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Biomedical subjects

A Gad

Publications and source records attributed to A Gad.

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

Pathology of the Achilles tendon in association with ciprofloxacin treatment.

Achilles tendon pain or rupture after fluoroquionolone treatment has been described as an uncommon adverse effect. We report two patients with ciprofloxacin-associated Achilles tendon disease, one with histopathological examination. Microscopic evaluation showed irregular collagen fiber arrangement, hypercellularity, and increased interfibrillar glycosaminoglycans. These pathological features are also seen in tendon overuse injuries in athletes.

Achilles Tendon↗
PubMed1997

Accurate detection of Helicobacter pylori infection with a simplified 13C urea breath test.

The urea breath test (UBT) has been shown to be a reliable non-invasive method for detection of H. pylori infection. There is widespread use of a test meal in the 13C UBT, but to what extent exclusion of the test meal actually influences the accuracy of the test has been poorly investigated. In addition, there is variability between test protocols in breath sampling frequency. In this evaluation, 91 patients with dyspeptic symptoms were investigated in an out-patient endoscopy ward, using a simplified 13C UBT without a test meal, and a single point breath evaluation after ingestion of 13C-labelled urea. Helicobacter pylori infection was diagnosed on upper endoscopy by histology and rapid urease tests on biopsies from the antrum and corpus mucosa of the stomach. Fifty-four percent of the patients had H. pylori infection. With the chosen cut-off level, the sensitivity and specificity of the 13C UBT were 92% and 95%, respectively. We conclude that this simplified 13C UBT is easy to perform and a very reliable test for detecting H. pylori infection, making it a suitable test in routine clinical work.

Adult↗
PubMed1997

Demonstration of Chlamydia pneumoniae in patients with chronic pharyngitis.

12 patients with longstanding throat symptoms, who were also positive by PCR (polymerase chain reaction) for Chlamydia pneumoniae were selected for a longitudinal study to determine whether C. pneumoniae is an aetiological agent for chronic pharyngitis. Specimens for culture and PCR detection of C. pneumoniae were taken from the retropharyngeal wall and blood specimens were taken for serology. Biopsies were taken from the mucosal membrane of the retropharyngeal wall for histological and immunohistochemical studies. C. pneumoniae was cultured from 4 cases. 10 patients had specific humoral antibodies to C. pneumoniae and 9 had high and increasing specific antibody titres to C. pneumoniae suggesting ongoing infection. The organism was demonstrated in the tissue from the retropharyngeal mucosal membrane by immunohistochemistry in 9 patients. The findings suggest that C. pneumoniae may be an aetiological agent for chronic pharyngitis.

Adolescent↗
PubMed1997

Tendon pathology in long-standing achillodynia. Biopsy findings in 40 patients.

We evaluated biopsy specimens from the Achilles tendon in 40 patients with long-standing achillodynia and an ultrasonographic widened tendon with hypoechogenic areas. We used a standardized protocol to assess the general tendon pathology score of paraffin-embedded specimens stained with HE. Stereologic measurement of the volume density of glycosaminoglycan (GAG)-rich areas, stained with the Alcian blue (pH 2.5)/periodic acid Schiff method (AB/PAS) was performed. 14 specimens obtained at autopsy served as reference material. Abnormal fiber structure and arrangement, focal variations in cellularity, rounded nuclei, decreased collagen stainability and increased non-collagenous extracellular matrix were seen in all biopsy specimens. Slight histopathological changes were noted in half of the controls. Increased vascularity was present in two thirds of the patient specimens and in one third of the controls, and signs of perivascular hemorrhage, as evidenced by hemosiderin deposition in 6/40 of the patients, but in none of the controls. The volume density of GAG-rich areas was higher in the patients 0.47 (0-0.86) than in the controls 0 (0-0.07). Changes in the fiber structure and arrangement, as well as increased amounts of interfibrillar GAG, appear to be characteristic morphological features in Achilles tendons with long-standing achillodynia and ultrasonographic widening. These findings may indicate that achillodynia is due to local disturbances in connective tissue metabolism or circulation or to both.

Achilles Tendon↗
PubMed1996

Tumour development, histology and grade of breast cancers: prognosis and progression.

Using 1,973 breast tumours from women aged 40-69 participating in the Swedish two-county trial of mammographic screening for breast cancer, we examined the effect of histological type on prognosis and sojourn time (the duration of the preclinical screen-detectable phase) by age. The hypothesis of dedifferentiation, according to which a cancer of mixed malignancy grade drifts towards grade 3 as the more poorly differentiated part of the tumour grows faster than the well-differentiated part, was also assessed. Ductal carcinoma in situ, invasive ductal carcinoma of grade 1, mucinous carcinoma and tubular carcinoma were all associated with good survival. Ductal carcinoma of grade 3 was associated with poor survival. Ductal carcinoma of grade 2, lobular and medullary carcinoma were associated with intermediate survival. These patterns were much the same in women aged 40-49 as in women aged 50-69. In women aged 40-49, sojourn time was estimated at about 2 years regardless of histological type. For women aged 50-69, there was a marked association of sojourn time with histological type, the shortest sojourn time being observed for lobular (2 years) and medullary (1.2 years) carcinoma, and the longest for ductal carcinoma grade 1 (7.7 years) and tubular carcinoma (7.1 years). There was strong evidence of a potential to dedifferentiation. A mover-stayer mixture of Markov chain models estimated that, in women aged 40-54, 91% of ductal tumours have the potential to dedifferentiate and, in women aged 55-69, 38% of ductal tumours have such a potential.

Adult↗
PubMed1996

Adenocarcinoid of the liver arising within an area of hamartoma with predominant bile duct component.

Malignant transformation in bile duct hamartomas has been previously reported in very rare instances. Here, we describe a unique case of a neuroendocrine tumor of the liver arising within an area of unusually large hamartoma with predominant bile duct component, hitherto unreported and distinct from the conventional von Meyenburg complex. The tumor was apparently secreting gastrin and chromogranin, with associated gastrinoma syndrome over several years. The histologic picture was reminiscent of a moderately differentiated adenocarcinoid, with positive mucin staining in a signet ring pattern. Tumor cells showed positive staining for neuron-specific enolase, chromogranin A, gastrin, and serotonin. Staining for pancreatic hormone peptides was negative. Resection of the tumor was apparently curative, with complete resolution of the patient's symptoms.

Bile Duct Diseases↗
PubMed1995

Efficacy of breast cancer screening by age. New results from the Swedish Two-County Trial.

BACKGROUND: Several studies have found a smaller effect of breast cancer screening on breast cancer mortality in women aged younger than 50 years compared with older women. Various possible reasons have been suggested for this, but none firmly is established. METHODS: The Swedish Two-County Study is a randomized trial of breast cancer screening of women aged 40-74 years, comprising with 133,065 women with a 13-year follow-up of 2467 cancers. The Breast Cancer Detection Demonstration Project (BCDDP) is a nonrandomized screening program in the United States, with a 14-year follow-up of 3778 cancers in women aged 40-74 years. The Swedish results by age were updated. The lesser effect of screening at ages 40-49 years was investigated in terms of sojourn time (the duration of the preclinical but detectable phase) size, lymph node status, and histologic type of the tumors diagnosed in the Swedish Study and their subsequent effect on survival using survival data from both studies. RESULTS: In the Swedish Trial, a 30% reduction in mortality associated with the invitation to screening of women aged 40-74 years was maintained after 13-years of follow-up. The reduction was 34% for women aged 50-74 years and 13% for women aged 40-49 years. Results indicated that the reduced effect on mortality for women aged 40-49 years was due to a differential effect of screening on the prognostic factors of tumor size, lymph node status, and histologic type. The mean sojourn times in the age groups 40-49 years, 50-59 years, 60-69 years, and 70-74 years were 1.7, 3.3, 3.8, and 2.6 years, respectively. CONCLUSIONS: These results suggest that much, although not all, of the smaller effect of screening on mortality in women aged 40-49 years is due to faster progression of a substantial proportion of tumors in this age group and the rapid increase in incidence during this decade of life. It is concluded that the interval between screenings should be shortened to achieve a greater benefit in this age group. It is estimated that a 19% reduction in mortality would result from an annual screening regime.

Adult↗
PubMed1995

Steady-state kinetics of fluoxetine and amitriptyline in patients treated with a combination of these drugs as compared with those treated with amitriptyline alone.

The steady-state kinetics of amitriptyline (AMI), fluoxetine (FLU), and their active metabolites nortriptyline (NTRIP) and norfluoxetine (NFLU) were studied in 15 patients treated once daily for long durations with 50 mg of AMI and 20 mg of FLU. These compounds were analyzed simultaneously in plasma by liquid chromatography. The means and (SEM) of the steady-state concentrations (Css) of AMI, NTRIP, FLU, and NFLU were 80.6 (14.2), 52.6 (10.3), 85.3 (16.1), and 90 (13.6) ng/mL, respectively, and the apparent oral clearances (CLor) of AMI and FLU were 42.4 (8.6) and 14.9 (2.5) L/hr, respectively. The metabolite/drug steady-state concentration ratio (Css(m)/Css) for NTRIP/AMI was 0.75 (0.14) and for NFLU/FLU was 1.27 (0.17). There was a significant correlation (P < 0.05) between Css of FLU and that of AMI or NTRIP. The Css and Css(m)/Css values obtained for AMI were higher (P < 0.056 and P < 0.0034, respectively) than those we observed in 10 patients treated solely with the same dose of AMI. The twofold increase in Css of AMI and ninefold increase in Css of NTRIP seem to be the result of inhibition of the metabolism of these compounds by FLU, particularly the ring hydroxylation. Norfluoxetine may have a small inhibitory influence on the metabolism of NTRIP but lacks this effect on the metabolism of AMI.

Adolescent↗
PubMed1995

Screening for breast cancer in women aged under 50: mode of detection, incidence, fatality, and histology.

OBJECTIVE: To assess the effect of screening for breast cancer in women aged 40-49 in the Swedish two county trial, in terms of mortality reduction, advanced cancer reduction, mode of detection, and the histology of tumours detected. SETTING: The Swedish two county trial of screening for breast cancer, in which 77,080 women aged 40-74 (19,844 aged 40-49) were randomly allocated to receive regular invitation to mammographic screening for breast cancer, and 55,985 women aged 40-74 (15,604 aged 40-49) were allocated to an unscreened control group. METHODS: The screening interval in the younger age group was two years and in the older age group about three years. Statistical analysis of mortality and incidence rates was performed by Poisson regression. Relative survival was estimated using proportional hazards regression. RESULTS: The relative mortality for the group invited to screening compared with the control group was 0.87 (95% confidence interval 0.54 to 1.41) in the 40-49 age group, in close agreement with the relative incidence of advanced cancers. For Kopparberg county the relative mortality was 0.73 (95% CI 0.37 to 1.41) and for Ostergotland 1.02 (95% CI 0.52 to 1.99). The lesser effect in the 40-49 group as a whole was largely due to a higher rate of interval cancers in this age group, and the occurrence in Ostergotland of a higher number of cancers after randomisation, but before screening started, and in women who refused screening. The higher interval cancer rate was consistent with the higher proportion of ductal grade 3 and medullary cancers in women aged 40-49 at diagnosis. CONCLUSIONS: A major difficulty in screening women aged 40-49 is the rapid progression of a subset of tumours arising in this age group. Shortening the screening interval from two years would be necessary to achieve a higher mortality reduction.

Adult↗
PubMed1995

Human fascioliasis in an Egyptian village: prevalence and some epidemiological determinants.

A cross-sectional survey was conducted in Abis area, 15 kilometers south east of Alexandria city, to determine the prevalence of human fascioliasis and to study some of the epidemiological determinants which may affect the infection. A specially designed questionnaire interview was completed, and a total number of 3475 stool samples were examined. The results revealed a prevalence rate of fascioliasis of 11% in the studied area which was only second to S. mansoni. The prevalence of infection was significantly higher among females in general and specifically in the age group 5 to less than 15 years and 25 to less than 35 years. Family aggregation of fasciola infection was noticed among the studied group. The prevalence and also the risk of infection were significantly higher among children whose mothers were infected. They were, however, insignificantly higher among illiterate, single males, and low social class group. In addition, the prevalence and risk of infection were significantly higher among individuals obtaining their raw green leafy vegetables from multiple sources. From the results it was concluded that human fascioliasis is an important public health problem in Abis area with increased risk of spread of infection to Alexandria city through raw green leafy vegetables which represent the main source of infection.

Adolescent↗
PubMed1994

Antibacterial therapy of Helicobacter pylori-associated peptic ulcer disease: a new strategy. The Swedes go for it.

A consensus meeting was held in Stockholm on Oct. 9, 1993, after consultations with the Swedish Association of Gastroenterology and Gastrointestinal Endoscopy. The meeting was attended by 35 physicians with a special interest in Helicobacter pylori-associated diseases representing the following medical disciplines: gastroenterology, surgery, internal medicine, histopathology, microbiology, immunology, infectious diseases, clinical physiology, and cancer epidemiology. The aims of the meeting were to define and recommend methods of diagnosis, indications for anti-H. pylori therapy, alternatives for treatment regimens, principles of follow-up observation, and suitable measures of quality control. The participants agreed to recommend anti-H. pylori therapy only for the treatment of H. pylori-associated gastric and duodenal ulcer disease. A combination of amoxicillin, 1,000 mg b.i.d., plus omeprazole, 20 mg b.i.d. for 2 weeks was considered the first-line treatment. Second-line options are not specified, but amoxicillin plus a higher-dose omeprazole, clarithromycin plus omeprazole, or various triple regimens were discussed.

Humans↗
PubMed1993

Behavior of cervical intraepithelial neoplasia (CIN) associated with various human papillomavirus (HPV) types.

201 cervical punch biopsies which showed CIN lesions and were obtained between 1967 to 1977 from Falu Hospital patients, with long-term follow-up data were examined histologically and by DNA typing for human papillomavirus (HPV). We used in situ hybridization for HPV types 6, 11, 16, 18, 31 and 33 and related our findings to the behaviour of the lesion (103 regressed spontaneously and 98 progressed, some of them to invasive cervical carcinoma). There was evidence of HPV infection in 75.6% (152/201) of these lesions on histological examination, and in 53.2% (107/201) on in situ DNA hybridization. Lesions positive for HPV by both methods occurred in the younger age group (Pearson's correlation coefficient, P = 0.008). HPV 16 was found in 51/152 (33.6%) of the HPV lesions, HPV in 12.5%, and HPV 33 in 8.5% HPV 16 was highly significantly (P = 0.0001), and HPV 18 and HPV 33 were significantly (P = 0.008 and P = 0.007, respectively) associated with increasing grades of CIN. Progression to invasive carcinoma was directly (and regression inversely) correlated with the severity of CIN in the first biopsy (P = 0.005). Almost 74% (17/23) of the HPV-CIN III lesions progressed, while only 25% of the HPV-NCIN lesions (6/24) did so. The progression rate was 84.6% for HPV 33 lesions and 52.9% for HPV 16. On the other hand, progression was less common with HPV 6 (25%), and HPV 31 (30.0%). Histological grade and HPV type appear to be of value as prognostic indices.

Adolescent↗
PubMed1992

[Endoscopic surgery in a gynecologic outpatient clinic].

From 1988 to 1989, we operated on 784 women in our daily ambulant clinic. In 462 of these cases, we performed laparoscopic surgery with 679 therapeutical interventions. Sterilisation is the most frequent operation in our cases of Fallopian tube surgery, but we have also had tubal pregnancy in 5 cases. In ovarian surgery, we found a great number of benign ovarian cysts followed by a high rate of ovarian adhesions, which, counted together with the Fallopian tube and intestinal adhesions, amounted to 201 cases. In 9 women, the extirpation of a myoma was necessary and the largest one was 5.5 cm in diameter. In comparison with the total number of our surgical interventions, we had a high rate of appendectomies. Each surgeon is aware of the various locations of the appendix, of its close relation to the adnexae and the difficulty of clinical diagnosis of appendicitis in women, especially in pregnant women. We removed the appendix in two pregnant women (4th and 18th week of pregnancy). A pathological substrate was found in more than 80%. Because of a good preliminary selection of our patients, we found no carcinoma in the abdominal cavity, except from an early metastasis on the appendix of an ovarian carcinoma. This patient came for staging re-laparoscopy after treatment of the ovarian carcinoma years ago. Since the beginning of 1989, we have used a Neodym: Yag laser in endoscopic operations. The good cutting effect loses its benefits of precision and time saving through bleeding as soon as a large vessel is involved.(ABSTRACT TRUNCATED AT 250 WORDS)

Ambulatory Surgical Procedures↗
PubMed1992

Update of the Swedish two-county program of mammographic screening for breast cancer.

The results of the Swedish two-county trial of mammographic screening for breast cancer are presented, updated to December 31, 1990, which is an average of 10.8 years follow-up per person. The main result of the trial in terms of breast cancer mortality remained the same: compared with the control group, the group invited to screening had a relative breast cancer mortality of 0.70 (P = 0.0002) with 95% confidence interval (0.58, 0.85). Analysis of survival showed that relative to the control group, the cancers detected at prevalence screen, incidence screens, and in the interval between screens had a good prognosis, whereas cancers detected in those who had refused screening had a very poor prognosis. When adjusted for tumor size, lymph node status, and tumor grade (differentiation), the better survival associated with incidence screen and interval detection was largely accounted for, indicating that the benefit of incidence screening is largely achieved through the effect of screening on the three prognostic variables, notably size of the tumor. Results indicate that to achieve a substantial mortality reduction, 50% of screen-detected invasive cancers should be less than 15 mm in diameter, at least 30% of screen-detected grade 3 tumors should be less than 15 mm, and at least 70% of screen-detected tumors should not have lymph node metastases. The percentage of grade 3 tumors of a given size should be the same in screen-detected cancers as in clinically detected, and breast cancer prevalence at first screen should be at least three times the expected incidence rate in the absence of screening. This should be achieved without the recall rate for further examination exceeding 9%, and procedures including further imaging techniques and fine needle aspiration or core biopsy should be used before resorting to surgical biopsy. These aims can be achieved in specialist screening centers if particular attention is paid to resources for screening and diagnostic evaluation, specialist training of clinical and technologic screening staff, and ongoing monitoring of mammographic quality, recall rates, and the attributes of the tumors detected.

Adult↗