| 1. |
|
|
| 2. |
- Hashemi, J, et al.
(författare)
-
Haplotype analysis and age estimation of the 113insR CDKN2A founder mutation in Swedish melanoma families.
- 2001
-
Ingår i: Genes, chromosomes & cancer. - : Wiley. - 1045-2257 .- 1098-2264. ; 31:2, s. 107-16
-
Tidskriftsartikel (refereegranskat)abstract
- Germline mutations in the CDKN2A tumor suppressor gene located on 9p21 have been linked to development of melanomas in some families. A germline 3-bp insertion in exon 2 of CDKN2A, leading to an extra arginine at codon 113 (113insR), has been identified in 17 Swedish melanoma families. Analysis of 10 microsatellite markers, spanning approximately 1 Mbp in the 9p21 region, showed that all families share a common allele for at least one of the markers closest to the CDKN2A gene, suggesting that the 113insR mutation is an ancestral founder mutation. Differences in the segregating haplotypes, due to meiotic recombinations and/or mutations in the short-tandem-repeat markers, were analyzed further to estimate the age of the mutation. Statistical analysis using a maximum likelihood approach indicated that the mutation arose 98 generations (90% confidence interval: 52-167 generations), or approximately 2,000 years, ago. Thus, 113insR would be expected to have a more widespread geographic distribution in European and North American regions with ancestral connections to Sweden. Alternatively, CDKN2A may lie in a recombination hot spot region, as suggested by the many meiotic recombinations in this narrow approximately 1-cM region on 9p21.
|
|
| 3. |
- Idvall, Ingrid, et al.
(författare)
-
Histopathological and cell biological factors of ductal carcinoma in situ before and after the introduction of mammographic screening
- 2001
-
Ingår i: Acta Oncologica. - : Informa UK Limited. - 1651-226X .- 0284-186X. ; 40:5, s. 653-659
-
Tidskriftsartikel (refereegranskat)abstract
- With the introduction of mammographic screening the incidence of ductal carcinoma in situ (DCIS) has increased to 10-15% of all breast cancers. The aim of this study was to investigate whether there were any morphological and cell biological differences between DCIS detected during the pre-screening (n = 39) as opposed to the screening period (n = 120). We could not demonstrate any statistically significant differences between the pre-screening and the screening period with regard to nuclear grade, presence of necrosis, the Van Nuys classification system, growth pattern, or cell biological factors (estrogen and progesterone receptors, c-erbB-2, p53, DNA ploidy status, Ki67, and Auer classes). These findings suggest that DCIS tumors detected during the two time periods have a similar malignant potential. DCIS detected during the screening period was further divided into the prevalence period versus the period thereafter, and symptomatic versus screening-detected asymptomatic cases. More cases with diffuse growth patterns were seen during the prevalence period than after the prevalence period, and screening-detected asymptomatic DCISs were more often 15 mm or smaller in diameter than DCISs detected symptomatically.
|
|
| 4. |
- Ingvar, Christian
(författare)
-
Papillary secretion. Diagnostic assessment and treatment.
- 2002
-
Ingår i: Scandinavian Journal of Surgery. - 1799-7267. ; 91:3, s. 50-246
-
Tidskriftsartikel (refereegranskat)abstract
- Papillary secretion is a common symptom in the breast clinic with many different underlying causes like intraductal papilloma, mammary duct ectasia, infected cysts and abscesses, breast cancer/carcinoma in situ (CIS) and rarely pituitary adenoma. The association with cancer/CIS is one of the two main concerns of the patient and must always be ruled out. The second item is that spontaneous and ongoing discharge causes embarrassment due to staining the clothes. Physical examination of the breast, imaging with mammography and ultrasonography should always be done and fine needle biopsy/core biopsy used with wide indications whenever there is any abnormal finding. With the use of modern ultrasonography in the combination with guided biopsy the use for ductography has diminished and might be saved for single duct investigations, especially if papilloma or single duct involvement is suspected. Surgery (when undertaken) due to benign discharge, should aim for radical excision of the underlying cause of the discharge sometimes only a dilated single duct with or without a papilloma or excision of the central ducts as in case of mammary duct ectasia. Discharge should be consistent, spontaneous and disturbing otherwise surgery should not be recommended in the absence of a suspicion of malignancy (negative triple test).
|
|
| 5. |
- Johansson, Arne, et al.
(författare)
-
Preoperative ropivacaine infiltration in breast surgery
- 2000
-
Ingår i: Acta Anaesthesiologica Scandinavica. - : Wiley. - 0001-5172. ; 44:9, s. 1093-1098
-
Tidskriftsartikel (refereegranskat)abstract
- Purpose: The aim of the study was to investigate whether preoperative infiltration with ropivacaine in conjunction with breast surgery improves postoperative pain management and attenuates postoperative nausea and vomiting. Method: Prospective, randomised, double-blind study, including 60 healthy women (ASA 1–2) allocated to one of two groups. Thirty patients were given 0.3 ml/kg saline in the operating field before surgery. Another 30 patients received a similar volume of ropivacaine 3.75 mg/ml. A visual analogue scale (0–100 mm) was used for evaluation of postoperative pain, nausea and vomiting. If the score was more than 30 mm at rest, the patients were given ketobemidone i.v. as treatment for postoperative pain, and dixyrazine i.v. against nausea and vomiting. The intra- and postoperative analgesic requirements and postoperative nausea and vomiting were registered. Results: The intraoperative fentanyl consumption was similar in the saline group 81±22 μg vs 76±28 μg; (ns) in the ropivacaine group. The postoperative 24-h ketobemidone consumption was also similar to those treated with ropivacaine (4.2±2.6 mg vs 4.2±4.3 mg; ns). Postoperative nausea and vomiting (PONV) occurred with similar frequencies in both groups. The 24-h dixyrazine consumption was the same in the two groups (2.1±2.7 mg in the saline group compared to 2.4±2.8 mg in the ropivacaine group; ns). After 6 h recovery, 41% of all patients had experienced nausea and 20% vomiting. Conclusion: We found no differences in postoperative pain management between 3.75 mg/ml ropivacaine and saline wound infiltration before breast surgery. The data show similar postoperative needs of analgesics and antiemetics with a similar frequency of PONV.
|
|
| 6. |
- Johansson, Anders, et al.
(författare)
-
Wound infiltration with ropivacaine and fentanyl: Effects on postoperative pain and PONV after breast surgery
- 2003
-
Ingår i: Journal of Clinical Anesthesia. - 1873-4529. ; 15:2, s. 113-118
-
Tidskriftsartikel (refereegranskat)abstract
- Study Objective: To determine whether Postoperative wound infiltration with local anesthetics combined with fentanyl improves analgesia following breast surgery; and to investigate awakening and Postoperative nausea/vomiting. Design: Prospectively randomized clinical study. Setting: University hospital. Patients: 45 ASA physical status I and II patients scheduled for breast surgery. Interventions: Patients were prospectively randomized and assigned to one of three treatments during general anesthesia: postsurgical wound infiltration with ropivacaine 0.375%; wound infiltration with ropivacaine 0.375% combined with fentanyl 0.5 mug/kg; and intravenous (IV) fentanyl 0.5 mug/kg before skin incision and no wound infiltration. Time to first verbal response, Pain at rest, Postoperative nausea and vomiting, and ketobemidone and dixyrazine utilization were compared. Measurements and Main Results: Time to first verbal response was significantly shorter in the IV fentanyl group compared to both infiltration groups (8.1 +/- 4.5 min vs. 15.3 +/- 4.3, and 12.0 +/- 5.0 min; p < 0.05, respectively). Postoperative Pain at rest, and nausea and vomiting occurred with similar frequencies in the groups. Ketobemidone utilization in both infiltration groups, (2.4 +/- 1.8 mg and 3.1 +/- 1.8 mg, respectively) was not different compared to the IV fentanyl group (2.9 +/- 2.0 mg; NS). There were no differences in Postoperative antiemetic requirements during the first, second and third two-hour periods postoperatively. The dixyrazine consumption was similar in the three groups, (0.9 +/- 1.5 mg, 0.8 +/- 1.3 mg, and 1.4 +/- 1.8 mg, respectively; NS). Conclusion: Postsurgical ropivacaine wound infiltration, with or without adding fentanyl, demonstrates no differences in postoperative Pain relief and nausea/vomiting compared to a balanced general anesthetic including IV fentanyl. (C) 2003 by Elsevier Science Inc.
|
|
| 7. |
- Johansson, Karin, et al.
(författare)
-
Arm Lymphoedema, Shoulder Mobility and Muscle Strength after Breast Cancer Treatment ? A Prospective 2-year Study
- 2001
-
Ingår i: Advances in Physiotherapy. - : Informa UK Limited. - 1651-1948 .- 1403-8196. ; 3:2, s. 55-66
-
Tidskriftsartikel (refereegranskat)abstract
- Arm lymphoedema and impaired shoulder mobility and muscle strength are well known side-effects to breast cancer treatment. The aim of this prospective study was to follow closely and describe the arm volume, range of motion of the shoulder and muscle strength of the shoulder and hand after breast cancer treatment in order to form a basis for further studies in the area including physiotherapy intervention. Sixty-one women treated for breast cancer with axillary dissection, with or without postoperative radiotherapy, were examined preoperatively and monthly until 6 months after the operation with 1- and 2-year follow-ups. 1 month after the operation, results revealed decrease in range of motion, after 2 months increase in arm volume difference and after the first 6 months decrease in muscle strength of shoulder adductors, flexors and internal rotators. A greater increase in arm volume difference and decrease in shoulder abduction, flexion and external rotation were noted throughout the follow-up period for the group receiving radiotherapy to the axdefinition illa area. Postoperative physiotherapeutic management needs to pay special attention to early impairments after breast cancer treatment particularly to the group receiving radiotherapy to the axilla area. Physiotherapeutic treatment might be introduced during the period when radiotherapy is being given.
|
|
| 8. |
- Johansson, Karin, et al.
(författare)
-
Factors associated with the development of arm lymphedema following breast cancer treatment: a match pair case-control study.
- 2002
-
Ingår i: Lymphology. - 0024-7766. ; 35:2, s. 59-71
-
Tidskriftsartikel (refereegranskat)abstract
- We examinedfactors that may influence the development of arm lymphedema following breast cancer treatment including the specific mode of therapy, patient occupation and life style. Medical record data and a questionnaire were used to collect information after surgery concerning such issues as wound seroma, infection, adjuvant treatment, vessel string (phlebitis), body mass index, smoking habits and stress. Occupational workload was assessed after surgery whereas housework, exercise, hobbies and body weight were assessed both before and after surgery. Seventy-one breast cancer treated women with arm lymphedema lasting more than 6 months but less than 2 years were matched to women similarly treatedfor breast cancer but without arm lymphedema (controls). The matching factors included axillary node status, time after axillary dissection, and age. In the lymphedema group, there was a higher body mass index at time of surgery (p=0.03) as well at time of study (p=0.04). No differences were found in occupational workload (n=38) or housework, but the lymphedema group reduced their spare time activities including exercise after surgery compared with the controls (p<0.01). In conclusion, women treated for breast cancer with axillary node dissection with or without adjuvant radiotherapy could maintain their level of physical activity and occupational workload after treatment without an added risk of developing arm lymphedema. On the other hand, a higher BMI before and after operation increases the lymphedema risk.
|
|
| 9. |
- Lindholm, Christer, et al.
(författare)
-
Invasive cutaneous malignant melanoma in Sweden, 1990-1999. A prospective, population-based study of survival and prognostic factors.
- 2004
-
Ingår i: Cancer. - : Wiley. - 0008-543X .- 1097-0142. ; 101:9, s. 2067-78
-
Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The objective of the current study was to compile prospective, population-based data on cutaneous invasive melanomas in Sweden during the period from 1990 to 1999, to describe and analyze survival data and prognostic factors, and to make comparisons with previously published Swedish and international data. METHODS: Twelve thousand five hundred thirty-three patients, which included 97% of all registered melanomas in Sweden, were included and described. Among these, 9515 patients with clinical Stage I and II melanoma were included in an analysis of survival and in a univariate analysis, and 6191 patients were included in a multivariate analysis of prognostic factors. RESULTS: There was no significant change in melanoma incidence during 1990-1999. Favorable prognostic factors were found, especially in younger and female patients, resulting in a relative 5-year survival rate of 91.5%. In the multivariate analysis, significant factors that had a negative effect on survival were Clark level of invasion, Breslow thickness, ulceration, older patient age, trunk location, greatest tumor dimension, nodular histogenetic type, and male gender. CONCLUSIONS: During the period from 1990 to 1999, the 5-year survival of patients with malignant melanoma in Sweden was better compared with the previously reported rates in published, population-based studies from Sweden, probably as a result of better secondary prevention due to better knowledge and awareness by both patients and the medical profession. The more favorable prognostic factors and the change in melanoma location found in younger patients, compared with earlier reports, may reflect changes in clothing as well as tanning habits; however, a decrease also was found in Clark Level II and thin melanomas for the same patient group. The authors concluded that further improvements can be achieved with better access to health care and with the use of early melanoma detection campaigns.
|
|
| 10. |
- Malmström, Per, et al.
(författare)
-
Breast conservation surgery, with and without radiotherapy, in women with lymph node-negative breast cancer: a randomised clinical trial in a population with access to public mammography screening.
- 2003
-
Ingår i: European journal of cancer (Oxford, England : 1990). - 0959-8049. ; 39, s. 1690-
-
Tidskriftsartikel (refereegranskat)abstract
- The effect of postoperative radiotherapy after sector resection for stage I-II lymph node-negative breast cancer was evaluated in a patient population with access to public mammographical screening. 1187 women were randomised to no further treatment or postoperative radiotherapy following a standardised sector resection and axillary dissection. Radiation was administered to a dose of 48-54 Gy. Median age was 60 years, and median size of the detected tumours was 12 mm. Of the women 65% had their tumours detected by mammographical screening. The relative risk (RR) of ipsilateral breast recurrence was significantly higher in the non-irradiated patients compared with the irradiated patients, RR=3.33 (95% Confidence Interval (CI) 2.13-5.19, P<0.001). The corresponding cumulative incidence at 5 years was 14% versus 4%, respectively. Overall survival (OS) was similar, RR=1.16 (95% CI 0.81-1.65, P=0.41), with 5 year probabilities of 93 and 94%, respectively. Recurrence-free survival (RFS) at 5 years was significantly lower in the non-irradiated women, 77% versus 88% (P<0.001). Although women above 49 years of age, whose tumours were detected with mammographical screening, had the lowest rate of ipsilateral breast recurrence in this study, the cumulative incidence of such event amounted to 10% at 5 years if radiotherapy was not given. Such a recurrence rate has been considered as unacceptably high, but is, however, in the same range as that reported after lumpectomy and postoperative radiotherapy in published series.
|
|
