PubMed Health⌕ Search

Biomedical subjects

A Jakobsen

Publications and source records attributed to A Jakobsen.

At least 73 records · Page 4Linked to original sources

[Costs of care in uremia. How much does kidney transplantation cost?].

The cost of kidney transplantation and hemodialysis have been recorded (in 1986). Tissue typing, operation and initial stay in hospital cost NOK 103,000 per patient, and further treatment for the first year after operation NOK 114,000. Subsequent annual costs were NOK 70,000, mainly for drugs. Hemodialysis costs NOK 287,000 per year. Transplantation was cost-effective by almost NOK one million per patient over a five-year period. If the current high national rate of transplantation (42 patients per million), which keeps both the national waiting list (23 patients per million) and the dialysis population at a low level, is sustained over the next five years, then total national expenditures for dialysis and transplantation are predicted to be approx. NOK 400 millions. If no transplants were performed during this period the waiting list would increase to 175 patients per million, and expenditures (for dialysis) to approx. NOK 750 millions. Additional huge investments would be needed in order to expand the facilities for dialysis. Because of high transplant rate, only 18 per cent of all treated uremics in Norway are now on dialysis, versus 73 per cent in Western Europe. Since transplantation is much cheaper than dialysis, national expenditures per treated patient are lower in Norway than in any other country.

Costs and Cost Analysis↗

Tumor-associated trypsin inhibitor and cancer antigen 125 in pelvic masses.

Tumor-associated trypsin inhibitor (TATI) and cancer antigen 125 (CA-125) were measured pre- and peroperatively in 183 patients with a pelvic mass to elucidate the value of TATI alone and in combination with CA-125 as a differential diagnostic tool. Malignant tumors were registered in 109 patients (90 ovarian and 19 nonovarian cases), borderline ovarian tumors in 8, and benign tumors in 66 (50 ovarian and 16 nonovarian). The TATI level was increased only in half of the patients with malignant tumors; therefore, the marker cannot be used alone as a preoperative diagnostic tool. In contrast, CA-125 had a sensitivity of 82%, which rose to 91% when the marker was used in combination with TATI. CA-125 and TATI had a combined specificity of 76% and positive and negative predictive values of 87 and 83%, respectively. Our results indicate that TATI measurement substantially improves the preoperative differential diagnostic information obtained with CA-125 and that it does not significantly increase the number of false-positive findings. We recommend the complementary measurement of TATI in patients who have a pelvic mass and a normal CA-125 level.

Adenoma↗

Predictive value of CA 125 during early chemotherapy of advanced ovarian cancer.

CA 125 was measured during early chemotherapy of 61 patients with epithelial ovarian carcinomas (FIGO stages III and IV) to determine if patients with a poor response to further treatment could be identified during early therapy. Blood samples were drawn before the start of chemotherapy and 1 month after the first, second, and third courses. Prior to therapy all patients had increased CA 125 levels, but 77% (47/61) had normal antigen levels after the third course. Second-look laparotomy was performed 4-10 months after the third course; 24 patients had no evidence of disease (NED) and 37 had residual tumor (RT). After three courses of chemotherapy, NED patients all had normal CA 125 values, whereas 38% (14/37) of the RT patients had increased antigen levels. In conclusion, increased CA 125 values after the third course of chemotherapy identified 38% of the patients who responded insufficiently to further therapy. Treatment in progress should here be stopped and replaced by palliative therapy if other curative regimens are considered nonexistent. Normal CA 125 values had no predictive value owing to the many (62%) false-negative antigen values.

Antigens, Tumor-Associated, Carbohydrate↗

Is radical hysterectomy always necessary in early cervical cancer?

A semiquantitative histopathologic grading system was used in combination with flow cytometric measurements of tumor cell DNA content to predict the risk of lymph node metastases in early cervical cancer. A retrospective study of 126 stage IB patients showed that a group with no risk of lymph node involvement could be identified by the use of both the histopathologic score and the DNA index. The results were confirmed in a prospective investigation of 59 new patients. Simple hysterectomy may be advised in low-risk patients.

DNA, Neoplasm↗

Tumour-associated trypsin inhibitor (TATI) and cancer antigen 125 (CA 125) in mucinous ovarian tumours.

A tumour-associated trypsin inhibitor (TATI) and the cancer antigen 125 (CA 125) were measured pre- or peroperatively in 30 patients with mucinous ovarian tumours (10 malignant, two borderline and 18 benign) to investigate the separate and combined use of the two markers as a diagnostic tool. In the malignant and borderline cases considered as a whole, TATI was elevated in 83% and CA 125 in 50%. The former marker was increased in one (6%) benign tumour and the latter in another (6%). The combined use of TATI and CA 125 ensured diagnosis of all malignant and borderline tumours. The specificity was 89% and the positive predictive value 86%. In conclusion, in the distinction of malignant and borderline mucinous ovarian tumours from benign ones TATI was a more reliable tumour marker than CA 125. The combined use of TATI and CA 125 ensured diagnosis of all malignant and borderline tumours in the present series.

Antigens, Tumor-Associated, Carbohydrate↗

DNA-index and stereological estimation of nuclear volume in primary and metastatic malignant melanomas: a comparative study with analysis of heterogeneity.

The aim of this study was to investigate the relationship between physical nuclear volume and ploidy level in malignant melanomas, and to analyse the heterogeneity of these two parameters among primary and corresponding secondary tumours. Unbiased stereological estimates of nuclear volume can be obtained objectively by point-sampled intercepts. Using this approach, the volume-weighted mean nuclear volume, nuclear vv, was estimated in ordinary histological sections from 34 primary cutaneous malignant melanomas and their corresponding 62 metastatic lesions. For comparison, DNA-indices (DI) were determined by flow cytometry in adjacent sections from the same paraffin-embedded tumours. Only a poor correlation was found between nuclear vv and DI (Kendall's tau = +0.21). The variability of nuclear vv among metastatic lesions was increased as compared to primary melanomas, whereas averaged mean values of nuclear vv did not differ significantly between the two types of neoplasms. Aneuploidy was not significantly associated with increased nuclear vv. Pronounced intra-patient heterogeneity of nuclear vv was disclosed among metastases and between the primary melanoma and the metastatic lesions. Likewise, no significant association between DI of primary and metastatic melanomas was demonstrated. Heterogeneity of nuclear vv and DI in malignant melanomas is in agreement with the theory of polyclonality.

Aneuploidy↗

Weekly oral idarubicin in postmenopausal women with advanced breast cancer. A phase II study.

Sixty postmenopausal women with advanced breast cancer entered a phase II study, evaluating idarubicin (IDA) in a weekly schedule. Starting dose was 22.5 mg/m2, and median age was 65 years. Five patients were considered ineligible and the response rate among 55 eligible patients was 33%. Median time to treatment failure was 19 weeks and median duration of tumor regression for 18 responding patients was 40 weeks. Hematologic toxicity was moderate and non-hematologic toxicity was mild. The study shows that IDA, administered orally in a weekly schedule, has pharmacodynamic properties comparable to IDA in a 3-weekly schedule and to doxorubicin in the treatment of advanced breast cancer.

Administration, Oral↗

Extracorporeal surgery and autotransplantation for complicated renal calculous disease in 108 kidneys.

One hundred and eight kidneys in 97 patients with staghorn (72%) or multiple pyelocalyceal (28%) calculi were treated by extracorporeal surgery and autotransplantation, and followed up for 1-12 (mean 3) years. Twenty-seven patients had a solitary kidney, and 11 were operated on bilaterally. Sixty-nine % had a history of previous stone surgery, 74% had urinary tract infection and 30% renal dysfunction. Postoperative and late mortality rates were 3.1 and 2.1%, respectively. In addition, three kidneys were lost postoperatively and two later. Only one case of renal calculus recurrence was observed. Sixty-nine per cent of preoperatively infected patients were cured of infection, and 18% improved. Ninety-two per cent of patients with functioning autograft had preserved or improved renal function at follow-up. We find extracorporeal calculus removal a highly effective procedure with an acceptable risk.

Adolescent↗

Radical hysterectomy in cervical carcinoma stage Ib.

We present a retrospective analysis of the results of radical hysterectomy in 115 patients with Stage Ib cervical carcinoma. The recurrence frequency was 10% and the 5-year survival rate was 95%. The prognosis correlated with the presence of lymph node metastases which were found in 14%. The 5-year survival rate was 98% in patients without lymph node involvement and 78% in patients with pelvic lymph node metastases. The operative mortality was zero and the frequency of complications was low. Sixty-nine per cent of the patients had returned to work three months after the operation. Radical hysterectomy of stage Ib patients is recommended as the treatment of choice provided a proper preoperative selection is performed.

Combined Modality Therapy↗

Alpha 1-acid glucoprotein in ovarian cancer with a reference to immunosuppressive acidic protein and cancer antigen 125.

Serum values of alpha 1-acid glucoprotein (alpha 1-AG) were measured by a radial immunodiffusion technique before the primary operation of 60 ovarian tumors and before the second-look laparotomy of 80 ovarian carcinomas. The results were compared with cancer antigen 125 (CA 125) measurements performed in the same samples by a radioimmunoassay or enzymeimmunoassay. The sensitivity and negative predictive value of the alpha 1-AG measurements were low both before the primary operation (37% and 31%, respectively) and the second-look operation (10% and 51%, respectively). Inversely, the CA 125 measurements before the primary operation demonstrated a sensitivity and negative predictive value of 93% and 81%, respectively. In the second-look group the corresponding CA 125 results were 41% and 62%, respectively. The specificity and positive predictive value of alpha 1-AG before the primary and the second-look operation were high and almost identical to those of CA 125 (93%-100%). All patients with increased alpha 1-AG values also had increased CA 125 levels. Alpha 1-AG cannot be distinguished from immunosuppressive acidic protein (IAP) by radial immunodiffusion technique. In conclusion, the alpha 1-AG analyses did not add new information to the CA 125 measurements. The use of alpha 1-AG (or IAP) as a tumor marker in ovarian cancer cannot be recommended.

Antigens, Tumor-Associated, Carbohydrate↗

Ploidy level, histopathological differentiation and response to chemotherapy in serious ovarian cancer.

The ploidy level was measured in tumour specimens from 64 patients with advanced epithelial ovarian cancer (FIGO stages III and IV) by flow cytometric analysis. The same tumours were histopathologically graded based on a score system considering eight histopathological parameters. The results showed that both the histopathological grading index (HGI) and the DNA index were important to the frequency of complete pathological remission as assessed by second look operation. A combination of the two parameters allowed a division of the patients into three groups with different frequencies of complete pathological remission and survival. It is concluded that flow cytometric analysis and extended histopathological grading may be important adjuncts in the evaluation of malignant epithelial ovarian tumours.

Antineoplastic Combined Chemotherapy Protocols↗