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Jørgensen AK, Bille C, Jylling AMB, Kaidar-Person O, Tramm T. Pathology and resection margins following mastectomy prior to immediate breast reconstruction. Gland Surg 2024; 13:561-570. [PMID: 38720674 PMCID: PMC11074653 DOI: 10.21037/gs-23-407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 03/01/2024] [Indexed: 05/12/2024]
Abstract
Risk of local recurrence (LR) (and even distant disease-free survival) after mastectomy is associated with margin status. Furthermore, the vast majority of LR are located at the anterior (superficial) margin. Margins in mastectomy are considered anatomical borders and not true resection margins; such a conception may erroneously lead to underestimation of the risk of LR after mastectomy. If dissection is accurate along the fascia, only skin, subcutaneous tissue and minimal residual breast gland tissue (rBGT) are expected to remain in the patient. However, the subcutaneous fascia is an inconsistent anatomical structure that may be absent in almost half of patients. Studies and routine clinical practice suggest that resection may frequently, though often focally, be within the breast glandular tissue leaving various amounts of rBGT. Such areas may be nidus for subsequent de novo or recurrent premalignant or malignant disease. There is no consensus on handling of close/positive margins and intervention is extrapolated from studies on breast conserving surgery with subsequent radiotherapy. Handling of a close/positive margin is complicated by poor correlation between the ex vivo findings on the specimen and the attempt to relocate the area of concern in a patient with reconstructed breasts. In this clinical practice review, we strongly advocate for reporting of the lesion-to-margin distance in mastectomies to collect further evidence on the association between LR and margin status.
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Affiliation(s)
| | - Camilla Bille
- Department of Plastic Surgery, Odense University Hospital, Odense, Denmark
| | - Anne Marie Bak Jylling
- Department of Pathology, Odense University Hospital, Odense, Denmark
- Research Unit of Pathology, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Orit Kaidar-Person
- Breast Cancer Radiation Therapy Unit, Sheba Medical Center, Ramat Gan, Israel
- The School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Trine Tramm
- Department of Pathology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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2
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Paaskesen CK, Bille C, Sørensen JA. [Alternatives to wire localization of non-palpable breast lesions]. Ugeskr Laeger 2022; 184:V02220106. [PMID: 36205159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
With the introduction of screening mammography, the proportion of smaller, clinically recognised tumors has increased. In cases in which lesions cannot be palpated, a guidewire or a wireless marker is placed. Wire localization is associated with several limitations, despite its status as gold standard. Several wireless methods that meet these limitations have been developed. Methods that increase efficiency and patient satisfaction. This review provides an overview of the existing literature on intra-operative localization methods, and the risk of re-resection associated with excision of non-palpable mammary lesions.
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Affiliation(s)
| | - Camilla Bille
- Plastikkirurgisk Afdeling, Odense Universitetshospital
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3
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Hemmingsen MN, Larsen A, Weltz TK, Ørholt M, Wiberg S, Bennedsen AK, Bille C, Carstensen LF, Jensen LT, Bredgaard R, Koudahl V, Schmidt VJ, Vester-Glowinski P, Hölmich LR, Sørensen SJ, Bjarnsholt T, Damsgaard T, Herly M. Prophylactic treatment of breast implants with a solution of gentamicin, vancomycin and cefazolin antibiotics for women undergoing breast reconstructive surgery: protocol for a randomised, double-blind, placebo-controlled trial (The BREAST-AB trial). BMJ Open 2022; 12:e058697. [PMID: 36115667 PMCID: PMC9486197 DOI: 10.1136/bmjopen-2021-058697] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
INTRODUCTION Periprosthetic infection is one of the most severe complications following implant-based breast reconstruction affecting 5%-10% of the women. Currently, many surgeons apply antibiotics locally on the breast implant to reduce the risk of postoperative infection, but no randomised, placebo-controlled trials have tested the treatment's efficacy. METHODS AND ANALYSIS The BREAST-AB trial (BREAST-AntiBiotics) is an investigator-initiated, multicentre, randomised, placebo-controlled, double-blind trial of local treatment with gentamicin, vancomycin and cefazolin on breast implants in women undergoing implant-based breast reconstruction. The trial drug consists of 80 mg gentamicin, 1 g vancomycin and 1 g cefazolin dissolved in 500 mL of isotonic saline. The placebo solution consists of 500 mL isotonic saline. The trial drug is used to wash the dissected tissue pocket and the breast implant prior to insertion. The primary outcome is all-cause explantation of the breast implant within 180 days after the breast reconstruction surgery. This excludes cases where the implant is replaced with a new permanent implant, for example, for cosmetic reasons. Key long-term outcomes include capsular contracture and quality of life. The trial started on 26 January 2021 and is currently recruiting. ETHICS AND DISSEMINATION The trial was approved by the Regional Ethics Committee of the Capital Region (H-20056592) on 1 January 2021 and the Danish Medicines Agency (2020070016) on 2 August 2020. The main paper will include the primary and secondary outcomes and will be submitted to an international peer-reviewed journal. TRIAL REGISTRATION NUMBER NCT04731025.
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Affiliation(s)
- Mathilde Nejrup Hemmingsen
- Department of Plastic Surgery and Burns Treatment, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Andreas Larsen
- Department of Plastic Surgery and Burns Treatment, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Tim K Weltz
- Department of Plastic Surgery and Burns Treatment, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Mathias Ørholt
- Department of Plastic Surgery and Burns Treatment, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Sebastian Wiberg
- Department of Anaesthesiology, Zealand University Hospital Koge, Køge, Denmark
| | - Anne Karen Bennedsen
- Department of Plastic Surgery and Burns Treatment, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Camilla Bille
- Department of Plastic Reconstructive Surgery, Odense University Hospital, Odense, Denmark
| | | | - Lisa Toft Jensen
- Department of Plastic Surgery and Burns Treatment, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Rikke Bredgaard
- Department of Plastic Surgery and Burns Treatment, Herlev og Gentofte, Copenhagen University Hospital, Herlev, Denmark
| | - Vibeke Koudahl
- Department of Plastic Surgery, Lillebaelt Hospital, Vejle, Denmark
| | - Volker Jürgen Schmidt
- Department of Plastic and Breast Surgery, Zealand University Hospital Roskilde, Roskilde, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Peter Vester-Glowinski
- Department of Plastic Surgery and Burns Treatment, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Lisbet Rosenkrantz Hölmich
- Department of Plastic Surgery and Burns Treatment, Herlev og Gentofte, Copenhagen University Hospital, Herlev, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Søren J Sørensen
- Department of Biology, Section of Microbiology, University of Copenhagen, Copenhagen, Denmark
| | - Thomas Bjarnsholt
- Department of Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Microbiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Tine Damsgaard
- Department of Plastic Surgery and Burns Treatment, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Mikkel Herly
- Department of Plastic Surgery and Burns Treatment, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark
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4
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Dyrberg DL, Bille C, Koudahl V, Gerke O, Sørensen JA, Thomsen JB. Commentary: Evaluation of Breast Animation Deformity following Pre- and Subpectoral Direct-to-Implant Breast Reconstruction: A Randomized Controlled Trial. Arch Plast Surg 2022; 49:V1. [PMID: 38405264 PMCID: PMC10883862 DOI: 10.1055/s-0043-1777254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2024] Open
Affiliation(s)
- Diana L. Dyrberg
- Department of Plastic Surgery, Odense University Hospital, Odense/Lillebaelt Hospital, Vejle, Denmark
| | - Camilla Bille
- Department of Plastic Surgery, Odense University Hospital, Odense, Denmark
| | - Vibeke Koudahl
- Department of Plastic Surgery, Odense University Hospital, Odense/Lillebaelt Hospital, Vejle, Denmark
| | - Oke Gerke
- Department of Nuclear Medicine, Odense University Hospital, Odense, Denmark
| | - Jens A. Sørensen
- Department of Plastic Surgery, Odense University Hospital, Odense, Denmark
| | - Jørn B. Thomsen
- Department of Plastic Surgery, Odense University Hospital, Odense, Denmark
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5
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Dyrberg DL, Bille C, Koudahl V, Gerke O, Sørensen JA, Thomsen JB. Evaluation of Breast Animation Deformity following Pre- and Subpectoral Direct-to-Implant Breast Reconstruction: A Randomized Controlled Trial. Arch Plast Surg 2022; 49:587-595. [PMID: 36159368 PMCID: PMC9507449 DOI: 10.1055/s-0042-1756337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 03/29/2022] [Indexed: 10/26/2022] Open
Abstract
Background The incidence of breast animation deformity (BAD) is reported to be substantial after direct-to-implant breast reconstruction with subpectoral implant placement. It has, however, never been examined if BAD can occur following prepectoral implant placement. Our primary aim was to compare the incidence and degree of BAD after direct-to-implant breast reconstruction using either subpectoral or prepectoral implant placement. Secondary aim of this study was to assess and compare the level of pain between sub- and prepectoral reconstructed women. Methods In this randomized controlled trial, patients were allocated to reconstruction by either subpectoral or prepectoral implant placement in accordance with the CONSORT guidelines. The degree of BAD was assessed by the "Nipple, Surrounding skin, Entire breast (NSE)" grading scale 12 months after surgery. The level of postoperative pain was assessed on a numerical pain rating scale. Results We found a significant difference in the degree of BAD favoring patients in the prepectoral group (23.8 vs. 100%, p < 0.0001; mean NSE grading scale score: 0.4 vs. 3.6, p < 0.0001). The subpectoral reconstructed group reported higher levels of pain on the three subsequent days after surgery. No significant difference in pain levels could be found at 3 months postoperatively. Conclusion The incidence and degree of BAD was significantly lower in women reconstructed by prepectoral direct-to-implant breast reconstruction. Unexpectedly, we found mild degrees of BAD in the prepectoral group. When assessing BAD, distortion can be challenging to discern from rippling.
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Affiliation(s)
- Diana L Dyrberg
- Department of Plastic Surgery, Odense University Hospital, Odense/Lillebaelt Hospital, Vejle, Denmark
| | - Camilla Bille
- Department of Plastic Surgery, Odense University Hospital, Odense, Denmark
| | - Vibeke Koudahl
- Department of Plastic Surgery, Odense University Hospital, Odense/Lillebaelt Hospital, Vejle, Denmark
| | - Oke Gerke
- Department of Nuclear Medicine, Odense University Hospital, Odense, Denmark
| | - Jens A Sørensen
- Department of Plastic Surgery, Odense University Hospital, Odense, Denmark
| | - Jørn B Thomsen
- Department of Plastic Surgery, Odense University Hospital, Odense, Denmark
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Dissing J, Bille C, Jylling AMB, Volf C. [Suspicion of malignant melanoma in a lymph node caused by tattoo pigment]. Ugeskr Laeger 2022; 184:V11210847. [PMID: 35410646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
This is a case report of a 31-year-old woman going through cancer staging after being diagnosed with breast cancer. During sentinel node dissection, a remarkable dark lymph node was found. Metastatic malignant melanoma was suspected, but with careful histochemical examination the lymph node was confirmed to only contain tattoo pigment. The patient had rather large tattoos on her arms, which was suspected to be the source of the ink in her lymph nodes. Tattoo pigment can complicate cancer staging, and it is important to know this rare effect on lymph nodes when dealing with cancer staging.
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Affiliation(s)
| | - Camilla Bille
- Plastikkirurgisk Afdeling, Odense Universitetshospital
| | | | - Carlo Volf
- Afdeling for Klinisk Patologi, Odense Universitetshospital
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Søby AKH, Andersen CM, Bille C, Larsen BF, Heidemann LN, Johansen RA, Timm H, Roessler KK. What do women at high risk of breast cancer request of a patient education day? Focus interviews with women before and after deciding about prophylactic interventions. Eur J Cancer Care (Engl) 2022; 31:e13588. [PMID: 35396775 PMCID: PMC9539475 DOI: 10.1111/ecc.13588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 02/12/2022] [Accepted: 03/28/2022] [Indexed: 11/27/2022]
Abstract
Objective At a Danish Hospital, we wished to establish a co‐designed patient education day about prophylactic interventions for women at high risk of developing breast cancer. However, knowledge is lacking on the women's acceptability and requests for content. The objective of this study is to gain knowledge about the acceptability and requests of the content of a patient education day among women at high risk of breast cancer considering prophylactic mastectomy. Methods A user panel consisting of patients and health care professionals developed an interview guide for two focus interviews with two groups of women at high risk of breast cancer; one group had received a prophylactic mastectomy and one group considered it. Thematic analysis was used to explore the participants' acceptability and requests for content. Results Meaningful content was knowledge about prophylactic interventions, how to share knowledge with partners and children, and talking to equals in a safe forum. Not all participants wished to discuss own surgery in a group setting. Conclusion An education day is an acceptable and supportive format for gaining knowledge about surgery, but since some topics may be vulnerable to discuss in a group setting to some women, we suggest the education day as a valuable supplement to the individual consultations.
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Affiliation(s)
| | | | - Camilla Bille
- Department of Plastic Surgery, Odense University Hospital, Odense, Denmark
| | | | | | | | - Helle Timm
- National Institute of Public Health, University of Southern Denmark, Odense, Denmark
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8
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von Arenstorff JF, Gravergaard AE, Bille C. [Autologous nanofat transplantation for scar treatment]. Ugeskr Laeger 2022; 184:V01210105. [PMID: 35315762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Damaging the normal skin barrier results in a cascade of reactions resulting in scar formation. Transforming growth factors cause the proliferation of fibroblasts to myofibroblasts, which keep secreting collagen. There are indications, that the proliferation might be inhibited by adipose-derived stem cells (ADSC). Nanofat is a liquid substance containing ADSC. This review is based on five observational human studies, where nanofat was injected into a variant of scars. A significant improvement was demonstrated in all the studies. Scars treated within five years has a better chance of regeneration. Randomized controlled trials are warranted.
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Affiliation(s)
| | | | - Camilla Bille
- Plastikkirurgisk Afdeling, Odense Universitetshospital
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9
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Vogsen M, Jensen JD, Christensen IY, Gerke O, Jylling AMB, Larsen LB, Braad PE, Søe KL, Bille C, Ewertz M, Hildebrandt MG. FDG-PET/CT in high-risk primary breast cancer-a prospective study of stage migration and clinical impact. Breast Cancer Res Treat 2020; 185:145-153. [PMID: 32920740 DOI: 10.1007/s10549-020-05929-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 09/04/2020] [Indexed: 02/06/2023]
Abstract
PURPOSE To investigate the clinical impact of FDG-PET/CT for staging and treatment planning in high-risk primary breast cancer. METHODS Women with high-risk primary breast cancer were enrolled between September 2017 and August 2019 at Odense University Hospital, Denmark. Conventional mammography with/without MRI was performed before staging by FDG-PET/CT. We studied the accuracy of FDG-PET/CT for the detection of distant metastases, the effect on the change of treatment, and the prevalence of incidental findings. Biopsy and follow-up were used as a reference standard for the accuracy analysis. RESULTS Of 103 women, 24 (23%) were diagnosed with distant metastases by FDG-PET/CT. Among these, breast surgery was omitted in 18 and could have been spared in six. Another sixteen (16%) patients were upstaged to more advanced loco-regional disease, leading to more extensive radiotherapy. Sensitivity and specificity for diagnosing distant metastases were 1.00 (95% confidence interval: 0.86-1.00) and 0.95 (0.88-0.99), respectively. Twenty-nine incidental findings were detected in 24 women (23%), leading to further examinations in 22 and diagnosis of eight (8/22, 36%) synchronous diseases: cancer (n = 4), thyroiditis (n = 2), aorta aneurysm (n = 1), and meningioma (n = 1). CONCLUSIONS FDG-PET/CT had a substantial impact on staging and change of treatment in women with high-risk primary breast cancer, and further examination of incidental findings was considered clinically relevant. Our findings suggest that FDG-PET/CT should be considered for primary staging in high-risk primary breast cancer to improve treatment planning.
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Affiliation(s)
- Marianne Vogsen
- Department of Oncology, Odense University Hospital, Odense, Denmark.
- Department of Nuclear Medicine, Odense University Hospital, Odense, Denmark.
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark.
- Odense Patient Data Explorative Network, Odense University Hospital, Odense, Denmark.
- Centre for Personalized Response Monitoring in Oncology (PREMIO), Odense University Hospital, Odense, Denmark.
- Department of Oncology and Department of Nuclear Medicine, Odense University Hospital, Kloevervaenget 47, 5000, Odense C, Denmark.
| | | | | | - Oke Gerke
- Department of Nuclear Medicine, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | | | | | - Poul-Erik Braad
- Department of Nuclear Medicine, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | | | - Camilla Bille
- Department of Plastic Surgery, Odense University Hospital, Odense, Denmark
| | - Marianne Ewertz
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Malene Grubbe Hildebrandt
- Department of Nuclear Medicine, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Centre for Personalized Response Monitoring in Oncology (PREMIO), Odense University Hospital, Odense, Denmark
- Centre for Innovative Medical Technology, Odense University Hospital, Odense, Denmark
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10
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Vogsen M, Jensen J, Christensen I, Gerke O, Jylling A, Larsen L, Braad PE, Søe K, Bille C, Ewertz M, Hildebrandt M. 250P FDG-PET/CT in high-risk primary breast cancer: A prospective study of stage migration and clinical impact. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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11
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Vogsen M, Bille C, Jylling AMB, Jensen MB, Ewertz M. Adherence to treatment guidelines and survival in older women with early-stage breast cancer in Denmark 2008-2012. Acta Oncol 2020; 59:741-747. [PMID: 32364416 DOI: 10.1080/0284186x.2020.1757148] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Objectives: The aims of this study were to compare patients 70 years or older with younger patients, to examine whether Danish patients with early-stage breast cancer aged 70 years or more received treatment according to guidelines, the reasons for deviating from the guidelines, and to analyze whether such deviations affected survival.Methods: From the Danish Breast Cancer Cooperative Group (DBCG) database we identified 23,247 women diagnosed with early-stage breast cancer in Denmark from 2008 to 2012. 17,391 were aged less than 70 years and 5856 were 70+ years. We reviewed medical charts of 441 patients aged 70+ years from Funen (a region of Denmark) to ascertain whether treatment was given according to the guidelines of DBCG and if not, the reason for deviating. Overall survival was analyzed by Cox proportional hazards models.Results: Up to age 80 years most women (94%) had surgery according to guidelines, decreasing to 41% in women aged 85+ years, the main reason for omitting surgery being patients' requests. Patients with breast cancer over the age of 80 years did not have an excess mortality compared with the general population in Funen. Compared with women who had surgery according to guidelines, women who did not have surgery had a significantly higher risk of dying with a hazard ratio (HR) of 8.38 (95% Confidence Intervals (CI) 4.46-15.8) if they were less than 80 years and HR = 2.56 (95% CI 1.63-4.01) if they were 80 years or more (p = .003 for interaction).Conclusions: Adherence to treatment according to guidelines decreases with increasing age, mainly for patients aged 80+ years. Our results suggest that surgery is important for the survival of patients aged less than 80 years.
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Affiliation(s)
- Marianne Vogsen
- Department of Oncology, Odense University Hospital, Odense, Denmark
- Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Camilla Bille
- Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Plastic Surgery, Odense University Hospital, Odense, Denmark
| | | | - Maj-Britt Jensen
- Danish Breast Cancer Cooperative Group, Copenhagen University Hospital, Copenhagen, Denmark
| | - Marianne Ewertz
- Department of Oncology, Odense University Hospital, Odense, Denmark
- Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
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Dyrberg DL, Gunnarsson GL, Bille C, Sørensen JA, Thomsen JB. Direct-to-Implant Extracellular Matrix Hammock-based Breast Reconstruction; Prepectoral or Subpectoral? Trials 2020; 21:160. [PMID: 32041661 PMCID: PMC7011213 DOI: 10.1186/s13063-020-4125-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Accepted: 01/31/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Skin-sparing mastectomy followed by immediate implant-based breast reconstruction is a commonly used treatment for breast cancer. However, when placing the implant in a subpectoral pocket, a high incidence of breast animation deformity (BAD) has been reported. Besides the nuisance that BAD can cause, lifting of the pectoralis major muscle (PMM) can result in a more extended postoperative recovery period. When placing the implant solely prepectorally leaving the PMM undisturbed, the incidence and severity of BAD might be mitigated. However, new challenges may occur because of thinner skin cover. METHODS/DESIGN A prospective, multi-centre, randomised controlled trial will be carried out with the primary aim of assessing and comparing the incidence and degree of BAD in women having a direct-to-implant breast reconstruction with either a prepectorally or a subpectorally placed implant. The secondary outcomes are shoulder and arm function, quality of life, aesthetic evaluation, length of stay, complications, need for surgical corrections, and development of capsular contracture. A total of 70 included patients will be followed under admittance and at clinical check-ups 3 months and 1 year after surgery. DISCUSSION To our knowledge, this trial is the first randomised controlled trial evaluating and comparing subpectoral and prepectoral implant placement when performing direct-to-implant breast reconstruction following skin-sparing mastectomy. The results will hopefully provide us with a broader knowledge of the outcomes of immediate breast reconstruction, making better preoperative planning possible in the future by providing our patients with a more objective information. TRIAL REGISTRATION ClinicalTrials.gov, ID: NCT03143335. Prospectively registered on 8 May 2017.
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Affiliation(s)
- Diana L Dyrberg
- Department of Plastic Surgery, Odense University Hospital, Odense/ Lillebaelt Hospital, Vejle, Sdr Boulevard 29, 5000, Odense, Denmark
| | | | - Camilla Bille
- Department of Plastic Surgery, Odense University Hospital, Odense, Denmark
| | - Jens A Sørensen
- Department of Plastic Surgery, Odense University Hospital, Odense, Denmark
| | - Jørn B Thomsen
- Department of Plastic Surgery, Odense University Hospital, Odense/ Lillebaelt Hospital, Vejle, Sdr Boulevard 29, 5000, Odense, Denmark.
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13
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Bille C, Dalaei F, Thomsen JB. Identifying the dissection plane for mastectomy-description and visualization of our technique. Gland Surg 2019; 8:S276-S280. [PMID: 31709167 PMCID: PMC6819889 DOI: 10.21037/gs.2019.05.04] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Accepted: 05/06/2019] [Indexed: 11/06/2022]
Abstract
In this visualized surgery paper, we present our experience identifying the optimal dissection plane in nipple-sparing mastectomy using hydrodissection through an inframammary incision. The surgical technique comprises of preoperative magnetic resonance imaging (MRI) aiming to assess the thickness and expected quality of the mastectomy flaps, an inframammary incision, and hydrodissection to assist the surgeon in identifying the optimal dissection plane. This surgical method results in an adequate resection of breast parenchyma to obtain the best oncological outcome, while retaining the maximum amount of subcutaneous adipose tissue on the skin flaps to achieve a superior aesthetic result resembling the natural breast. The mastectomy flap thickness and quality can then be assessed prior to an immediate reconstruction.
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Affiliation(s)
- Camilla Bille
- Department of Plastic Surgery, Odense University Hospital, Odense, Denmark
| | - Farima Dalaei
- Department of Plastic Surgery, Odense University Hospital, Odense, Denmark
| | - Jørn Bo Thomsen
- Department of Plastic Surgery, Odense University Hospital and Lillebaelt Hospital, Vejle, Denmark
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14
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Dyrberg DL, Bille C, Gunnarsson GL, Sørensen JA, Thomsen JB. Visualized pre- and subpectoral implant placement for immediate breast reconstruction. Gland Surg 2019; 8:S251-S254. [PMID: 31709163 PMCID: PMC6819886 DOI: 10.21037/gs.2019.05.09] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Accepted: 05/27/2019] [Indexed: 11/06/2022]
Abstract
The use of mesh for immediate breast reconstruction was introduced almost two decades ago. Lately, the number of prepectoral direct to implant breast reconstructions has increased as this technique seems to leave an unimpaired muscle function and may lead to less or no breast animation deformity (BAD) and quicker recovery. However, challenges still remain as there is a risk of thin tissue coverage, visible implant edges and secondary ptosis. In this visualized surgery paper, we visualize the technical disparities between the sub- and prepectoral direct to implant breast reconstruction.
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Affiliation(s)
- Diana L Dyrberg
- Department of Plastic Surgery, Odense University Hospital, Odense/Lillebaelt Hospital, Vejle, Denmark
| | - Camilla Bille
- Department of Plastic Surgery, Odense University Hospital, Odense, Denmark
| | | | - Jens A Sørensen
- Department of Plastic Surgery, Odense University Hospital, Odense, Denmark
| | - Jørn B Thomsen
- Department of Plastic Surgery, Odense University Hospital, Odense/Lillebaelt Hospital, Vejle, Denmark
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15
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Lorenzen MM, Gunnarsson GL, Bille C, Tos T, Koudahl V, Rindom MB, Sørensen JA, Thomsen JB. Visualized bilateral breast reconstruction by propeller thoracodorsal artery perforator flaps. Gland Surg 2019; 8:S262-S270. [PMID: 31709165 DOI: 10.21037/gs.2019.04.05] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Thoracodorsal artery perforator (TAP) flaps are versatile flaps that provide a consistent and aesthetically pleasing breast reconstruction. We prefer the TAP flap to the latissimus dorsi (LD) flap due to the morbidity associated with the LD flap. In this paper we aim to show how we perform bilateral TAP flap breast reconstruction and present our preliminary results from 32 bilateral reconstructions in 16 patients. The TAP flap breast reconstruction can be performed as a direct-to-implant or a delayed procedure depending on patient factors. Color Doppler ultrasonography (CDU) is used in the preoperative planning which promotes the safety and reliability of the flap by mapping perforators thus enabling faster dissection. The bilateral TAP flap breast reconstruction is usually performed in three steps: (I) raising the flaps at the recipient site; (II) rotating the TAP flaps and (III) completion of the breast reconstruction.
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Affiliation(s)
| | | | - Camilla Bille
- Department of Plastic Surgery, Odense University Hospital, Odense, Denmark
| | - Tina Tos
- Department of Plastic Surgery, Herlev Hospital, Herlev, Denmark
| | - Vibeke Koudahl
- Department of Plastic Surgery, Lillebaelt Hospital & Odense University Hospital, Vejle, Denmark
| | - Mikkel Børsen Rindom
- Department of Plastic Surgery, Lillebaelt Hospital & Odense University Hospital, Vejle, Denmark
| | - Jens Ahm Sørensen
- Department of Plastic Surgery, Odense University Hospital, Odense, Denmark
| | - Jørn Bo Thomsen
- Department of Plastic Surgery, Lillebaelt Hospital & Odense University Hospital, Vejle, Denmark
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16
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Gunnarsson GL, Holm J, Duus N, Børsen-Rindom M, Tos T, Bille C, Hölmich L, Sørensen JA, Thomsen JB. Corrigendum to `Propeller TAP flap breast reconstruction: A simplified surgical technique' [Journal of Plastic, Reconstructive & Aesthetic Surgery 71 (2018) 1424-1431]. J Plast Reconstr Aesthet Surg 2019; 72:528. [PMID: 30598395 DOI: 10.1016/j.bjps.2018.12.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
| | - Jens Holm
- Department of Plastic Surgery, Odense University Hospital, Denmark
| | - Nicolaj Duus
- Department of Plastic Surgery, Herlev Hospital, Denmark
| | - Mikkel Børsen-Rindom
- Department of Plastic Surgery, Odense University Hospital and Lillebaelt Hospital, Vejle, Denmark
| | - Tina Tos
- Department of Plastic Surgery, Herlev Hospital, Denmark
| | - Camilla Bille
- Department of Plastic Surgery, Odense University Hospital, Denmark
| | | | | | - Jørn Bo Thomsen
- Department of Plastic Surgery, Odense University Hospital and Lillebaelt Hospital, Vejle, Denmark.
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17
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Hyldig N, Joergensen JS, Wu C, Bille C, Vinter CA, Sorensen JA, Mogensen O, Lamont RF, Möller S, Kruse M. Cost-effectiveness of incisional negative pressure wound therapy compared with standard care after caesarean section in obese women: a trial-based economic evaluation. BJOG 2018; 126:619-627. [PMID: 30507022 DOI: 10.1111/1471-0528.15573] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/16/2018] [Indexed: 01/01/2023]
Abstract
OBJECTIVE To evaluate the cost-effectiveness of incisional negative pressure wound therapy (iNPWT) in preventing surgical site infection in obese women after caesarean section. DESIGN A cost-effectiveness analysis conducted alongside a clinical trial. SETTING Five obstetric departments in Denmark. POPULATION Women with a pregestational body mass index (BMI) ≥30 kg/m2 . METHOD We used data from a randomised controlled trial of 876 obese women who underwent elective or emergency caesarean section and were subsequently treated with iNPWT (n = 432) or a standard dressing (n = 444). Costs were estimated using data from four Danish National Databases and analysed from a healthcare perspective with a time horizon of 3 months after birth. MAIN OUTCOME MEASURES Cost-effectiveness based on incremental cost per surgical site infection avoided and per quality-adjusted life-year (QALY) gained. RESULTS The total healthcare costs per woman were €5793.60 for iNPWT and €5840.89 for standard dressings. Incisional NPWT was the dominant strategy because it was both less expensive and more effective; however, no statistically significant difference was found for costs or QALYs. At a willingness-to-pay threshold of €30,000, the probability of the intervention being cost-effective was 92.8%. A subgroup analysis stratifying by BMI shows that the cost saving of the intervention was mainly driven by the benefit to women with a pre-pregnancy BMI ≥35 kg/m2 . CONCLUSION Incisional NPWT appears to be cost saving compared with standard dressings but this finding is not statistically significant. The cost savings were primarily found in women with a pre-pregnancy BMI ≥35 kg/m2 . TWEETABLE ABSTRACT Prophylactic incisional NPWT reduces the risk of SSI after caesarean section and is probably dominant compared with standard dressings #healtheconomics.
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Affiliation(s)
- N Hyldig
- Department of Plastic Surgery, Odense University Hospital, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark.,Department of Gynaecology and Obstetrics, Odense University Hospital, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark.,OPEN Odense Patient data Explorative Network, Odense University Hospital, Odense, Denmark
| | - J S Joergensen
- Department of Gynaecology and Obstetrics, Odense University Hospital, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - C Wu
- Department of Gynaecology and Obstetrics, Odense University Hospital, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - C Bille
- Department of Plastic Surgery, Odense University Hospital, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - C A Vinter
- Department of Gynaecology and Obstetrics, Odense University Hospital, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - J A Sorensen
- Department of Plastic Surgery, Odense University Hospital, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - O Mogensen
- Division of Pelvic Cancer, Karolinska University Hospital, and the Karolinska Institute, Stockholm, Sweden
| | - R F Lamont
- Department of Gynaecology and Obstetrics, Odense University Hospital, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark.,Division of Surgery, University College London, London, UK
| | - S Möller
- OPEN Odense Patient data Explorative Network, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - M Kruse
- Department of Public Health, Danish Centre for Health Economics (DaCHE), University of Southern Denmark, Odense, Denmark
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18
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Krammer CW, Akram J, Vestergaard T, Kjærskov MW, Bille C. [Treatment algorithm for non-melanoma skin cancer]. Ugeskr Laeger 2018; 180:V01180044. [PMID: 30518464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Non-melanoma skin cancers are the most common malignant neoplasms in Denmark. The majority of cases are basal cell carcinomas (BCC) and squamous cell carcinomas (SCC). The choice of treatment depends on tumour, area, histology and patient-specific factors. Superficial and low-risk BCC can be treated with curettage, photodynamic therapy, imiquimod cream or cryotherapy. High-risk BCC and SCC should be treated by surgical excision or radiotherapy.
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19
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Hyldig N, Vinter CA, Kruse M, Mogensen O, Bille C, Sorensen JA, Lamont RF, Wu C, Heidemann LN, Ibsen MH, Laursen JB, Ovesen PG, Rorbye C, Tanvig M, Joergensen JS. Prophylactic incisional negative pressure wound therapy reduces the risk of surgical site infection after caesarean section in obese women: a pragmatic randomised clinical trial. BJOG 2018; 126:628-635. [PMID: 30066454 PMCID: PMC6586160 DOI: 10.1111/1471-0528.15413] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/09/2018] [Indexed: 12/15/2022]
Abstract
Objective To evaluate the reduction of surgical site infections by prophylactic incisional negative pressure wound therapy compared with standard postoperative dressings in obese women giving birth by caesarean section. Design Multicentre randomised controlled trial. Setting Five hospitals in Denmark. Population Obese women (prepregnancy body mass index (BMI) ≥30 kg/m2) undergoing elective or emergency caesarean section. Method The participants were randomly assigned to incisional negative pressure wound therapy or a standard dressing after caesarean section and analysed by intention‐to‐treat. Blinding was not possible due to the nature of the intervention. Main outcome measures The primary outcome was surgical site infection requiring antibiotic treatment within the first 30 days after surgery. Secondary outcomes included wound exudate, dehiscence and health‐related quality of life. Results Incisional negative pressure wound therapy was applied to 432 women and 444 women had a standard dressing. Demographics were similar between groups. Surgical site infection occurred in 20 (4.6%) women treated with incisional negative pressure wound therapy and in 41 (9.2%) women treated with a standard dressing (relative risk 0.50, 95% CI 0.30–0.84; number needed to treat 22; P = 0.007). The effect remained statistically significant when adjusted for BMI and other potential risk factors. Incisional negative pressure wound therapy significantly reduced wound exudate whereas no difference was found for dehiscence and quality of life between the two groups. Conclusion Prophylactic use of incisional negative pressure wound therapy reduced the risk of surgical site infection in obese women giving birth by caesarean section. Tweetable abstract RCT: prophylactic incisional NPWT versus standard dressings postcaesarean in 876 women significantly reduces the risk of SSI. RCT: prophylactic incisional NPWT versus standard dressings postcaesarean in 876 women significantly reduces the risk of SSI.
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Affiliation(s)
- N Hyldig
- Department of Plastic Surgery, Odense University Hospital, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark.,Department of Gynaecology and Obstetrics, Odense University Hospital, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark.,OPEN Odense Patient data Explorative Network, Odense University Hospital, Odense, Denmark
| | - C A Vinter
- Department of Gynaecology and Obstetrics, Odense University Hospital, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - M Kruse
- Danish Centre for Health Economics (DaCHE), Institute of Public Health, University of Southern Denmark, Odense, Denmark
| | - O Mogensen
- Department of Pelvic Cancer, Karolinska University Hospital and Karolinska Institute, Stockholm, Sweden
| | - C Bille
- Department of Plastic Surgery, Odense University Hospital, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - J A Sorensen
- Department of Plastic Surgery, Odense University Hospital, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - R F Lamont
- Department of Gynaecology and Obstetrics, Odense University Hospital, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark.,Division of Surgery, Northwick Park Institute of Medical Research Campus, University College London, London, UK
| | - C Wu
- Department of Gynaecology and Obstetrics, Odense University Hospital, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - L N Heidemann
- Department of Plastic Surgery, Odense University Hospital, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark.,Department of Gynaecology and Obstetrics, Lillebaelt Hospital, Kolding, Denmark
| | - M H Ibsen
- Department of Gynaecology and Obstetrics, Hospital of Southern Jutland, Esbjerg, Denmark
| | - J B Laursen
- Department of Gynaecology and Obstetrics, Hvidovre Hospital, University of Copenhagen, Hvidovre, Denmark
| | - P G Ovesen
- Department of Gynaecology and Obstetrics, Aarhus University Hospital, Skejby, Aarhus, Denmark
| | - C Rorbye
- Department of Gynaecology and Obstetrics, Hvidovre Hospital, University of Copenhagen, Hvidovre, Denmark
| | - M Tanvig
- Department of Gynaecology and Obstetrics, Odense University Hospital, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark.,Department of Gynaecology and Obstetrics, Lillebaelt Hospital, Kolding, Denmark
| | - J S Joergensen
- Department of Gynaecology and Obstetrics, Odense University Hospital, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
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20
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Gunnarsson GL, Holm J, Duus N, Børsen-Rindom M, Tos T, Bille C, Hölmich L, Sørensen JA, Thomsen JB. Propeller TAP flap breast reconstruction: A simplified surgical technique. J Plast Reconstr Aesthet Surg 2018; 71:1424-1431. [PMID: 29970345 DOI: 10.1016/j.bjps.2018.05.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Accepted: 05/29/2018] [Indexed: 11/30/2022]
Affiliation(s)
| | - Jens Holm
- Department of Plastic Surgery, Odense University Hospital, Denmark
| | - Nicolaj Duus
- Department of Plastic Surgery, Herlev Hospital, Denmark
| | - Mikkel Børsen-Rindom
- Department of Plastic Surgery, Odense University Hospital and Lillebaelt Hospital, Vejle, Denmark
| | - Tina Tos
- Department of Plastic Surgery, Herlev Hospital, Denmark
| | - Camilla Bille
- Department of Plastic Surgery, Odense University Hospital, Denmark
| | | | | | - Jørn Bo Thomsen
- Department of Plastic Surgery, Odense University Hospital and Lillebaelt Hospital, Vejle, Denmark.
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21
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Gunnarsson GL, Heidemann LN, Bille C, Sørensen JA, Thomsen JB. Nipple sparing mastectomy and the evolving direct to implant breast reconstruction. Gland Surg 2018; 7:267-272. [PMID: 29998076 DOI: 10.21037/gs.2017.08.06] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
In this paper, we describe the evolving use of the nipple-sparing mastectomy (NSM) and direct to implant breast reconstruction according to existing literature and our own experience. The surgical method enables superior aesthetic results resembling that of a natural breast while maintaining oncologic safety. Acellular dermal matrix enables direct to implant breast reconstruction by serving as a hammock and can be used with acceptable rates of complications. A successful nipple-sparing mastectomy and direct to implant breast reconstruction approach with acceptable postoperative complication rates relies upon quality of the mastectomy skin flaps and correct patient selection. The surgical method has developed with a rapid pace and expected to evolve further in terms of technical modalities, safety measure and lasting results.
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Affiliation(s)
| | | | - Camilla Bille
- Department of Plastic Surgery, Odense University Hospital, Odense, Denmark
| | - Jens Ahm Sørensen
- Department of Plastic Surgery, Odense University Hospital, Odense, Denmark
| | - Jørn Bo Thomsen
- Department of Plastic Surgery, Lillebaelt Hospital/Odense University Hospital, Vejle, Denmark.,Institute of Regional Health Services Research Center, Lillebaelt Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
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22
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Meyer L, Bille C, Foged T, Jylling AMB. Occult breast cancer in breast reduction specimens. Acta Oncol 2018; 57:170-173. [PMID: 29202610 DOI: 10.1080/0284186x.2017.1400178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Lotte Meyer
- Department of Pathology, Odense University Hospital, University of Southern Denmark, Odense, Denmark
| | - Camilla Bille
- Department of Plastic Surgery Z, Odense University Hospital, Odense, Denmark
| | - Thomas Foged
- Department of Plastic Surgery, Aarhus University Hospital, Aarhus, Denmark
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23
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Sollie M, Bille C. Smoking and mortality in women diagnosed with breast cancer-a systematic review with meta-analysis based on 400,944 breast cancer cases. Gland Surg 2017; 6:385-393. [PMID: 28861380 DOI: 10.21037/gs.2017.04.06] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
BACKGROUND It is evident that smoking is causing disease and increased mortality in general. Recently published data are now suggesting that smoking might increase both the overall mortality in women diagnosed with breast cancer but also increase their risk of dying from their breast cancer. METHODS A systematic review and meta-analysis on smoking status in women diagnosed with breast cancer, their mortality rate and cause of death. Based on all cohort studies published within the last ten years. RESULTS Twelve studies met our inclusion criteria, and 400,944 women diagnosed with primary invasive breast cancer was included. Hazard ratio (HR) for breast cancer associated death in former smokers was 1.02 (0.93, 1.12) and for current smokers 1.28 (1.17, 1.41) when compared to never smokers. For all-cause death, the HR for former smokers was 1.12 (1.04, 1.19), and for current smokers 1.52 (1.32, 1.76) when compared to never smokers. CONCLUSIONS This large systematic review and meta-analysis found a 28% increase in breast cancer-associated mortality in those who were current smokers compared to never smokers. The mortality in former smokers was equal to the one found in never smokers. This indicates that breast cancer patients ceasing to smoke can lower their risk of dying from their breast cancer disease dramatically, and possibly regain the risk of a never smoker.
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Affiliation(s)
- Martin Sollie
- Department of Plastic Surgery, Odense University Hospital, Sdr Boulevard 29, 5000 Odense C, Denmark
| | - Camilla Bille
- Department of Plastic Surgery, Odense University Hospital, Sdr Boulevard 29, 5000 Odense C, Denmark
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24
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Schierbeck J, Davidsen JR, Grindsted Nielsen S, Bille C. Silicone implant incompatibility syndrome (SIIS) in a 57-year-old woman with unilateral silicone breast implant. BMJ Case Rep 2017; 2017:bcr-2016-218709. [PMID: 28739610 DOI: 10.1136/bcr-2016-218709] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Since the 1960s, silicone implants have been used for breast augmentations, both cosmetically and in reconstructive surgery. Tissue exposed to silicone can react with multiple adverse advents. Autoimmune/inflammatory syndrome induced by adjuvants due to silicone exposure from ruptured silicone implants can lead to different interstitial lung manifestations predominantly with granuloma evolvement, leading to the so-called silicone implant incompatibility syndrome (SIIS). This case describes a 57-year-old woman with multiple lung infiltrations and a left-sided breast implant. The implant had been replaced twice, once due to implant rupture 36 years ago. The nodular infiltrates could not be related to infection, malignancy, interstitial lung disease, vasculitis or connective tissue disorder, and it was concluded that the nodular infiltrations were of inflammatory origin due to an autoimmune response secondary to the silicone implants (SIIS). After explantation, the patient's symptoms subsided and her physical condition has remarkably improved.
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Affiliation(s)
- Juliane Schierbeck
- Department of Plastic Surgery, Odense University Hospital, Odense, Denmark
| | | | | | - Camilla Bille
- Department of Plastic Surgery, Odense University Hospital, Odense, Denmark
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25
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Heidemann LN, Gunnarsson GL, Bille C, Sørensen JA, Thomsen JB. [Reconstructive breast surgery using implant and mesh]. Ugeskr Laeger 2017; 179:V10160755. [PMID: 28263160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
The demand for reconstructive surgery after therapeutic and prophylactic mastectomy is increasing. The hammock technique for breast reconstruction was introduced in 2001 and provides support for the implant using either biologically derived or synthetic mesh. The material is formed as a hammock in the lower pole of the reconstructed breast, and due to its supportive capabilities it has been found to shorten the time needed for reconstruction, decrease the risk of capsular contracture and leave a superior aesthetic result. Correct patient selection seems crucial for optimizing the aesthetic outcome and minimizing complications.
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Abstract
Post-mastectomy pain syndrome (PMPS) is a chronic neuropathic pain condition, affecting many women who have undergone breast cancer surgery. The development of PMPS is complex and the treatment options are limited. In this systematic review, we have analyzed the existing treatment modalities of PMPS. Six studies on five treatments were carefully selected, critically evaluated, and presented. The treatments were: antidepressants, anti-epileptics, topical capsaicin, and autologous fat grafting. Four of these treatments had a significant effect on PMPS. However, most of the studies had several flaws and therefore larger studies of high quality should be performed in the future.
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Affiliation(s)
| | - Jens Ahm Sørensen
- Department of Plastic Surgery, Odense University Hospital, Odense, Denmark
| | - Camilla Bille
- Department of Plastic Surgery, Odense University Hospital, Odense, Denmark
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27
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Hyldig N, Birke-Sorensen H, Kruse M, Vinter C, Joergensen JS, Sorensen JA, Mogensen O, Lamont RF, Bille C. Meta-analysis of negative-pressure wound therapy for closed surgical incisions. Br J Surg 2016; 103:477-86. [PMID: 26994715 PMCID: PMC5069647 DOI: 10.1002/bjs.10084] [Citation(s) in RCA: 159] [Impact Index Per Article: 19.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Revised: 08/16/2015] [Accepted: 11/18/2015] [Indexed: 12/13/2022]
Abstract
Background Postoperative wound complications are common following surgical procedures. Negative‐pressure wound therapy (NPWT) is well recognized for the management of open wounds and has been applied recently to closed surgical incisions. The evidence base to support this intervention is limited. The aim of this study was to assess whether NPWT reduces postoperative wound complications when applied to closed surgical incisions. Methods This was a systematic review and meta‐analysis of randomized clinical trials of NPWT compared with standard postoperative dressings on closed surgical incisions. Results Ten studies met the inclusion criteria, reporting on 1311 incisions in 1089 patients. NPWT was associated with a significant reduction in wound infection (relative risk (RR) 0·54, 95 per cent c.i. 0·33 to 0·89) and seroma formation (RR 0·48, 0·27 to 0·84) compared with standard care. The reduction in wound dehiscence was not significant. The numbers needed to treat were three (seroma), 17 (dehiscence) and 25 (infection). Methodological heterogeneity across studies led to downgrading of the quality of evidence to moderate for infection and seroma, and low for dehiscence. Conclusion Compared with standard postoperative dressings, NPWT significantly reduced the rate of wound infection and seroma when applied to closed surgical wounds. Heterogeneity between the included studies means that no general recommendations can be made yet. Good for closed wounds too Video Abstract
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Affiliation(s)
- N Hyldig
- Department of Plastic Surgery, Odense University Hospital, University of Southern Denmark, Institute of Clinical Research, Research Unit of Plastic Surgery, Odense, Denmark.,Department of Gynaecology and Obstetrics, Odense University Hospital, University of Southern Denmark, Institute of Clinical Research, Research Unit of Gynaecology and Obstetrics, Odense, Denmark
| | - H Birke-Sorensen
- Institute of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - M Kruse
- Centre for Health Economics Research (COHERE), University of Southern Denmark, Odense, Denmark
| | - C Vinter
- Department of Gynaecology and Obstetrics, Odense University Hospital, University of Southern Denmark, Institute of Clinical Research, Research Unit of Gynaecology and Obstetrics, Odense, Denmark
| | - J S Joergensen
- Department of Gynaecology and Obstetrics, Odense University Hospital, University of Southern Denmark, Institute of Clinical Research, Research Unit of Gynaecology and Obstetrics, Odense, Denmark
| | - J A Sorensen
- Department of Plastic Surgery, Odense University Hospital, University of Southern Denmark, Institute of Clinical Research, Research Unit of Plastic Surgery, Odense, Denmark
| | - O Mogensen
- Department of Gynaecology and Obstetrics, Odense University Hospital, University of Southern Denmark, Institute of Clinical Research, Research Unit of Gynaecology and Obstetrics, Odense, Denmark
| | - R F Lamont
- Department of Gynaecology and Obstetrics, Odense University Hospital, University of Southern Denmark, Institute of Clinical Research, Research Unit of Gynaecology and Obstetrics, Odense, Denmark.,Division of Surgery, University College London, Northwick Park Institute of Medical Research Campus, London, UK
| | - C Bille
- Department of Plastic Surgery, Odense University Hospital, University of Southern Denmark, Institute of Clinical Research, Research Unit of Plastic Surgery, Odense, Denmark
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28
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Sollie M, Bille C. The use of a single local analgesics infusion in operation cavity following mastectomy and its effect on postoperative pain—a retrospective cohort study. Eur J Plast Surg 2016. [DOI: 10.1007/s00238-016-1195-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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29
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Foged T, Sørensen JA, Søe KL, Bille C. Lack of nationwide Danish guidelines on mammography before non-oncological breast surgery. Dan Med J 2015; 62:A5076. [PMID: 26050829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
INTRODUCTION Non-oncological breast surgery like breast reduction and mastopexy are often performed in younger patients, i.e. in women who have not yet had mammography. Breast cancer is, however, a very frequent disease that is increasingly prevalent in women below 50 years of age. Occult breast cancer may not be recognised before breast surgery, which may result in several disadvantages for the women. Therefore, detecting a breast cancer before a woman undergoes non-oncological breast surgery is of paramount importance. METHODS All public plastic surgery and breast surgery departments and all private clinics or hospitals providing plastic surgery were asked two questions: 1) When do you recommend a mammography prior to non-oncological breast surgery? 2) How old must a mammogram be before it needs to be repeated? RESULTS Answers were received from all plastic surgery and breast surgery departments, and all but three of the private clinics and hospitals. Overall, information was obtained from 95.5% of the respondents (n = 63). CONCLUSION Currently, there are no Danish guidelines on mammography before non-oncological breast surgery. A national guideline could recommend a preoperative mammogram from the age of 40 years stipulating that the mammogram should have been made within the past 12 months; however, the final recommendation should be prepared by a multidisciplinary working group counting experts from plastic surgery, breast surgery, pathology and radiology. FUNDING not relevant. TRIAL REGISTRATION not relevant.
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Affiliation(s)
- Thomas Foged
- Plastikkirurgisk Afdeling, Odense Universitetshospital, Denmark, Søndre Boulevard 29, 5000 Odense C, Denmark.
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Børsen-Koch M, Bille C, Thomsen JB. Promising results after single-stage reconstruction of the nipple and areola complex. Dan Med J 2013; 60:A4674. [PMID: 24083522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
INTRODUCTION Reconstruction of the nipple-areola complex (NAC) traditionally marks the end of breast reconstruction. Several different surgical techniques have been described, but most are staged procedures. This paper describes a simple single-stage approach. MATERIAL AND METHODS We used a technique based on a local flap for reconstruction of the nipple in combination with immediate intradermal tattooing for reconstruction of the areola. RESULTS We reviewed the outcome of 22 cases of women who had simple single-stage reconstruction over a period of one year. We found no major and only two minor complications including one case of partial flap necrosis and one case of infection. Only three patients needed additional tattooing after a three-month period. The cosmetic outcome was satisfactory and none of the patients needed corrective procedures. The mean procedure time for unilateral reconstruction was 43 min. (30-50 min.). CONCLUSION This simple single-stage NAC reconstruction seems beneficial for both patient and surgeon as it seems to be associated with faster reconstruction and reduced procedure-related time without compromising the aesthetic outcome or the morbidity associated with surgery.
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Abstract
The aim of this study was to examine if a propeller thoracodorsal artery perforator (TAP) flap can be used for breast reconstruction. Fifteen women were reconstructed using a propeller TAP flap, an implant, and an ADM. Preoperative colour Doppler ultrasonography was used for patient selection to identify the dominant perforator in all cases. A total of 16 TAP flaps were performed; 12 flaps were based on one perforator and four were based on two. A permanent silicone implant was used in 14 cases and an expander implant in two. Minor complications were registered in three patients. Two cases had major complications needing additional surgery. One flap was lost due to a vascular problem. Breast reconstruction can be performed by a propeller TAP flap without cutting the descending branch of the thoracodorsal vessels. However, the authors would recommend that a small cuff of muscle is left around the perforator to ensure a sufficient venous return.
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Affiliation(s)
- Jørn Bo Thomsen
- Department of Plastic Surgery, Vejle Hospital/Odense University Hospital , Vejle , Denmark
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Abstract
This report describes a patent ductus arteriosus (PDA) in four puppies from the same family of Chihuahuas, bred from the same mother and from two different litters. Identification of this congenital anomaly relies on clinical examination, radiography and ultrasonography. Three of these puppies were female, and had a type-1 PDA. A conventional surgical ligation was performed on one of them, whilst the others underwent no treatment. One puppy was male, and presented with a type-4 PDA, requiring euthanasia. Post-mortem examination and histopathological examination of the PDA allowed characterisation of the histological anomalies, which were identical to those described in other breeds. The mother and the two stud dogs were not affected. Even though the mode of transmission has not been fully identified, it is evident that this PDA is hereditary in nature. To the authors' knowledge this is the first description of this congenital cardiopathy in a family of this breed, and in a significant number of first-generation individuals.
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Affiliation(s)
- E Bomassi
- Centre Hospitalier Vétérinaire des Cordeliers, 29 Avenue du Maréchal Joffre, F-77100 Meaux, France
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Grosen D, Bille C, Pedersen JK, Skytthe A, Murray JC, Christensen K. Recurrence risk for offspring of twins discordant for oral cleft: a population-based cohort study of the Danish 1936-2004 cleft twin cohort. Am J Med Genet A 2010; 152A:2468-74. [PMID: 20799319 DOI: 10.1002/ajmg.a.33608] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Our objective in this Danish population-based cohort study was to estimate the recurrence risk of isolated oral cleft (OC) for offspring of the unaffected co-twins of OC discordant twin pairs and to compare this risk to the recurrence risk in the offspring of the affected co-twin as well as to the risk in the background population. During 1936-2004, 207 twin pairs were ascertained, among whom at least one twin had an OC. The index persons were twins discordant for OC who had children (N=117), and their offspring (N=239). The participants were ascertained by linkage between The Danish Facial Cleft Database, The Danish Twin Registry and The Danish Civil Registration System. In the study OC recurrence risk for offspring of the affected and unaffected twin and relative risk were compared to the background prevalence. We found that among 110 children of the 54 OC affected twins, two (1.8%) children had OC corresponding to a significantly increased relative risk (RR=10; 95% CI 1.2-35) when compared to the frequency in the background population. Among the 129 children of the 63 unaffected twins, three (2.3%) children were affected, corresponding to a significantly increased relative risk (RR=13; 95% CI 2.6-36) when compared the background prevalence. We concluded that in OC discordant twin pairs similar increased recurrence risks were found among offspring of both OC affected and OC unaffected twins. This provides further evidence for a genetic component in cleft etiology and is useful information for genetic counseling of twin pairs discordant for clefting.
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Affiliation(s)
- Dorthe Grosen
- Department of Epidemiology, University of Southern Denmark, Odense, Denmark.
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Yttri JE, Christensen K, Knudsen LB, Bille C. Reproductive patterns among Danish women with oral clefts. Cleft Palate Craniofac J 2010; 48:601-7. [PMID: 20828272 DOI: 10.1597/09-245] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE The aim of this study was to compare reproduction patterns among Danish women born with isolated oral clefts versus the Danish background population. DESIGN AND SETTING A nationwide population-based historic cohort study based on three registers: The Danish Facial Cleft Register, The Danish Civil Registration System, and the Fertility of Women and Couples Dataset. PARTICIPANTS Through linkages of the registers, the number of children and the exact age at childbirth of all Danish women born with an oral cleft from 1950 through 1988 (N = 1931) were obtained. These data were compared with similar data for the entire Danish female background population (N = 1,184,390). RESULTS AND CONCLUSIONS This study suggests that childlessness is higher among women born with an oral cleft (55%) than among women in the Danish background population (44%). Excluding women without children, women born with oral cleft had an average of 1.98 children per woman. This did not differ significantly from the background population (2.02 children/woman). Furthermore, the present study found that Danish women born with oral clefts on average were older (27.3 years of age) than the background population (24.7 years of age) when they had their first child (difference = 2.6 years, confidence interval = 2.41 to 2.80). CONCLUSION Danish women born with an oral cleft more often are childless or have their first child later, but if they have children, they tend to have as many children as other Danish women. Social, psychological, and biological reasons might be responsible for the reduced fertility.
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Bille C, Pedersen DA, Andersen AMN, Mansilla MA, Murray JC, Christensen K, Ballard JL, Gorman EB, Cabrera RM, Finnell RH. Autoantibodies to folate receptor alpha during early pregnancy and risk of oral clefts in Denmark. Pediatr Res 2010; 67:274-9. [PMID: 19952865 PMCID: PMC2909840 DOI: 10.1203/pdr.0b013e3181cbd564] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The objective of this study was to determine whether IgG and IgM autoantibodies to folate receptor alpha (FRalpha) in pregnant women are associated with an increased risk of oral cleft-affected offspring. A case-control study nested in the prospective Danish National Birth Cohort (100,418 pregnancies, enrolled during 1997-2003) was done. Hundred eighty-five children were born with an oral cleft. Maternal serum from their mothers (cases) was compared with maternal serum from 779 randomly selected mothers of nonmalformed children (controls). We found that the average level of FRalpha IgG autoantibodies did not differ significantly among cases and controls (p = 0.71). Slightly higher levels of FRalpha IgM autoantibodies were found among controls compared with cases. This was, however, not statistically significant (p = 0.06), except for mothers of children with isolated cleft lip (p = 0.04). Blocking of folate binding to FR was similar among cases and controls (p = 0.54). The results did not change when stratifying into the cleft subgroups, nor when only isolated oral cleft cases were considered. In conclusion, high maternal autoantibody levels and blocking of folate binding to FRalpha in maternal serum during pregnancy are not associated with an increased risk of oral clefts in the offspring in this population-based cohort.
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Affiliation(s)
- Camilla Bille
- Division of epidemiology, University of Southern Denmark, Odense C, Denmark.
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Grosen D, Chevrier C, Skytthe A, Bille C, Mølsted K, Sivertsen A, Murray JC, Christensen K. A cohort study of recurrence patterns among more than 54,000 relatives of oral cleft cases in Denmark: support for the multifactorial threshold model of inheritance. J Med Genet 2009; 47:162-8. [PMID: 19752161 DOI: 10.1136/jmg.2009.069385] [Citation(s) in RCA: 148] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVES To determine if the anatomical severity of oral clefting affects familial recurrence in a large population based sample. To provide reliable recurrence risk estimates for oral cleft for first, second, and third degree relatives. DESIGN Population based cohort study. SETTING Denmark. PARTICIPANTS 6776 individuals affected with an oral cleft born from 1952 to 2005 and 54 229 relatives. MAIN OUTCOME MEASURES Recurrence risk estimates for oral cleft for first, second, and third degree relatives and stratification by severity, specificity, parent of origin effect, and family size for first degree relatives. RESULTS For cleft lip and palate probands we observed recurrence risks for first, second, and third degree relatives of respectively 3.5% (95% CI 3.1% to 4.0%), 0.8% (95% CI 0.6% to 1.0%), and 0.6% (95% CI 0.4% to 0.8%). Individuals affected by the most severe oral cleft had a significantly higher recurrence risk among both offspring and siblings, eg, the recurrence risk for siblings of a proband with isolated bilateral cleft lip with cleft palate was 4.6% (95% CI 3.2 to 6.1) versus 2.5% (95% CI 1.8 to 3.2) for a proband born with a unilateral defect. CONCLUSIONS Anatomical severity does have an effect on recurrence in first degree relatives and the type of cleft is predictive of the recurrence type. Highly reliable estimates of recurrence have been provided for first cousins in addition to more accurate estimates for first and second degree relatives. These results and the majority of prior data continue to support a multifactorial threshold model of inheritance.
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Affiliation(s)
- Dorthe Grosen
- Research Centre for the prevention of Infant Mortality and Congenital Illnesses, Institute of Public Health, University of Southern Denmark, JB Winsløws Vej 9, DK-5000 Odense, Denmark.
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Jugessur A, Shi M, Gjessing HK, Lie RT, Wilcox AJ, Weinberg CR, Christensen K, Boyles AL, Daack-Hirsch S, Trung TN, Bille C, Lidral AC, Murray JC. Genetic determinants of facial clefting: analysis of 357 candidate genes using two national cleft studies from Scandinavia. PLoS One 2009; 4:e5385. [PMID: 19401770 PMCID: PMC2671138 DOI: 10.1371/journal.pone.0005385] [Citation(s) in RCA: 85] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2009] [Accepted: 03/20/2009] [Indexed: 11/28/2022] Open
Abstract
Background Facial clefts are common birth defects with a strong genetic component. To identify fetal genetic risk factors for clefting, 1536 SNPs in 357 candidate genes were genotyped in two population-based samples from Scandinavia (Norway: 562 case-parent and 592 control-parent triads; Denmark: 235 case-parent triads). Methodology/Principal Findings We used two complementary statistical methods, TRIMM and HAPLIN, to look for associations across these two national samples. TRIMM tests for association in each gene by using multi-SNP genotypes from case-parent triads directly without the need to infer haplotypes. HAPLIN on the other hand estimates the full haplotype distribution over a set of SNPs and estimates relative risks associated with each haplotype. For isolated cleft lip with or without cleft palate (I-CL/P), TRIMM and HAPLIN both identified significant associations with IRF6 and ADH1C in both populations, but only HAPLIN found an association with FGF12. For isolated cleft palate (I-CP), TRIMM found associations with ALX3, MKX, and PDGFC in both populations, but only the association with PDGFC was identified by HAPLIN. In addition, HAPLIN identified an association with ETV5 that was not detected by TRIMM. Conclusion/Significance Strong associations with seven genes were replicated in the Scandinavian samples and our approach effectively replicated the strongest previously known association in clefting—with IRF6. Based on two national cleft cohorts of similar ancestry, two robust statistical methods and a large panel of SNPs in the most promising cleft candidate genes to date, this study identified a previously unknown association with clefting for ADH1C and provides additional candidates and analytic approaches to advance the field.
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Affiliation(s)
- Astanand Jugessur
- Craniofacial Development, Musculoskeletal Disorders, Murdoch Childrens Research Institute, Royal Children's Hospital, Parkville, Australia
| | - Min Shi
- Biostatistics Branch, National Institute of Environmental Health Sciences (NIEHS), Research Triangle Park, Durham, North Carolina, United States of America
| | - Håkon Kristian Gjessing
- Department of Epidemiology (EPAM), Norwegian Institute of Public Health, Oslo, Norway
- Section for Epidemiology and Medical Statistics, Department of Public Health and Primary Health Care, University of Bergen, Bergen, Norway
| | - Rolv Terje Lie
- Section for Epidemiology and Medical Statistics, Department of Public Health and Primary Health Care, University of Bergen, Bergen, Norway
- Medical Birth Registry of Norway, Norwegian Institute of Public Health, Bergen, Norway
| | - Allen James Wilcox
- Epidemiology Branch, National Institute of Environmental Health Sciences (NIEHS), Research Triangle Park, Durham, North Carolina, United States of America
| | - Clarice Ring Weinberg
- Biostatistics Branch, National Institute of Environmental Health Sciences (NIEHS), Research Triangle Park, Durham, North Carolina, United States of America
| | - Kaare Christensen
- Department of Epidemiology, University of Southern Denmark, Odense, Denmark
| | - Abee Lowman Boyles
- Epidemiology Branch, National Institute of Environmental Health Sciences (NIEHS), Research Triangle Park, Durham, North Carolina, United States of America
| | - Sandra Daack-Hirsch
- College of Nursing, University of Iowa, Iowa City, Iowa, United States of America
| | - Truc Nguyen Trung
- Medical Birth Registry of Norway, Norwegian Institute of Public Health, Bergen, Norway
| | - Camilla Bille
- Department of Epidemiology, University of Southern Denmark, Odense, Denmark
| | - Andrew Carl Lidral
- Departments of Pediatrics, Epidemiology and Biological Sciences, University of Iowa, Iowa City, Iowa, United States of America
| | - Jeffrey Clark Murray
- Department of Epidemiology, University of Southern Denmark, Odense, Denmark
- Departments of Pediatrics, Epidemiology and Biological Sciences, University of Iowa, Iowa City, Iowa, United States of America
- * E-mail:
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Zhu JL, Basso O, Obel C, Bille C, Olsen J. [Infertility and congenital malformations--secondary publication]. Ugeskr Laeger 2007; 169:918-20. [PMID: 17359737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
Studies indicate that children born by infertile couples have a higher frequency of congenital malformations. This may be a side effect of infertility treatment or may be caused by the underlying disease. We compared children of couples who received infertile treatment with children of infertile couples who conceived without treatment after more than 12 months of trying. We found no differences in the frequency of congenital malformations in the 2 groups, which may indicate that the underlying disease is more important than the treatment.
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Affiliation(s)
- Jin Liang Zhu
- Afdeling for Epidemiologi, Institut for Folkesundhed, Center for Epidemiologisk Grundforskning
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Abstract
Despite 15 years of evidence, preventable defects still occur
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Bille C, Olsen J, Vach W, Knudsen VK, Olsen SF, Rasmussen K, Murray JC, Andersen AMN, Christensen K. Oral clefts and life style factors — A case-cohort study based on prospective Danish data. Eur J Epidemiol 2007; 22:173-81. [PMID: 17295096 DOI: 10.1007/s10654-006-9099-5] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2006] [Accepted: 12/19/2006] [Indexed: 10/23/2022]
Abstract
This study examines the association between oral clefts and first trimester maternal lifestyle factors based on prospective data from the Danish National Birth Cohort. The cohort includes approximately 100,000 pregnancies. In total 192 mothers gave birth to child with an oral cleft during 1997-2003. Information on risk factors such as smoking, alcohol consumption, tea, coffee, cola, and food supplements was obtained during pregnancy for these and 828 randomly selected controls. We found that first trimester maternal smoking was associated with an increased risk of oral clefts (odds ratio (OR): 1.50; 95% confidence interval (CIs): 1.05, 2.14). Although not statistically significant, we also saw associations with first trimester consumption of alcohol (OR: 1.11; CIs: 0.79, 1.55), tea (OR: 1.31; CIs: 0.93, 1.86), and drinking more than 1 l of cola per week (OR: 1.40; CIs: 0.92, 2.12). Furthermore supplementation with > or =400 mcg folic acid daily during the entire first trimester (OR: 0.75; CIs: 0.46, 1.22) suggested an inverse associated with oral clefts, similar to our results on coffee drinking. No effects were found for smaller doses of folic acid, vitamin A, B6 or B12 in this study. The present study found an association between oral clefts and smoking and, although not conclusive, supports an association of oral cleft with alcohol.
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Affiliation(s)
- Camilla Bille
- Center for the Prevention of Congenital Malformations, Institute of Public Health, University of Southern Denmark, J.B. Winsløwsvej 9B, 5000 Odense C, Denmark.
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Abstract
OBJECTIVES To examine whether infertile couples (with a time to pregnancy of > 12 months), who conceive naturally or after treatment, give birth to children with an increased prevalence of congenital malformations. DESIGN Longitudinal study. SETTING Danish national birth cohort. PARTICIPANTS Three groups of liveborn children and their mothers: 50,897 singletons and 1366 twins born of fertile couples (time to pregnancy < or = 12 months), 5764 singletons and 100 twins born of infertile couples who conceived naturally (time to pregnancy > 12 months), and 4588 singletons and 1690 twins born after infertility treatment. MAIN OUTCOME MEASURES Prevalence of congenital malformations determined from hospital discharge diagnoses. RESULTS Compared with singletons born of fertile couples, singletons born of infertile couples who conceived naturally or after treatment had a higher prevalence of congenital malformations-hazard ratios 1.20 (95% confidence interval 1.07 to 1.35) and 1.39 (1.23 to 1.57). The overall prevalence of congenital malformations increased with increasing time to pregnancy. When the analysis was restricted to singletons born of infertile couples, babies born after treatment had an increased prevalence of genital organ malformations (hazard ratio 2.32, 1.24 to 4.35) compared with babies conceived naturally. No significant differences existed in the overall prevalence of congenital malformations among twins. CONCLUSIONS Hormonal treatment for infertility may be related to the occurrence of malformations of genital organs, but our results suggest that the reported increased prevalence of congenital malformations seen in singletons born after assisted reproductive technology is partly due to the underlying infertility or its determinants. The association between untreated infertility and congenital malformations warrants further examination.
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Affiliation(s)
- Jin Liang Zhu
- Danish Epidemiology Science Centre, Department of Epidemiology, Institute of Public Health, University of Aarhus, DK 8000 Aarhus C, Denmark.
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Abstract
OBJECTIVE We examined whether maternal smoking and use of nicotine substitutes during the first 12 weeks of pregnancy increased the prevalence of congenital malformations in general and of certain congenital malformations in particular. METHODS In the Danish National Birth Cohort (1997-2003) we identified 76,768 pregnancies (and their subsequent singleton births); 20,603 were exposed to tobacco smoking during the first 12 weeks of pregnancy. Birth outcomes were collected by linkage to the Central Population Register, the National Patients Register, and the National Birth Register. We identified congenital malformations from the Hospital Medical Birth Registry as they were recorded at birth or in the first year of follow-up. RESULTS Smoking mothers were younger, weighed less, consumed more alcohol, and had received less education. Children exposed to prenatal tobacco smoking had no increase in congenital malformations prevalence compared with the nonexposed children in both crude and adjusted analyses. Children born to nonsmokers, but who used nicotine substitutes, had a slightly increased relative congenital malformations prevalence ratio; relative prevalence rate ratio was 1.61 (95% confidence interval 1.01-2.58), which represents a 60% increased risk. When the analysis was restricted to musculoskeletal malformations, the relative prevalence rate ratio was 2.63 (95% confidence interval 1.53-4.52). CONCLUSION Our results showed no increase in congenital malformations related to prenatal tobacco smoking. However, we identified an increase of malformations risk in nonsmokers using nicotine substitutes. This finding needs to be replicated in other data sources. LEVEL OF EVIDENCE II-2.
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Affiliation(s)
- María M Morales-Suárez-Varela
- Unit of Public Health and Environmental Care, Department of Preventive Medicine, University of Valencia, Valencia, Spain.
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Abstract
OBJECTIVE The aim of this project was to assess whether any changes in the birth prevalence of cleft lip with/without cleft palate (CL[P]) occurred in Denmark during the period 1988 through 2001. In this period an official recommendation of a supplementation of folic acid to pregnant women was introduced; furthermore, smoking among pregnant women decreased considerably. DESIGN AND SETTINGS There are few places in which ecological studies of oral clefts are possible. Denmark provides a particularly good setting for this kind of study because of a high ascertainment and a centralized registration of subjects with cleft over the last 65 years. PARTICIPANTS Cleft occurrence in Denmark from 1936 to 1987 has previously been reported. Here we extend the study to include all live-born children with oral clefts born in Denmark in 1988 through 2001. Among a total of 992,727 live births, 1332 children with CL(P) were born during this period. RESULTS AND CONCLUSIONS The birth prevalence of CL(P) in Denmark has previously been found to be constant in the period 1962 through 1987, with a frequency of 1.4 to 1.5 per 1000 live births. This study showed a similar occurrence in 1988 through 2001 (birth prevalence = 1.44 per 1000 live births, 95% confidence interval = 1.37 to 1.52). The introduction of folic acid and the decrease in smoking prevalence among pregnant women do not seem to have reduced the birth prevalence. This may be due to noncompliance with the folic acid recommendation and/or only a weak causal association between folic acid and smoking and occurrence of CL(P).
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Affiliation(s)
- Camilla Bille
- Institute of Public Health, University of Southern Denmark, Odense, Denmark.
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Abstract
BACKGROUND Some malformations are clearly associated with older maternal age, but the effect of older age of the father is less certain. The aim of this study is to determine the degree to which maternal age and paternal age independently influence the risk of having a child with oral clefts. METHODS Among the 1,489,014 live births in Denmark during 1973-1996, there were 1920 children with nonsyndromic cleft lip with or without cleft palate and 956 children with nonsyndromic cleft palate. We used logistic regression to assess the impact of parental age on the occurrence of cleft lip with or without cleft palate and cleft palate. Interaction between mother's and father's age was included in the analysis. RESULTS Separate analyses of mother's and father's age showed that older age was associated with increased risk of both cleft lip with or without cleft palate and cleft palate only. In a joint analysis, both maternal and paternal ages were associated with the risk of cleft lip with or without cleft palate, but the contribution of each was dependent on the age of the other parent. In the analysis of cleft palate only, the effect of maternal age disappeared, leaving only paternal age as a risk factor. CONCLUSION Both high maternal age and high paternal age were associated with cleft lip with or without cleft palate. Higher paternal age but not maternal age increased the risk of cleft palate only.
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Affiliation(s)
- Camilla Bille
- Epidemiology, Institute of Public Health, University of Southern Denmark, J.B. Winsløwsvej 9, DK-5000 Odense C, Denmark.
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Bille C, Winther JF, Bautz A, Murray JC, Olsen J, Christensen K. Cancer risk in persons with oral cleft--a population-based study of 8,093 cases. Am J Epidemiol 2005; 161:1047-55. [PMID: 15901625 PMCID: PMC2839121 DOI: 10.1093/aje/kwi132] [Citation(s) in RCA: 88] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
The authors conducted a nationwide study of the occurrence of cancer among 8,093 Danish oral cleft cases born in 1936 through 1998 and followed in the Danish Cancer Registry from 1968 through 1998, a total of 175,863 person-years, to assess a possible association between cancer and oral clefts. Observed and expected numbers of cancers among oral cleft cases were summarized as the overall and as 52 site-specific standardized incidence ratios. The expected overall number of all cancers was 131, but 140 incident cancers were found, corresponding to a standardized incidence ratio of 1.07 (95% confidence interval (CI): 0.90, 1.26). Analyses of the 52 sites for all oral cleft cases and analyses stratified for three cleft subgroups and the two sexes revealed only a few significant associations: an increased occurrence of breast cancer among females born with cleft lip and/or cleft palate (standardized incidence ratio (SIR) = 1.52, 95% CI: 1.05, 2.14), primary brain cancer among females born with cleft palate (SIR = 3.11, 95% CI: 1.14, 6.78), and primary lung cancer among males born with both cleft lip and cleft palate (SIR = 2.49, 95% CI: 1.00, 5.14). The results do not provide evidence for an increased overall cancer risk for individuals born with oral clefts.
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Affiliation(s)
- Camilla Bille
- Center for the Prevention of Congenital Malformations, Institute of Public Health, University of Southern Denmark, Odense, Denmark.
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Laursen M, Bille C, Olesen AW, Hjelmborg J, Skytthe A, Christensen K. Genetic influence on prolonged gestation: a population-based Danish twin study. Am J Obstet Gynecol 2004; 190:489-94. [PMID: 14981395 DOI: 10.1016/j.ajog.2003.08.036] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
OBJECTIVE The purpose of this study was to test a possible genetic component to prolonged gestation. STUDY DESIGN The gestational duration of single, first pregnancies by both female and male twins was obtained by linking the Danish Twin Registry, The Danish Civil Registration System, and the Danish Medical Birth Register. A total of 2588 same-sex twin pairs of whom both cotwins became parents during 1978 to 1996 were identified. RESULTS The concordance rate for female twin pairs for a gestation of > or =41 weeks and > or =42 weeks was higher for monozygotic twin pairs than for dizygotic twin pairs, which indicates genetic effects. Biometric modeling suggested that genetic factors account for 23% to 30% of the liability to prolonged gestation. The difference in concordance rate between monozygotic and dizygotic male twin pairs was small, and the best fitting model indicated no genetic factors. CONCLUSION Maternal genes influence prolonged gestation. However, a substantial paternal genetic influence through the fetus was not found.
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Affiliation(s)
- Maja Laursen
- Department of Epidemiology, Danish Twin Registry, Institute of Public Health, University of Southern Denmark, Odense, Denmark
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