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- Hjertberg, Hans, 1946-
(författare)
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The use of ethanol as a marker to detect and quantify the absorption of irrigation fluid during transurethral resection of the prostate
- 1996
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- During transurethral resection of the prostate (TURP), the irrigation fluid is often absorbed by the circulatory system and/or the region around the prostate occasionally resulting in severe signs and symptoms. Instant detection and quantification of absorption of irrigation fluid have not been possible earlier. A method involving tagging of the irrigation fluid with ethamol for detection and quantification of absorbed irrigation fluid by measurement of ethanol in expired breath (EB) has been developed. The validity of measuring El3 ethanol to detect and quantify absorbed irrigation fluid was studied in 13 patients undergoing TURF. The EB ethanol was compared with three other methods: 1. Isotope tagging of the irrigation fluid and detection of absorbed fluid using a scintillation detector placed over large blood vessels. 2. Measuring changes in serum-sodium every 10 min. 3. Regular interval monitoring (RIM) of the difference between volume used for inigation and volume recovered from patients every 10 min. The method of measming El3 ethanol was found to be highly valid. The possibility of detecting absorption and the incidence of absorption using EB ethanol in the clinical routine was studied in 192 patients undergoing TURP. Half of them absorbed irrigation fluid, 25% absorbed more than 400 ml. The proportion of patients absorbing inigationlhlld was the same for both experienced and inexperienced resectionists. Clinical assessment of absorption of irrigation fluid was perfonned by the resectionists and the supervising nurses in 118 patients undergoing TURP. Prerequisites for massive absorption were found by the resectionist in 8/9 patients. The resectionist falsely indicated absorption in 22 patients. The nurses conectly indicated 3/9 patients and falsely indicated 4 patients. To investigate the method measuring EB ethanol to detect absorption of inigation fluid during general anaesthesia, 20 patients undervent TURP and EB ethanol was compared to the RIM method. There was a good correlation between the methods. Elevated pressure in the bladder-prostatic fossa is a prerequisite for absorption of irrigation fluid. Detection and quantification of absorbed irrigation fluid by EB ethanol was used for eompming 102 patients operated on with and without a pressure warning device alarming at 1.5 kPa in the bladder. Using the device reduced both the volume of absorbed irrigation fluid, and the number of patients absorbing irrigation fluid. Both ethanol per se and haemodilution by absorbed irrigation fluid may have impacts on the coagulation system. To investigate the influence of absorption of ethanol tagged mannitol on bleeding time, measurements were perl'omed before and after TURP in 57 patients. No difference in bleeding time was found among patients who absorbed irrigation fluid as compared to those who did not. In conclusion, measurement of ethanol in EB for detection and qum1tification of absorbed irrigation fluid is a highly valid method when compared to three other methods. Absorption of irrigation fluid was found in 50% of the patients tmdergoing TURP. Clinical assessments of absorption of irrigation fluid are inreliable. EB ethanol can be used in patients dllling general anaesthesia. Using a pressure warning device decreases the volume of absorbed irrigation fluid, a~ well as the number of patients absorbing it. Absorption of etillmol tagged mannitol as irrigation fluid has no influence on bleeding time.
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| 2. |
- Holmberg, Håkan, et al.
(författare)
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Economic evaluation of screening for prostate cancer : a randomized populaionbased programme during a 10 year period in Sweden
- 1998
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Ingår i: Health Policy. - 0168-8510 .- 1872-6054. ; 45:2, s. 133-147
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Tidskriftsartikel (refereegranskat)abstract
- Prostate cancer is a growing health problem representing considerable costs. Screening and early curative treatment may reduce morbidity and possibly prevent future escalating costs. However, population screening programmes are generally not well accepted at present due to uncerainty about whether screening for prostate cancer can result in reduced mortality. Evidence from large, randomized, controlled trials is still lacking. The objective of this study was to calculate clinical and economic consequences of general prostate cancer screening based on a limited screening trial in a Swedish community and a decision-tree model. A random selection of 1492 men (50–69 years) were invited to repeated screening in 1987. They have been examined every third year (four rounds). The other 7679 men in the population act as controls. The results show that the total incremental health care costs for prostate cacer will increase by 179 million SEK per year with screening compared to no-screening. The number of detected cases of localized cancer will increase by about 1000, which represents an additional cost of about 158 000 SEK per case. In conclusion, general screening for prostate cancer can be performed with a reasonable cost per detected localized cancer. Information on the long-term effect on life quality and cancer mortality is unknown.
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| 6. |
- Sandblom, Gabriel, et al.
(författare)
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Prostate Cancer Registration in Four Swedish Regions 1996 : Differences in Incidence, Age Structure and Management
- 1999
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Ingår i: Scandinavian Journal of Urology and Nephrology. - : Informa UK Limited. - 0036-5599 .- 1651-2065. ; 33:5, s. 306-311
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: In 1996 registration of prostate cancer in four of the six Swedish regions was started to facilitate evaluation of geographical variations in incidence and treatment.Material and methods: For all cases of prostate cancer, personal identification number, tumour stage, tumour grade and primary treatment were registered.Results: In the four regions covered by the register, 3541 cases of prostate cancer were registered. Altogether there were 5795 cases of prostate cancer diagnosed in Sweden the same year. The age-standardized incidence varied from 89/100 000 to 169/100 000 among counties. The proportion of localized tumours correlated positively to the incidence (p < 0.05) and negatively to mean age at diagnosis (p < 0.01). There was also a significant positive correlation between the proportion of localized tumours and the percentage of patients given curative treatment. All registered variables showed large geographical variations, especially concerning percentage of T1c tumours, treatment of localized tumours and choice of palliative treatment.Conclusion: Diagnostic activity varied considerably among counties, resulting in large variation in age-standardized incidence. High incidence is associated with a larger proportion of localized tumours, which, in turn, is associated with early age at diagnosis. In counties where a policy of detecting tumours early is practised, curative treatment is also given more often. Treatment of localized tumours and preference for palliative treatment seem to depend on local traditions. The lack of cytological and histopathological standards makes geographical comparisons based on tumour grade impossible.
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