Mechanical thrombectomy in acute ischemic stroke—experience from 6 years of practice

INTRODUCTION: We present our results from the first 6 years with mechanical thrombectomy in the treatment of ischemic stroke. METHODS: Every patient treated with mechanical thrombectomy for acute ischemic stroke from September 2005 to December 2011 was consecutively included in this retrospective analysis. Baseline and outcome data were retrieved from computerized records at the hospital. National Institute of Health Stroke Scale (NIHSS) score and the modified Rankin Scale (mRS) score were used as outcome parameters. Favorable outcome was defined as a mRS score of 0–2, corresponding to independence in activities of daily living. We also evaluated revascularization and severe adverse events, with focus on symptomatic intracranial hemorrhage. RESULTS: Good functional outcome (mRS 0–2) was achieved in 50 % (120/240) of all patients. For patients with no neurological deficit prior to stroke onset (i.e., mRS = 0 before stroke), the proportion with good functional outcome was 54 %. Symptomatic hemorrhages occurred in 4.6 % of the cases (5.7 % in the anterior circulation). CONCLUSION: In summary, our results supports that mechanical thrombectomy is a safe and effective method to restore blood flow in selected patients suffering from an acute ischemic stroke

EPI-CT: design, challenges and epidemiological methods of an international study on cancer risk after paediatric and young adult CT

Computed tomography (CT) has great clinical utility and its usage has increased dramatically over the years. Concerns have been raised, however, about health impacts of ionising radiation exposure from CTs, particularly in children, who have a higher risk for some radiation induced diseases. Direct estimation of the health impact of these exposures is needed, but the conduct of epidemiological studies of paediatric CT populations poses a number of challenges which, if not addressed, could invalidate the results. The aim of the present paper is to review the main challenges of a study on the health impact of paediatric CTs and how the protocol of the European collaborative study EPI-CT, coordinated by the International Agency for Research on Cancer (IARC), is designed to address them. The study, based on a common protocol, is being conducted in Belgium, Denmark, France, Germany, the Netherlands, Norway, Spain, Sweden and the United Kingdom and it has recruited over one million patients suitable for long-term prospective follow-up. Cohort accrual relies on records of participating hospital radiology departments. Basic demographic information and technical data on the CT procedure needed to estimate organ doses are being abstracted and passive follow-up is being conducted by linkage to population-based cancer and mortality registries. The main issues which may affect the validity of study results include missing doses from other radiological procedures, missing CTs, confounding by CT indication and socioeconomic status and dose reconstruction. Sub-studies are underway to evaluate their potential impact. By focusing on the issues which challenge the validity of risk estimates from CT exposures, EPI-CT will be able to address limitations of previous CT studies, thus providing reliable estimates of risk of solid tumours and leukaemia from paediatric CT exposures and scientific bases for the optimisation of paediatric CT protocols and patient protection

Does cancer originate in utero?

The purpose of the present thesis was to evaluate Trichopoulos' hypothesis that breast cancer can originate in utero, and to examine the role of antenatal estrogen exposure in the etiology of testicular cancer. First, we used data from a Swedish-Norwegian cohort study on risk factors for small-for-gestational-age births to identify markers for antenatal estrogen exposure. A total of 1,945 parous women were followed during gestation, and the follow-up included blood samples taken at 17, 25, 33 and 37 weeks of gestation. After delivery, 234 women who delivered at term (>=37 weeks) were selected for estriol analysis. Of these, 188 had been assessed three or more times during gestation. We calculated the cumulative estriol level for each woman and analyzed the associations between pregnancy characteristics, fetal and matemal anthropometrics and the cumulative levels of estriol. We found a strong positive association between birth weight and cumulative estriol. We also found that smoking decreases estriol throughout the duration of gestation with 20 to 30%, whereas matemal age and pregnancy weight gain were not associated with estriol. Second, we used the obtained markers (birth weight and matemal smoking) in studies on risk factors for breast and testicular cancer. In a population based case-control study on breast cancer among female twins from opposite- sexed twin pairs, we found birth weight strongly associated with breast cancer risk. Compared with women with a birth weight below 2,000 grams, women with a birth weight of more than 3,500 grams had a more than tenfold increase in breast cancer risk. As a marker for matemal smoking during gestation we used a matemal diagnosis of lung cancer. Through the use of the Swedish Cancer Register and the Swedish Generation Register we identified the offspring of women who had developed lung cancer between 1958 and 1997. We restricted the analysis to lung cancer subtypes with a known association to smoking. Of the 22,158 women who developed lung cancer during the study period, 19,869 were included. Of these, 11, 115 had a total of 23,530 children born after 1941. We found that male offspring of women with lung cancer had an almost twofold increase in testicular cancer risk, but we found no association between matemal lung cancer and risk of breast cancer. The last study of the thesis was a retrospective cohort study on preterm and small-for-gestational-age birth and subsequent cancer risk. By manually reviewing approximately 250,000 birth records from the period 1925 to 1949 at four major delivery units, we identified 3,361 infants who were born small for gestational age or before the 35th week of gestation. We assessed incident cancer cases in the cohort through the Swedish Cancer Register. We found no increased risk for cancer overall in the cohort, but infants with a birth weight of less than 2,000 grams had an almost fourfold increase in testicular cancer risk. The association was independent of gestational age. Women with a gestational duration of 33 to 34 weeks and a birth weight of 3,000 grams or more had a threefold increase in breast cancer risk, and among women born before 32 weeks, a birth weight of less than 2,000 grams was associated with a relative risk of 1.7. The association between birth weight and breast cancer suggests the role of antenatal hormonal exposures, but could be due to other factors. The strong association between birth weight and breast cancer among females from opposite-sexed twin pairs, much stronger than previously reported from same-sexed pairs in the same population, is, however, unlikely to be due to anything other than hormonal exposures in utero. Trichopoulos' hypothesis is therefore valid, but hormones other than estrogen must be of importance. In contradiction to the hypothesis on the role of estrogens in testicular carcinogenesis, we found markers for low estrogen levels during pregnancy being associated with an increased risk for testicular cancer

Reduced risk of prostate cancer in men who are childless as compared to those who have fathered a child: A population based case-control study.

Abstract is not available. This is the final, accepted and revised manuscript of this article. Use alternative location to go to the published article. Requires subscription

Pharmacological treatment and demographic characteristics of pediatric patients with Attention Deficit Hyperactivity Disorder, Sweden

The aim of this study was to describe the pediatric population with ADHD and their pharmacological treatment. Using the Swedish National Patient Register and the Prescribed Drug Register we identified individuals below 19 years of age who were diagnosed or medically treated for ADHD for the first time 2006-2007. The unique patient identifiers were used to link information from the two registers to describe demographic characteristics, hospital care and drug treatments. Logistic regression model estimated the association between age, sex, frequency of hospitalization, diagnosis or treatment for other mental disorders and risk of gap in the treatment. Totally the study included 7931 patients of whom 74% were males. The mean age at first diagnosis was 12 years. Some 84% were medically treated for ADHD and approximately 90% received methylphenidate as the first substance. Combination therapy was rare and the most common combination was methylphenidate and atomoxetine. More than 55% of the patients, which could be followed up for two years after start of treatment, had at least one treatment gap of six months. Older age at diagnosis, lower number of hospitalizations and comorbidity with other mental disorders increased risks of gaps in medication. Approximately one fifth of the patients recorded in the National Patient Register as diagnosed with ADHD did not receive pharmacological treatment. Medication adherence seems to be low, when measured as gaps in treatment

Pharmacological treatment and demographic characteristics of pediatric patients with Attention Deficit Hyperactivity Disorder, Sweden

The aim of this study was to describe the pediatric population with ADHD and their pharmacological treatment. Using the Swedish National Patient Register and the Prescribed Drug Register we identified individuals below 19 years of age who were diagnosed or medically treated for ADHD for the first time 2006-2007. The unique patient identifiers were used to link information from the two registers to describe demographic characteristics, hospital care and drug treatments. Logistic regression model estimated the association between age, sex, frequency of hospitalization, diagnosis or treatment for other mental disorders and risk of gap in the treatment. Totally the study included 7931 patients of whom 74% were males. The mean age at first diagnosis was 12 years. Some 84% were medically treated for ADHD and approximately 90% received methylphenidate as the first substance. Combination therapy was rare and the most common combination was methylphenidate and atomoxetine. More than 55% of the patients, which could be followed up for two years after start of treatment, had at least one treatment gap of six months. Older age at diagnosis, lower number of hospitalizations and comorbidity with other mental disorders increased risks of gaps in medication. Approximately one fifth of the patients recorded in the National Patient Register as diagnosed with ADHD did not receive pharmacological treatment. Medication adherence seems to be low, when measured as gaps in treatment

Academic achievement after a CT examination toward the head in childhood: Follow up of a randomized controlled trial

Introduction Increasing use of CT examinations has led to concerns of possible negative cognitive effects for children. The objective of this study is to examine if the ionizing radiation dose from a CT head scan at the age of 6–16 years affects academic performance and high school eligibility at the end of compulsory school. Materials and methods A total of 832 children, 535 boys and 297 girls, from a previous trial where CT head scan was randomized on patients presenting with mild traumatic brain injury, were followed. Age at inclusion was 6–16 years (mean of 12.1), age at follow up 15–18 years (mean of 16.0), and time between injury and follow up one week up to 10 years (mean of 3.9). Participants’ radiation exposure status was linked with the total grade score, grades in mathematics and the Swedish language, eligibility for high school at the end of compulsory school, previously measured GOSE-score, and their mothers’ education level. The Chi-Square Test, Student’s t-Test and factorial logistics were used to analyze data. Results Although estimates of school grades and high school eligibility were generally higher for the unexposed, the results showed no statistically significant differences between the exposed and unexposed participants in any of the aforementioned variables. Conclusions Any effect on high school eligibility and school grades from a CT head scan at the age of 6–16 years is too small to be detected in a study of more than 800 patients, half of whom were randomly assigned to CT head scan exposure

Academic achievement after a CT examination toward the head in childhood: Follow up of a randomized controlled trial.

IntroductionIncreasing use of CT examinations has led to concerns of possible negative cognitive effects for children. The objective of this study is to examine if the ionizing radiation dose from a CT head scan at the age of 6-16 years affects academic performance and high school eligibility at the end of compulsory school.Materials and methodsA total of 832 children, 535 boys and 297 girls, from a previous trial where CT head scan was randomized on patients presenting with mild traumatic brain injury, were followed. Age at inclusion was 6-16 years (mean of 12.1), age at follow up 15-18 years (mean of 16.0), and time between injury and follow up one week up to 10 years (mean of 3.9). Participants' radiation exposure status was linked with the total grade score, grades in mathematics and the Swedish language, eligibility for high school at the end of compulsory school, previously measured GOSE-score, and their mothers' education level. The Chi-Square Test, Student's t-Test and factorial logistics were used to analyze data.ResultsAlthough estimates of school grades and high school eligibility were generally higher for the unexposed, the results showed no statistically significant differences between the exposed and unexposed participants in any of the aforementioned variables.ConclusionsAny effect on high school eligibility and school grades from a CT head scan at the age of 6-16 years is too small to be detected in a study of more than 800 patients, half of whom were randomly assigned to CT head scan exposure