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Søren Friis

Publications and source records attributed to Søren Friis.

At least 19 recordsLinked to original sources
PubMed2007

[Prostate cancer in Denmark 1943-2002].

INTRODUCTION: Previous studies in Denmark have reported an increase in prostate cancer (PC) incidence- and mortality rates. So far, it has not been possible to establish the rising incidence as a consequence of an increase in diagnostic procedures. This study reviews the trends in PC incidence and mortality rates in Denmark during the 60-year-period from 1943 to 2002. MATERIAL AND METHODS: Register-based study. RESULTS: The age-standardised (World Standard Population) rate of PC in Denmark increased from 11.4/100,00 in the period 1943-47 to 38.2/100,000 in the period 1998-2002. Mortality rate increased from 13.5/100,000 in 1953 to 19.1/100,000 in the period 1993-98. Within the last 10 years changes in age-distribution and clinical stage, especially among younger patients, indicate a shift towards a more active diagnostic policy. CONCLUSION: In concordance with other studies we found an increasing PC incidence. In the last 10-year-period studied from 1993 to 2002, our study found the rise in incidence most likely explained by an increase in diagnostic activity, presumably as unsystematic PSA-based "gray-zone screening". This development contrasts with the national recommendation for PSA-based screening for PC. The rising incidence will necessitate allocation of increased resources for evaluation, treatment, and follow-up of patients with PC.

Aged↗
PubMed2006

Peroxisome proliferator-activated [corrected] receptor-gamma2 [corrected] Pro12Ala, interaction with alcohol intake and NSAID use, in relation to risk of breast cancer in a prospective study of Danes.

Use of non-steroid anti-inflammatory drugs (NSAIDs) has been associated with decreased risk of breast cancer in epidemiological studies. Thus, a high-inflammatory response may be associated with increased breast cancer risk. It is thus possible that genetic variations leading to a modified inflammatory response will influence breast cancer risk. The purpose of this study was to determine if polymorphisms associated with an altered inflammatory response are associated with breast cancer risk, and to investigate the possible interaction with lifestyle factors such as alcohol use, smoking and NSAID use. We matched 361 female breast cancer cases with 361 controls, nested within the prospective 'Diet, Cancer and Health' study. Carriers of the variant Ala-allele of PPARgamma2 Pro12Ala were at lower risk of breast cancer (IRR=0.67, 95% CI=0.46-0.97). This was primarily due to an interaction with alcohol consumption. Alcohol consumption was associated with a 1.21-fold increased risk of breast cancer per 10 g alcohol/day (95% CI=1.06-1.35) among homozygous wild-type carriers, whereas alcohol was not associated with breast cancer risk among variant allele carriers (P for interaction=0.005). Non-users of NSAID, who were carriers of the variant allele of PPARgamma2 Pro12Ala, were at lower risk of breast cancer (IRR=0.44; 95% CI=0.26-0.73) compared with non-users carrying wild-type alleles (P for interaction=0.03). No effects were found for IL6 G-174C, IL8 T-251A and COX2 T8473C. Our results suggest that PPARgamma2 Pro12Ala is an important determinant in alcohol mediated breast carcinogenesis. We also observe interaction between NSAID, alcohol consumption and PPARgamma2 Pro12Ala genotype in relation to breast cancer risk.

Alanine↗
PubMed2006

A cohort study of antihypertensive medication use and breast cancer among Danish women.

BACKGROUND: It has been suggested that specific antihypertensive medications (AHT) may either increase or decrease breast cancer risk. METHODS: We studied breast cancer incidence among 49,950 women in North Jutland, Denmark in order to determine if breast cancer risk is associated with specific classes of AHT use. Poisson regression analyses were used to calculate rate ratios for ever or exclusive use of each class of AHT, number of prescriptions for AHT, and years of follow-up. RESULTS: There was no statistically significant association between ever use of any AHT overall (RR = 0.95; 95% CI = 0.81-1.10) or any specific class of AHT (diuretics, beta blockers, calcium channel blockers (CCBs), angiotensin converting enzyme (ACE) inhibitors, and angiotensin II antagonists) and breast cancer. CONCLUSIONS: This study should offer further reassurance to women currently using AHT that their medication use is unlikely related to breast cancer risk.

Adrenergic beta-Antagonists↗
PubMed2006

Risk of second cancer among women with breast cancer.

A large number of women survive a diagnosis of breast cancer. Knowledge of their risk of developing a new primary cancer is important not only in relation to potential side effects of their cancer treatment, but also in relation to the possibility of shared etiology with other types of cancer. A cohort of 525,527 women with primary breast cancer was identified from 13 population-based cancer registries in Europe, Canada, Australia and Singapore, and followed for second primary cancers within the period 1943-2000. We used cancer incidence rates of first primary cancer for the calculation of standardized incidence ratios (SIRs) of second primary cancer. Risk of second primary breast cancer after various types of nonbreast cancer was also computed. For all second cancer sites combined, except contralateral breast cancer, we found a SIR of 1.25 (95% CI = 1.24-1.26) on the basis of 31,399 observed cases after first primary breast cancer. The overall risk increased with increasing time since breast cancer diagnosis and decreased by increasing age at breast cancer diagnosis. There were significant excesses of many different cancer sites; among these the excess was larger than 150 cases for stomach (SIR = 1.35), colorectal (SIR = 1.22), lung (SIR = 1.24), soft tissue sarcoma (SIR = 2.25), melanoma (SIR = 1.29), non-melanoma skin (SIR = 1.58), endometrium (SIR = 1.52), ovary (SIR = 1.48), kidney (SIR = 1.27), thyroid gland (SIR = 1.62) and leukaemia (SIR = 1.52). The excess of cancer after a breast cancer diagnosis is likely to be explained by treatment for breast cancer and by shared genetic or environmental risk factors, although the general excess of cancer suggests that there may be additional explanations such as increased surveillance and general cancer susceptibility.

Adult↗
PubMed2006

Influence of lung volume, glossopharyngeal inhalation and P(ET) O2 and P(ET) CO2 on apnea performance in trained breath-hold divers.

Breath-hold divers train and compete in maximal apnea performance. Glossopharyngeal inhalation (GI) is commonly used to increase lung volume above vital capacity (VC) prior to apnea. We investigated the hypothesis that this practice would increase apnea performance and relaxed airway pressure. Seven well-trained breath-hold divers performed maximal bouts of apnea at three different lung volumes (85% VC, VC and VC + GI) both at rest (dry static apnea) and during underwater swimming (dynamic apnea). Heart rate, apnea time and end tidal PCO(2) and PO(2) (P (ET) CO(2) and P (ET) O(2)) were recorded. In addition, relaxed airway pressure was measured after GI. Maximal GI increased lung volume by 1.59+/-0.57 l above VC and increased relaxed airway pressure to from 3.5+/-0.5 to 8.7+/-1.7 kPa. Dry static apnea time was higher at VC + GI (346+/-46 s) than at VC (309+/-38 s, P<0.05) and 85% VC (297+/-48 s, P<0.01). Likewise, dynamic apnea time was higher at VC + GI (97+/-27 s) than at VC (78+/-14 s, P<0.05) and 85% VC (71+/-17 s, P<0.05). P (ET) O(2) values reached 3.5+/-0.6 kPa at the end of dry static apnea bouts and this was not different from dynamic apnea when taking hydrostatic pressure at swimming depth into account (3.7+/-0.6 kPa, P=0.48). In conclusion, GI increases lung volume, relaxed airway pressure and apnea performance in well-trained breath-hold divers.

Adult↗
PubMed2006

Cancer risk among Danish women with cosmetic breast implants.

The available epidemiologic evidence does not support a carcinogenic effect of silicone breast implants on breast or other cancers. Data on cancer risk other than breast cancer are limited and few studies have assessed cancer risk beyond 10-15 years after breast implantation. We extended follow-up of our earlier cohort study of Danish women with cosmetic breast implants by 7 years, yielding 30 years of follow-up for women with longest implant duration. The study population consisted of women who underwent cosmetic breast implant surgery at private clinics of plastic surgery (n = 1,653) or public hospitals (n = 1,110), and a control group of women who attended private clinics for other plastic surgery (n = 1,736), between 1973-95. Cancer incidence through 2002 was ascertained using the Danish Cancer Registry. Risk evaluation was based on computation of standardized incidence ratios (SIR) and Cox proportional hazards models, adjusting for age, calendar period and reproductive history. We observed 163 cancers among women with breast implants compared to 136.7 expected based on general population rates (SIR = 1.2; 95% confidence interval [CI] = 1.0-1.4), during a mean follow-up period of 14.4 years (range = 0-30 years). Women with breast implants experienced a reduced risk of breast cancer (SIR = 0.7; 95% CI = 0.5-1.0), and an increased risk of non-melanoma skin cancer (SIR = 2.1; 95% CI = 1.5-2.7). Stratification by age at implantation, calendar year at implantation and time since implantation showed no clear trends, however, the statistical precision was limited in these analyses. When excluding non-melanoma skin cancer, the SIR for cancer overall was 1.0 (95% CI = 0.8-1.2). With respect to other site-specific cancers, no significantly increased or decreased SIR were observed. Similar results were found when directly comparing women who had implants at private clinics with women who attended private clinics for other plastic surgery, with rate ratios for cancer overall, breast cancer and non-melanoma skin cancer of 1.1 (95% CI = 0.8-1.6), 0.7 (95% CI = 0.4-1.3) and 1.5 (95% CI = 0.8-2.7), respectively. In conclusion, our study lends further support to the accumulating evidence that silicone breast implants are not carcinogenic. Reasons for the consistently reported deficit of breast cancer among women with breast implants remain unclear, whereas increased exposure to sunlight may explain the excess occurrence of non-melanoma skin cancer. We found no indication of delayed diagnosis of breast cancer due to the presence of breast implants.

Adolescent↗
PubMed2006

Second primary cancers in thyroid cancer patients: a multinational record linkage study.

CONTEXT: Increasing incidence and improved prognosis of thyroid cancer have led to concern about the development of second primary cancers, especially after radioiodine treatment. Thyroid cancer can also arise as a second primary neoplasm after other cancers. OBJECTIVE: The objective of the study was to assess the risk of second primary cancer after thyroid cancer and vice versa. DESIGN: This was a multinational record linkage study. SETTING: The study was conducted at 13 population-based cancer registries in Europe, Canada, Australia, and Singapore. PATIENTS OR OTHER PARTICIPANTS: A cohort of 39,002 people (356,035 person-yr of follow-up) with primary thyroid cancer were followed up for SPN for up to 25 yr, and 1,990 cases of thyroid cancer were diagnosed after another primary cancer. MAIN OUTCOME MEASURES: To assess any possible excess of second primary neoplasms after thyroid cancer, the observed numbers of neoplasms were compared with expected numbers derived from age-, sex-, and calendar period-specific cancer incidence rates from each of the cancer registries, yielding standardized incidence ratios (SIRs). The SIR of second primary thyroid cancer after various types of cancer was also calculated. RESULTS: During the observation period, there were 2821 second primary cancers (all sites combined) after initial diagnosis of thyroid cancer, SIR of 1.31 (95% confidence interval 1.26-1.36) with significantly elevated risks for many specific cancers. Significantly elevated risks of second primary thyroid cancer were also seen after many types of cancer. CONCLUSION: Pooled data from 13 cancer registries show a 30% increased risk of second primary cancer after thyroid cancer and increased risks of thyroid cancer after various primary cancers. Although bias (detection, surveillance, misclassification) and chance may contribute to some of these observations, it seems likely that shared risk factors and treatment effects are implicated in many. When following up patients who have been treated for primary thyroid cancer, clinicians should maintain a high index of suspicion for second primary cancers.

Aged↗
PubMed2006

Malignant melanoma and other types of cancer preceding Parkinson disease.

BACKGROUND: A large follow-up study in Denmark showed a two-fold higher incidence of malignant melanoma in patients with Parkinson disease than in the general population. Using a population-based case-control approach, we investigated the prevalence of malignant melanoma, skin carcinoma, and other cancers before a first hospitalization or outpatient visit for Parkinson disease. METHODS: We used the national Danish Hospital Register to identify 8090 patients with a primary diagnosis of Parkinson disease during the period of 1986-1998. Each case was matched with 4 population controls selected at random from among inhabitants alive at the date of first hospital contact with the patient. Incident cases of cancer since 1943 were ascertained by linkage to the Danish Cancer Registry, and the cancer histories of patients with Parkinson disease were compared with those of population controls. RESULTS: We observed an increased prevalence of malignant melanoma and skin carcinoma prior to the first hospital contact for Parkinson disease, with overall odds ratios of 1.44 (95% confidence intervals = 1.03-2.01) and 1.26 (1.11-1.43), respectively. To the contrary, we observed a reduced prevalence of cancers at smoking-related sites in patients before their first hospital contact for Parkinson disease. CONCLUSIONS: Our finding of an increased prevalence of malignant melanoma and skin carcinoma before the diagnosis of Parkinson disease weakens the suggested hypothesis that these cancers are caused by the treatment of Parkinson disease. The finding of a decreased prevalence of smoking-related cancers preceding Parkinson disease is consistent with the well-known higher risk of Parkinson disease among nonsmokers.

Aged↗
PubMed2005

Use of nonaspirin NSAIDs and risk of lung cancer.

Epidemiologic evidence is conflicting regarding the potential for nonsteroidal antiinflammatory drugs (NSAIDs) to lower the risk of lung cancer. We thus determined the incidence of lung cancer among a cohort of over 242,000 adults in Denmark who had been issued NSAID prescriptions during 1991-2002 and calculated the relative risks of this cancer according to the numbers of prescriptions received. Similar analyses were conducted among a subset with chronic obstructive pulmonary disease, of whom the large majority was assumed to have been smokers, as an indirect control for smoking. Utilization of Danish registries ensured essentially complete and unbiased ascertainment of prescriptions and cancer outcomes. The relative risks of lung cancer among NSAID users redeeming 10 or more prescriptions vs. nonusers in the general population and among chronic obstructive pulmonary disease patients were 1.51 (95% CI = 1.33-1.71) and 1.55 (95% CI = 0.93-2.60) and tended to decline with decreasing numbers of NSAIDs prescribed. Separate analyses for adenocarcinoma and squamous cell carcinoma also failed to show reduced risks among NSAID users. Confounding by indication may have contributed to the increased risks, but the study provides no evidence to suggest that recent NSAID intake may be protective for lung cancer.

Aged↗
PubMed2005

Risk of hospitalization for myocardial infarction among users of rofecoxib, celecoxib, and other NSAIDs: a population-based case-control study.

BACKGROUND: It remains uncertain if the excess cardiovascular risk of rofecoxib and celecoxib reported in clinical trials is present in routine practice and whether the use of other nonaspirin nonsteroidal anti-inflammatory drugs (NSAIDs) also carries an increased cardiovascular risk. We performed a population-based case-control study to examine the risk of myocardial infarction (MI) among users of various categories of nonaspirin NSAIDs. METHODS: Using data from hospital discharge registries in the counties of North Jutland, Viborg, and Aarhus, Denmark, and the Danish Civil Registration System, we identified 10,280 cases of first-time hospitalization for MI and 102,797 sex- and age-matched non-MI population controls. All prescriptions for nonaspirin NSAIDs filled before the date of admission for MI were identified using population-based prescription databases. Relative risk estimates for MI were adjusted for a history of cardiovascular disease, hypertension, diabetes mellitus, chronic bronchitis or emphysema, alcoholism, liver cirrhosis, upper gastrointestinal bleeding, rheumatoid arthritis, systemic lupus erythematosus and the use of high-dose aspirin, platelet inhibitors, insulin or oral hypoglycemic drugs, antihypertensive drugs, lipid-lowering drugs, oral anticoagulants, nitrates, penicillamine, gold, oral glucocorticoids, and hormone therapy before the date of admission for MI. RESULTS: Current users of rofecoxib had an elevated risk estimate for hospitalization for MI compared with nonusers of any category of nonaspirin NSAIDs (adjusted relative risk [ARR], 1.80; 95% confidence interval [CI], 1.47-2.21). Increased risk estimates were also found among current users of celecoxib (ARR, 1.25; 95% CI, 0.97-1.62), other cyclooxygenase-2 selective inhibitors (ARR, 1.45; 95% CI, 1.09-1.93), naproxen (ARR, 1.50; 95% CI, 0.99-2.29), and other conventional nonaspirin NSAIDs (ARR, 1.68; 95% CI, 1.52-1.85). The highest ARRs were found among new users of all examined drug categories. CONCLUSIONS: Current and new users of all classes of nonaspirin NSAIDs had elevated relative risk estimates for MI. Although the increased risk estimates may partly reflect unmeasured bias, they indicate the need for further examination of the cardiovascular safety of all nonaspirin NSAIDs.

Adult↗
PubMed2005

Cancer risk among statin users: a population-based cohort study.

Hydroxymethylglutaryl-CoA reductase inhibitors (statins) have been linked with potential chemopreventive effects; however, the data are conflicting. We conducted a population-based cohort study using data from the Prescription Database of North Jutland County and the Danish Cancer Registry for the period 1989-2002. In a study population of 334,754 county residents, we compared overall and site-specific cancer incidence among 12,251 statin users (> or =2 prescriptions) with cancer incidence among nonusers and users of other lipid-lowering drugs (n = 1,257). Statistical analyses were based on age-standardization and Poisson regression analysis, adjusting for age, gender, calendar period and use of NSAIDs, hormone replacement therapy and cardiovascular drugs. We identified 398 cancer cases among statin users during a mean follow-up period of 3.3 years (range 0-14 years). The age- and gender-standardized incidence rates of cancer overall were 596 per 100,000 person-years among statin users, 645 per 100,000 person-years among nonusers and 795 per 100,000 person-years among users of other lipid-lowering drugs. Adjusted rate ratios for cancer overall among statin users were 0.86 (95% CI, 0.78-0.95) compared to nonusers and 0.73 (95% CI, 0.55-0.98) compared to users of other lipid-lowering drugs. No significantly increased or decreased rate ratios were observed for any of the studied site-specific cancers (liver, colorectum, lung, breast, prostate, female genital organs and lymphatic and haematopoietic tissue), but most estimates tended to be less than 1.0. Stratification by duration of follow-up or number of prescriptions revealed no clear trends. In summary, individuals prescribed statins experienced a slightly reduced cancer incidence compared to population controls of nonusers and users of other lipid-lowering drugs. Larger and longer-term studies are needed to determine the potentially protective effect of statin use on cancer development.

Adult↗
PubMed2005

Reconstructive breast implantation after mastectomy for breast cancer: clinical outcomes in a nationwide prospective cohort study.

BACKGROUND: Clinical reports have raised concern about local complications following breast implantation used in reconstructive or cosmetic surgery, but there is a shortage of epidemiological studies in this area. OBJECTIVE: To assess in a prospective epidemiological manner the occurrence of short-term local complications in a nationwide implantation registry. DESIGN, SETTING, AND PARTICIPANTS: The Danish Registry for Plastic Surgery of the Breast prospectively collects preoperative, perioperative, and postoperative information on Danish women undergoing breast augmentation. Through the registry, we collected data on short-term local complications among 574 women who underwent postmastectomy reconstruction with breast implants from June 1, 1999, through July 24, 2003. MAIN OUTCOME MEASURES: Complication incidence rates. RESULTS: Thirty-one percent of the women who underwent initial implantation developed at least 1 adverse event. Forty-nine percent of the adverse events occurred within 3 months after implantation and 67% within 6 months. Surgical intervention was required after initial implantation among 21% of women, most frequently because of capsular contracture, asymmetry, or displacement of the implant. Thirty-six percent of women who underwent subsequent implantation experienced at least 1 adverse event, and 21% underwent surgical intervention to treat definitive complications or to optimize cosmetic result. CONCLUSIONS: Women who undergo postmastectomy breast implantation frequently experience short-term local complications. Surgical or medical intervention is commonly required during the reconstructive course, but reconstruction failure (loss of implant) is rare. However, when weighing benefits and risks associated with reconstruction, the patient should consider that breast reconstruction is a process involving planned and unplanned supplementary surgical correction to achieve the desired result.

Breast Implantation↗
PubMed2005

Age and colorectal cancer with focus on the elderly: trends in relative survival and initial treatment from a Danish population-based study.

PURPOSE: Elderly patients with colorectal cancer undergo surgery with curative intent less frequently than younger patients, and survival declines with increasing age. We compared relative survival of colorectal cancer among patients older than 75 years with that of younger patients in Denmark during the period 1977 to 1999. We also examined trends in choice of initial treatment. METHODS: From the files of the nationwide population-based Danish Cancer Registry, we identified all cases of colorectal cancer diagnosed between 1977 and 1999. We then linked this data to information on survival obtained from the Danish Register of Causes of Death and from the Central Population Register. RESULTS: During the entire study period, short-term and long-term relative survival improved for patients of all ages, but the improvement was more pronounced among elderly patients (>75 years). Radical resection was increasingly chosen as the initial treatment for elderly patients; during the 1995 to 1999 period it was performed on approximately 50 percent of such patients, almost as frequently as among younger patients. CONCLUSIONS: Relative survival of elderly colorectal cancer patients (>75 years) improved in Denmark between 1977 and 1999. In the most recent period studied, 1995 to 1997, only minor differences in five-year relative survival were observed among younger, middle-aged, and elderly patients. A simultaneous increase in the rate of radical resection among elderly patients, reflecting more effective treatment, may underlie this finding.

Adolescent↗
PubMed2005

Surgical intervention and capsular contracture after breast augmentation: a prospective study of risk factors.

Epidemiologic data on local complications after breast augmentation are scarce. In particular, few prospectively collected data are available on modern breast implants on this issue. Using data from the Danish Registry for Plastic Surgery of the Breast, the authors examined determinants of surgery-requiring complications and capsular contracture grades III to IV among 2277 women who underwent cosmetic breast implantation from June 1999 through April 2003. During an average follow-up period of 1.6 years after implantation, 4.3% of these women (3% of implants) required secondary surgery as a result of short-term complications. The most frequent clinical indications for surgery were displacement of the implant (38%), capsular contracture grades III to IV (16%), ptosis (13%), and hematoma (11%). Overall, the authors found that inframammary incision and subglandular placement were associated with decreased risks of developing complications requiring surgical intervention, whereas implants larger than 350 mL increased the risk of such complications (relative risk [RR], 2.3; 95% confidence interval [CI], 1.3-4.0). Thirty-nine Baker III to IV capsular contractures were identified, of which 22 were treated surgically within the study period. Submuscular placement of the implant decreased the risk of capsular contracture grades III to IV (RR, 0.3; 95% CI, 0.2-0.8), whereas surgical routes other than inframammary and drainage of implant cavity were associated with increased risk of capsular contracture. Current surgical practices and modern implants used for breast augmentation produce fewer short-term complications than procedures and devices of the past. This prospective study indicates that surgical procedures are more important predictors for local (short-term) complications than implant or patient characteristics.

Adult↗
PubMed2004

Outcome of upper gastro-intestinal bleeding and use of ibuprofen versus paracetamol.

BACKGROUND: Nonsteroidal anti-inflammatory drugs (NSAIDs) are known to increase the risk of upper gastrointestinal bleeding (UGIB). Whether the severity of outcome of UGIB associated with NSAIDs differs from non-NSAID-related UGIB is less clear. METHOD: Medical records of 228 patients hospitalized for UGIB in the Danish county of North Jutland were evaluated. Preadmission characteristics and clinical outcomes were compared between 112 patients who had been prescribed ibuprofen and 116 patients who had been prescribed paracetamol within 90 days of the hospitalization. RESULTS: The baseline characteristics of UGIB patients prescribed ibuprofen tended to differ from those prescribed paracetamol. The ibuprofen group significantly less often had histories of ulcer (11% vs 36%) and dyspepsia (19% vs 44%), or had been prescribed medications for these or other conditions, and had lower co-morbidity indices. Ibuprofen users also were somewhat less likely (31% vs 37%) to report GI pain at admission, but among hospitalized patients with endoscopic examinations were more likely (75% vs 58%) to be diagnosed with ulcer or hematemesis vs normal or gastritis/dyspepsia/reflux. For the clinical outcomes, 30 days case fatality rates were 12% for both ibuprofen and paracetamol users. The ibuprofen-related cases of UGIB more often required surgery (11% vs 3%) or transfusions (66% vs 57%), and those prescribed ibuprofen averaged 11 days in hospital, 4 days longer than those prescribed paracetamol. Adjustment for baseline characteristics and underlying conditions, or analyses eliminating patients with unconfirmed diagnoses and prior ulcers or restricted to patients with current hospital diagnoses of ulcer or hematemesis, did not materially alter the ibuprofen vs paracetamol differences in outcome measures. Generally similar results were obtained when restricting the analyses to patients prescribed ibuprofen or paracetamol within 30 days of UGIB hospitalization, except for a reduction in the 30 days case fatality rate among those prescribed ibuprofen. CONCLUSIONS: UGIB patients with antecedent ibuprofen prescriptions experienced about the same case fatality rates, but more surgery and longer hospital stays, than patients prescribed paracetamol. The differences appear in part due to differing characteristics among those prescribed ibuprofen compared with those prescribed paracetamol, but also raise the possibility of drug-related effects.

Acetaminophen↗
PubMed2004

Untreated silicone breast implant rupture.

Implant rupture is a well-known complication of breast implant surgery that can pass unnoticed by both patient and physician. To date, no prospective study has addressed the possible health implications of silicone breast implant rupture. The aim of the present study was to evaluate whether untreated ruptures are associated with changes over time in magnetic resonance imaging findings, serologic markers, or self-reported breast symptoms. A baseline magnetic resonance imaging examination was performed in 1999 on 271 women who were randomly chosen from a larger cohort of women having cosmetic breast implants for a median period of 12 years (range, 3 to 25 years). A follow-up magnetic resonance imaging examination was carried out in 2001, excluding women who underwent explantation in the period between the two magnetic resonance imaging examinations (n = 44). On the basis of these examinations, the authors identified 64 women who had at least one ruptured implant at the first magnetic resonance imaging examination and, for comparison, all women who had intact implants at both examinations (n = 98). Magnetic resonance images from the two examinations were compared and changes in rupture configuration were evaluated. Comparisons were also made for self-reported breast symptoms occurring during the study period and for changes in serum values of antinuclear antibodies, rheumatoid factor, and cardiolipin antibodies immunoglobulin G and immunoglobulin M. The majority of the women with implant rupture had no visible magnetic resonance imaging changes of their ruptured implants. For 11 implants (11 percent) in 10 women, the authors observed progression of silicone seepage, either as a conversion from intracapsular into extracapsular rupture (n = 7), as progression of extra-capsular silicone (n = 3), or as increasing herniation of the silicone within the fibrous capsule (n = 1); however, in most cases, these changes were minor. Some changes could be ascribed to trauma, but others seemed spontaneous. There was no increase in levels of autoantibodies during the study period in either study group. Women with untreated implant ruptures reported a significant increase in nonspecific breast changes (odds ratio, 2.1; 95 percent confidence interval, 1.2 to 3.8) compared with women without ruptures. On the basis of this first study of women with untreated silicone breast implant rupture, the authors conclude that implant rupture is a relatively harmless condition, which only rarely progresses and gives rise to notable symptoms. Even so, because of a small risk of silicone spread, the authors suggest that women with implant ruptures be followed clinically, if not operated on. Because implant ruptures often occur asymptomatically, any woman with silicone implants, regardless of rupture status, should be evaluated at regular intervals.

Adult↗