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- Ahlman, Håkan, 1947, et al.
(författare)
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En "ny" tumörmarkör.
- 1996
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Ingår i: Klinisk Kemi i Norden, 8.. - Göteborg. ; , s. 45-52
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Bokkapitel (övrigt vetenskapligt/konstnärligt)
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| 2. |
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| 3. |
- Fjälling, M, et al.
(författare)
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Systemic radionuclide therapy using indium-111-DTPA-D-Phe1-octreotide in midgut carcinoid syndrome.
- 1996
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Ingår i: Journal of nuclear medicine : official publication, Society of Nuclear Medicine. - 0161-5505. ; 37:9, s. 1519-21
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Tidskriftsartikel (refereegranskat)abstract
- A 55-yr-old woman with a midgut carcinoid syndrome due to metastatic spread of an ileal tumor to the liver, paraortic and mediastinal lymph nodes and to the skeleton was given systemic radionuclide therapy with 111In-DTPA-D-Phe1-octreotide. Before therapy, dosimetric calculations were performed on whole-body scintigraphs and 111In retention was shown to be long-lasting. Excretion was mainly seen during the first 24 hr after injection; thereafter whole-body retention remained stationary at 30%. Indium-111 activity in tumor biopsies and blood was measured using a gamma counter. Very high tumor-to-blood ratios were obtained: 150 for the primary tumor and 400-650 for liver metastases, which further justified radiation therapy. Indium-111-DTPA-D-Phe1-octreotide treatment was given on three separate occasions (3.0, 3.5 and 3.1 GBq) 8 and 4 wk apart. After each therapy, the patient experienced facial flush and pain over the skeletal lesions followed by symptomatic relief, even though no objective tumor regression was found radiologically after 5 mo. After initiation of octreotide treatment, there was a 14% reduction of the main tumor marker, urinary 5-HIAA. After three subsequent radionuclide therapies, there was a further 31% reduction of 5-HIAA levels. No adverse reactions, other than a slight decrease in leukocyte counts, were seen. The mean absorbed radiation dose after the three treatments was estimated to be about 10-12 Gy in liver metastases and 3-6 Gy in other tumors, depending on the size and location of the metastases. Assuming internalization of 111In into tumor cells and a radiobiological effect from short range Auger and conversion electrons, there might be a therapeutic effect on the tumor.
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| 6. |
- Johansson, Bo, 1957-
(författare)
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Methods, design and development of clinical decision support systems based on the Arden syntax : with applications in the clinical laboratory
- 1997
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Decision Support Systems (DSSs) are computer systems that permit explicit representation of knowledge and can execute a computer program that uses the knowledge to assist in the decision process. A clinical DSS uses both clinical data and medical knowledge to help health professionals make clinical decisions. Developing a DSS can be a costly and time-consuming task. Sharing of knowledge can decrease costs and development time and therefore increase the use of DSSs in clinical practice. One of the most important categories of DSSs in medicine is data driven systems where the knowledge base is linked to a clinical database. Methods that support knowledge base-database mapping are necessary when developing clinical DSSs.Arden Syntax is a standard specification for defining and sharing modular health knowledge bases among inflamation systems and institutions. The medical knowledge is written as independent Medical Logic Modules (MLMs) and the scope of the standard is to facilitate sharing of knowledge.In this thesis methods for implementing DSSs based on the Arden Syntax are described. Furthermore, DSS development tools and a system architecture for building clinical DSSs are presented, and design aspects such as database access, system validation, and platform independence are discussed. Clinical laboratory applications, where the DSS is integrated with an existing laboratory infotmation system for use in real time validation and interpretation of laboratory data, are implemented and evaluated. Since the DSS performs tasks that used to be done manually, such as retrieving the patients' previous test results, the system not only increases laboratory services but may also enhance diagnostic proficiency and save time. This experience has led to a search for other areas within the laboratory where a DSS can be both clinically valuable and cost-effective.
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| 8. |
- Wängberg, Bo, 1953, et al.
(författare)
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Survival of patients with disseminated midgut carcinoid tumors after aggressive tumor reduction.
- 1996
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Ingår i: World journal of surgery. - 0364-2313. ; 20:7
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Tidskriftsartikel (refereegranskat)abstract
- Sixty-four consecutive patients with disseminated midgut carcinoids were treated during an 8-year period according to a single clinical protocol aimed at aggressive tumor reduction by surgery alone or with subsequent hepatic artery embolization. All patients had markedly elevated urinary 5-hydroxyindoleacetic acid (5-HIAA) levels (581 +/- 79 micromol/24 h) and hormonal symptoms. Fourteen patients (22%) reached anatomic and biochemical cure by surgery alone. At follow-up, the mean 5-HIAA levels were still normal after 69.0 +/- 6. 2 months; two patients had died from unrelated causes. With the introduction of somatostatin receptor scintigraphy, subclinical disease was diagnosed in 7 of these 14 patients. Forty patients with bilobar hepatic disease underwent embolization in combination with octreotide. In this group, 5-HIAA levels were still reduced by 55% after 71 +/- 11 months of follow-up, and the 5-year survival was 56%, estimated from the total death hazard function. After embolization, two subgroups could be identified with marked differences in their long-term response to treatment. Ten patients were not embolized owing to complicating diseases. The 5-year survival for the entire series was 58%. A significantly increased risk of cardiovascular deaths was seen, which underlines the importance of total survival analysis in a disease with multiple hormonal effects. It is concluded that an active surgical approach must be recommended to patients with the midgut carcinoid syndrome. In patients with bilobar hepatic disease, embolization combined with octreotide treatment markedly reduced the 5-HIAA excretion and suggested a prolonged 5-year survival.
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