Sven Larsson

Long-term follow-up of patients with untreated scoliosis. A study of mortality, causes of death, and symptoms.

The mortality and causes of death in 115 patients (80 women), born 1902–1937, with untreated scoliosis were compared to the expected according to official Swedish statistics. Subgrouping for cause and onset of scoliosis was done. Fifty-five patients had died; 21 of respiratory failure and 17 of cardiovascular diseases. The mortality was significantly (P < 0.001) increased. The increased risk was apparent at 40–50 years of age. The mortality was significantly increased in infantile (P < 0.001) and juvenile (P < 0.01) scoliosis but not in adolescent scoliosis. The mortality was also increased in post-polio scoliosis, scoliosis combined with rickets and scoliosis of unknown etiology indicating an increased mortality in idiopathic scoliosis. Among the surviving patients anti-hypertunsive treatment was frequent (23 of 50).

Circulating cell adhesion molecules in bronchial lavage and serum in COPD patients with chronic bronchitis

The initial phase of inflammation in bronchial asthma appears to be triggered by the expression of leucocyte-endothelial adhesion molecules on endothelial cell surfaces. Cell adhesion molecules (CAMs) cause adhesion of leucocytes to the endothelium prior to their subsequent extravasation into inflamed tissue. We wanted to determine whether circulating intercellular adhesion molecule-1 (cICAM-1) and circulating E-selectin (cE-selectin) could be detected in bronchial lavage fluid and serum in patients with stable chronic obstructive pulmonary disease (COPD) and chronic bronchitis. Bronchoscopy and small volume bronchial lavage was performed in 19 patients with COPD and chronic bronchitis and in 13 control subjects. We found increased mean levels of cICAM-1 both in serum (481 micrograms.l-1) and in bronchial lavage (24 micrograms.l-1) in the COPD patients as compared to the controls (321 micrograms.l-1 in serum, 15 micrograms.l-1 in lavage). We also found higher mean levels of cE-selectin in serum from the COPD patients (86 micrograms.l-1) compared to controls (50 micrograms.l-1). The serum levels of cE-selectin correlated significantly with lung function measured as forced expiratory volume in one second (FEV1) in percentage of predicted. Patients with significant intrabronchial bacterial colonization had increased levels of serum cE-selectin. Our results indicate that cCAMs may reflect an upregulation of CAMs on endothelial and epithelial airway cells in COPD.

Quality of life of patients treated by home mechanical ventilation due to restrictive ventilatory disorders.

The quality of life of patients with hypoventilation and home mechanical ventilation (HMV) has not been well described. Modern quality of life assessment techniques were therefore introduced in a cross-sectional study of patients treated with HMV. The aim was to study various aspects of the patients quality of life and relate them to the underlying diseases, blood gases and the type of ventilatory connection. The study comprised 39 patients, most of them ventilated only during the night (n = 35). Nasal ventilation predominated (n = 29). Patients treated with HMV reported satisfactory levels of both psychosocial functioning and mental well-being that compared well with a general population group. Their quality of sleep was generally good. The quality of life measures were mainly influenced by the patients underlying disease. Patients with scoliosis expressed in almost all instances the best quality of life. The quality of life of patients with ventilation by tracheostomy was reported to be at least as good as that of patients with nasal ventilation. The global quality of life estimation was mainly determined by the mental state of the patients and their sleep quality and only to a minor extent by physical handicaps. In conclusion, the patients treated with HMV reported good psychosocial functioning and mental well-being, in spite of severe physical limitations and dependence on regular nocturnal ventilation.

Respiratory Failure in Scoliosis and Other Thoracic Deformities: A Survey of Patients with Home Oxygen or Ventilator Therapy in Sweden

Registers covering Swedish patients with home ventilator or long-term oxygen therapy were used to Study respiratory failure caused by thoracic deformities. In all, 107 patients were studied. Postpolio scoliosis was found in 47 patients. The age of starting therapy varied between 28 and 80 years. Fourteen patients had thoracic deformities other than scoliosis. The mean scoliotic angle was 135° among the patients with scoliosis, and the mean vital capacity was 26% (range, 13–54%) of predicted normal. The yearly demand for horns ventilator or oxygen therapy is calculated to three per million inhabitants. No operated patients had respiratory failure, and no patients were found with idiopathic scoliosis and respiratory failure younger than 30 years of age, which may indicate a preventive effect of corrective surgery on the development of respiratory failure.

Preventing exacerbations of chronic bronchitis and COPD

Papers p 1271 nnExacerbations of chronic obstructive pulmonary disease affect quality of life and the cost of managing the disease. Though the long term effects of hypersecretion on the deterioration of ventilatory function in patients with chronic obstructive pulmonary disease have been debated for many years,1 recent data show a good correlation between hypersecretion and long term deterioration of ventilatory function in these patients.2 This is why mucolytics, which seem to have an effect on hypersecretory exacerbations,3 might also influence disease progression in chronic obstructive pulmonary disease. Exacerbations are important events for patients with chronic bronchitis in that they negatively affect quality of life.1 Exacerbations also have socio-economic consequences.2 Therapies aiming at reducing the occurrence and severity of exacerbations are therefore of interest.nnThe Cochrane review in this weeks issue of the BMJ reports a meta-analysis of drugs considered to have mucolytic effects (p 1271).3 Twenty two studies of 10 drugs were included. Treated patients showed a significant reduction over controls in the number of exacerbations …

Circulating leukocyte adhesion molecules in stable asthma and nonobstructive chronic bronchitis.

Leukocyte adhesion molecules have been associated with airway inflammatory diseases such as asthma and obstructive chronic bronchitis. Lately, it has become possible to measure circulating forms of cell adhesion molecules ‘cCAMs) in body fluids. Elevated serum levels have been found in acute asthma and in obstructive chronic bronchitis. We investigated whether the patterns of cICAM‐1, cVCAM‐1, and cE‐selectin could serve as markers for airway inflammation in stable asthma and stable nonobstructive chronic bronchitis. Small‐volume bronchial lavage ‘BL) and serum from 15 controls, 13 asthmatics without steroid inhalation therapy, 11 asthmatics with regular steroid inhalation therapy, and 10 smokers with chronic bronchitis were analyzed. We found cICAM‐1, cVCAM‐1, and cE‐selectin to be present in serum from patients with stable asthma and stable nonobstructive chronic bronchitis. Only cICAM‐1 was found in BL fluid. No differences were seen between the subject groups for either cCAM, but levels of ECP were increased in the non‐steroid‐treated asthmatic group. Subject atopy or smoking did not increase the cCAM levels. In conclusion, the degree of airway inflammation in stable nonobstructive chronic bronchitis and stable asthma does not appear to be well associated with circulating ICAM‐1, cVCAM‐1, and cE‐selectin.

Life values in patients with COPD: relations with pulmonary functioning and health related quality of life.

Theories of coping and response shift have suggested that emotional adaptation is related to value changes, e.g. a deemphasized importance of lost life values and an enlargement of the scope of values. Perceived attainment and importance of 82 life values were examined in 65 patients with chronic obstructive pulmonary disease (COPD) and related to clinical and Health-Related Quality of Life (HRQL) measures. The life values covered 10 dimensions – harmony, positive relations, involvement, mobility, communication, knowledge, responsibility, comfort, religion and health. Forty-six of the patients were followed up after 1 year. The patients with COPD were compared with a healthy control group, a group of neurologically impaired and a non-disabled group representing the general population. Significant congruence was found between importance and attainment ratings in all groups (correlations from 0.44 to 0.53), suggesting that both impaired and healthy persons tend to perceive that they have what they find important in life. Congruence was significantly related to mood (correlations from 0.28 to 0.40), but not to functional status or clinical data. Compared to the healthy responders, the patients with COPD had significantly lower attainment ratings in health, mobility, involvement, but no differences were found for importance ratings. No evidence was found that they had replaced unattainable values with new available values, and no changes over time of perceived values were found. This suggests that patients with COPD do not seem to adapt by means of changing their value orientation.

Cutaneous delayed-type hypersensitivity reactions in smokers with chronic bronchitis and recurrent exacerbations: comparison with asymptomatic smokers and never-smokers

The aim of the present study was to investigate whether smoking patients with chronic bronchitis (CB) and recurrent exacerbations show signs of depressed cell-mediated immunity (CMI), as reflected in the cutaneous delayed-type hypersensitivity (DTH) reaction, in comparison with asymptomatic smokers and healthy never-smokers. The study was a comparative clinical study performed at a university hospital center of respiratory medicine. Sixteen smokers with stable CB and recurrent exacerbations, five of whom had mild airflow obstruction, 18 asymptomatic smokers and 18 healthy never-smokers, all aged between 35 and 64 years, participated. No subjects treated with corticosteroids or N-acetylcysteine were included. Cutaneous DTH-reactions to seven recall antigens were assessed with Multitest, a standardized in vivo test of clinical CMI. Reactions were assessed 48 h after application by measurement of skin induration. A score (sum in mm of positive reactions) was created to assess overall reactivity. Neither the score nor the number of positive reactions differed significantly between the three study groups. Men had a significantly higher reactivity than women (P < 0.05) irrespective of group affiliation. No influence of smoking status on DTH reactivity could be seen. In the CB group no correlation was found between DTH reactivity and number of exacerbations the past 2 years. Patients with chronic bronchitis and recurrent exacerbations did not differ from asymptomatic smokers or healthy never-smokers with respect to cutaneous DTH reactions. Depression of CMI, as measured in this study, does not seem to be a primary factor behind recurrent exacerbations in smokers with CB.