Postmastectomy seroma. A study of the nature and origin of seroma after mastectomy.

To investigate the nature and origin of postmastectomy seroma, the concentration of IgG, the number of leucocytes, granulocytes and lymphocytes in the drain fluid and seroma aspirates was studied in breast cancer patients after mastectomy. The composition of the fluid and aspirates and the time-related changes of the investigated criteria suggested that 1) seroma is not an accumulation of serum, but an exudate, 2) the exudate is an element in an acute inflammatory reaction, i.e. the first phase of wound repair, and 3) seroma formation reflects an increased intensity and a prolongation of this phase. By paying attention to factors influencing the duration and intensity of the first phase of wound repair, it should be possible to reduce the occurrence of seroma.

[Gynecomastia. A follow-up study]. / Gynaekomasti. En efterundersøgelse.

Classification of gynaecomastia as physiological/idiopathic is traditionally carried out by exclusion on the basis of the case history and results of the clinical examination. Out of 138 consecutive patients with gynaecomastia referred by general practitioners to the Surgical Gastroenterological Department K in Odense Hospital during the period 1978-1981 for treatment, 98 patients (71%) were classified in this manner. Following a period of observation ranging from four months to ten years, average 7.5 years, diseases were demonstrated in five of the physiological/idiopathic cases which were perhaps the causes of gynaecomastia. Employment of an extensive paraclinical programme of investigation would probably have resulted in demonstration of the underlying disease in three cases but would scarcely have improved the prognosis despite the possibility for earlier institution of treatment. Routine employment of extensive paraclinical investigations of selected patients with gynaecomastia of this type cannot be recommended on account of the limited diagnostic and therapeutic results. Classification of gynaecomastia based on the case history and clinical examination appears to be sufficiently exact in patients referred by general practitioners for treatment to a surgical department.

Nuclear thyroid hormone receptor binding in human mononuclear blood cells after goitre resection.

Nuclear thyroxine and triiodothyronine receptor-binding in human mononuclear blood cells were examined in 14 euthyroid persons prior to and 1, 6, 24 and 53 weeks after goitre resection. One week after resection decreased serum T3 from 1.47 nmol/l to 1.14 nmol/l (P less than 0.05), FT4I from 103 a. u. to 94 a. u. and SHBG from 80 nmol/l to 69 nmol/l (P less than 0.05) followed after 6 weeks by a rise in serum TSH from 1.2 mU/l to 11.0 mU/l (P less than 0.05) suggesting an initial slight hypothyroidism. Nuclear receptor-binding of T4 and T3 increased within one week and eventually decreased to preresectional values. We conclude that the expected alteration of the metabolic state caused by resection of the gland is opposed by increased nuclear binding of T4 and T3.

Significance of incisional biopsy in breast carcinoma: results from a clinical trial with intended excisional biopsy.

The recurrence-free survival rates (RFS) after one-stage mastectomy and partial axillary dissection in 1242 low risk breast cancer patients with invasive ductal carcinoma with or without residual cancer tissue (RCT) in the wall of the biopsy cavity were compared. RFS was significantly lower in patients with RCT (RCT-positive) whether premenopausal (n = 416) or postmenopausal (n = 826). By applying the Cox multivariate analysis on RCT and various known prognostic criteria, the incidence rates for RCT-positive patients relative to RCT-negative patients were estimated. The relative risk by RCT-positivity was in the order of 1.45, indicating that RCT is an independent risk factor contributing an increased risk of recurrence of about 45%.

Spontaneous pneumothorax and fibrin glue sealant during thoracoscopy.

The prophylactic treatment of the application of fibrin glue to the pulmonary surface during thoracoscopy in idiopathic spontaneous pneumothorax resulted in rapid and total pulmonary expansion in 33 of 35 patients. The 2 failures were due to apical cysts larger than 2 cm. The successfully treated patients were hospitalized for a median of 4 days (range 2-12). No complications were observed. All regained full working capacity within 1 month of discharge. Post-treatment X-ray examination of the chest was uniformly normal. During an observation time ranging from 7-24 months (median 12 months), 3 recurrences (9%) were seen at 7, 12, and 16 months, respectively. The treatment seems (1) to reduce the need for thoracotomy (2) to be associated with a high success rate, short and long-term, (3) to minimize the duration of hospital stay and (4) not to disturb the normal pleuro-pulmonary anatomy.

Total mastectomy with special reference to surgical technique, extent of axillary dissection and complications.

Total mastectomy and partial axillary dissection as advised in the DBCG (Danish Breast Cancer Cooperative Group) protocols was performed in 104 consecutive females with operable primary invasive breast cancer, aged 34-82 years, median 47 years. The glandular removal was complete as assessed by microscopic examination of side resection planes and deep fascia of the surgical specimen. The number of removed axillary lymph nodes ranged from 1 to 28, median 8. The mortality was zero. There were no general complications. Wound complications comprised seroma (47.1%), flap margin necrosis (5.8%) and infection (1.9%). The pitfalls in securing total mastectomy are discussed as is the extent of axillary dissection for staging purposes. Furthermore, the problem of axillary dissection and axillary irradiation in node positive patients is considered.

Bioptic strategy in breast cancer.

The bioptic strategy in breast cancer rests on the following basic conditions at the Department of Surgery K, Odense University Hospital: Firstly, clinical mammography precedes any bioptic procedure. Secondly, the bioptic procedure must secure representative tissue for histological examination. Thirdly, knife-biopsy should preferably be excisional. Finally, tissue examination is exclusively done by the pathologist and always on unfixed tissue. The application and outcome of the employed biopsy methods are illustrated by a series of 365 women with operable, primary invasive breast cancer, treated from 1982 to 1987. Definitive surgery was mainly based on excisional (62%) or needle biopsy (24%). Three-fourths of the patients were treated by the one-stage procedure. However, within the last year of the period the rate of needle biopsy and two-stage procedures was doubled, increasingly employing core-aspirating needle biopsy synchronously with mammography and done by the radiologist. So far, patient compliance and histological outcome is satisfactory.

Confirmatory analysis of survival data using left truncation of the life times of primary survivors.

In survival analysis, as in other branches of applied statistics, confirmatory analysis is often requested before an initial finding can be cleared of suspicion of being due just to mass significance. This paper points out that the special temporal structure of the classical clinical trial with staggered entry allows re-use of the initial survivors by left-truncating their remaining survival times. This procedure can often save a considerable amount of calendar time. The procedure is illustrated by data from the Danish Breast Cancer Cooperative Group.

Primary periareolar abscess in the nonlactating breast: risk of recurrence.

The estimated probability of relapse of primary periareolar abscess of the nonlactating breast was 38 percent (95 percent confidence interval 18 to 58 percent) 8 years after simple incision and healing by granulation. Relapses were mainly fistulas in the line of incision. An attempt to identify relapses early was unsuccessful. This finding, in combination with the unsatisfactory results of simple incision and healing by granulation and the character of relapses, suggests improper initial operation and multifactorial causes. Initial incision followed by a search for a possible sinus tract and extensive excision in all patients with primary abscesses has been described and is recommended.

Release of prolactin, thyrotropin, and growth hormone in women with cyclical mastalgia and fibrocystic disease of the breast.

Prolactin (PRL), thyroid stimulating hormone (TSH) and growth hormone (GH) response to metoclopramide and TRH was investigated in seven women with fibrocystic disease and cyclical mastalgia, in eight similar patients without mastalgia, and in six normal controls. The basal PRL level was significantly elevated in patients with cyclical mastalgia (P less than 0.025). PRL and TSH response to metoclopramide did not differ significantly between the three groups, indicating that decreased dopaminergic tone is not the cause of elevated basal PRL level in cyclical mastalgia. PRL and TSH response to TRH and the abscent GH response to both metoclopramide and TRH further indicate that the hypothalamicpituitary axis is not primarily disturbed in cyclical mastalgia. The basal GH level was elevated in patients with fibrocystic disease with or without mastalgia. The increased basal GH secretion is not believed to be directly involved in cyclical mastalgia, but may be of importance in fibrocystic disease.

Preliminary experience with mammography. Reliability of mammography in patients with a palpable tumour of the breast.

Radiologists with very limited practical experience in mammography initially achieved a low PVpos (0.50) and a high PVneg (0.95) in blind mammography of 80 patients with 85 excised and histologically examined breast tumours. After having read films from approximately 2500 patients the initial films were blindly reevaluated. PVneg was unchanged, whereas PVpos was elevated significantly (0.80). The intraobserver variation was 11.5 per cent. The actual interobserver variation was 3.2 per cent. These findings indicate that the reliability of blind mammography in patients with palpable tumours of the breast is considerable, also in case of only limited mammographic experience.

Cyclical mastalgia and breast pathology.

Histologic examination of mammary tissue from 39 patients with cyclical mastalgia and 68 with no mastalgia disclosed that fibrocystic disease was not in itself the cause of the cyclical condition. Nor did the study support the traditional concept of a relationship between major dysfunction of the internal genital organs and cyclical mastalgia. Although the organic basis for cyclical mastalgia is unknown, several observations strongly suggest that it is located in the mammary stroma. Future investigations of the organic basis for cyclical mastalgia should include the mammary stroma.