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Biomedical subjects

N Olsen

Publications and source records attributed to N Olsen.

At least 37 records · Page 2Linked to original sources

Mutation analysis of coding sequences for type I procollagen in individuals with low bone density.

Mutations in one of the two genes encoding type I procollagen (COL1A1 and COL1A2) are frequently the cause of osteogenesis imperfecta (OI), a disorder characterized by brittle bones. Here we tested whether patients with low bone density also have mutations in these genes. The 26 patients studied had no apparent metabolic bone disease, but most had a positive family history of osteopenia or osteoporosis. Although a diagnosis of OI was considered by the clinician in some cases, the clinical criteria for OI were not satisfied. Our strategy for mutation analysis consisted of PCR amplification of cDNA made to fibroblast mRNA using primers specific for the coding regions of COL1A1 and COL1A2. The PCR products were then sequenced directly with primers located within each PCR product. We found that 3 of 26 patients had mutations that altered the encoded amino acid. One mutation, at position alpha 2(I)-661 has been reported (Spotila et al. 1991 Proc Natl Acad Sci USA PNAS 88:5423). The other 2 patients, who were not related to each other, had a mutation that altered the proline codon at alpha 1(I)-27 to alanine. This mutation was not found in 81 normal individuals or in 37 additional osteopenic individuals. However, its effect on the biologic function of type I collagen, as well as its role in osteopenia, is uncertain. In addition to the two mutations, we found a polymorphism in codon alpha 2(I)-459. Although this polymorphism involved an amino acid substitution, it was present with equal frequency in the patient and the normal population. By analyzing this and previously reported neutral sequence variants in the COL1A2 gene, we determined that all patients expressed both alleles of the COL1A2 gene. The 12 patients who were heterozygous for a COL1A1 neutral sequence variant also expressed both alleles. Here we present all PCR primer and sequencing primer information. The results suggest that surveying a larger group of similarly selected individuals may reveal additional mutations in the COL1A1 or COL1A2 genes.

Adolescent↗

Familial scleroderma--evidence for environmental versus genetic trigger.

Families with more than one case of scleroderma are unusual. Four families each with two members (in one case monozygotic twins) with scleroderma (systemic sclerosis, SSc) were identified. Clinical, immunogenetic and autoantibody studies were carried out. Multicase SSc families cited in the literature were reviewed. Each family pair shared cutaneous subset of disease severity, and SSc-associated autoantibody. HLA typing showed two pairs shared an HLA-DR allele associated with scleroderma (DR3 or DR5), while one also had alleles reported in association with their SSc-specific autoantibody. Review of dates and ages of onset suggested that the timing of onset of scleroderma is more likely to have an environmental trigger than to be encoded genetically.

Adult↗

Vibration aftereffects on vasoconstrictor response to cold in the normal finger.

The acute effects of unilateral 30 min exposure to hand-arm vibration on the vasoconstrictor response to cold in a finger from both hands were investigated in 12 healthy men (age 18-38 years) who had never worked with vibrating tools. One hand was exposed to accelerations of 4.0 and 16.0 m.s-2 on 2 different days. The vasoconstrictor response to cold (R%) was expressed as the relative decrease in finger systolic blood pressure, measured using cuff and strain gauge techniques, when the finger was cooled from 30 to 10 degrees C. The R% of both third fingers were measured simultaneously before unilateral vibration exposure and 15, 60 and 120 min after the end of each exposure. The R% of both fingers were not affected by the low acceleration vibration (P > 0.10). Exposure to the high acceleration vibration was followed by an unchanged R% of the exposed finger but an increased R% of the non-exposed finger after 15 min (P < 0.05); there was an equal increase of 30%-40% in R% of both fingers after 60 min (P < 0.05). The R% of both fingers had returned to normal after 120 min (P > 0.10). The results would indicate that short-term exposure to vibration induces a transitory hyperreactive central vasoconstrictor drive to the central sympathetic nervous system or circulating agents, which initially was locally counteracted by an induced hyporeactive vasoconstrictor function of local vasomotor mechanisms of the vibration exposed digital arteries. The hyperreactive vasoconstrictor effect demonstrated may contribute to the development of vibration-induced white finger if cumulative exposure time were to be considerably increased.

Adolescent↗

Vasomotor functions of skin microcirculation in vasospastic Raynaud's phenomena.

An overview of our recent studies is given. The following subjects were investigated: Women with primary Raynaud's phenomenon (PRP) and their female controls (FC); vibration exposed workers without (HAV) and with vibration-induced white finger (VWF); men with chemotherapy-induced Raynaud's phenomenon (CRP) and men with similar treatment but without finger symptoms (CVB); and male controls (MC). All three forms of Raynaud's phenomenon (RP) had a vasospastic and not an obstructive disease. The relative capillary blood flow rate in the skin of the finger was measured by the local 133Xenon washout technique during three different postural stimuli before and after hand vibration and furthermore during hand vibration. The main results indicate a hyperreactivity of the central sympathetic nervous system in all three types of vasospastic RP, which may be responsible for episodes of RP; a dysfunction of the peripheral sensory nerve fibers in VWF; a chemotherapy-induced prolonged vascular-toxic effect only on the terminal arterioles regardless of finger symptoms; and an only transitory mechanical effect of hand vibration on the arteriolar vasomotor function. The applied quantitative mapping of the function levels of the different elements involved in sympathetic vasoconstriction may be valuable in the evaluation of the pathophysiological components in other forms of RP.

Adult↗

Vascular toxicity and the mechanism underlying Raynaud's phenomenon in patients treated with cisplatin, vinblastine and bleomycin.

The vascular toxicity and the mechanism of Raynaud's phenomenon (RP) were investigated in 32 patients treated with cisplatin, vinblastine, and bleomycin. Sixteen patients had RP and sixteen patients were without finger symptoms. The results were compared with values obtained in 10 male controls. The following postural vasomotor functions were measured: (a) the vasomuscular, non-neurogenic autoregulation, tested by 133xenon flow during elevation of the finger 20 cm; (b) the local veno-arteriolar vasoconstrictor axon reflex, tested similarly by lowering the finger 40 cm; and (c) the central sympathetic vasoconstrictor reflex elicited by central baroreceptors and tested by changing the body posture from supine to sitting upright. The central sympathetic vasoconstrictor reflex was significantly increased in the group of patients with RP and/or cold provocation test positive (n = 16) when compared with the control group (p less than 0.05), and normal in patients without RP (n = 16). The local axon reflex functioned normally, whereas the autoregulation was impaired in both groups of patients compared with the control group (p less than 0.05). The results indicate a hyper-reactivity in the central sympathetic nervous system of the patients with RP, which also may explain their attacks of white fingers. The impaired autoregulation indicates a reduced function of the smooth muscle cells in the terminal arterioles, whereas the greater arterioles seem unaffected, as evidenced by the normal local axon reflex.

Adult↗

Hyperreactivity of the central sympathetic nervous system in vibration-induced white finger.

Vibration exposed workers with and without vibration-induced white finger (VWF), subjects with primary Raynaud's phenomenon and non-exposed controls were investigated in the present studies. The applied stimuli comprised cold stimuli, vibration exposure, and postural stimuli. The digital vasomotor responses to these stimuli were objectively quantified by measurements of finger systolic blood pressure and relative capillary blood flow rate in the skin of the finger. The results indicate that hyperreactivity of the central sympathetic nervous system may function as an/the abnormal element of the reflex mechanisms triggering the predominant portion of the vasoconstriction in episodic arterial closure of VWF. The hyperreactivity of the central sympathetic nervous system may be induced by prolonged exposure to hand-arm vibration, possibly by activation of the vibration elicited central sympathetic vasoconstrictor reflex mechanisms.

Adult↗

Medical audit: assessment of surgical performance in a low volume specialty.

We describe a simple technique for auditing one aspect of the activity of a neurosurgical unit--the surgical operations performed. A proforma completed by the surgeon at the time of operation was brought up-to-date on subsequent daily ward rounds. Each week, the medical staff of the unit met to review the data sheets of those patients discharged during the previous seven days. This meeting served to ensure the completeness of the data and to discuss any problems in management before the records were computerized. At the end of the first year, problems which had become apparent in the system were identified and corrected. The revised system involves a comprehensive and prospective audit of relevant clinical information. It has led to the accumulation of a considerable quantity of reliable data and it involves frequent positive feedback which appears to be leading to an improvement in treatment outcome. The system is simple to administer and is economical of time. It should be suitable for any surgical specialty which resembles neurosurgery in dealing with a relatively small volume of major procedures, and it could easily be adapted to audit other aspects of the activity of a unit.

Evaluation Studies as Topic↗

Active and latent forms of transforming growth factor beta activity in synovial effusions.

We have evaluated the possible involvement of TGF-beta in rheumatoid arthritis by assay of 16 cell-free synovial fluids for the presence of its active and "latent" forms. Evidence has been obtained for TGF-beta-like activity in synovial effusions by four criteria: (a) TGF-beta receptor competition, (b) soft-agar colony formation of AKR-2B and NRK-49F indicator cells, (c) immunological neutralization of the biological activity, and (d) biochemical activation of a latent form.

Antigen-Antibody Reactions↗

Transitory postural vasomotor dysfunction in the finger after short term hand vibration.

The transitory effects of hand vibration (ah, w = 3.16 m/s2 during three minutes) on postural vasomotor functions of skin capillary blood flow rate in the finger were studied by the local 133xenon washout technique in ten men with vibration induced white finger (VWF), nine men professionally exposed to hand-arm vibration but without finger symptoms (HAV), and eight male controls (MC). The following postural vasomotor functions were measured: (a) the vasomuscular, non-neurogenic autoregulation, tested by raising the finger 20 cm; (b) the local venoarteriolar vasoconstrictor axon reflex, tested by lowering the finger 40 cm; and (c) the central sympathetic vasoconstrictor reflex elicited by central baroreceptors and tested by changing the body posture from supine to sitting upright. Before short term vibration the vasoconstriction elicited by central baroreceptors was increased in VWF (p less than 0.01) and normal in HAV (p greater than 0.10). The local axon reflex and the autoregulation functioned normally in VWF and HAV (p greater than 0.30). Three minutes after vibration, autoregulation was abolished and the functions of the central and local sympathetic vasoconstrictor reflexes were equally impaired in all three groups (p less than or equal to 0.01). All three vasomotor functions were completely restored 60 minutes after vibration in MC (p greater than 0.10) and also 30 minutes after vibration in one male control (p greater than 0.20). The results indicate a hyperreactivity of the central sympathetic nervous system in VWF, and a transitory, impaired function of digital arterioles after short term vibration in all groups.

Adult↗

Raynaud's phenomenon in patients treated with cisplatin, vinblastine, and bleomycin for germ cell cancer: measurement of vasoconstrictor response to cold.

The prevalence of Raynaud's phenomenon (RP) was studied in patients treated with cisplatin, vinblastine, and bleomycin. Thirty-two patients with germ cell cancer were followed for a median of 78 months (range, 49 to 106 months). All had obtained complete remission during treatment; none had relapsed at last follow-up examination. All blood samples, including serum magnesium, were normal. The arterial vasoconstrictor response to cold in the finger was measured by cuff- and strain-gauge techniques at 30, 15, and 10 degrees C. Blood pressure (BP) was measured auscultatorily, using a 12-cm broad cuff on the ipsilateral upper arm. Fourteen patients (44%) had developed anamnestic RP, and all showed an exaggerated response to cold; arterial closure was provoked in nine patients. Eighteen patients (56%) were without finger symptoms. These patients had an exaggerated response to cold in comparison with controls, and in two patients, RP was provoked. None of the patients had an increased systolic pressure gradient from arm to finger when compared with a control group. Thus, an exaggerated cold response was found to be a prolonged vasospastic side effect not only in patients with RP, but also in patients without finger symptoms.

Adult↗

Scintimetric assessment of synovitis activity during treatment with disease modifying antirheumatic drugs.

In a double blind trial of 36 patients with rheumatoid arthritis a new scintimetric method was applied to three comparable patient groups before and after eight months' treatment with levamisole, penicillamine, or azathioprine. Technetium-99m pyrophosphate scintigraphy of both hands was performed on a gammacamera with a computer attached, immediately after the administration of the tracer. The uptake ratio of each proximal interphalangeal (PIP) joint and the mid-half of the adjacent proximal phalanx was calculated from the activity counted for one minute. A scintimetric index was expressed as the sum of eight uptake ratios. This index was higher for each of the three patient groups before start of treatment than that for 10 age matched controls. After eight months of treatment the index, the number of PIP joints with clinical signs of synovitis, and the total circumference of the PIP joints decreased in the penicillamine and azathioprine groups. The scintimetric method reliably reflected local synovitis activity and its changes but, like grip strength and PIP circumference, was not a representative measure of the overall activity of the disease.

Adult↗

Vasoconstrictor response to cold in forestry workers: a prospective study.

In a five year prospective study of the vasoconstrictor response to cold 37 forestry workers were investigated in 1978 and again in 1983. The subjects were classified into three groups: group A (n = 13): no subjective finger symptoms in 1978 and continued sawing until 1983; group B (n = 12): no symptoms in 1978 and stopped sawing before 1983; group C (n = 12): vibration induced white finger (VWF) in 1978. A cold provocation test measuring the finger systolic blood pressure with a cuff and strain gauge technique during combined body cooling and finger cooling to 30 degrees, 15 degrees, and 6 degrees C was applied to all subjects at both investigations. In 1978 all groups had an increased cold response when compared with that of 20 non-exposed controls (p less than 0.05), and the response was more exaggerated in group C than in groups A and B (p less than 0.01). From 1978 to 1983 the vasoconstrictor response increased in group A (p less than 0.05), was in group B (p greater than 0.10), and improved in group C (p less than 0.05). The changes in cold response in groups A and C were significantly larger than the within day variation of the method (p less than 0.01). The aggravation of group A indicates that a further five years use of anti-vibration chain saws induced an increased hyperreactivity in the vasoconstrictor mechanisms but led to subjective symptoms of VWF in only one subject. The improvement in group C was in accordance with the improvements of subjective finger symptoms and was associated with a previous shift from saws without vibration damping devices to anti-vibration saws and with cessation of work. The results of group C indicate that VWF may improve or subjectively disappear if exposure to vibration is reduced or stopped. The cold provocation test was more sensitive than the Taylor-Pelmear stage assessments (p<0.05). The test may be of guidance in evaluation preventive measures.

Adolescent↗

Vibration elicited vasoconstrictor reflex in Raynaud's phenomena.

The fingers of seven women with primary Raynaud's phenomenon (PRP), 10 female controls, seven men with vibration induced white finger (VWF), and eight male controls were exposed to vibration and the relative change in finger capillary blood flow was measured by an atraumatic 133xenon washout technique without and during proximal nervous blockade. All four groups showed a vasoconstriction to vibration (p less than or equal to 0.02) which was abolished by proximal nervous blockade. Women with PRP had an augmented response to vibration (p less than 0.01) and men with VWF had a normal response (p greater than 0.10) when compared with that of their respective sex matched controls. The results show the existence of a vibration elicited central sympathetic vasoconstrictor reflex in the normal finger and in fingers affected by PRP and VWF. The results indicate a hyperreactivity of the central sympathetic nervous system in PRP and VWF and a dysfunction of the peripheral sensory nerve fibres in subjects with VWF. The described vibration test may be of guidance in the differentiation of PRP from VWF.

Adult↗

Diagnostic tests in Raynaud's phenomena in workers exposed to vibration: a comparative study.

Four objective tests to evaluate Raynaud's phenomena (RP) in workers exposed to handarm vibrations were applied on 23 exposed men with RP (vibration induced white finger 18, primary Raynaud's phenomenon 5), 56 exposed men without RP, and 15 male controls. Finger systolic blood pressure was measured by a cuff and strain gauge technique after combined body cooling and finger cooling during five minute ischaemia to 30 degrees, 15 degrees, and 6 degrees C. An attack of RP was detected as a zero pressure, FSP(0) test, whereas a pressure, reduced to a value below the normal 95% confidence limit at 6 degrees C, was regarded as an abnormal response, FSP(A) test. A hand cooling, preceded by 30 minute body precooling, was performed in water at 10 degrees C during five minute ischaemia. The finger colours after hand cooling were evaluated by a directly visual inspection, FCV test, and by a blind assessment of slides of the photographed hand, FCS test. A medical interview was used as a method of reference. The sensitivity did not differ significantly between FSP(0) (74%), FCS (61%), and FCV (57%) (p greater than 0.10). FSP(A) had a significantly higher sensitivity (96%) and lower specificity (64%) than those of FCV and FCS (p less than 0.0005) and of FSP(0) (p less than 0.05). Six of the seven men with a false positive FSP(0) had a positive FCV or FCS, and the seventh had a history of previously active RP. The six false negative FSP(0) test results did not correspond significantly to milder cases of RP (p greater than 0.20). The results indicate that a finger colour test may be as valuable as a FSP(0) test for diagnostic purposes. FSP(A) only indicates if a cold response is exaggerated and does not diagnose RP. The pressure measurements may further be of guidance in evaluating preventive measures and effects of treatments for RP.

Adult↗

Exaggerated postural vasoconstrictor reflex in Raynaud's phenomenon.

The central and local regulation of capillary blood flow in the finger was studied by the local xenon-133 washout technique in women with primary Raynaud's phenomenon, men with vibration induced white finger, and their respective sex matched controls. The vasoconstrictor response to venous stasis of 40 mm Hg elicited by local reflex was normal in both types of Raynaud's phenomenon. Change in posture from lying to sitting induced vasoconstriction in all groups, which was abolished by proximal nervous blockade. The vasoconstrictor response to sitting was augmented in both groups of subjects with Raynaud's phenomenon compared with their sex matched controls. These results show the existence of central and local postural vasoconstrictor reflexes in normal fingers. In both types of Raynaud's phenomenon there was hyperreactivity of the central sympathetic nervous system to orthostatic stress and normal function of digital arterioles and postganglionic sympathetic nerve fibres.

Adult↗