Predictability of esophagus- and cardiatumor resectability by preoperative computed tomography.

Prior to operation, 32 patients with a tumor in the esophagus or in the cardia region were examined with computed tomography (CT), to evaluate the predictability of tumor resectability by CT. Twenty patients had the tumor operatively resected, in 2 patients the bulk of tumor could only be partly resected, and 10 patients were non-resectable due to invasion into the surrounding structures. The tumor resectability evaluated by preoperative CT resulted in positive/negative predictive values of 91 and 90%, respectively. This indicates that CT is a valuable method in planning the therapeutic strategy in cases of carcinoma of the oesophagus and the cardia region. The predictability of lymph-node involvement in the mediastinum and abdomen was less convincing.

Morphology and function of the bladder and urethra in female urinary incontinence.

The conventional investigations, gynaecological examination and cystoscopy give very little information about the causes of incontinence. History taking makes it possible to divide the symptoms into either stress- or urge incontinence. Cystometry, lateral voiding cysto-urethrography and urodynamic examination including sphincter EMG enable us to divide the pathological conditions into suspension defects and bladder dysfunctions. The suspension defects are bladder base insufficiency, vesical descensus and trigonocele. The operation of choice for these conditions depends on whether the suspension defect is anterior or posterior. The bladder dysfunctions are supranuclear and infranuclear neurogenic dysfunctions. The treatment in these cases will ordinarily be medical.

Equity and improvement in outcome of breast cancer in Denmark.

The trend in the prognosis for female breast cancer patients was investigated by comparing Kaplan-Meier survival curves of different patient cohorts diagnosed during the period 1948-87. The study is based on 71,448 patients from the Danish Cancer Registry. The cohorts were defined by age at diagnosis, year of diagnosis, and residential area. The survival time from diagnosis nearly doubled from 1948-57 to 1978-87, the most important improvement taking place after 1978. Patients diagnosed in 1948-77 in the Copenhagen area had a far better prognosis than patients diagnosed during this period in other parts of Denmark. For patients diagnosed in 1978-87 the prognosis, however, reached an equal level in all parts of the country. Thus, it is reasonable to assume that the national programme introduced in 1977 by the Danish Breast Cancer Cooperative Group (DBCG) has played an important role and not only brought about therapeutic improvements in breast cancer treatment in Denmark, but also ensured equity in the outcome on a national scale.

[Mammographic examinations in Denmark, 1990-1991]. / Mammografiundersøgelser i Danmark, 1990-1991.

Diagnostic mammographic activity was studied in five regions in Denmark in 1990-1991. During this period there was only one organized mammography screening programme which started in the Copenhagen municipality on 1 April 1991. It is estimated that 49,000 diagnostic mammographic examinations were made in Denmark per year in the period 1990-1991. Almost two-thirds of these mammograms were taken in women below 50 years of age. It is important to monitor the diagnostic mammographic activity to ensure that this does not gradually develop into a screening activity. This is in particular important for women below 50 years for whom screening is not recommended.

[Improved prognosis of breast cancer]. / Prognoseforbedring for brystkraeft.

The trend in the prognosis of female patients with breast cancer has been investigated by comparing Kaplan-Meier survival curves of different patient cohorts diagnosed during the period 1948-87. The study is based on 71,448 patients from the Danish Cancer Registry. The cohorts were defined by age at diagnosis, year of diagnosis and residential area. The survival time from diagnosis to death nearly doubled from 1948-57 to 1978-87 with the most important improvement taking place after 1978. Patients diagnosed in 1948-77 in the Copenhagen area had a far better prognosis than patients during this period in the rest of the country. For patients diagnosed in 1978-87 the prognosis, however, reached an equal level in all parts of the country. Thus, it is reasonable to assume that the national programme introduced in 1977 by the Danish Breast Cancer Cooperative Group (DBCG) has played an important role in these improvements.

Bladder base insufficiency.

The normal female bladder base is defined. It is shown that the trigone does not always form part of a flat base. In 25% of all female patients referred for cystourethrography a specific defect of the anterior part of the base is seen caused by an insufficient upwards and backwards suspension of the bladder neck. 92% of these patients are stress incontinent. Urodynamically they have low protracted flows, but the most characteristic feature is a very low intravesical pressure and particularly a very low opening pressure. The low pressure is due to the fact that the internal orifice does not close correctly because of insufficient support. The protracted and low flows are due to an increased tone in the posterior urethra needed for continence when the bladder neck has lost its passive continence function.

[Use of fibrin glue in connection with a free gingival transplant]. / Brug af fibrinklaeber i forbindelse med frit gingivalt transplantat.

The case in question is a 20-year-old woman who previously had an operation performed including extraction of the first premolars and back-moving of the front section of the maxilla. Half a year postoperatively a gingival retraction and sequestration of osseous tissue occurred. To shape a new zone of attached gingiva, a free mucosal transplant was removed with a Mucotome from the palate and placed on the prepared recipient area. Instead of using the traditional suturing technique the transplant was fixed with fibrinsealer (Tisseel). Within a few minutes the transplant was firmly attached to the underlying tissue. The healing procedure did not show the common desquamation of the epithelium, probably because of a quick establishment of a sufficient nutrition. After 1 month a firm zone of keratinized gingiva was established. There was no cosmetic indication to cover the denuded root surface.

[The use of fibrin sealer (glue) and porous hydroxyapatite in the treatment of periodontal bony defects]. / Brug af fibrinklaeber og implantat af porøst hydroksylapatit hos patient med marginal knogledefekt.

The case report describes a method for treatment of osseous periodontal defects utilizing implantation of porous hydroxylapatite (Interpore 200) with fibrinsealer (Tisseel). Instead of the traditional flap operation-incision the Papillae Preservation Technique is used to protect the implanted material and prevent migration. The hydroxylapatite granulae were embedded in fibrinsealer before filling into the bone defects, and the flaps were fixed to the underlying tissue with fibrinsealer. One of the flaps was furthermore secured by matras-suture. The clinical results after 1-year observation show healthy gingival conditions without inflammation, and no pockets being more than 3-4 mm. The radiograph shows a proper fill-up of the periodontal bone defects.

Bladder base insufficiency. Radiological, urodynamic, and clinical aspects.

Among 420 consecutive patients referred for voiding cystourethrography 26% presented the picture of bladder base insufficiency (b.b.i.). The examination was carried out as a colpo-cysto-urethrography. A urodynamic and gynecological examination was performed in each patient. The characteristic morphological features were: Anterior and inferior displacement of the bladder neck and a pointed bladder base. The position and form of the vagina was normal. Radiological signs of detrusor function were weak and opening of the bladder neck was characterized by funneling. Urodynamically the patients with b.b.i. showed low opening and low detrusor contraction pressures. The flows were highly varying. Very high flows were seen in a few patients but the more common pattern was slightly reduced maximum flow rates. Opening of the internal urethral orifice is known to be caused by detrusor contraction. Closing is passive, caused by elastic properties in the tissues. In b.b.i. intravesical pressures during micturition were low and radiological signs of detrusor contraction were weak, indicating that the bladder neck was easily opened. This, on the other hand, means that the bladder neck was insufficiently closed during bladder reservoir function, and may explain the main symptom, stress incontinence, which was present in 84% of the patients. The underlying pathology in anatomical support and suspension of the bladder base is discussed.