Search PubMed⌕ Search

Biomedical subjects

K von Smitten

Publications and source records attributed to K von Smitten.

At least 37 records · Page 2Linked to original sources
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↗
PubMed1997

Treatment-related factors predisposing to chronic pain in patients with breast cancer--a multivariate approach.

A study was carried out to assess the factors predisposing to chronic post-treatment pain in the breast area and in the ipsilateral arm in patients treated for breast cancer using two multivariate models. In the study 509 patients with non-metastasized breast cancer who were treated during 1988-1994 completed the questionnaire about pain in the operated breast and in the ipsilateral arm 10-58 months after surgery. The factors included in the analysis were: age, type of operation, size of the tumour, number of lymph nodes removed, involvement of lymph nodes, complications of surgery, intensity of the acute postoperative pain remembered by the patient, number of doses of analgesics, number of months from surgery, adjuvant radiotherapy, chemotherapy and endocrine treatment. The most important factors included in the models of chronic pain were: intensity of the acute postoperative pain, the type of operation, involvement of regional lymph nodes and radiotherapy.

Adult↗
PubMed1996

Expression of tenascin in invasion border of early breast cancer correlates with higher risk of distant metastasis.

Tenascin (Tn) is an extracellular matrix glycoprotein transiently expressed in epithelial-mesenchymal interaction areas during embryogenesis. Tn is expressed in a limited manner in adult tissues but emerges during wound healing and tumorigenesis. We have studied Tn expression by immunohistochemistry in 137 small node-negative breast cancers treated with breast-conserving surgery and post-operative radiotherapy during 1985-1989. None of the patients had undergone any adjuvant hormonal therapy or chemotherapy. Stromal Tn expression itself could not predict distant metastasis. However, Tn staining in the area of the invasion border seemed to be a strong predictor of distant metastasis, with an estimated 5-year metastasis-free survival (MFS) of 85% in Tn-positive cases compared to 98% in Tn-negative ones. The prognostic impact of Tn in the invasion border on MFS was stronger than that of tumour size and grade. This staining appears to be a useful adjunct for the estimation of breast-cancer metastasis.

Breast Neoplasms↗
PubMed1996

Preoperative assessment of proliferative activity and hormonal receptor status in carcinoma of the breast: a comparison of needle aspiration and needle-core biopsies to the surgical specimen.

The applicability and reliability of estimates of proliferative activity in breast carcinomas using fine-needle aspiration (FNA) and needle-core biopsies (NC) was evaluated in 98 breast carcinoma patients. The Ki-67, Estrogen receptor (ER), and progesteron receptor (PR) immunolabelling of FNA and NC was compared with that of the surgical specimen. A statistically significant consistency between labelling was found in the Ki-67-NC (kappa = 0.474), ER-FNA (kappa = 0.318), ER-NC (kappa = 0.518), and PR-FNA (kappa = 0.404) groups. The consistency in the Ki-67-FNA group was less significant (kappa = 0.182), and there was no consistency in the PR-NC group (kappa = 0.062). There was a positive correlation of Ki-67 labelling in FNA and NC biopsies (Spearman rank, rho = 0.4; P = 0.0007), and also in ER labeling (Spearman rank rho = 0.6; P = 0.0001). These results indicate that NC and FNA can be used for preoperative assessment of proliferative activity and hormonal status in breast carcinoma.

Adult↗
PubMed1996

Pain and other symptoms during the first year after radical and conservative surgery for breast cancer.

This study assessed pain, neurological symptoms, oedema of the ipsilateral arm, anxiety and depression occurring in women treated surgically for breast cancer, the impact of these symptoms on daily life and how they evolved during the 1 year follow-up. Ninety-three consecutive patients with non-metastasised breast cancer who were treated during 1993-94 were examined before surgery and after 1, 6 and 12 months. They were asked about pain, neurological symptoms and oedema in the breast scar region and/or ipsilateral arm. Sensory testing was performed, and gripping force and the circumference of the arm were measured. Anxiety and depression were evaluated. One year after surgery, 80% of the women had treatment-related symptoms in the breast scar region and virtually all patients had symptoms in the ipsilateral arm. The incidence of chronic post-treatment pain was higher after conservative surgery than after radical surgery (breast area: 33% vs 17%, NS; ipsilateral arm: 23% vs 13%, NS). Numbness occurred in 75% and oedema of the ipsilateral arm in over 30% of the patients after both radical and conservative surgery. Phantom sensations in the breast were reported by 25% of the patients. No difference in psychic morbidity was detected after the two types of surgery. Both the anxiety and depression scores were highest before surgery, decreasing with time, and were significantly correlated with preoperative stressful events.

Activities of Daily Living↗
PubMed1996

Vas deferens aspiration and intracytoplasmic injection of frozen-thawed spermatozoa in a case of anejaculation in a diabetic man.

By using aspiration from the vas deferens, apparently good quality spermatozoa can be obtained for in-vitro fertilization (IVF) in cases of non-treatable anejaculation. Being squeezed from the epididymis during aspiration, the spermatozoa may be immature and their fertilizing capacity lower than that of ejaculated spermatozoa. Our case report describes a couple who achieved pregnancy when intracytoplasmic sperm injection (ICSI) was carried out with frozen-thawed spermatozoa aspirated from the vas deferens of a man whose anejaculation was associated with diabetes mellitus. In the aspiration, 50 x 10(6) spermatozoa were obtained. One half of them was frozen, and the other half was used fresh for conventional IVF, resulting in total fertilization failure of all the oocytes. The second treatment was ICSI, in which eight out of 11 oocytes injected with frozen-thawed spermatozoa showed normal fertilization. The second frozen embryo transfer resulted in a normal pregnancy.

Adult↗
PubMed1996

Pregnancy resulting from intracytoplasmic injection of spermatozoa from a frozen-thawed testicular biopsy specimen.

A testicular biopsy specimen was taken in connection with scrotal exploration of a healthy 35 year old man who had azoospermia. Bilateral severe scarring of unknown aetiology was found in the exploration, and no epididymal spermatozoa could be obtained. Spermatozoa from the fresh biopsy specimen were used for intracytoplasmic sperm injection (ICSI) on the same day. Two-embryo transfer resulted in biochemical pregnancy. The rest of the biopsy specimen was frozen as small pieces of tissue using glycerol as a cryoprotectant. ICSI was then performed with spermatozoa prepared from the frozen-thawed tissue. One embryo was obtained and transferred. The transfer resulted in pregnancy, and a living fetus was seen in ultrasound scans at the seventh and 16th weeks of pregnancy. It is possible to avoid repeated testicular biopsies by using cryopreservation of testicular tissue.

Adult↗
PubMed1996

Sequelae in the abdominal wall after pedicled or free TRAM flap surgery.

Twenty-seven free transverse rectus abdominis musculocutaneous (TRAM) and 16 pedicled TRAM flap breast reconstruction patients were studied for 7 to 41 months (mean, 23 months) postoperatively to compare abdominal sequelae after these two operations. The patient groups were demographically similar; mean age was 47 years in both groups. Subjective grading of the results was similar in both groups. The incidence of minor lower abdominal bulges was higher (44%, 7/16) in the pedicled group than in the free TRAM flap group (4%, 1/27). No hernias were found. Delayed healing of the abdominal scar occurred in 3 free TRAM flap and 1 pedicled TRAM flap patients. Two free TRAM flap (8%) and 7 pedicled TRAM (44%) flap patients had minor edge necrosis of the breast. Trunk strength was tested using an isokinetic device (Lido Multi Joint II), and peak torque for flexion (mean, 111 Nm +/- 25 Nm in the free TRAM flap group and 123 Nm +/- 28 Nm in the pedicled TRAM flap group) and extension (mean, 144 Nm +/- 38 Nm and 167 Nm +/- 45 Nm) were measured. No statistical differences occurred between these groups. Sit-up performance was tested and graded from 1 to 6. Both groups performed equally (4.8 and 4.8) and within normal values for this age group. Ultrasonography of the rectus muscles revealed that in the free TRAM flap group, the rectus muscle of the operated side was significantly thinner (cranial segment 6.8 mm vs. 7.8 mm, p < 0.05), thus the harvesting of a segment of muscle below the umbilicus seems to disturb the quality of the entire muscle. The mean size of the muscular defect in the free TRAM flap group was 4.3 x 6.1 cm. In this study no differences in patient satisfaction or trunk strength could be found between free and pedicled TRAM flap patients.

Abdominal Muscles↗
PubMed1995

Pain and other symptoms after different treatment modalities of breast cancer.

PURPOSE: The aim of this study was to analyse the risk factors that predispose women to chronic symptoms related to the treatment of breast cancer. PATIENTS AND METHODS: A questionnaire was sent to 569 women who had undergone modified radical mastectomies with axillary evacuation (MRM) or breast resection with axillary evacuation (BCT). RESULTS: Pain, paraesthesias and strange sensations were reported by half of the patients. The chronic pain slightly affected the daily lives of about 50% of the patients and moderately or more the daily lives of about 25% of the patients. Pain was reported significantly more often after BCT than after MRM both in the breast scar (BS) and in the ipsilateral arm (IA). The patients with chronic pain were significantly younger and had larger primary tumours. Postoperative complications increased the incidence of chronic pain in the IA. The highest incidence of pain in the IA was reported by patients who had had both radio- and chemotherapy. The fact that the incidence of pain (IA) had a significant correlation with the incidence of paraesthesias, oedema, strange sensations and muscle weakness may be an indication of nerve injury. CONCLUSIONS: Chronic pain was more common after breast-conserving surgery than after radical surgery. Surgical complications and postoperative radiotherapy and chemotherapy increased the risk of chronic pain and other symptoms. Modifications in the treatment protocol and preclusion of postoperative complications may be necessary in order to minimize chronic treatment-related symptoms.

Adult↗