One of the disadvantages of breast conserving treatment compared with mastectomy is the higher rate of local recurrence. Even though a local recurrence has no influence on survival, it is a psychological trauma for the woman it affects. Breast conserving treatment has been practised at Ullevaal Hospital since 1986. This study is based on data from 216 consecutive cases of breast conserving surgery, from January 1986 to March 1996. Mean observation time was 29 months. Nine (4.2%) patients experienced a local recurrence. Age, histological grade, and the size of the tumor were identified as risk factors, whereas there was no correlation between histology, axillary node involvement, and surgical margins.
Hashimoto disease is a chronic autoimmune thyroiditis. Despite adequate hormone substitution, some patients have persistent symptoms that may be the result of immunologic pathophysiology.To determine whether thyroidectomy improves symptoms in patients with Hashimoto thyroiditis who still have symptoms despite having normal thyroid gland function while receiving medical therapy.Randomized trial. (ClinicalTrials.gov: NCT02319538).Secondary care hospital in Norway.150 patients aged 18 to 79 years with persistent Hashimoto-related symptoms despite euthyroid status while receiving hormone replacement therapy and with serum antithyroid peroxidase (anti-TPO) antibody titers greater than 1000 IU/mL.Total thyroidectomy or medical management with hormone substitution to secure euthyroid status in both groups.The primary outcome was general health score on the Short Form-36 Health Survey (SF-36) at 18 months. Secondary outcomes were adverse effects of surgery, the other 7 SF-36 subscores, fatigue questionnaire scores, and serum anti-TPO antibody titers at 6, 12, and 18 months.During follow-up, only the surgical group demonstrated improvement: Mean general health score increased from 38 to 64 points, for a between-group difference of 29 points (95% CI, 22 to 35 points) at 18 months. Fatigue score decreased from 23 to 14 points, for a between-group difference of 9.3 points (CI, 7.4 to 11.2 points). Chronic fatigue frequency decreased from 82% to 35%, for a between-group difference of 39 percentage points (CI, 23 to 53 percentage points). Median serum anti-TPO antibody titers decreased from 2232 to 152 IU/mL, for a between-group difference of 1148 IU/mL (CI, 1080 to 1304 IU/mL). In multivariable regression analyses, the adjusted treatment effects remained similar to the unadjusted effects.Results are applicable only to a subgroup of patients with Hashimoto disease, and follow-up was limited to 18 months.Total thyroidectomy improved health-related quality of life and fatigue, whereas medical therapy did not. This improvement, along with concomitant elimination of serum anti-TPO antibodies, may elucidate disease mechanisms.Telemark Hospital.
The effect of H2-stimulation and blockade was studied in a dog model which made possible physiological stimulation by food and comparison of vagally innervated and denervated acid and pepsin response at the same time. 5 dogs were equipped with two pouches separated from the stomach, and stimulation was done by histamine as continuous infusion combined with a standard meal – a mixture of liver, heart and bonemeal, 10 g/kg. The response was compared with the effect of H2-blockade, cimetidine 5 g/kg, given 30 min before the meal. H2-agonism stimulated acid secretion and strongly inhibited pepsin secretion, and when H2-antagonism was applied, the effects were quite opposite. The results may explain the great differences in acid and pepsin secretion seen after H2-blockade.
Five Labrador retrievers provided with one vagally innervated and one denervated pouch were given graded doses of food composed of liver, heart and bonemeal to make dose/response curves of food-stimulated gastric secretion. A constant ranitidine infusion resulted in a decreased inhibition of acid output as the physiological stimulation increased both in the innervated and in the denervated pouch. The pepsin output behaved quite differently. The increased physiological stimulation did not increase the pepsin output. There was no inhibition by ranitidine in the innervated pouch and a constant inhibition by ranitidine in the denervated pouch. The results indicated a component of competitive interaction between meal-stimulated acid secretion and the H2-receptor antagonist, which is similar to the interaction between H2-receptor antagonist and histamine.
Components of the fibrinolytic system including functional activities of plasma antiplasmins were studied in experimental lung-insufficiency in a canine model. The procedure included hemorrhagic hypotension for 2 hours and occlusion of the hepatic artery, portal vein and common bile duct for 20 minutes of the hypotensive period. Plasma levels of plasminogen decreased gradually during the experiments. Using chromogenic peptide substrate assays, significant reductions of both "immediate" and "time dependent" antiplasmin activities were observed during the first few hours of the experiments. After 4 hours, both antiplasmin activities gradually increased. In 2 of the animals studied "time dependent" antiplasmin activities were 113 and 118 per cent of initial values at 12 hours. These findings emphasize that increased antiplasmin activities may be of great importance for fibrin deposition, leading to a state of microembolism in the lung in this condition.
We have compared the instantaneous mean blood velocity measured transcutaneously from total cross‐sections of arteries in dogs by the use of a new pulsed heterodyne ultrasound doppler equipment, with instantaneous blood flow as measured simultaneously by an electromagnetic flowmeter applied on the exposed vessels. The experiments were performed on the common carotid and the femoral arteries in a variety of flow situations, always with a close fit between the two curves. The results show that the output from the ultrasound equipment is proportional to flow.
