Editor-The finding of a persistently poor outcome of pregnancy in women with insulin dependent di... more Editor-The finding of a persistently poor outcome of pregnancy in women with insulin dependent diabetes in two (northern) English regions is an important statement of the problem. 1 2 Both studies provide figures and show outcomes that are no different from those widely reported in the past. Unfortunately, neither give evidence of any degree of centralisation of obstetric or diabetic care, with on-site neonatal intensive care, although this is a proved means of improving the outcome of pregnancy for diabetic mothers. 3 The St Vincent declaration guidelines on the outcome of pregnancy, referred to in the accompanying editorial (p 263), are based on the Scandinavian reports held up as examples of good practice and state that "an interdisciplinary team should provide centralized diabetic pregnancy care in a hospital treating at least 20-30 cases a year. Pregnant diabetic
European Journal of Cardio-Thoracic Surgery, Feb 1, 2005
Objective: Surgical resection for lung cancer is the mainstay of curative treatment, but studies ... more Objective: Surgical resection for lung cancer is the mainstay of curative treatment, but studies regarding postoperative results and long term outcome in the elderly have differed. The purpose of the present study was to assess the early and long-term results of surgical resection in patients more than 70 years of age. Methods: In Norway all clinical and pathologic departments submit reports on cancer patients to the Cancer Registry of Norway. This investigation included all patients more than 70 years of age resected for lung cancer in the time period 1993-2000. For results of long-time follow-up only patients operated on between 1993 and 1998 were included. Results: A total of 763 patients (541 men) were identified aged 71-87 years. Postoperative mortality rate was 9%, highest after bilobectomy and pneumonectomy. The most commonly reported causes of postoperative death were pneumonia and cardiac complications. The majority of patients had tumor categorized as clinical stage (cStage) Ia and Ib. More than 100 in each of these groups proved to have more advanced disease postoperatively (pStage). The 5-year relative survival rate was significantly better in patients with disease in pStage I compared to higher stages. Women had a significantly better 5-year survival rate compared to men, 62.8 and 35.7%, respectively. Conclusions: Lung cancer surgery appears to be a relatively safe procedure even in the elderly. There is a high postoperative mortality after bilobectomy and pneumonectomy. However, when old people survive the postoperative period the long term prognosis seems favorable.
Background: There is considerable variability in reported postoperative mortality and risk factor... more Background: There is considerable variability in reported postoperative mortality and risk factors for mortality after surgery for lung cancer. Population-based data provide unbiased estimates and may aid in treatment selection. Methods: All patients diagnosed with lung cancer in Norway from 1993 to the end of 2005 were reported to the Cancer Registry of Norway (n = 26 665). A total of 4395 patients underwent surgical resection and were included in the analysis. Data on demographics, tumour characteristics and treatment were registered. A subset of 1844 patients was scored according to the Charlson co-morbidity index. Potential factors influencing 30-day mortality were analysed by logistic regression. Results: The overall postoperative mortality rate was 4.4% within 30 days with a declining trend in the period. Male sex (OR 1.76), older age (OR 3.38 for age band 70-79 years), right-sided tumours (OR 1.73) and extensive procedures (OR 4.54 for pneumonectomy) were identified as risk factors for postoperative mortality in multivariate analysis. Postoperative mortality at high-volume hospitals (>20 procedures/year) was lower (OR 0.76, p = 0.076). Adjusted ORs for postoperative mortality at individual hospitals ranged from 0.32 to 2.28. The Charlson co-morbidity index was identified as an independent risk factor for postoperative mortality (p = 0.017). A prediction model for postoperative mortality is presented. Conclusions: Even though improvements in postoperative mortality have been observed in recent years, these findings indicate a further potential to optimise the surgical treatment of lung cancer. Hospital treatment results varied but a significant volume effect was not observed. Prognostic models may identify patients requiring intensive postoperative care.
Background: Very few population based results have been presented for survival after resection fo... more Background: Very few population based results have been presented for survival after resection for lung cancer. The purpose of this study was to present long term survival after resection and to quantify prognostic factors for survival. Methods: All lung cancer patients diagnosed in Norway in 1993-2002 were reported to the Cancer Registry of Norway (n = 19 582). A total of 3211 patients underwent surgical resection and were included for analysis. Supplementary information from hospitals (including co-morbidity data) was collected for patients diagnosed in 1993-8. Five year observed and relative survival was analysed for patients diagnosed and operated in 1993-9. Factors believed to influence survival were analysed by a Cox proportional hazard regression model. Results: Five year relative survival in the period 1993-9 was 46.4% (n = 2144): 58.4% for stage I disease (n = 1375), 28.4% for stage II (n = 532), 15.1% for IIIa (n = 133), 24.1% for IIIb (n = 63), and 21.1% for stage IV disease (n = 41). The high survival in stage IIIb and IV was due to the contribution of multiple tumours. Cox regression analysis identified male sex, higher age, procedures other than upper and middle lobectomy, histologies such as adenocarcinoma and large cell carcinoma, surgery on the right side, infiltration of resection margins, and larger tumour size as non-favourable prognostic factors. Conclusions: Survival was favourable for resected patients in a population based group including subgroups such as elderly patients, those with advanced stage, small cell lung cancer, tumours with nodal invasion, and patients with multiple tumours. These results question the validity of the current TNM system for lung cancer with regard to tumour size and categorization of multiple tumours.
Tidsskrift for Den Norske Laegeforening, Jan 3, 2008
Plassering av pasienter i sykehuskorridorer har i lang tid vaert praksis i Norge. Det er vanskeli... more Plassering av pasienter i sykehuskorridorer har i lang tid vaert praksis i Norge. Det er vanskelig å gi tilfredsstillende behandling, pleie og omsorg i en sykehuskorridor. Pasienter og personale lider under de e. Til tross for mange analyser og tiltak er det ingen tegn til bedring av situasjonen.
Kreftregisteret har siden sin opprettelse for 50 år siden hatt som hovedoppgave å registrere nyop... more Kreftregisteret har siden sin opprettelse for 50 år siden hatt som hovedoppgave å registrere nyoppdagede krefttilfeller etter organlokalisasjon, svulsttype, svulstutbredelse og en del andre medisinske forhold. De registrerte opplysningene har vaert fullstendige og gode på grunn av et godt rapporteringssystem med tre uavhengige kilder: patologiavdelinger, kliniske avdelinger og Dødsårsaksregisteret. Populasjonsbaserte data har dannet grunnlaget for forskning på årsaker og risikofaktorer for å få kreft, med vekt på forebygging av kreft. Kreftbildet i Norge har endret seg fra 50-årene hvor flertallet av kreftpasientene døde av sin sykdom, til i dag hvor over halvparten av de over 22 000 pasienter som diagnostiseres årlig vil overleve. Det lever i dag ca. 155 000 pasienter som har eller har hatt kreft. Den økende betydningen av behandling og kreftpasientenes bedrede leveutsikter har påvirket Kreftregisterets arbeid. Det fremstår som stadig viktigere å ha en korrekt registrering av ikke bare karakteristika ved svulsten, men også forhold rundt diagnostikk og behandling. I løpet av de siste 15 år har Kreftregisteret utvidet sitt virkefelt til å omfatte screening og registrering av populasjonsbaserte data om behandling og tilbakefall av kreft etter behandling. Forholdene ligger saerlig godt til rette for populasjonsbasert klinisk forskning i Norge på grunn av vårt fødselsnummersystem som gir mulighet for god oppfølging av behandlingsresultater. Kreftregisteret vil vaere et kvalitetsregister for alle svulstformer og vi vil i tiden fremover legge vekt på utvidet og landsomfattende samarbeid med fagmiljøer som innehar ekspertise på de enkelte svulstformer for å bedre vår registrering og legge forholdene til rette for aktivitet som kan gi bedre resultater både av behandling og forskning. Langmark F, Norstein J. The Cancer Registry of Norway -from registration of cancer incidence and survival to population-based clinical epidemiology.
Plassering av pasienter i sykehuskorridorer har i lang tid vaert praksis i Norge. Det er vanskeli... more Plassering av pasienter i sykehuskorridorer har i lang tid vaert praksis i Norge. Det er vanskelig å gi tilfredsstillende behandling, pleie og omsorg i en sykehuskorridor. Pasienter og personale lider under de e. Til tross for mange analyser og tiltak er det ingen tegn til bedring av situasjonen.
Kreftregisteret har siden sin opprettelse for 50 år siden hatt som hovedoppgave å registrere nyop... more Kreftregisteret har siden sin opprettelse for 50 år siden hatt som hovedoppgave å registrere nyoppdagede krefttilfeller etter organlokalisasjon, svulsttype, svulstutbredelse og en del andre medisinske forhold. De registrerte opplysningene har vaert fullstendige og gode på grunn av et godt rapporteringssystem med tre uavhengige kilder: patologiavdelinger, kliniske avdelinger og Dødsårsaksregisteret. Populasjonsbaserte data har dannet grunnlaget for forskning på årsaker og risikofaktorer for å få kreft, med vekt på forebygging av kreft. Kreftbildet i Norge har endret seg fra 50-årene hvor flertallet av kreftpasientene døde av sin sykdom, til i dag hvor over halvparten av de over 22 000 pasienter som diagnostiseres årlig vil overleve. Det lever i dag ca. 155 000 pasienter som har eller har hatt kreft. Den økende betydningen av behandling og kreftpasientenes bedrede leveutsikter har påvirket Kreftregisterets arbeid. Det fremstår som stadig viktigere å ha en korrekt registrering av ikke bare karakteristika ved svulsten, men også forhold rundt diagnostikk og behandling. I løpet av de siste 15 år har Kreftregisteret utvidet sitt virkefelt til å omfatte screening og registrering av populasjonsbaserte data om behandling og tilbakefall av kreft etter behandling. Forholdene ligger saerlig godt til rette for populasjonsbasert klinisk forskning i Norge på grunn av vårt fødselsnummersystem som gir mulighet for god oppfølging av behandlingsresultater. Kreftregisteret vil vaere et kvalitetsregister for alle svulstformer og vi vil i tiden fremover legge vekt på utvidet og landsomfattende samarbeid med fagmiljøer som innehar ekspertise på de enkelte svulstformer for å bedre vår registrering og legge forholdene til rette for aktivitet som kan gi bedre resultater både av behandling og forskning. Langmark F, Norstein J. The Cancer Registry of Norway -from registration of cancer incidence and survival to population-based clinical epidemiology.
SAMMENDRAGResultatene etter operasjon for kreft i endetarmen har vært preget av høy frekvens av ... more SAMMENDRAGResultatene etter operasjon for kreft i endetarmen har vært preget av høy frekvens av lokalt residiv og deravlav overlevelse. Resultater blant kurativt opererte i Norge i perioden 1986-88 viste at 28% utviklet lokaltresidiv og bare 55% overlevde fem år. For å bedre prognosen ved endetarmskreft (rectumcancer) ble det i1993 startet et nasjonalt prosjekt, og hensikten med denne studien er å evaluere effekten av de tiltak som bleiverksatt for å heve kvaliteten av behandlingen. Prosjektet har fokusert på å optimalisere kirurgisk behandlingved å innføre operasjonsmetoden ”Total Mesorectal Excision” (TME). I tillegg har en lagt vekt på åstandardisere de patologisk anatomiske undersøkelsene. En rekke kurs er blitt arrangert for å lære kirurgeneden nye operasjonsteknikken, mens patologer har gjennomgått kurs for å sikre kvaliteten i vurderingen avoperasjonspreparatene. Et nasjonalt register for endetarmskreft, etablert og drevet av fagmiljøene, ble opprettetved Kreftregisteret. Fr...
International journal of microcirculation, clinical and experimental / sponsored by the European Society for Microcirculation, 1992
The single fibre laser Doppler flowmetry technique has been designed to perform continuous quanti... more The single fibre laser Doppler flowmetry technique has been designed to perform continuous quantification of microvascular perfusion deep in tissue. In this study we have evaluated the use of the technique in renal tissue. A total number of 164 recordings were analyzed. Fluctuations in perfusion related to heart rate and respiration were observed. The possible nature of the low-frequency flow motion waves (10-12 min-1) is discussed. No significant difference in perfusion level could be detected between the upper, the middle and the lower parts of the kidneys (p greater than 0.69), or between the cortex and the medulla (p = 0.77). The spatial variation, expressed as the difference between two consecutive measurements, was large. The median and mean values of groups of data are however reproducible. When the renal artery is reopened after 30 sec of occlusion, the pre-occlusive flux levels are regained after approximately 1.5 sec. The single fibre laser Doppler flowmetry technique can ...
Background: There is considerable variability in reported postoperative mortality and risk factor... more Background: There is considerable variability in reported postoperative mortality and risk factors for mortality after surgery for lung cancer. Population-based data provide unbiased estimates and may aid in treatment selection. Methods: All patients diagnosed with lung cancer in Norway from 1993 to the end of 2005 were reported to the Cancer Registry of Norway (n = 26 665). A total of 4395 patients underwent surgical resection and were included in the analysis. Data on demographics, tumour characteristics and treatment were registered. A subset of 1844 patients was scored according to the Charlson co-morbidity index. Potential factors influencing 30-day mortality were analysed by logistic regression. Results: The overall postoperative mortality rate was 4.4% within 30 days with a declining trend in the period. Male sex (OR 1.76), older age (OR 3.38 for age band 70-79 years), right-sided tumours (OR 1.73) and extensive procedures (OR 4.54 for pneumonectomy) were identified as risk factors for postoperative mortality in multivariate analysis. Postoperative mortality at high-volume hospitals (>20 procedures/year) was lower (OR 0.76, p = 0.076). Adjusted ORs for postoperative mortality at individual hospitals ranged from 0.32 to 2.28. The Charlson co-morbidity index was identified as an independent risk factor for postoperative mortality (p = 0.017). A prediction model for postoperative mortality is presented. Conclusions: Even though improvements in postoperative mortality have been observed in recent years, these findings indicate a further potential to optimise the surgical treatment of lung cancer. Hospital treatment results varied but a significant volume effect was not observed. Prognostic models may identify patients requiring intensive postoperative care.
The aim of the study was to estimate the prevalence of hereditary cancers and the need for survei... more The aim of the study was to estimate the prevalence of hereditary cancers and the need for surveillance in Telemark county, Norway. All persons attending the Norwegian Colorectal Cancer Prevention (NORCCAP) trial in Telemark were interviewed about cases of cancer in the family. Diagnoses were verified, pedigrees constructed and families classified according to preset criteria aiming at identifying hereditary cancer. Mutation analyses were performed in kindreds at risk for breast cancers when possible. Immunohistochemistry of tumors in assumed inherited colorectal cancer families was undertaken. The screening examination was attended by 7,224 persons among whom 2,866 had cancer in the family. Of these, 2,479 had no suspicion of any known inherited cancer syndrome. Family information questionnaires were mailed to 387 persons and returned by 191. Sixty-four of these 191 met the clinical criteria for familial cancer by family history after verification of diagnoses. Observed prevalences for being at risk for hereditary breast and breast-ovarian cancer (HBOC) or hereditary non-polyposis colorectal cancer (HNPCC) were 2.8 per thousand and 0.77 per thousand, respectively. The number of colonoscopies and mammograms obtained per year serving those who needed them was limited and reduced by clinical genetic work-up from 2,866 with a family history of cancer to 64 proven cases. Continued surveillance of an unnecessarily high number leads to unjustified cancer worry, is costly and uses up health-care facilities. Genetic work-up is a one-time job that reduces input numbers to surveillance programs, provides a starting-point for mutation testing and is economically cost beneficial if inherited cancers are prevented or cured by the health-care programs offered.
The L1 antigen (calprotectin) is present in circulating monocytes but is restricted to certain su... more The L1 antigen (calprotectin) is present in circulating monocytes but is restricted to certain subsets of tissue macrophages. Its expression is significantly increased in inflammatory bowel disease, apparently because of newly recruited monocytes. In vitro experiments were performed to substantiate lack of L1 upregulation in tissue macrophages, thereby justifying the use of this marker to detect newly recruited cells. Its reliability was further evaluated by studying mononuclear cell infiltrates characteristic of acute kidney rejection. After pro-inflammatory stimulation, monocytes matured in vitro (n = 12) as well as adherent mononuclear cells from normal small intestinal mucosa (n = 5) were examined for L1 expression by immunocytochemistry and by ELISA (cell lysates). In addition, peritubular mononuclear L1+ cells were examined by immunohistochemistry in routine biopsy specimens from transplanted kidneys with (n = 11) or without (n = 14) histopathologically diagnosed acute rejection. L1 was not upregulated in monocytes matured in vitro, nor in mucosal macrophages after stimulation with interferon-gamma, LPS, phorbol ester, or supernatant from activated leucocytes. In transplanted kidneys with signs of acute rejection, the fraction of L1+ macrophages was significantly increased (P < 0.001). Because L1 is persistently downregulated in mature tissue macrophages and is formalin-resistant, it identifies young infiltrating macrophages in routinely processed biopsy material. L1 should therefore be a valuable adjunct in the diagnosis of kidney rejection.
Colorectal cancer is the fourth most common malignant disease in civilized countries, ranking beh... more Colorectal cancer is the fourth most common malignant disease in civilized countries, ranking behind cancer of the lung, breast, and prostate. In the United States it is estimated that 133,500 cases will be diagnosed in 1996. However, in numeric terms, colorectal cancer is the second most lethal malignancy after lung cancer. The number of deaths that will be attributable to
Aims: To evaluate serum secretory com- ponent in relation to early detection and clinical managem... more Aims: To evaluate serum secretory com- ponent in relation to early detection and clinical management ofliver metastasis in patients with colorectal cancer. Methods: Secretory component and carcinoembryonic antigen (CEA) were analysed in serial serum samples from 23 patients who had liver metastases as the only apparent recurrence, and in sera from 54 matched controls. Results of surgical treatment of recurrences were classified peroperatively as radical when no residual tumour was apparent and resection margins were free of disease. Results: In total, 18 (78%) patients had increased secretory component during the whole follow up period (median 16 months); 12 (52%) had raised secretory component concentrations before clinical recurrence *Males + females. tMedian (range). *Distant organ metastasis or irremovable tumour was assigned stage D according toTumbull et al. 14 Patients with stage D had their metastasis removed at the primary operation. **Time interval between prinary operation and clinical recurrence.
Completeness of reporting and accuracy of the diagnosis of ovarian cancer from one health region ... more Completeness of reporting and accuracy of the diagnosis of ovarian cancer from one health region in Norway to the Cancer Registry were examined. Data kept by the Cancer Registry were evaluated against discharge diagnosis data from all 8 hospitals in the health region during the period of 1987–1996. The assessment of the accuracy of the diagnosis recorded in the Cancer Registry was based on review of all medical records in the hospital setting and on slide review of all histologic diagnoses. The overall completeness of reporting ovarian cancer to the Cancer Registry was 99.6%. The organ specific completeness of registration of histologic verified ovarian cancer within the Cancer Registry was 95.3%; 0.9% was erroneously coded and 3.5% had their diagnosis changed to ovarian cancer at re‐evaluation. Of all ovarian cancer cases registered at the Cancer Registry, 91% had a primary histologic diagnosis. Among 591 cases identified with a histologic diagnosis in the Cancer Registry, the accu...
Cells in lymph draining the human gut have not been characterized previously. The aim of this stu... more Cells in lymph draining the human gut have not been characterized previously. The aim of this study was to phenotype B and T cells present in microlymphatics of Peyer's pathces and in mesenteric lymph. The studies were conducted by multicolor immunohistochemistry, flow cytometry, and immunocytochemistry. In decreasing order of frequency, microlymphatics in Peyer's patches contained naive T (CD3+CD45RA+ alpha 4 beta 7low) and B (sIgD+CD20+ alpha 4 beta 7low) lymphocytes, memory T (CD45RO+ alpha 4 beta 7+) and B (sIgD-CD20+ alpha 4 beta 7+) lymphocytes, and B-cell blasts (CD19+CD38high alpha 4 beta 7high). Naive cells were usually positive for L-selectin, memory cells were either positive or negative, and B-cell blasts were usually negative. Mesenteric lymph contained naive T (approximately 60%) and B (approximately 25%) lymphocytes, memory T and B lymphocytes (approximately 10%), and B-cell blasts (approximately 2%). Cytospins confirmed these results and showed, in addition, that B-cell blasts contained cytoplasmic immunoglobulin (Ig) A, IgM, or IgG in overall proportions of 5:1: < 0.5. Our results are similar to the phenotypes previously described in animal thoracic or mesenteric lymph. A fraction of the B cells stimulated in Peyer's patches are near terminal differentiation (contain cytoplasmic Ig) before they enter peripheral blood. Many memory cells, and most if not all B-cell blasts entering lymph show an adhesion molecule profile (alpha 4 beta 7high L-selectin low) in keeping with the presumed phenotype of lymphoid cells destined for mucosal effector sites such as the gut lamina propria.
Editor-The finding of a persistently poor outcome of pregnancy in women with insulin dependent di... more Editor-The finding of a persistently poor outcome of pregnancy in women with insulin dependent diabetes in two (northern) English regions is an important statement of the problem. 1 2 Both studies provide figures and show outcomes that are no different from those widely reported in the past. Unfortunately, neither give evidence of any degree of centralisation of obstetric or diabetic care, with on-site neonatal intensive care, although this is a proved means of improving the outcome of pregnancy for diabetic mothers. 3 The St Vincent declaration guidelines on the outcome of pregnancy, referred to in the accompanying editorial (p 263), are based on the Scandinavian reports held up as examples of good practice and state that "an interdisciplinary team should provide centralized diabetic pregnancy care in a hospital treating at least 20-30 cases a year. Pregnant diabetic
European Journal of Cardio-Thoracic Surgery, Feb 1, 2005
Objective: Surgical resection for lung cancer is the mainstay of curative treatment, but studies ... more Objective: Surgical resection for lung cancer is the mainstay of curative treatment, but studies regarding postoperative results and long term outcome in the elderly have differed. The purpose of the present study was to assess the early and long-term results of surgical resection in patients more than 70 years of age. Methods: In Norway all clinical and pathologic departments submit reports on cancer patients to the Cancer Registry of Norway. This investigation included all patients more than 70 years of age resected for lung cancer in the time period 1993-2000. For results of long-time follow-up only patients operated on between 1993 and 1998 were included. Results: A total of 763 patients (541 men) were identified aged 71-87 years. Postoperative mortality rate was 9%, highest after bilobectomy and pneumonectomy. The most commonly reported causes of postoperative death were pneumonia and cardiac complications. The majority of patients had tumor categorized as clinical stage (cStage) Ia and Ib. More than 100 in each of these groups proved to have more advanced disease postoperatively (pStage). The 5-year relative survival rate was significantly better in patients with disease in pStage I compared to higher stages. Women had a significantly better 5-year survival rate compared to men, 62.8 and 35.7%, respectively. Conclusions: Lung cancer surgery appears to be a relatively safe procedure even in the elderly. There is a high postoperative mortality after bilobectomy and pneumonectomy. However, when old people survive the postoperative period the long term prognosis seems favorable.
Background: There is considerable variability in reported postoperative mortality and risk factor... more Background: There is considerable variability in reported postoperative mortality and risk factors for mortality after surgery for lung cancer. Population-based data provide unbiased estimates and may aid in treatment selection. Methods: All patients diagnosed with lung cancer in Norway from 1993 to the end of 2005 were reported to the Cancer Registry of Norway (n = 26 665). A total of 4395 patients underwent surgical resection and were included in the analysis. Data on demographics, tumour characteristics and treatment were registered. A subset of 1844 patients was scored according to the Charlson co-morbidity index. Potential factors influencing 30-day mortality were analysed by logistic regression. Results: The overall postoperative mortality rate was 4.4% within 30 days with a declining trend in the period. Male sex (OR 1.76), older age (OR 3.38 for age band 70-79 years), right-sided tumours (OR 1.73) and extensive procedures (OR 4.54 for pneumonectomy) were identified as risk factors for postoperative mortality in multivariate analysis. Postoperative mortality at high-volume hospitals (>20 procedures/year) was lower (OR 0.76, p = 0.076). Adjusted ORs for postoperative mortality at individual hospitals ranged from 0.32 to 2.28. The Charlson co-morbidity index was identified as an independent risk factor for postoperative mortality (p = 0.017). A prediction model for postoperative mortality is presented. Conclusions: Even though improvements in postoperative mortality have been observed in recent years, these findings indicate a further potential to optimise the surgical treatment of lung cancer. Hospital treatment results varied but a significant volume effect was not observed. Prognostic models may identify patients requiring intensive postoperative care.
Background: Very few population based results have been presented for survival after resection fo... more Background: Very few population based results have been presented for survival after resection for lung cancer. The purpose of this study was to present long term survival after resection and to quantify prognostic factors for survival. Methods: All lung cancer patients diagnosed in Norway in 1993-2002 were reported to the Cancer Registry of Norway (n = 19 582). A total of 3211 patients underwent surgical resection and were included for analysis. Supplementary information from hospitals (including co-morbidity data) was collected for patients diagnosed in 1993-8. Five year observed and relative survival was analysed for patients diagnosed and operated in 1993-9. Factors believed to influence survival were analysed by a Cox proportional hazard regression model. Results: Five year relative survival in the period 1993-9 was 46.4% (n = 2144): 58.4% for stage I disease (n = 1375), 28.4% for stage II (n = 532), 15.1% for IIIa (n = 133), 24.1% for IIIb (n = 63), and 21.1% for stage IV disease (n = 41). The high survival in stage IIIb and IV was due to the contribution of multiple tumours. Cox regression analysis identified male sex, higher age, procedures other than upper and middle lobectomy, histologies such as adenocarcinoma and large cell carcinoma, surgery on the right side, infiltration of resection margins, and larger tumour size as non-favourable prognostic factors. Conclusions: Survival was favourable for resected patients in a population based group including subgroups such as elderly patients, those with advanced stage, small cell lung cancer, tumours with nodal invasion, and patients with multiple tumours. These results question the validity of the current TNM system for lung cancer with regard to tumour size and categorization of multiple tumours.
Tidsskrift for Den Norske Laegeforening, Jan 3, 2008
Plassering av pasienter i sykehuskorridorer har i lang tid vaert praksis i Norge. Det er vanskeli... more Plassering av pasienter i sykehuskorridorer har i lang tid vaert praksis i Norge. Det er vanskelig å gi tilfredsstillende behandling, pleie og omsorg i en sykehuskorridor. Pasienter og personale lider under de e. Til tross for mange analyser og tiltak er det ingen tegn til bedring av situasjonen.
Kreftregisteret har siden sin opprettelse for 50 år siden hatt som hovedoppgave å registrere nyop... more Kreftregisteret har siden sin opprettelse for 50 år siden hatt som hovedoppgave å registrere nyoppdagede krefttilfeller etter organlokalisasjon, svulsttype, svulstutbredelse og en del andre medisinske forhold. De registrerte opplysningene har vaert fullstendige og gode på grunn av et godt rapporteringssystem med tre uavhengige kilder: patologiavdelinger, kliniske avdelinger og Dødsårsaksregisteret. Populasjonsbaserte data har dannet grunnlaget for forskning på årsaker og risikofaktorer for å få kreft, med vekt på forebygging av kreft. Kreftbildet i Norge har endret seg fra 50-årene hvor flertallet av kreftpasientene døde av sin sykdom, til i dag hvor over halvparten av de over 22 000 pasienter som diagnostiseres årlig vil overleve. Det lever i dag ca. 155 000 pasienter som har eller har hatt kreft. Den økende betydningen av behandling og kreftpasientenes bedrede leveutsikter har påvirket Kreftregisterets arbeid. Det fremstår som stadig viktigere å ha en korrekt registrering av ikke bare karakteristika ved svulsten, men også forhold rundt diagnostikk og behandling. I løpet av de siste 15 år har Kreftregisteret utvidet sitt virkefelt til å omfatte screening og registrering av populasjonsbaserte data om behandling og tilbakefall av kreft etter behandling. Forholdene ligger saerlig godt til rette for populasjonsbasert klinisk forskning i Norge på grunn av vårt fødselsnummersystem som gir mulighet for god oppfølging av behandlingsresultater. Kreftregisteret vil vaere et kvalitetsregister for alle svulstformer og vi vil i tiden fremover legge vekt på utvidet og landsomfattende samarbeid med fagmiljøer som innehar ekspertise på de enkelte svulstformer for å bedre vår registrering og legge forholdene til rette for aktivitet som kan gi bedre resultater både av behandling og forskning. Langmark F, Norstein J. The Cancer Registry of Norway -from registration of cancer incidence and survival to population-based clinical epidemiology.
Plassering av pasienter i sykehuskorridorer har i lang tid vaert praksis i Norge. Det er vanskeli... more Plassering av pasienter i sykehuskorridorer har i lang tid vaert praksis i Norge. Det er vanskelig å gi tilfredsstillende behandling, pleie og omsorg i en sykehuskorridor. Pasienter og personale lider under de e. Til tross for mange analyser og tiltak er det ingen tegn til bedring av situasjonen.
Kreftregisteret har siden sin opprettelse for 50 år siden hatt som hovedoppgave å registrere nyop... more Kreftregisteret har siden sin opprettelse for 50 år siden hatt som hovedoppgave å registrere nyoppdagede krefttilfeller etter organlokalisasjon, svulsttype, svulstutbredelse og en del andre medisinske forhold. De registrerte opplysningene har vaert fullstendige og gode på grunn av et godt rapporteringssystem med tre uavhengige kilder: patologiavdelinger, kliniske avdelinger og Dødsårsaksregisteret. Populasjonsbaserte data har dannet grunnlaget for forskning på årsaker og risikofaktorer for å få kreft, med vekt på forebygging av kreft. Kreftbildet i Norge har endret seg fra 50-årene hvor flertallet av kreftpasientene døde av sin sykdom, til i dag hvor over halvparten av de over 22 000 pasienter som diagnostiseres årlig vil overleve. Det lever i dag ca. 155 000 pasienter som har eller har hatt kreft. Den økende betydningen av behandling og kreftpasientenes bedrede leveutsikter har påvirket Kreftregisterets arbeid. Det fremstår som stadig viktigere å ha en korrekt registrering av ikke bare karakteristika ved svulsten, men også forhold rundt diagnostikk og behandling. I løpet av de siste 15 år har Kreftregisteret utvidet sitt virkefelt til å omfatte screening og registrering av populasjonsbaserte data om behandling og tilbakefall av kreft etter behandling. Forholdene ligger saerlig godt til rette for populasjonsbasert klinisk forskning i Norge på grunn av vårt fødselsnummersystem som gir mulighet for god oppfølging av behandlingsresultater. Kreftregisteret vil vaere et kvalitetsregister for alle svulstformer og vi vil i tiden fremover legge vekt på utvidet og landsomfattende samarbeid med fagmiljøer som innehar ekspertise på de enkelte svulstformer for å bedre vår registrering og legge forholdene til rette for aktivitet som kan gi bedre resultater både av behandling og forskning. Langmark F, Norstein J. The Cancer Registry of Norway -from registration of cancer incidence and survival to population-based clinical epidemiology.
SAMMENDRAGResultatene etter operasjon for kreft i endetarmen har vært preget av høy frekvens av ... more SAMMENDRAGResultatene etter operasjon for kreft i endetarmen har vært preget av høy frekvens av lokalt residiv og deravlav overlevelse. Resultater blant kurativt opererte i Norge i perioden 1986-88 viste at 28% utviklet lokaltresidiv og bare 55% overlevde fem år. For å bedre prognosen ved endetarmskreft (rectumcancer) ble det i1993 startet et nasjonalt prosjekt, og hensikten med denne studien er å evaluere effekten av de tiltak som bleiverksatt for å heve kvaliteten av behandlingen. Prosjektet har fokusert på å optimalisere kirurgisk behandlingved å innføre operasjonsmetoden ”Total Mesorectal Excision” (TME). I tillegg har en lagt vekt på åstandardisere de patologisk anatomiske undersøkelsene. En rekke kurs er blitt arrangert for å lære kirurgeneden nye operasjonsteknikken, mens patologer har gjennomgått kurs for å sikre kvaliteten i vurderingen avoperasjonspreparatene. Et nasjonalt register for endetarmskreft, etablert og drevet av fagmiljøene, ble opprettetved Kreftregisteret. Fr...
International journal of microcirculation, clinical and experimental / sponsored by the European Society for Microcirculation, 1992
The single fibre laser Doppler flowmetry technique has been designed to perform continuous quanti... more The single fibre laser Doppler flowmetry technique has been designed to perform continuous quantification of microvascular perfusion deep in tissue. In this study we have evaluated the use of the technique in renal tissue. A total number of 164 recordings were analyzed. Fluctuations in perfusion related to heart rate and respiration were observed. The possible nature of the low-frequency flow motion waves (10-12 min-1) is discussed. No significant difference in perfusion level could be detected between the upper, the middle and the lower parts of the kidneys (p greater than 0.69), or between the cortex and the medulla (p = 0.77). The spatial variation, expressed as the difference between two consecutive measurements, was large. The median and mean values of groups of data are however reproducible. When the renal artery is reopened after 30 sec of occlusion, the pre-occlusive flux levels are regained after approximately 1.5 sec. The single fibre laser Doppler flowmetry technique can ...
Background: There is considerable variability in reported postoperative mortality and risk factor... more Background: There is considerable variability in reported postoperative mortality and risk factors for mortality after surgery for lung cancer. Population-based data provide unbiased estimates and may aid in treatment selection. Methods: All patients diagnosed with lung cancer in Norway from 1993 to the end of 2005 were reported to the Cancer Registry of Norway (n = 26 665). A total of 4395 patients underwent surgical resection and were included in the analysis. Data on demographics, tumour characteristics and treatment were registered. A subset of 1844 patients was scored according to the Charlson co-morbidity index. Potential factors influencing 30-day mortality were analysed by logistic regression. Results: The overall postoperative mortality rate was 4.4% within 30 days with a declining trend in the period. Male sex (OR 1.76), older age (OR 3.38 for age band 70-79 years), right-sided tumours (OR 1.73) and extensive procedures (OR 4.54 for pneumonectomy) were identified as risk factors for postoperative mortality in multivariate analysis. Postoperative mortality at high-volume hospitals (>20 procedures/year) was lower (OR 0.76, p = 0.076). Adjusted ORs for postoperative mortality at individual hospitals ranged from 0.32 to 2.28. The Charlson co-morbidity index was identified as an independent risk factor for postoperative mortality (p = 0.017). A prediction model for postoperative mortality is presented. Conclusions: Even though improvements in postoperative mortality have been observed in recent years, these findings indicate a further potential to optimise the surgical treatment of lung cancer. Hospital treatment results varied but a significant volume effect was not observed. Prognostic models may identify patients requiring intensive postoperative care.
The aim of the study was to estimate the prevalence of hereditary cancers and the need for survei... more The aim of the study was to estimate the prevalence of hereditary cancers and the need for surveillance in Telemark county, Norway. All persons attending the Norwegian Colorectal Cancer Prevention (NORCCAP) trial in Telemark were interviewed about cases of cancer in the family. Diagnoses were verified, pedigrees constructed and families classified according to preset criteria aiming at identifying hereditary cancer. Mutation analyses were performed in kindreds at risk for breast cancers when possible. Immunohistochemistry of tumors in assumed inherited colorectal cancer families was undertaken. The screening examination was attended by 7,224 persons among whom 2,866 had cancer in the family. Of these, 2,479 had no suspicion of any known inherited cancer syndrome. Family information questionnaires were mailed to 387 persons and returned by 191. Sixty-four of these 191 met the clinical criteria for familial cancer by family history after verification of diagnoses. Observed prevalences for being at risk for hereditary breast and breast-ovarian cancer (HBOC) or hereditary non-polyposis colorectal cancer (HNPCC) were 2.8 per thousand and 0.77 per thousand, respectively. The number of colonoscopies and mammograms obtained per year serving those who needed them was limited and reduced by clinical genetic work-up from 2,866 with a family history of cancer to 64 proven cases. Continued surveillance of an unnecessarily high number leads to unjustified cancer worry, is costly and uses up health-care facilities. Genetic work-up is a one-time job that reduces input numbers to surveillance programs, provides a starting-point for mutation testing and is economically cost beneficial if inherited cancers are prevented or cured by the health-care programs offered.
The L1 antigen (calprotectin) is present in circulating monocytes but is restricted to certain su... more The L1 antigen (calprotectin) is present in circulating monocytes but is restricted to certain subsets of tissue macrophages. Its expression is significantly increased in inflammatory bowel disease, apparently because of newly recruited monocytes. In vitro experiments were performed to substantiate lack of L1 upregulation in tissue macrophages, thereby justifying the use of this marker to detect newly recruited cells. Its reliability was further evaluated by studying mononuclear cell infiltrates characteristic of acute kidney rejection. After pro-inflammatory stimulation, monocytes matured in vitro (n = 12) as well as adherent mononuclear cells from normal small intestinal mucosa (n = 5) were examined for L1 expression by immunocytochemistry and by ELISA (cell lysates). In addition, peritubular mononuclear L1+ cells were examined by immunohistochemistry in routine biopsy specimens from transplanted kidneys with (n = 11) or without (n = 14) histopathologically diagnosed acute rejection. L1 was not upregulated in monocytes matured in vitro, nor in mucosal macrophages after stimulation with interferon-gamma, LPS, phorbol ester, or supernatant from activated leucocytes. In transplanted kidneys with signs of acute rejection, the fraction of L1+ macrophages was significantly increased (P < 0.001). Because L1 is persistently downregulated in mature tissue macrophages and is formalin-resistant, it identifies young infiltrating macrophages in routinely processed biopsy material. L1 should therefore be a valuable adjunct in the diagnosis of kidney rejection.
Colorectal cancer is the fourth most common malignant disease in civilized countries, ranking beh... more Colorectal cancer is the fourth most common malignant disease in civilized countries, ranking behind cancer of the lung, breast, and prostate. In the United States it is estimated that 133,500 cases will be diagnosed in 1996. However, in numeric terms, colorectal cancer is the second most lethal malignancy after lung cancer. The number of deaths that will be attributable to
Aims: To evaluate serum secretory com- ponent in relation to early detection and clinical managem... more Aims: To evaluate serum secretory com- ponent in relation to early detection and clinical management ofliver metastasis in patients with colorectal cancer. Methods: Secretory component and carcinoembryonic antigen (CEA) were analysed in serial serum samples from 23 patients who had liver metastases as the only apparent recurrence, and in sera from 54 matched controls. Results of surgical treatment of recurrences were classified peroperatively as radical when no residual tumour was apparent and resection margins were free of disease. Results: In total, 18 (78%) patients had increased secretory component during the whole follow up period (median 16 months); 12 (52%) had raised secretory component concentrations before clinical recurrence *Males + females. tMedian (range). *Distant organ metastasis or irremovable tumour was assigned stage D according toTumbull et al. 14 Patients with stage D had their metastasis removed at the primary operation. **Time interval between prinary operation and clinical recurrence.
Completeness of reporting and accuracy of the diagnosis of ovarian cancer from one health region ... more Completeness of reporting and accuracy of the diagnosis of ovarian cancer from one health region in Norway to the Cancer Registry were examined. Data kept by the Cancer Registry were evaluated against discharge diagnosis data from all 8 hospitals in the health region during the period of 1987–1996. The assessment of the accuracy of the diagnosis recorded in the Cancer Registry was based on review of all medical records in the hospital setting and on slide review of all histologic diagnoses. The overall completeness of reporting ovarian cancer to the Cancer Registry was 99.6%. The organ specific completeness of registration of histologic verified ovarian cancer within the Cancer Registry was 95.3%; 0.9% was erroneously coded and 3.5% had their diagnosis changed to ovarian cancer at re‐evaluation. Of all ovarian cancer cases registered at the Cancer Registry, 91% had a primary histologic diagnosis. Among 591 cases identified with a histologic diagnosis in the Cancer Registry, the accu...
Cells in lymph draining the human gut have not been characterized previously. The aim of this stu... more Cells in lymph draining the human gut have not been characterized previously. The aim of this study was to phenotype B and T cells present in microlymphatics of Peyer's pathces and in mesenteric lymph. The studies were conducted by multicolor immunohistochemistry, flow cytometry, and immunocytochemistry. In decreasing order of frequency, microlymphatics in Peyer's patches contained naive T (CD3+CD45RA+ alpha 4 beta 7low) and B (sIgD+CD20+ alpha 4 beta 7low) lymphocytes, memory T (CD45RO+ alpha 4 beta 7+) and B (sIgD-CD20+ alpha 4 beta 7+) lymphocytes, and B-cell blasts (CD19+CD38high alpha 4 beta 7high). Naive cells were usually positive for L-selectin, memory cells were either positive or negative, and B-cell blasts were usually negative. Mesenteric lymph contained naive T (approximately 60%) and B (approximately 25%) lymphocytes, memory T and B lymphocytes (approximately 10%), and B-cell blasts (approximately 2%). Cytospins confirmed these results and showed, in addition, that B-cell blasts contained cytoplasmic immunoglobulin (Ig) A, IgM, or IgG in overall proportions of 5:1: < 0.5. Our results are similar to the phenotypes previously described in animal thoracic or mesenteric lymph. A fraction of the B cells stimulated in Peyer's patches are near terminal differentiation (contain cytoplasmic Ig) before they enter peripheral blood. Many memory cells, and most if not all B-cell blasts entering lymph show an adhesion molecule profile (alpha 4 beta 7high L-selectin low) in keeping with the presumed phenotype of lymphoid cells destined for mucosal effector sites such as the gut lamina propria.
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Papers by Jarle Norstein