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Biomedical subjects

R Bergström

Publications and source records attributed to R Bergström.

At least 163 records · Page 9Linked to original sources
PubMed1992

Age as a determinant of axillary node involvement in invasive breast cancer.

We analyzed the age at diagnosis and the tumor size as determinants of axillary node involvement in 725 consecutive patients with breast cancer. The prevalence of nodal involvement increased consistently with tumor diameter from 18.9% in tumors smaller than 10 mm to 72.9% in those measuring 40 mm, or more. The risk also varied with age, the lowest prevalence being found in the youngest and the oldest patients and the highest one in the 40-59-year age group. When analyzed as a continuous variable age was best fitted as a second order term and it was a statistically significant (p = 0.04) determinant of axillary metastases in a multivariate model where tumor diameter, histopathological classification and estrogen receptor concentration were taken into account as possible confounding variables. The findings indicate that the parallelism between the establishment of metastases in lymph nodes and at distant sites may vary with age. The prognostic value of nodal status may therefore depend on age at diagnosis.

Adult↗
PubMed1992

Relationship between questionnaire data and medical records of height, weight and body mass index.

Although some studies have analysed the accuracy of self-reported weight and height data in survey studies, no attention has been paid to the accuracy of the body mass index (BMI, kg/m2), derived from these data and often considered as a reliable indirect estimate of relative body weight. Based on data from about 3400 participants in a study, questionnaire self-reports of these anthropometric data were compared to measured weight and height. A flat slope syndrome (under-reporting of high values, over-reporting of low ones) was found for weight and BMI for both sexes. A low sensitivity of BMI based on self-reported values were found, especially for the obese sub-population. Reliance upon questionnaire-derived self-reports will lead to considerable underestimation of the prevalence of obesity. Only 55 per cent of obese women and 60 per cent of obese men according to measured values were correctly classified as such. Correction of self-reported data according to regression models describing the relationship between questionnaire self-reports and medical records of body size parameters should be considered for some types of epidemiologic studies such as those using BMI as a categorized variable. The statistical rationale for the models used here is discussed.

Adult↗
PubMed1991

Stressful life events and Graves' disease.

The role of stressful life events in the onset of Graves' disease (toxic diffuse goitre) is controversial. However, the numerous early clinical reports that supported such an association were not adequately controlled and specificity of the diagnosis could be questioned. Later studies have not shown a causal relation, but these studies were small, did not have proper controls, or epidemiological methods were inappropriate. To assess possible associations between life events, heredity, social support, and Graves' disease, we have done a population-based case-control study in a defined area with about 1 million inhabitants. Over 2 years, 208 (95%) of 219 eligible patients with newly-diagnosed Graves' disease and 372 (80%) of all selected matched controls answered an identical mailed questionnaire about marital status, occupation, drinking and smoking habits, physical activity, familial occurrence of thyroid disease, life events, social support, and personality. Compared with controls, patients claimed to have had more negative life events in the 12 months preceding the diagnosis, and negative life-event scores were also significantly higher (odds ratio 6.3, 95% confidence interval 2.7-14.7, for the category with the highest negative score). Individuals who had relatives with thyroid disease (especially first-degree and second-degree relatives) were more likely to have Graves' disease (3.6, 2.2-5.9). Slightly more patients than controls were divorced (1.8, 1.0-3.3) and reported a less frequent intake of alcohol (0.4, 0.2-0.8). When results were adjusted for possible confounding factors in multivariate analyses, risk estimates were almost unchanged. These findings indicate that negative life events and hereditary factors may be risk factors for Graves' disease.

Adult↗
PubMed1991

The decline in the incidence of stomach cancer in Sweden 1960-1984: a birth cohort phenomenon.

Trends in the incidence of stomach cancer among 52,604 patients notified to the National Swedish Cancer Registry in 1960 through 1984 were analysed. Age-standardized incidence rates declined throughout the period, from 47.1 to 24.6 per 10(5) in males and from 23.8 to 12.7 per 10(5) in females. Among males the decline in incidence was more pronounced in younger age strata, 35-54 years, while in females it reached a maximum at ages 70-74 years. In a multivariate analysis the age-cohort model adequately represented the data and there was no reason to separate the effects of the full age-period-cohort model. Compared with the cohort born in 1876-1884, the relative risk of developing stomach cancer was 0.46 (95% CI:0.44-0.48) in males and 0.39 (95% CI:0.37-0.42) in females born in 1906-1914. This supports the view that the declining incidence is due to a change in the exposure of the population to aetiological factors of stomach cancer and not to refinement of the diagnosis and classification of abdominal tumours. The results also imply that exposure to aetiological factors early in life together with a long induction period is of importance in the development of stomach cancer.

Adult↗
PubMed1991

Risk factors for early lower limb loss after embolectomy for acute arterial occlusion: a population-based case-control study.

To identify risk factors for lower limb loss after arterial embolectomy a cohort of 1189 patients was studied. Detailed data were obtained for 165 patients who underwent a major amputation within 30 days of embolectomy and for 165 matched controls. The amputation risk was increased in patients with two or more myocardial infarctions (odds ratio (OR) 3.1, 95 per cent confidence interval (CI) 0.8-11.2), chronic ischaemia (OR 2.1, CI 0.9-4.9), long duration of symptoms (OR 4.3, CI 1.9-9.6, for greater than or equal to 25 h versus less than or equal to 6 h) or postoperative heart failure (OR 3.4, CI 1.8-6.5). Reduced risks were found in association with acute myocardial infarction (OR 0.3, CI 0.1-0.9) and postoperative anticoagulation treatment with warfarin (OR 0.3, CI 0.1-0.9). The independent prognostic value of chronic ischaemia and symptom duration, and the beneficial effect of postoperative anticoagulation gained additional support in multivariate analysis. We conclude that the risk of early amputation after arterial embolectomy or thrombectomy can be predicted by several clinical characteristics.

Acute Disease↗
PubMed1991

Neurosurgical intensive care improves outcome after severe head injury.

The present study compares the clinical outcome, as expressed by the Glasgow outcome scale, of two groups of severely head injured patients treated before (49 patients) and after (72 patients) the establishment of a neurosurgical intensive care (NIC) unit at the department of neurosurgery. Uppsala University Hospital. The number of "good recoveries" increased significantly after the establishment of the NIC. This was confirmed by univariate analysis (p less than 0.05) and by multivariate analysis using the logistic regression model to adjust for differences between the two groups of patients (p less than 0.05, p less than 0.005). The most striking improvement was found in patients with a Glasgow coma motor score (GCSM) greater than or equal to 4 on admission. In this subgroup of patients the "good recoveries" increased from 15% to 52%. The object of NIC is basically to prevent or minimize secondary brain damage, and it seems logical that the effect of such care is most obvious in GCS M greater than or equal to 4 patients in whom a good outcome can be anticipated if secondary damage can be prevented or minimized. In conclusion, the present study shows that improved clinical outcome after severe head injury can be achieved by organizing an NIC unit with a well trained staff capable of providing this care 24 hours a day using established methods of surveillance and treatment.

Adult↗
PubMed1991

Prognostic flow cytometric information in cervical squamous cell carcinoma: a multivariate analysis of 307 patients.

In a prospective study of 307 patients with invasive squamous cell carcinoma of the uterine cervix, the prognostic impact of flow cytometric parameters (ploidy level and the fraction of S-phase cells) and clinical variables was evaluated using univariate and multivariate analyses (Cox model). Mean follow-up time as 39 (4-84) months. A total of 93 patients died from their disease during the follow-up. The S-phase fraction was evaluable in 242 cases. By means of univariate models, lethality rate was found to increase significantly with increasing age, postmenopausal status, advancing stage, and increasing S-phase fraction. In a multivariate analysis of the clinical variables of age, stage, and grade, only clinical stage was prognostic. The inclusion of ploidy level in the analysis gave no additive prognostic information. In a multivariate analysis including all variables mentioned above, stage was the strongest predictor of survival. S-phase fraction was significantly related to survival both when studied as a continuous variable (P = 0.006) and when studied as a categorized variable (10, 15, 20% as cutoff points), and in this special analysis ploidy level was of prognostic interest with a poorer survival for near-diploid cases. The outcome was poorer with increasing age. The prognostic impact of the S-phase fraction remained highly significant in separate analyses of the clinically interesting stages Ib-IIb (P less than 0.001). We conclude that measurement of the S-phase fraction is of prognostic interest and may be used for the identification of high-risk patients within a given stage, whereas ploidy level yields little information.

Adult↗
PubMed1991

Determinants of prognosis in advanced colorectal cancer.

The relations between patient characteristics and prognosis were examined in 340 patients with advanced colorectal cancer treated with chemotherapy. Variables were tested for relation to survival and responses in univariate and multivariate analyses. Performance status (P less than 0.001), number of symptoms (P less than 0.001) and haemoglobin level (P less than 0.001) were the most important variables for survival in univariate analyses. In the multivariate analyses of survival, haemoglobin level (P less than 0.001) and disease-free interval (P less than 0.01) were the most influential variables. In addition, number of symptoms (P less than 0.01), performance status (P less than 0.05) and treatment of the primary tumour (P less than 0.05) were independently related to survival. The main independent determinant of response was haemoglobin level (P less than 0.01). Besides these pretreatment characteristics, type of chemotherapy regimen influenced both response rate and survival in multivariate analyses (P less than 0.001). We conclude that haemoglobin level, disease-free interval, symptoms and performance status are important prognostic factors in advanced colorectal cancer. The distribution of these variables may influence the results of clinical trials.

Adult↗
PubMed1991

Prognostic factors in progression-free survival and corrected survival in patients with advanced prostatic cancer: results from a randomized study comprising 150 patients treated with orchiectomy or estrogens.

In a population-based randomized study comparing 150 patients with advanced prostatic cancer treated with orchiectomy or estrogen, some possible prognostic factors were analyzed. The observation period was 78 to 114 months. M category, T category, tumor grade, performance status, pain, prostatic acid phosphatase, sedimentation rate, hemoglobin and serum creatinine level were all statistically significantly related to the interval to progression and to disease-specific death on univariate analyses. Variables that were statistically significant on multivariate analyses were M category, T category, sedimentation rate and patient age. The sedimentation rate predicted the intervals to progression and to disease-specific death, with the relative hazard and 95% confidence interval for the latter end point being 1.018 (range 1.010 to 1.027) for each millimeter increase in sedimentation rate per hour. An analysis that was stratified according to the extent of the disease as measured on a bone scan showed that the sedimentation rate was the only prognostic factor of statistical significance with an estimate of relative hazard of 1.52 if the sedimentation rate was elevated 20 mm. per hour. Progression-free survival but not disease-specific survival was statistically significantly better in the estrogen group (relative hazard 0.47), as assessed by multivariate analysis in which all variables were taken into account.

Estradiol Congeners↗
PubMed1991

Primary orchiectomy versus estrogen therapy in advanced prostatic cancer--a randomized study: results after 7 to 10 years of followup.

Of 163 new consecutively diagnosed cases of advanced (T3-4 M0 or T04M1) prostatic cancer 13 had contraindications for estrogen treatment, and the remainder were randomized to orchiectomy (76) or to estrogen treatment (74), consisting of 150 micrograms ethinyl estradiol daily and 80 mg. polyestradiol monthly. During the followup period of 7 to 10 years disease progression was noted in 27 patients (36%) treated with estrogen and 39 (51%) orchiectomized patients. The free of progression survival rate was significantly better (less than 0.05) among the estrogen treated patients but the over-all survival rates after orchiectomy and estrogen treatment were almost identical. A significantly higher frequency of cardiovascular side effects was noted in the estrogen group (23 cases) compared to the orchiectomy group (4 cases). Therefore, estrogen treatment in this form cannot be recommended for the palliative treatment of prostate cancer.

Aged↗
PubMed1991

Intestinal and diffuse types of gastric cancer: secular trends in Sweden since 1951.

In order to test the hypothesis that the general decline in gastric cancer observed in many countries is due to a selective decline in Laurén's intestinal type, we re-examined all 427 histologic sections obtained from gastric carcinomas diagnosed at the Department of Pathology, University Hospital, Uppsala, Sweden, in 1951, 1961, 1971-72 and 1981. The relative proportions of intestinal and diffuse type cancers were compared. The intestinal type was significantly (P less than 0.001) more common among elderly people than in the younger age groups. The relative proportions of intestinal type carcinoma in the four periods under study were 65%, 55%, 42% and 60%, respectively. The absence of any clearly discernible trend over time contradicts the hypothesis of diverse secular trends for intestinal and diffuse types of gastric carcinoma.

Age Factors↗
PubMed1991

Risk factors for operative mortality and morbidity in patients undergoing coronary artery bypass surgery for stable angina pectoris.

Risk factors for a poor early outcome of surgery for stable angina pectoris were evaluated in 2659 consecutive patients from a defined population. The total operative mortality (death within 30 days after surgery) was 2.6% and the frequency of myocardial injury (increase in S-ASAT to greater than 2.0 mu kat l-1 and in S-CKMB to greater than 1.5 mu kat l-1 within 48 h postoperatively or death in the operating room) 14%. Mortality was related to New York Heart Association (NYHA) classification (P less than 0.001), age (less than or greater than 70 years, P = 0.001), duration of symptoms (less than or greater than 8 years, P = 0.001), aortic cross-clamp (ACC) time (P less than 0.001), and cardiopulmonary bypass (CBP) time (P less than 0.001). A multivariate analysis showed that the combination of NYHA class, ACC time and age best predicted operative mortality. Myocardial injury was related to NYHA functional class (P less than 0.001), duration of symptoms (P less than 0.001), regrafting procedure (P less than 0.001), cardiac related dyspnoea (P = 0.015), ACC time (P = 0.001), CPB time (P = 0.001), relative volume of cardioplegic solution (P less than 0.001), and thromboendarterectomy procedure (P = 0.004). The set of variables that best predicted myocardial injury consisted of ACC time, relative volume cardioplegic solution, NYHA class, regrafting procedure and duration of symptoms. However, these risk factors indicated only moderately high risks, and high-risk patients could not be selected with sufficient accuracy.

Adult↗
PubMed1991

Prognostic significance of proliferation in endometrial adenocarcinomas: a multivariate analysis of clinical and flow cytometric variables.

In a prospective study, the prognostic significance of clinical and flow cytometric variables was evaluated in univariate and multivariate analyses of 489 cases of endometrial adenocarcinoma. Age, uterine cavity depth, stage, histopathologic grade, myometrial invasion, ploidy level, and S-phase fraction were of prognostic value in the univariate analysis. In a multivariate analysis of clinical variables, age and uterine cavity depth were insignificant. When adding flow cytometric variables (DNA content and S-phase fraction) separately to the clinical variables, the significance of myometrial invasion was reduced, and histopathologic grade became nonsignificant when S-phase fraction was included. When adding both DNA content and S-phase fraction, the DNA content became prognostically insignificant. S-phase fraction was, next to clinical stages III and IV, found to be the strongest predictor of outcome. It is concluded that S-phase fraction is a new, objective parameter that can be used for the identification of prognostically different subgroups of patients within a given stage and grade.

Adenocarcinoma↗
PubMed1991

Maternal factors associated with high birth weight.

Maternal characteristics associated with high birth weight were studied in 473 mothers delivered of singleton infants at term with a birth weight of 4500 g or more. The controls were mothers who gave birth to singleton infants at term, with a normal birth weight +/- 1 SD for Swedish newborns. In the multivariate analysis the maximum symphysis-fundus height measurement and gestational duration were strongly significant (p less than 0.001), after correction for other variables, for the probability of being delivered of an infant of high birth weight. Maternal height, weight at beginning of pregnancy, total gestational weight increase and previous live birth of an infant weighing greater than or equal to 4500 g were also important (p less than 0.05) for high birth weight. The maternal characteristics included were evaluated in a prognostic model. With symphysis-fundus height measurement included, the sensitivity increased from 80.3 to 83.3% and specificity from 78.8 to 85.6%, compared with a model where symphysis-fundus measurement was not available.

Adult↗
PubMed1991

Early results of aortic valve replacement with or without concomitant coronary artery bypass grafting.

Early results of aortic valve replacement were reviewed in 962 unselected patients, 659 without concomitant coronary bypass surgery (AVR group) and 303 with combined valve replacement and coronary artery bypass grafting (AVR + CABG). The early (less than 30-day) mortality was 4.6% in the AVR, and 5.9% in the AVR + CABG group. Multivariate analysis showed coronary artery stenoses and NYHA functional class to be independent predictors of early mortality in the AVR group, and the number of distal anastomoses as the strongest predictor in AVR + CABG. The incidence of peroperative technical complications in the cases with fatal outcome was 27% in the AVR and 6% in the AVR + CABG group. The incidence of myocardial injury (new Q wave or evidence of increased enzyme leakage) was 11% in AVR and 21% in AVR + CABG. Independent predictors of postoperative myocardial injury were aortic cross-clamp time, year of surgery, coronary artery stenoses and NYHA class in AVR and aortic cross-clamp time and year of surgery in AVR + CABG. The study suggests that coronary artery disease increases risk in aortic valve replacement with or without CABG. Replacement should be undertaken before endstage of the disease (NYHA IV), with CABG if significant coronary disease is present, and in multivessel disease the number of distal anastomoses should be restricted in order to shorten aortic cross-clamp time.

Adult↗
PubMed1991

Early results of mitral valve replacement.

Early results of mitral valve replacement were reviewed in 336 unselected patients, 261 without and 75 with concomitant coronary artery bypass grafting (MVR and MVR + CABG groups). Early (less than 30 days) mortality was 7% in the MVR and 16% in the MVR + CABG group, with cardiac failure as the dominant cause. In multivariate analysis, the variables most strongly related to early mortality were congestive heart failure, diabetes and previous cardiac surgery in the MVR group and congestive heart failure in MVR + CABG. In the cases with fatal outcome the incidence of peroperative technical complications was 32% at MVR and 17% at MVR + CABG. The incidence of myocardial injury was 21% and 35% in the respective groups, and the early mortality in these cases was 19% vs 23%. Half of all fatal cases showed signs of peroperative myocardial injury. Multivariate analysis showed factors independently related to myocardial injury to be year of surgery and aortic cross-clamp time in MVR and previous cardiac surgery in MVR + CABG. Operation before cardiac reserves are reduced, optimal peroperative myocardial preservation and avoidance of technical errors should improve results of MVR.

Coronary Artery Bypass↗