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  • 51.
    Kimme, Peter
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Anestesiologi med intensivvård. Linköpings universitet, Hälsouniversitetet.
    Gustafsson, U.
    Linköpings universitet, Hälsouniversitetet.
    Sollev, A.
    Department of Anaesthesiology, Karolinska Hospital, Stockholm, Sweden.
    Nilsson, G.
    Department of Biomedical Engineering, Linköping University, Sweden.
    Sjöberg, Folke
    Linköpings universitet, Institutionen för medicin och hälsa, Anestesiologi med intensivvård. Linköpings universitet, Institutionen för biomedicin och kirurgi, Hand och plastikkirurgi. Linköpings universitet, Hälsouniversitetet.
    Cerebral blood flow of the exposed brain surface measured by laser Doppler perfusion imaging1997Inngår i: Acta Physiologica Scandinavica, ISSN 0001-6772, E-ISSN 1365-201X, Vol. 159, nr 1, s. 15-22Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    A novel application of laser Doppler flowmetry (LDF), laser Doppler perfusion imaging (LDPI), was used to study cerebral cortical blood flow (CBFcortex). In contrast to the conventional laser Doppler perfusion monitor, LDPI creates two-dimensional maps of the tissue perfusion in a well defined area of up to 120×120 mm comprising 4096 measurement points. Measurements of CBFcortex were made through an optically transparent polyester film applied to a cranial window preparation in ventilated anaesthetized pigs. Temporal and spatial heterogeneity in CBFcortex were visualized by LDPI during provocations which are known to alter CBF (varying arterial PCO2 or MABP, or infusion of adenosine at constant MABP (concomitant angiotensin administration) or by hyperoxemia). During hypercapnia the recorded CBFcortex increased homogeneously. The adenosine-mediated increase in recorded CBFcortex was concentrated on the lower flow interval, as was the hyperoxemia-caused decline. At decreasing MABP the autoregulatory threshold was found to vary locally within the cortex. The results suggest that LDPI, apart from detecting localized changes in CBFcortex, also visualizes flow changes within different vascular segments. Together with the practical advantages of the system, i.e. not necessitating direct contact with the tissues, this feature makes the technique suitable for studies of CBFcortex distributions.

  • 52.
    Kimme, Peter
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Anestesiologi med intensivvård. Linköpings universitet, Hälsouniversitetet.
    Ledin, Torbjörn
    Linköpings universitet, Institutionen för nervsystem och rörelseorgan, Oto-Rhino-Laryngologi. Linköpings universitet, Hälsouniversitetet.
    Sjöberg, Folke
    Linköpings universitet, Institutionen för medicin och hälsa, Anestesiologi med intensivvård. Linköpings universitet, Institutionen för biomedicin och kirurgi, Hand och plastikkirurgi. Linköpings universitet, Hälsouniversitetet.
    Cortical blood flow autoregulation revisited using laser Doppler perfusion imaging2002Inngår i: Acta Physiologica Scandinavica, ISSN 0001-6772, E-ISSN 1365-201X, Vol. 176, nr 4, s. 255-262Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Methods of laser Doppler perfusion monitoring (LDPM) and imaging (LDPI) have been validated and found useful for measurements of brain blood flow in several studies. The present work was undertaken to examine the cortical blood flow autoregulatory phenomenon as it has lately been questioned and claimed to be method-dependent and related to sample volume. Spatial variations in cerebral cortical blood flow (CBFcortex) in the pressure range 20–140 mmHg (static cerebral autoregulation; caval block/angiotensin infusion) were studied in six mechanically ventilated (hypocapnic, normocapnic and hypercapnic) pigs anaesthetized with propofol and fentanyl. Although the cortical blood flow values sampled were highly heterogeneously distributed, they were strongly pressure-dependent as well as CO2-dependent (P < 0.001). A cumulative cerebral blood flow (CBF)–pressure (MAP) plot comprising all values obtained indicated a pressure range between 70 and 120 mmHg where CBF remained almost constant. However, at the local level in the cortex (mm2) the same type of ‘classic’ autoregulatory flow : pressure graphs (FPG) were found in only a few of the cases of the cortical areas examined (n = 96). Alterations in blood PaCO2 saturation did not affect the pressure : flow relationship at low perfusion pressures, whereas at normal or above normal values, and as anticipated, hypercapnia considerably increased CBF (P < 0.001). ‘Classic’ autoregulatory FPGs were found only when all values sampled were clustered together, whereas, as a new finding, data are presented indicating that autoregulatory capacity is lacking at the local level at some cortical surface areas.

  • 53.
    Kimme, Peter
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Anestesiologi med intensivvård. Linköpings universitet, Hälsouniversitetet.
    Ledin, Torbjörn
    Linköpings universitet, Institutionen för nervsystem och rörelseorgan, Oto-Rhino-Laryngologi. Linköpings universitet, Hälsouniversitetet.
    Sjöberg, Folke
    Linköpings universitet, Institutionen för biomedicin och kirurgi, Hand och plastikkirurgi. Linköpings universitet, Hälsouniversitetet.
    Dose effect of sevoflurane and isoflurane anesthetics on cortical blood flow during controlled hypotension in the pig2007Inngår i: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 51, nr 5, s. 607-613Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background:  The ability of the brain to preserve adequate cerebral blood flow (CBF) during alterations in systemic perfusion pressure is of fundamental importance. At increasing concentrations, isoflurane and sevoflurane have been known to alter CBF, which may be disadvantageous for patients with increased intracranial pressure. The aim was to examine the effects of isoflurane and sevoflurane at increasing minimum alveolar concentrations (MAC) on CBF, during controlled hypotension.

    Methods:  We studied eight pigs during variations in perfusion pressure induced by caval block (100, 60, 50, and 40 mmHg) under normocapnia. CBF was measured locally in a defined area (4 × 5 measurement points covering 1 cm2) of the motor cortex using laser Doppler perfusion imaging. Physiological variables, assessed by analysis of arterial O2 and CO2, hemoglobin and hematocrit, were controlled. CBF was measured during propofol (10 mg × kg−1× h−1) and fentanyl (0.002 mg × kg−1× h−1) anesthesia, and then during anesthesia with either isoflurane or sevoflurane (given in random order) at increasing MAC (0.3–1.2). After a washout period, the measurements were repeated with the other gas.

    Results:  CBF was significantly higher in the cortex during normotensive (control) settings, MAP ∼100 mmHg, compared with during hypotension (MAP 40–60 mmHg). Neither different anesthetic nor MAC or local measurement sites were found to influence CBF at any perfusion pressure.

    Conclusion:  In this experimental model, the effect of hypotension on CBF was not altered by the anesthetics used [isoflurane, sevoflurane (MAC 0.3–1.2) or propofol (10 mg × kg−1× h−1)]. In this aspect (cortical tissue perspective), these volatile agents appear as suitable as propofol for neurosurgical anesthesia for patients at risk.

  • 54.
    Kratz, Gunnar
    et al.
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för biomedicin och kirurgi, Hand och plastikkirurgi. Östergötlands Läns Landsting, Rekonstruktionscentrum, Hand- och plastikkirurgiska kliniken US.
    Huss, Fredrik
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för biomedicin och kirurgi, Hand och plastikkirurgi. Östergötlands Läns Landsting, Rekonstruktionscentrum, Hand- och plastikkirurgiska kliniken US.
    Tissue engineering - body parts from the Petri dish2003Inngår i: Scandinavian Journal of Surgery, ISSN 1457-4969, E-ISSN 1799-7267, Vol. 92, s. 241-247Artikkel i tidsskrift (Fagfellevurdert)
  • 55. Kuo, Yur-Ren
    et al.
    Kuo, Mei-Hui
    Chou, Wen-Chieh
    Liu, Yi-Tien
    Lutz, Barbara
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för biomedicin och kirurgi, Hand och plastikkirurgi.
    Jeng, Seng-Feng
    One-stage reconstruction of soft tissue and achilles tendon defects using a composite free anterolateral thigh flap with vascularized fascia lata: Clinical experience and functional assessment2003Inngår i: Annals of Plastic Surgery, ISSN 0148-7043, E-ISSN 1536-3708, Vol. 50, s. 149-155Artikkel i tidsskrift (Fagfellevurdert)
  • 56.
    Lidman, Disa
    et al.
    Linköpings universitet, Institutionen för biomedicin och kirurgi, Hand och plastikkirurgi. Linköpings universitet, Hälsouniversitetet.
    Danielsson, Pär
    Linköpings universitet, Institutionen för biomedicin och kirurgi, Hand och plastikkirurgi. Linköpings universitet, Hälsouniversitetet.
    Abdiu, Avni
    Linköpings universitet, Institutionen för biomedicin och kirurgi, Hand och plastikkirurgi. Linköpings universitet, Hälsouniversitetet.
    Fåhraeus, Bengt
    Linköpings universitet, Institutionen för biomedicin och kirurgi, Urologi. Linköpings universitet, Hälsouniversitetet.
    The functional result two years after a microsurgical penile replantation1999Inngår i: Scandinavian Journal of Plastic and Reconstructive Surgery and Hand Surgery, ISSN 2000-656X, E-ISSN 2000-6764, Vol. 33, nr 3, s. 325-328Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    We describe the technique of microsurgical penile replantation and a case followed up after two years. The patient was a young man with decompensated schizophrenia who emasculated himself with a kitchen knife. A particularly good functional result was achieved including restoration of sensation in the penile shaft and in the glans, and return of erectile capacity.

  • 57.
    Lindgren, Margareta
    et al.
    Linköpings universitet, Institutionen för medicin och vård, Omvårdnad. Linköpings universitet, Hälsouniversitetet.
    Malmqvist, Lars-Åke
    Linköpings universitet, Institutionen för medicin och vård, Omvårdnad. Linköpings universitet, Hälsouniversitetet.
    Sjöberg, Folke
    Linköpings universitet, Institutionen för biomedicin och kirurgi, Hand och plastikkirurgi. Linköpings universitet, Institutionen för medicin och hälsa, Anestesiologi med intensivvård. Linköpings universitet, Hälsouniversitetet.
    Ek, Anna-Christina
    Linköpings universitet, Institutionen för medicin och vård, Omvårdnad. Linköpings universitet, Hälsouniversitetet.
    Altered skin blood perfusion in areas with non blanchable erythema: an explorative study2006Inngår i: International Wound Journal, ISSN 1742-4801, E-ISSN 1742-481X, Vol. 3, nr 3, s. 215-223Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Non blanchable erythema, i.e. stage I pressure ulcer, is common in patients in acute and geriatric care and in nursing homes. Research has shown that this type of lesions is prone to develop into more severe pressure ulcers. The peripheral skin blood perfusion is of major importance for the development of pressure ulcers. The aim of this study was to explore the peripheral skin blood perfusion over time, in areas with non blanchable erythema and in corresponding undamaged areas on the opposite side of the body. A total of 19 measurements were performed, over time, using a laser Doppler perfusion imager. The blood flow distribution profiles over areas with non blanchable erythema and undamaged skin were found to be different. As the area of the non blanchable erythema decreased, the blood perfusion distribution profiles gradually became more heterogeneous; an area of high blood perfusion in the centre of the lesions was seen and the perfusion successively decreased closer to the edge. These results indicate that there are differences in blood perfusion between skin areas of non blanchable erythema and undamaged skin. The results also indicate that the visible redness in areas with non blanchable erythema is related to altered blood perfusion. The skin blood perfusion also seems to increase in relation to the size of the non blanchable erythema.

  • 58.
    Lindén, Maria
    et al.
    Linköpings universitet, Institutionen för medicinsk teknik. Linköpings universitet, Hälsouniversitetet.
    Golster, Helena
    Linköpings universitet, Institutionen för biomedicin och kirurgi, Hand och plastikkirurgi. Linköpings universitet, Institutionen för medicin och hälsa, Anestesiologi med intensivvård. Linköpings universitet, Hälsouniversitetet.
    Bertuglia, Silvia
    CNR Institute of Clinical Physiology, Via Trieste, Pisa, Italy.
    Colantuoni, Antonio
    CNR Institute of Clinical Physiology, Via Trieste, Pisa, Italy.
    Sjöberg, Folke
    Linköpings universitet, Institutionen för biomedicin och kirurgi, Hand och plastikkirurgi. Linköpings universitet, Institutionen för medicin och hälsa, Anestesiologi med intensivvård. Linköpings universitet, Hälsouniversitetet.
    Nilsson, Gert
    Linköpings universitet, Institutionen för medicinsk teknik. Linköpings universitet, Hälsouniversitetet.
    Evaluation of Enhanced High-Resolution Laser Doppler Imaging in an in Vitro Tube Model with the Aim of Assessing Blood Flow in Separate Microvessels1998Inngår i: Microvascular Research, ISSN 0026-2862, E-ISSN 1095-9319, Vol. 56, nr 3, s. 261-270Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    An enhanced high-resolution laser Doppler imaging (EHR-LDI) technique intended for visualization of separate microvessels was evaluated by use ofin vitroflow models. In EHR-LDI, a laser beam focused to a half-power diameter less than 40 μm successively scans the tissue under study in steps of 25 μm. Spatial blood flow variations within microvascular structures of 1.5 × 1.5 mm are rendered by 64 × 64 measurement sites. Individual microvessel diameters could be estimated and an average difference of 11 μm compared to microscopic measurements was obtained. For the flow algorithm used, the LDI output signal was found to scale linearly with average velocity (0–3.5 mm/s) when a plastic tube of inner diameter 175 μm was perfused with human blood (correlation coefficient 0.99). The LDI output signal was further found insensitive to hematocrit variations in the range 16–44%. Due to the limited laser light penetration in blood, a reduction in the LDI output signal was observed as the inner tube diameters were successively changed from 280 to 1400 μm.

  • 59.
    Lutz, Barbara
    Linköpings universitet, Institutionen för biomedicin och kirurgi, Hand och plastikkirurgi. Linköpings universitet, Hälsouniversitetet.
    Repair of divided peripheral nerves: experimental studies in rabbit and rat2004Doktoravhandling, med artikler (Annet vitenskapelig)
    Abstract [en]

    The general aim of this thesis was to provide new knowledge, through experimental studies, that may contribute to an improvement of the results after microsurgical peripheral nerve repair in patients.

    An adequate function of the human body depends, among other things, on a correctly functioning peripheral nervous system. Peripheral nerve injuries may impair the motor and sensory function of muscles, the proprioceptive joint control, the cutaneous sensibility, and the autonomic control of the skin, which can result in severe dysfunction of e.g. an extremity. The worst grade- of nerve injury is the division of an entire nerve. In the ideal case, the divided nerve can be sutured so that the distal and proximal nerve stumps are brought together. When peripheral nerve tissue has been lost at the site of injury, a direct repair is not possible. In such cases, the use of nerve grafts to bridge the defect, and/or suture of the distal nerve stump to an entirely different donor nerve is necessary to restore some function. Both types of such nerve repair, however, produce new sequelae due to loss of function of the nerves used for repair. To avoid such donor nerve morbidity, two different types of repair, end-to-end coaptation to part of a healthy donor nerve and end-to- side neurorrhaphy were investigated experimentally.

    Neurotomy studies in the rabbit showed that use of 1/3 of a donor nerve (ulnar nerve) for reinnervation of an agonistic recipient nerve (median nerve) results in a useful muscle function with negligible donor nerve morbidity.

    In the rat, end-to-side neurorrhaphy of a recipient nerve (median nerve) to an agonistic donor nerve (ulnar nerve) turned out to give a useful muscle function without causing donor nerve morbidity. After end-to-side neurorrhaphy, reinnervation of the recipient nerve stump was executed by collateral sprouting from intact donor nerve axons. The regeneration of sensory axons was numerically superior to the regeneration of motor axons. Altogether, however, good results after end-to-side neurorrhaphy are not predictable.

    Both types of nerve repair (end-to-side neurorrhaphy and partial end-to-end neurorrhaphy) give better results with respect to reinnervation of a nerve to a simple muscle target than with respect to reinnervation of a nerve to a complex muscle target.

    In the ideal situation, after conventional end-to-end nerve suture, nerve repair results in an axonal regeneration that restores muscle function as well as cutaneous sensibility and autonomous function. However, a completely normal function is usually not achieved due to e.g. aberrant axonal regeneration that results in a nerve-target mismatch. One of the causes for aberrant regeneration is axonal criss-crossing between fascicles in adjacency. Hence, barriers of different materials were tested in the rat to see if interfascicular axonal criss-crossing can be counteracted.

    Three materials - a pedicle fat flap, Integra®, and non-vascularized autologous fasciawere used as barriers between the peroneal and the tibial fascicles in rats. The results showed that all three barriers improved axonal alignment after sciatic nerve transection and fascicular end-to-end repair. The pedicle fat flap was the most valuable barrier.

    Finally, coaptation of the divided rat sciatic nerve with the aid of couplers, normally used for microvascular anastomoses, was evaluated as a method to hinder erratic centrifugal axon growth. The results showed that couplers provided a secluded coaptation site avoiding aberrant axonal sprouting to the surroundings. However, a minor nerve compression was evident.

    Altogether, these results show that the microsurgical repair of nerve transections can be improved a bit further. However, the future developments in this area are likely to occur at the molecular level.

    Delarbeid
    1. Nerve transfer to the median nerve using parts of the ulnar and radial nerves in the rabbit: effects on motor recovery of the median nerve and donor nerve morbidity
    Åpne denne publikasjonen i ny fane eller vindu >>Nerve transfer to the median nerve using parts of the ulnar and radial nerves in the rabbit: effects on motor recovery of the median nerve and donor nerve morbidity
    Vise andre…
    2000 (engelsk)Inngår i: Journal of Hand Surgery - British and European Volume, ISSN 0266-7681, E-ISSN 1532-2211, Vol. 25, nr 4, s. 329-335Artikkel i tidsskrift (Fagfellevurdert) Published
    Abstract [en]

    In this study, motor re-innervation of the median nerve by transfer of one-third, one-half, and two-thirds of either the agonistic ulnar nerve or the antagonistic radial nerve was investigated in both extremities of 20 rabbits.

    Recipient median nerve: Muscle contraction force of the flexor digitorum sublimus muscle after a one-third and a one-half of the ulnar nerve transfer achieved an average of 75 and 97% muscle power respectively as compared to conventional end-to-end neurorrhaphy. Muscle contraction force after one-third or one-half of the radial nerve transfer was significantly lower (36%).

    Donor nerves: Extensor carpi radialis muscle or flexor carpi ulnaris muscle contraction force 6 months postoperatively demonstrated a significant decrease after a one-half ulnar nerve and a two-thirds ulnar or radial nerve transfer, but not after a one-third transfer of either radial or ulnar nerves.

    Histologically, the number of axons in the re-innervated median nerve and both donor nerves distal to the coaptation site seemed to follow variable patterns.

    It was concluded that in the rabbit use of one-third of the agonistic ulnar nerve for re-innervation of the median nerve results in useful motor recovery with negligible donor site morbidity. Clinically, this technique may offer an alternative option for proximal nerve injuries or for free functioning muscle transplantations.

    HSV kategori
    Identifikatorer
    urn:nbn:se:liu:diva-84781 (URN)10.1054/jhsb.2000.0389 (DOI)
    Tilgjengelig fra: 2012-10-22 Laget: 2012-10-22 Sist oppdatert: 2017-12-07bibliografisk kontrollert
    2. Selection of donor nerves: an important factor in end-to-side neurorrhaphy
    Åpne denne publikasjonen i ny fane eller vindu >>Selection of donor nerves: an important factor in end-to-side neurorrhaphy
    Vise andre…
    2000 (engelsk)Inngår i: British Journal of Plastic Surgery, ISSN 0007-1226, E-ISSN 1465-3087, Vol. 53, nr 2, s. 149-154Artikkel i tidsskrift (Fagfellevurdert) Published
    Abstract [en]

    We have examined the effects of end-to-side neurorrhaphy on peripheral nerve regeneration usingthe median nerve as recipient nerve and either the antagonistic radial nerve or the agonistic ulnar nerve as donor nerves in rat upper limbs. A perineural window was created in all cases. Motor recovery up to 16 weeks postoperation was tested with the grasping test. No recovery of motor function was evident after end-to-side neurorrhaphy of the median nerve to the antagonistic radial nerve, whereas six of eight rats with end-to-side neurorrhaphy to the agonistic ulnar nerve achieved 367 g±47 g grasping power as compared to 526 g±6 g in end-to-end coapted control animals. No significant difference in flexor digitorum sublimus-motor nerve conduction velocity was found among all three groups. Radial nerve stimulation produced simultaneous contraction of both extensor and flexor muscles of the lower arm that disabled any coordinated movement of the paw. Histology (toluidine blue, acetylcholinesterase-stain) showed multiple regenerated (motor)-axons distal to the coaptation site in the median nerve. Reinnervation of the median nerve solely by the respective donor nerve was demonstrated by a retrograde double labelling technique. These results show that averaged 70% muscle power as compared to end-to-end neurorrhaphy with well coordinated muscle function can be achieved by axonal sprouting through end-to-side neurorrhaphy if an agonistic nerve is used as donor nerve. However, satisfying results are unpredictable. Antagonistic nerves show the ability to induce axonal regeneration, but no useful function can be expected.

    HSV kategori
    Identifikatorer
    urn:nbn:se:liu:diva-84782 (URN)10.1054/bjps.1999.3252 (DOI)
    Tilgjengelig fra: 2012-10-22 Laget: 2012-10-22 Sist oppdatert: 2017-12-07bibliografisk kontrollert
    3. Role of the target in end-to-side neurorrhaphy: reinnervation of a single muscle vs. multiple muscles
    Åpne denne publikasjonen i ny fane eller vindu >>Role of the target in end-to-side neurorrhaphy: reinnervation of a single muscle vs. multiple muscles
    2000 (engelsk)Inngår i: Journal of reconstructive microsurgery, ISSN 0743-684X, E-ISSN 1098-8947, Vol. 16, nr 6, s. 443-448Artikkel i tidsskrift (Fagfellevurdert) Published
    Abstract [en]

    The authors examined the effects of end-to-side neurorrhaphy for reinnervation of the musculocutaneous nerve (Group A) which innervates the biceps muscle, compared to reinnervation of the median nerve which innervates multiple muscles in a rat model. Additionally, end-to-end neurorrhaphy to the musculocutaneous nerve using one-third of the median nerve (Group B) was investigated. End-to-end coaptation of the musculocutaneous nerve served as a control (Group C). In a grooming test, the biceps muscle function in Group A animals demonstrated a slower but nearly similar good recovery to Groups B and C. Biceps muscle contraction force investigated after 24 weeks demonstrated no statistically significant differences among all groups. In Groups A and B, no significant impairment of the donor median nerve function was found in a grasping test and the muscle contraction force of the flexor carpi radialis muscle, and histologic evaluation of the musculocutaneous nerve showed multiple regenerated axons distal to the coaptation site. Retrograde double-labeling in Group A animals showed reinnervation of the musculocutaneous nerve by median nerve axons located at the coaptation site. These results validate that end-to-side neurorrhaphy to a nerve innervating a single muscle is more efficient than to a nerve innervating multiple muscles, as demonstrated in an earlier study. The reason for this phenomenon is most likely that all sprouting axons are directed toward one target rather than toward multiple targets, with the latter situation resulting in a smaller number of axons and a variable distribution of axons per target. Since donor nerve sprouting axons were observed at the coaptation site, a relevance of the selected site for end-to-side neurorrhaphy is suggested. Both end-to-side neurorrhaphy and end-to-end neurorrhaphy, using one-third of the median nerve, led to useful functional recovery in this rat model, if an agonistic donor nerve is employed.

    HSV kategori
    Identifikatorer
    urn:nbn:se:liu:diva-84783 (URN)10.1055/s-2006-947151 (DOI)10993090 (PubMedID)
    Tilgjengelig fra: 2012-10-22 Laget: 2012-10-22 Sist oppdatert: 2017-12-07bibliografisk kontrollert
    4. Interposition of a pedicle fat flap significantly improves specificity of reinnervation and motor recovery after repair of transected nerves in adjacency in rats
    Åpne denne publikasjonen i ny fane eller vindu >>Interposition of a pedicle fat flap significantly improves specificity of reinnervation and motor recovery after repair of transected nerves in adjacency in rats
    Vise andre…
    2001 (engelsk)Inngår i: Plastic and reconstructive surgery (1963), ISSN 0032-1052, E-ISSN 1529-4242, Vol. 107, nr 1, s. 116-123Artikkel i tidsskrift (Fagfellevurdert) Published
    Abstract [en]

    Despite highest standards in nerve repair, functional recovery following nerve transection still remains unsatisfactory. Nonspecific reinnervation of target organs caused by misdirected axonal growth at the repair site is regarded as one reason for a poor functional outcome. This study was conducted to establish a method for preventing aberrant reinnervation between transected and repaired nerves in adjacency.

    Rat sciatic nerve was transected and repaired as follows: epineural sutures of the sciatic nerve (group A, n = 6), fascicular repair of tibial and peroneal nerves respectively (group B, n = 8), and, as in group B, separating both nerves using a pedicle fat flap as barrier (group C, n = 8). As control only, the tibial nerve was transected and repaired (group D, n = 5).

    Muscle contraction force of the gastrocnemius muscle was significantly higher in group C as compared with groups A and B after 4 months. Muscle weight showed significantly lower values in group A as compared with groups B, C, and D. Histologic examination in group C revealed little growth of axons from the tibial to the peroneal nerve and vice versa. This axon crossing was observed only when gaps between the fat cells were available. These findings were confirmed by a significantly lower rate of misdirected axonal growth as compared with groups A and B using sequential retrograde double labeling technique of the soleus motoneuron pool.

    We conclude that a pedicle fat flap significantly prevents aberrant reinnervation between repaired adjacent nerves resulting in significantly improved motor recovery in rats. Clinically, this is of importance for brachial plexus, sciatic nerve, and facial nerve repair.

    HSV kategori
    Identifikatorer
    urn:nbn:se:liu:diva-84788 (URN)11176609 (PubMedID)
    Tilgjengelig fra: 2012-10-22 Laget: 2012-10-22 Sist oppdatert: 2017-12-07bibliografisk kontrollert
    5. Specificity of reinnervation and motor recovery after interposition of an artificial barrier between transected and repaired nerves in adjacency: an experimental study in the rat
    Åpne denne publikasjonen i ny fane eller vindu >>Specificity of reinnervation and motor recovery after interposition of an artificial barrier between transected and repaired nerves in adjacency: an experimental study in the rat
    Vise andre…
    2001 (engelsk)Inngår i: Acta Neurochirurgica, ISSN 0001-6268, E-ISSN 0942-0940, Vol. 143, nr 4, s. 393-399Artikkel i tidsskrift (Fagfellevurdert) Published
    Abstract [en]

    Non-specific re-innervation of target organs caused by misdirected axonal growth at the repair site is regarded as one reason for a poor functional outcome after peripheral nerve transsection and repair. This study investigates the rate of aberrant re-innervation and its influence on motor recovery in the rat sciatic nerve using artificial sheets as barrier between tibial and peroneal nerves.

    The sciatic nerve was transsected and repaired as follows: epineural sutures (A × 6), fascicular repair of tibial and peroneal nerves respectively (B × 8), and the same as in group B, but separating both nerves using an Integra®-sheet with silicone (C × 8), or Integra® without silicone (D × 8). As control, solely the tibial nerve was transsected and repaired (E × 5).

    Final investigations after 4 months revealed that in group C, 50% of the Integra®-silicone sheets were dislocated. No dislocation was found in group D. Muscle contraction force of the gastrocnemius muscle was significantly higher in group E as compared to all other groups. However although not significant, group D showed a consistently higher muscle contraction force than groups A, B, and C. Histology in groups A, B, and C with dislocated sheets demonstrated multiple axons growing from the tibial to the peroneal nerve and vice versa. In groups D and E, no such axonal growth was visible. These findings were confirmed by a significantly higher rate of specific re-innervation of the soleus muscle using sequential retrograde double labelling technique.

    Results of this study suggest that an artificial sheet such as Integra® bears the potential of preventing aberrant re-innervation between repaired adjacent nerves resulting in improved motor recovery. Clinically, this technique may be of importance for brachial plexus, sciatic nerve, and facial nerve repair.

    HSV kategori
    Identifikatorer
    urn:nbn:se:liu:diva-25220 (URN)10.1007/s007010170095 (DOI)9659 (Lokal ID)9659 (Arkivnummer)9659 (OAI)
    Tilgjengelig fra: 2009-10-07 Laget: 2009-10-07 Sist oppdatert: 2017-12-13bibliografisk kontrollert
    6. Structural and functional regeneration of muscle-related axons after transection and repair of the rat sciatic nerve using nonvascularized autologous fascia as a barrier between tibial and peroneal nerve fascicles
    Åpne denne publikasjonen i ny fane eller vindu >>Structural and functional regeneration of muscle-related axons after transection and repair of the rat sciatic nerve using nonvascularized autologous fascia as a barrier between tibial and peroneal nerve fascicles
    2004 (engelsk)Inngår i: Journal of reconstructive microsurgery, ISSN 0743-684X, E-ISSN 1098-8947, Vol. 20, nr 8, s. 637-644Artikkel i tidsskrift (Fagfellevurdert) Published
    Abstract [en]

    Aberrant reinnervation of target organs caused by misdirected axonal growth at the repair site is a major reason for the poor functional outcome usually seen after peripheral nerve transection and repair. This study investigates whether the criss-crossing of regenerating rat sciatic nerve axons between tibial and peroneal nerve fascicles can be reduced by using non-vascularized autologous fascia as a barrier.

    The left sciatic nerve was transected and repaired at midthigh as follows: epineurialy sutures (Group A); fascicular repair of tibial and peroneal nerve fascicles (Group B); fascicular repair of tibial and peroneal nerve fascicles separating the two fascicles by non-vascularized autologous fascia (Group C). In the control Group D, only the left tibial fascicle was transected and repaired. Five months postoperatively, the outcome of regeneration was evaluated by histology, by retrograde tracing, and by assessment of the contraction force of the gastrocnemius and tibial anterior muscles. The tracing experiments showed that muscle reinnervation was less abnormal in Group C than in Groups A and B. However, muscle contraction force was not better in Group C than in Groups A and B. With respect to the peroneal nerve innervated muscle, the contraction force in Group C was significantly lower than in Group B. The histologic picture indicated that this inferior result in Group C was due to nerve compression caused by fibrotic scar tissue at the site of the fascia graft.

    Results of this study show that a non-vascularized autologous fascial graft used as a barrier between two sutured nerve fascicles in adjacency reduces criss-crossing of regenerating axons between the fascicles, but causes significant nerve compression.

    HSV kategori
    Identifikatorer
    urn:nbn:se:liu:diva-24436 (URN)10.1055/s-2004-861524 (DOI)6543 (Lokal ID)6543 (Arkivnummer)6543 (OAI)
    Tilgjengelig fra: 2009-10-07 Laget: 2009-10-07 Sist oppdatert: 2017-12-13bibliografisk kontrollert
  • 60.
    Lutz, Barbara S.
    et al.
    Linköpings universitet, Institutionen för biomedicin och kirurgi, Hand och plastikkirurgi. Linköpings universitet, Hälsouniversitetet.
    Ma, S.-F.
    Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, College of Medicine & Chang Gung University, Taipei, Taiwan, R.O.C..
    Chuang, D. C. C
    Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, College of Medicine & Chang Gung University, Taipei, Taiwan, R.O.C..
    Lidman, Disa
    Linköpings universitet, Institutionen för biomedicin och kirurgi, Hand och plastikkirurgi. Linköpings universitet, Hälsouniversitetet.
    Wei, F.-Ch.
    Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, College of Medicine & Chang Gung University, Taipei, Taiwan, R.O.C..
    Specificity of reinnervation and motor recovery after interposition of an artificial barrier between transected and repaired nerves in adjacency: an experimental study in the rat2001Inngår i: Acta Neurochirurgica, ISSN 0001-6268, E-ISSN 0942-0940, Vol. 143, nr 4, s. 393-399Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Non-specific re-innervation of target organs caused by misdirected axonal growth at the repair site is regarded as one reason for a poor functional outcome after peripheral nerve transsection and repair. This study investigates the rate of aberrant re-innervation and its influence on motor recovery in the rat sciatic nerve using artificial sheets as barrier between tibial and peroneal nerves.

    The sciatic nerve was transsected and repaired as follows: epineural sutures (A × 6), fascicular repair of tibial and peroneal nerves respectively (B × 8), and the same as in group B, but separating both nerves using an Integra®-sheet with silicone (C × 8), or Integra® without silicone (D × 8). As control, solely the tibial nerve was transsected and repaired (E × 5).

    Final investigations after 4 months revealed that in group C, 50% of the Integra®-silicone sheets were dislocated. No dislocation was found in group D. Muscle contraction force of the gastrocnemius muscle was significantly higher in group E as compared to all other groups. However although not significant, group D showed a consistently higher muscle contraction force than groups A, B, and C. Histology in groups A, B, and C with dislocated sheets demonstrated multiple axons growing from the tibial to the peroneal nerve and vice versa. In groups D and E, no such axonal growth was visible. These findings were confirmed by a significantly higher rate of specific re-innervation of the soleus muscle using sequential retrograde double labelling technique.

    Results of this study suggest that an artificial sheet such as Integra® bears the potential of preventing aberrant re-innervation between repaired adjacent nerves resulting in improved motor recovery. Clinically, this technique may be of importance for brachial plexus, sciatic nerve, and facial nerve repair.

  • 61.
    Lutz, Barbara
    et al.
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för biomedicin och kirurgi, Hand och plastikkirurgi.
    Wieslander, Jan B
    Reconstruction with microvascular free flaps by visiting microsurgeons2003Inngår i: Scandinavian Journal of Plastic and Reconstructive Surgery and Hand Surgery, ISSN 2000-656X, E-ISSN 2000-6764, Vol. 37, s. 140-144Artikkel i tidsskrift (Fagfellevurdert)
  • 62.
    Marcusson, Agneta
    Linköpings universitet, Institutionen för biomedicin och kirurgi, Hand och plastikkirurgi. Linköpings universitet, Hälsouniversitetet.
    Adult patients with treated complete cleft lip and palate: Methodological and clinical stndies2001Doktoravhandling, med artikler (Annet vitenskapelig)
    Abstract [en]

    The purpose of the present thesis was to investigate the quality of life, satisfaction with treatment, prevalence of temporomandibular disorders, psychosocial distress, and occlusal stability in a treated group of adults with complete cleft lip and palate (CLP).

    Sixty-eight adults ( 44 men and 24 women) with a mean age of 24.2 years (range 19.5-29.2) with treated CLP were compared with a gender- and agematched group with no clefts. The CLP subjects were born between 1968 and 1977 and had undergone standardised plastic surgery at the Department of Plastic Surgery, University Hospital, Linköping, Sweden. Logopaedic, phoniatric, otological, and orthodontic examinations and treatment had been provided locally, supervised by the Cleft Palate Team.

    The subjects answered a multidimensional, self-report, standardised questionnaire regarding psychological and somatic conditions. The subjects underwent a clinical TMD examination and an evaluation of the occlusion. The reliability of the multidimensional questionnaire was analysed for the CLP group by a test-retest study within a 2-3 week interval and most questions showed an overall good reliability. A panel of professionals judged the outcome of the surgical treatment on colour slides of the CLP subjects. The dental plaster casts of 39 subjects born with complete unilateral cleft lip and palate (UCLP) were analysed (mean age 24.7 years, range 20.2-29.3) and compared with the dental plaster casts taken at mean age of 19.1 years (range 16.0-20.6).

    The overall level of quality of life was rather high in both groups. The CLP group rated some detached aspects, such as life meaning, family life, and private economy, significantly lower than did the group without clefts. Overall aspects such as well-being and social life were affected by having a treated cleft but not the more practical and tangible aspects of their daily living.

    There was an overall high level of satisfaction with all the different part of the body in both groups, but the CLP group reported significantly moredissatisfaction with their nose, lips, mouth, profile, and overall facial appearance than the group without clefts. The professionals and the subjects with CLP were generally not very satisfied with the results of surgical treatment. Thirty of the subjects with CLP (47%) wished to have more operations. The professional group recommended further operations in 38 of the subjects (59%) in particular, rhinoplasties.

    The CLP group had significantly higher frequencies of cross-bite than the group without clefts, but no differences regarding TMD pain were found between the two groups. In the subjects with treated UCLP, there was a significant deterioration in the occlusal score and the maxillary arch dimensions between 19 and 25 years. This was irrespective of the type of retention. The persisting morphological mal occlusion with a low frequency of interferences has had no influence on TMD symptoms in the group of CLP patients studied.

    The conclusion is that the CLP subjects in the present study seemed to be psycho-socially well adjusted to their disability. However, 47 per cent wished to have further surgical treatment. The persisting malocclusions did not provoke TMD symptoms.

    Delarbeid
    1. Reliability of a multidimensional questionnaire for adults with treated complete cleft lip and palate
    Åpne denne publikasjonen i ny fane eller vindu >>Reliability of a multidimensional questionnaire for adults with treated complete cleft lip and palate
    2001 (engelsk)Inngår i: Scandinavian Journal of Plastic and Reconstructive Surgery and Hand Surgery, ISSN 2000-656X, E-ISSN 2000-6764, Vol. 35, nr 3, s. 271-278Artikkel i tidsskrift (Fagfellevurdert) Published
    Abstract [en]

    The purpose of this study was to evaluate the reliability of a multidimensional questionnaire for Swedish adults with treated complete unilateral or bilateral cleft lip and palate (CLP). The questionnaire was designed to be used in the evaluation of adults with treated CLP after treatment. Before any conclusions were drawn from the results of the study we assessed the test-retest reliability of the questionnaire. The questionnaire included 168 questions and assessed the following domains: aesthetics, functions associated with CLP, satisfaction with treatment and perceived need for treatment, quality of life, depression and non-specific physical symptoms, body image, and jaw function. The subjects answered the questionnaire twice at a 2-3-week interval. Sixty-one adults (38 men, 23 women) mean age 24 years (range 20-29) participated in the study. The response rate for the questionnaire was acceptable at 75%. The test-retest reliability varied among the different domains. The reliability of questions regarding aesthetics, functions associated with CLP, and treatment satisfaction was good to excellent (intraclass correlation coefficient (ICC) = 0.51 to 0.89). Good to excellent (ICC = 0.61 to 1.0) reliability was also found for the quality of life in various life domains and the wellbeing scales. The reliability of the body image scale was moderate (kappa = 0.43-0.60) for most items and lower than that of other scales used in this study. The reliability of the mean depression symptom score (ICC = 0.93) and the mean non-specific physical symptoms score (ICC = 0.85) were excellent. The reliability of the mandibular function impairment was good (ICC = 0.67). The conclusion of the study is that an overall reliability was good for the multidimensional questionnaire.

    HSV kategori
    Identifikatorer
    urn:nbn:se:liu:diva-27872 (URN)10.1080/028443101750523177 (DOI)12632 (Lokal ID)12632 (Arkivnummer)12632 (OAI)
    Tilgjengelig fra: 2009-10-08 Laget: 2009-10-08 Sist oppdatert: 2017-12-13bibliografisk kontrollert
    2. Quality of life in adults with repaired complete cleft lip and palate
    Åpne denne publikasjonen i ny fane eller vindu >>Quality of life in adults with repaired complete cleft lip and palate
    2001 (engelsk)Inngår i: The Cleft Palate-Craniofacial Journal, ISSN 1055-6656, E-ISSN 1545-1569, Vol. 38, nr 4, s. 379-385Artikkel i tidsskrift (Fagfellevurdert) Published
    Abstract [en]

    Objective: This study evaluated the quality of life in adult Swedish subjects with repaired complete cleft lip and palate (CLP).

    Design/Patients: Sixty-eight adults with repaired CLP were compared with a group of 66 adults without cleft matched by gender and age.

    Outcome Measures: The outcome measures included a self-report questionnaire concerning quality of life in general, well-being, and health-related quality of life.

    Results: The CLP group rated their quality of life significantly lower than did the control group in the areas of life meaning (p < .05), family life (p < .0001), and private economy (p < .01). There were no significant differences between the groups concerning well-being. In the CLP group, the health-related quality of life was significantly lower concerning global life (p < .0001), disturbance to life (p < .01), well-being (p < .0001), social contacts (p < .0001), and family life (p < .05) but significantly higher concerning ability to make the most of leisure time (p < .001) and to be active (p < .001).

    Conclusions: The CLP group perceived a marked impact of the handicap on their lives concerning global aspects, well-being, and social life. More practical and tangible aspects of their daily living, however, were not affected, and only some minor aspects of their quality of life in general were poor in comparison with the control group, which indicates a fairly good life adjustment in spite of the handicap.

    HSV kategori
    Identifikatorer
    urn:nbn:se:liu:diva-27871 (URN)10.1597/1545-1569(2001)038<0379:QOLIAW>2.0.CO;2 (DOI)12631 (Lokal ID)12631 (Arkivnummer)12631 (OAI)
    Tilgjengelig fra: 2009-10-08 Laget: 2009-10-08 Sist oppdatert: 2017-12-13bibliografisk kontrollert
    3. Facial appearance in adults who had cleft lip and palate treated in childhood
    Åpne denne publikasjonen i ny fane eller vindu >>Facial appearance in adults who had cleft lip and palate treated in childhood
    2002 (engelsk)Inngår i: Scandinavian Journal of Plastic and Reconstructive Surgery and Hand Surgery, ISSN 2000-656X, E-ISSN 2000-6764, Vol. 36, nr 1, s. 16-23Artikkel i tidsskrift (Fagfellevurdert) Published
    Abstract [en]

    Sixty-eight adults (44 men and 24 women) with treated total cleft lip and palate were compared with a group of 66 adults (49 men and 17 women) without clefts, matched by sex and age. The outcome measures included a self-report questionnaire about body image, quality of life in general, health-related quality of life, somatisation, and depression. The group with clefts were also asked if they had further need of treatment. They reported significantly more dissatisfaction with their facial appearance (nose, lips, mouth, profile, and overall facial appearance) than the group without clefts. Satisfaction with facial appearance was significantly correlated with a better quality of life in both groups, and significantly correlated with a better health-related quality of life and a lower grade of somatisation in the group with clefts. Dissatisfaction with facial appearance was the most significant predictor of depression in both groups. A panel of four professionals from a cleft lip and palate treatment team judged the outcome of treatment in 64 of the subjects on colour slides. The professionals and the subjects with clefts were generally not very satisfied with the results of the surgical outcome. Thirty of the subjects with clefts (47%) wished to have more operations. The professional group recommended further operations in 38 of the cases (59%), in particular, rhinoplasties. We conclude that the subjects with treated clefts were not satisfied with their facial appearance, although they seem to be psychosocially well-adjusted to their disability.

    Emneord
    Adults, Cleft lip and palate, Facial appearance, Satisfaction with treatment outcome
    HSV kategori
    Identifikatorer
    urn:nbn:se:liu:diva-47061 (URN)10.1080/028443102753478327 (DOI)
    Tilgjengelig fra: 2009-10-11 Laget: 2009-10-11 Sist oppdatert: 2017-12-13bibliografisk kontrollert
    4. Temporomandibular disorders in adults with repaired cleft lip and palate: a comparison with controls
    Åpne denne publikasjonen i ny fane eller vindu >>Temporomandibular disorders in adults with repaired cleft lip and palate: a comparison with controls
    2001 (engelsk)Inngår i: European Journal of Orthodontics, ISSN 0141-5387, E-ISSN 1460-2210, Vol. 23, nr 2, s. 193-204Artikkel i tidsskrift (Fagfellevurdert) Published
    Abstract [en]

    The purpose of this study was to investigate the prevalence of temporomandibular disorders (TMD), and assess psycho‐social distress in adult subjects with repaired complete cleft lip and palate (CLP). Sixty‐three adults (42 males and 21 females, mean age 24.2 years, range 19.5–29.2) with repaired CLP (CLP group) were compared with a group of 66 adults without cleft (non‐cleft group, 49 males and 17 females, mean age 25.5 years, range 20.2–29.9). All subjects underwent a clinical TMD examination, which followed the guidelines in the Research Diagnostic Criteria for TMD (RDC/TMD). Jaw function was assessed by evaluating answers to the mandibular function impairment questionnaire (MFIQ).

    Tension‐type headache was diagnosed according to the International Headache Society (IHS) classification. Psychological status was assessed using the depression score and the non‐specific physical symptom score with subscales of the Revised Symptom Checklist‐90 (SCL‐90‐R).

    The prevalence of reported pain in the face, jaws and/or TMJs was 14 and 9 per cent for the CLP and non‐cleft group, respectively, and did not differ significantly between the groups. The CLP group exhibited a significantly reduced jaw‐opening pattern (P < 0.001) and a higher frequency of crossbites (P < 0.05) compared with the non‐cleft group. Whilst jaw function was similar in both groups, a few items, e.g. speech and drinking, were significantly more impaired (P < 0.01) in the CLP group than in the non‐cleft group. There were no significant differences between the two groups concerning tension‐type headache or psycho‐social distress.

    The study found that overall TMD pain or psycho‐social distress was not more common in this CLP group than in a non‐cleft group.

    HSV kategori
    Identifikatorer
    urn:nbn:se:liu:diva-27873 (URN)10.1093/ejo/23.2.193 (DOI)12633 (Lokal ID)12633 (Arkivnummer)12633 (OAI)
    Tilgjengelig fra: 2009-10-08 Laget: 2009-10-08 Sist oppdatert: 2017-12-13bibliografisk kontrollert
    5. Alterations in occlusion and maxillary dental arch dimensions in adults with treated unilateral complete cleft lip and palate
    Åpne denne publikasjonen i ny fane eller vindu >>Alterations in occlusion and maxillary dental arch dimensions in adults with treated unilateral complete cleft lip and palate
    (engelsk)Manuskript (preprint) (Annet vitenskapelig)
    Abstract [en]

    The purpose of this stndy was to evaluate the occlusion and maxillary dental arch dimensions in adults with repaired complete unilateral cleft lip and palate (UCLP) and to investigate the patterns of change in early adulthood. Study models from 39 subjects (25 men, 14 women) (mean age 24.7 years, range 20.2-29.3) with the diagnosis complete UCLP taken at a follow-up examination were analysed and compared with the study models taken at baseline examination (mean age 19.1 years, range 16.0-20.6). Lip closure was made according to the Millard technique and palatal closure according to the Wardill-Kilner technique. All subjects had received orthodontic treatment with fixed appliances. The subjects were divided into three groups according to the type of retention in the upper jaw: no retention (n = 15), retention with bonded twisted retainer (n = 13), onlay or fixed bridge (n = 11).

    Occlusion was evaluated according to a scoring system (Huddart and Bodenham, 1972). The maxillary dental arch dimensions were measured with a video imaging system. In the total sample there was a significant deterioration in the total occlusal score during the follow-up period. The impairment was larger on the cleft side than on the non-cleft side. There were no significant differences in the frontal scores. A comparison of the transversal and sagittal maxillary arch dimensions revealed significant differences in all measurements during the follow-up interval. The reduction was largest for the maxillary second premolar width, followed by the first molar width. The oveijet differed significantly between the registrations. The occlusal score and the maxillary arch dimensions were reduced in all of the three subgroups, but there were no differences between the groups. No gender differences were found.

    HSV kategori
    Identifikatorer
    urn:nbn:se:liu:diva-81068 (URN)
    Tilgjengelig fra: 2012-09-06 Laget: 2012-09-06 Sist oppdatert: 2012-09-06bibliografisk kontrollert
  • 63.
    Marcusson, Agneta
    et al.
    Linköpings universitet, Institutionen för nervsystem och rörelseorgan, Käkkliniken. Linköpings universitet, Hälsouniversitetet.
    Paulin, Gunnar
    Linköpings universitet, Institutionen för nervsystem och rörelseorgan, Käkkliniken. Linköpings universitet, Hälsouniversitetet.
    Östrup, Leif
    Linköpings universitet, Institutionen för biomedicin och kirurgi, Hand och plastikkirurgi. Linköpings universitet, Hälsouniversitetet.
    Facial appearance in adults who had cleft lip and palate treated in childhood2002Inngår i: Scandinavian Journal of Plastic and Reconstructive Surgery and Hand Surgery, ISSN 2000-656X, E-ISSN 2000-6764, Vol. 36, nr 1, s. 16-23Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Sixty-eight adults (44 men and 24 women) with treated total cleft lip and palate were compared with a group of 66 adults (49 men and 17 women) without clefts, matched by sex and age. The outcome measures included a self-report questionnaire about body image, quality of life in general, health-related quality of life, somatisation, and depression. The group with clefts were also asked if they had further need of treatment. They reported significantly more dissatisfaction with their facial appearance (nose, lips, mouth, profile, and overall facial appearance) than the group without clefts. Satisfaction with facial appearance was significantly correlated with a better quality of life in both groups, and significantly correlated with a better health-related quality of life and a lower grade of somatisation in the group with clefts. Dissatisfaction with facial appearance was the most significant predictor of depression in both groups. A panel of four professionals from a cleft lip and palate treatment team judged the outcome of treatment in 64 of the subjects on colour slides. The professionals and the subjects with clefts were generally not very satisfied with the results of the surgical outcome. Thirty of the subjects with clefts (47%) wished to have more operations. The professional group recommended further operations in 38 of the cases (59%), in particular, rhinoplasties. We conclude that the subjects with treated clefts were not satisfied with their facial appearance, although they seem to be psychosocially well-adjusted to their disability.

  • 64. Monstein, H-J
    et al.
    Jonsson, Y
    Zdolsek, Johann
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för biomedicin och kirurgi, Hand och plastikkirurgi. Östergötlands Läns Landsting, Rekonstruktionscentrum, Hand- och plastikkirurgiska kliniken US.
    Svanvik, Joar
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för biomedicin och kirurgi, Kirurgi. Östergötlands Läns Landsting, Kirurgi- och onkologicentrum, Kirurgiska kliniken i Östergötland med verksamhet i Linköping, Norrköping och Motala.
    Identification of Helicobacter pylori DNA in human cholesterol gallstones2002Inngår i: Scandinavian Journal of Gastroenterology, ISSN 0036-5521, E-ISSN 1502-7708, Vol. 37, nr 1, s. 112-119Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: The gallbladder mucosa secretes hydrogen ions and is covered by mucus. The environmental conditions for bacterial colonization are similar to those in the stomach. Gallbladder stones often contain DNA from enteric bacteria, but no compelling evidence demonstrates that Helicobacter spp. have been present. The aim of this study was to establish bacterial DNA profiles in cholesterol gallstones with special reference to Helicobacter pylori. Methods: Cholesterol gallstones from 20 patients were subjected to polymerase chain reaction, bacterial profiling by temporal temperature gradient gel electrophoresis, automated DNA sequencing, and Southern blot analysis using a Helicobacter sp. specific primer. A nested ureI-PCR assay was used to discriminate between gastric and non-gastric H. pylori. Results: TTGE, partial 16S rDNA sequencing, and hybridization analysis revealed the presence of DNA presumably representing a mixed bacterial flora in cholesterol gallstones, including H. pylori in the gallstone centres in 11 out of 20 patients. In three cases, the ureI-PCR assay revealed non-gastric H. pylori. Conclusions: These data support the presence of DNA from a mixed bacterial population, including H. pylori in cholesterol gallstones, reflecting either that H. pylori is an indigenous part of a flora in the stone-containing gallbladder or, alternatively, that H. pylori colonization in the biliary tract predisposes to cholesterol gallstone formation.

  • 65.
    Nayeri, Fariba
    et al.
    Linköpings universitet, Institutionen för molekylär och klinisk medicin, Infektionsmedicin. Linköpings universitet, Hälsouniversitetet.
    Xu, Junjang
    Linköpings universitet, Institutionen för molekylär och klinisk medicin, Infektionsmedicin. Linköpings universitet, Hälsouniversitetet.
    Abdiu, Avni
    Linköpings universitet, Institutionen för biomedicin och kirurgi, Hand och plastikkirurgi. Linköpings universitet, Hälsouniversitetet.
    Nayeri, Tayeb
    Linköpings universitet, Institutionen för molekylär och klinisk medicin, Infektionsmedicin. Linköpings universitet, Hälsouniversitetet.
    Aili, Daniel
    Linköpings universitet, Institutionen för fysik, kemi och biologi, Tillämpad Fysik. Linköpings universitet, Tekniska högskolan.
    Liedberg, Bo
    Linköpings universitet, Institutionen för fysik, kemi och biologi, Tillämpad Fysik. Linköpings universitet, Tekniska högskolan.
    Carlsson, Uno
    Linköpings universitet, Institutionen för fysik, kemi och biologi, Kemi. Linköpings universitet, Hälsouniversitetet.
    Autocrine production of biologically active hepatocyte growth factor (HGF) by injured human skin2006Inngår i: Journal of dermatological science (Amsterdam), ISSN 0923-1811, E-ISSN 1873-569X, Vol. 43, nr 1, s. 49-56Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background

    Hepatocyte growth factor (HGF) is a potent regenerative factor involved in wound healing. Previous studies have shown that mesenchymal cells produce HGF, stimulating epithelial cells in a paracrine fashion.

    Objective

    To examine whether autocrine HGF production by keratinocytes can occur upon skin injury.

    Methods

    A 31-year-old male patient sustained a burn affecting 80% of his total body surface area. Biopsies were taken from intact skin near the injured area, and skin keratinocytes were separated and cultured. Conditioned medium from keratinocytes was analyzed for HGF by ELISA, surface plasmon resonance (SPR), and dot blotting. Binding of HGF from conditioned medium to its receptor, c-Met, was compared with recombinant HGF by SPR. Finally, we examined the motogenic effect on mouse transformed skin epithelial cells (CCL-53.1) of HGF from conditioned medium.

    Results

    HGF was detected in the cultured keratinocyte medium. Similar to recombinant HGF, HGF from conditioned medium had a high affinity for dextran sulfate and albumin, and the same epitopes were engaged by the interaction of HGF with the c-Met receptor. The conditioned medium from keratinocytes obtained from the burn patient, but not medium from keratinocytes obtained from healthy volunteers, accelerated the motogenesis of CCL-53.1 cells. Unexpectedly, anti-HGF antibodies did not prevent this effect. However, anti-c-Met antibodies completely inhibited the motogenic effect.

    Conclusion

    Upon injury, human skin keratinocytes might produce biologically active HGF in an autocrine fashion. This HGF might have different structural and/or biological properties from HGF produced by mesenchymal cells.

  • 66. Neovius, Erik
    et al.
    Kratz, Gunnar
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för biomedicin och kirurgi, Hand och plastikkirurgi. Östergötlands Läns Landsting, Rekonstruktionscentrum, Hand- och plastikkirurgiska kliniken US.
    Tissue engineering by cocultivating human elastic chondrocytes and keratinocytes2003Inngår i: Tissue engineering, ISSN 1076-3279, E-ISSN 1557-8690, Vol. 9, s. 365-369Artikkel i tidsskrift (Fagfellevurdert)
  • 67.
    Nettelblad, Hans
    et al.
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för biomedicin och kirurgi, Hand och plastikkirurgi. Östergötlands Läns Landsting, Rekonstruktionscentrum, Hand- och plastikkirurgiska kliniken US.
    Tarpila, Erkki
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för biomedicin och kirurgi, Hand och plastikkirurgi. Östergötlands Läns Landsting, Rekonstruktionscentrum, Hand- och plastikkirurgiska kliniken US.
    Abdominal wall reconstruction with vascularised autologous tissue2003Inngår i: Scandinavian Journal of Surgery, ISSN 1457-4969, E-ISSN 1799-7267, Vol. 92, nr 4, s. 297-300Artikkel i tidsskrift (Fagfellevurdert)
  • 68. Nishiura, Y
    et al.
    Haapaniemi, Tomas
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för biomedicin och kirurgi, Hand och plastikkirurgi. Östergötlands Läns Landsting, Rekonstruktionscentrum, Hand- och plastikkirurgiska kliniken US.
    Dahlin, LB
    Hyperbaric oxygen treatment has different effects on nerve regeneration in acellular nerve and muscle grafts2001Inngår i: Journal of the peripheral nervous system, ISSN 1085-9489, E-ISSN 1529-8027, Vol. 6, nr 2, s. 73-78Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Effects of hyperbaric oxygen treatment (HBO) on nerve regeneration in acellular nerve and muscle grafts were investigated in rats. Nerve and muscle grafts were made acellular by freeze-thawing and the obtained grafts were used to bridge a 10-mm gap in the sciatic nerve on the left and right sides, respectively. Rats were treated with HBO (100% oxygen for 90 minutes at 2.5 atmospheres absolute pressure ATA) twice a day for 7 days. Axonal outgrowth, Schwann cell migration and invasion of macrophages were examined 10 days after the graft procedure by staining neurofilaments, S-100 proteins and the macrophage antibodies ED1 and ED2, respectively. Axonal outgrowth and Schwann cell migration in acellular nerve grafts were superior to that found in the acellular muscle grafts. However, there was no difference between HBO-treated and non-treated rats in acellular nerve grafts. Such a difference was found in acellular muscle grafts concerning both axonal outgrowth and Schwann cell migration from the proximal nerve end. No differences in the content of macrophages or neovascularization (alkaline phosphatase staining) in either of the grafts and treatments were seen. It is concluded that there is a differential effect of HBO-treatment in acellular nerve and muscle grafts and that HBO-treatment has no effect on the regeneration process in acellular nerve grafts, in contrast to fresh cellular nerve grafts where a beneficial effect has previously been reported.

  • 69.
    Nylander, Göran
    et al.
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för biomedicin och kirurgi, Hand och plastikkirurgi. Östergötlands Läns Landsting, Rekonstruktionscentrum, Hand- och plastikkirurgiska kliniken US.
    Carlström, C
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för biomedicin och kirurgi, Hand och plastikkirurgi. Östergötlands Läns Landsting, Rekonstruktionscentrum, Hand- och plastikkirurgiska kliniken US.
    Adolfsson, Lars
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för biomedicin och kirurgi, Hand och plastikkirurgi. Östergötlands Läns Landsting, Rekonstruktionscentrum, Hand- och plastikkirurgiska kliniken US.
    4,5 year follow-up after surgical correction of upper extremity deformities in spastic cerebral palsy.1999Inngår i: Journal of Hand Surgery - British and European Volume, ISSN 0266-7681, E-ISSN 1532-2211, Vol. 24, s. 719-723Artikkel i tidsskrift (Fagfellevurdert)
  • 70.
    Povlsen, B
    et al.
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för biomedicin och kirurgi, Hand och plastikkirurgi. Östergötlands Läns Landsting, Rekonstruktionscentrum, Hand- och plastikkirurgiska kliniken US.
    Sirsjö, A
    Sympathetic block significantly improves reperfusion in skeletal muscle following prolonged use of tourniquet.1999Inngår i: Journal of Hand Surgery - British and European Volume, ISSN 0266-7681, E-ISSN 1532-2211, Vol. 24, s. 738-740Artikkel i tidsskrift (Fagfellevurdert)
  • 71.
    Povlsen, Bo
    Linköpings universitet, Institutionen för biomedicin och kirurgi, Hand och plastikkirurgi. Linköpings universitet, Institutionen för biomedicin och kirurgi, Cellbiologi. Linköpings universitet, Hälsouniversitetet.
    Structural and functional studies on nerve regeneration in the rat1994Doktoravhandling, med artikler (Annet vitenskapelig)
    Abstract [en]

    Peripheral nerves cannot be repaired, but they may be helped to regenerate. The results of surgical treatment of nerve injuries remain disappointing, however. This is a biological rather than a technical challenge. An eventual future achievement of improved results with respect to nerve regeneration demands a better knowledge of the basic biological processes and how to manipulate them.

    The main aim of the present work was to generate knowledge on nerve regeneration, which may be relevant for the understanding of nerve injuries affecting the human hand and for the treatment of these conditions.

    Electron microscopic (EM) analysis of the occurrence of myelinated and unmyelinated axons shows that regeneration is not the same in articular, cutaneous and muscular branches after crush lesions of the mixed rat sciatic nerve or alter neurotomy and suturing. Each branch presents its own specific pattern. In some respects the abnormalities are larger alter the relatively mild crush lesion than after neurotomy. For example, theoccurrence of both sympathetic and sensory C-fibers increases dramaticallyin the articular branch following sciatic crush lesions (but not alter neurotomy), as judged from observations in chemically sympathectomized animals. Hence, the structural postregenerative pattern in one targetspecific nerve or nerve branch cannot be extrapolated from observations on mixed nerves or 8erve branches to other targets.

    EM examination of the normal fiber composition of the foot branch of the superficial peroneal nerve (fSPN) and the lateral plantar nerve (LPN) in the rat revealed that the LPN contains a higher proportion of myelinated axons than the fSPN. Some 25% of the myelinated LPN-axons are motor efferents, but the fSPN lacks such axons. Both nerves show about 60% fewer C-fibers after neonatal capsaicin treatment. Neither nerve contains postganglionic adrenergic sympathetic efferents at the level of the ankle. This data form a basis for experimental studies.

    Three months after crush lesions to the rat sciatic nerve the LPN exhibits elevated numbers of myelinated and unmyelinated axons. In the fSPN the number of myelinated axons is normal and there are fewer C-fibers. Following sciatic neurotomy and suturing the LPN exhibits a more markedly increased number of myeHnated axons and a less markedly decreased number of C-fibers. In the fSPN the number of myelinated axons is increased and the number of C-fibers is slightly decreased. This data show that the outcome of regeneration is different in the LPN and the fSPN after sciatic nerve lesions. The picture in the fSPN is similar to that seen in other nerves to hairy skin.

    Following rat sciatic nerve lesions the regeneration of functionalpolymodal nociceptors (PMNs; as revealed by stimulation-induced Evans blue extravasation) and low threshold mechanoreceptors (L TMs; as revealed by mild mechanical stimulation) is less efficient in LPN-related glabrous skin than in fSPN- or sural nerve-(SN) related hairy skin. In all three cutaneous domains the regeneration of functional PMNs is more complete than the regeneration of functional L TMs. Thus, this experimental model mirrors the clinical experience that some modalities recover better than others after injuries involving hand nerves. Interestingly, the spatial distribution of functional PMNs is also affected on the contralateral, unlesioned side. Therefore, the contralateral side cannot be used as a normal control in extravasation experiments.

    A comparison between axon counts and functional evaluations reveals that the number of regenerated axons in a nerve trunk does not reflect the extent of functional recovery.

    Following repair of divided rat sciatic nerves with fibrin glue (TisseeiDuo ®) the outcome of regeneration in the SN and the LPN differs from the outcome after repair with microsutures with respect to axon numbers, but not with respect to the spatial distribution of functional PMNs and L TMs. Hence, from a functional point of view repair of divided nerves with fibrin glue gives results similar to those seen after suturing.

  • 72.
    Povlsen, Bo
    et al.
    Linköpings universitet, Institutionen för biomedicin och kirurgi, Hand och plastikkirurgi. Linköpings universitet, Institutionen för biomedicin och kirurgi, Cellbiologi. Linköpings universitet, Hälsouniversitetet.
    Hansson, Thomas
    Linköpings universitet, Institutionen för biomedicin och kirurgi, Hand och plastikkirurgi. Linköpings universitet, Hälsouniversitetet.
    Functional evaluation of regenerated and misrouted axons to glabrous and hairy skin of the rat hind foot after sciatic neurotomy and suture1995Inngår i: Experimental Neurology, ISSN 0014-4886, E-ISSN 1090-2430, Vol. 132, nr 1, s. 99-104Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The function of misrouted regenerated polymodal nociceptor C-fibers and low-threshold mechanoreceptive axons in the lateral plantar nerve (LPN) and in the foot branch of the superficial peroneal nerve (fSPN) was evaluated 3 months after unilateral sciatic neurotomy and suture. Two weeks before evaluation the tibial fascicle (or the peroneal fascicle) above the neurotomy was cut and tied off. In this way only functional regeneration of misrouted axons was tested in the LPN (or the fSPN). In regenerated animals the glabrous skin area had no functional fSPN-related low-threshold mechanoreceptive axons. However, the hairy fSPN skin area showed function of misrouted LPN-related low-threshold mechanoreceptive axons. In both the glabrous skin domain innervated by the LPN and the hairy skin area supplied by the fSPN, functional regeneration of misrouted polymodal nociceptor C-fibers was found. We conclude that functional regeneration of misrouted axons related to polymodal nociceptive units and low-threshold mechanoreceptive units is more efficient in hairy skin of the rat foot whereas only misrouted polymodal nociceptor C-fibers recover function in glabrous skin.

  • 73.
    Rousseau, Andreas
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Anestesiologi med intensivvård. Linköpings universitet, Hälsouniversitetet.
    Abdiu, Avni
    Linköpings universitet, Institutionen för biomedicin och kirurgi, Hand och plastikkirurgi. Linköpings universitet, Hälsouniversitetet.
    Sjöberg, Folke
    Linköpings universitet, Institutionen för biomedicin och kirurgi, Hand och plastikkirurgi. Linköpings universitet, Hälsouniversitetet.
    Hyperoxaemia does not change concentrations of serotonin and beta‐thromboglobulin in blood of healthy humans2004Inngår i: Scandinavian Journal of Clinical and Laboratory Investigation, ISSN 0036-5513, E-ISSN 1502-7686, Vol. 64, nr 2, s. 81-85Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: The mechanisms of oxygen‐induced effects on blood vessels (vasoconstriction in hyperoxaemia and vasodilatation during hypoxaemia) are uncertain. Many investigators have suggested that the vasoconstriction seen during hyperoxia/hyperoxaemia is mediated through the endothelium as a result of either increased release or activity of vasoconstrictors (oxygen radicals, endothelin, norepinephrine, angiotensin II, or serotonin (5‐HT)), or reduced activity of vasodilators (prostaglandin E2 and nitric oxide). Serotonin has been assumed to have a central role.

    Methods: Eight healthy volunteers were exposed to FiO2 of 1.0 for 20 min and serum concentrations of serotonin and activated platelets were measured (indicated by concentrations of β‐thromboglobulin (β‐TG)).

    Results. During hyperoxaemia in humans, serum concentrations of serotonin and β‐TG remained unchanged.

    Conclusion: If serotonin is involved in oxygen‐induced vasoconstriction, the mechanism is more likely to be either a potentiating effect of serotonin on other vasoconstrictors or increased activity of serotonin on its receptor.

  • 74.
    Sirsjö, A
    et al.
    Karolinska institutet Stockholm.
    Gidlöf, A
    Stockholm.
    Nilsson, Gert
    Linköpings universitet, Tekniska högskolan. Linköpings universitet, Institutionen för medicinsk teknik, Biomedicinsk instrumentteknik.
    Povlsen, B
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för biomedicin och kirurgi, Hand och plastikkirurgi. Östergötlands Läns Landsting, Rekonstruktionscentrum, Hand- och plastikkirurgiska kliniken US.
    Skeletal muscle blood flow after prolonged tourniquet ischaemia and reperfusion with and without intervening reoxygenation: An experimental study in rats using laser Doppler perfusion imaging2001Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The total, safe, time available for operating during tourniquet ischaemia is thought to be prolonged by short, intervening episodes of reperfusion. However, animal experiments have suggested that this may cause a reduction of the postischaemic reperfusion injury. The purpose of the present study was to investigate the effect on final postischaemic reperfusion of intermittent, short periods of reperfusion compared with that of prolonged, continuous tourniquet ischaemia. A rat tourniquet model of total limb ischaemia and laser Doppler imaging to measure postischaemic microvascular perfusion in skeletal muscle was used in a total of 25 anaesthetised rats. Four were non-ischaemic controls. In 21 rats one hind leg was made totally ischaemic by a tourniquet. Fourteen were exposed to uninterrupted periods of either 1.5 hours or three hours, and seven to interrupted total ischaemia of three hours, with a 20 minutes reperfusion interval after 1.5 hours of ischaemia. The postischaemic blood flow was monitored 20 minutes after release of the tourniquet. Postischaemic skeletal muscle blood flow was significantly reduced after three hours of continuous ischaemia compared with the group that had an intervening short period of reoxygenation. The post-ischaemic reperfusion after three hours of ischaemia with a short reperfusion interval was not reduced after ischaemia compared with either that in controls or to that in the group exposed to only 1.5 hours of tourniquet ischaemia. These findings support the clinical practice of using intervening periods of reperfusion to prolong the total tourniquet time that can safely be used. There were no adverse effects on postischaemic reperfusion from intermittent reoxygenation.

  • 75.
    Sirsjö, Allan
    Linköpings universitet, Institutionen för biomedicin och kirurgi, Hand och plastikkirurgi. Linköpings universitet, Hälsouniversitetet.
    Acute skeletal muscle ischemia and reperfusion in the rat: The role of leukocytes and the effect of hyperbaric oxygen on microcirculation and metabolism during reperfusion1994Doktoravhandling, med artikler (Annet vitenskapelig)
    Abstract [en]

    Much experimental work in recent years seems to indicate that reperfusion after long periods of ischemia can damage tissue. Suggested factors of importance are accumulation of polymorphonuclear leukocytes (PMNs) and production of reactive oxygen metabolites (ROMs). In these experimental studies, a rat hindlimb tourniquet model was used to investi-gate the accumulation and the role of PMN's and the effect of hyperbaric oxygen (HBO) on post-ischemic skeletal muscle dysfunction. HBO was used, because post-ischemic oxygen delivery is said to be associated with production of ROM's. The activity of the PMN-specific enzyme myelo-peroxidase (MPO) in muscle homogenates was used as an index for the presence of PMNs.

    After 3 hours of ischemia, reperfusion periods longer than 1 hour were required to observe a significantly increased MPO activity com-pared to non-ischemic control. There was a significant increase in MPO activity after 5 hours of reperfusion, which was further increased up to 24 hours of reperfusion and had returned to control levels after 72 hours ofreperfusion. There was no significant correlation between MPO activity, edema and blood flow seen during reperfusion following 3 or 4 hours of ischemia, with one exception. Mter 4 hours of ischemia and I hour of reperfusion there was a significant correlation between the MPO activity and the extent of edema.

    Prevention of post-ischemic muscle accumulation of PMNs by pretreatment with antineutrophil serum did not affect the microvascular dysfunction (reduced blood flow and edema formation) and the metabolic restitution after 18 hours of reperfusion following 4 hours of ischemia.

    HBO treatment during the first hour of reperfusion after 3 hours of ischemia significantly increased the levels of ATP, PCr and glutathione and reduced the edema seen after 5 hours reperfusion. After 4 hours of ischemia HBO treatment failed to improve the levels of ATP, PCr and glutathione and affect the edema but improved the blood flow seen after 5 hours of reperfusion.

    It is concluded from these results that in this model, damage by PMN's seems minor during reperfusion. The improvement seen with HBO indicate that there is a prevailing or lingering effect of residual hypoxia in the post-ischemic muscle tissue that can be attenuated by HBO.

  • 76.
    Sjöberg, Folke
    et al.
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för medicin och vård, Anestesiologi. Östergötlands Läns Landsting, MKC - Medicin och kirurgicentrum, Anestesi. Östergötlands Läns Landsting, Rekonstruktionscentrum, Hand- och plastikkirurgiska kliniken med brännskadeenheten.
    Danielsson, Pär
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för biomedicin och kirurgi, Hand och plastikkirurgi. Östergötlands Läns Landsting, Rekonstruktionscentrum, Hand- och plastikkirurgiska kliniken med brännskadeenheten.
    Andersson, L
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för biomedicin och kirurgi, Hand och plastikkirurgi. Östergötlands Läns Landsting, Rekonstruktionscentrum, Hand- och plastikkirurgiska kliniken med brännskadeenheten.
    Steinwall, I
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för biomedicin och kirurgi, Hand och plastikkirurgi. Östergötlands Läns Landsting, Rekonstruktionscentrum, Hand- och plastikkirurgiska kliniken med brännskadeenheten.
    Zdolsek, Joachim
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för medicin och vård, Anestesiologi. Östergötlands Läns Landsting, Rekonstruktionscentrum, Hand- och plastikkirurgiska kliniken med brännskadeenheten.
    Östrup, Leif
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för biomedicin och kirurgi, Kirurgi.
    Monafo, W
    Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA.
    Utility of an intervention scoring system in documenting effects of changes in burn treatment2000Inngår i: Burns, ISSN 0305-4179, E-ISSN 1879-1409, Vol. 26, nr 6, s. 553-559Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The consequences of the introduction of a program of consistent use of topical antimicrobials and early aggressive excision of deep burn wounds by utilizing a comprehensive, computerized patient registry/therapeutic intervention scoring system, were investigated. Prospectively, the clinical course, mortality, outcome and hospital costs were compared for the year preceding (89 patients) and the 4 years following (226 patients) the introduction of the new treatment program. It was found that mortality decreased from 10.1 to 4.6% after change in therapy (P < 0.001), despite an increase in mean burn extent. The length of hospital stay per % burn surface area declined from 1.2 to 1.0 days (P < 0.001). The number and complexity of therapeutic interventions and the associated costs, also declined. Patients in the new treatment program had a better level of physical and psychosocial function at follow up. In conclusion, the introduction of a program of consistent use of topical antimicrobials and early, aggressive surgical excision was associated with an improved outcome at lesser cost. The combined registry-intervention scoring system permits ready analysis of results using data entered on a daily, near-real time basis.

  • 77.
    Sjöberg, Folke
    et al.
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för medicin och vård, Anestesiologi. Östergötlands Läns Landsting, MKC - Medicin och kirurgicentrum, Anestesi.
    Sjöberg, Folke
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för biomedicin och kirurgi, Hand och plastikkirurgi. Östergötlands Läns Landsting, Rekonstruktionscentrum, Hand- och plastikkirurgiska kliniken US.
    Östrup, Leif
    Brännskador2002Inngår i: Brännskador / [ed] Folke Sjöberg och Leif Östrup, Linköping: Linköpings universitet , 2002, 1, s. -233Kapittel i bok, del av antologi (Annet vitenskapelig)
    Abstract [sv]

    Brännskador är en lärobok i brännskadevård. Flera av bokens kapitel kan dessutom fungera som snabbreferens i akuta situationer.

    Boken är inte enbart avsedd för ABLS-kurserna utan också för grund-, vidare- och efterutbildningen av läkare, sjuksköterskor samt övrig civil och militär personal som kommer i kontakt med brännskadade patienter

  • 78.
    Sjöberg, Folke
    et al.
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för medicin och vård, Anestesiologi. Östergötlands Läns Landsting, MKC - Medicin och kirurgicentrum, Anestesi.
    Östrup, Leif
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för biomedicin och kirurgi, Hand och plastikkirurgi. Östergötlands Läns Landsting, Rekonstruktionscentrum, Hand- och plastikkirurgiska kliniken US.
    Brännskadeboken (Burn Care)2002Inngår i: Brännskador / [ed] Folke Sjöberg och Leif Östrup, Linköping: Linköpings universitet , 2002, 1, s. -233Kapittel i bok, del av antologi (Annet vitenskapelig)
    Abstract [sv]

    Brännskador är en lärobok i brännskadevård. Flera av bokens kapitel kan dessutom fungera som snabbreferens i akuta situationer.

    Boken är inte enbart avsedd för ABLS-kurserna utan också för grund-, vidare- och efterutbildningen av läkare, sjuksköterskor samt övrig civil och militär personal som kommer i kontakt med brännskadade patienter.

  • 79.
    Stankovic, N
    et al.
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för biomedicin och kirurgi, Hand och plastikkirurgi. Östergötlands Läns Landsting, Rekonstruktionscentrum, Hand- och plastikkirurgiska kliniken US.
    Johansson, O
    Öqvist, Gunilla
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för biomedicin och kirurgi, Cellbiologi.
    Hildebrand, Claes
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för biomedicin och kirurgi, Cellbiologi.
    Indirect effect of sciatic nerve injury on the epidermal thickness of plantar glabrous skin in rats2001Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    In patients with nerve injuries, the skin over the denervated part tends to atrophy. Few experimental studies have dealt with this issue. In this paper we examine the effects of nerve injury on the epidermis in plantar glabrous skin in rats. Analysis of paraffin sections showed that the epidermis becomes abnormally thin after sciatic neurotomy and suture or neurectomy, but not after nerve crush. Autoradiographic analysis showed a subnormal number of thymidine-labelled epidermal cells in plantar skin of rats subjected to sciatic neurectomy. However, after selective division of the sciatic foot branches, with preserved function of thigh and leg muscles, the number of labelled epidermal cells did not differ significantly between the side operated on and the control side. We conclude that the effect of sciatic nerve division on plantar skin in rats is caused by the motor deficiency in the foot rather than by deficient innervation of the skin.

  • 80.
    Stankovic, Nenad
    et al.
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för biomedicin och kirurgi, Hand och plastikkirurgi. Östergötlands Läns Landsting, Rekonstruktionscentrum, Hand- och plastikkirurgiska kliniken US.
    Johansson, O
    Karolinska inst Stockholm.
    Hildebrand, Claes
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för biomedicin och kirurgi, Cellbiologi.
    Increased occurrence of PGP 9.5-immunoreactive epidermal Langerhans cells in rat plantar skin after sciatic nerve injury.1999Inngår i: Cell and Tissue Research, ISSN 0302-766X, E-ISSN 1432-0878, Vol. 298, s. 255-260Artikkel i tidsskrift (Fagfellevurdert)
  • 81.
    Stankovics, Nenad
    Linköpings universitet, Institutionen för biomedicin och kirurgi, Hand och plastikkirurgi. Linköpings universitet, Institutionen för biomedicin och kirurgi, Cellbiologi. Linköpings universitet, Hälsouniversitetet.
    Cutaneous effects of nerve injury: An experimental study in the rat1998Doktoravhandling, med artikler (Annet vitenskapelig)
    Abstract [en]

    One of the most difficult tasks of the hand surgeon is to reach a satisfactory restoration of the nerve functions of the injuried hand. In spite of the use of meticulous microsurgery, the results of nerve repair are disappointing, particularly with respect to mixed nerve trunks. In order to understand better the factors influencing axon regeneration and to improve further the outcome of surgical nerve repair, experimental studies are imperative. Studies in the rat show that the number of axons crossing a sharp sciatic nerve lesion may be high at nerve trunk level, whereas the sensibility of the foot skin is very deficient. This mismatch led us to study, with immunohistochemistry, the restoration of nerve endings in rat foot skin after various nerve injuries. In addition, some effects of nerve injury on the non-nervous epidermal components are elucidated through histology, autoradiography and immunohistochemistry. The results show that the occurrence of epidermal protein gene product 9.5 (PGP 9.5) immunoreactive axon profiles in the skin of the foot is statistically normal3 months after a crush lesion, but deficient 3 months after sciatic neurotomy and suture. The epidermal axon profiles return late after neurotomy and suture. The occurrence of {putative sensory) calcitonin gene-related peptide- and/or substance P-immunoreactive profiles, and {putative sympathetic) tyrosine hydroxylase-immunoreactive axon profiles in rat foot skin is partly abnormal after sciatic nerve crush and very abnormal after sciatic neurotomy and suture, when the contralateral side is also affected. In rats subjected to sciatic neurotomy and suture or neurectomy, the plantar epidermis becomes abnormally thin, but this is not seen after nerve crush. The epidermal thinning concurs with a decreased occurrence of mitotic cells. Both sutured and neurectornized rats, but not crushed cases, showed a markedly abnormal gait. However, rats subjected to selective division of sciatic foot branches exhibited a normal postural and locomotor behavior. In these rats, the occurrence of mitotic epidermal cells was similar on the operated and contralateral sides. This indicates that the effect of sciatic nerve division on the epidennal thickness of rat plantar skin is indirect, probably being caused by an ab~onnal load situation. The presence of PGP 9.5-immunoreactive epidermal dendritic cells in rat plantar skin is statistically normal3 months after sciatic crush injury, but significantly increased 1 week-3 months after neurotomy and suture. Finally, we show that the epidermal PGP 9.5- imrnunoreactive dendritic cells present in rat plantar skin represent la-immunoreactive Langerhans cells and that the plantar skin of albino rats is devoid ofepidermal NKJ-immunoreactive melanocytes.

  • 82.
    Svernlöv, Birgitta
    et al.
    Linköpings universitet, Institutionen för biomedicin och kirurgi, Hand och plastikkirurgi. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Sinnescentrum, Hand- och plastikkirurgiska kliniken US.
    Adolfsson, Lars
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Ortopedi och idrottsmedicin. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Centrum för kirurgi, ortopedi och cancervård, Ortopedkliniken i Linköping.
    Non-operative treatment regime including eccentric training for lateral humeral epicondylalgia2001Inngår i: Scandinavian Journal of Medicine and Science in Sports, ISSN 0905-7188, E-ISSN 1600-0838, Vol. 11, nr 6, s. 328-334Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    In a pilot study 38 patients with lateral humeral epicondylalgia were randomly allocated to two treatment groups. Group S (stretching) was treated with a contract-relax-stretching program while group E (eccentric exercise) underwent an eccentric exercise program. Both groups also received forearm bands and wrist support nightly. The programs were carried out daily at home during 12 weeks. Evaluation before and 3, 6 and 12 months after treatment, included subjective assessment of symptoms using visual analogue scales and grip strength measurements. Thirty-five patients were available for follow-up. Five patients, three in group S and two in group E, did not complete the programs due to increased pain while 30 (86%) reported complete recovery or improvement. Reduced pain and increased grip strength were seen in both treatment groups but 12 out of 17 patients (71%) in group E rated themselves as completely recovered as compared to 7 out of 18 (39%) in group S (P=0.09), and in group E the increase in grip strength after 6 months was statistically significantly larger than in group S. In a second study the eccentric training regime was used in a consecutive series of 129 patients with lateral epicondy lalgia. The patients were divided into two groups with one group consisting of patients with less than one year duration of symtoms and the other comprised patients with a duration of symptoms for more than one year. The results of treatment were evaluated in the same way as in the pilot study, and also after 3.4 years using the scoring system by Verhaar et al. At the end of the treatment period statistically significant improvements were seen in all VAS recordings and in grip strength. After 3.4 years 38% had excellent, 28% good, 25% fair and 9% poor results according to the score. In the self-rated outcome 54% regarded themselves as completely recovered, 43% improved, 2% unchanged and 2% worse. No significant differences were seen between patients with a duration of symptoms for more than one year compared to patients with symptoms for less than one year. The eccentric training regime can considerably reduce symptoms in a majority of patients with lateral humeral epicondylalgia, regardless of duration, and is possibly superior to conventional stretching.

  • 83.
    Tarpila, Erkki
    Linköpings universitet, Institutionen för biomedicin och kirurgi, Hand och plastikkirurgi. Linköpings universitet, Hälsouniversitetet.
    Factors influencing the inflammatory response and secondary infection in rat pancreatitis1992Doktoravhandling, med artikler (Annet vitenskapelig)
    Abstract [en]

    A rat~model for bile-induced acute pancreatitis is used throughout the experiments. The model, which is well known, mimics the assumed events leading to biliary pancreatitis. The mortality from acute pancreatitis with this model was 23-33% and 73% of all deaths occurred within the first 24 hours.

    Cholecystokinin (CCK) is the strongest known stimulant of pancreatic enzyme secretion and pancreatic growth. During acute pancreatitis, stimulation with the CCK agonist cerulein augmented the pancreatitis. Blocking of the endogenous CCK by the CCK-receptor antagonist proglumide had no beneficial effect.

    Resorption of biologically active substances via the peritoneum has been suggested as a pathogenetic mechanism for systemic complications in acute pancreatitis. Peritoneal resorption of fluorescein-isothiocyanate-conjugated dextran 10 000 was studied in rats during acute pancreatitis induced by different means or with bacterial peritonitis. Peritoneal permeability was independent of both induction mode and severity of acute pancreatitis and of whether peritoneal inflammation was induced directly by bacteria or indirectly by pancreatitis. Absorption of toxic substances via the peritoneum seems to be of minor importance for the development of systemic complications in acute pancreatitis.

    Bacterial peritonitis resulted in hyperamylasemia. Light and electron microscopy in these cases revealed no damage to the exocrine pancreas. The amylase therefore was not of pancreatic origin.

    Reflux of infected bile or duodenal contents into the pancreatic duct can give rise to infected acute pancreatitis. Rats given infected bile into the pancreatic duct showed incresed consumption of C3, anergy to a recall antigen test and higher mortality than in rats with noninfected pancreatitis. Intraductal injection of infected bile frequently reulted also in infected suppuration of the pancreas after 7 days.

    Another mechanism for infected acute pancreatitis is translocation of bacteria through the intestinal wall. Acute pancreatitis, induced by sterile bile was associated with translocation of Escherichia coli and systemic contamination two days later. Bacterial overgrowth of both aerobic and anaerobic flora was seen in the intestines, but no damage to the intestinal mucosa. Bacterial translocation was a graded response, depending on the severity of pancreatitis. Pancreatic necrosis, however, was seldom infected 7 days after induction of acute pancreatitis with sterile bile. Bacterial translocation during acute pancreatitis therefore occurs only during the first days. The results of the experiments indicate ascending irfection as the main mechanism for secondary infected pancreatitis in rats with bile-induced acute pancreatitis.

  • 84.
    Thorfinn, Johan
    et al.
    Linköpings universitet, Institutionen för biomedicin och kirurgi, Hand och plastikkirurgi. Linköpings universitet, Hälsouniversitetet.
    Ragnemalm, Bengt
    Linköpings universitet, Institutionen för medicinsk teknik. Linköpings universitet, Hälsouniversitetet.
    Lidman, Disa
    Linköpings universitet, Institutionen för biomedicin och kirurgi, Hand och plastikkirurgi. Linköpings universitet, Hälsouniversitetet.
    A pressure-controlled alarm and monitoring device for pressure ulcer prophylaxis in patients with traumatic spinal cord injury: a prototypeManuskript (preprint) (Annet vitenskapelig)
    Abstract [en]

    Patients with spinal cord injury are prone to develop pressure ulcers, especially around the pelvic girdle and in the buttocks. Treatment of pressure ulcer is demanding for the health care system in terms of personal and economic resources, and for the patient because of extensive conservative or surgical treatments to achieve healing. The prevention of pressure ulcers is therefore of major importance for this patient group. A contributing factor to the development of pressure ulcers is the lack of biosensory feedback below the level of injury, that results in a lack of impulses to the patient to change body position. In this paper we describe the construction of a technical device that monitors sitting pressures in a wheel chair cushion, and alerts the user when the pressure has reached a critical level for a period of time long enough to risk tissue damage. This device also saves pressure data continuously for retrospective analysis to evaluate the patients' sitting and unloading behaviour, and to study the effect of pressure relieving wheel chair cushions over longer periods of time.

  • 85.
    Thorfinn, Johan
    et al.
    Linköpings universitet, Institutionen för biomedicin och kirurgi, Hand och plastikkirurgi. Linköpings universitet, Hälsouniversitetet.
    Sjöberg, Folke
    Linköpings universitet, Institutionen för biomedicin och kirurgi, Hand och plastikkirurgi. Linköpings universitet, Institutionen för medicin och vård, Anestesiologi. Linköpings universitet, Hälsouniversitetet.
    Lidman, Disa
    Linköpings universitet, Institutionen för biomedicin och kirurgi, Hand och plastikkirurgi. Linköpings universitet, Hälsouniversitetet.
    Perfusion of buttock skin in healthy volunteers after long and short repetitive loading evaluated by laser Doppler perfusion imager2007Inngår i: Scandinavian Journal of Plastic and Reconstructive Surgery and Hand Surgery, ISSN 2000-656X, E-ISSN 2000-6764, Vol. 41, nr 6, s. 297-302Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Frequent unloading is vital to avoid pressure ulcers of the seat area in patients with injuries to the spinal cord. The duration of unloading is probably as important as that of the sitting period in the prophylaxis of pressure ulcers. The aim of this study was to investigate the microcirculatory reactions after occlusion of the buttock skin after repeated ischaemic provocation. The perfusion of buttock skin was studied with a laser Doppler perfusion imager (LDPI) in healthy people after short and long periods of sitting (repeated four times). The perfusion increased significantly during the consecutive loadings compared with the first loading, and this effect was more profound after the long load. Repeated periods of ischaemia of the buttock skin without allowing the tissues to recover resulted in increasing reactive hyperaemia, and are therefore probably more damaging than single loadings. This is important when establishing clinical guidelines for the prophylaxis of pressure ulcers in patients with spinal cord injuries.

  • 86.
    Thorfinn, Johan
    et al.
    Linköpings universitet, Institutionen för biomedicin och kirurgi, Hand och plastikkirurgi. Linköpings universitet, Hälsouniversitetet.
    Sjöberg, Folke
    Linköpings universitet, Institutionen för biomedicin och kirurgi, Hand och plastikkirurgi. Linköpings universitet, Institutionen för medicin och vård, Anestesiologi. Linköpings universitet, Hälsouniversitetet.
    Lidman, Disa
    Linköpings universitet, Institutionen för biomedicin och kirurgi, Hand och plastikkirurgi. Linköpings universitet, Hälsouniversitetet.
    Sitting can cause ischaemia in the subcutaneous tissue of the buttocks, which implicates multilayer tissue damage in the development of pressure ulcers2009Inngår i: Scandinavian Journal of Plastic and Reconstructive Surgery and Hand Surgery, ISSN 2000-656X, E-ISSN 2000-6764, Vol. 43, nr 2, s. 82-89Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    A better understanding of how pressure ulcers develop in the buttocks will improve prophylactic measures. Our aim was to investigate signs of reduced perfusion and ischaemia in the subcutaneous fat in the buttocks during sitting. A microelectrode was used to quantify oxygen (pO2). Metabolites that indicate aerobic or anaerobic metabolism (glucose, lactate, pyruvate, and glycerol) were quantified using microdialysis. Sixteen healthy people were studied while they sat on a wheel chair cushion, and a hard surface. Sitting pressures were mapped, and the thickness of the subcutaneous fatty layer was measured. The results showed that pO2 and glucose were significantly reduced during sitting, and for pO2 the effect is significantly more profound during sitting on a hard surface. After loading, both glucose and pO2 increased significantly. We conclude that the subcutaneous adipose tissue covering the ischial tuberosities becomes ischaemic during sitting. This finding supports the theory that not only is the skin involved in early development of pressure ulcers, but also the deeper tissues.

  • 87.
    Thorfinn, Johan
    et al.
    Linköpings universitet, Institutionen för biomedicin och kirurgi, Hand och plastikkirurgi. Linköpings universitet, Hälsouniversitetet.
    Sjöberg, Folke
    Linköpings universitet, Institutionen för biomedicin och kirurgi, Hand och plastikkirurgi. Linköpings universitet, Institutionen för medicin och vård, Anestesiologi. Linköpings universitet, Hälsouniversitetet.
    Lidman, Disa
    Linköpings universitet, Institutionen för biomedicin och kirurgi, Hand och plastikkirurgi. Linköpings universitet, Hälsouniversitetet.
    Sitting pressure and perfusion of buttock skin in paraplegic and tetraplegic patients, and in healthy subjects: a comparative study2002Inngår i: Scandinavian Journal of Plastic and Reconstructive Surgery and Hand Surgery, ISSN 2000-656X, E-ISSN 2000-6764, Vol. 36, nr 5, s. 279-283Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The distribution of sitting pressure and ability to respond with reactive hyperaemia were studied in a group of paraplegic and tetraplegic patients (n = 8) with spinal cord lesions and healthy controls (n = 10) using a pressure sensitive plate and laser Doppler perfusion imager. The results show that the mean sitting pressure of the patients was 9.9 N/cm2 (left) and 11.7 N/cm2 (right) compared with 3.5 N/cm2 (left) and 3.6 N/cm2 (right) in controls. The differences were significant on both the left (p < 0.01) and right (p < 0.05) sides. The maximum pressure in patients was 42.9 N/cm2 (left) and 48.7 N/cm2 (right), and in controls 12.0 N/cm2 (left) and 12.9 (right) (p < 0.01). Both groups showed a reduction in skin perfusion in the seat area during sitting compared with unloaded resting, and in the controls it was significantly increased (p < 0.001 on both sides) during the reactive hyperaemic phase immediately after sitting. Compared with the preload values, the patients showed a similar but slightly weaker picture significant on the right side (p < 0.05), but not on the left. The hyperaemia was not uniformly distributed, but occurred where the pressure was greater than 2 N/cm2. There was no correlation between the amount of reactive hyperaemia and absolute values of sitting pressures. We conclude that tetraplegic and paraplegic patients have significantly higher sitting pressures than normal controls, and that the hyperaemic response in the buttock region in the upright position after pressure load is slightly weaker in the patients, which could be of importance for the development of decubitus ulcers.

  • 88.
    Thorfinn, Johan
    et al.
    Linköpings universitet, Institutionen för biomedicin och kirurgi, Hand och plastikkirurgi. Linköpings universitet, Hälsouniversitetet.
    Sjöberg, Folke
    Linköpings universitet, Institutionen för biomedicin och kirurgi, Hand och plastikkirurgi. Linköpings universitet, Institutionen för medicin och vård, Anestesiologi. Linköpings universitet, Hälsouniversitetet.
    Sjöstrand, Lotta
    Linköpings universitet, Hälsouniversitetet.
    Lidman, Disa
    Linköpings universitet, Institutionen för biomedicin och kirurgi, Hand och plastikkirurgi. Linköpings universitet, Hälsouniversitetet.
    Perfusion of the skin of the buttocks in paraplegic and tetraplegic patients, and in healthy subjects after a short and long load2006Inngår i: Scandinavian Journal of Plastic and Reconstructive Surgery and Hand Surgery, ISSN 2000-656X, E-ISSN 2000-6764, Vol. 40, nr 3, s. 153-160Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    In patients with spinal cord injuries (n=8) and healthy controls (n=8) the hyperaemic response in the buttock skin after sitting on a hard surface was studied using a laser Doppler perfusion imager. They sat for three minutes (short load), or 15 minutes (long load). An exponential mathematical function was used to compare the mean perfusion during the observed interval. The results showed that preloading perfusion is significantly higher among patients than healthy subjects. In both groups, the microcirculation of the skin increased significantly after loading, and peak perfusion was significantly lower after the short load. The mean perfusion was higher among the patients after both loadings, which suggests that there was stronger ischaemic provocation. The main outcome was that there was a dose-response relation between duration of loading and intensity of reactive hyperaemia, and that patients with spinal cord injuries have greater perfusion before and after loading than healthy controls.

  • 89. Turczynski, R
    et al.
    Tarpila, Erkki
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för biomedicin och kirurgi, Hand och plastikkirurgi. Östergötlands Läns Landsting, Rekonstruktionscentrum, Hand- och plastikkirurgiska kliniken US.
    Treatment of leg ulcers with split skin graft.Short-time and late results.1999Inngår i: Scandinavian Journal of Plastic and Reconstructive Surgery and Hand Surgery, ISSN 2000-656X, E-ISSN 2000-6764, Vol. 33, s. 301-305Artikkel i tidsskrift (Fagfellevurdert)
  • 90.
    Zdolsek, Hans Joachim
    et al.
    Linköpings universitet, Institutionen för medicin och vård, Anestesiologi. Linköpings universitet, Hälsouniversitetet.
    Lindahl, Olof Anton
    Department of Applied Physics and Electronics, Umeå University and Biomedical Engineering and Informatics, University Hospital of Northern Sweden, Umeå, Sweden .
    Sjöberg, Folke
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Brännskadevård. Linköpings universitet, Institutionen för biomedicin och kirurgi, Hand och plastikkirurgi. Linköpings universitet, Hälsouniversitetet.
    Non-invasive assessment of fluid volume status in the interstitium after haemodialysis2000Inngår i: Physiological Measurement, ISSN 0967-3334, E-ISSN 1361-6579, Vol. 21, nr 2, s. 211-220Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    During dialysis excess fluid is removed from uraemic patients. The excess fluid is mainly located in the skin and subcutaneous tissues. In this study we wished, with two non-invasive techniques, the IM (impression method) and BIA (bioimpedance analysis), to study what mechanical (IM) and electrical cellular membrane (BIA) effects the fluid withdrawal has on these tissues. The IM measures the resistive force of the tissues when mechanically compressed. From the force curve two parameters are calculated, the F(0), indicative of interstitial tissue pressure and the FT corresponding to the translocation of tissue fluid (interstitial movable water).

    The BIA phase angle shift (), i.e. geometrical angular transformation of the ratio between reactance and resistance, which has been associated with cellular membrane function, was used as a measurement of electrical cellular membrane effects.

    Twenty patients were studied before and after haemodialysis measuring the F(0), FT and . The results showed that the patients lost a median of 3.7 kg during the haemodialysis. F(0) increased until after dialysis, but did not reach significant values, whereas FT increased significantly after dialysis, p < 0.001, as compared with before. After a peak at one hour postdialysis the FT value returned to predialysis values at four hours after termination of dialysis. Also increased from before to after dialysis, p < 0.001, but already after one hour it returned to predialysis values.

    It is common knowledge that dialysis alters the dynamics of fluid in the interstitium of the skin and subcutis. We conclude that the impression method is sensitive enough to detect and chronicle these changes. Furthermore, with the BIA, (phase angle) signs of changes in the electrical properties of the tissues, possibly reflecting cellular membrane function, could be detected.

  • 91.
    Zdolsek, Hans Joachim
    et al.
    Linköpings universitet, Institutionen för medicin och vård, Anestesiologi. Linköpings universitet, Institutionen för biomedicin och kirurgi, Hand och plastikkirurgi. Linköpings universitet, Hälsouniversitetet.
    Lindahl, Olof Anton
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Brännskadevård. Linköpings universitet, Hälsouniversitetet.
    Ängquist, Karl-Axel
    Department of Biomedical Engineering, University Hospital of Northern Sweden, Umeå, Sweden.
    Sjöberg, Folke
    Linköpings universitet, Institutionen för medicin och vård, Anestesiologi. Linköpings universitet, Institutionen för biomedicin och kirurgi, Hand och plastikkirurgi. Linköpings universitet, Hälsouniversitetet.
    Non-invasive assessment of intercompartmental fluid shifts in burn victims1998Inngår i: Burns, ISSN 0305-4179, E-ISSN 1879-1409, Vol. 24, nr 3, s. 233-240Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Two non-invasive methods (the bioimpedance technique, BIA, and the impression method, IM) were studied, to find out whether they are sensitive enough to detect and chronicle the development of the oedema and fluid resuscitation effects (Parkland formula) that occur secondary to a major burn. Ten patients with a total burned body surface area (TBSA) of more than 10% were included in this prospective study. Total body water (TBW), as measured by the resistance (BIA) or F(0) variable (IM), reached a maximum on day 2. The tissue fluid translocation (INT) variable (IM) followed a different course, increasing slowly to reach a maximum on day 6, when it was 40% higher than the 12 h value. TBW and the interstitial translocatable fluid were still increased 1 week post-burn. The non-invasive measurements of TBW (resistance by BIA and F(0) by IM) reflected the anticipated changes in TBW. The phase angle (BIA) indicative of cellular membrane effects of burn and sepsis had its lowest values at day 1.5, and stayed significantly low until day 4. Interestingly, the phase angle was lowest in the two cases that died subsequently. The different time course of the INT value (IM), which reflected the translocatable interstitial fluid volume in skin, may be the result of resuscitation fluid remaining in this compartment, due to the excess sodium content together with a possible change in tissue compliance secondary to the early total water peak on day 2.

  • 92.
    Zdolsek, Hans Joachim
    et al.
    Linköpings universitet, Institutionen för medicin och vård, Anestesiologi. Linköpings universitet, Hälsouniversitetet.
    Sjöberg, Folke
    Linköpings universitet, Institutionen för biomedicin och kirurgi, Hand och plastikkirurgi. Linköpings universitet, Hälsouniversitetet.
    Lisander, Björn
    Linköpings universitet, Institutionen för medicin och vård, Anestesiologi. Linköpings universitet, Hälsouniversitetet.
    Jones, Wayne A.
    National Laboratory of Forensic Chemistry, Linköping, Sweden.
    The effect of hypermetabolism induced by burn trauma on the ethanol-oxidizing capacity of the liver1999Inngår i: Critical Care Medicine, ISSN 0090-3493, E-ISSN 1530-0293, Vol. 27, nr 12, s. 2622-2625Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective: To study the rate of elimination of ethanol after a major burn trauma.

    Design: Prospective, controlled study.

    Setting: National burns unit in a Swedish university hospital.

    Patients and Subjects: Eight consecutive patients suffering from 18%-72% total burned surface area and nine healthy male control subjects.

    Interventions: The patients received ethanol, 0.35-0.60 g/kg body weight intravenously, during 1 hr. This was repeated daily during the first week postburn. The control subjects received the same amount of ethanol once.

    Measurements and Main Results: Blood samples were drawn at 20- to 30-min intervals during 5 hrs after the start of the infusion. Serum ethanol was determined by headspace gas chromatography. The rate of elimination of ethanol was calculated from the concentration time profile. In the control subjects, the median elimination rate was 0.074 g/kg/hr (range, 0.059-0.083 g/kg/hr). In the patients, it was already 0.138 g/kg/hr (range, 0.111-0.201 g/kg/hr) on the first day; this increased even further over the following 6 days, reaching 0.183 g/kg/hr (range, 0.150-0.218 g/kg/hr) on the seventh day.

    Conclusions: Ethanol elimination is augmented postburn. A more effective reoxidation of reduced nicotinamide adenine dinucleotide seems the most likely explanation for the increased rate of ethanol elimination in these hypermetabolic trauma patients. This finding suggests that the oxidative capacity of the liver may be assessed by studying the rate of ethanol elimination in burn victims.

12 51 - 92 of 92
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