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Biomedical subjects

A Viste

Publications and source records attributed to A Viste.

At least 55 records · Page 3Linked to original sources
PubMed1991

Factors related to and consequences of weight loss in patients with stomach cancer. The Norwegian Multicenter experience. Norwegian Stomach Cancer Trial.

Of 1165 patients with stomach cancer included in a national, prospective multicenter study with 51 surgical units participating, information about weight loss before diagnosis was available for 855 patients (73%). Median weight loss was 5 kg; 259 patients (31%) experienced no weight loss. By logistic regression analysis the authors found that weight loss increased with age and advancing stages of disease (TNM Stage I-IV), with decreasing Karnofsky index, in Lauren's diffuse versus intestinal tumor type, and with tumors located at the cardia/esophagus. Increasing weight loss reduced the resectability rate significantly, but no association between weight loss and postoperative complication rate was found. The odds ratio for postoperative mortality was 2.5 to 1 for the weight loss group 5 to 10kg versus 0 kg. In conclusion, weight loss reflects a less favorable tumor status. Weight loss did not increase postoperative morbidity but did lead Weight to a higher death rate after surgery.

Adult↗
PubMed1991

Mortality from dementia among gastroduodenal ulcer patients.

STUDY OBJECTIVE: The aim was to examine whether a high intake of aluminium containing antacids is a risk for Alzheimer's disease. DESIGN: The mortality from dementia (1970-87), coded from death certificates as underlying or contributory cause of death, was compared with national rates in a cohort of patients who had surgery for gastroduodenal ulcer disease between 1911 and 1978. SETTING: Patient data were obtained from patient records from major hospitals in western Norway. PARTICIPANTS: 4179 patients were identified who met the study criteria, which included having had a documented stomach operation, having a reliably identifiable personal number, and being alive on Jan 1, 1970. MEASUREMENTS AND MAIN RESULTS: The standardised mortality ratio for dementia was 1.10 (95% CI 0.85-1.40, n = 64) for all patients, while for patients operated on in the period 1967-78 it was 1.25 (95% CI 0.66-2.13, n = 13). CONCLUSIONS: As the majority of patients operated on after 1963 have probably been heavy consumers of aluminium containing antacids, the study provides meager evidence that a high intake of aluminium is an important risk factor for Alzheimer's disease, the major cause of dementia. However, the possibility of a raised mortality from Alzheimer's disease cannot be ruled out due to probable misclassification both in diagnosis and exposure. In addition, the observation period may have been too short to detect an effect since the latent period for Alzheimer's disease may be very long.

Aged↗
PubMed1991

The Effect of Gastric Banding on Weight Loss in Patients with Morbid Obesity.

The results following operation for morbid obesity in 41 patients (8 men and 33 women) during the period 1983-1989 are reported. The median preoperative body mass index (BMI) was 43.6 (median excess weight 81%). All patients were preoperatively evaluated at the Department of Internal Medicine, and they had all tried several conservative regimens in order to lose weight. They were all operated on with gastric banding, creating a gastric stoma of 15 mm. Pneumonia developed in 10 patients, one patient got a wound infection, and one patient died postoperatively from a massive coronary embolism. The immediate postoperative weight loss was satisfactory, median BMI being reduced from 43.6 preoperative to 30.5 after 9 months. Median BMI after 3 and 5 years was 34 and 32 (median excess weight 42 and 41%, respectively). Six patients were reoperated, four having their band removed, two being converted to vertical gastric banding. In conclusion, gastric banding gives satisfactory results for most of the patients. The reoperation rate is, however, high and the long-term result is not favorable for all patients

Journal Article↗
PubMed1991

Patient and physician treatment delay in patients with stomach cancer in Norway: is it important? The Norwegian Stomach Cancer Trial.

The effect and consequences of treatment delay were studied in 1165 patients with stomach cancer included in a Norwegian multicentre study. Median patient delay was 42 days; median doctor delay 37 days; and median total treatment delay 107 days. By Cox proportional hazards model analyses we found that an increase in weight loss was associated with an increase in total delay, whereas a more advanced stage of disease was related to a short total delay. Physician delay was more pronounced in women, increased with increasing Karnofsky performance index, but decreased in patients with stage-IV disease. By logistic regression analyses we found no association between delays and postoperative complication rate. The relationship between physician delay and postoperative mortality was statistical significant, with increasing number of deaths with decreasing delay. In conclusion, there is no evidence that long treatment delay is an important negative factor in relation to outcome of surgery.

Adult↗
PubMed1991

Thyroid carcinoma: results from surgical treatment in 211 consecutive patients.

A retrospective study was undertaken of 211 patients who were operated on for thyroid carcinoma. The revised histological diagnoses were papillary (n = 167), follicular (n = 26), medullary (n = 9) and undifferentiated (n = 9). No patient was lost to follow up (mean 10 years). In 162 patients a palpable neck mass was the only clinical presentation of disease (76%). Fine needle aspiration cytology was increasingly used throughout the period. Total thyroidectomy was done in 167 (79%), hemi or subtotal thyroidectomy in 22 (10%), the remaining received palliative treatment. Accidental unilateral vocal cord paralysis occurred in 3 (1.4%). Total thyroidectomy was followed by permanent hypoparathyroidism in 19 (11%). The tumour recurred in 37 (19%), and 23 of the patients died thyroid cancer (11%). The disease specific mortality for patients with undifferentiated tumours was 77% compared with 8% for patients with differentiated tumours. In the latter group, death of cancer was correlated significantly with age, sex, tumour size, presence of regional metastases, and palliative treatment.

Adenocarcinoma↗
PubMed1990

Prognostic risk factors for graft failure following pancreas transplantation: results of multivariate analysis of data from the International Pancreas Transplant Registry.

A multivariate analysis of prognostic factors for graft failure was performed on patients in the International Pancreas Transplant Registry. The analysis was restricted to the period January 1978 to June 1987 and included 764 patients. All patients had at least 1 year of follow-up. The following variables were studied: transplant year, continent (N. America, Europe, others), type of donor (cadaver, living related mismatched, living related HLA-identical), donor mismatch at the HLA A, B loci, donor mismatch at the DR loci, preservation time, kidney association (pancreas transplant alone, simultaneous pancreas and kidney transplant, pancreas after kidney transplant), whole versus segmental pancreatic transplant, graft duct management technique (polymer injection, enteric drainage, stomach drainage, bladder drainage), and immunosuppression. By stepwise, logistic regression analysis, we found that the following factors were predictive for 1-year graft function: donor mismatch at the DR loci (P = 0.0003), kidney association (P less than 0.0001), type of donor (P = 0.04), and immunosuppression (P = 0.0002). For donor mismatch at the DR loci, we found an odds ratio for success of 2.2 for 0 versus 2 mismatches. The odds for success were 2.9 for simultaneous pancreas and kidney transplant versus pancreas transplant alone. The best results--79% 1-year graft survival--were obtained for the combination of 0 mismatches at the DR loci, pancreas after kidney transplant, living related HLA-identical donor, and the immunosuppressive regimen consisting of cyclosporin, azathioprine, and prednisone. Patients receiving a pancreas transplant alone with 0 mismatches at the DR loci, living related HLA-identical donor, and triple immunosuppressive regimen had a predicted 1-year graft survival of 71%.

Graft Rejection↗
PubMed1990

A simple on-line information system for quality assessment.

Many aspects of medicine would be well served by a simple method to assess the outcome of care in specified groups of patients. This study examined charts of patients with stomach cancer on a surgical service. Two digits were added to the ICD-9 number in the routine discharge data; one for the nature and severity of case and the other for the outcome of care. The digits were designed for on-line registration at discharge. Information was also obtained on resource consumption in the various groups of patients. Most of the variables had to be evaluated implicitly as there were no explicit judgement criteria and few empiric data available for comparison. Implicit evaluation of the results was significant and prompted steps for improving care. With current systems, the information obtained from traditional hospital statistics is limited and partly misleading. By slight modification, however, hospital statistics may provide valuable information for assessing quality of care and resource allocation during hospitalization.

Aged↗
PubMed1988

Treatment of stomach cancer, a national experience.

A total of 1165 patients with stomach cancer were entered into a prospective, observational national study. They represented 54 per cent of all stomach cancer patients reported to the Cancer Registry in Norway during the study period, and data are analysed for three hospital levels (local, county and university hospitals). The median age was 71 years (range 18-96 years). The median pretreatment delay was 113 days, and 46 per cent of patients had a performance status (Karnofsky index) of less than or equal to 80. The diagnosis was confirmed by pre-operative histology in 88 per cent of cases. In all, 88 per cent of patients underwent surgery, the resectability rate was 67 per cent and 50 per cent had a potential curative operation. Total gastrectomy was most commonly performed. Lymph node dissection was performed in 14 per cent of those undergoing a curative resection. The postoperative complication rate was 27 per cent but varied with the type of operation, being highest in proximal resection (55 per cent) and lowest after distal resection (19 per cent). A total of 7 per cent of the patients died postoperatively. Most patients had advanced disease at the time of treatment and only 6 per cent had stage I tumours. There were significant differences in patient and treatment characteristics between the three hospital levels. In conclusion, patient selection bias which will influence results does occur. A fairly aggressive attitude towards local disease was found, but the low proportion of patients undergoing lymph node dissection not only leads to questions regarding the efficacy of this treatment policy, but also casts doubt on the validity of staging of stomach cancer. Morbidity and mortality rates are still high. The consequences of the differences revealed between hospital groups are difficult to interpret. Proponents of both regionalization of treatment and small hospital care may find arguments for their case in the data.

Adult↗
PubMed1988

Postoperative complications and mortality after surgery for gastric cancer.

Complication rates and postoperative mortality were studied in 1010 consecutive patients entered into the Norwegian Stomach Cancer Trial. Twenty-eight per cent of the patients had one or more complications (31% of the men and 21% of the women). General complications (pneumonia, thromboembolic, and cardiac) were most frequent. The postoperative mortality rate for resected patients was 8.3% (63 of 763). Complication and mortality rates were highest for proximal resections (52% and 16%) followed by total gastrectomy (38% and 8%), subtotal resection (28% and 10%), and distal resection (19% and 7%). By logistic regression analysis it was found that age, sex, operative procedure, prophylactic antibiotics, and splenectomy were significantly related to postoperative complications. The odds ratio for complication for men versus women was 1.75: for no antibiotics versus antibiotic prophylaxis it was 2.5. Relative to distal resection the odds ratio for complications after subtotal resection was 2.2, for total gastrectomy was 3.9, and for proximal resection was 7.6. Age and sex were the only factors that affected operative mortality. The odds ratio for mortality for men versus women was 2.3. The odds ratio for operative mortality was 2.2 when the age of the patient increased with 10 years.

Adolescent↗
PubMed1988

Fine-needle aspiration cytology of focal liver lesions. Advantages and limitations.

Fine-needle aspiration cytology of focal liver lesions was performed 192 times in 175 patients over a 5-year period. Ultrasonic guidance was used for 153 punctures; the others were done peroperatively or on a palpable mass. A correct diagnosis of malignancy was obtained in 89/111 cases (80.2%), and of metastases (adenocarcinoma) to the liver in 71/84 (84.5%). The total of nonrepresentative aspirates was 26 (13.5%). The overall accuracy of cytologic evaluation was 87.5%, with 79.5% sensitivity and 100% specificity in malignant disease. The predictive values of positive and negative results were, respectively, 100% and 75.8%. There were no false positive tests, but 12.5% false negatives. No complications following the aspiration procedure were seen. Fine-needle aspiration biopsy is simple and safe, but the relatively high proportion of nonrepresentative aspirates is a problem. Possibly a more aggressive approach with multiple punctures may lessen this incidence and enhance the diagnostic accuracy in hepatic malignancy.

Adolescent↗
PubMed1987

Abdominal aortic aneurysms--a national multicentre study.

A prospective, observational, multicentre study has been carried out on 444 consecutive patients with abdominal aortic aneurysms to study the effect of the diffusion of vascular service on treatment results. Two-hundred and seventy-nine patients were admitted for elective surgery (E), 114 patients had a ruptured aneurysm (R), and 51 had impending rupture (IR). Patients with acute symptoms (R + IR) were generally older and had larger aneurysms than the E group. The postoperative mortality was 7.5%, 16.7%, and 63.1% in the E, IR and R group respectively. The study demonstrates that overall treatment results in these high risk patients are inferior to results published from specialised institutions. Consequently, the diffusion of vascular surgical service seems not to have worked to the benefit of our patients although further analysis may modify this conclusion.

Aged↗
PubMed1987

Stomach cancer: a prospective study of anastomotic failure following total gastrectomy.

The incidence and cause of esophagojejunal anastomotic leakage were prospectively studied in 350 patients following total gastrectomy for stomach cancer. Anastomotic leak was demonstrated in 30 patients (8.6%), ten of whom underwent reoperation. Nine of the 30 patients died. Statistical analysis revealed that the outcome was better for patients with stapled esophagojejunostomy than when the anastomosis was hand-sutured. The odds for leakage were 2.37 times higher in patients with hand-sutured, than in those with stapled anastomosis. Antibiotic prophylaxis may be significant in preventing leakage. No association was found between anastomotic leakage and type of hospital, patient age or sex, preoperative weight loss, concomitant splenectomy or residual tumor in the resection margin.

Adult↗