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Biomedical subjects

I Balslev

Publications and source records attributed to I Balslev.

At least 19 recordsLinked to original sources
PubMed1992

Time to loco-regional recurrence after resection of Dukes' B and C colorectal cancer with or without adjuvant postoperative radiotherapy. A multivariate regression analysis.

Factors influencing time to loco-regional recurrence were identified in a multivariate regression analysis of data from a series of 468 radically operated patients (260 Dukes' B and 208 Dukes' C) with carcinoma of the rectum and the rectosigmoid. A number of clinical and pathological characteristics were prospectively collected and recorded. In addition, carcinoembryonic antigen (CEA) was measured within 1 week before surgery. The endpoint used was recurrence below the level of the umbilicus. All patients were followed for at least 5 years or until time of death. The two Dukes' stages B and C were analysed in two separate analyses using the Cox proportional hazards model. In patients with Dukes' B tumours, an increased risk of loco-regional recurrence was associated with perineural invasion, tumour located less than 10 cm from the anal verge, patient aged above 70 years, and small tumour size. In patients with Dukes' C tumours, the necessity to resect neighbour organs, perineural and venous invasion, tumour located less than 10 cm from the anal verge, and large tumour size were all associated with a poor loco-regional outcome. Postoperative radiotherapy was not a significant prognosticator for loco-regional control. An update of the 5-year results of the randomised study of post-operative radiotherapy (50 Gy with 2 Gy per fraction in an overall treatment time of 7 weeks) showed no survival benefit from adjuvant radiotherapy in either Dukes' category and no statistically significant improvement in the 5-year loco-regional control rate. However, when the comparison was restricted to a group of high-risk patients there was a statistically significant benefit from radiotherapy with respect to loco-regional control (P = 0.03) but not with respect to survival (P = 0.23). The potential advantage, in terms of the required number of patients, of restricting clinical trials of intensified loco-regional therapies to the high-risk patients, is illustrated.

Adult↗
PubMed1992

A double-blinded multicenter trial of somatostatin in the treatment of acute pancreatitis.

To evaluate the effect of somatostatin in the treatment of acute pancreatitis, 63 patients were randomly allocated to continuous intravenous infusion for three days of 250 micrograms of somatostatin (Dura Scan, Odense, Denmark) per hour (n = 33), or placebo (n = 30). Patients with a first attack of pancreatitis, serum amylase level of more than 450 units per liter and symptoms for less than 24 hours were eligible for participation in the study. Apart from a slightly significant faster decrease in serum amylase concentrations, we were unable to demonstrate any significant benefit from somatostatin with regard to paraclinical values and clinical course.

Acute Disease↗
PubMed1992

Surgical treatment of acute malignant large bowel obstruction.

OBJECTIVE: To evaluate the morbidity and mortality in all patients operated on urgently for acute large bowel obstruction caused by carcinoma of the colon or rectum during a 10 year period. DESIGN: Retrospective study. SETTING: Aalborg Hospital, Denmark. SUBJECTS: 156 consecutive patients operated on for obstructing primary colorectal cancers. MAIN OUTCOME MEASURES: Operations done, morbidity and mortality. RESULTS: 95 patients (61%) had advanced disease (Dukes' stage C or "D") and their median age was 73 years (range 38-93). 97 had the obstructing lesion resected with a 30 day mortality of 5%. 43 patients underwent primary resection and 4 died (9%), and 54 underwent staged resection with one death (2%). Complications were common, particularly after staged resections, median hospital stay being 19 days after primary, compared with 30 days after staged resection. 59 patients (38%) had palliative operations with 29 deaths (49%); in 39 the tumor was completely unresectable. CONCLUSION: Patients with obstructing primary colorectal cancers are a high risk group who are characterised by advanced disease and old age. Only prospective trials comparing different operations can assess whether it is possible to achieve a reduction in mortality.

Adult↗
PubMed1990

Differential tumorigenicity of two autologous human breast carcinoma cell lines, HMT-3909S1 and HMT-3909S8, established in serum-free medium.

In a serum-free medium we have established two new human breast carcinoma cell lines from a single primary tumor. Cultures were maintained on chemically defined medium CDM3 or on minor modifications of this medium, Dulbecco's modified Eagle medium-Ham's F12 supplemented with epidermal growth factor, insulin, transferrin, estradiol, hydrocortisone, triiodothyronine, cyclic AMP, phosphoethanolamine, ethanolamine, fibronectin, fetuin, ascorbic acid, bovine serum albumin, and trace element salts including selenite (Petersen and van Deurs, Cancer Res., 47: 856-866, 1987). Primary cultures comprised both NADPH-neotetrazolium reductase-positive carcinoma cells and NADPH-neotetrazolium reductase-negative cells of stromal appearance, as well as normal epithelial cells (Petersen and van Deurs, Cancer Res., 46: 2013-2020, 1986). In subsequent passages the cells were monitored exclusively using the tumorigenicity assay on nude mice. Two cell lines, one nontumorigenic, HMT-3909S1, and one tumorigenic, HMT-3909S8, were selected from the primary cultures. Selection of S8 through subline S4 required transient supplementation of CDM3 with fetal calf serum. Permanent lines S1 and S8 were maintained on serum-free medium. Further characterization of the two cell lines in terms of normal breast gland differentiation (Petersen and van Deurs, Differentiation, 39: 197-215, 1988) was carried out using immunocytochemistry, immunochemistry, electron microscopy, and cytogenetics. S8 appeared to be identical with the NADPH-neotetrazolium reductase-positive carcinoma cells of the primary cultures, with a particular subpopulation of carcinoma cells in the tumor of origin, and with the tumorigenic cells of the nude mice. This subline was aneuploid, typically epithelial in morphology, and expressed keratins K8 and K18 and the glycoprotein MAM-6, typical of luminal epithelial cells in the normal breast gland. Subline S1 appeared more like the elongated cells in the primary cultures and like a second subpopulation of cells in the carcinoma of origin. However, S1 cells were in fact epithelial, since they expressed keratins. Also, S1 cells seemed to be a triploidation of a cell with close resemblance to S4, while only few cytogenetic differences were found between S4 and S8, suggesting an origin of S1 and S8 via S4 from a single hypothetical stem cell.

Biopsy↗
PubMed1990

Blood transfusion and prognosis in Dukes' B and C colorectal cancer.

To evaluate the prognostic influence of blood transfusion in cancer patients, transfusion data were reviewed on 468 radically operated patients (260 Dukes' B and 208 Dukes' C) with carcinoma of the rectum and the rectosigmoid. Data on whole blood and packed red blood cell transfusions were recorded together with a number of clinical, pathological and histochemical characteristics. The endpoint used was death with cancer. All patients were followed for 2-7 years or until time of death. Univariate statistical methods revealed a highly significant trend towards worsened prognosis with increasing volume of transfusion blood. However, this effect was insignificant when multivariate statistical methods were employed: patients receiving whole blood or packed red blood cell transfusions did no worse than expected from their clinico-pathological characteristics. It is concluded that in this series the observed association between transfusion status and prognosis is adequately explained by a multivariate prognostic model including well-established prognostic factors.

Aged↗
PubMed1989

[Gastric banding].

Twenty-three patients with a mean preoperative weight of 126 kg (100-163) and a mean preoperative Broca index of 1.89 (1.54-2.47) were submitted to gastric banding on account of severe obesity. The operative procedure, complications and results are described. The mean period of observation was 12 months (3/4-42). The mean weight loss after 12 months was 28.5 kg. The greatest weight loss per unit of time occurred during the first six months. In the majority of patients, the weight became stabilized after 12-24 months. Two patients did not lose weight and these were regarded as treatment failures. One patient died three weeks after the primary operation on account of infectious complications of pouch-perforation. Apart from this, no serious complications occurred. The incidence of wound infection was 17%, development of herniae in the scars occurred in 35% and transient symptoms of functional stenosis were encountered in 35%. Despite the high incidence of less serious complications, the authors consider that gastric banding is an employable alternative to intestinal and gastric bypass operations. In future, we will consider perioperative antibiotic therapy although gastric banding is, in principle, a clean operation. In addition, we will reserve gastric banding for patients who do not consume the majority of their calories in fluid form.

Adult↗
PubMed1989

[Prognosis in synchronous liver metastasis from colorectal cancer. A multicenter study of patients with cancer of the rectum and cancer of the rectosigmoid colon].

A prospective investigation of 188 patients with cancer of the rectum and rectosigmoid colon with synchronous liver metastases is described. The mean survival time for 183 patients who did not receive any treatment for the liver metastases was six months and only one survived for longer than 37 months. After extirpation of the primary tumour, the most significant prognostic factors were etrahepatic metastases, enlarged liver on account of metastases and more than three liver metastases. Serum basic phosphatases had the greatest significance among a series of laboratory tests. In the sub-groups with the best possible prognoses, the mean survival time was 12 months. 25% five-year survival has been described in the literature following resection of the liver in patients with a maximum of three metastases, no other metastases and age under 70 years. Provided this holds true, liver surgery will be a therapeutic possibility in at least 100 patients per annum in Denmark with synchronous liver metastases and 25 of these will be cured. This figure requires an improved programme for the diagnosis of synchronous liver metastases than at present and the same high frequency of extirpation of the primary colorectal cancer on a national basis which was achieved in the present material.

Aged↗
PubMed1988

Repeated fine needle aspirations in the diagnosis of soft tissue metastases in breast cancer.

In 36 patients, treated for breast cancer and with a suspected metastasis in the subcutis, the diagnostic efficacy of repeated fine needle aspiration (FNA) has been evaluated in 39 tumours. By increasing FNA from one to three, the diagnostic sensitivity was increased from 0.59 (95% C.L. 0.33-0.82) to 0.83 (95% C.L. 0.52-0.98). Diagnostic specificity for one aspiration was 0.95 (0.77-1.00), and for two and three aspirates it was 0.96 (0.80-1.00) if suspicious aspirates were considered as positive, and 1.00 for one, two and three aspirations when only aspirates with tumour cells were considered positive. Statistically, three aspirates were significantly better than one in establishing the diagnosis of a soft tissue tumour in patients with breast cancer.

Biopsy, Needle↗
PubMed1988

Long-term prognosis of patients with severe radiation enteritis.

One hundred thirty-six patients (median age 59 years) presented with intestinal complications of previous radiotherapy. Seventy-eight had bleeding or stricture and 58 had perforation or fistula. One hundred twenty-four patients survived for more than 3 months and were followed for a median of 4.5 years. Sixty-eight patients were free of symptoms, whereas 16 experienced operation-related complications. Twelve patients had continuing symptoms of radiation enteritis, and new radiation-induced complications developed in 28. Sixteen of 51 patients with perforation or fistula had new complications compared with 12 of 73 patients with bleeding of stricture (p = 0.05). Overall, 57 patients died during the study. Thirteen died from radiation-induced complications and 27, from recurrent malignancy. Radiation deaths occurred in the postoperative period but had no impact on long-term survival. Life expectancy was poorer in patients presenting with perforation or fistula compared with bleeding or stricture, the main reason being significantly more recurrences among patients with fistulas (p less than 0.05).

Adult↗
PubMed1988

A regression analysis of prognostic factors after resection of Dukes' B and C carcinoma of the rectum and rectosigmoid. Does post-operative radiotherapy change the prognosis?

The prognostic value of several clinical and histopathological characteristics has been evaluated in patients with Dukes' B and C carcinoma of the rectum and the rectosigmoid. Data on 260 Dukes' B and 208 Dukes' C tumours entered into a prospective, randomized clinical trial of post-operative radiotherapy (50 Gy given with 2 Gy/fraction in an overall time of 7 weeks) were analyzed by means of the Cox proportional hazards model. The Dukes' stages B and C were analyzed in two separate multivariate analyses. In patients with Dukes' B tumours, a poor prognosis was associated with age above 60, perineural and venous invasion, tumour located less than 10 cm from the anal verge and elevated pre-operative carcinoembryonic antigen (CEA) (greater than 3.2 ng ml-1). In patients with Dukes' C tumours, perineural and venous invasion, tumour located less than 10 cm from the anal verge, and elevated pre-operative CEA were associated with a poor prognosis. In addition, a large tumour diameter had a strong, negative influence on the prognosis. Males seemed to have a poorer prognosis than females among the Dukes' C patients. Resection of neighbouring organs was also associated with a poor prognosis in this stage. Post-operative radiotherapy as administered in the present series had no significant influence on prognosis. Based on the derived prognostic models patients with a hazard of death above the median in each stage were selected. A separate analysis of the survival in these high risk patients showed no survival benefit from radiotherapy. The proportional hazards model may be a useful tool in selecting patients for more aggressive adjuvant treatment.

Age Factors↗
PubMed1988

DNA ploidy and S-phase fraction in primary breast carcinomas in relation to prognostic factors and survival for premenopausal patients at high risk for recurrent disease.

Fine needle aspiration on small tumour pieces from 153 premenopausal women with primary breast cancer at high risk for developing recurrent disease has been used for flow cytometric DNA analysis; 133 of the tumours had either one or more cell populations different from diploid or a single, diploid cell population with an aspiration cytology showing presence of typical tumour cells. The distribution of tumour cell populations in this material was rather unusual with a high number of tetraploid populations. There were significant differences between various DNA ploidy classes with respect to prognostic factors such as lymph node involvement and oestrogen and progesterone receptor status. The S-phase fraction was significantly lower for diploid tumour cell populations compared to aneuploid populations. Diploid tumours with high S-phase fraction were not correlated to prognostic factors usually indicating a poor prognosis. Patients with an aneuploid tumour cell population classified as medium aneuploid had a significantly shorter recurrence-free survival than the rest of the patients. No conclusion on the effect of adjuvant treatment for patients with different tumour cell populations can be made at present.

Breast Neoplasms↗