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K von Smitten

Publications and source records attributed to K von Smitten.

At least 19 recordsLinked to original sources
PubMed2001

Intraoperative evaluation of blood flow in the internal mammary or thoracodorsal artery as a recipient vessel for a free TRAM flap.

Although the free microvascular transverse rectus abdominis musculocutaneous (TRAM) flap is in routine use for breast reconstruction, little is known of its hemodynamics. The purpose of this study was to determine whether any differences exist when the free TRAM flap is anastomosed to the thoracodorsal or internal mammary vessels. The study comprised 25 patients receiving a free TRAM flap for breast reconstruction. The thoracodorsal vessels were used as recipients in 21 patients and the internal mammary vessels were used in 4 patients. Blood flow rate was measured directly in the donor and recipient arteries, and after anastomosis by a transit-time ultrasonic flowmeter (CardioMed). Two- and 3-mm probes were used. The blood flow rate in the donor artery (deep inferior epigastric) before flap dissection was 11 +/- 6 ml per minute (mean +/- standard deviation). The rate was significantly (p < 0.05) lower (5 +/- 3 ml per minute) in the recipient thoracodorsal artery than in the donor, but after transplantation it increased to 14 +/- 5 ml per minute (p < 0.05), attaining the same value as the donor artery. The blood flow rate in the intact internal mammary artery was significantly higher (25 +/- 10 ml per minute) than in the donor and thoracodorsal arteries, but after anastomosis it dropped to the same value (12 +/- 3 ml per minute; p < 0.05) as the donor artery. The intake of blood in TRAM flaps supplied by the intemal mammary artery seems to be no greater than that in free flaps anastomosed to thoracodorsal vessels, although the flow in the internal mammary artery was much higher. The authors concluded that the blood supply in a free TRAM flap is independent of the flow in the recipient artery and that thoracodorsal vessels, although often in a scarred bed and radiated, are as suitable for anastomosing a free TRAM flap as are internal mammary vessels.

Adult↗
PubMed2000

Surgical management of breast cancer in the future.

In the 1970s the Halsted operation was abandoned for the modified, muscle-sparing, radical mastectomy by Madden or Patey; in the 1980s breast-conserving surgery was accepted in the surgical treatment of early breast cancer and during the last years of this century sentinel node biopsy has emerged as a method to avoid axillary clearance for node-negative axillae. This will lead to a diminishing number of axillary clearance procedures. Breast cancer surgery will increasingly be performed as day-case operations, under local anaesthesia. The real surgical challenges during the next decade will be immediate breast reconstruction and oncoplastic breast-conserving procedures. Therefore breast surgery will increasingly be performed by plastic surgeons.

Axilla↗
PubMed1999

Expression of glycodelin in human breast and breast cancer.

Glycodelin is a 28 kDa glycoprotein with structural homology to beta-lactoglobulins, particularly expressed in steroid-responsive tissues of the female reproductive tract. We previously found that transfection of glycodelin cDNA into MCF-7 breast cancer cells induces differentiation into organized acinar epithelium and up-regulation of epithelial markers. In this study, we used immunohistochemistry, Northern blotting and reverse transcription-polymerase chain reaction (RT-PCR) analyses to study glycodelin expression in normal and in malignant breast tissues. The results were compared with the expression of estrogen (ER) and progesterone receptors (PR) and p53 tumor suppressor protein. Glycodelin was found in ductal and lobular epithelium of 6/6 normal breast tissues, 27/29 morphologically normal breast tissues from breast cancer patients, 6/6 benign lactating adenomas, 21/35 ductal carcinomas, 9/9 tubular carcinomas, 9/9 mucinous carcinomas, 3/3 mixed ductal/tubular carcinomas and 7/11 lobular carcinomas. In the latter, of particular interest was the presence of glycodelin in paranucleolar vacuoles of carcinoma cells. Northern blot analysis of fresh frozen tissues revealed the normal full length 0.9 kb mRNA of glycodelin in ductal breast carcinoma. Using RT-PCR analysis, glycodelin messenger ribonucleic acid was found in 13/13 ductal and in 3/3 tubular tumor tissues. We also detected a splicing variant lacking exon 4, which includes the nucleotide sequence encoding the potential N-glycosylation site at Asn-85. Our results demonstrate the synthesis of glycodelin in normal breast and breast cancer. In addition, we show that the paranuclear vacuole, characteristically present in lobular breast cancer cells, contains abundant amounts of glycodelin.

Adenoma↗
PubMed1999

Cathepsin-D, urokinase plasminogen activator and type-1 plasminogen activator inhibitor in early breast cancer: an immunohistochemical study of prognostic value and relations to tenascin-C and other factors.

Cytosolic determinations of cathepsin-D (cath-D), urokinase plasminogen activator (uPA) and its specific inhibitor PAI-1 have shown an association with adverse prognosis in breast cancer. Our aim was to study the distribution of these markers in small axillary node-negative breast carcinomas using immunohistochemistry and relate the semiquantitative results to known prognostic factors, the expression of tenascin-C (Tn-C) in invasion border of the tumour and prognosis. All the 158 women (159 tumours) were treated with breast conserving surgery and postoperative radiotherapy. Cytoplasmic immunoreactivity for cath-D was seen in carcinoma cells in 47% and in stromal cells in 44%. Nearly all tumours expressed uPA and PAI-1, which were categorized to cytoplasmic expression in carcinoma cells and diffuse stromal expression and quantified -/+/++/ and further dichotomized for purposes of analysis. Expression of uPA and PAI-1 in stromal fibroblasts was recorded as -/+. Cytoplasmic and stromal cell cath-D contents were associated with grade, proliferation, Tn-C expression in the tumour invasion border and the development of distant metastasis. In multivariate analysis stromal cath-D proved to be an independent prognostic factor for metastasis. Stromal expression of uPA was associated with an increased risk of local recurrence; otherwise high levels of uPA did not associate with other prognostic factors nor with prognosis. Fibroblastic expression of PAI-1 showed an association with both local and distant disease recurrence. However, no consistent association between the immunohistochemically quantified uPA and PAI-1 and prognosis was found. In conclusion, immunohistochemical determination of cath-D seems to be a viable method to predict a higher risk of metastasis but not local recurrence in small axillary node-negative breast carcinomas.

Biomarkers↗
PubMed1999

Sentinel node biopsy in breast cancer.

The concept of breast sentinel node biopsy is based on the assumption that a breast cancer that metastasizes through the lymphatics will initially reach one or a few nodes in the corresponding lymph basin. The status of this or these sentinel node(s) will predict the status of all the other nodes in the basin. The sentinel node can be found stained blue or as being radioactive by injecting blue dye or a radioactive tracer around the tumour. Scintigraphy may further help to localize the sentinel node. The feasibility of the method has been validated by several studies comparing the status of the sentinel node with the node status of the axilla revealed by subsequent axillary clearance. Detection rates of 66-100% and false-negative rates of 17-0% have been reported. Before the method can be accepted for clinical use, a consensus concerning the accepted false-negative rate has to be reached and has to be shown in practice. From a theoretical point of view, a calculated false-negative risk rate of 2-3% can be accepted.

Axilla↗
PubMed1999

Free microvascular tram flaps: report of 185 breast reconstructions.

The free TRAM flap is the most elegant technique currently available for breast reconstruction. We describe here the surgical technique, the complications, the possible effects of the prognosis of the breast cancer, and the learning curve of the surgical team. From December 1990 to the end of 1995 we reconstructed 185 breasts (10 bilateral) in 175 patients with free TRAM flaps; 27 were immediate reconstructions. We harvested the flap based on the inferior epigastric pedicle on the opposite side to the affected breast. To dissect the rectus muscle we used a muscle-sparing technique. The flap was designed and de-epithelialised while still on the abdomen, and was anastomosed to the thoracodorsal or circumflex scapular vessels with loupes only. In the immediate reconstructions we removed the breast tissue through a periareolar incision; we dissected the group I axillary lymph nodes and exposed the recipient vessels through a separate incision. The areolar complex was autotransplanted as a free skin graft. Only two flaps were lost. Eight patients were reoperated on for thrombosis of the vessels. The complication rate was nearly 50% among the first 50 patients. However, as surgical experience grew, the figure was reduced, eventually being down to 20%-25%. Of the patients who had delayed reconstructions only two died during the follow-up period of 48 months. One patient had a local recurrence above the TRAM skin. During the last eight years the free TRAM flap has been our main method of breast reconstruction. Free flaps today are reliable and the reconstruction does not seem to worsen the prognosis of breast cancer.

Adult↗
PubMed1999

Automated stereotactic core needle biopsy of microcalcifications with correlation to surgical biopsy.

PURPOSE: To compare pathologic findings from stereotactic core and excisional biopsies in patients with microcalcifications in the breast. MATERIAL AND METHODS: Stereotactic core needle biopsies of 101 lesions with mammographic evidence of microcalcifications were performed with long-throw (2.2 cm) automated core biopsy devices fitted with 2.1-mm needles. The core specimens were placed on microscope slides and radiographed. The pathologic features of core and excisional specimens were compared. RESULTS: In 100 of the 101 breast lesions, a correct choice for an additional diagnostic procedure or definitive treatment could have been made upon histopathologic findings of the core needle biopsy. CONCLUSION: Stereotactic core needle biopsy is a reliable alternative to surgical biopsy of breast lesions with microcalcifications provided that specimen radiography has been performed to ensure that appropriate tissue has been obtained. Excisional biopsy may be avoided if microcalcifications are visible in radiographs of core biopsy specimen with benign histology.

Biopsy, Needle↗
PubMed1998

Effect of temperature of insufflated CO2 during and after prolonged laparoscopic surgery.

BACKGROUND: Pneumoperitoneum with room temperature carbon dioxide (CO2) has been shown to decrease core temperature and urine output. METHODS: The effect of 37 degrees C (warm) and room temperature (cool) CO2 pneumoperitoneum on core temperature, urine output, and central hemodynamics was compared in 26 randomized patients undergoing prolonged laparoscopic surgery (>90 min). RESULTS: The core temperature (p < 0.05) and cardiac index (p < 0.05) were significantly higher after warm than after cool pneumoperitoneum. Urine output was significantly higher during warm (2.3 +/- 1.6 ml/kg/h) than during cool (0.9 +/- 0.7 ml/kg/h) insufflation (p < 0. 05). Two of 13 patients with warm and 11 of 13 patients with cool pneumoperitoneum needed mannitol to maintain adequate diuresis (p < 0.05). CONCLUSIONS: Warm insufflation probably causes a local vasodilation in the kidneys and may be beneficial to patients with borderline renal function.

Body Temperature↗
PubMed1998

Expression of tenascin-C in intraductal carcinoma of human breast: relationship to invasion.

Tenascin-C (Tn-C) is an extracellular matrix glycoprotein that appears in areas of epithelial-mesenchymal interaction during fetal development and in neoplasia. The immunohistochemical expression of Tn-C and its relationship to histology, nuclear grade, microinvasion, oestrogen (ER) and progesterone receptors (PR), and to cell proliferation measured by Ki-67 expression were studied in 89 intraductal breast carcinomas (DCIS). Periductal Tn-C was noted in 87% and stromal Tn-C in 25% of the tumours. Stromal expression was associated with moderate to strong periductal expression and microinvasion. Periductal expression was associated with comedo-type, nuclear grade, microinvasion, Ki-67 expression, and lack of PR. The distribution of Tn-C was compared in DCIS and in the intraductal component from another series of small axillary node-negative invasive breast carcinomas (n = 44). Tn-C was present in the stroma of pure DCIS in 25% and in the intraductal component of the other series in 82%. Thus, stromal or moderate to strong periductal Tn-C expression in DCIS may relate to early invasion. DCIS with weak periductal or missing Tn-C expression may be a subgroup with benign behaviour.

Adult↗
PubMed1998

Tenascin-C expression in invasion border of early breast cancer: a predictor of local and distant recurrence.

We have recently demonstrated an association between distant metastasis and the expression of the extracellular matrix glycoprotein tenascin-C (Tn-C) in the invasion border of small axillary node-negative breast carcinomas. Our purpose was to assess the relationship between the expression of Tn-C in the tumour invasion border and several histopathological and biological variables and to compare their usefulness in predicting local and distant disease recurrences. The original patient group consisted of 143 women with axillary node-negative breast cancer (one bilateral) treated with breast-conserving surgery and post-operative radiotherapy, and followed for a median of 8 years. Because of the small number of recurrences an additional group of 15 similarly treated women with recurrent breast cancer was also studied. The size of the tumour, its histology, including a possible intraductal component, and grade were re-evaluated. The expression of erbB-2, p53, Ki-67 and Tn-C was evaluated by immunohistochemistry. Ploidy and S-phase fraction (SPF) were assessed by flow cytometry. The only statistically significant prognostic factor for local recurrence was Tn-C expression in the invasion border. For metastasis Ki-67 positivity, tumour size and Tn-C expression in the invasion border were statistically significant, but Ki-67 positivity was the only independent prognostic factor. Tn-C expression in the invasion border was associated with a higher proliferation rate measured by Ki-67 and SPF, which is consistent with the suggested growth-promoting activity of Tn-C. Tn-C may be a useful marker in selecting patients for adjuvant therapies to reduce the rate of both local and distant cancer recurrences.

Adult↗
PubMed1997

Wound tissue oxygen tension predicts the risk of wound infection in surgical patients.

OBJECTIVE: To test the hypothesis that subcutaneous wound oxygen tension (PsqO2) has a predictive relation to the development of wound infection in surgical patients. DESIGN: A noninterventional, prospective study. SETTING: A university department of surgery. PATIENTS: One hundred thirty operative general surgical patients at notable risk of infection as predicted by an anticipated Study on the Effect of Nosocomial Infection Control (SENIC) score of 1 or greater. OUTCOME MEASURES: PsqO2 was measured perioperatively. Its relation to the subsequent incidence of surgical wound infection was then determined and compared with the SENIC score as a criterion standard. RESULTS: Although the SENIC score and PsqO2 are inversely correlated, PsqO2 is the stronger predictor of infection. Low PsqO2 identified patients at risk and concentrated them in a cohort that was about half the size of that identified by the SENIC score. CONCLUSIONS: Subcutaneous perfusion and oxygenation are important components of immunity to wound infections. The SENIC score identifies systemic physiological variables that are important to the development of wound infection. Nevertheless, PsqO2 is the more powerful predictor of wound infection. Moreover, PsqO2 can be manipulated by available clinical means, and thus may direct interventions to prevent infection.

Adult↗
PubMed1997

Magnetic resonance imaging of the TRAM flap donor site.

High-field magnetic resonance imaging (Magnetom 42 SP, 1.0 Tesla) was performed a mean of 22 months (range, 8-42 months) postoperatively on 29 women who had undergone unilateral breast reconstruction with a transverse rectus abdominis musculocutaneous (TRAM) flap (19 free and 10 pedicled TRAM flaps). Fifteen T1-weighed, cross-sectional spin-echo images of the abdominal wall were obtained using a surface coil. The free TRAM flap was elevated sparing the lateral third of the rectus muscle. In the pedicled TRAM flap the whole rectus muscle was used. The patient groups were demographically similar, with no statistical differences in age or body mass index. In the free TRAM group the mean (+/-standard deviation) area of the rectus muscle in the upper third of the muscle (first five slices) was smaller on the operated side (376 +/- 135 mm2) than on the contralateral side (462 +/- 78 mm2), p = 0.02. The mean signal intensity (reflecting intramuscular fat content) of the upper third of the muscle was significantly higher on the operated side than on the nonoperated side, p = 0.04. Intramuscular fat content was also estimated and graded using an arbitrary scale from 1 to 4. The fat content of the upper third of the muscle was graded higher on the donor side (median, 3) than on the contralateral side (median, 2), p < 0.01. In pedicled TRAM flap patients, the remaining rectus was responsible for a mean of 47 +/- 5% of the distance between the lateral muscles, leaving a mean of 63 +/- 10 mm of the abdominal wall covered by fascia only. No hernias were detected in either group. This study shows that harvesting of a free TRAM flap seems to affect the quality of the donor rectus muscle over its whole length.

Case-Control Studies↗
PubMed1997

Urinary excretion of iohexol as a marker of disease activity in patients with inflammatory bowel disease.

BACKGROUND: Increased intestinal permeability of water-soluble contrast medium during an intestinal follow-through is found in patients with active Crohn's disease in the small bowel. METHODS: Urinary excretion of the water-soluble X-ray contrast medium iohexol was measured after oral administration in patients with inflammatory bowel disease and in healthy controls. The patients were grouped on the basis of disease activity and location and extent of intestinal involvement. RESULTS: Urinary excretion of iohexol was significantly higher in patients with active disease than in patients with quiescent disease or in healthy controls (P = 0.005), and it correlated positively with activity indices and with the extent of the disease. CONCLUSION: The intestinal permeability of iohexol is significantly increased in patients with active inflammatory bowel disease in the small bowel and in the colon, whereas the permeability of patients with inactive disease is similar to that in healthy controls. We suggest that urinary excretion of iohexol can be used as a marker of disease activity in patients with inflammatory bowel disease.

Administration, Oral↗
PubMed1997

Ki-67, p53, Er-receptors, ploidy and S-phase as prognostic factors in T1 node negative breast cancer.

The prognostic value of Ki-67, p53 and ER immunohistochemical labelling and flow-cytometric S-phase fraction and ploidy was evaluated in 212 pT1N0M0 breast carcinomas. The mean follow-up time was 8.3 years. Patients with breast carcinomas with high Ki-67 expression (> or = 10%) had a less favourable disease-free survival than those with low Ki-67 expression (< 10%) (p = 0.008). A positive p53 staining and high SPF were associated with a less favourable disease-free survival although it did not reach statistical significance. The subset of patients with ER negative, Ki-67 > or = 10% and p53 > or = 20% tumours, had a shorter disease-free survival compared with that of all the other patients (p = 0.03). We conclude that the potential value of Ki-67 labelling for prognostic evaluation of T1N0M0 breast carcinoma is good.

Adult↗