[Esophageal lesions associated with diphosphonates]. / Oesophagusskader relatert til bisfosfonater.

BACKGROUND: Bisphosphonates are potent inhibitors of osteoclast-mediated bone resorption and effective in preventing osteoporotic fractures, but they can occasionally cause oesophageal adverse events. MATERIAL AND METHODS: We report on seven patients who developed severe oesophagitis or oesophageal ulceration during treatment with bisphosphonates. They were registered at our endoscopy unit during a 31-month period. RESULTS: Six of the patients took alendronate (Fosamax) and one etidronate (Didronate). The oesophageal lesions heal on discontinuation of the bisphosphonate. Institution of gastric acid suppression treatment may enhance the healing process. INTERPRETATION: In order to minimise the risk of serious side-effects, it is important to give detailed instructions regarding medication and to ensure that the instructions are properly understood. The risk of serious complications can be reduced by early recognition of oesophageal symptoms and appropriate intervention.

Prognostic significance of contrast enhancement and tumor demarcation at CT of squamous cell carcinomas of the oral cavity and oropharynx.

A retrospective analysis of the CT examinations of 45 patients with squamous cell carcinomas of the tongue, floor of the mouth and tongue base with long-term follow-up is presented. The aim of the study was to determine whether differences in tumor contrast enhancement and tumor demarcation at contrast-enhanced CT were correlated to prognosis in terms of posttreatment residual tumor or local recurrence. Ill-defined tumor margins were by means of multiple regression analysis significantly correlated to local failures (p = 0.043). This feature was, however, not associated with a significant decreased survival. The degree of tumor contrast enhancement did not parallel variations in the histopathologic composition of the tumors.

Squamous cell carcinoma of the respiratory tract following laryngeal papillomatosis.

With the object to disclose an association between laryngeal papillomatosis and laryngeal carcinoma, we reviewed 102 patients with laryngeal papillomatosis treated between 1950 and 1979. Seven cases of laryngeal carcinomas were recorded and 1 patient with spread of papilloma to the bronchial tree developed a bronchial carcinoma. The time between onset of papilloma and diagnosis of carcinoma was 4-55 years (mean 24 years). For laryngeal carcinoma the ratio of observed to expected cases was 88. Of the 8 patients developing respiratory tract carcinoma, 2 had received treatment with radiation and 2 had been treated with Bleomycin. Four of these 8 patients were known smokers. This study shows that papillomatosis is more often associated with laryngeal carcinoma than previously reported. It appears, however, that laryngeal papillomas alone seldom induce carcinomas. Apart from irradiation and smoking, Bleomycin could be an important co-factor.

[Aquarium-borne Mycobacterium marinum infection]. / Mycobacterium marinum-infeksjon med akvarium som smittekilde.

Three cases of cutaneous Mycobacterium marinum infection are described. All these patients had most probably been infected from home aquariums. In one of the patients, M. marinum was isolated by culturing a biopsy specimen from a lesion. Clinical remission was achieved by means of antituberculous triple therapy, trimethoprim-sulfonamide, and no treatment, respectively.

Surgical treatment as a principle in patients with advanced abdominal carcinoid tumors.

Seventy-five patients with advanced abdominal carcinoid tumors (65 midgut, 10 others) have been examined retrospectively to evaluate the role of surgical treatment as a principle, irrespective of stage of disease. Eighteen of 52 patients (35%) exhibited the carcinoid syndrome. Two or more primaries were found in 39% of patients with midgut lesion, 81% of these patients had regional metastases, 5% of these patients had distant lymph node metastases, and 74% of the patients had liver secondaries. All patients underwent operation, an additional 34% of the patients had a further reoperation, 9% of the patients had a second reoperation, 3% of the patients had a third reoperation, and one patient (2%) had a fourth reoperation. Intraoperative debulking (liver excluded) was performed in 33% of the patients, and 48% of the patients had treatment (resection, hepatic artery ligation, embolization) directed at the liver. The postoperative mortality rate was 2% after the primary operation for midgut lesions. The median survival for midgut tumors was 92 months, compared to 40 months for other lesions (not significant). A significantly higher survival rate was revealed for those patients with midgut lesion who were undergoing intraabdominal debulking procedures (liver excluded); median survival was 139 months versus 69 months without debulking. For those patients with liver metastases, median survival after intervention was 216 months and 48 months without such treatment (p less than 0.001). It is concluded that resection of intraabdominal carcinoid tumor masses can be performed in a high proportion of patients. Despite the retrospective, uncontrolled nature of this study, the difference in survival probabilities in favor of aggressive surgical therapy is so marked that it is not unreasonable to conclude that surgery has played a role in prolonging life in these patients.

Are patients with fractures of the femoral neck more osteoporotic?

Combined cancellous/cortical density and mass in the femur and lumbar spine were assessed 2 or 3 days after femoral neck fractures and compared to identical measurements in control subjects. Cancellous density was also assessed in the spine. Correction for age differences between patients and controls were made by means of regression analyses and by selecting groups without age differences. After compensation for the age differences, the patients were found to have significantly lower femoral bone mass and lumbar density than the controls. The femoral density and lumbar mass density were not significantly different in the two groups after age correction. The findings for the cancellous spinal density was equivocal. The study indicates that in the femur the total bone mineral content is lower in patients with femur neck fractures and that it is at least one of the etiological factors of these fractures. However, in the femur it is not the bone density that is the decisive factor, but the amount of calcified bone, or the bone mass.

[Occurrence of recurrence after regression of low-grade dysplasia in vaginal cytological smears]. / Forekomst av residiv etter regress av lavgradig dysplasi i vaginalcytologiske prøver.

329 females with regress of low-grade dysplasia were followed up by annual vaginal smears for a maximum of 14 years. 53 developed recurrence of dysplasia. The average annual risk of recurrence was greatest 2-4 years after regress, being 4.3%. The average annual risk of recurrence for those followed up for more than ten years was 0.5%. None of the females developed cervical cancer. It is concluded that annual controls may prevent females with regress of previous low-grade dysplasia from developing cancer. After ten years with no further dysplasia, the females are recommended to follow the general practice for persons without previous dysplasia or cancer.