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Biomedical subjects

T H Edna

Publications and source records attributed to T H Edna.

At least 19 recordsLinked to original sources
PubMed2002

Ralitrexed (Tomudex) or Nordic-FLv regimen in metastatic colorectal cancer: a randomized phase II study focusing on quality of life, patients' preferences and health economics.

Raltitrexed (Tomudex) is proven effective in metastatic colorectal cancer. Between 1998-2000, 25 patients were included in a randomized phase II study comparing raltitrexed (13 patients) and the Nordic FLv regimen (12 patients). 23 patients were evaluable for response. The overall response rate was 2/12 (1 CR, 1 PR) in the raltitrexed arm and 1/11 (1 CR) in the Nordic FLv arm, respectively. There was no difference in overall survival (raltitrexed--14.7 months, Nordic FLv--15.4 months). 23 patients were evaluable for Quality of Life (QoL) analysis. 23/25 and 17/21 questionnaires (EORTC QLQ C-30) were returned at baseline and first evaluation. Raltitrexed tended to be the most toxic regimen, when looking at nausea and vomiting, appetite loss, diarrhea and global QoL. However, most patients (65%) recommended the raltitrexed treatment schedule. The total treatment cost was equal in both arms (about 6,800 EURO/patient) and the hospital/hospital hotel stay costs accounted for more than half of it.

Aged↗
PubMed1999

[Telepathology in Mid-Norway].

Telepathology can provide frozen section service to hospitals without a pathology service of their own. Using a dynamic-robotic system with 6 ISDN B-channels (Telemed A200, AM Elektronikk A/S, Oslo, Norway), the pathologists at the University Hospital in Trondheim, Norway during a three-year period from 1995 successfully performed 116 diagnostic sessions for two rural Norwegian hospitals. In 90% of the cases a diagnosis was provided. There was no false positive diagnosis and only 3% false negative cases without clinical consequence. Deferred cases (10%) were mainly due to poor quality of the frozen sections and a conservative attitude among the pathologists. It is concluded that the diagnostic accuracy is good, but for safety reasons telepathology should be offered on a regular basis, so that the skills of the technicians and pathologists involved are kept up. In Mid-Norway, five more hospitals will be included in a telemedicine network comprising eight hospitals in the region.

Attitude of Health Personnel↗
PubMed1999

Diabetes mellitus and the incidence of hip fracture: results from the Nord-Trøndelag Health Survey.

AIMS/HYPOTHESIS: To study if people with Type I (insulin-dependent) or Type II (non-insulin-dependent) diabetes mellitus have increased risk of hip fracture. METHODS: The study population consisted of 35,444 people 50 years of age and older, attending a health screening in a Norwegian county. They were followed up with respect to hip fracture for 9 years, and 1643 new hip fractures were recorded. RESULTS: The relative risk of hip fracture for women with Type I diabetes compared with women without diabetes was 6.9 (95% confidence interval 2.2-21.6) adjusted for age, body mass index and daily smoking. The relative risk for men was nearly the same, but not statistically significant. Among women 50-74 years of age with Type II diabetes for more than 5 years, the relative risk was 1.8 (95% confidence interval 1.1-2.9). This increased risk persisted when insulin-treated women were excluded from the analysis. After additional adjustment for possible medical consequences of diabetes (impaired vision, impaired motor abilities and history of stroke) the relative risk among women 50-75 years of age with Type II diabetes was reduced to 1.5 (95% confidence interval 0.9-2.5). CONCLUSION/INTERPRETATION: We found an increased risk of hip fracture in women younger than 75 years with Type I diabetes or with Type II diabetes of long duration. In older men, there was an increased risk associated with Type II diabetes of shorter duration. Whether the increased risk is attributed to reduced bone mass or to factors associated with falling has not been determined.

Age Factors↗
PubMed1999

Mental distress and risk of hip fracture. Do broken hearts lead to broken bones?

OBJECTIVE: Mental distress may entail increased risk of hip fracture, but it is uncertain whether the effect consists solely of an indirect effect through use of medication, or whether it is also mediated through other mechanism. The purpose of this study was to examine the association between mental distress and risk of hip fracture in women, adjusted for medication (that is, use of tranquillisers/sedatives or hypnotics). DESIGN: A three year follow up of hip fracture was conducted on 18,612 women, consisting of 92.5% of all women aged 50 years or older in a Norwegian county. Three hundred and twenty nine suffered a hip fracture. A mental distress index was based on questions about life dissatisfaction, nervousness, loneliness, sleep disorders, troubled and uneasy feelings, depression and impairment attributable to psychological complaints. Relative risk with 95% confidence intervals (CI) of hip fracture with respect to mental distress were controlled for medication, age, body mass index (BMI), smoking, physical inactivity, and physical illness by means of Cox regression. RESULTS: The 10% of women with the highest mental distress had more than twofold increased risk of hip fracture compared with the 10% of women with the lowest mental distress, after adjustment for age and medication. The relative risk was 1.95 (95% CI 1.2, 3.3) after additional control for BMI, smoking, physical inactivity, and physical illness. The relative risk of hip fracture for daily users of medication compared with never users was 2.1 (95% CI 1.6, 2.9). After adjusting for mental distress it was 1.5 (95% CI 1.0, 2.2). CONCLUSIONS: Risk of hip fracture was positively related to mental distress, also after adjustment for medication use. The effect of tranquillisers/sedatives or hypnotics on hip fracture risk may be overestimated in studies with no adjustments for mental distress.

Aged↗
PubMed1998

Perioperative blood transfusions reduce long-term survival following surgery for colorectal cancer.

PURPOSE: The aim of the study contained herein was to investigate the association between blood transfusion and long-term outcome for patients treated for colorectal cancer, controlling for the effect of other prognostic factors. We also wanted to study whether blood storage time influenced the prognosis. METHODS: Cox's proportional hazards regression analysis was used to analyze data from 336 patients who survived resection with curative intent. Median follow-up was 5.8 (2-16.8) years or until death. RESULTS: Local recurrences and distant metastases were significantly more frequent when more than two units of blood had been transfused. In the multivariate Cox's analysis, with backward elimination of nonsignificant factors at the 10 percent level, the following risk factors were significantly related to death by colorectal cancer: tumor stage (T stage and N stage), perforation of tumor, age, and the need for a blood transfusion. Transfusions of more than two units of blood were independently and significantly associated with death from colorectal cancer (relative hazard, 2.7; 95 percent confidence intervals, 1.4-5.2). Time of blood storage had no effect on the prognoses. In patients dying from diseases unrelated to colorectal cancer, age and American Society of Anesthesiologists group were significantly related to death, whereas blood transfusion was not. CONCLUSION: We found an independent and significant association between perioperative blood transfusion and poor prognosis in colorectal cancer patients. Blood storage time was not a prognostic factor.

Age Factors↗
PubMed1998

Association between transfusion of stored blood and infective bacterial complications after resection for colorectal cancer.

OBJECTIVE: To examine the association between blood transfusion and bacterial infective complications after resection for colorectal adenocarcinoma. DESIGN: Retrospective cohort study. SETTING: District hospital; Norway. SUBJECTS: 446 consecutive patients having resection of colorectal adenocarcinoma. MAIN OUTCOME MEASURES: Postoperative bacterial infective morbidity in hospital. RESULTS: 112 patients (25%) developed postoperative infections in hospital. Univariate analysis showed that the development of infection was significantly associated with increasing age (p=0.02), rectal compared with colonic cancer (p=0.002), preoperative radiotherapy (p=0.005), blood loss during operation (p=0.001), the extent of the primary tumour (T stage): T4 compared with T1-T3 (p=0.004), the presence of regional lymph node metastasis (N stage): N1-N3 compared with N0 (p=0.01), operating surgeon 1 (p=0.009), operating surgeon 2 (p=0.03), and blood transfusion (p < 0.001). Multivariate logistic regression analysis showed that the following variables were independent predictors of infection: age, rectal compared with colonic cancer, T stage, N stage, and blood transfusion. The corrected odds ratios for infection were 1.5 (95% CI 0.8 to 2.8) when 1-3 units of blood were given and 3.1 (95% CI 1.6 to 6.0) when more than three units were given. Storage time did not affect the rate of postoperative infections in patients given transfusions. CONCLUSION: Transfusion of non-filtered stored allogeneic blood suspended in saline-adenine-glucose-mannitol is an independent risk factor for the development of postoperative infections in hospital in patients having a resection of colorectal cancer.

Adenocarcinoma↗
PubMed1998

Small bowel obstruction in patients previously operated on for colorectal cancer.

OBJECTIVE: To find out the incidence, aetiology, and outcome of patients operated on for small bowel obstruction after previous operation for colorectal cancer. DESIGN: Retrospective cohort study. SETTING: District hospital serving a defined population, Norway. SUBJECTS: 472 consecutive patients operated on for colorectal cancer, followed up for a median of 5.5 years (range 2.0-16.8) or until death; 351 had had a resection with curative intent, and 121 a palliative operation. MAIN OUTCOME MEASURES: Incidence and aetiology of small bowel obstruction, postoperative mortality, and long term survival. RESULTS: Small bowel obstruction necessitated operation in 36/351 (10%) after resection with curative intent, and in 5/121 (4%) after a palliative operation. The causes of obstruction were benign adhesions (n=21), local recurrence (n=17) and peritoneal carcinomatosis (n=3). One patient died of a myocardial infarction and six of cancer within 30 days of the operation for small bowel obstruction. The estimated median survival after the operation for small bowel benign obstruction was 1.9 years (SE=0.6) compared with 0.36 years (SE=0.04) for malignant obstruction (p=0.0007, logrank test). Late small bowel obstruction by adhesions was associated with higher blood loss during the primary operation (p=0.02). None of the 62 patients who took thiazide diuretics at the time of the primary operation later developed obstructive adhesions. CONCLUSION: 41/472 patients (9%) developed small bowel obstruction after the primary operation for colorectal cancer. The aetiology was benign in 21 and malignant in 20 patients. Survival after operation for the obstruction was far better with benign than with malignant obstruction.

Adult↗
PubMed1998

Ex-smokers and risk of hip fracture.

OBJECTIVES: The purpose of this study was to examine the reversibility of the effect of smoking on hip fracture incidence rates. METHODS: A 3-year follow-up cohort study was conducted involving 35,767 adults 50 years of age or older. Of these individuals, 421 suffered a hip fracture. RESULTS: Among participants less than 75 years of age, the relative risk (RR) of hip fracture was elevated for ex-smokers, even for those who had quit smoking more than 5 years previously (men: RR = 4.4, 95% confidence interval [CI] = 1.2, 15.3; women: RR = 1.3, 95% CI = 0.6, 3.0), but was not as high as that for current smokers (men: RR = 5.0, 95% CI = 1.5, 16.9; women: RR = 1.9, 95% CI = 1.2, 3.1). CONCLUSIONS: The effect of smoking on risk of hip fracture was not reversed completely 5 years after smoking cessation.

Aged↗
PubMed1997

[Traditional surgical treatment of choledocholithiasis. An analysis of a 10-year material 1980-89].

During 1980-89, 224 patients, 129 women and 95 men, median age 72 years (18-96 years), were treated for common bile duct stones. 26 of the patients had remote cholecystectomy. 67 patients had additional acute cholecystitis, 37 acute cholangitis and 25 acute pancreatitis. 173 patients underwent a traditional open operation, 37 endoscopic papillotomy (EPT) and 14 were treated conservatively. No deaths occurred after elective operations in 52 patients, and one death occurred after early planned operation in 95 patients. Emergency operations and delayed operations for acute disease were encumbered with a lethality of 12%. During the last two years of the study, old septic patients were treated with papillotomy, and there was no mortality among the last 39 patients. The study shows that non-septic patients with common bile duct stones can be safely treated by open operation. Old patients with severe complicated gall stone disease should be treated by endoscopic papillotomy at an early stage.

Adult↗
PubMed1997

[Early elective cholecystectomy in acute stone-related cholecystitis].

During the period 1980 to 1989, 342 patients with acute cholecystitis, 202 women and 140 men, with median age 71 (19-100) years, were admitted to our department. The treatment strategy during the period was early planned cholecystectomy in operable stabile patients with a duration of the disease of less than 7-8 days. Seven patients (2.0%) died, three after emergency operation, three after delayed operation when conservative treatment had failed, and one after medical treatment only. None of 192 patients treated with early planned operation died, and there was no lethality among the patients below the age of 75. The stay in hospital was reduced by 5.2 days after early planned operation. Early planned cholecystectomy for acute cholecystitis is a safe and cost-effective treatment.

Acute Disease↗
PubMed1997

Estimating the probability of acute appendicitis using clinical criteria of a structured record sheet: the physician against the computer.

OBJECTIVE: To evaluate physicians' probability estimates of acute appendicitis based on structured collection of clinical data. DESIGN: Open prospective study. SETTING: District hospital, Norway. SUBJECTS: 304 patients admitted with suspected acute appendicitis. INTERVENTIONS: Initial diagnostic accuracy of physicians was compared with corresponding results from a computer model. MAIN OUTCOME MEASURES: The estimated probabilities of appendicitis in different testing groups were analysed using receiver operating characteristic (ROC) curves. RESULTS: Physicians' estimates had a mean area under ROC-curve of 0.81 (95% CI 0.79 to 0.82), not significantly different from the computer model. Both correlated well with the actual rate of appendicitis, but the physicians tended to overestimate the probability by 10%. CONCLUSION: Physicians' probability estimates perform rather well. Further attempts to implement a probabilistic approach in the diagnostic process of acute appendicitis therefore seem justified.

Acute Disease↗
PubMed1997

Additional value of biochemical tests in suspected acute appendicitis.

OBJECTIVE: To evaluate the efficacy of biochemical tests in diagnosing acute appendicitis. DESIGN: Open prospective study. SETTING: District hospital, Norway. SUBJECTS: 257 patients with suspected acute appendicitis. INTERVENTIONS: Initial diagnostic accuracy of a logistic regression model using available clinical data was compared with results of corresponding models that included an increasing number of inflammatory parameters. MAIN OUTCOME MEASURES: The estimated probabilities of appendicitis in different testing groups were analysed using receiver operating characteristic (ROC) curves. RESULTS: A model including only clinical variables had a mean area under the ROC curve of 0.854. When the total white blood cell count, C-reactive protein concentration, and neutrophil count were added, the model improved significantly to 0.920. CONCLUSION: Biochemical tests are of additional value in a computer model, and the tests should, if used rationally, also provide physicians with important information in the investigation of acute appendicitis.

Abdominal Pain↗
PubMed1996

Rectal cancer: the influence of type of operation on local recurrence and survival.

OBJECTIVE: To assess the results of standardised total mesorectal excision of rectal cancer with particular reference to local recurrence and survival. DESIGN: Prospective open study. SETTING: Central hospital, Norway. MAIN OUTCOME MEASURES: Local recurrence, survival. RESULTS: The resectability rate was 90% (107/118), of whom 81 (76%) underwent curative resection. The overall local recurrence rate in patients who underwent primary resection was 9% with an overall five-year survival rate of 53%. In patients who had had curative operations the local recurrence rate was 4% (3/81), with an overall five year survival of 65% and a cancer specific survival of 85%. None of the patients who had palliative treatment survived five years. In 12 patients whose tumours were thought to be unresectable but who were operated on, of whom nine were given additional radiotherapy (46 Gy), 5 (42%) developed local recurrences and the five year cancer free survival was 25%. CONCLUSION: Total mesorectal excision and strict adherence to the surgical principles of anatomical dissection in the pelvis and washing out of the rectal stump before anastomosis reduce local recurrences to a minimum. In patients with locally advanced, fixed cancers, preoperative irradiation with more than 46 Gy must precede operation to achieve local control.

Adenocarcinoma↗
PubMed1994

Interaction between current smoking, leanness, and physical inactivity in the prediction of hip fracture.

To study the association between smoking habits and the incidence of hip fracture, adjusted for leanness and physical inactivity, a cohort study with 3 years follow-up was conducted. Subjects were 34,856 adults aged 50 years or older who attended a health screening in Nord-Trøndelag County in Norway in 1984-1986 (91% of eligible subjects in 1986, n = 38,356). Of these, 421 suffered a hip fracture during the years 1986-1989. Using Cox regression models, the relative risk (with 95% confidence interval) of suffering a hip fracture for female smokers versus nonsmokers was 1.5 (1.0-2.4). These results refer to females when the female body mass index (BMI) was set at 25 kg/m2 in the female model (the mean BMI for the smoking female population in this study). Among thinner females, however, smoking had a much stronger effect. For instance, if the female BMI was set at 20 kg/m2, the relative risk was 3.0 (1.8-5.0). The relative risk of hip fracture for male smokers versus nonsmokers was 1.8 (1.2-2.9) irrespective of BMI. Smoking is associated with incidence of hip fracture in both sexes and also after adjusting for body mass index and physical inactivity (the effect of physical inactivity was adjusted for self-reported ill health because ill health was included in the model). For lean females, the association with current smoking was large, as large as if they added 10 years to their age.

Aged↗
PubMed1993

[Medial femoral neck fractures treated with hip compression screw. A product control study].

311 medial femoral neck fractures (213 of them displaced) treated with a hip compression screw were studied retrospectively. 90 patients were treated with a primary hemiprosthesis during the same period. Fixation was lost in the case of seven fractures within three months after the operation. Two patients developed pseudarthrosis and 53 late segmental collapse. 54 patients have been reoperated, and given an endoprosthesis. The radiographs of 176 patients (114 displaced fractures) who were accessible for follow-up until failure, or for at least three years, were analysed. The rates of late segmental collapse were particularly high for fractures with a postoperative anterior angulation exceeding 15 degrees. Displacement and time until operation were independently related to late segmental collapse.

Adult↗
PubMed1992

[Diagnosis-related groups and injuries. Is multiple trauma underrated?].

A consecutive registration of all trauma patients admitted to the Department of Surgery, total 868, was made in 1989. Such patients constituted 20% of all surgical patients. The aim was to study the relation between the Norwegian Diagnosis-related group (DRG) cost weights and severity of injury and use of resources. The DRG system correlated reasonably well with the Injury Severity Score and use of resources, except in the case of serious multi-trauma, which seemed to be under-rated.

Adolescent↗
PubMed1992

Association between blood transfusion and infection in injured patients.

The association between red blood cell transfusions and infectious complications in 484 patients with acute injuries was studied in 1989. The median age was 62 years (0.5-97) and the median stay 7 days (3-141). Infectious complications developed in 46 (9.5%) patients. A number of potential risk factors, except blood transfusion, were analyzed in a logistic regression model to determine significant predictors of infectious complications. Blood transfusion as a cofactor was then added to this model. The final logistic regression analysis showed a relationship between blood transfusions and infectious morbidity that was independent of the other significant factors; Injury Severity Score, age, and surgical procedure. The corrected odds ratios for infection were 1.6 (95% confidence interval: 0.7-3.7) when 1-4 units of blood were given and 6.4 (95% CI: 2.3-18.3) when more than 4 units were used.

Abbreviated Injury Scale↗