Ingrid Tengrup

The effects of an occlusive zinc medicated dressing on the bacterial flora in excised wounds in the rat

SummaryThe effects of three different dressings — two occlusive and one non-occlusive — on the bacterial flora of excised wounds in rats were studied. The number of colony forming units per gram of granulation tissue were significantly lower 4, 8 and 12 days postoperatively in wounds treated with a zinc medicated occlusive dressing compared with wounds treated with non-zinc medicated occlusive hydrocolloid dressing or wet-to-dry non-occlusive gauze dressing. The minimum inhibitory concentration (MIC) of zinc sulphate was determined on different strains of bacteria isolated from the wounds of rats and on strains isolated from humans. The most susceptible species isolated from both rat wounds and humans wereStreptococcus sp.,Staphylococcus aureus andEscherichia coli; whereas,Proteus andEnterococcus sp. had higher MIC-values.In vitro, the hydrocolloid dressing disclosed no antibacterial effects. If the practitioner prefers an occlusive dressing we believe, due to our animal andin vitro experiments, that the zinc medicated occlusive dressing will reduce the risk of wound infection in man.ZusamenfassungDie Wirkung von zwei verschiedenen Wundverbänden — zwei okklusiven und zwei nicht okklusiven — auf die bakterielle Besiedelung von Exzisionswunden wurde bei der Ratte untersucht. Bei Wunden, die mit einem zinkhaltigen Okklusivverband behandelt worden waren, war die Zahl der Koloniebildner pro Gramm Granulationsgewebe am 4., 8. und 12. postoperativen Tag signifikant geringer als bei Wunden, die mit einem Hydrokolloid-Okklusivverband ohne Zink oder feucht-trockenen Verbänden mit Wundgaze behandelt worden waren. Für verschiedene Bakterien, die aus den Wunden bei Ratten isoliert sowie für Stämme, die aus menschlichem Material angezüchtet worden waren, wurden die minimalen Hemmkonzentrationen von Zinksulfat bestimmt.Streptococcus sp.,Staphylococcus aureus undEscherichia coli von Rattenwunden wie auch die menschlichen Isolate dieser Spezies waren am empfindlichsten,Proteus undEnterococcus sp. wiesen höhere MHK-Werte auf. Der Hydrokolloid-Wundverband zeigtein vitro keinerlei antibakterielle Wirksamkeit. Wenn in der Praxis okklusive Wundverbände angewandt werden, ist nach unserer Erfahrung mit Tierversuchen undIn-vitro-Experimenten das Wundinfektionsrisiko beim Menschen durch Verwendung eines zinkhaltigen Wundverbandes geringer als bei Verbänden ohne Zink.

Age at diagnosis in relation to survival following breast cancer: a cohort study

BackgroundAge is an important risk factor for breast cancer, but previous data has been contradictory on whether patient age at diagnosis is also related to breast cancer survival. The present study evaluates age at diagnosis as a prognostic factor for breast cancer on a large cohort of patients at a single institution.MethodsAll 4,453 women diagnosed with breast cancer in Malmö University Hospital, Sweden between 1961 and 1991 were followed up on for 10xa0years with regards to breast cancer-specific mortality (BCSM) in different age groups. Corresponding relative risks (RR), with 95% confidence intervals, were obtained using Cox’s proportional hazards analysis. All analyses were adjusted for potential confounders and stratified for axillary lymph node involvement (ALNI) and diagnostic period.ResultsAs compared to women aged 40 to 49xa0years, those who were aged under 40 (RR: 1.40; 95% CI: 1.04 to 1.88) and 80 or more years (RR: 1.80; 95% CI: 1.45 to 2.25) had a statistically significant higher 10-year mortality rate. When adjusted for potential confounders, including stage at diagnosis, the associations only remained statistically significant for women aged 80xa0years or more. In the analyses stratified on ALNI, ALNI-negative women under 40xa0years had a statistically significant higher five-year mortality rate (RR: 2.65; 95% CI: 1.23 to 5.70). In the analyses stratified on diagnostic period, the positive association between women aged under 40 or aged 80 or more years and high BCSM rate remained, with statistically significant results for women aged 80xa0years or more in all periods.ConclusionsWomen under 40xa0years of age had a poor prognosis, and this association was strongest among young women with axillary lymph node negative breast cancer. An age of 80xa0years or more was a prognostic factor for poor survival, independent of stage at diagnosis and diagnostic period.

Parity in relation to survival following breast cancer.

AIMnThe present study examines the association between parity and survival following breast cancer diagnosis.nnnMETHODSnMedical records of 4453 women diagnosed with breast cancer in Malmö, Sweden, between 1961 and 1991 were analysed. All women were followed until 31 December 2003, using the Swedish Cause-of-Death Registry. Breast cancer specific mortality rate was calculated in different levels of parity. Corresponding relative risks, with 95% confidence intervals (CI), were obtained using Coxs proportional hazards analysis. All analyses were adjusted for potential prognostic factors and stratified for age, menopausal status and diagnostic period.nnnRESULTSnAs compared to women with one child, nulliparity (RR 1.27: 95% CI 1.09-1.47), and high parity (four or more children) (1.49: 1.20-1.85) were positively associated with a high mortality from breast cancer. When adjusted for potential confounders, the association was only statistically significant for high parity (1.33: 1.07-1.66). In the analyses stratified on age and menopausal status, there was a similar positive association between high parity and breast cancer death in all strata, although only statistically significant among women older than 45 years of age or postmenopausal. Nulliparity was associated with breast cancer death in women that were younger than 45 years of age (1.28: 0.79-2.09) or premenopausal (1.30: 0.95-1.80), but these associations did not reach statistical significance. There was no association between nulliparity and breast cancer death in women older than 45 years of age or postmenopausal. All associations were similar in analyses stratified for diagnostic period.nnnCONCLUSIONnWomen with four or more children have a poor breast cancer survival as compared to women with one child.

The Effects of Occlusive Dressings on Inflammation and Granulation Tissue Formation in Excised Wounds in Rats

The effects on the healing of full-thickness excisional wounds treated with either of two occlusive dressings (Mezinc or Duoderm) were compared with the effects of gauze soaked in saline. The wounds were made on 86 rats and were examined clinically, histologically and biochemically four, eight and twelve days after wounding. Four days postoperatively the Duoderm-treated wounds differed significantly from the other two groups. Clinically, an adherent discolored gelatinous mass remained after removal of the firm part of the Duoderm dressing. Histologically it corresponded to a superficial exudate containing polymorphonuclear leukocytes (PMNs), macrophages and condensed foreign material. There was also a more extensive inflammatory reaction in the underlying tissues compared with gauze or Mezinc treatment and debris was seen in vesicles extracellularly and in foamy macrophages. Foamy macrophages were only seen in the Duoderm-treated wounds. These macrophages were mainly confined to the granulation tissue, which was about twice as thick as in the other two treatment groups twelve days after excision.

Risk of recurrence following delayed large flap reconstruction after mastectomy for breast cancer.

The aim of this retrospective matched cohort study was to evaluate the rate of recurrence among women with delayed large flap breast reconstruction after mastectomy for breast cancer. The recurrence rate among women treated at a single hospital was compared with that in an individually matched control group of women with breast cancer who did not have reconstruction after mastectomy.

Effects of Zinc Oxide in an Occlusive, Adhesive Dressing on Granulation Tissue Formation

The role of zinc in an occlusive, adhesive dressing (Zn-tape) was investigated in two experiments in the rat. In the first one Zn-tape was compared with a similar tape without zinc components and also with an inert plastic coated fabric with regard to the wound inflammatory reaction in excisional wounds. In the second experiment we attempted to assess possible systemic effects of zinc absorbed from Zn-tape-treated excisional wounds by studying the granulation tissue formation in subcutaneously implanted Ivalon sponges. The excisional wounds were treated with either the Zn-tape or a titanium tape in which the Zinc oxide was replaced by an equivalent amount of titanium dioxide (Ti-tape). The granulation tissue produced was evaluated histologically, histochemically and biochemically. The plain adhesive mass and the Titape elicited an intense inflammatory reaction as indicated both by high activities of alkaline phosphatases and histological examination. The Zn-tape reduced inflammatory processes in the granu...

Granulation tissue formation and metabolism of zinc and copper in alloxan-diabetic rats.

The early wound healing phases, and zinc and copper metabolism were assessed in traumatized insulin dependent diabetic rats. Granulation tissue was obtained by implanting Ivalon sponges subcutaneously and analysed on the fourth and seventh postoperative days by applying quantitative biochemical methods. The DNA content on day 4 and the amounts of RNA, hydroxyproline and hemoglobin on day 7 were significantly lower in granulation tissue from diabetic rats. The alkaline phosphatase activity, a marker for polymorphonuclear leukocytes (PMNs), was raised in the diabetic granulation tissue. The concentrations of zinc and copper were found to be increased in the kidney of diabetic rats compared with operated, non-diabetic controls. Our data suggest that the early granulation tissue formation is disturbed, with a prolonged inflammatory phase, decreased collagen formation and reduced vascularization. Zinc and copper are accumulated in the kidney of rats with uncontrolled, insulin dependent diabetes mellitus.

Body mass index and breast cancer survival in relation to the introduction of mammographic screening

AIMSnMammographic screening reduces mortality in breast cancer. It is not known if this reduction is more pronounced in certain groups. Obesity has been associated with worse survival following breast cancer diagnosis. This study investigates BMI in relation to breast cancer mortality, and if this association is affected by invitation to mammographic screening.nnnMETHODSnIn 1976, a randomised mammographic screening trial, inviting 50% of all women aged 45-69 years (n=42 283), was set up in Malmö, Sweden. BMI in relation to breast cancer mortality was examined separately in women invited or not invited to screening in the trial. The analyses also included a historical control-group diagnosed before the screening trial. The study included 2974 women diagnosed in 1961-1991. Relative risks (RR) with a 95% confidence interval was obtained from a Cox proportional hazard analysis and in the analysis of all women, follow-up was limited to 10 years.nnnRESULTSnObese women (BMI> or =30) not invited to mammographic screening had a higher adjusted RR of dying of breast cancer as compared to normal weight women (2.08:1.13-3.81) in the 10-year follow-up. In women invited to screening there was no association between BMI and breast cancer mortality. In the historical control group, mortality was increased in overweight women (BMI: 25-30), RR=1.27:0.99-1.62, and obese women, RR=1.32:0.94-1.84, but these associations totally disappeared in the multivariate analysis, following adjustment for tumour size and stage.nnnCONCLUSIONSnOverweight and obese women may be a group that profit from mammographic screening to more than normal weight women.

Clinical Assessment of Axillary Lymph Nodes and Tumor Size in Breast Cancer Compared with Histopathological Examination: A Population-Based Analysis of 2,537 Women

BackgroundThe clinical assessment of axillary lymph nodes status and tumor size is important for the management of patients with breast cancer. The first goal of this study was to determine the accuracy of axillary lymph node status in relation to the presence of metastases as revealed by histopathological examination. The second goal was to compare the tumor size as assessed by physical examination, with the size obtained by histopathological examination.MethodsThis study was based on a consecutive series of 2,537 patients diagnosed with breast cancer in Malmö, Sweden, between 1987 and 2002. These patients had available information in the South Swedish Breast Cancer Group registry, corresponding to 97xa0%. The axillary lymph nodes status was compared with the results of the histopathological examination for the presence of metastases. Tumor size by physical examination was compared with the tumor size after histopathological examination.ResultsThere were 674 women with axillary lymph nodes metastases according to histological examination; only 206 of these cases had palpable lymph nodes at clinical examination. The sensitivity was 30xa0% and the specificity 93xa0%. There were 812 tumors measured to be larger than 20xa0mm according to histopathological examination, but only 665 of these tumors were considered larger than 20xa0mm by clinical examination. This corresponded to a sensitivity of 81xa0% and a specificity of 80xa0%.ConclusionsWe conclude that the possibility of axillary metastases estimated by clinical examination is subjected to a large proportion of false-positive and false-negative results. Similarly, tumor size estimated by clinical examination is subject to under- and overestimation in comparison to histopathological examination.

Overweight in relation to tumour size and axillary lymph node involvement in postmenopausal breast cancer patients—Differences between women invited to vs. not invited to mammography in a randomized screening trial

OBJECTIVESnOverweight is associated with advanced stage at diagnosis in breast cancer patients. This could be explained by specific tumour characteristics or tumour promoting factors in the obese, but a diagnostic delay could also be of importance. Mammographic screening has caused a change towards diagnosis of less advanced tumours. This study investigates invitation to mammographic screening and the association between overweight and tumour size/axillary lymph node involvement at breast cancer diagnosis in postmenopausal women.nnnMETHODSnIn 1976 a randomized mammographic screening trial, inviting 50% of all women aged 45-69 was set up in Malmö, Sweden. The present analysis examined overweight (body mass index >or=25) as a determinant for large tumours (>20mm) and axillary lymph node involvement in postmenopausal women. These associations were studied separately in patients diagnosed prior to the mammographic screening trial, in invited women and in non-invited subjects (controls). In all, 2478 postmenopausal women were diagnosed with invasive breast cancer in these groups between 1961 and 1991. Logistic regression analysis allowed adjustment for other potential determinants of tumours size and axillary lymph node involvement.nnnRESULTSnIn women diagnosed before the onset of the screening trial and in women not invited to mammography in the trial (controls), overweight was positively associated with large tumour size and axillary node involvement. There was no statistically significant association between overweight and these factors in women invited to mammographic screening.nnnCONCLUSIONnInvitation to mammographic screening may be particularly important for overweight postmenopausal women in order to detect breast tumours early.