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  • Olsson-Strömberg, Ulla, et al. (författare)
  • Comparison of busulphan, hydroxyurea and allogeneic bone marrow transplantation (BMT) in chronic myeloid leukaemia : BMT prolongs survival.
  • 2004
  • Ingår i: Hematol J. - 1466-4860. ; 5:6, s. 462-6
  • Tidskriftsartikel (refereegranskat)abstract
    • Introduction: Whether busulphan-treated patients develop blastic transformation earlier than hydroxyurea treated has been a controversial issue. In a randomised prospective study, we examined the busulphan versus hydroxyurea influence on time to blast crisis and on survival. When we opened our study in 1984, the clinical benefit of allogeneic bone marrow transplantation (BMT) was not well known, to follow up the long-time outcome of this treatment was therefore of great interest. Materials and methods: Previously untreated CML patients were randomly started on either hydroxyurea (30 mg/kg/day) or busulphan (0.1 mg/kg/day). The end points of the study were overall survival and time to blast crisis. A total of 26 patients subsequently underwent BMT. Results: A total of 179 patients were randomised, 90 to hydroxyurea, and 89 to busulphan treatment. There was no significant difference in survival between hydroxyurea- and busulphan-treated patients (P = 0.46), median survival was 3.5 and 3.2 years, respectively. In all, 85 of the patients were subsequently diagnosed with blast crisis, 41 in the busulphan and 44 in the hydroxyurea group. There was no significant difference between the two groups (P=0.91). The 26 patients who were allotransplanted survived significantly longer than those who were not transplanted (P=0.0001). The 5-year-survival rates were 50 and 22% and the 10-year-survival rates were 46 and 2%, respectively. The median survival was 4.7 years for the transplanted and 3.3 years for the nontransplanted patients. Conclusion: We did not find any difference between hydroxyurea and busulphan treatment, either in overall survival or in blast crisis-free survival, transplanted patients survived significantly longer than nontransplanted patients. © 2004 The European Hematology Association All rights reserved.
  • Pundziute-Lyckå, A, et al. (författare)
  • The incidence of Type I diabetes has not increased but shifted to a younger age at diagnosis in the 0-34 years group in Sweden 1983 to 1998
  • 2002
  • Ingår i: Diabetologia. - 0012-186X. ; 45:6, s. 783-791
  • Tidskriftsartikel (refereegranskat)abstract
    • Aims/hypothesis. To analyse the incidence of Type I (insulin-dependent) diabetes mellitus in the 0-34 years age group in Sweden 1983-1998. Methods. Incidence and cumulative incidence per 100 000 and Poisson regression analysis of age-period effects was carried out using 11 751 cases from two nation-wide prospective registers. Results. Incidence (95%-CI) was 21.4 (20.8-21.9) in men and 17.1 (16.6-17.5) in women between 0 and 34 years of age. In boys aged 0-14 and girls aged 0-12 years the incidence increased over time, but it tended to decrease at older age groups, especially in men. Average cumulative incidence at 35 years was 748 in men and 598 in women. Cumulative incidence in men was rather stable during four 4-year periods (736, 732, 762, 756), while in women it varied more (592, 542, 617, 631). In males aged 0-34 years, the incidence did not vary between the 4-year periods (p=0.63), but time changes among the 3-year age groups differed (p<0.001). In females the incidence between the periods varied (p<0.001), being lower in 1987-1990 compared to 1983-1986, but time changes in the age groups did not differ (p=0.08). For both sexes median age at diagnosis was higher in 1983-1986 than in 1995-1998 (p<0.001) (15.0 and 12.5 years in males, 11.9 and 10.4 in females, respectively). Conclusion/interpretation. During a 16-year period the incidence of Type I diabetes did not increase in the 0-34 years age group in Sweden, while median age at diagnosis decreased. A shift to younger age at diagnosis seems to explain the increasing incidence of childhood Type I diabetes.
  • Tuvemo, Torsten, et al. (författare)
  • Final height after combined growth hormone and GnRH analogue treatment in adopted girls with early puberty
  • 2004
  • Ingår i: Acta Paediatrica. - 0803-5253. ; 93:11, s. 1456-1462
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: Girls adopted from developing countries often have early or precocious puberty, requiring treatment with gonadotrophin-releasing hormone (GnRH) analogues. During such treatment, decreased growth velocity is frequent. Aim: To study whether the addition of growth hormone (GH) to GnRH analogue treatment improves final height in girls with early or precocious puberty. Methods: Forty-six girls with early or precocious puberty (age ≤9.5 y) adopted from developing countries were randomized for treatment for 2-4 y with GnRH analogue, or with a combination of GH and GnRH analogue. Results: During treatment, the mean growth velocity in the GH/GnRH analogue group was significantly higher compared to the control group. Combined GH/GnRH analogue treatment resulted in a higher final height: 158.9 cm compared to 155.8 cm in the GnRH analogue-treated group. Three out of 24 girls (13%) in the combined group and nine of the 22 girls (41%) treated with GnRH analogue alone attained a final height below -2 standard deviation scores (SDS). Conclusion: The difference between the two groups is statistically significant, and possibly of clinical importance. A future challenge is to identify a subgroup with clinically significant advantage of GH addition to GnRH analogue treatment. Being very short on arrival in Sweden and being short and young at start of treatment are possible indicators.
  • Nyström, J., et al. (författare)
  • Combined near-infrared spectroscopy and multifrequency bio-impedance investigation of skin alterations in diabetes patients based on multivariate analyses
  • 2003
  • Ingår i: Medical and Biological Engineering and Computing. - 0140-0118. ; 41:3, s. 324-329
  • Tidskriftsartikel (refereegranskat)abstract
    • A group of 34 diabetic men, with different degrees of diabetes complications, including skin changes, were studied by near-infrared (NIR) spectroscopy and total body multi-frequency bio-impedance analyses (MFBIA-body). Skin reflectance spectra were measured with a fibre-optic probe in four locations (sites): hand, arm, leg and foot. As control subjects, a group of 23 healthy males were also measured. A combined multivariate analysis of the two types of spectrum was performed. It was concluded that the NIR method has the potential to detect diabetes-related skin conditions and also that the combination of the two techniques provides a higher potential for classification and discrimination of the skin conditions, with correct classification increasing from 63% to 85%.
  • Aspholm-Hurtig, M, et al. (författare)
  • Functional adaptation of BabA, the H. pylori ABO blood group antigen binding adhesin.
  • 2004
  • Ingår i: Science (New York, N.Y.). - 1095-9203. ; 305:5683, s. 519-22
  • Tidskriftsartikel (refereegranskat)abstract
    • Adherence by Helicobacter pylori increases the risk of gastric disease. Here, we report that more than 95% of strains that bind fucosylated blood group antigen bind A, B, and O antigens (generalists), whereas 60% of adherent South American Amerindian strains bind blood group O antigens best (specialists). This specialization coincides with the unique predominance of blood group O in these Amerindians. Strains differed about 1500-fold in binding affinities, and diversifying selection was evident in babA sequences. We propose that cycles of selection for increased and decreased bacterial adherence contribute to babA diversity and that these cycles have led to gradual replacement of generalist binding by specialist binding in blood group O-dominant human populations.
  • Herlitz, J, et al. (författare)
  • Can we define patients with no chance of survival after out-of-hospital cardiac arrest?
  • 2004
  • Ingår i: Heart. - 1468-201X (Electronic). ; 90:10, s. 1114-8
  • Tidskriftsartikel (refereegranskat)abstract
    • Objective: To evaluate whether subgroups of patients with no chance of survival can be defined among patients with out-of-hospital cardiac arrest. Patients: Patients in the Swedish cardiac arrest registry who fulfilled the following criteria were surveyed: cardiopulmonary resuscitation (CPR) was attempted; the arrest was not crew witnessed; and patients were found in a non-shockable rhythm. Setting: Various ambulance organisations in Sweden. Design: Prospective observational study. Results: Among the 16 712 patients who fulfilled the inclusion criteria, the following factors were independently associated with a lower chance of survival one month after cardiac arrest: no bystander CPR; non-witnessed cardiac arrest; cardiac arrest occurring at home; increasing interval between call for and arrival of the ambulance; and increasing age. When these factors were considered simultaneously two groups with no survivors were defined. In both groups patients were found in a non-shockable rhythm, no bystander CPR was attempted, the arrest was non-witnessed, the arrest took place at home. In one group the interval between call for and arrival of ambulance exceeded 12 minutes. In the other group patients were older than 80 years and the interval between call for and arrival of the ambulance exceeded eight minutes. Conclusion: Among patients who had an out-of-hospital cardiac arrest and were found in a non-shockable rhythm the following factors were associated with a low chance of survival: no bystander CPR, non-witnessed cardiac arrest, the arrest took place at home, increasing interval between call for and arrival of ambulance, and increasing age. When these factors were considered simultaneously, groups with no survivors could be defined. In such groups the ambulance crew may refrain from starting CPR.
  • Herlitz, J, et al. (författare)
  • Decrease in the occurrence of ventricular fibrillation as the initially observed arrhythmia after out-of-hospital cardiac arrest during 11 years in Sweden
  • 2004
  • Ingår i: Resuscitation. - 0300-9572 (Print). ; 60:3, s. 283-90
  • Tidskriftsartikel (refereegranskat)abstract
    • Aim: To describe the change in the occurrence of ventricular fibrillation as initially observed arrhythmia among patients suffering from out-of-hospital cardiac arrest in Sweden. Patients: All patients included in the Swedish cardiac arrest registry between 1991 until 2001. The registry covers 85% of the population in Sweden. Methods: All patients with bystander witnessed out-of-hospital cardiac arrest included in the Swedish Cardiac Arrest Registry between 1991 and 2001 from the same ambulance organisation each year were included in the survey. Results: Over 11 years, among patients in Sweden with a bystander witnessed out-of-hospital cardiac arrest in whom cardiopulmonary resuscitation (CPR) was attempted (n = 9666), the occurrence of ventricular fibrillation as the initially obseved arrhythmia decreased from 45% in 1991 to 28% in 2001 (P &lt; 0.0001) if the arrest occurred at home, and from 57% to 41% if the arrest occurred outside home (P &lt; 0.0001). This was found despite the fact that the proportion who received bystander CPR increased from 29% in 1991 to 39% in 2001 if the arrest occurred at home (P &lt; 0.0001) and from 54% to 60% if the arrest occurred outside home (NS). There was a significant increase in age among patients with out-of-hospital cardiac arrest at home, no change in the estimated interval between collapse and call but an increase in the interval between call and arrival of the ambulance among patients with out-of-hospital cardiac arrest outside home. Conclusion: During 11 years in Sweden, there was a marked decrease in the proportion of patients found in ventricular fibrillation among patients with a bystander witnessed cardiac arrest regardless whether the arrest occurred at home or outside home. A modest increase in age and interval between call for, and arrival of, the ambulance was associated with these findings.
  • Herlitz, J, et al. (författare)
  • Is female sex associated with increased survival after out-of-hospital cardiac arrest?
  • 2004
  • Ingår i: Resuscitation. - 0300-9572 (Print). ; 60:2, s. 197-203
  • Tidskriftsartikel (refereegranskat)abstract
    • AIM: To evaluate survival after out-of-hospital cardiac arrest in relation to sex. METHODS: All patients with out-of-hospital cardiac arrest included in the Swedish Cardiac Arrest Registry between 1990 and 2000 in whom cardiopulmonary resuscitation (CPR) was attempted and who did not have a crew witnessed arrest were included. The registry covers 85% of the inhabitants of Sweden (approximately 8 million inhabitants). P-values were adjusted to differences in age. Survival was defined as patients being hospitalised alive and being alive one month after cardiac arrest. In all, 23,797 patients participated in the survey of which 27.9% were women. RESULTS: Among women 16.4% were hospitalised alive versus 13.2% among men ( P&lt;0.001). After one month 3.0% among women were alive versus 3.4% among men (NS). In a multivariate analysis considering differences in age and various factors at resuscitation female sex was an independent predictor for patients being hospitalised alive (odds ratio 1.66; 95% confidence limits 1.49-1.84) and for being alive after one month (odds ratio 1.27; 95% confidence limits 1.03-1.56). Women differed from men as they were older ( P&lt;0.001 ), had a lower prevalence of witnessed cardiac arrest ( P=0.01), a lower occurrence of bystander CPR (P&lt;0.001), a lower occurrence of ventricular fibrillation as initial arrhythmia (P&lt;0.001) and a lower occurrence of cardiac disease judged to be the cause of cardiac arrest ( P&lt;0.0001 ). On the other hand they had a cardiac arrest at home more frequently ( P&lt;0.001 ). CONCLUSION: Among patients suffering out-of-hospital cardiac arrest in Sweden which was not crew witnessed and in whom resuscitation efforts were attempted, female sex was associated with an increased survival.
  • Lindholm, C, et al. (författare)
  • Invasive cutaneous malignant melanoma in Sweden, 1990-1999. A prospective, population-based study of survival and prognostic factors.
  • 2004
  • Ingår i: Cancer. - 0008-543X. ; 101:9, s. 2067-78
  • Tidskriftsartikel (refereegranskat)abstract
    • BACKGROUND. The objective of the current study was to compile prospective, population-based data on cutaneous invasive melanomas in Sweden during the period from 1990 to 1999, to describe and analyze survival data and prognostic factors, and to make comparisons with previously published Swedish and international data. METHODS. Twelve thousand five hundred thirty-three patients, which included 97% of all registered melanomas in Sweden, were included and described. Among these, 9515 patients with clinical Stage I and II melanoma were included in an analysis of survival and in a univariate analysis, and 6191 patients were included in a multivariate analysis of prognostic factors. RESULTS. There was no significant change in melanoma incidence during 1990-1999. Favorable prognostic factors were found, especially in younger and female patients, resulting in a relative 5-year survival rate of 91.5%. In the multivariate analysis, significant factors that had a negative effect on survival were Clark level of invasion, Breslow thickness, ulceration, older patient age, trunk location, greatest tumor dimension, nodular histogenetic type, and male gender. CONCLUSIONS. During the period from 1990 to 1999, the 5-year survival of patients with malignant melanoma in Sweden was better compared with the previously reported rates in published, population-based studies from Sweden, probably as a result of better secondary prevention due to better knowledge and awareness by both patients and the medical profession. The more favorable prognostic factors and the change in melanoma location found in younger patients, compared with earlier reports, may reflect changes in clothing as well as tanning habits, however, a decrease also was found in Clark Level II and thin melanomas for the same patient group. The authors concluded that further improvements can be achieved with better access to health care and with the use of early melanoma detection campaigns.
  • Svensson, Maria, et al. (författare)
  • Signs of nephropathy may occur early in young adults with diabetes despite modern diabetes management: results from the nationwide population-based Diabetes Incidence Study in Sweden (DISS).
  • 2003
  • Ingår i: Diabetes Care. - American Diabetes Association. - 1935-5548. ; 26:10, s. 2903-2909
  • Tidskriftsartikel (refereegranskat)abstract
    • OBJECTIVE—To estimate the occurrence of early-onset renal involvement in a nationwide population-based cohort of young adults with diabetes in Sweden and relate the findings to glycemic control, type of diabetes, sex, smoking, and blood pressure. RESEARCH DESIGN AND METHODS—The Diabetes Incidence Study in Sweden aims to register all incident cases of diabetes in the age-group 15–34 years. In 1987–1988, 806 patients were reported and invited to participate in a follow-up study focusing on microvascular complications. Of them, 469 subjects participated. The assessment was based on questionnaires (n = 469), blood samples (n = 424), urine samples (n = 251) and, when appropriate, medical records (n = 186). RESULTS—During the follow-up time, median 9 years (range 6–12), 31 of 469 patients (6.6%) with incipient or overt diabetic nephropathy (i.e., micro- or macroalbuminuria) were found, 24 of 426 (5.6%) in type 1 and 7 of 43 (16%) in type 2 diabetic subjects (P = 0.016). Additionally, 24 of 31 patients (77%) had microalbuminuria and 7 (23%) had macroalbuminuria, which mainly occurred in patients with type 2 diabetes. In a Cox regression analysis, high mean HbA1c during the follow-up period and high blood pressure at follow-up increased the risk of developing signs of nephropathy (P = 0.020 and P = 0.003, respectively). Compared with patients with type 1 diabetes, those with type 2 diabetes tended to have an increased risk of renal involvement (P = 0.054) when adjusting for sex, tobacco use, glycemic control, and blood pressure. CONCLUSIONS—Despite modern treatment and self-monitoring of blood glucose, young adult patients with diabetes may still develop renal involvement during the first 10 years of diabetes duration. Inadequate HbA1c, high blood pressure, and type 2 diabetes appear to be risk markers for early occurrence of diabetic nephropathy.
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