Biomedical subjects

J A Andersen

Publications and source records attributed to J A Andersen.

At least 55 records · Page 3Linked to original sources

PubMed1992

Danish randomized trial comparing breast conservation therapy with mastectomy: six years of life-table analysis. Danish Breast Cancer Cooperative Group.

The Danish Breast Cancer Cooperative Group (DBCG) conducted a randomized trial comparing breast conservation with mastectomy in patients with invasive mammary carcinoma. From January 1983 to March 1989, the trial accrued a total of 1153 women. Of this number, 905 patients (79%) were randomly assigned to one of the two treatment options, whereas 248 patients (21%) did not accept randomization. Of the randomly assigned patients, 90% received the surgical option to which they had been originally assigned. In the breast conservation arm the tumor was excised with the intention of obtaining free margins determined at gross examination, and radiotherapy was subsequently administered to residual breast tissue. The axilla was dissected in all instances. Patient and tumor characteristics were similar in the two randomization arms. The median follow-up time was 40 months. At 6 years of life-table analysis the probability of recurrence-free survival was 70% in the breast conservation arm against 66% in the mastectomy arm. Survival figures were 79% against 82%, respectively.

Breast Neoplasms↗

PubMed1991

[Prognostic factors in pigmented villonodular synovitis].

By means of the diagnostic register, all of the patients in the County of Funn with the diagnosis pigmented villonodular synovitis (PVS) during the years 1973 to 1987 were localized. Out of 22 patients, 19 were followed-up clinically and radiologically. Fifteen patients had PVS in a knee, 63% were women. The diagnosis was established late. Repeated punctures of the knee with dark aspirate without relevant trauma should raise the suspicion of PVS. The clinical course of the disease could not be related to the radiographic findings or the histology but depended rather on the localization. In some patients, PVS ran a more aggressive course and arthroses were observed electively in patients treated early. The prognosis in cases diagnosed early was not better but, as treatment yielded considerable relief of symptoms, early treatment was considered to be of value. This consists of local resection of the nodular PVS elements and as radical synovectomy as possible in the diffuse cases. Treatment of recurrences should depend on the symptoms and the degree of possible arthrosis. One patient who had had three recurrences received irradiation with good results. Restricted joint mobility after synovectomy is treated effectively with brisement.

Adolescent↗

PubMed1991

[Rationalization profits of radiographic diagnosis with systematic follow-up DBCG (Danish Breast Cancer Cooperative Group) programs. 1].

In the follow-up programme of the DBCG-77 control and treatment protocols for primary operable breast cancer, bone scintigraphy and chest X-ray were performed 6 months after surgery and thereafter yearly until the diagnosis of any recurrence or another cancer. In the present study, the value of the two examinations was examined to the 6th year control. As a result of a low incidence of primary recurrence to the bone (0.6-3.9%) and to the chest (0.0-3.0%) the value was found to be low. About two thirds of the patients with primary chest recurrence addressed themselves with or had at the time of control pulmonary symptoms. About one half of those patients, in whom (during a 12-month period after the scheduled bone scintigraphy) bone metastases were diagnosed by another method, had a normal scheduled bone scintigraphy. False positive changes were not infrequent, especially at the bone scintigraphies. The diagnosis of asymptomatic chest recurrence did not reduce the mortality among stage II patients, among whom the greatest value of the control examination was found. It is concluded, that systematic use of bone scintigraphy and chest X-ray is not justified in a follow-up programme for stage I and II breast cancer patients.

Bone and Bones↗

PubMed1991

[Prognosis after surgical treatment of breast cancer. 3. The low-risk group of the DBCG (Danish Breast Cancer Cooperative Group)].

The two therapeutic protocols of The Danish Breast Cancer Cooperative Group (DBCG) DBCG 77a (1977-1982) and 82a (1982-1990) comprise patients who were classified as low risk patients after operation for cancer of the breast, a total of 7,315 women. Treatment consisted of mastectomy and dissection of the lower and middle axillary levels. The median period of observation for DBCG 77a was 9 1/2 years and for DBCG 82a 3 1/3 years. The curves for recurrence-free survival and survival were found to be congruent in the two protocols. The recurrence-free survival after five years was 70% and 55% after ten years. Survival was 87% after five years and 70% after ten years. Local recurrence developed in 12.7% and 1.1% had distant recurrences simultaneously. Local recurrence was distributed with 60% in the scar or thoracic wall, 33% in the axilla and 7% in the clavicular lymph nodes. Distant recurrence alone developed in 11.4%. The time curves for development of local or distant recurrences were practically congruent. Local recurrence developed in 3.8% of the patients per annum during the first four years and after that in 1.5% per annum. Distant recurrence was found in 3.5% per annum in the first four years and after that in 1.8% per annum. The survival was significantly different after local and distant recurrence. Patients with tumours of grade 1 anaplasia had better prognoses than patient with grade 2 og 3 tumours as regards recurrence-free survival and survival. Multivariate analysis revealed that age under 40 years and anaplasia grad were significant prognostic variables for the parameters: distant recurrence and local recurrence. In addition, the number of lymph nodes in the operation specimen was a prognostic variable for local recurrence.

Adult↗

PubMed1991

[Adjuvant endocrine treatment of postmenopausal patients with breast cancer with high risk of recurrence. 5. Results from the DBCG (Danish Breast Cancer Cooperative Group) 77C randomized trial].

The role of antiestrogen treatment of postmenopausal breast cancer patients with high risk of recurrent disease is evaluated in a nationwide, prospective trial conducted by the Danish Breast Cancer Cooperative Group (DBCG). After total mastectomy and postoperative radiotherapy (RT), 840 patients were randomized to treatment with tamoxifen (RT + TAM) for one year, and 824 were randomized to no further therapy (RT). The recurrenceree survival (RFS) after ten years of lifeable analysis is 31% in the RT + TAM treated group, and 28% in the RT group (p = 0.01). Survival is 38% and 34% in the two treatment groups, respectively (p = 0.04). The data were further analyzed with respect to prognostic factors such as age, number of positive nodes, tumour size, and degree of anaplasia. Survival is prolonged in nearly all subgroups of patients treated with RT + TAM. However, the prolongation is only significant in patients with four or more positive nodes, with tumours of less than 5 centimeters or with tumours of anaplasia grade II. Estrogen (ER) and progesterone receptor (PgR) concentrations were measured in tumours from 309 and 219 patients, respectively. Only patients with ER and PgR values above 100 fmol/mg cytosol protein seemed to have a prolongation of survival. In conclusion, a modest survival benefit is achieved with one year of adjuvant tamoxifen treatment. Nevertheless, this is the first example of a systemic treatment approach being able to change the fatal course of breast cancer in postmenopausal patients. By means of endocrine therapy, and in the context of a new randomized trial, the DBCG will try to improve the survival in these patients even further.

Aged↗

PubMed1991

[Adjuvant chemotherapy in premenopausal and menopausal high-risk patients with breast cancer. 4. Results of the DBCG (Danish Breast Cancer Cooperative Group) 77B study].

From October 1977 to November 1982 premenopausal and menopausal high-risk breast cancer patients were included in a randomized trial (DBCG 77B). The primary surgical treatment was total mastectomy with axillary dissection. In the trial, a total of 1,034 patients were enrolled and received postoperative radiotherapy (RT) and were further randomized to 1) no systemic treatment, 2) cyclophosphamide, or 3) cyclophosphamide + methotrexate + 5-fluorouracil. The chemotherapy was given for one year. With a median observation time of ten years, the survival was 45, 60 and 62%, respectively. Retrospectively, the survival benefit was observed to be most pronounced in the age group less than 40 years, in patients with tumour size less than or equal to 5 cm or with less than or equal to 3 positive lymph nodes. In high-risk premenopausal and menopausal patients adjuvant chemotherapy combined with RT thus resulted in a more than 25% relative reduction in mortality at ten years of observation compared with RT alone.

Adult↗

PubMed1991

Quality assurance for patients with head injuries admitted to a regional trauma unit.

The efficacy of trauma systems in reducing preventable deaths has been established but the methods of auditing care are still evolving. Various "audit filters" to identify which patients' charts should be reviewed have been proposed. An analysis of all patients admitted to the Regional Trauma Unit (RTU) over a 19-month period was conducted. Of 729 patients, 135 were identified as having suffered a traumatic intracranial hemorrhage (TICH). On review, neither delay in transfer from the emergency room to the operating room nor increasing time from the incident to the operating room correlated with increasing mortality. In contrast to delay, the Glasgow Coma Scale (GCS) score on admission correlated well with outcome. The charts of patients with anomalous outcomes based on admission GCS score were reviewed, and two possibly preventable deaths were identified. There were 48 patients with TICH who had no operations but there were no deaths attributable to a missed operation. There were 76 patients for whom the GCS score at the referring hospital and the GCS score on admission to the RTU were available. Seven of 19 patients who worsened on transfer declined because of significant pulmonary injuries. Anomalous outcomes based on admission GCS score and declining GCS scores are recommended as quality assurance filters.

Adult↗

PubMed1991

Immunohistochemical studies on the localization of fetal antigen 2 (FA2), laminin, and collagen type 4 in basal cell carcinoma.

The localization of fetal antigen 2 (FA2), a recently described basement membrane (BM) associated antigen, was studied by immunohistochemical techniques in 21 basal cell carcinomas (BCC). In both superficial and infiltrating BCC, FA2 was located in a broad diffuse band around the tumor elements and in close contact with the BM. Compared to normal skin, a more extensive distribution of FA2 was seen in BCC. In the infiltrating BCC, FA2 staining was also present in the interstitial stroma between the tumor islands. FA2 was absent in areas with inflammatory cell infiltrates and elastoid degeneration. Epithelial and tumor cells were FA2 negative. The distribution of FA2 was clearly different from that of laminin and collagen type 4. Collagen type 4 and laminin were present as a continuous linear band corresponding to the BM surrounding the tumors. The close contact to the BM and the increased content of FA2 in the reactive stroma around BCC suggest that FA2 is involved in the matrix and/or BM changes taking place during tumor growth and invasion.

Antigens↗

PubMed1991

Fetal antigen 2 in primary and secondary brain tumors.

Immunohistochemical deposition and distribution of fetal antigen 2 (FA2) was examined in normal brain tissue and in primary and metastatic tumors of the brain. In normal brain tissue FA2 was exclusively found linearly around the vessels, along pia and in arachnoidea. A similar localization was seen in primary brain tumors except in gliosarcoma where FA2 was distributed diffusely in the sarcoma region and was absent in the glioma region. In metastatic carcinoma with tumor stroma a diffuse staining reaction was seen in the stroma and with a basement membrane (BM) like staining at the tumor cell/stroma interface. Intracytoplasmic FA2 staining of the tumor cells was seen in areas without tumor stroma. In metastatic melanoma a BM like FA2 staining was seen around and between individual tumor cells. The staining patterns seen in the metastatic tumors were in accordance with that of the corresponding primary tumors.

Biomarkers, Tumor↗

PubMed1991

Synthesis and antibacterial activity of new C-10 quinolonyl-cephem esters.

A series of cephalosporins derived from cephalothin containing an ester-linked quinolonyl substituent at the C-10 position (C-10 quinolonyl-cephem esters) has been prepared and evaluated for in vitro antibacterial activity. The C-10 quinolonyl-cephem esters exhibited a broadened spectrum of activity when compared with cephalothin and the corresponding quinolones, including activity against beta-lactamase-producing bacteria.

Bacteria↗

PubMed1990

[Preventive antibiotic treatment in cases of complicated injuries of the extremities. A questionnaire study].

A questionnaire about prophylactic antibiotic treatment of open bone, tendon or joint lesions in the extremities was sent to the 83 casualty departments in Denmark. The questionnaire was answered by 56 casualty departments which treated 72% of the orthopaedic surgical injuries in Denmark. In cases of lesions of the hands and feet, 23% of the patients were treated in casualty departments where prophylactic antibiotic therapy was rarely employed while 24% were treated in casualty departments where prophylactic antibiotic therapy was always employed. In cases of lesions proximal to the wrist or ankle joints, the figures were 26% and 38%, respectively. Penicillin was nearly always employed and treatment was commenced before or during operation. The majority of departments continued treatment for four days or longer. Considerable scatter was reported in the dosage of penicillin employed. The literature about prophylactic antibiotic treatment in cases of complicated lesions of the extremities is insufficient and controlled investigations are necessary to elucidate a series of conditions.

Arm Injuries↗

PubMed1990

The relative influence of alcohol and seatbelt usage on severity of injury from motor vehicle crashes.

Seatbelt usage has been consistently documented to decrease mortality and injury severity from motor vehicle crashes (MVC); however, conflicting results are available comparing mortality and injury severity, and blood alcohol positivity. Prospective testing on all MVC admissions showed that 51.5% of the non-belted, and 22% of the shoulder-belted drivers had a positive blood alcohol content (p less than 0.001). A comparison of belted and non-belted MVC drivers revealed a significantly higher mean length of stay (LOS) (p less than 0.05) and Injury Severity Score (ISS) (p less than 0.01) for the non-belted drivers. A comparison of groups positive and negative for blood alcohol revealed no significant differences in LOS or ISS, suggesting that these parameters are related to seatbelt use and not alcohol consumption.

Accidents, Traffic↗

PubMed1989

Significance of incisional biopsy in breast carcinoma: results from a clinical trial with intended excisional biopsy.

The recurrence-free survival rates (RFS) after one-stage mastectomy and partial axillary dissection in 1242 low risk breast cancer patients with invasive ductal carcinoma with or without residual cancer tissue (RCT) in the wall of the biopsy cavity were compared. RFS was significantly lower in patients with RCT (RCT-positive) whether premenopausal (n = 416) or postmenopausal (n = 826). By applying the Cox multivariate analysis on RCT and various known prognostic criteria, the incidence rates for RCT-positive patients relative to RCT-negative patients were estimated. The relative risk by RCT-positivity was in the order of 1.45, indicating that RCT is an independent risk factor contributing an increased risk of recurrence of about 45%.

Axilla↗

PubMed1988

Axillary lymph node morphology in women with in situ breast carcinoma. An autopsy study.

Axillary lymph nodes in 184 female autopsy cases were studied using morphological criteria. Special attention was paid to the morphology in 34 women with in situ breast carcinoma (in situ BC) compared to the remaining women without malignant breast lesions, who served as controls. Sinus histiocytosis (SH) and diffuse cortical hyperplasia (DCH) were significantly more frequent among women with in situ BC compared to controls. No significant association was found between unilateral in situ BC and these lymph node patterns on the contralateral side. Germinal center and follicular hyperplasia (GCH/FH), lymphocyte depletion (LD), fibrosis, hyalinization, calcifications and lipomatosis were not associated with in situ BC. The results indicate that in situ BC provokes reactive morphological changes of the regional axillary lymph nodes similar to the changes associated with a good prognosis in women with invasive breast cancer (IBC).

Adult↗

PubMed1988

Frequency and types of chest wall recurrences among node negative breast cancer patients.

From 1979 to 1982 a total of 2,467 patients with invasive breast carcinoma were included in the DBCG low-risk group (protocol 77a) and treated with mastectomy only. During a follow-up period from 4 to 7 years, 246 cases (10%) were reported with chest wall recurrence as first site of failure. For several reasons 58 cases were omitted. The material therefore comprises 188 cases. By a histo-pathologic re-evaluation the material was classified in three groups, i.e. 1) 31 cases with an evident new primary cancer, 2) 9 cases with a questionable new primary cancer, and 3) 148 cases with a true recurrence. Demonstration of residual breast tissue, multicentricity, and high differentiation of the original cancer, were features significantly related to the group of evident and questionable new primary cancers. Within the follow-up period no difference in mortality between the three groups were found.

Adult↗

PubMed1988

A Danish randomized trial comparing breast-preserving therapy with mastectomy in mammary carcinoma. Preliminary results.

The present study comprises 847 women operated upon for invasive breast carcinoma at 19 surgical departments and enrolled in protocol DBCG-82TM from January 1983 to November 1987. Among them 662 (78%) were allocated for breast-preserving therapy or mastectomy by randomization, while 185 patients (22%) did not accept randomization. Within the randomized group 6% could not be entered into adjuvant protocols, i.e. subsequent programmes of postoperative therapy and follow-up. This left 619 evaluable patients. In the non-randomized series 26% did not fulfil the demands for entrance into the adjuvant protocols, leaving 136 evaluable patients, 60 of whom had chosen a breast-preserving operation and 76 mastectomy. In the randomized series the patients in the two treatment arms were comparable in age, menopausal status, site of tumour, pathoanatomical diameter of the tumour, number of removed axillary lymph nodes, number of metastatic axillary lymph nodes, and distribution on adjuvant regimens. Ninety per cent of the patients in the randomized group accepted the method offered, whereas 10% declined and wanted the alternate form of operation. The median follow-up period was approximately 1.75 years. The cumulative recurrence rate in the randomized group was 13% and in the non-randomized group 7%. These results are preliminary. Life-table analyses have not so far demonstrated differences in recurrence-free survival either in the randomized or the non-randomized series.

Adult↗

PubMed1988

Bioptic strategy in breast cancer.

The bioptic strategy in breast cancer rests on the following basic conditions at the Department of Surgery K, Odense University Hospital: Firstly, clinical mammography precedes any bioptic procedure. Secondly, the bioptic procedure must secure representative tissue for histological examination. Thirdly, knife-biopsy should preferably be excisional. Finally, tissue examination is exclusively done by the pathologist and always on unfixed tissue. The application and outcome of the employed biopsy methods are illustrated by a series of 365 women with operable, primary invasive breast cancer, treated from 1982 to 1987. Definitive surgery was mainly based on excisional (62%) or needle biopsy (24%). Three-fourths of the patients were treated by the one-stage procedure. However, within the last year of the period the rate of needle biopsy and two-stage procedures was doubled, increasingly employing core-aspirating needle biopsy synchronously with mammography and done by the radiologist. So far, patient compliance and histological outcome is satisfactory.

Biopsy↗

PubMed1988

The growth pattern of in situ carcinoma in the female breast.

The histopathological growth pattern of in situ carcinoma in the female breast is divided into three forms: 1) microfocal, 2) diffuse, and 3) tumour forming. This classification is clearly correlated to our diagnostic findings and forms furthermore the basis for our planning of treatment, as the growth pattern is probably of prognostic relevance.

Breast Neoplasms↗