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1.
V Spataro K Price A Goldhirsch F Cavalli E Simoncini M Castiglione C M Rudenstam J Collins J Lindtner R D Gelber 《Annals of oncology》1992,3(9):733-740
We retrospectively evaluated 401 selected patients who had estrogen receptor (ER) assays both at primary surgery and at relapse in an accessible site to determine the clinical relevance of the subsequent ER determination. The median time between ER assessments was 27 months (range: 2-122 months). The median follow-up time from diagnosis was 6 years (range: 2-12 years). For patients with ER+ tumors at primary diagnosis, 29% (76/261) had ER- tumors at relapse, while for ER- primaries, the conversion rate was 33% (46/140). Conversions from ER+ to ER- occurred more often when the time interval between assays was less than one year (p = 0.004), while conversions from ER- to ER+ tended to occur late (beyond three years; p = 0.0003). Treatments received between assays (usually adjuvant therapy) had only a slight influence on ER status conversion. Post-relapse survival was poor for patients who had the biopsy accessible recurrence within one year; an expression of the aggressive nature of the disease. Among patients whose accessible relapse was beyond one year, those with ER- primaries who converted to ER+ had a longer survival than those whose recurrence was classified again as ER- (p = 0.006). This group of patients with ER- primaries who recurred beyond one year with an ER+ tumor in an accessible site represented 29% (40/140) of all patients with ER- primaries and had an estimated overall survival rate of more than 60% at 6 years from the accessible relapse. ER determination upon relapse within one year has very little clinical relevance.(ABSTRACT TRUNCATED AT 250 WORDS) 相似文献
2.
G Karlstr?m G Bergstr?m B Folkow J Rudenstam G G?thberg 《Acta physiologica Scandinavica》1991,141(4):517-530
The kidneys have a humoral antihypertensive system, located in the renal medulla and presumably antagonizing the pro-hypertensive renin-angiotensin system. Medullipin I and II and maybe platelet activating factor (PAF), seem to be the mediators of this system, known to be activated after reversal of renovascular hypertension or when the perfusion pressure to a normotensive kidney is suddenly elevated. The present study was undertaken to investigate whether this system is functioning also in the spontaneously hypertensive rat (SHR), and if it is then reset in proportion to the increased mean arterial pressure (MAP). Isolated kidneys from spontaneously hypertensive rats and from Wistar Kyoto rats (WKY) were cross-perfused in vivo from anaesthetized intact Wistar Kyoto rat 'donors'. After 30 min of perfusion at 100 mmHg the perfusion pressure to the isolated kidneys were, for 60 min, either kept unaltered at 100 mmHg or, for the Wistar Kyoto rat kidneys, increased to 150-200 mmHg and, for the spontaneously hypertensive rat kidneys, raised to 200 or 250 mmHg. The results show that the humoral antihypertensive system is present also in spontaneously hypertensive rat kidneys, but is here reset upwards to or even beyond the elevated MAP level. Furthermore, all mean arterial pressure reductions caused by high-pressure perfusion of Wistar Kyoto and spontaneously hypertensive rat kidneys were accompanied by reductions in heart rate (HR) in the 'donors', in agreement with previous observations after reversing renal hypertension and after i.v. medullipin I injection. In fact, in spontaneously hypertensive rat kidneys, the 'incretory' depressor mechanism appears to be more markedly reset upwards than is the 'excretory' depressor mechanism inherent in pressure diuresis with consequent salt-volume elimination. In conclusion spontaneously hypertensive rats, like Wistar Kyoto rats and Wistar rats, have a humoral antihypertensive system in the kidneys, but it is reset upwards even beyond the elevated mean arterial pressure level in spontaneously hypertensive rats. The combination of a depressor response and reduced heart rate in the 'donors' renders further evidence that the medullipins are the principal, though probably not the only, humoral antihypertensive factors released from the cross-circulated kidneys. 相似文献
3.
A. Goldhirsch R. D. Gelber M. Castiglione A. O'Neill B. Thürlimann C.-M. Rudenstam J. Lindtner J. Collins J. Forbes D. Crivellari A. Coates F. Cavalli E. Simoncini M. F. Fey O. Pagani K. Price H.-J. Senn 《Annals of oncology》1997,8(8):751-756
Purpose: It has been postulated that breast cancer surgery performedduring the follicular phase of the menstrual cycle is associated with pooreroutcome.Patients and methods: We tested this hypothesis by evaluatingdisease-free survival (DFS) for 1033 premenopausal patients who receiveddefinitive surgery either during the follicular phase (n = 358) or theluteal phase (n = 675). All patients were enrolled in a randomized trialconducted between July 1986 and April 1993. All had node positive breastcancer and randomization was stratified by estrogen receptor (ER) status.All patients received at least three cycles of adjuvant cyclophosphamide,methotrexate, and 5-fluorouracil (CMF). The median follow-up was 60 months.Results: Patients who underwent definitive surgery for breast cancer inthe follicular phase had a slightly worse disease-free survival than thoseoperated on during the luteal phase (five-year DFS percentage: 53%versus 58%; hazard ratio, 1.13; 95% confidence interval (CI),0.94–1.38; P = 0.20). The effect was significantly greater for thesubpopulation of 300 patients with ER-negative primaries (P = 0.02interaction effect; five-year DFS percentages 42% vs. 59%;hazard ratio 1.60; 95% CI, 1.12–2.25; P = 0.008). The effect oftiming of surgery diminished for analyses based on lesser surgicalprocedures, e.g., excisional biopsies. In particular, no effect of timingwas observed for fine needle aspiration procedures.Conclusions: Surgical procedures which are more extensive than a fineneedle aspiration biopsy might be associated with worse prognosis if conductedduring the follicular phase of the menstrual cycle. This phenomenon was seenpredominantly for high risk breast cancer with low levels or no estrogenreceptors in the primary tumor. 相似文献
4.
M Colleoni S Li R D Gelber A S Coates M Castiglione-Gertsch K N Price J Lindtner C-M Rudenstam D Crivellari J Collins O Pagani E Simoncini B Thürlimann E Murray J Forbes D Erzen S Holmberg A Veronesi A Goldhirsch 《Annals of oncology》2005,16(5):716-725
BACKGROUND: Controversy persists about whether chemotherapy benefits all breast cancer patients. PATIENTS AND METHODS: In the International Breast Cancer Study Group (IBCSG) trial VII, 1212 postmenopausal patients with node-positive disease were randomized to receive tamoxifen for 5 years or tamoxifen plus three concurrent courses of cyclophosphamide, methotrexate and 5-fluorouracil ('classical' CMF) chemotherapy, either early, delayed or both. In IBCSG trial IX, 1669 postmenopausal patients with node-negative disease were randomized to receive either tamoxifen alone or three courses of adjuvant classical CMF prior to tamoxifen. Results were assessed according to estrogen receptor (ER) content of the primary tumor. RESULTS: For patients with node-positive, ER-positive disease, adding CMF either early, delayed or both reduced the risk of relapse by 21% (P=0.06), 26% (P=0.02) and 25% (P=0.02), respectively, compared with tamoxifen alone. There was no difference in disease-free survival when CMF was given prior to tamoxifen in patients with node-negative, ER-positive tumors. CONCLUSIONS: CMF given concurrently (early, delayed or both) with tamoxifen was more effective than tamoxifen alone for patients with node-positive, endocrine-responsive breast cancer, supporting late administration of chemotherapy even after commencement of tamoxifen. In contrast, sequential CMF and tamoxifen for patients with node-negative, endocrine-responsive disease was ineffective. 相似文献
5.
AIMS: Renal medullary blood flow is important in blood pressure regulation and is surprisingly unaffected by the vasoconstrictor action of angiotensin II (Ang II). This study tested if the effect of Ang II on the renal papillary circulation is modulated by bradykinins, prostaglandins or NO (NO). In anaesthetised Wistar rats, total renal blood flow (RBF) was measured, as was cortical (CBF) and papillary (PBF) blood flow, using the laser-Doppler technique, in responses to Ang II (30 ng kg(-1) min(-1)) alone and after ACE inhibition (enalapril) or bradykinin/prostaglandin synthesis inhibition (ketoprofen, aprotinin). PBF was also measured after blockade of NO formation with or without pretreatment with an Ang II receptor antagonist (losartan). MAJOR FINDINGS: (i) PBF did not change in response to Ang II infusion but MAP increased (+ 10%) and RBF and CBF decreased. (ii) Treatment with aprotinin and ketoprofen left MAP, RBF and CBF unchanged but decreased PBF. Ang II did not decrease PBF further but a significant increase in MAP was seen. (iii) Enalapril treatment left PBF unchanged but decreased MAP and increased RBF and CBF. When Ang II was infused PBF and MAP increased markedly. (iv) L-NAME reduced PBF independently of losartan treatment. PRINCIPAL CONCLUSION: Bradykinin and prostaglandins do not appear to cause the lack of renal papillary vasoconstriction to Ang II. However, the increase in PBF to Ang II seen after enalapril treatment suggests that enalapril treatment, possibly via its effects on kinin breakdown and subsequent NO formation, might affect the sensitivity of renal papillary autoregulation. This may be an important aspect of the blood pressure lowering effect of ACE inhibitors. 相似文献
6.
Soller MJ Kullendorff CM Békássy AN Alumets J Mertens F 《Cancer Genetics and Cytogenetics》2007,173(1):75-80
Adenocarcinomas of the kidney are rare childhood tumors. Only 30 cases with chromosomal abnormalities have been reported, and neither their karyotypic characteristics nor the molecular mechanisms behind their pathogenesis are clear, except for a special group of papillary tumors characterized by X-chromosome abnormalities. We have cytogenetically analyzed short-term cultured cells from two pediatric renal carcinomas, one papillary, and one chromophobe renal cell carcinoma, revealing the following karyotypes: 58-60,XX,-X,-1,+7,-8,-9,-11,-14,-15,+17,-18,-19,-21,-22 and 36,X,-X,-1,-2,-5,-6,-9,-10,-13,-17,-21/37,idem,+r/36,idem,-14,+1-2r, respectively. The findings indicate that subsets of pediatric renal cell carcinoma show karyotypes that are similar to their adult counterparts. 相似文献
7.
Castiglione-Gertsch M.; Johnsen C.; Goldhirsch A.; Gelber R. D.; Rudenstam C. M.; Collins J.; Lindtner J.; Hacking A.; Cortes-Funes H.; Forbes J.; Simpson J.; Tattersall M.H. N.; Brunner K.; Cavalli F.; Senn H.J.; International Breast CancerStudy Group Bern 《Annals of oncology》1994,5(8):717-724
BACKGROUND: Adjuvant systemic therapy prolongs disease-free and overallsurvival in both pre- and postmenopausal patients. Availabledata shown benefit from multi-agent chemotherapy, prolongedtamoxifen treatment, and ovarian ablation, and that the combinationof chemo- and endocrine therapy might be advantageous. In 1978the International (Ludwig) Breast Cancer Study Group (IBCSG)initiated four complementary randomized controlled clinicaltrials to evaluate the roles of chemo-endocrine combinationsor endocrine therapy alone in specific populations defined byrisk (for pre- and perimenopausal patients) or by age (for postmenopausalpatients). The results at 10 and 13 years' median follow-upfor these trials are summarized in this report and are comparedto those of the Overview meta-anal-ysis with regard to chemo-endocrineor endocrine therapy combinations. Furthermore, types of firstrelapses by sites and second malignant diseases are reported. PATIENTS AND METHODS: 1601 evaluable patients with node positive disease were includedinto the studies IIV. In Trial I (491 premenopausal patientswith 13 positive axillary nodes) we studied the additionof low-dose continuous prednisone (p) to a cyclophosphamide-methotrexate-fluorouracil(CMF) combination. In Trial n 327 premenopausal patients withfour or more positive axillary nodes were randomized to oneyear CMFp or to a surgical oophorectomy followed by CMFp. InTrial III (463 postmenopausal patients 65 years old or younger),combined chemoendocrine therapy (one year of CMFp plus tamoxifen(T)) was compared to endocrine therapy (1 year of p + T) orto surgery alone. In Trial IV 320 postmenopausal patients 66to 80 years old were treated either by surgery alone or by surgeryfollowed by 1 year prednisone and tamoxifen. RESULTS: In Trial I the addition of prednisone allowed a higher doseof cytotoxics to be administered compared with CMF alone. Despitethis increased dose intensity, 13-year disease-free survival(DFS) and overall survival (OS) were similar for the two treatmentgroups (49% vs. 52% DFS, 59% vs. 65% OS for CMFp vs. CMF). InTrial II the addition of surgical oophorectomy to CMFp yieldedan improved outcome which approached statistical significancefor the subset of 107 patients known to have estrogen receptor-positivetumors (DFS, 23% vs. 15%, p 相似文献
8.
Crivellari D.; Price K. N.; Hagen M.; Goldhirsch A.; Gelber R. D.; Castiglione M.; Coates A. S.; Rudenstam C.-M.; Collins J.; Lindtner J.; Cortes-Funes H.; Gudgeon A.; Simoncini E.; Byrne M.; Schniirch H. G.; Fey M.; Tattersall M. H. N.; Forbes J. F.; Cavalli F.; Reed R.; Senn H.-J. 《Annals of oncology》1995,6(8):769-776
Background: Follow-up tests for patients after diagnosis andprimary treatment of breast cancer are routinely performed.However, the usefulness of these follow-up parameters remainsunclear. We determined the yield of a variety of blood testsused to detect the presence of overt metastatic disease Methods: 4105 patients enrolled in International (Ludwig) BreastCancer Study Group (IBCSG) randomized clinical trials from 1978to 1985 were analyzed for abnormal or equivocal findings insix routine blood tests obtained every 3 months for the firsttwo years, every six months for years 35 and yearly thereafter.The relationship of test results to the occurrence of overtmetastatic disease was evaluated. The relapses were categorizedas follows in order to estimate the yield of the different testsfor relevant sites of metastases: any breast cancer relapse,bone ± other; liver ± other Results: Alkaline phosphatase alone was abnormal in a high proportionof patients with either bone metastases, liver metastases, orboth. SGOT and gamma-GT were also sensitive for patients withliver metastases. Bilirubin, serum calcium, and serum creatininewere relatively insensitive indicators of relapse. Abnormaltest results were reported sometime during a patient's disease-freeperiod for 3% to 6% of patients, depending on the test Conclusions: Alkaline phosphatase was the most effective bloodtest to distinguish patients with relapse from those withoutrelapse. It is inexpensive and its yield is relatively highfor predicting liver and bone metastases. The routine use ofthe other tests analyzed to detect metastases was not justified breast cancer, follow-up, evaluation, routine tests 相似文献
9.
As a direct consequence of Sweden's devastating losses in its war with Russia in 1808-9, an institute for the training of military surgeons was established in Stockholm in December 1810. This establishment soon became known as the Karolinska Institute and is the forerunner of today's eponymous institution. This paper records the nature of the British assistance that led indirectly to the founding of this institute. This aid took the form of a report into the high morbidity and mortality rates due to scurvy which were sustained by the Swedish Fleet in Carlscrona in the summer of 1808. This report, written by John Jamison, Fleet Physician to the Baltic Command of Sir James Saumarez, was used by the Stockholm medical authorities as part of their campaign for improved training of military medical personnel. Whilst Jamison's report did not in itself lead to the establishment of the Stockholm medico-surgical institute, it was undoubtedly important, and serves both as an example of Anglo-Swedish relations during the Napoleonic era and a reminder of the ravages of scurvy. 相似文献
10.
The endometrium in breast cancer patients on tamoxifen 总被引:3,自引:0,他引:3
Dallenbach-Hellweg G Schmidt D Hellberg P Bourne T Kreuzwieser E Dören M Rydh W Rudenstam G Granberg S 《Archives of gynecology and obstetrics》2000,263(4):170-177
We restudied histologically and immunohistochemically 17 endometrial carcinomas, 2 malignant mixed tumors and 180 endometria
with benign changes during or after tamoxifen therapy. The carcinomas were subtyped according to the 1994 WHO-classification.
Endometrial biopsies were taken only if the endometrial thickness was > 8 mm sonographically, when a polyp was seen, or for
postmenopausal bleeding. About half of the endometrial specimens showed simple or cystic atrophy, 55–76% had cystic-atrophic
polyps or regressive hyperplasia. Depending upon the dose of tamoxifen, 7–19% (30 mg) to 27– 36% (20 mg) showed moderate glandular
proliferation. 20–33% had foci of mucinous, clear cell or serous-papillary metaplasia. 68–70% revealed diffuse extensive fibrosis
of the endometrial stroma. None of 11 patients biopsied before starting tamoxifen therapy had advanced endometrial glandular
proliferation in the second endometrial biopsy after tamoxifen treatment. None of the 19 endometrial neoplasms after tamoxifen
therapy was of the endometrioid type: 11 were mucinous adenocarcinomas, 4 clear cell carcinomas, 2 serous-papillary carcinomas,
one carcinosarcoma and one malignant Müllerian mixed tumor. The reasons for discrepancies between suspicious sonograms and
endometrial atrophy are discussed.
Received: January 1999 / Accepted: 11 October 1999 相似文献