Recurrent respiratory papillomatosis in northern Sweden: Clinical characteristics and practical guidance

Conclusion: Recurrent respiratory papillomatosis (RRP) patients with high surgical treatment frequency (≥ 1/year, HF) were significantly younger and had a more widespread laryngeal disease compared to a low frequency treated group (< 1 treatment/year, LF). This study confirms the existence of a clinical RRP group, not primarily related to HPV sub-type, but more care-intensive and in need of more vigilant follow-up. Objectives: RRP is associated with high morbidity due to its influence on breathing and voice. The purpose of this study was to characterize RRP patients in northern Sweden and investigate possible predictor factors affecting therapeutic needs. Method: Patients from the regional referral area (northern Sweden) were categorized for age, disease duration, juvenile or adult onset, profile of disease development, number of surgical sessions in relation to disease duration, laryngeal deposition of papilloma, gender, and HPV sub-types, in order to identify patients with increased need for frequent surgical treatment. Results: The median age of the RRP patients (n = 48) was 44.5 years; 34 (71%) were males and 14 (29%) females, most were infected with HPV 6. Patients with high surgical treatment frequency/year were significantly younger and showed more widespread papillomatous vegetation in the larynx, compared to the low frequency treated group.     

Arm and ankle blood pressure response to treadmill exercise in normal people

Summary. Ninteen healthy volunteers, 10 men and nine women (mean age 38 and 30 years), exercised on a treadmill. The systolic blood pressure (BP) was measured at the ankle and in the arm after submaximal (8 min with a final load of 2 W kg^-1 body weight) and maximal exercise. The BP was measured for 10 min after exercise, or until the elimination of a negative pressure difference between ankle and arm. The pre-study resting systolic arm and ankle pressures were 122 ± 11 and 144 ± 13 mmHg. One minute after submaximal exercise, arm and ankle BP were 147 ± 18 and 159 ± 19 mmHg (ankle-arm pressure difference 12 ± 13 mmHg); 1 min after maximal exercise the corresponding figures were 182 ± 26 and 153 ± 35 mmHg (ankle-arm pressure difference -29 ± 33 mmHg). We conclude that maximal exercise, but not an appropriately chosen submaximal exercise level, causes a negative BP difference between ankle and arm in normal people.     

An overestimation of the prevalence of ASD among psychiatric patients

Journal of Autism and Developmental Disorders -     

Changes in miRNA expression in sera and correlation to duration of disease in patients with multifocal mucosal lichen planus

J Oral Pathol Med (2012) 41 : 86–89 Background: Mucosal lichen planus is a severe variant of lichen planus, Lichen planus (LP), which in many ways affect patients’ lives. The aetiology is not fully understood, and there is no treatment clearing the disease once and for all. Oral LP has by the WHO been classified as a precancerous lesion. Micro‐RNAs, miRNAs, are non‐coding, small single‐stranded RNAs involved in biological processes like apoptosis, proliferation, differentiation, metastasis, angiogenesis and immune response. Methods and Results: In sera from 30 patients with multifocal mucosal LP, 15 miRNAs were identified as significantly differentially expressed compared with controls. The three most up‐regulated miRNAs are all connected to oral squamous cell carcinoma or epithelial carcinoma in general. Discussion: Even if no specific LP‐associated miRNA profile was found, data clearly indicate that miRNAs could play a role in the earlier phases of lichen planus.     

Unspecific elevation of plasma troponin‐T and CK‐MB after coronary surgery

Objective—Biochemical markers of myocardial injury are frequently elevated after cardiac surgery. It is generally accepted that release unrelated to permanent myocardial damage explains a proportion of these elevations. However, little is known about the magnitude and temporal characteristics of this diagnostic noise. One way to address this issue would be to study a group without permanent myocardial injury.

Design—The unique release kinetics of troponin‐T (permanent myocardial injury causes a sustained release of structurally bound troponin) were used to identify patients with no or minimal permanent myocardial injury. Blood was sampled from patients undergoing coronary artery bypass grafting (CABG) with cardiopulmonary bypass (CPB) before surgery, 3 and 8?h after unclamping the aorta, and each morning until postoperative day 4, for analysis of enzymes and troponin‐T. From 302 consecutive patients a subgroup was identified that fulfilled the following criteria: (a) normalized troponin‐T levels ≤postoperative day 4; (b) no ECG changes indicating myocardial injury.

Results—Seventy‐seven patients fulfilled the criteria above and in this subgroup troponin‐T (2.08?±?1.42?μg/l; range 0.35–8.99?μg/l) peaked at the 3?h recording and creatine kinase monobasic (CK‐MB) (28.6?±?11.3?μg/l; range 11.9–86.0?μg/l) peaked at the 8?h recording after unclamping the aorta.

Conclusion—Substantial early elevations of plasma CK‐MB and troponin‐T occurred in patients with no or minimal permanent myocardial injury after CABG. Unspecific release was most pronounced during the timeframe that is usually studied to evaluate myocardial protective strategies or to compare revascularization procedures.     

Double-contrast examination of the pharynx

The radiographic techniques for evaluation of the pharynx are described, with particular emphasis on double-contrast examination. Radiographic anatomy of the pharynx is illustrated.     

Cineradiography in 45 patients with acute dysphagia

The function of the pharyngoesophageal stage of deglutition was studied by cineradiography in 45 patients with an acute onset of dysphagia. None of the patients had any radiographically detectable foreign body in the pharynx or esophagus. In 34 of the patients (76%) a functional or morphodynamic abnormality was disclosed; a defective closure of the laryngeal vestibule (26 patients), defective movements of the epiglottis (18 patients), uncoordinated relaxation of the cricopharyngeal muscle (14 patients), paresis of pharyngeal constrictor muscles (9 patients), and cervical webs (9 patients). In 21 of the patients more than 1 type of dysfunction was present. The results of this study suggest that cineradiography of the pharyngoesophageal stage of deglutition is useful in patients with acute dysphagia, without a foreign body, as functional abnormalities often can explain the patients' complaints.     

Carcinogenesis at colonic anastomotic sites

For three months 65 male Sprague-Dawley rats received subcutaneous 1,2-dimethylhydrazine (DMH) weekly. Of the 65 animals, 45 were subjected to resection of the transverse colon, which subsequently was stitched to the abdominal wall. The remaining 20 animals were shamoperated controls. Fifty-four per cent of the tumors occurred either at the anastomotic site in the functioning colon (31 per cent) or at the anastomotic site of the isolated and defunctionalized colonic loop (23 per cent). On the other hand, only 10 per cent of the tumors occurred in the transverse colon of sham-operated controls. The difference was significant (P<0.001). This study was supported by grants from the Cancer Society, Stockholm, and the Karolinska Institute.     

A vegan diet free of gluten improves the signs and symptoms of rheumatoid arthritis: the effects on arthritis correlate with a reduction in antibodies to food antigens

OBJECTIVE: Whether food intake can modify the course of rheumatoid arthritis (RA) is an issue of continued scientific and public interest. However, data from controlled clinical trials are sparse. We thus decided to study the clinical effects of a vegan diet free of gluten in RA and to quantify the levels of antibodies to key food antigens not present in the vegan diet. METHODS: Sixty-six patients with active RA were randomized to either a vegan diet free of gluten (38 patients) or a well-balanced non-vegan diet (28 patients) for 1 yr. All patients were instructed and followed-up in the same manner. They were analysed at baseline and after 3, 6 and 12 months, according to the response criteria of the American College of Rheumatology (ACR). Furthermore, levels of antibodies against gliadin and beta-lactoglobulin were assessed and radiographs of the hands and feet were performed. RESULTS: Twenty-two patients in the vegan group and 25 patients in the non-vegan diet group completed 9 months or more on the diet regimens. Of these diet completers, 40.5% (nine patients) in the vegan group fulfilled the ACR20 improvement criteria compared with 4% (one patient) in the non-vegan group. Corresponding figures for the intention to treat populations were 34.3 and 3.8%, respectively. The immunoglobulin G (IgG) antibody levels against gliadin and beta-lactoglobulin decreased in the responder subgroup in the vegan diet-treated patients, but not in the other analysed groups. No retardation of radiological destruction was apparent in any of the groups. CONCLUSION: The data provide evidence that dietary modification may be of clinical benefit for certain RA patients, and that this benefit may be related to a reduction in immunoreactivity to food antigens eliminated by the change in diet.