Timing of surgery in relation to menstrual cycle does not predict the prognosis in primary breast cancer. Danish Breast Cancer Cooperative Group.

From 1977 to 1989 6488 patients under 50 years with primary breast cancer were registered in the nationwide Danish Breast Cancer Cooperative Group (DBCG). Among these, information on last menstrual period prior to surgery was available in 1635 cases which constitute the study group of the present analysis. The group was representative of all women operated upon during the period with regard to prognostic factors and survival. In the study group time of surgery in relation to last menstrual period was found to have no influence on 5 and 10 years survival.

[Testicular cancer presenting as acute scrotum]. / Testiscancer debuterende med akut scrotum.

Acute scrotum is a condition which often causes diagnostic difficulties despite all the available investigation methods. Ruling out or confirming torsion of the testis is the main problem in most cases. Other more rare conditions, however, need acute exploration such as illustrated in this case report, where the sudden bleeding in a testicular neoplasm caused severe acute symptoms. The tumor may not necessarily be clearly apparent during surgery. Peroperative analysis of a specimen of testis tissue is therefore recommended in such cases.

[Pancreatic fracture diagnosed by ultrasound]. / Pancreasfraktur diagnosticeret ved ultralyd.

A case of complete fracture of the pancreas diagnosed preoperatively by ultrasound is reported. The diagnosis was confirmed intraoperatively and a Roux-en-Y-pancreaticojejunostomy was performed. A prominent role of ultrasound in the acute evaluation of the abdomen following blunt trauma is recommended.

[Acute epididymitis in boys]. / Akut epididymitis hos drenge.

Acute scrotum in children frequently causes diagnostic difficulties. Instantaneous treatment is essential especially in cases of torsion of the testis. Acute epididymitis (AE) is relatively frequent also in prepubertal boys but is probably underdiagnosed. Two cases and a review of AE and the differential diagnoses towards other acute scrotal diseases are presented. It is stressed that immediate diagnosis and treatment is important, and that referral to hospital is mandatory.

[Laparoscopic cholecystectomy during pregnancy]. / Laparoskopisk kolecystektomi under graviditet.

Pregnancy has been considered an absolute contraindication to laparoscopic cholecystectomy, but recently several successful cases have been published. Two patients operated upon during the second trimester with an uneventful intra- and postoperative course and subsequent uncomplicated obstetric course are reported. The procedure requires special consideration with respect to incisions, insertion of cannula and ports, establishment and maintenance of pneumoperitoneum with a pressure of 10 mmHg, intraoperative monitoring of maternal end-tidal pCO2, perioperative foetal monitoring and choice of postoperative analgesics. The use of intraoperative cholangiography is controversial, but it should probably be avoided in pregnant patients. It is not known whether perioperative tocolytic therapy is necessary. Laparoscopic cholecystectomy is not contraindicated during pregnancy.

[Menstrual cycle and surgery of breast cancer. Point of time for the surgery of primary breast cancer in connection with menstrual cycle is without prognostic significance]. / Menstruationscyklus og operation for mammacancer. Tidspunktet for operation for primoer mammacancer i forhold til menstruationscyklus er uden prognostisk betydning.

From 1977 to 1989 6488 patients under fifty years with primary breast cancer were registered in the nationwide Danish Breast Cancer Cooperative Group (DBCG). Among these information on last menstrual period prior to surgery was available in 1635 cases which constitute the study group of the present analysis. The group was representative of the total group with regard to prognostic factors and survival. In the study group time of surgery in relation to last menstrual period was found to have no influence on five- and ten year survival.

Is 0.6T magnetic resonance mammography adequate in the detection of breast cancer?

PURPOSE: To evaluate whether relevant diagnostic information can be achieved when using magnetic resonance mammography (MRM) on mid-field as a supplement to conventional imaging and clinical examination in women with primary breast cancer. MATERIAL AND METHODS: 30 women (55 breasts containing 49 malignant tumors) planned for uni- or bilateral mastectomy were examined with dynamic MRM on mid-field, 0.6T. The women were examined with mammography (M) and ultrasonography (US) prior to MRM. The descriptions of the conventional examinations were evaluated retrospectively, whereas the MRM was evaluated prospectively, with knowledge of the M+US findings. Imaging findings suggesting malignancy were registered and correlated with pathology after mastectomy. A home-made rating system for evaluation of the detected lesions was tested. RESULTS: MRM detected seven additional malignant tumors, failed to detect three lesions and characterized four as gray-zone lesions according to the rating system. Sensitivity of finding the tumors with M+US was 79.0%, with a PPV for malignant tumors of 84.4%. One breast in which MRM found a malignant tumor had not initially been examined with US. Sensitivity with MRM was 91.6%, with a positive predictive value of malignant tumors of 97.7%. CONCLUSION: MRM on mid-field seems to improve the detection of cancers when used as a supplement to M+US in women with primary breast cancer. We believe that the results are fair compared to MRM on high-field, although further research and refinement are needed.

Impact of laparoscopic technique on the quality of cholecystectomy.

To compare the quality of cholecystectomy before and after the introduction of laparoscopic technique, a comparison was made between 463 consecutive patients undergoing open cholecystectomy (OC) during the 1985-1989 and 329 consecutive patients cholecystectomized during 1991-1993 after the introduction of laparoscopic cholecystectomy (LC) (i.e., open or laparoscopic cholecystectomies). The frequency of procedure-related complications was unchanged in the two periods [13 vs. 9% (NS)], but general complications were reduced from 17 to 9% (p < 0.001), mainly attributable to a reduced incidence of pulmonary complications. Mortality was 2.2 and 0.9%, respectively (NS). The frequency of bile duct injury was 0.2% in the first and 0.6% in the second period (NS). The frequency of reoperations was 2.8 and 1.8% (NS), and residual stones were later detected in 3.0 and 3.6%, respectively (NS). Hospital stay after elective surgery was reduced from 6 days in the first period to 4 days in the second (all cases) (p < 0.001). Thus the quality of cholecystectomy improved regarding general complications, while mortality and number of reoperations were unchanged. Further improvement is desirable to prevent general as well as procedure-related complications.

Videothoracoscopic lung biopsy by a stapling technique.

OBJECTIVES: To describe initial experience with a new technique for obtaining lung biopsy specimens using video-thoracoscopy and Multifire Endo GIA (U.S. Surgical Corporation) stapler. DESIGN: Retrospective study. SETTING: Central hospital, Denmark. SUBJECTS: Nine patients with suspected pulmonary fibrosis. MAIN OUTCOME MEASURES: Diagnosis, morbidity, and mortality. RESULTS: The endoscopic method provided a specimen of lung tissue large enough to secure a reliable diagnosis in all cases. CONCLUSION: The thoracoscopic technique implies less surgical trauma than thoracotomy resulting in less postoperative pain and a better cosmetic result. In patients suitable for general anaesthesia the endoscopic method for obtaining lung tissue specimen seems to be the ideal method.