A modified Nottingham prognostic index for breast cancer patients diagnosed in Denmark 1978-1994.

Stage of disease at diagnosis is a predictor of breast cancer survival. We used data from the Danish Cancer Register and the Danish Breast Cancer Cooperative Group to study stage distribution in 0-69-year-old Danish breast cancer patients diagnosed in 1978-1994. We constructed a modified Nottingham Prognostic Index (NPI) calculated from the number of excised and positive lymph nodes, malignancy grade and tumour diameter. This NPI could be calculated for 63% of the patients, and among these the stage distribution improved during the study period. The proportion of patients with a poor prognostic score decreased from 27% to 20%. Based on a comparison of the crude 3-year survival of patients with an NPI score and those without, it seems probable that the stage of disease at diagnosis on average improved in Danish breast cancer patients below age 70 during the 1980s and the early 1990s.

Progress of emphysema in severe alpha 1-antitrypsin deficiency as assessed by annual CT.

PURPOSE: To assess serial CT as a measure of the progress of emphysema in patients with severe alpha 1-antitrypsin deficiency (phenotype PiZ). MATERIAL AND METHODS: In a randomized placebo-controlled study of alpha 1-antitrypsin augmentation therapy, 22 patients with moderate emphysema were followed for 2-4 years with an annual lung CT. The images were analysed by means of semiautomatic lung detection, and the degree of emphysema was quantitated by the density-mask and the percentile methods. The influence of lung volume was standardised by a regression model. RESULTS: A highly significant decline in Hounsfield units (HU) was found in low-density areas, corresponding to a mean (SE) annual loss of lung tissue of 2.1 (0.4) g/l lung volume. Analysis of a single slice at 5 cm below the level of the carina gave comparable results: 2.4 (0.4) g/l. CONCLUSION: Serial CT is a sensitive measure of the progress of emphysema in patients with severe alpha 1-antitrypsin deficiency.

[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.

Regional trends in breast cancer incidence and mortality in Denmark prior to mammographic screening.

To provide a basis for the evaluation of mammographic screening programmes in Denmark, a study was undertaken of the regional differences in breast cancer incidence and mortality. All 16 regions were followed for the 20 year period, 1970-89, before the start of the first population-based mammographic screening programme in the Copenhagen municipality in 1991. Multiplicative Poisson models were used for the analysis. In general, the incidence increased during this period from 55 to 70 [per 100,000 standardised world standard population (WSP)], and the analysis shows this to be most pronounced among women below age 60. The mortality was more stable, changing only from 24 to 28 (per 100,000 standardised WSP), but a significant increase occurred in the late 1980s. The study showed regional differences in both incidence and mortality of breast cancer in Denmark. Both the incidence and the mortality varied between the regions, with maximum differences of 22%. The analysis showed no variation in the time trends in the different regions, and thus indicates that the use of a regional comparison group would be a valid basis for evaluation of the Copenhagen programme. Our study, however, underlies the difficulties inherent in the evaluation of screening programmes without internal control groups.

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.

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.

Computed tomography and the TNM classification of lung cancer.

Computed tomography (CT) of the thorax and upper abdomen was prospectively evaluated in 84 patients with potentially operable lung cancer. Invasion into the thoracic wall and the mediastinal structures was not accurately demonstrated by CT. For metastatic mediastinal lymph nodes, the sensitivity and specificity of CT were, respectively, 86% and 61% and the positive and negative predictive indices 49% and 91%. For T1, T2 and T3 tumours the negative indices were 100%, 96% and 71%. Positive predictive index did not differ between squamous cell carcinoma and adenocarcinoma. Adrenal metastases were CT-suspected in 17 cases and liver metastases in eight, but were verified by ultrasonography in only one and four cases. CT should be used in preoperative investigation of lung cancer, irrespective of stage. Demonstration of thoracic-wall or mediastinal invasion need not exclude tumour resection. Preoperative mediastinoscopy is indicated if CT shows nodal metastases or if there are signs of tumour invasion, but not in CT-negative T1 or T2 tumour. Abdominal metastases indicated by CT should be investigated with CT-guided needle biopsy.

CT-scanning of the cochlea in Pendred's syndrome.

The inner ears of 5 adult patients with Pendred's syndrome were investigated using a Siemens SOMATOM DRG. Five normal hearing adults participated in the investigation as a control group. The CT-scanning comprised 10-15 consecutive scans of the cochlea. The CT evaluation was performed using both a special bone setting and a soft tissue setting. The cochlear content was quantitatively evaluated by drawing an irregular region of interest on the bone pictures. The region of interest was then transferred to the soft tissue pictures by means of the standard program of the CT-scanner. The resulting mean values of attenuation expressed in Hounsfield Units were significantly lower in the Pendred cochleas than in the normal cochleas. At the same time a typical Mondini malformed cochlea was demonstrated in all patients with Pendred's syndrome. The lower values of attenuation of the cochlea in Pendred's syndrome reflect the rudimentarily developed infra-cochlear osseous structures in this disease. We conclude that CT-scanning of the cochlea using this procedure is reliable enough to replace the conventional axial-pyramidal tomography when a Mondini cochlea is suspected.

[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.

[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.

Sterno-costo-clavicular hyperostosis. A case report with a review of the literature.

The clinical and radiologic findings in a case of sterno-costo-clavicular hyperostosis are reported and compared with the findings in the 23 Caucasian and about 300 Japanese cases reported in the literature. The main complaints are pain in the upper anterior chest wall and sometimes limited mobility of the shoulders. Radiologically, the clavicles, the sternum and the first ribs are grossly enlarged with complete fusion between them. As reported in previous cases, our patient had conspicuous congestion of the external jugular veins, but no other signs of compression in the thoracic inlet. There was asymptomatic compression of both subclavian veins, but none of the previously reported skin manifestations and no complaints from other parts of the locomotive system. The patient was HLA-B27 negative.

The effects of vaginal repair on anterior bladder suspension defects. A radiological and clinical evaluation.

In 22 patients with anterior bladder suspension defect as judged by colpocysto-urethrography (CCU) a vaginal repair was undertaken. In 14 patients urinary stress or urge and stress incontinence was the indication for operation, and in 8, genital prolapse. At follow-up more than 6 months postoperatively the CCU was repeated and a clinical evaluation undertaken. A normalization of the CCU was obtained in only 6 patients and 10 showed a less severe suspension defect. Nine of 14 patients were cured of incontinence. Only 3 of these had a normal follow-up CCU. Improvement of bladder suspension defect was not the sole responsible factor for postoperative continence. Urinary incontinence developed postoperatively in 2 of 8 patients operated on solely because of symptomatic genital prolapse. Very high cure rates for urinary incontinence have been reported following a colposuspension operation. A vaginal repair is not recommended as first-choice operation in incontinent females with anterior bladder suspension defects, if a CCU may be undertaken and the colposuspension technique is mastered.