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Biomedical subjects

L Janzon

Publications and source records attributed to L Janzon.

At least 109 records · Page 6Linked to original sources
PubMed1996

Rising incidence of pancreatic carcinoma in middle-aged and older women-time trends 1961-90 in the city of Malmö, Sweden.

The city of Malmö (population 230 000), situated in the south of Sweden, is in an area which has the highest incidence of pancreatic cancer in the country. The present study was designed to assess time trends of the incidence of pancreatic cancer 1961-90. The 1314 incident cases, 651 men and 663 women, were retrieved from the Regional Tumour Register and the National Cause-of-Death Register. In 75% of cases diagnosis was based on autopsy. Twenty per cent of the these cases were first found at autopsy, being undiagnosed. The average age-standardised incidence was 20.4 per 10(5) person-years for men and 13.7 for women. The incidence was higher for men than for women in all age groups above 44 years. No change in incidence over time was observed for men. In older and middle-aged women there was however a statistically significant increase. The average relative change in women above age 64 was 1.7% per year after age adjustment and in women aged 55-64 years 2.6% per year. We have found no results indicating that this increasing incidence could be caused by detection bias as a result of changing autopsy rates during the study period and hence conclude that the observed increase is explained by a growing number of women being exposed to factors with a potential tumour-promoting or -initiating effect.

Adult↗
PubMed1996

Prevalence of diabetic retinopathy in relation to age at onset of the diabetes, treatment, duration and glycemic control.

To study the frequency of diabetic retinopathy in relation to age at diagnosis, treatment, duration of diabetes and glycemic control as measured by means of HbA1c levels, we performed a cross-sectional, registered-based study in the Helsingborg area of southern Sweden, comprising 2232 diabetic patients. Of the known diabetic population < 75 years old, approximately 70% were estimated to be included. We graded retinopathy according to the alternative classification of the Wisconsin study. With an age at diagnosis < 30 years (19% of patients) the prevalence of retinopathy was 64%, whereas with an age at diagnosis > or = 30 years the prevalence of retinopathy was 57% in insulin-treated, and 26% in non-insulin treated patients. Levels of glycated hemoglobin and duration of diabetes were associated with retinopathy in the group with younger onset. In the older-onset group, there was a relationship between retinopathy and duration of diabetes and insulin treatment; glycated hemoglobin had a relationship which was of borderline significance with any retinopathy, but clearly significant with the pooled group: severe non-proliferative, proliferative retinopathy and/or macular edema. Hyperglycemia and duration of diabetes were thus associated with retinopathy in both younger- and older-onset diabetes, but hyperglycemia less so in the older-onset group.

Adult↗
PubMed1996

Incidence of blindness and visual impairment in diabetic patients participating in an ophthalmological control and screening programme.

We studied the incidence of blindness and visual impairment in patients who were enrolled in a photographic control- and screening program for diabetic retinopathy. The study cohort consisted of 2133 patients examined between January 1990 and December 1992 and followed until October 1st 1995. The occurrence of blindness (visual acuity < or = 0.1) and moderate visual impairment (visual acuity 0.2-0.4) was assessed. The Wisconsin scale was used to grade retinopathy. The mean HbA1c value for the last 8 years was used to represent long-term glycaemic control. Average follow-up time was 2.9 years. Seven patients were blind and 24 had visual impairment caused by retinopathy at the entry of the study. Six patients went blind due to retinopathy during the study period, corresponding to an incidence of 1.0 per 1000 person-years (95% confidence interval 0.4-2.1), and 28 became visually impaired, corresponding to an incidence of 4.6 per 1000 person-years (95% confidence interval 3.0-6.6). Multivariate analysis showed a statistically significant association between blindness/visual impairment and old age, long duration of diabetes, and poor glycaemic control. HbA1c values in the highest quartile, i.e. > or = 8.5%, were associated with a 65% increase in risk of blindness/visual impairment (95% confidence interval 14-130%). Retinopathy was the major cause of blindness and visual impairment in patients with diabetes. The study revealed a low incidence of blindness, which is in line with recent reports. Control of hyperglycaemia may be of value for the prevention of visual loss.

Adolescent↗
PubMed1996

Diabetic retinopathy before and after cataract surgery.

AIMS/BACKGROUND: Increased retinopathy progression has been reported after cataract surgery in patients with diabetes mellitus. To assess the influence of cataract surgery on visual acuity and retinopathy progression, all diabetic patients who were subjected to cataract surgery during 1991-3 have been followed up at the Department of Ophthalmology in Helsingborg. The average follow up time was 2 years. METHODS: One eye of each of 70 patients was included in the study, 35 monocularly and 35 binocularly operated on. Sixteen of the 70 patients had proliferative diabetic retinopathy (PDR) at baseline. The Wisconsin scale was used for the grading of retinopathy. The degree of glycaemic control was assessed by measurements of HbA1c. RESULTS: Most patients obtained improved visual acuity; a postoperative visual acuity of 0.5 or better was achieved in 89% of diabetic surgical eyes. Progression of the retinopathy occurred in 30 out of the 70 eyes, and was associated with mean level of HbA1c (p = 0.04), duration of diabetes (p = 0.02), insulin treatment (p = 0.001), and presence of retinopathy at baseline (p = 0.01). Patients who progressed had a significantly higher incidence of macular oedema (p = 0.006) than those who did not progress. No significant differences were found when operated and non-operated eyes were compared in the 35 patients with monocular surgery. Two patients in this group, however, ended up with macular oedema and worse vision in the operated eye than in the eye which was not operated on. Both patients had background retinopathy before surgery. CONCLUSIONS: Patients in this study, also those with PDR, obtained good visual acuity, better than in most previous studies. Poor glycaemic control was a factor of importance for the progression of diabetic retinopathy after cataract surgery.

Aged↗
PubMed1996

Alcohol consumption modifies the total lung capacity in smokers.

Smoking-related airflow obstruction can develop with or without emphysema. Moderate alcohol consumption has been suggested to diminish the risk of centrilobular emphysema caused by smoking. Our aim was to study the influence of total energy and nutrient (protein, fat, carbohydrate and alcohol) intake on smoking-related emphysema. Lung function and nutrient intake including alcohol consumption were recorded at age of 68 years in 478 men as part of the population study 'Men Born in 1914' in Malmö, Sweden. In nonsmokers (n = 88) and ex-smokers (n = 223), there were no significant relationships between energy and nutrient intake and lung function. In smokers (n = 167), men in the highest and lowest quintile of total lung capacity (TLC) differed in alcohol intake (p = 0.004) but not in intake of total energy or other nutrients. In smokers with a forced expiratory volume in 1 s/vital capacity ratio of below 70% (n = 81), alcohol intake was positively correlated with TLC (r = 0.31; p = 0.006) after adjustment for smoking and body mass index. We conclude that in men with smoking-related airway obstruction, emphysema defined as large TLC was associated with high alcohol consumption but not with the intake of total energy or other nutrients.

Aged↗
PubMed1996

The STIMS trial: the ticlopidine experience and its clinical applications. Swedish Ticlopidine Multicenter Study.

The mortality in patients with intermittent claudication can be reduced by treatment with ticlopidine. This is the clinically most significant result from STIMS, the Swedish Ticlopidine Multicenter Study. During an average treatment period of 5.6 years, 153 of the 687 patients died, 26.1% in the placebo group and 18.5% in the ticlopidine group (RR0.7, p = 0.015). The incidence of fatal vascular events in the two groups was 12% and 6%. In terms of lives saved per years of treatment, STIMS showed that by treating 200 claudicants for 5 years one can save 13 from a cardiovascular death, not merely dying from something else as treatment was associated with a reduced total mortality as well. The interpretation of the on-treatment analysis is that for those who tolerate the drug the combined vascular morbidity and mortality rate is lowered from 24% to 14%. The disadvantage is that many patients do not tolerate ticlopidine. In STIMS, 22% (2.5 times as many as in the control group) had to stop medication because of gastrointestinal side-effects. Although ticlopidine is associated with an increased risk of leukopenia, the risk in absolute numbers is small: according to STIMS, 4% during 5.6 years. All events were reversible. The 1.4% incidence of thrombocytopenia did not seem to be associated with ticlopidine treatment.

Cerebrovascular Disorders↗
PubMed1996

Operations in unselected patients with ulcerative colitis and indeterminate colitis. A long-term follow-up study.

OBJECTIVE: To assess the need for operative treatment for ulcerative colitis and indeterminate colitis. DESIGN: Retrospective study. SETTING: University Hospital, Sweden. SUBJECT: All patients diagnosed from 1958 to 1982, in Malmö, Sweden-ulcerative colitis (n = 471) and indeterminate colitis (n = 100). MAIN OUTCOME MEASURES: Incidence of colectomy. RESULTS: The mean follow-up was 15 years. The incidence of colectomy was 7.51, 1.90 and 36.13/1000 person years for definite ulcerative colitis, probable ulcerative colitis and indeterminate colitis, respectively. The incidence of colectomy in patients with definite ulcerative colitis in the present study was low compared with other studies. In contrast to other reports, men had a threefold risk while extent of inflammation did not influence the incidence. Patients with indeterminate colitis were a high risk group with a high incidence of colectomy. The high incidence among patients with indeterminate colitis compared with that in patients with definite ulcerative colitis was also seen in subgroups such as patients with total colitis at diagnosis, in patients in remission after the first attack, and in patients with a severe attack. CONCLUSION: As patients with indeterminate colitis seem to be at increased risk of colectomy it could be important to distinguish them from those with ulcerative colitis. Today, however, it is not possible to identify all patients with indeterminate colitis early in the course of the disease.

Adolescent↗
PubMed1996

The prevalence of anaemia and mineral supplement use in a Swedish middle-aged population. Results from the Malmö Diet and Cancer Study.

OBJECTIVE: To describe dietary habits and use of mineral supplements in relation to nutrient recommendations and anaemia. DESIGN: a population-based cohort study. SUBJECTS: 2665 men and 3878 women, born between 1926 and 1945, randomly invited and participating in the prospective 'Malmö Diet and Cancer study' during 1991-1992. METHODS: The diet was assessed using a combined 7-day menu book for hot meals, beverages and supplements and a quantitative food frequency questionnaire for other foods. Anaemia was defined as haemoglobin < or = 131 g/l for men and < or = 115 g/l for women. RESULTS: Intake of mineral supplements were reported by 19% of the men and 31% of the women. Less than 0.2% had intakes of iron and selenium above highest recommended Swedish long-term intakes. The percentage of women with intake below nutrient recommendations were: zinc and selenium (60%); magnesium (35%); calcium (21%) and iron (70%, premenopausal). The corresponding values for men were: zinc, selenium and magnesium (33-47%); calcium and iron (5%). The median contribution of calcium from supplements was less than 110 mg. Supplement users had higher intakes of fish, fruits, vegetables and tea and lower intakes of coffee and meat. The iron intake was correlated to haemoglobin levels, and iron supplementation constituted about 45% of the intake. Three per cent of premenopausal women had anaemia as did less than 2% of postmenopausal women. CONCLUSION: A substantial number had mineral intake below present recommendations despite supplement use. The nutrient content of some supplements could be improved, especially calcium. Iron supplementation among postmenopausal women and men are questionable.

Aged↗
PubMed1996

Asthma but not smoking-related airflow limitation is associated with a high fat diet in men: results from the population study "Men born in 1914", Malmö, Sweden.

The purpose of this study was to investigate whether there is an association between asthma and the intake of food with pro-oxidant or antioxidant activity (fat, alcohol, iron, zinc, and vitamins A and C), and to analyse whether any such association is specific to asthma or is found in airflow limitation in general. This study deals with 478 men, who were randomly selected from all the men born in Malmö in 1914. They were investigated using spirometry and their medical, occupational and dietary history was recorded in 1982-1983, at the age of 68 yrs, as part of the cohort study "Men born in 1914". Asthma was defined as a past or present physician's or nurse's diagnosis of asthma and airflow limitation was defined as a forced expiratory volume in one second/vital capacity ratio (FEV1/VC) of less than 70%. The relative risk of having asthma or airflow limitation as related to dietary intake at the age of 68 yrs was analysed after adjustments for smoking history and body mass index. Asthma was reported in 21 men and was not related to smoking history. Asthma was more common in men with a high fat intake (relative risk of asthma 1.74 for a 10% increase in fat intake, 95% confidence interval for the relative risk 1.13-2.68). The consumption of alcohol was higher for current smokers than ex-smokers and nonsmokers, and the intake of carbohydrates, vitamin C and iron was lower. Airflow limitation without asthma was present in 156 men and was related to smoking but not to dietary intake. Men with asthma had a significantly higher intake of fat than men without asthma. This difference appeared to be specific to asthma and was not found in airflow limitation in general.

Aged↗
PubMed1996

Risk of pancreatic carcinoma in smokers enhanced by weight gain. Results from 10-year follow-up of the Malmö preventive Project Cohort Study.

CONCLUSION: The increased risk of pancreatic carcinoma in smokers is enhanced by weight gain. Possible explanations are proposed and discussed. BACKGROUND: Between 1974 and 1992, 35,000 men and women below 55 yr of age participated in a general health examination at the Department of Preventive Medicine in Malmö, Sweden. Mortality and incidence of cancer have been updated by record linkage with the Cause of Death Register and the National Cancer Register. METHODS: The present study deals with the incidence of pancreatic carcinoma during 365,500 person years of follow-up. The 43 cases corresponded to an incidence per 100,000 person years of 13.4 in men and 6.1 in women. RESULTS: Nonsmokers, exsmokers, and smokers had an incidence of 1.5, 24.5, and 15.3/100,000 person years, respectively. The case-control approach used to assess risk factors for pancreatic carcinoma showed that the odds for smoking (odds ratio [O.R] 8.6; 95% confidence intervals [C.I.] 2.0-37.5), for weight gain more than 10 kg since the age of 30 (O.R. 1.8; 95% C.I. 0.9-3.6), and for epigastric pain (O.R. 3.2; 95% C.I. 1.4-7.2) were higher in cases than in controls. These odds ratios were all statistically significant in the logistic regression analysis.

Adult↗
PubMed1996

Biased risk factor assessment in prospective studies of peripheral arterial disease due to change in exposure and selective mortality of high-risk individuals.

BACKGROUND: Our aim was to assess whether risk factor assessment in prospective studies of peripheral disease (PAD) might be biased by change in exposure and selective mortality of individuals at high risk. METHODS: The cohort 'Men born in 1914' has been followed since the baseline examination 1969. PAD, (i.e. ankle-brachial pressure index < 0.9) at the age of 68 was related to risk factors measured at the age of 55 and 68. RESULTS: Hypertension was present in 64% of the men. Of these, 62% were normotensive at 55. Men with hypertension at the age of 55 had lower odds for PAD (odds ratio 1.9; 95% CI 0.8-4.5) than men who were normotensive at 55 (odds ratio 3.0. 95% CI 1.5-6.1). One-third remained smokers at 68; 27% were ex-smokers. The odds for PAD was 3.0 times higher (95% CI 1.4-6.3) in ex-smokers and 2.6 times higher (95% CI 1.3-5.4) in current smokers than in non-smokers. Less than half remained in the same cholesterol quartile. The odds for PAD was 1.5 (95% CI 0.8-2.8) in men with hypercholesterolaemia at 68 and 2.2 (95% CI 1.1-4.7) in men with hypercholesterolemia at both examinations. Smoking and hypertension at the age of 55 were both associated with an increased mortality rate: 26% Of the smokers and 31% of the men with hypertension died before the age of 68. CONCLUSION: Risk factor assessment in prospective studies of PAD is affected by change in exposure and selective mortality of individuals at high risk.

Aged↗
PubMed1995

Ten year cerebrovascular morbidity and mortality in 68 year old men with asymptomatic carotid stenosis.

OBJECTIVE: To study the natural course of carotid artery stenosis detected by ultrasonography. DESIGN: Prospective cohort study. Baseline examination in 1982-3 included ultrasound examination of carotid arteries, measurement of ankle-brachial blood pressure index, and detection of atrial fibrillation by 24 hour ambulatory electrocardiography. SETTING: Malmö, a city in southern Sweden with 230,000 inhabitants. SUBJECTS: 470 men aged 68 years randomly selected from the population. MAIN OUTCOME MEASURES: Incidence of stroke and transient ischaemic attack and all cause mortality during 10 years of follow up in relation to carotid stenosis, leg artery disease (ankle-brachial blood pressure index below 0.9), and atrial fibrillation. RESULTS: Fifty men had a stroke; six of these were haemorrhagic. Another 11 had a transient ischaemic attack. Eighteen of the men with carotid stenosis (21.6 events/1000 person years) and 43 of the men with normal carotid arteries (14.8 events/1000 person years) had a stroke or transient ischaemic attack (P = 0.188). Men with atrial fibrillation had an increased rate of cerebrovascular events (36.7/1000 person years (P = 0.048). The highest rate was found in men with asymptomatic disease of the leg arteries (38.6/1000 person years) (P < 0.001). The increased risk of stroke or transient ischaemic attack in this group remained after multivariate analysis (relative risk 2.0; 95% confidence interval 1.1 to 3.7). CONCLUSIONS: In this cohort carotid stenosis was not associated with an increased risk of stroke. Part of this lack of association was explained by the high mortality from ischaemic heart disease in men with severe stenosis. Twenty seven of the 61 cerebrovascular events, however, occurred in men who had normal carotid arteries, normal ankle pressure, and no atrial fibrillation.

Aged↗
PubMed1995

Incidence of colorectal cancer and all cause mortality in non-selected patients with ulcerative colitis and indeterminate colitis in Malmö, Sweden.

Cancer morbidity and all cause mortality were studied prospectively in all patients with definite and probable ulcerative colitis and indeterminate colitis diagnosed from 1958 to 1982, in the city of Malmö, Sweden. The follow-up to Jan. 1, 1990 was complete for all but ten patients. Nine of the 471 patients with ulcerative colitis and three of the 100 patients with indeterminate colitis developed colo-rectal cancer. The incidence of colorectal cancer in ulcerative colitis was 1.4 per 1000 person-years. The observed number of cases was 2.1 times higher than expected; (95% C.I. 1.0-4.1), based on the age- and sex-specific cancer incidence in the city during the study period. Indeterminate colitis was associated with a higher colorectal cancer risk than ulcerative colitis; 2.4 per 1000 person-years; (SMR 8.6, 95% C.I. 1.8-25.1). Both conditions were associated with a slight increased mortality rate, for ulcerative colitis 12.6 per 1000 person-years; (SMR 1.3, 95% C.I. 1.0-1.5), and for indeterminate colitis 11.7 per 1000 person-years; (SMR 2.7, 95% C.I. 1.6-4.4). Complications of colitis were the main cause of death in both groups. The cancer risk was related to extent of disease, duration of disease and female gender. Ten out of the 12 cases with cancer had or developed total colitis. However, only seven of the 134 cases with total ulcerative colitis and two of 87 cases with total indeterminate colitis developed cancer.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1995

Plethysmographic pulse wave amplitude and future leg arteriosclerosis.

A low pulse wave amplitude during calf plethysmography at 55 years of age was previously found to be associated with an increased mortality and incidence of myocardial infarction. In order to test the hypothesis that a low pulse wave amplitude is associated with an increased risk of future leg atherosclerosis as well, we have studied the relationship between a low ankle-brachial pressure index (ABPI; < 0.9) at 68 years of age and the pulse wave amplitude at 55 years of age in that same cohort. The prevalence of a low pulse wave amplitude (< or = 5 mm; lowest quintile) among men with a low ABPI (42%) was more than twice as high as it was among men who had a normal ABPI (19%) (P < 0.001). No association was found between a low ABPI and the plethysmographically recorded leg blood flow at 55 years of age. A low pulse wave amplitude might reflect early symptom-free arteriosclerosis, or age-dependent non-arteriosclerotic loss of vessel wall elasticity. The relationship between a low pulse wave amplitude and a low ABPI remained when controlling for smoking, hypertension and hyperlipidaemia. It is concluded that pulse wave measurement by plethysmography contributes information to improve leg atherosclerotic risk assessment in individuals exposed to known risk factors.

Aged↗
PubMed1995

The putative neuraminyllactose-binding hemagglutinin HpaA of Helicobacter pylori CCUG 17874 is a lipoprotein.

The ability of certain strains of Helicobacter pylori to cause sialic acid-sensitive agglutination of erythrocytes has been attributed to the HpaA protein (D.G. Evans, T.K. Karjalainen, D. J. Evans, Jr., D. Y. Graham, and C.H. Lee, J. Bacteriol. 175:674-683, 1993), the gene for which has been cloned and sequenced. On the basis of the hydropathy plot of HpaA and the presence of a potential lipoprotein signal sequence and modification site, and because of the similarities of these features with those of the cell envelope lipoprotein Lpp20 of H. pylori, we examined the possibility that HpaA was also a lipoprotein. Posttranslational processing of the HpaA protein expressed by the cloned gene was sensitive to globomycin, an inhibitor of the lipoprotein-specific signal peptidase II. Antibodies raised to the putative sialic acid-binding region of HpaA failed to bind to the surface of H. pylori cells in immunoelectron microscopy but instead were observed to have labeled the cytoplasm when thin sections were examined. This antibody recognized a 29,000-M(r) protein in Western blots (immunoblots) of cell extracts of H. pylori and Escherichia coli cells expressing the cloned hpaA gene. Determination of the sequence of hpaA from strain CCUG 17874 indicated significant differences from that determined by Evans and coworkers in the above-mentioned study, including extension of the gene into the open reading frame 3 downstream of hpaA to produce a protein with an M(r) of 26,414. Localization of HpaA indicated that it was predominantly located in the cytoplasmic fraction of the cell in both E. coli and H. pylori. HpaA was not observed in the sarkosyl-insoluble outer membrane fraction. An isogenic mutant generated by insertional inactivation of hpaA was unaffected in its ability to bind four different human cell lines as well as fixed sections of gastric tissue and had hemagglutination properties identical to those of the wild type. The data collectively suggest that HpaA is a nonessential lipoprotein internal to the H. pylori cell and that it is not involved in adhesion.

Adhesins, Bacterial↗
PubMed1995

Progression of retinopathy after change of treatment from oral antihyperglycemic agents to insulin in patients with NIDDM.

OBJECTIVE: In insulin-dependent diabetes mellitus, institution of good glycemic control has been shown to retard development of retinopathy even though temporary progression has occurred. Few data have been available from patients with non-insulin-dependent diabetes mellitus (NIDDM). To determine the impact of improved glycemic control on retinopathy in patients with NIDDM, we examined, in a case-control study, the progression of retinopathy in 94 patients who changed treatment from oral antihyperglycemic agents to insulin. RESEARCH DESIGN AND METHODS: We used the Wisconsin retinopathy scale and related progression of retinopathy during a 2-year observation period to changes in HbA1c after institution of insulin therapy. RESULTS: Progression of retinopathy > or = 3 levels occurred in 23% of the patients and was significantly more common in the patient group in which HbA1c was lowered > or = 3% compared with progression in the group in which HbA1c was lowered < 3% (P = 0.0001; relative risk 3.2; 95% confidence interval 1.5-6.9). CONCLUSIONS: Improved glycemic control as achieved by insulin therapy may be associated with worsening of retinopathy in patients with NIDDM.

Age of Onset↗
PubMed1995

Ulcerative colitis and indeterminate colitis in the city of Malmö, Sweden. A 25-year incidence study.

BACKGROUND: This study was designed to assess time trends in the incidence of ulcerative colitis and indeterminate colitis in an urban population. METHODS: Medical records of in- and out-patients with inflammatory bowel disease were reviewed by a panel to establish the diagnosis. All histopathologic specimens and almost all radiographs were re-examined. RESULTS: During the time period 1958 to 1982 there were 354 new cases of definite ulcerative colitis, 117 of probable ulcerative colitis, and 100 of indeterminate colitis. This corresponds to an average annual incidence per 100,000 of 5.5, 1.8, and 1.6, respectively. The incidence was higher in men than in women. Peak incidence was between 20 and 29 years, but indeterminate colitis was most common in 10- to 19-year-old males. The incidence was stable from 1958 to 1972 but then increased in almost all age groups in both sexes. The increase in annual incidence of definite ulcerative colitis from 4.2 to 9.4/10(5) corresponds to an average annual increase of about 5% (p < 0.001). The increase in the incidence of definite ulcerative colitis was due to an increased proportion of patients with proctitis. CONCLUSIONS: This study has shown an increased incidence of ulcerative colitis and indeterminate colitis, and we have found no reason to believe that this is a spurious finding.

Adolescent↗