Helicobacter pylori infection after partial gastrectomy for peptic ulcer and its role in relapsing disease.

OBJECTIVE: To elucidate the role of Helicobacter pylori in relapsing disease after partial gastrectomy for peptic ulcer. DESIGN: Retrospective study of gastroscopies between January 1985 and February 1988. SETTING: Department of Surgery, Helsinki University Central Hospital, Finland. PARTICIPANTS: One hundred and fifty-five patients, who had undergone partial gastrectomy for peptic ulcer disease. MAIN OUTCOME MEASURES: Correlation between clinical and laboratory data, macroscopic findings at gastroscopy and histopathology. RESULTS: At gastroscopy 41 patients showed an ulcer at the site of anastomosis or in the gastric stump and two patients had a history of a previous ulcer recurrence. The median time interval between operation and relapse was 4 years. There was no correlation between ulcer recurrence, sex, age, ABO blood group or other diseases. Smokers and patients using non-steroidal anti-inflammatory drugs (NSAIDs) or alcohol had more relapses, but the difference was not significant. The recurrence rate was higher after Billroth II (BII; 34%) than after Roux-en-Y (14%; P = 0.03) or Billroth I (BI) reconstruction (24%). Giemsa staining demonstrated H. pylori in the gastric stump of 37% of the patients. H. pylori expression was related to age but unrelated to sex, ABO blood group, NSAID use, smoking or alcohol consumption. H. pylori positivity was more common (52%) after BI than after BII (28%; P = 0.04) or Roux-en-Y resection (40%). Recurrent ulcer was more often found in gastric remnants with normal mucosa (36%) than in those with H. pylori-positive gastritis (18%; P = 0.03) or H. pylori-negative gastritis (26%). CONCLUSION: It seems that H. pylori infection plays a minor role in the pathogenesis of ulcer recurrence after partial gastrectomy for peptic ulcer disease. Eradication of H. pylori of the remnant stomach is therefore presumably not effective in preventing ulcer recurrence.

Duodenal diverticulum at endoscopic retrograde cholangiopancreatography, analysis of 123 patients.

BACKGROUND/AIMS: The aim of this study was to investigate the frequency, clinical characteristics, findings and possible varieties of treatment of duodenal diverticula in Finnish patients diagnosed by endoscopic retrograde cholangiopancreatography. MATERIAL AND METHODS: Among 1735 patients investigated by endoscopic retrograde cholangiopancreatography, there were 123 patients with one or more duodenal diverticula and with sufficient clinical data available for this study. Mean age of the patients was 63 years. The male/female ratio was 61/62. Three hundred twenty age and sex matched patients undergoing ERCP during the same time period, but without duodenal diverticula, served as controls. RESULTS: Sixty-one percent of the diverticula were juxtapapillary. Pain and jaundice were the symptoms indicating ERCP in 62% of patients. Laboratory findings were mostly within normal limits. A hepatic or pancreatic tumor was suspected in twelve patients at ultrasound and computer tomography, and five of them had cancer. In 65 patients, both ducts were cannulated at ERCP. In eleven patients, the finding was normal. There was no significant difference in the incidence of pathologic ERCP findings between the patients with juxtapapillary diverticula and diverticula in other parts of duodenum, except pancreatic duct, which was more frequently abnormal in patients with a non-juxtapapillary diverticulum. The patients with juxtapapillary diverticula had not had previous related complications or operations significantly more often than patients with diverticula in other parts of duodenum. The patients with juxtapapillary diverticula had significantly more often biliary stones at ERCP than control patients and they had idiopathic pancreatitis twice as often as control patients, but the difference was not statistically significant. In three patients, the therapy was directed to the diverticulum and 80 patients had some other treatment. CONCLUSION: These data do not reveal any clear correlation between a juxtapapillary diverticulum and pancreato-biliary disorders. However, common bile duct stones were more often found in patients with a juxtapapillary diverticulum than in controls.

Mammary skin thickening as a prognostic sign in breast cancer.

It has been claimed that mammary skin oedema measured from mammograms of breast cancer patients is a valuable prognostic sign. To test this finding mammograms of 70 patients were reviewed and the status after a follow-up of five years was clarified. 37% of the patients had thickening over 0.25 mm above the tumour and 20% in the inferior part of the breast regardless of the localization of the tumour. The oedematous thickening of the skin was dependent on the tumour size and depth, but independent of its localization. The thickening did not correlate with involved axillary nodes but correlated with the disease-free interval provided that the thickening was over 1.5 mm above the tumour or over 0.75 mm in the inferior part of the breast.

Prognostic factors associated with survival after breast cancer recurrence.

Factors associated with disease-free interval after the primary treatment and survival after a recurrence of breast cancer were studied in 331 female breast cancer patients treated in 1976-1980. Within five years after the primary treatment, recurrence occurred in 131 patients. The observation time of these patients after recurrence was from few weeks to twelve years. Twenty-nine patients were alive at the end of the follow-up. The average disease-free time was 2 years. The clinical stage of the disease in this material was not significantly associated with the disease-free interval. The median survival time after recurrence was 2.7 years when only breast cancer related deaths were included. Survival was significantly better for patients with primarily stage I disease than for patients with primarily stage II-IV disease. The size of the primary tumour was not significantly associated with survival after recurrence. The patients with loco-regional recurrence survived almost significantly better than those with distant recurrence. The disease-free time correlated positively with survival after a recurrence. The present study confirms the view that breast cancer includes several subgroups with a different type of clinical course.

Long-term survival in male breast cancer.

A total of 42 male breast cancer patients (mean and median age 66 years), were followed up for over 25 years or until death. In 24/42 patients (57%) radical surgery and radiotherapy was carried out, surgery alone in 11 patients (26%), and radiotherapy alone in 3 patients (7%). Of the patients 23 died of mammary cancer, 74% of them in five years after primary treatment; 9% of the patients survived 10 years and 7% for 20 years. If only deaths related to breast cancer were included, the 20-year survival was 45%.

A suggested follow-up time for breast cancer patients.

The data for this study, consisting of 300 females treated for breast cancer in 1951-1961, were evaluated in order to ascertain when excess mortality from breast cancer disappears and what would be an appropriate follow-up period for investigational purposes. The clinical stages of the patients were classified as follows: 23.3%, stage I; 49%, stage II; 20.3%, stage III and 7.3%, stage IV. Halsted's radical mastectomy was performed in 79.7% of the cases. Every patient was given radiotherapy. Two hundred and ninety-eight patients could be followed until death or up to the present. Forty-five patients (16%) were still alive. The survival rate over a 20-year period for the various stages was as follows: stage I, 46.1%; stage II, 22.7% and stage III, 10.9%. Only 26% of the patients with stage I died of breast cancer, while the respective figures for stage II were 57% and stage III, 70%. The death rate from the cancer diminished with time in every stage especially 10 years after primary treatment. After this the observed survival rate curves were almost parallel with the expected curves. Our data show that for follow-up studies a 5-year follow-up is good and a 10-year follow-up is very good to show the trend in the treatment of breast cancer.

Changes in the treatment and prognosis of breast cancer.

The data of 331 women with breast cancer treated in the Second Department of Surgery, Helsinki University, during the period 1976-1980 (patient material, treatment, prognostic factors) is evaluated and compared with an equally large patient material treated during the period 1951-1961 in the same hospital. A breast lump was the main symptom in 94% and the tumour was found by the patient in most cases. Only two patients were younger than 30 years. The median delays to the first medical contact and to operative treatment were 30 and 20 days respectively. The delay had no influence on the prognosis. Also, the age of the patients and the localization of the tumour had no significant effect on the prognosis. Simple mastectomy with axillary lymph node excision was the main operative treatment in the present material whereas Halsted's radical mastectomy was frequently performed in the previous study. Operative radicality was the same in both studies. The prognosis has improved in all clinical stages. The present relative five year survivals in stages I-IV were 95, 83, 53 and 18%, whereas in the previous study they were 75, 58, 41 and 0%, respectively. The improvement in stage II-IV breast cancers is probably due to advances in radio- and chemotherapy. However, the improvement in the prognosis of stage I and to a lesser extent of stage II breast cancers cannot be explained on this basis alone. Neither do the shorter delays in treatment fully explain the differences in the prognosis. The most frequent sites of metastasis were bone and lung/pleura where almost half of the total metastasis occurring during the follow-up were found.