Ume University Hospital

Umeå, Sweden

Ume University Hospital

Umeå, Sweden
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Nilsson S.,Karolinska Hospital | Strang P.,Karolinska Institutet | Aksnes A.K.,Algeta ASA | Franzn L.,Sundsvall Harnosand County Hospital | And 7 more authors.
European Journal of Cancer | Year: 2012

Purpose: To investigate the dose-response relationship and pain-relieving effect of radium-223, a highly bone-targeted alpha-pharmaceutical. Methods: One hundred patients with castration-resistant prostate cancer (CRPC) and painful bone metastases were randomized to a single intravenous dose of 5, 25, 50 or 100 kBq/kg radium-223. The primary end-point was pain index (visual analogue scale [VAS] and analgesic use), also used to classify patients as responders or non-responders. Results: A significant dose response for pain index was seen at week 2 (P =.035). At week 8 there were 40%, 63%, 56% and 71% pain responders (reduced pain and stable analgesic consumption) in the 5, 25, 50 and 100 kBq/kg groups, respectively. On the daily VAS, at week 8, pain decreased by a mean of -30, -31, -27 and -28 mm, respectively (P =.008, P =.0005, P =.002, and P <.0001) in these responders (post-hoc analysis). There was also a significant improvement in the brief pain inventory functional index for all dose-groups (P =.04,.01,.002 and.02, Wilcoxon signed rank test). Furthermore, a decrease in bone alkaline phosphatase in the highest dose-group was demonstrated (P =.0067). All doses were safe and well tolerated. Conclusion: Pain response was seen in up to 71% of the patients with a dose response observed 2 weeks after administration. The highly tolerable side-effect profile of radium-223 previously reported was confirmed. © 2011 Elsevier Ltd. All rights reserved.


Sun A.,Uppsala University Hospital | Sun A.,Ume University Hospital | Johansson S.,Uppsala University Hospital | Turesson I.,Uppsala University Hospital | And 2 more authors.
International Journal of Radiation Oncology Biology Physics | Year: 2012

Background: A growing body of in vitro evidence links alterations of the intermediary metabolism in cancer to treatment outcome. This study aimed to characterize tumor oxidative metabolism and perfusion in vivo using dynamic positron emission tomography (PET) with 1- [ 11C]-acetate (ACE) during radiotherapy. Methods and Materials: Nine patients with head-and-neck cancer were studied. Oxidative metabolic rate (k mono) and perfusion (rF) of the primary tumors were assessed by dynamic ACE-PET at baseline and after 15, 30, and 55 Gy was delivered. Tumor glucose uptake (Tglu) was evaluated with [ 18F]-fluorodeoxyglucose PET at baseline. Patients were grouped into complete (CR, n = 6) and partial responders (PR, n = 3) to radiotherapy. Results: The 3 PR patients died within a median follow-up period of 33 months. Baseline k mono was almost twice as high in CR as in PR (p = 0.02) and Tglu was lower in CR than in PR (p = 0.04). k mono increased during radiotherapy in PR (p = 0.004) but remained unchanged in CR. There were no differences in rF between CR and PR at any dosage. k mono and rF were coupled in CR (p = 0.001), but not in PR. Conclusions: This study shows that radiosensitive tumors might rely predominantly on oxidative metabolism for their bioenergetic needs. The impairment of oxidative metabolism in radioresistant tumors is potentially reversible, suggesting that therapies targeting the intermediary metabolism might improve treatment outcome. © 2012 Elsevier Inc.


Sorbe B.,Örebro University | Horvath G.,Sahlgrenska University Hospital | Andersson H.,Sahlgrenska University Hospital | Boman K.,Ume University Hospital | And 2 more authors.
International Journal of Radiation Oncology Biology Physics | Year: 2012

Purpose: To evaluate the value of adjuvant external beam pelvic radiotherapy as adjunct to vaginal brachytherapy (VBT) in medium-risk endometrial carcinoma, with regard to locoregional tumor control, recurrences, survival, and toxicity. Methods and Materials: Consecutive series of 527 evaluable patients were included in this randomized trial. Median follow-up for patients alive was 62 months. The primary study endpoints were locoregional recurrences and overall survival. Secondary endpoints were recurrence-free survival, recurrence-free interval, cancer-specific survival, and toxicity. Results: Five-year locoregional relapse rates were 1.5% after external beam radiotherapy (EBRT) plus VBT and 5% after vaginal irradiation alone (p = 0.013), and 5-year overall survival rates were 89% and 90%, respectively (p = 0.548). Endometrial cancer-related death rates were 3.8% after EBRT plus VBT and 6.8% after VBT (p = 0.118). Pelvic recurrences (exclusively vaginal recurrence) were reduced by 93% by the addition of EBRT to VBT. Deep myometrial infiltration was a significant prognostic factor in this medium-risk group of endometrioid carcinomas but not International Federation of Gynecology and Obstetrics grade or DNA ploidy. Combined radiotherapy was well tolerated, with serious (Grade 3) late side effects of less than 2%. However, there was a significant difference in favor of VBT alone. Conclusions: Despite a significant locoregional control benefit with combined radiotherapy, no survival improvement was recorded, but increased late toxicity was noted in the intestine, bladder, and vagina. Combined RT should probably be reserved for high-risk cases with two or more high-risk factors. VBT alone should be the adjuvant treatment option for purely medium-risk cases. © 2012 Elsevier Inc.


Isaksson S.,Uppsala University | Skoog Svanberg A.,Uppsala University | Sydsjo G.,Linköping University | Thurin-Kjellberg A.,Sahlgrenska Academy | And 4 more authors.
Human Reproduction | Year: 2011

Background Two decades after the introduction of Swedish legislation that allows children born as a result of gamete donation access to identifying information about the donor, a nationwide multicentre study on the psychosocial consequences of this legislation for recipients and donors of gametes was initiated in 2005. The aim of the present study was to investigate recipient couples' attitudes and behaviour regarding disclosure to offspring and others, attitudes towards genetic parenthood and perceptions of information regarding parenthood after donation.Methods The present study is part of the prospective longitudinal 'Swedish study on gamete donation, including all fertility clinics performing donation treatment in Sweden. A consecutive cohort of 152 heterosexual recipient couples of donated oocytes (72 response) and 127 heterosexual recipient couples of donated sperm (81 response) accepted participation in the study. In connection with the donation treatment, male and female participants individually completed two questionnaires with study-specific instruments concerning disclosure, genetic parenthood and informational aspects.Results About 90 of participants (in couples receiving anonymous donated gametes) supported disclosure and openness to the offspring concerning his/her genetic origin. Only 6 of all participants had not told other people about their donation treatment. Between 26 and 40 of participants wanted additional information/support about parenthood following donation treatment. Conclusions Two decades after the Swedish legislation of identifiable gamete donors, recipient couples of anonymously donated sperm and oocytes are relatively open about their treatment and support disclosure to offspring. Recipient couples may benefit from more information and support regarding parenthood after gamete donation. Further studies are required to follow-up on the future parents' actual disclosure behaviour directed to offspring. © 2011 The Author.


Budaus L.,University of Hamburg | Bolla M.,Center Hospitalier University | Bossi A.,Institute Gustave Roussy | Cozzarini C.,San Raffaele Scientific Institute | And 3 more authors.
European Urology | Year: 2012

Context: Prostate cancer (PCa) patients have many options within the realms of surgery or radiation therapy (RT). Technical advancements in RT planning and delivery have yielded different approaches, such as external beam, brachytherapy, and newer approaches such as image-guided tomotherapy or volumetric-modulated arc therapy. The selection of the optimal RT treatment for the individual is still a point of discussion, and the debate centres on two important outcomes - namely, cancer control and reduction of side-effects. Objective: To critically review and summarise the available literature on functional outcomes and rectal sequelae following RT for PCa treatment. Evidence acquisition: A review of the literature published between 1999 and 2010 was performed using Medline and Scopus search. Relevant reports were identified using the terms prostate cancer, radiotherapy, functional outcomes, external beam radiation, brachytherapy, IMRT, quality of life, and tomotherapy and were critically reviewed and summarised. Evidence synthesis: Related to nonuniform definition of their assessed functional end points and uneven standards of reporting, only a minority of series retrieved could be selected for analyses. Moreover, patterns of patient selection for different types of RT, inherent differences in the RT modalities, and the presence or absence of hormonal treatment also limit the ability to synthesise results from different publications or perform meta-analyses across the different treatment types. Nonetheless, several studies agree that recent technical improvements in the field of RT planning and delivery enable the administration of higher doses with equal or less toxicity. Regardless of the type of RT, the most frequently considered functional end points in the published analyses are gastrointestinal (GI) complications and rectal bleeding. Established risk factors for acute or late toxicities after RT include advanced age, larger rectal volume, a history of prior abdominal surgery, the concomitant use of androgen deprivation, preexisting diabetes mellitus, haemorrhoids, and inflammatory bowel disease (IBD). Similarly, mild acute irritative urinary symptoms are reported in several studies, whereas total urinary incontinence and other severe urinary symptoms are rare. Pretreatment genitourinary complaints, prior transurethral resection of the prostate (TURP), and the presence of acute genitourinary toxicity are suggested as contributing to long-term urinary morbidity. Erectile dysfunction (ED) is not an immediate side-effect of RT, and the occurrence of spontaneous erections before treatment is the best predictor for preserving erections sufficient for intercourse. In addition, the use of magnetic resonance imaging (MRI) permits a reduction in the dose delivered to vascular structures critical for erectile function. Conclusions: In the future, further improvement in RT planning and delivery will decrease side-effects and permit administration of higher doses. Related to the anatomy of the prostate, these higher doses may favour rectal sparing while not readily sparing the urethra and bladder neck. As a consequence, there may be a future shift from dose-limiting long-term rectal morbidity towards long-term urinary morbidity. In the absence of prospective randomised trials comparing different types of surgical and RT-based treatments in PCa, the introduction of validated tools for reporting functional and clinical outcomes is crucial for evaluating and identifying each individual's best treatment choice. © 2011 European Association of Urology. Published by Elsevier B.V. All rights reserved.


Rnn F.,Ume University Hospital | Rnn F.,Umeå University | Kesek M.,Ume University Hospital | Kesek M.,Umeå University | And 6 more authors.
Europace | Year: 2011

AimsLittle is known about the optimal right ventricular (RV) pacing site in cardiac resynchronization therapy (CRT). This study compares bi-ventricular pacing at the left ventricular (LV) free wall combined with two different RV stimulation sites: RV outflow tract (RVOTLV) vs. RV-apex (RVALV). Methods and resultsThirty-three patients (32 males) with chronic heart failure, NYHA class IIIIV, optimal drug therapy, QRS-duration <150 ms, and chronic atrial fibrillation (AF) received CRT with two different RV leads, in the apex (RVA) or outflow tract (RVOT), together with an LV lead, all connected to a bi-ventricular pacemaker. Randomization to pacing in RVOTLV or RVALV was made 1 month after implantation and cross-over to the alternate pacing configuration occurred after 3 months. The median age of patients was 69 ± 10 years, the mean QRS was 179 ± 23 ms, and 58 of patients had ischaemic heart disease. Seven patients had pacemaker rhythm at inclusion and 60 were treated with atrioventricular-junctional ablation before randomization. In the RVALV and RVOTLV pacing modes, 67 and 63 (nonsignificant) responded symptomatically with a decrease of at least 10 points in the Minnesota Living with Heart Failure score. The secondary end-points (6-min walk test, peak oxygen uptake, N-Terminal fragment of B-type Natriuretic Peptide, and left ventricular ejection fraction) showed significant improvement between baseline and CRT, but not between RVOTLV and RVALV. ConclusionIn this randomized controlled study, the exact RV pacing site, either apex or outflow tract, did not influence the benefits of CRT in a group of patients with chronic heart failure and AF. © 2011 The Author.


Lundstrom M.,Blekinge Hospital | Behndig A.,Ume University Hospital | Kugelberg M.,St Erik Eye Hospital | Montan P.,St Erik Eye Hospital | And 2 more authors.
Journal of Cataract and Refractive Surgery | Year: 2011

Purpose: To define the incidence of capsule complication and its risk factors in Sweden over an 8-year period. Setting: Fifty-two ophthalmic surgery units in Sweden. Design: Database study. Methods: Data were collected prospectively in the Swedish National Cataract Register (NCR) from 2002 through 2009. The NCR contains 97.3% of the total number of cataract extractions in Sweden over the 8-year study period. One mandatory variable in the register is capsule complications during surgery. As a means to validate the accuracy of register data on capsule complications, a randomly selected sample of 2400 registrations was compared with corresponding medical records. Results: The analyses were based on 602553 cataract extractions reported to the NCR. A capsule complication was reported in 12574 cataract extractions, corresponding to a frequency of 2.09%. The incidence of this complication consistently decreased each year from 2002 to 2006, after which it stabilized. Poor corrected distance visual acuity in the surgical eye (≤ 0.1), the occurrence of glaucoma, diabetic retinopathy, and age were among the parameters significantly related to a capsule complication. Some of these parameters also decreased over time. However, even after adjusting for this, there was an obvious decrease in capsule complications over time. The validity test showed a certain underreporting of capsule complications to the registry, but it was not significant and did not change over time. Conclusion: The incidence of capsule complications decreased over time. This may be partly the result of fewer risk factors and of better surgical quality. Financial Disclosure: No author has a financial or proprietary interest in any material or method mentioned. © 2011 ASCRS and ESCRS.


Domellof M.,Ume University Hospital
Nestle Nutrition Workshop Series: Pediatric Program | Year: 2010

Due to high iron requirements, young children are at risk for iron deficiency anemia. Iron supplements are therefore often recommended, especially since iron deficiency anemia in children is associated with poor neurodevelopment. However, in contrast to most other nutrients, excess iron cannot be excreted by the human body and it has recently been suggested that excessive iron supplementation of young children may have adverse effects on growth, risk of infections, and even on cognitive development. Recent studies support that iron supplements are beneficial in iron-deficient children but there is a risk of adverse effects in those who are iron replete. In populations with a low prevalence of iron deficiency, general supplementation should therefore be avoided. Iron-fortified foods can still be generally recommended since they seem to be safer than medicinal iron supplements, but the level of iron fortification should be limited. General iron supplementation is recommended in areas with a high prevalence of iron deficiency, with the exception of malarious areas where a cautious supplementation approach needs to be adopted, based either on screening or a combination of iron supplements and infection control measures. More studies are urgently needed to better determine the risks and benefits of iron supplementation and iron-fortified foods given to iron-deficient and iron-sufficient children. Copyright © 2010 S. Karger AG, Basel.


Ramazani M.,Ume University Hospital | Lundin C.,Ume University Hospital | Sund M.,Ume University Hospital
European Journal of Vascular and Endovascular Surgery | Year: 2011

Aim: The decision for abdominal aortic aneurysm (AAA) repair is based on aneurysm size. However, smaller aneurysms can rupture, while larger ones can remain stable. New variables and markers are needed to better select patients at high rupture risk. The study was done to analyse if AAA patients have increased levels of circulating basement-membrane (BM) fragments. Design: Circulating levels of BM components type IV and XVIII collagen were measured by enzyme-linked immunosorbent assay (ELISA) in 10 patients with AAA, nine patients with peripheral artery disease (PAD) and 10 healthy controls (CON). Results: AAA patients had significantly increased levels of type IV and XVIII collagen compared with CON (134.0 ± 24.8 ng ml-1 vs. 104.5 ± 16.4 ng ml-1; p = 0.005 and 149.0 ± 56.9 ng ml-1 vs. 59.6 ± 8.7 ng ml-1; p < 0.001, respectively). The PAD patients did not have significantly increased levels of these fragments when compared with CON. In addition, the AAA patients had significantly increased level of type XVIII collagen (149.0 ± 56.9 ng ml-1 vs. 58.3 ± 25.4 ng/ml-1; p < 0.01) when compared with the PAD group. Conclusion: Based on this preliminary analysis of a small number of subjects, patients with AAA had significantly increased levels of circulating BM components. BM fragments should be studied further to establish their potential role as biomarkers for AAA. © 2011 Published by Elsevier Ltd on behalf of European Society for Vascular Surgery. All rights reserved.


Andersson T.,Ume University Hospital | Soderstrom I.,Ume University Hospital | Simonyte K.,Ume University Hospital | Olsson T.,Ume University Hospital
Obesity | Year: 2010

Following menopause, body fat is redistributed from peripheral to central depots. This may be linked to the age related decrease in estrogen levels. We hypothesized that estrogen supplementation could counteract this fat redistribution through tissue-specific modulation of glucocorticoid exposure. We measured fat depot masses and the expression and activity of the glucocorticoid-activating enzyme 11Β-hydroxysteroid dehydrogenase type 1 (11ΒHSD1) in fat and liver of ovariectomized female rats treated with or without 17Β-estradiol. 11ΒHSD1 converts inert cortisone, or 11-dehydrocorticosterone in rats into active cortisol and corticosterone. Estradiol-treated rats gained less weight and had significantly lower visceral adipose tissue weight than nontreated rats (P 0.01); subcutaneous adipose weight was unaltered. In addition, 11ΒHSD1 activity/expression was downregulated in liver and visceral, but not subcutaneous, fat of estradiol-treated rats (P 0.001 for both). This downregulation altered the balance of 11ΒHSD1 expression and activity between adipose tissue depots, with higher levels in subcutaneous than visceral adipose tissue of estradiol-treated animals (P 0.05 for both), opposite the pattern in ovariectomized rats not treated with estradiol (P 0.001 for mRNA expression). Thus, estrogen modulates fat distribution, at least in part, through effects on tissue-specific glucocorticoid metabolism, suggesting that estrogen replacement therapy could influence obesity related morbidity in postmenopausal women.

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