Homicides in Western Norway, 1985-2009, time trends, age and gender differences.

This retrospective study from Western Norway is based on the cases of 196 homicide victims from 1985 to 2009. The median age of the victims was 35 years, in both genders. Within the cases, 113 of the victims were male and 83 female, 28 victims were under the age of 18, and 19 victims were not native Norwegians. Ethanol was detected in the blood of a higher proportion of male compared to female victims, whereas a higher proportion of female compared to male victims had both illegal/legal drugs detected in their blood. Most perpetrators were male. Men were most often killed by an acquaintance, women by their present or former intimate partner. In 14 cases of intimate partner homicide the perpetrator committed suicide after killing their female partner. The dominant scene of crime was private homes. Most victims were killed by blunt force, sharp force or gunshot. The head was the body region most often injured in the homicide victims. Female victims were more often killed by manual strangulation than male victims.

Birth weight as a predictor of breast cancer: a case-control study in Norway.

The hypothesis that birth weight is positively associated with adult risk of breast cancer implies that factors related to intrauterine growth may be important for the development of this malignancy. Using stored birth records from the two main hospitals in Trondheim and Bergen, Norway, we collected information on birth weight, birth length and placenta weight among 373 women who developed breast cancer. From the same archives, we selected as controls 1150 women of identical age as the cases without a history of breast cancer. Information on age at first birth and parity were collected from the Central Person Registry in Norway. Based on conditional logistic regression analysis, breast cancer risk was positively associated with birth weight and with birth length (P for trend=0.02). Birth weights in the highest quartile (3730 g or more) were associated with 40% higher risk (odds ratio, 1.4, 95% confidence interval, 1.1-1.9) of breast cancer compared to birth weights in the lowest quartile (less than 3090 g). For birth length, the odds ratio for women who were 51.5 cm or more (highest quartile) was 1.3 (95% confidence interval, 1.0-1.8) compared to being less than 50 cm (lowest quartile) at birth. Adjustment for age at first birth and parity did not change these estimates. Placenta weight was not associated with breast cancer risk. This study provides strong evidence that intrauterine factors may influence future risk of breast cancer. A common feature of such factors would be their ability to stimulate foetal growth and, simultaneously, to influence intrauterine development of the mammary gland.

Premorbid body weight and its relations to primary tumour diameter in breast cancer patients; its dependence on estrogen and progesteron receptor status.

Hormonal mechanisms have been offered as an explanation for the higher frequency of large tumours, lymph node metastases and poorer prognosis in obese breast cancer patients than in lean ones. If hormonal mechanisms are important for these relations, they should probably act more strongly in patients with hormonal receptor positive tumours than in those with negative ones. We have examined if the relations between premorbid body weight or Quetelet's index (weight/height2) and tumour diameter are modified by estrogen receptor alpha (ER) and progesteron receptor (PgR) status. The analyses were based on 1,241 women with unilateral disease treated with modified radical mastectomy living in the geografic area of Haukeland Hospital. Their body weight and height have been measured as a mean 12.5 years before presentation of the disease. Body weight and Quetelet's index have been adjusted for age. The relations were studied using linear regression analyses adjusting the effect of body weight with height and mean nuclear area of the tumour cells and adjusting the effect of Quetelet's index for mean nuclear area. The main findings showed that patients with high body weight or Quetelet's index presented more often with PgR positive tumours than lean ones. Quetelet's index was also positively related to ER. These relations were present in patients older than 50 years of age (older). Patients with large tumours (>2.0 cm) had significantly higher body weight and Quetelet's index than those with small ones. These differences were significantly present in older patients and in patients with PgR negative and ER negative-PgR negative tumours. Linear regression analyses confirmed that tumour diameter increases with body weight and Quetelet's index. These relations were present in both lymph node groups and in older patients. Stratification according to hormonal receptor status showed these relations to be significant in patients with ER negative, with PgR negative and those with ER negative-PgR negative tumours only. Taking age and hormonal receptor status into consideration simultaneously, both body weight and Quetelet's index were significantly related to tumour diameter in older patients with hormone receptor negative tumours. In conclusion body size was positively related to hormone receptor status and to diameter of the primary tumour. The relation to tumour diameter was present in older patients with hormone receptor negative tumours. Although hormonal mechanisms able to act on the tumour can not be excluded, mechanisms acting independent of hormonal receptors must be considered. Different mechanisms related to body fat cytokines are discussed.

Efferent vascular invasion in the axillary nodes in breast carcinoma: a potent prognostic factor.

Tumour cells in the efferent vessels of the axillary nodes in breast cancer (EV status) have been associated with poor prognosis since 1979. A prospective study (1980-1989) of all the nodes from 1037 consecutive female patients with unilateral breast cancer whose treatment included axillary node dissection yielded 471 node-positive cases. Tumour cells were found in the efferent nodal vessels of 210 patients, while 252 were negative. In the remaining 9 patients efferent nodal vessels could not be identified. At follow-up, 62% of the node-positive patients had died of breast carcinoma, in contrast to 32% of node-negative patients. The prognosis in cases with 1-3 versus 4+ tumour-bearing nodes was highly significant, 36% and 64%, respectively having died of breast carcinoma,. Prognosis was not dependent on the number of EV+ nodes in those cases showing efferent vascular invasion, one positive node was enough. Differentiation between these nodal growth forms thus provides a strong prognostic indicator, available to all with access to routine surgical pathology. We confirmed the significance of both variables using Cox's regression analysis and showed that the number of positive nodes adds significant prognostic information to that of EV status, which is the stronger of the two prognostic indicators. EV+ patients with more than three positive nodes have more than a three times higher risk of dying than EV- patients with three or fewer positive nodes.

The size of a micrometastasis in the axilla in breast cancer: a study of nodal tumour-load related to prognosis.

Much has been written on micrometastases to the axilla in breast cancer but there is no consensus as to their size. In this study three levels of nodal tumour-load are defined following measurement of nodal tumour area on histology. The two cut-points described are both of clinical interest. The smallest deposits, up to 0.0001 cm2, include embolic growth on the afferent side of the node, which is, as reported previously, of poor prognosis. In such cases post-operative prognosis approaches that in the "node-positive", here defined as cases with an axillary tumour-load of 0.5 cm2 or more. Between these two groups is a collection of cases, 40% of the total series, with a prognosis similar to the node-negative. It is suggested that the deposits in this intermediate group should be termed micrometastases, the high risk cases with embolic growth reported as such and those with larger deposits as node-positive.

The prognostic contribution of estrogen and progesterone receptor status to a modified version of the Nottingham Prognostic Index.

The aim of this study was to test the prognostic contribution of estrogen (ER) and progesterone (PgR) receptor status to an index consisting of the number of positive lymph nodes, the mean nuclear area of the breast cancer cells (MNA), and tumour diameter. This index is compared with a Danish index, which includes the same factors but uses histological grade instead of MNA. The Danish index has been developed from the Nottingham Prognostic Index (NPI). In the present study of 1629 breast cancer patients the Cox proportional hazard method is used to examine the time-dependency of the index, and to test for interaction between the index and the hormone receptors. The index sorts the patients into groups with low, intermediate, and high risk of dying. Logistic regression analysis is used to report the sensitivity and specificity of the index with and without ER and PgR. Our index gave information comparable to that of the Danish group. However, the information given by our index is time-dependent, its strength being weaker after 5-year of follow-up. PgR and ER add information to high risk patients, but only in the first 5-year period. High risk patients with positive hormone receptors have a prognosis similar to intermediate risk ones. PgR increases the ability of the index to predict breast cancer deaths correctly by 5 percent in high risk patients. In conclusion, PgR and ER act differently in groups of patients with different risk levels when time-dependency is considered. This indicates biological differences in subgroups as defined by the index.

The effect of Losartan, an angiotensin II antagonist, on cardiac function, mass and morphology in rats after repeated hyperbaric exposures.

Previously, we have found development of left ventricular hypertrophy (LVH), myocardial necrosis and haemodynamic changes in rats after repeated hyperbaric exposures to 5 bar. Exactly the same rat model and experimental set-up was applied in the present study. The purpose of this study was to investigate if angiotensin II (Ang-II) plays a role in the development of these cardiac changes. Losartan, a recently developed non-peptide Ang-II receptor antagonist, was administrated (20 mg kg-1 day-1) to each rat for 40 days. Nine test rats underwent chamber dives daily for 40 consecutive days, and 10 control rats were exposed in the same chamber for an equal period of time, but in air at 1 bar. After 40 days, test rats and control rats had equal right and left ventricular myocardial mass/100 g-1 body mass, thus indicating that Losartan inhibits hyperbarically induced LVH. Microscopic examination revealed no changes in the left ventricle, indicating that Losartan prevents myocardial necrosis. The left ventricular pressure (LVP) and the maximal velocity of LVP increase and decrease (+/-dP/dt) were similar in the test rats compared to the control rats at 1 bar. Previously we found a higher LVP and dP/dt in non-treated test rats in otherwise identical experiments. This indicates that Losartan "normalizes" the cardiac function of test rats after repeated hyperbaric exposures. The systolic arterial pressure, heart rate (HR) and respiratory frequency (RF) were similar in the two groups at 1 bar. However, treatment with Losartan lowered the blood pressure compared to previously non-treated rats. In conclusion, long-term Ang-II receptor blockade prevented previously shown changes in cardiac function and morphology, as well as myocardial mass, after 40 consecutive exposures to 5 bar.

Prognostic role of oestrogen and progesterone receptors in patients with breast cancer: relation to age and lymph node status.

AIMS: To consider the prognostic role of oestrogen receptor and progesterone receptor status in relation to the age at surgery, length of follow up and lymph node status. METHODS: The study population comprised 977 patients with histologically confirmed breast carcinoma, with a median follow up of nine years. The actuarial life table method was used to test for survival differences. The Cox proportional hazard model was used to test for interaction effects between each hormone receptor and age, lymph node status and length of follow up. As the analysis involved multiple subgroups, significance was set at the 1% level (p < 0.01). RESULTS: When the patients were subdivided into groups according to lymph node status and age, progesterone and oestrogen receptor status predicted prognosis in middle aged (46-60 years) patients with lymph node positive breast cancer. Their prognostic effect in this subgroup, however, was restricted to the first five years after surgery. Progesterone receptor status was the strongest predictor of outcome. CONCLUSION: The prognostic power of oestrogen and progesterone receptor status varies depending on age, lymph node status and length of follow up after surgery.

Aggressive thyroid carcinoma with predominant cribriform growth pattern. Case report.

Thyroid carcinomas demonstrate a morphological and biological spectrum from highly differentiated to undifferentiated (anaplastic) tumours, and the poorly differentiated carcinomas probably occupy an intermediate position, being characterized by a more solid structure. The present thyroid carcinoma, which occurred in a 77 year old male, showed a distinct cribriform growth pattern with marked apoptosis and high-grade features such as nuclear plemorphism, frequent mitotic figures, tumour necrosis and vascular invasion, suggesting the presence of a poorly differentiated carcinoma. Metastatic spread to the regional lymph nodes and lungs were present at the time of diagnosis, and the patient died after 15 months with progressive disease. It should be further studied whether cribriform structure may represent an independent feature of aggressive clinical behaviour.

Pre-morbid body-mass-index in breast cancer: reversed effect on survival in hormone receptor negative patients.

The present study consists of 1,238 women with unilateral breast cancer treated with modified radical mastectomy living in the geographic area of Haukeland Hospital. Their weight and height had been measured years before presentation of the disease. Age-adjusted Quetelet's index (weight/height2) showed that obese women had a 49% higher risk of dying from breast cancer than lean ones. The relative risk decreased slightly when adjusted for tumour diameter, lymph node status, and mean nuclear area of the tumour cells. The prognostic effect of Quetelet's index was examined according to the estrogen and/or progesterone receptor status of the tumour. In patients with a hormone receptor positive tumour, obese women had a risk that was more than three times higher than lean ones. In patients with hormone receptor negative tumour, the effect of obesity was reversed, lean patients having a risk that was more than six times higher than obese ones, even after adjustment for lymph node status, tumour diameter, and mean nuclear area. Quetelet's index, while being a prognostic variable in its own right, thus acts differently in patients with hormone receptor positive and negative tumours.

Lymph node-negative breast cancer: the prognostic role and time dependency of age, tumor diameter and mean nuclear area.

This study of 786 node-negative breast cancer patients demonstrates that the prognostic effect of age at operation, tumor diameter and mean nuclear area (MNA) changed over time. Identifying patients at higher risk of dying after 5 years may be of clinical importance. These are patients who may have had a low metastatic tumor burden at the time of operation and in whom cytostatic adjuvant treatment could be of value. When estimating 10-year survival, a significant loss of strength was found for age. A near significant loss of effect was also found for MNA, while tumor diameter was the variable best maintaining prognostic power during the observation period. Due to the loss of strength for MNA and age when estimating 10-year survival, the observation period was divided into two periods. When estimating 5-year survival, MNA was the strongest variable, while tumor diameter and age gave additional significant information. When estimating the next 5 years, excluding patients who died before 5 years, only tumor diameter gave significant prognostic information (573 cases). This again stresses the importance of tumor diameter in assessing prognosis in node-negative patients.

Repeated normoxic hyperbaric exposures induce haemodynamic and myocardial changes in rats.

The effect of repeated exposure to ambient pressures of 5 bar (500 kPa), in atmospheres comprising normal partial pressures of oxygen [0.2 bar (20 kPa)] and nitrogen [0.8 bar (80 kPa)] and 4 bar (400 kPa) helium, on cardiac function and morphology was assessed in conscious rats. Ten test rats underwent chamber dives daily for 40 consecutive days, and ten control rats were exposed in the same chamber for an equal period of time, but in air at 1 bar (100 kPa). Cardiac output (Qc) and myocardial blood flow (Qmyocardial) were determined by the microsphere method. After 40 days, the body mass was 7% greater in the control than in the test rats (P < 0.05), although they were given exactly the same amount of standard food. The test rats had a significantly higher (7% absolute, 12% ventricular mass to body mass, P < 0.05) heart mass (left ventricular myocardium, including the ventricular septum) than the control rats. The percentage tissue dry mass of the right and left ventricles was equal in the two groups. Microscopic examination revealed a number of small focal necroses in the left ventricle of the test rats but none in the control rats. The left ventricular pressure (LVP) and the maximum velocity of LVP increase (contractility) and decrease were significantly increased (25%-96%, P < 0.001) in the pre-exposed compared to the control rats at 1 bar (100 kPa). The systolic arterial pressure, heart rate and respiratory frequency were similar in the two groups at 1 bar (100 kPa).(ABSTRACT TRUNCATED AT 250 WORDS)

Koilocytosis in neoplasia of the urinary bladder.

Koilocytosis is commonly regarded as indicative of human papilloma virus infection in the uterine cervix. In 1987 morphologically similar changes were reported in bladder tumours. This is confirmed in the present study, the incidence here being 65%. In addition the incidence of koilocytic change was shown here to increase from non-infiltrative WHO grade I to infiltrative WHO II lesions, and to be more common in bladder lesions in women with cervical koilocytosis. The latter is in keeping with our previous report that the incidence of koilocytosis in the cervix of patients with bladder neoplasia is higher than expected in the general population, adding support to the hypothesis that both lesions may be virus-related.

The internal elastic lamina in the basilar artery and its possible significance for intimal thickening. A morphometric study.

The degree of intimal thickening, folding of the internal elastic lamina (IEL) and luminal radius/wall thickness ratio (RWR) have been compared between predilectional sites and a non-predilectional site for atherosclerosis in human basilar arteries. The findings are compatible with the hypothesis that a low degree of folding and a high RWR facilitate intimal thickening. A negative correlation between the fold index and intimal thickening index and a positive correlation between RWR index and intimal thickening index were found. Predilectional areas also have lower fold indices and higher RWR in younger subjects prior to any intimal thickening development.

Negative selection of human monocytes using magnetic particles covered by anti-lymphocyte antibodies.

We have developed a standardized procedure for the isolation of monocytes from peripheral blood by negative selection using magnetic polymer particles coated with monoclonal antibodies against T and B lymphocytes. The average purity of the monocyte suspension was 85%, and monocyte recovery was 72% from Ficoll-Hypaque gradient separated mononuclear cells and 32% from whole blood. In a lucigenin enhanced chemiluminescence assay there was no significant difference between cells separated immunomagnetically and those separated on a gradient. Nor did electron microscopy show any significant difference in morphology between such monocytes. Negative selection using magnetic polymer particles is an efficient method for the separation of monocytes with intact morphology and function as measured by chemiluminescence.

Risk of cervical intraepithelial neoplasia in women with glomerulonephritis.

OBJECTIVE: To investigate the occurrence of cervical intraepithelial neoplasia in women with glomerulonephritis and its possible association with immunosuppressive treatment. DESIGN: Retrospective study of cytological or histological specimens from women presenting with glomerulonephritis and a group of case and age matched controls. SETTING: University department of pathology, Norway. PATIENTS: 81 women presenting with glomerulonephritis from 1981 to 1988, from whom gynaecological cytological or histological specimens were available. A group of 162 case and age matched controls. MAIN OUTCOME MEASURES: Age when glomerulonephritis of cervical intraepithelial neoplasia was diagnosed, type and characteristics of kidney lesion, stage of cervical intraepithelial neoplasia and presence of human papillomavirus, use of immunosuppressive treatment. RESULTS: Cervical intraepithelial neoplasia was more common in women with glomerulonephritis than in their controls (16/81 (20%) v 7/162 (4%), p less than 0.001) and was more advanced in those with glomerulonephritis than in the controls (9/81 (11%) of the study group had grade III cervical intraepithelial neoplasia compared with 1/162 (1%) of the controls). The increased occurrence of cervical lesions was independent of the use of immunosuppressive treatment, but the individual lesions tended to be more advanced when it was used (four of the seven cervical lesions in women with glomerulonephritis who had received immunosuppressive treatment were carcinoma in situ). Of the nine cervical lesions tested, seven were virus associated. CONCLUSION: Women with glomerulonephritis should have regular cervical smears, irrespective of their use of immunosuppressive treatment.

Estrogen receptor in breast cancer; its relation to mean nuclear area, age and lymph node status.

A study of 378 patients with infiltrating breast carcinoma using linear logistic regression and ANOVA analysis demonstrated a different relation between age at operation and estrogen-receptor (ER) concentration in the lymph-node negative and the lymph-node positive groups. Tumours from patients between 51 and 70 years old had lower median ER concentration in the lymph-node negative group than in the lymph-node positive group. In the group older than 70 years, however, tumours from lymph-node negative patients had higher median ER concentrations than those from the lymph-node positive patients. Patients 50 years and younger had similar median ER concentrations in both lymph-node groups. Low mean nuclear area (MNA) of the tumour cells was associated with high frequency of tumours able to produce ER. No such association was found for age. Independent of age and lymph-node status tumours with low MNA also had high ER concentration. These findings suggest that tumours from different lymph-node/age groups may have different biological properties. The relationship between ER and nuclear size point to a key function of the nucleus, both as regards the ability to produce ER and its level of production.

One of 8 women with bladder neoplasia may have concomitant gastrointestinal pathology, including cancer.

A study of the pathology records during 6 years for 160 women with bladder neoplasia and 150 with malignant melanoma revealed differences in patient experience in regard to the incidence of surgical biopsies. Biopsy for additional skin lesions was common in melanoma patients, who produced few gastrointestinal lesions. In contrast, 19 of the bladder cancer patients produced 26 gastrointestinal lesions, including 5 carcinomas. The latter incidence is higher than expected in our population. This difference between the 2 sets of patients in regard to skin and gastrointestinal lesions is statistically significant. Few gynecological lesions were noted in either group but a common factor was human papillomavirus infection, as indicated by the presence of koilocytosis. The latter also was present in 17 per cent of 41 otherwise negative smears from patients with bladder neoplasia, that is considerably more than expected (less than 1 per cent), and is similar to that reported previously in patients with melanoma.

The prognostic role of progesterone receptor status and age in relation to axillary node status in breast cancer patients.

The prognostic role of axillary lymph node status, progesterone receptor (PgR) status, age of the patient at operation, oestrogen receptor (ER) status and tumour diameter was studied in 443 breast cancer patients treated by modified radical mastectomy. Logistic and proportional hazard regression analyses were used to estimate the prognosis from the time of operation up to 60 months. We also estimated the prognosis from 36 to 60 months for those who had survived 36 months (conditional analysis). PgR and age gave significant information in each node class, old age and PgR negativity being disadvantages. PgR status relative to node status was more important for estimating early (24 months) prognosis, while age was of more importance later (60 months). Node status and age were the only variables giving significant information in the conditional analyses. It is thus of importance to consider the time dependency of the prognostic variables when predicting survival in breast cancer patients. No effect was found for ER status or tumour diameter.