Biomedical subjects

R Bergström

Publications and source records attributed to R Bergström.

At least 199 records · Page 11Linked to original sources

PubMed1989

Psychosocial adjustment after mastectomy and breast-conserving treatment.

The possible advantages of breast-conserving surgery over mastectomy with respect to psychosocial adjustment were assessed in an interview study. Consecutive patients 40 to 80 years of age with invasive breast cancer of Stages I and II were eligible for the study. Of 161 women, 99 agreed to participate; 37 received breast-conserving treatment and 62 received a modified radical mastectomy. The study method consisted of a semistructured interview at 4 and 13 months after primary treatment based on the Social Adjustment Scale (SAS) and two scales for the estimation of anxiety, depression, and adjustment to a sexual relationship. The women's ratings in the SAS inventory for adjustment to work, social life, marriage, sexual relationship, and parental role showed no statistically significant differences between the two groups. In the interviewer's global rating in the SAS protocol of the overall adjustment after 13 months, 22.0% of the women in the mastectomy group versus 5.4% of those with a preserved breast were rated as having significant disturbances. A statistically nonsignificant tendency (P greater than 0.05) emerged for the other ratings in the interviewer's assessment in SAS and in the estimation of anxiety, depression, and adjustment to sexual relationships. The consistent tendency indicates that there might be clinically important differences in the psychosocial adjustment after the two treatment methods. Larger trials focused more sensitively on the problems after breast loss versus breast preservation in breast cancer surgery are needed to further explore this field.

Adult↗

PubMed1989

Lung cell reactions in guinea pigs after inhalation of asbestos (amosite).

To study the long-term effect of inhaled asbestos, guinea-pigs were exposed to airborne amosite at a concentration of 49 mg/m3, 2 h/day for 3 or 6 weeks and examined up to 2 years after exposure. Macrophages in lung lavage fluid (LLF) were increased at 16, 24 and 93 weeks and lymphocytes at 24 weeks. Examination of lung wall cells (LWC) 2 years after exposure compared to cells obtained by LLF showed higher proportions of LWC lymphocytes and neutrophils. Percoll gradient centrifugation of these cells showed a higher proportion of high density macrophages in LLF from the amosite-exposed animal and an increased number of low density lymphocytes in the LW. Cathepsin D was increased in LLF at 8 and 24 weeks and in alveolar macrophages 24 weeks and 2 years after exposure. Fibroblast cultures exposed to LLF did not show any statistical significant changes in their collagen synthesis. Histology 93 weeks after exposure showed macrophage and mediastinal lymph node accumulation of asbestos, as well as collagen in alveolar walls. Granulomas were found in the vicinity of blood vessels and in connection with the bronchioles. The data suggest that amosite at low doses ultimately causes fibrosis with a reaction pattern different from that seen in silicosis. The inflammation and fibrosis seems to develop only within the interstitium.

Administration, Inhalation↗

PubMed1989

Histopathologic characteristics and nuclear DNA content as prognostic factors in medullary thyroid carcinoma. A nationwide study in Sweden. The Swedish MTC Study Group.

Complete follow-up for 4 to 27 years was achieved for virtually all 249 patients with medullary thyroid carcinoma (MTC) diagnosed in Sweden in a 23-year period. Tumor specimens from 241 patients were re-examined with regard to calcitonin immunoreactivity, amyloid content, argyrophil reaction, tumor capsule condition, and nuclear DNA content. In univariate analyses, these factors, with the exception of the argyrophil reaction, were strong predictors of survival. There were twofold-to-threefold differences in hazard rate between patients with a high (greater than 50%) and low (less than 10%) frequency of calcitonin-immunoreactive tumor cells, between those with amyloid-containing and amyloid-free tumors, and between those with an intact and a nonintact tumor capsule. Calcitonin immunoreactivity and the amyloid content also provided prognostic information in multivariate analyses that adjusted for all the other factors mentioned above and in the full multivariate model, which in addition considered age, sex, heredity, stage of the disease, tumor size, and treatment. The strong prognostic capacity of the nuclear DNA content found in univariate analyses became considerably weaker when other morphologic characteristics were considered.

Adult↗

PubMed1989

Preoperative prediction of outcome in patients with rectal and rectosigmoid cancer.

This study evaluated the possibility of dividing patients with primary rectal carcinoma into prognostic groups before surgery based on preoperative serum levels of carcinoembryonic antigen (CEA), tissue polypeptide antigen (TPA), and an antigen defined by the monoclonal antibody C-50 (CA-50), as well as on some easily available clinical characteristics providing prognostic information. The evaluation was made both for patients who were "potentially curable" by surgery and, among those, for patients who were "potentially cured." Using the Cox regression model, the serum levels of the three tumor markers, together with the knowledge of whether or not the tumor was polypoid were combined to make up the set of variables that best predicted patient outcome. These variables and their associated regression coefficients were used to classify the patients according to prognosis. The cancer-specific mortality rate for the 24% of potentially curable patients with the best prognosis was 15%; for the 26% of potentially curable patients with the worst prognosis, the cancer-specific mortality rate was 57%. For potentially cured patients among those who were potentially curable, the cancer-specific mortality rates for patients with the best and worst prognoses were 14% and 47%, respectively. The information provided by these preoperatively available variables together was comparable with that given by Dukes' staging system, but the latter system was more informative. On the other hand, some of the preoperative variables provided information not provided by Dukes' staging system.

Adult↗

PubMed1989

Trends in survival from malignant melanoma: remarkable improvement in 23 years.

Trends in incidence of and mortality and survival from malignant melanoma in Sweden for 1960 through 1982 were analyzed. Incidence rates increased annually by 5.4% for females and by 5.8% for males, whereas mortality rates increased annually by 2.7% for females and 3.3% for males. For females, the 5-year relative survival (RS) rates increased by approximately 15 percentage points before 1970. In contrast, males before 1970 had a successive improvement in RS rates of 4.6-8.2 percentage points for each 5-year period of diagnosis. Multivariate analyses revealed that during the study period the malignant melanoma-specific hazard decreased by 71% [95% confidence interval (CI) = 59%-79%] for females and by 64% (95% CI = 54%-73%) for males during the first 5 years of follow-up.

Aged↗

PubMed1989

Natural history of localised prostatic cancer. A population-based study in 223 untreated patients.

In a population-based study, disease progression and survival were evaluated in untreated patients with newly diagnosed cancer of the prostate without distant metastases. Complete follow-up was achieved in 223 of 227 (98%) consecutively diagnosed, eligible patients of all ages. After 5 years, the cumulative progression-free survival (with 95% confidence interval) was 71.8 (65.5-78.1)% and survival corrected for causes of death other than prostatic cancer was 93.8 (88.3-97.6)%. Univariate and multivariate analyses showed no association between age at diagnosis and the natural course. Local progression was less common in localised, non-palpable tumours than in larger tumours. The rate of progression was 18.7 (6.1-57.1) times higher and that of disease-specific death 216.0 (31.2-1496) times higher in patients with poorly than in those with highly differentiated tumours. It is concluded that tumour grade at diagnosis is an excellent predictor of local and distant progression. The low death rate, especially in patients with highly and moderately differentiated tumours, means that any local or systemic therapy intended for patients with early prostatic cancer must be evaluated in clinical trials with untreated controls for comparison.

Actuarial Analysis↗

PubMed1989

Clinical characteristics in sporadic and familial medullary thyroid carcinoma. A nationwide study of 249 patients in Sweden from 1959 through 1981.

All patients with medullary thyroid carcinoma (MTC) diagnosed in Sweden during 1959 through 1981 were recruited for study from the Swedish Cancer Registry. Among a total of 249 patients, 66 were diagnosed in 1959 through 1969 and 183 from 1970 through 1981. Apparently sporadic MTC was present in 186 patients, and familial MTC in 63. Twenty-seven patients with familial MTC were diagnosed from clinical symptoms and 36 by screening. In both the sporadic group and the symptomatic familial group, approximately 80% of the patients had palpable thyroid tumors. Lymph node metastases were present in 44% of the sporadic group and in 37% of the group with symptomatic familial MTC, and distant metastases in approximately 20% of the patients in each of these groups. The patients detected by screening differed significantly from the two groups of symptomatic cases by having a lower frequency of palpable thyroid lesions (50%), smaller tumors, and lower frequencies of cervical lymph node metastases (14%) and distant metastases (0%). Multivariate analyses revealed no significant differences between sporadic cases and symptomatic familial cases regarding tumor size or stage. Large tumors (greater than 3 cm) were more frequently accompanied by palpable cervical lymph nodes and were associated with an approximately four times higher risk of distant metastases than tumors smaller than 1 cm. Women had significantly smaller tumors and a more favorable stage distribution than age-related men.

Adult↗

PubMed1989

Preoperative prediction of late cancer-specific deaths in patients with rectal and rectosigmoid carcinoma.

The possibility of predicting late cancer-specific deaths from (a) the preoperative serum levels of three tumour markers, carcinoembryonic antigen (CEA), tissue polypeptide antigen (TPA) and an antigen defined by the C-50 antibody (CA-50), from (b) one clinical factor of independent prognostic relevance, polypoid tumour growth, and from (c) Dukes' stage was evaluated in 276 patients with rectal carcinoma operated upon with curative intent ("potentially curable"), and in the 251 of those patients who were considered to be "potentially cured" after surgery. Using the Cox regression model, the preoperative serum levels of the tumour markers strongly predicted the cancer-specific mortality within the first year after surgery. This ability of S-CEA and S-CA-50 diminished for the mortality during the second year after surgery, and virtually disappeared thereafter. The ability of S-TPA to predict cancer-specific deaths did not change as dramatically with time as that of the other two markers, particularly in the group of "potentially cured" patients. Patients with polypoid tumour growth had a good prognosis which did not appear to change with time. Similarly, the prognostic information provided by Dukes' staging system was valid at all studied time intervals after surgery, although it declined after the second year. The importance of these results in relation to the selection of patients for adjuvant treatment is discussed.

Adenocarcinoma↗

PubMed1989

Radiocaesium from Chernobyl in Swedish moose.

The (137)Cs activity concentrations of muscle samples taken from moose collected from the central part of Sweden were determined. Pre-Chernobyl samples had a mean (137)Cs activity concentration of 23 Bq kg(-1). Samples collected during the hunting season (mainly October) had, on average, 760 Bq kg(-1) in 1986 and 664 Bq kg(-1) in 1987. No significant differences between various muscles (neck, thigh and leg) could be seen. The correlation between ground deposition of (137)Cs and activity concentration in moose muscle was significant. There seems, however, to be other important parameters. One is the percentage of farmland within the home range of the moose-less farmland gives higher (137)Cs activity concentrations.

Journal Article↗

PubMed1989

The association between anatomic site and survival in malignant melanoma. An analysis of 12,353 cases from the Swedish Cancer Registry.

The relationship between site and survival in cutaneous malignant melanoma was investigated by a follow-up of 12,353 Swedish patients diagnosed in 1960-1982. In males, the poorest prognosis was found for tumors located on the scalp-neck region (5-year relative survival rate, RS51%), followed by the lower extremity (RS66%) and trunk (RS68%). Among females, the poorest prognosis was noted for tumors located on the external ear (5-year RS 71%), trunk (RS 78%) and scalp-neck (RS 78%). The prognosis varied considerably between the sites of the head-neck region--for eyelid and facial lesions the prognosis was good, but for external ear and scalp-neck tumors it was poor. Multivariate analysis taking into account age and year of diagnosis showed the highest relative hazards (RH) for female lesions of the trunk (1.40) and male scalp-neck tumors (1.65), with the upper extremity used as reference (RH = 1.00). Except for lesions of the trunk, no significant differences in RH were found between the various sites after 4 years of observation.

Adult↗

PubMed1989

Predictive value of factors affecting early results and complications in eight years of coronary artery bypass surgery.

All cases of coronary bypass procedures without concomitant heart valve replacement occurring in a defined geographical area over a 8-year period (1980-1987) were reviewed and the 30-day mortality and complication rates associated with them were analyzed. The study comprised 3,484 patients with the diagnoses: stable (2477) or unstable (724) angina pectoris, angina pectoris combined with left ventricular aneurysm (165) or with an other complicating factor (96), postinfarction septal defect (13) and postinfarction mitral valve insufficiency (9). The total operative mortality during the study period was 3.1%. Persistent new Q waves in the electrocardiogram developed in 2.4% and increased enzyme release indicating myocardial injury (S-ASAT greater than 2.0 microkat/L and S-CKMB isoenzyme greater than 1.5 microkat/L) occurred in 15%. There were 478 complications in 378 patients (11%). Indication for surgery, year of surgery, NYHA class, congestive heart failure, age, sex, aortic cross-clamp time, and cardiopulmonary bypass time were significantly related to operative mortality (p less than 0.05). The same variables except sex were related to complications. Myocardial infarction (new persistent Q wave) was predictable by NYHA class, aortic cross-clamp time, and cardiopulmonary bypass time. The same variables and also year of surgery, regrafting procedure, congestive heart failure, and thromboendarterectomy were predictors of myocardial injury (enzyme release).

Angina Pectoris↗

PubMed1989

Circulating T-lymphocyte sub-subsets and NK-like cells in renal transplant patients: patterns associated with rejection.

The patterns of circulating T sub-subset and NK-like cells were monitored in 87 renal transplant patients on a total of 122 occasions. Combinations of monoclonal antibodies were used in two-colour flow cytometric (FACS) analysis to define the major T helper/inducer and T suppressor/cytotoxic subsets and their activated counterparts, the T suppressor inducer and T suppressor effector sub-subsets, NK-like cells and their activated counterparts. In patients with rejection, the proportions of T suppressor inducer and T suppressor effector cells were less and the proportion of activated NK-like cells greater compared with cases exhibiting stable graft function, and these group differences were highly significant. Analysis with stepwise multivariate logistic regression showed that combinations of several functional/activated lymphocyte subsets allow a predictive diagnostic power which is superior to the use of single variables.

Antibodies, Monoclonal↗

PubMed1989

Prognosis after breast cancer diagnosis in women exposed to estrogen and estrogen-progestogen replacement therapy.

The association between survival in breast cancer and menopausal hormone treatment prior to diagnosis was analyzed by comparing 261 women who developed the disease in a population-based cohort of estrogen-treated women with 6,617 breast cancer patients without any recorded estrogen treatment drawn from the same population. Complete follow-up was achieved during the 0-9 years of observation. The relative survival rate was significantly higher (p = 0.02), by about 10 percentage points at eight years, in patients who had received estrogen treatment--corresponding to an approximately 40% reduction in excess mortality. The more favorable course could be confirmed only in patients aged 50 years or more at diagnosis (p less than 0.01) and was most pronounced in recent users, that is, in women whose treatment was ongoing (p less than 0.01) or had been discontinued within one year prior to diagnosis. The time from first use to diagnosis and the total duration of estrogen medication were virtually unrelated to survival when the effect of recency was taken into account in multivariate analyses. The authors were unable to examine the effect of stage at diagnosis on the results. Several factors, particularly selection bias and surveillance bias, might have affected the results in favor of the women receiving hormone replacement therapy, but there is a possibility that exogenous female sex hormones affect survival in women with breast cancer.

Adult↗

PubMed1989

Mammographic parenchymal patterns in women receiving noncontraceptive estrogen treatment.

Two population-based registers, one of women with at least one estrogen prescription, and the other of women who had undergone mammographic screening, were linked by means of the national registration number, revealing 3,436 estrogen-treated women who had attended the mammography screening program. Their mammographic parenchymal pattern was classified according to the criteria of Wolfe into two groups, one with a low risk and the other with a high risk of development of breast cancer. Estrogen replacement therapy was more common in women with a high risk than in those with a low risk mammographic parenchymal pattern (standardized morbidity ratio = 1.3). The increased probability of receiving noncontraceptive estrogen treatment in women with a high risk mammographic parenchymal pattern remained when the impact of several possible confounding factors had been taken into account in a logistic regression analysis (odds ratio = 1.36, 95% confidence interval 1.24-1.49). No evidence was found of a shift toward the unfavorable mammographic parenchymal pattern during treatment, which suggests that the treatment itself was not responsible for the high proportion of P2 and DY patterns. The mammographic parenchymal pattern must therefore be looked upon as a confounder in the context of studying breast cancer risk after estrogen treatment.

Adult↗

PubMed1989

Immunologic diagnosis of kidney rejection using FACS analysis of graft-infiltrating functional and activated T and NK cell subsets.

In human organ transplantation, the correct diagnosis of rejection may be difficult using clinical and/or histopathologic criteria, and immunologic assays should therefore be considered. We have applied monoclonal antibodies in 2-color flow cytometric (FACS) analysis to study phenotypic patterns of kidney-infiltrating activated and functional T and NK cell subsets in 132 posttransplantation biopsies. Viable intragraft lymphocytes and kidney tubular cells were obtained by the use of medium-sized ultra-sound guided needle biopsy. In univariate analyses, highly significant differences were observed between rejecting and stable grafts. During rejection, the proportions of HLA-DR+ kidney tubular cells, total lymphocytes, T suppressor/cytotoxic cells, and natural killer (NK)-like cells increased; the fractions of phenotypically activated, HLA-DR+ cells within the latter 2 cell populations were elevated. Further, during rejection phenotypic T suppressor inducer and T suppressor effector cells were virtually absent in kidney tissue but reappeared rapidly upon successful antirejection therapy. Multivariate analyses revealed that combinations of antibodies in FACS analysis defining functional and activated subsubsets of T and NK cells allow a precise and rapid immunologic diagnosis of kidney rejection.

Antigens, Differentiation, T-Lymphocyte↗

PubMed1989

Survival compared to the general population and changes in health status among intensive care patients.

In order to evaluate intensive care, all adult patients (980) admitted to a multidisciplinary intensive care unit (ICU) during 1 year were followed prospectively. The ICU mortality was 9.6%. One year after admission the survival was 73.6%. By that time the surviving patients had a further survival that was 96% of that of the general population. Of the 1-year survivors, 22.3% had deteriorated in health status compared to 3 months before the stay in ICU. In the admission groups with high mortality the survivors had a more pronounced deterioration in health status. Increased age and length of stay in the ICU were associated with higher mortality but not with changes in health status. We conclude that the outcome of intensive care can be evaluated by studying only the survival, since the survival rate is correlated to changes in health status among survivors in the different admission groups. One year after admission most of the surviving patients had regained their previous health status and their further survival was almost the same as that of the general population.

Adolescent↗

PubMed1989

Postoperative predictive value of a new method of intraoperative angiographic assessment of runoff in femoropopliteal bypass grafting.

In 96 consecutive patients undergoing primary femoropopliteal bypass grafting, the runoff was evaluated with a new grading system, based on findings at intraoperative postreconstruction serial angiography. This concept, which takes foot vessel involvement into account in patients with only one patent crural artery, is a modification of the traditional method of runoff assessment. Good runoff was defined as patency of two or three lower leg arteries to the foot or one patent, vessel continuous with intact anterior or posterior foot arch. In limbs with no patent vessel or one patent vessel with deficient or occluded foot arches, the runoff was classified as poor. The cumulative primary patency rates at 12 months in groups with good and poor runoff were 81% and 37%, respectively. The predictive value of the new method was superior to that of other comparable methods (traditional method, Society for Vascular Surgery and International Society for Cardiovascular Surgery criteria, and modified Society for Vascular Surgery and International Society for Cardiovascular Surgery criteria). This improved prediction can be ascribed to the optimal angiographic technique for visualizing distal vessels, selective evaluation of foot vessel runoff with a new concept, and the criteria used to define good and poor runoff.

Adult↗

PubMed1988

Improved survival of patients with cancers of the colon and rectum?

The survival of 61,769 patients diagnosed as having colorectal cancer in the total Swedish population in 1960-1981 was analyzed. The 5-year relative survival rates during the total period were approximately 40%; patients with colonic carcinoma had a somewhat better prognosis than patients with rectal carcinoma, and men had a generally less favorable prognosis than women. Comparison of patients diagnosed in 1960-1964 and in 1975-1979 showed a slight improvement in survival during the more recent study period, i.e., an improvement rate of 7.0% for both cancer of the colon and cancer of the rectum. The improvement occurred mainly during the first months of follow-up. However, the excess mortality due to colorectal cancer 1-5 years after diagnosis as compared to the expected mortality in the general population remained virtually unaltered. A multivariate analysis in which adjustment was made for the possible confounding variables of sex, age, and site (of colonic carcinoma) gave consistent results. Reduced postoperative mortality was considered to be the most likely major explanation for the temporal trend toward a more favorable prognosis. Thus it seemed that the treatment of colorectal cancer in Sweden during the last two decades has not improved significantly except in terms of reduced postoperative mortality. Thus the challenge of improving survival in patients with colorectal cancer must be given high priority.

Actuarial Analysis↗