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Biomedical subjects

D Kunde

Publications and source records attributed to D Kunde.

At least 19 recordsLinked to original sources
PubMed2003

Ultracision in gynaecological laparoscopic surgery.

The Ultracision harmonic scalpel and laparosonic coagulating shears use high-frequency ultrasound energy and can be used as a substitute for electrosurgery, lasers and steel scalpels in both laparoscopic and conventional gynaecological surgery. Its unique mechanism of action allows cutting and coagulation without causing a significant rise in temperature at the tissue level. Its safety has been tested extensively in animal experiments and there is now ample evidence to suggest that it produces less thermal damage in vitro compared to electrosurgery and lasers. Although these results have been extrapolated to human beings, there are no in vivo studies in humans to corroborate the above observations. This review highlights the mechanism of action, tissue effects, safety aspects, applications, versatility and limitations of this novel technique. The many advantages demonstrated by this instrument over other energy sources used in laparoscopic surgery should make it more popular in forthcoming years.

Female↗
PubMed2002

Alcohol, tobacco and breast cancer--collaborative reanalysis of individual data from 53 epidemiological studies, including 58,515 women with breast cancer and 95,067 women without the disease.

Alcohol and tobacco consumption are closely correlated and published results on their association with breast cancer have not always allowed adequately for confounding between these exposures. Over 80% of the relevant information worldwide on alcohol and tobacco consumption and breast cancer were collated, checked and analysed centrally. Analyses included 58,515 women with invasive breast cancer and 95,067 controls from 53 studies. Relative risks of breast cancer were estimated, after stratifying by study, age, parity and, where appropriate, women's age when their first child was born and consumption of alcohol and tobacco. The average consumption of alcohol reported by controls from developed countries was 6.0 g per day, i.e. about half a unit/drink of alcohol per day, and was greater in ever-smokers than never-smokers, (8.4 g per day and 5.0 g per day, respectively). Compared with women who reported drinking no alcohol, the relative risk of breast cancer was 1.32 (1.19-1.45, P<0.00001) for an intake of 35-44 g per day alcohol, and 1.46 (1.33-1.61, P<0.00001) for >/=45 g per day alcohol. The relative risk of breast cancer increased by 7.1% (95% CI 5.5-8.7%; P<0.00001) for each additional 10 g per day intake of alcohol, i.e. for each extra unit or drink of alcohol consumed on a daily basis. This increase was the same in ever-smokers and never-smokers (7.1% per 10 g per day, P<0.00001, in each group). By contrast, the relationship between smoking and breast cancer was substantially confounded by the effect of alcohol. When analyses were restricted to 22 255 women with breast cancer and 40 832 controls who reported drinking no alcohol, smoking was not associated with breast cancer (compared to never-smokers, relative risk for ever-smokers=1.03, 95% CI 0.98-1.07, and for current smokers=0.99, 0.92-1.05). The results for alcohol and for tobacco did not vary substantially across studies, study designs, or according to 15 personal characteristics of the women; nor were the findings materially confounded by any of these factors. If the observed relationship for alcohol is causal, these results suggest that about 4% of the breast cancers in developed countries are attributable to alcohol. In developing countries, where alcohol consumption among controls averaged only 0.4 g per day, alcohol would have a negligible effect on the incidence of breast cancer. In conclusion, smoking has little or no independent effect on the risk of developing breast cancer; the effect of alcohol on breast cancer needs to be interpreted in the context of its beneficial effects, in moderation, on cardiovascular disease and its harmful effects on cirrhosis and cancers of the mouth, larynx, oesophagus and liver.

Adult↗
PubMed2002

Feasibility of performing TVT operation for stress urinary incontinence under general anaesthesia.

This study assesses the feasibility of performing the tension-free vaginal tape (TVT) operation under general anaesthesia (GA). Fifty patients underwent TVT operation under GA. The mean age was 51.3 years (range 32-80). The mean operating time was 21 minutes (range 15-24). Forty (80%) were primary and 10 (20%) were secondary procedures. Postoperatively 22 (44%) patients passed urine within 24 hours and an indwelling catheter was used in 28 (56%) patients. The mean stay was 40 hours (8 hours-5 days). Postoperative evaluation was performed at 2, 6 and 11 months (median follow up 6 months). One patient had an infected retropubic haematoma, necessitating removal of the sling. Of the 49 patients analysed, 72% were completely cured and another 20% were significantly improved. Our findings show that TVT operation can be performed under GA without intra-operative continence demonstration. The success rate of the operation is comparable with the published results.

Adult↗
PubMed2001

Vaginal route as the norm when planning hysterectomy for benign conditions: change in practice.

OBJECTIVE: To investigate if a deliberate decision to carry out as many hysterectomies as possible by the vaginal route can be effective in increasing the proportion of vaginal hysterectomies for benign conditions in the absence of prolapse. METHODS: Practice over 5 years at a district general hospital in the United Kingdom was studied. Patients with prolapse, adnexal disease, leiomyoma larger than 16 weeks, and malignancy were excluded, leaving 272 hysterectomies of 553 originally. Change in the route of hysterectomy, the main endpoint, was observed at yearly intervals. RESULTS: At the start of the study, the route of surgery was 68% abdominal and 32% vaginal. By the end of the fifth year the pattern was 5% abdominal 95% vaginal. The conversion from vaginal to abdominal hysterectomy occurred in only two cases during the study period. There was no change in the case mix during this period. In the fifth year of study most associated oophorectomies were also performed vaginally. There was no increase in patient morbidity. CONCLUSION: A major determinant of the route of hysterectomy is not the clinical situation but the attitude of the surgeon. There is no need for extra training and special skills or complicated equipment for vaginal hysterectomy.

Adult↗
PubMed2001

A prospective randomized control trial comparing medical and surgical treatment for early pregnancy failure.

A prospective randomized control trial was designed to assess the effectiveness of single dose, 800 microg misoprostol administered p.v. compared with surgical evacuation for the treatment of early pregnancy failure. A total of 80 women with a diagnosis of early pregnancy failure were randomized to study (vaginal misoprostol) and control (surgical curettage) groups. Success of treatment, side-effects as assessed during, immediately after and 10 days after treatment, and patient satisfaction were compared. Intravaginal misoprostol was successful in 82.5% (33 out of 40) of the patients. None of the control group patients required a repeat evacuation. The number of patients who experienced significant abdominal pain following treatment did not differ between the groups. The duration of pain was shorter in the control group; however, they required more analgesics during this short period. The number of patients with significant vaginal bleeding, the duration or severity of bleeding did not show any significant difference between the groups. All 33 patients in the study group who had successful treatment expressed satisfaction, whereas only 58% of the control group did so. In conclusion this randomized control study demonstrated the efficacy and safety of the administration of 800 microg of misoprostol p.v. for the management of early pregnancy failure.

Abortion, Incomplete↗
PubMed1997

[Paraneoplastic limbic encephalitis].

We report on a 69-year old male patient who presented with vague depressive symptoms and loss of weight accompanied by lack of appetite, ageusia and anosmia. The patient died of bronchial pneumonia, and neuropathological examination revealed a so-called limbic encephalitis. The paraneoplastic origin of this case was later confirmed by discovery of a clinically inapparent, indolently growing small cell lung cancer. This case illustrates the difficult clinical diagnosis of paraneoplastic limbic encephalitis and the need for a close cooperation of pathologists and neuropathologists in the clarification of such cases.

Aged↗
PubMed1991

Combined oral contraceptives containing chlormadinone acetate and breast cancer: results of a case-control study.

The main subject of this hospital-based case-control study was the possible relationship between use of combined oral contraceptives (OCs) containing chlormadinone acetate and breast cancer. Analyses were based on data from 490 cases with newly diagnosed breast cancer and 1,223 controls and were separately performed for combined OCs with and without chlormadinone. For either of the combined OCs, risk was not elevated in ever users, did not increase with duration of use and did not change with time since initial exposure or with time since most recent use. However, the relative risk was increased in current users: RR = 1.72 (0.88, 3.36) for combined OCs with chlormadinone and RR = 1.42 (1.01, 2.00) for combined OCs without chlormadinone, which is, however, explained as a screening effect. These results show that chlormadinone as a constituent of combined OCs does not influence breast cancer risk.

Adult↗
PubMed1990

Topographic criteria in the diagnosis of tumor emboli in intramammary lymphatics.

Topographic relationships to adjacent structures were used as criteria to identify intramammary lymphatics with tumor emboli in breast cancer patients, in addition to conventional morphologic criteria. Patterns of relationship to blood vessels, non-neoplastic lobules and ducts, and empty lymphatics were defined. Ninety-five cases were independently reviewed by two observers. Interobserver reproducibility of the diagnosis of lymphatic vessel invasion (LVI) was 82% (kappa 0.60). The observers agreed on the presence of LVI in 23 patients (24%), of whom 21 (91%) had positive lymph nodes. Only among patients in whom more than ten emboli were identified was the frequency of positive lymph nodes markedly higher than in the total material. The location of tumor emboli relative to the invasive tumor was of little significance. LVI was a more powerful predictor of lymph node status than tumor size, margin contour, histologic grade and histologic type, and was highly significant also when controlled for these features.

Breast↗
PubMed1990

Proliferation of cultivated cells from normal, preneoplastic and neoplastic human breast tissue--preliminary report.

The success of cultivation of epithelial cells from normal, neoplastic and preneoplastic tissues is reviewed. MCDB 170 medium with special supplements is useful for epithelial cell culture. The epithelial character was demonstrated by the reaction with 3 different monoclonal antibodies. Most cell populations from preneoplastic and neoplastic tissues were identified as fibroblasts. Cell proliferation as measured by cell doubling time, labeling index, flow cytometry did not differ between the tissue types examined. Only 3H-thymidine uptake showed an increased tendency in cells from preneoplastic and neoplastic tissues. The use of normal human breast epithelial cells for molecular biological studies is recommended.

Breast↗
PubMed1989

[The value of computed tomography in monitoring the preoperative chemotherapy of osteosarcoma].

Computed tomography was performed in 45 patients with osteosarcomas before and after preoperative chemotherapy. Changes of bone alterations, intramedullary tumour spread and the size of soft tissue masses are computer tomographic criteria for tumour response after chemotherapy. The computed tomography decision of responder or non-responder was correct in 37/45 patients. In comparison with conventional x-rays CT was superior. CT is a reliable method for preoperative extension diagnosis and for the decision-marking for limb-saving operations.

Adolescent↗
PubMed1989

[X-ray diagnosis of small breast cancers].

The incidence of breast carcinoma is steadily increasing in the developed countries. Mortality increases with tumour size. For a reduced mortality early detection must be achieved. Mammography is of high diagnostic value for the detection of small breast carcinoma.

Adult↗
PubMed1988

EGF binding is quantitatively related to growth in node-positive breast cancer.

Number of mitoses and EGF binding were determined in parallel in biopsies of 27 lymph-node positive and of 23 lymph-node negative breast cancer patients. For node-positive patients the parameters for cell growth and EGF binding were quantitatively correlated by the equation y = P3 + P1(1- exp(- P2x]. For node-negative cases neither the non-linear model nor the linear approximation described the data unambiguously. The results strongly suggest that in node-positive patients, growth of breast cancer is related to an EGF-dependent acceleration of cell division.

Adult↗
PubMed1988

DNA distributions in human normal, precancerous and cancerous breast tissue. II. Differences in heparin mediated changes in DNA distributions.

DNA distributions were recorded flow cytometrically (FCM) in human normal, precancerous (P1 characterized by ductal hyperplasia and/or lobular hyperplasia, and P2 characterized by carcinomata lobularia in situ and intraductal carcinoma) and malignant breast tissues. Heparin, a polyanion, mediated two changes: (a) a time-dependent increase in fluorescence intensity (IFI) considered to be inversely proportional to the proliferative activity. IFI was significantly lower in carcinomas than in P2, in normal and in P1 tissues; it identified a highly and a poorly heparin-sensitive subgroup of carcinomas, which differed in respect to histological type and tumor stage distribution; (b) a time-dependent increase in the percentage of recorded DNA aneuploid cells (IAC) at the expense of DNA diploid cells in mixed cell population. IAC is considered to correspond to cell membrane permeability. DNA aneuploid cell populations homogeneous in respect to DNA - index (DI) seem to be heterogeneous in respect to cell membrane function. Duct carcinomas showed significantly higher IAC than lobular carcinomas.

Aneuploidy↗
PubMed1987

Growth of mammary epithelial cells in breast-cancer biopsies correlates with EGF binding.

In order to understand the role of EGF in the development of human mammary epithelial tissue, we analysed the binding of 125I-EGF to sections of breast cancer biopsies. A mean specific 125I-EGF binding of 8.9 fmol per mg protein was estimated in thin sections of 17 breast cancer biopsies. Microautoradiographic analysis of 125I-EGF binding to the tissue sections was applied to demonstrate that EGF was bound predominantly to mammary epithelial cells. The binding was clearly correlated to the number of mitoses of mammary epithelial cells in the same samples. The highest EGF binding and proliferation rates were found in biopsies from breast cancer with axillary lymph-node metastases.

Animals↗
PubMed1987

Altered growth control by natural growth inhibitors in the mutant HD33 substrain of the Ehrlich-Lettré ascites mammary carcinoma.

The mutant substrain HD33 of the Ehrlich-Lettré ascites mammary carcinoma (EAC) was found to be altered in its ability to respond to and to produce natural growth inhibitors. Cells of this substrain did not respond to (1) a highly purified growth inhibitor from bovine mammary gland, inhibiting the proliferation of two strains of the original EAC already at concentrations of 0.5-2.0 ng/ml, (2) inhibitory activities found in the ascites fluid of these sensitive strains and partially purified. However, from the ascites fluid of the mutant substrain an inhibitory activity was partially purified, which was inhibitory towards this substrain. It also inhibited the cells from an original strain, although less effectively. This new inhibitory activity is similar in its properties to that of the others investigated in that its mol. wt is between 10,000 and 50,000 D, it is heat labile and its activity can be overcome by insulin, epidermal growth factor and 2'-deoxycytidine, the dose-response curve levels off at 35-45% inhibition. The results demonstrate that the regulation of cell proliferation by endogenous (autocrine) inhibitors can be altered by mutagen treatment.

Animals↗
PubMed1987

[Results of irradiation using different radiation sources in the treatment of malignant parotid tumors].

Patients with malignant parotid tumors were treated at two different centres with slightly ionizing radiation (110 patients) and neutron therapy (15 patients). The treatment results are compared. The principles of comparison applied in this analysis are identical. The histologic classification was made according to the W.H.O. recommendation of 1972 and the staging according to Becske. Local tumor control is the criterion applied in the comparative assessment of both methods. The analysis has shown that there is no significant difference in the treatment results within the individual stages of tumor's advancement after application of an orthovolt therapy and a telecobalt therapy. Patients treated in early stages (stages I and III) had a substantially higher rate of local tumor control (72%) than patients in advanced stages (46%, stages III and IV). A more favorable treatment results was achieved by neutron therapy in all stages of tumor's advancement. In this case the rate of patients with local tumor control (87%) was significantly higher than after radiotherapy with slightly ionizing radiation (46%).

Adenocarcinoma↗