Biomedical subjects
Publications and source records attributed to L Adolfsson.
30 patients with post-traumatic wrist pain were investigated by arthroscopy. The clinical findings and type of injury were compared to the pathological morphology seen at arthroscopy. In 21 (70%) of the patients, arthroscopic findings gave a plausible explanation for the symptoms.
Arthroscopy under anaesthesia was used to investigate 123 patients with painful shoulders. The clinical diagnosis was compared with the arthroscopic findings. Four types of rotator cuff lesions were found in which there were significant differences between sex and age. Instability detected under anaesthesia was an important cause of pain. These examinations proved valuable in the diagnosis of shoulder pain, particularly when the clinical diagnosis was uncertain.
The extreme manifestation of anterior shoulder instability is anterior dislocation. Minor anterior instability often gives rise to vague symptoms from which a diagnosis is difficult. The use of arthroscopy may increase diagnostic accuracy in cases of anterior shoulder instability. Examinations were performed on 145 patients with shoulder complaints using stability testing under anesthesia and arthroscopy; of these, 62 patients were found to have anterior shoulder instability. The clinical signs were compared with the findings on stability testing and arthroscopy, and the morphological changes noted on arthroscopy were recorded. The combination of arthroscopy and stability testing proved valuable in the diagnosis of minor anterior instability and for the morphological changes and associated injuries in established anterior dislocations.
The mode of F Xa inhibition was investigated on a thromboresistant surface with end-point attached partially depolymerized heparin of an approximate molecular weight of 8000. Affinity chromatography revealed that one fourth of the heparin used in surface coating had high affinity for antithrombin III (AT). The heparin surface adsorbed AT from both human plasma and solutions of purified AT. By increasing the ionic strength in the AT solution the existence of high and low affinity sites could be shown. The uptake of AT was measured and the density of available high and low affinity sites was found to be in the range of 5 and 11 picomoles/cm2, respectively. Thus the estimated density of biologically active high and low affinity heparin respectively would be 40 and 90 ng/cm2. The heparin coating did not take up or exert F Xa inhibition by itself. With AT adsorbed on both high and low affinity heparin the surface had the capacity to inhibit several consecutive aliquots of F Xa exposed to the surface. When mainly high affinity sites were saturated with AT the inhibition capacity was considerably lower. It was demonstrated that the density of AT on both high and low affinity heparin determines the F Xa inhibition capacity whereas the amount of AT on high affinity sites limits the rate of the reaction. This implies that during the inhibition of F Xa there is a continuous surface-diffusion of AT from sites of a lower class to the high affinity sites where the F Xa/AT complex is formed and leaves the surface. The ability of the immobilized heparin to catalyze inhibition of F Xa is likely to be an important component for the thromboresistant properties of a heparin coating with non-compromised AT binding sequences.
A simple and practical provocative test is needed for early asymptomatic pheochromocytoma, which is a major risk for patients with multiple endocrine neoplasia type 2 (MEN-2). We measured plasma catecholamines before and after submaximal exercise in 26 MEN-2 gene carriers, eight of whom with asymptomatic pheochromocytoma, nine with medullary thyroid carcinoma and 10 after uni- or bilateral adrenalectomy. Seventeen clinically healthy individuals and 11 patients with neurovegetative lability and symptoms mimicking pheochromocytoma served as controls. Plasma adrenaline, noradrenaline and dopamine increased after exercise except for adrenaline after bilateral adrenalectomy. The post-exercise levels of adrenaline and the adrenaline/dopamine ratio were significantly higher in the pheochromocytoma patients compared to the healthy controls and the patients with neurovegetative lability, while the patients with medullary thyroid carcinoma represented an intermediate group with a high probability of developing adrenal tumors. The present method is a physiological test with a high sensitivity and specificity. It is practical and well suited for repeated examinations and seems to be of value for the detection of early pheochromocytoma in MEN-2 patients. Furthermore, the test could be used in the differential diagnosis between pheochromocytoma and neurovegetative lability.
Reference values for exercise tests with continuous increase in load are presented. The exercise tests were performed on an electrically braked bicycle ergometer by 188 randomly selected Swedes of both sexes who were between 20 and 79 years of age. The reference values are related to sex, age (in decades) and weight and classified in decreasing levels of exercise capacity. Reference values for systolic blood pressure at different work loads are also given.
Metoprolol, a cardio-selective beta-adrenergic blocking agent, was studied in 25 patients to assess its effect on "non-specific" ST-segment and T-wave changes both at rest and during exercise. In two thirds of the patients with ST-T-abnormalities at rest, the changes disappeared completely after beta-blockade but reappeared during exercise in some of them. Only in 9 patients were the changes eliminated also during exercise implying that they were "functional", i.e., caused by increased sympathetic discharge. In those patients, where the ST-T-abnormalities were not affected at all by the beta-blockade, they were probably due to organic heart disease, whereas when they were reduced but not completely abolished, increased sympathetic tone as well as organic heart disease might be the cause. It is inferred that the diagnostic information is increased by studying the effect of beta-blockade not only at rest but also during exercise. Metoprolol seems to be well suited for the evaluation of "non-specific" ST-T-abnormalities, especially when non-selective beta-blockers should be avoided, e.g. in obstructive lung disease.
Nineteen patients with ischemic heart disease were randomized into two groups and received either metoprolol or H 87/07. Heart catheterization was performed, and the groups were studied at rest and during exercise--before and after intravenous drug administration. During work metoprolol gave a statistically significant reduction in left ventricular work (expressed as pressure-rate product) of about 20%, mainly depending on a reduction in heart rate. Cardiac output decreased by 21%. Stroke volume was almost unchanged. The abnormal increase in left ventricular filling pressure during work was slightly, but not significantly, reduced by the drug. For H 87/07 no significant changes were found in the corresponding variables. This seems, however, to depend on an inadequate dosage, since not even the heart rate during work was significantly reduced. In conclusion, in the doses used metoprolol has been shown to be a potent beta-adrenoceptive antagonist in contrast to H 87/07.
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A cardio-selective beta-adrenergic blocking agent (I.C.I. 50172), which has been studied both in normal subjects and in patients with angina pectoris during and after a standardized work test, produced a significant increase in the exercise tolerance of the patients. These favourable effects are comparable with those of propranolol.One patient with severe bronchial asthma and coronary insufficiency treated with I.C.I. 50172 improved and his respiratory function was not impaired.
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