Hormone replacement therapy (HRT) has gained widespread and in some areas indiscriminate use. In reference to recent epidemiological studies which showed unexpected and controversial associations of HRT use with malignant tumours, here we review the current understanding of the dynamics of tumour growth. The pathomorphological characteristics and sex hormone sensitivity of cancers of the breast, endometrium, ovary and colon are discussed. The development of cancer from the first malignant tumour cell to clinical diagnosis takes many years. Hormones can influence tumour growth, but it is questionable whether hormones induce malignant tumours de novo. It is much more likely that hormones 'merely' promote the growth of already existing tumour cells. The long developmental process of tumours is in apparent contradiction to results of some epidemiological studies that describe an increased cancer risk, implying primary initiation, in HRT users within observation periods of 1-6 years. The mechanisms of initiation versus promotion of hormone-sensitive cancers, particularly breast cancer, are only partly understood. The conventional methods of epidemiological studies cannot detect potential risk factors without bias if they do not include a pathomorphological component on growth characteristics. The results of previous studies should be interpreted with great caution with regard to tumour biology.
Zusammenfassung Zielstellung: In der Literatur wurde konsistent bei Nutzung oraler Contraceptiva (OCs) ein reduziertes Risiko von Uterus-und Ovarialtumoren berichtet. Der Effekt von niedrigdosierten OCs ist weniger klar. Methodik: Die Deutsche Kohortenstudie zur Frauengesundheit erfasst von Frauen aller Bundesländer, die sich zur Teilnahme bereit erklärt haben, selbst berichtete Daten zur Hormonnutzung. Diese Daten umfassen Angaben zu Zeit, Typ, Dosis der Exposition wie auch zur Zeit des Auftritts von Erkrankungen. Die ersten Kohortendaten von 1998 bis 2000 wurden mittels logistischer Regression analysiert, um den Zusammenhang zwischen lebenslanger OC-Nutzung und dem Auftreten von Uterus-und Ovarialtumoren zu analysieren. Ergebnisse: Die Frauenkohorte enthält gegenwärtig rund 396 000 Frauenbeobachtungsjahre von rund 10 000 Teilnehmerinnen mit 167 malignen sowie 1676 benignen Tumoren. Das adjustierte relative Risiko [RR] des Auftretens von Uterus-oder Ovarialkrebs bei OC-Nutzern verglichen mit Nienutzern war 0,5 (95% Konfidenzintervall [95 % CI]: 0,3 ± 0,7). Der Vergleich von Nutzern niedrigdosierter OCs mit Nienutzern ergab ein adjustiertes RR von 0,1 [95 % CI 0,1 ± 0,3]). Vergleichbare Ergebnisse wurden bei benignen Tumoren der primären Reproduktionsor- AbstractObjective: The literature consistently showed a decreased risk of uterine and ovarian tumours in users of oral contraceptives (OCs). The effect of OCs with low estrogen content is less clear. Methods: The German Cohort Study on Womens Health collects self-reported data on hormone use from women who responded to a call for participation circulated in all German states. The data include information on the exposure and time, type and dose of exposure as well as time of occurrence of any outcome. Initial cohort data from 1998 to 2000 were analysed using logistic regression to determine the association between historic OC use and the occurrence of tumours of the ovary and corpus uteri. Results: The cohort currently covers about 396 000 womenyears of observation on 10 000 participants including 167 cases of malignant and 1676 cases of benign uterine and ovarian tumours. The adjusted relative risk [RR] for the occurrence of any uterine or ovarian cancer comparing users and non-users of OCs is 0.5 (95% confidence interval [95 %CI]: 0.3 to 0.7). The comparison of users of low estrogen-dose OCs versus never-users shows an adjusted RR of 0.1 [95 % CI 0.1 to 0.3]). Similar results are found for benign tumours of the primary reproductive organs. Time since last OC use was an important effect modifier in malignant, but not in benign tumours. Originalarbeit 566Institutsangaben
IntroductionACOSOG-Z0011(Z11) trial showed that axillary node clearance (ANC) may be omitted in women with ≤2 positive nodes undergoing breast conserving surgery (BCS) and whole breast radiotherapy (RT). A confirmatory study is needed to clarify the role of axillary treatment in women with ≤2 macrometastases undergoing BCS and groups that were not included in Z11 for example, mastectomy and those with microscopic extranodal invasion. The primary objective of POsitive Sentinel NOde: adjuvant therapy alone versus adjuvant therapy plus Clearance or axillary radiotherapy (POSNOC) is to evaluate whether for women with breast cancer and 1 or 2 macrometastases, adjuvant therapy alone is non-inferior to adjuvant therapy plus axillary treatment, in terms of 5-year axillary recurrence.Methods and analysisPOSNOC is a pragmatic, multicentre, non-inferiority, international trial with participants randomised in a 1:1 ratio. Women are eligible if they have T1/T2, unifocal or multifocal invasive breast cancer, and 1 or 2 macrometastases at sentinel node biopsy, with or without extranodal extension. In the intervention group women receive adjuvant therapy alone, in the standard care group they receive ANC or axillary RT. In both groups women receive adjuvant therapy, according to local guidelines. This includes systemic therapy and, if indicated, RT to breast or chest wall. The UK Radiotherapy Trials Quality Assurance Group manages the in-built radiotherapy quality assurance programme. Primary endpoint is 5-year axillary recurrence. Secondary outcomes are arm morbidity assessed by Lymphoedema and Breast Cancer Questionnaire and QuickDASH questionnaires; quality of life and anxiety as assessed with FACT B+4 and State/Trait Anxiety Inventory questionnaires, respectively; other oncological outcomes; economic evaluation using EQ-5D-5L. Target sample size is 1900. Primary analysis is per protocol. Recruitment started on 1 August 2014 and as of 9 June 2021, 1866 participants have been randomised.Ethics and disseminationProtocol was approved by the National Research Ethics Service Committee East Midlands—Nottingham 2 (REC reference: 13/EM/0459). Results will be submitted for publication in peer-reviewed journals.Trial registration numberISRCTN54765244; NCT0240168Cite Now
Intravenous pulse methylprednisolone in chronic idiopathic thrombocytopenia 779 tolerated, carries the potential risks related to the use of plasma derivative products. The proposed indications for high dose gammaglobulin infusion are (a) when a rapid increase in platelet count is required, (b) as a substitute for immunosuppressive drugs, (c) when steroid treatment is ineffective, and (d) as an attempt to avoid splenectomy.6It is worth considering treatment with pulses of methylprednisolone in children who are unresponsive to standard corticosteroid and high dose intravenous gammaglobulin treatments before considering other therapeutic procedures. Patients and methodsWe reviewed the hospital records of all infants with a birthweight of less than 2-0 kg born at Nether Edge Hospital, Sheffield during 1976 to 1978 inclusive.Seven infants weighed less than 1*0 kg and all died.There were 87 infants with birthweights between 1P0 and 2-0 kg: 18 of these were born at term and are not included in this study. Ten of the remainder died within the first postnatal week (six from respiratory distress syndrome, three from lethal congenital anomalies, and one from severe birth asphyxia). This left 59 preterm infants. Thirty were appropriate for gestational age and 29 were small for gestational age (weight less than the 10th centile). Seventeen infants weighed less than 1*5 kg (five appropriate and six small for gestational age). Thirteen of the 59 infants had respiratory problems requiring increased inspired oxygen concentrations for more than 48 hours after birth. Several were also given continuous positive airways pressure. Facilities for mechanical ventilation were not available. Several infants received antibiotics for presumed or proved infection and several received theophylline for apnoea.
The aim of this study was to assess the time patients spend at the various stages of the surgical journey and identifying factors that lead to "bottlenecks". A prospective, observational study of 70 patients over 23 consecutive elective gynaecology lists. Timelines of patients' surgical journey were recorded and various outcomes such as room turnover and patient turnaround intervals calculated. Of the 70 patients (23 major and 47 intermediate), 32 were managed by one anaesthetist and 38 cases by two. The mean arrival in the operating theatreknife-to-skin interval for major cases was significantly longer than intermediate (17.9 vs. 12.05 min, p=0.001), but there were no statistically significant differences in other time intervals between major/intermediate cases. The mean patient turnaround and room turnover times for the 70 cases were 44.2 and 60.0 min, respectively, and only 60.3% of theatre time was actually spent on surgery. Having two anaesthetists reduced the arrival in the operating theatreknife-to-skin interval by a mean of 4 min (11.4 vs. 16.63 min, p=0.045) but had no positive effect on other variables. Prolonged patient turnover leads to significant delay, resulting in impaired efficiency. Factors in individual cases which affected patient turnaround time include inadequate preparation of equipment and delays in preparing the patient before anaesthesia. Deploying extra personal at the appropriate time can lead to efficiency savings but adequate planning of both schedules and equipment will lead to the best outcomes.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.