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Biomedical subjects

A Ekbom

Publications and source records attributed to A Ekbom.

At least 235 records · Page 13Linked to original sources
PubMed1992

Survival and causes of death in patients with inflammatory bowel disease: a population-based study.

Relative survival up to December 31, 1986 was analyzed for all patients diagnosed with ulcerative colitis (UC) (n = 2,509) and Crohn's disease (CD) (n = 1,469) within the Uppsala Region, Sweden 1965-1983. After 10 years survival was 96% of that expected for UC and CD. Patients with ulcerative proctitis, left-sided colitis, and pancolitis at diagnosis had relative survival rates of 98%, 96%, and 93% respectively. Survival did not differ by extent at diagnosis for patients with CD. After including prevalent cases, 684 deaths occurred compared with 481.1 expected deaths [standardized mortality ratio (SMR) = 1.4; 95% confidence interval (CI) = 1.3-1.5]. Inflammatory bowel disease was the main reason for this excess mortality. Colorectal cancer increased mortality (50 deaths observed vs. 15.2 expected). Death from other cancers were not greater than expected. Obstructive respiratory diseases, especially bronchitis, emphysema, and asthma increased mortality SMR = 1.5 (95% CI = 1.1-2.2) in UC. Cerebrovascular disease mortality occurred less often than expected (SMR = 0.7; 95% CI = 0.5-1.0). Mortality for other diseases and groups of diseases was close to that expected.

Cause of Death↗
PubMed1991

Is there clustering of inflammatory bowel disease at birth?

Evidence points to possible cohort effects in inflammatory bowel disease, the possible role of perinatal infection as a risk factor for inflammatory bowel disease, and the occurrence of clusters of Crohn's disease. This evidence suggests the value of searching for birth date clustering among cases of inflammatory bowel disease. The authors looked for clustering by birth date and maternal residence at birth in a population-based series of 845 Crohn's disease patients and 1,330 ulcerative colitis patients born from 1924 through 1957 and diagnosed in the Uppsala Health Care Region, Sweden, until the end of 1983. Over this period, 43% of persons with Crohn's disease had been born within 6 days of another case, compared with 36% of controls simulated to account for monthly variation in births (p = 0.0002). The number of pairs of inflammatory bowel disease cases whose births occurred in the same county (close in space) and whose birth dates were also close in time was statistically significantly greater than expected for most birth dates 23-57 days apart. Results after 1944, when ascertainment was more complete, generally corroborate these findings and suggest some seasonality in the birth dates of ulcerative colitis cases. Results from the entire study period and after 1944 thus provide evidence for clustering by birth (including seasonality) among Crohn's disease cases and also, to a lesser extent, among ulcerative colitis cases.

Causality↗
PubMed1991

Extracolonic malignancies in inflammatory bowel disease.

A population-based cohort with inflammatory bowel disease consisting of 4776 patients (3121 with ulcerative colitis and 1655 with Crohn's disease) was followed for 1 to 50 years for the occurrence of malignant neoplasms. Two hundred eighty-three cancers were observed versus 189.1 expected (standardized incidence ratio [SIR] = 1.5, 95% confidence limits [CL] 1.3 to 1.7). One hundred seventy-eight extracolonic cancers were observed versus 168.8 expected (SIR = 1.1, 95% CL 0.9 to 1.2). In Crohn's disease and extensive ulcerative colitis, observed cases were close to those expected but in ulcerative proctitis, the relative risk of extracolonic cancers was close to significantly increased (SIR = 1.3, 95% CL 1.0 to 1.7). Squamous skin cancers after Crohn's disease (SIR = 5.5, 95% CL 2.0 to 11.9) and connective tissue cancers after ulcerative colitis (SIR = 4.0, 95% CL 1.0 to 10.2) were significantly increased. Those having extensive ulcerative colitis at diagnosis had an increased risk of brain cancers (SIR = 2.4, 95% CL 1.0 to 4.6). Patients with extensive ulcerative colitis had lower than expected risk of breast cancer (SIR = 0.4, 95% CL 0.1 to 1.0).

Brain Neoplasms↗
PubMed1991

Cancer risk in patients with diabetes mellitus.

Cancer incidence was ascertained in a population-based cohort of 51,008 patients in Uppsala, Sweden, who were given a discharge diagnosis of diabetes mellitus during 1965-83. Complete follow-up through 1984 with exclusion of the first year of observation showed that the observed number of cancers in females (1,294) was eight percent higher than expected (relative risk [RR] = 1.1, 95 percent confidence interval = 1.0-1.1), whereas in males the observed number (1,123) was close to the expected (RR = 1.0, 0.9-1.1). Significantly increased risks of pancreatic (RR = 1.4, 1.2-1.7), primary liver (RR = 1.5, 1.2-1.7), and endometrial (RR = 1.5, 1.2-1.8) cancers and a lower than expected number of prostatic cancers (RR = 0.7, 0.7-0.9) were found in this cohort of diabetic patients. The excess risk of pancreatic cancer was similar in females and males and evident both during one through four years (RR = 1.7, 1.4-2.1) and five through nine years (RR = 1.3, 0.9-1.7) of follow-up, but not thereafter. A similar pattern was found for primary liver cancer, but the RRs were generally higher in males than in females.

Adult↗
PubMed1991

Ulcerative proctitis in central Sweden 1965-1983. A population-based epidemiological study.

Ulcerative proctitis has by tradition been regarded as a subgroup of ulcerative colitis. Population-based epidemiological studies of ulcerative proctitis are, however, virtually nonexistent. In an epidemiological study of inflammatory bowel disease in the Uppsala Health Care Region, 1065 cases of ulcerative proctitis were diagnosed from 1965 through 1983. Males predominated, with the male to female ratio 1.4:1. Annual incidence rates were higher in urban than in rural areas. The annual incidence rates increased threefold from 2.8 per 10(5) to 6.6 per 10(5) during the period, affecting all age groups over 14 years of age, in both urban and rural areas and in both sexes. Differences in temporal trends and certain other epidemiological characteristics between ulcerative proctitis and extensive ulcerative colitis suggest that ulcerative proctitis is a specific disease whose etiology differs from that of extensive ulcerative colitis.

Adolescent↗
PubMed1991

The epidemiology of inflammatory bowel disease: a large, population-based study in Sweden.

Previous population-based incidence studies of inflammatory bowel disease are limited by small numbers, short duration, or inadequate case-finding. To address these problems, we identified all persons with confirmed ulcerative colitis (n = 2509) or Crohn's disease (n = 1469) in the Uppsala Health Care Region from 1965 to 1983. Age-specific incidence rates by sex were slightly greater for males with ulcerative colitis and females with Crohn's disease. Incidence rates for ulcerative colitis and Crohn's disease were higher in urban than rural areas. The annual incidence rate of ulcerative colitis increased from less than 7 per 100,000 to more than 12 per 100,000 during the study period, while the rate for Crohn's disease remained between 5 and 7 per 100,000. The increase in the incidence of ulcerative colitis was the result of a marked increase in the number of patients with ulcerative proctitis. Analyses by 5-year birth cohorts suggest that those born from 1945 through 1954 were at higher risk for ulcerative colitis and Crohn's disease, and that this effect was accounted for by those born in the first half of the year. The seasonality in the cohort effect, combined with the urban preponderance of disease, suggests that environmental causes may be involved in ulcerative colitis and Crohn's disease.

Adolescent↗
PubMed1991

Risk factors for extensive ulcerative colitis and ulcerative proctitis: a population based case-control study.

To examine socioeconomic factors, dietary and other personal habits, and medical history as risk factors for ulcerative colitis, we studied 167 (98%) of all prevalent cases of ulcerative colitis diagnosed in Uppsala county from 1945 to 1964 and 167 age and sex matched population controls. Ulcerative colitis patients were less likely than controls to be current cigarette, pipe, or cigar smokers (odds ratio (OR) = 0.44; 95% confidence limits (CL) = 0.25-0.78), but more likely to have symptoms induced by drinking milk (OR = 4.63; 95% CL = 2.15-9.93). Patients with ulcerative colitis do not differ in most of the socioeconomic, dietary and personal habits compared with the background population.

Adolescent↗
PubMed1990

Ulcerative colitis and colorectal cancer. A population-based study.

BACKGROUND: The risk of colorectal cancer is increased among patients with ulcerative colitis. The magnitude of this increase in risk and the effects of the length of follow-up, the extent of disease at diagnosis, and age at diagnosis vary substantially in different studies. METHODS: To provide accurate estimates of the risk of colorectal cancer among patients with ulcerative colitis, we studied a population-based cohort of 3117 patients given a diagnosis of ulcerative colitis from 1922 through 1983 who were followed up through 1984. RESULTS: Ninety-two cases of colorectal cancer occurred in 91 patients. As compared with the expected incidence, the incidence of colorectal cancer in the cohort was increased (standardized incidence ratio [ratio of observed to expected cases] = 5.7; 95 percent confidence interval, 4.6 to 7.0). Less extensive disease at diagnosis was associated with a lower risk; for patients with ulcerative proctitis, the standardized incidence ratio was 1.7 (95 percent confidence interval, 0.8 to 3.2); for those with left-sided colitis, 2.8 (95 percent confidence interval, 1.6 to 4.4); and for those with pancolitis (extensive colitis, or inflammation of the entire colon), 14.8 (95 percent confidence interval, 11.4 to 18.9). Age at diagnosis and the extent of disease at diagnosis were strong and independent risk factors for colorectal cancer. For each increase in age group at diagnosis (less than 15 years, 15 to 29 years, 30 to 39 years, 40 to 49 years, 50 to 59 years, and greater than or equal to 60 years), the relative risk of colorectal cancer, adjusted for the extent of disease at diagnosis, decreased by about half (adjusted standardized incidence ratio = 0.51; 95 percent confidence interval, 0.46 to 0.56). The absolute risk of colorectal cancer 35 years after diagnosis was 30 percent for patients with pancolitis at diagnosis and 40 percent for those given this diagnosis at less than 15 years of age. CONCLUSIONS: Close surveillance and perhaps even prophylactic proctocolectomy should be recommended for patients given a diagnosis of pancolitis, especially those who are less than 15 years of age at diagnosis.

Adolescent↗
PubMed1990

Increased risk of large-bowel cancer in Crohn's disease with colonic involvement.

A cohort of 1655 patients with Crohn's disease diagnosed during 1983 in the Uppsala health care region, Sweden, was followed up with respect to the occurrence of colorectal cancer to the end of 1984. 12 colorectal cancers were diagnosed, yielding an increased overall risk of 2.5. The relative risk was similar for males and females. Duration of follow-up did not affect risk. Relative risk for disease of the terminal ileum only was 1.0; for terminal ileum and parts of colon 3.2; and for colon alone 5.6. Patients in whom Crohn's disease was diagnosed before age 30 with any colonic involvement at diagnosis had a higher relative risk (20.9) than those diagnosed at older ages (2.2).

Adult↗
PubMed1990

Perinatal risk factors for inflammatory bowel disease: a case-control study.

To examine perinatal risk factors for Crohn's disease and ulcerative colitis, the authors analyzed birth records for 257 known case participants delivered from 1924 through 1957 at the University Hospital in Uppsala County, Sweden, and compared them with records for 514 controls delivered at the hospital. The two groups were matched by date of birth, sex, and either maternal age or parity. Eleven study variables were abstracted from standard forms that recorded health events during the pregnancy and the delivery hospitalization. Participants were more likely than controls to have a recorded health event (odds ratio (OR) = 4.4; 95% confidence interval (CI) 3.0-6.4). In a multivariate model, this increased risk was evident for infectious (OR = 3.8; 95% CI 2.6-5.8) and noninfectious (OR = 3.5; 95% CI 2.0-6.3) events. Perinatal health events may have contributed to 40% of the inflammatory bowel disease cases in our study. Infants from families with low socioeconomic status had greater risk of inflammatory bowel disease than did infants from families with high socioeconomic status (OR = 3.0, 95% CI 1.5-6.1). Perinatal health events and low socioeconomic status independently increased the risk of inflammatory bowel disease.

Analysis of Variance↗
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

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↗
PubMed1987

Central venous catheters in acute blood malignancies.

A one-year prospective study to evaluate the use of central venous catheters in intensive treatment of patients with acute blood malignancies was performed. Forty-seven catheters in 29 patients were studied. In spite of thrombocytopenia in several patients, no severe bleeding episodes were observed. Five patients with agranulocytosis had episodes of bacterial growth in the blood. Four patients had a clinical infection in the subcutaneous tunnel of the catheter. Bacterial growths on the tips of the catheters were found in three cases. Six patients died during the observation period, none of these was in remission. One of these patients had a growth of coagulase negative staphylococci in the blood, and another on the tip of the catheter, without any other known source of infection. The use of central venous catheters facilitates patient care and minimizes discomfort. It is associated with acceptable complications, necessitating meticulous insertion techniques, and careful daily care on the ward or at home.

Adolescent↗
PubMed1982

Gastrocolic fistula. Report on two cases healed by medical treatment.

Two cases of gastrocolic fistula secondary to benign gastric ulcer disease are described in two patients without any previous gastric surgery. Both cases were successfully treated medically with cimetidine. Implications of the successful outcome of the medical treatment and the possible causes of the symptom of diarrhea are discussed.

Aged↗