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Biomedical subjects

S Berg

Publications and source records attributed to S Berg.

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

Phase I/II study of 72-hour infusional paclitaxel and doxorubicin with granulocyte colony-stimulating factor in patients with metastatic breast cancer.

PURPOSE: We conducted a phase I/II trial of concurrently administered 72-hour infusional paclitaxel and doxorubicin in combination with granulocyte colony-stimulating factor (G-CSF) in patients with previously untreated metastatic breast cancer and bidimensionally measurable disease. PATIENTS AND METHODS: We defined the maximum-tolerated dose (MTD) of concurrent paclitaxel and doxorubicin administration and then studied potential pharmacokinetic interactions between the two drugs. Forty-two patients who had not received prior chemotherapy for metastatic breast cancer received 296 total cycles of paclitaxel and doxorubicin with G-CSF. RESULTS: The MTD was determined to be paclitaxel 180 mg/m2 and doxorubicin 60 mg/m2 each by 72-hour infusion with G-CSF. Diarrhea was the dose-limiting toxicity (DLT) of this combination, with three of three patients developing abdominal computed tomographic (CT) scan evidence of typhlitis (cecal thickening) at the dose level above the MTD. All patients developed grade 4 neutropenia (absolute neutrophil count [ANC] < 500 microL), generally less than 5 days in duration. This combination was generally safely administered at dose levels at or below the MTD. The overall response rate was 72% (28 of 39 patients; 95% confidence interval [CI], 55% to 85%), with 8% complete responses (CRs) (three of 39; 95% CI, 2% to 21%) and a median response duration of 9 months. The median overall survival time for all patients is 23 months, with a median follow-up duration of 28 months. Pharmacokinetic studies showed that administration of paclitaxel and doxorubicin together by 72-hour infusion did not affect the steady-state concentrations of either drug. CONCLUSION: Concurrent 72-hour infusional paclitaxel and doxorubicin can be administered safely, but is associated with significant toxicity. The overall response rate of this combination in untreated metastatic breast cancer patients is similar to that achieved with other doxorubicin-based combination regimens. The modest complete response rate achieved suggests that this schedule of paclitaxel and doxorubicin administration does not produce significant additive or synergistic cytotoxicity against breast cancer.

Adult↗
PubMed1996

Finasteride therapy does not alter bone turnover in men with benign prostatic hyperplasia--a Clinical Research Center study.

Benign prostatic hyperplasia is often treated with finasteride, which inhibits the conversion of testosterone to dihydrotestosterone (DHT). Aside from the prostate, other androgen-dependent tissues seem to be unaffected by selective DHT deficiency, but the effect on bone density in humans has not yet been defined. To study this question, we compared indices of bone turnover and bone mineral density in 35 men treated with finasteride with controls. Bone resorption was assessed by measuring urinary excretion of N-telopeptide cross-links of type I collagen and hydroxyproline, and bone formation was assessed by measuring serum osteoncalcin and bone-specific alkaline phosphatase. Bone density of the spine and hip were assessed by dual energy x-ray absorptiometry. We found that finasteride-treated patients had mean DHT levels 81% lower than controls (P < 0.0001). There were no significant differences between the two groups in any of the markers of bone turnover or measures of bone density. These results suggest that testosterone can maintain bone density in men even in the absence of DHT. Although long term studies are needed, our results suggest that men who take finasteride are not at increased risk for bone loss.

Aged↗
PubMed1996

Incidence and prognosis of meningitis due to Haemophilus influenzae, Streptococcus pneumoniae and Neisseria meningitidis in Sweden.

The incidence, concomitant conditions and case fatality rate of Haemophilus influenzae (Hi) and pneumococcal meningitis and of invasive meningococcal infections were studied retrospectively in Sweden (population 8.4 million) for the years 1987-89, the period before vaccination against Hi type b started. A total of 1,019 cases with culture-verified infection were found. The incidence rates per 100,000 per year were 1.8 for Hi meningitis, 1.2 for pneumococcal meningitis and 1.0 for invasive meningococcal infections. The age-specific incidence was highest in the 3-23 months age group for the 3 bacterial species. Pneumococcal meningitis was common in individuals > or = 60 years and meningococcal infections in the age-group 10-24 years. A serious concomitant condition was known in 57% of all patients with pneumococcal meningitis while this was uncommon for the other organisms. The case fatality rate was 2% for Hi meningitis, 24% for pneumococcal meningitis and 10% for meningococcal infections. All 81 pneumococcal isolates which had been serotyped belonged to serotypes in the 23-valent pneumococcal vaccine. Of the meningococcal isolates, 65% belonged to serogroup B. In conclusion, the high incidence of Hib meningitis justifies general Hib vaccination. Development of a vaccine against N. meningitidis group B should have high priority. Furthermore, improved pneumococcal vaccines are needed for patients with predisposing conditions. The currently available pneumococcal polysaccharide vaccine seems to be underused.

Adolescent↗
PubMed1996

Incidence, aetiology, and prognosis of acute epiglottitis in children and adults in Sweden.

A retrospective study of the incidence, aetiology and case fatality rate of acute epiglottitis in children and adults was performed. The study covered the whole of Sweden (population 8.4 million) during the years 1987-89, before general vaccination against Haemophilus influenzae (Hi) type b was started. Patients were included if it was documented that they fulfilled all 3 of the following criteria: (a) red and swollen epiglottis visualized by indirect laryngoscopy, (b) inspiratory stridor or difficulties in swallowing, and (c) a temperature > or = 38 degrees C. A total of 306 children and adolescents (0-19 years) and 502 adults (> or = 20 years) were found. The age-specific incidence was highest in children aged 0-4 years, (14.7/100,000 per year). The total incidence was 3.2/100,000 per year. In the age group 0-19 years, blood cultures had been obtained from 195 (64%) and Hi was isolated from 154 (79%). In adults (> or = 20 years), 114 of 298 blood cultures yielded Hi, while pneumococci were isolated from 5 and group A streptococci from 3 patients. A total of 220 children (72%) and 114 adults (23%) needed an artificial airway. Five children and 12 adults died. In conclusion, the incidence of acute epiglottis in Sweden is very high. Compared to a previous country-wide study covering the years 1981-83 that used the same methods for case finding and case definition, the incidence in children had decreased while the incidence in adults had increased.

Adolescent↗
PubMed1995

Transient endotoxemia during burn wound revision causes leukocyte beta 2 integrin up-regulation and cytokine release.

After severe burns, a wound revision is often done to remove devitalized tissue and minimize bacterial growth. After such revision, the patient may show signs of sepsis. In a group of burned patients we found a transient endotoxemia, and a subsequent leukocyte activation, monitored as increased expression of the beta 2-integrin CD11b, after such wound revision. In most patients we could detect elevated levels of plasma TNF-alpha before the operation, with no increases in these levels after the operation. Plasma levels of IL-6 were elevated in all patients and increased after the wound revision in all patients. They also had elevated plasma levels of soluble E-selectin, indicating systemic inflammation. The close relation between endotoxin levels and CD11b expression, and lack of evidence for additional production of TNF-alpha, suggests that up-regulation of the beta 2 adhesion protein during wound revision is mainly caused by endotoxin interaction with the leukocyte.

Adolescent↗
PubMed1995

Stressful life events and cognitive functioning in late life.

To determine whether any relation exists between stressful life events and cognitive decline, 275 elderly persons living independently a) underwent cognitive tests at the ages of 70 and 76 years, and b) were interviewed at age 76 as to their recent life history, focusing on stressful events during the preceding six years. Intellectual abilities were generally found to decline between 70 and 76 years of age. During this period, two-thirds of the subjects had experienced one or more life stress situations, mostly related to health or bereavement. Contrary to the assumption that there exists a relationship between life stress and cognitive decline, our results indicated that this decline occurred regardless of stressful life experiences; the only exception was the bereavement situation (losing a spouse or child), which seemed to have a marked effect on cognitive abilities, and to which men appeared to be particularly vulnerable.

Aged↗
PubMed1995

Psychomotor speed and physical activity in 75-year-old residents in three Nordic localities.

Psychomotor speed was studied in samples of 75-year-old men and women in three Nordic localities, namely Glostrup (Denmark), Gothenburg (Sweden), and Jyväskylä (Finland). Both simple and multi-choice reaction and movement time tests were applied using visual and auditory stimuli. The aim of the present report was to analyze the role of habitual physical activity and physical fitness as associates of psychomotor speed. The results indicated a higher psychomotor speed in the physically more active and, in most cases, fitter subjects in both the simple and more complex tasks, a higher speed of performance in men compared to women, and, to some extent, more favorable values in Gothenburg and Jyväskylä than in Glostrup. The overall findings suggest that habitual physical activity may enhance psychomotor speed in elderly subjects. Basic differences in activity did not, however, explain the differences in psychomotor speed observed between the localities or between the sexes.

Acoustic Stimulation↗
PubMed1995

How midwives identify women as aboriginal or Torres Strait Islanders.

At the present time no reliable information is available about how midwives actually decide to record a person as Aboriginal or Torres Strait islander on the Perinatal Morbidity Statistics form. In 1993, Koori Health in the Department of Health and Community Services asked the Perinatal Data Collection Unit to undertake a study to determine how midwives make this decision. The study was conducted in seven country and city hospitals and two universities from August to December 1993. The hospitals ranged in size from 149 to 2359 births per year. During a routine education session the midwives were invited to take part in a focus group discussing 'Aboriginality'. Fifty-four midwives were involved in the study. Most mothers were not asked if they identified as 'Aboriginal or Torres Strait Islanders'. Midwives did ask women who they thought were 'Aboriginal' by appearance. Most midwives did not ask about 'Aboriginality' because they felt uncomfortable asking. They felt uncomfortable because they felt that both Aboriginal and non-Aboriginal women would feel ill at ease when asked if they identified as Aboriginal or Torres Strait Islanders. There were many reasons for this but they included negative perceptions of Aboriginal women. Some midwives made discriminatory comments. The conclusions of the study are that midwives need to know the reasons why they are requested to ask all women if they identify as Aboriginal or Torres Strait Islanders. Major barriers are often based on poor knowledge and understanding of definitions and issues. There was strong evidence of the existence of underlying beliefs and perceptions about Aboriginal people which 'inhibit' midwives from complying with the Data Collection Unit's explicit advice on the collection of this information.

Attitude of Health Personnel↗
PubMed1995

Three-dimensional imaging of the brain cavities in human embryos.

A system for high-resolution three-dimensional imaging of small structures has been developed, based on the Vingmed CFM-800 annular array sector scanner with a 7.5-MHz transducer attached to a PC-based TomTec Echo-Scan unit. A stepper motor rotates the transducer 180 degrees and the complete three-dimensional scan consists of 132 two-dimensional images, video-grabbed and scan-converted into a regular volumetric data set by the TomTec unit. Three normal pregnancies with embryos of gestational age 7, 9 and 10 weeks received a transvaginal examination with special attention to the embryonic/fetal brain. In all three cases, it was possible to obtain high-resolution images of the brain cavities. At 7 weeks, both hemispheres and their connection to the third ventricle were delineated. The isthmus rhombencephali could be visualized. At 9 weeks, the continuous development of the brain cavities could be followed and at 11 weeks the dominating size of the hemispheres could be depicted. It is concluded that present ultrasound technology has reached a stage where structures of only a few millimeters can be imaged in vivo in three-dimensions with a quality that resembles the plaster figures used in embryonic laboratories. The method can become an important tool in future embryological research and also in the detection of early developmental disorders of the embryo.

Brain↗
PubMed1995

Causes of Medicaid expenditure growth.

Expenditures for the Medicaid program grew at the alarming and unexpected average annual rate of nearly 20 percent from 1989 ($58 billion) to 1992 ($113 billion). These statistics raise a critical question: What caused spending to grow so dramatically? Using State-level data from 1984-92, this analysis examines the determinants of Medicaid expenditure growth. The results indicate that Medicaid enrollment, Federal Medicaid policy, and State policy are significantly related to Medicaid expenditure growth. The analysis also finds the prevalence of acquired immunodeficiency syndrome (AIDS) to be significantly related to Medicaid expenditures.

Acquired Immunodeficiency Syndrome↗
PubMed1995

Continuous intrathoracic pressure monitoring with a new esophageal microchip catheter in sleep-related upper airway obstructions.

A new small-diameter microchip catheter, especially developed for continuous intrathoracic pressure monitoring to assess the degree of respiratory obstruction and effort in patients with sleep-related upper airway obstructions, was investigated. The technical performance and clinical applicability of the catheter was tested in a simplified screening study comprising 122 sleep recordings in patients with varying complaints of snoring and daytime tiredness. In six obese snorers, sensitivity of the catheter to apneas, hypopneas, and nonapneic snoring was compared to the traditional assessment of respiratory events by conventional polysomnography. The catheter was found to be easy to handle and introduce, with technical qualities meeting the demands for overnight recordings of intrathoracic pressure variations. Patient tolerance was high (93%), and sensitivity to apneas and hypopneas was equivalent to that of traditional polysomnography. Periods with upper airway obstruction and increased respiratory effort on the borderline between asymptomatic obstructions and obstructions resulting in significant blood-gas changes could be detected primarily with intrathoracic pressure monitoring. Monitoring the intrathoracic pressure variations in the esophagus has been shown previously to reflect respiratory effort. Increased respiratory effort might be one of the explanations for the fragmented sleep patterns and sleep related daytime symptoms sometimes seen in patients without a pathologic respiratory index. In addition to being applicable for the detection of apneas and hypopneas, continuous nocturnal monitoring of the intrathoracic pressure variations also detects small increases in respiratory effort and thus may constitute a valuable tool for the understanding and diagnosis of upper airway resistance syndrome and obstructive sleep apnea syndrome.

Adult↗
PubMed1995

Intrathoracic pressure variations in obese habitual snorers.

Six obese patients with complaints of snoring and daytime fatigue were monitored with polysomnography (PSG) and continuous recording of esophageal pressure (Pes) during 1 night. Nonapneic episodes in different sleep stages, with and without snoring, were selected and analysed. Peak to peak pressure was found to be significantly increased during snoring in sleep stages 2 and 3/4 with blood gas variations within the limits of normal unobstructed breathing, indicating increased respiratory effort. The present investigation supports the assumption that daytime tiredness in nonapneic patients can be linked to increased respiratory effort during sleep and that continuous esophageal pressure measuring may contribute to assessment of this condition.

Adult↗
PubMed1994

Filtration of fentanyl is not the cause of the elevation of arterial blood pressure associated with post-bypass ultrafiltration in children.

Modified ultrafiltration after cardiopulmonary bypass in children has been shown to be associated with an increase in arterial blood pressure. As part of a series of studies to investigate the possible causes of this blood pressure elevation, the hypothesis that if filtration was removing a significant amount of fentanyl, then the increase in blood pressure might be due to pain was proposed. Ten children, aged between 0.5 and 9.3 years (median 3.8 years), weighing 5.9 to 25.5 kg (median 15.7 kg), underwent corrective cardiac surgery (incorporating modified ultrafiltration). A standard anesthetic protocol was followed, with up to 78 micrograms/kg of fentanyl given prebypass for analgesia. After completion of cardiopulmonary bypass, modified ultrafiltration was commenced at 100 mL/min until a hematocrit of 35% was reached. Samples were taken of arterial blood (prefiltration, 3, 10, and 20 minutes postfiltration), the venous reservoir blood (prefiltration) and the filtrate (5 and 10 minutes into filtration). Hemodynamic data were recorded both prefiltration and postfiltration. The hemodynamic data showed the expected rise in both systemic arterial pressure and cardiac index after ultrafiltration. The plasma fentanyl concentrations did not significantly change after ultrafiltration: 1.59 to 12.39 ng/mL (median 6.27 ng/mL) prefiltration and 2.05 to 15.59 ng/mL (6.29 ng/mL) at 3 minutes, 2.22 to 12.64 ng/mL (6.87 ng/mL) at 10 minutes, and 1.83 to 11.52 ng/mL (5.85 ng/mL) at 20 minutes postfiltration.(ABSTRACT TRUNCATED AT 250 WORDS)

Analgesia↗
PubMed1994

Autocrine transforming growth factor-beta(1) activity and glycosaminoglycan synthesis by human cutaneous scar fibroblasts.

Transforming growth factor-beta(1) is a well-known and potent biological response modifier that plays an important role in tissue repair and fibrosis. Among the extracellular constituents known to accumulate in fibrotic tissues, glycosaminoglycans are prominent. In this study we examined transforming growth factor-beta(1) synthesis by human dermal fibroblasts derived from both normal and fibrotic cutaneous tissues. We studied the influence of transforming growth factor-beta(1) on glycosaminoglycan synthesis and explored the role of transforming growth factor-beta(1) as an autocrine mediator of its own expression. These investigations are directed at understanding the persistence of the fibrotic phenotype in scarred skin. Transforming growth factor-beta(1) activity was measured by means of a mink lung epithelium growth inhibitory assay. Replicate explants (n = 3) of fibroblasts each derived from normal skin, normal scar, or hypertrophic scar were studied by adding exogenous transforming growth factor-beta(1) at a concentration range of 0 to 10 ng/ml. The resulting conditioned media were removed and assayed for transforming growth factor-beta(1) activity, then the cells were pulsed for an additional 24 hours with radiolabeled glycosaminoglycan precursor, [(3)H]-glucosamine, to evaluate glycosaminoglycan production. Cell-free glycosaminoglycan synthetic profiles were also developed. Transforming growth factor-beta(1) was found to cause a dose-dependent increase in glycosaminoglycan synthesis in hypertrophic scar and normal skin but not in normal scar fibroblasts in cell-mediated glycosaminoglycan synthesis; the reverse was observed in cell-free glycosaminoglycan synthesis, where transforming growth factor-beta(1) increased glycosaminoglycan synthesis in normal scar but not in normal skin or hypertrophic scar. Most endogenous transforming growth factor-beta(1) existed in latent form for normal skin cells but in active form for normal scar and hypertrophic scar fibroblasts.

Journal Article↗
PubMed1994

Evaluating customer satisfaction with colonoscopy.

Twenty patients were interviewed shortly after colonoscopy, and the adjectives and phrases they used to describe the experience were formed into a 31-item questionnaire, on which each item was rated using a seven-point scale. This questionnaire was completed by 110 similar patients. Principal components analysis of these responses yielded three components: satisfaction, physical discomfort, and emotional distress. This demonstrates that patients' experience of colonoscopy is multi-dimensional; whether or not a patient feels satisfied is unrelated to how distressing or uncomfortable it is. Component-based scale scores were calculated so as to quantify every patient's experience on each dimension. Procedures performed by the most experienced endoscopist were no less uncomfortable than others, but they were less distressing. Female patients experienced more discomfort than males, but were no more distressed or less satisfied. This questionnaire could be useful in any future audit of colonoscopy from the patients' point of view.

Analysis of Variance↗
PubMed1994

Dementia: not just a search for the gene.

We extend the reasoning commonly applied to the understanding of chronic diseases and their prevention to Alzheimer's disease and other dementing disorders. The highly visible progress in finding genetic bases of Alzheimer's disease may leave a large proportion of cases unexplained. Rather, both genetic susceptibility and environmental factors are demonstrably important for disease expression. Thus, the research and health policy implication would be to target resources toward identifying and modifying environmental risk factors that might delay or prevent dementia.

Aged↗