Biomedical subjects

O Gustafsson

Publications and source records attributed to O Gustafsson.

At least 19 recordsLinked to original sources

PubMed2006

Leaching of metals from sewage sludge during one year and their relationship to particle size.

Leaching of metals from sewage sludge can lead to their accumulation in topsoil and can also contaminate groundwater. Our objectives were to document the metal leachates and the size distribution of leached particles from sewage sludge and to identify possible correlations with physical factors. Results from monthly lysimeter sampling showed an initial release followed by decline for most metals. Cadmium, Ca, Sr, Li, Mn, Ni and Zn showed a "cyclic" behaviour. Filtration revealed that this "cyclicity" had no correlation to the size of released particles, but Al, Cr, Fe, Cu, Ag and Pb were clearly related to release of coarser particles most of the year. Total metal amounts leached during one year, relative to original sludge content, had the order Na>Ca=Mg>Mn>Sr>Zn>K>Li=Ni>Cd>Co>Rb>Ag>Cr>Ba=Cu>Ga>Al=Pb=Fe. There were no simple correlations between monthly measured leachate concentrations and precipitation, temperature or pH of precipitation. Occasional leachate sampling might give misleading values for metals with "cyclic" behaviour.

Adsorption↗

PubMed2005

Observations of the PCB distribution within and in-between ice, snow, ice-rafted debris, ice-interstitial water, and seawater in the Barents Sea marginal ice zone and the North Pole area.

To evaluate the two hypotheses of locally elevated exposure of persistent organic pollutants (POPs) in ice-associated microenvironments and ice as a key carrier for long-range transport of POPs to the Arctic marginal ice zone (MIZ), dissolved and particulate polychlorinated biphenyls (PCBs) were analyzed in ice, snow, ice-interstitial water (IIW), seawater in the melt layer underlying the ice, and in ice-rafted sediment (IRS) from the Barents Sea MIZ to the high Arctic in the summer of 2001. Ultra-clean sampling equipment and protocols were specially developed for this expedition, including construction of a permanent clean room facility and a stainless steel seawater intake system on the I/B ODEN as well as two mobile 370 l ice-melting systems. Similar concentrations were found in several ice-associated compartments. For instance, the concentration of one of the most abundant congeners, PCB 52, was typically on the order of 0.1-0.3 pg l(-1) in the dissolved (melted) phase of the ice, snow, IIW, and underlying seawater while its particulate organic-carbon (POC) normalized concentrations were around 1-3 ng gPOC(-1) in the ice, snow, IIW, and IRS. The solid-water distribution of PCBs in ice was well correlated with and predictable from K(ow) (ice log K(oc)-log K(ow) regressions: p<0.05, r2=0.78-0.98, n=9), indicating near-equilibrium partitioning of PCBs within each local ice system. These results do generally not evidence the existence of physical microenvironments with locally elevated POP exposures. However, there were some indications that the ice-associated system had harbored local environments with higher exposure levels earlier/before the melting/vegetative season, as a few samples had PCB concentrations elevated by factors of 5-10 relative to the typical values, and the elevated levels were predominantly found at the station where melting had putatively progressed the least. The very low PCB concentrations and absence of any significant concentration gradients, both in-between different matrices and over the Eurasian Arctic basin scale, suggest that ice is not an important long-range transport purveyor of POPs to the Arctic MIZ ecosystem.

Journal Article↗

PubMed2002

Soot-carbon influenced distribution of PCDD/Fs in the marine environment of the Grenlandsfjords, Norway.

The particle associations of polychlorinated dibenzo-p-dioxins and polychlorinated dibenzofurans (PCDD/Fs) were studied in both the water column and the surface sediments of a marine fiord system and were found to poorly obey expectations from the organic matter partitioning (OMP) paradigm. The field observations were instead consistent with the presence of a stronger sorbent subdomain such as pyrogenic soot-carbon (SC) playing an important role in affecting the environmental distribution and fate of PCDD/Fs. Solid-water distribution coefficients (Kd) of PCDD/ Fs actually observed in the water column were several orders of magnitude above predictions from a commonly used OMP model. Even when these elevated Kd values were normalized to the particulate organic carbon (POC) content (i.e., K(OC)), the variability in K(OC) for individual PCDD/ Fs at different fjord locations and seasons of factors 100-1,000 suggested that bulk organic matter was not the governing sorbent domain of the suspended particles. Further, POC-normalized particle concentrations of PCDD/ Fs (C(OC)) in a vertical profile (surface water-bottom water-surface sediment) revealed a strong increasing trend with depth. Factors of about 100 higher Coc for all PCDD/Fs in the sediment than in the surface water could not be explained by higher fugacity in the surrounding deep water nor with C:N or delta13C indexes of selective aging of the bulk organic matter. Instead this was hypothesized to reflect selective preservation of a more recalcitrant and highly sorbing, but minor, subdomain such as soot. The extent of enhanced PCDD/F sorption, above the OMP predictions, was positively correlated with the SC:POC ratio of the suspended particles in surface and deep waters. Finally, the geographical distribution of sedimentary PCDD/F concentrations were better explained by the SC content than by the bulk OC content of the sediment. Altogether, these field-based findings add to recent laboratory-based sorption studies to suggest that we need to consider both amorphous OC partitioning domains and SC particles as carriers of planar aromatic contaminants if we are to explain the environmental distribution and fate of pollutants such as PCDD/Fs.

Adsorption↗

PubMed2002

MR follow-up of small experimental intracranial haemorrhages from hyperacute to subacute phase.

PURPOSE: To compare pulse sequences in revealing intracranial bleeding from the hyperacute to subacute phase. MATERIAL AND METHODS: We injected 0.3-1 ml of autologous blood into the brain of 8 rabbits. MR imaging was performed immediately after haematoma creation and then at determined intervals up to 9-12 days. All images were analysed by two observers. After the last MR investigation, the brain was fixed in formalin. The last MR images were compared to the fixed brain sections and to the histologic findings. RESULTS: T2*-weighted GE sequences, both conventional spoiled and echoplanar sequences, revealed the intraparenchymal haematomas as hypointensities in all but 1 case, which was negative from the second day onward (a rabbit with 0.3 ml blood injected). The signal patterns remained unchanged during the follow-up. The haematoma sizes and shapes corresponded well to gross pathology. Blood in the cerebrospinal fluid (CSF) space was detected with T2*-weighted GE sequences in a great majority of the examinations during the first 2 days. The cases with the smallest injected volume of blood were negative. SE sequences were rather insensitive. The FLAIR sequence often revealed blood in CSF spaces but not in the brain. CONCLUSION: T2*-weighted GE sequences are capable of revealing very small intraparenchymal haemorrhages from the hyperacute to the subacute phase, and blood in CSF spaces during at least the first 2 days.

Acute Disease↗

PubMed2001

Dynamic colloid--water partitioning of pyrene through a coastal Baltic spring bloom.

Colloidal organic particles constitute the dominant portion of particulate organic matter in surface seawater, but their influence on the phase speciation and bioavailability of hydrophobic organic compounds (HOCs) is sparsely evaluated. Studies on colloid-water partitioning have been focused on other regimes and have largely been performed on chemically defined subportions of total colloids such as the humic fraction. Available estimates of colloid-water partition coefficients (Kcoc) are highly variable and not easily explained by regularly applied Kow-Koc relationships. Here, pyrene was partitioned to bulk natural colloids isolated using cross-flow ultrafiltration techniques from the surface water of a coastal bay. A key objective was to elucidate biogeochemical controls on the changing colloid-sorbent qualities over the course of the dynamic allochtonous-autochtonous transition of a well-constrained boreal coastal spring bloom. The pyrene Kcoc was found to decrease from 12.9+/-0.9 x 10(3) Lw/kg(oc) in the terrestrial runoff dominated regime to values around 2.9+/-0.7 x 10(3) Lw/kg(oc), once phytoplankton production became the governing source of organic matter to the surface waters. The changing Kcoc was well correlated with the molar extinction coefficient at 280 nm of the colloidal organic carbon. This study supports other reports of an improved prediction of HOC phase speciation through this simple molecular proxy of the "quality" of organic sorbents. While being poor sorbents on a carbon atom basis, relative to soils and sediments, coastal marine colloids, by their shear abundance, may significantly attenuate the truly dissolved exposures of HOCs with log Kow above 5.

Absorption↗

PubMed2001

Fate of linear alkylbenzenes released to the coastal environment near Boston Harbor.

Linear alkylbenzenes (LABs) were used to assess the fates of hydrophobic organic compounds (HOCs) released to a large urban harbor and the adjoining offshore waters. We found that particulate concentrations of the individual C12 LAB isomers in 1996 summertime surface waters decreased from 1 pM in Boston Harbor to 20-200 fM in coastal Massachusetts and Cape Cod Bays. Levels fell to only a few fM in offshore Gulf of Maine locations. These observations were consistent with municipal wastewater in Boston Harbor as the predominant input followed by dispersal via known circulation patterns in this region. Phase-dependent removal rate coefficients for flushing, vertical scavenging, volatilization, photodegradation, and biodegradation of individual LAB isomers were constrained from literature, field observations, and laboratory experiments and combined with estimates of wastewater release rates into a predictive 3-box model. Vertical scavenging, biodegradation, and flushing were predicted to be the most important fate processes for C12 LABs in the Boston Harbor-MA Bay-Cape Cod Bay flow system with about 1% of the harbor releases "surviving" passage. For HOCs such as the relatively bio-recalcitrant LAB, 6-phenyldodecane, it appears that we are at present able to predict the coastal fate of harbor-introduced HOCs in this system within a factor of 2. Contrary to expectations from biodegradation experiments, the ratio of internal-to-external (I/E) LAB isomers decreased offshore in both water and sediment samples, suggesting we are "missing" an important process affecting LAB fates.

Alkylation↗

PubMed2001

Process-diagnostic patterns of chlorobiphenyl congeners in two radiochronologically characterized sediment cores from the northern Baffin Bay.

Polychlorinated biphenyl (PCB) patterns were interpreted in two radioisotopically constrained sediment cores from the Arctic ocean in order to seek clues about their large-scale environmental fates. Low but clearly measurable fluxes of individual PCB congeners were observed in deeper layer sediments, corresponding to the past 170 years, in a single dated core from the Baffin Bay shelf. Fluxes of the dominant individual congeners in the surface sediments were 20-100 pg m(-2) d(-1). Combining these data with the sediment data from the Arctic Monitoring and Assessment Program, it appears that the PCB distribution in Arctic surface sediments is governed by the organic carbon (OC) content of the sediments. The historical development of the PCB congener fingerprint suggests that the modern sediments are enriched in medium-chlorinated congeners, implying that there are at least two significant, but distinctly different, sink processes acting on the PCB pool. The relative abundance of light-to-heavy congeners, in mid-shelf marine sediments of similar ages, between 40 degrees N and 76 degrees N latitude suggests a northward dilution of PCBs which is stronger attenuated for heavier congeners, consistent with a temperature-driven global fractionation process. The significant presence of PCB in historical archives pre-dating the organochlorine society, as observed in this and several previous studies, awaits a fuller explanation.

Arctic Regions↗

PubMed2001

Variation in percentage-free prostate-specific antigen (PSA) with prostate volume, age and total PSA level.

OBJECTIVE: To examine the correlation between prostate volume, patient age and total prostate-specific antigen (tPSA) with the percentage-free PSA (f/tPSA) in a population-based cohort of men with no prostate cancer and with a tPSA of < 10.0 ng/mL. SUBJECTS AND METHODS: Men who in 1988-1989, after randomized selection in the general population, participated in a population-based screening study for prostate cancer, were investigated. In all, 1622 of the men (aged 55-70 years) were considered free from prostate cancer and had a tPSA level of < 10.0 ng/mL. The f/tPSA and tPSA were determined in frozen sera from each individual, and related to prostate volume and age measured at the time of the study. The entire population was investigated, as were four subpopulations based on tPSA levels (< 2.0, 2.0-3.9, 4.0-6.9 and 7.0-9.9 ng/mL). Statistical calculations included multiple regression and correlation analysis. RESULTS: The f/tPSA level varied with prostate volume and age, but the decisive factor for this variation was the tPSA level. The closest correlation was in the tPSA interval 7.0-9.9 ng/mL, where volume and age together explained 47% of the variation in f/tPSA. Also, for men with tPSA levels in each of the intervals 2.0-3.9, 4.0-6.9 and 7.0-9.9 ng/mL, the f/tPSA increased with higher prostate volumes and age. In men with tPSA levels of < 2.0 ng/mL the f/tPSA was not affected by variations in prostate volume or age. CONCLUSION: The variation in f/tPSA with prostate volume, age and tPSA is highly dependent on the tPSA level. Volume and age in the tPSA interval 7.0-9.9 ng/mL can explain almost half the variation in f/tPSA, whereas this influence is insignificant in men with a tPSA of < 2.0 ng/mL.

Age Factors↗

PubMed2001

Ubiquitous observations of enhanced solid affinities for aromatic organochlorines in field situations: are in situ dissolved exposures overestimated by existing partitioning models?

This paper investigates the ability of the traditional organic matter partitioning (OMP) model to predict the solid-water distribution, and hence the dissolved exposures, of hydrophobic organic compounds (HOCs) in real field situations. Observed organic-carbon-normalized partitioning coefficients (Koc)obs) of polychlorinated biphenyls, polychlorinated benzenes, polychlorinated dibenzo-dioxins and -furans, and p,p'-dichlorodiphenyltrichlorethane (DDT) with metabolites were selected from the literature and compared with their respective OMP model estimates. For all compound classes and in a majority of the investigated cases, (Koc)obs values were significantly larger than predicted. This translated into factors of overestimated dissolved exposures ranging from 1 to 1,000. Various reasons are discussed for the discrepancies between predictions and actual observations, such as the effect of the diagenetic state and other properties of the particulate organic matter. The greater enhancement in (Koc)obs of planar over nonplanar compounds suggests in certain cases that efficient interactions with aromatic soot phases may be significant. For an improved predictability of (Koc)obs and dissolved exposures of HOCs in the real environment, the inclusion of soot and possibly other distinct subfractions of bulk organic carbon into an extended solid-water partitioning model may be considered.

Biological Availability↗

PubMed2000

Follow-up of prostate cancer patients by on-demand contacts with a specialist nurse: a randomized study.

OBJECTIVE: The effectiveness of traditional follow-up programs and the intensive search for disease progression in men with prostate cancer have been questioned. The aims of this randomized multi-centre study were to evaluate medical safety, patient satisfaction and resource utilization in an on-demand follow-up by a specialist nurse compared with traditional follow-up by a urologist. MATERIAL AND METHODS: Four hundred consecutively approached men with newly diagnosed or previously known prostate cancer in any stage at three hospitals in Sweden were randomized to follow-up in the nurse group (NG, 200 patients) or the urologist group (UG, 200 patients). In the NG, the nurse contacted the patient by phone every 6 months unless the patient himself initiated the contact. Patient satisfaction was evaluated twice a year via questionnaire. The questionnaire included the validated Hospital Anxiety and Depression Scale (HADS). The costs of all medical interventions and adverse events related to prostate cancer were calculated for all patients. RESULTS: Medical safety, measured as complication frequency and lag time from symptoms to intervention, during the first 3 years of the observation period, was similar in the NG and the UG. The total number of interventions due to symptoms from prostate cancer was also similar in both groups. The analysis of accessibility and the HAD scale showed no significant differences between the groups. The mean outpatient cost (excluding pharmaceutical costs) per patient was lower in the NG compared to the UG, especially among patients without metastases at inclusion (37% lower cost). CONCLUSIONS: Our study indicates that men with prostate cancer can be safely followed up by a specialist nurse. The study results show that this alternative follow-up is cost-effective, especially in men without metastases.

Aged↗

PubMed1999

Diagnostic value of percent free prostate-specific antigen: retrospective analysis of a population-based screening study with emphasis on men with PSA levels less than 3.0 ng/mL.

OBJECTIVES: To retrospectively investigate the use of percent free prostate-specific antigen (PSA) compared with total PSA in serum as predictor of prostate cancer in men selected randomly from the general population who underwent biopsy on the basis of abnormal findings on digital rectal examination (DRE) or transrectal ultrasound (TRUS) and/or serum PSA levels greater than 10 ng/mL. METHODS: A single intervention, population-based screening study was undertaken in 1988 and 1989. Of the 2400 men aged 55 to 70 years invited to participate, 1782 men responded and were examined with DRE, TRUS, and PSA testing (Tandem-Hybritech). In 1995, frozen serum samples from 1748 men were analyzed for percent free PSA (Prostatus, Wallac OY). Five-year follow-up data on new cancers in the screened population were obtained from the Swedish Cancer Registry (SCR). RESULTS: Of the 1748 men, 367 underwent TRUS-guided biopsies because of abnormal findings on either DRE or TRUS or serum PSA levels of greater than 10 ng/mL. This resulted in the diagnosis of 64 cases of prostate cancer (3.7%). PSA levels of 3.0 ng/mL or greater were found in 55 (86%) of 64 cancer cases and in 399 (24%) of the 1684 benign cases. Among the 1294 men with PSA less than 3.0 ng/mL, 9 prostate cancers were diagnosed (14% of all prostate cancers). All 9 patients with cancer and with PSA less than 3.0 ng/mL had a percent free PSA of 18% or less. In the group of 1109 patients with PSA less than 3.0 ng/mL and a percent free PSA greater than 18%, 159 biopsies were performed because of abnormal DRE or TRUS. However, no prostate cancer was diagnosed in this category of patients. Five years after the screening intervention, 7 more cases of prostate cancer were clinically diagnosed in the screened population according to the SCR. CONCLUSIONS: The combination of PSA levels less than 3.0 ng/mL and percent free PSA greater than 18% defines a large part of the population at a very low risk of cancer of the prostate both at the time of screening and during the following 5 years. Men in this group may be spared DRE, and longer screening intervals may be considered. However, the risk of having prostate cancer is not negligible in men with PSA less than 3.0 ng/mL and percent free PSA of 18% or less. The results of this study indicate that biopsy should be recommended to men fulfilling these criteria, although these results should be confirmed in larger prospective studies because of the limited number of patients with prostate cancer in the present series.

Aged↗

PubMed1999

Antibiotic prophylaxis for prostate biopsy: benefits and costs.

Transrectal ultrasound-guided core biopsy is a widely used method to diagnose prostate cancer. It is generally considered a safe procedure but the main concern is that significant complications such as infections do occur. To evaluate the effect of a combined two-dosage antibiotic prophylaxis with ciprofloxacin and metronidazole, a prospective study of 289 patients undergoing core-biopsy of the prostate was performed. Five patients (1.7%) developed urinary tract infection and all did recover without any further complications. The infection rate was significantly lower compared to our historic controls receiving no prophylaxis at all. This prophylactic regime resulted in a low infection rate and it was feasible from the patient perspective. The total cost of antibiotic medication and additional costs due to complications was 18 USD per patient and the cost-effectiveness compared to no prophylactic therapy at all was considered good.

Journal Article↗

PubMed1999

MR imaging of experimentally induced intracranial hemorrhage in rabbits during the first 6 hours.

PURPOSE: To evaluate the MR appearance of intracranial, especially intraparenchymal, hemorrhage during the first 6 hours after bleeding with various pulse sequences in an animal model. MATERIAL AND METHODS: Intracerebral hematomas and subarachnoid hemorrhage were created by injecting autologous blood in 9 rabbits. MR studies were performed using a 1.5 T scanner with pixel size and slice thickness comparable to those used in clinical practice before blood injection, immediately after injection, and at regular intervals during 6 hours. The images were compared with the hematoma sizes on formalin-fixed brain slices. RESULTS: In every animal, susceptibility-weighted gradient-echo (GRE) pulse sequences depicted the intraparenchymal hematomas and blood escape in the ventricles or subarachnoid space best as areas of sharply defined, strong hypointensity. The findings remained essentially unchanged during follow-up. The sizes corresponded well to the post-mortem findings. Gradient- and spin-echo (GRASE) imaging revealed some hypointensities, but these were smaller and less well defined. Spin-echo (SE) sequences (proton density-, T1- and T2-weighted) as well as a fluid-attenuated inversion recovery turbo spin-echo sequence (fast FLAIR) depicted the hemorrhage sites as mostly isointense to brain. CONCLUSION: Susceptibility-weighted GRE imaging at 1.5 T is highly sensitive to both hyperacute hemorrhage in the brain parenchyma and to subarachnoid and intraventricular hemorrhage.

Animals↗

PubMed1998

Prostate-specific antigen (PSA), PSA density and age-adjusted PSA reference values in screening for prostate cancer--a study of a randomly selected population of 2,400 men.

Prostate cancer screening with DRE, TRUS, and PSA testing was offered to 2,400 randomly selected men 55-70 years old. Among 1,782 examined, 65 (3.6%) men with prostate cancer were diagnosed. The PSA results were correlated to the diagnosis, the men's age, and the prostate volume. Least square regression analysis was used to calculate the 95% upper confidence intervals for PSA in each year of age in men without prostate cancer. The PPV was calculated for: (i) PSA > 4 ng/ml, (ii) PSAD > 0.15, (iii) PSAD > 0.20 and (iv) age-adjusted PSA reference values. A significant correlation was found between PSA and prostate volume, between PSA and age, and between the prostate volume and age. The calculated annual growth of the prostate was 1.6% and the annual increase in PSA was 2.4%. The age-adjusted upper PSA reference values for the three age categories studied (55-59, 60-64 and 65-70 years) were 5.2, 5.8, and 6.7 ng/ml, respectively. The PPVs for PSA > 4 ng/ml, PSAD > 0.15, PSAD > 0.20, and the age-adjusted PSA reference values were 17%, 14%, 22%, and 27%, respectively. Age-adjusted PSA or PSAD may increase the PPV compared to PSA > 4 ng/ml. The detection rate is, however, inadequate. A PSA cut-off at 4 ng/ml could therefore be maintained in men 55-70 years old. The median PSA values and median prostate volumes calculated for men with benign findings may serve as a reference in future studies.

Age Factors↗

PubMed1996

Dihydrotestosterone and testosterone levels in men screened for prostate cancer: a study of a randomized population.

OBJECTIVE: To investigate the possible relationship between serum levels of prostate specific antigen (PSA), dihydrotestosterone (DHT), testosterone, sexual-hormone binding globulin (SHBG) and tumour stage, grade and ploidy in 65 cases of prostate cancer diagnosed in a screening study compared to 130 controls from the same population. PATIENTS, SUBJECTS AND METHODS: From a population of 26,602 men between the ages of 55 and 70 years, 2400 were selected randomly and invited to undergo screening for prostate cancer using a digital rectal examination, transrectal ultrasonography and PSA analysis. Among the 1782 attendees, 65 cases of prostate cancer were diagnosed. Each case was matched with two control subjects of similar age and prostate volume from the screening population. Frozen serum samples were analysed for PSA, DHT, testosterone and SHBG, and compared to the diagnosis and tumour stage, grade and ploidy. Comparisons between these variables, and multivariate and regression analyses were performed. RESULTS: There were significant differences in PSA level with all variables except tumour ploidy. DHT levels were slightly lower in patients with prostate cancer but the difference was not statistically significant. There was a trend towards lower DHT values in more advanced tumours and the difference for T-stages was close to statistical significance (P = 0.059). Testosterone levels were lower in patients with cancer than in the control group, but the differences were not significant. There was no correlation between testosterone levels, tumour stage and ploidy, but the differences in testosterone level in tumours of a low grade of differentiation compared to those with intermediate and high grade was nearly significant (P = 0.058). The testosterone/DHT ratio tended to be higher in patients with more advanced tumours. SHBG levels were lower in patients with cancer than in controls but the differences were not statistically significant. There were no systematic variations of tumour stage, grade and ploidy. Multivariate analysis showed that if the PSA level was known, then DHT, testosterone or SHBG added no further information concerning diagnosis, stage, grade or ploidy. Regression analysis on T-stage, PSA level and DHT showed an inverse linear relationship between PSA and DHT for stage T-3 (P = 0.035), but there was no relationship between PSA and testosterone. CONCLUSION: PSA was of value in discriminating between cases and controls and between various tumour stages and grades, but no statistically significant correlation was found for ploidy. If PSA level was known, no other variable added information in individual cases. Within a group, DHT levels tended to be lower among cases and in those with more advanced tumours. There was an inverse relationship between tumour volume, as defined by PSA level, and 5 alpha-reductase activity, as defined by DHT level, and the testosterone/DHT ratio. This trend was most obvious with T-stage. No systematic variation were found in the levels of testosterone or SHBG.

Aged↗

PubMed1995

Cost-effectiveness analysis in early detection of prostate cancer: an evaluation of six screening strategies in a randomly selected population of 2,400 men.

Based on the findings in an early detection study for prostate cancer [Gustafsson et al.: J Urol 148:1827-1831, 1992] using digital rectal examination (DRE), transrectal ultrasound (TRUS), and prostate-specific antigen (PSA), a cost-effectiveness analysis was performed based on 6 screening strategies, namely: 1) DRE of all individuals; 2) TRUS of all individuals; 3) DRE, TRUS, and PSA analysis followed by reexamination of individuals with PSAs > or = 7 ng/ml; 4) DRE of individuals with PSAs of > or = 4 ng/ml; 5) TRUS of individuals with PSAs of > or = 4 ng/ml; 6) DRE and PSA analysis followed by TRUS on individuals with PSAs > or = 4 ng/ml. The detection rates of prostate cancer using these 6 strategies were 2.4%, 3.3%, 3.6%, 2.0%, 2.6%, and 3.2%, respectively. Except for costs per detected cancer, costs were also calculated per detected small cancer (< or = 1.5 cm) and per detected cancer treated for cure. The cost calculations were based on total costs, i.e., direct plus indirect costs. When the 6 strategies were compared, taking into account the detection rate of cancers treated for cure and cost-effectiveness with respect to cancers treated for cure, strategies 1), 2), 3), and 4) were ruled out as less favorable than the remaining 2 strategies. TRUS of individuals with PSAs > or = 4 ng/ml (strategy 5) was the most cost-effective strategy and detected 80% of the cancers actually treated for cure. Screening with DRE and PSA analysis followed by TRUS of individuals with PSAs > or = 4 ng/ml (strategy 6) had a somewhat lower cost-effectiveness, but detected 90% of the cancers treated for cure.

Aged↗

PubMed1995

Psychological reactions in men screened for prostate cancer.

OBJECTIVE: To investigate the possible negative psychological impact of screening for prostate cancer with special focus on the impact of false positive and true positive test results. SUBJECTS AND METHODS: As part of an early detection study for prostate cancer psychological and psychophysiological reactions to various phases of the diagnostic procedures were examined in 2400 randomly selected men divided into various groups. Their psychophysiological reactions were assessed by measurements of serum cortisol and their psychological reactions by questionnaires directed at determining emotional states and sleep disturbance. In a stratified sample of the population (100 men) measurements were made at the time of the screening examination and again 2 weeks later. In patients undergoing biopsy (307 men) measurements were made 2 weeks after screening, but before they were informed of the biopsy results, and again 4 and 16 weeks after screening. RESULTS: Serum cortisol levels at the screening examination were higher than corresponding levels of a comparable sample of Swedish men during normal daily activity, indicating that an invitation to examination for prostate cancer per se might create emotional stress. Two weeks after the screening the elevated levels had decreased to normal. The highest cortisol levels were found in men who had undergone biopsy, immediately before they were informed of the results 2 weeks after screening. After they were informed, cortisol levels fell, regardless of the results of the biopsy. The patterns of emotional state and sleep disturbance were similar except that sleep disturbance was delayed. CONCLUSION: In screening programmes for prostate cancer it is important to define clearly the high-risk groups to minimize the risk of adverse psychological reactions in those subjects with a low risk of having the disease. The results also emphasize the need to reduce the number of false positive results by choosing diagnostic tests of high specificity. The interval between a test and informing the subject of the results should be minimized to decrease the duration of the increased emotional stress.

Aged↗

PubMed1993

Intraoral ultrasonography in the diagnosis of peritonsillar abscess.

The diagnosis of quinsy is traditionally established on the basis of clinical observations and sometimes several diagnostic punctures. The present study has focused on the possible usefulness of intraoral ultrasonography (IOU) as a diagnostic tool when a peritonsillar abscess is suspected. The results show that it is possible to demonstrate, with a high degree of accuracy, the presence of an abscess, its volume, location, and its relation to the carotid artery. With this information an exact and safe diagnostic puncture can be performed when necessary and avoided in cases with clinical signs of quinsy with no abscess.

Adult↗