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Biomedical subjects

H Menck

Publications and source records attributed to H Menck.

At least 19 recordsLinked to original sources
PubMed1999

Axillary dissection in breast-conserving surgery for stage I and II breast cancer: a National Cancer Data Base study of patterns of omission and implications for survival.

BACKGROUND: Breast conservation (partial mastectomy, axillary node dissection or sampling, and radiotherapy) is the current standard of care for eligible patients with Stages I and II breast cancer. Because axillary node dissection (AND) has a low yield, some have argued for its omission. The present study was undertaken to determine factors that correlated with omission of AND, and the impact of the decision to omit AND on 10-year relative survival. STUDY DESIGN: A retrospective review of National Cancer Data Base (NCDB) data for 547,847 women with Stage I and Stage II breast cancer treated in US hospitals from 1985 to 1995 was undertaken. A subset of 47,944 Stage I and 23,283 Stage II women treated with breast-conserving surgery (BCS) was identified. Cross-tab analysis was used to compare patterns of surgical care within this subset. Relative survival was calculated as the ratio of observed survival to the expected survival for women of the same age and racial/ethnic background. RESULTS: The rate of BCS with and without AND increased steadily from 17.6% and 6.4% of patients from 1985-1989, to 36.6% and 10.6% of patients from 1993-1995 respectively. AND was more likely to be omitted in women with Stage I than women with Stage II disease (14.5% versus 5.5%). Similarly, AND was omitted more frequently in women with Grade 1 than women with higher grades (Grade 1, 14.9%; Grade 2, 10.1%; Grade 3, 7.1%; Grade 4, 7%). Although the rate of BCS with AND varied considerably according to location in the breast, the overall rate of BCS without AND appeared independent of site of lesion. Women over the age of 70 years were more than twice as likely to have AND omitted from BCS than their younger counterparts. Women with lower incomes, women treated in the Northeast, or at hospitals with annual caseloads <150 were all less likely to undergo AND than their corresponding counterparts. Ten-year relative survival for Stage I women treated with partial mastectomy and AND was 85% (n = 1242) versus 66% (n = 1684) for comparable women in whom AND was omitted. BCS with AND followed by radiation therapy for Stage I disease resulted in 94% (n = 5469) 10-year relative survival, compared with 85% (n = 1284) without AND. Addition of both radiation and chemotherapy to BCS with AND for Stage I disease resulted in 86% (n = 2800) versus 58% (n = 512) without AND. In contrast, Stage II women treated with BCS with AND followed by radiation and chemotherapy experienced a 72% 10-year relative survival. CONCLUSIONS: A significant number of women with Stage I breast cancer do not undergo AND as part of BCS. The trend is most pronounced for the elderly, but significant fractions of women of all ages are also being undertreated by current standards. Ten-year survival is significantly worse when AND is omitted. This adverse survival effect is not solely from understaging.

Adult↗
PubMed1994

Trends in treatment of localized prostate cancer by radical prostatectomy: observations from the Commission on Cancer National Cancer Database, 1985-1990.

OBJECTIVE: Tumor registry data were studied to assess the magnitude and nature of the trend toward increased use of radical prostatectomy for the treatment of newly diagnosed localized prostate cancer. METHODS: The Commission on Cancer of the American College of Surgeons National Cancer Data Base aggregates data from hospital tumor registries located throughout the United States. Data from this resource on 4,531 patients treated in 1985, 25,028 treated in 1988, and 21,697 treated in 1990 were reviewed. RESULTS: The data indicate that selection of radical prostatectomy increased markedly over this interval. Use of radical prostatectomy was greatest in younger men in every year studied. The proportion of patients treated by radical prostatectomy was greatest in the western United States and least in New England and the mid-Atlantic region. Radical prostatectomy was associated with patients' socioeconomic status and race as well as with the hospital's caseload of patients with cancer. CONCLUSIONS: The pattern of care for localized prostate cancer is changing significantly. Further research is needed to assess whether these variations reflect differences in access to care or patterns of patient preference.

Aged↗
PubMed1994

National patterns of prostate cancer treatment by radical prostatectomy: results of a survey by the American College of Surgeons Commission on Cancer.

To evaluate the patterns of use of radical prostatectomy for the treatment of prostate cancer in the United States, the American College of Surgeons Commission on Cancer in association with the American Cancer Society and American Urological Association surveyed 484 institutions concerning 2,122 patients treated in 1990. The results revealed that 93% of the patients were younger than 75 years when treated. Pretreatment prostate specific antigen level was greater than 4.0 ng./ml. in 85.4% of the patients. Surgical-pathological evaluation showed that 57.5% of the patients treated had American Joint Committee on Cancer pathological stages O, I and II corresponding to American Urological Association stages A1 to B2. Positive pathological findings, for example microscopic tumor extension or invasion, were associated with elevated prostate specific antigen levels at followup. The mortality rate associated with the operation was 0.7%. Impotence following treatment was observed in 56.6% of the patients who were potent preoperatively and complete incontinence was reported in 3.6% of the patients who were previously continent. The data may provide benchmarks by which further trends in prostate cancer treatment may be compared.

Age Factors↗
PubMed1993

Patterns of care.

Explore the source record for details and available documents.

Adolescent↗
PubMed1989

AIDS-related secular trends in cancer in Los Angeles County men: a comparison by marital status.

Data from the population-based cancer registry for Los Angeles County, an area with high risk of AIDS, were used to evaluate secular trends of Kaposi's sarcoma (KS), non-Hodgkin's lymphoma, and other possibly AIDS-related cancers in men aged 18 to 54. Marital status was used as a surrogate for homosexual behavior to compare the proportional incidence rates for the pre-AIDS era, 1972 to 1979, to those for 1980 to 1982 and 1983 to 1985. Both absolute incidence and proportional incidence of KS continue to increase sharply, although in absolute numbers, KS is making a smaller contribution to the total number of AIDS cases as the Los Angeles County epidemic progresses. For never-married men the proportional incidence rate of KS in 1983 to 1985 was nearly 100-fold greater than that of 1972 to 1979 and 7-fold greater than that of 1980 to 1982. High-grade lymphomas show statistically significant secular increases in both never-married and ever-married men, but only the rates of Burkitt's lymphomas have increased to a greater extent in never-married men. A small but significant increase of central nervous system lymphomas is seen in both marital status groups. There is no evidence of any AIDS-related increases in Hodgkin's disease, leukemia, testicular cancer, anal cancer, liver cancer, oral cancer, multiple myeloma, or malignant melanoma. As of 1985, cancer, as a manifestation of AIDS, is still apparently limited to KS and high-grade lymphomas (particularly Burkitt's) in Los Angeles County.

Acquired Immunodeficiency Syndrome↗
PubMed1988

Femoral shaft fracture after hip arthroplasty.

Femoral shaft fractures after hip arthroplasties were treated in 74 noncemented hemiarthroplasties and 65 cemented arthroplasties. In loose prostheses the best clinical results and the least number of operations were achieved with revision arthroplasty with a long-stem prosthesis, combined with simple internal fixation methods when applicable. In firmly fixed prostheses the results of revision arthroplasty and traction treatment were similar. Cemented revision arthroplasty did not interfere with fracture union. Internal fixation with the prosthesis in situ cannot be recommended because of a large number of secondary revision arthroplasties and nonunions. Removal of the femoral stem prosthesis and internal fixation nearly always require a secondary revision and cannot be recommended.

Adult↗
PubMed1988

Metastasis size in pathologic femoral fractures.

Radiographic assessment was made of metastases in 69 consecutive patients with pathologic femoral fractures. The following variables were considered: width of metastasis, ratio between width of metastasis and bone, axial length of cortical destruction, and proportion of cortical bone destroyed of the circumference. Differences in size of the metastases were not related to location in the femur or histologic type. In 62 of 69 fractures the ratio between width of the metastasis and bone was greater than or equal to 0.60, axial cortical destruction in the neck was greater than or equal to 13 mm and in other parts of the femur greater than or equal to 30 mm, and cortical destruction of the circumference greater than or equal to 50 percent. Prophylactic internal fixation need not be considered for femur metastatic lesions that do not reach these limits.

Adult↗
PubMed1987

Fractures after hemialloplastic hip replacement.

Forty-four patients sustaining ipsilateral femoral shaft fractures after hemialloplastic hip replacements are evaluated according to risk factors for the fractures, treatment and social costs. The fracture incidence was 0.10, and almost half of the fractures occurred within 1 year after the initial alloplastic operation. Possible factors increasing the risk of secondary fracture included loosening of the prosthesis (eight cases), osteoporosis (14 cases), varus angulation of the femoral stem (28 cases), calcar resorption (nine cases), major capsular calcifications (four cases), and cortical defects at the tip of the stem (three cases). The importance of correct insertion of the prostheses is emphasized. The degree of mobilization after fracture healing was overall reduced and most pronounced with increasing age and not correlated to treatment. The earliest mobilization was obtained in patients treated with long-stem prostheses supplemented with internal fixation, and this method of treatment is advocated.

Aged↗
PubMed1986

Hemi-arthroplasty of the hip followed by ipsilateral fracture of the femoral shaft.

In a series of 74 ipsilateral fractures of the femoral shaft in relation to hemi-arthroplasties, treatment by a cemented long-stem total hip replacement was found to be superior to conservative treatment or internal fixation without removal of the prosthesis. Acceptable clinical results were obtained in 89 per cent of these cases.

Aged↗
PubMed1985

Prophylactic antibiotics in amputation of the lower extremity for ischemia. A placebo-controlled, randomized trial of cefoxitin.

Of 152 patients who were scheduled for an amputation for ischemia, seventy-seven were randomly assigned to perioperative prophylaxis with cefoxitin (Mefoxin) and seventy-five patients, to injections of a placebo. The patients were followed for twenty-one days or, in the case of wound complications, to the end of treatment. An infected wound occurred in 38.7 per cent of the patients in the placebo group and 16.9 per cent of those in the antibiotic group (p less than 0.005). Clostridial infection occurred in eight patients in the placebo group and in none in the antibiotic group (p = 0.003). Three of the patients with clostridial infection died of gas gangrene. A multivariate analysis showed that the absence of antibiotic prophylaxis increased the risk of infection by a factor of 3.3 (p = 0.004) and increased the need for reamputation by a factor of 4.5 (p = 0.003). We concluded that amputation patients should have prophylaxis with a broad-spectrum antibiotic given perioperatively.

Adult↗
PubMed1983

Frictional forces and ankle fractures in sport.

The frictional forces between the sports footwear and the ground can induce distorsion trauma to the lower extremity. Two cases are reported in which fractures about the ankle are related to this friction. An adjustment and reduction of the frictional forces are recommendable.

Adolescent↗
PubMed1979

Risk factors for nodular sclerosis and other types of Hodgkin's disease.

The age-adjusted incidence rates of nodular sclerosis in Los Angeles County from 1972 to 1975 were 58% lower in Mexican-Americans and 42% lower in blacks than in other whites. They were the same for each sex among other whites and the curve of age-specific incidence peaked in young adulthood. The incidence of nodular sclerosis was directly associated with social class. In contrast, the rates for other histological varieties of Hodgkin's disease (lymphocyte predominance, mixed cellularity, lymphocyte depletion) were only 12% lower in Mexican-Americans but 34% lower in blacks. In other whites, the rates were 92% higher in men and increased gradually with age while there were no clear trends with social class. These characteristics support the hypothesis that, at least for purposes of etiology, the nodular sclerosis form of this disease should be considered a distinct entity. Self-administered questionnaire were completed by 218 of the 1972 to 1973 Hodgkin's disease patients and 218 individually matched neighbourhood controls. Significantly high risk ratios for Hodgkin's disease were found for prior appendectomy (risk ratios = 1.9, p = 0.01) and for past amphetamine use (risk ratios = 3.0, p = 0.01). The elevated risk associated with amphetamine use had been found in a previous study.

Adolescent↗
PubMed1976

Identification of Neisseria gonorrhoeae in cultures from tonsillo-pharyngeal specimens by means of a slide co-agglutination test (Phadebact Gonococcus Test).

A slide co-agglutination test (Phadebact Gonococcus Test) for the serological identification of Neisseria gonorrhoeae was assessed on gonococcal-like, oxidase positive colonies from 120 cultures, originating from about 6,500 consecutive tonsillo-pharyngeal specimens received at the Neisseria Department, Statens Seruminstitut. The test was performed after subculture on a serum-free medium, since this procedure was found to reduce the number of strains showing inconclusive reactions (pseudo co-agglutination). If this pseudo co-agglutination does occur, however, the test can be repeated with the addition of trypsin to the test system. This causes the previously inconclusive reactions to be reverted to clearly positive reactions in the case of gonococci, and to clearly negative reactions in more than half of the previously inconclusive reactions with other bacterial strains. The results obtained by the Phadebact Gonococcus Test were compared with those obtained by bacteriological identification procedures. Fifty-six of the 120 cultures examined contained gonococci, and all strains were identified by the slide co-agglutination test (five strains with the addition of trypsin). The remaining 64 cultures were negative or exhibited consistently pseudo co-agglutination (eight strains). The specificity and sensitivity of the reagent was further confirmed by the examination of 53 strains of Neisseria gonorrhoeae and 50 strains representing Neisseria species commonly occurring in tonsillo-pharyngeal specimens. The Phadebact Gonococcus Test was considered to be a reliable alternative to routine bacteriological identification of Neisseria gonorrhoeae.

Agglutination Tests↗
PubMed1975

Lung cancer and air pollution in southcentral Los Angeles County.

An increased rate of lung cancer has been consistently observed from 1968-1972 among males in southcentral Los Angeles. This excess risk occurs across several social classes and occupational categories. No differential excess of oral cavity, pancreatic, laryngeal and bladder cancer was observed in the same area, lessening the possibility that regional variations in smoking habits accounted for the excess lung cancer. Air sampling has indicated an excess of certain polynuclear aromatic hydrocarbons (PAH) in southcentral Los Angeles. There was a correlation between the geographic distribution of lung cancer cases and the general location of industries which have emitted these PAH. A case-controlled study of smoking, occupational and residential history in the southcentral area is underway.

Adult↗