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Östermalm, Sweden

Cheng G.,Karolinska Institutet | Cheng G.,Karolinska University Hospital | Butler R.,University of Houston | Warner M.,University of Houston | And 4 more authors.
Menopause | Year: 2013

Objective: The aim of this study was to evaluate among postmenopausal women the effects of a 3-month treatment with estradiol (E2) alone or in combination with norethindrone acetate (NA) on expression of hormone receptors and proliferation in the breast as well as on lipids and climacteric symptoms. Methods: Sixty healthy postmenopausal women were computer-randomized into two groups, with one group receiving 1 mg of E2 and the other group receiving 1 mg of E2 and 0.5 mg of NA daily for 12 weeks. Before and after treatment, middle-needle biopsies were obtained for histology and investigation of the expression levels of estrogen receptors (ERs; ER-α and ER-β), progesterone receptors (PRs; PR-A and PR-B), androgen receptor (AR), the proliferation marker Ki67, and collagen. Climacteric symptoms were recorded, and serum was collected to measure lipoprotein levels. Results: Fifty-six women finished the 12-week study. Proliferating cells (Ki67-positive) were very rare in all but a few of the untreated women. There were proliferating cells in both E2-and E2/NA-treated groups; however, these were not widespread and limited to nests of cells that amounted to 2% of the total epithelial cells. Some of these nests were positive for human epithelial growth factor receptor 2. Treatments caused no marked changes in the expression of ER->, ER-A, or AR. However, both treatments resulted in an increase in PR-A and PR-B expressions. The presence of collagen was clearly associated with a mammographic diagnosis of dense breasts, but neither hormone treatment affected breast density. Both E2 and E2/NA treatments were effective in relieving hot flashes and sweating without adverse effects on blood pressure, weight, and liver, kidney, and thyroid functions. A decrease in cholesterol, high-density lipoprotein cholesterol, and low-density lipoprotein cholesterol was induced by E2/NA but not by E2. Conclusions: This short-term prospective study shows that E2 and estrogen-progestogen treatment can up-regulate PRs but do not significantly affect ERs, AR, proliferation, or breast density. © 2013 by The North American Menopause Society. Source

Fahlen M.,Capio St. Gorans Hospital | Fahlen M.,Karolinska University Hospital | Fornander T.,Karolinska University Hospital | Johansson H.,Karolinska University Hospital | And 3 more authors.
European Journal of Cancer | Year: 2013

Background: The management of hormonal deficiency symptoms in breast cancer survivors is an unsolved problem. While hormone replacement therapy (HRT) may increase the risk of breast cancer in healthy women, its effects on recurrence is unclear. Observational studies have suggested decreased recurrence rates from HRT. The few clinical trials in this field have all been closed preterm. Methods: The Stockholm trial was started in 1997 and designed to minimise the dose of progestogen in the HRT arm. Disease-free women with a history of breast cancer were randomised to HRT (n = 188) or no HRT (n = 190). The trial was stopped in 2003 when another Swedish study (HABITS, the Hormonal Replacement After Breast Cancer-Is it Safe?) reported increased recurrence. However the Stockholm material showed no excess risk after 4 years of follow-up. A long term follow-up has now been performed. Findings: After 10.8 years of follow-up, there was no difference in new breast cancer events: 60 in the HRT group versus 48 among controls (hazard ratio (HR) = 1.3; 95% confidence interval (CI) = 0.9-1.9). Among women on HRT, 11 had local recurrence and 12 distant metastases versus 15 and 12 for the controls. There were 14 contra-lateral breast cancers in the HRT group and four in the control group (HR = 3.6; 95% CI = 1.2-10.9; p = 0.013). No differences in mortality or new primary malignancies were found. Interpretation: The number of new events did not differ significantly between groups, in contrast to previous reports. The increased recurrence in HABITS has been attributed to higher progestogen exposure. As both trials were prematurely closed, data do not allow firm conclusions. Both studies found no increased mortality from breast cancer or other causes from HRT. Current guidelines typically consider HRT contraindicated in breast cancer survivors. Findings suggest that, in some women symptom relief may outweigh the potential risks of HRT. © 2012 Elsevier Ltd. All rights reserved. Source

Weiss R.J.,Karolinska University Hospital | Weiss R.J.,Karolinska Institutet | Thorsell M.,Capio St. Gorans Hospital | Stark A.,Karolinska Institutet | And 4 more authors.
Acta Orthopaedica | Year: 2014

Background and purpose - There is an increase in demand for primary and revision total knee joint procedures. We studied implant survival and functional outcome of patients operated with a constrained condylar knee (CCK) or a rotating hinge implant (RH) as a primary or a revision total knee arthoplasty (TKA). Patients and methods - We evaluated clinically and radiographically 65 surgical procedures with a mean follow-up time of 5 (2-9) years (40 CCK and 25 RH). There were 24 primary TKAs - due to instability - and 41 revision TKAs, mostly due to aseptic loosening. Mean age at the index operation was 68 (31-88) years. Results - Overall, there were 12 failures, including 8 reoperations due to deep infection. The overall 5-year survival rate with reoperation as the endpoint was 82% (95% CI: 72-99). Radiolucent lines on either the femoral or the tibial side were seen in 36 cases. When comparing the cases that were operated as a primary TKA or as a revision TKA, function, health-related quality of life, and survival were similar. However, after primary TKA the patients generally had less pain and a higher proportion of patients were very satisfied or satisfied. Interpretation - Although a high rate of severe complications was observed, most patients improved in function after surgery regardless of whether it was a primary or a revision TKA. We found narrow radiolucent lines - mainly on the tibial side - in nearly half of the cases, but none of the implants were loose radiographically. Overall patient satisfaction and health-related quality of life were high, and a minority had problems with persistent pain. © 2014, Informa Healthcare. All rights reserved. Source

Blomgren L.,Karolinska University Hospital | Dahlberg-Akerman A.,Capio St. Gorans Hospital | Thermaenius P.,Capio St. Gorans Hospital | Bergqvist D.,Uppsala University Hospital
British Journal of Surgery | Year: 2011

Background: Routine preoperative duplex examination led to an improvement in results 2 years after surgery for primary varicose veins. The aim of the present study was to evaluate the impact of preoperative duplex imaging after 7 years, in relation to other risk factors for varicose vein recurrence. Methods: Patients with primary varicose veins were randomized to operation with (group 1), or without (group 2) preoperative duplex imaging. The same patients were invited to attend follow-up with interview, clinical examination and duplex imaging. Quality of life (QoL) was measured with the Short Form 36 questionnaire. Results: Some 293 patients (343 legs) were included initially; after 7 years 227 were interviewed, or their records reviewed: 114 in group 1 and 113 in group 2. One hundred and ninety-four legs (95 in group 1 and 99 in group 2) were examined clinically and with duplex imaging. Incompetence was seen at the saphenofemoral junction and/or saphenopopliteal junction in 14 per cent of legs in group 1 and 46 per cent in group 2 (P < 0·001). QoL was similar in both groups. After a mean follow-up of 7 years (and including patients who underwent surgery after the review), 15 legs in group 1 needed reoperation and 38 in group 2 (P = 0·001). Conclusion: Routine preoperative duplex imaging improved the results of surgery for primary varicose veins for at least 7 years. Registration number: NCT01195623 (). Copyright © 2011 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. Source

von Heideken J.,Karolinska University Hospital | Bostrom Windhamre H.,Capio St. Gorans Hospital | Une-Larsson V.,Capio St. Gorans Hospital | Ekelund A.,Capio St. Gorans Hospital
Journal of Shoulder and Elbow Surgery | Year: 2013

Background: Outcomes for patients with acromioclavicular joint dislocation, Rockwood type V, treated with acute or delayed hook plate surgery were investigated. Materials and methods: Patients treated with a hook plate for acromioclavicular joint dislocation, Rockwood type V, were retrospectively evaluated 1 to 8 years after the injury. Of 41 patients, 37 were re-evaluated, 32 in person and 5 by telephone or letter. The acute surgery group comprised 22 patients operated on with a hook plate within 4 weeks after the injury. The delayed surgery group comprised 15 patients, with unacceptable pain or functional disability after a minimum of 4 months of conservative treatment, who were operated on with modified Weaver-Dunn procedure augmented with a hook plate. The evaluation was based on radiographs, registration of activity level, and shoulder function. Results: The median Constant Score was 91 for the acute surgery group and 85 for the delayed surgery group (P = .097). The acutely treated patients had better outcomes according to the median Shoulder Pain and Disability Index (SPADI; P = .006), shortened version of the Disabilities of the Arm, Shoulder, and Hand (QuickDASH; P = .002), and Subjective Shoulder Value (P = .032). The acutely treated patients had less pain in their injured shoulder during rest (P = .014) and during movement (P = .005). There was a significant difference in subluxation between the groups in favor of the acute group, shown by weighted radiographs (P = .011), but no significant relation between subluxation on the weighted radiographs and the shoulder function according to Constant Score at follow-up (rs = .122, P = .619). Conclusions: Patients treated with acute surgery had a more satisfactory outcome than those with late surgery after failed conservative treatment. © 2013 Journal of Shoulder and Elbow Surgery Board of Trustees. Source

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