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Biomedical subjects

F Hartveit

Publications and source records attributed to F Hartveit.

At least 37 records · Page 2Linked to original sources
PubMed1991

Risk of cervical intraepithelial neoplasia in women with glomerulonephritis.

OBJECTIVE: To investigate the occurrence of cervical intraepithelial neoplasia in women with glomerulonephritis and its possible association with immunosuppressive treatment. DESIGN: Retrospective study of cytological or histological specimens from women presenting with glomerulonephritis and a group of case and age matched controls. SETTING: University department of pathology, Norway. PATIENTS: 81 women presenting with glomerulonephritis from 1981 to 1988, from whom gynaecological cytological or histological specimens were available. A group of 162 case and age matched controls. MAIN OUTCOME MEASURES: Age when glomerulonephritis of cervical intraepithelial neoplasia was diagnosed, type and characteristics of kidney lesion, stage of cervical intraepithelial neoplasia and presence of human papillomavirus, use of immunosuppressive treatment. RESULTS: Cervical intraepithelial neoplasia was more common in women with glomerulonephritis than in their controls (16/81 (20%) v 7/162 (4%), p less than 0.001) and was more advanced in those with glomerulonephritis than in the controls (9/81 (11%) of the study group had grade III cervical intraepithelial neoplasia compared with 1/162 (1%) of the controls). The increased occurrence of cervical lesions was independent of the use of immunosuppressive treatment, but the individual lesions tended to be more advanced when it was used (four of the seven cervical lesions in women with glomerulonephritis who had received immunosuppressive treatment were carcinoma in situ). Of the nine cervical lesions tested, seven were virus associated. CONCLUSION: Women with glomerulonephritis should have regular cervical smears, irrespective of their use of immunosuppressive treatment.

Adult↗
PubMed1991

Skip lesions in the axilla in breast cancer, and their association with micrometastases.

The term 'skip lesion', referring to a tumour-bearing node in the axilla in breast cancer, presupposes that nodal colonization usually occurs in sequence with the path of the lymph flow. Skip lesions are thus out of step with the system. The present study of axillary nodes from 73 node-positive patients demonstrates that skip lesions have much in common with lone micrometastases found at any level, and are thus but a variant of the pattern found in early colonization of the axilla. This in turn indicates that in contrast to a progressive build up of tumour growth first at the lower and later at the middle level, early colonization may be a random process. This again stresses the importance of nodal dissection versus biopsy in the management of breast cancer, particularly in view of recent reports on the prognostic significance of micrometastases.

Axilla↗
PubMed1991

Fat emboli in the lymphatic labyrinth in breast stroma.

Fat emboli may be seen in the fine lymphatic system of the human breast. In the present study they are described ultrastructurally in 3 cases in the stroma adjacent to breast carcinomas. While the significance of the finding is obscure at present, it is pointed out that factors leading to the aggregation of chylomicrons can be expected to alter the chemical make-up of the lymph, and this may affect the subsequent behaviour of cancer cells in it.

Biopsy↗
PubMed1991

Periodicity in metastatic tumour growth demonstrated in the human liver at autopsy. Preliminary report.

The present study is based on 1,069 autopsies made up of stomach, breast, renal and colonic cancer. Periodicity is described in the liver weight index (liver weight/body height) at death in patients with liver metastases. The seasonal variation tended to be more marked in females and among older patients, and it differed with tumour type. A period with maximum deaths tended to follow that of maximum liver weight index. A periodic difference previously reported in a small series of malignant melanomas is thus not an isolated phenomenon. This indicates that basic biological pathways concerned with the control of tumour growth may be involved. How the system works remains an open question.

Age Factors↗
PubMed1990

Clinically undiagnosed malignant tumours found at autopsy.

In a series of over 20,000 autopsies carried out over a 25-year period, 700 cancers (11%) were found in patients in whom the diagnosis of cancer had not been considered relevant clinically. In over half of them the unrecognized tumour was considered an incidential finding and thus of no importance to the individual concerned, though of epidemiological concern. As expected from the literature the main organs involved were kidney and prostate, with stomach cancer in third place. In contrast, the unrecognized cancers that caused death were most often from the pancreas or lung, again with the stomach in third place. These patients with stomach or lung cancer were frequently thought to have died of other diseases in the gastrointestinal/respiratory tract, and the disease cited was often present though not the cause of death. These patients tended to be older than those with clinically recognized disease, and had been hospitalized late in the course of their fatal illness, at which time clinical recognition would not have influenced the outcome. Earlier recognition of this type of cancer is thus essential. This cannot be achieved without definition and further analysis of the entities concerned.

Autopsy↗
PubMed1990

Underdiagnosis of carcinoma of the stomach in the elderly: a 25-year autopsy study.

Gastric carcinoma may present atypically in the elderly. Between 1955 and 1979, 571 autopsies on gastric carcinoma cases were carried out at the Gade Institute, Bergen. In 165 of them the diagnosis had not been made clinically. The latter patients were, on average, 10 years older at death than those in whom the diagnosis was made premortem, and their tumours were smaller. In 45 the tumour was considered an incidental autopsy finding, while 58 were diagnosed clinically as advanced cancer of unknown origin. In the remaining 62 cases the cancer was the underlying cause of death. Recognition of an elderly sub-group of patients whose gastric carcinomas presented atypically brings with it an increasing diagnostic challenge in our ageing population.

Aged↗
PubMed1989

Changes in the cancer spectrum at autopsy: 1975-1984.

In an autopsy series of 8571 cases from 1975 to 1984, cancer deaths increased significantly, particularly in those cases over 60 years of age. A similar trend was seen in the mortality statistics from the district. Study of the degree of correlation between the frequency for the different types of cancer and the total deaths from that cancer at autopsy in the population supplies guidelines for use in assessing the relevance of autopsy findings to epidemiological research. It is stressed that without autopsy control monitoring of cancer in a population is incomplete and unreliable. An autopsy frequency of 40 per cent or more for the cancer in question in the population as a whole is required combined with series of 5-600 cases if satisfactory studies are to be initiated. Such conditions are difficult to fulfil for the less common types, but offer a valid approach to the monitoring of those types of cancer that are numerous enough to merit such attention.

Age Factors↗
PubMed1989

Axillary metastasis in breast cancer: when, how, and why?

Axillary metastasis in breast cancer is a time-dependent phenomenon that varies greatly from tumour to tumour. It is discussed in relation to tumour diameter and the growth rate of the tumour cells. It parallels the former but is not directly related to either. A tumour age coefficient (Tac) is presented that demonstrates this lack of interrelationship. Tumour growth in the axillary nodes is progressive and in general mimics the potential tumour load elsewhere in the body. Qualitative rather than quantitative assessment is needed. This can be provided by simple means, using hilar nodal sections from standardised nodal samples. There is, however, as yet no definitive method of predicting the presence/absence of occult distant metastatic spread in either node-negative or node-positive cases. Treatment is thus based on statistical probability, which may or may not be relevant in the individual case.

Axilla↗
PubMed1989

The prognostic role of progesterone receptor status and age in relation to axillary node status in breast cancer patients.

The prognostic role of axillary lymph node status, progesterone receptor (PgR) status, age of the patient at operation, oestrogen receptor (ER) status and tumour diameter was studied in 443 breast cancer patients treated by modified radical mastectomy. Logistic and proportional hazard regression analyses were used to estimate the prognosis from the time of operation up to 60 months. We also estimated the prognosis from 36 to 60 months for those who had survived 36 months (conditional analysis). PgR and age gave significant information in each node class, old age and PgR negativity being disadvantages. PgR status relative to node status was more important for estimating early (24 months) prognosis, while age was of more importance later (60 months). Node status and age were the only variables giving significant information in the conditional analyses. It is thus of importance to consider the time dependency of the prognostic variables when predicting survival in breast cancer patients. No effect was found for ER status or tumour diameter.

Age Factors↗
PubMed1989

One of 8 women with bladder neoplasia may have concomitant gastrointestinal pathology, including cancer.

A study of the pathology records during 6 years for 160 women with bladder neoplasia and 150 with malignant melanoma revealed differences in patient experience in regard to the incidence of surgical biopsies. Biopsy for additional skin lesions was common in melanoma patients, who produced few gastrointestinal lesions. In contrast, 19 of the bladder cancer patients produced 26 gastrointestinal lesions, including 5 carcinomas. The latter incidence is higher than expected in our population. This difference between the 2 sets of patients in regard to skin and gastrointestinal lesions is statistically significant. Few gynecological lesions were noted in either group but a common factor was human papillomavirus infection, as indicated by the presence of koilocytosis. The latter also was present in 17 per cent of 41 otherwise negative smears from patients with bladder neoplasia, that is considerably more than expected (less than 1 per cent), and is similar to that reported previously in patients with melanoma.

Female↗
PubMed1989

Death certification: increased clinical confidence in diagnosis and lack of interest in confirmation by necropsy is not justified.

Comparison of 742 necropsies from 1975 with 833 from 1984 showed that the degree of certainty the clinicians attached to their diagnosis of the underlying cause of death had increased significantly in 1984. This was due almost exclusively to an increase in the certainty of the diagnosis of circulatory disease. Unfortunately, this was not justified as the numbers of false positive and false negative diagnoses were high in both years. With this increased certainty came a lack of interest in the necropsy. Similar lack of interest was also shown by surgeons in 1984, though in this instance it was accompanied by a high level of agreement between their diagnoses and necropsy findings.

Adolescent↗
PubMed1989

Estrogen receptor in breast cancer; its relation to mean nuclear area, age and lymph node status.

A study of 378 patients with infiltrating breast carcinoma using linear logistic regression and ANOVA analysis demonstrated a different relation between age at operation and estrogen-receptor (ER) concentration in the lymph-node negative and the lymph-node positive groups. Tumours from patients between 51 and 70 years old had lower median ER concentration in the lymph-node negative group than in the lymph-node positive group. In the group older than 70 years, however, tumours from lymph-node negative patients had higher median ER concentrations than those from the lymph-node positive patients. Patients 50 years and younger had similar median ER concentrations in both lymph-node groups. Low mean nuclear area (MNA) of the tumour cells was associated with high frequency of tumours able to produce ER. No such association was found for age. Independent of age and lymph-node status tumours with low MNA also had high ER concentration. These findings suggest that tumours from different lymph-node/age groups may have different biological properties. The relationship between ER and nuclear size point to a key function of the nucleus, both as regards the ability to produce ER and its level of production.

Age Factors↗
PubMed1988

Metastatic patterns of renal carcinoma: an analysis of 687 necropsies.

The metastatic behaviour of renal cell carcinoma has been studied in a series of 687 necropsies. The observations were consistent with the concept of "metastatic inefficiency", in that in 295 cases, including 25 with renal vein invasion, there were no detectable metastases. In the present series, renal vein involvement was not an important prognostic factor in stage 1 or 2 disease. In 73% of cases without lung metastases there were none in other sites, and in 84% of those with lung metastases there were others elsewhere, consistent with a metastatic "cascade" in which metastases first developed in the lungs and were later detected in other organs. However, the observations did not permit discrimination between anatomic cascades, in which other organs were seeded from metastasizing pulmonary metastases, and temporal cascades, in which the other were seeded at the same time as the lungs, but with fewer cancer cells. The patterns of arterial metastasis were consistent with the "seed-and-soil" hypothesis, and a novel index was developed to quantify differential organ "soils". The contralateral kidney was not the best soil for metastases from renal carcinoma. Given the presence of lymph node metastasis, the probability of heamatogenous metastasis is 90%. However, in the absence of nodal metastasis, approximately half the cases had haematogenous metastasis.

Adult↗
PubMed1988

Breast cancer: young, old, and very old. A preliminary report.

A new method of characterizing breast carcinomas is presented that may help further our understanding of this disease. A tumour age coefficient is described, derived from tumour diameter and the mean nuclear area of the tumour cells, the latter a measure of tumour growth rate. On this basis a series of 213 operative infiltrating breast carcinomas is divided into 3 tumour age groups (young, old, and very old). These are then related to axillary nodal status and the patient's age at operation. The likelihood of nodal spread is shown to increase with tumour age. This is interpreted as an expression of a build-up of tumours that have spread with time. There was no set tumour age by which metastatic spread could be expected, but some indication of a lower age limit.

Adult↗
PubMed1988

Palpation of the axillary nodes in breast cancer: what does the surgeon feel?

The findings on routine pre-operative palpation of the axilla in patients with infiltrative breast carcinoma are compared to the results of histological quantitation of the nodal lymphoid tissue and its tumour deposits in 91 consecutive cases in which a standardized axillary dissection had been carried out. The study demonstrates that lymphoid tissue, even when present in large amounts (up to 6 cm2 on histology), is seldom palpable. What the clinician identifies in favourable cases is the tumour deposit itself. When little lymphoid tissue is present very small tumour deposits (0.2 cm2) may be found on palpation, but large deposits (1 cm2) may be missed when surrounded by sufficient lymphoid tissue. These findings go far to explain the well documented unreliability of the nodal findings on axillary palpation in breast cancer.

Axilla↗
PubMed1988

Association of skin and other lesions with cervical dysplasia.

Association is reported in a series of 805 patients between cervical dysplasia and the occurrence of lesions in other organs, in particular the skin. The occurrence of associated lesions in these patients was markedly in excess of that in case-matched controls. It was not related to the increased frequency of gynaecological investigation in patients with cervical dysplasia. Pigmented naevi were the most common associated lesions, occurring before and after the diagnosis of cervical dysplasia. Three cases of malignant melanoma were seen in the test group. Gynaecological lesions were also common. The findings are discussed in the light of recent work on viral synergism in genital neoplasia.

Adolescent↗
PubMed1988

A link between malignant melanoma and cervical intra-epithelial neoplasia? A preliminary report.

The risk of malignant melanoma was found to be six times as great in a group of 805 patients with cervical dysplasia as in case-matched controls. In the latter it was similar to that in the general population. In keeping with this observation a further series of 13,030 women with no record of cervical intra-epithelial neoplasia showed a slightly lower risk than that expected in the general population. Conversely in a small group of women (71) with melanoma the risk of cervical intra-epithelial neoplasia was nine times as great as in the general population; judged on the basis of both case-matched and 'first smear' controls. The possibility of a common risk factor is discussed.

Cross-Sectional Studies↗