Radiation therapy in operable breast cancer: results from the Stockholm trial on adjuvant radiotherapy.

In a randomized trial, 960 women with Stage 1-3 operable breast cancer were treated by a modified radical mastectomy alone, or by the same procedure, preceded or followed by radiotherapy (4500 rad to the breast/chest wall, and internal mammary, axillary and supraclavicular lymph nodes). Up to ten years after treatment, there is an increasing gap between the recurrence-free survival of the irradiated patients and the surgical controls. Between the two types of radiotherapy, there was no difference. There were significantly fewer distant metastases and a tendency for improved survival in node positive patients treated with postoperative radiotherapy, compared to the surgical controls, this difference was, however, statistically not significant.

The significance of quantitative biological cell parameters in the handling of mammary carcinoma.

Recent work has shown that in breast cancer patients DNA measurements and estrogen receptor (ER)- analysis can contribute valuable information in the judgement of prognosis and choice of therapy. We report a case of advanced breast carcinoma with extensive liver metastases which clinically was regarded as beyond all therapeutic possibilities. Liver metastases were diagnosed first. Some time later a breast carcinoma was detected which was suggested to be the primary malignancy. Since high ER-values were demonstrated in the breast carcinoma, anti-estrogen therapy was given on trial. After three months the tumor mass in the liver had drastically diminished and today, more than 4 years after diagnosis, the patient is free from symptoms and doing excellently. A retrospective, microspectrophotometric DNA analysis in both the breast carcinoma and the liver metastasis showed DNA distribution patterns with nearly all the carcinoma cells exhibiting DNA values in the normal diploid region. This type of DNA profile has previously been shown to be correlated with good prognosis. We conclude that quantitative parameters such as DNA- and ER-content can give prognostic and therapeutic information over the above that furnished by clinical stage and morphological criteria.

Effect of suture materials on bacterial survival in infected wounds. An experimental study.

A non-capilllary and a capillary suture material were compared as regards the course of Staphylococcus areus infection at the site of implantation. The materials were implanted in the muscle of the rat, and bacterial counts were made at intervals over 41 days. The number of bacteria recovered at the implantation site during the test period decreased steadily and was significantly lower for the non-capillary than for the capillary materials. In the latter case the bacterial counts did not fall far below the initial value at inoculation. The number of bacteria isolated from the suture thread in relation to the total number from the thread and the surrounding muscle was significantly greater for the capillary material. The difference in the results for the two types of suture materials might be ascribed to differences in the extent to which the bacteria are exposed to the body's defence mechanism; in the case of the capillary suture material the bacteria would tend to be protected through their enclosure in the interstices of the material.

Preoperative radiotherapy in operable breast cancer: results in the Stockholm Breast Cancer Trial.

A randomized trial of preoperative radiotherapy in operable breast cancer was conducted from 1971 to 1976. The diagnosis was established by fine-needle aspiration biopsy. A dose of 4500 rad over five weeks was given to the chest wall, the breast and the lymph nodes of the axilla, the supraclavicular fossa and the internal mammary chain. Modified radical mastectomy was performed six weeks or more after completed radiotherapy. In control patients the same operation was performed without prior radiotherapy. By random allocation, one control group received no further treatment and postoperative irradiation was given to the other controls. Preoperative radiotherapy reduced the incidence of local and regional recurrence and of distant metastases, and also the mortality, as compared with the surgery only group. Postoperative radiotherapy as given in this trial gave almost equal reduction of local and regional recurrence but did not diminish the frequency of distant metastases or the mortality.

Serum hormone levels in benign prostatic hyperplasia.

The peripheral serum levels of FSH, LH, testosterone and total estrone (sum of free + conjugated estrone, mainly estrone sulphate) were determined in 20 patients with benign prostatic hyperplasia (BPH) aged 59--79 years and in 49 healthy men aged 58--79 years. There were no significant differences in the levels of FSH, LH and testosterone. The level of total estrone was significantly higher in the BPH group (p less than 0.05). The results are in accordance with our previous study on the urinary estrogen excretion in BPH and give additional support to the hypotheses concerning a role of the estrogens in the etiology of BPH.

Fluid absorption and capillarity of suture materials.

The fluid absorption and capillarity of different suture materials commonly used were investigated in saline and blood plasma. Linen and silk have high fluid absorption in plasma (92.2 +/- 1.3%, 65.2 +/- 0.7% of dry weight), and polyamide twisted with cover together with polyester considerably lower absorption (27.0 +/- 0.8%, 16.0 +/- 0.3%). Monofilament polyamide has fluid absorption ability in spite of its homogeneous structure (10.1 +/- 0.2%). Capillary properties were demonstrated in all multifilament synthetic and natural materials but were effectively eliminated by waxing treatment. The fluid transport rate constant varied considerably between different materials and was highest for polyamide with cover. Fluid absorption and capillary properties are presumed to be of significance for the impact of contaminating bacteria.

Suture material and bacterial transport. An experimental study.

The transport of bacteria and spreading of infection by suture materials was studied. An in vitro experiment showed that immobile bacteria can propagate inside multifilament materials. The spreading was correlated to the capillary properties of the threads. A similar result was obtained in an in vivo study in the muscle of the rat. The bacterial transport inside the thread was found to be of significantly greater importance for the spreading of wound infection than that on the surface of the material.

Experiences with polyglactin 910 (Vicryl) in general surgery.

The physical properties of polyglactin 910 (Vicryl) have been studied experimentally and clinically and compared with other synthetic and natural suture materials. Polyglactin 910 has a relatively high fluid absorption capacity but a low capillary capacity. The tensile strength is high and well comparable with, or superior, to other synthetic non-absorbable suture materials commonly used. The elongation at break is moderate. No unfavourable wound reaction to the suture material has been registered. The material has not increased the expected frequency of wound infections. The follow up of laparotomized patients 12-18 months after the operation showed a very low frequency of wound hernia. Neither was any recurrence noticed after repair of inguinal hernia. No clinical signs of leakage in the anastomoses of the gastrointestinal region was registrated. It is concluded that polyglactin 910 in a wide extent seems to be able to replace catgut and also non-absorbable suture materials when normal wound healing is to be expected.