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Biomedical subjects

G Holmberg

Publications and source records attributed to G Holmberg.

At least 19 recordsLinked to original sources
PubMed1992

Multiple renal masses in patients with renal cell carcinoma: diagnostic pitfalls and surgical implications.

Additional renal masses were found in the same or contralateral kidney in 41 of 131 patients with renal cell carcinoma. In 35 of the patients the additional renal masses were simple renal cysts situated in the kidney contralateral to the renal cell carcinoma in 16 patients, in the same kidney in 11 and bilaterally in 8 patients. Four patients had bilateral renal cell carcinomas. One patient had polycystic kidney disease as well as renal cell carcinoma and another patient had a benign tumour in the contralateral kidney. In 3 of the 30 patients with additional renal masses in the kidney contralateral to the renal cell carcinoma the radiologic examinations were insufficient to exclude malignancy. Only explorative surgery could establish a true diagnosis of these masses.

Adult↗
PubMed1992

Diagnostic aspects, functional significance and therapy of simple renal cysts. A clinical, radiologic and experimental study.

Simple renal cysts and renal cell carcinomas constitute the majority of the renal masses disclosed by radiologic methods. The reliability of radiologic diagnosis was studied in patients with different renal mass lesions. Based on the experiences from the study, ultrasonography is recommended when a renal mass is discovered at urography. Computerized tomography and rarely angiography and percutaneous puncture for cytologic examination are necessary when all criteria of a simple renal cyst have not been fulfilled. Forty-one patients with renal cell carcinoma and additional renal masses in the same or contralateral kidney were studied. In 3 patients the radiologic methods were insufficient to establish a definite diagnosis of the additional renal mass occurring in the kidney contra-lateral to the renal cell carcinoma. Only explorative surgery established the true diagnosis. A method for estimating single kidney glomerular filtration rate by gamma camera renography using 99mTc-DTPA was studied. The accuracy and reproducibility was satisfactory when compared to the 51Cr-EDTA clearance reference method. The functional consequences of simple renal cysts and percutaneous puncture were studied by gamma camera renography before as well as after puncture and evacuation of the cysts. Signs of obstruction of the renal outflow were rarely seen. No other effect on renal function was found and percutaneous puncture with evacuation of the cysts did not improve renal function significantly. The therapeutic efficacy of percutaneous puncture and instillation of bismuth-phosphate was compared to percutaneous puncture alone and to the natural course of simple renal cysts. After 24 months there were no significant difference in size between cysts that were only punctured and those that had no intervention. The cysts that were treated with bismuth-phosphate disappeared or diminished with few exceptions. The effects of bismuth-phosphate on the renal parenchyma and renal outflow tract were investigated by microangiography and histopathology in an experimental study. A zone of connective tissue around the deposited bismuth-phosphate was seen and no effects on glomeruli or renal vessels were disclosed. It is concluded that the radiologic diagnosis of simple renal cysts is definite when all diagnostic criteria are fulfilled by ultrasonography or computerized tomography. Simple renal cysts have no effect on renal function. Therapeutic interventions because of simple renal cysts are not indicated in patients without outflow obstruction.

Adult↗
PubMed1990

Renal cell carcinoma in a renal cyst: a case report and review of the literature.

We report a case of renal cell carcinoma within a simple renal cyst in the lower pole of the right kidney. Excretory urography showed a mass and ultrasonography revealed multiple renal cysts with a solid component arising from the wall in 1. This finding also was visualized by computerized tomography. Analysis of the cystic fluid showed a high cholesterol level but negative cytological results. At operation a 7 mm. tumor arose from the wall of the cyst. Histopathological examination showed grade 3 renal cell carcinoma with an aneuploid deoxyribonucleic acid content.

Aged↗
PubMed1989

An educational program on depressive disorders for general practitioners on Gotland: background and evaluation.

General practitioners are the psychiatrists' most important coworkers in the treatment of depressive disorders. A high degree of knowledge about this illness in this group of doctors is of decisive importance. However, the value of postgraduate educational programs for general practitioners has been questioned. The Swedish Committee for the Prevention and Treatment of Depression (PTD) offered an educational program on symptoms, etiology, diagnosis, prevention and treatment of depression to all general practitioners on the Swedish island of Gotland. Lectures on suicide, depressive illness in childhood and in old age and psychotherapy of depressive states were also given. In several control periods data were collected on suicides, referrals to the local psychiatric department, emergency admissions, the quantity of sick leave used and the quantity of inpatient care due to depression. Even the prescription of psychopharmacological drugs on the island was investigated. Overall, the results indicated that general practitioners gratefully accepted the educational program and achieved increasing competence and stringency in treating and preventing depressive states. The program was associated with decreases in the use of psychiatric inpatient care and the sick leave frequency of depressed patients. The possibility of preventing suicides was positively influenced.

Curriculum↗
PubMed1989

Treatment of simple renal cysts by percutaneous puncture and instillation of bismuth-phosphate.

One hundred and fifty-six patients with simple renal cysts had either a percutaneous puncture alone, percutaneous puncture combined with bismuth-phosphate instillation or no intervention at all. At follow-up, 25% of the cysts in which there was no intervention had grown and the mean size showed a slight increase. Ten per cent of the cysts which were only percutaneously punctured disappeared, while the mean size was reduced up to 24 months after puncture. Later, there was no statistically significant difference in change in mean size between punctured cysts and cysts that had no intervention. When puncture was combined with bismuth-phosphate instillation, a gradual reduction was seen in the mean size during the entire follow-up time and 44% of the cysts disappeared. Thirty-six or more months after puncture and instillation, the mean size was only 21% of the original size. It was concluded that percutaneous puncture combined with a bismuth-phosphate instillation is a meaningful treatment of simple renal cysts.

Aged↗
PubMed1988

A comparison of radiologic methods in the diagnosis of renal mass lesions.

The reliability of radiologic diagnosis was studied in 99 patients undergoing ultrasonography, computerized tomography and angiography in work up of renal mass lesions. The diagnoses were confirmed by angiography combined with percutaneous puncture or by surgery. Of the lesions, 37 were simple renal cysts and 56 were renal cell carcinomas. Eighty-eight percent were diagnosed correctly by ultrasonography, 96% by computerized tomography and 84% by angiography. The conclusion is that the radiologic evaluation of a renal mass lesion found at urography should start with ultrasonography. Percutaneous puncture is not recommended if all criteria of a simple renal cyst are strictly fulfilled at ultrasonography. In all other cases a computerized tomography is thought to be mandatory to avoid false negative diagnoses of malignant tumours or other diseases which may need therapy. In some patients a combination with angiography and percutaneous puncture is advised to establish a diagnosis prior to surgery.

Angiography↗
PubMed1988

Sedative effects of maprotiline and amitriptyline.

By means of critical flicker fusion measurements and subjective estimation of drowsiness, experiments with 12 healthy subjects over periods of 8 h showed that maprotiline caused less than half the amount of sedation compared to amitriptyline, both drugs given in single doses of 50 mg. The experiments were blind, randomized and placebo controlled. Implications for clinical use are discussed.

Amitriptyline↗
PubMed1988

Treatment, care, and rehabilitation of the chronic mentally ill in Sweden.

For the last 20 years in Sweden, there has been a trend to integrate psychiatry with general medical services. However, mental hospitals remain the dominant resource for psychiatric care, with psychiatric units in general hospitals providing less than 20 percent of psychiatric hospital beds. The imbalance between the high number of inpatient facilities and the low rate of outpatient visits is beginning to be corrected by the newly introduced sector system, which allocates mental health care resources among geographic zones. The sector system has been criticized, however, because some believe it is fostering disintegration of existing resources and loss of research opportunities. A general spirit of improvement exists, but at the same time the public budget is being squeezed.

Chronic Disease↗
PubMed1987

Anxiety disorders: classification and diagnosis.

Obsessive-Compulsive Disorder and Panic Disorder with or without agoraphobia are emphasized as specific entities that are easily accessible to pharmacological treatment, while more unspecific and heterogeneous syndromes are less predictable in their reaction to treatment. The DSM-III system, not yet official in Sweden, is described and commented on. Agoraphobia has undergone a re-evaluation and should be coupled with Panic Disorder, although the two illness components may have somewhat different genetic and biochemical mechanisms. Obsessive-Compulsive Disorder, on the other hand, should not be listed under Anxiety States, but have a place of its own. The relationship between anxiety and depression is discussed, and it is suggested that there is a clear break between specific affective disorders and specific anxiety disorders, while there may be continuity between Generalized Anxiety and Neurotic-reactive (dysthymic) depression, with mixed cases in between. Still, much work needs to be done in the classification of these disorders.

Adult↗
PubMed1984

Karyometric investigations on urinary bladder carcinoma, correlated to histopathological grading.

The aim of this study is to provide karyometric data which may be of value in the grading of urinary bladder tumours. For this purpose 27 biopsies were studied: four from normal bladder mucosae, eleven from grade I tumours, six from grade II tumours and another six from grade III tumours, according to a I-IV scale. After standardized fixation and plastic embedding, semithin sections were used for light microscopic stereology. Mean profile areas and mean volume densities of the nuclei tended to be higher in the more malignant cases. The nuclear volume densities were significantly higher in grade II than in grade I. The most important finding relates to the large nuclear profiles (greater than 90 microns 2), which were found almost exclusively in grade III tumours. Simple measurements of nuclear size can thus provide objective data to aid in the diagnostic procedure.

Aged↗
PubMed1981

Critical flicker fusion (CFF) test for sedative effect of antidepressants.

It is important to know in which direction and to what extent a drug affects cerebral arousal. Critical flicker fusion (CFF) is a most reliable method for measuring this particular quality of various drugs. A semi-automatic apparatus was used under standardized conditions, and double-blind technique was employed. Only acute experiments are described here. Dose-effect relationship can be demonstrated. The effect on cerebral arousal varies greatly from one antidepressant to another. Amitriptyline and doxepin were found to exert strong sedative effect, and amitriptyline-N-oxide an intermediate one, while imipramine and imipramine-N-oxide lacked this quality. Nomifensine in large doses has a significant stimulant action. Zimelidine in a low dose (75 mg) slightly, but significantly, lowered the CFF level, but at a dose of 150 mg no significant effect was obtained. At the doses 225 and 300 mg a slight increase was seen (about 2%). Various aspects of the findings are discussed in the paper.

Adult↗
PubMed1981

A pilot study of the effect of the 5-HT-uptake inhibitor, zimelidine, on phobic anxiety.

A new antidepressant, zimelidine, which is a selective inhibitor of 5-HT-uptake, was tested in an open study of 13 patients, in each of whom the principal clinical diagnosis was phobic neurosis. The dose varied from 200 to 300 mg daily. After 6 weeks of treatment, 6 patients dropped out of the study as they were not appreciably improved, but 7 patients definitely improved and completed a treatment course of at least 12 weeks. In these cases it was possible to observe subjective relief of symptoms, improved social function, increased working capacity and a reduced need for anxiolytics. The effect appeared similar to the previously described effects of clomipramine treatment. The incidence of side effects was low and those that occurred were mild. Tolerance was assessed as very good by the great majority of patients. The study suggests that zimelidine has a favourable effect on mild, moderate, and even in some severe phobic conditions. Some comparisons with MAO-inhibitors were made. The results are sufficiently encouraging to suggest a controlled study.

Adolescent↗
PubMed1979

Preliminary clinical test of zimelidine (H 102/09), a new 5-HT uptake inhibitor.

Zimelidine, a bicyclic compound, which in animal experiments causes specific inhibition of the uptake of 5-HT, was tried on 15 patients with depression of endogenous type. It produced considerable and highly significant 5-HT uptake inhibition in rat brain slices incubated in blood plasma from the patient under treatment, but no inhibition of NA uptake. Depressive symptoms were effectively relieved or entirely abolished in about two thirds of the patients. Only four patients did not react to the drug, and three of these were probably in need of NA uptake inhibitors, which on other occasions had worked well on their depressions. These three patients showed an extreme degree or retardation. During zimelidine treatment they were not just unaffected but showed signs of excitation, impatience and desperate feelings. These preliminary findings strongly indicate the true existence of depressive cases in need of an NA uptake inhibitor, but completely resistant to a specific 5-HT uptake inhibitor. The final dose of zimelidine was 75 mg b.i.d. This dose, although sufficient in most cases, was obviously somewhat low for a few of our patients. The concentration in blood plasma of zimelidine should probably reach a minimum level of 250 nmol/l and norzimelidine 500 nmol/l, and to achieve this a general dosage of 100 mg b.i.d. is recommended.

Adult↗