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G Hillerdal

Publications and source records attributed to G Hillerdal.

At least 19 recordsLinked to original sources
PubMed2001

[Screening for lung cancer--new possibilities with new methods!].

Screening for lung cancer has been regarded as unwarranted for many years. With new techniques, this is no longer the case. Screening with low dose CT scanning has been used in Japan and New York, among many places, for a number of years. We here describe some results. New lung cancers were found in 0.6 per cent of all participants in both studies at the yearly repeat scan. The tumors have been very small, almost all in Stage I, and survival is very good. Thus, the results are promising, and trials in Sweden will hopefully begin before long.

Controlled Clinical Trials as Topic↗
PubMed2001

Exposure to tremolite asbestos and respiratory health in Swedish dolomite workers.

OBJECTIVES: Deposits of carbonate rock like limestone and dolomite may contain tremolite asbestos. This study assessed the exposure to tremolite asbestos and the respiratory health of Swedish dolomite workers. METHODS: 95% of 137 eligible workers at two dolomite producing companies completed a self administered questionnaire that included questions on respiratory symptoms and were examined with spirometry as well as chest radiography. Total exposure to dust was gravimetrically measured and the tremolite asbestos content of the dust was assessed with polarisation and phase contrast microscopy. RESULTS: Dolomite dust concentrations were moderate (median 2.8 mg/m3) and tremolite asbestos concentrations were generally below the limit of detection (<0.03 fibres/ml). Somewhat higher values, around 0.1 fibres/ml, were obtained in manual stone sorting and bagging. Respiratory symptoms suggestive of chronic bronchitis were more related to smoking than to estimates of individual exposure to dust. The mean vital capacity was 0.2 l lower than expected after adjustment for sex, age, height, and smoking but the decline in lung function was not associated with current or cumulative exposure to dust in a clear cut way. Two definite cases of pleural plaques and one possible case of simple pneumoconiosis were noted, but the plaques could not be attributed exclusively to exposure to tremolite asbestos. CONCLUSIONS: Dolomite mining and milling may indeed entail low levels of exposure to tremolite asbestos, but this exposure was not a strong determinant of respiratory symptoms, lung function, or pneumoconiosis in exposed Swedish workers. This was true also for dolomite dust. The hazards of exposure to tremolite asbestos may vary across deposits, however, and additional studies at other sites of carbonate rock exploitation are warranted.

Adult↗
PubMed1999

The impact of pleurodesis in malignant effusion on respiratory function.

Pleurodesis of malignant pleural effusion provides for a substantially better quality of life compared to onging exudation with the need for repeated evacuation of fluid. Successful pleurodesis leads to permanent cessation of fluid production as a result of the formation of fibrous adhesion between the lung and costal pleura which in theory, however, might restrict lung mobility. In patients with poor lung function, or with need for bilateral pleurodesis, the apprehension of further impairment of lung function often arises. The aim of this study was to evaluate the effects of pleurodesis on lung function. Therefore 10 patients with malignant pleurisy with very limited tumour were investigated. They were without radiological signs of tumour infiltration in the lung parenchyma, without visible tumour growth in the pleural space during thoracoscopy and had undergone a successful one-sided pleurodesis. Respiratory function tests were performed at different times, 1-102 months after pleurodesis. The assessment consisted of: static and dynamic spirometry, exercise testing with blood gas determination and radiospirometry. Spirometric values were slightly low, but in general within the reference limits. Blood gas determination showed no signs of alveolar hypoventilation. Radiospirometry showed a slight attenuation of activity in the treated lung but similar turnover of gas of the treated vs. the untreated side. The study showed that pleurodesis in malignant pleurisy has only minor impact on respiratory function.

Adult↗
PubMed1999

Environmental asbestos exposure and malignant pleural mesothelioma.

Asbestos-related benign and malignant pleural diseases are endemic in some rural parts of central Turkey because of environmental exposure to asbestos fibres. We report here epidemiological data on 113 patients with diffuse malignant pleural mesothelioma (DMPM) diagnosed in our clinic in Eskişehir, located in central Turkey. Of the 113 patients, 59 were men and 54 women (male:female ratio = 1). Ninety-seven patients (86%) had non-occupational asbestos exposure; all were living in villages. Their mean age was 56 years. As the patients had been exposed to asbestos from birth, the latency period was equivalent to the age of the patients. Twenty-eight patients (29%) had lived in villages their entire lives. The other 69 (71%) had been born in a village but migrated to the city or had given up white-soil usage for various reasons. The mean exposure time was 55 years for those with a long exposure period and 25 years for those with a short exposure period, but there was no significant difference between the age of the disease appearance for both groups (55 and 56 years, respectively). Thus, the latency time of mesothelioma due to environmental exposure to asbestos was longer than that due to occupational exposure, but independent of the length of exposure. Soil samples from 67 villages were analysed, comprising a population of 10,120 villagers. Tremolite and some other types of asbestos were found. In conclusion, DMPM in our region is due to mainly to environmental exposure to asbestos. The risk is substantial as a large proportion of the villagers are exposed. After smoking, asbestos exposure is one of the most serious health hazards in our rural population.

Adult↗
PubMed1999

Mesothelioma: cases associated with non-occupational and low dose exposures.

OBJECTIVES: To estimate the importance of low dose exposure to asbestos on the risk of mesothelioma. METHODS: A review of the literature. RESULTS AND CONCLUSIONS: There is no evidence of a threshold level below which there is no risk of mesothelioma. Low level exposure more often than not contains peak concentrations which can be very high for short periods. There might exist a background level of mesothelioma occurring in the absence of exposure ot asbestos, but there is no proof of this and this "natural level" is probably much lower than the 1-2/million/year which has been often cited.

Asbestos↗
PubMed1999

Increased risk for cancer following sarcoidosis.

Little is known about the cancer risk following sarcoidosis. In a retrospective cohort study, we tested the hypothesis of an increased risk for malignant lymphomas, lung cancer as well as cancer in other organs frequently involved in sarcoidosis. Four hundred seventy-four patients from an incidence study 1966-1980 and 8,541 patients identified in the Swedish Inpatient Register (IPR) 1964-1994 were linked to the Cancer Register, the Register of Causes of Death, and the Register of Total Population. Relative risks were estimated using standardized incidence ratios (SIR). The overall relative risks for cancer were similar and elevated in both cohorts (IPR presented), SIR = 1.3; 95% confidence interval (CI) 1.2 to 1.4. For lung cancer and non-Hodgkin's lymphoma, the relative risk was doubled during the first decade of follow-up. Thereafter, the risk for lung cancer was significantly decreased whereas the risk for non-Hodgkin's lymphoma equaled unity. Throughout follow-up, elevated risks were found for melanoma (SIR = 1.6; 95% CI 1.0 to 2.3) and nonmelanoma skin cancer (SIR = 2.8; 95% CI 2.0 to 3.8). An increased risk was also found for liver cancer (SIR = 1.4; 95% CI 0.8 to 2.2). Thus, sarcoidosis appears to be associated with a significantly increased risk for cancer in affected organs. Chronic inflammation is a putative mediator of this risk.

Adult↗
PubMed1999

Malignant mesothelioma due to environmental exposure to erionite: follow-up of a Turkish emigrant cohort.

The incidence of malignant mesothelioma is extremely high in some Turkish villages where there is a low-level environmental exposure to erionite, a fibrous zeolite. The best known example is the village of Karain. However, since epidemiological studies are difficult to perform in Turkey, the incidence and the dose-response curve have not been thoroughly examined. A small cohort of immigrants from Karain who have lived in Sweden for many years were studied. Exposure data, i.e. the time residing in Karain, and hospital records including pathological diagnosis, were recorded. The cohort consisted of 162 people. During the observation time, 18 deaths occurred, 14 (78%) of which were due to malignant pleural mesothelioma. In addition, there were five patients with mesothelioma who were still alive, one of whom had a peritoneal mesothelioma. Thus, the risk of mesothelioma is 135-times and 1,336-times greater in males and females, respectively, than for the same sex and age groups in Sweden. The risk increased with duration of residence.

Adult↗
PubMed1999

Chlamydia pneumoniae may be associated with lung cancer. Preliminary report on a seroepidemiological study.

Material from 117 consecutive patients with lung cancer was investigated with respect to serological markers for chronic Chlamydia pneumoniae infection. Specific C. pneumoniae IgA antibodies were found significantly more often in patients with lung cancer than in control groups with coronary heart disease and in healthy controls, even after adjustment for smoking. The results suggest that chronic C. pneumoniae infection is common in patients with lung cancer.

Aged↗
PubMed1998

Prognostic value of malignant cells in pleural lavage at thoracotomy for bronchial carcinoma.

Despite seemingly radical surgery many patients operated on for bronchial carcinoma will die from their disease. Some patients might benefit from postoperative treatment and a prognostic factor that could identify those with an increased risk for tumor relapse would be of great clinical importance. One possible such factor is the occurrence of malignant cells in pleural lavage performed at operation. To test this hypothesis 224 consecutive patients who had been operated on due to verified or strongly suspected bronchial carcinoma, preoperatively staged as stage I or II, were investigated. After opening the thorax and before manipulation or palpation of the lungs, 300 ml of physiological saline solution was installed into the pleura. After excluding patients who were not radically operated, there remained 138 patients with histologically confirmed lung cancer (carcinoids excluded) and 12.3% showed tumour cells in the washings. Two of 18 patients with metastatic lung disease ( 11%) and one of ten patients with carcinoid tumor also showed malignant cells in the lavage. The patients with lung cancer have been followed for 3 years or until death. After three years 60.2% of those without malignant cells in the pleural lavage were still alive, while this figure was 41.2% in the other group. The difference was not statistically significant. Other factors, such as spread to local lymph nodes, size of tumor, etc. were related to the occurrence of malignant cells in the pleura, and these factors were also better prognostic ones. We conclude that the clinical use of pleural lavage cytology is limited.

Adult↗
PubMed1998

Improved lung function and quality of life following increased elastic recoil after lung volume reduction surgery in emphysema.

Lung volume reduction surgery for severe emphysema with removal of 20-30% of the most destroyed parts of the lung parenchyma has been reported to improve lung function substantially. Increased elastic recoil has been suggested as one underlying mechanism for the improvement. Fourteen patients, seven men and seven women with a mean age of 62 years, who underwent bilateral lung volume reduction surgery have been followed up for 3 months. We here report the data on quality of life, lung function and elastic recoil. FEV1.0 increased by a mean of 26% from 0.581 to 0.731 (P < 0.01). The mean TLC was reduced by 16% from 8.91 to 7.51 (P < 0.001). The level of hyperinflation decreased as implied by a reduction in the ratio of RV to TLC from 0.70 to 0.60 (P < 0.001). The pulmonary elastic recoil improved, with an increase in the transpulmonary pressure at maximal inspiration (PelTLC) from 0.95 kPa to 1.35 kPa (P < 0.05) and an average increase in the coefficient of retraction PelTLC/TLC) from 0.12 kPa l-1 to 0.19 kPa l-1 (P < 0.01). The resting PaO2 increased from a mean of 8.7 kPa to 9.8 kPa (P < 0.01). The patients reported a high degree of subjective improvement according to the St. George's Respiratory Questionnaire and the working capacity on a bicycle increased by 26% from a mean of 38 W to 48 W (P < 0.01). The promising short-term results of lung volume reduction surgery for severe emphysema appear to be related to improved pulmonary elastic recoil.

Aged↗
PubMed1997

[Photodynamic therapy, laser therapy, brachytherapy, stents. Local control of lung cancer].

As only a small proportion of patients presenting with lung cancer can be cured, palliation has a very important place in their treatment. The local effects of lung cancer often entail substantial deterioration of the patient's quality of life. Recent advances in such techniques as laser treatment, brachytherapy, photodynamic therapy and prosthetic stents have enabled important improvements to be made in the control of lung cancer (both primary tumours and metastases). Laser treatment is mainly used to obtain bronchial patency rapidly, but needs to be followed up with other treatments. Photodynamic therapy is confined to the treatment of very small early cancers, but may be curative in such cases. Brachytherapy, the brief introduction of a source of radiation in the bronchi, may be effective both in endobronchial tumours, and in cases where there is compression due to a tumour outside the bronchi. The method can be used repeatedly, even in patients undergoing external beam radiation therapy. Finally, prosthetic stents are increasingly used to maintain bronchial patency, both in malignant and in certain non-malignant diseases. The achievement of optimal results often entails the use of a combination of the various methods, thus necessitating close cooperation between lung specialists, oncologists, radiologists, ENT surgeons and GPs.

Brachytherapy↗
PubMed1997

New principles for the treatment of diffuse pulmonary emphysema.

Emphysema is due to destruction of lung tissue but the main cause of the dyspnoea is a diminished elasticity of the lungs. Medical therapy, such as bronchodilation, corticosteroids, and treatment of intercurrent infections, can give temporary relief. Long-term oxygen treatment can improve and prolong life in patients with severe epmphysema. Lung transplantation is a final option in selected patients. Rehabilitation including exercise training will cause increase in maximal exercise tolerance and decrease of dyspnoea, and thereby an improvement of quality of life. In recent years surgical reduction of the lung volume has been reintroduced and in selected cases given dramatic results. The goal is to reduce the volume in both lungs with about 30%. Depending on the distribution of the emphysema, pieces of the upper or lower lobes will be removed. Sternotomy or bilateral thoracoscopy, using staplers, are the most common methods. Short-term results are good, with an improvement of FEV1 of 22-96%, improved arterial oxygen pressure, and a radical improvement of life quality. The impact on the daily life of the patient can be dramatic. The long-term results are still not well known, and many questions remain before volume reduction surgery can be regarded as an established form of treatment for emphysema, and randomized studies are badly needed.

Humans↗