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Biomedical subjects

G Lindberg

Publications and source records attributed to G Lindberg.

At least 127 records · Page 7Linked to original sources
PubMed1986

Liver investigation in 149 asymptomatic patients with moderately elevated activities of serum aminotransferases.

The accidental finding of raised levels of serum aminotransferase levels may lead to extensive investigations of the liver in apparently healthy people. To identify diagnostic groups and their need for investigations, we have evaluated the results of all investigative procedures carried out in 149 asymptomatic patients with persistently raised serum levels of aminotransferases. Fatty liver was found in 64%. These patients often had a high body weight. A high alcohol intake and diabetes mellitus were also noted. Chronic active or persistent hepatitis was found in 20% of the patients. Six per cent had cirrhosis, 4% had alpha 1-antitrypsin deficiency, and 3.5% had hemochromatosis. Apart from ferritin, alpha 1-antitrypsin, and markers for hepatitis B, blood tests were of little value for distinguishing among different diagnostic groups. This was the case also for the imaging procedures, and neither liver scintigraphy nor ultrasonography was a reliable source of diagnostic information. The results of our study indicate that diagnosis in this group of patients cannot be made without liver biopsy.

Alanine Transaminase↗
PubMed1984

Rheumatic diseases in a health interview survey and in in-patient care. A record linkage study on two registers.

A record linkage was performed between the in-patient register of Stockholm County and the Stockholm County sample of a national health interview survey. The purpose was to describe and compare characteristics of the two registers, particularly as regards rheumatic diseases. All persons included in the health interview survey of 1977-78 were sought in the in-patient register for the same period. 37% of the population had reported long-term illness in the health interview survey and 22% had been hospitalized, according to the in-patient register. 11% reported a rheumatic disease in the health interview survey, but only 2% were hospitalized with a rheumatic diagnosis. Persons who reported a rheumatic disease in the health interview survey were compared with persons hospitalized with a rheumatic diagnosis by using items in the health interview survey on perceived health, physical mobility and work capacity. The most important difference between the groups was a much higher proportion of disabled persons in the hospitalized group. Perceived health was reported very similarly in the two groups. The reports on hospital episodes in the health interview survey were validated against the in-patient register. An under-reporting of 13% and several inaccuracies in the timing of the hospital episodes were found.

Adolescent↗
PubMed1983

A description of diagnostic strategies in jaundice.

Diagnostic strategies applied in 144 consecutive patients with jaundice were investigated. Diagnostic hypotheses formed on the basis of initial data--history, physical findings, and results of routine laboratory tests--enabled the clinician to adopt a single-target strategy in 75 patients and a multi-target strategy in 61 patients. Four patients died very early in the course of events and another four were excluded from analysis because they were judged not to benefit from further investigations. The single-target strategy, in which the clinician explored one diagnostic hypothesis only, often led to a short diagnostic process (mean, 11 days), and in 89% of the patients the clinician's hypothesis was correct. In the multi-target strategy several diagnostic hypotheses were evaluated. In these patients the correct diagnosis was included in the first set of hypotheses in 84%, and the mean duration of the diagnostic process was 25 days. Patients with cholestatic jaundice presented the most difficult diagnostic problem, and most of these were investigated by a multi-target strategy. The possibility of an extrahepatic obstruction often forced the clinician to use invasive procedures to rule out this diagnosis. Considerable time was spent in observing the clinical course and waiting for investigations to be carried out. To reduce the investigative cost, controlled studies of diagnostic value and optimal order of investigations are warranted.

Adult↗
PubMed1983

Decision theory as an aid in the diagnosis of cholestatic jaundice.

Current literature was reviewed for studies on diagnostic value and risk to the patient of different diagnostic techniques in jaundice. It was found that few studies of diagnostic techniques were in fact prospective trials and that many materials were highly selected. Reported figures were used for calculating expected risks and benefits of different investigative strategies. Decision analysis, here applied to a problem not as yet studied with this technique, enable us to compare the outcomes of different strategies and to construct a simple plan for the rational choice of investigative procedures in patients with cholestatic jaundice. According to this plan, following history-taking, physical examination and simple laboratory tests, the investigation should proceed directly with fine-needle PTC whenever the probability of extrahepatic cholestasis is judged to be greater than 87%, and with liver biopsy if this probability is judged to be lower than 2%. In all other cases further investigations should start with ultrasonography.

Cholestasis↗
PubMed1981

Inter-observer variation of symptoms and signs in jaundice.

Five observers each examined 20 jaundiced patients, recording clinical signs and symptoms on a form which also gave the definitions used for the study. The balanced design of the study allowed examination for order effects, but none were found, except for a tendency for agreement on indicants with more than two categories to improve as the study progressed. Chance agreement was corrected by the use of kappa statistics which showed that 80% of the indicants showed agreement significantly greater than expected by chance. Certain indicants (dark urine, variability of jaundice, abdominal pain, character of liver edge and presence of spleen) showed no evidence of significant agreement, even though the indicants were frequently observed in both states - present or absent. The percentage of correct clinical diagnoses reached by the observers (without biochemical or any other information) varied between 65% and 84%. The consensus diagnosis was correct in 80% of cases. Agreement was higher if the diagnosis was simplified to a 'Medical' or 'Surgical' diagnosis, the observers' accuracy being between 90 and 100%.

Adult↗
PubMed1979

Prediction of survival in patients with acute myocardial infarction. A clinical study on 100 consecutive patients.

Expected survival after acute myocardial infarction (AMI) in 100 consecutive patients was predicted by three doctors and two nurses at the time of discharge from a CCU. Predictions were compared with various coronary prognostic indices (CPI) and were found to be too optimistic for the first 9 months. Experienced physicians made more reliable predictions than junior physicians and nurses. All patients with a predicted survival of more than 10 years were alive after 1 year and all with predicted death within one month died during the first year. Intermediate predictions were unreliable with reference to the one-year survival. Regardless of which CPI was used, a low index score carried a very low one-year mortality and high index a high mortality. Intermediate index scores were unreliable. A comparison between the predictions and index scores showed that there was no difference in sensitivity and specificity between the methods. Our study thus shows that patients with either a very good or a very poor prognosis will be identified regardless of the method used. The problem of identifying the individual with an intermediate risk remains to be solved.

Acute Disease↗
PubMed1979

Enzyme-linked immunosorbent assay for immunological diagnosis of human tularemia.

The enzyme-linked immunosorbent assay (ELISA) was applied for immunological diagnosis of human tularemia, using lipopolysaccharide from Francisella tularensis as antigen. Sera collected from patients, healthy individuals, and vaccinated volunteers were investigated for antibodies against F. tularensis by ELISA and tube agglutination. In ELISA all sera were titrated with a polyspecific anti-immunoglobulin enzyme conjugate. A limited number of consecutive sera from individual patients were also investigated for immunoglobulin G (IgG) and IgM antibodies by means of immunoglobulin class-specific conjugates. On an average ELISA was more than 10-fold as sensitive as tube agglutination. Two weeks after onset of disease, sera from patients had significantly higher titers in ELISA than sera from healthy controls. High titers persisted after more than 2 years. Significant amounts of both IgG and IgM antibodies were present within 1 to 2 weeks after infection. The antibody activity increased during the first month, without any significant change of the relation between IgG and IgM titers. After 2.5 years the IgG/IgM titer ratio of sera from patients was significantly increased. Within 6 weeks after vaccination sera from about half of the vaccinees had significantly elevated titers in ELISA. Titers observed after vaccination were generally lower than those found after infection. An elevated ELISA titer can be of diagnostic importance by the end of the first week of illness. A significant increase of titer in consecutive serum samples indicates a diagnosis of tularemia. Determination of IgG and IgM antibodies may be of value in determing whether a positive titer of a single serum sample is of longstanding or recent origin.

Agglutination Tests↗
PubMed1975

Therapeutic effect of Leo 1031, an alkylating corticosteroid ester; in lymphoproliferative disorders. II. Lymphocytic lymphoma.

Leo 1031, a chlorambucil ester of prednisolone, has been administered to 20 patients with generalized lymphocytic lymphoma (LL) fo various histologic types. The average daily dose was 40 mg orally; the treatment was given continuously for 1-17 months (mean 7). Complete remission was obtained in five patients and partial remission in ten. The best results were obtained in patients with a nodular type of LL. Significant leucopenia was induced in two patients; no thrombocytopenia has occurred in any patient. In two patients a cushingoid habitus developed after 8 and 4 months, respectively. Leo 1031 may be of value as the single drug in the treatment of some types of LL. A combination therapy will Leo 1031 and vincristine has been tried in 5 of these patients; in 2 as initial therapy and in 3 later in association with relapse. Further trials to assess the value of Leo 1031 as part of a combination schedule are desirable.

Adult↗
PubMedDate not supplied

Minor role of hepatitis B virus in the causation of chronic liver disease in Somalia indicated by a case-control study.

Chronic liver disease (CLD) is frequent in Somalia. In a case-control study, 116 in-patients with CLD were compared with the same number of age and sex matched controls. Demographic variables, use of drugs, symptoms and signs, serological markers for hepatitis B virus (HBV) and serum alpha-foetoprotein (AFP) were assessed. Hepatitis B surface antigen (HBsAg) was found in 44 cases of which 17 had antibodies to hepatitis D virus (anti-HD) and 7 had hepatitis B e antigen (HBeAg). Twenty-three controls were HBsAg-positive, of whom 3 had anti-HD and one HBeAg. Increased relative risks (95% confidence intervals in parentheses) were 2.5 (1.3-4.5) for HBsAg, 6.5 (1.7-21.5) for anti-HD, and 7.4 (0.9-66.5) for HBeAg. Despite the association between the presence of HBV markers and CLD, 62% of the cases had no markers indicating current HBV infection. This was reflected in the low risk attributable to chronic HBV infection (22.6%), which was lower than that in patients with CLD in other African populations with a high HBsAg carrier rate. The prevalence of HBV markers did not differ between cases with AFP greater than 100 ng/ml and those with AFP less than 100 ng/ml. The former were characterized by male predominance, shorter duration of symptoms, and larger mean liver size, indicative of malignancy. The mean age of HBsAg-positive cases with AFP greater than 100 ng/ml was significantly lower (by 7.7 years) than that of HBsAg-negative cases with AFP greater than 100 ng/ml. Among the CLD patients with AFP less than 100 ng/ml, 48 were HBsAg-negative. These cases differed significantly from the other 68 cases in that more were females (35% against 16%), more originated from an agricultural area (56% against 30%), and more were regular consumers of drugs (48% against 28%). In conclusion, factors as yet undefined play a considerable role in the causation of CLD in Somalia. The possibility of determining the role of hepatitis C virus (HCV) awaits the development of more specific assays for anti-HCV antibodies.

Adolescent↗
PubMedDate not supplied

Serum levels of cholesterol and ischemic heart disease mortality. The Värmland Study.

The objective of the Värmland Study was to examine how serum cholesterol can be used to predict short- and long-term ischemic heart disease (IHD) mortality, especially in women aged 65 or older. This prospective cohort study involved about 20 years of follow-up after a single determination of serum cholesterol and included participants in a health screening undertaken from 1962 to 1965 (48,076 men, 48,732 women). The main outcome measures were mortality from IHD, acute myocardial infarction (MI), and chronic ischemic heart disease (CIHD). An IHD mortality trend was associated with increasing cholesterol levels for people younger than 65 years, and was more pronounced for men than women. For people 65 years or older, there was a weak trend for men, but not even a tendency for women. Regarding acute MI, significant trends were observed for males as well as females, for young as well as old people. A mild CIHD mortality trend was observed for young men. Otherwise no significant trend was seen.

Adult↗
PubMedDate not supplied

Development of an in vivo tumor-mimic model for learning radiofrequency ablation.

Radiofrequency ablation requires accurate probe placement using ultrasound guidance. The purpose of this study was to develop an in vivo tumor-mimic model for learning open and laparoscopic radiofrequency ablation. Tumor-mimics were created in ex vivo porcine livers by injecting a mixture of 3% agarose, 3% cellulose, 7% glycerol, and 0.05% methylene blue, which formed 1 cm hyperechoic, discrete lesions on ultrasound. Open and laparoscopic (using a box-trainer) ablation techniques were practiced. In vivo experiments were then conducted in 10 pigs. Three tumor-mimics were created in each animal using a laparoscopic approach. Lesions were characterized sonographically, ablated using an open (n = 5) or laparoscopic (n = 5) approach, and examined pathologically. An ablation in normal liver tissue was performed as a control. Tissue impedance was recorded. Target creation took 81 minutes per animal and 96% of injections were successful. Tissue impedance (48.8 +/- 5.8 vs. 49.6 +/- 5.4) and ablation size (25.1 +/- 3.4 vs. 24.3 +/- 5.1) were not significantly different for controls (n = 8) and tumor-mimics (n = 26), respectively. One animal died of a pulmonary embolism following injection of agarose into a hepatic vein. The agarose-based tissue-mimic creates realistic sonographic targets for learning ultrasound-guided open and laparoscopic radiofrequency ablation in an in vivo model.

Animals↗
PubMedDate not supplied

Fas deficiency exacerbates cerulein-induced pancreatitis.

Acute pancreatitis results in many deaths each year. Our understanding of pathophysiology is limited. To better understand the impact of apoptosis versus necrosis, we compared cerulein-induced pancreatitis in Fas-deficient (MRL lpr/lpr) versus Fas-sufficient (MRL +/+) mice. Average amylase values in Fas-deficient mice were substantially greater than in Fas-sufficient mouse. Histology graded on edema, inflammation, vacuolization, and necrosis showed greater injury in the Fas-deficient mouse. This finding suggests that the Fas pathway is important in controlling cerulein-induced pancreatitis.

Acute Disease↗