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Biomedical subjects

R Bergström

Publications and source records attributed to R Bergström.

At least 235 records · Page 13Linked to original sources
PubMed1987

Automatic analysis of Papanicolaou smears by digital image processing.

Papanicolaou smears from 378 patients were analyzed in a fully automated microscope system using an image analysis technique. The logic of the system subdivided the smears into "normal" (63%), "not possible to analyze in the machine" (17%) and "positive" (20%). The results have been compared with the conventional screening method available today taking into consideration the definition problems of a true diagnosis, cytopathological and histopathological consensus, reproducibility, sample-taking and interpretation mistakes, etc. As 37% (rejected and positive) of the smears in this particular study were analyzed visually after machine prescreening, it could be demonstrated that the false-negative rate among the remaining 63% of the specimens was significantly lower among the machine-screened smears when compared with visual screening if the results were correlated with histopathological consensus. The results clearly indicate that the technology required to build computerized microscope systems, which are able to automatically sort out at least two thirds of Papanicolaou smears is available today. The only limiting factor is the cost-benefit relationship.

False Negative Reactions↗
PubMed1987

Epidemiologic determinants of the mammographic parenchymal pattern. A population-based study within a mammographic screening program.

Epidemiologic data and information on the mammographic parenchymal pattern (classified according to Wolfe (Cancer 1976;37:2486-92)) were obtained from 38,757 (89%) of all women who were invited to undergo mammography in a population-based screening program in Kopparberg County, Sweden, starting in October 1977. The prevalence of the high-risk patterns (P2 and DY) was significantly higher in women aged 46-50 years than in any younger or older age group. A univariate analysis revealed that the odds ratio (OR) of having a high-risk pattern increased regularly with increasing age at first birth and was highest in nulliparous women. These associations remained evident in all age groups and were most pronounced in the oldest women. A history of breast biopsy increased the likelihood of having a high-risk pattern (OR = 1.57), whereas a similar weak overall association with prior cancer in the contralateral breast (OR = 1.40) and with familiar occurrence of breast cancer (OR = 1.20) was eliminated when other confounding factors were considered in a multivariate analysis. The authors conclude that characteristics of the reproductive lives of women have a significant and lifelong impact on their mammographic parenchymal patterns.

Adult↗
PubMed1987

Reflux esophagitis: assessment of therapy effects and observer variation by video documentation of endoscopy findings.

Twenty-eight patients with endoscopically confirmed erosive or ulcerative esophagitis completed an 8-week placebo-controlled trial evaluating the symptomatic and endoscopic improvement obtained with ranitidine, 150 mg twice daily. Twice daily the patients recorded the number of episodes of retrosternal pain, regurgitation, and pyrosis on a diary card during a trial period of 1 week and during the 1st and 5th study week. Video documentation of endoscopy findings was undertaken before and at the end of the trial. The symptomatic relief obtained with ranitidine was significantly better than that obtained with placebo. The videotapes were assessed blindly and independently by three experienced fiberoptic endoscopists. The tapes were also recoded and reassessed by the same endoscopist. No systematic difference between different observers, either before or after treatment, could be detected. The interobserver variation, expressed as Kendall's tau b correlation coefficient, was 0.44 to 0.74. This coefficient was higher in intra-observer variation (0.63 to 0.91). Corresponding kappa-values for inter- and intra-observer variations were 0.12 to 0.30 and 0.27 to 0.85, respectively. The esophagitis, as judged by all observers, improved more in the ranitidine group than in the placebo group, but the difference did not reach statistical significance.

Clinical Competence↗
PubMed1987

Is duodenal ulcer really a psychosomatic disease? A population-based case-control study.

Risk factors for prepyloric and duodenal ulcer were analysed by means of a questionnaire in 132 patients and 132 population controls, pairwise matched for age and sex. Several factors associated with a lower socioeconomic status, such as short education, low income and low housing standard, and a job characterized by low satisfaction, low demands, and low autonomy, were more prevalent among the patients. The odds ratio (OR) with 95% confidence limits (CL) in smokers versus non-smokers was 2.9 (CL, 1.7-5.0). A trend emerged in relation to the daily number of cigarettes, with an OR of 4.1 (CL, 2.2-7.5) for those smoking more than 10 cigarettes. The risk of having peptic ulcer disease was virtually unrelated to other psychiatric and somatic morbidity, to marital status, personal worries, type-A behaviour, experience of a hectic or psychologically demanding job, and to consumption of coffee, alcohol, and drugs. Our data lend no support to the concept that peptic ulcer disease is a disorder related to psychologic stress. Causative agents other than smoking should probably be sought among factors characterizing the life style of low socioeconomic classes.

Adolescent↗
PubMed1987

Long-term survival in malignant melanoma with special reference to age and sex as prognostic factors.

A total of 12,353 (97.5%) of all patients with a first malignant melanoma newly diagnosed in Sweden during the period 1960-82 were subjected to a complete computerized follow-up with respect to survival through December 31, 1982. Calculation of relative survival rates (RSs) revealed a consistently more favorable course in women than in men, the 5-year RSs being 80.8 and 68.0% and the 10-year RSs being 75.0 and 61.8%, respectively. Prolonged follow-up and analyses of annual excess mortality showed, in addition, that men surviving about 10 years constituted an apparently cured fraction, whereas among women there was an excess mortality throughout the observation period. The prognosis was increasingly more favorable at younger ages in males, whereas no regular age trend emerged in the female group of patients. A multivariate analysis indicated that the findings were not confounded by temporal trends in RSs or by differences in tumor location between the groups compared and also that the relative hazard was significantly higher for men than for women only during the first 8 years after diagnosis.

Adult↗
PubMed1987

Mortality after surgery for primary hyperparathyroidism: a follow-up of 441 patients operated on from 1956 to 1979.

Four hundred forty-one patients who were operated on for primary hyperparathyroidism were observed for up to 22 years. Mortality was significantly higher than expected during the first postoperative years, for both men and women. This was predominantly due to a higher than expected incidence of diseases of the circulatory organs. The greater risk of death--compared with the expected mortality in the general patient population--appeared to decrease after the initial 5 to 8 postoperative years. However, for the entire follow-up period, the cumulative survival ratio (i.e., the ratio between the expected and the observed rates) was less than 1 for both sexes. The preoperative concentration of serum calcium did not influence the survival rates. The findings are consistent with the hypothesis that untreated hyperparathyroidism carries an increased risk of death, particularly from cardiovascular diseases but that this risk is gradually reduced after surgery.

Actuarial Analysis↗
PubMed1987

Cessation of smoking in patients with intermittent claudication. Effects on the risk of peripheral vascular complications, myocardial infarction and mortality.

The effects of cessation of smoking were studied in 343 patients with intermittent claudication. One year after the initial examination 39 (11%) had stopped smoking and 304 (89%) continued to smoke. The outcome in these two groups was compared. They were comparable regarding baseline characteristics. Rest pain did not develop in any of the non-smokers. In smokers the cumulative proportion with rest pain was 16% after seven years (p less than 0.05). The cumulative proportions with myocardial infarctions after 10 years were 11 and 53%; the cumulative rates of cardiac deaths 6 and 43%; and the 10-year survival 82 and 46% among non-smokers and smokers, respectively. In multivariate Cox regression analyses the association between smoking and infarction (p less than 0.05) and cardiac death (p less than 0.05) was significant. The survival curves deviated and when they were compared after one year's follow-up the association between smoking and mortality was significant (p less than 0.05). The findings provide further evidence for the fact that it is of utmost importance that patients with intermittent claudication stop smoking.

Aged↗
PubMed1987

Self-rating of pain in nonulcer dyspepsia. A methodological study comparing a new fixed-point scale and the visual analogue scale.

Little attention has been paid to methodological aspects in the recording of gastrointestinal symptoms. We compared a new fixed-point scale for the self-recording of pain intensity with steps operationally linked to behavioral events and with additional monitoring of pain duration--termed the "duration-intensity-behavior scale" (DIBS)--with the visual analogue scale (VAS) in 32 patients with nonulcer dyspepsia. After randomization, the patients either recorded pain intensity (VAS) or pain intensity and duration (DIBS) four times daily during a 4-week period for 1 preliminary week without medication, followed by 3 weeks of antacid treatment. For both scales there was a high degree of compliance, and they seemed equally reliable and sensitive to changes in pain experience. Since DIBS yields more clinically useful information, this scale appears to be preferable for the monitoring of gastrointestinal pain.

Adult↗
PubMed1987

Relationships between calcium metabolic indices and blood pressure in patients with essential hypertension as compared with a healthy population.

Relations between indices of mineral metabolism and blood pressure were examined in 182 subjects, comprising 58 patients with essential hypertension (EHT) and 124 healthy subjects attending a general health survey. Multivariate techniques of statistical analysis were employed to test the hypothesis of different relationships between blood pressure and calcium metabolism within the subpopulations and to eliminate confounding effects of age, sex and obesity. Plasma ionized calcium was inversely related and the urinary calcium excretion positively related to blood pressure in the total group. This was not significantly different between the groups. Serum parathyroid hormone (PTH) was, however, related to diastolic blood pressure only in the EHT group. The EHT patients had significantly lower plasma levels of ionized calcium, significantly higher levels of PTH and significantly greater excretion of calcium in the urine than the healthy subjects. The results of this investigation support the hypothesis that among patients with EHT the renal tubular reabsorption of calcium is impaired resulting in a reduction of plasma ionized calcium and thereby stimulation of PTH. The findings of linear relationships suggests the possibility of a direct association between calcium metabolism and the regulation of blood pressure.

Adult↗
PubMed1986

Oral contraceptive use and breast cancer in young women. A joint national case-control study in Sweden and Norway.

The possible association between oral contraceptive (OC) use and the risk of breast cancer developing 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 a newly diagnosed breast cancer from May, 1984, to May, 1985, and from 722 (80.6%) of all contacted age-matched controls. A multivariate analysis, which accounted for several possible confounding factors, revealed a significant (p = 0.03) association between total duration of OC use and breast cancer risk. The relative risk (RR) of breast cancer after 12 or more years of OC use was 2.2 (1.2-4.0). OC use for more than 7 years before first full-term pregnancy entailed an increased breast cancer risk (RR = 2.0 [1.0-4.2]) which was of borderline significance. When total duration of use was considered, the risk of breast cancer was virtually unrelated to age at first OC use and latency from first use. The results suggest that long-term use of OCs may increase the risk of breast cancer in young women.

Adult↗
PubMed1986

Survival in breast cancer diagnosed between mammographic screening examinations.

In women drawn from a randomised, population-based trial of mammography screening for breast cancer the overall actuarial survival and disease-free survival for up to 7 years of observation were similar in 94 patients with interval cancers and 178 control patients with cancer diagnosed independent of screening. The similarity was confirmed by multiple regression analysis. These results contradict the hypothesis that a high growth rate of the primary tumour is associated with a greater metastatic potential and do not support the concept that patients with interval cancers should receive more aggressive local or systemic treatment.

Actuarial Analysis↗
PubMed1986

Absence of therapeutic benefit from antacids or cimetidine in non-ulcer dyspepsia.

We randomly assigned 159 patients with non-ulcer dyspepsia, defined as chronic or recurrent epigastric pain without concomitant symptoms of the irritable bowel syndrome and with no evidence of organic disease, to treatment for three weeks with an antacid suspension one and three hours after meals, 400 mg of cimetidine twice a day, or placebo, according to a double-blind, double-dummy model. The intensity and duration of epigastric pain were recorded by the patients four times daily during a one-week period without therapy and during the three weeks of treatment. The mean reduction in pain intensity after three weeks in the placebo group was 25 percent. Neither antacid nor cimetidine treatment resulted in more than a 4 percent better effect. The reduction of pain was statistically significant (P less than 0.01) in all three groups. The time course of the pain scores in the groups receiving active drugs followed closely those in the placebo group, and there were no significant differences between the groups at any stage of the treatment. We conclude that the neutralization or suppression of gastric acid is of no clinical value in patients with this syndrome.

Adolescent↗
PubMed1986

Serum estrogens and androgens in women with endometrial carcinoma.

Fifty-two postmenopausal women with newly diagnosed endometrial carcinoma and 58 postmenopausal age-matched controls were studied concerning serum levels of estrone, total estrone, estradiol, androstenedione, testosterone, dehydroepiandrosterone and its sulphate, sex steroid hormone binding globulin, follicle stimulating hormone, and luteinizing hormone. The patients had a higher mean serum level of estradiol (P = 0.006) and a lower level of follicle stimulating hormone (P = 0.001) than the controls and the significant differences remained after the number of years since the menopause and body index had been taken into account. As the serum levels of steroid hormone binding globulin tended to be lower among patients than among controls (P = 0.084), the difference in the biological effect of estradiol between the two groups was probably greater than the difference in serum concentrations would indicate. No significant difference in the ratio of estrone to androstenedione or in the mean serum level of androstenedione was found between patients and controls. These data support the role of estrogen in the etiology of endometrial carcinoma.

Aged↗
PubMed1986

Histologic parathyroid abnormalities in an autopsy series.

The parathyroid glands from 422 subjects without clinical, biochemical, or advanced histologic signs of renal disease were dissected at autopsy. The glands were evaluated histologically in relation to the subjects' age, sex, histologic renal features, other diseases, and medical therapy. Normal parathyroid glands generally had diffuse cellular arrangements, with variable fat cell content. Increased nodularity was observed, especially in enlarged parathyroid glands. Hyperplasia was present in 7 per cent and adenomas in 2.4 per cent. Hyperplastic glands were often nodular and asymmetric, and numbers of oxyphil cells were frequently increased. Some large nodules were histologically indistinguishable from adenomas. Serum calcium levels were elevated in subjects with adenomas or with hyperplastic glands containing large nodules. The findings seem to indicate that nodularity of the parathyroid tissue is a sign of abnormality and that adenomas may arise from such nodular hyperplasia. Hyperplasia and adenomas were more common in elderly subjects and in those with slight or moderate nephrosclerosis. Other diseases or medical therapy were not found to be correlated with parathyroid weight or histologic features.

Adolescent↗
PubMed1986

Indices of mineral metabolism in relation to blood pressure in a sample of a healthy population.

Indices of mineral metabolism in blood and urine were analysed in relation to blood pressure in 97 healthy subjects aged 16-82 years. In a multivariate analysis, after allowing for the effects of sex, body mass index (BMI) and age, there was an inverse relationship between plasma level of ionized calcium and mean blood pressure (MBP) (beta = -50.0 mmHg/mmol/l P-ionized calcium, p = 0.0005). In univariate analyses MBP also showed statistically significant inverse relationships with plasma ionized calcium, serum phosphate and renal threshold concentration of phosphate; positive relationships to MBP were found for fasting urinary excretion of calcium and cyclic adenosine monophosphate. However, when examined multivariately, only the relation between MBP and plasma ionized calcium persisted. This study supports previous findings of an inverse relationship between blood pressure and serum ionized calcium and extends the observations to the physiological range. It is further evident from this study that BMI and age should be taken into account in analyses of the relationship between blood pressure and mineral metabolism.

Adolescent↗
PubMed1986

Menstruation span--a time-limited risk factor for endometrial carcinoma.

A case-control study was undertaken to investigate the influence of reproductive factors on the risk of developing endometrial carcinoma. The study comprised 254 women with newly diagnosed endometrial carcinoma, resident in a defined geographical area, and 254 age-matched population controls. Nulliparity and late menopause were positively associated with endometrial carcinoma. Each additional full-term pregnancy resulted in a decrease in the risk by 16%. The importance of parity and menopausal age decreased with increasing life span, and in women older than 69 years these two variables did not discriminate significantly between cases and controls. The calculated number of years of menstruation (the "menstruation span") was used as a combined measure of the impact of parity, age at menarche and age at menopause on the risk of developing endometrial carcinoma. The patients had a significantly longer mean menstruation span than the controls (33.6 versus 31.2 years; p less than 0.001) and a longer span than 39 years gave a 4.2 times higher risk than one shorter than 25 years. It is suggested that the total length of time for which a woman is exposed to unopposed estrogen is important and that the effect of this hormonal influence is time-limited.

Adolescent↗