Kjell Elgen

Combined modality therapy of operated astrocytomas grade III and IV. Confirmation of the value of postoperative irradiation and lack of potentiation of bleomycin on survival time: A prospective multicenter trial of the scandinavian glioblastoma study group

In a controlled, prospective, randomized investigation, started in 1974, 118 patients with supratentorial astrocytoma Grade III–IV were divided into three groups. Groups 1 and 2 received 45 Gy postoperatively to the whole supratentorial brain. Bleomycin in 15‐mg doses and a total dose of 180 mg or placebo was given intravenously three times a week, one hour prior to radiotherapy, during weeks 1,2,4 and 5. Group 3 received conventional care but no radiotherapy or chemotherapy. Median survival rates of patients were 10.8 months in Groups 1 and 2, and 5.2 months in Group 3, a statistically significant difference. With regard to performance, the patients in Group 3 deteriorated faster than patients in Groups 1 and 2. Bleomycin had no positive or negative influence on survival.

Flupenthixol decanoate in recurrent manic-depressive illness. A comparison with lithium.

The hypothesis that flupenthixol decanoate may serve as an alter‐native to prophylactically administered lithium in recurrent manicdepressive illness, bipolar and unipolar type, was tested in two groups of patients. In Group I the patients were allocated randomly to maintenance treatment with either lithium or flupenthixol decanoate. The patients in Group II had previously been given lithium and were switched to flupenthixol decanoate because of unsatisfactory prophylactic effect of lithium, doubtful tablet compliance, troublesome side effects, or fear of later harmful effects. The flupenthixol decanoate dosage was 20 mg every 2–3 weeks. The study was not blind.

Irradiation, chemotherapy and surgery in esophageal cancer: a randomized clinical study. The first Scandinavian trial in esophageal cancer.

In a randomized trial, irradiation alone (35 Gy) or irradiation (30 Gy) and bleomycin was given as preoperative treatment of esophageal cancer. In inoperable patients, a split course of irradiation alone (63 Gy) or irradiation (55 Gy) and bleomycin was given. Bleomycin doses were 5 mg i.m. 1/2-1 h before each irradiation dose. No benefit was obtained by addition of bleomycin to irradiation concerning survival or palliation of dysphagia. No benefit of bleomycin was seen either in any subgroup of patients according to different primary tumour classifications, histopathological gradings or localizations of tumour. In patients with advanced/metastatic disease, bleomycin and adriamycin treatment gave a significantly longer survival than bleomycin alone. It was shown that the presence of T1 tumours was a significant prognostic factor for long-term survival and that performing a radical operation was a significant advantage for a longer survival. Female patients treated with irradiation with or without bleomycin survived significantly longer than males, but in operable patients there was no significant difference between the two sexes with regard to survival.

Bleomycin/cis-platin as neoadjuvant chemotherapy before radical radiotherapy in localized, inoperable carcinoma of the esophagus: A prospective randomized multicentre study: The second Scandinavian trial in esophageal cancer

Survival and swallowing function were studied in a randomized trial of 97 patients with inoperable, localized esophageal carcinoma. Radical radiotherapy was given to 51 patients, while 46 patients had two courses of bleomycin/cisplatin before radiotherapy. The survival was 29% after one year, and 6% after 3 years in the radiotherapy group. The survival in the combined treatment group was 18 and 0%, respectively; p = 0.1895. The number of patients who could swallow any food increased from 6% before treatment to 38% after 3 months in the radiotherapy group, and from 0% to 23% in the combined group. No benefit was found by combining bleomycin/cisplatin with radiotherapy.

Clinical multicentre study of citalopram compared double-blindly with mianserin in depressed patients in Finland

Ahlfors UG, Elovaara S, Harma P, Suoniemi I, Heikkila L, Nummi K, Vartiainen A, Var-tiainen H, Tarnminen T, Elgen K, Sundman K. Clinical multicentre study of citalopram compared double-blindly with mianserin in depressed patients in Finland.The aim of the trial was to study the antidepressant effect and side effects of citalopram and mianserin in a double-blind, multicentre study in six psychiatric hospitals in Finland. Patients of both sexes, aged 18 to 70 years, were included. The depression was classified as endogenous or non-endogenous by means of the Newcastle Depression Scale (1). Thirty-seven patients were allocated to treatment with citalopram and 34 to treatment with mianserin. Six patients (5+1) did not fulfil the inclusion criteria and nine patients (4+5) dropped out of the study. Citalopram. 40-60 mg daily, and mianserin, 60-90 mg daily, were given once a day in the evening for 4 weeks. The patients were assessed before treatment and after 1, 2, and 4 weeks. The Clinical Global Impression Scal...

Behandling med Citalopram vid demens. Normalisering av DST

It is well-known that the concentration of serotonin is reduced in patients with dementia of Alzheimertype (AD/SDAT) as well as in patients with cerebral vascular diseases. Postmortem investigations have shown low concentrations of both 5-hydroxytryptamine (5-HT) and 5 hydroxyindoleacetic acid (5-HIAA). An emotional blunting as well as a decrease of the intellectual functions have been reported in patients with dementia. Patients with dementia are often depressed, anxious and irritable. Since a disturbance of serotonin and norepinephrine may influence the emotional reactions a treatment with Citalopram was conducted. Citalopram selectively blocks the re-uptake of 5-HT and it is thus assumed that the pharmacological effect is an activation of the rate of serotonin metabolism in the brain. In a pilot investigation where 20-30 mg Citalopram was given daily to patients with dementia, significant improvements were found in spontaneous activity, power to concentrate, distractibility, anxiety and nervousness. An...

Treatment of acutely disturbed psychotic patients: assessment of a new treatment strategy

Psychiatric inpatients at Danderyd Hospital, Sweden, were studied over a 3-year period (1987-1989) for aggressive incidents and their consequences. Included in the study was the use of the Staff Observation Aggression Scale for recording and assessing aggressive incidents. Peak daily incidences of aggressive acts occurred at times of medication.In 1988, zuclopenthixol acetate - a novel neuroleptic preparation - was introduced into the study for the treatment of acutely disturbed patients. In 1988 and 1989 there followed an overall reduction in aggressive incidents and the peak incidences associated with medication times were abolished. The positive clinical experience with zuclopenthixol acetate has established this drug as first choice treatment for acutely disturbed psychotic patients at Danderyd Hospital.□ Aggression, Psychoses, Treatment, Zuclopenthixol acetate.

Aspects of clinical psychiatric research on depot neuroleptics: THE PRESENTATION OF TWO DOUBLE-BLIND TRIALS WITH CIS(Z)-CLOPENTHIXOL DECANOATE AND A WITHDRAWAL STUDY IN SCHIZOPHRENICS

Until recently clinicopharmacological studies in psychiatry have aroused little research interest. In the last few years, however, progress in clinical psychopharmacology has led to new methods of clinical therapeutic research which have been widely accepted. This research continues to build, however, mainly on clinical observations since it is not yet possible to find a way to apply in man pharmacological models of peuroleptics such as their effect on central receptor mechanisms. Perhaps further studies of their effects on monoamine metabolism and on the endocrine system may change this situation (Cotes et al. (1978)). The elucidation of the effect of neuroleptics must, therefore, be based on their effects on single symptoms and symptom clusters and on side effects and clinical global assessment. Thus symptom scales are essential for such research. About 15 years ago the symptom scales as an instrument of assessment competed with psychological tests which measured learning, reaction time, memory, etc. However, such psychological tests turned out to be of little value because Of poor reproducability and poor correlation with clinical symptoms. Thus symptom scales, though only rough instruments, came to dominate the process analysis of clinical therapy. However, critisism has been made of their value (see also Guilford (1954)): 1. From a validity point of view they may fail in relevance, in discrimination, and in predictive value and thus they do not measure what is intended. This applies to both diagnosis and rating of therapeutic effect. 2. Their reliability is doubtful which limits their use in the evaluation of the effects of treatment. Both the interand intrarater reliability therefore needs to be determined as a preliminary to any clinical trial. 3. Their correlation with a clinical global assessment and patients’ own evaluation (Katz (1970)) is uncertain.