Histologic examination of mammary tissue from 39 patients with cyclical mastalgia and 68 with no mastalgia disclosed that fibrocystic disease was not in itself the cause of the cyclical condition. ...Nor did the study support the traditional concept of a relationship between major dysfunction of the internal genital organs and cyclical mastalgia. Although the organic basis for cyclical mastalgia is unknown, several observations strongly suggest that it is located in the mammary stroma. Future investigations of the organic basis for cyclical mastalgia should include the mammary stroma.
Radiologists with very limited practical experience in mammography initially achieved a low PVpos (0.50) and a high PVneg (0.95) in blind mammography of 80 patients with 85 excised and histologically ...examined breast tumours. After having read films from approximately 2500 patients the initial films were blindly reevaluated. PVneg was unchanged, whereas PVpos was elevated significantly (0.80). The intraobserver variation was 11.5 per cent. The actual interobserver variation was 3.2 per cent. These findings indicate that the reliability of blind mammography in patients with palpable tumours of the breast is considerable, also in case of only limited mammographic experience.
In survival analysis, as in other branches of applied statistics, confirmatory analysis is often requested before an initial finding can be cleared of suspicion of being due just to mass ...significance. This paper points out that the special temporal structure of the classical clinical trial with staggered entry allows re-use of the initial survivors by left-truncating their remaining survival times. This procedure can often save a considerable amount of calendar time. The procedure is illustrated by data from the Danish Breast Cancer Cooperative Group.
Gynecomastia. A follow-up study Watt-Boolsen, S; Bak, S
Ugeskrift for læger,
1989-Apr-03, Letnik:
151, Številka:
14
Journal Article
Classification of gynaecomastia as physiological/idiopathic is traditionally carried out by exclusion on the basis of the case history and results of the clinical examination. Out of 138 consecutive ...patients with gynaecomastia referred by general practitioners to the Surgical Gastroenterological Department K in Odense Hospital during the period 1978-1981 for treatment, 98 patients (71%) were classified in this manner. Following a period of observation ranging from four months to ten years, average 7.5 years, diseases were demonstrated in five of the physiological/idiopathic cases which were perhaps the causes of gynaecomastia. Employment of an extensive paraclinical programme of investigation would probably have resulted in demonstration of the underlying disease in three cases but would scarcely have improved the prognosis despite the possibility for earlier institution of treatment. Routine employment of extensive paraclinical investigations of selected patients with gynaecomastia of this type cannot be recommended on account of the limited diagnostic and therapeutic results. Classification of gynaecomastia based on the case history and clinical examination appears to be sufficiently exact in patients referred by general practitioners for treatment to a surgical department.
The prophylactic effect of systemic metronidazole on infectious complications following elective colo-rectal surgery was compared with the prophylactic effect of oxytetracycline. Allocation to ...receive metronidazole or oxytetracycline was random. A total of 137 patients were accepted for the trial, 67 receiving metronidazole and 70 oxytetracycline. The numbers of abdominal wound infections, intra-abdominal infections, fever and deaths were few in both groups, and the differences statistically insignificant. Clinically significant side effects of the antimicrobial agents were not observed. The influence of the antimicrobial agents on colonic flora was also studied. No significant difference in the effect on colonic anaerobic flora was demonstrated, whereas the aerobic flora was significantly suppressed by oxytetracycline. It is concluded that systemic metronidazole, although acting solely on the anaerobic flora, is as effective as oxytetracycline in preventing postoperative infectious complications following elective colo-rectal surgery. The prophylactic use of metronidazole is advocated.
The estimated probability of relapse of primary periareolar abscess of the nonlactating breast was 38 percent (95 percent confidence interval 18 to 58 percent) 8 years after simple incision and ...healing by granulation. Relapses were mainly fistulas in the line of incision. An attempt to identify relapses early was unsuccessful. This finding, in combination with the unsatisfactory results of simple incision and healing by granulation and the character of relapses, suggests improper initial operation and multifactorial causes. Initial incision followed by a search for a possible sinus tract and extensive excision in all patients with primary abscesses has been described and is recommended.
In 42 patients with idiopathic chondromalacia patellae, the effect of anterior displacement of the tibial tuberosity was evaluated in a prospective and randomized study. The operation performed was a ...modified Bandi procedure, and it resulted in significant relief of the patellofemoral pains, compared with the effect of a standard shaving procedure. Shaving alone was done in 22 patients of whom 6 (27 per cent) were classified as good, a result which may have been due to the placebo effect. In another 20 patients shaving was combined with anterior displacement of the tibial tuberosity resulting in pain relief in 18 (9 degrees per cent). The lack of unambiguously good results may be due to the fact that, although an anterior displacement reduces the retropatellar pressure, it cannot by itself compensate for an abnormal, dynamic tracking pattern of the patella.
Prolactin (PRL), thyroid stimulating hormone (TSH) and growth hormone (GH) response to metoclopramide and TRH was investigated in seven women with fibrocystic disease and cyclical mastalgia, in eight ...similar patients without mastalgia, and in six normal controls. The basal PRL level was significantly elevated in patients with cyclical mastalgia (P < 0.025). PRL and TSH response to metoclopramide did not differ significantly between the three groups, indicating that decreased dopaminergic tone is not the cause of elevated basal PRL level in cyclical mastalgia. PRL and TSH response to TRH and the abscent GH response to both metoclopramide and TRH further indicate that the hypothalamicpituitary axis is not primarily disturbed in cyclical mastalgia. The basal GH level was elevated in patients with fibrocystic disease with or without mastalgia. The increased basal GH secretion is not believed to be directly involved in cyclical mastalgia, but may be of importance in fibrocystic disease.
During the 10-year period from 1960 to 1970 a total of 213 patients with diffuse or nodular toxic goitre underwent subtotal thyroidectomy. A short-term preoperative treatment with antithyroid drugs ...and iodine was given systematically. The observation period ranged from 5 to 15 years, average 9 years. A total of 203 patients (95%) were traced and followed up. The concentration of se-T4, se-T3, and se-TSH was measured and in selected cases a TRH test and BMR was carried out in addition. All thyroid specimens were re-examined by the same pathologist for histological grading. It was found that 85% of the patients had been rendered euthyroid for 5 years or more. The recorded incidence of thyroid hypofunction was 6% and the incidence of recurrent thyrotoxicosis was 9% of the series. Se-TSH was found to be elevated in 17%. The correlation between elevated se-TSH and se-T4 values was calculated and found to be fairly reasonable (r = -0.66). It is concluded that subtotal thyroidectomy preceded by short-term antithyroid drug therapy supplemented ultimately with iodine offers significant advantages in the management of thyrotoxicosis by rendering 85% of patients euthyroid on long-term surveillance.
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