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Biomedical subjects

M Bjellerup

Publications and source records attributed to M Bjellerup.

At least 19 recordsLinked to original sources
PubMed1999

Expression of tissue-type and urokinase-type plasminogen activator activities in chronic venous leg ulcers.

BACKGROUND: Chronic wounds have been shown to exhibit elevated levels of several classes of proteinases. Plasminogen activators (PAs) are proteinases which play a major role in the biological processes involved in wound healing and abnormalities in PAs may play a role in the pathology associated with chronic wounds. Here, we investigated the expression of tPA and uPA activities in chronic venous ulcer biopsies. PATIENTS AND METHODS: In 22 patients with chronic venous leg ulcers, punch biopsies were taken from the ulcer base, ulcer margin and uninvolved skin from the thigh of the affected limb and PA activities were assessed using in situ histological zymography. RESULTS: tPA is the main PA activity in uninvolved skin but was reduced in ulcer margin skin and venous leg ulcer tissue compared to normal skin. uPA activity appeared throughout the ulcer margin skin but was at low levels in normal skin. Ulcer base tissue appeared to exhibit a plasminogen-independent proteinase activity not seen in normal or ulcer margin skin. CONCLUSION: PA activities are altered in and around chronic venous leg ulcers and their distribution suggests that blood vessels in CVI may be damaged and that the tissue is in an inflamed state.

Aged↗
PubMed1997

Pain in venous leg ulcers.

A prospective study was conducted to assess the prevalence, severity and diagnostic utility of pain in patients with venous leg ulcers. A semi-structured questionnaire was completed by 140 consecutive patients in two specialist centres caring for patients with leg ulcers. A high proportion (64%) of the 94 patients with ulcers of purely venous aetiology reported severe pain; 50% of these patients were taking either mild analgesia or none at all. In 10 of 72 cases, leg elevation made the pain worse. Venous ulcers are painful. Pain in three distinct locations was reported by patients-within ulcers, around ulcers and elsewhere in the leg. The presence of severe pain does not necessarily indicate arterial disease or infection. Pain is, in general, inadequately controlled in these patients.

Adult↗
PubMed1997

Hydrostatic leg ulcers: a new classification.

The classification of leg ulcers into standard aetiologies was conducted using a sample of 205 patients referred to the department of dermatology, Malmö University Hospital in Sweden. Patients with venous ulcers formed the largest group (51%). Classification was not possible in 31 patients (approximately 15%) and this formed the second largest group. A comparison of ulcer characteristics between this unclassified group and the venous ulcer group showed that the unclassified ulcers occur in patients with little or no venous disease and display different characteristics from venous ulcers. As a result of these differences, we propose that there should be a further classification of ulcers, known as 'hydrostatic' ulcers. The identification of this type of ulcer has important consequences for future ulcer management as these patients will not require venous surgery or further compression therapy following healing.

Adult↗
PubMed1997

Efficacy of pinch grafting in leg ulcers of different aetiologies.

The prevalence of leg ulcer disease is high and the health care costs are extensive. Effective therapy is essential to minimise the health care costs and suffering on the part of the patient. If possible, first and foremost, therapy should be aimed at correcting the underlying aetiological defect causing the ulcer. After this has been considered, one of the local therapeutic options is skin grafting using small full thickness skin grafts, i.e. pinch grafting. During the period 1991-1993 altogether 145 therapy-resistant leg ulcers were treated with the pinch graft method at the Department of Dermatology, Malmö University Hospital. The healing rate after 3 months was studied in retrospect. An overall healing rate of 36% was found. The healing rate was dependent on aetiological diagnosis, with a healing rate of 22% in venous and 50% in arterial ulcers. The pinch graft method, which may be used on an out-patient basis offers a simple and relatively effective option in the treatment of leg ulcers. It is recommended as first line skin grafting method. As second line skin grafting method split thickness skin graft, with or without ulcer excision, is recommended.

Aged↗
PubMed1995

Leg ulcers: report on a multidisciplinary approach.

In a Swedish survey, leg ulcer disease has been found to have a prevalence of around 1%. The multifactorial etiology requires a multidisciplinary approach. Forty-three patients with leg ulcers have been examined clinically and by pathophysiological and roentgenological investigations. Proper conservative treatment was instituted in 25 of the patients, and the remaining were treated by venous surgery, arterial surgery and skin transplantation. The previously used therapy only achieved healing in 23% of these patients, but after multidisciplinary assessment and treatment the healing rate was improved to 83%. The ulcer-free period of the whole group was 62% during a follow-up of 24 (3-36) months. The healing of venous ulcers can be improved by a multidisciplinary assessment by a vascular surgeon and a dermatologist.

Adult↗
PubMed1994

Differences in phototoxic potency should be considered when tetracyclines are prescribed during summer-time. A study on doxycycline and lymecycline in human volunteers, using an objective method for recording erythema.

In order to test the phototoxic potency of the two tetracyclines most frequently prescribed in Sweden, a double-blind cross-over study using a double-dummy technique with doxycycline 0.1 g twice daily, lymecycline 0.6 g twice daily, and placebo, was performed in 15 healthy volunteers. Drugs were given for 3 consecutive days, and on the third day volunteers were tested with 25, 50, 75 and 100 J/cm2 of artificial long-wave ultraviolet radiation (UVA), and assessed 6 h later for erythematous photoreactions. Objective readings were made using skin reflectance spectrophotometry. All three substances were tested in each individual at weekly intervals. Within 50, 75 and 100 J/cm2 of UVA, lymecycline showed a slight increase in erythema compared with placebo, but this was not significant (50 and 100 J/cm2), or was of low significance (75 J/cm2). However, with the same doses, doxycycline showed a substantial increase in erythema compared with placebo, which was highly significant. We conclude that doxycycline has a higher phototoxic potency than lymecycline, and this is in agreement with earlier in vitro experimental data. We recommend that therapy with doxycycline is avoided during summer-time, and during holidays in a sunny climate.

Adult↗
PubMed1993

Quality of life in chronic leg ulcer patients. An assessment according to the Nottingham Health Profile.

Chronic leg ulcer is a disease of long duration, occurring predominantly in elderly people. Traditionally, little interest has been devoted to the study of the impact of this disease on life quality. In the present study the Nottingham Health Profile (NHP) was used to assess disease influence on six areas of daily life, namely: pain, physical mobility, sleep, energy, emotional reactions and social isolation. Standard questionnaires were distributed to patients with chronic leg ulcers of venous, arterial or mixed venous-arterial origin, treated at the Department of Dermatology. Complete data were obtained from 125 patients. The disease had a marked impact on the patient's subjectively perceived health. Males exhibited remarkably elevated scores, compared to the normative scores for men, especially in the areas of pain, emotional reactions, social isolation and physical restrictions. For women the impact of leg ulcer disease, although obvious, seems much less marked than for males. An exceptionally long median duration of leg ulcer disease was found among shop-assistants. It is possible that preventive measures should be undertaken in this group. The duration of leg ulcer disease did not seem to influence the quality of life. Patients with long disease duration in fact reported fewer problems than those with shorter duration, suggesting adaptive mechanisms. This study indicates that male leg ulcer patients should be more closely observed for symptoms of emotional stress, pain, social isolation and impaired physical mobility. More efforts should be made to alleviate pain. Above all this study underlines the importance of considering not only the ulcer but the whole patient.

Adult↗
PubMed1992

Leg and foot ulcers. Nursing care in Malmö, Sweden.

Questionnaires concerning nursing care of leg and foot ulcer patients in three major care-giving sectors of the national health service, namely the Department of Dermatology, general hospital wards/clinics, and primary care, have been analysed. The overall response rate was 88% (primary care: 100%). Forms regarding 193 patients with leg ulcers and 64 patients with foot ulcers were analysed. Substantial differences in nursing care were noted between the three sectors. In 55% of the leg ulcers and 45% of the foot ulcers fibrin slough was present in the ulcer. Black, necrotic tissue was present in 8% of the leg ulcers and 22% of the foot ulcers. Profuse ulcer-exudation was most commonly reported for leg ulcer patients treated at the Department of Dermatology, while the majority of foot ulcers had only a mild exudation. Frequency of dressing changes varied between 1.4 times/week for leg ulcers at the Department of Dermatology and 9.2 times/week (foot ulcers 11.6) at general hospital clinics. Local wound dressings were exclusively chosen by physicians at the Department of Dermatology, mainly by physicians at general hospital clinics, and equally often by physicians and nurses in primary care. Time since last evaluation of the ulcer by a physician varied. At the general hospital clinics, 89% of the patients with leg ulcers had been seen by a physician within the last 2-month period. At the Department of Dermatology, 89% and in primary care 61% of the patients were examined within this period. 11% of the patients in primary care had never consulted a physician for their ulcers.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1992

A demographic survey of leg and foot ulcer patients in a defined population.

By means of a questionnaire sent to all medical units in Malmö, including primary care, homes for the elderly, and industrial health clinics, 275 patients with leg and foot ulcers were identified. With a population of 232,908 in Malmö, this corresponds to a prevalence of 0.12%, which is lower than reported by others. Since the response rate was high (88% total, Primary Care: 100%), the prevalence of 0.12% is, however, believed to be real and might be explained by the urban area investigated, with easy access to care and proximity to one somatic hospital. 50% of the patients with leg and foot ulcers were treated in Primary Care, and 30% of the leg ulcer patients were treated at the Department of Dermatology. 88% of leg and foot ulcer patients were over 75 years of age. Median age was 79.5 years, with 80 for women and 76.5 for men. In Primary Care the median age was 82. There was a predominance of women in the study population with an overall sex ratio of 3:1. A higher proportion of patients living alone was found in Primary Care. The etiology of the ulcers was considered to be "unknown" or "other" or else no statement was given in 36% of the leg ulcer- and 22% of the foot ulcer patients. This might reflect an overall uncertainty about the underlying etiological cause. Medially and laterally located leg ulcers were reported equally often, but there was also a great proportion of wholly or partially circumferential ulcers. 76% of the foot ulcers were located on the toes.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1992

A novel dithranol formulation in the over night treatment of psoriasis at home.

The objective of this study was to compare the clinical efficacy and acceptability of two dithranol creams (Micanol and Amitase) in patients with plaque type psoriasis treating themselves daily at home. Thirty-five patients started with Amitase (0.1%) and 37 with Micanol (0.1%) applied at night in this 6-week single-blind parallel groups comparison study. Patients who responded more slowly than a theoretically estimated "standard" rate of improvement had their concentration increased to 0.25% at the visit after 2 or 4 weeks. By the end of the study slightly more than half of the number of patients remained on 0.1%. There was no difference between the treatment groups. In comparison with the level at start the composite sign severity score for patients in the Amitase group was reduced by 24% after 1 week, 36% after 2 weeks, 49% after 4 weeks and 62% after 6 weeks. The reduction in the Micanol group was similar. Patients in the Micanol group showed after 1 week of treatment more irritative reactions than patients in the Amitase group. At all follow-up visits, staining of perilesional skin was more prevalent in the Micanol group. Staining of clothing was, however, far more prevalent and severe for patients given the Amitase cream. It may be concluded that Micanol is an important alternative for home treatment of psoriasis.

Adult↗
PubMed1989

Nail-changes induced by penicillamine.

Peculiar nail-changes in a 70-year-old woman with rheumatoid arthritis occurring after approximately 1 year of penicillamine treatment are described. After cessation of treatment there was a gradual resolution with regain of normal nails after 7 months. Reinstitution of penicillamine treatment caused a recurrence thus proving a causal relationship between penicillamine and the described nail-changes. The fingernails were more affected than the toenails and clinically the changes consisted of absence of lunulae, longitudinal ridging, transverse or longitudinal defects of the nailplate and a tendency of onychoschizia.

Aged↗
PubMed1987

Double blind cross-over studies on phototoxicity to three tetracycline derivatives in human volunteers.

A double blind cross-over phototoxicity study using demethylchlortetracycline (DMCT) 0.3 g x 2, doxycycline 0.1 g x 2, lymecycline 0.6 g x 2 and placebo was performed on 8 healthy human volunteers. Drugs were given for 3 consecutive days, and on the third day the volunteers were tested with different modalities of artificial long-wave ultraviolet radiation (UVA) and assessed 24 h later for objective as well as subjective abnormal photoreactions. All 4 substances were tested in each individual at weekly intervals and serum concentrations of tetracycline were determined. It was found most convenient to irradiate relatively large skin areas using fluorescent tubes emitting mainly UVA but also a small proportion of UVB. Using this type of irradiation, weak erythemal reactions were obtained with all 3 derivatives. Taking only stronger reactions and stinging sensations into account, 0/8 reacted to lymecycline, 0/8 to DMCT and 4/8 to doxycycline. There was no significant difference in serum concentration among the 3 derivatives. It is concluded that doxycycline is the most potent photosensitizer at the dosage tested.

Adult↗
PubMed1986

Medium-wave ultraviolet radiation (UVB) is important in doxycycline phototoxicity.

The phototoxic reaction to doxycycline is provoked by long-wave ultraviolet light (UVA). It was shown by the in vivo mouse tail technique, measuring phototoxic edema, that the addition of medium-wave ultraviolet light (UVB) immediately after, immediately before and especially 24 h before the phototoxic trauma, enhanced the reaction more than could be expected from simple addition, thus demonstrating the importance of photoaugmentation in this process.

Animals↗
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↗
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↗