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Biomedical subjects

S Hagen

Publications and source records attributed to S Hagen.

At least 55 records · Page 3Linked to original sources

Improving the selection of patients for upper gastrointestinal endoscopy.

A retrospective study was undertaken to investigate how endoscopies yielding positive findings differ a priori from those yielding negative findings: and how those judged 'helpful' (in the sense of influencing management) differ a priori from those judged 'unhelpful'. A total of 483 patients undergoing endoscopy was sampled and a wide range of data abstracted, including 48 patient characteristics available to the gastroenterologist at the time of the decision to perform endoscopy. Sixty nine per cent of endoscopies were positive. Multivariate statistical analysis identified four variables which taken together were strongly predictive of a positive endoscopy. The resulting mathematical formula correctly predicted the outcome of 76% of endoscopies. Eighty two per cent of the endoscopies were retrospectively classified by the gastroenterologists as helpful. Six variables were strongly predictive of a helpful endoscopy. The corresponding formula correctly predicted the finding of 84% of endoscopies. Comparison of the two analyses shows that the two sets of predictions differ substantially. Thus it is important that decision tools should be based not on the crude distinction between positive and negative, but on the more useful distinction between helpful and unhelpful in influencing management.

Adolescent↗

[Late diagnosis of advanced breast cancer--a challenge for health services].

From 1982 to 1987, 1,637 cancers of the breast were diagnosed in Oslo. 235 were classified as advanced according to one or more of the following criteria: tumour size greater than or equal to 5 cm (T3) or T4, metastasis within 4 months, pathological diagnosis pT3, pT4 or pN2. These were further studied. The distribution of women with advanced cancer mammae was uneven. For no obvious reason, incidence was significantly higher in one out of four hospitals in Oslo. 169 of the patients discovered the tumour themselves. Many patients delayed seeking help. 93 waited for more than eight weeks before doing so. For patients with metastasis at time of diagnosis, survival was slightly more than one year, and for patients without metastasis it was four and a half year. The length of stay in hospital increased with increasing admissions.

Adult↗

Bleomycin/cis-platin as neoadjuvant chemotherapy before radical radiotherapy in localized, inoperable carcinoma of the esophagus. A prospective randomized multicentre study: the second Scandinavian trial in esophageal cancer.

Survival and swallowing function were studied in a randomized trial of 97 patients with inoperable, localized esophageal carcinoma. Radical radiotherapy was given to 51 patients, while 46 patients had two courses of bleomycin/cisplatin before radiotherapy. The survival was 29% after one year, and 6% after 3 years in the radiotherapy group. The survival in the combined treatment group was 18 and 0%, respectively; p = 0.1895. The number of patients who could swallow any food increased from 6% before treatment to 38% after 3 months in the radiotherapy group, and from 0% to 23% in the combined group. No benefit was found by combining bleomycin/cisplatin with radiotherapy.

Aged↗

A case of mastocytosis involving bone.

A case of mastocytosis of the bone associated with urticaria pigmentosa was first suspected of being a generalized metastatic malignancy, for the radiographic manifestations were not connected by us with the patient's skin disease. The histologic diagnosis of systemic mastocytosis was also missed primarily, because mast cells are not visualized in the conventional hematoxylin and eosin staining of the histologic sections. Special stainings revealed mastocytosis. Irregular remodeling of the bone was also seen, which was consistent with the radiographically irregular bone structure.

Adult↗

Relation between cognitive impairment and early death in the elderly.

STUDY OBJECTIVE: To study the association between cognitive impairment and early death in elderly patients living in the community. DESIGN: Case-control study of 410 patients assessed by the mental status questionnaire and followed up after three years. SETTING: A general practice in Inverurie, Aberdeenshire, with 14,000 patients. PATIENTS: 205 Patients aged greater than or equal to 65 with cognitive impairment according to the mental status questionnaire (score less than or equal to 8) and 205 patients scoring greater than 8 on the questionnaire matched for age and sex. MAIN OUTCOME MEASURE: Death. RESULTS: The relative risk of death in the cognitively impaired patients overall was 3.5. Those patients who scored less than or equal to 7 on the mental status questionnaire were five times more likely to die than their controls. There was no difference in risk of death between those with severe or moderate cognitive impairment. CONCLUSIONS: Cognitive impairment is associated with early death.

Aged↗

A method for preparation of renal tubular basement membrane.

A method is presented for the preparation of tubular basement membrane from renal cortex. The procedure utilizes a Polytron tissue disrupter, differential sieving, and for some species, sucrose density centrifugation. The procedure is especially useful for obtaining highly purified rabbit and bovine tubular basement membranes. Human tubular and glomerular basement membranes can be prepared with some cross contamination. The method offers the capability of rapidly generating large quantities of the basement membranes that retain the Goodpasture antigen and a TBM antigen associated with anti-TBM nephritis.

Animals↗

Percutaneous transluminal angioplasty for atheromatous renal artery stenosis--blood pressure response and discriminant analysis of outcome predictors.

Percutaneous transluminal angioplasty was performed in 39 consecutive patients with atheromatous renal artery stenosis associated with hypertension. The mean blood pressure before angioplasty was 191/107 mmHg and this had dropped to a mean of 167/90 mmHg at the patient's most recent visit, representing a significant fall in both systolic (p less than 0.01) and diastolic pressures (p less than 0.001). The mean serum creatinine was 166.7 mumol/l before percutaneous transluminal angioplasty and 155.3 mumol/l at the most recent visit (not statistically significant). The mean number of anti-hypertensive drugs fell from 2.4 to 1.9 after percutaneous transluminal angioplasty (p less than 0.05). Three patients (eight per cent) were 'cured' (diastolic blood pressure less than 90 mmHg without medication), 25 (64 per cent) had 'improved' (diastolic blood pressure less than 109 mmHg, with a fall of more than 15 per cent) and 11 (28 per cent) had not improved. Logistic discriminant analysis showed that pre-percutaneous transluminal angioplasty diastolic blood pressure, age, serum creatinine and smoking habit together correctly predicted the outcome of percutaneous transluminal angioplasty in 90 per cent of patients, with four 'false positives' and no 'false negatives'. Ten patients suffered a total of 12 serious complications related to the procedure: one death in acute renal failure, one myocardial infarction, one severe hypotension just after the procedure, one deep vein thrombosis, one episode of transient ischaemia of the toes and seven groin haematomas. Thus percutaneous transluminal angioplasty for atheromatous renal artery stenosis rarely 'cures' hypertension, but improved blood pressure control is often achieved, albeit at the expense of troublesome complications. A prospective, randomized trial is needed to establish whether or not the improvement is due directly to percutaneous transluminal angioplasty.

Age Factors↗

A randomized study on hormone-resistant prostatic cancer: estramustine phosphate versus low dose epirubicin with or without medroxyprogesterone acetate. A Norwegian multicenter study.

A prospective randomized study has been carried out in order to compare three different treatment modalities for symptomatic metastatic hormone-resistant prostatic cancer. A total of 79 patients were included. One group was treated with estramustine phosphate, another with Epirubicin plus Medroxyprogesterone acetate (MPA), while the third arm consisted of Epirubicin plus placebo. Best palliation was obtained by the combination of Epirubicin and MPA. This combination also seemed to be associated with the longest response duration.

Administration, Oral↗

Neuropsychiatric studies in a family with presenile dementia different from Alzheimer and Pick disease.

We have studied a family in which 14 persons among 73 are or have been suffering from presenile dementia. Post mortem examination showed atrophy but no sign of any known demential syndrome. Cerebral blood flow measured in the late stage of disease was low, but with no characteristic pattern in flow distribution. In one patient in the initial stage of disease, the cerebral blood flow was unexpectedly increased. The patients with presenile dementia in this family did not reveal pathological signs of any known demential syndrome and showed CBF-changes not earlier reported. Moreover, contrary to widely held views we have evidence that dementia may be connected to a high blood flow at least in the initial state. An increased blood flow was also seen in seven of ten well functioning first degree relatives, in some cases along with cerebral atrophy and/or psychological tests with signs of dementia. Are these people going to develop manifest dementia later in life?

Aged↗

Combined modality treatment of operated astrocytomas grade 3 and 4. A prospective and randomized study of misonidazole and radiotherapy with two different radiation schedules and subsequent CCNU chemotherapy. Stage II of a prospective multicenter trial of the Scandinavian Glioblastoma Study Group.

A prospective and randomized trial has been performed in order to evaluate combined modality therapy in patients with astrocytomas grade 3 and 4. Follow-up information is available on 244 patients. One half of the series received radiation therapy twice a week (40.00 Gy/5 weeks), the other half five times a week (50.00 Gy/5 weeks). Misonidazole 1.2 g/m2 was given orally to one half of the patients in the first radiation treatment group 3 1/2 to 4 hours before the treatment. The other half received placebo. The second radiation treatment group was also divided in two halves, one receiving 0.48 g/m2 misonidazole and the other placebo 3 1/2 to 4 hours before radiation. The randomization also included a subdivision of the material into eight groups of which four were given CCNU and four no chemotherapy, beginning 3 months after operation. The dose of CCNU was 120 mg/m2 body surface every 6 weeks. All eight treatment groups showed practically identical periods of median survival, and no statistically significant differences were observed with regard to performance status, side effects, or complications. Another dosage and timing of misonidazole administration in relation to the irradiation schedule, and a consideration of effects of concomitant drugs like dexamethasone and phenytoin are discussed.

Actuarial Analysis↗