| 1. |
- Wallerstedt, Susanna Maria, 1970, et al.
(författare)
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The specialty clinical pharmacology needs to be examined separately to guarantee a sufficient level of knowledge in medical students
- 2013
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Ingår i: European Journal of Clinical Pharmacology. - : Springer Science and Business Media LLC. - 0031-6970 .- 1432-1041. ; 69:6, s. 1331-1334
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Tidskriftsartikel (refereegranskat)abstract
- Purpose In medical schools small specialties like clinical pharmacology may be integrated in courses covering larger specialties and examined concomitantly. The results of a pilot study suggested that this approach would have negative consequences on the knowledge gained in clinical pharmacology with integration of this speciality in the course of internal medicine and concomitant examination. The aim of the present study was to assess in more detail whether students’ presumed tendency to study selectively influences approval (the pass mark), a surrogate marker of the knowledge gained. Methods A written examination for the integrated course in clinical pharmacology and internal medicine in Gothenburg, Sweden, was specifically designed in 2008 to evaluate the research question. The examination consisted of 50 short answer questions, of which five focused on clinical pharmacology (maximum score 10) and 45 were on internal medicine (maximum score 90). The cut-off level for approval (pass mark) was 60 %. Results Of the 81 students who wrote the examination, 73 (90.1 %) passed the examination as a whole. When the questions in clinical pharmacology were assessed separately, 62 (76.5 %) students passed the cut-off level of 60 %; the corresponding proportion of students achieving the cut-off level for questions on internal medicine was 90.1 %. There was a significant correlation between the results of the two specialties (p<0.001), but the questions on clinical pharmacology generated lower scores (p<0.001). The correlation coefficient between the results of two randomly chosen questions for clinical pharmacology was greater than that of two randomly chosen questions in internal medicine (p<0.001). Conclusions Our results confirm that a small specialty like clinical pharmacology may need to be examined separately in order to guarantee a sufficient level of knowledge among students.
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| 2. |
- Wallerstedt, Sven, 1944, et al.
(författare)
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Abdominal tenderness in ascites patients indicates spontaneous bacterial peritonitis
- 2007
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Ingår i: European journal of internal medicine. - : Elsevier BV. - 0953-6205 .- 1879-0828. ; 18:1, s. 44-47
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Tidskriftsartikel (refereegranskat)abstract
- Background: Spontaneous bacterial peritonitis (SBP), which has been reported to be present in 10-30% of patients with cirrhotic ascites, may easily be overlooked. An important aim of our study was to determine whether there are any clinical signs which, in clinical practice, may predict or exclude SBP. Methods: We studied 133 patients with cirrhotic ascites from medical units at nine Swedish university hospitals where there had been at least one diagnostic ascites tap with analysis of polymorphonuclear leukocytes in the ascites fluid. The patients had initially been questioned about background factors and physically examined according to a standardized case record form. Samples of blood, urine, and ascites were then drawn for analysis according to a structured schedule. Results: SBP could be excluded in 80% of all the cases and was confirmed in 8% of the 133 patients in the final analysis. Abdominal pain and abdominal tenderness were more common in patients with SBP (p < 0.01), but no other physical sign or laboratory test could separate SBP cases from the others. Conclusions: SBP was present in about one-tenth of the hospitalized patients with cirrhotic ascites in this cohort. Performing repeated physical examinations and paying particular attention to abdominal tenderness may be the best way to become aware of the possible development of this complication.
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| 3. |
- Wallerstedt, Sven, 1944, et al.
(författare)
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Educational Value of Doctor Trainee Employments (“Student Doctor”) —A Questionnaire Study
- 2015
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Ingår i: International Journal Clinical Medicine. - : Scientific Research Publishing, Inc.. - 2158-284X .- 2158-2882. ; 6:7, s. 469-474
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Tidskriftsartikel (refereegranskat)abstract
- In Sweden, medical students can work as employed doctor trainees under supervision during medical school breaks. The aim of the present study was to evaluate the educational value of such employments, as well as to compare university and non-university positions. Method: A questionnaire was administered to all employed doctor trainees at Sahlgrenska University Hospital, Gothenburg, in 2003-2004 (n = 67) plus all students in last term medical school 2005 who had had such a position inside or outside this university hospital (n = 43). The questionnaire included questions on trainee position/s, as well as statements regarding the educational value. Result: 75 unique individuals returned a filled-in questionnaire (response rate: 78%). The respondents experienced the positions as valuable concerning gain in professional confidence (mean ± standard deviation: 3.9 ± 1.1; 1 = total disagreement to 5 = total agreement) and independence (3.9 ± 1.1), subsequent learning in medical school (4.3 ± 0.9), and future professional work (4.2 ± 1.0). The gain in professional confidence and independence was greater for those who had worked in a non-university hospital (n = 17) than in a university hospital (n = 29): 4.4 ± 0.6 vs. 3.6 ± 3.6, P = 0.011; 4.3 ± 0.7 vs. 3.6 ± 1.1, P = 0.038. Conclusion: Employment as a doctor trainee seems to facilitate subsequent learning in medical school and enhance professional progress; the latter is particularly prominent in non-university hospitals.
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| 4. |
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| 5. |
- Wallerstedt, Sven, 1944, et al.
(författare)
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Moderate hyperkalemia in hospitalized patients with cirrhotic ascites indicates a poor prognosis
- 2013
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Ingår i: Scandinavian Journal of Gastroenterology. - : Informa Healthcare. - 0036-5521 .- 1502-7708. ; 48:3, s. 358-365
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Tidskriftsartikel (refereegranskat)abstract
- Objective. Development of ascites in patients with liver cirrhosis is an ominous sign with a poor outcome. A liver transplantation must be considered, and it then becomes important to know if there are any factors indicating a worsened prognosis. Material and methods. We used official registers for a follow-up study of at least 5 years considering the prognosis of 155 prospectively recruited in-patients with cirrhotic ascites from medical units at nine Swedish university hospitals. All patients had undergone at least one diagnostic ascites tap, and had initially been questioned about background factors and physically examined according to a standardized case record form, followed by sampling of blood, urine, and ascites. Results. Death occurred within 1 year after inclusion in 53% of the cases, and was primarily liver-related in 70%. In a multivariable analysis, the two ordinary variables that showed the strongest correlation with risk of death were serum potassium and abdominal tenderness. All 22 patients with a serum potassium concentration of at least 4.8 mmol/L (maximum 5.8 mmol/L) died within 1 year after inclusion. Potassium concentration was related to renal function and potassium-saving drugs. Conclusion. This follow-up study of a prospectively recruited cohort of in-patients with cirrhotic ascites confirms their poor prognosis. Awareness of an elevated serum potassium value, which would reflect a threatened renal function, seems essential, because it may offer a simple way to identify cases with the worst prognosis. An area for further research should be to explore the significance of including serum potassium in prognostic models.
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| 6. |
- Wallerstedt, Sven, 1944, et al.
(författare)
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Short Answer Questions or Modified Essay Questions— More than a Technical Issue
- 2012
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Ingår i: International Journal of Clinical Medicine. - : Scientific Research Publishing, Inc.. - 2158-284X .- 2158-2882. ; 3:1, s. 28-30
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Tidskriftsartikel (refereegranskat)abstract
- Purpose, The present article was built on the assumption that the form of an examination may influence learning, and may also reflect different kinds of knowledge. The aim of the study was to evaluate whether the results of an examination differ when short answer questions (SAQ) or modified essay questions (MEQ) are used. Method, Forty-nine students in the internal medicine course in Gothenburg, Sweden, performed a written examination in 2003, which included both SAQ and MEQ. Result, The correlation between the results of SAQ and MEQ was 0.59 (P < 0.001). The percentage correctly answered questions in the two types did not differ significantly. Some students had poor results in either SAQ or MEQ. Conclusion, The general outcome of the study indicates that results of SAQ and MEQ demonstrate a significant correlation. However, they may also reflect differences in mastery of the knowledge domain, which should be considered in relation to aspects of validity
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| 7. |
- Bernhardsson, Peter, 1982-, et al.
(författare)
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Ett genealogiskt nätverk kring en blivande karolin
- 2010
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Ingår i: Släktforskarnas årsbok 10. - Solna : Sveriges Släktforskarförbund. - 0280-3984. ; , s. 55-76
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)
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| 8. |
- Bernhardsson, Peter, 1982-, et al.
(författare)
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Ett stormigt officersliv i stormaktstidens Sverige
- 2010
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Ingår i: Släktforskarnas årsbok 10. - Solna : Sveriges Släktforskarförbund. - 0280-3984. ; , s. 33-54
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)
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| 9. |
- Bernhardsson, Peter, 1982-, et al.
(författare)
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Thavenius. En sörmländsk släkt med mytiskt ursprung.
- 2010
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Ingår i: Släktforskarnas årsbok 10. - Solna : Sveriges släktforskarförbund. - 0280-3984. ; , s. 275-293
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)
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| 10. |
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| 11. |
- Eriksson, Anders, 1957, et al.
(författare)
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Elevation of cytokines in peritoneal fluid and blood in patients with liver cirrhosis
- 2004
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Ingår i: Hepato-Gastroenterology. - 0172-6390. ; 51:56, s. 505-9
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND/AIMS: Liver cirrhosis, described as the endstage of a necroinflammatory process, is often accompanied by ascites formation. The rationale for this study was the hypothesis that patients with liver cirrhosis have a low-grade chronic inflammatory response, which leads to an increased amount of proinflammatory cytokines accumulated in ascites. Twenty-five patients with liver cirrhosis complicated by ascites and twelve healthy volunteers were prospectively included in the study. METHODOLOGY: Ascites and blood samples from the patients were obtained for analysis of inflammatory cytokines using enzyme-linked immunosorbent assay methodology. Blood samples were taken from the healthy volunteers to obtain reference values. RESULTS: Plasma and ascites concentrations of interleukin-1alpha, interleukin-6, and tumor necrosis factor-alpha were significantly elevated in the patients compared with plasma levels in the group of healthy controls. Significant elevation of interleukin-10 concentrations was found in ascites but not in plasma in the patients. There was no significant difference in interleukin-10 levels between patient and control plasma. CONCLUSIONS: The findings suggest that elevated cytokine concentrations in ascites and serum could perpetuate an inflammatory reaction that may be a source of preservation of an ongoing systemic inflammatory reaction. This may contribute to the maintenance, and even progress, of the liver dysfunction, leading to exaggerated ascites development.
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| 12. |
- Friis-Liby, Ingalill, et al.
(författare)
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Ikterus och kolestas
- 2012
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Ingår i: Läkartidningen. - 0023-7205. ; 109:46, s. 2093-6
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Tidskriftsartikel (refereegranskat)
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| 13. |
- Kaczynski, Jerzy, 1951, et al.
(författare)
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Clinical features in hepatocellular carcinoma and the impact of autopsy on diagnosis. A study of 530 cases from a low-endemicity area
- 2005
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Ingår i: Hepatogastroenterology. - 0172-6390. ; 52:66, s. 1798-802
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND/AIMS: Hepatocellular carcinoma (HCC) had been one of the malignancies with the highest reported increase of incidence in Sweden, but during the late 20-year period the incidence has been decreasing. The aims of our study were to state the impact of autopsy on diagnosis and to identify clinical characteristics in HCC. METHODOLOGY: This retrospective study was performed in Goteborg, Sweden and included all cases with a diagnosis of liver cancer from a period with a high autopsy frequency (1958-1979). The cases were reevaluated histopathologically and the autopsy records as well as the case files were scrutinized. RESULTS: The majority (63%) of the 530 biopsy verified cases of HCC were diagnosed unexpectedly at autopsy. Cirrhosis of the liver could be established in 71% of the cases, but was diagnosed or at least clinically suspected before the diagnosis of the tumor only in a minority (19%) of all HCC patients. At presentation, malaise (85%), weight loss (78%), anorexia (67%) and hepatomegaly (84%) were common. The median survival time from diagnosis was one month. In most cases (92%) the cause of death was either directly or indirectly related to HCC and/or underlying liver disease such as advanced tumor disease, hepatic failure and gastrointestinal bleeding. Spontaneous rupture of HCC was the cause of death in 17 cases (3%) CONCLUSIONS: In an unselected population in a low incidence area of HCC, most patients have clinically unknown cirrhosis of the liver and present with vague general paramalignant symptoms. HCC has an extremely poor prognosis. Since HCC, in a majority of cases, remains undiagnosed before death, the autopsy has great impact on the diagnosis. This should be considered in interpretation of results from epidemiological studies.
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| 14. |
- Kaczynski, Jerzy, 1951, et al.
(författare)
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Diabetes: one of few remarkable differences in clinicopathologic features between cirrhotic and noncirrhotic Swedes with hepatocellular carcinoma
- 2006
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Ingår i: Dig Dis Sci. - : Springer Science and Business Media LLC. - 0163-2116. ; 51:4, s. 796-802
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Tidskriftsartikel (refereegranskat)abstract
- The prognosis of hepatocellular carcinoma (HCC) is usually very poor, so increased knowledge of clinicopathologic characteristics and etiologic factors may improve the clinical handling. Because HCC in many patients is unrecognized before death, it is of particular interest to study cases from a period with a high autopsy frequency. The records and liver biopsies from all patients with a diagnosis of primary liver cancer in Goteborg, Sweden, during a 22-year period were scrutinized. Only patients with evaluable non-neoplastic liver tissue were included in the final analysis. The majority (95%) of 478 HCC cases were autopsied and cirrhosis of the liver could be established in 71%. At presentation, general paramalignant symptoms such as malaise, weight loss, anorexia, and hepatomegaly (84%) were common irrespective of cirrhosis. Alcoholism and diabetes mellitus were each significantly more common among cirrhotics (29% and 20%, respectively; P < .001), than among noncirrhotics, in which cholelithiasis was more common (54%; P < .001). The correlation between diabetes and cirrhosis was independent of reported alcoholism. In an unselected population in a low HCC incidence area, there are few differences in clinicopathologic features between cirrhotic and noncirrhotic patients. Diabetes mellitus seems to play an etiologic role in HCC in cirrhotics, and cholelithiasis in noncirrhotics.
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| 15. |
- Kaczynski, Jerzy, 1951, et al.
(författare)
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Increased porphyrins in primary liver cancer mainly reflect a parallel liver disease
- 2009
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Ingår i: Gastroenterol Res Pract. - 1687-6121. ; 2009
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Tidskriftsartikel (refereegranskat)abstract
- Hepatic porphyries have been associated with an increased risk of primary liver cancer (PLC), which on the other hand may cause an increased porphyrin production. To evaluate the role of an underlying liver disorder we analyzed porphyrins in patients with hepatocellular carcinoma (HCC) (n = 65), cholangiocellular carcinoma (n = 3), or suspected PLC, which turned out to be metastases (n = 18) or a benign disorder (n = 11). None of the patients had a family history of porphyry or clinical signs of porphyry. Increased aminolevulinic acid or porphyrin values were common not only in patients with PLC (43%) but also in metastatic (50%) and benign (64%) liver disorders. The corresponding proportion for HCC patients with liver cirrhosis (55%) was higher (P < .05) than in those without cirrhosis (17%). We conclude that symptomatic porphyries are unusual in PLC, whereas elevated urinary and/or faecal porphyrins are common, primarily reflecting a parallel liver disease and not the PLC.
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| 16. |
- Schult, Andreas, 1975, et al.
(författare)
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Waist-to-hip ratio but not body mass index predicts liver cirrhosis in women.
- 2018
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Ingår i: Scandinavian journal of gastroenterology. - : Informa UK Limited. - 1502-7708 .- 0036-5521. ; 53:2, s. 212-217
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Tidskriftsartikel (refereegranskat)abstract
- Being overweight can lead to fatty liver and end-stage liver disease. In men, higher body mass index is associated with higher risk of developing liver cirrhosis. The extent of association between overweight and liver cirrhosis in women is not fully elucidated.This study aimed to investigate the association between overweight and liver cirrhosis in women, taking into account different measures of adipose tissue distribution.A cohort of 1462 middle-aged women was followed over 40years. Cases of liver cirrhosis were identified by linkage to Hospital Discharge and Death Certificate registries. The hazard ratios for different anthropometric measures and liver cirrhosis were obtained by Cox proportional hazard regression, using propensity score methods to adjust for important confounders.During 48,062 person-years of follow-up, 11 cases of liver cirrhosis were identified. The incidence rate in women with waist-to-hip ratio≥0.8 was 131.8 (48.1-287.0), compared to 12.0 (3.9-28.1) in women with a lower ratio. A waist-to-hip ratio≥0.8 was associated with an increased risk of liver cirrhosis, the hazard ratio being 5.8 (95% confidence interval 1.6-21.4). No association between body mass index and liver cirrhosis was found and the hazard ratio for body mass index >25 was 1.8 (0.5-5.8).In women, an unfavorable adipose tissue distribution is more important for development of liver cirrhosis than total body fat per se. When assessing the risk for development of liver cirrhosis in women, waist-to-hip ratio is a better predictor than body mass index.
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| 17. |
- Sigurjónsdóttir, Helga A, 1964, et al.
(författare)
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Lakrits - så mycket mer än godis
- 2015
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Ingår i: Lakartidningen. - 0023-7205 .- 1652-7518. ; 112
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)
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| 18. |
- Sigurjónsdóttir, Helga A, 1964, et al.
(författare)
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Liquorice in moderate doses does not affect sex steroid hormones of biological importance although the effect differs between the genders.
- 2006
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Ingår i: Hormone research. - : S. Karger AG. - 0301-0163. ; 65:2, s. 106-10
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND/AIM: Liquorice is commonly consumed, at least in the western world, and we have earlier shown that even moderate doses of liquorice have significant effects on the cortisol metabolism by inhibiting 11beta-hydroxysteroid dehydrogenase type 2. The suggestion that liquorice decreases the testosterone levels in men makes it vital to study the effect of moderate doses of liquorice on sex steroid hormones. METHODS: Fifteen women and 21 men (healthy volunteers and subjects with essential hypertension) consumed 100 g of liquorice (150 mg glycyrrhetinic acid) daily in a 9-week, open-treatment trial. Blood and 24-hour urine samples were collected for hormone analysis before and after 4 weeks of liquorice consumption and 4 weeks after cessation of liquorice intake. RESULTS: The liquorice induced a moderate decrease in the serum concentrations of dehydroepiandrostenedione sulphate in men (p = 0.002). The relative change in serum levels of dehydroepiandrosterone sulphate differed between the genders (p = 0.03). No significant changes were observed in the serum testosterone levels after 4 weeks of liquorice consumption, and the urine excretion of androgens (etiocholanolone and androstenedione) did not change. CONCLUSIONS: Liquorice in moderate doses primarily affects the cortisol metabolism and only marginally the androgen hormones. Gender may influence the action of liquorice.
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| 19. |
- Sigurjónsdóttir, Helga A, 1964, et al.
(författare)
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The liquorice effect on the RAAS differs between the genders.
- 2006
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Ingår i: Blood pressure. - : Informa UK Limited. - 0803-7051 .- 1651-1999. ; 15:3, s. 169-72
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: Liquorice-induced increase in blood pressure (BP) is more profound in subjects with essential hypertension (HT) than in healthy individuals. Liquorice induces pseudohyperaldosteronism by inhibiting the 11beta-hydroxysteroid dehydrogenase type 2 and is also known to inhibit the renin-angiotensin-aldosterone system (RAAS). We explored the difference in response in BP, considering the RAAS and the genders. DESIGN: Patients with HT (eight men and three women, mean age 40.7 years) and healthy controls (13 men and 12 women, mean age 31.2 years) consumed 100 g of liquorice (150 mg glycyrrhetinic acid) daily for 4 weeks. METHODS: Blood, urine samples and BP were evaluated before and after 4 weeks of liquorice consumption and 4 weeks after cessation of liquorice consumption. RESULTS: The relative change in serum aldosterone levels differed between the genders (p < 0.02), men being more responsive than women, but not between patients with HT and healthy subjects. CONCLUSION: The liquorice-induced inhibition of aldosterone secretion differs between the genders and is not influenced by the BP levels. This difference between the genders has not been exposed before.
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