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Biomedical subjects

M L Lesser

Publications and source records attributed to M L Lesser.

At least 73 records · Page 4Linked to original sources
PubMed1984

Breast carcinoma in women 35 years of age or younger.

The relationship of the age at diagnosis and prognosis in breast carcinoma remains controversial. A widely held perception is that the disease has a particularly unfavorable prognosis in young women. To examine this question we have studied 166 women treated for primary operable breast carcinoma who were 35 years of age or younger at the time of diagnosis. Groups of patients treated consecutively in each of two time periods nearly a decade apart (1964-1970 and 1976-1979) have been studied. Differences between the patient groups in primary surgical treatment and postoperative adjuvant therapy were characterized in the 1970s by the increasing use of modified radical mastectomy and replacement of postoperative radiation therapy by systemic adjuvant chemotherapy. A trend to earlier stage of disease was found among patients treated in 1976 to 1979, but 5-year recurrence and survival rates were not significantly different from those of young women treated in the 1960s. Comparison of Stage II patients treated in 1964 to 1970 with postoperative radiotherapy with comparable women given adjuvant chemotherapy from 1976 to 1979 revealed no significant difference in disease-free survival in the first 3 years after surgery. It remains to be seen whether these changes in therapy will diminish the frequency of recurrences after 5 years, leading to an improvement in overall survival. When compared with historical controls from this and other institutions, the 5-year and 10-year survival rates of approximately 75% and 60%, respectively, found in this study of young women with primary operative disease were not appreciably different from those of women treated for breast cancer at a later age when the disease is more common.

Adult↗
PubMed1984

Breast carcinoma in elderly women: pathology, prognosis, and survival.

There is a widely held belief that breast carcinoma occurring in elderly women is characterized by a relatively favorable prognosis and unusual histologic types of tumors. To assess these topics in a single patient group, 169 women (greater than or equal to 75 years) treated by mastectomy for primary operable breast carcinoma at Memorial Hospital (1964 to 1970) were identified. Followup revealed that 117 patients (70 percent) died. Thirty-eight women (22 percent) developed recurrent breast carcinoma and 35 (21 percent) were known to have died of the disease. Death was attributable to a cause other than breast carcinoma in 82 cases (49 percent). Remaining alive were 48 patients (28 percent) including 3 with recurrent carcinoma. Four patients (2 percent) were lost to followup. The age-adjusted survival experience of our elderly breast cancer patients was significantly poorer than that of a standard population when compared by the life table method. This difference appeared largely to reflect the mortality effect of breast cancer. Median times to recurrence (25 mo) and to death from breast carcinoma (27 mo) were not prolonged. Pathologic analysis revealed that some tumor types with a relatively favorable prognosis (mucinous, papillary, infiltrating lobular) occur more often in elderly women. However, this probably has little bearing on overall prognosis in the group since infiltrating duct carcinoma which constitutes nearly three-quarters of the tumors was responsible for 86 percent of deaths due to breast carcinoma.

Axilla↗
PubMed1984

The development of infections of the genitourinary tract in the wives of infertile males and the possible role of spermatozoa in the development of salpingitis.

Genitourinary tract infections developing in wives during marital life in 1,350 infertile couples were examined. Women married to men with a history of genital tract infection had a significantly higher incidence of vaginitis, urinary tract infection, salpingitis and genital herpes when compared with women whose husbands did not have genital tract infections before the marriage. Of the variables examined, the two factors that showed the most significant association with the tendency to develop salpingitis were the sperm count and the length of time the couple had been trying to achieve a pregnancy. The wives of azoospermic males did not have pelvic inflammatory disease develop but had the same incidence of infection of the lower part of the genital tract as the other studied groups. It is suggested that the bacterial flora of the seminal fluid can play a role in developing salpingitis in the female and that spermatozoa may be involved in delivering bacteria to the higher genital tract structures.

Adult↗
PubMed1984

Common bile duct pressure changes after fentanyl, morphine, meperidine, butorphanol, and naloxone.

Five groups of 10 patients received thiamylal, enflurane, nitrous oxide-oxygen anesthesia for elective cholecystectomy. The common bile duct was intubated via the cystic duct with a 16-g plastic catheter, and the control intraductal pressure was measured. Patients then were given equi-analgesic doses of fentanyl, morphine, meperidine, butorphanol, or placebo intravenously, and the common bile duct pressure was recorded for 20 min. Fentanyl, morphine, and meperidine significantly increased pressure in the common duct (P less than 0.001). Butorphanol produced only insignificant changes. Naloxone given 20 min later significantly (P less than 0.001) decreased pressure in patients given fentanyl, morphine, and meperidine. Naloxone given without narcotics caused an increase in pressure that, although statistically significant (P less than 0.03), was clinically insignificant. In five additional patients anesthetized with thiamylal, nitrous oxide-oxygen and intermittent doses of fentanyl, common bile duct pressures were normal.

Anesthesia↗
PubMed1983

Nosocomial bacterial eye infections in intensive-care units.

A cluster of ten nosocomial eye infections occurred in three intensive-care units during an 18-month period. Nine of the ten patients were intubated, all were obtunded, and all had copious sputum production. The bacteria isolated from the patients' sputum samples and from the eyes were identical in nine cases. Pseudomonas aeruginosa caused six of the infections, including all those with complications (three corneal ulcers, two hypopyon, one opaque cornea, two corneal rupture). Three patients lost their sight. Only the left eye was infected in nine cases. In a prospective study of bacterial dispersion during tracheal suctioning of twenty intubated patients, patients with copious secretions had significantly higher bacterial colony counts on settle plates than those without. Colony counts were higher on the side opposite to the hand the nurse used to withdraw the catheter than on the same side. Nurses tended to withdraw the catheter diagonally across the patient's face, which may explain the selective involvement of the left eye.

Adolescent↗
PubMed1983

The relationship between family history, exposure to exogenous hormones, and estrogen receptor protein in breast cancer.

Eight-hundred and thirteen patients were prospectively studied to examine the influence of family history and the prior use of exogenous hormones as covariables in the subsequent expression of estrogen receptor protein (ERP) in the primary tumor of patients with breast cancer. Cases were divided by menstrual status; there were 385 pre- and perimenopausal and 428 postmenopausal patients. The influence of prior exposure to estrogen replacement therapy (ERT) in postmenopausal patients or oral contraceptives (OC) in pre- and perimenopausal patients on tumor ERP was analyzed controlling for family history: none, first degree (1 degree, mother or sister), second degree (2 degrees, grandmother or aunt), or both 1 degree and 2 degrees relatives. The results showed no influence of the prior use of ERT in postmenopausal women on subsequent tumor ERP. Among pre- and perimenopausal women, those with a family history of breast cancer in only a 1 degree relative, showed a borderline significant association between prior OC usage and subsequent tumor ERP. The use of OC was consistently associated with ERP negative tumors (9/9) whereas of 29 patients who had no prior OC exposure 17 had ERP negative tumors (P = 0.04, Fisher's Exact Test). Analysis of the prior exposure to OC, verified with the primary care physician or pharmacist, showed that these patients first used OC at the mean age of 32.2 years, had used OC for a mean duration of 41.9 months and stopped OC use a mean of 79.5 months before being diagnosed as having breast cancer. These results suggest that in a subset of patients with breast cancer, and a first degree relative only who had breast cancer, prior exposure to OC may influence the subsequent ERP status of the tumor. This is not due to exogenous estrogen saturation of receptors as there was a long latent period between exposure and diagnosis. Alternative hypotheses as to the mechanism of selection of subsequent tumor ERP may be either inhibition of ERP positive preneoplastic or tumor cell clones early in the evolution of the tumor or early selection of a tumor capable of endogenous estrogen synthesis with receptor saturation.

Breast Neoplasms↗
PubMed1983

Prophylactic oophorectomy in surgery for large-bowel cancer.

From 1968 to 1975, 201 women had prophylactic oophorectomy at the time of definitive large-bowel resection, while in 134 patients oophorectomy was not performed. Oophorectomy was performed more commonly in women with cancer of the rectum and rectosigmoid. More patients undergoing oophorectomy had Dukes' C primary carcinoma. Four patients undergoing synchronous oophorectomy (2.0 per cent) had ovarian involvement or metastases from large-bowel cancer. Three patients (2.2 per cent) developed subsequent ovarian disease: two cases of ovarian carcinoma and one case of ovarian metastases from primary breast cancer. No late ovarian recurrences of large-bowel cancer were seen during this study. No patient with ovarian involvement or metastases from large-bowel cancer survived five years nor was the overall survival of the group of women undergoing oophorectomy materially affected. While stage and site significantly influenced survival, oophorectomy, menopausal status, preoperative irradiation, tumor size, and degree of differentiation had no influence. The prevention of primary ovarian cancer in postmenopausal women is considered to be the main benefit of bilateral prophylactic oophorectomy. Selective recommendations for oophorectomy under other circumstances are discussed.

Adenocarcinoma↗
PubMed1983

Discontinuous or "skip" metastases in breast carcinoma. Analysis of 1228 axillary dissections.

Patterns of axillary lymph node metastases were analyzed in 1228 recently performed modified, radical, and extended radical mastectomies. In these specimens the position or level of lymph nodes was designated intraoperatively by the surgeon. No lymph node metastases were found in 720 (58) of the specimens while the remainder (508 or 41%) had at least one affected lymph node. The distribution of involvement by level showed progressive spread from level I to III as the number of positive lymph nodes increased. Discontinuous or "skip" metastases not following this pattern occurred in 1.6% of all cases and 3% of those with lymph node metastases (95% confidence interval, 1-5%). Half of those with "skip" metastases had tumor limited to level II. The presence of "skip" metastases was not related to the size, location in the breast, or histologic type of the primary tumor. It is apparent that the potential risk from "skip" metastases is not great and that this should not be a major consideration in therapeutic decisions. The risk is likely to be negligible for women treated by axillary dissections that include level II.

Adult↗
PubMed1982

A randomized trial of ascorbic acid in polyposis coli.

The possibility of pharmacological control of large bowel adenomas has been suggested by effectiveness of antioxidants in experimental tumor models and by the results of a limited clinical study using ascorbic acid. Over a two year period we tested this hypothesis in a randomized, double-blind study of 49 patients with polyposis coli. Of 36 patients who were evaluable at completion, 19 had received ascorbic acid, 3 g/day, and 17 had received a placebo. We found a reduction in polyp area in the ascorbic acid-treated group at nine months of follow-up (P less than 0.03) and trends toward reduction in both number and area of rectal polyps during the middle of the trial. A labeling study of rectal epithelium with tritiated thymidine also hinted at a treatment effect. Our data suggest that ascorbic acid temporarily influenced polyp growth or turnover. Although these results have no current therapeutic value, our findings support continued studies of chemoprevention in this and other high risk settings.

Adult↗
PubMed1982

Epidemiology of breast carcinoma III: relationship of family history to tumor type.

Previous breast carcinoma in at least one female relative was reported by 31% of 1024 women treated consecutively for breast carcinoma at Memorial Hospital. Eighty (7.9%) of their mothers had had breast cancer. Maternal breast cancer was significantly (P less than 0.006) more frequent among women with medullary carcinoma than those with other tumor types and among those who were pre- or perimenopausal at diagnosis (P less than 0.001). Among the 727 patients who had one or more sisters, 12% had a sister who had been treated for breast cancer. The highest frequency of carcinoma in at least one sister occurred in patients with lobular carcinoma while the medullary carcinoma group had the least number of patients with an affected sister (P less than 0.03). Occurrence of breast cancer in a sister was almost twice as common in patients who were postmenopausal at diagnosis (P less than 0.005) than in premenopausal patients. When stratified by histologic type, the mean age at diagnosis of the patients did not differ appreciably from the age at diagnosis of their sisters. Detailed analyses of histologic type and other more distant familial relationships were also obtained but were considered to be less reliable because of problems in ascertainment and there were fewer affected relatives. No single histologic type of carcinoma was consistently linked to a disproportionately high or low frequency of carcinoma in all classes of relatives. It is possible that studies of family history limited to information available when the patient is first treated present an incomplete picture of familial aggregation. Further follow-up after diagnosis is needed to obtain a more reliable measure of the extent to which relatives are affected by breast cancer and patterns of family distribution associated with specific tumor types.

Adult↗
PubMed1982

Epidemiology of breast carcinoma IV: age and histologic tumor type.

The purpose of this study was to correlate major chronologic events known to have a bearing on the risk for developing breast carcinoma with histologic tumor type. Data were obtained for 1024 consecutively treated patients with the seven most common forms of mammary carcinoma. The age of occurrence of the following events was determined: menarche; first marriage; first pregnancy and first childbirth; last pregnancy and last childhood; diagnosis. The interval between each of these events and diagnosis of breast cancer was also calculated. Patients with medullary carcinoma had a significantly lower mean age at diagnosis than those with any of the other tumor types. Because of the lower mean age at diagnosis, medullary carcinoma patients were found to have significantly shorter intervals between age at diagnosis and the following: menarche, first pregnancy or first childbirth, and last pregnancy or last childbirth. Intervals between age at diagnosis and these other events were not significantly different among patients with other types of carcinoma. The ages of menarche, marriage, or pregnancy were not related independently to any tumor type. These data indicate that except for current age, the age of occurrence of major risk factors for developing breast cancer is unrelated to the histological type of tumor a patient develops.

Adult↗
PubMed1982

Ureaplasma urealyticum and infertility: the effect of different antibiotic regimens on the semen quality.

Objectives criteria of semen quality were evaluated in 243 men treated for Ureaplasma urealyticum genital tract infection with 1 of 4 different antibiotic regimens. Significant improvement was observed in motility, quantity, quality, and percentages of oval and small forms. Doxycycline, whether used for 2 or 4 weeks, at a dosage of 100 mg, twice daily resulted in the same cure rate (79 and 81 per cent, respectively). Tetracycline regimens of 500 mg. 3 times daily for 2 or 4 weeks had significantly inferior cure rates (17 and 55 per cent, respectively). These findings suggest that antibiotic therapy could be valuable in improving semen quality when Ureaplasma is isolated, and that followup culture for the organism should decide the endpoint in therapy, since resistant strains for doxycycline and tetracycline are emerging.

Bacterial Infections↗
PubMed1982

Multicentricity and bilaterality in invasive breast carcinoma.

Multicentricity and bilaterality are well-established characteristics of breast carcinoma, but little is known about the relationship of these variables with each other. This question was explored by analyzing the data pertaining to 880 women with invasive breast carcinoma. Patients with multicentric carcinoma had bilateral disease more often than those whose carcinoma was apparently limited to a single quadrant. Among women who had lobular carcinoma in situ coexisting with infiltrating duct carcinoma or infiltrating lobular carcinoma, bilaterality and multicentricity were significantly more common than they were among patients whose only lesion was infiltrating duct or medullary cancer. Other variables associated with bilaterality and multicentricity were degree of ductal differentiation, tumor size, nodal status, type of tumor margin, intensity of lymphoid infiltrate, and menstrual status. Age at diagnosis and estrogen receptors were related to bilaterality but not to multicentricity. The following variables proved to be unrelated to bilaterality and multicentricity: family history of breast carcinoma, height, weight, and parity. The data obtained in this study tend to support a conclusion that multicentricity and bilaterality are manifestations of similar factors involved in the neoplastic transformation of mammary gland epithelium leading to the development of breast cancer.

Age Factors↗
PubMed1981

Estrogen and progesterone receptors in breast carcinoma: correlations with epidemiology and pathology.

Analysis of estrogen receptor protein (ERP) was carried out on 784 patients with primary breast carcinomas. Significant relationships were found with the following epidemiologic features; age at diagnosis, menstrual status, race, and use of exogenous hormones (contraceptive and menopausal estrogens). Patients taking either type of hormone at diagnosis had lower median total ERP binding levels. Although the data do not explain how recent hormone usage affects tumor ERP, it seems advisable to discontinue these hormones as early as possible before a breast biopsy because they may cause spuriously low ERP levels. Correlation with pathology variables confirmed most prior observations relating to tumor type, histologic grade, and lymphocytic infiltrate. However, in this large series, infiltrating lobular carcinomas were not ERP-positive more frequently than duct carcinomas to any significant degree. The pattern of progesterone receptors (PRP) did not vary significantly with menstrual status, but in other respects correlations of epidemiologic and pathologic variables were similar for ERP and PRP.

Age Factors↗
PubMed1981

Androgen stimulated chemotherapy in the Dunning R-3327 prostatic adenocarcinoma.

This study was undertaken to determine whether hormonal stimulation followed by chemotherapy with a cell-cycle specific agent would improve the effectiveness of the chemotherapy in a prostatic adenocarcinoma model. One hundred Copenhagen rats were randomised into 5 equal groups and injected subcutaneously with 2 x 10(7) cells of Dunning G strain prostatic adenocarcinoma. The groups were treated in the following fashion: 1. sham operated controls, 2. castration, 3. castration and methotrexate, 4. castration, testosterone and methotrexate and 5. castration and testosterone. When the tumours became palpable, all animals received the surgery to which they were randomised. Subsequent hormonal and chemotherapy was started 1 week thereafter. Therapy was given for 5 consecutive days followed by a 16-day recovery period and then continued in a cyclical fashion. Serial measurements of animal weights and tumour size were obtained. Analysis of tumour growth was restricted to the first 29 days of therapy because of a rapid decline in animal survival beyond that point. The group treated with castration, testosterone, and methotrexate inhibited tumour growth more than any other group and was the only group that was significantly different from control (P less than 0.05).

Adenocarcinoma↗