Olav Thulesius

Need for Supportive Counselling – the Professionals’ versus the Patients’ Perspective

Background: The aim of the study was to identify melanoma patients who suffered significant distress and were judged to be in need of supportive counselling, on the one hand, and, on the other, to investigate patient interest in such support. Methods: Out of 236 melanoma patients, who constitute a representative sample of melanoma patients in Western Austria, 215 patients participated in the study and were assessed with regard to psychosocial distress, coping strategies, social networks and interest in receiving psychosocial support. Multiple logistic regression analyses were performed with regard to patient interest in receiving psychosocial support either from the attending oncologist or from a mental health professional. Results: 65 patients (30.2%) experienced moderate and 30 patients (14.0%) severe distress, which was predominantly caused by tumour-related fears, tension and disturbance of emotional well-being. 83% of the severely distressed patients wanted psychosocial support from their oncologists, whereas only half of them were interested in additional support from a psychotherapist. In particular, patients who showed fear of tumour progression and felt that they were insufficiently informed about their disease preferred to consult their dermatologist for psychosocial support. On the other hand, patients with poor prognosis, receiving only low levels of support from their social network, and exhibiting a depressive coping style, showed interest in getting supplementary support from a psychotherapist. Conclusions: These findings underline the importance of educating oncologists with a view both to improve their communication skills and to help them identify patients making poor adjustment to illness in order to offer them appropriate emotional support.

Continuous non-invasive finger blood pressure monitoring in children

Tanaka H, Thulesius O, Yamaguchi H, Mino M, Konishi K. Continuous non‐invasive finger blood pressure monitoring in children. Acta Padiatr 1994;83:646–52. Stockholm. ISSN 0803–5253

Circulatory responses in children with unexplained syncope evaluated by continuous non‐invasive finger blood pressure monitoring

Cardiovascular responses on active standing in children with unexplained syncope were investigated with continuous non‐invasive finger artery pressure monitoring (Finapres). We examined 34 symptomatic patients (13 boys and 21 girls), aged 8–16 years, and 24 age‐matched controls. Finger blood pressure and heart rate were monitored continuously for 5 min in the supine position and for 10 min while standing. Ten of 34 patients developed fainting symptoms with hypotension during upright posture (fainters). In the initial standing phase (0–30 s), two prominent abnormal blood pressure responses were found in patients: a marked decrease 45 f 18/23 ± 8 mmHg and a prolonged recovery time (16.5 ± 2.9 versus 27.7 ± 13.6 s), which appeared to be based on impaired vasoconstriction. Either or both abnormalities were observed in 21 (62%) of the 34 patients and in 2 (8%) of the controls. In addition, fainters also had a more marked increase in heart rate during standing compared with non‐fainters. Our findings suggested that more than half of children with syncope had abnormal cardiovascular reflexes in the initial phase which appeared to be associated with vasodepressor syncope. The active standing test with a continuous beat‐to‐beat blood pressure recording has a high sensitivity in detecting abnormalities of autonomic function in patients with unexplained syncope.

Autonomic function in children with type 1 diabetes mellitus

We investigated autonomic function in 58 children and young adults with Type 1 diabetes mellitus (aged 7–22 years, duration from 3 to 18, 8.6 ± 3.4 years) and in 74 healthy controls (6–21 years) using power spectral analysis of blood pressure and heart rate in addition to conventional standard autonomic function tests: deep breathing, the Valsalva manoeuvre, and a standing test. None of the diabetic patients were symptomatic. Reproducibility of the tests was assessed by determining the coefficient of variation in 9 controls (7.8–37.7 %). Thirteen per cent of the subjects had difficulty in adequately performing the Valsalva manoeuvre. After adjustment for age, sex, body mass index, and respiratory frequency, results of the Valsalva manoeuvre and deep breathing were not different between patients and controls and there was no significant postural reduction in systolic blood pressure (≥ 20 mmHg) in the patients. Heart rate variation in the supine position during natural breathing was low in patients, although power spectral analysis of heart rate variation did not show a significant decrease in the power density in the high and the low frequency in patients compared to healthy controls. Beat‐to‐beat blood pressure fluctuation was significantly lower in patients and correlated with metabolic control (mean annual haemoglobin A1c), but not with disease duration and was abnormal in 7 diabetic children (12 %). In contrast, tests of vagal activity were not impaired in the patients in this age range. We concluded that vagal involvement in Type 1 diabetic patients determined by spectral analysis of R–R intervals in addition to conventional tests is uncommon, but that beat‐to‐beat blood pressure variation was more likely to be affected.

Psychosomatic and Psychosocial Symptoms Are Associated with Low Blood Pressure in Swedish Schoolchildren

Background: The relation between psychosomatic and psychosocial symptoms and blood pressure was studied in Swedish schoolchildren. Methods: Blood pressure was measured in 122 healthy Swedish schoolchildren, aged 6–16 years. Psychosomatic and psychosocial symptoms, delinquent behaviour, parental health and employment status were assessed. Results: Children with systolic blood pressure above +1 SD of mean reported significantly less symptoms (x̅ = 1.4) than children with blood pressure below –1 SD of the mean (x̅ = 2.7; p < 0.05). Children with three or more self-reported symptoms had significantly lower blood pressure than children without symptoms both in the supine (110 ± 12 vs. 120 ± 18 mm Hg; p < 0.05) and in the standing position (117 ± 17 vs. 127 ± 18 mm Hg; p < 0.05). Conclusions: We conclude that psychosomatic and psychosocial symptoms in children might be associated with low blood pressure.

Psychosomatic problems and countermeasures in Japanese children and adolescents

In Japan there are a number of children and adolescents with emotion-related disorders including psychosomatic diseases (orthostatic dysregulation, anorexia nervosa, recurrent pains), behavior problems and school absenteeism. According to our previous report, the Japanese children had significantly higher score of physical symptoms and psychiatric complaints than did the Swedish children, and these were more strongly influenced by school-related stress than by home-related stress. To enforce countermeasures for psychosomatic problems in children, the Japanese Society of Psychosomatic Pediatrics (established in 1982) have started several new projects including multi-center psychosomatic researches and society-based activities. In this article, we present an outline of our study on mental health in Japanese children in comparison with Swedish children. Countermeasures including clinical guidelines for child psychosomatic diseases are reviewed and discussed.

Effect of Diabetes on Cooling-induced Detrusor Muscle Contraction: Mediation Via Rho-kinase Activation

OBJECTIVES To investigate the possible involvement of Rho-kinase in cooling-induced contraction of the detrusor muscle. The etiology of diabetic cystopathy is not clear. It may be due to various changes in bladder innervation and/or detrusor muscle dysfunction. Because cooling of urinary bladder smooth muscle normally is a potent stimulus to micturition due to increase in muscle tone, we studied the effects of cooling on normal and diabetic bladder specimens. METHODS Urinary detrusor muscle strips isolated from rats were suspended in organ baths containing Krebs solution for isometric tension recording. Tissue responses to stepwise cooling were examined from normal and 12-week streptozocin-induced diabetic rats. We examined the effects of calcium-free, ethylene glycol bis (beta-aminoethylether)-N,N,N,N,-tetraacetic acid (1 mm)-containing Krebs solution, and the Rho-kinase inhibitor Y-27632 on the cooling responses. RESULTS Stepwise cooling from 37 degrees C to 5 degrees C induced a rapid and reproducible increase in basal tone, proportional to cooling temperature. This response was more pronounced in diabetic specimens. Cooling-induced contractions were significantly inhibited in calcium-free solutions in both control and diabetic bladders. Our investigation showed that the influx of extracellular calcium is important in inducing the cooling response. The Rho-kinase inhibitor Y-27632 (1 microm) inhibited cooling (20 degrees C)-induced contraction. It reduced the response by 52.1% +/- 10.0% in control and by 70.0% +/- 12.0% in diabetic rats. CONCLUSIONS Cooling-induced contractions in control and diabetic detrusor muscle preparations are highly calcium dependant. It also involves activation of Rho-kinase, which might be upregulated in the diabetic detrusor muscle. These results may help in the management of diabetes-induced incontinence due to involuntary detrusor muscle activity.

Thermal reactions of blood vessels in vascular stroke and heatstroke

Research on the pathophysiology and treatment of brain damage with special focus on thermal vascular responses is the subject of this minireview. Interruption of cerebral blood supply by vascular obstruction, temporary cardiac arrest or hyperthermia causes a sudden attack of vascular stroke or heatstroke with serious consequences. It may not induce immediate cell death, but can precipitate a complex biochemical cascade leading to a delayed neuronal loss. When testing thermal vasomotor responses by stepwise cooling of isolated carotid arteries, a temperature-proportional dilatation was observed while heating induced the opposite response: a marked vasoconstriction. General hyperthermia with an increased oxygen demand combined with a reduction of blood supply therefore is a serious consequence. At the cellular level an important mechanism involving hyperthermia is the temperature-dependent regulation of K+ channel tone of vascular smooth muscle. Further, their inhibition through temperature elevation causes vasoconstriction. In heatstroke, which can induce platelet aggregation and the release of the vasoconstrictor serotonin, arterial cooling attenuates this response. General hypothermia is induced to prevent or attenuate neurological damage in stroke. The procedure is not without serious side effects. Therefore, rapid institution of selective brain cooling has been considered in adults and in infants with postpartum encephalopathy.

Human exposures to acrylamide are below the threshold for carcinogenesis

Dose-response calculations for a threshold of carcinogenesis in animal studies do not support the notion that acrylamide (ACR) with the present status of consumption in food is carcinogenic for humans. This is in agreement with the recent reassuring epidemiological studies which have shown a lack of correlation between exposure to ACR in food and the incidence of cancer.

Variant autonomic regulation during active standing in Swedish and Japanese junior high school children

The present investigation is about cardiovascular responses and relevant autonomic function in Swedish and Japanese pubertal children on active standing using non‐invasive continuous beat‐to‐beat finger arterial pressure (FAP) monitoring and power spectral analysis. Examined were 54 Swedish and 57 Japanese children (13–15 years). FAP and heart rate (HR) was continuously recorded in the supine position and during standing. Supine FAP was significantly higher in Swedish compared with Japanese children (121/62 versus 103/53 mmHg, P < 0·001). Swedish children showed a higher increase in arterial pressure and HR upon uprising, resulting in a higher vasoconstrictor index (5·04 ± 0·22 versus 2·31 ± 0·11 mmHg s−1, P < 0·001, respectively). There were also higher increases in arterial pressure and HR in the following steady state period (1–7 min) between the two groups. These differences were also found after adjustment of body weight and height. Frequency domain analysis of HR and arterial pressure variability indicated significantly higher low/high frequency power of HR and low frequency power of arterial pressure. These results suggest that Swedish pubertal children have higher basal blood pressure and enhanced cardiovascular sympathetic responses. These differences in the two cohorts might be caused by genetic factors.