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Biomedical subjects

N B Kumar

Publications and source records attributed to N B Kumar.

At least 19 recordsLinked to original sources
PubMed1994

Visceral obesity and breast cancer risk.

BACKGROUND: The risk for breast cancer and the sex hormone abnormalities noted in breast cancer patients have been demonstrated in women with upper body fat obesity. The objective of this study was to determine if the visceral component of upper body fat obesity was correlated with breast cancer risk. METHODS: A case-control study of 40 consecutively enrolled women with breast cancer and 40 community-based age, weight, and waist circumference-matched control subjects was conducted. The areas of visceral fat, subcutaneous fat, and total fat were measured using computed tomography at the L-4 vertebral body. Calculations of relative risk for breast cancer were based on these fat compartments. RESULTS: Patients with breast cancer had a significantly greater visceral fat area (P = 0.01), visceral-to-total-fat area ratio (VT ratio) (P < 0.001) and significantly lower subcutaneous-to-visceral-fat area ratio (SV ratio) (P < 0.001) compared with the matched controls. The relative risk for breast cancer increased with increasing VT ratio (< or = 0.24 = 1.0; > 0.24 = 9.5) (P < 0.0001) and decreasing SV ratio (> or = 3.64 = 1.0; < 3.64 = 8.5) (P = 0.0002). CONCLUSIONS: Visceral obesity, as assessed by computed tomography, was a significant risk factor for breast cancer in women matched for age, weight, and waist circumference. Comparing the VT ratio for both groups, breast cancer patients had 45% more visceral fat compared with matched control subjects.

Adult↗
PubMed1993

Efficacy of interactive, automated programmed instruction in nutrition education for cancer prevention.

Ninety-two undergraduates were assigned into groups to evaluate the effectiveness of interactive, computer-delivered programmed instruction for nutrition education on the topic of diet and cancer compared to traditional passive modes of instruction. Students were monitored for knowledge gains by means of a single 50-item test and an application task, using a 4-day diet record, administered 4 weeks prior to and 3 weeks after intervention. Results indicated that although subjects in the interactive group took nearly twice as long to complete the program, having the opportunity to respond to program blanks, this group produced significantly greater knowledge gains and lowered their fat intake by 41.8% compared to 26.1% reduction in fat intake in the noninteractive computer group and 18.6% in the passive prose text groups. Results suggest that interactive, computer-delivered, programmed instruction can be a very important adjunct to health care and cancer prevention programs at high schools and university settings.

Adult↗
PubMed1992

Mammography screening credit card and compliance.

BACKGROUND: Screening for breast cancer using mammography has been shown to be effective in reducing mortality from breast cancer. The authors attempted to determine if use of a wallet-size plastic screening "credit" card would increase participants' compliance for subsequent mammograms when compared with traditional methods of increasing compliance. METHODS: Two hundred and twenty consecutive women, ages 40-70 years, undergoing their first screening mammography were recruited and assigned randomly to four groups receiving (1) a reminder plastic credit card (2) reminder credit card with written reminder; (3) appointment card; and (4) verbal recommendation. Return rates of the four groups were determined after 15 months. RESULTS: The return rate for subsequent mammograms was significantly higher for participants (72.4%) using the credit card than for participants (39.8%) exposed to traditional encouragement/reminders (P less than 0.0001). CONCLUSIONS: The credit card was designed to show the participant's screening anniversary, and the durability of the card may have been a factor in increasing the return rate. The use of reminder credit cards may increase compliance for periodic screening examinations for other cancers and other chronic diseases.

Adult↗
PubMed1991

Upper-body fat distribution and endometrial cancer risk.

STUDY OBJECTIVE: --To determine if body fat distribution affected endometrial cancer risk. DESIGN: --Case-control study. SETTING: --This study was carried out at the H. Lee Moffitt Cancer Center at the University of South Florida, Tampa, where all patients in the case group received their diagnoses and histological confirmations. PATIENTS: --Forty consecutive women newly diagnosed with endometrial cancer and 40 controls matched for age and Quetelet index. MAIN OUTCOME MEASURES: --Anthropometric measurements were taken for the abdomen, thigh, suprailiac, subscapular, biceps, and triceps skin fold thicknesses; waist and hip circumferences, weight, and height. Relative risks for endometrial cancer were calculated according to these anthropometric measurements. RESULTS: --Case patients with endometrial cancer had significantly greater waist-to-hip circumference ratios (P less than .001), abdomen-to-thigh skin fold ratios (P less than .01), and suprailiac-to-thigh skin fold ratios (P = .02) compared with control subjects matched for age and Quetelet index. The relative risk for endometrial cancer increased with an increasing waist-to-hip circumference ratio (less than or equal to 1.14 = 1.0; greater than 1.14 = 15.0), with an increasing abdomen-to-thigh skin fold ratio (less than or equal to 0.82 = 1.0; greater than 0.82 = 5.0), and with an increasing suprailiac to-thigh skin fold thickness ratio (less than or equal to 0.67 = 1.0; greater than 0.67 = 3.50). CONCLUSION: --Upper-body fat localization is a significant risk factor for endometrial cancer in women matched for age and Quetelet index.

Adult↗
PubMed1991

Estimate of breast cancer risk reduction with weight loss.

Upper body fat localization has been associated with an increased risk of cancer. This study demonstrated that 64.2% of 124 women with at least a 4.5-kg weight loss decreased their upper body fat localization, as measured by a reduction in their suprailiac-thigh skin fold ratio and other skin fold thicknesses associated with upper body fat localization. Based on a risk model previously developed for breast cancer and upper body fat localization, a reduction in estimated breast cancer relative risk of 45% was calculated for the entire group of women who lost 4.5 kg or more in weight. Greater weight loss further reduced upper body fat localization and estimated breast cancer risk based on this model.

Adult↗
PubMed1991

Obesity, body fat distribution, and sex hormones in breast cancer patients.

This study addresses the relationship between female sex hormones, obesity, body fat distribution, and breast cancer. Increasing obesity correlated with a progressive fall in sex hormone-binding globulin (SHBG) level and an increase in testosterone level. Premenopausal breast cancer patients were found to have significantly lower levels of SHBG compared with age-matched and weight-matched controls. This difference in SHBG level was not noted in postmenopausal breast cancer patients. The SHBG level decreased with increasing upper body fat localization in breast cancer patients and controls. This effect was more marked in breast cancer patients which may explain our earlier finding that women with upper body fat localization are at increased risk for developing breast cancer.

Adult↗
PubMed1991

Obesity and body fat distribution and breast cancer prognosis.

This study addresses the effect of obesity and body fat distribution on axillary lymph node involvement, tumor size, and estrogen receptor (ER) level in breast cancer patients. Anthropometric measurements were prospectively obtained on 248 consecutively and newly diagnosed women with invasive breast cancer. The anthropometric measurements evaluated were abdomen, thigh, subscapular, and midaxillary skinfolds; weight; and height. Weight and Quetelet Index (kg/m2) were significantly (P = 0.001) associated with lymph node involvement in postmenopausal patients. The abdomen:thigh skinfold ratio was significantly higher in premenopausal patients (P = 0.004) and postmenopausal (P = 0.03) without axillary node involvement compared with women with 4+ axillary node involvement. The abdomen:thigh skinfold was higher (P = 0.05) in women with smaller breast cancers (less than 2.0 cm) and higher ER levels. Weight and Quetelet Index did not affect tumor size or ER level. This study demonstrated that obese postmenopausal women who developed breast cancer tend to have more axillary node involvement than their leaner counterparts. Generalized obesity did not affect tumor size or ER level. Premenopausal and postmenopausal women with upper body fat distribution appear to be a subset of women who have a more favorable prognosis as measured by less lymph node involvement, smaller tumors, and higher levels of ER in their tumors.

Adult↗
PubMed1990

Abdominal obesity and breast cancer risk.

STUDY OBJECTIVE: To determine if body fat distribution affects breast cancer risk. DESIGN: Prospective case-control study. PATIENTS: The anthropometric measurements of 216 consecutively and newly diagnosed women with invasive carcinoma of the breast were compared with those of 432 age-matched controls. The anthropometric measurements taken were abdomen, thigh, suprailiac, biceps, triceps, subscapular, and midaxillary skinfolds; waist and hip circumference; and weight and height. Women between 25 and 83 years of age were included in the study. RESULTS: Patients with breast cancer had a significantly greater waist:hip circumference ratio than controls (P less than 0.001) and a significantly greater suprailiac:thigh skinfold ratio (P less than 0.001). The relative risk for breast cancer increased with increasing waist:hip circumference ratio (less than 0.73 = 1.00; 0.73 to 76 = 1.90; 0.77 to 0.80 = 2.83; greater than 0.80 = 6.46) and with suprailiac:thigh skinfold ratio (less than 0.42 = 1.00; 0.42 to 0.56 = 1.85; 0.57 to 0.71 = 2.25; greater than 0.71 = 5.85). At other sites of upper body obesity, such as the biceps and triceps, skinfolds were significantly greater in patients with breast cancer. CONCLUSION: Although obese women are at slightly higher risk for developing breast cancer, women with android obesity are a segment of obese women who appear to be at a significantly higher risk for developing breast cancer.

Adipose Tissue↗
PubMed1990

Serum cholesterol reduction with tamoxifen.

The serum cholesterol levels of 123 consecutively and newly diagnosed women with Stage I and II breast cancer taking tamoxifen were compared with a control group of 81 consecutively newly diagnosed women with Stage I and II breast cancer who were not taking a hormonal treatment or supplement. Other factors that were evaluated were age, menopausal status, tumor size, weight, height, Quetelet index, and smoking and alcohol intake history. The mean cholesterol change in patients on tamoxifen (34.2 +/- 3.6 mg/dl) was significantly greater than controls (1.0 +/- 4.1 mg/dl) (P less than 0.001). Serum cholesterol fell by more than 10 mg/dl in 72.9% of women on tamoxifen vs. 35.1% of controls and by more than 40 mg/dl in 39.9% of women on tamoxifen vs. 12.6% of controls. Multivariate analysis revealed that tamoxifen administration (P less than 0.0001), initial cholesterol level (P = 0.001), and age (P = 0.04) were significant factors in producing a decrease in serum cholesterol. The administration of tamoxifen as adjuvant therapy to women with newly diagnosed breast cancer resulted in a significant fall in serum cholesterol. This effect of tamoxifen on the serum cholesterol may prove to be an additional benefit in the form of reduced cardiovascular risk in these women.

Adult↗
PubMed1990

The value of current nutrition information.

To prevent or delay the occurrence of chronic diseases, scientific bodies from the cardiologic and oncologic disciplines have made recommendations regarding the daily dietary intake of certain macro- and micronutrients. This study assessed the knowledge of a random population of 2,305 individuals comprising members of the public, health care workers, university graduate students, and health club attendees. Segments of this population might be expected to have a greater understanding and ability to implement these dietary recommendations. We found that over 90% of the participants were unaware of the recommendations for calcium, salt, vitamin A, and fiber, and the fiber content in a high fiber cereal. Approximately 80% of the participants were unaware of the recommendations regarding fat intake and could not calculate the fat content of a food product. Almost half of the study population took a vitamin pill daily. Of the subjects who were aware of the correct unit measurement for vitamin A (IU), almost 25% of gave a response that exceeded the recommended daily intake. A majority of this study population were unaware of the dietary recommendations regarding the prevention of cardiovascular events and cancer. Subgroups of this study population that might be expected to have more information regarding these recommendations (i.e., having higher education or being a health care professional) did not display a satisfactory level of knowledge. To further compound the problems of adhering to the recommended guidelines, the labeling of many food products is misleading. The recommendations on dietary intake and the information on food product content must be transmitted to the public in a form that allows for ready application when purchasing and consuming food.

Adult↗
PubMed1989

Small cell carcinoma of the vagina with neuroendocrine features. A report of three cases.

Three patients were treated for primary small cell carcinoma of the vagina. The light microscopic features were similar to those of small cell carcinoma of the lung, cervix and endometrium. Electron microscopy revealed occasional cytoplasmic, neurosecretory-type granules and cytoplasmic processes, features consistent with neuroendocrine cells. Radiotherapy appears to provide local control, but widespread disease at presentation or early metastases suggest the use of adjuvant chemotherapy in the initial management of the neoplasm.

Adult↗
PubMed1988

Prognostic features of carcinoma of the fallopian tube.

One hundred fifteen women with carcinoma of the fallopian tube were examined in this retrospective review. A third of the patients were nulliparous and 37% had evidence of old pelvic inflammatory disease. The most common symptoms were bleeding, pain, and/or vaginal discharge. Prognostic factors that predicted death from tumor were the presence of extratubal disease at initial surgery and the bulk of residual tumor left after the initial surgery. With disease limited to the fallopian tube, the depth of invasion of the tubal wall was correlated with the risk of treatment failure. Among patients with disease limited to their fallopian tubes, there was no statistically significant improvement in survival with the addition of either pelvic irradiation or single-agent chemotherapy. Among women with extrapelvic disease, survival improved significantly with the use of cis-platinum-containing multiagent chemotherapy.

Adult↗
PubMed1987

Histopathology differentiates acute self-limited colitis from ulcerative colitis.

Acute self-limited colitis (ASLC) must be distinguished from chronic ulcerative colitis (CUC) for the proper early management of patients with the acute onset of bloody diarrhea. This study was undertaken to determine if any clinical, endoscopic, microbiologic, or histologic parameters can be used to make this distinction reliably and quickly. Forty-eight patients with ASLC, 36 patients with chronic ulcerative colitis during their first attack [CUC(F)], and 84 patients with recurrent flares of chronic ulcerative colitis [CUC(R)] were studied prospectively. The presence of fever (temperature greater than 100 degrees F), abdominal pain, or the time from onset of bloody diarrhea to presentation were not discriminatory. Overall clinical and endoscopic severity were identical among the three groups. Microbiologic studies identified an infectious agent in only 42% of patients with ASLC. Histopathologic features always distinguished patients with CUC from those with ASLC. No case of ASLC was misdiagnosed histologically as CUC or vice versa. Plasmacytosis in the lamina propria extending to the mucosal base and mucosal distortion were present in all cases of CUC(F) and CUC(R), but were absent in all cases of ASLC. The finding of focal cryptitis during the resolving phase of ASLC could be confused with similar lesions in biopsy specimens from patients with Crohn's disease and mandates clinical follow-up. Histopathology is thus the only reliable diagnostic tool for the rapid differentiation of ASLC from CUC. However, biopsy specimens are only diagnostic when obtained during the acute phase of illness; that is, usually within the first 4 days from the onset of symptoms.

Acute Disease↗
PubMed1987

Evaluation of an emergency cricothyrotomy instrument.

An emergency cricothyrotomy device was placed in 11 anesthetized dogs in order to assess airway damage and problems in placement, ventilation, and design. Posterior airway perforation without esophageal damage occurred in three animals. Submucosal hematomas or cricoid cartilage injury occurred in seven animals. As placement by an untrained operator was surprisingly difficult, prior operator training with this device is recommended. When properly installed, an excellent emergency airway was achieved. Some minor design shortcomings are noted and suggestions for improvement are made.

Airway Obstruction↗
PubMed1987

Quantification of IgG-containing plasma cells as an adjunct to histopathology in distinguishing acute self-limited colitis from active idiopathic inflammatory bowel disease.

ASLC is clinically and endoscopically similar to active idiopathic IBD, especially ulcerative colitis. While several histopathologic criteria have been described which are useful in distinguishing these conditions, the diagnosis can still be difficult. In this study, we review the use of immunofluorescence on formalin-fixed paraffin-embedded biopsies from patients with ASLC. While tissues from active IBD have a striking increase in the number of IgG- and a lesser increase in the IgA- and IgM-containing plasma cells in the lamina propria, tissues from ASLC have normal numbers of IgG-containing cells with only a slight increase in IgA- and IgM-containing cells. The use of immunofluorescence on these tissues can provide quantifiable information which may be a helpful diagnostic adjunct in distinguishing these alternatives if histopathologic evaluation is equivocal.

Colitis↗
PubMed1987

An assessment of pathologic features and treatment modalities in ovarian tumors of low malignant potential.

Sixty-eight patients with epithelial ovarian tumors of low malignant potential treated at the University of Michigan Medical Center were reviewed for clinical and pathologic features related to recurrence or death. The ovarian tumor of low malignant potential represented 12.6% of all ovarian cancers and 22% of all serous or mucinous tumors. Thirty-four patients were stage I (50%), 13 were stage II (19%), 17 were stage III (25%), two patients could not be staged, and two patients developed ovarian tumor of low malignant potential in a residual ovary. The risk of recurrence was significantly related to stage III disease (P = .023), high nuclear atypia (P = .020), and high grade (P = .017); and was unrelated to capsular status, the presence of psammoma bodies, nucleoli, cribriform pattern, stratification, cystadenofibroma, tumor size, or spillage at surgery. Therapy in all stages included observation, chemotherapy, or radiotherapy. There was one recurrence in 47 patients with stages I-II, and 11 recurrences in 17 patients with stage III disease. The ovarian tumor of low malignant potential carries an extremely favorable prognosis in stage I and II regardless of therapy. Radiotherapy appeared to extend disease-free survival in stage III disease, and future randomized studies should consider this treatment modality.

Adult↗
PubMed1986

Prognostic features of vulvar melanoma: a clinicopathologic analysis.

We studied 19 cases of vulvar melanoma to determine significant clinical and histologic prognostic predictors. The average follow-up time was 32 months. Fourteen patients died of melanoma, four patients are alive with no evidence of melanoma, and one patient is alive with residual melanoma. All disease-free survivors had clinical stage I disease and a maximum tumor thickness of 1.3 mm. The average mitotic count in this group was 5.5 per 10 high power fields (HPF) and 50% of the tumors were superficial spreading melanomas. All survivors were treated by radical vulvectomy with bilateral inguinal lymph node dissection. Of the nonsurvivors, four (28.5%) were clinical stage I, five (36%) were clinical stage II, four (28.5%) were clinical stage III, and one (7%) was clinical stage IV. The average tumor thickness for nonsurvivors was 9.5 mm (range 2.6-18 mm) and the average mitotic count was 13.3/10 HPF. Only three (21%) tumors from nonsurvivors were superficial spreading melanomas; the majority were nodular melanomas. The statistically significant prognostic predictors were clinical stage of disease and tumor thickness. Tumor type (i.e., superficial spreading, nodular, or acral lentiginous) correlated with tumor thickness and was indirectly related to prognosis. The mitotic count was also a useful prognostic feature.

Adult↗