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Biomedical subjects

H Brenner

Publications and source records attributed to H Brenner.

At least 235 records · Page 13Linked to original sources
PubMed1991

The role of socioeconomic factors in the survival of patients with colorectal cancer in Saarland/Germany.

The role of socioeconomic factors in the survival of patients with colorectal cancer was assessed using data from the cancer registry of Saarland/Germany, and census information. Among 2627 patients with colorectal cancer diagnosed from 1974 to 1983, patients from communities in the lowest of three categories defined by socioeconomic factors showed significantly lower survival rates than patients from other communities. After adjustment for potential biological and other sociogeographic risk factors in multivariate analyses, relative hazard of death associated with low socioeconomic status (SES) compared with high SES was estimated to be 1.22 (95% CI: 1.01-1.47) for colon cancer and 1.32 (95% CI: 1.09-1.60) for rectum cancer. The results are in agreement with earlier studies from North America, Hawaii and Sweden and indicate that an attempt to improve health care services and acceptance and possibly other relevant general living conditions in socioeconomically less privileged communities may be a rewarding approach towards increasing survival of patients with colorectal cancer.

Aged↗
PubMed1991

Acute renal failure associated with intraperitoneal cisplatin chemotherapy with systemic thiosulfate protection in ovarian cancer patients.

Acute renal failure associated with intraperitoneal cisplatin chemotherapy occurred in 4 courses of treatment each given to one patient, and comprised 3.4% of the total number of intraperitoneal treatment courses. The 4 patients recovered completely, 2 of them after dialysis. Several possible reasons for this complication, which occurred in spite of thiosulphate systemic protection, are considered. Strict adherence to the treatment protocol is mandatory in order to avoid severe nephrotoxicity.

Acute Kidney Injury↗
PubMed1990

[Immunoscintigraphy for the detection of inflammation foci in bone and joint diseases].

We evaluated the monoclonal antibody MAb, BW 250/183, which is easy to label with Tc-99m, with respect to its clinical application for the detection of inflammatory processes in bone and joint diseases. This monoclonal antibody is a murine immunoglobulin (IgG1 isotype), directed against NCA 95 (nonspecific cross-reacting antigen), which is also present on the surface of neutrophil granulocytes. We investigated patients with acute (n = 9) and chronic (n = 3) osteomyelitis, with coxitis (n = 3) and coxarthrosis (n = 2), with septic hip prosthesis (n = 8) and loosening hip prosthesis (n = 14), with low back pain (n = 4), with spondylitis (n = 5) and with postoperative spondylodiscitis (n = 9). With reference to the total number of patients examined in this study we found 29 true positive results, 22 true negative results, 4 false negative results and 2 false positive results. This gives a sensitivity of 88% and a specificity of 92%. The lesions were already visualized within 4 to 6 hours, but 24 hour pictures are desirable. SPECT pictures are mandatory in patients with diseases of the hip or of the spine because sensitivity is considerably improved thereby.

Adolescent↗
PubMed1990

A single cholesterol measurement underestimates the risk of coronary heart disease. An empirical example from the Lipid Research Clinics Mortality Follow-up Study.

In prospective epidemiologic studies of coronary heart disease, a single measurement of cholesterol is made to assess its relationship to the risk of coronary disease. Statistical theory states that if this measurement is subject to within-individual variability, the strength of the relationship will be underestimated. This is empirically shown for the example of plasma cholesterol. For the Lipid Research Clinics Follow-up Study population (comprising 2170 white men over 30 years of age), the age-adjusted coronary heart disease mortality regression coefficient increases from .453 to .496 if the average of two cholesterol measurements is used instead of a single measurement. Since the correlation between the two repeated cholesterol measurements is .815, an increase in the regression coefficient up to .556 would be expected if the true cholesterol values were available. Thus, epidemiologic studies have substantially underestimated the strength of the relationship between cholesterol levels and the risk of coronary disease by calculating the relationship on the basis of a single cholesterol determination.

Adult↗
PubMed1990

Projected impact of the trend toward delayed childbearing on breast cancer incidence in the Saarland/FRG.

The potential impact of the trend toward delayed childbearing or nulliparity on future breast cancer incidence is quantitatively assessed for the Saarland/FRG. Distribution of age at first birth is estimated from vital statistics for seven five-year birth cohorts from 1936-40 to 1966-70. Estimates of the relative risks associated with age at first birth or nulliparity are based on median results of 23 controlled epidemiologic studies conducted in Europe and North America. Compared to the birth cohorts around 1940, a steady increase in incidence up to about +15% is projected for the younger cohorts indicating a substantial public health impact. Using data of the population based cancer registry of the Saarland, the cumulative incidence of breast cancer up to age 50 is calculated as 1.52% for the 1936-40 birth cohort and is projected to rise to 1.75% in the 1966-70 cohort. Similar changes in fertility patterns have been observed in other parts of the FRG. Given the continuing rise in mortality from breast cancer in the FRG this stresses the need for more effective screening procedures.

Adolescent↗
PubMed1990

Magnitude and time trends of the life-time risk of developing cancer in Saarland, Germany.

The probability of developing cancer within defined age-intervals or during life-time was assessed for the population of Saarland, Germany in 1970-1972 and 1980-1985 based on life-tables and age-specific cancer incidence rates. As a result of increasing life expectancy and, for some forms of cancer, increasing age-specific incidence rates, the probability at birth of eventually developing a malignant neoplasm (ICD-9 140-208) increased from 24.12% in 1970-1972 to 32.35% in 1980-1985 in men, and from 24.76 to 29.72%, respectively, in women. Comparable calculations are presented and discussed for all of the most common malignancies in women and men. The relation to common measures of descriptive epidemiology, mainly the cumulative rate and the cumulative risk, is numerically illustrated.

Adolescent↗
PubMed1990

[Progress in the early detection of cervix cancer from the viewpoint of the Saarland cancer register].

The efficacy of the nationwide screening programme for cervical cancer in the Federal Republic of Germany, which has been in effect since 1971, has never been checked by means of controlled epidemiological studies. Therefore routinely collected mortality and morbidity data are up to now the only indicators of potential progress in early detection. Mortality statistics of cervical cancer are of restricted value due to lack of specificity regarding the cause of death on death certificates. Data of the population based cancer registry of Saarland are used to investigate trends in terms of age, stage and birth cohort-specific detection rates of cervical cancer and its preinvasive precursors. There was a substantial decrease in incidence rates of invasive cervical cancer, which was most pronounced for advanced tumour stages and young and middle-age groups and which is consistent with comparable results in other countries following the introduction of screening programmes. However, a selection effect of the screening programme suggested by a decrease in survival rates of women with invasive cervical cancer in the 1980ies, must also be taken into account.

Adult↗
PubMed1990

[Incidence of secondary tumors following cervical neoplasia in Saarland 1968-1987].

In 4468 patients diagnosed with invasive cancer or carcinoma in situ of the uterine cervix in Saarland/W-Germany in 1968-1987, 149 secondary cancers were observed compared to 150.6 which would have been expected had the same risk prevailed as in the general population (SMR = 0.99, 95% confidence interval 0.84-1.17). There were, however, substantial differences between the relative risks for specific cancer sites. For example, the risk of breast cancer was clearly lower than in the general population (SMR = 0.62, 95% confidence interval 0.43-0.88), while the risk of cancer of the urinary bladder was significantly increased (SMR = 2.88, 95% confidence interval 1.53-4.93). The results are consistent with findings from other countries, with current knowledge of risk factor profiles of different malignancies and with hypotheses on possible side effects of radiotherapy.

Carcinoma in Situ↗
PubMed1990

[Incidence and prognosis of breast cancer in young women in relation to changes in the risk factor profile].

Trends in breast cancer incidence in women aged 25-44 years are assessed in detail based on data from the population-based cancer registry of Saarland-Germany. Compared to 1968-72, from 1978-82 and 1983-87, a highly significant increase in age-standardised incidence by more than 30% was observed. The increase in incidence was most pronounced among women of 25-29 years of age (relative incidence rate 1978-87, compared to 1968-77: 2.03, 95% confidence interval: 1.11-3.71). The role of changes in prevalence of known and suspected risk factors, mainly the age at the onset of menarche, the age at first birth, parity and early and long-term use of oral contraceptives in adolescence, which may partly explain the observed trends, are discussed. The results have important public health implications, such as the need for extended cancer surveillance and epidemiologic research in the Federal Republic of Germany, and offer a quantitative basis for the development and implementation of future early detection programmes as well as the need for medical care facilities.

Adult↗
PubMed1990

The effects of sensitivity and specificity of case selection on validity, sample size, precision, and power in hospital-based case-control studies.

The consequences of imperfect sensitivity and specificity in disease diagnosis in epidemiologic studies have conventionally been assessed by models of misclassification which assume a fixed number of study participants. This assumption is not usually applicable to case-control studies in which disease diagnosis is part of the case selection process and sensitivity and specificity will, for a given time period and source of cases, affect the size of the case group. In this paper, a mathematical model that incorporates this is developed in the framework of a hospital-based case-control study. The separate and combined effects of imperfect sensitivity and specificity of case diagnosis on validity, sample size, precision, and power are assessed. The authors conclude that if several diagnostic procedures are available, specificity of case diagnosis should usually take precedence over sensitivity for the sake of validity. Although increasing specificity and sacrificing sensitivity may compromise precision to some extent, the latter can often be fully compensated for by an increased control:case ratio. Imperfect specificity also compromises power despite increased sample size. Since clinical diagnoses tend to focus on high sensitivity and sacrifice some specificity, their uncritical adoption for case recruitment in case-control studies may compromise their validity.

Case-Control Studies↗
PubMed1990

The intraindividual variability of fasting triglyceride--a challenge for further standardization.

The extraordinarily high intraindividual variability of fasting triglyceride levels often leads to substantial bias in epidemiologic studies and hinders the use of the former as potential markers of coronary heart disease risk in individual patients. The magnitude of the latter problem is illustrated applying the concept of the intraclass correlation coefficient to repeated fasting triglyceride measurements in 2227 white men aged 20 to 69 in the Lipid Research Clinics Prevalence Study. A one-way random effects analysis of variance model with the natural logarithm of triglycerides as the outcome variable is used to calculate 95% confidence intervals for a person's 'true' or 'steady-state' triglyceride level, depending on the number and results of measurements taken. For example, a 95% confidence interval corresponding to a single triglyceride measurement of 200 mg dl-1 (a commonly used threshold value for hypertriglyceridaemia) would be as wide as 124 to 323 mg dl-1. Although there is a substantial gain in precision if a second triglyceride measurement is available, the confidence intervals remain very large. The gain in precision from each additional measurement becomes progressively smaller and has to be weighed against considerations of costs and inconvenience.

Adult↗
PubMed1989

Hypofractionated radiation therapy and concurrent cisplatin in malignant cerebral gliomas. Rapid palliation in low performance status patients.

Twenty-eight patients with high-grade cerebral gliomas (16 biopsy-proven and 12 diagnosed clinically and by computed tomography scan) were treated with altered fraction radiation and concomitant cisplatin (C-DDP). Twenty cases (Groups IA and IB) whose Karnofsky performance status (KPS) was 60% or less received hypofractionation and C-DDP. All these patients had received high-dose Decadron (Merck Sharp & Dohme, West Point, PA), and their conditions were not improving or progressively deteriorating. The first 11 patients (Group IA) received from 600 cGy twice weekly to 3600 cGy over 3 weeks combined with C-DDP IV at 40 mg/M2 every 2 weeks for two courses. The nine subsequent patients (Group IB) received from 600 cGy weekly to 3600 cGy over 5 to 6 weeks with C-DDP IV at 40 mg/M2 every 1 to 2 weeks for four courses. The target volume in all cases was confined to the tumor as defined on computed tomography (CT) scan with a 2 cm to 3 cm margin. The C-DDP at 40 mg/M2 was administered immediately (within 5 minutes after radiation). Eight cases (Group II) with a KPS of more than 60% were treated with hyperfractionation, i.e., from 200 cGy twice daily to 4800 cGy in just under 3 weeks. The C-DDP was administered every 2 weeks for a total of two courses, as for Group IA. In Group I, 15 of 20 (75%) patients experienced rapid improvement in their performance status, which usually becoming evident within 1 to 2 weeks from the initiation of treatment, and progressed over time. Four patients with a KPS of 10% improved their KPS to over 60%. This regimen was both well tolerated and logistically very convenient both for the patients and attending staff. Follow-up CT scans in three of 16 evaluable patients in the hypofractionated group showed complete tumor resolution. Median survival for Group IA was 7 months, for Group IB was 12 months, and overall was eight months. The Group II median survival was 9 months. This experience suggests that hypofractionated radiation in combination with C-DDP may offer rapid palliation with improvement in functional status in severely compromised patients with malignant glioma.

Adult↗
PubMed1989

Intraperitoneal cisplatin chemotherapy versus abdominopelvic irradiation in ovarian carcinoma patients after second-look laparotomy.

The current study compares the outcome within 3 years after diagnosis in two groups of histologically confirmed Stage II-IV ovarian carcinoma patients in complete clinical remission with minimal or no residual disease at second-look laparotomy, performed after completion of cisplatin-based combination chemotherapy. One group (n = 18) received after reexploration abdominopelvic irradiation (RT group), the other, diagnosed during a later period (n = 19), received three courses of intraperitoneal cisplatin chemotherapy with systemic thiosulfate protection (IP group). The two groups were comparable with regard to age, stage at diagnosis, histologic category, grade of differentiation, size of residual tumor after the initial operation, and rate of negative second-look laparotomy. The overall survival probability after diagnosis was significantly better in the IP group, the maximal difference being observed at 36 months: 76.6% versus 44.4% in the RT group (P = 0.04). This difference was mainly evident in patients with a negative second-look laparotomy in whom the respective survival probabilities were 100% versus 70% (P = 0.04). Survival was significantly shorter (P less than 0.01) in patients with a positive second-look, and there was a nonsignificant trend for better survival in the IP group. Significantly improved probability of progression-free interval after diagnosis was also found in the IP group, the maximal difference being observed at 22 months: 78.3% as compared to 50.9% in the RT group (P = 0.04). This difference was again limited to patients with negative second-look, the respective values being 100% versus 60% (P = 0.05). Our retrospective data suggest an apparent advantage to intraperitoneal cisplatin treatment in these patients which should be further explored for definite evaluation.

Adult↗
PubMed1989

Melanotic paraganglioma of the orbit: a case report.

A paraganglioma of the orbit in a 21-year-old woman is presented, containing oculo-cutaneous melanin in many tumor cells, occasionally adjacent to neurosecretory granules, and in macrophages. This tumor expands the list of neuroectodermal tumors with potential melaninization.

Adult↗
PubMed1989

Second-look laparotomy in ovarian carcinoma patients after 8 and after 12 courses of cisplatin-based chemotherapy.

Sixteen ovarian carcinoma patients who received 12 courses and 21 patients who received 8 courses of cisplatin-based combination chemotherapy were compared. The two groups showed similar rates of second-look laparotomy (10/16 vs. 14/21) and similar rates of negative second-look laparotomies (6/10 vs. 9/14). The advantages of earlier reexploration are possibly lower toxicity and earlier recognition of patients with tumors resistant to the initial chemotherapy.

Adult↗
PubMed1989

[Model calculations of the effect of demographic changes on the incidence of cancer in Saarland].

Resulting from the population structure and current fertility and mortality rates, a rapid aging of the West German society is to be expected. The impact of these demographic changes on numbers of cancer cases and incidence rates is quantitatively assessed for the Saarland, which is the only state with reliable population-based cancer registration in the FRG. Despite a projected decrease in population size during the next decades, numbers of incident cases are expected to rise substantially in males and to remain almost constant in females for all of the most common forms of cancer. The projected changes have model character for other parts of the FRG.

Cohort Studies↗