Total mastectomy and partial axillary dissection as advised in the DBCG (Danish Breast Cancer Cooperative Group) protocols was performed in 104 consecutive females with operable primary invasive ...breast cancer, aged 34-82 years, median 47 years. The glandular removal was complete as assessed by microscopic examination of side resection planes and deep fascia of the surgical specimen. The number of removed axillary lymph nodes ranged from 1 to 28, median 8. The mortality was zero. There were no general complications. Wound complications comprised seroma (47.1%), flap margin necrosis (5.8%) and infection (1.9%). The pitfalls in securing total mastectomy are discussed as is the extent of axillary dissection for staging purposes. Furthermore, the problem of axillary dissection and axillary irradiation in node positive patients is considered.
The prophylactic treatment of the application of fibrin glue to the pulmonary surface during thoracoscopy in idiopathic spontaneous pneumothorax resulted in rapid and total pulmonary expansion in 33 ...of 35 patients. The 2 failures were due to apical cysts larger than 2 cm. The successfully treated patients were hospitalized for a median of 4 days (range 2-12). No complications were observed. All regained full working capacity within 1 month of discharge. Post-treatment X-ray examination of the chest was uniformly normal. During an observation time ranging from 7-24 months (median 12 months), 3 recurrences (9%) were seen at 7, 12, and 16 months, respectively. The treatment seems (1) to reduce the need for thoracotomy (2) to be associated with a high success rate, short and long-term, (3) to minimize the duration of hospital stay and (4) not to disturb the normal pleuro-pulmonary anatomy.
Nuclear thyroxine and triiodothyronine receptor-binding in human mononuclear blood cells were examined in 14 euthyroid persons prior to and 1, 6, 24 and 53 weeks after goitre resection. One week ...after resection decreased serum T3 from 1.47 nmol/l to 1.14 nmol/l (P less than 0.05), FT4I from 103 a. u. to 94 a. u. and SHBG from 80 nmol/l to 69 nmol/l (P less than 0.05) followed after 6 weeks by a rise in serum TSH from 1.2 mU/l to 11.0 mU/l (P less than 0.05) suggesting an initial slight hypothyroidism. Nuclear receptor-binding of T4 and T3 increased within one week and eventually decreased to preresectional values. We conclude that the expected alteration of the metabolic state caused by resection of the gland is opposed by increased nuclear binding of T4 and T3.
Basal serum prolactin and serum oestradiol-17-beta concentrations were measured four times during one menstrual cycle in 20 women with severe cyclical mastalgia and normal to slightly fibroadenotic ...breasts. A group of 10 normal women who had never experienced mastalgia served as controls. Basal serum prolactin was significantly elevated in patients compared to normals, although within the normal range. Serum oestradiol concentrations did not differ in the two groups and were also within the normal range. A significant positive correlation between oestradiol and prolactin was found in patients and normals, but with larger prolactin levels in patients. The results point towards a prolactin secretory hypersensitivity for oestradiol in patients with cyclical mastalgia. Prolactin is considered a central factor in the eliciting of cyclical mastalgia.
Bioptic strategy in breast cancer Watt-Boolsen, S; Dyreborg, U; Andersen, J A ...
Acta oncologica,
1988, Letnik:
27, Številka:
6A
Journal Article
Recenzirano
Odprti dostop
The bioptic strategy in breast cancer rests on the following basic conditions at the Department of Surgery K, Odense University Hospital: Firstly, clinical mammography precedes any bioptic procedure. ...Secondly, the bioptic procedure must secure representative tissue for histological examination. Thirdly, knife-biopsy should preferably be excisional. Finally, tissue examination is exclusively done by the pathologist and always on unfixed tissue. The application and outcome of the employed biopsy methods are illustrated by a series of 365 women with operable, primary invasive breast cancer, treated from 1982 to 1987. Definitive surgery was mainly based on excisional (62%) or needle biopsy (24%). Three-fourths of the patients were treated by the one-stage procedure. However, within the last year of the period the rate of needle biopsy and two-stage procedures was doubled, increasingly employing core-aspirating needle biopsy synchronously with mammography and done by the radiologist. So far, patient compliance and histological outcome is satisfactory.
The recurrence-free survival rates (RFS) after one-stage mastectomy and partial axillary dissection in 1242 low risk breast cancer patients with invasive ductal carcinoma with or without residual ...cancer tissue (RCT) in the wall of the biopsy cavity were compared. RFS was significantly lower in patients with RCT (RCT-positive) whether premenopausal (n = 416) or postmenopausal (n = 826). By applying the Cox multivariate analysis on RCT and various known prognostic criteria, the incidence rates for RCT-positive patients relative to RCT-negative patients were estimated. The relative risk by RCT-positivity was in the order of 1.45, indicating that RCT is an independent risk factor contributing an increased risk of recurrence of about 45%.
To investigate the nature and origin of postmastectomy seroma, the concentration of IgG, the number of leucocytes, granulocytes and lymphocytes in the drain fluid and seroma aspirates was studied in ...breast cancer patients after mastectomy. The composition of the fluid and aspirates and the time-related changes of the investigated criteria suggested that 1) seroma is not an accumulation of serum, but an exudate, 2) the exudate is an element in an acute inflammatory reaction, i.e. the first phase of wound repair, and 3) seroma formation reflects an increased intensity and a prolongation of this phase. By paying attention to factors influencing the duration and intensity of the first phase of wound repair, it should be possible to reduce the occurrence of seroma.
In a retrospective study of all post-mortem examinations and all celiotomies carried out at Glostrup Hospital in the period 1959-76, 81 patients with non-mechanical intestinal infarction were ...identified. Of these patients, 23 had suffered non-occlusive intestinal infarction. In 15 of the 23 patients the infarction was associated with cardiac disease and its treatment, in 2 patients it was associated with septic and haemorrhagic shock, and in 4 patients with still other diseases. Two patients were completely healthy, when struck by intestinal infarction. The course was fatal in 20 patients. It is concluded that non-occlusive intestinal infarction occurs often enough to be taken into consideration, whenever non-mechanical intestinal infarction is suspected. The treatment should be directed towards the conditions causing intestinal ischaemia.
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