1
|
Robert C, Lejeune F, Lebbé C, Lesimple T, Lundström E, Nicolas V, Gavillet B, Grégoire V, Crompton P. Combination of Triptorelin with Nivolumab in ICI Resistant Advanced Melanoma. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz451.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
2
|
Blomberg H, Lundström E, Toss H, Gedeborg R, Johansson J. Agreement between ambulance nurses and physicians in assessing stroke patients. Acta Neurol Scand 2014; 129:49-55. [PMID: 23710712 DOI: 10.1111/ane.12149] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/17/2013] [Indexed: 11/28/2022]
Abstract
OBJECTIVES If an ambulance nurse could bypass the emergency department (ED) and bring suspected stroke patients directly to a CT scanner, time to thrombolysis could be shortened. This study evaluates the level of agreement between ambulance nurses and emergency physicians in assessing the need for a CT scan, and interventions and monitoring beforehand, in patients with suspected stroke and/or a lowered level of consciousness. METHODS From October 2008 to June 2009, we compared the ambulance nurses' and ED physicians' judgement of 200 patients with stroke symptoms. Both groups answered identical questions on patients' need for a CT scan, and interventions and monitoring beforehand. RESULTS There was poor agreement between ambulance nurses and ED physicians in judging the need for a CT scan: κ = 0.22 (95% confidence interval (CI), 0.06-0.37). The nurses' ability to select the same patients as the physician for a CT scan had a sensitivity of 84% (95% CI, 77-89) and a specificity of 37% (95% CI, 23-53). Agreement concerning the need for interventions and monitoring was also low: κ = 0.32 (95% CI, 0.18-0.47). In 18% of cases, the nurses considered interventions before a CT scan unnecessary when the physicians' deemed them necessary. CONCLUSIONS Additional tools to support ambulance nurses decisions appear to be required before suspected stroke patients can be taken directly to a CT scanner.
Collapse
Affiliation(s)
- H. Blomberg
- Department of Surgical Sciences - Anesthesiology and Intensive Care; Uppsala University Hospital; Uppsala Sweden
- Centre of Emergency Medicine; Uppsala University Hospital; Uppsala Sweden
| | - E. Lundström
- Department of Neuroscience - Neurology and Rehabilitation Medicine; Uppsala University Hospital; Uppsala Sweden
| | - H. Toss
- Department of Internal Medicine; Uppsala University Hospital; Uppsala Sweden
| | - R. Gedeborg
- Department of Surgical Sciences - Anesthesiology and Intensive Care; Uppsala University Hospital; Uppsala Sweden
| | - J. Johansson
- Department of Surgical Sciences - Anesthesiology and Intensive Care; Uppsala University Hospital; Uppsala Sweden
- Centre of Emergency Medicine; Uppsala University Hospital; Uppsala Sweden
| |
Collapse
|
3
|
Södergren A, Karp K, Boman K, Eriksson C, Lundström E, Smedby T, Möller B, Rantapää-Dahlqvist S, Wållberg-Jonsson S. FRI0134 Progression of subclinical atherosclerosis over five years in patients with early rheumatoid arthritis. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2012-eular.2591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
|
4
|
Lundström E, Smits A, Terént A, Borg J. Time-course and determinants of spasticity during the first six months following first-ever stroke. J Rehabil Med 2010; 42:296-301. [DOI: 10.2340/16501977-0509] [Citation(s) in RCA: 89] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
|
5
|
Lundström E. I201 Mammographic density and breast cancer. Int J Gynaecol Obstet 2009. [DOI: 10.1016/s0020-7292(09)60201-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
6
|
Hofling M, Lundström E, Azavedo E, Svane G, Hirschberg AL, von Schoultz B. Testosterone addition during menopausal hormone therapy: effects on mammographic breast density. Climacteric 2009; 10:155-63. [PMID: 17453864 DOI: 10.1080/13697130701258812] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To study the effect on mammographic breast density of testosterone addition during combined estrogen/progestogen therapy in postmenopausal women. METHODS A prospective, randomized, double-blind, placebo-controlled trial. A total of 99 women were given 2 mg 17beta-estradiol and 1 mg norethisterone acetate in combination with either a testosterone patch (300 mug/24 h) or a placebo patch. Mammographic breast density at baseline and after 6 months was assessed by visual classification scales and by digitized quantification. A standardized questionnaire was used to quantify subjective breast symptoms. RESULTS Visual classifications showed an increase in mammographic density in 18-30% of the women, with no significant differences between the treatment groups. The mean increase of the area of dense breast during treatment according to digitized assessment was 7.4% in the placebo group and 5.4% in the testosterone group. Breast symptoms showed a positive association with the increase in density (r(s) = 0.34; p < 0.01). Symptoms were most pronounced at 2 months of treatment. Density, both at baseline (r(s) = -0.35; p < 0.01) and change during treatment (r(s) = -0.28; p < 0.01) showed a negative association with free testosterone levels. CONCLUSION The addition of testosterone does not appear to influence mammographic breast density in women concurrently treated with a common oral estrogen/progestogen regimen for a period of 6 months.
Collapse
Affiliation(s)
- M Hofling
- Department of Obstetrics and Gynecology, Karolinska Institutet and University Hospital, Stockholm, Sweden
| | | | | | | | | | | |
Collapse
|
7
|
Lundström E, Sahlin L, Skoog L, Hägerström T, Svane G, Azavedo E, Sandelin K, von Schoultz B. Expression of syndecan-1 in histologically normal breast tissue from postmenopausal women with breast cancer according to mammographic density. Climacteric 2009; 9:277-82. [PMID: 16857657 DOI: 10.1080/13697130600865741] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To analyze the expression of Syndecan-1 in dense and non-dense human breast tissue. METHODS Specimens of histologically normal tissue were obtained from postmenopausal women undergoing surgery for breast cancer. Each tissue block was subject to radiological examination and pair-wise samples of dense and non-dense tissue were collected. Semi-quantitative assessment of immunohistochemical staining intensity for Syndecan-1 and estrogen receptor subtypes was performed. RESULTS The expression of Syndecan-1 in all tissue compartments was significantly higher in dense than in non-dense specimens. The strongest staining was recorded in stromal tissue. There was a strong correlation between epithelial estrogen receptor alpha and stromal cell Syndecan-1 expression in dense tissue (rs = 0.7; p = 0.02). This association was absent in non-dense tissue. CONCLUSION An increase of Syndecan-1 in all tissue compartments and a redistribution from epithelium to stroma may be a characteristic feature for dense breast tissue.
Collapse
Affiliation(s)
- E Lundström
- Department of Obstetrics, Karolinska University Hospital, Stockholm, Sweden
| | | | | | | | | | | | | | | |
Collapse
|
8
|
Lundström E, Bygdeson M, Svane G, Azavedo E, von Schoultz B. Neutral effect of ultra-low-dose continuous combined estradiol and norethisterone acetate on mammographic breast density. Climacteric 2009; 10:249-56. [PMID: 17487652 DOI: 10.1080/13697130701385805] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To compare the effects of two different ultra-low doses of continuous combined hormone therapy and placebo on mammographic breast density in postmenopausal women. METHODS A subpopulation of 255 postmenopausal women from the CHOICE trial were randomly assigned to 0.5 mg 17beta-estradiol (E2) + 0.25 mg norethisterone acetate (NETA), 0.5 mg E2 + 0.1 mg NETA, or placebo. Women using hormone replacement therapy (HRT) up to 2 months prior to the study were excluded; 154 women fulfilled the inclusion criteria. Mammograms were performed at baseline and after 6 months. Breast density was evaluated by visual classification scales and a computer-assisted digitized technique. RESULTS No significant differences were detected between the active treatment groups and the placebo group in the digitized quantification. The mean baseline values for density around 20% were unchanged after 6 months. Also, visual classifications showed no increase in breast density in any study group. CONCLUSION In contrast to currently available bleed-free regimens, the new ultra-low-dose combination of 0.5 mg E2 and 0.1 mg NETA seems to have very little or even a neutral effect on the breast. Both digitized quantification and visual assessment of breast density were unchanged after 6 months. Larger prospective studies should be performed to confirm this new finding.
Collapse
Affiliation(s)
- E Lundström
- Department of Obstetrics, Karolinska University Hospital, Stockhom, Sweden
| | | | | | | | | |
Collapse
|
9
|
Lundström E, Wilczek B, von Palffy Z, Söderqvist G, von Schoultz B. Mammographic breast density during hormone replacement therapy: effects of continuous combination, unopposed transdermal and low-potency estrogen regimens. Climacteric 2009. [DOI: 10.1080/cmt.4.1.42.48] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
10
|
|
11
|
Abstract
OBJECTIVE To estimate the prevalence of disabling spasticity (DS) 1 year after first-ever stroke. DESIGN Cross-sectional survey 1 year after first-ever stroke. METHODS Patients above 18 years from one county with first-ever stroke were identified by use of the national stroke registry. A representative sample of 163 patients was created and 140 of these were followed up. Assessments of motor function and ability with the modified Ashworth Scale, the modified Rankin Scale (mRS), the Barthel Index (BI) and clinical evaluation were performed in order to identify patients with spasticity-related disability. RESULTS The observed prevalence of any spasticity was 17% and of DS 4%. Patients with DS scored significantly worse than those with no DS on the mRS (P = 0.009) and the BI (P = 0.005). DS was more frequent in the upper extremity, correlated positively with other indices of motor impairment and inversely with age. There was an independent effect of severe upper extremity paresis (OR 22, CI 3.9-125) and age below 65 years (OR 9.5, CI 1.5-60). CONCLUSIONS The prevalence of DS after first-ever stroke is low but corresponds to a large number of patients and deserves further attention with regards to prevention and treatment.
Collapse
Affiliation(s)
- E Lundström
- Department of Neuroscience, Neurology, Uppsala University Hospital, Uppsala, Sweden.
| | | | | |
Collapse
|
12
|
Lundström E, Brodin G, Lundin J, Marklund M, Bingham R, Collier J, Mendonça JT, Norreys P. Using high-power lasers for detection of elastic photon-photon scattering. Phys Rev Lett 2006; 96:083602. [PMID: 16606179 DOI: 10.1103/physrevlett.96.083602] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2005] [Indexed: 05/08/2023]
Abstract
The properties of four-wave interaction via the nonlinear quantum vacuum is investigated. The effect of the quantum vacuum is to generate photons with new frequencies and wave vectors, due to elastic photon-photon scattering. An expression for the number of generated photons is derived, and using state-of-the-art laser data it is found that the number of photons can reach detectable levels. In particular, the prospect of using the high-repetition Astra Gemini system at the Rutherford Appleton Laboratory is discussed. The problem of noise sources is reviewed, and it is found that the noise level can be reduced well below the signal level. Thus, detection of elastic photon-photon scattering may for the first time be achieved.
Collapse
Affiliation(s)
- E Lundström
- Department of Physics, Umeå University, SE-901 87 Umeå, Sweden
| | | | | | | | | | | | | | | |
Collapse
|
13
|
Abstract
OBJECTIVES The aims were to characterize the movements in cervical dystonia (CD) by using an estimate of the mechanical power and work involved in the movements and to describe this through a movement energy index (MEI). MATERIALS AND METHODS The subjects (patients n = 6, controls n = 6) were seated in front of a screen with a laser pointer attached to a headband while they performed standardized movements. A three-dimensional motion capture system was used and a test-retest was performed. RESULTS The mean value of MEI was significantly higher for the patients than for the controls. There was no significant difference between MEI from test to retest for the patients but there was a significant difference between MEI from test to retest for the controls. CONCLUSION This study suggests that MEI could be a useful measure for the quantification of movement dysfunction in CD and thus an objective outcome measure in comparison of different therapies.
Collapse
Affiliation(s)
- L Zetterberg
- Department of Neuroscience, Section of Physiotherapy, University of Uppsala, Uppsala, Sweden.
| | | | | | | | | | | |
Collapse
|
14
|
Jonsson SW, Backman C, Johnson O, Karp K, Lundström E, Sundqvist KG, Dahlqvist SR. Increased prevalence of atherosclerosis in patients with medium term rheumatoid arthritis. J Rheumatol 2001; 28:2597-602. [PMID: 11764203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
OBJECTIVE To measure the extent of atherosclerosis in patients with rheumatoid arthritis (RA) with a disease duration of considerable length, and in age and sex matched individuals. METHODS Thirty-nine patients with RA (30 women, 9 men) with disease onset occurring between 1974 and 1978, and less than 65 years of age at the time of investigation, were enrolled together with 39 sex and age matched controls. Quantitative measurement of intima-media thickness (IMT) and semiquantitative assessment of the presence of plaque were undertaken by B-mode ultrasound of the common carotid artery (CCA-IMT) and the common femoral artery on the right-hand side. Echo Doppler cardiography was performed with an Accuson Aspen. The results were related to disease activity variables and accumulated disease activity, to lipid levels [i.e., cholesterol, high density lipoproteins, low density lipoproteins, triglycerides (TG)], to hemostatic factors [tissue plasminogen activator antigen (tPAag), plasminogen activator inhibitor-1 (PAI-1), von Willebrand factor (vWF)], and to soluble adhesion molecules (sICAM-1 and sE-selectin). RESULTS Patients with RA had higher maximal and mean IMT values compared with controls. The difference concerning mean CCA-IMT reached statistical significance in patients with RA and correlated significantly with lipids (cholesterol, LDL, LDL/HDL ratio, TG) and tPAag. The prevalence of plaques, as well as of aortic cusp sclerosis, was higher in RA but only the difference in aortic cusp sclerosis was statistically significant. Patients with plaques had significantly higher levels of lipids (cholesterol, LDL, LDL/HDL ratio) than patients without plaques, while patients with cusp sclerosis had significantly higher cholesterol and TG levels. sICAM-1 was significantly higher both in patients with plaques and in those with aortic cusp sclerosis compared to patients without. CONCLUSION Our results suggest an accelerated atherosclerosis in patients with RA that is related mainly to lipid levels.
Collapse
Affiliation(s)
- S W Jonsson
- Department of Rheumatology, University Hospital of Umeå, Sweden
| | | | | | | | | | | | | |
Collapse
|
15
|
Lundström E, Wilczek B, von Palffy Z, Söderqvist G, von Schoultz B. Mammographic breast density during hormone replacement therapy: effects of continuous combination, unopposed transdermal and low-potency estrogen regimens. Climacteric 2001; 4:42-8. [PMID: 11379377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
Abstract
OBJECTIVE The aim of this study was to evaluate the impact of different hormone replacement therapy (HRT) regimens on mammographic breast density. STUDY DESIGN Mammographic density was recorded in women participating in a population-based screening program. At first mammogram, all women were non-users of HRT, and thereafter reported continuous use of the same HRT regimen. The study population comprised 158 women: a total of 52 women were using continuous combined HRT (conjugated equine estrogen 0.625 mg plus medroxyprogesterone acetate 5 mg); 51 women were using low-dose oral estrogen alone (estriol 2 mg daily); and 55 women were using unopposed transdermal estrogen given as a patch (estradiol 50 micrograms/24 h). Films were coded and analyzed for mammographic density by an independent radiologist blinded to treatments. Mammographic density was classified according to Wolfe. RESULTS An increase in mammographic density was much more common among women taking continuous combined HRT (40%) than for those using oral low-dose estrogen (6%) and transdermal (2%) treatment. The increase in density was already apparent at the first visit after starting HRT. During long-term follow-up, there was very little change in mammographic status. CONCLUSION HRT regimens were shown to have different effects on the normal breast. There is an urgent need to clarify the biological nature and significance of a change in mammographic density during treatment and, in particular, its relation to symptoms and breast cancer risk.
Collapse
Affiliation(s)
- E Lundström
- Department of Obstetrics and Gynecology, Karolinska Hospital, Stockholm, Sweden
| | | | | | | | | |
Collapse
|
16
|
Lundström E, Wilczek B, von Palffy Z, Söderqvist G, von Schoultz B. Mammographic breast density during hormone replacement therapy: differences according to treatment. Am J Obstet Gynecol 1999; 181:348-52. [PMID: 10454681 DOI: 10.1016/s0002-9378(99)70560-0] [Citation(s) in RCA: 115] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Our purpose was to investigate the effects of various hormone replacement regimens on mammographic breast density. STUDY DESIGN Mammographic density was recorded in women participating in a population-based screening program. All women were nonusers of hormone replacement therapy at first mammogram and thereafter reported continuous use of the same treatment: estrogen alone (n = 50) or estrogen in cyclic (n = 75) or continuous (n = 50) combination with progestogen. Mammographic density was quantified according to the Wolfe classification. RESULTS An increase in mammographic density was much more common among women receiving continuous combination hormone replacement therapy (52%) than among those receiving cyclic (13%) and estrogen-only (18%) treatment. The increase in density was apparent already at first visit after the start of hormone replacement therapy. There was little change in mammographic status during long-term follow-up. CONCLUSION Regimens of hormone replacement therapy were shown to have different effects on the normal breast. There is an urgent need to clarify the biologic nature and significance of a change in mammographic density during treatment and, in particular, its relation to symptoms and breast cancer risk.
Collapse
Affiliation(s)
- E Lundström
- Department of Obstetrics and Gynecology, Karolinska Hospital, Stockholm, Sweden
| | | | | | | | | |
Collapse
|
17
|
Finizia C, Dotevall H, Lundström E, Lindström J. Acoustic and perceptual evaluation of voice and speech quality: a study of patients with laryngeal cancer treated with laryngectomy vs irradiation. Arch Otolaryngol Head Neck Surg 1999; 125:157-63. [PMID: 10037282 DOI: 10.1001/archotol.125.2.157] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE To compare voice and speech function in patients who underwent laryngectomy with that of 2 control groups. DESIGN A cross-sectional study comparing acoustic and temporal variables with perceptual evaluations in 3 subject groups. SETTING University hospital in Göteborg, Sweden. SUBJECTS Two groups of patients with laryngeal carcinoma were examined: 12 male patients who had laryngectomy and were using a tracheoesophageal prosthesis and 12 male patients treated with radical radiotherapy who had a preserved larynx. The third group consisted of 10 normal controls without laryngeal disease. MAIN OUTCOME MEASURES Acoustic variables were fundamental frequency, absolute fundamental frequency perturbation, speech rate, and maximum phonation time. Perceptual evaluation included 15 listeners' perceptual evaluation and the patients' self-assessment of speech intelligibility, voice quality, and speech acceptability. RESULTS No significant acoustic or temporal differences were found between the laryngectomy and radical radiotherapy groups. There was a significant difference between the patient groups in perceptual evaluation. Both groups of patients differed from normal controls in acoustic and temporal measures, where the laryngectomy group generally deviated more from the normal controls than the patient group treated with radiotherapy. There was a weak, but significant, correlation between absolute fundamental frequency perturbation and perceived voice quality. CONCLUSIONS Perceptual evaluations could indicate significant differences between the patients who underwent laryngectomy and irradiated patients, where the acoustic analysis failed to reflect these differences. Both patient groups could be distinguished according to acoustic and temporal measures when compared with normal controls. The acoustic analyses were more sufficient in voices without severe dysfunction.
Collapse
Affiliation(s)
- C Finizia
- Department of Otorhinolaryngology, Sahlgrenska University Hospital, Göteborg, Sweden.
| | | | | | | |
Collapse
|
18
|
Ekercrantz T, Lundström E. Zur Kenntnis des Wachsöles. Arch Pharm (Weinheim) 1910. [DOI: 10.1002/ardp.19102480236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
|