[Experiences with cases of diphtheria in Stockholm during the spring of 1986].
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Biomedical subjects
Publications and source records attributed to L Hellström.
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A preliminary study of the relationship between a physically active versus a physically non-active life before a myocardial infarction and coping ability (e.g. psychosocial effects) after a myocardial infarction has been performed. In a mainly rural area in south-western Sweden all myocardial infarction sufferers (N = 49) during January 1984-August 1986, fulfilling certain criteria, were sent a questionnaire with special emphasis on their present and former exercise habits and psychosocial situation. The results indicate that there is a positive relation between a physically active as compared with a physically non-active life and coping ability in terms of fewer expressed depressions, better experienced relations in the family and higher degree of return to work, after a myocardial infarction among the physically active. However, further investigations are needed in order to explain the mechanisms involved. The results further imply that primary and secondary prevention must support the "risk-individual's" coping ability from a multifactorial view, built on holistic caring.
In the interval between screening examinations, some cases of breast cancer are invariably detected clinically in patients whose mammogram was considered to be normal at the earlier screening. During the first interval in the Stockholm study, 60 interval cancers were detected, giving a rate of 1.8 cases/1000 examinations/24 months. About half of these interval cases (31/60) were true interval tumours in that no sign of them could be found on the first mammogram; the other half, non-true, were possible to trace on the first mammogram. It is mainly women under 50 who feature in the interval group, above all in the sub-group of true interval cancers (p less than 0.05). The incidence of interval cancer rises, as expected, with the length of the interval (Fig. 1). In the final six months of the 2-year interval the incidence of interval cancers had risen to 88 per cent of the cancers detected in the control group in the same period of time. The cumulative incidence of interval cancers supports the hypothesis that the distribution of sojourn time in the interval 0-2 years is approximately rectangular. This means that shortening the interval by one-half would halve the number of interval cases. If mammography becomes a wide spread screening method for early detection of breast cancer, the number of non-true interval cancers could be a feed back on the effectiveness of the screening.(ABSTRACT TRUNCATED AT 250 WORDS)
The relationship between mammographic appearance of microcalcifications and tumor stage, malignancy grade, estrogen receptor (ER) content and nuclear DNA pattern was studied in 92 mammary carcinomas. The results indicate that no complementary prognostic guidance can be obtained from the radiographic appearance of a tumor apart from a high probability of a spiculated cancer being ER-rich. The finding of a relatively high proportion of aneuploid and ER-poor carcinomas among tumors with microcalcifications indicates that this radiographic characteristic might be associated with increased growth potential.
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In March 1981 a randomized single-view mammographic screening for breast cancer was started in the south of Stockholm. The screened population in the first round numbered 40,318 women, and 20,000 women served as a well-defined control group. The age groups represented were 40-64 years, and 80.7% of the invited women participated in the study. The first round disclosed 128 breast cancers (113 invasive and 15 noninvasive), or 4.0 per 1,000 women. Mean tumour size was 14.1 mm and axillary lymph node metastases were found in 21.8%. Fifty-five per cent of the tumours were small (less than or equal to 10 mm) or non-invasive, and 71% were stage I. Participation rates are high in all Swedish trials. The present results differ only slightly from other screening programs; the percentages of patients with axillary metastases and stage II tumours are similar in the Stockholm, Malmö and Kopparberg/Ostergötland studies. Comparisons of cancer prevalence in the various Swedish screening trials show that, in comparable age groups, there are some differences, even when the differences in the natural cancer incidence are taken into account. A decreased mortality was found recently in a Swedish trial in ages above 50 years but not below. In the Stockholm study more than one-third of the participants were aged 40-49 years.
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Forty-two so-called interval cancers of the breast were studied. The mammograms were reviewed and the tumors were classified as 14 'unrecognized', 9 'observer error', 1 'technical error' and 18 'true' interval cancers. By using a scoring system based upon histologic differentiation, axillary nodal status, estrogen receptor level, and nuclear DNA content, eight ductal carcinomas with high malignancy potential were identified. All of these tumors belonged to the group 'true' interval cancer. The data indicate that the mammographic subgroup 'true' interval cancer identifies the highly malignant tumors. However, even this strictly selected subgroup is heterogeneous since it also includes some tumors with low malignancy potential.
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The mammographic pattern and its relationship to the estrogen receptor (ER) content was studied in 184 breast cancers. The tumors were divided into five radiographic subgroups: mass with spicules (A), diffuse (B), clusters of calcifications without a mass (C), circumscribed (D), and not visible at mammography (E). The ER content of tumors belonging to group A was higher than that of the other subgroups in both pre- and postmenopausal women. 121 tumors belonged to group A, of which 80% were ductal cancers. The tumors in groups B and C had very low ER values and those of groups D and E had intermediate values. The likelihood of finding a high estrogen receptor content of a tumor is thus greater when the tumor radiographically is seen as a mass with spicules than when seen as an increased attenuation or as only clusters of calcifications. It is suggested that patients with tumors belonging to group A should have a more favorable prognosis than patients with tumors belonging to groups B and C.
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Serum concentrations of chloroquine were determined fluorometrically in 100 rheumatoid patients who had been treated with 0.25 gm daily for at least 2 mo. The total dose varied between 3.7 and 400 gm. No patient received more than 75 gm annually. In 15% of the patients side effects were noted. There was a relationship between serum concentrations and side effects but not with the total dose administered. Chloroquine displayed dose-dependent kinetics, which may indicate that close monitoring of serum concentrations is an aid to the safe and rational use of the drug.