Gastric tonometry and drain amylase analysis in the detection of cervical oesophagogastric leakage.
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Amylases↗
Biomedical subjects
C Busch
Publications and source records attributed to C Busch.
Multiple transrectal ultrasound-guided biopsies for the detection of prostate cancer and determination of tumor volume, grade, and seminal vesicle invasion.
A total of 251 men with suspected prostate cancer were examined by transrectal ultrasound (TRUS) in order to evaluate the usefulness of TRUS and core biopsies for the detection of prostate cancer and determination of tumor volume, grade, and seminal vesicle invasion (SVI). Biopsies targeting hypoechoic lesions were taken in combination with systematic biopsies obtained from six standardized locations. Bilateral seminal vesicle biopsies were obtained from 168 of the men. A total of 26 patients underwent surgery and a comparison between the results of the histopathological evaluation of core biopsies and the prostatectomy specimen was performed. A total of 137 cancers were detected. In 34 patients (25%) the tumors were diagnosed by systematic biopsies alone. Tumor volume as estimated by TRUS underestimated the volume when compared to a planimetric technique. Correlation between the two methods was not found by regression analysis. Systematic biopsies did not improve grading compared to the grading of prostatectomy specimens. A total of 24 SVIs were detected. Valuable information was obtained for the diagnosis of prostate cancer by taking systematic biopsies.
Adult↗
Mode of spread in the early phase of lymphatic metastasis in non-small-cell lung cancer: significance of nodal micrometastasis.
The impact of lymphatic micrometastases on prognosis of non-small-cell lung cancer has not been clearly established. We therefore prospectively assessed the frequency, mode of mediastinal spread, and prognostic significance of lymphatic micrometastases in lymph nodes of 93 patients with completely resected non-small-cell lung cancer staged as pT1 to pT4 pN0 and pN1 by conventional histopathologic techniques. Frozen tissue sections from 471 lymph nodes that were staged as free of metastases by routine histopathologic examination were screened for micrometastases by the alkaline phosphatase-antialkaline phosphatase immunostaining technique with the monoclonal antibody Ber-Ep-4. Twenty of 73 patients (27.4%) with disease staged as pN0 and nine of 20 patients (45.0%) with disease staged as pN1 had nodal micrometastases. Eight of 17 patients with upper lobe primary tumors and five of 12 patients with lower lobe primary tumors exhibited skip micrometastases. Mean relapse-free survival was significantly increased in patients with pN0 disease without micrometastases (41.1 vs 29 months, p = 0.0081). In patients with pN1 disease, mean relapse-free and cancer-related survivals were also significantly increased if no micrometastases were found (34.8 and 38.2 months vs 18 and 23.5 months, p = 0.0157 and p = 0.0094). Patients with disease staged as pN0 and pN1 with micrometastases revealed no difference in cancer-related survival compared with a control population of patients with disease staged as pN2. The mode of spread was erratic. The prognosis of patients after upstaging of pN0 and pN1 disease according to results of immunohistochemical staining correlated strongly with the prognosis of patients whose disease was staged at the higher stages by conventional histopathologic examination. These findings could represent a new indication for adjuvant therapy, supporting extensive lymph node sampling for staging purposes.
Adult↗
A 3-year follow-up of patients with localized prostate cancer operated on with or without pre-treatment with the GnRH-agonist triptorelin.
OBJECTIVE: To examine the effect of pre-operative androgen deprivation on the progression rate of malignancy in patients operated on for localized prostate cancer. PATIENTS AND METHODS: A total of 53 patients received no hormone therapy (group 1) and a further 38 patients (group 2) received the generic releasing-hormone agonist triptorelin during the 3 months before surgery. The patients in group 1 had T1b-T2 tumours, whereas 12 of those in group 2 had clinical stage T3 tumours. Despite this, the surgical specimens from the patients in group 2 showed a rate of cancer invasion of the surgical margins 20% lower than those from the patients in group 1. After prostatectomy, the patients were followed for 3 years by repeated analyses of prostate-specific antigen (PSA) in serum. RESULTS: During the follow-up, the PSA level exceeded the upper threshold (0.6 ng/mL) in 16% of the patients in group 1 and in 43% of those in group 2 (P < 0.05). This difference was mainly related to the pre-treatment stage of the tumor. Some of the patients in group 1 received post-operative radiotherapy but this was not reflected in their PSA levels. Of the patients in group 1 and 2, 4% and 14% respectively (P > 0.05), developed symptoms from skeletal metastases. CONCLUSION: There was no evidence that pre-operative hormone therapy slowed the progression of prostate cancer.
Aged↗
Long-term outcome and quality of life after thymectomy for myasthenia gravis.
OBJECTIVE: The authors identify criteria suitable to predict long-term clinical improvement and evaluate quality of life after thymectomy for myasthenia. DESIGN: Retrospective analysis with long-term follow-up (mean 92 months) was conducted for 86 patients and questionnaire interviews were performed for 65 patients who underwent thymectomy between 1976 and 1993. MAIN OUTCOME MEASURES: The authors used the Osserman Score and the European Organization for Research and Treatment of Cancer quality-of-life questionnaire. RESULTS: After thymectomy, lasting benefits were achieved predominantly by patients with moderate and severe myasthenia, and this association was significant (p < 0.001) in both bivariable and multiple analyses. No correlation was observed between outcome and thymic pathology, patient age or gender, duration of disease, preoperative plasmapheresis, and medication. Restitution to normal was complete at most recent follow-up as to physical status, working ability, and cognitive and social functions, but some emotional and vegetative deficits remained. CONCLUSION: Future patient selection for thymectomy should-apart from those with suspected thymoma-concentrate on patients with moderate and severe myasthenia unresponsive to conservative management.
Adult↗
DNA ploidy patterns in androgen-deprived localized prostate cancer.
Prostatectomy was performed in 48 patients with localized prostate cancer. Before surgery, they had been treated with the GnRH agonist triptorelin for 3 months. Specimens from the largest tumor focus (n = 6.3 + 3.6, mean + SD) were analyzed with regard to the DNA ploidy pattern. The results were compared with those obtained in a previous investigation of 54 patients who were subjected to surgery without hormone pretreatment. In both series, about 50% of the tumors showed a diploid DNA ploidy pattern, the rest being nondiploid. Ploidy heterogeneity, i.e., a mixture of diploid and nondiploid ploidy patterns in the single largest tumor focus, was found in 36% of the cases compared to 48% in the previous report (NS). In 13% of the tumors, all samples revealed a nondiploid DNA ploidy pattern as compared to 6% in the previous report (NS). In both series, needle biopsy examination (1/patient) prior to prostatectomy was associated with a significant and similar underestimate of the chromosomal aberration. In conclusion, despite the marked histopathological changes previously reported, there is no evidence that neoadjuvant triptorelin treatment during 3 months has any effect on the DNA ploidy pattern.
Androgen Antagonists↗
[Radiologic medical desktop conferences--clinical evaluation of the KAMEDIN teleradiology system in routine practice of a radiologic institute].
KAMEDIN is a teleradiology project of "Deutsche Telekom". ISDN based image transfer, visualisation and online-presentation of digital radiological images is performed. In this study the suitability of the KAMEDIN-system has been tested in a clinical environment. The software has been adapted to the requirements of radiological image visualisation. During 6 months over 50 conferences took place with an average of 36 CT-slices per patient. The amount of time was approximately 10 min for conference preparation, 20 min for image transfer and 8 min for conferencing. Software problems occurred and were solved. Image quality on the monitor as well as online presentation including "simultaneous cursors" showed high performance and achieved high acceptance by the clinicians. Thus KAMEDIN is a useful teleradiology system, especially if the system is adapted to the requirements of radiology departments.
Computer Systems↗
High frequency of chromosome 9p allelic loss and CDKN2 tumor suppressor gene alterations in squamous cell carcinoma of the bladder.
BACKGROUND: In the Western Hemisphere, 90% of bladder cancers are transitional cell carcinomas, while only 7% are classified as squamous cell carcinomas. In contrast, in Egypt and regions of the Middle East and Africa, where infection by the trematode Schistosoma haematobium is endemic, squamous cell carcinoma is the most common bladder cancer as well as the most common cancer in men. PURPOSE: We planned experiments to understand the genetic defects underlying the development of squamous cell carcinoma and to determine if the morphologically and clinically distinct squamous cell carcinoma and transitional cell carcinoma of the bladder evolve following different genetic alterations. METHODS: Squamous cell carcinoma specimens from high-risk (Egypt, n = 19) and low-risk (Sweden, n = 12) populations were examined for genetic defects known to be involved in transitional cell carcinoma tumorigenesis. Homozygous deletions of the CDKN2 tumor suppressor gene were detected by comparative multiplex polymerase chain reaction. Mutations in the CDKN2 and p53 (also known as TP53) genes were analyzed by single-strand conformation polymorphism and DNA sequencing. Immunohistochemical staining of p53 protein was also performed. Allelic losses in chromosome arms 9p, 9q, and 17p were determined by microsatellite analysis. RESULTS: Homozygous deletions and sequence mutations in the CDKN2 gene were found in 67% (eight of 12) of squamous cell carcinoma specimens, a frequency three times higher than that reported for uncultured transitional cell carcinomas (P = .009). Hemizygous and homozygous deletions in 9p, where CDKN2 resides, were found in 92% (11 of 12) of uncultured squamous cell carcinomas, while only about 39% (35 of 90) of transitional cell carcinomas showed these losses (P = .001). Deletions in 9p with no change in 9q were found in 92% (10 of 11) of squamous cell carcinomas compared with only 10% (11 of 110) of transitional cell carcinomas (P < .001) reported in the literature. The frequency of p53 mutations in squamous cell carcinomas was similar to that reported for invasive transitional cell carcinomas (60%), but the type and position of mutations differed between the two tumor types. Allelic losses in chromosome arm 17p, where the p53 gene resides, were found to be less frequent in squamous cell carcinomas (38%) than in invasive transitional cell carcinomas (60%). CONCLUSIONS: Our results suggest that a putative tumor suppressor gene on 9p, possibly CDKN2, may contribute to squamous cell carcinoma tumorigenesis. Our data on squamous cell carcinoma and previously reported data on transitional cell carcinoma indicate that these two bladder carcinomas differ in their genetic alterations, suggesting that distinct underlying genetic defects may explain, at least in part, the pathological differences between the two tumors of the bladder epithelium. IMPLICATIONS: Development of diagnostic and therapeutic strategies for squamous cell carcinoma of the bladder based on its distinct genetic alterations is warranted.
Alleles↗
[Angio-architecture of the colon in Crohn disease and ulcerative colitis. Light microscopy and scanning electron microscopy studies with reference to the morphology of the healthy large intestine].
The etiology and the pathogenesis of the chronic inflammatory bowel diseases known as Crohn's disease and ulcerative colitis have not been defined. Therefore, in this study the main emphasis was placed on description of the pathologic anatomy. Disturbed blood supply and vascular disorders have been discussed as etiopathogenetic factors. The results in the literature are frequently contradictory. For this reason, the vascular system of the colon in Crohn's disease and ulcerative colitis was systematically examined by means of various morphological methods in this study. Microvascular corrosion casting and translucent specimens were taken from operative specimens taken from 12 patients with Crohn's disease and 8 with ulcerative colitis. For comparison, tumor-free parts of 6 colon cancer specimens were examined. The evaluation was done by scanning electron- and/or stereoscopic microscopy. In the presence of chronic inflammatory bowel disease dilatation of the submucosal veins, caliber differences in the tunica muscularis and rarefaction of the penetrating blood vessels were found. In summary, an impairment of the blood flow in the tunica muscularis can be postulated. For the first time, the resulting venous stasis has been described, in contrast to the previously described disturbed arterial blood supply.
Adult↗
Ambulatory blood pressure monitoring in paediatric patients treated by regular haemodialysis and peritoneal dialysis.
Ambulatory blood pressure monitoring (ABPM) has been shown to be more representative of blood pressure (BP) levels than casual BP measurements in adult patients treated by haemodialysis (HD). In this study we compared ABPM using the oscillometric SpaceLabs 90207 monitor with casual BP measurements in 35 paediatric patients [17 treated by peritoneal dialysis (PD) and 18 by HD]. Heart rate and plasma concentrations of atrial natriuretic peptide were also measured. No correlations were found between ABPM and causal BP measurements, except for systolic day-time BP in PD patients (r = 0.63). Seventy percent of PD and 33% of HD patients were regarded as hypertensive when evaluated by ABPM, while casual BP measurements demonstrated hypertension in 47% (P < 0.05) of PD patients and in 44% (NS) of HD patients. One-third of patients were reclassified by ABPM either from normotensive to hypertensive (7/19) or from hypertensive to normotensive (5/16). BP assessed by ABPM was higher in PD than in HD patients. The physiological decline of BP at night was significant and more pronounced in PD than in HD patients. In HD patients day-time BP did not differ between the 1st and the 2nd interdialytic day, but increased in the night hours before the following dialysis session. A positive correlation was found between day-time BP and pre-dialysis plasma atrial natriuretic peptide in both treatment groups. In conclusion this study demonstrates that casual BP recordings are not representative of average BP in dialysed paediatric patients. ABPM is useful in the diagnosis and treatment of hypertension in children with end-stage renal disease.
Adolescent↗
Ambulatory blood pressure monitoring in healthy schoolchildren.
Ambulatory blood pressure monitoring (ABPM) was performed in 564 healthy schoolchildren during normal circadian activities. The data of two cohorts (155 boys and 139 girls aged 9-13 years and 184 boys and 168 girls with a body height between 120 and 155 cm) are presented. From the age of 9 to 13 years the mean 24-h systolic/diastolic blood pressure (SBP/DBP) increases from 107 +/- 9/66 +/- 7 mmHg to 115 +/- 13/68 +/- 9 mmHg in boys and from 104 +/- 5/64 +/- 6 mmHg to 109 +/- 8/65 +/- 9 mmHg in girls. When related to body height the values rise from 105 +/- 6/64 +/- 6 mmHg at 120 cm to 113 +/- 8/67 +/- 7 mmHg at 155 cm in boys and from 100 +/- 7/65 +/- 7 mmHg to 112 +/- 9/66 +/- 9 mmHg in girls. In comparison with the causal blood pressure data obtained from European studies, the presented ABPM values (daytime BP) are higher throughout, which may be explained by the increased activity during daytime with ABPM. There is a mean difference of 4.4 mmHg in boys and of 3.0 mmHg in girls for SBP and of 10.8 mmHg in boys and of 9.0 mmHg in girls for DBP when related to age. In relation to body height, there is a mean difference of 4.4 mmHg in boys and of 3.5 mmHg in girls for SBP and of 10.9 mmHg in boys and of 10.5 mmHg in girls for DBP. We conclude that standards derived from causal blood pressure measurements should not be used for the evaluation of ABPM data.
Adolescent↗
Numerical solution of the spatially inhomogeneous Boltzmann equation and verification of the nonlocal approach for an argon plasma.
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Journal Article↗
Transrectal ultrasonically-guided core biopsies in the assessment of local cure of prostatic cancer after radical external beam radiotherapy.
Fifty-five patients were included in an extended follow-up after radical radiation therapy (RRT) for localized prostatic cancer (T1-3, Nx, M0). Local cure was assessed by a combination of digital rectal examination (DRE), transrectal ultrasound (TRUS) and systematic 'mapping' with TRUS-guided core biopsies (TGCB). After a mean follow-up of 6.8 years, 33% (18/55) of the patients were locally free of tumour, while in 67% (37/55) of cases residual cancer was demonstrated in the biopsies. Endocrine treatment did not influence the local cure rate, nor did the T stage of tumour grade at diagnosis or the cumulative radiation effect (CRE) values within the range of the present study. The sensitivity of DRE and TRUS was low; 37% and 20% respectively, while the specificity of the DRE and TRUS methods was 83% and 94% respectively. The conclusion of the study is that residual tumour was found in the high proportion of biopsied patients nearly 7 years after RRT and that multiple, TRUS-guided core biopsies are mandatory in the assessment of local cure in patients irradiated for prostatic cancer; both DRE and TRUS on their own are less reliable.
Biopsy↗
Grading of transitional cell bladder carcinoma by image analysis of histological sections.
Image analysis of histological sections was used to achieve a more objective malignancy grading of transitional cell carcinoma of the bladder. Images from Feulgen-stained sections from a clinical material of 197 tumours were analyzed. Features at various levels of analysis, e.g. mainly related to individual objects, neighbouring objects and the entire image, were analyzed. The features used were based on relational rather than individual nuclear features. With this technique, typical tissue architecture and degree of order/disorder can be described. These characteristics were compared by means of multivariate statistical methods with the subjective grading of the pathologists at our institution. This comparison provided the best subset of features and the agreement between the subjective and computer-based classification was 73%. The size, orientation and variation of the grey scale of the nuclei were particularly powerful. On a continuous scale, from grade 1 to 2A and 2B to 3, the four grades formed two distinct classes, low and high grade. In this distribution, the intermediate grade 2A was identified as a displaced grade 1 and the other intermediate grade 2B as a displaced grade 3.
Carcinoma, Transitional Cell↗
A national telepathology trial in Sweden feasibility and assessment.
The telepathology trial in Sweden was designed to study several parameters, eg, the specific need, practical handling, image quality and acceptance of a static imaging system for consultations between pathologists. From September 1992 until December 1993, six telepathology systems were leased and temporarily installed for 8 to 10 weeks in 29 pathology departments in Swedish hospitals. Three telepathology systems were purchased by the university hospitals in Gothenburg, Linkôping and Uppsala and served as permanent nodes. To assess the project, pre and post field-test questionnaire (focusing on attitudes/expectations and experience/wishes for the future, respectively) were sent to all participating pathologists and cytologists. Although other assessment methods were included in the project, this paper concentrates on the study of questionnaire results. The study shows that the major medical requirements for telepathology in Sweden involve diagnostic questions concerning: cancers in general, grade of malignancy, malignancy of soft tissue, haematopoetic system, skeletal system, breast, uro-genital systems and applications in the field of dermatology, inflammations and transplantations. Telepathology will enhance diagnostic accuracy according to 37% of the responding physicians in the pre field-test study and 31% in the post field-test study, a drop which may reflect excessively high expectations or less than optimal test conditions. A static-image transfer telepathology system was used but the assessment clearly shows that pathologists and cytologists prefer a dynamic imaging telepathology system for the future. Image resolution is crucial and was not adequate for all applications in the study. Half of the respondents preferred having a telepathology system in their own departments.(ABSTRACT TRUNCATED AT 250 WORDS)
Computer Communication Networks↗
Future strategy for telepathology in Sweden: higher resolution, real time transmission in a multipurpose work station for diagnostic pathology.
The general reaction among Swedish pathologists to the nationwide experimentation static teletransmission of microscopic images can be briefly summarized as follows: "interesting, but technically imperfect: we need more friendly interface, faster transmission, preferably in real time, better resolution, and the possibility for slide operation by the receiver". In Sweden all Pathology laboratories are presently changing administrative routines to PC-platformed networks, which means that each pathologist has a microscope and a PC as obligatory tools to perform diagnostic work. Therefore, we plan to incorporate Telepathology, including picture archiving, along with administrative software and improved software for static DNA-measurements and morphometry. The latter is including a novel system for quantification of color images e.g. immunohistochemistry into a standard work-station for diagnostic pathology. The features of this technique are presented as well as the general outline of the work-station. Steps have been taken to build up and test such a work-station in the broad band (ATM) laboratories of the Ericsson Company and a cooperation with several Scandinavian partners in computer and teletechnology. Hopefully, similar competitive actions are taken elsewhere to help bring down the prices and facilitate adoption among diagnostic pathologists world-wide.
Computer Communication Networks↗
p53 deletion as a genetic marker in urothelial tumor by fluorescence in situ hybridization.
In order to investigate the significance of p53 deletion, 42 specimens of transitional cell carcinoma were analyzed by interphase cytogenetics with a fluorescence in situ hybridization technique and compared with clinicopathological and cytochemical parameters. In total, 27 (64%) and 16 (38%) specimens demonstrated p53 deletion and overexpression, respectively. The p53 deletion was significantly correlated with grade (P < 0.01), stage (P < 0.05), S-phase fraction (P < 0.05), and DNA ploidy (P < 0.01), while p53 overexpression correlated only with grade (P < 0.05). The close correlation of p53 deletion with clinicopathological parameters suggests p53 deletion to be of clinical importance to indicate the malignant potential of human urothelial tumors.
Adult↗
[Localized fibrous pleural mesothelioma. Value of image-producing methods for the differentiation from supradiaphragmatic tumors of the liver].
A 38-year-old woman in good health suddenly developed pain in the right chest and mild dyspnoea. She reported two bronchial infections in the preceding year. Physical examination revealed cyanosis of the lips and finger clubbing, slightly dulled percussion sounds and decreased breath sounds at the basis of the right chest, but no other abnormalities. Activity of the tumour marker CA 125 was raised (60 kU/l). The chest radiography showed a shadow in the right lower segment, resembling a high diaphragm. Computed tomography failed to separate the abnormal structure from the liver substance. Needle puncture discovered a small haemorrhagic effusion with mesothelial cells. Magnetic resonance imaging and a scintigraphy of the liver provided evidence that the mass was separate from the liver. At thoracotomy a tumour, 20 x 15 x 10 cm in size and connected by a pedicle to the pleura, was identified and excised. Immunocytochemical tests showed it to be a fibrous pleural mesothelioma without signs of malignancy. The patient was discharged 10 days postoperatively in good general condition.
Adult↗