Johannes Järhult

The Swedish Council on Technology Assessment in Health Care (SBU) Systematic Overview of Radiotherapy for Cancer including a Prospective Survey of Radiotherapy Practice in Sweden 2001--Summary and Conclusions

A systematic assessment of radiotherapy for cancer was conducted by The Swedish Council on Technology Assessment in Health Care (SBU) and published in 1996. The assessment reviewed the scientific literature up to 1993 on the use of radiotherapy in the treatment of solid tumours, and estimated the costs associated with radiotherapy. It also described the current practise of radiotherapy in Sweden 1992 and compared practise with scientific knowledge. The SBU has now conducted a follow-up study on radiotherapy for cancer, including a review of the scientific literature from 1994 and a prospective survey of radiotherapy practise in Sweden 2001. The following conclusions were drawn: <list id=l1 type=5> <item>The role of radiotherapy as an important form of treatment for cancer with both curative and palliative intent has been further confirmed.</item><item>The use of radiotherapy in Sweden has increased and is now at the internationally recommended level.</item><item>Radiotherapy in Sweden is mostly given in accordance with the scientific evidence but may still be underutilized in certain situations.</item><item>The resources for radiotherapy are being utilized more efficiently.</item><item>The costs of radiotherapy are still 5% of the total cost of cancer care, while the cost of an individual treatment (fraction) has decreased.</item><item>The need for radiotherapy capacity will increase. In addition, half of the treatment equipment will have to be replaced in the next few years.</item></list>

Immunohistochemical localization and vascular effects of vasoactive intestinal polypeptide in skeletal muscle of the cat

SummaryScattered vasoactive intestinal polypeptide (VIP) — immunoreactive nerves were found in the striated muscle of the hind limb of the cat, where they usually were associated with small blood vessels. VIP-immunoreactive nerves were also demonstrated in the sciatic nerve; after nerve ligation an abundance of intensely immunoreactive VIP fibres were seen proximal to the ligation. Intraarterial infusion of VIP into the isolated hind limb of the cat had dramatic effects on different sections of the vascular bed. Thus, VIP dilated the resistance vessels leading to a marked increment in muscle blood flow. VIP also relaxed the capacitance vessels causing regional pooling of blood; it increased the capillary surface area available for fluid exchange. Infusions of VIP at a dose of 8 μg/min significantly inhibited the vasoconstriction induced by electrical stimulation of the regional sympathetic nerves. It is suggested that local nervous release of VIP may act as a modulator of vascular tone in skeletal muscle.

Colonic motor and vascular responses to pelvic nerve stimulation and their relation to local peptide release in the cat.

1. The effects of stimulation of the pelvic nerves in atropinized cats at continuous, low frequencies from 1 to 16 Hz (continuous stimulation) were compared with those of stimulation at higher frequencies (10‐160 Hz) delivered in 1 s bursts at 10 s intervals (stimulation in bursts), the latter simulating a commonly observed discharge pattern in vivo. Both types of stimulation evoked a transient vasodilatation. Stimulation in bursts at 20 and 40 Hz evoked more pronounced vasodilatations than continuous stimulation delivering exactly the same number of impulses over the whole period of excitation. 2. Stimulation of the pelvic nerves in bursts failed to elicit an effective contraction of the colon at any frequency tested, whereas continuous stimulation invariably evoked a contraction. 3. There was a clear‐cut increase in the output of vasoactive intestinal polypeptide during both continuous and intermittent stimulation of the pelvic nerves. Stimulation in bursts caused a small but significant increase in the output of somatostatin but there was no change in the output of substance P in response to either type of pelvic nerve stimulation. 4. The colonic muscular contraction in response to continuous stimulation of the pelvic nerves was not affected by somatostatin when infused intra‐arterially at the large dose of 1.0 microgram/min. 5. It is concluded that the colonic responses of atropinized cats to pelvic nerve stimulation can be substantially altered merely by changing the pattern of stimulation. Thus, whereas continuous stimulation produces both muscular contraction and vasodilatation, stimulation in bursts favours vasodilatation but is ineffective in eliciting colonic contraction.

The role of the adrenergic innervation to the pancreatic islets in the control of insulin release during exercise in man

The normal depression of plasma insulin concentration during exercise has been ascribed to adrenergic inhibition of insulin release and the role of humoral catecholamines in this hormonal adjustment has repeatedly been stressed. In the present study this contention has been investigated in 6 bilaterally adrenalectomized patients and in 6 sex- and age-matched controls who undertook exercise on an ergometer until they were exhausted. No differences were observed in any cardiovascular or metabolic adjustments between the two groups during strenous exercise. Mean plasma insulin concentration fell by about 50% in both groups. Phentolamine effectively abolished the fall in plasma insulin concentration during exercise in 2 adrenalectomized patients. The results suggest that the adrenergic nerves that supply the B-cells have a functional role in man during exercise.

Influence of the sympatho-adrenal system and somatostatin on the secretion of insulin in the rat.

1. The effects of somatostatin on insulin secretion in anaesthetized rats subjected to different manipulations of the sympatho‐adrenal system have been investigated.

Neural vasodilator control in the rectum of the cat and its possible mediation by vasoactive intestinal polypeptide.

Vascular and motor responses in the rectum to pelvic nerve stimulation are described in the anaesthetized cat and compared with corresponding effects observed in the colon. The responses comprise a cholinergic and a non‐cholinergic component, and an attempt has been made to elucidate the latter. Pelvic nerve stimulation evoked a pronounced and well maintained vasodilator response in the rectum whereas that in the colon was transient. Maximal vasodilatation occurred at much lower stimulus frequencies in the rectum (2‐4 Hz) than it did in the colon (8‐16 Hz) and maximal blood flow under these conditions was also greater in the rectum (greater than 200 ml 100 g‐1 min‐1) than the colon (less than 150 ml 100 g‐1 min‐1). Muscarinic blockade further curtailed the colonic vasodilator response to pelvic nerve stimulation, whereas the rectal dilatation was only slightly reduced in the presence of atropine. Pelvic nerve stimulation caused a substantial release of vasoactive intestinal polypeptide (VIP) from the rectum, which was related both in magnitude and duration to the vasodilatation. Intra‐arterial infusions of VIP, which reproduced this rise in rectal venous VIP concentration, caused a rectal vasodilator response which closely resembled that during pelvic nerve stimulation after cholinergic blockade. The rectal vasculature was estimated to be 50‐100 times more sensitive to VIP than the colonic vasculature. VIP therefore seems to be the most likely putative neurotransmitter responsible for non‐cholinergic rectal vasodilatation. Stimulation of the pelvic nerves also caused rapid contractile motor responses before, and more gradual motor responses after, muscarinic blockade in both the colon and rectum, in the latter preceded by a non‐cholinergic relaxation. These patterns of motor activity largely confirm previous results. Infusions of substance P effectively mimicked the non‐cholinergic contractile motor responses but failed to demonstrate significant release of this peptide during pelvic nerve stimulation in the present experiments. However, substance P is rapidly inactivated and might possibly be involved in these responses. Stimulation of the pelvic nerves in bursts at high frequencies (up to 80 Hz), simulating a discharge pattern observed electrophysiologically in vivo, was effective in eliciting all the above responses, with the exception of the colonic contraction.

Alternating from subtotal thyroid resection to total thyroidectomy in the treatment of Graves' disease prevents recurrences but increases the frequency of permanent hypoparathyroidism.

PurposeThis study aims to compare the results of three different surgical techniques in the treatment of Graves’ disease.MethodsAll patients operated on due to Graves’ disease at a single institution between 1985 and 2009 were followed up for a median time of 152xa0months. The same endocrine surgeon operated altogether 265 patients; 111 with bilateral subtotal thyroid resection, 65 with lobectomyu2009+u2009unilateral subtotal resection (Dunhill’s operation) and 99 with total thyroidectomy.ResultsRecurrence of thyreotoxicosis was seen in 11 (9.9%) patients operated on with bilateral thyroid resection, in two (3.1%) of those operated on with Dunhill’s method and in none treated with total thyroidectomy. Permanent hypoparathyroidism was observed in 6% of the patients with total thyroidectomy, in 0.9% of those operated with bilateral subtotal resection and in none of the patients with Dunhill’s procedure (pu2009<u20090.001). The frequency of permanent paresis of one recurrent laryngeal nerve was 2%, 0% and 1.5%, respectively, in the three different groups. At follow-up, thyroxine supplementation therapy was given to 81 (73%) of the patients treated with bilateral subtotal resection, to 58 (89%) of those treated with Dunhill’s operation and to all of those treated with total thyroidectomy.ConclusionsIt is concluded that surgical treatment of Graves’ disease with Dunhill’s procedure, leaving a remnant of 1–2xa0g, seems to minimize the risks of both recurrences and permanent hypoparathyroidism.

VIP (vasoactive intestinal polypeptide)--immunoreactive innervation of the portal vein

SummaryNerve fibres displaying immunoreactivity for vasoactive intestinal polypeptide (VIP) were found in the wall of the portal vein in cats, guinea pigs, rats and mice. In whole-mount preparations a sparse network of VIP fibres was seen in the vessel wall. Electrical field stimulation of the rat portal vein in vitro caused a significant release of VIP. The results suggest that VIP ergic nerve fibres play a role in the regulation of portal blood flow.

Role of vasoactive intestinal polypeptide (VIP) in the neurogenic vasodilatation of the portal vein in the rabbit

A coarse network of nerve fibres displaying immunoreactivity for vasoactive intestinal polypeptide (VIP) was found in the wall of the hepatic portal vein of the rabbit. Electrical field stimulation of the rabbit portal vein in vitro, in the presence of adrenergic and cholinergic blockade, caused a marked relaxation of the vessel and a release of VIP into the perfusate. Addition of VIP to the tissue bath elicited a concentration-dependent inhibition of the mechanical activity of the portal vein. The results suggest that VIP containing neurones might participate in the non-cholinergic, non-adrenergic vasodilatation of the portal vein in the rabbit.

Effects of Food on Plasma Catecholamine and Gastrin Levels in Patients with Duodenal Ulcer and Normal Volunteers

Changes in plasma concentrations of adrenaline, noradrenaline, dopamine and gastrin in response to a standard meal were studied in 6 normal volunteers and 8 patients with chronic duodenal ulcer (DU) disease. Before the meal plasma gastrin and noradrenaline, but not adrenaline or dopamine, were higher in DU patients than in the controls. Food induced significant increments in plasma gastrin and noradrenaline concentration in both groups, whereas plasma adrenaline and dopamine levels remained unchanged. Plasma gastrin and noradrenaline concentrations were higher in DU patients than in the normal controls both during and after the meal. The results do not support the hypothesis that adrenaline is involved in the pathogenesis of duodenal ulcer disease, whereas the role of the increased plasma noradrenaline concentrations in this disease remains unclear.