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Biomedical subjects

H O Adami

Publications and source records attributed to H O Adami.

At least 325 records · Page 18Linked to original sources
PubMed1988

Stomach cancer after partial gastrectomy for benign ulcer disease.

We followed for 25 to 33 years 6459 patients who had undergone partial gastrectomy for benign ulcer disease to determine the incidence of stomach cancer. The overall risk was no different from that among sex- and age-matched controls from the Swedish Cancer Registry (standardized incidence ratio = 0.96; 95 percent confidence limits, 0.78 and 1.16). However, when the patients were classified according to the duration of follow-up after operation, sex, surgical procedure, diagnosis at the time of operation, and age at operation, differences in risk were observed between the subgroups. After adjustment for potential confounding variables, the average adjusted risk increased 28 percent (adjusted standardized incidence ratio = 1.28; 95 percent confidence limits, 1.11 and 1.49) for each successive five-year interval after operation. The adjusted risk was greater among women than men (adjusted standardized incidence ratio = 1.96; 95 percent confidence limits, 1.18 and 3.24). Patients who had undergone a Billroth I anastomosis had a lower crude risk, both overall (standardized incidence ratio = 0.40; 95 percent confidence limits, 0.20 and 0.71) and after we controlled for other confounding variables (adjusted standardized incidence ratio = 0.27; 95 percent confidence limits, 0.12 and 0.62), than did those who had undergone a Billroth II procedure. The adjusted risk of stomach cancer was greater among patients operated on for gastric ulcer than among those operated on for duodenal ulcer (adjusted standardized incidence ratio = 2.21; 95 percent confidence limits, 1.45 and 3.35). Risk decreased with increased age at operation. Between successive strata of age at operation (less than 39, 40 to 49, 50 to 59, and greater than or equal to 60 years of age), the adjusted risk decreased on the average by about half (adjusted standardized incidence ratio = 0.52; 95 percent confidence limits, 0.41 and 0.66).

Adult↗
PubMed1988

Improved survival of patients with cancers of the colon and rectum?

The survival of 61,769 patients diagnosed as having colorectal cancer in the total Swedish population in 1960-1981 was analyzed. The 5-year relative survival rates during the total period were approximately 40%; patients with colonic carcinoma had a somewhat better prognosis than patients with rectal carcinoma, and men had a generally less favorable prognosis than women. Comparison of patients diagnosed in 1960-1964 and in 1975-1979 showed a slight improvement in survival during the more recent study period, i.e., an improvement rate of 7.0% for both cancer of the colon and cancer of the rectum. The improvement occurred mainly during the first months of follow-up. However, the excess mortality due to colorectal cancer 1-5 years after diagnosis as compared to the expected mortality in the general population remained virtually unaltered. A multivariate analysis in which adjustment was made for the possible confounding variables of sex, age, and site (of colonic carcinoma) gave consistent results. Reduced postoperative mortality was considered to be the most likely major explanation for the temporal trend toward a more favorable prognosis. Thus it seemed that the treatment of colorectal cancer in Sweden during the last two decades has not improved significantly except in terms of reduced postoperative mortality. Thus the challenge of improving survival in patients with colorectal cancer must be given high priority.

Actuarial Analysis↗
PubMed1988

Standardization of the surgical technique in breast-conserving treatment of mammary cancer.

A number of designations--for example excision, wide excision, lumpectomy, tylectomy, extended tylectomy, partial mastectomy, tumorectomy, segmental resection and quadrantectomy--have been applied to operative procedures aimed at treating mammary carcinoma with preservation of the breast. None of them, however, has been explicitly linked to a defined surgical technique and there is no consensus about the terminology. We propose a simple classification system for breast-conserving procedures, which can facilitate the communication between surgeons and the interpretation and exchange of scientific data. We also describe a strictly defined and locally radical partial mastectomy--a sector resection--which has been used at several centres in Sweden for more than 5 years with a favourable outcome so far in terms of local tumour control and the cosmetic result.

Breast↗
PubMed1988

Prognosis in bilateral breast cancer. Effects of time interval between first and second primary tumours.

Survival rates for 67 women with bilateral breast cancer were compared to those for 1282 women with unilateral disease in a follow-up of 1349 women participating in a population-based study. Relative survival at 8 years of follow-up was 69% for women with unilateral disease as compared to 53% for women with bilateral cancer. When possible confounding histopathological differences--data about which were prospectively collected--and age were adjusted for in a multivariate analysis, the relative hazard rate was significantly higher for women with bilateral versus unilateral breast cancer (P = 0.006). The impact of interval time between the two primaries was analysed and a roughly two-fold higher hazard rate was seen for synchronous cancers with regularly falling risk for increasing interval times. This trend was however not statistically significant. The results indicate that the two tumours contribute independently to the patient's excess risk of dying and thus occur as two seemingly biologically unrelated events with respect to the tumour-host relationship and metastatic behaviour.

Aged↗
PubMed1988

Cigarette smoking, alcohol consumption and risk of breast cancer in young women.

The possible association between cigarette smoking, alcohol consumption and the risk of development of breast cancer before the age of 45 was investigated by means of a population-based case-control study in Sweden and Norway. Information was obtained, by personal interview, from 422 (89.2%) of all eligible patients with breast cancer newly diagnosed between May 1984 and May 1985, and from 527 (80.6%) of all age-matched controls. The possible confounding effects of oral contraceptive (OC) use, education, and reproductive and several other factors were taken into account in multivariate analyses. No association was found between ever smoking (versus never smoking) and breast cancer (odds ratio 1.0; 95% confidence interval (CI) 0.8-1.3). Further, there was no relation between breast cancer and duration of smoking, age at start of regular smoking, length of time since the start of regular smoking, or number of cigarettes smoked per day. There was no significant interaction between smoking, use of OCs, parity, and breast cancer. A moderate or high current consumption of beer, wine, liquor or total alcohol did not increase the risk of breast cancer. An alcohol intake of 5 grams per day or more was associated with a decreased risk of breast cancer (odds ratio 0.6; 95% CI 0.4-0.9), but possible effects of a change in habits after diagnosis, of recall bias and of residual confounding, e.g. by dietary habits, need serious consideration.

Adult↗
PubMed1988

Risk factors for breast and endometrial cancer in a cohort of women treated with menopausal oestrogens.

A matched case-control study was undertaken with the aim of determining the presence of several risk factors for breast and endometrial cancer in a cohort of women--recruited from a defined geographical area of Sweden--who had received at least one oestrogen prescription for menopausal symptoms. A mailed questionnaire was answered by 653 (88.8%) of 735 women sampled from the cohort (cases) and 952 (76.8%) of 1240 women sampled from the background population (controls) and these respondents formed the basis of the analyses. The prevalence rates of oophorectomy and hysterectomy were significantly higher among oestrogen-treated women than in the background population, 10.7% versus 2.6% (odds ratio (OR) = 5.1, 95% confidence interval (Cl) 3.1-8.5) and 19.0% versus 7.3% (OR = 2.7, Cl 1.9-3.8), respectively. Higher theoretical education entailed a more than twofold increase in the risk of receiving oestrogen treatment, compared with women with less than eight years at school. Women who had a first degree relative with breast cancer ran a relative risk of receiving oestrogen therapy of 0.6 (Cl 0.4-0.9) whereas the risk for women with a prior breast biopsy was 1.4 (Cl 1.0-2.1). For all other variables studied, ie diabetes, hypertension, age at menarche, age at first livebirth, nulliparity, age at menopause, height and weight, there were no statistically significant differences between the cohort of oestrogen-treated women and the background population. We conclude that the difference in the prevalence of hysterectomy has to be taken into account when calculating the risk of endometrial cancer in the cohort.(ABSTRACT TRUNCATED AT 250 WORDS)

Breast Neoplasms↗
PubMed1988

Increased risk of malignant diseases after surgery for primary hyperparathyroidism. A nationwide cohort study.

A cohort of 4,163 persons reported to the nationwide Swedish Cancer Registry by reason of hyperparathyroidism was followed for up to 22 completed years (24,593 person-years of observation). The occurrence of malignant disease manifested after parathyroid surgery was investigated through computerized linkage to the entire Cancer Registry. During the entire period, the hyperparathyroidism patients suffered malignant diseases significantly more often than the background population (relative risk (RR) = 1.6, 95% confidence interval (CI) 1.5-1.8). Even if all cases with malignant diseases detected at the same time as hyperparathyroidism or during the first year after parathyroid surgery were eliminated, a significantly increased risk remained for the following years (RR = 1.4, 95% CI 1.2-1.6). A significantly increased relative risk of developing gastrointestinal cancers, endocrine tumors, kidney carcinomas, and mammary carcinomas was found. During the first postoperative year, an increased surveillance of the cohort is likely to have contributed to the increased risk, but detection bias is considered unlikely to be the only explanation for the higher risk during all subsequent years. The findings indicate that hyperparathyroidism either promotes later development of malignant tumors or that this condition and certain malignant diseases have etiologic factors in common.

Adult↗
PubMed1988

The patient's appraisal of the cosmetic result of segmental mastectomy in benign and malignant breast disease.

Women's appraisal of the cosmetic result and their psychosocial adjustment after a standardized segmental mastectomy for benign or malignant breast disease was analyzed on the basis of a mailed questionnaire, which was satisfactorily answered by 263 (92%) of 285 women operated on consecutively. The overall result was favorable: 96.5% of the patients found the new appearance of their breast very good (30.7%), good (44.0%), or acceptable (21.8%). Women with a benign diagnosis ran a two-fold higher risk of being discontented with the new appearance of the breast than those with breast cancer. Complications of radiation therapy, preoperative concern that the breasts are important for the appearance, and anxiousness about the cosmetic result were associated with a significantly elevated risk of being less satisfied with the outcome. The main finding that it is possible to perform a locally radical operation that is highly acceptable to the woman is relevant to the surgical management of potentially malignant mammographic lesions and also to the scientific strategies for future evaluation of breast-conserving treatment modes in malignant disease.

Aged↗
PubMed1988

Prognostic significance of the Ackerman classification and other histopathological characteristics in breast cancer. An analysis of 1,349 consecutive cases with complete follow-up over seven years.

Survival rates during a follow-up period of more than seven years were analyzed in 1,349 women with breast cancer in relation to the histo-pathological classification of female breast cancer proposed by Ackerman and to other commonly used histo-pathological criteria, including the axillary node status. The information was collected prospectively during a case-control study. Major emphasis was placed on multivariate evaluation. In analyses based on the histo-pathological findings in the mastectomy specimen alone, the Ackerman grouping was found to be of prognostic value, but apart from nuclear polymorphism the other recorded characteristics (histo-pathological type, histological grading, lymphocyte infiltration, and sinus histiocytosis) did not give any prognostic information. When the axillary node status was included in the multivariate models, the presence of axillary metastases correlated well with the prognosis and the Ackerman classification provided no significant additional information. The results indicate that in cases where the histopathological axillary status is known, little additional prognostic information can be gained from traditional histo-pathological evaluation over and above this status. However, the Ackerman classification and the degree of nuclear polymorphism separate distinct prognostic groups with the same degree of difference in observed survival rates as one discriminated by the axillary node status.

Breast Neoplasms↗
PubMed1988

Aspects of descriptive epidemiology and survival in colorectal cancer.

World-wide cancer of the colon and rectum emerges as the third most frequent form of cancer in males and the fourth in females. Patients with colorectal cancer suffer from a considerable excess mortality during the first six to eight years after diagnosis, and the cure rate, which is in the order of 35-40% in the Swedish population, has remained largely unchanged over several decades. The incidence rates show a steep rise with age, marked international differences, increasing incidence in developing countries, adjustments in cancer risk within few decades in populations who move from low- to high-risk areas, and no consistent differences in relation to race. In addition, the incidence rates display a complex network of relationship to age, sex, segment of the large bowel and secular trends. These observations indicate that environmental factors play a predominant role in the development of colorectal cancer, that such factors may have specific influences in certain segments of the large bowel, and that they modulate the risk even in adult life.

Adult↗
PubMed1988

What can epidemiological methods mean to surgical research?

Traditionally, the aim of epidemiological research has been to determine and explain the incidence of a disease and thereby ultimately to reveal its causative mechanisms. Clinical research, or clinical epidemiology, on the other hand, has been devoted primarily to the evaluation of diagnostic and therapeutic techniques and to investigation of the course of a disease after its diagnosis. The aim of this brief discussion is to illustrate how these two areas of research--epidemiological and clinical--have the same methodological roots and use similar biostatistical tools. Whether they are carried out as experimental or as observational studies, the fundamental problem in the scientific method is to achieve validity by attenuating or controlling the effects of extraneous factors that influence the outcome under study. In modern epidemiology powerful methods of reaching this goal have been developed and thus a sound basis has been provided for drawing reliable conclusions concerning causal relations between "exposures" and outcomes. If surgical researchers become aware that epidemiological and clinical researchers obtain their scientific tools from the same conceptual domain and become familiar with the methods used in traditional epidemiology, this will probably result in fruitful scientific expansion in clinical surgery.

Clinical Trials as Topic↗
PubMed1987

Survival and renal function in untreated hypercalcaemia. Population-based cohort study with 14 years of follow-up.

172 persons with mild to moderate hypercalcaemia were followed up for 14 years. Life-table analyses showed that, among persons aged 70 years or less at the time of detection of the hypercalcaemia, survival was lower in the hypercalcaemic group than in a normocalcaemic age and sex matched control group. No such difference was found among older persons. The lower survival was related to degree of hypercalcaemia, and this held true when systolic and diastolic blood pressure, serum glucose, serum uric acid, and serum cholesterol were taken into account in a multivariate analysis. The lower survival seemed to be due mainly to deaths from diseases of the circulatory organs. No person with normal renal function at the beginning of the study period had a more than marginally raised serum creatinine at follow-up.

Actuarial Analysis↗
PubMed1987

Unaltered risk of colorectal cancer within 14-17 years of cholecystectomy: updating of a population-based cohort study.

The incidence of colorectal cancer after cholecystectomy was analysed in a historical population-based cohort study comprising 16,439 patients who were completely followed up for 14-17 years after operation. The observed number of colorectal cancers (150) was lower than the expected number of 166.3 (relative risk (RR) = 0.90:95 per cent confidence limits 0.77-1.05) and the overall risk for colon cancer (RR = 0.95) did not differ significantly from that of rectal cancer (RR = 0.82). Separate analyses by sex, age at operation and duration of follow-up revealed relative risks close to or lower than unity. Some deviations indicating a substantially reduced risk might have been due to the play of chance alone. Our results contradict the idea both of a causal and of a non-causal association-through common aetiological factors-between surgically confirmed gallbladder disease and colorectal cancer.

Adult↗
PubMed1987

Patients with primary hyperparathyroidism operated on over a 24-year period: temporal trends of clinical and laboratory findings.

Temporal trends of clinical and laboratory data of 441 patients operated upon for primary hyperparathyroidism (HPT) during 1956-1979 were analysed retrospectively. There was a marked increase in the number of operations for HPT during that time period, from 32 during 1956-1964 to 326 in 1970-1979. In parallel there was a decrease in the proportion of patients with classical manifestations of HPT such as renal stones or bone disease, the latter being on the whole rarely seen in this population. The increased number of operations was instead largely attributable to the more frequent diagnosis of HPT in patients with vague psychiatric or neuromuscular symptoms or with no clinical manifestations; the majority of these persons were older women, the proportion of operations in women 45 years of age or older, increasing from 56% during 1956-64 to 71% during 1970-79. The increased number of operations for HPT during the last decades should be mainly the consequence of a greater awareness of the disease.

Adenoma↗