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Biomedical subjects

U Laffer

Publications and source records attributed to U Laffer.

At least 37 records · Page 2Linked to original sources
PubMed1992

[Breast saving treatment of breast cancer: 10 questionable aspects].

Conservative treatment of breast cancer includes all those techniques by which a sizable amount of the gland is left behind after tumor resection, where the axilla is partially cleared and radiotherapy follows surgery. Thus, the subcutaneous mastectomy as a means of treating breast cancer does not fall into this category. Conservative treatment of breast cancer is a well-established technique as long as some basic principles concerning indication, technical details and general therapeutic plans are respected. Among many questions that have arisen from this kind of treatment, 10 are discussed. Among those is the fact of leaving behind vital carcinoma cells within breast tissue, the question of radiation-induced malignant tumours and other radiation sequelae, advantages and drawbacks of a simultaneous combination of radio- und chemotherapy, the quality of life, questions of follow-up and especially technical aspects in relation to the more radical quadrant resection or the cosmetically more advantageous tumorectomy. Considering all these aspects and open questions, conservative treatment of breast cancer has nevertheless to be regarded as the treatment of choice, at least for T1-lesions, as long as some clearly defined conditions are fulfilled. The aim of this multimodality treatment must be to achieve a cosmetic result better than that to be expected by reconstructive surgery after amputation of the breast, as long as the same survival figures can be obtained as after amputation.

Breast Neoplasms↗
PubMed1992

[Diagnostic problems in local recurrence after breast saving treatment].

353 patients with stages pTis, pT1-2, pN0-1, cM0 breast cancer have been treated consecutively by breast conserving therapy in a prospective, nonrandomized study at the University Hospital Basel and the Women's Clinic Rheinfelden/Baden/Germany. The median age was 47 years, the median follow-up time 67 months, and 4% only of this collective were lost to follow-up after a median time of 42 months. In 79% of the cases the tumor was excised totally, while in 19% the resection margins were positive and in 2% only the margins were not available for histological judgement. The rate of local failure reached 8% with a median time interval of 53 months. 116 patients showed postactinic induration in the primary tumor region. 73 of these were given additional diagnostic examination: The postactinic induration was judget clinically suspicious in 51 cases and clinically nonsuspicious of local failure in 22 cases. All 73 patients received additional examination by mammography and biopsy. By comparison with the histological results the clinical results were correct in 59% and false in 41%, while the mammographic results were correct in 82% and false in 18% of the cases.

Biopsy↗
PubMed1992

[1989 Basel Mammography Action].

To evaluate the compliance for a breast cancer screening program in the region of Basel, a mammography and a clinical examination has been offered free of charge to women between 40 and 60 years of age, especially to women with familial breast cancer. From September to November 1989, 602 women participated. Results were obtained from an epidemiologic questionnaire and a two-view mammography. The median age was 55.1 years. 70.2% of the women never had a mammography before. 28.8% indicated a history of familial breast cancer. So far 444 women have been evaluated. No pathological results were obtained in 84.8% In 10.7% a second examination has been recommended in the near future. In 4.5% the mammography led to an aspiration biopsy or surgical lumpectomy where 5 (1.2%) neoplasms have been detected. Due to the limited duration of the campaign and the invitation especially addressed to women at risk, our results are not comparable with large-scale screening campaigns known from the literature. Nevertheless, we succeeded to sensitize the female population for this kind of breast care. The overwhelming success shows that the basis for a large-scale screening program may exist.

Adult↗
PubMed1992

[Final evaluation of the randomized multicenter study SAKK 40/81: adjuvant portal chemotherapy of curatively resected colorectal cancer].

Between 1981 and 1987, 533 patients from 9 institutions have been entered in a randomized trial to assess the value of adjuvant portal infusion (5-Fluorouracil, Mitomycin C) compared to radical surgery alone. Analysis of 469 evaluable patients at a median follow-up of 5.8 years revealed 110 recurrences in the control and 94 recurrences in the infusion group. Estimated 5-year disease-free survival was 52% and 61% respectively (hazard ratio 1:0.75; 95% confidence interval 0.57-0.99; p = 0.046). Overall survival was 59% in the control and 69 in the infusion group (p = 0.048). Adjuvant portal infusion did not influence the occurrence of liver metastases but reduced the overall recurrence rate.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1991

Surgical experiences with 191 implanted venous Port-a-Cath systems.

The introduction of totally implantable catheter device has provided a simple, permanent and safe access to the vascular system. They have greatly improved the quality of life of the patients involved, whose activities, daily hygiene and bodily attractiveness remain practically unrestricted. To gain the greatest freedom from complications in the use of fully implantable catheter devices, the following requirements are important in to our experience: 1. Experience with only one kind of catheter system, irrespective of whether it is claimed to be the best, the simplest, or the cheapest. Various companies offer a variety of totally implantable catheter devices. Every system has its advantages and its disadvantages. However, each system also requires a considerable degree of surgical experience and experience in postoperative care and management to keep the complication rate as low as possible. Frequent changing to other systems does not enlarge the experience obtained. 2. The experience of the surgical team. In Basel catheter systems are implanted by three surgeons only. We are convinced that this contributes to our relatively low rate of complications. Brothers et al. (1988) also show that the rate of complications is inversely related to the experience of the surgeon involved. 3. The experience, commitment and training of the nursing staff responsible for the care and maintenance of the implanted catheter device. This care and maintenance of the implanted catheter device should start immediately after the surgical procedure.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1991

[Colorectal cancers: adjuvant therapy and after care (including tumor markers)].

Perioperative adjuvant treatment after radical surgery for colorectal cancer has proven to be possible without an increase of postoperative complications and postoperative mortality. In overcoming this surgical fear, a number of randomized studies, all of them investigating the role of adjuvant treatment, have been initiated. Preliminary results of these trials show, some of them already statistically significant, an advantage of the adjuvant treated patient group. Unless these results have been confirmed, adjuvant treatment should only be given in well designed, randomized clinical trials. Only these trials can prove the effectiveness of adjuvant therapy in radical surgery of colorectal neoplasms. In addition, these studies should be used to define the group of patients who really benefit of adjuvant treatment. The main goal of follow up methods after surgery for colorectal cancer should be the detection of asymptomatic and still treatable tumor recurrences. For this reason, frequent clinical investigations and frequent CEA level determinations seem to be the most important components at this time.

Biomarkers, Tumor↗
PubMed1990

Effectiveness and low toxicity of hepatic artery infusion with fluorouracil and mitomycin for metastatic colorectal cancer confined to the liver. The Swiss Group for Clinical and Epidemiological Cancer Research (SAKK).

The usefulness of hepatic artery infusion (HAI) with floxuridine is limited by the severe biliary and hepatic toxicity of floxuridine. This prompted the SAKK to evaluate the effectiveness, toxicity and feasibility of HAI with fluorouracil (FU) and mitomycin (MMC) administered by an external portable pump. Of 28 patients treated, partial responses were obtained in 14 (50%, 95% confidence interval: 30% to 70%) and stabilization in 11 (39%, 21% to 60%), for a median duration of 12.6+ months. Median survival was 19.5+ months. Grade I-II toxicity (WHO) consisted of nausea (46%), leucopenia (32%) thrombocytopenia (21%) and abdominal discomfort (25%). Two patients developed gastro-duodenal ulcers and two others grade III leucopenia. No life-threatening side effects, especially no sclerosing cholangitis or chemical hepatitis, were observed. In conclusion, HAI with FU and MMC is a valid alternative to floxuridine HAI in metastatic colorectal cancer confined to the liver.

Adult↗
PubMed1990

[What is the value of tumor debulking and intraperitoneal cytostasis].

Local recurrences of intraperitoneal malignancies are mainly localized at the primary tumor site and the peritoneal surface. Surgical procedures alone are neither able to further reduce the development of local recurrence nor to treat the already established recurrent disease. In this situation intraperitoneal chemotherapy as an "adjuvant" treatment modality could be thought helpful. Experimental and clinical trials have shown that high doses of cytotoxic agents can be applied to the abdominal cavity with less systemic side effects. While the recent published data are not promising for gastrointestinal malignancies, they seem to be more encouraging for ovarian cancer.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1990

[Following curative resection of colorectal cancer, portal chemotherapy especially benefits non-transfused patients].

After curative resection of colorectal cancer, immediate short-term postoperative intraportal adjuvant chemotherapy reduces the relative risk of recurrence and death in the non-transfused patient significantly, when compared to transfused patients without chemotherapy. This is demonstrated in a multivariate analysis using the Cox model on a group of 469 patients who have been intraoperatively randomized to receive either intraportal chemotherapy for 7 days or no further treatment. The transfused patients with chemotherapy and those receiving neither transfusions nor chemotherapy had a relative risk of recurrence and death situated in between the two groups mentioned above, not statistically different from either of them. In the setting of this study, 7 days postoperative intraportal chemotherapy seems particularly effective in the non-transfused patients.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1990

Gastro-intestinal metastases as first clinical manifestation of the dissemination of a breast cancer.

Of 1192 patients treated for breast cancer, four had extrahepatic gastro-intestinal metastases as first clinical manifestation of the tumour dissemination. One woman presented with gastric metastases mimicking a linitis plastica. Another had metastases localized to the rectum also mimicking a linitis plastica. Two women had peritoneal and retroperitoneal metastases that caused, in one case, a right hydronephrosis. Histology of the four primary tumours showed invasive lobular carcinoma (ILC) mixed with invasive ductal carcinoma in two. However, ILC exclusively was found at the site of the gastro-intestinal metastases involving the serosal layer (two cases) and extending to the submucosa (one case) or to the mucosal stroma (one case). Thus, when a women with previous history of invasive lobular breast cancer experiences gastro-intestinal symptoms, particular attention should be paid to the large and deep biopsy of lesions to ascertain the histological type and whether oestrogen or progesterone receptors differ from those of the primary breast lesion. Since survival is extremely variable (one woman is alive 7 years after the discovery of gastro-intestinal metastases), treatment including surgery, hormonal manipulation and chemotherapy with the expectation of a cure is often justifiable, particularly if no other extensive metastases are present.

Aged↗
PubMed1989

[Implantable catheter systems. Experience with 205 patients].

In a five-year period (1983-1988) catheters were implanted in 205 patients (118 venous, 31 peritoneal, 29 arterial, 25 epidural and 2 pleural), using the same system (Port-a-Cath). Total implant duration was 88,345 patient days (242 patient years). On average there was one catheter complication per 2000 patients days. The only catheter-system infections occurred with peritoneal catheters. This relatively low complication rate was probably due to the use of only one system, a uniform implantation technique practised by only three surgeons, and strict postoperative supervision by the oncology nursing team.

Adolescent↗
PubMed1989

[Initial results of adjuvant portal liver infusion following radical surgery of colorectal cancer (Swiss Study Group for Epidemiologic and Clinical Cancer Research Study 40/81)].

Between July 1981 and June 1987, 533 patients from 7 participating institutions have been entered in a prospective randomized trial to assess the value of adjuvant portal infusion (5-Fluorouracil 500 mg/m2/d x 7 continuous infusion + Mitomycin-C 10 mg/m2 on day 1 as a bolus injection through portal venous catheter) compared to radical surgery alone. The portal venous catheter was placed through any side-branch of the mesenteric venous system during laparotomy for the primary tumour. Using the transabdominal route, there have been no catheter-related complications. Overall hospital mortality in the study was 1.75% and was not influenced by adjuvant treatment. Analysis of 469 eligible patients at a median follow-up of 48 months revealed 39.1% recurrencies in the control group and 31.8% in the infusion group (p = 0.09, logrank). Median survival of control patients is 72 months, of chemotherapy treated patients not yet reached. Significant survival advantages have been detected for those 195 (85%) patients who received full-dose adjuvant chemotherapy (67% versus 53% 5-year survival). Due to the low number of deaths in this trial, prolonged follow-up is needed for definitive survival conclusions.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1989

[Blood transfusions and prognosis following curative resection of colorectal cancer: is there an association?].

More recently a number of retrospective analyses in rather ill defined patient populations demonstrated an association between perioperative blood transfusion and recurrence after curative resection of colorectal cancer. In the randomized trial (SAKK 40/81) (adjuvant cytotoxic intraportal infusion versus no further treatment) we evaluated the transfusion status in a well defined, prospectively documented and controlled patient population. Of 457 patients, 353 (77.2%) received either pre-, intra- or postoperatively blood transfusions. After a median follow-up of 4 years, the transfused patients developed significantly more recurrences (38.2%) than patients without blood transfusions (23.1%), the death-rate being 33.7% versus 23.0%, respectively. Patients without transfusion but treated with adjuvant intraportal chemotherapy are strikingly doing better (10.5% recurrences) than patients with perioperative blood transfusion not having an adjuvant treatment (44.5% recurrences).

Blood Transfusion↗
PubMed1989

[Antibiotic prophylaxis in colon surgery: cefazolin (Kefzol- ornidazole (Tiberal) versus cephazolin-placebo].

A prospective, randomized, double-blind and controlled clinical trial of systemic antibiotic prophylaxis with Cefazolin and Ornidazol (CO) versus Cefazolin and Placebo (CP) was carried out consecutively in 100 patients undergoing elective, colorectal surgery. The incidence of wound infection in the CP-group was 20% (n = 10) and in the CO-group 8% (n = 4) (p less than 0.10 ns). The reduction of anaerobic bacterias from 20% (n = 10) in the CP-group to 0% (n = 0) (CO) was significant (a1 = 0.0139; a2 = 0.0277 s, Fischer's exact test). The time of hospitalization was reduced from 20.3 days (CP) to 16.7 days (CO) (p less than 0.05 s). The agent for antibiotic prophylaxis in elective colorectal surgery is to cover the spectrum of anaerobic bacterias.

Adolescent↗