| 1. |
- Khamisi, Selwan, et al.
(författare)
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Fracture Incidence in Graves' Disease: A Population-Based Study.
- 2023
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Ingår i: Thyroid : official journal of the American Thyroid Association. - : Mary Ann Liebert. - 1557-9077 .- 1050-7256. ; 33:11, s. 1349-1357
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Tidskriftsartikel (refereegranskat)abstract
- Background: Population-based studies have indicated an increase in bone turnover in hyperthyroidism with a subsequent decrease in bone mineral density and an increased risk of fractures, especially in postmenopausal women. However, heterogeneity between studies prevents a definitive conclusion. Graves' disease (GD) is an autoimmune disease, and it is the most common cause of hyperthyroidism. The aim of this study was to investigate fracture risk in patients with GD. Methods: A total of 2134 patients with incident GD and 21,261 age, sex- and county-matched controls were included 16-18 years after diagnosis in a retrospective cohort study. Drug and patient national registries in Sweden were used to assess the risk of developing skeletal complications. Up to 10 years of age, sex- and county-matched controls per patient were selected from databases from the National Board of Health and Welfare and Statistics Sweden. Cox proportional hazards models were fitted to estimate hazard ratios (HR) and confidence intervals [CI]. Results: There were no significant differences in fracture rates between GD and controls but after adjustment for comorbidities, the data showed higher vertebral fracture rates in male GD patients aged >52 years compared to male controls, HR=2.83 [CI 1.05-7.64]. The rates of osteoporosis treatments as well as treatment with corticosteroids were higher in patients with GD. However, HR for the association between GD and fractures remained largely unchanged after adjustment for osteoporosis treatments and treatments with corticosteroids. Conclusions: There were no significant differences in total fracture rate between GD and the general population. However, men older than 52 years had a higher vertebral fracture rate. This study also shows that patients with treated GD receive more osteoporosis treatments compared to the general population.
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| 2. |
- Graves, J R, et al.
(författare)
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Survivors of out of hospital cardiac arrest: their prognosis, longevity and functional status.
- 1997
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Ingår i: Resuscitation. - : Elsevier Ireland Ltd. - 0300-9572 .- 1873-1570. ; 35:2, s. 117-21
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Tidskriftsartikel (refereegranskat)abstract
- This paper reports, consistent with Utstein Style definitions, 13 years experience observing out-of-hospital cardiac arrest survivors' prognosis, longevity and functional status. We report for all patients, available outcome information for out-of-hospital cardiac arrest survivors in Göteborg Sweden between 1980 and 1993. Patients were followed for at least 1 year and some for over 14 years. From 1980 to 1993 Göteborg EMS treated 3754 out-of-hospital cardiac arrests. 9% (n = 324) were discharged from the hospital alive. Survivors' median age was 67 and 21% (n = 67) were women. Mortality rate was: 21% (n = 61) at 1 year; 56% (n = 78) by 5 years; and 82% (n = 32) by 10 years following the arrest. During the first 3 years, 16% (n = 46) experienced another cardiac arrest, 19% (n = 53) had an acute myocardial infraction and a total of 81% (n = 232) were rehospitalized for various conditions. 14% (n = 40) returned to previous employment, and 74% (n = 229) had retired before their arrest occurred. Cerebral performance categories (CPC) scores were: At hospital discharge N = 324; Data available for 320-1 = 53% (n = 171), 2 = 21% (n = 66), 3 = 24% (n = 77), 4 = 2% (n = 6). One year post arrest N = 263; Data available for 212-1 = 73% (n = 156), 2 = 9% (n = 18), 3 = 17% (n = 36), 4 = 1% (n = 2). Overall, 21% (n = 61) of cardiac arrest survivors died during the first year, and an additional 16% (n = 46) experienced another arrest. 73% of those patients who were still alive after 1 year returned to pre-arrest function.
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| 3. |
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| 4. |
- Bartfay, Sven-Erik, et al.
(författare)
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Are biventricular assist devices underused as a bridge to heart transplantation in patients with a high risk of postimplant right ventricular failure?
- 2017
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Ingår i: Journal of Thoracic and Cardiovascular Surgery. - : Elsevier BV. - 0022-5223 .- 1097-685X. ; 153:2
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Tidskriftsartikel (refereegranskat)abstract
- Right ventricular failure in patients treated using left ventricular assist devices is associated with poor outcomes. We assessed the strategy of preplanned biventricular assist device implantation in patients with a high risk for right ventricular failure.Between 2010 and 2014, we assigned 20 patients to preplanned biventricular assist device and 21 patients to left ventricular assist device as a bridge to heart transplantation on the basis of the estimated risk of postimplant right ventricular failure. Preimplant characteristics and postimplant outcomes were compared between the 2 groups.Patients with a biventricular assist device were younger, more often female, and more frequently had nonischemic heart disease than left ventricular assist device recipients. At preoperative assessment, biventricular assist device recipients had poorer Interagency Registry for Mechanically Assisted Circulatory Support profiles, a lower cardiac index, and more compromised right ventricular function. Survival on device to heart transplantation/weaning/destination for biventricular assist device and left ventricular assist device recipients was 90% versus 86% (not significant), with shorter heart transplantation waiting times for biventricular assist device recipients (median days, 154 vs 302, P<.001). Overall survival at 1year was 85% (95% confidence interval, 62-95) versus 86% (95% confidence interval, 64-95) (not significant). The majority of both biventricular assist device and left ventricular assist device recipients could be discharged to home during the heart transplantation waiting time (55% vs 71%, not significant), and complication rates on device were comparable between groups (major stroke 10% vs 10%, not significant).Planned in advance, the biventricular assist device seems to be a feasible option as bridge to heart transplantation for patients with a high risk of postimplant right ventricular failure. The outcomes for these patients were similarto those observed for contemporary left ventricular assist device recipients, despite those receiving biventricular assist devices being more severely ill.
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| 5. |
- Holmberg, Mikael, 1950
(författare)
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Out-of-hospital cardiac arrest patients treated by emergency medical systems in Sweden 1990-1995
- 2000
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Between Jan 1990 and May 1995 the Swedish Cardiac Arrest Registry collected and analysed 14,065 standardised reports on cardiac arrests. The reports emanated from approximately half of Sweden's ambulance districts, which cover five of Sweden's 8.7 million inhabitants. From 1983 to 1995 approximately 15-20% of the inhabitants had been trained in CPR.Method: A prospective, observational study of cardiac arrests reported to the Swedish Cardiac Arrest Registry. Results: Resuscitation was attempted in 10,966 cases. The median age was 70 years. In 70% the arrest was witnessed, and in 43% patients had ventricular fibril--lation (VF). The incidence of VF at the time of cardiac arrest was estimated to be 80% in the cases with probable heart disease. In 1,692 cases (15.4 %) the patient was admitted alive in hospital and 544 patients (5.0 %) were alive after one month. Survival to one month in the subgroup with VF was 9.5 % and 1.6% for patients with non-shockable rhythm. The survivors were analysed in relation to time to defibrillation and we found a strong correlation between a short time and increased survival. Bystander cardiopulmonary resuscitation (B-CPR) was initiated in 36% of the cases. In 56% of these cases, the bystanders were lay persons and in 28% they were medical personnel. Most of the arrests took place at home (65%) and only 23% of these patients were given B-CPR in contrast to cardiac arrest in other places where 53% were given CPR. Survival to one month was significantly higher in all cases that received B-CPR (8.2% vs. 2.5%). The odds ratio for survival to one month with B-CPR was in a logistic regression analysis 2.5 (95% CI 1.9-3.1). Factors that were associated with the effect of B-CPR were the interval between the collapse and the start of B-CPR, the completeness of B-CPR, whether or not the bystander was a layperson, the interval between collapse and the arrival of the ambulance, age and the place of arrest. Adrenalin was given in 42% and 48% were intubated. Among patients given adrenalin 3.4% were alive after one month and among patients who were intubated 3.6% were alive after one month. In a multivariate analysis treatment with adrenalin and intubation were both independently associated with predictors of a lower chance of survival.Conclusion: In a survey in Sweden of out-of-hospital cardiac arrests the overall sur-vival was low (5.0%). Survival for the patients with VF was 9.5%. Initial incidence of VF was estimated to be 80% in patients with probable heart disease. Survival decreased with increasing time to defibrillation. Bystander-CPR increased survival two to three times. Intubation and adrenalin were not associated with an increased survival.
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| 6. |
- Lindqvist, Klas, 1957, et al.
(författare)
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Immediate versus deferred radiological investigation after acute renal colic: a prospective randomized study
- 2006
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Ingår i: Scand J Urol Nephrol. - : Informa UK Limited. ; 40:2, s. 119-124
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Tidskriftsartikel (refereegranskat)abstract
- Objective. The timing of radiological assessment after acute renal colic is controversial. The aim of this study was to investigate the value of immediate versus deferred radiological imaging and to compare morbidity rates after an attack of acute renal colic. Material and methods. Between September 2001 and December 2002 all 686 patients with acute renal colic attending our university hospital were registered. Of these, 172 patients rendered pain-free after analgesic injection were randomized to either immediate or deferred radiological investigation. All patients received a questionnaire encompassing questions on consumption of analgesics, impact of symptoms on normal daily activity (including working ability), need for additional emergency department visits and hospitalization. Stone treatments were registered. Results. The incidence of renal colic was 0.9/1000 inhabitants per year. In total, 74% of all patients became pain-free after analgesic injection. Morbidity was low among the randomized patients, and did not differ between the immediate or deferred radiological investigation groups. In both groups, the duration of impairment of normal daily activities and analgesic consumption was a median of 2 days. In the immediate group, 14% needed another emergency visit and 4% were hospitalized. Corresponding figures for the deferred group were 15% and 7%. In the immediate group, 17% had stone treatment, compared with 8% in the deferred group. Conclusion. For most patients with acute renal colic, parenteral analgesia resulted in complete symptom resolution. When initial medical treatment was successful, patient morbidity was low. In these patients, immediate radiological imaging did not lead to reduced morbidity compared with radiological imaging after 2-3 weeks.
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| 7. |
- Omerovic, Elmir, 1968, et al.
(författare)
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Levosimendan neither improves nor worsens mortality in patients with cardiogenic shock due to ST-elevation myocardial infarction.
- 2010
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Ingår i: Vascular health and risk management. - 1178-2048. ; 7:6, s. 657-663
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The aim of this study was to evaluate the effect of levosimendan on mortality in cardiogenic shock (CS) after ST elevation myocardial infarction (STEMI). METHODS AND RESULTS: Data were obtained prospectively from the SCAAR (Swedish Coronary Angiography and Angioplasty Register) and the RIKS-HIA (Register of Information and Knowledge about Swedish Heart Intensive Care Admissions) about 94 consecutive patients with CS due to STEMI. Patients were classified into levosimendan-mandatory and levosimendan-contraindicated cohorts. Inotropic support with levosimendan was mandatory in all patients between January 2004 and December 2005 (n = 46). After the SURVIVE and REVIVE II studies were presented, levosimendan was considered contraindicated and was not used in consecutive patients between December 2005 and December 2006 (n = 48). The cohorts were similar with respect to pre-treatment characteristics and concomitant medications. There was no difference in the incidence of new-onset atrial fibrillation, in-hospital cardiac arrest and length of stay at the coronary care unit. There was no difference in adjusted mortality at 30 days and at one year. CONCLUSION: The use of levosimendan neither improves nor worsens mortality in patients with CS due to STEMI. Well-designed randomized clinical trials are needed to define the role of inotropic therapy in the treatment of CS.
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| 8. |
- Varenhorst, Eberhard, 1937-, et al.
(författare)
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The National Prostate Cancer Register in Sweden 1998-2002 : trends in incidence, treatment and survival
- 2005
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Ingår i: Scandinavian Journal of Urology and Nephrology. - : Informa UK Limited. - 0036-5599 .- 1651-2065. ; 39:2, s. 117-123
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: To provide a descriptive review of the establishment of the National Prostate Cancer Register (NPCR) in Sweden, to present clinical characteristics at diagnosis and to calculate the relative survival of different risk groups after 5 years. MATERIAL AND METHODS: Since 1998, data on all newly diagnosed prostate cancers, including TNM classification, grade of malignancy, prostate-specific antigen (PSA) level and treatment, have been prospectively collected. For the 35,223 patients diagnosed between 1998 and 2002, relative survival in different risk groups has been calculated. RESULTS: Between 1998 and 2002, 96% of all prostate cancer cases diagnosed in Sweden were registered in the NPCR. The number of new cases increased from 6137 in 1998 to 7385 in 2002. The age-standardized rate rose in those aged < 70 years, while it was stable, or possibly declining from 1999, in the older age groups. The proportion of T1c tumours increased from 14% to 28% of all recorded cases. The age-adjusted incidence of advanced tumours (M1 or PSA > 100 ng/ml) decreased by 17%. The proportion of patients receiving curative treatment doubled. Patients with N1 or M1 disease or poorly differentiated tumours (G3 or Gleason score 8-10) had a markedly reduced relative 5-year survival rate. CONCLUSIONS: It is possible to establish a nationwide prostate cancer register including basic data for assessment of the disease in the whole of Sweden. The introduction of PSA screening has increased the detection of early prostate cancer in younger men and, to a lesser extent, decreased the incidence of advanced disease. The effect of these changes on mortality is obscure but the NPCR in Sweden will serve as an important tool in such evaluation.
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