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Biomedical subjects

H Vorherr

Publications and source records attributed to H Vorherr.

At least 19 recordsLinked to original sources
PubMed1987

Endocrinology of breast cancer.

Oestrogen predominance over progesterone may cause hyperproliferation of mammary epithelium and thus promote breast carcinogenesis. In patients with a hormone-dependent tumour, oestrogens may also accelerate cancer growth. Conversely, they may inhibit tumour growth in patients with an oestrogen receptor-negative carcinoma which has grown in an oestrogen-poor environment. Progesterone opposes oestrogen-induced epithelial proliferation and causes cellular differentiation with decreased mitosis, thus reducing the risk of breast cancer. Prolactin brings about mammary epithelial differentiation for secretory function; in the lactation state, epithelial proliferation is minimal. The role of androgens, melatonin, thymosin, metabolic hormones (growth hormone, thyroid hormone(s), insulin, glucocorticosteroids) and prostaglandins in the pathobiology of breast cancer is poorly understood. A breast cancer population consists of individuals in whom more than 20 different tumour subsets may be present, i.e. patients with different individual tumour pathobiology and endocrinology patterns and therefore different prognoses. Progress in the endocrinology of breast cancer seems possible through prospective studies in which hormones are determined in normal breast tissue (ductal fluid, cyst fluid) and then related to the corresponding concentrations in the plasma and urine of patients who develop breast cancer and those who do not. In addition, genetic and nonhormonal risk factors for breast cancer must be taken into consideration to define the endocrinological aspects involved.

Aged↗
PubMed1986

Fibrocystic breast disease: pathophysiology, pathomorphology, clinical picture, and management.

The pathophysiology of fibrocystic breast disease is determined by estrogen predominance and progesterone deficiency that result in hyperproliferation of connective tissue (fibrosis), which is followed by facultative epithelial proliferation; the risk of breast cancer is increased twofold to fourfold in these patients. The clinical correlate of fibrocystic disease is reflected by breast and axillary pain or tenderness in response to development of fibrocystic plaques, nodularity, macrocysts, and fibrocystic lumps. The disease progresses with advancing premenopausal age and is most pronounced in women during their 40s. Fibrocystic changes regress during the postmenopausal period. Medical treatment of fibrocystic disease is accomplished: by suppression of ovarian estrogen secretion with a low-estrogen oral contraceptive, whereby the action of estrogen on breast tissues is opposed by the oral contraceptive's progestin component (19-nortestosterone derivatives), or by cyclic administration of a progestogen (progesterone, medroxyprogesterone acetate) that modulates the mammary effects of estrogen. These treatment modalities are equally as effective as or superior to danazol therapy, which entails side effects in the majority of patients. Adjuvant therapy of fibrocystic breast disease with vitamin E is of value in patients with borderline or abnormal lipid profiles (low plasma levels of high-density lipoprotein and high plasma levels of low-density lipoprotein). With thorough diagnostic evaluation, appropriate medication, and close follow-up, treatment success can be achieved in almost every patient. Needle aspiration biopsy should be performed in patients with macrocysts and whenever clinical, ultrasonic, and/or mammographic examinations are suspicious for carcinoma. Patients at high risk of breast cancer (breast cancer in mother and/or sister) should have clinical examinations at 4- to 6-month intervals and mammography every 1 to 2 years; needle aspiration should be performed when the slightest suspicion arises. Fibrocystic breast disease is not a "harmless nondisease" but a distinct clinical entity that requires treatment to bring about relief to the patient, to reduce the incidence of breast surgical procedures, and to diminish the risk of breast cancer.

Adenofibroma↗
PubMed1985

[Objective measurement of lymphedema after mastectomy].

A new optic-electronic method for measuring arm volume was used on 275 women before and after mastectomy for carcinoma of the breast. Two weeks after modified radical mastectomy, an increase of over 150 ml in arm volume over the preoperative value was recorded in 12% of patients. Lymphoedema was demonstrated on average 19.3 months after the operation and telecobalt treatment in 42% of 200 women so treated; in 17% it was of moderately severe to severe degree (over 400 ml). In patients with severe lymphoedema a 15-day period of treatment reduced the oedema volume on average by 383 ml (62.1%). The described optic-electronic volumetric method makes it possible to obtain an objective comparison of swelling of the arm and thus early recognition and treatment of lymphoedema, as well as providing a means of assessing the effectiveness of any treatment.

Adult↗
PubMed1985

Breast aspiration biopsy with multihole needles for histologic and cytologic examination.

Multihole needle biopsy has been performed on 166 patients. Commercially available 22-, 20-, 18-, and 16-gauge hypodermic needles (40 to 75 mm in length) are prepared with three sharp-edged holes around the distal part of the needle, allowing aspiration of 3 to 6 ml or more of tissue, for both histologic and cytologic examination. Of patients with carcinoma, fibrocystic disease, fibroadenoma, intraductal proliferation (papillomatosis), and duct ectasia, multihole needle cytologic examination is significantly more accurate (35% to 83%) than single-hole needle examination (11% to 67%). Multihole needle histologic examination, however, is far more accurate, with diagnostic success ranging from 75% to 94% for the disorders described above. The procedure has several uses. For patients with isolated fibrocystic areas, duct ectasia, or papillomatosis, multihole needle biopsy not only is diagnostic but may also be therapeutic by virtue of removal of abnormal tissue by aspiration. Biopsies of areas of microcalcification can be obtained under x-ray control. In patients at high risk of breast cancer (carcinoma in mother and/or sister), breast aspiration is performed when the slightest suspicion arises. In patients with unilateral breast cancer at high risk of bilateral carcinoma (premenopausal breast cancer, lobular carcinoma, tubular carcinoma, family history of breast cancer), random needle biopsy is performed in the contralateral breast for cancer detection. Furthermore, during follow-up of breast cancer patients, biopsies of locoregional changes or suspicious areas in the contralateral breast are obtained with the multihole needle for diagnostic evaluation. Thus multihole needle biopsy represents an improvement over the single-hole needle currently used, with enough tissue provided for adequate initial diagnosis and follow-up diagnostic evaluations in patients with benign and malignant breast disease.

Adult↗
PubMed1985

Cystosarcoma phyllodes: epidemiology, pathohistology, pathobiology, diagnosis, therapy, and survival.

Cystosarcoma phyllodes is a very rare tumor which maybe difficult to diagnose clinically. The epidemiology and pathobiology are different from those of breast carcinoma. Risk factors, multicentricity, bilaterality, as associated with breast carcinoma, are not observed in patients with cystosarcoma phyllodes. Although the term "sarcoma" indicates a malignant tumor, only 10%-30% of cystosarcomas are histologically diagnosed as malignant; clinical diagnosis of malignancy does not exceed 10%. Axillary node involvement is rare, but hematogenous spread of cystosarcoma occurs into lung, pleura, bone, and liver. Clinically, cystosarcoma is a large (usually 3-5 cm in diameter) painless tumor with sudden growth acceleration especially during pregnancy. Cystosarcoma is usually circumscribed, containing firm and soft areas. The differential diagnosis has to include fibroadenoma, fibrocystic disease, mastitis, abscess, and medullary carcinoma. Neither clinical, mammographic or sonographic signs exist to predict a benign or malignant tumor. Therapy of cystosarcoma is not uniformly agreed upon. Radical, modified-radical, and simple mastectomy and tumorectomy are typical treatments; therapeutic results are the same for each treatment modality. For histologically diagnosed malignant cystosarcoma, the relative 5-year survival rate is about 80%. Clinically, malignant metastatic cystosarcoma is incurable; radiotherapy, endocrine treatment, and polychemotherapy are all ineffective. Because of the specific tumor pathobiology of cystosarcoma and its rarity, evaluation of treatment modalities and comparison of survival rates are difficult.

Breast Neoplasms↗
PubMed1984

Embryonic/fetal growth following suckling-induced delay of implantation.

In rats fertilized during the first or second day post partum (second consecutive pregnancy), suckling induces delay of implantation for 8 to 22 days. However, pregnancy is prolonged for only 3 to 17 days because accelerated embryonic and early fetal growth makes up 4 to 5 days of the implantation delay. After implantation, embryonic/fetal growth is accomplished within 11 to 12 days for a second consecutive pregnancy, whereas 16 days are required for first or second-spaced pregnancies. After weaning, increased function of the intestinal tract and liver is not needed anymore for mammary milk synthesis, and abundant nutrients can be shifted to the uteroplacental unit for rapid embryonic/fetal growth. Because the exponential curves for fetal growth are similar for first, second consecutive, and second-spaced pregnancies, it seems that, besides an increased supply of nutrients, an as yet unidentified maternal or a placentofetal factor(s) may play a role for embryonic/fetal growth.

Animals↗
PubMed1984

Adjuvant chemotherapy of breast cancer: hope--reality--hazard?

According to a NIH Consensus-Development Statement, adjuvant polychemotherapy following mastectomy is considered beneficial to premenopausal patients with positive axillary nodes. Nevertheless, the role of adjuvant chemotherapy in relation to menopausal status, axillary lymph node status, estrogen receptor status, choice and dose of agents, and long-term survival is not defined. Based on experimental background information and theoretical deductions, the clinical results have fallen short of expectations. The data of Bonadonna's CMF study reveal that the overall 5-year survival is increased by 4%; premenopausal patients benefit by 12% whereas treated postmenopausal patients have a 5% less chance of survival. Only those patients benefit who can tolerate a "full or nearly full dose"; these are only 17%. At this time it is not clear whether the small survival differences from adjuvant chemotherapy represent a real step forward in the fight against breast cancer. In the majority of patients (75 to 85%), at the time of adjuvant chemotherapy, systemically disseminated cancer cells are at mitotic rest or their proliferation is minimal. At this stage, adjuvant chemotherapy has no or little effect. Therefore, only a small proportion of patients (15 to 25%) has subclinical systemic cancer growth at the time of primary therapy or thereafter; only these patients have a chance to respond to chemotherapy. In view of this tumor kinetic problem and the hazards of chemotherapy, it seems advantageous (a) to focus on definition of patient subgroups at high risk for early recurrence post primary therapy to serve as participants in trials of adjuvant chemotherapy and/or (b) to concentrate on early diagnosis of recurrent disease for immediate institution of endocrine- and/or polychemotherapy.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1984

Pathobiology of breast cancer--treatment implications.

In most patients (approximately 85%), breast cancer at the time of diagnosis is already a systemic disease. Multicentricity (20-40%) and synchronous (5-10%) and metachronous (15-30%) bilaterality are indicative of etiologically similar noxae. Ductal and lobular carcinoma in situ become invasive in approximately 50% of patients. Whereas ductal carcinoma in situ is mainly diagnosed clinically (lumpiness, tissue irregularity), lobular carcinoma in situ, a small, nonpalpable lesion, is usually discovered accidentally following biopsy for fibrocystic disease and/or suspicious mammography. Treatment of in situ and minimal (small invasive) breast cancer (less than or equal to 5 mm in diameter) is controversial, ranging from observation (lobular carcinoma in situ) over segmental excision to simple or radical mastectomy with or without lymphadenectomy and contralateral "mirror-image" biopsies. Long-term survival rates (90-95%) appear similar for patients with treated or untreated lobular carcinoma in situ. Patients with minimal breast cancer have as good a prognosis as those with ductal carcinoma in situ (long-term survival, 80-90%). Presently, a trend from radical to conservative surgery (lumpectomy, segmentectomy) is observed. Especially for in situ carcinoma, modified radical or even simple mastectomy may be considered overtreatment. For invasive carcinomas, lumpectomy and radiotherapy provide as good a chance of survival as radical mastectomy. Such equal survival indicates that although in 25% to 45% of patients with invasive carcinoma multifocal disease (in situ and invasive carcinoma) is left behind, subsequent radiotherapy is effective. Accordingly, patients with carcinoma in situ may be spared mutilating surgery in favor of radiotherapy. Because many patients at extraordinarily high risk of breast cancer cannot accept prophylactic mastectomy, thorough follow-up by clinical examination, mammography, sonography and biopsy is essential.

Breast Neoplasms↗
PubMed1984

Antimicrobial effect of chlorhexidine and povidone-iodine on vaginal bacteria.

The antimicrobial potency of 4 per cent chlorhexidine gluconate was compared with that of 10 per cent povidone-iodine (1 per cent free iodine) on the vaginal bacteria of 150 premenopausal, non-pregnant women. From 30 of the women blood samples were taken before and at either 15, 30 or 60 minutes after vaginal cleansing with chlorhexidine for chlorhexidine analysis. Five minutes after applying either chlorhexidine or povidone-iodine almost 99 per cent of bacteria present on the lateral wall of the vagina were killed. Chlorhexidine was significantly more effective than povidone-iodine. Serosanguineous , mucoid or white-yellowish vaginal discharge did not alter the effectiveness of either antimicrobial agent. In contrast to povidone-iodine, vaginally applied chlorhexidine was not absorbed in measurable amounts (sensitivity of detection method: 0 X 1 mg/l) into the bloodstream. Chlorhexidine may therefore prove of value for treating vaginitis especially during pregnancy and also for combating microbes such as Group B streptococci which are potentially harmful to the newly-born child.

Absorption↗
PubMed1984

Suckling-induced delay of implantation and increased fecundity in rats.

In rats fertilized during the 1st or 2nd day postpartum (second consecutive pregnancy), suckling induces intrauterine blastocyst dormancy and delays implantation for 8-22 days. In spite of this relatively long time of blastocyst dormancy, associated with greatly reduced cellular metabolism, subsequent implantation and growth results in significantly larger litters (13.6 +/- 0.62; means +/- SE) than in primigravidas (10.4 +/- 0.89) or in rats with a second-spaced pregnancy (11.2 +/- 0.72). Enhanced fecundity in rats with second consecutive pregnancies may be attributed to increased ovarian blood supply of preceding gestation and/or to augmented pituitary FSH-LH secretion resulting in intensified ovarian gonadotropic stimulation for postpartum ovulation.

Animals↗
PubMed1982

Factors influencing fetal growth.

Fetal growth is exponential and during the last 20 weeks of gestation the fetus gains 95% of its weight. Genetic, nutritional, environmental, uteroplacental, and fetal factors have been suggested to influence fetal growth. Uteroplacental and umbilical blood flow and transplacental glucose and fetal insulin are major determinants of fetal growth. The role of the fetal pituitary (growth hormone) and thyroid in fetal growth is not well understood; human anencephalic or athyroid fetuses usually have no or only minor retardation of growth. Also, it is not clear whether placental lactogen or somatomedin or a somatostatin-like substance of the placenta and fetus influences fetal growth. From experiments on rats it may be assumed that a specific placental-fetal growth-promoting and growth-regulating factors(s) exists. Identification of such a placental-fetal growth factor(s) in humans might aid in the prevention, diagnosis, and treatment of fetal growth retardation.

Animals↗
PubMed1982

Aspects of breast cancer control: is prophylactic mastectomy a feasible modality?

Even though mammographic techniques have improved and small tumors of 0.5 cm in diameter can be detected, decreased breast cancer mortality has not yet resulted. Because small tumors may cause systemic spread, in many patients breast cancer at the time of diagnosis is a systemic disease which is incurable. A reduction in breast cancer mortality seems possible by prophylactic bilateral mastectomy in women at extraordinary high risk of breast cancer. These are patients with (a) breast cancer in mother and sister, (b) breast cancer in mother or sister and a combination of various risk factors (early menarche - late menopause, nulliparity, late first pregnancy), (c) noninvasive malignant breast disease (carcinoma in situ), (d) therapy-resistant fibrocystic disease with intolerable pain and/or extreme anxiety (carcinophobia, and (e) benign breast neoplasia with malignant potentials (cellular atypia = precancerosis). Also, in breast cancer patients without regional and systemic spread and who are at high risk for developing cancer in the other breast, prophylactic contralateral mastectomy may be indicated. These are patients with (a) unilateral invasive breast cancer in the premenopause and a family history (mother or sister) of breast cancer, (b) unilateral invasive lobular carcinoma or tubular (ductal) carcinoma, and (c) unilateral invasive breast cancer and precancerous lesions in the other breast.

Adult↗