The effect of an attachment-oriented couple intervention for breast cancer patients and partners in the early treatment phase: A randomised controlled trial.

OBJECTIVE: Patients and partners both cope individually and as a dyad with challenges related to a breast cancer diagnosis. The objective of this study was to evaluate the effect of a psychological attachment-oriented couple intervention for breast cancer patients and partners in the early treatment phase. METHODS: A randomised controlled trial including 198 recently diagnosed breast cancer patients and their partners. Couples were randomised to the Hand in Hand (HiH) intervention in addition to usual care or to usual care only. Self-report assessments were conducted for both patients and partners at baseline, postintervention (5 months), and follow-up (10 months), assessing cancer-related distress, symptoms of anxiety and depression, and dyadic adjustment. Patients' cancer-related distress was the primary outcome. RESULTS: Cancer-related distress decreased over time in both patients and partners, but the intervention did not significantly affect this decrease at postintervention (P = .08) or follow-up (P = .71). A significant positive effect was found on dyadic adjustment at follow-up for both patients (P = .04) and partners (P = .02). CONCLUSIONS: There was no significant effect of the HiH intervention cancer-related distress. The results suggest that most couples can cope with cancer-related distress in the context of usual care. However, the positive effect on dyadic adjustment implies that the HiH intervention benefitted both patients and partners. Future studies should investigate how to integrate a couple focus in usual cancer care to improve dyadic coping in the early treatment phase.

Two-step axillary operation increases risk of arm morbidity in breast cancer patients.

An investigation of the impact of axillary surgery on arm morbidity in patients who underwent sentinel lymph node biopsy (SLNB), axillary clearance in a one-step procedure, and axillary clearance in a two-step procedure, respectively, was performed. Over a period of 2 years 438 patients with invasive breast carcinoma or carcinoma in situ underwent SLNB at our clinic. Of these 393 were interviewed on symptoms of swelling, numbness, pain, reduced strength, reduced mobility and fatigue more than 1 year postoperatively. Using a standardised symptom score system postoperative morbidity was registered and differences between the patients were compared in a logistic regression analysis. Of the 393 patients who received the questionnaire 370 responded (94%). The mean follow-up was 23.5 months (range 12-37). SLNB resulted in significantly lower arm morbidity than axillary clearance. Doing stepwise logistic regression of the data the two-step axillary clearance represented the most important influential factor of the development of arm morbidity symptoms of swelling and numbness.

Radiation-associated angiosarcoma of the small bowel. A case of multiploidy and a fulminant clinical course. Case report.

Angiosarcoma developing in unusual sites such as the gastrointestinal tract is not uncommonly associated with a known eliciting factor. Thus, among hitherto reported cases of angiosarcoma of the small bowel, five were radiation-associated. One additional example of ileal angiosarcoma induced by therapeutic irradiation of endometrial carcinoma is herein reported as a reminder of this causal association. DNA analyses of the primary growth as well as the metastatic deposits showed at least four aneuploid cell clones indicating genetic instability. This observation corresponds to the consistently poor prognosis of radiation-associated angiosarcoma of the small bowel.

[Amebic abscess in the liver diagnosed initially as pneumonia]. / Amøbeabsces i leveren initialt diagnosticeret som pneumoni.

Three cases of amoebic liver abscess were initially diagnosed as pneumonia. All three patients had fever, respiratory pain at the right costal margin, increased erythrocyte sedimentation rate and white blood cell count, pulmonary infiltrate and pleural exudate. The first case was a relapse of an infection acquired at a visit to the tropics sixteen years previously. The second patient had spent a short holiday in Morocco seven months before the illness and the third patient was probably infected in Greenland. The correct diagnosis was confirmed by demonstration of a cavity in the liver, amoebic antibodies in the blood and good response to amoebicidal treatment which was combined with closed drainage in two cases.

[Examination of patients with monosymptomatic dipstick hematuria. A questionnaire study in Danish departments of surgery]. / Udredning af patienter med monosymptomatisk stixhaematuri. Spørgeskemaundersøgelse på danske kirurgiske afdelinger.

Routine procedures for urological investigations, treatment and follow-up of patients with monosymptomatic dipstick haematuria were studied by a questionnaire. This consisted of 13 questions and was filled in by the chief urologist in 45 (80%) of all surgical departments in Denmark. Dipstick testing was used by 98% of all departments, but only in 31% of these were the personnel reading the tests especially trained in the procedure. Cystourethroscopy and excretory urography were used in respectively 98% and 93% of the departments, although many different evaluation schedules were employed. Thirty-eight departments confirmed the initial dipstick result, of these 21 (55%) omitted further investigations in case of a negative result. Persistent monosymptomatic haematuria resulted in repeated urological examination in 36 departments (80%). The paper discusses the use of dipstick testing versus urine microscopy and gives recommendations for the investigation and follow-up of patients with monosymptomatic dipstick haematuria.

[Usefulness of urine dipsticks in the diagnosis of microscopic hematuria]. / Urinstix' anvendelighed til diagnostik af mikroskopisk haematuri.

The aim of this study was to evaluate the sensitivity of urine dipstick for diagnosing microscopic haematuria. We prospectively reanalyzed 122 consecutive urine samples, that had been read positive for blood by dipstick testing in two hospital departments, with repeated dipstick testing and fractionated microscopy at the laboratory. Out of these 53/122 (43%) were negative at the new dipstick analysis and 67/122 (55%) were negative by urine microscopy. We further examined urine samples from 31 healthy employees at the laboratory. Urine was collected before and after accurate instruction in the procedure for midstream urine sample. A complete correlation between dipstick analysis and microscopy was found. Samples from 8/31 (25%) persons showed microscopic haematuria before instructions and 6/31 (19%) after. It is concluded that instruction in correct dipstick reading and urine sampling could reduce the number of patients with microscopic haematuria by approximately 50%.

[Validation of the patient-administered Danish Prostate Symptom Score Schedule]. / Validering af det patientadministrerede Danske Prostate Symptom Scoringsskema.

The DAN-PSS-1 system, a self-administered quality-of-life questionnaire comprising 12 questions related to voiding problems and the perceived bother of each individual symptom, was compared to other extensively used score systems and furthermore included in different clinical situations so as to validate the system. The system was internally consistent (alpha cr = 0.73), the median test-retest reliability of answers to each question was 83.5% (range 0-99.7%). A high degree of construct validity demonstrated in the correlation with the Madsen-Iversen score system (rs = 0.51) and with the patients' answers to questions about how bothersome their symptoms were (rs = 0.71). The discriminant validity of the DAN-PSS-1 was excellent with an area under the ROC curve of 0.94. Finally, the DAN-PSS-1 was sensitive to changes following intervention, with scores decreasing 100% after transurethral prostatectomy and 65% after four months of treatment with an alpha-blocker. The DAN-PSS-1 is reliable, valid and responsive, and therefore can be recommended for assessing the severity of symptoms among patients presenting with lower urinary tract complaints suggestive of BPH and during follow-up.

Validation of a computer version of the patient-administered Danish prostatic symptom score questionnaire.

OBJECTIVE: To validate a computer version of the Danish Prostatic Symptom Score (DAN-PSS) questionnaire and compare it with the paper version. MATERIAL AND METHODS: Ninety-three male patients (aged 25-87 years), referred to a department of urology for lower urinary tract symptoms (LUTS), filled in a personal computer (PC) version and a paper version of the DAN-PSS questionnaire. Subsequently they answered a questionnaire concerning their preferences and computer experience. RESULTS: A fair correlation between the total scores from the paper and PC versions was found. The differences were independent of both total score and age. In the PC version all LUTS questions were answered while 9.8% were left blank in the paper version. The sexual questions were answered by 71% of patients in the paper version and by 87.5% in the PC version. For the questions in the PC version a learning curve was observed in terms of the time taken to answer the questions. Previous computer experience did not influence answering time, difference in score between paper and PC versions or total score. Almost all patients preferred the PC version to the paper version. CONCLUSION: The PC scores are reasonably reliable judging by comparison with previously validated traditional paper scores. The PC questionnaire had a higher response rate and was preferred by the majority of patients.

Single layer colonic anastomosis with a continuous absorbable monofilament polyglyconate suture.

OBJECTIVE: To report our experience with a single layer continuous absorbable monofilament polyglyconate suture technique in colonic anastomosis. DESIGN: Retrospective study. SETTING: Teaching hospital, Denmark. SUBJECTS: 105 consecutive patients operated on electively during the period January 1987-June 1990. INTERVENTIONS: Single layer continuous monofilament polyglyconate end-to-end anastomosis. MAIN OUTCOME MEASURES: Clinical signs of anastomotic leak and stricture, wound infections, and duration of hospital stay postoperatively. RESULTS: Of the 105 patients in the study, 1 developed an anastomotic leak (1%, 95% confidence interval 0 to 5.2%). Median duration of hospital stay was 8 days (range 4-72) and wound infections were recorded in 7 patients (7%, 95% confidence interval 2.7 to 13.2%). None of the patients had symptoms of anastomotic stricture at follow-up (median 19 months, range 2-48). CONCLUSION: Single layered continuous colonic anastomosis with an absorbable monofilament suture is a safe technique, easily learned even by relatively inexperienced surgeons and less expensive than other methods.

Air pollution in copenhagen. Part I. Element analysis and size distribution of aerosols.

Aerosols were monitored in Greater Copenhagen in the period June 1973 to July 1974. Size-fractionated cascade impactor samples and unfractionated filter samples were regularly collected and analyzed by neutron activation analysis, spark emission spectroscopy or proton-induced X-ray emission spectroscopy. Concentrations were determined of the following elements: Al, Si, S, Cl, K, Ca, Ti, V, Cr, Mn, Fe, Ni, Cu, Zn, Br, Mo, Cd, Sn, Sb, and Pb. All elements showed orders-of-magnitude fluctuations; the mean concentrations were roughly the same as in other large cities. In relation to proposed air quality standards, Pb was the most critical component. Statistical analysis of variation patterns, size distributions and interelement correlations indicate that automotive exhaust is the source of Br and Pb; fuel-oil combustion is the main source of V and Ni (and partly of S); soil dust raised by wind or by human activity (e. g. traffic) is the main source of Al, Si, Ca, Ti, and Fe.

Symptomatic outcome of transurethral prostatectomy, alpha-blockade and placebo in the treatment of benign prostatic hyperplasia. Evaluation of treatment with the Danish Prostatic Symptom Score (DAN-PSS-1) system. The ALFECH Study Group.

To assess the symptomatic outcome following transurethral prostatectomy (TURP), alpha-blockade and placebo treatment in uncomplicated benign prostatic hyperplasia (BPH), 260 patients were evaluated with the recently formulated Danish Prostatic Symptom Score (DAN-PSS-1) system: 205 were randomized to either the selective alpha-blocker alfuzosin or placebo and 55 underwent TURP. Following TURP, the DAN-PSS-1 score was reduced by 80% after 6-10 weeks (visit 2) and by 100% after 12-16 weeks (visit 3). In the alfuzosin group the corresponding reductions were 40% and 65% (p < 0.02 vs. placebo). In the placebo group the reduction was 25% at visit 2, with no further fall demonstrated thereafter. During alfuzosin treatment the bother score (impact of symptoms on quality of life) fell more than the symptom score. During placebo treatment there was no reduction in symptom score. We conclude that the DAN-PSS-1 questionnaire sensitively identifies clinically important responses to treatment of BPH.

The symptomatic outcome of transurethral prostatectomy evaluated with the DAN-PSS-1 score system.

We assessed the symptomatic outcome of transurethral prostatectomy with the newly developed self-administered questionnaire, Danish Prostate Symptom Score (DAN-PSS-1), in men suffering from uncomplicated benign prostatic hyperplasia (BPH). The questionnaire was filled in adequately by 53 men, median age 69 (range 52-82), preoperatively and 2, 4 and 6 months after transurethral prostatectomy (TUR-P). The DAN-PSS-1 symptom score showed a high degree of sensitivity as the preoperative total score was median 20 (quartiles 14-36) and decreased to 4, 0 and 1 (quartiles from 0-4) at the 2, 4, and 6-month control respectively. The symptoms related to voiding were relieved totally after 2 months while symptoms related to storage were first relieved completely at 4-month control. Bother from symptoms was relieved after 2 months, although some symptoms still remained. The questionnaire was internally consistent with a reliability coefficient, Cronbach's alpha (alphaCr), of 0.73. We conclude that the DAN-PSS-1 questionnaire is an efficient tool among others in the indication and evaluation of treatment of uncomplicated BPH.

DNA aneuploidy in gastric carcinoma. Flow cytometric data related to survival, location, and histopathologic findings.

BACKGROUND: The aim of the study was to evaluate the prognostic significance of DNA ploidy of gastric carcinomas. METHODS: The DNA content was analyzed by flow cytometry on archival paraffin-embedded material from tumors of 97 consecutive patients. RESULTS: A multivariate analysis showed that the DNA ploidy pattern and lymph node metastasis were the only independent prognostic markers for survival (p = 0.01 and p = 0.02, respectively). The relative risk of death due to gastric cancer was three times greater for patients with DNA hypertetraploid tumors than for patients with DNA diploid tumors and twice as high for patients with lymph node metastasis as for patients without. Well and moderately differentiated carcinomas were more frequently aneuploid than tumors with poor differentiation (p = 0.047). There was no correlation between tumor ploidy pattern and location. In univariate analysis tumor growth through the serosal wall was predictive of poor survival (p = 0.003). CONCLUSIONS: DNA ploidy is an independent prognostic indicator for cancer-specific survival in gastric cancer.

DNA ploidy in colorectal cancer, heterogeneity within and between tumors and relation to survival.

Flow cytometry was used to study the incidence of aneuploidy and to determine the significance of multiple sampling from colorectal tumors. DNA ploidy pattern has been proposed as a supplementary prognostic marker, but discrepancies in findings are major. DNA clonal heterogeneity, defined as two or more DNA aneuploid stemlines in the same tumor, is well established. However, most studies have been based on only one biopsy from each tumor. In our study multiple biopsies were taken from 163 patients (88 males and 75 females) electively operated for colorectal cancer. Tumor cells were harvested by fine needle aspiration from fresh frozen biopsies sampled at different sites of each tumor. DNA aneuploidy was detected in tumors from 145 patients (89%), and 18 patients (11%) had a solitary DNA diploid cell population. In a 79 month follow-up period 105 patients had died. Statistical analysis showed that distinction between diploidy and aneuploidy did not predict survival. However, grouping subpopulations into DNA diploid plus near diploid (DNA index (DI) 0. 97-1.15), DNA aneuploid with all aneuploid subpopulations in the interval 1.15-2.06, and DNA aneuploid with subpopulations with DI < 0.97 and/or DI > 2.06, showed a significant difference in survival in a Cox multivariate analysis including Dukes' stage P = 0.049 comparing the second group to the first and P = 0.01 comparing the third group to the first. In 21 (13%) patients only one subpopulation was found, 57 (35%) had two, 44 (27%) had three, and 41 (25%) had four or more different subpopulations. The association of DNA ploidy to survival is shown to be dependent on the number of biopsies analysed.

Physical and chemical processes of sulphur dioxide in the plume from an oil-fired power station.

The Danish contribution to the EUROCOP COST 61a project is described. Work concerned the physical and chemical reactions of sulphur dioxide released from a power station. The investigation was based on the application of two tracers. Inactive, inert SF6 is used to monitor the dispersion of and deposition from the plume; it was intended to use radioactive 35SO2 to determine the degree of oxidation of sulphur released from the stack; so far, however, public reaction has prevented the use of a release of activity in field experiments. The report describes the construction and testing of airborne instruments for continuous registration of sulphur dioxide, nitrogen oxides, ozone and the tracer SF6, as well as for measurements of temperature and humidity. Sulphur samples were collected on filter paper in a specially constructed low volume air sampler, and the subsequentchemical analysis in the laboratory is described. Finally, the problem of navigation is treated. It is shown that nitrogen oxides may be used as an internal tracer in plume experiments. Preliminary experiments based on inactive analysis only indicated an overall half-life for SO2 in the plume of about half an hour.

Comparison of the Danish Prostatic Symptom Score with the International Prostatic Symptom Score, the Madsen-Iversen and Boyarsky symptom indexes. ALFECH Study Group.

OBJECTIVE: To compare the Danish Prostatic Symptom Score (DAN-PSS) with the International Prostatic Symptom Score (IPSS). Madsen-Iversen and Boyarsky symptom indexes in a clinical setting, and to evaluate the potential significance of any differences in information obtained from these questionnaires. PATIENTS AND METHODS: The study comprised two substudies: in the first, 205 patients with lower urinary tract symptoms (LUTS) suggestive of bladder outlet obstruction (BOO), a Madsen-Iversen score > 6 and a maximum flow rate of < 10 mL/s were randomized to receive either placebo or alfuzosin in a double-blind study of 16 weeks. The symptoms were assessed using the Madsen-Iversen, DAN-PSS and the IPSS questionnaires. In the second, 138 patients with LUTS suggestive of BOO were selected for treatment with transurethral microwave thermotherapy (TUMT, 52 degrees C for 60 min, microwave energy 200 kJ) and their symptoms assessed using the Boyarsky and the DAN-PSS questionnaires. Patients were then followed for one year. Rank correlation coefficients and regression lines were calculated using Spearman's non-parametric test. The relative changes, i.e. responsiveness, calculated for the DAN-PSS, IPSS and Boyarsky indexes were compared pairwise using the Wilcoxon-Pratt test. RESULTS: The DAN-PSS, IPSS and Madsen-Iversen indexes were correlated on a pairwise basis. The DAN-PSS and IPSS indexes have significant construct validity in terms of correlation with the Madsen-Iversen system (Spearman's correlation coefficient, rs = 0.51 and rs = 0.45, respectively). The DAN-PSS and the IPSS indexes were correlated (rs = 0.61). The DAN-PSS was more sensitive than the IPSS to changes after pharmacological treatment, with scores decreasing 70% and 29% (P < 0.05), respectively, after treatment with an alpha-blocker for 4 months, and 50% and 29% (P < 0.05), respectively, after 4 months on placebo treatment. Finally, the responsiveness of the Boyarsky and DAN-PSS indexes to TUMT showed that the DAN-PSS system was significantly more responsive than the Boyarsky index, with scores decreasing 57% and 15% (P < 0.05), respectively, after one year. CONCLUSIONS: The DAN-PSS index is more sensitive than the IPSS, Madsen-Iversen and Boyarsky symptom indexes, incorporates important outcome events, includes a patient-weighting of each symptom, thereby reflecting better the patients' global assessment of outcome.

Validation of the self-administered Danish Prostatic Symptom Score (DAN-PSS-1) system for use in benign prostatic hyperplasia.

OBJECTIVE: To validate the Danish Prostatic Symptom Score (DAN-PSS-1), a self-administered quality-of-life questionnaire comprising 12 questions related to voiding problems and the perceived bother of each individual symptom. METHODS: Using published results from several comparisons of other symptom scoring systems with DAN-PSS-1, the test-retest reliability, internal consistency, construct and content validity, and responsiveness of the DAN-PSS-1 system were assessed. RESULTS: The system was internally consistent (Cronbach's alpha = 0.73), the median test-retest reliability of answers to each question was 83.5% (range 0-99.7%) and the questionnaire was well understood by the patients. The DAN-PSS-1 system demonstrated a high degree of construct validity, correlating with the extensively used Madsen-Iversen score system (Spearman's correlation coefficient, rs = 0.51) and with the patients' answers to questions about how bothersome their symptoms were (rs = 0.71). The DAN-PSS-1 system discriminated clearly between patients with benign prostatic hyperplasia (BPH) and control subjects (an area under the receiver operating characteristic curve of 0.94). Finally, the DAN-PSS-1 was sensitive to changes following intervention, with scores decreasing from a median of 20 to zero 4 months after patients underwent transurethral prostatectomy and from a median of 11.5 to 7.5 (65%) after patients had received 4 months treatment with an alpha-blocker. CONCLUSIONS: The DAN-PSS-1 system is reliable, valid and responsive, and therefore can be recommended for assessing the severity of symptoms among patients presenting with lower urinary tract complaints suggestive of BPH and in the follow-up after intervention.