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B Nilsson

Publications and source records attributed to B Nilsson.

At least 73 records · Page 4Linked to original sources
PubMed2000

Long-term follow-up of the Stockholm screening study on ovarian cancer.

OBJECTIVES: Seventy percent of ovarian cancer is diagnosed at advanced stages. Having a method for early diagnosis is a very attractive concept. Several attempts have been made, using monoclonal antibody-based immunoassays, ultrasound, or combinations of both, to identify methods that might prove to be sufficiently sensitive and specific as a screening test. Despite promising results, a mortality study of a large population has yet to be completed due in part to the high cost involved. METHODS: One of the first studies aimed at devising a screening strategy for ovarian cancer used the CA 125 immunoassay followed by ultrasound. The study was performed in Stockholm from 1986 through 1988. Ten years now having passed, an analysis has been performed to further evaluate the results of that study. RESULTS: Screening led to the diagnosis of ovarian cancer in six patients, five of whom have since died of the disease. By searching the Cancer Registry, we were able to identify 20 ovarian cancer patients who developed the disease after the screening period. Of these, 12 died of the disease, 2 are alive with disease, and 6 have no evidence of disease following treatment. The median survival for patients diagnosed by screening was 100 months. Median survival for ovarian cancer patients identified subsequent to screening was 20 months. Although there was no difference in survival between these two groups, median survival was better for women diagnosed by screening (borderline significance, P = 0.059). CONCLUSION: These results indicate that a study of a large number of women with a sufficiently long observation time will be required to establish whether or not screening can reduce ovarian cancer mortality. Such a study may also provide insight into the natural history of ovarian cancer.

Adult↗
PubMed2000

The liver protective effect of ischemic preconditioning may be mediated by adenosine.

We investigated the involvement of adenosine in ischemic preconditioning (IPC) by the unspecific antagonist, 8-phenyltheophylline (8-PT). Anesthetized Wistar rats were treated as follows: 1. non-ischemic controls, 2. ischemic controls: 60 min of clamping of the common hepatic artery followed by 60 min reperfusion, 3. IPC: 10 min ischemia followed by 15 min reperfusion, prior to the identical ischemia-reperfusion (IR) period as in group 2, 4. 8-PT + IPC: 8-PT 10 mg/kg i.v. was given 10 min prior to the identical procedure as in group 3. The peripheral liver blood flow was monitored by laser-Doppler flowmetry. Blood alanine aminotransferase (ALT) was analyzed once every 60 min. IPC significantly reduced impairment of liver blood flow, as well as ALT increase during reperfusion. This effect was abolished by pretreatment with 8-PT. Adenosine appears to be a crucial effector in IPC. Clinical studies need to be undertaken to explore a possible effect of IPC in liver transplantation.

Adenosine↗
PubMed2000

No benefit of reduced heparinization in thoracic aortic operation with heparin-coated bypass circuits.

BACKGROUND: Heparin coating of the cardiopulmonary bypass circuit attenuates inflammatory response and confer clinical benefits in cardiac operations. The positive effects may be amplified with reduced systemic heparin dosage. We studied markers of inflammation and coagulation in thoracic aortic operations with heparin-coated circuits and standard vs reduced systemic heparinization. METHODS: Thirty patients were randomized to standard (group S; 300 IU/kg initially; activated clotting times [ACT] > 480 seconds; 5,000 IU in prime; n = 16) or reduced (group R; 100 IU/kg initially; ACT > 250 seconds; 2,500 IU in prime; n = 14) dose systemic heparin. The following markers were analyzed perioperatively: (a) inflammatory response; acute phase cytokine interleukin-6, and granulocytic proteins myeloperoxidase and lactoferrin; (b) complement activation; factor C3a and the C5a-9 terminal complement complex [TCC]; and (c) coagulation; thrombin-antithrombin III complex. RESULTS: The clinical outcome did not differ between groups. Four (29%) patients in group R had a perioperative thromboembolic event. All studied markers were significantly elevated during and throughout cardiopulmonary bypass in both groups. Maximal values were higher in group R for all variables except for TCC. There were no statistically significant intergroup differences regarding markers of inflammation, complement activation, or coagulation activation. CONCLUSIONS: The blood trauma in thoracic aortic operation is extensive, as reflected by the elevation of the studied biochemical markers, even when heparin-coated cardiopulmonary bypass circuits are used. In this study, we did not detect any benefits, either biochemical or clinical, of reducing the dose of systemic heparin.

Aged↗
PubMed2000

Do anthracyclines have a role in the therapy of multiple myeloma?

INTRODUCTION: There is a great need for alternative treatments for patients with relapsing and refractory multiple myeloma. The new anthracycline idarubicin has the advantage of oral administration and has been suggested as part of new orally based chemotherapeutic combination regimens. The evidence of its own efficacy in this disorder is, however, insufficient. MATERIALS AND METHODS: In a multi-centre phase II study we administered oral idarubicin as a single drug in a dose of 10 mg/m(2) days 1-4 every four weeks to a total of 30 patients with relapsing (n=18) or refractory (n=12) multiple myeloma. RESULTS: Of 28 evaluable patients only one achieved a partial response of 15 months' duration. Other patients showed a very short minor response (n=1), "no change" (n=11) or progression (n=15) during the therapy. Toxicity was mostly mild and the drug was fairly well tolerated. None the less, half of the patients experienced WHO grade 3 and 4 toxicity in the form of granulocytopenia (n=10) or thrombocytopenia (n=4). CONCLUSION: Based on our experience and available data from three previously published reports, we consider idarubicin to have only a marginal effect in relapsing and refractory myeloma. A review of the literature on studies of anthracylines as single-agent therapy shows that only 5% of patients (19 out of 377) show a partial response. In our opinion the regular inclusion of an anthracycline in drug combinations for refractory myeloma should be reconsidered.

Aged↗
PubMed2000

Psoriasis patients with antibodies to gliadin can be improved by a gluten-free diet.

In a previous screening study, 16% of patients with psoriasis had IgA and/or IgG antibodies to gliadin (AGA). The aim of the present study was to evaluate the effect of a gluten-free diet (GFD) in 33 AGA-positive and six AGA-negative psoriasis patients. Of the 33 AGA-positive patients, two had IgA antibodies to endomysium (EmA) and 15 an increased number of lymphocytes in the duodenal epithelium, but in some this increase was slight. Two patients had villous atrophy. A 3-month period on a GFD was followed by 3 months on the patient's ordinary diet. The severity of psoriasis was evaluated with the psoriasis area and severity index (PASI). The examining dermatologists were unaware of the EmA and duodenal biopsy results throughout the study. Thirty of the 33 patients with AGA completed the GFD period, after which they showed a highly significant decrease in mean PASI. This included a significant decrease in the 16 AGA-positive patients with normal routine histology in duodenal biopsy specimens. The AGA-negative patients were not improved. After GFD, the AGA values were lower in 82% of those who improved. There was a highly significant decrease in serum eosinophil cationic protein in patients with elevated AGA. When the ordinary diet was resumed, the psoriasis deteriorated in 18 of the 30 patients with AGA who had completed the GFD period. In conclusion, psoriasis patients with raised AGA might improve on a GFD even if they have no EmA or if the increase in duodenal intraepithelial lymphocytes is slight or seemingly absent.

Adolescent↗
PubMed2000

Influence of body size and age on maximal systolic velocity of mitral annulus motion.

The maximal systolic velocity of the mitral annulus motion (or maximal systolic long-axis contraction velocity of the ventricle, MLACV) has been suggested as a means to assess left ventricular function. However, reference values for a wide range of age and body size are lacking. The maximal systolic velocity was studied with M-mode echocardiography using the apical four- and two-chamber views. Data are reported as the average of the measurements of four sites of the mitral annulus. Fifty-seven healthy subjects aged 6 months to 72 years were studied. In children and adolescents up to age 18, MLACV had a significant positive correlation with age, height, body surface area, weight and mitral annulus motion amplitude and a significant negative correlation with heart rate. In adults, there was a significant positive correlation between MLACV and height, mitral annulus motion amplitude and body surface area and a significant negative correlation with age and heart rate. Multiple stepwise analysis showed that the maximal systolic velocity is highly dependent on height and age in children and adolescents up to age 18, and on height in adults. The maximal long-axis contraction velocity (MLACV) can be described by the following equations: MLACV (mm s-1) = 24.0 + 0.34 x height (cm) (Standard Error of the Estimate (SEE)=10.5) in children and adolescents, and MLACV (mm s-1) = -50.5 + 0.75 x height (cm) (SEE=9.8) in adults over 18. There were significant differences between the four sites, with the highest velocity at the lateral site and the lowest velocity at the septal site. No significant difference was found between inspiratory and expiratory beats.

Adolescent↗
PubMed2000

Anti-SSA/Ro antibody determination by enzyme-linked immunosorbent assay as a supplement to standard immunofluorescence in antinuclear antibody screening.

The aim of this study was to investigate the frequency and possible clinical relevance of SSA/Ro antibodies, as determined by enzyme-linked immunosorbent assay (ELISA), in patient sera not exhibiting a concomitant positive reaction by the standard immunofluorescence (IF) test using HEP-2 cells as substrate. SSA/Ro reactivity, as shown by ELISA, was found in 285 (7%) of 4025 serum samples consecutively remitted for antinuclear antibody (ANA) screening. Seventy-five of these serum samples (26%), derived from 64 patients, were negative by the IF-ANA screening test. Serum samples from all 64 patients exhibiting SSA/Ro reactivity by ELISA without concomitant positivity by IF-ANA were further investigated by IF using transfected HEP-2 cells hyperexpressing the 60,000 MW SSA/Ro antigen (HEP-2000(R)) and by immunodiffusion (ID) and Western blot. In 55 of these 64 patients, SSA/Ro reactivity could be verified by one or more of the other techniques investigated. Twelve of these patients fulfilled four or more American College of Rheumatology (ACR) criteria for systemic lupus erythematosus (SLE) and another five patients exhibited a histologically confirmed cutaneous lupus erythematosus (LE). In four of the 12 IF-ANA-negative patients with a diagnosis of SLE, the SSA/Ro reactivity was only detectable by ELISA and Western blot. In conclusion, the use of a sensitive ELISA assay could provide a clinically important supplement to the routine ANA screening by IF, which does not detect certain anti-SSA/Ro-containing sera among patients with relevant autoimmune diagnoses. Detection of anti-SSA/Ro antibodies, however, does not alone signify cutaneous LE or SLE but adds weight to these diagnoses that should rely heavily on other clinical information.

Adult↗
PubMed2000

Sense of coherence in different stages of health and disease in northern Sweden--gender and psychosocial differences.

OBJECTIVE: To investigate "Sense of Coherence" (SOC) and its relation to perceived health, different stages of disease, and different psychosocial factors in a population-based study. DESIGN: Postal survey of a population-based sample, the MONICA study (1994). SETTING: Norrbotten and Västerbotten, the two northernmost counties in Sweden, with a total population of 510000 inhabitants. SUBJECTS: 837 men and 882 women in three mutually-exclusive groups: stomach trouble of many years' standing, identified disease (stroke, cardiac infarction, diabetes, anti-hypertension treatment) and no reported disease. MAIN OUTCOME MEASURES: SOC scores in relation to sociodemographic variables and perceived health. RESULTS: We found a relationship between low SOC scores and poor perceived health, low social support and low emotional support on a population level. When comparing persons with stomach trouble with those without disease, or with established diseases, we found similar relationships between low mean SOC scores in all strata for both women and men. "Perceived health", however, was only significantly correlated for women, and women had an overall stronger relationship. CONCLUSIONS: In a study in northern Sweden, female patients with stomach trouble comprise a vulnerable group. The concept of SOC introduces a new dimension for perceiving health and disease. In clinical practice, care providers can identify and elaborate on the relationship between SOC scores and sociodemographic data.

Adult↗
PubMed2000

Health-related quality of life measured by the EORTC QLQ-C30--reference values from a large sample of Swedish population.

The EORTC QLQ-C30 Health-Related Quality of Life (HRQOL) questionnaire was completed by 3069/3919 (78%) of a random sample of the Swedish population aged 18-79 years. The aims of the study were to provide normative data on the questionnaire and to investigate differences in HRQOL with respect to age, gender, sociodemographic characteristics and reported chronic health problems. Women had lower scores than men on all but one of the EORTC QLQ-C30 subscales and reported more chronic health problems. The oldest respondents (70-79 years) had a greater degree of impaired HRQOL than the other age groups, with one exception, 'Emotional functioning', in which they scored higher. Unemployed respondents reported poorer HRQOL than employed respondents. Higher income was associated with a more positive assessment of HRQOL. The results of the study present reference values for EORTC QLQ-C30 Version 3 questionnaire and clarify the influence of factors which should be taken into account when planning studies of HRQOL.

Adolescent↗
PubMed2000

Trends in the incidence and severity of stab wounds in Sweden 1987-1994.

OBJECTIVE: To evaluate the incidence, types of injury, medical consequences, and mortality of patients with stab wounds in Sweden. DESIGN: Retrospective case study. SETTING: The Swedish National Hospital Discharge Register (SNHDR) and the Register of Causes of Death, Statistics Sweden (RCDSS) SUBJECTS: 1315 patients with stab wounds. All 1507 episodes were treated in Swedish hospitals from 1987-1994. MAIN OUTCOME MEASURES: Incidence of stab wounds in Sweden, mortality, types of injuries and medical consequences. RESULTS: From 1987 to 1994, 1315 people were admitted to Swedish hospitals with stab wounds, which corresponds to 2.1 injuries/100,000 population/year. In all, 1507 episodes were treated in hospital. There were 1121 men (85%) and 194 women (15%), with a median age of 32 years (range 1-88). The annual incidence was relatively constant during this period. The total number of deaths was 45/1315 (3.4%). Among these, 13 (29%) had thoracic, 9 (21%) abdominal, 7 (16%) head/neck and 7 (15%) extremity injuries. Twenty percent of those admitted to hospital had to spend more than one week there. CONCLUSIONS: The incidence of stab wounds was low and the annual incidence stable. Young men in urban areas were the commonest victims. Injuries of the trunk were commonest, followed by injuries to the head and neck and limbs, 80% of the patients were discharged from hospital within a week, and 3% of those treated in hospital for stab wounds died.

Abdominal Injuries↗
PubMed2000

Heparin-coated cardiopulmonary bypass circuits reduce circulating complement factors and interleukin-6 in paediatric heart surgery.

Children are sensitive to the inflammatory side effects of cardiopulmonary bypass (CPB). Our intention was to investigate if the biocompatibility benefits of heparin-coated CPB circuits apply to children. In 20 operations, 19 children were randomized to heparin-coated (group HC, n = 10) or standard (group C, n = 10) bypass circuits. Plasma levels of acute phase reactants, interleukins, granulocytic proteins and complement factors were measured. All were significantly elevated after CPB. Levels of complement factor C3a (851 (791-959)ng/ml [median with quartiles] in group C, 497 (476-573)ng/ml in group HC, p < 0.001), Terminal Complement Complex (114 (71-130) AU/ml in group C, 35.5 (28.9-51.4) AU/ml in group HC, p < 0.001), and interleukin-6 (570 (203-743) pg/ml in group C, 168 (111-206)pg/ml in group HC, p = 0.005), were significantly reduced in group HC. Heparin-coated CPB circuits improve the biocompatibility of CPB during heart surgery in the paediatric patient population, as reflected by significantly reduced levels of circulating complement factors and interleukin-6.

Anticoagulants↗
PubMed2000

Is skeletal muscle luxury perfusion the main hemodynamic effect of high-dose insulin in cardiac surgery?

Insulin, in combination with glucose and potassium (GIK), can be used in heart surgery to improve hemodynamic performance. This study evaluates the role of skeletal muscle vasodilation in hemodynamic effects of high-dose GIK therapy early after coronary surgery. Thirty-three male patients undergoing coronary artery bypass grafting were included in a prospective, randomized and controlled study. Eleven patients received infusions of mixed amino acids (11.4 g) and insulin solution (225 IU insulin, glucose with the glucose clamp technique, and potassium), 11 patients received infusions of mixed amino acids (11.4 g) and 11 patients served as control subjects. During combined insulin and amino acid infusion, cardiac output increased by 13+/-3% (+0.6+/-0.2 L x min(-1)) and systemic vascular resistance decreased by 24+/-3% (-320+/-46 dyn x s x cm(-5)). The changes differed from those in the control group (CO: -0.2+/-0.1 L x min(-1), p < 0.05; SVR: +136+/-42 dyn x s x cm(-5), p < 0.05). Changes in skeletal muscle perfusion and leg vascular resistance did not differ significantly among the groups. At most, changes in leg blood flow could explain 40% of the changes in cardiac output. Skeletal muscle luxury perfusion is not the main hemodynamic effect of high-dose insulin in the early postoperative period after coronary surgery.

Aged↗
PubMed2000

Comparative dosimetry in narrow high-energy photon beams.

A comparison of the response of different dosimeters in narrow photon beams (phi > or = 4 mm) of 6 and 18 MV bremsstrahlung has been performed. The detectors used were a natural diamond detector, a liquid ionization chamber, a plastic scintillator and two dedicated silicon diodes. The diodes had a very small detection volume and one was a specially designed double diode using two parallel opposed active volumes with compensating interface perturbations. The characteristics of the detectors were investigated both for dose distribution measurements, such as depth-dose curves and lateral beam profiles, and for output factors. The dose rate and angular dependence of the diamond and the two diodes were also studied separately. The depth-dose distributions for small fields agree well for the diamond, the scintillator and the single diode, while the measured dose maximum for the double diode is about 1% higher and for the liquid chamber about 1% lower than the mean of the others when normalized at a depth of 10 cm. The plastic scintillator and the liquid ionization chamber detect a penumbra width that is slightly broadened due to the influence of their finite size, while the double diode may even underestimate the penumbra width due to its small size and high density. When corrected for the extension of the detector volume a good agreement with Monte Carlo calculated beam profiles was obtained for the plastic scintillator and the liquid ionization chamber. Profiles measured with the diamond show an asymmetry when positioned with the smallest dimension facing the beam, while the double diode, the scintillator and the liquid chamber measure symmetric profiles irrespective of positioning. Significant differences in the output factors were obtained with the different detectors. The natural diamond detector measures output factors close to those with an ionization chamber (less than 1% difference) for field sizes between 3 x 3 and 15 x 15 cm2, but overestimates the output factors for large fields and underestimates the output factors for the smallest field sizes. The single and double diodes overestimated the output factor for large field sizes by up to 7 and 12% respectively due to the high content of low-energy photons. The double diode, and to some extent the single diode, also showed a relative increase in response compared with the more water equivalent liquid chamber and plastic scintillator at the smallest fields where there is a lack of lateral electron equilibrium. Both the plastic scintillator and the liquid chamber also show responses that deviate from the ionization chamber for larger field sizes. The major deviations can be explained based on the characteristics of the sensitive materials and the construction of the detectors.

Dose-Response Relationship, Radiation↗
PubMed2000

Evidence for the involvement of blood flow-related mechanisms in the ovulatory process of the rat.

To elucidate whether any relationship exists between ovarian blood flow and ovulation rate, the effects on these parameters were examined in equine chorionic gonadotrophin/human chorionic gonadotrophin (eCG/HCG) (15I U/15I U) primed rats after bilateral ligation and severance of either the ovarian branch of the uterine artery and vein (UL), the ovarian artery and vein (OL) or both sites (UL+OL) in comparison to sham operations. Laser Doppler flowmetry demonstrated the presence of microcirculatory vasomotion and a reduction of blood flow after UL, OL and UL+OL performed during the intervals 0-3 h (78, 66 and 19% of pretreatment values respectively) and 6-9 h (68, 57 and 20%) after HCG. Experiments utilizing radioactive microspheres also indicated decreased ovarian blood flow by UL and OL. Ovulation rate was assessed 20 h after HCG in animals where ligations had been performed at 0, 3, 6 and 9 h after HCG. No ovulations were seen after UL+OL and significantly decreased ovulation rates ( approximately 50% of sham operated animals) were seen after UL at 0 and 3 h and after OL at 0, 6 and 9 h. Progesterone concentrations in blood 20 h after HCG were reduced by OL but not UL and ovarian weights were unaffected by ligation. It is concluded that acute blood flow reduction during the ovulatory interval reduces ovulation rate in the rat.

Animals↗
PubMed2000

The value of cysteinyldopa in the follow-up of disseminated malignant melanoma.

In a series of 92 patients with malignant melanoma, clinical stage III or IV, both 5-S-cysteinyldopa (5SCD) and 6-hydroxy-5-methoxyindole-2-carboxylic acid (6H5MI2C) were measured in urine during chemotherapy. A total of 434 urine specimens were analysed. The sensitivity of 5SCD for the detection of stage III-IV melanoma was 83%, while the corresponding sensitivity of 6H5MI2C was 52%. Fifty per cent of patients with one metastatic site had increased 5SCD excretion, while all patients with four or more metastatic sites had increased excretion. A significant correlation was found between 5SCD decrease and clinical regression (P<0.001) and between 5SCD increase and clinical progression (P<0.001). Corresponding correlations were not found for 6H5MI2C. Increments in 5SCD excretion (median 269 micromol/mol creatinine) were seen for 83% of the occasions when clinical progression was recorded, and decrements in 5SCD excretion (median 145 micromol/mol creatinine) were seen for 85% of the occasions when clinical regression was seen. During clinical 'stable disease' increases in 5SCD excretion were seen in 59% and decreases in 41%. The median value of 5SCD changes for stable disease was 7.0 micromol/mol creatinine, indicating a chemical marker stability in many cases. We recommend the use of 5SCD in urine as a valuable, reliable and simple biochemical marker to use in the clinical follow-up of melanoma patients with advanced disease.

Adult↗
PubMed2000

Victims of criminal homicide in Sweden: a matched case-control study of health and social risk factors among all 1,739 cases during 1978-1994.

OBJECTIVE: The psychiatric and medical characteristics of victims of homicide have not been systematically studied and are often confounded by race. This study was undertaken to determine health and social factors contributing to the risk of being murdered in the Swedish, predominantly Caucasian population. METHOD: All 1,739 homicides between 1978 and 1994 in Sweden were studied in terms of variables in national case registers regarding health, crimes, immigration, and marital status. The same data were extracted for matched comparison persons in the general population, with controls for time of exposure. The data were analyzed by conditional logistic regression on matched pairs. RESULTS: Traumatic brain injury, physical abuse, alcohol dependence, and criminal recidivism conferred risk of being murdered. CONCLUSIONS: To the authors' knowledge, this is the first report of traumatic brain injury, in both men and women, as a risk factor for being murdered. Brain injury may mark risk-taking behavior in general or may cause provocative behavior.

Adolescent↗
PubMed2000

Palliative care, assisted suicide and euthanasia: nationwide questionnaire to Swedish physicians.

The objective of this study was to investigate what actually happens between physicians and adult patients in difficult end-of-life situations. We circulated an anonymous questionnaire to a randomized sample of 952 Swedish physicians registered in specialties comprising care of dying adult patients, 122 palliative care physicians, and 130 physicians from the Swedish Association for the Study of Pain. Of special interest were themes in conversations between the physicians and the patients, desires expressed by the patients, and actions performed by the physicians that might affect the patients' expected survival. The overall response rate was 79%. Of these, 63% of the randomized physicians, 95% of the palliative care physicians, and 43% of the Association for the Study of Pain physicians had more than occasionally treated dying adult patients during the past year. About half of them had discussed palliative care with all their dying patients, and more than half of the physicians had heard their patients expressing a wish to die. About one-third of all the physicians had given analgesic or other drugs in such doses that some of their patients' deaths were hastened. The same proportion had also been asked for active euthanasia, while 10% had been asked to assist suicide. No case of euthanasia and only a few cases of assisted suicide were reported. By implication, the study suggests that improving patients' awareness of the possibilities to relieve pain, anxiety and dyspnoea during the final days of life is an important way to reduce requests for active euthanasia.

Adult↗