[Osler's disease - a disease with a wide variety of clinical manifestations deserving multidisciplinary competence]. / Mångfasetterade morbus Osler kräver multidisciplinär kunskap.

Hereditary haemorrhagic telangiectasia (HHT, Osler disease) is an autosomal dominant disease with a prevalence of about 1 in 5 000. The most common symptom is epistaxis in 90 percent of patients, with an average onset at the age of 12 years. Pulmonary arteriovenous malformations are present in 15-35 percent of patients and are associated with embolic complications, such as stroke and cerebral abscesses.  No causative treatment for HHT exists. Iron deficiency anaemia is a common complication. It is treated with oral or intravenous iron replacement depending on the response to tranexamic acid and local treatments. Bevacizumab has been reported to be effective in reducing bleeding complications as well as hepatic and cardiac failure. A multidisciplinary center for the treatment of HHT was established at the University Hospital in Uppsala in 2009.

[Spontaneous coronary artery dissection can cause acute coronary syndrome. Unusual condition that requires thoughtful management and more research]. / Spontan kranskärls-dissektion kan orsaka akut koronart syndrom - Ovanligt tillstånd som kräver genomtänkt handläggning och mer forskning.

Spontaneous coronary artery dissection (SCAD) is a non-traumatic and non-iatrogenic injury occurring in the vessel wall caused by either a primary intimal dissection or a primary hematoma in the medial layer. SCAD is more common among women than men and accounts for a small minority of acute coronary syndromes. The causes of SCAD are multifactorial. Peripartum SCAD is most common. Fibromuscular dysplasia has a strong association with SCAD. As spontaneous healing is common in SCAD and PCI is associated with complications an initial conservative approach should always be considered. Medical treatment is based on the underlying cause. Beta blockers are recommended to all patients. The prognosis varies; the highest mortality is reported among women suffering peripartum SCAD. Quality of life is often affected in SCAD patients and accompanied by a high rate of rehospitalizations. More research which focuses on the underlying causes, optimal treatment and rehabilitation is needed.

Nondestructive detection of decay in living trees.

We used a four-point resistivity method to detect wood decay in living trees. A low-frequency alternating current was applied to the stem and the induced voltage measured between two points along the stem. The effective resistivity of the stem was estimated based on stem cross-sectional area. A comparison within a group of trees showed that trees with butt rot had an effective resistivity that was at least a factor of two lower than that of healthy trees. In tests on several groups of Norway spruce (Picea abies (L.) Karst.) comprising more than 300 trees in total, the method detected butt rot with high accuracy. We validated the method both by measurements and by finite element modeling and simulations.

Difference in mRNA expression and occurrence of plasminogen activator inhibitors in intrauterine decidua of normal and ectopic human pregnancies.

The objective of this study was to elucidate the mechanisms involved in the formation of a functional decidua. The concentrations of plasminogen activators and plasminogen activator inhibitors in intrauterine decidua from normal and ectopic pregnancies were compared. Intrauterine decidua was obtained by curettage from 17 women with ectopic pregnancies and from five women with normal pregnancies. The gestational age was similar in the two groups. The antigen concentrations of plasminogen activators and plasminogen activator inhibitors in decidua homogenate were determined by ELISA and fibrinolytic activity was measured on fibrin plates. Localization was determined by immunohistochemical staining and mRNA was identified by in situ hybridization. Fibrinolytic activity was absent in decidua from normal pregnancies but present in the intrauterine decidua from ectopic pregnancies. High antigen concentrations of the inhibitors of fibrinolysis, PAI-1 and PAI-2, were found in normal decidua in contrast to low concentrations in decidua from ectopic pregnancies. Staining for PAI-1 as well as PAI-2 was positive in decidual cells. In situ hybridization resulted in high intensity signals for PAI-1 as well as for PAI-2 mRNA in decidua from normal pregnancies in contrast to very low intensity signals in decidua from ectopic pregnancies. The absence of proteolytic activity and high expression of PAI-1 and PAI-2 in normal decidua might facilitate attachment of the fertilized ovum and might also prevent detachment of the decidua.