Bo Lilja

Dry eyes or mouth—An epidemiological study in Swedish adults, with special reference to primary Sjögren's syndrome

The prevalence of dry eyes or dry mouth, and of primary Sjögrens syndrome (primary SS) according to the Copenhagen criteria were established in 705 randomly selected subjects, aged 52-72 years who answered a simple questionnaire, and of whom 247 (35%) reported symptoms. A subgroup with symptoms (n = 77) and a matched asymptomatic control group (n = 32) were examined with the Schimer-1 test (S1t), tear film break-up time (BUT), van Bijsterveld score (vB), unstimulated whole sialometry (Sialo) and, in about 40% of them labial salivary gland (LSG) biopsy and salivary gland scintigraphy. Apart from four cases of keratoconjunctivitis sicca (KCS) among controls, cases of KCS (15), xerostomia (12), autoimmune sialoadenitis (6) and primary SS (6) were exclusively confined to the symtomatic group. The calculated frequencies (with 95% confidence intervals) for the whole population were 14.9 (7.3-22.6)% for KCS, 5.5(3.0-7.9)% for xerostomia and 2.7 (1.0-4.5)% for autoimmune sialoadenitis and primary SS. The serum levels of ANA and RF were similar in the two groups, though those of anti-SS-B/La antibodies were higher in the group with symptoms (P less than 0.01).

Longstanding Groin Pain in Athletes A Multidisciplinary Approach

SummaryIn 21 male athletes (age 20 to 40 years) with longstanding unexplained groin pain, a multidisciplinary investigation was performed in order to reveal the underlying cause. These examinations included general surgery for detection of inguinal hernia and neuralgia, orthopaedic surgery for detection of adductor tenoperiostitis and symphysitis, urology for detection of prostatitis, radiology for performing herniography and plain film of the pelvic bones, nuclear medicine for isotope studies of the pubic bone and symphysis. In 19 patients there was a positive diagnosis for 2 or more of the diseases (10 patients had 2 diseases, 6 patients had 3 diseases, 3 patients had 4 diseases). Two patients had only signs of symphysitis.Our results show the complexity of longstanding groin pain in athletes. It also explains why therapy for one specific disease entity may fail. We conclude that this clinical setting demands the recruitment of a team with experience of different aspects of groin pain.

Autonomic vagal nerve dysfunction in patients with ulcerative colitis

Autonomic nerve function was evaluated in 40 patients with total ulcerative colitis and in 25 patients with irritable bowel syndrome by three established non-invasive tests based on the heart reactions to deep breathing (E/I ratio) and tilt (acceleration and brake index). None of the patients were diabetic. Most of the patients with ulcerative colitis were clinically and biochemically inactive; 10 had previously undergone colectomy. The results were compared with a control group consisting of 56 healthy individuals and 33 previously investigated patients with Crohns disease, 45% of whom demonstrated autonomic neuropathy (AN). Patients with ulcerative colitis had a significantly lower E/I ratio than controls in age-corrected values, indicating vagal nerve dysfunction. Altogether, 35% had signs of AN. In patients with irritable bowel syndrome 36% had evidence of AN, a figure in agreement with observations from other investigators. We conclude that AN is common in patients with ulcerative colitis, regardless of disease activity and previous colectomy. In contrast to a predominantly sympathetic dysfunction in Crohns disease, AN in ulcerative colitis was vagal.

Abnormal diastolic blood pressure and heart rate reactions to tilting in diabetes mellitus

SummaryThe orthostatic reaction to tilting was studied in 46 diabetics without symptoms of autonomic neuropathy and in 31 age-matched healthy control subjects. After tilting, the diastolic blood pressure rose in the control subjects but was unchanged or tended to fall in the diabetics, except in those of short duration without retinopathy. After tilting, the control subjects showed an immediate increase in heart rate with the highest value at 8.4±1.0 s (mean±SEM), followed by a transient decrease with lowest value at 21.2±0.9 s. The acceleration and brake index measured the changes in heart rate. The brake index was lower in diabetics of short duration with retinopathy (6.9±1.6) than in those without (14.4±2.3, p <0.01) as well as matched control subjects (18.7±2.5, p < 0.01). In the diabetics of long duration no differences were shown between those with or without retinopathy but the acceleration (10.3±1.6 vs 19.9±2.3, p < 0.05) and the brake index (5.3±1.4 vs 19.9±2.3, p < 0.01) were lower in those with vagal neuropathy.

Disturbed Autonomic Nerve Function in Patients with Crohn's Disease

Autonomic nerve function was evaluated in 33 patients with Crohns disease (age range, 19-66 years; mean, 36 years) by three established non-invasive tests based on the heart reactions to deep breathing (E/I ratio) and to tilt (acceleration and brake indices). Peripheral nerve function was evaluated neurographically and by measuring thresholds to vibration and temperature changes. None of the patients were diabetic, and all had normal thyroid function. In spite of normal peripheral nerve function, almost half of the patients, 48% (16/33), showed signs of autonomic neuropathy (AN). The occurrence of AN was not related to duration or severity of Crohns disease or to biochemical evidence of inflammation or malabsorption of vitamins and trace elements. We conclude that autonomic nerve dysfunction is a feature of Crohns disease which may be relevant with regard to the frequent disturbance in bowel function in patients with this disorder.

Autonomic Nerve Function in Rheumatoid Arthritis of Varying Severity

Autonomic nerve function was evaluated by deep breathing and tilt table tests in 17 patients with rheumatoid arthritis (RA) and in 24 healthy control subjects. The results showed that all RA patients had increased heart rates at rest, irrespective of the severity of the disease. Patients with severe RA had increased systolic and diastolic blood pressures before and after tilting. Pronounced abnormalities in the immediate heart rate reaction to tilting indicating autonomic neuropathy (AN) were also demonstrated in patients with severe RA. The abnormal immediate reaction to tilting was mainly the result of vagal neuropathy. From the present study it is evident that severe RA may be accompanied by AN and the consequences need to be elucidated.

Autonomic Neuropathy Predicts Deterioration in Glomerular Filtration Rate in Patients With IDDM

OBJECTIVE To evaluate whether autonomic neuropathy predicts deterioration in glomerular filtration rate in IDDM patients. RESEARCH DESIGN AND METHODS A prospective study in which 35 IDDM patients have been followed for 10–11 yr. Autonomic nerve function tests included heart-rate reactions to deep breathing (expiration-to-inspiration ratio) and to tilt (acceleration and brake indexes). GFR was evaluated by the 51Cr-EDTA plasma clearance method. RESULTS At entry to the study, no significant differences were noted in age (39 ± 2 [mean ± SE] vs. 42 ± 4 yr), duration of diabetes (20 ± 3 vs. 23 ± 4 yr), supine blood pressures (120/79 ± 3/2 mmHg vs. 121/78 ± 6/3 mmHg), and GFR (113 ± 6 vs. 107 ± 3 ml·min−1·1.73 m−2) between 20 patients with and 15 without autonomic neuropathy (age-corrected criteria). After 10–11 yr, GFR had decreased significantly (22 ± 4 ml·min−1·1.73 m−2 P < 0.001) in patients with autonomic neuropathy but not (8 ± 5 ml·min−1·1.73 m−2, NS) in patients without. In keeping with this, GFR decreased more than expected (difference in GFR/ expected decrease in GFR) in patients with autonomic neuropathy, compared with those without (4.46 ± 0.98 vs. 0.48 ± 0.73, P < 0.005). CONCLUSIONS Autonomic neuropathy predicts future deterioration in GFR in IDDM patients.

Diabetes Mellitus but not Impaired Glucose Tolerance is Associated with Dysfunction in Peripheral Nerves

To clarify whether long‐term impaired glucose tolerance (IGT) is associated with dysfunction of peripheral and autonomic nerves, age‐matched men with IGT and diabetes mellitus were followed prospectively for 12–15 years, when peripheral and autonomic nerve function was assessed. The patients comprised four subgroups: (1) 51 IGT subjects (duration of IGT at least 12–15 years); (2) 35 diabetic patients, with IGT 12–15 years ago, who later developed diabetes; (3) 34 diabetic patients, duration of diabetes at least 12–15 years; and (4) 62 age‐matched non‐diabetic control subjects. Mean age of the whole study population was 61±2 years (mean ±SD), not different in the four groups. Peripheral nerve function tests included nerve conduction velocities, amplitudes, distal latencies, F‐reflexes, and sensory perception thresholds for heat, cold, and vibration. Autonomic nerve function tests included the heart rate reaction during deep breathing (expiration to inspiration ratio) and to tilt (acceleration and brake indices). Despite 12–15 years of IGT, peripheral nerve function did not differ between IGT and control subjects, whereas autonomic nerve function deviated; an abnormal expiration to inspiration ratio (a sign of vagal nerve dysfunction) was significantly more common (15/51 versus 5/62;p<0.01) in IGT than in control subjects. Diabetic patients (groups 2 and 3) showed lower conduction velocities (in general 2–4 m s−1 lower) than IGT and control subjects in all tested nerves. In conclusion, diabetes but not IGT, is associated with peripheral nerve dysfunction.

Autonomic neuropathy in non‐insulin dependent (type II) diabetes mellitus. Possible influence of obesity

Abstract. To assess the prevalence of autonomic neuropathy (AN) in non‐insulin dependent diabetes mellitus (NIDDM) and its relationships with other diabetic complications, duration of diabetes, and obesity, we evaluated 51 NIDDM patients (age 41–59 years, mean 49 years, duration of diabetes 0–15 years, mean 6.9 years). AN tests included a deep breathing test (E/I ratio) and an orthostatic tilt table test (acceleration and brake indices). AN was prevalent: almost half of the patients showed signs of AN (25 of 51, 49%) and the most frequent disturbance was an impaired E/I ratio (18 of 25; 72%). There were no obvious correlations between AN indices and the duration of diabetes, symptoms of AN, peripheral neuropathy or retinopathy. However, an influence of obesity on AN was suggested. Patients with AN showed a significantly higher BMI than patients without AN (31.0±0.9 vs. 27.5±0.8; P<0.01).

Regional and Total Lung Function Studies in Patients with Hemidiaphragmatic Paralysis

Global and regional lung function were studied in 17 subjects with hemidiaphragmatic paralysis. Global lung function (VC, MVV, and FEV1) in the sitting postion was reduced by an average of about 25%. Regional lung function data in the same position showed a considerable decrease in perfusion (19%), ventilation (20%), and lung volume (7%) of the diseased side as compared to reference values obtained in healthy volunteers. Compared to the partition of function in the supine, the perfusion of the affected lung increased when it was lowermost in the lateral decubitus postion, while regional FRC decreased and ventilation changed little. When uppermost, perfusion and ventilation of the affected lung decreased while FRCr increased somewhat. The arterial oxygen tension was significantly below normal in the supine position but in the normal range in the sitting position. It increased further during exercise. Bronchography showed compression of the basal lung segments on the affected side in the erect, and kinking and obliteration of lower lobe bronchi in the supine position and still more when the lung was lowermost in the lateral decubitus position.