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Biomedical subjects

K Tveter

Publications and source records attributed to K Tveter.

At least 19 recordsLinked to original sources
PubMed2001

No randomised trial of prostate-cancer screening in Norway.

The Norwegian Urological Cancer Group (NUCG) decided against participating in the European Randomised Study on Screening for Prostate Cancer, to which they had planned to contribute data from a population of 75 000 men aged between 50 and 65. The plan was abandonned for three main reasons: Norwegian doubts about the statistical power of the trial, the possible ethical implications of screening a large number of men with no symptoms, and the belief that the trial would not produce clinically important results. In this review, the NUCG's reasons for not participating in the trial are discussed in full.

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PubMed2000

[Treatment of renal carcinoma with distant metastases].

BACKGROUND: There is no effective standard therapy for patients with distant metastases from renal cell carcinoma. Physicians should, however, know about the different treatment options and their efficacy in order to adequately inform and treat their patients. MATERIAL AND METHODS: Current relevant literature and experience at the Norwegian Radium Hospital are reviewed with emphasis on systemic therapy. RESULTS: Nephrectomy is indicated if the aim is to palliate or prevent local symptoms due to a large primary tumour, or if the operation renders a patient eligible for a clinical trial. Local symptoms due to metastatic lesions should be managed surgically or by radiotherapy. Hormone treatment and current chemotherapy are ineffective. In selected patients interferon-alpha (IFN-alpha) results in an approximately 15% response rate and 4-6 months' prolongation of life. Combination therapy with interleukins or with other drugs is experimental. INTERPRETATION: Patients with metastatic renal cell carcinoma should primarily be included in clinical trials. If this is not possible, interferon-alpha monotherapy represents today's standard systemic treatment, to be offered to selected and informed patients.

Antineoplastic Agents, Hormonal↗
PubMed1996

[Finanseride in symtomatic benign prostatic hyeprtrophy. A 2-year placebo-controlled study].

The efficacy and safety of treatment with finasteride 5 mg daily for 24 months was assessed in this multicentre double blind placebo-controlled study including 707 patients with moderately symptomatic benign prostatic hyperplasia. Efficacy parameters were changes in voiding- and bladder storage symptoms assessed by a validated symptom score, changes in maximum urinary flow rate and changes in the prostate volume. In the finasteride patients, symptom score improved during the whole study with a significant difference between active treatment and placebo after 24 months (p < 0.01). Maximum flow rate increased in finasteride treated patients resulting in a difference between these and the placebo treated patients of 1.8 ml/s after 24 months (p < 0.01). Prostate volume was reduced by 19% in the finasteride treated patients versus an increase of 12% in the placebo treated patient group (p < 0.01). Finasteride was well tolerated. Patients receiving placebo progressed in symptoms after 16 months. Finasteride can halt the natural progression of moderately symptomatic BPH over a 24 month period.

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PubMed1996

A randomized prospective study comparing long-term intravesical instillations of mitomycin C and bacillus Calmette-Guerin in patients with superficial bladder carcinoma.

PURPOSE: We compared the efficacy and toxicity of long-term mitomycin C versus bacillus Calmette-Guerin (BCG) instillation in patients at high risk for recurrence and progression of superficial bladder carcinoma. MATERIALS AND METHODS: Our randomized comparison study included 261 patients with primary dysplasia, or stage Tis, stage T1, grade 3 and multiple recurrent stage Ta/T1, grade 1 or 2 disease. Mitomycin C (40 mg.) or Pasteur strain BCG (120 mg.) was instilled weekly for 6 weeks, then monthly for up to 1 year and every 3 months during year 2. RESULTS: After a median followup of 39 months 49% of the patients given BCG and 34% given mitomycin C were disease-free (p < 0.03), compared to 48 and 35%, respectively, of those with stage Ta or T1 disease, and 54 and 33%, respectively, of those with dysplasia or stage Tis tumor. Tumor progressed in 13% of patients, with no statistically significant difference observed regarding progression between the mitomycin C and BCG groups. Side effects were more common after BCG instillation, with 5 cases of severe side effects compared to 1 in the mitomycin C group. Treatment was stopped due to toxicity in 10% of the patients. CONCLUSIONS: The majority of patients tolerated long-term intravesical therapy well. BCG instillation was hampered by more frequent side effects. BCG was superior regarding recurrence prophylaxis, since patients given BCG had fewer recurrences and a significantly longer time to treatment failure compared to those treated with mitomycin C. No statistically significant difference was observed regarding progression.

Adjuvants, Immunologic↗
PubMed1996

Randomised study of Casodex 50 MG monotherapy vs orchidectomy in the treatment of metastatic prostate cancer. The Scandinavian Casodex Cooperative Group.

The effect of Casodex (ICI 176,334), a new, once-daily, selective antiandrogen, given as 50 mg monotherapy, was compared with orchidectomy in a randomised, multicentre, open study in 376 patients with metastatic prostate cancer. At 3 months, PSA was reduced by 86% in the Casodex group and by 96% in the orchidectomy group. Treatment failed in 51 patients in the orchidectomy group and 66 showed a subjective response. Treatment failed in 86 patients treated with Casodex and 40 patients showed a subjective response. Patients treated with Casodex maintained their sexual interest better than those in the orchidectomy group. Median survival was significantly longer in the orchidectomy group. Casodex was well-tolerated. The most likely reason for the differences between the groups regarding time to treatment failure and survival is that the dose of Casodex was too small. Further studies with higher doses of Casodex are in progress.

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PubMed1995

Can finasteride reverse the progress of benign prostatic hyperplasia? A two-year placebo-controlled study. The Scandinavian BPH Study Group.

OBJECTIVES: To study if placebo-induced improvement in men with symptomatic benign prostatic hyperplasia (BPH) is maintained over 2 years, and to study the efficacy and safety from intervention with finasteride 5 mg for 24 months. METHODS: This was a multicenter, double-blind, placebo-controlled study involving 707 patients with moderate symptoms of BPH enrolled at 59 centers in five Scandinavian countries. Following enrollment and a 4-week single-blind placebo run-in period, patients were randomized to receive finasteride 5 mg once daily or placebo for 24 months. Urinary symptoms, urinary flow rate, prostate volume, postvoiding residual urinary volume, and serum concentrations of prostate-specific antigen together with laboratory safety parameters were measured at entry and at months 12 and 24. Interim physical and laboratory examinations were performed when indicated clinically. RESULTS: In finasteride-treated patients the total symptom score improved throughout the study, with a significant difference between the two groups at 24 months (P < or = 0.01), whereas in placebo-treated patients, there was an initial improvement in the symptom score but no change from baseline at 24 months. The maximum urinary flow rate decreased in the placebo group, but improved in the finasteride group, resulting in a between-group difference of 1.8 mL/s at 24 months (P < or = 0.01). The mean change in prostate volume was +12% in the placebo group versus -19% in the finasteride-treated group (P < 0.01). Finasteride was generally well tolerated throughout the 2-year study period. CONCLUSIONS: The efficacy of therapy with finasteride 5 mg in improving both symptoms and maximum urinary flow rate and reducing prostate volume has been shown to be maintained during 24 months while patients receiving placebo experienced a return to baseline or deterioration of these parameters during the study. These results demonstrate that finasteride can reverse the natural progression of BPH.

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PubMed1992

Prognostic factors in hormone-resistant progressing cancer of the prostate.

In 224 consecutive patients with hormone-resistant prostatic cancer referred to 2 European Cancer Centres for palliation of painful bone metastases the one year survival for all patients was 24% (2-year survival: 7%). The median survival was 8 months. In univariate analyses the following prognostic factors were identified: performance status, serum creatinine, alkaline phosphatase, duration of response to primary hormone treatment, degree of bone scan involvement and hemoglobin. Multivariate analyses confirmed the four first parameters to be independent factors. A prognostic model was established (no or one risk factors vs 2 risk factors vs 3 or 4 risk factors) based on performance status, creatinine, alkaline phosphatase and hormone response duration. The median survival of these groups was 10 months, 6 months and 3 months, respectively. This model proved to be discriminative in an external data set of 214 patients with hormone-resistant prostatic cancer entered in two prospective trials. The above differences in outcome between readily and simply defined prognostic groups are greater than the differences one can realistically hope to produce using new treatment strategies. These prognostic factors should be taken into account both in the design and interpretation of clinical studies dealing with the treatment of hormone-resistant progressing prostatic cancer and painful bone metastases.

Adult↗
PubMed1991

Early clinical stages of nonseminomatous testis cancer. Evaluation of the primary treatment and follow-up procedures of the SWENOTECA project.

During a 5-year period, 588 consecutive patients with nonseminomatous testicular germ cell cancer were included by 16 hospitals into the Swedish-Norwegian Testicular Cancer Project (SWENOTECA). A total of 370 (63%) had early clinical stages (CS1, CS1Mk+ and CS2A), and 345 (93%) of these patients underwent pathological staging (PS) by retroperitoneal lymph node dissection (RPLND). The overall clinical staging accuracy was 75%, with no significant difference between hospitals with low, medium or high patient accrual rate. Addition of bipedal lymphography did not improve the clinical staging accuracy compared to evaluation of the retroperitoneum by CT alone. Tumor serum markers before and close monitoring of the levels after orchiectomy gave valuable information regarding risk of retroperitoneal metastases. After a median follow-up period of 5 years 30 (13.8%) of 217 patients with PS1 disease relapsed, only 3 of them later than 18 months from the RPLND. Short orchiectomy to RPLND time interval, vascular invasion and absence of teratoma elements in the primary tumour were significant predictors of relapse in PS1 cases according to multivariate analysis. Unilateral RPLND was not associated with higher relapse rate than a bilateral procedure, but significantly reduced the risk of dry ejaculation after RPLND. None out of 122 PS2 patients who received adjuvant cisplatin-based chemotherapy after RPLND relapsed, despite the fact that 37 of them had only undergone a unilateral RPLND. Repeated CT examinations and most routine blood tests except serum alpha foeto protein (AFP), beta subunit of human chorionic gonadotropin (HCG) and lactate dehydrogenase (LD) may safely be omitted in the follow-up period for patients who have been pathologically staged with RPLND, provided that effective adjuvant chemotherapy has been given to the PS2 patients.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1991

Carcinoma of the prostate. Treatment of pain.

Treatment of different types of pain Type A: 1. Diflunisal 500 mg b.i.d./naproxen 500 mg b.i.d. or another NSAID. Satisfactory effect: Continue Partial effect: Continue, but add step 2 No effect: Proceed to step 2 2. Morphine. Conventional tablets/mixture or slow release morphine. Dosage as described above. Nausea is treated with haloperidol 1-5 mg at night. Some patients do better t.i.d. 3. Glucocorticosteroid, as described above 4. Epidural morphine/local anaesthetic Type B: 1. Amitriptyline. Starting dose: 10 mg at night. Increase by 10 mg every other night until the patient has pain relief or experiences unacceptable side effects 2. Nerve blocks, if possible 3. Glucocorticosteroids 4. Strong opioids 5. Epidural opioids/local anaesthetics Type C: 1. Carbamazepine in increasing doses to 200-400 mg t.i.d. 2. Proceed as described for type B Type D: 1. Urinary colic: flavoxolate (Urispadol) 200-400 mg t.i.d. or emepronium bromide (Cetiprin) 200-400 mg t.i.d. 2. Opioids perorally 3. Epidural local anaesthetic (sympathetic block)/opioids.

Analgesics↗
PubMed1989

[New therapeutic alternatives for patients with gallstones].

Calculi in the bile ducts are usually removed by surgery or endoscopic papillotomy. When these methods are contraindicated or fail, new and non-surgical alternatives can now be used. Percutaneous transhepatic balloon dilatation of the papilla of Vater enables expulsion of stones in the bile duct. Large stones in the bile ducts can be reduced in size using extracorporeal shock waves or completely dissolved by instillations of Methyl-tertiary-butyl ether in the common bile duct. We report the cases of three patients who were treated successfully for stones in the bile duct using combinations of these techniques.

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PubMed1989

Enhanced high energy phosphate recovery with ribose infusion after global myocardial ischemia in a canine model.

High energy phosphate levels are depressed following global ischemia and require several days to completely recover. Short-term methods to enhance ATP recovery have included infusion of ATP precursors, inhibition of enzymes that catabolize AMP, and membrane transport stabilization. Several precursors have been used to augment adenine nucleotide synthesis including adenosine, inosine, adenine, and ribose. Because of the short-term nature of previous experiments, recovery had been incomplete and the effects in the intact animal unknown. The purpose of this study was to determine the effects of ribose infusion in a long-term model of global ischemia and attempt to identify the precursor which limits myocardial ATP regeneration in the intact animal. Global myocardial ischemia (20 min, 37 degrees C) was produced in dogs on cardiopulmonary bypass. With reperfusion either ribose (80 mM) in normal saline or normal saline alone was infused at 1 ml/min into the right atrium and the animals were followed for 24 hr. Ventricular biopsies were obtained through an indwelling ventricular cannula prior to ischemia, at the end of ischemia, and 4 and 24 hr postischemia and analyzed for adenine nucleotides and creatine phosphate levels. Radiolabeled microspheres were used to measure myocardial and renal blood flows and no significant difference was found between ribose-treated control groups. In both groups, myocardial ATP levels fell by at least 50% at the end of ischemia. No significant ATP recovery occurred after 24 hr in the control dogs, but in the ribose-treated animals, ATP levels rebounded to 85% of control by 24 hr.(ABSTRACT TRUNCATED AT 250 WORDS)

Adenosine Triphosphate↗
PubMed1988

Distribution of Thyroliberin (TRH)- and 12-O-tetradecanoylphorbol 13-acetate (TPA)-activated adenylyl cyclase in normal and neoplastic tissue with special reference to the prostate.

Tissue specificity of the Thyroliberin (TRH)- and 12-O-tetradecanoylphorbol 13-acetate (TPA)-sensitive adenylyl cyclase has been studied using normal or neoplastic organ samples or cells from the pituitary gland, stomach, prostate, myocardium, liver and bone. It appeared that TRH stimulates the adenylyl cyclase in both normal (basal cells), hyperplastic and adenocarcinomatous prostate as well as in the pituitary and stomach. TPA also stimulated the enzyme from the prostate and other organs/cells, but to a greater extent in neoplastic tissue. Functional links from protein kinase C to adenylyl cyclase and from protein kinase C to tyrosine kinase/oncogene expression have been established. Hence it is believed that TRH, which stimulates the adenylyl cyclase and protein kinase C in the pituitary, may serve as a factor contributing to transformation of prostatic cells or enhanced cell proliferation in prostatic cancer.

Adenylyl Cyclases↗
PubMed1986

Long-term survival and morbidity in patients with metastatic malignant germ cell tumors treated with cisplatin-based combination chemotherapy.

Forty-three of 79 patients treated for clinically metastatic germ cell cancer survived for a median of 66 months (range, 52-83). In patients without previous chemotherapy the 5-year survival rate was 69%, whereas only 32% of patients with prior chemotherapy survived for 5 years. Limited disease, complete clinical response, histopathologically proven postchemotherapy tumor necrosis or complete resectability of a posttreatment mature teratoma indicated a favorable prognosis in patients without prior chemotherapy. Only 20% to 30% of the patients with less than a clinical complete response or with posttreatment residual malignant tumor can be salvaged by second line therapy. Posttreatment mature teratoma should be resected completely whenever possible, as this condition may lead to reactivation of the malignancy even after several years. Raynaud-like phenomena and/or gastrointestinal problems are the main long-term sequel (10%-15%) after modern multimodality treatment of advanced germ cell cancer (fertility-related problems are not considered here). In the majority of surviving patients, the lifestyle seems unaffected by the previous intensive treatment, evaluated about 5 years after discontinuation of all therapy.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1986

Treatment of T2/T3 bladder carcinoma: total cystectomy with and without preoperative irradiation.

Total cystectomy with or without preoperative radiotherapy was performed in 122 patients with T2/T3 bladder carcinoma (group 1:42 patients, 23 X 2 Gy; group 2:34 patients, 5 X 4 Gy; group 3:46 patients, 0 Gy). Crude and disease-free survival was 40 and 54%, respectively, in this retrospective study. No survival difference was observed between the different groups. 'Stage reduction' in the cystectomy specimen (P less than T) was the only significant prognostic parameter and was seen in 24, 15 and 18 patients from groups 1, 2 and 3, respectively. Distant metastases were found in 47 patients during follow-up, equally distributed between the 3 groups, but significantly less often in patients with 'stage reduction'. In patients with T2/T3 bladder cancer, the role of precystectomy radiotherapy remains undefined, though there might be a nonidentifiable subgroup of patients (about 20%) who probably benefit from preoperative irradiation. Preferably short-term radiotherapy should be applied. As distant metastases represent the most common reason for treatment failure after total cystectomy, the role of adjuvant systemic chemotherapy has to be explored in further clinical studies.

Carcinoma↗
PubMed1983

Changes in oncotic pressure, osmolality and electrolytes following transurethral resection of the prostate using glycine as irrigating solution.

Thirteen patients undergoing resection of benign prostatic hyperplasia were given furosemide 40 mg at the end of the procedure. The changes in body weight, colloid oncotic pressure (COP), osmolality, electrolyte concentrations and several haematological variables were compared with the values of 13 patients treated similarly, but without furosemide. During the operation there was an estimated mean absorption of 300 ml of irrigating fluid (glycine 1.5%). There was a significant peroperative decrease in serum sodium concentration, osmolality, COP, and haemoglobin concentration in both groups. The furosemide group had a more rapid return of COP towards preoperative values, and this group did also approach the preoperative weight more rapidly than the control group. In 10 selected patients variations in the total aminoacid pattern were measured. There was a significant increase in glycine concentration, with the maximum increase ten times the preoperative value. In the absence of uncontrolled bleeding, the resorption of fluid during TUR leads to hypervolemia and reduction in serum sodium and COP. This may lead to the TUR syndrome, as illustrated by one of our patients. Treatment in the symptomatic patient consists of reduction of circulating blood volume and when this is achieved, hypertonic saline may be beneficial if there are neurological symptoms.

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