Adam Taube

Prevalence of sleep apnea syndrome among Swedish men—an epidemiological study

The prevalence of the sleep apnea syndrome (SAS) among Swedish men 30-69 years old was estimated by a two-stage procedure. In the first stage, 4064 questionnaires were mailed to a random sample of a defined population in the municipality of Uppsala. The response rate was almost 80%; 15.6% of the responders were habitual snorers and 5.8% complained of daytime sleepiness. From these, a group of 166 men highly suspected of having SAS was selected. Eventually, 61 of these came for all-night polysomnographic studies, and 15 of these were found to have SAS. On this basis the lower limit of the prevalence of SAS was estimated to be as high as 1.3%. The majority of subjects with the syndrome were in the age group 50-59 years.

Pretreatment serum levels of CA-125, carcinoembryonic antigen, tissue polypeptide antigen, and placental alkaline phosphatase, in patients with ovarian carcinoma, borderline tumors, or benign adnexal masses: Relevance for differential diagnosis☆

Pretreatment serum levels of the antigens CA-125, tissue polypeptide Antigen (TPA), carcinoembryonic antigen (CEA), and placental alkaline phosphatase (PLAP) were determined in samples from 295 women with adnexal masses. At laparotomy 48% of patients had epithelial ovarian carcinoma, 9% had tumors of low malignant potential, and 8% suffered from malignancies of other kinds. The sensitivity of CA-125 with 35 U/ml as the cutoff was 88% in women with ovarian carcinoma, but 74% among those with limited disease and 58% in borderline malignancy. Only 6 of 17 mucinous ovarian carcinomas were detected. Specificity was 83%. CEA was elevated above 5.0 micrograms/liter in 15 of 17 patients with mucinous ovarian cancer. TPA detected advanced stages of malignancy, but the sensitivity was low, 53%, in cases with limited disease. PLAP was elevated in 46% of ovarian carcinoma patients. For detecting malignancy overall, the use of a parallel combination of the CA-125 and CEA assays was more sensitive than use of CA-125 as a single marker. This test combination may be of value in the diagnosis of adnexal masses. The predictive value of a positive result was 90%, and that of a negative result, 76%.

Shigella flexneri O-antigen-specific enzyme immunoassay: class-specific antibody titres against lipopolysaccharide antigens in healthy Vietnamese and Swedish populations

Sera collected from 397 healthy Vietnamese individuals, living in two districts in the surroundings of Hanoi, and 62 healthy Swedish individuals, living in the greater Stockholm area were analysed in enzyme-immunoassays (EIA) for their class-specific immunoglobulin titres against a panel of 10 O-antigen containing lipopolysaccharides (LPS) from Shigella flexneri, Shigella dysenteriae serotype I, Shigella sonnei and Salmonella serogroups A and B. The Vietnamese population was divided into age groups: 0·1–5 year, 1–2, 3–4, 5–9, 10–14 years, etc. Young Vietnamese children had low anti-S. flexneri LPS IgA, IgG and IgM titres which reached adult levels for IgA in the 10- to 14-year-old group, and for IgG and IgM in the 3- to-4-year-old group. The IgA, IgG and IgM titres were significantly higher (P < 0·001) in sera from Vietnamese individuals than in sera from Swedish individuals. The EIA titres against S dysenteriae serotype 1 and S. sonnei LPSs were higher in the Vietnamese than in Swedish population, but to a lesser extent than seen for S. flexneri. The titres against Salmonella serogroups A and B LPS antigens did not differ significantly in the study populations. These results suggest that the incidence of S. flexneri infections is high in Vietnam, followed in frequency by S. dysenteriae serotype I and S. sonnei infections. On the contrary the incidence of salmonellosis appears to be low.

Observations on intrauterine growth in urban Ethiopia.

ABSTRACT. A total of 3 144 deliveries comprising a wide range of socio‐economic groups in Addis Abeba were investigated. A positive correlation was found between family income and birth weight, with a difference of nearly 500 g between the extremes of socio‐economic classes. A seasonal variation in meart birth weight was also observed. The mean length of gestation was 7.4 days shorter, and the anthropometric measures at birth were significantly lower in the Ethiopian infants as compared with the Swedish norm. The median weight and length development in relation to gestational age in the Ethiopian newborns was similar to the Swedish standard up to approximately 34–35 weeks of gestation. After that time there was very little further intrauterine growth in Ethiopian infants. The possible reasons for the observed pattern of growth are discussed.

Patient accrual and quality of participation in a multicentre study on myeloma: a comparison between major and minor participating centres

Summary .The participation of minor centres in randomized trials has been questioned because of inferior quality of participation. We have studied this issue in a multicentre trial on myeloma, in which 5 74 patients were included from 99 participating centres in Sweden, Norway and Denmark from 1 June 1990 until 4 November 1992.

Prevalence of sleep apnea syndrome--estimation by two stage sampling.

This article describes stepwise the methodological and statistical considerations made in the planning of an epidemiological survey of the prevalence of the sleep apnea syndrome (SAS) in the municipality of Uppsala in Sweden. The investigation had to be confined to 60 subjects, since all-night polysomnographic studies are required for an unequivocal diagnosis of SAS. It was decided to investigate men 30 to 69 years old. Initially, the possibility of taking a simple random sample (SRS) was considered, but statistical calculations showed that for prevalences between 1-3% this would lead to totally unacceptable results. A postal questionnaire, sent to the total population of 35,779 men in this age group, was then considered and, depending on their replies, they would be divided into low-risk and high-risk stratums of SAS. Optimal numbers would then be called from each group for polysomnographic studies. This also proved impossible, as the lowest possible standard error was still too large and the samples would contain unacceptably few cases of SAS. We therefore decided to concentrate on the highrisk stratum, obtaining an estimated under limit of the prevalence. For economical reasons, we could not send a questionnaire to all the 35,779 individuals, but based the investigation on a SRS of 4,000 men, post-stratified in a high-risk and a low-risk group. From the high-risk group, 60 men were then selected for polysomnographic studies.

Personality characteristics influencing determinacy of day and night blood pressure and heart rate

The evidence of emotional impacts on day and night blood pressure (BP), heart rate (HR) and non‐dipping of BP remains fragmentary. Personality traits previously tested by self‐reports as determinants of office, screening or mean daytime BP produced mixed results. Therefore, we hypothesized that some traits are acting together as modifiers of 24‐h and day/night ambulatory BP and HR. A population sample of healthy 47–54 year‐old men, n = 85, unaware of their BP status, was evaluated. In multiple regression, 25% of the 24‐h systolic BP (SBP) variation was explained by independent augmenting predictors Trait Anger–Anger Expression Styles, Large and Lasting Emotions, and by an attenuating predictor Anxiety. Only Verbal Aggression increased night‐time SBP much more than daytime SBP and diminished day–night dipping of SBP. Strong Large/Lasting Emotions and Indirect Aggression increased daytime SBP only. Day and night HR increased with a high Suspicious Hostility (7.4% of variation), in particular with items Distrust/Vulnerability (11.5% of variation). In conclusion, mean levels of HR and BP during a 24‐h period are slightly modified by particular personality traits. Some traits appear to affect either daytime or night‐time periods more. Day to night carry‐over effects on SBP may occur.

Immunohistochemical detection of CA‐125 and carcinoembryonic antigen in ovarian tumors in relation to corresponding preoperative serum levels

The immunohistochemically detectable expression of CA-125 and CEA in ovarian tumor tissue from 187 patients was related to corresponding preoperative serum levels. A strong positive association between tissue expression and the serum level of both the CA-125 and CEA antigens was found in cases of invasive epithelial ovarian carcinoma. However, this relationship was absent for CA-125 in borderline cases and patients with benign ovarian tumors, although the antigen frequently was detectable in them. The presence of ascites could be verified in 3 of 10 cases with benign CA-125 negative tumors, but elevated CA-125 levels in serum. ‘False negative’ CA-125 levels were found in 6 borderline and 7 true invasive carcinoma cases despite positive tissue staining. Eight of those patients had limited stage I disease. The data suggests that although the tissue expression of the CA-125 and CEA antigens in invasive ovarian carcinoma has an important influence in the corresponding serum level, compartment barriers and low cell turnover in benign, and to a lesser extent borderline, cases result in low serum levels. In addition, other factors influence serum levels of CA-125, such as secondary peritoneal response with or without ascites, which may cause ‘falsely elevated’ CA-125 results in benign disease.

Reproducibility of tumor response evaluation in patients with high-grade malignant non-hodgkin’s lymphoma

Estimation of complete response (CR) and partial response (PR) in patients with non-Hodgkin’s lymphoma (NHL) is associated with a number of potential sources of error. The aim of this study was to define the reproducibility of response evaluation performed by an independent review committee (RC).In a phase III study of patients >60 yr with aggressive NHL, 60 patients who were already evaluated by the independent review committee (RC 1) for response were randomized to three groups and re-evaluated (RC 2). The assessment was classified into one of seven mutually exclusive categories, where the important borderlines with regard to one of the major end-points of the study, the CR rate, were between CR, “CR uncertain” (CRU), and PR. A discrepancy between RC 1 and 2 was found in 8/60 patients (13.3%), influencing the CR/CRU status in four of these patients. Two CR and two PR patients were reclassified as CRU. Thus, CR/CRU was changed in 4/60 (6.7%). The reports of the local investigators were compared with that of RC 1 in 254 patients. The CR/CRU status was affected in 41 of these patients (16.1%). It is concluded that an independent RC is a major prerequisite for a uniform response evaluation in phase III clinical trials. However, the good RC reproducibility does not motivate a second assessment. Moreover, in the phase III setting end-points other than the CR rate, such as time to treatment failure, cause specific and overall survival are preferred.

Interchangeability of Ambulatory and Office Blood Pressure: Limitations of Reproducibility and Agreement

A possible equivalence of office (Off) patient-recorded blood pressure (BP) and ambulatory (Amb) BP was evaluated. The criteria were the between-visits reproducibility (R) of oscillometrically measured supine office (Off), seated Off, and 24-h Amb BP and the agreement between Off and Amb data. Randomly ordered sessions were completed within 4 months in 59 untreated patients with Amb 24-h BP 136/87 (SD 14/10) mmHg and HR 72 (SD 9). R improves as SD of differences between sessions decreases with the number (