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Biomedical subjects

R Bergström

Publications and source records attributed to R Bergström.

At least 217 records · Page 12Linked to original sources
PubMed1988

Prognosis in bilateral breast cancer. Effects of time interval between first and second primary tumours.

Survival rates for 67 women with bilateral breast cancer were compared to those for 1282 women with unilateral disease in a follow-up of 1349 women participating in a population-based study. Relative survival at 8 years of follow-up was 69% for women with unilateral disease as compared to 53% for women with bilateral cancer. When possible confounding histopathological differences--data about which were prospectively collected--and age were adjusted for in a multivariate analysis, the relative hazard rate was significantly higher for women with bilateral versus unilateral breast cancer (P = 0.006). The impact of interval time between the two primaries was analysed and a roughly two-fold higher hazard rate was seen for synchronous cancers with regularly falling risk for increasing interval times. This trend was however not statistically significant. The results indicate that the two tumours contribute independently to the patient's excess risk of dying and thus occur as two seemingly biologically unrelated events with respect to the tumour-host relationship and metastatic behaviour.

Aged↗
PubMed1988

Cigarette smoking, alcohol consumption and risk of breast cancer in young women.

The possible association between cigarette smoking, alcohol consumption and the risk of development of breast cancer before the age of 45 was investigated by means of a population-based case-control study in Sweden and Norway. Information was obtained, by personal interview, from 422 (89.2%) of all eligible patients with breast cancer newly diagnosed between May 1984 and May 1985, and from 527 (80.6%) of all age-matched controls. The possible confounding effects of oral contraceptive (OC) use, education, and reproductive and several other factors were taken into account in multivariate analyses. No association was found between ever smoking (versus never smoking) and breast cancer (odds ratio 1.0; 95% confidence interval (CI) 0.8-1.3). Further, there was no relation between breast cancer and duration of smoking, age at start of regular smoking, length of time since the start of regular smoking, or number of cigarettes smoked per day. There was no significant interaction between smoking, use of OCs, parity, and breast cancer. A moderate or high current consumption of beer, wine, liquor or total alcohol did not increase the risk of breast cancer. An alcohol intake of 5 grams per day or more was associated with a decreased risk of breast cancer (odds ratio 0.6; 95% CI 0.4-0.9), but possible effects of a change in habits after diagnosis, of recall bias and of residual confounding, e.g. by dietary habits, need serious consideration.

Adult↗
PubMed1988

Changes in calcium metabolic indices during long-term treatment of patients with essential hypertension.

1. Disturbances of calcium metabolism, mimicking mild, compensated secondary hyperparathyroidism, accompany essential hypertension, but it is not known whether these alterations are primary or only secondary to the elevated blood pressure. 2. Indices of systemic calcium metabolism were followed prospectively during 6 months' treatment with either propranolol, bendroflumethiazide or verapamil in 35 patients with essential hypertension. Multivariate statistical methods were employed to study the effects of blood pressure reduction upon the metabolic indices with adjustment for the effects of the different antihypertensive agents. 3. Propranolol treatment increased the plasma ionized calcium and serum phosphate concentrations, and reduced the serum levels of parathyroid hormone, free fatty acids and glycerol. Neither the total nor the total albumin-modified serum calcium concentration was significantly affected. Thus, presumably the decrease in free fatty acids reduced the calcium complex and the calcium binding to albumin, and consequently increased the plasma ionized calcium, thereby suppressing the secretion of parathyroid hormone. 4. Bendroflumethiazide caused a reduction of the fasting renal calcium excretion to half the pretreatment level, but produced no other significant changes in the various indices of calcium metabolism. 5. During verapamil treatment, the fasting renal excretion of calcium and magnesium increased, whereas the free fatty acids and glycerol concentrations in serum were reduced. These two changes presumably balanced each other, as the plasma ionized calcium and serum parathyroid hormone concentrations were not significantly altered. 6. There were no consistent relationships between the decrease in blood pressure and the changes in the metabolic indices, either in the total sample or within any subgroup.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1988

The patient's appraisal of the cosmetic result of segmental mastectomy in benign and malignant breast disease.

Women's appraisal of the cosmetic result and their psychosocial adjustment after a standardized segmental mastectomy for benign or malignant breast disease was analyzed on the basis of a mailed questionnaire, which was satisfactorily answered by 263 (92%) of 285 women operated on consecutively. The overall result was favorable: 96.5% of the patients found the new appearance of their breast very good (30.7%), good (44.0%), or acceptable (21.8%). Women with a benign diagnosis ran a two-fold higher risk of being discontented with the new appearance of the breast than those with breast cancer. Complications of radiation therapy, preoperative concern that the breasts are important for the appearance, and anxiousness about the cosmetic result were associated with a significantly elevated risk of being less satisfied with the outcome. The main finding that it is possible to perform a locally radical operation that is highly acceptable to the woman is relevant to the surgical management of potentially malignant mammographic lesions and also to the scientific strategies for future evaluation of breast-conserving treatment modes in malignant disease.

Aged↗
PubMed1988

Biochemical markers in multiple myeloma: a multivariate analysis.

The analysis of individual biochemical and clinical variables in 121 patients with multiple myeloma showed that serum beta 2-microglobulin (S-beta 2m) had the most significant relation to survival. Other variables such as serum thymidine kinase (S-TK), serum lactate dehydrogenase (S-LDH), S-creatinine, haemoglobin (Hb), ESR, S-albumin, age and clinical stage were also significant. No such relationship was found with M-component, presence of light chains in urine, type of secreted immunoglobulin or S-calcium. The exclusion of clinical stage in the first multivariate analysis resulted in a model consisting of S-beta 2m, age and S-TK, none of the other variables gave additional information. When in the second multivariate analysis the basic variables involved in staging procedure were excluded and clinical stage included, stage III, but not stage II, was found to give additional information to the model described above. Individual analysis of the variables showed that Hb had the most significant relation to effect of initial therapy. Other significant variables were S-TK, S-beta 2m and age. When using the multivariate approach, Hb alone was found to contain all the relevant information.

Adult↗
PubMed1988

Survival of intensive care patients. I: Prognostic factors from the patient's medical history.

All adult patients (978) admitted in 1983 to a multidisciplinary intensive care unit (ICU) were studied prospectively. 9.6% died in the unit. The cumulative mortality was 26.5% 1 year after admission. Of the patients who were 65 years and older, 43.1% had died after 1 year compared to 10.6% in the youngest age group (15-44 years). Using multiple logistic regression analyses, prognostic factors for mortality were identified. All the factors were known at the time of admission. Risk factors for death in the ICU included age, admission for disorders in several organ systems, cardiopulmonary arrest and acute respiratory disorder. In addition to age and acute conditions at the time of admission, cumulative mortality after 1 year was also influenced by chronic conditions such as diabetes mellitus, chronic heart failure and cancer. These data document the importance of taking age and chronic illness into account when making a prognosis for intensive care patients.

Adult↗
PubMed1988

Survival of intensive care patients. II: Outcome prediction 1 hour after admission.

978 patients from a multidisciplinary intensive care unit (ICU) were followed prospectively to evaluate outcome. At 1 year after admission the cumulative mortality was 26.5%. Age, medical history and different condition variables 1 h after admission were included in logistic regression models in order to identify risk factors for death in the ICU and afterwards. By combining these predictive factors, it was possible to describe clinically interesting patient groups with a low and a high risk, respectively, of dying. 330 patients younger than 65 years, without any history of cancer and without any condition risk factors 1 h after admission, had a cumulative mortality of 6% at 1 year as compared to another group of patients with a 1-year mortality of 63%. In a small group of patients who had all the identified risk factors, the mortality rate at 1 year was 100%. It was also possible to identify a low-risk group of 251 patients (26% of total) who had a risk of death in the ICU of less than 0.5% as compared to 9.6% for the average patient.

Adult↗
PubMed1988

Effects of propranolol and verapamil on plasma ionized calcium and parathyroid hormone in short-term intense isokinetic leg exercise.

Physical exercise, beta-adrenergic stimulation and calcium channel blockade can affect calcium homeostasis. The present study investigated, in eight healthy males, the effects of orally administered propranolol or verapamil during a 2-min maximal, isokinetic, leg exercise. Immediately after exercise the plasma ionized calcium concentrations were increased, in control and drug tests, by 5-6%, and within 5 min of recovery they were almost returned to baseline. Serum parathyroid hormone (PTH) concentrations were unchanged at termination of exercise, but they increased during the first 5 min of recovery, coincident with the decline in calcium concentrations, which, however, were still elevated. Neither verapamil nor propranolol selectively changed basal or exercise plasma ionized calcium or serum PTH concentrations. Muscle strength, blood pH, lactate concentrations and plasma volume changes were not affected by any drug. Verapamil did not have any specific effect on the concentrations of plasma magnesium, phosphate, potassium or sodium while propranolol increased the concentrations of plasma potassium and decreased those of phosphate during exercise as well as recovery.

Adult↗
PubMed1988

Prognostic significance of the Ackerman classification and other histopathological characteristics in breast cancer. An analysis of 1,349 consecutive cases with complete follow-up over seven years.

Survival rates during a follow-up period of more than seven years were analyzed in 1,349 women with breast cancer in relation to the histo-pathological classification of female breast cancer proposed by Ackerman and to other commonly used histo-pathological criteria, including the axillary node status. The information was collected prospectively during a case-control study. Major emphasis was placed on multivariate evaluation. In analyses based on the histo-pathological findings in the mastectomy specimen alone, the Ackerman grouping was found to be of prognostic value, but apart from nuclear polymorphism the other recorded characteristics (histo-pathological type, histological grading, lymphocyte infiltration, and sinus histiocytosis) did not give any prognostic information. When the axillary node status was included in the multivariate models, the presence of axillary metastases correlated well with the prognosis and the Ackerman classification provided no significant additional information. The results indicate that in cases where the histopathological axillary status is known, little additional prognostic information can be gained from traditional histo-pathological evaluation over and above this status. However, the Ackerman classification and the degree of nuclear polymorphism separate distinct prognostic groups with the same degree of difference in observed survival rates as one discriminated by the axillary node status.

Breast Neoplasms↗
PubMed1988

Evaluation of a new method of assessing pruritus and antipruritic drugs.

A new method (Pain-Track) for recording subjective symptoms was evaluated for its capacity to quantify clinical itch. The Pain-Track system includes portable data loggers carried by the patients, a personal computer with a software package for storage and analysis of the data and a terminal unit to connect the loggers and computer. Every 60 min a signal from the logger commands the patient to mark his presence and rate the itch intensity. During night time the hourly buzz can be turned off but the intensity rate can be adjusted whenever wanted. The antipruritic effect of betamethasone dipropionate and its cream base was studied according to a double-blind, crossover protocol in 30 adult outpatients with atopic dermatitis, 26 of whom completed the study. Analysis with parametric and nonparametric methods showed that the itch intensity was significantly lower during active treatment than with placebo. Onset of the antipruritic action was rapid. Examination of the 'itch profile' revealed that atopics have more intense itch both in the mornings and evenings than during the day. It is concluded that by using a drug with known antipruritic effect we have shown that Pain-Track is a useful tool for assessing clinical pruritus and the antipruritic effects of drugs. The main advantages are possibilities for frequent recordings, surveillance of compliance improving authenticity, and storage and analysis of a large amount of data.

Adult↗
PubMed1988

Traumatic injury in large-for-date infants.

The risk of traumatic injury and low Apgar score was studied in 473 infants with a birth weight of 4500 g or more at term (LFD) and 473 infants with normal weight (NFD, birth weight +/- 1 SD of mean for the respective gestational age). The LFD group comprised 3.2% of all infants delivered during a 5-year period. Traumatic injuries were observed in 8.0% of the LFD versus 0.6% of the NFD group. The injuries in the LFD group were 28 fractured clavicles, four fractured humerus and 12 brachial plexus injuries. Six of the LFD infants had multiple injuries. The injuries in the NFD group were three fractured clavicles. All infants with traumatic injuries were delivered vaginally. Contributory obstetrical factors for traumatic injury were forceps, post-term pregnancy and vacuum extraction. High birth weight was correlated to a low Apgar score at one minute, as also was post-term pregnancy.

Birth Injuries↗
PubMed1988

Preoperative serum markers in carcinoma of the rectum and rectosigmoid. I. Prediction of tumour stage.

Preoperative serum concentrations of carcinoembryonic antigen (CEA), tissue polypeptide antigen (TPA) and a monoclonal-antibody-defined carcinoma-associated carbohydrate antigen, CA-50, were measured in 272 consecutive patients with histopathologically proven rectal carcinoma. The levels of all three tumour markers correlated directly to the stage of the disease. The serum TPA reflected both the local tumour burden and any metastatic spread, as shown by analysing mean levels of S-TPA and by the use of a Walker and Duncan regression model. S-CA-50 separated patients with and without distant metastases, but not with regard to the local tumour burden. Although the level of S-CEA correlated to the tumour stage, it did not discriminate patients with respect to locally advanced growth or generalized disease. In a multivariate analysis, the serum level of TPA was found to be the most informative preoperatively. Both S-CA-50 and S-CEA gave information additional to that provided by S-TPA in the prediction of the tumour stage (Dukes' stage A-D), and S-CA-50 was also useful in the prediction of metastatic disease.

Adult↗
PubMed1988

Preoperative serum markers in carcinoma of the rectum and rectosigmoid. II. Prediction of prognosis.

The prognostic value of a single preoperative determination of the serum (S) concentration of carcinoembryonic antigen (CEA), tissue polypeptide antigen (TPA) and the carcinoma-associated carbohydrate antigen CA-50, either alone or in combination was evaluated in 327 consecutive patients with carcinoma of the rectum. A strong correlation was found between the serum level of each of these tumour markers separately, and prognosis, both in terms of crude survival in all patients and in disease-free survival in 'potentially cured' patients. The prognostic information provided by S-TPA and S-CA-50 was stronger, however, than that given by S-CEA. In a multivariate approach, S-TPA was found to be most informative. With use of the Cox regression model, the critical serum values that best separated patients in regard to mortality were CEA 18 micrograms/l, TPA 120 U/l and S-CA-50 40 U/ml. The critical values that best discriminated disease-free survival in 'potentially cured' patients were CEA 12 micrograms/l, TPA 110 U/l and S-CA-50 28 U/ml. The clinical usefulness of these and other cut-off levels is discussed.

Adult↗
PubMed1988

Preoperative clinical and pathological variables in prognostic evaluation of patients with rectal cancer. A prospective study of 327 consecutive patients.

The prognostic information provided by a number of easily identified and preoperatively available characteristics was recorded prospectively and evaluated in 327 consecutive patients with rectal carcinoma. With use of the Cox regression model, the two variables indicating surgical non-curability, namely immobility of the tumour to the adjacent tissues and preoperatively diagnosed metastatic spread, showed the strongest relation to prognosis. Other variables predictive of a poorer outcome in all patients were abnormal liver function tests, large tumour size (number of degrees of the bowel wall circumference affected by the tumour), non-polypoid tumour growth, tumour ulceration, tumour stricture, tumour growth anteriorly and low histological differentiation in the preoperative biopsy. These variables, together with age, also gave information concerning the group of patients of interest for pre- or peroperatively initiated adjuvant therapy, i.e. patients potentially curable by surgery (locally resectable tumour and no known metastases). In this group, the two preoperatively available variables with the best prognostic value, polypoid tumour growth and age, appeared inferior to the postoperatively determined tumour stage (Dukes' staging). However, some clinical variables gave information additional to that provided by the tumour stage.

Adult↗
PubMed1987

Survival and renal function in untreated hypercalcaemia. Population-based cohort study with 14 years of follow-up.

172 persons with mild to moderate hypercalcaemia were followed up for 14 years. Life-table analyses showed that, among persons aged 70 years or less at the time of detection of the hypercalcaemia, survival was lower in the hypercalcaemic group than in a normocalcaemic age and sex matched control group. No such difference was found among older persons. The lower survival was related to degree of hypercalcaemia, and this held true when systolic and diastolic blood pressure, serum glucose, serum uric acid, and serum cholesterol were taken into account in a multivariate analysis. The lower survival seemed to be due mainly to deaths from diseases of the circulatory organs. No person with normal renal function at the beginning of the study period had a more than marginally raised serum creatinine at follow-up.

Actuarial Analysis↗
PubMed1987

Patients with primary hyperparathyroidism operated on over a 24-year period: temporal trends of clinical and laboratory findings.

Temporal trends of clinical and laboratory data of 441 patients operated upon for primary hyperparathyroidism (HPT) during 1956-1979 were analysed retrospectively. There was a marked increase in the number of operations for HPT during that time period, from 32 during 1956-1964 to 326 in 1970-1979. In parallel there was a decrease in the proportion of patients with classical manifestations of HPT such as renal stones or bone disease, the latter being on the whole rarely seen in this population. The increased number of operations was instead largely attributable to the more frequent diagnosis of HPT in patients with vague psychiatric or neuromuscular symptoms or with no clinical manifestations; the majority of these persons were older women, the proportion of operations in women 45 years of age or older, increasing from 56% during 1956-64 to 71% during 1970-79. The increased number of operations for HPT during the last decades should be mainly the consequence of a greater awareness of the disease.

Adenoma↗