Per-Ola Granberg

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.

Urolithiasis. A study of its frequency.

Considering the general impression of an increased number of patients with acute renal colic, the frequencies of roentgenologically verified ureteral and kidney calculi in a Swedish urban district have been studied for the periods 1953-55 and 1968-70. In a material of 986 outpatients (793 men and 193 women) we have proved an increase in incidence for upper urinary tract calculi in men from 2.2 to 3.3 0/00 (p less than 0.001) and in women from 0.5 to 0.8 0/00 (0.01 less than p less than 0.05). For the material as a whole, we have found a 50% increase (from 1.3 to 2.0 0/00; p less than 0.001) of acute urolithiasis between the periods studied. Some implications of the results in connection with primary hyperparathyroidism are discussed.

Adjuvant radiotherapy in operable breast cancer: correlation between dose in internal mammary nodes and prognosis.

In a controlled clinical trial preoperative radiotherapy was compared to modified radical mastectomy followed either by no further treatment or by postoperative radiotherapy. The total number of patients was 960; 654 of these had a follow-up time of more than five years. The patients who were irradiated preoperatively, had a significantly better survival rate than the patients who were treated with surgery only (p = 0.05); however, this was not true for those irradiated postoperatively. The radiation dose in the ipsilateral internal mammary nodes was, on the average, lower with the postoperative treatment technique than with the preoperative technique. This difference in dose-distribution in the internal mammary nodes is analyzed. The result of the study indicates that adequate local treatment may increase survival in a subgroup of patients.

Effects of positive end-expiratory pressure on renal function.

The effects were studied of positive end‐expiratory pressure (PEEP) on renal function in eight patients with acute respiratory failure, requiring mechanical ventilation. On application of PEEP+ 10 cmH2O, central venous pressure increased, systolic blood pressure decreased, urine flow and PAH‐clearance were reduced, while inulin clearance remained stable. There was a marked increase in fractional sodium reabsorption and a concurrent decrease in fractional osmolal excretion. Fractional free‐water clearance and the ratio Uosm/Posm did not change.

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.

The value of preoperative radiotherapy in operable mammary carcinoma

In a randomized trial preoperative radiotherapy (4500 rad to the breast, the internal mammary, the supraclavicular and the axillary lymph node regions) was compared to radical mastectomy followed either by no further treatment or by postoperative radiotherapy. The total number of patients was 960; 356 of these had a follow-up time of more than five years. Both preoperative and postoperative irradiation increased the disease-free survival, compared to survival in patients who were treated only by surgery. The patients who were irradiated preoperatively had significantly better survival rates than the control patients (p = 0.05). Compared to patients who were treated with surgery only the survival improvement was even more certain (p = 0.03). Patients whose tumors were located in the inner half of the breast seemed to benefit more from preoperative or postoperative irradiation than those with lateral tumors. This could support the hypothesis of the value of adequate irradiation of the internal mammary nodes.

Reoperation for primary hyperparathyroidism

Abstract The reasons for failure of the initial exploration and the results of reoperation were analyzed in 53 patients with a diagnosis of primary hyperparathyroidism, 29 of whom were referred after initial operations elsewhere. Seventy-nine reoperations were performed. Sternotomy was used in 15 patients, and in retrospect was necessary in only 5. There was no operative mortality. The reasons for initial failure were incorrect diagnosis in 6 patients, true recurrence in 4 and persistent disease in 43. Persistence was caused by surgical failure in two thirds and pathology failure in one third. Of 47 patients reoperated on for hyperparathyroidism, 39 (83 percent) were cured, a rate warranting this type of surgery. Analysis of a long-term series of initial operations demonstrates a persistence rate of 5 percent (24 of 461) and a recurrence rate of 1 percent (4 of 461) in this disease. The need for reoperation was less than 1 percent over the recent 5 year period.

Renal Function Studies in Medullary Sponge Kidney

Twenty-one patients with medullary sponge kidney but no clinical signs of renal infection underwent studies of renal function and repeated roentgenologic examinations. All but one of the patients had impaired tubular reabsorption of sodium, indicating damage to the tubules. As a result, the concentration capacity was greatly reduced. Measurements of pH and titrable acid in the urine after administration of ammonium chloride showed impaired capacity of the kidneys to equilibrate a metabolic acidosis. The extraction of PAH was diminished in 18 of 35 studied kidneys, suggesting that proximal tubules also are affected by the disease. No correlation was found between the severity of the roentgenologic changes and the renal function.

Fine-Needle Biopsy Cytology and DNA Analysis: Their Place in the Evaluation and Treatment of Patients with Thyroid Neoplasms

Fine-needle aspiration allows sampling of tissues without surgical biopsy. This technique provides accuracy, speed, patient acceptance, and individual cells for the study of neoplasia. When this procedure is combined with DNA analysis, it is possible to obtain preoperatively additional diagnostic and prognostic information superior to that obtained by clinical and morphologic methods alone. This information is of utmost importance when planning appropriate treatment.

Studies on the Renal Excretion of Citanest® and Xylocaine®

1 In clearance studies on normal human subjects Xylocaine was found to have a lower clearance than Citanest. 2 The clearance value is dependent on the pH of the urine. The drugs are excreted by non‐ionic diffusion. 3 The clearances are not enhanced by augmented urine flow induced by mannitol as an osmotic diuretic. 4 During rapid infusion of mannitol general toxic cerebral symptoms appeared. The acid‐base balance could also explain these reactions as the dehydration with mannitol might give an intracellular acidosis.