Characteristics of Hodgkin's lymphoma after infectious mononucleosis.

BACKGROUND: Infectious mononucleosis-related Epstein-Barr virus (EBV) infection has been associated with an increased risk of Hodgkin's lymphoma in young adults. Whether the association is causal remains unclear. METHODS: We compared the incidence rates of Hodgkin's lymphoma in two population-based Danish cohorts of patients who were tested for infectious mononucleosis: 17,045 with serologic evidence of having had acute EBV infection, and 24,614 with no such evidence. We combined the cohort of patients who had serologically verified infectious mononucleosis with a cohort of 21,510 Swedish patients with infectious mononucleosis (combined total, 38,555). Biopsy specimens of Hodgkin's lymphomas occurring during follow-up in this combined cohort were tested serologically for the presence of EBV. Using this information, we modeled the relative risk of EBV-negative and EBV-positive Hodgkin's lymphoma in different periods after the diagnosis of infectious mononucleosis and estimated the median incubation time for mononucleosis-related EBV-positive Hodgkin's lymphoma. RESULTS: Only serologically confirmed infectious mononucleosis was associated with a persistently increased risk of Hodgkin's lymphoma. Sixteen of 29 tumors (55 percent), obtained from patients with infectious mononucleosis, had evidence of EBV. There was no evidence of an increased risk of EBV-negative Hodgkin's lymphoma after infectious mononucleosis. In contrast, the risk of EBV-positive Hodgkin's lymphoma was significantly increased (relative risk, 4.0; 95 percent confidence interval, 3.4 to 4.5). The estimated median incubation time from mononucleosis to EBV-positive Hodgkin's lymphoma was 4.1 years (95 percent confidence interval, 1.8 to 8.3). CONCLUSIONS: A causal association between infectious mononucleosis-related EBV infection and the EBV-positive subgroup of Hodgkin's lymphomas is likely in young adults.

[Physicians and nurses subjected to disciplinary actions because of substance abuse. Ten years of experience with supervision in Copenhagen]. / Laeger og sygeplejersker under tilsyn. Ti års erfaringer med embedslaegernes tilsyn i Storkøbenhavn.

INTRODUCTION: Medical Health Officers supervise medical staff on behalf of the Danish National Board of Health. The Board can impose disciplinary action on registered providers of health care. MATERIAL AND METHODS: This retrospective investigation was based on case reports from 1 January 1989 to 31 December 1995 on medical staff under individual supervision because of alcohol or drug abuse, with a 3-year follow-up to 31 December 1998 in Greater Copenhagen (about 1.25 million inhabitants). RESULTS: Altogether 173 health personnel were identified. Of these, 47 physicians and 91 nurses had disciplinary actions imposed on them because of abuse. In well over a third the abuse had lasted less than two years, whereas in a third it had lasted more than five years before admission to individual supervision. Half of both physicians and nurses had undergone psychiatric treatment before that time. Frequent disciplinary actions imposed were examination of urine passed without prior warning and controlled treatment of alcohol abuse. Difficulties in adhering to these conditions were found in one third to half of the cases. The Medical Health Officers notified the National Board of Health of breaches in 64%, often several times for each person. At the end of the follow-up period, 49% were still working. There was a statistically significant excess mortality in the group. Of the 26 dead, four had committed suicide and in a further 12 cases poisoning or abuse was a contributory cause of death. DISCUSSION: Earlier detection, a tightening of sanctions, and improved treatment are recommended.

[Acceptance of mammographic screening by immigrant women]. / Indvandrerkvinders brug af mammografiscreening.

BACKGROUND: The aim was to investigate compliance by ethnic groups to the mammography screening programme in the City of Copenhagen over six years and to look at developments over time. MATERIAL AND METHODS: Mammography screening has, since 1 April 1991, been offered free of charge to all women between 50 and 69 years of age in the City of Copenhagen. Data on women born in Poland, Turkey, Yugoslavia, and Pakistan divided into five-year groups were compared to that of women born in Denmark and all other foreign-born women. Data from 1991 to 1997 were grouped according to the mammography performed, the offer refused, or non-appearance. RESULTS: Whereas 71% of Danish-born women accepted mammography, compliance by foreign-born women was significantly lower. The offer was accepted by 36% of Pakistanis, 45% of Yugoslavians, 53% of Turks, and 64% of Poles. Compliance fell in all ethnic groups with advancing age. Of the Danish women, 16% failed to keep the appointment. The corresponding percentages were 52 for Pakistanis, 48 for Yugoslavians, 41 for Turks, and 23 for Poles. The proportion of women who actively refused the offer was similar in all groups. The number of invited women fell during the period. CONCLUSIONS: The lower participation of women from the countries under study might have various explanations: among them the language barrier, procedure-related factors, and a lower incidence of breast cancer in the countries of origin.

[An international medical expert committee's participation in uncovering the truth on the liquidation of Polish officers found in mass graves at Katyn in the spring of 1943 and the biography of a Danish participant, Helge Tramsen (1910-1979)]. / En international laegekommissions medvirken til at afdaekke sandheden om likvideringen af polske officerer fundet i massegrave ved Katyn i foråret 1943; en dansk deltager, Helge Tramsen (1910-1979), og hans biografi.

The article is based on a paper read as a invited speaker at a conference, entitled "Medical experts and expertise in cases of humanitarian crises "convened by the University of Geneva and the Committee of the International Red Cross in April 2007. The article starts with an overview of Polish history from the end of World War I up to the disclosure of the mass graves in the spring of 1943, but is otherwise a translation of the original English lecture with some additions from new findings.in archives. Helge tramsen was born into a bourgois family in Copenhagen. After graduation in medicine from the University of Copenhegen in 1936 he married a British woman and joined the naval medical corps and also embarked on a surgical career.. From 1940 to 1943 he was prosector at the Institute of Forensic Medicine at the University of Copenhagen. After the finding of the mass graves at Katyn, Germany requested from a number of European countries under German control forensic experts to join an international commission to investigate the findings. As the professor of forensic medicine declined perobably due to health reasons Tramsen was sent. During the German occupation of Denmark 1940 to 1945 Tramsen according to family tradition participated in the resistance movement and he consulted with members of the more conservative part of it and was recommended to go to Germany with an added purpose of being able to transport material out of Germany. He went with special plane from Copenhagen to Berlin, where he joined the international group, which later flew to Smolensk via Warszawa. He conducted a post mortem on the body of a Polish officer, selected by himself. Following that he attended in the discussion on the final report, which later in Berlin was handed over to the German minister of health, and which later formed an important part of the official German material accusing the USSR for the killing. During his stay in Berlin he claimed to have collected material, which in his opinion was drawings of the Eder Möwe dams and brought it back to Copenhagen with the severed head of the body of the Polish officer, on which he has carried out the post mortem. After Tramsen's return to Denmark, a British agent obtained his travel report and sent it to London and he later obtained additional information from Tramsen on the unanimous and voluntary conclusion of the experts. No information on the drawings and the head can be found in British archives. According to Tramsen's own account as a naval officer on activities during the occupation, he participated in sabotage actions, but that can not be substantiated by other sources. However, he participated in July 1944 in an attach on a fortress north of Copenhagen, held by the German Navy; the attach failed, and Transen went under ground, but later returned to his flat in Copenhagen, where he was taken prisoner by German security police. As prisoner he underwent torture and was subjected to mocked execution. He was transferred to a concentration camp, but probably due to the intervention by the permanent secretary of the Danish Foreign office, which after the Danish Government has stopped functioning in August 1943 kept the administration running and retained contacts with the German occupation authorities, Tramsen was not sent to a concentration camp in Germany, where survival rates were very low, but to one in Denmark. After the German defeat in May 1945 Tramsen continued his career in surgery, but went into general practice in Copenhagen in 1947, when he also obtained a permanent position in the naval medical service., where he remained until normal retirement in 1970, in the latter part as the highest ranking medical naval officer. He also served as medical chief at the Danish hospital ship Jutlandia serving as Danish contribution to the UN off the coast of Korea during the Korean war. He also attended as representative of the Danish Ministry of Defence the conference on the revision of the Geneva Conventions. No doubt Tramsen feared Soviet retaliation, but on the other hand he also showed courage by giving evidence at the US congressional hearings in 1952, where he confirmed that there had been no German pressure on the participants, and their conclusions had been voluntary and unanimous. He also gave an interview on Radio Free Europe transmitted to Poland in 1962. in which he desribed his experiences in Katyn. In 1971 his eldest daughter died in Warsaw, offially by carbon-monoxid poisoning from a gas heater. In theory it could be an accident, homicide or suicide. He felt it could be a revenge and in his grief he felt responsible and had a nervous break down. He died from a somatic illness in 1979 and during his terminal illness he told about his experiences from the war to a nephew.

[Building confidence in biological products]. / Skabelse af tillid til biologiske produkter; Thorvald Madsen og international sundhed mellem de to verdenskrige.

During the last decades of the 19th century, discoveries in microbiology paved the way for health programmes as an integral part of social modernisation. Public opinion about the consequences for governmental involvement differed, but in Denmark the state's openness to modern medicine encouraged the establishment of Statens Serum Institut (SSI) in 1902, initially for the production of anti-diphtheritic serum. Under its director, Thorvald Madsen (1870-1957), the SSI soon acquired a reputation for the high quality of its products and its cutting edge research. After qualifying in medicine in 1893, Madsen worked both at the Pasteur Institute and with Paul Ehrlich in Frankfurt. During World War I, he served with the Red Cross, caring for German, Austrian and Russian prisoners of war. He had an extensive and expanding network of international contacts, and he was eminently qualified to assume the elected office of President of the League of Nations' Health Committee. The Committee served as the 'parliamentary body' of the League of Nations Health Organisation (LNHO), and Madsen's hand can be seen in much of the work undertaken by the LNHO. The drive to achieve uniform standards for biological products related directly to his own as well as the SSI's interests and expertise. Undoubtedly, standardization of biological products had an immense importance for their distribution, scientifically, commercially and therapeutically. Madsen was president of the LNHO's Commission on Biological Standardisation from 1924, and during the interwar years, the SSI was heavily involved in establishing standards for biological products such as tuberculin and tetanus antitoxin. Madsen's interests extended to application of prevention technologies, and he utilised the opportunities in Denmark to further their use, notably in the case of tuberculosis. The introduction of the BCG vaccine promised a solution to the TB problem, but the Lübeck disaster generated a widespread reaction against the vaccine. Sponsorship from the Rockefeller Foundation led to close investigation of TB incidence in Denmark, and eventually to the offer of vaccination of tuberculin-negative Danes. The programme provided a foundation for later UNICEF and WHO eradication policies. The paper throws light on how local cultures and experience, and personal dedication, shaped the policies developed by the interwar international movement.

The AIDS epidemic in the city of Copenhagen, Denmark: potential years of life lost and impact on life expectancy.

AIMS: This study seeks to describe the impact of AIDS on the city of Copenhagen by estimating potential years of life lost (PYLL) before the age of 65 years and to estimate the impact of AIDS deaths on life expectancy for males and females. METHODS: All AIDS cases reported to the national AIDS surveillance register for residents in the city of Copenhagen in the period 1983-98 were included. For comparative purposes data were obtained on six other causes of death: accidents, suicide, lung cancer, ischaemic heart disease, testicular cancer, and breast cancer. RESULTS: Overall, deaths from AIDS accounted for 8% of all PYLL in men and showed an increasing tendency from 1983 to 1991, when it became the leading cause of PYLL. AIDS had most impact in men in the age group 25-44 years and accounted for 29% of all PYLL in this group at the peak in 1993, decreasing significantly after the introduction of anti-retroviral treatments to 5% of PYLL in 1998. Other leading causes of PYLL, accidents and suicide, also showed a decreasing tendency over the years, but of a much smaller magnitude than AIDS. The impact of AIDS in women was more modest. In the entire study period suicide, accidents, and breast cancer were the leading causes of PYLL in women. It was shown that AIDS deaths at the top of the epidemic in 1991-95 were responsible for a loss of 0.76 years in life expectancy for men and 0.08 years for women. CONCLUSIONS: AIDS has had a considerable impact on potential years of life lost. A significant decline in AIDS deaths has been seen since 1995 with an effect on life expectancy for men in the city of Copenhagen.