestinal peptide-like hypothalamic peptide occurring as two variants, PACAP-27 and the C-terminally extended PACAP-38. Immunoreactive PACAP has also been demonstrated in the enteric nervous system and in the innervation of the respiratory tract. We have examined the possibility that PACAP occurs in the sensory nervous system of the rat. Immunocytochemistry revealed PACAP in numerous nerve fibres in the superficial layer of the dorsal horns of the spinal cord, in nerve cell bodies (most of them of small size) of the spinal ganglia and trigeminal ganglia and in nerve fibres running close to and within the surface epithelium in the skin of the nose, the tongue, the larynx-trachea, and the urinary bladder as well as around the ducts of the submandibular gland. In all locations, PACAP co-existed with calcitonin gene-related peptide and substance P, the PACAP-immunoreactive fibres and cell bodies constituting a subpopulation of those storing substance P and/or calcitonin gene-related peptide. Additional PACAP-immunoreactive fibres not associated with epithelia seemed to lack calcitonin gene-related peptide and substance P. Capsaicin treatment reduced the density of PACAP- and calcitonin gene-related peptide/substance P-immunoreactive fibres in the tissues examined. On the whole, the immunocytochemical results agreed with those obtained by radioimmunoassay for PACAP and CGRP. The data favour a role for PACAP in primary sensory neurons.
Pituitary adenylate cyclase activating peptide produces a marked and long-lasting depression of a C-fibre-evoked flexion reflex.
Pituitary adenylate cyclase activating peptide (PACAP) is a novel vasoactive intestinal peptide-like peptide. It has a neuronal localization and occurs in two forms, PACAP-38 and the C-terminally truncated PACAP-27. In a recent report we described a dense accumulation of PACAP-27-immunoreactive nerve fibres in the superficial layer of the dorsal horn in the spinal cord and a few PACAP-27-immunoreactive nerve cell bodies in the spinal ganglia in the rat. Double-immunostaining showed that immunoreactive PACAP-27 occurred in a subpopulation of the calcitonin gene related peptide/substance P-containing cell bodies and fibres. In this study, PACAP-27 (0.47-0.63 pmol) given intrathecally produced a significant and long-lasting suppression of C-fibre-evoked flexion reflex produced by the electrical stimulation of the plantar nerve and recorded as a reflex discharge in the peroneal nerve. With a higher dose, 1.25 pmol, the magnitude of the response was not increased further but the effect became longer-lasting. PACAP-38 and vasoactive intestinal peptide were tested in doses up to 5 pmol and produced a significant and, in the case of PACAP-38, long-lasting suppression of the spinal flexion reflex. PACAP-27 seemed to be much more potent than PACAP-38 and vasoactive intestinal peptide. Intrathecal PACAP-27 was without effect on the monosynaptic stretch reflex (evoked by electrical stimulation of the gastrocnemius nerve and recorded as a reflex discharge in the sciatic nerve), suggesting that its effect on the flexion reflex is specific.(ABSTRACT TRUNCATED AT 250 WORDS)
Chronic pain and the sociodemographic environment: results from the Pain Clinic at Malmö General Hospital in Sweden.
OBJECTIVE: To study the occurrence of chronic pain in relation to different sociodemographic factors. DESIGN AND PATIENTS: The study cohort included all 1,360 new patients who, between July 1, 1988, and June 30, 1991, were referred to the multidisciplinary Pain Clinic at Malmö General Hospital, Malmö, Sweden, because of chronic, nonmalignant pain. The patients were characterized by age, sex, type of pain (nociceptive, neurogenic, psychogenic), place of residence, and ethnic background. SETTING: The referred sample was from the municipality of Malmö, a city with 240,000 inhabitants in an industrialized area served by one hospital. RESULTS: The age and sex standardized number of patients referred per 10,000 inhabitants and year varied among the different city areas from 0.35 to 1.63. High-rate areas had, in comparison to the city average, a higher migration rate, a higher proportion of single households with children, a higher percentage of people in need of social security benefits, a higher unemployment rate, and a greater percentage of people with foreign background. The age and sex distribution differed greatly among the three pain categories. Nociceptive pain was the most common category, with a striking overrepresentation of young women. CONCLUSION: Our results support the view that the occurrence of pain in an urban population is related to a number of sociodemographic factors. Further studies should be performed to evaluate how these factors influence incidence, medical-seeking behavior, clinical course, and rules for referral.
Colorectal cancer risk after jejunoileal bypass: dysplasia and DNA content in longtime follow-up of patients operated on for morbid obesity.
Jejunoileal bypass (JIB) has been a widespread operation for treatment of morbid obesity. Bile acids are regarded as cofactors in the carcinogenesis of the colon, and, since intestinal bypass involves increased exposure of bile acids to the large intestinal mucosa, JIB has been postulated to increase the risk for colorectal carcinoma. In experimental studies on animals, the results have indicated an increased frequency of induced carcinomas, but in clinical series only one patient with colon carcinoma has been reported. Thirty women, operated on with JIB 11 to 17 years earlier, were examined by colonoscopy with multiple biopsies, systematically taken for histologic evaluation and flow cytometric DNA analysis. In only one patient, low-grade dysplasia was detected in an initial adenomatous lesion but was not visible macroscopically. No DNA aneuploidy was found. In a control group of 11 patients examined for non-neoplastic disease, neither dysplasia nor aneuploidy was diagnosed. Within 17 years postoperatively, we have, by these methods, not been able to verify any colorectal malignant transformation in patients operated on with JIB. However, since carcinogenesis is a long process, further surveillance will be demanded before an increased risk for colorectal carcinoma can be excluded.
Normal plasminogen activator inhibitor levels at long-term follow-up after jejuno-ileal bypass surgery in morbidly obese individuals.
Forty-five patients who had been subjected to jejuno-ileal bypass (JIB) surgery for morbid obesity and 10 obese nonsurgery subjects were studied. The former group was examined 14 to 20 years after surgery, and was found to have lower mean plasminogen activator inhibitor type 1 (PAI-1) activity (8.4 v 32 U/mL, P < .001), tissue plasminogen activator (tPA) antigen concentrations (7.2 v 12 micrograms/L, P < .01), body mass index (BMI), and fasting plasma insulin, triglyceride, and cholesterol levels. The PAI-1 levels were correlated with BMI, waist to hip ratio, and insulin, triglyceride, and cholesterol levels. Thus, previously obese subjects have normal PAI levels 14 to 20 years after treatment with JIB surgery, in contrast to the high PAI-1 levels in nonsurgery obese subjects.
[Can lasers relieve pain? Few controlled studies and uncertain results].
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Local corticosteroid application blocks transmission in normal nociceptive C-fibres.
The effect of a locally applied depot form of a corticosteroid on the electrical properties of nerves was investigated in an experimental model. The segmental transmission in electrically stimulated A-fibres and in C-fibres of the plantar nerve in the anaesthetized rat was utilized. A drop of methylprednisolone acetate or vehicle constituent was placed on the dissected plantar nerve proximal to the stimulating electrodes after recording control responses (A-fibre volley in the sciatic nerve and C-fibre evoked reflex discharge in flexor motoneurons). The corticosteroid was found to suppress the transmission in thin unmyelinated C-fibres but not in myelinated A-beta fibres. The effect was found to be due to the corticosteroid per se. The effect was reversed when the corticosteroid was removed, which suggests a direct membrane action.
Preliminary notes on vulnerability of the retina to injury from peripheral laser exposure conditions.
If laser exposures to the periphery of the retina from low-energy lasers cause a hemorrhage obscuring the optical pathway to the fovea, resulting in loss of visual function, the risks for soldiers on the battlefield may be greater than previously expected. Two off-axis experiments were undertaken to obtain an indication of the hazards involved in exposing the peripheral retina to visible laser irradiation. Both off-axis exposures caused immediate vitreal hemorrhages in the periphery. After 80 min, the hemorrhage in the first eye had diminished, and in the other it was significantly smaller than immediately after exposure; even the central hemorrhage was smaller. Another observation after 120 min revealed the same result. These results indicate that an obvious risk exists on the battlefield for peripheral hemorrhages due to lasers operating within the retinal hazard spectrum. However, it is necessary to make more observations to establish the findings firmly.
Vulnerability of the retina to injury from a military ruby rangefinder at battlefield distances.
This study investigates the possibility of causing a vitreal hemorrhage with a standard ruby rangefinder at battlefield engagement distances when the laser is observed with the naked eye or through magnifying optics or filters. The experiments were undertaken on the eyes of anesthetized pigs. The pigs were anesthetized with Mebumal and given 0.5% thropicamid in the eyes. They were then exposed to the radiation from a standard military ruby rangefinder (pulsewidth 25 ns, pulse energy 180 mJ). The rangefinder was aligned with a He-Ne laser and a beamsplitter. Eight experiments were performed, each with several exposures. The range was varied from 0.5-850 m. Some of the experiments were made using the naked eye, some with a filter, some with binoculars (7 x 50) and some with a combination of filter and binoculars. The pulse energy was varied from 91-6500 muJ. Vitreal hemorrhages were caused at distances of 410 and 850 m when a pair of binoculars (7 x 50) was placed in front of the eyes. The intraocular energy varied between 1500 and 4400 microJ. Results indicate that there is a possibility of causing a vitreal hemorrhage in a soldier who is using standard field binoculars and looking in the direction of an ordinary military rangefinder at distances at least up to 850 m.