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Query: UMLS:C0028754 (obesity)
 124,988 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Increasing duration and amount of postoperative fluid formation after axillary lymphadenectomy delays final healing. We postulated that multiple drains (instead of a single drain) might decrease postoperative fluid accumulation by their greater proximity to points of leakage. We randomized 65 women with clinical stage I or II carcinoma of the breast to single or multiple drains. They were stratified for axillary dissection or modified radical mastectomy. For axillary dissection, randomization to multiple drains meant placement of four catheters in the axilla, and randomized to the single drain, one catheter in the axilla. For modified radical mastectomy, the patients randomized to multiple drains received four catheters in the axilla and one catheter under the inferior flap; the patients randomized to single drains had one catheter in the axilla and one catheter under the inferior flap. All catheters exited separately. The two arms (single versus multiple drains) were determined to be homogeneous in other variables that may affect postoperative fluid formation--age, size of the breast, weight, height, obesity, presence of previous surgical biopsy, excision of pectoralis minor muscle, excision of thoracodorsal complex, level of axillary dissection, number of lymph nodes, number and proportion of positive lymph nodes and whether or not the dominant hand was on the side operated upon. Single versus multiple drains had no clinically significant effect on the amount or duration of drainage, as an inpatient or outpatient, or total. We recommend a single drain to the axilla after lymphadenectomy.
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PMID:A prospective randomized trial of single versus multiple drains in the axilla after lymphadenectomy. 144 Jan 67

The use of a contact Nd:YAG laser scalpel during radical and modified radical mastectomy was evaluated in 18 patients with carcinoma of the breast. The laser scalpel performed well as a haemostatic tool, the associated mean blood loss for modified radical mastectomy being 132 ml. Operating time, operative blood loss, laser energy required and postoperative wound drainage were all related to patient obesity, correlating significantly with body weight and/or breast weight. The incidence of axillary seroma was not reduced by laser surgery and occurred in 53% of patients undergoing modified radical mastectomy. The Nd:YAG laser scalpel is an excellent haemostatic tool but it does not appear to have any other advantages over conventional surgery for mastectomy.
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PMID:Radical breast surgery with a contact Nd:YAG laser scalpel. 152 22

To determine risk factors for carcinoma of the breast, the authors compared women with cancer on screening and diagnostic mammography with those in whom cancer was not detected. For 39 months, medical histories were collected by mammography technologists on 3492 women having routine screenings or diagnostic mammograms at their institution. Potential risk factors for women with biopsy-proven breast cancer were compared with those in women who had normal findings on mammograms or negative biopsy results (controls). Of the 3492 women, 49 had biopsy-proven breast cancer. There were 3361 patients in the control group, including those women with normal findings on mammograms (3294) and those with negative biopsy results (67). 82 women had incomplete questionnaires or were lost to follow up. Nearly all of those with breast cancer were postmenopausal compared with 68% of the controls. The mean length of lactation for breast cancer patients was significantly less than for the controls; 5.6 vs 7.5 weeks (p=.015). This was also true for the postmenopausal patients; 8.1 vs 6.1 weeks (p=.041). Postmenopausal breast cancer patients had menstruated significantly more years (p=.016) than postmenopausal control subjects: 34 vs 31 years, although the mean age at menarche was not different. When corrected for age, there was no significant difference in the total duration of menstruation in the postmenopausal cancer patients compared with the postmenopausal controls. Postmenopausal breast cancer patients had a significantly greater (p=.021) average body weight than postmenopausal control subjects: 71.7 vs 66.7 kg, although body weight was the same when all patients were considered. similar results were found when Quetelet's index for obesity (weight in kg/height in cm2 (p=.004) was calculated for postmenopausal patients: 28 for cancer patients and 26 for controls. There was no significant difference in height between cancer patients and controls when all subjects or just those who were postmenopausal were considered. History of oral contraceptive (OC) use was significantly less common among postmenopausal breast cancer patients than among postmenopausal controls: 9% vs 20%. Patients with breast cancer had lower parity than the controls. In this series of patients, women in whom breast cancer was detected on mammography lactated less, showed no significant difference in years of menstruation when corrected for age, had a greater average body weight, used OCs less often, and had fewer children than women in whom no cancer was detected on mammography.
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PMID:Risk factors for breast cancer in women undergoing mammography. 172 80

120 women with carcinoma of the breast were matched in a matched pairs analysis to 120 women as a control group. The estrogen use patterns for these women were determined after the matching and the relative risk (RR) of developing breast cancer during estrogen use was determined. The RR of developing breast cancer was increased significantly among patients who used conjugated estrogens. The RR did not increase as the length of estrogen use increased. Estradiol use caused a non-significant increase in the RR of developing breast cancer. Nulligravidity, hypertension, and obesity did not increase the RR of developing breast cancer during estrogen use.
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PMID:[Estrogen therapy in carcinoma of the breast (author's transl)]. 624 9

The poor prognosis of obese women with carcinoma of the breast has yet to find a satisfactory explanation. It is suspected that the hormonal milieu of these patients may favor tumor growth. This investigation explored the relationship between obesity, urinary estrogen excretion, and tumor estrogen receptors (ER) in women treated with mastectomy for carcinoma of the breast. The ER levels determined from the primary cancers of 129 women treated with mastectomy were compared with the obesity index (O.I.) of these patients, i.e., weight in pounds/height in inches. In addition, 24-hour total urinary estrogen determinations were performed in 30 postmenopausal women and compared with their O.I. and ER. A weak direct correlation was found between ER and O.I. in postmenopausal women. The urinary estrogens of postmenopausal women were correlated directly with obesity index, but no relationship could be established between urinary estrogens and the ER content of breast cancers. It is concluded that the excess estrogen production of obese women may be responsible for their poor prognosis by promoting tumor growth. The high tumor ER concentrations associated with obesity suggest a high frequency of hormonally sensitive tumors.
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PMID:Obesity, estrogen production, and tumor estrogen receptors in women with carcinoma of the breast. 683 4

Biological markers associated with in situ carcinoma and atypical intraductal hyperplasia in the breast are examined to help in identifying a subgroup of premalignant lesions whose natural history may be influenced by epigenetic factors. The biomarkers may be used as indices in clinical trials aiming to assess the effect of weight reduction, dietary intervention or hormone replacement therapy on the risk of progression to invasive breast cancer. In the current state of knowledge, the expression of oestrogen receptors, p53, bcl-2 and HER-2 neu oncogenes and the Ki-67 index of proliferative activity, are the most useful biomarkers for this purpose. In situ carcinoma of the breast manifests a variety of morphological phenotypes with specific biological characteristics. There is evidence that only a proportion of premalignant lesions are committed to progression to invasive cancer while other lesions undergo spontaneous regression at the time of the menopause. Cross-cultural studies suggest that it is the late-stage epigenetic promoting factors which are responsible for the high incidence of postmenopausal breast cancer in Western women. Obesity in middle life and the Western diet favour the development of hyperinsulinaemic insulin resistance, and the metabolic-endocrine effects of its concomitants may promote mammary carcinogenesis around the time of the menopause and increase the incidence of invasive cancer after the menopause. Because biomarker changes in premalignant lesions are nearer in time to these promoting influences, they could provide intermediate endpoints for testing the hypothesis.
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PMID:Premalignant breast lesions: role for biological markers in predicting progression to cancer. 1050 26

Within the context of a prospective study we investigated the influence of malignant and benign breast disease on the coagulation systems both prior to and after surgery. In addition we also investigated to what extent individual risk factors aid the formation of a thrombophiliac risk profile. Altogether 50 patients with carcinomas of the breast and 12 patients with benign breast disease were included in the study. The coagulation investigations took place prior to surgery and on the 1st, 3rd, 7th and 10th day following the operation. The results have already revealed that prior to surgery a clear activation of the haemostasis takes place among patients with a carcinoma of the breast. When compared to patients with benign breast conditions there was a far greater plasma level of factor VIII vWF, fibrinogen, thrombin-antithrombin III complex, D-dimer fibrin degradation products, tissue-type plasminogen activator and the activity and the antigen of plasminogen activator inhibitor 1. Also during the postoperative period the malignant tumour was a stimulus for additional increased activity of blood coagulation and fibrinolysis. Individual risk factors such as age, menopausal status, obesity and smoking lead to a thrombogenic risk profile which could provide a possible explanation for the observed increased incidence of thrombosis in breast cancer patients. For the clinical work there is a need for intensive pre- and postoperative monitoring in the cases of patients with malignant tumours including angiological examinations, intensive physiotherapy and a risk-adapted prophylactic anticoagulation.
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PMID:Perioperative development of a thrombogenic risk profile in patients with carcinomas of the breast: a cause of increased thrombosis. 1121 10

A carefully taken history and clinical examination are necessary for assessing the relative benefits and risks of estrogen replacement therapy for an individual patient. The patient's weight, blood pressure and urine need to be checked. Benefits of estrogen replacement are seen in relation to vasomotor symptoms, atrophy of the genital tract, bone metabolism, psychological symptoms, libido, skin, and cardiovascular effects. Estrogens are contraindicated with a history of previous deep vein thrombosis, ischemic heart disease or carcinoma of the breast. Care needs to be taken with liver disease, hyperlipidemias, diabetes, gallbladder disease, gross obesity, or in heavy smokers. Progesterones should always be administered if the uterus is present to prevent endometrial hyperplasia and adenocarcinoma. When properly selected and carefully monitored, many women may be relieved of unnecessary suffering due to menopause.
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PMID:Estrogen replacement therapy: its benefits and risks. 1227 83