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Biomedical subjects

B Andreasson

Publications and source records attributed to B Andreasson.

At least 37 records · Page 2Linked to original sources
PubMed1993

The significance of histology and morphometry in predicting lymph node metastases in patients with squamous cell carcinoma of the vulva.

The material consists of a series of 73 patients with squamous cell carcinoma of the vulva. The site and the size of the primary tumor and the histological status of the lymph nodes of the groin were known. Two pathologists evaluated nuclear hyperchromatism, nuclear polymorphism, histological differentiation, number of mitoses, inflammatory response, and vascular invasion and graded these parameters from one to three. The reliability of the histopathological grades evaluated by the kappa coefficient showed considerable interobserver variation. Despite this a model which included the subjective parameter nuclear hyperchromatism could predict patients without lymph node metastases. The model consisted of patients with tumors which were not situated on the clitoris, were less than 40 mm in diameter, and exhibited only slight hyperchromatism. The model fitted 19 (26%) and 14 (19%) of the patients with two different pathologists evaluating the nuclear hyperchromatism and none of these patients had lymph node metastases. The quantitative parameter--mean nuclear volume--determined by morphometry was of no diagnostic value for the prediction of patients without groin node metastases at the time of operation.

Adult↗
PubMed1992

Sexual function and somatopsychic reactions after local excision of vulvar intra-epithelial neoplasia.

Eighteen patients, under the age of 60 years, who have been treated with local excision of the vulva, participated in the study in which sexual function and somatopsychic reactions were evaluated by personal interviews. Furthermore both objective and subjective cosmetic results were registered. After this type of operation, fewer than one-third of the patients had postoperative sexual and somatopsychic problems, whereas more than half of the patients undergoing vulvectomy did report such problems. Fourteen out of 18 patients were satisfied with the cosmetic result and in 12 of the patients no disfiguration was found. This study shows that local excision of intra-epithelial neoplasia of the vulva is far less sexually traumatic than is vulvectomy.

Adult↗
PubMed1992

Induction of labor by vaginal prostaglandin E2. A randomized study comparing pessaries with vaginal tablets.

A prospective randomized study of 267 pregnant women was undertaken to compare the efficacy of a pharmacy-prepared 3-mg prostaglandin E2 (PGE2) vaginal suppository with a 3-mg PGE2 vaginal tablet for induction of labor and cervical ripening. No statistically significant difference in success frequency was found between the two groups, either on the first day (72% and 74%, respectively; p greater than 0.05) or on the second day (89% in both groups). There was an equal proportion of women requiring oxytocin augmentation in the two groups, but the slower releasing properties of the vaginal tablet were reflected in a longer mean induction--delivery interval of about 4 h for this group. In both the pessary and the vaginal tablet groups, women who had not gone into labor on the first day showed a statistically significant increment in the Bishop score on the morning of the second day. The frequency of cesarean section was the same in both groups, but instrumental deliveries were more frequent in the vaginal tablet group. It is concluded that PGE2 vaginal tablets--a chemically stable alternative to pharmacy prepared pessaries--appear to be effective as regards cervical ripening as well as for labor induction.

Administration, Intravaginal↗
PubMed1991

[Difficulties in early differential diagnosis of intra/extrauterine pregnancy].

Employing the new very sensitive pregnancy tests, pregnancy can be confirmed several weeks before it can be visualized by ultrasonic scanning or can be seen at laparoscopy or laparotomy. This involves the risk that unnecessary diagnostic interventions are performed in early pregnancy with symptoms suggestive of extrauterine pregnancy. Three case reports are quoted to illustrate the problems involved.

Adult↗
PubMed1991

[Treatment of cervix cancer in Denmark].

The current status of cervical cancer treatment in Denmark is discussed. Diagnostic aspects and problems of classification are presented briefly supplemented with a comment on new prognostic parameters based on a semiquantitative score system and flow cytometry. Surgery is the treatment of election for the early stages whereas radiotherapy is the treatment of choice in advanced stages. Chemotherapy should only be employed in the framework of clinical trials. It is concluded that centralised treatment should be maintained.

Denmark↗
PubMed1991

Laser and cryo surgery for cervical intraepithelial neoplasia. A randomized trial with longterm follow-up.

In a randomized study, 204 patients with exocervical intra-epithelial neoplasia were allocated to either laser evaporation (103) or cryocoagulation (101). The patients were treated on an outpatient basis without anesthesia. In the case of initial treatment failure the same method was to be used for retreatment. One hundred and eighty-seven patients were followed-up for an average of 50 months (12-80). Eighty-six of 94 laser-evaporated patients (91%) and 89 of 93 cryocoagulated patients (96%) were cured after one treatment. Five of 8 laser failures and 3 of 4 cryo failures were cured by retreatment. The cure rate after one or two laser evaporations was 97% (91 of 94 patients), and after one or two cryo coagulations, 99% (92 of 93 patients). Eighty per cent of residual or recurrent neoplasia occurred within 15 months and 96% within 2 years of treatment. No invasive neoplasia occurred during the follow-up period and no tendency was seen towards higher grades of intra-epithelial neoplasia in the failures compared with the initial diagnoses. It is concluded that laser evaporation and cryocoagulation are equally effective for the treatment of exocervical intra-epithelial neoplasia.

Cryosurgery↗
PubMed1990

Value of four models for selecting patients for local excision of invasive squamous cell carcinoma of the vulva.

For 75 women with squamous cell carcinoma of the vulva who underwent radical vulvectomy and inguinofemoral lymphadenectomy, the authors assessed the efficacy of four models for selecting patients who could have been treated adequately with local excision of the tumor. Each of the three models proposed by Andreasson and Nyboe covered 25% of the patients, none of whom had groin metastases or died of cancer. Local recurrence in the vulva occurred in 10%. A model suggested by the International Society for the Study of Vulvar Disease covered almost 10% of the patients. One of seven patients had groin metastases, none died of cancer, and one of seven developed local recurrence in the vulva. The criteria of the clinically best suited model are tumor not situated on the clitoris and less than 4 cm in diameter, with only slight hyperchromasia. This model ought to be tested in a randomized study.

Adult↗
PubMed1987

Outpatient treatment of cervical intra-epithelial neoplasia. The CO2 laser versus cryotherapy, a randomized trial.

In a randomized study, 204 patients were allocated to either laser or cryo treatment for cervical intra-epithelial neoplasia (CIN). The patients were treated on an outpatient basis without anesthesia unless other conditions requiring anesthesia had to be dealt with at the same time. Both the laser and the cryo method were highly acceptable to the patients. Slightly more patients experienced moderate or severe pain during laser treatment, compared with cryo treatment (P = 0.05). Peroperative hemorrhage did not exceed 25 cc except for one laser-treated patient. Postoperative vaginal discharge was more often seen after cryo coagulation, the discharge being malodorous in 36% of cryo-treated patients and in 17% of laser-treated patients. Pelvic inflammatory disease was found in one patient in each treatment group. Postoperative spotting occurred more often in laser-treated patients (49%) than in cryo-treated patients (22%). At follow-up colposcopy 3 months after treatment, the squamocolumnar junction was fully visible significantly more often in laser-treated patients (P less than 0.001). The cure rates after one laser or cryo treatment were 90% and 91%, respectively. Subsequent to 19 initial treatment failures, 8 patients have at present been retreated with the same method as initially used, and all 8 are cured. The cure rates after one or two treatments are 96% in the laser group and 93% in the cryo group. The rates are preliminary, due to the short observation time. Publications will appear when all patients have been followed for 2 and 5 years.

Adult↗
PubMed1986

Sexual function and somatopsychic reactions in vulvectomy-operated women and their partners.

Sexual function and somatopsychic reactions were examined in 25 women following vulvectomy and in 15 of their partners. More than half of the women had both sexual dysfunction and psychological problems. Their partners had no sexual dysfunction but almost half had psychological problems. An important reason for this seems to be insufficient information and advice both pre- and postoperatively and failure to recognize a developing stricture of the introitus vaginae. Frequent control and advice to both partners both pre- and postoperatively is desirable. Less extensive surgical procedures in selected cases should be considered.

Adult↗
PubMed1985

Value of prognostic parameters in squamous cell carcinoma of the vulva.

In a series of 137 patients with cancer of the vulva who had undergone radical surgery we investigated, by means of a Cox regression model, which combination of clinical variables and clinical as well as histopathological variables afforded the best prediction of survival/death from cancer and survival/death from other causes. Among clinical variables the best prediction was afforded by a combination of tumor site in the clitoris/not clitoris, tumor size greater or smaller than 40 mm, obesity/not obesity, and age. Among clinical and histopathological variables the best prediction was by a combination of groin node metastases/not groin node metastases, tumor site in the clitoris/not clitoris, degree of differentiation high/moderate + low, and age. The combination of clinical and histopathological variables had a significantly better predictive power than clinical variables alone. The best prognostic group in both combinations had a 5-year-survival for cancer of 98%, while the poorest prognostic group in the two combinations showed a 5-year survival for cancer of 19 and 9%. The best predictors of death from causes other than cancer were age and a poor general health. It is concluded that the poorest prognostic group is definitely under treated and that the best prognostic group is presumably over treated. Patients in poor general health and with a good cancer prognosis should receive a more conservative treatment.

Adult↗
PubMed1985

Dermatofibrosarcoma protuberans of the vulva.

A woman aged 52 years had a tumor of the mons pubis. The morphologic picture, featuring a whirling of spindle cells with long slender, interdigitating cell processes and so-called labyrinth nuclei, conformed to a dermatofibrosarcoma protuberans. Wide local excision is sufficient therapy, but more experience with this rare sarcoma of the vulva is necessary.

Cell Nucleus↗
PubMed1985

Predictive factors with reference to low-risk of metastases in squamous cell carcinoma in the vulvar region.

Among 122 patients operated upon for squamous cell carcinoma in the vulvar region 14 variables were investigated by a logistic regression analysis to determine their predictive value as to the presence/absence of metastases to the inguinal nodes. Factors of predictive value proved to be hyperchromasia, polymorphism, involvement of the clitoris, depth of invasion, and tumor size. On the basis of these variables, three different models of low-risk groups were set up. Model I comprised patients whose tumors showed slight hyperchromasia and did not involve the clitoris [metastatic rate: observed 0, estimated 2.1% (0.4-9.8%)]. Model II comprised patients whose tumors showed slight hyperchromasia, did not involve the clitoris, and measured less than 4 cm [metastatic rate: observed 0, estimated 1.6% (0.3-7.8%)]. Model III comprised patients whose tumors showed slight hyperchromasia, did not involve the clitoris, and had an invasion depth of less than or equal to 5 mm [metastatic rate: observed 0, estimated 1.3% (0.2-7.1%)].

Aged↗
PubMed1985

Intraepithelial neoplasia in the vulvar region.

From 1978 to 1982, 49 patients with intraepithelial neoplasia in the vulvar region were included in a prospective investigation. The main purpose was to evaluate the effect of treatment by local excision with a free margin of 2 mm and to estimate the importance of colposcopy. In 28% of the patients, the disease recurred after primary treatment, and in one patient microinvasion was shown. No patients died of cancer. A risk factor of recurrence was involvement of resection margins. Multicentric localization of the vulvar disease was found more frequently among patients treated for intraepithelial neoplasia of the cervix. In 66% of the patients the colposcopic findings were consistent with intraepithelial neoplasia. Local excision represents an improvement in the treatment of intraepithelial neoplasia of the vulva, but frequent follow-up is necessary.

Adult↗
PubMed1985

Induction of labor. A double-blind randomized controlled study of prostaglandin E2 vaginal suppositories compared with intranasal oxytocin and with sequential treatment.

In a double-blind randomized controlled study of 300 women, 150 primiparas and 150 multiparas, induction of labor by means of vaginal suppositories containing 3 mg prostaglandin E2 (PGE2) was compared with the conventional method of intranasal oxytocin and with a combined method of 3 mg PGE2 vaginal suppositories alternating with intranasal oxytocin. In the PGE2 group the intensity of delivery was significantly greater than in the oxytocin group, among both primiparas and multiparas and among the patients with ripe and unripe cervix. The efficiency of the combined treatment could no be evaluated because of the high intensity of delivery during the first 24 hours. There were no maternal side effects, and no significant difference in the frequencies of failed induction and cesarean section.

Administration, Intranasal↗