Biomedical subjects

P Enblad

Publications and source records attributed to P Enblad.

At least 55 records · Page 3Linked to original sources

PubMed1991

Heterogeneity in ploidy and S-phase fraction in colorectal adenocarcinomas.

The heterogeneity in the DNA content was analysed in multiple biopsies from the surgical specimens in 77 cases of colonic and 46 cases of rectal adenocarcinomas. Frozen and unfixed tumour tissue was analysed with the flow cytometric technique. A total of 78/123 (63%) of all tumours displayed aneuploid stemlines in one or more pieces of tumour tissue; 45 were homogeneously aneuploid and 33 were heterogeneous, presenting both aneuploid and near-diploid samples. The remaining 45 tumours were homogeneously near-diploid. The heterogeneity in ploidy tended to be slightly higher if ten as compared with four samples from each tumour were analysed. Ploidy correlated to localization in the bowel and gender, but not to age, histopathological tumour stage, tumour differentiation or to the resectability rate for cure. The mean value of the S-phase fraction was 17% (range 7-31%) in the near-diploid and 14% (range 8-20%) in the aneuploid tumours. The range of the intratumoural variation was small for the DNA index (at most 5%) and high for the S-phase fraction (19% for near-diploid and 24% for aneuploid tumour pieces). Neither the mean value nor the heterogeneity in the DNA index and in the S-phase fraction displayed any correlation with the studied characteristics. In conclusion, the ploidy and the S-phase fraction varied considerably both within and between the tumours. As a consequence, multiple sampling is mandatory for a correct classification of colorectal adenocarcinomas based on the DNA content.

Adenocarcinoma↗

PubMed1991

Radioimmunolocalization of human colonic cancer xenografts; aspects of extensive purification of monoclonal anti-CEA-antibodies.

Tumour-to-normal tissue ratios of i.p. injected 125I-labelled monoclonal antibodies (MAbs), reacting with CEA were determined in nude rats xenografted with human colonic cancer cells (LS 174 T). Two MAbs, I-38S1 and II-16, reactive with the GOLD 1-epitope on CEA were tested. MAb I-38S1 was also tested after additional purification using anion exchange chromatography (thereafter named AEC 38). In the external activity measurements, MAb AEC 38 showed significantly better tumour-to-liver ratios than did MAb II-16 on all 4 days after injection. MAb I-38S1 gave intermediate ratios but was significantly better than II-16 only on day 3. The mean tumour-to-blood ratios were 3.0, 2.6 and 1.5 and the mean tumour-to-liver ratios were 6.6, 4.8 and 3.5 for MAbs AEC 38, I-38S1 and II-16 respectively. Gamma camera registrations in 3 animals on 4 days showed good imaging properties for all three MAbs and the patterns of tissue uptake were consistent with those seen in the external measurements. Furthermore, histopathological and immunohistochemical determinations were performed, showing that MAb II-16 gave about the same spatial binding as the previously analysed MAb I-38S1. The results indicate that additional purification of MAbs using anion exchange chromatography may potentiate tumour uptake in this model.

Carcinoembryonic Antigen↗

PubMed1990

The risk of subsequent primary malignant diseases after cancers of the colon and rectum. A nationwide cohort study.

The occurrence of a second primary malignant disease was analyzed in 38,166 patients with cancer of the colon and 23,603 patients with rectal cancer reported to the Swedish Cancer Registry between 1960 and 1981. The overall relative risk (RR) of developing a second primary malignant disease was significantly (P less than 0.05) increased both after cancer of the colon (women, RR = 1.4; men, RR = 1.3) and rectum (women, RR = 1.4; men, RR = 1.3). Besides confirming an increased risk of metachronous colorectal cancer this study suggests that cancer of the small intestine, breast, endometrium, and possibly of the ovary and prostate may have etiologic factors in common with cancer of the large bowel, notably those located in the colon.

Adult↗

PubMed1990

Relationship between age and survival in cancer of the colon and rectum with special reference to patients less than 40 years of age.

The relative survival of all patients (n = 61,769) in the entire Swedish population reported to have a malignant tumour of the colon and rectum between 1960 and 1981 was analysed with special reference to patients under 40 years of age. The 5-year relative survival rate of patients with a tumour of the colon, irrespective of histopathological diagnosis, was 62.0 per cent below the age of 40 years and 44.4 per cent in those 40 years of age or older (P less than 0.05). The corresponding figures for patients with a tumour of the rectum were 46.6 per cent and 39.1 per cent, respectively. When the relative survival was analysed separately for patients with a histopathologically demonstrated adenocarcinoma, the 5-year survival rate among patients with a cancer of the colon was 50.9 per cent in patients below 40 years of age and 48.6 per cent in those 40 years of age or older. In patients with adenocarcinoma of the rectum, the 5-year relative survival rate was 41.1 per cent in patients younger than 40 years of age and 40.7 per cent in patients 40 years of age or older. Thus, patients below the age of 40 years with an adenocarcinoma of the colon and rectum as a group appear to have the same or even a better prognosis than older patients if all tumours are considered, irrespective of histopathological diagnosis.

Adenocarcinoma↗

PubMed1990

Anterior versus abdominoperineal resections in the management of mid-rectal tumours.

In order to assess if results after anterior resections (AR) compared with abdominoperineal resections (APR) for mid rectal tumours have changed since the circular stapler was introduced into clinical practice, two consecutive series of patients were reviewed. The first series comprises 81 patients treated between 1974-79. Sixteen were treated with AR and 65 with APR. Except for the later part of 1979, the stapling instrument was not available during this period. The second series comprises 156 patients (51 AR and 105 APR) operated on during the period 1980-85, when the circular stapler was in extensive use. All patients had curative operations for tumours 6-11 cm from the anal verge. In the first series the local recurrence rate was 5/13 (39%) after an AR and 25/61 (41%) after an APR, and in the second series 8/50 (16%) and 17/100 (17%) after AR and APR, respectively. Cancer specific survival did not differ between operations in any of the series. Thus no deterioration in results could be detected since the stapling technique became part of surgical routine.

Abdomen↗

PubMed1989

Can mortality from rectal and rectosigmoid carcinoma be predicted from histopathological variables in the diagnostic biopsy?

The prognostic information provided by histopathological variables in the diagnostic biopsy was evaluated retrospectively in 276 consecutive patients "potentially curable" by surgery using criteria recently proposed by Jass et al. concerning the main specimen. In 252 (91%) cases, the biopsy material was appropriate for the intended assessment. The majority of tumours were tubular (67%), tubular configuration mostly irregular (76%) and the tumour cells usually had small nuclei (81%). Remnants of adenomatous structures were identified in 21%. Most tumours were moderately differentiated (57%), and poorly differentiated tumours were somewhat more common (27%) than highly differentiated ones (16%). There was no real correlation between these histopathological variables, as expressed in biopsy, and Dukes' stage. Patients with a well-differentiated tumour had somewhat better survival than those with a moderately or poorly differentiated one (p = 0.04). Tumour type tended to influence cancer-specific mortality in that patients with papillary tumour had a slightly better prognosis than those with a different type. An attempt was also made to classify the patients into two groups on the basis of the observers' subjective impression of the tumour pattern and the expected outcome. Among the 143 patients in whom the over-all subjective impression was an "aggressive tumour pattern", 43% died (median follow-up 47 months). The cancer-specific death rate in patients in whom the tumour pattern was "non-aggressive" was 27% (p = 0.04). In summary, the extent to which these variables predicted mortality was far from clinically useful.

Adenocarcinoma↗

PubMed1989

The spatial distribution of parenterally administered monoclonal antibodies against CEA in a human colorectal tumour xenograft.

A recently developed experimental model consisting of athymic rats carrying human colonic tumours from the cell line LS 174 T in both hind legs was used. 125I-labelled anti-carcinoembryonic (anti-CEA) monoclonal antibodies were injected either intra-arterially after a bolus injection of mannitol, or intra-peritoneally with or without mannitol. On the fourth day the rats were killed and pieces from the tumours and various organs were measured in a well scintillation counter. Tumour pieces were then submitted to autoradiography and immunohistochemistry for examination of the antibody distribution at the cellular level. In all examined tumours injected with anti-CEA antibodies, most of the antibodies were located in the periphery close to fibrovascular septa. It appears, in addition to the specificity of the antibody for the CEA, that the tumour vascular permeability and anatomy are of utmost importance for tumour targeting in this experimental model with the particular antibody used.

Adenocarcinoma↗

PubMed1989

Jejunoileal bypass for morbid obesity. Report of a series with long-term results.

Of 72 patients who underwent jejunoileal bypass because of morbid obesity, 69 could be evaluated with special reference to long-term (median 11 years) results. One of the other three had fatal anastomotic leakage, one underwent resection and reversal of shunt because of postoperative gangrene in the bypassed segment, and one died of sepsis and liver failure following cholecystectomy 6 months after bypass. The median body mass index (kg/m2) fell from 45.4 preoperatively to 33.2 after 16 years. Shunt-related complications in early and late follow-up were diarrhoea (n = 15), anal/perianal disorders (15), arthralgia (15), urinary calculi (16), cholelithiasis (5), severe flatulence (7), liver cirrhosis (5), intestinal tuberculosis (1), ileitis (1), severe electrolyte disturbance (4), hypomagnesaemia (22), hypokalaemia (8), and deficiency of vitamin B12 (24), iron (24) and folate (17). Although jejunal bypass effectively reduces weight, the patients are at continuous risk of many complications. However, the improvement in quality of life should not be underestimated.

Adolescent↗

PubMed1989

Volvulus of the colon. A review of 93 cases and current aspects of treatment.

Ninety-three patients, comprising a consecutive, population-based series, were treated for volvulus of the colon between 1970 and 1985. The male:female ratio was 3.3:1 among the patients with volvulus of the sigmoid colon and 1:3.7 among those with caecal volvulus (p less than 0.001). Of the 60 patients with sigmoid volvulus, nine (15%) died. Elective surgery was performed in 13 of these 60 cases, without postoperative mortality. Previous volvulus attack(s) had occurred in 22 of the 60. Of the nine patients who underwent only detorsion at laparotomy, four had recurrence. Of the 33 patients with caecal volvulus, 31 underwent emergency laparotomy, and in seven of them the outcome was fatal. Of the nine patients who survived pexis operations, three had recurrence of volvulus. The results indicate that immediate laparotomy can be hazardous in patients with colonic volvulus. Semi-emergency resection after tube decompression, when the patient is in optimal condition and with preoperatively prepared bowel, is probably preferable.

Adult↗

PubMed1988

Improved survival of patients with cancers of the colon and rectum?

The survival of 61,769 patients diagnosed as having colorectal cancer in the total Swedish population in 1960-1981 was analyzed. The 5-year relative survival rates during the total period were approximately 40%; patients with colonic carcinoma had a somewhat better prognosis than patients with rectal carcinoma, and men had a generally less favorable prognosis than women. Comparison of patients diagnosed in 1960-1964 and in 1975-1979 showed a slight improvement in survival during the more recent study period, i.e., an improvement rate of 7.0% for both cancer of the colon and cancer of the rectum. The improvement occurred mainly during the first months of follow-up. However, the excess mortality due to colorectal cancer 1-5 years after diagnosis as compared to the expected mortality in the general population remained virtually unaltered. A multivariate analysis in which adjustment was made for the possible confounding variables of sex, age, and site (of colonic carcinoma) gave consistent results. Reduced postoperative mortality was considered to be the most likely major explanation for the temporal trend toward a more favorable prognosis. Thus it seemed that the treatment of colorectal cancer in Sweden during the last two decades has not improved significantly except in terms of reduced postoperative mortality. Thus the challenge of improving survival in patients with colorectal cancer must be given high priority.

Actuarial Analysis↗

PubMed1988

The expression of carcinoma-associated antigens and blood-group-related antigens in rectal carcinoids.

The immunohistochemical expression of blood-group substances and carcinoma-associated antigens were compared in rectal carcinoids and adenocarcinomas. Rectal carcinoid tumors, in contrast to rectal carcinomas, were consistently negative for CEA, gastrointestinal cancer antigen GICA (or CA 19-9), and carcinoma-associated antigen CA-50 (except in one case where less than 10 percent of the cells expressed CA-50). The carcinoids and rectal carcinomas extensively expressed blood-group substance A, B, and H, Lewis B antigen, and difucosylated carbohydrate antigens (DFCA). Thus, rectal carcinoids and adenocarcinomas possess both similar and different tumor antigen profiles. The occurrence of discrepant antigen determinants may be used in the differential diagnosis of these two types of tumors. The coexpression of blood-group substance A, B, and H, Lewis B antigen, and DFCA is consistent with the opinion that both rectal carcinomas and carcinoids have a common entoderm origin, but carcinoids are considered to rise from the endocrine-differentiated and the adenocarcinomas from the nonendocrine-differentiated enterocytes.

Adenocarcinoma↗

PubMed1988

The adenoma-carcinoma sequence in rectal adenomas. Support by the expression of blood group substances and carcinoma antigens.

The reaction patterns of eight antibodies directed against blood group substances A, B, and H and against Lewis B antigen, difucosylated carbohydrate antigens (DFCA), gastrointestinal cancer antigen (GICA) CA 19-9, carcinoma-associated antigen CA-50, and carcinoembryonic antigen (CEA) were studied in mucosa and adenomas of the rectum. Antigenic heterogeneity was a common feature of rectal mucosa and was observed to a considerable degree in adenomas. In general, the rectal mucosa expressed only a few antigens and to a limited extent. The adenomas were more extensively stained than the rectal mucosa. The proportion of positive cells increased with the grade of dysplasia but was relatively unrelated to the histologic type. The proportion of individual antigens expressed and the number of antigens extensively expressed increased between rectal mucosa, benign adenomas, and adenomas with early invasive carcinoma. These findings support the concept of an adenoma (dysplasia)-carcinoma sequence.

ABO Blood-Group System↗

PubMed1987

Expression of the carcinoma-associated antigens CA 19-9 and CA-50 in inflammatory bowel disease.

The expression of gastrointestinal cancer antigen, CA 19-9, and of carcinoma-associated antigen, CA-50, was studied in formalin-fixed and paraffin-embedded tissue from 18 patients with ulcerative colitis, 29 with Crohn's disease in the colon, four with diverticular disease, and eight with sigmoid volvulus. None of the patients with inflammatory bowel disease showed strong dysplasia or had manifest carcinoma. Both antigens were expressed frequently in patients with inflammatory bowel disease. Of the 18 patients with ulcerative colitis, 17 were positive for both CA 19-9 and CA-50, and of the 29 with Crohn's colitis, 21 were positive for CA 19-9 and 22 for CA-50. No distinct differences in antigenic expression were found between Crohn's disease and ulcerative colitis. CA-50 was expressed in normal colonic mucosa from 10 of 12 patients with sigmoid volvulus or diverticular disease, and such mucosa was positive for CA 19-9 in three of the four patients with diverticular disease and in two of the eight patients with sigmoid volvulus. It is concluded that immunodetection of CA-50 or CA 19-9 is of limited value in the differential diagnosis of inflammatory bowel disease. The usefulness of these antigens as markers for precancerous changes in inflammatory bowel disease is also doubtful, since the expression is also frequent in cases of inflammatory lesions, with no obviously increased risk of malignancy.

Antigens, Neoplasm↗

PubMed1987

Abdominal vs. perineal drainage in rectal surgery.

The efficiency of abdominal contra perineal drainage of the pelvic cavity after abdominoperineal resection for carcinoma of the rectum was evaluated retrospectively with regard to the frequency of perineal wound sepsis and length of hospital stay. Thirty-two (45 percent) of 71 patients with perineal drainage developed perineal wound sepsis, compared with four (12 percent) of 32 patients with abdominal drainage (P less than 0.01). Patients with perineal drainage stayed longer in the hospital (mean, 33 days) than those with abdominal drainage (mean, 24 days) (P less than 0.004). Furthermore, postoperative recovery was more comfortable in patients with abdominal drainage. Abdominal drainage therefore is recommended after abdominoperineal resection.

Abdomen↗

PubMed1987

Antigenic heterogeneity and individuality in adenocarcinomas of the rectum and their secondaries.

The reaction patterns of eight antibodies directed against blood group substances A, B and H, respectively, against Lewis B antigen, difucosylated carbohydrate antigens (DFCA), gastrointestinal cancer antigen CA 19-9 (GICA), carcinoma-associated antigen CA-50 and CEA, were studied in 68 rectal carcinomas using the avidin-biotin-peroxidase method. A pronounced intratumoral antigenic heterogeneity was revealed for most antigens. It thus became evident that an interpretation based upon small preoperative biopsies would be inaccurate. The overall proportion of positive carcinoma cells, however, did not vary much between larger samples taken postoperatively from different regions of the tumours. The intertumoral antigenic variability was also considerable: nearly all tumours had an individual immunohistochemical profile according to the proportions of positive cells. Heterogeneous staining patterns were also present within metastases, and lymph node metastases from the primary tumour in some cases differed completely from each other. The staining pattern did not correlate with Dukes' stage, and degree of differentiation; the expression of any individual antigen, or several antigens in combination.

ABO Blood-Group System↗

PubMed1986

Double stapling technique in the management of rectal tumours.

Before the circular stapling device was introduced, 25% of patients with rectal carcinoma underwent sphincter saving surgery. Stapling technique has been commonly used since 1980 and in the subsequent 5 years anterior resection was performed on 62% of patients treated for rectal carcinoma. "Single stapled" anastomosis, i.e. with a proximal and a distal purse-string suture, was performed in 33 cases, and in 22 cases a "double stapling" technique was used, i.e. the rectum was closed with a straight stapled suture and a circular anastomosis was then made through the stapled suture row of the closed rectum. No difference was found between the two stapling techniques regarding anastomotic dehiscence, pelvic abscess, postoperative fever, perioperative mortality or tendency to anastomotic stenosis. Among the patients with tumour 5-8 cm from the anal verge, a significantly higher proportion underwent a sphincter-preserving procedure with double stapling than with single stapling technique.

Anal Canal↗

PubMed1985

DNA content in carcinoma of the rectum and rectosigmoid.

Using single cell cytometry the pattern of DNA content in preoperative samples from 131 carcinomas of the rectum and rectosigmoid has been studied. For comparison, 21 carcinomas of the colon, 44 colorectal polyps and mucosa adjacent to the tumours were also included. The biopsies were classified into near diploid (ND), near diploid with aneuploid cells (ND-anc) and aneuploid (AN). A more specific subclassification of aneuploid samples was not consistent because of a commonly occurring multiclonality, where different clones dominated different parts of the tumours. Fifteen of all 130 representatively sampled rectal carcinomas were ND; however, all the ND scores were based on a single sample. Among 31 multiply-sampled carcinomas none registered as ND in all samples. There were no principal differences in patterns of DNA profiles between rectal and colon carcinomas. Five samples from the pericancerous mucosa and samples from 4 adenomas showed non-ND patterns, which may be a premalignant sign. The main conclusions of these results are that rectal carcinomas, even if they contain a substantial ND cell population, to a very great extent contains cells with an abnormal DNA content. The carcinomas can be classified according to their pre-operatively estimated DNA content. The clinical relevance of this will be judged when the patients have been followed for longer time periods.

Adenocarcinoma↗

PubMed1985

Clinical characteristics and their relation to surgical curability in adenocarcinoma of the rectum and rectosigmoid. A population-based study on 279 consecutive patients.

Between January 1980 and December 1982, 221 patients with rectal or rectosigmoid carcinoma were admitted from a defined population to one department of surgery in Sweden. In addition, all patients with a rectal tumour were traced in the population, and in this way 83 additional cases were recorded. A total of 304 malignant lesions were diagnosed and 279 (92%) of them were adenocarcinoma. The surgical curability rate in this unselected material of adenocarcinoma of the rectum and rectosigmoid, defined as the proportion of patients operated upon for cure with respect to both local radicality of surgery and absence of indications of disseminated disease, was 60%. Age (greater than or less than 80 years) but not sex had a major influence on the rate of surgical curability. Weight loss and pain, and also more than two tumour-related symptoms at presentation, were more common among patients with noncurable disease. A short diagnostic delay correlated to a more favourable tumour stage.

Adenocarcinoma↗