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Biomedical subjects

E Nyström

Publications and source records attributed to E Nyström.

At least 19 recordsLinked to original sources
PubMed1992

Occlusion of the incisal canal with bone chips. A procedure to facilitate insertion of implants in the anterior maxilla.

In 4 patients, who had lost one or both central maxillary incisors due to trauma, the incisal canals were filled with autogenous cancellous bone harvested from the chin. After a healing period of 4-5 months implants were inserted. At the time of implant surgery in all cases the canal appeared to be replaced by cancellous bone and the implants were placed partially into the grafted area. After another 6 months abutments were connected and crowns made. After follow-up of between 12 and 15 months no fixture has been lost.

Adolescent↗
PubMed1992

Screening of an elderly population in primary care for primary hyperparathyroidism.

In order to assess the diagnostic outcome of a screening for primary hyperparathyroidism (PHPT) in an elderly population, we determined ionized calcium in serum from 368 individuals participating in a health control at Mölnlycke Primary Care Centre (200 women, 168 men; age range 75-95 years); four-fifths of the individuals living in their homes, the remainder in homes for aged or nursing homes. Intact parathyroid hormone was determined in the samples with oinized calcium concentration greater than mean + 3SD of the truncated population sample, and these individuals were also recalled for another blood sample. Moderate hypercalcaemia, probably due to PHPT, was found in eight individuals (2% of the complete sample, 3% of the women), five having neuropsychiatric or neuromuscular symptoms consistent with PHPT. Surgical intervention is probably indicated in only a small proportion of elderly patients. We conclude that optimal benefits in relation to costs of screening for PHPT in old people will depend on the availability of a safe and simple pharmacological treatment that could determine any causal relationship between hypercalcaemia and symptoms.

Aged↗
PubMed1991

Thyroid disease in middle-aged and elderly Swedish women: thyroid-related hormones, thyroid dysfunction and goitre in relation to age and smoking.

The prevalence of thyroid disease and the concentration of thyroid hormones and thyrotropin were studied in a random population sample of 1154 women, aged 50-72 years, with special reference to the effect of age and smoking. The prevalence of spontaneous hypothyroidism was 3.3% (previously unknown overt and mild disease 1.3%) and the prevalence of hyperthyroidism was 2.5% (previously unknown disease 0.2%). Clinically suspected hyper- or hypothyroidism (very weak to strong) was recorded in 288 women, but was only verified in three cases. The prevalence of visible and palpable thyroid enlargement was 2.1% and 13-14%, respectively. Total thyroxine concentrations increased and free tri-iodothyronine levels decreased significantly with age (P less than 0.001). The serum thyrotropin concentrations were lower in smoking women than in non-smokers in the 50- and 58-year age groups (P less than 0.05). There was no increase in the prevalence of thyroid disease or goitre in the women who were smokers at the time of the study.

Age Factors↗
PubMed1990

Rebound increase in serum thyrotropin, anti-'microsomal' antibodies and thyroglobulin after discontinuation of L-thyroxine.

We assayed serum thyrotropin (TSH), antimicrosomal antibodies (MSA), antithyroglobulin antibodies and thyroglobulin in seven individuals with subclinical autoimmune hypothyroidism during two 6-month periods with L-thyroxine substitution and placebo, respectively. Serum TSH decreased during L-thyroxine administration, with a rebound increase in serum TSH of about 6 months duration during placebo treatment, and a parallel increase in serum thyroglobulin. In agreement with previous observations by other groups, we found decreased serum concentrations of MSA during L-thyroxine treatment in three individuals. In addition, a slow but significant transient increase in serum MSA was recorded during placebo administration in the four individuals who showed the most pronounced increase in serum TSH (greater than 20 mU l-1). This association between serum levels of MSA and TSH is most probably related to antigen presentation at the surface of the thyrocyte. We conclude that changes in serum TSH concentration should be taken into account in the interpretation of MSA in patients with thyroid disease, whether untreated or treated with L-thyroxine.

Aged↗
PubMed1990

Thyrotoxic atrial fibrillation: an underdiagnosed or overdiagnosed condition?

Hyperthyroidism has been considered to be underdiagnosed as a pathogenetic factor for atrial fibrillation, according to results of thyroliberin stimulation tests. We assessed, clinically and biochemically, thyroid function in 110 ambulatory patients with atrial fibrillation [mean age 64 (SD 11) years] from a group of consecutive cases referred to a specialist cardiology unit during one year. Patients finally categorized as euthyroid (n = 100) commonly presented with one or more symptoms or signs considered to be typical for thyrotoxic patients. Three patients (2.7%; 95% confidence interval, 0-7.5%) fulfilled criteria for hyperthyroidism, but only one was identified from clinical examination. The thyroliberin stimulation test (performed in all patients) identified another seven patients who might have been classified as hyperthyroid according to commonly used criteria for an abnormal thyrotropin response. However, none of these seven patients was judged as hyperthyroid after follow-up. Their thyrotropin concentrations were all above the detection limit for the immunoenzymometric assay. With few exceptions, they had thyroid hormone concentrations within reference limits calculated from the results for the 100 euthyroid subjects, and their concentration ratio for free 3,5,3'-triiodothyronine to free thyroxin, 0.31 (SD 0.05), was lower than that found in the euthyroid group [0.38 (SD 0.08), P less than 0.05]. We conclude that (a) criteria for evaluating results of the thyroliberin stimulation test should be revised, (b) this test is still useful in evaluating suspected cases of hyperthyroidism, for which results of current, improved methods for thyrotropin determination are equivocal, and (c) improved diagnostic methods should be used to characterize the relative importance of hyperthyroidism as a causal factor for atrial fibrillation.

Aged↗
PubMed1990

Morbidity, mortality, and quality of life for patients treated with levothyroxine.

In a population study of 1462 middle-aged women initiated in 1968 and 1969 we identified 29 women treated with levothyroxine from 1 to 28 years. In a 12-year follow-up in 1980 and 1981 we investigated the subjects for end-point myocardial infarction, diabetes mellitus, stroke, cancer, and death (the status of 99.7% of the initial participants was established). The women treated with levothyroxine showed no increase in morbidity or mortality. Of the 24 women still receiving levothyroxine in 1980 and 1981, 22 had serum thyrotropin and triiodothyronine concentrations with-in reference limits. These individuals were compared with the 968 women from the population study having no history of thyroid disease, and appeared identical as to laboratory and clinical data, with the exception of a slightly higher body mass, taller stature, and lower serum cholesterol concentration. The treated group did not differ in a life quality estimate based on 19 questions regarding life satisfaction and sensory function. We conclude that the levothyroxine-treated woman suffers no side effects from her life-long therapy.

Adult↗
PubMed1989

Evidence for a slow tissue adaptation to circulating thyroxine in patients with chronic L-thyroxine treatment.

We measured serum procollagen-III-peptide in 67 women with long-term L-thyroxine treatment and compared the results with age-matched controls. The strong correlation between serum free thyroxine and procollagen-III-peptide concentrations previously found after 6 months of L-thyroxine treatment was not found after long-term treatment. There were slightly higher procollagen-III-peptide concentration values in those chronically treated patients who had high free thyroxine levels but this increase was less marked than in patients previously studied after short-term treatment. An increase in procollagen-III-peptide concentration reflects an increased biosynthesis of collagen III, which is present in connective tissues throughout the body, and our findings may be explained by slow tissue adaptation to increased levels of thyroxine. We conclude that the increased thyroxine levels found in L-thyroxine-treated patients are of less clinical importance than thought previously. We also conclude that peripheral markers of thyroid hormone peripheral effects such as procollagen-III-peptide may be of less use than thought previously due to this slow tissue adaptation to changes in thyroxine concentration.

Adaptation, Physiological↗
PubMed1989

The population study of women in Gothenburg 1980-81--the third phase of a longitudinal study. Comparison between participants and non-participants.

A representative population sample comprising 1,462 women was studied in Gothenburg, Sweden in 1968-69, and a third follow-up study was carried out in 1980-81. The participation rates in the baseline study and during the follow-up studies were high. In 1980-81 women in two new age strata, aged 26 and 38, were added. Women who had moved to or from Gothenburg during the study period were not found to differ from those who were living in Gothenburg during the total study period, while there were a few differences of statistical significance between refusers and participants in 1980-81. The mortality among initial refusers was about doubled compared to that of those who participated in the baseline study.

Adult↗
PubMed1988

Screening for thyroid disease in a primary care unit with a thyroid stimulating hormone assay with a low detection limit.

In a study at a primary care centre in a predominantly rural area of Sweden the records of all patients with established thyroid disease were scrutinised and 2000 consecutive adult patients screened with an immunoenzymometric thyroid stimulating hormone assay. The aims of the study were fourfold: firstly, to assess the total burden of thyroid disease in primary care centres in Sweden; secondly, to assess the efficacy of clinical diagnosis of the disease in unselected populations of patients; thirdly, to assess the efficacy of clinical evaluation of treatment with thyroxine; and, lastly, to see whether a single analysis of the serum thyroid stimulating hormone concentration by recent methods would be enough to identify an abnormality of thyroid function. Of the roughly 17,400 adults in the study community, 111 women and 10 men were being treated for thyroid disease. Screening detected 68 patients (3.5%) not receiving thyroxine who had a serum thyroid stimulating hormone concentration of 0.20 mU/l or less, all of whom were followed up clinically. Fifty of these patients were also studied biochemically during follow up. Only nine of the 68 patients had thyroid disease (three with thyrotoxicosis requiring treatment), no evidence of the disease being found in the remainder. Sixteen patients had spontaneous hypothyroidism requiring treatment, and neither these nor three patients with thyrotoxicosis had been detected at the preceding clinical examination. Of 35 patients in whom thyroid disease was suspected clinically at screening, none had laboratory evidence of thyroid dysfunction. In this series 1.3% of all women in the study community (2.6% of all 50-59 year olds) and 0.1% of the men were being treated for thyroid disease at the primary care centre, roughly 1.0% of adults subjected to screening were found to have thyroid disease requiring treatment, and most patients with a thyroid stimulating hormone concentration of 0.20 mU/l or less did not have thyroid dysfunction. It is concluded that measuring the basal serum thyroid stimulating hormone concentration by present methods is insufficient for the biochemical assessment of thyroid dysfunction in unselected populations.

Cross-Sectional Studies↗
PubMed1988

The pain intensity at analgesic intake, and the efficacy of diflunisal in single doses and effervescent acetaminophen in single and repeated doses.

A double-blind, randomized analgesic trial was carried out in 150 patients undergoing surgical removal of their 2 impacted lower wisdom teeth. The analgesic efficacy of effervescent acetaminophen 500 or 1000 mg in a 2-dose regimen was compared with that of diflunisal 500 mg in a single dose. Each dose was taken when subjectively needed and the pain intensity was measured on a visual analog scale during the 10-hour period after first medication. The best pain reduction was achieved with diflunisal. The difference between diflunisal 500 mg and acetaminophen 1000 mg was significant, as was that between acetaminophen 1000 and 500 mg. The peak effect after the first dose occurred later but was greater with diflunisal than with acetaminophen. Patients needing analgesics at low pain intensities seemed to discriminate better between treatments, and the efficacy of acetaminophen was weakly dependent on the initial pain intensity. This intensity was difficult to predict, and only a poor correlation was found between the initial pain intensity and the patient's prior estimate of this.

Acetaminophen↗