Biomedical subjects

H O Adami

Publications and source records attributed to H O Adami.

At least 361 records · Page 20Linked to original sources

PubMed1986

Early postoperative course following elective splenectomy in haematological diseases: a high complication rate in patients with myeloproliferative disorders.

One hundred and sixty-seven patients subjected to splenectomy on haematological indications were studied. They were grouped into five diagnostic categories: auto-immune disorders (52 patients), Hodgkin's disease (32) lymphoproliferative malignancies (60), myeloproliferative malignancies (18) and miscellaneous (5). The total number of complications and deaths were 42 (25 per cent) and nine (5 per cent), respectively. Infections were the most common complication, occurring in 30 cases and accounting for 59 per cent of all sequelae. Patients with auto-immune disorders had a high frequency of subphrenic left-sided abscesses (5/52). Splenectomy for Hodgkin's disease was associated with a very low frequency of complications. In the 60 patients with lymphoproliferative malignancies left-sided pneumonia was common (9/60). Complications occurred in 56 per cent of the patients with myeloproliferative disorders, the associated mortality rate being 28 per cent. It is concluded that elective splenectomy in haematological diseases seems to be a safe procedure in most patients with the exception of individuals with myeloproliferative malignancies. The high operative risk in this group makes the benefit questionable. In patients with auto-immune disorders the high frequency of subphrenic abscesses indicates that prophylactic antibiotic treatment should be considered.

Adolescent↗

PubMed1986

Symptomatic cimetidine treatment of duodenal and prepyloric ulcers.

In a randomized trial, 75 patients with an endoscopically confirmed and symptomatic duodenal (N = 50) or prepyloric (N = 25) ulcer were allocated to cimetidine treatment (1 g/day) either regularly for four weeks (standard treatment group) or regularly for a minimum of one week and thereafter only until the symptoms were controlled (symptomatic treatment group). The four-week healing frequencies in the standard and symptomatic treatment groups were 72 and 67%, respectively. The difference +/- 95% confidence limits was 5 +/- 21%. Prospective recording of pain revealed that the two treatment regimens were about equally effective in relieving symptoms during weeks 2-4. Patients with unhealed ulcers reported pain during the day and night significantly more often than those with healed ulcers. In the symptomatic treatment group the average patient saved 11 days of cimetidine medication during weeks 2-4. We believe that disappearance of symptoms might be a valuable means of deciding when treatment for peptic ulcers can be discontinued. Provided its efficacy and safety can be further confirmed, symptomatic treatment might become a practical and possibly a money-saving mode of ulcer management, which should also be applicable to the ulcer regimens of tomorrow.

Adult↗

PubMed1986

Clinical results of reoperation after failed highly selective vagotomy.

The results after reoperation after failed highly selective vagotomy during a 10 year period have been reviewed retrospectively. Forty of 306 patients (13 percent) underwent reoperation due to recurrent ulcer (25 patients), severe dyspepsia without proved recurrence (12 patients), and gastric stasis without recurrence (3 patients). In the first two groups, 16 patients had a second vagotomy and 17 underwent partial gastrectomy, 10 with gastroduodenostomy and 7 with gastrojejunostomy. The need for a second reoperation was disquietingly high after both revagotomy (5 of 16 patients) and partial gastrectomy with gastroduodenostomy (4 of 10 patients). These results contrasted with a successful outcome in all seven patients who underwent reoperation with partial gastrectomy and gastrojejunostomy. At the time of follow-up, 85 percent of the reoperated patients (34 of 40 patients) were in Visick grade 1 or 2 as determined by their own judgement.

Dyspepsia↗

PubMed1986

Temporal trends in breast cancer survival in Sweden: significant improvement in 20 years.

Of all women with a newly diagnosed breast cancer diagnosed in 1960-78 in Sweden, 57,068 (98%) were included in a complete follow-up during 1-19 years of observation. The 5-year mortality attributable to breast cancer was reduced by 29% from the period 1960-64 to 1975-78, which corresponded to an increase in relative survival by 10.5% (95% confidence limits, 7.2 and 13.8). There was a highly significant and regular trend during the study period toward a decrease in the annual hazard rate; this was confined to the first 4-5 years after diagnosis. The temporal trend toward improved survival was apparent in all age groups, but it was of lower magnitude among women younger than 45 years old.

Adult↗

PubMed1986

Gastric cancer survival in Sweden. Lack of improvement in 19 years.

A total of 34,549 patients constituting 87.0% of all patients with gastric cancer diagnosed in Sweden in 1960-1978 and reported to the National Cancer Registry were included in a complete follow-up over a period of 1-20 years. The poor outcome in this disease was again established in this unselected material. Thus, the 5-year relative survival rate (with 95% confidence limits) was 12.7% (12.1-13.2%) among the men and 14.1% (13.4-14.9%) among the women, without any long-term difference between the sexes. The annual hazard rates in male and female patients were still 11.0% (8.3-13.7%) and 9.0% (7.1-10.9%), respectively, after 5 years and did not approach zero until 10 years after the diagnosis. Men older than 75 showed a slightly higher mortality during the first year, but there were seemingly no relationships of tumor-biological or clinical significance between age at diagnosis and long-term relative survival. The overall prognosis remained unchanged during the 19 years of the study, whereas the incidence was reduced by about 40% in the whole Swedish population.

Actuarial Analysis↗

PubMed1986

Excess sick-listing in nonulcer dyspepsia.

The pattern of sick leave among 88 patients with nonulcer dyspepsia (NUD) and 73 patients with duodenal/prepyloric ulcer disease (DU/PPU) was studied by means of a computerized register held by the National Health Insurance Service, which covered all instances in which patients received cash benefit due to sickness. Patients with either NUD or DU/PPU were associated with a considerably increased risk of being sick-listed. The risk of needing sick days was significantly higher in the NUD group than in the ulcer group (p less than 0.02), and the NUD patients had on an average 2.6 times as many sick days requiring compensation as the corresponding background population. The ulcer patients were absent from work mainly because of their abdominal symptoms; other reasons for sick-leave were rare. On the other hand, the sick-listing among NUD patients was due to a host of complaints, dominated not by abdominal but by musculoskeletal symptoms. Thus, it seems as if several factors other than dyspepsia contribute to the disposition towards absenteeism among NUD patients. Psychosocial factors might play an even greater role in NUD than in DU/PPU patients. The present study contradicts the concept of NUD and DU/PPU as different manifestations or stages of the same disease entity. In view of the high prevalence of NUD, the substantial amount of sickness absenteeism poses a considerable economic burden on society.

Absenteeism↗

PubMed1986

Reliability of endometrial cancer diagnoses in a Swedish Cancer Registry--with special reference to classification bias related to exogenous estrogens.

In this study, various qualitative aspects of endometrial cancer diagnoses were critically evaluated regarding cases included in the Swedish Cancer Registry from the Uppsala Health Care Region. By comparing the number of such cases in the registry with cases reported directly from the departments of pathology and of gynecological oncology in the same region, it was found that approximately 5% of all incident cases had not been notified to the registry. An independent histopathological review of the original specimens showed that almost 9% of the cases did not represent an endometrial neoplastic lesion, the majority of these being reclassified as uterine sarcoma. The review also revealed the problem of a diagnostic bias that might arise in connection with estrogen exposure, in that a significantly higher proportion of the cases observed in a cohort of women who had received estrogen prescriptions were reclassified as a premalignant endometrial lesion than of the cases from the background population without estrogen exposure (33% versus 10%). Additional independent reviews of cases showing discordant diagnoses in the primary review indicated variability in diagnostic criteria among pathologists. It is concluded that when cancer registry data are employed in epidemiological studies of endometrial cancer, the use of additional sources of case recruitment is desirable in order to obtain a complete material; also that an independent histopathological review is necessary to standardize diagnostic criteria and thereby to avoid a classification bias.

Estrogens↗

PubMed1986

The risk of endometrial neoplasia and treatment with estrogens and estrogen-progestogen combinations. First results of a cohort study after one to four completed years of observation.

This prescription-based cohort investigation was undertaken in order to study whether climacteric estrogen treatment of women in a Swedish population might be associated with an increased risk of endometrial cancer, and whether added progestogens can afford any protection from developing estrogen-related endometrial neoplasia. Some 23 000 women who had been prescribed estrogens were followed up regarding the outcome of neoplastic lesions of the endometrium. The results are based on an observation period of one to four completed years, corresponding to 89 000 person-years. Among those cohort members exposed to estrogens alone, regardless of the duration, the relative risk of endometrial cancer was 1.3 (95% confidence interval 0.9 to 1.7). The inclusion of premalignant endometrial changes resulted in a significantly increased relative risk of 1.6 (1.2-2.1). The relative risk estimates in association with estrogen-progestogen combinations were 0.6 (0.2-1.4) for endometrial cancer and 0.8 (0.4-1.5) when including premalignant lesions. These data indicated a possible protective effect of progestogens against the development of endometrial neoplasia. It was concluded that estrogens were - within an observation period of 4 years - associated with an increased risk of premalignant endometrial lesions.

Adult↗

PubMed1986

Menstruation span--a time-limited risk factor for endometrial carcinoma.

A case-control study was undertaken to investigate the influence of reproductive factors on the risk of developing endometrial carcinoma. The study comprised 254 women with newly diagnosed endometrial carcinoma, resident in a defined geographical area, and 254 age-matched population controls. Nulliparity and late menopause were positively associated with endometrial carcinoma. Each additional full-term pregnancy resulted in a decrease in the risk by 16%. The importance of parity and menopausal age decreased with increasing life span, and in women older than 69 years these two variables did not discriminate significantly between cases and controls. The calculated number of years of menstruation (the "menstruation span") was used as a combined measure of the impact of parity, age at menarche and age at menopause on the risk of developing endometrial carcinoma. The patients had a significantly longer mean menstruation span than the controls (33.6 versus 31.2 years; p less than 0.001) and a longer span than 39 years gave a 4.2 times higher risk than one shorter than 25 years. It is suggested that the total length of time for which a woman is exposed to unopposed estrogen is important and that the effect of this hormonal influence is time-limited.

Adolescent↗

PubMed1986

Climacteric symptoms and estrogen replacement therapy in women with endometrial carcinoma.

A case-control study was undertaken to investigate the influence of exogenous estrogens and climacteric symptoms on the risk of developing endometrial carcinoma. The study comprised 254 women with newly diagnosed endometrial carcinoma, resident in a defined geographical area, and 254 age-matched population controls. Treatment with estrogens for 4 years or longer was significantly more common among patients than among controls (odds ratio = 4.5; 95% confidence limit (CL) = 1.2-17.3). A history of climacteric symptoms was reported by significantly fewer patients than controls (odds ratio = 0.5; 95% CL = 0.3-0.7) and this difference was shown to be independent of weight. The decrease in risk associated with climacteric symptoms was limited to women younger than 70 years.

Adult↗

PubMed1986

Basal and food-stimulated levels of gastrin and pancreatic polypeptide in non-ulcer dyspepsia and duodenal ulcer.

Basal and food-stimulated levels of gastrin and pancreatic polypeptide (PP) were studied in 86 patients with non-ulcer dyspepsia (NUD), defined as chronic or recurrent epigastric pain without anatomical antecedents and without concomitant symptoms of irritable bowel. Thirteen patients with endoscopically confirmed duodenal ulcer disease (DU) and 13 healthy subjects constituted the reference groups. The mean basal gastrin concentration was moderately but significantly (p less than 0.05) higher in the NUD group than in the reference groups (24.3 +/- 1.6 (SEM) pmol/l in NUD, compared with 15.0 +/- 1.5 and 13.6 +/- 1.0 pmol/l among DU patients and healthy subjects, respectively). The well-established postprandial hypergastrinemia in duodenal ulcer patients could be confirmed in this study, and their gastrin response to food was significantly (p less than 0.01) greater than the responses observed both in healthy subjects and in NUD patients. The two latter groups did not differ significantly with regard to gastrin increments, but there was a tendency towards greater increases in the NUD group. A significantly (p less than 0.05) enhanced PP response to the test meal was observed among the DU patients, whereas the response pattern in NUD was closely similar to that in healthy subjects.

Adult↗

PubMed1986

Long-term survival in prostatic carcinoma, with special reference to age as a prognostic factor. A nation-wide study.

A total of 44,300 cases of prostatic cancer, comprising 90% of all newly diagnosed cases reported to the Swedish Cancer Registry in 1960 through 1978, constituted a cohort followed up for 1-19 years. Survival rates were adjusted for expected mortality in the general population, and were expressed as relative survival (RS). RS for the total cohort after 5, 10 and 15 years was 51, 34 and 24%, respectively, with an annual excess death rate of about 8% which persisted also after long-term observation. RS was similar in the age groups between 45 and 74 years, whereas among patients older than 74 at diagnosis, approximately 10% lower RS appeared early and was persistent. These data demonstrated that the highly varying natural course of prostatic cancer is only slightly related to patient age at diagnosis. The low long-term relative survival rate definitely contradicted the concept that biologically inactive (latent) tumours constitute a significant proportion of the prostatic cancers diagnosed in clinical practice.

Adult↗

PubMed1986

Late results of operation for primary hyperparathyroidism in 441 patients.

The late results of operation for primary hyperparathyroidism (HPT) were analyzed in 441 patients operated on 4 to 27 years earlier (mean follow-up time, 7.7 years). A conservative surgical approach was mainly used, attempting if possible to visualize all four parathyroid glands and extirpate only the enlarged glands. Subtotal resection was performed in patients with hyperplasia. The histopathologic diagnosis was adenoma in 77% and hyperplasia in 18%. In 5% of the patients, the histopathologic classification was uncertain. Hypercalcemia persisted after operation in 8% of all patients. This generally occurred because of an incomplete neck exploration or too limited a resection in the patients with hyperplasia. Recurrent hypercalcemia occurred in 16% of the patients operated on for hyperplasia and was noted 1 to 19 years after surgery. Recurrences were also seen in 3% of the patients with adenomas but not earlier than 9 years after the operation. These findings suggest that primary HPT may even in patients with adenomatous disease, sometimes affect all parathyroid glands. Nevertheless, it was obvious that most of the patients with adenomas would not have benefited from a more radical procedure. On the other hand, it was evidently important to obtain a correct histopathologic diagnosis intraoperatively so that patients with hyperplasia could be identified and adequatley treated.

Adenoma↗

PubMed1985

Age as a prognostic factor in breast cancer.

Long-term survival was evaluated in a total of 12,319 women with first breast cancer, comprising 94.9% of virtually all women with first breast cancers diagnosed in Sweden in 1959 through 1963. After correction for the expected mortality, it was found that age at diagnosis was an important predictor of the probability of escaping the risk of dying of breast cancer (relative survival), with a regular trend toward a more favorable course in younger women. This difference between the age groups is apparent as early as 5 years after diagnosis and increases throughout the period of observation. Thus the relative 20-year survival rates +/- 95% confidence limits were 51.3 +/- 3.8%, 41.2 +/- 3.4%, 34.2 +/- 3.8%, and 16.6 +/- 6.3% at ages 40 through 44, 50 through 54, 60 through 69, and 70 through 79 years, respectively. Patients younger than 40 years diverged from the general trend, with a survival rate of 44.1 +/- 4.6% at 20 years.

Adult↗

PubMed1985

Age at first primary as a determinant of the incidence of bilateral breast cancer. Cumulative and relative risks in a population-based case-control study.

This epidemiologic investigation comprised 1351 of 1423 women in a defined geographic area consecutively diagnosed as having a primary breast cancer. Simultaneous bilateral disease occurred in only 1 patient, whereas a history of previous cancer in the contralateral breast was reported by 65 patients. This prevalence was related to that of 23 previous cases in an age-matched control group of 1351 women from the same population. The relative risk of developing a second primary was 2.9 (95% confidence limit, 1.8-4.6) for the whole material and remained seemingly constant over several decades at a level predetermined by age at first diagnosis, namely 9.9 (95% confidence limit, 3.8-25.8) before the age of 50 and 1.9 (95% confidence limit, 1.1-3.2) after that age. The incidence ratio of bilateral to unilateral disease was used as an estimate of the lifetime risk of developing a second primary in this stable and well-defined population. This calculation revealed cumulative risk figures of 13.3% and 3.5% for women younger and older than 50 years, respectively, at first diagnosis. It was concluded that the occurrence of bilateral disease, which reflects a multicentric neoplastic transformation of the breast epithelium, is a characteristic of early-occurring (premenopausal) disease.

Adult↗

PubMed1985

Prognostic implication of estrogen receptor content in breast cancer.

The cytosolic estrogen receptor (ER) content of the primary tumor was determined by isoelectric focusing in 170 consecutive women with unilateral breast cancer diagnosed in 1977 through 1980. No adjuvant treatment over and above surgery and radiotherapy was given. The overall corrected survival was not significantly (p greater than 0.05) higher in ER-rich (less than 0.1 nmol/g DNA) than in ER-poor tumors, but the median period from recurrence to death was longer in the former (16 months) than in the latter (10 months) group. The difference in disease-free survival (DFS) in favour of the ER-rich tumors achieved its maximum-about 15%-after two years (p less than 0.01). At prolonged follow-up, however, the curves converged and there was no significant difference when the whole six year period of observation was taken into account. In patients without axillary metastases the same pattern emerged, with earlier recurrences in ER-poor tumors and a difference in DFS between the two ER groups at two years (p less than 0.01) which was diminished after five years (p less than 0.05). The ER content provided no significant prognostic information in patients with axillary node metastases or locally advanced disease. We conclude from the present and other available data that the ER content in breast cancer would seem to be an indicator of growth rate rather than of metastatic potential and accordingly a predictor of the pattern of recurrence and length of disease-free survival rather than of long-term survival.

Adult↗

PubMed1985

Long-term survival in 406 males with breast cancer.

Survival was analyzed during a follow-up period of up to 20 years in 406 (97%) of all 420 males in whom breast cancer was diagnosed in Sweden in 1960-1978. After correction for the expected mortality in the general population, cumulated survival rates (with 95% confidence limits) of 66 (58.7-72.5)% and 52 (42.0-62.1)% at 5 and 10 years respectively were found. These figures and the general pattern of relative survival rates were in close accordance with those noted in a concomitant series of female breast cancer. There was a trend toward slightly improved survival rates during the period of study and the median survival times were 3.9, 4.8 and 7.2 years for patients diagnosed in 1960-64, 1965-69 and 1970-74 respectively. Age at diagnosis was seemingly unrelated to the long-term relative survival. We conclude that, except for a slightly higher mean age at diagnosis in males, there is a striking similarity in the natural history of breast cancer between men and women after initial treatment, with an excess death rate which still persists at long-term observation.

Adolescent↗

PubMed1985

Endometrial polyps and hyperplasia as risk factors for endometrial carcinoma. A case-control study of curettage specimens.

As part of a comprehensive case-control study, the impact of previous endometrial pathology on the risk of developing endometrial carcinoma was investigated. The study comprised 254 consecutive women with histopathologically confirmed cancer of the uterine body in a well-defined population, and their age-matched controls. Ninety-eight (39%) of the patients and 81 (32%) of the controls had previously undergone endometrial curettage. More than one previous curettage was positively associated with endometrial carcinoma (odds ratio = 2.5; 95% CL = 1.4-4.5). Endometrial abnormalities in previous curettage specimens occurred significantly more often among carcinoma patients (57%) than among controls (25%) (odds ratio = 4.0; 95% CL = 2.0-8.0). Twelve patients, but no controls, had adenomatous hyperplasia and this hyperplasia antedated the cancer diagnosis by a mean of 4.6 years. Endometrial polyps were present significantly more often in patients (20%) than in controls (10%) (odds ratio = 3.4; 95% CL = 1.3-9.3). The present results suggest that both of these conditions are risk factors for endometrial carcinoma. Among women who had undergone endometrial curettage more than 4 years after the menopause, 19 out of 30 patients, but none out of 7 controls, showed abnormality in the curettage specimens. Postmenopausal women with endometrial abnormality should thus be regarded as being at risk of developing endometrial carcinoma.

Age Factors↗