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BackgroundMuch controversy surrounds the association of traditional cardiovascular disease risk factors with venous thromboembolism (VTE).MethodsWe performed an individual level random-effect meta-analysis including 9 prospective studies with measured baseline cardiovascular disease risk factors and validated VTE events. Definitions were harmonized across studies. Traditional cardiovascular disease risk factors were modeled categorically and continuously using restricted cubic splines. Estimates were obtained for overall VTE, provoked VTE (ie, VTE occurring in the presence of 1 or more established VTE risk factors), and unprovoked VTE, pulmonary embolism, and deep-vein thrombosis.ResultsThe studies included 244 865 participants with 4910 VTE events occurring during a mean follow-up of 4.7 to 19.7 years per study. Age, sex, and body mass index-adjusted hazard ratios for overall VTE were 0.98 (95% confidence interval [CI]: 0.89-1.07) for hypertension, 0.97 (95% CI: 0.88-1.08) for hyperlipidemia, 1.01 (95% CI: 0.89-1.15) for diabetes mellitus, and 1.19 (95% CI: 1.08-1.32) for current smoking. After full adjustment, these estimates were numerically similar. When modeled continuously, an inverse association was observed for systolic blood pressure (hazard ratio=0.79 [95% CI: 0.68-0.92] at systolic blood pressure 160 vs 110 mm Hg) but not for diastolic blood pressure or lipid measures with VTE. An important finding from VTE subtype analyses was that cigarette smoking was associated with provoked but not unprovoked VTE. Fully adjusted hazard ratios for the associations of current smoking with provoked and unprovoked VTE were 1.36 (95% CI: 1.22-1.52) and 1.08 (95% CI: 0.90-1.29), respectively.ConclusionsExcept for the association between cigarette smoking and provoked VTE, which is potentially mediated through comorbid conditions such as cancer, the modifiable traditional cardiovascular disease risk factors are not associated with increased VTE risk. Higher systolic blood pressure showed an inverse association with VTE.

Background: High-dose therapy with autologous stem cell support (HDT) has been a treatment option for lymphomas in Norway for 25 years. The purpose of the article was to describe the use of the therapy for lymphomas for the country as a whole and by health region, and to reveal the overall survival rate., Method: All lymphoma patients ≥ 18 years who received HDT in Norway in the period 1987-2008 are included. Patients, diagnostics and treatment are identified for each hospital. Data for the population base have been retrieved from Statistics Norway., Results: Altogether 726 lymphoma patients received HDT in Norway in the period 1987-2008, with an annual average of 0.72 per 100,000 inhabitants. The annual number of treatments increased until 2004 and has since been stable. The average number of treatments per 100,000 inhabitants per year was 0.94 for Northern Norway Health Region, 0.80 for South-Eastern Norway Health Region, 0.58 for Central Norway Health Region and 0.55 for Western Norway Health Region. Early mortality (death within 100 days) was 6%. Ten-year overall survival was 55% (95% CI 51-59%), and Hodgkin's lymphoma had the best survival of the lymphoma groups (p = 0.01)., Interpretation: The annual number of HDT increased gradually until 2004. The use of the treatment varied according to the patients' place of residence at the time of diagnosis, and was most frequently used for patients belonging to Northern Norway Health Region. More than half of the lymphoma patients are alive ten years after the treatment.

High-dose therapy with autologous stem cell support (HDT) has been a therapeutic option for lymphomas in Norway since as far back as 1987. By restoring bone marrow function through reinfusion of the patient's own stem cells, it is possible to administer cancer treatment in higher and otherwise lethal doses, and thereby achieve better treatment results. Originally stem cells were harvested from bone marrow and the high-dose therapy included total body irradiation, but since the mid 1990s stem cells have been harvested by apheresis and the high-dose therapy has consisted of chemotherapy alone (BEAM chemotherapy). In 1995 the treatment was regionalised and since then it has been performed in all health regions. The HDT procedure was introduced as an experimental treatment in clinical studies with international collaboration. The indications have changed over time, and this is now established treatment for a number of types of lymphoma.

Background: An explanation for the increased risk of myocardial infarction and stroke in patients with venous thrombosis is lacking. The objective of this study was to investigate whether risk factors for arterial cardiovascular disease also increase the risk of venous thrombosis., Design and Methods: Cases who had a first venous thrombosis (n=515) and matched controls (n=1,505) were identified from a population-based, nested, case-cohort study (the HUNT 2 study) comprising 71% (n=66,140) of the adult residents of Nord-Trøndelag County in Norway., Results: The age- and sex-adjusted odds ratio of venous thrombosis for subjects with concentrations of C-reactive protein in the highest quintile was 1.6 (95% confidence interval: 1.2-2.2) compared to subjects with C-reactive protein in the lowest quintile. This association was strongest in subjects who experienced venous thrombosis within a year after blood sampling with a three-fold increased risk of participants in the highest versus the lowest quintile. Having first degree relatives who had a myocardial infarction before the age of 60 years was positively associated with venous thrombosis compared to not having a positive family history [odds ratio 1.3 (95% confidence interval: 1.1-1.6)]. Subjects with blood pressure in the highest quintile had half the risk of developing venous thrombosis compared to subjects whose blood pressure was in the lowest quintile. There were no associations between the risk of venous thrombosis and total cholesterol, low density lipoprotein-cholesterol, high density lipoprotein-cholesterol, triglycerides, glucose or smoking. We confirmed the positive association between obesity and venous thrombosis., Conclusions: C-reactive protein and a family history of myocardial infarction were positively associated with subsequent venous thrombosis. Blood pressure was inversely correlated to venous thrombosis. These findings should be confirmed by further investigations.

Background: Bacteremia frequently complicates cytostatic treatment of hematological malignancies. Initial antibiotic treatment is chosen empirically before the results of cultures are available. Rational choices depend on updated knowledge of microbial resistance patterns. We have examined microorganisms in blood cultures over a 10-year period and compared them with the preceding 5-year period., Material and Methods: We analyzed isolates from blood cultures in patients with a hematological malignant disorder treated in the Hematology Unit, St. Olavs Hospital during the years 1995 - 2005., Results: We found 373 isolates and 322 episodes of bacteremia in 225 patients. Most patients had acute leukemia or myeloma, with neutropenia after cytostatic treatment. The dominating pathogens were Escherichia coli (20 %), coagulase-negative staphylococci (13 %) and alpha-haemolytic streptococci (10 %). Enterococcus infections seem to occur more frequently and were associated with a high mortality. Gram-negative organisms constituted 48 % and gram-positive organisms 48 % of the isolates. About 3 / 4 of the patients had infections with penicillin-resistant bacteria. There was a low prevalence of organisms resistant to aminoglycoside. Acute leukemia patients with bacteremia had a 30-days all-cause mortality of 10.3 %., Interpretation: We found small changes in the pattern of pathogens and antibiotic resistance over time. The rates of antibiotic resistance were favorable compared to other European countries. The mortality rate seems to be unchanged and acceptable. Penicillin G and aminoglycoside can still be considered as first-line treatment for suspected bacteremia in neutropenic patients in Norway.

Background: AL-amyloidosis is a serious disease with a short median survival without treatment. Treatment with high-dose melphalan with autologous stem cell support (HMAS) has a potential to increase survival, but is associated with toxicity and mortality. In this paper we report the Norwegian results retrospectively., Material and Methods: We used questionnaires and had personal contact with a local physician from each hospital with HMAS experience. Diagnosis and treatment were evaluated according to the guidelines at the time of treatment, and the results were compared to internationally published reports., Results: Stem cell harvesting was attempted in 18 patients from 1997 to 2006. 15 of these received HMAS treatment. Treatment-related mortality was 20%, and 5 of 11 (45%) had an organ response. Median survival was not reached within the 55-month median observation time. The course of the disease was more complicated when known risk factors for HMAS treatment were present, such as reduced kidney function, advanced heart involvement, reduced performance status, and multiorgan disease. Three of 18 patients were not diagnosed according to relevant guidelines. In seven of 12 patients the response to treatment was not evaluated adequately with respect to haematology., Interpretation: AL-amyloidosis is a difficult diagnosis and the condition is probably under-diagnosed in Norway. The results of HMAS treatment in Norway are comparable with those in published reports from centres abroad. The follow-up of patients should be improved.

Background: The introduction of high-dose treatment with autologous stem cell support (HMAS) in Norwegian regional hospitals in the early 1990s was controversial. Concerns that low numbers of patients would lead to unacceptably low quality were expressed., Material and Methods: We present treatment results in the health region of Middle Norway, based on nearly 10 years of experience and 100 treated patients. Myeloma results are compared to the results from other Norwegian regional hospitals., Results and Interpretation: Overall survival for multiple myeloma after HMAS (median 6.8 years) was not significantly different in middle Norway compared to the rest of the country, and comparable with published results. Treatment-related mortality was low (1.2%). Results and complications in malignant lymphoma, breast cancer or germ cell tumours are described. HMAS can be satisfactorily given in a regional hospital with relatively few patients.

Lead poisoning may cause irreversible health defects, including anaemia, central nervous system problems and various organ defects. We describe a patient with lead poisoning. A 54-year-old woman was admitted to hospital with anaemia and unspecific gastrointestinal symptoms. Peripheral blood smear and bone marrow aspirate showed basophilic stippling of erythrocytes suggestive of lead poisoning, which was confirmed by high concentrations of lead in her blood. The lead source was the glazing of a ceramic wine jug. Chelating therapy was started. Haemoglobin was normalised; the patient returned to work after nine months. Correct diagnosis and treatment can prevent serious health problems caused by lead poisoning.

Material and Methods: We present a review of the history, pathophysiology, diagnosis and treatment of lead poisoning based on relevant literature., Results and Interpretation: The human body does not metabolize lead, and lead accumulation may cause organ failure. Lead poisoning may cause serious health defects, including anaemia, central nervous system problems and various organ defects. Sources of lead may be found in the home as well as in the workplace or elsewhere in our environment, but lead poisoning is an infrequent condition. Prevention is important, but manifest lead poisoning can be treated effectively.

Background: Warfarin treatment of venous thromboembolism is the most frequent cause of reported serious and fatal adverse events associated with drug therapy in Norway. We assessed quality of treatment during transfer from hospital to community-based care., Material and Methods: 66 out of 100 consecutive patients with venous thromboembolism were studied by a retrospective survey that included data from hospital records and a questionnaire survey., Results: Time in therapeutic range was 57% during the first four weeks. Undertreatment was the most frequent deviation. Some patients reported a long time lag from INR measurement to dose prescription in community care; 42% did not receive written treatment information. There were six recurrences, but no serious or fatal bleeding complications during one year of observation. Patient satisfaction with information and treatment organisation was high., Interpretation: There is room for improvement of patient information and treatment quality in outpatient care in our area.

Background: Clinical studies over the last 20 years using more intensive cytostatic regimens show improved results in children and adolescents with aggressive non-Hodgkin's lymphoma and in adult patients specifically with Burkitt's lymphoma., Material and Methods: We present a retrospective analysis of the use of the Berlin-Frankfurt-Munster (BFM) regimen for patients older than 15 years from three Norwegian university hospitals during the 1992-99 period., Results: Survival data for 24 patients 15-69 years old with Burkitt's lymphoma/B-cell acute lymphoblastic leukaemia (B-ALL) show an estimated overall five year survival of 70% (75% for Burkitt's lymphoma only). Eight of ten adolescent patients 15-20 years old with other aggressive lymphomas were alive and disease free at last follow-up. All nine patients given the regimen after failure of prior therapy died of lymphoma within six years., Interpretation: The BFM regimen yields impressive results as the primary treatment of adolescent and adult patients with Burkitt's lymphomas/B-ALL.