PubMed Health⌕ Search

Biomedical subjects

G Lindmark

Publications and source records attributed to G Lindmark.

At least 55 records · Page 3Linked to original sources
PubMed1998

Are lymph node micrometastases of any clinical significance in Dukes Stages A and B colorectal cancer?

PURPOSE: The aim was to investigate the significance of lymph node micrometastases in Dukes Stages A and B colorectal cancer. METHODS: Archival specimens were examined from 147 patients (96 colon, 51 rectum; 44 Stage A, 103 Stage B) who had surgery between 1987 and 1994. One lymph node section from each node (colon, 1-11; median, 4; rectum, 1-15; median, 3) was examined with use of an anticytokeratin antibody. RESULTS: Forty-seven (32 percent) patients had micrometastases. At follow-up in June 1996, 23 patients had died of cancer or with known tumor relapse, after a median time of 28 (range, 5-67) months; 8 of 47 (17 percent) patients had micrometastases, 15 of 100 (15 percent) did not. No statistically significant differences were observed according to micrometastases when the results were analyzed with respect to Dukes stage or survival time. The median survival time of living patients with micrometastases was 48 (range, 18-97) months, and for patients without micrometastases, 48 (range, 19-111) months. Six of 96 living patients had a tumor relapse; three of these displayed micrometastases. CONCLUSION: Lymph node micrometastases are not a useful prognostic marker in Dukes Stages A and B and do not imply different strategies for additional therapy or follow-up.

Adult↗
PubMed1998

Ki-ras mutations and prognosis in colorectal cancer.

A total of 191 colorectal adenocarcinomas, obtained from consecutive patients with a median follow-up of 6 years, were studied in order to evaluate the possible association of Ki-ras mutations with tumour stage, tumour differentiation and survival time. Resected full-cross tumour samples were screened for Ki-ras mutations in codons 12 and 13 using temporal temperature gradient gel electrophoresis (TTGE). Ki-ras mutations were detected in 62 (32%) of the samples. The most frequent mutation, observed in 21 samples, was from GGT to GAT changing glycine to aspartic acid in codon 12. The study did not show any association between Ki-ras mutations and Dukes' stage or tumour differentiation. Patients with Ki-ras mutations had a marginally shorter survival time (median 50 months) compared with patients without (median 59 months), but the difference was not statistically significant. The results indicate that Ki-ras gene mutations have no relevant prognostic importance in this cohort of colorectal cancer patients.

Adult↗
PubMed1998

Increased serum p53 antibody levels indicate poor prognosis in patients with colorectal cancer.

Serum p53 antibody levels were analysed using an enzyme-linked immunosorbent assay in serum samples obtained before surgery from 184 consecutive patients with primary colorectal cancer. Possible associations with tumour stage and tumour differentiation and the relation to patient survival time after a median follow-up of 6 years were studied. Analysis of serum p53 antibodies in the entire material demonstrated prognostic value in univariate analysis (P = 0.02); a finding that did not remain (P = 0.07) when the Dukes' stage was included in a multivariate analysis model. When the survival analysis was restricted to the potentially cured patients in Dukes' stages A-C, the serum p53 antibody levels retained independent prognostic value (P = 0.03). No clear association with tumour differentiation was found. We conclude that analysis of serum p53 antibodies may be of value for the identification of patients with different prognoses. This may be of relevance for selection of patients for adjuvant treatment.

Adult↗
PubMed1998

The impact of obstetric risk factors and socioeconomic characteristics on utilization of antenatal care.

BACKGROUND: The objective of the study is to assess the impact of obstetric risk status and defined risk factors on utilization of antenatal care in a Swedish county. METHODS: An area-based, population study was carried out with retrospective review of standardized patient records before (n = 2008) and after (n = 1874) the introduction of a reduced schedule for surveillance of pregnancy. For assessment of individual risk factors a multiple regression model is used. RESULTS: Overall the number of contacts per pregnancy decreased from 13.2 to 11.4. With the reduced routine programme the difference between low-risk and high-risk women increased from 1.1 to 2.7 visits on average. In the multiple regression model socioeconomic characteristics had little influence on the use of antenatal care. Previous obstetric complications increased compliance to the schedule after the programme change. Complications during current pregnancy were important for the number of extra visits planned by the staff. Self referrals were most influenced by symptoms but in-patient care was influenced by multiple factors. The total explanatory ability of the regression model was low for time of first visit to the antenatal care unit and referrals for ultrasound examinations. CONCLUSIONS: With a reduced routine programme the surveillance became better apportioned to obstetric risk. Even a combination of medical or obstetric risk factors with socioeconomic characteristics explain only part of the variation in utilization of antenatal care.

Adolescent↗
PubMed1998

Potentially avoidable perinatal deaths in Denmark, Sweden and Lithuania as classified by the Nordic-Baltic classification.

OBJECTIVES: To analyse which subgroups of perinatal deaths contribute most to the perinatal mortality rate in Lithuania compared with Denmark/Sweden. DESIGN: Comparison of all perinatal deaths in Denmark/Sweden 1991 and Lithuania 1993-1994 by the common Nordic-Baltic perinatal death classification, based on information from the medical records. RESULTS: The doubled perinatal mortality in Lithuania compared with Denmark/Sweden is mainly explained by a threefold increase of intrapartum and two- to fivefold increase in neonatal deaths of nonmalformed infants. The higher rate of malformed infants is partly explained by a four times higher mortality from neural tube defects. CONCLUSIONS: The use of a common perinatal death classification has identified categories mainly responsible for the higher rate of perinatal mortality, but further investigation of potentially avoidable factors requires further study.

Adult↗
PubMed1997

Unplanned pregnancies in Harare: what are the social and sexual determinants?

A hospital-based study was undertaken in Harare, Zimbabwe to estimate the proportion of unplanned or unintended pregnancy among mothers who delivered at the referral hospital and to analyse their socio-demographic pattern and sexual relationships. A case-referent study design was used with systematic sampling of maternity records of mothers who had delivered. Interviews were performed before discharge using a semi-structured questionnaire. Mothers who reported that the index pregnancy was unplanned or unintended constituted the cases, and the referents were those reporting the pregnancy as planned. Out of 923 deliveries, 41% were unplanned and 9% unwanted. The mean age of the mothers was 25 years and women aged 19 or below [Odds Ratio (OR) = 2.2, 95% CI = 1.5-3.2] and 35 or above (OR = 2.8, 95% CI = 1.7-4.6) were significantly more likely to present with unplanned pregnancy. Nulliparous women (OR = 2.4) and mothers with five or more pregnancies (OR = 8.2) had a significantly increased likelihood of the pregnancy being unplanned. Level of education in the mothers studied had no independent association to planning of pregnancy. Unemployed (OR = 14) and single (OR = 7.8), or divorced/separated/widowed (OR = 5.1) women as well as those with low income (OR = 2.1) and whose partner earned no income (OR = 2.2), were more at risk of unplanned pregnancy. Those living with their own parents despite being pregnant were also more likely to report an unplanned pregnancy. In conclusion, there are documentable social and reproductive factors underlying unwanted pregnancy. Risk factors for unplanned pregnancy form a pattern similar to those for maternal mortality. Thus unplanned pregnancy is a major indicator of the presence of factors known to increase the risk of maternal death. Policy makers and health education should address factors contributing to unplanned pregnancy and its prevention in order to prevent reproductive mortality and morbidity. The presence of those factors associated with unplanned pregnancy at booking or delivery should also alert service providers to the need for appropriate contraceptive counselling as part of post delivery care.

Adult↗
PubMed1997

Stromal tenascin distribution as a prognostic marker in colorectal cancer.

A total of 169 colorectal adenocarcinomas, obtained from patients with a median follow-up of 6.5 years, were studied with immunohistochemical staining on cryosections using a monoclonal anti-tenascin antibody to evaluate the possible association between the staining patterns and tumour stage, tumour differentiation and survival. We found two different staining patterns in the tumour stroma--a diffuse stromal fibrillar staining in 92 out of 169 (54%) tumours and a subglandular staining in the remaining 77 tumours. When the entire group of patients (P < 0.01) and the group of potentially cured patients (P < 0.03) were analysed univariately, it was found that diffuse stromal fibrillar staining was associated with a shorter survival time than subglandular staining. In a multivariate analysis, the Dukes' stage and age were independent prognostic factors, whereas the tenascin expression did not retain a clear independent relationship to survival (P = 0.06). Hence, it appears that the tumour expression of tenascin may be a potential prognostic marker in colorectal cancer, in so far as a diffuse stromal fibrillar staining pattern seems to indicate an increased risk of poor outcome. However, after adjustment for age and Dukes' stage, the additional prognostic value of tenascin remains to be established in further analyses.

Adult↗
PubMed1997

Expression of tissue inhibitor of metalloproteinases TIMP-2 in human colorectal cancer--a predictor of tumour stage.

The aim of this study was to investigate whether immunohistochemical staining patterns of tissue inhibitor of metalloproteinases TIMP-2 and matrix metalloproteinases MMP-2 and MMP-9 can be predictors of tumour stage and survival time in colorectal cancer. Frozen tumour sections from 212 patients operated on between January 1987 and November 1990 were investigated. Three mouse monoclonal antibodies--T2-101 against TIMP-2, CA-4001 against MMP-2 and GE-213 against MMP-9--were used. Positive expression of TIMP-2 (a) in basement membranes and (b) diffusely in stroma with (c) subglandular enhancement was found significantly (P < 0.01, P < 0.05, P < 0.05) more often in localized tumours than in tumours with regional or distant metastases. Neither pattern correlated with tumour differentiation. Patterns (a) and (c) correlated with longer survival time (P < 0.05); (b) reached near significance (P < 0.07). When the survival analyses were restricted to potentially cured patients, neither pattern could foretell death from cancer. Positive expression of MMP-2 in tumour epithelium and of MMP-9 in tumour-infiltrating macrophages were both independent of tumour stage and were without correlation with survival time. A large number of MMP-9-positive macrophages correlated (P < 0.05) with poor tumour differentiation, whereas weak or absent epithelial MMP-2 staining reached near significance (P < 0.08). Exploration of TIMP-2 expression is valuable for the discrimination between macroscopically localized and metastatic colorectal cancer, but it cannot predict which of the potentially cured patients are likely to have micrometastases. MMP-2 and MMP-9 stainings are of minor value in staging and prognostic prediction.

Adult↗
PubMed1997

Randomized trial of a biofragmentable bowel anastomosis ring in high-risk colonic resection.

BACKGROUND: Biofragmentable anastomosis ring (BAR) has been proven to be a safe anastomotic device in elective surgery. The use of this anastomotic ring in high-risk patients has not been established. METHODS: During a 5-year period (1990-1995), 100 high-risk patients undergoing colonic resection and suitable for a primary anastomosis were allocated randomly to a standard suture technique or to anastomosis performed with a BAR. High risk was defined as large bowel obstruction, complicated diverticular disease, Crohn's disease, local cancer recurrence, previously irradiated colon, and trauma to the colon or rectum. The patients were equally distributed to the two groups regarding sex, age, emergency surgery and concomitant diseases. RESULTS: In three patients allotted to the BAR group, the device could not be used. There were three (6 per cent) postoperative deaths in each group; none was related to anastomotic problems. Three anastomotic dehiscences were diagnosed, two (4 per cent) in the BAR group and one (2 per cent) in the suture group. Postoperative complications and postoperative recovery were similar. CONCLUSION: This study shows that the BAR anastomosis probably is as safe as the standard band-sewn anastomosis in high-risk colorectal surgery. As the cost of a BAR anastomosis is substantially higher than that for a hand-sewn anastomosis, the latter technique is still the preferred method in the authors' unit.

Adult↗
PubMed1997

Operational factors affecting maternal mortality in Tanzania.

Identification of the main operational factors in cases of maternal death within and outside the health care system is necessary for safe motherhood programmes. In this study, a follow-up was done of all 117 cases of maternal deaths in Ilala district, Dar es Salaam, 1991-1993, at all levels of care. In all, 79% received some medical care whereas 11% arrived too late for treatment. For each case the major operational factors and all health care interventions were defined through interviews with family members and health care staff and from hospital records, and the avoidability of each case was determined. In the health institutions where the women had consulted, the available resources were assessed. It was found that in most cases the husband (29%) or the mother (31%) of the woman decided on her care in cases of complications, and together with the lack of transport, this often caused delay at home. Also, delay in transfer from the district hospital was common. Cases of abortion complications were often not managed on time because of the delay in reporting to hospital or misleading information. Suboptimal care was identified in 77% of the cases reaching health care. Inadequate treatment was identified by the district health staff in 61% and by the referral centres in 12% of their cases. Wrong decision at the district level and lack of equipment at the referral centre were the main reasons for inadequate care. It is concluded that although community education on danger signs in pregnancy and labour is important, provision of the core resources and supplies for emergency obstetric interventions, as well as clear protocols for management and referral, are absolutely necessary for improvement of maternal survival.

Developing Countries↗
PubMed1997

A community-based investigation of maternal mortality from obstetric haemorrhage in rural Zimbabwe. Maternal Mortality Study Group.

In the rural province Masvingo in Zimbabwe, 25% of maternal deaths were caused by obstetric haemorrhage, which had a cause specific maternal mortality rate (MMR) of 40 per 100,000 live births. Forty per cent of cases were due to a ruptured uterus, and 30% to an atonic uterus. Forty-two per cent were more than 35 years old and 44% para 5 or more. In spite of antenatal coverage for 85% of the women, 42% died outside any health facility. Fifty per cent of the women had had no intervention whatsoever before death from haemorrhage. The most important factor for prevention at community level is provision of emergency transport, which would have saved 50% of the women. Other non-health service factors contributing to the adverse outcome were found in actions of the patient herself or a traditional birth attendant. In the health services avoidable factors were identified in 58% of women. More effective antenatal attention to high risk factors, especially high age and parity, appropriate use of maternity waiting shelters, action programmes for management and haemorrhage at all levels, basic resources for resuscitation, improved surgical skills with supervision and available transport for referrals are all necessary parts of a programme to prevent maternal deaths from obstetric haemorrhage.

Adult↗
PubMed1997

Hemoconcentration in smoking mothers is associated with impaired fetal growth.

OBJECTIVE: To examine the effect of maternal smoking on the relationship between maternal hemoglobin levels and pregnancy outcome. DESIGN: A prospective study of healthy parous women from early pregnancy and of their infants. SETTING: Three Scandinavian university hospitals covering all deliveries from well defined geographical areas. SUBJECTS: Smoking (669) and non-smoking (368) mothers, para 1 and 2 and with > or = 37 weeks of gestational length. MAIN OUTCOME MEASURES: Birth weight and placental weight. Ponderal Index and Placental Index as measures of possible discordant fetal and placental growth. RESULTS: In non-smoking mothers the hemoglobin levels in the three trimesters had no relation to birth weight. In smoking mothers a significantly lower birth weight was seen with a high hemoglobin level in the third trimester, but hemoglobin levels in early or mid-pregnancy had no association to birth weight. Smoking mothers also had a significantly greater fall in hemoglobin concentration from first to second and third trimester as compared to non-smokers although ferritin levels were similar in smokers and non-smokers, implying similar iron stores. The ratio of placental weight to the weight of the newborn was significantly higher in smokers, but no association was found to different hemoglobin levels. CONCLUSIONS: Fetal growth impairment associated with maternal smoking is even more pronounced in smoking mothers with high hemoglobin levels in late pregnancy. Smoking mothers were also found to have disproportional fetal/placental growth with relatively high placental weights. In non-smoking mothers hemoglobin levels had no relation to birthweight.

Adult↗
PubMed1997

Intrapartum death of nonmalformed fetuses in Denmark and Sweden in 1991. A perinatal audit.

BACKGROUND: In 1991 the rate of intrapartum death of non-malformed fetuses was higher in Denmark than in Sweden (4.2 vs. 1.9 per 10,000, OR 2.24). However, it is not clear whether this difference reflects potentially avoidable cases and/or suboptimal care. MATERIAL AND METHODS: Short descriptions were made from medical records of all 50 intrapartum deaths in Denmark and Sweden in 1991. Ten obstetricians, two from each of the Nordic countries, reviewed the cases to determine whether (1) intra-uterine death might have occurred before admission, (2) surveillance and intervention were insufficient, (3) fetal death was potentially avoidable by improved obstetric care; and, if so, to suggest ways of improved health care. RESULTS: There was a statistically higher rate of insufficient care (surveillance and intervention) (high or less degree) in the Danish cases (66% vs. 55%). The proportion of potentially avoidable fetal deaths was also higher in Denmark (59% vs. 52%) although the difference was not statistically significant. CONCLUSION: The significantly higher rate of intrapartum death of non-malformed infants in 1991 in Denmark compared to Sweden might be reduced by improved intrapartum surveillance and interventions.

Adult↗
PubMed1997

Short stature: an obstetric risk factor? A comparison of two villages in Tanzania.

BACKGROUND: A short maternal stature is associated with an increased risk of obstructed labor due to cephalopelvic disproportion and most antenatal programs, including that of Tanzania, designate short women as 'at risk'. OBJECTIVE: To determine mean maternal height in two obstetric populations and the effect, if any, of maternity care practices pertaining to maternal height, on interventions and outcome of pregnancy and delivery. METHODS: A community based study of pregnancy outcome for women in two villages in rural Tanzania of different profiles and ethnicity. RESULTS: In Ilula 54% of cesarean sections were in the 4% of women under 150 cm and 39% of short women delivered in hospital. In Ikwiriri 23% of parturients were under 150 cm and height did not correlate to the duration of labor, referral patterns or Cesarean section rates. There are indications that fertility rate is reduced in short women in Ilula but not in Ikwiriri, a result of the problems and risks of Cesarean section for women living in rural areas. CONCLUSIONS: The distribution of maternal height in the population should be considered when the cut-off height for the 'at risk' designation is chosen. The implications of attaching an 'at risk' label is discussed and a call is made for regional specific and agreed risk criteria.

Adult↗
PubMed1997

Fetal growth impairment from smoking--is it influenced by maternal anthropometry?

BACKGROUND: It has been suggested that the effect of maternal smoking on fetal growth is partly mediated through nutritional factors. OBJECTIVE: To assess the effects of maternal smoking on birthweight in term pregnancies among mothers with different anthropometric stature. DESIGN: A prospective study from early pregnancy of healthy parous women and their infants. SETTING: Three Scandinavian university hospitals covering all deliveries from well defined geographic areas. SUBJECTS: Smoking (774) and non-smoking (325) mothers, para 1 and 2 and with > 36 weeks gestational length. MAIN OUTCOME MEASURE: Birthweight. RESULTS: Maternal age, smoking, pre-pregnancy weight, height, body mass index and pregnancy weight gain all independently influenced birthweight. Smoking mothers had significantly lower pre-pregnancy weight and lower body mass index compared to nonsmoking mothers. The negative influence of smoking on birthweight appeared to be uniformly distributed throughout all the different maternal height and weight groups. CONCLUSIONS: Birthweight was negatively related to amount cigarettes smoked per day, and no protective effect could be demonstrated from higher maternal weight, pregnancy weight gain or body mass index.

Body Height↗