Lars Lööf - Academia.edu (original) (raw)

Papers by Lars Lööf

Lakartidningen, Oct 18, 2016

The County Council's board for new therapies (the NT Council) provides recommendations on the... more The County Council's board for new therapies (the NT Council) provides recommendations on the use of new drugs based on the ethical platform of priorities, founded by the Swedish parliament. The Council has formulated a policy that interprets the parliamentary ethical platform and operationalize its need and solidarity principle and cost effectiveness principle in four dimensions. The NT Council weighs the health economic evaluation of the drug and the four dimensions: the severity of the condition, the rarity of the condition, the effect size and the data reliability to determine the willingness to pay level and whether the platform allows a recommendation for using of the drug. The severity of the condition has a greater impact than the other dimensions. In the assessment of severity there is also a trade-off between prevention and treatment of manifest diseases and in prevention, the size of the risk of falling ill is of importance. A slightly higher willingness to pay level ...

Journal of clinical nursing, Jan 14, 2016

To examine disease-related stress, coping strategies and the need for information and support in ... more To examine disease-related stress, coping strategies and the need for information and support in patients with inflammatory bowel disease (ulcerative colitis or Crohn's disease). Psychological stress is an important factor in ulcerative colitis and Crohn's disease, and therefore coping strategies and support needs should be considered in routine clinical practice. This is a qualitative study using a descriptive interview-based approach. Fifteen patients with ulcerative colitis (n=7) or Crohn's disease (n=8) were interviewed. The interviews were analysed with content analysis. The informants largely focused on disease-related stress (e.g., access to a toilet, symptoms and worries) and relations to other people (various reactions from others and social situations). Behavioural strategies (i.e. taking actions and the need for making plans, prepare and adapt), social strategies (seeking help and information and sharing feelings about the disease with others) and emotional st...

Journal of Clinical Gastroenterology, Sep 1, 1987

Little attention has been paid to methodological aspects in the recording of gastrointestinal sym... more Little attention has been paid to methodological aspects in the recording of gastrointestinal symptoms. We compared a new fixed-point scale for the self-recording of pain intensity with steps operationally linked to behavioral events and with additional monitoring of pain duration--termed the &amp;amp;amp;quot;duration-intensity-behavior scale&amp;amp;amp;quot; (DIBS)--with the visual analogue scale (VAS) in 32 patients with nonulcer dyspepsia. After randomization, the patients either recorded pain intensity (VAS) or pain intensity and duration (DIBS) four times daily during a 4-week period for 1 preliminary week without medication, followed by 3 weeks of antacid treatment. For both scales there was a high degree of compliance, and they seemed equally reliable and sensitive to changes in pain experience. Since DIBS yields more clinically useful information, this scale appears to be preferable for the monitoring of gastrointestinal pain.

Ther Drug Monit, 1980

A 2 year history of severe diarrhea, tiredness, and weight loss in a female patient could not be ... more A 2 year history of severe diarrhea, tiredness, and weight loss in a female patient could not be diagnosed satisfactorily despite repeated and extensive clinical investigations of various kinds. The final diagnosis of laxative abuse was arrived at after identification and quantitation of a bisacodyl metabolite in the urine from the patient. The metabolite was bisacodyl disphenol. The analytical method developed was based on liquid chromatographic determination after hydrolysis of the conjugated metabolite of bisacodyl and selective isolation from the urine. The precision of the method was 5% at the 2.3 microgram/ml level (n = 9) of bisacodyl diphenol, and the absolute recovery was estimated at 80%. The method allowed detection of 0.5 migrogram/ml of the metabolite in urine. After a single dose (10 mg) of bisacodyl to volunteers, urinary concentrations of the metabolite in the range of 1--5 microgram/ml were found. The bisacodyl diphenol recovered in the urine corresponded to 20--30% of the original dose. The urinary concentration of the diphenol derivative in the patient was estimated at 17 microgram/ml.

Journal of Hepatology, Apr 30, 1999

Background/Aims: Patients ,with primary sclerosing cholangitis (PSC) have an increased risk of de... more Background/Aims: Patients ,with primary sclerosing cholangitis (PSC) have an increased risk of developing cholangiocarcinoma (CC), which is notoriously difftcult to diagnose since these patients may have increased levels of bilirubin due to benign strictures. To evaluate the validity of different tumor markers as an aid to diagnosing CC, we have carried out serial serum tumor marker analyses in patients with PSC who have been followed for several years. Methods: Seventy-five patients with PSC, without any clinical signs of CC were included in the study. They were investigated every 6th months for 3 years, with extensive liver function tests and four tumor serum markers CEA, CA 19-9, CA 50 and CA 242. The patients were then followed for 5 years to exclude the possibility that CC remained unrecognized. Results: Of the 75 patients, two (3%) developed CC during the 3-year period. One of these had normal levels, and one had significantly increased levels of the tumor markers. In the follow-up part of the study two P ATIENTS with ulcerative colitis and primary sclerosing cholangitis (PSC) have an increased risk of developing neoplasias in both colon and bile ducts (l-4). Cholangiocarcinoma (CC) is the most frequent liver malignancy in these patients (2). While colon cancers can be screened for with colonoscopies, CC is much more difficult to detect in the early stages. PSC is diagnosed with endoscopic retrograde cholangiography (ERC) in combination with a liver biopsy. PSC is a slowly progressive disease and patients are in

The British Journal of Dermatology, Sep 1, 1996

The occurrence of EG2-positive (EG2+) eosinophils and IgE in biopsy specimens of duodenal mucosa ... more The occurrence of EG2-positive (EG2+) eosinophils and IgE in biopsy specimens of duodenal mucosa and skin from 39 psoriasis patients was studied, with emphasis on the relation to serum eosinophil cationic protein (ECP), serum IgE and the presence or absence of serum IgA and IgG antigliadin antibodies. Psoriasis patients had significantly elevated serum levels of ECP even after exclusion of five of 37 sera which were Phadiatop positive. The elevated serum ECP was not associated with the presence of IgA or IgG antibodies to gliadin. After exclusion of Phadiatop positive sera the serum IgE values did not differ from those of a group of healthy blood donors. Patients with psoriasis had a pronounced increase of EG2+ cells in their duodenal stroma. Patients without antibodies to gliadin tended to have even more EG2+ cells than those with such antibodies and those with increased duodenal intraepithelial lymphocytes. IgE+ cells were present in most duodenal specimens, and in some specimens there were > 100 IgE+ cells/section. The number of EG2+ cells was increased in lesional skin and, in some patients, also in non-involved skin, but there was a more pronounced increase in EG2 reactivity in the duodenal than in the skin specimens. IgE reactivity was increased both in non-involved and involved skin and was significantly related to the number of IgE-positive cells in the duodenal stroma. The results of this study indicate that the gastrointestinal tract and the eosinophil granulocyte might be involved in psoriasis in a hitherto unknown way.

Demographic epidemiology, current drug therapy and the health care resources required by patients... more Demographic epidemiology, current drug therapy and the health care resources required by patients clinically considered to have gastritis were studied during a four and a half year period-October 1978 to March 1983. The investigation was based on data from the Diagnosis and Therapy Survey, an on-going nation-wide sample study covering all out-patient care in Sweden. Gastritis was found to account for 1.9% of all out-patient consultations and for 30% of those for gastrointestinal disorders. The corresponding figures for peptic ulcer disease were 0.2% and 4%, respectively. The estimated minimum number of annual consultations for gastritis was 47 per 1,000 inhabitants. The majority of the consultations were dealt with in general practice, where gastritis was the fifth most common diagnosis. Drug therapy was considered to be indicated in 92% of the consultations. Antacids were prescribed in 77%, anticholinergic/spasmolytic drugs in 36% and histamine H2-receptor antagonists in 4%. The clinical diagnosis of gastritis was found to be the major indication for antacids and anticholinergic drugs and accounted for a substantial proportion of H2-receptor antagonist prescriptions. The patient groups with gastritis and duodenal ulcer showed a similar age distribution, with a mean age of about 50 years. In the gastritis group, the two sexes were equally represented, but in the duodenal ulcer group there was a predominance of men. The results of the Diagnosis and Therapy Survey indicate that the patient group with symptoms traditionally denoted as gastritis in clinical practice constitutes a major health care problem in our community.(ABSTRACT TRUNCATED AT 250 WORDS)

Scandinavian Journal of Gastroenterology, Feb 1, 1982

Bile salt sulphation in liver disease was investigated by measuring the bile salt sulphotransfera... more Bile salt sulphation in liver disease was investigated by measuring the bile salt sulphotransferase level in percutaneous liver biopsy specimens from 27 patients. The same magnitude of mean specific enzyme activity was found in patients with cholestatic and non-cholestatic liver disease. No significant difference of the mean bile salt sulphotransferase activity was found when patients with and without reduced liver function as evidence from the intravenous galactose tolerance test were compared. The present results indicate that induction of liver bile salt sulphotransferase does not occur to a significant extend in clinical conditions with cholestasis.

European Journal of Clinical Pharmacology, 2001

An attempt was made to estimate the total costs of non-ulcer dyspepsia (NUD) in Sweden by extract... more An attempt was made to estimate the total costs of non-ulcer dyspepsia (NUD) in Sweden by extracting information from different available sources. After extrapolation of figures from the in-patient register of the University Hospital in Uppsala to the whole of Sweden, the total annual expenditure for in-patient care was estimated to be 10.3 million SEK. Calculations of costs for out-patient care and drugs were based on data from a nation-wide sample survey, and the total expenses were estimated to be 197.5 million SEK and 60 million SEK, respectively. Among indirect social costs, economic losses due to death and early retirement were found to be comparatively moderate. Production loss due to short-term sick-leave was by far the most dominant item among all social costs. In a study of 88 consecutive patients with NUD, it was revealed that the average NUD patient was responsible for 26 more days of lost production than the average employee. Thus, the total annual cost for short-term sick-leave was estimated to be 2,496 million SEK. The grand total of these calculations amounts to no less than 2,786 million SEK. Although affected by a considerable degree of uncertainty, the presented figures point to important economic consequences for society.

Scandinavian Journal of Gastroenterology, Feb 1, 1979

An investigation of the occurrence of glycolithocholate sulphotransferase in the human gastrointe... more An investigation of the occurrence of glycolithocholate sulphotransferase in the human gastrointestinal tract and kidney is described. In addition to in the liver, glycolithocholate sulphotransferase was found in the small intestine, but no activity could be detected in the gastric mucosa, colonic mucosa, or kidney.

The Journal of Laboratory and Clinical Medicine, Aug 31, 1999

The cytochrome P450 system (CYP) is vital for the oxidation and detoxification of numerous drugs ... more The cytochrome P450 system (CYP) is vital for the oxidation and detoxification of numerous drugs and other xenobiotics in the liver. Many of the CYP enzymes are polymorphically expressed and may be induced or inhibited by xenobiotics including drugs and alcohol. The measurement of gene expression is thus important in studies of the mechanisms of interaction with and function of the CYP system. We have developed a quantitative reverse transcriptase-polymerase chain reaction (RT-PCR) method for the study of the mRNA expression of three CYP enzymes--2E1, 1A2, and 3A4--in snap-frozen percutaneous liver biopsy samples. The method was made quantitative by the introduction of a recombinant RNA internal standard that contains a transcript of the beta-globin gene and sequences specific for the studied CYP enzymes. The method allows the analysis of mRNA expression of several enzymes in as little as 5 mg of liver tissue. Liver tissue specimens from 19 patients with suspected liver disease were analyzed for CYP-specific mRNA expression. The mean mRNA concentrations for CYP1A2, 2E1, and 3A4 were 0.16, 0.74, and 0.32 amol of specific mRNA per nanogram of poly (A+) mRNA, respectively, but a large interindividual variation was observed. CYP3A7 primers were included in the internal standard. However, because of low expression it was not possible to quantitate the enzyme. This quantitative RT-PCR method is of value for studies of the mechanisms of variation and interactions with the members of the CYP enzyme family in healthy and diseased liver and other organs.

J Clin Gastroenterol, 1986

The pattern of sick leave among 88 patients with nonulcer dyspepsia (NUD) and 73 patients with du... more The pattern of sick leave among 88 patients with nonulcer dyspepsia (NUD) and 73 patients with duodenal/prepyloric ulcer disease (DU/PPU) was studied by means of a computerized register held by the National Health Insurance Service, which covered all instances in which patients received cash benefit due to sickness. Patients with either NUD or DU/PPU were associated with a considerably increased risk of being sick-listed. The risk of needing sick days was significantly higher in the NUD group than in the ulcer group (p less than 0.02), and the NUD patients had on an average 2.6 times as many sick days requiring compensation as the corresponding background population. The ulcer patients were absent from work mainly because of their abdominal symptoms; other reasons for sick-leave were rare. On the other hand, the sick-listing among NUD patients was due to a host of complaints, dominated not by abdominal but by musculoskeletal symptoms. Thus, it seems as if several factors other than dyspepsia contribute to the disposition towards absenteeism among NUD patients. Psychosocial factors might play an even greater role in NUD than in DU/PPU patients. The present study contradicts the concept of NUD and DU/PPU as different manifestations or stages of the same disease entity. In view of the high prevalence of NUD, the substantial amount of sickness absenteeism poses a considerable economic burden on society.

J Clin Immunol, 1987

In recent years defective function of the complement-mediated clearance of immune complexes (IC) ... more In recent years defective function of the complement-mediated clearance of immune complexes (IC) has been reported in patients with immune complex disease. The defect has been found at different levels in the clearance system. An important event in this sequential system is the binding of C3-coated particles to C3 receptors on erythrocytes and phagocytes. This study focuses on immunochemical properties of IC-bound C3 that reflect the functional state of the molecule. Sera from patients with primary biliary cirrhosis (PBC), rheumatoid arthritis (RA), and systemic lupus erythematosus (SLE) and from normal subjects were analyzed for their level of C3 precipitable in 2.7% (w/v) polyethylene glycol (PEG). The mean levels for the patient categories were significantly higher than that for the normal subjects. The immunochemical study revealed several differences among the different forms of PEG-precipitable C3. All forms expressed C3(D) antigens which are expressed by immune complex-associated and denatured forms but not by soluble physiological forms of C3. The expression of these antigens was proportionately lower for the complex-associated C3 of PBC compared to that of RA and SLE. Furthermore, employing monoclonal anti-C3(D) antibodies against the C3c and the C3d domain, distinct differences could be detected among all forms of PEG-precipitable C3. Sera from RA and SLE, in particular, contained PEG-precipitable C3 that exhibited distinctive immunochemical features with respect to these epitopes.

Ann Emerg Med, 1986

We randomly assigned 159 patients with non-ulcer dyspepsia, defined as chronic or recurrent epiga... more We randomly assigned 159 patients with non-ulcer dyspepsia, defined as chronic or recurrent epigastric pain without concomitant symptoms of the irritable bowel syndrome and with no evidence of organic disease, to treatment for three weeks with an antacid suspension one and three hours after meals, 400 mg of cimetidine twice a day, or placebo, according to a double-blind, double-dummy model. The intensity and duration of epigastric pain were recorded by the patients four times daily during a one-week period without therapy and during the three weeks of treatment. The mean reduction in pain intensity after three weeks in the placebo group was 25 percent. Neither antacid nor cimetidine treatment resulted in more than a 4 percent better effect. The reduction of pain was statistically significant (P less than 0.01) in all three groups. The time course of the pain scores in the groups receiving active drugs followed closely those in the placebo group, and there were no significant differences between the groups at any stage of the treatment. We conclude that the neutralization or suppression of gastric acid is of no clinical value in patients with this syndrome.

Journal of Clinical Gastroenterology, Jun 1, 1987

Nonucler dyspepsia lacks a clear definition, and probably conceals several entities under this he... more Nonucler dyspepsia lacks a clear definition, and probably conceals several entities under this heading. It seems appropriate to deal separately with symptoms likely to be elicited from the upper digestive tract. Therefore, we propose "epigastric distress syndrome" (EDS) as a designation for chronic or recurrent epigastric pain without any anatomical antecedents and without concomitant symptoms consistent with established criteria of the irritable bowel syndrome. In this study 185 dyspeptic patients with a tentative diagnosis of EDS, based on symptoms and negative upper endoscopy, underwent laboratory screening, peroral cholecystograms, ultrasound scanning of the liver, biliary tract, and pancreas, biopsies from the distal part of the duodenum, and acid secretory tests. There were very few pathological findings. Five patients had gallstones. No single case of chronic pancreatitis or celiac disease was disclosed. Thus, EDS seems to be a "safe" diagnosis, and it is not unreasonable to assume that it could represent a disease entity. Although many patients had symptoms closely similar to those in duodenal ulcer, the mean basal and maximal acid output in this patient category did not differ from that observed among healthy subjects.