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Biomedical subjects

M Hedberg

Publications and source records attributed to M Hedberg.

At least 37 records · Page 2Linked to original sources
PubMed1997

Peripheral muscle training in patients with clinical signs of heart failure.

The aim of the study was to evaluate, in a controlled setting, the effects of a 5-month dynamic peripheral training programme in patients with clinical signs of congestive heart failure with special reference to their anaerobic threshold, muscle function, heart rate variability and quality of life. Twenty-four randomized patients with clinical signs of heart failure in NYHA II-III entered the study. Training resulted in a significant (p = 0.01) change in the anaerobic threshold, the patients' ability to lift weights (p = 0.01) and performance of heel-lift (p = 0.01). The heart rate recorded during the training exercises decreased significantly (p = 0.04). There were no significant differences in peak oxygen uptake, isokinetic and isometric strength, HRV and quality of life except for three items in the control group. The results of this study indicate that peripheral training is beneficial for patients with clinical signs of congestive heart failure.

Aged↗
PubMed1996

The structure of an instrument for assessing the effects of assistive devices and altered working methods in women with rheumatoid arthritis.

OBJECTIVE: To use Rasch analysis to transform the ordinal score from a newly developed instrument, the Evaluation of Daily Activities Questionnaire (EDAQ), in order to obtain unidimensional linear measures; to analyze whether items change in difficulty with interventions; and to follow changes in subjects' degree of ability. METHODS: Twenty-one women with rheumatoid arthritis rated their perceived difficulty without and with assistive devices or altered working methods using the EDAQ; the EDAQ consists of 102 items of daily activities, divided into 11 dimensions. RESULTS: All items in the EDAQ could be structured into an acceptable model from "hard" to "easy" with the subjects overall measures ranging from "more able" to "less able." Forty-one items showed a significant reduction of difficulty with interventions. For some items results indicated that easier initial difficulty led to greater effect of interventions. In general, difficulty without assistive devices could not predict difficulty with interventions. Twenty women demonstrated a significant increase in activities of daily living (ADL) ability after interventions. CONCLUSION: The EDAQ analyzed with the Rasch model, demonstrated a hierarchical order of difficulty in 102 items showing that it was possible to evaluate the effect of using assistive devices or altered working methods.

Activities of Daily Living↗
PubMed1996

Rising incidence of pancreatic carcinoma in middle-aged and older women-time trends 1961-90 in the city of Malmö, Sweden.

The city of Malmö (population 230 000), situated in the south of Sweden, is in an area which has the highest incidence of pancreatic cancer in the country. The present study was designed to assess time trends of the incidence of pancreatic cancer 1961-90. The 1314 incident cases, 651 men and 663 women, were retrieved from the Regional Tumour Register and the National Cause-of-Death Register. In 75% of cases diagnosis was based on autopsy. Twenty per cent of the these cases were first found at autopsy, being undiagnosed. The average age-standardised incidence was 20.4 per 10(5) person-years for men and 13.7 for women. The incidence was higher for men than for women in all age groups above 44 years. No change in incidence over time was observed for men. In older and middle-aged women there was however a statistically significant increase. The average relative change in women above age 64 was 1.7% per year after age adjustment and in women aged 55-64 years 2.6% per year. We have found no results indicating that this increasing incidence could be caused by detection bias as a result of changing autopsy rates during the study period and hence conclude that the observed increase is explained by a growing number of women being exposed to factors with a potential tumour-promoting or -initiating effect.

Adult↗
PubMed1996

Beta-lactam resistance in anaerobic bacteria: a review.

The majority of the human microflora consists of anaerobic bacteria. Normally these bacteria have low pathogenicity, but under certain conditions, such as destruction of tissues and poor circulation or impaired host defense, they may cause serious infections. Bacteroides species are the most frequently isolated microorganisms from suppurative anaerobic infections and they have the broadest spectrum of resistance to the commonly used antimicrobial agents. Resistance to antimicrobial agents is an increasing problem, especially to beta-lactam compounds. Multiresistant clinical isolates, resistant to beta-lactam antibiotics as well as other antimicrobial agents used in the treatment and prophylaxis of anaerobic infections are now occurring. Resistance to beta-lactam antibiotics is usually mediated by beta-lactamase production. A few isolates of Bacteroides fragilis are producing metallo-beta-lactamases which are capable of hydrolyzing beta-lactamase stable compounds such as cefoxitin and imipenem. The enzyme activity in metallo-beta-lactamases is not affected by the clinically used beta-lactamase inhibitors clavulanic acid, sulbactam and tazobactam. Other resistance mechanisms are alterations in the penicillin-binding proteins (PBPs) or a decreased permeability through the outer membrane. Beta-lactam resistance and beta-lactamase production have also been detected in some species of clostridia, fusobacteria, Prevotella, Porphyromonas and in some other anaerobic bacteria.

Anti-Bacterial Agents↗
PubMed1996

Antimicrobial treatment of periodontal diseases disturbs the human ecology: a review.

Periodontal diseases are associated with specific pathogenic microorganisms and therefore antimicrobial agents are often used in the treatment of patients with periodontitis refractory to conventional mechanical therapy. Perorally administered antimicrobial agents often lead to ecological disturbances in the normal oral and intestinal microflora with overgrowth of potentially pathogenic microorganisms, which may spread within the host or from patient to patient, causing infections. The use of antimicrobial agents also promotes the emergence of bacterial drug resistance, both in the periodontal pocket and in the normal oral and intestinal microflora. Topical administration of antimicrobial agents in the periodontal pockets causes restricted disturbances in the intestinal microflora, although there is a substantial risk of development of resistance at the site of application. A number of clinical studies imply that correct use of antimicrobial agents might be beneficial for a subset of patients with adult or juvenile periodontitis. The choice of antimicrobial agent should always be based on accurate microbial analyses of the subgingival microflora and in vitro antimicrobial susceptibility tests of the most important periodontal pathogens. Preferably, agents with low potential of causing ecological disturbances should be used.

Anti-Bacterial Agents↗
PubMed1996

Thromboprophylaxis with a low molecular weight heparin (tinzaparin) in emergency abdominal surgery. A double-blind multicenter trial.

In this prospective randomized double-blind study the thromboprophylactic effect of postoperative low molecular weight heparin (tinzaparin) was compared with placebo in 80 patients undergoing emergency abdominal surgery. The fibrinogen uptake test was used but because of withdrawal of the labelled fibrinogen from the market the calculated number of patients was not reached. However, this is one of the few studies in emergency abdominal surgery we thought it important to report. The frequency of deep vein thrombosis was reduced with prophylaxis from 22% (95% conf. intervall 11-38%) to 8% (2-21%), a risk reduction of 65%, which is however not significant. Together with data from the few previously published studies it can be concluded that patients undergoing emergency abdominal surgery seem to benefit from prophylaxis, which should be instituted either before operation or at latest 24 hours after. The exact prophylactic relation between pre- and post-operative start would, however, require a separate, randomized study.

Abdomen↗
PubMed1996

Risk of pancreatic carcinoma in smokers enhanced by weight gain. Results from 10-year follow-up of the Malmö preventive Project Cohort Study.

CONCLUSION: The increased risk of pancreatic carcinoma in smokers is enhanced by weight gain. Possible explanations are proposed and discussed. BACKGROUND: Between 1974 and 1992, 35,000 men and women below 55 yr of age participated in a general health examination at the Department of Preventive Medicine in Malmö, Sweden. Mortality and incidence of cancer have been updated by record linkage with the Cause of Death Register and the National Cancer Register. METHODS: The present study deals with the incidence of pancreatic carcinoma during 365,500 person years of follow-up. The 43 cases corresponded to an incidence per 100,000 person years of 13.4 in men and 6.1 in women. RESULTS: Nonsmokers, exsmokers, and smokers had an incidence of 1.5, 24.5, and 15.3/100,000 person years, respectively. The case-control approach used to assess risk factors for pancreatic carcinoma showed that the odds for smoking (odds ratio [O.R] 8.6; 95% confidence intervals [C.I.] 2.0-37.5), for weight gain more than 10 kg since the age of 30 (O.R. 1.8; 95% C.I. 0.9-3.6), and for epigastric pain (O.R. 3.2; 95% C.I. 1.4-7.2) were higher in cases than in controls. These odds ratios were all statistically significant in the logistic regression analysis.

Adult↗
PubMed1995

Low molecular weight heparin started before surgery as prophylaxis against deep vein thrombosis: 2500 versus 5000 XaI units in 2070 patients.

The optimal administration regimens of low molecular weight heparins (LMWHs) have not yet been established. The aim of this study was to compare the efficacy and safety of 2500 and 5000 XaI units of the LMWH dalteparin in patients undergoing elective general surgery for malignant and benign abdominal disease. Prophylaxis was started in the evening before surgery and given once-daily every evening thereafter. The study was designed as a prospective, randomized, double-blind, multicentre trial. Some 66.4 per cent of patients were operated on for a malignant disorder. The primary endpoint was deep vein thrombosis (DVT) detected with the fibrinogen uptake test. Bleeding complications were recorded and classified. Analysis was made both on an intention to treat basis and in patients given correct prophylaxis (86.3 per cent). A total of 2097 patients were randomized and 27 excluded after randomization. A technically correct fibrinogen uptake test was obtained in 1957 patients. The incidence of DVT was significantly lower in patients given 5000 XaI units, this being true for both correct prophylaxis (6.8 versus 13.1 per cent, P < 0.001), on an intention to treat basis (6.6 versus 12.7 per cent, P < 0.001), and in patients with malignant disease (8.5 versus 14.9 per cent, P < 0.001). Sixty-seven patients (3.2 per cent) died within 30 days with no difference between the groups. There were two cases of fatal pulmonary embolism. The frequency of bleeding complications in the whole series was higher in patients randomized to 5000 XaI units (4.7 versus 2.7 per cent, P = 0.02), although this was not the case in those operated on for malignant disease (4.6 versus 3.6 per cent, P not significant). Dalteparin in the dose of 5000 XaI units started in the evening before surgery has a good thromboprophylactic effect in high-risk general surgery at the cost of a small bleeding risk. In patients with malignant disease there was no increased risk of bleeding. The overall frequency of fatal pulmonary embolism with dalteparin is extremely low, even in this high-risk group of patients.

Adult↗
PubMed1995

Induction of beta-lactamase by cefoxitin in anaerobic intestinal microflora.

Beta-lactamases produced by two anaerobic bacterial strains, Bacteroides ovatus Ax34:1 and Clostridium butyricum NBL3, were shown to be significantly inducible under anaerobic conditions in subinhibitory concentrations of cefoxitin. The induction ratio of beta-lactamase production for Bacteroides ovatus was 2.6 and for Clostridium butyricum 1.6. Incubation of faecal samples with different concentrations of cefoxitin did not result in any induction of beta-lactamase production. When adding a highly inducible aerobic strain (Citrobacter freundii F72:6, induction ratio of 26.5 in broth culture) to faecal samples, an induction ratio of 4.5 was reached. Faeces seem to inhibit beta-lactamase induction in aerobic and anaerobic bacteria. The inducible enzymes produced by the anaerobic strains did not have the same properties as beta-lactamases from aerobic inducible strains, according to substrate profiles and inhibition studies. The results of the present study indicate that increased levels of beta-lactamases in the normal intestinal microflora, which often are observed after administration of beta-lactam agents, are probably due to selection of stably derepressed mutants rather than to induction of beta-lactamase production.

Anti-Bacterial Agents↗
PubMed1995

Purification and characterization of a new beta-lactamase from Bacteroides uniformis.

A beta-lactam-resistant Bacteroides uniformis strain was isolated from a clinical specimen. The strain produced large amounts of beta-lactamase and was resistant to penicillins and cephalosporins. The specific activity of the unpurified beta-lactamase was 4.8 U/mg of protein with nitrocefin as the substrate. The enzyme was purified 188-fold by Q-Sepharose, Sephacryl S-300, and Mono Q column passages. Kinetic parameters of the enzyme were determined by a micromethod performed in microtiter plates. beta-Lactamase was inhibited by cefoxitin and imipenem and hydrolyzed cephalosporins more rapidly than penicillins. The molecular weight was determined by sodium dodecyl sulfate-gradient gel electrophoresis to be 32,500, and the isoelectric point was 4.5.

Amino Acid Sequence↗
PubMed1995

Muscle fiber characteristics, capillaries and enzymes in patients with fibromyalgia and controls.

In 11 female patients with Fibromyalgia Syndrome (FS), biopsies from the m. vastus lateralis were analyzed, in order to reveal any possible changes which might explain muscular weakness and fatigue. Nineteen healthy subjects served as a control group. Light microscopy did not show any gross histopathological findings. Fiber composition and fiber areas did not differ between the two groups, except for a greater coefficient of variation of the area of type II A fibers and of the mean fiber area in the FS group. The number of capillaries per square millimeter and also the fiber area in relation to the capillaries, was lower in the FS patients. Analyses of enzymes showed decreased levels of 3-hydroxy-CoA-dehydrogenase and citrate synthase in the patient group. The reduced oxidative enzyme levels and capillarization indicate reduced physical activity, although this does not associate with muscle fiber hypotrophy.

Adult↗
PubMed1994

Studies on maximal voluntary muscle contraction in patients with fibromyalgia.

In view of clinical experience of a low-force output in testing situations in patients with fibromyalgia syndrome (FS), this study evaluated the possibility of reaching a higher muscular performance by use of superimposed electrical stimulation: the tests mainly involved knee-extension in a Kin Com dynamometer. Twenty-five patients fulfilling the criteria of FS were compared with 22 healthy subjects. The patients showed a markedly reduced maximal voluntary contraction, but superimposed electrical stimulation revealed submaximal values. The electromyographic activity during stool climbing exceeded that recorded during maximum voluntary contraction during the dynamometric test. The cause of the reduced voluntary maximal performance is discussed. An impaired control mechanism at a supraspinal level is suggested. This has to be considered when measuring muscle strength in FS patients. Tests related to functional activities are recommended as measures of muscular performance in this patient group.

Adult↗
PubMed1994

Changes in muscle morphology, strength and enzymes in a 4-5-year follow-up of subjects with poliomyelitis sequelae.

Twenty subjects with polio sequelae were studied on two occasions 4-5 years apart by means of dynamometer measurements of knee-extension and flexion strength and muscle biopsy for histochemical and enzymatic analyses. The subjects were divided into those who reported (unstable, n = 12) and did not report (stable, n = 8) new or increased muscle weakness in the tested leg between the two examinations. Muscle strength decreased significantly in the unstable subjects, but only for knee-flexion in the stable subjects. However, the endurance test comprising 50 consecutive knee-extensions at 180 degrees/sec showed increased fatigability at the second examination only in the stable subjects. Most subjects had markedly increased muscle fiber areas, which in some subjects increased further, but in those already with very extreme hypertrophy the fiber size decreased. Capillarization and activity of citrate-synthase were decreased at the initial examination, but no significant further reduction was observed at the second examination. The results demonstrate individual patterns in the compensatory process for the presumed loss of motor units.

Adult↗
PubMed1993

Thromboprophylaxis in emergency surgery.

Except for hip fracture surgery, emergency surgery has been only exceptionally studied concerning thromboprophylaxis. There are, however, several reasons to believe the frequency to be fairly high and that the patient group would be in need of prophylaxis. This paper discusses various emergency situations and also gives the design for an ongoing controlled study on the effect of postoperative start of thromboprophylaxis with low molecular weight heparin in emergency abdominal surgery.

Abdomen↗
PubMed1992

Effect of beta-lactamase inhibitors on beta-lactamases from anaerobic bacteria.

Three beta-lactamase inhibitors in clinical use--clavulanic acid, sulbactam and tazobactam--were investigated for their activity on beta-lactamases from Bacteroides uniformis, Clostridium butyricum and Fusobacterium nucleatum. Purification of the beta-lactamases was carried out by anion-exchange chromatography, gel filtration and FPLC. The inactivation of beta-lactamase activity was determined spectrophotometrically with nitrocefin as substrate. Various concentrations of the inhibitors were preincubated at 30 degrees C together with the enzyme for different periods of time before determination of the beta-lactamase activity. The three beta-lactamases tested were more susceptible to tazobactam than to clavulanic acid and sulbactam. Clavulanic acid and sulbactam reduced the enzyme activity of the Bacteroides uniformis beta-lactamase more effectively than the Clostridium butyricum and Fusobacterium nucleatum beta-lactamases.

Bacteria, Anaerobic↗
PubMed1992

Purification and characterization of an imipenem hydrolysing metallo-beta-lactamase from Bacteroides fragilis.

An imipenem resistant beta-lactamase producing strain of Bacteroides fragilis was isolated from a clinical specimen. The specific activity of the unpurified beta-lactamase was 5.5 U/mg protein. The beta-lactamase was purified 60-fold by Q Sepharose, Sephacryl S-300 and Mono Q column passages. The strain was able to inactivate imipenem and cefoxitin in broth cultures. The enzyme hydrolysed imipenem more rapidly than ampicillin, benzylpenicillin, cephalothin and cefoxitin. The activity of the enzyme was Zn2+ dependent and was completely inhibited by EDTA. The inhibition was reversed by ZnSO4. Preincubation with the common beta-lactamase inhibitors clavulanic acid, sulbactam and tazobactam did not reduce the enzyme activity. The molecular weight was determined by sodium dodecyl sulfate gradient gel electrophoresis to be 31,000 Daltons and the isoelectric point was 4.5.

Bacteroides fragilis↗
PubMed1992

Effect of clavulanic acid, sulbactam and tazobactam on three different beta-lactamases from Bacteroides uniformis, Clostridium butyricum and Fusobacterium nucleatum.

The effect of three beta-lactamase inhibitors, clavulanic acid, sulbactam and tazobactam used in clinical practice were compared for their activity against purified beta-lactamases from Bacteroides uniformis, Clostridium butyricum and Fusobacterium nucleatum. The enzymes from B. uniformis and C. butyricum were produced in fermenters under controlled growth conditions and the enzyme from F. nucleatum was produced in batch cultures. Purification of the beta-lactamases was achieved by anion-exchange chromatography, gel filtration and FPLC-technique. The degree of inactivation of beta-lactamase activity was determined spectrophotometrically with nitrocefin as the substrate. The inhibitors in various concentrations were preincubated at 30 degrees C together with the enzyme for different time periods (0.5-120 min) before determination of the remaining beta-lactamase activity. The inhibitors all decreased the activity of the beta-lactamases investigated. Clavulanic acid and sulbactam were capable of reducing the enzyme activity of the B. uniformis beta-lactamase more effectively than the C. butyricum and F. nucleatum beta-lactamases. All beta-lactamases tested were more susceptible to tazobactam than to clavulanic acid and sulbactam.

Bacteroides↗