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Biomedical subjects

M Aström

Publications and source records attributed to M Aström.

At least 19 recordsLinked to original sources
PubMed2006

Attitude towards remission induction for elderly patients with acute myeloid leukemia influences survival.

Combination chemotherapy may induce remission from acute myeloid leukemia (AML), but validated criteria for treatment of elderly are lacking. The remission intention (RI) rate for elderly patients, as reported to the Swedish Leukemia Registry, was known to be different when comparing the six health care regions, but the consequences of different management are unknown. The Leukemia Registry, containing 1672 AML patients diagnosed between 1997 and 2001, with 98% coverage and a median follow-up of 4 years, was completed with data from the compulsory cancer and population registries. Among 506 treated and untreated patients aged 70-79 years with AML (non-APL), there was a direct correlation between the RI rate in each health region (range 36-76%) and the two-year overall survival, with no censored observations (6-21%) (chi-squared for trend=11.3, P<0.001; r2=0.86, P<0.02, nonparametric). A 1-month landmark analysis showed significantly better survival in regions with higher RI rates (P=0.003). Differences could not be explained by demographics, and was found in both de novo and secondary leukemias. The 5-year survival of the overall population aged 70-79 years was similar between the regions. Survival of 70-79-year-old AML patients is better in regions where more elderly patients are judged eligible for remission induction.

Acute Disease↗
PubMed2004

Granulocyte-macrophage colony-stimulating factor to increase efficacy of mitoxantrone, etoposide and cytarabine in previously untreated elderly patients with acute myeloid leukaemia: a Swedish multicentre randomized trial.

A total of 110 patients, aged 64 years or over, with de novo acute myeloid leukaemia (AML) and white blood cell counts <50 x 109/l were treated with 3 d of cytarabine 1 g/m2 twice daily, mitoxantrone 12 mg/m2 and etoposide 200 mg/m2, randomized with or without the addition of granulocyte-macrophage colony-stimulating factor (GM-CSF) 200 microg/m2. The primary aim was to evaluate the effect of GM-CSF on the remission rate. Secondary aims included comparison of duration of remission, survival and infectious complications and the impact of maintenance therapy with thioguanine. Complete remission (CR) was achieved by 64% of patients without GM-CSF, and by 65% of patients who received GM-CSF, the median remission duration was 13 vs. 6 months, the median overall survival (OS) was 14 vs. 9 months, the mean time to neutrophil recovery was 25 vs. 17 d (P = 0.03) and the number of positive blood cultures was 46 vs. 39 (P = 0.05) respectively. The impact of thioguanine remains unanswered since only 30 patients remained in CR after consolidation therapy. We conclude that induction therapy is feasible with acceptable toxicity in elderly patients with AML, albeit with a high relapse rate and short OS. GM-CSF prior to, and in combination with, induction treatment reduced the time to neutrophil recovery and the number of neutropenic septicaemia cases but did not improve the OS of AML in the elderly.

Acute Disease↗
PubMed2003

Detection of body position changes using the surface electrocardiogram.

A method for detecting body position changes that uses the surface vectorcardiogram (VCG) is presented. Such changes are often manifested as sudden shifts in the electrical axis of the heart and can erroneously be interpreted as acute ischaemic events. Axis shifts were detected by analysing the rotation angles obtained from the alignment of successive VCG loops to a reference loop. Following the rejection of angles originating from noise events, the detection of body position changes was performed on the angle series using a Bayesian approach. On a database of ECG recordings from normal subjects performing a predefined sequence of body position changes, a detection rate of 92% and a false alarm rate of 7% was achieved.

Adult↗
PubMed2001

Effect of ditching operations on stream-water chemistry in a boreal forested catchment.

The effects of ditching of boreal forest land on stream-water quality and quantity was assessed by comparing, over a 4-year-period, the physicochemical properties of the water in two small streams (western Finland), one whose catchment was ditched for forestry halfway through the sampling period and another nearby (control) stream whose catchment was not ditched ('paired catchment method'). While the artificial drainage did not have any significant effect on the hydrograph, it resulted in an increase in the aquatic concentrations of Mn, Ca, Mg, suspended material and alkalinity, a decrease in the concentrations of TOC and H3O+, while for Al and Fe there was a change in control mechanisms. The concentration and control changes after ditching are related to changes in hydrological pathways and to the exposure of both organic (peat) and inorganic (mineral soil) layers on the ditch slopes.

Forestry↗
PubMed2001

Prevalence of psychiatric disorders in gynecologic outpatients.

OBJECTIVE: This study was undertaken to determine the point prevalence of psychiatric disorders in an unselected gynecologic population. STUDY DESIGN: Participants were 1013 consecutive women attending 2 outpatient gynecology clinics in northern Sweden between November 16 and December 15, 1998. The Primary Care Evaluation of Mental Disorders (PRIME-MD) was used as a diagnostic tool for evaluating mood, anxiety, and eating disorders. RESULTS: Overall, 897 patients (88.5%) filled in the diagnostic tool's patient questionnaire. Psychiatric disorders were present in 30.5% of the patients. Mood disorders were most common; major depression was prevalent in 10.1% of patients and minor depression was seen in 12.4% of patients. Anxiety disorders were also common and were encountered in 12.1% of patients. Among patients with a diagnosis, only 21.4% had some form of treatment. CONCLUSIONS: The prevalence of mood and anxiety disorders in an outpatient gynecology clinic is high. The majority of women with a diagnosis based on the diagnostic tool did not have a previous diagnosis and were untreated.

Adolescent↗
PubMed2001

Adjustment of incidence rates after an estimate of completeness and accuracy in registration of acute leukemias in a Swedish population.

Earlier studies have revealed undernotification of hematological malignancies in Swedish and other Cancer Registries. We present epidemiological data on AML, ALL and unspecified AL in adults diagnosed 1987-1992 in a well-defined population. Blast crises of CML were excluded. The Swedish Cancer Registry and Cause of Death Registry were compared and patient records reviewed for validation. When available, listings of pathology bone marrow reports and inpatient discharge diagnoses were utilized for casefinding. 260 cases of acute leukemias could be verified in a population of 663,135 adults, corresponding to a yearly incidence of 6.5/100,000. The median age of the patients was 69.2 years. 214 cases were AML, 38 ALL and eight unspecified AL. Undernotification in the Cancer Registry was found to be 15.4%, greater for AML and unspecified AL than for ALL. In addition the coding was not uniform, resulting in an incidence rate in adults of 5.3/100,000 for the Cancer Registry which is 18.5% lower than that of our study. A significant survival advantage was seen for notified patients. Combination of the Cancer Registry and Cause of Death Registry gave acceptable coverage, omitting only four patients. As the incidence of acute leukemias in our study is comparatively high, we hypothesize that underestimation of incidence and overestimation of survival are general problems for cancer registries.

Acute Disease↗
PubMed2000

Laser Doppler flowmetry in the assessment of tendon blood flow.

This review of laser Doppler flowmetry (LDF) focuses on indications and limitations in general and the author's experience of LDF in the assessment of tendon perfusion in particular. LDF is easy to use, minimally invasive and well suited for the study of relative changes in perfusion during rapid events. Problems specifically related to LDF include motion artifacts, a non-flow dependent output of unknown significance and uncertainty regarding the spatial resolution. The human Achilles tendon has a lower perfusion at the insertion but otherwise an even distribution of blood flow. Male gender, advancing age and mechanical loading of the tendon are associated with diminished tendon blood flow. The lesion in chronic degenerative Achilles tendinopathy is associated with hyperemia of uncertain origin.

Achilles Tendon↗
PubMed2000

Treatment, long-term outcome and prognostic variables in 214 unselected AML patients in Sweden.

With the aim of describing an unselected series of acute myeloid leukaemias (AML) in adults, patients diagnosed 1987-1992 in the Orebro region of central Sweden were reviewed by investigating hospital records. By utilizing: (1) The Swedish Cancer Registry, (2) The Cause of Death Registry, (3) listings of pathology bone marrow reports and (4) listings of inpatient discharge diagnoses, we attempted to find all patients. Among secondary AML, only blast-crises of CML were excluded. A total of 214 cases of AML with a median age of 69.5 years were verified corresponding to a mean yearly incidence in adults of 5.4/100 000. Of all patients, 56% had received 'high-dose' induction treatment, 28% 'low-dose' treatment and 16% no cytostatic treatment. Median survival for all patients was 5.8 months and the probability of survival at 5 years was 9.3%. The 120 'high-dose' treated patients had a total CR rate of 67%, median CR duration 10.1 months and median survival 11.4 months. Age, LDH and kidney function were found to be independent prognostic variables for survival. The inclusion of patients unreferred from district hospitals makes this study unique as an example of unselected AML.

Acute Disease↗
PubMed2000

Vectorcardiographic loop alignment and the measurement of morphologic beat-to-beat variability in noisy signals.

The measurement of subtle morphologic beat-to-beat variability in the electrocardiogram (ECG)/vectorcardiogram (VCG) is complicated by the presence of noise which is caused by, e.g., respiration and muscular activity. A method was recently presented which reduces the influence of such noise by performing spatial and temporal alignment of VCG loops. The alignment is performed in terms of scaling, rotation and time synchronization of the loops. Using an ECG simulation model based on propagation of action potentials in cardiac tissue, the ability of the method to separate morphologic variability of physiological origin from respiratory activity was studied. Morphologic variability was created by introducing a random variation in action potential propagation between different compartments. The results indicate that the separation of these two activities can be done accurately at low to moderate noise levels (less than 10 microV). At high noise levels, the estimation of the rotation angles was found to break down in an abrupt manner. It was also shown that the breakdown noise level is strongly dependent on loop morphology; a planar loop corresponds to a lower breakdown noise level than does a nonplanar loop.

Action Potentials↗
PubMed1999

The prevalence of gallstone disease in a defined cohort of patients with Crohn's disease.

OBJECTIVE: Crohn's disease (CD) is associated with a high prevalence of gallstone disease but the relative risk has not been completely established. Ileal disease or resection have been considered as contributing factors to the increased risk. The aim of this study was to evaluate the prevalence of gallstone disease in a defined cohort of CD patients, to evaluate possible risk factors, and to evaluate the relative risk compared with the general population. METHODS: All inhabitants in Stockholm County born in 1933-1935 or 1953-1955, with CD diagnosed between 1955-1989 and not having had a previous cholecystectomy, were invited for an ultrasonography of the gallbladder. The prevalence of gallstone disease was related to disease extent, previous intestinal resections, age, and gender. The relative risk of developing gallstones was calculated using a recent study of gallstone disease in general, with similar age groups as controls. RESULTS: We found that 26.4% had gallstone disease (relative risk [RR] = 1.8; 95% confidence interval [CI], 1.2-2.7). The number of previous intestinal resections was the only significant risk factor. There was no significant difference in gallstone disease between gender (28.2% vs 24.1%) or age (34% vs 21.8%). CONCLUSIONS: Patients with Crohn's disease, regardless of gender and age, have almost a doubled risk of developing gallstone disease compared with the general population. Circumstances related to laparotomy may contribute to the increased risk. The lack of association between the disease extent and the site of previous intestinal resection, together with a previous finding of normal cholesterol saturation of the bile in patients with CD, indicate that these patients may develop pigment stones rather than cholesterol stones.

Adult↗
PubMed1998

D4 dopamine receptor gene exon III polymorphism and obesity risk.

Many genes have been identified that may play a role in increasing individual susceptibility to obesity. Reduced dopamine function appears to play a role in dysfunctional eating patterns and may predispose some individuals to obesity. The long version of the D4 dopamine receptor gene (D4DR) has been shown to alter receptor function and reduce intracellular response to dopamine. It also has been associated with novelty-seeking-related personality traits that are found with greater frequency in obese individuals. We examined the association between the long alleles of the D4DR and obesity in a sample of 115 obese patients participating in a weight management program. No direct relationship was found between the D4DR and body mass or novelty-seeking-related personality traits. We constructed four models of increased obesity risk that included combinations of traditional risk factors (i.e., long-term history of obesity, parental obesity, a body mass index > 40) and elevations on the novelty-seeking-related scales of the Karolinska Scales of Personality. There was a significant increase in the frequency of the D4DR long alleles in individuals defined as high risk using the combination of novelty-seeking-related personality traits, severe obesity (i.e., BMI > 40), and any other traditional risk factor, but not with the traditional risk factors alone. These preliminary data suggest a potential role for the D4DR gene in increasing obesity susceptibility.

Adult↗
PubMed1998

Differences in CD14 and alpha-naphthyl acetate esterase positivity and relation to prognosis in AML.

Alpha-naphthyl acetate esterase (ANAE) and CD14 expression, used for determination of monocytic cells, were compared and related to prognosis in 65 AML patients. Bone marrow aspiration material from AML patients has been used for the cytochemistry as well as flow cytometry. All non-erythroid cells have been included in the evaluation in both methods. 17/65 cases showed at least 15% difference between the proportion CD14 and ANAE positive cells. Cases with 20% or more CD14 positivity had poorer prognosis. For FAB classes M0-M3, presence of 10% or more CD14 was negative for overall survival (P = 0.01). ANAE did not show significant prognostic influence.

Acute Disease↗
PubMed1998

Partial rupture in chronic achilles tendinopathy. A retrospective analysis of 342 cases.

342 achilles tendons in 298 patients were operated on for painful chronic achilles tendinopathy (81% men; mean age 35 (18-82) years; 79% athletes). A partial rupture was found in 23%, tendinosis (degeneration) in 49% and no macroscopic pathology in 28% of the tendons. In partial ruptures, as compared with non-ruptured tendons, the lesion was commoner in the distal part of the tendon and more frequent in physically active men slightly below middle age who had received local steroid injections before surgery. In a logistic regression analyzing age, gender, physical activity and preoperative steroid injections, only preoperative steroid injections and male gender predicted a partial rupture.

Achilles Tendon↗
PubMed1997

Relationship between prophylactic effect of lithium therapy and family history of affective disorders.

Lithium therapy response and age of onset (AOO) were studied in 98 patients with bipolar affective disorder (BPAD) who were divided into subgroups depending on type of family history of affective disorders. The highest (33.0 years) and lowest (25.5 years) age of onset were found in nonfamilial patients and in familial patients with a first-degree relative of BPAD, respectively. Nonfamilial patients showed the best response to lithium. There were 0.9 episodes/year off lithium compared to 0.3 episodes/year on lithium (an 88% decrease). A poorer response (a 71% decrease; a reduction from 1.39 episodes per year off lithium to 0.65 on lithium) was found in familial patients with a first-degree relative of BPAD. Differences in serum lithium values between the groups could not explain the observed differences. Thus, familial patients showed a more severe manifestation of the disease with an earlier AOO and a lower prophylactic effect of lithium.

Age of Onset↗
PubMed1996

Imaging in chronic achilles tendinopathy: a comparison of ultrasonography, magnetic resonance imaging and surgical findings in 27 histologically verified cases.

OBJECTIVE: To compare information gained by ultrasonography and magnetic resonance imaging (MRI) in chronic achilles tendinopathy with regard to the nature and severity of the lesion. DESIGN: Imaging of both achilles tendons with ultrasonography and MRI was performed prior to unilateral surgery. Operative findings and histological biopsies together served as a reference. PATIENTS: Twenty-seven patients (22 men, 5 women; mean age 44 years; 21 athletes) suffering from chronic achilles tendinopathy participated in the study. Eighteen patients had unilateral and 9 had bilateral symptoms. RESULTS AND CONCLUSIONS: Surgical findings included 4 partial ruptures, 21 degenerative lesions and 2 macroscopically normal cases. Microscopy revealed tendinosis (degeneration) in all tendon biopsies, including cases with a partial rupture, but only slight changes in the paratendinous tissues (paratenon). Ultrasonography was positive in 21 of 26 and MRI in 26 of 27 cases. Severe intratendinous abnormalities and a sagittal tendon diameter > 10 mm suggested a partial rupture. In tendons with a false negative result histopathological changes were mild and a tendency towards a better clinical outcome was noted in the sonographic cases. Assessment of the paratenon was unreliable with both methods. Ultrasonography and MRI give similar information and may have their greatest potential as prognostic instruments.

Achilles Tendon↗
PubMed1996

Generalized anxiety disorder in stroke patients. A 3-year longitudinal study.

BACKGROUND AND PURPOSE: This prospective study examined the prevalence and longitudinal course of generalized anxiety disorder (GAD) after stroke and its comorbidity with major depression over time. The contributions of lesion characteristics, functional impairment, and psychosocial factors to the development of GAD after stroke were studied. METHODS: In a population-based cohort of 80 patients with acute stroke, we assessed GAD and comorbid major depression, functional ability, and social network at regular time points over 3 years. Cerebral atrophy and brain lesion parameters were determined from CT scans performed at the acute stage and after 3 years. RESULTS: The prevalence of GAD after stroke was 28% in the acute stage, and there was no significant decrease through the 3 years of follow-up. At 1 year, only 23% of the patients with early GAD (0 to 3 months) had recovered; those not recovered at this follow-up had a high risk of a chronic development of the anxiety disorder. Comorbidity with major depression was high and seemed to impair the prognosis of depression. At the acute stage after stroke, GAD plus depression was associated with left hemispheric lesion, whereas anxiety alone was associated with right hemispheric lesion. Cerebral atrophy was associated with both depression and anxiety disorder late but not early after stroke. Dependence in activities of daily living and reduced social network were associated with GAD at all follow-up periods except at the acute stage. CONCLUSIONS: GAD after stroke is a common and long-lasting affliction that interferes substantially with social life and functional recovery. There is a differentiation of factors implicated in its development based on the period of time since the stroke event.

Activities of Daily Living↗