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- Dickerman, Barbra A., et al.
(författare)
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Midlife metabolic factors and prostate cancer risk in later life
- 2018
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Ingår i: International Journal of Cancer. - Hoboken, USA : John Wiley & Sons. - 0020-7136 .- 1097-0215. ; 142:6, s. 1166-1173
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Tidskriftsartikel (refereegranskat)abstract
- Metabolic syndrome is associated with several cancers, but evidence for aggressive prostate cancer is sparse. We prospectively investigated the influence of metabolic syndrome and its components on risk of total prostate cancer and measures of aggressive disease in a cohort of Icelandic men. Men in the Reykjavik Study (n = 9,097, enrolled 1967-1987) were followed for incident (n = 1,084 total; n = 378 advanced; n = 148 high-grade) and fatal (n = 340) prostate cancer until 2014. Cox regression was used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for (1) measured metabolic factors at cohort entry (body mass index (BMI), blood pressure, triglycerides, fasting blood glucose) and (2) a metabolic syndrome score (range 0-4) combining the risk factors: BMI ≥30 kg/m2 ; systolic blood pressure (SBP) ≥130 or diastolic blood pressure (DBP) ≥85 mm Hg or taking antihypertensives; triglycerides ≥150 mg/dl; fasting blood glucose ≥100 mg/dl or self-reported type 2 diabetes. Hypertension and type 2 diabetes were associated with a higher risk of total, advanced, high-grade, and fatal prostate cancer, independent of BMI. Neither BMI nor triglycerides were associated with prostate cancer risk. Higher metabolic syndrome score (3-4 vs 0) was associated with a higher risk of fatal prostate cancer (HR 1.55; 95% CI: 0.89, 2.69; p trend = 0.08), although this finding was not statistically significant. Our findings suggest a positive association between midlife hypertension and diabetes and risk of total and aggressive prostate cancer. Further, metabolic syndrome as a combination of factors was associated with an increased risk of fatal prostate cancer.
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| 2. |
- Sigurdardottir, Johanna, et al.
(författare)
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Elective surgery should be considered after successful conservative treatment of recurrent diverticular abscesses
- 2020
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Ingår i: Scandinavian Journal of Gastroenterology. - : TAYLOR & FRANCIS LTD. - 0036-5521 .- 1502-7708. ; 55:4, s. 454-459
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: The purpose of this study was to evaluate the disease pattern and treatment of diverticular abscesses. Methods: Patients treated for diverticulitis (K57) in Vastmanland, Sweden were identified for this retrospective population-based study between January 2010 and December 2014. Patients with diverticular abscesses were included. The clinical and radiological data were extracted, and the computed tomography scans were reevaluated. Results: Of the 75 patients (45 women) with a median age of 62 years (range: 23-88 years), abscesses were localized pericolic in 42 patients (59%) and in the pelvis in 33 patients (41%). The median abscess size was 4.8 cm (range: 1.1-11.0 cm). Six patients (8%) required urgent surgical intervention during the index admission. The median follow-up time was 58 months (range: 0-95 months). During follow-up, 40 patients (58%) had disease recurrence and 35 of these patients (88%) presented with complicated diverticulitis. The median time until re-admission was 2 months (range: 3 days-94 months). Patients with pelvic abscesses developed fistulas more frequently, 3 versus 11 patients (p = .003). Twenty-three percent of patients with pericolic abscesses required surgery compared with 40% of patients with pelvic abscesses (p = .09). No patients had a recurrence of abscesses after a colonic resection. Conclusion: The majority of patients with diverticular abscesses had recurrences with repeated admissions regardless of abscess location. An unexpectedly high proportion of patients required surgical intervention during the follow-up period. A liberal approach regarding elective surgery for patients with recurrent diverticulitis abscesses who tolerate surgery seems justified.
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| 3. |
- Sigurdardottir, Johanna, et al.
(författare)
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Increased accuracy in diagnosing diverticulitis using predictive clinical factors
- 2022
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Ingår i: Upsala Journal of Medical Sciences. - : Uppsala Medical Society. - 0300-9734 .- 2000-1967. ; 127:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: The aim of this study was to identify clinical factors leading to increased diagnostic accuracy for acute colonic diverticulitis. Methods: Patients with clinical suspicion of acute colonic diverticulitis verified with computed tomography (CT) from two hospitals in Sweden between 9 January 2017 and 31 October 2017 were prospectively included. Symptoms, comorbidities, and laboratory results were documented. Candidate variables were analyzed using logistic regression, and the final variable set that yielded the most accurate predictions was identified using least absolute shrinkage and selection operator regression and evaluated using the area under the receiver operating characteristic (ROC) curve. Results: In total, 146 patients were included (73% women; median age 68 years; age range, 50-94 years). The clinical diagnostic accuracy was 70.5%. In the multiple logistic regression analysis, gender (female vs male odds ratio [OR]: 4.82; confidence interval [CI], 1.56-14.91), age (OR, 0.92; 95% CI, 0.87-0.98), pain on the lower left side of the abdomen (OR, 15.14; 95% CI, 2.65-86.58), and absence of vomiting (OR, 14.02; 95% CI, 2.90-67.88) were statistically significant and associated with the diagnosis of CT-verified diverticulitis. With seven predictors (age, gender, urinary symptoms, nausea, temperature, C-reactive protein, and pain left lower side), the area under the ROC curve was 0.82, and a formula was developed for calculating a risk score. Conclusion: We present a scoring system using common clinical variables that can be applied to patients with clinical suspicion of colonic diverticulitis to increase the diagnostic accuracy. The developed scoring system is available for free of charge at https://phille-wagner.shinyapps.io/Diverticulitis_risk_model/.
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