Changes of hormone serum levels during UVA and UVB irradiation.
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Adolescent↗
Biomedical subjects
M Schemper
Publications and source records attributed to M Schemper.
[Adjuvant chemotherapy in patients with radical resection of stomach cancer: 5-year results of a prospective randomized study].
102 patients with operable gastric carcinoma were randomly allocated to untreated control, polychemotherapy, chemoimmunotherapy. At a median follow-up of 5 years, chemotherapy did not improve the overall survival rate. However, in certain subgroups, patients with lymphnode metastases and intestinal tumor type showed a significant survival benefit when treated with adjuvant chemotherapy. Furthermore, we found the site of first recurrence very closely related to the type of tumor histology. Regardless of the positive effect of chemotherapy in retrospective subset-analysis, we do not generally recommend the use of polychemotherapy in operable gastric carcinoma.
Aged↗
[Liver resection of hematogenous and infiltrating metastases].
Of a total of 245 resections for hepatic metastases 124 operations were performed for hematogenic metastases and 36 for infiltrating metastases in continuity with the primary tumour. This group of so-called "major hepatic resections" is analysed. The series comprises 83 male and 77 female patients, mean age 62.2 years. There were 85 resections of the right lobe (39 of those with intrahepatic extension to the left), 45 right) and 30 atypical hepatectomies (at least bisegmentectomies). Hematogenic hepatic metastases: 80 resections of hepatic metastases following colorectal carcinoma, 15 following cancer of the stomach and esophagus, 12 after non-gastrointestinal malignant tumours, 4 resections after unknown primary cancer (44% solitary, 32% monolobar multiple, and 24% bilateral metastases); synchronous operations were performed in 32% of the patients, in 19% so-called interval surgery (mean 7.4 weeks), and in 49% metachrone surgery (mean 30 weeks). During 1983 and 1985 our morbidity rate amounted to 10% and the letality rate to 7%, as compared to 17% morbidity and 15% letality in the period 1965-1983. In both periods, septic postoperative complications outnumbered all other causes. The mean survival rate after colorectal carcinoma was 20 months, after non-gastro-intestinal malignant growth 19 months, after carcinoma of the stomach as well as after malignant biliary tract diseases 5 months. The three-year survival rate of colorectal carcinoma amounts to 30%, the five year survival rate to 15% including all metastatic stages. The results of interval and metachrone resections in forms of survival rates are clearly better than the results of synchronous resections with a mean survival time of five months.(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
[Autologous venous bypass in the therapy of arterial occlusive disease of the femoropopliteal area: long-term results].
The outcome of 532 femoro-popliteal vein grafts performed electively during the years 1970 to 1985 for obliterative arterial disease, was analyzed using the documentation-system of the Austrian Society for Vascular Surgery, as well as SAS and BMDP-software on an IBM 4381 computer of the Medical Faculty. The probability of function was estimated according to the Kaplan-Meier method, statistical differences were checked with Breslow's and Mantel's test, the proportional hazards regression model (Cox) was used to elucidate the influence of different risk factors on each own and in combination of each other. In the univariate analysis, the preoperative clinical status was found to be of prognostic significance, but technical details such as intraoperative as well as postoperative arteriography or site of the distal anastomosis were not important. A postoperative coumarine treatment had no demonstrable impact on graft function, but positively influenced the probability of patient survival. Taking into account the factors found to be of significance in the univariate analysis (e.g. set of factors: site of distal anastomosis, diabetic state and smoking habits) were analyzed using the proportional hazards regression model but were found of no major influence. The factors preoperative clinical status, patients age, and coumarine therapy significantly influenced the probability of patient survival, but diabetes mellitus and smoking were found to be not important.
Aged↗
[Status and tasks of biometry in clinical and experimental research].
The paper starts with reflections on the rôle of biometry in clinical research. Factors which might influence the efficacy of biostatistical consulting of clinicians are dealt with. Primarily, advantages and disadvantages of various behavioral patterns between the medical investigator and the biometrician are discussed. The recruitment and training of new biometricians, organizational structures and material foundations of clinical biometry are regarded as further factors influencing a constructive working practice. The paper ends with considerations on the future of the discipline.
Austria↗
[Consequences of after-care in colorectal cancer].
Results of a computer supported follow-up-program on patients with colorectal cancer are presented. Between 1978 and 1985 1024 patients underwent these program, the drop-out-rate was 18%. 231 recurrences in 137 patients were discovered (40% local recurrence, 30% liver metastases and 30% others). 54% of patients with local recurrence and 43% with liver metastases were free of symptoms. Radical surgery was performed in 47% of local recurrences and in 24% of liver metastases. The three year survival rate after radical surgery for recurrence amounted to 28% for local recurrences and to 31% for liver metastases.
Colonic Neoplasms↗
[Conservative treatment of peptic esophageal stenoses. Results of a prospective long-term study].
In a prospective long-term study the feasibility of conservative management of peptic oesophageal stenosis was investigated. Admission criteria were: endoscopic-bioptic evidence of peptic stricture of the oesophagus, acid gastro-oesophageal reflux on pH-metry, high operative risk or previous unsuccessful antireflux operation. Therapy consisted of two components: 1. bouginage of the stricture up to 38 to 45 French; 2. inhibition of gastric secretion by 4 X 400 mg daily cimetidine. A total of 33 patients were entered into the study; 28 were followed up for more than 6 months, the mean follow-up period being 15 months. Out of the 28 patients 16 were clinically free of symptoms, 5 had evident symptoms, 3 needed rebouginage and the remaining 4 were clear failures and had to be operated on because of persistent severe pain or rapid restenosis. Considerable improvement in reflux oesophagitis was obtained in 61.5% of cases; indeed, complete healing was noted in 46% of patients at follow-up. Both the clinical and endoscopic outcome were influenced by compliance. Irregular taking of cimetidine impaired results significantly (p less than 0.001 X2-test) and raised the frequency of rebouginage. These results show that 86% of cases with the most severe form of reflux oesophagitis were managed successfully by conservative therapy and that only the remaining few cases needed surgery.
Cimetidine↗
[Breast cancer in Austria: epidemiology and risk factors].
The incidence of breast cancer in Austria has been evaluated between 1971 and 1982. The incidence and mortality rates for this disease are comparable to the figures for Western Europe and the United States. A significant increase was observed in the overall incidence of breast cancer, which was, however, restricted to the age group before the 40th and after the 70th year of age. The incidence of breast cancer between 40 and 70 did not change significantly. The evaluation of high risk groups (first parity later than 30 years of age, nulliparity) showed decreasing incidence, whereas the frequency of women with early parity (earlier than 20 years of age)--representing a low-risk group--increased. Therefore, change of risk factors did not show any concordance with increasing breast cancer rate. Changes in diet in Austria over the past 30 years are discussed as a possible risk factor for increasing breast cancer rate.
Adult↗
Influence of anticoagulant treatment in preventing graft occlusion following saphenous vein bypass for femoropopliteal occlusive disease.
Seventy-one patients underwent a classical reversed saphenous vein graft for femoropopliteal occlusive disease and were enrolled in a controlled clinical trial. During the second postoperative week the patients were allocated randomly into one of two groups; group 1 consisted of 34 patients who received coumarin, group 2 (37 patients) served as a control group without any anticoagulant treatment. The mean follow-up was 18 months. After 12 months the cumulative patency rate was 81 per cent and after 18 months 75 per cent; for patients receiving coumarin treatment, the respective figures were 90 and 82 per cent and for those with no anticoagulant treatment 72 and 67 per cent, the decrease being significant. When the bypass operation was performed for limb salvage (clinical stages III and IV) the overall results were worse (12 months, 72 per cent; 18 months, 68 per cent) than in stage II and stage II-III (12 months, 90 per cent; 18 months, 85 per cent). In limb salvage surgery the positive effects of anticoagulant treatment were significant (with treatment: 12 months, 87 per cent; 18 months, 87 per cent; without treatment: 12 months, 60 per cent; 18 months, 53 per cent). The site of the distal anastomosis (above knee: 12 months, 81 per cent; 18 months, 73 per cent versus below knee: 12 months, 80 per cent; 18 months, 75 per cent) did not have any demonstrable influence on the patency rate.
Aged↗
Cyclosporin-A-induced hair growth in human renal allograft recipients and alopecia areata.
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Adolescent↗
Estrogen receptor analysis on biopsies and fine-needle aspirates from human breast carcinoma. Correlation of biochemical and immunohistochemical methods using monoclonal antireceptor antibodies.
Monoclonal antibodies against estrogen receptor (ER) were used for determination of ER status immunocytochemically in histologic specimens from 192 primary breast carcinomas. All tumors were also assayed biochemically for ER with the dextran-coated charcoal method (DCC). The comparison of biochemically and immunocytochemically determined ER status showed concordant results in 80% (P less than 0.0001). In only 2 cases (1%) with low ER levels (less than 20 fmol/mg protein) immunocytochemistry failed to detect ER. ER positivity determined with a semiquantified approach based on intensity and heterogeneity of immunocytochemical staining correlated significantly with biochemically determined ER levels (P = 0.0001). In a series of fine-needle aspirates of 34 breast carcinomas sufficient cell material was available for ER immunocytochemistry (ER-ICA). Overall, the results of ER-ICA in fine-needle aspirates were concordant with ER-ICA in histologic specimens in 88% of the samples. In a few cases with weak positivity of ER-ICA in histologic specimens, ER-ICA was negative in fine-needle aspirates. In no case was there a false-positive immunocytochemical ER determination in a tumor aspirate. Thus, ER-ICA seems to be a reliable assay which can be performed in histologic and cytologic specimens.
Antibodies, Monoclonal↗
[Comparison of immunohistochemical and biochemical analysis of estrogen receptors in breast carcinoma and correlations with the histological tumor classification].
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Antibodies, Monoclonal↗
Surgical treatment of distant metastases in differentiated thyroid cancer: indication and results.
A total of 45 patients have received surgical treatment for distant metastases in 41 follicular and four papillary carcinomas. Fifty-four metastatic lesions were removed. In the majority of cases (n = 25, 46%), surgical intervention was indicated on the basis of oncologic data (reduced administration of radioiodine). Sixteen patients (30%) underwent surgery to relieve pain, and 13 other patients (24%) had surgical treatment of pathologic fracture. At the time of surgery, 29 patients (64%) had only one resectable metastasis, while 16 patients (36%) had further nonresectable metastases (six in the bone, 10 in the bones and lungs). In the course of 53 operations, metastases were resected from bone in 46 cases, from the lungs and greater omentum in two cases, and from the skin, suprarenal gland, pleura, and intra-abdominal lymph node in one case each. A total of 25 metastases (17 bone, eight soft tissue) could be removed by resection. In 16 patients, the resulting bone defect was filled with bone cement after resection of the metastases. Osteosynthesis was necessary in another six cases, while seven required the implantation of an endoprosthesis. Thirty-eight patients died between 1 and 136 months after surgical treatment. Twenty-six (58%) died of their primary disease after an average 49.3 months, seven (15%) died with their carcinomas of other causes after an average of 12 months, and five (11%) died intercurrently after an average of 16 months. Seven patients (15%) are still alive after 12 to 264 months (average, 99.3 months); four of them are without recurrence and three have metastases. Five of these patients exhibit normal activity, while the activity of the other two is limited by the progress of the carcinoma or as a result of surgical treatment. The estimated cumulative survival rate (Kaplan-Meier) was 44.8 +/- 11.2% for 5 years and 32.7 +/- 11.0% for 10 years after removal of a solitary metastasis. Analysis of these patients shows that the surgical removal of resectable metastases can be a valuable complement to nuclear medical therapy. The complicated surgical treatment of metastases is justified by the favorable effect it has on prognosis and on the patient's quality of life.
Adenocarcinoma↗
[Incidence and regional distribution of colorectal cancers in Austria].
Based on data obtained from the official Austrian cancer registry, we evaluated the incidence of, and death rate from cancer of the colon and rectum. The increase in the incidence of colorectal cancer in Austria is comparable to that of other western industrial countries. There is an estimated rise in the annual figures of newly registered patients from 3174 in 1971 to 3981 cases in 1981. Regional distribution within Austria is not homogeneous: the highest risk of disease was observed in Vienna (60 new cases per year per 100000 inhabitants), the lowest in Tyrol with 40 new cases per 100000. The marked east-west slope in the incidence of colorectal cancer in Austria is a good basis for the investigation of pathogenetic factors.
Austria↗
Effect of adjuvant chemo- or immunotherapy on the prognosis of colorectal cancer operated for cure.
After radical surgery for colorectal cancer, 178 patients with a Dukes' B or C tumour were randomly assigned to one of three groups: A, controls (n = 62); B, chemotherapy (n = 59); C, immunotherapy (n = 57). Randomization criteria (age, sex, Dukes' stage, localization of tumour, operative procedure) were evenly distributed throughout the groups. After a median observation time of 30 months, statistical analyses were performed: survival and probability to be free of recurrence was described by Kaplan-Meier estimates of the survival function; for comparison of these survival functions, Breslow's test was used. Overall analyses show no benefit in the treatment group compared to controls. Separate analyses by Dukes' stages showed that in patients with Dukes' C tumours the probability of survival 40 months after surgery was 72 per cent in group C, 51 per cent in group B, and 33 per cent in group A. The differences between groups C and A, and B and A were statistically significant (P less than 0.02 and P less than 0.03 respectively). For a Dukes' C tumour the probability to be free of distant metastases at 30 months after surgery was 80 per cent in group B, 68 per cent in group C and 52 per cent in group A. Also for a Dukes' C tumour the probability to be free of liver metastases at 21 months after surgery was 83 per cent in group B, 81 per cent in group C, and 54 per cent in group A (significant differences: B-A and C-A P less than 0.04 for both). There was no influence on the estimated incidence of local recurrences for stage Dukes' C. Patients with a Dukes' B tumour did not benefit from either of the adjuvant therapy schemes.
Adjuvants, Immunologic↗
[Results of the first Austrian multicenter ovarian cancer study: prospective randomized comparison of sequential chemotherapy (adriamycin/cisplatin--vincristine/cyclophosphamide--methotrexate) with 2 standard protocols (adriamycin/cyclophosphamide or adriamycin/cisplatin) in stage III and IV patients].
From June 1980 to December 1982 164 patients with ovarian cancer stage III and IV were randomized into the three-legged Austrian Ovarian Cancer Study. A new polychemotherapy, known as the "changing-scheme" (adriamycin/cisplatinum--vincristine/cyclophosphamide--high dose methotrexate), developed in Vienna, was compared with adriamycin/cyclophosphamide and adriamycin/cisplatinum. The risk factors were stratified by means of special computer-assisted randomization. The first study evaluation in 1982 showed a significant advantage for the changing-scheme with regard to recurrence-free interval and survival (Mantel test: p less than 0.01, Breslow test: p less than 0.03). No difference was found between the combinations of adriamycin/cyclophosphamide and adriamycin/cisplatinum. At the second study evaluation in June 1984 the differences previously observed were no longe present to the same significant extent. The changing-scheme continued to be superior for the subgroups of patients with highly differentiated tumors, without ascites, with larger postoperative tumor burden and with liver metastases. The use of this therapy is be recommended for women with advanced ovarian cancer, especially in consideration of the much lower toxicity caused by the less frequent cisplatinum administrations as compared to the adriamycin/cisplatinum combination.
Antineoplastic Combined Chemotherapy Protocols↗
Simultaneous and sequential determinations of steroid hormone receptors in human breast cancer. Influence of intervening therapy.
Estrogen (ER), progesterone (PgR), and androgen (AR) receptors were measured in two simultaneous or subsequent specimens taken each from 259 patients with breast cancer. We studied in 182 patients results from receptor assays, either from one tumor or from the primary tumor, and a lymph node metastasis, and in 77 sequential biopsies with or without intervening therapy. All assays were performed in a single laboratory, considering 10 fmol/mg cytosol protein bound ligand as receptor positive. The concordance rate in simultaneous ER assays was 85%; however, we found a considerable high discordance rate for PgR in primary tumor and lymph node metastasis (25%). The overall discordance rate in sequential biopsies for ER was 38% and for PgR 25%. This discordance rate was primarily dependent on the receptor quality of the first assay (ER+: 50%, ER-: 24%, PgR+: 68%, PgR-: 9%). Considering only the ER+ and PgR+ cases, we found the greatest discordance rate in the patients having endocrine treatment following the first biopsy (55% and 84%, respectively). We conclude that the receptor status of one tumor biopsy is highly representative for other tumor or lymph node biopsies. Because of the high discordance rate of primarily receptor + cases in subsequent recurrences, the receptor quality of these lesions should be analyzed whenever possible.
Biopsy↗
Long-term treatment of peptic esophageal stenosis with dilatation and cimetidine: factors influencing clinical result.
Surgical treatment of severe peptic esophageal strictures is a serious problem in high-risk cases. Conservative treatment has to be considered as an alternative. In a prospective study, 33 patients were treated with dilatation of the stricture and a long-term medication with 4 X 400 mg cimetidine from 1977 to 1982. 28 patients were followed up for 6 months--6 years. 16 patients showed a good result (clinical stages I and II). 5 patients needed no further dilatation, but had significant symptoms (stage III). 4 patients had to be operated on because of serious symptoms and rapid restenosis. The clinical result was significantly less favorable in patients who took cimetidine irregularly or discontinued it (p less than 0.001) than in patients with good compliance. In addition, the result of endoscopy was poorer in poor compliance and the frequency of bougienage was greater than when cimetidine was taken regularly. Age, sex or initial length and diameter of the stricture did not significantly influence the outcome. We conclude that conservative treatment of peptic esophageal strictures yields good long-term results in 85% of patients, provided that a high dose of cimetidine is taken on a life-long basis.
Adult↗