Clinical science Lund

Skane, Sweden

Clinical science Lund

Skane, Sweden

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Stuart A.,Central Hospital | Amer-wahlin I.,Karolinska Institutet | Gudmundsson S.,Lund University | Marsal K.,Clinical science Lund | And 3 more authors.
Ultrasound in Obstetrics and Gynecology | Year: 2010

Objective Maternal diabetes during pregnancy is associated with congenital cardiac malformations and hypertrophic cardiomyopathy. Blood flow in the ductus venosus (DV) has been postulated to reflect cardiac function. The aim of our study was to investigate if diabetic pregnancies exhibit abnormal DV hemodynamics, hence indicating changes in fetal cardiac function. Methods The pulsatility index of the DV (DV-PI) was analyzed retrospectively in 142 diabetic patients and compared to previously published DV-PI reference values from a non-diabetic low-risk population. DV values were then correlated with maternal glycosylated hemoglobin (HbA1c). Results DV-PI was significantly higher in pregnancies complicated by either pre-existing insulin-dependent (DM) or gestational diabetes when compared with normal reference values. IncreasedDV-PI values were still evident in both diabetic groups when neonates that were small-for-gestational age and neonates with pathological umbilical blood flow pattern were excluded from the analysis. In DM pregnancies a statistically significant correlation was found between DV-PI and maternal HbA1c. Conclusion Diabetic pregnancies exhibit increased DVPI values when compared to a normal low-risk pregnant population, possibly indicating a fetal cardiac effect. © 2010 ISUOG. Published by John Wiley & Sons, Ltd.


Falck A.K.,Clinical science Lund | Falck A.K.,Hospital of Helsingborg | Rome A.,Lund University | Rome A.,Skåne University Hospital | And 6 more authors.
British Journal of Surgery | Year: 2016

Background Diagnosis by screening mammography is considered an independent positive prognostic factor, although the data are not fully in agreement. The aim of the study was to explore whether the mode of detection (screening-detected versus symptomatic) adds prognostic information to the St Gallen molecular subtypes of primary breast cancer, in terms of 10-year cumulative breast cancer mortality (BCM). Methods A prospective cohort of patients with primary breast cancer, who had regularly been invited to screening mammography, were included. Tissue microarrays were constructed from primary tumours and lymph node metastases, and evaluated by two independent pathologists. Primary tumours and lymph node metastases were classified into St Gallen molecular subtypes. Cause of death was retrieved from the Central Statistics Office. Results A total of 434 patients with primary breast cancer were included in the study. Some 370 primary tumours and 111 lymph node metastases were classified into St Gallen molecular subtypes. The luminal A-like subtype was more common among the screening-detected primary tumours (P = 0·035) and corresponding lymph node metastases (P = 0·114) than among symptomatic cancers. Patients with screening-detected tumours had a lower BCM (P = 0·017), and for those diagnosed with luminal A-like tumours the 10-year cumulative BCM was 3 per cent. For patients with luminal A-like lymph node metastases, there was no BCM. In a stepwise multivariable analysis, the prognostic information yielded by screening detection was hampered by stage and tumour biology. Conclusion The prognosis was excellent for patients within the screening programme who were diagnosed with a luminal A-like primary tumour and/or lymph node metastases. Stage, molecular pathology and mode of detection help to define patients at low risk of death from breast cancer. © 2016 The Authors. BJS published by John Wiley & Sons Ltd on behalf of BJS Society Ltd.


PubMed | Lund University, Unilabs Pathology Unit, Clinical science Lund and Linköping University
Type: Journal Article | Journal: The British journal of surgery | Year: 2016

Diagnosis by screening mammography is considered an independent positive prognostic factor, although the data are not fully in agreement. The aim of the study was to explore whether the mode of detection (screening-detected versus symptomatic) adds prognostic information to the St Gallen molecular subtypes of primary breast cancer, in terms of 10-year cumulative breast cancer mortality (BCM).A prospective cohort of patients with primary breast cancer, who had regularly been invited to screening mammography, were included. Tissue microarrays were constructed from primary tumours and lymph node metastases, and evaluated by two independent pathologists. Primary tumours and lymph node metastases were classified into St Gallen molecular subtypes. Cause of death was retrieved from the Central Statistics Office.A total of 434 patients with primary breast cancer were included in the study. Some 370primary tumours and 111 lymph node metastases were classified into St Gallen molecular subtypes. The luminal A-like subtype was more common among the screening-detected primary tumours (P=0035) and corresponding lymph node metastases (P=0114) than among symptomatic cancers. Patients with screening-detected tumours had a lower BCM (P=0017), and for those diagnosed with luminal A-like tumours the 10-year cumulative BCM was 3 per cent. For patients with luminal A-like lymph node metastases, there was no BCM. In a stepwise multivariable analysis, the prognostic information yielded by screening detection was hampered by stage and tumour biology.The prognosis was excellent for patients within the screening programme who were diagnosed with a luminal A-like primary tumour and/or lymph node metastases. Stage, molecular pathology and mode of detection help to define patients at low risk of death from breast cancer.


Ivarsson K.M.,Clinical science Lund | Akaberi S.,Skåne University Hospital | Isaksson E.,VO Urology | Reihner E.,Karolinska University Hospital | And 4 more authors.
Nephrology Dialysis Transplantation | Year: 2015

Background. Secondary hyperparathyroidism is a common condition in patients with end-stage renal disease and is associated with osteoporosis and cardiovascular disease. Despite improved medical treatment, parathyroidectomy (PTX) is still necessary for many patients on renal replacement therapy. The aim of this study was to evaluate the effect of PTX on patient survival. Methods. A nested index-referent study was performed within the Swedish Renal Registry (SRR). Patients on maintenance dialysis and transplantation at the time of PTX were analysed separately. The PTX patients in each of these strata were matched for age, sex and underlying renal diseases with up to five referent patients who had not undergone PTX. To calculate survival time and hazard ratios, indexes and referents were assigned the calendar date (d) of the PTX of the index patient. The risk of death after PTX was calculated using crude and adjusted Cox proportional hazards regressions. Results. There were 20 056 patients in the SRR between 1991 and 2009. Of these, 579 (423 on dialysis and 156 with a renal transplant at d) incident patients with PTX were matched with 1234/892 non-PTX patients. The adjusted relative risk of death was a hazard ratio (HR) of 0.80 [95% confidence interval (CI) 0.65-0.99] for dialysis patients at d who had undergone PTX compared with matched patients who had not. Corresponding results for the patients with a renal allograft at d were an HR of 1.10 (95% CI 0.71-1.70). Conclusions. PTX was associated with improved survival in patients on maintenance dialysis but not in patients with renal allograft. © The Author 2015. Published by Oxford University Press.


PubMed | VO Urology, Skåne University Hospital, Helsingborg Hospital, Clinical science Lund and Karolinska University Hospital
Type: Journal Article | Journal: Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association | Year: 2015

Secondary hyperparathyroidism is a common condition in patients with end-stage renal disease and is associated with osteoporosis and cardiovascular disease. Despite improved medical treatment, parathyroidectomy (PTX) is still necessary for many patients on renal replacement therapy. The aim of this study was to evaluate the effect of PTX on patient survival.A nested index-referent study was performed within the Swedish Renal Registry (SRR). Patients on maintenance dialysis and transplantation at the time of PTX were analysed separately. The PTX patients in each of these strata were matched for age, sex and underlying renal diseases with up to five referent patients who had not undergone PTX. To calculate survival time and hazard ratios, indexes and referents were assigned the calendar date (d) of the PTX of the index patient. The risk of death after PTX was calculated using crude and adjusted Cox proportional hazards regressions.There were 20 056 patients in the SRR between 1991 and 2009. Of these, 579 (423 on dialysis and 156 with a renal transplant at d) incident patients with PTX were matched with 1234/892 non-PTX patients. The adjusted relative risk of death was a hazard ratio (HR) of 0.80 [95% confidence interval (CI) 0.65-0.99] for dialysis patients at d who had undergone PTX compared with matched patients who had not. Corresponding results for the patients with a renal allograft at d were an HR of 1.10 (95% CI 0.71-1.70).PTX was associated with improved survival in patients on maintenance dialysis but not in patients with renal allograft.


Englund M.,Musculoskeletal science | Englund M.,Lund University | Englund M.,Boston University | Joud A.,Musculoskeletal science | And 6 more authors.
Rheumatology | Year: 2010

Objectives: To gain updated estimates of prevalence and incidence of RA and proportion on biological treatment in southern Sweden. Methods: Inpatient and outpatient health care provided to residents in the southernmost county of Sweden (1.2 million inhabitants) is registered in the Skåne Health Care Register (SHCR). We identified residents aged ≥20 years who had received a diagnosis of RA at least twice during 2003-08. Valid point prevalence estimates by 31 December 2008 were obtained by linkage to the Swedish population register, and information on biological treatment was obtained from the South Swedish Arthritis Treatment Group register. We also tested our estimates of RA occurrence in a series of sensitivity analyses to investigate the effect of altered case criteria and the uncertainty generated by clinical visits without diagnoses. Results: The prevalence of RA in adults was estimated to 0.66% (women = 0.94%, men = 0.37%). The prevalence peaked at age 70-79 years (women = 2.1%, men = 1.1%) before dropping in those aged ≥80 years. Of prevalent cases, 20% had ongoing biological treatment, a percentage that was highest in women aged 40-49 years (36%). The incidence of RA in 2008 was estimated as 50/100 000 (women = 68/100 000, men = 32/100 000). Conclusions: When compared with a previous report from southern Sweden, the prevalence of RA seems not to have declined in the last decade. The proportion of patients with ongoing biological treatment was slightly higher in women than men. SHCR data are promising additions to other methods to gain frequency estimates of clinically important disease in a timely and cost-efficient manner. © The Author 2010.


Kijowski R.,University of Wisconsin - Madison | Roemer F.,Friedrich - Alexander - University, Erlangen - Nuremberg | Roemer F.,Boston University | Englund M.,Clinical science Lund | And 4 more authors.
Osteoarthritis and Cartilage | Year: 2014

Joint injury has been recognized as a potent risk factor for the onset of osteoarthritis. The vast majority of studies using imaging technology for longitudinal assessment of patients following joint injury have focused on the injured knee joint, specifically in patients with anterior cruciate ligament injury and meniscus tears where a high risk for rapid onset of post-traumatic osteoarthritis is well known. Although there are many imaging modalities under constant development, magnetic resonance (MR) imaging is the most important instrument for longitudinal monitoring after joint injury. MR imaging is sensitive for detecting early cartilage degeneration and can evaluate other joint structures including the menisci, bone marrow, tendons, and ligaments which can be sources of pain following acute injury. In this review, focusing on imaging following acute knee trauma, several studies were identified with promising short-term results of osseous and soft tissue changes after joint injury. However, studies connecting these promising short-term results to the development of osteoarthritis were limited which is likely due to the long follow-up periods needed to document the radiographic and clinical onset of the disease. Thus, it is recommended that additional high quality longitudinal studies with extended follow-up periods be performed to further investigate the long-term consequences of the early osseous and soft tissue changes identified on MR imaging after acute knee trauma. © 2014 Osteoarthritis Research Society International.


PubMed | Clinical science Lund
Type: Journal Article | Journal: Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology | Year: 2013

To evaluate the prediction of large-for-gestational age (LGA) term neonates using the routine third-trimester ultrasound examination and to investigate whether the prediction could be further improved by adding information on maternal characteristics.Information on 56,792 singleton term pregnancies with a routine ultrasound examination at 32-34weeks gestation was retrieved from a population-based perinatal register. Estimated fetal weights (FW) were expressed as gestational age-specific standard deviation scores (Z-scores). The prediction of LGA was assessed by receiver-operating characteristics (ROC) curves, with LGA defined as birth weight Z-score>+2. The data set with complete clinical information (n=48,809) was divided into a development and a validation set. Using the development set, multiple logistic regression analysis was performed to identify maternal characteristics associated with LGA. The odds ratios obtained were converted into likelihood ratios. These were then applied to the validation set and the probability for LGA for each infant was estimated using the Bayesian theorem.The FW Z-score showed a high predictive ability for LGA (area under the ROC curve (AUC) 0.89 (95% CI, 0.89-0.90)). Prediction was further improved by using the model that included both FW Z-scores and maternal variables (AUC 0.91 (95% CI, 0.90-0.92)) (P for difference<10(-6) ). The corresponding AUC for a model including maternal characteristics only was 0.74 (95% CI, 0.73-0.76).Routine third-trimester ultrasound FW estimation is effective in the prediction of LGA neonates at term. The prediction of LGA might be further improved by using a model including maternal characteristics.


PubMed | Friedrich - Alexander - University, Erlangen - Nuremberg, Boston University, University of Wisconsin - Madison and Clinical science Lund
Type: Journal Article | Journal: Osteoarthritis and cartilage | Year: 2014

Joint injury has been recognized as a potent risk factor for the onset of osteoarthritis. The vast majority of studies using imaging technology for longitudinal assessment of patients following joint injury have focused on the injured knee joint, specifically in patients with anterior cruciate ligament injury and meniscus tears where a high risk for rapid onset of post-traumatic osteoarthritis is well known. Although there are many imaging modalities under constant development, magnetic resonance (MR) imaging is the most important instrument for longitudinal monitoring after joint injury. MR imaging is sensitive for detecting early cartilage degeneration and can evaluate other joint structures including the menisci, bone marrow, tendons, and ligaments which can be sources of pain following acute injury. In this review, focusing on imaging following acute knee trauma, several studies were identified with promising short-term results of osseous and soft tissue changes after joint injury. However, studies connecting these promising short-term results to the development of osteoarthritis were limited which is likely due to the long follow-up periods needed to document the radiographic and clinical onset of the disease. Thus, it is recommended that additional high quality longitudinal studies with extended follow-up periods be performed to further investigate the long-term consequences of the early osseous and soft tissue changes identified on MR imaging after acute knee trauma.

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