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Biomedical subjects

B Nilsson

Publications and source records attributed to B Nilsson.

At least 217 records · Page 12Linked to original sources
PubMed1994

The economic costs of acute myeloid leukemia in Sweden.

The direct and indirect costs of acute myeloid leukemia were estimated for Sweden in 1989. The calculated total cost was SEK 460 million. Nearly half of the costs, or 1.7 million per patient diagnosed, were indirect costs due to premature mortality. Direct costs of relapses and indirect costs of mortality represent costs due to the absence of completely curable therapy. They also represent potential cost savings that could be obtained after introduction of new treatment options in the future.

Acute Disease↗
PubMed1994

Reproducibility of a questionnaire on risk factors for osteoporosis in a multicentre prevalence survey: the European Vertebral Osteoporosis Study.

BACKGROUND: The European Vertebral Osteoporosis Study Group (EVOS) developed a questionnaire, back translated into 14 different European languages, for use in a multinational epidemiological study of vertebral osteoporosis. We investigated the reproducibility of this questionnaire in four of the participating study centres. METHODS: In all 151 men and women, aged 50-85 years, from Lubeck (Germany), Malmo (Sweden), Warsaw (Poland) and Oviedo (Northern Spain), were retested with the questionnaire on two occasions using a different observer within a 28-day period. RESULTS: Questions relating to personal or medical history were more reproducible than questions concerning subjective symptoms or aspects of lifestyle. The level of agreement for the non-ordinal categorical variables, as estimated by kappa, varied from 0.38 to 1.00 across the four centres. Agreement for the multicategory ordinal, mainly lifestyle, questions was in general poorer though improved when a weighted analysis was performed. For continuous data the 95% limits of agreement were narrow, and there was no evidence of bias between interviewers. There were no important differences in reproducibility across the four centres for either categorical or continuous data. CONCLUSION: The study indicates that the questionnaire may produce useful and comparable information concerning risk factors for osteoporosis across different countries and in different languages. It also highlights that questionnaire instruments designed for use in multinational population-based studies may provide data of comparable quality across a range of settings.

Aged↗
PubMed1994

Absence of effect on exercise capacity of 12-weeks treatment with ramipril in patients with moderate congestive heart failure. Ramipril Study Group.

Pharmacological therapy in cases of chronic congestive heart failure (CHF) is usually evaluated by maximal exercise time. To assess the effect of an angiotensin converting enzyme inhibitor, ramipril, 223 patients with moderate CHF were studied in 24 centres in four Nordic countries in a randomized, double-blind, placebo-controlled, parallel group design. The study drug was titrated from 1.25 mg to a maximum of 10 mg once daily (o.d) over a period of 4 weeks (mean dose 8 mg). A symptom-limited bicycle exercise test, starting at 30 watts and increasing by 10 watts.min-1, was used to evaluate exercise capacity. Reproducible tests were required at baseline, and the test was repeated after 4, 8 and 12 weeks of treatment. Seven deaths were recorded in the placebo group and one death in the ramipril group. A total of 195 patients completed 12 weeks of treatment (placebo group n = 91, ramipril group n = 104). The groups had similar baseline characteristics. Maximal exercise time was increased by mean (SD) 35 s (9) and 41 s (8) in the placebo and ramipril groups, respectively. The adjusted difference between the groups at 12 weeks was 9 s (12) (ns). A significant decrease in blood pressure and rate-pressure product at rest and at end of exercise was obtained by ramipril as compared with placebo. Significantly fewer patients deteriorated in NYHA class from baseline to 12 weeks of ramipril treatment compared to placebo (P = 0.012). Concomitant medication for CHF increased significantly in the placebo group as compared with ramipril-treated patients (P = 0.003).(ABSTRACT TRUNCATED AT 250 WORDS)

Cardiac Output, Low↗
PubMed1994

Short-term kinetics of the humoral anti-C1q response in SLE using the ELISPOT method: fast decline in production in response to steroids.

Twenty four systemic lupus erythaematosus patients and 17 patients with other diagnoses were investigated regarding the presence of cells producing C1q reactive antibodies in peripheral blood mononuclear cells using the ELISPOT technique. These results were then compared with parallel serum levels of C1q reactive antibodies. Current production of anti-C1q was almost entirely confined to the systemic lupus erythaematosus group. Longitudinal analysis of anti-C1q ELISPOT positive patients showed rapid changes in the number of anti-C1q producing cells, but only slowly changing serum levels of the corresponding antibodies in response to glucocorticoids. In one systemic lupus erythaematosus patient prednisolone treatment had a selective effect on this autoantibody production, as the production of anti-C1q spot forming cells rapidly dropped to zero, at the same time as the number of total spot-forming cells showed only less change. In another patient, self-limiting connective tissue disease was associated with temporal occurrence of IgM anti-C1q. We believe, from these data, that the ELISPOT method for determination of current antibody production may be of particular value in longitudinal evaluation of disease course and therapeutic effects in systemic lupus erythaematosus and other rheumatic diseases.

Adult↗
PubMed1994

Complement killing of Yersinia enterocolitica and retention of the bacteria by leucocyte removal filters.

We report studies on the complement sensitivity of four strains of Yersinia enterocolitica, serotypes O:3, O:9, O:5.27, and O:20, isolated from blood units involved in transfusion fatalities. Complement in fresh CPD plasma killed Y. enterocolitica within 4 h at 22 degrees C in 100% of the experiments. The bactericidal action was serotype and complement activation pathway dependent. Both classic and alternate pathways seemed to be active, but the latter to a lesser degree. When the classic pathway was blocked by chelation of Ca2+ no complete killing was obtained. Complement did not enhance or condition Yersinia for leucocyte filter retention. Direct removal of Yersinia by filtration was also related to serotype; all strains were reduced by filtration in heat-inactivated plasma, and all except serotype O:5.27 were reduced in Ca(2+)-chelated plasma. Our findings may explain why plasma products and platelet concentrates are rarely involved in Yersinia sepsis related to transfusion.

Adsorption↗
PubMed1994

Reconstitution of the alternative pathway of complement by plasma infusions given to a patient with an SLE-like syndrome associated with a hereditary C3 dysfunction.

OBJECTIVE: To reconstitute a dysfunctional form of complement factor C3 in a patient with a systemic lupus erythematosus (SLE)-like syndrome. METHODS: The propositus was treated with plasma infusions during five sessions over a period of eight months. RESULTS: The alternative pathway was reconstituted to normal levels for approximately two to three days after each infusion. C3 fragments were incorporated into previously detected deposits of IgG and IgM at the dermal-epidermal junction and the immune complex levels gradually decreased during the whole treatment period. CONCLUSION: The reconstitution appears to result in the solubilisation of tissue immune complexes and a subsequent transportation to the fixed macrophage system.

Antigen-Antibody Complex↗
PubMed1994

Liver disease in ulcerative colitis: an epidemiological and follow up study in the county of Stockholm.

In an epidemiological study of the incidence of ulcerative colitis (UC) in the county of Stockholm between 1955 and 1979, 1274 patients with UC were discovered. Almost all these patients had regularly been investigated with liver function tests; 142 (11%) of them showed signs of hepatobiliary disease. A follow up study on all 142 patients with abnormal liver function and UC was made between 1989 and 1991 to evaluate the cause of the liver abnormality and to find out if the liver disease had affected the survival rates. At follow up, eight patients were reclassified as having Crohn's disease, 60 had developed normal liver function as judged from test results, while the remaining 74 still had signs of hepatobiliary disease. The most common explanation for a transient abnormality in liver function was active colitis. The temporary signs of liver injury were not associated with changes in survival rates for these patients. Infections, especially those because of hepatitis B and C virus transmitted by blood transfusions accounted for the abnormalities in liver function in 21 patients, nine of which had a chronic, but non-fatal course. Twenty nine (2.3%) of the patients developed primary sclerosing cholangitis (PSC), and 12 of them died during the study period four because of cholangiocarcinoma and eight because of hepatic failure; one patient had a transplant. The estimated median time of survival from the first presentation of evidence of a liver function, compatible with the diagnosis of PSC, to death or liver transplantation was 21 years. A comparison of survival rates in patients with UC and patients with UC and concurrent PSC showed, a significant reduction in survival in the PSC group (p<0.0001). The number of patients with UC who developed PSC remained constant during the study period. Thus, although evidence of abnormal liver function is a common finding in UC, a spontaneous return to normal levels is common. In this study, which did not have a selection bias, the median time of survival among PSC patients was far longer than previously described although development of PSC among patients with UC does significantly reduce the estimated median time of survival.

Adolescent↗
PubMed1994

Neurohormonal activation in patients with mild or moderately severe congestive heart failure and effects of ramipril. The Ramipril Trial Study Group.

OBJECTIVES: To describe neurohormonal activation in patients with mild or moderate heart failure and how it may be modified by treatment with ramipril. SETTING: Cardiology departments at 24 hospitals in Denmark, Finland, Norway, and Sweden. PATIENTS: 223 patients with mild or moderately severe congestive heart failure who were taking diuretics with or without digitalis. DESIGN: Randomised, double bind, multicentre, placebo controlled comparison of ramipril and placebo. Venous blood samples were drawn at rest, before blind treatment, and after 12 weeks of treatment with the study drug. A probability prediction score for mortality derived by stepwise linear discriminant from neurohormone data in the first cooperative north Scandinavian enalapril survival study (CONSENSUS I) was used to assess combined activity of the different neurohormonal systems. RESULTS: Plasma concentrations of atrial natriuretic peptide were raised at baseline but angiotensin II, aldosterone, and noradrenaline concentrations were within normal limits. There was, however, a wide interindividual variation. Plasma noradrenaline concentration and prediction score were higher among patients with class III congestive heart failure according to the New York Heart Association's classification than among patients with class II congestive heart failure (P < 0.05). There was a modest but significant inverse correlation between exercise duration at baseline and plasma noradrenaline concentration (r = -0.21, P = 0.0023), aldosterone concentration (r = -0.14, P = 0.04), and prediction score (r = -0.24, P = 0.0004). Prediction score at baseline was significantly higher among those who died (n = 10) than among survivors (P = 0.03). Angiotensin converting enzyme activity was suppressed and plasma concentrations of aldosterone and atrial natriuretic peptide were reduced after 12 weeks of treatment with ramipril compared with placebo. In patients with the most pronounced neurohormonal activation at baseline (highest third of noradrenaline concentration or prediction score), noradrenaline concentration and prediction score were significantly lower after 12 weeks of taking ramipril compared with placebo. Patients with a prediction score in the highest third at baseline had a higher heart rate than to those in the lowest third (P = 0.003). CONCLUSIONS: Neurohormonal activation is associated with the degree of symptoms and the severity of disease in mild or moderately severe congestive heart failure. Treatment with ramipril attenuates neurohormonal activation. This effect is most pronounced among patients with the highest circulating concentrations of neurohormones before the start of treatment.

Adult↗
PubMed1994

Sensitivity of 880 blood culture isolates to 24 antibiotics.

Blood culture isolates (n = 880) collected during 2.5 years (period I n = 515, July 1988 to December 1989; period II n = 365, January 1992 to December 1992) were analysed with the agar dilution method to ascertain their sensitivity to 24 antibiotics. The susceptibility of bacteria was classified according to MIC values and susceptibility grouping used in the SIR system (sensitive-S, intermediate-I, resistant-R). Comparison of percentage S+I values for the 2 periods revealed no major development of resistance. Co-trimoxazole and some cephalosporins (cefpirom, cefepime and cefotaxime) were active (S+I) against 88-92% of the strains. Imipenem and the combination piperacillin-tazobaclam were active against 95% of the strains. A very large number of strains (98.2 to 98.6%) were inhibited (S+I) by the quinolones tested, ciprofloxacin and ofloxacin. Comparison of the present results with those of our 1980-81 study yielded no evidence of resistance development, except for an increase in betalactamase-producing S. aureus strains, from 67% to 85%.

Anti-Bacterial Agents↗
PubMed1994

Hyperfractionated radiotherapy of bladder cancer. A ten-year follow-up of a randomized clinical trial.

One hundred and sixty-eight patients with invasive bladder cancer, T2-T4, were randomized to one of two treatments; hyperfractionation with 1 Gy 3 times a day to a total of 84 Gy or conventional treatment 2 Gy once a day to a total of 64 Gy. Both treatments were given over 8 weeks with a rest interval of 2 weeks in the middle of the treatment period. The present report included all patients after a follow-up period of at least 10 years. The survival benefit from hyperfractionation previously reported after 5 years is still evident after 10 years. The effect was detectable in all three subsets (T2, T3 and T4) and in the pooled data. However, it only reached statistical significance in the T3 subset and in the total pooled data set. Local control was also assessed by cystoscopy and cytology on bladder washouts. An improvement in local control was seen at all follow-up intervals and at all times out to 10 years but the differences were not statistically significant due to the falling number of patients available for assessment. Complications in the bowel requiring surgical treatment were more common in the hyperfractionated group but the difference was not significant since this group consisted of a greater number of patients alive and therefore at risk. This trial showed that the benefit of the hyperfractionated schedule persisted over a 10-year follow-up period, both for local control and survival.

Aged↗
PubMed1994

Epstein-Barr virus infection, salted fish and nasopharyngeal carcinoma. A case-control study in southern China.

Two hundred and five histologically confirmed cases of nasopharyngeal carcinoma (NPC) in southern China, and an equal number of matched controls, were investigated for their dietary habits, occupational exposure, use of tobacco and alcohol, history of relatives with NPC, and IgA against Epstein-Barr virus (EBV) capsid antigen (IgA/VCA). Positive IgA/VCA and intake of salted fish were associated with a strong excess risk of NPC. The association persisted after adjustment for other factors. The combination of salted fish and EBV was strongly associated with NPC, and more so than EBV or salted fish per se. Multivariate analyses showed that IgA/VCA was the most important predictor of NPC, and salted fish the second most important. These results suggest that EBV has a strong effect on the development of NPC. The exclusion of EBV and genetic factors in earlier epidemiological studies may have resulted in an overestimation of salted fish as important etiological factor causing NPC.

Adult↗
PubMed1994

The prevalence of locomotor complaints in middle age and their relationship to health and socioeconomic factors.

The prevalence and coincidence of symptoms or signs or both of degenerative changes in the back, shoulders, hips, and knees were analyzed in 575, 55-year-old residents of Malmö, Sweden, and the relationship of these complaints to smoking and alcohol habits, nervous problems, body weight, social background, intelligence test in 1938, education, job satisfaction, income, life success, employment, and occupational workload were analyzed. Back pain was the most common complaint--nearly 1/3--in men and women. Locomotor discomfort coincided more often and was more frequent in women. Overweight was related to knee and back complaints in men. Men with shoulder complaints were more often smokers. Men with knee complaints had higher levels of serum glutamyl-transferase, indicating a higher alcohol intake. Sleeping disturbances were more common in subjects with shoulder, back, and knee complaints. Subjects with moderate or heavy work loads had more locomotor complaints, particularly in the back, hips, and knees. Job dissatisfaction was the variable with the strongest independent relation to locomotor discomfort in both genders.

Back Pain↗
PubMed1993

Cancer incidence in Estonian migrants to Sweden.

Cancer incidence in Estonians who took refuge in Sweden in 1944-1945 has been compared with that in the total Swedish population and that among Estonians in Estonia in 1974-1985 using data from the Swedish and the Estonian countrywide population-based cancer registries. The vast majority of the Estonian immigrants studied had been living in Sweden for 30 years when the follow-up with respect to cancer incidence started in this investigation. In spite of the long residence in Sweden, differences in cancer incidence could be observed between these immigrants and the total Swedish population. The age-standardized incidence of stomach cancer was higher in the Estonian migrants than in the total Swedish population (SIR = 1.6 and 2.1 for males and females, respectively). Breast cancer incidence was lower in the migrant women (SIR = 0.75) and lung cancer incidence higher in migrant men (SIR = 1.5). An increased incidence of colorectal cancer was also found for both sexes in the migrant population (SIR = 1.4 for both males and females). A comparison between Estonians in Estonia and the total Swedish population revealed that the cancer incidence for the Estonians was lower than expected at age 70 and over. Male lung cancer and stomach cancer showed a higher incidence in the Estonian population than in the Swedish and in the migrant populations. The migrant population showed an intermediate incidence relative to Estonians in Estonia and the entire Swedish population. The colon-cancer risk in Estonian migrants to Sweden was higher than the risk for Estonians in Estonia and for the Swedish population. This contrasts with most findings in the present and other studies on intermediate risks of migrants compared to the risks in the country of origin and in the new country of residence.

Adult↗