Biomedical subjects

N O Berg

Publications and source records attributed to N O Berg.

At least 19 recordsLinked to original sources

PubMed1991

Subcutaneous sarcoma. A population-based study of 129 patients.

We reviewed 129 patients with subcutaneous sarcoma diagnosed from 1964 to the end of 1985 in a population-based series of sarcoma cases from southern Sweden. The annual incidence was 0.4 per 100,000, comprising 32% of all soft-tissue sarcomas of the extremities or the trunk wall. Compared to deep-seated sarcomas, subcutaneous tumours were half the size at diagnosis, more common in the lower leg and foot, more often malignant fibrous histiocytoma, and of a lower grade of malignancy. None of the low-grade and only 7% of the high-grade tumours recurred locally after wide local excision without radiotherapy. The cumulative five-year survival for all 129 patients was 80%. Multivariate analysis identified only high grade of malignancy and the size of the tumour (greater than 5 cm) as independent prognostic factors. We conclude that systemic or local adjuvant therapy is not generally indicated for subcutaneous sarcoma because of the good prognosis and low local recurrence rate after wide excision.

Adolescent↗

PubMed1990

Prediction of survival in patients with high-grade soft tissue sarcoma.

Using the Cox proportional hazards model, and considering tumour necrosis and vascular invasion by tumour as additional factors in assessment, a series of 88 patients with primary Grade III and IV soft tissue sarcomas of the locomotor system was analysed for factors associated with death due to the tumour. Grade IV malignancy, a tumour size larger than 10 cm., tumour necrosis, and vascular invasion by tumour cells were significant risk factors. Patients with 0 or 1 risk factor, one half of the cases, had a 3 year survival rate of more than 90%, whereas the figure was 65% for those with 2 risk factors and 20% for those with 3 or 4 risk factors.

Adult↗

PubMed1990

Cellular DNA content and prognosis of high-grade soft tissue sarcoma: the Scandinavian Sarcoma Group experience.

The nuclear DNA content of 148 high-grade soft tissue sarcomas of the extremities and trunk was determined by flow cytometry, using tumor material from paraffin-embedded tissue. The patients were part of a prospective randomized clinical trial on the efficacy of adjuvant single-agent chemotherapy with doxorubicin. Chemotherapy did not improve the metastasis-free survival (MFS). After a median follow-up time of 48 months (range, 2 to 97), a multivariate analysis of prognostic factors for developing metastatic disease was performed. DNA aneuploidy was found to be an independent prognostic risk factor in addition to histologic malignancy grade IV, intratumoral vascular invasion, tumor size over 10 cm, and male sex. Patients with none or one risk factor had a 5-year MFS of 79%, with two risk factors 65%, with three risk factors 43%, and with four and five risk factors 0%. About one half (78 of 148) of the patients with three factors or less belonged to a group with a MFS over 60%. The combination of different risk factors, including DNA aneuploidy, seems to be a useful prognostic model for soft tissue sarcomas, which could be of value to select high-risk patients for further trials with adjunctive therapy.

Adolescent↗

PubMed1990

Morphologic changes in the small intestine after chronic alcohol consumption.

The morphology of the small-intestinal mucosa was studied in 11 alcoholic patients admitted to hospital for detoxification. A first biopsy specimen from the small intestine was taken as soon as possible after admission and a second specimen after about 6 weeks of abstinence. The specimens were studied in the light microscope, in the scanning electron microscope, and by immunohistochemistry. Morphometrically, a slight reduction in villus height in relation to crypt depth was observed. One patient had a subtotal villus atrophy. After abstinence the villus height was increased in five of the six patients who accepted a second biopsy. No obvious changes were seen in the frequency and appearance of peptidergic nerves or endocrine cells. Ultrastructurally, pronounced alterations were seen in the surface ultrastructure of the enterocytes. In two specimens bacterial adhesion to the mucosal surface was also found. The ultrastructural changes were unaltered after abstinence. In serum the concentrations of zinc were reduced, and the levels of copper were elevated compared with a group of teetotallers. A recently developed marker of high alcohol consumption, carbohydrate-deficient transferrin, was as good an indicator as the other conventional biochemical markers.

Adult↗

PubMed1989

Histopathology peer review of high-grade soft tissue sarcoma: the Scandinavian Sarcoma Group experience.

From 1981 to 1986, a total of 240 patients with a primary soft tissue sarcoma with malignancy grade III or IV were entered into an adjuvant chemotherapy multicenter trial conducted by the Scandinavian Sarcoma Group (SSG). Histopathologic peer review of all the specimens was performed by an expert pathology committee. The most common soft tissue sarcoma after review was malignant fibrous histiocytoma (MFH) (40%), followed by synovial sarcoma (15%), leiomyosarcoma (9%), liposarcoma (8%), and malignant Schwannoma (6%). In 25% of the cases the histologic type of sarcoma was reclassified, and in 40% of the cases the malignancy grade was changed. By survival analyses, the reclassification of malignancy grade seemed to be valid. Also, grading highly malignant soft tissue sarcoma in two grades (III and IV) increased the prognostic information. Of 164 tumors from the centers with the most reported cases (five centers with 25 to 51 tumors each), eight tumors were found to be ineligible for the adjuvant study (5%); of 76 tumors from 13 centers with few tumors (one to 16 tumors per center), 12 tumors were ineligible (16%). We conclude that histologic peer review is important in studies of soft tissue sarcoma.

Follow-Up Studies↗

PubMed1989

Prognosis in high-grade soft tissue sarcomas. The Scandinavian Sarcoma Group experience in a randomized adjuvant chemotherapy trial.

From 1981 to 1986, 240 patients with primary, malignancy grade III or IV soft-tissue sarcoma were entered into a randomized adjuvant chemotherapy multicenter trial, conducted by the Scandinavian Sarcoma Group. After a median follow-up time of 46 (2-97) months, a multivariate analysis of risk factors for metastases was performed in 138 radically operated on patients with tumors of the extremities. Adjuvant single-agent doxorubicin did not improve the metastasis-free survival. Histologic malignancy grade IV, tumor size greater than 10 cm, vascular invasion by tumor, and male sex were identified as risk factors. Patients with no or one risk factor had a 5-year metastasis-free survival of 0.7, with two risk factors 0.5, and with three or four risk factors 0.2. The combination of different risk factors provides a prognostic model for soft tissue sarcomas, which could be a basis for therapeutic trials.

Adolescent↗

PubMed1988

Prognostication in soft tissue sarcoma. A model with four risk factors.

A multivariate analysis of risk factors for death due to tumor was performed in 82 patients with highly malignant, histologic Grades III and IV primary soft tissue sarcoma of the locomotor system. All the patients had been operated on with a wide or radical surgical margin. Male sex, histologic malignancy Grade IV, extensive tumor necrosis, and tumor size greater than 10 cm were identified as risk factors. Patients with no or one risk factor had a 6(10)-year survival rate of 100% (100%), equal to 96% (96%) in a group with Grade I and Grade II tumors operated on with the same margin. These two groups comprised 50% of all the patients operated on with a wide or radical margin. The 6(10)-year survival rate decreased to 75% (75%) for patients with two risk factors and to 33% (22%) for patients with three or four risk factors. The risk factor model also applied to 62 patients operated on with marginal surgery; and for patients with three or four risk factors, more extensive surgery only had a small effect on long-term survival. The model could be of value when eligibility criteria for trials with adjunctive chemotherapy are determined.

Female↗

PubMed1988

Preoperative diagnosis of soft tissue tumours.

Over a period of 3 years in Southern Sweden 35 patients were seen with deep-seated limb sarcomas without metastases, 30 of whom were referred before any operation had been carried out. Thirty seven patients with deep-seated benign lesions were referred during the same period because of suspected malignancy. A preoperative diagnosis considered sufficient for a definitive operation was made from the clinical findings, aspiration cytology and radiographic examination, but without open biopsy, in 59 of these 67 cases. The differentiation between a benign and a malignant tumour was correct in all but one. The extent of excision necessary to achieve adequate margins for a soft-tissue sarcoma can often be reduced if open biopsy is avoided, with preservation of function. We conclude that treatment without open biopsy is possible in the great majority of patients with soft-tissue sarcoma.

Adult↗

PubMed1988

Gadolinium-DTPA enhancement of soft tissue tumors in magnetic resonance imaging--preliminary clinical experience in five patients.

In a preliminary report of a clinical trial of gadolinium-DTPA (Gd-DTPA) for enhancement of soft tissue tumors in magnetic resonance imaging (MRI), experience of the first five cases is presented. Enhancement was found to give better delineation of the tumor in richly vascularized parts of the tumors, compressed tissue immediately surrounding the tumor, and in atrophic, but richly vascularized, muscle.

Adult↗

PubMed1987

Bronchocarcinogenic properties of welding and thermal spraying fumes containing chromium in the rat.

The possible bronchocarcinogenic effects of fumes released during the shielded metal arc welding of stainless steel and the thermal spraying of chromium oxide (Cr2O3) have been studied on the rat. The fume particles were shown to contain tri- and hexavalent chromium in soluble and low soluble forms; they were collected and implanted as pellets in the bronchi of groups of 100 rats by the method of Laskin et al. A negative control group of 100 rats was included, as well as positive controls receiving pellets containing benz(a)pyrene. The experiment was continued for 34 months; no differences of biological significance were noted between the growth rates, survival times, and terminal organ weights of the test and negative control groups. At autopsy, the macroscopic and microscopic appearance of the organs in the three groups, including the local reaction to the implanted pellet, were similar. No precancerous changes were observed at the implantation sites; one rat, who received a pellet containing welding fumes, showed squamous cell carcinoma remote from the implantation site and not associated with the bronchus. It had the appearance of a metastasis. All three benz(a)pyrene control rats developed cancer at the implantation site. The occupational health implications of these findings are discussed.

Air Pollutants, Occupational↗

PubMed1987

Surveillance colonoscopy and biopsy in patients with ureterosigmoidostomy.

Colonoscopy with biopsy was included in the surveillance of 19 patients with ureterosigmoidostomy, because of the high incidence of colonic carcinoma reported in such cases. The patients were examined 1-6 times, at intervals of 1-2 years, 4-36 years after the urinary diversion. Random biopsies from the distal colon and rectum showed only discrete changes, and no dysplasia. Polyps with dysplastic changes were found close to ureteral anastomoses in three patients. For routine check-up of the rectosigmoid region and the ureteral implantation sites, examination with a flexible sigmoidoscope seems to be adequate and preferable, giving easy access to the risk zone for the development of cancer. Caution should be exercised, however, when performing biopsy close to the ureteral orifices.

Adult↗

PubMed1987

Survival in soft tissue sarcoma. Prognostic variables identified by multivariate analysis.

The prognostic influence of 15 separate factors on local recurrence and survival was analyzed in 144 patients with highly malignant (histologic Grades III and IV) soft tissue sarcoma of the locomotor system. The minimum follow-up time was 6 years, or until death. Three factors, marginal excision, tumor necrosis, and extracompartmental tumor location were identified as risk factors for local recurrence. Five factors, local recurrence, Grade IV, male sex, tumor necrosis, and increasing tumor size were associated with decreased life expectancy.

Adolescent↗

PubMed1984

Pulmonary bone-marrow embolisation after unfiltered autologous bone-marrow transplantation.

A 15-year-old girl had Ewing's sarcoma of the right scapula 1978 and was treated with local radiotherapy and adjuvant chemotherapy. She remained in complete remission until September 1982 when she developed a single pulmonary metastasis in the right lower lobe. She received a high dose of Melphalan twice, always followed by autologous bone-marrow transplantation. A segmental right lower lobectomy revealed haematopoietic bone-marrow tissue emboli within the alveolar capillaries and foreign body granulomatous lesions in the whole surgical specimen. No residual Ewing's sarcoma growth was seen.

Adolescent↗

PubMed1984

Epidemiology of soft-tissue sarcoma in the locomotor system. A retrospective population-based study of the inter-relationships between clinical and morphologic variables.

From all soft-tissue malignancies reported to the Swedish National Cancer Registry in Southern Sweden (1.3 mill. inhabitants) from 1964 through 1978, 278 cases were accepted as sarcomas after histologic re-examination. All these were malignancy-graded on a four-grade scale, without knowledge of the clinical course. A number of clinical and morphological variables were recorded and subjected to uni-, bi- and multi-variate analysis. Follow-up was available in all patients. The annual incidence rate over all ages was 1.4/100,000. The mean age was 58 years and males dominated (1.3/1). Malignant fibrous histiocytoma, liposarcoma and leiomyosarcoma were the most common histologic groups. Three-fourths of the tumors were high-grade malignant (Grade III-IV). Sixty per cent were deep-seated, having a median size of 8 cm compared to 4 cm for the superficial tumors. One third of all tumors were located in the thigh. The histologic groups were characterized by age, tumor depth and size, the occurrence of pain, malignancy grade and five-year survival; it was seen that each group, with respect to at least one of the variables, differed significantly from all the other groups. Thus histologic classification seems to identify different tumor entities. Out of several pair-wise associations the strongest were as follows: histologic groups versus depth, size, malignancy grade and age; depth versus size; and size versus malignancy grade (Grade IV tumors being larger). The proportion of superficial and small tumors in this series is high, compared to several reported series, probably owing to "referral selection" in the previous studies. The inter-relationships found between several variables and conclusions based on selected series may explain, in part, the differing opinions which can be found in the literature regarding prognostic variables in soft-tissue sarcoma.

Adolescent↗

PubMed1984

Prognosis for soft-tissue sarcoma in the locomotor system. A retrospective population-based follow-up study of 237 patients.

To identify variables of prognostic importance for soft-tissue sarcoma in the locomotor system, we performed a retrospective follow-up study on a consecutive, unselected, population-based series of 237 patients mainly treated by surgery, 1964-1978. Patients with metastasis at the time of diagnosis were not included. All histologic material was re-evaluated and histologic malignancy-grading (four-grade scale) performed without knowledge of the clinical course. The surgical procedures were classified as marginal and broad excisions. Patient follow-up ranged between 3- and 18 years. Multivariate analysis of the data by Coxs proportional hazard regression techniques disclosed seven negative prognostic variables of primary significance; high malignancy-grade (IV and III), pain at rest, male sex, increasing age and tumor size, a marginal excision and an extracompartmental tumor site, in order of decreasing relative risk (5.9-1.9) as regards survival. A secondary variable, that of local recurrence, was then included in the model and was found to have a stronger influence on survival than any of the other variables. Patients with local recurrence had a mortality risk which was 8.3 times that of patients without local recurrence. A risk curve based on the prognostic variables having primary significance was constructed. By this risk curve, patients with very good or very bad prognosis could be identified. The results are important when evaluating the efficiency of different therapies in non-randomized trials. In such studies the prognostic variables could be used to identify patients having comparable prognoses. In addition, patients found to have a good prognosis could be excluded from trials with adjuvant therapy.

Adolescent↗

PubMed1983

Size, site and clinical incidence of lipoma. Factors in the differential diagnosis of lipoma and sarcoma.

All 428 patients who had a non-visceral lipoma histopathologically diagnosed during 1 year in a defined population (0.74 million inhabitants) were analysed retrospectively as regards the age, duration of symptoms, size, site (location and depth) and multiplicity of the lipomas. Solitary subcutaneous lipomas were uncommon in the hand, thigh, lower leg and foot, and four-fifths of them (264/338) were smaller than 5 cm. Multiple subcutaneous lipomas were found in 61 patients, most of them young males. Subfascial lipomas, with a mean size (6 cm) double that of solitary subcutaneous lipomas, were found in 13 patients. A subgroup of 192 lipomas (153 patients) was reexamined histologically and the tumours were classified as either simple lipoma or angiolipoma. Angiolipomas were significantly more common in patients with multiple lipomas. To assess the reliability of a clinical diagnosis of lipoma as well as the proportion of clinically diagnosed lipomas not verified by histology, the records of patients seen in one department of surgery and in one health care centre were examined. Based on these data, the annual clinical incidence of lipoma (number of patients consulting a doctor for a lipoma, even if not histologically verified) was estimated to be 1/1000. When the data for solitary lipomas were compared to those for soft-tissue sarcoma, it was found that patient age and duration of symptoms were of minor value in the clinical differential diagnosis. However, if a tumour were (a) larger than 5 cm, irrespective of depth and location, (b) located in the thigh, irrespective of depth and size, or (c) deep, irrespective of location and size, it was more likely to be a sarcoma.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

PubMed1983

Treatment of soft-tissue sarcoma should be centralised.

New concepts regarding surgical margins and new modalities of preoperative examination make centralized care advantageous for patients with soft-tissue sarcomas. This study describes how the organizational level of surgical service and surgical technique have changed with time in southern Sweden. After reviewing all cases of soft-tissue sarcoma in the trunk and extremities registered during 1964-81, 261 patients remained for analysis. The material was divided into patients treated within or outside the Orthopaedic Oncology Group (OOG) for southern Sweden, which started in 1970. Patients treated by the OOG were separated into patients referred before and after surgery. In 1964-69, one-third (25/73) of the patients had a wide or compartmental excision at final surgery of the primary tumour compared with two-thirds (126/188) in 1970/81. Further, four-fifths (111/142) of the patients treated by the OOG finally had wide or compartmental excisions, whereas only one-third (15/46) of the patients treated outside the OOG over the same time period had obtained this type of surgery. When recorded, the tentative pre-operative diagnosis was a benign lesion in more than one-half of the patients treated outside the OOG. In two-thirds of the patients referred before surgery the biopsy and treatment, a wide or compartmental excision, were combined into one surgical procedure. Over the years the number of patients referred increased. During 1980-81, 35 of 38 patients with soft-tissue sarcomas were referred to the OOG: 11 before any biopsy, 14 after a malignant cytodiagnosis and 10 following marginal excisions.

Adolescent↗

PubMed1982

Enteropathy of coeliac disease in adults: increased number of enterochromaffin cells the duodenal mucosa.

Twenty-nine adult patients with coeliac disease and 39 patients with a normal duodenal morphology were studied with respect to the 5-ht containing enterochromaffin cells. Their number in duodenal biopsies was assessed by fluorescence histochemistry and they were examined by immunohistochemistry for peptides known or believed to occur in enterochromaffin cells. Antisera used were raised against substance P, motilin, and leu-enkephalin. In addition, the concentration of 5-HT was determined chemically. In adult coeliac disease there was a significant increase in the number of duodenal enterochromaffin cells compared with the control group. The concentration of 5-HT in the duodenal mucosa was also greatly increased. Substance P was found in a minority population of enterochromaffin cells. These cells were very few and did not increase in number in coeliac disease. Motilin cells were distinct from enterochromaffin cells. No enkephalin immunoreactive cells were found in the biopsies.

Adult↗