The Multidisciplinary Team Conference's Decision on M-Staging in Patients with Gastric- and Gastroesophageal Cancer is not Accurate without Staging Laparoscopy.

BACKGROUND: The implementation of the multidisciplinary team conference has been shown to improve treatment outcome for patients with gastric- and gastroesophageal cancer. Likewise, the staging laparoscopy has increased the detection of patients with disseminated disease, that is, patients who do not benefit from a surgical resection. The aim of this study was to compare the multidisciplinary team conference's decision in respect of M-staging with the findings of the following staging laparoscopy. METHODS: Patients considered operable and resectable within the multidisciplinary team conference in the period 2010-2012 were retrospectively reviewed. Patient data were retrieved by searching for specific diagnosis and operation codes in the in-house system. The inclusion criteria were as follows: biopsy-verified cancer of the esophagus, gastroesophageal junction or stomach, and no suspicion of peritoneal carcinomatosis or liver metastases on multidisciplinary team conference before staging laparoscopy. Furthermore, an evaluation with staging laparoscopy was required. RESULTS: In total, 222 patients met the inclusion criteria. Most cancers were located in the gastroesophageal junction, n = 171 (77.0%), and most common with adenocarcinoma histology, n = 196 (88.3%). The staging laparoscopy was M1-positive for peritoneal carcinomatosis in eight patients (16.7%) with gastric cancer versus nine patients (5.3%) with gastroesophageal junction cancer. Furthermore, liver metastases were evident in zero patients (0.0%) and four patients (2.3%) with gastric- and gastroesophageal junction cancer, respectively. The staging laparoscopy findings regarding peritoneal carcinomatosis were significantly different between gastric- and gastroesophageal junction cancers, p = 0.01. No significant differences were found regarding T-/N-stage or histological tumor characteristics between the positive- and negative-staging laparoscopy group. CONCLUSION: The M-staging of the multidisciplinary team conference without staging laparoscopy lacks accuracy concerning peritoneal carcinomatosis. Staging laparoscopy remains an essential part of the preoperative detection of disseminated disease in patients with gastric- and gastroesophageal cancer.

Intra-articular sodium hyaluronate 2 mL versus physiological saline 20 mL versus physiological saline 2 mL for painful knee osteoarthritis: a randomized clinical trial.

OBJECTIVE: Methodological constraints weaken previous evidence on intra-articular viscosupplementation and physiological saline distention for osteoarthritis. We conducted a randomized, patient- and observer-blind trial to evaluate these interventions in patients with painful knee osteoarthritis. METHODS: We centrally randomized 251 patients with knee osteoarthritis to four weekly intra-articular injections of sodium hyaluronate 2 mL (Hyalgan 10.3 mg/mL) versus physiological saline 20 mL (distention) versus physiological saline 2 mL (placebo) and followed patients for 26 weeks. Inclusion criteria were age over 59 years and daily knee pain more than 20 mm on a 100-mm visual analogue scale (VAS) without satisfactory response to analgesics. During the trial, rescue analgesic were allowed. The primary outcome was pain on movement. The secondary outcomes were pain at rest, pain during the night, Knee Injury and Osteoarthritis Outcome Score (KOOS), Osteoarthritis Research Society International (OARSI) criteria, and global assessment of the patient's condition. RESULTS: The mean age of the patients was 69.4 years; 55% were women. The effects of hyaluronate 2 mL, physiological saline 20 mL, and physiological saline 2 mL did not differ significantly in reducing knee pain, knee function, or consumption of analgesics. Using OARSI criteria, no significant differences were found. The VAS and KOOS outcomes all improved significantly over time (p<0.0005), regardless of intervention group. No adverse events were reported. CONCLUSIONS: Intra-articular hyaluronate or distention with physiological saline did not significantly reduce pain compared with physiological saline placebo in patients with osteoarthritis of the knee.

Treatment of knee osteoarthritis with pulsed electromagnetic fields: a randomized, double-blind, placebo-controlled study.

OBJECTIVE: The investigation aimed at determining the effectiveness of pulsed electromagnetic fields (PEMF) in the treatment of osteoarthritis (OA) of the knee by conducting a randomized, double-blind, placebo-controlled clinical trial. DESIGN: The trial consisted of 2h daily treatment 5 days per week for 6 weeks in 83 patients with knee OA. Patient evaluations were done at baseline and after 2 and 6 weeks of treatment. A follow-up evaluation was done 6 weeks after treatment. Activities of daily living (ADL), pain and stiffness were evaluated using the Western Ontario and McMaster Universities (WOMAC) questionnaire. RESULTS: Within group analysis revealed a significant improvement in ADL, stiffness and pain in the PEMF-treated group at all evaluations. In the control group there was no effect on ADL after 2 weeks and a weak significance was seen after 6 and 12 weeks. Significant effects were seen on pain at all evaluations and on stiffness after 6 and 12 weeks. Between group analysis did not reveal significant improvements over time. Analysis of ADL score for the PEMF-treated group revealed a significant correlation between less improvement and increasing age. Analysis of patients <65 years using between group analysis revealed a significant improvement for stiffness on treated knee after 2 weeks, but this effect was not observed for ADL and pain. CONCLUSIONS: Applying between group analysis we were unable to demonstrate a beneficial symptomatic effect of PEMF in the treatment of knee OA in all patients. However, in patients <65 years of age there is significant and beneficial effect of treatment related to stiffness.

Computed tomography scanning and recurrence after laparoscopic ventral hernia repair.

Laparoscopic ventral hernia repair is an advancing surgical method. It seems to have fewer recurrences than open surgery. However, with patients suspected of recurrence after laparoscopic hernia repair, it can be very difficult to determine whether or not there is recurrence by clinical examination alone. The purpose of this article is to show that computed tomography is a valuable diagnostic tool in excluding recurrence after laparoscopic ventral hernia repair. A total of 35 patients were included in a prospective study. They underwent laparoscopic ventral hernia repair, and all patients suspected of recurrence were computed tomography scanned. Four patients were suspected of recurrence. They all presented symptoms of swelling or pain or both. The computed tomography scanning did not show the presence of recurrence in any of the 4 cases. Computed tomography scanning can provide exact information about the content of swelling and whether there is recurrence or not. We conclude that computed tomography scanning is suitable as a valid imaging method in doubtful cases considering ventral hernia recurrence after laparoscopic ventral hernia repair.

[Staging of rectal cancer by means of MRI. Experiences with the first twenty-five patients]. / Stadieinddeling af rectumcancer ved hjaelp af MR-scanning. Erfaring med de første 25 patienter.

INTRODUCTION: The Danish Surgical Society recommends preoperative radiation for patients with T4 tumours of the rectum. However, the clinical examination with regard to fixation, especially for tumours in the upper part of the rectum, is encumbered by much uncertainty. MR imaging is a new modality in the staging procedure of the patient with rectal cancer. Our experience with the first 25 patients is presented. METHODS: After clinical examination, an MRI of the rectum was done and in the case of a T4 tumour preoperative radiotherapy was established. Preoperative MRI staging was correlated with the histopathology of the resection specimen. RESULTS: In cases of tumours in the lower third of the rectum, we found total agreement between the clinical examination and the MRI findings. In the middle third it was impossible to assess clinical fixation in two out of seven patients and in the upper third it was impossible in eight out of ten. With respect to possible involvement of lymph nodes, the MRI revealed a true positive diagnostic frequency of 0.78, a true negative diagnostic frequency of 0.92, a true positive nosographic frequency of 0.88 and a true negative nosographic frequency of 0.85. The corresponding values for tumour invasion were 0.94, 0.75, 0.94 and 0.75. DISCUSSION: Our results seem to indicate that preoperative MRI--especially in patients with tumours in the upper two-thirds of the rectum--is suitable for predicting fixation. MRI also seems to be suitable in the complete staging of the patient with a tumour of the rectum.

MRI of autosomal dominant pure spastic paraplegia.

We examined 16 patients with autosomal dominant pure spastic paraplegia (HSP) and 15 normal controls matched for age and sex using MRI of the brain and spinal cord. Images were assessed qualitatively by two independent radiologists, blinded to the clinical diagnosis. Areas of the brain and corpus callosum on one midsagittal slice and the area of the brain on one axial slice were measured and a "corpus-callosum index" expressing the size of the corpus callosum relative to that of the brain was calculated. Cross-sectional areas and anteroposterior and transverse diameters of the spinal cord at the levels of C 2, C 5, T 3, T 6, T 9 and T 11 were measured. No significant differences between patients and controls were found on qualitative evaluation of the images. The patients had a significantly smaller corpus callosum and "corpus-callosum index" than controls. This finding, not reported previously, might indicate that the disease process in pure HSP is not confined to the spinal cord. The anteroposterior diameters of the spinal cord at T 3 and T 9 were significantly smaller in patients than in controls. This might correspond to the degeneration of the pyramidal tracts and the dorsal columns described at neuropathological examination.

Gliomatosis cerebri--an appropriate diagnosis? Case reports.

PURPOSE: To evaluate the premises for the diagnosis gliomatosis cerebri in relation to diffuse astrocytomas. MATERIAL AND METHODS: CT, MR images and pathological analyses were used to assess the cases of 4 patients with diffusely infiltrating astrocytic tumours that radiologically, clinically and pathologically resembled gliomatosis cerebri. RESULTS AND CONCLUSION: Some astrocytomas have an immense potential for diffuse infiltration and they would seem to be more frequent than recognized hitherto. The definition of gliomatosis cerebri as a separate entity is questionable, and a diagnosis of diffusely infiltrating astrocytoma is recommended in such cases.

Modified midfacial degloving. A practical approach to extensive bilateral benign tumours of the nasal cavity and paranasal sinuses.

Midfacial degloving is a well-known technique for entering the nasal and paranasal cavities, the rhinopharynx and the base of the skull. We report our experience with a modification of midfacial degloving, applied to two patients with extensive bilateral benign tumours in the nasal cavities and the paranasal sinuses. No rhinoplastic procedure is necessary in this modification, and the access to the upper part of the nasal cavity is improved.

[Back pain in abdominal aortic aneurysm]. / Rygsmerter ved abdominalt aortaaneurisme.

Back pain is a typical symptom of abdominal aortic aneurysm. Symptoms of root compression may also be present if the aneurysm has caused changes to the vertebral column. A typical case is presented. The condition is life-threatening and requires vascular reconstruction.