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Biomedical subjects

Gunnar Hillerdal

Publications and source records attributed to Gunnar Hillerdal.

14 recordsLinked to original sources
PubMed2005

Phase III trial of gemcitabine plus carboplatin versus single-agent gemcitabine in the treatment of locally advanced or metastatic non-small-cell lung cancer: the Swedish Lung Cancer Study Group.

PURPOSE: This phase III study compared overall survival in patients with locally advanced or metastatic non-small-cell lung cancer (NSCLC) when treated with single-agent gemcitabine versus gemcitabine/carboplatin. Secondary objectives were to compare response, time to progression, toxicity, and quality of life. PATIENTS AND METHODS: Chemotherapy-naive patients received either gemcitabine alone (1,250 mg/m2 on days 1 and 8; gemcitabine arm) or with carboplatin (area under the curve 5 on day 1; GC arm) every 21 days. RESULTS: Demographics and disease characteristics of 334 randomly assigned patients were comparable on both arms. An intent-to-treat analysis showed significantly better overall survival (log-rank P = .0205) and 2-year survival (15% v 5%; P = .009) favoring the GC arm. Per Cox multivariate analysis, only two covariates, treatment arm (GC v G) and baseline performance status (0 or 1 v 2), independently influenced survival. Per-protocol analyses showed significantly longer median time to progression (5.7 v 3.9 months; P = .0001) and significantly higher objective response rate (29.6 v 11.3%; P < .0001) in the GC arm. Grade 3 to 4 leucopenia and thrombocytopenia were significantly more pronounced in the GC arm (P for both variables < .001) but importantly without associated increases in fever, infection, bleeding, or hospitalizations. There was no discernible difference in global quality-of-life patterns between treatment arms. CONCLUSION: In advanced NSCLC, gemcitabine/carboplatin therapy resulted in significant survival benefit compared with single-agent gemcitabine without undue increase in toxicity.

Adult↗
PubMed2005

Hemoptysis and coughing up of staples as a late complication of volume reduction surgery for emphysema.

Three patients with very similar clinical symptoms, i.e. hemoptysis and coughing up of staples some time after volume-reducing surgery, are described. There was no deterioration in lung function, nor in the patient's well-being, which could be ascribed to the coughing up of the staples. Thus, staples can some time after volume reducing surgery erode out into the bronchi and be coughed up, often with some small amounts of blood. This has no clinical significance other than the disturbing symptoms. Possibly, the calf pericardium used as strenghtener of the suture lines will with time cause an immunological reaction, causing destruction of the foreign material and thereby dislodging the staples.

Cough↗
PubMed2005

Comparison of lung volume reduction surgery and physical training on health status and physiologic outcomes: a randomized controlled clinical trial.

STUDY OBJECTIVES: In 1996, researchers in Sweden initiated a collaborative randomized study comparing lung volume reduction surgery (LVRS) and physical training with physical training alone. The primary end point was health status; secondary end points included survival and physiologic measurements. DESIGN: After an initial 6-week physical training program, researchers' patients were randomized to either LVRS (surgical group [SG]) with continued training for 3 months, or to continued training alone (training group [TG]) for 1 year. SETTING: All seven thoracic surgery centers in Sweden. PATIENTS: All patients in Sweden with severe emphysema fulfilling inclusion criteria for LVRS. INTERVENTIONS: Patients randomized to surgery underwent a median sternotomy, except for a few patients in whom thoracotomy or video-assisted thoracoscopy were performed. In the TG, supervised physical training continued for 1 year; in the SG, supervised physical training continued for 3 months postoperatively. MEASUREMENTS AND RESULTS: Fifty-three patients were included in each group. Six in-hospital deaths occurred after surgery (12%), and one more death occurred during follow-up. Two deaths occurred in the TG. The difference in death rates between the groups was not statistically significant. Health status, as measured by St. George Respiratory Questionnaire (SGRQ) [total scale score mean difference at 1 year, 14.7; 95% confidence interval (CI), 9.8 to 19.7] as well as by the Medical Outcomes Study Short-Form General Health Survey (physical function scale score mean difference at 1 year, 19.7; 95% CI, 12.1 to 27.3) was improved from baseline in the SG compared with the TG. FEV(1), residual volume, and shuttle walking test values also improved in the SG but not in the TG after 6 months and 12 months. CONCLUSIONS: In severe emphysema, LVRS can improve health status in survivors but is associated with mortality risk. The effects are stable for at least 1 year. Physical training alone failed to achieve a similar improvement.

Exercise Therapy↗
PubMed2005

Pleuropulmonary lesions, ergotamines and asbestos exposure.

OBJECTIVES: This study investigated the possibility of pleuropulmonary lesions, which can occur as rare but serious side effects of different ergot drugs, occurring more commonly in persons earlier exposed to asbestos. METHODS: All reports of pleuropulmonary side effects of the ergot drugs used in Sweden in the Swedish side effect registry from 1985 to 2003 were studied. In addition, the literature was reviewed. RESULTS: In the registry, 47 men and 3 women were found. Of the men, 24 were exposed to asbestos, and 2 denied such exposure; 2 of the 3 women were exposed. In the literature, 111 patients were found--32 had confirmed exposure and 15 denied it. For most of the patients, it was not possible to determine exposure. CONCLUSIONS: Enough evidence exists to postulate that earlier asbestos exposure in combination with the intake of ergot drugs can cause pleuropulmonary lesions.

Aged↗
PubMed2004

Pleurodesis in recurrent pleural effusions: a randomized comparison of a classical and a currently popular drug.

STUDY OBJECTIVES: Pleurodesis is generally regarded to give the best palliation in recurrent pleural effusion. Talc is now increasingly recommended but in our department quinacrine has been used successfully for many decades with good results and only minor side effects. It was therefore decided to make a prospective randomized clinical study comparing quinacrine (500 mg) with talc (5 g) with regard to efficacy and safety. METHODS: One hundred and ten eligible consecutive patients with recurrent and or malignant effusions, from 1 March 1996 till 31 March 1999 were randomized to chemical pleurodesis with either talc or quinacrine through a chest drainage tube after medical thoracoscopy. Patients were evaluated with chest radiographs at 2 weeks and 2, 4, and 6 months after pleurodesis. RESULTS: Chi-square test showed 84% power to distinguish between the groups and 10% to determine the primary endpoint. Primary success (fluid production < 50ml/24h within the first 6 days) was 96% of 56 patients with talc and 91% of 54 patients with quinacrine, a non-significant difference (P = 0.46). Quinacrine patients needed a repeated treatment in 31% (17 patients) and talc patients in 7% (4 patients) (P < 0.05). Side effects were minor with no significant difference between the substances. CONCLUSIONS: Both substances are effective. Talc treatment had less often to be repeated. This indicates that the recommendation of talc for pleurodesis is well founded. However, quinacrine is a good alternative.

Antineoplastic Agents↗
PubMed2004

Inflammatory parameters after pleurodesis in recurrent malignant pleural effusions and their predictive value.

Recurrent pleural malignant effusion is a common problem which can be treated by inducing symphysis of the pleural sheets. Many different drugs administered into the pleural space can be used to achieve this. The drugs cause an inflammatory response, which in turn is believed to cause the symphysis. Comparatively little has been published on the degree of pleural inflammation and the systemic response and whether this will affect the outcome. The aim of this study was to describe the systemic inflammatory reaction following instillation of a chemical agent into the pleura and to investigate whether this had any predictive value for the outcome (i.e. the pleurodesis). The markers investigated were simple ones: erythrocyte sedimentation rate, C-reactive protein, and leukocyte count from venous blood samples, and the fever reaction. Eighty-nine prospective patients with malignant pleural effusion who underwent pleurodesis with either talc (48 patients) or quinacrine (41 patients) were included in the study. Symphysis was achieved in 82 patients (92 per cent) and all had a prominent transitional elevation of the inflammatory parameters. The unsuccessful attempts caused negligible or very small elevations, but due to the small numbers only the degree of fever after 8 and 48 h showed a statistically significant difference. In conclusion, pleurodesis causes a systemic inflammation and there is a tendency to a correlation between the success of pleurodesis and the degree of inflammation. High fever and high inflammatory parameters including CRP are due to this inflammatory response and do not indicate infection.

Aged↗
PubMed2002

Patient's and doctors' delays in the diagnosis of chest tumors.

BACKGROUND: It is well known that there are delays in diagnosis of lung cancer, both from the patients and from the doctors. We decided to prospectively study this in our area. PATIENTS AND METHODS: All patients with known lung cancer (134 cases) seen at the Department of Respiratory Medicine in Gaevle from February 1, 1997, to February 28, 1998, were investigated prospectively. A questionnaire recorded all symptoms, smoking habits, etc. All dates for visits to doctors and investigations were noted. RESULTS: The mean delay of the patients, i.e. from the first symptom(s) until the GP was contacted, was 43 days (median 21). From the first contact with the GP until referral to the specialist the mean time was 56 days (median 33). From the first visit to the specialist to diagnosis the mean time was 33 days (median 9), with 68% of the patients diagnosed within a month. The mean time from first symptom(s) until treatment or the decision not to treat (the sum of all delays) was 203 days (median 189), i.e. around 7 months. CONCLUSION: The delays are in most instances fairly long. With a planned approach, the delays due to the doctors could probably be shortened.

Adult↗
PubMed2002

A prospective study of a total material of lung cancer from a county in Sweden 1997-1999: gender, symptoms, type, stage, and smoking habits.

The epidemiology of lung cancer is changing in many parts of the world. In the industrialized countries, there is a trend that the incidence in men is declining, while it is increasing for women. Also, adenocarcinomas are becoming relatively more common, especially among men. The purpose of this study was to investigate whether such trends also occur in Sweden and also to describe other aspects of an unselected lung cancer material today, such as symptoms, stage and smoking habits. In the county of Gaevleborg, Sweden, practically all patients with lung cancer are referred to the lung department, and thus a total material of lung cancer patients with only a minimal selection bias can be studied. All patients with lung cancer in the county from January 1, 1997 to December 31, 1999, were investigated prospectively regarding stage, type of cancer, and symptoms. In all, there were 364 patients, 237 (65.1%) men and 127 (34.9%) women. The mean age for men was 69.8 and for women, 68.1 years. 91.9% of the men and 78.6% of the women were smokers or ex-smokers. In general the men were heavier smokers than were the women (P<0.0001). Adenocarcinoma was the most common subtype found in women and squamous cell carcinoma in men. The excess of adenocarcinoma in women was due to never-smoking women; for smoking and ex-smoking men and women, the proportion of adenocarcinomas was the same. In all, 240 patients (68.0%) were diagnosed at Stage IIIb (27.2%) or IV (40.8%), with no significant differences between the sexes. The most common first symptom was cough. Only 7.0% of patients were asymptomatic. In conclusion, the trend of an increasing proportion of adenocarcinoma in lung cancer is seen also in Sweden. A depressingly high percentage of patients present in late stages and are thus inoperable.

Adenocarcinoma↗
PubMed2002

The 'reservoir' of undetected bronchial carcinomas in the general population.

STUDY OBJECTIVES: Autopsy studies have shown that a sizeable portion of lung cancers are never diagnosed and thus not entered into any cancer registry. DESIGN: In 1997, we decided to make all available efforts to find all patients with lung cancer who had not been registered previously. SETTING: The local hospitals in the county of Gävleborg, Sweden. PATIENTS: All patients with lung cancer diagnosed in the county from 1997 to 2000. INTERVENTIONS: In meetings with all the general practitioners of the county, these were asked to refer all suspected cases as early as possible, including those with a seemingly dismal prognosis. This initiative was also covered by the newspapers and the local television station. MEASUREMENTS AND RESULTS: From 1997 onwards, the incidence of lung cancer in the county was found to be 40-50 per 100,000 inhabitants compared with an incidence of about 30 during the ten preceding years. This difference is significant in time (P<0.0001) and is compared with the incidence of lung cancers in four neighboring counties (P=0.002). CONCLUSIONS: There can be a considerable number of patients with lung cancer who are never diagnosed. This can explain differences in survival between various countries and this will also affect the results of screening programs, since the control groups will also include a number of lung cancer cases which will never be recognized.

Carcinoma, Bronchogenic↗
PubMed2002

Computed tomography features in malignant pleural mesothelioma and other commonly seen pleural diseases.

OBJECTIVE: To investigate the computed tomography (CT) features of malignant pleural mesothelioma (MPM) cases, comparing them to those in other malignant and benign pleural diseases. MATERIALS AND METHODS: We reviewed the CT findings of 215 patients; 99 with MPM, 39 with metastatic pleural disease (MPD), and 77 with benign pleural disease. The findings were evaluated in univariate and multivariate analysis for differentiation of pleural diseases. RESULTS: In patients with MPM, the most common CT features were circumferential lung encasement by multiple nodules (28%); pleural thickening with irregular pleuropulmonary margins (26%); and pleural thickening with superimposed nodules (20%). In the majority (70%) of cases, there was rind-like extension of tumor on the pleural surfaces. In multivariate analysis, the CT findings of "rind-like pleural involvement", "mediastinal pleural involvement", and "pleural thickness more than 1 cm" were independent findings in differentiating MPM from MPD with the sensitivity/specificity values of 70/85, 85/67, and 59/82, respectively. "Rind-like pleural involvement", "mediastinal pleural involvement", "pleural nodularity" and "pleural thickness more than 1 cm" were independent findings for differentiation of malignant pleural diseases (MPM+MPD) from benign pleural disease with the sensitivity/specificity values of 54/95, 70/83, 38/96, and 47/64, respectively. Invasion of thoracic structures such as pericardium, chest wall, diaphragm, mediastinum, with pleural disease and nodular involvement of fissures, was detected infrequently; however, since these invasions were not seen in benign pleural diseases, it was concluded these invasions, if detected on a CT scan, directly suggested malignancy. CONCLUSION: A patient has extremely high probability of malignant pleural disease if one or more of these CT findings are found and the possibility of MPM is high. These findings may be important for patients in bad state or patients who do not want any invasive biopsy procedures. It is also possible to identify cases with a low probability of malignant disease.

Asbestosis↗
PubMedDate not supplied

The Swedish experience with asbestos: history of use, diseases, legislation, and compensation.

After World War II, large quantities of asbestos were imported to Sweden and used in construction and ship building. In 1976, the use of asbestos was for practical purposes prohibited. Today, the only exposures are environmental, from asbestos in place and when buildings are demolished or rebuilt, and there are very strict rules for such work. Consequently, it is assumed that the asbestos-related diseases will gradually disappear from society, but due to the long latency time, about 100 mesotheliomas still occur every year in Sweden, and so far there is no certain sign of a decrease in incidence. Compensation is from the state via general insurance and consists basically of compensation for lost income and medical costs.

Asbestosis↗